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63: Mental Health Disorders
PRACTICE QUESTIONS
1. A nurse collects data on a client with a diagnosis of bipolar affective disorder–mania. The finding that requires the nurse’s immediate intervention is: 1. The client’s outlandish behaviors and inappropriate dress 2. The client’s grandiose delusions of being a royal descendant of King Arthur 3. The client’s nonstop physical activity and poor nutritional intake 4. The client’s constant, incessant talking that includes sexual innuendoes and teasing the staff Answer: 3 Rationale: Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. It is a period when the mood is predominantly elevated, expansive, or irritable. Option 3 identifies a physiological need requiring immediate intervention. Test-Taking Strategy: Use the process of elimination and note the key words, immediate intervention. Use Maslow’s Hierarchy of Needs theory to assist in answering the question. Option 3 indicates a potential disruption in the client’s physiological status. Review care of the client with mania if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 214-215. 2. A client in a manic state emerges from her room. She is topless and is making sexual remarks and gestures toward staff and peers. The appropriate nursing action is to: 1. Quietly approach the client, escort her to her room, and assist her in getting dressed. 2. Approach the client in the hallway and insist that she go to her room. 3. Confront the client on the inappropriateness of her behaviors and offer her a time-out. 4. Ask the other clients to ignore her behavior; eventually she will return to her room. Answer: 1 Rationale: A person who is experiencing mania lacks insight and judgment, has poor impulse control, and is highly excitable. The nurse must take control without creating increased stress or anxiety to the client. A quiet, firm approach while distracting the client (walking her to her room and assisting her to get dressed) achieves the goal of having her being dressed appropriately and preserving her psychosocial integrity. Option 4 is inappropriate. “Insisting” that the client go to her room may meet with a great deal of resistance. Confronting the client and offering her a consequence of “time-out” may be meaningless to her. Test-Taking Strategy: Use the process of elimination and focus on the issue of the question. Noting that the issue relates to having the client dress appropriately will direct you to option 1. Review care of the client with mania if you had difficulty with this question. Level of Cognitive Ability: Application

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Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 221. 3. A nurse reviews the activity schedule for the day and determines that the best activity that the manic client could participate in is: 1. A brown bag lunch and a book review 2. Ping-Pong 3. A paint by number activity 4. A deep breathing and progressive relaxation group Answer: 2 Rationale: A person who is experiencing mania is overactive, full of energy, lacks concentration, and has poor impulse control. The client needs an activity that will allow him or her to utilize excess energy, but not endanger others during the process. Options 1, 3, and 4 are relatively sedate activities that require concentration, a quality that is lacking in the manic state. Such activities may lead to increased frustration and anxiety for the client. Ping-Pong is an activity that will help to expend the increased energy this client is experiencing. Test-Taking Strategy: Use the process of elimination. Note the similarity in options 1, 3, and 4 in that they are relatively sedate activities that require concentration. Review the appropriate interventions for a manic client if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, p. 355. 4. A client who is delusional says to the nurse, “The federal guards were sent to kill me.” The nurse should make which appropriate response to the client? 1. “The guards are not out to kill you.” 2. “I don’t believe this is true.” 3. “I don’t know anything about the guards. Do you feel afraid that people are trying to hurt you?” 4. “What makes you think the guards were sent to hurt you?” Answer: 3 Rationale: Disagreeing with delusions may make the client more defensive and the client may cling to the delusions even more. It is most therapeutic for the nurse to empathize with the client’s experience. Options 1 and 2 are statements that disagree with the client. Option 4 encourages discussion regarding the delusion. Test-Taking Strategy: Use therapeutic communication techniques for the client experiencing delusions. Eliminate options 1 and 2 because they are similar and are statements that disagree with the client. Option 4 encourages discussion regarding the delusion. Review communication techniques for the client experiencing delusions if you had difficulty with this question.

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Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 88, 100. 5. A woman comes into the emergency room in a severe state of anxiety following a car accident. The most important nursing intervention is to: 1. Remain with the client 2. Put the client in a quiet room 3. Teach the client deep breathing 4. Encourage the client to talk about her feelings and concerns Answer: 1 Rationale: If a client is left alone with severe anxiety, he or she may feel abandoned and become overwhelmed. Placing the client in a quiet room is also indicated, but the nurse must stay with the client. It is not possible to teach the client deep breathing until the anxiety decreases. Encouraging the client to discuss concerns and feelings would not take place until the anxiety has decreased. Test-Taking Strategy: Use the process of elimination. Note the key words, severe and most important nursing intervention. Eliminate options 3 and 4 first, knowing that these actions are not possible when the client is in a severe state of anxiety. From the remaining options, remember the most important intervention is to remain with the client. Review care of the client with severe anxiety if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 189. Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, p. 278. 6. A male client with delirium becomes agitated and confused in his room at night. The best initial intervention by the nurse is to: 1. Use a night-light and turn off the television. 2. Keep the television and a soft light on during the night. 3. Move the client next to the nurse’s station. 4. Play soft music during the night and maintain a well-lit room. Answer: 1 Rationale: It is important to provide a consistent daily routine and a low-stimulation environment when the client is agitated and confused. Noise levels including a radio and television may add to the confusion and disorientation. Moving the client next to the nurses’ station is not the initial intervention. Test-Taking Strategy: Use the process of elimination and note the key word, initial, in the stem

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of the question. Eliminate options 2 and 4 first because they are similar. From the remaining options, recalling that a low-stimulation environment is best will direct you to option 1. Review measures related to the client with agitation and confusion if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 168-169. 7. A nurse is collecting data on a client who is actively hallucinating. Which nursing statement would be therapeutic at this time? 1. "I talked to the voices you're hearing and they won't hurt you now." 2. "I can hear the voice and she wants you to come to dinner." 3. "Sometimes people hear things or voices others can't hear." 4. "I know you feel ‘they are out to get you’ but it's not true." Answer: 3 Rationale: It is important for the nurse to reinforce reality with the client. Options 1, 2, and 4 do not reinforce reality but reinforce the hallucination that the voices are real. Test-Taking Strategy: Use the process of elimination. Note that options 1, 2, and 4 all indicate reinforcement to the client that the voices are real. Option 3 is the only statement that indicates reality. Review nursing interventions related to the client who is hallucinating if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 88, 328. 8. A nurse is caring for a client with a diagnosis of depression. The nurse monitors for signs of constipation and urinary retention, knowing that these problems are most likely caused by: 1. Inadequate dietary intake and dehydration 2. Lack of exercise and poor diet 3. Poor dietary choices 4. Psychomotor retardation and side effects of medication Answer: 4 Rationale: Constipation can be related to inadequate food intake, lack of exercise, and poor diet. In this situation, urinary retention is most likely due to medications. Option 4 is the only option that addresses both constipation and urinary retention. Test-Taking Strategy: Use the process of elimination and focus on the data in the question. Options 1, 2, and 3 are all similar and address diet. Option 4 addresses both concerns, constipation and urinary retention. If you had difficulty with this question, review the interventions for a client with depression and the effects of medications prescribed for this

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disorder. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 220, 336. 9. A client is admitted to the inpatient unit and is being considered for electroconvulsive therapy (ECT). The client appears calm, but the family is hypervigilant and anxious. The client’s mother begins to cry and states, “My son’s brain will be destroyed. How can the doctor do this to him?” The nurse makes which therapeutic response? 1. “It sounds as though you need to speak to the psychiatrist.” 2. “Your son has decided to have this treatment. You should be supportive of him.” 3. “Perhaps you’d like to see the ECT room and speak to the staff.” 4. “It sounds as though you have some concerns about the ECT procedure. Why don’t we sit down together and discuss any concerns you may have.” Answer: 4 Rationale: The nurse needs to encourage the family and client to verbalize their fears and concerns. Option 4 is the only option that encourages verbalization. Options 1, 2, and 3 avoid dealing with the client or family concerns. Test-Taking Strategy: Use therapeutic communication techniques and focus on the client’s feelings and concerns. This will direct you to option 4. Review these techniques if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 88, 218. 10. A nurse is caring for a client who has been treated with long-term antipsychotic medication. As part of the nursing care plan, the nurse monitors for tardive dyskinesia. In the event that tardive dyskinesia occurs, the nurse would most likely observe: 1. Abnormal movements and involuntary movements of the mouth, tongue, and face 2. Abnormal breathing through the nostrils 3. Severe headache, flushing, tremor, and ataxia 4. Severe hypertension, migraine headache, and ‘marbles in the mouth’ syndrome Answer: 1 Rationale: Tardive dyskinesia is a severe reaction associated with the long-term use of antipsychotic medication. The clinical manifestations are abnormal movements (dyskinesia) and involuntary movements of the mouth, tongue, and face. In its more severe form, tardive dyskinesia involves the fingers, arms, trunk, and respiratory muscles. When this occurs, the medication is discontinued. Test-Taking Strategy: Knowledge regarding the clinical manifestations of tardive dyskinesia is

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required to answer this question. Remember, tardive dyskinesia involves abnormal and involuntary movements. If you had difficulty with this question, review the characteristics associated with this reaction. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 334-335. 11. A client who is diagnosed with pedophilia and has been recently paroled as a sex offender says, "I'm in treatment and I have served my time. Now this group has posters of me all over the neighborhood telling about me with my picture on it." Which of the following is an appropriate response by the nurse? 1. "You understand that people fear for their children but you're feeling unfairly treated?" 2. "When children are hurt as you hurt them, people want you isolated." 3. "You seem angry but you have committed serious crimes against several children, so your neighbors are frightened." 4. "You're lucky it doesn't escalate into something pretty scary after your crime." Answer: 1 Rationale: Focusing and verbalizing the implied is the therapeutic response because it assists the client to clarify thinking and re-examine what the client is really saying. Option 1 is the only option that reflects the use of this therapeutic communication technique. Option 2 is insensitive and anxiety-provoking. Option 3 does not facilitate the client’s expression of feelings. Option 4 gives advice and also does not facilitate the client's expression of feelings. Test-Taking Strategy: Use therapeutic communication techniques to answer the question. Remembering to focus on the client’s feelings and concerns will direct you to option 1. Review these techniques if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 88, 310. 12. A nurse is preparing for the hospital discharge of a client with a history of command hallucinations to harm self or others. The nurse instructs the client about interventions for hallucinations and anxiety and determines that the client understands the interventions when the client states: 1. "My medications won’t make me anxious." 2. "I can call my therapist when I'm hallucinating so that I can talk about my feelings and plans and not hurt anyone." 3. “I’ll go to support group and talk so that I won't hurt anyone." 4. “I won't get anxious or hear things if I get enough sleep and eat well." Answer: 2

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Rationale: There may be an increased risk for impulsive and/or aggressive behavior if a client is receiving command hallucinations to harm (self) or others. Talking about the auditory hallucinations can interfere with the subvocal muscular activity associated with a hallucination. Option 2 is a specific agreement to seek help and evidences self-responsible commitment and control over his or her own behavior. Test-Taking Strategy: Use the process of elimination. Note the relation between the word “hallucinations” in the question and in the correct option. Review care of the client with command hallucinations if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Teaching/Learning Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 331. 13. A nurse observes that a client is psychotic, pacing, agitated, and making aggressive gestures. The client’s speech pattern is rapid and the client’s affect is belligerent. Based on these observations, the nurse’s immediate priority of care is to: 1. Provide safety for the client and other clients on the unit 2. Offer the client a less stimulated area to calm down and gain control 3. Provide the clients on the unit with a sense of comfort and safety 4. Assist the staff in caring for the client in a controlled environment Answer: 1 Rationale: Safety to the client and other clients is the priority. Option 1 is the only option that addresses the client and other clients’ safety needs. Option 2 addresses the client’s needs. Option 3 addresses other clients’ needs. Option 4 is not client-centered. Test-Taking Strategy: Use the process of elimination and focus on the issue, safety. Option 1 is the umbrella (global) option and addresses the safety of all. Review care of the psychotic client if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Mental Health References: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 116. Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, p. 721. 14. A nurse is caring for a client diagnosed with catatonic stupor. The client is lying on the bed, with the body pulled into a fetal position. The appropriate nursing intervention is which of the following? 1. Leave the client alone and intermittently check on him. 2. Take the client into the dayroom with other clients so they can help watch him. 3. Sit beside the client in silence and verbalize occasional open-ended questions. 4. Ask direct questions to encourage talking.

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Answer: 3 Rationale: Clients with catatonic stupor may be immobile and mute and require consistent, repeated approaches. The nurse facilitates communication with the client by sitting in silence, asking open-ended questions, and pausing to provide opportunities for the client to respond. The nurse would not leave the client alone. Option 2 relies on other clients to care for this client and this is an inappropriate expectation. Asking direct questions of this client is not therapeutic. Option 3 is the best action because it provides for client supervision and communication as appropriate. Test-Taking Strategy: Use the process of elimination. Eliminate option 1 because the nurse would not leave the client alone. Eliminate option 2 next because this action relies on other clients to care for this client. Eliminate option 4 because asking direct questions of this client is not therapeutic. Review care of the client with catatonic stupor if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Fortinash, K., & Holoday-Worret, P. (2004). Psychiatric mental health nursing (3rd ed.). St. Louis: Mosby, p. 250. Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 328. 15. A mother of a teenage client with an anxiety disorder is concerned about her daughter’s progress on discharge. She states that her daughter “stashes food, eats all the wrong things that make her hyperactive,” and “hangs out with the wrong crowd.” In helping the mother prepare for her daughter’s discharge, the nurse advises the mother to: 1. Restrict the daughter’s socializing time with her friends. 2. Consider taking time from work to help her daughter readjust to the home environment. 3. Restrict the amount of chocolate and caffeine products in the home. 4. Keep her daughter out of school until she can adjust to the school environment. Answer: 3 Rationale: Clients with anxiety disorder should abstain from or limit their intake of caffeine, chocolate, and alcohol. These products have the potential of increasing anxiety. Options 1 and 4 are unreasonable and are an unhealthy approach. It may not be realistic for a family member to take time away from work. Test-Taking Strategy: Use the process of elimination. Options 1, 2, and 4 are similar and are concerned with monitoring or curtailing the client’s physical activities. Option 3 addresses preparation of the client’s environment and focuses on the concern or issue expressed in the question. Review discharge planning for the client with anxiety if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th

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ed.). St. Louis: Mosby, pp. 266, 487. 16. A client is unwilling to go out of the house for fear of “doing something crazy in public.” Because of this fear, the client remains homebound except when accompanied outside by the spouse. The nurse determines that the client has: 1. Social phobia 2. Agoraphobia 3. Claustrophobia 4. Hypochondriasis Answer: 2 Rationale: Agoraphobia is a fear of being alone in open or public places where escape might be difficult. Agoraphobia includes experiencing fear or a sense of helplessness or embarrassment if a phobic attack occurs. Avoidance of such situations usually results in the reduction of social and professional interactions. Social phobia focuses more on specific situations, such as the fear of speaking, performing, or eating in public. Claustrophobia is a fear of closed-in places. Clients with hypochondriacal symptoms focus their anxiety on physical complaints and are preoccupied with their health. Test-Taking Strategy: Use the process of elimination and focus on the data in the question. Recalling the specific types of phobias and associated client behaviors will direct you to option 2. If you had difficulty with this question, review phobia types and associated client behaviors. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 185-186. 17. A client has reported that crying spells have been a major problem over the past several weeks, and that the doctor said that depression is probably the reason. The nurse observes that the client is sitting slumped in the chair and the clothes that the client is wearing don’t fit well. The nurse interprets that further data collection should focus on: 1. Sleep patterns 2. Onset of the crying spells 3. Weight loss 4. Medication compliance Answer: 3 Rationale: All the options are possible issues to address; however, the weight loss is the first item that needs further data collection because ill-fitting clothing could indicate a problem with nutrition. The client has already told the nurse that the crying spells have been a problem. Medication or sleep patterns are not mentioned or addressed in the question. Test-Taking Strategy: Use the process of elimination and Maslow’s Hierarchy of Needs theory to answer the question. Focusing on the data in the question will assist in eliminating options 1, 2, and 4. Review the priorities of care for a client with depression if you had difficulty with this question. Level of Cognitive Ability: Analysis

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Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, p. 215. 18. A client was admitted to a medical unit with acute blindness. Many tests are performed and there seems to be no organic reason why this client cannot see. The nurse later learns that the client became blind after witnessing a hit-and-run car accident, in which a family of three was killed. The nurse suspects that the client may be experiencing a: 1. Psychosis 2. Conversion disorder 3. Dissociative disorder 4. Repression Answer: 2 Rationale: A conversion disorder is the alteration or loss of a physical function that cannot be explained by any known pathophysiological mechanism. It is thought to be an expression of a psychological need or conflict. In this situation, the client witnessed an accident that was so psychologically painful that the client became blind. A dissociative disorder is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness. Psychosis is a state in which a person’s mental capacity to recognize reality, communicate, and relate to others is impaired, thus interfering with the person’s capacity to deal with life’s demands. Repression is a coping mechanism in which unacceptable feelings are kept out of awareness. Test-Taking Strategy: Use the process of elimination. Noting that the client evidences no organic reason to account for the blindness will direct you to option 2. If you had difficulty with this question, review conversion disorders and defense mechanisms. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Morrison-Valfre, M. (2005). Foundations of mental health care (3rd ed.). St. Louis: Mosby, pp. 229-230. 19. A manic client announces to everyone in the dayroom that a stripper is coming to perform that evening. When the psychiatric aide firmly states that this will not happen, the manic client becomes verbally abusive and threatens physical violence to the aide. Based on the analysis of this situation, the nurse determines that the most appropriate action would be to: 1. Escort the manic client to his or her room, with assistance, and administer PRN haloperidol (Haldol). 2. Tell the client that smoking privileges are revoked for 24 hours. 3. Orient the client to time, person, and place. 4. Tell the client that the behavior is not appropriate. Answer: 1 Rationale: The client is at risk for injury to self and others and therefore should be escorted out of the dayroom. Hyperactive and agitated behavior usually responds to haloperidol (Haldol).

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Option 2 may increase the agitation that already exists in this client. Orientation will not halt the behavior. Telling the client that the behavior is not appropriate has already been attempted by the psychiatric aide. Test-Taking Strategy: Use the process of elimination and therapeutic interventions for the manic client. Options 2, 3, and 4 will not de-escalate the client’s agitation. If you had difficulty with this question, review the appropriate interventions in dealing with a manic client. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8th ed.). St. Louis: Mosby, p. 351. 20. A nurse notes documentation in a client’s record that the client is experiencing delusions of persecution. The nurse understands that these types of delusions are characteristic of which of the following? 1. The false belief that one is a very powerful person 2. The false belief that one is a very important person 3. The false belief that one’s partner is going out with other people 4. The false belief that one is being singled out for harm by others Answer: 4 Rationale: A delusion is a false belief held to be true even when there is evidence to the contrary. A delusion of persecution is the thought that one is being singled out for harm by others. A delusion of grandeur is the false belief that he or she is a very powerful and important person. A delusion of jealousy is the false belief that one’s partner is going out with other people. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 2 first, because they are similar. From the remaining options, note the relationship between the word “persecution” in the question and the description in option 4. Review the description of the types of delusions if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Reference: Mosby’s medical, nursing, and allied health dictionary (6th ed.). St. Louis: Mosby, p. 490. <AQ>21. Select all nursing interventions for a hospitalized client with mania who is exhibiting manipulative behavior. ____Communicate expected behaviors to the client. ____Enforce rules and inform the client that she will not be allowed to attend therapy groups. ____Ensure that the client knows that she is not in charge of the nursing unit. ____Be clear with the client regarding the consequences of exceeding limits set regarding behavior. ____Assist client in testing out alternative behaviors for obtaining needs. Answers:

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Communicate expected behaviors to the client. Be clear with the client regarding the consequences of exceeding limits set regarding behavior. Assist client in testing out alternative behaviors for obtaining needs. Rationale: Interventions for dealing with the client exhibiting manipulative behavior include setting clear, consistent, and enforceable limits on manipulative behaviors; being clear with the client regarding the consequences of exceeding limits set; following through with the consequences in a nonpunitive manner; and assisting the client in identifying personal strengths and in testing out alternative behaviors for obtaining needs. Enforcing rules and informing the client that she will not be allowed to attend therapy groups is a violation of the client’s rights. Ensuring that the client knows that she is not in charge of the nursing unit is inappropriate; power struggles need to be avoided. Test-Taking Strategy: Focus on the issue, manipulative behavior. Recalling clients’ rights and that power struggles need to be avoided will assist in selecting the correct interventions. Review care of the client with manipulative behavior if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Reference: Varcarolis, E. (2002). Foundations of psychiatric mental health nursing (4th ed.). Philadelphia: W.B. Saunders, p. 394.

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