Psychiatric Nursing Review 1
46. Nurse Jonel is providing information to a community group about violence in the family. Which statement by a group member would indicate a need to provide additional information? A. "Abuse occurs more in low-income families" B. "Abuser Are often jealous or self-centered" C. "Abuser use fear and intimidation" D. "Abuser usually have poor self-esteem"
A. "Abuse occurs more in low-income families" Personal characteristics of the abuser include low self-esteem, immaturity, dependence, insecurity, and jealousy.
30. When working with a male client suffering from a phobia about black cats, Nurse Trish should anticipate that a problem for this client would be? A. Anxiety when discussing phobia B. Anger toward the feared object C. Denying that the phobia exists D. Distortion of reality when completing daily routines
A. Anxiety when discussing phobia Discussion of the feared object triggers an emotional response to the object.
14. Nurse Patricia is aware that the major health complication associated with intractable anorexia nervosa would be? A. Cardiac dysrhythmias resulting in cardiac arrest B. Glucose intolerance resulting in protracted hypoglycemia C. Endocrine imbalance causing cold amenorrhea D. Decreased metabolism causing cold intolerance
A. Cardiac dysrhythmias resulting in cardiac arrest These clients have severely depleted levels of sodium and potassium because of their starvation diet and energy expenditure, these electrolytes are necessary for cardiac functioning.
8. A male client is diagnosed with schizotypal personality disorder. Which signs would this client exhibit during social situation? A. Paranoid thoughts B. Emotional affect C. Independence need D. Aggressive behavior
A. Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts.
19. Joey a client with antisocial personality disorder belches loudly. A staff member asks Joey, "Do you know why people find you repulsive?" this statement most likely would elicit which of the following client reaction? A. Defensiveness B. Embarrassment C. Shame D. Remorseful
A. Defensiveness When the staff member asks the client if he wonders why others find him repulsive, the client is likely to feel defensive because the question is belittling. The natural tendency is to counterattack the threat to self-image.
34. Nurse Joey is aware that the signs & symptoms that would be most specific for diagnosis of anorexia are? A. Excessive weight loss, amenorrhea & abdominal distension B. Slow pulse, 10% weight loss & alopecia C. Compulsive behavior, excessive fears & nausea D. Excessive activity, memory lapses & an increased pulse
A. Excessive weight loss, amenorrhea & abdominal distension These are the major signs of anorexia nervosa. Weight loss is excessive (15% of expected weight).
10. Nurse Tony was caring for a 41-year-old female client. Which behavior by the client indicates adult cognitive development? A. Generates new levels of awareness B. Assumes responsibility for her actions C. Has maximum ability to solve problems and learn new skills D. Her perception is based on reality
A. Generates new levels of awareness An adult age 31 to 45 generates a new level of awareness.
2. Nurse Hazel is caring for a male client who experiences false sensory perceptions with no basis in reality. This perception is known as: A. Hallucinations B. Delusions C. Loose associations D. Neologisms
A. Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality.
27. When teaching parents about childhood depression Nurse Trina should say? A. It may appear acting out behavior B. Does not respond to conventional treatment C. Is short in duration & resolves easily D. Looks almost identical to adult depression
A. It may appear acting out behavior Children have difficulty verbally expressing their feelings, acting out behavior, such as temper tantrums, may indicate underlying depression.
25. Nurse Monette recognizes that the focus of environmental (MILIEU) therapy is to: A. Manipulate the environment to bring about positive changes in behavior B. Allow the client's freedom to determine whether or not they will be involved in activities C. Role play life events to meet individual needs D. Use natural remedies rather than drugs to control behavior
A. Manipulate the environment to bring about positive changes in behavior Environmental (MILIEU) therapy aims at having everything in the client's surrounding area toward helping the client.
38. A nursing care plan for a male client with bipolar I disorder should include: A. Providing a structured environment B. Designing activities that will require the client to maintain contact with reality C. Engaging the client in conversing about current affairs D. Touching the client provide assurance
A. Providing a structured environment Structure tends to decrease agitation and anxiety and to increase the client's feeling of security.
11. A neuromuscular blocking agent is administered to a client before ECT therapy. The Nurse should carefully observe the client for? A. Respiratory difficulties B. Nausea and vomiting C. Dizziness D. Seizures
A. Respiratory difficulties neuromuscular blocker, such as SUCCINYLCHOLINE (Anectine) produces respiratory depression because it inhibits contractions of respiratory muscles.
9. Nurse Claire is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is? A. Encourage to avoid foods B. Identify the anxiety causing situations C. Eat only three meals a day D. Avoid shopping plenty of groceries
B. Bulimia disorder generally is a maladaptive coping response to stress and underlying issues. The client should identify the anxiety-causing situation that stimulates bulimic behavior and then learn new ways of coping with the anxiety.
6. A female client is admitted with a diagnosis of delusions of GRANDEUR. This diagnosis reflects a belief that one is: A. Being Killed B. Highly famous and important C. Responsible for the evil world D. Connected to client unrelated to oneself
B. Delusion of grandeur is a false belief that one is highly famous and important.
18. Conney with borderline personality disorder who is to be discharged soon threatens to "do something" to herself if discharged. Which of the following actions by the nurse would be most important? A. Ask a family member to stay with the client at home temporarily B. Discuss the meaning of the client's statement with her C. Request an immediate extension for the client D. Ignore the client's statement because it's a sign of manipulation
B. Discuss the meaning of the client's statement with her Any suicidal statement must be assessed by the nurse. The nurse should discuss the client's statement with her to determine its meaning in terms of suicide.
39. When planning care for a female client using ritualistic behavior, Nurse Gina must recognize that the ritual: A. Helps the client focus on the inability to deal with reality B. Helps the client control the anxiety C. Is under the client's conscious control D. Is used by the client primarily for secondary gains
B. Helps the client control the anxiety The rituals used by a client with obsessive-compulsive disorder help control the anxiety level by maintaining a set pattern of action.
50. Mario is admitted to the emergency room with drug-included anxiety related to over ingestion of prescribed antipsychotic medication. The most important piece of information the nurse in charge should obtain initially is the: A. Length of time on the med. B. Name of the ingested medication & the amount ingested C. Reason for the suicide attempt D. Name of the nearest relative & their phone number
B. In an emergency life-saving facts are obtained first. The name of the ingested medication and the amount of medication ingested are of utmost importance in treating this potentially life-threatening situation.
15. Nurse Anna can minimize agitation in a disturbed client by? A. Increasing stimulation B. limiting unnecessary interaction C. increasing appropriate sensory perception D. ensuring constant client and staff contact
B. Limiting unnecessary interaction will decrease stimulation and agitation.
36. Nurse Monette is aware that extremely depressed clients seem to do best in settings where they have: A. Multiple stimuli B. Routine Activities C. Minimal decision making D. Varied Activities
B. Routine Activities Depression usually is both emotional & physical. A simple daily routine is the best, least stressful, and least anxiety-producing.
4. Nurse Maureen is developing a plan of care for a female client with anorexia nervosa. Which action should the nurse include in the plan? A. Provide privacy during meals B. Set up a strict eating plan for the client C. Encourage client to exercise to reduce anxiety D. Restrict visits with the family
B. Set up a strict eating plan for the client Establishing a consistent eating plan and monitoring the client's weight is important to this disorder.
20. Which of the following approaches would be most appropriate to use with a client suffering from narcissistic personality disorder when discrepancies exist between what the client states and what actually exist? A. Rationalization B. Supportive confrontation C. Limit setting D. Consistency
B. The nurse would specifically use a supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for self.
43. A male client who is experiencing disordered thinking about food being poisoned is admitted to the mental health unit. The nurse use which communication technique to encourage the client to eat dinner? A. Focusing on self-disclosure of own food preference B. Using open-ended question and silence C. Offering opinion about the need to eat D. Verbalizing reasons that the client may not choose to eat
B. Using open ended question and silence Open-ended questions and silence are strategies used to encourage clients to discuss their problems in a descriptive manner.
31. Linda is pacing the floor and appears extremely anxious. The duty nurse approaches in an attempt to alleviate Linda's anxiety. The most therapeutic question by the nurse would be? A. Would you like to watch TV? B. Would you like me to talk with you? C. Are you feeling upset now? D. Ignore the client
B. Would you like me to talk with you? The nurse's presence may provide the client with support & a feeling of control.
35. A characteristic that would suggest to Nurse Anne that an adolescent may have bulimia would be: A. Frequent regurgitation & re-swallowing of food B. Previous history of gastritis C. Badly stained teeth D. Positive body image
C. Badly stained teeth Dental enamel erosion occurs from repeated self-induced vomiting.
26. Nurse Trish would expect a child with a diagnosis of reactive attachment disorder to: A. Have a more positive relationship with the father than the mother B. Cling to mother & cry on separation C. Be able to develop only superficial relationships with the others D. Have been physically abuse
C. Be able to develop only superficial relationships with the others Children who have experienced attachment difficulties with a primary caregiver are not able to trust others and therefore relate superficially
44. Nurse Nina is assigned to care for a client diagnosed with Catatonic Stupor. When Nurse Nina enters the client's room, the client is found lying on the bed with a body pulled into a fetal position. Nurse Nina should? A. Ask the client direct questions to encourage talking B. Rake the client into the dayroom to be with other clients C. Sit beside the client in silence and occasionally ask an open-ended question D. Leave the client alone and continue with providing care to the other clients
C. Clients who are withdrawn may be immobile and mute and require consistent, repeated interventions. Communication with withdrawn clients requires much patience from the nurse. The nurse facilitates communication with the client by sitting in silence, asking an open-ended question, and pausing to provide opportunities for the client to respond.
33. Nurse Benjie is communicating with a male client with substance-induced persisting dementia; the client cannot remember facts and fills in the gaps with imaginary information. Nurse Benjie is aware that this is typical of? A. Flight of ideas B. Associative looseness C. Confabulation D. Concretism
C. Confabulation or the filling in of memory gaps with imaginary facts is a defense mechanism used by people experiencing memory deficits.
40. A 32-year-old male graduate student, who has become increasingly withdrawn and neglectful of his work and personal hygiene, is brought to the psychiatric hospital by his parents. After a detailed assessment, a diagnosis of schizophrenia is made. It is unlikely that the client will demonstrate: A. Low self-esteem B. Concrete thinking C. Effective self boundaries D. Weak ego
C. Effective self boundaries A person with this disorder would not have adequate self-boundaries.
42. A long term goal for a paranoid male client who has unjustifiably accused his wife of having many extramarital affairs would be to help the client develop: A. Insight into his behavior B. Better self-control C. Feeling of self-worth D. Faith in his wife
C. Feeling of self-worth Helping the client to develop a feeling of self-worth would reduce the client's need to use pathologic defenses.
16. A 39-year-old mother with the obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking rituals. Nurse Trish recognizes that the basis of O.C. disorder is often: A. Problems with being too conscientious B. Problems with anger and remorse C. Feelings of guilt and inadequacy D. Feeling of unworthiness and hopelessness
C. Feelings of guilt and inadequacy Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy by maintaining an absolute set pattern of behavior.
21. Cely is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mmHg and pulse is 92 bpm. Which of the medications would the nurse expect to administer? A. Naloxone (Narcan) B. Benzlropine (Cogentin) C. Lorazepam (Ativan) D. Haloperidol (Haldol)
C. Lorazepam (Ativan) The nurse would most likely administer benzodiazepine, such as lorazepam (Ativan) to the client who is experiencing symptoms: The client experiences symptoms of withdrawal because of the rebound phenomenon when the sedation of the CNS from alcohol begins to decrease.
12. A 75-year-old client is admitted to the hospital with the diagnosis of dementia of the Alzheimer's type and depression. The symptom that is unrelated to depression would be? A. Apathetic response to the environment B. "I don't know" answer to questions C. Shallow of labile effect D. Neglect of personal hygiene
C. Shallow of labile effect With depression, there is little or no emotional involvement therefore little alteration in affect.
5. A client is experiencing an anxiety attack. The most appropriate nursing intervention should include? A. Turning on the television B. Leaving the client alone C. Staying with the client and speaking in short sentences D. Ask the client to play with other clients
C. Staying with the client and speaking in short sentences Appropriate nursing interventions for an anxiety attack include staying with the client and using short sentences when speaking, decreasing stimuli, remaining calm, and medicating as needed.
48. When planning the discharge of a client with chronic anxiety, Nurse Chris evaluates the achievement of the discharge maintenance goals. Which goal would be most appropriately having been included in the plan of care requiring evaluation? A. The client eliminates all anxiety from daily situations B. The client ignores feelings of anxiety C. The client identifies anxiety-producing situations D. The client maintains contact with a crisis counselor
C. The client identifies anxiety-producing situations Recognizing situations that produce anxiety allows the client to prepare and to cope with anxiety or avoid the specific stimuli.
1. Marco approached Nurse Trish asking for advice on how to deal with his alcohol addiction. Nurse Trish should tell the client that the only effective treatment for alcoholism is: A. Psychotherapy B. Alcoholics anonymous (A.A.) C. Total abstinence D. Aversion Therapy
C. Total abstinence is the only effective treatment for alcoholism.
45. Nurse Tina is caring for a client with delirium and states that "look at the spiders on the wall". What should the nurse respond to the client? A. "You're having a hallucination, there are no spiders in this room at all" B. "I can see the spiders on the wall, but they are not going to hurt you" C. "Would you like me to kill the spiders" D. "I know you are frightened, but I do not see spiders on the wall"
D. "I know you are frightened, but I do not see spiders on the wall" When hallucination is present, the nurse should reinforce reality with the client.
29. A 60-year-old female client who lives alone tells the nurse at the community health center "I really don't need anyone to talk to". The TV is my best friend. Does the nurse recognize that the client is using the defense mechanism known as? A. Displacement B. Projection C. Sublimation D. Denial
D. Denial The client statement is an example of the use of denial, a defense that blocks problems by unconscious refusing to admit they exist.
28. Nurse Perry is aware that language development in autistic children resembles: A. Scanning speech B. Speech lag C. Shuttering D. Echolalia
D. Echolalia The autistic child repeat sounds or words were spoken by others.
49. Nurse Tina is caring for a client with depression who has not responded to antidepressant medication. The nurse anticipates that what treatment procedure may be prescribed? A. Neuroleptic medication B. Short term seclusion C. Psychosurgery D. Electroconvulsive therapy
D. Electroconvulsive therapy is an effective treatment for depression that has not responded to medication.
37. To further assess a client's suicidal potential. Nurse Katrina should be especially alert to the client expression of: A. Frustration & fear of death B. Anger & resentment C. Anxiety & loneliness D. Helplessness & hopelessness
D. Helplessness & hopelessness The expression of these feelings may indicate that this client is unable to continue the struggle of life.
7. A 20-year-old client was diagnosed with a dependent personality disorder. Which behavior is most likely to be evidence of ineffective individual coping? A. Recurrent self-destructive behavior B. Avoiding relationship C. Showing interest in solitary activities D. Inability to make choices and decision without advice
D. Inability to make choices and decision without advice The individual with dependent personality disorder typically shows indecisiveness, submissiveness, and clinging behavior so that others will make decisions with them.
41. A 23-year-old client who has been admitted with a diagnosis of schizophrenia says to the nurse "Yes, it's march, March is a little woman". That's literal you know". These statements illustrate: A. Neologisms B. Echolalia C. Flight of ideas D. Loosening of association
D. Loosening of association Loose associations are thoughts that are presented without the logical connections usually necessary for the listening to interpret the message.
13. Nurse Trish is working in a mental health facility; the nurse priority nursing intervention for a newly admitted client with bulimia nervosa would be to? A. Teach client to measure I & O B. Involve client in planning daily meal C. Observe client during meals D. Monitor client continuously
D. Monitor client continuously These clients often hide food or force vomiting; therefore they must be carefully monitored.
47. During electroconvulsive therapy (ECT) the client receives oxygen by mask via positive pressure ventilation. The nurse assisting with this procedure knows that positive pressure ventilation is necessary because? A. Anesthesia is administered during the procedure B. Decrease oxygen to the brain increases confusion and disorientation C. Grand mal seizure activity depresses respirations D. Muscle relaxations given to prevent injury during seizure activity depress respirations.
D. Muscle relaxations given to prevent injury during seizure activity depress respirations. A short-acting skeletal muscle relaxant such as succinylcholine (Anectine) is administered during this procedure to prevent injuries during a seizure.
3. Nurse Monet is caring for a female client who has suicidal tendencies. When accompanying the client to the restroom, Nurse Monet should... A. Give her privacy B. Allow her to urinate C. Open the window and allow her to get some fresh air D. Observe her
D. Observe her The Nurse has a responsibility to observe continuously the acutely suicidal client. The Nurse should watch for clues, such as communicating suicidal thoughts, and messages; hoarding medications, and talking about death.
32. Nurse Penny is aware that the symptoms that distinguish post-traumatic stress disorder from other anxiety disorder would be: A. Avoidance of situation & certain activities that resemble the stress B. Depression and a blunted affect when discussing the traumatic situation C. Lack of interest in family & others D. Re-experiencing the trauma in dreams or flashback
D. Re-experiencing the trauma in dreams or flashback Experiencing the actual trauma in dreams or flashback is the major symptom that distinguishes post-traumatic stress disorder from other anxiety disorders.
22. Which of the following foods would the nurse Trish eliminate from the diet of a client in alcohol withdrawal? A. Milk B. Orange Juice C. Tea D. Regular Coffee
D. Regular coffee contains caffeine which acts as psychomotor stimulants and leads to feelings of anxiety and agitation. Serving coffee to the client may add to tremors or wakefulness.
24. To establish an open and trusting relationship with a female client who has been hospitalized with severe anxiety, the nurse in charge should? A. Encourage the staff to have frequent interaction with the client B. Share activity with the client C. Give client feedback about behavior D. Respect client's need for personal space
D. Respect client's need for personal space Moving into a client's personal space increases the feeling of threat, which increases anxiety.
17. Mario is complaining to other clients about not being allowed by staff to keep food in his room. Which of the following interventions would be most appropriate? A. Allowing a snack to be kept in his room B. Reprimanding the client C. Ignoring the clients' behavior D. Setting limits on the behavior
D. Setting limits on the behavior The nurse needs to set limits in the client's manipulative behavior to help the client control dysfunctional behavior. A consistent approach by the staff is necessary to decrease manipulation.
23. Which of the following would Nurse Hazel expect to assess for a client who is exhibiting late signs of heroin withdrawal? A. Yawning & diaphoresis B. Restlessness & Irritability C. Constipation & steatorrhea D. Vomiting and Diarrhea
D. Vomiting and diarrhea are usually the late signs of heroin withdrawal, along with muscle spasms, fever, nausea, repetitive, abdominal cramps, and backache.
