Psychiatric Nursing | NCLEX Quiz 183

1. Macoy and Helen seek emergency crisis intervention because he slapped her repeatedly the night before. The husband indicates that his childhood was marred by an abusive relationship with his father. When intervening with this couple. nurse Gerry knows they are at risk for repeated violence because the husband:

Has only moderate impulse control

Denies feelings of jealousy or possessiveness

Has learned violence as an acceptable behavior

Feels secure in his relationship with his wife

Family violence usually is a learned behavior. and violence typically leads to further violence. putting this couple at risk.Option A: Repeated slapping may indicate poor. not moderate. impulse control.Options B and D: Violent people commonly are jealous and possessive and feel insecure in their relationships

Explanation

Family violence usually is a learned behavior. and violence typically leads to further violence. putting this couple at risk.Option A: Repeated slapping may indicate poor. not moderate. impulse control.Options B and D: Violent people commonly are jealous and possessive and feel insecure in their relationships

2. Kevin is remanded by the courts for psychiatric treatment. His police record. which dates to his early teenage years. includes delinquency. running away. auto theft. and vandalism. He dropped out of school at age 16 and has been living on his own since then. His history suggests maladaptive coping. which is associated with:

Antisocial personality disorder

Borderline personality disorder

Obsessive-compulsive personality disorder

Narcissistic personality disorder

The client’s history of delinquency. running away from home. vandalism. and dropping out of school are characteristic of antisocial personality disorder. This maladaptive coping pattern is manifested by a disregard for societal norms of behavior and an inability to relate meaningfully to others.Option B: In borderline personality disorder. the client exhibits mood instability. poor self-image. identity disturbance. and labile affect.Option C: Obsessive-compulsive personality disorder is characterized by a preoccupation with impulses and thoughts that the client realizes are senseless but can’t control.Option D: Narcissistic personality disorder is marked by a pattern of self-involvement. grandiosity. and demand for constant attention.

Explanation

The client’s history of delinquency. running away from home. vandalism. and dropping out of school are characteristic of antisocial personality disorder. This maladaptive coping pattern is manifested by a disregard for societal norms of behavior and an inability to relate meaningfully to others.Option B: In borderline personality disorder. the client exhibits mood instability. poor self-image. identity disturbance. and labile affect.Option C: Obsessive-compulsive personality disorder is characterized by a preoccupation with impulses and thoughts that the client realizes are senseless but can’t control.Option D: Narcissistic personality disorder is marked by a pattern of self-involvement. grandiosity. and demand for constant attention.

3. Nurse Penny is aware that the following medical conditions is commonly found in clients with bulimia nervosa?

Allergies

Cancer

Diabetes mellitus

Hepatitis A

Bulimia nervosa can lead to many complications. including diabetes. heart disease. and hypertension.Options A. B. and D: The eating disorder isn’t typically associated with allergies. cancer. or hepatitis A.

Explanation

Bulimia nervosa can lead to many complications. including diabetes. heart disease. and hypertension.Options A. B. and D: The eating disorder isn’t typically associated with allergies. cancer. or hepatitis A.

4. A client whose husband just left her has a recurrence of anorexia nervosa. Nurse Vic caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to:

Manipulate her husband

Gain control of one part of her life

Commit suicide

Live up to her mother’s expectations

By refusing to eat. a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control.Option A: This eating disorder doesn’t represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement).Option C: The client isn’t attempting to commit suicide through starvation; rather. by refusing to eat. she is expressing feelings of despair. worthlessness. and hopelessness.

Explanation

By refusing to eat. a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control.Option A: This eating disorder doesn’t represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement).Option C: The client isn’t attempting to commit suicide through starvation; rather. by refusing to eat. she is expressing feelings of despair. worthlessness. and hopelessness.

5. Kellan. 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?

The student discusses conflicts over drug use

The student accepts a referral to a substance abuse counselor

The student agrees to inform his parents of the problem

The student reports increased comfort with making choice

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

Explanation

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

6. A male client who reportedly consumes one (1) qt of vodka daily is admitted for alcohol detoxification. To try to prevent alcohol withdrawal symptoms. Dr. Smith is most likely to prescribe which drug?

Clozapine (Clozaril)

Thiothixene (Navane)

Lorazepam (Ativan)

Lithium carbonate (Eskalith)

The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam. a benzodiazepine.Options A. B and D: Clozapine. and Thiothixene are antipsychotic agents. and lithium carbonate is an antimanic agent; these drugs aren’t used to manage alcohol withdrawal syndrome.

Explanation

The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam. a benzodiazepine.Options A. B and D: Clozapine. and Thiothixene are antipsychotic agents. and lithium carbonate is an antimanic agent; these drugs aren’t used to manage alcohol withdrawal syndrome.

7. Nurse Amy is aware that the client is at highest risk for suicide?

One who appears depressed frequently thinks of dying and gives away all personal possessions

One who plans a violent death and has the means readily available

One who tells others that he or she might do something if life doesn’t get better soon

One who talks about wanting to die

The client at highest risk for suicide is one who plans a violent death (for example. by gunshot. jumping off a bridge. or hanging). has a specific plan (for example. after the spouse leaves for work). and has the means readily available (for example. a rifle hidden in the garage).Options A. C. and D: A client who gives away possessions thinks about death. or talks about wanting to die or attempting suicide is considered at a lower risk for suicide because this behavior typically serves to alert others that the client is contemplating suicide and wishes to be helped.

Explanation

The client at highest risk for suicide is one who plans a violent death (for example. by gunshot. jumping off a bridge. or hanging). has a specific plan (for example. after the spouse leaves for work). and has the means readily available (for example. a rifle hidden in the garage).Options A. C. and D: A client who gives away possessions thinks about death. or talks about wanting to die or attempting suicide is considered at a lower risk for suicide because this behavior typically serves to alert others that the client is contemplating suicide and wishes to be helped.

8. A female client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health. nurse Tair should plan to:

Severely restrict the client’s physical activities

Weigh the client daily. after the evening meal

Monitor vital signs. serum electrolyte levels. and acid-base balance

Instruct the client to keep an accurate record of food and fluid intake

An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias. hypothermia. malnutrition. infection. or cardiac abnormalities secondary to electrolyte imbalances. Therefore. monitoring the client’s vital signs. serum electrolyte level. and acid-base balance is crucial.Option A may worsen anxiety.Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal.Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also. the client may record food and fluid intake inaccurately.

Explanation

An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias. hypothermia. malnutrition. infection. or cardiac abnormalities secondary to electrolyte imbalances. Therefore. monitoring the client’s vital signs. serum electrolyte level. and acid-base balance is crucial.Option A may worsen anxiety.Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal.Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also. the client may record food and fluid intake inaccurately.

9. A male client is being treated for alcoholism. After a family meeting. the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. Nurse Lily should suggest that the family join which organization?

Al-Anon

Make Today Count

Emotions Anonymous

Alcoholics Anonymous

Al-Anon is an organization that assists family members to share common experiences and increase their understanding of alcoholism.Option B: Make Today Count is a support group for people with life-threatening or chronic illnesses.Option C: Emotions Anonymous is a support group for people experiencing depression. anxiety. or similar conditions.Option D: Alcoholics Anonymous is an organization that helps alcoholics recover by using a twelve-step program.

Explanation

Al-Anon is an organization that assists family members to share common experiences and increase their understanding of alcoholism.Option B: Make Today Count is a support group for people with life-threatening or chronic illnesses.Option C: Emotions Anonymous is a support group for people experiencing depression. anxiety. or similar conditions.Option D: Alcoholics Anonymous is an organization that helps alcoholics recover by using a twelve-step program.

10. A male client has approached the nurse asking for advice on how to deal with his alcohol addiction. Nurse Sally should tell the client that the only effective treatment for alcoholism is:

Psychotherapy

Total abstinence

Alcoholics Anonymous (AA)

Aversion therapy

Total abstinence is the only effective treatment for alcoholism. Psychotherapy. attendance at AA meetings. and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.Options A. C. and D: Psychotherapy. attendance at AA meetings. and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.

Explanation

Total abstinence is the only effective treatment for alcoholism. Psychotherapy. attendance at AA meetings. and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.Options A. C. and D: Psychotherapy. attendance at AA meetings. and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.