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BASIC CONCEPTS 1. The DSM-IV is a tool utilized for diagnosis I mental health settings. This multi-axial system includes: a. Nursing and medical diagnosis b. Frameworks of specific theories c. Assessments for several areas of functioning d. Specific critical pathways 2. The nurse meets with the client daily. The client stays mostly in his room and speaks only when addressed, answering briefly and abruptly while keeping his eyes on the floor. In this stage of their relationship, the nurse focuses on the client’s ability to a. make decisions b. relate to other clients c. function independently d. express himself verbally 3. The client has tearfully described her negative feelings about herself to the nurse during their last three interactions. Which of the following goals would be most appropriate for the nurse to include in the care of plan at this time? The client will a. Increase her self-esteem b. Write her negative feelings in a daily journal c. Verbalize her work-related accomplishments. d. Verbalize three things she likes about herself 4. The most important assessment data for the nurse to gather from the client in crisis would be: a. The client’s work habits b. Any significant physical health data c. A past history of any emotional problems in the family d. the specific circumstances surrounding the perceived crisis situation 5. A female client is admitted for surgery. Although not physically distressed, the client appears apprehensive and alienated. A nursing action that may help the client to feel more at ease includes: a. Telling her that everything is all right b. Giving her a copy of hospital regulations c. Orienting her to the environment and unit personnel d. Reassuring her that staff will be available if she becomes upset TIP: Paranoid patients frequently use the defense mechanism of projection. 6. On arrival for admission to a voluntary unit, a female client loudly announces: “Everyone kneel, you are in the presence of the Queen of England.” This is: a. A delusion of self-belief b. A delusion of self-appreciation c. A nihilistic delusion d. A delusion of grandeur 7. A client refuses to eat food sent up on individual trays from the hospital kitchen. The client shouts, “You want to kill me.” The client has lost 8 pounds in 4 days. In discussion of this problem, with the assigned staff member, which statement by the nurse indicates an accurate interpretation of this client’s needs? a. “The client is malnourished and may require tube feedings.” b. “The client is terrified. Ask the kitchen to send foods that are not easily contaminated such as baked potatoes c. “Continue to observe the client. When the client gets hungry enough, the client will eat.” d. The client appears frightened. Spend more time with the client, showing a warm affection.” 8. The nurse is discussing the orientation phase. The student nurse asks what the primary goal between the nurse and the client is during this phase. The nurse should respond that the primary goal is to: a. Explain unit rules b. Establish a relationship c. Establish trust and support d. Formulate a mutual plan of action
9. A nurse is talking with a client who is hearing voices. The nurse states, “The only voices I hear are yours and mine.” This is an example of: a. Restating b. Clarification c. Focusing d. Presenting reality 10. The parents of a child who had open-heart surgery are informed that their child is in the recovery room and is stable. The mother is crying. The nurse can best help allay the mother’s anxiety by: a. Reassuring her that their child is doing well b. Allowing her to continue to express her feelings c. Bringing her and her husband to the recovery unit for several minutes d. Encouraging them both to go have a cup of coffee and return in 2 hours THERAPEUTIC COMMUNICATION 11. A 24-year old man with a diagnosis of chronic schizophrenia is admitted to the psychiatric unit. He is talking loudly as the nurse approaches him. When asked who he is talking to, he said, “I hear God’s voice.” Which of these responses by the nurse would be best? a. “It must make you think important to talk with God.” b. “I don’t hear a voice, but I know it’s real to you.” c. “Why do you think you’re hearing a voice?” d. “What could be God’s reason for talking to you?” 12. A patient who has a borderline personality disorder asks the nurse on a psychiatric unit if she may stay up beyond the designated bedtime. When the nurse says no, the patient says, “The nurse on duty last night let me stay up late.” Which of these responses by the nurse would be therapeutic? a. “You shouldn’t have been given that privilege.” b. “Everyone is required to go to bed, now.” c. “You can stay up for one more hour.” d.“Direct his focus away from his symptoms.” 13. A patient tells a nurse, “I really don’t want to have these shock treatments but my doctor insists.” Which of the following responses by the nurse would be therapeutic? a. “We should cancel the procedure until you feel better.” b. “Have you talked to your doctor about your fears?” c. “It’s normal to every patient who experienced dissatisfaction with this procedure.” d. “This procedure is the best treatment for your condition.” 14. During the admission procedure a client appears to be responding to voices. The client cries out at intervals, “No, no, I didn’t kill him. You know the truth; tell that policeman. Please help me!” The nurse should : a. Sit there quietly and not respond at all to the client’s statements b. Respond to the client by asking, “Whom are they saying you killed?” c. Respond by saying, “I want to help you and I realize you must be very frightened.” d. Saying. “Do not become so upset. No one is talking to you; the accusing voices are part of your illness. 15. A client on the unit believes another client has stolen his watch, and they want to discuss this with the nurse. What is the nurse’s best response? a. “I’ll meet with each of you individually.” b. “Tell me what you believed happened.” c. “I’m sure no one here would do a thing like that.” d. “Be careful when you accuse someone.” 16. During the nurse’ conversation with the client, the client states, “I have no reason to be sad. I have a great job and a wonderful wife and family.” Which of the following comments are would be best for the nurse to make at this time? a. “Why do you think you’re depressed?” b. “Think about how fortunate you are.” c. “You have many positive qualities.” d. “Depression can be caused by a chemical imbalance in the brain.”
SITUATION: The client was admitted to the psychiatric unit yesterday. The nurse observes that his head is bowed in a dejected manner, his facial expression is sad, and he isolates himself in his room. 17. After a few minutes of conversation, the client wearily asks the nurse, “Why pick me to talk to when there are so many other people here?” Which reply by the nurse would be best?” a. “I’m assigned to care for you today, if you’ll let me.” b. “You have a lot of potential, and I’d like to help you.” c. “Why shouldn’t I want to talk to you, as well as the others?” d. “You’re wondering why I’m interested in you, and not in others?” 18. The client begins to attend group sessions daily. She explains to the group how she lost her job. Which of the following statements by a group member would be most therapeutic for the client? a. “Tell us about what you did on your job?” b. “It must have been very upsetting for you.” c. With your skills, finding another job would be easy.” d. “The company must have had some reason for letting you go. 19. The client admits to having thoughts of suicide, he is lethargic, withdrawn and irritable. In conversations with the nurse, he stresses his faults. When he starts to point out the things he can’t do, which of the following responses by the nurse would provide best intervention? a. “You can do anything you out your mind to.” b. “Try to think more positively about yourself.” c. “Let’s talk about your plans for the weekend.” d. “You were able to write a letter to your friend today.” 20. The client states, “I’m looking forward to going back to work, but I wonder if I’ll be able to keep up with the demands of my job.” Which of the following statements by the nurse would be most helpful? a. “You’ll do well. You have an excellent work record.” b. “I wouldn’t worry about it. The main thing to remember is that you can work.” c. “You might need extra breaks at first until you feel better.” d. “You sound concerned. I want to hear more about how you are feeling.” PSYCHIATRIC DISORDERS AND CONDITIONS 21. The situation in which individuals have excessive worry or belief that they are suffering from a physical illness despite lack of medical evidence is known as: a. Pain disorder b. Phobic disorder c. Somatoform disorder d. Dissociative disorder 22. A newly admitted client states, “No one cares, everyone is against me.” This type of statement is consistent with what disorder? a. Paranoid personality disorder b. Schizoid personality disorder c. Schizotypal personality disorder d. Antisocial personality disorder 23. Your client states, “I work for the government, and I am so important in my office that that the other people will not be able to work without me.” This is characteristic of: a. A histrionic personality disorder b. An antisocial personality disorder c. A narcissistic personality disorder d. A multiple personality disorder 24. An appropriate nursing diagnosis of a client with a major depression is: a. Alteration in activity b. Alteration in perceptions c. Alteration in affect d. Alteration in social activity
25. A client is diagnosed with catatonic schizophrenia. Which is the highest priority nursing diagnosis? a. Noncompliance b. Impaired communication c. Ineffective coping d. Self-care deficit 26. A disorder where an individual may manifest a personality that is opposite to a previous identity is: a. Psychogenic amnesia b. Somatoform disorder c. La belle indifference d. Psychogenic fugue 27. Personality disorders, on the multi-axial diagnosis, appear in: a. Axis I b. Axis II c. Axis III d. Axis IV 28. For clients with paranoid disorders, which would be an initial goal? a. The clients will diminish suspicious behavior. b. The clients will express thoughts and feeling verbally. c. The clients will develop a sense of trust of reality that is validated by others d. The clients will establish trusting relationships with staff 29. Parents are at the clinic with a child diagnosed with attention deficit hyperactivity disorder. Which group of characteristics would the nurse most likely observe in the waiting room of the clinic? The child: a. Plays with 2 children in the waiting room b. Runs over and turns on the video player without listening to parents’ directions c. Constantly wiggles a leg when waiting to take a turn at the board game d. Puts the toy truck back into the playbox only after visiting with three other children and their parents 30. The nurse is careful not to act rushed or inpatient with the client and gradually learn that the client is very down and feel worthless and unloved. In view of the fact that the client had previously made a suicidal gesture, which of the following interventions by the nurse would be a priority at this time? a. Ask the client frankly if she has thought of or plans of committing suicide b. Avoid bringing up the subject of suicide to prevent giving the client ideas of self-harm c. Outline some alternative measures to suicide for the client to use during periods of sadness d. Mention others the nurse has known who have felt like the client and attempted suicide, to draw her out PSYCHIATRIC DRUGS 31. Based on the knowledge of electro-convulsive treatment, the nurse explains to the student nurse that atropine is given before the treatment primarily to: a. Minimize intestinal contractions b. Decrease anxiety c. Dry up body secretions d. Prevent aspiration 32. Lithium, the drug of choice for bipolar disorders, has a narrow therapeutic range of: a. 0.5 mEq/L to 1.5 mEq/L b. 0.6 mEq/L to 1.0 mEq/L c. 0.7 mEq/L to 1.3 mEq/L d. 1.0 mEq/L to 2.o mEq/L 33. A client is receiving monoamine oxidase inhibitors (MAOIs) as part of the treatment. Which food would be most important for the nurse to stress to avoid? a. Organ meats b. Sardines c. Shellfish d. Legumes
34. A patient receiving lithium carbonate complains of blurred vision and appears confused. The nurse also notices that the client is having difficulty maintaining balance. Which of these nursing actions are appropriate? a. Administer a PRN antiparkinsonism drug and hold all other drugs b. Take the client’s vital signs and administer high-potassium foods c. Hold the client’s next dose of medication and notify the physician immediately d. Sit with client to talk and teach the side effects of lithium 35. Many of the major tranquilizers display untoward side effects. The one side effect displaying irreversible, abnormal, involuntary movements of the tongue and mouth is: a. Akathisia b. Tardive dyskinesia c. Agranulocytosis d. Dystonia 36. Which classification of drugs may be used in children to treat enuresis? a. Tricyclic antidepressant b. Major tranquilizers c. Antianxiety agents d. Hypnotic 37. A client has been medicated with trifluperazine HCl (Stelazine) for a prolonged period of time. How would the nurse check for early signs of tardive dyskinesia? a. Akathisia of the lower extremities b. Cogwheel rigidity at the elbow c. Drying of the mucous membranes d. Vermiform movements of the tongue 38. When the nurse checks the lithium level of a client on the unit, it is 2.0 mEq/L. What would the interpretation/action by the nurse be? a. The level is within therapeutic range; do nothing. b. The level is below therapeutic range; call the physician. c. The level is slightly elevated but does not require any nursing action. d. This level is high; the client should be assessed for manifestation of toxicity.
39. The nurse judges correctly that a client is experiencing an adverse effect from amitriptyline hydrochloride (Elavil) when the client demonstrates a. An elevated blood glucose level b. Insomnia c. Hypertension d. Urinary retention 40. The client has been taking lithium carbonate (Lithane) for hyperactivity, as prescribed by his physician. While the client is taking this drug, the nurse should ensure that he has adequate intake of a. Sodium b. Iron c. Iodine d. Calcium TREATMENT MODALITIES & THERAPIES 41. What is the expected outcome when working with a client who has experienced a crisis? a. Stabilization of moods with medications and return to previous levels of functioning b. Recovery from the crisis and return to pre-crisis levels of functioning c. Recovery from the crisis with intense out-client therapy d. Recovery from the crisis with total adjustment at pre-crisis events 42. An actively psychotic client is being assessed by the nurse for a participation in a milieu group. Which is the most appropriate group for this client? a. A highly structured task-oriented group b. An activity group c. A group is not appropriate d. A movement therapy group, after a short period of isolation
43. The role of the nurse in environmental therapy includes: a. Coordinating team activities, maintaining the environment 24 hrs. a day b. Referring others to work with families, observing in groups c. Coordinating medical care, selecting programs d. Observing community meetings leading groups 44. The activity therapy the nurse would select to promote reminiscing in a group with age over 70 is: a. Poetry b. Art c. Movement d. Music 45. The registered nurse is discussing with a student the guidelines for the use of restraints. Which of the statements by the students indicates a need for clarification? a. An adequate number of staff are needed before restraints are attempted. b. Being restrained may help the client gain physical control c. A physician’s order is required initially, followed by frequent renewal d. The use of restraints requires the supervision of a licensed and certified professional 46. A client seeks counseling from the nurse for marital conflict that includes a history of physical abuse. What would be the initial intervention in this client’s plan of care? a. Assist the client in identifying aspects of the client’s life that are under the control of the client b. Facilitate the client’s desire to gain knowledge of the democratic family process c. Discuss issues of the use of stereotypic gender role behavior and the effect of violence in the family d. Explain theories of family violence so the client understands patterns in the marital conflict
47. A client is to receive his first electro-convulsive treatment (ECT). He states, “I’m afraid because my roommate told me I’ll forget everything and my memory will never return.” What is the best response? a. Don’t worry about it. You will get your memory back.” b. You may not experience memory loss, but you still need ECT to get better.” c. It may be best if you can’t remember certain things.” d. There is memory loss, but it will return over a 2-3 week period 48. A therapist is leading in a client group. Which is most important to the development of the group process? a. Planning b. Goal setting c. Problem-solving d. Reality orientation 49. Therapeutic treatment of a female client with ritualistic behavior should be directed a. Redirect her energy into activities to help others b. Learn that her behavior is not serving a realistic purpose c. Forget her fears by administering antianxiety medications d. Understand her behavior is caused by unconscious impulses that the fears toward helping her to:
50. A client is participating in a crafty therapy session when suddenly he begins to shout at another client, “Stop watching me. I know what you’re up to. I’ll get you…” What will be the best immediate action for the nurse to take? a. Disband the group immediately b. Instruct the client to follow the nurse to her room c. Tell the client that no one is watching her d. Ask the other clients to stop looking at this person
ANSWER KEY 1. C 2. D 3. D 4. D 5. C 6. D 7. B 8. C 9. D 10. B 11. B 12. B 13. B 14. C 15. B 16. D 17. D 18. B 19. D 20. D 21. C 22. A 23. C 24. C 25. D 26. D 27. A 28. B 29. B 30. A 31. D 32. A 33. B 34. C 35. B 36. A 37. D 38. D 39. D 40. A 41. D 42. C 43. A 44. D 45. D 46. B 47. D 48. B 49. D 50. B
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