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Psychiatric Nursing b.

Highly famous and important

Practice Test Part 1 c. Responsible for evil world


d. Connected to client unrelated to oneself
Marco approached Nurse Trish asking for
advice on how to deal with his alcohol A 20 year old client was diagnosed with

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

should… for a client diagnosed with bulimia is?


a. Encourage to avoid foods
a. Give her privacy
b. Identify anxiety causing situations
b. Allow her to urinate
c. Eat only three meals a day
c. Open the window and allow her to get some
d. Avoid shopping plenty of groceries
fresh air
10. Nurse Tony was caring for a 41 year old
d. Observe her
4. Nurse Maureen is developing a plan of care female client. Which behavior by the client

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

delusions of GRANDEUR. This diagnosis Alzheimer’s type and depression. The

reflects a belief that one is: symptom that is unrelated to depression


would be?
a. Being Killed
a. Apathetic response to the environment
b. “I don’t know” answer to questions a. Ask a family member to stay with the client at
c. Shallow of labile effect home temporarily
d. Neglect of personal hygiene b. Discuss the meaning of the client’s statement
13. Nurse Trish is working in a mental health with her
facility; the nurse priority nursing intervention c. Request an immediate extension for the client
for a newly admitted client with bulimia d. Ignore the clients statement because it’s a sign
nervosa would be to? of manipulation
a. Teach client to measure I & O Joey a client with antisocial personality
b. Involve client in planning daily meal disorder belches loudly. A staff member asks
c. Observe client during meals Joey, “Do you know why people find you
d. Monitor client continuously repulsive?” this statement most likely would
14. Nurse Patricia is aware that the major health elicit which of the following client reaction?
complication associated with intractable a. Depensiveness
anorexia nervosa would be? b. Embarrassment
a. Cardiac dysrhythmias resulting to cardiac arrest c. Shame
b. Glucose intolerance resulting in protracted d. Remorsefulness
hypoglycemia 20. Which of the following approaches would be
c. Endocrine imbalance causing cold amenorrhea most appropriate to use with a client suffering
d. Decreased metabolism causing cold intolerance from narcissistic personality disorder when
15. Nurse Anna can minimize agitation in a discrepancies exist between what the client
disturbed client by? states and what actually exist?
a. Increasing stimulation a. Rationalization
b. limiting unnecessary interaction b. Supportive confrontation
c. increasing appropriate sensory perception c. Limit setting
d. ensuring constant client and staff contact d. Consistency
16. A 39 year old mother with obsessive- 21. Cely is experiencing alcohol withdrawal
compulsive disorder has become immobilized exhibits tremors, diaphoresis and
by her elaborate hand washing and walking hyperactivity. Blood pressure is 190/87 mmhg
rituals. Nurse Trish recognizes that the basis and pulse is 92 bpm. Which of the
of O.C. disorder is often: medications would the nurse expect to
a. Problems with being too conscientious administer?
b. Problems with anger and remorse a. Naloxone (Narcan)
c. Feelings of guilt and inadequacy b. Benzlropine (Cogentin)
d. Feeling of unworthiness and hopelessness c. Lorazepam (Ativan)
17. Mario is complaining to other clients about not d. Haloperidol (Haldol)
being allowed by staff to keep food in his 22. Which of the following foods would the nurse
room. Which of the following interventions Trish eliminate from the diet of a client in
would be most appropriate? alcohol withdrawal?
a. Allowing a snack to be kept in his room a. Milk
b. Reprimanding the client b. Orange Juice
c. Ignoring the clients behavior c. Soda
d. Setting limits on the behavior d. Regular Coffee
18. Conney with borderline personality disorder 23. Which of the following would Nurse Hazel
who is to be discharge soon threatens to “do expect to assess for a client who is exhibiting
something” to herself if discharged. Which of late signs of heroin withdrawal?
the following actions by the nurse would be a. Yawning & diaphoresis
most important? b. Restlessness & Irritability
c. Constipation & steatorrhea
d. Vomiting and Diarrhea d. Denial
24. To establish open and trusting relationship 30. When working with a male client suffering
with a female client who has been phobia about black cats, Nurse Trish should
hospitalized with severe anxiety, the nurse in anticipate that a problem for this client would
charge should? be?
a. Encourage the staff to have frequent interaction a. Anxiety when discussing phobia
with the client b. Anger toward the feared object
b. Share an activity with the client c. Denying that the phobia exist
c. Give client feedback about behavior d. Distortion of reality when completing daily
d. Respect client’s need for personal space routines
25. Nurse Monette recognizes that the focus of 31. Linda is pacing the floor and appears
environmental (MILIEU) therapy is to: extremely anxious. The duty nurse
a. Manipulate the environment to bring about approaches in an attempt to alleviate Linda’s
positive changes in behavior anxiety. The most therapeutic question by the
b. Allow the client’s freedom to determine whether nurse would be?
or not they will be involved in activities a. Would you like to watch TV?
Role play life events to meet individual needs b. Would you like me to talk with you?
d. Use natural remedies rather than drugs to c. Are you feeling upset now?
control behavior d. Ignore the client
26. Nurse Trish would expect a child with a 32. Nurse Penny is aware that the symptoms that
diagnosis of reactive attachment disorder to: distinguish post traumatic stress disorder
a. Have more positive relation with the father than from other anxiety disorder would be:
the mother a. Avoidance of situation & certain activities that
b. Cling to mother & cry on separation resemble the stress
c. Be able to develop only superficial relation with b. Depression and a blunted affect when discussing
the others the traumatic situation
d. Have been physically abuse c. Lack of interest in family & others
27. When teaching parents about childhood d. Re-experiencing the trauma in dreams or
depression Nurse Trina should say? flashback
a. It may appear acting out behavior 33. Nurse Benjie is communicating with a male
b. Does not respond to conventional treatment client with substance-induced persisting
c. Is short in duration & resolves easily dementia; the client cannot remember facts
d. Looks almost identical to adult depression and fills in the gaps with imaginary
28. Nurse Perry is aware that language information. Nurse Benjie is aware that this is
development in autistic child resembles: typical of?
a. Scanning speech a. Flight of ideas
b. Speech lag b. Associative looseness
c. Shuttering c. Confabulation
d. Echolalia d. Concretism
29. A 60 year old female client who lives alone 34. Nurse Joey is aware that the signs &
tells the nurse at the community health symptoms that would be most specific for
center “I really don’t need anyone to talk to”. diagnosis anorexia are?
The TV is my best friend. The nurse a. Excessive weight loss, amenorrhea & abdominal
recognizes that the client is using the defense distension
mechanism known as? b. Slow pulse, 10% weight loss & alopecia
a. Displacement c. Compulsive behavior, excessive fears & nausea
b. Projection d. Excessive activity, memory lapses & an
c. Sublimation increased pulse
35. A characteristic that would suggest to Nurse d. Weak ego
Anne that an adolescent may have bulimia 41. A 23 year old client has been admitted with a
would be: diagnosis of schizophrenia says to the nurse
a. Frequent regurgitation & re-swallowing of food “Yes, its march, March is little woman”. That’s
b. Previous history of gastritis literal you know”. These statement illustrate:
c. Badly stained teeth a. Neologisms
d. Positive body image b. Echolalia
36. Nurse Monette is aware that extremely c. Flight of ideas
depressed clients seem to do best in settings d. Loosening of association
where they have: 42. A long term goal for a paranoid male client
a. Multiple stimuli who has unjustifiably accused his wife of
b. Routine Activities having many extramarital affairs would be to
c. Minimal decision making help the client develop:
d. Varied Activities a. Insight into his behavior
37. To further assess a client’s suicidal potential. b. Better self control
Nurse Katrina should be especially alert to the c. Feeling of self worth
client expression of: d. Faith in his wife
a. Frustration & fear of death 43. A male client who is experiencing disordered
b. Anger & resentment thinking about food being poisoned is
c. Anxiety & loneliness admitted to the mental health unit. The nurse
d. Helplessness & hopelessness uses which communication technique to
38. A nursing care plan for a male client with encourage the client to eat dinner?
bipolar I disorder should include: a. Focusing on self-disclosure of own food
a. Providing a structured environment preference
b. Designing activities that will require the client to b. Using open ended question and silence
maintain contact with reality c. Offering opinion about the need to eat
c. Engaging the client in conversing about current d. Verbalizing reasons that the client may not
affairs choose to eat
d. Touching the client provide assurance 44. Nurse Nina is assigned to care for a client
39. When planning care for a female client using diagnosed with Catatonic Stupor. When Nurse
ritualistic behavior, Nurse Gina must Nina enters the client’s room, the client is
recognize that the ritual: found lying on the bed with a body pulled into
a. Helps the client focus on the inability to deal a fetal position. Nurse Nina should?
with reality a. Ask the client direct questions to encourage
b. Helps the client control the anxiety talking
c. Is under the client’s conscious control b. Rake the client into the dayroom to be with
d. Is used by the client primarily for secondary other clients
gains c. Sit beside the client in silence and occasionally
40. A 32 year old male graduate student, who has ask open-ended question
become increasingly withdrawn and neglectful d. Leave the client alone and continue with
of his work and personal hygiene, is brought providing care to the other clients
to the psychiatric hospital by his parents. 45. Nurse Tina is caring for a client with delirium
After detailed assessment, a diagnosis of and states that “look at the spiders on the
schizophrenia is made. It is unlikely that the wall”. What should the nurse respond to the
client will demonstrate: client?
a. Low self esteem a. “You’re having hallucination, there are no
b. Concrete thinking spiders in this room at all”
c. Effective self boundaries
b. “I can see the spiders on the wall, but they are 50. Mario is admitted to the emergency room with
not going to hurt you” drug-included anxiety related to over
c. “Would you like me to kill the spiders” ingestion of prescribed antipsychotic
d. “I know you are frightened, but I do not see medication. The most important piece of
spiders on the wall” information the nurse in charge should obtain
46. Nurse Jonel is providing information to a initially is the:
community group about violence in the a. Length of time on the med.
family. Which statement by a group member b. Name of the ingested medication & the amount
would indicate a need to provide additional ingested
information? c. Reason for the suicide attempt
a. “Abuse occurs more in low-income families” d. Name of the nearest relative & their phone
b. “Abuser Are often jealous or self-centered” number
c. “Abuser use fear and intimidation” Answers and Rationale
d. “Abuser usually have poor self-esteem” Psychiatric Nursing
47. During electroconvulsive therapy (ECT) the
Practice Test Part 2
client receives oxygen by mask via positive
1.C. Total abstinence is the only
pressure ventilation. The nurse assisting with
effective treatment for alcoholism.
this procedure knows that positive pressure
2.A. Hallucinations are visual, auditory,
ventilation is necessary because?
gustatory, tactile or olfactory perceptions
a. Anesthesia is administered during the procedure
b. Decrease oxygen to the brain increases
that have no basis in reality.

confusion and disorientation 3.D. The Nurse has a responsibility to observe

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

counselor one is highly famous and important.

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

for being demanding. inhaling cocaine is?


B. The client must recognize the existence of a.Deterioration of nasal septum
the sub personalities so that interpretation b.Acute fluid and electrolyte imbalances
can occur. c.Extra pyramidal tract symptoms
D. An aloof, detached, withdrawn posture is a d.Esophageal varices
means of protecting the self by withdrawing 3.A tentative diagnosis of opiate addiction,
and maintaining a safe, emotional distance. Nurse Candy should assess a recently
C. The usual age of onset of schizophrenia is
hospitalized client for signs of opiate
adolescence or early childhood.
withdrawal. These signs would include:
A. Somatic delusion is a fixed false belief
a.Rhinorrhea, convulsions, subnormal
about one’s body.
temperature
C. These are the classic behaviors exhibited
b.Nausea, dilated pupils, constipation
by clients with a diagnosis of schizophrenia.
c.Lacrimation, vomiting, drowsiness
D. The fetal position represents regressed
behavior. Regression is a way of responding to d.Muscle aches, papillary constriction, yawning

overwhelming anxiety. 4.A 48 year old male client is brought to the

B. This provides a stimulus that competes psychiatric emergency room after


with and reduces hallucination. attempting to jump off a bridge. The client’s
D. Auditory hallucinations are most wife states that he lost his job several
troublesome when environmental stimuli are months ago and has been unable to find
diminished and there are few competing another job. The primary nursing
distractions. intervention at this time would be to assess
A. Projection is a mechanism in which inner for:
thoughts and feelings are projected onto the
a.A past history of depression
environment, seeming to come from outside
b.Current plans to commit suicide
the self rather than from within.
c.The presence of marital difficulties
B. This will help the client develop self-
d.Feelings of excessive failure
esteem and reduce the use of paranoid
5.Before helping a male client who has been
ideation.
sexually assaulted, nurse Maureen should
B. Denial is a method of resolving conflict or
escaping unpleasant realities by ignoring their recognize that the rapist is motivated by

existence. feelings of:

C. Alcohol is a central nervous system a.Hostility


depressant. These symptoms are the body’s b.Inadequacy
neurologic adaptation to the withdrawal of c.Incompetence
alcohol. d.Passion
6.When working with children who have been b.Understands the reason why frequent calls to
sexually abused by a family member it is the staff were made
important for the nurse to understand that c.Discuss concerns regarding the emotional
these victims usually are overwhelmed with condition that required hospitalizations
feelings of: d.No longer calls the nursing staff for
a.Humiliation assistance
b.Confusion 11.Nurse John is aware that the therapy that
c.Self blame has the highest success rate for people with
d.Hatred phobias would be:
7.Joy who has just experienced her a.Psychotherapy aimed at rearranging
second spontaneous abortion expresses maladaptive thought process
anger towards her physician, the hospital b.Psychoanalytical exploration of repressed
and the “rotten nursing care”. When conflicts of an earlier development phase
assessing the situation, the nurse c.Systematic desensitization using relaxation
recognizes that the client may be using the technique
coping mechanism of: d.Insight therapy to determine the origin of the
a.Projection anxiety and fear
b.Displacement 12.When nurse Hazel considers a client’s
c.Denial placement on the continuum of anxiety, a
d.Reaction formation key in determining the degree of anxiety
8.The most critical factor for nurse Linda to being experienced is the client’s:
determine during crisis intervention would a.Perceptual field
be the client’s: b.Delusional system
a.Available situational supports c.Memory state
b.Willingness to restructure the personality d.Creativity level
c.Developmental theory 13.In the diagnosis of a possible pervasive
d.Underlying unconscious conflict developmental autistic disorder. The nurse
9.Nurse Trish suggests a crisis intervention would find it most unusual for a 3 year old
group to a client experiencing a child to demonstrate:
developmental crisis.These groups are a.An interest in music
successful because the: b.An attachment to odd objects
a.Crisis intervention worker is a psychologist c.Ritualistic behavior
and understands behavior patterns d.Responsiveness to the parents
b.Crisis group supplies a workable solution to 14.Malou with schizophrenia tells Nurse
the client’s problem Melinda, “My intestines are rotted from
c.Client is encouraged to talk about personal worms chewing on them.” This statement
problems indicates a:
d.Client is assisted to investigate alternative a.Jealous delusion
approaches to solving the identified b.Somatic delusion
problem c.Delusion of grandeur
10.Nurse Ronald could evaluate that the staff’s d.Delusion of persecution
approach to setting limits for a demanding, 15.Andy is admitted to the psychiatric unit with
angry client was effective if the client: a diagnosis of borderline personality
a.Apologizes for disrupting the unit’s routine disorder. Nurse Hilary should expects the
when something is needed assessment to reveal:
a.Coldness, detachment and lack of tender 20.Initial interventions for Marco with acute
feelings anxiety include all except which of the
b.Somatic symptoms following?
c.Inability to function as responsible parent a.Touching the client in an attempt to comfort
d.Unpredictable behavior and intense him
interpersonal relationships b.Approaching the client in calm, confident
16.PROPRANOLOL (Inderal) is used in the manner
mental health setting to manage which of c.Encouraging the client to verbalize feelings
the following conditions? and concerns
a.Antipsychotic – induced akathisia and anxiety d.Providing the client with a safe, quiet and
b.Obsessive – compulsive disorder (OCD) to private place
reduce ritualistic behavior 21.Nurse Jessie is assessing a client suffering
c.Delusions for clients suffering from from stress and anxiety. A common
schizophrenia physiological response to stress and anxiety
d.The manic phase of bipolar illness as a mood is:
stabilizer a.Uticaria
17.Which medication can control the extra b.Vertigo
pyramidal effects associated with c.Sedation
antipsychotic agents? d.Diarrhea
a.Clorazepate (Tranxene) 22.When performing a physical examination on
b.Amantadine (Symmetrel) a female anxious client, nurse Nelli would
c.Doxepin (Sinequan) expect to find which of the following effects
d.Perphenazine (Trilafon) produced by the parasympathetic system?
18.Which of the following statements should be a.Muscle tension
included when teaching clients about b.Hyperactive bowel sounds
monoamine oxidase inhibitor (MAOI) c.Decreased urine output
antidepressants? d.Constipation
a.Don’t take aspirin or nonsteroidal anti- 23.Which of the following drugs have been
inflammatory drugs (NSAIDs) known to be effective in treating obsessive-
b.Have blood levels screened weekly for compulsive disorder (OCD)?
leucopenia a.Divalproex (depakote) and Lithium (lithobid)
c.Avoid strenuous activity because of the b.Chlordiazepoxide (Librium) and diazepam
cardiac effects of the drug (valium)
d.Don’t take prescribed or over the counter c.Fluvoxamine (Luvox) and clomipramine
medications without consulting the (anafranil)
physician d.Benztropine (Cogentin) and diphenhydramine
19.Kris periodically has acute panic (benadryl)
attacks. These attacks are unpredictable 24.Tony with agoraphobia has been symptom-
and have no apparent association with a free for 4 months. Classic signs and
specific object or situation. During an acute symptoms of phobia include:
panic attack, Kris may experience: a.Severe anxiety and fear
a.Heightened concentration b.Withdrawal and failure to distinguish reality
b.Decreased perceptual field from fantasy
c.Decreased cardiac rate c.Depression and weight loss
d.Decreased respiratory rate d.Insomnia and inability to concentrate
25.Which nursing action is most appropriate d.Transitory short and long term memory loss
when trying to diffuse a client’s impending and confusion
violent behavior? 30.Barbara with bipolar disorder is being
a.Place the client in seclusion treated with lithium for the first time. Nurse
b.Leaving the client alone until he can talk Clint should observe the client for which
about his feelings common adverse effect of lithium?
c.Involving the client in a quiet activity to a.Polyuria
divert attention b.Seizures
d.Helping the client identify and express c.Constipation
feelings of anxiety and anger d.Sexual dysfunction
26.Rosana is in the second stage of Alzheimer’s 31.Nurse Fred is assessing a client who has
disease who appears to be in pain. Which just been admitted to the ER
question by Nurse Jenny would best elicit department. Which signs would suggest an
information about the pain? overdose of an antianxiety agent?
a.“Where is your pain located?” a.Suspiciousness, dilated pupils and incomplete
b.“Do you hurt? (pause) “Do you hurt?” BP
c.“Can you describe your pain?” b.Agitation, hyperactivity and grandiose
d.“Where do you hurt?” ideation
27.Nursing preparation for a client undergoing c.Combativeness, sweating and confusion
electroconvulsive therapy (ECT) resemble d.Emotional lability, euphoria and impaired
those used for: memory
a.General anesthesia 32.Discharge instructions for a male client
b.Cardiac stress testing receiving tricyclic antidepressants include
c.Neurologic examination which of the following information?
d.Physical therapy a.Restrict fluids and sodium intake
28.Jose who is receiving monoamine oxidase b.Don’t consume alcohol
inhibitor antidepressant should avoid c.Discontinue if dry mouth and blurred vision
tyramine, a compound found in which of occur
the following foods? d.Restrict fluid and sodium intake
a.Figs and cream cheese 33.Important teaching for women in their
b.Fruits and yellow vegetables childbearing years who are receiving
c.Aged cheese and Chianti wine antipsychotic medications includes which of
d.Green leafy vegetables the following?
29.Erlinda, age 85, with major depression a.Increased incidence of dysmenorrhea while
undergoes a sixth electroconvulsive therapy taking the drug
(ECT) treatment. When assessing the client b.Occurrence of incomplete libido due to
immediately after ECT, the nurse expects to medication adverse effects
find: c.Continuing previous use of contraception
a.Permanent short-term memory loss and during periods of amenorrhea
hypertension d.Instruction that amenorrhea is irreversible
b.Permanent long-term memory loss and 34.A client refuses to remain on psychotropic
hypomania medications after discharge from an
c.Transitory short-term memory loss and inpatient psychiatric unit. Which
permanent long-term memory loss information should the community health
nurse assess first during the initial follow- client tells the nurse, “I’m no good. I’m a
up with this client? failure”. According to cognitive theory,
a.Income level and living arrangements these statements reflect:
b.Involvement of family and support systems a.Learned behavior
c.Reason for inpatient admission b.Punitive superego and decreased self-esteem
d.Reason for refusal to take medications c.Faulty thought processes that govern
35.The nurse understands that the therapeutic behavior
effects of typical antipsychotic medications d.Evidence of difficult relationships in the work
are associated with which neurotransmitter environment
change? 40.The nurse describes a client as anxious.
a.Decreased dopamine level Which of the following statement about
b.Increased acetylcholine level anxiety is true?
c.Stabilization of serotonin a.Anxiety is usually pathological
d.Stimulation of GABA b.Anxiety is directly observable
36.Which of the following best explains why c.Anxiety is usually harmful
tricyclic antidepressants are used with d.Anxiety is a response to a threat
caution in elderly patients? 41.A client with a phobic disorder is treated by
a.Central Nervous System effects systematic desensitization. The nurse
b.Cardiovascular system effects understands that this approach will do
c.Gastrointestinal system effects which of the following?
d.Serotonin syndrome effects a.Help the client execute actions that are
37.A client with depressive symptoms is given feared
prescribed medications and talks with his b.Help the client develop insight into irrational
therapist about his belief that he is fears
worthless and unable to cope with life. c.Help the client substitutes one fear for
Psychiatric care in this treatment plan is another
based on which framework? d.Help the client decrease anxiety
a.Behavioral framework 42.Which client outcome would best indicate
b.Cognitive framework successful treatment for a client with an
c.Interpersonal framework antisocial personality disorder?
d.Psychodynamic framework a.The client exhibits charming behavior when
38.A nurse who explains that a client’s around authority figures
psychotic behavior is unconsciously b.The client has decreased episodes of
motivated understands that the client’s impulsive behaviors
disordered behavior arises from which of c.The client makes statements of self-
the following? satisfaction
a.Abnormal thinking d.The client’s statements indicate no remorse
b.Altered neurotransmitters for behaviors
c.Internal needs 43.The nurse is caring for a client with an
d.Response to stimuli autoimmune disorder at a medical clinic,
39.A client with depression has been where alternative medicine is used as an
hospitalized for treatment after taking a adjunct to traditional therapies. Which
leave of absence from work. The client’s information should the nurse teach the
employer expects the client to return to client to help foster a sense of control over
work following inpatient treatment. The his symptoms?
a.Pathophysiology of disease process b.Basketball game with peers on the unit
b.Principles of good nutrition c.Reading a self-help book on depression
c.Side effects of medications d.Watching movie with the peer group
d.Stress management techniques 49.The home health psychiatric nurse visits a
44.Which of the following is the most client with chronic schizophrenia who was
distinguishing feature of a client with an recently discharged after a prolong stay in
antisocial personality disorder? a state hospital. The client lives in a
a.Attention to detail and order boarding home, reports no family
b.Bizarre mannerisms and thoughts involvement, and has little social
c.Submissive and dependent behavior interaction. The nurse plan to refer the
d.Disregard for social and legal norms client to a day treatment program in order
45.Which nursing diagnosis is most appropriate to help him with:
for a client with anorexia nervosa who a.Managing his hallucinations
expresses feelings of guilt about not b.Medication teaching
meeting family expectations? c.Social skills training
a.Anxiety d.Vocational training
b.Disturbed body image 50.Which activity would be most appropriate
c.Defensive coping for a severely withdrawn client?
d.Powerlessness a.Art activity with a staff member
46.A nurse is evaluating therapy with the b.Board game with a small group of clients
family of a client with anorexia nervosa. c.Team sport in the gym
Which of the following would indicate that d.Watching TV in the dayroom
the therapy was successful? Answers and Rationale
a.The parents reinforced increased decision Psychiatric Nursing Part
making by the client 3
b.The parents clearly verbalize their B. There is no set of symptoms associated
expectations for the client with cocaine withdrawal, only the depression
c.The client verbalizes that family meals are that follows the high caused by the drug.
now enjoyable A. Cocaine is a chemical that when inhaled,

d.The client tells her parents about feelings of causes destruction of the mucous membranes

low-self esteem of the nose.

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.

a.Art therapy in a small group


B. The client’s anger over the abortion is client checks with his physician and
shifted to the staff and the hospital because pharmacist before taking any other
she is unable to deal with the abortion at this medications.
time. B. Panic is the most severe level of
A. Personal internal strength and supportive anxiety. During panic attack, the client
individuals are critical factors that can be experiences a decrease in the perceptual
employed to assist the individual to cope with field, becoming more focused on self, less
a crisis. aware of surroundings and unable to process
D. Crisis intervention group helps client information from the environment. The
reestablish psychologic equilibrium by decreased perceptual field contributes to
assisting them to explore new alternatives for impaired attention andinability to concentrate.
coping. It considers realistic situations using A. The emergency nurse must establish
rational and flexible problem solving methods. rapport and trust with the anxious client
C. This would document that the client feels before using therapeutic touch. Touching an
comfortable enough to discuss the problems anxious client may actually increase anxiety.
that have motivated the behavior. D. Diarrhea is a common physiological
C. The most successful therapy for people response to stress and anxiety.
with phobias involves behavior modification B. The parasympathetic nervous system
techniques using desensitization. would produce incomplete G.I. motility
A. Perceptual field is a key indicator of resulting in hyperactive bowel sounds,
anxiety level because the perceptual fields possibly leading to diarrhea.
narrow as anxiety increases. C. The antidepressants fluvoxamine and
D. One of the symptoms of autistic child clomipramine have been effective in the
displays a lack of responsiveness to treatment of OCD.
others. There is little or no extension to the A. Phobias cause severe anxiety (such as
external environment. panic attack) that is out of proportion to the
B. Somatic delusions focus on bodily functions threat of the feared object or
or systems and commonly include delusion situation. Physical signs and symptoms of
about foul odor emissions, insect phobias include profuse sweating, poor motor
manifestations, internal parasites and control, tachycardia and elevated B.P.
misshapen parts. D. In many instances, the nurse can diffuse
D. A client with borderline personality impending violence by helping the client
displays a pervasive pattern of unpredictable identify and express feelings of anger and
behavior, mood and self image. Interpersonal anxiety. Such statement as “What happened
relationships may be intense and unstable and to get you this angry?” may help the client
behavior may be inappropriate and impulsive. verbalizes feelings rather than act on them.
A. Propranolol is a potent beta adrenergic B. When speaking to a client with Alzheimer’s
blocker and producing a sedating effect, disease, the nurse should use close-ended
therefore it is used to treat antipsychotic questions.Those that the client can answer
induced akathisia and anxiety. with “yes” or “no” whenever possible and
B. Amantadine is an anticholinergic drug used avoid questions that require the client to
to relive drug-induced extra pyramidal make choices. Repeating the question aids
adverse effects such as muscle weakness, comprehension.
involuntary muscle movements, A. The nurse should prepare a client for ECT
pseudoparkinsonism and tar dive dyskinesia. in a manner similar to that for general
D. MAOI antidepressants when combined with anesthesia.
a number of drugs can cause life-threatening C. Aged cheese and Chianti wine contain high
hypertensive crisis. It’s imperative that a concentrations of tyramine.
D. ECT commonly causes transitory short and Therefore, they are used with caution in
long term memory loss and confusion, elderly clients who may have increased risk
especially in geriatric clients. It rarely results factors for cardiac problems because of their
in permanent short and long term memory age and other medical conditions. The
loss. remaining side effects would apply to any
A. Polyuria commonly occurs early in the client taking a TCA and are not particular to
treatment with lithium and could result in an elderly person.
fluid volume deficit. B. Cognitive thinking therapy focuses on the
D. Signs of anxiety agent overdose include client’s misperceptions about self, others and
emotional lability, euphoria and impaired the world that impact functioning and
memory. contribute to symptoms. Using medications to
B. Drinking alcohol can potentiate the alter neurotransmitter activity is a
sedating action of tricyclic psychobiologic approach to treatment. The
antidepressants. Dry mouth and blurred other answer choices are frameworks for
vision are normal adverse effects of tricyclic care, but hey are not applicable to this
antidepressants. situation.
C. Women may experience amenorrhea, C. The concept that behavior is motivated and
which is reversible, while taking has meaning comes from the psychodynamic
antipsychotics. Amenorrhea doesn’t indicate framework. According to this perspective,
cessation of ovulation thus, the client can still behavior arises from internal wishes or needs.
be pregnant. Much of what motivates behavior comes from
D. The first are for assessment would be the the unconscious. The remaining responses do
client’s reason for refusing medication. The not address the internal forces thought to
client may not understand the purpose for the motivate behavior.
medication, may be experiencing distressing C. The client is demonstrating faulty thought
side effects, or may be concerned about the processes that are negative and that govern
cost of medicine. In any case, the nurse his behavior in his work situation – issues that
cannot provide appropriate intervention are typically examined using a cognitive
before assessing the client’s problem with the theory approach. Issues involving learned
medication. The patient’s income level, living behavior are best explored through behavior
arrangements, and involvement of family and theory, not cognitive theory. Issues involving
support systems are relevant issues following ego development are the focus
determination of the client’s reason for of psychoanalytic theory. Option 4 is incorrect
refusing medication. The nurse providing because there is no evidence in this situation
follow-up care would have access to the that the client has conflictual relationships in
client’s medical record and should already the work environment.
know the reason for inpatient admission. D. Anxiety is a response to a threat arising
A. Excess dopamine is thought to be the from internal or external stimuli.
chemical cause for psychotic thinking. The A. Systematic desensitization is a behavioral
typical antipsychotics act to block dopamine therapy technique that helps clients with
receptors and therefore decrease the amount irrational fears and avoidance behavior to face
of neurotransmitter at the synapses. The the thing they fear, without experiencing
typical antipsychotics do not increase anxiety. There is no attempt to promote
acetylcholine, stabilize serotonin, stimulate insight with this procedure, and the client will
GABA. not be taught to substitute one fear for
B. The TCAs affect norepinephrine as well as another. Although the client’s anxiety may
other neurotransmitters, and thus have decrease with successful confrontation of
significant cardiovascular side effects. irrational fears, the purpose of the procedure
is specifically related to performing activities A. One of the core issues concerning the
that typically are avoided as part of the family of a client with anorexia is control. The
phobic response. family’s acceptance of the client’s ability to
B. A client with antisocial personality disorder make independent decisions is key to
typically has frequent episodes of acting successful family intervention. Although the
impulsively with poor ability to delay self- remaining options may occur during the
gratification. Therefore, decreased frequency process of therapy, they would not necessarily
of impulsive behaviors would be evidence of indicate a successful outcome; the central
improvement. Charming behavior when family issues of dependence and
around authority figures and statements independence are not addresses on these
indicating no remorse are examples of responses.
symptoms typical of someone with this B. Use of cognitive techniques allows the
disorder and would not indicate successful nurse to help the client recognize that this
treatment. Self-satisfaction would be viewed negative beliefs may be distortions and that,
as a positive change if the client expresses by changing his thinking, he can adopt more
low self-esteem; however this is not a positive beliefs that are realistic and hopeful.
characteristic of a client with antisocial Agreeing with the client’s feelings and
personality disorder. presenting a cheerful attitude are not
D. In autoimmune disorders, stress and the consistent with a cognitive approach and
response to stress can exacerbate symptoms. would not be helpful in this situation. Denying
Stress management techniques can help the the client’s feelings is belittling and may
client reduce the psychological response to convey that the nurse does not understand
stress, which in turn will help reduce the the depth of the client’s distress.
physiologic stress response. This will afford A. Art therapy provides a nonthreatening
the client an increased sense of control over vehicle for the expression of feelings, and use
his symptoms. The nurse can address the of a small group will help the client become
remaining answer choices in her teaching comfortable with peers in a group setting.
about the client’s disease and treatment; Basketball is a competitive game that requires
however, knowledge alone will not help the energy; the client with major depression is
client to manage his stress effectively enough not likely to participate in this activity.
to control symptoms. Recommending that the client read a self-help
D. Disregard for established rules of society is book may increase, not decrease his isolation.
the most common characteristic of a client Watching movie with a peer group does not
with antisocial personality disorder. Attention guarantee that interaction will occur;
to detail and order is characteristic of therefore, the client may remain isolated.
someone with obsessive compulsive disorder. C. Day treatment programs provide clients
Bizarre mannerisms and thoughts are with chronic, persistent mental illness training
characteristics of a client with schizoid or in social skills, such as meeting and greeting
schizotypal disorder. Submissive and people, asking questions or directions, placing
dependent behaviors are characteristic of an order in a restaurant, taking turns in a
someone with a dependent personality. group setting activity. Although management
D. The client with anorexia typically feels of hallucinations and medication teaching may
powerless, with a sense of having little control also be part of the program offered in a day
over any aspect of life besides eating treatment, the nurse is referring the client in
behavior. Often, parental expectations and this situation because of his need for
standards are quite high and lead to the socialization skills. Vocational training
clients’ sense of guilt over not measuring up. generally takes place in a rehabilitation
facility; the client described in this situation
would not be a candidate for this service.
A. The best approach with a withdrawn client
is to initiate brief, nondemanding activities on
a one-to-one basis. This approach gives the
nurse an opportunity to establish a trusting
relationship with the client. A board game
with a group clients or playing a team sport in
the gym may overwhelm a severely
withdrawn client. Watching TV is a solitary
activity that will reinforce the client’s
withdrawal from others.

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