Psych practice questions
A client has been severely depressed since her husband died 6 months earlier. Her physician orders amitriptyline hydrochloride, 50 mg by mouth daily. Before administering amitriptyline, the nurse reviews the client's medical history. Which preexisting condition requires cautious use of this drug? a) Hepatic disease b) Hypernatremia c) Hypokalemia d) Hiatal hernia
A
A client has been treated for major depression and is taking antidepressants. He asks the nurse, "How long do I have to take these pills?" The nurse should tell the client: a) "Antidepressants are prescribed for 6 to 12 months before considering discontinuation." b) "You will need to take the medication for at least 3 months." c) "Once you are feeling better, the medication can be discontinued." d) "The medication can be discontinued when you do not have suicidal thoughts."
A
A client was found unconscious on the floor of his bathroom with self-inflicted wrist lacerations. An ambulance was called and the client was transferred to the inpatient psychiatric unit for observation and treatment with antidepressants. Which nursing intervention is most appropriate? a) Continue suicide precautions. b) Begin a therapeutic relationship. c) Explore precipitating factors for the suicide attempt. d) Observe for extrapyramidal symptoms.
A
A client with OCD is admitted to the hospital due to ritualistic hand washing that occupies several hours each day. The skin on the client's hands is red and cracked, with evidence of minor bleeding. The goal for this client is A decreasing the time spent washing hands. B eliminating the hand-washing rituals. C providing milder soap for hand washing. D providing good skin care.
A
A client with bipolar disorder begins taking lithium carbonate (lithium), 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." The best response by the nurse is which of the following? A "Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks." B "It is nothing to worry about unless it continues for the next month." C "Tremors can be an early sign of toxicity, but we'll keep monitoring your lithium level to make sure you're okay." D "You can expect tremors with lithium. You seem very concerned about such a small tremor.
A
A client with bulimia is learning to use the technique of self-monitoring. Which of the following interventions by the nurse would be most beneficial for this client? A Ask the client to write about all feelings and experiences related to food. B Assist the client to make out daily meal plans for 1 week. C Encourage the client to ignore feelings and impulses related to food. D Teach the client about nutrition content and calories of various foods.
A
A client with mania begins dancing around the day room. When she twirled her skirt in front of the male clients, it was obvious she had no underpants on. The nurse distracts her and takes her to her room to put on underpants. The nurse acted as she did to A minimize the client's embarrassment about her present behavior. B keep her from dancing with other clients. C avoid embarrassing the male clients who are watching. D teach her about proper attire and hygiene.
A
A depressed client tells a nurse, "I want to die. Life just isn't worth living." Which response by the nurse is most appropriate? a) "This must be a very difficult time for you." b) "Of course life is worth living. You'll feel better soon." c) "Why do you want to die?" d) "No one really wants to die."
A
A nurse is administering venlafaxine, 75 mg by mouth daily, to a client diagnosed with depression. What type of agent is venlafaxine? a) Second-generation antidepressant b) Monoamine oxidase inhibitor c) Lithium derivative d) Tricyclic antidepressant
A
A nurse is monitoring a client receiving tranylcypromine sulfate. Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor? a) Hypertensive crisis b) Hypotensive episodes c) Muscle flaccidity d) Hypoglycemia
A
After the nurse teaches a client and family about lithium therapy, which client statements indicates the need for further teaching? a) "I need to eliminate salt in my diet." b) "I will report any vomiting, diarrhea, blurred vision, or weakness." c) "I should avoid driving until I am stabilized." d) "I should drink 10 to 12 glasses of water daily."
A
All but which of the following are initial goals for treating the severely malnourished client with anorexia nervosa? A Correction of body image disturbance B Correction of electrolyte imbalances C Nutritional rehabilitation D Weight restoration
A
Antipsychotic drugs are also known as neuroleptic drugs because A they cause numerous neurological effects. B they frequently cause epilepsy. C they are also minor tranquilizers. D they are the only drugs known to directly affect nerves.
A
Haloperidol (Haldol) is a potent antipsychotic that is associated with A severe extrapyramidal effects. B severe sedation. C severe hypotension. D severe anticholinergic effects.
A
The client with OCD has counting and checking rituals that prolong attempts to perform ADLs and get ready for activities of the day. The nurse knows that interrupting the client's ritual to assist in faster task completion will likely result in A a burst of increased anxiety. B gratitude for the nurse's assistance. C relief from stopping the ritual. D symptoms of depression or suicidality
A
The client with mania is irritable and insulting to an unlicensed assistive personnel (UAP). The UAP states, "I cannot believe Mark is so rude. Should he not be overly happy?" Which response by the nurse should help the UAP understand the client's behavior? a) "I know it is difficult, but Mark is a client whose irritable mood is a symptom of his mania." b) "I will go and speak to him about his behavior and make sure he understands that he needs to control what he is saying." c) "It is our responsibility to listen to him even though we might not like what he's saying." d) "We must reprimand Mark for doing that because there is no reason for him to behave like that."
A
The most important short-term goal for the client who tries to manipulate others would be to A acknowledge own behavior. B express feelings verbally. C stop initiating arguments. D sustain lasting relationships.
A
The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which of the following interventions is indicated? A Supervise the client closely for 2 hours after meals and snacks. B Increase the daily caloric intake from 1500 to 2000 calories. C Increase the client's fluid intake. D Request an order from the physician for fluoxetine.
A
The nurse would assess for which of the following characteristics in a client with narcissistic personality disorder? A Entitlement B Fear of abandonment C Hypersensitivity D Suspiciousness
A
What are the most common types of side effects from SSRIs? A Dizziness, drowsiness, and dry mouth B Convulsions and respiratory difficulties C Diarrhea and weight gain D Jaundice and agranulocytosis
A
Which of the following typifies the speech of a person in the acute phase of mania? A Flight of ideas B Psychomotor retardation C Hesitant D Mutism
A
Which of the following would be an appropriate intervention for a client with OCD who has a ritual of excessive, constant cleaning? A A structured schedule of activities throughout the day B Intense psychotherapy sessions daily C Interruption of rituals with distracting activities D Negative consequences for ritual performance
A
Before administering lithium to a client, the nurse should check for the concomitant use of which of the following drugs, which could cause serious adverse effects? A Ibuprofen B Haloperidol C Thiazide diuretics D Antacids E Ketoconazole F Theophylline
A, B, C, D
Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the patient receiving antipsychotic drugs should include which of the following? A Positioning to decrease discomfort of dyskinesias B Implementing safety measures to prevent injury C Encouraging the patient to chew tablets to prevent choking D Careful teaching to alert the patient and family about this adverse effect E Applying ice to the joints to prevent damage F Pureeing all food to decrease the risk of aspiration
A, B, D
Which of the following activities would be appropriate for a client with mania? A Drawing a picture B Modeling clay C Playing bingo D Playing table tennis E Stretching exercises F Stringing beads
A, B, E
Which of the following would indicate an increased suicidal risk? A An abrupt improvement in mood B Calling family members to make amends C Crying when discussing sadness D Feeling overwhelmed by simple daily tasks E Statements such as "I'm such a burden for everyone" F Statements such as "Everything will be better soon"
A, B, F
A client reports that he thinks he is taking an antidepressant, but he is not sure. In reviewing his medication history, which of the following drugs would be considered antidepressants? A Tetracyclic drugs B Cholinergics C SSRIs D MAOIs E Angiotensin II receptor blockers F Benzodiazepines
A, C, D
Depression is a very common affective disorder that strikes many people. In assessing a client who might be suffering from depression, the nurse would expect to find which of the following? A Lack of energy B Hyperactivity C Sleep disturbances D Libido problems E Confusion F Decreased reflexes
A, C, D
The nurse is assessing a 38-year-old client at risk for suicide. Which of the following are significant assessment data when determining whether a client will require hospitalization? Select all that apply. a) Having an organized plan b) The client's history of substance abuse as a minor c) Being intoxicated with alcohol d) A description of command hallucinations e) The client's age
A, C, D
Which of the following characteristics describe the obsessional thoughts experienced by client's with OCD? A Intrusive B Realistic C Recurrent D Uncontrollable E Unwanted F Voluntary
A, C, D, E
A nurse doing an assessment with a client with anorexia nervosa would expect to find which of the following? A Belief that dieting behavior is not a problem B Feelings of guilt and shame about eating behavior C History of dieting at a young age D Performance of rituals or compulsive behavior E Strong desire to get treatment F View of self as overweight or obese
A, C, D, F
The client with a depressive disorder has been consistent with taking 12.5 mg of paroxetine extended release daily. The nurse judges the client to be benefiting from this drug therapy when the client demonstrates which behaviors? Select all that apply. a) verbalizes feelings b) increases somatization c) completes homework assignments d) takes 2-hour evening naps daily e) decreases pacing
A, C, E
A nurse is caring for an elderly client in a long-term care facility. This client has a history of attempted suicide. The nurse observes the client giving away personal belongings and has heard him express feelings of hopelessness to other residents. Which intervention should the nurse perform first? a) Referring the client to a mental health professional b) Removing items that the client could use in a suicide attempt c) Setting aside time to listen to the client d) Communicating a nonjudgmental attitude
B
Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include A insomnia and hypertension. B dry mouth, hypotension, and glaucoma. C diarrhea and excessive urination. D increased sexual drive and improved concentration.
B
Clients with OCD often have exposure/response prevention therapy. Which of the following statements by the client would indicate positive outcomes for this therapy? A "I am able to avoid obsessive thinking." B "I can tolerate the anxiety caused by obsessive thinking." C "I no longer have any anxiety when I have obsessive thoughts." D "I no longer feel a compulsion to perform rituals."
B
Clients with a schizotypal personality disorder are most likely to benefit from which of the following nursing interventions? A Cognitive restructuring techniques B Improving community functioning C Providing emotional support D Teaching social skills
B
Identify the serum lithium level for maintenance and safety. A 0.1 to 1.0 mEq/L B 0.5 to 1.5 mEq/L C 10 to 50 mEq/L D 50 to 100 mEq/L
B
The nurse is evaluating the progress of a client with bulimia. Which of the following behaviors would indicate that the client is making positive progress? A The client can identify calorie content for each meal. B The client identifies healthy ways of coping with anxiety. C The client spends time resting in her room after meals. D The client verbalizes knowledge of former eating patterns as unhealthy.
B
Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which of the following? A Anticonvulsant mood stabilizers B Antipsychotics C Benzodiazepines D Lithium
B
Treating clients with anorexia nervosa with a selective serotonin reuptake inhibitor antidepressant such as fluoxetine (Prozac) may present which of the following problems? A Clients object to the side effect of weight gain. B Fluoxetine can cause appetite suppression and weight loss. C Fluoxetine can cause clients to become giddy and silly. D Clients with anorexia get no benefit from fluoxetine.
B
Which classification of drugs is the most potentially fatal if a client takes an overdose? a) Phenothiazine antipsychotics b) Tricyclic antidepressants c) Dopaminergics d) Antihistamines
B
Which of the following statements is true? A Anorexia nervosa was not recognized as an illness until the 1960s. B Cultures where beauty is linked to thinness have an increased risk for eating disorders. C Eating disorders are a major health problem only in the United States and Europe. D Persons with anorexia nervosa are popular with their peers as a result of their thinness.
B
Which of the following underlying emotions is commonly seen in an avoidant personality disorder? A Depression B Fear C Guilt D Insecurity
B
Which outcome is therapeutic and realistic when the nurse is planning care for a female client with major depression and borderline personality disorder who is hospitalized for self-mutilation and threats of suicide? a) The client will ask the nurse for a prescribed medication when feeling out of control. b) The client will appropriately verbalize anger and sad feelings to the nurse. c) The client will stay in her room when overwhelmed by feelings. d) The client will leave the group when angry.
B
You might question an order for a monoamine oxidase inhibitor (MAOI) as a first step in the treatment of depression, remembering that these drugs are reserved for use in cases in which there has been no response to other agents because A MAOIs can cause hair loss. B MAOIs are associated with potentially serious drug-food interactions. C MAOIs are mostly recommended for use in surgical patients. D MAOIs are more expensive than other agents.
B
he drug of choice for a patient with a documented obsessive-compulsive disorder who is also suffering from depression and occasional panic disorder would be A Celexa. B Paxil. C Luvox. D Prozac.
B
The nurse working with a client with antisocial personality disorder would expect which of the following behaviors? A Compliance with expectations and rules B Exploitation of other clients C Seeking special privileges D Superficial friendliness toward others E Utilization of rituals to allay anxiety F Withdrawal from social activities
B, C, D
When working with a client with a personality disorder, the nurse would expect to assess which of the following? A High levels of self-awareness B Impaired interpersonal relationships C Inability to empathize with others D Minimal insight E Motivation to change F Poor reality testing
B, C, D
A nurse doing an assessment with a client with bulimia would expect to find which of the following? A Compensatory behaviors limited to purging B Dissatisfaction with body shape and size C Feelings of guilt and shame about eating behavior D Near-normal body weight for height and age E Performance of rituals or compulsive behavior F Strong desire to please others.
B, C, D, F
A client in the manic phase of bipolar disorder constantly belittles other clients and demands special favors from the nurses. Which nursing intervention is most appropriate for this client? a) Ask other clients and staff members to ignore the client's behavior. b) Offer the client an antianxiety drug when belittling or demanding behavior occurs. c) Set limits with consequences for belittling or demanding behavior. d) Offer the client a variety of stimulating activities to distract him from belittling others or making demands of them.
C
A nurse is caring for a client diagnosed with antisocial personality disorder. This client has a history of fighting, cruelty to animals, and stealing. Which trait is the nurse likely to uncover during assessment? a) Frequent expression of guilt regarding antisocial behavior b) History of gainful employment c) A low tolerance for frustration d) Demonstrated ability to maintain close, stable relationships
C
A nurse is instructing a new group of mental health aides. The nurse should teach the aides that setting limits is most important for: a) an anxious client. b) a suicidal client. c) a manic client. d) a depressed client.
C
Antipsychotic drugs are basically A serotonin reuptake inhibitors. B norepinephrine blockers. C dopamine-receptor blockers. D acetylcholine stimulators.
C
Depression is an affective disorder that is A always precipitated by a specific event. B most common in patients with head injuries. C characterized by overwhelming sadness, despair, and hopelessness. D very evident and easy to diagnose in the clinical setting.
C
Lithium toxicity can be dangerous. Patient assessment to evaluate for appropriate lithium levels would look for A serum lithium levels >3 mEq/L. B serum lithium levels >4 mEq/L. C serum lithium levels <1.5 mEq/L. D undetectable serum lithium levels.
C
The biogenic amine theory of depression states that depression is a result of A an unpleasant childhood. B GABA inhibition. C deficiency of norepinephrine, dopamine, or 5HT in key areas of the brain. D blockages within the limbic system, which controls emotions and affect.
C
The client with depression has been hospitalized for 3 days on the psychiatric unit. This is the second hospitalization during the past year. The healthcare provider prescribes tranylcypromine sulfate because the client did not respond positively to a tricyclic antidepressant. If the client's diet includes foods containing tyramine, the nurse should teach the client about which possible reaction? a) respiratory arrest b) heart block c) hypertensive crisis d) generalized tonic-clonic seizure
C
The client with rapid-cycling bipolar disorder who is about to receive his 1700 hours dose of carbamazepine tells the nurse he has a sore throat and chills. What should the nurse do next? a) Report the symptoms to the health care provider (HCP) in the morning. b) First, give the client acetaminophen as prescribed PRN. c) Call the health care provider (HCP) to report changes. d) Administer the prescribed amount of carbamazepine.
C
The nurse observes that a client with depression sat at a table with two other clients during lunch. The best feedback the nurse could give the client is which of the following? A "Do you feel better after talking with others during lunch?" B "I'm so happy to see you interacting with other clients." C "I see you were sitting with others at lunch today." D "You must feel much better than you were a few days ago."
C
When interviewing any client with a personality disorder, the nurse would assess for which of the following? A Ability to charm and manipulate people B Desire for interpersonal relationships C Disruption in some aspects of his or her life D Increased need for approval from others
C
When teaching a patient receiving tricyclic antidepressants (TCAs), it is important to remember that TCAs are associated with many anticholinergic adverse effects. Teaching about these drugs should include anticipation of A increased libido and increased appetite. B polyuria and polydipsia. C urinary retention, arrhythmias, and constipation. D hearing changes, cataracts, and nightmares.
C
When working with a client with a narcissistic personality disorder, the nurse would use which of the following approaches? A Cheerful B Friendly C Matter-of-fact D Supportive
C
Which of the following is an example of a cognitive-behavioral technique? A Distraction B Relaxation C Self-monitoring D Verbalization of emotions
C
Which statement should be included when teaching clients about monoamine oxidase (MAO) inhibitors? a) Avoid strenuous activity because of the drug's cardiac effects. b) Have blood levels screened weekly for leukopenia. c) Don't take any prescribed or over-the-counter medications without consulting a physician and pharmacist. d) Don't take an MAO inhibitor with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
C
A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse? A "Thank you. I think you are special too." B "I suspect you want something from me. What is it?" C "You probably say that to all your nurses." D "Are you thinking of suicide?"
D
A client who is taking lithium carbonate has nausea, dry mouth, and thirst. The nurse should tell the client: a) "We need to check the level of lithium in your blood." b) "Your symptoms really are no cause for concern." c) "I'll hold off on giving you your lithium until you feel better." d) "These common side effects of lithium will go away after 6 weeks."
D
A client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming and hygiene. Which nursing action is most appropriate? a) asking the client if he is ready to shower b) waiting until the client's family can participate in the client's care c) explaining the importance of hygiene to the client d) stating to the client that it is time for him to take a shower
D
A nurse notices that a depressed client who has been taking amitriptyline hydrochloride for 2 weeks has become very outgoing, cheerful, and talkative. The nurse suspects that the client: a) is responding appropriately to the antipsychotic. b) is experiencing a split personality. c) is ready to be discharged from treatment. d) may be experiencing increased energy and is at increased risk for suicide.
D
A teenaged girl is being evaluated for an eating disorder. Which of the following would suggest anorexia nervosa? A Guilt and shame about eating patterns B Lack of knowledge about food and nutrition C Refusal to talk about food-related topics D Unrealistic perception of body size
D
Adverse effects may limit the usefulness of TCAs with some patients. Nursing interventions that could alleviate some of the unpleasant aspects of these adverse effects include A always administering the drug when the patient has an empty stomach. B reminding the patient not to void before taking the drug. C increasing the dose to override the adverse effects. D taking the major portion of the dose at bedtime to avoid experiencing drowsiness and the unpleasant anticholinergic effects.
D
Cognitive restructuring techniques include all the following except a decatastrophizing. B positive self-talk. C reframing. D relaxation.
D
Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include A depression. B anxiety. C seizures. D schizophrenia.
D
Nurses should be aware of their own feelings about clients, and the difficulty of maintaining effective relationships with depressed clients experiencing suicidal ideation because of which behaviors? a) independence, which prevents them from asking for assistance b) poor personal grooming, which invites disgust and ridicule from others c) laziness, which keeps them from putting forth the necessary effort to get well d) pessimism, which arouses frustration and anger in others
D
The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which of the following? A Aggression B Anger C Anxiety D Psychomotor agitation
D
Venlafaxine (Effexor) is a relatively new antidepressant that might be very effective for use in patients who A have proven to be responsive to other antidepressants. B can tolerate multiple side effects. C are reliable at taking multiple daily dosings. D have not responded to other antidepressants and would benefit from once-a-day dosing.
D
What is the rationale for a person taking lithium to have enough water and salt in his or her diet? A Salt and water are necessary to dilute lithium to avoid toxicity. B Water and salt convert lithium into a usable solute. C Lithium is metabolized in the liver, necessitating increased water and salt. D Lithium is a salt that has greater affinity for receptor sites than sodium chloride.
D
When developing appropriate assignments for the staff, which client should the nurse manager judge to be at highest risk for suicide completion? a) a 34-year-old single Latino woman who has recently been diagnosed with cancer b) a 15-year-old girl of African descent whose boyfriend broke up with her c) a 52-year-old Asian man who was terminated from his job because of downsizing d) an 85-year-old Caucasian man who lives alone after his wife's death
D
Which statement by the nurse reflects the best understanding about suicide in an individual with depression? a) "The person who talks about suicide is less likely to try it." b) "Suicide is less likely when the individual is receiving antidepressant therapy." c) "The more severe the depression, the greater the probability for suicidal behavior." d) "Every client with depression is potentially suicidal."
D
Your patient is being treated for depression and is started on a regimen of Prozac (fluoxetine). She calls you 10 days after the drug therapy has started to report that nothing has changed and she wants to try a different drug. You should A tell her to try sertraline (Zoloft) because some patients respond to one selective serotonin reuptake inhibitor (SSRI) and not another. B ask her to try a few days without the drug to see whether there is any difference. C add an MAOI to her drug regimen to get an increased antidepressant effect. D encourage her to keep taking the drug as prescribed because it usually takes up to 4 weeks to see the full antidepressant effect.
D
Interventions for a client with obsessive-compulsive disorder would include A encouraging the client to verbalize feelings. B helping the client to avoid obsessive thinking. C interrupting rituals with appropriate distractions. D planning with the client to limit rituals. E teaching relaxation exercises to the client. F telling the client to tolerate any anxious feelings.
D, E, F
A client asks the nurse which vitamins should be taken daily for feelings of fatigue, anxiety, and depression 1 week before menses. Which of the following is the correct response by the nurse? a) Vitamin B6 b) Vitamin C c) Vitamin D d) Vitamin A
a
A client is diagnosed with posttraumatic stress disorder (PTSD). Which finding would the nurse most likely assess? a) Diaphoresis b) Constricted pupils c) Muscle flaccidity d) Bradycardia
a
A client taking paroxetine 40 mg PO every morning tells the nurse that her mouth "feels like cotton." Which statement by the client necessitates further assessment by the nurse? a) "I am drinking 12 glasses of water every day." b) "I am using sugarless gum." c) "I am sucking on sugarless candy." d) "I am sucking on ice chips."
a
A client tells the nurse that he is feeling depressed and low. Further assessment reveals that the client has difficulty verbalizing his feelings and needs, often feeling manipulated by others. Which of the following would the nurse suggest to the client to help relieve stress? a) Enroll in a class or workshop in assertiveness training b) Be realistic about how much you can accomplish c) Practice rephrasing thoughts that are negative or irrational d) Gain control over self-defeating thoughts
a
A client with panic disorder is taking alprazolam 1 mg PO three times daily. The nurse understands that this medication is effective in blocking the symptoms of panic because of its specific action on which neurotransmitter? a) gamma-aminobutyrate b) serotonin c) norepinephrine d) dopamine
a
A depressed client on a psychiatric unit asks the nurse to call the hospital lawyer to discuss writing out a will. What is the nurse's priority intervention? a) Discuss thoughts and explore intent for suicide with the client. b) Call a lawyer as requested by the client. c) Offer the client medication for anxiety. d) Inform the physician first, and place the client on suicide watch.
a
A health care provider (HCP) has prescribed valproic acid for a client with bipolar disorder who has achieved limited success with lithium carbonate. Which information should the nurse teach the client about taking valproic acid? a) Follow-up blood tests are necessary while on this medication. b) Tachycardia and upset stomach are common side effects. c) The extended-release tablet can be crushed if necessary for ease of swallowing. d) Consumption of a moderate amount of alcohol is safe if the medication is taken in the morning.
a
A nurse is assigned to care for a client with anorexia nervosa. During the first 48 hours of treatment, which nursing intervention is most appropriate for this client? a) Providing one-on-one supervision during meals and for 1 hour afterward b) Giving the client as much time to eat as desired c) Letting the client eat with other clients to create a normal mealtime atmosphere d) Trying to persuade the client to eat and thus restore nutritional balance
a
A nurse who will be working at a local health fair is preparing a presentation about depression. When developing the presentation, which of the following would the nurse most likely include? a) Depression is more common in women than in men. b) Older adult clients frequently exhibit characteristic symptoms. c) Depression is a common diagnosis in health care today. d) Individuals with depression often seek treatment for it.
a
An admitting nurse on a rehabilitation unit notices that an elderly client with a fractured hip and severe hypothyroidism is dirty and disheveled and that his personal hygiene is very poor. As the nurse gathers admission data, she further notes that the client has few personal connections, is depressed, and doesn't seem to care about his appearance. How should the nurse improve the client's performance of self-care activities? a) Provide initial and routine hygienic care, then evaluate the client daily as treatment progresses. b) Ask the physician to refer the client to social services for a full evaluation and follow-up. c) Provide complete hygienic care and make an appointment for the client to see the hospital barber. d) Offer to take the client to the shower and help him fix his hair.
a
During postprandial monitoring, a client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response? a) "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat." b) "I trust you not to purge." c) "Don't worry. I won't allow you to purge today." d) "I need to know how and when you purge."
a
In assessing an adolescent client at an outpatient clinic, the nurse is able to recognize that depression in adolescents is often which of the following? a) Often masked by aggressive behaviors b) A sign that the teenager needs to be admitted to the hospital c) Situational and not as serious as that of adult clients d) Similar in symptomology to that of adult clients
a
The nurse is caring for a 15-year-old client with anorexia nervosa and a body mass index (BMI) of 17. Which statement made by the client, would indicate to the nurse that the North America Nursing Diagnosis Association (NANDA) diagnosis or patient priority of Body image altered is appropriate? a) "I'm too ugly and fat." b) "I do not want to gain weight." c) "I like being a small size." d) "Skinny is the best body type."
a
The nurse is educating a client who insists that the newly prescribed imipramine is not working for her feelings of depression. When evaluating the client's statement, which question is most important to ask first? a) "How long have you been taking the medication?" b) "Do you feel worse since taking the medication?" c) "What time of day are you taking the medication?" d) "What is the dosage of medication that you are prescribed?"
a
The nurse is working with a client with depression in a mental health clinic. During the interaction, the nurse uses the technique of self-disclosure. In order for this technique to be therapeutic, which of the following steps must be a priority for the nurse? a) Ensuring relevance to, and quickly refocusing upon, the client's experience b) Allowing the client time to ask questions about the nurse's experience c) Discussing the nurse's experience in detail d) Asking for the client's perception of what the nurse has revealed
a
The nurse should explain that the most common cause for the unhappiness some children experience when first entering school is due to which factor? a) feelings of insecurity b) social isolation c) emotional maladjustment d) poor language development
a
When teaching a client with bulimia nervosa about possible complications, which condition should the nurse emphasize? a) Diabetes mellitus b) Hepatitis A c) Allergies d) Lung cancer
a
Which of the following clients would the nurse expect to have negative coping skills? a) A 19-year-old diagnosed with schizophrenia who is heading off to college b) A 37-year-old factory worker who is laid off for the summer c) A 72-year-old retiree who needs to take an expensive new chemotherapeutic agent d) A 13-year-old diabetic who joins a softball league
a
parents of a 15-year-old state that their child is moody and rude. The nurse should advise the parents to: a) discuss their feelings with their child. b) restrict their child's activities. c) talk to other parents of adolescents. d) obtain family counseling.
a
A 17-year-old male client is being admitted to the adolescent psychiatric unit. He was brought in by the police after beating up two male peers. The client says, "They said I was gay because I had sex with an older neighbor when I was 8 years old. I am not gay!" Which nursing interventions would be appropriate? Select all that apply. a) Help the client express anger safely. b) Discuss the client's attitude about going to jail after discharge. c) Ask the client if he would like to attend a support group. d) Monitor the client's level of anger and potential aggression. e) Assist the client in processing his feelings about the sexual abuse.
a, c, d, e
A client has been diagnosed with an adjustment disorder with mixed anxiety and depression. What are the primary nursing diagnoses the nurse would associate with this type of adjustment disorder? Select all that apply. a) Risk for situational low self-esteem. b) Impaired memory. c) Disturbed personal identity. d) Impaired social interaction. e) Activity intolerance. f) Acute confusion.
a, d
The nurse is talking with a client who was diagnosed with bulimia 3 months ago. The client needs more education about the illness if she makes which comments? Select all that apply. a) "When I am not bingeing and purging, I can skip that eating disorder support group." b) "I have made a real effort to be more social and involved in activities." c) "If I start severely restricting my eating, I may be building up to a bingeing episode." d) "My depression is gone so I do not need my antidepressant any longer." e) "I know that this illness is chronic and intermittent. I will always have to control it."
a, d
Which nursing action would be therapeutic for the client being admitted to the unit with panic disorder? Select all that apply. a) Respect the client's personal space. b) Touch the client to provide contact with reality. c) Confront the client's dysfunctional coping behaviors. d) Support the client's attempts to discuss feelings. e) Reassure the client of safety.
a, d, e
The nurse is planning an eating disorder protocol for hospitalized clients experiencing bulimia and anorexia. Which elements should be included in the protocol? Select all that apply. a) Clients must rest within view of a staff member for one half hour to an hour after eating. b) Clients are not allowed to discuss food or eating in groups or informal conversation with peers. c) Clients cannot participate in any groups after admission until they gain one pound (0.5 kg). d) Clients are not told their weight and cannot see their weight while being weighed. e) Clients may not go to the bathroom for one-half hour to an hour after eating. f) Clients must eat within view of a staff member.
a, d, e, f
A child being treated for conduct disorder is the last person on the unit selected for an activity. The nurse should expect the client to demonstrate: a) apathy. b) aggression. c) withdrawal. d) tearfulness.
b
A client admits to having thoughts of suicide. He is lethargic, withdrawn, and irritable. In conversations with the nurse, he stresses his faults. When he starts to point out the things he cannot do, which response by the nurse is best? a) "Try to think more positively about yourself." b) "You were able to write a letter to your friend today." c) "Let us talk about your plans for the weekend." d) "You can do anything you put your mind to."
b
A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which other disorder? a) Amnestic disorder b) Mood disorder c) Personality disorder d) Thought disorder
b
A client loses control and throws two chairs toward another client. What should the nurse do next? a) Administer an oral PRN tranquilizer, and prepare for a show of determination. b) Call for assistance to restrain the client, and administer a PRN intramuscular tranquilizer. c) Process the incident with the client and discuss alternative behaviors. d) Ask the client to go to the quiet area and talk about the behavior.
b
A client struggling with a binge eating disorder tells a nurse, "I don't know why I eat the way I do each night." What question would be most helpful for the nurse to ask this client? a) "Have you experienced changes in your leisure activities?" b) "What do you do when you feel stressed or upset?" c) "Do you worry that bad things will happen to you?" d) "Are there periods of time at night that you can't account for?
b
A client who is admitted to the adult unit of a mental health care facility with depression tells the nurse that he has pedophilia. The nurse should: a) recognize that because the client is depressed, the client will not be able to discuss the pedophilia. b) be aware of personal opinions and views. c) ensure that the client is never alone with other clients on the unit. d) refer the client to group therapy.
b
A client who's at high risk for suicide needs close supervision. To best ensure the client's safety, the nurse should: a) assure the client that she will hold in confidence anything he tells her. b) check the client frequently at irregular intervals. c) repeatedly discuss the client's previous suicide attempts with him. d) disregard decreased communication by the client because decreased communication is typical of suicidal clients.
b
A client with a diagnosis of anorexia nervosa is admitted to the psychiatric unit. Although she is 5′ 8″ (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly about how fat she is. Which measure should the nurse take first when caring for this client? a) Teach the client about nutrition, calories, and a balanced diet. b) Establish a trusting relationship with the client. c) Discuss cultural stereotypes regarding thinness and attractiveness. d) Explore the reasons why the client doesn't eat.
b
A client with acute mania exhibits euphoria, pressured speech, and flight of ideas. The client has been talking to the nurse nonstop for 5 minutes and lunch has arrived on the unit. What should the nurse do next? a) Tell the client he needs to stop talking because it is time to eat lunch. b) Excuse oneself while telling the client to come to the dining room for lunch. c) Walk away, and approach the client in a few minutes before the food gets cold. d) Do not interrupt the client, but wait for him to finish talking.
b
A nurse is assessing a 15-year-old female who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find? a) Tachycardia b) Muscle weakness c) Warm, flushed extremities d) Coarse hair growth
b
A nurse is assessing a client at a mental health clinic who threatens suicide and describes having a plan. Which of the following should the nurse recognize as the priority goal for the client? a) Obtaining admission to an acute care facility b) Working with the client to resolve the immediate crisis c) Establishing a foundation for long-term therapy d) Notifying family members of the suicide plan
b
A nurse is assessing an 82-year-old for depression. Because of the client's age, the nurses' assessment should be guided by the fact that: a) impairment of cognition usually is not present. b) sadness of mood is usually present, but it is masked by other symptoms. c) antidepressant therapies are less effective in older adults. d) psychosomatic tendencies do not tend to dominate.
b
A nurse is caring for a 14-year-old adolescent who states, "No one understands me." Which of the following statements by the nurse best demonstrates empathy? a) "Don't be so negative; things will get better." b) "It is difficult being a teenager. Tell me more." c) "I'm sure your parents understand you." d) "Explain why you think no one understands you.
b
A nurse is caring for a client diagnosed with bulimia nervosa. The most appropriate initial goal for this client is to: a) control eating impulses. b) identify a connection between anxiety and eating behaviors. c) avoid shopping for large amounts of food. d) restrict eating to three meals per day.
b
A nurse observes a male client who is hyperactive and intrusive sitting very close to a female client with his arm around her shoulders. The nurse hears the male client tell a sexually explicit joke. The nurse approaches the client and asks him to walk down the hallway. Which statement by the nurse should benefit the client? a) "I think a time-out in your room would be appropriate now." b) "Telling sexual jokes and touching others is not permitted here." c) "You need to be careful about what you say to other people." d) "She will not want to be around you with that kind of talk."
b
A nurse on the crisis team in the emergency department is caring for a client who is angry and is experiencing delusional episodes. The client says to the nurse, "I'm going to kill my wife and chop her up to get rid of her." What is the nurse's priority action in this situation? a) Include "risk for injury" on the care plan. b) Notify the wife that she may be in danger. c) Note it on the mental status form only. d) Ignore the remarks as delusional symptoms.
b
A nurse suspects that a client may be experiencing post-traumatic stress disorder (PTSD). Which assessment finding would help support the nurse's suspicion? a) Client recently lost a spouse to a chronic illness. b) Client was a victim of a rape and beating. c) Client was just told that he has lung cancer. d) Client had a foot amputated due to diabetes.
b
A nurse works in a suicide crisis clinic. The clients she should consider to represent the highest risk for suicide are those who state: a) "I'm always thinking about dying." b) "I'm thinking of driving my car into a tree on the way home." c) "I gave my clothes away because I'm depressed and think about death a lot." d) "If my life doesn't get better, I might take matters into my own hands."
b
A nurse works with a client diagnosed with bulimia. What is the most appropriate long-term client goal for this client? a) Eat meals at home without binging or purging. b) Manage stresses in life without binging or purging. c) Be able to attend college without binging or purging. d) Be able to eat out without binging or purging.
b
An unemployed client, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which behaviors by the client threaten the nurse-client relationship? a) Flat affect, social withdrawal, and unusual dress b) Low self-esteem, strong dependency needs, and impulsiveness c) Suspiciousness, hypervigilance, and emotional coldness d) Insensitivity to others, sexual acting out, and violence
b
For a client with anorexia nervosa, which goal takes the highest priority? a) The client will make a contract with the nurse that sets a target weight. b) The client will establish adequate daily nutritional intake. c) The client will verbalize the possible physiological consequences of self-starvation. d) The client will identify self-perceptions about body size as unrealistic.
b
Nursing students are reviewing different types of mental health problems in the older adult population. They demonstrate understanding of this information when they identify which condition as the most common affective disorder? a) Phobias b) Depression c) Schizophrenia d) Anxiety
b
The client is receiving 6 mg of selegiline transdermal system every 24 hours for major depression. The nurse should judge teaching about selegiline to be effective when the client makes which statement? a) "I need to wait until the next day to put on a new patch if it falls off." b) "I need to avoid using the sauna at the gym." c) "I can cut the patch and use a smaller piece." d) "I might gain at least 10 lb (4.5 kg) from the medication."
b
The nurse is caring for a client in strict isolation and assesses that the client is apathetic and has a decreased attention span. Which of the following nursing actions should the nurse implement? a) Provide earplugs to the client to block out noise. b) Encourage the client to share concerns and perceptions. c) Limit the client's use of the television. d) Touch the client only when necessary.
b
The nurse is working in a community mental health clinic. A client who is diagnosed with schizophrenia is taking clozapine and reports of a sore throat. What is the most appropriate action for the nurse to take? a) Suggest that the client drink warm beverages and rest. b) Obtain an order for the client to have a white blood cell count drawn. c) Have the client decrease the daily amount of clozapine by half. d) Encourage the use of saline mouth rinses until the sore throat is gone.
b
A nurse is caring for an anorexic client with a nursing diagnosis of imbalanced nutrition: less than body requirements related to dysfunctional eating patterns. Which interventions would be supportive for this client? Select all that apply. a) Allow the client to skip meals until the antidepressant levels are therapeutic. b) Encourage the client to eat three substantial meals per day. c) Provide small, frequent meals. d) Monitor the client during meals and for 1 hour after meals. e) Monitor weight gain. f) Encourage the client to keep a journal.
b, c, d, e,
A nurse is caring for a client diagnosed with persistent depressive disorder. Which defining characteristics are associated with this disorder? Select all that apply. a) Delusions or hallucinations. b) Suicidal thoughts. c) Symptoms that occur in the winter and resolve in spring. d) Onset of symptoms within a 2-week period. e) Appetite disturbance. f) Insomnia or hypersomnia
b, e, f
A client at 4 weeks postpartum tells the nurse that she cannot cope any longer and is overwhelmed by her newborn. The baby has old formula on her clothes and under her neck. The mother does not remember when she last bathed the baby and states she does not want to care for the infant. The nurse should encourage the client and her husband to call their health care provider (HCP) because the mother should be evaluated further for: a) postpartum blues. b) poor bonding. c) postpartum depression. d) infant abuse.
c
A client diagnosed with bulimia tells the nurse she only eats excessively when upset with her best friend, and then she vomits to avoid gaining a lot of weight. The nurse should next: a) work with the client to limit her purging. b) schedule daily family therapy sessions. c) enroll the client in a coping skills group. d) have the client take lorazepam 1 mg as needed whenever she feels the urge to binge.
c
A client states the following to the nurse: "I am a failure, and I wish I had died." Which of the following statements by the nurse demonstrates a therapeutic response? a) "I am glad to hear you speak about your feelings and I am glad you did not die." b) "I think you have had many successes in your life and you should focus on them." c) "You feel like a failure; would you like to talk more about the way you feel?" d) "You are depressed right now, so feeling like a failure is a normal manifestation."
c
A client with bipolar disorder, mania, has flight of ideas and grandiosity and becomes easily agitated. To prevent harmful behaviors, which of the following should the nurse do initially? a) Instruct the client to ask for medication when agitated. b) Encourage the client to stay in his room. c) Tell the client to seek out staff when feeling agitated. d) Seclude the client at the first sign of agitation.
c
A female client is admitted to a mental health unit with a diagnosis of depression and is participating in group sessions. She asks a male nurse if he is married or has a girlfriend. What is the best response by the nurse to maintain a therapeutic relationship? a) "It sounds as though you are interested in developing a relationship with me." b) "Group therapy is not the appropriate time to discuss my relationships." c) "I'm curious about your question, but I want to know how you are feeling today." d) "Tell me how you knew that I was not married or had a girlfriend."
c
A nurse is caring for a client who began taking the antidepressant paroxetine (Paxil) 2 weeks ago. The client recently began giving away prized possessions and tells the nurse, ?My mind is made up, I can do this.? What is the best action by the nurse to incorporate this information into the plan of care? a) Document the depression has resolved. b) Encourage the client to join a therapy group. c) Add the nursing diagnosis: Risk for self-harm. d) Tell another nurse about this client statement.
c
A nurse is developing a plan of care for a patient diagnosed with post-traumatic stress disorder (PTSD). Which of the following would be the priority? a) Teaching coping skills for self-care b) Assisting the patient to work through the traumatic experience c) Establishing a trusting nurse-patient relationship d) Administering prescribed drug therapy
c
A nurse is preparing a delusional client for a computed tomography scan of the brain to rule out an organic etiology. As the nurse accompanies the client to the radiology department, he looks around anxiously and states, "The Interpol is coming to kill me." What is the nurse's best response? a) "No one can hurt you here." b) "Your illness is causing you to hear voices." c) "It sounds like you're frightened." d) "The Interpol isn't here."
c
A nurse should intervene when a depressed client makes which statement? a) "Television does not interest me anymore." b) "I have gained a little weight." c) "Nobody cares about me." d) "I have trouble falling asleep."
c
After educating a class about depression, the instructor determines that additional class time is needed for teaching when the class identifies which of the following as an indicator of depression? a) Sleep disturbances b) Increased thoughts about death c) Increased concentration d) Feelings of worthlessness
c
During therapy, a client on the mental health unit is restless and is starting to make sarcastic remarks to others in the therapy session. The nurse responds by saying, "you look angry." Which of the following communication techniques is the nurse using? a) Clarification b) Mirroring c) Making observations d) Reaffirming
c
One of the goals for a client with anorexia nervosa is for the client to demonstrate increased individual coping by responding to stress in constructive ways. Which action is the best indicator that the client is working toward meeting the goal? a) The client drinks 4 L of fluid per day. b) The client paces around the unit most of the day. c) The client keeps a journal and discusses it with the nurse. d) The client talks almost constantly with friends by telephone.
c
The client with mania is skipping up and down the hallway, nearly running into other clients. The nurse should include which activity in the client's plan of care? a) reading the newspaper b) watching television c) cleaning the dayroom tables d) leading a group activity
c
The client with recurring depression will be discharged from the psychiatric unit. Which suggestion to the family is most important to include in the plan of care? a) Provide for a schedule of activities outside the home. b) Discourage visitors while the client is at home. c) Involve the client in usual at-home activities. d) Encourage the client to sleep as much as possible.
c
The nurse is evaluating a patient's social support network. The nurse evaluates that the network will assist the patient in coping with stress when which of the following is noted? a) Patient avoids situations exposing her to new people b) Patient's friends ask her for advice c) Daughter helps mother with laundry d) Son does not acknowledge his mother's diagnosis
c
The nurse makes a home visit to a primigravida on the fourth postpartum day after birth of a viable neonate. When the nurse enters the house, the nurse finds the client sitting in a chair, crying inconsolably, while the neonate is crying in another room. The client tells the nurse that she has not been sleeping well and has been hearing voices. The nurse determines that the client is most likely experiencing: a) normal reactions to being a new mother. b) postpartum depression. c) postpartum psychosis. d) the "baby blues."
c
When a patient says, "I don't care if I get better; I have nothing to live for, anyway," which type of counseling would be appropriate? a) Professional counseling b) Short-term counseling c) Motivational counseling d) Long-term counseling
c
When teaching a group of adolescents about anorexia nervosa, the nurse should describe this disorder as being characterized by which factor? a) excessive fear of becoming obese, near-normal weight, and a self-critical body image b) obsession with the weight of others, chronic dieting, and an altered body image c) intense fear of becoming obese, emaciation, and a disturbed body image d) extreme concern about dieting, calorie-counting, and an unrealistic body image
c
Which of the following phases of psychological reaction to rape is characterized by fear and flashbacks? a) Reorganization phase b) Acute disorganization phase c) Heightened anxiety phase d) Denial phase
c
While caring for a client who has bipolar disorder and alcohol dependency, which area is the priority for daily assessment? a) eating habits b) self-care ability c) mental status d) sleep pattern
c
A client is remanded by the courts for psychiatric treatment. His police record, which dates to his early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is associated with: a) obsessive-compulsive personality disorder. b) narcissistic personality disorder. c) borderline personality disorder. d) antisocial personality disorder.
d
A client is scheduled for cardiac catheterization the next morning. His physician ordered temazepam, 30 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that: a) sedatives interact with few drugs; hypnotics interact with many. b) sedatives don't depress respirations; hypnotics do. c) sedatives cause predictable responses; hypnotics cause unpredictable ones. d) sedatives reduce excitement; hypnotics induce sleep.
d
A client walks into the clinic and tells the nurse she has run out of money for crack, has crashed, and wants something to help her feel better. Which factor is most important for the nurse to assess? a) suspiciousness b) drug craving c) loss of appetite d) suicidal ideation
d
A client with bulimia binges twice a day. The nurse interprets these binges as most likely involving which factors for the client? a) feelings of euphoria and gratification b) eating increasing amounts of food for substantial weight gain c) leaving traces of food around to attract attention d) feeling out of control and disgusted with self
d
A client with bulimia binges twice a day. The nurse interprets these binges as most likely involving which factors for the client? a) leaving traces of food around to attract attention b) eating increasing amounts of food for substantial weight gain c) feelings of euphoria and gratification d) feeling out of control and disgusted with self
d
A nurse is assessing a patient with posttraumatic stress disorder (PTSD) who is exhibiting physiologic manifestations. The nurse interprets these manifestations as being the result of which of the following? a) Decreased plasma catecholamine levels b) Decreased urinary epinephrine levels c) Increased parasympathetic activity d) Increased sympathetic activity
d
A nurse is caring for a patient diagnosed with depression in the mental health unit. The nurse understands that therapeutic effects of tricyclic antidepressants occur at which timeframe?? a) 1 week b) 4 weeks c) 2 weeks d) 3 weeks
d
A nurse is developing a care plan for a client with anorexia nervosa. Which action should the nurse include in the plan? a) Provide privacy for the client during meals. b) Encourage the client to exercise, which will reduce her anxiety. c) Restrict visits with family members until the client begins to eat. d) Set up a strict eating plan with the client.
d
A nurse is teaching new staff members about groups considered at highest risk for suicide. Which group should the nurse emphasize? a) Alcohol abusers, widows, and young married men b) Women, divorced persons, and substance abusers c) Depressed persons, physicians, and persons living in rural areas d) Adolescents, men older than age 45, and persons who are unemployed
d
A nurse performing an assessment determines that a client with anorexia nervosa is currently unemployed and has a family history of affective disorders, obesity, and infertility. Based on this information, the nurse should monitor the client for which health concern? a) Avoidance behavior b) Explosive outbursts c) Alcohol abuse d) Suicide potential
d
A nurse plans to include the parents of a client with anorexia nervosa, in the client's therapy sessions. The nurse should anticipate that the parents will: a) maintain emotional distance from their child. b) alternate between expressing love for and rejection of their child. c) have a history of substance abuse. d) tend to overprotect their child.
d
A nursing student is studying depression in the elderly adult. Faculty members knows the student has mastered the information when she states which of the following? a) "Depression can resolve without treatment." b) "Depression is usually not accompanied by changes in behavior." c) "Sadness is most often associated with suicidal intent." d) "Treatment of depression includes counseling."
d
A severely dehydrated adolescent admitted to the hospital with hypotension and tachycardia undergoes evaluation for electrolyte disturbances. Her history includes anorexia nervosa and a 20-lb (9.1-kg) weight loss in the past month. She is 5′ 7″ (1.7 m) tall and weighs 80 lb (36.3 kg). Which nursing intervention takes highest priority? a) Addressing the client's low self-esteem b) Regularly monitoring vital signs and weight c) Instituting behavioral modification therapy as ordered d) Initiating caloric and nutritional therapy as ordered
d
An unemployed client, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which behaviors by the client threaten the nurse-client relationship? a) Suspiciousness, hypervigilance, and emotional coldness b) Insensitivity to others, sexual acting out, and violence c) Flat affect, social withdrawal, and unusual dress d) Low self-esteem, strong dependency needs, and impulsiveness
d
During the recuperation phase, a client with severe burns has become withdrawn. What concerns should the nurse explore? a) Concerns regarding coping abilities b) Concerns regarding how the client's family will respond c) Concerns regarding dependence and unwillingness to be discharged d) Concerns about body image and self esteem
d
The nurse is working on discharge plans with a client who is diagnosed with intermittent explosive disorder, characterized by sudden angry outbursts. The nurse determines that the client is ready for discharge when he makes which comment? a) "Drinking does not help, but I like being with my buddies at the bar." b) "I am just not going to let myself get angry anymore." c) "It would help if my mom would stop getting on my case all the time." d) "I will be taking valproic acid and propranolol to help stay in control."
d
The nurse notices that a client diagnosed with major depression and social phobia must get up and move to another area when someone sits next to her. Which action by the nurse is appropriate? a) Ignore the client's behavior. b) Have nursing staff follow the client as moves away. c) Question the client about her avoidance of others. d) Convey awareness of the client's anxiety about being around others
d
Though smoking is prohibited on hospital property, a client with anti-social personality disorder smokes in the client lounge and refuses to follow other unit and hospital rules. The client gets others to do his/her laundry and other personal chores and refuses to work with nurses he/she doesn't like. The plan of care for this client should focus on which of the following? a) Isolating the client from easily manipulated clients b) Engaging in power struggles until the client changes behaviors c) Eliminating negative behaviors with behavior modification d) Consistently enforcing unit rules and facility policy
d
Which of the following symptoms characterizes Korsakoff syndrome? a) Choreiform movement and dementia b) Tremor, rigidity, and bradykinesia c) Severe dementia and myoclonus d) Psychosis, disorientation, delirium, insomnia, and hallucinations
d
Which of the following would a nurse least likely assess in a client experiencing anxiety? a) Irritability b) Muscle tension c) Sleeping difficulties d) Positive self-talk
d
Which statement by a client taking valproic acid for bipolar disorder indicates that further teaching about this medication is necessary? a) "I need to call my health care provider if I start bruising easily." b) "I can take the pills with food." c) "I need to take the pills at the same time each day." d) "I can chew the pills if necessary."
d
Which statement made by an adolescent who has just begun taking an antidepressant would indicate the need for further teaching? a) "Now that I have had a week of my antidepressant, it is a little easier to get up in the morning." b) "A week ago when I started my antidepressant, I did not care about eating. Now I want to eat a bit more." c) "After a week of taking my antidepressant, I can sleep a little better—6 hours or so each night." d) "Now that I have been taking my antidepressant for 1 week, I am going to feel better about myself."
d
A client has been on antipsychotic medication for 20 years with little control of the positive and negative symptoms of schizophrenia. The client was recently switched to the second-generation antipsychotic clozapine. Which of the following assessment finds would indicate to the nurse that clozapine should be held? Select all that apply. a) An increase in weight b) An increase in motivation c) A decrease in blood pressure d) A decrease in white blood cells e) A seizure
d, e
