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A client with a history of substance abuse has been attending Alcoholics Anonymous meetings
regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those
meetings anymore. I'm not like the rest of those people. I'm not a drunk. "What is the most
appropriate response?

A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?"

B. "It's your decision. If you don't want to go, you don't have to."

C. "You seem upset about the meetings."

D. "You have to go to the meetings. It's part of your treatment plan."

Rationale: The substance abuser uses the substance to cope with feelings and may deny the
abuse. Asking if the client is upset about the meetings encourages the client to identify and deal
with feelings instead of covering them up. Arguing with the client about the substance abuse
(option A) or insisting that the client attend the meetings (option D) wouldn't help the client identify
resistance to treatment. Option B isn't therapeutic behavior because it plays down the importance
of attending meetings.

2. A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about
her daughter's weight loss and constant dieting. The nurse conducts a health history interview.
Which of the following comments indicates that the client may be suffering from anorexia

A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader."

B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends."

C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."

D. "I do diet around my periods; otherwise, I just get so bloated."

Rationale: Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to
get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when
compared to peers indicates poor self-esteem. Most clients with anorexia nervosa don't like the
way they look, and their self-perception may be distorted. A girl with cachexia may perceive
herself to be overweight when she looks in the mirror. Preferring fast food over healthy food is
common in this age-group. Because of the absence of body fat necessary for proper hormone
production, amenorrhea is common in a client with anorexia nervosa.

3. A man with a 5-year 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 with
chronic undifferentiated schizophrenia. The nurse should assign highest priority to which nursing

A. Anxiety
B. Impaired verbal communication

C. Disturbed thought processes

D. Self-care deficient: Dressing/grooming

Rationale: For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level),
manifested by the client's extreme withdrawal and attempt to protect himself from the
environment. The nurse must act immediately to reduce anxiety and protect the client and others
from possible injury. Impaired verbal communication, manifested by noncommunicativeness;
Disturbed thought processes, evidenced by inability to understand the situation; and Self-care
deficient: Dressing/grooming, evidenced by a disheveled appearance, are appropriate nursing
diagnoses but aren't the highest priority.

4. A high school student is referred to the school nurse for suspected substance abuse. Following
the nurse's assessment and interventions, what would be the most desirable outcome?

A. The student discusses conflicts over drug use.

B. The student accepts a referral to a substance abuse counselor.

C. The student agrees to inform his parents of the problem.

D. The student reports increased comfort with making choices

Rationale: All of the outcomes stated are desirable; however, the best outcome is that the
student would agree to seek the assistance of a professional substance abuse counselor.

5. A man is brought to the hospital by his wife, who states that for the past week her husband has
refused all meals and accused her of trying to poison him. During the initial interview, the client's
speech, only partly comprehensible, reveals that his thoughts are controlled by delusions that he
is possessed by the devil. The physician diagnoses paranoid schizophrenia. Schizophrenia is
best described as a disorder characterized by:

A. disturbed relationships related to an inability to communicate and think clearly.

B. severe mood swings and periods of low to high activity.

C. multiple personalities, one of which is more destructive than the others.

D. auditory and tactile hallucinations.

Rationale: Schizophrenia is best described as one of a group of psychotic reactions

characterized by disturbed relationships with others and an inability to communicate and think
clearly. Schizophrenic thoughts, feelings, and behavior commonly are evidenced by withdrawal,
fluctuating moods, disordered thinking, and regressive tendencies. Severe mood swings and
periods of low to high activity are typical of bipolar disorder. Multiple personality, sometimes
confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness. Many
schizophrenic clients have auditory hallucinations; tactile hallucinations are more common in
organic or toxic disorders.

6. Clients receiving monoamine oxidase inhibitor antidepressants must avoid tyramine, a

compound found in which of the following foods?

A. Aged cheese and Chianti wine

B. Green leafy vegetables

C. Figs and cream cheese

D. Fruits and yellow vegetables

Rationale: Aged cheese and Chianti wine contain high concentrations of tyramine. The other
foods listed are low in tyramine

7. During the assessment stage, a client with schizophrenia leaves his arm in the air after the
nurse has taken his blood pressure. His action shows evidence of:

A. somatic delusions.

B. waxy flexibility.

C. neologisms.

D. nihilistic delusions

Rationale: The correct answer is waxy flexibility, which is defined as retaining any position that
the body has been placed in. Somatic delusions involve a false belief about the functioning of the
body. Neologisms are invented meaningless words. Nihilistic delusions are false ideas about self,
others, or the world

8. Which of the following statements accurately describes therapeutic communication?

A. Offering advice and your opinion

B. Not verbalizing your feelings

C. Avoiding advice, judgment, false reassurance, and approval

D. Telling the client how to cope

Rationale: The goal of therapeutic communication is to help the client develop insight and skills
to solve his own problems. This is done by avoiding advice, judgment, false reassurance, and
approval. Pointing out mistakes can make a client defensive. The client-nurse relationship isn't
the place for the nurse to offer advice or an opinion. It also isn't the place for the nurse to
verbalize her own feelings. The client needs assistance in developing coping skills, not someone
to solve problems for him

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

A. tell him that she'll leave for now but will return soon.

B. ask him if it's okay if she sits quietly with him.

C. ask him why he wants to be left alone.

D. tell him that she won't let anything happen to him.

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

10. The physician orders lithium carbonate (Lithonate) for a client who's in the manic phase of
bipolar disorder. During lithium therapy, the nurse should watch for which adverse reactions?

A. Weakness, tremor, and urine retention

B. Anxiety, restlessness, and sleep disturbance

C. Constipation, lethargy, and ataxia

D. Nausea, diarrhea, tremor, and lethargy

Rationale: The most common adverse effects of lithium are nausea, diarrhea, tremor, and
lethargy. Lithium doesn't cause weakness, tremor, urine retention, anxiety, restlessness, sleep
disturbance, constipation, or ataxia.

11. When caring for an adolescent client diagnosed with depression, the nurse should remember
that depression manifests differently in adolescents and adults. In an adolescent, signs and
symptoms of depression are likely to include:

A. helplessness, hopelessness, hypersomnolence, and anorexia.

B. truancy, a change of friends, social withdrawal, and oppositional behavior.

C. curfew breaking, stealing from family members, truancy, and oppositional behavior.

D. hypersomnolence, obsession with body image, and valuing of peers' opinions

Rationale: In adolescents, depression typically manifests as truancy, a change of friends, social

withdrawal, and oppositional behavior. In adults, it usually produces helplessness, hopelessness,
hypersomnolence, and anorexia. Drug use may lead to curfew breaking, stealing, truancy, and
oppositional behavior. Adolescents normally display hypersomnolence, an obsession with body
image, and valuing of peers' opinions.

12. During the admission assessment, a client with a panic disorder begins to hyperventilate and
says, "I'm going to die if I don't get out of here right now!" What is the nurse's best response?
A. "Just calm down. You're getting overly anxious."

B. "What do you think is causing your panic attack?"

C. "You can rest alone in your room until you feel better."

D. "You're having a panic attack. I'll stay here with you

Rationale: During a panic attack, the nurse's best approach is to orient the client to what is
happening and provide reassurance that the client won't be left alone. The anxiety level is likely to
increase and the panic attack is likely to continue if the client is told to calm down (as in option A),
asked the reasons for the attack (as in option B), or left alone (as in option C

13. Which foods are contraindicated for a client taking tranylcypromine (Parnate)?

A. Whole grain cereals and bagels

B. Chicken livers, Chianti wine, and beer

C. Oranges and vodka

D. Chicken, rice, and apples

Rationale: A client taking a monoamine oxidase inhibitor antidepressant, such as

tranylcypromine (Parnate), shouldn't eat foods containing tyramine. Such foods include chicken
livers, Chianti wine, beer, ale, aged game meats, broad beans, aged cheeses, sour cream,
avocados, yogurt, pickled herring, yeast extract, chocolate, excessive caffeine, vanilla, and soy
sauce. The client also must refrain from taking cold and hay fever preparations that contain
vasoconstrictive agents.

14. Which is the drug of choice for treating Tourette syndrome?

A. fluoxetine (Prozac)

B. fluvoxamine (Luvox)

C. haloperidol (Haldol)

D. paroxetine (Paxil

Rationale: Haloperidol is the drug of choice for treating Tourette syndrome. Prozac, Luvox, and
Paxil are antidepressants and aren't used to treat Tourette syndrome.

Which of the following etiologic factors predispose a client to Tourette syndrome?

A. No known etiology

B. Abnormalities in brain neurotransmitters, structural changes in basal ganglia and caudate

nucleus, and genetics

C. Abnormalities in the structure and function of the ventricles

D. Environmental factors and birth-related trauma

Rationale: The etiology of Tourette syndrome includes genetics, abnormalities in

neurotransmission, and structural changes in the basal ganglia and caudate nucleus. The
ventricles in the brain, environmental factors, and birth trauma aren't involved.

15. Low doses of central nervous system (CNS) depressants produce an initial excitatory
response. This reaction is caused by:

A. a stimulating effect on the CNS.

B. the depression of acetylcholine.

C. the stimulation of dopamine by depressant drugs.

D. inhibitory synapses in the brain being depressed before excitatory synapses.

Rationale: Excitation can occur when inhibitory synapses are depressed. The other options are
incorrect because depressants don't stimulate the CNS or dopamine and don't depress

16.Upon returning home from work, a young man discovers that his mother has been in a serious
automobile accident. Initially, he responds to the news by stating, "No, I don't believe it. It can't be
true." Which defense mechanism is he using?

A. Introjection

B. Suppression

C. Denial

D. Repression

Rationale: Denial is the avoidance of reality by ignoring or refusing to acknowledge unpleasant

incidents. This defense mechanism is used to allay anxiety immediately after a stressful event.
Introjection is an intense form of identification in which one incorporates the values or qualities of
another person or group into one's own ego structure. Suppression is the conscious analog of
repression. A person intentionally uses suppression to consciously exclude material from
awareness. Repression is the unconscious exclusion of painful episodes from awareness.

17. A client visits the physician's office to seek treatment for depression, feelings of
hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty
making decisions. The client states that these symptoms began at least 2 years ago. Based on
this report, the nurse suspects:

A. cyclothymic disorder.

B. atypical affective disorder.

C. major depression.
D. dysthymic disorder.

Rationale: Dysthymic disorder is marked by feelings of depression lasting at least 2 years,

accompanied by at least two of the following symptoms: sleep disturbance, appetite disturbance,
low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, and
hopelessness. These symptoms may be relatively continuous or separated by intervening periods
of normal mood that last a few days to a few weeks. Cyclothymic disorder is a chronic mood
disturbance of at least 2 years' duration marked by numerous periods of depression and
hypomania. Atypical affective disorder is characterized by manic signs and symptoms. Major
depression is a recurring, persistent sadness or loss of interest or pleasure in almost all activities,
with signs and symptoms recurring for at least 2 weeks.

18. What occurs during the working phase of the nurse-client relationship?

A. The nurse assesses the client's needs and develops a plan of care.

B. The nurse and client evaluate and modify the goals of the relationship.

C. The nurse and client discuss their feelings about terminating the relationship.

D. The nurse and client explore each other's expectations of the relationship.

Rationale: The therapeutic nurse-client relationship consists of four phases: preinteraction,

introduction or orientation, working, and termination. During the working phase, the nurse and
client evaluate and refine the goals established during the orientation phase. In addition, major
therapeutic work takes place and insight is integrated into a plan of action. The orientation phase
involves assessing the client, formulating a contract, exploring feelings, and establishing
expectations about the relationship. During the termination phase, the nurse prepares the client
for separation and explores feelings about the end of the relationship

19. A client with anorexia nervosa describes herself as "a whale." However, the nurse's
assessment reveals that the client is 5′ 8" (1.7 m) tall and weighs only 90 lb (40.8 kg).
Considering the client's unrealistic body image, which intervention should be included in the plan
of care?

A. Asking the client to compare her figure with magazine photographs of women her age

B. Assigning the client to group therapy in which participants provide realistic feedback about her

C. Confronting the client about her actual appearance during one-on-one sessions, scheduled
during each shift

D. Telling the client of the nurse's concern for her health and desire to help her make decisions to
keep her healthy

Rationale: A client with anorexia nervosa has an unrealistic body image that causes
consumption of little or no food. Therefore, the client needs assistance with making decisions
about health. Instead of protecting the client's health, options A, B, and C may serve to make the
client defensive and more entrenched in her unrealistic body image.

20. The nurse is caring for a client, a Vietnam veteran, who exhibits signs and symptoms of
posttrauma syndrome. Signs and symptoms of posttrauma syndrome include:

A. hyperalertness and sleep disturbances.

B. memory loss of traumatic event and somatic distress.

C. feelings of hostility and violent behavior.

D. sudden behavioral changes and anorexia

Rationale: Signs and symptoms of posttrauma syndrome include hyperalertness, sleep

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

21. A client is admitted to the psychiatric unit with a diagnosis of conversion disorder. Since
witnessing the beating of his wife at gunpoint, he has been unable to move his arms, complaining
that they are paralyzed. When planning the client's care, the nurse should focus on:

A. helping the client identify and verbalize feelings about the incident.

B. convincing the client that his arms aren't paralyzed.

C. developing rehabilitation strategies to help the client learn to live with the disability.

D. talking about topics other than the beating to avoid causing anxiety.

Rationale: In conversion disorder, the client represses and converts emotional conflicts into
motor, sensory, or visceral symptoms with no physiologic cause. Interventions should focus on
helping the client identify the underlying emotional problem. A client with conversion disorder
can't be convinced that the physical problem isn't real; attempts to convince him may lead him to
seek other health care providers who may accept the reality of his symptoms. Treating the
physical symptoms as long-term or permanent may encourage the client to maintain them.
Ignoring the cause of the symptoms would prevent the client from dealing with his feelings about
his wife's beating.

22. A client with disorganized type schizophrenia has been hospitalized for the past 2 years on a
unit for chronic mentally ill clients. The client's behavior is labile and fluctuates from childishness
and incoherence to loud yelling to slow but appropriate interaction. The client needs assistance
with all activities of daily living. Which behavior is characteristic of disorganized type

A. Extreme social impairment

B. Suspicious delusions
C. Waxy flexibility

D. Elevated affect

Rationale: Disorganized type schizophrenia (formerly called hebephrenia) is characterized by

extreme social impairment, marked inappropriate affect, silliness, grimacing, posturing, and
fragmented delusions and hallucinations. A client with a paranoid disorder typically exhibits
suspicious delusions, such as a belief that evil forces are after him. Waxy flexibility, a condition in
which the client's limbs remain fixed in uncomfortable positions for long periods, characterizes
catatonic schizophrenia. Elevated affect is associated with schizoaffective disorder.

23. A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses
schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:

A. loss of identity and self-esteem.

B. multiple personalities and decreased self-esteem.

C. disturbances in affect, perception, and thought content and form.

D. persistent memory impairment and confusion

Rationale: The Diagnostic and Statistic Manual of Mental Disorders, 4th edition, defines
schizophrenia as a disturbance in multiple psychological processes that affects thought content
and form, perception, affect, sense of self, volition, relationship to the external world, and
psychomotor behavior. Loss of identity sometimes occurs but is only one characteristic of the
disorder. Multiple personalities typify multiple personality disorder, a dissociative personality
disorder. Mood disorders are commonly accompanied by increased or decreased self-esteem.
Schizophrenia doesn't cause a disturbance in sensorium, although the client may exhibit
confusion, disorientation, and memory impairment during the acute phase.

24. The nurse who uses self-disclosure should:

A. refocus on the client's experience as quickly as possible.

B. allow the client to ask questions about the nurse's experience.

C. discuss the nurse's experience in detail.

D. have the client explain his or her perception of what the nurse has revealed.

Rationale: The nurse's self-disclosure should be brief and to the point so that the interaction can
be refocused on the client's experience. Because the client is the focus of the nurse-client
relationship, the discussion shouldn't dwell on the nurse's own experience

25. A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase.
The physician decides to start the client on lithium carbonate (Lithonate) therapy. One week after
this therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should
the nurse do?
A. Call the physician immediately to report the laboratory result.

B. Observe the client closely for signs and symptoms of lithium toxicity.

C. Withhold the next dose and repeat the laboratory test.

D. Continue to administer the medication as ordered.

Rationale: The serum lithium level should be maintained between 1 and 1.4 mEq/L during the
acute manic phase; therefore, the nurse should continue to administer the medication as ordered.
Unless the client has signs or symptoms of lithium toxicity, the nurse has no need to call the
physician, withhold the medication, or repeat the laboratory test. Nonetheless, the nurse should
continue to monitor the client's serum lithium level and watch for indications of toxicity if the level
begins to rise

26. A client has been severely depressed since her husband died 6 months ago. Her physician
prescribes amitriptyline (Elavil), 50 mg by mouth daily. Before administering amitriptyline, the
nurse reviews the client's medical history. Which preexisting condition would require cautious use
of this drug?

A. Hiatal hernia

B. Hypernatremia

C. Hepatic disease

D. Hypokalemia

Rationale: Conditions requiring cautious use of amitriptyline include pregnancy, breast-feeding,

suicidal tendencies, cardiovascular disease, and impaired hepatic function. Hiatal hernia,
hypernatremia, and hypokalemia don't affect amitriptyline therapy

27. The nurse is caring for a client with hypochondriasis. Which behavior would the nurse be
most likely to encounter?

A. Ready acceptance of the physician's explanation that all medical and laboratory tests are

B. Expression of fear of dying after being diagnosed with advanced breast cancer

C. Expression of fear of colorectal cancer following 3 days of constipation

D. Lack of concern about having a serious disease

Rationale: The client with hypochondriasis is preoccupied with having a serious disease. She
may convince herself that a relatively minor symptom, such as constipation, is a sign of a serious
disorder. The client's fear of serious illness persists, even after a physician reassures her that all
medical and laboratory tests are normal. The fear of dying after receiving a diagnosis of
advanced breast cancer wouldn't be considered hypochondriasis. A client with hypochondriasis
shows an exaggerated level of anxiety, rather than a lack of concern about having a serious
disease or illness.

28. After an upsetting divorce, a client threatens to commit suicide with a handgun and is
involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis takes
highest priority for this client?

A. Hopelessness related to recent divorce

B. Ineffective individual coping related to inadequate stress management

C. Spiritual distress related to conflicting thoughts about suicide and sin

D. Risk for violence: Self-directed related to planning to commit suicide by handgun

Rationale: Although all of these options may apply to this client, safety is the nurse's first priority
in caring for any suicidal client. The nurse can address the client's hopelessness, ineffective
coping, and spiritual distress later in therapy

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

A. Ginkgo biloba

B. Echinacea

C. St. John's wort

D. Ephedra

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

30. When should the nurse introduce information about the end of the nurse-client 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 client can tolerate it

Rationale: Preparation for ending the nurse-client relationship should begin during the
orientation phase, when the limits of the relationship are established. Termination should also be
discussed as goals are achieved and the relationship nears an end. Although the nurse should
remind the client that only one or two sessions are left, the nurse must not wait until then to
prepare the client for termination. The client's ability to tolerate the end of a relationship shouldn't
dictate its timing. Because many clients have had negative experiences when ending
relationships, the nurse can use termination of the nurse-client relationship to prepare the client
for and work the client through positive termination experiences with others.

31. The nurse at a substance abuse center answers the phone. A probation officer asks if a client
is in treatment. The nurse responds, "No, the client you're looking for isn't here." Which of the
following statements best describes the nurse's response?

A. Correct because she didn't give out information about the client

B. A violation of confidentiality because she informed the officer that the client wasn't there

C. A breech of the principle of veracity because the nurse is misleading the officer

D. Illegal because she's withholding information from law enforcement agents

Rationale: The nurse violated confidentiality by informing the officer that the client wasn't in
treatment. Even with law enforcement agents, the nurse must be a client advocate and protect
the client's confidentiality. Information can be legally withheld when a court order isn't in place.

32. Nursing preparations for a client undergoing electroconvulsive therapy (ECT) resemble those
used for

A. physical therapy.

B. neurologic examination.

C. general anesthesia.

D. cardiac stress testing.

Rationale: The nurse should prepare a client for ECT in a manner similar to that for general
anesthesia. For example, the client should receive nothing by mouth for 8 hours before ECT to
reduce the risk of vomiting and aspiration. Also, the nurse should have the client void before
treatment to decrease the risk of involuntary voiding during the procedure; remove any full
dentures, glasses, or jewelry to prevent breakage or loss; and make sure the client is wearing a
hospital gown or loose-fitting clothing to allow unrestricted movement. Usually, these preparations
aren't indicated for a client undergoing physical therapy, neurologic examination, or cardiac stress

33. A client tells the nurse that the television newscaster is sending a secret message to her. The
nurse suspects the client is experiencing:

A. a delusion.

B. flight of ideas.

C. ideas of reference.

D. a hallucination.
Rationale: Ideas of reference refers to the mistaken belief that neutral stimuli have special
meaning to the individual such as the television newscaster sending a message directly to the
individual. A delusion is a false belief. Flight of ideas is a speech pattern in which the client skips
from one unrelated subject to another. A hallucination is a sensory perception, such as hearing
voices and seeing objects, that only the client experiences.

34. A client in an acute care mental health program refuses his morning dose of an oral
antipsychotic medication and believes he's being poisoned. The nurse should respond by taking
which of the following actions?

A. Administering the medication by injection

B. Omitting the dose and trying again the next day

C. Crushing the medication and putting it in his food

D. Consulting with the physician about a plan of care.

Rationale: To determine a plan of care for clients who are noncompliant with medications, the
nurse should consult with the physician. Unless the client presents a danger to himself or others,
medications can't be forced on a client. Intentionally deceiving or misleading a client violates the
therapeutic relationship.

35. Nursing care for a client after electroconvulsive therapy (ECT) should include

A. nothing by mouth for 24 hours after the treatment because of the anesthetic agent.

B. bed rest for the first 8 hours after a treatment.

C. assessment of short-term memory loss.

D. no special care.

Rationale: The nurse must assess the level of short-term memory loss. The client might need to
be reoriented. The client can get out of bed and eat as soon as he feels comfortable.

36. A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements
of which of the following disorders?

A. Personality disorder

B. Mood disorder

C. Thought disorder

D. Amnestic disorder

Rationale: According to the DSM-IV, schizoaffective disorder refers to clients suffering from
schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is
generally better than for the other types of schizophrenia, but it's worse than the prognosis for a
mood disorder alone. Option A is incorrect because personality disorders and psychotic illness
aren't listed together on the same axis. Option C is incorrect because schizophrenia is a major
thought disorder and the question asks for elements of another disorder. Clients with
schizoaffective disorder aren't suffering from schizophrenia and an amnestic disorder

37. Which of the following medications would the nurse expect the physician to order to reverse a
dystonic reaction?

A. prochlorperazine (Compazine)

B. diphenhydramine (Benadryl)

C. haloperidol (Haldol)

D. midazolam (Versed)

Rationale: Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition.

Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it.
Midazolam would make this client drowsy.

38. Assertive behavior involves which of the following elements?

A. Saying what is on your mind at the expense of others

B. Expressing an air of superiority

C. Avoiding unpleasant situations and circumstances

D. Standing up for your rights while respecting the rights of others

Rationale: The basic element of assertive behavior includes the ability to express your feelings
and thoughts while respecting the rights of others. Options A and B describe aggressive behavior,
and option C describes passive behavior.

39. Which psychosocial influence has been causally related to the development of aggressive
behavior and conduct disorder?

A. An overbearing mother

B. Rejection by peers

C. A history of schizophrenia in the family

D. Low socioeconomic status

Rationale: Studies indicate that children who are rejected by their peers are more likely to
behave aggressively. Aggression and conduct disorder are represented in all socioeconomic
groups. Schizophrenia and an overbearing mother haven't been associated with aggression or
conduct disorder.
40. The nurse has been caring for a client with chronic paranoid schizophrenia for several
months, including several one-to-one sessions. During one session, the client seems more
anxious than usual, speaking rapidly and loudly as the session starts. This behavior indicates a
possible change in which form of communication?

A. Appearance

B. Kinesics

C. Paralanguage

D. Proxemics

Rationale: Paralanguage is the use of vocal effects, such as tone and tempo, to convey a
message. Appearance refers to the way a person looks. Kinesics involves body language or
movement. Proxemics is the use of spatial relationships (the distance between people) during
interaction to communicate meaning.

41. The nurse is caring for a client who has been diagnosed with hypochondriasis. The client
attributes his cough to tuberculosis. A chest X-ray and skin test are negative for tuberculosis. The
client begins to complain about the sudden onset of chest pain. How should the nurse react

A. Let the client know the nurse understands his fears of serious illness.

B. Encourage the client to discuss his fear of having a serious illness.

C. Report the complaint of chest pain to the physician.

D. Determine if the illness is fulfilling a psychological need for the client.

Rationale: Because of the risk of missing an actual medical problem, any new symptoms
reported by a client with hypochondriasis should be reported to the physician. The other
interventions are appropriate after the nurse has determined that the client doesn't have a serious
medical disorder.

42. Additive central nervous system (CNS) depression can occur when combining a sedative-
hypnotic with which of the following drugs?

A. methylphenidate (Ritalin)

B. cocaine

C. amitriptyline (Elavil)

D. amphetamine (Adderall)

Rationale: Additive effects occur with concomitant use of CNS depressants, antihistamines,
antidepressants, and antipsychotics. Elavil is an antidepressant and the only correct answer. All
the other drugs are classified as stimulants.
43. Which statement about somatoform pain disorder is accurate?

A. The pain is intentionally fabricated by the client to receive attention.

B. The pain is real to the client, even though there may not be an organic etiology for the pain.

C. The pain is less than would be expected from what the client identifies as the underlying

D. The pain is what would be expected from what the client identifies as the underlying disorder

Rationale: In a somatoform pain disorder, the client has pain even though a thorough diagnostic
work-up reveals no organic cause. The nurse must recognize that the pain is real to the client. By
refusing to believe that the client is in pain, the nurse impedes the development of a therapeutic
relationship based on trust. While somatoform pain offers the client secondary gains, such as
attention or avoidance of an unpleasant activity, the pain isn't intentionally fabricated by the client.
Even if a pathological cause of the pain can be identified, the pain is often in excess of what
would normally be expected.

44. Which nonantipsychotic medication is used to treat some clients with schizoaffective

A. phenelzine (Nardil)

B. chlordiazepoxide (Librium)

C. lithium carbonate (Lithane)

D. imipramine (Tofranil)

Rationale: Lithium carbonate, an antimania drug, is used to treat clients with cyclical
schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes
affective symptoms, including maniclike activity. Lithium helps control the affective component of
this disorder. Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don't
respond to other antidepressant drugs such as imipramine. Chlordiazepoxide, an antianxiety
agent, generally is contraindicated in psychotic clients. Imipramine, primarily considered an
antidepressant agent, is also used to treat clients with agoraphobia and those undergoing
cocaine detoxification.

45. Which of the following medical conditions is commonly found in clients with bulimia nervosa?

A. Allergies

B. Cancer

C. Diabetes mellitus

D. Hepatitis A

Rationale: Bulimia nervosa can lead to many complications, including diabetes, heart disease,
and hypertension. The eating disorder isn't typically associated with allergies, cancer, or hepatitis

46. A client who lost her home and dog in an earthquake tells the admitting nurse at the
community health center that she finds it harder and harder to "feel anything." She says she can't
concentrate on the simplest tasks, fears losing control, and thinks about the earthquake
incessantly. She becomes extremely anxious whenever the earthquake is mentioned and must
leave the room if people talk about it. The nurse suspects that she has:

A. phobic disorder.

B. conversion disorder.

C. posttraumatic stress disorder (PTSD).

D. adjustment disorder.

Rationale: PTSD may occur in survivors of earthquakes and other events outside the range of
usual human experience. Typically, the victim repeatedly relives the event mentally and exhibits
numbed emotional responsiveness and difficulty concentrating. PTSD also may cause an inability
to function in daily life, memory impairment, chronic anxiety, insomnia, and hyperalertness. In a
phobic disorder, the client fears an object or situation that doesn't present any real danger.
Conversion disorder typically causes changes or losses in physical function that suggest a
physical disorder but actually are expressions of a psychological conflict. In adjustment disorder,
the stressor usually is less severe than in PTSD and is within the range of usual experience.

47. A client is transferred to the locked psychiatric unit from the emergency department after
attempting suicide by taking 200 acetaminophen (Tylenol) tablets. Now the client is awake and
alert but refuses to speak with the nurse. In this situation, the nurse's first priority is to:

A. establish a rapport to foster trust.

B. place the client in full leather restraints.

C. try to communicate with the client in writing.

D. ensure safety by initiating suicide precautions.

Rationale: The nurse's first priority is to keep a suicidal client safe and alive. Although
establishing a rapport and promoting trust are important in psychiatric nursing, neither is the
highest priority. Using restraints is inappropriate and could be interpreted as punishment of the
client or a convenience for the nurse. Trying to communicate in writing is also inappropriate
because the client can hear.

48. Which of the following is an example of the role of the psychiatric nurse in primary

A. Handling crisis intervention in an outpatient setting

B. Visiting a client's home to discuss medication management

C. Conducting a postdischarge support group

D. Providing sexual education classes for adolescents

Rationale: The psychiatric nurse participates in primary, secondary, and tertiary prevention
activities. Primary prevention includes providing sexual education classes for adolescents and
education programs that promote mental health and prevent future psychiatric episodes.
Secondary prevention involves treatment to reduce psychiatric problems (for example, handling
crisis intervention in an outpatient setting, administering and supervising medication regimens,
and participating in the therapeutic milieu). Tertiary prevention involves helping clients who are
recovering from psychiatric illness; activities directed toward providing aftercare and rehabilitation
are part of this role. Conducting a postdischarge support group is a tertiary prevention activity.

49. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations.
The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and
stops shouting in mid-sentence. Which nursing intervention is the most appropriate?

A. Approach the client and touch him to get his attention.

B. Encourage the client to go to his room where he'll experience fewer distractions.

C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear
these voices.

D. Ask the client to describe what the voices are saying.

Rationale: By acknowledging that the client hears voices, the nurse conveys acceptance of the
client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids
reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without
advance warning. The hallucinating client may believe that the touch is a threat or act of
aggression and respond violently. Being alone in his room encourages the client to withdraw and
may promote more hallucinations. The nurse should provide an activity to distract the client. By
asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse
should focus on the client's feelings, rather than the content of the hallucination.

50. A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help
the client ignore the voices, the nurse should recommend that he:

A. sit in a quiet, dark room and concentrate on the voices.

B. listen to a personal stereo through headphones and sing along with the music.

C. call a friend and discuss the voices and his feelings about them.

D. engage in strenuous exercise.

Rationale: Increasing the amount of auditory stimulation, such as by listening to music through
headphones, may make it easier for the client to focus on external sounds and ignore internal
sounds from auditory hallucinations. Option A would make it harder for the client to ignore the
hallucinations. Talking about the voices, as in option C, would encourage the client to focus on
them. Option D is incorrect because exercise alone wouldn't provide enough auditory stimulation
to drown out the voices.

51. A client diagnosed as having panic disorder with agoraphobia is admitted to the inpatient
psychiatric unit. Until her admission, she had been a virtual prisoner in her home for 5 weeks,
afraid to go outside even to buy food. When planning care for this client, what is the nurse's
overall goal?

A. To help the client perform self-care activities

B. To help the client function effectively in her environment

C. To help control the client's symptoms

D. To help the client participate in group therapy

Rationale: A client with panic disorder typically confines movements to increasingly smaller
areas to avoid confronting fears, which may dominate the client's life and limit everyday activities.
The overall goal of care is to help the client function within the environment as effectively as
possible. Panic disorder with agoraphobia doesn't impair the ability to perform self-care activities.
Controlling symptoms isn't the overall goal; furthermore, helping the client function effectively will
help control symptoms. Although participation in group therapy may help the client control
symptoms, encouraging such participation isn't the overall goal of nursing care.

52. A client is receiving treatment for severe depression. When evaluating the client for suicidal
ideation, the nurse checks for:

A. suicidal thoughts or plans.

B. further deterioration in self-worth.

C. hoarding of prized possessions.

D. the need for physical restraints.

Rationale: Suicidal ideation refers to thoughts or plans of suicide. To assess for these, the nurse
should ask directly if the client is thinking about or planning suicide. Common indicators of an
increased risk for suicide include giving away prized possessions and lifting of depression, not
further deterioration in self-worth. If the client has suicidal ideation or is at high risk for suicide, the
staff should ensure a safe environment, such as by conducting frequent checks (every 15
minutes) and removing potentially dangerous objects. Continuous observation is more effective
than physical restraints, which are reserved for clients who are physically violent and out of

53. Nursing care for a client with schizophrenia must be based on valid psychiatric and nursing
theories. The nurse's interpersonal communication with the client and specific nursing
interventions must be:

A. clearly identified with boundaries and specifically defined roles.

B. warm and nonthreatening.

C. centered on clearly defined limits and expression of empathy.

D. flexible enough for the nurse to adjust the plan of care as the situation warrants.

Rationale: A flexible plan of care is needed for any client who behaves in a suspicious,
withdrawn, or regressed manner or who has a thought disorder. Because such a client
communicates at different levels and is in control of himself at various times, the nurse must be
able to adjust nursing care as the situation warrants. The nurse's role should be clear; however,
the boundaries or limits of this role should be flexible enough to meet client needs. Because a
client with schizophrenia fears closeness and affection, a warm approach may be too threatening.
Expressing empathy is important, but centering interventions on clearly defined limits is
impossible because the client's situation may change without warning

54. A client diagnosed with major depression has started taking amitriptyline HCl (Elavil), a
tricyclic antidepressant. What is a common adverse effect of this drug?

A. Weight loss

B. Dry mouth

C. Hypertension

D. Muscle spasms

Rationale: Tricyclic antidepressants can have anticholinergic adverse effects, with dry mouth
being the most common. Hypotension would be expected, rather than hypertension. Weight gain
— not loss — is typical when taking this medication. Muscle spasms aren't an adverse effect of
tricyclic antidepressants

55. Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent
which adverse reaction?

A. Hypertension

B. Respiratory arrest

C. Tourette syndrome

D. Retinal pigmentation

Rationale: Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day.
The other options don't occur as a result of exceeding this dose.
56. A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back
from his forehead 15 times before carrying out any activity. The nurse notices that the client's hair
is thinning and the skin on the forehead is irritated — possible effects of this ritual. When planning
the client's care, the nurse should assign highest priority to:

A. helping the client identify how the ritualistic behavior interferes with daily activities.

B. exploring the purpose of the ritualistic behavior.

C. setting consistent limits on the ritualistic behavior if it harms the client or others.

D. using problem solving to help the client manage anxiety more effectively.

Rationale: Client safety is the paramount concern and must be maintained. Therefore, setting
consistent limits on potentially harmful ritualistic behavior takes highest priority. Although the
other options are important, they take lower priority. For instance, helping the client identify how
the ritualistic behavior interferes with daily activities increases the client's motivation for using
more effective coping behavior. Exploring the purpose of the ritualistic behavior helps the client
see this behavior as an attempt to control anxiety. As the client learns new ways to manage
anxiety, the ritualistic behavior is likely to decrease.

57. A client is brought to the psychiatric clinic by family members, who tell the admitting nurse
that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview
with the nurse, which statement by the client most strongly supports a diagnosis of psychoactive
substance abuse?

A. "I'm not addicted to alcohol. In fact, I can drink more than I used to without being affected."

B. "I only spend half of my paycheck at the bar."

C. "I just drink to relax after work."

D. "I know I've been arrested three times for drinking and driving, but the police are just trying to
hassle me."

Rationale: According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition,
diagnostic criteria for psychoactive substance abuse include a maladaptive pattern of such use,
indicated either by continued use despite knowledge of having a persistent or recurrent social,
occupational, psychological, or physical problem caused or exacerbated by substance abuse or
recurrent use in dangerous situations (for example, while driving). For this client, psychoactive
substance dependence must be ruled out; criteria for this disorder include a need for increasing
amounts of the substance to achieve intoxication (option A), increased time and money spent on
the substance (option B), inability to fulfill role obligations (option C), and typical withdrawal

58. A client is undergoing treatment for an anxiety disorder. Such a disorder is considered chronic
and generalized when excessive anxiety and worry about two or more life circumstances exist for
at least
A. 2 months.

B. 12 months.

C. 6 months.

D. 4 months.

Rationale: For generalized anxiety disorder, the diagnostic criteria listed in the Diagnostic and
Statistic Manual of Mental Disorders, 4th edition, include unrealistic or excessive anxiety and
worry about two or more life circumstances for 6 months or more, during which time these
concerns exist on a majority of days.

59. A client exhibits the following defining characteristics: denial of problems that are evident to
others, expressions of shame or guilt, perceptions of self as being unable to deal with events, and
projection of blame or responsibility for problems onto others. How would a nurse diagnose this

A. Anxiety

B. Chronic low self-esteem

C. Ineffective denial

D. Ineffective individual coping

Rationale: The defining characteristics are those of Chronic low self-esteem. The definition of
this diagnosis is negative self-evaluation, along with negative feelings about self or capabilities,
which may be directly or indirectly expressed. Anxiety, Denial, and Ineffective individual coping all
have different sets of defining characteristics.

60. Tourette syndrome is characterized by the presence of multiple motor and vocal tics. A vocal
tic that involves repeating one's own sounds or words is known as:

A. echolalia.

B. palilalia.

C. apraxia.

D. aphonia.

Rationale: Palilalia is defined as the repetition of sounds and words. Echolalia is the act of
repeating the words of others. Apraxia is the inability to carry out motor activities, and aphonia is
the inability to speak.

61. A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His
physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times
per day. Before administering the drug, the nurse reviews the client's medication history.
Concomitant use of which drug is likely to increase the risk of extrapyramidal effects?

A. guanethidine (Ismelin)

B. droperidol (Inapsine)

C. lithium carbonate (Lithonate)

D. alcohol

Rationale: When administered with any phenothiazine, droperidol may increase the risk of
extrapyramidal effects. The other options are incorrect.

62. A client with schizophrenia who receives fluphenazine (Prolixin) develops

pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize
extrapyramidal symptoms?

A. benztropine (Cogentin)

B. dantrolene (Dantrium)

C. clonazepam (Klonopin)

D. diazepam (Valium)

Rationale: Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse

effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the
neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene,
a hydantoin drug that reduces the catabolic processes, is administered to alleviate the symptoms
of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs.
Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control seizure
activity. Diazepam, a benzodiazepine ./drug, is administered to reduce anxiety.

63. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many
years. One approach that has proven to be effective for hallucinating clients is to:

A. take an as-needed dose of psychotropic medication whenever they hear voices.

B. practice saying "Go away" or "Stop" when they hear voices.

C. sing loudly to drown out the voices and provide a distraction.

D. go to their room until the voices go away.

Rationale: Researchers have found that some clients can learn to control bothersome
hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic
medication whenever the voices arise may lead to overmedication and put the client at risk for
adverse effects. Because the voices aren't likely to go away permanently, the client must learn to
deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly
may upset other clients and would be socially unacceptable after the client is discharged.
Hallucinations are most bothersome in a quiet environment when the client is alone, so sending
the client to his room would increase, rather than decrease, the hallucinations.

64. An agitated and incoherent client, age 29, comes to the emergency department with
complaints of visual and auditory hallucinations. The history reveals that the client was
hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol
(Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat:

A. dyskinesia.

B. dementia.

C. psychosis.

D. tardive dyskinesia.

Rationale: By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation.

Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in
elderly clients. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be
monitored for this adverse reaction.

65. When interviewing the parents of an injured child, which of the following is the strongest
indicator that child abuse may be a problem?

A. The injury isn't consistent with the history or the child's age.

B. The mother and father tell different stories regarding what happened.

C. The family is poor.

D. The parents are argumentative and demanding with emergency department personnel.

Rationale: When the child's injuries are inconsistent with the history given or impossible
because of the child's age and developmental stage, the emergency department nurse should be
suspicious that child abuse is occurring. The parents may tell different stories because their
perception may be different regarding what happened. If they change their story when different
health care workers ask the same question, this is a clue that child abuse may be a problem.
Child abuse occurs in all socioeconomic groups. Parents may argue and be demanding because
of the stress of having an injured child.

66. Which of the following statements is a guideline to help nurses avoid liability?

A. Follow every physician's order.

B. Do what the client desires even though you may disagree.

C. Practice within the scope of the Nurse Practice Act.

D. Obtain malpractice insurance.

Rationale: The Nurse Practice Act outlines acceptable standards for nursing. Practicing within
those guidelines will protect the nurse from liability. The client doesn't know standards of care and
isn't responsible for the nurse's actions. Physicians may not be aware of guidelines for nurses
and delegate inappropriate treatment or practice for the nurse. Insurance won't prevent a liability
suit, but only assist the nurse if a suit would be filed.

67. In group therapy, a client who has used I.V. heroin every day for the past 14 years says, "I
don't have a drug problem. I can quit whenever I want. I've done it before." Which defense
mechanism is the client using?

A. Denial

B. Obsession

C. Compensation

D. Rationalization

Rationale: A client who states that he or she doesn't have a drug problem and can quit using
drugs at any time — despite evidence to the contrary — is denying the drug addiction. Obsession
isn't a defense mechanism. In compensation, the client emphasizes positive attributes to
compensate for negative ones. In

rationalization, the client justifies behaviors by faulty logic.

68. A husband and wife seek emergency crisis intervention because he slapped her repeatedly
the night before. The husband indicates that his childhood was marred by an abusive relationship
with his father. When intervening with this couple, the nurse knows they are at risk for repeated
violence because the husband:

A. has only moderate impulse control.

B. denies feelings of jealousy or possessiveness.

C. has learned violence as an acceptable behavior.

D. feels secure in his relationship

Rationale: Family violence usually is a learned behavior, and violence typically leads to further
violence, putting this couple at risk. Repeated slapping may indicate poor, not moderate, impulse
control. Violent people commonly are jealous and possessive and feel insecure in their

69. A client with delusional thinking shows a lack of interest in eating at meal times. She states
that she is unworthy of eating and that her children will die if she eats. Which nursing action
would be most appropriate for this client?

A. Telling the client that she may become sick and die unless she eats
B. Paying special attention to the client's rituals and emotions associated with meals

C. Restricting the client's access to food except at specified meal and snack times

D. Encouraging the client to express her feelings at meal times

Rationale: Restricting access to food except at specified times prevents the client from eating
when she feels anxious, guilty, or depressed; this, in turn, decreases the association between
these emotions and food. Telling the client she may become sick or die may reinforce her
behavior because illness or death may be her goal. Paying special attention to rituals and
emotions associated with meals also would reinforce undesirable behavior. Encouraging the
client to express feelings at meal times would increase the association between emotions and
food; instead, the nurse should encourage her to express feelings at other times

70. Which of the following is the priority when assessing a suicidal client who has ingested a
handful of unknown pills?

A. Determining if the client was trying to harm himself

B. Determining if the client had a support system

C. Determining if the client's physical condition is life-threatening

D. Determining if the client has a history of suicide attempts

Rationale: If the client's physical condition is life-threatening, the priority is to treat the medical
condition. Any compromise to the client's airway, breathing, or circulation must be addressed
immediately. It's also imperative to determine the time of ingestion because this may determine
treatment. The psychiatric evaluation, which includes intent to harm oneself, adequate support
system, and history, can be done after the client is medically stable.

71. How long after amitriptyline (Elavil) therapy begins can the nurse expect the client to show
improved psychological symptoms?

A. 2 to 4 days

B. 4 to 6 days

C. 6 to 8 days

D. 10 to 14 days

Rationale: Because tricyclic antidepressants have long half-lives, a noticeable response may not
occur for 10 to 14 days; a full response may take up to 30 days.

72. Before the nurse administers the first dose of lithium carbonate (Lithonate) to a client, she
reviews information about the drug. Which statement accurately

describes the metabolism and excretion of lithium?

A. It's metabolized in the liver and excreted in the feces.

B. It's metabolized and excreted by the kidneys.

C. It isn't metabolized and is excreted unchanged by the kidneys.

D. It's metabolized in the liver and excreted by the kidneys

Rationale: Lithium isn't metabolized and is excreted unchanged by the kidneys.

73. A client continues to stalk a man whom she met briefly 3 years ago. She believes he loves
her and eventually will marry her and has been sending him cards and gifts. When she violates a
restraining order he has obtained, a judge orders her to undergo a 10-day psychiatric evaluation.
What is the most probable psychiatric diagnosis for this client?

A. Delusional disorder — jealous type

B. Induced psychotic disorder

C. Delusional disorder — erotomanic type

D. Schizophreniform disorder

Rationale: In delusional disorder of the erotomanic type, the client has an erotic delusion of
being loved by another person and tries to contact the object of the delusion through such
behaviors as sending gifts, calling, and stalking. The object of the undesired attention may be a
complete stranger and usually is of higher status. In a delusional disorder of the jealous type, the
client has a delusion that the sexual partner is unfaithful. In a psychotic disorder, a delusion of
suspicion occurs within the context of a close relationship. The individual may believe that
someone has an inappropriate or sexual interest in him. Schizophreniform disorder involves
bizarre delusions and hallucinations of less than 6 months' duration.

74. Which of the following signs should the nurse expect in a client with known amphetamine

A. Hypotension

B. Tachycardia

C. Hot, dry skin

D. Constricted pupils

Rationale: Amphetamines are central nervous system stimulants. They cause sympathetic
stimulation, including hypertension, tachycardia, vasoconstriction, and hyperthermia. Hot, dry skin
is seen with anticholinergic agents such as jimsonweed. Pupils will be dilated, not constricted.