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A patient with antisocial personality disorder tells Nurse A, 'You're a much better nurse than Nurse B said you were.' The patient tells Nurse B, 'Nurse A's upset with you for some reason.' To Nurse C the patient states, 'You'd like to think you're perfect, but I've seen three of your mistakes this morning.' These comments can best be assessed as:
- A. seductive.
- B. detached.
- C. guilt producing.
- D. manipulative.
Correct Answer: D
Rationale: The correct answer is D: manipulative. The patient's behavior demonstrates manipulation by attempting to create discord and control the relationships between the nurses. The patient uses different tactics to manipulate each nurse's emotions and perceptions for personal gain. Seductive (choice A) implies enticing or charming behavior, which is not evident in the scenario. Detached (choice B) suggests a lack of emotional connection, which is not the focus here. Guilt producing (choice C) involves inducing guilt, which the patient is not directly doing in this situation. Manipulative (choice D) best captures the patient's intent to influence others through deceptive and controlling tactics.
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While the nurse at the personality disorders clinic is interviewing a patient, the patient constantly scans the environment and frequently interrupts to ask what the nurse means by certain words or phrases. The nurse notes that the patient is very sensitive to the nurse's nonverbal behavior. His responses are often argumentative, sarcastic, and hostile. He suggests that he is being hospitalized 'so they can exploit me.' The patient's behaviors are most consistent with the clinical picture of:
- A. paranoid personality disorder.
- B. histrionic personality disorder.
- C. avoidant personality disorder.
- D. narcissistic personality disorder.
Correct Answer: A
Rationale: The correct answer is A: paranoid personality disorder. The patient's behaviors align with the diagnostic criteria for paranoid personality disorder, characterized by suspicion, distrust, sensitivity to criticism, and interpreting benign interactions as threatening. The patient's constant scanning of the environment, interrupting to clarify meanings, being sensitive to nonverbal cues, and displaying argumentative and hostile responses are all indicative of paranoid traits. Additionally, the belief that hospitalization is for exploitation is consistent with paranoid beliefs.
Choices B, C, and D can be ruled out:
B: Histrionic personality disorder is characterized by attention-seeking behavior, emotional instability, and dramatic expression. The patient's behaviors are not suggestive of seeking attention or being overly dramatic.
C: Avoidant personality disorder is marked by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. The patient's behaviors are more indicative of suspiciousness rather than avoidance.
D: Narcissistic personality disorder involves grandiosity, need for admiration, and lack of
A newly admitted patient with schizophrenia approaches the unit nurse and says, 'The voices are bothering me. They are yelling and telling me stuff. They are really bad.' Which response by the nurse would be most appropriate?
- A. Do you hear these voices very often?'
- B. Do you have a plan for getting away from the voices?'
- C. I'll stay with you. Tell me what you are hearing.'
- D. Try to ignore them and play cards with the others.'
Correct Answer: C
Rationale: The correct answer is C because it demonstrates active listening and empathy, which can help establish trust and rapport with the patient. By saying, "I'll stay with you. Tell me what you are hearing," the nurse acknowledges the patient's distress and offers support. This response can help the patient feel heard and understood, which is crucial in managing symptoms of schizophrenia.
Choice A is incorrect as it focuses more on the frequency rather than addressing the immediate distress. Choice B is incorrect as it assumes the patient has a plan to escape the voices, which may not be the case and can escalate the situation. Choice D is incorrect as it dismisses the patient's experience and suggests distraction rather than addressing the underlying issue.
Suzanne is a 10-year-old girl who has been diagnosed as experiencing depression. What is likely to be the most effective way to help Suzanne express her feelings?
- A. Have her participate in a group therapy session with other young children who are depressed
- B. Ask her to draw some pictures about things that shes been thinking about
- C. Arrange for individual psychotherapy sessions with a psychiatrist
- D. Observe her actions but dont seek to draw her out into conversation
Correct Answer: B
Rationale: Younger children who may have more difficulty verbally expressing feelings may be able to draw them.
A new client admits to having been battered by her live-in boyfriend several times over the past 2 years. She states to the nurse, 'We plan to get married next June, and I think things will be better then. He is always so sorry afterward, that I think I can trust him to change.' Which intervention should be included in the client's teaching plan?
- A. Support her hope that the battering will end after they are married.
- B. Assist her to enroll in a class to learn techniques of self-defense.
- C. Emphasize that the battering pattern usually remains the same in frequency and severity over time.
- D. Assist her in developing an emergency plan, since the pattern of violence is likely to continue.
Correct Answer: D
Rationale: The correct answer is D: Assist her in developing an emergency plan, since the pattern of violence is likely to continue. This choice is correct because it focuses on safety planning, which is crucial for individuals in abusive relationships. By helping the client develop an emergency plan, the nurse is acknowledging the seriousness of the situation and providing practical strategies to ensure her safety. It is important to have a plan in place in case of future violence.
Explanation for the incorrect choices:
A: Supporting her hope that the battering will end after they are married is not appropriate as it may give false hope and does not address the immediate safety concerns.
B: Enrolling in a self-defense class may not be effective in situations of domestic violence as it can escalate the violence and may not address the underlying issues causing the abuse.
C: Emphasizing that the battering pattern usually remains the same in frequency and severity over time is not as helpful as developing a concrete safety plan to address the immediate danger.
A core feature of all abnormal behavior is that it is
- A. culturally absolute
- B. learned
- C. maladaptive
- D. dependent on age
Correct Answer: C
Rationale: Maladaptive behavior, impairing function or causing distress, is a universal hallmark of abnormality.