Correct answer: A. Buspirone takes 2 to 3�weeks to become effective

The full effect of buspirone (BuSpar) takes at least 2 to 3�weeks to become apparent. BuSpar is routinely used for chronic anxiety. The adequacy of the dose cannot be assessed until after the drug has been taken for at least 2 to 3�weeks. There is no evidence that food or the absence of it has any effect on absorption.

Correct answer: B. "Combining medicine and therapy gives better, more lasting results."

Research demonstrates a better outcome with combination therapy when treating a client with agoraphobia. A drug will decrease clinical manifestations on its own. Telling the client to tell the doctor about wanting to quit therapy passes off the nurse’s responsibility to address this issue presently. Reminding a client about the commitment to stay in therapy for six sessions tries to keep the client in therapy by inducing guilt.

Correct answer: C. "That kind of exposure may well do more harm than good."

Intense exposure to feared stimuli without careful planning and the agreement of the client is likely to increase clinical manifestations and decrease trust. Affirming the spouse’s comments shows the nurse’s lack of understanding of the dynamics of phobia. Telling the spouse that such a plan should be a surprise demonstrates a lack of respecting the need for client involvement in the treatment planning. Asking the client’s spouse if other family members’ opinions have been sought is not pertinent.

Correct answer: A. Social phobia

One of the variants of social phobia is being unable to perform some common activity, such as eating, speaking, or writing, in the presence of others. Individuals with a general anxietydisorder worry about a number of things. A client with a social phobia does not report either obsessive thoughts or compulsive behaviors. Xenophobia is a fear of strangers, and this client reports a phobic reaction with associates.

Correct answer: C. "Very often, people’s obsessive ideas seem rather bizarre to them."

Obsessive thoughts are commonly considered to be odd, foreign, and shameful to those who have them. Telling a client that using the word "crazy" may be offensive to someone may well prompt the client to feel the nurse and others will be angry. It would be inappropriate to tell a client with an obsessive-compulsive disorder that it is serious. The doctor would know that these kinds of thoughts are typical in obsessivecompulsive disorders. Clients pose no particular danger to self or others. It would be inappropriate to ask why the client thinks someone is angry, because the client has no idea why this is believed and this question will just increase the client’s anxiety.

Correct answer: D. Encourage a client with a generalized anxiety disorder to verbalize personal feelings

Developing a plan of care, monitoring laboratory tests, and taking a detailed social history are all assignments that should be performed by a registered nurse. It would be appropriate to delegate to a licensed practical nurse talking to a client and encouraging the verbalization of feelings.

Correct answer: C. "It sounds like you’re having some anxiety."

Saying that the client may be having some anxiety encourages the client to become aware of and explore the anxiety. Telling the client not to worry, for whatever what reason, cuts off an exploration of the client’s concern. It would be inappropriate to ask a client to anticipate what might happen, because the client has already indicated having only a general sense of impending doom. Offering the client some medication is incorrect because such an intervention is premature.

Correct answer: C. exacerbates the illness.

Stress is one of the key components that exacerbates and intensifies the somatoform clinical manifestations. Stress is not the only feature, however, because there are psychological, neurobiological, and familial components as well. Stress does not contribute to overcoming the illness. The presence of stress actually makes the condition worse. Stress is a precursor to developing somatoform disorders.

Correct answer: C. The client’s psychological makeup

A psychological makeup determines the client’s ability to recognize the dysfunctional manifestations of a somatoform disorder and take corrective action. The etiology of the stress is outside the nurse’s control. The ability to manipulate the environment also depends on external sources for control. The somatoform disorder does not have a medical etiology.

Correct answer: D. Somatoform disorder is not usually within the awareness of the client

The cure for somatoform disorder lies in the client being able to identify the etiology of the disorder. The client may not be able to link the precipitating event to the disorder. The disorder is not within the awareness of the client. Unlike malingering, the primary goal is not manipulation.

Correct answer: C. "Do you have multiple pain sites?"

Hypochondriasis manifests itself in at least four sites to meet the diagnostic criteria. Pain is manifested in multiple sites. The client does not recognize the etiology of the pain.

Correct answer: A. The client has feelings of guilt

An unresolved guilt is a major contributor to somatoform disorder. Once the guilt is cleared up, the disorder abates. Somatoform disorder is accompanied by multiple physical complaints before the age of 30�years. Physiologic laboratory tests fail to show any physical abnormalities in somatoform disorder.

Correct answer: A. Attempt to identify the sources of anxiety

The major treatment objective of hypochondriasis is to identify the source of anxiety and treat it. Ignoring the client’s preoccupation with illness will escalate the behavior. Acknowledgment of the client’s concern with a redirection toward the source of anxiety is more therapeutic. Telling the client about normal sensations does not help the client deal with personal manifestations. Health care visits should be encouraged at routine times to discourage overuse for the purpose of gaining attention.

Correct answer: A. Identify somatic clinical manifestations as coping strategies

The priority intervention for a client with a somatization disorder is that the client recognizes that the pain is a coping strategy. The use of pain relievers or anxiolytics should be discouraged to avoid dependence. The primary source of a pain disorder is psychological, so medical interventions are not effective. The need for social interaction is important, because the consequence of diminished social interaction is social isolation.

Correct answer: C. "Significant distress in social functioning is a result of your disorder."

Social isolation is a major contributor to a body dysmorphic disorder. It is a cyclical process in which the more withdrawn the client becomes, the more the dysmorphic belief will contribute to more withdrawal. The disorder will become even more pronounced. There may be a minor problem, but the response to it is beyond reasonable. Clients tend to avoid social contact because of self-consciousness concerning the imagined defect. Any defects the client is experiencing are not real.

Correct answer: C. The client is indifferent to the condition

One of the classic signs of conversion disorder is the client’s indifference to sudden and severe impairment, "la belle indiff�rence." The site of the clinical manifestations is not as important as the precipitating factors. The disorder is not to achieve secondary gain and is out of the client’s control. Conversion disorder is directly related to underlying conflict.

Correct answer: D. There is a secondary gain

Factitious disorder is well within the awareness of the client, and clinical manifestations may be real or feigned. It is the secondary gain, for attention or financial reward, that is the priority feature for diagnosis of factitious disorder. Clinical manifestations are intentionally produced for personal gain.

Correct answer: D. The client actively seeks attention

Malingering is characterized by the client’s deliberate attempt to gain attention. The clinical manifestations are not confirmed by lab tests. The client will bring the clinical manifestations to the attention of others for secondary gain. The client does not withdraw but becomes demanding of health care providers and others.

Correct answer: C. Empathize with a client who has a somatoform disorder by understanding the client’s pain

Notifying the physician of a client being admitted with a suspected condition, assessing the client for the diagnostic criteria, and establishing the nursing diagnoses are assignments that should be performed by a registered nurse. Any nurse working with a client with a somatization disorder should be prepared to empathize with the client by understanding the client’s pain. Empathizing would be appropriate to delegate to a licensed practical nurse.

Correct answer: B. The client fails to see the relationship between clinical manifestations and conflicts

Somatoform disorder is characterized by the client’s inability to link the clinical manifestations with unresolved conflicts. This link is a key to overcoming the disorder. The client has no voluntary control over the clinical manifestations. The client’s ability to perform tasks is highly diminished. The client is very aware of the clinical manifestations and only unaware of their etiology.

Correct answer: B. caution the client about dependence on drugs.

Somatoform disorder is characterized by the risk that the client may become addicted to either pain medications or anxiolytics. Careful client teaching is necessary to help the client avoid an overdependence on drugs. The client will need to understand the purpose of the clinical manifestations before relinquishing them. Routine health care visits are essential to not encourage anxiety or overuse. Shifting treatment to alternative medicine does not address the etiology of the disorder, but merely shifts the dependence to another substance.

Correct answer: D. Selective serotonin reuptake inhibitor

Selective serotonin reuptake inhibitors are the drugs recommended in the treatment of somatoform disorders, because they have relatively few adverse effects and a good response. The benzodiazepines are addictive. There is a high potential for dependence on the anxiolytics as well. The antipsychotics are inappropriate, because the client is not psychotic.

Correct answer: C. exhibit an increased preoccupation with appearance of an imagined defect.

The primary clinical manifestation of a body dysmorphic disorder is an increased preoccupation with the appearance of the imagined defect. Social withdrawal is common. There is an increase in grooming behaviors. The client does not disengage but becomes increasingly anxious.

Correct answer: D. An abrupt rise in temperature

Neuromalignant syndrome is characterized by a high fever, 39.4�C (103�F) or higher, and can be fatal. The client’s agitation may be from sources other than a drug. The client’s restlessness may be from a drug; however, the clinical manifestations need to be observed over a period of time. The client may be sleeping due to factors other than drugs.

Correct answer: D. The client’s increased ability to cope with anxiety

The reduction in clinical manifestations is manifested in the ability to appropriately dealwith psychological anxiety. The client’s clinical manifestations need to abate rather than move. The need for an additional drug is not a sign of dealing with hypochondria. The clinical manifestations should diminish rather than increase.

Correct answer: C. The client’s inability to recall personal information

A client with dissociative amnesia is unable to recall familiar personal information. The amnesia is not associated with a medical condition, such as brain injury, trauma, or toxicity of substances. The amnesia is beyond common forgetfulness.

Correct answer: D. The presence of alternating control by two or more personalities

The presence of multiple personalities is a classic feature of dissociative identity disorder. The personalities are sometimes aware of each other but often out of the awareness of the primary personality. Dissociative identity disorder is a condition in a diagnostic category by itself and is not necessarily tied to schizophrenia. The personalities may possess different sexual, racial, and intellectual characteristics.

Correct answer: D. Meet safety and security needs

Ensuring the safety and security needs of the client are the priority goals for a client experiencing dissociative identity disorder, because the normal protective processes for the client are impaired. Reorientation of the client to the identity is done with a therapist at the appropriate time in the therapy. The client will need to understand the stress-producing events in the course of therapy in order to deal with the anxiety. The client will need to discuss stress-producing subjects to help develop methods of dealing appropriately with the stress.

Correct answer: A. Rule out the use of substances or the existence of a medical condition

It is essential that the use of substances and the existence of a medical condition are ruled out, because they may cause the same type of clinical manifestations. The client cannot recall all lost information. The client may or may not be depressed, which is not a precondition for a dissociative disorder. The client may not remember what precipitated the dissociative event.

Correct answer: A. Establish a therapeutic alliance

The nurse must establish a therapeutic alliance, so that trust may develop and the client may be able to reveal traumatic events with reduced anxiety. The nurse should not fill in the history for the client, because the client may find it frustrating and because mobilizing the memory is healing for the client. Hypnosis has been used with mixed success and is now considered much less effective than initially thought. Establishing the triggering event is the work of the client and the psychotherapist at the appropriate time in the therapy.

Correct answer: C. Mechanical dreamy or detached feelings

A client with depersonalization disorder has a mechanical dreamy or detached feeling. Client anger is not a cardinal sign. The client does not lose the ability to perform reality tests. Ambivalence is not a criterion for the diagnosis of depersonalization disorder.

Correct answer: A. Safety

Safety is the priority goal when caring for a client with a dissociative disorder, because the client’s natural protective instincts have been compromised. Behavioral therapy is inappropriate for a dissociative disorder, because it involves cognitive restructuring. Family therapy may be appropriate at a later date but is not usually indicated.

Correct answer: A. child abuse.

Traumatic events are often precipitating factors in dissociative disorders because they result in the individual’s attempt to protect the self from remembering traumatic events. Brain tumors, substance abuse, and epilepsy have not been established as positive links to dissociative disorders.

Correct answer: B. Assist the client to understand the benefits of dissociation to cope

The nurse should assist the client who has a dissociative disorder to understand the benefits of the dissociation to cope. The client should be reoriented to person, place, and time. The nurse should encourage and assist the client to make personal decisions.

Correct answer: C. The inability to recall important personal information, usually of a traumatic nature

The inability to recall important personal information is paramount in dissociative amnesia, because the memory does not selectively block information when attempting to suppress traumatic events. Disturbances occur outside the course of other mental disorders. The clinical manifestations create great distress. Memory is not voluntarily retrievable. The existence of two distinct subpersonalities is a feature of dissociative identity disorder.

Correct answer: B. The presence of a change in voice and mannerism when under stress

The presence of alternate personalities with different affective states and changes in mannerisms, voice, and gender may appear under stress in a client with a dissociative disorder. There is no presence of hallucinations as there is in schizophrenia. The client can follow directions because the ability to understand instructions is not impaired. The etiology of the disorder is not due to substance abuse or a medical condition.

Correct answer: B. Aid the client to learn to deal constructively with stress

Stress precipitates the splitting off of personalities in a client with a dissociative disorder. Constructive reintegration relies on the ability to deal with stress. The client should not suppress anxiety, because it will reemerge in the subpersonality. Clients cannot ignore the alternative personalities, even though they lie outside of the client’s control. Clients are often unable to maintain occupational functioning due to the intensity of the disorder.

Correct answer: D. Expressions of suicide and hopelessness

Expressions of suicidal ideation and feelings of hopelessness and worthlessness are critical markers for impending suicide attempts in a client who has a dissociative disorder. They indicate that the client’s condition is deteriorating and that intervention is imperative. Forgetfulness is not in itself a dangerous risk. Substance abuse may preclude the diagnosis of a dissociative disorder because the substance masks the disorder. The client with a dissociative disorder maintains the ability to conduct activities of daily living.

Correct answer: D. The client identifies significant others

As personality disturbances clear with a dissociative disorder, the client will regain the ability to identify and recognize significant others. There will be an absence of subpersonalities. Feelings will not be suppressed but will become available for recall. The client can identify and recognize the environment.

Correct answer: B. The client attempts self-harm from alternate personalities

The client’s attempt of self-harm is a secondary manifestation in a dissociative disorder. The client’s confusion and assaultive behavior may worsen. The client is likely to experience an escalation in panic.

Correct answer: C. Prevent dissociative episodes by becoming aware of triggers

Awareness of the triggers of the dissociative process allows the client the control to reduce the occurrence of episodes. Outside activities are encouraged, such as music, physical activity, and socialization. Therapy involves the free exchange of communication, including any existence of delusions. The client’s recovery depends on the ability of the client to deal with the stressors in life.

Correct answer: D. Unlicensed assistive personnel provide a safe environment for a client with a dissociative disorder

Unlicensed assistive personnel may provide a safe environment for a client with a dissociative disorder. Only a registered nurse should write nursing diagnoses to direct a plan of care. A registered nurse should assess a client for clinical manifestations. It is inappropriate for unlicensed assistive personnel to encourage a client to verbalize feelings of suicide.

Correct answer: A. Disturbed personal identity

The appropriate nursing diagnosis for a client who is experiencing amnesia related to a traumatic event would be disturbed personal identity.

Correct answer: C. Make a suicide contract with the client

One-to-one supervision and making a suicide contract with a client who has a dissociative disorder are priorities to meet the safety needs of the client under distress. Confidentiality is of the utmost importance. Never try to force recall of information the client is not prepared to know. Reduction of anxiety helps avoid the emergence of subpersonalities.

Correct answer: B. Decrease the confusion and noise in the environment

Nursing interventions appropriate for a client with a dissociative disorder include decreasing confusion and noise in the environment. This will decrease anxiety. Group therapy is recommended. Simple instructions for grooming and activities of daily living are recommended. Social interaction is encouraged to avoid withdrawal and isolation.

Correct answer: D. has an inability to recall important information of the event.

Inability to recall important personal information of the event is a diagnostic criterion for dissociative amnesia. It is not precipitated by substances or a medical condition. The amnesia causes great distress to the client.

Correct answer: C. The client was confronted with an intolerable terror event

The initial event of a dissociative disorder was an event the client confronted and found so intolerable that the client’s memory split off into another personality. The personalities are often out of the awareness of the primary personality. The disorder can be episodic or chronic. Recall of the traumatic event is not available to the primary personality.

Correct answer: D. Adolescence or early adult

Adolescence or early adulthood is the time of onset. Personalities are formed during childhood. Therefore, dysfunctional pathology will not appear until the client’s personalities have been tested by the trials of life. These life events begin in adolescence or early adulthood.

Correct answer: B. Acknowledge the client’s situation with empathy while encouraging independence

Clients with dependent personality disorder feel inadequate to make decisions for themselves. By acknowledging their difficulties, confidence is built. In turn, the confidence will facilitate independence from care providers and others they may be dependent on.

Correct answer: D. Deliver education individually in a clear and concise manner

The client with schizoid personality disorder is technically minded. Attempting to draw the client into a personal or therapeutic relationship or to participate in a group or social setting may push the client to withdraw and become isolated.

Correct answer: D. Depression and impulsiveness

Serotonin is believed to maintain mood stability and control impulsivity, rage, aggression, and depressive clinical manifestations. Delusions result from a faulty thought structure and are related to thought disturbances such as paranoia and grandiose beliefs. Restlessness and agitation are symptomatic of increased serotonin levels.

Correct answer: B. Personality traits that are beyond the range found in most people

Personality characteristics are formed in childhood to early teens. The characteristics are set and stable over time. Events and situations may make characteristics more apparent, but these characteristics do not change. Changes in personality in advanced age are potentially related to a medical condition. The prolonged stability of the personality structure makes treating personality disorders a difficult and long process.

Correct answer: A. displays behavior lacking social tact or grace in a group.

Individuals with schizoid personality disorder have difficulty showing and sharing their emotions. They lack the desire to be part of a group or have intimacy in their relationships. This leads to inappropriate behaviors and a lack of social tact and grace in a group or social setting.

Correct answer: D. "I can tell that what you’re seeing frightens you; how can I help to make you more comfortable?"

Telling the client who complains of seeing UFOs that "I can tell that what you’re seeing frightens you; how can I help to make you more comfortable?" validates the client’s feelings without agreeing with or challenging the client’s irrational beliefs.

Correct answer: C. Address the client with closed-ended questions and permit only responses that are relevant

Histrionic personality disorder is a personality disorder in which the client seeks attention and has excessive emotionality. The client with histrionic personality disorder needs to know from the group leader what the boundaries of the group are. This learning may need to be shown by example. Simply ignoring the client will only escalate the behavior, and allowing or endorsing the behavior will be maladaptive to the group and the individual. For clients with personality disorders, this is how they have learned to have their needs met in the past. They need to relearn appropriate behavior. Reprimanding the client may lead to the client’s lack of investment in therapy.

Correct answer: B. The client’s attempts to manipulate the nurse

Clients with antisocial personality disorder engage in relationships easily and need to have rapport built to engage in therapeutic relationships. Clients with antisocial personality disorder misrepresent themselves in an effort to meet their needs above all else. Their behavior is manipulative. Clients with this disorder also embellish or exaggerate experiences in an effort to appear different from those around them.

Correct answer: B. The client’s fear of abandonment

Clients with borderline personality disorders have an extreme instability in their relationships with a great fear of being abandoned. Their behaviors are maladaptive but they attempt to keep people close to them.

Correct answer: B. To identify irrational thoughts and beliefs that the client’s decision making is founded on

An appropriate goal for helping a client with borderline personality disorder is to focus on the client and the client’s belief system in order to encourage an understanding of how those beliefs affect relationships. The client with borderline personality disorder is already focused on relationships with others, which continues the chaotic relationship. The client focuses on others and fails to focus on oneself. Once the client can distinguish between rational and irrational thoughts, the client can begin to evaluate surrounding relationships.

Correct answer: A. A lack of empathy for others

Lack of empathy, arrogance, and a need for admiration are key characteristics of narcissistic personality disorder. Persons with this disorder want to feel better or more important than others, and so would not promote self-esteem in another person. Their dependency is outwardly expressed in the need for admiration, so they focus on surrounding themselves with "special" people, those who are considered to be important or influential. A style of speech that lacks detail is characteristic of histrionic personality disorder.

Correct answer: C. Assist a client with borderline personality disorder to the dayroom for group therapy

Skills that involve reporting, developing a plan of care, and assessing a client are all assignments that should be performed by a registered nurse. A licensed practical nurse may assist a client to a dayroom for group therapy.

Correct answer: B. promoting a rapport by showing interest in personal stories.

Engaging, listening, and connecting with the client will build rapport with a client who has narcissistic personality disorder. The nurse should never encourage the grandiosity but must remain nonjudgmental to what the client says. Approaching the client in a cold, technical manner will stop the grandiosity but will also impair the therapeutic relationship.

Correct answer: B. promote self-esteem by praising the client’s success.

A client with avoidant personality disorder disregards and violates the rights of others. Classic features are social inhibition and feelings of inadequacy. The client may never feel comfortable enough on his or her own to join the group, so the client remains isolated and fosters avoidance behaviors. The client needs encouragement to participate along with acknowledgment of vulnerability. Any successes and accomplishments by the client should be praised. Goal setting should be a combined effort by the nurse and client. The nurse needs to drive the advancement of the goals for the client to make progress.

Correct answer: A. Task completion hampered by perfectionism

A client with obsessive-compulsive disorder likes to hoard money and finds it hard to discard worn-out possessions. Such a client is preoccupied with details, aspires to perfection, is excessively devoted to work, is overconscientious, is rigid, and is reluctant to delegate tasks. Aspirations for perfection may hamper task completion. Fantasies of unlimited success are related to narcissistic personality disorder. Clients with paranoid personality disorder look for hidden meanings in the actions of others. Task completion hampered by lack of confidence is indicative of dependent personality disorder.

Correct answer: A. The client views the therapeutic relationship as a waste of time because the client doesn’t see a personal behavior problem

A client with obsessive-compulsive personality disorder views a therapeutic relationship as a waste of time, because personal behavior is not recognized as a problem. A client with dependent personality disorder is eager to start any kind of relationship. Such a client will go anywhere at any time for the sense of attachment and security. A client eager to be admired falls into the category of narcissistic personality disorder. The vacillation between wanting a relationship and then pushing it away is indicative of borderline personality disorder.

Correct answer: A. Assess the client for suicidal risk, method, and ability to carry the plan out

Assessing the client is necessary before determining if the client needs to be hospitalized or not. Assessing for past suicide attempts is very important, but the priority is to determine if the client has a plan.

Correct answer: C. Short-term memory loss

Short-term memory loss would be an expected clinical manifestation post electroconvulsive therapy (ECT), occurring after treatment and lasting for 1�week to 2�months or more. Unilateral placement of the electrodes may decrease the amount of short-term memory loss, because the current passes through only the nondominant side of the brain. Unilateral placement is less effective in treating depression than bilateral placement. Although dizziness, heartburn, and nausea and vomiting may be experienced post ECT, they would not be expected clinical manifestations for 1�week to 2�months post ECT.

Correct answer: C. "Major depression is a depressed mood state that requires antidepressant medication, whereas bipolar disorder is an upward swing of mood that requires mood stabilizers for treatment."

Major depression and bipolar disorder are two different mood disorders with different treatment regimens. Major depression is a downward swing of mood, and bipolar disorder is an upward swing of mood (mania) and a downward swing of mood (hypomania). Major depression is treated with an antidepressant, whereas bipolar disorder is treated with a mood stabilizer such as gabapentin (Neurontin) or divalproex sodium (Depakote).

Correct answer: B. Administer vitamin B6 100 mg per day for 2�weeks prior to the menstrual cycle

Instructing a client to monitor mood, sleep, and appetite during the month is an appropriate nursing intervention to assist the nurse in knowing when the client is having difficulty with clinical manifestations. Encouraging the intake of fluids will increase water retention and will increase irritability. Administering vitamin B6 100 mg per day for 2�weeks prior to the menstrual cycle is the most appropriate intervention. Vitamin B6 is a precursor to serotonin, which can assist in decreasing clinical manifestations of depressed mood and irritability. Instructing the client to consume caffeine-containing beverages and chocolate would not be appropriate because it would increase fluid retention and therefore increase clinical manifestations of irritability and depression.

Correct answer: D. Set limits with the client if the client is getting into the personal space of others

Cyclothymia is a mood disorder that is generally chronic, lasting at least 2�years, and involves hypomanic and dysthymic mood swings. Setting limits for a client with hypomania is a priority nursing intervention, because the client is unaware of the intrusiveness and the annoyance of this behavior to other clients. The client who is hypomanic presents an inflated self-esteem or grandiosity but is using it to cover chronic feelings of low self-esteem. Asking about issues related to self-esteem would be an appropriate nursing intervention but is not the priority at this time. Encouraging the client to perform relaxation techniques during the hypomanic state is also appropriate but not a priority. Increasing stimuli in the environment will not prevent the client who is hypomanic from becoming depressed and would not be an appropriate nursing intervention, because it�would further increase the irritable or elevated mood.

Correct answer: B. risk of suicide.

Although it is important for the nurse to assess the client’s areas of functioning, current mood, and fluid/electrolyte balance, assessing the suicide risk of the client with major depression takes priority.

Correct answer: A. Encourage the client to explore feelings of worthlessness

Instructing a client who is feeling worthless not to feel that way and exploring positive thoughts about herself minimizes and discourages the exploration of the client’s thoughts and feelings about feeling worthless. Instructing the client to take an antidepressant drug disregards the comment made by the client. By exploring feelings of worthlessness, the client will more easily identify the source of the feelings. The client will also feel a sense of having been heard by the nurse, thus increasing trust.

Correct answer: D. "It is a bright white light that is used to help treat depression in the winter months."

Phototherapy is a bright white light that is used to treat seasonal affective depression in the winter months, generally between September and March. The light (approximately 2500 to 10,000 lux) can be used from 30�minutes to 2�hours each day during the winter months. It does not decrease stress and most likely would be used prior to or after electroconvulsive therapy treatments.

Correct answer: D. "Each individual is different. Sit in front of the light just long enough so that you do not get a headache."

If a client sits in front of the phototherapy light for too long, the client will develop a headache. The length of time is different for each individual. Some individuals may experience a headache within 30�minutes. Sitting in front of the light while reading or comfortable are statements of when, not how long, the client should use phototherapy each day. During the first one or two treatments, the client may get a headache because the period of treatment has not yet been established and the client does not yet know yet what reaction he or she will have to the treatment.

Correct answer: D. Encourage the client to verbalize feelings

The best plan for a nursing intervention for the client who may be contemplating suicide is to encourage the client to discuss feelings, because this will allow the nurse to understand the client’s emotional state and the client’s mood. Although instructing the client about the consequences for hidden anger and talking to the client about the need to keep safe are important, neither of these is a priority nursing intervention. Avoiding depressing topics is not the priority nursing intervention, because there may be depressing topics or situations that may be contributing to the depression.

Correct answer: B. "What is happening in your life that would cause you to attempt to kill yourself?"

Although asking a client how he or she is feeling after an overdose, where the pill bottle is, and what can be done to make life better are appropriate interventions, the priority is to ask the client what has led to the attempted suicide. This gets at the heart of the matter of a suicide attempt and encourages the building of the nurse-client relationship. This encouragement will allow the client to further express personal thoughts and feelings.

Correct answer: B. explore feelings of worthlessness and hopelessness.

Although it is important to encourage the client to identify self-defeating thoughts, it is not the most appropriate intervention in the outpatient setting. While exploring the client’s feelings of worthlessness and hopelessness, the nurse can assist the client in exploring a sense of worth, value, and hope. There are numerous clients living in the community who are chronically suicidal and can be managed on an outpatient basis. Removing all potentially dangerous objects from the immediate area and seeking immediate psychiatric hospitalization are premature.

Correct answer: A. Provide limits for the client while allowing the client space

A client who is manic and exhibiting the clinical manifestation of psychomotor agitation is only minimally able to have insight into those behaviors or ways to change the behaviors. This client requires limits within provided structure and space.

Correct answer: C. Identify the time of day the client is utilizing the phototherapy treatment

A client with a bipolar disorder and a superimposed seasonal affective depression needs to be careful about the time of day that the phototherapy is utilized. Because of circadian rhythms, it has been found that bipolar clients with seasonal depression do best if they utilize the phototherapy treatment in the later afternoon. If the phototherapy is used in the morning, manic manifestations may result. Exploring appetite, energy level, feelings of self-worth, and how much money the client is spending may all be important interventions, but determining the time of day the client is using the phototherapy allows the nurse to obtain the information that may be causing the dramatic change and elevation in mood.

Correct answer: A. Openly express thoughts and feelings of depression

The priority outcome for a client with depression would be to openly express thoughts and feelings of depression. Although not the priority, it may prove beneficial to share a more realistic expectation of the client, to help the client identify negative and unrealistic thoughts about him- or herself, and discuss reasons why the client has turned the anger inward.

Correct answer: D. Electrocardiogram (ECG)

Approximately 20% to 25% of clients with certain medical conditions, such as myocardial infarction, cancer, stroke, and diabetes mellitus, will develop a major depressive disorder. An electrocardiogram (ECG) would assess the client’s cardiac status.

Correct answer: D. Ensure a client is NPO for electroconvulsive therapy

A licensed practical nurse may ensure a client is NPO for electroconvulsive therapy. Developing a plan of care, teaching a class, and organizing care to be provided to a client should be performed by a registered nurse.

Correct answer: C. reality orientation.

Requesting a client who is disoriented and psychotic to interact with peers, participate in unit programs, or encourage involvement in the milieu would agitate the client. Reality orientation would orient the client to the surroundings.

Correct answer: D. Negative symptoms

Negative clinical manifestations of schizophrenia are much harder to detect and describe than are positive clinical manifestations. The negative clinical manifestations, such as flattened affect, slowed thinking, and lack of motivation, are observed and in many ways are more debilitating. Unlike positive clinical manifestations, negative clinical manifestations are behaviors not fundamentally different from behaviors exhibited by many people. They are more common and severe in schizophrenia. They are particularly obvious when contrasted to how the client was before the onset of the disorder. Delusions and hallucinations are positive clinical manifestations because they must be self-reported by the client.

Correct answer: A. There is an excess of dopamine found at the synaptic clefts in the brain

Although the etiology of schizophrenia remains unknown, there is research suggesting the validity of the dopamine hypothesis-that the functional abnormalities in schizophrenia are the result of excessive amounts of the dopamine in the brain. Normally dopamine is produced in the brain and functions as a neurotransmitter.

Correct answer: B. "It would most likely find enlarged lateral and third ventricles."

Computerized tomography scanning may be used to evaluate brain structure in schizophrenic clients. The results have shown that clients with schizophrenia have larger lateral ventricles than nonschizophrenic individuals. This is a well-documented fact, but the meaning behind this finding remains unclear. It remains unknown as to whether the enlargement is the cause or a consequence of the schizophrenia. It also has no bearing on the severity of the clinical manifestations. Some data demonstrate that the ventricular enlargement is related to cerebral atrophy. Although speculative, there is some research suggesting that schizophrenia may be a degenerative neurological disorder.

Correct answer: D. The monozygotic twin

Schizophrenia is a disorder that has a large genetic component. This conclusion has been reached based on the close incidence of schizophrenia in twins and particularly monozygotic twins, which have a higher concordance rate than any other biological relationship. Although genetics plays a role in the development of schizophrenia, the relationship remains unclear. Some studies indicate that this relationship may be as high as 50%, but other studies indicate that a monozygotic twin has less than a 10% chance of developing schizophrenia when the other twin is affected.

Correct answer: A. Settle the client in the room

Catatonic schizophrenia is a type of schizophrenia in which there is a marked decrease in reactivity to the environment. The client will not likely be able to socialize or adequately communicate secondary to the catatonia. Although administering prescribed drugs may be appropriate, it is not the priority. Decreasing the stimuli in the client’s environment is the priority. The client with catatonia will be less stimulated in the client’s room.

Correct answer: B. attend appointments with health care providers.

A function of case management is to coordinate the client’s health care needs. The priority goal for a client with paranoid schizophrenia is to encourage the client to regularly attend all the scheduled appointments with health care providers. Although taking public transportation, maintaining a steady job, or socializing with the neighbors may be appropriate interventions, they are not the priority. Clients with paranoid schizophrenia are likely to be socially isolated and have few trusting relationships.

Correct answer: B. The belief that a radio can control someone’s thoughts

An idea of influence is a client’s false impression that outside activities have a unique meaning for the client. It is an internal thought regarding some content in which the client’s thoughts are controlled by an external entity. The client’s inability to identify person, place, and time, as well as the client’s confusion to the point of delirium, is related to the client’s orientation. Interpreting a shadow as a person is an illusion that is an incorrect perception of a sensory stimulus.

Correct answer: D. Selective serotonin reuptake inhibitor

Dopamine has been specifically identified as having an influence on both the positive and negative clinical manifestations of schizophrenia. Selective serotonin reuptake inhibitors treat depression. Anxiolytics treat anxiety, and sedatives are calming agents.

Correct answer: D. the mother’s genetics at the time of diagnosis.

The mother’s genetics at the time of diagnosis of schizophrenia is the major risk factor for the client diagnosed with schizophrenia. Being recently divorced, from a lower socioeconomic status, and a recent search for employment are all environmental influences.

Correct answer: D. Disturbed thought processes

Delusions are false ideas that an individual believes to be real despite evidence to the contrary. They are disturbed thought processes, so a nursing diagnosis of disturbed thought processes would be appropriate. A nursing diagnosis of disturbed role performance would be appropriate with a loss of function. Impaired verbal communication would be an appropriate nursing diagnosis for a clinical manifestation of incomprehensible language. Hallucinations are a sensory perception for which there is no reality, and disturbed sensory perception would be an appropriate nursing diagnosis.

Correct answer: C. These beliefs will affect his social relationships

Paranoid delusions are disturbances in thought processes that generally affect only an individual’s social relationships. They do not predominantly impact the work environment or daily functioning.

Correct answer: B. using methamphetamine tonight.

Methamphetamine causes psychosis and is the most recent drug that was abused by the client, so it would be the most plausible explanation for the behavior. Current use of alcohol may cause psychosis but not alcohol taken a week ago. Marijuana used 2�days ago and use of tranquilizers are both unlikely to cause psychosis.

Correct answer: D. The woman is experiencing auditory and visual hallucinations

About 30% of the homeless suffer from schizophrenia. The woman is showing signs of responding to internal stimuli. Auditory and visual hallucinations are precipitated by internal stimuli. Speaking on a cell phone and calling to a friend down the street are both external stimuli.

Correct answer: C. Obtain serum sodium and potassium levels

Although monitoring the intake and output may be an appropriate intervention, it is not the priority intervention, because the client is a new admission and the electrolyte levels need to be monitored first to determine if any other nursing interventions are necessary. Educating the client about a low-sodium diet may also be an appropriate intervention but is not the priority. The client’s oral intake should not be restricted unless there is a medical reason to do so.

Correct answer: D. Cultural variations of spiritual beliefs exist

Culture variations that exist among spiritual beliefs in family and friends are the most plausible explanation for a lack of concern over seeing "visions."

Correct answer: B. "I’m your nurse; tell me if you need something."

Telling a client who is experiencing delusions that you are the nurse provides the least threatening approach to initiate conversation. The client is most likely experiencing some paranoia along with the delusional content. Asking a client what happened to cause the visit to the hospital has an accusatory tone. Asking what is bothering the client is too intrusive for an initial stage of establishing trust. Telling the client that the other clients want to meet the client is perceived as a socially uncomfortable situation for someone who is experiencing paranoia.

Correct answer: A. Document the description of the hallucinations a client is experiencing

A licensed practical nurse may document the hallucinations a client is experiencing. Planning a medication schedule, instructing a client on a drug, and discussing a treatment plan with a client’s family are all activities that should be performed by a registered nurse.

Correct answer: A. "rule out any medical causes for the psychiatric clinical manifestations."

A physical examination is a necessary part of the initial assessment for a client diagnosed to be a psychiatric client, because many clinical manifestations that appear to be psychiatric in nature may in actuality have a medical etiology. Any medical cause must be ruled out before making a definitive psychiatric diagnosis. A physical exam cannot determine functional status. A physical exam cannot replace the mental status exam. Testing the client’s perception of what is happening is not the primary reason for conducting a physical exam.