Showing posts with label psychiatric. Show all posts
Showing posts with label psychiatric. Show all posts
Posted on
Saturday, October 13, 2012
Psychiatric Nursing Practice Exam by Budek (http://pinoybsn.blogspot.com)
Answer Key: http://www.4shared.com/office/XaQB-Qum/89_Item_Psychiatric_Nursing_Ex.html?
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1. An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?
A. Flat affect, social withdrawal, and unusual dress
B. Suspiciousness, hypervigilance, and emotional coldness
C. Lack of self-esteem, strong dependency needs, and impulsive behavior
D. Insensitivity to others, sexual acting out, and violence
2.In a toddler, which of the following injuries is most likely the result of child abuse?
A. A hematoma on the occipital region of the head
B. A 1-inch forehead laceration
C. Several small, dime-sized circular burns on the child's back
D. A small isolated bruise on the right lower extremity
3. A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5′ 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that she has had trouble eating lately and can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has:
A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
D. schizophrenia.
4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses to eat. Which of the following statements is the best response from the nurse?
A. "You don't have to eat. It's your choice."
B. "I hope you'll eat your food by mouth. Tube feedings and I.V. lines can be uncomfortable."
C. "Why do you think you're fat? You're underweight. Here — look in the mirror."
D. "You really look terrible at this weight. I hope you'll eat."
5. A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk. "What is the most appropriate response?
A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."
6. A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. The nurse plans to write a behavioral contract. To best promote compliance, the contract should be written:
A. abstractly.
B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.
7. During which phase of alcoholism is loss of control and physiologic dependence evident?
A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase
8. Which of the following is important when restraining a violent client?
A. Have three staff members present, one for each side of the body and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team approach after the decision is made to restrain the client.
D. Secure restraints to the gurney with knots to prevent escape.
9. A client who's actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which of the following common assessment findings indicates that the client may have ingested PCP?
A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood
10. A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. Her history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the last month. She is 5′ 7" (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority?
A. Initiating caloric and nutritional therapy as ordered
B. Instituting behavioral modification therapy as ordered
C. Addressing the client's low self-esteem
D. Regularly monitoring vital signs and weight
11. A client tells the nurse that he is having suicidal thoughts every day. In conferring with the treatment team, the nurse should make which of the following recommendations?
A. A no-suicide contract
B. Weekly outpatient therapy
C. A second psychiatric opinion
D. Intensive inpatient treatment
12. Which of the following etiologic factors predispose a client to Tourette syndrome?
A. No known etiology
B. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and caudate nucleus, and genetics
C. Abnormalities in the structure and function of the ventricles
D. Environmental factors and birth-related trauma
13. A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?
A. Withdrawal
B. Logical thinking
C. Repression
D. Denial
14. An 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include:
A. violence on television.
B. passive parents.
C. an internal locus of control.
D. a single-parent family
15. A client is brought to the emergency department after being beaten by her husband, a prominent attorney. The nurse caring for this client understands that:
A. open boundaries are common in violent families.
B. violence usually results from a power struggle.
C. domestic violence and abuse span all socioeconomic classes.
D. violent behavior is a genetic trait passed from one generation to the next.
16. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:
A. avoid all products containing alcohol.
B. adhere to concomitant vitamin B therapy.
C. return for monthly blood drug level monitoring.
D. limit alcohol consumption to a moderate level.
17. During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on the forearms. What is the nurse's best response?
A. "That's it! You're on suicide precautions."
B. "I'm going to tell your physician. Do you want to tell me why you did that?"
C. "Tell me what type of instrument you used. I'm concerned about infection."
D. "The team needs to know when something important occurs in treatment. I need to tell the others, but let's talk about it first."
18. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:
A. barbiturates.
B. amphetamines.
C. methadone.
D. benzodiazepines.
19. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:
A. dilated pupils and slurred speech.
B. rapid speech and agitation.
C. dilated pupils and agitation.
D. euphoria and constricted pupils.
20. Which of the following signs should the nurse expect in a client with known amphetamine overdose?
A. Hypotension
B. Tachycardia
C. Hot, dry skin
D. Constricted pupils
21. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available. After the nurse completes the initial assessment, what is the first priority?
A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output
B. Checking the client's medical records for health history information
C. Attempting to contact the client's family to obtain more information about the client
D. Restricting fluids and leaving the client alone to "sleep off" the episode
22. Which nursing action is best when trying to diffuse a client's impending violent behavior?
A. Helping the client identify and express feelings of anxiety and anger
B. Involving the client in a quiet activity to divert attention
C. Leaving the client alone until the client can talk about feelings
D. Placing the client in seclusion
23. The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client?
A. Abstinence is the basis for successful treatment.
B. Attendance at Alcoholics Anonymous meetings every day will cure alcoholism.
C. For treatment to be successful, family members must participate.
D. An occasional social drink is acceptable behavior for the alcoholic
24. Which psychosocial influence has been causally related to the development of aggressive behavior and conduct disorder?
A. An overbearing mother
B. Rejection by peers
C. A history of schizophrenia in the family
D. Low socioeconomic status
25. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, "I don't have a drug problem. I can quit whenever I want. I've done it before." Which defense mechanism is the client using?
A. Denial
B. Obsession
C. Compensation
D. Rationalization
26. A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, the nurse expects the physician to prescribe:
A. lidocaine (Xylocaine).
B. procainamide (Pronestyl).
C. nitroglycerin (Nitro-Bid IV).
D. epinephrine.
27. A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?
A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader."
B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends."
C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."
D. "I do diet around my periods; otherwise, I just get so bloated."
28. Which is the drug of choice for treating Tourette syndrome?
A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil)
29. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse?
A. "Why didn't you get someone else to drive you?"
B. "Tell me how you feel about the accident."
C. "You should know better than to drink and drive."
D. "I recommend that you attend an Alcoholics Anonymous meeting." a
30. A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?
A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above 101° F (38.3° C), and pruritus
C. Hypertension, diaphoresis, and seizures
D. Diaphoresis, tremors, and nervousness
31. When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:
A. norepinephrine (Levophed) and lidocaine (Xylocaine).
B. nifedipine (Procardia) and lidocaine.
C. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc).
D. nifedipine and esmolol
32. A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?
A. The client will commit to a drug-free lifestyle.
B. The client will work with the nurse to remain safe.
C. The client will drink plenty of fluids daily.
D. The client will make a personal inventory of strengths
33. A client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, the nurse should assess for which behavioral clues?
A. A rigid posture, restlessness, and glaring
B. Depression and physical withdrawal
C. Silence and noncompliance
D. Hypervigilance and talk of past violent acts
34. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?
A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected."
B. "I only spend half of my paycheck at the bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."
35. A client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. Based on this finding, the nurse should formulate a nursing diagnosis of:
A. Ineffective individual coping related to feelings of guilt.
B. Situational low self-esteem related to feelings of loss of control.
C. Risk for violence: Self-directed related to impulsive mutilating acts.
D. Risk for violence: Directed toward others related to verbal threats.
36. A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
D. Panic disorder
37. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:
A. begin after 7 days.
B. not occur at all because the time period for their occurrence has passed.
C. begin anytime within the next 1 to 2 days.
D. begin within 2 to 7 days.
38. The nurse is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?
A. Providing one-on-one supervision during meals and for 1 hour afterward
B. Letting the client eat with other clients to create a normal mealtime atmosphere
C. Trying to persuade the client to eat and thus restore nutritional balance
D. Giving the client as much time to eat as desired
39. A client begins to experience alcoholic hallucinosis. What is the best nursing intervention at this time?
A. Keeping the client restrained in bed
B. Checking the client's blood pressure every 15 minutes and offering juices
C. Providing a quiet environment and administering medication as needed and prescribed
D. Restraining the client and measuring blood pressure every 30 minutes
40. Which assessment finding is most consistent with early alcohol withdrawal?
A. Heart rate of 120 to 140 beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mm Hg
D. Blood pressure of 140/80 mm Hg
41. Which client is at highest risk for suicide?
A. One who appears depressed, frequently thinks of dying, and gives away all personal possessions
B. One who plans a violent death and has the means readily available
C. One who tells others that he or she might do something if life doesn't get better soon
D. One who talks about wanting to die
42. Which of the following medical conditions is commonly found in clients with bulimia nervosa?
A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A
43. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?
A. The student discusses conflicts over drug use.
B. The student accepts a referral to a substance abuse counselor.
C. The student agrees to inform his parents of the problem.
D. The student reports increased comfort with making choices.
44. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?
A. clozapine (Clozaril)
B. thiothixene (Navane)
C. lorazepam (Ativan)
D. lithium carbonate (Eskalith)
45. A client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?
A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous
46. A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to:
A. severely restrict the client's physical activities.
B. weigh the client daily, after the evening meal.
C. monitor vital signs, serum electrolyte levels, and acid-base balance.
D. instruct the client to keep an accurate record of food and fluid intake.
47. A young man is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with:
A. antisocial personality disorder.
B. borderline personality disorder.
C. obsessive-compulsive personality disorder.
D. narcissistic personality disorder.
48. A husband and wife seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple, the nurse knows they are at risk for repeated violence because the husband:
A. has only moderate impulse control.
B. denies feelings of jealousy or possessiveness.
C. has learned violence as an acceptable behavior.
D. feels secure in his relationship with his wife.
49. A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to:
A. manipulate her husband.
B. gain control of one part of her life.
C. commit suicide.
D. live up to her mother's expectations.
50. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:
A. psychotherapy.
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.
51. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?
A. Seizures
B. Shivering
C. Anxiety
D. Chest pain
52. The nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:
A. avoid shopping for large amounts of food.
B. control eating impulses.
C. identify anxiety-causing situations.
D. eat only three meals per day.
53. A client who's at high risk for suicide needs close supervision. To best ensure the client's safety, the nurse should:
A. check the client frequently at irregular intervals throughout the night.
B. assure the client that the nurse will hold in confidence anything the client says.
C. repeatedly discuss previous suicide attempts with the client.
D. disregard decreased communication by the client because this is common in suicidal clients.
54. Which of the following drugs should the nurse prepare to administer to a client with a toxic acetaminophen (Tylenol) level?
A. deferoxamine mesylate (Desferal)
B. succimer (Chemet)
C. flumazenil (Romazicon)
D. acetylcysteine (Mucomyst)
55. A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal?
A. naloxone (Narcan)
B. haloperidol (Haldol)
C. magnesium sulfate
D. chlordiazepoxide (Librium)
56. During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response?
A. "I trust you not to purge."
B. "How are you purging and when do you do it?"
C. "Don't worry. I won't allow you to purge today."
D. "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."
57. A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response?
A. "If you continue to talk like that, I'm going to stop speaking to you."
B. "You told me you got fired from your last job for missing too many days after taking drugs all night."
C. "Tell me more about how it felt to get high."
D. "Don't you know it's illegal to use drugs?"
58. For a client with anorexia nervosa, which goal takes the highest priority?
A. The client will establish adequate daily nutritional intake.
B. The client will make a contract with the nurse that sets a target weight.
C. The client will identify self-perceptions about body size as unrealistic.
D. The client will verbalize the possible physiological consequences of self-starvation.
59. When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem?
A. The injury isn't consistent with the history or the child's age.
B. The mother and father tell different stories regarding what happened.
C. The family is poor.
D. The parents are argumentative and demanding with emergency department personnel.
60. For a client with anorexia nervosa, the nurse plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa?
A. They tend to overprotect their children.
B. They usually have a history of substance abuse.
C. They maintain emotional distance from their children.
D. They alternate between loving and rejecting their children.
61. In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene?
A. Remaining with the client and staying calm
B. Calling a security guard and another staff member for assistance
C. Telling the client's husband that he must leave at once
D. Determining why the husband feels so angry
62. The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?
A. Fill out the client's menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal.
C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.
63. The nurse is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority?
A. Assessing the client's home environment and relationships outside the hospital
B. Exploring the nurse's own feelings about suicide
C. Discussing the future with the client
D. Referring the client to a clergyperson to discuss the moral implications of suicide
64. A client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings?
A. Avoid discussing the client's perceptions and feelings.
B. Focus discussions on food and weight.
C. Avoid discussing unrealistic cultural standards regarding weight.
D. Provide objective data and feedback regarding the client's weight and attractiveness.
65. The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products?
A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese
66. The nurse is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?
A. Restrict visits with the family until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.
67. Victims of domestic violence should be assessed for what important information?
A. Reasons they stay in the abusive relationship (for example, lack of financial autonomy and isolation)
B. Readiness to leave the perpetrator and knowledge of resources
C. Use of drugs or alcohol
D. History of previous victimization
68. A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. The nurse realizes that these symptoms probably result from:
A. acetate accumulation.
B. thiamine deficiency.
C. triglyceride buildup.
D. a below-normal serum potassium level
69. A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused?
A. The child cries uncontrollably throughout the examination.
B. The child pulls away from contact with the physician.
C. The child doesn't cry when the shoulder is examined.
D. The child doesn't make eye contact with the nurse.
70. When planning care for a client who has ingested phencyclidine (PCP), which of the following is the highest priority?
A. Client's physical needs
B. Client's safety needs
C. Client's psychosocial needs
D. Client's medical needs
71. Which outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder?
A. Accept responsibility for own behaviors.
B. Be able to verbalize own needs and assert rights.
C. Set firm and consistent limits with the client.
D. Allow the child to establish his own limits and boundaries.
72. A client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at her bleeding wrists while staff members call for an ambulance. How should the nurse approach her initially?
A. Enter the room quietly and move beside her to assess her injuries.
B. Call for staff back-up before entering the room and restraining her.
C. Move as much glass away from her as possible and sit next to her quietly.
D. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her.
73. A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5′ 8" (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client's unrealistic body image, which intervention should be included in the plan of care?
A. Asking the client to compare her figure with magazine photographs of women her age
B. Assigning the client to group therapy in which participants provide realistic feedback about her weight
C. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift
D. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy
74. Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect:
A. a postoperative infection.
B. alcohol withdrawal.
C. acute sepsis.
D. pneumonia.
75. Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered?
A. Phencyclidine (PCP) intoxication
B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal
76. One of the goals for a client with anorexia nervosa is that the client will demonstrate increased individual coping by responding to stress in constructive ways. Which of the following actions is the best indicator that the client is working toward meeting the goal?
A. The client drinks 4 L of fluid per day.
B. The client paces around the unit most of the day.
C. The client keeps a journal and discusses it with the nurse.
D. The client talks almost constantly with friends
76. One of the goals for a client with anorexia nervosa is that the client will demonstrate increased individual coping by responding to stress in constructive ways. Which of the following actions is the best indicator that the client is working toward meeting the goal?
A. The client drinks 4 L of fluid per day.
B. The client paces around the unit most of the day.
C. The client keeps a journal and discusses it with the nurse.
D. The client talks almost constantly with friends by telephone.
77. The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond:
A. "You must first stop drinking."
B. "Your physician must refer you to this program."
C. "Admit you're powerless over alcohol and that you need help."
D. "You must bring along a friend who will support you."
78. An attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm's employee assistance program. The nurse knows that the client's behavior most likely represents the use of which defense mechanism?
A. Regression
B. Projection
C. Reaction-formation
D. Intellectualization
79. After completing chemical detoxification and a 12-step program to treat crack addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future?
A. "I'm never going to use crack again."
B. "I know what I have to do. I have to limit my crack use."
C. "I'm going to take 1 day at a time. I'm not making any promises."
D. "I will substitue crack for something else"
80. The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:
A. accurately describe the amount consumed.
B. underestimate the amount consumed.
C. overestimate the amount consumed.
D. deny any consumption of alcohol.
81. The nurse is assessing a 15-year-old female who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?
A. Tachycardia
B. Warm, flushed extremities
C. Parotid gland tenderness
D. Coarse hair growth
82. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:
A. impending coma.
B. manipulating behavior.
C. suppression.
D. perceptual disorders.
83. The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder?
A. Wearing tight-fitting clothing
B. Increased blood pressure
C. Oily skin
D. Excessive and ritualized exercise
84. A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?
A. Alcohol withdrawal
B. Cannibis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal
85. A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. Although she is 5′ 8" (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly about how fat she is. Which measure should the nurse take first when caring for this client?
A. Teach the client about nutrition, calories, and a balanced diet.
B. Establish a trusting relationship with the client.
C. Discuss cultural stereotypes regarding thinness and attractiveness.
D. Explore the reasons why the client doesn't eat.
86. A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see:
A. tension and irritability.
B. slow pulse.
C. hypotension.
D. constipation.
87. Which of the following drugs may be abused because of tolerance and physiologic dependence.
A. lithium (Lithobid) and divalproex (Depakote).
B. verapamil (Calan) and chlorpromazine (Thorazine)
C. alprazolam (Xanax) and phenobarbital (Luminal)
D. clozapine (Clozaril) and amitriptyline (Elavil)
88. Which of the following groups are considered to be at highest risk for suicide?
A. Adolescents, men over age 45, and persons who have made previous suicide attempts
B. Teachers, divorced persons, and substance abusers
C. Alcohol abusers, widows, and young married men
D. Depressed persons, physicians, and persons living in rural areas
89. Tourette syndrome is characterized by the presence of multiple motor and vocal tics. A vocal tic that involves repeating one's own sounds or words is known as:
A. echolalia.
B. palilalia.
C. apraxia.
D. aphonia.
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Psychiatric Nursing Practice Exam by Budek (http://pinoybsn.blogspot.com)
Answer Key: http://www.4shared.com/office/XaQB-Qum/89_Item_Psychiatric_Nursing_Ex.html?
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1. An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?
A. Flat affect, social withdrawal, and unusual dress
B. Suspiciousness, hypervigilance, and emotional coldness
C. Lack of self-esteem, strong dependency needs, and impulsive behavior
D. Insensitivity to others, sexual acting out, and violence
2.In a toddler, which of the following injuries is most likely the result of child abuse?
A. A hematoma on the occipital region of the head
B. A 1-inch forehead laceration
C. Several small, dime-sized circular burns on the child's back
D. A small isolated bruise on the right lower extremity
3. A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5′ 4" (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that she has had trouble eating lately and can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has:
A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
D. schizophrenia.
4. A 15-year-old girl with anorexia has been admitted to a mental health unit. She refuses to eat. Which of the following statements is the best response from the nurse?
A. "You don't have to eat. It's your choice."
B. "I hope you'll eat your food by mouth. Tube feedings and I.V. lines can be uncomfortable."
C. "Why do you think you're fat? You're underweight. Here — look in the mirror."
D. "You really look terrible at this weight. I hope you'll eat."
5. A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk. "What is the most appropriate response?
A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"
B. "It's your decision. If you don't want to go, you don't have to."
C. "You seem upset about the meetings."
D. "You have to go to the meetings. It's part of your treatment plan."
6. A client is admitted to the inpatient adolescent unit after being arrested for attempting to sell cocaine to an undercover police officer. The nurse plans to write a behavioral contract. To best promote compliance, the contract should be written:
A. abstractly.
B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.
7. During which phase of alcoholism is loss of control and physiologic dependence evident?
A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase
8. Which of the following is important when restraining a violent client?
A. Have three staff members present, one for each side of the body and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team approach after the decision is made to restrain the client.
D. Secure restraints to the gurney with knots to prevent escape.
9. A client who's actively hallucinating is brought to the hospital by friends. They say that the client used either lysergic acid diethylamide (LSD) or angel dust (phencyclidine [PCP]) at a concert. Which of the following common assessment findings indicates that the client may have ingested PCP?
A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood
10. A severely dehydrated teenager admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. Her history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the last month. She is 5′ 7" (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority?
A. Initiating caloric and nutritional therapy as ordered
B. Instituting behavioral modification therapy as ordered
C. Addressing the client's low self-esteem
D. Regularly monitoring vital signs and weight
11. A client tells the nurse that he is having suicidal thoughts every day. In conferring with the treatment team, the nurse should make which of the following recommendations?
A. A no-suicide contract
B. Weekly outpatient therapy
C. A second psychiatric opinion
D. Intensive inpatient treatment
12. Which of the following etiologic factors predispose a client to Tourette syndrome?
A. No known etiology
B. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and caudate nucleus, and genetics
C. Abnormalities in the structure and function of the ventricles
D. Environmental factors and birth-related trauma
13. A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using?
A. Withdrawal
B. Logical thinking
C. Repression
D. Denial
14. An 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include:
A. violence on television.
B. passive parents.
C. an internal locus of control.
D. a single-parent family
15. A client is brought to the emergency department after being beaten by her husband, a prominent attorney. The nurse caring for this client understands that:
A. open boundaries are common in violent families.
B. violence usually results from a power struggle.
C. domestic violence and abuse span all socioeconomic classes.
D. violent behavior is a genetic trait passed from one generation to the next.
16. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching the client about this drug, the nurse emphasizes the need to:
A. avoid all products containing alcohol.
B. adhere to concomitant vitamin B therapy.
C. return for monthly blood drug level monitoring.
D. limit alcohol consumption to a moderate level.
17. During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on the forearms. What is the nurse's best response?
A. "That's it! You're on suicide precautions."
B. "I'm going to tell your physician. Do you want to tell me why you did that?"
C. "Tell me what type of instrument you used. I'm concerned about infection."
D. "The team needs to know when something important occurs in treatment. I need to tell the others, but let's talk about it first."
18. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:
A. barbiturates.
B. amphetamines.
C. methadone.
D. benzodiazepines.
19. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include:
A. dilated pupils and slurred speech.
B. rapid speech and agitation.
C. dilated pupils and agitation.
D. euphoria and constricted pupils.
20. Which of the following signs should the nurse expect in a client with known amphetamine overdose?
A. Hypotension
B. Tachycardia
C. Hot, dry skin
D. Constricted pupils
21. A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available. After the nurse completes the initial assessment, what is the first priority?
A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output
B. Checking the client's medical records for health history information
C. Attempting to contact the client's family to obtain more information about the client
D. Restricting fluids and leaving the client alone to "sleep off" the episode
22. Which nursing action is best when trying to diffuse a client's impending violent behavior?
A. Helping the client identify and express feelings of anxiety and anger
B. Involving the client in a quiet activity to divert attention
C. Leaving the client alone until the client can talk about feelings
D. Placing the client in seclusion
23. The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client?
A. Abstinence is the basis for successful treatment.
B. Attendance at Alcoholics Anonymous meetings every day will cure alcoholism.
C. For treatment to be successful, family members must participate.
D. An occasional social drink is acceptable behavior for the alcoholic
24. Which psychosocial influence has been causally related to the development of aggressive behavior and conduct disorder?
A. An overbearing mother
B. Rejection by peers
C. A history of schizophrenia in the family
D. Low socioeconomic status
25. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, "I don't have a drug problem. I can quit whenever I want. I've done it before." Which defense mechanism is the client using?
A. Denial
B. Obsession
C. Compensation
D. Rationalization
26. A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, the nurse expects the physician to prescribe:
A. lidocaine (Xylocaine).
B. procainamide (Pronestyl).
C. nitroglycerin (Nitro-Bid IV).
D. epinephrine.
27. A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa?
A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader."
B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends."
C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."
D. "I do diet around my periods; otherwise, I just get so bloated."
28. Which is the drug of choice for treating Tourette syndrome?
A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil)
29. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse?
A. "Why didn't you get someone else to drive you?"
B. "Tell me how you feel about the accident."
C. "You should know better than to drink and drive."
D. "I recommend that you attend an Alcoholics Anonymous meeting." a
30. A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition?
A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above 101° F (38.3° C), and pruritus
C. Hypertension, diaphoresis, and seizures
D. Diaphoresis, tremors, and nervousness
31. When monitoring a client recently admitted for treatment of cocaine addiction, the nurse notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:
A. norepinephrine (Levophed) and lidocaine (Xylocaine).
B. nifedipine (Procardia) and lidocaine.
C. nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc).
D. nifedipine and esmolol
32. A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority?
A. The client will commit to a drug-free lifestyle.
B. The client will work with the nurse to remain safe.
C. The client will drink plenty of fluids daily.
D. The client will make a personal inventory of strengths
33. A client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, the nurse should assess for which behavioral clues?
A. A rigid posture, restlessness, and glaring
B. Depression and physical withdrawal
C. Silence and noncompliance
D. Hypervigilance and talk of past violent acts
34. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse?
A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected."
B. "I only spend half of my paycheck at the bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."
35. A client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. Based on this finding, the nurse should formulate a nursing diagnosis of:
A. Ineffective individual coping related to feelings of guilt.
B. Situational low self-esteem related to feelings of loss of control.
C. Risk for violence: Self-directed related to impulsive mutilating acts.
D. Risk for violence: Directed toward others related to verbal threats.
36. A client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. The nurse notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
D. Panic disorder
37. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to:
A. begin after 7 days.
B. not occur at all because the time period for their occurrence has passed.
C. begin anytime within the next 1 to 2 days.
D. begin within 2 to 7 days.
38. The nurse is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client?
A. Providing one-on-one supervision during meals and for 1 hour afterward
B. Letting the client eat with other clients to create a normal mealtime atmosphere
C. Trying to persuade the client to eat and thus restore nutritional balance
D. Giving the client as much time to eat as desired
39. A client begins to experience alcoholic hallucinosis. What is the best nursing intervention at this time?
A. Keeping the client restrained in bed
B. Checking the client's blood pressure every 15 minutes and offering juices
C. Providing a quiet environment and administering medication as needed and prescribed
D. Restraining the client and measuring blood pressure every 30 minutes
40. Which assessment finding is most consistent with early alcohol withdrawal?
A. Heart rate of 120 to 140 beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mm Hg
D. Blood pressure of 140/80 mm Hg
41. Which client is at highest risk for suicide?
A. One who appears depressed, frequently thinks of dying, and gives away all personal possessions
B. One who plans a violent death and has the means readily available
C. One who tells others that he or she might do something if life doesn't get better soon
D. One who talks about wanting to die
42. Which of the following medical conditions is commonly found in clients with bulimia nervosa?
A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A
43. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome?
A. The student discusses conflicts over drug use.
B. The student accepts a referral to a substance abuse counselor.
C. The student agrees to inform his parents of the problem.
D. The student reports increased comfort with making choices.
44. A client who reportedly consumes 1 qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, the physician is most likely to prescribe which drug?
A. clozapine (Clozaril)
B. thiothixene (Navane)
C. lorazepam (Ativan)
D. lithium carbonate (Eskalith)
45. A client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. The nurse should suggest that the family join which organization?
A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous
46. A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to:
A. severely restrict the client's physical activities.
B. weigh the client daily, after the evening meal.
C. monitor vital signs, serum electrolyte levels, and acid-base balance.
D. instruct the client to keep an accurate record of food and fluid intake.
47. A young man is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with:
A. antisocial personality disorder.
B. borderline personality disorder.
C. obsessive-compulsive personality disorder.
D. narcissistic personality disorder.
48. A husband and wife seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple, the nurse knows they are at risk for repeated violence because the husband:
A. has only moderate impulse control.
B. denies feelings of jealousy or possessiveness.
C. has learned violence as an acceptable behavior.
D. feels secure in his relationship with his wife.
49. A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to:
A. manipulate her husband.
B. gain control of one part of her life.
C. commit suicide.
D. live up to her mother's expectations.
50. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:
A. psychotherapy.
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.
51. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?
A. Seizures
B. Shivering
C. Anxiety
D. Chest pain
52. The nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:
A. avoid shopping for large amounts of food.
B. control eating impulses.
C. identify anxiety-causing situations.
D. eat only three meals per day.
53. A client who's at high risk for suicide needs close supervision. To best ensure the client's safety, the nurse should:
A. check the client frequently at irregular intervals throughout the night.
B. assure the client that the nurse will hold in confidence anything the client says.
C. repeatedly discuss previous suicide attempts with the client.
D. disregard decreased communication by the client because this is common in suicidal clients.
54. Which of the following drugs should the nurse prepare to administer to a client with a toxic acetaminophen (Tylenol) level?
A. deferoxamine mesylate (Desferal)
B. succimer (Chemet)
C. flumazenil (Romazicon)
D. acetylcysteine (Mucomyst)
55. A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal?
A. naloxone (Narcan)
B. haloperidol (Haldol)
C. magnesium sulfate
D. chlordiazepoxide (Librium)
56. During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response?
A. "I trust you not to purge."
B. "How are you purging and when do you do it?"
C. "Don't worry. I won't allow you to purge today."
D. "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."
57. A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response?
A. "If you continue to talk like that, I'm going to stop speaking to you."
B. "You told me you got fired from your last job for missing too many days after taking drugs all night."
C. "Tell me more about how it felt to get high."
D. "Don't you know it's illegal to use drugs?"
58. For a client with anorexia nervosa, which goal takes the highest priority?
A. The client will establish adequate daily nutritional intake.
B. The client will make a contract with the nurse that sets a target weight.
C. The client will identify self-perceptions about body size as unrealistic.
D. The client will verbalize the possible physiological consequences of self-starvation.
59. When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem?
A. The injury isn't consistent with the history or the child's age.
B. The mother and father tell different stories regarding what happened.
C. The family is poor.
D. The parents are argumentative and demanding with emergency department personnel.
60. For a client with anorexia nervosa, the nurse plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa?
A. They tend to overprotect their children.
B. They usually have a history of substance abuse.
C. They maintain emotional distance from their children.
D. They alternate between loving and rejecting their children.
61. In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene?
A. Remaining with the client and staying calm
B. Calling a security guard and another staff member for assistance
C. Telling the client's husband that he must leave at once
D. Determining why the husband feels so angry
62. The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?
A. Fill out the client's menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal.
C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.
63. The nurse is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority?
A. Assessing the client's home environment and relationships outside the hospital
B. Exploring the nurse's own feelings about suicide
C. Discussing the future with the client
D. Referring the client to a clergyperson to discuss the moral implications of suicide
64. A client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings?
A. Avoid discussing the client's perceptions and feelings.
B. Focus discussions on food and weight.
C. Avoid discussing unrealistic cultural standards regarding weight.
D. Provide objective data and feedback regarding the client's weight and attractiveness.
65. The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products?
A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese
66. The nurse is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?
A. Restrict visits with the family until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.
67. Victims of domestic violence should be assessed for what important information?
A. Reasons they stay in the abusive relationship (for example, lack of financial autonomy and isolation)
B. Readiness to leave the perpetrator and knowledge of resources
C. Use of drugs or alcohol
D. History of previous victimization
68. A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. The nurse realizes that these symptoms probably result from:
A. acetate accumulation.
B. thiamine deficiency.
C. triglyceride buildup.
D. a below-normal serum potassium level
69. A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused?
A. The child cries uncontrollably throughout the examination.
B. The child pulls away from contact with the physician.
C. The child doesn't cry when the shoulder is examined.
D. The child doesn't make eye contact with the nurse.
70. When planning care for a client who has ingested phencyclidine (PCP), which of the following is the highest priority?
A. Client's physical needs
B. Client's safety needs
C. Client's psychosocial needs
D. Client's medical needs
71. Which outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder?
A. Accept responsibility for own behaviors.
B. Be able to verbalize own needs and assert rights.
C. Set firm and consistent limits with the client.
D. Allow the child to establish his own limits and boundaries.
72. A client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at her bleeding wrists while staff members call for an ambulance. How should the nurse approach her initially?
A. Enter the room quietly and move beside her to assess her injuries.
B. Call for staff back-up before entering the room and restraining her.
C. Move as much glass away from her as possible and sit next to her quietly.
D. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her.
73. A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5′ 8" (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client's unrealistic body image, which intervention should be included in the plan of care?
A. Asking the client to compare her figure with magazine photographs of women her age
B. Assigning the client to group therapy in which participants provide realistic feedback about her weight
C. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift
D. Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy
74. Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect:
A. a postoperative infection.
B. alcohol withdrawal.
C. acute sepsis.
D. pneumonia.
75. Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered?
A. Phencyclidine (PCP) intoxication
B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal
76. One of the goals for a client with anorexia nervosa is that the client will demonstrate increased individual coping by responding to stress in constructive ways. Which of the following actions is the best indicator that the client is working toward meeting the goal?
A. The client drinks 4 L of fluid per day.
B. The client paces around the unit most of the day.
C. The client keeps a journal and discusses it with the nurse.
D. The client talks almost constantly with friends
76. One of the goals for a client with anorexia nervosa is that the client will demonstrate increased individual coping by responding to stress in constructive ways. Which of the following actions is the best indicator that the client is working toward meeting the goal?
A. The client drinks 4 L of fluid per day.
B. The client paces around the unit most of the day.
C. The client keeps a journal and discusses it with the nurse.
D. The client talks almost constantly with friends by telephone.
77. The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond:
A. "You must first stop drinking."
B. "Your physician must refer you to this program."
C. "Admit you're powerless over alcohol and that you need help."
D. "You must bring along a friend who will support you."
78. An attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm's employee assistance program. The nurse knows that the client's behavior most likely represents the use of which defense mechanism?
A. Regression
B. Projection
C. Reaction-formation
D. Intellectualization
79. After completing chemical detoxification and a 12-step program to treat crack addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future?
A. "I'm never going to use crack again."
B. "I know what I have to do. I have to limit my crack use."
C. "I'm going to take 1 day at a time. I'm not making any promises."
D. "I will substitue crack for something else"
80. The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:
A. accurately describe the amount consumed.
B. underestimate the amount consumed.
C. overestimate the amount consumed.
D. deny any consumption of alcohol.
81. The nurse is assessing a 15-year-old female who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?
A. Tachycardia
B. Warm, flushed extremities
C. Parotid gland tenderness
D. Coarse hair growth
82. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:
A. impending coma.
B. manipulating behavior.
C. suppression.
D. perceptual disorders.
83. The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder?
A. Wearing tight-fitting clothing
B. Increased blood pressure
C. Oily skin
D. Excessive and ritualized exercise
84. A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?
A. Alcohol withdrawal
B. Cannibis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal
85. A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. Although she is 5′ 8" (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly about how fat she is. Which measure should the nurse take first when caring for this client?
A. Teach the client about nutrition, calories, and a balanced diet.
B. Establish a trusting relationship with the client.
C. Discuss cultural stereotypes regarding thinness and attractiveness.
D. Explore the reasons why the client doesn't eat.
86. A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see:
A. tension and irritability.
B. slow pulse.
C. hypotension.
D. constipation.
87. Which of the following drugs may be abused because of tolerance and physiologic dependence.
A. lithium (Lithobid) and divalproex (Depakote).
B. verapamil (Calan) and chlorpromazine (Thorazine)
C. alprazolam (Xanax) and phenobarbital (Luminal)
D. clozapine (Clozaril) and amitriptyline (Elavil)
88. Which of the following groups are considered to be at highest risk for suicide?
A. Adolescents, men over age 45, and persons who have made previous suicide attempts
B. Teachers, divorced persons, and substance abusers
C. Alcohol abusers, widows, and young married men
D. Depressed persons, physicians, and persons living in rural areas
89. Tourette syndrome is characterized by the presence of multiple motor and vocal tics. A vocal tic that involves repeating one's own sounds or words is known as:
A. echolalia.
B. palilalia.
C. apraxia.
D. aphonia.
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Psychiatric Nursing Concept Practice Test by Budek (http://pinoybsn.blogspot.com)
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Password: ilovenursing
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1. 60 year old post CVA patient is taking TPA for his disease, the nurse understands that this is an example of what level of prevention?
a. primary
b. secondary
c. tertiary
d. nota
2. A female client undergoes yearly mammography. This is a type of what level of prevention?
a. primary
b. secondary
c. tertiary
d. nota
3. A Diabetic patient was amputated following an unexpected necrosis on the right leg, he sustained and undergone BKA. He then underwent therapy on how to use his new prosthetic leg. this is a type of what level of prevention?
a. primary
b. secondary
c. tertiary
d. nota
4. As a care provider, The nurse should do first:
a. Provide direct nursing care.
b. Participate with the team in performing nursing intervention.
c. Therapeutic use of self.
d. Early recognition of the client’s needs.
5. As a manager, the nurse should:
a. Initiates nursing action with co workers.
b. Plans nursing care with the patient.
c. Speaks in behalf of the patient.
d. Works together with the team.
6. the nurse shows a patient advocate role when
a. defend the patients right
b. refer patient for other services she needs
c. work with significant others
d. intercedes in behalf of the patient.
7. which is the following is the most appropriate during the orientation phase ?
a. patients perception on the reason of her hospitalization
b. identification of more effective ways of coping
c. exploration of inadequate coping skills
d. establishment of regular meeting of schedules
8. preparing the client for the termination phase begins :
a. pre orientation
b. orientation
c. working
d. termination
9. a helping relationship is a process characterized by :
a. recovery promoting
b. mutual interaction
c. growth facilitating
d. health enhancing
10. During the nurse patient interaction, the nurse assess the ff: to determine the patients coping strategy :
a. how are you feeling right now?
b. do you have anyone to take you home?
c. what do you think will help you right now?
d. How does your problem affect your life?
11. As a counsellor, the nurse performs which of the ff: task?
a. encourage client to express feelings and concerns
b. helps client to learn a dance or song to enable her to participate in activities
c. help the client prepare in group activities
d. assist the client in setting limits on her behaviour
12. Freud stresses out that the EGO
a. Distinguishes between things in the mind and things in the reality.
b. Moral arm of the personality that strives for perfection than pleasure.
c. Reservoir of instincts and drives
d. Control the physical needs instincts.
13. A 16 year old child is hospitalized, according to Erik Erikson, what is an appropriate intervention?
a. tell the friends to visit the child
b. encourage patient to help child learn lessons missed
c. call the priest to intervene
d. tell the child’s girlfriend to visit the child.
14. NMS is characterized by :
a. hypertension, hyperthermia, flushed and dry skin.
b. Hypotension, hypothermia, flushed and dry skin.
c. Hypertension, hyperthermia, diaphoresis
d. Hypertension, hypothermia, diaphoresis
15. Which of the following drugs needs a WBC level checked regularly?
a. Lithane
b. Clozaril
c. Tofranil
d. Diazepam
Angelo, an 18 year old out of school youth was caught shoplifting in a department store. He has history of being quarrelsome and involving physical fight with his friends. He has been out of jail for the past two years
16. Initially, The nurse identifies which of the ff: Nursing diagnosis:
a. self centred disturbance
b. impaired social interaction
c. sensory perceptual alteration
d. altered thought process
17. which of the ff: is not a characteristic of PD?
a. disregard rights of others
b. loss of cognitive functioning
c. fails to conform to social norms
d. not capable of experiencing guild or remorse for their behaviour
18. the most effective treatment modality for persons if anti social PD is
a. hypnotherapy
b. gestalt therapy
c. behaviour therapy
d. crisis intervention
19. Which of the following is not an example of alteration of perception?
a. ideas of reference
b. flight of ideas
c. illusion
d. hallucination
20. The type of anxiety that leads to personality disorganization is :
a. Mild b. moderate c. severe d. panic
21. A client is admitted to the hospital. Twelve hours later the nurse observes hand tremors, hyperexicitability, tachycardia, diaphoresis and hypertension. The nurse suspects alcohol withdrawal. The nurse should ask the client:
a. at what time was your last drink taken?
b. Why didn’t you tell us you’re a drinker?
c. Do you drink beer or hard liquor?
d. How long have you been drinking?
22. client with a history of schizophrenia has been admitted for suicidal ideation. The client states "God is telling me to kill myself right now." The nurse's best response is:
a. I understand that god’s voice are real to you, But I don’t hear anything. I will stay with you.
b. The voices are part of your illness, it will stop if you take medication
c. The voices are all in your imagination, think of something else and itll go away
d. Don’t think of anything right now, just go and relax.
23. In assessing a client's suicide potential, which statement by the client would give the nurse the HIGHEST cause for concern?
a. my thoughts of hurting my self are scary to me
b. I’d like to go to sleep and not wake up
c. I’ve thought about taking pills and alcohol till I pass out
d. Id like to be free from all these worries
24. A client with paranoid schizophrenia has persecutory delusions and auditory hallucinations and is extremely agitated. He has been given a PRN dose of Thorazine IM. Which of the following would indicate to the nurse that the medication is having the desired effect?
a. Complains of dry mouth
b. State he feels restless in his body
c. Stops pacing and sits with the nurse
d. Exhibits increase activity and speech
25. A client who was wandering aimlessly around the streets acting inappropriately and appeared disheveled and unkempt was admitted to a psychiatric unit and is experiencing auditory and visual hallucinations. The nurse would develop a plan of care based on:
a. borderline personality disorder
b. anxiety disorder
c. schizophrenia
d. depression
26. A decision is made to not hospitalize a client with obsessive-compulsive disorder. Of the following abilities the client has demonstrated, the one that probably most influenced the decision not to hospitalize him is his ability to:
a. Hold a job.
b. Relate to his peers.
c. Perform activities of daily living.
d. Behave in an outwardly normal
27. A client is admitted to the inpatient psychiatric unit. He is unshaven, has body odor, and has spots on his shirt and pants. He moves slowly, gazes at the floor, and has a flat affect. The nurse's highest priority in assessing the client on admission would be to ask him:
a. How he sleeps at night.
b. If he is thinking about hurting himself.
c. About recent stresses.
d. How he feels about himself.
28. The nurse should know that the normal therapeutic level of lithium is :
a. .6 to 1.2 meq/L
b. 6 to 12 meq/L
c. .6 to .12 cc/ml
d. .6 to .12 cc3/L
29. The patient complaint of vomiting, diarrhea and restlessness after taking lithane. The nurse’s initial intervention is :
a. Recognize that this is a sign of toxicity and withhold the next medication.
b. Notify the physician.
c. Check V/S to validate patient’s concerns.
d. Recognize that this is a normal side effects of lithium and still continue the drug.
30. The client is taking TOFRANIL. The nurse should closely monitor the patient for :
a. Hypertension
b. Hypothermia
c. Increase Intra Ocular Pressure
d. Increase Intra Cranial Pressure
31. A client was hospitalized with major depression with suicidal ideation for 1 week. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse judges:
a. The client to be decompensating and in need of being readmitted to the hospital.
b. The client to need an adjustment or increase in his dose of antidepressant.
c. The depression to be improving and the suicidal ideation to be lessening.
d. The presence of suicidal ideation to warrant a telephone call to the client's physician
32. The client is taking sertraline (Zoloft), 50 mg q AM. The nurse includes which of the following in the teaching plan about Zoloft?
a. Zoloft causes erectile dysfunction in men.
b. Zoloft causes postural hypotension
c. Zoloft increases appetite and weight gain
d. It may take 3-4 weeks before client will start feeling better.
33. After 3 days of taking haloperidol, the client shows an inability to sit still, is restless and fidgety, and paces around the unit. Of the following extrapyramidal adverse reactions, the client is showing signs of:
a. Dystonia.
b. Akathisia.
c. Parkinsonism.
d. Tardive dyskinesia.
34. After 10 days of lithium therapy, the client's lithium level is 1.0 mEq/L. The nurse knows that this value indicates which of the following?
a. A laboratory error.
b. An anticipated therapeutic blood level of the drug.
c. An atypical client response to the drug.
d. A toxic level.
35. When caring for a client receiving haloperidol (Haldol), the nurse would assess for which of the following?
a. Hypertensive episodes.
b. Extrapyramidal symptoms.
c. Hypersalivation.
d. Oversedation.
36. A client is brought to the hospital’s emergency room by a friend, who states, "I guess he had some bad junk (heroin) today." In assessing the client, the nurse would likely find which of the following symptoms?
a. Increased heart rate, dilated pupils, and fever.
b. Tremulousness, impaired coordination, increased blood pressure, and ruddy complexion.
c. Decreased respirations, constricted pupils, and pallor.
d. Eye irritation, tinnitus, and irritation of nasal and oral mucosa.
37. The client has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil), 10 mg bid. The physician orders a selective serotonin reuptake inhibitor (SSRI), paroxetine (Paxil), 20 mg given every morning. The nurse:
a. Gives the medication as ordered.
b. Questions the physician about the order.
c. Questions the dosage ordered.
d. Asks the physician to order benztropine (Cogentin) for the side effects.
38. Which of the following client statements about clozapine (Clozaril) indicates that the client needs additional teaching?
a. "I need to have my blood checked once every several months while I’m taking this drug."
b. "I need to sit on the side of the bed for a while when I wake up in the morning."
c. "The sleepiness I feel will decrease as my body adjusts to clozapine."
d. "I need to call my doctor whenever I notice that I have a fever or sore throat."
39. A client has been taking lithium carbonate (Lithane) for hyperactivity, as prescribed by his physician. While the client is taking this drug, the nurse should ensure that he has an adequate intake of:
a. Sodium.
b. Iron.
c. Iodine.
d. Calcium.
40. The client has been taking clomipramine (Anafranil) for his obsessive-compulsive disorder. He tells the nurse, "I'm not really better, and I've been taking the medication faithfully for the past 3 days just like it says on this prescription bottle." Which of the following actions would the nurse do first?
a. Tell the client to continue taking the medication as prescribed because it takes 5 to 10 weeks for a full therapeutic effect.
b. Tell the client to stop taking the medication and to call the physician.
c. Encourage the client to double the dose of his medication.
d. Ask the client if he has resumed smoking cigarettes.
41. The nurse judges correctly that a client is experiencing an adverse effect from amitriptyline hydrochloride (Elavil) when the client demonstrates:
a. An elevated blood glucose level.
b. Insomnia.
c. Hypertension.
d. Urinary retention.
42. Which of the following health status assessments must be completed before the client starts taking imipramine (Tofranil)?
a. Electrocardiogram (ECG).
b. Urine sample for protein.
c. Thyroid scan.
d. Creatinine clearance test.
43. A client comes to the outpatient mental health clinic 2 days after being discharged from the hospital. The client was given a 1-week supply of clozapine (Clozaril). The nurse reviews information about clozapine with the client. Which client statement indicates an accurate understanding of the nurse's teaching about this medication?
a."I need to call my doctor in 2 weeks for a checkup."
b."I need to keep my appointment here at the hospital this week for a blood test."
c. "I can drink alcohol with this medication."
d. "I can take over-the-counter sleeping medication if I have trouble sleeping."
44. The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of schizophrenia. Which of the following negative symptoms will improve?.
a. Abnormal thought form.
b. Hallucinations and delusions.
c. Bizarre behaviour.
d. Asocial behaviour and anergia.
45. The nurse would teach the client taking tranylcypromine sulfate (Parnate) to avoid which food because of its high tyramine content?
a. Nuts.
b. Aged cheeses.
c. Grain cereals.
d. Reconstituted milk.
46. Which of the following clinical manifestations would alert the nurse to lithium toxicity?
a. Increasingly agitated behaviour.
b. Markedly increased food intake.
c. Sudden increase in blood pressure.
d.Anorexia with nausea and vomiting.
47. The client with depression has been hospitalized for 3 days on the psychiatric unit. This is the second hospitalization during the past year. The physician orders a different drug, tranylcypromine sulfate (Parnate), when the client does not respond positively to a tricyclic antidepressant. Which of the following reactions should the client be cautioned about if her diet includes foods containing tryaminetyramine?
a. Heart block.
b. Grand mal seizure.
c. Respiratory arrest.
d. Hypertensive crisis.
48. After the nurse has taught the client who is being discharged on lithium (Eskalith) about the drug, which of the following client statements would indicate that the teaching has been successful?
a. "I need to restrict eating any foods that contain salt."
b. "If I forget a dose, I can double the dose the next time I take it."
c. "I'll call my doctor right away for any vomiting, severe hand tremors, or muscle weakness."
d. "I should increase my fluid”
49. A nurse is caring for a client with Parkinson's disease who has been taking carbidopa/levodopa (Sinemet) for a year. Which of the following adverse reactions will the nurse monitor the client for?
a. dykinesia
b. glaucoma
c. hypotension
d. respiratory depression
50. A client is taking fluoxetine hydrochloride (Prozac) for treatment of depression. The client asks the nurse when the maximum therapeutic response occurs. The nurse's best response is that the maximum therapeutic response for fluoxetine hydrochloride may occur in the:
a. 10-14 days
b. First week
c. Third week
d. Fourth week
Answer Key: http://www.4shared.com/office/wi3iDyaK/50_item_Psychiatric_Exam_Answe.html?
Password: ilovenursing
Adobe PDF Reader is required
1. 60 year old post CVA patient is taking TPA for his disease, the nurse understands that this is an example of what level of prevention?
a. primary
b. secondary
c. tertiary
d. nota
2. A female client undergoes yearly mammography. This is a type of what level of prevention?
a. primary
b. secondary
c. tertiary
d. nota
3. A Diabetic patient was amputated following an unexpected necrosis on the right leg, he sustained and undergone BKA. He then underwent therapy on how to use his new prosthetic leg. this is a type of what level of prevention?
a. primary
b. secondary
c. tertiary
d. nota
4. As a care provider, The nurse should do first:
a. Provide direct nursing care.
b. Participate with the team in performing nursing intervention.
c. Therapeutic use of self.
d. Early recognition of the client’s needs.
5. As a manager, the nurse should:
a. Initiates nursing action with co workers.
b. Plans nursing care with the patient.
c. Speaks in behalf of the patient.
d. Works together with the team.
6. the nurse shows a patient advocate role when
a. defend the patients right
b. refer patient for other services she needs
c. work with significant others
d. intercedes in behalf of the patient.
7. which is the following is the most appropriate during the orientation phase ?
a. patients perception on the reason of her hospitalization
b. identification of more effective ways of coping
c. exploration of inadequate coping skills
d. establishment of regular meeting of schedules
8. preparing the client for the termination phase begins :
a. pre orientation
b. orientation
c. working
d. termination
9. a helping relationship is a process characterized by :
a. recovery promoting
b. mutual interaction
c. growth facilitating
d. health enhancing
10. During the nurse patient interaction, the nurse assess the ff: to determine the patients coping strategy :
a. how are you feeling right now?
b. do you have anyone to take you home?
c. what do you think will help you right now?
d. How does your problem affect your life?
11. As a counsellor, the nurse performs which of the ff: task?
a. encourage client to express feelings and concerns
b. helps client to learn a dance or song to enable her to participate in activities
c. help the client prepare in group activities
d. assist the client in setting limits on her behaviour
12. Freud stresses out that the EGO
a. Distinguishes between things in the mind and things in the reality.
b. Moral arm of the personality that strives for perfection than pleasure.
c. Reservoir of instincts and drives
d. Control the physical needs instincts.
13. A 16 year old child is hospitalized, according to Erik Erikson, what is an appropriate intervention?
a. tell the friends to visit the child
b. encourage patient to help child learn lessons missed
c. call the priest to intervene
d. tell the child’s girlfriend to visit the child.
14. NMS is characterized by :
a. hypertension, hyperthermia, flushed and dry skin.
b. Hypotension, hypothermia, flushed and dry skin.
c. Hypertension, hyperthermia, diaphoresis
d. Hypertension, hypothermia, diaphoresis
15. Which of the following drugs needs a WBC level checked regularly?
a. Lithane
b. Clozaril
c. Tofranil
d. Diazepam
Angelo, an 18 year old out of school youth was caught shoplifting in a department store. He has history of being quarrelsome and involving physical fight with his friends. He has been out of jail for the past two years
16. Initially, The nurse identifies which of the ff: Nursing diagnosis:
a. self centred disturbance
b. impaired social interaction
c. sensory perceptual alteration
d. altered thought process
17. which of the ff: is not a characteristic of PD?
a. disregard rights of others
b. loss of cognitive functioning
c. fails to conform to social norms
d. not capable of experiencing guild or remorse for their behaviour
18. the most effective treatment modality for persons if anti social PD is
a. hypnotherapy
b. gestalt therapy
c. behaviour therapy
d. crisis intervention
19. Which of the following is not an example of alteration of perception?
a. ideas of reference
b. flight of ideas
c. illusion
d. hallucination
20. The type of anxiety that leads to personality disorganization is :
a. Mild b. moderate c. severe d. panic
21. A client is admitted to the hospital. Twelve hours later the nurse observes hand tremors, hyperexicitability, tachycardia, diaphoresis and hypertension. The nurse suspects alcohol withdrawal. The nurse should ask the client:
a. at what time was your last drink taken?
b. Why didn’t you tell us you’re a drinker?
c. Do you drink beer or hard liquor?
d. How long have you been drinking?
22. client with a history of schizophrenia has been admitted for suicidal ideation. The client states "God is telling me to kill myself right now." The nurse's best response is:
a. I understand that god’s voice are real to you, But I don’t hear anything. I will stay with you.
b. The voices are part of your illness, it will stop if you take medication
c. The voices are all in your imagination, think of something else and itll go away
d. Don’t think of anything right now, just go and relax.
23. In assessing a client's suicide potential, which statement by the client would give the nurse the HIGHEST cause for concern?
a. my thoughts of hurting my self are scary to me
b. I’d like to go to sleep and not wake up
c. I’ve thought about taking pills and alcohol till I pass out
d. Id like to be free from all these worries
24. A client with paranoid schizophrenia has persecutory delusions and auditory hallucinations and is extremely agitated. He has been given a PRN dose of Thorazine IM. Which of the following would indicate to the nurse that the medication is having the desired effect?
a. Complains of dry mouth
b. State he feels restless in his body
c. Stops pacing and sits with the nurse
d. Exhibits increase activity and speech
25. A client who was wandering aimlessly around the streets acting inappropriately and appeared disheveled and unkempt was admitted to a psychiatric unit and is experiencing auditory and visual hallucinations. The nurse would develop a plan of care based on:
a. borderline personality disorder
b. anxiety disorder
c. schizophrenia
d. depression
26. A decision is made to not hospitalize a client with obsessive-compulsive disorder. Of the following abilities the client has demonstrated, the one that probably most influenced the decision not to hospitalize him is his ability to:
a. Hold a job.
b. Relate to his peers.
c. Perform activities of daily living.
d. Behave in an outwardly normal
27. A client is admitted to the inpatient psychiatric unit. He is unshaven, has body odor, and has spots on his shirt and pants. He moves slowly, gazes at the floor, and has a flat affect. The nurse's highest priority in assessing the client on admission would be to ask him:
a. How he sleeps at night.
b. If he is thinking about hurting himself.
c. About recent stresses.
d. How he feels about himself.
28. The nurse should know that the normal therapeutic level of lithium is :
a. .6 to 1.2 meq/L
b. 6 to 12 meq/L
c. .6 to .12 cc/ml
d. .6 to .12 cc3/L
29. The patient complaint of vomiting, diarrhea and restlessness after taking lithane. The nurse’s initial intervention is :
a. Recognize that this is a sign of toxicity and withhold the next medication.
b. Notify the physician.
c. Check V/S to validate patient’s concerns.
d. Recognize that this is a normal side effects of lithium and still continue the drug.
30. The client is taking TOFRANIL. The nurse should closely monitor the patient for :
a. Hypertension
b. Hypothermia
c. Increase Intra Ocular Pressure
d. Increase Intra Cranial Pressure
31. A client was hospitalized with major depression with suicidal ideation for 1 week. He is taking venlafaxine (Effexor), 75 mg three times a day, and is planning to return to work. The nurse asks the client if he is experiencing thoughts of self-harm. The client responds, "I hardly think about it anymore and wouldn't do anything to hurt myself." The nurse judges:
a. The client to be decompensating and in need of being readmitted to the hospital.
b. The client to need an adjustment or increase in his dose of antidepressant.
c. The depression to be improving and the suicidal ideation to be lessening.
d. The presence of suicidal ideation to warrant a telephone call to the client's physician
32. The client is taking sertraline (Zoloft), 50 mg q AM. The nurse includes which of the following in the teaching plan about Zoloft?
a. Zoloft causes erectile dysfunction in men.
b. Zoloft causes postural hypotension
c. Zoloft increases appetite and weight gain
d. It may take 3-4 weeks before client will start feeling better.
33. After 3 days of taking haloperidol, the client shows an inability to sit still, is restless and fidgety, and paces around the unit. Of the following extrapyramidal adverse reactions, the client is showing signs of:
a. Dystonia.
b. Akathisia.
c. Parkinsonism.
d. Tardive dyskinesia.
34. After 10 days of lithium therapy, the client's lithium level is 1.0 mEq/L. The nurse knows that this value indicates which of the following?
a. A laboratory error.
b. An anticipated therapeutic blood level of the drug.
c. An atypical client response to the drug.
d. A toxic level.
35. When caring for a client receiving haloperidol (Haldol), the nurse would assess for which of the following?
a. Hypertensive episodes.
b. Extrapyramidal symptoms.
c. Hypersalivation.
d. Oversedation.
36. A client is brought to the hospital’s emergency room by a friend, who states, "I guess he had some bad junk (heroin) today." In assessing the client, the nurse would likely find which of the following symptoms?
a. Increased heart rate, dilated pupils, and fever.
b. Tremulousness, impaired coordination, increased blood pressure, and ruddy complexion.
c. Decreased respirations, constricted pupils, and pallor.
d. Eye irritation, tinnitus, and irritation of nasal and oral mucosa.
37. The client has been taking the monoamine oxidase inhibitor (MAOI) phenelzine (Nardil), 10 mg bid. The physician orders a selective serotonin reuptake inhibitor (SSRI), paroxetine (Paxil), 20 mg given every morning. The nurse:
a. Gives the medication as ordered.
b. Questions the physician about the order.
c. Questions the dosage ordered.
d. Asks the physician to order benztropine (Cogentin) for the side effects.
38. Which of the following client statements about clozapine (Clozaril) indicates that the client needs additional teaching?
a. "I need to have my blood checked once every several months while I’m taking this drug."
b. "I need to sit on the side of the bed for a while when I wake up in the morning."
c. "The sleepiness I feel will decrease as my body adjusts to clozapine."
d. "I need to call my doctor whenever I notice that I have a fever or sore throat."
39. A client has been taking lithium carbonate (Lithane) for hyperactivity, as prescribed by his physician. While the client is taking this drug, the nurse should ensure that he has an adequate intake of:
a. Sodium.
b. Iron.
c. Iodine.
d. Calcium.
40. The client has been taking clomipramine (Anafranil) for his obsessive-compulsive disorder. He tells the nurse, "I'm not really better, and I've been taking the medication faithfully for the past 3 days just like it says on this prescription bottle." Which of the following actions would the nurse do first?
a. Tell the client to continue taking the medication as prescribed because it takes 5 to 10 weeks for a full therapeutic effect.
b. Tell the client to stop taking the medication and to call the physician.
c. Encourage the client to double the dose of his medication.
d. Ask the client if he has resumed smoking cigarettes.
41. The nurse judges correctly that a client is experiencing an adverse effect from amitriptyline hydrochloride (Elavil) when the client demonstrates:
a. An elevated blood glucose level.
b. Insomnia.
c. Hypertension.
d. Urinary retention.
42. Which of the following health status assessments must be completed before the client starts taking imipramine (Tofranil)?
a. Electrocardiogram (ECG).
b. Urine sample for protein.
c. Thyroid scan.
d. Creatinine clearance test.
43. A client comes to the outpatient mental health clinic 2 days after being discharged from the hospital. The client was given a 1-week supply of clozapine (Clozaril). The nurse reviews information about clozapine with the client. Which client statement indicates an accurate understanding of the nurse's teaching about this medication?
a."I need to call my doctor in 2 weeks for a checkup."
b."I need to keep my appointment here at the hospital this week for a blood test."
c. "I can drink alcohol with this medication."
d. "I can take over-the-counter sleeping medication if I have trouble sleeping."
44. The client is taking risperidone (Risperdal) to treat the positive and negative symptoms of schizophrenia. Which of the following negative symptoms will improve?.
a. Abnormal thought form.
b. Hallucinations and delusions.
c. Bizarre behaviour.
d. Asocial behaviour and anergia.
45. The nurse would teach the client taking tranylcypromine sulfate (Parnate) to avoid which food because of its high tyramine content?
a. Nuts.
b. Aged cheeses.
c. Grain cereals.
d. Reconstituted milk.
46. Which of the following clinical manifestations would alert the nurse to lithium toxicity?
a. Increasingly agitated behaviour.
b. Markedly increased food intake.
c. Sudden increase in blood pressure.
d.Anorexia with nausea and vomiting.
47. The client with depression has been hospitalized for 3 days on the psychiatric unit. This is the second hospitalization during the past year. The physician orders a different drug, tranylcypromine sulfate (Parnate), when the client does not respond positively to a tricyclic antidepressant. Which of the following reactions should the client be cautioned about if her diet includes foods containing tryaminetyramine?
a. Heart block.
b. Grand mal seizure.
c. Respiratory arrest.
d. Hypertensive crisis.
48. After the nurse has taught the client who is being discharged on lithium (Eskalith) about the drug, which of the following client statements would indicate that the teaching has been successful?
a. "I need to restrict eating any foods that contain salt."
b. "If I forget a dose, I can double the dose the next time I take it."
c. "I'll call my doctor right away for any vomiting, severe hand tremors, or muscle weakness."
d. "I should increase my fluid”
49. A nurse is caring for a client with Parkinson's disease who has been taking carbidopa/levodopa (Sinemet) for a year. Which of the following adverse reactions will the nurse monitor the client for?
a. dykinesia
b. glaucoma
c. hypotension
d. respiratory depression
50. A client is taking fluoxetine hydrochloride (Prozac) for treatment of depression. The client asks the nurse when the maximum therapeutic response occurs. The nurse's best response is that the maximum therapeutic response for fluoxetine hydrochloride may occur in the:
a. 10-14 days
b. First week
c. Third week
d. Fourth week
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