Situation: The nurse is interviewing a handsome man. He is intelligent and very charming. When asked about his family, he states he has been married four times. He says three of those marriages were "shotgun" weddings. He states he never really loved any of his wives. He doesn't know much about his three children. "I've lost track," he states.
1. If a patient is very resistant in taking responsibility of his action and asks, "Can you just give me some medication?" the best response is:
a. "The medication has too many side effects."
b. You don't want to take medication, do you?"
c. Medication is given only as a East resort."
d. "There is no medication specific for your condition."
2. The patient asks the nurse, "What is this therapy for anyway. I just don't understand it." the best reply is:
a. "It keeps you from being put on medications."
b. "It helps you to change others in the family."
c. "The purpose of therapy is to help you change."
d. "No one but professionals can really understand
3. For patient in group therapy, the goal is:
a. Exchanging information and ideas
b. Developing insight by relating to others
c. Learning that everyone has problems
d. All of the above
4. In planning care for the patient with a personality disorder, the nurse realizes that this patient will most likely:
a. Not need long-term therapy
b. Not require medication
c. Require anti-anxiety medication
d. Resist any change in behavior
5. The person with an antisocial personality is participating in therapy while a patient at a psychiatric hospital. The nurse’s expectations are that he will:
a. Make a complete recovery
b. Make significant changes
c. Begin the slow process of change
d. Make few changes, if any
6. One of the reasons that persons with antisocial personalities may marry repeatedly or get into trouble with legal authorities is:
a. They usually just don't care
b. They are borderline mentally retarded
c. They are too psychotic to see what’s going on
d. They do not learn from past mistakes
7. The nurse recognizes that these are traits of:
a. Bipolar disorder
b. Alcoholic personality
c. Antisocial personality
d. Borderline personality
Situation: The patient with bipolar disorder is pacing continuously and is skipping meals.
8. Blood levels are drawn on the patient who has been taking Lithium for about six months. The present level is 2.1 meq/L. The nurse evaluates this level as:
b. Below therapeutic
c. Potentially dangerous
d. Fatally toxic
9. The priority in working with patient a thought disorder is:
a. Get him to understand what you're saying
b. Get him to do his ADLs
c. Reorient him to reality
d. Administer antipsychotic medications
10. The most recent Lithium level on bipolar patient indicates a drop non-therapeutic level. What associated behavior does the nurse assess?
11. Adequate fluid intake for a patient on Lithium is:
a. 1,000 ml per day
b. 1,500 ml per day
c. 2,000 ml per day
d. 3,600 ml per day
12. The physician orders Lithium carbonate for the bipolar patient. The nurse is aware that:
a. The patient should be put on a special diet
b. The medication should be given only at night
c. A salt-free should be provided for the patient
d. The drug level should be monitored regularly
13. The nursing plan should emphasize:
a. Offering him finger foods
b. Telling him he must sit down and eat
c. Serving food in his room and staying with him
d. Telling him to order fast food of he wants to eat
Situation: Anna, 25 years old was raped six months ago states, "I just can't seem to get over this. My husband and I don't even have sex anymore. What can I do?"
14. Supportive therapy to the rape victim is directed at overwhelming feeling that the victim experiences just after the rape has occurred?
15. Anna asks, "Why do I need to have pelvic exam?" The nurse explains:
a. "To make sure you're not pregnant."
b. "To see if you got an infection."
c. "To make sure you were really raped."
d. "To gather legal evidence that is required."
16. In providing support therapy, the nurse explains that rape has nothing to do with sexual desires or heeds. The two most common elements in rape are:
a. Guilt and shame
b. Shame and jealousy
c. Embarrassment and envy
d. Power and anger
17. The rape victim will not talk, is withdrawn and depressed. The defensive mechanism being used is:
18. The composite picture of rape victim reveals that most victimized women are:
19. The best intervention is:
a. Tell her it just takes a long time
b. Ask her if her husband is angry
c. Refer her and her husband to sex therapy
d. Tell her she is suffering PTSD
Situation: Obsessions are recurring thoughts that become prevalent in the consciousness and may be considered as senseless or repulsive white compulsion are the repetitive acts that follow obsessive thoughts.
20. To understand the meaning of the cleaning rituals, the nurse must realize:
a. The patient cannot help herself
b. The patient cannot change
c. Rituals relieve intense anxiety
d. Medications cannot help
21. Upon admission to the hospital the patient increases the ritual behavior at bedtime. She cannot sleep. The treatment plan should include:
a. Recommending a sedative medication
b. Modifying the routine to diminish her bedtime anxiety
c. Reminding her to perform rituals early in the evening
d. Limit the amount of time she spends washing her hands
22. A patient has been diagnosed with a personality disorder with .compulsive traits. Of the following behavior's, which one would you expect the patient to exhibit?
a. Inability to make decisions
b. Spontaneous playfulness
c. Inability to alter plans
d. Insistence that things be done his way
23. The patient will not be able to stop her compulsive washing routines until she:
a. Acquires more superego
b. Recognizes the behavior is unrealistic
c. No longer needs them to manage her feelings of anxiety
d. Regains contact with reality
24. A 48-year-old female patient is brought to the hospital by her husband because her behavior is blocking her ability to meet her family's needs. She has uncontrollable and constant desire to scrub her hands, the walls, floors and sofa. She keeps repeating," Everything is dirty." This is an example of:
25. The female patient is preoccupied with rules and regulations. She becomes upset if others do not follow her lead and adhere to the rules exactly. This is a characteristic of which of the following personality?
26. In planning care focused on decreasing the patient's anxiety, what plan should the nurse have in regards to the rituals?
a. Encourage the routines
b. Ignore rituals
c. Work with her to develop limits of behavior
d. Restrain her from the rituals
27. After the patient entered the hospital she began to increase her ritualistic hand washing at bedtime and could; not sleep. The nurse plans care around the fact that this patient needs:
a. A substitute activity to relieve anxiety
b. Medication for sleeping
c. Anti-anxiety medication such as Xanax
d. More scheduled activities during the day
28. The patient states, "I know all this scrubbing is silly but I can’t help it:'', this statement indicates that the patient does not recognize:
a. What she is doing
b. Why she is cleaning
c. Her level of anxiety
d. Need for medication
Situation: Substance, abuse is a common, growing health problem in this country.
29. The nurse is monitoring a drug abuser who states he was given cocaine and heroine that war cut with cornstarch or some other kind of powder. He states, "It was really bad stuff." Which complication is most threatening to this patient?
c. Pulmonary abscess
d. Pulmonary embolism
30. The chronic drug abuser is suffering lymphedema in all extremities, but particularly in the arm where the drug was obviously injected. There is severe obstruction of veins and lymphatics. The nurse suspects the patient used:
a. A dull, contaminated needle
b. A needle contaminated with AIDS
c. Contaminated drugs
d. Cocaine mixed with uncut heroin
31. The nurse is assessing a heroin user who injected the drug into an artery instead of a vein. Which complication is the nurse most likely to expect?
b. Cardiac dysrhythmias
32. The nurse is assessing a 16-year-old patient for drug abuse. The patient is incoherent. Because she notes irritation of eyes, nose and mouth, she suspects inhalants. Which sign is most indicative of inhalant abuse?
b. Bad breath
c. Bad trip
d. Sudden fear
33. An impaired nurse has been admitted for treatment of Demerol addiction. She asks, "When will the withdrawal begin?" the best response is:
a. "It varies, with each individual."
b. "There is no way to tell."
c. "Withdrawal begins soon after the last dose."
d. "It depends upon how well the Demerol works."
34. The patient has a blood pressure of 180/100, heart rate of 120, associated with extreme restlessness. He is very suspicious of the hospital environment and actions of healthcare workers. The nurse should confront this patient on abuse of;
35. The nursing interventions most effective in working with substance dependent patients are:
a. Firm and directive
b. Instillation of values
c. Helpful and advisory
d Subjective and non-judgmental
36. An adolescent patient has bloodshot eyes, a voracious appetite (especially for junk foods), and a dry mouth. Which drug of abuse would the nurse most likely suspect?
Situation: Defense mechanisms are unconscious intrapsychic process implemented to cope with anxiety. The use of some of these mechanisms is healthy, while she use of others is unhealthy.
37. A patient cries and curls in a fetal position refusing to move or talk. This is an example of:
38. A person who expands sexual energy in a nonsexual, socially accepted way is using the coping mechanism of.
39. "The reason I did not do well on the exam is that I was tired." This is an example of:
40. An unattractive girl becomes a very good student. This is an example of:
41. A patient has been sharing a painful experience of sexual abuse during his childhood. Suddenly he stops and says, “l can't remember any more." The nurse assesses his behavior as:
42. The patient has a phobia about walking down in dark halls. The nurse recognizes that the coping mechanism usually associated with phobia is:
43. The patient is denying that he is an alcoholic He states that his wife is an alcoholic. The defense mechanism he is utilizing is: v
Situation: Ms. Dwane, 17 years old, is admitted with anorexia nervosa. You have been assigned to sit with her while she eats her dinner. Ms. Dwane says "My primary nurse trusts me. I don't see why you don't."
44. Which observation of the client with anorexia nervosa indicates the client is improving?
a. The client eats meats in the dining room
b. The client gains one pound per week
c. The client attends group therapy sessions
d. The client has a more realistic self-concept
45. The nurse is caring for a client with anorexia nervosa who is to be placed on behavioral modification. Which is appropriate to include in (he nursing care plan?
a. Remind the client frequently to eat all the food served on the tray
b. Increased phone calls allowed for client by one per day for each pound gained
c. Include the family of the client in therapy sessions two times per week
d. Weigh the client each day at 6:00 am in hospital gown and slippers after she voids
46. A nursing intervention based on the behavior modification model of treatment for anorexia nervosa would be:
a. Role playing the client's interaction with her parents
b. Encouraging the client to vent her feelings through exercise
c. Providing a high-calorie, high protein diet with between meals snacks
d. Restricting the client's privileges until she gains three pounds
47. While admitting Ms. Dwane, the nurse discovers a bottle of pills that Ms. Dwane calls antacids. She takes them because her stomach hurts. The nurse's best initial response is:
a. Tell me more about your stomach pain
b. These do not look like antacids. I need to get an order for you to have them
c. Tell me more about you drug use
d. Some girls take pills to help them lose weight
48. The primary objective in the treatment of the hospitalized anorexic client is to:
a. Decrease the client's anxiety
b. Increase the insight into the disorder
c. Help the mother to gain control
d. Get the client to ea and gain weight
49. Your best response for Ms. Dwane is:
a. I do trust you, but I was assigned to be with you
b. It sounds as if you are manipulating me
c. Ok, when I return, you should have eaten everything
d. Who is your primary nurse?
Situation: The nurse suspects a client is denying his feelings of anxiety
50. The nurse is monitoring a patient who is experiencing increasing anxiety related to recent accident. She notes an increase in vital signs from 130/70 to 160/30, pulse rate of 120, respiration 36. He is having difficulty communicating. His level of anxiety is:
51. The patient who suffers panic attacks is prescribed a medication for short-term therapy. The nurse prepares to administer.
52. In attempting to control a patient who is suffering panic attack, the nursing priority is:
a. Provide safely
b. Hold the patient
c. Describe crisis in detail
d. Demonstrate ADLs frequently
53. Which assessment would the nurse most likely find in a person who is suffering increased anxiety?
a. Increasing BP, increasing heart rate and respirations
b. Decreasing BP, heart rate and respirations
c. Increased BP and decreased respirations
d. Increased respirations and decreased heart rate
54. A patient who suffers an acute anxiety disorder approaches the nurse and while clutching at his shirt states "I think I'm having a heart attack." The priority nursing action is:
a. Reassure him he is OK
b. Take vital signs stat
c. Administer Valium IM
d. Administer Xanax PO
55. In teaching stress management, the goal of therapy is to:
a. Get rid of the major stressor
b. Change lifestyle completely
c. Modify responses to stress
d. Learn new ways of thinking
56. Another client walks in to the mental health outpatient center and States, "I've had it. I can't go on any longer. You've got to help me. "The nurse asks the client to be seated in a private interview room. Which action should the nurse take next?
a. Reassure the client that someone will help him soon
b. Assess the client's insurance coverage
c. Find out more about what is happening to the client
d. Call the client's family to come and provide support
57. Mr. Juan is admitted for panic attack. He frequently experiences shortness of breath, palpitations, nausea, diaphoresis, and terror. What should the nurse include in the care plan for Mr. Juan? When he is shaving a panic attack?
a. Calm reassurance, deep breathing and medications as ordered
b. Teach Mr. Juan problem solving in relation to his anxiety
c. Explain the physiologic responses of anxiety
d. Explore alternate methods for dealing with the cause of his anxiety
58. Ms. Wendy is pacing about the unit and wringing his hands. She is breathing rapidly and complains of palpitations and nausea, and she has difficulty focusing on what the nurse is saying. She says she is having a heart attack but refuses to rest. The nurse would interpret her level of anxiety as:
59. When assessing this client, the nurse must be particularly alert to:
b. Tapping of the feet
c. Wringing of the hands
d. His or her own anxiety level
Situation: Raul aged 70 was recently admitted to a nursing home because of confusion, disorientation, and negativistic behavior. Her family states that Raul is in good health. Raul asks you, "Where am I?"
60. Another patient, Mr. Pat, has been brought to the psychiatric unit and is pacing up and down the hall. The nurse is to admit him to the hospital. To establish a nurse-client relationship, which approach should the nurse try first?
a. Assign someone to watch Mr. Pat until he is calm
b. Ask Mr. Pat to sit down and orient him to the nurse's name and the need for information
c. Check Mr. Pat's vital signs, ask him about allergies, and call the physician for sedation
d. Explain the importance of accurate assessment data to Mr. Pat .
61. If Raul will say "I'm so afraid! Where I am? Where is my family'?" How should the nurse respond?
a. "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is one hour from now"
b. "You know were you are. You were admitted here 2 weeks ago. Don’t worry your family will be back soon."
c. "I just told you that you're in the hospital and your family will be here soon."
d. "The name of the hospital is on the sigh over the door. Let's go read it again."
62. Raul has had difficulty sleeping since admission. Which of the following would be the best intervention?
a. Provide him with glass of warm milk
b. Ask the physician for a mild sedative
c. Do not allow Raul to take naps during the day
d. Ask him family what they prefer
63. Which activity would you engage in Raul at the nursing home?
a. Reminiscence groups
d. Discussion groups
c. Exercise class
64. Which of the following would be an appropriate strategy in reorienting a confused client to where her room is?
a. Place pictures of her family on the bedside stand
b. Put her name in large letters on her forehead
c. Remind the client where her room is
d. Let the other residents know where the client’s room is
65. The best response for the nurse to make is:
a. Don't worry, Raul. You're safe here
b. Where do you think you are?
c. What did your family tell you?
d. You're at the community nursing home
Situation: The police bring a patient to the emergency department. He has been locked in his apartment for the past 3 days, making frequent calls to the police and emergency services and stating that people are trying to kill him.
66. A client on an inpatient psychiatric unit refuses to eat and states that the staff is poisoning her food. Which action should the nurse include in the client's care plan?
a. Explain to the client that the staff can be trusted
b. Show the client that others eat the food without harm
c. Offer the client factory-sealed foods and beverages
d. Institute behavioral modification with privileges dependent on intake
67. The client tells the nurse that he can't eat because his food has been poisoned. This statement is an indication of which of the following?
b. Delusion of persecution
68. The client on antipsychotic drugs begins to exhibit signs and symptoms of which disorder?
c. Tardive dyskinesia
d. Oculogyric crisis
69. During a patient history, a patient state that she used to believe she was God. But she knows this isn't true. Which of the following would be your best response?"
a. "Does it bother you that you used to believe that about yourself?"
b. "Your thoughts are now more appropriate"
c. "Many people have these delusions."
d. "What caused you to think you were God?"
70. The nurse is caring for a client who is experiencing auditory hallucination. What would be most crucial for the nurse to assess?
a. Possible hearing impairment
b. Family history of psychosis
c. Content of the hallucination
d. Otitis media
71. A patient with schizophrenia reports that the newscaster on the radio has a divine message especially for her. You would interpret this as indicating.
a. Loose of associations
b. Delusion of reference
c. Paranoid speech
d. Flight of ideas
72. What type of delusions is the patient experiencing?
Situation: Helen, with a diagnosis of disorganized schizophrenia is creating a disturbance in the day room. She is yelling and pointing at another patient, accusing him to stealing her purse. Several patients are in the day room when this incident starts.
73. The nurse is preparing to care for a client diagnosed with catatonic schizophrenia. In anticipation of this client's arrival, what should the nurse do?
a. Notify security
b. Prepare a magnesium sulfate drip
c. Place a specialty mattress overlay on the bed
d. Communicable the client's nothing-by-mouth status to the dietary department
74. The nurse is caring for a client whom she suspects is paranoid. How would the nurse confirm this assessment?
a. indirect questioning
b. Direct questioning
d. Open-ended sentences
75. Which of the following is an example of a negative symptom of schizophrenia?
b. Disorganized speech
c. Flat affect
d. Catatonic behavior
76. The patient tells you that a "voice" keeps laughing at him and tells him he must crawl on his hands and knees like a dog. Which of the following would be the most appropriate response?
a. "They are imaginary voices and we're here to make them go, away."
b. "If it makes you feel better, do what the voices tell you."
c. "The voices can't hurt you here in the hospital"
d. "Even though I don't hear the voices, I understand that you do."
77. A 23-year-old patient is receiving antipsychotic medication to treat his schizophrenia. He's experiencing some motor abnormalities called extrapyramidal effects. Which of the following extrapyramidal effects occurs most frequently in younger make patients?
78. Which of the following should you do next?
a. Firmly redirect the patient to her room to discuss the incident
b. Call the assistance and place the patient in locked seclusion
c. Help the patient look for her purse
d. Don't intervene - the patients need a little bit of room in which to work out differences
Situation: John is admitted with a diagnosis of paranoid schizophrenia.
79. You're reaching a community group about schizophrenia disorders. You explain the different types of schizophrenia and delusional disorders. You also explain that, unlike schizophrenia, delusional disorders:
a. Tend to begin in early childhood
b. Affect more men than women
c. Affect more women than men
d. May be related to certain medical conditionsa
80. A patient with schizophrenia (catatonic type) is mute and can't perform activities of daily living. The patient stares out the window for hours. What is your first priority in this situation?
a. Assist the patient with feeding
b. Assist the patient with showering and tasks for hygiene
c. Reassure the patient about safely, and try to orient him to his surroundings
d. Encourage, socialization with peers, and provide a stimulating environment
81. Which of the following would you suspect in a patient receiving Chlorpromazine (Thorazine) who complains of a sore throat and has a fever?
a. An allergic reaction
82. While providing information for the family of a patient with schizophrenia, you should be sure to inform them about which of the following characteristics of the disorder?
a. Relapse can be prevented if the patient takes medication
b. Support is available to help family members meet their own needs
c. Improvement should occur if the patient's environment is carefully maintained
d. Stressful situations in the family in the family can precipitate a relapse in the patient
83. While caring for John, the nurse knows that John may have trouble with:
a. Staff who are cheerful
b. Simple direct sentences
c. Multiple commands
d. Violent behaviors
84 Which nursing diagnosis is most likely to be associated with a person who has a medical diagnosis of schizophrenia, paranoid type?
a. Fear of being along
b. Perceptual disturbance related to delusion of persecution
c. Social isolation related to impaired ability to trust
d. Impaired social skills related to inadequate developed superego
85. Which of the following behaviors can the nurse anticipate with this client?
a. Negative cognitive distortions
b. Impaired psychomotor development
c. Delusions of grandeur and hyperactivity
d. Alteration of appetite and sleep pattern
Situation: A client is admitted to the hospital. During the assessment the nurse notes that the client has not slept for a week. The client is talking rapidly, and throwing his arms around randomly.
86. When writing an assessment of a client with mood disorder, the nurse should specify:
a. How flat the client's affect
b. How suicidal the client is
c. How grandiose the client is
d. How the client is behaving
87. It is an apprehensive anticipation of an unknown danger:
88. It is an, emotional response to a consciously recognized threat.
89. All but one is an example of situational crisis:
b. Role changes
90. What would be the highest priority in formulating a nursing care plan for this client?
a. Isolate the client until he or she adjusts to 'the hospital
b. Provide nutritious food and a quite place to rest
c. Protect the client and others from harm
d. Create a structured environment
Situation: Wendell, 24 year-old student with a primary sleep disorder, is unable to initiate maintenance of sleep. Primary sleep disorders may be categorized as dyssomnias or parasomnias.
91. The nurse is caring for a client who complains; of fat?gue, inability to concentrate, and palpitations. The client stales that she has been experiencing these symptoms for the past 6 months. Which factor in the client’s history has most likely contributed to.these symptoms?
a. History of recent fever
b. Shift work
92. If Wendell complains of experiencing an overwhelming urge to sleep and states that he's been falling asleep while studying and reports that these episodes occur about 5 times daily Wendell is most likely experiencing which sleep disorder?
a. Breathing-related sleep disorder
c. Primary hypersomnia
d. Circadian rhythm disorder
93. The nurse is preparing a teaching plan for a client diagnosed with primary insomnia. Which of the following teaching topics should be included in the plan?
a. Eating unlimited spicy foods, and limiting caffeine and alcohol
b. Exercising 1 hour before bedtime to promote sleep
c. Importance of steeping whenever the client tires
d. Drinking warm milk before bed to induce sleep
94. Examples of dyssomnia includes:
a. Insomnia, hypersomnia, narcolepsy
b. Sleepwalking, nightmare
c. Snoring while sleeping
d. Non-rapid eye movement
Situation: The following questions refer to therapeutic communication.
95. When preparing to conduct group therapy, the nurse keeps in mind that the optimal number of clients in a group would be:
a. 6 to 8
b. 10 to 12
c. 3 to 5
96. What occurs during the working phase of the-nurse-client relationship?
a. The nurse assesses the client's needs and develops a plan of care
b. The nurse and client together evaluate and modify the goals of the relationship
c. The nurse and client discuss their feelings about terminating the relationship
d. The nurse and client explore each other's expectations of-the relationship
97. A 42 year-old homemaker arrives at the emergency department with uncomfortable crying and anxiety. Her husband of 17 years has recently asked her for a divorce. The patient is sitting in a chair, rocking back and forth. Which is the best response for the nurse to make?
a. "You must stop crying so that we can discuss your feelings about the divorce."
b. "Once you find a job, you will feel much better and more secure."
c. "I can see how upset you are. Let's sit in the office so that we can talk about how you're feeling."
d. "Once you have a lawyer looking out for your interests, you will feel better."
98. A client on the unit tells the nurse that his wife's nagging really gets on his nerves. He asks the nurse if she will talk with his wife about nagging during their family session tomorrow afternoon. Which of the following would be most therapeutic response to client?
a. "Tell me more specifically about her complaints"
b. "Can you think why she might nag you so much?"
c. "I'll help you think about how to bring this up yourself tomorrow."
d. "Why do you want me to initiate this discussion in tomorrow's session rather than you?"
99. The nurse is working with a client who has just stimulated her anger by using a condescending tone of voice. Which of the following responses by the nurse would be the most therapeutic?
a. "I feel angry when I hear that tone of voice"
b. "You make me so angry when you talked to me that way."
c. "Are you trying to make me angry?"
d. "Why do you use that condescending tone of voice with me?"
100. A 35 year-old client tells the nurse that he never disagrees with anyone and that he has loved everyone he's ever known. What would be the nurse's best response to this client?
a. "How do you manage to do that?"
b. "That's hard to believe. Most people couldn't to that."
c. "What do you do with your feelings of dissatisfaction or anger?"
d. "How did you come to adopt such a way of life?"
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