PSYCHOPHARMACOLOGY

A male client is admitted to a psychiatric facility by court order for evaluation for antisocial personality disorder. This client has a long history of initiating fights and abusing animals and recently was arrested for setting a neighbor's dog on fire. When evaluating this client for the potential for violence, nurse Perry should assess for which behavioral clues? A. A rigid posture, restlessness, and glaring B. Depression and physical withdrawal C. Silence and noncompliance D. Hypervigilance and talk of past violent acts

A. A rigid posture, restlessness, and glaring

Alfred was newly diagnosed with anxiety disorder. The physician prescribed buspirone (BuSpar). The nurse is aware that the teaching instructions for newly prescribed buspirone should include which of the following? A. A warning about the drug's delayed therapeutic effect, which is from 14 to 30 days. B. A warning about the incidence of neuroleptic malignant syndrome (NMS). C. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug. D. A warning that immediate sedation can occur with a resultant drop in pulse.

A. A warning about the drug's delayed therapeutic effect, which is from 14 to 30 days.

The nurse is aware that the outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder? A. Accept responsibility for own behaviors. B. Be able to verbalize own needs and assert rights. C. Set firm and consistent limits with the client. D. Allow the child to establish his own limits and boundaries.

A. Accept responsibility for own behaviors.

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.

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.

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.

Nicolas is experiencing hallucinations and tells the nurse, "The voices are telling me I'm no good." The client asks if the nurse hears the voices. The most appropriate response by the nurse would be: A. "It is the voice of your conscience, which only you can control." B. "No, I do not hear your voices, but I believe you can hear them". C. "The voices are coming from within you and only you can hear them." D. "Oh, the voices are a symptom of your illness; don't pay any attention to them."

B. "No, I do not hear your voices, but I believe you can hear them".

Kellan, a high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome? A. The student discusses conflicts over drug use. B. The student accepts a referral to a substance abuse counselor. C. The student agrees to inform his parents of the problem. D. The student reports increased comfort with making choices.

B. The student accepts a referral to a substance abuse counselor.

A male client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. Nurse Gian realizes that these symptoms probably result from: A. Acetate accumulation B. Thiamine deficiency C. Triglyceride buildup. D. A below-normal serum potassium level

B. Thiamine deficiency

A male client has approached the nurse asking for advice on how to deal with his alcohol addiction. Nurse Sally should tell the client that the only effective treatment for alcoholism is: A. Psychotherapy B. Total abstinence C. Alcoholics Anonymous (AA) D. Aversion therapy

B. Total abstinence

Anthony is very hostile toward one of the staff for no apparent reason. He is manifesting: A. Splitting B. Transference C. Countertransference D. Resistance

B. Transference

A 14-year-old client was brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. Nurse Kris conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader." B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." D. "I do diet around my periods; otherwise, I just get so bloated."

C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."

A female client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. Based on this finding, the nurse Lenny should formulate a nursing diagnosis of: A. Ineffective individual coping related to feelings of guilt. B. Situational low self-esteem related to feelings of loss of control. C. Risk for violence: Self-directed related to impulsive mutilating acts. D. Risk for violence: Directed toward others related to verbal threats.

C. Risk for violence: Self-directed related to impulsive mutilating acts.

The outcome that is unrelated to a crisis state is: A. Learning more constructive coping skills. B. Decompensation to a lower level of functioning. C. Adaptation and a return to a prior level of functioning. D. A higher level of anxiety continuing for more than 3 months.

D. A higher level of anxiety continuing for more than 3 months.

Tony refuses his evening dose of Haloperidol (Haldol), then becomes extremely agitated in the dayroom while other clients are watching television. He begins cursing and throwing furniture. Nurse Oliver first action is to: A. Check the client's medical record for an order for an as-needed I.M. dose of medication for agitation. B. Place the client in full leather restraints. C. Call the attending physician and report the behavior. D. Remove all other clients from the dayroom.

D. Remove all other clients from the dayroom.

Nurse Mylene recognizes that the most important factor necessary for the establishment of trust in a critical care area is: A. Privacy B. Respect C. Empathy D. Presence

D. Presence

Dennis has a lithium level of 2.4 mEq/L. The nurse immediately would assess the client for which of the following signs or symptoms? A. Weakness B. Diarrhea C. Blurred vision D. Fecal incontinence

C. Blurred vision

When assessing a premorbid personality characteristics of a client with a major depression, it would be unusual for the nurse to find that this client demonstrated: A. Rigidity B. Stubbornness C. Diverse interest D. Over meticulousness

C. Diverse interest

Jerome who has an eating disorder often exhibits similar symptoms. Nurse Lhey would expect an adolescent client with anorexia to exhibit: A. Affective instability B. Dishered, unkempt physical appearance C. Depersonalization and derealization D. Repetitive motor mechanisms

A. Affective instability

Which medications have been found to help reduce or eliminate panic attacks? A. Antidepressants B. Anticholinergics C. Antipsychotics D. Mood stabilizers

A. Antidepressants

Kevin 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. Antisocial personality disorder B. Borderline personality disorder C. Obsessive-compulsive personality disorder D. Narcissistic personality disorder

A. Antisocial personality disorder

Nurse Krina recognizes that the suicidal risk for depressed client is greatest: A. As their depression begins to improve. B. When their depression is most severe. C. Before any type of treatment is started. D. As they lose interest in the environment.

A. As their depression begins to improve.

Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her hands for long periods each day. How should the nurse respond to this compulsive behavior? A. By designating times during which the client can focus on the behavior. B. By urging the client to reduce the frequency of the behavior as rapidly as possible. C. By calling attention to or attempting to prevent the behavior. D. By discouraging the client from verbalizing anxieties.

A. By designating times during which the client can focus on the behavior.

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 with suicidal clients.

A. Check the client frequently at irregular intervals throughout the night.

When establishing an initial nurse-client relationship, Nurse Hazel should explore with the client the: A. Client's perception of the presenting problem. B. Occurrence of fantasies the client may experience. C. Details of any ritualistic acts carried out by the client. D. Client's feelings when external; controls are instituted.

A. Client's perception of the presenting problem.

A male client recently admitted to the hospital with sharp, substernal chest pain suddenly complains of palpitations. Nurse Ryan notes a rise in the client's arterial blood pressure and a heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine recently after previously denying use of the drug. The nurse concludes that the client is at high risk for which complication of cocaine use? A. Coronary artery spasm B. Bradyarrhythmias C. Neurobehavioral deficits D. Panic disorder

A. Coronary artery spasm

Tim is admitted with a diagnosis of delusions of grandeur. The nurse is aware that this diagnosis reflects a belief that one is: A. Highly important or famous. B. Being persecuted. C. Connected to events unrelated to oneself. D. Responsible for the evil in the world.

A. Highly important or famous.

Nurse John recognizes that paranoid delusions usually are related to the defense mechanism of: A. Projection B. Identification C. Repression D. Regression

A. Projection

Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client? A. Providing one-on-one supervision during meals and for one (1) hour afterward. B. Letting the client eat with other clients to create a normal mealtime atmosphere. C. Trying to persuade the client to eat and thus restore nutritional balance. D. Giving the client as much time to eat as desired.

A. Providing one-on-one supervision during meals and for one (1) hour afterward.

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

Rudolf is admitted for an overdose of amphetamines. When assessing the client, the nurse should expect to see: A. Tension and irritability B. Slow pulse C. Hypotension D. Constipation

A. Tension and irritability

A male client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from nurse Julia? A. "Why didn't you get someone else to drive you?" B. "Tell me how you feel about the accident." C. "You should know better than to drink and drive." D. "I recommend that you attend an Alcoholics Anonymous meeting."

B. "Tell me how you feel about the accident."

A client seeks care because she feels depressed and has gained weight. To treat her atypical depression, the physician prescribes tranylcypromine sulfate (Parnate), 10 mg by mouth twice per day. When this drug is used to treat atypical depression, what is its onset of action? A. 1 to 2 days B. 3 to 5 days C. 6 to 8 days D. 10 to 14 days

B. 3 to 5 days

Nurse John is aware that most crisis situations should resolve in about: A. 1 to 2 weeks B. 4 to 6 weeks C. 4 to 6 months D. 6 to 12 months

B. 4 to 6 weeks

Marielle, 17 years old was sexually attacked while on her way home from school. She is brought to the hospital by her mother. Rape is an example of which type of crisis: A. Situational B. Adventitious C. Developmental D. Internal

B. Adventitious

Ricky with chronic schizophrenia takes neuroleptic medication and is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction: A. Tardive dyskinesia B. Dystonia C. Neuroleptic malignant syndrome D. Akathisia

C. Neuroleptic malignant syndrome

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.

Tranylcypromine sulfate (Parnate) is prescribed for a depressed client who has not responded to the tricyclic antidepressants. After teaching the client about the medication, Nurse Marian evaluates that learning has occurred when the client states, "I will avoid: A. Citrus fruit, tuna, and yellow vegetables." B. Chocolate milk, aged cheese, and yogurt" C. Green leafy vegetables, chicken, and milk." D. Whole grains, red meats, and carbonated soda."

B. Chocolate milk, aged cheese, and yogurt"

When planning care for a client who has ingested phencyclidine (PCP), nurse Wayne is aware that the following is the highest priority? A. Client's physical needs B. Client's safety needs C. Client's psychosocial needs D. Client's medical needs

B. Client's safety needs

Jeremy is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum. A. Heroin B. Cocaine C. LSD D. Marijuana

B. Cocaine

Nurse Gerry is aware that the defense mechanism commonly used by clients who are alcoholics is: A. Displacement B. Denial C. Projection D. Compensation

B. Denial

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.

The psychiatrist orders lithium carbonate 600 mg p.o t.i.d for a female client. Nurse Katrina would be aware that the teaching about the side effects of this drug were understood when the client state, "I will call my doctor immediately if I notice any: A. Sensitivity to bright light or sun. B. Fine hand tremors or slurred speech. C. Sexual dysfunction or breast enlargement. D. Inability to urinate or difficulty when urinating.

B. Fine hand tremors or slurred speech.

A client whose husband just left her has a recurrence of anorexia nervosa. Nurse Vic caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to: A. Manipulate her husband. B. Gain control of one part of her life. C. Commit suicide. D. Live up to her mother's expectations.

B. Gain control of one part of her life.

Nurse Cristina 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

The initial nursing intervention for the significant-others during shock phase of a grief reaction should be focused on: A. Presenting the full reality of the loss of the individuals. B. Directing the individual's activities at this time. C. Staying with the individuals involved. D. Mobilizing the individual's support system.

C. Staying with the individuals involved.

Nurse Bea notices a female client sitting alone in the corner smiling and talking to herself. Realizing that the client is hallucinating. Nurse Bea should: A. Invite the client to help decorate the dayroom. B. Leave the client alone until he stops talking. C. Ask the client why he is smiling and talking. D. Tell the client it is not good for him to talk to himself.

B. Leave the client alone until he stops talking.

Grace is exhibiting withdrawn patterns of behavior. Nurse Johnny is aware that this type of behavior eventually produces a feeling of: A. Repression B. Loneliness C. Anger D. Paranoia

B. Loneliness

Nurse Amy is aware that the client is at highest risk for suicide? A. One who appears depressed frequently thinks of dying and gives away all personal possessions. B. One who plans a violent death and has the means readily available. C. One who tells others that he or she might do something if life doesn't get better soon. D. One who talks about wanting to die.

B. One who plans a violent death and has the means readily available.

Richard is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations? A. Aggressive behavior B. Paranoid thoughts C. Emotional affect D. Independence needs

B. Paranoid thoughts

A 65 years old client is in the first stage of Alzheimer's disease. Nurse Patricia should plan to focus this client's care on: A. Offering nourishing finger foods to help maintain the client's nutritional status. B. Providing emotional support and individual counseling. C. Monitoring the client to prevent minor illnesses from turning into major problems. D. Suggesting new activities for the client and family to do together.

B. Providing emotional support and individual counseling.

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.

A nursing diagnosis for a male client with a diagnosed multiple personality disorder is chronic low self-esteem probably related to childhood abuse. The most appropriate short-term client outcome would be: A. Verbalizing the need for anxiety medications. B. Recognizing each existing personality. C. Engaging in object-oriented activities. D. Eliminating defense mechanisms and phobia.

B. Recognizing each existing personality.

Which information is most important for the nurse Trinity to include in a teaching plan for a male schizophrenic client taking clozapine (Clozaril)? A. Monthly blood tests will be necessary. B. Report a sore throat or fever to the physician immediately. C. Blood pressure must be monitored for hypertension. D. Stop the medication when symptoms subside.

B. Report a sore throat or fever to the physician immediately.

Richard with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include: A. Insomnia and an inability to concentrate. B. Severe anxiety and fear. C. Depression and weight loss. D. Withdrawal and failure to distinguish reality from fantasy.

B. Severe anxiety and fear.

Miranda, a psychiatric client is to be discharged with orders for haloperidol (Haldol) therapy. When developing a teaching plan for discharge, the nurse should include cautioning the client against: A. Driving at night. B. Staying in the sun. C. Ingesting wines and cheeses. D. Taking medications containing aspirin.

B. Staying in the sun.

The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent? A. Combativeness, sweating, and confusion B. Agitation, hyperactivity, and grandiose ideation C. Emotional lability, euphoria, and impaired memory D. Suspiciousness, dilated pupils, and increased blood pressure

C. Emotional lability, euphoria, and impaired memory

Nurse Fey is aware that the drug of choice for treating Tourette syndrome? A. Fluoxetine (Prozac) B. Fluvoxamine (Luvox) C. Haloperidol (Haldol) D. Paroxetine (Paxil)

C. Haloperidol (Haldol)

David 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."

C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."

Meryl, age 19, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. Meryl asks the nurse, "Why has this happened to me?" What is the nurse's best response? A. "You've developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again." B. "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical." C. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened." D. "It isn't uncommon for someone with your personality to develop a conversion disorder during times of stress."

C. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."

After taking an overdose of phenobarbital (Barbita), Mario is admitted to the emergency department. Dr. Trinidad prescribes activated charcoal (Charcocaps) to be administered by mouth immediately. Before administering the dose, the nurse verifies the dosage ordered. What is the usual minimum dose of activated charcoal? A. 5 g mixed in 250 ml of water B. 15 g mixed in 500 ml of water C. 30 g mixed in 250 ml of water D. 60 g mixed in 500 ml of water

C. 30 g mixed in 250 ml of water

What parental behavior toward a child during an admission procedure should cause Nurse Ron to suspect child abuse? A. Flat affect B. Expressing guilt C. Acting overly solicitous toward the child. D. Ignoring the child.

C. Acting overly solicitous toward the child.

When asking the parents about the onset of problems in young client with the diagnosis of schizophrenia, Nurse Linda would expect that they would relate the client's difficulties began in: A. Early childhood B. Late childhood C. Adolescence D. Puberty

C. Adolescence

Dervid, an adolescent boy, was admitted for substance abuse and hallucinations. The client's mother asks Nurse Armando to talk with his husband when he arrives at the hospital. The mother says that she is afraid of what the father might say to the boy. The most appropriate nursing intervention would be to: A. Inform the mother that she and the father can work through this problem themselves. B. Refer the mother to the hospital social worker. C. Agree to talk with the mother and the father together. D. Suggest that the father and son work things out.

C. Agree to talk with the mother and the father together.

A male client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink six (6) hours before admission. Based on this response, nurse Lorena should expect early withdrawal symptoms to: A. Begin after seven (7) days. B. Not occur at all because the time period for their occurrence has passed. C. Begin anytime within the next one (1) to two (2) days. D. Begin within two (2) to seven (7) days.

C. Begin anytime within the next one (1) to two (2) days.

Nurse Penny is aware that the following medical conditions are commonly found in clients with bulimia nervosa? A. Allergies B. Cancer C. Diabetes mellitus D. Hepatitis A

C. Diabetes mellitus

Macoy and Helen seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple, nurse Gerry knows they are at risk for repeated violence because the husband: A. Has only moderate impulse control. B. Denies feelings of jealousy or possessiveness. C. Has learned violence as an acceptable behavior. D. Feels secure in his relationship with his wife.

C. Has learned violence as an acceptable behavior.

Nurse Mickey 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.

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.

Within a few hours of alcohol withdrawal, nurse John should assess the male client for the presence of: A. Disorientation, paranoia, tachycardia B. Tremors, fever, profuse diaphoresis C. Irritability, heightened alertness, jerky movements D. Yawning, anxiety, convulsions

C. Irritability, heightened alertness, jerky movements

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.

A male client who reportedly consumes one (1) qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms, Dr. Smith is most likely to prescribe which drug? A. Clozapine (Clozaril) B. Thiothixene (Navane) C. Lorazepam (Ativan) D. Lithium carbonate (Eskalith)

C. Lorazepam (Ativan)

Nurse Amy is providing care for a male client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with: A. Barbiturates B. Amphetamines C. Methadone D. Benzodiazepines

C. Methadone

Kitty, a 9-year-old child has a very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. Profound B. Mild C. Moderate D. Severe

C. Moderate

A male client with a history of cocaine addiction is admitted to the coronary care unit for evaluation of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation of the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client's history of drug abuse, nurse Greg expects the physician to prescribe: A. Lidocaine (Xylocaine). B. Procainamide (Pronestyl). C. Nitroglycerin (Nitro-Bid IV). D. Epinephrine.

C. Nitroglycerin (Nitro-Bid IV).

Nurse Jannah is monitoring a male client who has been placed in restraints because of violent behavior. Nurse determines that it will be safe to remove the restraints when: A. The client verbalizes the reasons for the violent behavior. B. The client apologizes and tells the nurse that it will never happen again. C. No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints. D. The administered medication has taken effect.

C. No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints.

Clonidine (Catapres) can be used to treat conditions other than hypertension. Nurse Sally is aware that the following conditions might the drug be administered? A. Phencyclidine (PCP) intoxication B. Alcohol withdrawal C. Opiate withdrawal D. Cocaine withdrawal

C. Opiate withdrawal

When developing an initial nursing care plan for a male client with a Bipolar I disorder (manic episode) nurse Ron should plan to? A. Isolate his gym time. B. Encourage his active participation in unit programs. C. Provide foods, fluids, and rest. D. Discourage his participation in programs.

C. Provide foods, fluids, and rest.

A female client begins to experience alcoholic hallucinosis. Nurse Joy is aware that the best nursing intervention at this time? A. Keeping the client restrained in bed. B. Checking the client's blood pressure every 15 minutes and offering juices. C. Providing a quiet environment and administering medication as needed and prescribed. D. Restraining the client and measuring blood pressure every 30 minutes.

C. Providing a quiet environment and administering medication as needed and prescribed.

Joy's stream of consciousness is occupied exclusively with thoughts of her father's death. Nurse Ronald should plan to help Joy through this stage of grieving, which is known as: A. Shock and disbelief B. Developing awareness C. Resolving the loss D. Restitution

C. Resolving the loss

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.

Nurse Marco is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? A. Restricts visits with the family and friends 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.

Dervid, an adolescent has a history of truancy from school, running away from home and "borrowing" other people's things without their permission. The adolescent denies stealing, rationalizing instead that as long as no one was using the items, it was all right to borrow them. It is important for the nurse to understand the psychodynamically, this behavior may be largely attributed to a developmental defect related to the: A. Id B. Ego C. Superego D. Oedipal complex

C. Superego

Nurse Krina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD): A. benztropine (Cogentin) and diphenhydramine (Benadryl). B. chlordiazepoxide (Librium) and diazepam (Valium) C. fluvoxamine (Luvox) and clomipramine (Anafranil) D. divalproex (Depakote) and lithium (Lithobid)

C. fluvoxamine (Luvox) and clomipramine (Anafranil)

Nurse Maureen knows that the non-antipsychotic medication used to treat some clients with schizoaffective disorder is: A. phenelzine (Nardil) B. chlordiazepoxide (Librium) C. lithium carbonate (Lithane) D. imipramine (Tofranil)

C. lithium carbonate (Lithane)

A male client is brought to the psychiatric clinic by family members, who tell the admitting nurse that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview with the nurse Linda, which statement by the client most strongly supports a diagnosis of psychoactive substance abuse? A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected." B. "I only spend half of my paycheck at the bar." C. "I just drink to relax after work." D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."

D. "I know I've been arrested three times for drinking and driving, but the police are just trying to hassle me."

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 had 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.

The nurse is caring for a client diagnosed with an antisocial personality disorder. The client has a history of fighting, cruelty to animals, and stealing. Which of the following traits would the nurse be most likely to uncover during the assessment? A. History of gainful employment. B. Frequent expression of guilt regarding antisocial behavior. C. Demonstrated ability to maintain close, stable relationships. D. A low tolerance for frustration.

D. A low tolerance for frustration.

A dying male client gradually moves toward resolution of feelings regarding impending death. Basing care on the theory of Kubler-Ross, Nurse Trish plans to use nonverbal interventions when assessment reveals that the client is in the: A. Anger stage B. Denial stage C. Bargaining stage D. Acceptance stage

D. Acceptance stage

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)

When being admitted to a mental health facility, a young female adult tells Nurse Mylene that the voices she hears frighten her. Nurse Mylene understands that the client tends to hallucinate more vividly: A. While watching TV B. During mealtime C. During group activities D. After going to bed

D. After going to bed

A male client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, he sits staring blankly at his bleeding wrists while staff members call for an ambulance. How should Nurse Anuktakanuk approach her initially? A. Enter the room quietly and move beside him to assess his injuries. B. Call for staff back-up before entering the room and restraining him. C. Move as much glass away from him as possible and sit next to him quietly. D. Approach him slowly while speaking in a calm voice, calling his name, and telling him that the nurse is here to help him.

D. Approach him slowly while speaking in a calm voice, calling his name, and telling him that the nurse is here to help him.

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)

Ramon is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but that he can control his use if he chooses. Which coping mechanism is he using? A. Withdrawal B. Logical thinking C. Repression D. Denial

D. Denial

A male adult client voluntarily admits himself to the substance abuse unit. He confesses that he drinks one (1) qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition? A. Vomiting, diarrhea, and bradycardia B. Dehydration, temperature above 101° F (38.3° C), and pruritus C. Hypertension, diaphoresis, and seizures D. Diaphoresis, tremors, and nervousness

D. Diaphoresis, tremors, and nervousness

Nurse Kate would expect that a client with vascular dementia would experience: A. Loss of remote memory related to anoxia. B. Loss of abstract thinking related to emotional state. C. Inability to concentrate related to decreased stimuli. D. Disturbance in recalling recent events related to cerebral hypoxia.

D. Disturbance in recalling recent events related to cerebral hypoxia.

Mr. Cruz visits the physician's office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse Tiffany suspects: A. Cyclothymic disorder. B. Atypical affective disorder. C. Major depression. D. Dysthymic disorder.

D. Dysthymic disorder.

Josefina is to be discharged on a regimen of lithium carbonate. In the teaching plan for discharge the nurse should include: A. Advising the client to watch the diet carefully. B. Suggesting that the client take the pills with milk. C. Reminding the client that a CBC must be done once a month. D. Encouraging the client to have blood levels checked as ordered.

D. Encouraging the client to have blood levels checked as ordered.

After seeking help at an outpatient mental health clinic, Ruby who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby? A. Recommending a high-protein, low-fat diet. B. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle. C. Allowing the client time to heal. D. Exploring the meaning of the traumatic event with the client.

D. Exploring the meaning of the traumatic event with the client.

One morning, nurse Diane finds a disturbed client curled up in the fetal position in the corner of the dayroom. The most accurate initial evaluation of the behavior would be that the client is: A. Physically ill and experiencing abdominal discomfort. B. Tired and probably did not sleep well last night. C. Attempting to hide from the nurse. D. Feeling more anxious today.

D. Feeling more anxious today.

Mr. Marquez reports losing his job, not being able to sleep at night, and feeling upset with his wife. Nurse John responds to the client, "You may want to talk about your employment situation in group today." The Nurse is using which therapeutic technique? A. Observations B. Restating C. Exploring D. Focusing

D. Focusing

The primary nursing diagnosis for a female client with a medical diagnosis of major depression would be: A. Situational low self-esteem related to altered role B. Powerlessness related to the loss of idealized self C. Spiritual distress related to depression D. Impaired verbal communication related to depression

D. Impaired verbal communication related to depression

Nurse Jen is caring for a male client with manic depression. The plan of care for a client in a manic state would include: A. Offering high-calorie meals and strongly encouraging the client to finish all food. B. Insisting that the client remain active through the day so that he'll sleep at night. C. Allowing the client to exhibit hyperactive, demanding, manipulative behavior without setting limits. D. Listening attentively with a neutral attitude and avoiding power struggles.

D. Listening attentively with a neutral attitude and avoiding power struggles.

Nurse Judy knows that statistics show that in adolescent suicidal behavior: A. Females use more dramatic methods than males. B. Males account for more attempts than do females. C. Females talk more about suicide before attempting it. D. Males are more likely to use lethal methods than are females.

D. Males are more likely to use lethal methods than are females.

Jen, a nursing student is anxious about the upcoming board examination but is able to study intently and does not become distracted by a roommate's talking and loud music. The student's ability to ignore distractions and to focus on studying demonstrates: A. Mild-level anxiety B. Panic-level anxiety C. Severe-level anxiety D. Moderate-level anxiety

D. Moderate-level anxiety

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.

The therapeutic approach in the care of Armand an autistic child includes the following EXCEPT: A. Engage in diversionary activities when acting-out. B. Provide an atmosphere of acceptance. C. Provide safety measures. D. Rearrange the environment to activate the child.

D. Rearrange the environment to activate the child.

What is Nurse John likely to note in a male client being admitted for alcohol withdrawal? A. Perceptual disorders B. Impending coma C. Recent alcohol intake D. Depression with mutism

A. Perceptual disorders

Nurse Gina is aware that the dietary implications for a client in manic phase of bipolar disorder is: A. Serve the client a bowl of soup, buttered French bread, and apple slices. B. Increase calories, decrease fat and decrease protein. C. Give the client pieces of cut-up steak, carrots, and an apple. D. Increase calories, carbohydrates, and protein.

D. Increase calories, carbohydrates, and protein.

Celia with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals? A. Alcohol withdrawal B. Cannabis withdrawal C. Cocaine withdrawal D. Opioid withdrawal

D. Opioid withdrawal

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.

A 25-year-old male is admitted to a mental health facility because of inappropriate behavior. The client has been hearing voices, responding to imaginary companions, and withdrawing to his room for several days at a time. Nurse Monette understands that the withdrawal is a defense against the client's fear of: A. Phobia B. Powerlessness C. Punishment D. Rejection

D. Rejection

Mr. Garcia, an attorney who throws books and furniture around the office after losing a case, is referred to the psychiatric nurse in the law firm's employee assistance program. Nurse Beatriz knows that the client's behavior most likely represents the use of which defense mechanism? A. Regression B. Projection C. Reaction-formation D. Intellectualization

A. Regression

Nurse Myrna develops a counter-transference reaction. This is evidenced by: A. Revealing personal information to the client. B. Focusing on the feelings of the client. C. Confronting the client about discrepancies in verbal or nonverbal behavior. D. The client feels angry towards the nurse who resembles his mother.

A. Revealing personal information to the client.

Jose, who has been hospitalized with schizophrenia tells Nurse Ron, "My heart has stopped and my veins have turned to glass!" Nurse Ron is aware that this is an example of: A. Somatic delusions B. Depersonalization C. Hypochondriasis D. Echolalia

A. Somatic delusions

Nurse Alice is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products? A. Carbonated beverages B. Aftershave lotion C. Toothpaste D. Cheese

B. Aftershave lotion

A 25 -year old client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority? A. The client will commit to a drug-free lifestyle. B. The client will work with the nurse to remain safe. C. The client will drink plenty of fluids daily. D. The client will make a personal inventory of strength.

B. The client will work with the nurse to remain safe.

Kathleen is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to: A. Severely restrict the client's physical activities. B. Weigh the client daily, after the evening meal. C. Monitor vital signs, serum electrolyte levels, and acid-base balance. D. Instruct the client to keep an accurate record of food and fluid intake.

C. Monitor vital signs, serum electrolyte levels, and acid-base balance.

Which nursing intervention would be most appropriate if a male client develops orthostatic hypotension while taking amitriptyline (Elavil)? A. Consulting with the physician about substituting a different type of antidepressant. B. Advising the client to sit up for 1 minute before getting out of bed. C. Instructing the client to double the dosage until the problem resolves. D. Informing the client that this adverse reaction should disappear within 1 week.

B. Advising the client to sit up for 1 minute before getting out of bed.

In recognizing common behaviors exhibited by a male client who has a diagnosis of schizophrenia, nurse Josie can anticipate: A. Slumped posture, pessimistic outlook, and flight of ideas B. Grandiosity, arrogance, and distractibility C. Withdrawal, regressed behavior, and lack of social skills D. Disorientation, forgetfulness, and anxiety

C. Withdrawal, regressed behavior, and lack of social skills

Tristan is on Lithium and has suffered from diarrhea and vomiting. What should the nurse in-charge do first: A. Recognize this as a drug interaction. B. Give the client Cogentin. C. Reassure the client that these are common side effects of lithium therapy. D. Hold the next dose and obtain an order for a stat serum lithium level.

D. Hold the next dose and obtain an order for a stat serum lithium level.

Nurse Anne is caring for a client who has been treated long term with antipsychotic medication. During the assessment, Nurse Anne checks the client for tardive dyskinesia. If tardive dyskinesia is present, Nurse Anne would most likely observe: A. Abnormal movements and involuntary movements of the mouth, tongue, and face. B. Abnormal breathing through the nostrils accompanied by a "thrill." C. Severe headache, flushing, tremors, and ataxia. D. Severe hypertension, migraine headache.

A. Abnormal movements and involuntary movements of the mouth, tongue, and face.

A male client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. Nurse Lily should suggest that the family join which organization? A. Al-Anon B. Make Today Count C. Emotions Anonymous D. Alcoholics Anonymous

A. Al-Anon

One morning a female client on the inpatient psychiatric service complains to nurse Hazel that she has been waiting for over an hour for someone to accompany her to activities. Nurse Hazel replies to the client "We're doing the best we can. There are a lot of other people in the unit who need attention too." This statement shows that the nurse's use of: A. Defensive behavior B. Reality reinforcement C. Limit-setting behavior D. Impulse control

A. Defensive behavior

When developing a plan of care for a female client with acute stress disorder who lost her sister in a car accident. Which of the following would the nurse expect to initiate? A. Facilitating progressive review of the accident and its consequences. B. Postponing discussion of the accident until the client brings it up. C. Telling the client to avoid details of the accident. D. Helping the client to evaluate her sister's behavior.

A. Facilitating progressive review of the accident and its consequences.

Nurse Bella is aware that assessment finding is most consistent with early alcohol withdrawal? A. Heart rate of 120 to 140 beats/minute B. Heart rate of 50 to 60 beats/minute C. Blood pressure of 100/70 mmHg D. Blood pressure of 140/80 mmHg

A. Heart rate of 120 to 140 beats/minute

Nurse Irish is aware that Ritalin is the drug of choice for a child with ADHD. The side effects of the following may be noted by the nurse: A. Increased attention span and concentration. B. Increase in appetite. C. Sleepiness and lethargy. D. Bradycardia and diarrhea.

A. Increased attention span and concentration.

Junnel, who is manic, but not yet on medication, comes to the drug treatment center. The nurse would not let this client join the group session because: A. The client is disruptive. B. The client is harmful to self. C. The client is harmful to others. D. The client needs to be on medication first.

A. The client is disruptive.

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."

Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. Nurse Melinda should suspect: A. A postoperative infection B. Alcohol withdrawal C. Acute sepsis. D. Pneumonia.

B. Alcohol withdrawal

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

B. Sodium

A female client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, nurse Tair should plan to: A. Severely restrict the client's physical activities. B. Weigh the client daily, after the evening meal. C. Monitor vital signs, serum electrolyte levels, and acid-base balance. D. Instruct the client to keep an accurate record of food and fluid intake.

C. Monitor vital signs, serum electrolyte levels, and acid-base balance.

In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle knows that succinylcholine (Anectine) will be administered for which therapeutic effect? A. Short-acting anesthesia B. Decreased oral and respiratory secretions C. Skeletal muscle paralysis D. Analgesia

C. Skeletal muscle paralysis

Jose is diagnosed with amphetamine psychosis and was admitted to the emergency room. Nurse Ronald would most likely prepare to administer which of the following medication? A. Librium B. Valium C. Ativan D. Haldol

D. Haldol

Nurse Josefina is caring for a client who has been diagnosed with delirium. Which statement about delirium is true? A. It's characterized by an acute onset and lasts about 1 month. B. It's characterized by a slowly evolving onset and lasts about 1 week. C. It's characterized by a slowly evolving onset and lasts about 1 month. D. It's characterized by an acute onset and lasts hours to a number of days.

D. It's characterized by an acute onset and lasts hours to a number of days.

When monitoring a female client recently admitted for treatment of cocaine addiction, nurse Aaron notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe: A. Norepinephrine (Levophed) and Lidocaine (Xylocaine) B. Nifedipine (Procardia) and Lidocaine. C. Nitroglycerin (Nitro-Bid IV) and Esmolol (Brevibloc) D. Nifedipine and Esmolol

D. Nifedipine and Esmolol

Aira has taken amitriptyline HCL (Elavil) for 3 days, but now complains that it "doesn't help" and refuses to take it. What should the nurse say or do? A. Withhold the drug. B. Record the client's response. C. Encourage the client to tell the doctor. D. Suggest that it takes a while before seeing the results.

D. Suggest that it takes a while before seeing the results.

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.

Isabel with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that: A. This medication may be habit-forming and will be discontinued as soon as the client feels better. B. This medication has no serious adverse effects. C. The client should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication. D. This medication may initially cause tiredness, which should become less bothersome over time.

D. This medication may initially cause tiredness, which should become less bothersome over time.