Which activity would be most appropriate for a severely withdrawn client?
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Solution
Art activity with a staff member
Option A: The best approach with a withdrawn client is to initiate brief, non-demanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client.
Options B and C: A board game with a group of clients or playing a team sport in the gym may overwhelm a severely withdrawn client.
Option D: Watching TV is a solitary activity that will reinforce the client’s withdrawal from others.
The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:
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Solution
Social skills training
Option C: Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking questions or directions, placing an order in a restaurant, taking turns in a group setting activity.
Options A and B: Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills.
Option D: Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.
A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself?
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Solution
Art therapy in a small group
Option A: Art therapy provides a non-threatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with peers in a group setting.
Option B: Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity.
Option C: Recommending that the client read a self-help book may increase, not decrease his isolation.
Option D: Watching movie with a peer group does not guarantee that interaction will occur; therefore, the client may remain isolated.
A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach?
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Solution
Challenge the accuracy of the client’s belief
Option B: Use of cognitive techniques allows the nurse to help the client recognize that these negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful.
Options A and D: Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation.
Option C: Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.
A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?
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Solution
The parents reinforced increased decision making by the client
Option A: One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention.
Options B, C, and D: Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.
Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations?
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Solution
Powerlessness
Option D: The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.
Which of the following is the most distinguishing feature of a client with an antisocial personality disorder?
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Solution
Disregard for social and legal norms
Option D: Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder.
Option A: Attention to detail and order is characteristic of someone with obsessive-compulsive disorder.
Option B: Bizarre mannerisms and thoughts are characteristics of a client with schizoid or schizotypal disorder.
Option C: Submissive and dependent behaviors are characteristic of someone with a dependent personality.
The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms?
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Solution
Stress management techniques
Option D: In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms.
Options A, B, and C: The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.
Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder?
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Solution
The client has decreased episodes of impulsive behaviors
Option B: A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore, decreased frequency of impulsive behaviors would be evidence of improvement.
Options A and D: Charming behavior when around authority figures and statements indicating no remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment.
Option C: Self-satisfaction would be viewed as a positive change if the client expresses low self-esteem; however, this is not a characteristic of a client with antisocial personality disorder.
A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?
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Solution
Help the client execute actions that are feared
Option A: Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety.
Options B and C: There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another.
Option D: Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing activities that typically are avoided as part of the phobic response.