A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client motions to the nurse to come over so he can tell the nurse how things have been going since he was discharged. While talking with the client, the nurse determines that the client's therapy has been effective when the client states which of the following?

Correct Answer: B

Rationale: The correct answer is B because the client's behavior of going to the workshop to work on projects when his mother-in-law visits indicates a healthy coping mechanism to manage stress. This shows that the therapy has been effective in helping the client find a constructive way to deal with his anxiety triggers. Choice A indicates ongoing stress, which suggests therapy may not be effective. Choice C shows a habit that has not changed, indicating little progress. Choice D suggests the use of alcohol as a coping mechanism, which is not a healthy or sustainable way to manage anxiety.

Correct Answer: C

Rationale: The correct answer is C: maladaptive behavior. Clients with antisocial personality disorder often engage in maladaptive behaviors, such as binge drinking, to cope with their emotions and impulsivity. Binge drinking is a harmful coping mechanism that can lead to negative consequences, reflecting maladaptive behavior. Choice A (defiant personality) is incorrect as it does not directly relate to the behavior of binge drinking. Emotional regulation (Choice B) is also incorrect as individuals with antisocial personality disorder typically struggle with regulating their emotions, leading to impulsive behaviors like binge drinking. Self-determination (Choice D) is not the most appropriate answer as it does not directly address the maladaptive nature of binge drinking in individuals with antisocial personality disorder.

Correct Answer: C

Rationale: Rationale: C is correct because choosing gastric bypass over the outlined plan indicates a lack of commitment to the agreed weight loss plan. It suggests that Malika may not be fully engaged in following the recommendations provided by the nurse practitioner. This choice also implies a preference for a more invasive and potentially risky procedure over a more conservative approach. Options A, B, and D are incorrect because they do not challenge or contradict the nurse practitioner's plan, indicating a willingness to address depression, engage in psychotherapy, and recognize potential benefits of weight loss on comorbid conditions.

Correct Answer: B

Rationale: The correct answer is B because feeling rested upon awakening indicates improved sleep quality, reflecting effective teaching on relaxation techniques. Choice A does not directly measure the effectiveness of the teaching intervention. Choice C indicates reliance on medication rather than improved sleep hygiene. Choice D, sleeping for short intervals, does not necessarily signify improved sleep quality.

Correct Answer: D

Rationale: The correct answer is D. In clients with co-occurring disorders in early recovery, cognitive impairment from alcohol use may hinder their ability to learn new things. This is crucial to consider as it directly impacts the client's learning process. Option A is incorrect as suggestibility is not the main concern in this scenario. Option B is incorrect as critical reasoning ability is not the primary focus. Option C is incorrect as brain cells can regenerate, and not all are destroyed by alcohol abuse. Therefore, understanding and addressing potential cognitive impairment is key for effective teaching and support in the client's recovery journey.

Correct Answer: B

Rationale: The correct answer is B. Having the shaman meet the attending physician at the hospital is the most appropriate nursing intervention because it allows for collaboration between traditional beliefs and modern medical care. This approach respects the client's cultural and spiritual preferences while ensuring the client receives necessary medical treatment. It also helps establish a supportive and holistic care environment. Choice A is incorrect because denying the shaman access may lead to resistance from the client and hinder effective communication and trust-building. Choice C is inappropriate as it disregards the client's autonomy and may create conflict within the family. Choice D is incorrect as blaming the shaman for the client's condition is disrespectful and unprofessional.

Correct Answer: A

Rationale: The correct answer is A because it directly acknowledges the patient's emotions and perspective without judgment. It shows understanding and validation of the patient's feelings, indicating empathy. Choice B focuses on the nurse's feelings, not the patient's. Choice C offers a solution without addressing the patient's emotional state. Choice D minimizes the seriousness of the patient's situation and lacks empathy. Overall, choice A demonstrates the most empathetic response by recognizing and empathizing with the patient's emotional distress.

Correct Answer: C

Rationale: The correct answer is C because depending on frequent praise from others to feel good about oneself indicates a lack of self-confidence and self-esteem, which are key components of successful completion of the psychosocial developmental task of infancy according to Erikson's theory. This statement suggests an inability to develop a sense of autonomy and self-reliance, which are crucial in the infancy stage. Choice A is incorrect because preferring to work alone rather than on a team may indicate a preference for autonomy, which is a positive trait related to the successful completion of the task of autonomy vs. shame and doubt in infancy. Choice B is incorrect because not allowing others to truly get to know oneself could indicate introversion or privacy preferences, which may not necessarily suggest unsuccessful completion of the infancy developmental task. Choice D is incorrect because needing to do things several times before getting them right may indicate a learning style or perfectionism rather than a sign of unsuccessful completion of the psychosocial developmental task of infancy.

Correct Answer: A

Rationale: The correct answer is A because first-order changes refer to small, incremental adjustments within the system. In this scenario, the parent returning to work while the children are all in school signifies a gradual shift in the family dynamic. The other choices involve significant and more disruptive changes like a daughter leaving for college, a son getting married and moving out, and the death of a family member, which are considered second-order changes that lead to more substantial shifts in the family system.