NCLEX questions test 1

A client diagnosed with paranoid personality disorder is being admitted on an involuntary 24 hour hold after a physical altercation with a police officer who was investigating the clients threatening phone calls to his neighbors. He states that his neighbors are spying on him for the government saying "I want them to stop and leave me alone. Now they have you nurses and doctors involved in the conspiracy". Which nursing approaches are most appropriate? Select all that apply 1. Approach the quiet and a professional matter-of-fact manner 2. Avoid intrusive interactions with the client 3. Gently present reality to counteract the clients current paranoid beliefs 4. Develop trust consistently with the client 5. Avoid pressuring the client to attend any groups

1,2,4,5

Which symptoms are expected indications that a client has alcohol withdrawal delirium? Select all that apply. 1. Tachycardia 2. Tachypnea 3. Dry flushed skin 4. Thirst 5. Hypertension 6. Abdominal cramping

1,2,5

A client moved in with her family after her boyfriend of four weeks told her to leave. She is admitted to the subacute unit after reporting feeling empty and lonely being unable to sleep and eating very little for the Last week. Her arms are scarred from frequent self-mutilation. What should the nurse do in order Of priority from first to last? All options must be used 1. Monitor for suicide and self mutilation 2. Discuss the issues of loneliness and emptiness 3. Monitor sleeping and eating behaviors 4. Discuss her housing options for after discharge

1,3,2,4

A new client on the psychiatric unit has been diagnosed with depression and obsessive compulsive personality disorder. During visiting hours her husband states to the nurse that he does not understand this OCPD and what can be done about it. What information should the nurse share with the client and her husband? select all that apply 1. Perfectionism and over emphasis on tasks usually interfere with friendships and leisure time 2. It will help to interrupt her tasks and tell her you are going out for the evening 3. There are medication such as clomipramine or fluoxetine that may help 4. Remind your wife that it is OK to be human and make mistakes 5. Reinforce with her that she is not allowed to expect the whole family to be perfect too 6. This disorder typically involves in flexibility and I need to be in control

1,3,4,6

A client has been diagnosed with dementia related to chronic and heavy alcohol consumption. In a family meeting with the client discharge plans are being discussed. Which point should the nurse share with the family and client? Select all that apply. 1. Even after all alcohol has been removed from the home clients frequently find ways to get more 2. Without continued alcohol intake the client will gradually get better 3. With the memory loss answer the clients question once and then ignore that question when asked again 4. Safety alarms on the doors will help to keep the client from wandering off 5. As the need for supervision increases it may be necessary for the client to be placed in an extended care facility

1,4,5

The most common reason given by mentally ill clients for noncompliance with medication is there uncomfortable adverse effects. When teaching the families, what needs to the nurse identify as the greatest? 1. Alternative ways to manage the adverse effects 2. Home visits to set up a weeks supply of medication 3. Family monitoring of the administration of medication 4. Outpatient monitoring of medication compliance

1. Alternative ways to manage the adverse effects

The nurse is talking with a client who has been diagnosed with antisocial personality disorder about how to socialize during activities without being seductive. The nurse should focus the discussion on which area? 1. Explaining the negative reactions of others towards his behavior 2. Suggesting he apologize to others for his behavior 3. Asking him to explain the reasons for his seductive behavior 4. Discussing his relationship with his mother

1. Explaining the negative reactions of others towards his behavior

Which behavior indicates to the nurse that the client diagnosed with avoidant personality disorder is improving? 1. Interacting with two other clients 2. Listening to music with headphones 3. Sitting at a table and painting 4. Talking on the telephone

1. Interacting with two other clients

A client is being discharged before complete stabilization of symptoms. When developing a discharge plan for this client, the nurse should ensure that the client will have which factor in place? 1. More medical consultations after discharge 2. Monthly outpatient visits 3. Many coordinated services 4. A caring and supportive family

1. Many coordinated services

The nurse orient an unlicensed assistive personnel New to the mental health unit about the principles for the care of a client diagnosed with personality disorder. What information should the nurse include? 1. The clients are accepted although their behavior may not be 2. The clients need limits on their behavior 3. The staff members are the primary ones left to care about these clients 4. The staff should use minimal humor when working with these clients

1. The clients are accepted although their behavior may not be

The nurse is reviewing laboratory values of a client receiving clonazepine. Which of the following laboratory values does the nurse immediately report to the healthcare provider? 1. WBC of 3,500 2. hgb of 11.9 g/dl 3. sodium of 136 mEq/L 4. hyaline casts in the urinalysis

1. WBC of 3,500

when developing the plan of care for a client diagnosed with a personality disorder, the nurse plans to assist the client primarily with what factor? 1. specific dysfunctional behaviors 2. psychopharmacologic compliance 3. examination of developmental conflicts 4. manipulation of the environment

1. specific dysfunctional behaviors

Crisis intervention plays a major role in the management of care for clients with chronic mental illnesses. Although the safety of the client and others is always a priority, these clients typically need crisis intervention in which situation? Select all that apply. 1. Inability to keep outpatient appointments 2. Signs of relapse and decompensation 3. Threat of eviction from housing 4. Unpaid bills and lack of food 5. Occasionally missing a dose of medication

2,3,4

in an outpatient addiction group a recovering client says that before her treatment her husband drank on social occasions. "Now he drinks at home, from time from the time he comes home from work and drinks until he goes to bed. He says that he doesn't like me anymore and that I expect him to do more work on the house and the yard. I used to ignore that stuff. I don't know what to do. " in which order of priority from first to last would the nurse make the comments? All options must be used 1. What do you think you could do to have your husband come in for an evaluation 2. I hear how confused and frustrated you are 3. It can happen that as one person sobers up the spouse deteriorates 4. What have you tried to do about your husband's behaviors

2,3,4,1

The client was diagnosed borderline personality disorder tells the nurse "you're the best nurse here. I can talk to you and you listen. You're the only one here that can help me. "Which response by the nurse is most therapeutic? 1. Thank you you're a good person 2. All of the nurses here provide good care 3. Other clients have told me that too 4. Mary and Sam are good nurses too

2. All of the nurses here provide good care

A client with a diagnosis of antisocial personality disorder has a potential for violence and aggressive behavior. Which short term client outcome is most appropriate for the nurse to include in the plan of care? 1. Use Humor when expressing anger 2. Discuss feelings of anger with staff 3. Ask the nurse for medication when upset 4. Use indirect behaviors to express anger

2. Discussed feelings of anger with staff

A 25-year-old client diagnosed with chronic schizophrenia states, "I stopped taking my medication a week ago. I was just tired of not being able to drink with my friends. Besides, I feel fine without them. "Which response by the nurse is most appropriate? 1. It's important for you to go back on your medication 2. I hear how difficult it must be to live with the changes caused by your illness 3. You'll have to talk to your healthcare provider about stopping your medication 4. Your buddies will understand that you can't drink anymore

2. I hear how difficult it must be to live with the changes caused by your illness

A nurse is teaching the families of client with chronic mental illness about the causes of relapse and rehospitalization. what should the nurse include as the primary cause? 1. Loss of family support 2. Noncompliance with medication 3. Sudden changes in medication 4. Non-attendance at treatment programs

2. Noncompliance with medication

a client is complaining to other clients about not bein allowed by staff to keep food in the clients room. What should the nurse do? 1. Ignore the clients behavior 2. Set limits on the behavior 3. Reprimand the client 4. Allow the snack to be kept in the clients room

2. Set limits on the behavior

The mother of a client with schizophrenia caused that visiting nurse in the outpatient clinic to report that her daughter has not answered the phone in 10 days. "She was doing so well for months. I don't know what's wrong. I'm worried. "Which response by the nurse is most appropriate? 1. Maybe she's just mad at you. Do you have an argument? 2. She may have stopped taking her medication. I'll check on her 3. Don't worry about this. It happens sometimes 4. Go over to her apartment and see what's going on

2. She may have stopped taking her medication. I'll check on her

The nurse assesses a client to be at risk for self mutilation and implement a safety contract with the client. Which client behavior indicates that the contract is working? 1. The client with draws to the clients room when feeling overwhelmed 2. The client will notify staff when anxiety is increasing 3. The client suppress feelings when angry 4. The client displaces feelings onto the healthcare provider

2. The client will notify staff when anxiety is increasing

Which approach is most appropriate to use with a client diagnosed with a narcissistic personality disorder when discrepancies exist between what the client states and what actually exists? 1. Limit setting 2. Supportive confrontation 3. Consistency 4. Rationalization

2. supportive confrontation

a client has been diagnosed with avoidant personality disorder. The client reports loneliness, but has fears about making friends. The client also reports anxiety about being rejected by others. In a long-term treatment plan, in what order, from first to last, should the nurse list interventions for the client. all options must be used. 1. teach the client anxiety management and social skills 2. ask the client to join in a chosen activity with the nurse and two other clients 3. talk with the client about self-esteem and fears 4. help the client make a list of small group activities at the center that the client would find interesting

3,1,4,2

A client admitted with a diagnosis of schizoaffective disorder, manic phase, who is currently taking fluoxetine, valproic acid, and olanzapine as prescribed, Has had an increase in manic symptoms in the past week. The healthcare provider prescribes a valproic acid blood level to be drawn at once. What does the nurse understand is the rationale for this prescription? 1. All clients taking valproic acid need periodic valproic acid levels drawn 2. Fluoxetine can decrease the effectiveness of the valproic acid 3. A decrease in the level of valproic acid could explain the increase in manic symptoms 4. The valproic acid level is needed before a short course of lorazepam for agitation can be prescribed

3. A decrease in the level of valproic acid could explain the increase in manic symptoms

A nurse working at an outpatient mental health center primarily with chronically mentally ill clients received a telephone call from the mother of the client who lives at home. The mother reports that the client has not been taking her medication and now is refusing to go to The work center where she has worked for the past year. What should the nurse do first? 1. Call the Director of the work center for information about the client 2. Reserve an inpatient bed in preparation for the clients admission 3. Ask to speak to the client directly on the phone 4. Make an appointment for the client to see the healthcare provider

3. Ask to speak to the client directly on the phone

A 22 year old client is being admitted with a diagnosis of brief psychotic disorder. Which finding would the nurse expect to find during the admission interview that is consistent with the clients diagnosis? 1. Current treatment for pneumonia 2. Regular use of alcohol or marijuana 3. Evidence of delusions or hallucinations 4. A history of chronic depression

3. Evidence of delusions or hallucinations

The client who has a history of angry outbursts when frustrated begins to curse at the nurse during an appointment after being informed that she will have to wait to have her medication refilled. Which response by the nurse is most appropriate? 1. You're being very childish 2. I'm sorry if you can't wait 3. I won't continue to talk with you if you curse 4. Come back tomorrow and your medication will be ready

3. I won't continue to talk with you if you curse

The Director of an outpatient rehab program tells the nurse that the client with schizophrenia has done well for six months until last week, when a new person started the program. This new person worked faster than the client did and took his place as leader of the group. Based on this information, which intervention is most appropriate? 1. Make a home visit, and tell the client that if he does not return to the program, he will lose his place there 2. Ask the Director to assign the client to another group when he returns to the program 3. Make an appointment to meet the client at the mental health center, and ask him about the situation 4. Arrange for the placement of the client in a skilled training program

3. Make an appointment to meet the client at the mental health center, and ask him about the situation

A 23 year old client diagnosed with schizophrenia cheerfully announces, "my mom and I are so excited that I'm pregnant. She is willing to help us take care of the baby too. "Which reason should Cause the nurse to be concerned about this situation? 1. The client did not say that the father of the baby was excited about this 2. The mother is not likely to provide enough help for what the client needs 3. Symptom management will be difficult in early pregnancy without medication 4. The client will have difficulty financially supporting the baby

3. Symptom management will be difficult in early pregnancy without medication

a client diagnosed with paranoid personality disorder is hospitalized for physically threatening his wife because he suspects her of having an affair with a coworker. What approach should the nurse employ with this client? 1. authoritarian 2. parental 3. matter of fact 4. controlling

3. matter of fact

During a home visit the nurse discovers that the client is less verbal, less active, less responsive to directions, severely anxious, and more dazed. The nurse interprets these findings to indicate that the client needs which intervention? 1. A sleep aid 2. A clinic appointment 3. An increase in medication 4. An immediate medical evaluation

4. An immediate medical evaluation

The stigma related to having a mental illness, especially a chronic illness, persists despite improvements in the management of illnesses and an increase in public education. Which view most perpetuate the stigma? 1. Mental illness is hereditary 2. Mental Illnesses have bio chemical bases 3. Clients cannot prevent mental illness if they want to do so 4. Clients can recover from mental illness if they have willpower

4. Clients can recover from mental illness if they have willpower

A young adult client is admitted to a psychiatric unit with a diagnosis of alcohol abuse and personality disorder. The clients mother states "he's always in trouble just like when he was a boy. Now he's just a bigger prankster and out of control." In view of the clients history which intervention is most important initially? 1. Letting the client know the staff has the authority to subdue him if he gets unruly 2. Keeping the client isolated from other clients until he is better known by the staff 3. Emphasizing to the client that he will have to pay for any damages he causes 4. Closely observing the clients behavior to establish a baseline pattern of functioning

4. Closely observing the clients behavior to establish a baseline pattern of functioning

An older adult experience is short term memory problems and occasional disorientation a few weeks after her husband's death she also is not sleeping cause urinary frequency and burning and sees rats in the kitchen. The home care nurse calls the woman's healthcare provider to discuss the client situation and background, assess, and give recommendations. The nurse concludes that the client most likely has which problem? 1. The onset of Alzheimer's disease 2. Trouble adjusting to living alone without her husband 3. Delayed grieving related to her Alzheimer's disease 4. Delirium and urinary tract infection

4. Delirium and urinary tract infection

The client diagnosed with borderline personality disorder who is to be discharged soon threatens to do something to herself if discharged. What should the nurse do first? 1. Request that the clients discharge be cancelled 2. Ignore the client statement because it is a sign of manipulation 3. Ask a family member to stay with a client at home temporarily 4. Discuss the meaning of the client's statement with her

4. Discuss the meaning of the client's statement with her

One evening the client takes the nurse aside and whispers "don't tell anybody but I'm going to call in a bomb threat to this hospital tonight." Which action is the priority? 1. Warning the client that his telephone privileges will be taken away if he abuses them 2. Offering to disregard the client plan if he does not go through with it 3. Notifying the proper authorities after saying nothing until the client has actually completed the call 4. Explaining to the client that this information will have to be shared immediately with the staff and the healthcare provider

4. Explaining to the client that this information will have to be shared immediately with the staff and the healthcare provider

The client approaches various staff with numerous requests and needs to the point of disrupting the staff to work with other clients. The nurse meets with the staff to Decide on a consistent therapeutic approach for this client. Which approach will be most effective? 1. Telling the client to stay in the clients room until staff approach 2. Limiting the client to the day room and dining area 3. Giving the client a list of permissible requests 4. Having the client discussed needs with the staff person assigned

4. Having the client discuss needs with the staff person assigned

Which facility with the nurse rank is the lowest priority to expand when developing a community-based service program for clients with chronic mental illnesses? 1. Partial hospitalization programs 2. Psychiatric home care 3. Residential services 4. Long term hospitals

4. Long-term hospitals

A client brought to the clinic after being arrested for harassing and stalking his ex-wife denies any other symptoms or problems except anger about being arrested. The ex-wife reports to the police, "he's fine except for this irrational belief that will remarry. "When collaborating with the healthcare provider about a plan of care, which intervention would be most effective for the client at this time? 1. A prescription for olanzapine 10 mg daily 2. A joint session with the client and his ex-wife 3. A prescription of fluoxetine 20 mg every morning 4. Referral to an outpatient counselor

4. Referral to an outpatient counselor

The client with histrionic personality disorder is melodramatic and response to others in situations in an exaggerated manner. The nurse should recommend which activity for this client? 1. Party planning 2. Music group 3. Cooking class 4. Role-playing

4. Role-playing

For the client who has difficulty falling asleep at night because of withdrawal symptoms from alcohol, which are abating, which nursing intervention is likely the most effective? 1. Inviting the client to play a board game with the nurse 2. Allowing the client to sit in the community room until the client feels sleepy 3. Advising the client to take multiple short naps during the day until symptoms improve 4. Teaching the client relaxation exercises to use before bedtime

4. Teaching the client relaxation exercises to use before bedtime

The client tells the nurse at the outpatient clinic that she does not need to attend groups because "she is not a regular like those other people here." How should the nurse respond to the client? 1. Because you are not a regular client sit in the fall when the others are in group 2. Your family wants you to attend and they'll be very disappointed if you don't 3. I'll have to mark you as absent from the clinic today and speak to the healthcare provider about it 4. You say you are not a regular here but you're experiencing what others are experiencing

4. You say you are not a regular here but you're experiencing what others are experiencing

A young client with a diagnosis of major depression and dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse "I don't know if I can make it in an apartment without my parents." How should the nurse respond to the client? 1. You are an adult now not a child who needs to be cared for 2. Your parents will not be around forever. After all they are getting older 3. Your parents need a break and you need a break from them 4. Your parents have been supported supportive and will continue to be even if you live part

4. Your parents have been supportive and will continue to be even if you live apart

when planning care for a client diagnosed with schizotypal personality disorder, which intervention helps the client become involved with others? 1. participating solely in group activities 2. being involved with primarily one-to-one activities 3. leading a sing-along in the afternoon 4. attending an activity with the nurse

4. attending an activity with the nurse

a client diagnosed with borderline personality disorder has self-inflicted cuts on the arms. The nurse is assessing the client for the risk of suicide. What should the nurse ask the client first? a. about medication the client has taken recently b. if the client is taking antidepressants c. if the client has a suicide plan d. why the client self-inflicted the cuts

c. if the client has a suicide plan