Psych-Final
A client has been taking fluoxetine, 40 mg daily at 0900 for 1 week. The client states he feels nervous and has had diarrhea. The nurse determines the client's symptoms are: a) indicative of an exacerbation of the client's depression. b) indicative that a dose increase is needed to treat the client's underlying anxiety. c) not significant because the client's symptoms are adverse effects of Prozac. d) important, probably suggesting a decrease in dosage or change to another medication.
d) important, probably suggesting a decrease in dosage or change to another medication.
A nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to order which psychotropic drug regimen on a short-term basis? a) Alprazolam, 0.25 mg orally every 8 hours b) Benztropine, 2 mg orally twice per day c) Buspirone, 15 mg two times per day 200 mg orally twice per day d) Chlorpromazine, 25 mg orally three times per day
a) Alprazolam, 0.25 mg orally every 8 hours
A client walks into the clinic and tells the nurse she has run out of money for crack, has crashed, and wants something to help her feel better. Which factor is most important for the nurse to assess? a) loss of appetite b) drug craving c) suicidal ideation d) suspiciousness
c) suicidal ideation
Drag and Drop question - Click and drag the following steps to place them in the correct order. Question: A client with a history of cocaine abuse is receiving intravenous therapy and exits the hospital "to visit a friend." The client returns to the nursing unit 1 hour later, agitated, aggressive, combative, and reporting "chest pain." Place the nurse's actions in priority order from first to last. All options must be used. 1 Obtain a urine sample. 2 Contact the security department. 3 Obtain an ECG. 4 Initiate a referral to obtain drug rehabilitation counseling.
Contact the security department. Obtain an ECG. Obtain a urine sample. Initiate a referral to obtain drug rehabilitation counseling.
A client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation in the anteroseptal leads and T-wave inversion in leads V3 to V5. Which medication should the nurse prepare to administer? a) Nitroglycerin b) Procainamide c) Epinephrine d) Lidocaine
a) Nitroglycerin
A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations? a) Aggressive behavior b) Paranoid thoughts c) Independence needs d) Emotional affect
b) Paranoid thoughts
A client has been severely depressed since her husband died 6 months earlier. Her physician orders amitriptyline hydrochloride, 50 mg by mouth daily. Before administering amitriptyline, the nurse reviews the client's medical history. Which preexisting condition requires cautious use of this drug? a) Hypernatremia b) Hepatic disease c) Hypokalemia d) Hiatal hernia
b) Hepatic disease
A client diagnosed with borderline personality disorder has self-inflicted cuts on her arms. The nurse is assessing the client for the risk of suicide. What should the nurse ask the client first? a) why she cut herself b) if she has a suicide plan c) if she is taking antidepressants d) about medications she has taken recently
b) if she has a suicide plan
Which statement by a client taking valproic acid for bipolar disorder indicates that further teaching about this medication is necessary? a) "I can take the pills with food." b) "I need to take the pills at the same time each day." c) "I can chew the pills if necessary." d) "I need to call my health care provider if I start bruising easily."
c) "I can chew the pills if necessary."
A client with bulimia binges twice a day. The nurse interprets these binges as most likely involving which factors for the client? a) feelings of euphoria and gratification b) eating increasing amounts of food for substantial weight gain c) feeling out of control and disgusted with self d) leaving traces of food around to attract attention
c) feeling out of control and disgusted with self
As an angry client becomes more agitated while talking about his problems, the nurse decides to ask for staff assistance in taking control of the situation when the client demonstrates which behavior? a) coming out of his room instead of staying in time-out b) making a fist and pounding loudly on the table c) picking up a pool cue stick and telling the nurse to get out of his way d) swearing about his wife's behaviors when discussing marital problems
c) picking up a pool cue stick and telling the nurse to get out of his way
client admitted for alcohol detoxification is taking disulfiram. The nurse should instruct the client to avoid ingestion of which foods and/or liquids? Select all that apply. a) communal wine at church b) aged cheese c) chocolates d) beer e) cough syrup
a) communal wine at church d) beer e) cough syrup
The nurse is assessing a client for heroin addiction. Which finding indicates the client has used heroin? a) pupils large and dilated b) pupils small and constricted c) sclera red and bloodshot d) drooping eyelids
b) pupils small and constricted
Which effects do most antipsychotic medications exert on the central nervous system (CNS)? a) They stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors. b) They sedate the CNS by stimulating serotonin at the synaptic cleft. c) They depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. d) They depress the CNS by stimulating the release of acetylcholine.
c) They depress the CNS by blocking the postsynaptic
A nurse is caring for a client diagnosed with bulimia nervosa. The most appropriate initial goal for this client is to: a) identify a connection between anxiety and eating behaviors. b) control eating impulses. c) restrict eating to three meals per day. d) avoid shopping for large amounts of food.
a) identify a connection between anxiety and eating behaviors.
A nurse is conducting a group session for children and adolescents who have been diagnosed with depression. Which behaviors would a nurse anticipate in this group? Select all that apply. a) Mania b) Suicidal thoughts c) Irritability d) Anxiety e) Somatic symptoms, such as headache and stomachache f) Delusions
b) Suicidal thoughts c) Irritability d) Anxiety e) Somatic symptoms, such as headache and stomachache
A young adult client with severe depression and suicide ideation has been started on the selective seratonin reuptake inhibitor (SSRI) sertraline. Which client statement would indicate the client needs further teaching about seratraline? a) "I can take this medicine with food." b) "It may take several weeks for depression to get better " c) "Being on sertraline will significantly decrease the chances that I might hurt myself." d) "Sexual side effects are pretty common with sertraline."
c) "Being on sertraline will significantly decrease the chances that I might hurt myself."
A nurse is caring for a client diagnosed with antisocial personality disorder. This client has a history of fighting, cruelty to animals, and stealing. Which trait is the nurse likely to uncover during assessment? a) History of gainful employment b) Demonstrated ability to maintain close, stable relationships c) A low tolerance for frustration d) Frequent expression of guilt regarding antisocial behavior
c) A low tolerance for frustration
A 6-year-old client is diagnosed with attention deficit hyperactivity disorder (ADHD). When asking this client to complete a task, what techniques should the nurse use to communicate most effectively with him? a) Fully explain to the client the actions required of him, and offer verbal praise and a food reward for task completion. b) Demonstrate to the client what he is to do, have him imitate the nurse's actions, and give a food reward if he completes the task. c) Obtain eye contact before speaking, use simple language, and have him repeat what was said. Praise him if he completes the task. d) Explain to the client what he is to do, the consequences if he does not comply, and follow through with praise or consequences as appropriate.
c) Obtain eye contact before speaking, use simple language, and have him repeat what was said.
A nurse in a psychiatric care unit finds that a client with psychosis has become violent and has struck another client in the unit. What action should the nurse take in this case? a) Do not restrain the client, as it is equivalent to false imprisonment. b) Do not restrain the client, as it is equivalent to battery. c) Restrain the client, as he is harmful to the other clients. d) Inform the physician and complete a comprehensive assessment.
c) Restrain the client, as he is harmful to the other clients.
A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl)(43.2 mmol/dL). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in his hands and feet. The nurse realizes that these symptoms probably result from: a) triglyceride buildup. b) acetate accumulation. c) thiamine deficiency. d) a below-normal serum potassium level.
c) thiamine deficiency.
A nurse works in a suicide crisis clinic. The clients she should consider to represent the highest risk for suicide are those who state: a) "If my life doesn't get better, I might take matters into my own hands." b) "I gave my clothes away because I'm depressed and think about death a lot." c) "I'm always thinking about dying." d) "I'm thinking of driving my car into a tree on the way home."
d) "I'm thinking of driving my car into a tree on the way home."
When planning the care of a client experiencing aggression, the nurse incorporates the principle of "least restrictive alternative," meaning that less restrictive interventions must be tried before more restrictive measures are employed. Which measure should the nurse consider to be the most restrictive? a) haloperidol given intramuscularly b) voluntary seclusion or time-out c) haloperidol given orally d) tension reduction strategies
a) haloperidol given intramuscularly
A nurse is caring for a client with bruises on her face and arms. Her husband refuses to leave the client's bedside and answers all of the questions for the client. Which intervention by the nurse would be most appropriate? a) Tell the husband that he must leave because he is intimidating the client. b) Question the woman in front of her husband. c) Contact hospital security to escort the husband from the hospital. d) Collaborate with the physician to make a referral to social services.
d) Collaborate with the physician to make a referral to social services.
A client prescribed an antipsychotic medication develops a high fever, muscle rigidity, and hypertension. The nurse immediately notifies the health care provider with concerns that the client is experiencing which life threatening condition? a) hypertensive crisis b) extrapyramidal reactions c) malignant hyperthermia d) neuroleptic malignant syndrome
d) neuroleptic malignant syndrome
Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together? a) To reduce anxiety and potentiate the neuroleptic's sedative action b) To counteract the neuroleptic's extrapyramidal effects c) To increase a client's level of awareness and concentration d) To manage depressed clients
a) To reduce anxiety and potentiate the neuroleptic's sedative action
A nurse is teaching a group of families who have members experiencing addiction about this problem. Which of the following, if stated by the families, indicates that the teaching was successful? a) A single factor is usually responsible for development of addiction. b) Addiction rarely results in the person experiencing relapse. c) Addiction is not a result of a person having moral faults. d) Addiction results from a defect in the person's character.
c) Addiction is not a result of a person having moral faults.
A client who has experienced the loss of her husband through divorce, the loss of her job and apartment, and the development of drug dependency is suffering situational low self-esteem. Which outcome is most appropriate initially? a) The client will identify two positive qualities. b) The client will prioritize problems. c) The client will discuss her feelings related to her losses. d) The client will explore her strengths.
c) The client will discuss her feelings
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 client's 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 their conspiracy." Which nursing approaches are most appropriate? Select all that apply. a) Develop trust consistently with the client. b) Gently present reality to counteract the client's paranoid beliefs. c) Avoid intrusive interactions with the client. d) Approach the client in a professional, matter-of-fact manner. e) Do not pressure the client to attend any groups.
a) Develop trust consistently with the client. c) Avoid intrusive interactions with the client. d) Approach the client in a professional, matter-of-fact manner. e) Do not pressure the client to attend any groups.
A client is being discharged after 3 days of hospitalization for a suicide attempt that followed the receipt of a divorce notice. Which client finding indicates to the nurse that the client is ready for discharge? a) Has a list of support persons and community resources. b) Displays emotional stability. c) Has the names and phone numbers of two divorce lawyers. d) Expresses a readiness for discharge.
a) Has a list of support persons and community resources.
A client admitted to the psychiatric unit for treatment of substance abuse tells a nurse, "It felt so wonderful to get high." What is an appropriate response? a) "Tell me more about how it felt to get high." b) "Don't you know it's illegal to use drugs?" c) "You told me you got fired from your last job for missing too many days after taking drugs all night." d) "If you continue to talk like that, I'm going to stop speaking to you."
c) "You told me you got fired from your last job for missing too many days after taking drugs all night."
Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect: a) a postoperative infection. b) septicemia. c) alcohol hallucinosis. d) alcohol withdrawal.
d) alcohol withdrawal.
A nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is: a) diphenhydramine. b) haloperidol. c) propranolol. d) benztropine.
d) benztropine.
A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase. The physician decides to start the client on lithium carbonate therapy. One week after this therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should the nurse do? a) Continue to administer the medication as ordered. b) Call the physician immediately to report the laboratory result. c) Withhold the next dose and repeat the laboratory test. d) Observe the client closely for signs and symptoms of lithium toxicity.
a) Continue to administer the medication as ordered.
A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome? a) The student reports increased comfort with making choices. b) The student discusses conflicts over drug use. c) The student agrees to inform his parents of his problem. d) The student accepts a referral to a substance abuse counselor.
d) The student accepts a referral to a substance abuse counselor.
An outpatient client who has a history of paranoid schizophrenia and chronic alcohol dependency has been taking risperidone for several months. She reports that she stopped drinking 4 days ago. The client is very frightened by the tactile hallucinations of bugs crawling under her skin. Which factor should the nurse incorporate into the plan of care when explaining the tactile hallucinations? a) interaction of alcohol and risperidone b) ineffectiveness of risperidone c) alcohol intoxication d) alcohol withdrawal
d) alcohol withdrawal
The nurse is assessing an adolescent with an annual physical. The mother reports that she has noticed a change in the child's behavior lately including mood swings, withdrawal from the family, and failing school grades. The mother does not know what to do and asks the nurse for guidance. What is the most appropriate guidance from the nurse? a) ?Adolescents are generally difficult children. Sometimes punishment is necessary to make them change their attitudes.? b) ?Let?s admit your child to an acute care facility so that we can run more tests.? c) ?These could be signs of substance abuse. Open communication and a referral to a counselor that specializes in substance abuse would be beneficial.? d) ?This is typical adolescent behavior. Ignore it and it will improve.?
c) ?These could be signs of substance abuse. Open communication and a referral to a counselor that specializes in substance abuse would be beneficial.?
A nurse is assigned to care for a client with anorexia nervosa. During the first 48 hours of treatment, which nursing intervention is most appropriate for this client? a) Trying to persuade the client to eat and thus restore nutritional balance b) Giving the client as much time to eat as desired c) Providing one-on-one supervision during meals and for 1 hour afterward d) Letting the client eat with other clients to create a normal mealtime atmosphere
c) Providing one-on-one supervision during meals and for 1 hour afterward
Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect: a) septicemia. b) a postoperative infection. c) alcohol withdrawal. d) alcohol hallucinosis.
c) alcohol withdrawal.
A client diagnosed with bulimia tells the nurse she only eats excessively when upset with her best friend, and then she vomits to avoid gaining a lot of weight. The nurse should next: a) have the client take lorazepam 1 mg as needed whenever she feels the urge to binge. b) schedule daily family therapy sessions. c) work with the client to limit her purging. d) enroll the client in a coping skills group.
d) enroll the client in a coping skills group.
A client is admitted to the emergency department having just used cocaine. The nurse should assess this client for which factors? Select all that apply. a) increased blood pressure b) mood swings c) constricted pupils d) feeling of euphoria e) tachycardia
a) increased blood pressure b) mood swings d) feeling of euphoria e) tachycardia
A nurse works in a suicide crisis clinic. The clients she should consider to represent the highest risk for suicide are those who state: a) "I'm always thinking about dying." b) "I gave my clothes away because I'm depressed and think about death a lot." c) "I'm thinking of driving my car into a tree on the way home." d) "If my life doesn't get better, I might take matters into my own hands."
c) "I'm thinking of driving my car into a tree on the way home."
What term best describes a person's sense of his or her own adequacy and worth? a) Self-esteem b) Esteem c) Self-actualization d) Love
a) Self-esteem
The client is admitted to the hospital for alcohol detoxification. Which intervention should the nurse use? Select all that apply. a) explaining to the client that the symptoms of withdrawal are temporary b) placing the client in restraints as a safety measure c) reinforcing reality if the client is disoriented or hallucinating d) taking vital signs e) monitoring intake and output
a) explaining to the client that the symptoms of withdrawal are temporary c) reinforcing reality if the client is disoriented or hallucinating d) taking vital signs e) monitoring intake and output
A nurse is facilitating mandated group therapy for clients who have sexually abused children. Children who are victims of sexual abuse are typically: a) willing to engage in sexual acts with adults. b) strangers to the abuser. c) from any segment of the population. d) of low socioeconomic background.
c) from any segment of the population.
Which finding indicates that a client who has been raped will have future adjustment problems and need additional counseling? a) She becomes upset when talking about the rape to anyone. b) She seeks support from formerly ignored relatives and friends. c) Her life becomes focused on helping other rape victims like herself. d) Her parents show shame and suspicion about her part in the rape.
d) Her parents show shame and suspicion about her part in the rape.
A client with major depression and suicidal ideation is suddenly calmer and more energetic. Which conclusion should the nurse reach? a) The client is improving. b) The client's medication dosage is too high. c) The client is overstimulated. d) The client is imminently suicidal.
d) The client is imminently suicidal.
A client has been receiving chlorpromazine, an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism? a) Involuntary rolling of the eyes b) Restlessness, difficulty sitting still, and pacing c) Extremity and neck spasms, facial grimacing, and jerky movements d) Tremors, shuffling gait, and masklike face
d) Tremors, shuffling gait, and masklike face
client is admitted to an inpatient unit for treatment of recurrent anorexia nervosa. The client states that 1 month before her admission her spouse took the children, moved out of the family home, and filed for divorce. The nurse recognizes that the client's exacerbation of anorexia nervosa most likely results from the client's effort to: a) manipulate her husband. b) live up to her parent's expectations. c) commit suicide. d) regain a sense of control.
d) regain a sense of control.
Which outcome criterion is appropriate for a child diagnosed with oppositional defiant disorder? a) The child will recognize responsibility for own behaviors. b) The child will establish his own limits and boundaries. c) The child will ask the nurses permission to sleep late. d) The child will verbalize his own needs and assert his rights.
a) The child will recognize responsibility for own behaviors.
A hospitalized client craves a drink after withdrawing from alcohol. Which measure is the best way to help the client resist the urge to drink? a) one-to-one supervision by the staff b) a routine search of visitors c) a locked-door policy d) support from other alcoholic clients
d) support from other alcoholic clients
A severely dehydrated adolescent admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. Her history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the past month. She is 5′ 7″ (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority? a) Addressing the client's low self-esteem b) Initiating caloric and nutritional therapy as ordered c) Instituting behavioral modification therapy as ordered d) Regularly monitoring vital signs and weight
b) Initiating caloric and nutritional therapy as ordered
A nurse is assessing a client at a mental health clinic who threatens suicide and describes having a plan. Which of the following should the nurse recognize as the priority goal for the client? a) Working with the client to resolve the immediate crisis b) Establishing a foundation for long-term therapy c) Notifying family members of the suicide plan d) Obtaining admission to an acute care facility
a) Working with the client to resolve the immediate crisis
A female client who is hospitalized for an eating disorder weighs 15 pounds less than ideal body weight. Which goal is a priority for this client? a) The client reports an improved self-image. b) The client attends all eating disorder support groups. c) The client gains 1 pound per week. d) The client eats bigger meals at breakfast.
c) The client gains 1 pound per week.
In assessing an adolescent client at an outpatient clinic, the nurse is able to recognize that depression in adolescents is often which of the following? a) Similar in symptomology to that of adult clients b) Often masked by aggressive behaviors c) A sign that the teenager needs to be admitted to the hospital d) Situational and not as serious as that of adult clients
b) Often masked by aggressive behaviors
After an upsetting divorce, a client who threatens to commit suicide with a handgun is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis takes highest priority for this client? a) Ineffective coping related to inadequate stress management b) Hopelessness related to recent divorce c) Spiritual distress related to conflicting thoughts about suicide and sin d) Risk for self-directed violence related to planning to commit suicide with a handgun
d) Risk for self-directed violence related to planning to commit suicide with a handgun
A nurse performing an assessment determines that a client with anorexia nervosa is currently unemployed and has a family history of affective disorders, obesity, and infertility. Based on this information, the nurse should monitor the client for which health concern? a) Suicide potential b) Alcohol abuse c) Avoidance behavior d) Explosive outbursts
a) Suicide potential
A client diagnosed with major depression and substance dependence is being admitted to the concurrent disorder treatment unit. In explaining the focus of this program, the nurse should tell what information to the client? a) There will be simultaneous treatment of the addiction and depression. b) As the addiction is treated, the depression will clear up on its own. c) The addiction will be treated first, then the depression. d) The depression with be treated first, then the addiction.
a) There will be simultaneous treatment of the addiction and depression.
A client is taking diazepam while establishing a therapeutic dose of antidepressants for generalized anxiety disorder. Which instruction should the nurse give to this client? Select all that apply. a) to take the medication on an empty stomach b) not to use alcohol while taking the drug c) to stop taking the drug if he experiences swelling of the lips and face and difficulty breathing d) to consult with his health care provider (HCP) before he stops taking the drug e) to avoid eating cheese and other tyramine-rich foods
b) not to use alcohol while taking the drug c) to stop taking the drug if he experiences swelling of the lips and face and difficulty breathing d) to consult with his health care provider (HCP) before he stops taking the drug
After teaching nursing students about substance abuse and its effects on individuals and families, the instructor determines that additional teaching is necessary when the students state which of the following? a) "Substance abuse is widespread, occurring in all types of settings." b) "People experiencing substance abuse problems often have difficulty using adaptive behaviors." c) "Individuals frequently engage in substance use and abuse to enhance their decision-making ability." d) "Substance abuse involves use of alcohol and illegal, prescribed, or over-the-counter drugs."
c) "Individuals frequently engage in substance use and abuse to enhance their decision-making ability."
A nurse working at an outpatient mental health center primarily with chronically mentally ill clients receives a telephone call from the mother of a 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? a) Call the director of the work center for information about the client. b) Make an appointment for the client to see the health care provider (HCP). c) Ask to speak to the client directly on the phone. d) Reserve an inpatient bed in preparation for the client's admission.
c) Ask to speak to the client directly on the phone.
A client newly admitted to a psychiatric inpatient setting demands a soda from a staff member who tells him to wait until lunch arrives in 20 minutes. The client becomes angry, pushes over a sofa, throws an end table, and dumps a potted plant. Which goal should a nurse consider to be of primary importance? a) Learning to effectively express needs to staff and others b) Talking with the client's family about his angry feelings c) Demonstrating control over aggressive behavior d) Performing an assessment for tardive dyskinesia
c) Demonstrating control over aggressive behavior
