Psychiatric Nursing Review

Situation - The nurse-patient relationship is a modality through which the nurse meets the client's needs.
1. The nurse's most unique tool in working with the emotionally ill client is his/her A. personality make up B. communication skills C. emotional reactions D. theoretical knowledge

2. The psychiatric nurse who is alert to both the physical and emotional needs of clients is working from the philosophical framework that states A. All behavior is meaningful; communicating a message or a need B. Human beings are systems of interdependent and interrelated parts C. There is a basic similarity among all human beings. D. Each individual has the potential for growth and change in the direction of positive mental health

3. Which of the following refers to the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client?

A. Trust B. Acceptance C. Empathy D. Congruence

4. All of the following responses are non therapeutic. Which is the MOST "direct violation of the concept, congruence of behavior ?
A. Tolerating all behavior in the client. B. Rejecting the client as a unique human being C. Responding in a punitive manner to the client. D. Communicating ambivalent messages to the client

5. The mentally ill person responds positively to the nurse who is warm and caring. This is a demonstration of the nurse's role as A. mother surrogate B. Therapist C. counselor D. socializing agent

Situation - It is common that clients ask the nurse personal questions.

6. Anticipation of personal questions is given adequate attention during which phase of the nurse patient relationship?
A. Termination phase B. Orientation phase C. Working phase D. Pre-interaction phase

7. If the client asks for the nurse's telephone number, which of these responses is NOT appropriate?
A. "Are you asking for an official number of that hospital/clinic for your reference?" B. "What would you do with my number if I give it to you?" C. "If I say No to your request, what are your thoughts about this?" D. "It is confidential. I just don't give it to anyone."

8. When the client asks about the family of the nurse. The MOST appropriate response is A. "Why don't we talk about your family instead?" B. Avoid the situation and redirect the client's attention C. Introduce another topic like the client's interests D. Give a brief and simple response and focus on the client.

9. When the nurse is asked a personal question. Which of these reactions indicate a need for him/her to introspect?
A. The client is simply curious. B. Some patients are like children in seeking recognition from the nurse. C. His/Her right to privacy is being intruded. D. The client knows no other way to begin a conversation.

10. It is 10 o'clock on your watch. The client asks, 'What time is it?" The nurse's appropriate response is
A. "Guess, what time is it?" B. "It is 10 o'clock. C. "Why do you ask?" D. "Are you getting bored?"

12. A therapeutic nurse-patient relationship is one in which: A. The nurse sets the priorities and goals using the nursing process B. The nurse permits the patient to establish the direction of the interactions C. The nurse and the patient meet each others needs D. The nurse plans interactions to help the patient meet his needs

13. Most therapeutic interaction with a patient occurs during which phase of the nurse-patient relationship?
A. Preinteraction B. Orientation C. Working D. Termination

14. The nurse who uses self-disclosure should

A. refocus on the patients experience as quickly as possible B. allow the patient to ask questions about her experience C. discuss her experience in detail D. have the patient explain his perception of what the nurse has revealed

15. During the mental status examination a patient may be asked to explain several proverbs, such as Dont cry over spilled milk. The purpose is to evaluate the patients ability to think A. B. C. D. rationally concretely abstract tangentially

16. The terms judgment and insight sometimes are use incorrectly. Insight is the ability to
A. make appropriate choices B. control inappropriate impulses C. explain ones psychiatric diagnosis D. understand the nature of ones problem or situation

17. The nurse who suspects that a patients behavior has a cultural basis should A. read several articles about the patients culture B. ask staff members of similar culture about the patients behavior C. observe the patient and his family and friends interacting with each other and other staff members D. accept the patients behavior because it is probably culturally based

18. Which contribution of the psychoanalytical model is particularly useful to psychiatric nurses? A. All behavior has meaning A. Behavior that is reinforced will be perpetuated B. The first 6 years of a persons life determine his personality C. Behavioral deviations result from an incongruence between verbal and nonverbal communication

19. According to Freuds psychosexual theory, the ego has several function, one of which is to
A. serve as the source of instinctual drives B. stimulate psychic energy C. operate a conscience that controls unacceptable drives D. test reality and direct behavior

20. Erickson described the psychosocial tasks of the developing person in his theoretical model. The primary development task of the young adult (age 18 to 25) is
A. B. C. D. Intimacy versus isolation Industry versus inferiority Generativity versus stagnation Trust versus mistrust

21. Which of the following is a generally accepted criterion of mental health?

A. Self-acceptance B. Absence of anxiety C. Ability to control others D. Happiness

22. The basis for a therapeutic nursepatient relationship begins with the nurses
A. sincere desire to help others B. acceptance on others C. self-awareness and understanding D. sound knowledge of psychiatric nursing

23. Which of the following should occur during the working phase of the nurse-patient relationship? A. The nurse assesses the patients needs and develops a plan of care for the patient B. The nurse and the patient together evaluate an modify the goals of the relationship C. The nurse and the patient discuss their feelings regarding the termination of the relationship D. The nurse and the patient explore each others expectations of the relationship

24. The nurse should introduce information about the end of the nurse-patient relationship
A. during the orientation phase B. as the goals of the relationship are reached C. at least one or two sessions before the last meeting D. when the patient is able to tolerate it

25. The MOST effective way for the nurse to set limits for a newly admitted who puts out his cigarettes on the dayroom floor is to A. restrict the patients smoking to times when he can be closely supervised by a staff member B. encourage other patients to speak with the patient about dirtying the dayroom floor C. ask the patient if he puts out his cigarettes on the floor at home D. hand the patient an ashtray and tell him he must use it or he will not be allowed to smoke

26. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, How is Carol doing? She is my best friend and is seen at your clinic every week. The MOST appropriate response is which of the following? A. Im not supposed to discuss this, but because you are my neighbor, I can tell you that she is doing great! B. Im not supposed to discuss this, but because you are my neighbor, I can tell you that she really has some problems! C. If you want to know about Carol, you have to ask her yourself. D. I cannot discuss any client situation with you.

27. The nurse is preparing the client for the termination phase of the nurse-client relationship. The nurse prepares to implement which nursing task that is MOST appropriate for this phase? A. Identifying expected outcomes B. Planning short term goals C. Making appropriate referrals D. Developing realistic solutions

28. During the termination phase of the nurseclient relationship, the clinic nurse observes that the client continuously demonstrates burst of anger. The MOST appropriate interpretation of the behavior is that the client A. requires further treatment and is not ready to be discharged B. is displaying typical behaviors that can occur during termination C. needs to be admitted to the hospital D. needs to be referred to the psychiatrist as soon as possible

29. The nurse is conversing with a client. The client says to the nurse, I have a secret that I want to tell you, You wont tell anyone about it, will you? The MOST appropriate nursing response is which of the following? A. No, I wont tell anyone. B. I cannot promise to keep a secret. C. If you tell me a secret, I will tell it to your doctor. D. If you tell me a secret, I will need to document it in your record.

30. A client with depression who attempted suicide says to the nurse, I should have died. Ive always been a failure. Nothing ever goes right for me. The MOST therapeutic response to the client is
A. I dont see you as a failure. B. Feeling like this is all part of being ill. C. Youve been feeling like a failure for a while? D. You have everything to live for.

31. The community health nurse visits a client at home. The client states, I havent slept at all couple of nights. Which response by the nurse illustrates the MOST therapeutic technique for this client? A. Go on .. B. Sleeping? C. The last couple of nights? D. Youre having difficulty sleeping?

32. The nurse is performing an admission on a client and is attempting to obtain subjective data regarding the clients sexual/reproductive status. The client states, I dont want to discuss this; its private and personal. Which statement, if made by the nurse, indicates that the nurse is therapeutic? A. I hate being asked these sorts of questions too. B. I am a professional nurse, and as such Ill have you know that all information is kept confidential. C. I know that some of these questions are difficult for you, but as a professional nurse, I must legally respect your confidentiality. D. This is difficult for you to speak about it; but I am trying to perform a complete assessment and I need this information.

Situation Nancy, mother of 2 young kids, 36 years old, had a mammogram and was told that she has breast cysts and that she may need surgery. This causes her anxiety as shown by increase in her pulse and respiratory rate, sweating and feelings of tension.

33. Considering her level of anxiety, the nurse can best assist Nancy by
A. giving detailed explanations about the treatments she will undergo B. giving her clear but brief information at the level of her understanding C. giving her activities to divert her attention D. preparing her and her family in case surgery is not successful

34. The nurse visits Nancy and prods her to eat her food. Nancy replies Whats the use? My time is running out. The nurses best response would be A. You sound like you are giving up. B. The doctor ordered full diet for you so that you will be strong for surgery C. Have you told your doctor how you feel? Are you changing your mind about your surgery? D. I understand how you feel but you have to try for your childrens sake

35. Realizing she feels angry about Nancys condition, the nurse learns that being self-aware is a conscious process that she should do in any situation like this because A. the nurse is a role model for the client and should be strong B. this is a necessary part of the nurse-client relationship process C. how the nurse thinks and feels affects her actions towards her client and her work D. the nurse has to be therapeutic at all time and should not be affected.

Situation - Jimmy developed his goal for hospitalization. "To get a handle on my nervousness." The nurse is going to collaborate with him to reach his goal. Jimmy was admitted to the hospital because he called his therapist that he planned to asphyxiate himself with exhaust from his car but frightened instead. He realized he needed help.

36. The nurse recognized that Jimmy had to conceptualized his problem and that the goal in the care plan is to help the client to A. communicate B. plan alternatives C. cope with the present problem D. find meaning in his experience

37. The nurse is guided that Jimmy is aware of his concerns of the "here and now" when he crossed out which item from this "list of what to know"? A. Anxiety laden unconscious conflicts B. Subjective idea of the range of mild to severe anxiety C. Early signs of anxiety D. Physiologic indices of anxiety

38. While Jimmy was discussing the signs and symptoms of anxiety with his nurse, he recognized that complete disruption of the ability to perceive occurs in A. B. C. D. mild anxiety moderate anxiety panic state of anxiety severe anxiety

39. Jimmy initiates independence and takes an active part in his self care with the following, EXCEPT A. becoming aware of the conscious feelings towards anxiety B. agreeing to contact the staff when he is anxious C. assessing need for medication and medicating himself D. writing out a list of behaviors that he identified as anxious

40. The nurse notes effectiveness of interventions in using subjective and objective data in the
A. initial plans or orders B. Database C. progress notes D. problem list

Situation - The purpose of the nursing care plan is to identify the care for an individual patient based on his problems. The nurse writes a nursing care plan for a patient based on nursing care standards.

41. Given this example of a problem; "Anxiety due to a job interview". The "due to" or the reason for the problem should be included if it is known. The initial step in identifying problems is A. B. C. D. gather the data about the patient determine if the problems are usual or unusual analyze the data analyze the problems as concisely as possible

42. Given this example of an expected outcome: "Openly verbalize anxiety about job interview. Identify how he can prepare for the job interview." Which of these is NOT a criterion of expected outcomes? A. An expected outcome is stated in terms of what the patient will do B. An expected outcome is stated in terms of what the nurse will do C. Every outcome must be measurable D. Every outcome answers the question, How will you know when the problem is resolved?

43. The following are reasons for setting deadlines within which to achieve outcomes of care EXCEPT A. Indicate specific times to review progress or lack of progress B. Does not allow plans to be changed C. Allow plans the need to be changed D. Set the time by which the expected outcome should be reached

44. Which of these is NOT a relevant nursing order? A. Ask patient any untoward side effects of medications he is taking B. Have patient role play interview situation C. Discuss with a patient with specific means he might prepare for the job interview D. Ask the patient what he is feeling about the job interview

45. Which of these practices on evaluation support nursing care? Review of care plan is A. a nursing team responsibility B. the sole responsibility of the primary nurse C. the responsibility of peers D. the sole responsibility of the supervisor

46. The nurse as a counselor performs which one of the following nursing interventions? A. Encourage the patient to express her feeling and concerns B. Helps the patient modify his behavior C. Encourages the patient modify his behavior D. Help patient develop insight into an ineffective relationship

47. It is most helpful to the nurse who is attempting to apply the principles of positive mental health to understand that A. emotionally ill people can empathize easily with others B. emotionally healthy people function optimally in all settings C. a sense of mastery of self and environment are crucial to emotional health D. mental illness is always characterized by observable signs or socially inappropriate behavior

48. Which of the following occurs when the client unconsciously transfers to the nurse feelings he has for significant people in his life?
A. Displacement B. Countertransference C. Reaction Formation D. Transference

49. A staff nurse on a medical surgical unit has been assigned to have daily one-to-one interactions with a number of clients. Before making an initial contact with the clients, the nurse decides to review their individual medical records. This phase of the nurse client relationship could best be referred to as the A. working phase B. termination phase C. orientation phase D. preinteraction phase

50. The nurse and patient are in working phase of their relationship. During the interaction, the patient has been talking about some important problems and revealing a lot about himself. Now he falls silent. The best initial nursing action would be A. encourage the patient to keep on talking B. remain silent with the patient staying attentive C. ask the patient a non threatening question D. terminate the interaction

51. After having one conversation with a female nurse, a young male patient asks the nurse for her phone number, stating that he would like to date her. Which of the following responses would be appropriate? A. I'm sorry, but I'm married and not interested in dating. B. It's against hospital policy for me to date patients. C. This is a professional relationship and we need to stay clear on that. D. I may consider dating once you have fully recovered.

52. The MOST basic therapeutic tool used by the nurse to assist a clients psychologic coping is the
A. self B. clients intellect C. milieu D. helping process

53. A newly admitted patient tells the nurse that he had a fight with his wife 2 days ago and that yesterday, on his way home from work, he decided it would be thoughtful to buy her the emerald ring she always wanted. Which ego defense mechanism is this patient using?
A. B. C. D. Displacement Rationalization Projection Undoing

54. Three-year old J. is admitted to the pediatric unit. The nurse notes that J. will drink fluids only through a bottle even though his mother states that he has been drinking from a cup for the past 9 months. The nurse concludes that the child is using the ego defense mechanism of
A. Denial B. Regression C. Repression D. Sublimation

55. A., who is pursuing a nursing degree only to please her parents, is nominated for senior nursing class president. In her campaign speech, she speaks sincerely about how professional nursing is the best possible career choice. A.s behavior is an example of which ego defense mechanism?
A. B. C. D. Reaction formation Identification Compensation Denial

56. A patient with a large duodenal ulcer is told that she must follow a bland diet. When her teenage children bring home a pepperoni pizza, she states. How wonderful. My physician said that I have a small ulcer but that I can eat anything I want. The patient is probably using which ego defense mechanism? A. Splitting B. Compensation C. Rationalization D. Denial

57. A young male patient recovering from a cholecystectomy is undergoing psychotherapy to help him cope with his ego-dystonic homosexuality. One morning, he emphatically whispers to the nurse, You must get my room changed. My roommate is making homosexual gestures toward me. The patient is using the ego defense mechanism of A. Displacement B. Intellectualization C. Projection D. Identification

58. A busy woman attorney with a successful law practice is admitted to the acute care hospital with epigastric pain. Since admission, she has called the nurse every 15 minutes with one request or any other. The patient is exhibiting

A. B. C. D.

Repression Somatization Regression Conversion

59. G. lost an important advertising account and had a flat tire on the way home. That evening, he began to find fault with everyone. Which defense mechanism is he using? A. B. C. D. Displacement Projection Regression Sublimation

60. Which primary unconscious defense mechanism keeps highly anxiety-producing situation out of conscious awareness? A. B. C. D. Introjection Regression Repression Denial

61. J., age 17, rarely expresses his feelings and usually remains passive; however, when he is angry, his face typically becomes flushed and his blood pressure rises to 170/100 mm Hg. His parents are described as passive and easygoing. J. may be using which defense mechanism to handle his anger? A. B. C. D. Displacement Introjection Projection Sublimation

Situation - F., age 18, returns home from school to discover that her mother has been in a serious automobile accident.

62. F. initially responds to the news by yelling, No, I dont believe it. It cant be true, F. is using which defense mechanism? A. B. C. D. Introjection Suppression Denial Repression

63. F. excuses herself from the hospital to go home by saying to her father, I have to go home. I cant stay awake anymore, and Ive been here most of the day. Which defense mechanism is F. using?

A. B. C. D.

Reaction formation Rationalization Denial Regression

64. On arriving home, F. encounters neighbors who ask about her mothers condition. F. tells them all the details unemotionally and without feeling upset. This behavior illustrates her use of A. B. C. D. displacement introjection intellectualization conversion

Situation - W., a 27-year old secretary, is brought to the hospital in an agitated state. She is admitted to the psychiatric unit for observation and treatment.

65. The nurse enters W.s room for the first time and says, W., Im E., the nurse. Ill help you get settled. W. responds, I want another nurse. I dont like you. Youre mean. The nurse recognizes that W,s responses is an example of

A. B. C. D.

identification regression counter transference transference

66. Before responding to W.s initial outburst, the nurse should

A. make sure she is in a safe distance from the patient B. move closer to the patient to show that she is not afraid C. assess her own feelings and responses to the patients behavior D. recognize that it takes time for relationships to develop and nor feel hurt

67. What would be the MOST therapeutic INITIAL response by the nurse?

A. Say nothing accept what the patient has said, and remain nearby B. Say, W., weve just met. Why do you think Im mean? C. Say, Im only trying to be helpful. Let me help you put your things away D. Say, Ill be back in half an hour, then leave the patients room

68. As W. puts her things away, she talks rapidly and folds and unfolds her clothes several times. She cannot seem to settle down. Which nursing diagnostic category is MOST applicable initially? A. B. C. D. Self-care deficit Anxiety Impaired verbal communication Powerlessness

69. The nurse needs to complete Ws admission interview. In light of the patients initial behavior, which nursing approach is BEST?
A. Allow W. as much time as she needs to arrange her clothes and belongings B. Recognize that W. is upset, but stress that the admission interview must be completed C. Tell W. that her repetitious behavior is interfering with the interview and that she must stop and cooperate D. Suggest that W. finish arranging her belongings later, and mention that she needs to complete her admission interview

70. The best way to continue Ws mental status interview is to ask

A. Why are you here, W? B. What events led to your coming to the hospital? C. What do you want us to do for you while you are here? D. Tell me about your family, W.

71. A nurse explains to the mental health care technician that a clients obsessive compulsive behaviors are related to unconscious conflict between id impulses and the superego. On which of the following theories does the nurse based this statement? A. Behavioral theory B. Cognitive theory C. Interpersonal theory D. Psychoanalytic theory

72. It is important that the needs of the infant should be met because this will help him

A. lay the foundation for the development of trust B. spare the infant from frustration C. establish bonding between the mother and child D. stabilize the self-identity of the infant

Situation - The nurse has been caring for G., a 58year-old chronic paranoid schizophrenic patient, for several months. She has held several one-toone session with him. During this particular session, he appears more anxious than usual. At the beginning of the session, G. speaks quiet rapidly and loudly.

73. Besides his loud, rapid speech, G. swings his feet and rapidly taps his fingers on the arm of the chair. Yet he says, I certainly feel calm today I didnt know life could be so tranquil. Which response by the nurse is MOST appropriate?
A. Im glad to hear you are feeling calm and settled this morning B. You tell me that you are calm, but your body seems to be sending a different message C. I think we should talk about how calm the weather is today D. Im glad you are feeling so calm. Things will be better for you now you can count on that

74. G.s anxiety level takes a toll on the nurse, and she feels her body tensing. The nurse momentarily questions the therapeutic quality of her listening skills. Which behavior on the nurses part indicates her decreased attention to Gs problems? A. B. C. D. Moving her chair so she directly faces G. Leaning forward toward G. Maintaining direct eye contact Crossing her arms and legs

75. Which statement is MOST appropriate to end the one-to-one session with G?

A. Your body seems more relaxed now, G. B. Today we talked about your body can provide clues to your feelings C. Did you think todays session was of value to you? D. Im going to lunch now; out time is up

76. The client asks, "Do you think my doctor is a good doctor?" Which of the following is the most therapeutic nurse response?
A. Why are you concerned? B. Sounds like you have some concerns C. Everyone here really likes your doctor D. I havent been here very long and I dont know the doctors very well

77. A client is dying from heart failure. The family has been called. The nurse caring for the client has been caring for the client and helped the client move through the stages of grief. The client tells the nurse he wants the nurse to have his watch "...to remember me by." Which of the following approaches is MOST therapeutic? A. Say, Thank you! Im honored! But youd better put that in writing. B. I think you should save that for your family C. Say. Thank you Im honored. But makes sure the family gets the watch. D. You have shared a lot of yourself with me that I dont need the watch to remember you. I will never forget you.

78. Which of the following is NOT a concept of therapy derived from Behaviorism?

A. Systematic desensitization B. Token economy C. Extinction D. Here and Now

79. An elderly who has lots of regrets, unhappy and miserable is experiencing
A. B. C. D. Crisis Despair Ambivalence Loss

80. A male nurse is caring for a client. The client states, You know, Ive never had a male nurse before. The nurses BEST reply would be
A. Does it bother you to have a male nurse? B. There arent many of us; were a minority. C. How do you feel about having a male nurse? D. You sound upset. Would you prefer a female nurse?

Situation - Through the nurse-patient relationship, the nurse intervenes utilizing effective communication techniques. The following are varied situations in a psychiatry ward.

81. Soledad is terminally ill of cancer. Looking sad she expresses, "Wala na yata akong pag-asang mabuhay pa. A response which fosters hope is?
A. Mukhang napakabigat ng dinaramdam ninyo. Andito po ako at puwede tayong mag-usap B. "Huwag po ninyong isipin sakit ninyo. Bale wala yon. Andito naman ako para makausap ninyo." C. Lakasan ang loob ninyo. Lahat naman po tayo ay doon ang patutunguhan." D. "Gagaling din po kayo. Huwag po kayong magalala."

82. Camilia verbalizes. Pinag-uusapan nila ako. Ayaw nila ako. "A therapeutic response is? A. "Nalulungkot ba ang pakiramdam mo. B. 'Hayaan mo sila. Ang mahalaga ay ang palagay mo sa sarili mo." C. Sino ang nila' ang tinutukoy mo? D. Huwag mong isipin yan. Hindi tama yan.

83. Purita talks about her joy in having responsible and accomplished children and recalls challenging career as a lawyer. She is demonstrating a sense of
A. B. C. D. ego integrity generativity industry Initiative

84. This is the environment in which communication occurs and can include the time and the physical, social, emotional, and cultural environment.
A. B. C. D. Content Context Scenario Milieu

85. Nodding and saying yes I follow what you say is a technique called A. B. C. D. making Observations accepting making broad openings silence

86. Dream analysis and free association are techniques in which of the following? A. Client-centered therapy B. Gestalt therapy C. Logotherapy D. Psychoanalysis

87. Four levels of anxiety were described by

A. Erik Erikson B. Sigmund Freud C. Hildegard Peplau D. Carl Rogers

88. The relationship that is of extreme importance in the formation of the personality is the A. B. C. D. Peer Sibling Parent-child Heterosexual

89. Problems with dependence versus independence develop during the stage of growth and development known as
A. B. C. D. Infancy Toddler Preschool School age

90. During the oedipal stage of growth and development, the child A. loves and hates (ambivalence) both parents B. loves the parent of the same sex and the parent of the opposite sex C. loves the parent of the opposite sex and hates the parent of the same sex D. loves the parent of the same sex and hates the parent of the opposite sex

91. The stage of growth and development basically concerned with role identification is the A. B. C. D. Oral stage Genital stage Oedipal stage Latency stage

92. Resolution of the oedipal complex takes place when the child overcomes the castration complex and
A. B. C. D. Rejects the parent of the same sex Introjects behaviors of both parents Identifies with the parent of the same sex Identifies with the parent of the opposite sex

93. Any surgery should be delayed if possible, because of the effects on personality development during the
A. B. C. D. Oral stage Anal stage Oedipal stage Latency stage

94. Evidence of the existence of the unconscious is BEST demonstrated by: A. B. C. D. The ease of recall Slips of the tongue Dj vu experiences Free-floating anxiety

95. Mental experiences operate on different levels of awareness. The level that BEST portrays ones attitudes, feelings and desires is the
A. B. C. D. Conscious Unconscious Preconscious Foreconscious

96. The superego is that part of the psyche which

A. Contains the instinctual drives B. Is the source of creative energy C. Operates on the pleasure principle and demands immediate gratification D. Develops from internalizing the concepts of parents and significant others

97. Another term for the superego is

A. Self B. Ideal self C. Narcissism D. Equilibrium

98. The superego is that part of the self which says A. I like what I want B. I want what I want C. I should not want that D. I can wait for what I want

99. Incidents of child molestation that come out years later when the victim is an adult can BEST be explained by the ego defense mechanism of A. B. C. D. Repression Regression Rationalization Reaction Formation

100. A client with diabetes mellitus is able to discuss in great detail the metabolic process in diabetes while eating a piece of chocolate cake topped with butter frosting. This is an example of the defense mechanism known as A. B. C. D. Projection Dissociation Displacement Intellectualization

101. The level of anxiety that BEST enhances an individuals power of perception is: A. B. C. D. MILD PANIC SEVERE MODERATE

102. Sublimation is a defense mechanism that helps the individual: A. Act out in reverse something already done or thought B. Return to an earlier, less mature stage of development C. Exclude from the conscious things that are psychologically disturbing D. Channel unacceptable sexual drives into socially approved behavior

103. A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. This is an example of the mechanism of:
A. B. C. D. Introjection Sublimation Compensation Reaction Formation

104. What conceptual model of a psychiatric mental health practice stipulates that anxiety is experienced interpersonally?
A. Medical B. Behavioral C. Interpersonal D. Psychoanalytic

105. To protect the lives of depressed and suicidal patients, what need must be assured?
A. Love B. Security C. Physiologic D. Safety

106. Cecilia has a lot of irrational thoughts. The goal of therapy is to modify her: A. cognition C. perception B. observation D. Communication

107. Cognitive therapy is indicated for Cecilia when she is already able to handle anxiety reactions. Which of the following should the nurse implement?
A. assist her in recognizing irrational beliefs and thoughts B. help find meaning in her behavior C. administer anxiolytic drug D. provide positive reinforcement for acceptable behavior

108. A recovering alcoholic joins Alcoholic Anonymous (AA) to help maintain sobriety. AA is classified as a A. social group B. self-help group C. resocialization group D. psychotherapeutic group

109. Mang Pepeng, is encouraged to join a selfhelp group when discharged from the mental health facility. The purpose of having people work in a group is to provide
A. support B. therapy C. confrontation D. self-awareness

110. Membership dropout generally occurs in group therapy after a member

A. accomplishes his goal in joining the group B. discusses personal concerns with group members C. experiences feelings of frustration in the group D. discovers that his feelings are shared by the group members

111. Which of the following questions illustrates the group role of an encourager? A. Why haven't we heard from you? B. Where do you go from here? C. Who wants to respond next? D. What were you saying?

112. Which of the following is a characteristic of the working phase of group therapy? A. Competition B. Cohesiveness C. Confusion D. Caution

113. The treatment of the family as a unit is based on the belief that the family A. is a social system and all the members are interrelated components of that system B. who has therapy together will tend to remain together C. as a unit of society needs the opportunity to change its own destiny D. is "contaminated" by the presence of deviant member and all members need treatment

114. The most advantageous therapy for a preschool-age child with a history of physical and sexual abuse would be
A. play B. group C. family D. psychodrama

115. A mental health nurse is caring for a male client with phobia. The nurse tells the client that the client will attend a music therapy session. The client tells the nurse that he cannot sing and refuses to attend. The MOST APPROPRIATE nursing response would be which of the following? A. You dont have to sing at the session. You can listen and enjoy the music. B. Why dont you want to attend? What is the real reason? C. The physician has prescribed this therapy for you. D. You must go. You have no choice.

116. A cognitive behavioral approach is used as part of treatment plan for a client with anorexia nervosa. The nurse understands that the purpose of this approach is to
A. help the client identify and examine dysfunctional thoughts and beliefs B. emphasize social interaction with clients who withdraw C. provide a supportive environment D. examine intrapsychic conflicts and past issues

117. Nurse Jane is caring for a client with phobia who is being treated for the condition. The client is introduced to short periods of exposure to the phobic object while in a relaxed state. Nurse Jane understands that this form of behavior modification can BEST be described as
A. systematic desensitization B. self-control therapy C. milieu therapy D. aversion therapy

118. Aling Kingking asks Nurse Gigi about milieu therapy. Nurse Gigi responds, knowing that the primary focus of milieu therapy can BEST be described as which of the following?
A. A form of behavior modification therapy B. A cognitive approach to changing behavior C. A living, learning, or working environment D. A behavioral approach to changing behavior

119. Lorelie upon discharge was referred to a volunteer group where she has learned to pattern, cut out fabric and use a sewing machine to make simple outfits that will help earn in the future. What type of activity therapy is this? A. Recreational therapy B. Vocational therapy C. Educational therapy D. Art therapy

120. The goal of remotivation therapy is to facilitate A. B. C. D. socialization productivity insight intimacy

121. Which of the following is a form of cognitive restructuring technique that was developed to eliminate intrusive, unwanted thoughts?
A. Reflecting B. Thought stopping C. Clouding/fogging D. Verbalizing the implied

122. In a residential treatment home for adolescent girls, the clients were becoming increasingly tense and upset because of shortening of their recreation time. To de-escalate possible anger and aggression among the clients, it is BEST to play A. religious music B. relaxation music C. rock music D. dance music

123. The accurate information of the nurse of the goal of desensitization is to

A. help the clients relax and progressively work up a list of anxiety provoking situations through imagery. B. provide corrective emotional experiences through a one-to-one intensive relationship. C. help clients in a group therapy setting to take on specific roles and reenact in front of an audience, situations in which interpersonal conflict is involved. D. help clients cope with their problems by learning behaviors that are more functional and be better equipped to face reality and make decisions.

124.It is essential in desensitization for the patient to A. have rapport with the therapist B. use deep breathing or another relaxation technique C. assess one's self for the need of an anxiolytic drug D. work through unresolved unconscious conflicts

125. A token economy system is based on the principle of A. Psychoanalytical theory B. Psychosocial theory C. Behavior modification theory D. Interpersonal theory

126. The success of a token economy system depends on A. consistency of all staff members in rewarding targeted behaviors B. Redemption of tokens for concrete rewards, such as candy, soda, or other snacks C. Setting behavioral goals high enough to motivate the patient D. Flexibility of staff members in allowing for slippage when the patient is having a difficult day

127. Which of the following principles is cognitive restructuring based on? A. Behavior can be learned B. Here and now C. Intrapsychic issue resolution D. Psychoanalysis

128. Which of the following DOES NOT comprise the concepts of behavior therapy program? A. learning B. extinction C. placebo as a form of treatment D. reward and punishment

129. A victim of rape joined a group therapy and later became a counselor and shares her experiences with the new victims to help them cope. Which principle of group therapy is present in this situation? A. Universality B. Altruism C. Cohesiveness D. Oneness

130. In a self-help group

A. clients themselves facilitate the therapy B. a professional therapist should lead the group C. formal therapy sessions should be followed D. clients should commit themselves to end the therapy as entered in the contract

131. Which statement most accurately describes Alcoholic Anonymous (AA)? A. AA is a complex organization in which professional counselors help alcoholic persons with their problems B. AA consists of local, loosely organized groups on which alcoholic persons help each other to stay sober C. AA is an organization that focuses on teaching the public about alcoholism D. AA works indirectly with alcoholic persons through research and education programs

Situation: F., the nurse-manager in the cardiac clinic, notes that many patients seem confused and overwhelmed by the number of medications prescribed for their heart conditions. She suggests implementing medication management groups. The idea is well received by the treatment team.

132. F. should begin planning for the groups by carefully assessing A. the nature of the problems that patients are having with their medications B. which patients would be interested in joining such a group C. which staff members are prepared to be leaders or co-leaders of the groups D. the best time of day to offer such groups

133. F. consults the hospitals clinic nurse specialist in psychiatric nursing about group size. The nurse specialists will most likely say that the optimal number of patients in each group is: A. 5 B. 10 C. 20 D. Unlimited

134. The nurse specialist recommends forming three medication management groups, with F. as leader and another nurse as co-leader. Each group meets once a week for 30 minutes in 4-week cycles. What is the best approach to establishing membership in each group?
A. Require all cardiac clinic patients to attend B. Assign patients to groups that are offered on their clinic visit days C. Permit patients to join any group or attend any session D. Screen patients, and explain the groups goals and purpose to them

135. F. and her co-leader plan to meet weekly with the clinical nurse specialist for supervision and review of group progress. To facilitate these sessions, the nurse specialist should
A. ask the leader and co-leader to keep a log or journal of each group session B. review each group members chart weekly C. ask the patients how they feel the group and its progress D. meet with the leader and co-leader separately for supervision

136. During the group sessions, F. identifies several patients who demonstrate anxiety, ineffective coping, and hopelessness related to the impact of adjusting to a serious cardiac illness. The most beneficial form of group therapy for these patients is likely to be led by A. F. and another nurse B. A psychiatric clinical nurse specialist C. A cardiology resident D. Other cardiac patients who have coped successfully with similar problems

Situation: A., age 15, is admitted to the unit for chronic psychiatric patients. This unit uses a token economy system as its treatment modality.

137. As treatment plan states that he will receive one token for making his bed each morning. After 2 weeks, the nurse reports that A. has not earned any tokens for making his bed. The nurse suggests that A. The goal remain the same; he will earn a token when he makes his bed B. An attempt to motivate A. should be made by offering him two tokens for making his bed C. The goal should be changed to a one-token penalty when his bed is not made D. The goal should be modified to reflect more attainable goals at this time

138. A staff member reports that A. may be receiving tokens from other patients who feel sorry for him. Which strategy will control such donations? A. Keep an accurate account of all tokens earned and spent B. Use special, personalized tokens for A. C. Penalize the other patients for giving tokens to A. D. Penalize A. for accepting tokens from others.

Situation: The following set of questions pertains to crisis situations and interventions. T., a 44-year-old married woman with one son, was referred to the mental health clinic by her family physician after he ruled out any physical basis for her complaints of insomnia, anxiety, fatigue, and loss of interests in her usual activities. On arrival at the clinic, T. states that her symptoms have increased over the last few weeks to the point that she feels too tires most of the time to take care of her home or leave the house.

139. During the initial assessment, the nurse suspects that T. may be having a situational crisis. Which question is most effective in beginning to explore this possibility? A. What has changed in your life recently? B. Do you think your symptoms are related to a recent event in your life? C. What do you think is causing your symptoms? D. Tell me all about yourself

140. T. relates that her father dies 7 years ago and her mother is extremely lonely and misses her father very much. While listening to T., the nurse should further assess for: A. The patents feelings about her mother B. The patients feeling about her father C. Any recent losses in the patients life D. The patients relationship with relatives and friends

141. During the assessment interview, T. reveals that her only son moved to another state 2 months ago and that her husband has been traveling frequently on business lately. The nurse inquiries should be directed at: A. Encouraging the patient to form closer relationship with others to replace those with her son and husband B. Identifying the patients available support systems C. Helping the patients to realize she is not alone D. Helping the patient to develop new coping mechanisms.

142. The treatment team determines that T. is in a situational crisis. Which nursing diagnostic category is MOST applicable at this time?
A. Dysfunctional grieving B. Altered thought processes C. Adjustment disorder D. Ineffective individual coping

143. All of the following therapeutic approaches are appropriate for counseling T. EXCEPT A. Ventilation B. Clarification C. Support of defenses D. Interpretation

144. The nurses role in crisis therapy should be

A. Nondirective and passive B. Firm and confrontational C. Active and directive D. Calm and nonexpressive

145. The best indicator that crisis counseling has been effective is T.s A. working through her feelings of loss over her fathers death B. developing a closer relationship with her mother C. resuming her precrisis routines and activities D. visiting her son for several weeks

146. The nurse is aware that the main goal in planning care for a client in crisis would be to A. schedule follow up counseling for the client B. restore the clients precrisis equilibrium C. have the client gain insight into the problem D. refer the client for occupational and physiotherapy

147. The outcome that is UNRELATED to a crisis state is A. learning more constructive coping skills B. decompensation to a lower level of functioning C. adaptation and a return to a prior level of functioning D. a high level of anxiety continuing for more than 3 months

148. The nurse is aware that the approach to be used during crisis intervention should be A. passive and reflective B. active and goal-directed C. future-oriented and passive D. interpretative and analytical

149. The MOST important assessment data for the nurse to gather from the client in crisis would be
A. the clients work habits B. any significant physical health data C. a history of any emotional problems in the family D. the specific circumstances surrounding the perceived crisis situation

150. The BEST example of the nurses use of crisis intervention would be A. Tell me what you have done to help yourself. B. Can you tell me about what is bothering you? C. I understand in the past you have had problems. D. I will be here for you to help you figure things out.

151. A nurse educator emphasizes that nurses caring for middle-aged adults who are experiencing midlife crisis should be aware that this crisis is MOST often due to A. individuals perception of his or her life situation B. many role changes adults experience at this time C. anticipation of negative changes associated with old age D. lack of support from family members who are busy with their own lives

152. In assisting clients under crisis to cope, the professional care provider should consider which of the following as PRIORITY?
A. Stabilize the victim B. Intervene immediately C. Encourage self reliance D. Facilitate understanding of the events E. Utilize available resources

153. Nurse Siri is developing a plan of care for a client in a crisis state. When developing the plan, Nurse Siri considers which of the following? A. Presenting symptoms in a crisis situation are similar for all individuals experiencing a crisis. B. A crisis state indicates that the individual is suffering from an emotional illness C. A crisis state indicates that the individual is suffering from a mental illness D. A clients response to a crisis is individualized, and what constitutes a crisis for one person may not constitute a crisis for another person

154. The treatment team determines that T. is in a situational crisis. Which nursing diagnostic category is MOST applicable at this time?
A. Dysfunctional grieving B. Altered thought processes C. Adjustment disorder D. Ineffective individual coping

155. One of the volunteers asks, WHAT IS CRISIS? The nurse should reply that a crisis is a situation in which a person or a family A. is too subjectively involved to realize when there is a problem B. Constantly looks to others to resolve certain conflicts C. Has difficulty with growth and development periods D. Has had no experience in knowing how to deal with a problem

156. Those working with people on crisis should recognize that one of the first reactions to crisis is the use of defense mechanisms. They should know that this defenses at the time of a crisis
A. Are useful in helping clients protect themselves B. Are irrelevant, as they are part of the basic personality C. Should be interrupted to prevent further damage D. Are an indication that the client is coping well

157. A nurse states that when the person is in crisis, the BEST support group would be
A. Volunteers in the community B. Close family and friends C. Other people having similar problems D. Professional working in crisis center

158. A nurse told a volunteer in the crisis center that when people first come in the center to seek information about their problem, only specific questions should be answered, with no details given at this time. Why is the approach taken? A. The person may be mentally incompetent and may lose control B. A nurse or doctor should give a specific information C. The person may be overwhelmed with excessive information D. The person is not interested in detailed information

159. The crisis intervention is limited from 4 to 6 weeks. A nurse states that a person can stand the disequilibrium only for a limited time, and during this time will: A. More likely accept intervention to help with coping B. Return to a familiar pattern of behavior C. Require a long-term counseling after this period D. Refuse help from any other support groups

Situation: The school nurse is caring for L., a 16year-old girl who has been seen vomiting in the lavatory after lunch on several occasions during the past few months. L. tells the nurse that she had a fight with her boyfriend earlier in the day, then consumed two pizzas, 1 gallon of ice cream, and 2 liters of soda at lunch in order to make herself vomit.

160. The nurse realizes that this type of behavior is characteristics of someone with A. bulimia B. conduct disorder C. anorexia nervosa D. gluttony

161. Psychologically, a bulimic patient differs from an anorexic patient through awareness that her behavior is
A. acceptable for maintaining weight B. abnormal C. easy to control D. physically dangerous

162. The personality of bulimic patient differs from that of an anorexic patient in that she is commonly
A. impulsive B. controlled C. serious D. intelligent

Situation: Kara, 17 years old, is admitted with anorexia nervosa. You have been assigned to sit with her while she eats dinner.

163. Kara says to you, My primary nurse trusts me. I dont see why you dont. Your BEST response is A. I do trust you, but I was assigned to be with you. B. It sounds as if you are manipulating me. C. OK. When I return, you should have eaten everything. D. Who is your primary nurse?

164. Kara is 64 inches tall and weighs 100 lbs. The PRIMARY objective in the treatment of Kara is to
A. decrease the clients anxiety B. increase insight into the disorder C. help the mother to relinquish control D. get the client to eat and gain weight

165. A nursing intervention based on the behavior modification model of treatment for anorexia nervosa would be A. role playing the clients interactions with her parents B. encouraging the client to vent her feelings through exercise C. providing a high calorie, high protein diet between-meal snacks D. restricting the clients privileges until she gains three pounds

Situation: Bulimia nervosa is characterized by episodes of bingeing and purging.

166. The major difference between anorexia nervosa and bulimia nervosa is that the individual with bulimia nervosa A. is obese and is attempting to lose weight B. has a distorted body image and sees the body as fat C. has behaviors and an appearance that appear more normal D. is struggling with a conflict of dependence versus independence

167. A therapeutic environment for clients with bulimia nervosa would be one that is A. controlling B. empathetic C. focused on food D. based on realistic limits

Situation: K., age 16, is brought to the adolescent clinic by her mother, who is worried that her daughter is becoming seriously ill. K. is 5 (152 cm) tall and weighs 75 lb (34 kg). She consumes only 100 to 200 calories a day appear emaciated, and has amenorrhea.

168. Which disorder should the nurse suspect based on the above history findings? A. Bulimia B. Pica C. Compulsive eating disorder D. Anorexia nervosa

169. Which nursing diagnosis category is LEAST applicable to this patient? A. Ineffective individual coping B. Body image disturbance C. Altered nutrition, less than body requirements D. Dressing and grooming self-care deficit

170. Which nursing action is inappropriate for K. at this time? A. Starting K. on a behavior modification program B. Taking necessary measures to control K.s manipulative behavior C. Referring K. for psychotherapy D. Using logic and reasoning to persuade K. to alter her behavior

171. The nurse realizes that K.s behavior probably is a result of her effort to A. meet others expectations B. live up to standard weight and height charts C. gain control over at least one aspect of her life D. satisfy peer pressure

Situation: Ms. C., female client, age 16, is admitted to the psychiatric service with the diagnosis of anorexia nervosa. She has lost 20 pounds in 6 weeks. She is very thin but excessively concerned being overweight. Her daily intake is 10 cups of coffee.

172. The MOST important INITIAL nursing intervention would be to A. compliment her on her lovely figure B. try to establish a relationship of trust C. explain the value of adequate nutrition D. explore the reasons why she does not eat

173. An appropriate behavior modification goal for a client with anorexia nervosa would be the client will
A. eat every meal for a week B. gain a pound of weight a week C. attend group therapy everyday D. talk about food for 1 hour a day

174. Evaluation of anorexic clients requires reassessment of behaviors after admission. The assessment that indicates that the therapy is beginning to become effective is when the client A. is hiding food in pocket of clothing B. states that the admission has been helpful C. has gained 6 pounds since admission 3 weeks ago D. is the first to sit down and the last to leave the dining room table

175. Ms. C. appears cachectic, with dehydration and electrolyte imbalances. She takes enemas and laxatives several times a week, and engages in self-induced vomiting. When planning care for Ms. C, a PRIORITY would be A. establishing a contract for treatment goals B. controlling impulsive behaviors C. identifying personal strengths D. correcting electrolyte imbalances

MOOD DISORDERS

176. The nurse knows that the major factor that distinguishes bipolar from a unipolar disorder is the
A. higher incidence in women B. severity of the depression C. genetic etiology D. presence of mania

177. Mr. B., 34 years old, is hospitalized with bipolar disorder. At 2 A.M. the nurse finds him phoning friends all across the country to discuss his new plan for eradicating world hunger. His excited explanations are keeping the entire unit awake, but he wont quiet down. The nurse caring for Mr. B. knows the drug MOST likely to be prescribed for this client is A. a tricyclic antidepressant B. an MAO-inhibitor antidepressant C. lithium carbonate (Eskalith) D. an antianxiety drug

178. Supportive therapy for a client who is exhibiting manic behavior may include all of the following EXCEPT
A. Psychoanalysis B. Cognitive therapy C. Interpersonal therapy D. Problem-solving therapy

179. Ms. F., 38 years old, was admitted to the psychiatric unit after a failed suicide attempt by drug overdose. She had been in treatment with a clinical pathologists on a biweekly basis for six weeks. Upon initial contact, she looked exhausted, affect was sad, movements and responses were slowed, and self-care impairments were evident. She is convinced that a blemish on her face is a melanoma that is invading her brain and eating away at the tissue. Ms. Fs disorder is BEST classified as A. Bipolar disorder B. Depression with melancholia C. Dysthymic disorder D. Major depression

180. Which nursing diagnosis is of GREATEST PRIORITY at the time of Ms. Fs admission? A. Alteration in nutrition: less than body requirements B. Ineffective individual coping C. Potential for violence: self-directed D. Bathing/hygiene self-care deficit

181. In attempting to stabilize Ms. Fs activities of daily living in an optimally therapeutic way, she and the nurse would MOST likely plan to
A. allow her to catch up on lost sleep for the first three days of her hospitalization B. have her fully involved in all therapeutic activities C. have her husband visit for a brief periods of time D. schedule balanced periods of rest and therapeutic activity

Situation - Nicanor was discharged from the hospital and recovered from a manic episode of Bipolar Disorder. Nicanor was readmitted with an entirely different behavior. He was very depressed.

182. The defense mechanism utilized by manic patients to cover up depression is A. reaction formation B. compensation C. displacement D. denial

183. The psychodynamics of depression is

A. lax super-ego B. weak super-ego C. internalized hostility feelings D. narcissistic personality

184. Which of these drugs is likely to be indicated for Nicanor? A. Serenace (Haloperidol) B. Valium (Diazepam) C. Tofranil (Imipramine HCi) D. Trilafon (Perphenazine

185. Therapeutic use of self is essential in relating with psychiatric patients. This is BEST demonstrated in A. sympathizing with the miserable feelings of Nicanor B. engaging Nicanor in productive activity C. engaging Nicanor in introspective thinking D. suppressing her own feelings toward Nicanor

186. After three days of antidepressant medication, Nicanor still manifests depression. The nurse evaluates this as A. unusual because action of antidepressant drug is immediate B. expected because it takes about two weeks for the medication to be effective C. unexpected because it takes within one week for the medication to be effective D. ineffective because perhaps the drug's dosage is inadequate

187. A positive nursing action when caring for Mang Nicanor is to A. play a game of chess with him B. allow him to make personal decisions C. sit down next to him as often as possible D. provide him with frequent periods of thinking time

188. An activity that would be MOST appropriate for Mang Nicanor during his early part of hospitalization would be a
A. Game of Monopoly B. project involving drawing C. small dance-therapy program D. card game with three other clients

Situation: A client attempted suicide by slashing her wrists is transferred from the emergency room to the psychiatric unit.

189. When the client arrives on the unit, the PRIORITY intervention should be to A. obtain the clients vital signs B. initiate a therapeutic relationship C. inspect the bandages for signs of bleeding D. institute continuous observation of the client

190. After admission, Nurse Judy need to evaluate a depressed clients potential for suicide. The approach that would BEST gain this information would be to ask A. the client about plans for the future B. the client whether suicide is now being considered C. family members whether the client has ever attempted suicide D. other clients about suicide while the client is in the group

191. The action by Nurse Judy that would be MOST therapeutic when a depressed client states, I am no good. Im better off dead, would be A. stating, I think youre good, you should think of living. B. alerting the staff to provide a 24-hour observation of the client C. responding, I will stay with you until you are less depressed. D. unobtrusively removing those articles that could be used in a suicide attempt

192. On the second day after admission, a suicidal client asks Nurse Judy, Why am I being observed around the clock, and why is my freedom to move around the unit restricted? Nurse Judys MOST appropriate response would be A. Why do you think we are observing you? B. What makes you think that we are observing you? C. We are concerned that you might try to harm yourself. D. Your doctor has ordered it and is the one you should ask about it.

Situation: C., age 36 and single, is brought to the local psychiatric hospital by her brother, who tells the nurse that she has been involved in a whirlwind of activity that began several months ago and that she seems out of control. She told friends that she was devoting all her time to writing a novel that was nearly complete, but at the same time, she began painting the interior of her seven-room home. When her friend tried to get her to slow down, she increased her activities, taking little time to sleep or eat, and began spending huge amounts of money. Her admission was necessitated when she wrote a check for P500,000, with a back balance of only P5. At admission, C. is agitated, speaking loudly and challenging other patients. Her admitting diagnosis is bipolar reaction, manic phase.

193. The BEST approach to meeting C.s hydration and nutrition needs would be to A. leave finger foods and liquids in her room and let her eat and drink as she move about B. bring her to the dining room and encourage her to sit and eat with calm, quiet companions C. explain mealtime routines and allow her to make her own decisions about eating D. provide essential nutrition through highcalorie gavage feedings

193. The physician decides to start C. on lithium (Lithane) therapy. Which of the following BEST describes her dietary requirements while she is receiving this medication? A. A high calorie diet with reduced sodium and adequate fluid intake B. A regular diet with normal sodium and adequate fluid intake C. A low-calorie diet with reduced sodium and increased fluid intake D. A regular diet with reduced sodium and adequate fluid intake

194. C. would benefit MOST from which activity during the manic phase of her illness? A. Playing a game of badminton B. Attending the units weekly bingo game C. Putting together an intricate puzzle D. Drawing or painting in her room

195. One week after C. begins taking lithium, the nurse notes that her serum lithium level is 1 mEq/liter. How should the nurse respond? A. Call the physician immediately to report the laboratory results B. Observe the patient closely for signs of lithium toxicity C. Withhold the next close and repeat the blood work D. Continue administering the medication as ordered

196. Early signs of lithium toxicity include

A. fine tremors, nausea, vomiting, and diarrhea B. ataxia, confusion, and seizures C. elevated white blood cell count and orthostatic hypotension D. restlessness, shuffling gait, and involuntary muscle movements

197. In view of Cs elated state, the nurse should arrange for her to be in a room A. with another client who is very quiet B. that will provide a great deal of stimuli C. that has had most of the furniture removed D. with another client exhibiting similar behavior

198. When C has a manic episode, has a superior, authoritative manner and is constantly instructing the other clients in the unit about how to dress, what to eat, and where to sit. These behaviors will eventually make the other clients feel A. Angry B. Inadequate C. Dependent D. Ambivalent

199. While C has a manic episode, she is extremely active, talks constantly, and tends to box the other clients, some of home are now becoming agitated. The BEST strategy to use with this client is A. Sympathy B. Distraction C. Assertiveness D. Confrontation

ANXIETY RELATED DISODERS

200. The nurse observes a client who is becoming increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high-pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as A. Mild B. Moderate C. Severe D. Panic

201. When assessing a client with anxiety, the nurses questions should be A. avoided until the anxiety is gone B. open-ended C. postponed until the client volunteers information D. specific and direct

202. During the assessment, the client tells the nurse that she cannot stop worrying about her appearance and that she often removes old make-up and applies fresh make-up every hour or two throughout the day. The nurse identifies this behavior as indicative of a(n) A. acute stress disorder B. generalized anxiety disorder C. panic disorder D. obsessive-compulsive disorder

203. The BEST goal for a client learning a relaxation technique is that the client will A. confront the source of anxiety directly B. experience anxiety without feeling overwhelmed C. report no episodes of anxiety D. suppress anxious feelings

204. Which of the four classes of medications used for panic disorder is considered the SAFEST because of low incidence of side effects and lack of physiologic dependence?
A. Benzodiazepines B. Tricyclics C. Monoamine oxidase inhibitors D. Selective serotonin reuptake inhibitors

205. Which of the following intervention is INAPPROPRIATE for clients with anxiety? A. Offer choices B. Provide a quiet and calm environment C. Provide brief, direct-to-the-point and specific explanations D. Bring anxiety down to a controllable level

Situation Camila, 25-years old, was reported to be gradually withdrawing and isolating herself from friends and family members. She became neglectful of her personal hygiene. She was observed to be talking irrelevantly and incoherently. She was diagnosed as schizophrenia disorder.

206. The past history of Camila would MOST probably reveal that her premorbid personality is A. extrovert B. schizoid C. ambivert D. cycloid

207. Camila refuses to relate with others because she A. is irritable B. feels superior of others C. is depressed D. anticipates rejection

208. Camila's indifference toward the environment is a compensatory behavior to overcome A. narcissistic behavior C. insecurity feelings B. guilt feelings D. ambivalence

Situation - For more than a month now, Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to happen. She fears being alone in places and situations where she thinks that no one might come to rescue her just in case something happens to her.

209. Cecilia is demonstrating

A. agoraphobia B. xenophobia

C. claustrophobia D. acrophobia

210. Cecilia's problem is that she always sees and thinks negative things hence she is always fearful. Phobia is a symptom described as A. psychotic B. organic C. psychosomatic D. neurotic

211. Which of these behaviors indicate a positive result of being able overcome her phobia after discharge?
A. She watches television with the family in the recreation room B. She reads a book in the public library C. She drives alone along the long expressway. D. She joins an art therapy group

Situation - The nurse visited the Reyes family to check on their two growing children, aged 7 and 4 years. Upon her visit she observed that common areas of arguments between Mr. and Mrs. Reyes are about conflicting ways of bringing up their children. Mrs. Reyes is lax and tolerant while Mr. Reyes often insists strict ways to a point of over protectiveness from what he perceives as unsafe i.e. community and neighbors that cannot be trusted.

212. Mrs. Reyes expressed that her socializing with neighbors is limited because her husband thinks she is getting overly friendly with a guy next door. Which of the following would the nurse emphasize as BASIC? A. Keeping trust in the relationship B. Avoid relating with neighbors to minimize conflict C. Be assertive to express her individuality D. Ignore the husband and just be supportive

213. For the nurse to be effective in developing rapport with the family it is essential that she keeps her appointment on time and stick to a care plan. She is applying the principle of
A. responsibility and accountability B. consistency and predictability C. honesty and integrity D. empathy and compassion

214. Which of these symptoms if demonstrated by Mr. Reyes would necessitate referral to a doctor? A. Hypervigilance B. Suspicious affect C. Hypersensitive D. Loss of reality contact

215. The paranoid client utilizes which of the following defense mechanisms? A. Sublimation B. Projection C. Rationalization D. Reaction formation

Situation - Jim, age 25, recalled that his problem began around age 15 or 16. He would count pencils in a mug over and over with the thought that stopping could result in something bad happening.

216. There are many things Jim seems he has to do. This is to keep him from feeling A. confused B. suspicious C. excited D. anxious

217. He has to change clothes 20 times before work, chew each bite he eats 24 times and go up and down the stairs four to five times before it feels right. He is demonstrating
A. ideas of reference B. denial and projection C. obsession and compulsion D. rationalization and over reaction

218. The objective of nursing care for Jim is to develop or increase feelings of A. self-mastery B. self-esteem C. self-actualization D. self-determination

219. The following are therapeutic interventions for obsessive compulsive behaviors, EXCEPT A. impose limits every time the behavior becomes repetitive B. establish a routine for him C. assign task that can be done repetitively D. facilitate self-expression

SITUATION: Bee, 45 years old, is admitted to a psychiatric inpatient unit for treatment of severe obsessivecompulsive disorder.

220. Bee has a compulsive bedtime ritual that includes making and remaking his bed 26 times before he can retire. Occasionally, he does not get to bed until 3:00 a.m. Which nursing intervention is MOST helpful?
A. Discussing the ridiculous of his repetitive behavior B. Taking turns making and remarking the bed with B. to conserve his energy and allow him to retire sooner C. Prohibiting Mr. Bee from carrying out his bedtime ritual D. Suggesting that he begin his ritual earlier in the evening so he can retire by 11:30 p.m

221. Besides performing his nighttime ritual, Bee has recently begun a morning bed-making ritual. To help Bee limit and potentially alter this maladaptive behavior, all of the following nursing interventions are therapeutic, EXCEPT A. having Bee engage in constructive activities that leave less time for compulsive behaviors B. verbalizing tactful, mild disapproval of his behavior C. providing positive reinforcement of nonritualistic behavior D. offering reflective feedback, such as I see you have remade your bed many times. You must be exhausted

222. The psychiatrist orders Lorazepam ( Ativan ) 1 mg orally three times a day. While Bee is taking this medication, the nurse should remind him to
A. avoid caffeine B. avoid aged cheese C. stay out of the sun D. maintain an adequate salt intake

SITUATION: S., a 19-year-old college sophomore, makes an appointment at the college health service, where he tells the nurse that he recently has been having trouble concentrating in class. He reports that his grades have suffered because he has been so out of it. He forget to do assignment and cannot remember when the tests are scheduled. He also reports insomnia, loss of appetite, headaches, and constant fatigue.

223. S. says to the nurse, I dont know whats wrong. Either theres something seriously wrong with me, or I must be going crazy. What would be the BEST response in this situation? A. You look healthy to me. Im sure there is something seriously wrong with you B. Its best not to jump to conclusions. Well do some test that should give us a clearer picture of what the problem is C. We have an excellent health service here. Whatever the problem is, we will help you D. Tell me more about when you began experiencing these symptoms and feelings

224. The results of S.s physical examination and laboratory tests are negative. Two weeks after his initial visit, S. reports that he continues to suffer from nightmares that cause insomnia. He says, I dont know what to do. Finals are coming up, and I cant study. Im so exhausted. Which reply by the nurse is BEST? A. You mentioned you are having nightmares. Tell me more about them B. I understand your frustration. Its terrible not being about to sleep. I can get you a prescription for sleep medication C. Have you talked with your professors? Perhaps if they were aware of your problem, you could get extensions for your work D. Youre exhausted? In what way?

225. S. reveals that he was in an automobile accident during final exam week in his freshman year. Although he suffered only minor cuts and bruises, a young man in the other car was killed in light of this information, the nurse suspects that S. is experiencing A. conversion disorder B. panic disorder C. phobic disorder D. post-traumatic stress disorder

226. Which medications have recently been found helpful in reducing or eliminating panic attacks?
A. Antidepressants B. Anticholinergics C. Antipsychotics D. Antianxiety

227. A client asks why a beta blocker has been prescribed for anxiety. When answering this question the nurse should explain that beta blockers are effective for treatment of which symptoms associated with anxiety? A. Cognitive dissonance and confusion B. Depression and suicidal ideations C. Insomnia and nightmares D. Palpitations and rapid heart rate

228. Which of the following questions would be MOST appropriate to ask when assessing a client for signs of generalized anxiety disorder? A. Are you more anxious at home or in a crowd? B. Do you experience sudden, intense fear for no reason? C. Do you find yourself worrying frequently about a number of different things? D. Have you ever had a flashback or a nightmare about a traumatic event?

229. A client with an obsessive-compulsive disorder (OCD) repeatedly reports feeling of inadequacy and makes statements such as, I cant do my job at work anymore, and I am not even a good parent anymore. The MOST appropriate nursing diagnosis for this client would be A. altered role performance. B. altered thought processes. C. impaired family coping. D. impaired family relationships.

230. A nurse is reviewing the record of a client admitted to the mental health unit. The nurse notes documentation that the client experiences flashbacks. The nurse would EXPECT that this client has been diagnosed with which of the following?
A. Agoraphobia B. Posttraumatic stress disorder (PTSD) C. Anxiety D. Schizophrenia

231.The nursing management of anxiety related with post traumatic stress disorder includes the following EXCEPT
A. encourage participation in recreation or sports activities B. reassure client's safety while touching client C. speak in a calm soothing voice D. remain with the client while fear level is high

232. Ruth is an adult admitted to the psychiatric hospital for hand washing rituals. The day after admission she is scheduled for lab tests. To assure that the client is there on time, the nurse should
A. remind Ruth several times of her appointment B. limit the number of hand washings C. tell her it is her responsibility to be there on time D. provide ample time for her to accomplish her rituals

233. Lana is an adult who is hospitalized with an obsessive-compulsive disorder. She washes her hands many times a day. Which of the following is an APPROPRIATE treatment for this client? A. An unstructured schedule of activities B. A structured schedule of activities C. Intense counseling D. Negative reinforcement every time she performs the ritual

234. Mr. K, 24 years old, was admitted on a voluntary basis to psychiatric services. He has been in psychiatric care for three years, has a long history of petty crimes. He is arrogant and manipulative. He uses other clients to his own needs and often pioneers causes that are disruptive to the milieu. The diagnostic title that BEST describes Mr. Ks behavior is A. antisocial personality disorder B. borderline personality disorder C. passive-aggressive personality disorder D. passive-dependent personality disorder

235. Ms. A is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. All of the following components of a nursing history are extremely important to explore with this client EXCEPT A. ego-strength assessment B. social history C. cognitive aspect of mental status exam D. past psychiatric treatment history

236. Mr. J is admitted to a psychiatric unit with a diagnosis of antisocial personality disorder. In planning care for Mr. J. it is important for the nurse to recognize that all of the following are likely to occur EXCEPT A. staff and client agree when setting treatment goals B. staff and client are in a constant struggle for control of the milieu C. staff and client feel threatened by another D. staff and client use the same defense mechanisms when interacting

237. Key interventions for a client with an antisocial personality disorder include all of the following EXCEPT A. assisting him to identify and clarify his feelings B. changing staff assigned to the client at his request C. making expectations about his behavior clear as well as consequences for same D. setting firm limits with clear consequences

238. Mr. L is a 26 year-old man who has been hospitalized with an antisocial PD. He was admitted on a voluntary basis as an alternative to serving a jail sentence. At the time of discharge the nurse UNDERSTANDS that Mr. L is MOST likely to A. be committed to another facility for a longer length of stay B. be committed to a virtuous and socially acceptable lifestyle C. discontinue treatment with the outpatient therapist D. revert to prehospitalization behaviors

SITUATION - W., a 20-year-old college junior, is admitted to a medical-surgical unit in a small community hospital after she has a sudden onset of paralysis in both legs. Extensive examination and testing reveal no physical basis for the paralysis. The medical diagnosis is conversion disorder.

239. The nurse plans interventions for W. based on which correct statement about conversion disorder? A. The symptoms are a conscious attempt to control others in the environment B. The patient will exhibit a high level of anxiety in response to the conversion symptom C. The conversion symptom typically has some symbolic meaning for the patient D. The patient will respond positively to confrontational approaches by the nurse

240. W. reveals that her boyfriend has been pressuring her to have sex with him. She says, I love him, but Im frightened about getting pregnant or getting some disease like AIDS. What should I do? The nurses best response would be: A. There are ways to protect yourself against pregnancy and sexually transmitted diseases. I can refer you to the clinic if you like B. You shouldnt let anyone pressure you into sex. Perhaps he doesnt care about you as much as you think he does C. It sounds like this problem may be related to your paralysis D. Your concerns are realistic. How do you feel about being pressured by your boyfriend?

241. During her hospitalization, W. develops insight into her response to threatening situations. When she is discharged, she plans to continue psychotherapy that will focus on A. preventing further incidents of paralysis B. learning new strategies for dealing with stress and conflict C. breaking of f her stress-inducing relationship with her boyfriend D. developing a healthier attitude toward her sexuality.

242. Which intervention would be most helpful for Y. when he experience a panic attack? A. Encouraging her to identify what precipitated the attack B. Promoting interaction with others to reduce her anxiety through diversion C. Staying with her and remaining calm, confident, and reassuring D. Reducing intolerance stimuli by encouraging her to stay in her room alone until she feels less anxious

SITUATION - A young man is brought to the logic emergency department by the police. He approached a police officer in a large metropolitan bus depot stating, I dont know who or where I am. I have no identification on me. Can you help me? The young man appears to be in good physical health and between ages 18 and 22. He is clean and neatly groomed. The physical examination reveals no evidence of trauma or other abnormal findings. Staff members refer to him as X.

243. In the absence of physical findings to explain X.s memory loss, the most likely diagnosis is
A. Schizophrenia B. Personality disorder C. Somatoform disorder D. Dissociative disorder

244. X. is admitted to the psychiatric unit for further evaluation and treatment. He probably will react to his inability to recall his identity by exhibiting A. intense preoccupation with discovering who he is B. depression C. anger and frustration D. complacency

245. In working with X., the nurse should direct her FIRST intervention toward A. establishing a climate of trust and acceptance B. identifying the cause of the patients memory loss C. encouraging the patient to remember events leading to the memory loss D. helping the patient recall his first name

246. Nursing interventions for X. should be based on the understanding that A. Once the patients anxiety is alleviated, his memory will return B. Memory loss usually is precipitated by severe psychological stress C. The patient could remember his identity if he really wanted to B. The patient probably will regain his memory slowly but have an incomplete recall of immediate events

247. A client diagnosed with a conversion disorder tells the nurse that he cannot see, though he rarely bumps into any objects when walking unassisted. This is BEST explained by A. The clients blindness may get him out of some conflict or role. B. The client is faking blindness to obtain sympathy. C. The client has other highly developed senses tocompensate for blindness. D. The client has some residual sight.

248. A client who developed a glove anesthesia of the right (dominant) hand was unable to play in the piano competition yesterday. The consequence of the symptom, not having to perform, is BEST described as A. Phobia. B. Primary gain. C. Carpal tunnel dysmorphia. D. Secondary gain.

249. Which of the following is TRUE about clients with hypochondriasis? A. They may interpret normal body sensations as sign of disease B. They often exaggerate or fabricate physical symptoms for attention C. They do not show signs of distress about their physical symptoms D. All of the above are true statements

250. The client's family asks the nurse What is hypochondriasis? The best response by the nurse is Hypochondriasis is A. a persistent preoccupation with getting a serious disease B. an illness not fully explained by a diagnosed medical condition C. characterized by a variety of symptoms over a number of years D. the eventual result of excessive worrying about diseases

251. A client had assumed a new identity and gained employment in a job when he was found 400 miles away from his home. The nurse interprets that wandering to this new area is characteristic of A. Amnesia. B. Akathisia C. Confabulation. D. Fugue state.

252. Client education about dissociation would be effective if the dissociative client states A. When I want to get out of a situation, I choose to space out. B. When I have to cope with problems, I imagine I am somewhere else. C. When Im under stress, I have a tendency to dissociate. D. When I think about my life, I pretend I am someone else.

253. When planning nursing care for a client diagnosed with a dependent personality disorder, the nurse anticipates that this individual will A. Tend to be manipulative. B. Believe he or she cannot function without the help of others. C. See others as threatening. D. Display dramatic, attention-seeking behavior.

254. The mental health nurse would do which of the following to decrease a clients tendency to control interpersonal relationships through the use of manipulation? A. Justify rules and regulations. B. Be flexible about rules and regulations. C. Set reasonable and necessary limits on behavior. D. Allow the client to make decisions.

255. A client was admitted with a diagnosis of antisocial personality disorder. He comes to the nurses station at 11 P.M. asking to use the phone in order to call his estranged wife although no phone calls are allowed after 10 P.M. Which of the following responses is therapeutic? A. You may go ahead and use the phone, I know this situation is hard for you. B. You know better than to try to break the rules, Im surprised at you. C. It is after 10 P.M.; you can call your wife in the morning. D. You can call but dont tell other patients I let you break the rule.

256. The nurse determines the presence of a personality disorder is most clearly signaled by a clients manifestation of which of the following patterns over time?
A. Behavioral deviation from societys norm B. Persistent and maladaptive response patterns C. Pervasive suspiciousness and mistrust D. A sense of self-importance and an unlimited need for attention

257. A client has been diagnosed with a dependent personality disorder. Which statement is likely to be her response to the nurses suggestion that she complete her morning care? A. Ill have no problem in deciding what to wear. B. I think you should wear more makeup. C. I think this outfit looks good on me. D. What do you think I should wear?

258. What might be a typical staff response when working with a client diagnosed with a paranoid personality disorder? A. He constantly criticizes his care. Im so frustrated. B. He is so pleasant but so shy. C. He has a wonderful sense of humor. D. I am pleased he was so helpful with his roommate.

259. A client comes in for her psychiatric appointment wearing a cocktail dress and theatrical makeup. She announces dramatically and flirtatiously that she needs to be seen immediately as she is experiencing overwhelming psychological distress. The most likely axis II diagnosis would be A. Borderline personality disorder. B. Narcissistic personality disorder. C. Histrionic personality disorder. D. Antisocial personality disorder.

260. A client diagnosed with antisocial personality disorder tells Nurse A, Youre a much better nurse than Nurse B said you were. The client then tells Nurse B, Nurse A is upset with you for some reason. To Nurse C, the client states, I think youre great, but Nurse A said she saw you make three mistakes this morning. This interaction can best be described as an attempt to A. Gain acceptance. B. Gain attention. C. Create guilt in the staff. D. Manipulate the staff.

261. The nurse determines that a client who is described as a loner and who does not express a desire for close interpersonal relationship reflects a behavioral pattern associated with which type of personality disorder? A. Antisocial B. Schizotypal C. Paranoid D. Schizoid

SCHIZOPHRENIA AND OTHER PSYCHOSES

H., age 40, is brought to the hospital by his wife, who states that for the past week her husband has refused all meals and accused her trying to poison him. She claims that before this drastic change in behavior, he become withdrawn, forgetful, and inattentive and had frequent mood swings. During the initial interviews, H. appears suspicious. His speech, which is only partly comprehensible, reveals that his thoughts are controlled by delusions of possession by the devil. He claims that the evil told him that people around him are trying to destroy him and that he should trust no one. The physician diagnoses paranoid schizophrenia and admits the patients to the psychiatric unit.

262. Schizophrenia is BEST described as a disorder characterized by A. disturbed relationship related to an inability to communicate and think clearly B. severe mood swings and periods of low to high activity C. multiple personalities, one which is more destructive than the others D. auditory and visual hallucinations

263. The nurse observes H. pacing in his room. He is alone but talking in an angry tone. When asked what he was experience, he replies, The devil is yelling in my ear. He says people here wants to hurt me. The nurses BEST response is A. Can you tell me more about what the devils is saying to you? B. How do you feel when the devil says such things to you? C. I dont hear any voice, H. Are you feeling afraid right now? D. H., the devil cannot talk to you?

264. Although H. refuses to eat, he continues to take his medication. Considering his suspicious behavior and delusions, what is the BEST way to administer his medication? A. Administer all medications parentally to ensure adequate dosage B. Administer medications only in liquid form to eliminate the possibility of the patient not swallowing his tablets C. Administer a combination of liquid and tablets to ensure that the patient is getting at least some medication D. Administer the medication in the same form each time

265. During the physical assessment, Ms arm remains outstretched after her pulse and blood pressure are taken, and the nurse must repositions it for her. The patient is manifesting A. suggestibility B. negativity C. waxy flexibility D. retardation

Situation: J., a 32-year-old man with a 5year history of multiple psychiatric admissions, is brought to the emergency department by the police. He was found wandering the streets, disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed as having chronic undifferentiated schizophrenia.

266. During the next several days, J. is observed laughing, yelling, and talking to himself. His behavior is characteristic of
A. delusion B. looseness of association C. illusion D. hallucination

267. J. tells the nurse, The earth is doomed, you know. The ozone layer is being destroyed by hair spray. You should get away before you die. J. appears frightened as he says this. The MOST helpful response is to A. say, J., I think you are overreacting. I know there is some concern about the earths ozone layer, but there is no immediate danger to anyone B. say, Ive heard about the destruction of the ozone layer and its effect on the earth. Why dont you tell me more about it? C. ignore J.s statement and redirect his attention to some activity on the unit D. say, J., are you saying you feel as though something bad will happen to you?

268. A client begins to show paranoid behavior. He states, I know that the neighbors are after me for beating my wife when Im drunk. Before responding, the nurse should recognize that the patient is exhibiting a thought disorder called A. Nihilistic delusion B. Delusion of persecution C. Delusion of grandeur D. Ideas of reference

269. Projection, rationalization, denial and distortion by hallucination and delusions are examples of disturbance in
A. logic B. association C. reality testing D. thought processes

270. Which of the following is an example of alteration of perception? A. Hallucination B. Echolalia C. Flight of ideas D. Ideas of reference

280. A client changes topics quickly while relating past psychiatric history. This clients pattern of thinking is called
A. Looseness of association B. Flight of ideas C. Tangential thinking D. Circumstantial thinking

281. A disturbed client starts to repeat phrases that others have just said. This type of speech is known as:

A. Autism B. Echolalia

C. Neologism D. Echopraxia

282. A person seeing a design on the wallpaper perceives it as an animal. This is an animal. This is an example of:
A. an illusion B. a delusion C. a hallucination D. an idea of reference

283. As the nurse approaches the lounge area, the client states, The sun is shining. Where is my sun? I love Lucy. Lets play ball. The client is displaying. A. Concreteness B. Flight of ideas C. Depersonalization D. Use of neologism

Situation - It is the nurse's primary responsibility to ensure a safe environment for the patients at the Psychiatry ward

284. Which of the following is NOT true?

A. Hostility is destructive B. Frustration develops in response to unmet needs, wants and desire C. Anger is incompatible with love D. Aggression can be expressed in a constructive as well as a destructive manner

285. Carlo is acting out hostile and aggressive feeling by kicking the chairs in the room. The MOST effective way to deal with Carlo's behavior is INITIALLY to
A. set limits on the behavior by verbal command B. administer prn tranquilizer C. remove the chairs from the room D. restrain the patient and place him in the "Isolation Room"

286. Mrs. Dizon was visiting her son at the Psychiatry Ward. Which of the following items will the nurse NOT allow to be brought inside the ward?
A. String rosary bracelet B. Box of cake C. Bottle of coke D. Rubber shoes

Situation: The following set of questions pertains to Somatic therapies and ECT.

287. B. does not respond to the medication. At a team conference, staff members recommend electroconvulsive therapy (ECT). When should nursing interventions begin? A. As soon as the patient and her family are presented with this treatment alternative B. The night before ECT is scheduled C. Immediately after ECT is administered D. When the patient returns to the unit after ECT therapy

288. B.s depression does not improve with antidepressants medication, and the physician orders electroconvulsive therapy (ECT). ECTs mechanism of action is A. related to the patients perception of ECT as well-deserved punishment B. unclear at present C. related to an increased production of chemicals in the brain D. similar to that of antidepressant drugs

289. When preparing B. for ECT, the nurse should ensure that the following have been done EXCEPT? A. The patient has signed an informed consent document B. The patient and her family have been instructed about the ECT procedure C. The patient has undergone a thorough medical evaluation D. The patient has received lithium

290. The nurse is administering atropine sulfate to B. who is about to undergo electroconvulsive therapy (ECT). Which assessment indicates that the medication is effective? A. The clients heart rate is 48 beats/minute. B. The client states that his mouth is dry. C. The client appears calm and relaxed. D. The client falls asleep.

291. The nurse is documenting a plan of care for a client who has undergone electroconvulsive therapy (ECT). The nurse should include which intervention? A. Monitoring the clients vital signs every hour for 4 hours B. Placing the client in Trendelenburgs position C. Encouraging early ambulation D. Reorienting the client to time and place

292. A client is scheduled for an electroconvulsive therapy (ECT) treatment and says to the nurse, Ive seen this in a movie, and Im scared that will hurt. The MOST APPROPRIATE response by the nurse is which of the following? A. Dont be afraid. Your doctor has done this procedure hundreds of times, and you need not worry. B. You have a very serious psychiatric problem that can be helped by this procedure. C. Tell me what you know about the procedure. D. All clients undergoing ECT have the same fears.

293. Most people respond emotionally to the thought of electric current passing thorough their brain. When discussing the subject with the patient, the nurse should: A. Use the term shock in neutral, calm manner B. Refer to the procedure as the patients treatment instead of shock therapy C. Refer to it as ECT B. Explain how the convulsion are artificially induced

294. B. and her husband begin to express concern about the proposed ECT treatment. Which nursing actions is most appropriate initially? A. Refer all questions to the physician who will actually administered the ECT treatment B. Listen for misconceptions and clarify any confusing information C. Orient B. and her husband to the ECT so they become familiar and comfortable with the surroundings D. Provide B. and her husband with booklets explaining the procedure in simple, understandable terms

295. B. asks the nurse, Why do I have to sign a consent form? which response is most appropriate? A. IT indicates that you have been fully informed about the procedure and the risks involved B. Your physician should have explained this to you yesterday. Didnt he tell you about signing a consent? C. Its just a hospital rule. Sign here, please D. most of the medications used can be dangerous. Your consent is required

296. When B. returns to her room after awakening from the ECT treatment, the nurse should: A. Place a No visitors sign on the door so she can rest undisturbed B. Perform a complete physical assessment C. Orient her to person, place, and time D. Remains with her until all confusion disappears

297. Which other nursing action should the nurse perform after the patient returns from ECT treatment? A. Take vital signs every 15 minutes for the next 2 hours B. Open all locked closed so the patient can have access to her belongings C. Offer the patient a cigarette if she smokes, to help her relax D. Touch the patient by grasping her hand or massaging her shoulders while talking to her

298. Which side effects are most common after ECT treatment? A. Headache and dizziness B. Diarrhea and urinary incontinence C. Nausea and vomiting D. Temporary memory loss and confusion

Situation: Following questions are related to Psychopharmacology.

299. Which of the following is classified as a tricyclic antidepressant drug? A. Flouxetine (Prozac) B. Venlafaxine (Effexor) C. Sertraline (Zoloft) D. Imipramine (Tofranil)

300. The nurse is teaching a schizophrenic client about treatment for the chemical imbalance associated with the disease. Which neurotransmitter would the nurse identify as being the target for antipsychotic medications?
A. Dopamine B. Serotonin C. Acetylcholine D. GABA

301. Which of the following is considered as an atypical antipsychotic? A. Thorazine B. Prolixin C. Clozapine D. Haldol

302. Which of the following classes of psychotropics is considered as first-line antidepressants?

A. MAOIs B. TCAs C. SSRIs D. Lithium carbonate

303. Which of the following is the mechanism of action of MAOIs? A. Block the reuptake of serotonin and norepinephrine at the presynaptic neuron B. Block neurotransmitter metabolism C. Increase dopamine bioavailability D. Increase acetylcholine levels

304. Which of the following neurotransmitters is increased when taking anxiolytics? A. Dopamine B. GABA C. Glutamate D. Serotonin