PNLE V for Care of Clients with Physiologic and Psychosocial Alterations (Part 3)

1. Mr. Marquez reports of 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?

1. Observations
2. Restating
3. Exploring
4. Focusing

2. 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:

1. Check the client’s medical record for an order for an as-needed I.M. dose of medication for agitation.
2. Place the client in full leather restraints.
3. Call the attending physician and report the behavior.
4. Remove all other clients from the dayroom.

3. Tina 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:

1. The client is disruptive.
2. The client is harmful to self.
3. The client is harmful to others.
4. The client needs to be on medication first.

4. 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:

1. Inform the mother that she and the father can work through this problem themselves.
2. Refer the mother to the hospital social worker.
3. Agree to talk with the mother and the father together.
4. Suggest that the father and son work things out.

5. What is Nurse John likely to note in a male client being admitted for alcohol withdrawal?

1. Perceptual disorders.
2. Impending coma.
3. Recent alcohol intake.
4. Depression with mutism.

6. 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?

1. Withhold the drug.
2. Record the client’s response.
3. Encourage the client to tell the doctor.
4. Suggest that it takes awhile before seeing the results.

7. Dervid, an adolescent has a history of truancy from school, running away from home and “barrowing” 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:

1. Id
2. Ego
3. Superego
4. Oedipal complex

8. In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle knows that succinylcoline (Anectine) will be administered for which therapeutic effect?

1. Short-acting anesthesia
2. Decreased oral and respiratory secretions.
3. Skeletal muscle paralysis.
4. Analgesia.

9. Nurse Gina is aware that the dietary implications for a client in manic phase of bipolar disorder is:

1. Serve the client a bowl of soup, buttered French bread, and apple slices.
2. Increase calories, decrease fat, and decrease protein.
3. Give the client pieces of cut-up steak, carrots, and an apple.
4. Increase calories, carbohydrates, and protein.

10.What parental behavior toward a child during an admission procedure should cause Nurse Ron to suspect child abuse?

1. Flat affect
2. Expressing guilt
3. Acting overly solicitous toward the child.
4. Ignoring the child.

11.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?

1. By designating times during which the client can focus on the behavior.
2. By urging the client to reduce the frequency of the behavior as rapidly as possible.
3. By calling attention to or attempting to prevent the behavior.
4. By discouraging the client from verbalizing anxieties.

12.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?

1. Recommending a high-protein, low-fat diet.
2. Giving sleep medication, as prescribed, to restore a normal sleepwake cycle.
3. Allowing the client time to heal.
4. Exploring the meaning of the traumatic event with the client.

13.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?

1. “You’ve developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again.”
2. “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.”
3. “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.”
4. “It isn’t uncommon for someone with your personality to develop a conversion disorder during times of stress.”

14.Nurse Krina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD):

1. benztropine (Cogentin) and diphenhydramine (Benadryl).
2. chlordiazepoxide (Librium) and diazepam (Valium)
3. fluvoxamine (Luvox) and clomipramine (Anafranil)
4. divalproex (Depakote) and lithium (Lithobid)

15.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?

1. A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days.
2. A warning about the incidence of neuroleptic malignant syndrome (NMS).
3. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug.
4. A warning that immediate sedation can occur with a resultant drop in pulse.

16.Richard with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:

1. Insomnia and an inability to concentrate.
2. Severe anxiety and fear.
3. Depression and weight loss.
4. Withdrawal and failure to distinguish reality from fantasy.

17.Which medications have been found to help reduce or eliminate panic attacks?

1. Antidepressants
2. Anticholinergics
3. Antipsychotics
4. Mood stabilizers

18.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?

1. 1 to 2 days
2. 3 to 5 days
3. 6 to 8 days
4. 10 to 14 days

19. 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:

1. Offering nourishing finger foods to help maintain the client’s nutritional status.
2. Providing emotional support and individual counseling.
3. Monitoring the client to prevent minor illnesses from turning into major problems.
4. Suggesting new activities for the client and family to do together.

20.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?

1. Combativeness, sweating, and confusion
2. Agitation, hyperactivity, and grandiose ideation
3. Emotional lability, euphoria, and impaired memory
4. Suspiciousness, dilated pupils, and increased blood pressure

21.The nurse is caring for a client diagnosed with 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 assessment?

1. History of gainful employment
2. Frequent expression of guilt regarding antisocial behavior
3. Demonstrated ability to maintain close, stable relationships
4. d. A low tolerance for frustration

22.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:

1. Barbiturates
2. Amphetamines
3. Methadone
4. Benzodiazepines

23.Nurse Cristina is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:

1. Delusions
2. Hallucinations
3. Loose associations
4. Neologisms

24. Nurse Marco is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?

1. Restricts visits with the family and friends until the client begins to eat.
2. Provide privacy during meals.
3. Set up a strict eating plan for the client.
4. Encourage the client to exercise, which will reduce her anxiety.

25.Tim is admitted with a diagnosis of delusions of grandeur. The nurse is aware that this diagnosis reflects a belief that one is:

1. Highly important or famous.
2. Being persecuted
3. Connected to events unrelated to oneself
4. Responsible for the evil in the world.

26.Nurse Jen is caring for a male client with manic depression. The plan of care for a client in a manic state would include:

1. Offering a high-calorie meals and strongly encouraging the client to finish all food.
2. Insisting that the client remain active through the day so that he’ll sleep at night.
3. Allowing the client to exhibit hyperactive, demanding, manipulative behavior without setting limits.
4. Listening attentively with a neutral attitude and avoiding power struggles.

27.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?

1. Withdrawal
2. Logical thinking
3. Repression
4. Denial

28.Richard is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?

1. Aggressive behavior
2. Paranoid thoughts
3. Emotional affect
4. Independence needs

29. Nurse Mickey is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:

1. Avoid shopping for large amounts of food.
2. Control eating impulses.
3. Identify anxiety-causing situations
4. Eat only three meals per day.

30.Rudolf is admitted for an overdose of amphetamines. When assessing the client, the nurse should expect to see:

1. Tension and irritability
2. Slow pulse
3. Hypotension
4. Constipation

31.Nicolas is experiencing hallucinations 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:

1. “It is the voice of your conscience, which only you can control.”
2. “No, I do not hear your voices, but I believe you can hear them”.
3. “The voices are coming from within you and only you can hear them.”
4. “Oh, the voices are a symptom of your illness; don’t pay any attention to them.”

32.The nurse is aware that the side effect of electroconvulsive therapy that a client may experience:

1. Loss of appetite
2. Postural hypotension
3. Confusion for a time after treatment
4. Complete loss of memory for a time

33.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:

1. Anger stage
2. Denial stage
3. Bargaining stage
4. Acceptance stage

34.The outcome that is unrelated to a crisis state is:

1. Learning more constructive coping skills
2. Decompensation to a lower level of functioning.
3. Adaptation and a return to a prior level of functioning.
4. A higher level of anxiety continuing for more than 3 months.

35.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:

1. Driving at night
2. Staying in the sun
3. Ingesting wines and cheeses
4. Taking medications containing aspirin

36.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:

1. Mild-level anxiety
2. Panic-level anxiety
3. Severe-level anxiety
4. Moderate-level anxiety

37.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:

1. Rigidity
2. Stubbornness
3. Diverse interest
4. Over meticulousness

38.Nurse Krina recognizes that the suicidal risk for depressed client is greatest:

1. As their depression begins to improve
2. When their depression is most severe
3. Before nay type of treatment is started
4. As they lose interest in the environment

39.Nurse Kate would expect that a client with vascular dementis would experience:

1. Loss of remote memory related to anoxia
2. Loss of abstract thinking related to emotional state
3. Inability to concentrate related to decreased stimuli
4. Disturbance in recalling recent events related to cerebral hypoxia.

40.Josefina is to be discharged on a regimen of lithium carbonate. In the teaching plan for discharge the nurse should include:

1. Advising the client to watch the diet carefully
2. Suggesting that the client take the pills with milk
3. Reminding the client that a CBC must be done once a month.
4. Encouraging the client to have blood levels checked as ordered.

41.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:

1. Sensitivity to bright light or sun
2. Fine hand tremors or slurred speech
3. Sexual dysfunction or breast enlargement
4. d. Inability to urinate or difficulty when urinating

42.Nurse Mylene recognizes that the most important factor necessary for the establishment of trust in a critical care area is:

1. Privacy
2. Respect
3. Empathy
4. Presence

43.When establishing an initial nurse-client relationship, Nurse Hazel should explore with the client the:

1. Client’s perception of the presenting problem.
2. Occurrence of fantasies the client may experience.
3. Details of any ritualistic acts carried out by the client
4. Client’s feelings when external; controls are instituted.

44.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:

1. Citrus fruit, tuna, and yellow vegetables.”
2. Chocolate milk, aged cheese, and yogurt’”
3. Green leafy vegetables, chicken, and milk.”
4. Whole grains, red meats, and carbonated soda.”

45.Nurse John is a aware that most crisis situations should resolve in about:

1. 1 to 2 weeks
2. 4 to 6 weeks
3. 4 to 6 months
4. 6 to 12 months

46. Nurse Judy knows that statistics show that in adolescent suicide behavior:

1. Females use more dramatic methods than males
2. Males account for more attempts than do females
3. Females talk more about suicide before attempting it
4. Males are more likely to use lethal methods than are females

47. Dervid with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?

1. “Your behavior won’t be tolerated. Go to your room immediately.”
2. “You’re just doing this to get back at me for making you come to therapy.”
3. “Your cursing is interrupting the activity. Take time out in your room for 10 minutes.”
4. “I’m disappointed in you. You can’t control yourself even for a few minutes.”

48.Nurse Maureen knows that the nonantipsychotic medication used to treat some clients with schizoaffective disorder is:

1. phenelzine (Nardil)
2. chlordiazepoxide (Librium)
3. lithium carbonate (Lithane)
4. imipramine (Tofranil)

49.Which information is most important for the nurse Trinity to include in a teaching plan for a male schizophrenic client taking clozapine (Clozaril)?

1. Monthly blood tests will be necessary.
2. Report a sore throat or fever to the physician immediately.
3. Blood pressure must be monitored for hypertension.
4. Stop the medication when symptoms subside.

50.Ricky with chronic schizophrenia takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which lifethreatening reaction:

1. Tardive dyskinesia.
2. Dystonia.
3. Neuroleptic malignant syndrome.
4. Akathisia.

51.Which nursing intervention would be most appropriate if a male client develop orthostatic hypotension while taking amitriptyline (Elavil)?

1. Consulting with the physician about substituting a different type of antidepressant.
2. Advising the client to sit up for 1 minute before getting out of bed.
3. Instructing the client to double the dosage until the problem resolves.
4. Informing the client that this adverse reaction should disappear within 1 week.

52.Mr. Cruz visits the physician’s office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low selfesteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse Tyfany suspects:

1. Cyclothymic disorder.
2. Atypical affective disorder.
3. Major depression.
4. Dysthymic disorder.

53. 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?

1. 5 g mixed in 250 ml of water
2. 15 g mixed in 500 ml of water
3. 30 g mixed in 250 ml of water
4. 60 g mixed in 500 ml of water

54.What herbal medication for depression, widely used in Europe, is now being prescribed in the United States?

1. Ginkgo biloba
2. Echinacea
3. St. John’s wort
4. Ephedra

55.Cely with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication?

1. Calcium
2. Sodium
3. Chloride
4. Potassium

56.Nurse Josefina is caring for a client who has been diagnosed with delirium. Which statement about delirium is true?

1. It’s characterized by an acute onset and lasts about 1 month.
2. It’s characterized by a slowly evolving onset and lasts about 1 week.
3. It’s characterized by a slowly evolving onset and lasts about 1 month.
4. It’s characterized by an acute onset and lasts hours to a number of days.

57.Edward, a 66 year old client with slight memory impairment and poor concentration is diagnosed with primary degenerative dementia of the Alzheimer’s type. Early signs of this dementia include subtle personality changes and withdrawal from social interactions. To assess for progression to the middle stage of Alzheimer’s disease, the nurse should observe the client for:

1. Occasional irritable outbursts.
2. Impaired communication.
3. Lack of spontaneity.
4. Inability to perform self-care activities.

58.Isabel with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that:

1. This medication may be habit forming and will be discontinued as soon as the client feels better.
2. This medication has no serious adverse effects.
3. The client should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication.
4. This medication may initially cause tiredness, which should become less bothersome over time.

59.Kathleen is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client’s physical health, the nurse should plan to:

1. Severely restrict the client’s physical activities.
2. Weigh the client daily, after the evening meal.
3. Monitor vital signs, serum electrolyte levels, and acid-base balance.
4. Instruct the client to keep an accurate record of food and fluid intake.

60.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?

1. Alcohol withdrawal
2. Cannibis withdrawal
3. Cocaine withdrawal
4. Opioid withdrawal

61.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?

1. Regression
2. Projection
3. Reaction-formation
4. Intellectualization

62.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:

1. Abnormal movements and involuntary movements of the mouth, tongue, and face.
2. Abnormal breathing through the nostrils accompanied by a “thrill.”
3. Severe headache, flushing, tremors, and ataxia.
4. Severe hypertension, migraine headache,

63.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?

1. Weakness
2. Diarrhea
3. Blurred vision
4. Fecal incontinence

64.Nurse Jannah is monitoring a male client who has been placed inrestraints because of violent behavior. Nurse determines that it will be safe to remove the restraints when:

1. The client verbalizes the reasons for the violent behavior.
2. The client apologizes and tells the nurse that it will never happen again.
3. No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints.
4. The administered medication has taken effect.

65.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:

1. Increased attention span and concentration
2. Increase in appetite
3. Sleepiness and lethargy
4. Bradycardia and diarrhea

66.Kitty, a 9 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification:

1. Profound
2. Mild
3. Moderate
4. Severe

67.The therapeutic approach in the care of Armand an autistic child include the following EXCEPT:

1. Engage in diversionary activities when acting -out
2. Provide an atmosphere of acceptance
3. Provide safety measures
4. Rearrange the environment to activate the child

68.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.

1. Heroin
2. Cocaine
3. LSD
4. Marijuana

69.Nurse Pauline is aware that Dementia unlike delirium is characterized by:

1. Slurred speech
2. Insidious onset
3. Clouding of consciousness
4. Sensory perceptual change

70.A 35 year old female has intense fear of riding an elevator. She claims “ As if I will die inside.” The client is suffering from:

1. Agoraphobia
2. Social phobia
3. Claustrophobia
4. Xenophobia

71.Nurse Myrna develops a counter-transference reaction. This is evidenced by:

1. Revealing personal information to the client
2. Focusing on the feelings of the client.
3. Confronting the client about discrepancies in verbal or non-verbal behavior
4. The client feels angry towards the nurse who resembles his mother.

72.Tristan is on Lithium has suffered from diarrhea and vomiting. What should the nurse in-charge do first:

1. Recognize this as a drug interaction
2. Give the client Cogentin
3. Reassure the client that these are common side effects of lithium therapy
4. Hold the next dose and obtain an order for a stat serum lithium level

73.Nurse Sarah ensures a therapeutic environment for all the client. Which of the following best describes a therapeutic milieu?

1. A therapy that rewards adaptive behavior
2. A cognitive approach to change behavior
3. A living, learning or working environment.
4. A permissive and congenial environment

74.Anthony is very hostile toward one of the staff for no apparent reason. He is manifesting:

1. Splitting
2. Transference
3. Countertransference
4. Resistance

75.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:

1. Situational
2. Adventitious
3. Developmental
4. Internal

76. Nurse Greta is aware that the following is classified as an Axis I disorder by the Diagnosis and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) is:

1. Obesity
2. Borderline personality disorder
3. Major depression
4. Hypertension

77.Katrina, a newly admitted is extremely hostile toward a staff member she has just met, without apparent reason. According to Freudian theory, the nurse should suspect that the client is experiencing which of the following phenomena?

1. Intellectualization
2. Transference
3. Triangulation
4. Splitting

78.An 83year-old male client is in extended care facility is anxious most of the time and frequently complains of a number of vague symptoms that interfere with his ability to eat. These symptoms indicate which of the following disorders?

1. Conversion disorder
2. Hypochondriasis
3. Severe anxiety
4. Sublimation

79. Charina, a college student who frequently visited the health center during the past year with multiple vague complaints of GI symptoms before course examinations. Although physical causes have been eliminated, the student continues to express her belief that she has a serious illness. These symptoms are typically of which of the following disorders?

1. Conversion disorder
2. Depersonalization
3. Hypochondriasis
4. Somatization disorder

80. Nurse Daisy is aware that the following pharmacologic agents are sedative hypnotic medication is used to induce sleep for a client experiencing a sleep disorder is:

1. Triazolam (Halcion)
2. Paroxetine (Paxil)\
3. Fluoxetine (Prozac)
4. Risperidone (Risperdal)

81. Aldo, with a somatoform pain disorder may obtain secondary gain. Which of the following statement refers to a secondary gain?

1. It brings some stability to the family
2. It decreases the preoccupation with the physical illness
3. It enables the client to avoid some unpleasant activity
4. It promotes emotional support or attention for the client

82. Dervid is diagnosed with panic disorder with agoraphobia is talking with the nurse in-charge about the progress made in treatment. Which of the following statements indicates a positive client response?

1. “I went to the mall with my friends last Saturday”
2. “I’m hyperventilating only when I have a panic attack”
3. “Today I decided that I can stop taking my medication”
4. “Last night I decided to eat more than a bowl of cereal”

83. The effectiveness of monoamine oxidase (MAO) inhibitor drug therapy in client with posttraumatic stress disorder can be demonstrated by which of the following client self –reports?

1. “I’m sleeping better and don’t have nightmares”
2. “I’m not losing my temper as much”
3. “I’ve lost my craving for alcohol”
4. “I’ve lost my phobia for water”

84. Mark, with a diagnosis of generalized anxiety disorder wants to stop taking his lorazepam (Ativan). Which of the following important facts should nurse Betty discuss with the client about discontinuing the medication?

1. Stopping the drug may cause depression
2. Stopping the drug increases cognitive abilities
3. Stopping the drug decreases sleeping difficulties
4. Stopping the drug can cause withdrawal symptoms

85. Jennifer, an adolescent who is depressed and reported by his parents as having difficulty in school is brought to the community mental health center to be evaluated. Which of the following other health problems would the nurse suspect?

1. Anxiety disorder
2. Behavioral difficulties
3. Cognitive impairment
4. Labile moods

86. Ricardo, an outpatient in psychiatric facility is diagnosed with dysthymic disorder. Which of the following statement about dysthymic disorder is true?

1. It involves a mood range from moderate depression to hypomania
2. It involves a single manic depression
3. It’s a form of depression that occurs in the fall and winter
4. It’s a mood disorder similar to major depression but of mild to moderate severity

87. The nurse is aware that the following ways in vascular dementia different from Alzheimer’s disease is:

1. Vascular dementia has more abrupt onset
2. The duration of vascular dementia is usually brief
3. Personality change is common in vascular dementia
4. The inability to perform motor activities occurs in vascular dementia

88. Loretta, a newly admitted client was diagnosed with delirium and has history of hypertension and anxiety. She had been taking digoxin, furosemide (Lasix), and diazepam (Valium) for anxiety. This client’s impairment may be related to which of the following conditions?

1. Infection
2. Metabolic acidosis
3. Drug intoxication
4. Hepatic encephalopathy

89. Nurse Ron enters a client’s room, the client says, “They’re crawling on my sheets! Get them off my bed!” Which of the following assessment is the most accurate?

1. The client is experiencing aphasia
2. The client is experiencing dysarthria
3. The client is experiencing a flight of ideas
4. The client is experiencing visual hallucination

90. Which of the following descriptions of a client’s experience and behavior can be assessed as an illusion?

1. The client tries to hit the nurse when vital signs must be taken
2. The client says, “I keep hearing a voice telling me to run away”
3. The client becomes anxious whenever the nurse leaves the bedside
4. The client looks at the shadow on a wall and tells the nurse she sees frightening faces on the wall.

91. During conversation of Nurse John with a client, he observes that the client shift from one topic to the next on a regular basis. Which of the following terms describes this disorder?

1. Flight of ideas
2. Concrete thinking
3. Ideas of reference
4. Loose association

92. Francis tells the nurse that her coworkers are sabotaging the computer. When the nurse asks questions, the client becomes argumentative. This behavior shows personality traits associated with which of the following personality disorder?

1. Antisocial
2. Histrionic
3. Paranoid
4. Schizotypal

93. Which of the following interventions is important for a Cely experiencing with paranoid personality disorder taking olanzapine (Zyprexa)?

1. Explain effects of serotonin syndrome
2. Teach the client to watch for extrapyramidal adverse reaction
3. Explain that the drug is less affective if the client smokes
4. Discuss the need to report paradoxical effects such as euphoria

94. Nurse Alexandra notices other clients on the unit avoiding a client diagnosed with antisocial personality disorder. When discussing appropriate behavior in group therapy, which of the following comments is expected about this client by his peers?

1. Lack of honesty
2. Belief in superstition
3. Show of temper tantrums
4. Constant need for attention

95. Tommy, with dependent personality disorder is working to increase his selfesteem. Which of the following statements by the Tommy shows teaching was successful?

1. “I’m not going to look just at the negative things about myself”
2. “I’m most concerned about my level of competence and progress”
3. “I’m not as envious of the things other people have as I used to be”
4. “I find I can’t stop myself from taking over things other should be doing”

96. Norma, a 42-year-old client with a diagnosis of chronic undifferentiated schizophrenia lives in a rooming house that has a weekly nursing clinic. She scratches while she tells the nurse she feels creatures eating away at her skin. Which of the following interventions should be done first?

1. Talk about his hallucinations and fears
2. Refer him for anticholinergic adverse reactions
3. Assess for possible physical problems such as rash
4. Call his physician to get his medication increased to control his psychosis

97. Ivy, who is on the psychiatric unit is copying and imitating the movements of her primary nurse. During recovery, she says, “I thought the nurse was my mirror. I felt connected only when I saw my nurse.” This behavior is known by which of the following terms?

1. Modeling
2. Echopraxia
3. Ego-syntonicity
4. Ritualism

98. Jun approaches the nurse and tells that he hears a voice telling him that he’s evil and deserves to die. Which of the following terms describes the client’s perception?

1. Delusion
2. Disorganized speech
3. Hallucination
4. Idea of reference

99. Mike is admitted to a psychiatric unit with a diagnosis of undifferentiated schizophrenia. Which of the following defense mechanisms is probably used by mike?

1. Projection
2. Rationalization
3. Regression
4. Repression

100. Rocky has started taking haloperidol (Haldol). Which of the following instructions is most appropriate for Ricky before taking haloperidol?

1. Should report feelings of restlessness or agitation at once
2. Use a sunscreen outdoors on a year-round basis
3. Be aware you’ll feel increased energy taking this drug
4. This drug will indirectly control essential hypertension

Answers and Rationales