34903 Reviewer PSYCH

7/28/2019 34903 Reviewer PSYCH

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StuffedNurse : PSYCHIATRIC EXAM PRACTICE TEST

source: lippincott, mosby and incredibly easy nclex questionnaires

1. The nurse is caring for a client who experiences false sensory perceptions

with no basis in reality. These perceptions are known as:

a. delusions.

b. hallucinations.

c. loose associations.

d. neologisms.

RATIONALE: Hallucinations are visual, auditory, gustatory, tactile, or olfactory

perceptions that have no basis in reality. Delusions are false beliefs, rather

than perceptions, that the client accepts as real. Loose associations are rapid

shifts among unrelated ideas. Neologisms are bizarre words that have

meaning only to the client.

2. The nurse is caring for a client who is suicidal. When accompanying the

client to the bathroom, the nurse should:

a. give him privacy in the bathroom.

b. allow him to shave.

c. open the window and allow him to get some fresh air.

d. observe him.

RATIONALE: The nurse has a responsibility to observe continuously the

acutely suicidal client not provide privacy. The nurse should watch for clues,

such as communicating suicidal thoughts, threats, and messages; hoarding

medications; and talking about death. By accompanying the client to the

bathroom, the nurse will naturally prevent hanging or other injury. The nurse

will check the client's area and fix dangerous conditions, such as exposed

pipes and windows without safety glass. The nurse will also remove

potentially dangerous objects, such as belts, razors, suspenders, glass, and
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knives.

3. The nurse is developing a care plan for a client with anorexia nervosa.

Which action should the nurse include in the plan?

a. Restrict visits with the family until the client begins to eat.

b. Provide privacy during meals.

c. Set up a strict eating plan for the client.

d. Encourage the client to exercise, which will reduce her anxiety.

RATIONALE: Establishing a consistent eating plan and monitoring the client's

weight are important for this disorder. The family should be included in theclient's care. The client should be monitored during meals not given privacy.

Exercise must be limited and supervised.

4. A client whose husband recently left her is admitted to the hospital with

severe depression. The nurse suspects that the client is at risk for suicide.

Which of the following questions would be most appropriate and helpful for

the nurse to ask during an assessment for suicide risk?

a. "Are you sure you want to kill yourself?"

b. "I know if my husband left me, I'd want to kill myself. Is that what you

think?"

c. "How do you think you would kill yourself?"

d. "Why don't you just look at the positives in your life?"

RATIONALE: To determine if a client is at risk for suicide, ask, "How do you

think you would kill yourself?" If the client has a plan, she may be closer to

carrying out the act. Option 1 requires a yes-or-no response and is self-

limiting. In option 2, the nurse is telling the client what to think and feel.Option 4 dismisses the client's feelings

5. The nurse is caring for a client who she believes has been abusing opiates.

Assessment findings in a client abusing opiates, such as morphine, include:


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a. dilated pupils and slurred speech.

b. rapid speech and agitation.

c. dilated pupils and agitation.

d. euphoria and constricted pupils.

RATIONALE: Assessment findings in a client abusing opiates include agitation,

slurred speech, euphoria, and constricted pupils.

6. The nurse is caring for a client experiencing an anxiety attack. Appropriate

nursing interventions include:

a. turning on the lights and opening the windows so that the client doesn't feelcrowded.

b. leaving the client alone.

c. staying with the client and speaking in short sentences.

d. turning on stereo music.

RATIONALE: Appropriate nursing interventions for an anxiety attack include

using short sentences, staying with the client, decreasing stimuli, remaining

calm, and medicating as needed. Leaving the client alone, turning on a stereo

or lights, and opening windows may increase the client's anxiety.

7. The nurse is teaching a new group of mental health aides. The nurse should

teach the aides that setting limits is most important for:

a. a depressed client.

b. a manic client.

c. a suicidal client.d. an anxious client.

RATIONALE: Setting limits for unacceptable behavior is most important in a

manic client. Typically, depressed, anxious, or suicidal clients don't physically

or mentally test the limits of the caregiver.


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8. A client is admitted with a diagnosis of delusions of grandeur. This

diagnosis reflects a belief that one is:

a. highly important or famous.

b. being persecuted.

c. connected to events unrelated to oneself.

d. responsible for the evil in the world.

RATIONALE: A delusion of grandeur is a false belief that one is highly

important or famous. A delusion of persecution is a false belief that one is

being persecuted. A delusion of reference is a false belief that one is

connected to events unrelated to oneself or a belief that one is responsible forthe evil in the world.

9. The nurse is caring for a client, a Vietnam veteran, who exhibits signs and

symptoms of posttraumatic stress disorder. Signs and symptoms of

posttraumatic stress disorder include:

a. hyperalertness and sleep disturbances.

b. memory loss of traumatic event and somatic distress.

c. feelings of hostility and violent behavior.

d. sudden behavioral changes and anorexia.

RATIONALE: Signs and symptoms of posttraumatic stress disorder include

hyperalertness, sleep disturbances, exaggerated startle, survival guilt, and

memory impairment. Also, the client relives the traumatic event through

dreams and recollections. Hostility, violent behavior, and anorexia aren't usual

signs or symptoms of posttraumatic stress disorder

10. The nurse is caring for a client with manic depression. The care plan for a

client in a manic state would include:

a. offering high-calorie meals and strongly encouraging the client to finish all


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food.

b. insisting that the client remain active throughout the day so that he'll sleep

at night.

c. allowing the client to exhibit hyperactive, demanding, manipulative behavior

without setting limits.

d. listening attentively with a neutral attitude and avoiding power struggles.

RATIONALE: The nurse should listen to the client's requests, express

willingness to seriously consider the requests, and respond later. The nurse

should encourage the client to take short daytime naps because he expends so

much energy. The nurse shouldn't try to restrain the client when he feels the

need to move around as long as his activity isn't harmful. High-calorie finger

foods should be offered to supplement the client's diet, if he can't remainseated long enough to eat a complete meal. The client shouldn't be forced to

stay seated at the table to finish a meal. The nurse should set limits in a calm,

clear, and self-confident tone of voice

11. A client is a Vietnam War veteran with a diagnosis of posttraumatic stress

disorder. He has a history of nightmares, depression, hopelessness, and

alcohol abuse. Which option offers the client the most lasting relief of his

symptoms?

a. The opportunity to verbalize memories of trauma to a sympathetic listener

b. Family support

c. Prescribed medications taken as ordered

d. Alcoholics Anonymous (AA) meetings

RATIONALE: Although it's difficult, clients with posttraumatic stress disorder

can obtain the most lasting relief if they verbalize memories of the trauma to asympathetic listener. Family members are commonly frightened by the

information and can't be consistently supportive. Antidepressants may help

but these drugs can mask feelings and can't provide lasting relief. Treatment

for alcohol abuse, including AA meetings, must be considered when planning

care but alone doesn't provide lasting relief


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12. A client is admitted for detoxification after a cocaine overdose. The client

tells the nurse that he frequently uses cocaine but that he can control his use

if he chooses. Which coping mechanism is he using?

a. Withdrawal

b. Logical thinking

c. Repression

d. Denial

RATIONALE: Denial is an unconscious defense mechanism in which emotional

conflict and anxiety is avoided by refusing to acknowledge feelings, desires,

impulses, or external facts that are consciously intolerable. Withdrawal is a

common response to stress, characterized by apathy. Logical thinking is theability to think rationally and make responsible decisions, which would lead

the client to admitting the problem and seeking help. Repression is

suppressing past events from the consciousness because of guilty association

13. A 22-year-old client is diagnosed with dependent personality disorder.

Which behavior is most likely evidence of ineffective individual coping?

a. Inability to make choices and decisions without advice

b. Showing interest only in solitary activities

c. Avoiding developing relationships

d. Recurrent self-destructive behavior with history of depression

RATIONALE: Individuals with dependent personality disorder typically show

indecisiveness, submissiveness, and clinging behaviors so that others will

make decisions for them. These clients feel helpless and uncomfortable when

alone and don't show interest in solitary activities. They also pursuerelationships in order to have someone to take care of them. Although clients

with dependent personality disorder may become depressed and suicidal if

their needs aren't met, this isn't a typical response

14. A 38-year-old client is admitted for alcohol withdrawal. The most common


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early sign or symptom that this client is likely to experience is:

a. impending coma.

b. manipulating behavior.

c. suppression.

d. perceptual disorders.

RATIONALE: Perceptual disorders, especially frightening visual hallucinations,

are very common with alcohol withdrawal. Coma isn't an immediate

consequence. Manipulative behaviors are part of the alcoholic client's

personality but not a sign of alcohol withdrawal. Suppression is a conscious

effort to conceal unacceptable thoughts, feelings, impulses, or acts and serves

as a coping mechanism for most alcoholics

15. A client is admitted with a diagnosis of schizotypal personality disorder.

Which signs would this client exhibit during social situations?

a. Aggressive behavior

b. Paranoid thoughts

c. Emotional affect

d. Independence needs

RATIONALE: Clients with schizotypal personality disorder experience

excessive social anxiety that can lead to paranoid thoughts. Aggressive

behavior is uncommon, although these clients may experience agitation with

anxiety. Their behavior is emotionally cold with a flattened affect, regardless

of the situation. These clients demonstrate a reduced capacity for close or

dependent relationships

16. The nurse is caring for a client in an acute manic state. What's the most

effective nursing action for this client?

a. Assigning him to group activities

b. Reducing his stimulation


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c. Assisting him with self-care

d. Helping him express his feelings

RATIONALE: Reducing stimuli helps to reduce hyperactivity during a manic

state. Group activities would provide too much stimulation. Trying to assist the

client with self-care could cause increased agitation. When in a manic state,

these clients aren't able to express their inner feelings in a productive,

introspective manner. The focus of treatment for a client in the manic state is

behavior control

17. The nurse is caring for a client diagnosed with bulimia. The most

appropriate initial goal for a client diagnosed with bulimia is to:

a. avoid shopping for large amounts of food.

b. control eating impulses.

c. identify anxiety-causing situations.

d. eat only three meals per day.

RATIONALE: Bulimic behavior is generally a maladaptive coping response to

stress and underlying issues. The client must identify anxiety-causing

situations that stimulate the bulimic behavior and then learn new ways of

coping with the anxiety. Controlling shopping for large amounts of food isn't a

goal early in treatment. Managing eating impulses and replacing them with

adaptive coping mechanisms can be integrated into the care plan after initially

addressing stress and underlying issues. Eating three meals per day isn't a

realistic goal early in treatment

18. The nurse is caring for a 40-year-old client. Which behavior by the clientindicates adult cognitive development?

a. Has perceptions based on reality

b. Assumes responsibility for actions

c. Generates new levels of awareness

d. Has maximum ability to solve problems and learn new skills


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RATIONALE: Adults between ages 31 and 45 generate new levels of

awareness. Having perceptions based on reality and assuming responsibility

for actions indicate socialization development not cognitive development.

Demonstrating maximum ability to solve problems and learning new skills

occur in young adults between ages 20 and 30

19. A client with bipolar disorder is being treated with lithium for the first

time. The nurse should observe the client for which common adverse effect of

lithium?

a. Sexual dysfunction

b. Constipationc. Polyuria

d. Seizures

RATIONALE: Polyuria commonly occurs early in the treatment with lithium and

could result in fluid volume deficit. Sexual dysfunction isn't a common adverse

effect of lithium; it's more common with sedatives and tricyclic

antidepressants. Diarrhea, not constipation, occurs with lithium. Constipation

can occur with other psychiatric drugs, such as antipsychotic drugs. Seizures

may be a later sign of lithium toxicity

20. A client is admitted for an overdose of amphetamines. When assessing this

client, the nurse should expect to see:

a. tension and irritability.

b. slow pulse.

c. hypotension.d. constipation.

RATIONALE: An amphetamine is a nervous system stimulant that's subject to

abuse because of its ability to produce wakefulness and euphoria. An overdose

increases tension and irritability. Options B and C are incorrect because

amphetamines stimulate norepinephrine, which increases the heart rate and


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blood flow. Diarrhea is a common adverse effect, so option D is incorrect

21. During a shift report, the nurse learns that she'll be providing care for a

client who is vulnerable to panic attack. Treatment for panic attacks includes

behavioral therapy, supportive psychotherapy, and medication such as:

a. barbiturates.

b. antianxiety drugs.

c. depressants.

d. amphetamines.

RATIONALE: Antianxiety drugs provide symptomatic relief. Barbiturates andamphetamines can precipitate panic attacks. Depressants aren't appropriate

for treating panic attacks

22. A client comes to the emergency department while experiencing a panic

attack. The nurse can best respond to a client having a panic attack by:

a. staying with the client until the attack subsides.

b. telling the client everything is under control.

c. telling the client to lie down and rest.

d. talking continually to the client by explaining what's happening.

RATIONALE: The nurse should remain with the client until the attack subsides.

If the client is left alone, he may become more anxious. Giving false

reassurance is inappropriate in this situation. The client should be allowed to

move around and pace to help expend energy. The client may be so

overwhelmed that he can't follow lengthy explanations or instructions, so thenurse should use short phrases and slowly give one direction at a time.

23. A 24-year-old client is experiencing an acute schizophrenic episode. He

has vivid hallucinations that are making him agitated. The nurse's best

response at this time would be to:


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a. take the client's vital signs.

b. explore the content of the hallucinations.

c. tell him his fear is unrealistic.

d. engage the client in reality-oriented activities.

RATIONALE: Exploring the content of the hallucinations will help the nurse

understand the client's perspective on the situation. The client shouldn't be

touched, such as in taking vital signs, without telling him exactly what's going

to happen. Debating with the client about his emotions isn't therapeutic. When

the client is calm, engage him in reality-based activities

24. A client with paranoid type schizophrenia becomes angry and tells the

nurse to leave him alone. The nurse should:

a. tell him that she'll leave for now but will return soon.

b. ask him if it's okay if she sits quietly with him.

c. ask him why he wants to be left alone.

d. tell him that she won't let anything happen to him.

RATIONALE: If the client tells the nurse to leave, the nurse should leave but

let the client know that she'll return so that he doesn't feel abandoned. Not

heeding the client's request can agitate him further. Also, challenging the

client isn't therapeutic and may increase his anger. False reassurance isn't

warranted in this situation

25. A client begins taking haloperidol (Haldol). After a few days, he

experiences severe tonic contractures of muscles in the neck, mouth, andtongue. The nurse should recognize this as:

a. psychotic symptoms.

b. parkinsonism.

c. akathisia.

d. dystonia.


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RATIONALE: These symptoms describe dystonia, which commonly occurs after

a few days of treatment with haloperidol. The symptoms may be confused with

psychotic symptoms and misdiagnosed. Parkinsonism results in muscle

rigidity, shuffling gait, stooped posture, flat-faced affect, tremors, and

drooling. Signs and symptoms of akathisia are restlessness, pacing, and

inability to sit still

26. The nurse must administer a medication to reverse or prevent Parkinson-

type symptoms in a client receiving an antipsychotic. The medication the client

will likely receive is:

a. benztropine (Cogentin).

b. diphenhydramine (Benadryl).

c. propranolol (Inderal).

d. haloperidol (Haldol).

RATIONALE: Benztropine, trihexyphenidyl, or amantadine is prescribed for a

client with Parkinson-type symptoms. Diphenhydramine provides rapid relief

for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-

type symptoms

27. Which information is most important for the nurse to include in a teaching

plan for a schizophrenic client taking clozapine (Clozaril)?

a. Monthly blood tests will be necessary.

b. Report a sore throat or fever to the physician immediately.

c. Blood pressure must be monitored for hypertension.

d. Stop the medication when symptoms subside.

RATIONALE: A sore throat and fever are indications of an infection caused by

agranulocytosis, a potentially life-threatening complication of clozapine.

Because of the risk of agranulocytosis, white blood cell (WBC) counts are

necessary weekly, not monthly. If the WBC count drops below 3,000/ml, the

medication must be stopped. Hypotension may occur in clients taking this


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medication. Warn the client to stand up slowly to avoid dizziness from

orthostatic hypotension. The medication should be continued, even when

symptoms have been controlled. If the medication must be stopped, it should

be slowly tapered over 1 to 2 weeks and only under the supervision of a

physician

28. A client with manic episodes is taking lithium. Which electrolyte level

should the nurse check before administering this medication?

a. Calcium

b. Sodium

c. Chlorided. Potassium

RATIONALE: Lithium is chemically similar to sodium. When sodium levels are

reduced, such as from sweating or diuresis, lithium is reabsorbed by the

kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict

their intake of sodium and should drink adequate amounts of fluid each day.

The other electrolytes are important for normal body functions, but sodium is

most important to the absorption of lithium

29. A client is admitted to the inpatient unit of the mental health center with a

diagnosis of paranoid schizophrenia. He's shouting that the government of

France is trying to assassinate him. Which of the following responses is most

appropriate?

a. "I think you're wrong. France is a friendly country and an ally of the United

States. Their government wouldn't try to kill you."b. "I find it hard to believe that a foreign government or anyone else is trying

to hurt you. You must feel frightened by this."

c. "You're wrong. Nobody is trying to kill you."

d. "A foreign government is trying to kill you? Please tell me more about it."

RATIONALE: Responses should focus on reality while acknowledging the


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client's feelings. Arguing with the client or denying his belief isn't therapeutic.

Arguing can also inhibit development of a trusting relationship. Continuing to

talk about delusions may aggravate the psychosis. Asking the client if a

foreign government is trying to kill him may increase his anxiety level and can

reinforce his delusions

30. A client has been receiving chlorpromazine (Thorazine), an antipsychotic,

to treat his psychosis. Which finding should alert the nurse that the client is

experiencing pseudoparkinsonism?

a. Restlessness, difficulty sitting still, pacing

b. Involuntary rolling of the eyesc. Tremors, shuffling gait, masklike face

d. Extremity and neck spasms, facial grimacing, jerky movements

RATIONALE: Pseudoparkinsonism may appear 1 to 5 days after starting an

antipsychotic and may also include drooling, rigidity, and pill rolling. Akathisia

may occur several weeks after starting antipsychotic therapy and consists of

restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is

recognized by uncontrollable rolling back of the eyes and, along with dystonia,

should be considered an emergency. Dystonia may occur minutes to hours

after receiving an antipsychotic and may include extremity and neck spasms,

jerky muscle movements, and facial grimacing

31. A 54-year-old female was found unconscious on the floor of her bathroom

with self-inflicted wrist lacerations. An ambulance was called and the client

was taken to the emergency department. When she was stable, the client was

transferred to the inpatient psychiatric unit for observation and treatmentwith antidepressants. Now that the client is feeling better, which nursing

intervention is most appropriate?

a. Observing for extrapyramidal symptoms

b. Beginning a therapeutic relationship

c. Canceling any no-suicide contracts


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d. Continuing suicide precautions

RATIONALE: As antidepressants begin to take effect and the client feels better,

she may have the energy to initiate and complete another suicide attempt. As

the client's energy level increases, the nurse must continue to be vigilant to

the risk of suicide. Extrapyramidal symptoms may occur with antipsychotics

and aren't adverse effects of antidepressants. A therapeutic relationship

should be initiated upon admission to the psychiatric unit, after suicide

precautions have been instituted. It's through this relationship that the client

develops feelings of self-worth and trust and problem-solving takes place. In a

no-suicide contract, the client states verbally or in writing that she won't

attempt suicide and will seek out staff if she has suicidal thoughts. When the

time period for a contract has expired, a new contract should be obtained fromthe client

32. A 26-year-old male reports losing his sight in both eyes. He's diagnosed as

having a conversion disorder and is admitted to the psychiatric unit. Which

nursing intervention would be most appropriate for this client?

a. Not focusing on his blindness

b. Providing self-care for him

c. Telling him that his blindness isn't real

d. Teaching eye exercises to strengthen his eyes

RATIONALE: Focusing on the client's blindness can positively reinforce the

blindness and further promote the use of maladaptive behaviors to obtain

secondary gains. The client should be encouraged to participate in his own

self-care as much as possible to avoid fostering dependency. To promote self-

esteem, give positive reinforcement for what the client can do. Blindness andother physical symptoms in a conversion disorder aren't under the client's

control and are real to him. Eye exercises won't resolve the client's blindness

because no organic pathology is causing the symptoms

33. A client has a diagnosis of borderline personality disorder. She has


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attached herself to one nurse and refuses to speak with other staff members.

She tells the nurse that the other nurses are mean, withhold her medication,

and mistreat her. The staff is discussing this problem at their weekly

conference. Which intervention would be most appropriate for the nursing

staff to implement?

a. Provide an unstructured environment for the client.

b. Rotate the nurses who are assigned to the client.

c. Ignore the client's behaviors.

d. Bend unit rules to meet the client's needs.

RATIONALE: Rotating staff members who work with a client with a borderline

personality disorder keeps the client from becoming dependent on any onenurse and reduces the use of splitting behaviors and her fear of abandonment.

Firm rules and consistency among staff members will help control the client's

behavior. Ignoring splitting behaviors can cause the client to increase the

behavior by trying to get a response from the staff. Unit rules must be

consistently enforced and followed by each nurse to help the client control

behavior

34. A client is being admitted to the substance abuse unit for alcohol

detoxification. As part of the intake interview, the nurse asks him when he had

his last alcoholic drink. He says that he had his last drink 6 hours before

admission. Based on this response, the nurse should expect early withdrawal

symptoms to:

a. not occur at all because the time period for their occurrence has passed.

b. begin anytime within the next 1 to 2 days.

c. begin within 2 to 7 days.d. begin after 7 days.

RATIONALE: Acute withdrawal symptoms from alcohol may begin 6 hours after

the client has stopped drinking and peak 1 to 2 days later. Delirium tremens

may occur 2 even up to 7 days after the last drink.


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35. Which of the following factors would have the most influence on the

outcome of a crisis situation?

a. Age

b. Previous coping skills

c. Self-esteem

d. Perception of the problem

RATIONALE: Coping is a process by which a person deals with problems using

cognitive and noncognitive components. Cognitive responses come from

learned skills; noncognitive responses are automatic, focusing on relieving the

discomfort. Age could have either a positive or negative effect during crisis,

depending on previous experiences. Previous coping skills are cognitive andinclude the thought and learning necessary to identify the source of stress in a

crisis situation. Therefore, previous coping skills is the best answer. Although

sometimes useful, noncognitive measures, such as self-esteem, may prevent

the person from learning more about the crisis as well as a better solution to

the problem. The person involved could have correct or incorrect perception of

the problem that could have either a positive or negative outcome

36. The nurse is caring for an elderly client in a long-term care facility. The

client has a history of attempted suicide. The nurse observes the client giving

away personal belongings and has heard the client express feelings of

hopelessness to other residents. Which intervention should the nurse perform

first?

a. Setting aside time to listen to the client

b. Removing items that the client could use in a suicide attempt

c. Communicating a nonjudgmental attituded. Referring the client to a mental health professional

RATIONALE: The nurse's first responsibility is to protect the client from

injuring himself. Listening and being nonjudgmental are important elements of

the nurse's communication with the client. After the client's safety has been

established, he would benefit from a referral to a mental health professional


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37. The nurse is caring for an adolescent female who reports amenorrhea,

weight loss, and depression. Which additional assessment finding would

suggest that the woman has an eating disorder?

a. Wearing tight-fitting clothing

b. Increased blood pressure

c. Oily skin

d. Excessive and ritualized exercise

RATIONALE: A client with an eating disorder will normally exercise to excess

in an effort to burn as many calories as possible. The client will usually wearloose-fitting clothing to hide what she considers to be a fat body. Skin and

nails become dry and brittle, and blood pressure and body temperature drop

from excessive weight loss

38. A high school student is referred to the school nurse for suspected

substance abuse. Following the nurse's assessment and interventions, what

would be the most desirable outcome?

a. The student discusses conflicts over drug use.

b. The student accepts a referral to a substance abuse counselor.

c. The student agrees to inform his parents of the problem.

d. The student reports increased comfort with making choices.

RATIONALE: All of the outcomes stated are desirable; however, the best

outcome is that the student would agree to seek the assistance of a

professional substance abuse counselor

39. The nurse is using drawing, puppetry, and other forms of play therapy

while treating a terminally ill, school-age child. The purpose of these

techniques is to help the child:

a. internalize his feelings about death and dying.

b. accept responsibility for his situation.


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c. express feelings that he can't articulate.

d. have a good time while he's in the hospital.

RATIONALE: Children may not have the verbal and cognitive skills to express

what they feel and may benefit from alternative modes of expression. It's

important for the child to find a way to express internalized feelings. The child

must also know that he isn't to blame for this situation. In the process of

doing play therapy, the child can also have fun, but that isn't the main goal of

therapy

40. The nurse is working with a client who abuses alcohol. Which of the

following facts should the nurse communicate to the client?

a. Abstinence is the basis for successful treatment.

b. Attendance at Alcoholics Anonymous (AA) meetings every day will cure

alcoholism.

c. For treatment to be successful, family members must participate.

d. An occasional social drink is acceptable behavior for the alcoholic.

RATIONALE: The foundation of any treatment for alcoholism is abstinence.

Attendance at AA is helpful to some individuals to maintain strict abstinence.

Participation in treatment by the family is beneficial to both the client and the

family but isn't essential. Abstinence requires refraining from social drinking.

41. One staff member in a psychiatric unit says to the nurse, "Why are we

carrying out suicide precautions for someone who is dying? It's pointless and

a waste of time." The nurse should:

a. Assign the staff member to other clients.

b. Ask the psychiatric clinical nurse specialist to meet with the staff member.

c. Agree with the staff member and discontinue suicide precautions.

d. Call for a multidisciplinary staff meeting.

RATIONALE: The nurse would call for a multidisciplinary staff meeting because


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there is a need for staff members to share their feelings of anger, frustration,

and grief. Because nurses focus on saving human lives, any feelings of

hopelessness regarding a dying client can interfere with the client's care and

management. Assigning the staff member to other clients ignores the staff's

need to work through feelings. Calling the clinical nurse specialist to deal with

the staff member does nothing to help the immediate situation. The

psychiatric clinical nurse specialist would be included in the staff meeting to

help the entire staff deal with their feelings. Agreeing with the staff member

and discontinuing suicide precautions is highly inappropriate.

42. The client with dual diagnoses of major depression and alcohol abuse

states, "I only drink when I can't sleep." An initial outcome for this client isthat the client will:

a. Describe adaptive methods of coping to induce sleep.

b. Verbalize negative effects of alcohol on the body.

c. Describe dangerous effects when combining alcohol and antidepressant

medication.

d. Verbalize the desire to stop drinking alcohol.

RATIONALE: Verbalizing the desire to stop drinking alcohol is an initial

outcome that acknowledges alcohol consumption as a problem behavior and

leads to further participation in treatment. Describing adaptive methods to use

instead of drinking alcohol to induce sleep is an outcome to be reached later in

the client's course of treatment. Verbalizing the negative effects of alcohol on

the body is a therapeutic behavior but is not specific to helping the client

sleep. Describing the dangerous effects of using alcohol with antidepressant

medication is a therapeutic behavior but is not specific to helping the client

sleep.

43. The nurse will conduct a psychoeducational group for family members

about depression. Which of the following topics would be of little help to the

family members?


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a. Managing the depressed client at home.

b. Drug classifications.

c. Support and self-help groups.

d. Education about depression.

RATIONALE: Focusing on antidepressant medications would be helpful, but the

topic of drug classifications is too general. A topic such as managing the

depressed client at home will help family members learn positive techniques

for managing day-to-day problems and will promote family cohesiveness. A

topic such as receiving support from self-help groups is helpful to family

members to reduce feelings of isolation and powerlessness. Educating the

family about the illness dispels myths, enlists family cooperation, and

promotes adaptive coping skills.

44. In teaching a client about Alcoholics Anonymous, the nurse states that

Alcoholics Anonymous has helped in the rehabilitation of many alcoholics,

probably because many people find it easier to change their behavior when

they:

a. Have the support of rehabilitated alcoholics.

b. Know that rehabilitated alcoholics will sympathize with them.

c. Can depend on rehabilitated alcoholics to help them identify personal

problems related to alcoholism.

d. Realize that rehabilitated alcoholics will help them develop defense

mechanisms to cope with their alcoholism.

RATIONALE: Membership in Alcoholics Anonymous is voluntary. Its

rehabilitated members are available to support alcoholics, and the

understanding and influence of these rehabilitated members often helpsalcoholics change their behavior. The role of rehabilitated members does not

include sympathizing with others abusing alcohol. The role of rehabilitated

members does not include helping others abusing alcohol to identify personal

problems. The role of rehabilitated members does not include helping others

abusing alcohol to develop defense mechanisms to cope with alcoholism.


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45. A client walks into the mental health clinic and states to the nurse, "I

guess I can't make it without my wife. I can't even sleep without her." Which

of the following responses by the nurse would be most therapeutic?

a. "Things always look worse before they get better."

b. "I'd say that you're not giving yourself a fair chance."

c. "I'll ask the doctor for some sleeping pills for you."

d. "Tell me more about what you mean when you say you can't make it

without your wife."

RATIONALE: The nurse helps the client explore his feelings by expressing

interest in knowing more about his problem in order to make an accurateassessment. Cliches minimize the client's feelings and block expression.

Statements that make unwarranted judgments about the client block

communication and may suggest that he should feel guilty for his feelings. The

nurse has not explored the client's feelings or made any assessment. Asking

the doctor for sleeping pills reflects poor judgment based on insufficient

assessment data. Sleeping pills may be inappropriate and not therapeutic for

this client.

46. During the conversation with the nurse, a victim of physical abuse says,

"Let me try to explain why I stay with my husband." Which of the following

reasons would the client be LEAST likely to mention?

a. "I'm responsible for keeping my family together."

b. "When it's not too bad, the abuse adds spice to our relationship."

c. "I love my husband."

d. "I'm not sure I could get a job that pays even minimum wage."

RATIONALE: Violence is never acceptable to a victim; this myth condones the

use of violence. Often, an episode of battering is followed by a period of

pleasant relations between the partners, during which the victim may hope

that the violence will never happen again. The victim may stay in the

relationship for that reason.Women are conditioned to be responsible for the


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family's well-being. This is often a motivation for a battered woman to stay in

an abusive relationship. The victim believes that she can save the relationship

and that her partner will change. Feelings of guilt surrounding issues such as

these often influence an abused woman's decisions about staying with her

partner. A woman's lack of job skills and financial resources may cause her to

stay. Many women are injured or killed when they try to leave in a violent

relationship.

47. During a home visit, the client tells the nurse she's not taking prescribed

doses of haloperidol (Haldol) because she's tired of bothering with it and

doesn't need it. The nurse's best action is to:

a. Explain the negative effects of skipping the medication.

b. Consult with the physician about changing the medication to haloperidol

decanoate (Haldol Decanoate) injections.

c. Have the client's family begin commitment procedures so that her

medication regimen can be supervised more closely.

d. Refer the client to a partial hospitalization program so that she can

participate regularly in group therapy sessions.

RATIONALE: For the client who is noncompliant with oral medication, depot

medication is advantageous because the client will only need to keep one

appointment every 2 to 4 weeks instead of taking medication daily. Education

may or may not affect the client's compliance with medication. Long-term

commitment is unnecessary at this time. Participation in a partial

hospitalization program may be a desirable referral but would only indirectly

affect the client's compliance with medication.

48. The client has been taking the monoamine oxidase inhibitor (MAOI)

phenelzine (Nardil), 10 mg bid. The physician orders a selective serotonin

reuptake inhibitor (SSRI), paroxetine (Paxil), 20 mg given every morning. The

nurse:

a. Gives the medication as ordered.


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b. Questions the physician about the order.

c. Questions the dosage ordered.

d. Asks the physician to order benztropine (Cogentin) for the side effects.

RATIONALE: The nurse questions the physician about the order because the

client who has been taking an MAOI such as phenelzine must wait 14 days

after stopping the MAOI before starting an SSRI such as paroxetine. Serotonin

syndrome, a potentially lethal consequence, can occur when combining an

MAOI and an SSRI. Serotonin syndrome is characterized by hyperreflexia,

hyperthermia, myoclonus, and other symptoms similar to neuroleptic

malignant syndrome. Giving the medication as ordered can result in serious

adverse consequences, as described above.

The dosage is accurate. Benztropine is not given with an SSRI; it is an

antiparkinsonian agent usually ordered for the side effects of antipsychotic

medication.

49. A voluntary client has been taking haloperidol (Haldol) as prescribed. One

morning, she refuses to take the Haldol. Which of the following actions should

the nurse take?

a. Summon another nurse to help ensure that the client takes her medicine.

b. Tell the client that she can take the medication either orally or by injection.

c. Withhold the medication until it is determined why the client is refusing to

take it.

d. Tell the client that she needs to take her "vitamin" to stay healthy.

RATIONALE: The client has a legal right to refuse treatment. When a client

refuses medication, the nurse must explore the reason for the refusal. Thedesire to avoid unwanted side effects is a common reason. Legally a client

cannot be forcibly medicated unless she is a danger to herself or others or

there is a court order to treat. Legally a client cannot be forcibly medicated

unless she is a danger to herself or others or there is a court order to treat.

Lying to a client about a medication is neither appropriate nor ethical.


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50. The client is taking fluoxetine (Prozac) 20 mg at bedtime. He states that

Prozac is not helping him to sleep. The nurse judges:

a. That the client should take Prozac in the morning.

b. That dose is too high.

c. That the client's symptoms of depression seem to be getting worse.

d. That the client is on the wrong medication.

RATIONALE: Fluoxetine should be taken as early in the day as possible so as

not to interfere with nighttime sleep; it may cause nervousness in some

clients. The dose is therapeutic and not too high. There is no evidence in this

situation to justify the conclusion that the client's depression is worsening.There is no evidence in this situation to justify the conclusion that the client is

on the wrong medication.

Documents

34903 Reviewer PSYCH