Professional Documents
Culture Documents
addiction. Nurse Trish should tell the client dependent personality disorder. Which
that the only effective treatment for behavior is not most likely to be evidence of
alcoholism is:
ineffective individual coping?
a. Recurrent self-destructive behavior
a. Psychotherapy
b. Avoiding relationship
Alcoholics anonymous (A.A.)
c. Showing interest in solitary activities
c. Total abstinence
d. Inability to make choices and decision without
d. Aversion Therapy
advise
2. Nurse Hazel is caring for a male client who
experience false sensory perceptions with no 8. A male client is diagnosed with schizotypal
basis in reality. This perception is known as: personality disorder. Which signs would this
client exhibit during social situation?
a. Hallucinations
a. Paranoid thoughts
b. Delusions
b. Emotional affect
c. Loose associations
c. Independence need
d. Neologisms
d. Aggressive behavior
3. Nurse Monet is caring for a female client who
has suicidal tendency. When accompanying 9. Nurse Claire is caring for a client diagnosed
the client to the restroom, Nurse Monet with bulimia. The most appropriate initial goal
for a female client with anorexia nervosa. indicates adult cognitive development?
a. Generates new levels of awareness
Which action should the nurse include in the
b. Assumes responsibility for her actions
plan?
c. Has maximum ability to solve problems and
a. Provide privacy during meals
learn new skills
b. Set-up a strict eating plan for the client
d. Her perception are based on reality
c. Encourage client to exercise to reduce anxiety
11. A neuromuscular blocking agent is
d. Restrict visits with the family
5. A client is experiencing anxiety attack. The administered to a client before ECT therapy.
most appropriate nursing intervention should The Nurse should carefully observe the client
include? for?
a. Respiratory difficulties
Turning on the television
b. Nausea and vomiting
b. Leaving the client alone
c. Dizziness
c. Staying with the client and speaking in short
d. Seizures
sentences
12. A 75 year old client is admitted to the hospital
d. Ask the client to play with other clients
6. A female client is admitted with a diagnosis of with the diagnosis of dementia of the
c. Grand mal seizure activity depresses continuously the acutely suicidal client. The
respirations Nurseshould watch for clues, such as
d. Muscle relaxations given to prevent injury communicating suicidal thoughts, and
during seizure activity depress respirations. messages; hoarding medications and
48. When planning the discharge of a client with talking about death.
chronic anxiety, Nurse Chris evaluates 4.B. Establishing a consistent eating plan and
achievement of the discharge maintenance monitoring client’s weight are important to
goals. Which goal would be most
this disorder.
appropriately having been included in the plan
5.C. Appropriate nursing interventions for an
of care requiring evaluation?
anxiety attack include using short
a. The client eliminates all anxiety from daily
sentences, staying with the client,
situations
decreasing stimuli, remaining calm and
b. The client ignores feelings of anxiety
medicating as needed.
c. The client identifies anxiety producing situations
d. The client maintains contact with a crisis
6.B. Delusion of grandeur is a false belief that
49. Nurse Tina is caring for a client with 7.D. Individual with dependent personality
depression who has not responded to disorder typically shows
antidepressant medication. The nurse indecisiveness submissiveness and clinging
anticipates that what treatment procedure behavior so that others will make decisions
may be prescribed? with them.
a. Neuroleptic medication 8.A. Clients with schizotypal personality
b. Short term seclusion
disorder experience excessive social anxiety
c. Psychosurgery
that can lead to paranoid thoughts.
d. Electroconvulsive therapy
9.B. Bulimia disorder generally is a 20.B. The nurse would specifically use
maladaptive coping response to stress and supportive confrontation with the client to
underlying issues. The client should identify point out discrepancies between what the
anxiety causing situation that stimulate the client states and what actually exists to
bulimic behavior and then learn new ways increase responsibility for self.
of coping with the anxiety. 21.C. The nurse would most likely administer
10.A. An adult age 31 to 45 generates new benzodiazepine, such as lorazepan (ativan)
level of awareness. to the client who is experiencing symptom:
11.A. Neuromuscular Blocker, such as The client’s experiences symptoms of
SUCCINYLCHOLINE (Anectine) produces withdrawal because of the rebound
respiratory depression because it inhibits phenomenon when the sedation of the CNS
contractions of respiratory muscles. from alcohol begins to decrease.
12.C. With depression, there is little or no 22.D. Regular coffee contains caffeine which
emotional involvement therefore little acts as psychomotor stimulants and leads
alteration in affect. to feelings of anxiety and agitation. Serving
13.D. These clients often hide food or force coffee top the client may add to tremors or
vomiting; therefore they must be carefully wakefulness.
monitored. 23.D. Vomiting and diarrhea are usually the
14.A. These clients have severely depleted late signs of heroin withdrawal, along with
levels of sodium and potassium because of muscle spasm, fever, nausea, repetitive,
their starvation diet and energy abdominal cramps and backache.
expenditure, these electrolytes are 24.D. Moving to a client’s personal space
necessary for cardiac functioning. increases the feeling of threat, which
15.B. Limiting unnecessary interaction will increases anxiety.
decrease stimulation and agitation. 25.A. Environmental (MILIEU) therapy aims at
16.C. Ritualistic behavior seen in this disorder having everything in the client’s
is aimed at controlling guilt and inadequacy surrounding area toward helping the client.
by maintaining an absolute set pattern of 26.C. Children who have experienced
behavior. attachment difficulties with primary
17.D. The nurse needs to set limits in the caregiver are not able to trust others and
client’s manipulative behavior to help the therefore relate superficially
client control dysfunctional behavior. A 27.A. Children have difficulty verbally
consistent approach by the staff is expressing their feelings, acting out
necessary to decrease manipulation. behavior, such as temper tantrums, may
18.B. Any suicidal statement must be assessed indicate underlying depression.
by the nurse. The nurse should discuss the 28.D. The autistic child repeat sounds or words
client’s statement with her to determine its spoken by others.
meaning in terms of suicide. 29.D. The client statement is an example of
19.A. When the staff member ask the client if the use of denial, a defense that blocks
he wonders why others find him repulsive, problem by unconscious refusing to admit
the client is likely to feel defensive because they exist.
the question is belittling. The natural 30.A. Discussion of the feared object triggers
tendency is to counterattack the threat to an emotional response to the object.
self image. 31.B. The nurse presence may provide the
client with support & feeling of control.
32.D. Experiencing the actual trauma in ended question and pausing to provide
dreams or flashback is the major symptom opportunities for the client to respond.
that distinguishes post traumatic stress 45.D. When hallucination is present, the
disorder from other anxiety disorder. nurse should reinforce reality with the
33.C. Confabulation or the filling in of memory client.
gaps with imaginary facts is a 46.A. Personal characteristics of abuser include
defense mechanismused by people low self-esteem, immaturity, dependence,
experiencing memory deficits. insecurity and jealousy.
34.A. These are the major signs of anorexia 47.D. A short acting skeletal muscle relaxant
nervosa. Weight loss is excessive (15% of such as succinylcholine (Anectine) is
expected weight). administered during this procedure to
35.C. Dental enamel erosion occurs from prevent injuries during seizure.
repeated self-induced vomiting. 48.C. Recognizing situations that produce
36.B. Depression usually is both emotional & anxiety allows the client to prepare to cope
physical. A simple daily routine is the best, with anxiety or avoid specific stimulus.
least stressful and least anxiety producing. 49.D. Electroconvulsive therapy is an effective
37.D. The expression of these feeling may treatment for depression that has not
indicate that this client is unable to responded to medication.
continue the struggle of life. 50.B. In an emergency, lives saving facts are
38.A. Structure tends to decrease agitation obtained first. The name and the amount of
and anxiety and to increase the client’s medication ingested are of outmost
feeling of security. important in treating this potentially life
39.B. The rituals used by a client with threatening situation.
obsessive compulsive disorder help control Psychiatric Nursing
the anxiety level by maintaining a set Practice Test Part 2
pattern of action. 1.Nurse Tony should first discuss terminating
40.C. A person with this disorder would not the nurse-client relationship with a client
have adequate self-boundaries. during the:
41.D. Loose associations are thoughts that are a.Termination phase when discharge plans are
presented without the logical connections being made.
usually necessary for the listening to b.Working phase when the client shows some
interpret the message. progress.
42.C. Helping the client to develop feeling of c.Orientation phase when a contract is
self worth would reduce the client’s need to established.
use pathologic defenses. d.Working phase when the client brings it up.
43.B. Open ended questions and silence are 2.Malou is diagnosed with major depression
strategies used to encourage clients to spends majority of the day lying in bed with
discuss their problem in descriptive manner. the sheet pulled over his head. Which of the
44.C. Clients who are withdrawn may be following approaches by the nurse would be
immobile and mute, and require consistent, the most therapeutic?
repeated interventions. Communication a.Question the client until he responds
with withdrawn clients requires much b.Initiate contact with the client frequently
patience from the nurse.The c.Sit outside the clients room
nurse facilitates communication with the d.Wait for the client to begin the conversation
client by sitting in silence, asking open-
3.Joe who is very depressed exhibits a.Echolalia
psychomotor retardation, a flat affect and b.Neologism
apathy. The nursein charge observes Joe to c.Clang associations
be in need of grooming and hygiene. Which d.Flight of ideas
of the following nursing actions would be 8.Terry with mania is skipping up and down the
most appropriate? hallway practically running into other
a.Waiting until the client’s family can clients. Which of the
participate in the client’s care following activities would the nurse in
b.Asking the client if he is ready to take charge expect to include in Terry’s plan of
shower care?
c.Explaining the importance of hygiene to the a.Watching TV
client b.Cleaning dayroom tables
d.Stating to the client that it’s time for him to c.Leading group activity
take a shower d.Reading a book
4.When teaching Mario with a typical 9.When assessing a male client for suicidal
depression about foods to avoid while risk, which of the following methods of
taking phenelzine(Nardil), which of the suicide would the nurse identify as most
following would the nurse in charge lethal?
include? a.Wrist cutting
a.Roasted chicken b.Head banging
b.Fresh fish c.Use of gun
c.Salami d.Aspirin overdose
d.Hamburger 10.Jun has been hospitalized for major
5.When assessing a female client who is depression and suicidal ideation. Which of
receiving tricyclic antidepressant therapy, the following statements indicates to the
which of the following would alert the nurse that the client is improving?
nurse to the possibility that the client is a.“I’m of no use to anyone anymore.”
experiencing anticholinergic effects? b.“I know my kids don’t need me anymore
a.Urine retention and blurred vision since they’re grown.”
b.Respiratory depression and convulsion c.“I couldn’t kill myself because I don’t want to
c.Delirium and Sedation go to hell.”
d.Tremors and cardiac arrhythmias d.“I don’t think about killing myself as much as
6.For a male client with dysthymic disorder, I used to.”
which of the following approaches 11.Which of the following activities would
would the nurseexpect to implement? Nurse Trish recommend to the client who
a.ECT becomes very anxious when thoughts of
b.Psychotherapeutic approach suicide occur?
c.Psychoanalysis a.Using exercise bicycle
d.Antidepressant therapy b.Meditating
7.Danny who is diagnosed with bipolar disorder c.Watching TV
and acute mania, states the nurse, “Where d.Reading comics
is my daughter? I love Louis. Rain, rain go 12.When developing the plan of care for a
away. Dogs eat dirt.” The nurse interprets client receiving haloperidol, which of the
these statements as indicating which of the following medications would nurse Monet
following?
anticipate administering if the client a.Attending an activity with the nurse
developed extra pyramidal side effects? b.Leading a sing a long in the afternoon
a.Olanzapine (Zyprexa) c.Participating solely in group activities
b.Paroxetine (Paxil) d.Being involved with primarily one to
c.Benztropine mesylate (Cogentin) one activities
d.Lorazepam (Ativan) 17.Which statement about an individual with a
13.Jon a suspicious client states that “I know personality disorder is true?
you nurses are spraying my food with a.Psychotic behavior is common during acute
poison as you take it out of the cart.” Which episodes
of the following would be the best response b.Prognosis for recovery is good with
of the nurse? therapeutic intervention
a.Giving the client canned supplements until c.The individual typically remains in the
the delusion subsides mainstream of society, although he has
b.Asking what kind of poison the client problems in social and occupational roles
suspects is being used d.The individual usually seeks treatment
c.Serving foods that come in sealed packages willingly for symptoms that are personally
d.Allowing the client to be the first to open the distressful.
cart and get a tray 18.Nurse John is talking with a client who has
14.A client is suffering from catatonic been diagnosed with antisocial personality
behaviors. Which of the following would the about how to socialize
nurse use to determine that the medication during activities without being
administered PRN have been most seductive. Nurse John would focus the
effective? discussion on which of the following areas?
a.The client responds to verbal directions to a.Discussing his relationship with his mother
eat b.Asking him to explain reasons for his
b.The client initiates simple activities without seductive behavior
direction c.Suggesting to apologize to others for his
c.The client walks with the nurse to her room behavior
d.The client is able to move all extremities d.Explaining the negative reactions of others
occasionally toward his behavior
15.Nurse Hazel invites new client’s parents to 19.Tina with a histrionic personality disorder is
attend the psycho educational program for melodramatic and responds to others and
families of the chronically mentally ill. The situations in an exaggerated manner. Nurse
program would be most likely to help the Trish would recommend which of the
family with which of the following issues? following activities for Tina?
a.Developing a support network with other a.Baking class
families b.Role playing
b.Feeling more guilty about the client’s illness c.Scrap book making
c.Recognizing the client’s weakness d.Music group
d.Managing their financial concern and 20.Joy has entered the chemical dependency
problems unit for treatment of alcohol
16.When planning care for Dory with dependency. Which of the following client’s
schizotypal personality disorder, which of possession will the nurse most likely place
the following would help the client become in a locked area?
involved with others? a.Toothpaste
b.Shampoo d.Confusion
c.Antiseptic wash 26.Jose is diagnosed with amphetamine
d.Moisturizer psychosis and was admitted in the
21.Which of the following assessment would emergency room. Nurse Ronald would most
provide the best information about the likely prepare to administer which of the
client’s physiologic response and the following medication?
effectiveness of the medication prescribed a.Librium
specifically for alcohol withdrawal? b.Valium
a.Sleeping pattern c.Ativan
b.Mental alertness d.Haldol
c.Nutritional status 27.Which of the following liquids would nurse
d.Vital signs Leng administer to a female client who is
22.After administering naloxone (Narcan), an intoxicated with phencyclidine (PCP) to
opioid antagonist, Nurse Ronald should hasten excretion of the chemical?
monitor the female client carefully for which a.Shake
of the following? b.Tea
a.Respiratory depression c.Cranberry Juice
b.Epilepsy d.Grape juice
c.Kidney failure 28.When developing a plan of care for a female
d.Cerebral edema client with acute stress disorder who lost
23.Which of the following would nurse Ronald her sister in a car accident. Which of the
use as the best measure to determine a following would the nurse expect to initiate?
client’s progress in rehabilitation? a.Facilitating progressive review of the accident
a.The way he gets along with his parents and its consequences
b.The number of drug-free days he has b.Postponing discussion of the accident until
c.The kinds of friends he makes the client brings it up
d.The amount of responsibility his job entails c.Telling the client to avoid details of the
24.A female client is brought by ambulance to accident
the hospital emergency room after taking d.Helping the client to evaluate her sister’s
an overdose of barbiturates is behavior
comatose. Nurse Trish would be especially 29.The nursing assistant tells nurse Ronald
alert for which of the following? that the client is not in the dining room for
a.Epilepsy lunch. Nurse Ronald would direct the
b.Myocardial Infarction nursing assistant to do which of the
c.Renal failure following?
d.Respiratory failure a.Tell the client he’ll need to wait until supper
25.Joey who has a chronic user of cocaine to eat if he misses lunch
reports that he feels like he has b.Invite the client to lunch and accompany him
cockroaches crawling under his skin. His to the dining room
arms are red because of scratching. The c.Inform the client that he has 10 minutes to
nurse in charge interprets these findings as get to the dining room for lunch
possibly indicating which of the following? d.Take the client a lunch tray and let the client
a.Delusion eat in his room
b.Formication
c.Flash back
30.The initial nursing intervention for the b.Powerlessness related to the loss of idealized
significant-others during shock phase of a self
grief reaction should be focused on: c.Spiritual distress related to depression
a.Presenting full reality of the loss of the d.Impaired verbal communication related to
individuals depression
b.Directing the individual’s activities at this 36.When developing an initial nursing care plan
time for a male client with a Bipolar I disorder
c.Staying with the individuals involved (manic episode) nurse Ron should plan to?
d.Mobilizing the individual’s support system a.Isolate his gym time
31.Joy’s stream of consciousness is occupied b.Encourage his active participation in unit
exclusively with thoughts of her father’s programs
death. Nurse Ronald should plan to help Joy c.Provide foods, fluids and rest
through this stage of grieving, which is d.Encourage his participation in programs
known as: 37.Grace is exhibiting withdrawn patterns of
a.Shock and disbelief behavior. Nurse Johnny is aware that this
b.Developing awareness type of behavior eventually produces
c.Resolving the loss feeling of:
d.Restitution a.Repression
32.When taking a health history from a female b.Loneliness
client who has a moderate level of cognitive c.Anger
impairment due to dementia, the nurse d.Paranoia
would expect to note the presence of: 38.One morning a female client on the
a.Accentuated premorbid traits inpatient psychiatric service complains to
b.Enhance intelligence nurse Hazel that she has been waiting for
c.Increased inhibitions over an hour for someone to accompany
d.Hyper vigilance her to activities. Nurse Hazel replies to the
33.What is the priority care for a client with a client “We’re doing the best we can. There
dementia resulting from AIDS? are a lot of other people on the unit who
a.Planning for remotivational therapy needs attention too.” This statement shows
b.Arranging for long term custodial care that the nurse’s use of:
c.Providing basic intellectual stimulation a.Defensive behavior
d.Assessing pain frequently b.Reality reinforcement
34.Jerome who has eating disorder often c.Limit-setting behavior
exhibits similar symptoms. Nurse Lhey d.Impulse control
would expect an adolescent client with 39.A nursing diagnosis for a male client with a
anorexia to exhibit: diagnosed multiple personality disorder is
a.Affective instability chronic low self-esteem probably related to
b.Dishered, unkempt physical appearance childhood abuse. The most appropriate
c.Depersonalization and derealization short term client outcome would be:
d.Repetitive motor mechanisms a.Verbalizing the need for anxiety medications
35.The primary nursing diagnosis for a female b.Recognizing each existing personality
client with a medical diagnosis of major c.Engaging in object-oriented activities
depression would be: d.Eliminating defense mechanisms and phobia
a.Situational low self-esteem related to altered 40.A 25 year old male is admitted to a mental
role health facility because of inappropriate
behavior. The client has been hearing b.Tired and probably did not sleep well last
voices, responding to imaginary night
companions and withdrawing to his room c.Attempting to hide from the nurse
for several days at a time. Nurse Monette d.Feeling more anxious today
understands that the withdrawal is a 45.Nurse Bea notices a female client sitting
defense against the client’s fear of: alone in the corner smiling and talking to
a.Phobia herself.Realizing that the client is
b.Powerlessness hallucinating. Nurse Bea should:
c.Punishment a.Invite the client to help decorate the
d.Rejection dayroom
41.When asking the parents about the onset of b.Leave the client alone until he stops talking
problems in young client with the diagnosis c.Ask the client why he is smiling and talking
of schizophrenia, Nurse Linda would expect d.Tell the client it is not good for him to talk to
that they would relate the client’s himself
difficulties began in: 46.When being admitted to a mental health
a.Early childhood facility, a young female adult tells Nurse
b.Late childhood Mylene that the voices she hears frighten
c.Adolescence her. Nurse Mylene understands that the
d.Puberty client tends to hallucinate more vividly:
42.Jose who has been hospitalized with a.While watching TV
schizophrenia tells Nurse Ron, “My heart b.During meal time
has stopped and my veins have turned to c.During group activities
glass!” Nurse Ron is aware that this is an d.After going to bed
example of: 47.Nurse John recognizes that paranoid
a.Somatic delusions delusions usually are related to the defense
b.Depersonalization mechanism of:
c.Hypochondriasis a.Projection
d.Echolalia b.Identification
43.In recognizing common behaviors exhibited c.Repression
by male client who has a diagnosis of d.Regression
schizophrenia, nurse Josie can anticipate: 48.When planning care for a male client using
a.Slumped posture, pessimistic out look and paranoid ideation, nurse Jasmin should
flight of ideas realize the importance of:
b.Grandiosity, arrogance and distractibility a.Giving the client difficult tasks to provide
c.Withdrawal, regressed behavior and lack of stimulation
social skills b.Providing the client with activities in which
d.Disorientation, forgetfulness and anxiety success can be achieved
44.One morning, nurse Diane finds a disturbed c.Removing stress so that the client can relax
client curled up in the fetal position in the d.Not placing any demands on the client
corner of the dayroom. The most accurate 49.Nurse Gerry is aware that the defense
initial evaluation of the behavior would be mechanism commonly used by clients who
that the client is: are alcoholics is:
a.Physically ill and experiencing abdominal a.Displacement
discomfort b.Denial
c.Projection
d.Compensation D. Flight of ideas is speech pattern of rapid
50.Within a few hours of alcohol withdrawal, transition from topic to topic, often without
nurse John should assess the male client finishing one idea. It is common in mania.
for the presence of: B. The client with mania is very active &
needs to have this energy channeled in a
a.Disorientation, paranoia, tachycardia
constructive task such as cleaning or tidying
b.Tremors, fever, profuse diaphoresis
the room.
c.Irritability, heightened alertness, jerky
C. A crucial factor is determining the lethality
movements
of a method is the amount of time that occurs
d.Yawning, anxiety, convulsions
between initiating the method & the delivery
Answers and Rationale of the lethal impact of the method.
Psychiatric Nursing D. The statement “I don’t think about killing
Practice Test Part 2 myself as much as I used to.” Indicates a
C. When the nurse and client agree to work lessening of suicidal ideation and
together, a contract should be established, improvement in the client’s condition.
the length of the relationship should be A. Using exercise bicycle is appropriate for
discussed in terms of its ultimate termination. the client who becomes very anxious when
B. The nurse should initiate brief, frequent thoughts of suicidal occur.
contacts throughout the day to let the client C. The drug of choice for a client experiencing
know that he is important to the nurse. This extra pyramidal side effects from haloperidol
will positively affect the client’s self-esteem. (Haldol) is benztropine mesylate (cogentin)
D. The client with depression is preoccupied, because of its anti cholinergic properties.
has decreased energy, and is unable to make D. Allowing the client to be the first to open
decisions. The nurse presents the situation, the cart & take a tray presents the client with
“It’s time for a shower”, and assists the client the reality that the nurses are not touching
with personal hygiene to preserve his dignity the food & tray, thereby dispelling the
and self-esteem. delusion.
C. Foods high in tyramine, those that are B. Although all the actions indicate
fermented, pickled, aged, or smoked must be improvement, the ability to initiate simple
avoided because when they are ingested in activities without directions indicates the most
combination with MAOIs a hypertensive crisis improvement in the catatonic behaviors.
will occur. A. Psychoeducational groups for families
A. Anticholinergic effects, which result from develop a support network. They provide
blockage of the parasympathetic education about the biochemical etiology of
(craniosacral) nervous system including urine psychiatric disease to reduce, not increase
retention, blurred vision, dry mouth & family guilt.
constipation. C. Attending activity with the nurse assists
B. Dysthymia is a less severe, chronic the client to become involved with others
depression diagnosed when a client has had a slowly. The client with schizotypal personality
depressed mood for more days than not over disorder needs support, kindness & gentle
a period of at least 2 years. Client with suggestion to improve social skills &
dysthymic disorder benefit from interpersonal relationship.
psychotherapeutic approaches that assist the C. An individual with personality disorder
client in reversing the negative self image, usually is not hospitalized unless a coexisting
negative feelings about the future. Axis I psychiatric disorder is present.
Generally, these individuals make marginal
adjustments and remain in society, although
they typically experience relationship and
occupational problems related to their failure is the most likely cause of death from
inflexible behaviors. Personality disorders are barbiturate over dose.
chronic lifelong patterns of behavior; acute B. The feeling of bugs crawling under the skin
episodes do not occur. Psychotic behavior is is termed as formication, and is associated
usually not common, although it can occur in with cocaine use.
either schizotypal personality disorder or D. The nurse would prepare to administer an
borderline personality disorder. Because these antipsychotic medication such as Haldol to a
disorders are enduring and evasive and the client experiencing amphetamine psychosis to
individual is inflexible, prognosis for recovery decrease agitation & psychotic symptoms,
is unfavorable. Generally, the individual does including delusions, hallucinations & cognitive
not seek treatment because he does not impairment.
perceive problems with his own behavior. C. An acid environment aids in the excretion
Distress can occur based on other people’s of PCP. The nurse will definitely give the client
reaction to the individual’s behavior. with PCP intoxication cranberry juice to acidify
D. The nurse would explain the negative the urine to a ph of 5.5 & accelerate
reactions of others towards the client’s excretion.
behaviors to make the clients aware of the A. The nurse would facilitate progressive
impact of his seductive behaviors on others. review of the accident and its consequence to
B. The nurse would use role-playing to teach help the client integrate feelings & memories
the client appropriate responses to others and and to begin the grieving process.
in various situations. This client dramatizes B. The nurse instructs the nursing assistant to
events, drawn attention to self, and is invite the client to lunch & accompany him to
unaware of and does not deal with feelings. the dinning room to decrease manipulation,
The nurse works to help the client clarify true secondary gain, dependency and
feelings & learn to express them reinforcement of negative behavior while
appropriately. maintaining the client’s worth.
C. Antiseptic mouthwash often contains C. This provides support until the individuals
alcohol & should be kept in locked area, coping mechanisms and personal support
unless labeling clearly indicates that the systems can be immobilized.
product does not contain alcohol. C. Resolving a loss is a slow, painful,
D. Monitoring of vital signs provides the best continuous process until a mental image of
information about the client’s overall the dead person, almost devoid of negative or
physiologic status during alcohol withdrawal & undesirable features emerges.
the physiologic response to the medication A. A moderate level of cognitive impairment
used. due to dementia is characterized by
A. After administering naloxone (Narcan) the increasing dependence on environment &
nurse should monitor the client’s respiratory social structure and by increasing psychologic
status carefully, because the drug is short rigidity with accentuated previous traits &
acting & respiratory depression may recur behaviors.
after its effects wear off. C. This action maintains for as long as
B. The best measure to determine a client’s possible, the clients intellectual functions by
progress in rehabilitation is the number of providing an opportunity to use them.
drug- free days he has. The longer the client A. Individuals with anorexia often display
is free of drugs, the better the prognosis is. irritability, hospitality, and a depressed mood.
D. Barbiturates are CNS depressants; the D. Depressed clients demonstrate decreased
nurse would be especially alert for the communication because of lack of psychic or
possibility of respiratory failure. Respiratory physical energy.
C. The client in a manic episode of the illness Psychiatric Nursing
often neglects basic needs, these needs are a Practice Test Part 3
priority to ensure adequate nutrition, fluid,
1. Francis who is addicted to cocaine withdraws
and rest.
from the drug. Nurse Ron should expect to
B. The withdrawn pattern of behavior
observe:
presents the individual from reaching out to
a.Hyperactivity
others for sharing the isolation produces
b.Depression
feeling of loneliness.
c.Suspicion
A. The nurse’s response is not therapeutic
because it does not recognize the client’s d.Delirium
needs but tries to make the client feel guilty 2.Nurse John is aware that a serious effect of
d.The client tells her parents about feelings of causes destruction of the mucous membranes
47.A client with dysthymic disorder reports to a D. These adaptations are associated with
opiate withdrawal which occurs after
nurse that his life is hopeless and will never
cessation or reduction of prolonged moderate
improve in the future. How can the nurse
or heavy use of opiates.
best respond using a cognitive approach?
B. Whether there is a suicide plan is a
a.Agree with the client’s painful feelings
criterion when assessing the client’s
b.Challenge the accuracy of the client’s belief
determination to make another attempt.
c.Deny that the situation is hopeless
A. Rapists are believed to harbor and act out
d.Present a cheerful attitude hostile feelings toward all women through the
48.A client with major depression has not act of rape.
verbalized problem areas to staff or peers C. These children often have nonsexual needs
since admission to a psychiatric unit. Which met by individual and are powerless to
activity should the nurse recommend to refuse.Ambivalence results in self-blame and
help this client express himself? also guilt.