1. Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe:
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:
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:
c. Self blame
7. Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the “rotten nursing care”. When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of:
d. Reaction formation
8. The most critical factor for nurse Linda to determine during crisis intervention would be the client’s:
a. Available situational supports
b. Willingness to restructure the personality
c. Developmental theory
d. Underlying unconscious conflict
9. Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis.These groups are successful because the:
a. Crisis intervention worker is a psychologist and understands behavior patterns
b. Crisis group supplies a workable solution to the client’s problem
c. Client is encouraged to talk about personal problems
d. Client is assisted to investigate alternative approaches to solving the identified problem
10. Nurse Ronald could evaluate that the staff’s approach to setting limits for a demanding, angry client was effective if the client:
a. Apologizes for disrupting the unit’s routine when something is needed
b. Understands the reason why frequent calls to the staff were made
c. Discuss concerns regarding the emotional condition that required hospitalizations
d. No longer calls the nursing staff for assistance
11. Nurse John is aware that the therapy that has the highest success rate for people with phobias would be:
a. Psychotherapy aimed at rearranging maladaptive thought process
b. Psychoanalytical exploration of repressed conflicts of an earlier development phase
c. Systematic desensitization using relaxation technique
d. Insight therapy to determine the origin of the anxiety and fear
12. When nurse Hazel considers a client’s placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client’s:
a. Perceptual field
b. Delusional system
c. Memory state
d. Creativity level
13. In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3 year old child to demonstrate:
a. An interest in music
b. An attachment to odd objects
c. Ritualistic behavior
d. Responsiveness to the parents
14. Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from worms chewing on them.” This statement indicates a:
a. Jealous delusion
b. Somatic delusion
c. Delusion of grandeur
d. Delusion of persecution
15. Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expects the assessment to reveal:
a. Coldness, detachment and lack of tender feelings
b. Somatic symptoms
c. Inability to function as responsible parent
d. Unpredictable behavior and intense interpersonal relationships
16. PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions?
a. Antipsychotic – induced akathisia and anxiety
b. Obsessive – compulsive disorder (OCD) to reduce ritualistic behavior
c. Delusions for clients suffering from schizophrenia
d. The manic phase of bipolar illness as a mood stabilizer
17. Which medication can control the extra pyramidal effects associated with antipsychotic agents?
a. Clorazepate (Tranxene)
b. Amantadine (Symmetrel)
c. Doxepin (Sinequan)
d. Perphenazine (Trilafon)
18. Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants?
a. Don’t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
b. Have blood levels screened weekly for leucopenia
c. Avoid strenuous activity because of the cardiac effects of the drug
d. Don’t take prescribed or over the counter medications without consulting the physician
19. Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience:
a. Heightened concentration
b. Decreased perceptual field
c. Decreased cardiac rate
d. Decreased respiratory rate
20. Initial interventions for Marco with acute anxiety include all except which of the following?
a. Touching the client in an attempt to comfort him
b. Approaching the client in calm, confident manner
c. Encouraging the client to verbalize feelings and concerns
d. Providing the client with a safe, quiet and private place
21. Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:
22. When performing a physical examination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system?
a. Muscle tension
b. Hyperactive bowel sounds
c. Decreased urine output
23. Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?
a. Divalproex (depakote) and Lithium (lithobid)
b. Chlordiazepoxide (Librium) and diazepam (valium)
c. Fluvoxamine (Luvox) and clomipramine (anafranil)
d. Benztropine (Cogentin) and diphenhydramine (benadryl)
24. Tony with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobia include:
a. Severe anxiety and fear
b. Withdrawal and failure to distinguish reality from fantasy
c. Depression and weight loss
d. Insomnia and inability to concentrate
25. Which nursing action is most appropriate when trying to diffuse a client’s impending violent behavior?
a. Place the client in seclusion
b. Leaving the client alone until he can talk about his feelings
c. Involving the client in a quiet activity to divert attention
d. Helping the client identify and express feelings of anxiety and anger
26. Rosana is in the second stage of Alzheimer’s disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?
a. “Where is your pain located?”
b. “Do you hurt? (pause) “Do you hurt?”
c. “Can you describe your pain?”
d. “Where do you hurt?”
27. Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for:
a. General anesthesia
b. Cardiac stress testing
c. Neurologic examination
d. Physical therapy
28. Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods?
a. Figs and cream cheese
b. Fruits and yellow vegetables
c. Aged cheese and Chianti wine
d. Green leafy vegetables
29. Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find:
a. Permanent short-term memory loss and hypertension
b. Permanent long-term memory loss and hypomania
c. Transitory short-term memory loss and permanent long-term memory loss
d. Transitory short and long term memory loss and confusion
30. Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium?
d. Sexual dysfunction
31. Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent?
a. Suspiciousness, dilated pupils and incomplete BP
b. Agitation, hyperactivity and grandiose ideation
c. Combativeness, sweating and confusion
d. Emotional lability, euphoria and impaired memory
32. Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information?
a. Restrict fluids and sodium intake
b. Don’t consume alcohol
c. Discontinue if dry mouth and blurred vision occur
d. Restrict fluid and sodium intake
33. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?
a. Increased incidence of dysmenorrhea while taking the drug
b. Occurrence of incomplete libido due to medication adverse effects
c. Continuing previous use of contraception during periods of amenorrhea
d. Instruction that amenorrhea is irreversible
34. A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client?
a. Income level and living arrangements
b. Involvement of family and support systems
c. Reason for inpatient admission
d. Reason for refusal to take medications
35. The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change?
a. Decreased dopamine level
b. Increased acetylcholine level
c. Stabilization of serotonin
d. Stimulation of GABA
36. Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients?
a. Central Nervous System effects
b. Cardiovascular system effects
c. Gastrointestinal system effects
d. Serotonin syndrome effects
37. A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Psychiatric care in this treatment plan is based on which framework?
a. Behavioral framework
b. Cognitive framework
c. Interpersonal framework
d. Psychodynamic framework
38. A nurse who explains that a client’s psychotic behavior is unconsciously motivated understands that the client’s disordered behavior arises from which of the following?
a. Abnormal thinking
b. Altered neurotransmitters
c. Internal needs
d. Response to stimuli
39. A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client’s employer expects the client to return to work following inpatient treatment. The client tells the nurse, “I’m no good. I’m a failure”. According to cognitive theory, these statements reflect:
a. Learned behavior
b. Punitive superego and decreased self-esteem
c. Faulty thought processes that govern behavior
d. Evidence of difficult relationships in the work environment
40. The nurse describes a client as anxious. Which of the following statement about anxiety is true?
a. Anxiety is usually pathological
b. Anxiety is directly observable
c. Anxiety is usually harmful
d. Anxiety is a response to a threat
41. A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?
a. Help the client execute actions that are feared
b. Help the client develop insight into irrational fears
c. Help the client substitutes one fear for another
d. Help the client decrease anxiety
42. Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder?
a. The client exhibits charming behavior when around authority figures
b. The client has decreased episodes of impulsive behaviors
c. The client makes statements of self-satisfaction
d. The client’s statements indicate no remorse for behaviors
43. The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms?
a. Pathophysiology of disease process
b. Principles of good nutrition
c. Side effects of medications
d. Stress management techniques
44. Which of the following is the most distinguishing feature of a client with an antisocial personality disorder?
a. Attention to detail and order
b. Bizarre mannerisms and thoughts
c. Submissive and dependent behavior
d. Disregard for social and legal norms
45. Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations?
b. Disturbed body image
c. Defensive coping
46. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?
a. The parents reinforced increased decision making by the client
b. The parents clearly verbalize their expectations for the client
c. The client verbalizes that family meals are now enjoyable
d. The client tells her parents about feelings of low-self esteem
47. A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach?
a. Agree with the client’s painful feelings
b. Challenge the accuracy of the client’s belief
c. Deny that the situation is hopeless
d. Present a cheerful attitude
48. A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself?
a. Art therapy in a small group
b. Basketball game with peers on the unit
c. Reading a self-help book on depression
d. Watching movie with the peer group
49. The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:
a. Managing his hallucinations
b. Medication teaching
c. Social skills training
d. Vocational training
50. Which activity would be most appropriate for a severely withdrawn client?
a. Art activity with a staff member
b. Board game with a small group of clients
c. Team sport in the gym
d. Watching TV in the dayroom
Answers and Rationale Psychiatric Nursing Part 2
1. B. There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.
2. A. Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.
3. D. These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.
4. B. Whether there is a suicide plan is a criterion when assessing the client’s determination to make another attempt.
5. A. Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.
6. C. These children often have nonsexual needs met by individual and are powerless to refuse.Ambivalence results in self-blame and also guilt.
7. B. The client’s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.
8. A. Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.
9. D. Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic situations using rational and flexible problem solving methods.
10. C. This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.
11. C. The most successful therapy for people with phobias involves behavior modification techniques using desensitization.
12. A. Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.
13. D. One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.
14. B. Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal parasites and misshapen parts.
15. D. A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive.
16. A. Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.
17. B. Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle movements, pseudoparkinsonism and tar dive dyskinesia.
18. D. 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.
19. B. Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention andinability to concentrate.
20. A. The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety.
21. D. Diarrhea is a common physiological response to stress and anxiety.
22. B. The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.
23. C. The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.
24. A. Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia and elevated B.P.
25. D. In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as “What happened to get you this angry?” may help the client verbalizes feelings rather than act on them.
26. B. When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no” whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.
27. A. The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.
28. C. Aged cheese and Chianti wine contain high concentrations of tyramine.
29. D. ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and long term memory loss.
30. A. Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.
31. D. Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.
32. B. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants.
33. C. Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation thus, the client can still be pregnant.
34. D. The first are for assessment would be the client’s reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication. The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission.
35. A. Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.
36. B. The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.
37. B. Cognitive thinking therapy focuses on the client’s misperceptions about self, others and the world that impact functioning and contribute to symptoms. Using medications to alter neurotransmitter activity is a psychobiologic approach to treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.
38. C. The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.
39. C. The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory. Option 4 is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment.
40. D. Anxiety is a response to a threat arising from internal or external stimuli.
41. A. Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another. Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing activities that typically are avoided as part of the phobic response.
42. B. A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore, decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.
43. D. In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.
44. D. Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.
45. D. The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.
46. A. One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.
47. B. Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.
48. A. Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity. Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that interaction will occur; therefore, the client may remain isolated.
49. C. Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.
50. A. The best approach with a withdrawn client is to initiate brief, nondemanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client. A board game with a group clients or playing a team sport in the gym may overwhelm a severely withdrawn client. Watching TV is a solitary activity that will reinforce the client’s withdrawal from others.