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Psychiatric Nursing Practice Exam 3 (PM)
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Question 1
A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Psychiatric care in this treatment plan is based on which framework?
A
Cognitive framework
B
Interpersonal framework
C
Psychodynamic framework
D
Behavioral framework
Question 1 Explanation:
Cognitive thinking therapy focuses on the client’s misperceptions about self, others and the world that impact functioning and contribute to symptoms. Using medications to alter neurotransmitter activity is a psychobiologic approachto treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.
Question 2
A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include:
A
Lacrimation, vomiting, drowsiness
B
Muscle aches, papillary constriction, yawning
C
Rhinorrhea, convulsions, subnormal temperature
D
Nausea, dilated pupils, constipation
Question 2 Explanation:
These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.
Question 3
Which medication can control the extra pyramidal effects associated with antipsychotic agents?
A
Perphenazine (Trilafon)
B
Doxepin (Sinequan)
C
Amantadine (Symmetrel)
D
Clorazepate (Tranxene)
Question 3 Explanation:
Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle movements, pseudoparkinsonism and tar dive dyskinesia.
Question 4
A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client?
A
Reason for inpatient admission
B
Involvement of family and support systems
C
Reason for refusal to take medications
D
Income level and living arrangements
Question 4 Explanation:
The first are for assessment would be the client’s reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication. The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission.
Question 5
A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client’s employer expects the client to return to work following inpatient treatment. The client tells the nurse, “I’m no good. I’m a failure”. According to cognitive theory, these statements reflect:
A
Punitive superego and decreased self-esteem
B
Learned behavior
C
Faulty thought processes that govern behavior
D
Evidence of difficult relationships in the work environment
Question 5 Explanation:
The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory.There is no evidence in this situation that the client has conflictual relationships in the work environment.
Question 6
When performing a physicalexamination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system?
A
Decreased urine output
B
Hyperactive bowel sounds
C
Muscle tension
D
Constipation
Question 6 Explanation:
The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.
Question 7
Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?
A
Fluvoxamine (Luvox) and clomipramine (anafranil)
B
Divalproex (depakote) and Lithium (lithobid)
C
Benztropine (Cogentin) and diphenhydramine (benadryl)
D
Chlordiazepoxide (Librium) and diazepam (valium)
Question 7 Explanation:
The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.
Question 8
The nurse describes a client as anxious. Which of the following statement about anxiety is true?
A
Anxiety is a response to a threat
B
Anxiety is directly observable
C
Anxiety is usually harmful
D
Anxiety is usually pathological
Question 8 Explanation:
Anxiety is a response to a threat arising from internal or external stimuli.
Question 9
A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client’s wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for:
A
A past history of depression
B
Current plans to commit suicide
C
Feelings of excessive failure
D
The presence of marital difficulties
Question 9 Explanation:
Whether there is a suicide plan is a criterion when assessing the client’s determination to make another attempt.
Question 10
A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?
A
The client verbalizes that family meals are now enjoyable
B
The client tells her parents about feelings of low-self esteem
C
The parents clearly verbalize their expectations for the client
D
The parents reinforced increased decision making by the client
Question 10 Explanation:
One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.
Question 11
In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3 year old child to demonstrate:
A
An attachment to odd objects
B
An interest in music
C
Ritualistic behavior
D
Responsiveness to the parents
Question 11 Explanation:
One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.
Question 12
Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients?
A
Serotonin syndrome effects
B
Gastrointestinal system effects
C
Central Nervous System effects
D
Cardiovascular system effects
Question 12 Explanation:
The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.
Question 13
PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions?
A
Delusions for clients suffering from schizophrenia
B
The manic phase of bipolar illness as a mood stabilizer
C
Antipsychotic – induced akathisia and anxiety
D
Obsessive – compulsive disorder (OCD) to reduce ritualistic behavior
Question 13 Explanation:
Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.
Question 14
Tony with agoraphobia has been symptom-free for 4 months. Classicsigns and symptoms of phobia include:
A
Insomnia and inability to concentrate
B
Severe anxiety and fear
C
Withdrawal and failure to distinguish reality from fantasy
D
Depression and weight loss
Question 14 Explanation:
Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia and elevated B.P.
Question 15
A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself?
A
Basketball game with peers on the unit
B
Art therapy in a small group
C
Reading a self-help book on depression
D
Watching movie with the peer group
Question 15 Explanation:
Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with
peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity.
Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that
interaction will occur; therefore, the client may remain isolated.
Question 16
Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for:
A
Cardiac stress testing
B
Neurologic examination
C
Physical therapy
D
General anesthesia
Question 16 Explanation:
The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.
Question 17
The most critical factor for nurse Linda to determine during crisis intervention would be the client’s:
A
Developmental theory
B
Available situational supports
C
Willingness to restructure the personality
D
Underlying unconscious conflict
Question 17 Explanation:
Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.
Question 18
Nurse John is aware that the therapy that has the highest success rate for people with phobias would be:
A
Systematic desensitization using relaxation technique
B
Psychotherapy aimed at rearranging maladaptive thought process
C
Insight therapy to determine the origin of the anxiety and fear
D
Psychoanalytical exploration of repressed conflicts of an earlier development phase
Question 18 Explanation:
The most successful therapy for people with phobias involves behavior modification techniques using desensitization.
Question 19
Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants?
A
Have blood levels screened weekly for leucopenia
B
Don’t take prescribed or over the counter medications without consulting the physician
C
Avoid strenuous activity because of the cardiac effects of the drug
D
Don’t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
Question 19 Explanation:
MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It’s imperative that a client checks with his physician and pharmacist before taking any other medications.
Question 20
A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?
A
Help the client substitutes one fear for another
B
Help the client develop insight into irrational fears
C
Help the client decrease anxiety
D
Help the client execute actions that are feared
Question 20 Explanation:
Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another.
Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing
activities that typically are avoided as part of the phobic response.
Question 21
Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expects the assessment to reveal:
A
Coldness, detachment and lack of tender feelings
B
Somatic symptoms
C
Inability to function as responsible parent
D
Unpredictable behavior and intense interpersonal relationships
Question 21 Explanation:
A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive.
Question 22
When nurse Hazel considers a client’s placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client’s:
A
Memory state
B
Perceptual field
C
Delusional system
D
Creativity level
Question 22 Explanation:
Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.
Question 23
A nurse who explains that a client’s psychotic behavior is unconsciously motivated understands that the client’s disordered behavior arises from which of the following?
A
Abnormal thinking
B
Altered neurotransmitters
C
Internal needs
D
Response to stimuli
Question 23 Explanation:
The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.
Question 24
Nurse Fred is assessing a client who has just been admitted to the ER department.Which signs would suggest an overdose of an antianxiety agent?
A
Combativeness, sweating and confusion
B
Agitation, hyperactivity and grandiose ideation
C
Suspiciousness, dilated pupils and incomplete BP
D
Emotional lability, euphoria and impaired memory
Question 24 Explanation:
Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.
Question 25
Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:
A
Sedation
B
Diarrhea
C
Uticaria
D
Vertigo
Question 25 Explanation:
Diarrhea is a common physiological response to stress and anxiety.
Question 26
The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms?
A
Stress management techniques
B
Side effects of medications
C
Principles of good nutrition
D
Pathophysiology of disease process
Question 26 Explanation:
In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.
Question 27
Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder?
A
The client exhibits charming behavior when around authority figures
B
The client makes statements of self-satisfaction
C
The client has decreased episodes of impulsive behaviors
D
The client’s statements indicate no remorse for behaviors
Question 27 Explanation:
A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore, decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no
remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a
positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.
Question 28
Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium?
A
Seizures
B
Sexual dysfunction
C
Polyuria
D
Constipation
Question 28 Explanation:
Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.
Question 29
A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach?
A
Agree with the client’s painful feelings
B
Deny that the situation is hopeless
C
Present a cheerful attitude
D
Challenge the accuracy of the client’s belief
Question 29 Explanation:
Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.
Question 30
Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?
A
Increased incidence of dysmenorrhea while taking the drug
B
Continuing previous use of contraception during periods of amenorrhea
C
Instruction that amenorrhea is irreversible
D
Occurrence of incomplete libido due to medication adverse effects
Question 30 Explanation:
Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation thus, the client can still be pregnant.
Question 31
Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information?
A
Restrict fluid and sodium intake
B
Don’t consume alcohol
C
Restrict fluids and sodium intake
D
Discontinue if dry mouth and blurred vision occur
Question 31 Explanation:
Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants.
Question 32
Rosana is in the second stage of Alzheimer’s disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
A
“Where is your pain located?”
B
“Where do you hurt?”
C
“Do you hurt? (pause) “Do you hurt?”
D
“Can you describe your pain?”
Question 32 Explanation:
When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no” whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.
Question 33
Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from worms chewing on them.” This statement indicates a:
A
Delusion of persecution
B
Delusion of grandeur
C
Somatic delusion
D
Jealous delusion
Question 33 Explanation:
Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal parasites and misshapen parts.
Question 34
Before helping a male client who has been sexually assaulted, nurse Maureen should recognize that the rapist is motivated by feelings of:
A
Hostility
B
Passion
C
Incompetence
D
Inadequacy
Question 34 Explanation:
Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.
Question 35
Nurse John is aware that a serious effect of inhaling cocaine is?
A
Extra pyramidal tract symptoms
B
Deterioration of nasal septum
C
Esophageal varices
D
Acute fluid and electrolyte imbalances
Question 35 Explanation:
Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.
Question 36
The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change?
A
Decreased dopamine level
B
Stimulation of GABA
C
Stabilization of serotonin
D
Increased acetylcholine level
Question 36 Explanation:
Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.
Question 37
Nurse Ronald could evaluate that the staff’s approach to setting limits for a demanding, angry client was effective if the client:
A
Apologizes for disrupting the unit’s routine when something is needed
B
Discuss concerns regarding the emotional condition that required hospitalizations
C
No longer calls the nursing staff for assistance
D
Understands the reason why frequent calls to the staff were made
Question 37 Explanation:
This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.
Question 38
Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis.These groups are successful because the:
A
Client is assisted to investigate alternative approaches to solving the identified problem
B
Client is encouraged to talk about personal problems
C
Crisis group supplies a workable solution to the client’s problem
D
Crisis intervention worker is a psychologist and understands behavior patterns
Question 38 Explanation:
Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic situations using rational and flexible problem solving methods.
Question 39
Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods?
A
Figs and cream cheese
B
Aged cheese and Chianti wine
C
Fruits and yellow vegetables
D
Green leafy vegetables
Question 39 Explanation:
Aged cheese and Chianti wine contain high concentrations of tyramine.
Question 40
The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:
A
Managing his hallucinations
B
Vocational training
C
Medication teaching
D
Social skills training
Question 40 Explanation:
Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking
questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.
Question 41
Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations?
A
Anxiety
B
Defensive coping
C
Disturbed body image
D
Powerlessness
Question 41 Explanation:
The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental
expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.
Question 42
Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe:
A
Delirium
B
Depression
C
Hyperactivity
D
Suspicion
Question 42 Explanation:
There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.
Question 43
Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find:
A
Transitory short-term memory loss and permanent long-term memory loss
B
Transitory short and long term memory loss and confusion
C
Permanent long-term memory loss and hypomania
D
Permanent short-term memory loss and hypertension
Question 43 Explanation:
ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and long term memory loss.
Question 44
Initial interventions for Marco with acute anxiety include all except which of the following?
A
Encouraging the client to verbalize feelings and concerns
B
Providing the client with a safe, quiet and private place
C
Touching the client in an attempt to comfort him
D
Approaching the client in calm, confident manner
Question 44 Explanation:
The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety.
Question 45
When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of:
A
Hatred
B
Confusion
C
Self blame
D
Humiliation
Question 45 Explanation:
These children often have nonsexual needs met by individual and are powerless to refuse.Ambivalence results in self-blame and also guilt.
Question 46
Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience:
A
Decreased perceptual field
B
Heightened concentration
C
Decreased respiratory rate
D
Decreased cardiac rate
Question 46 Explanation:
Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention and inability to concentrate.
Question 47
Which activity would be most appropriate for a severely withdrawn client?
A
Board game with a small group of clients
B
Team sport in the gym
C
Watching TV in the dayroom
D
Art activity with a staff member
Question 47 Explanation:
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.
Question 48
Which of the following is the most distinguishing feature of a client with an antisocial personality disorder?
A
Bizarre mannerisms and thoughts
B
Disregard for social and legal norms
C
Attention to detail and order
D
Submissive and dependent behavior
Question 48 Explanation:
Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and
order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or
schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.
Question 49
Which nursing action is most appropriate when trying to diffuse a client’s impending violent behavior?
A
Involving the client in a quiet activity to divert attention
B
Helping the client identify and express feelings of anxiety and anger
C
Leaving the client alone until he can talk about his feelings
D
Place the client in seclusion
Question 49 Explanation:
In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as “What happened to get you this angry?” may help the client verbalizes feelings rather than act on them.
Question 50
Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the “rotten nursing care”. When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of:
A
Displacement
B
Projection
C
Reaction formation
D
Denial
Question 50 Explanation:
The client’s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.
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Psychiatric Nursing Practice Exam 3 (EM)
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Question 1
A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client’s employer expects the client to return to work following inpatient treatment. The client tells the nurse, “I’m no good. I’m a failure”. According to cognitive theory, these statements reflect:
A
Faulty thought processes that govern behavior
B
Evidence of difficult relationships in the work environment
C
Punitive superego and decreased self-esteem
D
Learned behavior
Question 1 Explanation:
The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory.There is no evidence in this situation that the client has conflictual relationships in the work environment.
Question 2
Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium?
A
Polyuria
B
Constipation
C
Seizures
D
Sexual dysfunction
Question 2 Explanation:
Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.
Question 3
Rosana is in the second stage of Alzheimer’s disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
A
“Where do you hurt?”
B
“Do you hurt? (pause) “Do you hurt?”
C
“Can you describe your pain?”
D
“Where is your pain located?”
Question 3 Explanation:
When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no” whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.
Question 4
The most critical factor for nurse Linda to determine during crisis intervention would be the client’s:
A
Developmental theory
B
Underlying unconscious conflict
C
Willingness to restructure the personality
D
Available situational supports
Question 4 Explanation:
Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.
Question 5
Nurse Ronald could evaluate that the staff’s approach to setting limits for a demanding, angry client was effective if the client:
A
No longer calls the nursing staff for assistance
B
Apologizes for disrupting the unit’s routine when something is needed
C
Discuss concerns regarding the emotional condition that required hospitalizations
D
Understands the reason why frequent calls to the staff were made
Question 5 Explanation:
This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.
Question 6
Initial interventions for Marco with acute anxiety include all except which of the following?
A
Encouraging the client to verbalize feelings and concerns
B
Providing the client with a safe, quiet and private place
C
Touching the client in an attempt to comfort him
D
Approaching the client in calm, confident manner
Question 6 Explanation:
The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety.
Question 7
Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find:
A
Transitory short and long term memory loss and confusion
B
Permanent short-term memory loss and hypertension
C
Permanent long-term memory loss and hypomania
D
Transitory short-term memory loss and permanent long-term memory loss
Question 7 Explanation:
ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and long term memory loss.
Question 8
PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions?
A
Delusions for clients suffering from schizophrenia
B
Antipsychotic – induced akathisia and anxiety
C
Obsessive – compulsive disorder (OCD) to reduce ritualistic behavior
D
The manic phase of bipolar illness as a mood stabilizer
Question 8 Explanation:
Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.
Question 9
Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?
A
Increased incidence of dysmenorrhea while taking the drug
B
Instruction that amenorrhea is irreversible
C
Continuing previous use of contraception during periods of amenorrhea
D
Occurrence of incomplete libido due to medication adverse effects
Question 9 Explanation:
Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation thus, the client can still be pregnant.
Question 10
A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself?
A
Basketball game with peers on the unit
B
Art therapy in a small group
C
Watching movie with the peer group
D
Reading a self-help book on depression
Question 10 Explanation:
Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with
peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity.
Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that
interaction will occur; therefore, the client may remain isolated.
Question 11
Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information?
A
Don’t consume alcohol
B
Restrict fluid and sodium intake
C
Discontinue if dry mouth and blurred vision occur
D
Restrict fluids and sodium intake
Question 11 Explanation:
Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants.
Question 12
A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include:
A
Lacrimation, vomiting, drowsiness
B
Nausea, dilated pupils, constipation
C
Rhinorrhea, convulsions, subnormal temperature
D
Muscle aches, papillary constriction, yawning
Question 12 Explanation:
These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.
Question 13
Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis.These groups are successful because the:
A
Client is assisted to investigate alternative approaches to solving the identified problem
B
Client is encouraged to talk about personal problems
C
Crisis group supplies a workable solution to the client’s problem
D
Crisis intervention worker is a psychologist and understands behavior patterns
Question 13 Explanation:
Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic situations using rational and flexible problem solving methods.
Question 14
When nurse Hazel considers a client’s placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client’s:
A
Memory state
B
Delusional system
C
Perceptual field
D
Creativity level
Question 14 Explanation:
Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.
Question 15
When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of:
A
Humiliation
B
Hatred
C
Confusion
D
Self blame
Question 15 Explanation:
These children often have nonsexual needs met by individual and are powerless to refuse.Ambivalence results in self-blame and also guilt.
Question 16
A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Psychiatric care in this treatment plan is based on which framework?
A
Cognitive framework
B
Psychodynamic framework
C
Interpersonal framework
D
Behavioral framework
Question 16 Explanation:
Cognitive thinking therapy focuses on the client’s misperceptions about self, others and the world that impact functioning and contribute to symptoms. Using medications to alter neurotransmitter activity is a psychobiologic approachto treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.
Question 17
A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client’s wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for:
A
Current plans to commit suicide
B
A past history of depression
C
Feelings of excessive failure
D
The presence of marital difficulties
Question 17 Explanation:
Whether there is a suicide plan is a criterion when assessing the client’s determination to make another attempt.
Question 18
Tony with agoraphobia has been symptom-free for 4 months. Classicsigns and symptoms of phobia include:
A
Insomnia and inability to concentrate
B
Withdrawal and failure to distinguish reality from fantasy
C
Severe anxiety and fear
D
Depression and weight loss
Question 18 Explanation:
Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia and elevated B.P.
Question 19
Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients?
A
Serotonin syndrome effects
B
Cardiovascular system effects
C
Central Nervous System effects
D
Gastrointestinal system effects
Question 19 Explanation:
The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.
Question 20
A nurse who explains that a client’s psychotic behavior is unconsciously motivated understands that the client’s disordered behavior arises from which of the following?
A
Response to stimuli
B
Internal needs
C
Abnormal thinking
D
Altered neurotransmitters
Question 20 Explanation:
The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.
Question 21
Which nursing action is most appropriate when trying to diffuse a client’s impending violent behavior?
A
Helping the client identify and express feelings of anxiety and anger
B
Leaving the client alone until he can talk about his feelings
C
Place the client in seclusion
D
Involving the client in a quiet activity to divert attention
Question 21 Explanation:
In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as “What happened to get you this angry?” may help the client verbalizes feelings rather than act on them.
Question 22
A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach?
A
Present a cheerful attitude
B
Agree with the client’s painful feelings
C
Deny that the situation is hopeless
D
Challenge the accuracy of the client’s belief
Question 22 Explanation:
Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.
Question 23
A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client?
A
Reason for refusal to take medications
B
Reason for inpatient admission
C
Income level and living arrangements
D
Involvement of family and support systems
Question 23 Explanation:
The first are for assessment would be the client’s reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication. The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission.
Question 24
Which medication can control the extra pyramidal effects associated with antipsychotic agents?
A
Amantadine (Symmetrel)
B
Perphenazine (Trilafon)
C
Clorazepate (Tranxene)
D
Doxepin (Sinequan)
Question 24 Explanation:
Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle movements, pseudoparkinsonism and tar dive dyskinesia.
Question 25
The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms?
A
Pathophysiology of disease process
B
Stress management techniques
C
Side effects of medications
D
Principles of good nutrition
Question 25 Explanation:
In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.
Question 26
In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3 year old child to demonstrate:
A
Ritualistic behavior
B
An attachment to odd objects
C
An interest in music
D
Responsiveness to the parents
Question 26 Explanation:
One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.
Question 27
Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expects the assessment to reveal:
A
Inability to function as responsible parent
B
Unpredictable behavior and intense interpersonal relationships
C
Somatic symptoms
D
Coldness, detachment and lack of tender feelings
Question 27 Explanation:
A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive.
Question 28
The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change?
A
Stabilization of serotonin
B
Stimulation of GABA
C
Decreased dopamine level
D
Increased acetylcholine level
Question 28 Explanation:
Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.
Question 29
Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods?
A
Figs and cream cheese
B
Fruits and yellow vegetables
C
Aged cheese and Chianti wine
D
Green leafy vegetables
Question 29 Explanation:
Aged cheese and Chianti wine contain high concentrations of tyramine.
Question 30
Nurse John is aware that a serious effect of inhaling cocaine is?
A
Acute fluid and electrolyte imbalances
B
Esophageal varices
C
Deterioration of nasal septum
D
Extra pyramidal tract symptoms
Question 30 Explanation:
Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.
Question 31
A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?
A
The parents reinforced increased decision making by the client
B
The parents clearly verbalize their expectations for the client
C
The client verbalizes that family meals are now enjoyable
D
The client tells her parents about feelings of low-self esteem
Question 31 Explanation:
One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.
Question 32
Nurse Fred is assessing a client who has just been admitted to the ER department.Which signs would suggest an overdose of an antianxiety agent?
A
Agitation, hyperactivity and grandiose ideation
B
Suspiciousness, dilated pupils and incomplete BP
C
Emotional lability, euphoria and impaired memory
D
Combativeness, sweating and confusion
Question 32 Explanation:
Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.
Question 33
Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe:
A
Hyperactivity
B
Depression
C
Delirium
D
Suspicion
Question 33 Explanation:
There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.
Question 34
Which activity would be most appropriate for a severely withdrawn client?
A
Board game with a small group of clients
B
Team sport in the gym
C
Watching TV in the dayroom
D
Art activity with a staff member
Question 34 Explanation:
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.
Question 35
Which of the following is the most distinguishing feature of a client with an antisocial personality disorder?
A
Bizarre mannerisms and thoughts
B
Disregard for social and legal norms
C
Submissive and dependent behavior
D
Attention to detail and order
Question 35 Explanation:
Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and
order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or
schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.
Question 36
A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?
A
Help the client substitutes one fear for another
B
Help the client execute actions that are feared
C
Help the client develop insight into irrational fears
D
Help the client decrease anxiety
Question 36 Explanation:
Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another.
Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing
activities that typically are avoided as part of the phobic response.
Question 37
Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?
A
Benztropine (Cogentin) and diphenhydramine (benadryl)
B
Fluvoxamine (Luvox) and clomipramine (anafranil)
C
Chlordiazepoxide (Librium) and diazepam (valium)
D
Divalproex (depakote) and Lithium (lithobid)
Question 37 Explanation:
The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.
Question 38
Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from worms chewing on them.” This statement indicates a:
A
Jealous delusion
B
Delusion of grandeur
C
Somatic delusion
D
Delusion of persecution
Question 38 Explanation:
Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal parasites and misshapen parts.
Question 39
Before helping a male client who has been sexually assaulted, nurse Maureen should recognize that the rapist is motivated by feelings of:
A
Inadequacy
B
Incompetence
C
Hostility
D
Passion
Question 39 Explanation:
Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.
Question 40
Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:
A
Uticaria
B
Diarrhea
C
Sedation
D
Vertigo
Question 40 Explanation:
Diarrhea is a common physiological response to stress and anxiety.
Question 41
The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:
A
Vocational training
B
Medication teaching
C
Social skills training
D
Managing his hallucinations
Question 41 Explanation:
Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking
questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.
Question 42
When performing a physicalexamination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system?
A
Decreased urine output
B
Muscle tension
C
Constipation
D
Hyperactive bowel sounds
Question 42 Explanation:
The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.
Question 43
Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants?
A
Have blood levels screened weekly for leucopenia
B
Don’t take prescribed or over the counter medications without consulting the physician
C
Avoid strenuous activity because of the cardiac effects of the drug
D
Don’t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
Question 43 Explanation:
MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It’s imperative that a client checks with his physician and pharmacist before taking any other medications.
Question 44
Nurse John is aware that the therapy that has the highest success rate for people with phobias would be:
A
Psychotherapy aimed at rearranging maladaptive thought process
B
Systematic desensitization using relaxation technique
C
Insight therapy to determine the origin of the anxiety and fear
D
Psychoanalytical exploration of repressed conflicts of an earlier development phase
Question 44 Explanation:
The most successful therapy for people with phobias involves behavior modification techniques using desensitization.
Question 45
Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for:
A
Cardiac stress testing
B
Neurologic examination
C
General anesthesia
D
Physical therapy
Question 45 Explanation:
The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.
Question 46
Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations?
A
Powerlessness
B
Anxiety
C
Defensive coping
D
Disturbed body image
Question 46 Explanation:
The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental
expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.
Question 47
Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder?
A
The client has decreased episodes of impulsive behaviors
B
The client exhibits charming behavior when around authority figures
C
The client’s statements indicate no remorse for behaviors
D
The client makes statements of self-satisfaction
Question 47 Explanation:
A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore, decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no
remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a
positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.
Question 48
Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience:
A
Decreased cardiac rate
B
Decreased perceptual field
C
Decreased respiratory rate
D
Heightened concentration
Question 48 Explanation:
Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention and inability to concentrate.
Question 49
The nurse describes a client as anxious. Which of the following statement about anxiety is true?
A
Anxiety is directly observable
B
Anxiety is a response to a threat
C
Anxiety is usually pathological
D
Anxiety is usually harmful
Question 49 Explanation:
Anxiety is a response to a threat arising from internal or external stimuli.
Question 50
Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the “rotten nursing care”. When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of:
A
Displacement
B
Reaction formation
C
Projection
D
Denial
Question 50 Explanation:
The client’s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.
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1. Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe:
Hyperactivity
Depression
Suspicion
Delirium
2. Nurse John is aware that a serious effect of inhaling cocaine is?
Deterioration of nasal septum
Acute fluid and electrolyte imbalances
Extra pyramidal tract symptoms
Esophageal varices
3. A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include:
Rhinorrhea, convulsions, subnormal temperature
Nausea, dilated pupils, constipation
Lacrimation, vomiting, drowsiness
Muscle aches, papillary constriction, yawning
4. A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client’s wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for:
A past history of depression
Current plans to commit suicide
The presence of marital difficulties
Feelings of excessive failure
5. Before helping a male client who has been sexually assaulted, nurse Maureen should recognize that the rapist is motivated by feelings of:
Hostility
Inadequacy
Incompetence
Passion
6. When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of:
Humiliation
Confusion
Self blame
Hatred
7. Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the “rotten nursing care”. When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of:
Projection
Displacement
Denial
Reaction formation
8. The most critical factor for nurse Linda to determine during crisis intervention would be the client’s:
Available situational supports
Willingness to restructure the personality
Developmental theory
Underlying unconscious conflict
9. Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis. These groups are successful because the:
Crisis intervention worker is a psychologist and understands behavior patterns
Crisis group supplies a workable solution to the client’s problem
Client is encouraged to talk about personal problems
Client is assisted to investigate alternative approaches to solving the identified problem
10. Nurse Ronald could evaluate that the staff’s approach to setting limits for a demanding, angry client was effective if the client:
Apologizes for disrupting the unit’s routine when something is needed
Understands the reason why frequent calls to the staff were made
Discuss concerns regarding the emotional condition that required hospitalizations
No longer calls the nursing staff for assistance
11. Nurse John is aware that the therapy that has the highest success rate for people with phobias would be:
Psychotherapy aimed at rearranging maladaptive thought process
Psychoanalytical exploration of repressed conflicts of an earlier development phase
Systematic desensitization using relaxation technique
Insight therapy to determine the origin of the anxiety and fear
12. When nurse Hazel considers a client’s placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client’s:
Perceptual field
Delusional system
Memory state
Creativity level
13. In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3 year old child to demonstrate:
An interest in music
An attachment to odd objects
Ritualistic behavior
Responsiveness to the parents
14. Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from worms chewing on them.” This statement indicates a:
Jealous delusion
Somatic delusion
Delusion of grandeur
Delusion of persecution
15. Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expects the assessment to reveal:
Coldness, detachment and lack of tender feelings
Somatic symptoms
Inability to function as responsible parent
Unpredictable behavior and intense interpersonal relationships
16. PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions?
Antipsychotic – induced akathisia and anxiety
Obsessive – compulsive disorder (OCD) to reduce ritualistic behavior
Delusions for clients suffering from schizophrenia
The manic phase of bipolar illness as a mood stabilizer
17. Which medication can control the extra pyramidal effects associated with antipsychotic agents?
Clorazepate (Tranxene)
Amantadine (Symmetrel)
Doxepin (Sinequan)
Perphenazine (Trilafon)
18. Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants?
Don’t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
Have blood levels screened weekly for leucopenia
Avoid strenuous activity because of the cardiac effects of the drug
Don’t take prescribed or over the counter medications without consulting the physician
19. Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience:
Heightened concentration
Decreased perceptual field
Decreased cardiac rate
Decreased respiratory rate
20. Initial interventions for Marco with acute anxiety include all except which of the following?
Touching the client in an attempt to comfort him
Approaching the client in calm, confident manner
Encouraging the client to verbalize feelings and concerns
Providing the client with a safe, quiet and private place
21. Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:
Uticaria
Vertigo
Sedation
Diarrhea
22. When performing a physical examination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system?
Muscle tension
Hyperactive bowel sounds
Decreased urine output
Constipation
23. Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?
Divalproex (depakote) and Lithium (lithobid)
Chlordiazepoxide (Librium) and diazepam (valium)
Fluvoxamine (Luvox) and clomipramine (anafranil)
Benztropine (Cogentin) and diphenhydramine (benadryl)
24. Tony with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobia include:
Severe anxiety and fear
Withdrawal and failure to distinguish reality from fantasy
Depression and weight loss
Insomnia and inability to concentrate
25. Which nursing action is most appropriate when trying to diffuse a client’s impending violent behavior?
Place the client in seclusion
Leaving the client alone until he can talk about his feelings
Involving the client in a quiet activity to divert attention
Helping the client identify and express feelings of anxiety and anger
26. Rosana is in the second stage of Alzheimer’s disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
“Where is your pain located?”
“Do you hurt? (pause) “Do you hurt?”
“Can you describe your pain?”
“Where do you hurt?”
27. Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for:
General anesthesia
Cardiac stress testing
Neurologic examination
Physical therapy
28. Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods?
Figs and cream cheese
Fruits and yellow vegetables
Aged cheese and Chianti wine
Green leafy vegetables
29. Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find:
Permanent short-term memory loss and hypertension
Permanent long-term memory loss and hypomania
Transitory short-term memory loss and permanent long-term memory loss
Transitory short and long term memory loss and confusion
30. Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium?
Polyuria
Seizures
Constipation
Sexual dysfunction
31. Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent?
Suspiciousness, dilated pupils and incomplete BP
Agitation, hyperactivity and grandiose ideation
Combativeness, sweating and confusion
Emotional lability, euphoria and impaired memory
32. Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information?
Restrict fluids and sodium intake
Don’t consume alcohol
Discontinue if dry mouth and blurred vision occur
Restrict fluid and sodium intake
33. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?
Increased incidence of dysmenorrhea while taking the drug
Occurrence of incomplete libido due to medication adverse effects
Continuing previous use of contraception during periods of amenorrhea
Instruction that amenorrhea is irreversible
34. A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client?
Income level and living arrangements
Involvement of family and support systems
Reason for inpatient admission
Reason for refusal to take medications
35. The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change?
Decreased dopamine level
Increased acetylcholine level
Stabilization of serotonin
Stimulation of GABA
36. Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients?
Central Nervous System effects
Cardiovascular system effects
Gastrointestinal system effects
Serotonin syndrome effects
37. A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Psychiatric care in this treatment plan is based on which framework?
Behavioral framework
Cognitive framework
Interpersonal framework
Psychodynamic framework
38. A nurse who explains that a client’s psychotic behavior is unconsciously motivated understands that the client’s disordered behavior arises from which of the following?
Abnormal thinking
Altered neurotransmitters
Internal needs
Response to stimuli
39. A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client’s employer expects the client to return to work following inpatient treatment. The client tells the nurse, “I’m no good. I’m a failure”. According to cognitive theory, these statements reflect:
Learned behavior
Punitive superego and decreased self-esteem
Faulty thought processes that govern behavior
Evidence of difficult relationships in the work environment
40. The nurse describes a client as anxious. Which of the following statement about anxiety is true?
Anxiety is usually pathological
Anxiety is directly observable
Anxiety is usually harmful
Anxiety is a response to a threat
41. A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?
Help the client execute actions that are feared
Help the client develop insight into irrational fears
Help the client substitutes one fear for another
Help the client decrease anxiety
42. Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder?
The client exhibits charming behavior when around authority figures
The client has decreased episodes of impulsive behaviors
The client makes statements of self-satisfaction
The client’s statements indicate no remorse for behaviors
43. The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms?
Pathophysiology of disease process
Principles of good nutrition
Side effects of medications
Stress management techniques
44. Which of the following is the most distinguishing feature of a client with an antisocial personality disorder?
Attention to detail and order
Bizarre mannerisms and thoughts
Submissive and dependent behavior
Disregard for social and legal norms
45. Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations?
Anxiety
Disturbed body image
Defensive coping
Powerlessness
46. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?
The parents reinforced increased decision making by the client
The parents clearly verbalize their expectations for the client
The client verbalizes that family meals are now enjoyable
The client tells her parents about feelings of low-self esteem
47. A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach?
Agree with the client’s painful feelings
Challenge the accuracy of the client’s belief
Deny that the situation is hopeless
Present a cheerful attitude
48. A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself?
Art therapy in a small group
Basketball game with peers on the unit
Reading a self-help book on depression
Watching movie with the peer group
49. The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:
Managing his hallucinations
Medication teaching
Social skills training
Vocational training
50. Which activity would be most appropriate for a severely withdrawn client?
Art activity with a staff member
Board game with a small group of clients
Team sport in the gym
Watching TV in the dayroom
Answers and Rationales
B. There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.
A. Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.
D. These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.
B. Whether there is a suicide plan is a criterion when assessing the client’s determination to make another attempt.
A. Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.
C. These children often have nonsexual needs met by individual and are powerless to refuse.Ambivalence results in self-blame and also guilt.
B. The client’s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.
A. Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.
D. Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic
situations using rational and flexible problem solving methods.
C. This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.
C. The most successful therapy for people with phobias involves behavior modification techniques using desensitization.
A. Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.
D. One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.
B. Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal
parasites and misshapen parts.
D. A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be
intense and unstable and behavior may be inappropriate and impulsive.
A. Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.
B. Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle
movements, pseudoparkinsonism and tar dive dyskinesia.
D. MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It’s imperative that a client checks with his physician and pharmacist before taking any other medications.
B. Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self,
less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention
andinability to concentrate.
A. The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually
increase anxiety.
D. Diarrhea is a common physiological response to stress and anxiety.
B. The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.
C. The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.
A. Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and
symptoms of phobias include profuse sweating, poor motor control, tachycardia and elevated B.P.
D. In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as
“What happened to get you this angry?” may help the client verbalizes feelings rather than act on them.
B. When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no”
whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.
A. The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.
C. Aged cheese and Chianti wine contain high concentrations of tyramine.
D. ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and
long term memory loss.
A. Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.
D. Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.
B. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of
tricyclic antidepressants.
C. Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation thus, the client
can still be pregnant.
D. The first are for assessment would be the client’s reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication. The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission.
A. Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore
decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.
B. The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with
caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.
B. Cognitive thinking therapy focuses on the client’s misperceptions about self, others and the world that impact functioning and contribute to symptoms.
Using medications to alter neurotransmitter activity is a psychobiologic approachto treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.
C. The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.
C. The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically
examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory. Option 4 is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment.
D. Anxiety is a response to a threat arising from internal or external stimuli.
A. Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear,
without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another.
Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing
activities that typically are avoided as part of the phobic response.
B. A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore,
decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no
remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a
positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.
D. In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce
the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.
D. Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and
order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or
schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.
D. The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental
expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.
A. One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent
decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.
B. Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.
A. Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with
peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity.
Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that
interaction will occur; therefore, the client may remain isolated.
C. Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking
questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training 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.