Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is conducting an in-service for a group of newly licensed nurses about the interventions used for clients experiencing non-suicidal self-harm (NSSH). Which of the following should the nurse include?.
A. Discourage clients from discussing the NSSH with friends.
Discouraging clients from discussing NSSH with friends may not be beneficial. Open communication can provide support and understanding.
B. Early recognition is crucial to successful treatment.
Early recognition is crucial to successful treatment. Timely intervention can prevent the escalation of self-harm behaviors and facilitate recovery.
C. Recognize non-suicidal self-harm as an attention-seeking behavior.
Recognizing NSSH as an attention-seeking behavior can be a misconception. NSSI is a complex behavior often associated with various underlying issues like emotional distress.
D. Ask the client why they do this as soon as possible.
Asking the client why they do this as soon as possible may not always be helpful. The focus should be on understanding their feelings and providing support.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Rn Custom Nurs 120 Psychiatric Nursing Fa23 Proctored Exam 2. Take the full exam now
Full Explanation
Choice A rationale:
Discouraging clients from discussing NSSH with friends may not be beneficial. Open communication can provide support and understanding.
Choice B rationale:
Early recognition is crucial to successful treatment. Timely intervention can prevent the escalation of self-harm behaviors and facilitate recovery.
Choice C rationale:
Recognizing NSSH as an attention-seeking behavior can be a misconception. NSSI is a complex behavior often associated with various underlying issues like emotional distress.
Choice D rationale:
Asking the client why they do this as soon as possible may not always be helpful. The focus should be on understanding their feelings and providing support.
Similar Questions
A nurse is talking with a client who has schizophrenia.
Suddenly the client states, "I'm frightened.
Do you hear that? The voices are telling me to do terrible things.”. Which of the following responses by the nurse is appropriate?.
A. "What are the voices telling you to do?".
Asking “What are the voices telling you to do?” shows empathy and concern without validating the hallucination.
B. "Why do you think you are hearing the voices?".
Asking “Why do you think you are hearing the voices?” might imply that the nurse is validating the hallucination.
C. "You need to understand that there are no voices.”.
Telling the client “You need to understand that there are no voices.”. might make the client feel misunderstood.
D. "You need to tell the voices to leave you alone.”.
Telling the client “You need to tell the voices to leave you alone.”. is not recommended as it might validate the hallucination.
Full Explanation
Choice A rationale:
Asking “What are the voices telling you to do?” shows empathy and concern without validating the hallucination.
Choice B rationale:
Asking “Why do you think you are hearing the voices?” might imply that the nurse is validating the hallucination.
Choice C rationale:
Telling the client “You need to understand that there are no voices.”. might make the client feel misunderstood.
Choice D rationale:
Telling the client “You need to tell the voices to leave you alone.”. is not recommended as it might validate the hallucination.
A nurse is planning care for a client who has dependent personality disorder.
Which of the following actions should the nurse plan to take?
A. Monitor the client closely to prevent self-mutilation.
Monitoring the client closely to prevent self-mutilation is more associated with self-harm disorders rather than dependent personality disorder.
B. Give positive feedback when the client is assertive with staff or clients.
Giving positive feedback when the client is assertive with staff or clients can encourage independence and confidence.
C. Discourage flamboyant or seductive behaviors.
Discouraging flamboyant or seductive behaviors is more related to histrionic personality disorder.
D. Set limits to prevent exploitation of other clients.
Setting limits to prevent exploitation of other clients is more associated with antisocial personality disorder.
Full Explanation
Choice A rationale:
Monitoring the client closely to prevent self-mutilation is more associated with self-harm disorders rather than dependent personality disorder.
Choice B rationale:
Giving positive feedback when the client is assertive with staff or clients can encourage independence and confidence.
Choice C rationale:
Discouraging flamboyant or seductive behaviors is more related to histrionic personality disorder.
Choice D rationale:
Setting limits to prevent exploitation of other clients is more associated with antisocial personality disorder.
A nurse is caring for a young adult client who has acute schizophrenic disorder and tells the nurse, "Yesterday noon the sun moon went over the rover to see the lawnmower.”. Which of the following manifestations is the client exhibiting?
A. Delusional disorder.
Delusional disorder is characterized by the presence of one or more delusions for a month or longer, which could be plausible but are not real. This is not the case here.
B. Anhedonia.
Anhedonia refers to the inability to experience pleasure, a common symptom in many mental disorders, including depression. It does not apply to this situation.
C. Associative looseness.
Associative looseness, or loose associations, is a thought disorder characterized by speech in which ideas shift from one subject to another that is unrelated or minimally related. The client’s statement is an example of this.
D. Hallucination.
Hallucinations are sensory experiences that occur in the absence of actual stimulation. The client’s statement is not a hallucination, but a disorganized thought process.
Full Explanation
Choice A rationale:
Delusional disorder is characterized by the presence of one or more delusions for a month or longer, which could be plausible but are not real. This is not the case here.
Choice B rationale:
Anhedonia refers to the inability to experience pleasure, a common symptom in many mental disorders, including depression. It does not apply to this situation.
Choice C rationale:
Associative looseness, or loose associations, is a thought disorder characterized by speech in which ideas shift from one subject to another that is unrelated or minimally related. The client’s statement is an example of this.
Choice D rationale:
Hallucinations are sensory experiences that occur in the absence of actual stimulation. The client’s statement is not a hallucination, but a disorganized thought process.