PSYCHIATRIC NURSING

1. 60 year old post CVA patient is taking TPA for his disease, the nurse understands that this
is an example of what level of prevention?

a. primary

b. secondary

c. tertiary

d. nota

C. Tertiary

The client already had stroke, TPA stands for TRANSPLASMINOGEN ACTIVATOR which
are thrombolytics, dissolving clots formed in the vessels of the brain. We are just preventing
COMPLICATIONS here.

2. A female client undergoes yearly mammography. This is a type of what level of

prevention?

a. primary

b. secondary

c. tertiary

d. nota

b. secondary

: The client is never sick of anything but we are detecting the POSSIBILITY by giving yearly

mammography. Remember that all kinds of tests, case findings and treatment belongs to the
secondary

level of prevention.

3. A Diabetic patient was amputated following an unexpected necrosis on the right leg, he
sustained and undergone BKA. He then underwent therapy on how to use his new prosthetic
leg. this is a type of what level of prevention?

a. primary

b. secondary
c. tertiary

d. nota

c. tertiary

: Tertiary prevention involves rehabilitation. Client is now being assisted to perform ADLs at
his

optimum functioning. Remember that all kinds of rehabilitatory and palliative management is
included in tertiary prevention.

4. As a care provider, The nurse should do first:

a. Provide direct nursing care.

b. Participate with the team in performing nursing intervention.

c. Therapeutic use of self.

d. Early recognition of the client’s needs.

d. Early recognition of the client’s needs.

: we are talking about what should the nurse do first.

ASSESSMENT involves early recognition of clients needs. A,B,C are all involve in the
intervention phase of the nursing process.

5. As a manager, the nurse should:

a. Initiates nursing action with co-workers.

b. Plans nursing care with the patient.

c. Speaks in behalf of the patient.

d. Works together with the team.

d. Works together with the team

. : As a nurse manager, you should be able to work with the team.

A,B,C are not specific of a nurse manager. They can be done by an ordinary R.N.

6. the nurse shows a patient advocate role when

a. defend the patient's right

b. refer patient for other services she needs

c. work with significant others

d. intercedes in behalf of the patient.

a. defend the patients right

: An advocate role is shown when the nurse defends the rights of the

client. Interceding in behalf of the patient should not be done by a nurse. Counter
transference can

develop in that case and we should avoid that. Only the family and the health attorney of the
patient can

intercede or speak for the patient.

7. which is the following is the most appropriate during the orientation phase ?

a. patients perception on the reason of her hospitalization

b. identification of more effective ways of coping

c. exploration of inadequate coping skills

d. establishment of regular meeting of schedules

d. establishment of regular meeting of schedules

: Orientation phase is synonymous with CONTRACT

ESTABLISHMENT. Here, the nurse will establish regular meeting of schedule, agreements
and giving the

client information that there is a TERMINATION. Letter A and B assesses the client’s coping
skills, which is

in the working phase and so is letter B. In working phase, The nurse assesses the coping skills
of the

client and formulate plans and intervention to correct deficiencies. Although assessment is
also made in

the orientation phase, COPING SKILLS are assessed in the working phase.

8. preparing the client for the termination phase begins :

a. pre orientation

b. orientation

c. working

d. termination

c. working :

Telling the client that there is a TERMINATION PHASE should be in the ORIENTATION
PHASE,

however, in preparing the client for the TERMINATION, it should be done in the working
phase. The nurse will start to lessen the number of meetings to prevent development of
transference or counter

transference.

9. a helping relationship is a process characterized by :

a. recovery promoting

b. mutual interaction

c. growth facilitating

d. health enhancing

c. growth facilitating :

In psychiatric nursing, The epitome of all nursing goal should focus on facilitating

GROWTH of the client.

10. During the nurse patient interaction, the nurse assess the ff: to determine the patients
coping strategy

a. how are you feeling right now?

b. do you have anyone to take you home?

c. what do you think will help you right now?

d. How does your problem affect your life?

d. How does your problem affect your life?

: this is the only question that determines the effects of

the problem on the client and the ways she is dealing with it. Letter A can only be answered
by FINE and

close further communication. B is unrelated to coping strategies. Letter C, asking the client
what do you

think can help you right now is INAPPROPRIATE for the nurse to ask. The client is in the
hospital because

she needs help. If she knows something that can help her with her problem she shouldn’t be
there.

11. As a counsellor, the nurse performs which of the ff: task?

a. encourage client to express feelings and concerns

b. helps client to learn a dance or song to enable her to participate in activities

c. help the client prepare in group activities

d. assist the client in setting limits on her behaviour

a. encourage client to express feelings and concerns : A counselor is much more of a

listener than a

speaker. She encourage the client to express feelings and concerns as to formulate necessary
response

and facilitate a channel to express anger, disappointments and frustrations.

12. Freud stresses out that the EGO

a. Distinguishes between things in the mind and things in the reality.

b. Moral arm of the personality that strives for perfection than pleasure.

c. Reservoir of instincts and drives

d. Control the physical needs instincts.

a. Distinguishes between things in the mind and things in the reality.

: The ego is responsible for

distinguishing what is REAL and what is NOT. It is the one that balances the ID and super
ego. B and D is

a characteristic of the SUPER EGO which is the CONTROLLER of instincts and drives and
serve as our

CONSCIENCE or the MORAL ARM. The ID is our DRIVES and INSTINCTS that is
mediated by the EGO and

controlled by the SUPER EGO.

13. A 16 year old child is hospitalized, according to Erik Erikson, what is an appropriate
intervention?

a. tell the friends to visit the child

b. encourage patient to help child learn lessons missed

c. call the priest to intervene

d. tell the child’s girlfriend to visit the child.

a. tell the friends to visit the child

: The child is 16 years old, In the stage of IDENTITY VS. ROLE

CONFUSION. The most significant persons in this group are the PEERS. B refers to children
in the school

age while C refers to the young adulthood stage of INTIMACY VS. ISOLATION. The child
is not dying and

the situation did not even talk about the child’s belief therefore, calling the priest is
unnecessary.

14. NMS is characterized by :

a. hypertension, hyperthermia, flushed and dry skin.

b. Hypotension, hypothermia, flushed and dry skin.

c. Hypertension, hyperthermia, diaphoresis

d. Hypertension, hypothermia, diaphoresis

b. Clozaril

: Clozapine is a dreaded aypical antipsychotic because it causes severe bone marrow

depression, agranulocytosis, infection and sore throat. WBC count is important to assess if
the clients

immune function is severely impaired. The first presenting sign of agranulocytosis is SORE
THROAT.

15. Which of the following drugs needs a WBC level checked regularly?

a. Lithane

b. Clozaril

c. Tofranil

d. Diazepam

b. Clozaril

: Clozapine is a dreaded aypical antipsychotic because it causes severe bone marrow

depression, agranulocytosis, infection and sore throat. WBC count is important to assess if
the clients

immune function is severely impaired. The first presenting sign of agranulocytosis is SORE
THROAT.

Angelo, an 18 year old out of school youth was caught shoplifting in a department store. He
has history of being quarrelsome and involving physical fight with his friends. He has been
out of jail for the past two years

16. Initially, The nurse identifies which of the ff: Nursing diagnosis:

a. self centred disturbance

b. impaired social interaction

c. sensory perceptual alteration

d. altered thought process

b. impaired social interaction :

There is no such nursing diagnosis as A , looking at C and D, they are

much more compatible to schizophrenia which is not a characteristic of an ANTI SOCIAL

P.D which is
shown in the situation. Remember that Personality Disorder is FAR from Psychoses. When
client exhibits

altered thought process or sensory alteration, It is not anymore a personality disorder but
rather, a sign

and symptom of psychoses.

17. which of the ff: is not a characteristic of PD?

a. disregard rights of others

b. loss of cognitive functioning

c. fails to conform to social norms

d. not capable of experiencing guild or remorse for their behaviour

b. loss of cognitive functioning

: As I said, symptoms of PD will never show alteration in cognitive

functioning. They are much more of SOCIAL Disturbances rather than PSYCHOLOGICAL.

18. the most effective treatment modality for persons if anti social PD is

a. hypnotherapy

b. gestalt therapy

c. behavior therapy

d. crisis intervention

c. behavior therapy

: The problem of the patient is his behavior. A is done for patient who has insomnia

or severe anxiety. B is a therapy that promotes growth by providing a contact, either a person
or an

environment who will facilitate the growth of an individual. It is a humanistic

psychotherapeutic model

approach. D is done on clients who are in crisis like trauma, post traumatic disorders, raped
or accidents.

19. Which of the following is not an example of alteration of perception?

a. ideas of reference

b. flight of ideas

c. illusion

d. hallucination

b. flight of ideas

: Flight of ideas is a condition in which patient talks continuously and then switching to

unrelated topic. An example is “ Ang ganda ng bulaklak na ito no budek? Rose ito hindi ba?
Kilala mo ba si

jack yung boyfriend ni rose? Grabe yung barko no ang laki laki tapos lumubog lang. Dapat
sana nag

seaman ako eh, gusto kasi ng nanay ko. “. Loose association is somewhat similar but the
switch in topic is more obvious and completely unrelated. Example “ Ang cute nung rabbit,
paano si paul kasi tanga eh,

papapatay ko yan kay albert. Ang ganda nung bag na binigay ni jenny, tanga nga lang yung
aswang dun

sa kanto. Pero bakit ka ba andito? Wala akong pagkain, Penge ako kotse aakyat ako everest.”

A,C,D are all alteration in perception. A refers to a person thinking that everyone is talking
about him. C

and D are all sensory alterations. The difference is that, in hallucination, there is no need for a
stimuli. In

illusion, a stimuli [ A phone cord ] is mistakenly identified by the client as something else [
Snake ]

20. The type of anxiety that leads to personality disorganization is :

a. Mild b. moderate c. severe d. panic

d. panic

: Panic is the only level of anxiety that leads to personality disorganization.

21. A client is admitted to the hospital. Twelve hours later the nurse observes hand tremors,

hyperexicitability, tachycardia, diaphoresis and hypertension. The nurse suspects alcohol

withdrawal. The
nurse should ask the client:

a. at what time was your last drink taken?

b. Why didn’t you tell us you’re a drinker?

c. Do you drink beer or hard liquor?

d. How long have you been drinking?

a. at what time was your last drink taken? :

This question will give the nurse idea WHEN will the

withdrawal occur. Withdrawal occurs 5 to 10 hours after the last intake of alcohol. This is a
crucial and

mortality is very high during this period. Client will undergo delirium tremens, seizures and
DEATH if not

recognize earlier by the nurse. B is very judgmental, C is non specific, whether it is a beer or
a wine It is

still alcohol and has the same effects. D is a valuable question to determine the chronic
effects of alcohol

ingestion but asking letter A can broaden the line between life and death.

22. client with a history of schizophrenia has been admitted for suicidal ideation. The client
states "God is telling me to kill myself right now." The nurse's best response is:

a. I understand that god’s voice are real to you, But I don’t hear anything. I will stay with
you.

b. The voices are part of your illness, it will stop if you take medication

c. The voices are all in your imagination, think of something else and itll go away

d. Don’t think of anything right now, just go and relax.

a. I understand that god’s voice are real to you, But I don’t hear anything. I will stay
with you.

: The nurse should first ACKNOWLEDGE that the voices are real to the patient and then,
PRESENT

REALITY by telling the patient that you do not hear anything. The third part of the nursing
intervention in
hallucination is LESSENING THE STIMULI by either staying with the patient or removing
the patient from a

highly stimulating place.

Telling the client that the voices is part of his illness is not therapeutic. People with
schizophrenia do not

think that they are ILL. Letter C and D disregards the client’s concern and therefore, not
therapeutic.

23. In assessing a client's suicide potential, which statement by the client would give the
nurse the

HIGHEST cause for concern?

a. my thoughts of hurting myself are scary to me

b. I’d like to go to sleep and not wake up

c. I’ve thought about taking pills and alcohol till I pass out

d. I’d like to be free from all these worries

c. I’ve thought about taking pills and alcohol till I pass out

: This is the only statement of the client

that contains a specific and technical plan. B,D are all indicative of suicidal ideation but it
contains no

specific plans to carry out the objective. Letter A admits the client thinks of hurting himself,
but not doing

it because it scares him, therefore, it is not indicative of suicidal ideation.

24. A client with paranoid schizophrenia has persecutory delusions and auditory
hallucinations and is

extremely agitated. He has been given a PRN dose of Thorazine IM. Which of the following
would indicate to the nurse that the medication is having the desired effect?

a. Complains of dry mouth

b. State he feels restless in his body

c. Stops pacing and sits with the nurse

d. Exhibits increase activity and speech

c. Stops pacing and sits with the nurse

: Thorazine is a neuroleptic. Desired effect evolve on

controlling the client’s psychoses. Letter A is the side effect of the drug, which is not desired.
B and D

indicates that the drug is not effective in controlling the client’s agitation, restlessness and
disorders of

perception.

25. A client who was wandering aimlessly around the streets acting inappropriately and
appeared

disheveled and unkempt was admitted to a psychiatric unit and is experiencing auditory and
visual

hallucinations. The nurse would develop a plan of care based on:

a. borderline personality disorder

b. anxiety disorder

c. schizophrenia

d. depression

c. schizophrenia

: When disorders of perception and thoughts came in, The only feasible diagnosis a

doctor can make is among the choices is schizophrenia. A,B and D can occur in normal
individuals without

altering their perceptions. Schizophrenia is characterized by disorders of thoughts,

hallucination, delusion,

illusion and disorganization.

26. A decision is made to not hospitalize a client with obsessive-compulsive disorder. Of the
following abilities the client has demonstrated, the one that probably most influenced the
decision not to hospitalize him is his ability to:

a. Hold a job.
b. Relate to his peers.

c. Perform activities of daily living.

d. Behave in an outwardly normal

c. Perform activities of daily living

: If a client can do ADLs , there is no reason for that client to be

hospitalized.

27. A client is admitted to the inpatient psychiatric unit. He is unshaven, has body odor, and
has spots on his shirt and pants. He moves slowly, gazes at the floor, and has a flat affect. The
nurse's highest priority in assessing the client on admission would be to ask him:

a. How he sleeps at night.

b. If he is thinking about hurting himself.

c. About recent stresses.

d. How he feels about himself.

b. If he is thinking about hurting himself

: The client shows typical sign and symptoms of

DEPRESSION. Moving slowly, gazes on the floor, blank stares and showing flat affect. The
highest priority

among depressed client is assessing any suicide plans or ideation for the nurse to establish a
no suicide

contract early on or, in any case client do not participate in a no suicide contract, a 24 hour
continuous

monitoring is established.

28. The nurse should know that the normal therapeutic level of lithium is :

a. .6 to 1.2 meq/L

b. 6 to 12 meq/L

c. .6 to .12 cc/ml

d. .6 to .12 cc3/L
a. .6 to .12 meq/L

: According to brunner and suddarths MS nursing, The normal therapeutic level of

lithium is .6 to 1.2 meq/L. Some books will say .5 to 1.5 meq/L.

29. The patient complaint of vomiting, diarrhea and restlessness after taking lithane. The
nurse’s initial

intervention is :

a. Recognize that this is a sign of toxicity and withhold the next medication.

b. Notify the physician.

c. Check V/S to validate patient’s concerns.

d. Recognize that this is a normal side effects of lithium and still continue the drug.

a. Recognize that this is a sign of toxicity and withhold the next medication

. : The nurse should

recognize that this is an early s/s of lithium toxicity. Taking the clients vital signs will not
confirm diarrhea,vomiting or restlessness. Notifying the physician is unnecessary at this point
and the physician will likely to withhold the medication.

30. The client is taking TOFRANIL. The nurse should closely monitor the patient for :

a. Hypertension

b. Hypothermia

c. Increase Intra Ocular Pressure

d. Increase Intra Cranial Pressure

c. Increase Intra Ocular Pressure

: Tofranil is a neuroleptic. It is well known that this is the

antipsychotic that increases the IOP and contraindicated in patients with glaucoma.
Hypertension is not specific with TOFRANIL. All neuroleptics can cause NMS or the
neuroleptic malignant syndrome.

31. A client was hospitalized with major depression with suicidal ideation for 1 week. He is
taking
venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse
asks the

client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it
anymore and wouldn't do anything to hurt myself." The nurse judges:

a. The client to be decompensating and in need of being readmitted to the hospital.

b. The client to need an adjustment or increase in his dose of antidepressant.

c. The depression to be improving and the suicidal ideation to be lessening.

d. The presence of suicidal ideation to warrant a telephone call to the client's physician

c. The depression to be improving and the suicidal ideation to be lessening.

: too obvious, no

need to rationalize.

32. The client is taking sertraline (Zoloft), 50 mg q AM. The nurse includes which of the
following in the

teaching plan about Zoloft?

a. Zoloft causes erectile dysfunction in men.

b. Zoloft causes postural hypotension

c. Zoloft increases appetite and weight gain

d. It may take 3-4 weeks before client will start feeling better.

a. Zoloft causes erectile dysfunction in men

: When you take zoloft, mag zozoloft ka nalang sa buhay.

Because it causes erectile dysfuntion and decrease libido. Letter B and C are specific of
TCAs. Zoloft will

exert its effects as early as 1 week.

33. After 3 days of taking haloperidol, the client shows an inability to sit still, is restless and
fidgety, and paces around the unit. Of the following extrapyramidal adverse reactions, the
client is showing signs of:

a. Dystonia.
b. Akathisia.

c. Parkinsonism.

d. Tardive dyskinesia.

b. Akathisia :

The client shows sign of motor restlessness, which is specific for Akathisia or MAKATI
SYA.

34. After 10 days of lithium therapy, the client's lithium level is 1.0 mEq/L. The nurse knows
that this

value indicates which of the following?

a. A laboratory error.

b. An anticipated therapeutic blood level of the drug.

c. An atypical client response to the drug.

d. A toxic level.

b. An anticipated therapeutic blood level of the drug.

35. When caring for a client receiving haloperidol (Haldol), the nurse would assess for which
of the following?

a. Hypertensive episodes.

b. Extrapyramidal symptoms.

c. Hypersalivation.

d. Oversedation.

b. Extrapyramidal symptoms

: Haldol is a neuroleptic, Specific to these neuroleptics are the EPS. The

client will likely be hypotensive than hypertensive because neuroleptics causes postural
hypotension, The client will complaint of dry mouth due to its anticholinergic properties.
Dizziness and drowsiness are side effects of neuroleptics but not oversedation.

36. A client is brought to the hospital’s emergency room by a friend, who states, "I guess he
had some bad junk (heroin) today." In assessing the client, the nurse would likely find which
of the following symptoms?
a. Increased heart rate, dilated pupils, and fever.

b. Tremulousness, impaired coordination, increased blood pressure, and ruddy complexion.

c. Decreased respirations, constricted pupils, and pallor.

d. Eye irritation, tinnitus, and irritation of nasal and oral mucosa.

c. Decreased respirations, constricted pupils, and pallor

. : Heroin is a narcotic. Together with

morphine, meperidine, codeine and opiods, they are DEPRESSANTS and will cause decrease
respiration,

constricted pupils and pallor due to vasoconstriction.

37. The client has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil),
10 mg bid.The physician orders a selective serotonin reuptake inhibitor (SSRI), paroxetine
(Paxil), 20 mg given every morning. The nurse:

a. Gives the medication as ordered.

b. Questions the physician about the order.

c. Questions the dosage ordered.

d. Asks the physician to order benztropine (Cogentin) for the side effects.

b. Questions the physician about the order

: 2 anti depressants cannot be given at the same time

unless the other one is tapered while the other one is given gradually.

38. Which of the following client statements about clozapine (Clozaril) indicates that the
client needs additional teaching?

a. "I need to have my blood checked once every several months while I’m taking this drug."

b. "I need to sit on the side of the bed for a while when I wake up in the morning."

c. "The sleepiness I feel will decrease as my body adjusts to clozapine."

d. "I need to call my doctor whenever I notice that I have a fever or sore throat."

d. "I need to call my doctor whenever I notice that I have a fever or sore throat."
: Clozapine

causes AGRANULOCYTOSIS and bone marrow depression. Early s/s includes fever and
sore throat. The

medication is to be withheld this time or the patient might develop severe infection leading to
death.

39. A client has been taking lithium carbonate (Lithane) for hyperactivity, as prescribed by
his physician.

While the client is taking this drug, the nurse should ensure that he has an adequate intake of:

a. Sodium.

b. Iron.

c. Iodine.

d. Calcium.

a. Sodium

: The levels of lithium in the body are dependent on sodium. The higher the sodium, The
lower

the levels of lithium. Clients should have an adequate intake of sodium to prevent sudden
increase in the

levels of lithium leading to toxicity and death.

40. The client has been taking clomipramine (Anafranil) for his obsessive-compulsive
disorder. He tells the nurse, "I'm not really better, and I've been taking the medication
faithfully for the past 3 days just like it says on this prescription bottle." Which of the
following actions would the nurse do first?

a. Tell the client to continue taking the medication as prescribed because it takes 5 to 10
weeks for a full therapeutic effect.

b. Tell the client to stop taking the medication and to call the physician.

c. Encourage the client to double the dose of his medication.

d. Ask the client if he has resumed smoking cigarettes.

a. Tell the client to continue taking the medication as prescribed because it takes 5 to 10
weeks
for a full therapeutic effect

. : Anafranil is an anti depressant, effects are noticeable within 1 to 2

weeks.

41. The nurse judges correctly that a client is experiencing an adverse effect from
amitriptyline

hydrochloride (Elavil) when the client demonstrates:

a. An elevated blood glucose level.

b. Insomnia.

c. Hypertension.

d. Urinary retention.

d. Urinary retention :

Elavil is an TC antidepressant. It should not cause insomnia. Hypertension are

specific of MAOI anti depressants when tyramine is ingested. Due to the anticholinergic s/e
of TCAs,

Urinary retention is an adverse effect.

42. Which of the following health status assessments must be completed before the client
starts taking

imipramine (Tofranil)?

a. Electrocardiogram (ECG).

b. Urine sample for protein.

c. Thyroid scan.

d. Creatinine clearance test.

a. Electrocardiogram (ECG).

regular ECG schedule. Most TCAs causse tachycardias and ECG changes, an ECG should be
done before

the client takes the medication.

43. A client comes to the outpatient mental health clinic 2 days after being discharged from
the hospital.

The client was given a 1-week supply of clozapine (Clozaril). The nurse reviews information
about

clozapine with the client. Which client statement indicates an accurate understanding of the
nurse's

teaching about this medication?

a."I need to call my doctor in 2 weeks for a checkup."

b."I need to keep my appointment here at the hospital this week for a blood test."

c. "I can drink alcohol with this medication."

d. "I can take over-the-counter sleeping medication if I have trouble sleeping."

b."I need to keep my appointment here at the hospital this week for a blood test."

: Regular blood check up is required for patients taking clozaril. As frequent as every 2
weeks. Clozapine can cause bone marrow depression, therefore, frequent blood counts are
necessary.

44. The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of

schizophrenia. Which of the following negative symptoms will improve?.

a. Abnormal thought form.

b. Hallucinations and delusions.

c. Bizarre behaviour.

d. Asocial behaviour and anergia.

d. Asocial behaviour and anergia

: A,B and C are all positive symptoms of schizophrenia. Negative

symptoms includes anhedonia, anergia, associative looseness and Asocial behavior.

45. The nurse would teach the client taking tranylcypromine sulfate (Parnate) to avoid which
food because of its high tyramine content?

a. Nuts.
b. Aged cheeses.

c. Grain cereals.

d. Reconstituted milk.

b. Aged cheeses.

: This is high in tyramine, and therefore, removed from patients diet to prevent

hypertensive crisis.

46. Which of the following clinical manifestations would alert the nurse to lithium toxicity?

a. Increasingly agitated behaviour.

b. Markedly increased food intake.

c. Sudden increase in blood pressure.

d.Anorexia with nausea and vomiting.

d.Anorexia with nausea and vomiting.

47. The client with depression has been hospitalized for 3 days on the psychiatric unit. This is
the second hospitalization during the past year. The physician orders a different drug,
tranylcypromine sulfate (Parnate), when the client does not respond positively to a tricyclic
antidepressant. Which of the following reactions should the client be cautioned about if her
diet includes foods containing tryaminetyramine?

a. Heart block.

b. Grand mal seizure.

c. Respiratory arrest.

d. Hypertensive crisis.

d. Hypertensive crisis.

48. After the nurse has taught the client who is being discharged on lithium (Eskalith) about
the drug, which of the following client statements would indicate that the teaching has been
successful?

a. "I need to restrict eating any foods that contain salt."

b. "If I forget a dose, I can double the dose the next time I take it."
c. "I'll call my doctor right away for any vomiting, severe hand tremors, or muscle
weakness."

d. "I should increase my fluid”

c."I'll call my doctor right away for any vomiting, severe hand tremors, or muscle
weakness."

:This is a sign of light lithium toxicity. Increasing fluid intake will cause dilutional decrease
of lithium level. Restriction of sodium will cause dilutional increase in lithium level.

49. A nurse is caring for a client with Parkinson's disease who has been taking
carbidopa/levodopa

(Sinemet) for a year. Which of the following adverse reactions will the nurse monitor the
client for?

a. dykinesia

b. glaucoma

c. hypotension

d. respiratory depression

c. hypotension

: Hypotension, dizziness and lethargy are side effects of anti parkinson drugs like

levodopa and carbidopa.

50. A client is taking fluoxetine hydrochloride (Prozac) for treatment of depression. The
client asks thenurse when the maximum therapeutic response occurs. The nurse's best
response is that the maximum therapeutic response for fluoxetine hydrochloride may occur in
the:

a. 10-14 days

b. First week

c. Third week

d. Fourth week

c. Third week

: A and B are similar, therefore , removed them first. Recognizing that most
antidepressants exerts their effects within 2-3 weeks will lead you to letter C.

1. Mental health is defined as:

a. The ability to distinguish what is real from what is not.

b. A state of well-being where a person can realize his own abilities can cope with normal
stresses of life and work productively.

c. Is the promotion of mental health, prevention of mental disorders, nursing care of patients
during illness and rehabilitation

d. Absence of mental illness

Answer: (B) A state of well-being where a person can realize his own abilities can cope
with normal stresses of life and work productively.

2. Which of the following describes the role of a technician?

a. Administers medications to a schizophrenic patient.

b. The nurse feeds and bathes a catatonic client

c. Coordinates diverse aspects of care rendered to the patient

d. Disseminates information about alcohol and its effects.

Answer: (A) Administers medications to a schizophrenic patient.

3. Liza says, “Give me 10 minutes to recall the name of our college professor who failed
many students in our anatomy class.” She is operating on her:

a. Subconscious

b. Conscious

c. Unconscious

d. Ego

Answer: (A) Subconscious

Subconscious refers to the materials that are partly remembered partly forgotten but these can
be 4. The superego is that part of the psyche that:
a. Uses defensive function for protection.

b. Is impulsive and without morals.

c. Determines the circumstances before making decisions.

d. The censoring portion of the mind.

Answer: (D) The censoring portion of the mind.

5. Primary level of prevention is exemplified by:

a. Helping the client resume self care.

b. Ensuring the safety of a suicidal client in the institution.

c. Teaching the client stress management techniques

d. Case finding and surveillance in the community

Answer: (C) Teaching the client stress management techniques

6. Situation: In a home visit done by the nurse, she suspects that the wife and her child are
victims of abuse. Which of the following is the most appropriate for the nurse to ask?

a. “Are you being threatened or hurt by your partner?

b. “Are you frightened of you partner”

c. “Is something bothering you?”

d. “What happens when you and your partner argue?”

Answer: (A) “Are you being threatened or hurt byyour partner?

7. The wife admits that she is a victim of abuse and opens up about her persistent distaste for
sex. This sexual disorder is:

a. Sexual desire disorder

b. Sexual arousal Disorder

c. Orgasm Disorder

d. Sexual Pain Disorder

Answer: (A) Sexual desire disorder

8. What would be the best approach for a wife who is still living with her abusive husband?

a. “Here’s the number of a crisis center that you can call for help .”

b. “Its best to leave your husband.”

c. “Did you discuss this with your family?”

d. “ Why do you allow yourself to be treated this way”

Answer: (A) “Here’s the number of a crisis center that you can call for help .”

9. Which comment about a 3 year old child if made by the parent may indicate child abuse?

a. “Once my child is toilet trained, I can still expect her to have some"

b. “When I tell my child to do something once, I don’t expect to have to tell"

c. “My child is

expected to try to do things such as, dress and feed.”

d. “My 3 year old loves to say NO.”

Answer: (B) “When I tell my child to do something once, I don’t expect to have to tell"

10. The primary nursing intervention for a victim of child abuse is:

a. Assess the scope of the problem

b. Analyze the family dynamics

c. Ensure the safety of the victim

d. Teach the victim coping skills

Answer: (C) Ensure the safety of the victim

11. Situation: A 30 year old male employee frequently complains of low back pain that leads
to frequent absences from work. Consultation and tests reveal negative results. The client has
which somatoform disorder?

a. Somatization Disorder

b. Hypochondriaisis

c. Conversion Disorder

d. Somatoform Pain Disorder

Answer: (D) Somatoform Pain Disorder

12. Freud explains anxiety as:

a. Strives to gratify the needs for satisfaction and security

b. Conflict between id and superego

c. A hypothalamic-pituitary-adrenal reaction to stress

d. A conditioned response to stressors

Answer: (B) Conflict between id and superego

13. The following are appropriate nursing diagnosis for the client EXCEPT:

a. Ineffective individual coping

b. Alteration in comfort, pain

c. Altered role performance

d. Impaired social interaction

Answer: (D) Impaired social interaction

14. The following statements describe somatoform disorders:

a. Physical symptoms are explained by organic causes

b. It is a voluntary expression of psychological conflicts

c. Expression of conflicts through bodily symptoms

d. Management entails a specific medical treatment

Answer: (C) Expression of conflicts through bodily symptoms

15. What would be the best response to the client’s repeated compla ints of pain:

a. “I know the feeling is real tests revealed negative results.”

b. “I think you’re exaggerating things a little bit.”

c. “Try to forget this feeling and have activities to take it off your mind”

d. “So tell me more about the pain”

Answer: (A) “I know the feeling is real tests revealed negative results.”

16. Situation: A nurse may encounter children with mental disorders. Her knowledge of these
various disorders is vital. When planning school interventions for a child with a diagnosis of
attention deficit hyperactivity disorder, a guide to remember is to:

a. provide as much structure as possible for the child

b. ignore the child’s overactivity.

c. encourage the child to engage in any play activity to dissipate energy

d. remove the child from the classroom when disruptive behavior occurs
Answer: (A) provide as much structure as possible for the child

17. The child with conduct disorder will likely demonstrate:

a. Easy distractibility to external stimuli.

b. Ritualistic behaviors

c. Preference for inanimate objects.

d. Serious violations of age related norms.

Answer: (D) Serious violations of age related norms.

18. Ritalin is the drug of choice for chidren with ADHD. The side effects of the following
may be noted:

a. increased attention span and concentration

b. increase in appetite

c. sleepiness and lethargy

d. bradycardia and diarrhea

Answer: (A) Increased attention span and concentration

19. School phobia is usually treated by:

a. Returning the child to the school immediately with family support.

b. Calmly explaining why attendance in school is necessary

c. Allowing the child to enter the school before the other children

d. Allowing the parent to accompany the child in the classroom

Answer: (A) Returning the child to the school immediately with family support.

20. A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of
45. She is diagnosed to have Mental retardation of this classification:

a. Profound

b. Mild

c. Moderate
d. Severe

Answer: (C) Moderate

The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation
has an I.Q. of below 20; Mild mental retardation 50-70 and

Severe mental retardation has an I.Q. of 20-35.

21. The nurse teaches the parents of a mentally retarded child regarding her care. The
following guidelines may be taught except:

a. overprotection of the child

b. patience, routine and repetition

c. assisting the parents set realistic goals

d. giving reasonable compliments

Answer: (A) overprotection of the child

22. The parents express apprehensions on their ability to care for their maladaptive child. The
nurse identifies what nursing diagnosis:

a. hopelessness

b. altered parenting role

c. altered family process

d. ineffective coping

Answer: (B) altered parenting role

23. A 5 year old boy is diagnosed to have autistic disorder. Which of the following
manifestations may be noted in a client with autistic disorder?

a. argumentativeness, disobedience, angry outburst

b. intolerance to change, disturbed relatedness, stereotypes

c. distractibility, impulsiveness and overactivity

d. aggression, truancy, stealing, lying

Answer: (B) intolerance to change, disturbed relatedness, stereotypes

These are manifestations of autistic disorder. A. These manifestations are noted in

Oppositional Defiant Disorder, a disruptive disorder among children. C.

These are manifestations of Attention Deficit Disorder D. These are the manifestations of
Conduct Disorder

24. The therapeutic approach in the care of an autistic child include the following EXCEPT:

a. Engage in diversionary activities when acting -out

b. Provide an atmosphere of acceptance

c. Provide safety measures

d. Rearrange the environment to activate the child

Answer: (D) Rearrange the environment to activate the child

25. According to Piaget a 5 year old is in what stage of development:

a. Sensory motor stage

b. Concrete operations

c. Pre-operational

d. Formal operation

Answer: (C) Pre-operational

Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should

expect to observe:

a. Hyperactivity
b. Depression

c. Suspicion

d. Delirium

2. Nurse John is aware that a serious effect of inhaling cocaine is?

a. Deterioration of nasal septum

b. Acute fluid and electrolyte imbalances

c. Extra pyramidal tract symptoms

d. Esophageal varices

3. A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently

hospitalized client for signs of opiate withdrawal. These signs would include:

a. Rhinorrhea, convulsions, subnormal temperature

b. Nausea, dilated pupils, constipation

c. Lacrimation, vomiting, drowsiness

d. Muscle aches, papillary constriction, yawning

4. A 48 year old male client is brought to the psychiatric emergency room after

attempting to jump off a bridge. The client’s wife states that he lost his job several

months ago and has been unable to find another job. The primary nursing

intervention at this time would be to assess for:

a. A past history of depression

b. Current plans to commit suicide

c. The presence of marital difficulties

d. Feelings of excessive failure

5. Before helping a male client who has been sexually assaulted, nurse Maureen

should recognize that the rapist is motivated by feelings of:

a. Hostility

b. Inadequacy

c. Incompetence

d. Passion

6. When working with children who have been sexually abused by a family member it

is important for the nurse to understand that these victims usually are

overwhelmed with feelings of:

a. Humiliation

b. Confusion

c. Self blame

d. Hatred

7. Joy who has just experienced her second spontaneous abortion expresses anger

towards her physician, the hospital and the “rotten nursing care”. When assessing

the situation, the nurse recognizes that the client may be using the coping
mechanism of:

a. Projection

b. Displacement

c. Denial

d. Reaction formation

8. The most critical factor for nurse Linda to determine during crisis intervention

would be the client’s:

a. Available situational supports

b. Willingness to restructure the personality

c. Developmental theory

d. Underlying unconscious conflict

9. Nurse Trish suggests a crisis intervention group to a client experiencing a

developmental crisis.These groups are successful because the:

a. Crisis intervention worker is a psychologist and understands behavior patterns

b. Crisis group supplies a workable solution to the client’s problem

c. Client is encouraged to talk about personal problems

d. Client is assisted to investigate alternative approaches to solving the identified

problem

10. Nurse Ronald could evaluate that the staff’s approach to setting limits for a

demanding, angry client was effective if the client:

a. Apologizes for disrupting the unit’s routine when something is needed

b. Understands the reason why frequent calls to the staff were made

c. Discuss concerns regarding the emotional condition that required hospitalizations

d. No longer calls the nursing staff for assistance

11. Nurse John is aware that the therapy that has the highest success rate

for people with phobias would be:

a. Psychotherapy aimed at rearranging maladaptive thought process

b. Psychoanalytical exploration of repressed conflicts of an earlier development phase

c. Systematic desensitization using relaxation technique

d. Insight therapy to determine the origin of the anxiety and fear

12. When nurse Hazel considers a client’s placement on the continuum of anxiety, a

key in determining the degree of anxiety being experienced is the client’s:

a. Perceptual field

b. Delusional system

c. Memory state

d. Creativity level

13. In the diagnosis of a possible pervasive developmental autistic disorder. The

nurse would find it most unusual for a 3 year old child to demonstrate:

a. An interest in music

b. An attachment to odd objects

c. Ritualistic behavior

d. Responsiveness to the parents

14. Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from

worms chewing on them.” This statement indicates a:

a. Jealous delusion

b. Somatic delusion

c. Delusion of grandeur
d. Delusion of persecution

15. Andy is admitted to the psychiatric unit with a diagnosis of borderline personality

disorder. Nurse Hilary should expects the assessment to reveal:

a. Coldness, detachment and lack of tender feelings

b. Somatic symptoms

c. Inability to function as responsible parent

d. Unpredictable behavior and intense interpersonal relationships

16. PROPRANOLOL (Inderal) is used in the mental health setting to manage which of

the following conditions?

a. Antipsychotic – induced akathisia and anxiety

b. Obsessive – compulsive disorder (OCD) to reduce ritualistic behavior

c. Delusions for clients suffering from schizophrenia

d. The manic phase of bipolar illness as a mood stabilizer

17. Which medication can control the extra pyramidal effects associated with

antipsychotic agents?

a. Clorazepate (Tranxene)

b. Amantadine (Symmetrel)

c. Doxepin (Sinequan)

d. Perphenazine (Trilafon)

18. Which of the following statements should be included when teaching clients about

monoamine oxidase inhibitor (MAOI) antidepressants?

a. Don’t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

b. Have blood levels screened weekly for leucopenia

c. Avoid strenuous activity because of the cardiac effects of the drug

d. Don’t take prescribed or over the counter medications without consulting the

physician

19. Kris periodically has acute panic attacks. These attacks are unpredictable and

have no apparent association with a specific object or situation. During an acute

panic attack, Kris may experience:

a. Heightened concentration

b. Decreased perceptual field

c. Decreased cardiac rate

d. Decreased respiratory rate

20. Initial interventions for Marco with acute anxiety include all except which of the

following?

a. Touching the client in an attempt to comfort him

b. Approaching the client in calm, confident manner

c. Encouraging the client to verbalize feelings and concerns

d. Providing the client with a safe, quiet and private place

21. Nurse Jessie is assessing a client suffering from stress and anxiety. A common

physiological response to stress and anxiety is:

a. Uticaria

b. Vertigo

c. Sedation

d. Diarrhea

22. When performing a physical examination on a female anxious client, nurse Nelli
would expect to find which of the following effects produced by the

parasympathetic system?

a. Muscle tension

b. Hyperactive bowel sounds

c. Decreased urine output

d. Constipation

23. Which of the following drugs have been known to be effective in treating

obsessive-compulsive disorder (OCD)?

a. Divalproex (depakote) and Lithium (lithobid)

b. Chlordiazepoxide (Librium) and diazepam (valium)

c. Fluvoxamine (Luvox) and clomipramine (anafranil)

d. Benztropine (Cogentin) and diphenhydramine (benadryl)

24. Tony with agoraphobia has been symptom-free for 4 months. Classic signs and

symptoms of phobia include:

a. Severe anxiety and fear

b. Withdrawal and failure to distinguish reality from fantasy

c. Depression and weight loss

d. Insomnia and inability to concentrate

25. Which nursing action is most appropriate when trying to diffuse a client’s

impending violent behavior?

a. Place the client in seclusion

b. Leaving the client alone until he can talk about his feelings

c. Involving the client in a quiet activity to divert attention

d. Helping the client identify and express feelings of anxiety and anger

26. Rosana is in the second stage of Alzheimer’s disease who appears to be in

pain. Which question by Nurse Jenny would best elicit information about the pain?

a. “Where is your pain located?”

b. “Do you hurt? (pause) “Do you hurt?”

c. “Can you describe your pain?”

d. “Where do you hurt?”

27. Nursing preparation for a client undergoing electroconvulsive therapy (ECT)

resemble those used for:

a. General anesthesia

b. Cardiac stress testing

c. Neurologic examination

d. Physical therapy

28. Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid

tyramine, a compound found in which of the following foods?

a. Figs and cream cheese

b. Fruits and yellow vegetables

c. Aged cheese and Chianti wine

d. Green leafy vegetables

29. Erlinda, age 85, with major depression undergoes a sixth electroconvulsive

therapy (ECT) treatment. When assessing the client immediately after ECT, the

nurse expects to find:

a. Permanent short-term memory loss and hypertension

b. Permanent long-term memory loss and hypomania

c. Transitory short-term memory loss and permanent long-term memory loss

d. Transitory short and long term memory loss and confusion

30. Barbara with bipolar disorder is being treated with lithium for the first time. Nurse

Clint should observe the client for which common adverse effect of lithium?

a. Polyuria

b. Seizures

c. Constipation

d. Sexual dysfunction

31. Nurse Fred is assessing a client who has just been admitted to the ER

department. Which signs would suggest an overdose of an antianxiety agent?

a. Suspiciousness, dilated pupils and incomplete BP

b. Agitation, hyperactivity and grandiose ideation

c. Combativeness, sweating and confusion

d. Emotional lability, euphoria and impaired memory

32. Discharge instructions for a male client receiving tricyclic antidepressants include

which of the following information?

a. Restrict fluids and sodium intake

b. Don’t consume alcohol

c. Discontinue if dry mouth and blurred vision occur

d. Restrict fluid and sodium intake

33. Important teaching for women in their childbearing years who are receiving

antipsychotic medications includes which of the following?

a. Increased incidence of dysmenorrhea while taking the drug

b. Occurrence of incomplete libido due to medication adverse effects

c. Continuing previous use of contraception during periods of amenorrhea

d. Instruction that amenorrhea is irreversible

34. A client refuses to remain on psychotropic medications after discharge from an

inpatient psychiatric unit. Which information should the community health nurse

assess first during the initial follow-up with this client?

a. Income level and living arrangements

b. Involvement of family and support systems

c. Reason for inpatient admission

d. Reason for refusal to take medications

35. The nurse understands that the therapeutic effects of typical antipsychotic

medications are associated with which neurotransmitter change?

a. Decreased dopamine level

b. Increased acetylcholine level

c. Stabilization of serotonin

d. Stimulation of GABA

36. Which of the following best explains why tricyclic antidepressants are used with

caution in elderly patients?

a. Central Nervous System effects

b. Cardiovascular system effects

c. Gastrointestinal system effects

d. Serotonin syndrome effects

37. A client with depressive symptoms is given prescribed medications and talks with
his therapist about his belief that he is worthless and unable to cope with life.

Psychiatric care in this treatment plan is based on which framework?

a. Behavioral framework

b. Cognitive framework

c. Interpersonal framework

d. Psychodynamic framework

38. A nurse who explains that a client’s psychotic behavior is unconsciously motivated

understands that the client’s disordered behavior arises from which of the

following?

a. Abnormal thinking

b. Altered neurotransmitters

c. Internal needs

d. Response to stimuli

39. A client with depression has been hospitalized for treatment after taking a leave

of absence from work. The client’s employer expects the client to return to work

following inpatient treatment. The client tells the nurse, “I’m no good. I’m a

failure”. According to cognitive theory, these statements reflect:

a. Learned behavior

b. Punitive superego and decreased self-esteem

c. Faulty thought processes that govern behavior

d. Evidence of difficult relationships in the work environment

40. The nurse describes a client as anxious. Which of the following statement about

anxiety is true?

a. Anxiety is usually pathological

b. Anxiety is directly observable

c. Anxiety is usually harmful

d. Anxiety is a response to a threat

41. A client with a phobic disorder is treated by systematic desensitization. The nurse

understands that this approach will do which of the following?

a. Help the client execute actions that are feared

b. Help the client develop insight into irrational fears

c. Help the client substitutes one fear for another

d. Help the client decrease anxiety

42. Which client outcome would best indicate successful treatment for a client with an

antisocial personality disorder?

a. The client exhibits charming behavior when around authority figures

b. The client has decreased episodes of impulsive behaviors

c. The client makes statements of self-satisfaction

d. The client’s statements indicate no remorse for behaviors

43. The nurse is caring for a client with an autoimmune disorder at a medical clinic,

where alternative medicine is used as an adjunct to traditional therapies. Which

information should the nurse teach the client to help foster a sense of control over

his symptoms?

a. Pathophysiology of disease process

b. Principles of good nutrition

c. Side effects of medications

d. Stress management techniques

44. Which of the following is the most distinguishing feature of a client with an

antisocial personality disorder?

a. Attention to detail and order

b. Bizarre mannerisms and thoughts

c. Submissive and dependent behavior

d. Disregard for social and legal norms

45. Which nursing diagnosis is most appropriate for a client with anorexia nervosa

who expresses feelings of guilt about not meeting family expectations?

a. Anxiety

b. Disturbed body image

c. Defensive coping

d. Powerlessness

46. A nurse is evaluating therapy with the family of a client with anorexia nervosa.

Which of the following would indicate that the therapy was successful?

a. The parents reinforced increased decision making by the client

b. The parents clearly verbalize their expectations for the client

c. The client verbalizes that family meals are now enjoyable

d. The client tells her parents about feelings of low-self esteem

47. A client with dysthymic disorder reports to a nurse that his life is hopeless and

will never improve in the future. How can the nurse best respond using a cognitive

approach?

a. Agree with the client’s painful feelings

b. Challenge the accuracy of the client’s belief

c. Deny that the situation is hopeless

d. Present a cheerful attitude

48. A client with major depression has not verbalized problem areas to staff or peers

since admission to a psychiatric unit. Which activity should the nurse recommend

to help this client express himself?

a. Art therapy in a small group

b. Basketball game with peers on the unit

c. Reading a self-help book on depression

d. Watching movie with the peer group

49. The home health psychiatric nurse visits a client with chronic schizophrenia who

was recently discharged after a prolong stay in a state hospital. The client lives in

a boarding home, reports no family involvement, and has little social interaction.

The nurse plan to refer the client to a day treatment program in order to help him

with:

a. Managing his hallucinations

b. Medication teaching

c. Social skills training

d. Vocational training

50. Which activity would be most appropriate for a severely withdrawn client?

a. Art activity with a staff member

b. Board game with a small group of clients

c. Team sport in the gym

d. Watching TV in the dayroom

Marco approached Nurse Trish asking for advice on how to deal with his
alcohol addiction. Nurse Trish should tell the client that the only

effective treatment for alcoholism is:

a.

Psychotherapy

b.

Alcoholics anonymous (A.A.)

c.

Total abstinence

d.

Aversion Therapy

Nurse Hazel is caring for a male client who experience false sensory

perceptions with no basis in reality. This perception is known as:

a.

Hallucinations

b.

Delusions

c.
Loose associations

d.

Neologisms

Nurse Monet is caring for a female client who has suicidal tendency. When

accompanying the client to the restroom, Nurse Monet should…

a.

Give her privacy

b.

Allow her to urinate

c.

Open the window and allow her to get some fresh air

d.

Observe her

Nurse Maureen is developing a plan of care for a female client with anorexia

nervosa. Which action should the nurse include in the plan?

a.

Provide privacy during meals

b.
Set-up a strict eating plan for the client

c.

Encourage client to exercise to reduce anxiety

d.

Restrict visits with the family

A client is experiencing anxiety attack. The most appropriate nursing

intervention should include?

a.

Turning on the television

b.
Leaving the client alone

c.

Staying with the client and speaking in short sentences

d.

Ask the client to play with other clients

A female client is admitted with a diagnosis of delusions of GRANDEUR. This

diagnosis reflects a belief that one is:

a.

Being Killed

b.

Highly famous and important

c.

Responsible for evil world

d.

Connected to client unrelated to oneself

A 20 year old client was diagnosed with dependent personality disorder.

Which behavior is not most likely to be evidence of

ineffective individual coping?

a.

Recurrent self-destructive behavior

b.

Avoiding relationship

c.

Showing interest in solitary activities

d.

Inability to make choices and decision without advise

A male client is diagnosed with schizotypal personality disorder. Which signs

would this client exhibit during social situation?

a.

Paranoid thoughts

b.

Emotional affect

c.

Independence need
d.

Aggressive behavior

Nurse Claire is caring for a client diagnosed with bulimia. The most

appropriate initial goal for a client diagnosed with bulimia is?

a.

Encourage to avoid foods

b.

Identify anxiety causing situations

c.

Eat only three meals a day

d.

Avoid shopping plenty of groceries

Nurse Tony was caring for a 41 year old female client. Which behavior by the

client indicates adult cognitive development?

a.

Generates new levels of awareness

b.

Assumes responsibility for her actions

c.

Has maximum ability to solve problems and learn new skills

d.

Her perception are based on reality

A neuromuscular blocking agent is administered to a client before ECT

therapy. The Nurse should carefully observe the client for?

a.

Respiratory difficulties

b.

Nausea and vomiting

c.

Dizziness

d.

Seizures

A 75 year old client is admitted to the hospital with the diagnosis of dementia
of the Alzheimer’s type and depression. The symptom that is unrelated to

depression would be?

a.

Apathetic response to the environment

b.

“I don’t know” answer to questions

c.

Shallow of labile effect

d.

Neglect of personal hygiene

Nurse Trish is working in a mental health facility; the nurse priority nursing

intervention for a newly admitted client with bulimia nervosa would be to?

a.

Teach client to measure I & O

b.

Involve client in planning daily meal

c.
Observe client during meals

d.

Monitor client continuously

Nurse Patricia is aware that the major health complication associated with

intractable anorexia nervosa would be?

a.

Cardiac dysrhythmias resulting to cardiac arrest

b.

Glucose intolerance resulting in protracted hypoglycemia

c.

Endocrine imbalance causing cold amenorrhea

d.

Decreased metabolism causing cold intolerance

Nurse Anna can minimize agitation in a disturbed client by?

a.

Increasing stimulation

b.
limiting unnecessary interaction

c.

increasing appropriate sensory perception

d.

ensuring constant client and staff contact

A 39 year old mother with obsessive-compulsive disorder has become

immobilized by her elaborate hand washing and walking rituals. Nurse Trish

recognizes that the basis of O.C. disorder is often:

a.

Problems with being too conscientious

b.

Problems with anger and remorse

c.

Feelings of guilt and inadequacy

d.

Feeling of unworthiness and hopelessness

Mario is complaining to other clients about not being allowed by staff to keep
food in his room. Which of the following interventions would be most

appropriate?

a.

Allowing a snack to be kept in his room

b.

Reprimanding the client

c.

Ignoring the clients behavior

d.

Setting limits on the behavior

Conney with borderline personality disorder who is to be discharge soon

threatens to “do something” to herself if discharged. Which of the following

actions by the nurse would be most important?

a.

Ask a family member to stay with the client at home

temporarily

b.

Discuss the meaning of the client’s statement with her

c.

Request an immediate extension for the client

d.

Ignore the clients statement because it’s a sign of manipulation

Joey a client with antisocial personality disorder belches loudly. A staff

member asks Joey, “Do you know why people find you repulsive?” this

statement most likely would elicit which of the following client reaction?

a.

Defensiveness

b.

Embarrassment

c.

Shame

d.

Remorsefulness

Which of the following approaches would be most appropriate to use with a

client suffering from narcissistic personality disorder when discrepancies exist

between what the client states and what actually exist?

a.

Rationalization

b.

Supportive confrontation

c.

Limit setting

d.

Consistency

Cely is experiencing alcohol withdrawal exhibits tremors, diaphoresis and

hyperactivity. Blood pressure is 190/87 mmhg and pulse is 92 bpm. Which of

the medications would the nurse expect to administer?

a.

Naloxone (Narcan)

b.

Benzlropine (Cogentin)

c.
Lorazepam (Ativan)

d.

Haloperidol (Haldol)

Which of the following foods would the nurse Trish eliminate from the diet of a

client in alcohol withdrawal?

a.

Milk

b.

Orange Juice

c.

Soda

d.

Regular Coffee

Which of the following would Nurse Hazel expect to assess for a client who is

exhibiting late signs of heroin withdrawal?

a.

Yawning & diaphoresis

b.
Restlessness & Irritability

c.

Constipation & steatorrhea

d.

Vomiting and Diarrhea

To establish open and trusting relationship with a female client who has been

hospitalized with severe anxiety, the nurse in charge should?

a.

Encourage the staff to have frequent interaction with the client

b.

Share an activity with the client

c.

Give client feedback about behavior

d.

Respect client’s need for personal space

Nurse Monette recognizes that the focus of environmental (MILIEU) therapy is

to:
a.

Manipulate the environment to bring about positive changes in

behavior

b.

Allow the client’s freedom to determine whether or not they will

be involved in activities

c.

Role play life events to meet individual needs

d.

Use natural remedies rather than drugs to control behavior

Nurse Trish would expect a child with a diagnosis of reactive attachment

disorder to:

a.

Have more positive relation with the father than the mother

b.

Cling to mother & cry on separation

c.
Be able to develop only superficial relation with the others

d.

Have been physically abuse

When teaching parents about childhood depression Nurse Trina should say?

a.

It may appear acting out behavior

b.

Does not respond to conventional treatment

c.

Is short in duration & resolves easily

d.

Looks almost identical to adult depression

Nurse Perry is aware that language development in autistic child resembles:

a.

Scanning speech

b.
Speech lag

c.

Shuttering

d.

Echolalia

A 60 year old female client who lives alone tells the nurse at the community

health center “I really don’t need anyone to talk to”. The TV is my best friend.

The nurse recognizes that the client is using the defense mechanism known

as?

a.

Displacement

b.

Projection

c.

Sublimation

d.

Denial

When working with a male client suffering phobia about black cats, Nurse
Trish should anticipate that a problem for this client would be?

a.

Anxiety when discussing phobia

b.

Anger toward the feared object

c.

Denying that the phobia exist

d.

Distortion of reality when completing daily routines

Linda is pacing the floor and appears extremely anxious. The duty nurse

approaches in an attempt to alleviate Linda’s anxiety. The most therapeutic

question by the nurse would be?

a.

Would you like to watch TV?

b.

Would you like me to talk with you?

c.
Are you feeling upset now?

d.

Ignore the client

Nurse Penny is aware that the symptoms that distinguish post traumatic

stress disorder from other anxiety disorder would be:

a.

Avoidance of situation & certain activities that resemble the

stress

b.

Depression and a blunted affect when discussing the traumatic

situation

c.

Lack of interest in family & others

d.

Re-experiencing the trauma in dreams or flashback

Nurse Benjie is communicating with a male client with substance-induced

persisting dementia; the client cannot remember facts and fills in the gaps

with imaginary information. Nurse Benjie is aware that this is typical of?
a.

Flight of ideas

b.

Associative looseness

c.

Confabulation

d.

Concretism

Nurse Joey is aware that the signs & symptoms that would be most specific

for diagnosis anorexia are?

a.

Excessive weight loss, amenorrhea & abdominal distension

b.

Slow pulse, 10% weight loss & alopecia

c.

Compulsive behavior, excessive fears & nausea

d.
Excessive activity, memory lapses & an increased pulse

A characteristic that would suggest to Nurse Anne that an adolescent may

have bulimia would be:

a.

Frequent regurgitation & re-swallowing of food

b.

Previous history of gastritis

c.

Badly stained teeth

d.

Positive body image

Nurse Monette is aware that extremely depressed clients seem to do best in

settings where they have:

a.

Multiple stimuli

b.
Routine Activities

c.

Minimal decision making

d.

Varied Activities

To further assess a client’s suicidal potential. Nurse Katrina should be

especially alert to the client expression of:

a.

Frustration & fear of death

b.

Anger & resentment

c.

Anxiety & loneliness

d.

Helplessness & hopelessness

A nursing care plan for a male client with bipolar I disorder should include:

a.
Providing a structured environment

b.

Designing activities that will require the client to maintain

contact with reality

c.

Engaging the client in conversing about current affairs

d.

Touching the client provide assurance

When planning care for a female client using ritualistic behavior, Nurse Gina

must recognize that the ritual:

a.

Helps the client focus on the inability to deal with reality

b.

Helps the client control the anxiety

c.

Is under the client’s conscious control

d.
Is used by the client primarily for secondary gains

A 32 year old male graduate student, who has become increasingly withdrawn

and neglectful of his work and personal hygiene, is brought to the psychiatric

hospital by his parents. After detailed assessment, a diagnosis of

schizophrenia is made. It is unlikely that the client will demonstrate:

a.

Low self esteem

b.

Concrete thinking

c.

Effective self boundaries

d.

Weak ego

A 23 year old client has been admitted with a diagnosis of schizophrenia says

to the nurse “Yes, its march, March is little woman”. That’s literal you know”.

These statement illustrate:

a.

Neologisms
b.

Echolalia

c.

Flight of ideas

d.

Loosening of association

A long term goal for a paranoid male client who has unjustifiably accused his

wife of having many extramarital affairs would be to help the client develop:

a.

Insight into his behavior

b.

Better self control

c.

Feeling of self worth

d.

Faith in his wife

A male client who is experiencing disordered thinking about food being

poisoned is admitted to the mental health unit. The nurse uses which

communication technique to encourage the client to eat dinner?

a.

Focusing on self-disclosure of own food preference

b.

Using open ended question and silence

c.

Offering opinion about the need to eat

d.

Verbalizing reasons that the client may not choose to eat

Nurse Nina is assigned to care for a client diagnosed with Catatonic Stupor.

When Nurse Nina enters the client’s room, the client is found lying on the bed

with a body pulled into a fetal position. Nurse Nina should?

a.

Ask the client direct questions to encourage talking

b.

Rake the client into the dayroom to be with other clients

c.
Sit beside the client in silence and occasionally ask open-ended

question

d.

Leave the client alone and continue with providing care to the

other clients

Nurse Tina is caring for a client with delirium and states that “look at the

spiders on the wall”. What should the nurse respond to the client?

a.

“You’re having hallucination, there are no spiders in this room

at all”

b.

“I can see the spiders on the wall, but they are not going to

hurt you”

c.

“Would you like me to kill the spiders”

d.

“I know you are frightened, but I do not see spiders on the

wall”

Nurse Jonel is providing information to a community group about violence in

the family. Which statement by a group member would indicate a need to

provide additional information?

a.

“Abuse occurs more in low-income families”

b.

“Abuser Are often jealous or self-centered”

c.

“Abuser use fear and intimidation”

d.

“Abuser usually have poor self-esteem”

During electroconvulsive therapy (ECT) the client receives oxygen by mask via

positive pressure ventilation. The nurse assisting with this procedure knows

that positive pressure ventilation is necessary because?

a.

Anesthesia is administered during the procedure

b.
Decrease oxygen to the brain increases confusion and

disorientation

c.

Grand mal seizure activity depresses respirations

d.

Muscle relaxations given to prevent injury during seizure

activity depress respirations.

When planning the discharge of a client with chronic anxiety, Nurse Chris

evaluates achievement of the discharge maintenance goals. Which goal would

be most appropriately having been included in the plan of care requiring

evaluation?

a.

The client eliminates all anxiety from daily situations

b.

The client ignores feelings of anxiety

c.

The client identifies anxiety producing situations

d.
The client maintains contact with a crisis counselor

Nurse Tina is caring for a client with depression who has not responded to

antidepressant medication. The nurse anticipates that what treatment

procedure may be prescribed?

a.

Neuroleptic medication

b.

Short term seclusion

c.

Psychosurgery

d.

Electroconvulsive therapy

Mario is admitted to the emergency room with drug-included anxiety related

to over ingestion of prescribed antipsychotic medication. The most important

piece of information the nurse in charge should obtain initially is the:

a.

Length of time on the med.

b.
Name of the ingested medication & the amount ingested

c.

Reason for the suicide attempt

d.

Name of the nearest relative & their phone number