1. Mrs. Chua a 78 year old client is admitted with the diagnosis of mild chronic heart failure. The nurse expects to hear when listening to client’s lungs indicative of chronic heart failure would be:
a. Stridor
b. Crackles
c. Wheezes
d. Friction rubs
2. Patrick who is hospitalized following a myocardial infarction asks the nurse why he is taking morphine. The nurse explains that morphine:
a. Decrease anxiety and restlessness
b. Prevents shock and relieves pain
c. Dilates coronary blood vessels
d. Helps prevent fibrillation of the heart
3. Which of the following should the nurse teach the client about the signs of digitalis toxicity?
a. Increased appetite
b. Elevated blood pressure
c. Skin rash over the chest and back
d. Visual disturbances such as seeing yellow spots
4. Nurse Trisha teaches a client with heart failure to take oral Furosemide in the morning. The reason for this is to help…
a. Retard rapid drug absorption
b. Excrete excessive fluids accumulated at night
c. Prevents sleep disturbances during night
d. Prevention of electrolyte imbalance
5. What would be the primary goal of therapy for a client with pulmonary edema and heart failure?
a. Enhance comfort
b. Increase cardiac output
c. Improve respiratory status
d. Peripheral edema decreased
6. Nurse Linda is caring for a client with head injury and monitoring the client with decerebrate posturing. Which of the following is a characteristic of this type of posturing?
a. Upper extremity flexion with lower extremity flexion
b. Upper extremity flexion with lower extremity extension
c. Extension of the extremities after a stimulus
d. Flexion of the extremities after stimulus
7. A female client is taking Cascara Sagrada. Nurse Betty informs the client that the following maybe experienced as side effects of this medication:
a. GI bleeding
b. Peptic ulcer disease
c. Abdominal cramps
d. Partial bowel obstruction
8. Dr. Marquez orders a continuous intravenous nitroglycerin infusion for the client suffering from myocardial infarction. Which of the following is the most essential nursing action?
a. Monitoring urine output frequently
b. Monitoring blood pressure every 4 hours
c. Obtaining serum potassium levels daily
d. Obtaining infusion pump for the medication
9. During the second day of hospitalization of the client after a Myocardial Infarction. Which of the following is an expected outcome?
a. Able to perform self-care activities without pain
b. Severe chest pain
c. Can recognize the risk factors of Myocardial Infarction
d. Can Participate in cardiac rehabilitation walking program
10. A 68 year old client is diagnosed with a right-sided brain attack and is admitted to the hospital. In caring for this client, the nurse should plan to:
a. Application of elastic stockings to prevent flaccid by muscle
b. Use hand roll and extend the left upper extremity on a pillow to prevent contractions
c. Use a bed cradle to prevent dorsiflexion of feet
d. Do passive range of motion exercise
11. Nurse Liza is assigned to care for a client who has returned to the nursing unit after left nephrectomy. Nurse Liza’s highest priority would be…
a. Hourly urine output
b. Temperature
c. Able to turn side to side
d. Able to sips clear liquid
12. A 64 year old male client with a long history of cardiovascular problem including hypertension and angina is to be scheduled for cardiac catheterization. During pre cardiac catheterization teaching, Nurse Cherry should inform the client that the primary purpose of the procedure is…..
a. To determine the existence of CHD
b. To visualize the disease process in the coronary arteries
c. To obtain the heart chambers pressure
d. To measure oxygen content of different heart chambers
13. During the first several hours after a cardiac catheterization, it would be most essential for nurse Cherry to…
a. Elevate clients bed at 45°
b. Instruct the client to cough and deep breathe every 2 hours
c. Frequently monitor client’s apical pulse and blood pressure
d. Monitor clients temperature every hour
14. Kate who has undergone mitral valve replacement suddenly experiences continuous bleeding from the surgical incision during postoperative period. Which of the following pharmaceutical agents should Nurse Aiza prepare to administer to Kate?
a. Protamine Sulfate
b. Quinidine Sulfate
c. Vitamin C
d. Coumadin
15. In reducing the risk of endocarditis, good dental care is an important measure. To promote good dental care in client with mitral stenosis in teaching plan should include proper use of…
a. Dental floss
b. Electric toothbrush
c. Manual toothbrush
d. Irrigation device
16. Among the following signs and symptoms, which would most likely be present in a client with mitral gurgitation?
a. Altered level of consciousness
b. Exceptional Dyspnea
c. Increase creatine phospholinase concentration
d. Chest pain
17. Kris with a history of chronic infection of the urinary system complains of urinary frequency and burning sensation. To figure out whether the current problem is in renal origin, the nurse should assess whether the client has discomfort or pain in the…
a. Urinary meatus
b. Pain in the Labium
c. Suprapubic area
d. Right or left costovertebral angle
18. Nurse Perry is evaluating the renal function of a male client. After documenting urine volume and characteristics, Nurse Perry assesses which signs as the best indicator of renal function.
a. Blood pressure
b. Consciousness
c. Distension of the bladder
d. Pulse rate
19. John suddenly experiences a seizure, and Nurse Gina notice that John exhibits uncontrollable jerking movements. Nurse Gina documents that John experienced which type of seizure?
a. Tonic seizure
b. Absence seizure
c. Myoclonic seizure
d. Clonic seizure
20. Smoking cessation is critical strategy for the client with Burgher’s disease, Nurse Jasmin anticipates that the male client will go home with a prescription for which medication?
a. Paracetamol
b. Ibuprofen
c. Nitroglycerin
d. Nicotine (Nicotrol)
21. Nurse Lilly has been assigned to a client with Raynaud’s disease. Nurse Lilly realizes that the etiology of the disease is unknown but it is characterized by:
a. Episodic vasospastic disorder of capillaries
b. Episodic vasospastic disorder of small veins
c. Episodic vasospastic disorder of the aorta
d. Episodic vasospastic disorder of the small arteries
22. Nurse Jamie should explain to male client with diabetes that self-monitoring of blood glucose is preferred to urine glucose testing because…
a. More accurate
b. Can be done by the client
c. It is easy to perform
d. It is not influenced by drugs
23. Jessie weighed 210 pounds on admission to the hospital. After 2 days of diuretic therapy, Jessie weighs 205.5 pounds. The nurse could estimate the amount of fluid Jessie has lost…
a. 0.3 L
b. 1.5 L
c. 2.0 L
d. 3.5 L
24. Nurse Donna is aware that the shift of body fluids associated with Intravenous administration of albumin occurs in the process of:
a. Osmosis
b. Diffusion
c. Active transport
d. Filtration
25. Myrna a 52 year old client with a fractured left tibia has a long leg cast and she is using crutches to ambulate. Nurse Joy assesses for which sign and symptom that indicates complication associated with crutch walking?
a. Left leg discomfort
b. Weak biceps brachii
c. Triceps muscle spasm
d. Forearm weakness
26. Which of the following statements should the nurse teach the neutropenic client and his family to avoid?
a. Performing oral hygiene after every meal
b. Using suppositories or enemas
c. Performing perineal hygiene after each bowel movement
d. Using a filter mask
27. A female client is experiencing painful and rigid abdomen and is diagnosed with perforated peptic ulcer. A surgery has been scheduled and a nasogastric tube is inserted. The nurse should place the client before surgery in
a. Sims position
b. Supine position
c. Semi-fowlers position
d. Dorsal recumbent position
28. Which nursing intervention ensures adequate ventilating exchange after surgery?
a. Remove the airway only when client is fully conscious
b. Assess for hypoventilation by auscultating the lungs
c. Position client laterally with the neck extended
d. Maintain humidified oxygen via nasal canula
29. George who has undergone thoracic surgery has chest tube connected to a water-seal drainage system attached to suction. Presence of excessive bubbling is identified in water-seal chamber, the nurse should…
a. “Strip” the chest tube catheter
b. Check the system for air leaks
c. Recognize the system is functioning correctly
d. Decrease the amount of suction pressure
30. A client who has been diagnosed of hypertension is being taught to restrict intake of sodium. The nurse would know that the teachings are effective if the client states that…
a. I can eat celery sticks and carrots
b. I can eat broiled scallops
c. I can eat shredded wheat cereal
d. I can eat spaghetti on rye bread
31. A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulted to ascites. The nurse should be aware that the ascites is most likely the result of increased…
a. Pressure in the portal vein
b. Production of serum albumin
c. Secretion of bile salts
d. Interstitial osmotic pressure
32. A newly admitted client is diagnosed with Hodgkin’s disease undergoes an excisional cervical lymph node biopsy under local anesthesia. What does the nurse assess first after the procedure?
a. Vital signs
b. Incision site
c. Airway
d. Level of consciousness
33. A client has 15% blood loss. Which of the following nursing assessment findings indicates hypovolemic shock?
a. Systolic blood pressure less than 90mm Hg
b. Pupils unequally dilated
c. Respiratory rate of 4 breath/min
d. Pulse rate less than 60bpm
34. Nurse Lucy is planning to give pre operative teaching to a client who will be undergoing rhinoplasty. Which of the following should be included?
a. Results of the surgery will be immediately noticeable postoperatively
b. Normal saline nose drops will need to be administered preoperatively
c. After surgery, nasal packing will be in place 8 to 10 days
d. Aspirin containing medications should not be taken 14 days before surgery
35. Paul is admitted to the hospital due to metabolic acidosis caused by Diabetic ketoacidosis (DKA). The nurse prepares which of the following medications as an initial treatment for this problem?
a. Regular insulin
b. Potassium
c. Sodium bicarbonate
d. Calcium gluconate
36. Dr. Marquez tells a client that an increase intake of foods that are rich in Vitamin E and beta-carotene are important for healthier skin. The nurse teaches the client that excellent food sources of both of these substances are:
a. Fish and fruit jam
b. Oranges
c. Carrots and potatoes
d. Spinach and mangoes
37. A client has Gastroesophageal Reflux Disease (GERD). The nurse should teach the client that after every meals, the client should…
a. Rest in sitting position
b. Take a short walk
c. Drink plenty of water
d. Lie down at least 30 minutes
38. After gastroscopy, an adaptation that indicates major complication would be:
a. Nausea and vomiting
b. Abdominal distention
c. Increased GI motility
d. Difficulty in swallowing
39. A client who has undergone a cholecystectomy asks the nurse whether there are any dietary restrictions that must be followed. Nurse Hilary would recognize that the dietary teaching was well understood when the client tells a family member that:
a. “Most people need to eat a high protein diet for 12 months after surgery”
b. “I should not eat those foods that upset me before the surgery”
c. “I should avoid fatty foods as long as I live”
d. “Most people can tolerate regular diet after this type of surgery”
40. Nurse Rachel teaches a client who has been recently diagnosed with hepatitis A about untoward signs and symptoms related to Hepatitis that may develop. The one that should be reported immediately to the physician is:
a. Restlessness
b. Yellow urine
c. Nausea
d. Clay- colored stools
41. Which of the following antituberculosis drugs can damage the 8th cranial nerve?
a. Isoniazid (INH)
b. Paraoaminosalicylic acid (PAS)
c. Ethambutol hydrochloride (myambutol)
d. Streptomycin
42. The client asks Nurse Annie the causes of peptic ulcer. Nurse Annie responds that recent research indicates that peptic ulcers are the result of which of the following:
a. Genetic defect in gastric mucosa
b. Stress
c. Diet high in fat
d. Helicobacter pylori infection
43. Ryan has undergone subtotal gastrectomy. The nurse should expect that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery?
a. Bile green
b. Bright red
c. Cloudy white
d. Dark brown
44. Nurse Joan is assigned to come for client who has just undergone eye surgery. Nurse Joan plans to teach the client activities that are permitted during the post operative period. Which of the following is best recommended for the client?
a. Watching circus
b. Bending over
c. Watching TV
d. Lifting objects
45. A client suffered from a lower leg injury and seeks treatment in the emergency room. There is a prominent deformity to the lower aspect of the leg, and the injured leg appears shorter that the other leg. The affected leg is painful, swollen and beginning to become ecchymotic. The nurse interprets that the client is experiencing:
a. Fracture
b. Strain
c. Sprain
d. Contusion
46. Nurse Jenny is instilling an otic solution into an adult male client left ear. Nurse Jenny avoids doing which of the following as part of the procedure
a. Pulling the auricle backward and upward
b. Warming the solution to room temperature
c. Pacing the tip of the dropper on the edge of ear canal
d. Placing client in side lying position
47. Nurse Bea should instruct the male client with an ileostomy to report immediately which of the following symptom?
a. Absence of drainage from the ileostomy for 6 or more hours
b. Passage of liquid stool in the stoma
c. Occasional presence of undigested food
d. A temperature of 37.6 °C
48. Jerry has diagnosed with appendicitis. He develops a fever, hypotension and tachycardia. The nurse suspects which of the following complications?
a. Intestinal obstruction
b. Peritonitis
c. Bowel ischemia
d. Deficient fluid volume
49. Which of the following compilations should the nurse carefully monitors a client with acute pancreatitis.
a. Myocardial Infarction
b. Cirrhosis
c. Peptic ulcer
d. Pneumonia
50. Which of the following symptoms during the icteric phase of viral hepatitis should the nurse expect the client to inhibit?
a. Watery stool
b. Yellow sclera
c. Tarry stool
d. Shortness of breath
ANSWER:
- B. Left sided heart failure causes fluid accumulation in the capillary network of the lung. Fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration.
- B. Morphine is a central nervous system depressant used to relieve the pain associated with myocardial infarction, it also decreases apprehension and prevents cardiogenic shock.
- D. Seeing yellow spots and colored vision are common symptoms of digitalis toxicity
- C. When diuretics are taken in the morning, client will void frequently during daytime and will not need to void frequently at night.
- B. The primary goal of therapy for the client with pulmonary edema or heart failure is increasing cardiac output. Pulmonary edema is an acute medical emergency requiring immediate intervention.
- C. Decerebrate posturing is the extension of the extremities after a stimulus which may occur with upper brain stem injury.
- C. The most frequent side effects of Cascara Sagrada (Laxative) is abdominal cramps and nausea.
- D. Administration of Intravenous Nitroglycerin infusion requires pump for accurate control of medication.
- A. By the 2nd day of hospitalization after suffering a Myocardial Infarction, Clients are able to perform care without chest pain
- B. The left side of the body will be affected in a right-sided brain attack.
- A. After nephrectomy, it is necessary to measure urine output hourly. This is done to assess the effectiveness of the remaining kidney also to detect renal failure early.
- B. The lumen of the arteries can be assessed by cardiac catheterization. Angina is usually caused by narrowing of the coronary arteries.
- C. Blood pressure is monitored to detect hypotension which may indicate shock or hemorrhage. Apical pulse is taken to detect dysrhythmias related to cardiac irritability.
- A. Protamine Sulfate is used to prevent continuous bleeding in client who has undergone open heart surgery.
- C. The use of electronic toothbrush, irrigation device or dental floss may cause bleeding of gums, allowing bacteria to enter and increasing the risk of endocarditis.
- B. Weight gain due to retention of fluids and worsening heart failure causes exertional dyspnea in clients with mitral regurgitation.
- D. Discomfort or pain is a problem that originates in the kidney. It is felt at the costovertebral angle on the affected side.
- A. Perfusion can be best estimated by blood pressure, which is an indirect reflection of the adequacy of cardiac output.
- C. Myoclonic seizure is characterized by sudden uncontrollable jerking movements of a single or multiple muscle group.
- D. Nicotine (Nicotrol) is given in controlled and decreasing doses for the management of nicotine withdrawal syndrome.
- D. Raynaud’s disease is characterized by vasospasms of the small cutaneous arteries that involves fingers and toes.
- A. Urine testing provides an indirect measure that maybe influenced by kidney function while blood glucose testing is a more direct and accurate measure.
- C. One liter of fluid approximately weighs 2.2 pounds. A 4.5 pound weight loss equals to approximately 2L.
- A. Osmosis is the movement of fluid from an area of lesser solute concentration to an area of greater solute concentration.
- D. Forearm muscle weakness is a probable sign of radial nerve injury caused by crutch pressure on the axillae.
- B. Neutropenic client is at risk for infection especially bacterial infection of the gastrointestinal and respiratory tract.
- C. Semi-fowlers position will localize the spilled stomach contents in the lower part of the abdominal cavity.
- C. Positioning the client laterally with the neck extended does not obstruct the airway so that drainage of secretions and oxygen and carbon dioxide exchange can occur.
- B. Excessive bubbling indicates an air leak which must be eliminated to permit lung expansion.
- C. Wheat cereal has a low sodium content.
- A. Enlarged cirrhotic liver impinges the portal system causing increased hydrostatic pressure resulting to ascites.
- C. Assessing for an open airway is the priority. The procedure involves the neck, the anesthesia may have affected the swallowing reflex or the inflammation may have closed in on the airway leading to ineffective air exchange.
- A. Typical signs and symptoms of hypovolemic shock includes systolic blood pressure of less than 90 mm Hg.
- D. Aspirin containing medications should not be taken 14 days before surgery to decrease the risk of bleeding.
- A. Metabolic acidosis is anaerobic metabolism caused by lack of ability of the body to use circulating glucose. Administration of insulin corrects this problem.
- D. Beta-carotene and Vitamin E are antioxidants which help to inhibit oxidation. Vitamin E is found in the following foods: wheat germ, corn, nuts, seeds, olives, spinach, asparagus and other green leafy vegetables. Food sources of beta-carotene include dark green vegetables, carrots, mangoes and tomatoes.
- A. Gravity speeds up digestion and prevents reflux of stomach contents into the esophagus.
- B. Abdominal distension may be associated with pain, may indicate perforation, a complication that could lead to peritonitis.
- D. It may take 4 to 6 months to eat anything, but most people can eat anything they want.
- D. Clay colored stools are indicative of hepatic obstruction
- D. Streptomycin is an aminoglycoside and damage on the 8th cranial nerve (ototoxicity) is a common side effect of aminoglycosides.
- D. Most peptic ulcer is caused by Helicopter pylori which is a gram negative bacterium.
- D. 12 to 24 hours after subtotal gastrectomy gastric drainage is normally brown, which indicates digested food.
- C. Watching TV is permissible because the eye does not need to move rapidly with this activity, and it does not increase intraocular pressure.
- A. Common signs and symptoms of fracture include pain, deformity, shortening of the extremity, crepitus and swelling.
- C. The dropper should not touch any object or any part of the client’s ear.
- A. Sudden decrease in drainage or onset of severe abdominal pain should be reported immediately to the physician because it could mean that obstruction has been developed.
- B. Complications of acute appendicitis are peritonitis, perforation and abscess development.
- D. A client with acute pancreatitis is prone to complications associated with respiratory system.
- B. Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy.
1. Nurse Tony should first discuss terminating 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 spends majority of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse would be the most therapeutic?
a. Question the client until he responds
b. Initiate contact with the client frequently
c. Sit outside the clients room
d. Wait for the client to begin the conversation
3. Joe who is very depressed exhibits psychomotor retardation, a flat affect and apathy. The nurse in charge observes Joe to be in need of grooming and hygiene. Which of the following nursing actions would be 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 depression about foods to avoid while taking phenelzine(Nardil), which of the following would the nurse in charge include?
a. Roasted chicken
b. Fresh fish
c. Salami
d. Hamburger
5. When assessing a female client who is receiving tricyclic antidepressant therapy, which of the following would alert the nurse to the possibility that the client is experiencing anticholinergic effects?
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 nurse expect to implement?
a. ECT
b. Psychotherapeutic approach
c. Psychoanalysis
d. Antidepressant therapy
7. Danny who is diagnosed with bipolar disorder and acute mania, states the nurse, “Where is my daughter? I love Louis. Rain, rain go away. Dogs eat dirt.” The nurse interprets these statements as indicating which of the following?
a. Echolalia
b. Neologism
c. Clang associations
d. Flight of ideas
8. Terry with mania is skipping up and down the 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
9. When assessing a male client for suicidal risk, which of the following methods of suicide would the nurse identify as most lethal?
a. Wrist cutting
b. Head banging
c. Use of gun
d. Aspirin overdose
10. Jun has been hospitalized for major depression and suicidal ideation. Which of the following statements indicates to the nurse that the client is improving?
a. “I’m of no use to anyone anymore.”
b. “I know my kids don’t need me anymore 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 becomes very anxious when thoughts of suicide occur?
a. Using exercise bicycle
b. Meditating
c. Watching TV
d. Reading comics
12. When developing the plan of care for a client receiving haloperidol, which of the following medications would nurse Monet anticipate administering if the client developed extra pyramidal side effects?
a. Olanzapine (Zyprexa)
b. Paroxetine (Paxil)
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
c. Serving foods that come in sealed packages
d. Allowing the client to be the first to open the cart and get a tray
14. A client is suffering from catatonic behaviors. Which of the following would the nurse use to determine that the medication administered PRN have been most effective?
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 attend the psycho educational program for families of the chronically mentally ill. The program would be most likely to help the family with which of the following issues?
a. Developing a support network with other families
b. Feeling more guilty about the client’s illness
c. Recognizing the client’s weakness
d. Managing their financial concern and problems
16. When planning care for Dory with schizotypal personality disorder, which of the following would help the client become involved with others?
a. Attending an activity with the nurse
b. Leading a sing a long in the afternoon
c. Participating solely in group activities
d. Being involved with primarily one to 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 willingly for symptoms that are personally distressful.
18. Nurse John is talking with a client who has been diagnosed with antisocial personality about how to socialize during activities without being seductive. Nurse John would focus the discussion on which of the following areas?
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 melodramatic and responds to others and situations in an exaggerated manner. Nurse Trish would recommend which of the following activities for Tina?
a. Baking class
b. Role playing
c. Scrap book making
d. Music group
20. Joy has entered the chemical dependency unit for treatment of alcohol dependency. Which of the following client’s possession will the nurse most likely place in a locked area?
a. Toothpaste
b. Shampoo
c. Antiseptic wash
d. Moisturizer
21. Which of the following assessment would provide the best information about the client’s physiologic response and the effectiveness of the medication prescribed specifically for alcohol withdrawal?
a. Sleeping pattern
b. Mental alertness
c. Nutritional status
d. Vital signs
22. After administering naloxone (Narcan), an opioid antagonist, Nurse Ronald should monitor the female client carefully for which of the following?
a. Respiratory depression
b. Epilepsy
c. Kidney failure
d. Cerebral edema
23. Which of the following would nurse Ronald 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?
a. Epilepsy
b. Myocardial Infarction
c. Renal failure
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
d. Confusion
26. Jose is diagnosed with amphetamine psychosis and was admitted in the emergency room. Nurse Ronald would most likely prepare to administer which of the following medication?
a. Librium
b. Valium
c. Ativan
d. Haldol
27. Which of the following liquids would nurse Leng administer to a female client who is intoxicated with phencyclidine (PCP) to hasten excretion of the chemical?
a. Shake
b. Tea
c. Cranberry Juice
d. Grape juice
28. When developing a plan of care for a female client with acute stress disorder who lost her sister in a car accident. Which of the 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 lunch. Nurse Ronald would direct the nursing assistant to do which of the following?
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
d. Mobilizing the individual’s support system
31. Joy’s stream of consciousness is occupied exclusively with thoughts of her father’s death. Nurse Ronald should plan to help Joy through this stage of grieving, which is known as:
a. Shock and disbelief
b. Developing awareness
c. Resolving the loss
d. Restitution
32. When taking a health history from a female client who has a moderate level of cognitive impairment due to dementia, the nurse would expect to note the presence of:
a. Accentuated premorbid traits
b. Enhance intelligence
c. Increased inhibitions
d. Hyper vigilance
33. What is the priority care for a client with a dementia resulting from AIDS?
a. Planning for remotivational therapy
b. Arranging for long term custodial care
c. Providing basic intellectual stimulation
d. Assessing pain frequently
34. Jerome who has eating disorder often exhibits similar symptoms. Nurse Lhey would expect an adolescent client with anorexia to exhibit:
a. Affective instability
b. Dishered, unkempt physical appearance
c. Depersonalization and derealization
d. Repetitive motor mechanisms
35. The primary nursing diagnosis for a female client with a medical diagnosis of major depression would be:
a. Situational low self-esteem related to altered role
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?
a. Isolate his gym time
b. Encourage his active participation in unit programs
c. Provide foods, fluids and rest
d. Encourage his participation in programs
37. Grace is exhibiting withdrawn patterns of behavior. Nurse Johnny is aware that this type of behavior eventually produces feeling of:
a. Repression
b. Loneliness
c. Anger
d. Paranoia
38. One morning a female client on the inpatient psychiatric service complains to nurse Hazel that she has been waiting for over an hour for someone to accompany her to activities. Nurse Hazel replies to the client “We’re doing the best we can. There are a lot of other people on the unit who needs attention too.” This statement shows that the nurse’s use of:
a. Defensive behavior
b. Reality reinforcement
c. Limit-setting behavior
d. Impulse control
39. A nursing diagnosis for a male client with a diagnosed multiple personality disorder is chronic low self-esteem probably related to childhood abuse. The most appropriate short term client outcome would be:
a. Verbalizing the need for anxiety medications
b. Recognizing each existing personality
c. Engaging in object-oriented activities
d. Eliminating defense mechanisms and phobia
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 companions and withdrawing to his room for several days at a time. Nurse Monette understands that the withdrawal is a defense against the client’s fear of:
a. Phobia
b. Powerlessness
c. Punishment
d. Rejection
41. When asking the parents about the onset of problems in young client with the diagnosis of schizophrenia, Nurse Linda would expect that they would relate the client’s difficulties began in:
a. Early childhood
b. Late childhood
c. Adolescence
d. Puberty
42. Jose who has been hospitalized with schizophrenia tells Nurse Ron, “My heart has stopped and my veins have turned to glass!” Nurse Ron is aware that this is an example of:
a. Somatic delusions
b. Depersonalization
c. Hypochondriasis
d. Echolalia
43. In recognizing common behaviors exhibited by male client who has a diagnosis of schizophrenia, nurse Josie can anticipate:
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 client curled up in the fetal position in the corner of the dayroom. The most accurate initial evaluation of the behavior would be that the client is:
a. Physically ill and experiencing abdominal discomfort
b. Tired and probably did not sleep well last night
c. Attempting to hide from the nurse
d. Feeling more anxious today
45. Nurse Bea notices a female client sitting alone in the corner smiling and talking to herself. Realizing that the client is hallucinating. Nurse Bea should:
a. Invite the client to help decorate the dayroom
b. Leave the client alone until he stops talking
c. Ask the client why he is smiling and talking
d. Tell the client it is not good for him to talk to himself
46. When being admitted to a mental health facility, a young female adult tells Nurse Mylene that the voices she hears frighten her. Nurse Mylene understands that the client tends to hallucinate more vividly:
a. While watching TV
b. During meal time
c. During group activities
d. After going to bed
47. Nurse John recognizes that paranoid delusions usually are related to the defense mechanism of:
a. Projection
b. Identification
c. Repression
d. Regression
48. When planning care for a male client using 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
d. Not placing any demands on the client
49. Nurse Gerry is aware that the defense mechanism commonly used by clients who are alcoholics is:
a. Displacement
b. Denial
c. Projection
d. Compensation
50. Within a few hours of alcohol withdrawal, nurse John should assess the male client for the presence of:
a. Disorientation, paranoia, tachycardia
b. Tremors, fever, profuse diaphoresis
c. Irritability, heightened alertness, jerky movements
d. Yawning, anxiety, convulsions
ANSWER:
- C. When the nurse and client agree to work together, a contract should be established, the length of the relationship should be discussed in terms of its ultimate termination.
- B. The nurse should initiate brief, frequent contacts throughout the day to let the client know that he is important to the nurse. This will positively affect the client’s self-esteem.
- D. The client with depression is preoccupied, has decreased energy, and is unable to make decisions. The nurse presents the situation, “It’s time for a shower”, and assists the client with personal hygiene to preserve his dignity and self-esteem.
- C. Foods high in tyramine, those that are fermented, pickled, aged, or smoked must be avoided because when they are ingested in combination with MAOIs a hypertensive crisis will occur.
- A. Anticholinergic effects, which result from blockage of the parasympathetic (craniosacral) nervous system including urine retention, blurred vision, dry mouth & constipation.
- B. Dysthymia is a less severe, chronic depression diagnosed when a client has had a depressed mood for more days than not over a period of at least 2 years. Client with dysthymic disorder benefit from psychotherapeutic approaches that assist the client in reversing the negative self image, negative feelings about the future.
- D. Flight of ideas is speech pattern of rapid transition from topic to topic, often without finishing one idea. It is common in mania.
- B. The client with mania is very active & 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 between initiating the method & the delivery 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 lessening of suicidal ideation and improvement in the client’s condition.
- A. Using exercise bicycle is appropriate for the client who becomes very anxious when thoughts of suicidal occur.
- C. The drug of choice for a client experiencing extra pyramidal side effects from haloperidol (Haldol) is benztropine mesylate (cogentin) because of its anti cholinergic properties.
- D. Allowing the client to be the first to open the cart & take a tray presents the client with the reality that the nurses are not touching the food & tray, thereby dispelling the delusion.
- B. Although all the actions indicate improvement, the ability to initiate simple activities without directions indicates the most improvement in the catatonic behaviors.
- A. Psychoeducational groups for families develop a support network. They provide education about the biochemical etiology of psychiatric disease to reduce, not increase family guilt.
- C. Attending activity with the nurse assists the client to become involved with others slowly. The client with schizotypal personality disorder needs support, kindness & gentle suggestion to improve social skills & interpersonal relationship.
- C. An individual with personality disorder usually is not hospitalized unless a coexisting Axis I psychiatric disorder is present. Generally, these individuals make marginal adjustments and remain in society, although they typically experience relationship and occupational problems related to their inflexible behaviors. Personality disorders are chronic lifelong patterns of behavior; acute episodes do not occur. Psychotic behavior is usually not common, although it can occur in either schizotypal personality disorder or borderline personality disorder. Because these disorders are enduring and evasive and the individual is inflexible, prognosis for recovery is unfavorable. Generally, the individual does not seek treatment because he does not perceive problems with his own behavior. Distress can occur based on other people’s reaction to the individual’s behavior.
- D. The nurse would explain the negative reactions of others towards the client’s behaviors to make the clients aware of the impact of his seductive behaviors on others.
- B. The nurse would use role-playing to teach the client appropriate responses to others and in various situations. This client dramatizes events, drawn attention to self, and is unaware of and does not deal with feelings. The nurse works to help the client clarify true feelings & learn to express them appropriately.
- C. Antiseptic mouthwash often contains alcohol & should be kept in locked area, unless labeling clearly indicates that the product does not contain alcohol.
- D. Monitoring of vital signs provides the best information about the client’s overall physiologic status during alcohol withdrawal & the physiologic response to the medication used.
- A. After administering naloxone (Narcan) the nurse should monitor the client’s respiratory status carefully, because the drug is short acting & respiratory depression may recur after its effects wear off.
- B. The best measure to determine a client’s progress in rehabilitation is the number of drug- free days he has. The longer the client is free of drugs, the better the prognosis is.
- D. Barbiturates are CNS depressants; the nurse would be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate over dose.
- B. The feeling of bugs crawling under the skin is termed as formication, and is associated with cocaine use.
- D. The nurse would prepare to administer an antipsychotic medication such as Haldol to a client experiencing amphetamine psychosis to decrease agitation & psychotic symptoms, including delusions, hallucinations & cognitive impairment.
- C. An acid environment aids in the excretion of PCP. The nurse will definitely give the client with PCP intoxication cranberry juice to acidify the urine to a ph of 5.5 & accelerate excretion.
- A. The nurse would facilitate progressive review of the accident and its consequence to help the client integrate feelings & memories and to begin the grieving process.
- B. The nurse instructs the nursing assistant to invite the client to lunch & accompany him to the dinning room to decrease manipulation, secondary gain, dependency and reinforcement of negative behavior while maintaining the client’s worth.
- C. This provides support until the individuals coping mechanisms and personal support systems can be immobilized.
- C. Resolving a loss is a slow, painful, continuous process until a mental image of the dead person, almost devoid of negative or undesirable features emerges.
- A. A moderate level of cognitive impairment due to dementia is characterized by increasing dependence on environment & social structure and by increasing psychologic rigidity with accentuated previous traits & behaviors.
- C. This action maintains for as long as possible, the clients intellectual functions by providing an opportunity to use them.
- A. Individuals with anorexia often display irritability, hospitality, and a depressed mood.
- D. Depressed clients demonstrate decreased communication because of lack of psychic or 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 because it does not recognize the client’s needs but tries to make the client feel guilty for being demanding.
- B. The client must recognize the existence of the sub personalities so that interpretation can occur.
- D. An aloof, detached, withdrawn posture is a means of protecting the self by withdrawing 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 behavior. Regression is a way of responding to overwhelming anxiety.
- B. This provides a stimulus that competes with and reduces hallucination.
- D. Auditory hallucinations are most troublesome when environmental stimuli are diminished and there are few competing distractions.
- A. Projection is a mechanism in which inner 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 self-esteem and reduce the use of paranoid ideation.
- B. Denial is a method of resolving conflict or escaping unpleasant realities by ignoring their existence.
- C. Alcohol is a central nervous system depressant. These symptoms are the body’s neurologic adaptation to the withdrawal of alcohol.
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
d. Delirium
2. Nurse John is aware that a serious effect of inhaling cocaine is?
a. Deterioration of nasal septum
b. Acute fluid and electrolyte imbalances
c. Extra pyramidal tract symptoms
d. Esophageal varices
3. A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include:
a. Rhinorrhea, convulsions, subnormal temperature
b. Nausea, dilated pupils, constipation
c. Lacrimation, vomiting, drowsiness
d. Muscle aches, papillary constriction, yawning
4. A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client’s wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for:
a. 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 recognize that the rapist is motivated by feelings of:
a. Hostility
b. Inadequacy
c. Incompetence
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
c. Self blame
d. Hatred
7. Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the “rotten nursing care”. When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of:
a. Projection
b. Displacement
c. Denial
d. Reaction formation
8. The most critical factor for nurse Linda to determine during crisis intervention would be the client’s:
a. Available situational supports
b. Willingness to restructure the personality
c. Developmental theory
d. Underlying unconscious conflict
9. Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis. These groups are successful because the:
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 approaches to solving the identified problem
10. Nurse Ronald could evaluate that the staff’s approach to setting limits for a demanding, angry client was effective if the client:
a. Apologizes for disrupting the unit’s routine when something is needed
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 has the highest success rate for people with phobias would be:
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 placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client’s:
a. Perceptual field
b. Delusional system
c. Memory state
d. Creativity level
13. In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3 year old child to demonstrate:
a. An interest in music
b. An attachment to odd objects
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
b. Somatic delusion
c. Delusion of grandeur
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 pyramidal effects associated with antipsychotic agents?
a. Clorazepate (Tranxene)
b. Amantadine (Symmetrel)
c. Doxepin (Sinequan)
d. Perphenazine (Trilafon)
18. Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants?
a. Don’t take aspirin or nonsteroidal anti-inflammatory 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 and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience:
a. Heightened concentration
b. Decreased perceptual field
c. Decreased cardiac rate
d. Decreased respiratory rate
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
c. Sedation
d. Diarrhea
22. When performing a physical examination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system?
a. Muscle tension
b. Hyperactive bowel sounds
c. Decreased urine output
d. Constipation
23. Which of the following drugs have been known to be effective in treating obsessive-compulsive 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-free for 4 months. Classic signs and symptoms of phobia include:
a. Severe anxiety and fear
b. Withdrawal and failure to distinguish reality from fantasy
c. Depression and weight loss
d. Insomnia and inability to concentrate
25. Which nursing action is most appropriate when trying to diffuse a client’s impending violent behavior?
a. Place the client in seclusion
b. Leaving the client alone until he can talk 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 disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
a. “Where is your pain located?”
b. “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
b. Cardiac stress testing
c. Neurologic examination
d. Physical therapy
28. Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods?
a. Figs and cream cheese
b. Fruits and yellow vegetables
c. Aged cheese and Chianti wine
d. Green leafy vegetables
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
d. Transitory short and long term memory loss and confusion
30. Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium?
a. Polyuria
b. Seizures
c. Constipation
d. Sexual dysfunction
31. Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent?
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 receiving tricyclic antidepressants include which of the following information?
a. Restrict fluids and sodium intake
b. Don’t consume alcohol
c. Discontinue if dry mouth and blurred vision occur
d. Restrict fluid and sodium intake
33. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?
a. Increased incidence of dysmenorrhea while taking the drug
b. 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-up with this client?
a. Income level and living arrangements
b. Involvement of family and support systems
c. Reason for inpatient admission
d. Reason for refusal to take medications
35. The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change?
a. Decreased dopamine level
b. Increased acetylcholine level
c. Stabilization of serotonin
d. Stimulation of GABA
36. Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients?
a. Central Nervous System effects
b. Cardiovascular system effects
c. Gastrointestinal system effects
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
b. Cognitive framework
c. Interpersonal framework
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
d. Response to stimuli
39. A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client’s employer expects the client to return to work following inpatient treatment. The client tells the nurse, “I’m no good. I’m a failure”. According to cognitive theory, these statements reflect:
a. Learned behavior
b. Punitive superego and decreased self-esteem
c. Faulty thought processes that govern behavior
d. Evidence of difficult relationships in the work environment
40. The nurse describes a client as anxious. Which of the following statement about anxiety is true?
a. Anxiety is usually pathological
b. Anxiety is directly observable
c. Anxiety is usually harmful
d. Anxiety is a response to a threat
41. A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?
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 successful treatment for a client with an antisocial personality disorder?
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 self-satisfaction
d. The client’s statements indicate no remorse for behaviors
43. The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms?
a. Pathophysiology of disease process
b. Principles of good nutrition
c. Side effects of medications
d. Stress management techniques
44. Which of the following is the most distinguishing feature of a client with an antisocial personality disorder?
a. Attention to detail and order
b. Bizarre mannerisms and thoughts
c. Submissive and dependent behavior
d. Disregard for social and legal norms
45. Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations?
a. Anxiety
b. Disturbed body image
c. Defensive coping
d. Powerlessness
46. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?
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
d. Present a cheerful attitude
48. A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself?
a. Art therapy in a small group
b. Basketball game with peers on the unit
c. Reading a self-help book on depression
d. Watching movie with the peer group
49. The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:
a. Managing his hallucinations
b. Medication teaching
c. Social skills training
d. Vocational training
50. Which activity would be most appropriate for a severely withdrawn client?
a. Art activity with a staff member
b. Board game with a small group of clients
c. Team sport in the gym
d. Watching TV in the dayroom
ANSWER
- B. There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.
- A. Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.
- D. These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.
- B. Whether there is a suicide plan is a criterion when assessing the client’s determination to make another attempt.
- A. Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.
- C. These children often have nonsexual needs met by individual and are powerless to refuse. Ambivalence results in self-blame and also guilt.
- B. The client’s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.
- A. Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.
- D. Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic situations using rational and flexible problem solving methods.
- C. This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.
- C. The most successful therapy for people with phobias involves behavior modification techniques using desensitization.
- A. Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.
- D. One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.
- B. Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal parasites and misshapen parts.
- D. A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive.
- A. Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.
- B. Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle movements, pseudoparkinsonism and tar dive dyskinesia.
- D. MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It’s imperative that a client checks with his physician and pharmacist before taking any other medications.
- B. Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention and inability to concentrate.
- A. The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety.
- D. Diarrhea is a common physiological response to stress and anxiety.
- B. The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.
- C. The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.
- A. Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia and elevated B.P.
- D. In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as “What happened to get you this angry?” may help the client verbalizes feelings rather than act on them.
- B. When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions. Those that the client can answer with “yes” or “no” whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.
- A. The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.
- C. Aged cheese and Chianti wine contain high concentrations of tyramine.
- D. ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and long term memory loss.
- A. Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.
- D. Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.
- B. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants.
- C. Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation thus, the client can still be pregnant.
- D. The first are for assessment would be the client’s reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication. The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission.
- A. Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.
- B. The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.
- B. Cognitive thinking therapy focuses on the client’s misperceptions about self, others and the world that impact functioning and contribute to symptoms. Using medications to alter neurotransmitter activity is a psychobiologic approach to treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.
- C. The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.
- C. The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory. Option 4 is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment.
- D. Anxiety is a response to a threat arising from internal or external stimuli.
- A. Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another. Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing activities that typically are avoided as part of the phobic response.
- B. A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore, decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.
- D. In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.
- D. Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.
- D. The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.
- A. One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.
- B. Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.
- A. Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity. Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that interaction will occur; therefore, the client may remain isolated.
- C. Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.
- A. The best approach with a withdrawn client is to initiate brief, nondemanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client. A board game with a group clients or playing a team sport in the gym may overwhelm a severely withdrawn client. Watching TV is a solitary activity that will reinforce the client’s withdrawal from others.
