A1 PASSERS TRAINING, RESEARCH, REVIEW and assessment and interventions, what would be the most B.
would be the most B. ask him if it's okay if she sits quietly with him.
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."
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. Which of the following
comments indicates 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."
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 chronic
undifferentiated schizophrenia. 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
4. A high school student is referred to the school nurse for
suspected substance abuse. Following the nurse's
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
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.
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
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
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
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.
C. ask him why he wants to be left alone.
D. tell him that she won't let anything happen to him.
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
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
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
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
14. Which is the drug of choice for treating Tourette
syndrome?
A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil
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.
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
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.
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.
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
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
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.
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
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
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.
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.
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
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
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
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
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
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
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.
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.
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.
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.
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
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)
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
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
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
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.
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)
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
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
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.
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.
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
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.
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.
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
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.
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.
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
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
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.
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."
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.
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
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
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) 66. Which of the following statements is a guideline to help
B. droperidol (Inapsine) nurses avoid liability?
C. lithium carbonate (Lithonate) A. Follow every physician's order.
D. alcohol B. Do what the client desires even though you may
62. A client with schizophrenia who receives fluphenazine disagree.
(Prolixin) develops C. Practice within the scope of the Nurse Practice Act.
pseudoparkinsonism and akinesia. What drug would the D. Obtain malpractice insurance.
nurse administer to minimize 67. In group therapy, a client who has used I.V. heroin
extrapyramidal symptoms? every day for the past 14 years says, "I
A. benztropine (Cogentin) don't have a drug problem. I can quit whenever I want. I've
B. dantrolene (Dantrium) done it before." Which defense
C. clonazepam (Klonopin) mechanism is the client using?
D. diazepam (Valium) A. Denial
63. A client with paranoid schizophrenia has been B. Obsession
experiencing auditory hallucinations for many C. Compensation
years. One approach that has proven to be effective for D. Rationalization
hallucinating clients is to: 68. A husband and wife seek emergency crisis intervention
A. take an as-needed dose of psychotropic medication because he slapped her repeatedly
whenever they hear voices. the night before. The husband indicates that his childhood
B. practice saying "Go away" or "Stop" when they hear was marred by an abusive relationship
voices. with his father. When intervening with this couple, the nurse
C. sing loudly to drown out the voices and provide a knows they are at risk for repeated
distraction. violence because the husband:
D. go to their room until the voices go away. A. has only moderate impulse control.
64. An agitated and incoherent client, age 29, comes to the B. denies feelings of jealousy or possessiveness.
emergency department with C. has learned violence as an acceptable behavior.
complaints of visual and auditory hallucinations. The history D. feels secure in his relationship
reveals that the client was 69. A client with delusional thinking shows a lack of interest
hospitalized for paranoid schizophrenia from ages 20 to 21. in eating at meal times. She states
The physician prescribes haloperidol that she is unworthy of eating and that her children will die
(Haldol), 5 mg I.M. The nurse understands that this drug is if she eats. Which nursing action
used in this client to treat: would be most appropriate for this client?
A. dyskinesia. A. Telling the client that she may become sick and die
B. dementia. unless she eats
C. psychosis. B. Paying special attention to the client's rituals and
D. tardive dyskinesia. emotions associated with meals
65. When interviewing the parents of an injured child, which C. Restricting the client's access to food except at specified
of the following is the strongest meal and snack times
indicator that child abuse may be a problem? D. Encouraging the client to express her feelings at meal
A. The injury isn't consistent with the history or the child's times
age. 70. Which of the following is the priority when assessing a
B. The mother and father tell different stories regarding suicidal client who has ingested a
what happened. handful of unknown pills?
C. The family is poor. A. Determining if the client was trying to harm himself
D. The parents are argumentative and demanding with B. Determining if the client had a support system
emergency department personnel.
C. Determining if the client's physical condition is life-
threatening
D. Determining if the client has a history of suicide attempts
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
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
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
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
75. Which of the following is an example of a negative
symptom of schizophrenia?
a. Delusions
b. Disorganized speech
c. Flat affect
d. Catatonic behavior
76. The patient tells you that a "voice" keeps laughing at
him and tells him he must crawl on his hands and
knees like a dog. Which of the following would be the most
appropriate response?
a. "They are imaginary voices and we're here to make them
go, away."
b. "If it makes you feel better, do what the voices tell you."
c. "The voices can't hurt you here in the hospital"
d. "Even though I don't hear the voices, I understand that
you do."
77. A 23-year-old patient is receiving antipsychotic
medication to treat his schizophrenia. He's
experiencing some motor abnormalities called
extrapyramidal effects. Which of the following
extrapyramidal effects occurs most frequently in younger
make patients?
a. Akathisia
b. Akinesia
c. Dystonia
d. Pseudoparkinsonism
78. Which of the following should you do next?
a. Firmly redirect the patient to her room to discuss the
incident
b. Call the assistance and place the patient in locked
seclusion
c. Help the patient look for her purse
d. Don't intervene - the patients need a little bit of room in
which to work out differences
Situation: John is admitted with a diagnosis of paranoid
schizophrenia.
79. You're reaching a community group about
schizophrenia disorders. You explain the different types
of schizophrenia and delusional disorders. You also explain
that, unlike schizophrenia, delusional disorders:
a. Tend to begin in early childhood
b. Affect more men than women
c. Affect more women than men
d. May be related to certain medical conditionsa
80. A patient with schizophrenia (catatonic type) is mute
and can't perform activities of daily living. The
patient stares out the window for hours. What is your first
priority in this situation?
a. Assist the patient with feeding
b. Assist the patient with showering and tasks for hygiene
c. Reassure the patient about safely, and try to orient to his
surroundings
d. Encourage, socialization with peers, and provide a
stimulating environment
81. Which of the following would you suspect in a patient
receiving Chlorpromazine (Thorazine) who
complains of a sore throat and has a fever?
a. An allergic reaction
b. Jaundice
c. Dyskinesia
d. Agranulocytosis
82. While providing information for the family of a patient
with schizophrenia, you should be sure to
inform them about which of the following characteristics of
the disorder?
a. Relapse can be prevented if the patient takes medication
b. Support is available to help family members meet their
own needs
c. Improvement should occur if the patient's environment is
carefully maintained
d. Stressful situations in the family in the family can
precipitate a relapse in the patient
83. While caring for John, the nurse knows that John may
have trouble with:
a. Staff who are cheerful
b. Simple direct sentences
c. Multiple commands
d. Violent behaviors
84 Which nursing diagnosis is most likely to beassociated
with a person who has a medical diagnosis
of schizophrenia, paranoid type?
a. Fear of being along
b. Perceptual disturbance related to delusion of persecution
c. Social isolation related to impaired ability to trust
d. Impaired social skills related to inadequate developed
superego
85. Which of the following behaviors can the nurse
anticipate with this client?
a. Negative cognitive distortions
b. Impaired psychomotor development
c. Delusions of grandeur and hyperactivity
d. Alteration of appetite and sleep pattern
Situation: A client is admitted to the hospital. During the
assessment the nurse notes that the client has not slept for
a week. The client is talking rapidly, and throwing his arms
around randomly.
86. When writing an assessment of a client with mood
disorder, the nurse should specify:
a. How flat the client's affect
b. How suicidal the client is
c. How grandiose the client is
d. How the client is behaving
87. It is an apprehensive anticipation of an unknown
danger:
a. Fear
b. Anxiety
c. Antisocial
d. Schizoid
88. It is an, emotional response to a consciously
recognized threat.
a. Fear
b. Anxiety
c. Antisocial
d. Schizoid
89. All but one is an example of situational crisis:
a. Menstruation
b. Role changes
c. Rape
d. Divorce
90. What would be the highest priority in formulating a
nursing care plan for this client?
a. Isolate the client until he or she adjusts to 'the hospital
b. Provide nutritious food and a quite place to rest
c. Protect the client and others from harm
d. Create a structured environment
Situation: Wendell, 24 year-old student with a primary sleep
disorder, is unable to initiate maintenance of
sleep. Primary sleep disorders may be categorized as
dyssomnias or parasomnias.
91. The nurse is caring for a client who complains; of fat
due to inability to concentrate, and palpitations. The
client stales that she has been experiencing these
symptoms for the past 6 months. Which factor in the
client’s history has most likely contributed to. these
symptoms?
a. History of recent fever
b. Shift work
c. Hyperthyroidism
d. Fear
92. If Wendell complains of experiencing an overwhelming
urge to sleep and states that he's been
falling asleep while studying and reports that these
episodes occur about 5 times daily Wendell is most
likely experiencing which sleep disorder?
a. Breathing-related sleep disorder
b. Narcolepsy
c. Primary hypersomnia
d. Circadian rhythm disorder
93. The nurse is preparing a teaching plan for a client
diagnosed with primary insomnia. Which of the
following teaching topics should be included in the plan?
a. Eating unlimited spicy foods, and limiting caffeine and
alcohol
b. Exercising 1 hour before bedtime to promote sleep
c. Importance of steeping whenever the client tires
d. Drinking warm milk before bed to induce sleep
94. Examples of dyssomnia includes:
a. Insomnia, hypersomnia, narcolepsy
b. Sleepwalking, nightmare
c. Snoring while sleeping
d. Non-rapid eye movement
Situation: The following questions refer to therapeutic
communication.
95. When preparing to conduct group therapy, the nurse
keeps in mind that the optimal number of clients
in a group would be:
a. 6 to 8
b. 10 to 12
c. 3 to 5
d. Unlimited
96. What occurs during the working phase of the-
nurseclient relationship?
a. The nurse assesses the client's needs and develops a
plan of care
b. The nurse and client together 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
97. A 42 year-old homemaker arrives at the emergency
department with uncomfortable crying and anxiety.
Her husband of 17 years has recently asked her for a
divorce. The patient is sitting in a chair, rocking back
and forth. Which is the best response for the nurse to
make?
a. "You must stop crying so that we can discuss your
feelings about the divorce."
b. "Once you find a job, you will feel much better and more
secure."
c. "I can see how upset you are. Let's sit in the office so
that we can talk about how you're feeling."
d. "Once you have a lawyer looking out for your interests,
you will feel better."
98. A client on the unit tells the nurse that his wife's
nagging really gets on his nerves. He asks the nurse if
she will talk with his wife about nagging during their family
session tomorrow afternoon. Which of the following would
be most therapeutic response to client?
a. "Tell me more specifically about her complaints"
b. "Can you think why she might nag you so much?"
c. "I'll help you think about how to bring this up yourself
tomorrow."
d. "Why do you want me to initiate this discussion in
tomorrow's session rather than you?"
99. The nurse is working with a client who has just
stimulated her anger by using a condescending tone of
voice. Which of the following responses by the nurse would
be the most therapeutic?
a. "I feel angry when I hear that tone of voice"
b. "You make me so angry when you talked to me that
way."
c. "Are you trying to make me angry?"
d. "Why do you use that condescending tone of voice with
me?"
100. A 35 year-old client tells the nurse that he never
disagrees with anyone and that he has loved everyone
he's ever known. What would be the nurse's best response
to this client?
a. "How do you manage to do that?"
b. "That's hard to believe. Most people couldn't to that."
c. "What do you do with your feelings of dissatisfaction or
anger?"
d. "How did you come to adopt such a way of