Mental Health Disorders: Personality Disorders and Therapeutic Interventions, Exams of Nursing

Download Mental Health Disorders: Personality Disorders and Therapeutic Interventions and more Exams Nursing in PDF only on Docsity! eee PSYCHIATRIC MENTAL NURSING TESTS 1&2 UPDATED 2024/2025 JM  Psychiatric Mental Nursing Tests 1&2 Updated 2024/2025 All the questions in the quiz along with their answers are shown below. Your answers are bolded. The correct answers have a green background while the incorrect ones have a red background. 1. Your patient is very dependent and submissive. There are times that the patient is very clingy. This behavior reflects what type of personality disorder? ▪ a. Antisocial personality ▪ b. Dependent Personality ▪ c. Manic behavior ▪ d. Anxiety disorder Dependent personality is characterized by dependence, submission and being clingy. Antisocial personality is impulsive, aggressive and manipulative. 2. The appropriate therapeutic distance between you and a psychiatric patient is? ▪ a. 12 inches ▪ b. 35 inches ▪ c. 12 feet ▪ d. 4 feet Intimate zone: 0-18 inches. Parents with young children, people who mutually desire personal contact, or people whispering. Personal zone: 18-36 inches. Between family and friends talking. Social zone: 4-12 feet. Communication in social, work and business settings. Public zone: 12-25 inches. Speaker and an audience. Therapeutic distance: 3-6 feet. 3. Nurse Anna is instructing the new nurse to the psychiatric set-up. She also reminded her to use her therapeutic communication skills in dealing with clients. Which of the following techniques enlaces therapeutic communication? ▪ a. What are you thinking about? ▪ b. What made you think that way? ▪ c. Why did you say that? ▪ d. Let’s not talk about that. What do you think? This is using the therapeutic technique BROAD OPENING that allows the client to take the initiative to introduce a topic. 4. Mr. Juan is diagnosed with Alzheimer’s disease. The nurse’s intervention should focus on helping the client be oriented with the physical set-up and daily events. Which of the following is the most effective nursing intervention in orienting patients who has Alzheimer’s disease? ▪ a. Encourage the client to talk to family members to reminisce things ▪ b. Provide simple and easily understood directions ▪ a. Defending ▪ b. Testing ▪ c. Making stereotyped comments ▪ d. Disagreeing Testing is appraising a client’s degree of insight such as by asking the patient of the risks involved when he cut himself. This forces the client to recognize his problems. Defending is attempting to protect someone from a verbal attack. Stereotyped comments are meaningless clichés such as ―it’s for your own good.‖ 10. A therapy that assists with discharge planning and rehabilitation, focusing on vocational skills and activities of daily living (ADL) to raise self-esteem and promote independence is called: ▪ a. Behavior modification ▪ b. Milieu therapy ▪ c. Recreational therapy ▪ d. Occupational therapy Occupational therapy - Assists with discharge planning and rehabilitation, focusing on vocational skills and activities of daily living (ADL) to raise self-esteem and promote independence 11. Nurse Marie is caring for a patient that underwent alcohol detoxification. Which of the following symptoms would Nurse Marie be most concern? ▪ a. Fever ▪ b. Delusions ▪ c. Excessive sweating ▪ d. Increase BP Once hallucinations and delusions are present; the client’s condition will most likely progress to delirium tremens. 12. The Distance that is observed when family members or friends are talking is under what zone: ▪ a. Intimate ▪ b. Therapeutic ▪ c. Personal ▪ d. Social Personal zone: 18-36 inches. Between family and friends talking. Intimate zone: 0-18 inches. Parents with young children, people who mutually desire personal contact, or people whispering. Social zone: 4-12 feet. Communication in social, work and business settings. Therapeutic distance: 3-6 feet. 13. The client is sharing Nurse Marie about his experiences. Suddenly, he paused, looked to the nurse and is hesitant to continue. The nurse responded, ―Go on, and tell me about it.‖ What therapeutic communication technique is the nurse using? ▪ a. Exploring ▪ b. Focusing ▪ c. Encouraging expression ▪ d. General leads General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable of the topic. Examples include, ―Go on,‖ ―Tell me about it,‖ and ―And then?‖ 14. In a therapeutic communication, ―why questions‖ are discouraged. For what reason is this question not useful? ▪ a. The question is intimidating and the client may be defensive in trying to explain him/herself. ▪ b. It forces the client to recognize his or her problems. The client’s acknowledgement that s/he doesn’t know things may be helpful to the nurse’s needs but not the client. ▪ c. It indicates that the client is right rather than wrong. ▪ d. It tends to make the client used and invaded. Using ―why question‖ is asking to client the client to provide reasons for thoughts, feeling and behaviors. The question is intimidating and the client may be defensive in trying to explain him/herself. ▪ d. Not drinking medications One the patient attempts to harm himself, restraints is acceptable. 20. If a client is on restraints which of the following would the nurse do? ▪ a. Leave the client in the room for the whole 8 hours ▪ b. Do not allow the client to eat ▪ c. Take pictures of the client for evaluation ▪ d. monitor the extremity circulation When a client is placed on restraint, monitor the circulation to prevent physiologic damage of the extremity. 21. A client is scheduled for an electroconvulsive therapy (ECT). Which of the following medications can be given to the client before the procedure? ▪ a. Atropine ▪ b. Epinephrine ▪ c. Hydralazine ▪ d. Phenobarbital Before ECT atropine can be given to the client to decrease oral and respiratory function thereby preventing risks of aspiration. Atropine is antiarrythmic and at the same time an anticholinergic medication. 22. To ensure that your client knows about the procedure, risks and outcome and has been informed of the other alternative therapy. Which of the following must be accomplished? ▪ a. A signed informed consent by a client’s family member ▪ b. A signed informed consent by a 23-year old client who has voluntarily admitted himself in the unit. ▪ c. A signed informed consent of a 23-year old client’s parent ▪ d. A signed informed consent by a 17-year old client Clients of legal age can sign an informed consent. 23. The client says that he is hearing voices. What is nurse’s initial response? ▪ a. ―I don’t hear any voices.‖ ▪ b. ―From where are those voices coming from?‖ ▪ c. “What are the voices telling you?” ▪ d. ―Are you sure about that?‖ Initially the nurse has to assess what the voices are telling the client to promote safety. Because if the voices are telling the client to kill himself or someone safety precautions must be implemented. 24. What is the most important criteria that must be accomplished by the nurse before dealing with psychiatric patients? ▪ a. Salary rate ▪ b. Self-awareness ▪ c. Self-understanding ▪ d. Standard of nursing practice Before a nurse can understand him/herself, being aware of what his/her strengths, weaknesses, limitations, belief and principles is very essential. A nurse who barely knows and understand herself cannot effectively establish a therapeutic communication with psychiatric clients. 25. If a client is a chain smoker, how should his medication dosage be adjusted? ▪ a. Same medication dose ▪ b. Increase the dose ▪ c. Decrease the dose ▪ d. Withhold the dose Smoking cigarettes increases the metabolism of some psychiatric medications, thus, medication dose should be increased. underlying reasons for rituals takes time and isn't a realistic goal after 1 week. Most clients with OCD are aware that the ritual is irrational but can't stop it, making option D inappropriate as well. 5. Because antianxiety agents such as chlordiazepoxide (Librium) can potentiate the effects of other drugs, nurse Raquel should incorporate which of the following instructions in her teaching plan? ▪ a. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants ▪ b. Avoid taking antianxiety drugs at bedtime ▪ c. Avoid taking antianxiety drugs on an empty stomach ▪ d. Avoid consuming aged cheese when taking antianxiety agents Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted with monoamine oxidase inhibitors, not Librium. 6. Danilo, arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time? ▪ a. Ineffective individual coping ▪ b. Hopelessness ▪ c. Risk for injury ▪ d. Disturbed identity This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although the other options also are appropriate, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury. 7. Gina, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall 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. The client asks nurse Rose, "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." The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear. Saying that it must be awful not to be able to move her legs wouldn't answer the client's question; knowing that the cause is psychological wouldn't necessarily make her feel better. Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn't help her understand and resolve the underlying conflict. 8. Dr. Luistro orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse Kesselyn would be most appropriate? ▪ a. "Take this medication. It will reduce your anxiety." ▪ b. "Do you have any concerns about taking the medication?" ▪ c. "Trust us. This medication has helped many people. We wouldn't have you take it if it were dangerous." ▪ d. "How can we help you if you won't cooperate?" Providing an opportunity for the client to express concerns about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the right to refuse the medication. Instead of simply ordering the client to take it, as in option A, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option C, or threatening the client, as in option D, would increase anxiety. 9. After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client? ▪ a. Exploring the meaning of the traumatic event with the client ▪ b. Allowing the client time to heal ▪ c. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle ▪ d. Recommending a high-protein, low-fat diet The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self- destructive behavior such as substance abuse. The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. A special diet isn't indicated unless the client also has an eating disorder or a nutritional problem. 10. Jane is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive- compulsive disorder (OCD) is associated with: ▪ a. Physical signs and symptoms with no physiologic cause ▪ b. Apprehension ▪ c. Inability to concentrate ▪ d. Repetitive thoughts and recurring, irresistible impulses OCD is characterized by repetitive thoughts that the client can't control or exclude from consciousness, along with recurring, irresistible impulses to perform a particular action. Physical signs and symptoms with no physiologic cause typify somatoform disorder. Apprehension and inability to concentrate characterize anxiety disorders. 11. A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. Nurse Leo notices that the client's hair is thinning and the skin on the forehead is irritated — possible effects of this ritual. When planning the client's care, the nurse should assign highest priority to: ▪ a. Helping the client identify how the ritualistic behavior interferes with daily activities ▪ b. Exploring the purpose of the ritualistic behavior ▪ c. Setting consistent limits on the ritualistic behavior if it harms the client or others 15. Angel, is admitted to the unit visibly anxious. When assessing her, the nurse would expect to see which of the following cardiovascular effects produced by the sympathetic nervous system? ▪ a. Syncope ▪ b. Decreased blood pressure ▪ c. Increased heart rate ▪ d. Decreased pulse rate Sympathetic cardiovascular responses to stress include increased heart rate, cardiac contractility, and cardiac output; increased blood pressure; and peripheral vasoconstriction. Syncope is a response to parasympathetic stimulation. 16. A male client with Alzheimer's disease has a nursing diagnosis of Risk for injury related to memory loss, wandering, and disorientation. Which nursing intervention should appear in this client's plan of care to prevent injury? ▪ a. Provide the client with detailed instructions ▪ b. Keep the client sedated whenever possible ▪ c. Remove hazards from the environment ▪ d. Use restraints at all times By removing environmental hazards, such as bottles of hydrogen peroxide and benzoin, the nurse can help prevent injury to the client. For a client with Alzheimer's disease, the nurse should provide single, simple instructions, rather than many detailed instructions. The nurse should administer medication as prescribed and as needed — not to keep the client sedated. The nurse should use restraints only when required to prevent self-harm by the client. 17. Rudy was found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client's wife states that he was diagnosed with Alzheimer's disease 3 years ago and has had increasing memory loss. She tells nurseAngelie she is worried about how she'll continue to care for him. Which response by the nurse would be most helpful? ▪ a. "Because of the nature of your husband's disease, you should start looking into nursing homes for him." ▪ b. "What aspect of caring for your husband is causing you the greatest concern?" ▪ c. "You may benefit from a support group called Mates of Alzheimer's Disease Clients." ▪ d. "Do you have any children or friends who could give you a break from his care every now and then?" The nurse should determine the specific concerns of the client's wife. Jumping to conclusions regarding the client's need for a nursing home or other care placement options would be inappropriate. The nurse must tailor care to the client and family, focusing on their needs. Although support groups, children, and friends may prove helpful to the client's wife, the nurse must establish a plan for continued care that addresses her specific concerns. 18. Nurse Agnes is aware that nursing action most appropriate when trying to diffuse a male client's impending violent behavior? ▪ a. Helping the client identify and express feelings of anxiety and anger ▪ b. Involving the client in a quiet activity to divert attention ▪ c. Leaving the client alone until he can talk about his feelings ▪ d. Placing the client in seclusion In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as "What happened to get you this angry?" may help the client verbalize feelings rather than act on them. Close interaction with the client in a quiet activity may place the nurse at risk for injury should the client suddenly become violent. An agitated and potentially violent client shouldn't be left alone or unsupervised because the danger of the client's acting out is too great. The client should be placed in seclusion only if other interventions fail or the client requests this. Unlocked seclusion can be helpful for some clients because it reduces environmental stimulation and provides a feeling of security. 19. A male client has been taking imipramine (Tofranil), 125 mg by mouth daily, for 1 week. Now the client reports wanting to stop taking the medication because he still feels depressed. At this time, what is the best response of nurse Charlyn? ▪ a. "Imipramine may not be the most effective medication for you. You should call your physician for further evaluation." Reserved for clients with acute depression who don't respond to pharmacologic or psychiatric measures, ECT is the passage of an electrical current through the brain to induce a brief seizure. According to ECT proponents, the seizure causes desirable changes in neurotransmitters and receptor sites similar to those caused by antidepressant drugs. ECT is administered by a physician or an anesthesiologist. Although ECT may reduce the severity of depression, it doesn't necessarily cure it. Before ECT, the client receives a medication that provides short-term amnesia of the entire event. 24. Julius, an adolescent becomes increasingly withdrawn, is irritable with family members, and has been getting lower grades in school. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. This adolescent is at risk for: ▪ a. Suicide ▪ b. Anorexia nervosa ▪ c. School phobia ▪ d. Psychotic break Changes in academic performance and familial communications, social withdrawal, and giving away of treasured possessions suggest that this adolescent is contemplating suicide. Anorexia nervosa would cause weight loss and other related symptoms. This adolescent's signs and symptoms don't suggest fear of school and typify depression, not psychosis. 25. Nurse Bea is aware the when preparing a client for electroconvulsive therapy (ECT), she should make sure that: ▪ a. The client sees family members immediately before the procedure ▪ b. The client is scheduled for a brain scan immediately after the procedure ▪ c. The client has undergone a thorough medical evaluation ▪ d. The client has received lithium carbonate (Lithonate) Before an ECT treatment, the nurse should ensure that the client has had a medical evaluation that includes an ECG, a chest X-ray, neurologic and laboratory tests, and spinal X-rays, if indicated. Although making sure that the client sees family members immediately before the procedure would be appropriate, it's unnecessary (unless the client requests this). A brain scan isn't required after ECT because it can't evaluate the therapeutic effects of this treatment. Lithium must be discontinued before ECT because it prolongs the effects of succinylcholine chloride (Anectine), a muscle relaxant given just before the shock is delivered. Psychiatric Mental Health Nursing Test Part 3 All the questions in the quiz along with their answers are shown below. Your answers are bolded. The correct answers have a green background while the incorrect ones have a red background. 1. A male adult client with bipolar disorder is being treated with lithium for the first time. Nurse Joy should observe the client for which common adverse effect of lithium? ▪ a. Sexual dysfunction ▪ b. Constipation ▪ c. Polyuria ▪ d. Seizures Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Sexual dysfunction isn't a common adverse effect of lithium; it's more common with sedatives and tricyclic antidepressants. Diarrhea, not constipation, occurs with lithium.Constipation can occur with other psychiatric drugs, such as antipsychotic drugs. Seizures may be a later sign of lithium toxicity. 2. Mr. Velasquez is brought to the crisis intervention center by his wife, who states that he has been increasingly listless and less involved with his family recently. She reports that he sleeps poorly, eats little, and can barely perform basic self-care activities. She also reveals that 3 months ago he was in a car accident in which his best friend was killed. After the physician diagnoses acute depression, the nurse should anticipate administering: ▪ a. paroxetine (Paxil), 20 mg by mouth (P.O.) every morning ▪ b. amitriptyline (Elavil), 20 mg P.O. daily ▪ c. doxepin (Sinequan), 500 mg daily ▪ d. imipramine (Tofranil), 500 mg daily All of the drugs listed are antidepressants that may be prescribed for this client. However, paroxetine, 20 mg P.O. every morning, is the only correct dosage. Amitriptyline is usually started at 75 to 150 mg P.O. daily in divided doses. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. Imipramine is started at 50 to 75 mg daily and, if tolerated, titrated upward to a maximum daily dose of 300 mg. 3. Nurse Vanessa is administering venlafaxine (Effexor) 75 mg by mouth daily to a client diagnosed with depression. What type of agent is venlafaxine? ▪ a. Monoamine oxidase inhibitor ▪ b. Tricyclic antidepressant ▪ c. Second-generation antidepressant ▪ d. Lithium derivative Physicians prescribe venlafaxine to treat depressive disorders; the drug is a second-generation antidepressant agent 4. At night, Victor a geriatric client with senile dementia wanders into other clients' rooms, awakening them. What is the best nursing intervention for dealing with the client's insomnia and nocturnal roaming? ▪ a. Administer a benzodiazepine at bedtime as prescribed ▪ b. Administer a phenothiazine at bedtime as prescribed ▪ c. Administer a barbiturate at bedtime as prescribed ▪ c. Have blood levels screened weekly for leukopenia. ▪ d. Don't take with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It's imperative that a client checks with his physician and pharmacist before taking any other medications. Activity doesn't need to be limited. Blood dyscrasias aren't a common problem with MAOIs. Aspirin and NSAIDs are safe to take with MAOIs. 9. Michael,a teenager was driving a car that slipped off an icy road, killing two of his friends. He repeatedly tells the nurse that he should be dead instead of his friends. The client's behavior is an example of: ▪ a. survivor's guilt ▪ b. denial ▪ c. anticipatory grief ▪ d. repression Individuals who survive a traumatic experience in which others have died commonly report powerful feelings of guilt that they survived and others didn't. This guilt is referred to as survivor's guilt. In denial, a person refuses to accept that a situation or feeling exists. Anticipatory grief occurs when an individual experiences grief before a loss occurs. In repression, an individual involuntarily blocks an unpleasant experience, memory, or feeling from consciousness. 10. Angelo with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. Client teaching would include which of the following statements? ▪ a. Klonopin may interact with organ meats. ▪ b. The medications shouldn't be taken together. ▪ c. Klonopin is a minor depressant and may aggravate symptoms of depression. ▪ d. The order needs to be clarified; call the physician. Klonopin is a central nervous system (CNS) depressant and can aggravate symptoms in depressed clients. It doesn't interact with organ meats and can be taken with antidepressant medication. There is no need to call the physician; the medications can be safely taken together. 11. A male client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, nurse Ericka should provide which instruction to the client? ▪ a. Take the medication 1 hour before a meal. ▪ b. Decrease the dosage if signs of illness decrease. ▪ c. Apply a sunscreen before being exposed to the sun. ▪ d. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease. Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it. 12. For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, nurse Ronie suspects malignant neuroleptic syndrome. What steps should the nurse take? ▪ a. Give the next dose of fluphenazine, call the physician, and monitor vital signs. ▪ b. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. ▪ c. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation. ▪ d. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake. Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising blood pressure even higher. 13. During a group therapy session in the psychiatric unit, Joyce constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. Nurse Joey realizes that these behaviors are typical of: ▪ a. paranoid personality disorder ▪ b. avoidant personality disorder ▪ c. histrionic personality disorder ▪ d. borderline personality disorder This client's behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention. Typically, a client with paranoid personality disorder is suspicious, cold, hostile, and argumentative. Avoidant personality disorder is characterized by anxiety, fear, and social isolation. Borderline personality disorder is characterized by impulsive, unpredictable behavior and unstable, intense interpersonal relationships. 14. Nurse Jason is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered? ▪ a. To reduce psychotic symptoms ▪ b. To reduce extrapyramidal symptoms ▪ c. To control nausea and vomiting ▪ d. To relieve anxiety Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting. 15. Dr. Ryan would probably be ordered medication for the acutely aggressive schizophrenic client? ▪ a. chlorpromazine (Thorazine) ▪ b. haloperidol (Haldol) ▪ c. lithium carbonate (Lithonate) ▪ d. amitriptyline (Elavil) Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression. ▪ a. ask the client which activity he would prefer to do first ▪ b. negotiate a time when the client will perform activities ▪ c. tell the client specifically and concisely what needs to be done ▪ d. prepare the client ahead of time for the activity The client needs to be informed of the activity and when it will be done. Giving the client choices isn't desirable because he can be manipulative or refuse to do anything. Negotiating and preparing the client ahead of time also isn't therapeutic with this type of client because he may not want to perform the activity. 21. Judah receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to: ▪ a. reassure the client and administer as needed lorazepam (Ativan) I.M. ▪ b. administer as needed dose of benztropine (Cogentin) I.M. as ordered. ▪ c. administer as needed dose of benztropine (Cogentin) by mouth as ordered. ▪ d. administer as needed dose of haloperidol (Haldol) by mouth. The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction. 22. Nurse Irma is aware that the most antipsychotic medications exert which of following effects on the central nervous system (CNS)? ▪ a. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors. ▪ b. Sedate the CNS by stimulating serotonin at the synaptic cleft. ▪ c. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. ▪ d. Depress the CNS by stimulating the release of acetylcholine. The exact mechanism of antipsychotic medication action is unknown, but appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. They don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release. 23. Teresa with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority? ▪ a. Assist the client with feeding. ▪ b. Assist the client with showering. ▪ c. Reassure the client about safety. ▪ d. Encourage socialization with peers. According to Maslow's hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging. 24. Aiza with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to: ▪ a. take an as-needed dose of psychotropic medication whenever they hear voices. ▪ b. practice saying "Go away" or "Stop" when they hear voices. ▪ c. sing loudly to drown out the voices and provide a distraction. ▪ d. go to their room until the voices go away Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations. ▪ c. allow the client to get out feelings to relieve tension ▪ d. assign a staff to be with the client at all times to help maintain control The manic client is hyperactive and may engage in injurious activities. A quiet environment and consistent and firm limits should be set to ensure safety. Option B, clear, concise directions are given because of the distractibility of the client but this is not the priority. Option C, the manic client tend to externalize hostile feelings, however only non- destructive methods of expression should be allowed. Option D, nurses set limit as needed. Assigning a staff to be with the client at all times is not realistic. 5. A 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 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. The predominant behavioral characteristic of the client with borderline personality disorder is impulsiveness, especially of a physically self-destructive sort. The observation that the client has scratched wrists doesn't substantiate the other options. 6. Which 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 mm Hg ▪ d. Blood pressure of 140/80 mm Hg Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertensiontypically occurs in early withdrawal. Hypotension, although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don't receive treatment. The nurse should monitor the client's vital signs carefully throughout the entire alcohol withdrawal process. 7. A client 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 An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid base balance is crucial. Option A may worsen anxiety. Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately. 8. Daisy Caparas is a 35 year old woman with two young children. She had been admitted withsevere depression. During the initial phase of the nurse-patient relationship, the most helpful nursing intervention for Mrs. Caparas is: ▪ a. alleviating symptoms ▪ b. assessing anxiety ▪ c. providing sympathy ▪ d. setting limits During the initial phase of the nurse-patient relationship in this situation, tasks include establishing boundaries of the relationship, identifying problems, assessing anxiety levels, and identifying expectations. All other responses aren’t part of this phase of the relationship. 9. The best way to promote communication with Mrs. Caparas is to: ▪ a. allow her to remain isolated in her room ▪ b. Suggest that the client take a leading role in the social activities ▪ c. Provide the client with extra time for one on one sessions ▪ d. Allow the client to negotiate the plan of care Agree on a consistent approach among the staff assigned to the client. A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of exploiting the weakness in others or create conflicts among the staff. Bargaining should not be allowed. Option B, this is not therapeutic because the client tends to control and dominate others. Option C, limits are set for interaction time. Option D, allowing the client to negotiate may reinforce manipulative behavior. 15. Jade Gomez is a 33 year old housewife. She has been diagnosed with clinical depression. In a therapeutic relationship, the nurse assumes which role with Mrs. Gomez? ▪ a. Doer ▪ b. Friend ▪ c. Helper ▪ d. Listener A therapeutic relationship is a helping relationship. 16. when beginning a therapeutic relationship with Mrs. Gomez, the first phase of nurse-patient interactions is known as the: ▪ a. helping phase ▪ b. orientation phase ▪ c. talking phase ▪ d. working phase During the orientation phase of the therapeutic relationship, the nurse and patient make an agreement that they will be working together to solve one or more of the patient’s problems. 17. Which statement about patient touch is true? ▪ a. Most patients prefer not to be touched. ▪ b. Most patients prefer to be touched. ▪ c. Nurse-patient touching is an issue that requires sensitivity on the part of the nurse. ▪ d. Patients should never be touched. Touch has many meanings to patients. Although many patients are eager for human touch, others may perceive touch as human-boundary violation. Therefore, touching requires sensitivity on the part of the nurse. 18. Tourette syndrome is characterized by the presence of multiple motor and vocal tics. A vocal tic that involves repeating one's own sounds or words is known as: ▪ a. echolalia. ▪ b. palilalia. ▪ c. apraxia. ▪ d. aphonia. Palilalia is defined as the repetition of sounds and words. Echolalia is the act of repeating the words of others. Apraxia is the inability to carry out motor activities, and aphonia is the inability to speak. 19. Anxiety is caused by: ▪ a. an objective threat ▪ b. a subjectively perceived threat ▪ c. hostility turned to the self ▪ d. masked depression Anxiety is caused by a subjectively perceived threat. Option A, Fear is caused by an objective threat. Option C, a depressed client internalizes hostility. Option D, mania is due to masked depression. 20. A 29 year old client newly diagnosed with breast cancer is pacing, with rapid speech headache and inability to focus with what the doctor was saying. The nurse assesses the level of anxiety as: ▪ a. Mild ▪ b. Moderate ▪ c. Severe ▪ d. Panic The client’s manifestations indicate severe anxiety. Option A, mild anxiety is manifested by slight muscle tension, slight fidgeting, alertness, ability to concentrate and capable of problem solving. Option B, moderate muscle tension, increased vital signs, periodic slow pacing, increased rate of speech and difficulty in concentrating are noted in moderate anxiety. Option D, panic level of anxiety is characterized immobilization, incoherence, feeling of being overwhelmed and disorganization 21. Winnie Cruz is a 33 year old woman who is admitted to the hospital for observation after she attempted suicide. The nurse includes a psychosocial assessment that includes Mrs. Cruz’s marital relationship, based on the nurse’s knowledge that: ▪ a. spouses are often the first to be aware of a potential suicide ▪ b. spouses may be able to intervene in future suicide attempts ▪ c. suicide attempts may adversely affect the marital relationship ▪ d. the number one risk factor for suicide in adult woman is spousal abuse Information regarding the patient’s relationship with her spouse is important because spousal abuse is the leading cause of attempted and actual suicides in adult women. 22. Psychiatric follow-up for Mrs. Cruz is essential because she: ▪ a. is definitely depressed ▪ b. is probably angry that she’ll still alive ▪ c. may try to commit suicide again ▪ d. obviously hates her life Patients who have attempted suicide are at much higher risk for repeat attempts in the future. 23. Kevin, a 21 year old college student fell from a train and sustained a spinal cord injury, leaving him paralyzed below the waist. He’s in a spinal cord rehabilitation program and is refusing to do things for himself or practices in his prescribed program. One of Kevin’s nursing diagnosis is self-esteem disturbance. Which of the following is the most therapeutic nursing intervention? ▪ a. asking his friends to encourage self-care ▪ b. enlisting him in the planning of his own care ▪ c. moving him to a different hospital environment ▪ d. teaching him to perform self-care measures Encouraging a patient to be as independent as possible will promote self-reliance and self-confidence, both of which are components of a healthy self-esteem. An effective means of encouraging this independence is enlisting the patient in the planning of his won care. Teaching self-care measures and eliciting his peers to encourage him will be Nursing Board Review: Psychiatric Nursing Practice Test Part 2 All the questions in the quiz along with their answers are shown below. Your answers are bolded. The correct answers have a green background while the incorrect ones have a red background. 1. A male client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? ▪ a. Chlorpromazine (Thorazine) ▪ b. Imipramine (Tofranil) ▪ c. Lithium carbonate (Lithane) ▪ d. Fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it’s commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia. 2. Which of the following medications would the nurse in-charge expect the doctor to order to reverse a dystonic reaction? ▪ a. Procholorperazine (Compazine) ▪ b. Diphenhydramine (Benadryl) ▪ c. Haloperidol (Haldol) ▪ d. Midazolam (Versed) Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this patient drowsy. 3. A nurse places a female client in full leather restraints. How often must the nurse check the client’s circulation? ▪ a. Once per hour ▪ b. Once per shift ▪ c. Every 10 to 15 minutes ▪ d. Every 2 hours Circulation as well as skin and nerve damage can occur within 15 minutes. Checking every hour, 2 hours, or 8 hours isn’t often enough and could result in permanent damage to the client’s extremities. Restraints should be removed every 2 hours, and range-of-motion exercises should be performed. 4. The client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from the nurse? ▪ 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." An open-ended statement or question is the most therapeutic response. It encourages the widest range of client responses, makes the client an active participant in the conversation, and shows the client that the nurse is interested in his feelings. Asking the client why he drove while intoxicated can make him feel defensive and intimidated. A judgmental approach isn't therapeutic. By giving advice, the nurse suggests that the client isn't capable of making decisions, thus fostering dependency. 5. A 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 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to: ▪ a. begin after 7 days. ▪ b. not occur at all because the time period for their occurrence has passed. ▪ c. begin anytime within the next 1 to 2 days. ▪ d. begin within 2 to 7 days. Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink. 6. Which is the highest priority in the post ECT care? ▪ a. Observe for confusion ▪ b. Monitor respiratory status ▪ c. Reorient to time, place and person ▪ d. Document the client’s response to the treatment A side effect of ECT which is life threatening is respiratory arrest. Options A and C, Confusion and disorientation are side effects of ECT but these are not the highest priority. 7. Which of the following medical conditions is commonly found in clients with bulimia nervosa? ▪ a. Allergies ▪ b. Cancer ▪ c. Diabetes mellitus ▪ d. Hepatitis A Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. The eating disorder isn't typically associated with allergies, cancer, or hepatitis A. 8. A client tends to be insensitive to others, engages in abusive behaviors and does not have a sense of remorse. Which personality disorder is he likely to have? ▪ a. Narcissistic ▪ b. Paranoid ▪ c. Histrionic ▪ d. Antisocial These are the characteristics of an individual with antisocial personality. A. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. B. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. C. Individuals with histrionic have excessive emotionality, and attention-seeking behaviors. 9. The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting: ▪ a. tardive dyskinesia ▪ d. “I only need access to your arm. Putting up your sleeve is fine.” ―I only need access to your arm. Putting up your sleeve is fine.‖ The nurse needs to deal with the client with sexually connotative behavior in a casual, matter of fact way. Options A and B, these responses are not therapeutic because they are challenging and rejecting. Option C, threatening the client is not therapeutic. 14. Diana Gil is a 45 year old mother of three, is a patient on a burn unit. She received full thickness burn on 20% of her body in a house fire in which two of her children died. Which behavior would most suggest to the nurse that Mrs. Gil is still in the earliest stage of the grief process? ▪ a. Outburst of anger toward her family and the staff ▪ b. Questions about job retaining ▪ c. Statements that ―it’s a dream‖ and ―it didn’t really happen‖ ▪ d. Wanting to be left alone in a dark and quiet room Early grief involves shock, disbelief and denial; therefore, statements such as ―it’s a dream‖ and ―it didn’t really happen‖ are expected reactions in that stage. Job retaining questions are more suggestive of either the acceptance phase or dysfunctional grief, in which the individual is failing to grieve. Anger is the second phase of grief. Isolation is more suggestive of the depression phase of grief. 15. Shortly after midnight, Mrs. Gil is awakened by the sound of an arriving ambulance outside the window of her room. She exhibits screaming, crying, vigorous attempts to get out of the bed, and incoherent speech. These manifestations are most suggestive of which level of anxiety? ▪ a. Mild ▪ b. Moderate ▪ c. Panic ▪ d. Severe Extreme behaviors such as Mrs. Gil distorted response to the ambulance are indicative of panic. In the lesser degree of anxiety, the patient’s typical behavior is changed, but not exaggerated level that is seen in panic. 16. During this episode, which nursing intervention is most appropriate? ▪ a. Discuss appropriate coping mechanisms with Mrs. Gil. ▪ b. Encourage Mrs. Gil to express her feelings about the event. ▪ c. Have Mrs. Gil remain in bed and apply soft wrist restrains. ▪ d. Stay with Mrs. Gil and provide assurance and safety. When a patient is experiencing panic, it’s most important for the nurse to remain with the patient to provide physical and verbal assurance as well as to protect her from further injury. During panic, teaching her to discuss her feelings is less appropriate intervention because they can agitate the patient even more. Use of restrains requires a doctors order and can cause injury to the skin and joints. 17. A 26 year old unemployed woman seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis? ▪ a. Flat affect, social withdrawal, and unusual dress ▪ b. Suspiciousness, hypervigilance, and emotional coldness ▪ c. Lack of self-esteem, strong dependency needs, and impulsive behavior ▪ d. Insensitivity to others, sexual acting out, and violence Borderline personality disorder is characterized by lack of self-esteem, strong dependency needs, and impulsive behavior. Instability in interpersonal relationships, mood, and poor self-image also is common. Typically, the client can't tolerate being alone and expresses feelings of emptiness or boredom. Flat affect, social withdrawal, and unusual dress are characteristic of schizoid personality disorder. Suspiciousness, hypervigilance, and emotional coldness are seen in paranoid personality disorders. In antisocial personality disorder, clients are usually insensitive to others and act out sexually; they may also be violent 18. How soon after chlorpromazine administration should the nurse in charge expect to see a patient’s delusion thoughts and hallucinations eliminated? ▪ a. Several minutes ▪ b. Several hours ▪ c. Several days ▪ d. Several weeks ▪ c. A second psychiatric opinion ▪ d. Intensive inpatient treatment Inpatient care is the best intervention for a client who is thinking about suicide every day. Implementing a no-suicide contract is an important strategy, but this client requires additional care. Weekly therapy wouldn't provide the intensity of care that this case warrants. Obtaining a second opinion would take time; this client requires immediate intervention. 24. During a private conversation, a client with borderline personality disorder asks the nurse to keep his secret and then displays multiple, self-inflicted, superficial lacerations on the forearms. What is the nurse's best response? ▪ a. "That's it! You're on suicide precautions." ▪ b. "I'm going to tell your physician. Do you want to tell me why you did that?" ▪ c. "Tell me what type of instrument you used. I'm concerned about infection." ▪ d. "The team needs to know when something important occurs in treatment. I need to tell the others, but let's talk about it first." This response informs the client of the nurse's planned actions and allows time to discuss the client's actions. Options A and B put the client on the defensive and may lead to a power struggle. Option C ignores the psychological implications of the client's actions. 25. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect? ▪ a. Seizures ▪ b. Shivering ▪ c. Anxiety ▪ d. Chest pain Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose. Less common adverse effects include shivering, anxiety, and chest pain. Psychiatric Nursing Practice Test Part 1 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 2. Nurse Hazel is caring for a male client who experience false sensory perceptions with no basis in reality. This perception is known as: a. Hallucinations b. Delusions c. Loose associations d. Neologisms 3. Nurse Monet is caring for a female client who has suicidal tendency. 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 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 5. A client is experiencing 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 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 evil world d. Connected to client unrelated to oneself 7. A 20 year old client was diagnosed with dependent personality disorder. Which behavior isnot most likely to be evidence of ineffective individual coping? a. Recurrent self-destructive behavior b. Avoiding relationship b. Glucose intolerance resulting in protracted hypoglycemia c. Endocrine imbalance causing cold amenorrhea d. Decreased metabolism causing cold intolerance 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 16. A 39 year old mother with 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 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 18. Conney with borderline personality disorder who is to be discharge 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 clients statement because it’s a sign of manipulation 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. Depensiveness b. Embarrassment c. Shame d. Remorsefulness 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 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) 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. Soda d. Regular Coffee 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 24. To establish 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 an activity with the client c. Give client feedback about behavior d. Respect client’s need for personal space 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 26. Nurse Trish would expect a child with a diagnosis of reactive attachment disorder to: a. Have more positive relation with the father than the mother b. Cling to mother & cry on separation c. Be able to develop only superficial relation with the others d. Have been physically abuse 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 28. Nurse Perry is aware that language development in autistic child resembles: a. Scanning speech b. Speech lag 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 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 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 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 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 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 41. A 23 year old client has been admitted with a diagnosis of schizophrenia says to the nurse ―Yes, its march, March is little woman‖. That’s literal you know‖. These statement illustrate: a. Neologisms b. Echolalia c. Flight of ideas d. Loosening of association 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 43. A male client who is experiencing disordered thinking about food being poisoned is admitted to the mental health unit. The nurse uses 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 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 open-ended question d. Leave the client alone and continue with providing care to the other clients 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 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‖ 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‖ 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. 48. When planning the discharge of a client with chronic anxiety, Nurse Chris evaluates 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 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? Answers and Rationale Psychiatric Nursing Practice Test Part 1 1. C. Total abstinence is the only effective treatment for alcoholism. 2. A. Hallucinations are visual, auditory, gustatory, tactile or olfactory perceptions that have no basis in reality. 3. D. 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. 4. B. Establishing a consistent eating plan and monitoring client’s weight are important to this disorder. 5. C. Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm and medicating as needed. 6. B. Delusion of grandeur is a false belief that one is highly famous and important. 7. D. Individual with dependent personality disorder typically shows indecisivenesssubmissiveness and clinging behavior so that others will make decisions with them. 8. A. Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. 9. B. Bulimia disorder generally is a maladaptive coping response to stress and underlying issues. The client should identify anxiety causing situation that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. 10. A. An adult age 31 to 45 generates new level of awareness. 11. A. Neuromuscular Blocker, such as SUCCINYLCHOLINE (Anectine) produces respiratory depression because it inhibits contractions of respiratory muscles. 12. C. With depression, there is little or no emotional involvement therefore little alteration in affect. 13. D. These clients often hide food or force vomiting; therefore they must be carefully monitored. 14. A. 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. 15. B. Limiting unnecessary interaction will decrease stimulation and agitation. 16. C. Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy by maintaining an absolute set pattern of behavior. 17. D. 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. 18. B. 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. 19. A. When the staff member ask 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. 20. B. The nurse would specifically use supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for self. 21. C. The nurse would most likely administer benzodiazepine, such as lorazepan (ativan) to the client who is experiencing symptom: The client’s experiences symptoms of withdrawal because of the rebound phenomenon when the sedation of the CNS from alcohol begins to decrease. 22. D. Regular coffee contains caffeine which acts as psychomotor stimulants and leads to feelings of anxiety and agitation. Serving coffee top the client may add to tremors or wakefulness. 23. D. Vomiting and diarrhea are usually the late signs of heroin withdrawal, along with muscle spasm, fever, nausea, repetitive, abdominal cramps and backache. 24. D. Moving to a client’s personal space increases the feeling of threat, which increases anxiety. 25. A. Environmental (MILIEU) therapy aims at having everything in the client’s surrounding area toward helping the client. 26. C. Children who have experienced attachment difficulties with primary caregiver are not able to trust others and therefore relate superficially 27. A. Children have difficulty verbally expressing their feelings, acting out behavior, such as temper tantrums, may indicate underlying depression. 28. D. The autistic child repeat sounds or words spoken by others. 29. D. The client statement is an example of the use of denial, a defense that blocks problem by unconscious refusing to admit they exist. 30. A. Discussion of the feared object triggers an emotional response to the object. 31. B. The nurse presence may provide the client with support & feeling of control. 32. D. Experiencing the actual trauma in dreams or flashback is the major symptom that distinguishes post traumatic stress disorder from other anxiety disorder. 33. C. Confabulation or the filling in of memory gaps with imaginary facts is a defense mechanism used by people experiencing memory deficits. 34. A. These are the major signs of anorexia nervosa. Weight loss is excessive (15% of expected weight). 35. C. Dental enamel erosion occurs from repeated self-induced vomiting. 36. B. Depression usually is both emotional & physical. A simple daily routine is the best, least stressful and least anxiety producing. 37. D. The expression of these feeling may indicate that this client is unable to continue the struggle of life. 38. A. Structure tends to decrease agitation and anxiety and to increase the client’s feeling of security. 39. B. The rituals used by a client with obsessive compulsive disorder help control the anxiety level by maintaining a set pattern of action. 40. C. A person with this disorder would not have adequate self-boundaries. 41. D. Loose associations are thoughts that are presented without the logical connections usually necessary for the listening to interpret the message. 42. C. Helping the client to develop feeling of self worth would reduce the client’s need to use pathologic defenses. 43. B. Open ended questions and silence are strategies used to encourage clients to discuss their problem in descriptive manner. 44. 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 open-ended question and pausing to provide opportunities for the client to respond. 45. D. When hallucination is present, the nurse should reinforce reality with the client. 46. A. Personal characteristics of abuser include low self-esteem, immaturity, dependence, insecurity and jealousy. 47. D. A short acting skeletal muscle relaxant such as succinylcholine (Anectine) is administered during this procedure to prevent injuries during seizure. 48. C. Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid specific stimulus. 49. D. Electroconvulsive therapy is an effective treatment for depression that has not responded to medication. 50. B. In an emergency, lives saving facts are obtained first. The name and the amount of medication ingested are of outmost important in treating this potentially life threatening situation. b. Asking what kind of poison the client suspects is being used c. Serving foods that come in sealed packages d. 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? a. The client responds to verbal directions to eat b. The client initiates simple activities without direction c. The client walks with the nurse to her room d. 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? a. Developing a support network with other families b. Feeling more guilty about the client’s illness c. Recognizing the client’s weakness d. 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? a. Attending an activity with the nurse b. Leading a sing a long in the afternoon c. Participating solely in group activities d. Being involved with primarily one to one activities 17. Which statement about an individual with a personality disorder is true? a. Psychotic behavior is common during acute episodes b. Prognosis for recovery is good with therapeutic intervention c. The individual typically remains in the mainstream of society, although he has problems in social and occupational roles d. 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? a. Discussing his relationship with his mother b. Asking him to explain reasons for his seductive behavior c. Suggesting to apologize to others for his behavior d. 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? a. Baking class b. Role playing c. Scrap book making d. 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? a. Toothpaste b. Shampoo a. Shake b. Tea c. Cranberry Juice d. 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? 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 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? a. Tell the client he’ll need to wait until supper to eat if he misses lunch b. Invite the client to lunch and accompany him to the dining room c. Inform the client that he has 10 minutes to get to the dining room for lunch d. 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: a. Presenting 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 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: a. Shock and disbelief b. Developing awareness c. Resolving the loss d. 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: a. Accentuated premorbid traits b. Enhance intelligence c. Increased inhibitions d. Hyper vigilance 33. What is the priority care for a client with a dementia resulting from AIDS? a. Planning for remotivational therapy b. Arranging for long term custodial care c. Providing basic intellectual stimulation d. Assessing pain frequently 34. Jerome who has 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 35. 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 36. 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. 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: a. Repression b. Loneliness c. Anger d. 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: a. Defensive behavior b. Reality reinforcement c. Limit-setting behavior d. 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: a. Verbalizing the need for anxiety medications b. Recognizing each existing personality c. Engaging in object-oriented activities d. 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: 48. When planning care for a male client using paranoid ideation, nurse Jasmin should realize the importance of: a. Giving the client difficult tasks to provide stimulation b. Providing the client with activities in which success can be achieved c. Removing stress so that the client can relax d. Not placing any demands on the client 49. Nurse Gerry is aware that the defense mechanism commonly used by clients who are alcoholics is: a. Displacement b. Denial c. Projection d. Compensation 50. 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 Answers and Rationale Psychiatric Nursing Practice Test Part 2 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 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. Psychiatric Nursing Practice Test Part 3 1. Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe: a. Hyperactivity b. Depression c. Suspicion d. Delirium 2. Nurse John is aware that a serious effect of inhaling cocaine is? a. Deterioration of nasal septum b. Acute fluid and electrolyte imbalances c. Extra pyramidal tract symptoms d. Esophageal varices 3. A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include: a. Rhinorrhea, convulsions, subnormal temperature b. Nausea, dilated pupils, constipation c. Lacrimation, vomiting, drowsiness d. Muscle aches, papillary constriction, yawning 4. A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client’s wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for: a. A past history of depression b. Current plans to commit suicide c. The presence of marital difficulties d. Feelings of excessive failure 5. Before helping a male client who has been sexually assaulted, nurse Maureen should recognize that the rapist is motivated by feelings of: a. Hostility b. Inadequacy c. Incompetence d. Passion 6. When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of: a. Humiliation b. Confusion c. Self blame d. Hatred