The nurse is working with an adolescent client with social anxiety disorder who will be attending college in 6 months. The parent tells the nurse that this anticipated change is already causing increased anxiety for the client. Which action reported by the client does the nurse evaluate as indicating the greatest amount of progress? The client: a. arranges an overnight visit at a college with a current student b. sends an electronic application to a college close to home c. attends open houses at colleges of interest with the parent d. decides to go to a community college and commute from home 2. A hospitalized client is dying and is very weak, tired and short of breath. The appropriate nursing care plan for this client and the client’s family will include: a. allowing family members to spend as much time as possible with the client b. limiting visiting hours to help the client conserve energy c. planning all of the client’s care to be done at one time so long intervals of rest can be scheduled d. having the client do as much self care as possible to increase self esteem and independence 3. The community health nurse notes several suspicious bruises and old burns on an infant. Which is the nurse’s priority action? a. call the child protection hotline and report possible abuse b. discuss the family with the physician and social worker at the next team meeting c. carefully record the visit for follow-up d. tell the parent that child protection will be notified if injuries are noted at the next visit. 4. The nurse understands that the best explanation for involuntary admission for psychiatric treatment is that: a. a psychiatrist has determined the client’s behavior is irrational b. the client exhibits behavior that is a threat to either the client or to society c. The client is unable to manage the affairs necessary for daily life d. the client has broken a law

5. A client diagnosed with borderline personality disorder purposely cuts his arm with a piece of broken glass when his favorite nurse calls in sick. When the client’s favorite

nurse returns to the unit, they meet to discuss the cutting incident. How can the nurse best prevent future incidents of self mutilating behavior in this client? a. ask the client to make a promise to discuss any self destructive feelings that the client may have with a staff member b. emphasize that self destructive behavior is unacceptable and obtain a written contract from the client stating, “I will not harm myself.” c. tell the client that he is making increasingly unrealistic demands on the nurse and other staff members d. assign a staff member to supervise the client’s whereabouts at all times 6. The nurse is interviewing an elderly client who may have been abused by the neighbor who provides much of the client’s care. The nurse’s interview questions should: a. avoid asking the client about the potential abuse b. avoid directly asking the client if the client has ever been hurt by someone c. be confrontational d. be nonthreatening and nonjudgemental 7. The nurse realizes that a typical characteristic of clients with anorexia nervosa is they: a. have problems with self control b. do poorly in school c. exercise relentlessly d. are truthful in reporting their eating habits 8. In planning the initial care for a client with an acute schizophrenic illness, the nurse will appropriately emphasize: a. establishing a daily routine to promote orientation to the unit b. encouraging the client to enter into simple group activities c. providing a variety of activities to keep the client focused on reality based topics d. assign the same staff members of the nursing staff to work with the client each day. 9. A client is admitted to the psychiatric unit on a temporary detention order. The nurse observes that the client is staring out the 4th floor window and replying to voices that the nurse is unable to see. The initial therapeutic statement that the nurse makes to the client is: a. tell me what the voices are saying to you b. who are you talking to? c. are you thinking about jumping out the window? d. why are you looking outside?

10. The client is admitted to the hospital with injuries sustained in an automobile accident. The client, who has a history of previous arrests for driving under the influence

(DUI) has an admission blood alcohol level of 0.25. When the nurse asks the client how much alcohol the client consumes daily, the nurse knows the most likely response by the client is: a. I can drink more than anyone I know b. not much, I don’t even get drunk c. I am not sure, I don’t keep track d. How much do you think I drink? 11. Which behavior would best indicate that the antisocial client is making the most progress in treatment? a. serving as a judge for the unit’s talent show b. volunteering to chair the client government meeting c. requesting a weekend pass to go home d. assisting a depressed roommate to fill out a menu 12. The client tells the nurse that the television set in the room is really a two way radio. The client states that “voices are coming from the TV and everything we say in this room is being recorded.” The appropriate nursing response would be: a. what are the voices saying? b. That must be very frightening c. do you recognize the voices? d. Is the television set turned on? 13. The nurse approaches the triage window to see a client who is well known to the emergency room staff as being a frequent visitor who demonstrates drug seeking behavior. When asked what the problem is, the client states, “I want to see the doctor. I am having chest pains.” What is the most appropriate action for the nurse to take? a. bring the client to a treatment room and obtain a STAT electrocardiogram b. take the client’s pulse and blood pressure at the triage window c. instruct the client to wait in the waiting room until it is his turn to be seen d. ask the client an open ended question to elict information about his manifestations 14. Which treatment approach would be most therapeutic for a hospitalized client with antisocial behavior? a. participation in group therapy b. negotiating the treatment plan with the client c. a one to one nurse client relationship d. providing an unstructured environment

15. After one week in a behavior modification program, a bulimic client has gained three pounds. The nurse learns that the client still has the urge to vomit after eating. How can the nurse best deal with this behavior? a. suggest the client share this concern during a group therapy session

b. praise the client for having gained three pounds this week c. establish a contract with the client to seek out a staff member if they feel the urge to vomit d. remove privileges if the client vomits to reinforce that this behavior is inappropriate 16. The nursing staff decides to develop a behavioral modification program to help a young anorexic client gain weight. Which intervention is contraindicated for this client? a. permitting the client to spend some quiet time alone after each meal b. allowing the client to select meals from the same daily menu offered to all clients c. refraining from commenting about the client’s eating during meal times d. providing positive reinforcement for each pound the client gains 17. A client with paranoid delusions believes the hospital food is being poisoned by the staff. The nurse knows the meal presentation that is the most effective method of encouraging nutritional intake is to serve: a. the client’s favorite foods in an attractive arrangement b. only warm foods that arrive from the kitchen with lids in place c. individual items that are pre-packaged and sealed d. food items that are the same as what other clients in the dining room are eating 18. The nurse enters an anorexic client’s room and finds the client doing vigorous pushups on the floor. What is the most therapeutic nursing action? a. remind the client that if there is a decrease in weight, privileges will be forfeited b. tell the client to stop doing the push-ups and suggest a less strenuous activity c. wait for the client to finish exercising, then ask why the client feels the need to exercise d. leave the client’s room and allow the client to exercise in private 19. The nurse would question the order if the physician prescribed a benzodiazepine for the treatment of: a. status epilepticus b. skeletal muscle injuries c. chronic pain syndrome d. insomnia

20. The nurse knows which medication may be safely prescribed for a client already taking lithium (Lithane)? a. Hydrochlorothiazide (hydroDIURIL) b. Ibuprofen (Advil) c. Succinylcholine (Anectine)

d. Valproic Acid (Depakane) 21. In caring for abused children, the nurse understands that sexual abuse of children is: a. often repeated from generation to generation b. significantly less common than physical abuse and neglect c. more prevalent in economically depressed segments of society d. usually perpetrated by strangers 22. A client is admitted through the emergency department with a diagnosis of depression. During the initial phase of the relationship with this client, the nurse would expect which reaction to interpersonal communication? a. insight b. silence c. anger d. elation 23. Which will the nurse expect to be ordered to manage a client’s withdrawal from alcohol? a. promethazine (Phenergan) b. Chlordiazepoxide (Librium) c. Haloperidol (haldol) d. disulfiram (antabuse) 24. The nursing care plan for the antisocial client should stress: a. supervising the client closely to prevent any destructive behavior b. helping the client gain insight into what motivates behavior c. setting clear rules and expectations about the client’s behavior d. ignoring the client’s past acts and focusing on current issues 25. Thirty minutes after receiving diazepam (valium), an emergency room client reports feeling much calmer. “I can’t believe how scared I was when I came in. I will do anything to avoid having another panic attack.” The nurse realizes the most important action at this time is: a. tell the client to try and reduce personal stress b. advise the client to be admitted to the psychiatric unit c. make an appointment for outpatient psychotherapy d. tell the client to just return to the emergency room if another panic attack occurs

26. A client was admitted recently with a diagnosis of schizophrenia, paranoid type. Since admission, the client has had several verbal outbursts of anger but has not been violent. A staff member tells the nurse the client is pacing up and down the hallway very rapidly and muttering in an angry manner. What would the nurse do first? a. prepare a PRN intramuscular injection of haloperidol (haldol) to give the client

b. observe the client’s behavior and approach the client in a nonthreatening manner c. contact the client’s psychiatrist and request an order to place the client in seclusion d. gather several staff members to approach the client together 27. A client has been admitted to the emergency department following a rape. The nurse will expect that the client may manifest post-traumatic stress disorder. The nurse is aware that this syndrome can be best described as: a. unconsciously denying the rape and rapidly returning to normal activities b. re-experiencing the fear and hopelessness of the original trauma c. guilt, shame and the feeling that they provoked the attack or should have prevented the rape d. displacing feelings of anger onto hospital staff members 28. The nurse has an order to administer donepezil (aricept) daily to a client with Alzheimer’s disease. The nurse knows that this drug should be administered: a. with eight ounces of water b. before breakfast c. at bedtime d. with dinner 29. The nurse is talking to a resident of a long term care facility who has returned from an overnight stay with his son and son’s wife. Which statement by the resident would warrant further investigation by the nurse for elder abuse? a. The food wasn’t very good. My daughter in law was never a very good cook b. we had a nice visit. My grandchildren are a little unruly, but I enjoy that in small doses c. they needed a new TV, so I gave them money so they could buy one d. Those bruises aren’t anything. I got clumsy at my son’s house 30. Initially the nurse would expect a client to react to a diagnosis of cancer with: a. anger b. denial c. acceptance d. fear

31. The nurse would judge that a client might be developing Wernicke-Korsakoff syndrome when the client exhibits: a. mood swings and suicidal ideation b. suspicion and fearfulness c. short term memory loss and disorientation

d. aggression and impulsiveness 32. A priority nursing intervention for a client experiencing an acute manic episode? a. discourage the client’s use of vulgar language b. protect the client from impulsive behavior c. maintain the client’s contact with his/her family d. redirect excessive energy to creative tasks 33. The nurse learns that a client with OCD brushes his/her tongue several times a day and has developed ulcerations on it. The priority nursing goal for this client at this time is. The client will: a. re-establish healthy tissue in the oral cavity b. seek out the nurse when feeling anxious c. discontinue brushing and oral care rituals d. verbalize the underlying cause of the behavior 34. A client who is taking chlorpromazine hydrochloride (Thorazine) is experiencing extrapyramidal side effects (EPS). The nurse understands that EPS is: a. dysfunction of the cardiovascular system b. involuntary muscle movements c. similar to a seizure disorder d. a toxic reaction of the liver 35. Family therapy is scheduled for an anorexic client and family. The parents ask how the family therapy will help the client’s eating problems. The best nursing response is that the focus of the therapy will primarily be: a. the client’s dysfunctional eating behaviors b. teaching family members to better meet each other’s needs c. improving communication between the family members d. how parental behavior may be causing the client to stop eating 36. The nurse knows an appropriate short term goal for a client exhibiting manic behavior is for the client to: a. identify three strengths b. compete in a unit volley ball game c. chair the unit’s self-government meeting d. paint alone for 15 minutes

37. A client is admitted with a history of extremely elevated, irritable mood for a week. On assessment the nurse notes grandiosity, insomnia, flight of ideas, and psychomotor agitation. The nurse sets as a priority short term goal: the client will demonstrate: a. improvement in judgement b. adequate nutrition and rest

c. understanding of medication regimen d. stability of mood 38. In the early stages of Alzheimer’s disease, the nurse would anticipate that a client will retain the ability to: a. cope with stressful experiences b. solve simple mathematical problems c. remember a daily schedule d. recall the events of the distant past 39. What would the nurse most expect to observe in a client with impulsive behavior? a. ability to delay gratification b. low tolerance for frustration c. good problem solving skills d. commitment to long term goals 40. A client is being prepared to receive electroconvulsive therapy (ECT) when the nurse realizes the client has not signed an informed consent. What provides the rationale for the appropriate nursing action needed to address this issue? a. permission is assumed since the client is an involuntary admission b. failure to obtain informed consent can result in a lawsuit c. a physician is needed to witness the consent form d. verbal consent by the client is sufficient 41. The nurse knows the most common side effect of benzodiazepine antianxiety medications is: a. confusion b. headache c. sedation d. flatulence 42. An elderly client with Alzheimer’s disease has begun to strike out at staff members when they try to assist the client to bed at night. In addition, the staff members report that the client is awake and restless most of the night. After further assessment, the nurse decides to contact the physician for a medication order. The nurse anticipates that the physician will most likely order: a. diazepam (valium) as needed b. haloperidol (haldol) at bedtime c. chlorpromazine (thorazine) three times a day d. hydroxyzine (vistaril) twice daily 43. A client on the psychiatric unit is unresponsive or mumbles incoherently whenever the nurse asks the client questions. The nurse will best deal with the client’s communication problems by: a. encouraging the client to ask direct questions

b. continuing to speak with the client using short, clear statements or open ended questions c. filling in silent periods by talking about topics interesting to the nurse d. sitting quietly with the client during his/her scheduled times until the client indicates a willingness to talk 44. A psychiatrist admits a client to an eating disorders program. The admitting nurse learns that the client has lost 25 pounds over the last month and now weighs 85 pounds. In assessing the client, the nurse knows that an early manifestation of anorexia nervosa is: a. amenorrhea b. tachycardia c. appetite loss d. insomnia 45. A female client is seen in the emergency room with ecchymosis of the trunk, face and periorbital area. On direct questioning, the client admits to having been struck by her spouse. When offered information about shelters for battered women, the client declines stating, “I could never leave my husband because of my kids.” The nurse’s appropriate response is: a. can you identify the situations that provoke your husband? b. aren’t you worried about the safety of your children? c. I wouldn’t put up with it if I was you d. I am very concerned about your safety 46. The nurse in the oncology unit provides support to the parents of a child newly diagnosed with glioblastoma tumor of the brain. In planning care, the nurse understands the parents’ initial reaction to a potentially terminal illness in their child is: a. denial and disbelief b. depression c. fear and anxiety d. anger and guilt 47. A nurse working with a client with agoraphobia recognizes that the most effective technique for treatment of agoraphobia is: a. gradual desensitization by controlled exposure to the situation the client fears b. teaching relaxation techniques c. repeated exposure to the situations the client fears d. distraction each time the client brings up the problem

48. the nurse is preparing a brochure on marijuana use for adolescent clients. The nurse includes several reasons meant to discourage adolescents from using marijuana. Which reason is least likely to make an impression on adolescents? a. your breath will smell

b. your teeth will get yellow c. your coach make kick you off the team d. your parents will not approve 49. After 6 months on lithium (lithane), the physician determines that the client is no longer responding well. After discontinuing the lithium, the physician prescribes valproic acid (depakote), an anticonvulsant that is also effective in bipolar disorders. What special instructions should the nurse give the client about valproic acid? a. a pre-treatment EEG must be done and repeated in six months b. The white blood count must be monitored regularly c. liver function and hematology levels must be monitored regularly d. thyroid function tests must be done every six months 50. A homeless client with a history of alcohol abuse comes to the drop in shelter where the nurse volunteers. The client arrives apparently intoxicated with the smell of alcohol on the breath and admits to have been drinking to the nurse. Once admitted for the night, the client begins to shout obscenities at the other clients and staff and becomes belligerent and threatening. The nurse advises the staff and other volunteers to: a. evict the client from the shelter until sober b. have the client transported to the hospital c. restrain the client to prevent self harm d. allow the client to blow off steam until tired.

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