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Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test

Bank
Chapter 49
Question 1
Type: MCSA
The nurse is leading a discussion group when a client asks who determines what is mentally healthy and what is
not. The nurse's best response explains that mental health and mental illness are defined:
1. Essentially the same throughout the world.
2. Differently as culture and society change attitudes.
3. According to whatever the client believes is right.
4. According to the definition in the dictionary.
Correct Answer: 2
Rationale 1: While there are certain characteristics common to the mentally healthy individual, mental illness is
often defined differently in different cultures, and is based on societal beliefs of what is right and wrong.
Rationale 2: While there are certain characteristics common to the mentally healthy individual, mental illness is
often defined differently in different cultures, and is based on societal beliefs of what is right and wrong.
Rationale 3: While there are certain characteristics common to the mentally healthy individual, mental illness is
often defined differently in different cultures, and is based on societal beliefs of what is right and wrong.
Rationale 4: While there are certain characteristics common to the mentally healthy individual, mental illness is
often defined differently in different cultures, and is based on societal beliefs of what is right and wrong.
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Explain key concepts about mental disorders, including why they are difficult to diagnose
and treat.
Question 2
Type: MCSA
The nurse assesses the client's thinking to determine if it is concrete or abstract by:
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

1. Giving the client a familiar proverb to interpret.


2. Asking the client to subtract nines backwards from 100.
3. Giving the client five objects to recall in five minutes' time.
4. Asking the client to draw either a circle or a square.
Correct Answer: 1
Rationale 1: Asking the client to interpret a proverb helps the nurse determine if he can think abstractly. If he
interprets the proverb literally, it indicates concrete thinking.
Rationale 2: Asking the client to interpret a proverb helps the nurse determine if he can think abstractly. If he
interprets the proverb literally, it indicates concrete thinking.
Rationale 3: Asking the client to interpret a proverb helps the nurse determine if he can think abstractly. If he
interprets the proverb literally, it indicates concrete thinking.
Rationale 4: Asking the client to interpret a proverb helps the nurse determine if he can think abstractly. If he
interprets the proverb literally, it indicates concrete thinking.
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Describe the nurse's role in promoting mental health.
Question 3
Type: MCSA
Which of the following activities performed by the nurse would be considered secondary prevention of a mental
disorder or disorders?
1. Providing drug abuse prevention lectures in the school
2. Teaching money management to clients with mental disorders
3. Performing depression screenings at the local mall
4. Administering medications to relieve extrapyramidal side effects
Correct Answer: 3

Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Rationale 1: Performing screenings for existing depression is secondary prevention. Drug abuse lectures are
primary prevention aimed at keeping students from beginning to use illegal substances. Teaching money
management is a rehabilitation or tertiary care act, as is medication administration to relieve side effects.
Rationale 2: Performing screenings for existing depression is secondary prevention. Drug abuse lectures are
primary prevention aimed at keeping students from beginning to use illegal substances. Teaching money
management is a rehabilitation or tertiary care act, as is medication administration to relieve side effects.
Rationale 3: Performing screenings for existing depression is secondary prevention. Drug abuse lectures are
primary prevention aimed at keeping students from beginning to use illegal substances. Teaching money
management is a rehabilitation or tertiary care act, as is medication administration to relieve side effects.
Rationale 4: Performing screenings for existing depression is secondary prevention. Drug abuse lectures are
primary prevention aimed at keeping students from beginning to use illegal substances. Teaching money
management is a rehabilitation or tertiary care act, as is medication administration to relieve side effects.
Global Rationale:
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Describe the nurse's role in promoting mental health.
Question 4
Type: MCSA
The nurse assesses the client with schizophrenia and determines that which of the following demonstrates
negative symptoms of the disorder?
1. The client says she is Jesus, and is preaching and baptizing.
2. Her speech is coherent, and the content is appropriate.
3. The client has a flat or very blunted affect most of the time.
4. Speech pattern is loose, moving from one idea to another.
Correct Answer: 3
Rationale 1: Negative symptoms of schizophrenia involve a deficit or decrease of normal function, such as a
blunted or flat affect. Positive symptoms are an excess or distortion of normal functioning, such as delusions,
hallucinations, or rapid speech pattern producing a word salad that has little meaning to the listener.
Rationale 2: Negative symptoms of schizophrenia involve a deficit or decrease of normal function, such as a
blunted or flat affect. Positive symptoms are an excess or distortion of normal functioning, such as delusions,
hallucinations, or rapid speech pattern producing a word salad that has little meaning to the listener.
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Rationale 3: Negative symptoms of schizophrenia involve a deficit or decrease of normal function, such as a
blunted or flat affect. Positive symptoms are an excess or distortion of normal functioning, such as delusions,
hallucinations, or rapid speech pattern producing a word salad that has little meaning to the listener.
Rationale 4: Negative symptoms of schizophrenia involve a deficit or decrease of normal function, such as a
blunted or flat affect. Positive symptoms are an excess or distortion of normal functioning, such as delusions,
hallucinations, or rapid speech pattern producing a word salad that has little meaning to the listener.
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Identify diagnostic criteria, treatment, and nursing care for clients with schizophrenia.
Question 5
Type: MCSA
The nurse is working on an inpatient psychiatric unit that uses milieu therapy. The nurse's role in this form of
therapy is to:
1. Avoid caring for the same client every day.
2. Model normal behavior for the clients.
3. Provide verbal rewards for good behavior.
4. Provide negative reinforcement for bad behavior.
Correct Answer: 2
Rationale 1: In milieu therapy, the nurse acts as a role model of normal behavior in the hopes the client will
model the behavior. Negative reinforcement is never indicated.
Rationale 2: In milieu therapy, the nurse acts as a role model of normal behavior in the hopes the client will
model the behavior. Negative reinforcement is never indicated.
Rationale 3: In milieu therapy, the nurse acts as a role model of normal behavior in the hopes the client will
model the behavior. Negative reinforcement is never indicated.
Rationale 4: In milieu therapy, the nurse acts as a role model of normal behavior in the hopes the client will
model the behavior. Negative reinforcement is never indicated.
Global Rationale:
Cognitive Level: Applying
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Client Need: Psychosocial Integrity


Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: List three major types of treatment used for clients with major mental health disorders.
Question 6
Type: MCSA
The nurse, screening for tardive dyskinesia symptoms, identifies which of the following?
1. Tongue protrusion during sleep
2. Rocking back and forth
3. Involuntary staring without blinking
4. Involuntary lip smacking
Correct Answer: 4
Rationale 1: Lip smacking is indicative of tardive dyskinesia, which includes repetitive movements.
Rationale 2: Lip smacking is indicative of tardive dyskinesia, which includes repetitive movements.
Rationale 3: Lip smacking is indicative of tardive dyskinesia, which includes repetitive movements.
Rationale 4: Lip smacking is indicative of tardive dyskinesia, which includes repetitive movements.
Global Rationale:
Cognitive Level: Applying
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: List three major types of treatment used for clients with major mental health disorders.
Question 7
Type: MCSA
The nurse is following up with a client who was begun on antipsychotic medication last week to treat
schizophrenia symptoms. The client says, "That medicine makes my mouth dry, and it's not helping me at all, so I
want to stop taking it." The nurse's best response is:
1. "You should need talk with the doctor before stopping the medication."
2. "You have the right to refuse your medication if you think that is best."
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

3. "You need to take this medicine for at least 3-6 weeks before it will be effective."
4. "You should not stop this medication suddenly, or it can have negative effects."
Correct Answer: 3
Rationale 1: The nurse should explain that antipsychotic medications do not begin to work immediately but must
establish a blood level over 3-6 weeks before effects will be seen, and then encourage the client not to give up,
and provide options for coping with side effects.
Rationale 2: The nurse should explain that antipsychotic medications do not begin to work immediately but must
establish a blood level over 3-6 weeks before effects will be seen, and then encourage the client not to give up,
and provide options for coping with side effects.
Rationale 3: The nurse should explain that antipsychotic medications do not begin to work immediately but must
establish a blood level over 3-6 weeks before effects will be seen, and then encourage the client not to give up,
and provide options for coping with side effects.
Rationale 4: The nurse should explain that antipsychotic medications do not begin to work immediately but must
establish a blood level over 3-6 weeks before effects will be seen, and then encourage the client not to give up,
and provide options for coping with side effects.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Identify diagnostic criteria, treatment, and nursing care for clients with schizophrenia.
Question 8
Type: MCSA
The nurse hears the client on the psychiatric inpatient unit tell another client, "They'll all be sorry when I'm gone."
The nurse's priority action is to:
1. Ask the client, "Are you thinking about killing or hurting yourself?"
2. Leave a note for the physician giving the details of her suspicions.
3. Call the client's family or significant other and ask them to visit and report conversations.
4. Ask the client what was meant by the overheard comment.
Correct Answer: 1

Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Rationale 1: This comment indicates the client is considering a world without him, and might be planning
suicide. It is important for the nurse to question the client directly by asking if he is considering killing or hurting
himself. Leaving a note for the physician would delay assessment of the client, and could have a negative
outcome if the client is in imminent danger. The family is not the best source of information. The nurse should
question the client very specifically, and not ask for an interpretation of the comment.
Rationale 2: This comment indicates the client is considering a world without him, and might be planning
suicide. It is important for the nurse to question the client directly by asking if he is considering killing or hurting
himself. Leaving a note for the physician would delay assessment of the client, and could have a negative
outcome if the client is in imminent danger. The family is not the best source of information. The nurse should
question the client very specifically, and not ask for an interpretation of the comment.
Rationale 3: This comment indicates the client is considering a world without him, and might be planning
suicide. It is important for the nurse to question the client directly by asking if he is considering killing or hurting
himself. Leaving a note for the physician would delay assessment of the client, and could have a negative
outcome if the client is in imminent danger. The family is not the best source of information. The nurse should
question the client very specifically, and not ask for an interpretation of the comment.
Rationale 4: This comment indicates the client is considering a world without him, and might be planning
suicide. It is important for the nurse to question the client directly by asking if he is considering killing or hurting
himself. Leaving a note for the physician would delay assessment of the client, and could have a negative
outcome if the client is in imminent danger. The family is not the best source of information. The nurse should
question the client very specifically, and not ask for an interpretation of the comment.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Name several types of mood disorders and describe treatments and nursing care for them.
Question 9
Type: MCMA
The nurse working with a group of clients assesses which of the following as being mentally healthy? Select all
that apply.
Standard Text: Select all that apply.
1. The client who believes her dead mother is in heaven watching what she does
2. The client who lives with his mother, drinks beer all day, and has never held a job
3. The client who is extremely angry at his ex-wife, and avoids contact with her when the children are around
4. The client who works as a nurse and washes his hands frequently to prevent the spread of infection
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

5. The client who says he dislikes people and prefers to be alone rather than socializing with others
Correct Answer: 1,3,5
Rationale 1: It is not unusual for people from some cultural or religious backgrounds to believe their dead
relatives can see them from heaven, and it often motivates them to follow societal rules. The client who is angry is
able to control his emotions enough to avoid exposing his children to the bad feelings between him and his wife.
The nurse who washes his hands frequently comes from a culture that promotes the importance of this behavior.
These clients would be considered mentally healthy. The client who drinks beer all day most likely has a
substance abuse problem, and the client who prefers to be alone does not have the ability to relate to others, so
these two clients would be suspected of a mental disorder, but more information would be required in order to
determine this definitively.
Rationale 2: It is not unusual for people from some cultural or religious backgrounds to believe their dead
relatives can see them from heaven, and it often motivates them to follow societal rules. The client who is angry is
able to control his emotions enough to avoid exposing his children to the bad feelings between him and his wife.
The nurse who washes his hands frequently comes from a culture that promotes the importance of this behavior.
These clients would be considered mentally healthy. The client who drinks beer all day most likely has a
substance abuse problem, and the client who prefers to be alone does not have the ability to relate to others, so
these two clients would be suspected of a mental disorder, but more information would be required in order to
determine this definitively.
Rationale 3: It is not unusual for people from some cultural or religious backgrounds to believe their dead
relatives can see them from heaven, and it often motivates them to follow societal rules. The client who is angry is
able to control his emotions enough to avoid exposing his children to the bad feelings between him and his wife.
The nurse who washes his hands frequently comes from a culture that promotes the importance of this behavior.
These clients would be considered mentally healthy. The client who drinks beer all day most likely has a
substance abuse problem, and the client who prefers to be alone does not have the ability to relate to others, so
these two clients would be suspected of a mental disorder, but more information would be required in order to
determine this definitively.
Rationale 4: It is not unusual for people from some cultural or religious backgrounds to believe their dead
relatives can see them from heaven, and it often motivates them to follow societal rules. The client who is angry is
able to control his emotions enough to avoid exposing his children to the bad feelings between him and his wife.
The nurse who washes his hands frequently comes from a culture that promotes the importance of this behavior.
These clients would be considered mentally healthy. The client who drinks beer all day most likely has a
substance abuse problem, and the client who prefers to be alone does not have the ability to relate to others, so
these two clients would be suspected of a mental disorder, but more information would be required in order to
determine this definitively.
Rationale 5: It is not unusual for people from some cultural or religious backgrounds to believe their dead
relatives can see them from heaven, and it often motivates them to follow societal rules. The client who is angry is
able to control his emotions enough to avoid exposing his children to the bad feelings between him and his wife.
The nurse who washes his hands frequently comes from a culture that promotes the importance of this behavior.
These clients would be considered mentally healthy. The client who drinks beer all day most likely has a
substance abuse problem, and the client who prefers to be alone does not have the ability to relate to others, so
these two clients would be suspected of a mental disorder, but more information would be required in order to
determine this definitively.
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Identify characteristics of a mentally healthy person.
Question 10
Type: MCSA
The nurse screens all children for early symptoms of mental health disorders because:
1. Untreated mental disorders can lead to move severe, difficult-to-treat, and debilitating mental disorders in later
life.
2. People with mental disorders in childhood are more likely to become violent in later life.
3. Symptoms are more obvious and easy to see in children because children are so honest about their feelings.
4. Disorders that are caught early are easier to cure.
Correct Answer: 1
Rationale 1: Mental disorders often begin in childhood, and if left untreated, they tend to become move severe
mental disorders in adulthood that are harder to treat. Early intervention can make a big difference in the life of
the child.
Rationale 2: Mental disorders often begin in childhood, and if left untreated, they tend to become move severe
mental disorders in adulthood that are harder to treat. Early intervention can make a big difference in the life of
the child.
Rationale 3: Mental disorders often begin in childhood, and if left untreated, they tend to become move severe
mental disorders in adulthood that are harder to treat. Early intervention can make a big difference in the life of
the child.
Rationale 4: Mental disorders often begin in childhood, and if left untreated, they tend to become move severe
mental disorders in adulthood that are harder to treat. Early intervention can make a big difference in the life of
the child.
Global Rationale:
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Discuss mental health and mental health disorders in children.
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Question 11
Type: MCSA
The nurse working in a pediatrician's office admits an 8-year-old child whose growth was within the 50th
percentile until the past year, when his weight failed to increase. He is now in the 10th percentile for growth. The
child's mother reports that he sleeps all the time and all he wants to do when he is awake is play on the computer.
His grades have been slipping, and his mother reports he claims he doesn't feel well and can't go to school at least
2-3 times per week. The nurse assesses the child and asks him:
1. "What is school like this year?"
2. "Are you feeling depressed?"
3. "Do you like school?"
4. "Sounds like you're not doing well in school. Why is that?"
Correct Answer: 1
Rationale 1: Asking an open-ended question like "What is school like this year?" does not place an expectation
for a specific answer on the wording, and requires more information than a simple yes or no. While this child
most likely is experiencing depression, asking him if he is depressed is unlikely to yield useful information; he
might not really understand the meaning of the term, and it is a question that can be answered in one word.
Putting emphasis on poor school performance is liable to make the child defensive, and will not improve nurseclient rapport.
Rationale 2: Asking an open-ended question like "What is school like this year?" does not place an expectation
for a specific answer on the wording, and requires more information than a simple yes or no. While this child
most likely is experiencing depression, asking him if he is depressed is unlikely to yield useful information; he
might not really understand the meaning of the term, and it is a question that can be answered in one word.
Putting emphasis on poor school performance is liable to make the child defensive, and will not improve nurseclient rapport.
Rationale 3: Asking an open-ended question like "What is school like this year?" does not place an expectation
for a specific answer on the wording, and requires more information than a simple yes or no. While this child
most likely is experiencing depression, asking him if he is depressed is unlikely to yield useful information; he
might not really understand the meaning of the term, and it is a question that can be answered in one word.
Putting emphasis on poor school performance is liable to make the child defensive, and will not improve nurseclient rapport.
Rationale 4: Asking an open-ended question like "What is school like this year?" does not place an expectation
for a specific answer on the wording, and requires more information than a simple yes or no. While this child
most likely is experiencing depression, asking him if he is depressed is unlikely to yield useful information; he
might not really understand the meaning of the term, and it is a question that can be answered in one word.
Putting emphasis on poor school performance is liable to make the child defensive, and will not improve nurseclient rapport.
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Name several types of mood disorders and describe treatments and nursing care for them.
Question 12
Type: MCSA
The nurse is caring for a client with major depressive disorder who was recently placed on a high-potency
neuroleptic (antipsychotic) medication. The client has not been eating well, is starting to get dehydrated, and has a
temperature of 101F. The physician orders antibiotics. Six hours later, the nurse notice that the client's
temperature has risen to 103F, and the client has muscle rigidity, and a fluctuating blood pressure. The priority of
action for the nurse is to:
1. Discontinue neuroleptic and report symptoms to physician immediately.
2. Chart the assessment findings and report them to the primary nurse at change of shift.
3. Discontinue the neuroleptic and document assessment findings as cause for the action.
4. Continue the medications and perform more frequent assessments of the client.
Correct Answer: 1
Rationale 1: These symptoms are indicative of neuroleptic malignant syndrome, a potentially fatal idiopathic
response to high-potency neuroleptic medications. The medication should be discontinued, and the physician
notified immediately.
Rationale 2: These symptoms are indicative of neuroleptic malignant syndrome, a potentially fatal idiopathic
response to high-potency neuroleptic medications. The medication should be discontinued, and the physician
notified immediately.
Rationale 3: These symptoms are indicative of neuroleptic malignant syndrome, a potentially fatal idiopathic
response to high-potency neuroleptic medications. The medication should be discontinued, and the physician
notified immediately.
Rationale 4: These symptoms are indicative of neuroleptic malignant syndrome, a potentially fatal idiopathic
response to high-potency neuroleptic medications. The medication should be discontinued, and the physician
notified immediately.
Global Rationale:
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Client Need Sub:


Nursing/Integrated Concepts: Nursing Process: Implementation
Learning Outcome: Name several types of mood disorders and describe treatments and nursing care for them.
Question 13
Type: MCMA
The nurse working on an inpatient psychiatric unit admits a client diagnosed with antisocial personality disorder.
After obtaining admission data from the client, the nurse plans care to include: (Select all that apply.)
Standard Text: Select all that apply.
1. Careful monitoring of the new client's interaction with others on the unit.
2. Consistency in staff assigned to care for this client.
3. Strict limit-setting, with the rules carefully explained and written for the client.
4. Involvement in group therapy.
5. Encouraging socialization with other clients on the unit
Correct Answer: 1,2,3
Rationale 1: Clients with antisocial personality disorder often are manipulative, so it is important to carefully
monitor interactions with other clients, because they can be very upsetting to the unit as they manipulate other
clients to do their bidding. There should be consistency in staff assignments because the client often will play one
staff member against another. Further, consistent staffing is most effective in setting limits and consistently
maintaining them.
Rationale 2: Clients with antisocial personality disorder often are manipulative, so it is important to carefully
monitor interactions with other clients, because they can be very upsetting to the unit as they manipulate other
clients to do their bidding. There should be consistency in staff assignments because the client often will play one
staff member against another. Further, consistent staffing is most effective in setting limits and consistently
maintaining them.
Rationale 3: Clients with antisocial personality disorder often are manipulative, so it is important to carefully
monitor interactions with other clients, because they can be very upsetting to the unit as they manipulate other
clients to do their bidding. There should be consistency in staff assignments because the client often will play one
staff member against another. Further, consistent staffing is most effective in setting limits and consistently
maintaining them.
Rationale 4: Clients with antisocial personality disorder often are manipulative, so it is important to carefully
monitor interactions with other clients, because they can be very upsetting to the unit as they manipulate other
clients to do their bidding. There should be consistency in staff assignments because the client often will play one
staff member against another. Further, consistent staffing is most effective in setting limits and consistently
maintaining them.
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Rationale 5: Clients with antisocial personality disorder often are manipulative, so it is important to carefully
monitor interactions with other clients, because they can be very upsetting to the unit as they manipulate other
clients to do their bidding. There should be consistency in staff assignments because the client often will play one
staff member against another. Further, consistent staffing is most effective in setting limits and consistently
maintaining them.
Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Planning
Learning Outcome: Identify key aspects of personality disorders and describe nursing care for clients with this
disorder.
Question 14
Type: MCSA
The nurse is caring for a client who has difficulty making decisions, frequently saying "I'm so stupid. What do
you think I should do?" The client's actions lead the nurse to suspect the possibility of what personality disorder?
1. Paranoid
2. Schizoid
3. Dependent
4. Avoidant
Correct Answer: 3
Rationale 1: The client with dependent personality disorder needs to be taken care of, has difficulty making
decisions, takes no initiative, and displays powerlessness, often referring to herself as stupid or incompetent so
others will help her.
Rationale 2: The client with dependent personality disorder needs to be taken care of, has difficulty making
decisions, takes no initiative, and displays powerlessness, often referring to herself as stupid or incompetent so
others will help her.
Rationale 3: The client with dependent personality disorder needs to be taken care of, has difficulty making
decisions, takes no initiative, and displays powerlessness, often referring to herself as stupid or incompetent so
others will help her.
Rationale 4: The client with dependent personality disorder needs to be taken care of, has difficulty making
decisions, takes no initiative, and displays powerlessness, often referring to herself as stupid or incompetent so
others will help her.
Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.

Global Rationale:
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: Identify key aspects of personality disorders and describe nursing care for clients with this
disorder.

Ramont, Niedringhous, Comprehensive Nursing Care 2nd Edition Update Test Bank
Copyright 2012 by Pearson Education, Inc.