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StuffedNurse : PSYCHIATRIC EXAM PRACTICE TEST

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

a. delusions.
b. hallucinations.
c. loose associations.
d. neologisms.

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


2. The nurse is caring for a client who is suicidal. When accompanying the client to the bathroom, the nurse should:

a. give him privacy in the bathroom.
b. allow him to shave.
c. open the window and allow him to get some fresh air.
d. observe him.

RATIONALE: The nurse has a responsibility to observe continuously the acutely suicidal client not provide privacy. The nurse should watch for clues, such as communicating suicidal thoughts, threats, and messages; hoarding medications; and talking about death. By accompanying the client to the bathroom, the nurse will naturally prevent hanging or other injury. The nurse will check the client's area and fix dangerous conditions, such as exposed pipes and windows without safety glass. The nurse will also remove potentially dangerous objects, such as belts, razors, suspenders, glass, and knives.


3. The nurse is developing a care plan for a client with anorexia nervosa. Which action should the nurse include in the plan?

a. Restrict visits with the family until the client begins to eat.
b. Provide privacy during meals.
c. Set up a strict eating plan for the client.
d. Encourage the client to exercise, which will reduce her anxiety.

RATIONALE: Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals not given privacy. Exercise must be limited and supervised.
4. A client whose husband recently left her is admitted to the hospital with severe depression. The nurse suspects that the client is at risk for suicide. Which of the following questions would be most appropriate and helpful for the nurse to ask during an assessment for suicide risk?

a. "Are you sure you want to kill yourself?"
b. "I know if my husband left me, I'd want to kill myself. Is that what you think?"
c. "How do you think you would kill yourself?"
d. "Why don't you just look at the positives in your life?"

RATIONALE: To determine if a client is at risk for suicide, ask, "How do you think you would kill yourself?" If the client has a plan, she may be closer to carrying out the act. Option 1 requires a yes-or-no response and is self-limiting. In option 2, the nurse is telling the client what to think and feel. Option 4 dismisses the client's feelings


5. The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates, such as morphine, include:

a. dilated pupils and slurred speech.
b. rapid speech and agitation.
c. dilated pupils and agitation.
d. euphoria and constricted pupils.

RATIONALE: Assessment findings in a client abusing opiates include agitation, slurred speech, euphoria, and constricted pupils.


6. The nurse is caring for a client experiencing an anxiety attack. Appropriate nursing interventions include:

a. turning on the lights and opening the windows so that the client doesn't feel crowded.
b. leaving the client alone.
c. staying with the client and speaking in short sentences.
d. turning on stereo music.

RATIONALE: Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm, and medicating as needed. Leaving the client alone, turning on a stereo or lights, and opening windows may increase the client's anxiety.


7. The nurse is teaching a new group of mental health aides. The nurse should teach the aides that setting limits is most important for:

a. a depressed client.
b. a manic client.
c. a suicidal client.
d. an anxious client.

RATIONALE: Setting limits for unacceptable behavior is most important in a manic client. Typically, depressed, anxious, or suicidal clients don't physically or mentally test the limits of the caregiver.


8. A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is:

a. highly important or famous.
b. being persecuted.
c. connected to events unrelated to oneself.
d. responsible for the evil in the world.

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


9. The nurse is caring for a client, a Vietnam veteran, who exhibits signs and symptoms of posttraumatic stress disorder. Signs and symptoms of posttraumatic stress disorder include:

a. hyperalertness and sleep disturbances.
b. memory loss of traumatic event and somatic distress.
c. feelings of hostility and violent behavior.
d. sudden behavioral changes and anorexia.

RATIONALE: Signs and symptoms of posttraumatic stress disorder include hyperalertness, sleep disturbances, exaggerated startle, survival guilt, and memory impairment. Also, the client relives the traumatic event through dreams and recollections. Hostility, violent behavior, and anorexia aren't usual signs or symptoms of posttraumatic stress disorder


10. The nurse is caring for a client with manic depression. The care plan for a client in a manic state would include:

a. offering high-calorie meals and strongly encouraging the client to finish all food.
b. insisting that the client remain active throughout the day so that he'll sleep at night.
c. allowing the client to exhibit hyperactive, demanding, manipulative behavior without setting limits.
d. listening attentively with a neutral attitude and avoiding power struggles.

RATIONALE: The nurse should listen to the client's requests, express willingness to seriously consider the requests, and respond later. The nurse should encourage the client to take short daytime naps because he expends so much energy. The nurse shouldn't try to restrain the client when he feels the need to move around as long as his activity isn't harmful. High-calorie finger foods should be offered to supplement the client's diet, if he can't remain seated long enough to eat a complete meal. The client shouldn't be forced to stay seated at the table to finish a meal. The nurse should set limits in a calm, clear, and self-confident tone of voice


11. A client is a Vietnam War veteran with a diagnosis of posttraumatic stress disorder. He has a history of nightmares, depression, hopelessness, and alcohol abuse. Which option offers the client the most lasting relief of his symptoms?

a. The opportunity to verbalize memories of trauma to a sympathetic listener
b. Family support
c. Prescribed medications taken as ordered
d. Alcoholics Anonymous (AA) meetings

RATIONALE: Although it's difficult, clients with posttraumatic stress disorder can obtain the most lasting relief if they verbalize memories of the trauma to a sympathetic listener. Family members are commonly frightened by the information and can't be consistently supportive. Antidepressants may help but these drugs can mask feelings and can't provide lasting relief. Treatment for alcohol abuse, including AA meetings, must be considered when planning care but alone doesn't provide lasting relief

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

a. Withdrawal
b. Logical thinking
c. Repression
d. Denial

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


13. A 22-year-old client is diagnosed with dependent personality disorder. Which behavior is most likely evidence of ineffective individual coping?

a. Inability to make choices and decisions without advice
b. Showing interest only in solitary activities
c. Avoiding developing relationships
d. Recurrent self-destructive behavior with history of depression

RATIONALE: Individuals with dependent personality disorder typically show indecisiveness, submissiveness, and clinging behaviors so that others will make decisions for them. These clients feel helpless and uncomfortable when alone and don't show interest in solitary activities. They also pursue relationships in order to have someone to take care of them. Although clients with dependent personality disorder may become depressed and suicidal if their needs aren't met, this isn't a typical response


14. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:

a. impending coma.
b. manipulating behavior.
c. suppression.
d. perceptual disorders.

RATIONALE: Perceptual disorders, especially frightening visual hallucinations, are very common with alcohol withdrawal. Coma isn't an immediate consequence. Manipulative behaviors are part of the alcoholic client's personality but not a sign of alcohol withdrawal. Suppression is a conscious effort to conceal unacceptable thoughts, feelings, impulses, or acts and serves as a coping mechanism for most alcoholics


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

a. Aggressive behavior
b. Paranoid thoughts
c. Emotional affect
d. Independence needs

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


16. The nurse is caring for a client in an acute manic state. What's the most effective nursing action for this client?

a. Assigning him to group activities
b. Reducing his stimulation
c. Assisting him with self-care
d. Helping him express his feelings

RATIONALE: Reducing stimuli helps to reduce hyperactivity during a manic state. Group activities would provide too much stimulation. Trying to assist the client with self-care could cause increased agitation. When in a manic state, these clients aren't able to express their inner feelings in a productive, introspective manner. The focus of treatment for a client in the manic state is behavior control


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

a. avoid shopping for large amounts of food.
b. control eating impulses.
c. identify anxiety-causing situations.
d. eat only three meals per day.

RATIONALE: Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping for large amounts of food isn't a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the care plan after initially addressing stress and underlying issues. Eating three meals per day isn't a realistic goal early in treatment


18. The nurse is caring for a 40-year-old client. Which behavior by the client indicates adult cognitive development?

a. Has perceptions based on reality
b. Assumes responsibility for actions
c. Generates new levels of awareness
d. Has maximum ability to solve problems and learn new skills

RATIONALE: Adults between ages 31 and 45 generate new levels of awareness. Having perceptions based on reality and assuming responsibility for actions indicate socialization development not cognitive development. Demonstrating maximum ability to solve problems and learning new skills occur in young adults between ages 20 and 30

19. A client with bipolar disorder is being treated with lithium for the first time. The nurse should observe the client for which common adverse effect of lithium?

a. Sexual dysfunction
b. Constipation
c. Polyuria
d. Seizures

RATIONALE: Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Sexual dysfunction isn't a common adverse effect of lithium; it's more common with sedatives and tricyclic antidepressants. Diarrhea, not constipation, occurs with lithium. Constipation can occur with other psychiatric drugs, such as antipsychotic drugs. Seizures may be a later sign of lithium toxicity


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

a. tension and irritability.
b. slow pulse.
c. hypotension.
d. constipation.

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


21. During a shift report, the nurse learns that she'll be providing care for a client who is vulnerable to panic attack. Treatment for panic attacks includes behavioral therapy, supportive psychotherapy, and medication such as:

a. barbiturates.
b. antianxiety drugs.
c. depressants.
d. amphetamines.

RATIONALE: Antianxiety drugs provide symptomatic relief. Barbiturates and amphetamines can precipitate panic attacks. Depressants aren't appropriate for treating panic attacks


22. A client comes to the emergency department while experiencing a panic attack. The nurse can best respond to a client having a panic attack by:

a. staying with the client until the attack subsides.
b. telling the client everything is under control.
c. telling the client to lie down and rest.
d. talking continually to the client by explaining what's happening.

RATIONALE: The nurse should remain with the client until the attack subsides. If the client is left alone, he may become more anxious. Giving false reassurance is inappropriate in this situation. The client should be allowed to move around and pace to help expend energy. The client may be so overwhelmed that he can't follow lengthy explanations or instructions, so the nurse should use short phrases and slowly give one direction at a time.


23. A 24-year-old client is experiencing an acute schizophrenic episode. He has vivid hallucinations that are making him agitated. The nurse's best response at this time would be to:

a. take the client's vital signs.
b. explore the content of the hallucinations.
c. tell him his fear is unrealistic.
d. engage the client in reality-oriented activities.

RATIONALE: Exploring the content of the hallucinations will help the nurse understand the client's perspective on the situation. The client shouldn't be touched, such as in taking vital signs, without telling him exactly what's going to happen. Debating with the client about his emotions isn't therapeutic. When the client is calm, engage him in reality-based activities


24. A client with paranoid type schizophrenia becomes angry and tells the nurse to leave him alone. The nurse should:

a. tell him that she'll leave for now but will return soon.
b. ask him if it's okay if she sits quietly with him.
c. ask him why he wants to be left alone.
d. tell him that she won't let anything happen to him.

RATIONALE: If the client tells the nurse to leave, the nurse should leave but let the client know that she'll return so that he doesn't feel abandoned. Not heeding the client's request can agitate him further. Also, challenging the client isn't therapeutic and may increase his anger. False reassurance isn't warranted in this situation


25. A client begins taking haloperidol (Haldol). After a few days, he experiences severe tonic contractures of muscles in the neck, mouth, and tongue. The nurse should recognize this as:

a. psychotic symptoms.
b. parkinsonism.
c. akathisia.
d. dystonia.

RATIONALE: These symptoms describe dystonia, which commonly occurs after a few days of treatment with haloperidol. The symptoms may be confused with psychotic symptoms and misdiagnosed. Parkinsonism results in muscle rigidity, shuffling gait, stooped posture, flat-faced affect, tremors, and drooling. Signs and symptoms of akathisia are restlessness, pacing, and inability to sit still


26. The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is:

a. benztropine (Cogentin).
b. diphenhydramine (Benadryl).
c. propranolol (Inderal).
d. haloperidol (Haldol).

RATIONALE: Benztropine, trihexyphenidyl, or amantadine is prescribed for a client with Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms

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

a. Monthly blood tests will be necessary.
b. Report a sore throat or fever to the physician immediately.
c. Blood pressure must be monitored for hypertension.
d. Stop the medication when symptoms subside.

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


28. A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication?

a. Calcium
b. Sodium
c. Chloride
d. Potassium

RATIONALE: Lithium is chemically similar to sodium. When sodium levels are reduced, such as from sweating or diuresis, lithium is reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day. The other electrolytes are important for normal body functions, but sodium is most important to the absorption of lithium


29. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?

a. "I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
b. "I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
c. "You're wrong. Nobody is trying to kill you."
d. "A foreign government is trying to kill you? Please tell me more about it."

RATIONALE: Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions


30. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which finding should alert the nurse that the client is experiencing pseudoparkinsonism?

a. Restlessness, difficulty sitting still, pacing
b. Involuntary rolling of the eyes
c. Tremors, shuffling gait, masklike face
d. Extremity and neck spasms, facial grimacing, jerky movements

RATIONALE: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and pill rolling. Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing


31. A 54-year-old female was found unconscious on the floor of her bathroom with self-inflicted wrist lacerations. An ambulance was called and the client was taken to the emergency department. When she was stable, the client was transferred to the inpatient psychiatric unit for observation and treatment with antidepressants. Now that the client is feeling better, which nursing intervention is most appropriate?

a. Observing for extrapyramidal symptoms
b. Beginning a therapeutic relationship
c. Canceling any no-suicide contracts
d. Continuing suicide precautions

RATIONALE: As antidepressants begin to take effect and the client feels better, she may have the energy to initiate and complete another suicide attempt. As the client's energy level increases, the nurse must continue to be vigilant to the risk of suicide. Extrapyramidal symptoms may occur with antipsychotics and aren't adverse effects of antidepressants. A therapeutic relationship should be initiated upon admission to the psychiatric unit, after suicide precautions have been instituted. It's through this relationship that the client develops feelings of self-worth and trust and problem-solving takes place. In a no-suicide contract, the client states verbally or in writing that she won't attempt suicide and will seek out staff if she has suicidal thoughts. When the time period for a contract has expired, a new contract should be obtained from the client


32. A 26-year-old male reports losing his sight in both eyes. He's diagnosed as having a conversion disorder and is admitted to the psychiatric unit. Which nursing intervention would be most appropriate for this client?

a. Not focusing on his blindness
b. Providing self-care for him
c. Telling him that his blindness isn't real
d. Teaching eye exercises to strengthen his eyes


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