PSYCHIATRIC NURSING 1.

The most effective nursing intervention for a severely anxious client who is pacing vigorously would be to: a. Instruct her to sit down and quit pacing b. Place her in bed to reduce stimuli and allow rest c. Allow her to walk until she becomes physically tired d. Give her PRN medication and walk with her at a gradually slowing pace 2. Which of the following is accurate about benzodiazepines: " a. It act on the cause of diagnosis b. Used anesthetics, anticonvulsants, and muscle relaxants c. Has less problem of dependence and withdrawal d. Started at a high dose then gradually decreased 3. The nurse has been interviewing a client who has not been able to discuss any feelings. This day, 5 minutes before the time is over, the client begins to talk about important feelings. The intervention is to: a. Go over the agreed-upon time, as the client is finally able to discuss important feelings. b. Tell the client that it is time to end the session now, but another nurse will discuss his feelings with him. c. Set at extra meeting time a little later to discuss these feelings. d. End just as agreed, but tell the client these are very important feelings and he can continue tomorrow. 4. ln working with a depressed client, the nurse should understand that depression is most directly related to a person's: a. Experiencing poor interpersonal relationships with other. b. Remembering his traumatic childhood. c. Having experienced a sense of loss. d. Stage in life. 5. Three days after admission for depression, a 54-year-old female client approaches the nurse and says; "I know I have cancer of the uterus. Can't you let me stay in bed and have some peace before I die?" In responding, the nurse must keep in mind that:

a. The client must be post-menopausal b. Thoughts of disease are common in depressed clients. c. Clients suffering from depression can be demanding, making many request of the nurse. d. Antidepressant medications frequently cause vaginal spotting. 6 A client makes a suicide attempt on the evening shift. The staff intervenes in time to prevent harm. In assessing the situation, the most important rationale for the staff to discuss the incident is that: a. They need to reenact the attempt so that they understand exactly what happened. b. The staff needs to file an incident report so that the hospital administration is kept informed. c. The staff needs to discuss the client's behavior to determine what cues, in his behavior might have warned them that he was contemplating suicide. d. Because the client made one suicide attempt, there is high probability he will make a second .attempt in the immediate future 7.A client with the diagnosis of manic episode is racing around the psychiatric unit trying to organize games with the clients. An appropriate nursing intervention is to: a. Have the client play Ping-Pong. b. Suggest video exercises with the other clients. c. Take the client outside for a walk. d. Do nothing, as organizing a game is considered therapeutic. 8. The primary nurse is performing an admission assessment on a client admitted with pneumonia. When should the nurse begin discharge planning for this client? a. The day after discharge b. When the client's condition is stabilized c. At the admission time d. When the physician writes the discharge order 9. A nurse enters a client's roams and the client is demanding release from the hospital. Tile nurse renews the client's record and notes that the client was admitted 2 days ago for treatment of an anxiety disorder and that the admission was voluntary. Which of the following actions will the nurse take? a. Tell the client that discharge is not possible at this time.

b. Call the client's family c. Contact the physician d. Persuade the client to stay a few more days 10.When teaching a patient who has a diagnosis of schizophrenia about successful independent living in the community, a nurse should encourage the patient to: a. Establish a structured daily routine b. Spend time alone c. Ran a program of self-fulfillment d. Discontinue medication when symptoms disappear 11. A patient who has a borderline personality disorder praise one nurse and asserts that all other staff members are terrible. The praised nurse should respond by: a. Showing appreciation for the patient's positive evaluation b. Providing reassuring information about the patient's psychological integrity c. Maintaining objectivity regarding the patient's remarks d. Conveying acceptance of the patient's need for a false belief system 12. The physician orders flouxetine (Prozac) orally every morning for a 72-year-dd a client with depression. The nurse would expect the physician to order which of the following dosages for this client? a. 0.5 mg b. 10 mg c. 25 mg d. 30 mg 13. A client who is depressed states, "I am an awful person. Everything about me is bad. I can't do anything right." Which of the following responses by the nurse would be most therapeutic? a. "Everybody around here likes you." b. "I can see many good qualities about you." . c. "Let's discuss what you haw done correctly." d. "You were able to bathe daily." 14. The nurse denies the request of a dient with major depression and psychotic features, admitted involuntarily, to

leave the hospital because commitment papers have been initiated by the physician. Which of the following would the nurse identify as a criterion for the client to be legally committable? a. Evidence of psychosis b. Being gravely disabled c. Risk of harm to self or others d. Diagnosis of mental illness 15.When preparing a teaching plan for a client about imipranine (Tofranil), which of the following substances will the nurse tell the client to avoid while taking the .medication? a. Caffeinated coffee b. Sunscreen c. Alcohol d. Artificial tears 16. A client with bipolar behavior manic phase is exhibiting euphoria, hyperactivlty, and distractibility. He is unable to remain seated during mealtime Song enough to eat adequately. Which of the following "finger foods" would most benefit this client? a. Bacon, lettuce, and tomato sandwich b. Cheeseburger c. tee cream cone d. Cut-up vegetables 17. A client with acute mania has been taking lithium (Lithium Carbonate) 600 mg PO three times daily for 14 days. The nurse analyzes the client's serum lithium level, noting that it is therapeutic when the level is within which of the following ranges? a. 0.5 to 1.5mEq/L b. 1.6to2.5mEq/L c. 2.6 to 3.2 mEq/L d. 3.3 to 4.0 rnEq/L 18. A patient who has begun taking a tricyclic antidepressant is given instructions regarding its use. Which of the following' comments would indicate that the patient understands the information?

a. "I like active exercise, but I won't be able to do it while I'm on this medication." b. "This medicine will make my ears ring, but I guess i can tolerate that." c. "I won't eat cheese if one of my visitors bring me some." d. "I don't feel any better, but I've only been taking the medicine for a week." 19. Diazepam (Valium) is prescribed for a patient with low back pain. The desired therapeutic action of valiurn in this situation is to: a. Reduce anxiety levels b. Eliminate pain sensation c. Suppress the inflammatory process d. Lessen muscle spasticity 30. A patient is brought to the psychiatric unit. Which of the following activities the registered nurse rather than the licensed practical nurse would perform? a. Administering a stat dose of lorazepam (Ativan) 2 mg intramuscularity (IM) b. Admitting the patient to the psychiatric unit c. Asking the patient whether he hears voices other people do not hear d. Drawing a blood sample for a lithium level 16. A 32-year-old woman is admitted to a psychiatric unit for evaluation after terrorizing her co-worker with a knife. She is verbally .abusive. One afternoon, she starts hitting another female patient without any apparent provocation. The other patient is removed from her presence. Which of the following statements by the nurse would be appropriate handling of the patient's behavior? a. "Why did you hit that patient?" b. "You will have to stay in the seclusion room to keep you away from other patients." c. "Hitting others is dangerous. I am not going to allow you to repeat this behavior." d. "I am going to discuss your behavior with other patients at the next ward meeting." . 17. A patient refuses to sit in a chair offered by the nurse

during a ward meeting. The patient claims that, "They are trying to destroy me. They have planted a bomb under this chair." He accuses the nurse as being "one of them." Which of the following approaches would be most helpful in dealing with patient's delusional system? a. Sit on the chair to prove that the chair is safe. b. Tell the patient, "No one is trying to destroy you and I am certainly not one of those who you think want to kill you." c. Allow the patient to select his/her own chair. d. Ask the patient, "Why do you think anyone would plot to destroy you." 17. A patient refuses to sit in a chair offered by the nurse during a ward meeting. The patient claims that, "They are trying to destroy me. They have planted a bomb under this chair." He accuses the nurse as being "one of them." Which of the following approaches would be most helpful in dealing with patient's delusional system? a. Sit on the chair to prove that the chair is safe. b. Tell the patient, "No one is trying to destroy you and I am certainly not one of those who you think want to kill you." c. Allow the patient to select his/her own chair. d. Ask the patient, "Why do you think anyone would plot to destroy you." 18. When a pediatric nurse tries to take an admission history on a 3-year-old, the child's mother burst into tears and cannot answer any questions. Which of the following actions should the nurse take? a. Continue to take the history. b. Encourage the mother to verbalize her fears concerning her child's illness. c. Ask the mother to assist in the admission physical assessment. d. Ask the mother to join her husband in the waiting room. 19. A patient who is diagnosed with an eating disorder describes herseif as "a very fat person." Which of the following responses by the nurse would be MOST appropriate? a. "You don't look fat at all." b "Why do you say you are fat?" c. "I don't understand why you think you are fat." d. "You seem to think you are fat but \ see you as very thin."

20. During an acute psychotic episode, patients can become frightened of their own ^ bizarre sensory experiences. They also fear losing control over their own impulses. Which of the following nursing interventions would help a patient to feel less frightened? a. Assure the patient that his/her sensory experiences wilt disappear, in no time. b. Let the patient know that the staff will assist him/her in maintaining control. c. Keep the patient in a well-lighted; stimulating environment at all times. d. Keep potentially harmful objects out of patient's reach. 21.When developing the plan of care for a client receiving haloperidol; which of the following medications would the nurse anticipate administering if the client developed extrapyramidat sidejeffiects? a. Lorazepam (Ativan) b. Benztripine mesylate (Cogentin) c. Paroxetine (Paxil) d. Olanzapine (Zyprexia) 22. Nursing Licensure and Practice are regulated by: a. Nursing Practice Law b. Board of Nursing c. Professional Regulations Commission d. All of the above 23. While documenting on a client's patient care flow sheet the nurse notices that she made a mistake? How-should the nurse proceed? a. Use correction fluid and continue to document b. Draw a single line through the entry c. Cross out error completely d. Erase error 24. Which of the following would be most critical when caring for a client who is experiencing delirium? a. Controlling behavior symptoms with low-dose psychotropics.

b. Correcting the underlying causative condition or illness. c. Manipulating the environment to increase orientation. d. Decreasing or discounting any nonessential medications 25.A client with panic disorder should be monitored for the existence of which of the following other psychosocial problems? a. Attention deficit hyperacidity disorder (ADHD) b. Developmental disability c. Dissociative behavior d. Substance abuse 26. Which of the following nursing interventions is given priority in a care plan for a person having panic disorder? a. Tell the client to take deep breaths. b. Have the client talk about the anxiety. c. Encourage the client to verbalize feelings. d. Ask the client about the cause of the attack. 27. Which of the following interventions should the nurse initially implement when caring for a client with panic disorder? a. Make the client role-play the panic attack. b. Assist the client to develop an exercise program. c. Teach the client to identify cognitive distortions. d. Teach the client to identify sources of anxiety. 28. Which of the following statements is typical of a client with social phobia? a. "Without people around, I just feel so lost." b. "There is nothing wrong with my behavior." c "I like to be the center of attention." d. "I knew I can’t accept that award for my brother." 29. Which of the following behavior modification techniques is useful in the treatment of the phobias? a. Aversion therapy b. Irritation or modeling c. Positive reinforcement d. Systematic desensitization

30.A client suspected of haying a posttraumatic stress disorder should assessed for which of the following problems? a. Eating disorder b. Schizophrenia c. Suicide d. "Sundown" syndrome 31. Which of the following psychological symptoms would the nurse expect to find in a hospitalized client who is the only survivor of a train accident? a. Denial b. Indifference c. Perfectionism d. Trust 32. Which of the following client statements indicates an understanding of survivor guilt? a. "I think I can see the purpose of my survival” b. "I can't help but feel that everything is their fault." c. "I new understand why I'm not able to forgive myself." d. "I wish I could stop sabotaging my family relationships" 33. The effectiveness of monoamine oxidase (MAO) inhibitor drug therapy in a client with posttraumatic stress disorder can be demonstrated by which of the following client self-reports? a. "I'm sleeping better and don’t have nightmares” b. "I'm not losing my temper as much." c. "I've lost my craving for alcohol." d. "I've lost my phobia for water." 34. Which of the following findings should the nurse expect when talking about school to a child diagnosed with a generalized anxiety disorder? a. The child has been fighting with peers for the past month. b. The child can't stop lying to parents and teachers. c. The child has gained 15 pounds in the past month. d. The child expresses concerns about grades. 37. A client with paranoid personality disorder tells a nurse of his decision to stop talking to his wife. Which of the following

areas should be assessed? a. The client's doubts about the partner's loyalty. b. The client's need to be alone and have time for self. c. The client's decision to separate from the marital partner. d. The client's fears about becoming too much like the partner. 38. The wife of the client diagnosed with paranoid personality disorder tells the client she wants a divorce. When discussing this situation with the couple, which of the following factors would help the nurse form a care plan for this couple? a. Denied grief b. Intense jealousy c. Exploitation of others d. Self-destructive tendencies 30. Which of the following short-term goals for a client with an antisocial personality disorder and a history of polysubstance abuse? a. Develop goals for personal improvement. b. Identify situations that are out of the client's control. c. Encourage the client to identify traumatic life events. d. Learn to express feelings in a nondestructive manner. 41. Which of the following goals is most appropriate for a client with antisocial personality disorder with a high risk .for violence directed at others? a. The client will discuss the desire to hurt others rather than act. b. The client will be given something to destroy to displace the anger. c. The client will develop a list of resources to use when anger escalates. d. The client will understand the difference between anger and physical symptoms. 41. Which of the following characteristics or situations is indicated when a client with borderline personality disorders has a crisis? a. Antisocial behavior b. Suspicious behavior c. Relationship problems d. Auditory hallucinations

42. A schizophrenic client tells his primary nurse that he's scheduled to meet the King of Samoa at a special time, making it impossible for the client to leave his room for dinner. Which of the following responses by the nurse is most appropriate? a. "It's meal time. Let's go so you can eat." b. "The King of Samoa told me to take you to dinner” c. "Your physician expects you to follow the unit's schedule." d. "People who don't eat, on this unit aren't being cooperative." 43.A Client diagnosed with schizophrenia several years ago tells the nurse that he feels "very sad." The nurse observes that he's smiling when he says it. Which of the following terms best describes the nurse's observation? a. Inappropriate affect b. Extrapyramidal c. Insight d. Inappropriate mood 44. Which of the following conditions or characteristics is related to the cluster of symptoms associated with disorganized schizophrenia? a. Odd beliefs b. Flat affect c. Waxy flexibility d. Systematized delusions 45. A client approaches a nurse and tells her that he hears a voice telling him that he's evil and deserves to die. Which of the following terms describes the client's perception? a. Delusion b. Disorganized speech c. Hallucinations d. Idea of reference 46. Which of the following numbers of members in a therapy group is ideal? a. 1 to 4 b. 4 to 7 c. 7 to 10 d. 10-to15

47. Which of the following nursing diagnosis is most appropriate for a client with acute schizophrenic reaction? a. Social isolation related to impaired ability to trust b. Impaired mobility related to fear of hostile impulses c. Disturbed steep patterns related to impaired thinking ability d. Risk for other-directed violence related to perceptual distortions 48. A client tells a nurse voices are telling him to do "terrible things." Which of the following actions is part of the initial therapy? a. Find out what the voices are telling him. b. Let him go to his room to decrease his anxiety. c. Begin talking to the client about an unrelated topic. d. Tell the client the voices aren't real. 49. A client is preoccupied with his belief that the CIA has been planning to take him away to save the agency from his influence. These delusions are a defense against which of the following underlying feelings? a. Aggression b. Guilt c. Inferiority d. Persecution 50.1n preparation for discharge, a client diagnosed with schizophrenia was taught self-symptom management as part of a relapse prevention program. Which of the following statements indicates a client understands symptom monitoring? a. "When I hear voices, I become afraid I’ll relapse." b. "My parents aren't involved enough to be aware if I begin to relapse." c. "My family is more protected from stress if J keep them out of my illness process." d. "When I'm feeling stressed, I go to a quiet room by myself and do imagery." 51. A client diagnosed with schizophrenia has been taking haloperidol (Haldol) for 1 week when a nurse observes that the client's eyeball is fixated on the ceiling. Which of the following specific conditions is the client exhibiting?

a. Akathisia b. Neuroleptic malignant syndrome c. Oculogyric crisis d. Tardive dyskinesia 52. Which of the following interventions is important for a client who engages in sexual act with animals (zoophilia)? a. Place the client is the seclusion room. b. Assess triggers that stimulate the behaviors. c. Have the primary health care provide order and antidepressant medication. d. Counsel the client not to discuss his sexual behaviors with anyone. 53. A 38-year-old woman was returning home from the store late one evening and was sexually assaulted. When she's brought to the emergency department, she's crying. Which of the following concerns for this client should be the nurse's first priority? a. Filing a police report b. Calling the client's family c. Encouraging the client to enroll in a self-defense class d. Remaining with the client and assisting her through the crisis 54. Which of the following therapies may be used with a client who admits to frottage? a. Electroconvulsive therapy b. Relaxation therapy c. Administration of psychotic agents d. Positive reinforcement and group therapy 55. When working with a client with paraphiliac disorder, which of the following goals is appropriate for the client? a. To attend all meetings on the unit b. To use triggers to initiate sexual behaviors c. To inform his employer of the reason for hospitalization d. To verbalize appropriate methods to meet sexual upon discharge 56. When assessing rooms for clients, the nurse should not place which of the following clients with a client who has a diagnosis of sexual sadism? a. A client with a diagnosis of sexual masochism

b. A client with a diagnosis of voyeurism c. A client who's an exhibitionist d. A client who's a homosexual 57. The nurse is obtaining a health history from a client when he states he has been diagnosed with voyeurism. The nurse knows which of the following actions is characteristic of a voyeur? a. Observing others while they disrobe b. Wearing clothing of the opposite sex c. Rubbing against a no consenting person d. Using rubber sheeting for sexual arousal 58. Which of the following definitions best describes necrophilia? a. Obscene phone calling b. Sexual activity with animals c. Sexual activity with corpses d. Sexual arousal by contact with urine 59. A 39-year-ofd mate wishes to undergo a sex-reassignment operation, because 'he feels trapped in his male body. Which of the following actions is the next step the client should take if he wants to have the operations? a. Tell his family and friends b. Attend psychotherapy c. Visit transsexual bars d. See a surgeon 60. A 35-year-old male who has been married-for 10 years arrives in the psychiatric clinic stating, "I can't live this lie any more. I wish I were a woman, I don't want my wife. I need a man." Which of the following initial actions would be most appropriate from the nurse? a. Call the primary health care provider. b. Encourage the client to speak to his wife. c. Have the client admitted. d. Sit down with the client, and talk about his feelings. 61 A female client enjoys wearing men's clothing. Her sister tells the nurse that the client wishes a sexual reassignment

operation. The client tells the nurse she just wants to be left. Which of the following initial nursing interventions is most appropriate? a. Allow the client to deal with her sister. b. Encourage the client to verbalize her feelings. c. Tell the client's sister to mind her own business. d. Encourage the client to continue doing what is comfortable for her. 62. A client in a psychiatric unit has been identified as peeping Tom. What's the medical term for the client's disorder? a. Voyeurism b. Gender identity disorder c. Pedophilia d. Fetishism 63. A client with anorexia nervosa has started taking flouxetine hydrochloride (Prozac). Which of the following adverse reactions complicates the treatment of this eating disorder? a. Drowsiness b. Dry mouth c. Light-headedness d. Nausea 64. Mental health is defined as: a. A disturbance in a person's thoughts, feelings and behavior. b. A state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work productively. c. A science which deals with measures employed to promote mental health, to reduce the incidence of mental illness through preservation and early treatment. d. is concerned with the promotion of mental health, prevention of mental disorders, and the nursing care of patients during mental illness and rehabilitation. 65. The following are nursing responsibilities in mental health promotion except: a. Participate in the promotion of mental health among families and the community b. Help people in the community understand basic emotional needs c. Teach parents the Importance of providing emotional support to

their children d. Be aware of the potential causes of breakdown and when necessary take possible preventive action

66. A nurse works in a mental health facility that a therapeutic community (milieu) to client. Which of the following statements describes the nurse's role in this facility? a. Primary caregiver b. Member of the milieu c. Supervision more than counseling d. Distinctly seperate from the psychiatrist 67. A community mental health nurse visits a client diagnosed with paranoid schizophrenia. When she arrives at his house, he calls for Satan, shouts at her, and tells her to back away. Which of the following interventions has priority? a. use his phone and call the police b. remain safe by leaving the house c. talk to him In a calm voice to reduce his agitation d. remind him who she is and that she has nothing to fear

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