Psychiatric Nursing NCLEX Review Part 2

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

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