Practice questions Flashcards
(109 cards)
1
Q
Mr. J. is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of psychosocial development (according to Erikson) would you place Mr. J.?
a. Intimacy vs. isolation
b. Generativity vs. self-absorption
c. Trust vs. mistrust
d. Autonomy vs. shame and doubt
A
B
2
Q
Mr. J. has been diagnosed with Schizophrenia. He refuses to eat, and told the nurse he knew he was “being poisoned.” According to Erikson’s theory, in what developmental stage would you place Mr. J.?
a. Intimacy vs. isolation
b. Generativity vs. self-absorption
c. Trust vs. mistrust
d. Autonomy vs. shame and doubt
A
C
3
Q
Janet, a psychiatric client diagnosed with Borderline Personality Disorder, has just been hospitalized for threatening suicide. According to Mahler’s theory, Janet did not receive the critical “emotional refueling” required during the rapprochement phase of development. What are the consequences of this deficiency?
a. She has not yet learned to delay gratification.
b. She does not feel guilt about wrongdoings to others.
c. She is unable to trust others.
d. She has internalized rage and fears of abandonment.
A
D
4
Q
John is on the Alcohol Treatment Unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the remote and changes the channel, saying, “That’s a stupid program! I want to watch something else!” In what stage of development is John fixed according to Sullivan’s interpersonal theory?
a. Juvenile. He is learning to form satisfactory peer relationships.
b. Childhood. He has not learned to delay gratification.
c. Early adolescence. He is struggling to form an identity.
d. Late adolescence. He is working to develop a lasting relationship.
A
B
5
Q
Adam has Antisocial Personality Disorder. He says to the nurse, “I’m not crazy. I’m just fun-loving. I believe in looking out for myself. Who cares what anyone thinks? If it feels good, do it!” Which of the following describes the psychoanalytical structure of Adam’s personality?
a. Weak id, strong ego, weak superego
b. Strong id, weak ego, weak superego
c. Weak id, weak ego, punitive superego
d. Strong id, weak ego, punitive superego
A
B
6
Q
Danny has been diagnosed with Schizophrenia. On the unit he appears very anxious, paces back and forth, and darts his head from side to side in a continuous scanning of the area. He has refused to eat, making some barely audible comment related to “being poisoned.” In planning care for Danny, which of the following would be the primary focus for nursing?
a. To decrease anxiety and develop trust
b. To set limits on his behavior
c. To ensure that he gets to group therapy
d. To attend to his hygiene needs
A
A
7
Q
- A decrease in which of the following neurotransmitters has been implicated in depression?
a. GABA, acetylcholine, and aspartate
b. Norepinephrine, serotonin, and dopamine
c. Somatostatin, substance P, and glycine
d. Glutamate, histamine, and opioid peptides
A
B
8
Q
11. Psychotropic medications that block the reuptake of serotonin may result in which of the following side effects? a. Dry mouth b. Constipation c. Blurred vision d. Sexual dysfunction
A
D
9
Q
12. Psychotropic medications that block the acetylcholine receptor may result in which of the following side effects? a. Dry mouth b. Sexual dysfunction c. Nausea d. Priapism
A
A
10
Q
13. Psychotropic medications that are strong blockers of the D2 receptor may result in which of the following side effects? a. Sedation b. Urinary retention c. Extrapyramidal symptoms d. Hypertensive crisis
A
C
11
Q
- An example of a treatable (reversible) form of NCD is one that is caused by which of the following? Select all that apply.
a. Multiple sclerosis
b. Multiple small brain infarcts
c. Electrolyte imbalances
d. HIV disease
e. Folate deficiency
A
C, E
12
Q
- Mrs. G has been diagnosed with NCD due to Alzheimer’s disease. The cause of this disorder is which of the following?
a. Multiple small brain infarcts
b. Chronic alcohol abuse
c. Cerebral abscess
d. Unknown
A
D
13
Q
- Mrs. G has been diagnosed with NCD due to Alzheimer’s disease. The primary nursing intervention in working with Mrs. G is which of the following?
a. Ensuring that she receives food she likes, to prevent hunger.
b. Ensuring that the environment is safe, to prevent injury.
c. Ensuring that she meets the other patients, to prevent social isolation.
d. Ensuring that she takes care of her own ADLs, to prevent dependence
A
B
14
Q
- Which of the following medications have been indicated for improvement in cognitive functioning in mild to moderate Alzheimer’s disease? Select all that apply.
a. Donepezil (Aricept)
b. Rivastigmine (Exelon)
c. Risperidone (Risperdal)
d. Sertraline (Zoloft)
e. Galantamine (Razadyne)
A
A, D, E
15
Q
- Mrs. G, who has NCD due to Alzheimer’s disease, says to the nurse, “I have a date tonight. I always have a date on Christmas.” Which of the following is the most appropriate response?
a. “Don’t be silly. It’s not Christmas, Mrs. G.”
b. “Today is Tuesday, Oct. 21, Mrs. G. We will have supper soon, and then your daughter will come to visit.”
c. “Who is your date with, Mrs. G?”
d. “I think you need some more medication, Mrs. G. I’ll bring it to you now.”
A
B
16
Q
- In addition to disturbances in cognition and orientation, individuals with Alzheimer’s disease may also show changes in which of the following? Select all that apply.
a. Personality
b. Vision
c. Speech
d. Hearing
e. Mobility
A
A, C, E
17
Q
- Mrs. G, who has NCD due to Alzheimer’s disease, has trouble sleeping and wanders around at night. Which of the following nursing actions would be best to promote sleep in Mrs. G?
a. Ask the doctor to prescribe flurazepam (Dalmane).
b. Ensure that Mrs. G gets an afternoon nap so she will not be overtired at bedtime.
c. Make Mrs. G a cup of tea with honey before bedtime.
d. Ensure that Mrs. G gets regular physical exercise during the day.
A
D
18
Q
- The night nurse finds Mrs. G, a client with Alzheimer’s disease, wandering the hallway at 4 a.m. andtrying to open the door to the side yard. Which statement by the nurse probably reflects the most
accurate assessment of the situation?
a. “That door leads out to the patio, Mrs. G. It’s nighttime. You don’t want to go outside now.”
b. “You look confused, Mrs. G. What is bothering you?”
c. “This is the patio door, Mrs. G. Are you looking for the bathroom?”
d. “Are you lonely? Perhaps you’d like to go back to your room and talk for a while.”
A
C
19
Q
- A client says to the nurse, “I read an article about Alzheimer’s and it said the disease is hereditary. My mother has Alzheimer’s disease. Does that mean I’ll get it when I’m old?” The nurse bases her response
on the knowledge that which of the following factors is not associated with increased incidence of NCD due to Alzheimer’s disease?
a. Multiple small strokes
b. Family history of Alzheimer’s disease
c. Head trauma
d. Advanced age
A
A
20
Q
- Mr. Stone is a client in the hospital with a diagnosis of Vascular NCD. In explaining this disorder to Mr. Stone’s family, which of the following statements by the nurse is correct?
a. “He will probably live longer than if his disorder was of the Alzheimer’s type.”
b. “Vascular NCD shows step-wise progression. This is why he sometimes seems okay.”
c. “Vascular NCD is caused by plaques and tangles that form in the brain.”
d. “The cause of vascular NCD is unknown.”
A
B
21
Q
- Which of the following interventions is most appropriate in helping a client with Alzheimer’s disease with her ADLs? Select all that apply.
a. Perform ADLs for her while she is in the hospital.
b. Provide her with a written list of activities she is expected to perform.
c. Assist her with step-by-step instructions.
d. Tell her that if her morning care is not completed by 9:00 a.m., it will be performed for her by the
nurse’s aide so that she can attend group therapy.
e. Encourage her and give her plenty of time to perform as many of her ADLs as possible independently
A
C, E
22
Q
- Tony, age 21, has been diagnosed with Schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Tony is to
a. give him an injection of Thorazine.
b. ensure a safe environment for him and others.
c. place him in restraints.
d. order him a nutritious diet.
A
B
23
Q
- The primary goal in working with an actively psychotic, suspicious client would be to
a. promote interaction with others.
b. decrease his anxiety and increase trust.
c. improve his relationship with his parents.
d. encourage participation in therapy activities.
A
B
24
Q
- The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Why is chlorpromazine ordered?
a. To reduce extrapyramidal symptoms
b. To prevent neuroleptic malignant syndrome
c. To decrease psychotic symptoms
d. To induce sleep
A
C
25
4. The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication?
a. The client’s level of agitation increases.
b. The client complains of a sore throat.
c. The client’s skin has a yellowish cast.
d. The client develops tremors and a shuffling gait.
D
26
5. Clint, a client on the psychiatric unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is:
a. “That’s ridiculous, Clint. No one is going to hurt you.”
b. “The CIA isn’t interested in people like you, Clint.”
c. “Why do you think the CIA wants to kill you?”
d. “I know you believe that, Clint, but it’s really hard for me to believe.”
D
27
6. Clint, a client on the psychiatric unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clint’s belief is an example of a
a. delusion of persecution.
b. delusion of reference.
c. delusion of control or influence.
d. delusion of grandeur.
A
28
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7. The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely
experiencing
a. somatic delusions.
b. catatonic stupor.
c. auditory hallucinations.
d. pseudoparkinsonism.
```
C
29
8. The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client’s illness. The most appropriate nursing intervention for this symptom is to:
a. ask the client to describe his physical symptoms.
b. ask the client to describe what he is hearing.
c. administer a dose of benztropine.
d. call the physician for additional orders.
B
30
9. When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first?
a. Provide large motor activities to relieve the client’s pent-up tension.
b. Administer a dose of prn chlorpromazine to keep the client calm.
c. Call for sufficient help to control the situation safely.
d. Convey to the client that his behavior is unacceptable and will not be permitted.
C
31
10. The primary focus of family therapy for clients with schizophrenia and their families is
a. to discuss concrete problem-solving and adaptive behaviors for coping with stress.
b. to introduce the family to others with the same problem.
c. to keep the client and family in touch with the health-care system.
d. to promote family interaction and increase understanding of the illness.
A
32
1. Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she “didn’t have anything more to live for.” She has
been hospitalized with Major Depressive Disorder. The priority nursing diagnosis for Margaret would be
a. imbalanced nutrition: less than body requirements.
b. complicated grieving.
c. risk for suicide.
d. social isolation.
C
33
2. The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68-year-old woman with Major Depressive Disorder. After 3 days of taking the medication, Margaret says to the nurse, “I don’t think this medicine is doing any good. I don’t feel a bit better.” What is the most appropriate response by the nurse?
a. “Cheer up, Margaret. You have so much to be happy about.”
b. “Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms.”
c. “I’ll report that to the physician, Margaret. Maybe he will order something different.”
d. “Try not to dwell on your symptoms, Margaret. Why don’t you join the others down in the dayroom?”
B
34
3. The goal of cognitive therapy with depressed clients is to
a. identify and change dysfunctional patterns of thinking.
b. resolve the symptoms and initiate or restore adaptive family functioning.
c. alter the neurotransmitters that are creating the depressed mood.
d. provide feedback from peers who are having similar experiences.
A
35
4. Education for the client who is taking monoamine oxidase inhibitors (MAOIs) should include which of the
following?
a. Fluid and sodium replacement when appropriate, frequent blood drug levels, signs and symptoms of
toxicity.
b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks.
c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment.
d. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician
notification.
D
36
5. In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? Select all that apply.
a. Don’t eat chocolate while taking this medication.
b. Keep taking this medication, even if you don’t feel it is helping. It sometimes takes a while to take
effect.
c. Don’t take this medication with the migraine drugs “triptans.”
d. Go to the lab each week to have your blood drawn for therapeutic level of this drug.
e. This drug causes a high degree of sedation, so take it just before bedtime.
B, C
37
6. A client has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply.
a. Slumped posture
b. Delusional thinking
c. Feelings of despair
d. Feels best early in the morning and worse as the day progresses
e. Anorexia
A, B, C, E
38
8. John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideations, and has been seeing the psychiatric nurse every three days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from his nurse at each visit. Today he comes to
the clinic in a cheerful mood, much different than he seemed just 3 days ago. How might the nurse assess this behavioral change?
a. The sertraline is finally taking effect.
b. He is no longer in need of antidepressant medication.
c. He has completed the grief response over loss of his wife.
d. He may have decided to carry out his suicide plan.
D
39
13. ECT is thought to effect a therapeutic response by
a. stimulation of the CNS.
b. decreasing the levels of acetylcholine and monoamine oxidase.
c. increasing the levels of serotonin, norepinephrine, and dopamine.
d. altering sodium metabolism within nerve and muscle cells.
C
40
1. Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she didn’t need it anymore. She is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. “I’m afraid she’s going to just collapse!” Margaret is
admitted to the psychiatric unit. The priority nursing diagnosis for Margaret is
a. imbalanced nutrition: less than body requirements related to not eating.
b. risk for injury related to hyperactivity.
c. disturbed sleep pattern related to agitation.
d. ineffective coping related to denial of depression.
B
41
2. Margaret, age 68, is diagnosed with Bipolar I Disorder, Current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to
a. sit with her during meals to ensure that she eats everything on her tray.
b. have her sister-in-law bring all her food from home because she knows Margaret’s likes and dislikes.
c. provide high-calorie, nutritious finger foods and snacks that Margaret can eat “on the run.”
d. tell Margaret that she will be on room restriction until she starts gaining weight.
C
42
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3. The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute
mania is
a. 1.0 to 1.5 mEq/L.
b. 10 to 15 mEq/L.
c. 0.5 to 1.0 mEq/L.
d. 5 to 10 mEq/L.
```
A
43
4. Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply.
a. Olanzepine (Zyprexa)
b. Paroxetine (Paxil)
c. Carbamazepine (Tegretol)
d. Gabapentin (Neurontin)
e. Tranylcypromine (Parnate)
A, C, D
44
5. Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the ED by her sister-in-law. Margaret yells, “My sister-in-law is just jealous of me! She’s trying to make it look like I’m insane!” This behavior is an example of a
a. delusion of grandeur.
b. delusion of persecution.
c. delusion of reference.
d. delusion of control or influence.
B
45
6. The most common comorbid condition in children with bipolar disorder is
a. schizophrenia.
b. substance disorder.
c. oppositional defiant disorder.
d. attention-deficit/hyperactivity disorder.
D
46
7. A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for?
a. Fever, sore throat, malaise
b. Tinnitus, severe diarrhea, ataxia
c. Occipital headache, palpitations, chest pain
d. Skin rash, marked rise in blood pressure, bradycardia
B
47
8. A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse?
a. Tell the client she cannot wear this outfit while she is in the hospital.
b. Do nothing and allow her to learn from the responses of her peers.
c. Quietly walk with her back to her room and help her change into something more appropriate.
d. Explain to her that if she wears this outfit she must remain in her room.
C
48
9. The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority.
______ a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night
______ b. Risk for injury related to manic hyperactivity
______ c. Impaired social interaction evidenced by manipulation of others
______ d. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin
turgor
B, D, A, C
49
10. A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these
comorbid conditions most likely be treated?
a. No medication would be given for either condition.
b. Medication would be given for both conditions simultaneously.
c. The bipolar condition would be stabilized first before medication for the ADHD would be given.
d. The ADHD would be treated before consideration of the bipolar disorder.
C
50
1. Which of the following is most likely to initiate a grief response in an individual?
a. Death of the pet dog
b. Being told by her doctor that she has begun menopause
c. Failing an examination
d. Answer a only
e. All of the above
E
51
```
2. Nancy, who is dying of cancer, says to the nurse, “I just want to see my new grandbaby. If only God will let me live until she is born. Then I’ll be ready to go.” This is an example of which of Kübler-Ross’s stages
of grief?
a. Denial
b. Anger
c. Bargaining
d. Acceptance
```
C
52
3. Gloria, a recent widow, states, “I’m going to have to learn to pay all the bills. Hank always did that. I don’t know if I can handle all of that.” This is an example of which of the tasks described by Worden?
a. Task I. Accepting the reality of the loss
b. Task II. Processing the pain of grief
c. Task III. Adjusting to a world without the lost entity
d. Task IV. Finding an enduring connection with the lost entity in the midst of embarking on a new life
C
53
4. Engel identifies which of the following as successful resolution of the grief process?
a. When the bereaved person can talk about the loss without crying
b. When the bereaved person no longer talks about the lost entity
c. When the bereaved person puts all remembrances of the loss out of sight
d. When the bereaved person can discuss both positive and negative aspects about the lost entity
D
54
5. Which of the following is thought to facilitate the grief process?
a. The ability to grieve in anticipation of the loss
b. The ability to grieve alone without interference from others
c. Having recently grieved for another loss
d. Taking personal responsibility for the loss
A
55
6. When Frank’s wife of 34 years dies, he is very stoic, handles all the funeral arrangements, doesn’t cry or appear sad, and comforts all of the other family members in their grief. Two years later, when Frank’s best friend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing on his job. This is an example of which of the following maladaptive responses to loss?
a. Delayed grieving
b. Distorted grieving
c. Prolonged grieving
d. Exaggerated grieving
A
56
7. A major difference between normal and maladaptive grieving has been identified by which of the following?
a. There are no feelings of depression in normal grieving.
b. There is no loss of self-esteem in normal grieving.
c. Normal grieving lasts no longer than 1 year.
d. In normal grief the person does not show anger toward the loss.
B
57
8. Which grief reaction can the nurse anticipate in a 10-year-old child?
a. Statements that the deceased person will soon return
b. Regressive behaviors, such as loss of bladder control
c. A preoccupation with the loss
d. Thinking that they may have done something to cause the death
C
58
9. Which of the following is a correct statement when attempting to distinguish normal grief from clinical
depression?
a. In clinical depression, anhedonia is prevalent.
b. In normal grieving, the person has generalized feelings of guilt.
c. The person who is clinically depressed relates feelings of depression to a specific loss.
d. In normal grieving, there is a persistent state of dysphoria
A
59
10. Which of the following is not true regarding grieving by an adolescent?
a. Adolescents may not show their true feelings about the death.
b. Adolescents tend to have an immortal attitude.
c. Adolescents do not perceive death as inevitable.
d. Adolescents may exhibit acting out behaviors as part of their grief.
C
60
1. A depressed client states, “I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again.” Which nursing response is appropriate?
1. “Medications only address biological factors. Environmental and interpersonal factors must also be considered.”
2. “Because biological factors are the sole cause of depression, medications will improve your mood.”
3. “Environmental factors have been shown to exert the most influence in the development of depression.”
4. “Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment).”
1
61
2. A client diagnosed with major depressive disorder asks, “What part of my brain controls my emotions?” Which nursing response is appropriate?
1. “The occipital lobe governs perceptions, judging them as positive or negative.”
2. “The parietal lobe has been linked to depression.”
3. “The medulla regulates key biological and psychological activities.”
4. “The limbic system is largely responsible for one’s emotional state.”
4
62
3. Which part of the nervous system should a nurse identify as playing a major role during stressful situations?
1. Peripheral nervous system
2. Somatic nervous system
3. Sympathetic nervous system
4. Parasympathetic nervous system
3
63
4. Which client statement reflects an understanding of circadian rhythms in psychopathology?
1. “When I dream about my mother’s horrible train accident, I become hysterical.”
2. “I get really irritable during my menstrual cycle.”
3. “I’m a morning person. I get my best work done before noon.”
4. “Every February, I tend to experience periods of sadness.”
3
64
5. Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?
1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy.
2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill.
3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents.
4. Studies in which monozygotic twins were raised together by mentally ill biological parents.
5. All of the above.
5
65
7. A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior?
1. Dendrites
2. Axons
3. Neurotransmitters
4. Synapses
3
66
8. An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?
1. Regeneration
2. Reuptake
3. Recycling
4. Retransmission
2
67
A nurse concludes that a restless, agitated client is manifesting a fight- or-flight response. The nurse should associate this response with which neurotransmitter?
1. Acetylcholine
2. Dopamine
3. Serotonin
4. Norepinephrine
4
68
10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client’s neurotransmitters should a nurse expect to be elevated?
1. Serotonin
2. Dopamine
3. Gamma-aminobutyric acid (GABA)
4. Histamine
2
69
11. A client’s wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client’s therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist’s recommendations?
1. The therapist is using an interpersonal approach.
2. The client has an alteration in neurotransmitters.
3. It is routine practice to remind clients about nutrition, exercise, and rest.
4. The client is susceptible to illness because of effects of stress on the immune system.
4
70
Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level?
1. Major depressive episode
2. Schizophrenia
3. Anorexia nervosa
4. Alzheimer’s disease
2
71
14. A nurse understands that the abnormal secretion of growth hormone may play a role in which illness?
1. Acute mania
2. Schizophrenia
3. Anorexia nervosa
4. Alzheimer’s disease
3
72
15. A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms?
1. Abnormal levels of serotonin
2. Decreased levels of dopamine
3. Increased levels of norepinephrine
4. Decreased levels of acetylcholine
4
73
16. A nurse should recognize that a decrease in norepinephrine levels would play a significant role in the development of which mental illness?
1. Bipolar disorder: mania
2. Schizophrenia spectrum disorder
3. Generalized anxiety disorder
4. Major depressive episode
4
74
17. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness?
1. Schizophrenia spectrum disorder
2. Major depressive disorder
3. Body dysmorphic disorder
4. Parkinson’s disease
1
75
1. A jilted college student is admitted to a hospital following a suicide attempt and states, “No one will ever love a loser like me.” According to Erikson’s theory of personality development, a nurse should recognize that this patient has a deficit in which developmental stage?
1. Trust versus mistrust
2. Initiative versus guilt
3. Intimacy versus isolation
4. Ego integrity versus despair
3
76
2. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed?
1. Learning to count on others
2. Learning to delay satisfaction
3. Identifying oneself
4. Developing skills in participation
2
77
4. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role?
1. Technical expert
2. Resource person
3. Surrogate
4. Leader
3
78
5. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept?
1. A possible genetic basis for the client’s problems
2. The structure and dynamics of the personality
3. Behavioral responses to stressors
4. Maladaptive cognitions
2
79
6. Which underlying concept should a nurse associate with interpersonal theory when assessing a client?
1. The effects of social processes on personality development
2. The effects of unconscious processes and personality structures
3. The effects on thoughts and perceptual processes
4. The effects of chemical and genetic influences
1
80
7. A physically healthy, 35-year-old, single client lives with parents, who provide total financial support. According to Erikson’s theory, which developmental task should a nurse assist the client to accomplish?
1. Establishing the ability to control emotional reactions
2. Establishing a strong sense of ethics and character structure
3. Establishing and maintaining self-esteem
4. Establishing a career, personal relationships, and societal connections
4
81
9. A 6-year-old boy uses his father’s flashlight to explore his 3-year-old sister’s genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal?
1. Oral
2. Anal
3. Phallic
4. Latency
3
82
10. A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson’s developmental theory?
1. Industry versus inferiority
2. Identity versus role confusion
3. Intimacy versus isolation
4. Generativity versus stagnation
3
83
11. A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson’s developmental theory?
1. Industry versus inferiority
2. Identity versus role confusion
3. Intimacy versus isolation
4. Generativity versus stagnation
1
84
12. A client has flashbacks of sexual abuse by her uncle. She had not had these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivan’s concept of the self-system?
1. The good me
2. The bad me
3. The not me
4. The bad you
3
85
13. According to Freud, which statement should a nurse associate with predominance of the superego?
1. “No one is looking, so I will take three cigarettes from Mom’s pack.”
2. “I don’t ever cheat on tests; it is wrong.”
3. “If I skip school, I will get into trouble and fail my test.”
4. “Dad won’t miss this little bit of vodka.”
2
86
14. A female complains that her husband only satisfies his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husband’s actions?
1. The id
2. The superid
3. The ego
4. The superego
1
87
1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?
1. Clarify personal attitudes, values, and beliefs.
2. Obtain thorough assessment data.
3. Determine the client’s length of stay.
4. Establish personal goals for the interaction.
1
88
2. If a client demonstrates transference toward a nurse, how should the nurse respond?
1. Promote safety and immediately terminate the relationship with the client.
2. Encourage the client to ignore these thoughts and feelings.
3. Immediately reassign the client to another staff member.
4. Help the client to clarify the meaning of the relationship, based on the present situation.
4
89
3. What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?
1. Acknowledge the client’s actions and generate alternative behaviors.
2. Establish rapport and develop treatment goals.
3. Attempt to find alternative placement.
4. Explore how thoughts and feelings about this client may adversely impact nursing care.
2
90
4. Which client action should a nurse expect during the working phase of the nurse-client relationship?
1. The client gains insight and incorporates alternative behaviors.
2. The client establishes rapport with the nurse and mutually develops treatment goals.
3. The client explores feelings related to reentering the community.
4. The client explores personal strengths and weaknesses that impact behavioral choices.
1
91
5. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship?
1. “I can’t bear the thought of leaving here and failing.”
2. “I might have a hard time working with you, because you remind me of my mother.”
3. “I really don’t want to talk any more about my childhood abuse.”
4. “I’m not sure that I can count on you to protect my confidentiality.”
3
92
6. A mother who is notified that her child was killed in a tragic car accident states, “I can’t bear to go on with my life.” Which nursing statement conveys empathy?
1. “This situation is very sad, but time is a great healer.”
2. “You are sad, but you must be strong for your other children.”
3. “Once you cry it all out, things will seem so much better.”
4. “It must be horrible to lose a child, and I’ll stay with you until your husband arrives.”
4
93
7. When an individual is “two-faced,” which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing?
1. Respect
2. Genuineness
3. Sympathy
4. Rapport
2
94
8. On which task should a nurse place priority during the working phase of relationship development?
1. Establishing a contract for intervention
2. Examining feelings about working with a particular client
3. Establishing a plan for continuing aftercare
4. Promoting the client’s insight and perception of reality
4
95
Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”
1. Restatement
2. Offering general leads
3. Focusing
4. Accepting
1
96
10. Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
1. Reflecting
2. Making observations
3. Formulating a plan of action
4. Giving recognition
3
97
11. The nurse is interviewing a newly admitted psychiatric client. Which of the following nursing statements is an example of offering a “general lead”?
1. “Do you know why you are here?”
2. “Are you feeling depressed or anxious?”
3. “Yes, I see. Go on.”
4. “Can you order the specific events that led to your admission?”
3
98
12. A nurse says to a client, “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
1. The therapeutic technique of giving advice
2. The therapeutic technique of defending
3. The nontherapeutic technique of presenting reality
4. The nontherapeutic technique of giving reassurance
4
99
13. A client diagnosed with post-traumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of “broad openings”?
1. “What occurred prior to the rape, and when did you go to the emergency department?”
2. “What would you like to talk about?”
3. “I notice you seem uncomfortable discussing this.”
4. “How can we help you feel safe during your stay here?”
2
100
16. What is a nurse’s purpose for providing appropriate feedback?
1. To give the client good advice
2. To advise the client on appropriate behaviors
3. To evaluate the client’s behavior
4. To give the client critical information
4
101
18. A mother rescues two of her four children from a house fire. In an emergency department, she cries, “I should have gone back in to get them. I should have died, not them.” What is the nurse’s best response?
1. “The smoke was too thick. You couldn’t have gone back in.”
2. “You’re experiencing feelings of guilt, because you weren’t able to save your children.”
3. “Focus on the fact that you could have lost all four of your children.”
4. “It’s best if you try not to think about what happened. Try to move on.”
2
102
17. A client exhibiting dependent behaviors says, “Do you think I should move from my parent’s house and get a job?” Which nursing response is most appropriate?
1. “It would be best to do that in order to increase independence.”
2. “Why would you want to leave a secure home?”
3. “Let’s discuss and explore all of your options.”
4. “I’m afraid you would feel very guilty leaving your parents.”
3
103
20. Which of the following characteristics should be included in a therapeutic nurse-client relationship? (Select all that apply.)
1. Meeting the psychological needs of the nurse and the client
2. Ensuring therapeutic termination
3. Promoting client insight into problematic behavior
4. Collaborating to set appropriate goals
5. Meeting both the physical and psychological needs of the client
2, 3, 4, 5
104
21. Which of the following individuals are communicating a message? (Select all that apply.)
1. A mother spanking her son for playing with matches
2. A teenage boy isolating himself and playing loud music
3. A biker sporting an eagle tattoo on his biceps
4. A teenage girl writing, “No one understands me”
5. A father checking for new e-mail on a regular basis
1, 2, 3, 4
105
1. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems?
1. Medical history is of little significance and can be eliminated from the nursing assessment.
2. Assessment provides a holistic view of the client, including biopsychosocial aspects.
3. Comprehensive assessments can be performed only by advanced practice nurses.
4. Psychosocial evaluations are gained by subjective reports rather than objective observations.
2
106
2. Which statement regarding nursing interventions should a nurse identify as accurate?
1. Nursing interventions are independent from the treatment team’s goals.
2. Nursing interventions are solely directed by written physician orders.
3. Nursing interventions occur independently but in concert with overall treatment team goals.
4. Nursing interventions are standardized by policies and procedures.
3
107
7. What is the purpose of a nurse gathering client information?
1. It enables the nurse to modify behaviors related to personality disorders.
2. It enables the nurse to make sound clinical judgments and plan appropriate care.
3. It enables the nurse to prescribe the appropriate medications.
4. It enables the nurse to assign the appropriate Axis I diagnosis.
2
108
10. How should a nurse prioritize nursing diagnoses?
1. By the established goal of care
2. By the life-threatening potential
3. By the physician’s priority of care
4. By the client’s preference
2
109
16. Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.)
1. Client outcomes are specifically formulated by nurses.
2. Client outcomes are not restricted by time frames.
3. Client outcomes are specific and measurable.
4. Client outcomes are realistically based on client capability.
5. Client outcomes are formally approved by the psychiatrist.
3, 4
