ST. TONIS COLLEGECollege Of NursingBulanao, Tabuk City, Kalinga

Nursing Care Management 105 : Prelim Examinations

Name : Section : Date :

IINSTRUCTIONS: Choose and encircle the best answer for the following items. No erasures, alterations, and unnecessary markings. Make your answer sheets as clean as possible.

1. 2. Which applies to the scope of practice of the Psychiatric/Mental Health Registered Nurse?A. Minimum of a masters degree in mental health nursing.B. Ability to order medications based on lab values.C. Crisis intervention.D. Ability to designate a clients Axis assessment.3. Which is the overall, priority goal of in-patient psychiatric treatment?A. Maintenance of stability in the community.B. Medication compliance.C. Stabilization and return to the community.D. Better communication skills.4. When the nurse creates an environment to facilitate healing, the nurses actions are based on which of the following assumptions? Select all that apply.A. A therapeutic relationship can be a healing experience.B. A healthy relationship cannot be transferred to other relationships.C. Group settings can support ego strengths.D. Treatment plans can be formulated by observing social behaviors.E. Promoting countertransference eases the establishment of the nurse-client relationship.5. Which of the following was the reason for the establishment of large hospitals or asylums that addressed the care of the mentally ill? Select all that apply.A. Mental illness was perceived as incurable.B. Clients with mental illness were perceived as a threat to self and others.C. Dorothea Dix saw a need for humane care for the mentally ill.D. Federal funding initially was available.E. They were mandated by the National Institute of Mental Health.6. Which situation led to the deinstitutionalization movement?A. Dorothea Dix advocated for deinstitutionalization.B. Clients with mental illness were feared by the general population.C. The passing of the Community Mental Health Centers Act.D. The establishment of the National Institute of Mental Health.7. Primary prevention in a community mental health setting is exemplified by which of the following concepts?A. Ongoing assessment of individuals at high risk for illness exacerbation.B. Teaching physical and psychosocial effects of stress to elementary school students.C. Referral for treatment of individuals in whom illness symptoms have been assessed.D. Monitoring effectiveness of aftercare services.8. Which nursing intervention within the community is aimed at reducing the residual defects that are associated with severe or chronic mental illness?A. Referring clients for various aftercare services such as day treatment programs.B. Providing care for individuals in whom mental illness symptoms have been assessed.C. Providing education and support to women entering the workforce.D. Teaching concepts of mental health to various groups within the community.9. In the emergency department, the nurse is assessing a client who is aggressive and is experiencing auditory and visual hallucinations. The client states, I believe that the CIA is plotting to kill me. To which mental health setting would the nurse expect this client to be admitted?A. Long-term in-patient facility.B. Day treatment.C. Short-term in-patient, locked unit.D. Psychiatric case management.10. Which action of a mental health nurse case manager reflects the activity of service planning?A. Identifying a client who is missing appointments and seeking other community resources to ensure correct treatment.B. Calling a client when the client misses an appointment to determine the cause of the absence.C. Making an appointment for a client with a nutritionist for dietary counseling.D. Holding a care conference for a client who is having difficulty returning to school.11. A client with a long history of alcohol dependence has been diagnosed with Wernicke-Korsakoff syndrome. Which member of the mental health care team would the nurse collaborate with to meet this clients described need?A. The psychiatrist to obtain an order for anti-Alzheimers medication.B. The psychologist to set up counseling sessions to explore stressors.C. The dietitian to help the client increase consumption of thiamine-rich foods.D. The social worker to plan transportation to Alcoholics Anonymous (AA) support groups.12. A client on an in-patient psychiatric unit has a nursing diagnosis of noncompliance R/T not taking antipsychotic medications. The nurse is functioning in which role when the nurse checks for cheeking?A. Advocate.B. Educator.C. Medication manager.D. Counselor.13. On an in-patient psychiatric setting, which action reflects the nurses role of teacher?A. The nurse assesses potentially stressful characteristics of the environment and develops strategies to eliminate or decrease stressors.B. The nurse orients new clients to the unit and assists them to fit comfortably into the environment.C. The nurse assists the client and family members to cope with the effects of mental illness.D. The nurse is the guardian of the therapeutic environment.14. In an in-patient psychiatric setting, which action of the nurse reflects the nurses role as advocate?A. The nurse speaks on behalf of a mentally ill client to ensure adequate access to needed mental health services.B. The nurse focuses on improving the mentally ill clients and family members self-care knowledge and skills.C. The nurse ensures that new clients fit comfortably into the therapeutic environment.D. The nurse monitors the client in the milieu for side effects of psychotropic medications.15. A resource persons function is to give specific answers to specific questions, as a counselors function is to:A. Identify learning needs and provide information required by the client to improve health situations.B. Encourage the client to be an active participant in designing a nursing plan of care.C. Serve as a substitute figure for another person.D. Listen as a client reviews feelings related to difficulties experienced in any aspect of life.16. On an in-patient psychiatric unit, a client diagnosed with major depressive disorder states, Im so glad that the Zoloft that my doctor just prescribed will quickly help me with my mood. Which nursing response reflects the role of teacher?A. Ill set up a time with your doctor to clarify information about this medication.B. Lets talk about how you feel about taking this new medication.C. Its great that you have learned this information about your new medication.D. This medication will probably take 2 to 4 weeks to be effective.17. On an in-patient psychiatric unit, a client diagnosed with borderline personality disorder is challenging other clients and splitting staff. Which response by the nurse reflects the nurses role of milieu manager?A. Setting strict limits and communicating these limits to all staff members.B. Using role-play to demonstrate ways of dealing with frustration.C. Seeking orders from the physician to force medications.D. Holding a group session on relationship skills.18. On an in-patient psychiatric unit, a client diagnosed with major depressive disorder is anxious and distressed, and states, God has abandoned me. Which action by the nurse would initiate collaboration with the member of the mental health care team who can assist this client with this assessed problem?A. Notify the psychiatrist to get an order for an antianxiety medication PRN.B. Consult the social worker to provide community resources to meet spiritual needs.C. Notify the psychologist that testing is necessary.D. Consult with the chaplin and describe the clients concerns.19. A client on an in-patient psychiatric unit exhibits traits of borderline personality disorder. Which action by the nurse would initiate collaboration with the member of the mental health care team who can confirm this diagnosis?A. Notify the psychiatrist to get an order for medication specifically targeted for this disorder.B. Collaborate with the occupational therapist to meet this clients retraining needs.C. Collaborate with the clinical psychologist to prepare the client for personality testing.D. Meet with the recreational therapist to plan activities to release the clients anxiety.20. A client with a long history of alcoholism comes to the out-patient clinic after losing a job and drivers license because of a DUI. Which member of the mental health care team would the nurse collaborate with to meet this clients described need?A. The psychiatrist to obtain an order for an antianxiety medication.B. The psychologist to set up counseling sessions to explore stressors.C. The occupational therapist for retraining and job placement.D. The social worker to plan housing.21. A client states, My wife is unfaithful. I think I am not worth anything. Which of the following describes this assessment information? Select all that apply.A. This is subjective information or chief complaint.B. This information must be validated by significant others.C. This objective information must be verified by individuals other than the client.D. This information needs objective measurement by a mood rating scale.E. This information indicates the use of defense mechanisms.22. Which assessment information would be evaluated as objective data?A. Clinical Institute Withdrawal Assessment (CIWA) score of 10.B. Clients statements of generalized anxiety.C. Complaints of anorexia.D. Client states, I cant keep my thoughts together.23. The nurse is interviewing a client admitted to an in-patient psychiatric unit with major depressive disorder. Which is the primary goal in the assessment phase of the nursing process for this client?A. To build trust and rapport.B. To identify goals and outcomes.C. To collect and organize information.D. To identify and validate the medical diagnosis.24. The nurse uses the clock face assessment test to obtain which assessment data?A. Early signs of dementia.B. Overall rating of assessment of functioning.C. Evidence of alcohol/substance abuse problems.D. Signs and symptoms of depression.25. A client who is a welder by trade and has recently lost his arm in a motor vehicle accident is being admitted to an in-patient psychiatric facility. The client states, Im useless. I cant support my family anymore! Which nursing diagnosis is most reflective of this clients presenting problem?A. Ineffective coping R/T poor self-esteem.B. Ineffective role performance R/T loss of job.C. Impaired social interaction R/T altered body image.D. Knowledge deficit R/T wound and skin care.26. An 85-year-old client has become agitated and physically aggressive after having a stroke with right-sided weakness. The client is started on risperidone (Risperdal) PO 0.5 mg QHS. Which is a priority nursing diagnosis for this client?A. Risk for falls R/T right-sided weakness and sedation from risperidone (Risperdal).B. Activity intolerance R/T right-sided weakness.C. Disturbed thought processes R/T acting out behaviors.D. Anxiety R/T change in health status and dependence on others.27. Which is an example of the therapeutic technique of voicing doubt?A. What I heard you say was . . . ?B. I find that hard to believe.C. Are you feeling that no one understands?D. Lets see if we can find the answer.28. Indicating that there is no cause for anxiety is to reassuring as sanctioning or denouncing the clients ideas or behaviors is to:A. Approving/disapproving.B. Rejecting.C. Interpreting.D. Probing.29. Demanding proof from the client is to challenging as persistent questioning of the client and pushing for answers the client does not wish to discuss is to:A. Advising.B. Defending.C. Rejecting.D. Probing.30. Which is an example of the non-therapeutic technique of giving reassurance?A. Thats good. Im glad that you. . . .B. Hang in there, every dog has his day.C. Dont worry, everything will work out.D. I think you should. . . .31. Which is an example of the non-therapeutic technique of requesting an explanation?A. Who made you so angry last night?B. Do you still have the idea that . . .?C. How could you be dead, when youre still breathing?D. Why do you feel this way?32. A client on a psychiatric unit says, Its a waste of time to be here. I cant talk to you or anyone. Which would be an appropriate therapeutic nursing response?A. I find that hard to believe.B. Are you feeling that no one understands?C. I think you should calm down and look on the positive side.D. Our staff here is excellent, and you are in good hands.33. Which nurse-client communication-centered skill implies respect?A. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification.B. The nurse communicates an understanding of the clients world from the clients internal frame of reference, with sensitivity to the clients current feelings, and the ability to communicate this understanding in a language attuned to the client.C. The nurse communicates that the nurse is an open person who is self-congruent, authentic, and transparent.D. The nurse communicates specific terminology rather than abstractions in the discussion of the clients feelings, experiences, and behaviors.34. A client on a psychiatric unit tells the nurse, Im all alone in the world now, and I have no reason to live. Which response by the nurse would encourage further communication by the client?A. You sound like youre feeling lonely and frightened.B. Why do you think that suicide is the answer to your loneliness?C. I live by myself and know it can be very lonely and frightening.D. Just hang in there and, youll see, things will work out.35. The nurse is attempting to establish a therapeutic relationship with an angry, depressed client on a psychiatric unit. Which is the most appropriate nursing intervention?A. Work on establishing a friendship with the client.B. Use humor to defuse emotionally charged topics of discussion.C. Show respect that is not based on the clients behavior.D. Sympathize with the client when the client shares sad feelings.36. On a substance abuse unit, a client diagnosed with cirrhosis of the liver tells the nurse, I really dont believe that my drinking a couple of cocktails a night has anything to do with my liver problems. Which is the best nursing response?A. You find it hard to believe that drinking alcohol can damage the liver?B. How long have you been drinking a couple of cocktails a night?C. If not alcohol, explain how your liver became damaged.D. Its common knowledge that consuming alcohol continually over a long period of time can damage the liver.37. In dealing therapeutically with a variety of psychiatric clients, the nurse knows that incorporating humor in the communication process should be used for which purpose?A. To diminish feelings of anger.B. To refocus the clients attention.C. To maintain a balanced perspective.D. To delay dealing with the inevitable.38. Which nurse-client communication-centered skill implies empathic understanding?A. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification.B. The nurse communicates an understanding of the clients world from the clients internal frame of reference, with sensitivity to the clients current feelings, and the ability to communicate this understanding in a language attuned to the client.C. The nurse communicates that the nurse is an open person who is self-congruent, authentic, and transparent.D. The nurse communicates specific terminology rather than abstractions in the discussion of the clients feelings, experiences, and behaviors.39. A client on an in-patient psychiatric unit has pressured speech and flight of ideas and is extremely irritable. During an intake assessment, which is the most appropriate nursing response?A. I think you need to know more about your medications.B. What have you been thinking about lately?C. I think we should talk more about what brought you into the hospital.D. Yes, I see. And go on please.40. A client in an out-patient clinic states, I am so tired of these medications. Which nursing response would encourage the client to elaborate further?A. I see you have been taking your medications.B. Tired of taking your medications?C. Lets discuss different ways to deal with your problems.D. How would your family feel about your stopping your medications?41. Which nurse-client communication-centered skill implies genuineness?A. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification.B. The nurse communicates an understanding of the clients world from the clients internal frame of reference, with sensitivity to the clients current feelings, and the ability to communicate this understanding in a language attuned to the client.C. The nurse communicates that the nurse is an open person who is self-congruent, authentic, and transparent.D. The nurse communicates specific terminology rather than abstractions in the discussion of the clients feelings, experiences, and behaviors.42. A client diagnosed with major depression after a stroke has been admitted to the psychiatric unit. The report indicates that the client has special communication needs because of aphasia and dysarthria. Which communication adaptation technique by the nurse would be most helpful to this client?A. Using simple sentences and avoiding long explanations.B. Speaking to the client as though the client could hear.C. Listening attentively, allowing time, and not interrupting.D. Providing an interpreter (translator) as needed.43. A client who has been scheduled for electroconvulsive therapy (ECT) in the morning tells the nurse, Im really nervous about having ECT tomorrow. Which would be the best nursing response?A. Ill ask the doctor for a little medication to help you relax.B. Its okay to be nervous. What are your concerns about the procedure?C. Clients who have had ECT say theres nothing to it.D. Your doctor is excellent and has done hundreds of these procedures.44. An instructor overhears the nursing student ask a client, This is your third admission. Why did you stop taking your medications? Which statement by the instructor would be appropriately related to the students question?A. Your question implied criticism and could have the effect of making the client feel defensive.B. Your question invited the client to share thoughts and feelings regarding the clients non-compliance.C. Your question recognized and acknowledged the clients reasons for his or her actions.D. Your question pursued the topic to make the clients intentions clear.45. The nurses focus on client behavior rather than on the client himself or herself is one of the many strategies of nonthreatening feedback. What is the reason for using this particular strategy?A. This strategy reports what occurred, rather than evaluating it in terms of right or wrong or good or bad.B. This strategy refers to what the client actually does, rather than how the nurse perceives the client to be.C. This strategy refers to a variety of alternatives for accomplishing a particular objective and impedes premature acceptance of solutions or answers that may not be appropriate.D. This strategy implies that the most crucial and important feedback is given as soon as it is appropriate to do so.46. When the nurse focuses on a clients specific behavior rather than on the client himself or herself, the nurse is using a strategy of nonthreatening feedback. Which nursing statement is an example of this strategy?A. Its okay to be angry, but throwing the book was unacceptable behavior.B. I cant believe you are always this manipulative.C. You are an irresponsible person regarding your life choices.D. Asking for meds every 2 hours proves you are drug seeking.47. The nurse understands that one of the many strategies of nonthreatening feedback is to limit the feedback to an appropriate time and place. While in the milieu, which nursing statement is an example of this strategy?A. Lets talk about your marital concerns in the conference room after visiting hours.B. I know your mother is visiting you, but I need answers to these questions.C. Why dont we talk about your childhood sexual abuse?D. Lets talk about your grievance with your doctor during group.48. Which nurse-client communication-centered skill implies correctness?A. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification.B. The nurse communicates an understanding of the clients world from the clients internal frame of reference, with sensitivity to the clients current feelings, and the ability to communicate this understanding in a language attuned to the client.C. The nurse communicates that the nurse is an open person who is self-congruent, authentic, and transparent.D. The nurse communicates specific terminology rather than abstractions in the discussion of the clients feelings, experiences, and behaviors.49. To understand and participate in therapeutic communication, the nurse must understand which of the following? Select all that apply.A. More than half of all messages communicated are nonverbal.B. All communication is best accomplished in a social space context.C. Touch is always a positive form of communication to convey warmth and caring.D. The physical space between two individuals has great meaning in the communication process.E. The use of silence never varies across cultures.50. A nurse is communicating with a client on an in-patient psychiatric unit. The client moves closer and invades the nurses personal space, making the nurse uncomfortable. Which is an appropriate nursing intervention?A. The nurse ignores this behavior because it shows the client is progressing.B. The nurse expresses a sense of discomfort and limits behaviors.C. The nurse understands that clients require various amounts of personal space and accepts the behavior.D. The nurse confronts and informs the client that the client will be secluded if this behavior continues.51. A client on a psychiatric unit is telling the nurse about losing an only child in a plane crash and about anger toward the airline. In which situation is the nurse demonstrating active listening?A. Agreeing with the client.B. Repeating everything the client says to clarify.C. Assuming a relaxed posture and leaning toward the client.D. Expressing sorrow and sadness regarding the clients loss.52. A client on an in-patient psychiatric unit states, Theyre putting rat poison in my food. Which intervention would assist this client to be medication compliant while on the in-patient psychiatric unit?A. Remind the client that the psychiatrist ordered the medication for him or her.B. Maintain the same routine for medication administration.C. Use liquid medication to avoid cheeking.D. Keep medications in sealed packages, and open them in front of the client.53. Which nursing intervention would assist the client experiencing bothersome hallucinations to be medication compliant?A. Using liquid or IM injection to avoid cheeking of medications.B. Teaching the client about potential side effects from prescribed medications.C. Reminding the client that the medication addresses the bothersome hallucinations.D. Notifying the client of the action, peak, and duration of the medication.54. A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply.A. Chlordiazepoxide (Librium).B. Clonazepam (Klonopin).C. Lithium carbonate (lithium).D. Clozapine (Clozaril).E. Oxazepam (Serax).55. A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective?A. The client verbalizes that the clonazepam (Klonopin) is to be used for long-term therapy in conjunction with buspirone (BuSpar).B. The client verbalizes that buspirone (BuSpar) can cause sedation and should be taken at night.C. The client verbalizes that clonazepam (Klonopin) is to be used short-term until the buspirone (BuSpar) takes full effect.D. The client verbalizes that tolerance can result with long-term use of buspirone (BuSpar).56. In which situation would benzodiazepines be prescribed appropriately?A. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal.B. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation.C. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension.D. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.57. A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important?A. Monitor for signs and symptoms of worsening depression and suicidal ideation.B. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor.C. Monitor for hyperpyresis, dystonia, and muscle rigidity.D. Monitor for spasms of face, legs, and neck and for bizarre facial movements.58. Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply.A. Insomnia.B. Tremor.C. Delirium.D. Dry mouth.E. Lethargy.59. In which situation would the nurse expect an additive central nervous system depressant effect?A. When the client is prescribed chloral hydrate (Noctec) and thioridazine (Mellaril).B. When the client is prescribed temazepam (Restoril) and pemoline (Cylert).C. When the client is prescribed zolpidem (Ambien) and buspirone (BuSpar).D. When the client is prescribed zaleplon (Sonata) and verapamil (Calan).60. Which of the following clients would have to be monitored closely when prescribed triazolam (Halcion) 0.125 mg QHS? Select all that apply.A. An 80-year-old man diagnosed with major depressive disorder.B. A 45-year-old woman diagnosed with alcohol dependence.C. A 25-year-old woman admitted to the hospital after a suicide attempt.D. A 60-year-old man admitted after a panic attack.E. A 50-year-old man who has a diagnosis of Parkinsons disease.61. A client is prescribed estazolam (ProSom) 1 mg QHS. In which situation would the nurse clarify this order with the physician?A. A client with a blood urea nitrogen of 16 mmol/L and creatine of 1.0 mg/dL.B. A client with an aspartate aminotransferase of 60 mcg/L and an alanine aminotransferase of 70 U/L.C. A client sleeping 2 to 3 hours per night.D. A client rating anxiety level at night to be a 5 out of 10.62. A client complains of poor sleep and loss of appetite. When prescribed trazodone (Desyrel) 50 mg QHS, the client states, Why am I taking an antidepressant? Im not depressed. Which nursing response is most appropriate?A. Sedation is a side effect of this low dose of trazodone. It will help you sleep.B. Trazodone is an appetite stimulant used to prevent weight loss.C. Trazodone is an antianxiety medication that decreases restlessness at bedtime.D. Weight gain is a side effect of trazodone. It will improve your appetite.63. A client currently in treatment for alcohol dependency enters the emergency department complaining of throbbing head and neck pain, dizziness, sweating, and confusion. Blood pressure is 100/60 mm Hg, pulse is 130, and respiratory rate is 26. Which question should the nurse ask to assess this situation further?A. Are you currently on any medications for the treatment of alcohol dependence?B. How long have you been abstinent from using alcohol?C. Are you currently using any illegal street drugs?D. Have you had any diarrhea or vomiting?64. A client currently hospitalized for the third alcohol detoxification in 1 year believes relapses are partially due to an inability to control cravings. Which prescribed medication would meet this clients need?A. Buspirone (BuSpar).B. Disulfiram (Antabuse).C. Naltrexone (ReVia).D. Lorazepam (Ativan).65. Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to:A. Anxiety.B. Depression.C. Mania.D. Alcohol dependency.66. For the past year, a client has received haloperidol (Haldol). The nurse administering the clients next dose notes a twitch on the right side of the clients face and tongue movements. Which nursing intervention takes priority?A. Administer haloperidol (Haldol) along with benztropine (Cogentin) 1 mg IM PRN per order.B. Assess for other signs of hyperglycemia resulting from the use of the haloperidol (Haldol).C. Check the clients temperature, and assess mental status.D. Hold the haloperidol (Haldol), and call the physician.67. A client has been prescribed ziprasidone (Geodon) 40 mg bid. Which of the following interventions are important related to this medication? Select all that apply.A. Obtain a baseline EKG initially and periodically throughout treatment.B. Teach the client to take the medication with meals.C. Monitor the clients pulse because of the possibility of palpitations.D. Institute seizure precautions, and monitor closely.E. Watch for signs and symptoms of a manic episode.68. A client prescribed quetiapine (Seroquel) 50 mg bid has a nursing diagnosis of risk for injury R/T sedation. Which nursing intervention appropriately addresses this clients problem?A. Assess for homicidal and suicidal ideations.B. Remove clutter from the environment to avoid injury.C. Monitor orthostatic changes in pulse or blood pressure.D. Evaluate for auditory and visual hallucinations.69. A client is prescribed hydroxyzine (Atarax) 50 mg QHS and clozapine (Clozaril) 25 mg bid. Which is an appropriate nursing diagnosis for this client?A. Risk for injury R/T serotonin syndrome.B. Risk for injury R/T possible seizure.C. Risk for injury R/T clozapine (Clozaril) toxicity.D. Risk for injury R/T depressed mood.70. Which atypical antipsychotic medication has the most potential for a client to experience sedation, weight gain, and hypersalivation?A. Haloperidol (Haldol).B. Chlorpromazine (Thorazine).C. Risperidone (Risperdal).D. Clozapine (Clozaril).71. A client has been compliant with risperidone (Risperdal) 4 mg QHS for the past year. On assessment, the nurse notes that the client has bizarre facial and tongue movements. Which is a priority nursing intervention?A. With the next dose of risperidone (Risperdal), give the ordered PRN dose of benztropine (Cogentin).B. Hold the next dose of risperidone (Risperdal), and notify the physician to discontinue the medication.C. Ask the physician to increase the dose of risperidone (Risperdal) to assist with the bizarre behaviors.D. Explain to the client that these side effects are temporary and should subside in 2 to 3 weeks.72. A woman in an out-patient clinic is prescribed olanzapine (Zyprexa) 10 mg QHS. At her 3-month follow-up, the client states, I knew it was a possible side effect, but I cant believe I am not getting my period anymore. Which is a priority teaching need?A. Sometimes amenorrhea is a temporary side effect of medications and should resolve itself.B. I am sure this was very scary for you. How long have you been without your period?C. Although your periods have stopped, there is still a potential for you to become pregnant.D. Maybe the amenorrhea is not due to your medication. Have your periods been regular in the past?73. A client is exhibiting sedation, auditory hallucinations, dystonia, and grandiosity. The client is prescribed haloperidol (Haldol) 5 mg tid and trihexyphenidyl (Artane) 4 mg bid. Which statement about these medications is accurate?A. Trihexyphenidyl (Artane) would assist the client with sedation.B. Trihexyphenidyl (Artane) would assist the client with auditory hallucinations.C. Haloperidol (Haldol) would assist the client to decrease grandiosity.D. Haloperidol (Haldol) would assist the patient with dystonia.74. A client is prescribed aripiprazole (Abilify) 10 mg QAM. The client complains of sedation and dizziness. The clients vital signs are blood pressure 100/60 mm Hg, pulse 80, respiration rate 20, and temperature 97.4F. Which nursing diagnosis takes priority?A. Risk for noncompliance R/T irritating side effects.B. Knowledge deficit R/T new medication prescribed.C. Risk for injury R/T orthostatic hypotension.D. Activity intolerance R/T dizziness and drowsiness.75. A client recently prescribed fluphenazine (Prolixin) complains to the nurse of severe muscle spasms. On examination, heart rate is 110, blood pressure is 160/92 mm Hg, and temperature is 101.5F. Which nursing intervention takes priority?A. Check the chart for a PRN order of benztropine mesylate (Cogentin) because of increased extrapyramidal symptoms.B. Hold the next dose of fluphenazine (Prolixin), and call the physician immediately to report the findings.C. Schedule an examination with the clients physician to evaluate cardiovascular function.D. Ask the client about any recreational drug use, and ask the physician to order a drug screen.76. Which of the following are examples of anticholinergic side effects from tricyclic antidepressants? Select all that apply.A. Urinary hesitancy.B. Constipation.C. Blurred vision.D. Sedation.E. Weight gain.77. A client has been fired from work because of downsizing. Although clearly upset, when explaining the situation to a friend, the client states, Imagine what I can do with this extra time. Which defense mechanism is this client using?A. Denial.B. Intellectualization.C. Rationalization.D. Suppression.78. Which best exemplifies a clients use of the defense mechanism of reaction formation?A. A client feels rage at being raped at a young age, which later is expressed by joining law enforcement.B. A client is unhappy about being a father, although others know him to dote on his son.C. A client is drinking 6 to 8 beers a day while still going to AA as a group leader.D. A client is angry that the call bell is not answered and decides to call the nurse when it is unnecessary.79. Which best exemplifies an individuals use of the defense mechanism of compensation?A. A woman feels unattractive, but decides to pursue fashion design as a career.B. A shy woman who abuses alcohol tells others that alcohol helps her overcome her shyness.C. A poorly paid employee consistently yells at his assistant for minimal mistakes.D. A teenager injures an ankle playing basketball and curls into a fetal position to deal with the pain.80. Which best exemplifies the use of the defense mechanism of sublimation?A. A child who has been told by parents that stealing is wrong reminds a friend not to steal.B. A man who loves sports but is unable to play decides to become an athletic trainer.C. Having chronic asthma with frequent hospitalizations, a young girl admires her nurses. She later chooses nursing as a career.D. A boy who feels angry and hostile decides to become a therapist to help others.81. A nursing instructor is teaching about defense mechanisms. Which of the following student statements indicates that learning has occurred? Select all that apply.A. Defense mechanisms are used when anxiety increases, and the strength of the ego is tested.B. All individuals who use defense mechanisms as a means of stress adaptation exhibit healthy egos.C. When defense mechanisms are overused or maladaptive, unhealthy ego development may result.D. Defense mechanisms are used only by mentally ill individuals to assist with coping.E. At times of mild to moderate anxiety, defense mechanisms are used adaptively to deal with stress.82. A client is admitted to the emergency department after a car accident, but does not remember anything about it. The client is using which defense mechanism?A. Undoing.B. Rationalization.C. Suppression.D. Repression.83. A client in the emergency department was violently attacked and raped. When discussing the incident with the nurse, the client shows no emotion related to the event. Which defense mechanism is the client using?A. Isolation.B. Displacement.C. Compensation.D. Regression.84. After failing an examination, a young physician in his psychiatric residency begins smoking a pipe and growing a beard that makes him look like Sigmund Freud. The nurse manager, realizing the physicians insecurities, recognizes the use of which defense mechanism?A. Identification.B. Repression.C. Regression.D. Reaction formation.85. Which situation reflects the defense mechanism of projection?A. A husband has an affair, then buys his wife a diamond anniversary bracelet.B. A promiscuous wife accuses her husband of having an affair.C. A wife, failing to become pregnant, works hard at becoming teacher of the year.D. A man who was sexually assaulted as a child remembers nothing of the event.86. Which situation reflects the defense mechanism of denial?A. When his twin brother excels in golf, the client begins lessons with a golf pro.B. After a mother spanks her child for misbehaving, the child pulls the cats tail.C. After years of excessive drinking, the client fails to acknowledge a problem.D. The client expresses to his family that 50% of people with his diagnosis survive.87. During visiting hours, a client who is angry at her ex-husbands charges of child neglect expresses this anger by lashing out at her sister-in-law. The nurse understands that the client is demonstrating the use of which defense mechanism?A. Denial.B. Projection.C. Displacement.D. Rationalization.88. On an in-patient unit, a client is isolating self in room and refusing to attend group therapy. Which is an appropriate short-term outcome for this client?A. Client participation will be expected in one group session.B. Provide opportunities for the client to increase self-esteem by discharge.C. The client will communicate with staff by the end of the 3-to-11 shift.D. The client will demonstrate socialization skills when in the milieu.89. A client on an in-patient psychiatric unit is sarcastic to staff and avoids discussions in group therapy. Which long-term outcome is appropriate for this client?A. The client will not injure himself or herself or someone else.B. The client will express feelings of anger in group therapy by end of shift.C. The client will take responsibility for his or her own feelings.D. The client will participate in out-patient therapy within 2 weeks of discharge.90. A girl is jealous of her best friend for winning the scholarship she herself expected. She agrees to meet her friend for lunch and then arrives 1 hour late, apologizing and begging forgiveness. The girl is displaying which behavior?A. Self-assertion.B. Passive-aggressiveness.C. Splitting.D. Omnipotence.91. Which is an example of a cognitive response to a mild level of anxiety?A. Increased respirations.B. Feelings of horror or dread.C. Pacing the hall.D. Increased concentration.92. Which is an example of a behavioral response to a moderate level of anxiety?A. Narrowing perception.B. Heart palpitations.C. Limited attention span.D. Restlessness.93. Which is an example of a physiological response to a panic level of anxiety?A. Inability to focus.B. Loss of consciousness.C. Dilated pupils.D. Possible psychosis.94. A nurse on an in-patient psychiatric unit is assessing a client at risk for acting out behaviors. Which behavioral symptom would the nurse expect to be exhibited?A. Invasion of personal space.B. Flushed face.C. Increased anxiety.D. Misinterpretation of stimuli.95. Which immediate biological responses are associated with fight-or-flight syndrome?A. Bronchioles in the lungs dilate, and respiration rate increases.B. Vasopressin increases fluid retention and increases blood pressure.C. Thyrotropic hormone stimulates the thyroid gland to increase metabolic rate.D. Gonadotropins cause a decrease in secretion of sex hormone and produce impotence.96. A severely anxious client experiencing headaches, palpitations, and inability to concentrate is admitted to a medical floor. Which nursing intervention would take priority?A. Encourage the client to express feelings.B. Discuss alternative coping strategies with the client.C. Use a distraction, such as having the client attend group.D. Sit with the client, and use a calm but directive approach.97. A client is exhibiting tension and needs direction to solve problems. Which intervention would the nurse implement using a behavioral approach?A. Assess the clients family history for anxiety disorders.B. Encourage the client to use deep breathing techniques.C. Ask the client to think of a time in the past when anxiety was manageable.D. Encourage journal writing to express feelings.98. The nursing student is developing a plan of care for a client experiencing a crisis situation. Number the following in priority order for implementation of this plan.___ Assess for suicidal and homicidal ideation.___ Discuss coping skills used in the past, and note if they were effective.___ Establish a working relationship by active listening.___ Develop a plan of action for dealing with future stressors.___ Evaluate the developed plans effectiveness.99. The nurse is assessing clients on an in-patient psychiatric unit. Which client would require immediate intervention?A. A client experiencing rapid, pressured speech and poor personal boundaries.B. A client expressing homicidal ideations toward the neighborhood butcher.C. A client sleeping only 1 to 2 hours per night for the last 2 nights.D. A client secluding self from others and refusing to attend groups in the milieu.100. The nursing student is reviewing information about crisis. Which of the following student statements indicate(s) that learning has occurred? Select all that apply.A. A crisis is associated with psychopathology.B. A crisis is precipitated by a specific identifiable event.C. A crisis is chronic in nature and needs multiple interventions over time.D. A crisis is specific to an individual, and the cause may vary.E. A crisis contains the potential for psychological growth or deterioration.101. At an out-patient obstetrical clinic, a pregnant client on welfare exhibits extreme anxiety when discussing a failure in school. This is an example of which type of crisis?A. Dispositional crisis.B. Crisis of anticipated life transition.C. Maturational/developmental crisis.D. Crisis reflecting psychopathology.

-===== Good luck & God bless =====-

Prepared by:

Lucky P. Roaquin, RN, MANSTCI-CON Faculty