TEST V - Care of Clients with Physiologic and Psychosocial Alterations part 2

TEST V - Care of Clients with Physiologic and Psychosocial Alterations part 2

51. Which nursing intervention would be most

appropriate if a male client develop orthostatic

hypotension while taking amitriptyline (Elavil)?

a. Consulting with the physician about

substituting a different type of

antidepressant.

b. Advising the client to sit up for 1 minute

before getting out of bed.

c. Instructing the client to double the

dosage until the problem resolves.

d. Informing the client that this adverse

reaction should disappear within 1

week.

52. Mr. Cruz 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 Tyfany suspects:

a. Cyclothymic disorder.

b. Atypical affective disorder.

c. Major depression.

d. Dysthymic disorder.

53. After taking an overdose of phenobarbital

(Barbita), Mario is admitted to the emergency

department. Dr. Trinidad prescribes activated

charcoal (Charcocaps) to be administered by

mouth immediately. Before administering the

dose, the nurse verifies the dosage ordered.

What is the usual minimum dose of activated

charcoal?

a. 5 g mixed in 250 ml of water

b. 15 g mixed in 500 ml of water

c. 30 g mixed in 250 ml of water

d. 60 g mixed in 500 ml of water

54. 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

55. Cely with manic episodes is taking lithium.

Which electrolyte level should the nurse check

before administering this medication?

a. Clcium

b. Sodium

c. Chloride

d. Potassium

56. Nurse Josefina is caring for a client who has been

diagnosed with delirium. Which statement about

delirium is true?

a. It's characterized by an acute onset and

lasts about 1 month.

b. It's characterized by a slowly evolving

onset and lasts about 1 week.

c. It's characterized by a slowly evolving

onset and lasts about 1 month.

d. It's characterized by an acute onset and

lasts hours to a number of days.

57. Edward, a 66 year old client with slight memory

impairment and poor concentration is diagnosed

with primary degenerative dementia of the

Alzheimer's type. Early signs of this dementia

include subtle personality changes and

withdrawal from social interactions. To assess

for progression to the middle stage of

Alzheimer's disease, the nurse should observe

the client for:

a. Occasional irritable outbursts.

b. Impaired communication.

c. Lack of spontaneity.

d. Inability to perform self-care activities.

58. Isabel with a diagnosis of depression is started

on imipramine (Tofranil), 75 mg by mouth at

bedtime. The nurse should tell the client that:

a. This medication may be habit forming

and will be discontinued as soon as the

client feels better.

b. This medication has no serious adverse

effects.

c. The client should avoid eating such

foods as aged cheeses, yogurt, and

chicken livers while taking the

medication.

d. This medication may initially cause

tiredness, which should become less

bothersome over time.

59. Kathleen is admitted to the psychiatric clinic for

treatment of anorexia nervosa. To promote the

client's physical health, the nurse should plan to:

a. Severely restrict the client's physical

activities.

b. Weigh the client daily, after the evening

meal.

c. Monitor vital signs, serum electrolyte

levels, and acid-base balance.

d. Instruct the client to keep an accurate

record of food and fluid intake.

60. Celia with a history of polysubstance abuse is

admitted to the facility. She complains of nausea

and vomiting 24 hours after admission. The

nurse assesses the client and notes piloerection,

pupillary dilation, and lacrimation. The nurse

suspects that the client is going through which of

the following withdrawals?

a. Alcohol withdrawal

b. Cannibis withdrawal

c. Cocaine withdrawal

d. Opioid withdrawal

61. Mr. Garcia, an attorney who throws books and

furniture around the office after losing a case is

referred to the psychiatric nurse in the law firm's

employee assistance program. Nurse Beatriz

knows that the client's behavior most likely

represents the use of which defense

mechanism?

a. Regression

b. Projection

c. Reaction-formation

d. Intellectualization

62. Nurse Anne is caring for a client who has been

treated long term with antipsychotic medication.

During the assessment, Nurse Anne checks the

client for tardive dyskinesia. If tardive dyskinesia

is present, Nurse Anne would most likely

observe:

a. Abnormal movements and involuntary

movements of the mouth, tongue, and

face.

b. Abnormal breathing through the nostrils

accompanied by a “thrill.”

c. Severe headache, flushing, tremors, and

ataxia.

d. Severe hypertension, migraine

headache,

63. Dennis has a lithium level of 2.4 mEq/L. The

nurse immediately would assess the client for

which of the following signs or symptoms?

a. Weakness

b. Diarrhea

c. Blurred vision

d. Fecal incontinence

64. Nurse Jannah is monitoring a male client who

has been placed inrestraints because of violent

behavior. Nurse determines that it will be safe to

remove the restraints when:

a. The client verbalizes the reasons for the

violent behavior.

b. The client apologizes and tells the nurse

that it will never happen again.

c. No acts of aggression have been

observed within 1 hour after the release

of two of the extremity restraints.

d. The administered medication has taken

effect.

65. Nurse Irish is aware that Ritalin is the drug of

choice for a child with ADHD. The side effects of

the following may be noted by the nurse:

a. Increased attention span and

concentration

b. Increase in appetite

c. Sleepiness and lethargy

d. Bradycardia and diarrhea

66. Kitty, a 9 year old child has very limited

vocabulary and interaction skills. She has an I.Q.

of 45. She is diagnosed to have Mental

retardation of this classification:

a. Profound

b. Mild

c. Moderate

d. Severe

67. The therapeutic approach in the care of Armand

an autistic child include the following EXCEPT:

a. Engage in diversionary activities when

acting -out

b. Provide an atmosphere of acceptance

c. Provide safety measures

d. Rearrange the environment to activate

the child

68. Jeremy is brought to the emergency room by

friends who state that he took something an

hour ago. He is actively hallucinating, agitated,

with irritated nasal septum.

a. Heroin

b. Cocaine

c. LSD

d. Marijuana

69. Nurse Pauline is aware that Dementia unlike

delirium is characterized by:

a. Slurred speech

b. Insidious onset

c. Clouding of consciousness

d. Sensory perceptual change

70. A 35 year old female has intense fear of riding an

elevator. She claims “ As if I will die inside.” The

client is suffering from:

a. Agoraphobia

b. Social phobia

c. Claustrophobia

d. Xenophobia

71. Nurse Myrna develops a counter-transference

reaction. This is evidenced by:

a. Revealing personal information to the

client

b. Focusing on the feelings of the client.

c. Confronting the client about

discrepancies in verbal or non-verbal

behavior

d. The client feels angry towards the nurse

who resembles his mother.

72. Tristan is on Lithium has suffered from diarrhea

and vomiting. What should the nurse in-charge

do first:

a. Recognize this as a drug interaction

b. Give the client Cogentin

c. Reassure the client that these are

common side effects of lithium therapy

d. Hold the next dose and obtain an order

for a stat serum lithium level

73. Nurse Sarah ensures a therapeutic environment

for all the client. Which of the following best

describes a therapeutic milieu?

a. A therapy that rewards adaptive

behavior

b. A cognitive approach to change behavior

c. A living, learning or working

environment.

d. A permissive and congenial environment

74. Anthony is very hostile toward one of the staff

for no apparent reason. He is manifesting:

a. Splitting

b. Transference

c. Countertransference

d. Resistance

75. Marielle, 17 years old was sexually attacked

while on her way home from school. She is

brought to the hospital by her mother. Rape is

an example of which type of crisis:

a. Situational

b. Adventitious

c. Developmental

d. Internal

76. Nurse Greta is aware that the following is

classified as an Axis I disorder by the Diagnosis

and Statistical Manual of Mental Disorders, Text

Revision (DSM-IV-TR) is:

a. Obesity

b. Borderline personality disorder

c. Major depression

d. Hypertension

77. Katrina, a newly admitted is extremely hostile

toward a staff member she has just met, without

apparent reason. According to Freudian theory,

the nurse should suspect that the client is

experiencing which of the following

phenomena?

a. Intellectualization

b. Transference

c. Triangulation

d. Splitting

78. An 83year-old male client is in extended care

facility is anxious most of the time and

frequently complains of a number of vague

symptoms that interfere with his ability to eat.

These symptoms indicate which of the following

disorders?

a. Conversion disorder

b. Hypochondriasis

c. Severe anxiety

d. Sublimation

79. Charina, a college student who frequently visited

the health center during the past year with

multiple vague complaints of GI symptoms

before course examinations. Although physical

causes have been eliminated, the student

continues to express her belief that she has a

serious illness. These symptoms are typically of

which of the following disorders?

a. Conversion disorder

b. Depersonalization

c. Hypochondriasis

d. Somatization disorder

80. Nurse Daisy is aware that the following

pharmacologic agents are sedative- hypnotic

medication is used to induce sleep for a client

experiencing a sleep disorder is:

a. Triazolam (Halcion)

b. Paroxetine (Paxil)\

c. Fluoxetine (Prozac)

d. Risperidone (Risperdal)

81. Aldo, with a somatoform pain disorder may

obtain secondary gain. Which of the following

statement refers to a secondary gain?

a. It brings some stability to the family

b. It decreases the preoccupation with the

physical illness

c. It enables the client to avoid some

unpleasant activity

d. It promotes emotional support or

attention for the client

82. Dervid is diagnosed with panic disorder with

agoraphobia is talking with the nurse in-charge

about the progress made in treatment. Which of

the following statements indicates a positive

client response?

a. “I went to the mall with my friends last

Saturday”

b. “I’m hyperventilating only when I have a

panic attack”

c. “Today I decided that I can stop taking

my medication”

d. “Last night I decided to eat more than a

bowl of cereal”

83. The effectiveness of monoamine oxidase (MAO)

inhibitor drug therapy in a client with

posttraumatic stress disorder can be

demonstrated by which of the following client

self –reports?

a. “I’m sleeping better and don’t have

nightmares”

b. “I’m not losing my temper as much”

c. “I’ve lost my craving for alcohol”

d. I’ve lost my phobia for water”

84. Mark, with a diagnosis of generalized anxiety

disorder wants to stop taking his lorazepam

(Ativan). Which of the following important facts

should nurse Betty discuss with the client about

discontinuing the medication?

a. Stopping the drug may cause depression

b. Stopping the drug increases cognitive

abilities

c. Stopping the drug decreases sleeping

difficulties

d. Stopping the drug can cause withdrawal

symptoms

85. Jennifer, an adolescent who is depressed and

reported by his parents as having difficulty in

school is brought to the community mental

health center to be evaluated. Which of the

following other health problems would the nurse

suspect?

a. Anxiety disorder

b. Behavioral difficulties

c. Cognitive impairment

d. Labile moods

86. Ricardo, an outpatient in psychiatric facility is

diagnosed with dysthymic disorder. Which of the

following statement about dysthymic disorder is

true?

a. It involves a mood range from moderate

depression to hypomania

b. It involves a single manic depression

c. It’s a form of depression that occurs in

the fall and winter

d. It’s a mood disorder similar to major

depression but of mild to moderate

severity

87. The nurse is aware that the following ways in

vascular dementia different from Alzheimer’s

disease is:

a. Vascular dementia has more abrupt

onset

b. The duration of vascular dementia is

usually brief

c. Personality change is common in

vascular dementia

d. The inability to perform motor activities

occurs in vascular dementia

88. Loretta, a newly admitted client was diagnosed

with delirium and has history of hypertension

and anxiety. She had been taking digoxin,

furosemide (Lasix), and diazepam (Valium) for

anxiety. This client’s impairment may be related

to which of the following conditions?

a. Infection

b. Metabolic acidosis

c. Drug intoxication

d. Hepatic encephalopathy

89. Nurse Ron enters a client’s room, the client says,

“They’re crawling on my sheets! Get them off

my bed!” Which of the following assessment is

the most accurate?

a. The client is experiencing aphasia

b. The client is experiencing dysarthria

c. The client is experiencing a flight of ideas

d. The client is experiencing visual

hallucination

90. Which of the following descriptions of a client’s

experience and behavior can be assessed as an

illusion?

a. The client tries to hit the nurse when

vital signs must be taken

b. The client says, “I keep hearing a voice

telling me to run away”

c. The client becomes anxious whenever

the nurse leaves the bedside

d. The client looks at the shadow on a wall

and tells the nurse she sees frightening

faces on the wall.

91. During conversation of Nurse John with a client,

he observes that the client shift from one topic

to the next on a regular basis. Which of the

following terms describes this disorder?

a. Flight of ideas

b. Concrete thinking

c. Ideas of reference

d. Loose association

92. Francis tells the nurse that her coworkers are

sabotaging the computer. When the nurse asks

questions, the client becomes argumentative.

This behavior shows personality traits associated

with which of the following personality disorder?

a. Antisocial

b. Histrionic

c. Paranoid

d. Schizotypal

93. Which of the following interventions is

important for a Cely experiencing with paranoid

personality disorder taking olanzapine

(Zyprexa)?

a. Explain effects of serotonin syndrome

b. Teach the client to watch for

extrapyramidal adverse reaction

c. Explain that the drug is less affective if

the client smokes

d. Discuss the need to report paradoxical

effects such as euphoria

94. Nurse Alexandra notices other clients on the unit

avoiding a client diagnosed with antisocial

personality disorder. When discussing

appropriate behavior in group therapy, which of

the following comments is expected about this

client by his peers?

a. Lack of honesty

b. Belief in superstition

c. Show of temper tantrums

d. Constant need for attention

95. Tommy, with dependent personality disorder is

working to increase his self- esteem. Which of

the following statements by the Tommy shows

teaching was successful?

a. “I’m not going to look just at the

negative things about myself”

b. “I’m most concerned about my level of

competence and progress”

c. “I’m not as envious of the things other

people have as I used to be”

d. “I find I can’t stop myself from taking

over things other should be doing”

96. Norma, a 42-year-old client with a diagnosis of

chronic undifferentiated schizophrenia lives in a

rooming house that has a weekly nursing clinic.

She scratches while she tells the nurse she feels

creatures eating away at her skin. Which of the

following interventions should be done first?

a. Talk about his hallucinations and fears

b. Refer him for anticholinergic adverse

reactions

c. Assess for possible physical problems

such as rash

d. Call his physician to get his medication

increased to control his psychosis

97. Ivy, who is on the psychiatric unit is copying and

imitating the movements of her primary nurse.

During recovery, she says, “I thought the nurse

was my mirror. I felt connected only when I saw

my nurse.” This behavior is known by which of

the following terms?

a. Modeling

b. Echopraxia

c. Ego-syntonicity

d. Ritualism

98. Jun approaches the nurse and tells that he hears

a voice telling him that he’s evil and deserves to

die. Which of the following terms describes the

client’s perception?

a. Delusion

b. Disorganized speech

c. Hallucination

d. Idea of reference

99. Mike is admitted to a psychiatric unit with a

diagnosis of undifferentiated schizophrenia.

Which of the following defense mechanisms is

probably used by mike?

a. Projection

b. Rationalization

c. Regression

d. Repression

100. Rocky has started taking haloperidol (Haldol).

Which of the following instructions is most

appropriate for Ricky before taking

haloperidol?

a. Should report feelings of restlessness or

agitation at once

b. Use a sunscreen outdoors on a yearround

basis

c. Be aware you’ll feel increased energy

taking this drug

d. This drug will indirectly control essential

hypertension