1. Which nursing intervention is best for facilitating communication with a psychiatric client who speaks a foreign language?

a. Rely on nonverbal communication.

b. Select symbolic pictures as aids.

c. Speak in universal phrases.

d. Use the services of an interpreter.

2. The nurse explains to a mental health care technician that a client’s obsessive-compulsive behaviors are related to unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement?

a. Behavioral theory

b. Cognitive theory

c. Interpersonal theory

d. Psychoanalytic theory

3. The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety?

a. “I guess you’re worried about something, aren’t you?

b. “Can I get you some medication to help calm you?”

c. “Have you been pacing for a long time?”

d. “I notice that you’re pacing. How are you feeling?”

4. A client with obsessive-compulsive disorder is hospitalized on an inpatient unit. Which nursing response is most therapeutic?

a. Accepting the client’s obsessive-compulsive behaviors

b. Challenging the client’s obsessive-compulsive behaviors

c. Preventing the client’s obsessive-compulsive behaviors

d. Rejecting the client’s obsessive-compulsive behaviors

5. A 45-year-old woman with a history of depression tells a nurse in her doctor’s office that she has difficulty with sexual arousal and is fearful that her husband will have an affair. Which of the following factors would the nurse identify as least significant in contributing to the client’s sexual difficulty?

a. Education and work history

b. Medication used

c. Physical health status

d. Quality of spousal relationship

6. Which nursing intervention is most appropriate for a client with anorexia nervosa during initial hospitalization on a behavioral therapy unit?

a. Emphasize the importance of good nutrition to establish normal weight.

b. Ignore the client’s mealtime behavior and focus instead on issues of dependence and independence.

c. Help establish a plan using privileges and restrictions based on compliance with refeeding.

d. Teach the client information about the long-term physical consequence of anorexia.

7. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful?

a. The parents reinforce increased decision making by the client.

b. The parents clearly verbalize their expectations for the client.

c. The client verbalizes that family meals are now enjoyable.

d. The client tells her parents about feelings of low-self-esteem.

8. The nurse is working with a client with a somatoform disorder. Which client outcome goal would the nurse most likely establish in this situation?

a. The client will recognize signs and symptoms of physical illness.

b. The client will cope with physical illness.

c. The client will take prescribed medications.

d. The client will express anxiety verbally rather than through physical symptoms.

9. Which method would a nurse use to determine a client’s potential risk for suicide?

a. Wait for the client to bring up the subject of suicide.

b. Observe the client’s behavior for cues of suicide ideation.

c. Question the client directly about suicidal thoughts.

d. Question the client about future plans.

10. A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed thought processes related to difficulty concentrating, secondary to flight of ideas. Which of the following outcome criteria would indicate improvement in the client?

a. The client verbalizes feelings directly during treatment.

b. The client verbalizes positive “self” statement.

c. The client speaks in coherent sentences.

d. The client reports feelings calmer.

11. A client tells a nurse. “Everyone would be better off if I wasn’t alive.” Which nursing diagnosis would be made based on this statement?

a. Disturbed thought processes

b. Ineffective coping

c. Risk for self-directed violence

d. Impaired social interaction

12. Which information is most essential in the initial teaching session for the family of a young adult recently diagnosed with schizophrenia?

a. Symptoms of this disease imbalance in the brain.

b. Genetic history is an important factor related to the development of schizophrenia.

c. Schizophrenia is a serious disease affecting every aspect of a person’s functioning.

d. The distressing symptoms of this disorder can respond to treatment with medications.

13. A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes related to the client’s delusional perceptions would the nurse establish?

a. The client will demonstrate realistic interpretation of daily events in the unit.

b. The client will perform daily hygiene and grooming without assistance.

c. The client will take prescribed medications without difficulty.

d. The client will participate in unit activities.

14. A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command hallucinations. Which of the following is the priority nursing diagnosis?

a. Anxiety

b. Impaired social interaction

c. Disturbed sensory-perceptual alteration (auditory)

d. Risk for other-directed violence

15. A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his stressful marriage and difficult job. Which defense mechanisms is this client using?

a. Displacement

b. Projection

c. Rationalization

d. Sublimation

16. An 11-year-old child diagnosed with conduct disorder is admitted to the psychiatric unit for treatment. Which of the following behaviors would the nurse assess?

a. Restlessness, short attention span, hyperactivity

b. Physical aggressiveness, low stress tolerance disregard for the rights of others

c. Deterioration in social functioning, excessive anxiety and worry, bizarre behavior

d. Sadness, poor appetite and sleeplessness, loss of interest in activities

17. The nurse understands that if a client continues to be dependent on heroin throughout her pregnancy, her baby will be at high risk for:

a. Mental retardation.

b. Heroin dependence.

c. Addiction in adulthood.

d. Psychological disturbances.

18. The emergency department nurse is assigned to provide care for a victim of a sexual assault. When following legal and agency guidelines, which intervention is most important?

a. Determine the assailant’s identity.

b. Preserve the client’s privacy.

c. Identify the extent of injury.

d. Ensure an unbroken chain of evidence.

19. Which factor is least important in the decision regarding whether a victim of family violence can safely remain in the home?

a. The availability of appropriate community shelters

b. The nonabusing caretaker’s ability to intervene on the client’s behalf

c. The client’s possible response to relocation

d. The family’s socioeconomic status

20. The nurse would expect a client with early Alzheimer’s disease to have problems with:

a. Balancing a checkbook.

b. Self-care measures.

c. Relating to family members.

d. Remembering his own name

21. Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has frequent episodes emotional lability?

a. Attempt humor to alter the client mood.

b. Explore reasons for the client’s altered mood.

c. Reduce environmental stimuli to redirect the client’s attention.

d. Use logic to point out reality aspects.

22. Which neurotransmitter has been implicated in the development of Alzheimer’s disease?

a. Acetylcholine

b. Dopamine

c. Epinephrine

d. Serotonin

23. Which factors are most essential for the nurse to assess when providing crisis intervention foe a client?

a. The client’s communication and coping skills

b. The client’s anxiety level and ability to express feelings

c. The client’s perception of the triggering event and availability of situational supports

d. The client’s use of reality testing and level of depression

24. The nurse considers a client’s response to crisis intervention successful if the client:

a. Changes coping skills and behavioral patterns.

b. Develops insight into reasons why the crisis occurred.

c. Learns to relate better to others.

d. Returns to his previous level of functioning.

25. Two nurses are co-leading group therapy for seven clients in the psychiatric unit. The leaders observe that the group members are anxious and look to the leaders for answers. Which phase of development is this group in?

a. Conflict resolution phase

b. Initiation phase

c. Working phase

d. Termination phase

26. Group members have worked very hard, and the nurse reminds them that termination is approaching. Termination is considered successful if group members:

a. Decide to continue.

b. Elevate group progress

c. Focus on positive experience

d. Stop attending prior to termination.

27. The nurse is teaching a group of clients about the mood-stabilizing medications lithium carbonate. Which medications should she instruct the clients to avoid because of the increased risk of lithium toxicity?

a. Antacids

b. Antibiotics

c. Diuretics

d. Hypoglycemic agents

28. When providing family therapy, the nurse analyzes the functioning of healthy family systems. Which situations would not increase stress on a healthy family system?

a. An adolescent’s going away to college

b. The birth of a child

c. The death of a grandparent

d. Parental disagreement

29. A client taking the monoamine oxidase inhibitor (MAOI) antidepressant isocarboxazid (Marplan) is instructed by the nurse to avoid which foods and beverages?

a. Aged cheese and red wine

b. Milk and green, leaf vegetables

c. Carbonated beverages and tomato products

d. Lean red meats and fruit juices

30. Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurse should:

a. Assess skin color and sclera

b. Assess the radial pulse

c. Take the client’s blood pressure

d. Ask the client to void

31. The nurse understands that electroconvulsive therapy is primary used in psychiatric care for the treatment of:

a. Anxiety disorders.

b. Depression.

c. Mania.

d. Schizophrenia.

32. A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the medications listed below. Which medication would cause the nurse to express concern and therefore initiate further teaching?

a. Acetaminophen (Tylenol)

b. Diphenhydramine (Benadryl)

c. Furosemide (Lasix)

d. Isosorbide dinitrate (Isordil)

33. The nurse is administering a psychotropic drug to an elderly client who has history of benign prostatic hypertrophy. It is most important for the nurse to teach this client to:

a. Add fiber to his diet.

b. Exercise on a regular basis.

c. Report incomplete bladder emptying

d. Take the prescribed dose at bedtime.

34. The nurse correctly teaches a client taking the benzodiazepine oxazepam (Serax) to avoid excessive intake of:

a. Cheese

b. Coffee

c. Sugar

d. Shellfish

35. The nurse provides a referral to Alcoholics Anonymous to a client who describes a 20-year history of alcohol abuse. The primary function of this group is to:

a. Encourage the use of a 12-step program.

b. Help members maintain sobriety.

c. Provide fellowship among members.

d. Teach positive coping mechanisms.

36. Which client outcome is most appropriately achieved in a community approach setting in psychiatric nursing?

a. The client performs activities of daily living and learns about crafts.

b. The client’s is able to prevent aggressive behavior and monitors his use of medications.

c. The client demonstrates self-reliance and social adaptation.

d. The client experience experiences anxiety relief and learns about his symptoms.

37. A client with panic disorder experiences an acute attack while the nurse is completing an admission assessment. List the following interventions according to their level of priority.

a. Remain with the client.

b. Encourage physical activity.

c. Encourage low, deep breathing.

d. Reduce external stimuli.

e. Teach coping measures.

38. The doctor has prescribed haloperidol (Haldol) 2.5 mg. I.M. for an agitated client. The medication is labeled haloperidol 10 mg/2 ml. The nurse prepares the correct dose by drawing up how many milliliters in the syringe?

a. 0.3

b. 0.4

c. 0.5

d. 0.6

39. The nurse enters the room of a client with a cognitive impairment disorder and asks what day of the week it is: what the date, month, and year are; and where the client is. The nurse is attempting to assess:

a. Confabulation

b. Delirium

c. Orientation

d. Perseveration

40. Which of the following will the nurse use when communicating with a client who has a cognitive impairment?

a. Complete explanations with multiple details

b. Picture or gestures instead of words

c. Stimulating words and phrases to capture the client’s attention

d. Short words and simple sentences

41. A 75-year-old client has dementia of the Alzheimer’s type and confabulates. The nurse understands that this client:

a. Denies confusion by being jovial.

b. Pretends to be someone else.

c. Rationalizes various behaviors.

d. Fills in memory gaps with fantasy.

42. An elderly client with Alzheimer’s disease becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to:

a. Tell the client family that it is time to get dressed.

b. Obtain assistance to restrain the client for safety.

c. Remain calm and talk quietly to the client.

d. Call the doctor and request an order for sedation.

43. In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called:

a. Aphasia

b. Agnosia

c. Sundowning

d. Confabulation

44. Which of the following outcome criteria is appropriate for the client with dementia?

a. The client will return to an adequate level of self-functioning.

b. The client will learn new coping mechanisms to handle anxiety.

c. The client will seek out resources in the community for support.

d. The client will follow an establishing schedule for activities of daily living.

45. The school guidance counselor refers a family with an 8-year-old child to the mental health clinic because of the child’s frequent fighting in school and truancy. Which of the following data would be a priority to the nurse doing the initial family assessment?

a. The child’s performance in school

b. Family education and work history

c. The family’s perception of the current problem

d. The teacher’s attempts to solve the problem

46. The parents of a young man with schizophrenia express feelings of responsibility and guilt for their son’s problems. How can the nurse best educate the family?

a. Acknowledge the parent’s responsibility.

b. Explain the biological nature of schizophrenia.

c. Refer the family to a support group

d. Teach the parents various ways they must change.

47. The nurse collecting family assessment data asks. “Who is in your family and where do they live?” which of the following is the nurse attempting o identify?

a. Boundaries

b. Ethnicity

c. Relationships

d. Triangles

48. According to the family systems theory, which of the following best describes the process of differentiation?

a. Cooperative action among members of the family

b. Development of autonomy within the family

c. Incongruent massages wherein the recipient is a victim

d. Maintenance of system continuity or equilibrium

49. The nurse is interacting with a family consisting of a mother, a father, and a hospitalized adolescent who has a diagnosis of alcohol abuse. The nurse analyzes the situation and agrees with the adolescent’s view about family rules. Which intervention is most appropriate?

a. The nurse should align with the adolescent, who is the family scapegoat.

b. The nurse should encourage the parents to adopt more realistic rules.

c. The nurse should encourage the adolescent to comply with parental rules.

d. The nurse should remain objective and encourage mutual negotiation of issues.

50. A 16-year-old girl has retuned home following hospitalization for treatment of anorexia nervosa. The parents tell the family nurse performing a home visit that their child has always done everything to please them and they cannot understand her current stubbornness about eating. The nurse analyzes the family situation and determines it is characteristic of which relationship style?

a. Differentiation

b. Disengagement

c. Enmeshment

d. Scapegoating

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