Psychiatry MCQPART IElectroconvulsive Therapy 1. The nurse understands that ECT treatments are thought to alleviate symptoms of depression by which action?A. Altering serotonin levels B. Enhancing the efficacy of psychotropic drugsC. Causing memory loss D. Stimulating the thyroid glandAnswer. A Electroconvulsive therapy is thought to correct the biochemical abnormalities of serotonin and dopamine during the transmission of nerve impulses between synapses. It can result in transient memory disturbances but this is an adverse effect of the treatment, not the reason for its use. It does not enhance drug therapy; rather it is commonly used in clients who have not responded to drug therapy. It does not affect the thyroid gland.2. The nurse in the outpatient ECT clinic reviews the client's history for which of the following that might increase the client's risk during ECT?A. Degenerative joint disease B. Insulin-dependent diabetes mellitusC. Recent myocardial infarction D. Use of multiple medicationsAnswer.C The client's risk for injury or complications with ECT is increased with a history of a recent myocardial infarction or other cardiac disease. Degenerative joint disease, diabetes, and multiple medication use are not conditions associated with an increased risk to the client.3. The nurse teaches the client scheduled for ECT treatment that preparation includes which of the following?A. Eating a light breakfast at least 3 hours before treatmentB. Limiting intake of carbohydrates at least 3 days before treatmentC. Refraining from food and fluids for at least 8 hours before treatmentD. Washing hair the morning of treatmentAnswer. C Prior to ECT, food and fluids are withheld from the client for at least 8 hours. Hair does not need to be washed before treatment.4. Which intervention would be the priority during the ECT procedure?A. Assessing EEG B. Assisting the physicianC. Monitoring seizure actions D. Protecting the clientAnswer. D During the ECT procedure, the priority is protecting the client from injury that may result from the motor seizures secondary to the procedure. Assessing the EEG and seizure activity is the responsibility of the anesthesiologist and physician. Assisting the client, not the physician, is the priority.5. In the post-ECT recovery period, which finding would alert the nurse to a possible problem?A. Sleepiness B. Lack of seizure activityC. Urinary incontinence D. Vital sign alterationsAnswer. D Vital sign alterations should be reported to the physician immediately. Like any other procedure performed under general anesthesia, vital sign changes indicate a problem. Typically after ECT, the client is sleepy. Seizure activity is not evident and urinary incontinence may have occurred during the ECT procedure.6 A client scheduled for electroconvulsive therapy asks the nurse how the therapy helps relieve her depression. The nurse’s response is based on an understanding that ECT:A. Eliminates the neurotransmitter acetylcholine.B. Increases the perception of external stimuli.C. Decreases levels of cortisol from the adrenal cortex.D. Produces a seizure that temporarily alters brain chemicals.

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Answer. D is correct. Electroconvulsive therapy produces a tonic-clonic seizure that temporarily increases brain chemicals, serotonin, dopamine, and norepinephrine.7. Which is the highest priority in the post ECT care?A. Observe for confusion B. Monitor respiratory statusC. Reorient to time, place and person D. Document the client’s response to the treatmentAnswer. (B) Monitor respiratory status A side effect of ECT which is life threatening is respiratory arrest. A and C. Confusion and disorientation are side effects of ECT but these are not the highest priority.8. A 23-year-old woman is experiencing an acute phase of catatonic schizophrenia that is not responding to psychopharmacological treatment. She is scheduled for ECT in the morning. A preoperative drug that the nurse would most likely administer prior to the treatment would be:A. Atropine B. Inderal (propranolol)C. Lithium D. Dalmane (flurazepam)Answer. (A) Atropine is given prior to ECT because it acts to prevent airway complications from excessive secretions during the treatment. (B) Propranolol is a -blocker not used in conjunction with ECT. (C) Lithium is used in the treatment of bipolar disorders. (D) Flurazepam is used for insomnia.Pharma9. When administering the neuroleptic haloperidol (Haldol) to a client, the nurse understands that it is decreasing the amounts of which neurotransmitter?a. Acetylcholine b. Dopamine c. Serotonin d. HistamineAnswer.. B Haloperidol acts on dopamine, blocking its action. It does not affect other neurotransmitters such as acetylcholine, serotonin, or histamine.10. For the client receiving the antipsychotic medication clozapine (Clozaril), which laboratory study would be most important for the nurse to monitor?a. Complete blood count b. Liver function studyc. Thyroid profile d. Renal function studyAnswer.. A Clozapine is specifically associated with agranulocytosis. Therefore, the nurse would monitor the complete blood cell count for changes in white blood cell count. Other laboratory studies may be indicated based on the client's condition. Liver and renal functions studies are commonly done for many drugs because most drugs are metabolized by the liver and excreted by the kidneys.11. A client receiving the neuroleptic medication chlorpromazine (Thorazine) exhibits excessive drooling and fine hand tremors. Which medication would the nurse expect the physician to order?a. Benztropine (Cogentin) b. Acetaminophen (Tylenol)c. Lorazepam (Ativan) d. Naproxen (Aleve)Answer.. A The client is exhibiting signs and symptoms of parkinsonism, an adverse effect of typical antipsychotic agents. This condition can be treated with administration of an anticholinergic agent such as benztropine (Cogentin). Acetaminophen and naproxen are nonnarcotic analgesics. Lorazepam is an antianxiety agent not associated with the development of parkinsonism.12. The nurse instructs a client receiving the MAOI agent phenelzine (Nardil) about dietary restrictions for foods high in tyramine to prevent which adverse effect?a. Gastrointestinal upsetb. Hypertensive crisisc. Neuromuscular effectsd. Urinary retention

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Answer.. B Ingestion of foods high in tyramine while receiving MAOI therapy can lead to hypertensive crisis. Gastrointestinal upset is an adverse effect commonly seen with many pharmacologic agents. Neuromuscular adverse effects are associated with antipsychotic agents. Urinary retention is associated with anticholinergic agents.13. The nurse advises the client taking lithium carbonate to do which of the following to prevent toxic effects of lithium?a. Maintain adequate sodium and water intake.b. Avoid foods high in tyramine.c. Establish a schedule for regular sleep.d. Monitor for increased temperature.Answer. A To prevent the possibility of lithium toxicity, the nurse would instruct the client to maintain an adequate intake of sodium and water. Foods high in tyramine are to be avoided when a client is receiving MAOI therapy. Establishing a regular sleep schedule would be helpful for clients receiving hypnotic agents. Monitoring for an increased temperature suggestive of infection would be important for clients receiving clozapine (due to possible agranulocytosis).14. The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting:A. tardive dyskinesia B. PseudoparkinsonismC. akinesia D. dystoniaAnswer. (B) Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle rigidity A. Tardive dyskinesia is manifested by lip smacking, wormlike movement of the tongue C. Akinesia is characterized by feeling of weakness and muscle fatigue D. Dystonia is manifested by torticollis and rolling back of the eyes15. Which of the following is included in the health teachings among clients receiving Valium?:A. Avoid foods rich in tyramine.B. Take the medication after meals.C. It is safe to stop it anytime after long term use.D. Double up the dose if the client forgets her medication.Answer. (B) Antianxiety medications cause G.I. upset so it should be taken after meals. A. This is specific for antidepressant MAOI. Taking tyramine rich food can cause hypertensive crisis. C. Valium causes dependency. In which case, the medication should be gradually withdrawn to prevent the occurrence of convulsion. D The dose of Valium should not be doubled if the previous dose was not taken. It can intensify the CNS depressant effects.16. During the mental status examination a patient may be asked to explain several proverbs, such as "Don't cry over spilled milk." The purpose is to evaluate the pat's ability to think:a) rationally b) concretely c) abstractly d) tangentiallyAnswer. C - Abstract thinking is the ability to conceptualize and interpret meaning. It is a higher level of intellectual functioning than a concrete thinking, in which the patient would explain the proverb by its literal meaning. Rational thinking involves the ability to think logically, make judgments, and be goal directed. Tangential thinking is scattered, non-goal-directed, and difficult to swallow. 17. The nurse expects to assess which of the following in a client with the diagnosis of schizophrenia, paranoid type?a. Anger, auditory hallucinations, persecutory delusionsb. Abnormal motor activity, frequent posturing, autismc. Flat affect, anhedonia, alogiad. Silly behavior, poor personal hygiene, incoherent speech

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Answer. A Clients with schizophrenia, paranoid type, tend to experience persecutory or grandiose delusions and auditory hallucinations in addition to behavioral changes such as anger, hostility, or violent behavior. Abnormal motor activity, posturing, autism, stupor, and echolalia are associated with schizophrenia, catatonic type. Flat affect, anhedonia, and alogia are negative symptoms associated with schizophrenia in general. Schizophrenia, disorganized type, is characterized by withdrawal, incoherent speech, and lack of attention to personal hygiene.18. The nurse would assess a client diagnosed with cyclothymic disorder for which behaviors?a. Feelings of grandiosity and increased spendingb. Feelings of depression and decreased sleepc. Periods of hypomania and depressive symptomsd. Periods of depression accompanied by anxietyAnswer. C A client with a cyclothymic disorder displays numerous periods of hypomania and depression that do not meet the criteria for a major depressive episode. Feelings of grandiosity with increased spending may be associated with manic episodes of bipolar disorder. Feelings of depression and decreased sleep are associated with a major depressive disorder. Periods of depression accompanied by anxiety may be associated with depressive disorder not otherwise specified.19. Which symptom would the nurse expect to assess related to anger expression in a client diagnosed with borderline personality disorder?a. Controlled, subtle anger b. Inappropriate, intense angerc. Inability to recognize anger d. Substitution of physical symptoms for angerAnswer. B A client with borderline personality disorder would most likely exhibit impulsive, unpredictable behavior related to gambling, shoplifting, sex, and substance abuse. Contributing to unstable, intense interpersonal relationships are inappropriate, intense anger; unstable affect reflecting depression, dysphoria, or anxiety; disturbance in self-concept, including gender identity; and the inability to control one's emotions. A client with a somatoform disorder develops physical symptoms in response to anxiety, not anger.20. An adolescent client tells the nurse that she frequently feels compelled to eat a large amount of food in a small amount of time. The nurse identifies this problem as characteristic of which condition?a. Anorexia b. Bulimia c. Overeating d. CompulsivenessAnswer. B Bulimia is characterized as the ingestion of a large amount of food over a short amount of time or less than the usual time it would take to consume that amount of food. Anorexia refers to the refusal to maintain weight at or above minimally normal weight through restricting food intake or engaging in binge-eating or purging. Overeating refers to the ingestion of large amounts of food. Compulsiveness refers to an insistent, repetitive urge to engage in an activity.21. Which nursing intervention would be the priority for a client with suicidal intent?a. Encouraging verbalization of negative feelingsb. Pointing out the positive aspects of livingc. Providing activities to keep the client busyd. Reassuring the client that thoughts of suicide will decreaseAnswer. A The priority intervention for a client with suicidal intent is to encourage the client to verbalize negative feelings. Doing so helps clients to explore the reasons underlying the suicidal ideation and provides them with support. Pointing out the positive aspects of living is nappropriate and non-therapeutic. Providing activities to keep the client busy ignores the client's needs. Telling the client that thoughts of suicide will decrease is false reassurance.

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22. A client has committed suicide while hospitalized on an inpatient psychiatric unit. The nursing staff and treatment team participate in a process of reviewing the client's behaviors and the completed suicide despite all precautions implemented on the unit. The staff is engaging in which of the following?a. Psychological autopsy b. Postvention processc. Treatment analysis d. Team discussionAnswer. A Interaction with the staff, in which the staff reviews the client's behaviors and suicidal act, is referred to as a psychological autopsy, a process used to examine what clues, if any, were missed so that staff members can learn from the evaluation of a particular situation. This process also provides staff members with an opportunity to self-assess their behavior and responses and discuss their concerns with peers. Postvention is a therapeutic program for bereaved survivors of a suicide. Treatment analysis and team discussion are general terms related to client care.23. Your first assignment in the psychiatric–mental health clinical setting is to provide care for a female client who appears sad and verbalizes hopelessness to the staff. You are uncertain how to approach the client. Which of the following actions would be the most effective?a. Ask a peer to introduce you to the client.b. Wait for the client to approach you to avoid bothering the client.c. Ask a staff member what approach is usually effective with the client.d. Discuss your feelings with your instructor before approaching the client.Answer. D: When in doubt in any situation in the clinical area, it is always best to discuss your client care concerns with your instructor, who can provide you with guidance as to how to proceed. Your instructor is knowledgeable about the clinical area as well as aware of your nursing program's policies and procedures. If additional information is needed, then you, together with your instructor, can discuss the client's care with the staff member caring for the client. Asking a peer to introduce you to the client is inappropriate and could lead to client confusion about who will be providing care. Waiting for the client to approach the nurse is inappropriate because the client is verbalizing feelings of hopelessness, and thus would not seek out contact with others.24. You overhear two of your friends talking about mental illness. They agree that mentally ill persons are not capable of living alone or working. Your friends are exhibiting which of the following?a. Stereotyping b. Prejudice c. Introspection d. CensorshipAnswer. A :Stereotyping refers to categorizing persons based on generalized beliefs about a group. Prejudice refers to feelings of intolerance for another. Introspection refers to self-reflection, an attempt to25. Which of the following questions would be most appropriate to use during the psychiatric admission assessment to obtain data about the client's affect?a. What are you feeling? b. Are you happy or sad? c. You look upset; are you? d.What brought you to the hospital? Answer. A Asking the client a general lead-in question such as “What are you feeling?†provides information about the client's affect or feelings, or emotions. Asking if the client is happy or sad or asking if the client is upset labels the emotion and does not allow the client to verbalize the emotion or feeling. Asking the client about what brought him to the hospital does not address the client's emotion or affect. Rather it focuses on the client's chief complaint or problem.26. Which of the following outcomes is most appropriate for the client with a nursing diagnosis of Social Isolation related to inability to trust as evidenced by withdrawal from others?

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a. The client will ask the nurse for permission to be excused from activities.b. The client will identify positive qualities in self and others.c. The client will state that his or her level of trust in others is improved.d. The client will spend time with peers and staff members in unit activities.Answer. D The most appropriate outcome would be the client spending time with peers and staff members in unit activities. By participating in unit activities with others, the client is no longer socially isolated. In addition, this participation helps to foster a beginning sense of trust. Asking for permission to be excused from activities would only serve to reinforce the client's isolation. The ability to identify positive qualities in oneself and others is important but unrelated to the problem of social isolation. Stating that the level of trust is improved, though also important, does not indicate that the client's social isolation is being addressed.27. The nurse reviews the psychiatric history of a client with the DSM-IV-TR diagnosis of Borderline Personality Disorder. This diagnosis is coded on which of the following diagnostic axes?a. Axis I b. Axis II c. Axis III d. Axis IVAnswer. B Axis II addresses personality disorders and mental retardation. Borderline personality disorder is coded on Axis II of the DSM-IV-TR. Axis I identifies clinical disorders and other conditions that may be a focus of attention. Axis III involves general medical conditions. Axis IV addresses psychosocial and environmental problems.28. An adolescent client tells the evening-shift nurse that the day-shift nurse promised that she could stay up late to watch a special television program. The evening nurse does which of the following to maintain the therapeutic milieu?a. Allows the client to stay up late to promote staff unityb. Encourages client to express feelings about staff disagreement on this issuec. Maintains the same rules for all clients, therefore refusing client requestd. Uses staying up late as a reward for this client's good behaviorsAnswer. C To maintain the therapeutic milieu, the nurse is consistent with the limits that are set, thus maintaining the same rules for all clients. Allowing the client to stay up or using this as a reward interferes with the foundation of the milieu. An attitude of overall acceptance and optimism is conveyed with any conflicts in staff about issues being handled and resolved to ensure the milieu.29. The nurse assesses all of the following factors in a client complaining of insomnia. Which of the following does the nurse encourage the client to modify?a. Drinking coffee before midday b. Going to bed at the same time each nightc. Exercising 2 hours before bedtime d. Reducing noise at bedtimeAnswer. C Measures to help promote sleep include avoiding exercising before bedtime. Exercise stimulates body functions and is not considered relaxing. Drinking coffee before midday would be allowed because the caffeine at this time would not affect the client's ability to sleep. However, ingestion of caffeine after midday would be problematic. Going to bed at the same time each night provides a routine that promotes sleep. Reducing noise also has been shown to facilitate sleep.30. Virtual reality is to be used to treat a client's phobic response. The nurse interprets this type of treatment as an example of which of the following?a. Assertiveness training b. Aversion therapyc. Implosive therapy d. Behavior modificationAnswer. C Virtual reality is an example of implosive therapy or flooding in which the individual is exposed to intense forms of anxiety producers either in real life or in imagination. Assertiveness training involves measures to appropriately relate to others using frank, honest, and direct expressions. Aversion therapy uses unpleasant or noxious stimuli to change inappropriate

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behavior. Behavior modification uses Pavlov's theory of conditioning and Skinner's theory of operant conditions involving the use of reinforcers in response to behavior.31. An older adult client is admitted to the nursing home for rehabilitation after surgery to repair a fractured hip. The client is fearful that she will not be able to return to her previous independent lifestyle. Which intervention would be the priority?a. Collaborating with the physical therapist to motivate the clientb. Encouraging the client to verbalize feelings and thoughts about the current situationc. Providing reassurance that the situation will work out okayd. Teaching the client about various community supports availableAnswer. B The priority is to encourage the client to verbalize feelings and thoughts about the current situation. This information would be helpful in determining the most appropriate actions for the nurse. Collaboration with the physical therapist may be appropriate but later in the course of the client's care. Providing reassurance is never appropriate because it can lead to mistrust should the client be unable to achieve her previous level of functioning. Teaching about community supports would be appropriate later on in the care of the client.32. When assessing the risk of suicide for a depressed client, the nurse knows that:A. People who talk about suicide are not likely to harm themselves.B. The availability of means is essential to even the simplest suicide plan.C. Clients who survive unsuccessful suicide attempts are not likely to try again.D. An overdose of pills is never as lethal as injury by firearms.Answer. B is correct. Even the simplest plan for suicide requires that the means be available. Answers A and C are not true statements; therefore, they are incorrect. Overdose by pills is sometimes as fatal as injury by firearms; therefore, Answer D is incorrect.33. A client with depression and suicidal ideation is admitted to the behavioral health unit for observation. Which of the following interventions provides best for the client’s safety?A. Day hall supervision B. Constant supervisionC. Checks every 15 minutes D. One-on-one night supervisionAnswer. B is correct. The client admitted with suicidal thoughts or suicidal gestures is best cared for by constant supervision. Answers A, C, and D do not provide for continual observations to ensure the client’s safety; therefore, they are incorrect.34. A client with mania is unable to complete her meals because of her elevated level of activity. To help her maintain sufficient nourishment the nurse should: A. Allow her access to the kitchen between meals B. Serve high-calorie foods she can carry with her C. Provide small attractively arranged trays D. Allow her to order meals outside the hospitalAnswer. B is correct. The nurse should provide the client with high-calorie foods that she can eat as she moves about. Answers A, C, and D do not ensure proper nutrition; therefore, they are incorrect.35. A client admitted to the chemical dependency unit states “My wife is making too much of this. I don’t drink any more than the next guy.” What defense mechanism is the client using? A. Rationalization B. Projection C. Dissociation D. SplittingAnswer. A is correct. The client is using the defense mechanism of rationalization to justify his behavior. Answers B, C, and D are not reflected by the client’s statement; therefore, they are incorrect.36. The nurse is formulating a plan of care for a client with schizophrenia. Which activity is best for increasing the client’s social interaction? A. Participating in a game of volleyball B. Selecting a book from the hospital library

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C. Participating in a card game D. Watching TV in the unit dayroomAnswer. C is correct. Participating in a card game allows the client to socially interact with a limited number of others. Participating in a game of volleyball can be overwhelming for a client with schizophrenia; therefore, Answer A is incorrect. Reading and watching TV do not encourage social interaction; therefore, Answers B and D are incorrect.37. Lithium carbonate (Lithobid) has been ordered for a client with mania. Which finding increases the likelihood of the client developing lithium toxicity? A. Calcium level of 8.2 mg/Dl B. Potassium level of 4.0 mEq/L C. Magnesium level of 1.8 mg/dL D. Sodium level of 120 mEq/LAnswer. D is correct. Hyponatremia places the client at risk for the development of lithium toxicity. Answers A, B, and C, which are within normal limits, are not associated with an increased risk for lithium toxicity.38. A client on Lithium has diarrhea and vomiting. What should the nurse do first:A. Recognize this as a drug interactionB. Give the client CogentinC. Reassure the client that these are common side effects of lithium therapyD. Hold the next dose and obtain an order for a stat serum lithium levelAnswer. (D) Hold the next dose and obtain an order for a stat serum lithium level Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is used to manage the extra pyramidal symptom side effects of antipsychotics. C. The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.39. During morning assessments, the nurse finds that a client who has been taking chlorpromazine (Thorazine) has signs of dystonia and torticollis. The nurse should give priority to: A. Applying an oxygen saturation monitor to detect hypoxia B. Administering prescribed anti-Parkinson medication C. Applying a heating pad to the neck and shoulders D. Offering additional fluids to reduce dry mouthAnswer. B is correct. The client’s symptoms are an adverse reaction to antipsychotic medication. Administering anti-Parkinson medication will alleviate the client’s dystonia and torticollis. Answers A, C, and D do not take priority over Answer B; therefore, they are incorrect.40. A client with bulimia nervosa reports that she binges at least two times a week.The nurse recognizes that binge episodes are associated with: A. A sense of euphoria B. Substantial weight gain C. Feelings of self-loathing D. Severe weight lossAnswer. C is correct. Feelings of self-loathing and low self-esteem are associated with binge episodes. Answer A is incorrect because the client is depressed rather than euphoric. Answer B is incorrect because the client’s weight is normal or near normal. Answer D is incorrect because it refers to the client with anorexia nervosa, rather than bulimia nervosa.41. Which action is best for the nurse to take when he observes a client engaging in ritualistic behavior? A. Ask the client to carry out his rituals in his room B. Help the client explore the dynamics of his behavior C. Allow the client to complete his ritualistic behavior D. Administer sedative medication when the client begins his use of ritualsAnswer. C is correct. Allowing the client to complete his ritualistic behavior willhelp reduce the client’s anxiety level. Answers A, B, and D do not effective ways ofdecreasing the client’s ritualistic behavior; therefore, they are incorrect.

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42. The nurse is caring for a client who is receiving olanzapine (Zyprexa). Which observation requires immediate nursing intervention? A. The client asks for additional water. B. The client’s morning temperature was 104° F. C. The client complains of dizziness when he stands. D. The client’s skin is red after sitting in the sunlight.Answer. Answer B is correct. The use of antipsychotic medications such as Zyprexa can result in neuroleptic malignant syndrome, which is reflected by extreme elevations in temperature. Answers A, C, and D are side effects associated with antipsychotic medication that require the nurse’s attention; however, they are not as severe as elevations in temperature.43. A behavioral program for weight gain is started for a client with anorexia nervosa.Which nursing intervention is most specific to goal attainment? A. Providing emotional support and active listening B. Giving positive rewards for weight gain C. Assisting with identification of maladaptive behaviors D. Initiating tube feedings with high-calorie supplementsAnswer. B is correct. Giving positive rewards for weight gain is most specific to the client’s behavioral program. Answers A and C are not specific to the client’s behavioral program for weight gain; therefore, they are incorrect. Answer D is incorrect because tube feedings are a last resort in the treatment of a client with anorexia nervosa.44. The nurse is formulating a nursing care plan for a client with paranoid schizophrenia who is experiencing command hallucinations. Which nursing diagnosis should receive priority? A. Altered thought process related to impaired judgment B. Social isolation related to mistrust of others C. Ineffective individual coping related to inadequate support systems D. Risk for violence directed at self or others related to disturbed thinkingAnswer. D is correct. A client with paranoid schizophrenia who is experiencing command hallucinations represents a risk of violence to himself and others. Answers A, B, and C are incorrect because they do not take priority over the risk of violence.45. A client who has been taking chlorpromazine (Thorazine) has developed akathisia.Which behavior should the nurse expect the client to exhibit? A. Pacing and generalized restlessness B. Involuntary repetition of words spoken by others C. Use of words by sound rather than meaning D. Slow, rhythmical movementsAnswer. A is correct. Akathisia, a side effect of antipsychotic drug therapy, is characterized by motor restlessness such as pacing and rocking. Answer B is incorrect because it refers to echolalia. Answer C is incorrect because it refers to clang association. Answer D is incorrect because it refers to tardive dyskinesia.46. Situation : The nurse assigned in the detoxification unit attends to various patients with substance-related disorders.A 45 years old male revealed that he experienced a marked increase in his intake of alcohol to achieve the desired effect This indicates:A. withdrawal B. tolerance C. intoxication D. psychological dependenceAnswer. (B) tolerance refers to the increase in the amount of the substance to achieve the same effects. A. Withdrawal refers to the physical signs and symptoms that occur when the addictive substance is reduced or withheld. B. Intoxication refers to the behavioral changes that occur upon recent ingestion of a substance. D. Psychological dependence refers to the intake of the substance

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to prevent the onset of withdrawal symptoms.47. A client is admitted with needle tracts on his arm, stuporous and with pin point pupil will likely be managed with:A. Naltrexone (Revia) B. Narcan (Naloxone)C. Disulfiram (Antabuse) D. Methadone (Dolophine)Answer. (B) Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. A. This is an opiate receptor blocker used to relieve the craving for heroine C. Disulfiram is used as a deterrent in the use of alcohol. D. Methadone is used as a substitute in the withdrawal from heroine48. The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client:A. receives adequate nutrition and hydrationB. will reminisce to decrease isolationC. remains in a safe and secure environmentD. independently performs self careAnswer. (C) Safety is a priority consideration as the client’s cognitive ability deteriorates.. A is appropriate interventions because the client’s cognitive impairment can affect the client’s ability to attend to his nutritional needs, but it is not the priority B. Patient is allowed to reminisce but it is not the priority. D. The client in the moderate stage of Alzheimer’s disease will have difficulty in performing activities independently49. Situation: A 17 year old gymnast is admitted to the hospital due to weight loss and dehydration secondary to starvation.Which of the following nursing diagnoses will be given priority for the client?A. altered self-image B. fluid volume deficitC. altered family process D. altered nutrition less than body requirementsAnswer. (B) Fluid volume deficit is the priority over altered nutrition (A) since the situation indicates that the client is dehydrated. A and D are psychosocial needs of a client with anorexia nervosa but they are not the priority.50. Situation: A 20 year old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Extensive examination revealed no physical basis for the complaint.The nurse plans intervention based on which correct statement about conversion disorder?A. The symptoms are conscious effort to control anxietyB. The client will experience high level of anxiety in response to the paralysis.C. The conversion symptom has symbolic meaning to the clientD. A confrontational approach will be beneficial for the client.Answer. (C) the client uses body symptoms to relieve anxiety. A. The condition occurs unconsciously. B. The client is not distressed by the lost or altered body function. D. The client should not be confronted by the underlying cause of his condition because this can aggravate the client’s anxiety.51. Situation: A widow age 28, whose husband died one year ago due to AIDS, has just been told that she has AIDS. Pamela says to the nurse,Why me? How could God do this to me? This reaction is one of:A. Depression B. Denial C. anger D. bargainingAnswer. (C) Anger is experienced as reality sets in. This may either be directed to God, the deceased or displaced on others. A. Depression is a painful stage where the individual mourns for what was lost. B. Denial is the first stage of the grieving process evidenced by the statement “No, it can’t be true.” The individual does not acknowledge that the loss has occurred to protect self from the psychological pain of the loss. D. In bargaining the individual holds out hope for

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additional alternatives to forestall the loss, evidenced by the statement “If only…”52. One morning the nurse sees the client in a depressed mood. The nurse asks her “What are you thinking about?” This communication technique is:A. focusing B. validating C. reflecting D. giving broad openingAnswer. (D) Broad opening technique allows the client to take the initiative in introducing the topic. A,B and C are all therapeutic techniques but these are not exemplified by the nurse’s statement.53. The client says to the nurse ” Pray for me” and entrusts her wedding ring to the nurse. The nurse knows that this may signal which of the following:A. anxiety B. suicidal ideationC. Major depression D. HopelessnessAnswer. (B) The client’s statement is a verbal cue of suicidal ideation not anxiety. While suicide is common among clients with major depression, this occurs when their depression starts to lift. Hopelessness indicates no alternatives available and may lead to suicide, the statement and non verbal cue of the client indicate suicide.54. Which of the following interventions should be prioritized in the care of the suicidal client?A. Remove all potentially harmful items from the client’s room.B. Allow the client to express feelings of hopelessness.C. Note the client’s capabilities to increase self esteem.D. Set a “no suicide” contract with the client.Answer. (A) Accessibility of the means of suicide increases the lethality. Allowing patient to express feelings and setting a no suicide contract are interventions for suicidal client but blocking the means of suicide is priority. Increasing self esteem is an intervention for depressed clients bur not specifically for suicide.55. The nurse ensures a therapeutic environment for the client. Which of the following best describes a therapeutic milieu?A. A therapy that rewards adaptive behavior B. A cognitive approach to change behaviorC. A living, learning or working environment. D. A permissive and congenial environmentAnswer. (C) A therapeutic milieu refers to a broad conceptual approach in which all aspects of the environment are channeled to provide a therapeutic environment for the client. The six environmental elements include structure, safety, norms, limit setting, balance and unit modification. A. Behavioral approach in psychiatric care is based on the premise that behavior can be learned or unlearned through the use of reward and punishment. B. Cognitive approach to change behavior is done by correcting distorted perceptions and irrational beliefs to correct maladaptive behaviors. D. This is not congruent with therapeutic milieu.56. The client is concerned about his coming discharge, manifested by being unusually sad. Which is the most therapeutic approach by the nurse?A. “You are much better than when you were admitted so there’s no reason to worry.”B. “What would you like to do now that you’re about to go home?”C. “You seem to have concerns about going home.”D. “Aren’t you glad that you’re going home soon?”Answer. (C) “. This statement reflects how the client feels. Showing empathy can encourage the client to talk which is important as an alternative more adaptive way of coping with stressors.. A. Giving false reassurance is not therapeutic. B. While this technique explores plans after discharge, it does not focus on expression of feelings. D. This close ended question does not encourage verbalization of feelings.57. Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A nurse observes that a client with a potential for violence is agitated, pacing up and

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down the hallway and making aggressive remarks.Which of the following statements is most appropriate to make to this patient?A. What is causing you to become agitated?B. You need to stop that behavior now.C. You will need to be restrained if you do not change your behavior.D. You will need to be placed in seclusion.Answer. (A) In a non-violent aggressive behavior, help the client identify the stressor or the true object of hostility. This helps reveal unresolved issues so that they may be confronted. B. Pacing is a tension relieving measure for an agitated client. C. This is a threatening statement that can heighten the client’s tension. D. Seclusion is used when less restrictive measures have failed.58. The client jumps up and throws a chair out of the window. He was restrained after his behavior can no longer be controlled by the staff. Which of these documentations indicates the safeguarding of the patient’s rights?A. There was a doctor’s order for restraints/seclusionB. The patient’s rights were explained to him.C. The staff observed confidentialityD. The staff carried out less restrictive measures but were unsuccessful.Answer. (D) This documentation indicates that the client has been placed on restraints after the least restrictive measures failed in containing the client’s violent behavior.59. Situation: Clients with personality disorders have difficulties in their social and occupational functions.Clients with personality disorder will most likely:A. recover with therapeutic interventionB. respond to antianxiety medicationC. manifest enduring patterns of inflexible behaviorsD. Seek treatment willingly from some personally distressing symptomsAnswer. (C) Personality disorders are characterized by inflexible traits and characteristics that are lifelong. A and D. This disorder is manifested by life-long patterns of behavior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not recover from therapeutic intervention. B. Medications are generally not recommended for personality disorders.60. A teenage girl is diagnosed to have borderline personality disorder. Which manifestations support the diagnosis?A. Lack of self esteem, strong dependency needs and impulsive behaviorB. social withdrawal, inadequacy, sensitivity to rejection and criticismC. Suspicious, hypervigilance and coldnessD. Preoccupation with perfectionism, orderliness and need for controlAnswer. (A) These are the characteristics of client with borderline personality. B. This describes the avoidant personality. C. These are the characteristics of a client with paranoid personality D. This describes the obsessive compulsive personality61. The plan of care for clients with borderline personality should include:A. Limit setting and flexibility in scheduleB. Giving medications to prevent acting outC. Restricting her from other clientsD. Ensuring she adheres to certain restrictionsAnswer. (D) The client is manipulative. The client must be informed about the policies, expectations, rules and regulation upon admission. A. Limits should be firmly and consistently implemented. Flexibility and bargaining are not therapeutic in dealing with a manipulative client. B. There is no specific medication prescribed for this condition. C. This is not part of the care

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plan. Interaction with other clients are allowed but the client should be observed and given limits in her attempt to manipulate and dominate others62. The client says “ the police is out to get me.” The nurse’s best response is:A. “The police is not out to catch you.”B. “I don’t believe that.”C. “I don’t know anything about that. You are afraid of being harmed.”D. “ What made you think of that.”Answer. (C) This presents reality and acknowledges the clients feeling A and B. are not therapeutic responses because these disagree with the client’s false belief and makes the client feel challenged D. unnecessary exploration of the false63. Which of the following represents appropriate criteria for the involuntary admission of a client into a psychiatric facility?a. Client who is competent but refuses admissionb. Client who has threatened suicidec. Client who has a long history of mental illnessd. Client whose family has requested admissionAnswer. B The key element or criteria for involuntary admission is that the client is considered to be a threat to himself or others. Refusing admission, a long history of mental illness, and a family's request for admission are not considered appropriate criteria.64. Lucy J., a successful teacher, is admitted in the morning for treatment of gastritis. Near the end of a 12-hour shift, the nurse notices which of the following symptoms that would which suggest(s) alcohol withdrawal?A) Delirium tremens B) Tremors, anorexia, and diaphoresisC) Persistent hallucinations D) Aggressive behavior and difficulty with balanceAnswer. (B). The signs of alcohol withdrawal, which appear within the first 8–12 hours, are tremors, anorexia, and diaphoresis.Scenario: Questions 8–13. Two staff nurses were considered for promotion to head nurse. The promotion is announced via a memo on the unit bulletin board.65. When the nurse who was not promoted first read the memo and learned the that the other nurse had received the promotion, she left the room in tears. This behavior is an example of:A. conversion. B. regression. C. introjections. D. rationalization.Answer. (B) Crying is a regressive behavior. The ego returned to an earlier, comforting, and less mature way of behaving in the face of disappointment. Conversion involves the transformation of anxiety into a physical symptom. Introjection involves intense unconscious identification with another person. Rationalization involves the unconscious process of developing acceptable explanations to justify unacceptable ideas, actions, or feelings.66. The nurse then went to the utility room and slammed several cupboard doors while looking for Kleenex. This behavior exemplifies:A. displacement. B. sublimation C. conversion. D. reaction formation.Answer. (A) Displacement unconsciously transfers emotions associated with a person, object, or situation to another less threatening person, object, or situation. She slammed doors instead of striking the other nurse or the administrator who made the promotion decision. Sublimation is the unconscious process of substituting constructive activity for unacceptable impulses. This option cannot be considered correct because the slamming of the cupboard doors cannot be considereda constructive activity. Conversion involves unconsciously transforming anxiety into a physical symptom. Reaction formation keeps unacceptable feelings or behaviors out of awareness by using the opposite feeling or behavior.

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67 An aide comes into the utility room and remarks, “You seem pretty angry.” The nurse replies that she isn’t the least bit angry. In this instance the nurse in probably utilizing:A. reaction formation. B. repression. C. compensation. D. denial.Answer. (D) Denial involves an unconscious process of escaping an unpleasant reality by ignoring its existence; in this case the nurse is unable to acknowledge her true feelings. Reaction formation is an unconscious process that would call for her to display a feeling that is the opposite of anger. Repression would operate unconsciously to exclude the event from awareness. Compensation requires unconsciously making up for perceived deficits 68. The nurse who was not promoted tells a friend, “Oh, well, I really didn’t want the job anyway.” This is an example of:A. rationalization. B. denial. C. projection. D. compensation.Answer. (A) This is called the “sour grapes” form of rationalization. Rationalization is an unconscious form of self-deception in which we make excuses. Denial is an unconscious process that would call for her to ignore the existence of the situation. Projection operates unconsciously and would result in blaming behavior. Compensation would result in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.69. The nurse who was not promoted tells another friend, “I knew I’d never get the job. The hospital administrator hates me.” If she actually believes this of the administrator, who, in reality, knows little of her, she is demonstrating:A. compensation. B. reaction formation. C. projection. D. denial.Answer. (C) Projection results in unconsciously adopting blaming behavior. It allows us to attribute our own unacceptable attributes to other people. 70. If, when the nurse who was not promoted met the newly promoted nurse in the hall, she suddenly found she had lost her voice and was unable to offer her congratulations, she would probably be demonstrating:A. denial. B. conversion. C. suppression. D. repression.Answer. (C) Conversion unconsciously transforms anxiety into a physical symptom that has no organic basis. The symptom resolves a conflict. In this case, if one cannot speak, one cannot be expected to offer congratulations. 71. In the last week, five clients have died in the intensive care unit. Which intervention would be most helpful to reduce the nurse’s stress?A. providing literature on stress reductionB. a “debriefing” session lead by a mental health nurseC individual counseling sessions with a mental health nurseD. requiring each nurse to write out feelings in a journal each weekAnswer. (C) A “debriefing” session will allow nurses to ventilate feelings and gain support from each other. Individual counseling sessions are not time- or cost-effective. Providing literature and journaling are not effective in reducing stress. Journaling is effective in identifying feelings.72. An effective intervention for a client diagnosed with an obsessive compulsive disorder would be:A. discuss the repetitive action.B. insist the client not perform the repetitive act.C. inform the client the act is not necessary.D. encourage daily exercise.Answer. (D) Obsessive compulsive disorder is an anxiety disorder. Exercise will release emotional energy, limit time for the maladaptive behavior and direct the client’s attention outward. Initially, nurses should not interfere with performance of the repetitive act, try reasoning the client out of the behavior or ridicule the behavior.

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73. The nurse is caring for a 35-year-old woman with agoraphobia. Which of the following behaviors would the nurse expect to observe in the client?A. The client is afraid of talking to other people.B. The client is afraid to leave her home.C. The client is afraid of pain.D. The client is afraid of fire.Answer. (B) Clients with agoraphobia are afraid to leave their homes for fear of being trapped without the ability to escape. (C) The fear of pain is called algophobia. (D) The fear of fire is called pyrophobia.74. In implementing treatment for a client with a phobic disorder, nursing actions include:A. Insight-oriented psychotherapy B. Administering lithiumC. Desensitization treatment D. Crisis interventionAnswer. (C) Desensitization treatment is an appropriate part of the nursing care plan for phobic clients. By gradually exposing these clients to the phobic stimulus, such as leaving their homes or the hospital unit, anxiety can gradually be decreased, and the clients can begin to function more effectively. 75. In providing care to a client with an obsessive-compulsive disorder, the nurse recognizes that the client’s frequent, intensive, and extensive hand washing is an attempt to:A. Relieve underlying anxiety B. Give herself a sense of control over her lifeC. Increase her self-esteem D. Reduce the possibility of infectionAnswer. (A) The client with obsessive-compulsive disorder uses the rituals to cope with intense anxiety related to aggressive impulses and guilt. (B) Clients with obsessive-compulsive disorder often recognize that they have little control over their obsessions and compulsions and that they are interfering with their ability to function. (C) The rituals do not contribute to a sense of self-esteem for clients with this disorder. They often recognize that the rituals are unreasonable and excessive. (D) The excessive hand washing contributes to the risk of infection because it threatensskin integrity.76. One nursing goal in the care plan for a client with a paranoid personality disorder is promoting consensual validation of reality. Which of the following nursing actions would be most appropriate to achieve this goal?A. Reinforce reality but avoid arguing with the client about his perceptions.B. Use humor to challenge his perceptions.C. Discourage him from verbalizing his perceptions.D. Administer antidepressant drugs to decrease his depression.Answer. (A) An effective implementation for promoting consensual validation of reality is to reinforce reality, but the nurse should avoid arguing with the client about his perceptions. Arguing about his suspicions will reinforce them. (B) These clients often interpret the use of humor in others as a personal assault—that they are the intended focus of the joke. (C) Interventions include assisting these clients to clarify thoughts and feelings. They need opportunities to discuss their perceptions. (D) Antidepressant medications are used frequently for clients with depressive disorder, not paranoid personality disorder77. A 55-year-old woman is scheduled for ECT the next morning. The nurse knows that ECT is most commonly prescribed for:A. Disorganized schizophrenia B. Major depressionC. Antisocial personality disorder D. Dissociative disorderAnswer. (B) ECT is commonly used for treatment of major depression in clients who have not responded to antidepressants, who have medical problems that contraindicate the use of

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antidepressants. (A) ECT is not commonly used for treatment of schizophrenia. Major ranquilizers are most commonly used. (C) ECT is not commonly used in treatment of personality disorders. (D) ECT is not the treatment of choice for clients with dissociative disorders.78. A 22-year-old client with a diagnosis of undifferentiated schizophrenia is being treated with haloperidol 5 mg bid. He was estranged from his father for several years. Recently he has been spending some time with his father. His father comes with him to an appointment at the mental health clinic and asks the nurse what the haloperidol is for. The nurse explains that haloperidol is given to:A. Reduce extrapyramidal symptoms B. Prevent neuroleptic malignant syndromeC. Decrease psychotic symptoms D. Assist with sleep Answer. (C) Neuroleptics such as haloperidol are effective in decreasing psychotic symptoms so that clients with psychotic disorders may interact more functionally with their environment. (A) Side effects of neuroleptic drugs are extrapyramidal symptoms. (B) Neuroleptic malignant syndrome is a rare, potentially fatal complication of treatment with neuroleptic drugs. (D) Although neuroleptic drugs such as haloperidol may make a client drowsy, it is not given to promote sleep.79. The nurse is collecting data to plan the care of a 21-year old woman with a diagnosis of catatonic schizophrenia. The nurse would likely observe that this client:A. Has excessive weight gain B. Appears overhydratedC. Is hyperreactive to stimuli D. Stands, sits, or lies immobileAnswer. (D) The client with catatonic schizophrenia can be observed standing, sitting, or lying immobile. The immobility can last for minutes, hours, or days. (A) A client with catatonic schizophrenia tends to lose weight because of inability or unwillingness to eat secondary to symptoms of stuporous withdrawal and distorted perceptions. (B) This client would most likely exhibit symptoms of dehydration secondary to poor fluid intake. (C) The client with catatonic schizophrenia has diminished ability to deal with environmental stimuli and withdraws.80. A 42-year-old woman has been admitted to the psychiatric unit with a diagnosis of bipolar disorder, manic phase. She had discontinued her medication as an outpatient and has experienced a significant increase in dysfunctional behavior. On admission, the client is dressed in very colorful clothes with heavy makeup. During the manic phase, the nurse would anticipate assessing which behavior in the client?A. Bizarre thoughts B. Intense, labile moodC. Extreme suspiciousness D. Auditory hallucinations Answer. (B) Intense, labile mood is characteristic of clients in the manic phase of bipolar disorder. These clients may be euphoric and elated, then suddenly become very irritable and hostile. Behaviors must be closely monitored to maintain safety because these clients often experience poor impulse control with their labile mood. (A) Bizarre thoughts are more characteristic of clients with schizophrenia. (C) Extreme suspiciousness is more characteristic of clients with paranoid personality disorder or paranoid schizophrenia. (D) Auditory hallucinations are not a common characteristic of clients with bipolar disorder.81. The symptoms the nurse would expect to observe in clients experiencing lithium toxicity would be:A. Skin rash, photosensitivity B. Urinary retention, orthostatic hypotensionC. Dystonia, akathesia D. Ataxia, persistent nausea and vomiting, severe diarrhea Answer. (D) Early symptoms of lithium toxicity include ataxia, persistent nausea and vomit-ing, severe diarrhea, tinnitus, and blurred vision. More serious symptoms include increasing muscle tremors and mental confusion. The most serious symptoms include nystagmus, delirium,

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arrhythmias, and cardiovascular collapse. (A) Skin rash and photosensitivity can be side effects of antipsychotic medications, but they are not symptoms of lithium toxicity. (B) Urinary retention and orthostatic hypotension can be side effects of antidepressant medications, but they are not symptoms of lithium toxicity. (C) Dystonia and akathesia are extrapyramidal symptoms that can occur with antipsychotic medications, but they are not symptoms of lithium toxicity.82. In interacting with clients on the psychiatric inpatient unit, the nurse demonstrates congruence between what she feels and what she expresses. This characteristic, which is important in establishing a therapeutic relationship, is known as:A. Trust B. Respect C. Genuineness D. Empathy Answer. (C) When a nurse is aware of internal experiences while interacting with a client and responds to the client with honesty and openness, the nurse is demonstrating genuineness. In the client, this promotes a feeling of being connected to others in a meaningful way. (A) Trust involves a sense of confidence that another person is interested in one’s welfare and has a desire to be of assistance. (B) Respect involves the unconditional acceptance of another person as a worthwhile and unique person. (D) Empathy is the ability to accurately perceive and understand what another person is feeling or experiencing.Situation: W., a 27 year old secretary, is brought to the hospital in an agitated state. She is admitted to the psychiatric unit for observation and treatment.83. The nurse enters W.'s room for the first time and says, "W., I'm E., the nurse. I'll help you get settled." W. responds, "I want another nurse. I don't like you. You're mean." The nurse recognizes that W.'s response in an example of:a) identification b) regression c) countertransference d) transferenceAnswer. D- when a patient's response to the nurse is extremely negative or extremely positive with no apparent basis, transference of feelings from another relationship is probably occurring. If the nurse has similar unwarranted responses to the patient, countertransference is taking place. Identification is a defense mechanism in which the patient adopts the characteristics of the nurse. Regression is a retreat to behaviors manifested during an earlier developmental level84. Before responding to W.'s initial outburst, the nurse should:a) make sure she is a safe distance from the patientb) move closer to the patient to show that she is not afraidc) assess her own feelings and responses to the patient's behaviord) recognize that it takes time for relationships to develop and not feel hurtAnswer. C- the nurse must first identify her feelings toward the patient and use them as a guide to determine an appropriate response. An accurate assessment of the distance needed between the nurse patient is possibly only if the nurse assesses her own response first. The nurse's recognition hat trust takes time to develop may be useful in planning an appropriate response; however, the nurse should identify her feelings about the patient before formulating a response.85. What would be the most therapeutic initial response by the nurse?a) say nothing, accept what the patient has said, and remain nearbyb) say, "W., we've just met. Why do you think I'm mean?"c) say, "I'm only trying to be helpful. Let me help you put your things away."d) say, "I'll be back in half an hour," then leave the patient's roomAnswer. A- displaying an accepting attitude of the patient's negative response helps foster trust. It also demonstrates the nurse's interest in and concern for the patient without challenging the patient, denying the patient's feelings, or leaving the patient alone. The patient probably cannot verbalize why she feels the way she does; challenging her will only increase her anxiety and make her feel more vulnerable. By emphasizing that she is only being helpful, the nurse implies that the patient's feelings are erroneous. Leaving the room serves no purpose and may exacerbate the patient's anxiety by increasing her feelings of aloneness and introducing a feeling of

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desertion.86. What is the most important priority in providing nursing care for a patient with a terminal illness?a. Physical comfort. b. Medications to reduce pain.c. Prevention of pressure sores. d. Encouraging unlimited visits from family members.Answer. A-a Physical comfort is the priority nursing care of a terminally ill client. This is the global response, it includes b&c.87. 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.Answer. C Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn't have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.88. 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 outputB. Checking the client's medical records for health history informationC. Attempting to contact the client's family to obtain more information about the clientD. Restricting fluids and leaving the client alone to "sleep off" the episodeAnswer. A A nurse who lacks adequate information to determine which level of care a client requires must take all possible precautions to ensure the client's physical safety and prevent complications. To do otherwise could place the client at risk for potential complications. After taking all possible precautions, the nurse can begin seeking health history information and, as needed, modify the plan of care. Fluids are typically increased unless contraindicated by a preexisting medical condition.89. 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)Answer. C The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a benzodiazepine. Clozapine and thiothixene are antipsychotic agents, and lithium carbonate is an antimanic agent; these drugs aren't used to manage alcohol withdrawal syndrome.90. 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. CheeseAnswer. B. Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to avoid products containing alcohol such as aftershave lotions. Carbonated beverages, toothpaste, and cheese don't contain alcohol and don't need to be avoided by the client.

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91. Parkinson’s disease has been diagnosed in a client exhibiting tremors. Which of the following is lacking in this disorder?A. Celestone B. Dopamine C. Serotonin D. Anti-diuretic hormoneAnswer B is correct. The neurotransmitter dopamine is missing in clients with Parkinson’s disease. Most of the treatment involves replacement of this drug. Answer A is a steroid. Answer C is a neurotransmitter not missing in Parkinson’s disease, and Answer D is secreted by the pituitary gland not related to the stated diagnosis; therefore Answers A, C, and D are incorrect.92. The nurse on a neurological unit is observing a student performing an assessment. The student asks the client to stand with arms at sides and feet and knees close together. The student instructs the client to first stand with the eyes open and then with eyes closed. What does the nurse deduce that the student is testing? A. Clonus B. Tonicity C. Romberg’s sign D. Babinski reflexAnswer C is correct. Romberg’s sign tests balance and is performed in this manner. Answers A and B are muscular actions often seen in seizure activity, so they are incorrect. Answer D is a reflex abnormal in anyone older than two years of age, so it is wrong.93. 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?Answer d: this is the only question that determines the effects of the problem on the client and the ways she is dealing with it. Letter A can only be answered by FINE and close further communication. B is unrelated to coping strategies. Letter C, asking the client what do you think can help you right now is INAPPROPRIATE for the nurse to ask. The client is in the hospital because she needs help. If she knows something that can help her with her problem she shouldn’t be there.94. As a counsellor , the nurse performs which of the ff: task?a. encourage client to express feelings and concernsb. helps client to learn a dance or song to enable her to participate in activitiesc. help the client prepare in group activitiesd. assist the client in setting limits on her behaviourAnswer A. encourage client to express feelings and concerns : A counselor is much more of a listener than a speaker . She encourage the client to express feelings and concerns as to formulate necessary response and facilitate a channel to express anger , disappointments and frustrations.95. Which of the following drugs needs a WBC level checked regularly?a. Lithane b. Clozaril c. Tofranil d. DiazepamAnswer b. Clozaril : Clozapine is a dreaded aypical antipsychotic because it causes severe bone marrow depression, agranulocytosis, infection and sore throat. WBC count is important to assess if the clients immune function is severely impaired. The first presenting sign of agranulocytosis is SORE THROAT.96. 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 medicationc. The voices are all in your imagination, think of something else and itll go awayd. Don’t think of anything right now, just go and relax.Answer A. I understand that god’s voice are real to you, But I don’t hear anything. I will stay with you. : The nurse should first ACKNOWLEDGE that the voices are real to the patient and then, PRESENT REALITY by telling the patient that you do not hear anything. The third part of

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the nursing intervention in hallucination is LESSENING THE STIMULI by either staying with the patient or removing the patient from a highly stimulating place.Telling the client that the voices is part of his illness is not therapeutic. People with schizophrenia do not think that they are ILL. Letter C and D disregards the client’s concern and therefore, not therapeutic.97. 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 myself are scary to meb. I’d like to go to sleep and not wake upc. I’ve thought about taking pills and alcohol till I pass outd. I’d like to be free from all these worriesAnswer C. I’ve thought about taking pills and alcohol till I pass out : This is the only statement of the client that contains a specific and technical plan. B,D are all indicative of suicidal ideation but it contains no specific plans to carry out the objective. Letter A admits the client thinks of hurting himself, but not doing it because it scares him, therefore, it is not indicative of suicidal ideation.98. 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 bodyc. Stops pacing and sits with the nurse d. Exhibits increase activity and speechAnswer C. Stops pacing and sits with the nurse : Thorazine is a neuroleptic. Desired effect evolve on controlling the client’s psychoses. Letter A is the side effect of the drug, which is not desired. B and D indicates that the drug is not effective in controlling the client’s agitation, restlessness and disorders of perception.99. 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 disorderc. schizophrenia d. depressionAnswer C. schizophrenia : When disorders of perception and thoughts came in, The only feasible diagnosis a doctor can make is among the choices is schizophrenia. A,B and D can occur in normal individuals without altering their perceptions. Schizophrenia is characterized by disorders of thoughts, hallucination, delusion, illusion and disorganization.100. 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 normalAnswer c. Perform activities of daily living : If a client can do ADLs , there is no reason for that client to be hospitalized.101. 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 depressionAnswer C. hypotension : Hypotension, dizziness and lethargy are side effects of anti parkinson drugs like levodopa and carbidopa.102. Milieu therapy is best employed to do which of the following?

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1. Investigate the patient’s view of the world.2. Promote socialization skills.3. Focus on inappropriate behavior.4. Provide repetitive ordinary experiences on a daily basis.Answer (4) Milieu therapy provides repetitive ordinary experiences on a daily basis, controls the environment by minimizing change as much as possible, and decreases disruptive behavior by keeping tasks simple.103. The “token economy” is a type of therapy that focuses on:1. play therapy. 2. behavior modification.3. milieu therapy. 4. physical changes.Answer (2) Behavior modification gives positive feedback and rewards for appropriate behavior. Behavior modification requires negative behavior if its not destructive or life threatening.104. How does the American Nurses’ Association (ANA) define the psychiatric nursing role?1. a specialized area of nursing practice that employs theories of human behavior as its “science” and the powerful use of self as its “art”2. a specialized area of nursing practice that assists the therapist to relieve the symptoms of the patient3. a specialized area of nursing practice that involves solving the patient’s problems and giving him the answers4. a specialized area of nursing practice in which the patient is committed to long-term therapy with the nurseAnswer (1) The ANA sets standards of practice on psychiatric and mental health nursing roles: the quality of care, performance appraisal, education, ethics, collaboration, and research through the use of the nursing process.105. The general adaptation syndrome is based on the concept of stressor and response to stressors over time. This theory was developed by:1. Freud. 2. Sullivan. 3. Selye. 4. Dixs.(3) Hans Selye published his research concerning the physiologic response of a biological system to stress or change imposed upon it.106. Maladaptation is said to be present when the person’s responses are:1. directed at stabilizing internal biological processes.2. directed toward the preserving of self-esteem.3. aimed at maintaining the individual’s integrity.4. aimed at disrupting the individual’s integrity.Answer (4) Maladaption is viewed as negative or unhealthy. It disrupts the integrity of a person.107. In the General Adaptive Syndrome (GAS) phases, which one is thought to cause illnesses?1. alarm stage 2. resistance stage 3. exhaustion stage 4. recuperative stageAnswer (3) Exhaustion stage occurs when the patient’s adaptive energy is depleted and the patient has no other resources for adaptation: disease of adaptation of HA, CAD, ulcers, colitis, and mental disorders.108. The way a person perceives and responds to stress is most affected by which of these predisposing factors?1. Age 2. Gender 3. Past experiences 4. family historyAnswer (3) Past experiences result in learned patterns that can influence an individual’s adaptive responses.109. Coping strategies are considered maladaptive when the conflict being experienced:1. gets resolved. 2. intensifies.

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3. increases energy sources. 4. maintains vital signs in normal parameters.Answer (2) Coping strategies are maladaptive when conflict being experienced goes unresolved or intensifies. Energy sources are depleted. This increases vulnerability to physical and psychological illnesses.110. A nurse observes a client sitting alone and talking. When asked, the client reports he is talking to the voices. The nurse’s next action would be:1. touch the client to help return to reality.2. leave the client alone until reality returns.3. ask the client to describe what is happening.4. tell the client there are no voices.Answer (3) Nurses frequently observe behavioral cues that indicate the presence of hallucinations. Talking about the hallucinations is reassuring and validating to the client. Focusing on the symptoms and asking about the hallucinations empowers the client to gain control.111. A client in an acute care psychiatric hospital asks, “Who are those two people by the door?” The nurse recognizes the client is having a hallucination, and the best response would be:1. “I do not see anyone. Can you tell me more about what you are seeing?”2. “There is no one there. You are seeing things again.”3. “Just ignore them. They will go away.”4. “I told you before there is no one there. Why do you keep bothering me?”Answer (1) Nurses need to inform clients that there is a difference in perceptions and pay attention to the content of the hallucination. Nurses need to determine whether a command hallucination is occurring that tells the client to harm himself or others. When the client is able, an appropriate intervention is to assist the client to identify triggers for the hallucination.112. A client with a diagnosis of schizophrenia has been released from an acute care setting. The client had a prolonged recovery from relapse. The parents discuss the situation with the nurse. “I do not understand what is going on. The hospital said she was better, but all she does is sit around all day and smoke. We cannot get her to go to the vocational training you arranged.” The nurse recognizes more teaching is needed about:1. the pathophysiology and acting out behaviors of schizophrenia.2. support groups that can help the parents release their feelings of frustration.3. the prolonged recovery time and depressive effects of medicines to prevent relapse.4. motivational techniques that are effective in clients with schizophrenia.Answer (3) The nurse conducting discharge teaching must stress the lengthy recuperation process with emphasis on the sedative qualities of the medication used to prevent relapse. Support groups are useful to the caregivers. The emphasis on recuperation is to maintain nutrition and hygiene.113. A nurse is teaching a group of clients with a diagnosis of schizophrenia who are nearing discharge from a residential care facility. An essential topic to include would be:1. pathophysiology of the disease and expected symptoms.2. how to recognize and manage symptoms of relapse.3. need to take extra medication when feeling stressed.4. contact with follow-up care daily.Answer (2) Clients are usually aware of the symptoms that indicate relapse is occurring. The client needs to know how to find a safe environment and to seek help. The first two stages of relapse are more difficult to recognize because they do not present symptoms that indicate psychosis. Initially, the client feels anxious and overwhelmed and may proceed to becoming

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withdrawn. This is the crucial period to intervene. The client needs to go to a safe environment with someone that is trusted, avoid negative people, and decrease stimuli and stress.114. A woman asks, “How much alcohol can I safely drink while pregnant?” The nurse’s best response would be:1. “No amount of alcohol is safe during pregnancy.”2. “Consuming one or two beers or glasses of wine a day is considered safe for a healthy pregnant woman.”3. “Drinking three or more drinks on any given occasion, binging, is the only harmful type of drinking during pregnancy.”4. “You can have a drink to help you relax and get to sleep at night.”Answer (1) The best recommendation is that no alcohol be consumed during pregnancy. Fetal alcohol syndrome is a combination of mental and physical abnormalities present in infants born to mothers who have consumed alcohol during pregnancy. The amount of alcohol needed to cause fetal alcohol syndrome has not been determined.115. Antidepressants are considered the treatment of choice for major depression; however, they should be used with caution in clients with:1. respiratory disease. 2. cardiac disease. 3. renal disease. 4. liver disease.Answer (2) Tricyclic antidepressants may cause orthostatic hypotension, tachycardia, and conduction defects. Amitriptyline has been shown to cause sudden cardiac death in clients with pre-existing heart disease. Tricyclic antidepressants improve ventricular dysrhythmias. Second generation antidepressants (Maprotiline, Trazodone, Fluoxetine) cause decreased heart rate and orthostatic hypotension. Clients receiving antidepressants require serial blood pressure andelectrocardiogram monitoring.117. A client is admitted with a diagnosis of multiple drug use. The nurse plans care base upon knowledge that:1. multiple drug use is very uncommon.2. people may use more than one drug to enhance the effect or relieve withdrawal symptoms.3. alcohol and barbiturates used together are not dangerous because one is a stimulant and the other a depressant.4. assessment and intervention are easier with multiple drug use because of the synergistic effect.Answer (2) Simultaneous or sequential use of more than one substance is very common. Multiple drug use may enhance, lessen, or change the nature of the intoxication or relieve withdrawal symptoms. Heroin users often also use alcohol, marijuana, or benzodiazepines. Multiple drug use is especially dangerous if synergistic drugs are combined. Multiple drug use complicates assessment and intervention because the client may be demonstrating effects or withdrawal from several drugs.118. While admitting a client to an acute care psychiatric unit, the nurse asks about substance use based upon knowledge that:1. in addicted populations, there is greater prevalence of psychiatric illness.2. people with psychiatric disorders are more prone to substance abuse.3. substance disorders are easily detected and diagnosed in acute care psychiatric settings.4. undetected substance problems have no real effect on treatment of psychiatric disorders.Answer (2) The failure to address substance abuse among clients with psychiatric disorders interferes with treatment effectiveness and contributes to relapse. Misdiagnosis of psychiatric disorder, suboptimal pharmacological treatment, neglect of appropriate interventions, and an inappropriate referral may also occur.119. When planning care of a client who has been diagnosed with amphetamine abuse, the nurse uses the knowledge that:

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1. amphetamines increase energy by increasing dopamine levels at neural synapses.2. amphetamines have low risk of tolerance or addiction.3. amphetamines produce a 10–20 second rush followed by a 2–4 hour high.4. addiction to barbiturates and amphetamines is rare because they have opposite effects.Answer (1) Amphetamines cause the release of norepinephrine and dopamine from storage vesicles into the synapse. The increased catecholamines at the receptors causes increased stimulation. Clear patterns of tolerance and withdrawal have not been described. Prolonged or excessive use of amphetamines can lead to psychosis. People use amphetamines for the feelings of euphoria, relief from fatigue, and energy and alertness. Overdose may cause seizures, cardiac arrhythmias, hypertension, and hyperthermia. When abstaining the client may experience fatigue, depression, and irritability lasting for several weeks. Drug cravings are common and may lead to relapse.120. Methadone is used to aid withdrawal and provide maintenance for persons with opiate addiction because methadone:1. replaces endorphins so craving is diminished.2. produces dramatic negative symptoms if opiates are used.3. enhances euphoria by increasing neurotransmitters of enkaphalens.4. does not interfere with the ability to function productively.Answer (4) Maintenance programs for long-term opiate addiction may last for years using substitute narcotics. LAAM is a longer acting opiate antagonist. Methadone will produce addiction; however, the person remains productive.121. Parents of a 14-year-old child who is being treated for marijuana use discuss the child’s apathy and lack of desire to achieve. The nurse explains that:1. this is typical teenage behavior and not related to the marijuana use.2. prolonged marijuana use causes amotivational syndrome.3. this behavior is a precursor to a psychotic stage.4. the behavior is due to the physical dependence on the drug.Answer (2) People use marijuana for the effects of relaxation, mild euphoria, and reduced inhibitions. Undesirable effects of marijuana use include tachycardia and panic. Prolonged use has been associated with decreased motivation, poor hygiene, lack of energy, and loss of desire to be productive.122. A client diagnosed with bipolar disease has begun a regimen of lithium. The most critical issue for the first two weeks is:1. monitoring the blood pressure.2. educating about side effects of the medicine.3. ensuring blood levels reach a therapeutic level.4. ascertaining that the client receives the full dose.Answer (3) Lithium may take 2 weeks to reach therapeutic levels. The client will be tested periodically to ensure that the blood level of the drug is at a therapeutic level.123. A school nurse is counseling students after a fellow student died following inhalant use. The nurse includes the information that inhalants:1. are costly and produce a prolonged effect without dependence or tolerance.2. produce feelings of lethargy, vulnerability, and apathy.3. have no withdrawal symptoms.4. cause death due to cardiac arrhythmias or suicide.Answer (4) In addition to causing death, inhalants may result in permanent cognitive impairment. The withdrawal symptoms include headache, chills, and abdominal cramps. Inhalants are popular among preteens because of the low cost and easy availability.124. A client states that she is codependent. The nurse explains that this means the client:

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1. forms close personal relationships.2. is preoccupied with the lives, feelings, and problems of others.3. attempts to take responsibility for own behavior.4. discourages the spouse to continue using drugs.Answer (2) Codependency implies a person is only satisfied in caring for others at the expense of personal health and welfare. Clients with codependency problems usually have low self-esteem and enable others to use drugs.125. A client has been receiving lithium for a diagnosis of bipolar disorder. The client reports new onset of hand trembling, dizziness, and stumbling. The nurse would:1. reassure the client these are temporary side effects.2. monitor these effects to make sure they do not worsen.3. notify the prescriber that the client is showing signs of toxicity.4. request the client return in three days when the prescriber is present.Answer (3) Lithium has a very narrow window of effectiveness. Side effects that may be temporary include nausea, vomiting, diarrhea, hand tremors, muscle weakness, thirst, fatigue, and drowsiness. Signs of lithium toxicity include nausea, drowsiness, confusion, slurred speech, blurred vision, muscle twitching, and cardiac dysrhythmias.126. The desired outcome for a client withdrawing from a mood-altering substance would be for the client to:1. have no withdrawal symptoms.2. attend two support group meetings per day.3. make a daily commitment to abstain.4. recognize and talk about hallucinations or illusions.Answer (4) Although desirable, it is unrealistic to assume a client will have no withdrawal symptoms. The second and third choices are desired outcomes for the client who is abstaining from substance use after the withdrawal period.127. A desired outcome for the client abstaining from using a mood-altering substance would be for the client to:1. contact a support person when the urge to use the substance is experienced.2. remain oriented to person, time, and place at all times.3. correctly interpret environmental stimuli and discuss feelings about stimuli.4. never be tempted to use the substance again.Answer (1) During abstinence, the client needs to recognize when the desire to use the substance is experienced and contact a support person. The other choices are outcomes for the withdrawal period.128. When working with a client who has been started on a psychotropic medication, the nurse would assist the client to adhere to the medical regime by:1. informing the client that side effects are temporary.2. using community and family support available to the client.3. requesting the client make an appointment in four weeks.4. maintaining a casual, social relationship with the client. Answer (2) Involving the family and increasing support through community resources will help the client adhere to the regimen.The client needs to be monitored closely for adherence and side effects of the medication.129. An elderly client is being placed on a psychotropic medication. The nurse recognizes that older adults:1. require a higher dose because the medicine is not absorbed.2. often do not have an effective response to psychotropic medicines.3. are reluctant to take medicine because of the stigma attached to mental illness.

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4. usually require a lower dose of medicine due to decreased metabolism.Answer (4) Hepatic and renal function declines with age. Therefore, medications are often metabolized more slowly in older adults, resulting in a longer half-life. The dose needs to either be decreased or the time between medication dose increased.130. A client agrees to stop using marijuana. Select the best information for the nurse to teach the client about marijuana withdrawal.1. Marijuana is not associated with withdrawal symptoms.2. Seizures often occur during marijuana withdrawal.3. The client might have flashbacks for months after abstaining from marijuana.4. Dry mouth and nose are common symptoms during marijuana withdrawal.Answer (1) Marijuana usually has no withdrawal symptoms. Seizures may occur with alcohol and other depressant withdrawal. Flashbacks can occur for years after hallucinogen use. Dry mouth and red eyes are signs of marijuana use.131. A client reports that he drinks because of his stressful job and wife’s inability to care for the house and children. The nurse recognizes his comments as:1. avoidance. 2. identification. 3. rationalization. 4. denial.Answer (3) Clients who abuse substances frequently use blame-placing and rationalization to explain their behavior. The nurse should limit rationalization and direct the client’s focus to the substance abuse problem.132. A parent asks the school nurse why they are teaching the third grade class about substance abuse. The nurse’s best response would be:1. “Gateway drugs lead the child to smoking and drinking.”2. “The average age to start smoking is 12 and drinking alcohol is 16.”3. “The children are at an age where they can put pressure on their parents to stop using drugs.”4. “Children at this age have already started experimenting with drugs.”Answer (2) The age that children start smoking and drinking dropped in the late 1990s. In recent surveys, about half of all high school students had consumed alcohol in the past month. Prevention programs are targeted at students before they begin experimenting with drugs. Gateway drugs are drugs that lead to other drug use. Tobacco and marijuana are consideredgateway drugs.133. The nurse determines that a client has symptoms of tardive dyskinesia and:1. records the physical symptoms and client statements.2. withholds the next dose of the medication.3. documents the medication has the desired effect.4. consults the psychiatrist for an anticholinergic drug.(4) Tardive dyskinesia is a neurologic disorder caused by long-term use of neuroleptic drugs. Although there is no cure,many of the symptoms can be managed with anticholinergics, dopamine agonists, and benzodiazepines.134. A family member of a client with a diagnosis of schizophrenia asks about the prognosis. The nurse’s response is based upon the knowledge that schizophrenia:1. affects women more often than men.2. usually is diagnosed between the ages of 15 and 45.3. is a chronic deteriorating disease with periods of remission.4. is diagnosed later in women due to a protective hormone effect.(3) Although all of the answers are true about schizophrenia, only option 3 answers the question asked.135. A client receiving pre-operative instructions asks questions repetitively about when to stop eating the night before the procedure. The nurse repeatedly tries to refocus the client

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on other aspects. The nurse notes the client is frequently startled by noises in the hall. Assessment reveals rapid speech, trembling hands, tachypnea, tachycardia, and elevated blood pressure. The client admits to feeling nervous and having trouble sleeping.Based upon the assessment, the nurse documents the client has:1. mild anxiety.2. moderate anxiety.3. severe anxiety.4. a panic attack.(3) With mild anxiety, stimuli are readily perceived and processed; the ability to learn and problem solve is enhanced. Moderate anxiety narrows the perceptual field, but the client will notice things brought to his attention. In severe anxiety, the client focuses upon small or scattered details. The person is unable to problem solve. During a panic attack, the person is disorganized and may be unable to speak or act or may be hyperactive.136. The nurse wishes to decrease the client’s use of denial and increase the client’s expression of feelings during a crisis intervention. In order to do this the nurse would:1. tell the client to stop using the defense mechanism of denial.2. positively reinforce each expression of feelings.3. instruct the client to express feelings.4. challenge the client each time denial is used.(2) In crisis intervention, defenses are not attacked, but defenses are encouraged or discouraged. There is not enoughtime in crisis intervention to replace attacked defenses with new ones. Returning the client to a prior level of functioningis the goal, not restructuring of defenses.137. What is the correct term for the situation characterized by a person or group of persons experiencing a stressful event(s) that results in failure of usual coping mechanisms and/or the utilization of problem-solving resources?1. crisis 2. Stressor 3. Depression 4. hypomaniaAnswer (1) A crisis is characterized by severe disorganization precipitated by failure of customary coping mechanisms or lack of or failure of usual resources. A stressor may be an event or event(s) extrinsic or intrinsic that combines with other factors to bring about the crisis situation. Depression and/or hypomania may result from sustained crisis situations and ineffective resolutions.138. A young child experiences the death of an older sibling. Which of the following behaviors indicates the need for mental health referral?1. sleep disturbances beyond six months2. initial weight loss and eating disturbance3. crying4. preoccupation with memories, sayings of the deceased, and redecoration of the bedroom with photos, drawings, and other reminders of the deceasedAnswer (1) All of the behaviors can be expected during acute loss and bereavement; however, when symptoms such as sleep disturbances become protracted, medical intervention and/or counseling are necessary.139. A man becomes restless and anxious following retirement. He states, “I do not know what is wrong with me. I was looking forward to having the time to do my favorite hobbies. Now I cannot concentrate on anything.” The nurse suspects the client is developing which type of crisis?1. maturational 2. Adventitious 3. Situational 4. transitional

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Answer (1) There are three types of crises. Maturational crisis occurs during transitional periods that require a change in roles, such as adolescence, marriage, parenthood, and retirement. Situational crises occur during acute events such as job loss, loss of loved one, unwanted pregnancy, and medical illness. Adventitious crises occur during disasters with multiple losses 140. When planning intervention for a client during a crisis, the nurse would have a desired outcome to be:1. client will explore deep psychological problems.2. client will express positive feeling about event.3. client will identify needs that are threatened by the event.4. client will use constructive coping mechanisms.(4) The primary goal of crisis intervention is to relieve the symptoms of anxiety and foster constructive coping.Previous psychological issues may recur during crisis, but the focus is on short-term resolution of the current problem.At the end, the nurse credits the client for positive changes and helps the client understand what was learned. Thisallows the client to use the learned coping mechanisms when new problems arise.141. A nurse is talking to a client who was diagnosed with diabetes mellitus two days ago. The client states, “No one in my family has diabetes. My sister has been overweight all her life; she should be the one with diabetes. I cannot manage the diet and testing. I want the tests rerun.” The nurse identifies the client is in which stage of crisis?1. impact 2. Honeymoon 3. Disillusionment 4. reconstruction(1) Five stages of crisis resolution have been identified. Initially the client feels the impact of the situation and experiences shock, denial, panic, and fear. Constructive activity occurs during the heroism phase. The honeymoon stage occurs when the client exhibits a desire to help others. Disillusionment occurs next with the client comparing his plight with that of others. During reconstruction, the client will rebuild his life.142. A client is transferred to an inpatient psychiatric unit after treatment for self-inflicted burns. What is the nurse’s highest priority?1. client protection2. suicidal assessment3. impulse control4. self esteem(1) With self-inflicted injuries, the highest priority is to ensure the client does not harm self or others. The other interventions are desirable after the client’s safety is ensured.143. Which of the following assessment findings is likely for a client with anorexia nervosa?1. hyperkalemia2. dysmenorrhea3. dehydration4. dental erosion (4) Dental erosion occurs due to the gastric acid with frequent vomiting. Hypokalemia also results from loss of electrolytes in gastric fluid. A female with a body weight of less than 90 pounds may have amenorrhea.145. A client with anorexia nervosa weighs 80 percent of normal body weight and states “I am so fat I cannot get into my clothes.” The nurse’s best response would be:1. “You are under your ideal body weight, and it is causing you medical problems.”2. “You only weigh 100 pounds. How can you say you are fat?’3. “You need to stop thinking like that. How else can you describe your body?”4. “Why do you perceive yourself to be fat?”

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(1) The best response is to provide a factual nonjudgmental answer. The client is not able to explain why they have adistorted perception.146. A client diagnosed with bipolar disease is running in the halls and entering other client’s rooms. Select thenurse’s best response.1. “You need to walk with me to get some medicine to help you calm down.”2. “You need to stay out of other peoples rooms.”3. “If you cannot stay in the living area, you will need to stay in your room.”4. “Why are you running in the halls?”(3) The nurse needs to consistently set and enforce limits on undesirable behavior for the client experiencing the manicphase of bipolar disease. This answer provides the client with information about the acceptable behaviors.370. A client is admitted following a suicide attempt. The client is disheveled, disorganized, and dehydrated. The priority for the first 24 hours is:1. hydration by forcing fluids.2. assisting with showering and clean clothes.3. assessing factors that contributed to suicide attempt.4. protecting client from self.(4) Clients at risk for self-inflicted harm need to be protected. Assisting the client with hydration and showering areless important, as is determining the reasons for the attempt.147. An adolescent is brought to the mental health center after witnessing the death of a friend in a car crash. The nurse determines that this is which type of crisis?1. maturational 2. Situational 3. Adventitious 4. situational and maturational Answer (4) Maturational crisis occurs during transitional periods that require a change in roles, such as adolescence, marriage, parenthood, and retirement. Situational crises occur during acute events such as job loss, loss of loved one, unwanted pregnancy, and medical illness. Adventitious crises occur during disasters with multiple losses. Combinations of crises events can occur. Frequently situational crises occur at transitional periods.148. During the 6-month well child visit, the nurse notices the mother is unkempt and tearful. The mother reports extreme fatigue and feelings of inadequacy. The nurse would document the mother may be experiencing postpartum:1. blues. 2. depression. 3. psychosis. 4. melancholia.Answer (2) Postpartum blues occurs within five days of delivery, lasts 1–2 weeks, and is due to hormonal changes and fatigue. Postpartum depression can occur from 2 weeks to 1 year after delivery, but often is seen about 6 months. Postpartum psychosis usually occurs within the first week after delivery and is associated with hallucinations, paranoia, confusion, rapid speech, and mood swings.149. What is the best nursing intervention when a client is experiencing a panic attack?1. “Please try to concentrate on what I am saying.”2. “Let’s go for a short walk until you are calmer.3. “Just sit back in your chair and take a few deep breaths.”4. “I am going to get you some Valium now.”Answer (4) Panic results in disorganized thinking and loss of the ability to concentrate. The client is unable to use relaxation techniques or other anxiety-reducing activities.150. A nurse is planning care of a client admitted for attempted suicide. Which intervention will the nurse include in the plan of care?

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1. Check the client every 15 minutes.2. One-to-one suicide precautions.3. Teach the client to report any suicidal thoughts.4. Place the client on bedrest with bilateral wrist restraints.(2) A serious threat of suicide requires constant one-to-one observation. Based on Maslow’s hierarchy, safety is the prioritywhen physiological needs are met.151. A client reports that someone is in the room and trying to kill him. The nurse’s best response would be:1. “There is no one in your room. Let’s get you more medicine.”2. “I do not see anyone, but you seem to be very frightened.”3. “No one can hurt you here.”4. “Just tell the person to go away.”(2) It is important to acknowledge the client’s fear. The other actions deny the client’s perceptions.152. The nurse is developing a care plan for the client with severe anxiety. Within 4 days the client will:1. have decreased anxiety.2. talk to the nurse for 10 minutes.3. sit quietly for 30 minutes.4. develop an adaptive coping mechanism.(2) Outcome criteria need to be specific, measurable, and realistic. Talking for 10 minutes meets all of these conditions.It is not realistic to expect a severely anxious client to sit quietly for 30 minutes. The other statements are vagueand not measurable.153. An effective intervention for a client diagnosed with an obsessive compulsive disorder would be:1. discuss the repetitive action.2. insist the client not perform the repetitive act.3. inform the client the act is not necessary.4. encourage daily exercise.(4) Obsessive compulsive disorder is an anxiety disorder. Exercise will release emotional energy, limit time for themaladaptive behavior and direct the client’s attention outward. Initially, nurses should not interfere with performanceof the repetitive act, try reasoning the client out of the behavior or ridicule the behavior.154. A man reports his wife is constantly cleaning. The activity has interfered with the family life. Friends havestopped visiting because she makes them uncomfortable. He states he has awakened in the middle of the night andfound her cleaning. The nurse consults with the couple and recommends the husband can help with therapy by:1. telling his wife to stop cleaning whenever he notices her actions.2. making a baseline record of the time the wife spends cleaning.3. decreasing the stimuli in the home.4. helping his wife with cleaning. (3) His wife is exhibiting obsessive compulsive behavior. Since this is an anxiety disorder, it is desirable to maintain an

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environment that is calm and as stress free as possible. Attempting to stop or focusing on the behavior can increase thewife’s anxiety and, therefore, the repetitive behavior.155. When helping the client gain insight into anxiety, the nurse would:1. help relate anxiety to specific behaviors.2. ask the client to describe events that precede increased anxiety.3. instruct the client to practice relaxation techniques.4. confront the client’s resistive behavior.(2) To gain insight, the client needs to recognize causal events. The other activities focus on recognition of when anxietyis occurring and how to manage the anxiety.156. A client has been taking alprazolam (Xanax) for four years to manage anxiety. The client reports taking 0.5 mg four times a day. Which statement indicates the client has learned the nurse’s teaching about discontinuing the medication?1. “I can drink alcohol now that I will be decreasing my Xanax.”2. “I will not take another Xanax pill. Here is what is left of my last prescription.”3. “I will take three pills per day next week, then two pills for one week, then one pill for one week.”4. “I can expect be sleepy for several days after stopping the medicine.”(3) Xanax, like other benzodiazepines, causes withdrawal symptoms including agitation, insomnia, hypertension,seizures, and abdominal pain. The drug needs to be slowly decreased to prevent these side effects. The drug must betapered slowly to minimize rebound symptoms of insomnia and anxiety. If symptoms occur, the dose needs to be raisedagain until symptoms are gone and tapering resumed at a slower rate.157. The nurse observes a staff member not following the plan of care for a client with an antisocial personality disorder. The nurse would:1. confront the staff member immediately and say “You know that is not the treatment plan.”2. write an incident report so there is a “paper trail” of the staff’s failure to follow the planned program.3. ask the staff member to talk in private and reinforce how antisocial clients try to divide staff.4. bring up the incident during the weekly conference so this staff will not be assigned to work withantisocial persons again.(3) It is essential that the treatment program be followed exactly for clients with antisocial personality disorder becausethey are very manipulative and will attempt to divide staff. However, confronting the staff member in front of the clientwill enhance the division of staff. Talking with the staff member in private will allow the person to develop skills towork with this client population.158. A client diagnosed with a borderline personality disorder frequently attempts to burn herself. The best intervention to facilitate behavior change would be:1. constantly observe the client to prevent self-harm.2. enlist client in defining and describing harmful behaviors.3. check on the client every 15 minutes to ensure she is not engaging in harmful behavior.4. remove all items from the environment that the client could use to harm self.

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(2) The challenge when intervening with clients who may harm themselves is to maintain client safety while facilitatingbehavior change. Enlisting the client to identify the triggers for self-harm will make the client an active participantin treatment. Nurses are less judgmental when they understand the source of the behavior and can be sensitive to clientfeelings.159. A nurse is developing a treatment plan for a client with a diagnosis of antisocial personality disorder. Which of the following would be a good positive reinforcer of desired behavior?1. Place the client in isolation when undesirable behavior occurs.2. Have the client save tokens for an outing once a month.3. Accumulate points for daily trip to canteen.4. Praise the client for desired behavior.(3) Reinforcers for clients with antisocial behavior disorder need to be concrete and readily available. This group ofclient’s required immediate gratification; therefore, accumulated points need short-term rewards. Removing the clientfrom contact with others may be necessary when the client cannot control behavior.160. Which of the following statements indicates that a client diagnosed with antisocial personality disorder is meeting a desired short-term outcome?1. Client describes interpersonal strengths and weaknesses.2. Client does not manipulate other residents into giving him their belongings.3. Client participates in a mutually satisfying interpersonal relationship.4. Client uses interpersonal relationships as alternative to self-mutilation.(2) Goals for clients with antisocial personality disorder include developing close interpersonal relationships and toleratingdistress. A short-term objective would be to not engage in manipulation of other residents.161. A family member of a client in the emergency department is pacing the floor. The family member stops between the nurse and the door and loudly states “You said the doctor would see my sister soon. We have been waiting for four hours. We want to see the doctor now.” The nurse believes the family member is becoming aggressive and says:1. “You are next in line. The doctor will see you in 5 minutes. That is not too long.”2. “There are sick people here. You need to calm down, or I will call security.”3. “I know how you feel. Doctors always make you wait, even when you have an appointment.”4. “I am sorry you have had to wait. It must be difficult to see your sister in pain.”(4) When communicating with someone who is becoming aggressive, the nurse should remain calm and speak in a soft, nonprovocative manner. The most important intervention is to listen to the person. The nurse can apologize for delays and problems with the system. Threatening the person or making promises you cannot keep will escalate the anger.162. A client is admitted to an acute care unit with a diagnosis of bipolar disorder. In past admissions, the client had assaulted others when stressed. To provide the client some control, during the admission assessment the nurse would:1. instruct the client that he would receive one token per hour he was not aggressive.2. ask the client what methods worked in the past to decrease aggressive behavior.3. inform the client when agitated that the client would be taken to the gym to work off energy.4. place the client in isolation until it was determined whether he was aggressive.(2) Involving the client in identification of triggers and methods to decrease agitation and aggression empowers the

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client. For some clients, exercise decreases agitation; for others, exercise increases it. Token programs may be effectiveif the reward is something the client is willing to work toward. Unless the client is aggressive at time of admission, heshould not be placed in isolation.163. A nurse is developing a contract with a client with anorexia nervosa. A realistic goal for the first 2 weeks would be:1. the client will not lose any weight for the first 2 weeks.2. the client will gain 2 pounds each week.3. the client will attain a realistic view of her body.4. the client will identify irrational thoughts about her weight.(1) A realistic initial goal for a client with anorexia nervosa is to refrain from activities that cause weight loss: binging,purging, laxative use, and exercise. Long-term goals include identifying triggers for the eating, purging, and exercisingbehaviors; recognizing faulty thinking; and acquiring adaptive coping responses.163. A patient who has suffered a right hemisphere cardiovascular accident (CVA) will be expected to exhibit:1. nonfluent aphasia.2. impulsivity, highly distractible.3. slow and cautious behavior.4. motor deficit on the right side.(2) Right hemisphere CVA behaviors include motor deficit on the left side; spatial perceptual loss; denial or unawarenessof deficit, overestimates of one’s ability; poor judgment; impulsivity; highly distractible and left visual field loss.164. The most sensitive indicator of changes in level or orientation of perception is:1. pupillary responses.2. change in level of consciousness.3. Change in locus of control.4. slurred speech.(3) Change in locus of control (LOC) is the most sensitive indicator of changes in perception/sensation. This precedesslurred speech or changed pupillary responses.165. Expressive aphasia is associated with:1. left hemisphere cardiovascular accident (CVA).2. right hemisphere cardiovascular accident (CVA).3. occipital area cardiovascular accident (CVA).4. temporal area cardiovascular accident (CVA).(1) Expressive, nonfluent aphasia is associated with left hemisphere cardiovascular accident (CVA).166. Which area of the brain is associated with perception?1. temporal lobe2. parietal lobe3. frontal lobe4. occipital lobe(2) The right side of the brain, especially the parietal lobe, is important in perception. Temporal lobe makes memories

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and stores them. Frontal lobe is reasoning, personality, and mathematical. Occipital lobe is for vision.167. Agnasia is a sequelae of cardiovascular accident (CVA). This involves the loss of ability to:1. recognize and use familiar objects correctly.2. read and write.3. carry out a learned sequence.4. recognize relationships of various body parts.(1) Agnasia involves the inability to recognize familiar objects.168. Parkinson’s disease is a chronic, progressive motor disorder caused by the loss of:1. dopamine from substantia nigra.2. acetylcholine from the basal ganglia.3. muscarinic receptors in the muscles.4. myelenation of the motor nerves.(1) Destruction of the dopaminergic neurons in substantia regia reduces the amount of neurotransmitter dopamine.169. The four classic manifestations of Parkinson’s disease are:1. tremors, rigidity, bradykinesia, and postural inability.2. ptosis, salivation, altered gait, and postural inability.3. sporadic muscle jerkiness, dysphagia, altered gait, and urinary overflow.4. fatigue, paresthesias, decrease of temperature, and paralysis.(4) Tremor of Parkinson’s disease is known as pill rolling (nonintentional) tremors; muscle movement is slowed andstiff. Rigidity causes the loss of facial expression and forward tilt of the body for posture.170. Myasthemia Gravis is a rare, chronic disease that affects the deficit of which neurotransmitter?1. dopamine2. acetylcholine3. GABA4. serotonin(2) Acetylocholine, a neurotransmitter, decreases the number of acetylcholine reception post-synaptic membrane.171. The medication most commonly used in the management of Parkinson’s disease is:1. Mestinon.2. Sinemet.3. Allopurinol.4. Crestor.(2) The drug of choice in managing Parkinson’s disease is Sinemet. This drug is a combination of Carbidopa andLevodopa, which restores dopamine to the brain. Carbidopa blocks peripheral conversion of the Levodopa makingmore dopamine available in the brain. Levodopa crosses the blood brain barrier and is converted to dopamine.Select all that apply.172. Clients with special needs require specific communication techniques. Which specific communication techniques should a nurse utilize when caring for a client who is cognitively impaired? Select all that apply.a. Maintain eye contact b. Keep communication simple and concretec. Use open-ended questions d. Demonstrate or pantomime ideas

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Correct answers: a and b.The nurse should maintain eye contact, keep communication simple and concrete, avoid open-ended questions, and be client when communicating with a client who is cognitively impaired. Demonstration or pantomiming ideas are not effective techniques for communicating with those who are cognitively impaired.173. Trust-building is an important nursing activity when establishing a nurse–client relationship. When a nurse draws the curtains around a client’s bed, which trust builders are the nurse utilizing? a. Providing a comfortable environment b. Ensuring client confidentialityc. Enhancing client privacy d. Providing a personal spaceCorrect answers: a, b, c, and d.By performing the simple act of drawing the curtains around a client’s bed, the nurse is providing a more comfortable environment, ensuring client confidentiality, enhancing client privacy, and providing a personal space; all of which aid the client in establishing a sense of trustwith the nurs174. Which actions by the nurse are barriers to therapeutic nurse—client communication? a. Focusing on the diagnosis instead of the client b. Using slang terminologyc. Using open-ended questions d. Giving adviceCorrect answers: a, b, and d.Barriers to therapeutic communication include: focusing on the diagnosis instead of the client; using slang terminology; and giving advice. Using open-ended questions isa therapeutic communication technique.175. The goal of the therapeutic environment is to promote health and healing. Which statements are true regarding clients in a therapeutic environment? a. Clients are active participants in their own livesb. Clients take ownership of their behavior and environmentc. Clients are independent and self-sufficientd. Clients are responsible for safety and trust developmentCorrect answers: a, b, and c.Clients in a therapeutic environment are active participants in their lives, take ownership of their behavior and environment, and function independently and self-sufficiently. The nurse is responsible for facilitating safety development and trust development within the therapeutic environment.176. Room assignments on a psychiatric unit are based on which factors?a. The client’s gender b. The client’s fragilityc. The client’s race d. The client’s length of stayCorrect answers: a, b, and d.Room assignments on a psychiatric unit are based upon numerous factors which include: gender, fragility, length of stay, age, overall behavior, and level of personal distress.177. The nurse assists the mental health client in achieving and maintaining self-control of behavior. A commonly-used behavioral management technique is the use of contracts made with the client. Which statements are accurate regarding client contracts? a. A contract gives a client greater control over negaive thinkingb. A contract may be used to hold a client accountable for his/her actionsc. A contract serves as a constant reminder of client tasks and goalsd. A contract promotes self-expression and the exchange of ideasCorrect answers: b and c. A contract may be used to hold a client accountable for his/her own actions and serves as a constant reminder of client tasks and goals. Cognitive restructuring gives a client greater control over negative thinking by correcting the distortions. Group therapy promotes self-expressionand the exchange of ideas.

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178. During a crisis, the client and family cannot function normally and require interventions to regain equilibrium. In crisis situations, the nurse should facilitate referrals to which health care professionals? a. A psychiatrist b. A psychiatric nurse specialistc. A hospital emergency department d. A crisis centerCorrect answers: a, b, c, and d.In crisis situations, it is appropriate for the nurse to facilitate referrals to psychiatrists, psychiatric nurse specialists, hospital emergency departments, and crisis centers179. When caring for a client on suicide precautions, which items should the nurse remove from the room?a. Hand mirror b. Nail file c. Aerosol deodorantd. Alcohol based mouth wash e. Nail polish remover f. MatchesCorrect answer: all of the above.Anything, glass, sharp objects, flammable liquids, or items in any way able to inflict injury must be removed from the room. This includes alcohol-based solutions and aerosol cans. If the client is not is in a private room, these types of items belonging to the other person in the room must also be removed.180. Clients with histories of which of the following factors are at increased risk for committing suicide?a. Substance abuse b. Impulsiveness c. Intractable, severe paind. Family history of child abuse e. Altered body imageCorrect answer: all of the above. Substance abuse, impulsiveness, intractable, severe pain, family history of child abuse and altered body image are all risk factors for suicide.181. Domestic violence is rarely a one-time occurrence in a relationship; it usually continues and escalates in severity. Which factors increase the risk of an individual becoming violent? a. Alcoholism b. High stress levelsc. Financial independency d. Physical dependencyCorrect answers: a, b, and d. Risk factors for abuse include: alcoholism; high stress levels; physical, emotional, and/or financial dependency; high emotions; and history of violence.182. A nurse in the Emergency Department is caring for a client who has been smoking crack cocaine. The client’s pupils are dilated and the client is euphoric, tachycardic, and agitated. As the client experiences withdrawal from crack cocaine, which side effects should the nurse anticipate? a. Psychosis b. Hallucinations c. Illusions d. Nausea and vomitingCorrect answers: a, b, and d. A client who is undergoing withdrawal from cocaine may experience side effects which include psychosis, hallucinations, delusions, depression, paranoia, ideas of persecution, hypervigilance, aggression, tremors, insomnia, fatigue, muscle pain, suicidal ideation, nausea, vomiting,hyperthermia and general malaise.183. Opioids are often prescribed by physicians for pain control and are commonly-abused substances. Which medications are opioids? (a. morphone (Dilaudid) b. Meperidine (Pethidine)c. MDMA (Ecstasy) d. Lorazepam (Ativan)Correct answers: a and b.Hydromorphone (Dilaudid) and meperidine (Demerol) are opioids. MDMA (Ecstasy) is a form of methamphetamine. Lorazepam (Ativan) is a benzodiazepine184. Which nursing interventions are appropriate for a client experiencing alcohol withdrawal? a. Provide a private, lighted environment for recovery b. Implement seizure precautions

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c. Orient the client to person, place, and time d. Provide small, frequent, high-carbohydrate feedingsCorrect answers: a, b, c, and d. When caring for a client who is experiencing alcohol withdrawal, it is appropriate for the nurse to provide a private, lighted environment to reduce the potential for hallucinations, implement seizure precautions, orient the client to person, place, and time, provide small, frequent high-carbohydrate feedings, monitor vital signs and neurological status, record intake and output, and provide support to the client, family, and significant others185. A nurse is discharging a client from a psychiatric unit who has been under suicide precautions. The nurse is providing discharge teaching to the client and the family. Which content would be appropriate for the nurse to teach? (Select all that apply.)a. Signs of an impending crisis b. Signs of suicidal behaviorc. Signs of chemical abuse and dependency d. Signs of emotional abuseCorrect answers: a, b, and c. It is appropriate for the nurse to teach the client and family about the signs of an impending crisis that could precipitate suicidal thoughts, the signs of suicidal behavior to help the family recognize risk for suicide, and signs of chemical abuse and dependency, which is commonlyssociated with suicidal behavior. There is nothing to suggest that the client has been emotionally abused or is an emotional abuser.186. Electroconvulsive therapy (ECT) is used as an effective treatment for which mental disorders? a. Depression b. Severe catatonia c. Mania d. SchizophreniaCorrect answers: a, b, c, and d. ECT may be used as an effective treatment for depression that does not respond to antidepressant pharmacotherapy, severe catatonia, mania, or schizophrenia.187. A nurse on a psychiatric unit is performing an initial assessment on the mental health of a client. Which assessment finding could be indicative of psychopathology? a. Calm affect b. Disorientationc. Inappropriate dress d. Poor hygieneCorrect answers: b, c, and d. Abnormal assessment findings that could be indicative of psychopathology include disorientation, inappropriate dress, poor hygiene, absent memory recall, and incoherent or illogical thought processes.188. Antidepressant medications must be prescribed and administered with care, particularly when being given to elderly clients. Which adverse effects should the nurse anticipate when administering antidepressants to elderly clients? a. Anticholinergic effects b. Cardiac effects c. Agitation d. HostilityCorrect answers: a and b. Antidepressants may cause anticholinergic, cardiac, and orthostatic side effects as well as interactions with other medications. Agitation and hostility are not side effects of antidepressant use.189. A nurse is caring for an elderly client who is experiencing dementia. Which assessment findings would the nurse expect? a. Forgetfulness b. Memory loss c. Hostility d. HallucinationsCorrect answers: a, b, and c. Forgetfulness, memory loss, and hostility are all signs of dementia in the elderly. Hallucinations are a sign of delirium—a medical emergency.190. Which statement made by a participant in a seminar on delirium indicates that additional clarification is needed?a. “If untreated, permanent brain damage can occur.” b. “It is considered a medical emergency.”c. “It mostly affects elderly living in institutional settings.” d. “It may result in hallucinations.”Correct answers: a, b, and d. Delirium begins with confusion and progresses to disorientation over a brief time span. It is considered a medical emergency and, if untreated, may result in permanent brain

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damage. Hallucinations are a sign of delirium. Dementia mostly affects elderly living in institutional settings.191. When assessing a client for cocaine use, for which signs would the nurse observe? a. Hypotension b. Tachycardia c. Tachypnea d. Dilated pupilse. Agitation f. Lack of concentration g. Slurred speech h. Poor coordinationi. Hypervigilance j. TremorsCorrect answers: b, c, d, e, and f.Tachycardia, tachypnea, dilated pupils, agitation, and lack of ability to concentrate are all effects of cocaine use. Hypertension, not hypotension, is also an effect. Slurred speech and poor coordination are signs of benzodiazepine use. Hypervigilance and tremors are signs ofcocaine withdrawal.192. A client recently released from prison for embezzlement has a history of blaming others for his problems and becoming defensive and angry when criticized. He has expressed neither remorse for his actions nor any response to his conviction. He claims his actions were justified since his employer did not treat him fairly. He is displaying characteristics of which personality disorder?A. Narcissistic B. Histrionic C. Antisocial D. Borderline Rationale C. Antisocial: The described behavior reflects DSM-IV diagnostic criteria for antisocial personality disorder. His behavior is not characteristic of individuals diagnosed with narcissistic, histrionic, or borderline personality disorder.193. A 35-year-old client is being interviewed by the nurse. The client’s history indicates that she has few friends, fears criticism and rejection from others, and withholds information about her thoughts and feelings because she anticipates a negative reaction. Based on the data, the nurse suspects that the client may have which of the following personality disorders?A. Schizotypal B. Paranoid C. Avoidant D. SchizoidRationale C. Avoidant : The described behavior reflects the DSM-IV diagnostic criteria for avoidant personality disorder. Her behavior is not characteristic of individuals diagnosed with schizotypal, paranoid, or schizoid personality disorder.194. A client who is unable to cope with the sudden loss of a job and who is feeling confused and unable to make decisions is said to be experiencing which of the following?A. Adventitious crisisB. Maturational crisisC. Situational crisisD. Social crisisRationale: A situational crisis is one that is often sudden and unavoidable. The stressful event threatens a person’s physical, emotional, or social integrity. An adventitious crisis (option 1) occurs from an accidental or sporadic event. A maturational crisis (option 2) occurs because of a situation occurring from the maturing process, such as in adolescents or older adults. A social crisis (option 4) is a crisis that occurs within a social context.195. The nurse on an alcohol and drug rehabilitation unit teaches a client group about depression and suicide. Which behavioral clue would the nurse identify as suggestive of suicide?a. Joking about stressful situationsb. Verbalizing feelings of hopelessness and helplessness about problemsc. Engaging in weekend drinking episodesd. Seeking help for symptoms of depressionCorrect answers B Feelings of hopelessness and helplessness are key indicators suggesting suicide. Joking indicates a coping mechanism. Engaging in weekend drinking episodes suggests a

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substance abuse problem. Seeking help for symptoms of depression indicates the client's desire for a positive change.196. The nursing plan of care for a client with depression who has verbalized the wish to die identifies the period of greatest suicide risk as which of the following?a. During the period of recovery from depressionb. During the period of deepest depressionc. Prior to effective onset of action of antidepressantsd. When the client continues to ruminate about problemsCorrect answers. A Although the client's risk for suicide is ever-present, the greatest risk for suicide occurs during the recovery period from depression. At this time, individuals with severe depression experience the energy level to follow through with self-destructive thoughts.197. The nursing assessment of a client who expresses suicidal intent is made based on which of the following principles about suicide prevention?a. Clients expressing intentions of suicide rarely follow through with the action.b. Degree of suicidal intent is not a static quality and may change day-to-day.c. Following a suicidal gesture, the client will be grateful to be alive.d. Questions related to the specific details of a suicide plan are not therapeutic.Correct answers. B A client's degree of suicidality is not a static quality, possibly fluctuating quickly and unpredictably. Therefore, assessment of suicide risk is an ongoing process, not a single event. Clients expressing suicide intent may or may not follow through with the action. After a suicidal gesture, the client may be more depressed about not having been successful. Direct questioning about suicide intent, including specific details of the plan, is essential.198. Which nursing intervention would be the priority for a client with suicidal intent?a. Encouraging verbalization of negative feelingsb. Pointing out the positive aspects of livingc. Providing activities to keep the client busyd. Reassuring the client that thoughts of suicide will decreaseCorrect answers. A The priority intervention for a client with suicidal intent is to encourage the client to verbalize negative feelings. Doing so helps clients to explore the reasons underlying the suicidal ideation and provides them with support. Pointing out the positive aspects of living is inappropriate and non-therapeutic. Providing activities to keep the client busy ignores the client's needs. Telling the client that thoughts of suicide will decrease is false reassurance.199. A client has committed suicide while hospitalized on an inpatient psychiatric unit. The nursing staff and treatment team participate in a process of reviewing the client's behaviors and the completed suicide despite all precautions implemented on the unit. The staff is engaging in which of the following?a. Psychological autopsyb. Postvention processc. Treatment analysisd. Team discussionCorrect answers. A Interaction with the staff, in which the staff reviews the client's behaviors and suicidal act, is referred to as a psychological autopsy, a process used to examine what clues, if any, were missed so that staff members can learn from the evaluation of a particular situation. This process also provides staff members with an opportunity to self-assess their behavior and responses and discuss their concerns with peers. Postvention is a therapeutic program for bereaved survivors of a suicide. Treatment analysis and team discussion are general terms related to client care.

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PART II1.The basic functional unit of the nervous system is called aA. neuron. B. synapse. C. receptor. D. neurotransmitter.2.Treatment of mental illnesses using psychotropic drugs is directed atA.altering brain neurochemistry. B. correcting brain anatomical defects.C.regulation of social behaviors. D. activating the body's normal response to stress.3.Which of the following is classified as a circadian rhythm?A. sex drive B. skeletal muscle contractionC. sleep cycle D. maintenance of a focused stream of consciousness4.Homeostasis is promoted via interaction between the brain and internal organs mediated byA. conscious behavior. B. the autonomic nervous system.C. the sympathetic nervous system. D. the parasympathetic nervous system.5. Cells that respond to stimuli, conduct electrical impulses and release neurotransmitters are calledA. neurons. B. synapses. C. dendrites. D. receptors.6.Which imaging technique can provide information about brain function?A. CT scan B. PET scan C. MRI scan D. skull x-ray7.When a tumor of the cerebellum is present, the nurse would expect that the client would initially demonstrateA. disequilibrium. B. abnormal eye movement.C. impaired social judgment. D. blood pressure irregularities.8.Which organs secrete hormones that are a normal component of the body's general response to stress?A. brain, thyroid gland, pancreas B. brain, pituitary gland, adrenal glandsC. pituitary gland, pancreas, thyroid gland D. adrenal glands, parathyroid glands9.The behavior of an individual who seems unable to learn right from wrong and who repeatedly violates norms and laws demonstrates problems related to the brain's inability toA. regulate conscious mental activity. B. retain and recall past experience.C. regulate social behavior. D.maintain homeostasis10.A client receiving a psychotropic drug complains to the nurse that he is drowsy all the time and is having difficulty focusing his attention. The nurse will correctly interpret this symptom as related to the drug's effect on the brain's ability to regulateA. mood. B. thought. C. memory. D. alertness.11.A client's communication is marked by loose associations and word salad. Dysfunction of which portion of the brain can the nurse hypothesize is responsible for these symptoms?A. cerebrum B. cerebellum C. brain stem D. basal ganglia12. Based on current understanding of neurotransmitters, the nurse can view a client's symptoms of profound depression as at least partially related toA. increased dopamine level. B. decreased serotonin level.C. increased norepinephrine level. D. decreased acetylcholine level.13.A client taking a medication known to block H1 should be carefully observed forA. sedation, weight gain, hypotension. B. motor abnormalities, GI disturbances.C. priapism, ejaculatory disturbances. D. dry mouth, urinary retention, constipation.14.When the nurse knows a client is taking a medication that has anticholinergic properties, the nurse would assess forA. sedation, drowsiness, hypotension, weight gain. B. orthostatic hypotension, memory dysfunction.

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C. blurred vision, dry mouth, constipation.D. tremors, tachycardia, ejaculatory dysfunction.15.The physician mentions to the nurse that the medication prescribed for a client is thought to potentiate the action of GABA. The nurse would evaluate treatment as being successful when the client demonstratesA. less anxiety. B. normal appetite.C. improved sleep pattern. D. reduced auditory hallucinations.16.The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. What change would cause the nurse to evaluate the treatment as successful?A. mood elevation B. decreased painC. improved memory D. reduced aggression17.The physician tells a client who demonstrates use of many rituals, "We want to do an imaging study that will tell us which parts of your brain are particularly active. We believe the study will help us determine how to treat your symptoms." From this explanation, the nurse can determine that the physician will order a/anA. CT scan. B. PET scan. C. ventriculogram. D. electroencephalogram.18.A client is admitted to the hospital with severe depression. The physician mentions the possibility that depression may be related to hormonal imbalances associated with stress. Which substance would be implicated?A. buspirone B. cortisol C. mirtazapine D. clomipramine 19.Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by:A. Blocking the reuptake of neurotransmitters at nerve endingsB. Increasing alertness levels in the brainC. Decreasing levels of epinephrine and serotonin at nerve endingsD. Increasing the placebo effect20. Patients taking antipsychotic medications may be periodically prescribed a “drug-free holiday.” The nurse explains that the purpose of this is to help prevent:A. Noncompliance due to side effectsB. Higher costs by decreasing amount of drug usedC. Destructive behaviors by allowing patient to regain controlD. Tardive dyskinesia and other extrapyramidal reactions21. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"The head man expects some cash today." Nurse-"I am not sure what you mean. Who is the head man?"A. informing B.theme identification C.clarification D.sharing perception22. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"My mother hates me." Nurse-"Tell me about a time when you thought your mother hated you."A.focusing B.broad opening C.reflection D.suggesting23.Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"I need to change my appointment time again" (Said with an expression of dread). Nurse-"I am wondering from your expression if it is difficult for you to ask."A.clarification B.sharing perception C.theme identification D.reflection24. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"I don't know what to do. My cat is home and no one is there to feed it." Nurse-"Have you thought about asking a friend to feed your cat?"A.restating B.suggesting C.informing D.restating

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25.Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"I don't know where to start." Nurse-"Tell me about what has been on your mind recently."A.broad opening B.reflection C.sharing perception D.suggesting26. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"Since my wife left me nothing matters." Nurse-"You have spoken so often of feeling deserted by your wife. It seems this change has left you feeling empty."A.clarification B.focusing C.informing D.theme identification27. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"I just want to scream when my husband spends all his time at the computer." Nurse-"You are feeling very frustrated about your husband spending time at the computer."A.focusing B.restating C.reflection D.broad opening28. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"I am going to a restaurant on my pass." Nurse-"Let's review the special diet required while you are taking this antidepressant."A.theme identification B.informing C.clarification D.suggesting29. Read the communication dialogue and select the appropriate technique from the choices provided. Patient-"After my son left home at fourteen, my life went downhill." Nurse-"You say your life is going downhill since your son left?"A.restating B.sharing perception C.broad opening D.focusing 30. What type of relaxation technique does Lyza uses if a machine is showing her pulse rate, temperature and muscle tension which she can visualize and assess?A. Biofeedback B. MassageC. Autogenic training D. Visualization and Imagery31. Adequate fluid intake for a patient on Lithium is:a. 1,000 ml per day 1,500 ml per day c. 2,000 ml per day d. 3,600 ml per day32. The most recent Lithium level on bipolar patient indicates a drop nontherapeutic level. What associated behavior does the nurse assess?a. Ataxia b. Confusion c. Hyperactivity d. Lethargy33. To understand the meaning of the cleaning rituals, the nurse must realize:a. The patient cannot help herself b. The patient cannot changec. Rituals relieve intense anxiety d. Medications cannot help34. 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 medicationb. Modifying the routine to diminish her bedtime anxietyc. Reminding her to perform rituals early in the eveningd. Limit the amount of time she spends washing her hands35. 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 playfulnessc. Inability to alter plans d. Insistence that things be done his way36. The patient will not be able to stop her compulsive washing routines until she:a. Acquires more superego b. Recognizes the behavior is unrealisticd. Regains with reality c. No longer needs them to manage her feelings of anxiety35. The nursing interventions most effective in working with substance dependent pts are:a. Firm and directive b. Instillation of valuesc. Helpful and advisory d Subjective and non-judgmental

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37. In attempting to control a patient who is suffering panic attack, the nursing priority is:a. Provide safely b. Hold the patientc. Describe crisis in detail d. Demonstrate ADLs frequently38. Which assessment would the nurse most likely find in a person who is suffering increased anxiety?a. Increasing BP, increasing heart rate and respirationsb. Decreasing BP, heart rate and respirationsc. Increased BP and decreased respirationsd. Increased respirations and decreased heart rate39. In teaching stress management, the goal of therapy is to:a. Get rid of the major stressor b. Change lifestyle completelyc. Modify responses to stress d. Learn new ways of thinking40. 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?a. Paranoia b. Delusion of persecution c. Hallucination d. Illusion41. 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 psychosisc. Content of the hallucination d. Otitis media42. The nurse is caring for a client whom she suspects is paranoid. How would thenurse confirm this assessment?a. indirect questioning b. Direct questioningc. Les-ad-in-sentences d. Open-ended sentences43. Which of the following is an example of a negative symptom of schizophrenia?a. Delusions b. Disorganized speechc. Flat affect d. Catatonic behavior44. 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 feedingb. Assist the patient with showering and tasks for hygienec. Reassure the patient about safely, and try to orient him to his surroundingsd. Encourage, socialization with peers, and provide a stimulating environment45. 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 b. Jaundice c. Dyskinesia d. Agranulocytosis46. 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 alongb. Perceptual disturbance related to delusion of persecutionc. Social isolation related to impaired ability to trustd. Impaired social skills related to inadequate developed superego47. 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 isc. How grandiose the client is d. How the client is behaving48. 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 alcoholb. Exercising 1 hour before bedtime to promote sleep

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c. Importance of steeping whenever the client tiresd. Drinking warm milk before bed to induce sleep49. When preparing to conduct group therapy, the nurse keeps in mind that theoptimal number of clients in a group would be:a. 6 to 8 b. 10 to 12 c. 3 to 5 d. Unlimited50. Which treatment approach would be most therapeutic for a hospitalized client with antisocial behavior?a. participation in group therapy b. negotiating the treatment plan with the clientc. a one to one nurse client relationship d. providing an unstructured environment51. The nurse knows which medication may be safely prescribed for a client alreadytaking lithium (Lithane)?a. Hydrochlorothiazide b. Ibuprofen (Advil)c. Succinylcholine (Anectine) d. Valproic Acid (Depakane)52. A client is admitted through the emergency department with a diagnosis of depression. During the initial phase of the relationship with this client, the nurse would expect which reaction to interpersonal communication?a. insight b. silence c. anger d. elation53. Initially the nurse would expect a client to react to a diagnosis of cancer with:a. anger b. denial c. acceptance d. fear54. A priority nursing intervention for a client experiencing an acute manic episode?a. discourage the client’s use of vulgar language b. protect the client from impulsive behaviorc. maintain the client’s contact with his/her familyd. redirect excessive energy to creative tasks55. A client who is taking chlorpromazine hydrochloride (Thorazine) is experiencing extrapyramidal side effects (EPS). The nurse understands that EPS is:a. dysfunction of the cardiovascular system b. involuntary muscle movementsc. similar to a seizure disorder d. a toxic reaction of the liver56. The nurse knows an appropriate short term goal for a client exhibiting manic behavior is for the client to:a. identify three strengths b. compete in a unit volley ball gamec. chair the unit’s self-government meeting d. paint alone for 15 minutes57. A client is admitted with a history of extremely elevated, irritable mood for a week. On assessment the nurse notes grandiosity, insomnia, flight of ideas, and psychomotor agitation. The nurse sets as a priority short term goal: the client will demonstrate:a. improvement in judgement b. adequate nutrition and restd. stability of mood c. understanding of medication regimen58. In the early stages of Alzheimer’s disease, the nurse would anticipate that a client will retain the ability to:a. cope with stressful experiences b. solve simple mathematical problemsc. remember a daily schedule d. recall the events of the distant past59. What would the nurse most expect to observe in a client with impulsive behavior?a. ability to delay gratification b. low tolerance for frustrationc. good problem solving skills d. commitment to long term goals60. The nurse knows the most common side effect of benzodiazepine antianxiety medications is:a. confusion b. headache c. sedation d. flatulence61.An ongoing critically important responsibility of nurses working on an in-patient psychiatric unit is

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A. fostering research. B. milieu management.C. sympathetic listening. D. providing negative feedback.62 .Which is a characteristic of a therapeutic in-patient milieu?A. It provides for client safety.B. Clients are responsible for all decisions about privileges.C. Rules and behavioral limits are inconsistently enforced.D. Staff provide frequent and ongoing negative feedback to clients.63.In most in-patient psychiatric units it can be expected that administration of medications will involveA. the nurse taking a medication cart from client to client.B. the nurse taking medications to one client at a time.C. clients coming to a central location to receive medication.D. less than one-quarter of the clients receiving medication.64.Which would not be considered a crisis on a psychiatric unit?A. Mr. R. goes into shock.B. Ms. T goes into cardiopulmonary arrest.C. Mr. S demonstrates anger that escalates to physical assault.D. Mrs. U, who hears voices telling her to hit others, asks for and receives prn medication.65.When a client is admitted to a behavioral health unit, which of the following does he/she NOT have a patient's right to do?A. refuse treatment B. send and receive mailC. seek legal counsel D. retain all possessions brought to the hospital66.A basic nursing student assigned to the psychiatric inpatient unit shouldA. view clients as potential threats to personal safety.B. take unilateral action to make changes in client care plans.C. maintain open communication with staff, managers and instructors.D. seek opportunities to inform interdisciplinary staff of less restrictive alternatives.67.When a number of staff gather to provide silent support for a staff member who has given a directive to a client in an attempt to de-escalate a crisis, the intervention is calledA. show of force. B. milieu management.C. behavioral contingency. D. management by coercion.68 karmah is being prepared for discharge. The nurse instructs tier husband to observe signs of depression. The following behaviors indicate recurrence of depression. Except:a. Grandiosity b. Insomniac. psychomotor retardation d. feeling of hopelessness69. AS the nurse approaches pt he says"If you come any closer, I die." This is an example of:a. Hallucination b. Delusion c. illusion d. idea of reference70. The best response for the nurse to make to this behavior is:a. How can I hurt you? b. I'm the nursec. Tell me more about this d. That's a silly thing to say71. Trust may develop in the nurse -client relationship when the nursea. avoid limit setting b. encourage the client to use "testing" behaviorsc. tell him how he should behave d. Uses consistency in approaching the client.72. A client is suffering from post-traumatic stress disorder following a rape by anunknown assailant. One of the primary goals of nursing care for this client would be to;a. Establish safe, supportive environment b. Control aggressive behaviorc. Deal with the client's anxiety d. Discuss client's nightmare and reactions.

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73. A mate client on the psychiatric unit becomes upset and breaks a chair when a visitor does not show up. The first nursing intervention should be to"a. Say with the client during the stressful time.b. Ask direct questions about the client's behaviorc. Set limits and restrict client's behaviord. Ran with the client on hew he can better handle frustration.74. Ms. Zepetee is treated for multiple stab wounds to the abdomen. After surgical repair the nurse notes that the client's pain does not seem to be relieved by the prescribed IM pethidine. The nurse recognizes that the failure to achieve pain relief from indicates that she is probably experiencing the phenomenon of:a. tolerance b. habituation c. physical addiction d. psychologic75. During the physical assessment Lizbeth's arms remains outstretched after her pulse and blood pressure were taken and the nurse has to reposition it for her. Lizbeth is showing;a. Distractability b. Muscle rigidity c. Waxy flexibility d. Echopraxia76. A male client who has delusions of persecution and auditory hallucination is admitted for psychiatric evaluation after stabbing a friend. Later a nurse on the unit greets the client by saying, "Good evening. How are you?" The client who has been referring to himself as "man," answers, "The man is bad." This is example of:a. Dissociation b. Transference c. Displacement d. Reaction formation77. A disturb client starts to repeat phrase that others have just said. This type of speech is known as:a. Autism b. Echolalia c. Neologism d. Echopraxia78. Projection, rationalization, denial, and distortion by hallucinations and delusions are examples of a disturbance in:a. Logic b. Association c. Reality testing d. The thought process79. The major reasons for treating severe emotional disorders with tranquilizers is to:a. Reduce the neurotic syndrome b. Prevent secondary complicationc. Prevent destructiveness d. Make the client more amenable to psychotherapy80. The nurse recognizes that dementia of the Alzheimer's type is characterized by a. Aggressive acting out behavior b. Periodic remissions and exacerbationsc. Hypoxia of of brain tissue d. Areas of brain destruction called senile plaques81. 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 ADLsc. Reorient him to reality d. Administer antipsychotic medications82. Which of the following is a therapeutic response to a patient in depression when he says, "Don't waste your time with me."a. "Just call me when you are okey." b. “I’ll stay with you for a while."c. "Why did you say that?" d. " Can you manage alone?"83. Which of the following nursing intervention would be most appropriate for a patient with bipolar disorder in Manic stage?a. restraints c. Frequently reminding patient of things he should not do.b. Ensure safety d. Do not respond to their enthusiasm.84. A patient taking MAOI Is correct when he states:a."I will drink beer instead of wine."b. "MAO inhibitors are considered as effective as other forms of treatment."c. "I will not eat bananas especially those which are over ripe."d. "I should avoid milk & milk products

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85. What js the difference between a depression of a normal person and that of a mentally ill person?a. the same c. Mentally ill is subject to suicidal tendenciesb. no cure d. Seldom occurs and does not last long in normal person.86. A client In MAOI (Nardil) therapy can eat which of tie following food?a. Chocolates b. Avocado c. cheese d. fresh vegetables87. Which organ functioning should be assessed prior to giving lithiuma. Kidney b. Liver c. heart d. lungs88. Lithium serum of 2.5 is:a. above normal b. normal c. toxic d. non therapeutic89. Difficulty in naming previously known objects is:a. expressive aphasia b. dysplasia c. global aphasia d. dysphagia90. Which of the following types of behavior is expected from a client diagnosed withparanoid personality disorder?a. Eccentric b. Exploitative c. Hypersensitive d. Seductive91. Which of the following is not a sign of anxiety?a. Dyspnea b. Hyperventilation c. Moist mouth d. GI symptoms92. Which of the following is not a characteristic of a panic disorder?a. Nausea b. Excessive perspiration c. Urination d. Chest pain93. Which of the following describes a person using words that have no known meaning?a. Neologisms b. Neolithic c. Verbalism d. Delusional blocking94. On arrival for admission to a voluntary unit, a female client loudly announces: “Everyone kneel, you are in the presence of the Queen of England.” This is: a. A delusion of self-belief b. A delusion of self-appreciation c. A nihilistic delusion d. A delusion of grandeur95. The situation in which individuals have excessive worry or belief that they are suffering from a physical illness despite lack of medical evidence is known as: a. Pain disorder b. Phobic disorder c. Somatoform disorder d. Dissociative disorder 96. A newly admitted client states, “No one cares, everyone is against me.” This type of statement is consistent with what disorder? a. Paranoid personality disorder b. Schizoid personality disorder c. Schizotypal personality disorder d. Antisocial personality disorder 97. Your client states, “I work for the government, and I am so important in my office that that the other people will not be able to work without me.” This is characteristic of: a. A histrionic personality disorder b. An antisocial personality disorder c. A narcissistic personality disorder d. A multiple personality disorder 98. An appropriate nursing diagnosis of a client with a major depression is: a. Alteration in activity b. Alteration in perceptions c. Alteration in affect d. Alteration in social activity99. A client is diagnosed with catatonic schizophrenia. Which is the highest priority nursing diagnosis? a. Noncompliance b. Impaired communication c. Ineffective coping d. Self-care deficit 100. A disorder where an individual may manifest a personality that is opposite to a previous identity is: a. Psychogenic amnesia b. Somatoform disorder c. La belle indifference d. Psychogenic fugue

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PART III MATCHING ANSWERSColumn A WITH ANSWERS Column B1. a Diazepam (Valium) a. Benzodiazepine antianxiety agent2. b Phenelzine (Nardil) b. Monoamine oxidase inhibitor(MAOI)antidepressant3. e Sertraline (Zoloft) c. Benzodiazepine antagonist4. f Methylphenidate (Ritalin) d. Psychedelic5. o Buspirone (BuSpar) e. Selective serotonin reuptake inhibitor antidepressant6. b Tranylcypromine (Parnate) f. Methamphetamine7. a Lorazepam (Ativan) g. Opiate antagonist8. c Flumazenil (Aexate) h. Antipsychotic9. n Valproic acid (Depokene) i. Serotonin modulator antidepressant10 g Naloxone (Narcan) j. Tricyclic antidepressant11. h Chlorpromazine (Thorazine) k. Alcohol deterrent12. j Imipramine HCl (Tofranil) l. Antimania (mood stabilizing) agent13. h Haloperidol (Haldol) m. Anti-Parkinsonism agent14. j Amitriptyline HCl (Elavil) n. Anticonvulsant15. k Disulfiram (Antabuse) o. Other antianxiety agent16. h Olanzapine (Zyprexa) p. Other antidepressant17. l Lithium carbonate (Eskalith)18. m Benztropine (Cogentin)19. h Clozapine (Clozaril)20. h Risperidone (Risperdal

Match the following (note that descriptions may be used once, more than once, or not ECT: Match the terms on the left with the descriptions listed on the right.

Column AColumn AAnsw a. Major indication for ECTb. The only absolute contraindication for ECTc. Given prior to ECT to decrease secretions and increase heart rated. Administered prior to, during, and following ECTe. Most common cause of mortality associated with ECTf. Administered as a short-acting anestheticg. Thought to be increased by ECTh. Most common side effects of ECTi. Required before treatment can be initiatedj. Muscle relaxant given to prevent bone fractures

1. Atropine sulfate2. Succinylcholine3. Thiopental sodium4. Increased intracranial pressure5. Temporary memory loss and confusion6. Major depression7. Oxygen8. Informed consent9. Norepinephrine and serotonin

10 .Recent myocardial infarction

1. c 2. j3. f4. b5. h 6. a7. d8. i

9 .g10 .e

Indicate whether each of the following statements is true or false. About SuicideAnsw 1. Suicide is an inherited trait.2. Gunshot wounds are the leading cause of death among suicide victims.3. Most people give clues and warnings about their suicidal intentions.4. If a person has attempted suicide, he or she will not do it again.5. Suicide is the act of a psychotic person.6. Once a person is suicidal, he or she is suicidal forever.7. Most suicides occur when the severe depression has started to improve.8. Most suicidal people have ambivalent feelings abut living and dying.9. If a suicidal person is intent upon dying, he or she cannot be stopped.

10 .People who talk about suicide don’t commit suicide.

1. F 2. T3. T 4. F5. F 6. F7. T8. T

9 .F 10 .F

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