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MH/PSYCH NP Clinical modal Exam 3
Questions and Answers.
How many stages are in Piaget's developmental theory? - Correct answer four stages What personality disorder: Characteristics: suspicious of others; fear others will exploit, harm, or deceive them; fear of confiding in others (fear personal information will be used against them); misread compliments as manipulation; hypervigilant; prone to counterattack; hostile; and aloof. Psychotic episodes may occur in times of stress. Nurses should give straightforward explanations of tests, history taking, and procedures, side effects of drugs, changes in treatment plan, and possible further procedures, to counteract client fear. - Correct answer Paranoid personality disorder What personality disorder: Characteristics: avoids close relationships, is socially isolated, has poor occupational functioning, and appears cold, aloof, and detached. Social awareness is lacking and relationships generate fear and confusion in the client. Nurses should strive for simplification and clarity to help decrease client anxiety. - Correct answer Schizoid personality disorder What personality disorder: Characteristics: ideas of reference; magical thinking or odd beliefs; perceptual distortions; vague, stereotyped speech; frightened, suspicious, blunted affect; distant and strained social
relationships. These clients tend to be frightened and suspicious in social situations. Explanations can ease their anxiety. - Correct answer schizotypal personality disorder What are the cluster A personality disorders - Correct answer 1. Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder What are the cluster B personality disorders? - Correct answer 1. Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder What personality disorder is this: Characteristics: has superficial charm, violates rights of others, exploits others, lies, cheats, lacks guilt or remorse, is impulsive, acts out, and lacks empathy. As clients these individuals are extremely manipulative and aggressive. Nurses must establish and adhere to a plan of care, and maintain clear boundaries if they are to minimize client manipulation and acting out. - Correct answer antisocial personality disorder What personality disorder is this: Characteristics: unstable, intense relationships; identity disturbances; impulsivity; self-mutilation; rapid mood shifts; chronic emptiness; intense fear of abandonment; splitting; and anger. A major defense is splitting (alternating between idealizing and devaluing). Self-mutilation and suicide-prone behavior are often-used impulsive self-destructive behaviors. Anger is intense and pervasive and help with anger management is an important
What personality disorder: Characteristics: social inhibition, feelings of inadequacy, hypersensitivity to criticism, preoccupation with fear of rejection and criticism, and self perceived to be socially inept. Low self- esteem and hypersensitivity grow as support networks decrease. Demands of workplace often overwhelming. Project that caregivers will harm them through disapproval and perceive rejection where none exists. Nurses can teach socialization skills, provide positive feedback, and build self-esteem - Correct answer avoidant personality disorder What personality disorder: Characteristics: inability to make daily decisions without advice and reassurance, need of others to be responsible for important areas of life, anxious and helpless when alone, and submissive. Solicit care taking by clinging. Fear abandonment if they are too competent. Experience anxiety and may have co-existing depression. - Correct answer dependent personality disorder What personality disorder: Characteristics: preoccupied with rules, perfectionist, too busy to have friends, rigid control, and superficial relationships. Complains about others' inefficiencies and gives others directions.
- Correct answer obsessive-compulsive personality disorder To receive a diagnosis of __________________, an individual must demonstrate the criteria behaviors persistently and to such an extent that they impair the ability to function socially and occupationally. - Correct answer personality disorder __________________ is the capacity to pay attention, non- judgmentally to the present moment. It is derived from teachings
of the Buddha, the Zen tradition being perhaps one of its most well-known proponents. _____________ is all about living in the moment, experiencing your emotions and all your senses and being aware of them. - Correct answer Mindfulness Mindfulness is a tool used in what form of therapy and used in to treat what specific disorder - Correct answer DBT, Treats BPD Are considered the "right" patterns of behavior for a society - Correct answer norms Should be included for problem-solving therapy for a child with conduct disorder. - Correct answer event interpretation Can promote the greatest change in an adolescent's behavior. - Correct answer family therapy Describes a family's progression through the lifecycle. - Correct answer developmental theoretical approach Most children will adopt the same world view as ____________ - Correct answer their parents (ex. If a child was brought up by parents who thought the world was hostile they would most likely adopt this view as they grow older. Uses books and a librarian as resources. - Correct answer bibliotherapy Allows the child to play out their fears and frustrations. - Correct answer play therapy Help the most in evaluating outcomes of child therapy. - Correct answer objective observations
BPD: A major defense is _________ (alternating between idealizing and devaluing). - Correct answer splitting Stored bodies of knowledge that interact with incoming information to influence selective attention and memory search - Correct answer schemas An expressive therapy which involves using child and adolescent literature to help the child express feelings in a supportive environment, gain insight into feelings and behavior, and learn new ways to cope with difficult situations. - Correct answer bibliotherapy Form of therapy : Child-centered and typically builds on the foundation of the psychodynamic, object-relations, and attachment theories. - Correct answer play therapy When does play therapy start? (what age) - Correct answer Age 3 In children this form of therapy is useful for: Posttraumatic stress disorder, disruptive behavior disorders, mood disorders, and reactive attachment disorder. - Correct answer play therapy Is normally viewed as the best way to begin play therapy. Structured play is rarely used until nondirective play has enabled a full assessment of relevant themes and issues, and the child's trust around anxiety-laden issues has been developed. - Correct answer nondirective play _____________ in play therapy such as aggressive behavior toward a father doll) can have several meanings and should never be interpreted in a standardized fashion - Correct answer symbols
This method is selected when interactions among family members need attention in order to address specific problems exhibited by the child. The goal is to increase the likelihood that improvements in the child's mental health will occur and will be supported in the home with consistent and sustained family patterns - Correct answer Family therapy During family therapy sessions, a nurse realizes that the mother frequently allies with her daughter against the father. This is an example of which of Bowen's concepts of family functioning? A. Multigenerational transmission of anxiety B. Differentiation of self C. Emotional triangles D. Genogram generation - Correct answer C. Emotional triangles
- During the first family therapy session, the mother of a child being treated for truancy and Emotional outbursts asks the nurse, Why are you bothering to ask the rest of us questions? My Son is the one with the problems. The best response for the nurse would be: A. Well get more accurate information if the entire family is involved. B. It may seem strange to you, but well get better results doing it this way. C. When one family member is sick, the whole family system is sick as well. D. Every family members perceptions are very important to the total picture. - Correct answer D. Every family members perceptions are very important to the total picture
- A 5-year-old girl on a behavior modification program is admitted to the unit. The nurse
Nurse includes play therapy because it assists the child to: A. Learn adaptive behaviors through acting. B. Express feelings that cannot easily be verbalized. C. Act out aggression in a sociably acceptable manner. D. Interact with other children in the appropriate age group. - Correct answer B. Express feelings that cannot be easily verbalized Parents ask a nurse why their child will be engaged in play therapy, as "our child can play at home." Which of the following is the most appropriate response? A. "Play therapy is guided by the therapist, helping the child use specific toys to work through specific issues" B. "Play therapy involves the child and parents in a psychodynamic situation that is observed by the therapist" C. "Play therapy gives the child complete freedom to express emotions the child cannot express verbally so that the therapist can help the child work through them." D. "Play therapy encourages the child to verbalize thoughts and feelings as the therapist asks the child whathis or her imaginative play means." - Correct answer C. Play therapy gives the child complete freedom to express emotions the child cannot express verbally so that the therapist can help the child work through them In keeping with the mandate to treat patients in the least restrictive environment possible, how should nursing staff respond when a patient with borderline personality disorder erupts in anger and threatens to harm herself? A. A single staff member should approach the patient to avoid startling or intimidating her. B. One member of the staff should distract the patient by shouting at her while several others grab her from behind and wrestle her to the ground, where they pin her until she calms down.
C. Several staff members should approach the patient and ask firmly that she adhere to behavioral guidelines; if she does not, she should be placed in wrist and ankle restraints and released when the nurse in charge determines the patient is no longer at risk. D. Several staff members should approach the patient and make clear they will not allow her to harm herself; if she does not de- escalate her behavior, she shou - Correct answer D. Several staff members should approach the patient and make clear they will not allow her to harm herself; if she does not de-escalate her behavior, she should be placed in restraints or seclusion sufficient to ensure her safety, and the nurse should obtain and order for a restraint
- Which of the following personality disorders have female gender as a risk factor? A. Borderline personality disorder B. Narcissistic personality disorder C. Schizotypal personality disorder D. Antisocial personality disorder - Correct answer A. Borderline personality disorder
- A physician describes a patient as having a Cluster C personality disorder. The patient could have which of the following (select all that apply)? A. Obsessive-compulsive personality disorder B. Paranoid personality disorder C. Avoidant personality disorder D. Borderline personality disorder E. Narcissistic personality disorder - Correct answer A. Obsessive- compulsive personality disorder C. Avoidant personality disorder
- When working with a patient with a dependent personality disorder, a nurse would most likely engage in which of the following therapeutic interventions? A. Help the patient to verbalize feelings assertively and with confidence. B. Help the patient to complete tasks in a timely manner. C. Adopt a matter-of-fact tone in response to patient expressions of emotions. D. Clarify consequences for stealing from other patients - Correct answer A. Help the patient to verbalize feelings assertively and with confidence
- What nursing diagnosis might be given to a patient with schizoid personality disorder? A. Risk for self-directed violence related to unpredictable and erratic behavior as evidence by impulsivity B. Risk for other-directed violence related to pervasive disregard for the rights of others related to absence of empathy C. Chronic low self-esteem related to identity disturbance as evidenced by fear of abandonment D. Impaired social interaction related to emotional detachment as evidenced by disinterest in close relationships - Correct answer C. Chronic low self esteem related to identity disturbance as evidenced by fear of abandonment
- What nursing outcomes would be appropriate for a patient diagnosed with avoidant personality disorder? The patient will: A. Refrain from injuring self B. Demonstrate reality-based thoughts C. Demonstrate self-restraint with others D. Verbalize positive statements about self and life - Correct answer D. Verbalize positive statements about self and life
- The patient with antisocial personality disorder is learning appropriate outlets for anger and tension. The nurse will know that more teaching is necessary if the patient says: A. "Just put me in restraints if I get out of control." B. "I will practice my deep breathing to help calm me." C. "Taking time-outs from stressful situations may help me regain control." D. "If the other interventions aren't working I can take a PRN medication as ordered by my nurse Practitioner." - Correct answer A. Just put me in restraints if i get out of control"
- The patient reports to the nurse that he has self-mutilated by cutting his arm. Which nursing interventions should be implemented (select all that apply)? A. Provide care to wounds B. Obtain an order for tranquilizing medications C. Work with the patient to determine triggers D. Provide empathy E. Positively reinforce the behavior F. Assist with social skills G. Perform a risk assessment - Correct answer A. Provide care to the wounds C. Work with the patient to determine triggers G. Perform a risk assessment The patient diagnosed with narcissistic personality disorder demands at 2 a.m. To speak with the nurse practitioner about the treatment plan. Which nursing statement is appropriate? A. "Please be quiet and go back to bed. You are waking the other clients." B. "I can give you medication to help your anxiety." C. "I can see that you are angry. However, this is not an appropriate time to address your issues."
- A Puerto Rican American patient uses dramatic body language when describing emotional Discomfort. Which analysis most likely explains the patients behavior? The patient: A. Has a histrionic personality disorder. B. Believes dramatic body language is sexually appealing. C. Wishes to impress staff with the degree of emotional pain. D. Belongs to a culture in which dramatic body language is the norm. - Correct answer d. Belongs to a culture where dramatic body language is the norm The psychiatric advanced practice nurse is developingthe care plan for an 8-year-old child with intermittentexplosive disorder. Based on Piaget, which of thefollowing goals would be appropriate? The child will: A)connect consequences of his behavior with the behavior itself. B)generalize the consequences of his anger and aggression to different situations C)identify situations in which he is likely to feel abandoned. D)experience an increase in autonomous behavior. - Correct answer A. Connect consequences of his behavior with the behavior itself' Who invented theory of cognitive development - Correct answer piaget Piaget identified how many major developmental stages that children progress through when moving from infancy and continuing into early adolescence? - Correct answer four What are the four stages of cognitive devleopment according to piaget? - Correct answer 1. Sensorimotor - birth to 2 years
- Preoperational - 2-7 years
- Concrete operation - 7-12 years
- Formal operational - 12 years- adulthood What is the first stage of cognitive development (Piaget) - Correct answer sensorimotor - birth to 2 years Key components - circular reactions, object permanence What is the second stage of cognitive development (piaget) - Correct answer preoperational - 2-7 years Key components - symbolic play, magical thinking What is the third stage of cognitive development (piaget) - Correct answer concrete operational - 7-12 years. Key components - reversibility, conservation What is the last (fourth) stage of cognitive development (piaget) - Correct answer formal operational- ages 12 to adulthood Key components - abstract thinking and logical thinking Efforts to prevent an injury or illness from ever occurring. - Correct answer primary prevention Efforts to limit the effects of an injury or illness that you cannot completely prevent. - Correct answer Secondary prevention Actions taken to contain damage once a disease or disability has progressed beyond its early stages - Correct answer tertiary prevention
O Unresponsive patients with penetrating head wounds, high spinal cord injuries, wounds involving multiple anatomical sites and organs, 2nd/3rd degree burns in excess of 60% of body surface area, seizures or vomiting within 24hr after radiation exposure, profound shock with multiple injuries, agonal respirations; no pulse, no BP, pupils fixed and dilated - Correct answer Expectant Mass casualty incident triage category: Injuries are life-threatening but survivable with minimal intervention. Individuals in this group can progress rapidly to expectant if treatment is delayed. O Sucking chest wound, airway obstruction secondary to mechanical cause, shock, hemothorax, tension pneumothorax, asphyxia, unstable chest and abdominal wounds, incomplete amputations, open fractures of long bones, and 2nd/3rd degree burns of 15%-40% total body surface area. - Correct answer Immediate Mass casualty incident triage category: Injuries are significant and require medical care but can wait hours without threat to life or limb. Individuals in this group receive treatment only after immediate casualties are treated. O Stable abdominal wounds without evidence of significant hemorrhage; soft tissue injuries; maxillofacial wounds without airway compromise; vascular injuries with adequate collateral circulation; genitourinary tract disruption; fractures requiring open reduction, débridement, and external fixation; most eye and CNS injuries - Correct answer Delayed
Mass casualty incident triage category: Injuries are minor and treatment can be delayed hours to days. Individuals in this group should be moved away from the main triage area. O Upper extremity fractures, minor burns, sprains, small lacerations without significant bleeding, behavioral disorders or psychological disturbances. - Correct answer Minimal The abcs of psychological first aid include focusing on A -? B -? C -? - Correct answer A (arousal), B (behavior) C (cognition). Mental health problem that can occur in the first 2 days to one month after a traumatic event - Correct answer Acute stress disorder First line treatment of patients with ASD - Correct answer multiple session, trauma-focused cognitive behavioral therapy Mental health problem that can occur for longer than 1 month after at traumatic event - Correct answer PTSD ______ is a psychosocial treatment developed by Marsha M. Linehan specifically to treat individuals with borderline personality disorder. - Correct answer DBT
