Psychiatric Answers III

61. Answer: B

Rationale: Understanding the stages leading to the acceptance of death may help the family to understand the client's moods and anger. Option A may not be true unless stated by the client; some clients welcome death as a release from pain. Option C is untrue; anger is one of the stages of accepting death. Option D is an assumption by the nurse unless stated by the client. (Mosby, 17th Edition, 2003)

62. Answer: D

Rationale: For psychologic equilibrium the client's environment must be one of novel and changing stimuli, promoting physical activity and effective interaction with others. Option A is incorrect; in order to prevent urinary stasis and dehydration, fluid intake should be encouraged. In option B, although stimulation is important, it should be varies and the client's preferences taken into consideration; radio and television do not promote interaction. In option C, since the client has been able to control elimination, frequent toileting is not the problem. (Mosby, 17th Edition, 2003)

63. Answer: B

Rationale: Incontinence without a physiologic basis is an act of hostility that the individual uses to deal with anxiety-producing situations. Option A is not correct because incontinence is often seen as a symbol of regression and loss of control. Option C is untrue for incontinence is rarely the result of conscious effort. Option D is incorrect because incontinence is not a necessary complication of age and inactivity; it can be prevented by a bladder-training program. (Mosby, 17th Edition, 2003)

64. Answer: D

Rationale: The client's statement is really saying, “I can manage this myself. I am capable.” In option A, nothing in the statement can be interpreted as denial; the client has stated, “I know I'm sick.” Option B is incorrect because none of the information given would lead to this conclusion. IN option C, the statement would not be reassuring to the family member who brought the client to the hospital and who probably is more reassured having the client hospitalized. (Mosby, 17th Edition, 2003)

65. Answer: A

Rationale: The potential for death is constant on clients undergoing dialysis, which may result in reactive depression. In option B, although paranoia is occasionally seen in the terminal stage of the illness it is not known as “postpump psychosis.” Option C is incorrect because episodes of feeling detached, numb, or unreal are not common occurrences; reactive depression is the most common. Option D is incorrect because Dialysis Disequilibrium is a physiologic problem resulting from cerebral fluid shifts that can result in seizures. (Mosby, 17th Edition, 2003)

66. Answer: C

Rationale: It is very important that the nurse discontinue previous antipsychotic medications before starting risperidone to minimize the period of overlap to avoid a drug interaction. In option A, although safety is of concern, it would be more important to monitor for mood change and suicidal tendencies once the drug titrate level has been reached, when the client will have clearer thought processes and more energy. Option B is incorrect because the symptoms of extrapyramidal reactions are not likely to occur with this low dosage of Risperdal. Option D would not allow enough of the lag period between the two drugs and could precipitate a drug reaction. (Mosby, 17th Edition, 2003)

67. Answer: D

Rationale: Prolixin decanoate can be given IM every 2 to 3 weeks for clients who cannot be relied upon to take oral medications; it allows them to live in the community while keeping the symptoms under control. Haloperidol (Haldol) IM has an action duration of 4 to 8 hours only. Both Valium and Lithium carbonate are not given for schizophrenia. (Mosby, 17th Edition, 2003)

68. Answer: B

Rationale: Haldol causes photosensitivity. Severe sunburn can occur on exposure to the sun. Option A is incorrect because there is no known side effect that would affect night driving. Option C would be true if the client were taking a MAO inhibitor. Option D is incorrect because aspirin is not contraindicated. (Mosby, 17th Edition, 2003)

69. Answer: D

Rationale: All these drugs are used to control the extrapyramidal (parkinsonism-like) symptoms that often develop as a side effect of neuroleptic therapy. Option A is incorrect because barbiturates do not have extrapyramidal side effects, which would respond to these drugs. Option B is incorrect because antiparkinsonian drugs are not usually prescribed in conjunction with antidepressants because antidepressants do not cause parkinsonism-like symptoms. Option C is also incorrect because there is no documented use of these drugs with antianxiety agents because they do not have extrapyramidal side effects. (Mosby, 17th Edition, 2003)

70. Answer: C

Rationale: Tardive dyskinesia occur as a late and persistent extrapyramidal complication of long-term antipsychotic therapy. It can take many forms (e.g., torsion spasm, opisthotonos, oculogyric crisis, drooping of the head, protrusion of the tongue). Options A, B and D are reversible with administration of Cogentin and Benadryl. (Mosby, 17th Edition, 2003)

71. Answer: B

Rationale: Any behavioral therapy or learning of new methods of dealing with situations requires modifications o0f approach and attitudes; hence personality is always capable of change. In option A, certain personality traits are established by age 2, but not the total personality. Option C is incorrect because the capacity for change exists throughout the life cycle. Option D is incorrect because accepting this theory would close the door om all future growth and development. (Mosby, 17th Edition, 2003)

72. Answer: C

Rationale: Before this age (24 months) the infant has not developed enough ego strength to have an identity or personality. Option A is incorrect because 6 months is too early. Option B is wrong because at 9 months self-concept is nonexistent. In option D, the primary emergence of the personality has already occurred. (Mosby, 17th Edition, 2003)

73. Answer: C

Rationale: The parameters set by birth, psychologic experiences and the environment make each individual unique. Although other factors may impinge to a slight degree, these factors form the personality. Options A and D answers are not inclusive; they are limited to only some aspects of personality development; race plays no part. In option B, autoimmunity plays no part in personality development. (Mosby, 17th Edition, 2003)

74. Answer: C

Rationale: Children view their own worth by the response received from their parents. This sense of worth sets the basic ego strengths and is vital to the formation of the personality. Option A is incorrect because peer groups come later in a child's development, but the parent-child relationship is still the most important. Option B, although important, it is not as important as the parent-child relationship. Option D comes later in life, after the basic personality has been formed. (Mosby, 17th Edition, 2003)

75. Answer: D

Rationale: 3 to 5 ½ years is the age of Freud's phallic stage and Erikson's stage of initiative versus guilt. Option A (Adolescence) is Freud's genital stage and Erikson's stage of identity versus role confusion. Option B (6 to 12 years) is Freud's latency stage and Erikson's stage of industry versus inferiority. Option C (birth to 1 year) is Freud's oral stage and Erikson's stage of trust versus mistrust. (Mosby, 17th Edition, 2003)

76. Answer: B

Rationale: Slips of the tongue, also called “Freudian slips,” are material from the unconscious that slips out in unguarded moments. Option A is incorrect because material in the unconscious cannot deliberately be brought back to awareness. Option C is incorrect because there is no evidence linking Déja vu experiences to the unconscious. In option D, although free-floating anxiety is linked to the unconscious, the best evidence of the unconscious is still the slips of the tongue. (Mosby, 17th Edition, 2003)

77. Answer: B

Rationale: mediating frustration within the real world is an ego function and requires ego strengths. Option A is incorrect because the id is unable to tolerate frustration for it is totally involved with gratification. Option C is incorrect because the superego is involved with putting pressure on the ego because the id does not tolerate frustration. Option D is incorrect because the unconscious does not deal with frustration. (Mosby, 17th Edition, 2003)

78. Answer: D

Rationale: The superego incorporates all experiences and learning from external environments (society, family, etc.) into the internal environment. Options A and C are functions of the id. Option B is incorrect because it is the id with its drives the source of creative energy. (Mosby, 17th Edition, 2003)

79. Answer: D

Rationale: A healthy ego can delay gratification and is in balance with reality. Option A is incorrect because it does not reflect any part of the self. Option B is incorrect because it is the id seeking satisfaction. Option C is incorrect because conscience and a sense of right and wrong are expressed in the superego, which acts to counterbalance the id's desire for immediate gratification. (Mosby, 17th Edition, 2003)

80. Answer: D

Rationale: The mature personality does not respond to the immediate gratification demands of the id or the oppressive control of the superego because the ego is strong enough to maintain a balance between them. Option A is incorrect because there would be no healthy resolution of conflicts if the superego were always in control. (Mosby, 17th Edition, 2003)

81. Answer: C

Rationale: Freud's theory is that a child develops a sexualized love for the parents of the opposite sex and becomes jealous of the parent of the same sex. These thoughts result in feelings of guilt, anxiety, fear and hate toward the parent of the same sex, which are repressed. Option A is incorrect because ambivalence does not occur in the Oedipal stage of development. Options B and D are incorrect because the child loves the parent of the opposite sex and hates the parent of the same sex. (Mosby, 17th Edition, 2003)

82. Answer: B

Rationale: Values and beliefs from the parents and society are expressed through the child's play world. These values become part of the child's system through the process of internalization (Introjection). Option A (projection) is incorrect because if this happened, children learn to blame others for their own faults. Option C (Competition) occurs at a later age. Option D (Independence) is incorrect because the environment and others in it, rather than play, influence independence. (Mosby, 17th Edition, 2003)

83. Answer: C

Rationale: The child resolves Oedipal conflicts by learning to identify with the parent of the same sex and accomplishes this by mimicking the role of this parent. Option A (Oral stage) is the earliest stage of development and operates solely on the pleasure principle, largely id oriented; this stage is concerned with development of trust In option B (Genital stage) there is an interest shift from the anal region to the genital region, and questions about sexuality arise. In option D (Latency stage) there is increasing sex-role development; this stage is concerned with peer-group identification. (Mosby, 17th Edition, 2003)

84. Answer: B

Rationale: Children 2 to 7 years old (Preoperative stage) have difficulty distinguishing reality from fantasy; this would present the greatest challenge to the nurse. (A) Children 0 to 1 years of age (Sensorimotor stage) focus on “in the moment” thinking; preoperative preparation would most likely not be recalled. (C) Children 7 to 11 years of age (Concrete operational stage) have the ability to comprehend and visualize a series of events and can think about the pas and present; it would provide less of a challenge to absorb preoperative teachings. (D) Children 12 to 16 years of age (Formal operational stage) can think in the abstract and have the ability to solve complex problems; it would not pose difficulty in preoperative teachings. (Mosby, 17th Edition, 2003)

85. Answer: A

Rationale: The sense of Ego integrity comes from satisfaction with life and acceptance of what has been and what is. Despair is due to guilt or remorse over what might have been. (B) During puberty, adolescents attempt to find themselves and integrate values with those of society; an inability to solve conflict results in confusion and hinders mastery of future roles. (C) During early and middle adulthood the individual is concerned with the ability to produce and to care for that which is produced or created; failure during this stage leads to self-absorption or stagnation. (D) Autonomy is developed during the toddler period and corresponds to the child's ability to control the body and environment; Doubt can result when made to feel ashamed or embarrassed. (Mosby, 17th Edition, 2003)

86. Answer: A

Rationale: Use of denial involves failure to acknowledge the reality of a situation. Options B and D are incorrect because it is not demonstrated by the situation. Option C is incorrect because intellectualization involves discussing the child's problem in a technical manner; this is not demonstrated in the example. (Mosby, 17th Edition, 2003)

87. Answer: C

Rationale: Secondary reinforcers involve the use of social approval; behaviors such as a hug meet this requirement. Options A and B are incorrect because food is a primary reinforcer and should not be associated with behavior modification. Option D is incorrect because the child may not select an appropriate secondary reinforcer. (Mosby, 17th Edition, 2003)

88. Answer: B

Rationale: By monitoring and reporting changes in the child's behavior, the physician can determine the effectiveness of the medication. Option A id wrong because parents should not be encouraged to tutor children because there is usually too much emotional interaction. Option C is incorrect because behavior is not deliberate or controllable; this type of statement could lead to diminishing the child's self-esteem if control does not occur. Option D is incorrect because children need more structure and rules than adults. (Mosby, 17th Edition, 2003)

89. Answer: A

Rationale: IQ levels between 52 and 68 are considered MILD intellectual impairment. IQ levels between 20 and 35 are specific to SEVERE intellectual impairment. IQ levels below 20 indicate PROFOUND intellectual impairment. IQ levels between 36 and 51 are specific to MODERATE intellectual impairment (Mosby, 17th Edition, 2003)

90. Answer: D

Rationale: Research studies have shown that the prognosis for normal productive functioning in autistic people is guarded, particularly if there are delays in language development. Option A is incorrect because early accurate diagnosis is difficult and has not been shown to affect prognosis to any extent. In option B, while temperament may affect the child's response to treatment, it does not affect prognosis to any extent. Option C is false reassurance to the parents and would not be helpful. (Mosby, 17th Edition, 2003)

91. Answer: A

Rationale: By 2 years of age the child should demonstrate an interest in others, communicate verbally and possess the ability to learn from the environment. Before these skills develop, autism is difficult to diagnose. In option B, autism can be diagnosed long before this age (6 years of age). In options C and D, infantile autism can occur at this ages but is difficult to diagnose. (Mosby, 17th Edition, 2003)

92. Answer: B

Rationale: Providing a constructive distraction will help to redirect the autistic child's behavior. Option A id incorrect because physical contact is anxiety provoking for the autistic child. In option C, since the reason is probably unknown, it is not appropriate to questions such behavior. Option D is incorrect because autistic children need sameness; moving furniture will produce anxiety. (Mosby, 17th Edition, 2003)

93. Answer: D

Rationale: Autistic behavior turns inward. These children do not respond to the environment but attempt to maintain emotional equilibrium by rubbing and manipulating themselves and displaying a compulsive need for behavioral repetition. Option A is wrong because large group (or small group) activity would have little effect on the autistic child's response. In option B, although these children do seem to respond to music, but it doesn't necessarily loud, cheerful music. Option C is incorrect because part of the autistic pattern is the inability to interact with others in the environment. (Mosby, 17th Edition, 2003)

94. Answer: D

Rationale: Methylphenidate hydrochloride (Ritalin) is the drug of choice for children diagnosed with Attention-deficit Hyperactivity disorder (ADHD). It appears to act by stimulating release of norepinephrine from nerve endings in the brainstem. (A) Lorazepam (Ativan) is a benzodiazepine used to treat anxiety and insomnia. (B) Haloperidol (Haldol) is an antipsychotic medication. (C) Methocarbamol (Robaxin) is a muscle relaxant. (Mosby, 17th Edition, 2003)

95. Answer: C

Rationale: Focusing on specifics is important for children who are easily distracted. Option A is incorrect because focusing on more than one item at a time might be difficult for an easily distracted child. Option B is incorrect because hyperactive children respond best to concrete tasks; this is not a concrete task. Option D is incorrect because a child who is easily distracted would have difficulty talking to a group of children regarding a particular topic. (Mosby, 17th Edition, 2003

96. Answer: B

Rationale: Clients with dementia of the Alzheimer's type need a simple environment. Because of brain cell destruction, they are unable to make choices. Option A is incorrect because a well-balanced diet is important throughout life, not just during senescence; a diet high in carbohydrates and protein may be lacking other nutrients such as fats. Option C is incorrect because the client is incapable of making choice; providing many alternative choices will only increase anxiety. Option D is incorrect because physical and emotional needs must bee met on a continuous basis, not just at a fixed time. (Mosby, 17th Edition, 2003)

97. Answer: C

Rationale: Clients with vascular dementia attempts to utilize defense mechanisms that have worked in the past but use them in an exaggerated manner. Because of brain cell destruction such clients are unable to focus on one defense mechanism or develop new ones. Option A is incorrect because clients with vascular dementia will depend on old, familiar defense mechanisms. Option B is incorrect because the client is not capable of focusing on one defense mechanism. Option D is wrong because the client is incapable of developing new defense mechanisms at this time. (Mosby, 17th Edition, 2003)

98. Answer: D

Rationale: The client who has delirium, dementia or another cognitive disorder will be most comfortable with the familiar and repetitive daily routine because it creates less anxiety. In option A, it would be beyond the client's capabilities to develop new social skills. In option B, the memory impairment might make this impossible. In option C, cognitive changes would make this unrealistic. (Mosby, 17th Edition, 2003)

99. Answer: D

Rationale: This would provide information about the client's ability to think or use imagination , which are lost in dementia. Option A is incorrect because knowledge of the client's previous appearance is essential before an assessment of current appearance can be made. Options B and C are incorrect because well-practiced behavior may be repeated by the client with dementia. (Mosby, 17th Edition, 2003)

100. Answer: B

Rationale: The current trend in psychiatry is to treat the clients while maintaining them in the community. This trend includes the family and community in the plan and has reduced the number of clients in institutions. Option A might be part of the overall treatment plan but not the only aspect. Option C would possibly have the effect of masking the symptoms and should be used only in conjunction with psychotherapy. Option D would be unrealistic for most of these clients. (Mosby, 17th Edition, 2003)