1. A. Children with oppositional defiant disorder frequently violate the rights of others. They are defiant, disobedient, and blame others for their actions. Accountability for their actions would demonstrate progress for the oppositional child. Options C and D aren’t outcome criteria but interventions. Option B is incorrect as the oppositional child usually focuses on his own needs.
2. C. Nihilistic delusions are false ideas about the self, others, or the world. Somatic delusions involve a false belief about the functioning of the body. Body dysmorphic disorder is characterized by a belief that the body is deformed or defective in a specific way. Apraxia is the inability to carry out motor activities.
3. D. The nurse is using the technique of exploring because she’s willing to delve further into the client’s concern. She isn’t presenting reality or making observations or simply restating. The nurse is encouraging the client to explore his feelings.
4. C. During the working phase, or the middle phase of a group, the nurse continues to encourage cohesiveness among its members. During the orientation phase, or the initial phase, the nurse leading the group should explain the purpose and goals of the group. During the termination phase, or the final phase, the leader encourages a discussion of feelings associated with termination. When leading a group, the nurse should act as a facilitator; offering advice isn’t appropriate. The group members should work together to resolve conflicts.
5. B. Misgivings and fears are common in the beginning of pregnancy. It doesn’t necessarily mean that she requires counseling at this time. Exploring her feelings may help her understand her concerns more deeply but won’t provide reassurance that her feelings are normal. She may benefit by discussing her feelings with her husband, but the husband also needs to be reassured that these feelings are normal at this time.
6. B. Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. Aggressive behavior is uncommon, although these clients may experience agitation with anxiety. Their behavior is emotionally cold with a flattened affect, regardless of the situation. These clients demonstrate a reduced capacity for close or dependent relationships.
7. C. This client’s behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention. Typically, a client with paranoid personality disorder is suspicious, cold, hostile, and argumentative. Avoidant personality disorder is characterized by anxiety, fear, and social isolation. Borderline personality disorder is characterized by impulsive, unpredictable behavior and unstable, intense interpersonal relationships.
8. B. Commonly, family members are reluctant to talk to a client who has had a total laryngectomy and can no longer speak. To promote a supportive environment, the nurse should encourage family members to continue normal communication. The nurse should teach the client to clean the tracheostomy tube with hydrogen peroxide and rinse it with sterile saline solution, to consume oral fluids as desired, and to eat protein-rich foods to promote healing.
9. A. Violence on television has been correlated with an increase in aggressive behavior. Passive parents contribute to acting-out behaviors but not specifically to violence. An internal locus of control leads to a positive sense of self-esteem and isn’t related to violence or aggression. There is no direct correlation between single-parent families and violence.
10. A. The foundation of any treatment for alcoholism is abstinence. Attendance at Alcoholics Anonymous is helpful to some individuals to maintain strict abstinence. Participation in treatment by the family is beneficial to both the client and the family but isn’t essential. Abstinence requires refraining from social drinking.
11. C. This is an example of a negative attitude and passive-agressive behavior to word demands for adequate performance. People with this disorder won’t confront or discuss issues with others but will go to great lengths to "get even." Obsessive-compulsive disorder involves rituals or rules that interfere with normal functioning. A person with a narcissistic personality has an exaggerated sense of self-worth. A person with a dependent personality is submissive and frequently apologizes and backs down when confronted.
12. A. Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren’t able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar or manic disease. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.
13. B. Total abstinence is the only effective treatment for alcoholism. Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.
14. D. A delusion is a false belief based on a misrepresentation of a real event or experience. Although anxiety can increase delusional responses, it isn’t considered the primary symptom. Projection is falsely attributing to another person one’s own unacceptable feelings. Hallucinations, which characterize most psychoses, are perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation.
15. C. Giving advice blocks rather than promotes effective communication with a client. The other options promote effective communication.
16. B. The phases through which young children progress when separated from their parents include protest, despair, and denial or detachment.
17. D. Among Jehovah’s Witnesses, surgery is not prohibited, but the administration of blood and blood products is forbidden. Faith healing is forbidden in this religious group. Administration of medication is an acceptable practice, except if the medication is derived from blood products.
18. A. Coping mechanisms are behavior used to decrease stress and anxiety. In response to a death, ineffective coping is manifested by an extremem behavior that in some cases may be harmful to the individual physically or psychologically.
19. A. Nodding or smiling by a Chinese-American client may reflect only the cultural value of interpersonal harmony. This nonverbal behavior may not be an indication of agreement with the speaker, an acceptance of the treatment, or an understanding of the procedure.
20. C. Bargaining identifies a behavior in which the individual is willing to do anything to avoid loss or change prognosis or fate.
21. C. Ethnocentrism is a tendency to view one’s own way of life as the most desirable, acceptable, or best and to act in a superior manner toward another culture. Cultural imposition is the tendency to impose one’s own beliefs, values, and patterns of behavior on individuals from another culture.
22. C. Pulmonary edema causes the client to be extremely agitated and anxious. The client may complain of a sense of drowning, suffocation, or something.
23. D. The five categories of complementary and alternative medicine (CAM) include whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, and energy medicine. The other options contain therapies within each category of CAM.
24. C. Native American clients often avoid eye contact when being cared for by health care personnel. In this culture, eye contact is considered a sign of disrespect. Therefore, this client’s action is culturally appropriate behavior. Options A, B, and D are inappropriate interpretations of the client’s behavior.
25. C. Acculturation is a process of learning a different culture to adapt to a new or changing environment. Option A describes ethnic identity. Option B describes an ethnic group. Option D describes a subculture.
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