Psychiatric Nursing Practice Exam 2

1. Nurse Tony should first discuss terminating the nurse-client relationship with a client during the:

1. Termination phase when discharge plans are being made.
2. Working phase when the client shows some progress.
3. Orientation phase when a contract is established.
4. Working phase when the client brings it up.

2. Malou is diagnosed with major depression spends majority of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse would be the most therapeutic?

1. Question the client until he responds
2. Initiate contact with the client frequently
3. Sit outside the clients room
4. Wait for the client to begin the conversation

3. Joe who is very depressed exhibits psychomotor retardation, a flat affect and apathy. The nurse in charge observes Joe to be in need of grooming and hygiene. Which of the following nursing actions would be most appropriate?

1. Waiting until the client’s family can participate in the client’s care
2. Asking the client if he is ready to take shower
3. Explaining the importance of hygiene to the client
4. Stating to the client that it’s time for him to take a shower

4. When teaching Mario with a typical depression about foods to avoid while taking phenelzine(Nardil), which of the following would the nurse in charge include?

1. Roasted chicken
2. Fresh fish
3. Salami
4. Hamburger

5. When assessing a female client who is receiving tricyclic antidepressant therapy, which of the following would alert the nurse to the possibility that the client is experiencing anticholinergic effects?

1. Urine retention and blurred vision
2. Respiratory depression and convulsion
3. Delirium and Sedation
4. Tremors and cardiac arrhythmias

6. For a male client with dysthymic disorder, which of the following approaches would the nurse expect to implement?

1. ECT
2. Psychotherapeutic approach
3. Psychoanalysis
4. Antidepressant therapy

7. Danny who is diagnosed with bipolar disorder and acute mania, states the nurse, “Where is my daughter? I love Louis. Rain, rain go away. Dogs eat dirt.” The nurse interprets these statements as indicating which of the following?

1. Echolalia
2. Neologism
3. Clang associations
4. Flight of ideas

8. Terry with mania is skipping up and down the hallway practically running into other clients. Which of the following activities would the nurse in charge expect to include in Terry’s plan of care?

1. Watching TV
2. Cleaning dayroom tables
3. Leading group activity
4. Reading a book

9. When assessing a male client for suicidal risk, which of the following methods of suicide would the nurse identify as most lethal?

1. Wrist cutting
2. Head banging
3. Use of gun
4. Aspirin overdose

10. Jun has been hospitalized for major depression and suicidal ideation. Which of the following statements indicates to the nurse that the client is improving?

1. “I’m of no use to anyone anymore.”
2. “I know my kids don’t need me anymore since they’re grown.”
3. “I couldn’t kill myself because I don’t want to go to hell.”
4. “I don’t think about killing myself as much as I used to.”

11. Which of the following activities would Nurse Trish recommend to the client who becomes very anxious when thoughts of suicide occur?

1. Using exercise bicycle
2. Meditating
3. Watching TV
4. Reading comics

12. When developing the plan of care for a client receiving haloperidol, which of the following medications would nurse Monet anticipate administering if the client developed extra pyramidal side effects?

1. Olanzapine (Zyprexa)
2. Paroxetine (Paxil)
3. Benztropine mesylate (Cogentin)
4. Lorazepam (Ativan)

13. Jon a suspicious client states that “I know you nurses are spraying my food with poison as you take it out of the cart.” Which of the following would be the best response of the nurse?

1. Giving the client canned supplements until the delusion subsides
2. Asking what kind of poison the client suspects is being used
3. Serving foods that come in sealed packages
4. Allowing the client to be the first to open the cart and get a tray

14. A client is suffering from catatonic behaviors. Which of the following would the nurse use to determine that the medication administered PRN have been most effective?

1. The client responds to verbal directions to eat
2. The client initiates simple activities without direction
3. The client walks with the nurse to her room
4. The client is able to move all extremities occasionally

15. Nurse Hazel invites new client’s parents to attend the psycho educational program for families of the chronically mentally ill. The program would be most likely to help the family with which of the following issues?

1. Developing a support network with other families
2. Feeling more guilty about the client’s illness
3. Recognizing the client’s weakness
4. Managing their financial concern and problems

16. When planning care for Dory with schizotypal personality disorder, which of the following would help the client become involved with others?

1. Attending an activity with the nurse
2. Leading a sing a long in the afternoon
3. Participating solely in group activities
4. Being involved with primarily one to one activities

17. Which statement about an individual with a personality disorder is true?

1. Psychotic behavior is common during acute episodes
2. Prognosis for recovery is good with therapeutic intervention
3. The individual typically remains in the mainstream of society, although he has problems in social and occupational roles
4. The individual usually seeks treatment willingly for symptoms that are personally distressful.

18. Nurse John is talking with a client who has been diagnosed with antisocial personality about how to socialize during activities without being seductive. Nurse John would focus the discussion on which of the following areas?

1. Discussing his relationship with his mother
2. Asking him to explain reasons for his seductive behavior
3. Suggesting to apologize to others for his behavior
4. Explaining the negative reactions of others toward his behavior

19. Tina with a histrionic personality disorder is melodramatic and responds to others and situations in an exaggerated manner. Nurse Trish would recommend which of the following activities for Tina?

1. Baking class
2. Role playing
3. Scrap book making
4. Music group

20. Joy has entered the chemical dependency unit for treatment of alcohol dependency. Which of the following client’s possession will the nurse most likely place in a locked area?

1. Toothpaste
2. Shampoo
3. Antiseptic wash
4. Moisturizer

21. Which of the following assessment would provide the best information about the client’s physiologic response and the effectiveness of the medication prescribed specifically for alcohol withdrawal?

1. Sleeping pattern
2. Mental alertness
3. Nutritional status
4. Vital signs

22. After administering naloxone (Narcan), an opioid antagonist, Nurse Ronald should monitor the female client carefully for which of the following?

1. Respiratory depression
2. Epilepsy
3. Kidney failure
4. Cerebral edema

23. Which of the following would nurse Ronald use as the best measure to determine a client’s progress in rehabilitation?

1. The way he gets along with his parents
2. The number of drug-free days he has
3. The kinds of friends he makes
4. The amount of responsibility his job entails

24. A female client is brought by ambulance to the hospital emergency room after taking an overdose of barbiturates is comatose. Nurse Trish would be especially alert for which of the following?

1. Epilepsy
2. Myocardial Infarction
3. Renal failure
4. Respiratory failure

25. Joey who has a chronic user of cocaine reports that he feels like he has cockroaches crawling under his skin. His arms are red because of scratching. The nurse in charge interprets these findings as possibly indicating which of the following?

1. Delusion
2. Formication
3. Flash back
4. Confusion

26. Jose is diagnosed with amphetamine psychosis and was admitted in the emergency room. Nurse Ronald would most likely prepare to administer which of the following medication?

1. Librium
2. Valium
3. Ativan
4. Haldol

27. Which of the following liquids would nurse Leng administer to a female client who is intoxicated with phencyclidine (PCP) to hasten excretion of the chemical?

1. Shake
2. Tea
3. Cranberry Juice
4. Grape juice

28. 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?

1. Facilitating progressive review of the accident and its consequences
2. Postponing discussion of the accident until the client brings it up
3. Telling the client to avoid details of the accident
4. Helping the client to evaluate her sister’s behavior

29. The nursing assistant tells nurse Ronald that the client is not in the dining room for lunch. Nurse Ronald would direct the nursing assistant to do which of the following?

1. Tell the client he’ll need to wait until supper to eat if he misses lunch
2. Invite the client to lunch and accompany him to the dining room
3. Inform the client that he has 10 minutes to get to the dining room for lunch
4. Take the client a lunch tray and let the client eat in his room

30. The initial nursing intervention for the significant-others during shock phase of a grief reaction should be focused on:

1. Presenting full reality of the loss of the individuals
2. Directing the individual’s activities at this time
3. Staying with the individuals involved
4. Mobilizing the individual’s support system

31. 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:

1. Shock and disbelief
2. Developing awareness
3. Resolving the loss
4. Restitution

32. When taking a health history from a female client who has a moderate level of cognitive impairment due to dementia, the nurse would expect to note the presence of:

1. Accentuated premorbid traits
2. Enhance intelligence
3. Increased inhibitions
4. Hyper vigilance

33. What is the priority care for a client with a dementia resulting from AIDS?

1. Planning for remotivational therapy
2. Arranging for long term custodial care
3. Providing basic intellectual stimulation
4. Assessing pain frequently

34. Jerome who has eating disorder often exhibits similar symptoms. Nurse Lhey would expect an adolescent client with anorexia to exhibit:

1. Affective instability
2. Dishered, unkempt physical appearance
3. Depersonalization and derealization
4. Repetitive motor mechanisms

35. The primary nursing diagnosis for a female client with a medical diagnosis of major depression would be:

1. Situational low self-esteem related to altered role
2. Powerlessness related to the loss of idealized self
3. Spiritual distress related to depression
4. Impaired verbal communication related to depression

36. When developing an initial nursing care plan for a male client with a Bipolar I disorder (manic episode) nurse Ron should plan to?

1. Isolate his gym time
2. Encourage his active participation in unit programs
3. Provide foods, fluids and rest
4. Encourage his participation in programs

37. Grace is exhibiting withdrawn patterns of behavior. Nurse Johnny is aware that this type of behavior eventually produces feeling of:

1. Repression
2. Loneliness
3. Anger
4. Paranoia

38. 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 on the unit who needs attention too.” This statement shows that the nurse’s use of:

1. Defensive behavior
2. Reality reinforcement
3. Limit-setting behavior
4. Impulse control

39. 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:

1. Verbalizing the need for anxiety medications
2. Recognizing each existing personality
3. Engaging in object-oriented activities
4. Eliminating defense mechanisms and phobia

40. 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:

1. Phobia
2. Powerlessness
3. Punishment
4. Rejection

41. 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:

1. Early childhood
2. Late childhood
3. Adolescence
4. Puberty

42. 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:

1. Somatic delusions
2. Depersonalization
3. Hypochondriasis
4. Echolalia

43. In recognizing common behaviors exhibited by male client who has a diagnosis of schizophrenia, nurse Josie can anticipate:

1. Slumped posture, pessimistic out look and flight of ideas
2. Grandiosity, arrogance and distractibility
3. Withdrawal, regressed behavior and lack of social skills
4. Disorientation, forgetfulness and anxiety

44. 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:

1. Physically ill and experiencing abdominal discomfort
2. Tired and probably did not sleep well last night
3. Attempting to hide from the nurse
4. Feeling more anxious today

45. 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:

1. Invite the client to help decorate the dayroom
2. Leave the client alone until he stops talking
3. Ask the client why he is smiling and talking
4. Tell the client it is not good for him to talk to himself

46. 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:

1. While watching TV
2. During meal time
3. During group activities
4. After going to bed

47. Nurse John recognizes that paranoid delusions usually are related to the defense mechanism of:

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

48. When planning care for a male client using paranoid ideation, nurse Jasmin should realize the importance of:

1. Giving the client difficult tasks to provide stimulation
2. Providing the client with activities in which success can be achieved
3. Removing stress so that the client can relax
4. Not placing any demands on the client

49. Nurse Gerry is aware that the defense mechanism commonly used by clients who are alcoholics is:

1. Displacement
2. Denial
3. Projection
4. Compensation

50. Within a few hours of alcohol withdrawal, nurse John should assess the male client for the presence of:

1. Disorientation, paranoia, tachycardia
2. Tremors, fever, profuse diaphoresis
3. Irritability, heightened alertness, jerky movements
4. Yawning, anxiety, convulsions

Answers and Rationales

1. C. When the nurse and client agree to work together, a contract should be established, the length of the relationship should be discussed in terms of its ultimate termination.
2. B. The nurse should initiate brief, frequent contacts throughout the day to let the client know that he is important to the nurse. This will positively affect the client’s self-esteem.
3. D. The client with depression is preoccupied, has decreased energy, and is unable to make decisions. The nurse presents the situation, “It’s time for a shower”, and assists the client with personal hygiene to preserve his dignity and self-esteem.
4. C. Foods high in tyramine, those that are fermented, pickled, aged, or smoked must be avoided because when they are ingested in combination with MAOIs a hypertensive crisis will occur.
5. A. Anticholinergic effects, which result from blockage of the parasympathetic (craniosacral) nervous system including urine retention, blurred vision, dry mouth & constipation.
6. B. Dysthymia is a less severe, chronic depression diagnosed when a client has had a depressed mood for more days than not over a period of at least 2 years. Client with dysthymic disorder benefit from psychotherapeutic approaches that assist the client in reversing the negative self image, negative feelings about the future.
7. D. Flight of ideas is speech pattern of rapid transition from topic to topic, often without finishing one idea. It is common in mania.
8. B. The client with mania is very active & needs to have this energy channeled in a constructive task such as cleaning or tidying the room.
9. C. A crucial factor is determining the lethality of a method is the amount of time that occurs between initiating the method & the delivery of the lethal impact of the method.
10. D. The statement “I don’t think about killing myself as much as I used to.” Indicates a lessening of suicidal ideation and improvement in the client’s condition.
11. A. Using exercise bicycle is appropriate for the client who becomes very anxious when thoughts of suicidal occur.
12. C. The drug of choice for a client experiencing extra pyramidal side effects from haloperidol (Haldol) is benztropine mesylate (cogentin) because of its anti cholinergic properties.
13. D. Allowing the client to be the first to open the cart & take a tray presents the client with the reality that the nurses are not touching the food & tray, thereby dispelling the delusion.
14. B. Although all the actions indicate improvement, the ability to initiate simple activities without directions indicates the most improvement in the catatonic behaviors.
15. A. Psychoeducational groups for families develop a support network. They provide education about the biochemical etiology of psychiatric disease to reduce, not increase family guilt.
16. C. Attending activity with the nurse assists the client to become involved with others slowly. The client with schizotypal personality disorder needs support, kindness & gentle suggestion to improve social skills & interpersonal relationship.
17. C. An individual with personality disorder usually is not hospitalized unless a coexisting Axis I psychiatric disorder is present. Generally, these individuals make marginal adjustments and remain in society, although they typically experience relationship and occupational problems related to their inflexible behaviors. Personality disorders are chronic lifelong patterns of behavior; acute episodes do not occur. Psychotic behavior is usually not common, although it can occur in either schizotypal personality disorder or borderline personality disorder. Because these disorders are enduring and evasive and the individual is inflexible, prognosis for recovery is unfavorable. Generally, the individual does not seek treatment because he does not perceive problems with his own behavior. Distress can occur based on other people’s reaction to the individual’s behavior.
18. D. The nurse would explain the negative reactions of others towards the client’s behaviors to make the clients aware of the impact of his seductive behaviors on others.
19. B. The nurse would use role-playing to teach the client appropriate responses to others and in various situations. This client dramatizes events, drawn attention to self, and is unaware of and does not deal with feelings. The nurse works to help the client clarify true feelings & learn to express them appropriately.
20. C. Antiseptic mouthwash often contains alcohol & should be kept in locked area, unless labeling clearly indicates that the product does not contain alcohol.
21. D. Monitoring of vital signs provides the best information about the client’s overall physiologic status during alcohol withdrawal & the physiologic response to the medication used.
22. A. After administering naloxone (Narcan) the nurse should monitor the client’s respiratory status carefully, because the drug is short acting & respiratory depression may recur after its effects wear off.
23. B. The best measure to determine a client’s progress in rehabilitation is the number of drug- free days he has. The longer the client is free of drugs, the better the prognosis is.
24. D. Barbiturates are CNS depressants; the nurse would be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate over dose.
25. B. The feeling of bugs crawling under the skin is termed as formication, and is associated with cocaine use.
26. D. The nurse would prepare to administer an antipsychotic medication such as Haldol to a client experiencing amphetamine psychosis to decrease agitation & psychotic symptoms, including delusions, hallucinations & cognitive impairment.
27. C. An acid environment aids in the excretion of PCP. The nurse will definitely give the client with PCP intoxication cranberry juice to acidify the urine to a ph of 5.5 & accelerate excretion.
28. A. The nurse would facilitate progressive review of the accident and its consequence to help the client integrate feelings & memories and to begin the grieving process.
29. B. The nurse instructs the nursing assistant to invite the client to lunch & accompany him to the dinning room to decrease manipulation, secondary gain, dependency and reinforcement of negative behavior while maintaining the client’s worth.
30. C. This provides support until the individuals coping mechanisms and personal support systems can be immobilized.
31. C. Resolving a loss is a slow, painful, continuous process until a mental image of the dead person, almost devoid of negative or undesirable features emerges.
32. A. A moderate level of cognitive impairment due to dementia is characterized by increasing dependence on environment & social structure and by increasing psychologic rigidity with accentuated previous traits & behaviors.
33. C. This action maintains for as long as possible, the clients intellectual functions by providing an opportunity to use them.
34. A. Individuals with anorexia often display irritability, hospitality, and a depressed mood.
35. D. Depressed clients demonstrate decreased communication because of lack of psychic or physical energy.
36. C. The client in a manic episode of the illness often neglects basic needs, these needs are a priority to ensure adequate nutrition, fluid, and rest.
37. B. The withdrawn pattern of behavior presents the individual from reaching out to others for sharing the isolation produces feeling of loneliness.
38. A. The nurse’s response is not therapeutic because it does not recognize the client’s needs but tries to make the client feel guilty for being demanding.
39. B. The client must recognize the existence of the sub personalities so that interpretation can occur.
40. D. An aloof, detached, withdrawn posture is a means of protecting the self by withdrawing and maintaining a safe, emotional distance.
41. C. The usual age of onset of schizophrenia is adolescence or early childhood.
42. A. Somatic delusion is a fixed false belief about one’s body.
43. C. These are the classic behaviors exhibited by clients with a diagnosis of schizophrenia.
44. D. The fetal position represents regressed behavior. Regression is a way of responding to overwhelming anxiety.
45. B. This provides a stimulus that competes with and reduces hallucination.
46. D. Auditory hallucinations are most troublesome when environmental stimuli are diminished and there are few competing distractions.
47. A. Projection is a mechanism in which inner thoughts and feelings are projected onto the environment, seeming to come from outside the self rather than from within.
48. B. This will help the client develop self-esteem and reduce the use of paranoid ideation.
49. B. Denial is a method of resolving conflict or escaping unpleasant realities by ignoring their existence.
50. C. Alcohol is a central nervous system depressant. These symptoms are the body’s neurologic adaptation to the withdrawal of alcohol.