A female client who is a retired school teacher is admitted for a breast biopsy. After being told that the biopsy was positive for cancer, she becomes dependent and asks her family for help with activities of daily living that she is physically capable of performing. Which interpretation of this client's behavior by the nurse is likely to be most accurate?

Expected, as the client is attempting to reduce anxiety by regressing to a state of lesser anxiety.

Should be encouraged as representative of the client's non-destructive method of fear expression.

Unacceptable, and limits should be set to encourage the client to maintain her independence.

Should be accepted by staff as the first step the client must experience in the grieving process.

Answer and Explanation

The Correct Answer is A

A.   This behavior can be seen as a regression aimed at reducing anxiety during a stressful time, which is a relatively common psychological response to stress or trauma.
B.   While it may be a way for the client to cope, encouraging dependency might not necessarily be the best approach to fostering independence.
C.   While independence is important, setting rigid limits might not address the underlying emotional needs during a period of distress.
D.   Acknowledging and understanding the client's behavior as a coping mechanism within the grieving process can help the staff provide appropriate support and care.

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Correct Answer is A

Explanation

A. Providing a quiet room is important. This is because individuals with PTSD are often hypersensitive to noise and other stimuli, which can trigger flashbacks or other
symptoms. A quiet environment can help to reduce anxiety and promote relaxation.
B. Acquainting the client with the unit rules is important, but connecting the client with peers who understand their experiences can be more therapeutic initially.
C. Ensuring a well-balanced diet is essential but might not be the priority in the immediate plan of care for someone newly admitted with PTSD.
D. Introducing the client to others with similar diagnoses helps foster a sense of belonging.
However, this is a long-term rather than an immediate intervention.

A. Increased talkativeness and pressure to keep talking. B. Illogical response to questions asked. C. Poor concentration and slow thought process. D. Ritual daily breast exams for fear of cancer.

Correct Answer is D

Explanation

A. Increased talkativeness and pressure to keep talking might be seen in conditions like mania or anxiety, not specifically illness anxiety disorder.
B. Illogical responses could be indicative of thought disorders but are not characteristic of illness anxiety disorder.
C. Poor concentration and slow thought processes might suggest cognitive issues but are not specifically linked to illness anxiety disorder.
D. Ritualistic behaviors such as daily breast exams due to fear of cancer are characteristic of illness anxiety disorder (previously known as hypochondriasis).

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with post-traumatic stress disorder (PTSD) is admitted to the psychiatric unit. Which intervention is most important for the nurse to include in this client's plan of care?

Correct Answer is A

Explanation

The nurse is conducting client assessments in an outpatient psychiatric clinic. Which client finding is characteristic of illness anxiety disorder?

Correct Answer is D

Explanation

Prior to initiating a treatment regimen with the antidepressant sertraline, it is most important for the nurse to obtain which information?

A client with schizophrenia returns to the clinic two weeks after receiving a prescription for haloperidol. To assess for neuroleptic malignant syndrome (NMS), which information is most important for the nurse to obtain during this visit?

A young female client is admitted to the emergency room because she was raped that evening by her date. Which computer documentation should the nurse enter in the electronic medical record as the client's chief complaint?

A female client engages in repeated checks of door and window locks and behavior that prevents her from arriving on time and interfering with her ability to function effectively. Which action should the nurse take?

A middle-aged adult with major depressive disorder suffers from psychomotor retardation, hypersomnia, and lack of motivation. Which intervention is likely to be most effective in returning this client to a normal level of functioning?

The nurse is preparing the physical environment to interview a new client for admission to the mental health unit. Which environmental setting facilitates the best outcome of the interview?

The mother of an 8-month-old infant with profound mental and physical disabilities tells the nurse how depressed she is because she realizes that her child will never achieve normal growth and development milestones. How should the nurse respond to this mother?