Psychiatric Nursing Practice Test Part 1

c. Responsible for evil world

d. Connected to client unrelated to

1. Marco approached Nurse Trish asking for
oneself
advice on how to deal with his alcohol
7. A 20 year old client was diagnosed with
addiction. Nurse Trish should tell the client
dependent personality disorder. Which
that the only effective treatment for
behavior is not most likely to be evidence
alcoholism is:
of ineffective individual coping?
a. Psychotherapy
a. Recurrent self-destructive behavior
b. Alcoholics anonymous (A.A.)
b. Avoiding relationship
c. Total abstinence
c. Showing interest in solitary
d. Aversion Therapy
activities
2. Nurse Hazel is caring for a male client who
d. Inability to make choices and
experience false sensory perceptions with
decision without advise
no basis in reality. This perception is known
8. A male client is diagnosed with schizotypal
as:
personality disorder. Which signs would
a. Hallucinations
this client exhibit during social situation?
b. Delusions
a. Paranoid thoughts
c. Loose associations
b. Emotional affect
d. Neologisms
c. Independence need
3. Nurse Monet is caring for a female client
d. Aggressive behavior
who has suicidal tendency. When
9. Nurse Claire is caring for a client diagnosed
accompanying the client to the restroom,
with bulimia. The most appropriate initial
Nurse Monet should…
goal for a client diagnosed with bulimia is?
a. Give her privacy
a. Encourage to avoid foods
b. Allow her to urinate
b. Identify anxiety causing situations
c. Open the window and allow her to
c. Eat only three meals a day
get some fresh air
d. Avoid shopping plenty of groceries
d. Observe her
10. Nurse Tony was caring for a 41 year old
4. Nurse Maureen is developing a plan of care
female client. Which behavior by the client
for a female client with anorexia nervosa.
indicates adult cognitive development?
Which action should the nurse include in
a. Generates new levels of awareness
the plan?
b. Assumes responsibility for her
a. Provide privacy during meals
actions
b. Set-up a strict eating plan for the
c. Has maximum ability to solve
client
problems and learn new skills
c. Encourage client to exercise to
d. Her perception are based on reality
reduce anxiety
11. A neuromuscular blocking agent is
d. Restrict visits with the family
administered to a client before ECT
5. A client is experiencing anxiety attack. The
therapy. The Nurse should carefully
most appropriate nursing intervention
observe the client for?
should include?
a. Respiratory difficulties
a. Turning on the television
b. Nausea and vomiting
b. Leaving the client alone
c. Dizziness
c. Staying with the client and
d. Seizures
speaking in short sentences
12. A 75 year old client is admitted to the
d. Ask the client to play with other
hospital with the diagnosis of dementia of
clients
the Alzheimer’s type and depression. The
6. A female client is admitted with a diagnosis
symptom that is unrelated to depression
of delusions of GRANDEUR. This diagnosis
would be?
reflects a belief that one is:
a. Apathetic response to the
a. Being Killed
environment
b. Highly famous and important
b. “I don’t know” answer to questions
 c. Shallow of labile effect threatens to “do something” to herself if

d. Neglect of personal hygiene discharged. Which of the following actions

13. Nurse Trish is working in a mental health by the nurse would be most important?

facility; the nurse priority nursing a. Ask a family member to stay with

intervention for a newly admitted client the client at home temporarily

with bulimia nervosa would be to? b. Discuss the meaning of the client’s

a. Teach client to measure I & O statement with her

b. Involve client in planning daily c. Request an immediate extension

meal for the client

c. Observe client during meals d. Ignore the clients statement

d. Monitor client continuously because it’s a sign of manipulation

14. Nurse Patricia is aware that the major 19. Joey a client with antisocial personality
health complication associated with disorder belches loudly. A staff member

intractable anorexia nervosa would be? asks Joey, “Do you know why people find

a. Cardiac dysrhythmias resulting to you repulsive?” this statement most likely

cardiac arrest would elicit which of the following client

b. Glucose intolerance resulting in reaction?

protracted hypoglycemia a. Depensiveness

c. Endocrine imbalance causing cold b. Embarrassment

amenorrhea c. Shame

d. Decreased metabolism causing d. Remorsefulness

cold intolerance 20. Which of the following approaches would

15. Nurse Anna can minimize agitation in a be most appropriate to use with a client

disturbed client by? suffering from narcissistic personality

a. Increasing stimulation disorder when discrepancies exist between

b. limiting unnecessary interaction what the client states and what actually

c. increasing appropriate sensory exist?

perception a. Rationalization

d. ensuring constant client and staff b. Supportive confrontation

contact c. Limit setting

16. A 39 year old mother with obsessive- d. Consistency

compulsive disorder has become 21. Cely is experiencing alcohol withdrawal

immobilized by her elaborate hand washing exhibits tremors, diaphoresis and

and walking rituals. Nurse Trish recognizes hyperactivity. Blood pressure is 190/87

that the basis of O.C. disorder is often: mmhg and pulse is 92 bpm. Which of the

a. Problems with being too medications would the nurse expect to

conscientious administer?

b. Problems with anger and remorse a. Naloxone (Narcan)

c. Feelings of guilt and inadequacy b. Benzlropine (Cogentin)

d. Feeling of unworthiness and c. Lorazepam (Ativan)

hopelessness d. Haloperidol (Haldol)

17. Mario is complaining to other clients about 22. Which of the following foods would the

not being allowed by staff to keep food in nurse Trish eliminate from the diet of a

his room. Which of the following client in alcohol withdrawal?

interventions would be most appropriate? a. Milk

a. Allowing a snack to be kept in his b. Orange Juice

room c. Soda

b. Reprimanding the client d. Regular Coffee

c. Ignoring the clients behavior 23. Which of the following would Nurse Hazel

d. Setting limits on the behavior expect to assess for a client who is

18. Conney with borderline personality exhibiting late signs of heroin withdrawal?

disorder who is to be discharge soon a. Yawning & diaphoresis

 b. Restlessness & Irritability center “I really don’t need anyone to talk

c. Constipation & steatorrhea to”. The TV is my best friend. The nurse

d. Vomiting and Diarrhea recognizes that the client is using the

24. To establish open and trusting relationship defense mechanism known as?

with a female client who has been a. Displacement

hospitalized with severe anxiety, the nurse b. Projection

in charge should? c. Sublimation

a. Encourage the staff to have d. Denial

frequent interaction with the client 30. When working with a male client suffering

b. Share an activity with the client phobia about black cats, Nurse Trish should

c. Give client feedback about anticipate that a problem for this client

behavior would be?

d. Respect client’s need for personal a. Anxiety when discussing phobia

space b. Anger toward the feared object

25. Nurse Monette recognizes that the focus of c. Denying that the phobia exist

environmental (MILIEU) therapy is to: d. Distortion of reality when

a. Manipulate the environment to completing daily routines

bring about positive changes in 31. Linda is pacing the floor and appears

behavior extremely anxious. The duty nurse

b. Allow the client’s freedom to approaches in an attempt to alleviate

determine whether or not they will Linda’s anxiety. The most therapeutic

be involved in activities question by the nurse would be?

c. Role play life events to a. Would you like to watch TV?

meet individual needs b. Would you like me to talk with you?

d. Use natural remedies rather than c. Are you feeling upset now?

drugs to control behavior d. Ignore the client

26. Nurse Trish would expect a child with a 32. Nurse Penny is aware that the symptoms

diagnosis of reactive attachment disorder that distinguish post traumatic stress

to: disorder from other anxiety disorder would

a. Have more positive relation with be:

the father than the mother a. Avoidance of situation & certain

b. Cling to mother & cry on separation activities that resemble the stress

c. Be able to develop only superficial b. Depression and a blunted affect

relation with the others when discussing the traumatic

d. Have been physically abuse situation

27. When teaching parents about childhood c. Lack of interest in family & others

depression Nurse Trina should say? d. Re-experiencing the trauma in

a. It may appear acting out behavior dreams or flashback

b. Does not respond to conventional 33. Nurse Benjie is communicating with a male

treatment client with substance-induced persisting

c. Is short in duration & resolves dementia; the client cannot remember

easily facts and fills in the gaps with imaginary

d. Looks almost identical to adult information. Nurse Benjie is aware that this

depression is typical of?

28. Nurse Perry is aware that language a. Flight of ideas

development in autistic child resembles: b. Associative looseness

a. Scanning speech c. Confabulation

b. Speech lag d. Concretism

c. Shuttering 34. Nurse Joey is aware that the signs &

d. Echolalia symptoms that would be most specific for

29. A 60 year old female client who lives alone diagnosis anorexia are?

tells the nurse at the community health

 a. Excessive weight loss, amenorrhea neglectful of his work and personal

& abdominal distension hygiene, is brought to the psychiatric

b. Slow pulse, 10% weight loss & hospital by his parents. After detailed

alopecia assessment, a diagnosis of schizophrenia is

c. Compulsive behavior, excessive made. It is unlikely that the client will

fears & nausea demonstrate:

d. Excessive activity, memory lapses a. Low self esteem

& an increased pulse b. Concrete thinking

35. A characteristic that would suggest to c. Effective self boundaries

Nurse Anne that an adolescent may have d. Weak ego

bulimia would be: 41. A 23 year old client has been admitted with

a. Frequent regurgitation & re- a diagnosis of schizophrenia says to the

swallowing of food nurse “Yes, its march, March is little

b. Previous history of gastritis woman”. That’s literal you know”. These

c. Badly stained teeth statement illustrate:

d. Positive body image a. Neologisms

36. Nurse Monette is aware that extremely b. Echolalia

depressed clients seem to do best in c. Flight of ideas

settings where they have: d. Loosening of association

a. Multiple stimuli 42. A long term goal for a paranoid male client

b. Routine Activities who has unjustifiably accused his wife of

c. Minimal decision making having many extramarital affairs would be

d. Varied Activities to help the client develop:

37. To further assess a client’s suicidal a. Insight into his behavior

potential. Nurse Katrina should be b. Better self control

especially alert to the client expression of: c. Feeling of self worth

a. Frustration & fear of death d. Faith in his wife

b. Anger & resentment 43. A male client who is experiencing

c. Anxiety & loneliness disordered thinking about food being

d. Helplessness & hopelessness poisoned is admitted to the mental health

38. A nursing care plan for a male client with unit. The nurse uses which communication

bipolar I disorder should include: technique to encourage the client to eat

a. Providing a structured environment dinner?

b. Designing activities that will a. Focusing on self-disclosure of own

require the client to maintain food preference

contact with reality b. Using open ended question and

c. Engaging the client in conversing silence

about current affairs c. Offering opinion about the need to

d. Touching the client provide eat

assurance d. Verbalizing reasons that the client

39. When planning care for a female client may not choose to eat

using ritualistic behavior, Nurse Gina must 44. Nurse Nina is assigned to care for a client

recognize that the ritual: diagnosed with Catatonic Stupor. When

a. Helps the client focus on the Nurse Nina enters the client’s room, the

inability to deal with reality client is found lying on the bed with a body

b. Helps the client control the anxiety pulled into a fetal position. Nurse Nina

c. Is under the client’s conscious should?

control a. Ask the client direct questions to

d. Is used by the client primarily for encourage talking

secondary gains b. Rake the client into the dayroom to

40. A 32 year old male graduate student, who be with other clients

has become increasingly withdrawn and

 c. Sit beside the client in silence and a. The client eliminates all anxiety

occasionally ask open-ended from daily situations

question b. The client ignores feelings of

d. Leave the client alone and continue anxiety

with providing care to the other c. The client identifies anxiety

clients producing situations

45. Nurse Tina is caring for a client with d. The client maintains contact with a

delirium and states that “look at the crisis counselor

spiders on the wall”. What should the nurse 49. Nurse Tina is caring for a client with

respond to the client? depression who has not responded to

a. “You’re having hallucination, there antidepressant medication. The nurse

are no spiders in this room at all” anticipates that what treatment procedure

b. “I can see the spiders on the wall, may be prescribed?

but they are not going to hurt you” a. Neuroleptic medication

c. “Would you like me to kill the b. Short term seclusion

spiders” c. Psychosurgery

d. “I know you are frightened, but I do d. Electroconvulsive therapy

not see spiders on the wall” 50. Mario is admitted to the emergency room

46. Nurse Jonel is providing information to a with drug-included anxiety related to over

community group about violence in the ingestion of prescribed antipsychotic

family. Which statement by a group medication. The most important piece of

member would indicate a need to provide information the nurse in charge should

additional information? obtain initially is the:

a. “Abuse occurs more in low-income a. Length of time on the med.

families” b. Name of the ingested medication &

b. “Abuser Are often jealous or self- the amount ingested

centered” c. Reason for the suicide attempt

c. “Abuser use fear and intimidation” d. Name of the nearest relative &

d. “Abuser usually have poor self- their phone number

esteem”

47. During electroconvulsive therapy (ECT) the

client receives oxygen by mask via positive

pressure ventilation. The nurse assisting

with this procedure knows that positive

pressure ventilation is necessary because?

a. Anesthesia is administered during Answers and Rationale Psychiatric Nursing

Practice Test Part 2
the procedure

b. Decrease oxygen to the brain

1. C. Total abstinence is the only effective treatment
increases confusion and
for alcoholism.
disorientation
2. A. Hallucinations are visual, auditory, gustatory,
c. Grand mal seizure activity
tactile or olfactory perceptions that have no basis
depresses respirations
in reality.
d. Muscle relaxations given to prevent
3. D. The Nurse has a responsibility to observe
injury during seizure activity
continuously the acutely suicidal client. The
depress respirations.

48. When planning the discharge of a client Nurseshould watch for clues, such as

with chronic anxiety, Nurse Chris evaluates communicating suicidal thoughts, and messages;

achievement of the discharge maintenance hoarding medications and talking about death.

goals. Which goal would be most 4. B. Establishing a consistent eating plan and
appropriately having been included in the monitoring client’s weight are important to this
plan of care requiring evaluation? disorder.
5. C. Appropriate nursing interventions for an anxiety belittling. The natural tendency is to counterattack

attack include using short sentences, staying with the threat to self image.

the client, decreasing stimuli, remaining calm and 20. B. The nurse would specifically use supportive

medicating as needed. confrontation with the client to point out

6. B. Delusion of grandeur is a false belief that one is discrepancies between what the client states and

highly famous and important. what actually exists to increase responsibility for

7. D. Individual with dependent personality disorder self.

typically shows indecisiveness submissiveness and 21. C. The nurse would most likely administer

clinging behavior so that others will make decisions benzodiazepine, such as lorazepan (ativan) to the

with them. client who is experiencing symptom: The client’s

8. A. Clients with schizotypal personality disorder experiences symptoms of withdrawal because of

experience excessive social anxiety that can lead the rebound phenomenon when the sedation of the

to paranoid thoughts. CNS from alcohol begins to decrease.

9. B. Bulimia disorder generally is a maladaptive 22. D. Regular coffee contains caffeine which acts as

coping response to stress and underlying issues. psychomotor stimulants and leads to feelings of

The client should identify anxiety causing situation anxiety and agitation. Serving coffee top the client

that stimulate the bulimic behavior and then learn may add to tremors or wakefulness.

new ways of coping with the anxiety. 23. D. Vomiting and diarrhea are usually the late signs

10. A. An adult age 31 to 45 generates new level of of heroin withdrawal, along with muscle spasm,

awareness. fever, nausea, repetitive, abdominal cramps and

11. A. Neuromuscular Blocker, such as backache.

SUCCINYLCHOLINE (Anectine) produces respiratory 24. D. Moving to a client’s personal space increases

depression because it inhibits contractions of the feeling of threat, which increases anxiety.

respiratory muscles. 25. A. Environmental (MILIEU) therapy aims at having

12. C. With depression, there is little or no emotional everything in the client’s surrounding area toward

involvement therefore little alteration in affect. helping the client.

13. D. These clients often hide food or force vomiting; 26. C. Children who have experienced attachment

therefore they must be carefully monitored. difficulties with primary caregiver are not able to

14. A. These clients have severely depleted levels of trust others and therefore relate superficially

sodium and potassium because of their starvation 27. A. Children have difficulty verbally expressing their

diet and energy expenditure, these electrolytes are feelings, acting out behavior, such as temper

necessary for cardiac functioning. tantrums, may indicate underlying depression.

15. B. Limiting unnecessary interaction will decrease 28. D. The autistic child repeat sounds or words spoken

stimulation and agitation. by others.

16. C. Ritualistic behavior seen in this disorder is aimed 29. D. The client statement is an example of the use of

at controlling guilt and inadequacy by maintaining denial, a defense that blocks problem by

an absolute set pattern of behavior. unconscious refusing to admit they exist.

17. D. The nurse needs to set limits in the client’s 30. A. Discussion of the feared object triggers an

manipulative behavior to help the client control emotional response to the object.

dysfunctional behavior. A consistent approach by 31. B. The nurse presence may provide the client with

the staff is necessary to decrease manipulation. support & feeling of control.

18. B. Any suicidal statement must be assessed by the 32. D. Experiencing the actual trauma in dreams or

nurse. The nurse should discuss the client’s flashback is the major symptom that

statement with her to determine its meaning in distinguishes post traumatic stress disorder from

terms of suicide. other anxiety disorder.

19. A. When the staff member ask the client if he 33. C. Confabulation or the filling in of memory gaps

wonders why others find him repulsive, the client is with imaginary facts is a defense mechanismused

likely to feel defensive because the question is by people experiencing memory deficits.
34. A. These are the major signs of anorexia nervosa. 49. D. Electroconvulsive therapy is an effective

Weight loss is excessive (15% of expected weight). treatment for depression that has not responded to

35. C. Dental enamel erosion occurs from repeated medication.

self-induced vomiting. 50. B. In an emergency, lives saving facts are obtained

36. B. Depression usually is both emotional & physical. first. The name and the amount of medication

A simple daily routine is the best, least stressful ingested are of outmost important in treating this

and least anxiety producing. potentially life threatening situation.

37. D. The expression of these feeling may indicate

that this client is unable to continue the struggle of

life.

38. A. Structure tends to decrease agitation and

anxiety and to increase the client’s feeling of

security.

39. B. The rituals used by a client with obsessive

compulsive disorder help control the anxiety level

by maintaining a set pattern of action.

40. C. A person with this disorder would not have

adequate self-boundaries.

41. D. Loose associations are thoughts that are

presented without the logical connections usually

necessary for the listening to interpret the

message.

42. C. Helping the client to develop feeling of self

worth would reduce the client’s need to use

pathologic defenses.

43. B. Open ended questions and silence are strategies

used to encourage clients to discuss their problem

in descriptive manner.

44. C. Clients who are withdrawn may be immobile and

mute, and require consistent, repeated

interventions. Communication with withdrawn

clients requires much patience from the nurse.The

nurse facilitates communication with the client by

sitting in silence, asking open-ended question and

pausing to provide opportunities for the client to

respond.

45. D. When hallucination is present, the nurse should

reinforce reality with the client.

46. A. Personal characteristics of abuser include low

self-esteem, immaturity, dependence, insecurity

and jealousy.

47. D. A short acting skeletal muscle relaxant such as

succinylcholine (Anectine) is administered during

this procedure to prevent injuries during seizure.

48. C. Recognizing situations that produce anxiety

allows the client to prepare to cope with anxiety or

avoid specific stimulus.

 c. Salami

d. Hamburger

5. When assessing a female client who is receiving

tricyclic antidepressant therapy, which of the

following would alert the nurse to the possibility

that the client is experiencing anticholinergic

effects?

a. Urine retention and blurred vision

b. Respiratory depression and convulsion

c. Delirium and Sedation

d. Tremors and cardiac arrhythmias

6. For a male client with dysthymic disorder, which of

the following approaches would the nurseexpect to

implement?
Psychiatric Nursing Practice Test Part 2
a. ECT
1. Nurse Tony should first discuss terminating the
b. Psychotherapeutic approach
nurse-client relationship with a client during the:
c. Psychoanalysis
a. Termination phase when discharge plans are being
d. Antidepressant therapy
made.
7. Danny who is diagnosed with bipolar disorder and
b. Working phase when the client shows some
acute mania, states the nurse, “Where is my
progress.
daughter? I love Louis. Rain, rain go away. Dogs
c. Orientation phase when a contract is established.
eat dirt.” The nurse interprets these statements as
d. Working phase when the client brings it up.
indicating which of the following?
2. Malou is diagnosed with major depression spends
a. Echolalia
majority of the day lying in bed with the sheet
b. Neologism
pulled over his head. Which of the following
c. Clang associations
approaches by the nurse would be the most
d. Flight of ideas
therapeutic?
8. Terry with mania is skipping up and down the
a. Question the client until he responds
hallway practically running into other
b. Initiate contact with the client frequently
clients. Which of the following activities would the
c. Sit outside the clients room
nurse in charge expect to include in Terry’s plan of
d. Wait for the client to begin the conversation
care?
3. Joe who is very depressed exhibits psychomotor
a. Watching TV
retardation, a flat affect and apathy. The nursein
b. Cleaning dayroom tables
charge observes Joe to be in need of grooming and
c. Leading group activity
hygiene. Which of the following nursing actions
d. Reading a book
would be most appropriate?
9. When assessing a male client for suicidal risk, which
a. Waiting until the client’s family can participate in the
of the following methods of suicide would the
client’s care
nurse identify as most lethal?
b. Asking the client if he is ready to take shower
a. Wrist cutting
c. Explaining the importance of hygiene to the client
b. Head banging
d. Stating to the client that it’s time for him to take a
c. Use of gun
shower
d. Aspirin overdose
4. When teaching Mario with a typical depression about
10. Jun has been hospitalized for major depression and
foods to avoid while taking phenelzine(Nardil),
suicidal ideation. Which of the following statements
which of the following would the nurse in charge
indicates to the nurse that the client is improving?
include?
a. “I’m of no use to anyone anymore.”
a. Roasted chicken

b. Fresh fish
b. “I know my kids don’t need me anymore since b. Feeling more guilty about the client’s illness

they’re grown.” c. Recognizing the client’s weakness

c. “I couldn’t kill myself because I don’t want to go to d. Managing their financial concern and problems

hell.” 16. When planning care for Dory with schizotypal

d. “I don’t think about killing myself as much as I used personality disorder, which of the following would

to.” help the client become involved with others?

11. Which of the following activities would Nurse Trish a. Attending an activity with the nurse

recommend to the client who becomes very b. Leading a sing a long in the afternoon

anxious when thoughts of suicide occur? c. Participating solely in group activities

a. Using exercise bicycle d. Being involved with primarily one to one activities

b. Meditating 17. Which statement about an individual with a

c. Watching TV personality disorder is true?

d. Reading comics a. Psychotic behavior is common during acute episodes

12. When developing the plan of care for a client b. Prognosis for recovery is good with therapeutic

receiving haloperidol, which of the following intervention

medications would nurse Monet anticipate c. The individual typically remains in the mainstream of

administering if the client developed extra society, although he has problems in social and

pyramidal side effects? occupational roles

a. Olanzapine (Zyprexa) d. The individual usually seeks treatment willingly for

b. Paroxetine (Paxil) symptoms that are personally distressful.

c. Benztropine mesylate (Cogentin) 18. Nurse John is talking with a client who has been

d. Lorazepam (Ativan) diagnosed with antisocial personality about how to

13. Jon a suspicious client states that “I know you socialize during activities without being

nurses are spraying my food with poison as you seductive. Nurse John would focus the discussion

take it out of the cart.” Which of the following on which of the following areas?

would be the best response of the nurse? a. Discussing his relationship with his mother

a. Giving the client canned supplements until the b. Asking him to explain reasons for his seductive

delusion subsides behavior

b. Asking what kind of poison the client suspects is c. Suggesting to apologize to others for his behavior

being used d. Explaining the negative reactions of others toward

c. Serving foods that come in sealed packages his behavior

d. Allowing the client to be the first to open the cart 19. Tina with a histrionic personality disorder is

and get a tray melodramatic and responds to others and

14. A client is suffering from catatonic situations in an exaggerated manner. Nurse Trish

behaviors. Which of the following would the would recommend which of the

nurse use to determine that the medication following activities for Tina?

administered PRN have been most effective? a. Baking class

a. The client responds to verbal directions to eat b. Role playing

b. The client initiates simple activities without direction c. Scrap book making

c. The client walks with the nurse to her room d. Music group

d. The client is able to move all extremities 20. Joy has entered the chemical dependency unit for

occasionally treatment of alcohol dependency. Which of the

15. Nurse Hazel invites new client’s parents to attend following client’s possession will the nurse most

the psycho educational program for families of the likely place in a locked area?

chronically mentally ill. The program would be a. Toothpaste

most likely to help the family with which of the b. Shampoo

following issues? c. Antiseptic wash

a. Developing a support network with other families d. Moisturizer

21. Which of the following assessment would provide 27. Which of the following liquids would nurse Leng

the best information about the client’s physiologic administer to a female client who is intoxicated

response and the effectiveness of the medication with phencyclidine (PCP) to hasten excretion of the

prescribed specifically for alcohol withdrawal? chemical?

a. Sleeping pattern a. Shake

b. Mental alertness b. Tea

c. Nutritional status c. Cranberry Juice

d. Vital signs d. Grape juice

22. After administering naloxone (Narcan), an opioid 28. When developing a plan of care for a female client

antagonist, Nurse Ronald should monitor the with acute stress disorder who lost her sister in a

female client carefully for which of the following? car accident. Which of the following would the

a. Respiratory depression nurse expect to initiate?

b. Epilepsy a. Facilitating progressive review of the accident and

c. Kidney failure its consequences

d. Cerebral edema b. Postponing discussion of the accident until the client

23. Which of the following would nurse Ronald use as brings it up

the best measure to determine a client’s progress c. Telling the client to avoid details of the accident

in rehabilitation? d. Helping the client to evaluate her sister’s behavior

a. The way he gets along with his parents 29. The nursing assistant tells nurse Ronald that the

b. The number of drug-free days he has client is not in the dining room for lunch. Nurse

c. The kinds of friends he makes Ronald would direct the nursing assistant to do

d. The amount of responsibility his job entails which of the following?

24. A female client is brought by ambulance to the a. Tell the client he’ll need to wait until supper to eat if

hospital emergency room after taking an overdose he misses lunch

of barbiturates is comatose. Nurse Trish would be b. Invite the client to lunch and accompany him to the

especially alert for which of the following? dining room

a. Epilepsy c. Inform the client that he has 10 minutes to get to

b. Myocardial Infarction the dining room for lunch

c. Renal failure d. Take the client a lunch tray and let the client eat in

d. Respiratory failure his room

25. Joey who has a chronic user of cocaine reports that 30. The initial nursing intervention for the significant-

he feels like he has cockroaches crawling under his others during shock phase of a grief reaction

skin. His arms are red because of scratching. The should be focused on:

nurse in charge interprets these findings as a. Presenting full reality of the loss of the individuals

possibly indicating which of the following? b. Directing the individual’s activities at this time

a. Delusion c. Staying with the individuals involved

b. Formication d. Mobilizing the individual’s support system

c. Flash back 31. Joy’s stream of consciousness is occupied

d. Confusion exclusively with thoughts of her father’s

26. Jose is diagnosed with amphetamine psychosis and death. Nurse Ronald should plan to help Joy

was admitted in the emergency room. Nurse through this stage of grieving, which is known as:

Ronald would most likely prepare to administer a. Shock and disbelief

which of the following medication? b. Developing awareness

a. Librium c. Resolving the loss

b. Valium d. Restitution

c. Ativan 32. When taking a health history from a female client

d. Haldol who has a moderate level of cognitive impairment

 due to dementia, the nurse would expect to note attention too.” This statement shows that the

the presence of: nurse’s use of:

a. Accentuated premorbid traits a. Defensive behavior

b. Enhance intelligence b. Reality reinforcement

c. Increased inhibitions c. Limit-setting behavior

d. Hyper vigilance d. Impulse control

33. What is the priority care for a client with a 39. A nursing diagnosis for a male client with a

dementia resulting from AIDS? diagnosed multiple personality disorder is chronic

a. Planning for remotivational therapy low self-esteem probably related to childhood

b. Arranging for long term custodial care abuse. The most appropriate short term client

c. Providing basic intellectual stimulation outcome would be:

d. Assessing pain frequently a. Verbalizing the need for anxiety medications

34. Jerome who has eating disorder often exhibits b. Recognizing each existing personality

similar symptoms. Nurse Lhey would expect an c. Engaging in object-oriented activities

adolescent client with anorexia to exhibit: d. Eliminating defense mechanisms and phobia

a. Affective instability 40. A 25 year old male is admitted to a mental health

b. Dishered, unkempt physical appearance facility because of inappropriate behavior. The

c. Depersonalization and derealization client has been hearing voices, responding to

d. Repetitive motor mechanisms imaginary companions and withdrawing to his

35. The primary nursing diagnosis for a female client room for several days at a time. Nurse Monette

with a medical diagnosis of major depression would understands that the withdrawal is a defense

be: against the client’s fear of:

a. Situational low self-esteem related to altered role a. Phobia

b. Powerlessness related to the loss of idealized self b. Powerlessness

c. Spiritual distress related to depression c. Punishment

d. Impaired verbal communication related to d. Rejection

depression 41. When asking the parents about the onset of

36. When developing an initial nursing care plan for a problems in young client with the diagnosis of

male client with a Bipolar I disorder (manic schizophrenia, Nurse Linda would expect that they

episode) nurse Ron should plan to? would relate the client’s difficulties began in:

a. Isolate his gym time a. Early childhood

b. Encourage his active participation in unit programs b. Late childhood

c. Provide foods, fluids and rest c. Adolescence

d. Encourage his participation in programs d. Puberty

37. Grace is exhibiting withdrawn patterns of 42. Jose who has been hospitalized with schizophrenia

behavior. Nurse Johnny is aware that this type of tells Nurse Ron, “My heart has stopped and my

behavior eventually produces feeling of: veins have turned to glass!” Nurse Ron is aware

a. Repression that this is an example of:

b. Loneliness a. Somatic delusions

c. Anger b. Depersonalization

d. Paranoia c. Hypochondriasis

38. One morning a female client on the inpatient d. Echolalia

psychiatric service complains to nurse Hazel that 43. In recognizing common behaviors exhibited by

she has been waiting for over an hour for someone male client who has a diagnosis of schizophrenia,

to accompany her to activities. Nurse Hazel replies nurse Josie can anticipate:

to the client “We’re doing the best we can. There a. Slumped posture, pessimistic out look and flight of

are a lot of other people on the unit who needs ideas

b. Grandiosity, arrogance and distractibility

c. Withdrawal, regressed behavior and lack of social 50. Within a few hours of alcohol withdrawal, nurse

skills John should assess the male client for the presence

d. Disorientation, forgetfulness and anxiety of:

44. One morning, nurse Diane finds a disturbed client a. Disorientation, paranoia, tachycardia

curled up in the fetal position in the corner of the b. Tremors, fever, profuse diaphoresis

dayroom. The most accurate initial evaluation of c. Irritability, heightened alertness, jerky movements

the behavior would be that the client is: d. Yawning, anxiety, convulsions

a. Physically ill and experiencing abdominal discomfort

b. Tired and probably did not sleep well last night

c. Attempting to hide from the nurse

d. Feeling more anxious today

45. Nurse Bea notices a female client sitting alone in

the corner smiling and talking to herself.Realizing

that the client is hallucinating. Nurse Bea should:

a. Invite the client to help decorate the dayroom

b. Leave the client alone until he stops talking

c. Ask the client why he is smiling and talking

d. Tell the client it is not good for him to talk to himself

46. When being admitted to a mental health facility, a

young female adult tells Nurse Mylene that the

voices she hears frighten her. Nurse Mylene

understands that the client tends to hallucinate

Answers and Rationale Psychiatric Nursing
more vividly: Practice Test Part 2

a. While watching TV
1. C. When the nurse and client agree to work
b. During meal time
together, a contract should be established,
c. During group activities
the length of the relationship should be
d. After going to bed
discussed in terms of its ultimate
47. Nurse John recognizes that paranoid delusions
termination.
usually are related to the defense mechanism of: 2. B. The nurse should initiate brief, frequent
a. Projection contacts throughout the day to let the
b. Identification client know that he is important to the
c. Repression nurse. This will positively affect the client’s

d. Regression self-esteem.

48. When planning care for a male client using 3. D. The client with depression is

paranoid ideation, nurse Jasmin should realize the preoccupied, has decreased energy, and is

unable to make decisions. The nurse

importance of:
presents the situation, “It’s time for a
a. Giving the client difficult tasks to provide stimulation
shower”, and assists the client with
b. Providing the client with activities in which success
personal hygiene to preserve his dignity
can be achieved
and self-esteem.
c. Removing stress so that the client can relax
4. C. Foods high in tyramine, those that are
d. Not placing any demands on the client
fermented, pickled, aged, or smoked must
49. Nurse Gerry is aware that the defense mechanism
be avoided because when they are
commonly used by clients who are alcoholics is:
ingested in combination with MAOIs a
a. Displacement hypertensive crisis will occur.
b. Denial 5. A. Anticholinergic effects, which result from
c. Projection blockage of the parasympathetic
d. Compensation (craniosacral) nervous system including
 urine retention, blurred vision, dry mouth & personality disorder needs support,

constipation. kindness & gentle suggestion to improve

6. B. Dysthymia is a less severe, chronic social skills & interpersonal relationship.

depression diagnosed when a client has 17. C. An individual with personality disorder
had a depressed mood for more days than usually is not hospitalized unless a

not over a period of at least 2 years. Client coexisting Axis I psychiatric disorder is

with dysthymic disorder benefit from present. Generally, these individuals make

psychotherapeutic approaches that assist marginal adjustments and remain in

the client in reversing the negative self society, although they typically experience

image, negative feelings about the future. relationship and occupational problems
7. D. Flight of ideas is speech pattern of rapid related to their inflexible behaviors.

transition from topic to topic, often without Personality disorders are chronic lifelong

finishing one idea. It is common in mania. patterns of behavior; acute episodes do not
8. B. The client with mania is very active & occur. Psychotic behavior is usually not

needs to have this energy channeled in a common, although it can occur in either

constructive task such as cleaning or schizotypal personality disorder or

tidying the room. borderline personality disorder. Because

9. C. A crucial factor is determining the these disorders are enduring and evasive

lethality of a method is the amount of time and the individual is inflexible, prognosis

that occurs between initiating the method for recovery is unfavorable. Generally, the

& the delivery of the lethal impact of the individual does not seek treatment

method. because he does not perceive problems

10. D. The statement “I don’t think about with his own behavior. Distress can occur

killing myself as much as I used to.” based on other people’s reaction to the

Indicates a lessening of suicidal ideation individual’s behavior.

and improvement in the client’s condition. 18. D. The nurse would explain the negative
11. A. Using exercise bicycle is appropriate for reactions of others towards the client’s

the client who becomes very anxious when behaviors to make the clients aware of the

thoughts of suicidal occur. impact of his seductive behaviors on

12. C. The drug of choice for a client others.

experiencing extra pyramidal side effects 19. B. The nurse would use role-playing to
from haloperidol (Haldol) is benztropine teach the client appropriate responses to

mesylate (cogentin) because of its anti others and in various situations. This client

cholinergic properties. dramatizes events, drawn attention to self,

13. D. Allowing the client to be the first to open and is unaware of and does not deal with

the cart & take a tray presents the client feelings. The nurse works to help the client

with the reality that the nurses are not clarify true feelings & learn to express

touching the food & tray, thereby dispelling them appropriately.

the delusion. 20. C. Antiseptic mouthwash often contains

14. B. Although all the actions indicate alcohol & should be kept in locked area,

improvement, the ability to initiate simple unless labeling clearly indicates that the

activities without directions indicates the product does not contain alcohol.

most improvement in the catatonic 21. D. Monitoring of vital signs provides the
behaviors. best information about the client’s overall
15. A. Psychoeducational groups for families physiologic status during alcohol

develop a support network. They provide withdrawal & the physiologic response to

education about the biochemical etiology the medication used.

of psychiatric disease to reduce, not 22. A. After administering naloxone (Narcan)

increase family guilt. the nurse should monitor the client’s
16. C. Attending activity with the nurse assists respiratory status carefully, because the

the client to become involved with others drug is short acting & respiratory

slowly. The client with schizotypal

 depression may recur after its effects wear 33. C. This action maintains for as long as
off. possible, the clients intellectual functions
23. B. The best measure to determine a by providing an opportunity to use them.

client’s progress in rehabilitation is the 34. A. Individuals with anorexia often display
number of drug- free days he has. The irritability, hospitality, and a depressed

longer the client is free of drugs, the better mood.

the prognosis is. 35. D. Depressed clients demonstrate

24. D. Barbiturates are CNS depressants; the decreased communication because of lack

nurse would be especially alert for the of psychic or physical energy.

possibility of respiratory failure. 36. C. The client in a manic episode of the

Respiratory failure is the most likely cause illness often neglects basic needs, these

of death from barbiturate over dose. needs are a priority to ensure adequate
25. B. The feeling of bugs crawling under the nutrition, fluid, and rest.

skin is termed as formication, and is 37. B. The withdrawn pattern of behavior

associated with cocaine use. presents the individual from reaching out
26. D. The nurse would prepare to administer to others for sharing the isolation produces

an antipsychotic medication such as Haldol feeling of loneliness.

to a client experiencing amphetamine 38. A. The nurse’s response is not therapeutic

psychosis to decrease agitation & because it does not recognize the client’s

psychotic symptoms, including delusions, needs but tries to make the client feel

hallucinations & cognitive impairment. guilty for being demanding.

27. C. An acid environment aids in the 39. B. The client must recognize the existence
excretion of PCP. The nurse will definitely of the sub personalities so that

give the client with PCP intoxication interpretation can occur.

cranberry juice to acidify the urine to a ph 40. D. An aloof, detached, withdrawn posture
of 5.5 & accelerate excretion. is a means of protecting the self by
28. A. The nurse would facilitate progressive withdrawing and maintaining a safe,

review of the accident and its consequence emotional distance.

to help the client integrate feelings & 41. C. The usual age of onset of schizophrenia
memories and to begin the grieving is adolescence or early childhood.

process. 42. A. Somatic delusion is a fixed false belief

29. B. The nurse instructs the nursing assistant about one’s body.

to invite the client to lunch & accompany 43. C. These are the classic behaviors
him to the dinning room to decrease exhibited by clients with a diagnosis of

manipulation, secondary gain, dependency schizophrenia.

and reinforcement of negative behavior 44. D. The fetal position represents regressed
while maintaining the client’s worth. behavior. Regression is a way of
30. C. This provides support until the responding to overwhelming anxiety.

individuals coping mechanisms and 45. B. This provides a stimulus that competes
personal support systems can be with and reduces hallucination.

immobilized. 46. D. Auditory hallucinations are most

31. C. Resolving a loss is a slow, painful, troublesome when environmental stimuli

continuous process until a mental image of are diminished and there are few

the dead person, almost devoid of negative competing distractions.

or undesirable features emerges. 47. A. Projection is a mechanism in which inner

32. A. A moderate level of cognitive thoughts and feelings are projected onto

impairment due to dementia is the environment, seeming to come from

characterized by increasing dependence on outside the self rather than from within.

environment & social structure and by 48. B. This will help the client develop self-
increasing psychologic rigidity with esteem and reduce the use of paranoid

accentuated previous traits & behaviors. ideation.

 49. B. Denial is a method of resolving conflict 3. A tentative diagnosis of opiate addiction, Nurse
or escaping unpleasant realities by Candy should assess a recently hospitalized client
ignoring their existence. for signs of opiate withdrawal. These signs would
50. C. Alcohol is a central nervous system include:
depressant. These symptoms are the
a. Rhinorrhea, convulsions, subnormal temperature
body’s neurologic adaptation to the
b. Nausea, dilated pupils, constipation
withdrawal of alcohol.
c. Lacrimation, vomiting, drowsiness

d. Muscle aches, papillary constriction, yawning

4. A 48 year old male client is brought to the

psychiatric emergency room after attempting to

jump off a bridge. The client’s wife states that he

lost his job several months ago and has been

unable to find another job. The primary nursing

intervention at this time would be to assess for:

a. A past history of depression

b. Current plans to commit suicide

c. The presence of marital difficulties

d. Feelings of excessive failure

5. Before helping a male client who has been sexually

assaulted, nurse Maureen should recognize that

the rapist is motivated by feelings of:

a. Hostility

b. Inadequacy

c. Incompetence

d. Passion

6. When working with children who have been sexually

abused by a family member it is important for the

nurse to understand that these victims usually are

overwhelmed with feelings of:

a. Humiliation

b. Confusion

c. Self blame

d. Hatred

7. Joy who has just experienced her

second spontaneous abortion expresses anger

Psychiatric Nursing Practice Test Part 3
towards her physician, the hospital and the “rotten

nursing care”. When assessing the situation, the

1. Francis who is addicted to cocaine withdraws from
nurse recognizes that the client may be using the
the drug. Nurse Ron should expect to observe:
coping mechanism of:
a. Hyperactivity
a. Projection
b. Depression
b. Displacement
c. Suspicion
c. Denial
d. Delirium
d. Reaction formation
2. Nurse John is aware that a serious effect of inhaling
8. The most critical factor for nurse Linda to determine
cocaine is?
during crisis intervention would be the client’s:
a. Deterioration of nasal septum
a. Available situational supports
b. Acute fluid and electrolyte imbalances
b. Willingness to restructure the personality
c. Extra pyramidal tract symptoms
c. Developmental theory
d. Esophageal varices
d. Underlying unconscious conflict 14. Malou with schizophrenia tells Nurse Melinda, “My

9. Nurse Trish suggests a crisis intervention group to a intestines are rotted from worms chewing on

client experiencing a developmental crisis.These them.” This statement indicates a:

groups are successful because the: a. Jealous delusion

a. Crisis intervention worker is a psychologist and b. Somatic delusion

understands behavior patterns c. Delusion of grandeur

b. Crisis group supplies a workable solution to the d. Delusion of persecution

client’s problem 15. Andy is admitted to the psychiatric unit with a

c. Client is encouraged to talk about personal problems diagnosis of borderline personality disorder. Nurse

d. Client is assisted to investigate alternative Hilary should expects the assessment to reveal:

approaches to solving the identified problem a. Coldness, detachment and lack of tender feelings

10. Nurse Ronald could evaluate that the staff’s b. Somatic symptoms

approach to setting limits for a demanding, angry c. Inability to function as responsible parent

client was effective if the client: d. Unpredictable behavior and intense interpersonal

a. Apologizes for disrupting the unit’s routine when relationships

something is needed 16. PROPRANOLOL (Inderal) is used in the mental

b. Understands the reason why frequent calls to the health setting to manage which of the following

staff were made conditions?

c. Discuss concerns regarding the emotional condition a. Antipsychotic – induced akathisia and anxiety

that required hospitalizations b. Obsessive – compulsive disorder (OCD) to reduce

d. No longer calls the nursing staff for assistance ritualistic behavior

11. Nurse John is aware that the therapy that has the c. Delusions for clients suffering from schizophrenia

highest success rate for people with phobias would d. The manic phase of bipolar illness as a mood

be: stabilizer

a. Psychotherapy aimed at rearranging maladaptive 17. Which medication can control the extra pyramidal

thought process effects associated with antipsychotic agents?

b. Psychoanalytical exploration of repressed conflicts of a. Clorazepate (Tranxene)

an earlier development phase b. Amantadine (Symmetrel)

c. Systematic desensitization using relaxation c. Doxepin (Sinequan)

technique d. Perphenazine (Trilafon)

d. Insight therapy to determine the origin of the 18. Which of the following statements should be

anxiety and fear included when teaching clients about monoamine

12. When nurse Hazel considers a client’s placement oxidase inhibitor (MAOI) antidepressants?

on the continuum of anxiety, a key in determining a. Don’t take aspirin or nonsteroidal anti-inflammatory

the degree of anxiety being experienced is the drugs (NSAIDs)

client’s: b. Have blood levels screened weekly for leucopenia

a. Perceptual field c. Avoid strenuous activity because of the cardiac

b. Delusional system effects of the drug

c. Memory state d. Don’t take prescribed or over the counter

d. Creativity level medications without consulting the physician

13. In the diagnosis of a possible pervasive 19. Kris periodically has acute panic attacks. These

developmental autistic disorder. The nurse would attacks are unpredictable and have no apparent

find it most unusual for a 3 year old child to association with a specific object or

demonstrate: situation. During an acute panic attack, Kris may

a. An interest in music experience:

b. An attachment to odd objects a. Heightened concentration

c. Ritualistic behavior b. Decreased perceptual field

d. Responsiveness to the parents c. Decreased cardiac rate

d. Decreased respiratory rate d. Helping the client identify and express feelings of

20. Initial interventions for Marco with acute anxiety anxiety and anger

include all except which of the following? 26. Rosana is in the second stage of Alzheimer’s

a. Touching the client in an attempt to comfort him disease who appears to be in pain. Which question

b. Approaching the client in calm, confident manner by Nurse Jenny would best elicit information about

c. Encouraging the client to verbalize feelings and the pain?

concerns a. “Where is your pain located?”

d. Providing the client with a safe, quiet and private b. “Do you hurt? (pause) “Do you hurt?”

place c. “Can you describe your pain?”

21. Nurse Jessie is assessing a client suffering from d. “Where do you hurt?”

stress and anxiety. A common physiological 27. Nursing preparation for a client undergoing

response to stress and anxiety is: electroconvulsive therapy (ECT) resemble those

a. Uticaria used for:

b. Vertigo a. General anesthesia

c. Sedation b. Cardiac stress testing

d. Diarrhea c. Neurologic examination

22. When performing a physical examination on a d. Physical therapy

female anxious client, nurse Nelli would expect to 28. Jose who is receiving monoamine oxidase inhibitor

find which of the following effects produced by the antidepressant should avoid tyramine, a compound

parasympathetic system? found in which of the following foods?

a. Muscle tension a. Figs and cream cheese

b. Hyperactive bowel sounds b. Fruits and yellow vegetables

c. Decreased urine output c. Aged cheese and Chianti wine

d. Constipation d. Green leafy vegetables

23. Which of the following drugs have been known to 29. Erlinda, age 85, with major depression undergoes a

be effective in treating obsessive-compulsive sixth electroconvulsive therapy (ECT)

disorder (OCD)? treatment. When assessing the client immediately

a. Divalproex (depakote) and Lithium (lithobid) after ECT, the nurse expects to find:

b. Chlordiazepoxide (Librium) and diazepam (valium) a. Permanent short-term memory loss and

c. Fluvoxamine (Luvox) and clomipramine (anafranil) hypertension

d. Benztropine (Cogentin) and diphenhydramine b. Permanent long-term memory loss and hypomania

(benadryl) c. Transitory short-term memory loss and permanent

24. Tony with agoraphobia has been symptom-free for long-term memory loss

4 months. Classic signs and symptoms of phobia d. Transitory short and long term memory loss and

include: confusion

a. Severe anxiety and fear 30. Barbara with bipolar disorder is being treated with

b. Withdrawal and failure to distinguish reality from lithium for the first time. Nurse Clint should

fantasy observe the client for which common adverse

c. Depression and weight loss effect of lithium?

d. Insomnia and inability to concentrate a. Polyuria

25. Which nursing action is most appropriate when b. Seizures

trying to diffuse a client’s impending violent c. Constipation

behavior? d. Sexual dysfunction

a. Place the client in seclusion 31. Nurse Fred is assessing a client who has just been

b. Leaving the client alone until he can talk about his admitted to the ER department. Which signs would

feelings suggest an overdose of an antianxiety agent?

c. Involving the client in a quiet activity to divert a. Suspiciousness, dilated pupils and incomplete BP

attention b. Agitation, hyperactivity and grandiose ideation

c. Combativeness, sweating and confusion b. Cognitive framework

d. Emotional lability, euphoria and impaired memory c. Interpersonal framework

32. Discharge instructions for a male client receiving d. Psychodynamic framework

tricyclic antidepressants include which of the 38. A nurse who explains that a client’s psychotic

following information? behavior is unconsciously motivated understands

a. Restrict fluids and sodium intake that the client’s disordered behavior arises from

b. Don’t consume alcohol which of the following?

c. Discontinue if dry mouth and blurred vision occur a. Abnormal thinking

d. Restrict fluid and sodium intake b. Altered neurotransmitters

33. Important teaching for women in their childbearing c. Internal needs

years who are receiving antipsychotic medications d. Response to stimuli

includes which of the following? 39. A client with depression has been hospitalized for

a. Increased incidence of dysmenorrhea while taking treatment after taking a leave of absence from

the drug work. The client’s employer expects the client to

b. Occurrence of incomplete libido due to medication return to work following inpatient treatment. The

adverse effects client tells the nurse, “I’m no good. I’m a failure”.

c. Continuing previous use of contraception during According to cognitive theory, these statements

periods of amenorrhea reflect:

d. Instruction that amenorrhea is irreversible a. Learned behavior

34. A client refuses to remain on psychotropic b. Punitive superego and decreased self-esteem

medications after discharge from an inpatient c. Faulty thought processes that govern behavior

psychiatric unit. Which information should the d. Evidence of difficult relationships in the work

community health nurse assess first during the environment

initial follow-up with this client? 40. The nurse describes a client as anxious. Which of

a. Income level and living arrangements the following statement about anxiety is true?

b. Involvement of family and support systems a. Anxiety is usually pathological

c. Reason for inpatient admission b. Anxiety is directly observable

d. Reason for refusal to take medications c. Anxiety is usually harmful

35. The nurse understands that the therapeutic effects d. Anxiety is a response to a threat

of typical antipsychotic medications are associated 41. A client with a phobic disorder is treated by

with which neurotransmitter change? systematic desensitization. The nurse understands

a. Decreased dopamine level that this approach will do which of the following?

b. Increased acetylcholine level a. Help the client execute actions that are feared

c. Stabilization of serotonin b. Help the client develop insight into irrational fears

d. Stimulation of GABA c. Help the client substitutes one fear for another

36. Which of the following best explains why tricyclic d. Help the client decrease anxiety

antidepressants are used with caution in elderly 42. Which client outcome would best indicate

patients? successful treatment for a client with an antisocial

a. Central Nervous System effects personality disorder?

b. Cardiovascular system effects a. The client exhibits charming behavior when around

c. Gastrointestinal system effects authority figures

d. Serotonin syndrome effects b. The client has decreased episodes of impulsive

37. A client with depressive symptoms is given behaviors

prescribed medications and talks with his therapist c. The client makes statements of self-satisfaction

about his belief that he is worthless and unable to d. The client’s statements indicate no remorse for

cope with life. Psychiatric care in this treatment behaviors

plan is based on which framework? 43. The nurse is caring for a client with an autoimmune

a. Behavioral framework disorder at a medical clinic, where alternative

 medicine is used as an adjunct to traditional c. Reading a self-help book on depression

therapies. Which information should the nurse d. Watching movie with the peer group

teach the client to help foster a sense of control 49. The home health psychiatric nurse visits a client

over his symptoms? with chronic schizophrenia who was recently

a. Pathophysiology of disease process discharged after a prolong stay in a state hospital.

b. Principles of good nutrition The client lives in a boarding home, reports no

c. Side effects of medications family involvement, and has little social interaction.

d. Stress management techniques The nurse plan to refer the client to a day

44. Which of the following is the most distinguishing treatment program in order to help him with:

feature of a client with an antisocial personality a. Managing his hallucinations

disorder? b. Medication teaching

a. Attention to detail and order c. Social skills training

b. Bizarre mannerisms and thoughts d. Vocational training

c. Submissive and dependent behavior 50. Which activity would be most appropriate for a

d. Disregard for social and legal norms severely withdrawn client?

45. Which nursing diagnosis is most appropriate for a a. Art activity with a staff member

client with anorexia nervosa who expresses b. Board game with a small group of clients

feelings of guilt about not meeting family c. Team sport in the gym

expectations? d. Watching TV in the dayroom

a. Anxiety

b. Disturbed body image

c. Defensive coping

d. Powerlessness

46. A nurse is evaluating therapy with the family of a

client with anorexia nervosa. Which of the following

would indicate that the therapy was successful?

a. The parents reinforced increased decision making by

the client

b. The parents clearly verbalize their expectations for

the client

c. The client verbalizes that family meals are now

enjoyable

d. The client tells her parents about feelings of low-self

esteem

47. A client with dysthymic disorder reports to a nurse

that his life is hopeless and will never improve in

the future. How can the nurse best respond using a

cognitive approach?

a. Agree with the client’s painful feelings

b. Challenge the accuracy of the client’s belief

c. Deny that the situation is hopeless Answers and Rationale Psychiatric Nursing
Part 3
d. Present a cheerful attitude

48. A client with major depression has not verbalized 1. B. There is no set of symptoms associated

problem areas to staff or peers since admission to with cocaine withdrawal, only the

a psychiatric unit. Which activity should the nurse depression that follows the high caused by

recommend to help this client express himself? the drug.

a. Art therapy in a small group 2. A. Cocaine is a chemical that when inhaled,

causes destruction of the mucous

b. Basketball game with peers on the unit
membranes of the nose.
3. D. These adaptations are associated with intense and unstable and behavior may be

opiate withdrawal which occurs after inappropriate and impulsive.

cessation or reduction of prolonged 16. A. Propranolol is a potent beta adrenergic

moderate or heavy use of opiates. blocker and producing a sedating effect,
4. B. Whether there is a suicide plan is a therefore it is used to treat antipsychotic

criterion when assessing the client’s induced akathisia and anxiety.

determination to make another attempt. 17. B. Amantadine is an anticholinergic drug

5. A. Rapists are believed to harbor and act used to relive drug-induced extra

out hostile feelings toward all women pyramidal adverse effects such as muscle

through the act of rape. weakness, involuntary muscle movements,

6. C. These children often have nonsexual pseudoparkinsonism and tar dive

needs met by individual and are powerless dyskinesia.

to refuse.Ambivalence results in self-blame 18. D. MAOI antidepressants when combined

and also guilt. with a number of drugs can cause life-
7. B. The client’s anger over the abortion is threatening hypertensive crisis. It’s

shifted to the staff and the hospital imperative that a client checks with his

because she is unable to deal with the physician and pharmacist before taking

abortion at this time. any other medications.

8. A. Personal internal strength and 19. B. Panic is the most severe level of
supportive individuals are critical factors anxiety. During panic attack, the client

that can be employed to assist the experiences a decrease in the perceptual

individual to cope with a crisis. field, becoming more focused on self, less
9. D. Crisis intervention group helps client aware of surroundings and unable to

reestablish psychologic equilibrium by process information from the

assisting them to explore new alternatives environment. The decreased perceptual

for coping. It considers realistic situations field contributes to impaired attention

using rational and flexible problem solving andinability to concentrate.

methods. 20. A. The emergency nurse must establish

10. C. This would document that the client rapport and trust with the anxious client

feels comfortable enough to discuss the before using therapeutic touch. Touching

problems that have motivated the an anxious client may actually increase

behavior. anxiety.
11. C. The most successful therapy for people 21. D. Diarrhea is a common physiological
with phobias involves behavior response to stress and anxiety.

modification techniques using 22. B. The parasympathetic nervous system

desensitization. would produce incomplete G.I. motility
12. A. Perceptual field is a key indicator of resulting in hyperactive bowel sounds,

anxiety level because the perceptual fields possibly leading to diarrhea.

narrow as anxiety increases. 23. C. The antidepressants fluvoxamine and

13. D. One of the symptoms of autistic child clomipramine have been effective in the

displays a lack of responsiveness to treatment of OCD.

others. There is little or no extension to the 24. A. Phobias cause severe anxiety (such as
external environment. panic attack) that is out of proportion to
14. B. Somatic delusions focus on bodily the threat of the feared object or

functions or systems and commonly situation. Physical signs and symptoms of

include delusion about foul odor emissions, phobias include profuse sweating, poor

insect manifestations, internal parasites motor control, tachycardia and elevated

and misshapen parts. B.P.

15. D. A client with borderline personality 25. D. In many instances, the nurse can diffuse
displays a pervasive pattern of impending violence by helping the client

unpredictable behavior, mood and self identify and express feelings of anger and

image. Interpersonal relationships may be anxiety. Such statement as “What

 happened to get you this angry?” may help already know the reason for inpatient

the client verbalizes feelings rather than admission.

act on them. 35. A. Excess dopamine is thought to be the

26. B. When speaking to a client with chemical cause for psychotic thinking. The

Alzheimer’s disease, the nurse should use typical antipsychotics act to block

close-ended questions.Those that the client dopamine receptors and therefore

can answer with “yes” or “no” whenever decrease the amount of neurotransmitter

possible and avoid questions that require at the synapses. The typical antipsychotics

the client to make choices. Repeating the do not increase acetylcholine, stabilize

question aids comprehension. serotonin, stimulate GABA.

27. A. The nurse should prepare a client for 36. B. The TCAs affect norepinephrine as well
ECT in a manner similar to that for general as other neurotransmitters, and thus have

anesthesia. significant cardiovascular side effects.

28. C. Aged cheese and Chianti wine contain Therefore, they are used with caution in

high concentrations of tyramine. elderly clients who may have increased risk
29. D. ECT commonly causes transitory short factors for cardiac problems because of

and long term memory loss and confusion, their age and other medical conditions. The

especially in geriatric clients. It rarely remaining side effects would apply to any

results in permanent short and long term client taking a TCA and are not particular

memory loss. to an elderly person.

30. A. Polyuria commonly occurs early in the 37. B. Cognitive thinking therapy focuses on
treatment with lithium and could result in the client’s misperceptions about self,

fluid volume deficit. others and the world that impact

31. D. Signs of anxiety agent overdose include functioning and contribute to symptoms.

emotional lability, euphoria and impaired Using medications to alter

memory. neurotransmitter activity is a

32. B. Drinking alcohol can potentiate the psychobiologic approach to treatment. The

sedating action of tricyclic other answer choices are frameworks for

antidepressants. Dry mouth and blurred care, but hey are not applicable to this

vision are normal adverse effects of situation.

tricyclic antidepressants. 38. C. The concept that behavior is motivated

33. C. Women may experience amenorrhea, and has meaning comes from the

which is reversible, while taking psychodynamic framework. According to

antipsychotics. Amenorrhea doesn’t this perspective, behavior arises from

indicate cessation of ovulation thus, the internal wishes or needs. Much of what

client can still be pregnant. motivates behavior comes from the

34. D. The first are for assessment would be unconscious. The remaining responses do

the client’s reason for refusing medication. not address the internal forces thought to

The client may not understand the purpose motivate behavior.

for the medication, may be experiencing 39. C. The client is demonstrating faulty
distressing side effects, or may be thought processes that are negative and

concerned about the cost of medicine. In that govern his behavior in his work

any case, the nurse cannot provide situation – issues that are typically

appropriate intervention before assessing examined using a cognitive theory

the client’s problem with the medication. approach. Issues involving learned

The patient’s income level, living behavior are best explored through

arrangements, and involvement of family behavior theory, not cognitive theory.

and support systems are relevant issues Issues involving ego development are the

following determination of the client’s focus of psychoanalytic theory. Option 4 is

reason for refusing medication. The nurse incorrect because there is no evidence in

providing follow-up care would have access this situation that the client has conflictual

to the client’s medical record and should relationships in the work environment.
40. D. Anxiety is a response to a threat arising with schizoid or schizotypal disorder.

from internal or external stimuli. Submissive and dependent behaviors are

41. A. Systematic desensitization is a characteristic of someone with a

behavioral therapy technique that helps dependent personality.

clients with irrational fears and avoidance 45. D. The client with anorexia typically feels
behavior to face the thing they fear, powerless, with a sense of having little

without experiencing anxiety. There is no control over any aspect of life besides

attempt to promote insight with this eating behavior. Often, parental

procedure, and the client will not be taught expectations and standards are quite high

to substitute one fear for another. Although and lead to the clients’ sense of guilt over

the client’s anxiety may decrease with not measuring up.

successful confrontation of irrational fears, 46. A. One of the core issues concerning the
the purpose of the procedure is specifically family of a client with anorexia is control.

related to performing activities that The family’s acceptance of the client’s

typically are avoided as part of the phobic ability to make independent decisions is

response. key to successful family intervention.

42. B. A client with antisocial personality Although the remaining options may occur

disorder typically has frequent episodes of during the process of therapy, they would

acting impulsively with poor ability to delay not necessarily indicate a successful

self-gratification. Therefore, decreased outcome; the central family issues of

frequency of impulsive behaviors would be dependence and independence are not

evidence of improvement. Charming addresses on these responses.

behavior when around authority figures 47. B. Use of cognitive techniques allows the
and statements indicating no remorse are nurse to help the client recognize that this

examples of symptoms typical of someone negative beliefs may be distortions and

with this disorder and would not indicate that, by changing his thinking, he can

successful treatment. Self-satisfaction adopt more positive beliefs that are

would be viewed as a positive change if the realistic and hopeful. Agreeing with the

client expresses low self-esteem; however client’s feelings and presenting a cheerful

this is not a characteristic of a client with attitude are not consistent with a cognitive

antisocial personality disorder. approach and would not be helpful in this

43. D. In autoimmune disorders, stress and the situation. Denying the client’s feelings is

response to stress can exacerbate belittling and may convey that the nurse

symptoms. Stress management techniques does not understand the depth of the

can help the client reduce the client’s distress.

psychological response to stress, which in 48. A. Art therapy provides a nonthreatening

turn will help reduce the physiologic stress vehicle for the expression of feelings, and

response. This will afford the client an use of a small group will help the client

increased sense of control over his become comfortable with peers in a group

symptoms. The nurse can address the setting. Basketball is a competitive game

remaining answer choices in her teaching that requires energy; the client with major

about the client’s disease and treatment; depression is not likely to participate in this

however, knowledge alone will not help the activity. Recommending that the client

client to manage his stress effectively read a self-help book may increase, not

enough to control symptoms. decrease his isolation. Watching movie

44. D. Disregard for established rules of with a peer group does not guarantee that

society is the most common characteristic interaction will occur; therefore, the client

of a client with antisocial personality may remain isolated.

disorder. Attention to detail and order is 49. C. Day treatment programs provide clients
characteristic of someone with obsessive with chronic, persistent mental illness

compulsive disorder. Bizarre mannerisms training in social skills, such as meeting

and thoughts are characteristics of a client and greeting people, asking questions or
 directions, placing an order in a restaurant,

taking turns in a group setting activity.

Although management of hallucinations

and medication teaching may also be part

of the program offered in a day treatment,

the nurse is referring the client in this

situation because of his need for

socialization skills. Vocational training

generally takes place in a rehabilitation

facility; the client described in this situation

would not be a candidate for this service.

50. A. The best approach with a withdrawn
client is to initiate brief, nondemanding

activities on a one-to-one basis. This

approach gives the nurse an opportunity to

establish a trusting relationship with the

client. A board game with a group clients or

playing a team sport in the gym may

overwhelm a severely withdrawn client.

Watching TV is a solitary activity that will

reinforce the client’s withdrawal from

others.