NCLEX Practice Exam for Psychiatric Nursing 1

EXPLANATION

 

✔Correct answer:

Symptoms are an expression of psychological conflicts through physical manifestations.  Somatoform disorders, now commonly referred to as somatic symptom and related disorders, involve the expression of psychological conflicts and distress through physical symptoms. These physical symptoms cannot be fully explained by any underlying medical or organic condition, and the symptoms are not intentionally produced or feigned. The manifestation of these symptoms is the body's way of coping with psychological issues, often leading to significant distress and impairment in daily functioning.

Imagine feeling nervous about an upcoming presentation. Instead of just feeling anxious, your body responds by giving you a stomachache. The stomachache is a real physical symptom, but it's caused by your psychological stress.

Individuals with somatoform disorders often experience real physical discomfort and may frequently seek medical attention, but the root cause of their symptoms lies in unresolved psychological conflicts. Understanding this connection is crucial for effective management, which often involves a combination of psychological therapies, such as cognitive-behavioral therapy (CBT), and supportive care rather than purely medical treatments.

 

✘Incorrect answer options:

Physical symptoms are directly explained by organic causes. This statement is inaccurate because, by definition, somatoform disorders involve physical symptoms that cannot be fully explained by organic causes. The symptoms are instead linked to psychological factors.

Symptoms are a voluntary manifestation of psychological conflicts. This is incorrect because somatoform disorder symptoms are not produced voluntarily or intentionally. They are involuntary and reflect the individual's psychological state.

Management of somatoform disorders includes specific medical treatments targeted at the symptoms. While medical treatments may be used to address some physical symptoms, the primary management of somatoform disorders focuses on psychological therapies to address the underlying psychological conflicts. Purely medical treatments are often ineffective because the symptoms stem from psychological rather than organic causes.

 

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Publishing.
• Kaplan, H. I., & Sadock, B. J. (2015). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

Implement a highly structured environment for the child. Children with attention deficit hyperactivity disorder (ADHD) often benefit from a highly structured environment. Structure provides predictability and stability, helping these children manage their symptoms more effectively. A structured environment includes clear rules, consistent routines, and specific instructions, which can help reduce anxiety and improve focus. This approach can also minimize the child's impulsive and hyperactive behaviors by providing a predictable framework within which they can operate more comfortably.

Think of a structured environment as a well-organized closet. Just as an organized closet makes it easier to find and put away items, a structured environment helps children with ADHD navigate their day more smoothly, reducing confusion and improving focus.

The predictable nature of a structured environment can help mitigate some of the challenges faced by children with ADHD, such as difficulties with attention, impulsivity, and hyperactivity. Clear expectations and routines can provide a sense of security and reduce behavioral issues, making it easier for the child to succeed academically and socially.

 

✘Incorrect answer options:

Overlook the child’s hyperactive behaviors. Ignoring hyperactive behaviors is not an effective strategy. While some minor behaviors may be overlooked to avoid unnecessary attention, generally overlooking hyperactivity can lead to a lack of intervention and support for the child, exacerbating the problem.

Promote participation in any form of play to help manage energy levels. While physical activity is important, not all forms of play are suitable for managing energy levels in children with ADHD. Activities should be structured and supervised to ensure they are beneficial and not overstimulating or leading to increased hyperactivity.

Exclude the child from the classroom during episodes of disruptive behavior. Exclusion can be detrimental to the child's educational and social development. Instead of exclusion, strategies such as positive reinforcement, time-out within the classroom, or other behavioral interventions should be used to manage disruptive behavior while keeping the child engaged in the learning environment.

 

References

• Barkley, R. A. (2013). Taking Charge of ADHD: The Complete, Authoritative Guide for Parents. Guilford Press.
• American Academy of Pediatrics. (2019). ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics.

EXPLANATION

 

✔Correct answer:

Somatoform Pain Disorder. Somatoform Pain Disorder, now often referred to as Somatic Symptom Disorder with predominant pain, is characterized by severe and prolonged pain that causes significant distress or impairment, despite no clear medical explanation. The key feature here is the presence of pain that is inconsistent with physical findings, which aligns with the patient's ongoing low back pain and negative test results. This disorder often leads to significant functional impairment and frequent absences from work, as described in the scenario.

Imagine constantly feeling an intense toothache, but every time you visit the dentist, they find no issues with your teeth. The pain is real and distressing, even though the medical tests show nothing wrong.

Somatoform Pain Disorder can be influenced by psychological factors, such as stress or unresolved emotional issues. The pain experienced is real to the patient, even if there is no identifiable physical cause. Treatment often involves a multidisciplinary approach, including pain management, psychotherapy, and sometimes medication to address associated anxiety or depression.

 

✘Incorrect answer options:

Somatization Disorder. Somatization Disorder involves multiple physical complaints affecting various body systems, typically beginning before age 30. It usually includes gastrointestinal, neurological, and sexual symptoms, not limited to pain. The scenario focuses specifically on low back pain, making this disorder less likely.

Hypochondriasis. Hypochondriasis, now classified as Illness Anxiety Disorder, is characterized by excessive worry about having a serious illness despite medical reassurance and minimal somatic symptoms. The patient's primary issue is persistent pain rather than a fear of illness, so this disorder is not the best fit.

Conversion Disorder. Conversion Disorder involves neurological symptoms, such as paralysis, blindness, or seizures, that cannot be explained by medical conditions. It typically manifests as sudden onset of dramatic symptoms affecting motor or sensory function. The patient's complaint of chronic low back pain does not align with the typical presentation of Conversion Disorder.

 

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Publishing.
• Kaplan, H. I., & Sadock, B. J. (2015). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

"When I tell my child to do something, I don’t expect to have to tell her again." This statement suggests unrealistic expectations for a 3-year-old child's behavior and obedience. At this developmental stage, children are still learning to understand and follow instructions, and it is normal for them to require repeated reminders. Expecting immediate and unfaltering obedience could indicate a potential for overly strict or punitive responses from the parent, which might lead to emotional or physical abuse if the child fails to meet these expectations.

Consider a young puppy learning to follow commands. It would be unreasonable to expect the puppy to consistently obey after being told once. Similarly, a 3-year-old child needs patient guidance and repeated instructions to learn and understand expectations.

The development of children at the age of three includes exploring autonomy and testing boundaries, often by not immediately obeying commands. Parents who have rigid expectations for compliance may resort to harsh disciplinary measures, which can harm the child's emotional and physical well-being. Recognizing such statements in clinical settings can help healthcare professionals provide timely guidance and intervention to prevent potential abuse.

 

✘Incorrect answer options:

"Once my child is toilet trained, I can still expect her to have accidents occasionally." This statement reflects an understanding and acceptance of normal developmental processes. It indicates patience and realistic expectations from the parent, which are positive attributes in child-rearing.

"My child is encouraged to try doing things like dressing and feeding herself." Encouraging independence in tasks appropriate for a child's age, such as dressing and feeding, is considered a healthy practice. It supports the child's developmental milestones and autonomy.

"My 3-year-old loves to say 'NO' to everything." This observation is typical for the developmental stage known as the "terrible threes," where children assert their independence and may frequently use "NO" to express themselves. Acknowledging this behavior as a normal phase shows parental awareness of normal child development.

 

References

• American Academy of Pediatrics. (2020). Caring for Your Baby and Young Child: Birth to Age 5. 7th ed. Bantam Books.
• Zero to Three. (2018). Early Development & Well-Being. Zero to Three.

EXPLANATION

 

✔Correct answer:

Impaired social interaction. Impaired social interaction refers to difficulty engaging in or maintaining social relationships and activities. In the context of a client who frequently complains of low back pain without any positive medical findings, this diagnosis is less relevant. There is no indication from the provided information that the client's social interactions are affected by his condition. The primary issues appear to be related to coping with pain, comfort levels, and role performance, rather than social interactions.

If someone frequently misses work due to back pain but still attends social events and maintains friendships without difficulty, it wouldn’t make sense to diagnose them with impaired social interaction.

This diagnosis would focus on social behaviors and relationships, which are not the main concern in this scenario. The client's main challenges revolve around managing pain and its impact on his daily functioning and role performance. Addressing these issues is more relevant to his current situation and would provide a more accurate and effective care plan.

 

✘Incorrect answer options:

Ineffective individual coping. This diagnosis is appropriate as it addresses the client's potential difficulty in managing his symptoms and the resulting stress or frustration, which could be contributing to his frequent complaints of pain.

Altered comfort: pain. This diagnosis directly pertains to the client's ongoing complaint of low back pain. It acknowledges the discomfort and aims to find strategies to alleviate or manage the pain, even if it is not supported by medical findings.

Altered role performance. This diagnosis is relevant because the client's frequent absences from work due to pain indicate a disruption in his ability to perform his expected role as an employee. Addressing this issue can help in developing strategies to improve his work attendance and performance.

 

References

• Herdman, T. H., & Kamitsuru, S. (2018). NANDA International Nursing Diagnoses: Definitions and Classification, 2018-2020. Thieme.
• Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care. F.A. Davis Company.

EXPLANATION

 

✔Correct answer:

Sexual Desire Disorder. Sexual desire disorder, also known as hypoactive sexual desire disorder (HSDD), is characterized by a persistent or recurrent lack of interest in sexual activity. The wife's admission of abuse and her expression of a persistent distaste for sexual activity align with the symptoms of a sexual desire disorder. This condition often results from psychological factors such as trauma, abuse, or emotional distress, which can significantly impact a person's interest in engaging in sexual activities.

Imagine having a favorite hobby, like painting, which you suddenly lose all interest in after a traumatic experience related to it. This loss of interest and aversion to something you once enjoyed is similar to what happens in sexual desire disorder.

Sexual desire disorder can be heavily influenced by past trauma, such as abuse, leading to an aversion to sexual activities. Psychological counseling and therapy are often essential components of treatment, helping individuals address and process their trauma. Understanding the underlying psychological causes is crucial for effective treatment and management of the disorder.

 

✘Incorrect answer options:

Sexual Arousal Disorder. Sexual arousal disorder involves difficulty in becoming sexually aroused or maintaining arousal during sexual activity. It is more about the physical response rather than a lack of desire. Given the wife's expressed distaste and persistent avoidance of sexual activity, this category does not fit as well as sexual desire disorder.

Orgasm Disorder. Orgasm disorder refers to difficulties in achieving orgasm despite adequate arousal and stimulation. This issue is distinct from a lack of sexual desire, focusing more on the physiological response rather than the desire to engage in sexual activity.

Sexual Pain Disorder. Sexual pain disorders involve pain associated with sexual intercourse, such as dyspareunia or vaginismus. The wife's issue, characterized by a lack of desire and aversion to sexual activity rather than physical pain during intercourse, does not align with this category.

 

References

• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Wolters Kluwer.
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Publishing.

EXPLANATION

 

✔Correct answer:

Administering medications to a patient diagnosed with schizophrenia. The role of a technician in psychiatric care, particularly a psychiatric technician, often involves direct patient care tasks such as administering medications. Technicians are trained to manage and administer psychotropic medication under the supervision of registered nurses or physicians, which is critical for patients with conditions like schizophrenia where medication adherence is essential for effective management.

Think of a technician as a gardener who ensures that the plants get the right amount and type of nutrients they need at the right time. Just as the gardener uses specific tools and knowledge to care for the garden, the technician uses their skills and tools to provide the right medications to help manage psychiatric conditions.

Psychiatric technicians play a crucial role in the therapeutic environment of psychiatric units. Their responsibilities are pivotal in implementing treatment plans, which includes medication management—a key component in the stabilization of psychiatric symptoms.

 

✘Incorrect answer options:

Feeding and bathing a patient in a catatonic state. These tasks are generally within the scope of nursing assistants or caregivers who provide basic care and assistance with daily living activities, rather than technicians who focus more on therapeutic interventions.

Overseeing and coordinating all aspects of a patient’s care. This responsibility typically falls to registered nurses or clinical nurse leaders who have broader duties that include coordination and oversight of patient care plans.

Providing education about the effects of alcohol. While technicians might assist in educational tasks, this role is more commonly associated with health educators or nurses who specialize in patient and family education and have extensive training in counseling and educational methodologies.

 

References

• American Association of Psychiatric Technicians. (2022). Roles and Responsibilities.
• National Alliance on Mental Illness. (2020). Understanding the Roles in Mental Health Services.

EXPLANATION

 

✔Correct answer:

Ensuring the child's immediate safety. The most critical intervention in cases of suspected child abuse is ensuring the child's immediate safety. This priority aligns with the fundamental nursing principle of safeguarding the patient's well-being. In situations where abuse is suspected, the child's safety is paramount to prevent further harm. Ensuring safety might involve removing the child from the abusive environment, arranging protective custody, or involving child protective services.

Imagine finding a child in a dangerous situation, like standing in the middle of a busy road. The first and most crucial step is to get the child out of immediate harm's way before addressing any other concerns.

Prioritizing the child's immediate safety can help prevent further trauma and allow for a secure environment in which the child can begin to heal. It also provides a foundation for subsequent interventions, such as therapeutic support and family dynamics exploration, to be more effective.

 

✘Incorrect answer options:

Evaluating the extent of the abuse. While assessing the extent of abuse is important for treatment and legal purposes, it should come after ensuring the child's safety. Focusing on evaluation first may delay removing the child from a harmful situation.

Exploring the dynamics within the family. Understanding family dynamics is essential for long-term intervention and support, but it is secondary to immediate safety concerns. Once the child is safe, comprehensive assessments can be conducted to understand the context and provide appropriate support.

Providing the child with coping mechanisms. Teaching coping mechanisms is vital for the child's psychological recovery and resilience. However, this step is more effective once the child is in a safe environment and the immediate threat has been addressed.

 

References

• Hockenberry, M. J., & Wilson, D. (2018). Wong's Nursing Care of Infants and Children. 11th ed. Elsevier.
• American Academy of Pediatrics. (2020). Recognizing and Reporting Child Abuse. American Academy of Pediatrics.

EXPLANATION

 

✔Correct answer:

Long-term memory. When the patient is trying to remember the name of a college professor, they are accessing information stored in their long-term memory. Long-term memory involves the storage of information over an extended period, including names, personal experiences, and knowledge acquired over time. Recalling the name of a professor from college, which likely occurred years ago, involves retrieving information from long-term memory.

Think of long-term memory as a vast library where you store books of information from different periods of your life. When you want to find a specific book (like the name of a college professor), you need to search through the library’s catalog to locate it.

Nurse Andrews should give the patient time to recall the information, as retrieving data from long-term memory can take a moment. Encouraging the patient and providing a calm environment can aid in the recall process. If the patient struggles to remember, gentle prompting or asking related questions can help trigger the memory.

 

✘Incorrect answer options:

Short-term memory Short-term memory involves the temporary storage of information that is currently being used or processed, typically lasting for a few seconds to a minute. It is not primarily used for recalling information from years ago.

Working memory Working memory is a cognitive system that temporarily holds and manipulates information needed for tasks such as reasoning, learning, and comprehension. It involves actively processing and managing information currently in use but is not the primary system used for retrieving long-term memories.

Sensory memory Sensory memory is the shortest-term element of memory that stores sensory impressions (such as sights and sounds) for a brief period, usually less than a second. It is not involved in the recall of information stored over long periods.

 

References

• Townsend, M. C. (2018). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (9th ed.). Philadelphia, PA: F.A. Davis.
• Varcarolis, E. M. (2020). Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care (4th ed.). St. Louis, MO: Elsevier.

EXPLANATION

 

✔Correct answer:

It serves as the censoring part of the mind. The superego is one of the three components of Sigmund Freud's model of the psyche, which also includes the id and the ego. The superego is responsible for enforcing moral standards and ideals acquired from parents and society. It functions as the internal censor, monitoring and regulating behaviors by producing feelings of guilt or pride based on whether one's actions align with these internalized standards. The superego strives to suppress the urges of the id and to make the ego act upon idealistic standards rather than upon realistic principles.

Think of the superego as a strict parent or a judge inside your mind, constantly evaluating your actions and thoughts to ensure they align with moral and societal standards. If you do something wrong, it makes you feel guilty, and if you do something right, it makes you feel proud.

The superego plays a crucial role in shaping an individual's conscience and moral behavior. It develops during early childhood through the process of internalizing the values and norms of parents and significant figures. A well-developed superego leads to a strong sense of right and wrong, while an overly harsh superego can result in excessive feelings of guilt and self-criticism. Conversely, a weak superego might lead to a lack of moral direction and impulsive behaviors.

 

✘Incorrect answer options:

It engages in defensive mechanisms to protect the self. This describes the function of the ego, not the superego. The ego employs defense mechanisms such as repression, denial, and rationalization to manage conflict between the id and the superego and to protect the self from anxiety.

It acts impulsively and lacks a moral framework. This describes the id, which is the part of the psyche driven by primitive impulses and desires. The id operates based on the pleasure principle and seeks immediate gratification without considering moral or societal constraints.

It evaluates situations before making decisions. This describes the function of the ego. The ego operates based on the reality principle, balancing the demands of the id and the superego while taking into account the practical aspects of situations to make rational decisions.

 

References

• Videbeck, S. L. (2020). *Psychiatric-Mental Health Nursing*. Wolters Kluwer.
• Townsend, M. C., & Morgan, K. I. (2021). *Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice*. F.A. Davis.

EXPLANATION

 

✔Correct answer:

Intolerance to change, difficulty in forming relationships, and repetitive behaviors. Autism Spectrum Disorder (ASD) is characterized by a range of symptoms that typically include intolerance to change, difficulty in forming relationships, and engaging in repetitive behaviors. Children with autism often prefer routines and may become distressed with changes in their environment or schedule. They may struggle with social interactions and have difficulty understanding social cues, making it hard to form relationships. Repetitive behaviors or restricted interests, such as hand-flapping, lining up toys, or intense focus on specific topics, are also common.

Think of someone who feels comfortable only in their own house and gets very anxious if they have to stay somewhere else. They also prefer doing the same activities every day and get upset if the routine is disrupted. This comfort with sameness and routine, and difficulty with change, mirrors the experiences of many children with autism.

Recognizing these core symptoms is crucial for early identification and intervention, which can significantly improve outcomes for children with autism. Interventions may include behavioral therapies, social skills training, and educational support to help children develop communication skills, manage behavior, and enhance social interactions.

 

✘Incorrect answer options:

Argumentativeness, disobedience, and frequent angry outbursts. These behaviors are more commonly associated with Oppositional Defiant Disorder (ODD), where children exhibit a pattern of angry, defiant, and argumentative behavior.

Distractibility, impulsiveness, and hyperactivity. These symptoms are characteristic of Attention-Deficit/Hyperactivity Disorder (ADHD), where children struggle with maintaining attention, controlling impulses, and regulating activity levels.

Aggressive behavior, truancy, stealing, and lying. These behaviors are indicative of Conduct Disorder, which involves a persistent pattern of violating societal norms and the rights of others through aggressive and antisocial behaviors.

 

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Publishing.
• Lord, C., & Bishop, S. L. (2015). Autism Spectrum Disorder: Diagnosis, Prevalence, and Services for Children and Families. Social Policy Report.

EXPLANATION

 

✔Correct answer:

Reintroducing the child to school immediately with support from family members. The most effective approach for treating school phobia, also known as school refusal, involves reintroducing the child to the school environment as soon as possible, with appropriate support from family members and school staff. This method aims to prevent prolonged avoidance of school, which can exacerbate anxiety and make reintegration more difficult. The support from family members provides emotional security and reassurance, helping the child gradually overcome their fear.

Think of facing a fear of swimming by gradually re-entering the pool with a trusted friend. Their support makes you feel safer and more confident, helping you to face and overcome your fear.

Immediate reintroduction with support helps the child confront their fears in a structured and supportive manner. Avoidance can reinforce anxiety, so a gradual and supported return to school helps desensitize the child to their fears and promotes positive coping strategies. Family involvement is crucial as it provides consistent encouragement and reinforcement, aiding the child in building resilience and confidence.

 

✘Incorrect answer options:

Patiently explaining the importance of attending school. While educating the child on the importance of school is beneficial, it alone is unlikely to address the underlying anxiety associated with school phobia. Action-oriented approaches are typically more effective.

Permitting the child to enter the school before other students arrive. This approach may provide temporary relief but does not address the broader issue of anxiety related to school attendance and social interaction. It can also reinforce avoidance behavior by allowing the child to evade normal school routines.

Allowing a parent to stay with the child in the classroom. While initially comforting, this approach can create dependency and hinder the child's ability to develop independence and coping skills. It may also disrupt the classroom environment and the child's ability to integrate with peers.

 

References

• Kearney, C. A. (2008). School Refusal Behavior in Youth: A Functional Approach to Assessment and Treatment. American Psychological Association.
• Elliott, J. G., & Place, M. (2019). Children in Difficulty: A Guide to Understanding and Helping. 3rd ed. Routledge.

EXPLANATION

 

✔Correct answer:

Moderate. An I.Q. of 45 falls within the range of moderate intellectual disability, which is typically characterized by an I.Q. of 35-49. Children with moderate intellectual disability usually exhibit significant developmental delays, including limited vocabulary and interaction skills. They can learn basic communication and self-care skills but require considerable support in daily living and academic activities. This classification helps guide the appropriate level of educational and social support the child needs.

Think of learning to drive. A person with moderate intellectual disability might be like someone who needs extra help to understand the rules of the road and how to operate a car, requiring ongoing instruction and support to drive safely.

Children with moderate intellectual disability benefit from specialized educational programs and therapeutic interventions that focus on developing functional skills. They often require structured environments and individualized teaching strategies to make progress in their development. Social and emotional support is also crucial to help them build confidence and improve their quality of life.

 

✘Incorrect answer options:

Profound. Profound intellectual disability is characterized by an I.Q. below 20-25. Individuals with profound intellectual disability have severe limitations in communication, mobility, and self-care, requiring extensive support for all daily activities. This classification does not fit the described I.Q. of 45.

Mild. Mild intellectual disability is characterized by an I.Q. of 50-70. Individuals with mild intellectual disability can achieve higher levels of academic and social functioning with appropriate support. The described delays and I.Q. of 45 indicate a more significant impairment than what is seen in mild intellectual disability.

Severe. Severe intellectual disability is characterized by an I.Q. of 20-34. While this is closer to the described I.Q. of 45, it still denotes more severe limitations than what the moderate classification encompasses. Severe intellectual disability typically involves greater challenges in daily functioning than those described for the child in this case.

 

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Publishing.
• Hodapp, R. M. (1997). Development and Disabilities: Intellectual, Sensory, and Motor Impairments. Cambridge University Press.

EXPLANATION

 

✔Correct answer:

Pre-operational stage. According to Jean Piaget’s theory of cognitive development, a 5-year-old child is in the pre-operational stage, which typically ranges from ages 2 to 7. During this stage, children begin to engage in symbolic play and learn to manipulate symbols, but they do not yet understand concrete logic. Their thinking is still very much egocentric, meaning they have difficulty seeing things from perspectives other than their own.

Children in the pre-operational stage are characterized by rapid development of language and imagination. They use words and images to represent objects, but they cannot perform operations or reversible mental processes. This stage also includes an increase in pretend play and the use of symbols, like a stick becoming a sword.

Imagine the cognitive development of a child as building a house. During the pre-operational stage, the child is laying the groundwork by gathering bricks and materials (symbols and words) but hasn’t yet learned how to construct complex structures (logical thinking and operations). They can envision a house and play pretend with their materials, but they can’t yet build a stable, functional structure.

Understanding that a 5-year-old child is in the pre-operational stage is crucial for tailoring educational activities and communication strategies. Nurses and educators should use simple language, visual aids, and interactive play to facilitate learning and ensure that instructions are clear and concrete. Activities that encourage symbolic play, such as drawing, storytelling, and role-playing, can be particularly beneficial.

 

✘Incorrect answer options:

Sensory motor stage. The sensory motor stage occurs from birth to approximately 2 years of age. During this stage, infants learn about the world through their senses and actions, such as looking, touching, and mouthing objects. This stage includes the development of object permanence.

Concrete operational stage. The concrete operational stage occurs from approximately 7 to 11 years of age. In this stage, children begin to think logically about concrete events. They gain a better understanding of the concept of conservation and can perform mathematical operations.

Formal operational stage. The formal operational stage begins around age 12 and continues into adulthood. During this stage, individuals develop the ability to think abstractly, reason logically, and plan systematically. They can solve hypothetical problems and think about future possibilities.

 

References

• Piaget, J. (1952). The Origins of Intelligence in Children. International Universities Press.
• Santrock, J. W. (2018). Child Development (15th ed.). McGraw-Hill Education.

EXPLANATION

 

✔Correct answer:

Overprotection of the child. Overprotection can hinder a child's development by limiting their opportunities to learn and practice new skills, gain independence, and build confidence. While it is natural for parents to want to protect their child, especially if they have intellectual disabilities, it is important to balance protection with encouragement of independence and self-sufficiency. Overprotection can lead to increased dependence, reduced self-esteem, and can prevent the child from reaching their full potential.

Imagine teaching a child to ride a bike. If you never let go of the bike because you fear they might fall, they will never learn to balance and ride on their own.

Allowing children to face challenges and learn from their experiences, with appropriate support and supervision, is crucial for their development. Encouraging small steps towards independence can help children build confidence, problem-solving skills, and resilience. It is important to create a supportive environment where children feel safe to explore and learn, but also to encourage them to take on new challenges and responsibilities.

 

✘Incorrect answer options:

Emphasizing patience, establishing routines, and repetitive learning. These strategies are beneficial for children with intellectual disabilities. Establishing routines and using repetitive learning techniques help reinforce skills and provide a sense of stability and predictability.

Helping the parents set realistic goals for the child. Setting realistic goals is important for maintaining motivation and ensuring steady progress. It helps in tracking development and celebrating achievements, no matter how small.

Offering genuine praise and positive reinforcement. Positive reinforcement and genuine praise are essential for encouraging desired behaviors and building self-esteem. Recognizing and celebrating achievements, no matter how small, can motivate children to continue making efforts and improving their skills.

 

References

• Heward, W. L. (2013). Exceptional Children: An Introduction to Special Education. 10th ed. Pearson.
• Turnbull, A., Turnbull, R., Wehmeyer, M. L., & Shogren, K. A. (2013). Exceptional Lives: Special Education in Today's Schools. 8th ed. Pearson.

EXPLANATION

 

✔Correct answer:

Rearranging the environment to encourage the child to be more active. Rearranging the environment to encourage a child with autism to be more active is not typically included as a therapeutic approach in the care of an autistic child. Children with autism often thrive on routine and predictability, and sudden changes in their environment can cause significant stress and anxiety. Instead, therapeutic approaches focus on creating a stable, predictable environment and using evidence-based strategies to support the child's development and well-being.

Children with autism may have difficulties with sensory processing, and altering their environment drastically could lead to overstimulation or distress. Effective therapeutic strategies emphasize a structured environment where routines are maintained, and changes are introduced gradually and with preparation. The goal is to create a sense of safety and predictability, allowing the child to engage in therapeutic activities without feeling overwhelmed.

Think of an autistic child like a plant that thrives in a specific type of soil, with consistent sunlight and water. Suddenly changing the soil or the environment can cause the plant to wither rather than flourish. Similarly, an autistic child benefits from a stable and predictable environment rather than one that is constantly changing.

It is crucial for nurses and caregivers to create a supportive and accepting environment for children with autism. This involves understanding the child's unique needs and preferences, maintaining consistent routines, and providing clear and predictable communication. Safety measures are also essential to protect the child from potential hazards, especially if they have a tendency to engage in self-injurious behaviors or elopement.

 

✘Incorrect answer options:

Engaging the child in diversionary activities during episodes of acting out. Engaging a child with autism in diversionary activities can be an effective strategy to manage episodes of acting out. These activities can help redirect the child's focus and reduce stress or anxiety that may be contributing to the behavior.

Creating an atmosphere of acceptance around the child. Creating an atmosphere of acceptance is a fundamental therapeutic approach for children with autism. It helps build trust and allows the child to feel safe and understood, which is crucial for their emotional and social development.

Implementing safety measures to protect the child. Implementing safety measures is essential in the care of children with autism. Due to potential issues such as elopement, self-injurious behaviors, and sensory sensitivities, ensuring a safe environment is a top priority for caregivers and healthcare professionals.

 

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Volkmar, F. R., & Wiesner, L. A. (2009). A Practical Guide to Autism: What Every Parent, Family Member, and Teacher Needs to Know. John Wiley & Sons.

EXPLANATION

 

✔Correct answer:

A state of well-being enabling one to recognize personal abilities, manage everyday stress, and contribute productively. This definition aligns with the World Health Organization’s perspective on mental health, emphasizing it as a positive state of well-being. It highlights the ability to cope with normal life stresses, work productively, and contribute to the community, which are critical components for fostering a comprehensive understanding of mental health. It reflects a holistic view where mental health is not just the absence of mental illness but includes emotional, psychological, and social well-being.

Think of mental health like a garden. Just as a garden requires regular care, watering, and sunlight to thrive, our mental health needs self-awareness, stress management skills, and social interaction to flourish.

Understanding mental health as a state of well-being allows healthcare providers to support people in not just surviving but thriving. By framing mental health positively, we can promote proactive engagement in mental health enhancement and destigmatize mental health challenges.

 

✘Incorrect answer options:

The capacity to differentiate reality from illusion. This definition is overly narrow and aligns more specifically with symptoms of particular psychiatric conditions like schizophrenia or severe psychosis rather than encompassing broader mental health.

The enhancement and protection of mental health, the prevention of mental disorders, and the comprehensive care and rehabilitation during illness. While important, this definition describes actions related to mental health rather than what mental health itself entails.

Simply the lack of any mental disorders. This outdated perspective is reductionist and misleading. The absence of diagnosable mental illnesses does not necessarily equate to good mental health, as it ignores aspects of emotional, psychological, and social well-being that contribute to overall mental health.

 

References

• World Health Organization. (2021). Mental health: strengthening our response.
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

EXPLANATION

 

✔Correct answer:

"Can you explain how your child got these injuries?" This question is direct yet sensitive, allowing the mother to explain the circumstances without feeling immediately accused or defensive. It provides an opportunity for Nurse Reynolds to gather more information about the situation and assess whether the injuries are consistent with the explanation provided. This approach is non-confrontational and focuses on understanding the cause of the injuries, which is crucial for identifying potential abuse while maintaining a supportive and investigative stance.

Imagine a teacher notices a student is frequently absent and asks, "Can you tell me why you've been missing school lately?" This question opens the door for the student to share their situation without feeling judged or cornered.

Nurse Reynolds should document the mother's response and assess whether the explanation aligns with the physical evidence. She should also observe the child's behavior and interaction with the mother, and be prepared to take appropriate action if abuse is suspected, such as reporting to child protective services. Throughout the process, maintaining a non-judgmental and empathetic approach is crucial to ensure the safety and well-being of the child.

 

✘Incorrect answer options:

"Why do you think your child has these bruises?" This question may seem accusatory and could make the mother defensive, potentially hindering an open and honest conversation.

"Are you hurting your child?" Directly asking if the mother is hurting her child can be perceived as accusatory and is likely to lead to denial or defensiveness, which could shut down communication.

"Do you often discipline your child harshly?" This question assumes a specific type of behavior and might not fully capture the situation. It could also cause the mother to become defensive or justify her actions rather than providing an accurate account of how the injuries occurred.

 

References

• Townsend, M. C. (2018). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (9th ed.). Philadelphia, PA: F.A. Davis.
• Varcarolis, E. M. (2020). Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care (4th ed.). St. Louis, MO: Elsevier.

EXPLANATION

 

✔Correct answer:

Parental Role Conflict. Parental Role Conflict is the most appropriate nursing diagnosis for parents who express concerns about their ability to care for a child with maladaptive behaviors. This diagnosis addresses the stress and uncertainty parents may feel regarding their roles and responsibilities in managing their child's needs. It reflects the internal and external conflicts they may experience in balancing their parental duties and their own well-being.

Imagine trying to juggle several fragile items at once. The fear of dropping one or not being able to manage them all creates a sense of conflict and stress. Similarly, parents may feel overwhelmed and conflicted about how to best care for their child while managing their own stress and responsibilities.

Nurse Thompson should provide support and education to the parents, helping them develop effective strategies to manage their child's behavior. This includes teaching coping skills, providing resources for additional support, and encouraging open communication within the family. Addressing Parental Role Conflict can help parents feel more confident and capable in their caregiving roles.

 

✘Incorrect answer options:

Ineffective Health Maintenance This diagnosis is more appropriate for individuals who have difficulty managing their own health needs. It does not specifically address the concerns related to parenting a child with maladaptive behaviors.

Risk for Injury This diagnosis would be suitable if there were concerns about the child's safety or if the child's behaviors posed a risk of physical harm. However, it does not capture the parents' feelings of inadequacy or conflict in their roles.

Social Isolation While social isolation can be a concern for families dealing with maladaptive behaviors, it is not the primary issue expressed by the parents in this scenario. The primary concern is their ability to manage and fulfill their parental role effectively.

 

References

• Townsend, M. C. (2018). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (9th ed.). Philadelphia, PA: F.A. Davis.
• Varcarolis, E. M. (2020). Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care (4th ed.). St. Louis, MO: Elsevier.

EXPLANATION

 

✔Correct answer:

"I understand that you're in pain. Let's discuss some strategies to manage your symptoms." This response is empathetic and acknowledges the patient's pain, regardless of the test results. It validates the patient's experience and demonstrates a willingness to help manage the symptoms. By focusing on strategies to manage the pain, Nurse Daniels can provide practical support and potentially improve the patient's quality of life.

Think of a friend complaining about constant headaches despite normal tests. Instead of dismissing their concern, you acknowledge their discomfort and offer to find ways together to help relieve their pain, showing care and support.

Nurse Daniels should explore various pain management techniques, such as physical therapy, pain relief medications, relaxation techniques, and lifestyle changes. She should also consider the possibility of psychological factors contributing to the pain and discuss options like counseling or cognitive-behavioral therapy if appropriate. Building a comprehensive pain management plan that addresses both physical and psychological aspects can be highly beneficial.

 

✘Incorrect answer options:

"There's nothing wrong with you, the tests are negative." This response dismisses the patient's pain and may lead to feelings of frustration and invalidation. It is not supportive or empathetic.

"You should try to ignore the pain and go about your daily activities." Ignoring the pain is not a practical solution and does not address the patient's need for support and pain management. It can also lead to worsening of the condition if the underlying issue is not addressed.

"The pain is probably just in your head since the tests are negative." This statement is dismissive and can be perceived as blaming the patient for their symptoms. It is not an empathetic or supportive approach and can damage the therapeutic relationship.

 

References

• Townsend, M. C. (2018). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (9th ed.). Philadelphia, PA: F.A. Davis.
• Varcarolis, E. M. (2020). Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care (4th ed.). St. Louis, MO: Elsevier.

EXPLANATION

 

✔Correct answer:

Committing serious violations of social norms appropriate for their age. Conduct disorder is characterized by a persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. Children with conduct disorder often exhibit behaviors such as aggression towards people and animals, destruction of property, deceitfulness or theft, and serious violations of rules. These behaviors go beyond ordinary childhood mischief and are indicative of significant social, academic, or occupational dysfunction.

Imagine a child repeatedly breaking windows, stealing items from classmates, and bullying peers. These actions violate expected social norms and indicate conduct disorder.

Conduct disorder is associated with significant psychological and behavioral issues, often requiring comprehensive treatment approaches. This can include therapy, family interventions, and sometimes medication to manage symptoms and underlying conditions. Early intervention is crucial to address these behaviors and prevent escalation into more severe antisocial behaviors in adulthood.

 

✘Incorrect answer options:

Becoming easily distracted by external stimuli. This behavior is more characteristic of attention-deficit/hyperactivity disorder (ADHD), where children struggle with inattention, hyperactivity, and impulsivity.

Engaging in repetitive, ritualistic behaviors. This description fits more with obsessive-compulsive disorder (OCD) or autism spectrum disorder (ASD), where children may exhibit repetitive behaviors and rituals.

Showing a preference for inanimate objects. This behavior is often seen in children with autism spectrum disorder (ASD), where there may be a preference for routines and inanimate objects over social interactions.

 

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Publishing.
• Kazdin, A. E. (2017). Conduct Disorders in Childhood and Adolescence. Sage Publications.

EXPLANATION

 

✔Correct answer:

Educating a client on stress management techniques. Primary prevention aims to prevent the onset of disease or injury before it occurs by reducing risk factors or enhancing resistance to disease or injury. Educating clients on stress management techniques helps prevent the potential physical and mental health issues that can arise from chronic stress, such as hypertension, heart disease, anxiety, and depression. This education empowers clients to manage stress proactively, reducing the likelihood of developing related health conditions.

Think of primary prevention as wearing a helmet while riding a bicycle. Just as a helmet helps prevent head injuries by providing protection before an accident occurs, primary prevention strategies like stress management education help prevent health issues before they develop.

Stress management education equips individuals with the knowledge and skills to handle stress effectively, promoting mental well-being and reducing the risk of stress-related disorders. Techniques may include mindfulness, relaxation exercises, physical activity, and time management. These proactive measures foster resilience and improve overall quality of life.

 

✘Incorrect answer options:

Assisting a client in resuming self-care activities. This represents tertiary prevention, which focuses on helping individuals manage long-term health problems and disabilities to improve their quality of life and function. It involves rehabilitation and supportive care after the disease or injury has occurred.

Ensuring the safety of a client with suicidal tendencies within a healthcare facility. This is an example of secondary prevention, which aims to reduce the impact of a disease or injury that has already occurred. It involves early detection and prompt intervention to prevent worsening of the condition.

Conducting case finding and surveillance within the community. This also falls under secondary prevention. Case finding and surveillance help detect early signs of disease within the community, allowing for timely treatment and control measures to prevent further spread or complications.

 

References

• Stanhope, M., & Lancaster, J. (2020). *Public Health Nursing: Population-Centered Health Care in the Community*. Elsevier.
• Edelman, C. L., Kudzma, E. C., & Mandle, C. L. (2017). *Health Promotion Throughout the Life Span*. Elsevier.

EXPLANATION

 

✔Correct answer:

Increased appetite Increased appetite is not typically observed as a side effect of Ritalin (methylphenidate). In fact, one of the common side effects of Ritalin is a decreased appetite, which can lead to weight loss. This medication is a central nervous system stimulant and is commonly used to treat ADHD by helping increase attention and decrease impulsiveness and hyperactivity.

Think of Ritalin as something that makes the body's engine run faster. Just like how running a car engine hard can burn more fuel and make it run hotter, Ritalin can increase activity in the brain and body, leading to side effects like decreased appetite and increased heart rate.

Nurse Thompson should educate parents on the common side effects of Ritalin, including insomnia, weight loss, and increased heart rate. Parents should be advised to monitor their child's weight and eating habits, as well as any changes in sleep patterns or heart rate. Additionally, Nurse Thompson should discuss strategies to manage these side effects, such as administering the medication earlier in the day to reduce insomnia and ensuring the child has nutritious meals and snacks to mitigate weight loss.

 

✘Incorrect answer options:

Insomnia Insomnia is a common side effect of Ritalin due to its stimulating effects, which can make it difficult for children to fall asleep or stay asleep.

Weight loss Weight loss is also a common side effect of Ritalin, primarily due to its appetite-suppressing effects.

Increased heart rate Increased heart rate is another common side effect of Ritalin, as it is a stimulant that can increase cardiovascular activity.

 

References

• Townsend, M. C. (2018). Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice (9th ed.). Philadelphia, PA: F.A. Davis.
• Varcarolis, E. M. (2020). Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care (4th ed.). St. Louis, MO: Elsevier.

EXPLANATION

 

✔Correct answer:

It represents a conflict between the id and superego.  Freud's interpretation of anxiety is grounded in his psychoanalytic theory, which posits that anxiety arises from an internal conflict between the id (the part of the psyche driven by primal urges and desires) and the superego (the part of the psyche that represents moral standards and social norms). The ego, which mediates between the id and the superego, experiences anxiety when it struggles to balance these conflicting demands. This anxiety is a signal to the ego to employ defense mechanisms to manage the tension and protect the individual from psychological distress.

Imagine a tightrope walker balancing between two towers, with one tower representing primal desires (id) and the other representing societal rules (superego). The anxiety felt by the tightrope walker reflects the tension and fear of falling (conflict), prompting careful maneuvers (defense mechanisms) to maintain balance (psychological stability).

According to Freud, anxiety serves as a warning signal to the ego that something is amiss within the psyche. The ego then activates defense mechanisms, such as repression, denial, or projection, to protect the individual from conscious awareness of these internal conflicts. Understanding this framework helps in recognizing how unresolved unconscious conflicts can manifest as anxiety and influence behavior.

 

✘Incorrect answer options:

It strives to satisfy both the needs for gratification and security. While this statement touches on the concept of balancing different needs, it does not accurately capture Freud's explanation of anxiety as a conflict between the id and superego.

It is a reaction involving the hypothalamic-pituitary-adrenal axis in response to stress. This explanation pertains to the physiological response to stress, involving the hypothalamic-pituitary-adrenal (HPA) axis, and is more relevant to biological theories of anxiety rather than Freud's psychoanalytic theory.

It is a learned response to stressors. This explanation aligns with behavioral theories of anxiety, which suggest that anxiety is a learned response through conditioning. It does not reflect Freud's psychoanalytic perspective on the internal conflict between the id and superego.

 

References

• Freud, S. (1926). Inhibitions, Symptoms, and Anxiety. The Standard Edition of the Complete Psychological Works of Sigmund Freud.
• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Wolters Kluwer.

EXPLANATION

 

✔Correct answer:

"I have the contact information for a crisis center where you can seek immediate assistance." This statement is the most appropriate as it provides practical support and resources without being judgmental or pressuring the wife to make a decision. It offers a concrete solution that can enhance her safety while respecting her autonomy. By giving her information about a crisis center, Nurse Reynolds empowers the wife with the option to seek help when she feels ready, thereby supporting her in a non-judgmental and empowering way.

Imagine being lost in a foreign city. Instead of someone telling you what you should have done, a helpful person provides you with a map and directions to the nearest help center, empowering you to find your way safely when you're ready.

Offering resources like crisis center contact information is a key aspect of supporting individuals in abusive situations. It acknowledges their difficult circumstances without judgment and provides them with an immediate option for assistance. This approach helps build trust and allows the individual to feel more in control of their decisions, which is crucial for their mental and emotional well-being.

 

✘Incorrect answer options:

"Consider the safety benefits of leaving your current situation." While this statement has good intentions, it can come across as pressuring the wife to leave the relationship. It implies that leaving is the best or only option, which may not feel feasible or safe for her at the moment. It can make her feel judged or misunderstood, potentially discouraging her from seeking further help.

"Have you had a chance to talk about this situation with your family?" This statement assumes that discussing the situation with family is a viable option. However, it might not be safe or comfortable for the wife to involve her family. It can also be perceived as diverting the responsibility to the family instead of offering professional support.

"Can you help me understand your reasons for staying in this situation?" Although this question aims to understand the wife's perspective, it can be interpreted as judgmental or blaming. It may make her feel defensive or ashamed about her situation, which is not conducive to providing support.

 

References

• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Wolters Kluwer.
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Publishing.