Professional Documents
Culture Documents
1. An unemployed woman, age 24, seeks help because she feels depressed and
abandoned and doesn't know what to do with her life. She says she has quit her last five
jobs because her coworkers didn't like her and didn't train her adequately. Last week, her
boyfriend broke up with her after she drove his car into a tree after an argument. The
client's initial diagnosis is borderline personality disorder. Which nursing observations
support this diagnosis?
2.In a toddler, which of the following injuries is most likely the result of child abuse?
3. A client is admitted to the emergency department after being found unconscious. Her
blood pressure is 82/50 mm Hg. She is 5′ 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and
appears dehydrated and emaciated. After regaining consciousness, she reports that she
has had trouble eating lately and can't remember what she ate in the last 24 hours. She
also states that she has had amenorrhea for the past year. She is convinced she is fat and
refuses food. The nurse suspects that she has:
A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
D. schizophrenia.
4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses
to eat. Which of the following statements is the best response from the nurse?
5. A client with a history of substance abuse has been attending Alcoholics Anonymous
meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm
not going to those meetings anymore. I'm not like the rest of those people. I'm not a
drunk. "What is the most appropriate response?
A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."
6. A client is admitted to the inpatient adolescent unit after being arrested for attempting
to sell cocaine to an undercover police officer. The nurse plans to write a behavioral
contract. To best promote compliance, the contract should be written:
A. abstractly.
B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.
A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase
A. Have three staff members present, one for each side of the body and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team approach after the decision is made to restrain the
client.
D. Secure restraints to the gurney with knots to prevent escape.
9. A client who's actively hallucinating is brought to the hospital by friends. They say that
the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine
[PCP]) at a concert. Which of the following common assessment findings indicates that
the client may have ingested PCP?
A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood
10. A severely dehydrated teenager admitted to the hospital with hypotension and
tachycardia undergoes evaluation for electrolyte disturbances. Her history includes
anorexia nervosa and a 20-lb (9.1-kg) weight loss in the last month. She is 5′ 7" (1.7 m)
tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority?
11. A client tells the nurse that he is having suicidal thoughts every day. In conferring
with the treatment team, the nurse should make which of the following
recommendations?
A. A no-suicide contract
B. Weekly outpatient therapy
C. A second psychiatric opinion
D. Intensive inpatient treatment
12. Which of the following etiologic factors predispose a client to Tourette syndrome?
A. No known etiology
B. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and
caudate nucleus, and genetics
C. Abnormalities in the structure and function of the ventricles
D. Environmental factors and birth-related trauma
13. A client is admitted for detoxification after a cocaine overdose. The client tells the
nurse that he frequently uses cocaine but he can control his use if he chooses. Which
coping mechanism is he using?
A. Withdrawal
B. Logical thinking
C. Repression
D. Denial
14. An 16-year-old boy is admitted to the facility after acting out his aggressions
inappropriately at school. Predisposing factors to the expression of aggression include:
A. violence on television.
B. passive parents.
C. an internal locus of control.
D. a single-parent family
15. A client is brought to the emergency department after being beaten by her husband, a
prominent attorney. The nurse caring for this client understands that:
16. On discharge after treatment for alcoholism, a client plans to take disulfiram
(Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes
the need to:
A. avoid all products containing alcohol.
B. adhere to concomitant vitamin B therapy.
C. return for monthly blood drug level monitoring.
D. limit alcohol consumption to a moderate level.
17. During a private conversation, a client with borderline personality disorder asks the
nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations
on the forearms. What is the nurse's best response?
18. The nurse is providing care for a client undergoing opiate withdrawal. Opiate
withdrawal causes severe physical discomfort and can be life-threatening. To minimize
these effects, opiate users are commonly detoxified with:
A. barbiturates.
B. amphetamines.
C. methadone.
D. benzodiazepines.
19. The nurse is caring for a client who she believes has been abusing opiates.
Assessment findings in a client abusing opiates such as morphine include:
20. Which of the following signs should the nurse expect in a client with known
amphetamine overdose?
A. Hypotension
B. Tachycardia
C. Hot, dry skin
D. Constricted pupils
21. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication
and suspected alcohol dependence. Other assessment findings include an enlarged liver,
jaundice, lethargy, and rambling, incoherent speech. No other information about the
client is available. After the nurse completes the initial assessment, what is the first
priority?
A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid
intake and output
B. Checking the client's medical records for health history information
C. Attempting to contact the client's family to obtain more information about the client
D. Restricting fluids and leaving the client alone to "sleep off" the episode
22. Which nursing action is best when trying to diffuse a client's impending violent
behavior?
A. Helping the client identify and express feelings of anxiety and anger
B. Involving the client in a quiet activity to divert attention
C. Leaving the client alone until the client can talk about feelings
D. Placing the client in seclusion
23. The nurse is working with a client who abuses alcohol. Which of the following facts
should the nurse communicate to the client?
24. Which psychosocial influence has been causally related to the development of
aggressive behavior and conduct disorder?
A. An overbearing mother
B. Rejection by peers
C. A history of schizophrenia in the family
D. Low socioeconomic status
25. In group therapy, a client who has used I.V. heroin every day for the past 14 years
says, "I don't have a drug problem. I can quit whenever I want. I've done it before."
Which defense mechanism is the client using?
A. Denial
B. Obsession
C. Compensation
D. Rationalization
26. A client with a history of cocaine addiction is admitted to the coronary care unit for
evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-
segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5.
Considering the client's history of drug abuse, the nurse expects the physician to
prescribe:
A. lidocaine (Xylocaine).
B. procainamide (Pronestyl).
C. nitroglycerin (Nitro-Bid IV).
D. epinephrine.
27. A 15-year-old client is brought to the clinic by her mother. Her mother expresses
concern about her daughter's weight loss and constant dieting. The nurse conducts a
health history interview. Which of the following comments indicates that the client may
be suffering from anorexia nervosa?
A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader."
B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my
friends."
C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other
girls."
D. "I do diet around my periods; otherwise, I just get so bloated."
A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil)
29. The client tells the nurse he was involved in a car accident while he was intoxicated.
What would be the most therapeutic response from the nurse?
30. A client voluntarily admits himself to the substance abuse unit. He confesses that he
drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that
afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of
this condition?
31. When monitoring a client recently admitted for treatment of cocaine addiction, the
nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these
problems, the nurse expects the physician to prescribe:
32. A client experiencing alcohol withdrawal is upset about going through detoxification.
Which of the following goals is a priority?
33. A client is admitted to a psychiatric facility by court order for evaluation for
antisocial personality disorder. This client has a long history of initiating fights and
abusing animals and recently was arrested for setting a neighbor's dog on fire. When
evaluating this client for the potential for violence, the nurse should assess for which
behavioral clues?
34. A client is brought to the psychiatric clinic by family members, who tell the admitting
nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During
an interview with the nurse, which statement by the client most strongly supports a
diagnosis of psychoactive substance abuse?
A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being
affected."
B. "I only spend half of my paycheck at the bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three times for drinking and driving, but the police are just
trying to hassle me."
35. A client with borderline personality disorder is admitted to the psychiatric unit. Initial
nursing assessment reveals that the client's wrists are scratched from a recent suicide
attempt. Based on this finding, the nurse should formulate a nursing diagnosis of:
36. A client recently admitted to the hospital with sharp, substernal chest pain suddenly
complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and
a heart rate of 144 beats/minute. On further questioning, the client admits to having used
cocaine recently after previously denying use of the drug. The nurse concludes that the
client is at high risk for which complication of cocaine use?
37. A client is being admitted to the substance abuse unit for alcohol detoxification. As
part of the intake interview, the nurse asks him when he had his last alcoholic drink. He
says that he had his last drink 6 hours before admission. Based on this response, the nurse
should expect early withdrawal symptoms to:
38. The nurse is assigned to care for a client with anorexia nervosa. Initially, which
nursing intervention is most appropriate for this client?
39. A client begins to experience alcoholic hallucinosis. What is the best nursing
intervention at this time?
40. Which assessment finding is most consistent with early alcohol withdrawal?
A. One who appears depressed, frequently thinks of dying, and gives away all personal
possessions
B. One who plans a violent death and has the means readily available
C. One who tells others that he or she might do something if life doesn't get better soon
D. One who talks about wanting to die
42. Which of the following medical conditions is commonly found in clients with bulimia
nervosa?
A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A
43. A high school student is referred to the school nurse for suspected substance abuse.
Following the nurse's assessment and interventions, what would be the most desirable
outcome?
44. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol
detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most
likely to prescribe which drug?
A. clozapine (Clozaril)
B. thiothixene (Navane)
C. lorazepam (Ativan)
D. lithium carbonate (Eskalith)
45. A client is being treated for alcoholism. After a family meeting, the client's spouse
asks the nurse about ways to help the family deal with the effects of alcoholism. The
nurse should suggest that the family join which organization?
A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous
46. A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To
promote the client's physical health, the nurse should plan to:
47. A young man is remanded by the courts for psychiatric treatment. His police record,
which dates to his early teenage years, includes delinquency, running away, auto theft,
and vandalism. He dropped out of school at age 16 and has been living on his own since
then. His history suggests maladaptive coping, which is associated with:
49. A client whose husband just left her has a recurrence of anorexia nervosa. The nurse
caring for her realizes that this exacerbation of anorexia nervosa results from the client's
effort to:
50. A client has approached the nurse asking for advice on how to deal with his alcohol
addiction. The nurse should tell the client that the only effective treatment for alcoholism
is:
A. psychotherapy.
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.
51. Flumazenil (Romazicon) has been ordered for a client who has overdosed on
oxazepam (Serax). Before administering the medication, the nurse should be prepared for
which common adverse effect?
A. Seizures
B. Shivering
C. Anxiety
D. Chest pain
52. The nurse is caring for a client diagnosed with bulimia. The most appropriate initial
goal for a client diagnosed with bulimia is to:
53. A client who's at high risk for suicide needs close supervision. To best ensure the
client's safety, the nurse should:
A. check the client frequently at irregular intervals throughout the night.
B. assure the client that the nurse will hold in confidence anything the client says.
C. repeatedly discuss previous suicide attempts with the client.
D. disregard decreased communication by the client because this is common in suicidal
clients.
54. Which of the following drugs should the nurse prepare to administer to a client with a
toxic acetaminophen (Tylenol) level?
55. A client is admitted to the substance abuse unit for alcohol detoxification. Which of
the following medications is the nurse most likely to administer to reduce the symptoms
of alcohol withdrawal?
A. naloxone (Narcan)
B. haloperidol (Haldol)
C. magnesium sulfate
D. chlordiazepoxide (Librium)
56. During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You
can sit with me, but you're just wasting your time. After you sat with me yesterday, I was
still able to purge. Today, my goal is to do it twice." What is the nurse's best response?
57. A client admitted to the psychiatric unit for treatment of substance abuse says to the
nurse, "It felt so wonderful to get high." Which of the following is the most appropriate
response?
A. "If you continue to talk like that, I'm going to stop speaking to you."
B. "You told me you got fired from your last job for missing too many days after taking
drugs all night."
C. "Tell me more about how it felt to get high."
D. "Don't you know it's illegal to use drugs?"
58. For a client with anorexia nervosa, which goal takes the highest priority?
59. When interviewing the parents of an injured child, which of the following is the
strongest indicator that child abuse may be a problem?
A. The injury isn't consistent with the history or the child's age.
B. The mother and father tell different stories regarding what happened.
C. The family is poor.
D. The parents are argumentative and demanding with emergency department personnel.
60. For a client with anorexia nervosa, the nurse plans to include the parents in therapy
sessions along with the client. What fact should the nurse remember to be typical of
parents of clients with anorexia nervosa?
61. In the emergency department, a client with facial lacerations states that her husband
beat her with a shoe. After the health care team repairs her lacerations, she waits to be
seen by the crisis intake nurse, who will evaluate the continued threat of violence.
Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is
the first priority of the health care worker who witnesses this scene?
62. The nurse is caring for a client with bulimia. Strict management of dietary intake is
necessary. Which intervention is also important?
A. Fill out the client's menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least 2
hours after each meal.
C. Let the client choose her own food. If she eats everything she orders, then stay with
her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but she should keep a
strict calorie count.
63. The nurse is assigned to care for a suicidal client. Initially, which is the nurse's
highest care priority?
A. Assessing the client's home environment and relationships outside the hospital
B. Exploring the nurse's own feelings about suicide
C. Discussing the future with the client
D. Referring the client to a clergyperson to discuss the moral implications of suicide
64. A client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what
I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's
distorted perceptions and feelings?
65. The nurse is caring for a client being treated for alcoholism. Before initiating therapy
with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully
on which of the following products?
A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese
66. The nurse is developing a plan of care for a client with anorexia nervosa. Which
action should the nurse include in the plan?
A. Restrict visits with the family until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.
67. Victims of domestic violence should be assessed for what important information?
A. Reasons they stay in the abusive relationship (for example, lack of financial autonomy
and isolation)
B. Readiness to leave the perpetrator and knowledge of resources
C. Use of drugs or alcohol
D. History of previous victimization
68. A client is hospitalized with fractures of the right femur and right humerus sustained
in a motorcycle accident. Police suspect the client was intoxicated at the time of the
accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client
later admits to drinking heavily for years. During hospitalization, the client periodically
complains of tingling and numbness in the hands and feet. The nurse realizes that these
symptoms probably result from:
A. acetate accumulation.
B. thiamine deficiency.
C. triglyceride buildup.
D. a below-normal serum potassium level
70. When planning care for a client who has ingested phencyclidine (PCP), which of the
following is the highest priority?
71. Which outcome criteria would be appropriate for a child diagnosed with oppositional
defiant disorder?
72. A client is found sitting on the floor of the bathroom in the day treatment clinic with
moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly
at her bleeding wrists while staff members call for an ambulance. How should the nurse
approach her initially?
A. Enter the room quietly and move beside her to assess her injuries.
B. Call for staff back-up before entering the room and restraining her.
C. Move as much glass away from her as possible and sit next to her quietly.
D. Approach her slowly while speaking in a calm voice, calling her name, and telling her
that the nurse is here to help her.
73. A client with anorexia nervosa describes herself as "a whale." However, the nurse's
assessment reveals that the client is 5′ 8" (1.7 m) tall and weighs only 90 lb (40.8 kg).
Considering the client's unrealistic body image, which intervention should be included in
the plan of care?
A. Asking the client to compare her figure with magazine photographs of women her age
B. Assigning the client to group therapy in which participants provide realistic feedback
about her weight
C. Confronting the client about her actual appearance during one-on-one sessions,
scheduled during each shift
D. Telling the client of the nurse's concern for her health and desire to help her make
decisions to keep her healthy
74. Eighteen hours after undergoing an emergency appendectomy, a client with a
reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7°
C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure,
140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to
kill the bugs in the bed. The nurse should suspect:
A. a postoperative infection.
B. alcohol withdrawal.
C. acute sepsis.
D. pneumonia.
75. Clonidine (Catapres) can be used to treat conditions other than hypertension. For
which of the following conditions might the drug be administered?
76. One of the goals for a client with anorexia nervosa is that the client will demonstrate
increased individual coping by responding to stress in constructive ways. Which of the
following actions is the best indicator that the client is working toward meeting the goal?
76. One of the goals for a client with anorexia nervosa is that the client will demonstrate
increased individual coping by responding to stress in constructive ways. Which of the
following actions is the best indicator that the client is working toward meeting the goal?
77. The nurse in the substance abuse unit is trying to encourage a client to attend
Alcoholics Anonymous meetings. When the client asks the nurse what he must do to
become a member, the nurse should respond:
78. An attorney who throws books and furniture around the office after losing a case is
referred to the psychiatric nurse in the law firm's employee assistance program. The nurse
knows that the client's behavior most likely represents the use of which defense
mechanism?
A. Regression
B. Projection
C. Reaction-formation
D. Intellectualization
79. After completing chemical detoxification and a 12-step program to treat crack
addiction, a client is being prepared for discharge. Which remark by the client indicates a
realistic view of the future?
80. The nurse is assessing a client on admission to the chemical dependency unit for
alcohol detoxification. When the nurse asks about alcohol use, this client is most likely
to:
81. The nurse is assessing a 15-year-old female who's being admitted for treatment of
anorexia nervosa. Which clinical manifestation is the nurse most likely to find?
A. Tachycardia
B. Warm, flushed extremities
C. Parotid gland tenderness
D. Coarse hair growth
82. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign
or symptom that this client is likely to experience is:
A. impending coma.
B. manipulating behavior.
C. suppression.
D. perceptual disorders.
83. The nurse is caring for an adolescent female who reports amenorrhea, weight loss,
and depression. Which additional assessment finding would suggest that the woman has
an eating disorder?
84. A client with a history of polysubstance abuse is admitted to the facility. She
complains of nausea and vomiting 24 hours after admission. The nurse assesses the client
and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the
client is going through which of the following withdrawals?
A. Alcohol withdrawal
B. Cannibis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal
85. A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa.
Although she is 5′ 8" (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly
about how fat she is. Which measure should the nurse take first when caring for this
client?
86. A client is admitted for an overdose of amphetamines. When assessing this client, the
nurse should expect to see:
87. Which of the following drugs may be abused because of tolerance and physiologic
dependence.
88. Which of the following groups are considered to be at highest risk for suicide?
A. Adolescents, men over age 45, and persons who have made previous suicide attempts
B. Teachers, divorced persons, and substance abusers
C. Alcohol abusers, widows, and young married men
D. Depressed persons, physicians, and persons living in rural areas
89. Tourette syndrome is characterized by the presence of multiple motor and vocal tics.
A vocal tic that involves repeating one's own sounds or words is known as:
A. echolalia.
B. palilalia.
C. apraxia.
D. aphonia.