Nursing Practice V- care Of Clients With Physiologic And Psychosocial Alterations (Practice Mode)- Www.Rnpedia.Com

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  • 1/100 Questions

    Nurse Ron enters a client’s room, the client says, “They’re crawling on my sheets! Get them off my bed!” Which of the following assessment is the most accurate?

    • The client is experiencing aphasia
    • The client is experiencing dysarthria
    • The client is experiencing a flight of ideas
    • The client is experiencing visual hallucination
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Nursing Practice V- care Of Clients With Physiologic And Psychosocial Alterations (Practice Mode)- Www.Rnpedia.Com - Quiz

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  • 2. 

    Nurse Anne is caring for a client who has been treated long term with antipsychotic medication. During the assessment, Nurse Anne checks the client for tardive dyskinesia. If tardive dyskinesia is present, Nurse Anne would most likely observe:

    • Abnormal movements and involuntary movements of the mouth, tongue, and face.

    • Abnormal breathing through the nostrils accompanied by a “thrill.”

    • Severe headache, flushing, tremors, and ataxia.

    • Severe hypertension, migraine headache,

    Correct Answer
    A. Abnormal movements and involuntary movements of the mouth, tongue, and face.
    Explanation
    Tardive dyskinesia is a severe reaction associated with long term use of antipsychotic medication. The clinical manifestations include abnormal movements (dyskinesia) and involuntary movements of the mouth, tongue (fly catcher tongue), and face.

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  • 3. 

    Aira has taken amitriptyline HCL (Elavil) for 3 days, but now complains that it “doesn’t help” and refuses to take it. What should the nurse say or do?

    • Withhold the drug.

    • Record the client’s response.

    • Encourage the client to tell the doctor.

    • Suggest that it takes awhile before seeing the results.

    Correct Answer
    A. Suggest that it takes awhile before seeing the results.
    Explanation
    The client needs a specific response; that it takes 2 to 3 weeks (a delayed effect) until the therapeutic blood level is reached.

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  • 4. 

    A 35 year old female has intense fear of riding an elevator. She claims “ As if I will die inside.” The client is suffering from:

    • Agoraphobia

    • Social phobia

    • Claustrophobia

    • Xenophobia

    Correct Answer
    A. Claustrophobia
    Explanation
    Claustrophobia is fear of closed space. A. Agoraphobia is fear of open space or being a situation where escape is difficult. B. Social phobia is fear of performing in the presence of others in a way that will be humiliating or embarrassing. D. Xenophobia is fear of strangers.

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  • 5. 

    After seeking help at an outpatient mental health clinic, Ruby who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby?

    • Recommending a high-protein, low-fat diet.

    • Giving sleep medication, as prescribed, to restore a normal sleepwake cycle.

    • Allowing the client time to heal.

    • Exploring the meaning of the traumatic event with the client.

    Correct Answer
    A. Exploring the meaning of the traumatic event with the client.
    Explanation
    The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse. The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. A special diet isn't indicated unless the client also has an eating disorder or a nutritional problem.

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  • 6. 

    Which of the following descriptions of a client’s experience and behavior can be assessed as an illusion?

    • The client tries to hit the nurse when vital signs must be taken

    • The client says, “I keep hearing a voice telling me to run away”

    • The client becomes anxious whenever the nurse leaves the bedside

    • The client looks at the shadow on a wall and tells the nurse she sees frightening faces on the wall.

    Correct Answer
    A. The client looks at the shadow on a wall and tells the nurse she sees frightening faces on the wall.
    Explanation
    Minor memory problems are distinguished from dementia by their minor severity and their lack of significant interference with the client’s social or occupational lifestyle. Other options would be included in the history data but don’t directly correlate with the client’s lifestyle.

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  • 7. 

    Tim is admitted with a diagnosis of delusions of grandeur. The nurse is aware that this diagnosis reflects a belief that one is:

    • Highly important or famous.

    • Being persecuted

    • Connected to events unrelated to oneself

    • Responsible for the evil in the world.

    Correct Answer
    A. Highly important or famous.
    Explanation
    A delusion of grandeur is a false belief that one is highly important or famous. A delusion of persecution is a false belief that one is being persecuted. A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.

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  • 8. 

    Dervid is diagnosed with panic disorder with agoraphobia is talking with the nurse in-charge about the progress made in treatment. Which of the following statements indicates a positive client response?

    • “I went to the mall with my friends last Saturday”

    • “I’m hyperventilating only when I have a panic attack”

    • “Today I decided that I can stop taking my medication”

    • “Last night I decided to eat more than a bowl of cereal”

    Correct Answer
    A. “I went to the mall with my friends last Saturday”
    Explanation
    Clients with panic disorder tent to be socially withdrawn. Going to the mall is a sign of working on avoidance behaviors. Hyperventilating is a key symptom of panic disorder. Teaching breathing control is a major intervention for clients with panic disorder. The client taking medications for panic disorder; such as tricylic antidepressants and benzodiazepines, must be weaned off these drugs. Most clients with panic disorder with agoraphobia don’t have nutritional problems.

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  • 9. 

    The effectiveness of monoamine oxidase (MAO) inhibitor drug therapy in client with posttraumatic stress disorder can be demonstrated by which of the following client self –reports?

    • “I’m sleeping better and don’t have nightmares”

    • “I’m not losing my temper as much”

    • “I’ve lost my craving for alcohol”

    • "I’ve lost my phobia for water”

    Correct Answer
    A. “I’m sleeping better and don’t have nightmares”
    Explanation
    MAO inhibitors are used to treat sleep problems, nightmares, and intrusive daytime thoughts in individual with posttraumatic stress disorder. MAO inhibitors aren’t used to help control flashbacks or phobias or to decrease the craving for alcohol.

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  • 10. 

    What parental behavior toward a child during an admission procedure should cause Nurse Ron to suspect child abuse?

    • Flat affect

    • Expressing guilt

    • Acting overly solicitous toward the child.

    • Ignoring the child.

    Correct Answer
    A. Acting overly solicitous toward the child.
    Explanation
    This behavior is an example of reaction formation, a coping mechanism.

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  • 11. 

    Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her hands for long periods each day. How should the nurse respond to this compulsive behavior?

    • By designating times during which the client can focus on the behavior.

    • By urging the client to reduce the frequency of the behavior as rapidly as possible.

    • By calling attention to or attempting to prevent the behavior.

    • By discouraging the client from verbalizing anxieties.

    Correct Answer
    A. By designating times during which the client can focus on the behavior.
    Explanation
    The nurse should designate times during which the client can focus on the compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. She shouldn't call attention to or try to prevent the behavior. Trying to prevent the behavior may cause pain and terror in the client. The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.

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  • 12. 

    Richard with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:

    • Insomnia and an inability to concentrate.

    • Severe anxiety and fear.

    • Depression and weight loss.

    • Withdrawal and failure to distinguish reality from fantasy.

    Correct Answer
    A. Severe anxiety and fear.
    Explanation
    Phobias cause severe anxiety (such as a panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia, and elevated blood pressure. Insomnia, an inability to concentrate, and weight loss are common in depression. Withdrawal and failure to distinguish reality from fantasy occur in schizophrenia.

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  • 13. 

    Nurse Marco is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?

    • Restricts visits with the family and friends until the client begins to eat.

    • Provide privacy during meals.

    • Set up a strict eating plan for the client.

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

    Correct Answer
    A. Set up a strict eating plan for the client.
    Explanation
    Establishing a consistent eating plan and monitoring the client’s weight are very important in this disorder. The family and friends should be included in the client’s care. The client should be monitored during meals-not given privacy. Exercise must be limited and supervised.

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  • 14. 

    Tranylcypromine sulfate (Parnate) is prescribed for a depressed client who has not responded to the tricyclic antidepressants. After teaching the client about the medication, Nurse Marian evaluates that learning has occurred when the client states, “I will avoid:

    • Citrus fruit, tuna, and yellow vegetables.”

    • Chocolate milk, aged cheese, and yogurt’”

    • Green leafy vegetables, chicken, and milk.”

    • Whole grains, red meats, and carbonated soda.”

    Correct Answer
    A. Chocolate milk, aged cheese, and yogurt’”
    Explanation
    These high-tyramine foods, when ingested in the presence of an MAO inhibitor, cause a severe hypertensive response.

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  • 15. 

    Which nursing intervention would be most appropriate if a male client develop orthostatic hypotension while taking amitriptyline (Elavil)?

    • Consulting with the physician about substituting a different type of antidepressant.

    • Advising the client to sit up for 1 minute before getting out of bed.

    • Instructing the client to double the dosage until the problem resolves.

    • Informing the client that this adverse reaction should disappear within 1 week.

    Correct Answer
    A. Advising the client to sit up for 1 minute before getting out of bed.
    Explanation
    To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed. Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy. In these cases, the dosage may be reduced or the physician may prescribe nortriptyline, another tricyclic antidepressant. Orthostatic hypotension disappears only when the drug is discontinued.

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  • 16. 

      Jun approaches the nurse and tells that he hears a voice telling him that he’s evil and deserves to die. Which of the following terms describes the client’s perception?

    • Delusion

    • Disorganized speech

    • Hallucination

    • Idea of reference

    Correct Answer
    A. Hallucination
    Explanation
    Hallucinations are sensory experiences that are misrepresentations of reality or have no basis in reality. Delusions are beliefs not based in reality. Disorganized speech is characterized by jumping from one topic to the next or using unrelated words. An idea of reference is a belief that an unrelated situation holds special meaning for the client.

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  • 17. 

    Katrina, a newly admitted is extremely hostile toward a staff member she has just met, without apparent reason. According to Freudian theory, the nurse should suspect that the client is experiencing which of the following phenomena?

    • Intellectualization

    • Transference

    • Triangulation

    • Splitting

    Correct Answer
    A. Transference
    Explanation
    Transference is the unconscious assignment of negative or positive feelings evoked by a significant person in the client’s past to another person. Intellectualization is a defense mechanism in which the client avoids dealing with emotions by focusing on facts. Triangulation refers to conflicts involving three family members. Splitting is a defense mechanism commonly seen in clients with personality disorder in which the world is perceived as all good or all bad.

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  • 18. 

    Nurse Sarah ensures a therapeutic environment for all the client. Which of the following best describes a therapeutic milieu?

    • A therapy that rewards adaptive behavior

    • A cognitive approach to change behavior

    • A living, learning or working environment.

    • A permissive and congenial environment

    Correct Answer
    A. A living, learning or working environment.
    Explanation
    A therapeutic milieu refers to a broad conceptual approach in which all aspects of the environment are channeled to provide a therapeutic environment for the client. The six environmental elements include structure, safety, norms; limit setting, balance and unit modification. A. Behavioral approach in psychiatric care is based on the premise that behavior can be learned or unlearned through the use of reward and punishment. B. Cognitive approach to change behavior is done by correcting distorted perceptions and irrational beliefs to correct maladaptive behaviors. D. This is not congruent with therapeutic milieu.

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  • 19. 

    Mark, with a diagnosis of generalized anxiety disorder wants to stop taking his lorazepam (Ativan). Which of the following important facts should nurse Betty discuss with the client about discontinuing the medication?

    • Stopping the drug may cause depression

    • Stopping the drug increases cognitive abilities

    • Stopping the drug decreases sleeping difficulties

    • Stopping the drug can cause withdrawal symptoms

    Correct Answer
    A. Stopping the drug can cause withdrawal symptoms
    Explanation
    Stopping antianxiety drugs such as benzodiazepines can cause the client to have withdrawal symptoms. Stopping a benzodiazepine doesn’t tend to cause depression, increase cognitive abilities, or decrease sleeping difficulties.

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  • 20. 

    Nicolas is experiencing hallucinations tells the nurse, “The voices are telling me I’m no good.” The client asks if the nurse hears the voices. The most appropriate response by the nurse would be:

    • “It is the voice of your conscience, which only you can control.”

    • “No, I do not hear your voices, but I believe you can hear them”.

    • "The voices are coming from within you and only you can hear them.”

    • “Oh, the voices are a symptom of your illness; don’t pay any attention to them.”

    Correct Answer
    A. “No, I do not hear your voices, but I believe you can hear them”.
    Explanation
    The nurse, demonstrating knowledge and understanding, accepts the client’s perceptions even though they are hallucinatory.

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  • 21. 

    Ricky with chronic schizophrenia takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which lifethreatening reaction:

    • Tardive dyskinesia.

    • Dystonia.

    • Neuroleptic malignant syndrome.

    • Akathisia.

    Correct Answer
    A. Neuroleptic malignant syndrome.
    Explanation
    The client's signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.

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  • 22. 

    When establishing an initial nurse-client relationship, Nurse Hazel should explore with the client the:

    • Client’s perception of the presenting problem.

    • Occurrence of fantasies the client may experience.

    • Details of any ritualistic acts carried out by the client

    • Client’s feelings when external; controls are instituted.

    Correct Answer
    A. Client’s perception of the presenting problem.
    Explanation
    The nurse can be most therapeutic by starting where the client is, because it is the client’s concept of the problem that serves as the starting point of the relationship.

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  • 23. 

    Tristan is on Lithium has suffered from diarrhea and vomiting. What should the nurse in-charge do first:

    • Recognize this as a drug interaction

    • Give the client Cogentin

    • Reassure the client that these are common side effects of lithium therapy

    • Hold the next dose and obtain an order for a stat serum lithium level

    Correct Answer
    A. Hold the next dose and obtain an order for a stat serum lithium level
    Explanation
    Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is used to manage the extra pyramidal symptom side effects of antipsychotics. C. The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.

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  • 24. 

    Anthony is very hostile toward one of the staff for no apparent reason. He is manifesting:

    • Splitting

    • Transference

    • Countertransference

    • Resistance

    Correct Answer
    A. Transference
    Explanation
    Transference is a positive or negative feeling associated with a significant person in the client’s past that are unconsciously assigned to another A. Splitting is a defense mechanism commonly seen in a client with personality disorder in which the world is perceived as all good or all bad C. Countert-transference is a phenomenon where the nurse shifts feelings assigned to someone in her past to the patient D. Resistance is the client’s refusal to submit himself to the care of the nurse

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  • 25. 

    Nurse Mickey is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:

    • Avoid shopping for large amounts of food.

    • Control eating impulses.

    • Identify anxiety-causing situations

    • Eat only three meals per day.

    Correct Answer
    A. Identify anxiety-causing situations
    Explanation
    Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of
    coping with the anxiety.

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  • 26. 

    Rudolf is admitted for an overdose of amphetamines. When assessing the client, the nurse should expect to see:

    • Tension and irritability

    • Slow pulse

    • Hypotension

    • Constipation

    Correct Answer
    A. Tension and irritability
    Explanation
    An amphetamine is a nervous system stimulant that is subject to abuse because of its ability to produce wakefulness and euphoria. An overdose increases tension and irritability. Options B and C are incorrect because amphetamines stimulate norepinephrine, which increase the heart rate and blood flow. Diarrhea is a common adverse effect so option D in is incorrect.

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  • 27. 

    What herbal medication for depression, widely used in Europe, is now being prescribed in the United States?

    • Ginkgo biloba

    • Echinacea

    • St. John's wort

    • Ephedra

    Correct Answer
    A. St. John's wort
    Explanation
    St. John's wort has been found to have serotonin-elevating properties, similar to prescription antidepressants. Ginkgo biloba is prescribed to enhance mental acuity. Echinacea has immune-stimulating properties. Ephedra is a naturally occurring stimulant that is similar to ephedrine.

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  • 28. 

    Tony refuses his evening dose of Haloperidol (Haldol), then becomes extremely agitated in the dayroom while other clients are watching television. He begins cursing and throwing furniture. Nurse Oliver first action is to:

    • Check the client’s medical record for an order for an as-needed I.M. dose of medication for agitation.

    • Place the client in full leather restraints.

    • Call the attending physician and report the behavior.

    • Remove all other clients from the dayroom.

    Correct Answer
    A. Remove all other clients from the dayroom.
    Explanation
    The nurse’s first priority is to consider the safety of the clients in the therapeutic setting. The other actions are appropriate responses after ensuring the safety of other clients.

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  • 29. 

    Nurse Gina is aware that the dietary implications for a client in manic phase of bipolar disorder is:

    • Serve the client a bowl of soup, buttered French bread, and apple slices.

    • Increase calories, decrease fat, and decrease protein.

    • Give the client pieces of cut-up steak, carrots, and an apple.

    • Increase calories, carbohydrates, and protein.

    Correct Answer
    A. Increase calories, carbohydrates, and protein.
    Explanation
    This client increased protein for tissue building and increased calories to replace what is burned up (usually via carbohydrates).

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  • 30. 

    Ramon is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but that he can control his use if he chooses. Which coping mechanism is he using?

    • Withdrawal

    • Logical thinking

    • Repression

    • Denial

    Correct Answer
    A. Denial
    Explanation
    Denial is unconscious defense mechanism in which emotional conflict and anxiety is avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable. Withdrawal is a common response to stress, characterized by apathy. Logical thinking is the ability to think rationally and make responsible decisions, which would lead the client admitting the problem and seeking help. Repression is suppressing past events from the consciousness because of guilty association.

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  • 31. 

    Richard is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?

    • Aggressive behavior

    • Paranoid thoughts

    • Emotional affect

    • Independence needs

    Correct Answer
    A. Paranoid thoughts
    Explanation
    Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. Aggressive behavior is uncommon, although these clients may experience agitation with anxiety. Their behavior is emotionally cold with a flattened affect, regardless of the situation. These clients demonstrate a reduced capacity for close or dependent relationships.

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  • 32. 

    Nurse Jannah is monitoring a male client who has been placed inrestraints because of violent behavior. Nurse determines that it will be safe to remove the restraints when:

    • The client verbalizes the reasons for the violent behavior.

    • The client apologizes and tells the nurse that it will never happen again.

    • No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints.

    • The administered medication has taken effect.

    Correct Answer
    A. No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints.
    Explanation
    The best indicator that the behavior is controlled, if the client exhibits no signs of aggression after partial release of restraints. Options A, B, and D do not ensure that the client has controlled the behavior.

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  • 33. 

      Norma, a 42-year-old client with a diagnosis of chronic undifferentiated schizophrenia lives in a rooming house that has a weekly nursing clinic. She scratches while she tells the nurse she feels creatures eating away at her skin. Which of the following interventions should be done first?

    • Talk about his hallucinations and fears

    • Refer him for anticholinergic adverse reactions

    • Assess for possible physical problems such as rash

    • Call his physician to get his medication increased to control his psychosis

    Correct Answer
    A. Assess for possible physical problems such as rash
    Explanation
    Clients with schizophrenia generally have poor visceral recognition because they live so fully in their fantasy world. They need to have as in-depth assessment of physical complaints that may spill over into their delusional symptoms. Talking with the client won’t provide as assessment of his itching, and itching isn’t as adverse reaction of antipsychotic drugs, calling the physician to get the client’s medication increased doesn’t address his physical complaints.

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  • 34. 

    Nurse Cristina is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:

    • Delusions

    • Hallucinations

    • Loose associations

    • Neologisms

    Correct Answer
    A. Hallucinations
    Explanation
    Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. Delusions are false beliefs, rather than perceptions, that the client accepts as real. Loose associations are rapid shifts among unrelated ideas. Neologisms are bizarre words that have meaning only to the client.

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  • 35. 

    The nurse is aware that the side effect of electroconvulsive therapy that a client may experience:

    • Loss of appetite

    • Postural hypotension

    • Confusion for a time after treatment

    • Complete loss of memory for a time

    Correct Answer
    A. Confusion for a time after treatment
    Explanation
    The electrical energy passing through the cerebral cortex during ECT results in a temporary state of confusion after treatment.

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  • 36. 

    A dying male client gradually moves toward resolution of feelings regarding impending death. Basing care on the theory of Kubler-Ross, Nurse Trish plans to use nonverbal interventions when assessment reveals that the client is in the:

    • Anger stage

    • Denial stage

    • Bargaining stage

    • Acceptance stage

    Correct Answer
    A. Acceptance stage
    Explanation
    Communication and intervention during this stage are mainly nonverbal, as when the client gestures to hold the nurse’s hand.

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  • 37. 

    Nurse John is a aware that most crisis situations should resolve in about:

    • 1 to 2 weeks

    • 4 to 6 weeks

    • 4 to 6 months

    • 6 to 12 months

    Correct Answer
    A. 4 to 6 weeks
    Explanation
    Crisis is self-limiting and lasts from 4 to 6 weeks.

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  • 38. 

    Meryl, age 19, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. Meryl asks the nurse, "Why has this happened to me?" What is the nurse's best response?

    • "You've developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again."

    • "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical."

    • "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."

    • "It isn't uncommon for someone with your personality to develop a conversion disorder during times of stress."

    Correct Answer
    A. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."
    Explanation
    The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her
    symptoms will disappear. Saying that it must be awful not to be able to move her legs wouldn't answer the client's question; knowing that the cause is psychological wouldn't necessarily make her feel better. Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn't help her understand and resolve the underlying conflict.

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  • 39. 

    Josefina is to be discharged on a regimen of lithium carbonate. In the teaching plan for discharge the nurse should include:

    • Advising the client to watch the diet carefully

    • Suggesting that the client take the pills with milk

    • Reminding the client that a CBC must be done once a month.

    • Encouraging the client to have blood levels checked as ordered.

    Correct Answer
    A. Encouraging the client to have blood levels checked as ordered.
    Explanation
    Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because there is only a small range between therapeutic and toxic levels.

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  • 40. 

    Which information is most important for the nurse Trinity to include in a teaching plan for a male schizophrenic client taking clozapine (Clozaril)?

    • Monthly blood tests will be necessary.

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

    • Blood pressure must be monitored for hypertension.

    • Stop the medication when symptoms subside.

    Correct Answer
    A. Report a sore throat or fever to the physician immediately.
    Explanation
    A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. Because of the risk of agranulocytosis, white blood cell (WBC) counts are
    necessary weekly, not monthly. If the WBC count drops below 3,000/ÎĽl, the medication must be stopped. Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.

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  • 41. 

    Dervid, an adolescent has a history of truancy from school, running away from home and “barrowing” other people’s things without their permission. The adolescent denies stealing, rationalizing instead that as long as no one was using the items, it was all right to borrow them. It is important for the nurse to understand the psychodynamically, this behavior may be largely attributed to a developmental defect related to the:

    • Id

    • Ego

    • Superego

    • Oedipal complex

    Correct Answer
    A. Superego
    Explanation
    This behavior shows a weak sense of moral consciousness. According to Freudian theory, personality disorders stem from a weak superego.

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  • 42. 

    The therapeutic approach in the care of Armand an autistic child include the following EXCEPT:

    • Engage in diversionary activities when acting -out

    • Provide an atmosphere of acceptance

    • Provide safety measures

    • Rearrange the environment to activate the child

    Correct Answer
    A. Rearrange the environment to activate the child
    Explanation
    The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be re-channeling through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling.

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  • 43. 

    Charina, a college student who frequently visited the health center during the past year with multiple vague complaints of GI symptoms before course examinations. Although physical causes have been eliminated, the student continues to express her belief that she has a serious illness. These symptoms are typically of which of the following disorders?

    • Conversion disorder

    • Depersonalization

    • Hypochondriasis

    • Somatization disorder

    Correct Answer
    A. Hypochondriasis
    Explanation
    Hypochodriasis in this case is shown by the client’s belief that she has a serious illness, although pathologic causes have been eliminated. The disturbance usually lasts at lease 6 with identifiable life stressor such as, in this case, course examinations. Conversion disorders are characterized by one or more neurologic symptoms. Depersonalization refers to persistent recurrent episodes of feeling detached from one’s self or body. Somatoform disorders generally have a chronic course with few remissions.

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  • 44. 

    Jeremy is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum.

    • Heroin

    • Cocaine

    • LSD

    • Marijuana

    Correct Answer
    A. Cocaine
    Explanation
    The manifestations indicate intoxication with cocaine, a CNS stimulant. A. Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. C. Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, synesthesia and increase in vital signs D. Intoxication with Marijuana, a cannabinoid is manifested by sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment and hallucinations.

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  • 45. 

      Loretta, a newly admitted client was diagnosed with delirium and has history of hypertension and anxiety. She had been taking digoxin, furosemide (Lasix), and diazepam (Valium) for anxiety. This client’s impairment may be related to which of the following conditions?

    • Infection

    • Metabolic acidosis

    • Drug intoxication

    • Hepatic encephalopathy

    Correct Answer
    A. Drug intoxication
    Explanation
    This client was taking several medications that have a propensity for producing delirium; digoxin (a digitalis glycoxide), furosemide (a thiazide diuretic), and diazepam (a benzodiazepine). Sufficient supporting data don’t exist to suspect the other options as causes.

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  • 46. 

    Dervid, an adolescent boy was admitted for substance abuse and hallucinations. The client’s mother asks Nurse Armando to talk with his husband when he arrives at the hospital. The mother says that she is afraid of what the father might say to the boy. The most appropriate nursing intervention would be to:

    • Inform the mother that she and the father can work through this problem themselves.

    • Refer the mother to the hospital social worker.

    • Agree to talk with the mother and the father together.

    • Suggest that the father and son work things out.

    Correct Answer
    A. Agree to talk with the mother and the father together.
    Explanation
    By agreeing to talk with both parents, the nurse can provide emotional support and further assess and validate the family’s needs.

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  • 47. 

    Nurse Josefina is caring for a client who has been diagnosed with delirium. Which statement about delirium is true?

    • It's characterized by an acute onset and lasts about 1 month.

    • It's characterized by a slowly evolving onset and lasts about 1 week.

    • It's characterized by a slowly evolving onset and lasts about 1 month.

    • It's characterized by an acute onset and lasts hours to a number of days.

    Correct Answer
    A. It's characterized by an acute onset and lasts hours to a number of days.
    Explanation
    Delirium has an acute onset and typically can last from several hours to several days.

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  • 48. 

    Kitty, a 9 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification:

    • Profound

    • Mild

    • Moderate

    • Severe

    Correct Answer
    A. Moderate
    Explanation
    The child with moderate mental retardation has an I.Q. of 35- 50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35.

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  • 49. 

    Francis tells the nurse that her coworkers are sabotaging the computer. When the nurse asks questions, the client becomes argumentative. This behavior shows personality traits associated with which of the following personality disorder?

    • Antisocial

    • Histrionic

    • Paranoid

    • Schizotypal

    Correct Answer
    A. Paranoid
    Explanation
    Because of their suspiciousness, paranoid personalities ascribe malevolent activities to others and tent to be defensive, becoming quarrelsome and argumentative. Clients with antisocial personality disorder can also be antagonistic and argumentative but are less suspicious than paranoid personalities. Clients with histrionic personality disorder are dramatic, not suspicious and argumentative. Clients with schizoid personality disorder are usually detached from other and tend to have eccentric behavior.

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  • Mar 21, 2023
    Quiz Edited by
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  • May 13, 2012
    Quiz Created by
    RNpedia.com
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