THERAPIES & TREATMENT
A nurse is teaching a client about cognitive processing therapy (CPT) for PTSD. Which statement by the client indicates understanding?
A. "This therapy will help me avoid thinking about the trauma."
B. "This therapy can help me identify and change unhelpful thoughts related to the trauma."
C. "This therapy focuses only on taking medication."
D. "This therapy requires me to forget the traumatic event."
B
Rationale:CPT is a trauma-focused cognitive therapy that helps clients identify and challenge unhelpful beliefs and thoughts related to the traumatic experience.
A school-age child with ADHD frequently leaves their seat, interrupts others, and has difficulty remaining focused during class. Which intervention should the nurse recommend?
A. Provide lengthy instructions.
B. Use short, clear instructions and positive reinforcement.
C. Ignore all inappropriate behaviors.
D. Punish the child for every interruption.
B
Rationale:Children with ADHD often benefit from brief instructions, structure, consistency, positive reinforcement, and minimizing distractions.
According to Freud's psychoanalytic theory, which component of personality operates according to the pleasure principle?
A. Ego
B. Superego
C. Id
D. Conscious mind
C — Id
Rationale:The id seeks immediate gratification and operates according to the pleasure principle.
A pregnant client reports using alcohol throughout pregnancy. Which fetal complication is the nurse most concerned about?
A. Fetal alcohol spectrum disorder
B. Improved fetal growth
C. Increased birth weight
D. Enhanced neurological development
A
Rationale:Alcohol exposure during pregnancy can cause fetal alcohol spectrum disorders, which may result in growth problems, facial abnormalities, and lifelong cognitive and behavioral effects.
A 10-year-old child is brought to the clinic because teachers report difficulty sitting still, frequent interruptions, and problems completing assignments. The parent reports the behavior occurs at both home and school. Which disorder should the nurse suspect?
A. Autism spectrum disorder
B. ADHD
C. Conduct disorder
D. ODD
B — ADHD
Rationale:ADHD involves persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning. Symptoms occurring in multiple settings support the diagnosis.
A client with schizophrenia is participating in group therapy. Which nursing intervention is most appropriate?
A. Encourage the client to dominate the conversation.
B. Establish clear expectations and encourage appropriate social interaction.
C. Require the client to discuss hallucinations with the entire group.
D. Allow the client to isolate during the entire session.
B
Rationale:Group therapy can help clients develop communication and social skills. The nurse should provide structure, clear expectations, and opportunities for appropriate interaction.
A nurse is assessing a child with autism spectrum disorder. Which finding would the nurse expect?
A. Difficulty with social communication and interaction
B. Consistently strong social skills
C. No repetitive behaviors
D. Rapid development of social relationships
A
Rationale:Autism spectrum disorder involves persistent difficulties with social communication/interaction and restricted or repetitive patterns of behavior, interests, or activities.
A client says, "I know I shouldn't spend all my money, but I really want this right now!" Which part of Freud's personality structure is primarily seeking immediate gratification?
A. Id
B. Ego
C. Superego
D. Reality principle
A — Id
Rationale:The id seeks immediate pleasure and gratification without considering consequences.
A pregnant client reports using opioids regularly. Which newborn finding should the nurse anticipate?
A. Neonatal withdrawal symptoms
B. Increased muscle tone with no withdrawal
C. Improved feeding
D. No possible effects
A
Rationale:Infants exposed to opioids during pregnancy can develop neonatal opioid withdrawal syndrome, which may include irritability, tremors, feeding difficulties, diarrhea, and sleep disturbances.
A client who experienced a serious car accident refuses to drive, experiences nightmares, and becomes extremely anxious when seeing another vehicle similar to the one involved in the accident.Which intervention is most appropriate?
A. Encourage gradual exposure to trauma-related triggers as part of appropriate therapy.
B. Tell the client to avoid all reminders permanently.
C. Tell the client the accident is in the past and should be forgotten.
D. Encourage the client to immediately drive alone.
A
Rationale:Avoidance can maintain PTSD symptoms. Trauma-focused treatments, including appropriate exposure-based approaches and CPT, can help clients process trauma and reduce avoidance.
A client with depression has difficulty identifying negative thought patterns. Which therapy would be most appropriate?
A. Cognitive behavioral therapy
B. Psychoanalysis only
C. Seclusion therapy
D. Exposure to trauma without preparation
A
Rationale:Cognitive behavioral therapy helps clients identify and change unhealthy thought patterns and behaviors. It is commonly used to treat depression and anxiety disorders.
A child with autism becomes overwhelmed by loud noises and begins covering their ears and rocking back and forth. What is the nurse's best initial action?
A. Increase environmental stimulation.
B. Tell the child to stop the behavior.
C. Reduce sensory stimulation and provide a calm environment.
D. Immediately place the child in seclusion.
C
Rationale:
Sensory sensitivity is common in autism. Reducing excessive sensory stimulation can decrease distress and help the child regain control.
A client with factitious disorder repeatedly presents to hospitals with fabricated symptoms and undergoes unnecessary medical procedures. What is the nurse most likely to understand about this behavior?
A. The client is intentionally seeking financial compensation.
B. The client intentionally produces symptoms to assume the sick role.
C. The client is experiencing symptoms they are imagining but not intentionally producing.
D. The client has no awareness of their behavior.
B
Rationale:Factitious disorder involves intentionally producing or falsifying illness symptoms primarily to assume the sick role. Unlike malingering, the primary motivation is not an obvious external reward.
A pregnant client asks why substance use is particularly concerning during pregnancy. Which response is best?
A. "Only alcohol can affect the fetus."
B. "Substances can cross the placenta and potentially affect fetal development."
C. "The placenta completely protects the fetus."
D. "The fetus is only affected during labor."
B
Rationale:Many substances can cross the placenta and affect fetal growth and development. The type, dose, timing, and duration of exposure can influence the effects.
A 17-year-old has been repeatedly fighting at school, stealing from classmates, damaging school property, and threatening teachers. The parents report that the behavior has been occurring for more than a year. Which diagnosis is most consistent with these findings?
A. ODD
B. ADHD
C. Conduct disorder
D. Intermittent explosive disorder
C — Conduct disorder
Rationale:The client demonstrates a persistent pattern of aggression, theft, property destruction, and serious rule violations. These behaviors are characteristic of conduct disorder.
A client with PTSD avoids driving because they were previously involved in a serious motor vehicle accident. Which therapy may help the client gradually confront the feared situation in a controlled manner?
A. Exposure therapy
B. Supportive therapy only
C. Psychoanalysis
D. Electroconvulsive therapy
A
Rationale:Exposure-based therapies gradually expose clients to trauma-related memories, situations, or triggers in a safe and controlled environment to reduce avoidance and anxiety.
A nurse is differentiating ADHD from conduct disorder. Which behavior is more consistent with conduct disorder?
A. Difficulty remaining seated
B. Forgetfulness
C. Repeatedly physically attacking others
D. Difficulty completing homework
C
Rationale:Conduct disorder involves serious violations of the rights of others or societal rules, including aggression, destruction, theft, and other severe behaviors.
A client says, "Everyone at work hates me because they think I'm incompetent." The client interprets neutral facial expressions as criticism. Which concept is most relevant?
A. Social cognition
B. Classical conditioning
C. Delirium
D. Psychomotor retardation
A — Social cognition
Rationale: Social cognition refers to how individuals perceive, interpret, and respond to social information. Distorted interpretations can affect relationships and behavior.
The nurse is caring for a pregnant client who uses cocaine. Which fetal complication is the nurse concerned about?
A. Placental abruption
B. Increased fetal growth
C. Improved oxygenation
D. Reduced maternal blood pressure
A
Rationale:Cocaine causes vasoconstriction and can increase the risk of complications such as placental abruption, fetal growth restriction, and preterm birth.
A client arrives at the emergency department after intentionally cutting their arm. The client states, "I wasn't trying to die. I just needed the emotional pain to stop." The client has a history of depression and recently lost their job. What should the nurse do first?
A. Ask the client why they lost their job.
B. Determine whether the client has current suicidal thoughts, intent, plan, and access to lethal means.
C. Tell the client that self-harm is unhealthy.
D. Begin teaching relaxation techniques.
B
Rationale:Even when a client reports that self-harm was not intended to cause death, NSSI is associated with increased suicide risk. Immediate safety assessment takes priority.
The nurse is planning treatment for several clients. Which client would most likely benefit from group therapy?
A. A client experiencing acute psychosis who cannot maintain reality orientation
B. A client who needs to develop interpersonal and social skills
C. A client who is actively suicidal and requires constant observation
D. A client experiencing severe withdrawal with unstable vital signs
B
Rationale:Group therapy can be especially helpful for improving interpersonal skills, communication, socialization, coping, and learning from others with similar experiences. Clients who are acutely unstable may require individual stabilization first.
The parents of an adolescent with conduct disorder state, "We don't understand why our child keeps getting into fights and breaking rules." Which nursing response is most appropriate?
A. "Your child just needs stricter punishment."
B. "Conduct disorder involves a persistent pattern of behaviors that violate others' rights or major rules."
C. "This behavior is completely normal for adolescents."
D. "You should avoid setting any limits."
B
Rationale:Conduct disorder is more than typical adolescent rebellion. Consistent behavioral interventions, clear limits, family involvement, and treatment of coexisting conditions may be necessary.
The nurse is comparing factitious disorder and malingering. Which statement is correct?
A. Factitious disorder is always motivated by financial gain.
B. Malingering involves intentionally producing symptoms for an external incentive.
C. Factitious disorder involves unconscious production of symptoms.
D. Malingering is considered a personality disorder.
B
Rationale:Malingering = external gain, such as avoiding work, obtaining medications, or receiving financial compensation. Factitious disorder = assuming the sick role without an obvious external reward.
A pregnant client reports using multiple substances and asks the nurse, "Should I just stop everything immediately?" What is the nurse's best response?
A. "Yes. Stop everything immediately without medical supervision."
B. "You should discuss stopping substances with your healthcare provider so withdrawal and fetal safety can be appropriately managed."
C. "Continue using the substances until delivery."
D. "Only alcohol needs to be stopped."
B
Rationale:Abrupt cessation of some substances can create significant withdrawal risks. Pregnancy and substance use require individualized medical management. The nurse should encourage prompt professional evaluation rather than giving unsafe instructions.
A nurse is caring for a 16-year-old adolescent who was recently diagnosed with conduct disorder. The adolescent has been suspended from school for repeatedly fighting, stealing, and destroying school property.During the interview, the adolescent says:
"Everyone keeps telling me I'm the problem. I don't care what happens anymore."
The parent reports that over the past 6 months the adolescent has also been using alcohol, skipping school, staying out all night, and becoming increasingly aggressive. The adolescent's older sibling was recently incarcerated.The nurse notices that the adolescent becomes angry whenever limits are discussed and responds, "You're not my boss."
Which nursing intervention should be included FIRST in the treatment plan?
A. Allow the adolescent to establish their own rules to prevent power struggles.
B. Establish clear, consistent limits and consequences while maintaining a calm, nonjudgmental approach.
C. Use strict punishment immediately after every inappropriate behavior to discourage future violations.
D. Encourage the adolescent to discuss childhood experiences before establishing behavioral expectations.
B
Rationale:The priority when caring for an adolescent with conduct disorder is to establish clear, consistent boundaries and expectations while maintaining a therapeutic relationship.The adolescent's behavior involves aggression, theft, destruction of property, substance use, and serious rule violations. A structured environment with predictable consequences helps reduce behavioral problems and provides consistency.