Psych final practice questions from Brittany

client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse?

A. "I get upset once in a while, too." Rationale: Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client to confide in the nurse

A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate? A. "Your behavior won't be tolerated. Go to your room immediately." B. "You're just doing this to get back at me for making you come to therapy." C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes." D. "I'm disappointed in you. You can't control yourself even for a few minutes."

A. "Your behavior won't be tolerated. Go to your room immediately." Rationale: The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended, as in option A. Option B is incorrect because it implies that the client's actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks, such as option D, may decrease the client's self-esteem.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? A. Dystonia B. Akinesia C. Akathisia D. Tardive dyskinesia

A. Dystonia Rationale: Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Akinesia refers to decreased or absent movement; akathisia, to restlessness or inability to sit still; and tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.

Positive symptoms of schizophrenia include which of the following? A. Hallucinations, delusions, and disorganized thinking B. Somatic delusions, echolalia, and a flat affect C. Waxy flexibility, alogia, and apathy D. Flat affect, avolition, and anhedonia

A. Hallucinations, delusions, and disorganized thinking Rationale: The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia. A flat affect, alogia, apathy, avolition, and anhedonia refer to the negative symptoms. Negative symptoms list the diminution or loss of normal function

The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable? A. The client spends more time by himself. B. The client doesn't engage in delusional thinking. C. The client doesn't harm himself or others. D. The client demonstrates the ability to meet his own self-care needs.

A. The client spends more time by himself. Rationale: The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome would specify that the client spend more time with other clients and staff on the unit. Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome. Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome.

A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client's: A. thinking, perceiving, and decision-making skills. B. verbal and nonverbal communication processes. C. affect and behavior. D. psychomotor activity.

A. thinking, perceiving, and decision-making skills. Rationale: Nursing assessment of a psychotic client should include careful inquiry about and observation of the client's thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a client typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior; changes in personality, coping, and sense of self; lack of self-motivation; presence of psychosocial stressors; and degeneration of adaptive functioning. Although assessing communication processes, affect, behavior, and psychomotor activity would reveal important information about the client's condition, the nurse should concentrate on determining whether the client is hallucinating by assessing thought processes and decision-making ability.

A client who has been diagnosed with bipolar disorder states, "God has taught me how to decode the Bible." A nurse should anticipate that which combination of medications would be ordered to address this client's symptoms? A. Lithium carbonate (Lithobid) and risperidone (Risperdal) B. Lithium carbonate (Lithobid) and carbamazepine (Tegretol) C. Valproic acid (Depakote) and sertraline (Zoloft) D. Valproic acid (Depakote) and lamotrigine (Lamictal)

ANS: A Clients diagnosed with bipolar disorder experience cognition and perception fragmentation often resulting in psychosis in acute mania. Rapid thinking proceeds to disjointed thinking and leads to hallucinations and delusions (paranoid and grandiose are common).

A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom? A. "I can't stop my sexual urges. They have led me to numerous affairs." B. "I'm the world's most perceptive attorney." C. "My wife is distraught about my overspending." D. "The FBI has tapped my room and are out to get me."

ANS: B Grandiosity is defined as a belief that personal abilities are better than anyone else's. This client is experiencing delusions of grandeur which are commonly experienced in mania.

After teaching a client about lithium carbonate (Lithane), which client statement would indicate to the nurse that teaching has been successful? A. "I should expect to feel better in a couple of days." B. "I'll call my doctor immediately if I experience any diarrhea or ringing in my ears." C. "If I forget a dose, I can double the dose the next time I take this drug." D. "I need to restrict my intake of any food containing salt."

ANS: B The initial signs of lithium toxicity include ataxia, blurred vision, severe diarrhea, persistent nausea and vomiting, and tinnitus.

A newly admitted client is experiencing the manic phase of bipolar disorder. The nurse should assign which priority nursing diagnosis to this client? A. Ineffective individual coping R/T hospitalization AEB alcohol abuse B. Altered nutrition: less than body requirements R/T mania AEB 10 lb weight loss C. Risk for violence: directed toward others R/T agitation and hyperactivity D. Sleep pattern disturbance R/T flight of ideas AEB sleeps 1 to 2 hours per night

ANS: C The signs and symptoms of mania are manic excitement, delusional thinking, and hallucinations. Because of these symptoms clients are at risk for self or other directed violence.

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? A. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." B. "Mood euthymic. Exhibiting magical thinking. Restless." C. "Mood labile. Exhibiting delusions of reference. Hyperactive." D. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

ANS: D The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting signs of irritation accompanied by aggressive behavior. Grandiosity refers to the attitude that one's abilities are better than everyone else's

Patient states she feels strangers are saying bad things about her and sometimes hears man's voice what is priority assessment

Assess auditory hallucinations for presence of command hallucinations

Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal) ? A. The absence of anticholinergic effects B. A lower incidence of extrapyramidal effects C. Photosensitivity and sedation D. No incidence of neuroleptic malignant syndrome

B. A lower incidence of extrapyramidal effects Rationale: Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage.

A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response? A. Say, "You know it's your medicine." B. Allow him to open the individual wrappers of the medication. C. Say, "Don't worry about what is in the pills. It's what is ordered." D. Ignore the comment because it's probably a joke.

B. Allow him to open the individual wrappers of the medication. Rationale: Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance.

A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect? A. phenytoin (Dilantin) B. amantadine (Symmetrel) C. benztropine (Cogentin) D. diphenhydramine (Benadryl)

B. Amantadine (Symmetrel) Rationale: An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism; diphenhydramine or benztropine may be used to control other extrapyramidal effects. Phenytoin is used to treat seizure activity.

The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as: A. delusions. B. hallucinations. C. loose associations. D. neologisms.

B. hallucinations. Rationale: Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. Delusions are false beliefs, rather than perceptions, that the client accepts as real. Loose associations are rapid shifts among unrelated ideas. Neologisms are bizarre words that have meaning only to the client.

A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he: A. sit in a quiet, dark room and concentrate on the voices. B. listen to a personal stereo through headphones and sing along with the music. C. call a friend and discuss the voices and his feelings about them. D. engage in strenuous exercise.

B. listen to a personal stereo through headphones and sing along with the music. Rationale: Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations. Option A would make it harder for the client to ignore the hallucinations. Talking about the voices, as in option C, would encourage the client to focus on them. Option D is incorrect because exercise alone wouldn't provide enough auditory stimulation to drown out the voices.

Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond? A. "Why do you think there is a bomb in the elevator?" B. "That is the same thing you said in yesterday's session." C. "I know you think there are bombs in the elevator, but there aren't." D. "If you have something to say, you must do it according to our group rules."

C. "I know you think there are bombs in the elevator, but there aren't." Rationale: Option C is the most therapeutic response because it orients the client to reality. Options A and B are condescending. Option D sounds punitive and could embarrass the client.

One week after Sharon begins taking lithium, the nurse notes that her serum lithium level is 1 mEq/L. How should the nurse respond?

Continue admin D - the serum lithium level should be maintained between 1 and 1.5 mEq/L during the acute manic phase; therefore, the nurse should continue administering the medication. In the absence of other signs of lithium toxicity, the nurse has no need to call the physician, withhold the medication, or repeat the blood work. Nevertheless, she should continue to monitor the patient's lithium level and watch for signs of toxicity if the level begins to rise

A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior? A. Word salad B. Tangential C. Perseveration D. Avolition

D. Avolition Rationale: Avolition refers to impairment in the ability to initiate goal-directed activity. Word salad is when a group of words are put together in a random fashion without logical connection. Tangential is where a person never gets to the point of the communication. Perseveration is when a person repeats the same word or idea in response to different questions.

A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? A. chlorpromazine (Thorazine) B. imipramine (Tofranil) C. lithium carbonate (Lithane) D. fluphenazine decanoate (Prolixin Decanoate)

D. Fluphenazine decanoate (Prolixin Decanoate) Rationale: Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.

A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development? A. Autonomy versus shame and doubt B. Generativity versus stagnation C. Integrity versus despair D. Trust versus mistrust

D. Trust versus mistrust Rationale: This client's paranoid ideation indicates difficulty trusting others. The stage of autonomy versus shame and doubt deals with separation, cooperation, and self-control. Generativity versus stagnation is the normal stage for this client's chronologic age. Integrity versus despair is the stage for accepting the positive and negative aspects of one's life, which would be difficult or impossible for this client.

The physician decides to start sharon on lithium/Lithane therapy which of the following best describes her dietary requirements while she is receiving this medication

Regular diet with normal Na and adequate fluid intake. B - while receiving lithium, the patient should maintain a regular diet with adequate fluid intake (about 70 to 100 oz or 2 to 3 liters per day). Lithium is a salt, and its retention in the body is directly influenced by the body's sodium and fluid balance. Sodium depletion must be avoided because lithium will replace sodium in the cells, leading to lithium toxicity. Low-sodium diets and high- and low-calorie diets do not provide adequate balance for proper lithium regulation.