Q and A

1. 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. "Ìf it had been your emergency, Ì would have made the other client wait."
B. "Ì know it's frustrating to wait. Ì'm sorry this happened."
C. "You had to wait. Can we taIk about how this is making you feeI right now?"
D. "Ì really care about you and Ì'll never let this happen again."

Rationale: This response may diffuse the client's anger by helping to maintain a therapeutic
relationship and addressing the client's feelings. Option A wouldn't address the client's anger.
Option B is incorrect because the client with a borderline personality disorder blames others for
things that happen, so apologizing reinforces the client's misconceptions. The nurse can't
promise that a delay will never occur again, as in option D, because such matters are outside
the nurse's control.

2. 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.

Rationale: Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications
are caused by a low level of dopamine. Dopamine receptor agonists stimulate dopamine
receptors and thereby reduce rigidity. They don't affect norepinephrine or acetylcholine.

3. The nurse formulates a nursing diagnosis of Ìmpaired social interaction related to disorganized
thinking for a client with schizotypal personality disorder. Based on this nursing diagnosis,
which nursing intervention takes highest priority?

A. Helping the client to participate in social interactions
B. EstabIishing a one-on-one reIationship with the cIient
C. Exploring the effects of the client's behavior on social interactions
D. Developing a schedule for the client's participation in social interactions

Rationale: By establishing a one-on-one relationship, the nurse helps the client learn how to
interact with people in new situations. The other options are appropriate but should take place
only after the nurse-client relationship is established.

4. A client with paranoid type schizophrenia becomes angry and tells the nurse to leave him
alone. The nurse should

A. teII him that she'II Ieave for now but wiII return soon.
B. ask him if it's okay if she sits quietly with him.
C. ask him why he wants to be left alone.
D. tell him that she won't let anything happen to him

Rationale: Ìf the client tells the nurse to leave, the nurse should leave but let the client know
that she'll return so that he doesn't feel abandoned. Not heeding the client's request can
agitate him further. Also, challenging the client isn't therapeutic and may increase his anger.
False reassurance isn't warranted in this situation

5. Propranolol (Ìnderal) is used in the mental health setting to manage which of the following

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

Rationale: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect;
therefore, it's used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is
used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some
antidepressants have been effective in treating OCD.

6. A client has the psychiatric diagnosis of borderline personality disorder. The nurse would
expect to asses for which of the following symptoms in relation to the expression of anger?
a. Controlled and Subtle
b. Inappropriate and, intense anger
c. Ìnability to recognize anger
d. Substitution of Physical symptom of anger

7. The client with a border line personality disorder tells the nurse that he is the best nurse in the
hospital until the nurse sets limits on the client behavior. Then the client complains that the
nurse is cruel and a "poor excuse for a person¨. The symptom that the client is demonstrating
is called?
a. denial
b. rationalization
c. spIitting
d. projection
8. A client with the diagnosis of antisocial personality disorder who is hospitalized in psychiatric
unit would be expected to have difficulty with which of the following aspects of milieu therapy?
a. Accepting and respecting others
b. Maintain reality orientation
c. Maintain Self-Care
d. verbalize wants and needs
9. The nurse utilizes which of the following implementation for the client who expresses feelings
of depersonalization as one of the manifestations of a personality disorders?
a. Challenge feelings
b. Identify the origin of these feeIings
c. Reinforce Reality
d. Use Diversional activities
10. The Nurse limits in a therapeutic manner by doing which of the following?
a. identifying Iimits in a cIear manner without apoIogizing
b. Negotiating limits appropriate for individual client
c. Providing various reasons that limits are important
d. substituting persuasive statements for specific limits.
11. During the admission interview, a patient states to the nurse that she has no interest in sexual
intercourse with her husband. The nurse first:
a. Advises the patient to talk to the doctor about this
b. Tells the patient not to worry about it now
c. Directs the patient to discuss another subject
d. Further question the patient about this concern
12. A patient states to the nurse, "Ì feel so guilty because Ì fondled by daughter's 7-year old friend.
Which of the following responses is most appropriate?
a. "We can't do anything about that now¨
b. "TeII me more about what happened"
c. "Your guilt will lessen after your medication starts to work¨
d. "Does your wife know about this?¨
13. A patient is an incest perpetrator, in a discussion with the patient's wife, the nurse:
a. Tells the wife to divorce the husband
b. Explains that the husband alone needs treatment
c. Recommends support group for the wife
d. Advises the wife to call the police about her husband's activity
14. A patient with major depression is also known paedophile. The nurse includes which of the
following strategies in the plan of care?
a. Ìsolate the patient in his room as much as possible
b. HeIp the patient to discuss his feeIings about himseIf and his probIems
c. Tell the patient that he ought to be ashamed of himself
d. Advise the patient to discuss his problems openly with other patients in the unit.
15. Ìndividuals with personality disorders:
a. Experience discomfort because of others' reaction toward them
b. Receive psychotropic medication to eliminate their personality disorder
c. Are flexible in how they relate with others
d. Are usually hospitalized for their personality disorders
16. Which nursing approach is most appropriate for a patient with paranoid personality disorder?
a. Ìnvolve the patient in groups as much as possible
b. Use Iight-hearted manner in interacting with the patient
c. Comfort the patient's use of projection and need to control
d. Use clear, simple explanations when making requests
17. A patient with borderline disorder uses self mutilation:
a. As a means to get attention
b. To express intense feeIings of anger or frustration
c. To express feelings of autonomy
d. As means to manipulate staff
18. Mrs. Salas withdraws from everyone on the unit. She refuses to go to activities because no
one will like her, and she feels she is unable to initiate conversation with others. The nurse
a. Escort Mrs. Salas to her activity and leave her there
b. Tell the patient that she should rest in her room until she feels more comfortable with
c. IncIude Mrs SaIas when the nurse initiates a conversation whiIe with the patient's
d. Suggest to the patient that she discuss these difficulties with her doctor
19. Mr. Brand constantly bends rules to meet his needs and then gets angry when other patients
and staff confront him on his behaviour. He threatens patients and manipulates staff to get
what he wants. Which is the best nursing approach to use with Mr. Band?
a. Administer PRN medication every time Mr. Brand does not follow the rules
b. Ìgnore this behaviour and privately tell the other patients to let MR. Brand switch the
television channels as much as he wants
c. Encourage the other staff to take turns watching Mr. Brand
d. Set firm Iimits for Mr. Brand and be consistent in confronting behaviours and
enforce unit ruIes.
20. Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A
nurse observes that a client with a potential for violence is agitated, pacing up and down the
hallway and making aggressive remarks. Which of the following statements is most
appropriate to make to this patient?
a. What is causing you to become agitated?
b. You need to stop that behavior now.
c. You will need to be restrained if you do not change your behavior.
d. You will need to be placed in seclusion.
21. The nurse closely observes the client who has been displaying aggressive behavior. The nurse
observes that the client's anger is escalating. Which approach is least helpful for the client at
this time?
a. Acknowledge the client's behavior
b. Maintain a safe distance from the client
c. Assist the client to an area that is quiet
d. Initiate confinement measures
22. The charge nurse of a psychiatric unit is planning the client assignment for the day. The most
appropriate staff to be assigned to a client with a potential for violence is which of the following:
a. A timid nurse
b. A mature experienced nurse
c. an inexperienced nurse
d. a soft spoken nurse
23. A client tends to be insensitive to others, engages in abusive behaviors and does not have a
sense of remorse. Which personality disorder is he likely to have?
a. Narcissistic
b. Paranoid
c. Histrionic
d. AntisociaI

24. The client joins a support group and frequently preaches against abuse, is demonstrating the
use of:
a. denial
b. reaction formation
c. rationalization
d. projection

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