Psychiatric Questions

Situation 1: Zed, 22 year old, was admitted to the psychiatric nursing unit for treatment of psychotic behavior.

1. When collecting data from the client, the nurse notes that the client is admitted by involuntary status. Based on this type of admission, the nurse most likely expects that the client:

a. Presents harm to self

b. Requested the admission

c. Consented to the admission

d. Provided written application to the facility for admission

2. Zed is at the locked exit door, and is shouting, “Let me out. There's nothing wrong with me. I don't belong here.” The nurse identifies this behavior as:

a. Projection c. Regression

b. Denial d. Rationalization

3. Zed states to the nurse, “I haven't slept at all the last couple of nights.” The most therapeutic response of the nurse is:

a. “Go on.....”

b. “Sleeping?”

c. “The last couple of nights?”

d. “You're having difficulty sleeping?”

4. Laboratory work is prescribed on Zed who has been experiencing delusions. When the laboratory technician approaches the client to obtain a specimen of the client's blood, he begins to shout “You're all vampires. Let me out of here!” The nurse who is present at the time would respond most appropriately by stating which of the following?

a. “The technician is not going to hurt you, but is going to help you!”

b. “What makes you think that the technician is a vampire?”

c. “The technician will leave and come back later for your blood.”

d. “It must be fearful to think others want to hurt you.”

5. Nurse Roya assist in planning care for the client who is scheduled to be discharged from the psychiatric nursing unit. The nurse knows that unresolved feelings related to loss may resurface during which phase of the therapeutic nurse-client relationship?

a. Orientation phase c. Working phase

b. Termination phase d. Trusting phase

Situation 2. Therapies are used to modify feelings, attitudes and behaviors of clients

6. A nurse is caring for a client who is scheduled for electroconvulsive therapy (ECT). The nurse notes that an informed consent has not been obtained for the procedure. On review of the record, the nurse notes that the admission was an involuntary hospitalization. Based on this information, the nurse determines that:

a. An informed consent does not need to be obtained

b. An informed consent should be obtained from the family

c. An informed consent needs to be obtained from the client

d. The physician will obtain the informed consent

7. After a group therapy session, a client approaches the licensed practical nurse (LPN) and verbalizes a need for seclusion because of uncontrollable feelings. The LPN reports the findings to the registered nurse (RN) and expects that the RN will take which of the following actions?

a. Inform the client that seclusion has not been prescribed

b. Obtain an informed consent

c. Call the client's family

d. Place the client in seclusion immediately

8. Milieu therapy is prescribed for a client. The nurse understands that this type of 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. The client is involved in setting goals

d. A behavioral approach to changing behavior

9. Disulfiram (Antabuse) is prescribed for a client with a problem related to alcohol. The nurse understands that this medication works on the principle of which of the following therapies?

a. Desensitization

b. Milieu therapy

c. Self-control therapy

d. Aversion therapy

10. A nurse is assisting in monitoring a group therapy session. During this session, the members are identifying tasks and boundaries. The nurse understands that these activities are characteristic of which stage of group development?

a. Forming c. Storming

b. Norming d. Performing

Situation 3. Successful therapeutic communication includes appropriateness, efficiency, flexibility and feedback.

11. A client with depression who attempted suicide says to the nurse, “I should have died. I've always been a failure. Nothing ever goes right to me.” The most therapeutic response of the nurse is:

a. “I don't see you as a failure.”

b. “Feeling like this is all part of being ill.”

c. “You've been feeling like a failure for a while?”

d. “You have everything to live for.”

12. While the male nurse is gathering psychosocial data from a female client, the client states, “I don't want to discuss this – it's private and personal.” Which statement by the male nurse indicates a therapeutic response?

a. “This often happens to me. Perhaps you would find it easier to speak to a nurse who is female.”

b. “I am a nurse and as such I'll have you know that all information is kept confidential.”

c. “I know that some of these questions are difficult for you, but as a nurse, I must legally respect your confidentiality.”

d. “This is difficult for you to speak about, but I am trying to perform a complete data collection and I am no different from a female nurse, if that's your problem.”

13. A nurse is caring for a Native-American client who says, “I don't want you to touch me. I'll take care of myself!” The most therapeutic response of the nurse is:

a. “I will respect your feelings. I'll just leave this cup for you to collect your urine in. After breakfast, I will take more blood from you.”

b. “If you didn't want our care, why did you come here?”

c. “Why are you being so difficult? I only want to help you.”

d. Sounds like you're feeling pretty troubled by all of us. Let's work together so you can do everything for yourself as you request.”

14. A client says to the nurse, “I'm going to die, and I wish my family would stop hoping for a 'cure'! I get so angry when they carry on like this! After all, I'm the one who's dying.” The most therapeutic response by the nurse is:

a. “You're feeling angry that your family continues to hope for you to be 'cured'?”

b. “I think we should talk more about your anger with your family.”

c. “Well, it sounds like you're being pretty pessimistic. After all, years ago people died of pneumonia.

d. “Have you shared your feelings with your family?”

15. A nurse is providing care to a client admitted to the hospital with a diagnosis of anxiety disorder. The nurse is talking with the client. The client says to the nurse, “I have a secret that I want to tell you. You won't tell anyone about it, will you?” The most appropriate nursing response is which of the following?

a. “No, I won't tell anyone.”

b. “I cannot promise to keep a secret.”

c. “If you tell me the secret, I will tell it to your doctor.”

d. If you tell me the secret, I will need to document it in your record.”

Situation 4. Rebecca, a 23 year old college student, is accompanied by her mother to the psychiatric nursing unit. Her mother states that she has been acting strangely lately.

16. Nurse Joy collects data on the client with an admitting diagnosis of bipolar affective disorder- mania. The symptom presentation that requires the nurse's immediate intervention is:

a. The client's outlandish behaviors and inappropriate dress

b. The client's grandiose delusions of being a royal descendant of Lakandula

c. The client's nonstop physical activity and poor nutritional intake.

d. The client's constant, incessant talking that includes sexual innuendos and teasing the staff

17. Rebecca is in a manic state as she emerges from her room. She is topless and is making sexual remarks and gestures toward staff and peers. The best initial nursing action is to:

a. Quietly approach the client, escort her to her room, and assist her in getting dressed

b. Approach the client in the hallway and insist that she go to her room.

c. Confront the client on the inappropriateness of her behaviors and offer her a time-out

d. Ask the other clients to ignore her behavior; eventually she will return to her room

18. A nurse reviews the activity schedule for the day and determines the best activity that the manic client could participate in is:

a. A brown-bag luncheon and a book review

b. Tetherball

c. A paint-by-number activity

d. A deep breathing and progressive relaxation group.

19. Rebecca announce to everyone in the day-room that a striper is coming to perform this evening. When the psychiatric aide firmly states that this behavior is not appropriate, the manic client becomes verbally abusive and threatens physical violence to the aide. Based on the analysis of this situation, the nurse determines that the most appropriate action would be to:

a. With assistance, escort the manic client to her room and administer PRN haloperidol (Haldol)

b. Tell the client that smoking privilege are revoked for 24 hours

c. Orient the client to time, person and place

d. Tell the client that the behavior is not appropriate

20. Rebecca is to undergo electroconvulsive therapy (ECT), which is scheduled for the next morning. Which of the following would not be a component of the plan of care?

a. Withhold food and fluids for 6 hours before the treatment

b. Have the client void before the procedure

c. Remove dentures and contact lenses before the procedure

d. Administer tap water enemas on the evening before the procedure.

Situation 5. Eating disorders are characterized by uncertain self-identification and grossly disturbed eating habits. The following questions pertain to eating disorders.

21. An 18 year old woman is admitted to an inpatient psychiatric unit with the diagnosis of anorexia nervosa. A behavior therapy approach is used as part of her treatment plan. The nurse understands that the purpose of the 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 conflicts and past issues.

22. A nurse is caring for a female client who was recently admitted for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate?

a. Allow the client to complete her exercise program

b. Tell the client that she is not allowed to exercise rigorously

c. Interrupt the client and offer to take her for a walk

d. Interrupt the client and weigh immediately

23. A nurse is caring for a client with anorexia nervosa. The nurse monitoring the client's behavior understands that the client with anorexia nervosa manages anxiety by:

a. Always reinforcing self-approval

b. Having the need to always make the right decision

c. Engaging in immoral acts

d. Observing rigid rules and regulations

24. A nurse is developing a plan of care for the hospitalized client with bulimia nervosa. Which of the following would not be included in the plan of care?

a. Monitoring intake and output

b. Monitoring electrolyte levels

c. Observing for excessive exercise

d. Checking for the presence of laxatives and diuretics in the client's belongings.

25. A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a two-bed room. A newly admitted client will be assigned to this client's room. Which of the following clients would be an appropriate choice as this client's roommate?

a. A client with pneumonia

b. A client receiving diagnostic tests

c. A client who could benefit from the client's assistance at mealtime

d. A client who thrives on managing others

Situation 6. Nurse Miki is caring for Ziko, 39 years old, who has history of alcohol abuse.

26. Nurse Miki is monitoring Ziko for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for delirium tremors (Dts)?

a. Hypertension, changes in level of consciousness, hallucinations

b. Hypotension, ataxia, vomiting

c. Stupor, agitation, muscular rigidity

d. Hypotension, coarse hand tremors, agitation

27. Elda, the wife of Ziko, says to the nurse “I should get out of this bad situation.” The most helpful response by the nurse would be:

a. “I agree with you. You should get out of this situation.”

b. “What do you find difficult about this situation?”

c. “Why don't you tell your husband about this?”

d. “This is not the best time to make that decision.”

28. Ziko is at risk for alcohol withdrawal. The nurse monitors the client knowing that the early signs of withdrawal will develop within how much time after cessation or reduction of alcohol intake?

a. Within a few hours c. In 1 week

b. After several hours d. In 2 to 3 weeks

29. Nurse Miki determines that Elda is benefiting from attending an Al Anon group when she hears the wife say:

a. “My attandance at the meeting has helped me to see that I provoke my husband's violence.”

b. “I no longer feel that I deserve the beatings my husband inflicts on me.”

c. “I can tolerate my husband's destructive behaviors now that I know they are common with alcoholics.”

d. “I enjoy attending the meetings because they get me out of my house and away from my husband.”

30. Ziko, who has been drinking alcohol on a regular basis, admits to having “a problem.” The client is asking for assistance with the problem. The nurse would support the client to attend with of the following community groups?

a. Al Anon c. Alateen

b. Alcoholics Anonymous

d. Fresh Start