Title: Final Exam
Course: NUR 1521C Psychiatric/Mental Health Nursing > Section: Module 8

Q: What is an important nursing intervention when giving care to a client withdrawing from a CNS stimulant?
- make physical contact by frequently touching the client.
- offer intellectual activities requiring concentration.
- observe for depression and suicidal ideation.
- avoid manipulation by denying all client requests.
A: observe for depression and suicidal ideation.

Q: What is a nursing diagnosis commonly applied to both paranoid schizophrenic clients and clients with amphetamine-induced psychosis?
- disturbed thought processes.
- powerlessness.
- ineffective thermoregulation.
- deficient knowledge.
A: disturbed thought processes.

Q: An individual uses alcohol to relieve tension. When he first began self-medicating with alcohol, two drinks made him relaxed and drowsy. Now, after 1 year, he needs four drinks to bring himself to the same relaxed, drowsy state. The reason for this is
- the alcohol is less potent.
- he is developing tolerance.
- hypomagnesemia.
- antagonistic effects.
A: he is developing tolerance.

Q: What is the most therapeutic approach for the nurse to take initially when working with a client entering treatment for alcohol abuse?
- strongly confrontive.
- empathetic, supportive.
- cool and somewhat distant.
- skeptical and wary.
A: empathetic, supportive.

Q: What is a short-term outcome that can be identified for a client completing his fourth alcohol detoxification program in 1 year?
- that the client will use denial and rationalization in a healthier way.
- that the client will identify constructive outlets for anger.
- that the client will state that he sees the need for ongoing treatment.
- that the client will develop a dependent relationship with one staff member.
A: that the client will state that he sees the need for ongoing treatment.

Q: A client newly admitted to the medical unit has needle tracks on both arms. A friend has stated that the client uses heroin. The nurse should assess the client for which withdrawal symptoms?
- slurred speech, excessive drowsiness, and bradycardia.
- runny nose, yawning, insomnia, and chills.
- anxiety, agitation, and aggression.
- paranoid delusions, tactile hallucinations, and panic.
A: runny nose, yawning, insomnia, and chills.

Q: What are the symptoms the nurse should expect/ observe in an individual who has just "shot up" with heroin prior to being brought to the E. R.?
- anxiety, restlessness, and paranoid delusions.
- muscle aching, dilated pupils, and tachycardia.
- heightened sexuality, insomnia, and euphoria.
- drowsiness, constricted pupils, and slurred speech.
A: drowsiness, constricted pupils, and slurred speech.

Q: A client has smoked two packs of cigarettes daily for many years. When she does not smoke or tries to "cut back," she becomes anxious, craves a cigarette, cannot concentrate, and gets a headache. How could these symptoms be assessed?
- substance abuse.
- substance intoxication.
- substance dependence.
- recreational use of a social drug.
A: substance dependence.

Q: The nurse has recently set limits for a client with borderline personality disorder. The client tells the nurse "You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You're hateful." How would this outburst be assessed?
- splitting.
- denial.
- reaction formation.
- separation-individuation strategies.
A: splitting.

Q: What is the most challenging nursing intervention with clients with personality disorders who use manipulation to get their needs met?
- supporting behavioral change.
- using aversive therapy.
- maintaining consistent limits.
- monitoring suicide attempts.
A: maintaining consistent limits.

Q: Five years following Mrs. Ross' husband's unexpected and tragic death, she remains sad, has limited interactions, cannot work and has several somatic complaints. How would the nurse assess Mrs. Ross's symptoms?
- Powerlessness
- Normal grieving
- Dysfunctional grieving
- Altered thought processes
A: Dysfunctional grieving

Q: A client admitted for treatment of trauma sustained in a fall while intoxicated believes bugs are crawling on the bed. The client is anxious, agitated, and diaphoretic. What medication can the nurse anticipate that the physician will order?
- benzodiazepine such as diazepam (Valium) or chlordiazepoxide (Librium).
- phenothiazine such as chlorpromazine (Thorazine) or thioridazine (Mellaril).
- monoamine oxidase inhibitor such as phenelzine (Nardil).
- narcotic such as codeine.
A: benzodiazepine such as diazepam (Valium) or chlordiazepoxide (Librium).

Q: A client who is being admitted for depression should be assessed for disturbances in circadian rhythms. What question would best assess for this disturbance?
- "What time of day do you feel worst and when do you feel best?"
- "Do you ever see or hear things that others do not?"
- "How would you describe your thinking?"
- "Would you say your memory is failing?"
A: "What time of day do you feel worst and when do you feel best?"

Q: Which statement made by a nurse during a nurse-client interaction may underrate a client's feelings and belittle his or her concerns?
- "You appear tense."
- "Everything will be all right."
- "I notice you are biting your lip."
- "I'm not sure I follow you."
A: "Everything will be all right."

Q: A nurse is caring for four clients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. In which client should the nurse be most alert for alterations in cardiac or cerebral electrical conductivity and fluid and electrolyte imbalance?
- The client receiving lithium (Lithobid)
- The client receiving clozapine (Clozaril)
- The client receiving fluoxetine (Prozac)
- The client receiving venlafaxine (Effexor)
A: The client receiving lithium (Lithobid)

Q: A client is assessed as experiencing severe anxiety. What should the nurse do to reduce the client's level of anxiety as quickly as possible?
- stay with him.
- tell him that help will come.
- tell him he will not be allowed to hurt anyone.
- question him to discover the events that led to his decompensation.
A: stay with him.

Q: What environmental conditions should the nurse arrange for a client with delirium while the client is experiencing perceptual alterations?
- Provide a well-lit room without glare or shadows and limit noise
- Have the client sit by the nurse's desk while awake and provide rest periods in a room with the television on
- Light room brightly around the clock and awaken hourly to check mental status
- Keep room shadowy with soft lighting around the clock and keep a radio on continuously
A: Provide a well-lit room without glare or shadows and limit noise

Q: Which of the following statements are correct concerning dementia? (choose all that apply)
- It is a chronic, usually irreversible cognitive disorder with a gradual onset.
- The duration is commonly brief and reversible.
- Clients may use confabulation to hide memory deficits.
- Symptoms can occur as a result of alcohol withdrawal.
A: Clients may use confabulation to hide memory deficits.

Q: A depressed client who is scheduled to receive electroconvulsive therapy this morning asks the nurse "How is this treatment supposed to help me?" The best reply would be "Electroconvulsive therapy
- probably increases the availability of brain neurotransmitters."
- makes you confused and you forget why you're feeling depressed."
- serves as a punishment so your own conscience can stop punishing you."
- works by opening your mind to learning and applying new coping skills."
A: probably increases the availability of brain neurotransmitters."

Q: What is an important intervention for a client with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations?
- avoidance of physical contact.
- application of wrist and ankle restraints.
- careful observation and supervision.
- a high level of sensory stimulation.
A: careful observation and supervision.

Q: A client has a short attention span and is easily distracted. When giving information to him about his care, which of the following interventions is most appropriate?
- Establish goals and share them with the client.
- Offer information at bedtime.
- Offer information in a group area.
- Keep information brief and simple.
A: Keep information brief and simple.

Q: During a study session, a nursing student explains the difference between delirium and dementia. The student is correct in stating which of the following when explaining dementia?
- Personality change is common. The illness is reversible in only 2% to 3% of cases.
- Duration of the illness is brief. Symptoms are common during alcohol withdrawal.
- It can be caused by a severe migraine headache. It is most often reversible.
- Level of consciousness is affected. Symptoms of illusions and hallucinations are common.
A: Personality change is common. The illness is reversible in only 2% to 3% of cases.

Q: What client need assumes priority when implementing care for a client with late-stage dementia?
- meaningful verbal communication.
- promotion of self-care activities.
- maintenance of nutrition and hydration.
- prevention of the client from wandering.
A: maintenance of nutrition and hydration.

Q: A client with mild -to-moderate Alzheimer's disease has been determined to have a dressing/grooming self-care deficit. What is an appropriate intervention to include in the client's nursing care plan?
- dress client in soft warm clothing.
- label clothing with the client's name and name of the item.
- provide necessary items and expect the client to proceed independently.
- administer anxiolytic medication before bathing and dressing.
A: label clothing with the client's name and name of the item.

Q: A 20-year-old economics major became severely depressed after failing two examinations. She gave her roommate three expensive sweaters to keep. Later she was found her unconscious on the floor, with an empty pill bottle nearby. Which client behavior provided the best clue to the suicide attempt?
- calling her parents.
- staying in her dorm room.
- giving away her sweaters.
- excessive crying.
A: giving away her sweaters.

Q: What is the most helpful response for the nurse to make when a client being treated as an outpatient states "I am considering committing suicide"?
- "I am glad you shared this. There is nothing to worry about. We will handle it together."
- "We need to talk about the things you have to live for."
- "I think you should admit yourself to the hospital to get help with this."
- "Telling me about this is a very positive action on your part."
A: "Telling me about this is a very positive action on your part."

Q: Mrs. Davis, an 80 year-old client, is admitted to the hospital after an episode of mental confusion that has worsened over the course of one week. A preliminary diagnosis of Alzheimer's disease is given. You would question this diagnosis because:
- Alzheimer's disease does not occur after age 70 years.
- Persons with Alzheimer's disease develop confusion in less than one week.
- A thorough examination was done.
- Alzheimer's disease does not develop suddenly.
A: Alzheimer's disease does not develop suddenly.

Q: The nurse is caring for a client with dementia. The client is unable to feed herself even though motor functioning is intact. The nurse assesses the client is exhibiting which symptom?
- Aphasia
- Apraxia
- Agnosia
- Confabulation
A: Apraxia

Q: If an intoxicated client admitted for trauma treatment last night at 2 AM is going to have withdrawal symptoms, when should the nurse be alert for the symptoms to begin?
- between 8 and 10 AM today (6 to 8 hours after drinking stopped).
- about 2 AM tomorrow (24 hours after drinking stopped).
- about 2 AM of hospital day 2 (48 hours after drinking stopped).
- about 2 AM of hospital day 3 (72 hours after drinking stopped).
A: between 8 and 10 AM today (6 to 8 hours after drinking stopped).

Q: A client asks the nurse "What is Alcoholics Anonymous all about?" What is the best response for the nurse to make?
- "It is a group that learns about drinking from a group leader."
- "It is a form of group therapy led by a psychiatrist."
- "It is a self-help group that helps clients with drinking problems remain sober."
- "It is a group that advocates strong punishment for drunk drivers."
A: "It is a self-help group that helps clients with drinking problems remain sober."

Q: What would be the most appropriate response by the nurse when a despondent client says "nothing matters anymore"?
- "Are you having thoughts of suicide?"
- "I am not sure I understand what you are trying to say."
- "Try to stay hopeful. Things have a way of working out."
- "Tell me more about the things that interested you before you began to feel depressed."
A: "Are you having thoughts of suicide?"

Q: Which statement provides the best rationale for the nursing intervention of monitoring the severely depressed client closely during antidepressant therapy?
- as depression lifts, physical energy becomes available to carry out a plan for suicide.
- suicide may be precipitated by a variety of internal and external events.
- suicidal clients have difficulty using social supports.
- suicide is an impulsive act.
A: as depression lifts, physical energy becomes available to carry out a plan for suicide.

Q: A 42-year-old woman seeks crisis intervention. She tells the nurse "I cannot take it anymore! It has to stop. Last year my husband had an affair. Three months ago I found a lump in my breast and yesterday my 20-year-old daughter told me she is quitting college and moving to another state with her boyfriend." What type of crisis is the client experiencing?
- maturational.
- situational.
- adventitious.
- recurring.
A: maturational.

Q: A client, aged 42 years, seeks crisis intervention. She tells the nurse "I cannot take it anymore! It has to stop. Last year my husband had an affair. Three months ago I found a lump in my breast and yesterday my 20-year-old daughter told me she is quitting college and moving to another state with her boyfriend." What is the priority assessment for the nurse to make?
- what measures might be used to help improve the couple's communication.
- whether the husband is still engaged in an affair.
- how the client feels about the possibility of having a mastectomy.
- what the client has in mind when she says she "cannot take it anymore."
A: what the client has in mind when she says she "cannot take it anymore."

Q: During the initial interview at the crisis center, a client reveals that his wife asked him for a divorce. He is so anxious that he "cannot think straight." What could the nurse say to assess personal coping skills?
- "I can see you are upset. You can rely on us to help you feel better."
- "What would you like us to do to help you feel more relaxed?"
- "In the past, how did you handle difficult or stressful situations?"
- "Do you think you deserve to have things like this happen to you?"
A: "In the past, how did you handle difficult or stressful situations?"

Q: The client tells the nurse "My doctor prescribed Prozac [fluoxetine]. I suppose I'll have to get used to the side effects like the ones I experienced when I was taking Tofranil [imipramine]." The nurse should explain that Prozac (fluoxetine) has different side effects and is classified as which of the following?
- tricyclic antidepressant.
- MAO inhibitor.
- SSRI.
- selective norepinephrine reuptake inhibitor.
A: SSRI.

Q: I have thoroughly read the course description, requirements, assignments/due dates, and calendar information on this site. Further, I have reviewed the procedures for using the discussion, assignments dropbox, and e-mail features of the site. I understand what is required to complete this course successfully and how to use the online tools to do so.
- Yes, I do
- No, I don't
A: Yes, I do
If right: Great, then begin work on Module 1.
If wrong: Uh oh! Then go back and re-read the syllabus materials completely. If you still cannot answer, Yes, I do, contact the instructor immediately.

Q: How can the nurse best communicate to the client that she or he is interested in listening?
- by restating the feeling or thought the client has expressed.
- by making a judgment about the client's problem.
- by asking a direct question, such as "Did you feel angry?"
- by saying "I understand what you're saying."
A: by restating the feeling or thought the client has expressed.

Q: Which of the following questions best evaluates the client's insight?
- "Do you have any thoughts that you have difficulty getting rid of"?
- "Do you remember what ten times ten is"?
- "What do you think brought all of this on?"
- "What do you think about most?"
A: "What do you think brought all of this on?"

Q: A newly admitted client is severely depressed and has lost 20 pounds over the past month. He has chronic low self-esteem, suicidal ideation and a plan for committing suicide. He has been taking a selective serotonin reuptake inhibitor for 1 week without remission of symptoms. What is the priority nursing diagnosis?
- imbalanced nutrition: less than body requirements.
- chronic low self-esteem.
- risk for suicide.
- ineffective protection.
A: risk for suicide.

Q: Which statement made by a client provides the nurse with the best understanding of the client's current problem and reason for seeking treatment?
- "I can always trust my wife."
- "You never know who will turn against you."
- I've been hearing the voices of my dead parents."
- "I wish I knew what I've done to deserve such bad luck."
A: I've been hearing the voices of my dead parents."

Q: What action by a psychiatric nurse supports the elderly client's right to be treated with dignity and respect?
- the nurse addresses the client by his title and surname (e.g., Mr. Jones).
- the nurse discusses the client's condition with his physician as they have lunch in the cafeteria.
- the nurse tells the treatment team that the client is too drowsy to be consulted about the plan of care.
- the nurse strongly encourages the client to participate in recreational activities available on the unit.
A: the nurse addresses the client by his title and surname (e.g., Mr. Jones).

Q: A male adolescent was admitted to a psychiatric unit after a violent physical outburst. He asks the nurse to promise to keep confidential a plan he has to kill his father. How should the nurse respond?
- "Those kinds of thoughts will make your hospitalization longer."
- "I can make that promise to you based on nurse-client privilege."
- "You really should share this thought with your psychiatrist."
- "I am obligated to share that information with the treatment team."
A: "I am obligated to share that information with the treatment team."

Q: The nurse moves about the psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitor's closet is locked, and all sharp objects are being used under supervision of staff. What do these observations relate to?
- management of milieu safety.
- coordinating care of clients.
- management of the interpersonal climate.
- use of therapeutic intervention strategies.
A: management of milieu safety.

Q: Systematic desensitization is one method of treatment used for clients with phobic reactions. Which of these statements best describes this treatment method?
- The use of group and family sessions.
- Gradual exposure of clients to the phobic threat.
- Stopping the presentation of phobic threat if client's anxiety occurs.
- Presenting clients with massive exposure to the feared object.
A: Gradual exposure of clients to the phobic threat.

Q: What instructions are most important to be included in the teaching plan for a client taking clozapine?
- Report sore throat and fever immediately.
- Avoid foods high in polyunsaturated fats.
- Practice unprotected sex.
- Use over-the-counter preparations for rashes.
A: Report sore throat and fever immediately.

Q: Under mental illness/managed care guidelines the criteria for inpatient hospitalization is?
- clients who are noncompliant with medication at home.
- clients who present a clear danger to self or others.
- clients who develop new symptoms during the course of the illness.
- clients who have no support systems in the community.
A: clients who present a clear danger to self or others.

Q: A client demonstrates disorganized and delusional thinking. The tentative diagnosis is schizophrenia. The nurse can anticipate that a PET scan would be most likely to show dysfunction in the part of the brain called the
- temporal lobe.
- cerebellum.
- brainstem.
- frontal lobe.
A: frontal lobe.

Q: A client hospitalized with a mood disorder displays an elevated, unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse begins planning medication teaching based on the expectation that the psychiatrist is most likely to prescribe a medication classified as a(n)
- anticholinergic.
- mood stabilizer.
- psychostimulant.
- antidepressant.
A: mood stabilizer.

Q: What technique is used more often in crisis intervention than in traditional counseling?
- role modeling.
- advice giving.
- thought stopping.
- empathetic listening.
A: advice giving.

Q: A client asks the nurse, "What are neurotransmitters? My doctor says they are at the root of my problem." What is the best reply?
- "You must feel relieved to know that your problem has a physical basis."
- "It is a rather high-level concept to explain. Perhaps you should ask the doctor to tell you more."
- "Neurotransmitters are substances we eat daily that influence the brain functions of memory and mood."
- "Neurotransmitters are chemicals manufactured in the brain that are responsible for passing messages between brain cells."
A: "Neurotransmitters are chemicals manufactured in the brain that are responsible for passing messages between brain cells."

Q: The husband of a client with schizophrenia asks the nurse, "I simply don't understand why my wife has schizophrenia." What response by the nurse that will help the husband better understand his wife's condition?
- "It must be frustrating for you that your wife is sick so much of the time."
- "You can count on the fact that her illness is the result of genetic factors."
- "Although it seems impossible, psychological stress really is at the root of most mental disorders."
- "New findings tell us that your wife's condition is more likely biological than psychological in origin."
A: "New findings tell us that your wife's condition is more likely biological than psychological in origin."

Q: When the nurse uses Maslow's hierarchy of needs to plan care for a client who is psychotic, which client problem below will receive priority?
- Inability to perform self-care
- Feelings of alienation from family
- Reluctance to participate in unit social activities
- Need to be taught about medication action and side effects
A: Inability to perform self-care

Q: Which client should be assessed as demonstrating increased aggression and potential for violence?
- Client A, who stomps away from the nurses' station, goes into the day room, and grabs a pool cue from a client standing at the pool table.
- Client B, who bursts into tears, leaves the community meeting, and sits on her bed hugging her pillow and sobbing.
- Client C, who tells her primary nurse "When you told me that I could not have a pass, I felt angry."
- Client D, who tells the medication nurse "I am not going to take that, or any other, medication."
A: Client A, who stomps away from the nurses' station, goes into the day room, and grabs a pool cue from a client standing at the pool table.

Q: A teenager is brought to the emergency department by a girlfriend who accompanied her to a party. The teenager reports being raped after being given a glass of wine. Emergency department staff notices semen and blood on her underclothes. The priority actions of staff should be focused on
- preserving rape evidence.
- obtaining a description of the rape.
- determining who was with her at the party.
- maintaining the client's airway.
A: preserving rape evidence.

Q: A rape victim tells the emergency room nurse "I feel so dirty. Please let me take a shower before the doctor examines me. I just cannot stand being so filthy." What should the nurse do?
- arrange for the client to shower.
- give the client a basin of hot water and towels.
- explain that washing would destroy evidence.
- explain that bathing facilities are not available in the emergency department.
A: explain that washing would destroy evidence.

Q: What intervention will increase compliance when providing discharge teaching to a victim of violence and sexual assault?
- give referral information verbally and in writing.
- notify the client's family of the problem so they can offer support.
- offer to stay with the client until she regains stability.
- advise the client to try not to think about the assault.
A: give referral information verbally and in writing.

Q: A wife has been severely beaten by her husband. She has no relatives or friends in the community, has no financial resources, no job skills and is afraid to return home. While preparing her for discharge which referral is essential?
- community food cupboard.
- vocational counseling.
- law enforcement.
- a women's shelter.
A: a women's shelter.

Q: A victim of physical abuse by her domestic partner is being treated for a broken humerus. She tells the nurse her partner abuses her most often when he is intoxicated. What is the best nursing diagnosis for this client?
- impaired social interaction related to husband's unemployment.
- risk for injury related to husband's physical abuse when intoxicated.
- deficient knowledge: community supports related to inability to read.
- disturbed sleep pattern related to problems in the home, as evidenced by behavior of husband and children.
A: risk for injury related to husband's physical abuse when intoxicated.

Q: A woman who is a victim of severe emotional violence tells the nurse that her husband abuses her most often when he is intoxicated. She states he is always apologetic and brings her gifts after an incident. During which stage in the cycle of violence is gift giving likely to occur?
- tension-building stage.
- acute battering stage.
- honeymoon stage.
- recovery stage.
A: tension-building stage.

Q: A 35-year-old married woman who works full time has recently been absent for 3-day periods on several occasions. Each time she returned to work wearing dark glasses. Facial and body bruises were apparent. Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse. What is the priority question for the nurse to ask when assessing the client?
- "How did this happen to you?"
- "Do you drink excessively?"
- "Did your husband beat you?"
- "What did you do to deserve this?"
A: "How did this happen to you?"

Q: A victim of domestic abuse is being discharged from the emergency department. What is the most important nursing intervention?
- notify the client's family of the problem to seek client support.
- give referral information verbally and in writing.
- offer to stay with the client until she regains stability.
- advise the client to try not to think about the incident.
A: give referral information verbally and in writing.

Q: What legal principle should be kept in mind when choosing nursing interventions to manage a client whose aggression is quickly escalating?
- staff should match client's affective level, tone of voice, and so forth.
- immediately use physical containment measures.
- ask the client what will be most helpful to him or her.
- begin with the least restrictive measure possible.
A: begin with the least restrictive measure possible.

Q: The emergency department nurse realizes that the husband of a client appears increasingly irritable as he waits. What intervention would prevent escalation of anger?
- periodically updating the husband about what is being done for his wife.
- explaining that his wife will have to wait because clients are treated in order of need.
- asking that he relax, explaining that his wife's condition is not life threatening.
- suggesting that he return home and have the physician call with an update in 3 hours.
A: periodically updating the husband about what is being done for his wife.

Q: What medication should the nurse choose from a list of PRN medications to provide immediate intervention for an angry psychotic client whose aggressive behavior continues to escalate despite verbal intervention?
- lithium.
- Trazodone (Desyrel).
- valproic acid (Depakote).
- haloperidol.
A: haloperidol.

Q: Which individual should be assessed as being at greatest risk for demonstrating violent behavior?
- a client who has a history of spousal abuse.
- a client who is severely agoraphobic.
- a client who verbalizes hopelessness and powerlessness.
- a client who demonstrates bizarre somatic delusions.
A: a client who has a history of spousal abuse.

Q: A client is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the client by name and say
- "Please quiet down."
- "Hey, what's up?"
- "You seem upset. Tell me about it."
- "You need to go to your room to get control of yourself."
A: "You seem upset. Tell me about it."

Q: What behavior would be considered inconsistent with the clinical picture of a client who is becoming increasingly aggressive?
- pacing.
- sobbing inconsolably.
- rigid posture with a clenched jaw.
- staring with narrowed eyes into the eyes of another.
A: sobbing inconsolably.

Q: The nursing diagnosis of "powerlessness related to lack of a plan to resolve crisis" has been established for a client seeking crisis intervention. What would be an appropriate outcome for this nursing diagnosis?
- the client will sign a no-suicide contract within 30 minutes.
- the client will meet pre-crisis role expectations within 36 hours.
- the client will state he feels less anxious within 4 hours of the interview.
- the client will state two possible alternative solutions during the first interview.
A: the client will state two possible alternative solutions during the first interview.

Q: The client receiving lithium should be assessed for what side effects?
- muscle weakness, diaphoresis, and nausea.
- alopecia, purpura, and dystonia.
- ascites, dyspnea, and edema.
- pharyngitis, mydriasis, and drowsiness.
A: muscle weakness, diaphoresis, and nausea.

Q: A client with bipolar disorder who became hyperactive after discontinuing lithium has not eaten or slept for 3 days. Which of the following nursing diagnoses would be of priority importance?
- Ineffective coping
- Risk for injury
- Caregiver role strain
- Impaired social interaction
A: Risk for injury

Q: A client with bipolar disorder is commanding another client to "Get me that book; take this other stuff out of here," and so forth. The nurse wants to interrupt this behavior without entering into a power struggle with the client. What is the best approach to use?
- humor: "How much are you paying servants these days?"
- distraction: "Let's go to the dining room for a snack."
- limit setting: "You must stop ordering other clients around."
- honest feedback: "Your behavior is annoying other clients."
A: distraction: "Let's go to the dining room for a snack."

Q: When a client displaying acute mania is admitted to a psychiatric unit, what initial nursing intervention should be planned?
- Allowing the client to act out feelings because a safe environment can be provided
- Providing verbal instructions to the client to try to remain calm
- Being available to set limits on client behavior as necessary
- Restraining the client to reduce hyperactivity and aggression
A: Being available to set limits on client behavior as necessary

Q: A depressed client is receiving imipramine (Tofranil) 300 mg daily. What side effect of this drug should have immediate medical attention?
- dry mouth.
- blurred vision.
- nasal congestion.
- urinary retention.
A: urinary retention.

Q: Of the following clients on a medical-surgical unit, which one should be observed most closely by staff for symptoms of depression?
- L, age 36 years, married, diagnosis of laparoscopic cholecystectomy
- M, age 42 years, single, diagnosis of postoperative bilateral vein ligation
- T, age 24 years, married, diagnosis of infectious hepatitis
- C, age 38 years, divorced, diagnosis of testicular carcinoma
A: C, age 38 years, divorced, diagnosis of testicular carcinoma

Q: A client is diagnosed with bipolar, manic phase. Which of the following would receive nursing priority?
- Insisting that the client bathes everyday.
- Providing monitored rest periods.
- Keeping the client away from other clients
- Strict monitoring of the client's phone use
A: Providing monitored rest periods.

Q: A newly admitted manic client has become vulgar in her language. This is disturbing to the other clients on the unit. The nurse's best initial intervention should be to
- Seclude her and tell her why.
- Walk with her to her room to reduce environmental stimuli.
- Tell her those kinds of comments are not allowed here.
- Tell her she is not acting like the lady she is.
A: Walk with her to her room to reduce environmental stimuli.

Q: When assessing an eating disorder client's behaviors after she has
consumed a meal, what is the nurse most concerned with?
- monitoring for, and interrupting purging.
- monitoring for the bulimic client's attempts to hoard food
- weighing the anorexic client to assure adequate intake
- encouraging the bulimic client's involvement in exercise to burn the excess calories
A: monitoring for, and interrupting purging.

Q: What physical symptom is evident in clients with bulimia?
- prominent parotid glands.
- lanugo
- thin, brittle hair.
- amenorrhea.
A: prominent parotid glands.

Q: What instructions should be included in a medication teaching plan for a client taking lithium?
- maintain normal salt and fluids in the diet.
- drink twice the usual daily amount of fluid.
- double the lithium dose if diarrhea or vomiting occurs.
- avoid eating aged cheese, processed meats, and red wine.
A: maintain normal salt and fluids in the diet.

Q: Planned interventions for a severely depressed client should include
- allowing the client to remain alone if he or she prefers.
- careful observation around the clock.
- encouraging the client to spend a major portion of each day in bed.
- opportunities to assume a leadership role in the therapeutic milieu.
A: careful observation around the clock.

Q: The wife of a client with schizophrenia is worried about her 17-year-old daughter and asks the nurse what symptoms mark the early/prodromal stage of schizophrenia. What symptoms should the nurse make the mother aware of?
- withdrawal, misinterpreting, poor concentration, and preoccupation with religion.
- auditory hallucinations, ideas of reference, thought insertion, and broadcasting.
- stereotyped behavior, echopraxia, echolalia, and waxy flexibility.
- loose associations, concrete thinking, and echolalia neologisms.
A: withdrawal, misinterpreting, poor concentration, and preoccupation with religion.

Q: A client's nursing care plan includes assessment for auditory hallucinations. What symptoms would suggest the client may be hallucinating?
- aloofness, haughtiness, and suspicion.
- elevated mood, hyperactivity, and distractibility.
- performing rituals and avoiding open places.
- darting eyes, tilted head, and mumbling to self.
A: darting eyes, tilted head, and mumbling to self.

Q: Social isolation related to lack of trust is one nursing diagnosis for a suspicious client. What behavior would show that this problem is resolved?
- He remains in his room most of the time.
- He sits alone during group activities
- He approaches other for interaction.
- He socialized when staff reminds him.
A: He approaches other for interaction.

Q: A client referred to the eating disorders clinic has lost 35 pounds during the summer. She was referred by her physician, who was alarmed by her weight loss. To best assess the client's eating patterns, what question should the nurse ask?
- "Do you often feel fat?"
- "Who plans the family meals?"
- "What do you eat in a typical day?"
- "What do you think about your present weight?"
A: "What do you eat in a typical day?"

Q: A client received maintenance doses of Thorazine daily for 2 years. The clinic nurse notes the client is grimacing and seems to be constantly smacking her lips. Her tongue goes in and out involuntarily. What side effects are the symptoms consistent with?
- agranulocytosis.
- tardive dyskinesia.
- Tourette's syndrome.
- anticholinergic effects.
A: tardive dyskinesia.

Q: The nurse is caring for a client with paranoid schizophrenia who is noncompliant with medication. The client repeatedly states he does not like taking pills. What treatment strategy should the nurse discuss with the physician?
- use of an antipsychotic decanoate preparation.
- adjunctive use of amitriptyline (Elavil).
- use of benzodiazepines such as diazepam (Valium).
- use of chlordiazepoxide (Librium).
A: use of an antipsychotic decanoate preparation.

Q: A client with schizophrenia who admits to auditory hallucinations anxiously tells the nurse "The voice is telling me to do things." What is a priority assessment question the nurse should ask?
- "Do you recognize the voice speaking to you?'
- "How long has the voice been directing your behavior?"
- "Does what the voice tell you to do frighten you?"
- "What is the voice telling you to do?"
A: "What is the voice telling you to do?"

Q: The nurse is sitting with a client diagnosed as having schizophrenia, disorganized type, who starts to laugh uncontrollably, although the nurse has not said anything funny. What should the nurse say?
- "Please share the joke with me."
- "Why are you laughing?"
- "I don't think I said anything funny."
- "You're laughing. Tell me what's happening."
A: "You're laughing. Tell me what's happening."

Q: The nurse initiates contact at frequent intervals and makes sure a client is out of his room at least three times daily. Which symptoms will the nurse's interventions best treat?
- A reclusive, withdrawn client who fantasizes.
- The suspicious client who has delusions of control.
- The client who actively socializes with peers.
- The client who is verbally and physically combative.
A: A reclusive, withdrawn client who fantasizes.

Q: What nursing intervention of high priority will best assist a client with a somatoform disorder?
- shift focus from somatic symptoms to feelings.
- imply that somatic symptoms are not real.
- help client suppress feelings of anger.
- focus on each physical symptom as it is offered.
A: shift focus from somatic symptoms to feelings.

Q: Mrs. Ellis is diagnosed with a delusional disorder. She attacked her husband's secretary because she believes his secretary is having an affair with him. An appropriate nursing diagnosis for Mrs. Ellis is?
- Disturbed sensory perception
- Impaired verbal communications
- Self-esteem disturbance
- Disturbed thought processes
A: Disturbed thought processes

Q: To evaluate the effectiveness of interventions for most schizophrenic clients, the nurse should observe for behavioral changes related to which primary symptoms?
- Aggression, agitation, acute confusion
- Autism, ambivalence, inappropriate affect, loose associations
- Amnesia, anhedonia, apathy, aphasia
- Aphasia, akathesia, anxiety, agitation
A: Autism, ambivalence, inappropriate affect, loose associations

Q: A combat veteran has intrusive thoughts of missiles screaming toward him and exploding. He re-experiences feelings of terror first experienced in combat. What illness do these recurrent events indicate?
- obsessive-compulsive disorder.
- generalized anxiety disorder.
- panic disorder with agoraphobia.
- posttraumatic stress disorder.
A: posttraumatic stress disorder.

Q: Which statement made by a client who washes his hands compulsively identifies the thinking typical of a client with obsessive-compulsive disorder?
- "I know I'll get my hands clean eventually: it just takes time.
- "I need a milder soap that will not damage my hands so much."
- "I feel driven to wash my hands, although I do not like doing it."
- "I feel so much better when my hands are clean. I can get on to do other things."
A: "I feel driven to wash my hands, although I do not like doing it."

Q: A client tells the nurse that she wants her physician to prescribe diazepam (Valium) for anxiety reduction. The physician has prescribed buspirone (BuSpar). The nurse's reply should emphasize that an advantage of buspirone (Buspar) is?
- That it can be administered PRN.
- That it does not predispose the client to blood dyscrasias.
- That it is not habituating.
- That it is faster acting.
A: That it is not habituating.

Q: A client reveals that he becomes panic stricken when he sees a dog. This behavior indicates which psychiatric disorder?
- social phobia.
- specific phobia.
- agoraphobia.
- generalized anxiety disorder.
A: specific phobia.

Q: Which of the following is the most appropriate short-term goal for a client with a phobic disorder? The client will:
- Repress fears and feelings of anxiety.
- Eliminate anxiety-evoking situations.
- Function in anxiety evoking situations without experiencing severe anxiety.
- Recover from deficits in motor functioning.
A: Function in anxiety evoking situations without experiencing severe anxiety.

Q: An outcome for an anxious client is to learn one positive way to better cope with stress and anxiety. Which statement by the client demonstrates progress?
- "I've learned a couple of beers help me calm down"
- " I'm learning not to overreact to everything"
- "I take another Xanax when I feel edgy."
- "I deal with my stress by working harder."
A: " I'm learning not to overreact to everything"

Q: A new client with an obsessive-compulsive disorder goes to her room to unpack. Thirty minutes later, the nurse observes her folding and unfolding her clothes several times. Which intervention by the nurse is best?
- Give the client a task to complete to get her mind off the ritual.
- Allow the client as much time as she needs to perform the ritual.
- Interrupt the client and engage her in an activity.
- Inform the client that she must join the other clients in the day room.
A: Allow the client as much time as she needs to perform the ritual.