Psych NCLEX Exam for Stress, Anxiety, Eating & Mind-Body Disorders

1. Adam is a 20-year-old student diagnosed of having obsessive-compulsive behavior. A psychiatrist prescribes clomipramine (Anafranil) to treat his condition. Nurse Anna understands the rationale for this treatment is that the clomipramine:

  1.  increases dopamine levels.
  2.  increases serotonin levels.
  3.  decreases norepinephrine levels.
  4.  decreases GABA levels.

2. Nurse Sarah is developing a care plan for a female client with post-traumatic stress disorder. Which of the following would she do initially?

  1. Instruct the client to use distraction techniques to cope with flashbacks.
  2. Encourage the client to put the past in proper perspective.
  3. Encourage the client to verbalize thoughts and feelings about the trauma.
  4. Avoid discussing the traumatic event with client.

3. A group of community nurses sees and plans care for various clients with different types of problems. Which of the following clients would they consider the most vulnerable to post-traumatic stress disorder?

  1. An 8 year-old boy with asthma who has recently failed a grade in school
  2. A 20 year-old college student with DM who experienced date rape
  3. A 40 year-old widower who has recently lost his wife to cancer
  4. A wife of an individual with a severe substance abuse problem

4. Which outcome is most appropriate for Francis who has a dissociative disorder?

  1. Francis will deal with uncomfortable emotions on a conscious level.
  2. Francis will modify stress with the use of relaxation techniques.
  3. Francis will identify his anxiety responses.
  4. Francis will use problem-solving strategies when feeling stressed.

5. The psychiatric nurse uses cognitive-behavioral techniques when working with a client who experiences panic attacks. Which of the following techniques are common to this theoretical framework? Select all that apply.

  1. Administering anti-anxiety medication as prescribed
  2. Encouraging the client to restructure thoughts
  3. Helping the client to use controlled relaxation breathing
  4. Helping the client examine evidence of stressors
  5. Questioning the client about early childhood relationships
  6. Teaching the client about anxiety and panic

6. Marty is pacing and complains of racing thoughts. Nurse Lally asks the client if something upsetting happened, and Marty’s response is vague and not focused on the question. Nurse Lally assess Marty’s level of anxiety as:

  1. mild.
  2. moderate.
  3. severe.
  4. panic.

7. Nurse Martha is teaching her students about anxiety medications, she explains that benzodiazepines affect which brain chemical?

  1. Acetylcholine
  2. Gamma-aminobutyric acid (GABA)
  3. Norepinephrine
  4. Serotonin

8. Nurse Mandy is assessing a client for recent stressful life events. She recognizes that stressful life events are both:

  1. desirable and growth-promoting.
  2. positive and negative.
  3. undesirable and harmful.
  4. predictable and controllable.

9. During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events?

  1. Avoidance of stress is an important goal for living.
  2. Control over one’s response to stress is possible.
  3. Most people have no control over their level of stress.
  4. Significant others are important to provide care and concern.

10. Genevieve only attends social events when a family member is also present. She exhibits behavior typical of which anxiety disorder?

  1. Agoraphobia
  2. Generalized anxiety disorder
  3. Obsessive-compulsive disorder
  4. Post-traumatic stress disorder

11. Mr. Johnson is newly admitted to a psychiatric unit because of severe obsessive compulsive behavior. Which initial response by the nurse would be most therapeutic for him?

  1. Accepting the client’s ritualistic behaviors
  2. Challenging the client’s need for rituals
  3. Expressing concern about the harmfulness of the client’s rituals
  4. Limiting the client’s rituals that are excessive

12. Nurse Vicky is assessing a newly admitted client for symptoms of post-traumatic stress disorder (PTSD). Which symptoms are typically seen with this diagnosis? Select all that apply.

  1. Anger with numbing of other emotions
  2. Exaggerated startle response
  3. Feeling that one is having a heart attack
  4. Frequent thoughts about contamination
  5. Frequent nightmares
  6. Survivor’s guilt

13. Jordanne is a client with a fear of air travel. She is being treated in a mental institution for phobic disorder. The treatment method involves systematic desensitization. The nurse would consider the treatment successful if:

  1. Jordanne plans a trip requiring air travel.
  2. Jordanne takes a short trip in an airplane.
  3. Jordanne recognizes the unrealistic nature of the fear of riding on airplanes.
  4. Jordanne verbalizes a decreased fear about air travel.

14. Nurse Kerrick observes Toni who is hospitalized on an eating disorder unit during mealtimes and for 1 hour after eating. An explanation for this intervention is:

  1. to develop trusting relationship.
  2. to maintain focus on importance of nutrition.
  3. to prevent purging behaviors.
  4. to reinforce the behavioral contact.

15. Marlyn is diagnosed of anorexia nervosa and is admitted in the special eating disorder unit. The initial treatment priority for her is:

  1. to determine her current body image.
  2. to identify family interaction patterns.
  3. to initiate a refeeding program.
  4. to promote the client’s independence.

16. The nurse evaluates the treatment of Mrs. Montez with somatoform disorder as successful if:

  1. Mrs. Montez practices self-medication rather than changing health care providers.
  2. Mrs. Montez recognizes that physical symptoms increase anxiety level.
  3. Mrs. Montez researches treatment protocols for various illnesses.
  4. Mrs. Montez verbalizes anxiety directly rather than displacing it.

17. Which of the following attitudes from a nurse would hinder a discussion with an adolescent client about sexuality?

  1. Accepting
  2. Matter-of-fact
  3. Moralistic
  4. Nonjudgemental

18. Nurse David is planning a psychoeducational discussion for a group of adolescent clients with anorexia nervosa. Which of the following topics would Nurse David select to enhance understanding about central issues in this disorder?

  1. Anger management
  2. Parental expectations
  3. Peer pressure and substance abuse
  4. Self-control and self-esteem

19. Nurse Ginia understands that her client Glenda who is bulimic feels shame and guilt over binge eating and purging. This disorder is therefore considered:

  1. ego-distorting.
  2. ego-dystonic.
  3. ego-enhancing.
  4. ego-syntonic.

20. The psychoanalytic theory explains the etiology of anorexia nervosa as:

  1. the achievement of secondary gain through control of eating.
  2. a conflict between mother and child over separation and individualization.
  3. family dynamics that lead to enmeshment of members.
  4. the incorporation of thinness as an ideal body image.

21. The school nurse assesses for anorexia nervosa in an adolescent girl. Which of the following findings are characteristic of this disorder? Select all that apply.

  1. Bradycardia
  2. Hypotension
  3. Chronic pain in one or more sites
  4. Fear of having a serious illness
  5. Irregular or absent menses
  6. Refusal to maintain minimally normal weight

22. Mr. Bartowski who is newly diagnosed with rheumatoid arthritis asks the community nurse how stress can affect his disease. The nurse would explain that:

  1. the psychological experience of stress will not affect symptoms of physical disease.
  2. psychological stress can cause painful emotions, which are harmful to a person with an illness.
  3. stress can overburden the body’s immune system, and therefore one can experience increased symptoms.
  4. the body’s stress response is stimulated when there are major disruptions in one’s life.

23. During a mother’s class, the nurse who is teaching the participants on stress management is questioned about the use of alternative treatments, such as herbal therapy and therapeutic touch. She explains that the advantage of these methods would include all of the following except:

  1. they are congruent with many cultural belief systems.
  2. they encourage the consumer to take an active role in health management.
  3. they promote interrelationships within the mind-body-spirit.
  4. they usually work better than traditional medical practice.

24. David is preoccupied with numerous bodily complaints even after a careful diagnostic workup reveals no physiologic problems. Which nursing intervention would be therapeutic for him?

  1. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems.
  2. Challenge the physical complaints by confronting the client with the normal diagnostic findings.
  3. Ignore the client’s complaints, but request that the client keep a list of all symptoms.
  4. Listen to the client’s complaints carefully, and question him about specific symptoms.

25. Nurse Kenzo is teaching a client about sertraline (Zoloft), which has been prescribed for depression. A significant side effect is interference with sexual arousal by inhibiting erectile function. How should the Nurse Kenzo approach this topic?

  1. Nurse Kenzo should avoid mentioning the sexual side effects to prevent the client from having anxiety about potential erectile problems.
  2. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed.
  3. Nurse Kenzo should explain that the client’s sexual desire will probably decrease while on this medication.
  4. Nurse Kenzo should tell the client that sexual side effects are expected, but that they will decrease when his depression lifts.
Answers and Rationales
  1. Answer: B. increases serotonin levels. According to the psychobiologic theory, dysregulation of the neurotransmitter serotonin is thought to contribute to obsessive-compulsive behavior. Clomipramine (Anafranil) is used to increase serotonin levels, thereby decreasing the need for obsessive-compulsive behaviors.
  2. Answer: C. Encourage the client to verbalize thoughts and feelings about the trauma. Planning care for a client with post-traumatic stress disorder would involve helping the client to verbalize thoughts and feelings about the trauma. This will help the client work through the strong emotions connected with the trauma and, therefore foster the belief that she is able to cope. Avoiding discussion and using distraction techniques would be inappropriate. Option B may be possible later, after the client is able to verbalize strong emotions.
  3. Answer: B. A 20 year-old college student with DM who experienced date rape. Post-traumatic stress disorder is caused by the the experience of severe, specific trauma. Rape is a severely traumatic event. Although the situations in options A, C, and D are certainly stressful, they are not at the level of severe trauma.
  4. Answer: A. Francis will deal with uncomfortable emotions on a conscious level. Dissociative disorders occur when traumatic events are beyond an individual’s recall because this memories have been “blocked” from conscious awareness. Bringing the feelings associated with these events into conscious awareness and coping with these feelings will decrease the need for dissociation.
  5. Answer: B, C, D, F. These are all appropriate techniques based on the framework of cognitive-behavioral therapy.
  6. Answer: C. severe. When the client has difficulty focusing and exhibits excessive motor activity, the level of anxiety is severe. Mild anxiety is characterized by increased alertness and problem-solving ability. Moderate anxiety is characterized by the ability to focus on central concerns but the inability to problem-solve without assistance. Panic level of anxiety is characterized by complete inability to focus and reduced perceptions.
  7. Answer: B. Gamma-aminobutyric acid (GABA). Antianxiety medications stimulate the neurotransmitter GABA, which is a chemical associated with relaxation. The other options are not affected by benzodiazepines.
  8. Answer: B. positive and negative. The concept of stressful life event is based on the research of Holmes and Rahe, who found that both positive and negative changes result on stress. Stressful life events are not always desirable and growth promoting, nor are they always undesirable and harmful. Some stressful life events can be predictable and controllable; however, many life events are entirely unpredictable.
  9. Answer: B. Control over one’s response to stress is possible. When learning to manage stress, clients find it helpful to believe that they have the ability to control their response to it. It is impossible to avoid stress, which is a normal life experience. Stress can be positive and growth enhancing as well as harmful. The belief that one has some control is the significant factor in minimizing stress response.
  10. Answer: A. Agoraphobia. Agoraphobia is a disorder characterized by avoidance of situations in which escape may not be possible or help may be unavailable.
  11. Answer: A. Accepting the client’s ritualistic behaviors. It is important to accept the client’s need to perform ritualistic behaviors in this situation; admission to a psychiatric unit is stressful, and this client will tend to increase rituals when anxious. Other options are not appropriate for a newly admitted client.
  12. Answer: A, B, E, F. These are common symptoms of PTSD. Option C is common in panic disorder, and option D is characteristic of obsessive-compulsive disorder.
  13. Answer: B. Jordanne takes a short trip in an airplane. Systematic desensitization is a behavioral technique in which the client with a specific phobia is gradually able to work through hierarchal fears until the most fearful situation is encountered. In this case, the most fearful is riding an airplane. The responses in options A and D may occur earlier in treatment, but not indicative of success. Generally, a phobic individual recognizes that his fear is disproportionate to the things he fears.
  14. Answer: C. to prevent purging behaviors. Toni may experience increased anxiety during treatment and, therefore, may resume behaviors designed to prevent weight gain, such as vomiting or excessive exercise.
  15. Answer: C. to initiate a refeeding program. The physical need to reestablish near-normal weight takes priority because of the physiologic, life-threatening consequences of anorexia.
  16. Answer: D. Mrs. Montez verbalizes anxiety directly rather than displacing it. Mrs. Montez with somatoform disorder unconsciously displaces anxiety onto physical symptoms. The ability to recognize and verbalize anxious feelings directly rather than displacing them is a criterion of treatment success. Options A and C indicate continuation of the problem.
  17. Answer: C. Moralistic. Adolescents are not likely to feel free to ask questions and participate in a discussion if the nurse has a moralistic attitude toward sexual issues. Having an accepting, matter-of-fact, or nonjudgmental attitude will be helpful in allowing adolescents to feel comfortable discussing sexual issues.
  18. Answer: D. Self-control and self-esteem. Self-control and self-esteem are central issues for clients with eating disorders. Such clients feel a loss of self-control over their life and experience diminished self-esteem and severe doubts about their self-worth.
  19. Answer: B. ego-dystonic. An ego dystonic disorder is one in which the client views behaviors or symptoms as incongruent with self-image and therefore feels guilt, shame, and distress about the symptoms. An ego-syntonic disorder is one which the client views behaviors as congruent with her self-image (as in anorexia nervosa).
  20. Answer: B. a conflict between mother and child over separation and individualization. According to psychoanalytic theory, early mother-child dynamics lead to difficulty with a child establishing a sense of separateness from the mother. Control of eating becomes one area in which the child establishes a sense of independence. Option A is the behavioral view of anorexia nervosa. Option C reflects the family theory view of anorexia nervosa, which deals with the issue of lack of generational boundaries. Option D characterizes the sociocultural view of anorexia nervosa, which identifies thinness as being a culturally determined ideal.
  21. Answer: A, B, E, F. These are all characteristics of anorexia nervosa. Option C is common for somatoform pain disorder and option D is common in hypochondriasis.
  22. Answer: C. Stress can overburden the body’s immune system, and therefore one can experience increased symptoms. The stress response causes stimulation of the hypothalamic-pituitary-adrenal axis, which can further compromise an immune system that has been activated by the autoimmune disorder of rheumatoid arthritis. Consequently, the client can expect disease symptoms to exacerbate when under stress.
  23. Answer: D. they usually work better than traditional medical practice. Complementary alternative medicine treatments are often used as adjuncts to traditional medical treatment. Although an individual may choose a particular alternative treatment method, there is really no current scientific proof that these methods will work better than traditional medicine.
  24. Answer: A. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems. After physical factors are ruled out, somatic complaints are thought to be expressions of anxiety. The complaints are real to the client, but the nurse should not focus on them. Prompting the client about other concerns will encourage expression of anxiety and dependency needs.
  25. Answer: B. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed. Clients commonly discontinue medications to avoid or correct sexual side effects, but they are less likely to do that when health professionals offer assistance with sexual issues. Generally, clients avoid discussing sexual issues unless health professionals give permission by raising the issue first.