Psychiatric NCLEX questions

A nurse admits a client to the mental health unit with a preliminary diagnosis of acute stress disorder. As the nurse interviews the client and his son, what should her primary concern be? - The son's disapproval of the admission - Bruises on the client's body - A statement by the client that he doesn't want to live - The client's report of not eating or sleeping for 2 days.

A statement by the client that he doesn't want to live

Which nursing intervention is most appropriate for a client with obsessive-compulsive disorder? - Encouraging the client to concentrate on and pay attention to unwanted thoughts - Giving antipsychotic medications as needed - Interrupting the client's ritual to empower the client in gaining control over the ritual - Allowing the client to carry out his rituals.

Allowing the client to carry out his rituals

Three days ago, a client with chronic schizophrenia received 20 mg of fluphenazine deconoate by IM injection. Now the client has muscle contractions that contort the neck. Which extrapyramidal reaction is the client demonstrating? - Dystonia - Akinesia - Akathisia - Tardive dyskinesia

Dystonia

A nurse is caring for a client who is suspected of actively using opiates. Assessment findings in a client abusing opiates, such as morphine, include: - dilated pupils and slurred speech - Rapid speech and agitation - Dilated pupils and agitation - Euphoria and constricted pupils

Euphoria and constricted pupils

A client has been receiving treatment for depression for 3 weeks. Which behavior suggests that the client is recovering? - He talks about the difficulties of returning to college after discharge - He spends most of the day sitting alone in the corner of the room - He wears a hospital gown instead of street clothes - He shows no emotion when visitors leave

He talks about the difficulties of returning to college after discharge

Which nursing action is most effective in defusing a client's impending violent behavior? - Helping the client identify and express feelings of anxiety and anger - Involving the client in a quiet activity to divert attention - Leaving the client alone until he can talk about his feelings - Placing the client in supervised seclusion

Helping the client identify and express feelings of anxiety and anger

A client with panic disorder with agoraphobia is talking with the nurse about his treatment progress. Which statement indicated a positive client response? - I went to the mall with my friend last Saturday - I'm hyperventilating only when I have a panic attack - Today, I decided I can stop taking my medication - Last night I decided to eat more than one bowl of cereal

I went to the mall with my friend last Saturday

A client with schizophrenia becomes very aggressive in a group session on a psychiatric unit. What is the best way to handle this client? - Assess the client's medical history - Seclude the client - Assess the client's potential for violence - Intervene early to de-escalate the situation

Intervene early to de-escalate the situation

A client has just been transferred to the locked psychiatric unit from the emergency department after attempting suicide by taking 200 acetaminophen (Tylenol) tablets. Now the client is awake and alert but refuses to speak with the nurse. What is the nurse's first priority? - Establish a rapport with the client - Place the client in full leather restraints - Try to communicate with the client in writing - Maintain safety by initiating suicide precautions

Maintain safety by initiating suicide precautions.

A client is suffering from Alzheimer's type dementia. Which intervention would be most useful in managing his dementia - Provide a safe environment - Provide a stimulating environment - Avoid the use of touch - Use restraints whenever necessary

Provide a safe environment

To prevent lithium toxicity in a client with bipolar disorder who is receiving 300 mg of lithium citrate PO TID, the nurse should: - Assess him for decreased urine output - Give a nonsteroidal anti-inflammatory drug for mild pain - Regularly monitor his lithium level - Maintain the lithium level between 1.5 and 2 mEq/L

Regularly monitor his lithium level

A client diagnosed with schizophrenia is alone in a room but is having a heated discussion with "someone." When approaching a client who is having visual hallucinations, the nurse should do what first? - Seek the client's permission to discuss the hallucinations - Explain the reason for the hallucinations - Avoid discussion of the hallucinations and present reality - Administer an antipsychotic drug.

Seek the client's permission to discuss the hallucinations

A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? - Calcium - Sodium - Chloride - Potassium

Sodium.

A nurse is caring for a client experiencing an anxiety attack. Appropriate nursing interventions include: - Turning on the lights and opening the windows so that the client - Leaving the client alone - Staying with the client and speaking in short sentences - Turning on stereo music.

Staying with the client and speaking short sentences

Recently, an adolescent has become increasingly withdrawn, has grown irritable with family members, and has been getting lower grades on schoolwork. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. Which problem is the adolescent at risk for? - Suicide - Anorexia - School phobia - Psychotic episode

Suicide.

A client who experiences panic disorder identifies that he frequently is overwhelmed by feelings of powerlessness. In working with this client, the nurse would initiate which nursing intervention? - Assist the client to recognize what unnecessary risk-taking is - Explore with the client issues related to identify problem - Teach the client problem-solving and decision-making skills - Have the client discuss the things desired in a relationship.

Teach the client problem-solving and decision-making skills

A nurse is talking with a delusional client when the fire alarm sounds and a staff member closes the door to the client's room. The client becomes very agitated and declares, "The aliens have arrived!" Which actions are appropriate for the nurse to take? Select all that apply. - Leave the room, telling the client she'll return soon - Tell the client that there's no danger and that everything's fine - Tell the client the alarm is just a drill and he shouldn't be afraid - Stay with the client and wait for an update about the situation - Continue to speak with the client in a reassuring tone

- Stay with the client and wait for an update about the situation - Continue to speak with the client in a reassuring tone

A nurse is teaching a new group of mental health nursing assistances. The nurse should teach the nursing assistants that setting limits is most important for: - A depressed client - A manic client - A suicidal client - An anxious client

A manic client

A client on the psychiatric unit refuses to take his oral medication. The nurse threatens the client and tells him that, if the medication isn't taken, restraints will be applied and the medication will be given by IV injection. The nurse's statement constitutes which legal tort? - Right to refuse care - Negligence - Battery - Assault.

Assault

A client with antisocial personality disorder smokes where it is prohibited and doesn't follow other unit or facility rules. The client gets others to do the laundry and other personal chores, tries to divide the staff, and works only with certain nurses. The primary focus of this client's care plan should be: - Consistently enforcing unit rules and facility policy - Isolating the client to decrease contact with easily manipulated clients - Engaging in power struggles with the client to decrease the incidence of manipulative behavior - Using behavior modification to decrease the amount of negative behavior by using negative reinforcement

Consistently enforcing unit rules and facility policy

A client with major depression sleeps 18 to 20 hours a day, has no interest in previously enjoyed activities, and reports a 17-lb weight loss in the past month. Because this is the client's first hospitalization the physician is most likely to prescribe which drug? - Phenelzine (Nardil) - Thiothixene (Navane) - Fluxetine (Prozac) - Trazodone (Oleptro)

Fluxetine (Prozac)

The nurse should teach a client taking phenelzine, and MAO inhibitor, to avoid: - Acetaminophen - OTC cold remedies - Aspirin - Vitamin C

OTC cold remedies

A nurse is caring for a client who is suicidal. When accompanying the client to the bathroom, the nurse shoud: - Give him privacy - Allow him to shave - Open the window and allow him to get some fresh air - Observe him

Observe him

A client was discharged from an acute care facility 6 months ago. He has been taking haloperidol for 1 month. When he comes to the outpatient clinic the nurse notes that he's grimacing, smacking his lips, and his tongue is protruding dramatically. The nurse suspects: - Tardive dyskinesia - Akathisia - Pseudoparkinsonism - Neuroleptic synrome

Tardive dyskinesia

A nurse admits a client who presents with symptoms of severe depression and a diagnosis of rapid cycling bipolar disorder. Several hours later, the nurse observes the client pacing in the hall. The client asks the nurse to check him because he thinks he might have a fever. His vital signs are: BP - 148/90; pulse - 133; respirations - 24; and temperature 99.2 F. What should the nurse infer from these findings? - The client has an infection - The client is experiencing a depressive episode - The client is experiencing a conversion reaction - The client needs further evaluation for illness

The client needs further evaluation for illness

A client with major depression tells the nurse, "Life isn't worth living. I can't stand the pain any longer." The nurse should recognize this statement as indicative of: - The need for a suicide assessment - the need for a pain assessment - the need to administer an antidepressant - the need to provide diversional stimuli

The need for a suicide assessment

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

Trust versus mistrust

A client was admitted to the psychiatric unit in a manic state and attacked anther client. Seclusion has been ordered, and the nurse is assessing the client every 15 minutes. Which assessment should receive the highest priority? - Level of psychomotor agitation - Vital signs - Nutritional intake - Verbal and nonverbal behavior

Vital signs

When assessing a 9 year old girl for possible sexual abuse, which physical signs or symptoms should the nurse look for? Select all that apply. - Pain or difficulty walking or sitting - Dressing inappropriately for the weather - Listlessness and tiredness - Bruises, edema, or pain in the genital area, vagina, or rectum - Frequent urination or dysuria - Bulimia

- Pain or difficulty walking or sitting - Bruises, edema, or pain in the genital area, vagina, or rectum - Frequent urination or dysuria

A nurse explains the guidelines for the unit's seclusion room to a client with an impulse control disorder. Which client statement indicates that the nurse has adequately communicated the client's rights? - Although I don't think I will, I can ask to go into seclusion, but I know you can me go into the seclusion room. - If I lose my temper in the community room, I'll be locked up in the seclusion room - When I go into seclusion, I won't be able to see my physician until I calm myself down - Every time I decide that I won't attend a group meeting, I'll be put in seclusion.

Although I don't think I will, I can ask to go into seclusion, but I know you can make me go into the seclusion room

A client is on the psychiatric unit. His employer calls the nursing station inquiring about his progress. The nurse doesn't know if consent has been given by the client to allow the staff to give information to callers on the phone. Which of the following responses by the nurse would be best?' - I'm not permitted to discuss his progress - I'll give you the name and telephone number of his physician - I'll have him call you - I can't confirm whether your employee is a client here.

I can't confirm whether your employee is a client here

A nurse is providing care for a client who is undergoing opiate withdrawal. What's the priority nursing diagnosis for this client? - Ineffective coping - Risk for injury - Chronic low self-esteem - Impaired social interaction

Risk for injury

In preparation for discharge, a client with intermittent explosive disorder receives a prescription for carbamezepine (Tegretol). Which blood study should be drawn before discharge to serve as a baseline for monitoring potential drug adverse effects? - Fasting blood sugar - CBC - Electrolyte tests - cholesterol studies

CBC

A client is admitted to the psychiatric unit for treatment of bipolar disorder. The client is exhibiting symptoms of pressured speech, racing thoughts, frequent pacing, and an inability to sleep more than 3 hours every 36 to 48 hours. Which client goal should the nurse address first? - Demonstrate a clear-thinking pattern - Demonstrate nonpressured speech pattern - Reestablish sleeping patterns - Examine reasons for pacing.

Reestablish sleeping patterns

A client who had outpatient surgery is experiencing alcohol withdrawal symptoms. The client's family states that it has been 14 hours since the client's last alcoholic drink. The nurse explains the progression of alcohol withdrawal symptoms and assists the family in obtaining treatment. Place in chronological order the common progression of alcohol withdrawal symptoms. Use all options - Elevated blood pressure - Restlessness and irribility - Hand tremors - Transient hallucinations

2, 3, 1, 4 - Restlessness and irritability - Hand tremors - Elevated blood pressure - Transient hallucinations.

A client who was recently ordered antipsychotic medication comes to the hospital emergency department with a high fever and Parkinsonian type symptoms. The staff suspects the client may have neuroleptic malignant syndrome. Place in chronological order the most common progression of NMS signs and symptoms. Use all options. - Stupor - Elevated vital signs - Muscle rigidity - Deteriorated mental status

4, 2, 1, 3 - Deteriorated mental status - Elevated vital signs - Stupor - Muscle rigidity

An elderly client with Alzheimer's disease has been living with his grown child's family for the past 6 months. He needs help with activities of daily living and he wanders at night. Which statement suggests that his family is successfully adjusting to this arrangement? - It's difficult dealing with Dad. It's a thankless job. - How much longer will this go on? We had no idea this would be so difficult. It's our cross to bear. - Dad really seems to be making progress. We're hoping he'll be able to move back into his home soon. - Dad presents many challenges. We have alarms on all the outside doors now. Respite care gives us a break.

Dad presents many challenges. We have alarms on all the outside doors now. Respite care gives us a break.

A client approaches a nurse and asks for advice on how to deal with his alcohol addiction. The nurse should tell the client that effective treatment for alcoholism includes: - Psychotherapy, rehabilitation, shock therapy, and alcoholics anonymous - Detoxification, rehabilitation, psychotherapy, and AA - Crisis intervention, detoxification, rehabilitation, and psychotherapy - Detoxification, aversion therapy, and psychotherapy

Detoxification, rehabilitation, psychotherapy, and AA

After being admitted to the hospital, a bulimic client states that she'll run away if she can't figure out how to stop binge eating. After establishing safety and elopement precautions, which action should the nurse take first? - Acknowledge the client's level of stress - Establish an activity schedule for the client - Develop a written contract with the client - Assess the client for substance abuse

Develop a written contract with the client

A family tells the nurse that they haven't been successful in meeting their goal for home management of their son with schizoaffective disorder. They report that the client posses a threat to their safety. Which action should the nurse take based on this information? - Have the client evaluated for a voluntary admission in a mental health facility - Discuss how the family can chemically restrain the client at home - Tell the family that the client's behavior releases them from the care of duty - Arrange for respite care because the family could be aggravating the client's condition

Have the client evaluated for a voluntary admission in a mental health facility

A client with bipolar disorder is energetic, impulsive, and engages in loud verbalizations in the community room. To prevent injury to himself or others while complying with the least restrictive environmental principle, which action should the nurse take to prevent escalation of the client's mood? - Place the client in seclusion and keep the door open - Obtain a court mandate for a higher level of treatment - Help the client channel his energy into appropriate activities - Monitor the client for escalation of manipulative behavior

Help the client channel his energy into appropriate activities

Which question is most useful in assessing the self-esteem of a client with anorexia nervosa? - How would you describe yourself to others? - What activities do you enjoy doing with your friends? - Do you play any sports at school or in your community? - How do you decide where to spend your free time?

How would you describe yourself to others?

A client admitted with depression has been receiving sertraline (Zoloft) and is to continue this medication on discharge. Which statement by the client would indicate the need for further teaching? - I'll take my medication in the morning after brushing my teeth - I'll take my medication with food and lots of fluids - I'll continue to take my medications, even if i develop adverse symptoms, because they will resolve - I'll continue to take my medications even when I feel less depressed.

I'll continue to take my medications, even if I develop adverse symptoms, because they will resolve.

A client admitted with severe depression has been prescribed fluoxetine (Prozac) for 3 weeks. The client approaches the nurse complaining of a headache. Which of the following would be the nurse's best response? - I'll withhold your next dose of Prozac - You need to have a computed tomography (CT) scan of your head. - Just lay down. You'll be fine - I'll see if you have an order for Tylenol.

I'll see if you have an order for Tylenol

After completing chemical detoxification and 12-step program for crack addiction, a client is preparing for discharge. Which remark by the client indicates a realistic view of the future? - I'm never going to use crack again - I know what i have to do. I have to limit my crack use - I'm going to take one day at a time. It won't be easy - I can't touch crack again, but I sure could use a drink. I've earned it.

I'm going to take one day at a time. It won't be easy.

A 35 year old client who's a divorced parent of three was admitted 5 days ago with major depression after a suicide attempt. He was prescribed a daily dosage of fluoxetine (Prozac). Since starting the medication, his appetite and participation in group therapy have improved. Which nursing diagnosis should receive the highest priority. - Risk for self-directed violence related to suicide attempt - Deficient knowledge related to antidepressant therapy - Chronic low self-esteem related to recurrent depression - Anxiety related to disruption in role performance.

Risk for self-directed violence related to suicide attempt

A client in the manic phase of bipolar disorder constantly belittles other clients and demands special favors from the nurses. Which nursing intervention is the most appropriate for this client/ - Ask other clients and staff members to ignore the client's behavior - Set limits with consequences for belittling or demeaning behavior - Offer the client and antianxiety drug when belittling or demanding behavior occurs - Offer the client various stimulating activities to distract him from belittling or making demands of others.

Set limits with consequences for belittling or demeaning behavior

Before eating a meal, a client with obsessive-compulsive disorder must wash his hands for 18 minutes, comb his hair 444 strokes, and switch the bathroom light on and off 44 times. What is the most appropriate long-term treatment goal for this client? - Omit one unacceptable behavior each day - Increase the client's acceptance of therapeutic drug use - Allow ample time for the client to complete all rituals before each meal - Systematically decrease the amount of time spent in, and the number of repetitions of, rituals

Systematically decrease the amount of time spent in, and the number of repetitions of, rituals.

A nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should: - Ask the client which activity he would prefer to do first - Negotiate a time when the client will perform activities - Tell the client specifically and concisely what needs to be done - Prepare the client ahead of time for the activity

Tell the client specifically and concisely what needs to be done

Which concept refers to the role of the professional nurse in client advocacy? - The nurse makes decisions for clients who can't make decisions for themselves - The nurse follows the basic standards of care and hospital policies and procedures for providing care for clients - The nurse promotes and protects the client's rights and interests - The nurse adapts a paternalistic approach to the care of the client.

The nurse promotes and protects the client's rights and interests

Which laboratory value should the nurse check before administering clonazepam (Klonopin)? - Liver function tests - WBC count - BUN - Cardiac enzymes

WBC count

During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on his forearms. What is the most appropriate way for the nurse to respond? - This type of behavior requires you to be on suicide precautions - I'm going to tell your physician. Do you want to tell me why you did that? - Tell me what type of instrument you used. I'm concerned about infection - Whenever something important occurs, the team needs to know about it. I'll have to tell the others, but let's talk about it first.

Whenever something important occurs, the team needs to know about it. I'll have to tell the others, but let's talk about it first.