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
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