311 - QUIZ #1

33. Which statement best describes the practice of psychiatric nursing? 1. Helps people with present or potential mental health problems 2. Ensures clients' legal and ethical rights by being a client advocate 3. Focuses interpersonal skills on people with physical or emotional problems 4. Acts in a therapeutic way with people who are diagnosed as having a mental disorder

1

64. A nurse is teaching clients about dietary restrictions when taking a monoamine oxidase inhibitor (MAOI). What response does the nurse tell them to anticipate if they do not follow these restrictions? 1. Occipital headaches 2. Generalized urticaria 3. Severe muscle spasms 4. Sudden drop in blood pressure

1

63. A depressed client has been prescribed a tricyclic antidepressant. How long should the nurse inform the client it will take before noticing a significant change in the depression? 1. 4-6 days 2. 2-4 weeks 3. 5-6 weeks 4. 12-16 hours

2

68. What medication should the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines? 1. Lithium 2. Flumazenil 3. Methadone 4. ChlorproMAZINE

2

53. An adult who has been in a gay relationship for 3 years arrives at the emergency department in a near panic state. The client states, "My partner just left me. I am a wreck." What should the nurse do to help the client cope with this loss? Select all that apply 1. Identify the client's support systems 2. Explore the client's psychotic thoughts 3. Reinforce the client's current self image 4. Encourage the client to talk about the situation 5. Suggest that the client explore personal sexual attitudes.

1, 4

54. Which approaches should a nurse use during crisis intervention? Select all that apply 1. Active 2. Passive 3. Reflective 4. Interpretive 5. Goal-directed

1, 5

37. A male nurse is caring for a client. The client states, "You know, I've never had a male nurse before." What is the nurse's best reply? 1. "Does it bother you to have a male nurse?" 2. "How do you feel about having a male nurse?" 3. "There aren't many male nurses. We are a minority." 4. "You sound upset. I will get a female nurse to care for you."

2

38. A nurse reminds a client that it is time for group therapy. The client responds by yelling at the nurse. "You are always telling me what to do, just like my father!" What defense mechanism is the client using? 1. Regression 2. Transference 3. Reaction formation 4. Cognitive distortion

2

45. At a group therapy session a client tearfully tells the other members, "I just lost my job this week." What is the nurse leaders' most appropriate response? 1. Ask the client to consider the reasons this may have occurred. 2. Quietly observe how the group responds to the client's statement 3. Gently suggest that the client check the help-wanted advertisements in the local paper 4. Request that the group help the client reflect on how the dismissal may have been prevented

2

47. A client with the diagnosis of paranoid schizophrenia throws a chair across the room and starts screaming at the other clients. Several of these clients have frightened expressions, one starts to cry, and another begins to pace. A nurse removes the agitated client from the room. What should the nurse remaining in the room do next? 1. Continue the unit's activities as if nothing happened 2. Arrange a unit meeting to discuss what just happened 3. Refocus clients' negative comments to more positive topics 4. Have a private talk with the clients who cried or started to pace

2

52. What is the priority goal when planning care for a client in crisis? 1. Referring the client for occupational therapy 2. Restoring the client's psychologic equilibrium 3. Scheduling the client for follow-up counseling 4. Having the client gain insight into the problem

2

56. An extremely anxious client enters a crisis center and asks a nurse for help. Which response best reflects the nurse's role in crisis intervention? 1. "Tell me what you have done to help yourself." 2. "I will be here for you to help you figure things out." 3. "I understand that in the past you have had problems." 4. "Tell me about the things that are bothering you the most."

2

35. What is the most difficult initial task when developing a nurse-client relationship? 1. Remaining therapeutic and professional 2. Being able to understand and accept a client's behavior 3. Developing an awareness of self and the professional role in the relationship 4. Accepting responsibility for identifying and evaluating the real needs of a client

3

44. During a group meeting a client tells everyone, "I am afraid of my impending discharge from the hospital." What is the most appropriate response by the nurse facilitator? 1. "You ought to be happy that you're leaving" 2. "Maybe you're not ready to be discharged yet." 3. "Maybe others in the group have similar feelings that they would share." 4. "How many in the group feel that this member is ready to be discharged?"

3

50. A nurse is aware that a co-worker's mother died 16 months ago. The co-worker cries every time someone says the word "mother" or if the mother's name is mentioned. What does the nurse conclude about this behavior? 1. It is an expected response 2. Most people cry when their mother dies 3. The co-worker may need help with grieving 4. The co-worker was extremely attached to the mother

3

65. A client is receiving lithium. What is an important nursing intervention while this medication is being administered? 1. Restrict the client's daily sodium intake 2. Test the client's urine specific gravity weekly 3. Monitor the client's drug blood level regularly 4. Withhold the client's other medications for several days

3

36. A parent of a 13-year-old adolescent who was recently diagnosed with Hodgkin disease tells a nurse, "I don't want my child to know the diagnosis." How would the nurse respond? 1. "It is best if your child knows the diagnosis." 2. "Did you know the cure rate for Hodgkin disease is high?" 3. "Would you like someone with Hodgkin disease to talk with you?" 4. "Let's talk about your feeling regarding you child's diagnosis."

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40. A latino client with schizophrenia is admitted to a mental health unit in an aggravated and disheveled state after failing to take prescribed medications for the last 5 days. When developing a plan of care that incorporates the client's cultural background, the nurse gives priority to: 1. Socioeconomic and considerations regarding hospitalization 2. The meaning and attention the client places on the future 3. The client's need to control care to ensure desired outcomes 4. inclusion of the family in the plan of care with the client's permission

4

39. What is the most important tool a nurse brings to the therapeutic nurse-client relationship? 1. Oneself and a desire to help 2. Knowledge of psychopathology 3. Advanced communication skills 4. Years of experience in psychiatric nursing

1

42. A nurse encourages a client to join a self-help group after being discharged from a mental health facility. What is the purpose of having people work in a group? 1. Support 2. Confrontation 3. Psychotherapy 4. Self-awareness

1

49. A client is diagnosed with a borderline personality disorder. What is a realistic initial intervention for this client? 1. Establish clear boundaries 2. Explore job possibilities with the nurse 3. Initiate discussion of feelings of being victimized 4. Spend one hour twice a day discussing problems with the nurse

1

51. A nurse educator is leading a class on supporting middle-aged adults who are experiencing midlife crisis. What should the nurse include as the most significant factor in the development of this type of crisis? 1. The perception of their life situation 2. Many role changes that alter their experiences at this time 3. The anticipation of negative changes associated with old age 4. Lack of support from family members who are busy with their own lives

1

58. A child in the first grade is murdered, and counseling is planned for the other children in the school. What should a nurse identify first before assessing a child's response to a crisis? 1. Developmental level of the child 2. Quality of the child's peer relationships 3. Child's perception of the crisis situation 4. Child's communication patterns with family members

1

46. A 44-year old client is unable to function since her husband asked for a divorce 2 weeks ago. She is brought to the crisis intervention center by a friend. What type of crisis reflects this situation? 1. Social 2. Situational 3. Maturational 4. Developmental

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59 What is an initial client objective in relation to anger management? 1. Expressing remorse over aggressive actions 2. Taking responsibility for the hostile behavior 3. Developing alternative methods to release feelings 4. Teaching others how to avoid triggering the angry behavior

2

61. A nurse is working with a married woman who has come to the emergency department several times with injuries that appear to be related to domestic violence. While talking with the nurse manager, a nurse expresses disgust that the woman returns to the same situation. What is the nurse manager's best response? 1. "She must not have the financial resources to leave her husband." 2. "Most woman attempt to leave about six times before they are able to do so." 3. "There is nothing the staff can do because people are free to choose their own life." 4. "These women should be told how foolish they are to remain in their current situation."

2

69. A nurse is caring for a client who abruptly withdrew from barbiturate use. What should the nurse anticipate that the client may experience? 1. Ataxia 2. Seizures 3. Diarrhea 4. Urticaria

2

70. Chlordiazepoxide (Librium) 100 mg PO per hour is prescribed for a client with a Clinical Institute Withdrawal Assessment (CIWA) score of 25. The client had 300 mg in 3 hours and is still displaying acute alcohol withdrawal symptoms. What is the next nursing action? 1. Inform the client that the limit of chlordiazepoxide has been reached 2. Administer chlordiazepoxide as indicated by the client's CIWA score 3. Request a prescription for another medication to replace the chlordiazepoxide 4. Inform the health care provider that the maximum dose of chlordiazepoxide has been reached

2

75. A health care provider prescribes haloperidol (Haldol) for a client. What should the nurse teach the client to avoid while taking this medication? 1. driving at night 2. staying in the sun 3. ingesting aged cheeses 4. taking medications containing aspirin

2

57. When assisting clients to cope with a crisis, the health care provider should follow the principles of intervention. Place the following interventions in order of their priority. 1. Stabilize the client 2. Intervene immediately 3. Encourage self-reliance 4. Use the available resources 5. Facilitate understanding of the event

2, 1, 5, 4, 3

30. Among members of the nursing team, which functions are registered nurses legally permitted to perform in a mental health hospital? Select all that apply 1. Psychotherapy 2. Health promotion 3. Case management 4. Prescribing medication 5. Treating human responses

2, 3, 5

60. A nurse leads an assertiveness training program for a group of clients. Which client statement demonstrates that the treatment has been effective? 1. "I know I should put the needs of others before mine." 2. "I won't stand for it, so I told my boss he's a jerk and to get off my back." 3. "It annoys me when people call me Dearie, so I told him not to do it anymore." 4. "It is easier for me to agree up front and then just do enough so that no one notices."

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41. A family member brings a relative to the local community hospital because the relative "has been acting strange." Which statements meet involuntary hospitalization criteria? Select all that apply. 1. "I cry all the time, I am so sad" 2. "Since I retired I have been so depressed" 3. "I would like to end it all with sleeping pills." 4. "Voices say it is okay for me to kill all prostitutes." 5. My boss makes me so angry by always picking on me.

3, 4

71. A client with schizophrenia who has type II (negative) symptoms is prescribed risperidone (Risperdal). Which outcomes indicate that the medication has minimized these symptoms? Select all that apply. 1. there is less agitation 2. there are fewer delusions 3. there is more interest shown in unit activities 4. the client reports that the hallucinations have stopped 5. the client performs activities of daily living independently

3, 5

74. Imipramine (Tofranil), 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when administering this medication? 1. Tell the client that barbiturates and steroids will not be prescribed. 2. Warn the client not to eat cheese, fermenting products, and chicken liver 3. Monitor the client for increased tolerance and report the dosage is no longer effective 4. Have the client checked for increased intraocular pressure and teach about symptoms of glaucoma

4

73. A client is scheduled for a 6-week electroconvulsive therapy (ECT) treatment program. What intervention is important during the 6-week course of treatment? 1. Provision of tyramine-free meals 2. Avoidance of exposure to the sun 3. Maintenance of a steady sodium intake 4. Elimination of benzodiazepines for nighttime sedation

4

2

31. A health care provider orders "restraints prn" for a client who has a history of violent behavior. What is the nurse's responsibility concerning this order? 1. Ask that the order indicate the type of restraint 2. Recognize that prn orders for restraints are unacceptable 3. Implement the restraint order when the client begins to act out 4. Ensure that the entire staff is aware of the order for the restraint

32. A client on the psychiatric unit asks a nurse about psychiatric advance directives (PADs). What information should form the basis of the nurse's response? 1. The appointment of the surrogate decision maker is unnecessary 2. A client is permitted to dictate what treatments will be given during future hospitalizations 3. The need for involuntary admissions is eliminated where a client is a threat to self or others 4. A client is allowed to consent or refuse to potential psychiatric treatments if a future incapacitating mental health crisis occurs

4

34. A physician is admitted to the psychiatric unit of a community hospital. The client, who was restless, loud, aggressive, and resistive during the admission procedure, states, "I will take my own blood pressure." What is the nurses most therapeutic response? 1. "Right now you are just another client" 2. "If you would rather, I'm sure you will do it correctly." 3. "I will get the attendants to assist me if you do not cooperate." 4. "I am sorry, but I cannot allow that because I must take your blood pressure."

4

43. As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join because "I have nothing to talk about." What is the best response by the nurse? 1. "Maybe tomorrow you will feel more like talking." 2. "Could you start off by talking about your family?" 3. "A person like you has a great deal to offer the group." 4. "You feel you will not be accepted unless you have something to say?"

4

48. A client with a history of violence is becoming increasingly agitated. Which nursing intervention will most likely increase the risk of acting out behavior? 1. Being assertive 2. Responding early 3. Providing choices 4. Teaching relaxation

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55. Which is the most important assessment data for a nurse to gather from the client in a crisis? 1. The client's work habits 2. Any significant physical health data 3. A history of emotional problems in the family 4. The client's perception of the circumstances surrounding the crisis

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62. What is the most important information a nurse should teach to prevent relapse in a client with a psychiatric illness? 1. Develop close support systems 2. Create a stress-free environment 3. Refrain from activities that cause anxiety 4. Follow the prescribed medication regimen

4

66. A client in the hyperactive phase of a mood disorder, bipolar type, is receiving lithium. A nurse identifies that the client's lithium blood level is 1.8 mEq/L. What is the most appropriate nursing action? 1. Continue the usual dose of lithium and note and adverse reactions. 2. Discontinue the drug until the lithium serum level drops to 0.5 mEq/L 3. Ask the health care provider to increase the dose of lithium because the blood lithium level is too low 4. Hold the drug and notify the health care provider immediately because the blood lithium level may be toxic

4

67. A nurse administers an antipsychotic to a client. For which common manageable side effect should the nurse assess the client? 1. Jaundice 2. Melanocytosis 3. Drooping eyelids 4. Unintentional tremors

4

72. A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2-3 weeks? 1. Lithium 2. Diazepam 3. Fluvoxamine 4. Fluphenazine

4