A1 PASSERS TRAINING, RESEARCH, Which of the following comments indicates chronic undifferentiated schizophrenia.
rentiated schizophrenia. student would agree to seek the
REVIEW and DEVELOPMENT
COMPANY
PSYCHIATRIC NURSING
COMPREHENSIVE EXAM
1. A client with a history of substance
abuse has been attending Alcoholics
Anonymous meetings regularly in the
psychiatric unit. One afternoon, the client
tells the nurse, "I'm not going to those
meetings anymore. I'm not like the rest of
those people. I'm not a drunk. "What is the
most appropriate response?
A. "If you aren't an alcoholic, why do you
keep drinking and ending up in the
hospital?"
B. "It's your decision. If you don't want to
go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's
part of your treatment plan."
Rationale: The substance abuser uses
the substance to cope with feelings and
may deny the
abuse. Asking if the client is upset about
the meetings encourages the client to
identify and deal
with feelings instead of covering them up.
Arguing with the client about the
substance abuse
(option A) or insisting that the client attend
the meetings (option D) wouldn't help the
client identify
resistance to treatment. Option B isn't
therapeutic behavior because it plays
down the importance
of attending meetings.
2. A 15-year-old client is brought to the
clinic by her mother. Her mother
expresses concern about
her daughter's weight loss and constant
dieting. The nurse conducts a health
history interview.
that the client may be suffering from
anorexia
nervosa?
A. "I like the way I look. I just need to keep
my weight down because I'm a
cheerleader."
B. "I don't like the food my mother cooks. I
eat plenty of fast food when I'm out with
my friends."
C. "I just can't seem to get down to the
weight I want to be. I'm so fat compared to
other girls."
D. "I do diet around my periods; otherwise,
I just get so bloated."
Rationale: Low self-esteem is the highest
risk factor for anorexia nervosa. Constant
dieting to
get down to a "desirable weight" is
characteristic of the disorder. Feeling
inadequate when
compared to peers indicates poor self-
esteem. Most clients with anorexia
nervosa don't like the
way they look, and their self-perception
may be distorted. A girl with cachexia may
perceive
herself to be overweight when she looks in
the mirror. Preferring fast food over
healthy food is
common in this age-group. Because of the
absence of body fat necessary for proper
hormone
production, amenorrhea is common in a
client with anorexia nervosa.
3. A man with a 5-year history of multiple
psychiatric admissions is brought to the
emergency
department by the police. He was found
wandering the streets disheveled,
shoeless, and
confused. Based on his previous medical
records and current behavior, he is
diagnosed with
The nurse should assign highest priority to
which nursing
diagnosis?
A. Anxiety
B. Impaired verbal communication
C. Disturbed thought processes
D. Self-care deficient: Dressing/grooming
Rationale: For this client, the highest-
priority nursing diagnosis is Anxiety
(severe to panic-level),
manifested by the client's extreme
withdrawal and attempt to protect himself
from the
environment. The nurse must act
immediately to reduce anxiety and protect
the client and others
from possible injury. Impaired verbal
communication, manifested by
noncommunicativeness;
Disturbed thought processes, evidenced
by inability to understand the situation;
and Self-care
deficient: Dressing/grooming, evidenced
by a disheveled appearance, are
appropriate nursing
diagnoses but aren't the highest priority.
4. A high school student is referred to the
school nurse for suspected substance
abuse. Following
the nurse's assessment and interventions,
what would be the most desirable
outcome?
A. The student discusses conflicts over
drug use.
B. The student accepts a referral to a
substance abuse counselor.
C. The student agrees to inform his
parents of the problem.
D. The student reports increased comfort
with making choices
Rationale: All of the outcomes stated are
desirable; however, the best outcome is
that the
assistance of a professional substance
abuse counselor.
5. A man is brought to the hospital by his
wife, who states that for the past week her
husband has
refused all meals and accused her of
trying to poison him. During the initial
interview, the client's
speech, only partly comprehensible,
reveals that his thoughts are controlled by
delusions that he
is possessed by the devil. The physician
diagnoses paranoid schizophrenia.
Schizophrenia is
best described as a disorder characterized
by:
A. disturbed relationships related to an
inability to communicate and think clearly.
B. severe mood swings and periods of low
to high activity.
C. multiple personalities, one of which is
more destructive than the others.
D. auditory and tactile hallucinations.
Rationale: Schizophrenia is best
described as one of a group of psychotic
reactions
characterized by disturbed relationships
with others and an inability to
communicate and think
clearly. Schizophrenic thoughts, feelings,
and behavior commonly are evidenced by
withdrawal,
fluctuating moods, disordered thinking,
and regressive tendencies. Severe mood
swings and
periods of low to high activity are typical of
bipolar disorder. Multiple personality,
sometimes
confused with schizophrenia, is a
dissociative personality disorder, not a
psychotic illness. Many
schizophrenic clients have auditory
hallucinations; tactile hallucinations are
more common in
organic or toxic disorders.
6. Clients receiving monoamine oxidase
inhibitor antidepressants must avoid
tyramine, a
compound found in which of the following
foods?
A. Aged cheese and Chianti wine
B. Green leafy vegetables
C. Figs and cream cheese
D. Fruits and yellow vegetables
Rationale: Aged cheese and Chianti wine
contain high concentrations of tyramine.
The other
foods listed are low in tyramine
7. During the assessment stage, a client
with schizophrenia leaves his arm in the
air after the
nurse has taken his blood pressure. His
action shows evidence of:
A. somatic delusions.
B. waxy flexibility.
C. neologisms.
D. nihilistic delusions
Rationale: The correct answer is waxy
flexibility, which is defined as retaining any
position that
the body has been placed in. Somatic
delusions involve a false belief about the
functioning of the
body. Neologisms are invented
meaningless words. Nihilistic delusions
are false ideas about self,
others, or the world
8. Which of the following statements
accurately describes therapeutic
communication?
A. Offering advice and your opinion
B. Not verbalizing your feelings
C. Avoiding advice, judgment, false
reassurance, and approval
D. Telling the client how to cope
Rationale: The goal of therapeutic
communication is to help the client
develop insight and skills
to solve his own problems. This is done by
avoiding advice, judgment, false
reassurance, and
approval. Pointing out mistakes can make
a client defensive. The client-nurse
relationship isn't
the place for the nurse to offer advice or
an opinion. It also isn't the place for the
nurse to
verbalize her own feelings. The client
needs assistance in developing coping
skills, not someone
to solve problems for him
9. A client with paranoid type
schizophrenia becomes angry and tells
the nurse to leave him
alone. The nurse should:
A. tell him that she'll leave for now but will
return soon.
B. ask him if it's okay if she sits quietly
with him.
C. ask him why he wants to be left alone.
D. tell him that she won't let anything
happen to him.
Rationale: If the client tells the nurse to
leave, the nurse should leave but let the
client know that
she'll return so that he doesn't feel
abandoned. Not heeding the client's
request can agitate him
further. Also, challenging the client isn't
therapeutic and may increase his anger.
False
reassurance isn't warranted in this
situation.
10. The physician orders lithium carbonate
(Lithonate) for a client who's in the manic
phase of
bipolar disorder. During lithium therapy,
the nurse should watch for which adverse
reactions?
A. Weakness, tremor, and urine retention
B. Anxiety, restlessness, and sleep
disturbance
C. Constipation, lethargy, and ataxia
D. Nausea, diarrhea, tremor, and lethargy
Rationale: The most common adverse
effects of lithium are nausea, diarrhea,
tremor, and
lethargy. Lithium doesn't cause weakness,
tremor, urine retention, anxiety,
restlessness, sleep
disturbance, constipation, or ataxia.
11. When caring for an adolescent client
diagnosed with depression, the nurse
should remember
that depression manifests differently in
adolescents and adults. In an adolescent,
signs and
symptoms of depression are likely to
include:
A. helplessness, hopelessness,
hypersomnolence, and anorexia.
B. truancy, a change of friends, social
withdrawal, and oppositional behavior.
C. curfew breaking, stealing from family
members, truancy, and oppositional
behavior.
D. hypersomnolence, obsession with body
image, and valuing of peers' opinions
Rationale: In adolescents, depression
typically manifests as truancy, a change of
friends, social
withdrawal, and oppositional behavior. In
adults, it usually produces helplessness,
hopelessness,
hypersomnolence, and anorexia. Drug use
may lead to curfew breaking, stealing,
truancy, and
oppositional behavior. Adolescents
normally display hypersomnolence, an
obsession with body
image, and valuing of peers' opinions.
12. During the admission assessment, a
client with a panic disorder begins to
hyperventilate and
says, "I'm going to die if I don't get out of
here right now!" What is the nurse's best
response?
A. "Just calm down. You're getting overly
anxious."
B. "What do you think is causing your
panic attack?"
C. "You can rest alone in your room until
you feel better."
D. "You're having a panic attack. I'll stay
here with you
Rationale: During a panic attack, the
nurse's best approach is to orient the
client to what is
happening and provide reassurance that
the client won't be left alone. The anxiety
level is likely to
increase and the panic attack is likely to
continue if the client is told to calm down
(as in option A),
asked the reasons for the attack (as in
option B), or left alone (as in option C
13. Which foods are contraindicated for a
client taking tranylcypromine (Parnate)?
A. Whole grain cereals and bagels
B. Chicken livers, Chianti wine, and beer
C. Oranges and vodka
D. Chicken, rice, and apples
Rationale: A client taking a monoamine
oxidase inhibitor antidepressant, such as
tranylcypromine (Parnate), shouldn't eat
foods containing tyramine. Such foods
include chicken
livers, Chianti wine, beer, ale, aged game
meats, broad beans, aged cheeses, sour
cream,
avocados, yogurt, pickled herring, yeast
extract, chocolate, excessive caffeine,
vanilla, and soy
sauce. The client also must refrain from
taking cold and hay fever preparations that
contain
vasoconstrictive agents.
14. Which is the drug of choice for treating
Tourette syndrome?
A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil
Rationale: Haloperidol is the drug of
choice for treating Tourette syndrome.
Prozac, Luvox, and
Paxil are antidepressants and aren't used
to treat Tourette syndrome.
Which of the following etiologic factors
predispose a client to Tourette syndrome?
15. Low doses of central nervous system
(CNS) depressants produce an initial
excitatory
response. This reaction is caused by:
A. a stimulating effect on the CNS.
B. the depression of acetylcholine.
C. the stimulation of dopamine by
depressant drugs.
D. inhibitory synapses in the brain being
depressed before excitatory synapses.
Rationale: Excitation can occur when
inhibitory synapses are depressed. The
other options are
incorrect because depressants don't
stimulate the CNS or dopamine and don't
depress
acetylcholine.
16.Upon returning home from work, a
young man discovers that his mother has
been in a serious
automobile accident. Initially, he responds
to the news by stating, "No, I don't believe
it. It can't be
true." Which defense mechanism is he
using?
A. Introjection
B. Suppression
C. Denial
D. Repression
Rationale: Denial is the avoidance of
reality by ignoring or refusing to
acknowledge unpleasant
incidents. This defense mechanism is
used to allay anxiety immediately after a
stressful event.
Introjection is an intense form of
identification in which one incorporates the
values or qualities of
another person or group into one's own
ego structure. Suppression is the
conscious analog of
repression. A person intentionally uses
suppression to consciously exclude
material from
awareness. Repression is the
unconscious exclusion of painful episodes
from awareness.
17. A client visits the physician's office to
seek treatment for depression, feelings of
hopelessness, poor appetite, insomnia,
fatigue, low self-esteem, poor
concentration, and difficulty
making decisions. The client states that
these symptoms began at least 2 years
ago. Based on
this report, the nurse suspects:
A. cyclothymic disorder.
B. atypical affective disorder.
C. major depression.
D. dysthymic disorder.
Rationale: Dysthymic disorder is marked
by feelings of depression lasting at least 2
years,
accompanied by at least two of the
following symptoms: sleep disturbance,
appetite disturbance,
low energy or fatigue, low self-esteem,
poor concentration, difficulty making
decisions, and
hopelessness. These symptoms may be
relatively continuous or separated by
intervening periods
of normal mood that last a few days to a
few weeks. Cyclothymic disorder is a
chronic mood
disturbance of at least 2 years' duration
marked by numerous periods of
depression and
hypomania. Atypical affective disorder is
characterized by manic signs and
symptoms. Major
depression is a recurring, persistent
sadness or loss of interest or pleasure in
almost all activities,
with signs and symptoms recurring for at
least 2 weeks.
18. What occurs during the working phase
of the nurse-client relationship?
A. The nurse assesses the client's needs
and develops a plan of care.
B. The nurse and client evaluate and
modify the goals of the relationship.
C. The nurse and client discuss their
feelings about terminating the relationship.
D. The nurse and client explore each
other's expectations of the relationship.
Rationale: The therapeutic nurse-client
relationship consists of four phases:
preinteraction,
introduction or orientation, working, and
termination. During the working phase, the
nurse and
client evaluate and refine the goals
established during the orientation phase.
In addition, major
therapeutic work takes place and insight is
integrated into a plan of action. The
orientation phase
involves assessing the client, formulating
a contract, exploring feelings, and
establishing
expectations about the relationship.
During the termination phase, the nurse
prepares the client
for separation and explores feelings about
the end of the relationship
19. A client with anorexia nervosa
describes herself as "a whale." However,
the nurse's
assessment reveals that the client is 5′ 8"
(1.7 m) tall and weighs only 90 lb (40.8
kg).
Considering the client's unrealistic body
image, which intervention should be
included in the plan
of care?
A. Asking the client to compare her figure
with magazine photographs of women her
age
B. Assigning the client to group therapy in
which participants provide realistic
feedback about her
weight
C. Confronting the client about her actual
appearance during one-on-one sessions,
scheduled
during each shift
D. Telling the client of the nurse's concern
for her health and desire to help her make
decisions to
keep her healthy
Rationale: A client with anorexia nervosa
has an unrealistic body image that causes
consumption of little or no food. Therefore,
the client needs assistance with making
decisions
about health. Instead of protecting the
client's health, options A, B, and C may
serve to make the
client defensive and more entrenched in
her unrealistic body image.
20. The nurse is caring for a client, a
Vietnam veteran, who exhibits signs and
symptoms of
posttrauma syndrome. Signs and
symptoms of posttrauma syndrome
include:
A. hyperalertness and sleep disturbances.
B. memory loss of traumatic event and
somatic distress.
C. feelings of hostility and violent
behavior.
D. sudden behavioral changes and
anorexia
Rationale: Signs and symptoms of
posttrauma syndrome include
hyperalertness, sleep
disturbances, exaggerated startle, survival
guilt, and memory impairment. Also, the
client relives
the traumatic event through dreams and
recollections. Hostility, violent behavior,
and anorexia
aren't usual signs or symptoms of
posttraumatic stress disorder.
21. A client is admitted to the psychiatric
unit with a diagnosis of conversion
disorder. Since
witnessing the beating of his wife at
gunpoint, he has been unable to move his
arms, complaining
that they are paralyzed. When planning
the client's care, the nurse should focus
on:
A. helping the client identify and verbalize
feelings about the incident.
B. convincing the client that his arms
aren't paralyzed.
C. developing rehabilitation strategies to
help the client learn to live with the
disability.
D. talking about topics other than the
beating to avoid causing anxiety.
Rationale: In conversion disorder, the
client represses and converts emotional
conflicts into
motor, sensory, or visceral symptoms with
no physiologic cause. Interventions should
focus on
helping the client identify the underlying
emotional problem. A client with
conversion disorder
can't be convinced that the physical
problem isn't real; attempts to convince
him may lead him to
seek other health care providers who may
accept the reality of his symptoms.
Treating the
physical symptoms as long-term or
permanent may encourage the client to
maintain them.
Ignoring the cause of the symptoms would
prevent the client from dealing with his
feelings about
his wife's beating.
22. A client with disorganized type
schizophrenia has been hospitalized for
the past 2 years on a
unit for chronic mentally ill clients. The
client's behavior is labile and fluctuates
from childishness
and incoherence to loud yelling to slow but
appropriate interaction. The client needs
assistance
with all activities of daily living. Which
behavior is characteristic of disorganized
type
schizophrenia?
A. Extreme social impairment
B. Suspicious delusions
C. Waxy flexibility
D. Elevated affect
Rationale: Disorganized type
schizophrenia (formerly called
hebephrenia) is characterized by
extreme social impairment, marked
inappropriate affect, silliness, grimacing,
posturing, and
fragmented delusions and hallucinations.
A client with a paranoid disorder typically
exhibits
suspicious delusions, such as a belief that
evil forces are after him. Waxy flexibility, a
condition in
which the client's limbs remain fixed in
uncomfortable positions for long periods,
characterizes
catatonic schizophrenia. Elevated affect is
associated with schizoaffective disorder.
23. A client is admitted to the psychiatric
unit with active psychosis. The physician
diagnoses
schizophrenia after ruling out several other
conditions. Schizophrenia is characterized
by:
A. loss of identity and self-esteem.
B. multiple personalities and decreased
self-esteem.
C. disturbances in affect, perception, and
thought content and form.
D. persistent memory impairment and
confusion
Rationale: The Diagnostic and Statistic
Manual of Mental Disorders, 4th edition,
defines
schizophrenia as a disturbance in multiple
psychological processes that affects
thought content
and form, perception, affect, sense of self,
volition, relationship to the external world,
and
psychomotor behavior. Loss of identity
sometimes occurs but is only one
characteristic of the
disorder. Multiple personalities typify
multiple personality disorder, a
dissociative personality
disorder. Mood disorders are commonly
accompanied by increased or decreased
self-esteem.
Schizophrenia doesn't cause a
disturbance in sensorium, although the
client may exhibit
confusion, disorientation, and memory
impairment during the acute phase.
24. The nurse who uses self-disclosure
should:
A. refocus on the client's experience as
quickly as possible.
B. allow the client to ask questions about
the nurse's experience.
C. discuss the nurse's experience in
detail.
D. have the client explain his or her
perception of what the nurse has revealed.
Rationale: The nurse's self-disclosure
should be brief and to the point so that the
interaction can
be refocused on the client's experience.
Because the client is the focus of the
nurse-client
relationship, the discussion shouldn't dwell
on the nurse's own experience
25. A client is admitted to the local
psychiatric facility with bipolar disorder in
the manic phase.
The physician decides to start the client on
lithium carbonate (Lithonate) therapy. One
week after
this therapy starts, the nurse notes that
the client's serum lithium level is 1 mEq/L.
What should
the nurse do?
A. Call the physician immediately to report
the laboratory result.
B. Observe the client closely for signs and
symptoms of lithium toxicity.
C. Withhold the next dose and repeat the
laboratory test.
D. Continue to administer the medication
as ordered.
Rationale: The serum lithium level should
be maintained between 1 and 1.4 mEq/L
during the
acute manic phase; therefore, the nurse
should continue to administer the
medication as ordered.
Unless the client has signs or symptoms
of lithium toxicity, the nurse has no need
to call the
physician, withhold the medication, or
repeat the laboratory test. Nonetheless,
the nurse should
continue to monitor the client's serum
lithium level and watch for indications of
toxicity if the level
begins to rise
26. A client has been severely depressed
since her husband died 6 months ago. Her
physician
prescribes amitriptyline (Elavil), 50 mg by
mouth daily. Before administering
amitriptyline, the
nurse reviews the client's medical history.
Which preexisting condition would require
cautious use
of this drug?
A. Hiatal hernia
B. Hypernatremia
C. Hepatic disease
D. Hypokalemia
Rationale: Conditions requiring cautious
use of amitriptyline include pregnancy,
breast-feeding,
suicidal tendencies, cardiovascular
disease, and impaired hepatic function.
Hiatal hernia,
hypernatremia, and hypokalemia don't
affect amitriptyline therapy
27. The nurse is caring for a client with
hypochondriasis. Which behavior would
the nurse be
most likely to encounter?
A. Ready acceptance of the physician's
explanation that all medical and laboratory
tests are
normal
B. Expression of fear of dying after being
diagnosed with advanced breast cancer
C. Expression of fear of colorectal cancer
following 3 days of constipation
D. Lack of concern about having a serious
disease
Rationale: The client with
hypochondriasis is preoccupied with
having a serious disease. She
may convince herself that a relatively
minor symptom, such as constipation, is a
sign of a serious
disorder. The client's fear of serious illness
persists, even after a physician reassures
her that all
medical and laboratory tests are normal.
The fear of dying after receiving a
diagnosis of
advanced breast cancer wouldn't be
considered hypochondriasis. A client with
hypochondriasis
shows an exaggerated level of anxiety,
rather than a lack of concern about having
a serious
disease or illness.
28. After an upsetting divorce, a client
threatens to commit suicide with a
handgun and is
involuntarily admitted to the psychiatric
unit with major depression. Which nursing
diagnosis takes
highest priority for this client?
A. Hopelessness related to recent divorce
B. Ineffective individual coping related to
inadequate stress management
C. Spiritual distress related to conflicting
thoughts about suicide and sin
D. Risk for violence: Self-directed related
to planning to commit suicide by handgun
Rationale: Although all of these options
may apply to this client, safety is the
nurse's first priority
in caring for any suicidal client. The nurse
can address the client's hopelessness,
ineffective
coping, and spiritual distress later in
therapy
29. What herbal medication for
depression, widely used in Europe, is now
being prescribed in the
United States?
A. Ginkgo biloba
B. Echinacea
C. St. John's wort
D. Ephedra
Rationale: St. John's wort has been found
to have serotonin-elevating properties,
similar to
prescription antidepressants. Ginkgo
biloba is prescribed to enhance mental
acuity. Echinacea
has immune-stimulating properties.
Ephedra is a naturally occurring stimulant
that is similar to
ephedrine.
30. When should the nurse introduce
information about the end of the nurse-
client relationship?
A. During the orientation phase
B. As the goals of the relationship are
reached
C. At least one or two sessions before the
last meeting
D. When the client can tolerate it
Rationale: Preparation for ending the
nurse-client relationship should begin
during the
orientation phase, when the limits of the
relationship are established. Termination
should also be
discussed as goals are achieved and the
relationship nears an end. Although the
nurse should
remind the client that only one or two
sessions are left, the nurse must not wait
until then to
prepare the client for termination. The
client's ability to tolerate the end of a
relationship shouldn't
dictate its timing. Because many clients
have had negative experiences when
ending
relationships, the nurse can use
termination of the nurse-client relationship
to prepare the client
for and work the client through positive
termination experiences with others.
31. The nurse at a substance abuse
center answers the phone. A probation
officer asks if a client
is in treatment. The nurse responds, "No,
the client you're looking for isn't here."
Which of the
following statements best describes the
nurse's response?
A. Correct because she didn't give out
information about the client
B. A violation of confidentiality because
she informed the officer that the client
wasn't there
C. A breech of the principle of veracity
because the nurse is misleading the
officer
D. Illegal because she's withholding
information from law enforcement agents
Rationale: The nurse violated
confidentiality by informing the officer that
the client wasn't in
treatment. Even with law enforcement
agents, the nurse must be a client
advocate and protect
the client's confidentiality. Information can
be legally withheld when a court order isn't
in place.
32. Nursing preparations for a client
undergoing electroconvulsive therapy
(ECT) resemble those
used for
A. physical therapy.
B. neurologic examination.
C. general anesthesia.
D. cardiac stress testing.
Rationale: The nurse should prepare a
client for ECT in a manner similar to that
for general
anesthesia. For example, the client should
receive nothing by mouth for 8 hours
before ECT to
reduce the risk of vomiting and aspiration.
Also, the nurse should have the client void
before
treatment to decrease the risk of
involuntary voiding during the procedure;
remove any full
dentures, glasses, or jewelry to prevent
breakage or loss; and make sure the client
is wearing a
hospital gown or loose-fitting clothing to
allow unrestricted movement. Usually,
these preparations
aren't indicated for a client undergoing
physical therapy, neurologic examination,
or cardiac stress
testing
33. A client tells the nurse that the
television newscaster is sending a secret
message to her. The
nurse suspects the client is experiencing:
A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.
Rationale: Ideas of reference refers to the
mistaken belief that neutral stimuli have
special
meaning to the individual such as the
television newscaster sending a message
directly to the
individual. A delusion is a false belief.
Flight of ideas is a speech pattern in which
the client skips
from one unrelated subject to another. A
hallucination is a sensory perception, such
as hearing
voices and seeing objects, that only the
client experiences.
34. A client in an acute care mental health
program refuses his morning dose of an
oral
antipsychotic medication and believes he's
being poisoned. The nurse should
respond by taking
which of the following actions?
A. Administering the medication by
injection
B. Omitting the dose and trying again the
next day
C. Crushing the medication and putting it
in his food
D. Consulting with the physician about a
plan of care.
Rationale: To determine a plan of care for
clients who are noncompliant with
medications, the
nurse should consult with the physician.
Unless the client presents a danger to
himself or others,
medications can't be forced on a client.
Intentionally deceiving or misleading a
client violates the
therapeutic relationship.
35. Nursing care for a client after
electroconvulsive therapy (ECT) should
include
A. nothing by mouth for 24 hours after the
treatment because of the anesthetic
agent.
B. bed rest for the first 8 hours after a
treatment.
C. assessment of short-term memory loss.
D. no special care.
Rationale: The nurse must assess the
level of short-term memory loss. The client
might need to
be reoriented. The client can get out of
bed and eat as soon as he feels
comfortable.
36. A client diagnosed with schizoaffective
disorder is suffering from schizophrenia
with elements
of which of the following disorders?
A. Personality disorder
B. Mood disorder
C. Thought disorder
D. Amnestic disorder
Rationale: According to the DSM-IV,
schizoaffective disorder refers to clients
suffering from
schizophrenia with elements of a mood
disorder, either mania or depression. The
prognosis is
generally better than for the other types of
schizophrenia, but it's worse than the
prognosis for a
mood disorder alone. Option A is incorrect
because personality disorders and
psychotic illness
aren't listed together on the same axis.
Option C is incorrect because
schizophrenia is a major
thought disorder and the question asks for
elements of another disorder. Clients with
schizoaffective disorder aren't suffering
from schizophrenia and an amnestic
disorder
37. Which of the following medications
would the nurse expect the physician to
order to reverse a
dystonic reaction?
A. prochlorperazine (Compazine)
B. diphenhydramine (Benadryl)
C. haloperidol (Haldol)
D. midazolam (Versed)
Rationale: Diphenhydramine, 25 to 50 mg
I.M. or I.V., would quickly reverse this
condition.
Prochlorperazine and haloperidol are both
capable of causing dystonia, not reversing
it.
Midazolam would make this client drowsy.
38. Assertive behavior involves which of
the following elements?
A. Saying what is on your mind at the
expense of others
B. Expressing an air of superiority
C. Avoiding unpleasant situations and
circumstances
D. Standing up for your rights while
respecting the rights of others
Rationale: The basic element of assertive
behavior includes the ability to express
your feelings
and thoughts while respecting the rights of
others. Options A and B describe
aggressive behavior,
and option C describes passive behavior.
39. Which psychosocial influence has
been causally related to the development
of aggressive
behavior and conduct disorder?
A. An overbearing mother
B. Rejection by peers
C. A history of schizophrenia in the family
D. Low socioeconomic status
Rationale: Studies indicate that children
who are rejected by their peers are more
likely to
behave aggressively. Aggression and
conduct disorder are represented in all
socioeconomic
groups. Schizophrenia and an overbearing
mother haven't been associated with
aggression or
conduct disorder.
40. The nurse has been caring for a client
with chronic paranoid schizophrenia for
several
months, including several one-to-one
sessions. During one session, the client
seems more
anxious than usual, speaking rapidly and
loudly as the session starts. This behavior
indicates a
possible change in which form of
communication?
A. Appearance
B. Kinesics
C. Paralanguage
D. Proxemics
Rationale: Paralanguage is the use of
vocal effects, such as tone and tempo, to
convey a
message. Appearance refers to the way a
person looks. Kinesics involves body
language or
movement. Proxemics is the use of spatial
relationships (the distance between
people) during
interaction to communicate meaning.
41. The nurse is caring for a client who
has been diagnosed with hypochondriasis.
The client
attributes his cough to tuberculosis. A
chest X-ray and skin test are negative for
tuberculosis. The
client begins to complain about the
sudden onset of chest pain. How should
the nurse react
initially?
A. Let the client know the nurse
understands his fears of serious illness.
B. Encourage the client to discuss his fear
of having a serious illness.
C. Report the complaint of chest pain to
the physician.
D. Determine if the illness is fulfilling a
psychological need for the client.
Rationale: Because of the risk of missing
an actual medical problem, any new
symptoms
reported by a client with hypochondriasis
should be reported to the physician. The
other
interventions are appropriate after the
nurse has determined that the client
doesn't have a serious
medical disorder.
42. Additive central nervous system (CNS)
depression can occur when combining a
sedativehypnotic
with which of the following drugs?
A. methylphenidate (Ritalin)
B. cocaine
C. amitriptyline (Elavil)
D. amphetamine (Adderall)
Rationale: Additive effects occur with
concomitant use of CNS depressants,
antihistamines,
antidepressants, and antipsychotics. Elavil
is an antidepressant and the only correct
answer. All
the other drugs are classified as
stimulants.
43. Which statement about somatoform
pain disorder is accurate?
A. The pain is intentionally fabricated by
the client to receive attention.
B. The pain is real to the client, even
though there may not be an organic
etiology for the pain.
C. The pain is less than would be
expected from what the client identifies as
the underlying
disorder.
D. The pain is what would be expected
from what the client identifies as the
underlying disorder
Rationale: In a somatoform pain disorder,
the client has pain even though a thorough
diagnostic
work-up reveals no organic cause. The
nurse must recognize that the pain is real
to the client. By
refusing to believe that the client is in pain,
the nurse impedes the development of a
therapeutic
relationship based on trust. While
somatoform pain offers the client
secondary gains, such as
attention or avoidance of an unpleasant
activity, the pain isn't intentionally
fabricated by the client.
Even if a pathological cause of the pain
can be identified, the pain is often in
excess of what
would normally be expected.
44. Which nonantipsychotic medication is
used to treat some clients with
schizoaffective
disorder?
A. phenelzine (Nardil)
B. chlordiazepoxide (Librium)
C. lithium carbonate (Lithane)
D. imipramine (Tofranil)
Rationale: Lithium carbonate, an
antimania drug, is used to treat clients with
cyclical
schizoaffective disorder, a psychotic
disorder once classified under
schizophrenia that causes
affective symptoms, including maniclike
activity. Lithium helps control the affective
component of
this disorder. Phenelzine is a monoamine
oxidase inhibitor prescribed for clients who
don't
respond to other antidepressant drugs
such as imipramine. Chlordiazepoxide, an
antianxiety
agent, generally is contraindicated in
psychotic clients. Imipramine, primarily
considered an
antidepressant agent, is also used to treat
clients with agoraphobia and those
undergoing
cocaine detoxification.
45. Which of the following medical
conditions is commonly found in clients
with bulimia nervosa?
A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A
Rationale: Bulimia nervosa can lead to
many complications, including diabetes,
heart disease,
and hypertension. The eating disorder isn't
typically associated with allergies, cancer,
or hepatitis
A.
46. A client who lost her home and dog in
an earthquake tells the admitting nurse at
the
community health center that she finds it
harder and harder to "feel anything." She
says she can't
concentrate on the simplest tasks, fears
losing control, and thinks about the
earthquake
incessantly. She becomes extremely
anxious whenever the earthquake is
mentioned and must
leave the room if people talk about it. The
nurse suspects that she has:
A. phobic disorder.
B. conversion disorder.
C. posttraumatic stress disorder (PTSD).
D. adjustment disorder.
Rationale: PTSD may occur in survivors
of earthquakes and other events outside
the range of
usual human experience. Typically, the
victim repeatedly relives the event
mentally and exhibits
numbed emotional responsiveness and
difficulty concentrating. PTSD also may
cause an inability
to function in daily life, memory
impairment, chronic anxiety, insomnia,
and hyperalertness. In a
phobic disorder, the client fears an object
or situation that doesn't present any real
danger.
Conversion disorder typically causes
changes or losses in physical function that
suggest a
physical disorder but actually are
expressions of a psychological conflict. In
adjustment disorder,
the stressor usually is less severe than in
PTSD and is within the range of usual
experience.
47. A client is transferred to the locked
psychiatric unit from the emergency
department after
attempting suicide by taking 200
acetaminophen (Tylenol) tablets. Now the
client is awake and
alert but refuses to speak with the nurse.
In this situation, the nurse's first priority is
to:
A. establish a rapport to foster trust.
B. place the client in full leather restraints.
C. try to communicate with the client in
writing.
D. ensure safety by initiating suicide
precautions.
Rationale: The nurse's first priority is to
keep a suicidal client safe and alive.
Although
establishing a rapport and promoting trust
are important in psychiatric nursing,
neither is the
highest priority. Using restraints is
inappropriate and could be interpreted as
punishment of the
client or a convenience for the nurse.
Trying to communicate in writing is also
inappropriate
because the client can hear.
48. Which of the following is an example
of the role of the psychiatric nurse in
primary
prevention?
A. Handling crisis intervention in an
outpatient setting
B. Visiting a client's home to discuss
medication management
C. Conducting a postdischarge support
group
D. Providing sexual education classes for
adolescents
Rationale: The psychiatric nurse
participates in primary, secondary, and
tertiary prevention
activities. Primary prevention includes
providing sexual education classes for
adolescents and
education programs that promote mental
health and prevent future psychiatric
episodes.
Secondary prevention involves treatment
to reduce psychiatric problems (for
example, handling
crisis intervention in an outpatient setting,
administering and supervising medication
regimens,
and participating in the therapeutic milieu).
Tertiary prevention involves helping clients
who are
recovering from psychiatric illness;
activities directed toward providing
aftercare and rehabilitation
are part of this role. Conducting a
postdischarge support group is a tertiary
prevention activity.
49. The nurse is caring for a client with
schizophrenia who experiences auditory
hallucinations.
The client appears to be listening to
someone who isn't visible. He gestures,
shouts angrily, and
stops shouting in mid-sentence. Which
nursing intervention is the most
appropriate?
A. Approach the client and touch him to
get his attention.
B. Encourage the client to go to his room
where he'll experience fewer distractions.
C. Acknowledge that the client is hearing
voices but make it clear that the nurse
doesn't hear
these voices.
D. Ask the client to describe what the
voices are saying.
Rationale: By acknowledging that the
client hears voices, the nurse conveys
acceptance of the
client. By letting the client know that the
nurse doesn't hear the voices, the nurse
avoids
reinforcing the hallucination. The nurse
shouldn't touch the client with
schizophrenia without
advance warning. The hallucinating client
may believe that the touch is a threat or
act of
aggression and respond violently. Being
alone in his room encourages the client to
withdraw and
may promote more hallucinations. The
nurse should provide an activity to distract
the client. By
asking the client what the voices are
saying, the nurse is reinforcing the
hallucination. The nurse
should focus on the client's feelings, rather
than the content of the hallucination.
50. A client with schizophrenia tells the
nurse he hears the voices of his dead
parents. To help
the client ignore the voices, the nurse
should recommend that he:
A. sit in a quiet, dark room and
concentrate on the voices.
B. listen to a personal stereo through
headphones and sing along with the
music.
C. call a friend and discuss the voices and
his feelings about them.
D. engage in strenuous exercise.
Rationale: Increasing the amount of
auditory stimulation, such as by listening
to music through
headphones, may make it easier for the
client to focus on external sounds and
ignore internal
sounds from auditory hallucinations.
Option A would make it harder for the
client to ignore the
hallucinations. Talking about the voices,
as in option C, would encourage the client
to focus on
them. Option D is incorrect because
exercise alone wouldn't provide enough
auditory stimulation
to drown out the voices.
51. A client diagnosed as having panic
disorder with agoraphobia is admitted to
the inpatient
psychiatric unit. Until her admission, she
had been a virtual prisoner in her home for
5 weeks,
afraid to go outside even to buy food.
When planning care for this client, what is
the nurse's
overall goal?
A. To help the client perform self-care
activities
B. To help the client function effectively in
her environment
C. To help control the client's symptoms
D. To help the client participate in group
therapy
Rationale: A client with panic disorder
typically confines movements to
increasingly smaller
areas to avoid confronting fears, which
may dominate the client's life and limit
everyday activities.
The overall goal of care is to help the
client function within the environment as
effectively as
possible. Panic disorder with agoraphobia
doesn't impair the ability to perform self-
care activities.
Controlling symptoms isn't the overall
goal; furthermore, helping the client
function effectively will
help control symptoms. Although
participation in group therapy may help the
client control
symptoms, encouraging such participation
isn't the overall goal of nursing care.
52. A client is receiving treatment for
severe depression. When evaluating the
client for suicidal
ideation, the nurse checks for:
A. suicidal thoughts or plans.
B. further deterioration in self-worth.
C. hoarding of prized possessions.
D. the need for physical restraints.
Rationale: Suicidal ideation refers to
thoughts or plans of suicide. To assess for
these, the nurse
should ask directly if the client is thinking
about or planning suicide. Common
indicators of an
increased risk for suicide include giving
away prized possessions and lifting of
depression, not
further deterioration in self-worth. If the
client has suicidal ideation or is at high risk
for suicide, the
staff should ensure a safe environment,
such as by conducting frequent checks
(every 15
minutes) and removing potentially
dangerous objects. Continuous
observation is more effective
than physical restraints, which are
reserved for clients who are physically
violent and out of
control.
53. Nursing care for a client with
schizophrenia must be based on valid
psychiatric and nursing
theories. The nurse's interpersonal
communication with the client and specific
nursing
interventions must be:
A. clearly identified with boundaries and
specifically defined roles.
B. warm and nonthreatening.
C. centered on clearly defined limits and
expression of empathy.
D. flexible enough for the nurse to adjust
the plan of care as the situation warrants.
Rationale: A flexible plan of care is
needed for any client who behaves in a
suspicious,
withdrawn, or regressed manner or who
has a thought disorder. Because such a
client
communicates at different levels and is in
control of himself at various times, the
nurse must be
able to adjust nursing care as the situation
warrants. The nurse's role should be clear;
however,
the boundaries or limits of this role should
be flexible enough to meet client needs.
Because a
client with schizophrenia fears closeness
and affection, a warm approach may be
too threatening.
Expressing empathy is important, but
centering interventions on clearly defined
limits is
impossible because the client's situation
may change without warning
54. A client diagnosed with major
depression has started taking amitriptyline
HCl (Elavil), a
tricyclic antidepressant. What is a
common adverse effect of this drug?
A. Weight loss
B. Dry mouth
C. Hypertension
D. Muscle spasms
Rationale: Tricyclic antidepressants can
have anticholinergic adverse effects, with
dry mouth
being the most common. Hypotension
would be expected, rather than
hypertension. Weight gain
— not loss — is typical when taking this
medication. Muscle spasms aren't an
adverse effect of
tricyclic antidepressants
55. Drug therapy with thioridazine
(Mellaril) shouldn't exceed a daily dose of
800 mg to prevent
which adverse reaction?
A. Hypertension
B. Respiratory arrest
C. Tourette syndrome
D. Retinal pigmentation
Rationale: Retinal pigmentation may
occur if the thioridazine dosage exceeds
800 mg per day.
The other options don't occur as a result
of exceeding this dose.
56. A client with obsessive-compulsive
disorder and ritualistic behavior must
brush the hair back
from his forehead 15 times before carrying
out any activity. The nurse notices that the
client's hair
is thinning and the skin on the forehead is
irritated — possible effects of this ritual.
When planning
the client's care, the nurse should assign
highest priority to:
A. helping the client identify how the
ritualistic behavior interferes with daily
activities.
B. exploring the purpose of the ritualistic
behavior.
C. setting consistent limits on the ritualistic
behavior if it harms the client or others.
D. using problem solving to help the client
manage anxiety more effectively.
Rationale: Client safety is the paramount
concern and must be maintained.
Therefore, setting
consistent limits on potentially harmful
ritualistic behavior takes highest priority.
Although the
other options are important, they take
lower priority. For instance, helping the
client identify how
the ritualistic behavior interferes with daily
activities increases the client's motivation
for using
more effective coping behavior. Exploring
the purpose of the ritualistic behavior
helps the client
see this behavior as an attempt to control
anxiety. As the client learns new ways to
manage
anxiety, the ritualistic behavior is likely to
decrease.
57. A client is brought to the psychiatric
clinic by family members, who tell the
admitting nurse
that the client repeatedly drives while
intoxicated despite their pleas to stop.
During an interview
with the nurse, which statement by the
client most strongly supports a diagnosis
of psychoactive
substance abuse?
A. "I'm not addicted to alcohol. In fact, I
can drink more than I used to without
being affected."
B. "I only spend half of my paycheck at the
bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three times
for drinking and driving, but the police are
just trying to
hassle me."
Rationale: According to the Diagnostic
and Statistical Manual of Mental
Disorders, 4th edition,
diagnostic criteria for psychoactive
substance abuse include a maladaptive
pattern of such use,
indicated either by continued use despite
knowledge of having a persistent or
recurrent social,
occupational, psychological, or physical
problem caused or exacerbated by
substance abuse or
recurrent use in dangerous situations (for
example, while driving). For this client,
psychoactive
substance dependence must be ruled out;
criteria for this disorder include a need for
increasing
amounts of the substance to achieve
intoxication (option A), increased time and
money spent on
the substance (option B), inability to fulfill
role obligations (option C), and typical
withdrawal
symptoms.
58. A client is undergoing treatment for an
anxiety disorder. Such a disorder is
considered chronic
and generalized when excessive anxiety
and worry about two or more life
circumstances exist for
at least
A. 2 months.
B. 12 months.
C. 6 months.
D. 4 months.
Rationale: For generalized anxiety
disorder, the diagnostic criteria listed in
the Diagnostic and
Statistic Manual of Mental Disorders, 4th
edition, include unrealistic or excessive
anxiety and
worry about two or more life
circumstances for 6 months or more,
during which time these
concerns exist on a majority of days.
59. A client exhibits the following defining
characteristics: denial of problems that are
evident to
others, expressions of shame or guilt,
perceptions of self as being unable to deal
with events, and
projection of blame or responsibility for
problems onto others. How would a nurse
diagnose this
client?
A. Anxiety
B. Chronic low self-esteem
C. Ineffective denial
D. Ineffective individual coping
Rationale: The defining characteristics
are those of Chronic low self-esteem. The
definition of
this diagnosis is negative self-evaluation,
along with negative feelings about self or
capabilities,
which may be directly or indirectly
expressed. Anxiety, Denial, and Ineffective
individual coping all
have different sets of defining
characteristics.
60. Tourette syndrome is characterized by
the presence of multiple motor and vocal
tics. A vocal
tic that involves repeating one's own
sounds or words is known as:
.
A. echolalia.
B. palilalia.
C. apraxia.
D. aphonia.
Rationale: Palilalia is defined as the
repetition of sounds and words. Echolalia
is the act of
repeating the words of others. Apraxia is
the inability to carry out motor activities,
and aphonia is
the inability to speak.
61. A 26-year-old client is admitted to the
psychiatric unit with acute onset of
schizophrenia. His
physician prescribes the phenothiazine
chlorpromazine (Thorazine), 100 mg by
mouth four times
per day. Before administering the drug,
the nurse reviews the client's medication
history.
Concomitant use of which drug is likely to
increase the risk of extrapyramidal
effects?
A. guanethidine (Ismelin)
B. droperidol (Inapsine)
C. lithium carbonate (Lithonate)
D. alcohol
Rationale: When administered with any
phenothiazine, droperidol may increase
the risk of
extrapyramidal effects. The other options
are incorrect.
62. A client with schizophrenia who
receives fluphenazine (Prolixin) develops
pseudoparkinsonism and akinesia. What
drug would the nurse administer to
minimize
extrapyramidal symptoms?
A. benztropine (Cogentin)
B. dantrolene (Dantrium)
C. clonazepam (Klonopin)
D. diazepam (Valium)
Rationale: Benztropine is an
anticholinergic drug administered to
reduce extrapyramidal adverse
effects in the client taking antipsychotic
drugs. It works by restoring the equilibrium
between the
neurotransmitters acetylcholine and
dopamine in the central nervous system
(CNS). Dantrolene,
a hydantoin drug that reduces the
catabolic processes, is administered to
alleviate the symptoms
of neuroleptic malignant syndrome, a
potentially fatal adverse effect of
antipsychotic drugs.
Clonazepam, a benzodiazepine drug that
depresses the CNS, is administered to
control seizure
activity. Diazepam, a benzodiazepine
./drug, is administered to reduce anxiety.
63. A client with paranoid schizophrenia
has been experiencing auditory
hallucinations for many
years. One approach that has proven to
be effective for hallucinating clients is to:
A. take an as-needed dose of
psychotropic medication whenever they
hear voices.
B. practice saying "Go away" or "Stop"
when they hear voices.
C. sing loudly to drown out the voices and
provide a distraction.
D. go to their room until the voices go
away.
Rationale: Researchers have found that
some clients can learn to control
bothersome
hallucinations by telling the voices to go
away or stop. Taking an as needed dose
of psychotropic
medication whenever the voices arise may
lead to overmedication and put the client
at risk for
adverse effects. Because the voices aren't
likely to go away permanently, the client
must learn to
deal with the hallucinations without relying
on drugs. Although distraction is helpful,
singing loudly
may upset other clients and would be
socially unacceptable after the client is
discharged.
Hallucinations are most bothersome in a
quiet environment when the client is alone,
so sending
the client to his room would increase,
rather than decrease, the hallucinations.
64. An agitated and incoherent client, age
29, comes to the emergency department
with
complaints of visual and auditory
hallucinations. The history reveals that the
client was
hospitalized for paranoid schizophrenia
from ages 20 to 21. The physician
prescribes haloperidol
(Haldol), 5 mg I.M. The nurse understands
that this drug is used in this client to treat:
A. dyskinesia.
B. dementia.
C. psychosis.
D. tardive dyskinesia.
Rationale: By treating psychosis,
haloperidol, an antipsychotic drug,
decreases agitation.
Haloperidol is used to treat dyskinesia in
clients with Tourette syndrome and to treat
dementia in
elderly clients. Tardive dyskinesia may
occur after prolonged haloperidol use; the
client should be
monitored for this adverse reaction.
65. When interviewing the parents of an
injured child, which of the following is the
strongest
indicator that child abuse may be a
problem?
A. The injury isn't consistent with the
history or the child's age.
B. The mother and father tell different
stories regarding what happened.
C. The family is poor.
D. The parents are argumentative and
demanding with emergency department
personnel.
Rationale: When the child's injuries are
inconsistent with the history given or
impossible
because of the child's age and
developmental stage, the emergency
department nurse should be
suspicious that child abuse is occurring.
The parents may tell different stories
because their
perception may be different regarding
what happened. If they change their story
when different
health care workers ask the same
question, this is a clue that child abuse
may be a problem.
Child abuse occurs in all socioeconomic
groups. Parents may argue and be
demanding because
of the stress of having an injured child.
66. Which of the following statements is a
guideline to help nurses avoid liability?
A. Follow every physician's order.
B. Do what the client desires even though
you may disagree.
C. Practice within the scope of the Nurse
Practice Act.
D. Obtain malpractice insurance.
Rationale: The Nurse Practice Act
outlines acceptable standards for nursing.
Practicing within
those guidelines will protect the nurse
from liability. The client doesn't know
standards of care and
isn't responsible for the nurse's actions.
Physicians may not be aware of guidelines
for nurses
and delegate inappropriate treatment or
practice for the nurse. Insurance won't
prevent a liability
suit, but only assist the nurse if a suit
would be filed.
67. In group therapy, a client who has
used I.V. heroin every day for the past 14
years says, "I
don't have a drug problem. I can quit
whenever I want. I've done it before."
Which defense
mechanism is the client using?
A. Denial
B. Obsession
C. Compensation
D. Rationalization
Rationale: A client who states that he or
she doesn't have a drug problem and can
quit using
drugs at any time — despite evidence to
the contrary — is denying the drug
addiction. Obsession
isn't a defense mechanism. In
compensation, the client emphasizes
positive attributes to
compensate for negative ones. In
rationalization, the client justifies
behaviors by faulty logic.
68. A husband and wife seek emergency
crisis intervention because he slapped her
repeatedly
the night before. The husband indicates
that his childhood was marred by an
abusive relationship
with his father. When intervening with this
couple, the nurse knows they are at risk
for repeated
violence because the husband:
A. has only moderate impulse control.
B. denies feelings of jealousy or
possessiveness.
C. has learned violence as an acceptable
behavior.
D. feels secure in his relationship
Rationale: Family violence usually is a
learned behavior, and violence typically
leads to further
violence, putting this couple at risk.
Repeated slapping may indicate poor, not
moderate, impulse
control. Violent people commonly are
jealous and possessive and feel insecure
in their
relationships.
69. A client with delusional thinking shows
a lack of interest in eating at meal times.
She states
that she is unworthy of eating and that her
children will die if she eats. Which nursing
action
would be most appropriate for this client?
A. Telling the client that she may become
sick and die unless she eats
B. Paying special attention to the client's
rituals and emotions associated with
meals
C. Restricting the client's access to food
except at specified meal and snack times
D. Encouraging the client to express her
feelings at meal times
Rationale: Restricting access to food
except at specified times prevents the
client from eating
when she feels anxious, guilty, or
depressed; this, in turn, decreases the
association between
these emotions and food. Telling the client
she may become sick or die may reinforce
her
behavior because illness or death may be
her goal. Paying special attention to rituals
and
emotions associated with meals also
would reinforce undesirable behavior.
Encouraging the
client to express feelings at meal times
would increase the association between
emotions and
food; instead, the nurse should encourage
her to express feelings at other times
70. Which of the following is the priority
when assessing a suicidal client who has
ingested a
handful of unknown pills?
A. Determining if the client was trying to
harm himself
B. Determining if the client had a support
system
C. Determining if the client's physical
condition is life-threatening
D. Determining if the client has a history of
suicide attempts
Rationale: If the client's physical condition
is life-threatening, the priority is to treat the
medical
condition. Any compromise to the client's
airway, breathing, or circulation must be
addressed
immediately. It's also imperative to
determine the time of ingestion because
this may determine
treatment. The psychiatric evaluation,
which includes intent to harm oneself,
adequate support
system, and history, can be done after the
client is medically stable.
71. How long after amitriptyline (Elavil)
therapy begins can the nurse expect the
client to show
improved psychological symptoms?
A. 2 to 4 days
B. 4 to 6 days
C. 6 to 8 days
D. 10 to 14 days
Rationale: Because tricyclic
antidepressants have long half-lives, a
noticeable response may not
occur for 10 to 14 days; a full response
may take up to 30 days.
72. Before the nurse administers the first
dose of lithium carbonate (Lithonate) to a
client, she
reviews information about the drug. Which
statement accurately
describes the metabolism and excretion of
lithium?
A. It's metabolized in the liver and
excreted in the feces.
B. It's metabolized and excreted by the
kidneys.
C. It isn't metabolized and is excreted
unchanged by the kidneys.
D. It's metabolized in the liver and
excreted by the kidneys
Rationale: Lithium isn't metabolized and
is excreted unchanged by the kidneys.
73. A client continues to stalk a man
whom she met briefly 3 years ago. She
believes he loves
her and eventually will marry her and has
been sending him cards and gifts. When
she violates a
restraining order he has obtained, a judge
orders her to undergo a 10-day psychiatric
evaluation.
What is the most probable psychiatric
diagnosis for this client?
A. Delusional disorder — jealous type
B. Induced psychotic disorder
C. Delusional disorder — erotomanic type
D. Schizophreniform disorder
Rationale: In delusional disorder of the
erotomanic type, the client has an erotic
delusion of
being loved by another person and tries to
contact the object of the delusion through
such
behaviors as sending gifts, calling, and
stalking. The object of the undesired
attention may be a
complete stranger and usually is of higher
status. In a delusional disorder of the
jealous type, the
client has a delusion that the sexual
partner is unfaithful. In a psychotic
disorder, a delusion of
suspicion occurs within the context of a
close relationship. The individual may
believe that
someone has an inappropriate or sexual
interest in him. Schizophreniform disorder
involves
bizarre delusions and hallucinations of
less than 6 months' duration.
74. Which of the following signs should the
nurse expect in a client with known
amphetamine
overdose?
A. Hypotension
B. Tachycardia
C. Hot, dry skin
D. Constricted pupils
Rationale: Amphetamines are central
nervous system stimulants. They cause
sympathetic
stimulation, including hypertension,
tachycardia, vasoconstriction, and
hyperthermia. Hot, dry skin
is seen with anticholinergic agents such as
jimsonweed. Pupils will be dilated, not
constricted.
75. Which of the following is an
example of a negative
symptom of schizophrenia?
a. Delusions
b. Disorganized speech d. Don't intervene - the patients need a 82. While providing information for the c. Delusions of grandeur and hyperactivity
c. Flat affect little bit of room family of a d. Alteration of appetite and sleep pattern
d. Catatonic behavior in which to work out differences patient with schizophrenia, you should Situation: A client is admitted to the
76. The patient tells you that a "voice" Situation: John is admitted with a be sure to hospital. During the
keeps laughing diagnosis of paranoid inform them about which of the assessment the nurse notes that the client
at him and tells him he must crawl on schizophrenia. following has not slept
his hands and 79. You're reaching a community group characteristics of the disorder? for a week. The client is talking rapidly,
knees like a dog. Which of the about a. Relapse can be prevented if the patient and throwing his
following would be the schizophrenia disorders. You explain takes arms around randomly.
most appropriate response? the different types medication 86. When writing an assessment of a
a. "They are imaginary voices and we're of schizophrenia and delusional b. Support is available to help family client with mood
here to make disorders. You also members meet disorder, the nurse should specify:
them go, away." explain that, unlike schizophrenia, their own needs a. How flat the client's affect
b. "If it makes you feel better, do what the delusional disorders: c. Improvement should occur if the b. How suicidal the client is
voices tell a. Tend to begin in early childhood patient's c. How grandiose the client is
you." b. Affect more men than women environment is carefully maintained d. How the client is behaving
c. "The voices can't hurt you here in the c. Affect more women than men d. Stressful situations in the family in the 87. It is an apprehensive anticipation of
hospital" d. May be related to certain medical family can an unknown
d. "Even though I don't hear the voices, I conditionsa precipitate a relapse in the patient danger:
understand that 80. A patient with schizophrenia 83. While caring for John, the nurse a. Fear
you do." (catatonic type) is knows that John b. Anxiety
77. A 23-year-old patient is receiving mute and can't perform activities of may have trouble with: c. Antisocial
antipsychotic daily living. The a. Staff who are cheerful d. Schizoid
medication to treat his schizophrenia. patient stares out the window for b. Simple direct sentences 88. It is an, emotional response to a
He's hours. What is your c. Multiple commands consciously
experiencing some motor first priority in this situation? d. Violent behaviors recognized threat.
abnormalities called a. Assist the patient with feeding 84 Which nursing diagnosis is most a. Fear
extrapyramidal effects. Which of the b. Assist the patient with showering and likely to be b. Anxiety
following tasks for associated with a person who has a c. Antisocial
extrapyramidal effects occurs most hygiene medical diagnosis d. Schizoid
frequently in c. Reassure the patient about safely, and of schizophrenia, paranoid type? 89. All but one is an example of
younger make patients? try to orient a. Fear of being along situational crisis:
a. Akathisia him to his surroundings b. Perceptual disturbance related to a. Menstruation
b. Akinesia d. Encourage, socialization with peers, delusion of b. Role changes
c. Dystonia and provide a 253 c. Rape
d. Pseudoparkinsonism stimulating environment persecution d. Divorce
78. Which of the following should you 81. Which of the following would you c. Social isolation related to impaired 90. What would be the highest priority
do next? suspect in a ability to trust in formulating a
a. Firmly redirect the patient to her patient receiving Chlorpromazine d. Impaired social skills related to nursing care plan for this client?
room to discuss the (Thorazine) who inadequate developed a. Isolate the client until he or she adjusts
incident complains of a sore throat and has a superego to 'the
b. Call the assistance and place the fever? 85. Which of the following behaviors hospital
patient in locked a. An allergic reaction can the nurse b. Provide nutritious food and a quite
seclusion b. Jaundice anticipate with this client? place to rest
c. Help the patient look for her purse c. Dyskinesia a. Negative cognitive distortions c. Protect the client and others from harm
d. Agranulocytosis b. Impaired psychomotor development d. Create a structured environment
Situation: Wendell, 24 year-old student b. Exercising 1 hour before bedtime to divorce. The patient is sitting in a chair, a. "I feel angry when I hear that tone of
with a primary promote sleep rocking back voice"
sleep disorder, is unable to initiate c. Importance of steeping whenever the and forth. Which is the best response b. "You make me so angry when you
maintenance of client tires for the nurse to talked to me that
sleep. Primary sleep disorders may be d. Drinking warm milk before bed to make? way."
categorized as induce sleep a. "You must stop crying so that we can c. "Are you trying to make me angry?"
dyssomnias or parasomnias. 94. Examples of dyssomnia includes: discuss your d. "Why do you use that condescending
91. The nurse is caring for a client who a. Insomnia, hypersomnia, narcolepsy feelings about the divorce." tone of voice
complains; of b. Sleepwalking, nightmare b. "Once you find a job, you will feel much with me?"
fat?gue, inability to concentrate, and c. Snoring while sleeping better and 100. A 35 year-old client tells the nurse
palpitations. The d. Non-rapid eye movement more secure." that he never
client stales that she has been Situation: The following questions refer to c. "I can see how upset you are. Let's disagrees with anyone and that he has
experiencing these therapeutic sit in the office so loved everyone
symptoms for the past 6 months. communication. that we can talk about how you're he's ever known. What would be the
Which factor in the 254 feeling." nurse's best
client’s history has most likely 95. When preparing to conduct group d. "Once you have a lawyer looking out for response to this client?
contributed to.these therapy, the your a. "How do you manage to do that?"
symptoms? nurse keeps in mind that the optimal interests, you will feel better." b. "That's hard to believe. Most people
a. History of recent fever number of clients 98. A client on the unit tells the nurse couldn't to that."
b. Shift work in a group would be: that his wife's c. "What do you do with your feelings of
c. Hyperthyroidism a. 6 to 8 nagging really gets on his nerves. He dissatisfaction
d. Fear b. 10 to 12 asks the nurse if or anger?"
92. If Wendell complains of c. 3 to 5 she will talk with his wife about d. "How did you come to adopt such a
experiencing an d. Unlimited nagging during their way of
overwhelming urge to sleep and states 96. What occurs during the working family session tomorrow afternoon.
that he's been phase of the-nurseclient Which of the
falling asleep while studying and relationship? following would be most therapeutic
reports that these a. The nurse assesses the client's needs response to
episodes occur about 5 times daily and develops a client?
Wendell is most plan of care a. "Tell me more specifically about her
likely experiencing which sleep b. The nurse and client together complaints"
disorder? evaluate and modify b. "Can you think why she might nag you
a. Breathing-related sleep disorder the goals of the relationship so much?"
b. Narcolepsy c. The nurse and client discuss their c. "I'll help you think about how to
c. Primary hypersomnia feelings about bring this up
d. Circadian rhythm disorder terminating the relationship yourself tomorrow."
93. The nurse is preparing a teaching d. The nurse and client explore each d. "Why do you want me to initiate this
plan for a client other's expectations discussion in
diagnosed with primary insomnia. of-the relationship tomorrow's session rather than you?"
Which of the 97. A 42 year-old homemaker arrives at 99. The nurse is working with a client
following teaching topics should be the emergency who has just
included in the department with uncomfortable crying stimulated her anger by using a
plan? and anxiety. condescending tone of
a. Eating unlimited spicy foods, and Her husband of 17 years has recently voice. Which of the following
limiting caffeine and asked her for a responses by the nurse
alcohol would be the most therapeutic?