Psych Exam 1 practice questions

A client tells the therapist, "I thought I would just die when my husband told me he was leaving me. If I had been a better wife, he wouldn't have fallen in love with another woman. It's all my fault." The therapist asks the client to explore what responsibilities the husband may have in the breakup. What cognitive therapy technique is the therapist using? a. Reattribution b. Role-play c. Decatastrophizing d. Thought recording

a

A client with depression asks the nurse, "Why would they be checking my thyroid function when I clearly have depression and I'm not overweight?" Which of these is an accurate response? a. An underactive thyroid gland can manifest as depression. b. Depression has been proven to be a hormonal illness. c. Thyroid hormone replacement is a first-line treatment for most clients with depression. d. All of the above.

a

A law school graduate failing the bar exam and a 15-year-old high school girl not being selected for the cheerleading squad are examples of which of the following? a. Focal stimuli b. Contextual stimuli c. Residual stimuli d. Spatial stimuli

a

A nurse who is helping a client in the preparation stage of the Psychological Recovery Model might include which of the following interventions? a. Teach about effects of the illness and how to recognize, monitor, and manage symptoms. b. Help the client identify triggers that cause distress or discomfort. c. Help the client establish a daily maintenance list. d. Listen actively while the client composes his or her personal story.

a

Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Maturational/developmental crisis c. Dispositional crisis d. Crisis of anticipated life transitions

a

Anna, who is 72 years old, is of the age when she may have experienced several losses in a short time. What is this called? a. Bereavement overload b. Normal mourning c. Isolation d. Cultural relativity

a

Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Brandon's belief is an example of a: a. Delusion of persecution. b. Delusion of reference. c. Delusion of control or influence. d. Delusion of grandeur.

a

Elisa says to the nurse, "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which of the following is an empathetic response by the nurse? a. "You are very angry now. This is a normal response to your loss." b. "I know what you mean. Men can be very insensitive." c. "I understand completely. My husband divorced me, too." d. "You are depressed now, but you will feel better in time."

a

How do antianxiety medications, such as benzodiazepines, produce a calming effect? a. Depressing the CNS b. Decreasing levels of norepinephrine and serotonin in the brain c. Decreasing levels of dopamine in the brain d. Inhibiting production of the enzyme MAO

a

IA concern with children on long-term therapy with CNS stimulants for ADHD is: a. Addiction b. Weight gain c. Substance abuse d. Growth suppression

a

Joe, an American Indian, appears at the community health clinic with an oozing stasis ulcer on his lower right leg. It is obviously infected, and he tells the nurse that the shaman has been treating it with herbs. The nurse determines that Joe needs emergency care, but Joe states he will not go to the emergency department (ED) unless the shaman is allowed to help treat him. How should the nurse handle this situation? a. Contact the shaman and have him meet them at the ED to consult with the attending physician. b. Tell Joe that the shaman is not allowed in the ED. c. Explain to Joe that the shaman is at fault for his leg being in the condition it is in now. d. Have the shaman try to talk Joe into going to the ED without him

a

Kaylee, age 26, graduated from law school with a 3.2/4.0 grade point average. She recently took the bar exam and did not pass. Because of this, she had to give up her job at a law firm. She became very depressed and sought counseling at the mental health clinic. During the intake assessment, Kaylee says to the psychiatric nurse, "I am a complete failure. I'm so dumb, I can't do anything right." What is the most appropriate nursing diagnosis for Kaylee? Which of the following outcome criteria would be most appropriate for the client described in question 1? a. Kaylee is able to express positive aspects about herself and her life situation. b. Kaylee is able to accept constructive criticism without becoming defensive. c. Kaylee is able to develop positive interpersonal relationships. d. Kaylee is able to accept positive feedback from others

a

Mark, who has come to the mental health clinic with symptoms of depression, says to the nurse, "My father is dying. I have always hated my father. He physically abused me when I was a child. We haven't spoken for many years. He wants to see me now, but I don't know if I want to see him." With which spiritual need is Joe struggling? a. Forgiveness b. Faith c. Hope d. Meaning and purpose in life

a

Mrs. S. asks the nurse, "Do you think I should tell my husband about my affair with my boss?" Which is the most appropriate response by the nurse? a. "What do you think would be best for you to do?" b. "Of course you should. Marriage has to be based on truth." c. "Of course not. That would only make things worse." d. "I can't tell you what to do. You have to decide for yourself."

a

One of the goals of therapeutic community is for clients to become more independent and accept self-responsibility. Which of the following approaches by staff best encourages fulfillment of this goal? a. Including client input and decisions into the treatment plan b. Insisting that each client take a turn as "president" of the community meeting c. Making decisions for the client regarding plans for treatment d. Requiring that the client be bathed, dressed, and attend breakfast on time each morning

a

Part of the nurse's continual assessment of the client taking antipsychotic medications is to observe for extrapyramidal symptoms. Which of the following are examples of extrapyramidal symptoms? a. Muscular weakness, rigidity, tremors, facial spasms b. Dry mouth, blurred vision, urinary retention, orthostatic hypotension c. Amenorrhea, gynecomastia, retrograde ejaculation d. Elevated blood pressure, severe occipital headache, stiff neck

a

Sam has a diagnosis of major depression. After an unsuccessful trial of antidepressant medication, Sam's physician has hospitalized him for a course of ECT treatments. Sam says to the nurse on admission, "I don't want to end up like McMurphy in One Flew Over the Cuckoo's Nest! I'm scared!" What is Sam's priority nursing diagnosis at this time? a. Anxiety related to deficient knowledge about ECT b. Risk for injury related to risks associated with ECT c. Deficient knowledge related to negative media presentation of ECT d. Acute confusion related to side effects of ECT

a

Simone, a depressed client who has been unkempt and untidy for weeks, today comes to group therapy wearing makeup and a clean dress with hair washed and combed. Which of the following responses by the nurse is most appropriate? a. "Simone, I see you have put on a clean dress and combed your hair." b. "Simone, you look wonderful today!" c. "Simone, I'm sure everyone will appreciate that you have cleaned up for the group today." d. "Now that you see how important it is, I hope you will do this every day."

a

The Quality and Safety Education for Nurses guidelines identify that student nurses need to be well schooled on informatics. This most directly refers to which of the following? a. Learning how to effectively communicate information using electronic health records b. Learning the SBAR method of reporting information c. Learning guidelines for preventing lawsuits d. Learning information about new treatments to keep nursing skills current

a

The client says to the nurse, "I've been offered a promotion, but I don't know if I can handle it." The nurse replies, "You're afraid you may fail in the new position." This is an example of which therapeutic technique? a. Restating b. Making observations c. Focusing d. Verbalizing the implied

a

The goal of cognitive therapy with depressed clients is to: a. Identify and change dysfunctional patterns of thinking. b. Resolve the symptoms and initiate or restore adaptive family functioning. c. Alter the neurotransmitters that are creating the depressed mood. d. Provide feedback from peers who are having similar experiences.

a

The most appropriate nursing intervention with Jenny (from question 5) would be to: a. Facilitate arrangements for her to start attending Alateen meetings. b. Help her identify the positive things in her life and recognize that her situation could be a lot worse than it is. c. Teach her about the effects of alcohol on the body and that it can be hereditary. d. Refer her to a psychiatrist for private therapy to learn to deal with her home situation.

a

The nurse decides to respect family wishes and not tell the client of his terminal status because that would bring the most happiness to the most people. Which of the following ethical theories is considered in this decision? a. Utilitarianism b. Kantianism c. Christian ethics d. Ethical egoism

a

The nurse hears John, a client with a history of violence, yelling in the dayroom. The nurse observes his increased agitation, clenched fists, and loud, demanding voice. He is challenging and threatening staff and the other clients. The nurse's priority intervention would be to: a. Call for assistance. b. Draw up a syringe of prn haloperidol. c. Ask John if he would like to talk about his anger. d. Tell John if he does not calm down he will have to be restrained.

a

The nurse identifies the primary nursing diagnosis for Theresa as Risk for suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would be most appropriate for this diagnosis? a. The client has experienced no physical harm to herself. b. The client sets realistic goals for herself. c. The client expresses some optimism and hope for the future. d. The client has reached a stage of acceptance in the loss of the relationship with her boyfriend.

a

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the diagnosis step of the nursing process? a. Identifies nursing diagnosis: Risk for suicide b. Notes that client's family reports recent suicide attempt c. Prioritizes the necessity for maintaining a safe environment for the client d. Obtains a short-term contract from the client to seek out staff if feeling suicidal

a

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the planning step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Obtains a short-term contract from the client to seek out staff if feeling suicidal d. Establishes goal of care: Client will not harm self during hospitalization

a

The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with bipolar I disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is: a. 1.0 to 1.5 mEq/L. b.10 to 15 mEq/L. c.0.5 to 1.0 mEq/L. d.5 to 10 mEq/L.

a

The thought recording (two-column and three-column) cognitive therapy techniques help clients: a. Identify automatic thoughts. b. Modify automatic thoughts. c. Identify rational alternatives. d. All of the above.

a

Tommy says to his friend, "I can't ever talk to my Daddy until after he has read his newspaper." This is an example of which of the following? a. A rigid boundary b. A boundary violation c. An enmeshed boundary d. A flexible boundary

a

When Jack is not accepted at the law school of his choice, he thinks, "I'm so stupid. No law school will ever accept me." What automatic thought does this statement represent? a. Overgeneralization b. Magnification c. Selective abstraction d. Minimization

a

When an individual's stress response is sustained over a long period, the endocrine system involvement results in which of the following? a. Decreased resistance to disease b. Increased libido c. Decreased blood pressure d. Increased inflammatory response

a

Which of the following hormones has been implicated in the etiology of mood disorder with seasonal pattern? a. Increased levels of melatonin b. Decreased levels of oxytocin c. Decreased levels of prolactin d. Increased levels of thyrotropin

a

Which of the following individuals is at highest risk for a suicide attempt? a. John, who reports he is in deep emotional pain, feels hopeless, and says "No one is there for me." b. Kelly, who has been seeing a doctor for chronic, intractable pain and is taking pain medication. c. Jim, an American Indian who just graduated from high school with honors. d. Mike, a physician who reports feeling "burnt out" and is considering retirement.

a

Guidelines relating to "duty to warn" state that a therapist should consider taking action to warn a third party when his or her client does which of the following? (Select all that apply.) a. Threatens violence toward another individual b. Identifies a specific intended victim c. Is having command hallucinations d. Reveals paranoid delusions about another individual

a, b

. Psychotropic medications may act at the neural synapse to accomplish which of the following? (Select all that apply) a. Inhibit the reuptake of certain neurotransmitters, creating more availability b. Inhibit catabolic enzymes, promoting more availability of a neurotransmitter c. Block receptors, resulting in less neurotransmitter activity d. Add synthetic neurotransmitters found in the drug

a, b, c

John comes to the mental health clinic with reports of anxiety and depression. According to the transactional model of stress and adaptation, which of the following are important to consider when assessing John's complaints? (Select all that apply.) a. John's perception of precipitating events b. Past stressors and degree of positive coping abilities c. Existing social supports d. Physical strength e. Pupillary adaptation to light

a, b, c

Lashona was sexually abused as a child. She is a client on the milieu unit with a diagnosis of Borderline Personality Disorder. She has refused to talk to anyone. Which of the following therapies might the IDT team choose for Lashona? (Select all that apply.) a. Music therapy b. Art therapy c. Psychodrama d. Electroconvulsive therapy

a, b, c

Which of the following are basic assumptions of milieu therapy? (Select all that apply.) a. The client owns his or her own environment. b. Each client owns his or her behavior. c. Peer pressure is a useful and powerful tool. d. Inappropriate behaviors are punished immediately.

a, b, c

Which of the following behaviors suggest a possible breach of professional boundaries? (Select all that apply.) a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shares the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment. d. The nurse shares how she dealt with a similar difficult situation

a, b, c

Which of the following interventions are appropriate for a client on suicide precautions? (Select all that apply.) a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. b. Accompany the client to off-unit activities. c. Reassess intensity of suicidal thoughts and urges on a regular basis. d. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.

a, b, c

Which of the following is true about aggression? (Select all that apply.) a. It is goal directed. b. Its aim is to do harm to a person or object. c. It has a requisite of intent. d. It energizes and mobilizes the body for self-defense.

a, b, c

Which of these procedures is important immediately following an episode of violence on the unit? (Select all that apply.) a. Document all observations and occurrences. b. Conduct a debriefing with staff. c. Discuss what occurred with other clients who witnessed the incident. d. Warn the client that it could happen again if he becomes violent.

a, b, c

Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? (Select all that apply.) a. Unresolved grief over loss of her husband b. Loss of several relatives and friends over the last few years c. Repressed feelings of guilt over the way Lucky died d. Inability to prepare in advance for the loss

a, b, c, d

S.T. is a 15-year-old girl who has just been admitted to the adolescent psychiatric unit with a diagnosis of anorexia nervosa. She is 5 feet 5 inches tall and weighs 82 pounds. She was selected to join the cheerleading squad for the fall but states that she is not as good as the others on the squad. The treatment team has identified the following problems: refusal to eat, occasional purging, refusing to interact with staff and peers, and fear of failure. Which of the following nursing diagnoses would be appropriate for S.T.? (Select all that apply.) a. Social isolation b. Disturbed body image c. Low self-esteem d. Imbalanced nutrition: Less than body requirements

a, b, c, d

Which of the following conditions increases the risk of adverse events associated with ECT? (Select all that apply.) a.Increased intracranial pressure b. Recent myocardial infarction c. Severe underlying hypertension d. Congestive heart failure e. Breast cancer

a, b, c, d

A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? (Select all that apply.) a. Slumped posture b. Delusional thinking c. Feelings of despair d. Feels best early in the morning and worse as the day progresses e. Anorexia

a, b, c, e

A client expresses interest in alternative treatments for depression with seasonal variations and asks the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the client? (Select all that apply.) a. Light therapy has demonstrated effectiveness that is comparable to antidepressants. b. Light therapy should be used regularly until the season changes. c. Light therapy should be used only when ECT has proven to be ineffective. d. Side effects such as headache, nausea, or agitation, when they occur, are usually mild and transient. e. Light therapy causes sedation, so the best time to use it is before bedtime.

a, b, d

An individual may be considered gravely disabled for which of the following reasons? (Select all that apply.) a. A person, because of mental illness, cannot fulfill basic needs. b. A mentally ill person is in danger of physical harm based on inability to care for himself or herself. c. A mentally ill person lacks the resources to provide the necessities of life. d. A mentally ill person is unable to make use of available resources to meet daily living requirements

a, b, d

John, a client with a history of violence, has been hospitalized on the psychiatric unit. He becomes agitated and begins to threaten the staff and other clients. When all other interventions fail, John is placed in restraints in the seclusion room for his and others' protection. Which of the following are interventions for the client in restraints? (Select all that apply.) a. Check temperature and pulse of extremities. b. Document all observations. c. Explain to the client that restraint is his punishment for violent behavior. d. Provide ongoing assessment and observation. e.Withhold food and fluid until client is calm and can be released from restraints.

a, b, d

Recent research on the RAISE approach to treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply.) a. Early intervention at the first episode of psychosis b. Support for employment and/or educational pursuits c. Rapid high-dose loading with antipsychotic medication d. Court-ordered sanctions for treatment e. Recovery-focused psychotherapy

a, b, d

Sally is admitted to the hospital with major depressive disorder and repeatedly makes negative statements about herself. Which of the following interventions are identified as those that will promote positive self-esteem in the patient? (Select all that apply.) a. Teach assertive communication skills. b. Make observations to Sally when she completes a goal or task. c. Instruct Sally that you will not talk with her unless she stops talking negatively about herself. d. Offer to spend time with Sally using a nonjudgmental, accepting approach.

a, b, d

The environment in which the communication takes place influences the outcome of the interaction. Which of the following are aspects of the environment that influence communication? (Select all that apply.) a. Territoriality b. Density c. Dimension d. Distance e. Intensity

a, b, d

A nurse is engaging in psychoeducation about improving self-esteem with Shelley, who has depression and low self-esteem. Which of the following are important for the nurse to assess? (Select all that apply.) a. Shelley's focal, contextual, and residual stimuli b. Shelley's abilities with regard to establishment of boundaries c. Shelley's age and whether or not she is married d. The nurse's awareness of his or her own ability to establish appropriate boundaries e. Shelley's predominant communication style and her understanding of assertiveness

a, b, d, e

On the milieu unit, duties of the staff psychiatric nurse include which of the following? (Select all that apply.) a. Medication administration b. Client teaching c. Medical diagnosis d. Reality orientation e. Relationship development f. Group therapy

a, b, d, e

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply.) a. Olanzapine (Zyprexa) b. Oxycodone (OxyContin) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) e. Tranylcypromine (Parnate)

a, c, d

Which of the following behaviors are associated with the phenomenon of transference? (Select all that apply.) a. The client attributes toward the nurse feelings associated with a person from the client's past. b. The nurse attributes toward the client feelings associated with a person from the nurse's past. c. The client forms an overwhelming affection for the nurse. d. The client becomes excessively dependent on the nurse and forms unrealistic expectations of him or her.

a, c, d

Which of the following describe advantages of electronic health records (EHRs)? (Select all that apply.) a. They reduce redundancy of information. b. They reduce privacy issues. c. They decrease charting time. d. They facilitate communication between disciplines.

a, c, d

The nurse in the emergency department encounters a patient, Niko, who is expressing suicide ideation. The nurse recognizes that which of the following considerations are important to good suicide risk assessment? (Select all that apply.) a. Collaborating with the patient b. Asking specific questions about leisure activities c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of his intention to die e. Identifying whether the patient has thought about a plan for trying to kill himself

a, c, d, e

The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night Risk for injury related to manic hyperactivity Impaired social interaction evidenced by manipulation of others Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turg

a= 3 b= 1 c= 4 d= 2

. Anna has been grieving the death of Lucky for 3 years. She is unable to take care of her normal activities because she insists on visiting Lucky's grave daily. What is the most likely reason that Anna's daughter has put off seeking help for Anna? a. Women are less likely than men to seek help for emotional problems. b. Relatives often try to normalize behavior rather than label it mental illness. c. She knows that all older people are expected to be a little depressed. d. She is afraid that the neighbors will think her mother is "crazy."

b

. The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the evaluation step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Obtains a short-term contract from the client to seek out staff if feeling suicidal d. Establishes goal of care: Client will not harm self during hospitalization

b

A client states, "I refuse to shower in this room. I must be very cautious. The FBI has placed a camera in here to monitor my every move." Which of the following is the most therapeutic response? a. "That's not true." b. "I have a hard time believing that is true." c. "Surely you don't really believe that." d. "I will help you search this room so that you can see there is no camera."

b

A client tells the therapist, "I thought I would just die when my husband told me he was leaving me. If I had been a better wife, he wouldn't have fallen in love with another woman. It's all my fault." The therapist wants to use the technique of "examining the evidence." Which of the following statements reflects this technique? a. "How do you think you could have been a better wife?" b. "Okay, you say it's all your fault. Let's discuss why it might be your fault, and then we will look at why it may not be." c. "Let's talk about what would make you a happier person." d. "Would you have wanted him to stay if he didn't really want to?"

b

A decrease in which of the following neurotransmitters has been implicated in depression? a. Gamma-aminobutyric acid, acetylcholine, and aspartate b. Norepinephrine, serotonin, and dopamine c. Somatostatin, substance P, and glycine d. Glutamate, histamine, and opioid peptides

b

A nurse is educating a client about his lithium therapy and explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia

b

A patient has been ordered ECT and asks the nurse, "Exactly how does ECT work?" Which of the following is the most accurate response by the nurse? a. "I'm not allowed to tell you that because that would be informed consent." b. "The exact mechanism is unknown, but there are several ways that ECT may have antidepressant effects." c. "The administration of a shock to the brain induces memory loss, which will make you forget you are depressed." d. "The neuroplasticity affected by seizure activity prevents further brain damage."

b

Abby, an adolescent, just returned from group therapy and is crying. She says to the nurse, "All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I've never had a close friend. I guess I never will." Which is the most appropriate response by the nurse? a. "What makes you think you will never have any friends?" b. "You're feeling pretty down on yourself right now." c. "I'm sure they didn't mean to hurt your feelings." d. "Why do you feel this way about yourself?"

b

An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? a. "Do you like exercise?" b. "Come with me. I will go with you to group therapy." c. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" d. "Why do you stay in your room all the time?"

b

Anna's daughter notices that Anna appears to be listening to another voice when just the two of them are in a room together. When questioned, Anna admits that she hears someone telling her that she was a horrible caretaker for Lucky and did not deserve to ever have a pet. Which of the following best describes what Anna is experiencing? a. Neurosis b. Psychosis c. Depression d. Bereavement

b

Antipsychotic medications are thought to decrease psychotic symptoms by: a. Blocking reuptake of norepinephrine and serotonin b. Blocking the action of dopamine in the brain c. Inhibiting production of the enzyme MAO d. Depressing the CNS

b

Atropine sulfate is administered to a client receiving ECT for what purpose? a. To alleviate anxiety b. To decrease secretions c. To relax muscles d. As a short-acting anesthetic

b

Barbara burned the toast. She thinks, "I'm a totally incompetent person." What automatic thought does this statement represent? a. Selective abstraction b. Magnification c .Minimization d. Personalization

b

Doses of bupropion should be administered at least 4 to 6 hours apart and never doubled when a dose is missed in order to prevent: a. Orthostatic hypotension b. Seizures c. Hypertensive crisis d. Extrapyramidal symptoms

b

If the foregoing extrapyramidal symptoms should occur, which of the following would be a priority nursing intervention? a. Notify the physician immediately. b. Administer prn trihexyphenidyl (Artane). c. Withhold the next dose of antipsychotic medication. d. Explain to the client that these symptoms are only temporary and will disappear shortly.

b

In determining degree of suicidal risk with a client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? a. Low risk b. High risk c. Imminent risk d. Unable to be determined

b

In the community meeting, which of the following actions is most important for reinforcing the democratic posture of the therapy setting? a. Allowing each person a specific and equal amount of time to talk b. Reviewing group rules and behavioral limits that apply to all clients c. Reading the minutes from yesterday's meeting d. Waiting until all clients are present before initiating the meeting

b

Jessica told Andrea a secret that Eva had told her. This is an example of which of the following? a. Too flexible a boundary b. A boundary violation c. Too rigid a boundary d. An enmeshed boundary

b

John and his girlfriend had an argument during her visit. Which behavior by John would indicate he is learning to adaptively problem-solve his frustrations? a. John says to the nurse, "Give me some of that medication before I end up in restraints!" b. When his girlfriend leaves, John goes to the exercise room and punches on the punching bag. c. John says to the nurse, "I guess I'm going to have to dump that broad!" d. John says to his girlfriend, "You'd better leave before I do something I'm sorry for."

b

John tells the nurse, "I think lights out at 10 o'clock on a weekend is stupid. We should be able to watch TV until midnight!" Which of the following is the most appropriate response from the nurse on the milieu unit? a. "John, you were told the rules when you were admitted." b. "You may bring it up before the others at the community meeting, John." c. "Some people want to go to bed early, John." d. "You are not the only person on this unit, John. You must think of others besides yourself."

b

Josh, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Josh is to: a. Give him an injection of Thorazine. b. Ensure a safe environment for him and others. c. Place him in restraints. d. Order him a nutritious diet.

b

Kaylee, age 26, graduated from law school with a 3.2/4.0 grade point average. She recently took the bar exam and did not pass. Because of this, she had to give up her job at a law firm. She became very depressed and sought counseling at the mental health clinic. During the intake assessment, Kaylee says to the psychiatric nurse, "I am a complete failure. I'm so dumb, I can't do anything right." What is the most appropriate nursing diagnosis for Kaylee? a. Chronic low self-esteem b. Situational low self-esteem c. Defensive coping d. Risk for situational low self-esteem

b

Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of: a. A delusion of grandeur. b. A delusion of persecution. c. A delusion of reference. d. A delusion of control or influence.

b

Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sisterin-law reports that Margaret quit taking her medication a few months ago, thinking she no longer needed it. Margaret is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. What is the prioritynursing diagnosis for Margaret? a. Imbalanced nutrition: Less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression

b

Maria is an Italian American who is in the hospital after having suffered a miscarriage at 5 months' gestation. Her room is filled with relatives who have brought a variety of foods and gifts for Maria. They are all talking, seemingly at the same time, and some, including Maria, are crying. They repeatedly touch and hug Maria and each other. How should the nurse handle this situation? a. Explain to the family that Maria needs her rest and they must all leave. b. Allow the family to remain and continue their activity as described, as long as they do not disturb other clients. c. Explain that Maria will not get over her loss if they keep bringing it up and causing her to cry so much. d. Call the family priest to come and take charge of this family situation.

b

Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become increasingly despondent. Her husband has become very concerned and takes her to the local mental health center. What is this type of crisis called? a. Dispositional crisis b. Crisis of anticipated life transitions c. Psychiatric emergency d. Crisis resulting from traumatic stress

b

Nurse Rosetta, who is the adult child of an alcoholic, is working with John, a client who abuses alcohol. John has experienced a successful detoxification process and is beginning a rehabilitation program. He says to Rosetta, "I'm not going to go to those stupid AA meetings. They don't help anything." Rosetta, whose father died of complications from alcoholism, responds with anger: "Don't you even care what happens to your children?" Rosetta's response is an example of which of the following? a. Transference b. Countertransference c. Self-disclosure d. A breach of professional boundaries

b

Sarah is an African American woman who receives a visit from the psychiatric home health nurse. A referral for a mental health assessment was made by the public health nurse, who noticed that Sarah was becoming exceedingly withdrawn. When the psychiatric nurse arrives, Sarah says to her, "No one can help me. I was an evil person in my youth, and now I must pay." How might the nurse assess this statement? a. Sarah is having delusions of persecution. b. Some African Americans believe illness is God's punishment for their sins. c. Sarah is depressed and just wants to be left alone. d. African Americans do not believe in psychiatric help

b

Sondra, who lives in Maine, hears on the evening news that 25 people were killed in a tornado in south Texas. Sondra experiences no anxiety upon hearing of this stressful situation. What is the most likely reason that Sondra experiences no anxiety? a. She is selfish and does not care what happens to other people. b. She appraises the event as irrelevant to her own situation. c. She assesses that she has the skills to cope with the stressful situation. d. She uses suppression as her primary defense mechanism.

b

Success of long-term psychotherapy with Theresa (who attempted suicide following a break-up with her boyfriend) could be measured by which of the following behaviors? a. Theresa has a new boyfriend. b. Theresa has an increased sense of self-worth. c. Theresa does not take antidepressants anymore. d. Theresa told her old boyfriend how angry she was with him for breaking up with her.

b

The most appropriate crisis intervention with Amanda (from question 3) would be to: a. Encourage her to recognize how lucky she is to be alive. b. Discuss stages of grief and feelings associated with each. c. Identify community resources that can help Amanda. d. Suggest that she find a place to live that provides a storm shelter.

b

The most appropriate nursing intervention with Ginger (from question 7) would be to: a. Suggest she move to a college closer to home. b. Work with Ginger on unresolved dependency issues. c. Help her find someone in the college town from whom she could seek assistance rather than calling her mother regularly. d. Recommend that the college physician prescribe an antianxiety medication for Ginger.

b

The nurse assists the physician with electroconvulsive therapy on a client who has refused to give consent. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality

b

The nurse decides to go against family wishes and tell the client of his terminal status because that is what she would want if she were the client. Which of the following ethical theories is considered in this decision? a. Kantianism b. Christian ethics c. Natural law theories d. Ethical egoism

b

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to: a. Ask the client to describe his physical symptoms. b. Ask the client to describe what he is hearing. c. Administer a dose of benztropine. d. Call the physician for additional orders.

b

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the assessment step of the nursing process? a. Identifies nursing diagnosis: Risk for suicide b. Notes that client's family reports recent suicide attempt c. Prioritizes the necessity of maintaining a safe client environment d. Obtains a short-term contract from the client to seek out staff if feeling suicidal

b

The nurse must give Frank, a Latino American, a physical examination. She asks him to remove his clothing and put on an examination gown. Frank refuses. What cultural norm among Latino Americans most likely explains Frank's response? a. Frank does not believe in taking orders from a woman. b. Frank is modest and embarrassed to remove his clothes. c. Frank does not understand why he must remove his clothes. d. Frank does not think he needs a physical examination.

b

The nurse says to a client, "You are being readmitted to the hospital. Why did you stop taking your medication?" What communication technique does this represent? a. Disapproving b. Requesting an explanation c. Disagreeing d. Probing

b

The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68-year-old woman with major depressive disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a. "Cheer up, Margaret. You have so much to be happy about." b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c. "I'll report that to the physician, Margaret. Maybe he will order something different." d. "Try not to dwell on your symptoms, Margaret. Why don't you join the others down in the dayroom?"

b

The primary goal in working with an actively psychotic, suspicious client would be to: a. Promote interaction with others. b. Decrease his anxiety and increase trust. c. Improve his relationship with his parents. d. Encourage participation in therapy activities.

b

There is a very narrow margin between the therapeutic and toxic levels of lithium carbonate. Symptoms of toxicity are most likely to appear if the serum levels exceed: a. 0.15 mEq/L b. 1.5 mEq/L c. 15.0 mEq/L d. 150 mEq/L

b

Twins Jan and Jean still dress alike even though they are grown and married. This is an example of which of the following? a. Rigid boundary b. Enmeshed boundary c. A boundary violation d. Boundary pliancy

b

When the nurse shows unconditional acceptance of an individual as a worthwhile and unique human being, he or she is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

b

Which of the following activities would be a responsibility of the psychiatric clinical nurse specialist on the IDT team? a. Manages the therapeutic milieu on a 24-hour basis b. Conducts group therapies and provides consultation and education to staff nurses c. Directs a group of clients in acting out a situation that is otherwise too painful for a client to discuss openly d. Locates halfway house and arranges living conditions for client being discharged from the hospital

b

Which of the following best describes the average number of ECT treatments given and the timing of administration? a. One treatment per month for 6 to 12 months b. One treatment every other day, three times a week for a total of 6 to 12 treatments c. One treatment three times per week for 6 to 12 months d. One treatment every day for a total of 10 to 20 treatments

b

Which of the following statements by Anna might suggest that she is achieving resolution of her grief over Lucky's death? a. "I don't cry anymore when I think about Lucky." b. "It's true. Lucky didn't always mind me. Sometimes he ignored my commands." c. "I remember how it happened now. I should have held tighter to his leash!" d. "I won't ever have another dog. It's just too painful to lose them."

b

Why is stress management extremely important in today's society? a. Evolution has diminished the human capability for fight-or-flight responses. b. The stressors of today tend to be ongoing, resulting in a sustained response. c. We have stress disorders that did not exist in the days of our ancestors. d. One never knows when one will have to face a grizzly bear or saber-toothed tiger in today's society

b

John, age 27, was brought to the emergency department by two police officers. He smelled strongly of alcohol and was combative. His blood alcohol level was measured at 293 mg/dL. His girlfriend reports that he drinks excessively every day and is verbally and physically abusive. The nurses give John the nursing diagnosis of Risk for other-directed violence. What would be appropriate outcome objectives for this diagnosis? (Select all that apply.) a. The client will not verbalize anger or hit anyone. b. The client will verbalize anger rather than hit others. c. The client will not harm self or others. d. The client will be restrained if he becomes verbally or physically abusive.

b, c

Psychoneuroimmunology is a branch of science that involves which of the following? (Select all that apply.) a. The impact of psychoactive medications at the neural synapse b. The relationships between the immune system, the nervous system, and psychological processes including mental illness c. The correlation between psychosocial stress and the onset of illness d. The potential role of viruses in the onset of schizophrenia e. The genetic factors that influence prevention of mental illness

b, c, d

Which of the following assessment data would the nurse consider as risk factors for possible violence in a client? (Select all that apply.) a. A diagnosis of somatization disorder b. A diagnosis of schizophrenia or bipolar disorder c. Substance intoxication d. Argumentative and demanding behavior e. Past history of violence

b, c, d, e

Which of the following is a true statement about mental health recovery? (Select all that apply.) a. Mental health recovery applies only to severe and persistent mental illnesses. b. Mental health recovery serves to provide empowerment to the consumer. c. Mental health recovery is based on the medical model. d. Mental health recovery is a collaborative process.

b, d

Which of the following statements is correct regarding the use of restraints? (Select all that apply.) a. Restraints may never be initiated without a physician's order. b. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents. c. Clients in restraints must be observed and assessed every hour for issues regarding circulation, nutrition, respiration, hydration, and elimination. d. An in-person evaluation must be conducted within 1 hour of initiating restraints.

b, d

Theresa, who has been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions are most appropriate in this instance? (Select all that apply.) a. Restrict access to any item that might be harmful by placing the client in a seclusion room. b. Check on Theresa every 15 minutes at irregular intervals, or assign a staff person to stay with her on a one-to-one basis. c. Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicide ideas. d. Do not allow Theresa to participate in any unit activities while she is on suicide precautions. e. Ask Theresa specific questions about her thoughts, plans, and intentions related to suicide

b, e

Which of the following tasks are associated with the orientation phase of relationship development? (Select all that apply.) a. Promoting the client's insight and perception of reality b. Creating an environment for the establishment of trust and rapport c. Using the problem-solving model toward goal fulfillment d. Obtaining available information about the client from various sources e. Formulating nursing diagnoses and setting goals

b, e

. Attempting to calm an angry client by using "talk therapy" is an example of which of the following clients' rights? a. The right to privacy b. The right to refuse medication c. The right to the least-restrictive treatment alternative d. The right to confidentiality

c

. Miss Lee is an Asian American on the psychiatric unit. She tells the nurse, "I must have the hot ginger root for my headache. It is the only thing that will help." What cultural belief is likely associated with Miss Lee's request? a. She is being obstinate and wants control over her care. b. She believes that ginger root has magical qualities. c. She subscribes to the restoration of health through the balance of yin and yang. d. Asian Americans refuse to take traditional medicine for pain.

c

. Nurse Mary has been providing care for Tom during his hospital stay. On Tom's day of discharge, his wife brings a bouquet of flowers and box of chocolates to his room. He presents these gifts to Nurse Mary, saying, "Thank you for taking care of me." What is a correct response by the nurse? a. "I don't accept gifts from patients." b. "Thank you so much! It is so nice to be appreciated." c. "Thank you. I will share these with the rest of the staff." d. "Hospital policy forbids me to accept gifts from patients."

c

A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition. b. Medication would be given for both conditions simultaneously. c. The bipolar condition would be stabilized before ADHD medication would be given. d. The ADHD would be treated before consideration of the bipolar disorder.

c

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing, and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit, she must remain in her room.

c

A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment and the police said I had to come with them." This is an example of what symptom of schizophrenia? a. Delusions of reference b. Loose association c. Anosognosia d. Auditory hallucinations

c

A client who has been in restraints is now calm. He apologizes to the nurse and says, "I hope I didn't hurt anyone." The nurse's best response is: a. "This is our job. We know how to handle violent clients." b. "We understand you were out of control and didn't really mean to hurt anyone." c. "It is fortunate that no one was hurt. You will not be placed in restraints as long as you can control your behavior." d. "It is an unpleasant situation to have to restrain someone, but we have to think of the other clients. We can't have you causing injury to others. I just hope it won't happen again

c

A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." b. "I can understand how you must feel." c. "Those feelings are a normal part of the grief response." d. "Just think about the good times that you had while he was alive."

c

A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes in an effort to keep him from leaving. With which of the following legal actions might the nurse be charged because of this nursing action? a. Assault b. Battery c. False imprisonment d. Breach of confidentiality

c

A nurse is assisting an individual with mental illness recovery using the Tidal Model. Which of the following is a component of this model? a. The wellness toolbox b. The daily maintenance list c. The individual's personal story d. Triggers

c

A nurse who is helping a client with mental illness recovery using the WRAP Model says to the client, "First you must create a wellness toolbox." She explains to the client that a wellness toolbox is which of the following? a. A list of words that describe how the individual feels when he or she is feeling well b. A list of things the client needs to do every day to maintain wellness c. A list of strategies the client has used in the past that help relieve disturbing symptoms d. A list of the client's favorite health-care providers and phone numbers

c

Amanda tried out for the cheerleading squad in junior high but was rejected. At age 15, she had looked forward to trying out for the cheerleading squad in high school. She took cheerleading classes and practiced for many hours every day. However, when tryouts were held, she was not selected. She has become despondent, and her mother takes her to the mental health clinic for counseling. Amanda tells the nurse, "What's the use of trying? I'm not good at anything!" The psychiatric nurse encourages Amanda (the client in question 3) to express her anger. Why is this an appropriate nursing intervention? a. Anger is the basis for self-esteem problems. b. The nurse suspects that Amanda was abused as a child. c. The nurse is attempting to guide Amanda through the grief process. d. The nurse recognizes that Amanda has long-standing repressed anger.

c

Andrew, a New York City firefighter, and his entire unit responded to the terrorist attacks at the World Trade Center. Working as a team, he and his best friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't!" This statement by Andrew suggests that he is experiencing: a. Spiritual distress. b. Night terrors. c. Survivor's guilt. d. Suicidal ideation.

c

Anna's dog, Lucky, her pet for 16 years, was killed by a car 3 years ago. Since that time, Anna has lost weight, rarely leaves her home, and talks excessively about Lucky. Why would Anna's behavior be considered maladaptive? a. It has been more than 3 years since Lucky died. b. Her grief is too intense over the loss of a dog. c. Her grief is interfering with her functioning. d. Cultural norms typically do not comprehend grief over the loss of a pet.

c

At a synapse, the determination of further impulse transmission is accomplished by means of which of the following? a. Potassium ions b. Interneurons c. Neurotransmitters d. The myelin sheath

c

Electroconvulsive therapy is most commonly prescribed for which of the following? a. Bipolar disorder, manic b. Paranoid schizophrenia c. Major depression d. Obsessive-compulsive disorder

c

Elena has just received a promotion on her job. She is very happy and excited about moving up in her company, but she has been experiencing anxiety since receiving the news. Her primary appraisal is that she most likely views the situation as which of the following? a. Benign-positive b. Irrelevant c. Challenging d. Threatening

c

For what reason would Anna's illness be considered a neurosis rather than a psychosis? a. She is unaware that her behavior is maladaptive. b. She exhibits inappropriate affect (emotional tone). c. She experiences no loss of contact with reality. d. She tells the nurse, "There is nothing wrong with me!"

c

Frank is a Latino American who has an appointment at the community health center for 1 p.m. The nurse is angry when Frank shows up at 3:30 p.m. stating, "I was visiting with my brother." How must the nurse interpret this behavior? a. Frank is being passive-aggressive by showing up late. b. This is Frank's way of defying authority. c. Frank is a member of a cultural group that is present-time oriented. d. Frank is a member of a cultural group that rejects traditional medicine

c

In prioritizing care within the therapeutic environment, which of the following nursing interventions would receive the highest priority? a. Ensuring that the physical facilities are conducive to achievement of the goals of therapy b. Scheduling a community meeting for 8:30 each morning c. Attending to the nutritional and comfort needs of all clients d. Establishing contacts with community resources

c

Initial symptoms of lithium toxicity include: a. Constipation, dry mouth b. Dizziness, thirst c. Vomiting, diarrhea d. Anuria, arrhythmias

c

Janet failed her first test in nursing school. She thinks, "Well, that's it! I'll never be a nurse." What automatic thought does this statement represent? a. Overgeneralization b. Magnification c. Catastrophic thinking d. Personalization

c

Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Maturational/developmental crisis c. Dispositional crisis d. Crisis reflecting psychopathology

c

John, who was hospitalized with alcohol intoxication and violent behavior, is sitting in the dayroom watching TV with the other clients when the nurse approaches with his 5 p.m. dose of haloperidol. John says, "I feel in control now. I don't need any drugs." The nurse's best response is based on which of the following statements? a. John must have the medication, or he will become violent. b. John knows that if he will not take the medication orally, he will be restrained and given an intramuscular injection. c. John has the right to refuse the medication provided there is no immediate danger to self or others. d. John must take the medication at this time in order to maintain adequate blood levels.

c

Judy has been in the hospital for 3 weeks. She has used Valium "to settle her nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time but states to the nurse, "I don't know if I will be able to make it without Valium after I go home. I'm already starting to feel nervous. I have so many personal problems." Which is the most appropriate response by the nurse? a. "Why do you think you need drugs to deal with your problems?" b. "Everybody has problems, but not everybody uses drugs to deal with them. You'll just have to do the best that you can." c. "Let's explore some things you can do to decrease your anxiety without resorting to drugs." d. "Just hang in there. I'm sure everything is going to be okay."

c

Lucky sometimes refused to obey Anna's commands to come back to her, including when he ran into the street on the day of the accident. But Anna continues to insist, "He was the very best dog. He always minded me. He always did everything I told him to do." Which defense mechanism is Anna exhibiting? a. Sublimation b. Compensation c. Reaction formation d. Undoing

c

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband is buried. She told her sister today that she "doesn't have anything more to live for." She has been hospitalized with major depressive disorder. The priority nursing diagnosis for Margaret would be: a. Imbalanced nutrition: less than body requirements. b. Complicated grieving. c. Risk for suicide. d. Social isolation.

c

Margaret, age 68, is diagnosed with bipolar I disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to: a. Sit with her during meals to ensure that she eats everything on her tray. b. Have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes. c. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run." d. Tell Margaret that she will be on room restriction until she starts gaining weight.

c

Nursing diagnoses are prioritized according to which of the following? a. Degree of potential for resolution b. Legal implications associated with nursing intervention c. Life-threatening potential d. Client and family requests

c

Opal is a 43-year-old woman who is suffering from depression and suicidal ideation. Opal says, "I'm such a worthless person. I don't deserve to live." The therapist responds, "I would like for you to think about what problems committing suicide would solve." The therapist is using which of the following cognitive therapy techniques? a. Imagery b. Role play c. Problem-solving d. Thought recording

c

Sam, who has been hospitalized for ECT treatments, says to the nurse on admission, "I don't want to end up like McMurphy in One Flew Over the Cuckoo's Nest! I'm scared!" Which of the following statements would be most appropriate by the nurse in response to Sam's expression of concern? a. "I guarantee you won't end up like McMurphy, Sam." b. "The doctor knows what he is doing. There's nothing to worry about." c. "I know you are scared, Sam, and we're going to talk about what you can expect from the therapy." d. "I'm going to stay with you as long as you are scared."

c

Succinylcholine is administered to a client receiving ECT for what purpose? a. To alleviate anxiety b. To decrease secretions c. To relax muscles d. As a short-acting anesthetic

c

Tam has a new diagnosis of panic disorder. Dr. S has written a prn order for alprazolam (Xanax) for when Tam is feeling anxious. She says to the nurse, "Dr. S prescribed buspirone for my friend's anxiety. Why did he order something different for me?" The nurse's answer is based on which of the following? a. Buspirone is not an antianxiety medication. b. Alprazolam and buspirone are essentially the same medication, so either one is appropriate. c. Buspirone has delayed onset of action and cannot be used on a prn basis. d. Alprazolam is the only medication that really works for panic disorder.

c

The husband says to his wife, "What do you want to do tonight?" and his wife responds, "Whatever you want to do." This is an example of which of the following? a. Extremely rigid boundaries b. A boundary violation c. Extremely flexible boundaries d. Showing respect for the boundary of another

c

The nurse decides to tell the client of his terminal status because she believes it is her duty to do so. Which of the following ethical theories is considered in this decision? a. Natural law theories b. Ethical egoism c. Kantianism d. Utilitarianism

c

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Why is chlorpromazine ordered? a. To reduce extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep

c

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing: a. Somatic delusions. b. Catatonic stupor. c. Auditory hallucinations. d. Pseudoparkinsonism.

c

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the implementation step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Collaborates with the client to develop a plan for ongoing safety and suicide prevention d. Establishes goal of care: Client will not harm self during hospitalization

c

The therapist teaches a client that when the idea of herself as a worthless person starts to form in her mind, she should immediately start to whistle the tune of "Dixie." What cognitive therapy technique is the therapist using? a. Behavioral rehearsal b. Social skills training c. Distraction d. Generating alternatives

c

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. "You are safe here. We will make sure nothing happens to you." b. "You're just lucky your roommate came home when she did." c. "What exactly do you plan to do?" d. "I don't understand. You have so much to live for."

c

Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for six years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time, Theresa." b. "Forget him. There are other fish in the sea." c. "You must be feeling very sad about your loss." d. "Why do you think he broke up with you, Theresa?"

c

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. Provide large motor activities to relieve the client's pent-up tension. b. Administer a dose of prn chlorpromazine to keep the client calm. c. Call for sufficient help to control the situation safely. d. Convey to the client that his behavior is unacceptable and will not be permitted.

c

When it has been assessed that a client is in control and no longer requires restraining, how does the nurse proceed? a. The nurse removes the restraints. b. The nurse calls for assistance to remove the restraints. c. With assistance, the nurse removes one restraint. d. The nurse tells the client he will have to wait until the doctor comes in.

c

When there is congruence between what is felt and what is expressed, the nurse is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

c

Which of the following activities would be a responsibility of the clinical psychologist member of the IDT? a. Locates halfway house and arranges living conditions for client being discharged from the hospital b. Manages the therapeutic milieu on a 24-hour basis c. Administers and evaluates psychological tests that assist in diagnosis d. Conducts psychotherapy and administers electroconvulsive therapy treatments

c

Which of the following is a correct assumption regarding the concept of crisis? a. Crises occur only in individuals with psychopathology. b. The stressful event that precipitates crisis is seldom identifiable. c. A crisis situation contains the potential for psychological growth or deterioration. d. Crises are chronic situations that recur many times during an individual's life.

c

Which of the following is a desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety? a. The individual will experience no anxiety. b. The individual will demonstrate hope for the future. c. The individual will identify that anxiety is at a manageable level. d. The individual will verbalize acceptance of self as worthy.

c

. Dorothy was involved in an automobile accident while under the influence of alcohol. She swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate? a. "Now that you know what can happen when you drink and drive, I'm sure you won't let it happen again." b. "You know that was a terrible thing you did. That child could have been killed." c. "I'm sure everything is going to be okay now that you understand the possible consequences of such behavior." d. "How are you feeling about what happened?"

d

. Education for the client who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment d. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification

d

. Miss Lee, an Asian American on the psychiatric unit, says she is afraid that no one from her family will visit her. On what belief does Miss Lee base her statement? a. Many Asian Americans do not believe in hospitals . b. Many Asian Americans do not have close family support systems. c. Many Asian Americans believe the body will heal itself if left alone. d. Many Asian Americans view psychiatric problems as bringing shame to the family

d

A nurse is assisting an individual with mental illness recovery using the Psychological Recovery Model. The client says to the nurse, "I have schizophrenia. Nothing can be done. I might as well die." In which stage of the Psychological Recovery Model would the nurse assess this individual to be? a. The awareness stage b. The preparation stage c. The rebuilding stage d. The moratorium stage

d

Amanda tried out for the cheerleading squad in junior high but was rejected. At age 15, she had looked forward to trying out for the cheerleading squad in high school. She took cheerleading classes and practiced for many hours every day. However, when tryouts were held, she was not selected. She has become despondent, and her mother takes her to the mental health clinic for counseling. Amanda tells the nurse, "What's the use of trying? I'm not good at anything!" Which of the following nursing interventions is best for Amanda's specific problem? a. Encourage Amanda to talk about her feeling of shame over the second failure. b. Assist Amanda to problem-solve her reasons for not making the team. c. Help Amanda understand the importance of good self-care and personal hygiene in the maintenance of self-esteem. d. Explore with Amanda her past successes and accomplishments.

d

Anna states that Lucky was her closest friend, and since his death, there is no one who could ever replace the relationship they had. According to Maslow's hierarchy of needs, which level of need is not being met? a. Physiological needs b. Self-esteem needs c. Safety and security needs d. Love and belonging needs

d

As a child, Joe was physically abused by his father. The father is now dying and has expressed a desire to see his son before he dies. Joe is depressed and says to the mental health nurse, "I'm so angry! Why did God have to give me a father like this? I feel cheated of a father! I've always been a good person. I deserved better. I hate God!" From this subjective data, which nursing diagnosis might the nurse apply to Joe? a. Readiness for enhanced religiosity b. Risk for impaired religiosity c. Readiness for enhanced spiritual well-being d. Spiritual distress

d

Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: a. "That's ridiculous, Brandon. No one is going to hurt you." b. "The CIA isn't interested in people like you, Brandon." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, Brandon, but it's really hard for me to believe."

d

Cindy regularly develops nausea and vomiting when she is faced with a stressful situation. Which of the following is most likely a predisposing factor to this maladaptive response by Cindy? a. Cindy inherited her mother's "nervous" stomach. b. Cindy is fixed in a lower level of development. c. Cindy has never been motivated to achieve success. d. When Cindy was a child, her mother pampered her and kept her home from school when she was ill.

d

Client teaching is an important nursing function in milieu therapy. Which of the following statements by the client indicates the need for knowledge and a readiness to learn? a. "Get away from me with that medicine! I'm not sick!" b. "I don't need psychiatric treatment. It's my migraine headaches that I need help with." c. "I've taken Valium every day of my life for the last 20 years. I'll stop when I'm good and ready!" d. "The doctor says I have bipolar disorder. What does that really mean?"

d

Crises occur when an individual: a. Is exposed to a precipitating stressor. b. Perceives a stressor to be threatening. c. Has no support systems. d. Experiences a stressor and perceives coping strategies to be ineffective.

d

Education for the client who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment d. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification

d

Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Dispositional crisis c. Psychiatric emergency d. Maturational/developmental crisis

d

Hildegard Peplau identified seven subroles within the role of the nurse. She believed the emphasis in psychiatric nursing was on which of the subroles? a. The resource person b. The teacher c. The surrogate d. The counselor

d

Joe is very restless and is pacing the room. The nurse says to Joe, "If you don't sit down in the chair and be still, I'm going to put you in restraints!" With which of the following legal actions might the nurse be charged because of this nursing action? a. Defamation of character b. Battery c. Breach of confidentiality d. Assault

d

Joe, an American Indian, goes to the emergency department (ED) because he has an oozing stasis ulcer on his leg. He is accompanied by the tribal shaman, who has been treating Joe on the reservation. As a greeting, the physician extends his hand to the shaman, who lightly touches the physician's hand, then quickly moves away. What cultural norm among American Indians most likely explains the shaman's behavior? a. The shaman is snubbing the physician. b. The shaman is angry at Joe for wanting to go to the ED. c. The shaman does not believe in traditional medicine. d. The shaman does not feel comfortable with touch.

d

Karen's counselor asked her if she would like a hug. This is an example of which of the following? a. Rigid boundary b. A boundary violation c. Enmeshed boundary d. Showing respect for the boundary of another

d

Lucky's accident occurred when he got away from Anna while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember the circumstances of his death. This is an example of what defense mechanism? a. Rationalization b. Suppression c. Denial d. Repression

d

Nancy's new in-laws came to dinner for the first time. When Nancy's mother-in-law left some food on her plate, Nancy thought, "I must be a lousy cook." What automatic thought does this statement represent? a. Dichotomous thinking b. Overgeneralization c. Minimization d. Personalization

d

Nurse Jones is working with Kim, a client in the anger-management program. Which of the following identifies actions associated with the working phase of the therapeutic relationship? a. Kim tells Nurse Jones she wants to learn more adaptive ways to handle her anger. Together, they set some goals. b. The goals of therapy have been met, but Kim cries and says she has to keep coming to therapy in order to be able to handle her anger appropriately. c. Nurse Jones reads Kim's previous medical records. She explores her feelings about working with a woman who has abused her child. d. Nurse Jones helps Kim practice various techniques to control her angry outbursts. She gives Kim positive feedback for attempting to improve maladaptive behaviors.

d

S.T. is a 15-year-old girl who has just been admitted to the adolescent psychiatric unit with a diagnosis of anorexia nervosa. She is 5 feet 5 inches tall and weighs 82 pounds. She was selected to join the cheerleading squad for the fall but states that she is not as good as the others on the squad. The treatment team has identified the following problems: refusal to eat, occasional purging, refusing to interact with staff and peers, and fear of failure. Which of the following nursing diagnoses would be the priority diagnosis for S.T.? a. Social isolation b. Disturbed body image c. Low self-esteem d. Imbalanced nutrition: Less than body requirements

d

The daily record of dysfunctional thoughts (DRDT) is used in cognitive therapy to help clients: a. Identify automatic thoughts. b. Modify automatic thoughts. c. Identify rational alternatives. d. All of the above

d

The most appropriate nursing intervention with Marie (from question 9) would be to: a. Refer her to her family physician for a complete physical examination. b. Suggest she seek outside employment now that her children have left home. c. Identify convenient support systems for times when she is feeling particularly despondent. d. Begin grief work and assist her to recognize areas of self-worth separate and apart from her children.

d

The most common side effects of ECT are: a. Permanent memory loss and brain damage. b. Fractured and dislocated bones. c. Myocardial infarction and cardiac arrest. d. Temporary memory loss and confusion.

d

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication? a. The client's level of agitation increases. b. The client complains of a sore throat. c. The client's skin has a yellowish cast. d. The client develops muscle spasms.

d

The nurse is using nursing process to care for a client who is suicidal. Which of the following nursing actions is a part of the outcome identification step of the nursing process? a. Prioritizes the necessity for maintaining a safe environment for the client b. Determines if nursing interventions have been appropriate to achieve desired results c. Obtains a short-term contract from the client to seek out staff if feeling suicidal d. Establishes goal of care: Client will not harm self during hospitalization

d

The primary focus of family therapy for clients with schizophrenia and their families is: a. To discuss concrete problem-solving and adaptive behaviors for coping with stress. b. To introduce the family to others with the same problem. c. To keep the client and family in touch with the health-care system. d. To promote family interaction and increase understanding of the illness.

d

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain Theresa's suicide attempt in which of the following ways? a. She feels hopeless about her future without her boyfriend. b. Without her boyfriend, she feels like an outsider with her peers. c. She is feeling intense guilt because her boyfriend broke up with her. d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.

d

Walter is angry with his psychiatrist and says to the nurse, "He doesn't know what he is doing. That medication isn't helping a thing!" The nurse responds, "He has been a doctor for many years and has helped many people." This is an example of what nontherapeutic technique? a. Rejecting b. Disapproving c. Probing d. Defending

d

What is the most common comorbid condition in children with bipolar disorder? a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention-deficit/hyperactivity disorder

d

What is the priority nursing intervention before starting ECT therapy? a. Take vital signs and record. b. Have the patient void. c. Administer succinylcholine. d. Ensure that the consent form has been signed.

d

Intervention with Andrew (from question 15) would include: a. Encouraging expression of feelings. b. Antianxiety medications. c. Participation in a support group. d. a and c. e. All of the above.

e