Practice Test Psychiatric Nursing 150 Items

Psychiatric Nursing Practice Test Part 1 Marco approached Nurse Trish asking for

b. Highly famous and important c.

d. Connected to client unrelated to oneself

advice on how to deal with his alcohol

A 20 year old client was diagnosed with

addiction. Nurse Trish should tell the client

dependent personality disorder. Which

that the only effective treatment for

behavior is not most likely to be evidence of ineffective individual coping?

alcoholism is: a. Psychotherapy Alcoholics anonymous (A.A.) c.

Total abstinence

d. Aversion Therapy

a. Recurrent self-destructive behavior b. Avoiding relationship c.

experience false sensory perceptions with no

advise

8. A male client is diagnosed with schizotypal personality disorder. Which signs would this

basis in reality. This perception is known as:

client exhibit during social situation?

a. Hallucinations b. Delusions Loose associations

d. Neologisms

3. Nurse Monet is caring for a female client who has suicidal tendency. When accompanying

a. Paranoid thoughts b. Emotional affect c.

d. Aggressive behavior

9. Nurse Claire is caring for a client diagnosed with bulimia. The most appropriate initial goal

should…

for a client diagnosed with bulimia is?

b. Allow her to urinate Open the window and allow her to get some fresh air d. Observe her

a. Encourage to avoid foods b. Identify anxiety causing situations c.

10. Nurse Tony was caring for a 41 year old female client. Which behavior by the client indicates adult cognitive development?

for a female client with anorexia nervosa. Which action should the nurse include in the

a. Generates new levels of awareness

plan?

b. Assumes responsibility for her actions

a. Provide privacy during meals

c.

Encourage client to exercise to reduce anxiety

d. Restrict visits with the family

Has maximum ability to solve problems and learn new skills

b. Set-up a strict eating plan for the client

d. Her perception are based on reality

11. A neuromuscular blocking agent is administered to a client before ECT therapy.

5. A client is experiencing anxiety attack. The most appropriate nursing intervention should

The Nurse should carefully observe the client

include?

for?

Turning on the television b. Leaving the client alone c.

Eat only three meals a day

d. Avoid shopping plenty of groceries

4. Nurse Maureen is developing a plan of care

c.

Independence need

the client to the restroom, Nurse Monet a. Give her privacy

c.

Showing interest in solitary activities

d. Inability to make choices and decision without

2. Nurse Hazel is caring for a male client who

c.

Responsible for evil world

Staying with the client and speaking in short sentences

d. Ask the client to play with other clients

6. A female client is admitted with a diagnosis of

a. Respiratory difficulties b. Nausea and vomiting c.

Dizziness

d. Seizures

12. A 75 year old client is admitted to the hospital with the diagnosis of dementia of the

delusions of GRANDEUR. This diagnosis

Alzheimer’s type and depression. The

reflects a belief that one is:

symptom that is unrelated to depression

a. Being Killed

would be? a. Apathetic response to the environment

b. “I don’t know” answer to questions c.

a. Ask a family member to stay with the client at

Shallow of labile effect

d. Neglect of personal hygiene

home temporarily b. Discuss the meaning of the client’s statement

13. Nurse Trish is working in a mental health

with her

facility; the nurse priority nursing intervention

c.

for a newly admitted client with bulimia

d. Ignore the clients statement because it’s a sign

nervosa would be to?

Request an immediate extension for the client

of manipulation

a. Teach client to measure I & O

Joey a client with antisocial personality

b. Involve client in planning daily meal

disorder belches loudly. A staff member asks

c.

Joey, “Do you know why people find you

Observe client during meals

d. Monitor client continuously

repulsive?” this statement most likely would

14. Nurse Patricia is aware that the major health

elicit which of the following client reaction?

complication associated with intractable

a. Depensiveness

anorexia nervosa would be?

b. Embarrassment

a. Cardiac dysrhythmias resulting to cardiac arrest

c.

b. Glucose intolerance resulting in protracted

d. Remorsefulness

hypoglycemia c.

Shame

20. Which of the following approaches would be most appropriate to use with a client suffering

Endocrine imbalance causing cold amenorrhea

d. Decreased metabolism causing cold intolerance

from narcissistic personality disorder when

15. Nurse Anna can minimize agitation in a

discrepancies exist between what the client

disturbed client by?

states and what actually exist?

a. Increasing stimulation

a. Rationalization

b. limiting unnecessary interaction

b. Supportive confrontation

c.

c.

increasing appropriate sensory perception

Limit setting

d. ensuring constant client and staff contact

d. Consistency

16. A 39 year old mother with obsessive-

21. Cely is experiencing alcohol withdrawal

compulsive disorder has become immobilized

exhibits tremors, diaphoresis and

by her elaborate hand washing and walking

hyperactivity. Blood pressure is 190/87 mmhg

rituals. Nurse Trish recognizes that the basis

and pulse is 92 bpm. Which of the

of O.C. disorder is often:

medications would the nurse expect to administer?

a. Problems with being too conscientious b. Problems with anger and remorse

a. Naloxone (Narcan)

c.

b. Benzlropine (Cogentin)

Feelings of guilt and inadequacy

d. Feeling of unworthiness and hopelessness

c.

17. Mario is complaining to other clients about not

d. Haloperidol (Haldol)

being allowed by staff to keep food in his

Lorazepam (Ativan)

22. Which of the following foods would the nurse

room. Which of the following interventions

Trish eliminate from the diet of a client in

would be most appropriate?

alcohol withdrawal?

a. Allowing a snack to be kept in his room

a. Milk

b. Reprimanding the client

b. Orange Juice

c.

c.

Ignoring the clients behavior

Soda

d. Setting limits on the behavior

d. Regular Coffee

18. Conney with borderline personality disorder

23. Which of the following would Nurse Hazel

who is to be discharge soon threatens to “do

expect to assess for a client who is exhibiting

something” to herself if discharged. Which of

late signs of heroin withdrawal?

the following actions by the nurse would be

a. Yawning & diaphoresis

most important?

b. Restlessness & Irritability c.

Constipation & steatorrhea

d. Vomiting and Diarrhea

d. Denial

24. To establish open and trusting relationship

30. When working with a male client suffering

with a female client who has been

phobia about black cats, Nurse Trish should

hospitalized with severe anxiety, the nurse in

anticipate that a problem for this client would

charge should?

be?

a. Encourage the staff to have frequent interaction with the client

a. Anxiety when discussing phobia b. Anger toward the feared object

b. Share an activity with the client

c.

c.

d. Distortion of reality when completing daily

Give client feedback about behavior

d. Respect client’s need for personal space

25. Nurse Monette recognizes that the focus of

routines

31. Linda is pacing the floor and appears

environmental (MILIEU) therapy is to:

extremely anxious. The duty nurse approaches in an attempt to alleviate Linda’s

a. Manipulate the environment to bring about

anxiety. The most therapeutic question by the

positive changes in behavior

nurse would be?

b. Allow the client’s freedom to determine whether or not they will be involved in activities

a. Would you like to watch TV?

Role play life events to meet individual needs

b. Would you like me to talk with you?

d. Use natural remedies rather than drugs to control behavior

26. Nurse Trish would expect a child with a

c.

32. Nurse Penny is aware that the symptoms that distinguish post traumatic stress disorder from other anxiety disorder would be:

a. Have more positive relation with the father than the mother

a. Avoidance of situation & certain activities that

b. Cling to mother & cry on separation Be able to develop only superficial relation with

Are you feeling upset now?

d. Ignore the client

diagnosis of reactive attachment disorder to:

c.

Denying that the phobia exist

resemble the stress b. Depression and a blunted affect when discussing

the others

the traumatic situation

d. Have been physically abuse

c.

27. When teaching parents about childhood

d. Re-experiencing the trauma in dreams or

depression Nurse Trina should say? a. It may appear acting out behavior

Lack of interest in family & others

flashback

33. Nurse Benjie is communicating with a male

b. Does not respond to conventional treatment

client with substance-induced persisting

c.

dementia; the client cannot remember facts

Is short in duration & resolves easily

d. Looks almost identical to adult depression

and fills in the gaps with imaginary

28. Nurse Perry is aware that language

information. Nurse Benjie is aware that this is

development in autistic child resembles:

typical of?

a. Scanning speech

a. Flight of ideas

b. Speech lag

b. Associative looseness

c.

c.

Shuttering

Confabulation

d. Echolalia

d. Concretism

29. A 60 year old female client who lives alone

34. Nurse Joey is aware that the signs &

tells the nurse at the community health

symptoms that would be most specific for

center “I really don’t need anyone to talk to”.

diagnosis anorexia are?

The TV is my best friend. The nurse

a. Excessive weight loss, amenorrhea & abdominal

recognizes that the client is using the defense mechanism known as?

distension b. Slow pulse, 10% weight loss & alopecia

a. Displacement

c.

b. Projection

d. Excessive activity, memory lapses & an

c.

Sublimation

Compulsive behavior, excessive fears & nausea

increased pulse

35. A characteristic that would suggest to Nurse Anne that an adolescent may have bulimia

d. Weak ego

41. A 23 year old client has been admitted with a

would be:

diagnosis of schizophrenia says to the nurse

a. Frequent regurgitation & re-swallowing of food

“Yes, its march, March is little woman”. That’s

b. Previous history of gastritis

literal you know”. These statement illustrate:

c.

Badly stained teeth

a. Neologisms

d. Positive body image

b. Echolalia

36. Nurse Monette is aware that extremely

c.

Flight of ideas

depressed clients seem to do best in settings

d. Loosening of association

where they have:

42. A long term goal for a paranoid male client

a. Multiple stimuli

who has unjustifiably accused his wife of

b. Routine Activities

having many extramarital affairs would be to

c.

help the client develop:

Minimal decision making

d. Varied Activities

a. Insight into his behavior

37. To further assess a client’s suicidal potential.

b. Better self control

Nurse Katrina should be especially alert to the

c.

client expression of:

d. Faith in his wife

a. Frustration & fear of death

Feeling of self worth

43. A male client who is experiencing disordered

b. Anger & resentment

thinking about food being poisoned is

c.

admitted to the mental health unit. The nurse

Anxiety & loneliness

d. Helplessness & hopelessness

uses which communication technique to

38. A nursing care plan for a male client with

encourage the client to eat dinner?

bipolar I disorder should include:

a. Focusing on self-disclosure of own food

a. Providing a structured environment b. Designing activities that will require the client to

c.

preference b. Using open ended question and silence

maintain contact with reality

c.

Engaging the client in conversing about current

d. Verbalizing reasons that the client may not

affairs d. Touching the client provide assurance

choose to eat

44. Nurse Nina is assigned to care for a client

39. When planning care for a female client using

diagnosed with Catatonic Stupor. When Nurse

ritualistic behavior, Nurse Gina must

Nina enters the client’s room, the client is

recognize that the ritual:

found lying on the bed with a body pulled into a fetal position. Nurse Nina should?

a. Helps the client focus on the inability to deal with reality

a. Ask the client direct questions to encourage

b. Helps the client control the anxiety c.

Is under the client’s conscious control

talking b. Rake the client into the dayroom to be with

d. Is used by the client primarily for secondary gains

40. A 32 year old male graduate student, who has become increasingly withdrawn and neglectful of his work and personal hygiene, is brought

other clients c.

Sit beside the client in silence and occasionally ask open-ended question

d. Leave the client alone and continue with providing care to the other clients

to the psychiatric hospital by his parents.

45. Nurse Tina is caring for a client with delirium

After detailed assessment, a diagnosis of

and states that “look at the spiders on the

schizophrenia is made. It is unlikely that the

wall”. What should the nurse respond to the

client will demonstrate:

client?

a. Low self esteem b. Concrete thinking c.

Offering opinion about the need to eat

Effective self boundaries

a. “You’re having hallucination, there are no spiders in this room at all”

b. “I can see the spiders on the wall, but they are

c.

50. Mario is admitted to the emergency room with

not going to hurt you”

drug-included

“Would you like me to kill the spiders”

ingestion

46. Nurse Jonel is providing information to a

antipsychotic

community group about violence in the

a. Length of time on the med.

family. Which statement by a group member

b. Name of the ingested medication & the amount

information? a. “Abuse occurs more in low-income families” b. “Abuser Are often jealous or self-centered” “Abuser use fear and intimidation”

d. “Abuser usually have poor self-esteem”

47. During electroconvulsive therapy (ECT) the client receives oxygen by mask via positive pressure ventilation. The nurse assisting with this procedure knows that positive pressure ventilation is necessary because? a. Anesthesia is administered during the procedure b. Decrease oxygen to the brain increases confusion and disorientation

ingested c.

Reason for the suicide attempt

d. Name of the nearest relative & their phone number

Answers and Rationale Psychiatric Nursing Practice Test Part 2 1.C. Total abstinence is the only effective treatment for alcoholism. 2.A. Hallucinations are visual, auditory, gustatory, tactile or olfactory perceptions that have no basis in reality. 3.D. The Nurse has a responsibility to observe

Grand mal seizure activity depresses

continuously the acutely suicidal client. The

respirations

Nurseshould watch for clues, such as

d. Muscle relaxations given to prevent injury during seizure activity depress respirations.

48. When planning the discharge of a client with chronic anxiety, Nurse Chris evaluates achievement of the discharge maintenance goals. Which goal would be most appropriately having been included in the plan of care requiring evaluation? a. The client eliminates all anxiety from daily situations b. The client ignores feelings of anxiety The client identifies anxiety producing situations

d. The client maintains contact with a crisis counselor

49. Nurse Tina is caring for a client with

communicating suicidal thoughts, and messages; hoarding medications and talking about death. 4.B. Establishing a consistent eating plan and monitoring client’s weight are important to this disorder. 5.C. Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm and medicating as needed. 6.B. Delusion of grandeur is a false belief that one is highly famous and important. 7.D. Individual with dependent personality

depression who has not responded to

disorder typically shows

antidepressant medication. The nurse

indecisiveness submissiveness and clinging

anticipates that what treatment procedure

behavior so that others will make decisions

may be prescribed?

with them.

a. Neuroleptic medication b. Short term seclusion c.

over

initially is the:

would indicate a need to provide additional

c.

prescribed

to

information the nurse in charge should obtain

spiders on the wall”

c.

related

medication. The most important piece of

d. “I know you are frightened, but I do not see

c.

of

anxiety

Psychosurgery

d. Electroconvulsive therapy

8.A. Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts.

9.B. Bulimia disorder generally is a

20.B. The nurse would specifically use

maladaptive coping response to stress and

supportive confrontation with the client to

underlying issues. The client should identify

point out discrepancies between what the

anxiety causing situation that stimulate the

client states and what actually exists to

bulimic behavior and then learn new ways

increase responsibility for self.

of coping with the anxiety. 10.A. An adult age 31 to 45 generates new level of awareness. 11.A. Neuromuscular Blocker, such as

21.C. The nurse would most likely administer benzodiazepine, such as lorazepan (ativan) to the client who is experiencing symptom: The client’s experiences symptoms of

SUCCINYLCHOLINE (Anectine) produces

withdrawal because of the rebound

respiratory depression because it inhibits

phenomenon when the sedation of the CNS

contractions of respiratory muscles.

from alcohol begins to decrease.

12.C. With depression, there is little or no

22.D. Regular coffee contains caffeine which

emotional involvement therefore little

acts as psychomotor stimulants and leads

alteration in affect.

to feelings of anxiety and agitation. Serving

13.D. These clients often hide food or force vomiting; therefore they must be carefully monitored. 14.A. These clients have severely depleted

coffee top the client may add to tremors or wakefulness. 23.D. Vomiting and diarrhea are usually the late signs of heroin withdrawal, along with

levels of sodium and potassium because of

muscle spasm, fever, nausea, repetitive,

their starvation diet and energy

abdominal cramps and backache.

expenditure, these electrolytes are necessary for cardiac functioning. 15.B. Limiting unnecessary interaction will decrease stimulation and agitation. 16.C. Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy by maintaining an absolute set pattern of behavior. 17.D. The nurse needs to set limits in the client’s manipulative behavior to help the client control dysfunctional behavior. A

24.D. Moving to a client’s personal space increases the feeling of threat, which increases anxiety. 25.A. Environmental (MILIEU) therapy aims at having everything in the client’s surrounding area toward helping the client. 26.C. Children who have experienced attachment difficulties with primary caregiver are not able to trust others and therefore relate superficially 27.A. Children have difficulty verbally

consistent approach by the staff is

expressing their feelings, acting out

necessary to decrease manipulation.

behavior, such as temper tantrums, may

18.B. Any suicidal statement must be assessed by the nurse. The nurse should discuss the client’s statement with her to determine its meaning in terms of suicide. 19.A. When the staff member ask the client if

indicate underlying depression. 28.D. The autistic child repeat sounds or words spoken by others. 29.D. The client statement is an example of the use of denial, a defense that blocks

he wonders why others find him repulsive,

problem by unconscious refusing to admit

the client is likely to feel defensive because

they exist.

the question is belittling. The natural tendency is to counterattack the threat to self image.

30.A. Discussion of the feared object triggers an emotional response to the object. 31.B. The nurse presence may provide the client with support & feeling of control.

32.D. Experiencing the actual trauma in dreams or flashback is the major symptom that distinguishes post traumatic stress disorder from other anxiety disorder. 33.C. Confabulation or the filling in of memory gaps with imaginary facts is a

ended question and pausing to provide opportunities for the client to respond. 45.D. When hallucination is present, the nurse should reinforce reality with the client. 46.A. Personal characteristics of abuser include

defense mechanismused by people

low self-esteem, immaturity, dependence,

experiencing memory deficits.

insecurity and jealousy.

34.A. These are the major signs of anorexia

47.D. A short acting skeletal muscle relaxant

nervosa. Weight loss is excessive (15% of

such as succinylcholine (Anectine) is

expected weight).

administered during this procedure to

35.C. Dental enamel erosion occurs from repeated self-induced vomiting. 36.B. Depression usually is both emotional &

prevent injuries during seizure. 48.C. Recognizing situations that produce anxiety allows the client to prepare to cope

physical. A simple daily routine is the best,

with anxiety or avoid specific stimulus.

least stressful and least anxiety producing.

49.D. Electroconvulsive therapy is an effective

37.D. The expression of these feeling may indicate that this client is unable to continue the struggle of life. 38.A. Structure tends to decrease agitation

treatment for depression that has not responded to medication. 50.B. In an emergency, lives saving facts are obtained first. The name and the amount of

and anxiety and to increase the client’s

medication ingested are of outmost

feeling of security.

important in treating this potentially life

39.B. The rituals used by a client with

threatening situation.

the anxiety level by maintaining a set

Psychiatric Nursing Practice Test Part 2

pattern of action.

1.Nurse Tony should first discuss terminating

obsessive compulsive disorder help control

40.C. A person with this disorder would not have adequate self-boundaries. 41.D. Loose associations are thoughts that are presented without the logical connections usually necessary for the listening to interpret the message. 42.C. Helping the client to develop feeling of self worth would reduce the client’s need to use pathologic defenses. 43.B. Open ended questions and silence are

the nurse-client relationship with a client during the: a.Termination phase when discharge plans are being made. b.Working phase when the client shows some progress. c.Orientation phase when a contract is established. d.Working phase when the client brings it up. 2.Malou is diagnosed with major depression

strategies used to encourage clients to

spends majority of the day lying in bed with

discuss their problem in descriptive manner.

the sheet pulled over his head. Which of the

44.C. Clients who are withdrawn may be immobile and mute, and require consistent,

following approaches by the nurse would be the most therapeutic?

repeated interventions. Communication

a.Question the client until he responds

with withdrawn clients requires much

b.Initiate contact with the client frequently

patience from the nurse.The

c.Sit outside the clients room

nurse facilitates communication with the

d.Wait for the client to begin the conversation

client by sitting in silence, asking open-

3.Joe who is very depressed exhibits

a.Echolalia

psychomotor retardation, a flat affect and

b.Neologism

apathy. The nursein charge observes Joe to

c.Clang associations

be in need of grooming and hygiene. Which

d.Flight of ideas

of the following nursing actions would be

8.Terry with mania is skipping up and down the

most appropriate? a.Waiting until the client’s family can participate in the client’s care b.Asking the client if he is ready to take shower c.Explaining the importance of hygiene to the client d.Stating to the client that it’s time for him to take a shower 4.When teaching Mario with a typical

hallway practically running into other clients. Which of the following activities would the nurse in charge expect to include in Terry’s plan of care? a.Watching TV b.Cleaning dayroom tables c.Leading group activity d.Reading a book 9.When assessing a male client for suicidal

depression about foods to avoid while

risk, which of the following methods of

taking phenelzine(Nardil), which of the

suicide would the nurse identify as most

following would the nurse in charge

lethal?

include?

a.Wrist cutting

a.Roasted chicken

b.Head banging

b.Fresh fish

c.Use of gun

c.Salami

d.Aspirin overdose

d.Hamburger

10.Jun has been hospitalized for major

5.When assessing a female client who is

depression and suicidal ideation. Which of

receiving tricyclic antidepressant therapy,

the following statements indicates to the

which of the following would alert the

nurse that the client is improving?

nurse to the possibility that the client is

a.“I’m of no use to anyone anymore.”

experiencing anticholinergic effects?

b.“I know my kids don’t need me anymore

a.Urine retention and blurred vision b.Respiratory depression and convulsion c.Delirium and Sedation d.Tremors and cardiac arrhythmias 6.For a male client with dysthymic disorder, which of the following approaches would the nurseexpect to implement?

since they’re grown.” c.“I couldn’t kill myself because I don’t want to go to hell.” d.“I don’t think about killing myself as much as I used to.” 11.Which of the following activities would Nurse Trish recommend to the client who

a.ECT

becomes very anxious when thoughts of

b.Psychotherapeutic approach

suicide occur?

c.Psychoanalysis

a.Using exercise bicycle

d.Antidepressant therapy

b.Meditating

7.Danny who is diagnosed with bipolar disorder

c.Watching TV

and acute mania, states the nurse, “Where

d.Reading comics

is my daughter? I love Louis. Rain, rain go

12.When developing the plan of care for a

away. Dogs eat dirt.” The nurse interprets

client receiving haloperidol, which of the

these statements as indicating which of the

following medications would nurse Monet

following?

anticipate administering if the client

a.Attending an activity with the nurse

developed extra pyramidal side effects?

b.Leading a sing a long in the afternoon

a.Olanzapine (Zyprexa)

c.Participating solely in group activities

b.Paroxetine (Paxil)

d.Being involved with primarily one to

c.Benztropine mesylate (Cogentin) d.Lorazepam (Ativan) 13.Jon a suspicious client states that “I know you nurses are spraying my food with poison as you take it out of the cart.” Which of the following would be the best response of the nurse? a.Giving the client canned supplements until the delusion subsides b.Asking what kind of poison the client suspects is being used

one activities 17.Which statement about an individual with a personality disorder is true? a.Psychotic behavior is common during acute episodes b.Prognosis for recovery is good with therapeutic intervention c.The individual typically remains in the mainstream of society, although he has problems in social and occupational roles d.The individual usually seeks treatment

c.Serving foods that come in sealed packages

willingly for symptoms that are personally

d.Allowing the client to be the first to open the

distressful.

cart and get a tray 14.A client is suffering from catatonic

18.Nurse John is talking with a client who has been diagnosed with antisocial personality

behaviors. Which of the following would the

about how to socialize

nurse use to determine that the medication

during activities without being

administered PRN have been most

seductive. Nurse John would focus the

effective?

discussion on which of the following areas?

a.The client responds to verbal directions to eat b.The client initiates simple activities without direction c.The client walks with the nurse to her room d.The client is able to move all extremities occasionally 15.Nurse Hazel invites new client’s parents to

a.Discussing his relationship with his mother b.Asking him to explain reasons for his seductive behavior c.Suggesting to apologize to others for his behavior d.Explaining the negative reactions of others toward his behavior 19.Tina with a histrionic personality disorder is

attend the psycho educational program for

melodramatic and responds to others and

families of the chronically mentally ill. The

situations in an exaggerated manner. Nurse

program would be most likely to help the

Trish would recommend which of the

family with which of the following issues?

following activities for Tina?

a.Developing a support network with other families

a.Baking class b.Role playing

b.Feeling more guilty about the client’s illness

c.Scrap book making

c.Recognizing the client’s weakness

d.Music group

d.Managing their financial concern and

20.Joy has entered the chemical dependency

problems 16.When planning care for Dory with

unit for treatment of alcohol dependency. Which of the following client’s

schizotypal personality disorder, which of

possession will the nurse most likely place

the following would help the client become

in a locked area?

involved with others?

a.Toothpaste

b.Shampoo

d.Confusion

c.Antiseptic wash

26.Jose is diagnosed with amphetamine

d.Moisturizer

psychosis and was admitted in the

21.Which of the following assessment would

emergency room. Nurse Ronald would most

provide the best information about the

likely prepare to administer which of the

client’s physiologic response and the

following medication?

effectiveness of the medication prescribed

a.Librium

specifically for alcohol withdrawal?

b.Valium

a.Sleeping pattern

c.Ativan

b.Mental alertness

d.Haldol

c.Nutritional status

27.Which of the following liquids would nurse

d.Vital signs

Leng administer to a female client who is

22.After administering naloxone (Narcan), an

intoxicated with phencyclidine (PCP) to

opioid antagonist, Nurse Ronald should

hasten excretion of the chemical?

monitor the female client carefully for which

a.Shake

of the following?

b.Tea

a.Respiratory depression

c.Cranberry Juice

b.Epilepsy

d.Grape juice

c.Kidney failure

28.When developing a plan of care for a female

d.Cerebral edema

client with acute stress disorder who lost

23.Which of the following would nurse Ronald

her sister in a car accident. Which of the

use as the best measure to determine a client’s progress in rehabilitation? a.The way he gets along with his parents b.The number of drug-free days he has c.The kinds of friends he makes d.The amount of responsibility his job entails 24.A female client is brought by ambulance to the hospital emergency room after taking an overdose of barbiturates is comatose. Nurse Trish would be especially alert for which of the following?

following would the nurse expect to initiate? a.Facilitating progressive review of the accident and its consequences b.Postponing discussion of the accident until the client brings it up c.Telling the client to avoid details of the accident d.Helping the client to evaluate her sister’s behavior 29.The nursing assistant tells nurse Ronald that the client is not in the dining room for

a.Epilepsy

lunch. Nurse Ronald would direct the

b.Myocardial Infarction

nursing assistant to do which of the

c.Renal failure

following?

d.Respiratory failure 25.Joey who has a chronic user of cocaine reports that he feels like he has cockroaches crawling under his skin. His arms are red because of scratching. The nurse in charge interprets these findings as possibly indicating which of the following? a.Delusion b.Formication c.Flash back

a.Tell the client he’ll need to wait until supper to eat if he misses lunch b.Invite the client to lunch and accompany him to the dining room c.Inform the client that he has 10 minutes to get to the dining room for lunch d.Take the client a lunch tray and let the client eat in his room

30.The initial nursing intervention for the significant-others during shock phase of a grief reaction should be focused on: a.Presenting full reality of the loss of the individuals b.Directing the individual’s activities at this time c.Staying with the individuals involved

b.Powerlessness related to the loss of idealized self c.Spiritual distress related to depression d.Impaired verbal communication related to depression 36.When developing an initial nursing care plan for a male client with a Bipolar I disorder (manic episode) nurse Ron should plan to?

d.Mobilizing the individual’s support system

a.Isolate his gym time

31.Joy’s stream of consciousness is occupied

b.Encourage his active participation in unit

exclusively with thoughts of her father’s

programs

death. Nurse Ronald should plan to help Joy

c.Provide foods, fluids and rest

through this stage of grieving, which is

d.Encourage his participation in programs

known as:

37.Grace is exhibiting withdrawn patterns of

a.Shock and disbelief

behavior. Nurse Johnny is aware that this

b.Developing awareness

type of behavior eventually produces

c.Resolving the loss

feeling of:

d.Restitution

a.Repression

32.When taking a health history from a female

b.Loneliness

client who has a moderate level of cognitive

c.Anger

impairment due to dementia, the nurse

d.Paranoia

would expect to note the presence of:

38.One morning a female client on the

a.Accentuated premorbid traits

inpatient psychiatric service complains to

b.Enhance intelligence

nurse Hazel that she has been waiting for

c.Increased inhibitions

over an hour for someone to accompany

d.Hyper vigilance

her to activities. Nurse Hazel replies to the

33.What is the priority care for a client with a

client “We’re doing the best we can. There

dementia resulting from AIDS?

are a lot of other people on the unit who

a.Planning for remotivational therapy

needs attention too.” This statement shows

b.Arranging for long term custodial care

that the nurse’s use of:

c.Providing basic intellectual stimulation

a.Defensive behavior

d.Assessing pain frequently

b.Reality reinforcement

34.Jerome who has eating disorder often

c.Limit-setting behavior

exhibits similar symptoms. Nurse Lhey

d.Impulse control

would expect an adolescent client with

39.A nursing diagnosis for a male client with a

anorexia to exhibit:

diagnosed multiple personality disorder is

a.Affective instability

chronic low self-esteem probably related to

b.Dishered, unkempt physical appearance

childhood abuse. The most appropriate

c.Depersonalization and derealization

short term client outcome would be:

d.Repetitive motor mechanisms

a.Verbalizing the need for anxiety medications

35.The primary nursing diagnosis for a female

b.Recognizing each existing personality

client with a medical diagnosis of major

c.Engaging in object-oriented activities

depression would be:

d.Eliminating defense mechanisms and phobia

a.Situational low self-esteem related to altered role

40.A 25 year old male is admitted to a mental health facility because of inappropriate

behavior. The client has been hearing voices, responding to imaginary

b.Tired and probably did not sleep well last night

companions and withdrawing to his room

c.Attempting to hide from the nurse

for several days at a time. Nurse Monette

d.Feeling more anxious today

understands that the withdrawal is a

45.Nurse Bea notices a female client sitting

defense against the client’s fear of:

alone in the corner smiling and talking to

a.Phobia

herself.Realizing that the client is

b.Powerlessness

hallucinating. Nurse Bea should:

c.Punishment d.Rejection

a.Invite the client to help decorate the dayroom

41.When asking the parents about the onset of

b.Leave the client alone until he stops talking

problems in young client with the diagnosis

c.Ask the client why he is smiling and talking

of schizophrenia, Nurse Linda would expect

d.Tell the client it is not good for him to talk to

that they would relate the client’s difficulties began in:

himself 46.When being admitted to a mental health

a.Early childhood

facility, a young female adult tells Nurse

b.Late childhood

Mylene that the voices she hears frighten

c.Adolescence

her. Nurse Mylene understands that the

d.Puberty

client tends to hallucinate more vividly:

42.Jose who has been hospitalized with

a.While watching TV

schizophrenia tells Nurse Ron, “My heart

b.During meal time

has stopped and my veins have turned to

c.During group activities

glass!” Nurse Ron is aware that this is an

d.After going to bed

example of:

47.Nurse John recognizes that paranoid

a.Somatic delusions

delusions usually are related to the defense

b.Depersonalization

mechanism of:

c.Hypochondriasis

a.Projection

d.Echolalia

b.Identification

43.In recognizing common behaviors exhibited

c.Repression

by male client who has a diagnosis of

d.Regression

schizophrenia, nurse Josie can anticipate:

48.When planning care for a male client using

a.Slumped posture, pessimistic out look and flight of ideas b.Grandiosity, arrogance and distractibility c.Withdrawal, regressed behavior and lack of social skills d.Disorientation, forgetfulness and anxiety 44.One morning, nurse Diane finds a disturbed

paranoid ideation, nurse Jasmin should realize the importance of: a.Giving the client difficult tasks to provide stimulation b.Providing the client with activities in which success can be achieved c.Removing stress so that the client can relax

client curled up in the fetal position in the

d.Not placing any demands on the client

corner of the dayroom. The most accurate

49.Nurse Gerry is aware that the defense

initial evaluation of the behavior would be

mechanism commonly used by clients who

that the client is:

are alcoholics is:

a.Physically ill and experiencing abdominal discomfort

a.Displacement b.Denial c.Projection

d.Compensation

D. Flight of ideas is speech pattern of rapid

50.Within a few hours of alcohol withdrawal,

transition from topic to topic, often without

nurse John should assess the male client

finishing one idea. It is common in mania.

for the presence of:

B. The client with mania is very active &

a.Disorientation, paranoia, tachycardia b.Tremors, fever, profuse diaphoresis c.Irritability, heightened alertness, jerky movements d.Yawning, anxiety, convulsions

needs to have this energy channeled in a constructive task such as cleaning or tidying the room. C. A crucial factor is determining the lethality of a method is the amount of time that occurs

Answers and Rationale Psychiatric Nursing Practice Test Part 2

between initiating the method & the delivery

C. When the nurse and client agree to work

lessening of suicidal ideation and

together, a contract should be established,

improvement in the client’s condition.

the length of the relationship should be

A. Using exercise bicycle is appropriate for

discussed in terms of its ultimate termination.

the client who becomes very anxious when

B. The nurse should initiate brief, frequent

thoughts of suicidal occur.

contacts throughout the day to let the client

C. The drug of choice for a client experiencing

know that he is important to the nurse. This

extra pyramidal side effects from haloperidol

will positively affect the client’s self-esteem.

(Haldol) is benztropine mesylate (cogentin)

D. The client with depression is preoccupied,

because of its anti cholinergic properties.

has decreased energy, and is unable to make

D. Allowing the client to be the first to open

decisions. The nurse presents the situation,

the cart & take a tray presents the client with

“It’s time for a shower”, and assists the client

the reality that the nurses are not touching

with personal hygiene to preserve his dignity

the food & tray, thereby dispelling the

and self-esteem.

delusion.

C. Foods high in tyramine, those that are

B. Although all the actions indicate

fermented, pickled, aged, or smoked must be

improvement, the ability to initiate simple

avoided because when they are ingested in

activities without directions indicates the most

combination with MAOIs a hypertensive crisis

improvement in the catatonic behaviors.

will occur.

A. Psychoeducational groups for families

A. Anticholinergic effects, which result from

develop a support network. They provide

blockage of the parasympathetic

education about the biochemical etiology of

(craniosacral) nervous system including urine

psychiatric disease to reduce, not increase

retention, blurred vision, dry mouth &

family guilt.

constipation.

C. Attending activity with the nurse assists

B. Dysthymia is a less severe, chronic

the client to become involved with others

depression diagnosed when a client has had a

slowly. The client with schizotypal personality

depressed mood for more days than not over

disorder needs support, kindness & gentle

a period of at least 2 years. Client with

suggestion to improve social skills &

dysthymic disorder benefit from

interpersonal relationship.

psychotherapeutic approaches that assist the

C. An individual with personality disorder

client in reversing the negative self image,

usually is not hospitalized unless a coexisting

negative feelings about the future.

Axis I psychiatric disorder is present.

of the lethal impact of the method. D. The statement “I don’t think about killing myself as much as I used to.” Indicates a

Generally, these individuals make marginal adjustments and remain in society, although they typically experience relationship and

occupational problems related to their

failure is the most likely cause of death from

inflexible behaviors. Personality disorders are

barbiturate over dose.

chronic lifelong patterns of behavior; acute

B. The feeling of bugs crawling under the skin

episodes do not occur. Psychotic behavior is

is termed as formication, and is associated

usually not common, although it can occur in

with cocaine use.

either schizotypal personality disorder or

D. The nurse would prepare to administer an

borderline personality disorder. Because these

antipsychotic medication such as Haldol to a

disorders are enduring and evasive and the

client experiencing amphetamine psychosis to

individual is inflexible, prognosis for recovery

decrease agitation & psychotic symptoms,

is unfavorable. Generally, the individual does

including delusions, hallucinations & cognitive

not seek treatment because he does not

impairment.

perceive problems with his own behavior.

C. An acid environment aids in the excretion

Distress can occur based on other people’s

of PCP. The nurse will definitely give the client

reaction to the individual’s behavior.

with PCP intoxication cranberry juice to acidify

D. The nurse would explain the negative

the urine to a ph of 5.5 & accelerate

reactions of others towards the client’s

excretion.

behaviors to make the clients aware of the

A. The nurse would facilitate progressive

impact of his seductive behaviors on others.

review of the accident and its consequence to

B. The nurse would use role-playing to teach

help the client integrate feelings & memories

the client appropriate responses to others and

and to begin the grieving process.

in various situations. This client dramatizes

B. The nurse instructs the nursing assistant to

events, drawn attention to self, and is

invite the client to lunch & accompany him to

unaware of and does not deal with feelings.

the dinning room to decrease manipulation,

The nurse works to help the client clarify true

secondary gain, dependency and

feelings & learn to express them

reinforcement of negative behavior while

appropriately.

maintaining the client’s worth.

C. Antiseptic mouthwash often contains

C. This provides support until the individuals

alcohol & should be kept in locked area,

coping mechanisms and personal support

unless labeling clearly indicates that the

systems can be immobilized.

product does not contain alcohol.

C. Resolving a loss is a slow, painful,

D. Monitoring of vital signs provides the best

continuous process until a mental image of

information about the client’s overall

the dead person, almost devoid of negative or

physiologic status during alcohol withdrawal &

undesirable features emerges.

the physiologic response to the medication

A. A moderate level of cognitive impairment

used.

due to dementia is characterized by

A. After administering naloxone (Narcan) the

increasing dependence on environment &

nurse should monitor the client’s respiratory

social structure and by increasing psychologic

status carefully, because the drug is short

rigidity with accentuated previous traits &

acting & respiratory depression may recur

behaviors.

after its effects wear off.

C. This action maintains for as long as

B. The best measure to determine a client’s

possible, the clients intellectual functions by

progress in rehabilitation is the number of

providing an opportunity to use them.

drug- free days he has. The longer the client

A. Individuals with anorexia often display

is free of drugs, the better the prognosis is.

irritability, hospitality, and a depressed mood.

D. Barbiturates are CNS depressants; the

D. Depressed clients demonstrate decreased

nurse would be especially alert for the

communication because of lack of psychic or

possibility of respiratory failure. Respiratory

physical energy.

C. The client in a manic episode of the illness often neglects basic needs, these needs are a priority to ensure adequate nutrition, fluid, and rest. B. The withdrawn pattern of behavior presents the individual from reaching out to others for sharing the isolation produces feeling of loneliness. A. The nurse’s response is not therapeutic

Psychiatric Nursing Practice Test Part 3 1. Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe: a.Hyperactivity b.Depression c.Suspicion

because it does not recognize the client’s

d.Delirium

needs but tries to make the client feel guilty

2.Nurse John is aware that a serious effect of

for being demanding.

inhaling cocaine is?

B. The client must recognize the existence of

a.Deterioration of nasal septum

the sub personalities so that interpretation

b.Acute fluid and electrolyte imbalances

can occur.

c.Extra pyramidal tract symptoms

D. An aloof, detached, withdrawn posture is a

d.Esophageal varices

means of protecting the self by withdrawing

3.A tentative diagnosis of opiate addiction,

and maintaining a safe, emotional distance. C. The usual age of onset of schizophrenia is adolescence or early childhood. A. Somatic delusion is a fixed false belief about one’s body. C. These are the classic behaviors exhibited by clients with a diagnosis of schizophrenia. D. The fetal position represents regressed

Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include: a.Rhinorrhea, convulsions, subnormal temperature b.Nausea, dilated pupils, constipation c.Lacrimation, vomiting, drowsiness

behavior. Regression is a way of responding to

d.Muscle aches, papillary constriction, yawning

overwhelming anxiety.

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

B. This provides a stimulus that competes

psychiatric emergency room after

with and reduces hallucination.

attempting to jump off a bridge. The client’s

D. Auditory hallucinations are most

wife states that he lost his job several

troublesome when environmental stimuli are

months ago and has been unable to find

diminished and there are few competing

another job. The primary nursing

distractions.

intervention at this time would be to assess

A. Projection is a mechanism in which inner

for:

thoughts and feelings are projected onto the environment, seeming to come from outside the self rather than from within. B. This will help the client develop selfesteem and reduce the use of paranoid ideation. B. Denial is a method of resolving conflict or

a.A past history of depression b.Current plans to commit suicide c.The presence of marital difficulties d.Feelings of excessive failure 5.Before helping a male client who has been sexually assaulted, nurse Maureen should

escaping unpleasant realities by ignoring their

recognize that the rapist is motivated by

existence.

feelings of:

C. Alcohol is a central nervous system

a.Hostility

depressant. These symptoms are the body’s

b.Inadequacy

neurologic adaptation to the withdrawal of

c.Incompetence

alcohol.

d.Passion

6.When working with children who have been 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.Confusion

b.Understands the reason why frequent calls to the staff were made c.Discuss concerns regarding the emotional condition that required hospitalizations d.No longer calls the nursing staff for assistance 11.Nurse John is aware that the therapy that

c.Self blame

has the highest success rate for people with

d.Hatred

phobias would be:

7.Joy who has just experienced her 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.Projection b.Displacement

a.Psychotherapy aimed at rearranging maladaptive thought process b.Psychoanalytical exploration of repressed conflicts of an earlier development phase c.Systematic desensitization using relaxation technique d.Insight therapy to determine the origin of the anxiety and fear 12.When nurse Hazel considers a client’s

c.Denial

placement on the continuum of anxiety, a

d.Reaction formation

key in determining the degree of anxiety

8.The most critical factor for nurse Linda to

being experienced is the client’s:

determine during crisis intervention would

a.Perceptual field

be the client’s:

b.Delusional system

a.Available situational supports

c.Memory state

b.Willingness to restructure the personality

d.Creativity level

c.Developmental theory

13.In the diagnosis of a possible pervasive

d.Underlying unconscious conflict

developmental autistic disorder. The nurse

9.Nurse Trish suggests a crisis intervention

would find it most unusual for a 3 year old

group to a client experiencing a

child to demonstrate:

developmental crisis.These groups are

a.An interest in music

successful because the:

b.An attachment to odd objects

a.Crisis intervention worker is a psychologist and understands behavior patterns b.Crisis group supplies a workable solution to the client’s problem c.Client is encouraged to talk about personal problems d.Client is assisted to investigate alternative

c.Ritualistic behavior d.Responsiveness to the parents 14.Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from worms chewing on them.” This statement indicates a: a.Jealous delusion

approaches to solving the identified

b.Somatic delusion

problem

c.Delusion of grandeur

10.Nurse Ronald could evaluate that the staff’s 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

d.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:

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 16.PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions? a.Antipsychotic – induced akathisia and anxiety b.Obsessive – compulsive disorder (OCD) to reduce ritualistic behavior c.Delusions for clients suffering from schizophrenia d.The manic phase of bipolar illness as a mood stabilizer 17.Which medication can control the extra

20.Initial interventions for Marco with acute anxiety include all except which of the following? a.Touching the client in an attempt to comfort him b.Approaching the client in calm, confident manner c.Encouraging the client to verbalize feelings and concerns d.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: a.Uticaria b.Vertigo

pyramidal effects associated with

c.Sedation

antipsychotic agents?

d.Diarrhea

a.Clorazepate (Tranxene)

22.When performing a physical examination on

b.Amantadine (Symmetrel)

a female anxious client, nurse Nelli would

c.Doxepin (Sinequan)

expect to find which of the following effects

d.Perphenazine (Trilafon)

produced by the parasympathetic system?

18.Which of the following statements should be

a.Muscle tension

included when teaching clients about

b.Hyperactive bowel sounds

monoamine oxidase inhibitor (MAOI)

c.Decreased urine output

antidepressants?

d.Constipation

a.Don’t take aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) b.Have blood levels screened weekly for leucopenia c.Avoid strenuous activity because of the cardiac effects of the drug d.Don’t take prescribed or over the counter medications without consulting the physician 19.Kris periodically has acute panic attacks. These attacks are unpredictable

23.Which of the following drugs have been known to be effective in treating obsessivecompulsive disorder (OCD)? a.Divalproex (depakote) and Lithium (lithobid) b.Chlordiazepoxide (Librium) and diazepam (valium) c.Fluvoxamine (Luvox) and clomipramine (anafranil) d.Benztropine (Cogentin) and diphenhydramine (benadryl) 24.Tony with agoraphobia has been symptom-

and have no apparent association with a

free for 4 months. Classic signs and

specific object or situation. During an acute

symptoms of phobia include:

panic attack, Kris may experience: a.Heightened concentration b.Decreased perceptual field

a.Severe anxiety and fear b.Withdrawal and failure to distinguish reality from fantasy

c.Decreased cardiac rate

c.Depression and weight loss

d.Decreased respiratory rate

d.Insomnia and inability to concentrate

25.Which nursing action is most appropriate when trying to diffuse a client’s impending violent behavior?

d.Transitory short and long term memory loss and confusion 30.Barbara with bipolar disorder is being

a.Place the client in seclusion

treated with lithium for the first time. Nurse

b.Leaving the client alone until he can talk

Clint should observe the client for which

about his feelings c.Involving the client in a quiet activity to divert attention d.Helping the client identify and express feelings of anxiety and anger 26.Rosana is in the second stage of Alzheimer’s

common adverse effect of lithium? a.Polyuria b.Seizures c.Constipation d.Sexual dysfunction 31.Nurse Fred is assessing a client who has

disease who appears to be in pain. Which

just been admitted to the ER

question by Nurse Jenny would best elicit

department. Which signs would suggest an

information about the pain?

overdose of an antianxiety agent?

a.“Where is your pain located?” b.“Do you hurt? (pause) “Do you hurt?” c.“Can you describe your pain?” d.“Where do you hurt?” 27.Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for: a.General anesthesia

a.Suspiciousness, dilated pupils and incomplete BP b.Agitation, hyperactivity and grandiose ideation c.Combativeness, sweating and confusion d.Emotional lability, euphoria and impaired memory 32.Discharge instructions for a male client

b.Cardiac stress testing

receiving tricyclic antidepressants include

c.Neurologic examination

which of the following information?

d.Physical therapy

a.Restrict fluids and sodium intake

28.Jose who is receiving monoamine oxidase

b.Don’t consume alcohol

inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods? a.Figs and cream cheese

c.Discontinue if dry mouth and blurred vision occur d.Restrict fluid and sodium intake 33.Important teaching for women in their

b.Fruits and yellow vegetables

childbearing years who are receiving

c.Aged cheese and Chianti wine

antipsychotic medications includes which of

d.Green leafy vegetables

the following?

29.Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find: a.Permanent short-term memory loss and hypertension b.Permanent long-term memory loss and hypomania c.Transitory short-term memory loss and permanent long-term memory loss

a.Increased incidence of dysmenorrhea while taking the drug b.Occurrence of incomplete libido due to medication adverse effects c.Continuing previous use of contraception during periods of amenorrhea d.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-

client tells the nurse, “I’m no good. I’m a

up with this client?

failure”. According to cognitive theory,

a.Income level and living arrangements

these statements reflect:

b.Involvement of family and support systems

a.Learned behavior

c.Reason for inpatient admission

b.Punitive superego and decreased self-esteem

d.Reason for refusal to take medications

c.Faulty thought processes that govern

35.The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change?

behavior d.Evidence of difficult relationships in the work environment 40.The nurse describes a client as anxious.

a.Decreased dopamine level

Which of the following statement about

b.Increased acetylcholine level

anxiety is true?

c.Stabilization of serotonin

a.Anxiety is usually pathological

d.Stimulation of GABA

b.Anxiety is directly observable

36.Which of the following best explains why

c.Anxiety is usually harmful

tricyclic antidepressants are used with

d.Anxiety is a response to a threat

caution in elderly patients?

41.A client with a phobic disorder is treated by

a.Central Nervous System effects

systematic desensitization. The nurse

b.Cardiovascular system effects

understands that this approach will do

c.Gastrointestinal system effects

which of the following?

d.Serotonin syndrome effects 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? a.Behavioral framework

a.Help the client execute actions that are feared b.Help the client develop insight into irrational fears c.Help the client substitutes one fear for another d.Help the client decrease anxiety 42.Which client outcome would best indicate

b.Cognitive framework

successful treatment for a client with an

c.Interpersonal framework

antisocial personality disorder?

d.Psychodynamic framework 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? a.Abnormal thinking b.Altered neurotransmitters c.Internal needs

a.The client exhibits charming behavior when around authority figures b.The client has decreased episodes of impulsive behaviors c.The client makes statements of selfsatisfaction d.The client’s statements indicate no remorse for behaviors 43.The nurse is caring for a client with an

d.Response to stimuli

autoimmune disorder at a medical clinic,

39.A client with depression has been

where alternative medicine is used as an

hospitalized for treatment after taking a

adjunct to traditional therapies. Which

leave of absence from work. The client’s

information should the nurse teach the

employer expects the client to return to

client to help foster a sense of control over

work following inpatient treatment. The

his symptoms?

a.Pathophysiology of disease process

b.Basketball game with peers on the unit

b.Principles of good nutrition

c.Reading a self-help book on depression

c.Side effects of medications

d.Watching movie with the peer group

d.Stress management techniques

49.The home health psychiatric nurse visits a

44.Which of the following is the most

client with chronic schizophrenia who was

distinguishing feature of a client with an

recently discharged after a prolong stay in

antisocial personality disorder?

a state hospital. The client lives in a

a.Attention to detail and order

boarding home, reports no family

b.Bizarre mannerisms and thoughts

involvement, and has little social

c.Submissive and dependent behavior

interaction. The nurse plan to refer the

d.Disregard for social and legal norms

client to a day treatment program in order

45.Which nursing diagnosis is most appropriate

to help him with:

for a client with anorexia nervosa who

a.Managing his hallucinations

expresses feelings of guilt about not

b.Medication teaching

meeting family expectations?

c.Social skills training

a.Anxiety

d.Vocational training

b.Disturbed body image

50.Which activity would be most appropriate

c.Defensive coping

for a severely withdrawn client?

d.Powerlessness

a.Art activity with a staff member

46.A nurse is evaluating therapy with the

b.Board game with a small group of clients

family of a client with anorexia nervosa.

c.Team sport in the gym

Which of the following would indicate that

d.Watching TV in the dayroom

the therapy was successful? 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 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? a.Agree with the client’s painful feelings b.Challenge the accuracy of the client’s belief c.Deny that the situation is hopeless

Answers and Rationale Psychiatric Nursing Part 3 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

d.Present a cheerful attitude

hostile feelings toward all women through the

48.A client with major depression has not

act of rape.

verbalized problem areas to staff or peers

C. These children often have nonsexual needs

since admission to a psychiatric unit. Which

met by individual and are powerless to

activity should the nurse recommend to

refuse.Ambivalence results in self-blame and

help this client express himself?

also guilt.

a.Art therapy in a small group

B. The client’s anger over the abortion is

client checks with his physician and

shifted to the staff and the hospital because

pharmacist before taking any other

she is unable to deal with the abortion at this

medications.

time.

B. Panic is the most severe level of

A. Personal internal strength and supportive

anxiety. During panic attack, the client

individuals are critical factors that can be

experiences a decrease in the perceptual

employed to assist the individual to cope with

field, becoming more focused on self, less

a crisis.

aware of surroundings and unable to process

D. Crisis intervention group helps client

information from the environment. The

reestablish psychologic equilibrium by

decreased perceptual field contributes to

assisting them to explore new alternatives for

impaired attention andinability to concentrate.

coping. It considers realistic situations using

A. The emergency nurse must establish

rational and flexible problem solving methods.

rapport and trust with the anxious client

C. This would document that the client feels

before using therapeutic touch. Touching an

comfortable enough to discuss the problems

anxious client may actually increase anxiety.

that have motivated the behavior.

D. Diarrhea is a common physiological

C. The most successful therapy for people

response to stress and anxiety.

with phobias involves behavior modification

B. The parasympathetic nervous system

techniques using desensitization.

would produce incomplete G.I. motility

A. Perceptual field is a key indicator of

resulting in hyperactive bowel sounds,

anxiety level because the perceptual fields

possibly leading to diarrhea.

narrow as anxiety increases.

C. The antidepressants fluvoxamine and

D. One of the symptoms of autistic child

clomipramine have been effective in the

displays a lack of responsiveness to

treatment of OCD.

others. There is little or no extension to the

A. Phobias cause severe anxiety (such as

external environment.

panic attack) that is out of proportion to the

B. Somatic delusions focus on bodily functions

threat of the feared object or

or systems and commonly include delusion

situation. Physical signs and symptoms of

about foul odor emissions, insect

phobias include profuse sweating, poor motor

manifestations, internal parasites and

control, tachycardia and elevated B.P.

misshapen parts.

D. In many instances, the nurse can diffuse

D. A client with borderline personality

impending violence by helping the client

displays a pervasive pattern of unpredictable

identify and express feelings of anger and

behavior, mood and self image. Interpersonal

anxiety. Such statement as “What happened

relationships may be intense and unstable and

to get you this angry?” may help the client

behavior may be inappropriate and impulsive.

verbalizes feelings rather than act on them.

A. Propranolol is a potent beta adrenergic

B. When speaking to a client with Alzheimer’s

blocker and producing a sedating effect,

disease, the nurse should use close-ended

therefore it is used to treat antipsychotic

questions.Those that the client can answer

induced akathisia and anxiety.

with “yes” or “no” whenever possible and

B. Amantadine is an anticholinergic drug used

avoid questions that require the client to

to relive drug-induced extra pyramidal

make choices. Repeating the question aids

adverse effects such as muscle weakness,

comprehension.

involuntary muscle movements,

A. The nurse should prepare a client for ECT

pseudoparkinsonism and tar dive dyskinesia.

in a manner similar to that for general

D. MAOI antidepressants when combined with

anesthesia.

a number of drugs can cause life-threatening

C. Aged cheese and Chianti wine contain high

hypertensive crisis. It’s imperative that a

concentrations of tyramine.

D. ECT commonly causes transitory short and

Therefore, they are used with caution in

long term memory loss and confusion,

elderly clients who may have increased risk

especially in geriatric clients. It rarely results

factors for cardiac problems because of their

in permanent short and long term memory

age and other medical conditions. The

loss.

remaining side effects would apply to any

A. Polyuria commonly occurs early in the

client taking a TCA and are not particular to

treatment with lithium and could result in

an elderly person.

fluid volume deficit.

B. Cognitive thinking therapy focuses on the

D. Signs of anxiety agent overdose include

client’s misperceptions about self, others and

emotional lability, euphoria and impaired

the world that impact functioning and

memory.

contribute to symptoms. Using medications to

B. Drinking alcohol can potentiate the

alter neurotransmitter activity is a

sedating action of tricyclic

psychobiologic approach to treatment. The

antidepressants. Dry mouth and blurred

other answer choices are frameworks for

vision are normal adverse effects of tricyclic

care, but hey are not applicable to this

antidepressants.

situation.

C. Women may experience amenorrhea,

C. The concept that behavior is motivated and

which is reversible, while taking

has meaning comes from the psychodynamic

antipsychotics. Amenorrhea doesn’t indicate

framework. According to this perspective,

cessation of ovulation thus, the client can still

behavior arises from internal wishes or needs.

be pregnant.

Much of what motivates behavior comes from

D. The first are for assessment would be the

the unconscious. The remaining responses do

client’s reason for refusing medication. The

not address the internal forces thought to

client may not understand the purpose for the

motivate behavior.

medication, may be experiencing distressing

C. The client is demonstrating faulty thought

side effects, or may be concerned about the

processes that are negative and that govern

cost of medicine. In any case, the nurse

his behavior in his work situation – issues that

cannot provide appropriate intervention

are typically examined using a cognitive

before assessing the client’s problem with the

theory approach. Issues involving learned

medication. The patient’s income level, living

behavior are best explored through behavior

arrangements, and involvement of family and

theory, not cognitive theory. Issues involving

support systems are relevant issues following

ego development are the focus

determination of the client’s reason for

of psychoanalytic theory. Option 4 is incorrect

refusing medication. The nurse providing

because there is no evidence in this situation

follow-up care would have access to the

that the client has conflictual relationships in

client’s medical record and should already

the work environment.

know the reason for inpatient admission.

D. Anxiety is a response to a threat arising

A. Excess dopamine is thought to be the

from internal or external stimuli.

chemical cause for psychotic thinking. The

A. Systematic desensitization is a behavioral

typical antipsychotics act to block dopamine

therapy technique that helps clients with

receptors and therefore decrease the amount

irrational fears and avoidance behavior to face

of neurotransmitter at the synapses. The

the thing they fear, without experiencing

typical antipsychotics do not increase

anxiety. There is no attempt to promote

acetylcholine, stabilize serotonin, stimulate

insight with this procedure, and the client will

GABA.

not be taught to substitute one fear for

B. The TCAs affect norepinephrine as well as

another. Although the client’s anxiety may

other neurotransmitters, and thus have

decrease with successful confrontation of

significant cardiovascular side effects.

irrational fears, the purpose of the procedure

is specifically related to performing activities

A. One of the core issues concerning the

that typically are avoided as part of the

family of a client with anorexia is control. The

phobic response.

family’s acceptance of the client’s ability to

B. A client with antisocial personality disorder

make independent decisions is key to

typically has frequent episodes of acting

successful family intervention. Although the

impulsively with poor ability to delay self-

remaining options may occur during the

gratification. Therefore, decreased frequency

process of therapy, they would not necessarily

of impulsive behaviors would be evidence of

indicate a successful outcome; the central

improvement. Charming behavior when

family issues of dependence and

around authority figures and statements

independence are not addresses on these

indicating no remorse are examples of

responses.

symptoms typical of someone with this

B. Use of cognitive techniques allows the

disorder and would not indicate successful

nurse to help the client recognize that this

treatment. Self-satisfaction would be viewed

negative beliefs may be distortions and that,

as a positive change if the client expresses

by changing his thinking, he can adopt more

low self-esteem; however this is not a

positive beliefs that are realistic and hopeful.

characteristic of a client with antisocial

Agreeing with the client’s feelings and

personality disorder.

presenting a cheerful attitude are not

D. In autoimmune disorders, stress and the

consistent with a cognitive approach and

response to stress can exacerbate symptoms.

would not be helpful in this situation. Denying

Stress management techniques can help the

the client’s feelings is belittling and may

client reduce the psychological response to

convey that the nurse does not understand

stress, which in turn will help reduce the

the depth of the client’s distress.

physiologic stress response. This will afford

A. Art therapy provides a nonthreatening

the client an increased sense of control over

vehicle for the expression of feelings, and use

his symptoms. The nurse can address the

of a small group will help the client become

remaining answer choices in her teaching

comfortable with peers in a group setting.

about the client’s disease and treatment;

Basketball is a competitive game that requires

however, knowledge alone will not help the

energy; the client with major depression is

client to manage his stress effectively enough

not likely to participate in this activity.

to control symptoms.

Recommending that the client read a self-help

D. Disregard for established rules of society is

book may increase, not decrease his isolation.

the most common characteristic of a client

Watching movie with a peer group does not

with antisocial personality disorder. Attention

guarantee that interaction will occur;

to detail and order is characteristic of

therefore, the client may remain isolated.

someone with obsessive compulsive disorder.

C. Day treatment programs provide clients

Bizarre mannerisms and thoughts are

with chronic, persistent mental illness training

characteristics of a client with schizoid or

in social skills, such as meeting and greeting

schizotypal disorder. Submissive and

people, asking questions or directions, placing

dependent behaviors are characteristic of

an order in a restaurant, taking turns in a

someone with a dependent personality.

group setting activity. Although management

D. The client with anorexia typically feels

of hallucinations and medication teaching may

powerless, with a sense of having little control

also be part of the program offered in a day

over any aspect of life besides eating

treatment, the nurse is referring the client in

behavior. Often, parental expectations and

this situation because of his need for

standards are quite high and lead to the

socialization skills. Vocational training

clients’ sense of guilt over not measuring up.

generally takes place in a rehabilitation

facility; the client described in this situation would not be a candidate for this service. A. The best approach with a withdrawn client is to initiate brief, nondemanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client. A board game with a group clients or playing a team sport in the gym may overwhelm a severely withdrawn client. Watching TV is a solitary activity that will reinforce the client’s withdrawal from others.