ASN Traditional 2015-2017 Adaptive Quizzing for the NCLEX-RN Exam: Psychobiological Disorders

When a nurse sits next to a depressed client and begins to talk, the client responds, "I'm stupid and useless. Talk with the other people who are more important." Which response is most therapeutic?

"I want to talk with you because you are important to me."

A client with schizophrenia is admitted to a psychiatric unit. The client is talking while walking in the hall, is unkempt, and obviously has not washed in several days. What should the nurse say when trying to help this client shower?

"I'll help you take your shower now."

A client with schizophrenia reports having ongoing auditory hallucinations that he describes as "voices telling me that I'm a bad person" to the nurse. What is the best response by the nurse?

"Try to ignore the voices."

After detoxification a client with a long history of alcohol abuse decides to attend Alcoholics Anonymous (AA) meetings at the hospital. On the day of the second meeting the client says, "I can't go to the AA meeting today because I'm expecting an important phone call." The most therapeutic response by the nurse is:

"You are expected to go to the meeting."

Clients with eating disorders often exhibit similar symptoms. What should the nurse expect an adolescent with anorexia nervosa to exhibit?

Affective instability

When caring for a newly admitted depressed client, a nurse arranges for a staff member to remain with the client continuously. What information supports the nurse's decision to institute this precaution? Select all that apply.

Agitated pacing in the hall History of suicide attempts Statements that life is not worth living

An adolescent with a major depressive disorder is prescribed venlafaxine (Effexor). What signs or symptoms related to the medication should the nurse communicate immediately to the prescribing provider? Select all that apply.

Blurred vision Suicidal ideation Difficult urination

A client with schizophrenia is started on a regimen of chlorpromazine (Thorazine). After 10 days a shuffling gait, tremors, and some rigidity are apparent. Benztropine mesylate (Cogentin) 2 mg by mouth daily is prescribed. What should the nurse remember when administering these medications together?

Both medications have a cholinergic blocking action.

The nurse is caring for a client with dementia whose expression of emotions is altered. Which behavior is unexpected with this client?

Curiosity

A nurse is making a home visit to a young male client manifesting chronic symptoms of AIDS. The nurse assesses the client for signs of altered mental health function associated with AIDS. Select all that apply.

Delusions Memory loss Hopelessness Paranoid thinking

A nurse determines that a client is pretending to be ill. What does this behavior usually indicate?

Malingering

The nurse manager of a psychiatric unit informs the primary nurse that a client will be admitted to the unit within an hour. The client's admission diagnosis is paranoid schizophrenia. What classic clinical findings should the nurse anticipate? Select all that apply.

Prominent delusions Auditory hallucinations

A severely depressed client is to have electroconvulsive therapy (ECT). What should a nurse include when discussing this therapy with the client?

Sleep will be induced and the treatment will not cause pain.

A client with the diagnosis of borderline personality disorder has been exhibiting manipulative, inappropriate behavior and consistently attempting to take advantage of the other clients. What should the nurse consider first before confronting the client?

The depth of their working relationship

What is the prognosis for a normal productive life for a child with autism?

Unlikely because of interference with so many parameters of function

A nurse who is assessing a recently hospitalized client with a diagnosis of opioid addiction should look for signs of withdrawal. What are these signs? Select all that apply.

Yawning Muscle aches

A depressed client tells a nurse, "I want to die." What is the most therapeutic response by the nurse?

"You would rather not live."

A client who is a polysubstance abuser has been ordered by the court to seek drug and alcohol counseling. When working with the client, the nurse identifies several treatment goals. List in priority order the outcome criteria for this client.

1. Verbalizes that a substance abuse problem exists 2. Discusses effect of drug use on self and others 3. Expresses negative feelings about the current life situation 4. Explores the use of substances and problematic behaviors

A nurse is assessing a client with dementia. Which clinical manifestations are expected? Select all that apply.

Agitation Short attention span Disordered reasoning Impaired motor activities

A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients in how to dress, what to eat, and where to sit. The nurse should intervene because these behaviors eventually will cause the other clients to feel:

Angry

A nurse recalls that in a conversion disorder, pseudoneurological symptoms such as paralysis or blindness:

Are generally necessary for the client to cope with a stressful situation

A male adolescent with the diagnosis of antisocial personality disorder spends a great deal of time with a female adolescent client on the unit. One day the nursing assistant enters the female client's room and finds them in bed together. The nursing assistant reports the incident to the nurse. The nurse should:

Arrange a discussion with both adolescents and follow mandatory reporting guidelines related to child abuse.

A hyperactive client with bipolar I disorder becomes loud and insulting and says to a staff member, "Get lost, you old buzzard!" The nurse can best handle this situation by:

Asking the client to come with her for a walk

An admission assessment is conducted for a young adult client being admitted for suicidal ideation. In light of this information, the nurse recognizes that the priority intervention is:

Assessing the client for confusion and hyperreflexia

All of the following are appropriate crisis interventions. Place the interventions in the order the nurse would implement them for a client experiencing escalating levels of anxiety.

Attempt to identify the source of the anxiety. Encourage deep breathing and relaxation techniques. Provide firm but kind directions. Place the client in restraints if deemed dangerous.

A nurse is caring for several clients with major thought disorders such as schizophrenia. They are all being treated with neuroleptic drugs. How do these drugs act in the body to promote mental health?

By blocking access to dopamine receptors at the postsynaptic receptor site

When determining whether a client has anorexia nervosa or bulimia nervosa, the nurse should identify those characteristics that relate only to anorexia nervosa. Select all that apply.

Cachexia Delayed psychosexual development

A parent of a 17-year-old girl who has been hospitalized for extremely disturbed acting-out behavior leaves a gift for the daughter but says, "I'm too busy to visit today." The daughter becomes upset and tearful after being given the message and opening the package. What does the nurse conclude that the parent's actions represent?

Double-bind message

A client is brought to the emergency department by friends because of increasingly bizarre behavior. Which signs does the nurse identify that indicate that the client was using cocaine? Select all that apply.

Euphoria Agitation Hypervigilance Impaired judgment

A client with a diagnosis of schizophrenia, undifferentiated type, is being admitted to the psychiatric unit. What clinical manifestations does the nurse expect when assessing this client? Select all that apply.

Excited behaviors Loose associations Inappropriate affect

A client with obsessive-compulsive disorder is working toward discussing how his anxiety influences his feelings and the ability to function. What should the nurse include when planning care for this client? Select all that apply.

Exploration of anxiety-provoking situations Assisting the client in examining personal standards

A client is admitted to the psychiatric unit during the first episode of an acute psychotic disorder. The plan of care calls for psychiatric, medical, and neurological evaluation. What essential intervention should be included in the plan?

Instituting psychopharmacologic prescriptions and supportive communication

What should be the nurse's first intervention in the care of a client with a generalized anxiety disorder?

Removing as many stimuli from the client's environment as possible

The multidisciplinary team decides to use a behavior modification approach for a young woman with anorexia nervosa. Which planned nursing intervention is an appropriate approach to use with this client?

Restricting the client to her room until she has gained 2 lb

A client has been attending weekly outpatient psychotherapy sessions for several months. The nurse psychotherapist has been working with the client to help lessen obsessive-compulsive behaviors that have interfered with the client's work performance. What information about the client best validates the client's improvement?

She receives a letter from a supervisor at work stating that her job performance has improved.

A client comes to a mental health center with severe anxiety, evidenced by crying, hand-wringing, and pacing. What should the first nursing intervention be?

Staying physically close to the client

The nurse is acting as group leader for the weekly gathering of clients with bipolar disorder and their families. When the wife of one client expresses concern that, "he's not taking the medications right and will never get better," other family members begin to express their concerns about medication effectiveness. Several clients respond that the family members just don't understand what they are dealing with. Place the following nursing interventions in the appropriate order to best address the issues being expressed.

The nurse needs to reestablish a tone of mutual respect, trust, and confidentiality among the group's members. Restating expectations and guidelines will assist in achieving that goal. Identifying concerns in a manner that allows all members to be involved will help eliminate misconceptions and flawed assumptions. The nurse can them accurately assess the problems and concerns. Providing time for the discussion of specific concerns by both family and clients supports effective discussion of the problems and concerns. Identifying positive outcomes facilitates hope and focuses attention on the plan of care. Once communication and specific concerns are addressed, the members can turn their attention to the task of refocusing on the plan of care.

What should the nurse do when a client with the diagnosis of schizophrenia talks about being controlled by others?

React to the feeling tone of the client's delusion.

A client's severe anxiety and panic are often considered "contagious." What action should be taken when a nurse's personal feelings of anxiety are increasing?

Saying, "Another staff member is coming in. I'll leave and come back later."

A client who has just begun attending Alcoholics Anonymous (AA) meetings asks a nurse how important it is to attend meetings regularly. What is the best response by the nurse?

"Do you think that attending these meetings won't be helpful?"

A nurse approaches a depressed client who is sitting alone in the dayroom. What is best for the nurse to say to the client?

"I'll be sitting with you for a while today."

A client with a diagnosis of schizophrenia, undifferentiated type, was admitted to the mental health hospital 3 days ago. The client stays in the bedroom except to eat and has no verbal interaction with other clients. When the nurse approaches, the client walks away and says, "Just leave me alone." What is the best response by the nurse?

"I'll talk to you later."

A school-aged child is brought to the clinic by the mother, who states, "Something is very wrong. My child never seems happy, and he refuses to play." When assessing this child for depressed behavior, the nurse initially begins with the statement:

"Let's talk about what you do after school."

A client who uses a ritual of counting paper in the printer tells the nurse, "I'm spending 30 minutes counting each time I make copies, and my boss is getting very upset. What should I do?" What is the best response by the nurse?

"Limit photocopying by clustering it to two or three times a day."

The nurse is interviewing a female adolescent with anorexia nervosa who is malnourished and severely underweight. The nurse concludes that the client is experiencing secondary gains from her behavior when she says:

"My mother keeps trying to get me to eat."

What is most appropriate for a nurse to say when interviewing a newly admitted depressed client whose thoughts are focused on feelings of worthlessness and failure?

"Tell me how you feel about yourself."

What is the priority nursing intervention in the planning of nursing care for an adolescent client with anorexia nervosa?

Rewarding weight gain by increasing privileges

A psychiatric nurse has been working with a client who is experiencing a relapse of psychotic symptoms. Command hallucinations are ruled out, and the content of the auditory messages has been determined. What should the nurse's next planned intervention be?

Assisting the client in recognizing hallucinations when they occur

A nurse is caring for a client with the diagnosis of alcohol withdrawal delirium. Which action is most appropriate for the nurse to implement?

Assuring the client that the symptoms are part of the withdrawal syndrome

A client is admitted to the drug detoxification unit for cocaine withdrawal. What is the nurse's primary concern while working with clients withdrawing from cocaine?

Risk for self-injury

When caring for clients with the diagnosis of anorexia nervosa or bulimia nervosa, it is important that the nurse understand the sociocultural influences related to eating disorders in the United States. What are these influences? Select all that apply.

Diet industry Fashion trends Competitive women's athletics

A nurse is interviewing a client newly admitted to an outpatient program after withdrawal from alcohol. What behavior best indicates that the client has accepted that drinking is a problem?

Attends Alcoholics Anonymous meetings daily

During the intake interview at a mental health clinic, a client in withdrawal reveals to the nurse long-term, high-dose cocaine use. Which signs and symptoms support the conclusion that the client has been abusing cocaine for a prolonged time? Select all that apply.

Sadness Psychomotor retardation

The only survivor of a motor vehicle collision is found to have posttraumatic stress disorder. The client verbalizes that one long-term goal is to have a sense of control over personal feelings related to the trauma. What should the nurse include in the client's plan of care?

Discussing life situations that the client is able to manage

When establishing a plan of care, the nurse should understand that a male client's delusion that he is an important government adviser is most likely related to:

A need to feel a sense of importance within his environment

A practitioner prescribes divalproex (Depakote) for a client with the diagnosis of bipolar I disorder, manic episode. What side effects of this medication might the client report during a follow-up visit?

Dizziness, nausea, and vomiting

Shortly after admission an adolescent falls to the floor and exhibits tonic-clonic movements. There is no verbal response, but a nurse observes that the client is still chewing gum. What should the nurse do next?

Document the observation.

An agitated, acting-out, delusional client is receiving large doses of haloperidol (Haldol), and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations should alert the nurse to stop the drug immediately? Select all that apply.

Jaundice Tachycardia

A client has been in the alcohol detoxification unit for 5 days. In the evening the client complains of numbness and tingling in the feet and legs. What is the most appropriate nursing intervention?

Keeping the bed linens off the client's legs with a mechanical aid

Schizophrenia is associated with negative symptoms. In the assessment of a client with schizophrenia, which symptoms are classified as negative symptoms? Select all that apply.

Lack of energy Poor grooming

A client is admitted to an alcohol rehabilitation center. On the fourth day after admission, the nurse detects a strong odor of alcohol on the client's breath. What is the nurse's first action?

Locating and removing the alcoholic substance

A nurse is caring for an angry, hostile client with the diagnosis of borderline personality disorder. What is probably an issue for this client?

Low self-esteem

A nurse who works in a mental health facility determines that the priority nursing intervention for a newly admitted client with bulimia nervosa is to:

Check on the client continually.

A nurse is assessing a client with a diagnosis of primary insomnia. Which findings from the client's history may be the cause of this disorder? Select all that apply.

Chronic stress Excessive caffeine Environmental noise/distractors

A client is anxious, and the health care provider prescribes Alprazolam (Xanax) 5 mg by mouth 3 times a day. What should the nurse do before administering this prescription?

Clarify the prescription with the health care provider The prescribed dosage is excessive, and it must be questioned before its administration. Ventilation of feelings does not affect the need to question the prescription. Therapeutic dosages of Alprazolam (Xanax) range from 0.75 mg to 4 mg daily; the maximal daily dose for panic attacks is 8 mg.

A client is not responding to antidepressant medications for treatment of major depression with suicidal ideation. After learning about electroconvulsive therapy (ECT), the client discusses the advantages and disadvantages with the primary nurse. The nurse concludes that the client understands the disadvantages of ECT when he states that one major disadvantage of ECT is that:

Memory is impaired just before and after the treatment.

An older client with vascular dementia has difficulty following simple directions for selecting clothes to be worn for the day. The nurse identifies that these problems as the result of:

Receptive aphasia

What defense mechanism should the nurse anticipate that a client with the diagnosis of schizophrenia, undifferentiated type, will most often exhibit?

Regression

An adolescent with a conduct disorder is undergoing behavioral therapy in an attempt to limit behaviors that violate societal norms. A specific outcome criterion unique to adolescents with this problem is:

Demonstration of respect for the rights of others

One morning a client tells the nurse, "My legs are turning to rubber because I have an incurable disease called schizophrenia." The nurse identifies that this as an example of:

Depersonalization

A client's antidepressant medication therapy has recently been modified to substitute a tricyclic antidepressant for the monoamine oxidase inhibitor (MAOI) prescribed 2 years ago. In light of this assessment data, collected during the follow-up appointment, the nurse should first:

Determine exactly when the client began taking the amitriptyline (Elavil).

When a nurse is admitting an older client to the mental health unit, it is important to identify any signs of dementia. What signs and symptoms denote the presence of dementia of the Alzheimer type? Select all that apply.

Forgetfulness Expressive aphasia

A 13-year-old student visits the school nurse numerous times over the course of several weeks. The student has reported, "I worry about my parents because I don't want them to get a divorce. They tell me that they're happy, but I can't stop worrying. I'm having trouble sleeping, I'm always tired, and my grades have dropped." Which condition does the nurse consider that this student may be experiencing?

Generalized anxiety

A client is admitted to the psychiatric hospital after many self-inflicted nonlethal injuries over the preceding month. Of which level of suicidal behavior is the client's behavior reflective?

Gestures

A 25-year-old male client is being treated for an anxiety disorder and issues related to impaired social interaction. The client accuses the health care providers of being homosexuals. This behavior indicatesthat the client is most likely:

Having difficulty handling unacceptable feelings about himself

A school nurse is caring for a 12-year-old child with school phobia. What should the school nurse anticipate will be included in the initial treatment plan?

Having the child present somewhere in the school building during the day

A disturbed male client, unprovoked, attacks another client. A short-term initial plan for this client should include:

Having the client sit with a staff member in whom he trusts

A hospitalized client hurriedly approaches the nurse, saying that it sounds like there is a roaring fire in the bathroom. In reality, the client's roommate has just turned the shower on full force. What term best describes this experience?

Illusion

A depressed client is admitted to the mental health unit. What factor should the nurse consider most important when evaluating the client's current risk for suicide?

Impending anniversary of the loss of a loved one

An older client is admitted to the hospital with the diagnosis of dementia of the Alzheimer type and depression. Which signs of depression does the nurse identify? Select all that apply.

Increased appetite Neglect of personal hygiene "I don't know" answers to questions "I can't remember" answers to questions

A client with a history of alcohol abuse was admitted 2 days ago for treatment of a gastrointestinal bleed. She has remained in bed as her pulse rate and blood pressure has gradually increased. She now has a low-grade fever. Place the following nursing interventions in the appropriate order to best minimize the client's risk for injury.

Initiate seizure precautions

A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? Select all that apply.

Neglect of personal hygiene "I don't know" answers to questions Apathetic response to the environment

Personality disorders are identified in the DSM-V in clusters. How should the nurse describe the behaviors of an individual with a cluster A personality disorder?

Odd and eccentric

To help a disturbed, acting-out child develop a trusting relationship, the nurse should:

Offer periodic support and emphasize safety in play activities.

A client with a history of gambling is experiencing legal difficulties for embezzling money and has been required to obtain counseling. During an intake interview the client says, "I never would have done this if I'd been paid what I am worth." What factor will create the greatest difficulty in helping this client develop insight?

Projection of reasons for difficulties onto others

When planning care for a 72-year-old client who has been admitted to the hospital because of bizarre behavior, forgetfulness, and confusion, the nurse should give priority to:

Promoting a structured environment

Which intervention will the nurse implement when assisting a child with a history of aggressive behavior to regain control in the triggering phase of an assault cycle?

Provide the child with a quiet, low stimulus environment.

Two weeks after a client has been admitted to the mental health hospital, the client's depression begins to lift. The nurse encourages involvement with unit activities, primarily because this type of activity:

Provides for group interaction

A nurse is caring for a client with bipolar I disorder. What should the plan of care for this client include? Select all that apply.

Providing a structured environment for the client Ensuring that the client's nutritional needs are met

A 30-year-old female client asks the nurse to change her room, stating that she hates her roommate and can't stand to be in the same room with her. Just as she finishes speaking, her roommate enters and the client tells her she missed her and has been all over the unit looking for her. The nurse recognizes that the client is using:

Reaction formation

A 54-year-old client has demonstrated increasing forgetfulness, irritability, and antisocial behavior. After being found walking down a street, disoriented and semi-naked, the client is admitted to the hospital, and a diagnosis of dementia of the Alzheimer type is made. The client expresses fear and anxiety. What is the best approach for the nurse to take?

Reassuring the client with the frequent presence of staff

The nurse notes that a young female client with anorexia nervosa telephones home just before each mealtime. She ignores reminders to eat and continues talking until the other clients are finished eating. She then refuses to eat food that has gotten cold. The nurse should initially:

Schedule a family meeting to discuss the problem.

A hyperactive, self-destructive child is to be discharged from an inpatient setting in a few days. In preparation for the child's discharge, it is most important for the nurse to plan to:

Schedule a team conference with the child and the parents.

The ritual of a male client with obsessive-compulsive disorder involves washing the hands every 30 minutes. The client becomes anxious and agitated if he is unable to perform this ritual. What should the nurse in the mental health daycare center do?

Set a contract with the client stating the frequency of the ritual.

What manifestations does the nurse expect to identify when taking a health history from a client with moderate dementia? Select all that apply.

Sundowning Exaggeration of premorbid traits

A nurse is teaching a group of recently hired staff members about conscious and unconscious defense mechanisms that are used to defend the self against anxiety. What is an example of a conscious defense mechanism that the nurse should include?

Suppression

A health care provider prescribes lithium carbonate for a client with bipolar disorder, depressive episode. What instructions should the nurse include when teaching the client about lithium? Select all that apply.

Take the medication with food. It may take several weeks for beneficial results to occur. You do not have to restrict your intake of dietary sodium.

When implementing a tertiary preventive program for cognitively impaired individuals the nurse should:

Teach children how to feed themselves.

What should the nurse do when an adolescent girl with the diagnosis of anorexia nervosa starts to discuss food and eating?

Tell the client gently but firmly to direct her discussion of food to the nutritionist.

The nurse is talking with a delusional client who has been hospitalized for 2 weeks. In the middle of the conversation the client suddenly stops talking, seems preoccupied, and then states, "I hear voices." Because the nurse has already assessed the content of the hallucinations, what is the most therapeutic response?

Telling the client, "I didn't hear any voices," and then focusing on the conversation