Situation 1: Zed, 22 year old, was admitted to the psychiatric nursing unit for treatment of psychotic behavior. 1.

When collecting data from the client, the nurse notes that the client is admitted by involuntary status. Based on this type of admission, the nurse most likely expects that the client: a. Presents harm to self b. Requested the admission c. Consented to the admission d. Provided written application to the facility for admission 2. Zed is at the locked exit door, and is shouting, Let me out. There's nothing wrong with me. I don't belong here. The nurse identifies this behavior as: a. Projection c. Regression b. Denial d. Rationalization 3. Zed states to the nurse, I haven't slept at all the last couple of nights. The most therapeutic response of the nurse is: a. Go on..... b. Sleeping? c. The last couple of nights? d. You're having difficulty sleeping?

4. Laboratory work is prescribed on Zed who has been experiencing delusions. When the laboratory technician approaches the client to obtain a specimen of the client's blood, he begins to shout You're all vampires. Let me out of here! The nurse who is present at the time would respond most appropriately by stating which of the following? a. The technician is not going to hurt you, but is going to help you! b. What makes you think that the technician is a vampire? c. The technician will leave and come back later for your blood. d. It must be fearful to think others want to hurt you. 5. Nurse Roya assist in planning care for the client who is scheduled to be discharged from the psychiatric nursing unit. The nurse knows that unresolved feelings related to loss may resurface during which phase of the therapeutic nurse-client relationship? a. Orientation phase c. Working phase b. Termination phase d. Trusting phase

Situation 2. Therapies are used to modify feelings, attitudes and behaviors of clients 6. A nurse is caring for a client who is scheduled for electroconvulsive therapy (ECT). The nurse notes that an informed consent has not been obtained for the procedure. On review of the record, the nurse notes that the admission was an involuntary hospitalization. Based on this information, the nurse determines that: a. An informed consent does not need to be obtained b. An informed consent should be obtained from the family

c. An informed consent needs to be obtained from the client d. The physician will obtain the informed consent

7. After a group therapy session, a client approaches the licensed practical nurse (LPN) and verbalizes a need for seclusion because of uncontrollable feelings. The LPN reports the findings to the registered nurse (RN) and expects that the RN will take which of the following actions? a. Inform the client that seclusion has not been prescribed b. Obtain an informed consent c. Call the client's family d. Place the client in seclusion immediately

8. Milieu therapy is prescribed for a client. The nurse understands that this type of therapy can best be described as which of the following? a. A form of behavior modification therapy b. A cognitive approach to changing behavior c. The client is involved in setting goals d. A behavioral approach to changing behavior 9. Disulfiram (Antabuse) is prescribed for a client with a problem related to alcohol. The nurse understands that this medication works on the principle of which of the following therapies? a. Desensitization b. Milieu therapy c. Self-control therapy d. Aversion therapy 10. A nurse is assisting in monitoring a group therapy session. During this session, the members are identifying tasks and boundaries. The nurse understands that these activities are characteristic of which stage of group development? a. Forming c. Storming b. Norming d. Performing

Situation 3. Successful therapeutic communication includes appropriateness, efficiency, flexibility and feedback. 11. A client with depression who attempted suicide says to the nurse, I should have died. I've always been a failure. Nothing ever goes right to me. The most therapeutic response of the nurse is: a. I don't see you as a failure. b. Feeling like this is all part of being ill. c. You've been feeling like a failure for a while? d. You have everything to live for.

12. While the male nurse is gathering psychosocial data from a female client, the client states, I don't want to discuss this it's private and personal. Which statement by the male nurse indicates a therapeutic response? a. This often happens to me. Perhaps you would find it easier to speak to a nurse who is female. b. I am a nurse and as such I'll have you know that all information is kept confidential. c. I know that some of these questions are difficult for you, but as a nurse, I must legally respect your confidentiality. d. This is difficult for you to speak about, but I am trying to perform a complete data collection and I am no different from a female nurse, if that's your problem. 13. A nurse is caring for a Native-American client who says, I don't want you to touch me. I'll take care of myself! The most therapeutic response of the nurse is: a. I will respect your feelings. I'll just leave this cup for you to collect your urine in. After breakfast, I will take more blood from you. b. If you didn't want our care, why did you come here? c. Why are you being so difficult? I only want to help you. d. Sounds like you're feeling pretty troubled by all of us. Let's work together so you can do everything for yourself as you request. 14. A client says to the nurse, I'm going to die, and I wish my family would stop hoping for a 'cure'! I get so angry when they carry on like this! After all, I'm the one who's dying. The most therapeutic response by the nurse is: a. You're feeling angry that your family continues to hope for you to be 'cured'? b. I think we should talk more about your anger with your family. c. Well, it sounds like you're being pretty pessimistic. After all, years ago people died of pneumonia. d. Have you shared your feelings with your family?

15. A nurse is providing care to a client admitted to the hospital with a diagnosis of anxiety disorder. The nurse is talking with the client. The client says to the nurse, I have a secret that I want to tell you. You won't tell anyone about it, will you? The most appropriate nursing response is which of the following? a. No, I won't tell anyone. b. I cannot promise to keep a secret. c. If you tell me the secret, I will tell it to your doctor. d. If you tell me the secret, I will need to document it in your record.

Situation 4. Rebecca, a 23 year old college student, is accompanied by her mother to the psychiatric nursing unit. Her mother states that she has been acting strangely lately.

16. Nurse Joy collects data on the client with an admitting diagnosis of bipolar affective disorder- mania. The symptom presentation that requires the nurse's immediate intervention is: a. The client's outlandish behaviors and inappropriate dress b. The client's grandiose delusions of being a royal descendant of Lakandula c. The client's nonstop physical activity and poor nutritional intake. d. The client's constant, incessant talking that includes sexual innuendos and teasing the staff 17. Rebecca is in a manic state as she emerges from her room. She is topless and is making sexual remarks and gestures toward staff and peers. The best initial nursing action is to: a. Quietly approach the client, escort her to her room, and assist her in getting dressed b. Approach the client in the hallway and insist that she go to her room. c. Confront the client on the inappropriateness of her behaviors and offer her a time-out d. Ask the other clients to ignore her behavior; eventually she will return to her room 18. A nurse reviews the activity schedule for the day and determines the best activity that the manic client could participate in is: a. A brown-bag luncheon and a book review b. Tetherball c. A paint-by-number activity d. A deep breathing and progressive relaxation group.

19. Rebecca announce to everyone in the day-room that a striper is coming to perform this evening. When the psychiatric aide firmly states that this behavior is not appropriate, the manic client becomes verbally abusive and threatens physical violence to the aide. Based on the analysis of this situation, the nurse determines that the most appropriate action would be to: a. With assistance, escort the manic client to her room and administer PRN haloperidol (Haldol) b. Tell the client that smoking privilege are revoked for 24 hours c. Orient the client to time, person and place d. Tell the client that the behavior is not appropriate 20. Rebecca is to undergo electroconvulsive therapy (ECT), which is scheduled for the next morning. Which of the following would not be a component of the plan of care? a. Withhold food and fluids for 6 hours before the treatment b. Have the client void before the procedure c. Remove dentures and contact lenses before the procedure d. Administer tap water enemas on the evening before the procedure.

Situation 5. Eating disorders are characterized by uncertain self-identification and grossly disturbed eating habits. The following questions pertain to eating disorders. 21. An 18 year old woman is admitted to an inpatient psychiatric unit with the diagnosis of anorexia nervosa. A behavior therapy approach is used as part of her treatment plan. The nurse understands that the purpose of the approach is to: a. Help the client identify and examine dysfunctional thoughts and beliefs b. Emphasize social interaction with clients who withdraw

c. Provide a supportive environment d. Examine conflicts and past issues. 22. A nurse is caring for a female client who was recently admitted for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? a. Allow the client to complete her exercise program b. Tell the client that she is not allowed to exercise rigorously c. Interrupt the client and offer to take her for a walk d. Interrupt the client and weigh immediately 23. A nurse is caring for a client with anorexia nervosa. The nurse monitoring the client's behavior understands that the client with anorexia nervosa manages anxiety by: a. Always reinforcing self-approval b. Having the need to always make the right decision c. Engaging in immoral acts d. Observing rigid rules and regulations 24. A nurse is developing a plan of care for the hospitalized client with bulimia nervosa. Which of the following would not be included in the plan of care? a. Monitoring intake and output b. Monitoring electrolyte levels c. Observing for excessive exercise d. Checking for the presence of laxatives and diuretics in the client's belongings. 25. A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a two-bed room. A newly admitted client will be assigned to this client's room. Which of the following clients would be an appropriate choice as this client's roommate? a. A client with pneumonia b. A client receiving diagnostic tests c. A client who could benefit from the client's assistance at mealtime d. A client who thrives on managing others Situation 6. Nurse Miki is caring for Ziko, 39 years old, who has history of alcohol abuse. 26. Nurse Miki is monitoring Ziko for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for delirium tremors (Dts)? a. Hypertension, changes in level of consciousness, hallucinations b. Hypotension, ataxia, vomiting c. Stupor, agitation, muscular rigidity d. Hypotension, coarse hand tremors, agitation 27. Elda, the wife of Ziko, says to the nurse I should get out of this bad situation. The most helpful response by the nurse would be: a. I agree with you. You should get out of this situation. b. What do you find difficult about this situation?

c. Why don't you tell your husband about this? d. This is not the best time to make that decision.

28. Ziko is at risk for alcohol withdrawal. The nurse monitors the client knowing that the early signs of withdrawal will develop within how much time after cessation or reduction of alcohol intake? a. Within a few hours c. In 1 week b. After several hours d. In 2 to 3 weeks

29. Nurse Miki determines that Elda is benefiting from attending an Al Anon group when she hears the wife say: a. My attandance at the meeting has helped me to see that I provoke my husband's violence. b. I no longer feel that I deserve the beatings my husband inflicts on me. c. I can tolerate my husband's destructive behaviors now that I know they are common with alcoholics. d. I enjoy attending the meetings because they get me out of my house and away from my husband. 30. Ziko, who has been drinking alcohol on a regular basis, admits to having a problem. The client is asking for assistance with the problem. The nurse would support the client to attend with of the following community groups? a. Al Anon c. Alateen b. Alcoholics Anonymous d. Fresh Start

Situation 7. Crisis is a temporary state of severe emotional disorganization resulting from failure of coping mechanisms or lack of support. Treatment should be immediate, supportive and directly responsive to the immediate crisis. 31. A nurse is reviewing the health care record of a client admitted to the psychiatric unit. The nurse notes that the admission nurse has documented that the client is experiencing anxiety as a result of a situational crisis. The nurse would determine that this type of crisis could be caused by: a. A fire that destroyed the client's home b. A recent rape episode experienced by the client c. The death of a loved one d. Witnessing a murder 32. A nurse is gathering data from a client in crisis. When determining the client's perception of the precipitating event that led to the crisis, the most appropriate question to ask is: a. What leads you to seek help now? b. Who is available to help you? c. What do you usually do to feel better? d. With whom do you live?

33. A nurse is assisting in developing a plan of care for a client in a crisis state. When developing the plan, the nurse will consider which of the following? a. Presenting symptoms in a crisis situation are similar for all individuals experiencing a crisis. b. A crisis state indicates that the individual is suffering from an emotional illness c. A crisis state indicates that the individual is suffering from a mental illness d. A client's response to a crisis is individualized and what constitutes a crisis for one person may not constitute a crisis for another person. 34. A female client, whose long term live-in lover has just terminated their relationship, come to the emergency service in severe crisis. After being seen by the nurse the client agrees to call the local mental health clinic for short term counseling. The nurse evaluates that the nursing intervention was effective based on the fact that the client: a. Is seeking out assistance in making a decision b. Has returned to her precrisis level of functioning c. Has learned new methods of coping with her loss d. Is demonstrating diminished symptoms of anxiety and sadness 35. During a staff development program, the nurse educator emphasizes that nurses caring for middle-agers who are experiencing midlife crisis should be aware that this crisis is most often due to the: a. Individual's perception of his/her life situation b. Many role changes adults experience at this time c. Anticipation of negative changes associated with old age d. Lack of support from family members who are busy with their own lives Situation 8. The nurse was assigned to care for a client with a diagnosis of severe depression. 36. During a conversation with the depressed client on a psychiatric unit, the client says to the nurse My family would be better off without me. The nurse's best response is: a. Everyone feels this way when they are depressed. b. Have you talked to your family about this? c. You sound very upset. Are you thinking of hurting yourself? d. You will feel better once your medication begins to work. 37. The client recently lost her husband which aggravates her condition. The client says, No one cares about me anymore. All the people I loved are dead. Which of the following responses by the nurse is most therapeutic? a. That seems rather unlikely to me. b. You must be feeling all alone at this point. c. I don't believe that and neither do you. d. Right! Why not just 'pack it in'? 38. In caring for a client with severe depression, which of the following activities would be most appropriate?

a. Paint by number c. Drawing b. A puzzle d. Checkers

39. Which behaviors observed by the nurse might lead to the suspicion that the client may be suicidal? a. The client becomes angry while speaking on the telephone and slams the receiver down on the hook. b. The client runs out of the therapy group swearing at the group leader and runs to her room. c. The client gets angry with her roommate when the roommate borrows the client's clothes without asking. d. The client gives away a prized CD and a cherished autograph picture of the performer.

40. The client has a history of serious suicidal attempt by hanging. The nurse's most important aspect of care is to maintain client safety. This is accomplished best by: a. Assigning a staff member to the client who will remain with the client at all times. b. Admitting the client to a seclusion room where all potentially dangerous articles are removed. c. Removing the client's clothing and placing the client in a hospital gown d. Requesting that a peer remain with the client at all times. Situation 9. A nurse is tasked to take care of a client who is taking anti-manic medication. 41. The nurse is assisting in preparing a teaching plan for a client who is taking lithium carbonate (Eskalith). Which of the following would not be a component of the teaching plan? a. Lithium blood levels must be monitored very closely. b. Contact the physician if excessive diarrhea, vomiting or diaphoresis occurs. c. Take the lithium with meals d. Decrease fluid intake while taking the lithium 42. A client receiving lithium carbonate (Eskalith) complains of loose, watery stools and difficulty walking. The nurse would expect the serum lithium level to be which of the following? a. 0.7 mEq/L c. 1.2 mEq/L b. 1.0 mEq/L d. 1.7 mEq/L 43. A client who is on lithium carbonate (Eskalith) therapy is scheduled for surgery. The nurse informs the client that: a. The medication will be discontinued several days before surgery and resumed by injection in the immediate postoperative period. b. The medication is to be taken until the day of surgery and resumed by injection in the immediate postoperative period. c. The medication will be discontinued 1 to 2 days before the surgery and resumes as soon as full oral intake is allowed. d. The medication will be discontinued a week before the surgery and resumed a week after the surgery.

44. A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine followup evaluation and the level is 3.0 mEq/L. The nurse knows this level is: a. Normal b. Slightly above normal c. Excessively below normal d. Toxic 45. A client who is on lithium carbonate (Eskalith) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will instruct the client that it is most important to: a. Avoid soy sauce, wine, and aged cheese b. Take medication only as prescribed because it can become addicting c. Check with the psychiatrist before using any over-the-counter medications or prescription medications. d. Have the lithium level checked every 2 weeks.

Situation 10. The following questions are related to anti-depressant medications 46. Fluoxetine HCl (Prozac) is prescribed for the client. The nurse provides instruction to the client regarding the administration of the medication. Which of the following statements if made by the client indicates an understanding regarding the administration of the medication: a. I should take the medication right before bedtime. b. I should take the medication with my evening meal. c. I should take the medication at noon time with an antacid. d. I should take the medication in the morning when I first arise. 47. When teaching a client who is being started on imipramine HCl (Tofranil), the nurse would inform the client that the desired effects of the medication may: a. Start during the first week of administration b. Start during the second week of administration c. Not occur for 2 to 3 weeks of administration d. Not occur until after a month of administration

48. A client admitted to the hospital gives the nurse a bottle of clomiprmine (Anafranil). The nurse notes that the medication has not taken by the client in 2 months. What behaviors observed in the client would validate noncompliance with this medication? a. Frequent hand washing with hot soapy water b. Complains of hunger c. A pulse rate below 60 beats per minute d. Complains of insomnia

49. A client arrives at the health care clinic and tells the nurse that they have been doubling the daily dosage of bupropion (Wellbutrin) to aid them in getting better faster. Which ongoing data collection is required based on this information? a. Monitor for orthostatic hypotension b. Monitor for seizure activity c. Monitor for weight gain d. Monitor for insomnia

50. A depressed client who is on tranylcypromine sulfate (Parnate) has been instructed on diet. The nurse feels confident that the client understands the diet when given a choice of restaurant foods if the client selects: a. Pepperoni pizza, salad and cola b. Roasted chicken, roasted potatoes and beer c. Picked herring, french fries and milk d. Fried haddock, baked potato and cola Situation 11. Una, a 20 year old female client, was granted a weekend pass by the mental health unit. 51. During the one-on-one interaction with a nurse, Una states, I'm worried about going home. The nurse responds, Tell me more about this. This response is an example of: a. Focusing c. Reflecting b. Clarifying d. Refocusing 52. During a group discussion, it is learned that Una masked her depression and suicidal urges and indeed committed suicide several days ago. The group leaders should be prepared primarily to deal with: a. The guilt that the group feels because they could not prevent another's suicide b. The lack of concern over the member's suicide expressed by some of the group c. The guilt, fear and anger of the co-leaders that they failed to anticipate and prevent the suicide d. The fear and anxiety that some members of the group may have their own suicidal urges may go unnoticed and unprotected. 53. During the group discussion regarding the unexpected suicide of Una while on a weekend pass, one of the other clients stand up and shouts, Oh, I know what you're all thinking; you think that I should have known that she was going to kill herself. You think I helped her plan this. The most therapeutic response by the group leader would be: a. It will help if you tell us the truth. b. Oh, no. We all know you liked her. c. You fell we're blaming you for her death? d. Helping another person to plan a suicide would not be healthy.

54. During a special meeting to discuss the unexpected suicide of Una, the nurse overhears another client moan softly, I'm next. Oh, my God, I'm next. They couldn't prevent hers and they can't protect me. It would be most therapeutic for the nurse to respond by saying:

a. You are afraid you will hurt yourself? b. The other client was a lot sicker than you are. c. It's different. The other client was home; you are here. d. There is no need to worry. All passes will be canceled for a while.

55. To deal in a growth-promoting manner with the occasional silence that occurs during a group session, the leaders should: a. Be willing to sit indefinitely to wait the silence out b. Call on specific members to talk when silence occurs c. Go around the group, requiring each member to talk in turn d. Comment on the silence or nonverbal behavior related to the silence

Situation 12. Psychiatric/Mental Health nursing caters to all clients from different age groups. 56. The most advantageous therapy for a preschool-aged child with a history of physical and sexual abuse would be: a. Play therapy c. Group therapy b. Psychodrama d. Family therapy

57. The nurse sits with an elderly depressed client twice a day, although there is little verbal communication. One afternoon, the client asks, Do you think they'll ever let me out of here? the nurse's best reply would be: a. Why don't you ask your doctor? b. Everyone says you're doing just fine. c. Why, do you think you are ready to leave d. You have the feeling that you might not leave? 58. The most therapeutic nursing intervention to help the late middle-aged individual deal with emotional aspects of aging would include: a. Focusing on the individual's past experiences b. Having the individual attend lectures on aging c. Assisting the individual with plans for the future d. Attentive listening to what the individual is saying

59. A nurse is assigned to care for a regressed 19 year old college student newly admitted to the psychiatric unit with a 1-month history of talking to unseen people and refusing to get out of bed, go to class, or get involved in daily grooming activities. The nurse's initial efforts should be directed toward helping the client by: a. Providing frequent rest periods to avoid exhaustion b. Facilitating the client's social relationships with a peer group c. Reducing environmental stimuli and maintaining dietary intake d. Attempting to establish a meaningful relationship with the client

60. A 45 year old physician is admitted to the psychiatric unit of a community hospital. The client is restless, loud, aggressive, and resistive during the admission procedure and states, I will take my own blood pressure. the most therapeutic response by the nurse would be: a. Right now, doctor, you are just another client. b. I am sorry but I cannot allow that. I must take your BP. c. If you would rather, doctor. I'm sure you will do it OK. d. If you do not cooperate, I will get the attendants to hold you down. Situation 13. Emotional problems related to physical health and childbearing 61. The nurse should plan to explain to the adult daughters of a dying client, whose mood changes and apparent anger at them is causing them concern, that their mother is: a. Frightened by her impending death b. Working through acceptance of her situation c. Attempting to reduce her family's dependence on her d. Hurt that the family will not take her home to die in her own bed

62. When a continent, bedridden client with a chronic illness expresses anger through urinary incontinence, the nurse should: a. Limit the client's fluid intake in the evening b. Provide television or radio for the client when alone c. Frequently ask if the client need the bedpan to void d. Create an environment that prevents sensory monotony

63. A client with a chronic illness who had been incontinent of urine at home has not been incontinent since being hospitalized. When discussing past and present elimination patterns, the client also tells the nurse about being angry at being bedridden and unable to go anywhere or see anyone. The nurse deduces that the client's incontinence at home may have been related to: a. A way of maintaining control b. An unconscious expression of hostility c. A method to determine the family's love d. A physiologic response expected with the elderly. 64. A female client who has had multiple hospital admissions for recurring congestive heart failure is returned to the hospital by her daughter. The client is admitted to the coronary care unit for observation. She states, I know I'm sick, but I could really take care of myself at home. the nurse recognizes that the client is attempting to: a. Deny her illness b. Suppress her fears c. Reassure her daughter d. Maintain her independence

65. Clients on dialysis frequently experience the psychological problem of:

a. Reactive depression b. Postpump psychosis c. Depersonalization disorder d. Dialysis disequilibrium

Situation 14. Joey, a 50 year old male client, was admitted to a psychiatric nursing unit. He exhibits negative symptoms (flat affect, isolation, poverty of speech and lack of motivation) of Schizophrenia. 66. A psychiatrist is making morning rounds and after examining Joey who continues to exhibit negative symptoms of Schizophrenia, the doctor writes an order to change from haloperidol (Haldol) to resperidone (Risperdal). The dosage ordered is 1 mg BID for 3 days. It is most important that the nurse: a. Monitor the client for mood changes and suicidal tendencies especially during early therapy b. Assess for the side effects of sedation, restlessness, and muscle spasm once the drug has been administered c. Determine if the morning dosage of Haldol had been given and then start the initial dose of Risperdal at bedtime d. Review the medication sheet to determine the time of the last dose of Haldol before administering the correct dosage of Risperdal at 2 PM 67. Joey is about to be discharged to a halfway house. This is his fifth admission in less than 1 year. He improves while in the unit, but after discharge he forgets to take his medication, is unable to function, and must be returned to the unit again. A medication that could be given IM to this client on an outpatient basis every 2 to 3 weeks would be: a. Haldol c. Lithium carbonate b. Valium d. Prolixin decanoate 68. Joey is to be discharged with orders for haloperidol (Haldol) therapy. When developing a teaching plan for discharge, the nurse should include cautioning the client against: a. Driving at night b. Staying in the sun c. Ingesting wines and cheeses d. Taking medications containing aspirin 69. Drugs such as trihexyphenidyl (Artane), biperiden (Akineton), or benztropine (Cogentin) is often prescribed in conjunction with: a. Barbiturates b. Antidepressants c. Antianxiety agents/anxiolytics d. Antipsychotic agents/neuroleptics

70. An extrapyramidal symptom that is potentially irreversible side effect of antipsychotic drugs is: a. Torticollis b. Oculogyric crisis

c. Tardive dyskinesia d. Pseudoparkinsonism

Situation 15. Personality development is the sum of all traits that differentiate one individual from another. 71. A generally accepted concept of personality development is: a. By 2 years of age the basic personality is rather firmly set b. The personality is capable of change and modification throughout life c. The capacity for personality change decreases rapidly after adolescence d. By the end of the first 6 years, the personality has reached its adult parameters 72. According to psychosexual theory, the primary emergence of the personality is demonstrated around the age of: a. 6 months c. 24 months b. 9 months d. 48 months

73. Personality is unique for every individual because it is the result of the person's: a. Intellectual capacity, race and socioeconomic status b. Genetic background, placement in family and autoimmunity c. Biologic constitution, psychologic development and cultural setting d. Childhood experiences, intellectual capacity and socioeconomic status 74. The relationship that is of extreme importance in the formation of the personality is the: a. Peer c. Parent-child b. Sibling d. Heterosexual 75. The nurse is aware that Freud's phallic stage of psychosexual development, which compares with Erikson's psychosocial phase of initiative vs guilt, is best seen at: a. Adolescence c. Birth to 1 year b. 6 to 12 years d. 3 to 5 years

Situation 16. In understanding Psychiatric/Mental Health Nursing, nurses should know the factors involved in personality development 76. Evidence of the existence of the unconscious is best demonstrated by: a. The ease of recall c. Dja vu experiences b. Slips of the tongue d. Free-floating anxiety

77. The ability to tolerate frustration is an example of one of the functions of the: a. Id c. Superego b. Ego d. Unconscious 78. The superego is the part of the psyche that:

a. Contains the instinctual drives b. Is the source of creative energy c. Operates on the pleasure principle and demands immediate gratification d. Develops from internalizing the concepts of parents and significant others 79. The ego is that part of the self that says: a. I like what I want b. I want what I want c. I should not want that d. I can wait for what I want 80. A person has a mature personality if the: a. Ego responds to the demands of the superego b. Society sets demands to which the ego responds c. Superego has replaced and increased all the controls of the parents d. Ego acts as a balance between the pressures of the id and the superego

Situation 17. The personality of an individual develops in overlapping stages that shades and merge together. It is further supported by different theories. 81. During the oedipal stage of growth and development, the child: a. Love and hates (ambivalence) both parents b. Loves the parent of the same sex and the parent of the opposite sex c. Loves the parent of the opposite sex and hates the parent of the same sex d. Loves the parent of the same sex and hates the parent of the opposite sex

82. Play for the preschool-age child is necessary for the emotional development of: a. Projection c. Competition b. Introjection d. Independence

83. The stage of growth and development basically concerned with role identification is the: a. Oral stage c. Oedipal stage b. Genital stage d. Latency stage 84. Surgery can be very traumatic event for a child. The nurse when performing preoperative preparation knows that according to Piaget's stages of cognitive development children will experience the greatest fear during the: a. Sensorimotor stage b. Preoperational stage c. Concrete operational stage d. Formal operational stage 85. An elderly client with a diagnosis of early dementia of the Alzheimer's type tells the nurse, I am useless to everyone, even myself. the nurse recognizes that the client has probably failed to accomplish Erikson's developmental task of: a. Ego integrity versus Despair

b. Identity versus Role Confusion c. Generativity versus Stagnation d. Autonomy versus Shame/Doub Situation 18. There are disorders first evident before adulthood. Nurses should be aware of this. 86. About a month after their toddler is diagnosed as moderately retarded, the parents' discussion of the toddler's future reflects plans for their child's normal independent functioning. The nurse recognizes that the parents: a. Are using denial b. Accept the diagnosis c. Are using intellectualization d. Understand their child's limitations 87. When using behavior modification to foster toilet training efforts in a cognitively impaired child, the nurse should reinforce appropriate use of the toilet by giving the child a: a. Piece of fruit c. Hug and praise b. Piece of candy d. Choice of rewards

88. A 7 year old male has recently been diagnosed with an attention-deficit disorder with hyperactivity. Cylert 37.5 mg/day has been prescribed. In discussing their child's treatment with the parents, the nurse emphasizes the fact that it would be important for them to: a. Tutor their son in the subjects that are troublesome b. Monitor the effect of the medication on their son's behavior c. Point out to their son that he can control his behavior if he desires d. Avoid imposing too many rules because they would frustrate their son 89. A child scores between 55 and 68 on a standardized intelligent quotient (IQ) assessment test. The nurse is aware that this degree of intellectual impairment would be considered: a. Mild c. Profound b. Severe d. Moderate 90. The prognosis for a normal productive life for a child diagnosed with an autistic disorder is: a. Dependent upon an early diagnosis b. Often related to the child's overall temperament c. Emphasized with the parents regardless of the child's level of functioning d. Looked upon with caution because of interference with so many parameters of functioning Situation 19. Autism and ADHD (Attention-deficit Hyperactive disorder) are two of the most common mental disorders among children. Nurses should be knowledgeable on this. 91. Autism can usually be diagnosed when the child is about: a. 2 years of age c. 6 months of age b. 6 years of age d. 1 to 3 months of age

92. The 6 years old child who has been diagnosed as autistic is admitted for sever dehydration. The child demonstrates frequent spinning and hand-flapping activities. Nursing intervention to limit these activities should focus on: a. Physically holding the child b. Redirecting the child's behavior c. Asking the child why the spinning and hand-flapping is done d. Moving furniture to minimize the space available for these activities 93. When planning activities for a child with autism, the nurse must remember that autistic children respond best to: a. Large group activity b. Loud, cheerful music c. Individuals in small group d. Their own self-stimulating acts 94. Attention-deficit hyperactivity disorder in children is usually treated with: a. Lorazepam (Ativan) b. Haloperidol (Haldol) c. Methocarbamol (Robaxin) d. Methylphenidate hydrochloride (Ritalin) 95. The nursing assessment of a hyperactive 9 year old with a history of an attention-deficit disorder, admitted for observation following a motor vehicle accident, reveals a knowledge deficit regarding personal safety. Nursing actions to meet the goal of personal safety should focus on: a. Requesting the child write at least 3 safety rules b. Asking the child to verbalize as many safety rules as possible c. Talking with the child about the importance of using a seat belt d. Encouraging the child to talk with other children about their opinions of safety rules Situation 20. Delirium, dementia and other cognitive disorders 96. The approach that would be most helpful in meeting the needs of an elderly client hospitalized with the diagnosis of dementia of the Alzheimer's type is: a. Providing a nutritious diet high in carbohydrates and proteins b. Simplifying the environment as much as possible while eliminating need for choices c. Providing an opportunity for many alternative choices in the daily schedule to stimulate interest d. Developing a consistent nursing pan with fixed schedules to provide for physical and emotional needs

97. When attempting to understand the behavior of an elderly client diagnosed with vascular dementia, the nurse recognizes that the client is probably: a. Not capable of using any defense mechanisms b. Using one method of defense for every situation c. Making exaggerated use of old, familiar mechanisms

d. Attempting to develop new defense mechanisms to meet the current situation 98. When planning care for a client with delirium, dementia or other cognitive disorders, the nurse should appropriately: a. Teach the client new social skills to encourage participation b. Encourage the client to talk of the past and early experiences c. Discuss current events to keep the client in contact with reality d. Maintain the daily routine of living with which the client is familiar 99. The nurse is assessing a client with dementia. To effectively elicit information about the client's ability to provide self-care, the nurse should: a. State, I notice that your shoes do not match your dress. b. State, Continue to knit and I shall observe you for a while. c. Ask, Can you find your way from the bed to the bathroom? d. Ask, Can you show me how you would open the door if you had a key? 100. The current trend in the treatment of the older adult with delirium, dementia or other cognitive disorder is to: a. Provide occupational therapy b. Maintain them in the community c. Medicate during stressful periods d. Encourage the assumption of responsibility

Answers

1. Answer: A Rationale: Involuntary admission is made without the client's consent. Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment or physical care. Options B, C and D describe the process of voluntary admission. (Saunders, 2nd Edition) 2. Answer: B Rationale: Denial is refusal to admit to a painful reality, which is treated as if it does not exist. (A) In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other people, objects or situations. (C) In regression, the client returns to an earlier, more comforting, although less mature way of behaving. (D) Rationalization is justifying the unacceptable attributes about oneself. (Saunders, 2nd Edition) 3. Answer: D Rationale: Option D identifies the therapeutic communication technique of restatement. Although it is a technique that has a prompting component to it, it repeats the client's major theme and provides the perception of the problem from the client's perspective. Option A allows the client to direct the discussion when it needs to be more focused at this point. Option B uses reflection that simply repeats the client's last words to prompt further discussion. Option C focuses on the number of nights rather than the specific problem of sleep. (Saunders, 2nd Edition) 4. Answer: D Rationale: Option D is the only option that recognizes the client's need. This response helps the client to focus on the emotion underlying the delusion, but does not argue with it. If the nurse attempts to change the client's mind, the delusion may in fact be even more strongly held. (Saunders, 2nd Edition) 5. Answer: C Rationale: In the termination phase, the relationship comes to a close. Ending treatment may sometimes be traumatic for clients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. Options A, B and D are incorrect. (Saunders, 2nd Edition) 6. Answer: C Rationale: Clients who are involuntarily admitted do not lose their right to informed consent. The informed consent needs to be obtained from the client. Options A, B and D are incorrect. (Saunders, 2nd Edition) 7. Answer: B Rationale: A client may request to be secluded or restrained. Federal laws require the consent of the client unless an emergency situation exists in which an immediate risk to the client or others can be documented. The use of seclusion and restraint is permitted only on the written order of a physician, which also must specify the type of restraint to be used. (Saunders, 2nd Edition)

8. Answer: C Rationale: Milieu therapy provides a safe environment that is adapted to the individual client's needs and also provides greater comfort and freedom of expression that has been experienced in the past by the client. All members contribute to the planning and functioning of the setting. (Saunders, 2nd Edition) 9. Answer: D Rationale: Aversion therapy, also known as aversion conditioning or negative reinforcement, is a technique used to change behavior. In this therapy, a stimulus (alcohol) attractive to the client is paired with an unpleasant event in hopes of instituting the stimulus with negative properties. (A) Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus in a weaker and milder form. (B) Self-control therapy combines cognitive and behavioral approaches and is useful to deal with stress. (C) Milieu therapy provides positive environmental manipulation, both physical and social, to effect a positive change in the client. (Saunders, 2nd Edition) 10. Answer: A Rationale: In the forming or initial stage, the members are identifying tasks and boundaries. (B) Storming involves responding emotionally to tasks. In the norming stage, members express intimate personal opinions and feelings around personal tasks. (D) In the performing stage, members direct group energy toward the completion of tasks. (Saunders, 2nd Edition) 11. Answer: C Rationale: responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. Options A, C and D block communication because they minimize the client's experience and do not facilitate exploration of the client's expressed feelings. (Saunders, 2nd Edition)

12. Answer: C Rationale: When reading the question, you do not know whether the client is responding to the nurse's gender or is simply uncomfortable sharing personal information. The most therapeutic response for the male nurse is not to bring what may be his own gender issues into the response at this time. Options A, B and D are nontherapeutic responses. (Saunders, 2nd Edition) 13. Answer: D Rationale: The most therapeutic response is the one that reflects the client's feelings and offers the client control of care. In option A, the nurse uses avoidance and information giving. Option B is an aggressive and nontherapeutic communication technique. Option C is social and nontherapeutic because it labels the client's behavior and is likely to provoke anger from the client. (Saunders, 2nd Edition) 14. Answer: A Rationale: Reflection is the therapeutic communication technique that redirects the client's feeling back in order to validate what the client is saying. In option B, the nurse attempts to use focusing, but the attempt to discuss central issues seems premature. In option C, the nurse makes

a judgment and is nontherapeutic in the one-on-one relationship. In option D, the nurse is attempting to assess the client's ability to openly discuss feelings with family members. Although this may be appropriate, the timing is somewhat premature and closes off facilitation of the client's feeling. (Saunders, 2nd Edition)

15. Answer: B Rationale: The nurse should never promise to keep a secret. Secrets are appropriate in a social relationship but not in a therapeutic one. The nurse need to be honest with the client and tell the client that a promise cannot be made to keep the secret. (Saunders, 2nd Edition) 16. Answer: C Rationale: Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep and impaired ability to concentrate or complete a single train of thought. It is a period when the mood is predominantly elevated, expansive or irritable. Option C identifies a physiological need requiring immediate intervention. (Saunders, 2nd Edition)

17. Answer: A Rationale: A person who is experiencing mania lacks insight and judgment, has poor impulse control and is highly excitable. The nurse must take control without increasing the client's stress or anxiety. A quiet, firm approach while distracting the client (walking her to her room and assisting with dressing) achieves the goal of having her dressed appropriately and preserving psychosocial integrity. In option B, Insisting that the client go to her room may meet with a great deal of resistance. In option C, confronting the client and offering the client a consequence of time-out may be meaningless. Option D is inappropriate. (Saunders, 2nd Edition) 18. Answer: B Rationale: A person who is experiencing mania is overactive, full of energy, lacks concentration and has poor impulse control. The client needs an activity that will allow her to use excess energy, yet not endanger others during the process. Option A, C and D are relatively sedate activities that require concentration, a quality that is lacking in the manic state. Such activities may lead to increased frustration and anxiety for the client. Tetherball is an exercise that uses the large muscle groups of the body and is a great way to expend the increased energy this client is experiencing. (Saunders, 2nd Edition) 19. Answer: A Rationale: The client is at risk for injury to self and others and therefore should be escorted out of the dayroom. Hyperactive and agitated behavior usually responds to haloperidol (Haldol). Option B may increase the agitation that already exist in this client. In option C, orientation will not halt the behavior. In option D, telling the client that the behavior is not appropriate has already been attempted by the psychiatric aide. (Saunders, 2nd Edition) 20. Answer: D Rationale: Enemas are not a component of the pretreatment care for a client scheduled for ECT. Options A, B and C are a part of the pretreatment plan. Additionally, an informed consent is

required and the nurse should teach the client and family what to expect with ECT and allow the client to discuss her feelings regarding the procedure. (Saunders, 2nd Edition) 21. Answer: A Rationale: Behavior therapy is used to help clients identify and examine dysfunctional thoughts as well as identify and examine values and belief that maintain these thoughts. Options B, C and D are incorrect. (Saunders, 2nd Edition) 22. Answer: C Rationale: Clients with anorexia nervosa are frequently preoccupied with rigorous exercise and pu7sh themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise as well as place limits on rigorous activities. Options A, b and D are inappropriate nursing actions. (Saunders, 2nd Edition) 23. Answer: D Rationale: Clients with anorexia nervosa have the desire to please others. Their need to be correct or perfect interferes with rational decision-making processes. These clients are moralistic. Rules and rituals help these clients manage their anxiety. Options A and B have absolute word always and should be eliminated. Option C is not characteristic of the client with anorexia. (Saunders, 2nd Edition) 24. Answer: C Rationale: Excessive exercise is a characteristic of anorexia nervosa, not a characteristic of clients with bulimia. Frequent vomiting, in addition to laxative and diuretic abuse, may lead to dehydration and electrolyte imbalance. Assessing for dehydration and electrolyte imbalance are important nursing actions. Option C is the only option that is not a characteristic of bulimia. (Saunders, 2nd Edition) 25. Answer: B Rationale: The client receiving diagnostic tests is an acceptable roommate. The client with anorexia is most likely experiencing hematological complications, such as leukopenia. In option A, having a roommate with pneumonia would place the client with anorexia nervosa at risk for infection. In options C and D, the client with anorexia nervosa should not be put in a situation in which they are able to focus on the nutritional needs of others or being managed by others, because this may contribute to sublimation and suppression of their own hunger. (Saunders, 2nd Edition) 26. Answer: A Rationale: The symptoms associated with DTs (delirium tremors) typically are anxiety, insomnia, anorexia, hypertension, disorientation, visual or tactile hallucinations, changes in level of consciousness, agitation, fever and delusions. (Saunders, 2nd Edition) 27. Answer: B Rationale: The most helpful response is the one that encourages the client to problem-solve. In option A, giving advice implies that the nurse knows what is best and can also foster dependency. The nurse is also agreeing with the client, which should be avoided. Option C uses the word Why, which should be avoided in communication. Option D should be eliminated

because this option places the client's feelings on hold. The nurse should not request the client to provide explanations. (Saunders, 2nd Edition) 28. Answer: A Rationale: Early signs of alcohol withdrawal develop within a few hours after cessation or reduction of alcohol and peaks after 24 to 48 hours. (Saunders, 2nd Edition) 29. Answer: B Rationale: Al Anon support groups are a protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain suggestions about successful behavioral changes. Option B is the most healthy response because it exemplifies an understanding that the alcoholic partner is responsible for his behavior and cannot be allowed to blame family members for loss of control. In option A, the nonalcoholic partner indicates responsibility when the spouse loses control. Option C, indicates that the wife remains codependent. Option D indicates that the group is being seen as an escape, not a place to work on issues. (Saunders, 2nd Edition) 30. Answer: B Rationale: Alcoholic Anonymous is a major self-help organization for the treatment of alcoholism. Option A is a group for families of alcoholics. Option C is a group for the children of alcoholics. Option D is for nicotine addicts. (Saunders, 2nd Edition) 31. Answer: C Rationale: A situational crisis arises from external rather than internal sources. External situations that could precipitate crisis include loss of or change of a job, the death of a loved one, abortion, a change in financial status, divorce, the addiction of new family members, pregnancy and sever illness. Options A, B and D identify adventitious crisis. An adventitious crisis is not a part of every day life, is unplanned and accidental. (Saunders, 2nd Edition) 32. Answer: A Rationale: A nurse's initial task when gathering data from a client in crisis is to assess the individual or family and the problem. The more clearly the problem can be defined, the better the chance a solution can be found. Option A will assist in determining data related to the precipitating event that led to the crisis. Options B and D identify situational supports. Option C identifies personal coping skills. (Saunders, 2nd Edition) 33. Answer: D Rationale: Although each crisis response can be described in similar terms as far as presenting symptoms are concerned, what constitutes a crisis for one person may not constitute a crisis for another person because each is a unique individual. Being in a crisis state does not mean that the client is suffering from an emotional or mental illness as stated in options B and C. (Saunders, 2nd Edition) 34. Answer: A Rationale: Going for counseling demonstrates the client's recognition that assistance is needed. In option B, there are no data to support such conclusion. (Mosby, 17th Edition, 2003)

35. Answer: A Rationale: It is not the events but how the individual perceives them that is most significant in either precipitating or avoiding crisis. In option B, changes in role may occur but again, the individual's perception of these changes is most influential. Option C may be a factor but perception is most important. Option D is not a significant factor; the family may provide support and yet a crisis can still occur. (Mosby, 17th Edition, 2003) 36. Answer: C Rationale: Clients who are depressed may be at risk for suicide. It is critical for the nurse to assess suicidal ideation and plan. The client should be directly asked if a plan for self-harm exists. Options A, B and D are not therapeutic responses. (Saunders, 2nd Edition)

37. Answer: B Rationale: the client is experiencing loss and is feeling hopeless. The most therapeutic response by the nurse is the one that attempts to translate words into feelings. In option A, the nurse is voicing doubt, which is often used when a client verbalizes delusional ideas. In option C, the nurse is disagreeing with the client, which implies that the nurse has passed judgment on the client's ideas or opinions. In option D, the nurse uses sarcasm, which gives advice and is nontherapeutic as a nursing response. (Saunders, 2nd Edition) 38. Answer: C Rationale: Concentration and memory are poor in a client with severe depression. When a client has a diagnosis of severe depression, the nurse needs to provide activities that require little concentration. Activities that have no right or wrong choices or decisions minimize opportunities for the client to put themselves down. (Saunders, 2nd Edition) 39. Answer: D Rationale: A depressed, suicidal client often gives away that which is of value as way of saying good-bye and wanting to be remembered. Options A, B and C identify acting-out behaviors. (Saunders, 2nd Edition)

40. Answer: A Rationale: Hanging is a serious suicide attempt. The plan of care must reflect action that will promote the client's safety. Constant observation status (one-on-one) with a staff member who is never less than an arm's length away is the best intervention. (Saunders, 2nd Edition)

41. Answer: D Rationale: Because therapeutic and toxic dosage ranges are so close, lithium blood levels must be monitored very closely, more frequently at first and then once every several months (A). The client should be instructed to contact the physician if excessive diarrhea, vomiting or diaphoresis occurs (B). Lithium is irritating to the gastric mucosa; therefore lithium should be taken with meals (C). A normal diet and normal salt and fluid intake (1500 to 3000 ml per day) should be

maintained because lithium decreases sodium reabsorption by the renal tubules, which could cause sodium depletion. A low sodium intake causes lithium retention and could lead to toxicity. (Saunders, 2nd Edition) 42. Answer: D Rationale: The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. Serum lthium levels above the therapeutic level will produce signs of toxicity. (Saunders, 2nd Edition) 43. Answer: C Rationale: The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is ordered after the surgery. Options A, B and D are incorrect. (Saunders, 2nd Edition) 44. Answer: D Rationale: The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity. (Saunders, 2nd Edition) 45. Answer: C Rationale: Lithium is the medication of choice to treat manic-depressive illness. Many over-thecounter (OTC) medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is not addicting (B) and although serum lithium levels need to be monitored, it is not necessary to check these levels every 2 weeks (D). In option A, a tyramine-free diet is associated with monoamine oxidase inhibitors (MAOIs). (Saunders, 2nd Edition) 46. Answer: D Rationale: Fluoxetine HCl (Prozac) is administered in the early morning without consideration to meals. Options A, B and C are incorrect. (Saunders, 2nd Edition) 47. Answer: C Rationale: The therapeutic effects of administration of imipramine HCl (Tofranil) may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated. (Saunders, 2nd Edition) 48. Answer: A Rationale: Clomipramine (Anafranil) is commonly used in the treatment of obsessivecompulsive disorder. Handwashing is a common obsessive-compulsive behavior. Weight gain is a common side effect of this medication. Tachycardia and sedation are side effects. Insomnia may occur as a seldom side effect. (Saunders, 2nd Edition)

49. Answer: B Rationale: Bupropion (Wellbutrin) does not cause significant orthostatic blood pressure changes (A). Seizure activity is common in dosages greater than 450 mg a day. Bupropion frequently causes a drop in body weight. Insomnia is side effect (D), but seizure activity causes a greater client risk. (Saunders, 2nd Edition)

50. Answer: D

Rationale: Tranylcypromine sulfate (Parnate) is a monoamine oxidase inhibitor (MAOI) used to treat depression. A tyramine-restricted diet is required while on this medication to avoid hypertensive crisis, a life-threatening side effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or picked fish, beef or chicken liver, and dry sausage (salami, pepperoni, bologna). In addition, figs, bananas, aged cheese, yogurt, sour cream, beer, red wine, alcoholic beverages, soy sauce, yeast extract, chocolate, caffeine, and aged, pickled, fermented or smoked foods need to be avoided. Many over-the-counter medications also contain tyramine and must be avoided as well. (Saunders, 2nd Edition) 51. Answer: A Rationale: In option A, the response invited the client to explore the issue in more depth by focusing on it. (B) Clarifying is a technique used to ask the client to give an example to better understand the nature of the client's statement. (C) Reflecting is a technique used to either reiterate the content or the feeling message; in content reflection, the nurse repeats basically the same statement; in feeling reflection, the nurse verbalizes what seems to be implied about feelings in the comment. (D) This is incorrect; refocusing is to bring the subject back to a previous point; there is no information that this was discussed previously. (Mosby, 17th Edition, 2003) 52. Answer: D Rationale: Ambivalence about life and death plus the introspection commonly found in clients with emotional problems would lead to increased anxiety and fear in the group members. Option A will probably be a secondary goal of the group leader. Option B is not a primary goal; but this lack of concern should also be explored later on to see what is behind such apparent indifference, which may be a mask to cover feelings. In option C, these feelings must be handled within the support and supervisory systems for the staff; the other group members are the primary concern. (Mosby, 17th Edition, 2003) 53. Answer: C Rationale: Option C puts the focus on feelings, not on a statement of what did or did not happen. Option A implies that the client may have had some part in causing another person's death. Option B does not give the client an opportunity to explore feelings. Option D closes the door to any further communication of feelings or fears. (Mosby, 17th Edition, 2003) 54. Answer: A Rationale: This statement recognizes the importance of feelings and provide an opening so that client may talk about them. In the statement on option B, the client is not going to believe this, and it is not helping the client express feelings. Option C is incorrect because the nursing goal is to help people function outside the hospital environment, not be afraid to leave it. In option D, a statement like this avoids the real issue and solves nothing. (Mosby, 17th Edition, 2003)

55. Answer: D Rationale: Commenting on the silence will encourage exploration of what is happening in the group and the members' thoughts and feelings about it. (A) waiting indefinitely can result in increased anxiety and a power struggle between members and leaders, each determined to outwait the other. In option B, calling on specific members limit growth potential of members. In

option C, forcing responses instead of allowing spontaneous responses will decrease thoughtful exploration of what is happening. (Mosby, 17th Edition, 2003) 56. Answer: A Rationale: It is the most effective method for the child to play out feelings; when the feelings are allowed to surface, the child can then learn to face them by controlling, accepting, or abandoning them; through this process, the child can experience growth. Options B, C and D are not child specific and generally are more suited for adolescents, young adults and adults. (Mosby, 17th Edition, 2003) 57. Answer: D Rationale: The nurse's response urges the client to reflect on feelings and encourages the communication of feeling tones. Option A is an evasion technique which shift the responsibility from the nurse to the doctor. Option B closes the door to further communication since it is not what the client is asking the nurse. In option C, Why asks the client to draw a conclusion, which this client may not be able to do. (Mosby, 17th Edition, 2003) 58. Answer: C Rationale: Helping an individual to maintain an interest in future is therapeutic. Option A would be appropriate for an older-aged adult. In option B, lectures may or may not include emotional aspects of aging. In option D, listening is therapeutic; however, it does not ensure the client will discuss the emotional aspects of aging. (Mosby, 17th Edition, 2003)

59. Answer: D Rationale: The first step in a plan of care should be the establishment of a meaningful relationship because it is through this relationship that the client can be helped. In option A. encouraging this behavior would not be therapeutic. Option B would be a long-term goal. In option C, reduction of stimuli may limit the hallucinations, but there is no evidence the client is not eating meals. (Mosby, 17th Edition, 2003) 60. Answer: B Rationale: This simply states facts without getting involved in role conflict. Being a doctor is a big part of this client's self-esteem, and by the remarks made by the nurse on option A is threatening that self-esteem. Option C is incorrect because firm, consistent limits need to be set and the nurse-client role should be established. Option D is incorrect because threats will only make the situation worse and set the tone for future nurse-client interactions. (Mosby, 17th Edition, 2003) 61. Answer: B Rationale: Understanding the stages leading to the acceptance of death may help the family to understand the client's moods and anger. Option A may not be true unless stated by the client; some clients welcome death as a release from pain. Option C is untrue; anger is one of the stages of accepting death. Option D is an assumption by the nurse unless stated by the client. (Mosby, 17th Edition, 2003) 62. Answer: D

Rationale: For psychologic equilibrium the client's environment must be one of novel and changing stimuli, promoting physical activity and effective interaction with others. Option A is incorrect; in order to prevent urinary stasis and dehydration, fluid intake should be encouraged. In option B, although stimulation is important, it should be varies and the client's preferences taken into consideration; radio and television do not promote interaction. In option C, since the client has been able to control elimination, frequent toileting is not the problem. (Mosby, 17th Edition, 2003)

63. Answer: B Rationale: Incontinence without a physiologic basis is an act of hostility that the individual uses to deal with anxiety-producing situations. Option A is not correct because incontinence is often seen as a symbol of regression and loss of control. Option C is untrue for incontinence is rarely the result of conscious effort. Option D is incorrect because incontinence is not a necessary complication of age and inactivity; it can be prevented by a bladder-training program. (Mosby, 17th Edition, 2003) 64. Answer: D Rationale: The client's statement is really saying, I can manage this myself. I am capable. In option A, nothing in the statement can be interpreted as denial; the client has stated, I know I'm sick. Option B is incorrect because none of the information given would lead to this conclusion. IN option C, the statement would not be reassuring to the family member who brought the client to the hospital and who probably is more reassured having the client hospitalized. (Mosby, 17th Edition, 2003) 65. Answer: A Rationale: The potential for death is constant on clients undergoing dialysis, which may result in reactive depression. In option B, although paranoia is occasionally seen in the terminal stage of the illness it is not known as postpump psychosis. Option C is incorrect because episodes of feeling detached, numb, or unreal are not common occurrences; reactive depression is the most common. Option D is incorrect because Dialysis Disequilibrium is a physiologic problem resulting from cerebral fluid shifts that can result in seizures. (Mosby, 17th Edition, 2003)

66. Answer: C Rationale: It is very important that the nurse discontinue previous antipsychotic medications before starting risperidone to minimize the period of overlap to avoid a drug interaction. In option A, although safety is of concern, it would be more important to monitor for mood change and suicidal tendencies once the drug titrate level has been reached, when the client will have clearer thought processes and more energy. Option B is incorrect because the symptoms of extrapyramidal reactions are not likely to occur with this low dosage of Risperdal. Option D would not allow enough of the lag period between the two drugs and could precipitate a drug reaction. (Mosby, 17th Edition, 2003) 67. Answer: D

Rationale: Prolixin decanoate can be given IM every 2 to 3 weeks for clients who cannot be relied upon to take oral medications; it allows them to live in the community while keeping the symptoms under control. Haloperidol (Haldol) IM has an action duration of 4 to 8 hours only. Both Valium and Lithium carbonate are not given for schizophrenia. (Mosby, 17th Edition, 2003) 68. Answer: B Rationale: Haldol causes photosensitivity. Severe sunburn can occur on exposure to the sun. Option A is incorrect because there is no known side effect that would affect night driving. Option C would be true if the client were taking a MAO inhibitor. Option D is incorrect because aspirin is not contraindicated. (Mosby, 17th Edition, 2003) 69. Answer: D Rationale: All these drugs are used to control the extrapyramidal (parkinsonism-like) symptoms that often develop as a side effect of neuroleptic therapy. Option A is incorrect because barbiturates do not have extrapyramidal side effects, which would respond to these drugs. Option B is incorrect because antiparkinsonian drugs are not usually prescribed in conjunction with antidepressants because antidepressants do not cause parkinsonism-like symptoms. Option C is also incorrect because there is no documented use of these drugs with antianxiety agents because they do not have extrapyramidal side effects. (Mosby, 17th Edition, 2003) 70. Answer: C Rationale: Tardive dyskinesia occur as a late and persistent extrapyramidal complication of longterm antipsychotic therapy. It can take many forms (e.g., torsion spasm, opisthotonos, oculogyric crisis, drooping of the head, protrusion of the tongue). Options A, B and D are reversible with administration of Cogentin and Benadryl. (Mosby, 17th Edition, 2003) 71. Answer: B Rationale: Any behavioral therapy or learning of new methods of dealing with situations requires modifications o0f approach and attitudes; hence personality is always capable of change. In option A, certain personality traits are established by age 2, but not the total personality. Option C is incorrect because the capacity for change exists throughout the life cycle. Option D is incorrect because accepting this theory would close the door om all future growth and development. (Mosby, 17th Edition, 2003) 72. Answer: C Rationale: Before this age (24 months) the infant has not developed enough ego strength to have an identity or personality. Option A is incorrect because 6 months is too early. Option B is wrong because at 9 months self-concept is nonexistent. In option D, the primary emergence of the personality has already occurred. (Mosby, 17th Edition, 2003) 73. Answer: C Rationale: The parameters set by birth, psychologic experiences and the environment make each individual unique. Although other factors may impinge to a slight degree, these factors form the personality. Options A and D answers are not inclusive; they are limited to only some aspects of personality development; race plays no part. In option B, autoimmunity plays no part in personality development. (Mosby, 17th Edition, 2003) 74. Answer: C

Rationale: Children view their own worth by the response received from their parents. This sense of worth sets the basic ego strengths and is vital to the formation of the personality. Option A is incorrect because peer groups come later in a child's development, but the parent-child relationship is still the most important. Option B, although important, it is not as important as the parent-child relationship. Option D comes later in life, after the basic personality has been formed. (Mosby, 17th Edition, 2003)

75. Answer: D Rationale: 3 to 5 years is the age of Freud's phallic stage and Erikson's stage of initiative versus guilt. Option A (Adolescence) is Freud's genital stage and Erikson's stage of identity versus role confusion. Option B (6 to 12 years) is Freud's latency stage and Erikson's stage of industry versus inferiority. Option C (birth to 1 year) is Freud's oral stage and Erikson's stage of trust versus mistrust. (Mosby, 17th Edition, 2003) 76. Answer: B Rationale: Slips of the tongue, also called Freudian slips, are material from the unconscious that slips out in unguarded moments. Option A is incorrect because material in the unconscious cannot deliberately be brought back to awareness. Option C is incorrect because there is no evidence linking Dja vu experiences to the unconscious. In option D, although free-floating anxiety is linked to the unconscious, the best evidence of the unconscious is still the slips of the tongue. (Mosby, 17th Edition, 2003) 77. Answer: B Rationale: mediating frustration within the real world is an ego function and requires ego strengths. Option A is incorrect because the id is unable to tolerate frustration for it is totally involved with gratification. Option C is incorrect because the superego is involved with putting pressure on the ego because the id does not tolerate frustration. Option D is incorrect because the unconscious does not deal with frustration. (Mosby, 17th Edition, 2003) 78. Answer: D Rationale: The superego incorporates all experiences and learning from external environments (society, family, etc.) into the internal environment. Options A and C are functions of the id. Option B is incorrect because it is the id with its drives the source of creative energy. (Mosby, 17th Edition, 2003) 79. Answer: D Rationale: A healthy ego can delay gratification and is in balance with reality. Option A is incorrect because it does not reflect any part of the self. Option B is incorrect because it is the id seeking satisfaction. Option C is incorrect because conscience and a sense of right and wrong are expressed in the superego, which acts to counterbalance the id's desire for immediate gratification. (Mosby, 17th Edition, 2003) 80. Answer: D Rationale: The mature personality does not respond to the immediate gratification demands of the id or the oppressive control of the superego because the ego is strong enough to maintain a balance between them. Option A is incorrect because there would be no healthy resolution of conflicts if the superego were always in control. (Mosby, 17th Edition, 2003)

81. Answer: C Rationale: Freud's theory is that a child develops a sexualized love for the parents of the opposite sex and becomes jealous of the parent of the same sex. These thoughts result in feelings of guilt, anxiety, fear and hate toward the parent of the same sex, which are repressed. Option A is incorrect because ambivalence does not occur in the Oedipal stage of development. Options B and D are incorrect because the child loves the parent of the opposite sex and hates the parent of the same sex. (Mosby, 17th Edition, 2003) 82. Answer: B Rationale: Values and beliefs from the parents and society are expressed through the child's play world. These values become part of the child's system through the process of internalization (Introjection). Option A (projection) is incorrect because if this happened, children learn to blame others for their own faults. Option C (Competition) occurs at a later age. Option D (Independence) is incorrect because the environment and others in it, rather than play, influence independence. (Mosby, 17th Edition, 2003) 83. Answer: C Rationale: The child resolves Oedipal conflicts by learning to identify with the parent of the same sex and accomplishes this by mimicking the role of this parent. Option A (Oral stage) is the earliest stage of development and operates solely on the pleasure principle, largely id oriented; this stage is concerned with development of trust In option B (Genital stage) there is an interest shift from the anal region to the genital region, and questions about sexuality arise. In option D (Latency stage) there is increasing sex-role development; this stage is concerned with peer-group identification. (Mosby, 17th Edition, 2003) 84. Answer: B Rationale: Children 2 to 7 years old (Preoperative stage) have difficulty distinguishing reality from fantasy; this would present the greatest challenge to the nurse. (A) Children 0 to 1 years of age (Sensorimotor stage) focus on in the moment thinking; preoperative preparation would most likely not be recalled. (C) Children 7 to 11 years of age (Concrete operational stage) have the ability to comprehend and visualize a series of events and can think about the pas and present; it would provide less of a challenge to absorb preoperative teachings. (D) Children 12 to 16 years of age (Formal operational stage) can think in the abstract and have the ability to solve complex problems; it would not pose difficulty in preoperative teachings. (Mosby, 17th Edition, 2003) 85. Answer: A Rationale: The sense of Ego integrity comes from satisfaction with life and acceptance of what has been and what is. Despair is due to guilt or remorse over what might have been. (B) During puberty, adolescents attempt to find themselves and integrate values with those of society; an inability to solve conflict results in confusion and hinders mastery of future roles. (C) During early and middle adulthood the individual is concerned with the ability to produce and to care for that which is produced or created; failure during this stage leads to self-absorption or stagnation. (D) Autonomy is developed during the toddler period and corresponds to the child's ability to control the body and environment; Doubt can result when made to feel ashamed or embarrassed. (Mosby, 17th Edition, 2003)

86. Answer: A Rationale: Use of denial involves failure to acknowledge the reality of a situation. Options B and D are incorrect because it is not demonstrated by the situation. Option C is incorrect because intellectualization involves discussing the child's problem in a technical manner; this is not demonstrated in the example. (Mosby, 17th Edition, 2003)

87. Answer: C Rationale: Secondary reinforcers involve the use of social approval; behaviors such as a hug meet this requirement. Options A and B are incorrect because food is a primary reinforcer and should not be associated with behavior modification. Option D is incorrect because the child may not select an appropriate secondary reinforcer. (Mosby, 17th Edition, 2003) 88. Answer: B Rationale: By monitoring and reporting changes in the child's behavior, the physician can determine the effectiveness of the medication. Option A id wrong because parents should not be encouraged to tutor children because there is usually too much emotional interaction. Option C is incorrect because behavior is not deliberate or controllable; this type of statement could lead to diminishing the child's self-esteem if control does not occur. Option D is incorrect because children need more structure and rules than adults. (Mosby, 17th Edition, 2003)

89. Answer: A Rationale: IQ levels between 52 and 68 are considered MILD intellectual impairment. IQ levels between 20 and 35 are specific to SEVERE intellectual impairment. IQ levels below 20 indicate PROFOUND intellectual impairment. IQ levels between 36 and 51 are specific to MODERATE intellectual impairment (Mosby, 17th Edition, 2003) 90. Answer: D Rationale: Research studies have shown that the prognosis for normal productive functioning in autistic people is guarded, particularly if there are delays in language development. Option A is incorrect because early accurate diagnosis is difficult and has not been shown to affect prognosis to any extent. In option B, while temperament may affect the child's response to treatment, it does not affect prognosis to any extent. Option C is false reassurance to the parents and would not be helpful. (Mosby, 17th Edition, 2003) 91. Answer: A Rationale: By 2 years of age the child should demonstrate an interest in others, communicate verbally and possess the ability to learn from the environment. Before these skills develop, autism is difficult to diagnose. In option B, autism can be diagnosed long before this age (6 years of age). In options C and D, infantile autism can occur at this ages but is difficult to diagnose. (Mosby, 17th Edition, 2003)

92. Answer: B Rationale: Providing a constructive distraction will help to redirect the autistic child's behavior. Option A id incorrect because physical contact is anxiety provoking for the autistic child. In option C, since the reason is probably unknown, it is not appropriate to questions such behavior.

Option D is incorrect because autistic children need sameness; moving furniture will produce anxiety. (Mosby, 17th Edition, 2003) 93. Answer: D Rationale: Autistic behavior turns inward. These children do not respond to the environment but attempt to maintain emotional equilibrium by rubbing and manipulating themselves and displaying a compulsive need for behavioral repetition. Option A is wrong because large group (or small group) activity would have little effect on the autistic child's response. In option B, although these children do seem to respond to music, but it doesn't necessarily loud, cheerful music. Option C is incorrect because part of the autistic pattern is the inability to interact with others in the environment. (Mosby, 17th Edition, 2003) 94. Answer: D Rationale: Methylphenidate hydrochloride (Ritalin) is the drug of choice for children diagnosed with Attention-deficit Hyperactivity disorder (ADHD). It appears to act by stimulating release of norepinephrine from nerve endings in the brainstem. (A) Lorazepam (Ativan) is a benzodiazepine used to treat anxiety and insomnia. (B) Haloperidol (Haldol) is an antipsychotic medication. (C) Methocarbamol (Robaxin) is a muscle relaxant. (Mosby, 17th Edition, 2003) 95. Answer: C Rationale: Focusing on specifics is important for children who are easily distracted. Option A is incorrect because focusing on more than one item at a time might be difficult for an easily distracted child. Option B is incorrect because hyperactive children respond best to concrete tasks; this is not a concrete task. Option D is incorrect because a child who is easily distracted would have difficulty talking to a group of children regarding a particular topic. (Mosby, 17th Edition, 2003 96. Answer: B Rationale: Clients with dementia of the Alzheimer's type need a simple environment. Because of brain cell destruction, they are unable to make choices. Option A is incorrect because a wellbalanced diet is important throughout life, not just during senescence; a diet high in carbohydrates and protein may be lacking other nutrients such as fats. Option C is incorrect because the client is incapable of making choice; providing many alternative choices will only increase anxiety. Option D is incorrect because physical and emotional needs must bee met on a continuous basis, not just at a fixed time. (Mosby, 17th Edition, 2003) 97. Answer: C Rationale: Clients with vascular dementia attempts to utilize defense mechanisms that have worked in the past but use them in an exaggerated manner. Because of brain cell destruction such clients are unable to focus on one defense mechanism or develop new ones. Option A is incorrect because clients with vascular dementia will depend on old, familiar defense mechanisms. Option B is incorrect because the client is not capable of focusing on one defense mechanism. Option D is wrong because the client is incapable of developing new defense mechanisms at this time. (Mosby, 17th Edition, 2003)

98. Answer: D Rationale: The client who has delirium, dementia or another cognitive disorder will be most comfortable with the familiar and repetitive daily routine because it creates less anxiety. In

option A, it would be beyond the client's capabilities to develop new social skills. In option B, the memory impairment might make this impossible. In option C, cognitive changes would make this unrealistic. (Mosby, 17th Edition, 2003) 99. Answer: D Rationale: This would provide information about the client's ability to think or use imagination , which are lost in dementia. Option A is incorrect because knowledge of the client's previous appearance is essential before an assessment of current appearance can be made. Options B and C are incorrect because well-practiced behavior may be repeated by the client with dementia. (Mosby, 17th Edition, 2003) 100. Answer: B Rationale: The current trend in psychiatry is to treat the clients while maintaining them in the community. This trend includes the family and community in the plan and has reduced the number of clients in institutions. Option A might be part of the overall treatment plan but not the only aspect. Option C would possibly have the effect of masking the symptoms and should be used only in conjunction with psychotherapy. Option D would be unrealistic for most of these clients. (Mosby, 17th Edition, 2003)