NURSING COMPETENCY APPRAISAL II – PART 1 REVIEW QUESTIONS AND ANSWERS

NURSING
BOARD REVIEW QUESTIONS

1. A 45-year-old man is treated in the emergency room for acute alcohol intoxication. He has a five-year history of alcohol abuse. He is agitated and verbally abusive. His admission orders include chlordiazepoxide (Librium) 50 mg IM or PO every 4-6 hours for agitation. The nurse should take which of the following precautions after Librium is administered?

A. Place the patient in restraints.
B. Leave the patient in a room by himself until the tranquilizer takes effect.
C. Assign a practical nurse to stay with the patient and assess his condition.
D. Ask the security guard to stay with the patient.

2. A client in an acute care mental health program refuses his morning dose of an oral antipsychotic medication and believes he's being poisoned. The nurse should respond by taking which of the following actions?

A. Administering the medication by injection
B. Omitting the dose and trying again the next day
C. Crushing the medication and putting it in his food
D. Consulting with the physician about a plan of care

3. In addition to hydration during delirium tremens, the physician prescribes parenteral administration of chlordiazepoxide (Librium) for the client. The nurse understands that chlordiazepoxide is given during detoxification primarily to:

A. Prevent physical injury to the client when convulsions occur
B. Enable the client to sleep and eat better during periods of agitation
C. Quiet the client and encourage cooperation and acceptance of treatment
D. Reduce the anxiety-tremor state and prevent more serious withdrawal symptoms

4. The nurse visits the client in a group home 1 week after discharge. He is prescribed fluoxetine (Prozac), 40 mg daily at 9 AM. The client states he feels nervous and has had diarrhea. The nurse appraises the client's symptoms to be:

A. Important, probably suggesting a decrease in dosage or change to another medication.
B. Of no consequence because the client's symptoms are side effects of the Prozac.
C. Indicative of an exacerbation of the client's depression.
D. Unimportant and a method to elicit the nurse's empathy and attention.

5. A client with bipolar disorder meets with the nurse at the community mental health center for follow-up care. The client has been taking valproic acid (Depakene), 500 mg three times a day for 1 month. The serum blood level is 60 µg/mL. The client states that her stomach feels upset after she takes the medication. Which of the following statements by the nurse would be most helpful?

A. "We'll adjust the dose of your medication."
B. "Chew the tablet before swallowing it."
C. "Take the valproic acid with meals or food."
D. "We'll have you take your medication all at one time."


6. The psychiatrist orders lithium carbonate 600 mg PO tid for a client. The nurse would be aware that the teaching about the side effects of this drug were understood when the client states, "I will call my doctor immediately if I notice any:

A. Sensitivity to bright light or sun."
B. Fine hand tremors or slurred speech."
C. Sexual dysfunction or breast enlargement."
D. Inability to urinate or difficulty when urinating."

7. A man receiving chlorpromazine (Thorazine) tells the nurse that he feels dizzy when he stands up. The nurse should recognize that this problem is primarily due to which of the following?

A. Thorazine can cause hypoglycemia.
B. Thorazine can affect the cerebellum.
C. Thorazine can affect the vestibular branch of the auditory nerve.
D. Thorazine can cause orthostatic hypotension.

8. One nurse strongly believes that all psychiatric medication is a form of chemical mind control. When the client's wife asks about the efficacy of antidepressant medications, which of the following courses of action would be best for this nurse to take?

A. Give an honest opinion of the treatment.
B. Refer the client's wife to another knowledgeable person for information about the treatment.
C. Explain that there are not enough current statistics about the efficacy of the treatment.
D. Provide a package insert for the wife to read.

9. Clients receiving monoamine oxidase inhibitor antidepressants must avoid tyramine, a compound found in which of the following foods?

A. Aged cheese and Chianti wine
B. Green leafy vegetables
C. Figs and cream cheese
D. Fruits and yellow vegetables

10. Discharge instructions for clients receiving tricyclic antidepressants include which of the following information?

A. Don't consume alcohol.
B. Discontinue if dry mouth and blurred vision occur.
C. Restrict fluid and sodium intake.
D. It's safe to continue taking during pregnancy.

11. 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.

12. Lorazepam (Ativan) is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together?

A. To reduce anxiety and potentiate the sedative action of the neuroleptic
B. To counteract extrapyramidal effects of the neuroleptic
C. To manage depressed clients
D. To increase the client's level of awareness and concentration

13. A client's nursing diagnosis is Chronic Low Self-Esteem related to self-doubt as evidenced by self-deprecatory statements. Which of the following expected outcomes specifically relates to this diagnosis? The client will:

A. Identify positive aspects of self.
B. Demonstrate reality-based thinking.
C. Use relaxation exercises.
D. Set attainable goals.

14. Sedative-hypnotic drugs are used to treat which of the following disorders?

A. Obsessive-compulsive disorder (OCD)
B. Attention deficit hyperactivity disorder (ADHD)
C. Hallucinations and delusions
D. Anxiety and insomnia
15. When teaching a client about lithium (Lithobid), the nurse should instruct the client to:

A. drink at least six to eight glasses of water per day and to avoid caffeine.
B. limit the use of salt in his diet.
C. discontinue medicine when feeling better.
D. increase the amount of sodium in his diet.

16. The nurse performs teaching with a patient who will be receiving phenelzine (Nardil) after discharge. The patient should be told by the nurse to avoid which of the following drugs?

A. Ibuprofen (Motrin).
B. Pseudoephedrine (Sudafed).
C. Acetaminophen (Tylenol).
D. Acetylsalicylic acid (Aspirin).

17. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:

A. reassure the client and administer as-needed lorazepam (Ativan) I.M.
B. administer as-needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as-needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as-needed dose of haloperidol (Haldol) by mouth.

18. 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.

19. Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:

A. double the dose if missed to maintain a therapeutic level.
B. be sure to take the drug with a meal because it's very irritating to the stomach.
C. discontinue the drug if the client reports weight gain.
D. notify the physician if the client notices an increase in bruising.

20. Dextroamphetamine (Dexedrine) has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication acts as:
A. an antianxiety agent.
B. a central nervous system (CNS) depressant.
C. a CNS stimulant.
D. a mood stabilizer.

21. A client who is taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of antipsychotic therapy?
A. Agranulocytosis
B. Extrapyramidal effects
C. Anticholinergic effects
D. Neuroleptic malignant syndrome (NMS)

22. A client has carbamazepine (Tegretol) 450 mg ordered. The nurse has available a liquid suspension that contains 100 mg/5 mL. How many mL should the nurse prepare to administer?

A. 10.5 mL.
B. 20 mL.
C. 22.5 mL.
D. 30 mL.

23. Which of the following client statements about clozapine (Clozaril) indicates that the client needs additional teaching?

A. "I need to have my blood checked once every several months while I’m taking this drug."
B. "I need to sit on the side of the bed for a while when I wake up in the morning."
C. "The sleepiness I feel will decrease as my body adjusts to clozapine."
D. "I need to call my doctor whenever I notice that I have a fever or sore throat."

24. Which of the following is one of the advantages of the antipsychotic medication risperidone (Risperdal)?

A. The absence of anticholinergic effects
B. A lower incidence of extrapyramidal effects
C. Photosensitivity
D. No incidence of neuroleptic malignant syndrome (NMS)

25. The nurse judges correctly that a client is experiencing an adverse effect from amitriptyline hydrochloride (Elavil) when the client demonstrates:
A. An elevated blood glucose level.
B. Insomnia.
C. Hypertension.
D. Urinary retention.

26. A client's nursing diagnosis is Chronic Low Self-Esteem related to self-doubt as evidenced by self-deprecatory statements. Which of the following expected outcomes specifically relates to this diagnosis? The client will:

A. Identify positive aspects of self.
B. Demonstrate reality-based thinking.
C. Use relaxation exercises.
D. Set attainable goals.

27. The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:
A. barbiturates.
B. amphetamines.
C. methadone.
D. benzodiazepines.

28. 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 is that 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.

29. The nurse is working in a community mental health center. A client with an Axis I diagnosis of Anxiolytic Withdrawal is prescribed prazepam (Centrax) in daily decreasing doses for 3 weeks. She has been taking Centrax for 3 days. The client had been dependent on diazepam (Valium), which she had been taking daily for the past 8 months at a dose of 60 mg. The client states she feels shaky, is having problems sleeping, and does not want to continue with Centrax. She asks the nurse if she can stop taking the Centrax now. The nurse's best response is:

A. "You need to continue the Centrax as prescribed to ensure a slow and safe withdrawal."
B. "Because your symptoms of withdrawal are minimal, you can take the Centrax when you feel you need it."
C. "You can discontinue the Centrax because the worse symptoms of withdrawal are over."
D. "I recommend one dose of Centrax at bedtime to help you sleep."
30. The nurse is teaching a client about the disease concept of alcoholism. Which of the following client statements indicates that the client understands the nurse's teaching?

A. "Now that I know I have this disease, it's up to me to decide if I'm going to take that drink."
B. "I can't help it if I drink. I have an illness."
C. "All of my relatives have problems with alcohol, but I' m not as bad as they are."
D. "My children won't be affected by my drinking because I've quit."

31. 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 mechanisms to cope with their alcoholism.

32. The client in an outpatient alcohol treatment program states to the nurse, "Why do we need to talk about relapse? I know I'll never drink again." Which of the following responses by the nurse is best?

A. "Anyone can slip. Relapse commonly occurs during the first few months after a treatment program."
B. "Relapse prevention is important in follow-up care."
C. "It's important to talk about relapse prevention because your recovery has only begun."
D. "If you don't continue with follow-up care, you won't hear about relapse prevention."

33. The nursing care coordinator in the surgical intensive care unit notes that a number of clients do not seem to be responding to meperidine (Demerol) that has been administered for pain. Later that evening the coordinator finds a staff nurse in the nurses' lounge dozing. On being awakened the staff nurse appears somewhat uncoordinated and drugged with slurred speech. The coordinator should:

A. Ask the other staff members whether they have noticed anything unusual
B. Tell the staff nurse that everyone now knows who has been stealing the Demerol
C. Call the nursing director and have the director present before confronting the staff nurse
D. Arrange to secretly observe the staff nurse the next time the staff nurse administers Demerol

34. To give clients with long histories of alcohol abuse greater responsibility for self-control, the nurse should initially plan to:

A. Tell them about detoxification programs
B. Confront them with their substance abuse
C. Assist them to identify and adopt more healthful coping patterns
D. Administer their medications according to the prescribed schedule

35. A client is admitted to the psychiatric unit with complaints of sleep disturbance, fatigue, feelings of uselessness, and inability to concentrate. The client was let go from her place of employment last month owing to her inability to keep up with the demands of her position. On the day after an interview during which the client talked at length and tearfully about feeling useless and old, she failed to keep an appointment with the nurse. Which action would be best for the nurse to take?

A. Assume that the client had a good reason for not coming and let her make the next move.
B. Confront the client with her behavior and ask her to explain the reason for her absence.
C. Seek out the client at the end of the scheduled interview time and tell her she was missed today.
D. Arrange for another session with the client later the same day and say nothing about her absence.

36. A client who has not left the bus station for 3 days is brought to the mental health center by a police officer because she had been bothering other people. She denies this, will not give her name, and holds tightly to her purse. She refuses to talk to anyone except to say, "You have no right to keep me here. I have money, and I can take care of myself." The police can hold her for disturbing the peace but think she needs psychiatric evaluation. Which of the following factors would be most relevant to a decision about this client's disposition?

A. She seems able to care for herself.
B. She has no known family.
C. She is not known to the mental health center.
D. She has $500 in cash and says she will go to a hotel.

37. A patient with anorexia nervosa tells the nurse she has been vomiting after meals. Which of the following responses by the nurse would be most therapeutic?

A. "You know that it is not good for you to throw-up your meals because you will hurt your body."
B. "You already are so thin. Why would you want to vomit your meals?"
C. "It seems like this is difficult for you and that you don't really want to be throwing up."
D. "Vomiting is unhealthy for you. It is important not to lose nutrients for the health of your body."

38. A client is admitted to the emergency room with a cut finger that is bleeding profusely. She displays signs of alcohol intoxication, and a blood test confirms this. After the client's wound is sutured but before she leaves the emergency room, it would be best for the nurse to ensure that the client:

A. Takes a nap.
B. Does some exercising.
C. Restricts fluid intake.
D. Drinks generous amounts of black coffee.

39. The nurse is interviewing a client who is currently under the influence of a controlled substance and shows signs of becoming agitated. What should the nurse do?

A. Use confrontation.
B. Express disgust with the client's behavior.
C. Be aware of hospital security.
D. Communicate a scolding attitude to intimidate the client.

40. 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.

41. The third major health problem in the United States is which of the following disorders?

A. Cancer
B. Heart disease
C. Alcoholism
D. Bipolar illness
42. A client has approached the nurse asking for advice on how to deal with his alcohol addiction. The nurse should tell the client that the only effective treatment for alcoholism is:

A. psychotherapy.
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.

43. 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:

A. dilated pupils and slurred speech.
B. rapid speech and agitation.
C. dilated pupils and agitation.
D. euphoria and constricted pupils.

44. The nurse is caring for a postoperative patient receiving morphine via patientcontrolled analgesia (PCA). The patient complains that he wakes up in severe pain after sleeping. Which of the following actions by the nurse would be most appropriate?

A. Administer the medication for the patient every hour
B. Request that the physician order a bolus dose of pain medication
C. Notify the physician to increase the patient's dosage
D. Instruct the patient to use the PCA pump every 10 minutes during the hour prior to sleep

45. While the client is in chemical dependency rehabilitation, which nursing intervention would be least appropriate?

A. Call a Narcotics Anonymous group for the client to tell them to expect the client after discharge.
B. Enforce unit policies.
C. Confront the client's inappropriate behaviors.
D. Help the client to express feelings.

46. When developing a one-to-one relationship with the client who is withdrawing from alcohol after she is physiologically stable, the nurse should use the first meeting to determine the client's:

A. Healthy coping mechanisms.
B. Most probable reasons for alcohol abuse.
C. Knowledge about Alcoholics Anonymous.
D. Childhood experiences that predispose to alcoholism.

47. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:

A. impending coma.
B. manipulating behavior.
C. suppression.
D. perceptual disorders.

48. After a dose-response test, the client with an overdose of barbiturates receives pentobarbital sodium (Nembutal) at a nonintoxicating maintenance level for 2 days and at decreasing doses thereafter. This regimen is prescribed primarily to help prevent possibly fatal:

A. Psychosis.
B. Convulsions.
C. Hypotension.
D. Hypothermia.

49. A client with a history of polysubstance abuse is admitted to the health care facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?

A. Alcohol withdrawal
B. Cannabis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal

50. A client is brought to the hospital's emergency room by a friend, who states, "I guess he had some bad junk (heroin) today." In assessing the client, the nurse would likely find which of the following symptoms?

A. Increased heart rate, dilated pupils, and fever.
B. Tremulousness, impaired coordination, increased blood pressure, and ruddy complexion.
C. Decreased respirations, constricted pupils, and pallor.
D. Eye irritation, tinnitus, and irritation of nasal and oral mucosa.


For answers click the link below:

NURSING COMPETENCY APPRAISAL II - PART 1 Answers

http://zipansion.com/e7Su

http://zipansion.com/e7Su

COMPETENCY APPRAISAL II – PART 1 - QUESTIONS AND ANSWERS

COMPETENCY APPRAISAL II – PART 1 - QUESTIONS AND ANSWERS
1. A 24-year-old secretary, pregnant for the first time, receives a letter from her boyfriend with a check for $500 and the news that he has left. The client is very upset, feels at the end of her rope, and calls the crisis intervention center for help. The nurse recognizes that the client is experiencing a crisis because:

A. The client is under a great deal of stress
B. The client is going to have to raise her child alone
C. The client's boyfriend left her when she was pregnant
D. The client's past methods of adapting are ineffective for this situation

2. A client is hospitalized with Pneumocystis carinii pneumonia. The nurse notes that the client has had no visitors, is withdrawn, avoids eye contact, and refuses to take part in conversation. In a loud and angry voice the client demands the nurse leave the room. The nurse formulates a nursing diagnosis of Social isolation. Based on this diagnosis what is an appropriate goal for this client?

A. Identifying one way to increase social interaction
B. Reporting increased adaptation to changes in health status
C. Identifying at least one factor contributing to altered sexuality patterns
D. Returning a demonstration of measures that can increase independence

3. Which electrolyte imbalance would a nurse expect when assessing a patient with bulimia?

A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypocalcemia

4. A client calls out to every nursing staff member who passes by the door and asks them to do or get something. The nurse can best manage this behavior by:

A. Closing the door to the room so the client cannot see the staff members as they pass by
B. Assigning one staff member to approach the client regularly and spend time talking with the client
C. Informing the client that one staff member will come in frequently to see whether the client has any requests
D. Arranging for a variety of staff members to take turns going into the room to see whether the client has any requests

5. Which statement best exemplifies spiritual distress in relation to adult survivors of childhood sexual abuse?

A. "Life is not fair."
B. "It was my fault that this happened."
C. "I don't go to church every week."
D. "I'm going to pray for the person who die this to me."

6. The nurse attempts to interact with a client who barely responds with yes or no. The client states, "Don't bother me. I want to die." The nurse's best action is to:

A. Leave the client alone.
B. Send another staff member to interact with the client.
C. Sit with the client for 10 minutes.
D. Turn on the television for the client.
7. The nurse judges a client to no longer need constant one-to-one observation for self-directed violence when the client:

A. Begins to interact with the nurse.
B. Stops putting his head in the toilet to drown himself.
C. Displays a sudden elevation in mood.
D. Eats his meals in the dining room.


8. A client is admitted to the psychiatric unit with complaints of sleep disturbance, fatigue, feelings of uselessness, and inability to concentrate. The client was let go from her place of employment last month owing to her inability to keep up with the demands of her position. On the day after an interview during which the client talked at length and tearfully about feeling useless and old, she failed to keep an appointment with the nurse. Which action would be best for the nurse to take?

A. Assume that the client had a good reason for not coming and let her make the next move.
B. Confront the client with her behavior and ask her to explain the reason for her absence.
C. Seek out the client at the end of the scheduled interview time and tell her she was missed today.
D. Arrange for another session with the client later the same day and say nothing about her absence.

9. Which of the following rights does a client lose by being admitted involuntarily to a psychiatric hospital? The right to:

A. Send and receive mail.
B. Vote in a national election.
C. Make a will or legally binding contract.
D. Sign out of the hospital against medical advice.

10. A 3-year-old girl with a fractured femur is brought to the emergency room by her mother. The nurse observes several bruises and burns in various states of healing on the child's arms, legs, and back. While the child is being assessed by the nurse, the child's mother refuses to leave her side and shouts at the nurse, "Don't touch my daughter; you'll hurt her." Which of the following is the BEST interpretation of the mother's behavior?

A. She is repressing her guilt feelings.
B. She is projecting her feelings onto the nurse.
C. She is displacing her anger onto the nurse.
D. She is sublimating her anger.

11. Touching other people without their permission, reading someone else's mail, and using personal possessions without asking permission are all examples of:

A. antisocial behavior.
B. manipulation.
C. poor boundaries.
D. passive-aggressive behavior.

12. The nurse is caring for a client who has a mood disorder. This disorder has a very strong biological and genetic component. What disorder does this client most likely have?

A. Generalized anxiety disorder
B. Adjustment disorder with depressed mood
C. Posttraumatic stress disorder
D. Bipolar disorder

13. An inexperienced nurse assigned to a mental health day-care setting elects to have a one-to-one therapeutic relationship with an elderly, depressed, withdrawn, female client. The nurse's selection was most likely based on the fear of being:

A. Hurt by a more active client
B. Rejected by a more alert client
C. Useless and then saying the wrong thing to a more alert client
D. Overly concerned for a younger client's well-being and mental status

14. At an emergency shelter, an earthquake victim tells the nurse that he is going to spend the night in his own bed at home. Which defense mechanism is the client exhibiting?

A. Intellectualization.
B. Denial.
C. Rationalization.
D. Undoing.
15. A crisis can best be defined as:

A. An imbalance of life
B. A threat to homeostasis
C. The perception of the problem by the client
D. A situation requiring help other than personal resources

16. The nurse is caring for a client who spontaneously aborted an 8-week-old fetus. The client is sobbing and moaning after the expulsion of the fetus. A priority goal for this client is that she'll:

A. verbalize her feelings related to the pregnancy loss.
B. express decreased pain and increased comfort.
C. discuss the causes of the spontaneous abortion.
D. avoid sexual intercourse for at least 2 days.

17. Which of the following nursing diagnoses should the nurse use to best address the suicidal patient's feelings of despair?

A. Ineffective coping
B. Spiritual distress
C. Anxiety
D. Dysfunctional grieving

18. Which of the following statements best explains the common observation that health care personnel avoid terminally ill people?

A. The family members who are present can provide essential care.
B. Health care personnel do not understand their own feelings about death and dying.
C. The dying person requires minimal physical care to be comfortable.
D. To protect a person's right to die with dignity, it is best to avoid interrupting the client.

19. The nurse is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:

A. sedation.
B. diarrhea.
C. vertigo.
D. urticaria.

20. A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. The client is being admitted to the stress unit with the diagnosis of Acute Stress Disorder. The client tells the nurse in a matter-of-fact manner that her husband is paraplegic, "but that's better than total paralysis." Which protective mechanism is the client exhibiting?

A. Suppression.
B. Rationalization.
C. Denial.
D. Intellectualization.

21. Which of the following would be an effective relaxation strategy for a school-age child to use during a painful procedure?

A. Having the child keep his eyes shut at all times
B. Having the child hold his breath and not allowing him to yell
C. Having the child take a deep breath and then blow it out until told to stop
D. Being honest with the child and telling him the procedure will hurt a lot

22. A single, pregnant client, attending a crisis intervention group, has decided to go through with the pregnancy and keep the baby. Now the crisis intervention nurse's primary responsibility is to:

A. Support the client for making a wise decision
B. Explore other problems the client may be experiencing
C. Make an appointment for the client to see a physician for prenatal care
D. Provide information about other health resources where the client may receive additional assistance

23. A 45-year-old woman is brought to the mental health center by her family. She is experiencing severe headaches, insomnia, and a poor appetite. Each time a question is asked, the patient provides a lengthy, detailed description of events. Which of the following actions, if taken by the nurse, would be MOST appropriate?

A. Remind her of the time.
B. Tell her not to worry.
C. Sit and listen to her.
D. Ask her to be brief.

24. In closed or locked units, the nurse judges the milieu as therapeutic because priorities are given to:

A. Socialization and self-understanding.
B. Education and vocation counseling.
C. Safety, structure, and support.
D. Developing communication, social, and leisure skills.

25. The most accurate definition of "depression," as used in psychiatry, is a:

A. Difficulty in decision making and functioning
B. Total loss of control over emotional impulses
C. Disturbance in mood as a reaction to the loss of a love object
D. Disturbance in mood as a result of frustrated instinctual strivings

26. The emotional-informal leader of a group is one who:

A. Reflects the feeling or tone of the group
B. Designates the roles within the group
C. Has an authoritarian role within the group
D. Selects those who are to be members of the group

27. A 29-year-old woman who has been raped comes to the emergency room for evaluation and treatment. Which of the following instructions should the nurse give the patient?

A. "Remove all of your clothing from the waist down and do not eat or drink."
B. "Remove all of your clothing and thoroughly wash your genital area."
C. "Leave all your clothing on and have something to eat while you're waiting to be examined."
D. "Remove all of your clothing carefully; do not wash, eat, or drink."

28. The nurse is at the rape intervention clinic when a rape victim comes in saying, "I've got to talk to someone or I'll go crazy. I should not have dated him." In assessing the client's condition, it is important for the nurse to identify the client's:

A. Support network
B. Sexual background
C. Ability to relate the facts
D. Knowledge of rape victimology

29. A mother whose daughter is killed in a school bus accident tells the nurse that her daughter was just getting over the chickenpox and did not want to go to school, but she insisted that she go. The mother cries bitterly and says her child's death is her fault. The nurse should realize that perceiving a death as preventable will most often influence the grieving process in that:

A. The loss may be easier to understand and to accept
B. Bereavement may be of greater intensity and duration
C. The grieving process may progress to a psychiatric illness
D. It causes the mourner to experience a pathologic grief reaction
30. Which of the following behaviors would a patient with borderline personality disorder most likely demonstrate when feeling abandoned by a significant other?

A. Apathetic
B. Disoriented
C. Self-destructive
D. Psychotic

31. When the rights of a client on a mental health unit are suspended, the nurse has the specific responsibility to:

A. Inform the client's family or guardian
B. Carefully monitor all pharmacologic intervention
C. Complete a rights denial form and forward it to the administrative officer
D. Document the client's behavior and the reason why specific rights were denied

32. What is the nurse's most important role in caring for a client with a mental health disorder?

A. To offer advice
B. To know how to solve the client's problems
C. To establish trust and rapport
D. To set limits with the client

33. During a family therapy session, the nurse notes that the wife is sitting with her arms and legs crossed and her body turned away from her husband. This non-verbal behavior is an example of

A. incongruence.
B. distancing.
C. blocking.
D. cultural posturing.

34. A 49-year-old client with acute respiratory distress watches everything the staff does and demands full explanations for all procedures and medications. Which of the following actions would best indicate that the client has achieved an increased level of psychological comfort?

A. Making decreased eye contact
B. Asking to see family members
C. Joking about the present condition
D. Sleeping undisturbed for 3 hours

35. When assessing a family suspected of abusing its 4-year-old child, which of the following is the most important criteria that would suggest abuse?

A. Attempts by the child to defend or verify what the parent states
B. Incompatibility between the history (mechanism) and the injury
C. Responsibility taken by the child for the act
D. A complaint other than the one associated with the signs of abuse

36. Which sign is least likely to indicate abuse in a 4-year-old child?

A. Conflicting stories about the accident or injury from the parents
B. History inconsistent with the child's developmental level
C. Disheveled parental appearance and low socioeconomic status
D. Exaggerated or absent emotional response by the caregiver

37. When a preschooler's family displays high levels of mistrust, monitors everyone's performance, wants high levels of information, and asks for rule changes, which of the following strategies would be inappropriate?

A. Ask their opinion and use their suggestions.
B. Be positive about building a trusting relationship.
C. Be flexible regarding rules.
D. Show support while controlling the care of the child.

38. A client is admitted to the inpatient psychiatric unit. He is unshaven, has body odor, and has spots on his shirt and pants. He moves slowly, gazes at the floor, and has a flat affect. The nurse's highest priority in assessing the client on admission would be to ask him:

A. How he sleeps at night.
B. If he is thinking about hurting himself.
C. About recent stresses.
D. How he feels about himself.

39. The nurse planning interventions for the victim of physical abuse would base the plan on knowledge that:

A. A woman in crisis is unlikely to be receptive to professional help.
B. The client generally can control the batterer.
C. Assessing the client's level of danger is a prerequisite to intervention.
D. The victim will want to leave the abuser immediately.

40. A 65-year-old recently retired salesman is brought to the psychiatric hospital by his wife. His wife states that since his retirement, he is listless and roams around the house complaining that he has nothing to do. The patient states, "Without a job I have no purpose in life." His wife adds that he has recently lost 10 pounds and sleeps for only two to three hours each night. In order to prioritize the patient's nursing care, the nurse should assess which of the following areas FIRST?

A. Suicidal ideation.
B. Level of insight into his problem.
C. Nutritional deficiencies.
D. Motivation to solve his personal problems.

41. Situational crises are usually resolved in a time period of:

A. 1 to 4 days
B. 2 to 3 weeks
C. 1 to 2 months
D. 2 to 6 months

42. A client says to the nurse, "My father died of a heart attack when he was 60, and I suppose I will too." Which of the following responses by the nurse would be the most appropriate?

A. "Tell me more about what you are feeling."
B. "Are you thinking that you won't recover from this illness?"
C. "You have a fine doctor. Everything will be all right soon, I'm sure."
D. "Would you agree that this would be very unlikely?"

43. Group therapy can best help those who:

A. Are emotionally ill
B. Are dependent on others
C. Feel they have a problem
D. Have no one to listen to them

44. The physician discusses the need for an abdominoperineal resection and a colostomy with a male client. After the physician leaves, the client tells the nurse that he is pleased only minor surgery is necessary. The nurse recognizes that the client's reaction is an example of:

A. Reflection
B. Regression
C. Repudiation
D. Reconciliation
45. A client has a diagnosis of borderline personality disorder. She has 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.

46. An adolescent male being treated for depression arrives with his family at the Adolescent Day Treatment Center for an initial therapy meeting with the staff. The nurse explains that one of the goals of the family meeting is to encourage the adolescent to

A. trust the nurse who will solve his problems.
B. learn to live with anxiety and tension.
C. accept responsibility for his actions and choices.
D. use the members of the therapeutic milieu to solve his problems.

47. A husband and wife seek emergency crisis intervention because he slapped her repeatedly the night before. The husband says he grew up in a household where his father frequently abused his mother and him. When intervening with this couple, the nurse knows they're at risk for repeated violence because the husband:

A. has only moderate impulse control.
B. denies feelings of jealousy or possessiveness.
C. has learned violence as an acceptable behavior.
D. feels secure in his relationship with his wife.

48. The group setting is especially conducive to therapy, since it:

A. Fosters one-to-one relationships
B. Creates a new learning environment
C. Decreases the focus on the individual
D. Confronts individual members with their shortcomings

49. An elementary school student is referred to a community mental health agency by the school principal. During the past 8 months, the student has bitten several teachers and classmates, has stolen money from a classroom charity project, has been involved in numerous fights, has been truant, and has been intoxicated while at school. What is the goal of crisis intervention for this client?

A. Resolve all the client's problems.
B. Explore the parents' feelings about the client's behavior.
C. Explore the teachers' feelings about the client's behavior
D. Decrease the incidence of behaviors that reflect conduct disorder.
50. Assertive behavior involves which of the following elements?

A. Saying what is on your mind at the expense of others
B. Expressing an air of superiority
C. Avoiding unpleasant situations and circumstances
D. Standing up for your rights while respecting the rights of others

51. A client with recurrent, endogenous depression has been hospitalized on the psychiatric unit for 3 days. He exhibits psychomotor retardation, anhedonia, indecision, and suicidal thoughts. Which goal of nursing care should have highest priority?

A. Provide for contact between the client and his wife.
B. Use measures to protect the client from harming himself.
C. Reassure the client of his worthiness.
D. Maintain a calm environment.

52. To maintain a therapeutic relationship with a client diagnosed as having a borderline personality disorder, the nurse on the psychiatric unit should:

A. Be firm, consistent, and understanding and focus on specific behaviors
B. Provide an unstructured environment for the client to promote self-expression
C. Use an authoritarian approach because this type of client needs to learn to conform to rules of society
D. Record but ignore marked shifts in mood, suicidal threats, and temper displays because they last only a few hours

53. The nurse is caring for a client whom she suspects is paranoid. How would the nurse confirm this assessment?

A. Indirect questioning
B. Direct questioning
C. Lead-in sentences
D. Open-ended sentences

54. On being discharged, a client with emotional problems should be encouraged to:

A. Return to regular activities
B. Continue in an aftercare clinic
C. Phone the unit whenever stress increases
D. Join a group that has similar problems to foster support

55. The nurse observes that a client on a psychiatric unit is looking around the room with eyes darting to a chair in the corner. The client grimaces then states, "Bastard," under his breath. Which of the following nursing actions is most appropriate?

A. Ignore the client because he appears to be hallucinating.
B. Approach the client to interrupt the hallucinations.
C. Suggest the client spend some time in his room.
D. Remind the client that vulgar language is not appropriate in the hospital.

56. The nurse is caring for a client hospitalized on numerous occasions for complaints of chest pain and fainting spells, which she attributes to her deteriorating heart condition. No relatives or friends report ever actually seeing a fainting spell. After undergoing an extensive cardiac, pulmonary, GI, and neurologic workup, she's told that all test results are completely negative. The client remains persistent in her belief that she has a serious illness. What diagnosis is appropriate for this client?

A. Exhibitionism
B. Somatoform disorder
C. Degenerative dementia
D. Echolalia

57. A 3-year-old girl with a fractured femur is brought to the emergency room by her mother. The nurse observes several bruises and burns in various states of healing on the child's arms, legs, and back. While the child is being assessed by the nurse, the child's mother refuses to leave her side and shouts at the nurse, "Don't touch my daughter; you'll hurt her." Which of the following is the BEST interpretation of the mother's behavior?

A. She is repressing her guilt feelings.
B. She is projecting her feelings onto the nurse.
C. She is displacing her anger onto the nurse.
D. She is sublimating her anger.

58. The nurse is caring for a client who believes he has cancer. He has visited several oncologists and undergone many tests. Thus far, no evidence of cancer has been found. The client remains convinced he's gravely ill and tells the nurse he doesn't expect to live much longer. What specific type of disorder is the client exhibiting?

A. Hypochondriasis
B. Dependency
C. Denial
D. Confabulation

59. Which of the following psychiatric disturbances are most common among the elderly?
A. Depression
B. Anxiety
C. Bipolar disorders
D. Personality disorders

60. A client is admitted to the psychiatric unit with complaints of sleep disturbance, fatigue, feelings of uselessness, and inability to concentrate. The client was let go from her place of employment last month owing to her inability to keep up with the demands of her position. On the day after an interview during which the client talked at length and tearfully about feeling useless and old, she failed to keep an appointment with the nurse. Which action would be best for the nurse to take?

A. Assume that the client had a good reason for not coming and let her make the next move.
B. Confront the client with her behavior and ask her to explain the reason for her absence.
C. Seek out the client at the end of the scheduled interview time and tell her she was missed today.
D. Arrange for another session with the client later the same day and say nothing about her absence.

61. What is the nurse's most important role in caring for a client with a mental health disorder?
A. To offer advice
B. To know how to solve the client's problems
C. To establish trust and rapport
D. To set limits with the client

62. A 22-year-old client is diagnosed with dependent personality disorder. Which behavior is most likely to be evidence of ineffective 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

63. A client with an obsessive-compulsive disorder washes his feet frequently. Which of the following nursing diagnoses is specifically related to this behavior?
A. Self-Care Deficit.
B. Ineffective Coping.
C. Risk for Impaired Skin Integrity.
D. Anxiety.

64. The nurse is caring for a client with disorganized schizophrenia. The client is responding well to therapy but has had limited social contact with others. Which of the following interventions is most appropriate?

A. Discourage the client from interacting with others because if his efforts fail it will be too traumatic for him.
B. Encourage the client to attend a party thrown for the residents of the facility.
C. Encourage the client to participate in one-on-one interactions.
D. Encourage the client to place a personal advertisement in the local newspaper, but not to reveal his mental disability.

65. A client with bipolar disorder, manic phase, begins to swear at the nurse when reminded to limit his telephone call to 10 minutes. Which statement by the nurse is most effective in this situation?
A. "You need to act like an adult."
B. "You know better than to use that language."
C. "Others can hear you."
D. "Stop! Swearing is not appropriate behavior."

66. The nurse planning to establish a trusting relationship with a client who is using paranoid ideation should begin by:
A. Seeking the client out frequently to spend long blocks of time together
B. Sitting on the ward and observing the client's behavior throughout the day
C. Being available on the ward frequently but waiting for the client to approach
D. Calling the client into the office to establish a contract for regular therapy sessions

67. The night nurse reports that a young client with paranoid schizophrenia has been awake for several nights. The day nurse reviews the chart and finds this client did not have an interrupted sleep-pattern disorder prior to a transfer from a private to a four-bed room 3 days ago. The nurse recognizes that a cause of the client's sleeplessness might be related to:

A. Fear of the other clients
B. Worry about family at home
C. Watching for an opportunity to escape
D. Trying to work out emotional problems

68. A client is admitted to the hospital in the manic phase of bipolar disorder. When placing a diet order for the client, which foods would be most appropriate?

A. A bowl of soup, crackers, and a dish of peaches
B. A cheese sandwich, carrot sticks, fresh grapes, and cookies
C. Roast chicken, mashed potatoes, and peas
D. A tuna sandwich, an apple, and a dish of ice cream

69. An adolescent client with an antisocial personality disorder was admitted to the hospital because of drug abuse and repeated sexual acting-out behavior. The nurse could evaluate that nursing actions directed toward modifying the behavior of this client had been successful when the client:

A. Promises never to take drugs again
B. Discusses the need to seduce other adolescents
C. Recognizes the need to conform to society's norms
D. Identifies the feelings underlying the acting-out behavior

70. Encouragement and praise should be given to hyperactive clients to help them increase their feelings of self-esteem. When they have behaved well, the best way to let them know the staff is aware of their improvement is for the nurse to say:

A. "You behaved well today."
B. "I knew you could behave."
C. "Everyone likes you better when you behave like this."
D. "Your behavior today was much better than yesterday."

71. 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.

72. A nurse is accompanying a client with a diagnosis of anxiety disorder who is pacing the halls and crying. When the client's pacing and crying increase, the nurse suddenly feels uncomfortable and experiences a strong desire to leave. The probable reason for this feeling is:

A. An empathic communication of anxiety
B. A desire to go off duty after a busy day
C. A fear of the client becoming assaultive
D. An inability to tolerate any more bizarre behavior

73. While the nurse is assisting a client with the diagnosis of schizophrenia with morning care, the client suddenly throws off the covers and starts shouting, "My body is disintegrating; I am being pinched." The term that best describes the client's behavior is:
A. Paranoid ideation
B. Depersonalization
C. Loose association
D. Ideas of reference
74. A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the plan of care?

A. Exercising the client's arms regularly
B. Insisting that the client eat without assistance
C. Working with the client rather than the family
D. Teaching the client how to use nonpharmacologic pain-control methods

75. While in the hospital, a client with obsessive-compulsive disorder saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures of them. Which outcome would indicate successful inpatient treatment for this client?

A. The client throws away all disposable cups.
B. The client is discharged and takes the cups home.
C. The client creates cup sculptures in the dayroom.
D. The client goes home, on pass, to arrange the magazines.

76. A female client has been hospitalized for 3 weeks while receiving a tricyclic medication for a severe depression. One day the client states to the nurse, "I'm really feeling better, my energy level is up. Did the nurse's aide tell you I gave her my designer purse?" The nurse recognizes that this statement may indicate:

A. An increased risk of suicide
B. An improved socialization level
C. A marked improvement in mood
D. decreased need for continued observation

77. The nurse is conducting a mental status examination on a client with a cognitive disorder. Which of the following statements does the nurse judge to be an impairment in abstract thinking? The client's:

A. Ability to remember her wedding day.
B. Inability to find a similarity between a bird and a butterfly.
C. Memories regarding her vacation 5 years ago.
D. Inability to state her home address.

78. The nurse should recognize that a patient who is unable to remember being raped by her brother when she was 10 years old is using which of the following ego defense mechanisms?

A. Compensation
B. Repression
C. Undoing
D. Regression

79. Which of the following behaviors by an adolescent patient suspected of having an anxiety disorder would best support a nursing diagnosis of high risk for violence, self-directed?

A. Poor impulse control
B. Criticism of others
C. Poor concentration
D. Low achievement in school

80. The nurse is caring for a client diagnosed with body dysmorphic disorder. When the client verbalizes disapproval of her physical features, the nurse should:

A. encourage verbalizations about fears and stressful life situations.
B. agree with the client because she feels a specific physical feature is awful.
C. ignore the comment and talk about less threatening issues.
D. compliment the client on her appearance.

81. Nursing care for a client after electroconvulsive therapy (ECT) should include:

A. nothing by mouth for 24 hours after the treatment because of the anesthetic agent.
B. bed rest for the first 8 hours after a treatment.
C. assessment of short-term memory loss.
D. no special care.

82. A nurse notices the mother of a hospitalized one-month-old boy sitting and talking on the telephone while the infant lies in the crib crying. Which of the following statements by the nurse would be most appropriate?

A. "Your baby is crying and needs your attention now."
B. "Let's check your baby together to see what he needs."
C. "Why do you think your baby is crying at this time?"
D. "When did you last feed your baby?"

83. A client scans the adult inpatient unit on his arrival at the hospital. He is neatly dressed and clutches a leather briefcase tightly in his arms. The client refuses to let the nurse touch his briefcase or check it for valuables or contraband. Which of the following actions by the nurse would be best?

A. Obtaining help to take the briefcase away from the client.
B. Asking the client to open the briefcase while he describes its contents.
C. Inspecting the briefcase when the client is temporarily out of the room.
D. Telling the client that he must follow hospital policy if he wishes to stay.

84. A hyperkinetic 5-year-old child exhibits signs of extreme restlessness, short attention span, and impulsiveness. Which of the following ways could the nurse alter the child's milieu that would likely be most therapeutic for him?

A. Increase the child's sensory stimulation and activity.
B. Limit the child's opportunities to display anger and frustration.
C. Define behaviors of the child that will be acceptable and those that will be unacceptable.
D. Allow the child freedom to choose activities in which to participate and other children with whom to associate.

85. After hearing a client with bulimia talk about her bizarre eating binges of raw pancake batter and bowls of whipped cream, the nurse feels disgusted and feels like telling her to "snap out of it." Which of the following would be the best action for the nurse at this time?

A. Share these feelings with the client, pointing out that the client’s behavior alienates people.
B. Ask the client to talk more about her eating habits, trying to understand her underlying problem.
C. Suggest that another nurse work with the client because this relationship is no longer therapeutic.
D. Discuss these feelings with another nurse or colleague in an attempt to help to resolve them.

86. A psychiatric patient continues ti disrupt the unit milieu by pacing up and down the hall. The nurse responds by placing the patient in the seclusion room. As a result of her actions, the nurse may be held responsible for which of the following legal implications?

A. False imprisonment
B. Battery
C. Invasion of privacy
D. Defamation of character

87. During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of:

A. somatic delusions.
B. waxy flexibility.
C. neologisms.
D. nihilistic delusions.

88. The nurse is caring for a client who has generalized anxiety disorder. Which statement is true about this client?
A. The client has regular obsessions.
B. Relaxation techniques and psychotherapy are necessary for cure.
C. Nightmares and flashbacks are common in individuals who suffer from generalized anxiety disorder.
D. Generalized anxiety disorder is characterized by anxiety that lasts longer than 6 months.

89. A 20-year-old client with paranoid schizophrenia is in the fourth day of hospitalization. The client's parents visit and state to the nurse, "What did we do wrong? What caused this awful thing to happen?" Which of the following explanations by the nurse is most accurate and therapeutic?
A. "We really don't know. There are many theories about schizophrenia."
B. "Let's talk about your family background. Schizophrenia is is often genetic."
C. "You didn't cause schizophrenia by doing something wrong. Schizophrenia is a biologic brain disease and can be caused by biochemical and structural changes in the brain."
D. "Try not to worry. Paranoid schizophrenia has a good prognosis."

90. A client misses breakfast because of an elaborate handwashing ritual. During the early period of the client's hospitalization, it would be most therapeutic for the nurse to:
A. Prevent the client from beginning the ritual until after breakfast is served
B. Encourage the client to interrupt the ritual for meals at the scheduled times
C. Allow the client to choose between eating breakfast or completing the ritual
D. Wake the client early so the ritual can be completed before breakfast is served

91. A client is admitted to the unit with a diagnosis of Axis I Delusional Disorder, Persecutory Type. The nurse appraises the client's thought content to include nonbizarre delusions. Which of the following statements by the client validates the nurse's judgment?
A. "Aliens from outer space are following me."
B. "My neighbor is trying to steal my land. He is going to move his fence to impinge on my property."
C. "My wife is being unfaithful and I have proof. She's seeing other men."
D. "No one knows but I'm the President's most secret top adviser."

92. A client in an inpatient psychiatric unit tells the nurse, "I'm going to divorce my no-good husband. I hope he rots in hell. But I miss him so bad. I love him. When's he going to come get me out of here?" The nurse interprets the client's statements as indicative of which of the following?
A. Ambivalence.
B. Autistic thinking.
C. Associative looseness.
D. Auditory hallucinations.

93. A client is being admitted to the psychiatric unit. She responds to some of the nurse's questions with one-word answers. Her eyes are downcast and her movements are very slow. Later that morning, the nurse approaches the client and asks how she feels about being in the hospital. The client does not respond verbally and continues to gaze at the floor. Which of the following actions should the nurse take first?
A. Spend time sitting in silence with the client.
B. Leave the client alone and tell her that you will be back later to talk.
C. Introduce another client to her and ask him to join you.
D. Ask another staff member to include the client in an informal group discussion.


94. The nurse is caring for a client with bipolar disorder. The plan of care for a client in a manic state would include:

A. offering high-calorie meals and strongly encouraging the client to finish all food.
B. insisting that the client remain active through 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.

95. A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse is aware that of all the extrapyramidal effects associated with these drugs, the one causing the most concern would be:
A. Akathisia
B. Tardive dyskinesia
C. Parkinsonian syndrome
D. An acute dystonic reaction

96. A client in an acute care mental health program refuses his morning dose of an oral antipsychotic medication and believes he's being poisoned. The nurse should respond by taking which of the following actions?
A. Administering the medication by injection
B. Omitting the dose and trying again the next day
C. Crushing the medication and putting it in his food
D. Consulting with the physician about a plan of care

97. A 38-year-old woman is brought to the community mental health center by her husband. One year ago her youngest son was killed in a car accident. The graduation of his high school class triggered feelings of sadness and guilt. As a result she has been having severe headaches, insomnia, and poor appetite. In planning care for this patient, the nurse should recognize that her symptoms are an example of

A. turning aggression inward.
B. receiving inadequate support from her family.
C. displacement of anger.
D. delayed grief reaction.


98. What client data would be most important for the nurse to consider in deciding to institute suicide precautions because of high-risk behavior? The client:

A. States that he still has thoughts of harming himself but feels he can control them.
B. States that he is worried about his child's reaction.
C. Expresses guilt and shame about trying to harm himself.
D. Has recently attempted suicide with a lethal method.

99. Which of the following measures is most appropriate for a nurse to take to prevent injury in a patient who is confused?

A. Apply a soft restraint on the patient's wrist
B. Administer lorazepam (Ativan) as ordered
C. Change the patient's environment
D. Keep the bed in the lowest position

100. When caring for an adolescent client diagnosed with depression, the nurse should remember that depression manifests differently in adolescents and adults. In an adolescent, signs and symptoms of depression are likely to include:

A. helplessness, hopelessness, hypersomnolence, and anorexia.
B. truancy, a change of friends, social withdrawal, and oppositional behavior.
C. curfew breaking, stealing from family members, truancy, and oppositional behavior.
D. hypersomnolence, obsession with body image, and valuing of peers' opinions.



ANSWERS

1. D
2. A
3. B
4. B
5. C
6. C
7. B
8. C
9. D
10. B
11. C
12. D
13. C
14. B
15. B
16. A
17. B
18. B
19. B
20. D
21. C
22. D
23. C
24. C
25. C
26. A
27. D
28. A
29. B
30. C
31. D
32. C
33. B
34. D
35. B
36. C
37. D
38. B
39. C
40. A
41. D
42. A
43. C
44. C
45. B
46. C
47. C
48. B
49. D
50. D
51. B
52. A
53. B
54. B
55. B
56. B
57. B
58. A
59. A
60. C
61. C
62. A
63. C
64. C
65. D
66. C
67. A
68. B
69. D
70. A
71. B
72. A
73. B
74. A
75. A
76. A
77. B
78. B
79. A
80. A
81. C
82. B
83. B
84. C
85. D
86. A
87. B
88. D
89. C
90. D
91. B
92. A
93. A
94. D
95. B
96. D
97. D
98. D
99. D
100. B