Psychiatric Nursing Practice Test 3 (Practice Mode)- Rnpedia

1. Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods?

Figs and cream cheese

Fruits and yellow vegetables

Aged cheese and Chianti wine

Green leafy vegetables

Aged cheese and Chianti wine contain high concentrations of tyramine.

Explanation

Aged cheese and Chianti wine contain high concentrations of tyramine.

2. Tony with agoraphobia has been symptom-free for 4 months. Classicsigns and symptoms of phobia include:

Severe anxiety and fear

Withdrawal and failure to distinguish reality from fantasy

Depression and weight loss

Insomnia and inability to concentrate

Phobias cause severe anxiety (such as 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 B.P.

Explanation

Phobias cause severe anxiety (such as 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 B.P.

3. Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from worms chewing on them.” This statement indicates a:

Jealous delusion

Somatic delusion

Delusion of grandeur

Delusion of persecution

Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal
parasites and misshapen parts.

Explanation

Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal
parasites and misshapen parts.

4. A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself?

Art therapy in a small group

Basketball game with peers on the unit

Reading a self-help book on depression

Watching movie with the peer group

Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with
peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity.
Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that
interaction will occur; therefore, the client may remain isolated.

Explanation

Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with
peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity.
Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that
interaction will occur; therefore, the client may remain isolated.

5. The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with:

Managing his hallucinations

Medication teaching

Social skills training

Vocational training

Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking
questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.

Explanation

Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking
questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.

6. Which of the following is the most distinguishing feature of a client with an antisocial personality disorder?

Attention to detail and order

Bizarre mannerisms and thoughts

Submissive and dependent behavior

Disregard for social and legal norms

Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and
order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or
schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.

Explanation

Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and
order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or
schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.

7. Initial interventions for Marco with acute anxiety include all except which of the following?

Touching the client in an attempt to comfort him

Approaching the client in calm, confident manner

Encouraging the client to verbalize feelings and concerns

Providing the client with a safe, quiet and private place

The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually
increase anxiety.

Explanation

The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually
increase anxiety.

8. When nurse Hazel considers a client’s placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client’s:

Perceptual field

Delusional system

Memory state

Creativity level

Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.

Explanation

Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.

9. Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information?

Restrict fluids and sodium intake

Don’t consume alcohol

Discontinue if dry mouth and blurred vision occur

Restrict fluid and sodium intake

Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of
tricyclic antidepressants.

Explanation

Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of
tricyclic antidepressants.

10. A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client’s wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for:

A past history of depression

Current plans to commit suicide

The presence of marital difficulties

Feelings of excessive failure

Whether there is a suicide plan is a criterion when assessing the client’s determination to make another attempt.

Explanation

Whether there is a suicide plan is a criterion when assessing the client’s determination to make another attempt.

11. Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find:

Permanent short-term memory loss and hypertension

Permanent long-term memory loss and hypomania

Transitory short-term memory loss and permanent long-term memory loss

Transitory short and long term memory loss and confusion

ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and
long term memory loss.

Explanation

ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and
long term memory loss.

12. Nurse John is aware that a serious effect of inhaling cocaine is?

Deterioration of nasal septum

Acute fluid and electrolyte imbalances

Extra pyramidal tract symptoms

Esophageal varices

Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.

Explanation

Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.

13. Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expects the assessment to reveal:

Coldness, detachment and lack of tender feelings

Somatic symptoms

Inability to function as responsible parent

Unpredictable behavior and intense interpersonal relationships

A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be
intense and unstable and behavior may be inappropriate and impulsive.

Explanation

A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be
intense and unstable and behavior may be inappropriate and impulsive.

14. A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client?

Income level and living arrangements

Involvement of family and support systems

Reason for inpatient admission

Reason for refusal to take medications

The first are for assessment would be the client’s reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication. The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission.

Explanation

The first are for assessment would be the client’s reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client’s problem with the medication. The patient’s income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client’s reason for refusing medication. The nurse providing follow-up care would have access to the client’s medical record and should already know the reason for inpatient admission.

15. Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:

Uticaria

Vertigo

Sedation

Diarrhea

Diarrhea is a common physiological response to stress and anxiety.

Explanation

Diarrhea is a common physiological response to stress and anxiety.

16. The nurse describes a client as anxious. Which of the following statement about anxiety is true?

Anxiety is usually pathological

Anxiety is directly observable

Anxiety is usually harmful

Anxiety is a response to a threat

Anxiety is a response to a threat arising from internal or external stimuli.

Explanation

Anxiety is a response to a threat arising from internal or external stimuli.

17. When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of:

Humiliation

Confusion

Self blame

Hatred

hese children often have nonsexual needs met by individual and are powerless to refuse.Ambivalence results in self-blame and also guilt.

Explanation

hese children often have nonsexual needs met by individual and are powerless to refuse.Ambivalence results in self-blame and also guilt.

18. Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants?

Don’t take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

Have blood levels screened weekly for leucopenia

Avoid strenuous activity because of the cardiac effects of the drug

Don’t take prescribed or over the counter medications without consulting the physician

MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It’s imperative that a client checks with his physician and pharmacist before taking any other medications.

Explanation

MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It’s imperative that a client checks with his physician and pharmacist before taking any other medications.

19. Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience:

Heightened concentration

Decreased perceptual field

Decreased cardiac rate

Decreased respiratory rate

Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self,
less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention
andinability to concentrate.

Explanation

Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self,
less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention
andinability to concentrate.

20. Which nursing action is most appropriate when trying to diffuse a client’s impending violent behavior?

Place the client in seclusion

Leaving the client alone until he can talk about his feelings

Involving the client in a quiet activity to divert attention

Helping the client identify and express feelings of anxiety and anger

In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as
“What happened to get you this angry?” may help the client verbalizes feelings rather than act on them.

Explanation

In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as
“What happened to get you this angry?” may help the client verbalizes feelings rather than act on them.

21. Nurse John is aware that the therapy that has the highest success rate for people with phobias would be:

Psychotherapy aimed at rearranging maladaptive thought process

Psychoanalytical exploration of repressed conflicts of an earlier development phase

Systematic desensitization using relaxation technique

Insight therapy to determine the origin of the anxiety and fear

The most successful therapy for people with phobias involves behavior modification techniques using desensitization.

Explanation

The most successful therapy for people with phobias involves behavior modification techniques using desensitization.

22. Which activity would be most appropriate for a severely withdrawn client?

Art activity with a staff member

Board game with a small group of clients

Team sport in the gym

Watching TV in the dayroom

The best approach with a withdrawn client is to initiate brief, nondemanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client. A board game with a group clients or playing a team sport in the gym may overwhelm a severely withdrawn client. Watching TV is a solitary activity that will reinforce the client’s withdrawal from others.

Explanation

The best approach with a withdrawn client is to initiate brief, nondemanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client. A board game with a group clients or playing a team sport in the gym may overwhelm a severely withdrawn client. Watching TV is a solitary activity that will reinforce the client’s withdrawal from others.

23. Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis.These groups are successful because the:

Crisis intervention worker is a psychologist and understands behavior patterns

Crisis group supplies a workable solution to the client’s problem

Client is encouraged to talk about personal problems

Client is assisted to investigate alternative approaches to solving the identified problem

Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic
situations using rational and flexible problem solving methods.

Explanation

Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic
situations using rational and flexible problem solving methods.

24. Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for:

General anesthesia

Cardiac stress testing

Neurologic examination

Physical therapy

The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.

Explanation

The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.

25. Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder?

The client exhibits charming behavior when around authority figures

The client has decreased episodes of impulsive behaviors

The client makes statements of self-satisfaction

The client’s statements indicate no remorse for behaviors

A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore,
decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no
remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a
positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.

Explanation

A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore,
decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no
remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a
positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.

26. The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms?

Pathophysiology of disease process

Principles of good nutrition

Side effects of medications

Stress management techniques

In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce
the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.

Explanation

In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce
the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client’s disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.

27. A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach?

Agree with the client’s painful feelings

Challenge the accuracy of the client’s belief

Deny that the situation is hopeless

Present a cheerful attitude

Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.

Explanation

Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client’s feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress.

28. The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change?

Decreased dopamine level

Increased acetylcholine level

Stabilization of serotonin

Stimulation of GABA

Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore
decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.

Explanation

Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore
decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.

29. Which medication can control the extra pyramidal effects associated with antipsychotic agents?

Clorazepate (Tranxene)

Amantadine (Symmetrel)

Doxepin (Sinequan)

Perphenazine (Trilafon)

Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle
movements, pseudoparkinsonism and tar dive dyskinesia.

Explanation

Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle
movements, pseudoparkinsonism and tar dive dyskinesia.

30. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?

Increased incidence of dysmenorrhea while taking the drug

Occurrence of incomplete libido due to medication adverse effects

Continuing previous use of contraception during periods of amenorrhea

Instruction that amenorrhea is irreversible

Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation thus, the client
can still be pregnant.

Explanation

Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation thus, the client
can still be pregnant.

31. Before helping a male client who has been sexually assaulted, nurse Maureen should recognize that the rapist is motivated by feelings of:

Hostility

Inadequacy

Incompetence

Passion

Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.

Explanation

Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.

32. The most critical factor for nurse Linda to determine during crisis intervention would be the client’s:

Available situational supports

Willingness to restructure the personality

Developmental theory

Underlying unconscious conflict

Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.

Explanation

Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.

33. PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions?

Antipsychotic – induced akathisia and anxiety

Obsessive – compulsive disorder (OCD) to reduce ritualistic behavior

Delusions for clients suffering from schizophrenia

The manic phase of bipolar illness as a mood stabilizer

Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.

Explanation

Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.

34. Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients?

Central Nervous System effects

Cardiovascular system effects

Gastrointestinal system effects

Serotonin syndrome effects

The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with
caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.

Explanation

The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with
caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.

35. Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the “rotten nursing care”. When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of:

Projection

Displacement

Denial

Reaction formation

The client’s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.

Explanation

The client’s anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.

36. When performing a physicalexamination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system?

Muscle tension

Hyperactive bowel sounds

Decreased urine output

Constipation

The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.

Explanation

The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.

37. Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium?

Polyuria

Seizures

Constipation

Sexual dysfunction

Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.

Explanation

Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.

38. Nurse Fred is assessing a client who has just been admitted to the ER department.Which signs would suggest an overdose of an antianxiety agent?

Suspiciousness, dilated pupils and incomplete BP

Agitation, hyperactivity and grandiose ideation

Combativeness, sweating and confusion

Emotional lability, euphoria and impaired memory

Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.

Explanation

Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.

39. In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3 year old child to demonstrate:

An interest in music

An attachment to odd objects

Ritualistic behavior

Responsiveness to the parents

One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.

Explanation

One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.

40. Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?

Divalproex (depakote) and Lithium (lithobid)

Chlordiazepoxide (Librium) and diazepam (valium)

Fluvoxamine (Luvox) and clomipramine (anafranil)

Benztropine (Cogentin) and diphenhydramine (benadryl)

The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.

Explanation

The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.

41. Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe:

Hyperactivity

Depression

Suspicion

Delirium

There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.

Explanation

There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.

42. Rosana is in the second stage of Alzheimer’s disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain?

“Where is your pain located?”

“Do you hurt? (pause) “Do you hurt?”

“Can you describe your pain?”

“Where do you hurt?”

When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no”
whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.

Explanation

When speaking to a client with Alzheimer’s disease, the nurse should use close-ended questions.Those that the client can answer with “yes” or “no”
whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.

43. A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Psychiatric care in this treatment plan is based on which framework?

Behavioral framework

Cognitive framework

Interpersonal framework

Psychodynamic framework

Cognitive thinking therapy focuses on the client’s misperceptions about self, others and the world that impact functioning and contribute to symptoms.
Using medications to alter neurotransmitter activity is a psychobiologic approachto treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.

Explanation

Cognitive thinking therapy focuses on the client’s misperceptions about self, others and the world that impact functioning and contribute to symptoms.
Using medications to alter neurotransmitter activity is a psychobiologic approachto treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.

44. Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations?

Anxiety

Disturbed body image

Defensive coping

Powerlessness

The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental
expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.

Explanation

The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental
expectations and standards are quite high and lead to the clients’ sense of guilt over not measuring up.

45. A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include:

Rhinorrhea, convulsions, subnormal temperature

Nausea, dilated pupils, constipation

Lacrimation, vomiting, drowsiness

Muscle aches, papillary constriction, yawning

These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.

Explanation

These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.

46. Nurse Ronald could evaluate that the staff’s approach to setting limits for a demanding, angry client was effective if the client:

Apologizes for disrupting the unit’s routine when something is needed

Understands the reason why frequent calls to the staff were made

Discuss concerns regarding the emotional condition that required hospitalizations

No longer calls the nursing staff for assistance

This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.

Explanation

This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.

47. A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client’s employer expects the client to return to work following inpatient treatment. The client tells the nurse, “I’m no good. I’m a failure”. According to cognitive theory, these statements reflect:

Learned behavior

Punitive superego and decreased self-esteem

Faulty thought processes that govern behavior

Evidence of difficult relationships in the work environment

The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically
examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory. Option 4 is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment.

Explanation

The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically
examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory. Option 4 is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment.

48. A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following?

Help the client execute actions that are feared

Help the client develop insight into irrational fears

Help the client substitutes one fear for another

Help the client decrease anxiety

Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear,
without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another.
Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing
activities that typically are avoided as part of the phobic response.

Explanation

Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear,
without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another.
Although the client’s anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing
activities that typically are avoided as part of the phobic response.

49. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?

The parents reinforced increased decision making by the client

The parents clearly verbalize their expectations for the client

The client verbalizes that family meals are now enjoyable

The client tells her parents about feelings of low-self esteem

One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent
decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.

Explanation

One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent
decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.

50. A nurse who explains that a client’s psychotic behavior is unconsciously motivated understands that the client’s disordered behavior arises from which of the following?

Abnormal thinking

Altered neurotransmitters

Internal needs

Response to stimuli

The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.

Explanation

The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.