42. What are the risk factors for the development of depression? Select all that apply. C.

C. When the client and her family are presented with the treatment plan by the healthcare
provider
1. Childhood sexual abuse D. When the client is admitted to the mental health unit
2. Family member with depression
3. Being Caucasian 45. Miss Laura Luke, an 18-year-old client, is isolating herself from peers and refuses to go to
4. Dysfunctional family relationship school. She refuses to maintain her ADLs. Upon admission to a mental health unit, Miss Luke
5. Being male is diagnosed with major depressive disorder. Which intervention should you initiate upon
admission to the unit?
A. 1,2,3
B. 3,4,5 A. Help the client identify personal weaknesses.
C. 1,2, 4 B. Isolate the client from others.
D. 1,2,5 C. Provide a safe, protective environment.
D. Create an environment free of excessive stimulation.
43. You are taking a mental health assessment of Mrs. Castillo, a woman in her 30's. Mrs.
Castillo tells you that she has been having feelings of deep sadness all summer and that she 46. A highly agitated client paces the unit and states, "I could buy and sell this place." The
has never experienced this type of long-lasting sadness before. She tells you that she is client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most
usually optimistic and energetic, but in the past 4 months her mood has completely accurate documentation of this client's behavior?
changed. Upon further questioning, you learn that Mrs. Castillo has two children, ages 2 and
5, and that a year ago she and her family moved to a new city where she has no friends or A. "Rates mood 8/10. Exhibiting looseness of association. Euphoric."
extended family members. Based on this information, which mood disorder is Mrs. Castillo B. "Mood euthymic. Exhibiting magical thinking. Restless."
C. "Mood labile. Exhibiting delusions of reference. Hyperactive."
most likely experiencing?
D. "Agitated and pacing. Exhibiting grandiosity. Mood labile."
A. Seasonal affective disorder
B. Bipolar disorder
C. Major depressive disorder 47. A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1
D. Postpartum depression year, presents in an emergency department with severe diarrhea, blurred vision, and
tinnitus. How should the nurse interpret these symptoms?

44. Ms. Carla Simmons, age 26, is admitted to a mental health unit. She has been avoiding
her family responsibilities, has not left the house for a month, and has not had a good
appetite. During the past 2 months, she has lost over 20 pounds. Ms. Simmons is diagnosed
with severe depression. At an interdisciplinary conference, the recommendation is made for
electroconvulsive therapy (ECT). When would the nurse start preparing the client for this
procedure?
A. Immediately after the procedure is completed
B. The night before the ECT is planned to occur
A. Symptoms indicate consumption of foods high in tyramine.
B. Symptoms indicate lithium carbonate discontinuation syndrome.
C. Symptoms indicate the development of lithium carbonate
D. Symptoms indicate lithium carbonate toxicity.
48. A client is diagnosed with bipolar disorder: manic phase. Which nursing intervention
would be implemented to achieve the outcome of "Client will gain 2 lbs by the end of the
week?"
A. Provide clients with high-calorie finger foods throughout the day.
B. Accompany clients to the cafeteria to encourage adequate dietary consumption.
C. Initiate total parenteral nutrition to meet dietary needs.
D. Teach the importance of a varied diet to meet nutritional needs.
49. A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit.
Which is the prior outcome for this client?
A. The client will accomplish activities of daily living independently by discharge.
B. The client will verbalize feelings during group sessions by discharge.
C. The client will remain safe throughout hospitalization.
D. The client will use problem solving to cope adequately after discharge.
50. A nurse learns in a report that a newly admitted client experiencing mania is
demonstrating grandiose delusions. The nurse should recognize which client statement
would provide supportive evidence of this symptom?
A. "I can't stop my sexual urges. They have led me to numerous affairs."
B. "I'm the world's most perceptive attorney."
C. "My wife is distraught about my overspending."
D. "The FBI has tapped my room and are out to get me.
51. A client on an inpatient unit is diagnosed with bipolar disorder, manic phase. During a
discussion in the dayroom about weekend activities, the client raises voice, becomes
irritable, and insists that plans change. What should be the nurse's initial intervention?
A. Ask the group to take a vote on alternative weekend events.
B. Remind the client to quiet down or leave the dayroom.
C. Assist the client to move to a calmer location.
D. Discuss with the client impulse control problems
52. A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on
sertraline (Zoloft). Family members report that the client has experienced anorexia,
insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize?
A. Risk for suicide R/T hopelessness
B. Anxiety: severe R/T hyperactivity
C. Imbalanced nutrition: less than body requirements R/T refusal to eat
D. Dysfunctional grieving R/T loss of employment
53. A nursing instructor is discussing various challenges in the treatment of clients diagnosed
with bipolar disorder. Which student statement demonstrates an understanding of the most
critical challenge in the care of these clients?
A. "Treatment is compromised when elients can't sleep."
B. "Treatment is compromised when irritability interferes with social interactions."
C. "Treatment is compromised when clients have no insight into their problems."
D. "Treatment is compromised when clients choose not to take their medications."
54. A nurse at Nurseslabs Medical Center is developing a care plan for a female client with
post-traumatic stress disorder. Which of the following would she do initially?
A. Instruct the client to use distraction techniques to cope with flashbacks.
B. Encourage the client to put the past in proper perspective.
C. Encourage the client to verbalize thoughts and feelings about the trauma.
D. Avoid discussing the traumatic event with a client.
55. A group of community nurses sees and plans care for various clients with different types
of problems. Which of the following clients would they consider the most vulnerable to
post-traumatic stress disorder?
A. An 8 year-old boy with asthma who has recently failed a grade in school.
B. A 20 year-old college student with DM who experienced date rape.
C. A 40 year-old widower who has recently lost his wife to cancer.
D. A wife of an individual with a severe substance abuse problem.
56. The nurse is talking with a client who just had a beautiful bouquet of roses delivered.
Suddenly the client becomes tearful and stares out the window. The client has a history of
sexual abuse. Which of the following should the nurse include in the plan of care for this
client?
A. Tell the client that the sexual abuse was in the past.
B. Tell the client to relax and enjoy the roses.
C. Assess if the client is having a flashback.
D. Give the client some alone time and return later.
 61. Family dynamics are thought to be a major influence in the development of anorexia
57. When planning the care of a client who is experiencing post-traumatic stress disorder, nervosa. Which statement regarding a client's home environment should a nurse associate
the nurse identifies which of the following as an appropriate goal? The client will report: with the development of anorexia nervosa?

A. A decrease in flashbacks and nightmares, A. The home environment maintains loose personal boundaries.
B. Spending less time on ritualistic behavior. B. The home environment places an overemphasis on food.
C. A decrease in hearing voices, C. The home environment is overprotective and demands perfection.
D. Having more energy. D. The home environment condones corporal punishment.

58. A client is prescribed alprazolam (Xanax) for acute ariety. What client history should 62. A client's altered body image is evidenced by claims of feeling fat, even though the client
cause a nurse to question this order? is emaciated. Which is the appropriate outcome criterion for this client's problem?

A. History of alcohol dependence A. The client will consume adequate calories to sustain normal weight
B. History of personality disorder B. The client will cease strenuous exercise programs.
C. History of schizophrenia C. The client will perceive personal ideal body weight and shape as normal.
D. History of hypertension D. The client will not express a preoccupation with food.

59. After being robbed and beaten by an unknown assailant, a patient is diagnosed with 63. A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of
post-traumatic stress disorder (PTSD). When developing a plan of care for the patient, which tooth enamel deterioration, Which explanation for this complication of bulimia nervosa,
of these interventions will the healthcare provider plan to implement first? should the nurse provide?

A. Assist the patient in recalling the details of the event A. The emesis produced during purging is acidic and corrodes the tooth enamel.
B. Teach the patient coping skills to deal with anxiety B. Purging causes the depletion of dietary calcium.
C. Promote the establishment of a trusting relationship C. Food is rapidly ingested without proper mastication.
D. Ensure the patient is taking medications as prescribed D. Poor dental and oral hygiene leads to dental caries.

60. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny 64. A nurse is teaching a client diagnosed with an eating disorder about behavior-
servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is modification programs. Why is this intervention the treatment of choice?
95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?
A. It helps the client correct a distorted body image.
A. Binge eating disorder B. It addresses the underlying client anger.
B. Anorexia nervosa
C. It manages the client's uncontrollable behaviors.
C. Bulimia nervosa D. It allows clients to maintain control.
D. Pica
65. A potential Olympic figure skater collapses during practice and is hospitalized for severe
malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight
related to this disorder?
A. Skaters need to be thin to improve their daily performance.
B. All the skaters on the team are following an approved 1200-calorie diet.
C. The exercise of skating reduces my appetite but improves my energy level.
D. I am angry at my mother. I can only get her approval when I win competitions.
66. The family of a client diagnosed with anorexia nervosa becomes defensive when the
treatment team calls for a family meeting. Which is the appropriate nursing response?
A. Tell me why this family meeting is causing you to be defensive. All clients are required to
participate in two family sessions.
B. Eating disorders have been correlated to certain familial patterns; without addressing
these, your child's condition will not improve.
C. Family dynamics are not linked to eating disorders. The meeting is to provide your child
with family support.
D. Clients diagnosed with anorexia nervosa are part of the family system, and any alteration
in family processes needs to be addressed.
67. A client diagnosed with bulimia nervosa has been attending a mental health clinic for
several months. Which factor should a nurse identify as an appropriate indicator of a
positive client behavioral change?
A. The client gained two pounds in one week.
B. The client focused conversations on nutritious food.
C. The client demonstrated healthy coping mechanisms that decreased anxiety.
D. The client verbalized an understanding of the etiology of the disorder.
68. A nurse is attempting to differentiate between the symptoms of anorexia nervosa and
the symptoms of bulimia. Which statement delineates the difference between these two
disorders?
A. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas
clients diagnosed with bulimia nervosa do not.
B. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients
diagnosed with anorexia.
C. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo,
whereas clients nervosa do not diagnosed with anorexia nervosa do not.
D. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients
diagnosed with bulimia nervosa do not.
69. A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after
being medically cleared. The client states, "My parents watch me like a hawk and never let
me out of their sight." Which nursing diagnosis would take priority at this time?
A. Altered nutrition less than body requirements
B. Altered social interaction
C. Impaired verbal communication
D. Altered family processes
70. Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating
disorder. Which outcome indicator is most appropriate to monitor?
A. Weight, muscle, and fat are congruent with height, frame, age, and sex.
B. Calorie intake is within the required parameters of the treatment plan.
C. Weight reaches the established normal range for the patient.
D. Patient expresses satisfaction with body appearance.
71. A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3
months. To assess the patient's oral intake, the nurse should ask:
A. Do you often feel fat?
B. Who plans the family meals?
C. What do you eat on a typical day?
D. What do you think about your present weight?
72. A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and
has lost 25% of body weight. A nurse asks, "Describe what you think about your present
weight and how you look." Which response by the patient is most consistent with the
diagnosis?
A. I am fat and ugly.
B. What I think about myself is my business.
C. I am grossly underweight, but that's what I want.
D. I am a few pounds overweight, but I can live with it.
73. A patient was diagnosed with anorexia nervosa. The history shows the patient virtually
stopped eating 5 months ago and has lost 25% of body weight. The patient's current serum
potassium is 2.7 mg/dl. Which nursing diagnosis applies?
A. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte
imbalances and weight loss.
B. Disturbed energy field, related to physical exertion in excess of energy produced through
caloric intake as evidenced by weight loss and hyperkalemia.
C. Ineffective health maintenance, related to self-induced vomiting as evidenced by swollen
parotid glands and hyperkalemia.
D. Imbalanced nutrition: less than body requirements, related to malnutrition as evidenced
by loss of 25% of body weight and hypokalemia.
74. Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select
the most important outcome related to the nursing diagnosis: Imbalanced nutrition: less
than body requirements. Within 1 week, the patient will:
A. weigh yourself accurately using balanced scales.
B. limit exercise to less than 2 hours daily.
C. select clothing that fits properly.
D. gain 1 to 2 pounds.
75. Which nursing intervention has priority as a patient diagnosed with anorexia nervosa
begins to gain weight?
A. Assess for depression and anxiety.
B. Observe adverse effects of re-feeding.
C. Communicate empathy for the patient's feelings.
D. Help the patient balance energy expenditure and caloric intake
76. A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the
rationale for establishing a contract with the patient to participate in measures designed to
produce a specified weekly weight gain?
A. Because severe anxiety concerning eating is expected, objective and subjective data must
be routinely collected.
B. Patient involvement in decision-making increases a sense of control and promotes
compliance with the treatment.
C. A team approach to planning the diet ensures that physical and emotional needs of the
patient are met.
D. Because of increased risk for physical problems with re-feeding, obtaining patient
permission is required.
77. The nursing care plan for a patient diagnosed with anorexia nervosa includes the
intervention Monitor for complications of refeeding. Which body system should a nurse
closely monitor for dysfunction?
A. Renal
B. Endocrine
C. Central nervous
D. Cardiovascular
78. A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient
diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of
therapy?
A. What are your feelings about not eating the food that you prepare?
B. You seem to feel much better about yourself when you eat something.
C. It must be difficult to talk about private matters to someone you just met.
D. Being thin does not seem to solve your problems. You are thin now but still unhappy.
79. An appropriate intervention for a patient diagnosed with bulimia nervosa who binges
and purges is to teach the patient to:
A. eat a small meal after purging.
B. avoid skipping meals or restricting food.
C. concentrate oral intake after 4 PM daily.
D. understand the value of reading journal entries aloud to others.80. What behavior by a
nurse caring for a patient diagnosed with an eating disorder indicates the nurse needs
supervision?
80. What behavior by a nurse caring for a patient diagnosed with an eating disorder
indicates the nurse needs supervision?
A. The nurse's comments are nonjudgmental.
B. The nurse uses an authoritarian manner when interacting with the patient.
C. The nurse teaches the patient to recognize signs of increasing anxiety and ways to
intervene.
D. The nurse refers the patient to a self-help group for individuals with eating disorders.
81. A nursing diagnosis for a patient diagnosed with bulimia nervosa is: Ineffective coping,
related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-
induced vomiting. The best outcome related to this diagnosis is, Within 2 weeks the patient
will:
A. appropriately express angry feelings.
B. verbalize two positive things about self.
C. verbalize the importance of eating a balanced diet.
D. identify two alternative methods of coping with loneliness.
82. Which nursing intervention has the highest priority for a patient diagnosed with bulimia
nervosa?
A. Assist the patient to identify triggers to binge eating.
B. Provide corrective consequences for weight loss.
C. Explore patient needs for health teaching.
D. Assess for signs of impulsive eating.
83. While providing health teaching for a patient diagnosed with bulimia nervosa, a nurse
should emphasize information about:
A. self-monitoring of daily food and fluid intake.
B. establishing the desired daily weight gain.
C. recognizing symptoms of hypokalemia.
D. self-esteem maintenance.
84. As a patient admitted to the eating disorders unit undresses, a nurse observes that the
patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet, 4
inches tall. Which condition should be documented?
A. Amenorrhea
B. Alopecia
C. Lanugo
D. Stupor
85. A patient being admitted to the eating disorders unit has a yellow cast to the skin and
fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet, 4 inches.
The patient is quiet and says only. "I won't eat until I look thin." What is the priority initial
nursing diagnosis?
A. Anxiety, related to fear of weight gain
B. Disturbed body image, related to weight loss
C. Ineffective coping, related to lack of conflict resolution skills
D. Imbalanced nutrition: less than body requirements, related to self-starvation
86. A nurse conducting group therapy on the eating disorders unit schedules the sessions
immediately after meals for the primary purpose of:
A. maintaining the patient's concentration and attention.
B. shifting the patient's focus from food to psychotherapy.
C. focusing on weight control mechanisms and food preparation.
D. processing the heightened anxiety associated with eating.
87. Physical assessment of a patient diagnosed with bulimia nervosa often reveals: D. Play therapy

A. prominent parotid glands. 92. A nurse is assessing a child with attention deficit hyperactivity disorder (ADHD). For
B. peripheral edema. every question asked by the nurse, the child answers, "I don't know." What is the most likely
C. thin, brittle hair. reason for the child to respond in this way?
D. amenorrhea.
A. The child is not willing to answer the nurse.
88. When personality characteristic is a nurse most likely to assess in a patient diagnosed B. The child is not able to understand what the nurse is asking.
with anorexia nervosa? C. The child does not like talking to the nurse.
D. The child is not paying attention to the nurse's questions.
A. Carefree flexibility
B. Rigidity, perfectionism 93. During a comprehensive assessment of a child, which person does the nurse interview
C. Open displays of emotion first?
D. High spirits and optimism
A. child
89. Which statement is a nurse most likely to hear from a patient diagnosed with anorexia B. parent
nervosa? C. caregiver
D. grandparents
A. I would be happy if I could lose 20 more pounds.
B. My parents don't pay much attention to me.
94. What materials would assist the preschool age child to develop rapport with the nurse?
C. I'm thin for my height. Select all that apply.
D. I have nice eyes.
1. Paint and an easel 2. Puppets 3. Video games 4. Puzzles 5. Dress up clothes
90. When a nurse finds a patient diagnosed with anorexia nervosa vigorously exercising
A. 1,2,3
before gaining the agreed-upon weekly weight, the nurse should state:
B. 1,2,4
A. You and I will have to sit down and discuss this problem. C. 1,2,5
B. It bothers me to see you exercising. You'll lose more weight. D. 2,3,5
C. Let's discuss the relationship between exercise and weight loss and how that affects your
body.
95. A nurse is working with a child undergoing behavioral modification therapy for attention
D. According to our agreement, no exercising is permitted until you have gained a specific
amount of weight. deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be
the most likely reason for this observation?
91. Which type of intervention may be helpful for children who are bullies? A. The child finds food distasteful.
A. Social skills training B. The child has decreased appetite.
B. Bibliotherapy C. The child is genetically predisposed to being thin.
C. Art therapy D. The child cannot sit through meals,
 100. Which aspect of managing a child with attention deficit hyperactivity disorder (ADHD)
may often be overlooked in the treatment plan?
96. A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The
child is given medication and behavioral modification therapy to treat the condition. Which A. Effects on school performance
outcome achieved within 3 days would indicate successful therapy? B. Effects on parents' coping styles
C. Effects on the marriage
A. The child is able to express positive statements about the self. D. Effects on siblings
B. The child is able to demonstrate successful interaction with family members over a long
period of time.
C. The child is able to interact and to develop successful peer relationships.
D. The child is able to complete assignments or tasks with assistance.

97. An adolescent client says the client has become bored with the video game that has
been used as a reward for positive behavior. Which is the most effective intervention for
this client?

A. Tell the client that the client no longer has to clean the client's room in order to play.
B. Reinforce to the client that the client selected the video game and the client needs to
stick with it.
C. Tell the client that the client has to use this video game to ensure understanding of value.
D. Let the client choose another reward that would be more fun.

98. Which is a disturbance of the normal fluency and time patterning of speech?

A. Phonologic disorder
B. Stuttering
C. Mixed receptive-expressive language disorder
D. Expressive language disorder

99. The client is a 6-year-old who has been diagnosed with autism spectrum disorder. Which
symptom would the client display?

A. The client has multiple motor tics and several vocal tics.
B. The client has an irresistible urge to pull out the client's own hair.
C. The client becomes overly attached to those around the client.
D. The client spends time alone with little interest in making friends.