TEST V - Care of Clients with Physiologic and Psychosocial Alterations part 1

TEST V - Care of Clients with Physiologic and

Psychosocial Alterations part 1

1. Mr. Marquez reports of losing his job, not being

able to sleep at night, and feeling upset with his

wife. Nurse John responds to the client, “You

may want to talk about your employment

situation in group today.” The Nurse is using

which therapeutic technique?

a. Observations

b. Restating

c. Exploring

d. Focusing

2. Tony refuses his evening dose of Haloperidol

(Haldol), then becomes extremely agitated in the

dayroom while other clients are watching

television. He begins cursing and throwing

furniture. Nurse Oliver first action is to:

a. Check the client’s medical record for an

order for an as-needed I.M. dose of

medication for agitation.

b. Place the client in full leather restraints.

c. Call the attending physician and report

the behavior.

d. Remove all other clients from the

dayroom.

3. Tina who is manic, but not yet on medication,

comes to the drug treatment center. The nurse

would not let this client join the group session

because:

a. The client is disruptive.

b. The client is harmful to self.

c. The client is harmful to others.

d. The client needs to be on medication

first.

4. Dervid, an adolescent boy was admitted for

substance abuse and hallucinations. The client’s

mother asks Nurse Armando to talk with his

husband when he arrives at the hospital. The

mother says that she is afraid of what the father

might say to the boy. The most appropriate

nursing intervention would be to:

a. Inform the mother that she and the

father can work through this problem

themselves.

b. Refer the mother to the hospital social

worker.

c. Agree to talk with the mother and the

father together.

d. Suggest that the father and son work

things out.

5. What is Nurse John likely to note in a male client

being admitted for alcohol withdrawal?

a. Perceptual disorders.

b. Impending coma.

c. Recent alcohol intake.

d. Depression with mutism.

6. Aira has taken amitriptyline HCL (Elavil) for 3

days, but now complains that it “doesn’t help”

and refuses to take it. What should the nurse say

or do?

a. Withhold the drug.

b. Record the client’s response.

c. Encourage the client to tell the doctor.

d. Suggest that it takes a while before

seeing the results.

7. Dervid, an adolescent has a history of truancy

from school, running away from home and

“barrowing” other people’s things without their

permission. The adolescent denies stealing,

rationalizing instead that as long as no one was

using the items, it was all right to borrow them.

It is important for the nurse to understand the

psychodynamically, this behavior may be largely

attributed to a developmental defect related to

the:

a. Id

b. Ego

c. Superego

d. Oedipal complex

8. In preparing a female client for electroconvulsive

therapy (ECT), Nurse Michelle knows that

succinylcoline (Anectine) will be administered

for which therapeutic effect?

a. Short-acting anesthesia

b. Decreased oral and respiratory

secretions.

c. Skeletal muscle paralysis.

d. Analgesia.

9. Nurse Gina is aware that the dietary implications

for a client in manic phase of bipolar disorder is:

a. Serve the client a bowl of soup, buttered

French bread, and apple slices.

b. Increase calories, decrease fat, and

decrease protein.

c. Give the client pieces of cut-up steak,

carrots, and an apple.

d. Increase calories, carbohydrates, and

protein.

10. What parental behavior toward a child during an

admission procedure should cause Nurse Ron to

suspect child abuse?

a. Flat affect

b. Expressing guilt

c. Acting overly solicitous toward the child.

d. Ignoring the child.

11. Nurse Lynnette notices that a female client with

obsessive-compulsive disorder washes her hands

for long periods each day. How should the nurse

respond to this compulsive behavior?

a. By designating times during which the

client can focus on the behavior.

b. By urging the client to reduce the

frequency of the behavior as rapidly as

possible.

c. By calling attention to or attempting to

prevent the behavior.

d. By discouraging the client from

verbalizing anxieties.

12. After seeking help at an outpatient mental

health clinic, Ruby who was raped while walking

her dog is diagnosed with posttraumatic stress

disorder (PTSD). Three months later, Ruby

returns to the clinic, complaining of fear, loss of

control, and helpless feelings. Which nursing

intervention is most appropriate for Ruby?

a. Recommending a high-protein, low-fat

diet.

b. Giving sleep medication, as prescribed,

to restore a normal sleep- wake cycle.

c. Allowing the client time to heal.

d. Exploring the meaning of the traumatic

event with the client.

13. Meryl, age 19, is highly dependent on her

parents and fears leaving home to go away to

college. Shortly before the semester starts, she

complains that her legs are paralyzed and is

rushed to the emergency department. When

physical examination rules out a physical cause

for her paralysis, the physician admits her to the

psychiatric unit where she is diagnosed with

conversion disorder. Meryl asks the nurse, "Why

has this happened to me?" What is the nurse's

best response?

a. "You've developed this paralysis so you

can stay with your parents. You must

deal with this conflict if you want to walk

again."

b. "It must be awful not to be able to move

your legs. You may feel better if you

realize the problem is psychological, not

physical."

c. "Your problem is real but there is no

physical basis for it. We'll work on what

is going on in your life to find out why

it's happened."

d. "It isn't uncommon for someone with

your personality to develop a conversion

disorder during times of stress."

14. Nurse Krina knows that the following drugs have

been known to be effective in treating

obsessive-compulsive disorder (OCD):

a. benztropine (Cogentin) and

diphenhydramine (Benadryl).

b. chlordiazepoxide (Librium) and

diazepam (Valium)

c. fluvoxamine (Luvox) and clomipramine

(Anafranil)

d. divalproex (Depakote) and lithium

(Lithobid)

15. Alfred was newly diagnosed with anxiety

disorder. The physician prescribed buspirone

(BuSpar). The nurse is aware that the teaching

instructions for newly prescribed buspirone

should include which of the following?

a. A warning about the drugs delayed

therapeutic effect, which is from 14 to

30 days.

b. A warning about the incidence of

neuroleptic malignant syndrome (NMS).

c. A reminder of the need to schedule

blood work in 1 week to check blood

levels of the drug.

d. A warning that immediate sedation can

occur with a resultant drop in pulse.

16. Richard with agoraphobia has been symptomfree

for 4 months. Classic signs and symptoms of

phobias include:

a. Insomnia and an inability to concentrate.

b. Severe anxiety and fear.

c. Depression and weight loss.

d. Withdrawal and failure to distinguish

reality from fantasy.

17. Which medications have been found to help

reduce or eliminate panic attacks?

a. Antidepressants

b. Anticholinergics

c. Antipsychotics

d. Mood stabilizers

18. A client seeks care because she feels depressed

and has gained weight. To treat her atypical

depression, the physician prescribes

tranylcypromine sulfate (Parnate), 10 mg by

mouth twice per day. When this drug is used to

treat atypical depression, what is its onset of

action?

a. 1 to 2 days

b. 3 to 5 days

c. 6 to 8 days

d. 10 to 14 days

19. A 65 years old client is in the first stage of

Alzheimer's disease. Nurse Patricia should plan

to focus this client's care on:

a. Offering nourishing finger foods to help

maintain the client's nutritional status.

b. Providing emotional support and

individual counseling.

c. Monitoring the client to prevent minor

illnesses from turning into major

problems.

d. Suggesting new activities for the client

and family to do together.

20. The nurse is assessing a client who has just been

admitted to the emergency department. Which

signs would suggest an overdose of an

antianxiety agent?

a. Combativeness, sweating, and confusion

b. Agitation, hyperactivity, and grandiose

ideation

c. Emotional lability, euphoria, and

impaired memory

d. Suspiciousness, dilated pupils, and

increased blood pressure

21. The nurse is caring for a client diagnosed with

antisocial personality disorder. The client has a

history of fighting, cruelty to animals, and

stealing. Which of the following traits would the

nurse be most likely to uncover during

assessment?

a. History of gainful employment

b. Frequent expression of guilt regarding

antisocial behavior

c. Demonstrated ability to maintain close,

stable relationships

d. A low tolerance for frustration

22. Nurse Amy is providing care for a male client

undergoing opiate withdrawal. Opiate

withdrawal causes severe physical discomfort

and can be life-threatening. To minimize these

effects, opiate users are commonly detoxified

with:

a. Barbiturates

b. Amphetamines

c. Methadone

d. Benzodiazepines

23. Nurse Cristina is caring for a client who

experiences false sensory perceptions with no

basis in reality. These perceptions are known as:

a. Delusions

b. Hallucinations

c. Loose associations

d. Neologisms

24. Nurse Marco is developing a plan of care for a

client with anorexia nervosa. Which action

should the nurse include in the plan?

a. Restricts visits with the family and

friends until the client begins to eat.

b. Provide privacy during meals.

c. Set up a strict eating plan for the client.

d. Encourage the client to exercise, which

will reduce her anxiety.

25. Tim is admitted with a diagnosis of delusions of

grandeur. The nurse is aware that this diagnosis

reflects a belief that one is:

a. Highly important or famous.

b. Being persecuted

c. Connected to events unrelated to

oneself

d. Responsible for the evil in the world.

26. Nurse Jen is caring for a male client with manic

depression. The plan of care for a client in a

manic state would include:

a. Offering a high-calorie meals and

strongly encouraging the client to finish

all food.

b. Insisting that the client remain active

through the day so that he’ll sleep at

night.

c. Allowing the client to exhibit

hyperactive, demanding, manipulative

behavior without setting limits.

d. Listening attentively with a neutral

attitude and avoiding power struggles.

27. Ramon is admitted for detoxification after a

cocaine overdose. The client tells the nurse that

he frequently uses cocaine but that he can

control his use if he chooses. Which coping

mechanism is he using?

a. Withdrawal

b. Logical thinking

c. Repression

d. Denial

28. Richard is admitted with a diagnosis of

schizotypal personality disorder. hich signs

would this client exhibit during social situations?

a. Aggressive behavior

b. Paranoid thoughts

c. Emotional affect

d. Independence needs

29. Nurse Mickey is caring for a client diagnosed

with bulimia. The most appropriate initial goal

for a client diagnosed with bulimia is to:

a. Avoid shopping for large amounts of

food.

b. Control eating impulses.

c. Identify anxiety-causing situations

d. Eat only three meals per day.

30. Rudolf is admitted for an overdose of

amphetamines. When assessing the client, the

nurse should expect to see:

a. Tension and irritability

b. Slow pulse

c. Hypotension

d. Constipation

31. Nicolas is experiencing hallucinations tells the

nurse, “The voices are telling me I’m no good.”

The client asks if the nurse hears the voices. The

most appropriate response by the nurse would

be:

a. “It is the voice of your conscience, which

only you can control.”

b. “No, I do not hear your voices, but I

believe you can hear them”.

c. “The voices are coming from within you

and only you can hear them.”

d. “Oh, the voices are a symptom of your

illness; don’t pay any attention to them.”

32. The nurse is aware that the side effect of

electroconvulsive therapy that a client may

experience:

a. Loss of appetite

b. Postural hypotension

c. Confusion for a time after treatment

d. Complete loss of memory for a time

33. A dying male client gradually moves toward

resolution of feelings regarding impending

death. Basing care on the theory of Kubler-Ross,

Nurse Trish plans to use nonverbal interventions

when assessment reveals that the client is in the:

a. Anger stage

b. Denial stage

c. Bargaining stage

d. Acceptance stage

34. The outcome that is unrelated to a crisis state is:

a. Learning more constructive coping skills

b. Decompensation to a lower level of

functioning.

c. Adaptation and a return to a prior level

of functioning.

d. A higher level of anxiety continuing for

more than 3 months.

35. Miranda a psychiatric client is to be discharged

with orders for haloperidol (haldol) therapy.

When developing a teaching plan for discharge,

the nurse should include cautioning the client

against:

a. Driving at night

b. Staying in the sun

c. Ingesting wines and cheeses

d. Taking medications containing aspirin

36. Jen a nursing student is anxious about the

upcoming board examination but is able to study

intently and does not become distracted by a

roommate’s talking and loud music. The

student’s ability to ignore distractions and to

focus on studying demonstrates:

a. Mild-level anxiety

b. Panic-level anxiety

c. Severe-level anxiety

d. Moderate-level anxiety

37. When assessing a premorbid personality

characteristic of a client with a major

depression, it would be unusual for the nurse to

find that this client demonstrated:

a. Rigidity

b. Stubbornness

c. Diverse interest

d. Over meticulousness

38. Nurse Krina recognizes that the suicidal risk for

depressed client is greatest:

a. As their depression begins to improve

b. When their depression is most severe

c. Before any type of treatment is started

d. As they lose interest in the environment

39. Nurse Kate would expect that a client with

vascular dementis would experience:

a. Loss of remote memory related to

anoxia

b. Loss of abstract thinking related to

emotional state

c. Inability to concentrate related to

decreased stimuli

d. Disturbance in recalling recent events

related to cerebral hypoxia.

40. Josefina is to be discharged on a regimen of

lithium carbonate. In the teaching plan for

discharge the nurse should include:

a. Advising the client to watch the diet

carefully

b. Suggesting that the client take the pills

with milk

c. Reminding the client that a CBC must be

done once a month.

d. Encouraging the client to have blood

levels checked as ordered.

41. The psychiatrist orders lithium carbonate 600

mg p.o t.i.d for a female client. Nurse Katrina

would be aware that the teachings about the

side effects of this drug were understood when

the client state, “I will call my doctor

immediately if I notice any:

a. Sensitivity to bright light or sun

b. Fine hand tremors or slurred speech

c. Sexual dysfunction or breast

enlargement

d. Inability to urinate or difficulty when

urinating

42. Nurse Mylene recognizes that the most

important factor necessary for the establishment

of trust in a critical care area is:

a. Privacy

b. Respect

c. Empathy

d. Presence

43. When establishing an initial nurse-client

relationship, Nurse Hazel should explore with

the client the:

a. Client’s perception of the presenting

problem.

b. Occurrence of fantasies the client may

experience.

c. Details of any ritualistic acts carried out

by the client

d. Client’s feelings when external; controls

are instituted.

44. Tranylcypromine sulfate (Parnate) is prescribed

for a depressed client who has not responded to

the tricyclic antidepressants. After teaching the

client about the medication, Nurse Marian

evaluates that learning has occurred when the

client states, “I will avoid:

a. Citrus fruit, tuna, and yellow

vegetables.”

b. Chocolate milk, aged cheese, and

yogurt’”

c. Green leafy vegetables, chicken, and

milk.”

d. Whole grains, red meats, and

carbonated soda.”

45. Nurse John is a aware that most crisis situations

should resolve in about:

a. 1 to 2 weeks

b. 4 to 6 weeks

c. 4 to 6 months

d. 6 to 12 months

46. Nurse Judy knows that statistics show that in

adolescent suicide behavior:

a. Females use more dramatic methods

than males

b. Males account for more attempts than

do females

c. Females talk more about suicide before

attempting it

d. Males are more likely to use lethal

methods than are females

47. Dervid with paranoid schizophrenia repeatedly

uses profanity during an activity therapy session.

Which response by the nurse would be most

appropriate?

a. "Your behavior won't be tolerated. Go to

your room immediately."

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b. "You're just doing this to get back at me

for making you come to therapy."

c. "Your cursing is interrupting the activity.

Take time out in your room for 10

minutes."

d. "I'm disappointed in you. You can't

control yourself even for a few minutes."

48. Nurse Maureen knows that the nonantipsychotic

medication used to treat some clients with

schizoaffective disorder is:

a. phenelzine (Nardil)

b. chlordiazepoxide (Librium)

c. lithium carbonate (Lithane)

d. imipramine (Tofranil)

49. Which information is most important for the

nurse Trinity to include in a teaching plan for a

male schizophrenic client taking clozapine

(Clozaril)?

a. Monthly blood tests will be necessary.

b. Report a sore throat or fever to the

physician immediately.

c. Blood pressure must be monitored for

hypertension.

d. Stop the medication when symptoms

subside.

50. Ricky with chronic schizophrenia takes

neuroleptic medication is admitted to the

psychiatric unit. Nursing assessment reveals

rigidity, fever, hypertension, and diaphoresis.

These findings suggest which life- threatening

reaction:

a. Tardive dyskinesia.

b. Dystonia.

c. Neuroleptic malignant syndrome.

d. Akathisia.