PSYCHIATRIC NURSING REFRESHER REVIEW NOTES

PROFESSOR ARCHIE ALVIZ

NURSE-CLIENT RELATIONSHIP
journal, relatives)
- the nurse should develop self awareness

NURSE-CLIENT RELATIONSHIP
2. Orientation / Interaction:
 two-way - establish trust
 series of interaction between the nurse and - assess the client
the client - establish mutual agreement
 GOAL: POSITIVE BEHAVIORAL CHANGE - informing client about the day of termination
(1st day)

BONUS QUESTION 3. Working:

Q1: When does the therapeutic relationship begins? - longest phase
- ORIENTATION PHASE - achieve goals
- sharing facts
Q2: The only tool available for the nurse? - explore
- SELF (SELF-AWARENESS) - resolve the problems

4. Termination:
Elements of Therapeutic Relationship
- moving towards independence
- observe for regressive behaviors (relapse)
T> TRUST
 goals are partially met only
 reinforce previous management
R> RAPPORT
 re-evaluate
 modification will occur depending on the
U> UNCONDITIONAL POSITIVE REGARD
result

S> SET LIMITS

T> THERAPEUTIC USE OF SELF THERAPEUTIC COMMUNICATION

THERAPEUTIC COMMUNICATION
BONUS QUESTION
 dynamic process of exchanging information
Q3: When is trust established?
 verbal and non-verbal techniques
- WHEN PATIENT IS SHARING ALREADY
 nurse-patient

Elements of Therapeutic Communication

Therapeutic Behaviors
1. Sender/ Encoder: source of the message
1. Genuineness: sincerity and honesty 2. Message: information being transmitted
2. Concreteness: ability to identify one’s feelings 3. Receiver/ Decoder: recipient of the message
3. Respect: consideration that each client is unique 4. Feedback: receives the response
(acceptance)

Non-Verbal Communication
Phases of Therapeutic Relationship
1. Proxemics:
1. Pre-Interaction / Pre-Orientation: - “physical space” between the sender and the
- no contact receiver
- data sourcing from secondary sources (chart, - ideal: 3-6 ft or 1 arm and a half

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2. Kinetics: 4. Broad Openings:

- body movements (gestures, facial expressions,
and mannerisms)
- enhances the credibility of what you’re saying
3. Touch:
- intimate physical contact
- always ask for consent
- “Where would you like to begin?”
5. Making Observations:
- “I noticed you have combed your hair today.”
6. Summarizing:
- “In the past 15 minutes, we have talked about..”

4. Silence: 7. Encouraging Description of Perception:

- convey listening - Pt: “ I am hearing voices.”
- encourage the patient to talk - Nurse: “What are the voices telling you?”
- explore the content of hallucination
5. Paralanguage:
- “voice quality” 8. Presenting Reality:
- tone and infliction - “I know that the voices seem real to you, but
- how the message is delivered there are no voices here.”
- acknowledge/validate then present reality

Verbal Communication ILLUSION HALLUCINATION

 therapeutic and appropriate - with stimuli - without stimuli
 simple and concise - ex: - ex:
 credible electric fan becomes can still see snake
snake 1. Visual: vision
1. Offering Self: 2. Auditory: hearing and
- “Let me sit with you for 5 minutes.” is most dangerous
- should be time-bounded (time-specific) 3. Tactile: feelings
4. Gustatory: taste
S > SPECIFIC
9. Seeking Clarification:
M > MEASURABLE
-”Do you mean?”

A > ATTAINABLE
10. Reflecting:
- Let the patient decide
R > REALISTIC
11. Restating:
T > TIME-BOUNDED
- rephrasing/repeating
- Pt: “I am down.”
2. Active Listening: - Nurse: “You feel depressed?”
- “Ah-huh”
- “Yes” 12. General Leads:
- “No” - “Go on.”
- encourages patient to talk - “Then?”
- “Tell me more.”
3. Explaining:
- “You said Hannah was the best, can you 13. Focusing:
describe her?” - “Let us look at it more closely.”

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PROFESSOR ARCHIE ALVIZ
- plastic

NON- THERAPEUTIC 4. Rationalization:

COMMUNICATION
- reasoning out

5. Projection:
NON-THERAPEUTIC COMMUNICATION
- blaming others
 Giving advise
 Talking about self 6. Introjection:
 Telling the client is wrong > arouses - blaming self/ exact replica
dispute > argument > loss of trust
 False reassurance 7. Compensation:
 Asking Why: demands an answer > arouses - weak on one aspect to strong on other aspect
deep seated feelings Ex: weak on sports to academic excellence

8. Denial:
SPHERES - non-acceptance of truth

NON-THERAPEUTIC COMMUNICATION
9. Displacement:
1. ID - channeling of anxiety
-pleasure
- irrational 10. Regression:
- Increased ID: ANTISOCIAL - going back to the previous developmental stage

2. EGO 11. Undoing:

-reality-based - hugas-kamay
- sanity - because of guilt
- ideal, balances ID and SUPEREGO
12. Conversion:
3. SUPEREGO - turning anxiety into physical symptoms
- conscience
- morality 13. Intellectualization:
- Increased SUPEREGO: OCPD - reasoning out in a detailed/reference or

step-by-step manner
- acknowledging without emotions
DEFENSE MECHANISMS
14. Substitution:
DEFENSE MECHANISMS
- making unavailable to available
1. Repression:
- unconscious forgetting 15. Identification:
- “di sadya” - Idolization but only certain features

2. Suppression:
- consciously forgetting
- “sadya” CRISIS
Types of Crisis
3. Reaction Formation:
1. Maturational/Developmental:

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- predictable and is expected - can’t go back to previous position

Ex: Marriage, Pregnancy, Menarche - can’t be molded

2. Situational: 5. Echopraxia:
- unexpected/unpredictable - purposeless imitations
Ex: Loss of job, Accidents, Death of loved ones - mirror-like imitation

3. Adventitious/Social:
- Acts of God and hideous crimes
Ex: War, Rape, Earthquakes, Pandemic DISTURBANCES IN
COMMUNICATION
STAGES OF DEATH AND DYING Disturbances in Communication

1. Mutism: act of being mute

Stages of Death and Dying

2. Negativism:
D > DENIAL: unacceptance of truth - always saying “NO”
- Defense Mechanism: Regression
A > ANGER: project/introject
3. Circumstantiality:
B > BARGAINING: unrealistic offers - beating around the bush
- “paligoy- ligoy”
D > DEPRESSION: dangerous stage, suicidal - arrives with an answer
- should be near the nurse’s station
- doors should be opened 4. Tangentiality:
- frequent irregular visits - beating around the bush
- without answer
A > ACCEPTANCE: moving forward
5. Stilted Language: use of flowery words

DISTURBANCES IN APPEARANCE 6. Flight of Ideas:

- slightly related
- with meaning
Disturbances in Appearance

1. Automatisms: repeated purposeless behavior 7. Lose Associations:

- not related
2. Psychomotor Retardation: - without meaning
- slowed movements - usually in statement form
- commonly seen in DEPRESSED patients
8. Perseveration:
3. Waxy Flexibility: - adherence to single topic only
- maintenance of awkward posture - go back to the same topic
- go back to previous position
- can be molded 9. Echolalia:
- parrot-like imitation
4. Catatonia:
- maintenance of awkward posture - repeating of words of others

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10. Palilalia:
- stereotyped words/last syllable
DISTURBANCES IN AFFECT
- Ex: Nahulog-log-log-log
Disturbances in Affect

11. Verbigeration: 1. Inappropriate: incongruent words and actions

- repeating the same words over and over again
- repeating words of own 2. Blunted: little/minimal response

12. Coprolalia: 3. Restricted: display only one type of expression

- copro (feces), lalia (logic)
- cursing/ shit-like talking 4. Labile Mood: unpredictable/ mood swings

13. Neologism: coining of new words 5. Apathy:

- flat affect
14. Blocking: sudden cessation of thought - absence of emotions

15. Word Salad: mixture of unrelated words 6. Ambivalence:

- opposing feelings
16. Clang Association: use of rhyming words - mixed emotions

7. Anhedonia: absence of pleasure

8. Euphoria: extreme pleasure

DISTURBANCES IN PERCEPTION
Disturbances in Perception

1. Delusions: fixed false belief STRESS

3 Stages of Stress
2. Magical Thinking
1. Stage I:
3. Paranoia: extreme suspiciousness - Alarm Reaction
- You have determined that there is stress
4. Religiousity: obsession in religious ideas 2. Stage II:
- Stage of Resistance
5. Phobia: irrational fear - You will utilize all the resources available to
solve the problem
6. Obsession: persistent thoughts (mind) ---------------PROBLEM IS UNRESOLVED-----------------
3. Stage III:
7. Compulsion: persistent actions (actions) - Stage of Exhaustion
- You have utilized all the resources but the `
8. Preoccupation: idea with intense desire problem is not solved

9. Thought Broadcasting: others know what I think

10. Delusions of Reference: feeling talk of the town ANXIETY VS. FEAR
ANXIETY FEAR
- unknown cause - known cause

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 No phobias, no panic attacks, no OC

4 Levels of Anxiety manifestations
1. Mild: Signs and Symptoms:
- logical thinking - Palpitations
- increase concentration - Chest pain
- increase alertness - Headache
- problem-solving approach - Insomnia
Management:
2. Moderate: - assist in problem-solving
- increase irritability - teach coping behaviors
- decreased attention span - assess previous coping
- selective inattentiveness Drug of Choice:
Management: - Benzodiazepines and Anxiolytics
 Relaxation techniques (DBE) - Antianxiety agents “pam” “lam”
 Encourage verbalization of feelings
Medications:
2. PANIC DISORDER
 Benzodiazepines (diazepam, vallium)
 Anxiolytics “pam” “lam”  Recurrent
 Unpredictable
3. Severe:  Panic attacks
- extreme muscle tension Signs and Symptoms:
- loud and rapid speech - trembling
- difficulty of focusing even with assistance - racing heart (tachycardia: SNS response),
- distorted perception - chest pain
Management: - DOB
 Stay with the patient - choking sensations
- numbness
4. Panic: Management:
- suicidal tendencies/ attempts - assist in problem-solving
- fixed eyes
- hysterical/ - teach coping behaviors
- mute Drug of Choice:
- incoherence - benzodiazepines
Management: - other meds:
 Assist in relaxation techniques beta blockers “lol”
 Decrease stimuli SSRI (selective serotonin reuptake inhibitors)
 Stay with the client MAOIs (monoamine oxidase inhibitors)
 PAPER BAG: hyperventilation, respiratory
alkalosis ****IF WITH ADDICTION TO BENZODIAZEPINES,
USE ANTIHISTAMINES FOR ITS SECONDARY
EFFECT.

ANXIETY RELATED DISORDERS

Primary Effect: Anti-cholinergic
Secondary Effect: Sedative Effect

1. GENERALIZED ANXIETY DISORDER (GAD)

3. ACUTE STRESS DISORDER
 Worry worm: pacing
 No apparent reason  Common in typhoon victims
 6 months and above

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Signs and Symptoms: - thought stopping (diversion > rubber band)

- after 2 days to 4 weeks or 1 month - guided imagery: conditioning
Management:
- progressive review of the trauma
6. OBSESSIVE-COMPULSIVE DISORDER
Drug of Choice:
- benzodiazepines  Obsession: repetitive/persistent thoughts
 Compulsion: repetitive/persistent actions
Management:
4. POST TRAUMATIC STRESS DISORDER (PTSD)
- Aversion: punishment (most effective)
 Signs and symptoms are more than 4 weeks, - give time for ritualistic behaviors unless
greater than 1 month dangerous
 Recurrent flashbacks (intrusive thoughts: - establish limits
nakakabagabag) - diversional activities
 Re-experiencing of trauma - SLRC> Set Limits
 Defense Mechanism: Displacement Reality Consistent
Signs and Symptoms: Drug of Choice:
- starts with general numbing > somatic (bodily) - SSRI (selective serotonin reuptake inhibitors):
symptoms decreases anxiety
- irritability
- depression

ANXIETY RELATED DISORDERS

- anger
- social withdrawal
Management:
ANXIETY RELATED DISORDERS
- assist in gaining control over angry impulses
(acceptance) 1. Bipolar I
Drug of Choice: 2. Bipolar II
- Benzodiazepines 3. Manic Disorder
- other meds: 4. Major Depressive Disorder
Betablockers 5. Cyclothemia
Antihistamines 6. Dysthemia

5. PHOBIC DISORDER/ PHOBIA BI BII MDO MDD CY DY

 Persistent irrational fear Mania
 Fear is unreasonable proportion to the actual
danger Hypomania
3 MAIN TYPES:
1. Agoraphobia: NORMAL
- fear of open public places Hypodepression
- always stay near exits/at home
2. Social Major Depression
3. Simple:
- specific types: claustrophobia, hydorphobia, etc.
Management:
- systemic desensitization: gradual exposure to ***MAJOR DEPRESSIVE DISORDER CAN
the feared object PROGRESS TO BIPOLAR D/O
(opposite: flooding: sudden exposure > not
effective)
- breathing exercises

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2. DISORGANIZED
MAJOR DEPRESSION BIPOLAR DISORDER
- over dependence and - mask of depression  Bizarre baheviors
loss Signs and Symptoms:
- thoughts
Defense Mechanism: Defense Mechanism: - movements
- Introjection - Reaction formation - speech
Signs and Symptoms: Signs and Symptoms: Defense Mechanism:
- anhedonia - hyperactivity - Regression
- psychomotor - manipulative Nursing Diagnosis:
retardation - controlling - Impaired Social Functioning
- negative s/sx - inattentive Management:
Attitude: Attitude: - ADL assistance
- kind firmness - Matter-of-fact
Activity: Activity:
3. PARANOID
- counting seashells - breaking leaves
- writing - modeling clay  Suspiciousness
Therapy: - walking  Ideas of reference
- group therapy Therapy: Signs and Symptoms:
- non-competitive - solitary therapy - Delusion
WOF: - non-competitive - Hallucinations
- Suicide (safety) ***FINGER FOODS - Flight of Ideas
Defense Mechanism:
- Projection
Nursing Diagnosis:

SCHIZOPHRENIA
- Potential for Injury Directed to Self and Others
- Priority: Safety
Management:
Schizophrenia
- Nutrition and safety
 Increase Dopamine Meds:
- Antipsychotics: 3-4 weeks therapeutic effects
Goal: decrease dopamine
1. CATATONIC
WOF:
 Abnormal motor behavior 1. Pseudoparkinsonism:
Signs and Symptoms: - s/sx of parkinsons disease:
- catatonia - mask-like face
- tremors
- waxy flexibility - shuffling gait
- mutism
- negativism 2. EPS (Extrapyramidal S/E): anticholinergics
Defense Mechanism: Akineton
- Repression Artane
Nursing Diagnosis: Cogentin
- Impaired Motor Activity Benadryl
Management:
Priority: 3. NMS (Neuroleptic Malignant Syndrome)
1. Circulation: PROM exercises - wide BP fluctuations
2. Nutrition

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- stop prevent suicide

- notify the physician
- monitor vital signs
3. Histrionic

 “I love attention”

PERSONALITY DISORDERS 

Attention-seeker
Dramatic
 Excessively emotional
CLUSTER A: ECCENTRIC

1. Paranoid 4. Narcissistic

 Extreme suspiciousness and distrust  “I love myself”

 Due to personal or traumatic experiences  Grandiosity
 Need constant affirmation from others
 Exaggerated sense of being important
2. Schizoid

 Social withdrawal Management:

 Aloof - anticonvulsant: relaxant
 Problem: Maintaining relationship - lithium: for manic symptoms
- MAOI’s (monoamine oxidase inhibitors)

3. Schizotypal
CLUSTER C: ANXIOUS/FEARFUL
 Bizarre behaviors
 Silly laughing 1. Avoidant:
 Magical thinking - “I avoid because I hate criticisms”
 Mild Psychotic symptoms - Low self-esteem

Management: 2. Dependent:
- Antidepressants - “I can’t live if living is without you.”
- Low dose antipsychotics - Over reliance
- submissive

CLUSTER B: ERRATIC/DRAMATIC
3. Obsessive-Compulsive Personality Disorder
(OCPD)
1. Antisocial

OCD OCPD
 No guilt, no remorse, no conscience - anxiety-related d/o - personality d/o
 Disregard rights, rules and laws - aware - unaware
 <18yo: Conduct Disorder - real - no real obsessions/
 >18y/o: Antisocial Personality Disorder obsessions/compulsions compulsions
- perfectionist
-rigid/inflexible
2. Borderline
- moralistic
 Suicidal tendencies
 Body mutilation Management:
 Fear of being alone - Benzodiazepines
 Manipulative - Anxiolytics
 Give antidepressants: control behavior and

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POST-TEST
1. Seng, a 24-year-old client is experiencing an acute
schizophrenic episode. She has vivid hallucinations that
are making him agitated. The nurse's best response at this
time would be to:
a. take the client's vital signs.
b. explore the content of the hallucinations.
c. tell him his fear is unrealistic.
d. engage the client in reality-oriented activities.
2. Ofel, a client with paranoid type schizophrenia becomes
angry and tells the nurse to leave her alone. The nurse
should:
a. tell her that she'll leave for now but will return soon.
b. ask her if it's okay if she sits quietly with him.
c. ask her why he wants to be left alone.
d. tell her that she won't let anything happen to him.
3. Ruth, a client begins taking haloperidol (Haldol). After
a few days, she experiences severe tonic contractures of
muscles in the neck, mouth, and tongue. The nurse should
recognize this as:
a. psychotic symptoms.
b. parkinsonism.
c. akathisia.
d. dystonia.
4. Ed, a psychotic client reports to the evening nurse that
the day nurse put something suspicious in his water with
his medication. The nurse replies, "You're worried about
your medication?" The nurse's communication is:
a. an example of presenting reality.
b. reinforcing the client's delusions.
c. focusing on emotional content.
d. a nontherapeutic technique called mind reading.
5. Prometheus is admitted to the inpatient unit of the
mental health center with a diagnosis of paranoid
schizophrenia. He's shouting that the the government of
France is trying to assassinate him. Which of the following
responses is most appropriate?
a. "I think you're wrong. France is a friendly country and an ally
of the United States. Their government wouldn't try to kill you."
b. "I find it hard to believe that a foreign government or anyone
else is trying to hurt you. You must feel frightened by this."
c. "You're wrong. Nobody is trying to kill you."
d. "A foreign government is trying to kill you? Please
tell me more about it."
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6. Propranolol (Inderal) is used in the mental health setting
to manage which of the following conditions?
a. Antipsychotic-induced akathisia and anxiety
b. The manic phase of bipolar illness as a mood stabilizer
c. Delusions for clients suffering from schizophrenia
d. Obsessive-compulsive disorder (OCD) to reduce ritualistic
behavior
7. Orly, a client with borderline personality disorder
becomes angry when he is told that today's psychotherapy
session with the nurse will be delayed 30 minutes because
of an emergency. When the session finally begins, the
client expresses anger. Which response by the nurse
would be most helpful in dealing with the client's anger?
A. "If it had been your emergency, I would have made the other
client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you
feel right now?"
D. "I really care about you and I'll never let this happen again.”
8. How soon after chlorpromazine (Thorazine)
administration should the nurse expect to see a client's
delusional thoughts and hallucinations eliminated?
a. Several minutes
b. Several hours
c. Several days
d. Several weeks
9. Lhoy, a client receiving haloperidol (Haldol) complains
of a stiff jaw and difficulty swallowing. The nurse's first
action is to:
A. reassure the client and administer as needed lorazepam
(Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as
ordered.
C. administer as needed dose of benztropine (Cogentin) by
mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.
10. Jiffery, a client with a diagnosis of paranoid
schizophrenia comments to the nurse, "How do I know
what is really in those pills?" Which of the following is the
best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is
ordered."
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D. Ignore the comment because it's probably a joke. d. a hallucination.
11. The nurse is caring for Guy, a client with schizophrenia
who experiences auditory hallucinations. The client
appears to be listening to someone who isn't visible. He
gestures, shouts angrily, and stops shouting in mid-
sentence. Which nursing intervention is the most
appropriate?
a. Approach the client and touch him to get his attention.
b. Encourage the client to go to his room where he'll experience
fewer distractions.
c. Acknowledge that the client is hearing voices but make it
clear that the nurse doesn't hear these voices.
d. Ask the client to describe what the voices are saying.
12. Yesterday, James, a client with schizophrenia began
treatment with haloperidol (Haldol). Today, the nurse
notices that the client is holding his head to one side and
complaining of neck and jaw spasms. What should the
nurse do?
a. Assume that the client is posturing.
b. Tell the client to lie down and relax.
c. Evaluate the client for adverse reactions to haloperidol.
d. Put the client on the list for the physician to see tomorrow
13. Alvin, a client with paranoid schizophrenia has been
experiencing auditory hallucinations for many years. One
approach that has proven to be effective for hallucinating
clients is to:
a. take an as-needed dose of psychotropic medication
whenever they hear voices.
b. practice saying "Go away" or "Stop" when they hear voices.
c. sing loudly to drown out the voices and provide a distraction.
d. go to their room until the voices go away.
14. Violet, a client with catatonic schizophrenia is mute,
can't perform activities of daily living, and stares out the
window for hours. What is the nurse's first priority?
a. Assist the client with feeding.
b. Assist the client with showering.
c. Reassure the client about safety.
d. Encourage socialization with peers.
15. Mai-mai, a client tells the nurse that the television
newscaster is sending a secret message to her. The nurse
suspects the client is experiencing:
a. a delusion.
b. flight of ideas.
c. ideas of reference.
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16. The nurse knows that the physician has ordered the
liquid form of the drug chlorpromazine (Thorazine) rather
than the tablet form because the liquid:
a. has a more predictable onset of action.
b. produces fewer anticholinergic effects.
c. produces fewer drug interactions.
d. has a longer duration of action.
17. Gay-gay, a client who has been hospitalized with
disorganized type schizophrenia for 8 years can't complete
activities of daily living (ADLs) without staff direction and
assistance. The nurse formulates a nursing diagnosis of
Self-care deficient: Dressing/grooming related to inability
to function without assistance. What is an appropriate goal
for this client?
a. "Client will be able to complete ADLs independently within 1
month."
b. "Client will be able to complete ADLs with only verbal
encouragement within 1 month."
c. "Client will be able to complete ADLs with assistance in
organizing grooming items and clothing within 1 month."
d. "Client will be able to complete ADLs with complete
assistance within 1 month."
18. The nurse is planning care for Chester, a client
admitted to the psychiatric unit with a diagnosis of
paranoid schizophrenia. Which nursing diagnosis should
receive the highest priority?
a. Risk for violence toward self or others
b. Imbalanced nutrition: Less than body requirements
c. Ineffective family coping
d. Impaired verbal communication
19. The nurse is preparing for the discharge of Charlie, a
client who has been hospitalized for paranoid
schizophrenia. The client's husband expresses concern
over whether his wife will continue to take her daily
prescribed medication. The nurse should inform him that:
a. his concern is valid but his wife is an adult and has the right
to make her own decisions.
b. he can easily mix the medication in his wife's food if she
stops taking it.
c. his wife can be given a long-acting medication that is
administered every 1 to 4 weeks.
d. his wife knows she must take her medication as prescribed
to avoid future hospitalizations.
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20. Benztropine (Cogentin) is used to treat the
extrapyramidal effects induced by antipsychotics. This
drug exerts its effect by:
a. decreasing the anxiety causing muscle rigidity.
b. blocking the cholinergic activity in the central nervous system
(CNS).
c. increasing the level of acetylcholine in the CNS.
d. increasing norepinephrine in the CNS.
21. Aida, a client is admitted to the inpatient unit of the
mental health center with a diagnosis of paranoid
schizophrenia. She's shouting that the government of
France is trying to assassinate her. Which of the following
responses is most appropriate?
a. "I think you're wrong. France is a friendly country and an ally
of the United States. Their government wouldn't try to kill you."
b. "I find it hard to believe that a foreign government or anyone
else is trying to hurt you. You must feel frightened by this.
c. "You're wrong. Nobody is trying to kill you."
d. "A foreign government is trying to kill you? Please tell me
more about it."
22. A dopamine receptor agonist such as bromocriptine
(Parlodel) relieves muscle rigidity caused by antipsychotic
medication by:
a. blocking dopamine receptors in the central nervous system
(CNS).
b. blocking acetylcholine in the CNS.
c. activating norepinephrine in the CNS.
d. activating dopamine receptors in the CNS.
23. Most antipsychotic medications exert which of
following effects on the central nervous system (CNS)?
a. Stimulate the CNS by blocking postsynaptic dopamine,
norepinephrine, and serotonin receptors.
b. Sedate the CNS by stimulating serotonin at the synaptic
cleft.
c. Depress the CNS by blocking the postsynaptic transmission
of dopamine, serotonin, and norepinephrine.
d. Depress the CNS by stimulating the release of acetylcholine.
24. Frowline, a client is admitted to the psychiatric unit of a
local hospital with chronic undifferentiated schizophrenia.
During the next several days, the client is seen laughing,
yelling, and talking to herself. This behavior is
characteristic of:
a. delusion.
b. looseness of association.
c. illusion.
TOPRANK REVIEW ACADEMY | TO TOP THE BOARD EXAM!
d. hallucination.
25. Which of the following medications would the nurse
expect the physician to order to reverse a dystonic
reaction?
a. prochlorperazine (Compazine)
b. diphenhydramine (Benadryl)
c. haloperidol (Haldol)
d. midazolam (Versed)
26. A schizophrenic client states, "I hear the voice of King
Tut." Which response by the nurse would be most
therapeutic?
a. "I don't hear the voice, but I know you hear what sounds like
a voice."
b. "You shouldn't focus on that voice."
c. "Don't worry about the voice as long as it doesn't belong to
anyone real."
d. "King Tut has been dead for years."
27. Daryl, a client has been receiving chlorpromazine
(Thorazine), an antipsychotic, to treat his psychosis.
Which findings should alert the nurse that the client is
experiencing pseudoparkinsonism?
a. Restlessness, difficulty sitting still, and pacing
b. Involuntary rolling of the eyes
c. Tremors, shuffling gait, and masklike face
d. Extremity and neck spasms, facial grimacing,
and jerky movements
28. For several years, a client with chronic schizophrenia
has received 10 mg of fluphenazine hydrochloride (Prolixin)
by mouth four times per day. Now the client has a
temperature of 102° F (38.9° C), a heart rate of 120
beats/minute, a respiratory rate of 20 breaths/minute, and
a blood pressure of 210/140 mm Hg. Because the client
also is confused and incontinent, the nurse suspects
malignant neuroleptic syndrome. What steps should the
nurse take?
a. Give the next dose of fluphenazine, call the physician, and
monitor vital signs.
b. Withhold the next dose of fluphenazine, call the physician,
and monitor vital signs.
c. Give the next dose of fluphenazine and restrict the client to
the room to decrease stimulation.
d. Withhold the next dose of fluphenazine, administer an
antipyretic agent, and increase the client's fluid intake.
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29. Gelyn, a schizophrenic client with delusions tells the
nurse, "There is a man wearing a red coat who's out to get
me." The client exhibits increasing anxiety when focusing
on the delusions. Which of the following would be the best
response?
a. "This subject seems to be troubling you. Let's walk to the
activity room."
b. "Describe the man who's out to get you. What does he look
like?"
c. "There is no reason to be afraid of that man.
d. "There is no need to be concerned with a man hospital is
very secure." who isn't even real."
30. Important teaching for women in their childbearing
years who are receiving antipsychotic medications
includes which of the following?
a. Occurrence of increased libido due to medication adverse
effects
b. Increased incidence of dysmenorrhea while taking the drug
c. Continuing previous use of contraception during periods of
amenorrhea
d. Instruction that amenorrhea is irreversible
31. Tic-tic, a client is admitted to a psychiatric facility with
a diagnosis of chronic schizophrenia. The history
indicates that the client has been taking neuroleptic
medication for many years. Assessment reveals unusual
movements of the tongue, neck, and arms. Which
condition should the nurse suspect?
a. Tardive dyskinesia
b. Dystonia
c. Neuroleptic malignant syndrome
d. Akathisia
32. When planning the care for Gerly who is abused, which
of the following measures would be most important to
include?
a. Helping the patient develop a safety plan.
b. Explaining to the patient her personal and legal rights.
c. Teaching her about abuse and the cycle of violence.
d. Being compassionate and empathetic.
33. The nurse is assessing Renee’s methods of coping. A
patient who is being abused would be least likely to
demonstrate which of the following?
a. Self-blame.
b. Alcohol abuse.
c. Assertiveness.
d. Suicidal thoughts.
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34. One of the myths about sexual abuse of young children
is that it usually involves physically violent acts. Which of
the following behaviors is more likely to be used by the
abusers?
a. Asking for the child’s consent for sex.
b. Coercion as a result of the trusting relationship.
c. Tying the child down.
d. Bribery with money.
35. Aura is suspected of being sexually abused because
she demonstrates the self-destructive behaviors of head
banging and self-mutilation. Which of the following
behaviors would the nurse also commonly expect to
assess?
a. Substance abuse.
b. Overcontrol of anger.
c. Truancy and running away.
d. Inability to play.
36. Desiree who has been sexually abused has difficulty
putting feelings into words. Which of the following would
the nurse employ with the child?
a. Role-playing.
b. Giving the patient’s drawings to the abuser.
c. Engaging in play therapy.
d. Reporting the abuse to a prosecutor.
37. When developing a teaching plan for a high school
health class about anorexia nervosa, which of the
following would the nurse include as the primary group
affected by this disease?
a. Women, age at onset between 12 to 20 years.
b. Men, onset during the college years.
c. Women, onset typically after 30 years of age.
d. Men, onset before 20 years of age.
38. When assessing Edna, a patient with anorexia nervosa,
the nurse would expect to find which of the following?
a. Lanugo, hypothermia, and hypotension.
b. Constipation, dysmenorrheal, and hypertension.
c. Diarrhea, dry skin and menorrhagia.
d. Hyperthermia, oliguria and bradycardia.
39. Krisha, diagnosed with bulimia tells the nurse that she
eats excessively when she is upset and then vomits so she
won’t gain a lot of weight. Which of the following nursing
diagnostic categories would be most appropriate for her?
a. Ineffective coping.
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b. Imbalanced nutrition: more than body requirements.
c. Anxiety.
d. Disabled family coping.
40. During the initial interview, Kriszel who has a
compulsive eating disorder remarks, “I can’t stand myself
and the way I look.” Which of the following statements by
the nurse would be most therapeutic?
a. “Don’t worry, you’ll soon be back in shape.”
b. “Tell me more about your feelings.”
c. “Everyone who has the same problem feels like you do.”
d. “I don’t think you look bad at all.”
41. Josh, a 3-year-old child is brought into the physician’s
office by her parents who are concerned by his behavior.
They state that he resists their affection, twirls around
frequently, and refuses to respond to other children and
adults. Based on the analysis of these behaviors, which of
the following would the nurse suspect?
a. Tourette syndrome.
b. Schizophrenia.
c. ADHD.
d. Autism.
42. The nurse is with the parents of Kevin, a 16- yearold
boy who recently attempted suicide. The nurse cautions
the parents to be especially alert for which of the following
in their son?
a. Decision to try out for an extracurricular activity.
b. Giving away valued personal items.
c. Desire to spend more time with friends.
d. Expression of a desire to date.
43. The nurse at the mental health clinic is meeting a new
patient who is Kezia, a 7-year-old girl with Tourette
syndrome. Which of the following would the nurse expect
to assess?
a. Isolated verbal tics.
b. Alternating simple and complex motor tics.
c. Multiple motor and verbal tics.
d. Primarily motor tics.
44. Which of the following medications would the nurse
anticipate administering as a treatment for tic disorders,
including Tourette disorder?
a. Lithium.
b. Clonidine.
c. Chlorpromazine.
d. Imipramine.
TOPRANK REVIEW ACADEMY | TO TOP THE BOARD EXAM!
45. When assessing Toni, a 17-year-old male patient with
depression for suicide risk, which of the following
questions would be best?
a. “Are you thinking about killing yourself?”
b. “What movies about death have you watched lately?”
c. “Can you tell me what you think about suicide?”
d. “Has anyone in your family ever committed suicide?”
46. Which of the following would the nurse expect to
include in the teaching plan for the parents of Kyle who is
receiving methylphenidate (Ritalin)?
a. Allowing concurrent use of any over-the counter medications
with this drug.
b. Giving the medication at the same time every evening.
c. Having the child take two doses at the same time if the last
dose was missed.
d. Giving the single-dose form of the medication early in the
day.
47. During the assessment stage, Sweet, a client with
schizophrenia leaves his arm in the air after the nurse has
taken his blood pressure. His action shows evidence of:
a. somatic delusions.
b. waxy flexibility.
c. neologisms.
d. nihilistic delusions.
48. Salty, a client in the manic phase of bipolar disorder
constantly belittles other clients and demands special
favors from the nurses. Which nursing intervention would
be most appropriate for this client?
a. Ask other clients and staff members to ignore the client's
behavior.
b. Set limits with consequences for belittling or demanding
behavior.
c. Offer the client an antianxiety drug when belittling or
demanding behavior occurs.
d. Offer the client a variety of stimulating activities to distract
him from belittling or making demands of others.
49. Bitter, a client diagnosed with depression tells the
nurse, "I won't allow myself to cry because it upsets the
whole family when I cry." This is an example of:
a. manipulation.
b. insight.
c. rationalization.
d. repression.
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50. When monitoring Howard, a male client recently
admitted for treatment of cocaine addiction, the nurse
notes sudden increase in the arterial blood pressure and
heart rate. To correct these problems, the nurse expects
the physician to prescribe:
a. Norepinephrine (Levophed) and lidocaine
(Xylocaine)
b. Nifedipine (Procardia) and lidocaine
c. Nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc)
d. Nifedipine and nitroglycerin

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 PSYCHIATRIC NURSING REFRESHER REVIEW NOTES
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6. Johnny owns a small business that has recently been
EVALUATIVE EXAM
Situation: The nurse is working with a client is having difficulty
understanding and associating present symptoms with the
illness.
1. In which of the following components of the mental
status assessment would this information be
documented?
A. insight
B. level of awareness
C.orientation
D.judgment
2. Which of the following statements made by a client
indicate a possible problem with the individual’s present
state of mental health?
A. “I am involved in many community activities”
B. “My children don’t care about me anymore”
C. “I enjoy the solitude of living by myself”
D. “I try not to let the things upset me”
3. In general a client diagnosed with a mental illness would
demonstrate which of the following?
A. Rational and realistic thought processing
B Ability to function alone or with others.
C. Disrupted interpersonal relationship
D. Motivation and inner values and strengths
4. Which of the following is a component of the client’s
mental status nursing assessment?
A. post medical history
B. mood and affect
C. medical diagnosis
D. nursing diagnosis
5. When gathering data concerning the present mental
status of a client, the nurse would recognize which of the
following as a perceptual disturbance?
A. persistent use of rationalization to explain present situation
B. description of reoccurring voices that are talking to him
C. inability to stay focused on the question asked
D. retention of immediate happenings is decreased
Situations: In a complex society a lot of people are now prone
to experience a high degree of Anxiety and depression. It is
important if additional help is required to clients.
TOPRANK REVIEW ACADEMY | TO TOP THE BOARD EXAM!
experiencing reduced sales and profits. He obtained a
bank loan to cover losses from the past few months and
obtain merchandises for inventory. The bank loan will be
due for repayment in 6- months. Which of the following
describes William solution to his anxiety over his financial
situation?
A. Adaptive coping strategy
B. Palliative coping strategy
C. Maladaptive coping method
D. Dysfunctional management
7. A client is scheduled for a radical mastectomy. As the
nurse enters the client’s hospital room , the client says, “it
would be easier if I just didn’t wake up from the surgery ”.
The best response for the nurse to make at this time is
A. “You are just afraid now, everything will look different
tomorrow”
B. “ You feel, it would be easier to die than to face the loss of
your breast?”
C. “Some people feel the same way you do , but his does not
mean that the end of your life”
D. “Why do you think it would be easier to die than to wake up
after surgery?”
8. The nurse is assessing a client whose wallet was stolen.
The client is experiencing palpitation, hyperventilation,
diaphoresis and confusion. Although alert and talking, the
client is unable provide a name and address. The nurse
would document this as the client is experiencing which
level of anxiety?
A. Mild Anxiety
B. Moderate Anxiety
C. Severe Anxiety
D. Panic Level
9. A client is seen in the emergency room for acute
symptoms of anxiety and situational crisis. The examining
physician asks that arrangement be made to refer this
client to a mental health clinic for counseling. This action
by the physician recognizes which of the client rights to
appropriate treatment?
A. to accept or refuse treatment
B. to know qualifications of professionals involved in care
C. to receive explanations of treatment
D. to be treated in least restrictive setting
10. The nurse is doing client teaching for a client taking a
newly prescribed antianxiety medication. Which statement
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PROFESSOR ARCHIE ALVIZ
by the client would alert the nurse to the need for further B. “None of my family seems to understand just how bad this
teaching? feeling is.”
A. “I will continue taking the drug even if it makes me sleepy.” C. “I am happiest when I am breast-feeding my 2-months-old
B. “May be now I can enjoy an evening of wine and dinner with daughter.”
my wife.” D. “Sometimes I feel like I am going crazy and have to leave
C. “I guess I won’t feel better right away from taking this drug.” the room.”
D. “Hopefully, I will only need to take this for a short period of
time.” 15. A 16 year old female client with a diagnosis of panic
disorder jumps when spoken to, complains of feeling
Situation: Panic disorders can occur in anticipation of an events uneasy and states” It’s as though something bad is going
as a result, clients restrict activities outside the safety of their to happen “It would be most therapeutic for the nurse to“
homes. A Psychiatric Nurse is attending to clients with intense A. Be physically present
fear and discomfort. B. Encourage the client to communicate with the staff
C. Allow the client to set the parameters for the interactions
11. A client has just been diagnosed with panic disorder. D. Help the client to understand the cause of the feelings
Which of the following symptoms would the nurse expect described
to observe?
A. hypotension 16. A 70 year old client states to the nurse that, “My life is a
B. feelings of suffocation pile of shambles with nothing to show for it” the client is
C. constipation experiencing what Erikson would term?
D. logical thought processes A. Doubt
B. Inferiority
12. Which of the following would be the most appropriate C. Despair
direct question for the nurse to use during an initial D. Stagnation
interview with a client who has just experienced a panic
attack? 17. A 4 –year old boy tells the nurse, “When I grow up, I am
A. “Does anyone else in your family have these feelings?” going to marry Mommy.” Which stage of psychosocial
B. “Have you ever felt this way before?” stage of development is portrayed by this statement?
C. “Tell me what you are feeling now?” A. Phallic
D. “Tell me about what causes you to feel this way.” B. Anal
C. Latency
13. When planning care for the client experiencing a Panic D. Genital
level of anxiety, which if the following is the most
appropriate initial outcome for the nurse to set for the 18. According to Piaget, children who seek to control their
client? world from a centrated point of view would in which stage
A. will develop a trusting relationship with the nurse of development?
B. will demonstrate insight into the cause of anxiety A. Sensorimotor
C. will identify alternate methods of coping B. Preoperational
D. will reduce anxiety at least one level C. Concrete
D. Formal
14. A client is being seen for increasing symptoms of
Panic attacks. The client asks the physician for 19. A person refrains from telling the truth to a friend
“something for my nerves.” Which of the following whose partner is having an affair with a co-worker to avoid
comments by the client should the nurse report to the hurting his friend. According to Kohlberg, this
physician as data that suggests a drug should not be demonstrates which level of moral development?
prescribed? A. Pre-conventional- Stage 2
A. “The panic attacks happen most when I am in a room full of B. Conventional- Stage 3
people.” C. Conventional- Stage 4
D. Post conventional- Stage 5

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 PSYCHIATRIC NURSING REFRESHER REVIEW NOTES
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20. A client is being seen who is unable to maintain 25. Which of the following best prepares the nurse to
employment. He states there is always an ulterior motives assist in viewing themselves and their behaviors more
on company policies that affect him. Which of the realistically?
following psychosocial stage is likely unresolved? A. developing an honest evaluation of oneself
A. Trust Vs. Mistrust B. psychosocial assessment of the client
B. Autonomy Vs. Doubt C. knowledge of personality development theories
C. Initiative VS. Guilt D. communication techniques
D. Industry Vs. Inferiority
Situation: The Nurse Client relationship exists for the benefit of
Situation: Marco 38 year old, has been arrested for physical the client. It is a well planned and goal directed interactions for
assault of another individual. He has a history of an abusive the purpose of understanding the clients.
childhood and previous aggressive offenses.
26. When establishing a therapeutic environment, which of
21. Behavioral theory would explain this behavior as the following factors would be most important in forming
A. Feelings of repressed hostility the foundation for a trusting nurse-client relationship?
B. A diminished sense of self esteem A. nurse’s sympathetic attitude
C. An innate impulsive drive for survival B. client’s educational background
D. reinforcement of early learning experiences C. amount of time spent with the client
D. nurse’s honesty and consistent integrity
22. The nurse is caring for a client who has been recently
diagnosed with Leukemia. Which of the following should 27. The nurse is working with a client who says, “You are
the nurse include in a psychological assessment of this the only one who really cares about me. I feel like everyone
client? else is giving me the shove just because I am getting out
A. Available coping behaviors of here this week.” Which of the following is indicated by
B. Relaxation techniques the client’s statement?
C. Consistency of care givers A. avoidance
D. Explanation of diagnostic exams B. withdrawal
C. ambivalence
23. For which of the following behaviors would the nurse D. Manipulation
recognize seclusions as an inappropriate intervention for
behavior management? 28. During a discussion between the nurse and a client, the
A. continued verbal aggression toward staff and other clients client suddenly starts shouting and tightening his fists.
B. physical aggression toward the nurse and other personnel Which of the following would be an appropriate action for
C. a client who continues to threaten suicidal intent the nurse at this time?
D. disruptive behavior during session of group therapy A. change the subject or topic of discussion
B. tell the client that hr will be secluded if he continues
24. While observing a client receiving behavioral therapy, C. touch the client’s arm and ask him to calm down
the nurse would recognize a positive treatment response D. walk away from the client without responding
when the client:
A. has insight into early relationships and experiences as the 29. In which of the following situations has the nurse
problem source violated professional boundaries in the nurse client
B. demonstrate noticeable behavioral change within a relatively relationship?
short time A. encouraged a client to discuss feelings of remorse over
C. identifies distorted thinking patterns that lead to problem rejection by another client
behaviors B. agreed to relay personal information about the client to the
D. performs behaviors included in signed agreement with the therapist
therapist C. returned cell phone call received from a client discharged 2
weeks earlier
D. assisted a disabled client with physical hygiene and bathing

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30. A client tells the nurse “I feel so secure when I am with 34. The nurse is caring for a client whose serum Lithium
you. Don’t tell the others, but you are the best nurse here.”
What is the most appropriate response for the nurse at this
time?
A. “I am glad you feel secure with me. I will try to spend more
time with you.”
B. “You don’t mean that. There are many good nurses here.”
C. “Why do you feel more secure with me than the others?”
D. “It seems as though you are feeling anxious. Can you tell me
about that?”
Situation: The Nurse has a very important role in the successful
psychopharmacologic treatment of the patient. One of the
major nursing responsibilities is to continuously monitor the
side effects on the patients and institute measures to minimize
side effects.
31. The nurse administering a Psychotropic agent to a
client with a mental disorder would recognize that the
primary goal of pharmacologic treatment is to:
A. cure the underlying cause of the mental disorder
B. prevent reoccurrence of behavioral problems
C. assure compliance with the therapeutic regimen
D. control or reduce symptoms of the disorder
32. The nurse is providing client teaching to a client for
whom the Antipsychotic agent Risperidone (Risperdal)
has been prescribed. Which statement by the client would
indicate a need for further teaching?
A. “I need to take the medication when I eat so it doesn’t upset
my stomach.”
B. “It may be week or two before I feel really good.”
C. “I can still go riding on my bike in the afternoon like I usually
do.”
D. “I better sit on the edge of the bed awhile before I get up in
the morning.”
33. The Physician has ordered the drug Benztropine
(Cogentin) for a client who has been taking the
Antipsychotic medication Haloperidol (Haldol). Which of
the following would the nurse expect to assess in this
client?
A. increased delusional thinking
B. intractable hiccups
C. diminished drive and apathy
D. protruding tongue movements
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Carbonate level is 1.5 mEq/L. The nurse expect the
Physician to do which of the following?
A. order an additional dose to be given one time only
B. increase the daily dosage of the medication
C. order the next dose of the drug to be held
D. stop the medication
35. It is important for the Nurse to include which of the
following instructions when teaching the client taking a
TCA?
A. take the medication with coffee or tea to enhance its effect
B. the medication can be discontinued after a few weeks of
therapy
C. you can omit the morning dose of your medication if it makes
you too sleepy
D. wear a hat and long-sleeve shirt when you are outdoors in
the sun
Situation: The nurse is documenting observations made during
an initial contact with a client who has a currently been
diagnosed with Acute Schizophrenia, undifferentiated type.
36. Which of the following behavior assessments would be
considered a positive symptom of Schizophrenia?
A. presents with a blunted affect
B. expresses indications of avolition
C. having auditory hallucinations
D. disheveled and unkempt appearance
37. The nurse is planning care for a client who has been
newly diagnosed with Paranoid Schizophrenia. Which of
the following perceptual changes should the nurse
anticipate?
A. clients does not notice or respond to changes in the
environment
B. client recognizes that he is not responding normally stimuli
C. client accepts and understands the irrational nature of his
ideations
D. client frequently misinterprets social and environmental
stimuli
38. A client with Paranoid Schizophrenia believes her
medications are tainted with poisonous substances and
refuses to take them. Which action should the nurse take?
A. matter-of-factly reinforce to need to take the medication
B. ask the client what the medication is tainted with
C. ask the client why she thinks the medication is tainted
D. withhold the medication and try again later
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39. The nurse is assessing a client with Chronic C. is experiencing alcohol withdrawal
Schizophrenia who has stopped taking medication and is
being admitted with acute psychotic symptoms. The
client’s perception of the present problem would best be
documented by the nurse.
A. using exact words in client statements
B. with information obtained from the family
C. by observing behavior for several hours
D. an interpreted from the client thoughts
40. To increase the self esteem of the client with
Schizophrenia, the Nurse should plan to:
A. Reward healthy behaviors
B. Identify various means of coping
C. Encourage good hygiene and grooming
D. Explain the diagnosis and treatment plan
Situation: Alcohol is a mind and mood altering substance, a
Central Nervous System depressant that affects areas of the
brain and several neurotransmitters.
41. A client with a history of Alcohol Abuse tells the Nurse
Sandro, “I haven’t always drink this much, but lately my
life has just gone to pot.” The nurse notes that the client is
rubbing his hands together and squirming in his seat.
Which of the following responses would be appropriate at
this time?
A. “Go on….”
B. “What do you mean by your life has gone to pot?”
C. “Are you blaming someone else for your drinking?”
D. “What could be so bad that you need to drink more?”
42. Nurse Sandro is assessing hourly vital signs on a
client in acute alcohol withdrawal. The client is conscious
and coherent but the client’s blood pressure and pulse
were recorded as 132/68, 78 at 2200; 138/72, 84 at 1400;
148/86, 90 at 0200 and 160/94/94 at 0400. Which of the
following actions would Nurse Sandro initiate?
A. increase fluid intake to 3000 cc in the next 12 hours
B. initiate interventions for fall precautions
C. obtain a clean catch urine specimen
D. notify the physician
43. Jeff an adult client is admitted to the Psychiatric unit
with a blood alcohol level of 0.03%. He is disoriented with
slurred speech and a staggering gait. Nurse Sandro would
correctly asses that the client
A. has symptoms of intoxication
B. has developed a tolerance to alcohol
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D. is probably using more than one substance
44. Ronald tells the nurse he is not an Alcoholic. He states
he drinks “two or three beers” with his buddies every day
after work and maybe one or two after he gets home. He
says, “I can handle it. I’ve never missed work because of it.”
The nurse would recognize Ronald is using the mental
mechanism of:
A. denial
B. projection
C. displacement
D. Rationalization
45. While Nurse Sandro is assessing a client to be
admitted for treatment of alcohol dependency, the client
says, “I suppose you to think I am just another drunk.” The
Nurse’s best response to this statement would be which of
the following?
A. “We treat many people who have the same problem you do.”
B. “Why do you think you are a drunk?”
C. “At least you are being honest about it.”
D. “We are most concerned that you receive treatment for your
problem”
Situation: Personality disorders occur when the personality of
the individual is characterized by inflexible and maladaptive
traits that are considered to be different from the expectations
of the individual’s culture causing impairment in interpersonal
functioning.
46. The nurse notes that a client is monopolizing most of
the conversation during breakfast. He is loud and
criticizing other clients. Which of the following is the most
appropriate intervention for the nurse to make at this time?
A. reprimand him for his inappropriate behavior
B. provide him with medication to calm him down
C. put him in seclusion until he can control his actions
D. redirect and reinforce limits on his behavior
47. Which of the following statements is true regarding
clients with Personality disorders?
A. they are aware that they have a behavior problem
B. manipulative patterns often render treatment ineffective
C. most have a sincere motivation to change behaviors
D. most recognize how their behavior affects others
48. Which of the following types of behavior could be
interpreted as a form of self-destruction?
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 PSYCHIATRIC NURSING REFRESHER REVIEW NOTES
PROFESSOR ARCHIE ALVIZ
A. avoiding close relationships and intimacy
B. involvement in no-win relationships
C. eccentric dress habits and mannerisms
D. exaggerated sense of importance

49. The individual with an Antisocial Personality Disorder

demonstrates a false sense of privileged revenge against
others. Which of the following best describes the result of
this thinking?
A. an outward focus of control over inner pain
B. repeated unsuccessful attempts to secure stability
C. persistent disregard and indifference to laws of society and
humanity
D. unrealistic expectations and standards of perfection

50. Which of the following terms would be characteristics

common to all Personality Disorders?
A. inflexible and maladaptive behaviors
B. odd or eccentric behaviors
C. cold, aloof, and suspicious tendencies
D. displaying ideas of reference in everyday occurrence

TOPRANK REVIEW ACADEMY | TO TOP THE BOARD EXAM! thaliarhoda | 21