Midterm I Flashcards
1
Q
Which client statement reflects an understanding of circadian rhythms in psychopathology?
- “When I dream about my mother’s horrible train accident, I become hysterical.”
- “I get really irritable during my menstrual cycle.”
- “I’m a morning person. I get my best work done before noon.”
- “Every February, I tend to experience periods of sadness.”
A
3
2
Q
Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?
- Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy.
- Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill.
- Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents.
- Studies in which monozygotic twins were raised together by mentally ill biological parents.
- All of the above.
A
5
3
Q
A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior?
- Dendrites
- Axons
- Neurotransmitters
- Synapses
A
3
4
Q
Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective?
- Neuroendocrinology
- Psychoimmunology
- Diagnostic technology
- Neurophysiology
A
2
5
Q
An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?
- Regeneration
- Reuptake
- Recycling
- Retransmission
A
2
6
Q
A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms?
- Abnormal levels of serotonin
- Decreased levels of dopamine
- Increased levels of norepinephrine
- Decreased levels of acetylcholine
A
4
7
Q
A nurse concludes that a restless, agitated client is manifesting a fight- or-flight response. The nurse should associate this response with which neurotransmitter?
- Acetylcholine
- Dopamine
- Serotonin
- Norepinephrine
A
4
8
Q
Which part of the nervous system should a nurse identify as playing a major role during stressful situations?
- Peripheral nervous system
- Somatic nervous system
- Sympathetic nervous system
- Parasympathetic nervous system
A
3
9
Q
A depressed client states, “I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again.” Which nursing response is appropriate?
- “Medications only address biological factors. Environmental and interpersonal factors must also be considered.”
- “Because biological factors are the sole cause of depression, medications will improve your mood.”
- “Environmental factors have been shown to exert the most influence in the development of depression.”
- “Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment).”
A
1
10
Q
A nurse understands that the abnormal secretion of growth hormone may play a role in which illness?
- Acute mania
- Schizophrenia
- Anorexia nervosa
- Alzheimer’s disease
A
3
11
Q
A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client’s neurotransmitters should a nurse expect to be elevated?
- Serotonin
- Dopamine
- Gamma-aminobutyric acid (GABA)
- Histamine
A
2
12
Q
A client diagnosed with major depressive disorder asks, “What part of my brain controls my emotions?” Which nursing response is appropriate?
- “The occipital lobe governs perceptions, judging them as positive or negative.”
- “The parietal lobe has been linked to depression.”
- “The medulla regulates key biological and psychological activities.”
- “The limbic system is largely responsible for one’s emotional state.”
A
4
13
Q
A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness?
- Schizophrenia spectrum disorder
- Major depressive disorder
- Body dysmorphic disorder
- Parkinson’s disease
A
1
14
Q
A client’s wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client’s therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist’s recommendations?
- The therapist is using an interpersonal approach.
- The client has an alteration in neurotransmitters.
- It is routine practice to remind clients about nutrition, exercise, and rest.
- The client is susceptible to illness because of effects of stress on the immune system.
A
4
15
Q
Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level?
- Major depressive episode
- Schizophrenia
- Anorexia nervosa
- Alzheimer’s disease
A
2
16
Q
Which cerebral structure should a nursing instructor describe to students as the “emotional brain”?
- The cerebellum
- The limbic system
- The cortex
- The left temporal lobe
A
2
17
Q
A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness?
- Bipolar disorder: mania
- Schizophrenia spectrum disorder
- Generalized anxiety disorder
- Major depressive episode
A
4
18
Q
What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?
- Clarify personal attitudes, values, and beliefs.
- Obtain thorough assessment data.
- Determine the client’s length of stay.
- Establish personal goals for the interaction.
A
1
19
Q
If a client demonstrates transference toward a nurse, how should the nurse respond?
- Promote safety and immediately terminate the relationship with the client.
- Encourage the client to ignore these thoughts and feelings.
- Immediately reassign the client to another staff member.
- Help the client to clarify the meaning of the relationship, based on the present situation.
A
4
20
Q
What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?
- Acknowledge the client’s actions and generate alternative behaviors.
- Establish rapport and develop treatment goals.
- Attempt to find alternative placement.
- Explore how thoughts and feelings about this client may adversely impact nursing care.
A
2
21
Q
Which client action should a nurse expect during the working phase of the nurse-client relationship?
- The client gains insight and incorporates alternative behaviors.
- The client establishes rapport with the nurse and mutually develops treatment goals.
- The client explores feelings related to reentering the community.
- The client explores personal strengths and weaknesses that impact behavioral choices.
A
1
22
Q
Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship?
- “I can’t bear the thought of leaving here and failing.”
- “I might have a hard time working with you, because you remind me of my mother.”
- “I really don’t want to talk any more about my childhood abuse.”
- “I’m not sure that I can count on you to protect my confidentiality.”
A
3
23
Q
A mother who is notified that her child was killed in a tragic car accident states, “I can’t bear to go on with my life.” Which nursing statement conveys empathy?
- “This situation is very sad, but time is a great healer.”
- “You are sad, but you must be strong for your other children.”
- “Once you cry it all out, things will seem so much better.”
- “It must be horrible to lose a child, and I’ll stay with you until your husband arrives.”
A
4
24
Q
When an individual is “two-faced,” which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing?
- Respect
- Genuineness
- Sympathy
- Rapport
A
2
25
On which task should a nurse place priority during the working phase of relationship development?
1. Establishing a contract for intervention
2. Examining feelings about working with a particular client
3. Establishing a plan for continuing aftercare
4. Promoting the client’s insight and perception of reality
4
26
Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”
1. Restatement
2. Offering general leads
3. Focusing
4. Accepting
1
27
Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
1. Reflecting
2. Making observations
3. Formulating a plan of action
4. Giving recognition
3
28
The nurse is interviewing a newly admitted psychiatric client. Which of the following nursing statements is an example of offering a “general lead”?
1. “Do you know why you are here?”
2. “Are you feeling depressed or anxious?”
3. “Yes, I see. Go on.”
4. “Can you order the specific events that led to your admission?”
3
29
A nurse says to a client, “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
1. The therapeutic technique of giving advice
2. The therapeutic technique of defending
3. The nontherapeutic technique of presenting reality
4. The nontherapeutic technique of giving reassurance
4
30
A client diagnosed with post-traumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of “broad openings”?
1. “What occurred prior to the rape, and when did you go to the emergency department?”
2. “What would you like to talk about?”
3. “I notice you seem uncomfortable discussing this.”
4. “How can we help you feel safe during your stay here?”
2
31
A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?
1. S
2. O
3. L
4. E
5. R
2
32
An instructor is correcting a nursing student’s clinical worksheet. Which instructor statement is the best example of effective feedback?
1. “Why did you use the client’s name on your clinical worksheet?”
2. “You were very careless to refer to your client by name on your clinical worksheet.”
3. “Surely you didn’t do this deliberately, but you breeched confidentiality by using names.”
4. “It is disappointing that after being told you’re still using client names on your worksheet.”
3
33
What is a nurse’s purpose for providing appropriate feedback?
1. To give the client good advice
2. To advise the client on appropriate behaviors
3. To evaluate the client’s behavior
4. To give the client critical information
4
34
A client exhibiting dependent behaviors says, “Do you think I should move from my parent’s house and get a job?” Which nursing response is most appropriate?
1. “It would be best to do that in order to increase independence.”
2. “Why would you want to leave a secure home?”
3. “Let’s discuss and explore all of your options.”
4. “I’m afraid you would feel very guilty leaving your parents.”
3
35
A mother rescues two of her four children from a house fire. In an emergency department, she cries, “I should have gone back in to get them. I should have died, not them.” What is the nurse’s best response?
1. “The smoke was too thick. You couldn’t have gone back in.”
2. “You’re experiencing feelings of guilt, because you weren’t able to save your children.”
3. “Focus on the fact that you could have lost all four of your children.”
4. “It’s best if you try not to think about what happened. Try to move on.”
2
36
A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation?
1. “Everyone diagnosed with OCD needs to control their ritualistic behaviors.”
2. “It is important for you to discontinue these ritualistic behaviors.”
3. “Why are you asking for help, if you won’t participate in unit therapy?”
4. “Let’s figure out a way for you to attend unit activities and still wash your hands.”
4
37
During an inpatient educational group, a client shouts out, “This information is worthless. Nothing you have said can help me.” These statements indicate to a nurse leader that the client is assuming which group role?
1. The group role of aggressor
2. The group role of initiator
3. The group role of gatekeeper
4. The group role of blocker
1
38
During a group discussion, members freely interact with each other. Which member statement is an example of Yalom’s curative group factor of imparting information?
1. “I found a Web site explaining the different types of brain tumors and their treatment.”
2. “My brother also had a brain tumor and now is completely cured.”
3. “I understand your fear and will be by your side during this time.”
4. “My mother was also diagnosed with cancer of the brain.”
1
39
An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Which group is this nurse most qualified to lead?
1. A psychodrama group
2. A psychotherapy group
3. A parenting group
4. A family therapy group
3
40
Prayer group members at a local Baptist church are meeting with a poor, homeless family whom they are supporting. Which member statement is an example of Yalom’s curative group factor of altruism?
1. “I’ll give you the name of a friend that rents inexpensive rooms.”
2. “The last time we helped a family, they got back on their feet and prospered.”
3. “I can give you all of my baby clothes for your little one.”
4. “I can appreciate your situation. I had to declare bankruptcy last year.”
3
41
When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group?
1. Open-ended membership; circle of chairs; group size of 5 to 10 members
2. Open-ended membership; chairs around a table; group size of 10 to 15 members
3. Closed membership; circle of chairs; group size of 5 to 10 members
4. Closed membership; chairs around a table; group size of 10 to 15 members
3
42
During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating?
1. Democratic
2. Autocratic
3. Laissez-faire
4. Bureaucratic
1
43
During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style?
1. The nurse mandates that all group members reveal an embarrassing personal situation.
2. The nurse asks for a show of hands to determine group topic preference.
3. The nurse sits silently as the group members stray from the assigned topic.
4. The nurse shuffles through papers to determine the facility policy on length of group.
3
44
A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary?
1. “Psychodrama provides a safe setting in which to discuss painful issues.”
2. “In psychodrama, the client is the protagonist.”
3. “In psychodrama, the client observes actor interactions from the audience.”
4. “Psychodrama facilitates resolution of interpersonal conflicts.”
2
45
During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development?
1. “It’s hard for me to tell my story when I’m not sure about the reactions of others.”
2. “I think Joe’s Antabuse suggestion is a good one and might work for me.”
3. “My situation is very complex, and I need professional, not peer, advice.”
4. “I am really upset that you expect me to solve my own problems.”
2
46
A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior?
1. They are experiencing problems with termination, leading to feelings of abandonment.
2. They did not think any new material would be covered at the last session.
3. They were angry with the leader for not extending the length of the group.
4. They were bored with the material covered in the group.
1
47
A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom’s curative group factors does this illustrate?
1. Imparting of information
2. Instillation of hope
3. Altruism
4. Universality
4
48
A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred?
1. “There is little research to support AA’s effectiveness.”
2. “Self-help groups used to be the treatment of choice, but their popularity is waning.”
3. “These groups have no external regulation, so clients need to be cautious.”
4. “Members themselves run the group, with leadership usually rotating among the members.”
4
49
During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader?
1. The leader should referee the debate.
2. The leader should adamantly oppose physical disciplining measures.
3. The leader should redirect the group to a less-controversial topic.
4. The leader should encourage the group to solve the problem collectively.
4
50
A client diagnosed with alcohol use disorder experiences a first relapse. During an AA meeting, another group member states, “I relapsed three times, but now have been sober for 15 years.” Which of Yalom’s curative group factors does this illustrate?
1. Imparting of information
2. Instillation of hope
3. Catharsis
4. Universality
2
51
Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development?
1. The group leader establishes the rules that will govern the group after discharge.
2. The group leader encourages members to rely on each other for problem solving.
3. The group leader presents and discusses the concept of group termination.
4. The group leader helps the members to process feelings of loss.
4
52
Which situation should a nurse identify as an example of an autocratic leadership style?
1. The president of Sigma Theta Tau assigns members to committees to research problems.
2. Without faculty input, the dean mandates that all course content be delivered via the Internet.
3. During a community meeting, a nurse listens as clients generate solutions.
4. The student nurses’ association advertises for candidates for president.
2
53
A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis?
1. This type of crisis is precipitated by unexpected external stressors.
2. This type of crisis is precipitated by preexisting psychopathology.
3. This type of crisis is precipitated by an acute response to an external situational stressor.
4. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.
4
54
A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, “I can’t function any longer under all this stress.” Which type of crisis is the client experiencing?
1. Maturational/developmental crisis
2. Psychiatric emergency crisis
3. Anticipated life transition crisis
4. Traumatic stress crisis
2
55
A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this client’s crisis?
1. The client will change his type A personality traits to more adaptive ones by one week.
2. The client will list five positive self-attributes.
3. The client will examine how childhood events led to his overachieving orientation.
4. The client will return to previous adaptive levels of functioning by week six.
4
56
A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client?
1. Ineffective coping R/T situational crisis AEB powerlessness
2. Anxiety R/T fear of failure
3. Risk for self-directed violence R/T hopelessness
4. Risk for low self-esteem R/T loss events AEB suicidal ideations
3
57
After threatening to jump off of a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first?
1. “Are you currently thinking about harming yourself?”
2. “Why do you want to harm yourself?”
3. “Have you thought about the consequences of your actions?”
4. “Who is your emergency contact person?”
1
58
An involuntarily committed client when offered a dinner tray pushes it off the bedside table onto the floor. Which nursing intervention should a nurse implement to address this behavior?
1. Initiate forced medication protocol.
2. Help the client to explore the source of anger.
3. Ignore the act to avoid reinforcing the behavior.
4. With staff support and a show of solidarity, set firm limits on the behavior.
4
59
A college student who was nearly raped while jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met?
1. “You’ve really been helpful. Can I count on your for continued support?”
2. “I work out in the college gym rather than jogging outdoors.”
3. “I’m really glad I didn’t go home. It would have been hard to come back.”
4. “I carry mace when I jog. It makes me feel safe and secure.”
4
60
A despondent client who has recently lost her husband of 30 years tearfully states, “I’ll feel a lot better if I sell my house and move away.” Which nursing response is most appropriate?
1. “I’m confident you know what’s best for you.”
2. “This may not be the best time for you to make such an important decision.”
3. “Your children will be terribly disappointed.”
4. “Tell me why you want to make this change.”
2
61
An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior should alert a nurse to escalating anger and aggression?
1. The client requests prn medications.
2. The client has a tense facial expression and body language.
3. The client refuses to eat lunch.
4. The client sits in group with back to peers.
2
62
What is the best nursing rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place on an inpatient unit?
1. Reinforce unit rules with the client population.
2. Create protocols for the future release of tensions associated with anger.
3. Process client feelings and alleviate fears of undeserved seclusion and restraint.
4. Discuss the situation that led to inappropriate expressions of anger.
4
63
An aggressive client has been placed in restraints after all other interventions have failed. Which protocol would apply in this situation?
1. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 1 hour of the initiation of the restraints.
2. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 2 hours of the initiation of the restraints.
3. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 3 hours of the initiation of the restraints.
4. An in-person evaluation by a physician or other licensed independent practitioner must be conducted within 4 hours of the initiation of the restraints.
1
64
A combative adolescent client has been placed in seclusion after all other interventions have failed. Which protocol would apply in this situation?
1. The physician or other licensed independent practitioner must reissue a new order for restraints every 24 hours.
2. The physician or other licensed independent practitioner must reissue a new order for restraints every 8 hours.
3. The physician or other licensed independent practitioner must reissue a new order for restraints every 3 to 4 hours.
4. The physician or other licensed independent practitioner must reissue a new order for restraints every 1 to 2 hours.
4
65
A nursing instructor is teaching about the Roberts’ Seven-Stage Crisis Intervention Model. Which nursing action should be identified with Stage IV?
1. Collaboratively implement an action plan.
2. Help the client identify the major problems or crisis precipitants.
3. Help the client deal with feelings and emotions.
4. Collaboratively generate and explore alternatives.
3
66
A nursing instructor is teaching about complementary therapies. Which student statement indicates that learning has occurred?
1. “Complementary therapies view all humans as being biologically similar.”
2. “Complementary therapies view a person as a combination of multiple, integrated elements.”
3. “Complementary therapies focus on primarily the structure and functions of the body.”
4. “Complementary therapies view disease as a deviation from a normal biological state.”
2
67
A client reports taking St. John’s wort for major depressive episode. The client states, “I’m taking the recommended dose, but it seems like if two capsules are good, four would be better!” Which is an appropriate nursing response?
1. “Herbal medicines are more likely to cause adverse reactions than prescription medications.”
2. “Increasing the amount of herbal preparations can lead to overdose and toxicity.”
3. “FDA does not regulate herbal remedies, therefore, ingredients are often unknown.”
4. “Certain companies are better than others. Always buy a reputable brand.”
2
68
A client with chronic lower back pain says, “My nurse practitioner told me that acupuncture may enhance the effect of the medications and physical therapy prescribed.” What type of therapy is the nurse practitioner recommending?
1. Alternative therapy
2. Physiotherapy
3. Complementary therapy
4. Biopsychosocial therapy
3
69
A client diagnosed with chronic migraine headaches is considering acupuncture. The client asks a clinic nurse, “How does this treatment work?” Which is the best response by the nurse?
1. “Western medicine believes that acupuncture stimulates the body’s release of pain-fighting chemicals called endorphins.”
2. “I’m not sure why he suggested acupuncture. There are a lot of risks, including HIV.”
3. “Acupuncture works by encouraging the body to increase its development of serotonin and norepinephrine.”
4. “Your acupuncturist is your best resource for answering your specific questions.”
1
70
Alternative approaches refer to interventions that are used instead of conventional treatment. A client asks a nurse to explain the difference between alternative and complementary medicine. Which is an appropriate nursing response?
1. “Alternative medicine is a more acceptable practice than complementary medicine.”
2. “Alternative and complementary medicine are terms that essentially mean the same thing.”
3. “Complementary medicine disregards traditional medical approaches.”
4. “Complementary therapies partner alternative approaches with traditional medical practice.”
4
71
A lethargic client is diagnosed with major depressive disorder. After taking antidepressant therapy for 6 weeks, the client’s symptoms have not resolved. Which nutritional deficiency should a nurse identify as potentially contributing to the client’s symptoms?
1. Vitamin A deficiency
2. Vitamin C deficiency
3. Iron deficiency
4. Folic acid deficiency
3
72
A client inquires about the practice of therapeutic touch. Which nursing response best explains the goal of this therapy?
1. “The goal is to improve circulation to the body by deep, circular massage.”
2. “The goal is to re-pattern the body’s energy field by the use of rhythmic hand motions.”
3. “The goal is to improve breathing by increasing oxygen to the brain and body tissues.”
4. “The goal is to decrease blood pressure by body toxin release.”
2
73
A nursing student, having no knowledge of alternative treatments, states, “Aren’t these therapies ‘bogus’ and, like a fad, will eventually fade away?” Which is an accurate nursing response?
1. “Like nursing, complementary therapies take a holistic approach to healing.”
2. “The American Nurses Association is researching the effectiveness of these therapies.”
3. “It is important to remain nonjudgmental about these therapies.”
4. “Alternative therapy concepts are rooted in psychoanalysis.”
1
74
Herbs and plants can be useful in treating a variety of conditions. Which treatment should a nurse determine is appropriate for a client experiencing frequent migraine headaches?
1. Saint John’s wort combined with an antidepressant
2. Ginger root combined with a beta-blocker
3. Feverfew, used according to directions
4. Kava-kava added to a regular diet
3
75
A nurse teaches a client about alternative therapies for back pain. When a practitioner corrects subluxation by manipulating the vertebrae of the spinal column, what therapy is the practitioner employing?
1. Allopathic therapy
2. Therapeutic touch therapy
3. Massage therapy
4. Chiropractic therapy
4
76
A nursing instructor is teaching about the impaired nurse and the consequences of this impairment. Which statement by a student indicates that further instruction is needed?
1. “The state board of nursing must be notified with factual documentation of impairment.”
2. “All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice.”
3. “Many state boards of nursing require an impaired nurse to successfully complete counseling treatment programs prior to a return to work.”
4. “After a return to practice, a recovering nurse may be closely monitored for several years.”
2
77
Which client statement indicates a knowledge deficit related to a substance use disorder?
1. “Although it’s legal, alcohol is one of the most widely abused drugs in our society.”
2. “Tolerance to heroin develops quickly.”
3. “Flashbacks from LSD use may reoccur spontaneously.”
4. “Marijuana is like smoking cigarettes. Everyone does it. It’s essentially harmless.”
4
78
A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to AA, would be most appropriate for a nurse to discuss with the client during discharge teaching?
1. After discharge, the client will immediately attend 90 AA meetings in 90 days.
2. After discharge, the client will rely on an AA sponsor to help control alcohol cravings.
3. After discharge, the client will incorporate family in AA attendance.
4. After discharge, the client will seek appropriate deterrent medications through AA.
1
79
A nurse is assessing a pathological gambler. What would differentiate this client’s behaviors from the behaviors of a non-pathological gambler?
1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not.
2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men.
3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course.
4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.
1
80
A client presents with symptoms of alcohol withdrawal and states, “I haven’t eaten in three days.” A nurse’s assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis?
1. Knowledge deficit
2. Fluid volume excess
3. Imbalanced nutrition: less than body requirements
4. Ineffective individual coping
3
81
A nurse is interviewing a client in an outpatient addiction clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish?
1. The client will identify one person to turn to for support.
2. The client will give up all old drinking buddies.
3. The client will be able to verbalize the effects of alcohol on the body.
4. The client will correlate life problems with alcohol use.
4
82
A nurse evaluates a client’s patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance addiction?
1. Narcotic pain medication is contraindicated for all clients with active substance use disorders.
2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control.
3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance.
4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.
2
83
A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurse’s first priority?
1. Hearing and visual impairment
2. Blood pressure of 180/100 mm Hg
3. Mood rating of 2/10 on numeric scale
4. Dehydration
2
84
A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur?
1. 50 mg/dL
2. 100 mg/dL
3. 250 mg/dL
4. 300 mg/dL
2
85
A client’s wife has been making excuses for her alcoholic husband’s work absences. In family therapy, she states, “His problems at work are my fault.” Which is the appropriate nursing response?
1. “Why do you assume responsibility for his behaviors?”
2. “I think you should start to confront his behavior.”
3. “Your husband needs to deal with the consequences of his drinking.”
4. “Do you understand what the term enabler means?”
3
86
What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?
1. Risk for injury R/T central nervous system stimulation
2. Disturbed thought processes R/T tactile hallucinations
3. Ineffective coping R/T powerlessness over alcohol use
4. Ineffective denial R/T continued alcohol use despite negative consequences
1
87
Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine withdrawal delirium?
1. Haloperidol (Haldol) and fluoxetine (Prozac)
2. Carbamazepine (Tegretol) and donepezil (Aricept)
3. Disulfiram (Antabuse) and lorazepan (Ativan)
4. Chlordiazepoxide (Librium) and phenytoin (Dilantin)
4
88
Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal?
1. Antagonist therapy
2. Deterrent therapy
3. Codependency therapy
4. Substitution therapy
4
89
Which client statement demonstrates positive progress toward recovery from a substance use disorder?
1. “I have completed detox and therefore am in control of my drug use.”
2. “I will faithfully attend Narcotic Anonymous (NA) when I can’t control my cravings.”
3. “As a church deacon, my focus will now be on spiritual renewal.”
4. “Taking those pills got out of control. It cost me my job, marriage, and children.”
4
90
A client diagnosed with major depressive episode and substance use disorder has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions?
1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance.
2. Sedative-hypnotics are expensive and have numerous side effects.
3. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep.
4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.
1
91
A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual’s situation?
1. Psychological addiction
2. Physical addiction
3. Substance induced disorder
4. Social induced disorder
1
92
A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse’s rationale for this intervention?
1. To assess for emotional strength
2. To assess for Wernicke-Korsakoff syndrome
3. To assess for tachycardia
4. To assess for fine tremors
4
93
On the first day of a client’s alcohol detoxification, which nursing intervention should take priority?
1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days.
2. Educate the client about the biopsychosocial consequences of alcohol abuse.
3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.
4. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.
3
94
A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the client’s physician to treat this disorder. The nurse would give the client information on which medications?
1. Escitalopram (Lexapro) and clozapine (Clozaril)
2. Citalopram (Celexa) and olanzapine (Zyprexa)
3. Lithium carbonate (Lithobid) and sertraline (Zoloft)
4. Naltrexone (ReVia) and ziprasidone (Geodon)
3
95
A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client’s safety?
1. Assess for medication nonadherance.
2. Note escalating behaviors and intervene immediately.
3. Interpret attempts at communication.
4. Assess triggers for bizarre, inappropriate behaviors.
2
96
A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse’s teaching?
1. The side effects of medications
2. Deep breathing techniques to decrease stress
3. How to make eye contact when communicating
4. How to be a leader
3
97
A 16-year-old client diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client’s parents ask a nurse, “Where do the voices come from?” Which is the appropriate nursing response?
1. “Your child has a chemical imbalance of the brain, which leads to altered perceptions.”
2. “Your child’s hallucinations are caused by medication interactions.”
3. “Your child has too little serotonin in the brain, causing delusions and hallucinations.”
4. “Your child’s abnormal hormonal changes have precipitated auditory hallucinations.”
1
98
Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response?
1. “Tell him to stop discussing the voices.”
2. “Ignore what he is saying, while attempting to discover the underlying cause.”
3. “Focus on the feelings generated by the hallucinations and present reality.”
4. “Present objective evidence that the voices are not real.”
3
99
A client diagnosed with schizophrenia spectrum disorder states, “Can’t you hear him? It’s the devil. He’s telling me I’m going to hell.” Which is the most appropriate nursing response?
1. “Did you take your medicine this morning?”
2. “You are not going to hell. You are a good person.”
3. “The voices must sound scary, but the devil is not talking to you. This is part of your illness.”
4. “The devil only talks to people who are receptive to his influence.”
3
100
A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client?
1. Disturbed sensory perception
2. Altered thought processes
3. Risk for violence: directed toward others
4. Risk for injury
3
101
Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder?
1. Provide neon lights and soft music.
2. Maintain continual eye contact throughout the interview.
3. Use therapeutic touch to increase trust and rapport.
4. Provide personal space to respect the client’s boundaries.
4
102
Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder?
1. Establishing personal contact with family members
2. Being reliable, honest, and consistent during interactions
3. Sharing limited personal information
4. Sitting close to the client to establish rapport
2
103
A paranoid client diagnosed with schizophrenia spectrum disorder states, “My psychiatrist is out to get me. I’m sad that the voice is telling me to stop him.” What symptom is the client exhibiting, and what is the nurse’s legal responsibility related to this symptom?
1. Magical thinking; administer an antipsychotic medication.
2. Persecutory delusions; orient the client to reality.
3. Command hallucinations; warn the psychiatrist.
4. Altered thought processes; call an emergency treatment team meeting.
3
104
A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine?
1. Tactile hallucinations
2. Tardive dyskinesia
3. Restlessness and muscle rigidity
4. Reports of hearing disturbing voices
3
105
A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client’s positive and negative symptoms of schizophrenia?
1. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia.
2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia.
3. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia.
4. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia
2
106
A 60-year-old client diagnosed with schizophrenia spectrum disorder presents in an ED with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?
1. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications
2. Agranulocytosis treated by administration of clozapine (Clozaril)
3. Extrapyramidal symptoms treated by administration of benztropine (Cogentin)
4. Tardive dyskinesia treated by discontinuing antipsychotic medications
4
107
After taking chlorpromazine (Thorazine) for 1 month, a client presents to an ED with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?
1. Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium)
2. Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication
3. Dystonia treated by administering trihexyphenidyl (Artane)
4. Dystonia treated by administering bromocriptine (Parlodel)
1
108
A client diagnosed with schizophrenia spectrum disorder takes an antipsychotic agent daily. Which assessment finding should a nurse prioritize?
1. Respirations of 22 beats/minute
2. Weight gain of 8 pounds in 2 months
3. Temperature of 104F (40C)
4. Excessive salivation
3
109
An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate?
1. “Make sure you concentrate on taking slow, deep, cleansing breaths.”
2. “Watch your diet and try to engage in some regular physical activity.”
3. “Rise slowly when you change position from lying to sitting or sitting to standing.”
4. “Wear sunscreen and try to avoid midday sun exposure.”
3
110
A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately?
1. Sore throat, fever, and malaise
2. Akathisia and hypersalivation
3. Akinesia and insomnia
4. Dry mouth and urinary retention
1
111
During an admission assessment, a nurse assesses that a client diagnosed with schizophrenia spectrum disorder has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated?
1. Haloperidol (Haldol), because it is used only in older patients
2. Clozapine (Clozaril), because it is incompatible with desipramine
3. Risperidone (Risperdal), because it exacerbates symptoms of depression
4. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
4
112
A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis?
1. The client has experienced impaired reality testing for a 24-hour period.
2. The client has experienced auditory hallucinations for the past 3 hours.
3. The client has experienced bizarre behavior for 1 day.
4. The client has experienced confusion for 3 weeks.
2
113
A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD). What would differentiate this client’s symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)?
1. Clients diagnosed with SIPD experience delusions, whereas clients diagnosed with BPD do not.
2. Clients diagnosed with BPD experience hallucinations, whereas clients diagnosed with SIPD do not.
3. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features.
4. Catatonic features may be associated with BPD, whereas SIPD has no catatonic features.
3
114
A nurse prepares to assess a client using the Abnormal Involuntary Movement Scale (AIMS). Which side effect of antipsychotic medications led to the use of this assessment tool?
1. Dystonia
2. Tardive dyskinesia
3. Akinesia
4. Akathisia
2
115
A nurse discovers a client’s suicide note that details the time, place, and means to commit suicide. What should be the priority nursing action, and why?
1. Administer lorazepam (Ativan) prn, because the client is angry about plan exposure.
2. Establish room restrictions, because the client’s threat is an attempt to manipulate the staff.
3. Place client on one-to-one suicide precautions, because specific plans likely lead to attempts.
4. Call an emergency treatment team meeting, because the client’s threat must be addressed.
3
116
In planning care for a suicidal client, which correctly written outcome should be a nurse’s first priority?
1. The client will not physically harm self.
2. The client will express hope for the future by day three.
3. The client will establish a trusting relationship with the nurse.
4. The client will remain safe during hospital stay.
4
117
A nurse administers 100% oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure?
1. To prevent increased intracranial pressure resulting from anoxia.
2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation.
3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles.
4. To prevent blocked airway, resulting from seizure activity.
3
118
Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client?
1. On his or her side, to prevent aspiration
2. In high Fowler’s position, to prevent increased intracranial pressure
3. In Trendelenburg’s position, to promote blood flow to vital organs
4. In prone position, to prevent airway blockage
1
119
A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder?
1. Altered communication R/T feelings of worthlessness AEB anhedonia
2. Social isolation R/T poor self-esteem AEB secluding self in room
3. Altered thought processes R/T hopelessness AEB persecutory delusions
4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia
2
120
A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse’s priority intervention at this time?
1. Obtaining an order for locked seclusion until client is no longer suicidal.
2. Conducting 15-minute checks to ensure safety.
3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations.
4. Encouraging client to express feelings related to suicide.
3
121
A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis?
1. The client is disheveled and malodorous.
2. The client refuses to interact with others and isolates self in room.
3. The client is unable to feel any pleasure.
4. The client has maxed-out charge cards and exhibits promiscuous behaviors.
4
122
A client with a history of suicide attempts has been taking fluoxetine (Prozac) for one month. The client suddenly presents with a bright affect, rates mood at 9 out of 10, and is much more communicative. Which action should be the nurse’s priority at this time?
1. Give the client off-unit privileges as positive reinforcement.
2. Encourage the client to share mood improvement in group.
3. Increase the level of this client’s suicide precautions.
4. Request that the psychiatrist reevaluate the current medication protocol.
3
123
A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis?
1. Thyroid-stimulating hormone (TSH) level of 25 U/mL
2. Potassium (K+) level of 4.2 mEq/L
3. Sodium (Na+) level of 140 mEq/L
4. Calcium (Ca2+) level of 9.5 mg/dL
1
124
A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client’s depressive symptoms?
1. According to psychoanalytic theory, depression is a result of negative perceptions.
2. According to object-loss theory, depression is a result of overprotection.
3. According to learning theory, depression is a result of repeated failures.
4. According to cognitive theory, depression is a result of anger turned inward.
3
125
What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode?
1. The attention during the assessment is beneficial in decreasing social isolation.
2. Depression can generate somatic symptoms that can mask actual physical disorders.
3. Physical health complications are likely to arise from antidepressant therapy.
4. Depressed clients avoid addressing physical health and ignore medical problems.
2
126
A nurse is planning care for a 13 -year-old who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents?
1. Paroxetine (Paxil)
2. Sertraline (Zoloft)
3. Citalopram (Celexa)
4. Escitalopram (Lexipro)
4
127
A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam?
1. To rule out bipolar disorder
2. To rule out schizophrenia
3. To rule out neurocognitive disorder
4. To rule out personality disorder
3
128
A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention, related to this medication, should be initiated to maintain this client’s safety upon discharge?
1. Provide a 6-month supply of Elavil to ensure long-term compliance.
2. Provide a 1-week supply of Elavil, with refills contingent on follow-up appointments.
3. Provide pill dispenser as a memory aid.
4. Provide education regarding the avoidance of foods containing tyramine.
2
129
An older client has recently been prescribed sertraline (Zoloft). The client’s spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why?
1. Neuroleptic malignant syndrome; caused by ingestion of two different seratonin reuptake inhibitors (SSRIs)
2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI)
3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI
4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs
4
130
A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, “I heard about something called a monoamine oxidase inhibitor (MAOI). Can’t my doctor add that to my medications?” Which is an appropriate nursing response?
1. “This combination of drugs can lead to delirium tremens.”
2. “A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis.”
3. “That’s a good idea. There have been good results with the combination of these two drugs.”
4. “The only disadvantage would be the exorbitant cost of the MAOI.”
2
131
A number of assessment rating scales are available for measuring severity of depressive symptoms. Which scale would a nurse practitioner use to assess a depressed client?
1. Zung Depression Scale
2. Hamilton Depression Rating Scale
3. Beck Depression Inventory
4. AIMS Depression Rating Scale
2
132
The severity of depressive symptoms in the postpartum period varies from a feeling of the “blues,” to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms?
1. Maternity blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions)
2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby)
3. Postpartum melancholia (overprotection of infant, expresses concern about inability to care for baby, mysophobia)
4. Postpartum depressive psychosis (transient depressed mood, agitation, abnormal fear of child abduction, suicidal ideations)
2
133
A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of “automatic thoughts.” Which client statement is evidence of the “automatic thought” of discounting positives?
1. “It’s all my fault for trusting him.”
2. “I don’t play games. I never win.”
3. “She never visits because she thinks I don’t care.”
4. “I don’t have a green thumb. Any old fool can grow a rose.”
4
134
A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, “My physician told me there was no need to worry about dietary restrictions.” Which would be the most appropriate nursing response?
1. “Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended.”
2. “You must have misunderstood. An MAOI like Emsam always has dietary restrictions.”
3. “Only oral MAOIs require dietary restrictions.”
4. “All transdermal MAOIs do not require dietary modifications.”
1
135
After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn’t seem as effective as before. Which question should the nurse ask to determine the cause of this problem?
1. “Are you consuming foods high in tyramine?”
2. “How many packs of cigarettes do you smoke daily?”
3. “Do you drink any alcohol?”
4. “Are you taking St. John’s wort?”
2
136
A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, “Do you receive special messages from certain sources, such as the television or radio?” The nurse is assessing which potential symptom of this disorder?
1. Thought insertion
2. Paranoid delusions
3. Magical thinking
4. Delusions of reference
4
