1. Which of the following medications would the nurse in-charge expect the doctor to order to reverse a dystonic reaction?

a. Procholorperazine (Compazine)

b. Diphenhydramine (Benadryl)

c. Haloperidol (Haldol)

d. Midazolam (Versed)

2. While pacing in the hall, a female patient with paranoid schizophrenia runs to the nurse and says, “Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. Give me back my soul!” how should the nurse respond?

a. “I’m a nurse, I’m not poisoning you. It’s against the nursing code of ethics.”

b. “I’m a nurse, and you’re a patient in the hospital. I’m not going to harm you.”

c. “I’m not poisoning you. And how could I possibly steal your soul?”

d. “I sense anger, Are you feeling angry today?”

3. After completing chemical detoxification and a 12-step program to treat crack addiction, a male patient is being prepared for discharge. Which remark by the patient indicates a realistic view of the future?

a. “I’m never going to use crack again.”

b. “I know what I have to do. I have to limit my crack use.”

c. “I’m going to take 1 day at a time. I’m not making any promises.”

d. “I can’t touch crack again, but I sure could use a drink. I’ve earned it.”

4. The nurse formulates a nursing diagnosis of “impaired verbal communication” for a male patient with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate?

a. Helping the patient to participate in social interactions

b. Establishing a one-on-one relationship with the patient

c. Establishing alternative forms of communication

d. Allowing the patient to decide when he wants to participate in verbal communication with you

5. A female patient with obsessive-compulsive disorder tells the nurse that he must check the lock on his apartment door 25 times before leaving for an appointment. The nurse knows that this behavior represents the patient’s attempt to:

a. Call attention to himself

b. Control his thoughts

c. Maintain the safety of his home

d. Reduce anxiety

6. A patient, age 42, is admitted for surgical biopsy of a suspicious lump in her left breast. When the nurse comes to her surgery, she is

tearfully finishing a letter to her children. She tells the nurse, “I want to leave this for my children in case anything goes wrong today. “Which response by the nurse would be most therapeutic?

a. “In case anything goes wrong? What are your thoughts and feelings right now?”

b. “I can’t understand that you’re nervous, but this is really a minor procedure. You’ll be back in your room before you know it.”

c. “Try to take a few deep breaths and relax. I have some medication that will help.”

d. “I’m sure your children know how much you love them. You’ll be able to talk to them on the phone in a few hours.”

7. Which nursing intervention is most important when restraining a violent male patient?

a. Reviewing hospital policy regarding how long the patient can be restrained

b. Preparing a p.r.n. dose of the patient’s psychotropic medication

c. Checking that the restraints have been applied correctly

d. Asking if the patient needs to use the bathroom or is thirsty

8. How soon after chlorpromazine administration should the nurse in charge expect to see a patient’s delusion thoughts and hallucinations eliminated?

a. Several minutes

b. Several hours

c. Several days

d. Several weeks

9. Mental health laws in each state specify when restraints can be used and which type of restraints are allowed. Most laws stipulate that restraints can be used:

a. For a maximum of 2 hours

b. As necessary to control the patient

c. If the patient poses a present danger to self or others

d. Only with the patient’s consent

10. A female patient has been severely depressed since her husband died 6 months ago. Her doctor prescribes amitriptyline hydrochloride (Elavil), 50 mg P.O. daily. Before administering amitriptyline, the nurse reviews the patient’s medical history. Which preexisting condition would require cautions use of this drug?

a. Hiatal hernia

b. Hypernatremia

c. Hepatic disease

d. Hypokalemia

11. The physician orders a new medication for a male client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse would be most appropriate?

a. “Take this medication. It will reduce your anxiety.”

b. “Do you have any concern about taking the medication?”

c. “Trust us. This medication has helped many people. We wouldn’t have you take it if it were dangerous.”

d. “How can we help you if you won’t cooperate?”

12. The nurse is aware that the Hormonal effects of the antipsychotic medications include which of the following?

a. Retrograde ejaculation and gynecomastia

b. Dysmenorrhea and increased vaginal bleeding

c. Polydipsia and dysmenorrheal

d. Akinesia and dysphasia

13. The nurse is caring for a female client in the manic phase of bipolar disorder who’s ready for discharge from the psychiatric unit. As the nurse begins to terminate the nurse-client relationship, which client response is most appropriate?

a. Expressing feeling of anxiety

b. Displaying anger, shouting, and banging the table

c. Withdrawing from the nurse in silence

d. Rationalizing the termination, saying that “everything comes to an end”

14. The nurse is caring for a male client with schizophrenia. Which outcome is the least desirable?

a. The client spends more time by himself

b. The client doesn’t engage in delusional thinking

c. The client doesn’t harm himself or others

d. The client demonstrates the ability to meet his own self-care needs

15. The nurse is assigned to care for a recently admitted female client who has attempted suicide. What should the nurse do?

a. Search the client’s belongings and room carefully for items that could be used to attempt suicide

b. Express trust that the client won’t cause self-harm while in the facility

c. Respect the client’s privacy by not searching any belongings

d. Remind all staff members to check on the client frequently

16. A male client becomes angry and belligerent toward the nurse after speaking on the phone with his mother. The nurse recognizes this as what defense mechanism?

a. Rationalization

b. Repression

c. Displacement

d. Suppression

17. Nursing preparations for a client undergoing electroconvulsive therapy (ECT) resembles those used for:

a. Physical therapy

b. Neurologic examination

c. General anesthesia

d. Cardiac stress testing

18. Nursing care for a male client with schizophrenia must be based on valid psychiatric and nursing theories. The nurse’s interpersonal communication with the client and specific nursing intervention must be:

a. Clearly identified with boundaries and specifically defined roles

b. Warn and non threatening

c. Centered on clearly defined limits and expression of empathy

d. Flexible enough for the nurse to adjust the care plan as the situation warrants

19. Before eating a meal, a female client with obsessive-compulsive disorder (OCD) must wash his hands for 18 minutes, comb his hair 444 strokes, and switch the bathroom lights 44 times. What is the most appropriate goal of care for this client?

a. Omit one unacceptable behavior each day

b. Increase the client’s acceptance of therapeutic drug use

c. Allow ample time for the client to complete all rituals before each meal

d. Systematically decrease the number of repetitions of rituals and the amount of time spent performing them.

20. A male client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client?

a. Chlorpromazine (Thorazine)

b. Imipramine (Tofranil)

c. Lithium carbonate (Lithane)

d. Fluphenazine decanoate (Prolixin Decanoate)

21. A 23-year-old client is diagnosed with dependent personality disorder. Which behavior is most likely to be evidence of ineffective individual coping?

a. In ability to make choices and decisions without advice

b. Showing interest only in solitary activities

c. Avoiding developing relationship

d. Recurrent self-destructive behavior with history of depression

22. During the mental status examination, a female client may be asked to explain such proverbs as “Don’t cry over spilled milk.” The purpose is to evaluate the client’s ability to think:

a. Rationally

b. Concretely

c. Abstractly

d. Tangentially

23. After an upsetting divorce, a male 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 coping related to inadequate stress management

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

d. Risk for self-directed-violence related to planning to commit suicide with a handgun

24. A 25-year-old man reports losing his sight in both eyes. He’s diagnosed as having conversion disorder and is admitted to the psychiatric unit. Which nursing intervention would be most appropriate for this client?

a. Not focusing on his blindness

b. Providing self-care for him

c. Telling him that his blindness isn’t real

d. Teaching eye exercises to strengthen his eyes

25. In group therapy, a male client angrily speaks up and responds to a peer, “You’re always whining and I’m getting tired of listening to you! Here is the world’s smallest violin playing for you.” Which role is the client playing?

a. Blocker

b. Monopolizer

c. Recognition seeker

d. Aggressor

26. A nurse places a female client in full leather restraints. How often must the nurse check the client’s circulation?

a. Once per hour

b. Once per shift

c. Every 10 to 15 minutes

d. Every 2 hours

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

a. The injury isn’t consistent with the history of 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

28. Unhealthy personal boundaries are a product of dysfunctional families and a lack of positive role models. Unhealthy boundaries may also be a result of:

a. Structured limit setting

b. Supportive environment

c. Abuse and neglect

d. Direction and attention

29. When monitoring a male client recently admitted for treatment of cocaine addiction, the nurse notes sudden increase in the arterial blood pressure and heart rate. To correct these problems, the nurse expects the physician to prescribe:

a. Norepinephrine (Levophed) and lidocaine (Xylocaine)

b. Nifedipine (Procardia) and lidocaine

c. Nitroglycerin (Nitro-Bid IV) and esmolol (Brevibloc)

d. Nifedipine and nitroglycerin

30. Conditions necessary for the development of a positive sense of self-esteem include:

a. Consistent limits

b. Critical environment

c. Inconsistent boundaries

d. Physical discipline

ANSWERS AND RATIONALE

1. Answer B. 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 patient drowsy.

2. Answer B. The nurse should directly orient a delusional patient to reality, especially to place and person. Option A and C encourage further delusions

by denying poisoning and offering information related to the delusion. Validating the patient’s feeling, as in option D, occurs during a later stage in the therapeutic process.

3. Answer C. Twelve-step programs focus on recovery 1 day at a time. Such programs discourage people from claiming that they will never again use a substance, because relapse is common. The belief that one may use a limit amount of an abused substance indicates denial. Substituting one abused substance for another predisposes the patient to cross-addiction.

4. Answer B. By establishing a one-to-one relationship, the nurse helps the patient learn how to interact with other people in new situations. The other options are appropriate but should take place only after the nurse-patient relationship is established.

5. Answer D. A compulsion is a repetitive act or impulse helps a person to reduce anxiety unconsciously. An obsessive-compulsive patient does not want to call attention to self and cannot control thoughts. This patient’s priority is to reduce anxiety, not maintain the safety of the home.

6. Answer A. By acknowledging how the patient feels, this response encourages further expression of thoughts and feelings. Minimizing feelings or offering empty reassurances is not therapeutic or helpful. Deep breathing or preoperative medication would be appropriate only after the patient’s fears have been expressed and dealt with.

7. Answer C. The nurse must determine whether the restraints have been applied correctly to make sure that patient’s circulation and respiration are not restricted and that adequate padding has been used. The nurse should document the patient’s response and status carefully after the restraints are applied. All staff members involved in restraining patients should be aware of hospital policy before using restraints. If p.r.n. medication is ordered, it should be given before the restraints are in place and with the assistance of other team members. The nurse should attend to the patient’s elimination and hydration needs after the patient is properly restrained.

8. Answer D. Although most phenothiazine produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.

9. Answer C. Most states allow restraints to be used if the patient presents a danger to self or others. This danger must be reevaluated every few hours. If the patient is still a danger, restraints can be used until the violent behavior abates. No standing orders for restraints are allowed, and restraints are permitted only until more “humane” methods, such as sedatives, become more effective. Violent patients who are intoxicated with drugs or alcohol present a problem because they rarely can be sedated until the drug or alcohol is metabolized. In such cases, restraints may be needed for a longer

period, but the patient must be closely observed. Obtaining consent is not always possible, especially when the patient’s violent behavior results from a psychosis, such as paranoid schizophrenia.

10. Answer C. Conditions requiring cautious use of amitriptyline include pregnancy, lactation, suicidal tendencies, cardiovascular disease, and impaired hepatic function. Hiatal hernia, hypernatremia, and hypokalemia do not affect amitriptyline therapy.

11. Answer B. Providing an opportunity for the client to express concern about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the right to refuse the medication. Instead of simply ordering the client to take it, as in option 1, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option 3, or threatening the client, as option 4, would increase anxiety.

12. Answer A. Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Polydipsia, akinesia, and dysphasia aren’t hormonal effects.

13. Answer A. Anxiety is a normal reaction to the termination of the nurse-client relationship. The nurse should help the client explore his feelings about the end of the therapeutic relationship. While anger about the termination may be a healthy response, banging the table, shouting, and other forms of acting out aren’t appropriate behavior. Withdrawal isn’t a healthy response to the termination of a relationship. By rationalizing the termination, the client avoids expressing his feelings and emotions.

14. Answer A. The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn’t be a desirable outcome. Rather, a desirable outcome would specify that the client spend more time with other clients and staff on the unit. Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome. Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome.

15. Answer A. Because a client who has attempted suicide could try again, the nurse should search the client’s belongings and room to remove any items that could be used in another suicide attempt. Expressing trust that the client won’t cause self-harm may increase guilt and pain if the client can’t

live up to that trust. The nurse should search the client’s belonging because the need to maintain a safe environment supersedes the client’s right to privacy. Although frequent checks by staff members are helpful, they aren’t enough because the client may attempt suicide between checks.

16. Answer C. Displacement is a defense mechanism in which the client transfers his feelings for one person toward another person who is less threatening. Rationalization is a defense mechanism in which the client makes excuses to justify unacceptable feeling or behaviors. Repression is characterized by an involuntary blocking of unpleasant experiences from one’s consciousness. Suppression is the conscious blocking of unpleasant experiences form one’s awareness.

17. Answer C. 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 denture, 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 testing.

18. Answer D. A flexible care plan needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has 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 clear defined limits is impossible because the client’s situation may change without warning.

19. Answer D. When caring for a client with OCD, the goal is to systematically decrease the undesirable behavior. (Therapy may not completely extinguish certain behaviors.) Expecting to omit one behavior each day is unrealistic because the client may have used ritualistic behavior would perpetuate the undesirable behavior.

20. Answer D. Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it’s commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to

maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.

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

22. Answer C. Abstract thinking is the ability to conceptualize and interpret meaning. It’s higher level of intellectual functioning than concrete thinking, in which the client explains the proverb by its literal meaning. Rational thinking involves the ability to think logically, make judgments, and be goal-directed. Tangential thinking is scattered, non-goal-directed, and hard to follow. Clients with such conditions as organic brain disease and schizophrenia typically can’t conceptualize and comprehend abstract meaning. They interpret such statement as “Don’t cry over spilled milk” in a literal sense, such as “Even if you spill your milk, you shouldn’t cry about it.”

23. Answer D. Although all 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.

24. Answer A. Focusing on the client’s blindness can positively reinforce the blindness and further promote the use of maladaptive behaviors to obtain secondary gains. The client should be encouraged to participate in his own care as much as possible to avoid fostering dependency. To promote self-esteem, give positive reinforcement for what the client can do. Blindness and other physical symptoms in a conversion disorder aren’t under the client’s control and are real to him. Eye exercises won’t resolve the client’s blindness because no organic pathology is causing the symptoms.

25. Answer D. The aggressor is negative and hostile and uses sarcasm to degrade others. The role of the blocker is to resist group efforts. The monopolizer controls the group by dominating conversations. The recognition seeker talks about accomplishments to gain attention.

26. Answer C. Circulation as well as skin and nerve damage can occur within 15 minutes. Checking every hour, 2 hours, or 8 hours isn’t often enough and could result in permanent damage to the client’s extremities. Restraints

should be removed every 2 hours, and range-of-motion exercises should be performed.

27. Answer A. 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. Parent may argue and be demanding because of the stress of having an injured child.

28. Answer C. Abuse and neglect lead to poor self-concept and confusion, the basis for unhealthy personal boundaries. Healthy boundaries are established in childhood when parent provide consistent, supportive limits and attention.

29. Answer D. This client requires a vasodilation such as nifedipine to treat hypertension, and a beta-adrenergic blocker such as esmolol to reduce the heart rate. Lidocaine, an antirrhythmic, isn’t indicated because the client doesn’t have an arrhythmia. Although nitrolycerin may be used to treat coronary vasospasm, it isn’t the drug of choice in hypertension.

30. Answer A. A structured lifestyle demonstrates acceptance and caring provides a sense of security. A critical environment erodes a person’s esteem. Inconsistent boundaries lead to feelings of insecurity and lack of concern. Physical discipline can decrease self-esteem