Psychiatric Nursing Practice Exam 9

1. An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn’t know what to do with her life. She says she has quit her last five jobs because her coworkers didn’t like her and didn’t train her adequately. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client’s initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?

  1. Flat affect, social withdrawal, and unusual dress
  2. Suspiciousness, hypervigilance, and emotional coldness
  3. Lack of self-esteem, strong dependency needs, and impulsive behavior
  4. Insensitivity to others, sexual acting out, and violence

2.In a toddler, which of the following injuries is most likely the result of child abuse?

  1. A hematoma on the occipital region of the head
  2. A 1-inch forehead laceration
  3. Several small, dime-sized circular burns on the child’s back
  4. A small isolated bruise on the right lower extremity

3. A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5′ 4″ (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that she has had trouble eating lately and can’t remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has:

  1. bulimia nervosa.
  2. anorexia nervosa.
  3. depression.
  4. schizophrenia.

4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses to eat. Which of the following statements is the best response from the nurse?

  1. “You don’t have to eat. It’s your choice.”
  2. “I hope you’ll eat your food by mouth. Tube feedings and I.V. lines can be uncomfortable.”
  3. “Why do you think you’re fat? You’re underweight. Here — look in the mirror.”
  4. “You really look terrible at this weight. I hope you’ll eat.”

5. A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, “I’m not going to those meetings anymore. I’m not like the rest of those people. I’m not a drunk. “What is the most appropriate response?

  1. “If you aren’t an alcoholic, why do you keep drinking and ending up in the hospital?”
  2. “It’s your decision. If you don’t want to go, you don’t have to.”
  3. “You seem upset about the meetings.”
  4. “You have to go to the meetings. It’s part of your treatment plan.”

6. A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. The nurse plans to write a behavioral contract. To best promote compliance, the contract should be written:

  1. abstractly.
  2. by the client alone.
  3. jointly by the client and nurse.
  4. jointly by the physician and nurse.

7. During which phase of alcoholism is loss of control and physiologic dependence evident?

  1. Prealcoholic phase
  2. Early alcoholic phase
  3. Crucial phase
  4. Chronic phase

8. Which of the following is important when restraining a violent client?

  1. Have three staff members present, one for each side of the body and one for the head.
  2. Always tie restraints to side rails.
  3. Have an organized, efficient team approach after the decision is made to restrain the client.
  4. Secure restraints to the gurney with knots to prevent escape.

9. A client who’s actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which of the following common assessment findings indicates that the client may have ingested PCP?

  1. Dilated pupils
  2. Nystagmus
  3. Paranoia
  4. Altered mood

10. A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. Her history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the last month. She is 5′ 7″ (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority?

  1. Initiating caloric and nutritional therapy as ordered
  2. Instituting behavioral modification therapy as ordered
  3. Addressing the client’s low self-esteem
  4. Regularly monitoring vital signs and weight

11. A client tells the nurse that he is having suicidal thoughts every day. In conferring with the treatment team, the nurse should make which of the following recommendations?

  1. A no-suicide contract
  2. Weekly outpatient therapy
  3. A second psychiatric opinion
  4. Intensive inpatient treatment

12. Which of the following etiologic factors predispose a client to Tourette syndrome?

  1. No known etiology
  2. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and caudate nucleus, and genetics
  3. Abnormalities in the structure and function of the ventricles
  4. Environmental factors and birth-related trauma

13. A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?

  1. Withdrawal
  2. Logical thinking
  3. Repression
  4. Denial

14. An 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include:

  1. violence on television.
  2. passive parents.
  3. an internal locus of control.
  4. a single-parent family

15. A client is brought to the emergency department after being beaten by her husband, a prominent attorney. The nurse caring for this client understands that:

  1. open boundaries are common in violent families.
  2. violence usually results from a power struggle.
  3. domestic violence and abuse span all socioeconomic classes.
  4. violent behavior is a genetic trait passed from one generation to the next.

16. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:

  1. avoid all products containing alcohol.
  2. adhere to concomitant vitamin B therapy.
  3. return for monthly blood drug level monitoring.
  4. limit alcohol consumption to a moderate level.

17. During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on the forearms. What is the nurse’s best response?

  1. “That’s it! You’re on suicide precautions.”
  2. “I’m going to tell your physician. Do you want to tell me why you did that?”
  3. “Tell me what type of instrument you used. I’m concerned about infection.”
  4. “The team needs to know when something important occurs in treatment. I need to tell the others, but let’s talk about it first.”

18. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:

  1. barbiturates.
  2. amphetamines.
  3. methadone.
  4. benzodiazepines.

19. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:

  1. dilated pupils and slurred speech.
  2. rapid speech and agitation.
  3. dilated pupils and agitation.
  4. euphoria and constricted pupils.

20. Which of the following signs should the nurse expect in a client with known amphetamine overdose?

  1. Hypotension
  2. Tachycardia
  3. Hot, dry skin
  4. Constricted pupils

21. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available. After the nurse completes the initial assessment, what is the first priority?

  1. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output
  2. Checking the client’s medical records for health history information
  3. Attempting to contact the client’s family to obtain more information about the client
  4. Restricting fluids and leaving the client alone to “sleep off” the episode

22. Which nursing action is best when trying to diffuse a client’s impending violent behavior?

  1. Helping the client identify and express feelings of anxiety and anger
  2. Involving the client in a quiet activity to divert attention
  3. Leaving the client alone until the client can talk about feelings
  4. Placing the client in seclusion

23. The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client?

  1. Abstinence is the basis for successful treatment.
  2. Attendance at Alcoholics Anonymous meetings every day will cure alcoholism.
  3. For treatment to be successful, family members must participate.
  4. An occasional social drink is acceptable behavior for the alcoholic

24. Which psychosocial influence has been causally related to the development of aggressive behavior and conduct disorder?

  1. An overbearing mother
  2. Rejection by peers
  3. A history of schizophrenia in the family
  4. Low socioeconomic status

25. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, “I don’t have a drug problem. I can quit whenever I want. I’ve done it before.” Which defense mechanism is the client using?

  1. Denial
  2. Obsession
  3. Compensation
  4. Rationalization

26. A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client’s history of drug abuse, the nurse expects the physician to prescribe:

  1. lidocaine (Xylocaine).
  2. procainamide (Pronestyl).
  3. nitroglycerin (Nitro-Bid IV).
  4. epinephrine.

27. A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter’s weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?

  1. “I like the way I look. I just need to keep my weight down because I’m a cheerleader.”
  2. “I don’t like the food my mother cooks. I eat plenty of fast food when I’m out with my friends.”
  3. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to other girls.”
  4. “I do diet around my periods; otherwise, I just get so bloated.”

28. Which is the drug of choice for treating Tourette syndrome?

  1. fluoxetine (Prozac)
  2. fluvoxamine (Luvox)
  3. haloperidol (Haldol)
  4. paroxetine (Paxil)

29. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse?

  1. “Why didn’t you get someone else to drive you?”
  2. “Tell me how you feel about the accident.”
  3. “You should know better than to drink and drive.”
  4. “I recommend that you attend an Alcoholics Anonymous meeting.”

30. A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?

  1. Vomiting, diarrhea, and bradycardia
  2. Dehydration, temperature above 101° F (38.3° C), and pruritus
  3. Hypertension, diaphoresis, and seizures
  4. Diaphoresis, tremors, and nervousness

31. When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:

  1. norepinephrine (Levophed) and lidocaine (Xylocaine).
  2. nifedipine (Procardia) and lidocaine.
  3. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc).
  4. nifedipine and esmolol

32. A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?

  1. The client will commit to a drug-free lifestyle.
  2. The client will work with the nurse to remain safe.
  3. The client will drink plenty of fluids daily.
  4. The client will make a personal inventory of strengths

33. A client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor’s dog on fire. When evaluating this client for the potential for violence, the nurse should assess for which behavioral clues?

  1. A rigid posture, restlessness, and glaring
  2. Depression and physical withdrawal
  3. Silence and noncompliance
  4. Hypervigilance and talk of past violent acts

34. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?

  1. “I’m not addicted to alcohol. In fact, I can drink more than I used to without being affected.”
  2. “I only spend half of my paycheck at the bar.”
  3. “I just drink to relax after work.”
  4. “I know I’ve been arrested three times for drinking and driving, but the police are just trying to hassle me.”

35. A client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client’s wrists are scratched from a recent suicide attempt. Based on this finding, the nurse should formulate a nursing diagnosis of:

  1. Ineffective individual coping related to feelings of guilt.
  2. Situational low self-esteem related to feelings of loss of control.
  3. Risk for violence: Self-directed related to impulsive mutilating acts.
  4. Risk for violence: Directed toward others related to verbal threats.

36. A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client’s arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use?

  1. Coronary artery spasm
  2. Bradyarrhythmias
  3. Neurobehavioral deficits
  4. Panic disorder

37. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:

  1. begin after 7 days.
  2. not occur at all because the time period for their occurrence has passed.
  3. begin anytime within the next 1 to 2 days.
  4. begin within 2 to 7 days.

38. The nurse is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?

  1. Providing one-on-one supervision during meals and for 1 hour afterward
  2. Letting the client eat with other clients to create a normal mealtime atmosphere
  3. Trying to persuade the client to eat and thus restore nutritional balance
  4. Giving the client as much time to eat as desired

39. A client begins to experience alcoholic hallucinosis. What is the best nursing intervention at this time?

  1. Keeping the client restrained in bed
  2. Checking the client’s blood pressure every 15 minutes and offering juices
  3. Providing a quiet environment and administering medication as needed and prescribed
  4. Restraining the client and measuring blood pressure every 30 minutes

40. Which assessment finding is most consistent with early alcohol withdrawal?

  1. Heart rate of 120 to 140 beats/minute
  2. Heart rate of 50 to 60 beats/minute
  3. Blood pressure of 100/70 mm Hg
  4. Blood pressure of 140/80 mm Hg

41. Which client is at highest risk for suicide?

  1. One who appears depressed, frequently thinks of dying, and gives away all personal possessions
  2. One who plans a violent death and has the means readily available
  3. One who tells others that he or she might do something if life doesn’t get better soon
  4. One who talks about wanting to die

42. Which of the following medical conditions is commonly found in clients with bulimia nervosa?

  1. Allergies
  2. Cancer
  3. Diabetes mellitus
  4. Hepatitis A

43. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse’s assessment and interventions, what would be the most desirable outcome?

  1. The student discusses conflicts over drug use.
  2. The student accepts a referral to a substance abuse counselor.
  3. The student agrees to inform his parents of the problem.
  4. The student reports increased comfort with making choices.

44. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?

  1. clozapine (Clozaril)
  2. thiothixene (Navane)
  3. lorazepam (Ativan)
  4. lithium carbonate (Eskalith)

45. A client is being treated for alcoholism. After a family meeting, the client’s spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?

  1. Al-Anon
  2. Make Today Count
  3. Emotions Anonymous
  4. Alcoholics Anonymous

46. A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client’s physical health, the nurse should plan to:

  1. severely restrict the client’s physical activities.
  2. weigh the client daily, after the evening meal.
  3. monitor vital signs, serum electrolyte levels, and acid-base balance.
  4. instruct the client to keep an accurate record of food and fluid intake.

47. A young man is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with:

  1. antisocial personality disorder.
  2. borderline personality disorder.
  3. obsessive-compulsive personality disorder.
  4. narcissistic personality disorder.

48. A husband and wife seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple, the nurse knows they are at risk for repeated violence because the husband:

  1. has only moderate impulse control.
  2. denies feelings of jealousy or possessiveness.
  3. has learned violence as an acceptable behavior.
  4. feels secure in his relationship with his wife.

49. A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client’s effort to:

  1. manipulate her husband.
  2. gain control of one part of her life.
  3. commit suicide.
  4. live up to her mother’s expectations.

50. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:

  1. psychotherapy.
  2. total abstinence.
  3. Alcoholics Anonymous (AA).
  4. aversion therapy.
Answers and Rationales
  1. C. Lack of self-esteem, strong dependency needs, and impulsive behavior. Borderline personality disorder is characterized by lack of self-esteem, strong dependency needs, and impulsive behavior. Instability in interpersonal relationships, mood, and poor self-image also is common. Typically, the client can’t tolerate being alone and expresses feelings of emptiness or boredom. Flat affect, social withdrawal, and unusual dress are characteristic of schizoid personality disorder. Suspiciousness, hypervigilance, and emotional coldness are seen in paranoid personality disorders. In antisocial personality disorder, clients are usually insensitive to others and act out sexually; they may also be violent
  2. C. Several small, dime-sized circular burns on the child’s back. Small circular burns on a child’s back are no accident and may be from cigarettes. Toddlers are injury prone because of their developmental stage, and falls are frequent because of their unsteady gait; head injuries aren’t uncommon. A small area of ecchymosis isn’t suspicious in this age-group.
  3. B. anorexia nervosa. Anorexia nervosa is an eating disorder characterized by self-imposed starvation with subsequent emaciation, nutritional deficiencies, and atrophic and metabolic changes. Typically, the client is hypotensive and dehydrated. Depending on the severity of the disorder, anorexic clients are at risk for circulatory collapse (indicated by hypotension), dehydration, and death. Bulimia nervosa is an eating disorder characterized by binge eating followed by self-induced vomiting. Although depression may be accompanied by weight loss, it isn’t characterized by a body image disturbance or the intense fear of obesity seen in anorexia nervosa. Schizophrenia may cause bizarre eating patterns, but it rarely causes the full syndrome of anorexia nervosa.
  4. B. “I hope you’ll eat your food by mouth. Tube feedings and I.V. lines can be uncomfortable.” Clients with anorexia can refuse food to the point of cardiac damage. Tube feedings and I.V. infusions are ordered to prevent such damage. The nurse is informing her of her treatment options. Option A doesn’t tell the client about the consequences of choosing not to eat. Telling clients that they are too thin won’t change their self-image.
  5. C. “You seem upset about the meetings.” The substance abuser uses the substance to cope with feelings and may deny the abuse. Asking if the client is upset about the meetings encourages the client to identify and deal with feelings instead of covering them up. Arguing with the client about the substance abuse (option A) or insisting that the client attend the meetings (option D) wouldn’t help the client identify resistance to treatment. Option B isn’t therapeutic behavior because it plays down the importance of attending meetings.
  6. C. jointly by the client and nurse. A contract written jointly by the client and nurse most successfully promotes cooperation and consistent behavior. The most effective contract — and the type least likely to allow for manipulation and misinterpretation — states the behavioral terms as concretely as possible. A contract written solely by the client may not be agreeable to staff members; one written by the physician and nurse may not be agreeable to the client.
  7. C. Crucial phase.  The crucial phase is marked by physical dependence. The prealcoholic phase is characterized by drinking to medicate feelings and for relief from stress. The early phase is characterized by sneaking drinks, blackouts, rapidly gulping drinks, and preoccupation with alcohol. The chronic phase is characterized by emotional and physical deterioration.
  8. C. Have an organized, efficient team approach after the decision is made to restrain the client. Emergency department personnel should use an organized, team approach when restraining violent clients so that no one is injured in the process. The leader, located at the client’s head, should take charge; four staff members are required to hold and restrain the limbs. For safety reasons, restraints should be fastened to the bed frame instead of the side rails. For quick release, loops should be used instead of knots
  9. B. Nystagmus. Phencyclidine is an anesthetic with severe psychological effects. It blocks the reuptake of dopamine and directly affects the midbrain and thalamus. Nystagmus and ataxia are common physical findings of PCP use. Dilated pupils are evidence of LSD ingestion. Paranoia and altered mood occur with both PCP and LSD ingestion.
  10. A. Initiating caloric and nutritional therapy as ordered. The client with anorexia nervosa is at risk for death from self-starvation. Therefore, initiating caloric and nutritional therapy takes highest priority. Behavioral modification (in which client privileges depend on weight gain) and psychoanalysis (which addresses the client’s low self-esteem, guilt, anxiety, and feelings of hopelessness and depression) are important aspects of care but are secondary to stabilizing the client’s physical condition. Monitoring vital signs and weight is important in evaluating nutritional therapy but doesn’t take precedence over providing adequate caloric intake to ensure survival
  11. D. Intensive inpatient treatment. Inpatient care is the best intervention for a client who is thinking about suicide every day. Implementing a no-suicide contract is an important strategy, but this client requires additional care. Weekly therapy wouldn’t provide the intensity of care that this case warrants. Obtaining a second opinion would take time; this client requires immediate intervention.
  12. B. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and caudate nucleus, and genetics.  The etiology of Tourette syndrome includes genetics, abnormalities in neurotransmission, and structural changes in the basal ganglia and caudate nucleus. The ventricles in the brain, environmental factors, and birth trauma aren’t involved.
  13. D. Denial.  Denial is an unconscious defense mechanism in which emotional conflict and anxiety are avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable. Withdrawal is a common response to stress, characterized by apathy. Logical thinking IS the ability to think rationally and make responsible decisions, which would lead the client to admitting the problem and seeking help. Repression is suppressing past events from the consciousness because of guilty association.
  14. A. violence on television. Violence on television has been correlated with an increase in aggressive behavior. Passive parents contribute to acting-out behaviors but not specifically to violence. An internal locus of control leads to a positive sense of self-esteem and isn’t related to violence or aggression. There is no direct correlation between single-parent families and violence.
  15. C. domestic violence and abuse span all socioeconomic classes. Domestic violence and abuse affect all socioeconomic classes. Closed boundaries and an imbalance of power, with one member having control over the others, are common in violent families. Although violent behavior may be passed from one generation to the next, it’s a learned behavior, not a genetic trait.
  16. A. avoid all products containing alcohol. To avoid severe adverse effects, the client taking disulfiram must strictly avoid alcohol and all products that contain alcohol. Vitamin B therapy and blood monitoring aren’t necessary during disulfiram therapy.
  17. D. “The team needs to know when something important occurs in treatment. I need to tell the others, but let’s talk about it first.” This response informs the client of the nurse’s planned actions and allows time to discuss the client’s actions. Options A and B put the client on the defensive and may lead to a power struggle. Option C ignores the psychological implications of the client’s actions.
  18. C. methadone. Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn’t have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.
  19. D. euphoria and constricted pupils. Assessment findings in a client abusing opiates include agitation, slurred speech, euphoria, and constricted pupils.
  20. B. Tachycardia. Amphetamines are central nervous system stimulants. They cause sympathetic stimulation, including hypertension, tachycardia, vasoconstriction, and hyperthermia. Hot, dry skin is seen with anticholinergic agents such as jimsonweed. Pupils will be dilated, not constricted.
  21. A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output. A nurse who lacks adequate information to determine which level of care a client requires must take all possible precautions to ensure the client’s physical safety and prevent complications. To do otherwise could place the client at risk for potential complications. After taking all possible precautions, the nurse can begin seeking health history information and, as needed, modify the plan of care. Fluids are typically increased unless contraindicated by a preexisting medical condition.
  22. A. Helping the client identify and express feelings of anxiety and anger. In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as “What happened to get you this angry?” may help the client verbalize feelings rather than act on them. Close interaction with the client in a quiet activity may place the nurse at risk for injury should the client suddenly become violent. An agitated and potentially violent client shouldn’t be left alone or unsupervised because the danger of the client acting out is too great. The client should be placed in seclusion only if other interventions fail or the client requests this. Unlocked seclusion can be helpful for some clients because it reduces environmental stimulation and provides a feeling of security.
  23. A. Abstinence is the basis for successful treatment. The foundation of any treatment for alcoholism is abstinence. Attendance at Alcoholics Anonymous is helpful to some individuals to maintain strict abstinence. Participation in treatment by the family is beneficial to both the client and the family but isn’t essential. Abstinence requires refraining from social drinking.
  24. B. Rejection by peers. Studies indicate that children who are rejected by their peers are more likely to behave aggressively. Aggression and conduct disorder are represented in all socioeconomic groups. Schizophrenia and an overbearing mother haven’t been associated with aggression or conduct disorder
  25. A. Denial. A client who states that he or she doesn’t have a drug problem and can quit using drugs at any time — despite evidence to the contrary — is denying the drug addiction. Obsession isn’t a defense mechanism. In compensation, the client emphasizes positive attributes to compensate for negative ones. In rationalization, the client justifies behaviors by faulty logic.
  26. C. nitroglycerin (Nitro-Bid IV). The elevated ST segments in this client’s ECG indicate myocardial ischemia. To reverse this problem, the physician is mostlikely to prescribe an infusion of nitroglycerin to dilate the coronary arteries. Lidocaine and procainamide are cardiac drugs that may be indicated for this client at some point but aren’t used for coronary artery dilation. If a cocaine user experiences ventricular fibrillation or asystole, the physician may prescribe epinephrine. However, this drug must be used with caution because cocaine may potentiate its adrenergic effects.
  27. C. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to other girls.” Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a “desirable weight” is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Most clients with anorexia nervosa don’t like the way they look, and their self-perception may be distorted. A girl with cachexia may perceive herself to be overweight when she looks in the mirror. Preferring fast food over healthy food is common in this age-group. Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.
  28. C. haloperidol (Haldol). Haloperidol is the drug of choice for treating Tourette syndrome. Prozac, Luvox, and Paxil are antidepressants and aren’t used to treat Tourette syndrome
  29. B. “Tell me how you feel about the accident.” An open-ended statement or question is the most therapeutic response. It encourages the widest range of client responses, makes the client an active participant in the conversation, and shows the client that the nurse is interested in his feelings. Asking the client why he drove while intoxicated can make him feel defensive and intimidated. A judgmental approach isn’t therapeutic. By giving advice, the nurse suggests that the client isn’t capable of making decisions, thus fostering dependency.
  30. D. Diaphoresis, tremors, and nervousness. Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic hallucinosis, and alcohol withdrawal delirium (formerly delirium tremens). Signs of alcohol withdrawal include diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure and pulse rate, sleep disturbance, and irritability. Although diarrhea may be an early sign of alcohol withdrawal, tachycardia — not bradycardia — is associated with alcohol withdrawal. Dehydration and an elevated temperature may be expected, but a temperature above 101° F indicates an infection rather than alcohol withdrawal. Pruritus rarely occurs in alcohol withdrawal. If withdrawal symptoms remain untreated, seizures may arise later.
  31. D. nifedipine and esmolol. This client requires a vasodilator, such as nifedipine, to treat hypertension, and a beta-adrenergic blocker, such as esmolol, to reduce the heart rate. Lidocaine, an antiarrhythmic, isn’t indicated because the client doesn’t have an arrhythmia. Although nitroglycerin may be used to treat coronary vasospasm, it isn’t the drug of choice in hypertension.
  32. B. The client will work with the nurse to remain safe. The priority goal in alcohol withdrawal is maintaining the client’s safety. Committing to a drug-free lifestyle, drinking plenty of fluids, and identifying personal strengths are important goals, but ensuring the client’s safety is the nurse’s top priority.
  33. A. A rigid posture, restlessness, and glaring. Behavioral clues that suggest the potential for violence include a rigid posture, restlessness, glaring, a change in usual behavior, clenched hands, overtly aggressive actions, physical withdrawal, noncompliance, overreaction, hostile threats, recent alcohol ingestion or drug use, talk of past violent acts, inability to express feelings, repetitive demands and complaints, argumentativeness, profanity, disorientation, inability to focus attention, hallucinations or delusions, paranoid ideas or suspicions, and somatic complaints. Violent clients rarely exhibit depression, silence, or hypervigilance.
  34. D. “I know I’ve been arrested three times for drinking and driving, but the police are just trying to hassle me.” According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for psychoactive substance abuse include a maladaptive pattern of such use, indicated either by continued use despite knowledge of having a persistent or recurrent social, occupational, psychological, or physical problem caused or exacerbated by substance abuse or recurrent use in dangerous situations (for example, while driving). For this client, psychoactive substance dependence must be ruled out; criteria for this disorder include a need for increasing amounts of the substance to achieve intoxication (option A), increased time and money spent on the substance (option B), inability to fulfill role obligations (option C), and typical withdrawal symptoms.
  35. C. Risk for violence: Self-directed related to impulsive mutilating acts. The predominant behavioral characteristic of the client with borderline personality disorder is impulsiveness, especially of a physically self-destructive sort. The observation that the client has scratched wrists doesn’t substantiate the other options.
  36. A. Coronary artery spasm. Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial infarction, dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death. Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at postsynaptic receptor sites. Consequently, the drug is more likely to cause tachyarrhythmias than bradyarrhythmias. Although neurobehavioral deficits are common in neonates born to cocaine users, they are rare in adults. As craving for the drug increases, a person who’s addicted to cocaine typically experiences euphoria followed by depression, not panic disorder.
  37. C. begin anytime within the next 1 to 2 days. Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink.
  38. A. Providing one-on-one supervision during meals and for 1 hour afterward. Because the client with anorexia nervosa may discard food or induce vomiting in the bathroom, the nurse should provide one-on-one supervision during meals and for 1 hour afterward. Option B wouldn’t be therapeutic because other clients may urge the client to eat and give attention for not eating. Option C would reinforce control issues, which are central to this client’s underlying psychological problem. Instead of giving the client unlimited time to eat, as in option D, the nurse should set limits and let the client know what is expected.
  39. C. Providing a quiet environment and administering medication as needed and prescribed. Manifestations of alcoholic hallucinosis are best treated by providing a quiet environment to reduce stimulation and administering prescribed central nervous system depressants in dosages that control symptoms without causing oversedation. Although bed rest is indicated, restraints are unnecessary unless the client poses a danger to himself or others. Also, restraints may increase agitation and make the client feel trapped and helpless when hallucinating. Offering juice is appropriate, but measuring blood pressure every 15 minutes would interrupt the client’s rest. To avoid overstimulating the client, the nurse should check blood pressure every 2 hours.
  40. A. Heart rate of 120 to 140 beats/minute. Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertension typically occurs in early withdrawal. Hypotension, although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don’t receive treatment. The nurse should monitor the client’s vital signs carefully throughout the entire alcohol withdrawal process.
  41. B. One who plans a violent death and has the means readily available. The client at highest risk for suicide is one who plans a violent death (for example, by gunshot, jumping off a bridge, or hanging), has a specific plan (for example, after the spouse leaves for work), and has the means readily available (for example, a rifle hidden in the garage). A client who gives away possessions, thinks about death, or talks about wanting to die or attempting suicide is considered at a lower risk for suicide because this behavior typically serves to alert others that the client is contemplating suicide and wishes to be helped.
  42. C. Diabetes mellitus. Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. The eating disorder isn’t typically associated with allergies, cancer, or hepatitis A.
  43. B. The student accepts a referral to a substance abuse counselor. All of the outcomes stated are desirable; however, the best outcome is that the student would agree to seek the assistance of a professional substance abuse counselor.
  44. C. lorazepam (Ativan). The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs aren’t used to manage alcohol withdrawal syndrome.
  45. A. Al-Anon. Al-Anon is an organization that assists family members to share common experiences and increase their understanding of alcoholism. Make Today Count is a support group for people with life-threatening or chronic illnesses. Emotions Anonymous is a support group for people experiencing depression, anxiety, or similar conditions. Alcoholics Anonymous is an organization that helps alcoholics recover by using a twelve-step program.
  46. C. monitor vital signs, serum electrolyte levels, and acid-base balance. An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client’s vital signs, serum electrolyte level, and acid base balance is crucial. Option A may worsen anxiety. Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.
  47. A. antisocial personality disorder. The client’s history of delinquency, running away from home, vandalism, and dropping out of school are characteristic of antisocial personality disorder. This maladaptive coping pattern is manifested by a disregard for societal norms of behavior and an inability to relate meaningfully to others. In borderline personality disorder, the client exhibits mood instability, poor self-image, identity disturbance, and labile affect. Obsessive-compulsive personality disorder is characterized by a preoccupation with impulses and thoughts that the client realizes are senseless but can’t control. Narcissistic personality disorder is marked by a pattern of self-involvement, grandiosity, and demand for constant attention.
  48. C. has learned violence as an acceptable behavior. Family violence usually is a learned behavior, and violence typically leads to further violence, putting this couple at risk. Repeated slapping may indicate poor, not moderate, impulse control. Violent people commonly are jealous and possessive and feel insecure in their relationships.
  49. B. gain control of one part of her life. By refusing to eat, a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. This eating disorder doesn’t represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement). The client isn’t attempting to commit suicide through starvation; rather, by refusing to eat, she is expressing feelings of despair, worthlessness, and hopelessness.
  50. B. total abstinence. Total abstinence is the only effective treatment for alcoholism. Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.