PSYCH Practice Quiz #1
Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication, nurse Gina should be prepared for which common adverse effect? A) Seizures B) Shivering C) Anxiety D) Chest pain
A) Seizures Rationale: Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain.
For a female client with anorexia nervosa, Nurse Jimmy is aware that which goal takes the highest priority? A) The client will establish adequate daily nutritional intake B) The client will make a contract with the nurse that sets a target weight C) The client will identify self-perceptions about body size as unrealistic D) The client will verbalize the possible physiological consequences of self-starvation
A) The client will establish adequate daily nutritional intake Rationale: According to Maslow's hierarchy of needs, all humans need to meet basic physiological needs first. Because a client with anorexia nervosa eats little or nothing, the nurse must first plan to help the client meet this basic, immediate physiological need. The nurse may give lesser priority to goals that address long-term plans (as in option B), self-perception (as in option C), and potential complications (as in option D).
In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene? A) Remaining with the client and staying calm B) Calling a security guard and another staff member for assistance C) Telling the client's husband that he must leave at once D) Determining why the husband feels so angry
B) Calling a security guard and another staff member for assistance Rationale: The health care worker who witnesses this scene must take precautions to ensure personal as well as client safety, but shouldn't attempt to manage a physically aggressive person alone. Therefore, the first priority is to call a security guard and another staff member. After doing this, the health care worker should inform the husband what is expected, speaking in concise statements and maintaining a firm but calm demeanor. This approach makes it clear that the health care worker is in control and may diffuse the situation until the security guard arrives. Telling the husband to leave would probably be ineffective because of his agitated and irrational state. Exploring his anger doesn't take precedence over safeguarding the client and staff.
A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response? A) "If you continue to talk like that, I'm going to stop speaking to you." B) "You told me you got fired from your last job for missing too many days after taking drugs all night." C) "Tell me more about how it felt to get high." D) "Don't you know it's illegal to use drugs?"
B) "You told me you got fired from your last job for missing too many days after taking drugs all night." Rationale: Confronting the client with the consequences of substance abuse helps to break through denial. Making threats (option A) isn't an effective way to promote self-disclosure or establish a rapport with the client. Although the nurse should encourage the client to discuss feelings, the discussion should focus on how the client felt before, not during, an episode of substance abuse (option C). Encouraging elaboration about his experience while getting high may reinforce the abusive behavior. The client undoubtedly is aware that drug use is illegal; a reminder to this effect (option D) is unlikely to alter behavior.
For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa? A) They tend to overprotect their children B) They usually have a history of substance abuse C) They maintain emotional distance from their children D) They alternate between loving and rejecting their children
A) They tend to overprotect their children Rationale: Clients with anorexia nervosa typically come from a family with parents who are controlling and overprotective. These clients use eating to gain control of an aspect of their lives. The characteristics described in options B, C, and D isn't typical of parents of children with anorexia.
A 24-year old client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings? A) Avoid discussing the client's perceptions and feelings B) Focus discussions on food and weight C) Avoid discussing unrealistic cultural standards regarding weight D) Provide objective data and feedback regarding the client's weight and attractiveness
D) Provide objective data and feedback regarding the client's weight and attractiveness Rationale: By focusing on reality, this strategy may help the client develop a more realistic body image and gain self-esteem. Option A is inappropriate because discussing the client's perceptions and feeling wouldn't help her to identify, accept, and work through them. Focusing discussions on food and weight would give the client attention for not eating, making option B incorrect. Option C is inappropriate because recognizing unrealistic cultural standards wouldn't help the client establish more realistic weight goals.
When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem? A) The injury isn't consistent with the history or the child's age B) The mother and father tell different stories regarding what happened C) The family is poor D) The parents are argumentative and demanding with emergency department personnel
A) The injury isn't consistent with the history or the child's age Rationale: When the child's injuries are inconsistent with the history given or impossible because of the child's age and developmental stage, the emergency department nurse should be suspicious that child abuse is occurring. The parents may tell different stories because their perception may be different regarding what happened. If they change their story when different health care workers ask the same question, this is a clue that child abuse may be a problem. Child abuse occurs in all socioeconomic groups. Parents may argue and be demanding because of the stress of having an injured child.
Nurse Mary is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority? A) Assessing the client's home environment and relationships outside the hospital B) Exploring the nurse's own feelings about suicide C) Discussing the future with the client D) Referring the client to a clergyperson to discuss the moral implications of suicide
B) Exploring the nurse's own feelings about suicide Rationale: The nurse's values, beliefs, and attitudes toward self-destructive behavior influence responses to a suicidal client; such responses set the overall mood for the nurse-client relationship. Therefore, the nurse initially must explore personal feelings about suicide to avoid conveying negative feelings to the client. Assessment of the client's home environment and relationships may reveal the need for family therapy; however, conducting such an assessment isn't a nursing priority. Discussing the future and providing anticipatory guidance can help the client prepare for future stress, but this isn't a priority. Referring the client to a clergyperson may increase the client's trust or alleviate guilt; however, it isn't the highest priority.
Nurse Taylor is aware that the victims of domestic violence should be assessed for what important information? A) Reasons they stay in the abusive relationship (for example, lack of financial autonomy and isolation) B) Readiness to leave the perpetrator and knowledge of resources C) Use of drugs or alcohol D) History of previous victimization
B) Readiness to leave the perpetrator and knowledge of resources Rationale: Victims of domestic violence must be assessed for their readiness to leave the perpetrator and their knowledge of the resources available to them. Nurses can then provide the victims with information and options to enable them to leave when they are ready. The reasons they stay in the relationship are complex and can be explored at a later time. The use of drugs or alcohol is irrelevant. There is no evidence to suggest that previous victimization results in a person's seeking or causing abusive relationships.
Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: A) Avoid shopping for large amounts of food B) Control eating impulses C) Identify anxiety-causing situations D) Eat only three meals per day
C) Identify anxiety-causing situations Rationale: Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping for large amounts of food isn't a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues. Eating three meals per day isn't a realistic goal early in treatment.
Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? A) Fill out the client's menu and make sure she eats at least half of what is on her tray. B) Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal C) Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal D) Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.
C) Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal Rationale: Allowing the client to select her own food from the menu will help her feel some sense of control. She must then eat 100% of what she selected. Remaining with the client for at least 1 hour after eating will prevent purging. Bulimic clients should only be allowed to eat food provided by the dietary department.
A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused? A) The child cries uncontrollably throughout the examination. B) The child pulls away from contact with the physician. C) The child doesn't cry when the shoulder is examined. D) The child doesn't make eye contact with the nurse.
C) The child doesn't cry when the shoulder is examined. Rationale: A characteristic behavior of abused children is lack of crying when they undergo a painful procedure or are examined by a health care professional. Therefore, the nurse should suspect child abuse. Crying throughout the examination, pulling away from the physician, and not making eye contact with the nurse are normal behaviors for preschoolers.
During postprandial monitoring, a female 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 trust you not to purge." B) "How are you purging and when do you do it?" C) "Don't worry. I won't allow you to purge today." D) "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."
D) "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat." Rationale: This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives. Because their therapeutic relationships with caregivers are less important than their need to purge, they don't fear betraying the nurse's trust by engaging in the activity. They commonly plot purging and rarely share their secrets about it. An authoritarian or challenging response may trigger a power struggle between the nurse and client.
Which of the following drugs should Nurse Mary prepare to administer to a client with a toxic acetaminophen (Tylenol) level? A) Deferoxamine mesylate (Desferal) B) Succimer (Chemet) C) Flumazenil (Romazicon) D) Acetylcysteine (Mucomyst)
D) Acetylcysteine (Mucomyst) Rationale: The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic metabolites to nontoxic metabolites. Deferoxamine mesylate is the antidote for iron intoxication. Succimer is an antidote for lead poisoning. Flumazenil reverses the sedative effects of benzodiazepines.
A male client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is Nurse Alice most likely to administer to reduce the symptoms of alcohol withdrawal? A) Naloxone (Narcan) B) Haloperidol (Haldol) C) Magnesium sulfate D) Chlordiazepoxide (Librium)
D) Chlordiazepoxide (Librium) Rationale: Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal. Haloperidol (Haldol) may be given to treat clients with psychosis, severe agitation, or delirium. Naloxone (Narcan) is administered for narcotic overdose. Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.
A female client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5′ 8″ (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client's unrealistic body image, which intervention should nurse Angel be included in the plan of care? A) Asking the client to compare her figure with magazine photographs of women her age B) Assigning the client to group therapy in which participants provide realistic feedback about her weight C) Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift D) Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy
D) Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy Rationale: A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about health. Instead of protecting the client's health, options A, B, and C may serve to make the client defensive and more entrenched in her unrealistic body image.
A female client who's at high risk for suicide needs close supervision. To best ensure the client's safety, Nurse Mary should: A) Check the client frequently at irregular intervals throughout the night B) Assure the client that the nurse will hold in confidence anything the client says C) Repeatedly discuss previous suicide attempts with the client D) Disregard decreased communication by the client because this is common in suicidal clients
A) Check the client frequently at irregular intervals throughout the night Rationale: Checking the client frequently but at irregular intervals prevents the client from predicting when observation will take place and altering behavior in a misleading way at these times. Option B may encourage the client to try to manipulate the nurse or seek attention for having a secret suicide plan. Option C may reinforce suicidal ideas. Decreased communication is a sign of withdrawal that may indicate the client has decided to commit suicide; the nurse shouldn't disregard it (option D)
Nurse Harry is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? A) Restrict visits with the family until the client begins to eat B) Provide privacy during meals C) Set up a strict eating plan for the client D) Encourage the client to exercise, which will reduce her anxiety
C) Set up a strict eating plan for the client Rationale: Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals — not given privacy. Exercise must be limited and supervised.
