Yboa and Sabio Reviewer a.

Low self-esteem
b. Assertiveness
1. An 18-year old college student, Glady's has lost 35 lbs. for five c. Hostility
weeks. Her parents brought her to take hospital for medical d. Impulsiveness
evaluation. The working diagnosis: Anorexia nervosa. Upon
admission, Gladys says to the nurse, "Why am I here. I am not sick. I 5. An effective nursing intervention the nurse can carry out is:
don't have any health problem." This statement exemplifies a
common defense mechanism used by anorectic client known as one a. Telling you she will report to the physician if she does not
of the following b. Allow her time to eat
a. Ethnic background
a. Conversion
b. Life experiences
b. Denial
c. Regression
6. A community health nurse is preparing a lecture on crisis
d. Suppression
intervention to be given in a gathering of health workers in a
community. In the assessment of a person in crisis, which one of the
2. A behavior modification program is to be carried out for Gladys. An
following information is most important?
appropriate nursing intervention would be one of the following:
a. Ethnic background
a. Help her to accept that she has problematic
b. Life experiences
b. Involve her in any dietary planning to solve her
c. Socio-economic level
c. Allow her to express her feelings and concerns
d. Educational background
d. Give positive rewards for gradual weight gain
7. Which of the following statements is TRUE of crisis intervention?
3. In caring for client with anorexia nervosa, the appropriate attitudes
of the nurse is one of the
a. Focuses on identifying the stressors in the client's life
following:
b. Help the client develop problem solving skills
c. Focusing on the coping mechanism which was used by the client
a. Consistency and friendliness
d. All persons experiencing crisis present similar
b. Accepting and non-judgmental
c. Firm and directive
8. Which of the following best describes a crisis state which will help
d. Non-confrontational and accepting
the nurse develop a plan of care for the client?
4. Clients with anorexia nervosa usually manifest one of the following
a. A crisis state may indicate that the client is suffering from
behaviors:
emotional disturbance
b. A crisis state is a good indicator that the client is suffering from a a. Turning on the television
mental illness b. Leaving the client alone
c. A person responds to crisis differently c. Staying with client and speak in short sentences
d. All persons experiencing crisis present similar d. Ask the client to play with other clients

9. Which of the following is the first step in crisis intervention? 13. Nurse Claire is caring for a client diagnosed with bulimia! The
most appropriate initial goal for a client diagnosed with bulimia is?
a. Encourage client to use adaptive mechanism
b. Identify stress producing situations for the client a. Encourage to avoid foods
c. Initial referral to relevant community resources which can help the b. Identity anxiety causing situations
client c. Eat only three meals a day
d. Assessment of the situation thoroughly d. Avoid shopping plenty of groceries

10. Which of the following statements describe crisis: 14. To establish open and trusting relationship with a female client
who has been hospitalized nurse in charge should?
a. Feeling of apprehension to anticipation of external threat or danger
b. Internal disturbance that results from a stressful event a. Encourage the staff to have frequent interaction with the client
c. Unpleasant feeling of discomfort due to consciously recognized and b. Share an activity with the client
realistic danger c. Give client feedback about behavior
d. State of intense anxiety due to stressful event. d. Respect client’s need for personal space

15. Linda is pacing the floor and appears extremely anxious. The duty
11. Nurse Maureen is developing a plan of care for a female client nurse approaches in an attempt to alleviate Linda's anxiety. The most
with anorexia nervosa. Which action should the nurse include in the therapeutic question by the nurse would be?
plan?
a. Would you like to watch TV?
a. Provide privacy during meals b. Would you like me to talk with you?
b. Set-up strict eating plan for the client c. Are feeling upset now?
c. Encourage client to exercise to reduce anxiety d. Ignore the client
d. Restrict visits with the family
16. Nurse Penny is aware that the symptoms that distinguish post-
12. A client is experiencing anxiety attack. The most appropriate traumatic stress disorder from other anxiety disorder would be:
nursing intervention should include?
A. Avoidance of situation & certain activities that resemble the stress
B. Depression and a blunted affect when discussing the traumatic distracted by a roommate's talking and loud music. The student's
situation ability to ignore distractions and to focus on studying demonstrates:
C. Lack of interest in family & others
D. Re-experiencing the trauma in dreams or flashback a. Mild-level anxiety
b. Panic-level anxiety
17. A characteristic that would suggest to Nurse Anne that an c. Severe-level anxiety
adolescent may have bulimia would be d. Moderate-level anxiety
21. Anxiety is
a. Frequent regurgitation & re-swallowing of food s a. An abnormal response to everyday stress
b. Previous history of gastritis b. A sense of psychological distress
c. Badly stained teeth c. A physiological response to stress
d. Positive body image e. A normal response to everyday stress

18. When planning the discharge of a client with chronic anxiety. 22. Mild levels of Anxiety result in
Nurse Chris evaluates achievement of the discharge maintenance
goals. Which goal would be most appropriately having been included a. A heightened sense of awareness
in the plan of care requiring evaluation? b. Distorted sensory awareness
c. Mild forgetfulness
A. The client eliminates all anxiety from daily situation d. Impaired ability to concentrate
b. The client ignores feelings of anxiety
c. The client identifies anxiety producing situations 23. Generalized anxiety disorder is characterized by
d. The client maintains contact with a crisis counselor
a. Excessive worry or anxiety lasting more than 6 months
19. Nurse Cardo is caring for a client diagnosed with bulimia. The b. Flashbacks and feelings of unreality
most appropriate initial goal for a client diagnosed with bulimia is to: c. Fear of going outdoors
d. Repetitive, ritualized behavior
a. Avoid shopping for large amounts of food.
b. Control eating 24. A Client comes to the mental health clinic saying she has been “on
c. Identify anxiety-causing situations edge” lately. She states she has been preoccupied with work, is
d. Eat only three meals per day making mistakes because she can’t concentrate, and is forgetting
important meetings. She says she thinks she’s going crazy. These
20. Lovie a nursing student is anxious about the upcoming board symptoms of anxiety are
examination but is able to study intently and does not become
a. affective
b. physiologic c. “You will be gradually exposed to the object you fear until you
c. cognitive become desensitized to it”
d. behavior d. “You will be taught a problem-solving technique that will help you
manage everyday stress, which is contributing to your phobic
25. A client with generalized anxiety disorders states she is worried response”
about her finances. She has substantial savings that are managed by
reputable financial company. She says she is afraid the company will 28. A nurse is developing a care plan for a female client with post-
go bankrupt and she will lose her money. Which response by the traumatic stress disorder. Which of the following would she do
nurse is most therapeutic? initially?

a. “It’s sounds to me like you have managed your money responsibly” A. Instruct the client to use distraction techniques to cope with
b “Your money is insured; there is no need to worry” flashbacks.
c. “Has something changed that is causing you to worry” B. Encourage the client to put the past in proper perspective.
d. “Why do you think the company will go bankrupt?” C. Encourage the client to verbalize thoughts and feelings about the
trauma.
26. A 40- year old man with a history of panic attacks complains that D. Avoid discussing the traumatic event with the client.
his attacks are becoming more frequent. He is a good and health and
exercises regularly. He states he occasionally drinks wine with dinner. 29. The psychiatric nurse uses cognitive-behavioral techniques when
Which of the following interventions should the nurse discussed with working with a client who experiences panic attacks. Which of the
the client? following techniques are common to this theoretical framework?
(Select all that apply.)
a. Desensitization
b. Lifestyle challenges A. Administering anti-anxiety medication as prescribed
c. Problem-solving strategies B. Encouraging the client to restructure thoughts
d. Controlled breathing techniques C. Helping the client to use controlled relaxation breathing
D. Helping the client examine evidence of stressors
27. A nurse is discussing treatment options with client has intense E. Questioning the client about early childhood relationships
fear of snakes. The nurse correctly describes the treatment approach F. Teaching the client about anxiety and panic
when she makes which of the following?
30. Marty is pacing and complains of racing thoughts. Nurse Lally asks
a. “You will meet weekly with a psychiatrist who will discuss the client if something upsetting happened, and Marty's response is
childhood issues with you” vague and not focused on the question. Nurse Lally assess Marty's
b. “You will be treated with medications; antidepressants that affect level of anxiety as:
serotonin levels are the treatment of choice for phobias”
a. mild. a. Avoided until the anxiety is gone
b. moderate. b. Open ended
c. severe. c. Postponed until the client volunteer information
d. panic d. Specific and Direct

31. Mandy, a nurse who works at Nurseslabs Rehabilitation Center is 35. During the assessment, the client tells the nurse that she cannot
assessing a client for recent stressful life events. She recognizes that stop worrying about her appearance and
stressful life events are both: that she often removes "old" makeup and applies fresh makeup every
hour or two throughout the day. The nurse identifies this behavior as
a. desirable and growth-promoting. indicative of a
b. positive and negative.
c. undesirable and harmful. a. Acute stress disorder
d. predictable and controllable. b. Generalized anxiety disorder
c. Panic disorder
32. During a community visit, volunteer nurses teach stress d. Obsessive-compulsive disorder
management to the participants. The nurses will most likely advocate
which belief as a method of coping with stressful life events? 36. The best goal for a client learning a relaxation technique is that
the client will
a. Avoidance of stress is an important goal for living.
b. Control over one's response to stress is possible. a. Confront the source of anxiety directly
c. Most people have no control over their level of stress. b. Experience anxiety without feeling overwhelmed
d. Significant others are important to provide care and concern. c. Report no episodes of anxiety
d. Suppress anxious thoughts
33. Genevieve only attends social events when a family member is
also present. She exhibits behavior typical of which anxiety disorder? 37. The nurse observes a client who is becoming increasingly upset.
He is rapidly pacing, hyperventilating, clenching his jaw, wringing his
a. Agoraphobia hands, and trembling. His speech is high pitched and random; he
b. Generalized Anxiety disorder seems preoccupied with his thoughts. He is pounding his fist into his
c. Obsessive Compulsive behavior other hand. The nurse identifies his anxiety level as
d. Post-traumatic stress disorder
a. Mild
34. When assessing a client with anxiety, the nurse’s questions should b. Moderate
be: c. Severe
d. Panic
38. Mr. Bartowski who is newly diagnosed with rheumatoid arthritis 41. An adolescent entering high school voices anxiety over changing schools.
asks the community nurse how stress can affect his disease. The Stating anxiety is an act of
nurse would explain that:
a) Valuation
A, the psychological experience of stress will not affect symptoms of b) Adaptation
physical disease. c) Evaluation
B. psychological stress can cause painful emotions, which are harmful 42. You are the nurse caring for a 72-year-old female who is recovering from
to a person with an illness. abdominal surgery on the Medical Surgical unit. The surgery was very
C, stress can overburden the body's immune system, and therefore stressful and prolonged and you note on the chart that her blood sugars are
one can experience increased symptoms. elevated yet she in not been diagnosed with diabetes. To what do you
D. the body's stress response is stimulated when there are major attribute this elevation in blood sugars?
disruptions in one's life.
a) It is a result of antidiuretic hormone.
39. David is preoccupied with numerous bodily complaints even after a
b) She must have had diabetes prior to surgery.
careful diagnostic workup reveals no physiologic problems. Which nursing
c) She has become a diabetic from the abdominal surgery.
intervention would be therapeutic for him?
d) The blood sugars are probably a result of the "fight-or-flight" reaction

A. Acknowledge that the complaints are real to the client, and refocus the
43. You walk into your patients' room and find her sobbing uncontrollably.
client on other concerns and problems.
When you ask what the problem is your patient responds "I am so scared. I
B. Challenge the physical complaints by confronting the client with the
have never known anyone who goes into a hospital and comes out alive."
normal diagnostic findings.
On this patient's care plan you note a nursing diagnosis of "Ineffective
C. Ignore the client's complaints, but request that the client keep a list of all
coping related to stress". What is the best outcome you can expect for this
symptoms.
patient?
D. Listen to the client's complaints carefully, and question him about specific
symptoms.
a) Patient will avoid stressful situations.
40. A middle-aged woman's father has passed away, and her mother b) Patient will start anti-anxiety agent.
requires physical and emotional help due to disabilities. The woman is c) Patient will adapt relaxation techniques to reduce stress.
married and raising two children, along with working full time. All of the d) Patient will be stress free.
factors described are
44. A nurse is caring for a client who is grieving the loss of a spouse. The
nurse understands that grief is a combination of various factors including all
a) Stressors
except:
b) Demands
c) Illnesses
a. Moral
d) Stimuli
b. Psychological
c. Biological 2. Involve the client in occupational therapy and use diversional activity
d. Behavioral 3. Delay one-to-one interactions until medications reduce psychiatric
symptoms
4. Involve the client in multiple small-group discussions to distract attention
45. A nurse is conducting a grief and loss assessment interview and from the fantasy world
understands that the current loss, the history of previous losses, and
lifestyle are all a part of this assessment. What question will the nurse ask 49. The statement that best describes the practice of psychiatric nursing is:
the client to assess the current loss?
a. Helps people with present or potential mental health problems
a. "Do you drink on a regular basis?" b. Ensures clients' legal and ethical rights by acting as a client advocate
b. "Are you having trouble carrying on with your normal activities?" c. Focuses interpersonal skills on people with physical or emotional
c. "What types of coping mechanisms have you employed to work through problems
your grief? d. Acts in a therapeutic way with people who are diagnosed as having a
d. "Do you have an active support system?" mental disorder

46. The concept system for classifying and diagnosing mental disorders was 50. A nurse asks the supervisor, “What coping strategy could I develop to
established by the prevent over-responding to stress in the future?” The supervisor could best
respond
a. American Nurses Association

b. Professional Regulation Commission a. Monitor your problem solving skills

b. Improve your time management skills
c. American Psychiatric Association c. Ignore situations that you can change
d. Develop a wide variety of coping strategies
d. American Mental Health Association

47. A client is admitted for surgery. Although not physically distressed, the 51. Which of the four classes of medications used for panic disorder
client appears apprehensive and withdrawn. What is the nurse's best is considered the safest because of low incidence of side effects and
action? lack of physiological dependence?

1. Orient the client to the unit environment. a. Benzodiazepines

2. Have a copy of hospital regulations available. b. Tricyclics
3. Explain that there is no reason to be concerned. c. Monoamine oxidase inhibitors
4. Reassure the client that the staff is available to answer questions. d. SSRIs

48. An acutely ill client with the diagnosis of schizophrenia has just been
52. . Which would be the best intervention for a client having a panic
admitted to the mental health unit. When working with this client initially,
the nurse's most therapeutic action should be to:
attack?

1. Spend time with the client to build trust and demonstrate acceptance a. Involve the client in a physical activity
b. Offer a distraction such as music d. narrowed perceptual field.
c. Remain with the client e. selective attention.
d. Teach the client a relaxation technique f. inability to connect thoughts independently.

53. A client with GAD states, “I have learned that the best thing I can 57. The nurse observes that a client with bipolar disorder is pacing in
do is to forget my worries. “How would the nurse evaluate this the hall, talking loudly and rapidly, and using elaborate hand gestures.
statement? The nurse concludes that the client is
a. The client is developing insight demonstrating which?
b. The client’s coping skills have improved a. Aggression
c. The client needs encouragement to verbalize feelings b. Anger
d. The client’s treatment has been successful c. Anxiety
d. Psychomotor agitation
54. A client with anxiety is beginning treatment with lorazepam
(Ativan). It is most important for the nurse to assess the client’s 58. A client with bipolar disorder begins taking lithium carbonate
a. Motivation for treatment (lithium) 300mg four times a day. After 3 days of therapy, the client
b. Family and social support says, “My hands are shaking”. Which is the best response by the
c. Use of coping mechanisms nurse?
d. Use of alcohol
a. Fine motor tremors are an early effect of lithium therapy that
55. Interventions for a client with panic disorder would include (Select usually subsides in a few weeks.”
all that apply.) B. it is nothing to worry about unless it continues for the next month
C. tremors can be an early sign of toxicity but will keep monitoring
a. encouraging the client to verbalize feelings. your lithium level to make sure you're okay
b. helping the client to avoid panic-producing situations. D. you can't expect tremors with lithium you seem very concerned
c. reminding the client to practice relaxation when anxiety level is about such a small tremor
low.
d. teaching the client reframing techniques 59. What are the most common types of side effects from SSRIs?
e. teaching relaxation exercises to the client.
f. telling the client to ignore any anxious feelings. a. Dizziness, drowsiness, and dry mouth
b. convulsions and respiratory difficulties
56. When working with a client with moderate anxiety, the nurse c. diarrhea and weight gain
would expect to see (Select all that apply.) d. jaundice and agranulocytosis

a. inability to complete tasks. 60. The nurse observes that a client with depression sat at a table
b. failure to respond to redirection. with two other clients during lunch. The best feedback the nurse
c. increased automatisms or gestures. could give the client is which of the following.
 no underpants on. the nurse distracts her and takes her to her room
A. Do you feel better after talking with others during lunch? to put on underpants. the nurse acted as she did to:
B. I'm so happy to see you interacting with other clients.
C. I see you were sitting with others at lunch today? A. minimize the clients embarrassment about her present behavior
D. you must feel much better than you were a few days ago B.keep her from dancing with other clients
C. avoid embarrassing the male clients who are watching
61. Which of the following typifies the speech of a person in the D. teach her about proper attire and hygiene
acute phase of mania?
65. What is the rational for a person taking lithium to have enough
A. flight of ideas water and salt in his or
B. psychomotor retardation her diet?
C. hesitant
D. mutism A. salt and water are necessary to dilute lithium to avoid toxicity
B. water and salt convert lithium into a usable solute
62. What is the rationale for a person taking lithium to have enough C. lithium is metabolized in the liver, necessitating increased water
water and salt in his or her diet? and salt
D. lithium is a salt that has greater affinity for receptor sites then
A. salt and water are necessary to dilute lithium to avoid toxicity sodium chloride
B. water and salt convert lithium into a usable solute
C. lithium is metabolized in the liver, necessitating increased water 66. Identify the serum lithium level for maintenance and safety.
and salt
D. lithium is a salt that has greater affinity for receptor sites then A. 0.1 to 1 mEq/L
sodium chloride B. 0.5 to 1.5 mEq/L
C. 10 - 50 mEq/L
63. A client says to the nurse, "you are the best nurse I've ever met. I D. 50 - 100 mEq/L
want you to remember me." what is an appropriate response by the
nurse? 67. Martha Cummings contacted Visiting Nurses Association (VNA) to
discuss her concerns about her 29-year-old daughter Susan, who is a
A. thank you. I think you are special too. graphic designer. Martha explains that Susan has always been a shy
B. I suspect you want something from me. what is it? person, has one or two close friends, and has difficulty dealing with
C. you probably say that to all your nurses new situations. Over the past 4 months, Martha reports, Susan has
D. are you thinking of suicide? been increasingly reluctant to leave her apartment, making excuses
about not visiting her family and asking her mother to run errands
64. A client with mania begins dancing around the day room. when and even purchase groceries for her. Martha also states that Susan
she twirled her skirt in front of the male clients it was obvious she had has quit going to the office, but has continued her job by working at
home. Her employer has allowed her to do this for several weeks, but
is becoming more impatient with Susan. Marth fears Susan may lose F. stringing beds
her job. When Martha attempts to talk to Susan about this situation,
Susan becomes very anxious and agitated. She doesn't want to 71. Which of the following would indicate an increase suicidal risk?
discuss her problems, and keeps insisting she can't "go out there" select all that apply
anymore. Martha has not been able to convince Susan to see a
doctor, so she contacted VNA to see if they would go to Susan's A. An abrupt Improvement in mood
apartment to see her. Susan has agreed to talk to the nurse if the B. Calling family members to make amends.
nurse comes to her apartment. C. Crying when discussing sadness
D. Feeling overwhelmed by simple daily tasks.
68. What type(s) of treatment are available for Susan? E. Statements such as "I'm such a burden for everyone."
F. Statements such as "everything will be better soon"
Susan could be treated with SSRI antidepressants, systematic
desensitization, and nonchemical methods to manage her anxiety
response, such as progressive muscle relaxation, imagery, and 72. A nurse's best approach when caring for a confused, older client is
cognitive-behavioral reframing techniques. to provide an environment with:

69. How is Martha's behavior affecting Susan's situation? What 1. space for privacy
suggestions might the nurse make to Martha? 2. group involvement
3. trusting relationships
At this point, Martha's intended helpfulness is enabling Susan to 4. activities that are varied
remain in her apartment without seeking help or treatment. The
nurse could suggest to Martha that she work with Susan's treaters 73. An older adult on the mental health unit begins acting out while in
about ways she could be supportive and helpful to Susan without the day room. What is a nurse's initial intervention?
enabling her. Should Susan refuse treatment, Martha could make an
appointment with a therapist or counselor for herself to get a. instruct the client to be quiet
assistance and support. b. allow the client to act out until fatigue sets in
c. give the client directions in a firm, low-pitched voice
70. Which of the following activities would be appropriate for a client d. guide the client from the room by gently holding their arm
with mania? e. give the client directions in a firm, low-pitched voice
select all that apply
74. A nurse is assessing an older adult with the diagnosis of dementia.
A. drawing a picture Which manifestations are expected in the client? (SATA)
B. modeling clay
C. playing bingo 1. resistance to change
D. playing table tennis 2. inability to recognize familiar objects
E. stretching exercises 3. preoccupation with personal appearance
4. inability to concentrate on new activities or interests 3. short attention span
5. tendency to dwell on the past and ignore the present 4. disordered reasoning
5.impaired motor activities
75. When answering questions from the family of a client with 76. What is the priority nursing objective of the therapeutic
Alzheimer disease, the nurse explains, " This disease is: psychiatric environment for a confused client?

1. one that emerges in the fourth decade of life." 1. assist the client to relate to others
2. a slow and relentless deterioration of the mind." 2. make the hospital atmosphere more home-like
3. functional in origin that occurs in the later years." 3. help the client become accepted in a controlled setting
4. diagnosed through laboratory and psychologic tests." 4. maintain the highest level of safe. independent functioning

76. A client in the early dementia stage of Alzheimer's disease is 77. What is the most appropriate nursing intervention for clients who
admitted to a long-term care facility. Which activities must the nurse exhibit mild cognitive impairment?
initiate? (SATA)
1. reality orientation
1. weigh the client once a week 2. behavioral confrontation
2. Have specialized rehabilitation equipment available 3. reflective communication
3. keep the client in pajamas and robe most of the day 4. reminiscence group therapy
4. establish a schedule with periods of rest after activities
5. review the client's weekly budget and use of community resources 78. What are the fours A's for which nurse's should assess clients
6. set up a plan for weekly entertainment through a senior citizens suspected of having Alzheimer disease?
group 1. amnesia, apraxia, agnosia, aphasia
2. avoidance, aloofness, asocial, asexual
77. Nurses working with clients who have a diagnosis of dementia 3. autism, loose association, apathy, affect
should adopt a common approach of care because clients need to: 4. aggressive, amoral, ambivalent, attractive

1. relate in a consistent manner to staff 79. An older adult is brought to the clinic by a family member because
2. learn that the staff cannot be manipulated of increasing confusion over the past week. What can the nurse ask
3.accept controls that are concrete and fairly applied clients to assess their orientation to place?
4. have sameness and consistency in their environment
1. explain a proverb
78. A nurse is assessing a client with dementia. Which clinical 2. state where they were born
manifestations are expected? (SATA) 3. identify the name of the town
4. recall what they had for breakfast
1. agitation
2. pessimism
80. A nurse is assigned to care for a regressed college student who 2. help the client realize the suspicions are unrealisitc
has been talking to unseen people and refusing to get out of bed, go 3. ask the client to explain the reason for the feelings
to class, or get involved in daily grooming activities. What is the 4. help the client to feel accepted by the staff on the unit
nurse's initial effort toward helping this client? 4. help the client to feel accepted by the staff on the unit
1. providing frequent rest periods
2. reducing environmental stimuli 84. One evening a nurse finds a client that has been experiencing
3. facilitating the client's social relationships with a peer group persecutory delusions trying to get out the door. The client states
4. attempting to establish a meaningful relationship with the client "Please let me go. I trust you. The Mafia is going to kill me tonight."
Which response is most therapeutic?
81. A client diagnosed with schizophrenia is experiencing auditory
hallucinations. A nurse makes the following statements when 1. you are frightened come with me to your room and we can talk
interacting with this client. Place these statements in the order in about it.
which should occur. 2. come with me to your room ill lock the door and no one will get in
to harm you.
1. I do not hear any voices 3. nobody here wants to harm you and you know that I’ll come with
2. come with me for a walk you to your room.
3. hearing voices must be frightening 4. thank you for trusting me maybe you can trust me when I tell you
4. the voices you hear are a part of your illness no one here will kill you.
5. let’s play cards with another client
85. A delusional client refuses to eat because of a belief that the food
3-4-1-2-5 is poisoned. What is the most appropriate initial nurse intervention?

82, A client with schizophrenia has a history of hearing voices that say 1. make sure the food isn't poisoned
"you are a bad person." While having a conversation with a nurse 2. taste the food in the client's presence
with whom the client has been working the client states "I am starting 3. show the client that other people are eating without being harmed
to hear the same voices again." What is the nurse's best response? 4. tell the client that tube feeding will be started if eating doesn't
begin
1. try to ignore the voices 86. A client with schizophrenia is admitted to an acute care
2. what are they saying to you psychiatric unit. Which clinical findings indicate positive signs and
3. do you believe what he voices are saying symptoms associated with schizophrenia?
4. try not to be afraid because they are only voices
1. withdrawal, poverty of speech, inattentiveness
83. What should a nurse do when caring for a client whose behavior is 2. flat affect, decreased spontaneity, asocial behavior
characterized by pathologic suspicion? 3. hypomania, labile mood swings, episodes of euphoria
4. hyperactivity, auditory hallucinations, loose associations
1. protect the client from environmental stress
87. An acutely ill client with the diagnosis of schizophrenia has just 90. A client is delusional, talking about people who are plotting to do
been admitted to the mental health unit. What is the most harm. A nurse identifies that the client is pacing more than usual and
therapeutic initial nursing intervention? is concerned that the client is beginning to lose control. What is the
best nursing intervention?
1. spend time with the client to build trust and demonstrate
acceptance 1. advise the client to use a punching bag
2. involve the client in occupational therapy and use diversional 2. move the client to a quiet place on the unit
activity 3. encourage the client to sit down for awhile
3. delay one to one client interactions until medications reduce the 4. allow the client to continue pacing with supervision
psychotic symptoms 91. A client with a history of schizophrenia attends the mental health
4. involve the client in multiple small group discussions to distract clinic for a regularly scheduled group therapy session. The client
attention from the fantasy world arrives agitated and exhibits behaviors that indicates the hearing of
voices. When a nurse begins to walk toward the client, the client pulls
88. A client with schizophrenia plans an activity schedule with the out a large knife. Which is the nurse's best approach?
help of the treatment team. A written copy is posted in the client's
room. What should the nurse say when it's time for the client to go 1. firm
for a walk? 2. passive
3. empathetic
1. It's time for you to go for a walk now 4. confrontational
2. do you want to take your scheduled walk now
3. when would you like to go for your walk today 92. While a nurse is talking with a client, another client comes up and
4. you are supposed to be going for your walk now yells "I hate you, you're talking about me again!" and throws a glass
of juice at the nurse. What is the nurse's best response to this
89. During the admission procedure, a client appears to be behavior?
responding to voices. The client cries out at intervals. " No NO O
didn't kill him. you know the truth; tell that police officer. Please help 1. repeat the client's words and ask for clarification
me!" What is the nurse's most appropriate response? 2. remove the client from the room because limits must be placed on
the behavior
1. sit quietly and not respond to the client's statements 3. ignore both the behavior and the client, clean up the juice, and talk
2. listen attentively and assume a facial expression of disbelief with the client later
3. respond by saying i want to help you. I realize you must be very 4. verbalize feelings of annoyance as an example of the client that it is
frightened more acceptable to verbalize feelings than to act them out
4. say do not become so upset no one is talking to you; those voices
are part of your illnes 93. As a nurse enters a room and approaches a client who has
schizophrenia, the client states, "Get out of here before I hit you. Go
away!" The nurse concludes that this aggressive behavior is probably 4. remove the client from the family home
related to the fact that the client felt:
1. that voices were directing the behavior 97. A client experiencing hallucinations tells a nurse "The voices are
2. trapped when the nurse walked into the room telling me I'm no good." the client asks whether the nurse hears the
3. afraid of doing harm to the nurse if the nurse came closer voices. Which is the nurse's most appropriate response?
4. that nurse was similar to someone who was previously frightening
1. No I don't hear the voices, but I believe you can hear them
94. A client who experiences auditory hallucination agrees to discuss 2. It is the voice of your conscience, which only you can control
alternative coping strategies with a nurse. For the next 3 days when 3. Those voices are coming from within you; only you can hear them
the nurse attempts to focus on alternative strategies, the client gets 4. Hearing the voices are a symptom of your illness; don't pay
up and leaves the interaction. What is the nurse's most therapeutic attention to them
response?
98. A nurse enters a client's room and identifies that the client
1. come back. you agreed that you would discuss other ways to cope appears preoccupied. Turning to the nurse, the client states "They are
2. you seem very uncomfortable every time I bring up a new way to saying terrible things about me. Can't you hear them?" What is the
cope nurse's most therapeutic response?
3. did you agree to talk about other ways to cope because you
thought that was what I wanted 1. it seems you heard them before
4. you walk out each time I start to discuss the hallucinations; does 2. try to get control of your feelings
that mean you've changed your mind 3. there is no one here but me and I don't hear anything
4. I don't hear anyone else talking, but I can see you are upset
95. What is a nurse's most appropriate action when a client is seen
openly masturbating in the recreation room? 99. A nurse observes a regressed, emotionally disturbed client using
the hands to eat soft foods. What is the best nursing intervention?
1. restraining the client's hands
2. putting the client in seclusion 1. give the client a spoon and suggest it be used
3. escorting the client out of the room 2. say in a joking manner well I guess fingers were made before forks
4. teaching the client acceptable behavior 3. ignore the behavior and observe several additional meals before
intervening
96. What should the nurse do to achieve a primary objective of 4. remove the food while saying you can't have any more until you
providing a therapeutic daycare environment for a client who is use your spoon
withdrawn and reclusive?
100. What clinical manifestation is the most serious indication of
1. foster a trusting relationship impending assaultive behavior by a client on a mental health unit?
2. administer medications on time
3. involve the client in a group with peers 1. uses profane language
2. touches people excessively 104. A client tells the nurse "I am a terrible, evil person; the voices are
3. exhibits a sudden withdrawal telling me that God needs to punish me." What is the nurse's most
4. experiences command hallucinations therapeutic response?
1. God is loving and will not punish you
101. While watching TV in the day room, a client who has 2. Those voices you are hearing are a fantasy
demonstrated withdrawn, regressed behavior suddenly screams, 3. Tell me what you are thinking about yourself
bursts into tears, and runs out of the room to the far end of the 4. You aren't wicked, since both God and I love you
hallway. What is the most therapeutic action by the nurse?
105. What is the most appropriate way for the nurse to help a
1. walk to the end of the hallway where the client is standing withdrawn, emotionally disturbed adolescent client to accept the
2. accept the action as being impulsive behavior of a sick person realities of daily living?
3. ask another client in the day room why the client acted as she did
4. document the incident in the client's record while the memory is 1. Assist the client to care for personal hygiene needs
fresh 2. encourage the client to keep up with school studies
3. persuade the client to join the other clients in group activities
102. How should a nurse intervene when a regressed, emotionally 4. leave the client alone when there appears to be a disinterest in
disturbed client voids on the floor in the sitting room of the mental daily activities
health unit? 106. What is the best nursing intervention to encourage a withdrawn,
non-communicative client to talk?
1. make the client mop the floor
2. restrict the client's fluids for the rest of the day 1. focus on nonthreatening subjects
3. toilet the client more frequently with supervision 2. try to get the client to discuss feelings
4. withhold the client's privileges each time the client voids on the 3. ask simple questions that require a yes or no answer
floor 4. Sit quietly while looking through magazines with the client

103. A regressed, emotionally disturbed client who has been watching 107. What is an important aspect of nursing care for a client
a nurse for a few days suddenly walks up and shouts "You think exhibiting psychotic patterns of thinking and behavior?
you're so damned perfect and good. I think you stink." What is the
nurse's most appropriate response? 1. help keep the client oriented to reality
2. involve the client in activities throughout the day
1. do you mean I smell 3. help the client understand that it is harmful to withdraw from
2. you seem angry with me situations
3. Boy, you're in a bad mood 4. encourage the client to discuss why interacting with other people is
4. I can't be all that bad, can I being avoided
108. Why is observation an especially important aspect of nursing C. "Your child has too little serotonin in the brain causing delusions
care for a withdrawn client? and hallucinations."
D. "Your child's abnormal hormonal changes have precipitated
1. it assists in confirming the client's diagnosis auditory hallucinations."
2. it helps in understanding the client's behavior 112. Parents ask a nurse how they should reply when their child,
3. the staff is informed about the client's illness diagnosed with paranoid schizophrenia, tells them that voices
4. the degree of the client's depression is indicated
command him to harm others. Which is the appropriate nursing
reply?
109. A paranoid client presents with bizarre behaviors, neologisms,
and thought insertion. Which nursing action should be prioritized to
A. "Tell him to stop discussing the voices."
maintain this client's safety?
B. "Ignore what he is saying, while attempting to discover the
underlying cause."
A. Assess for medication noncompliance
C. "Focus on the feelings generated by the hallucinations and present
B. Note escalating behaviors and intervene immediately
reality."
C. Interpret attempts at communication
D. "Present objective evidence that the voices are not real."
D. Assess triggers for bizarre, inappropriate behaviors

113. A nurse is assessing a client diagnosed with paranoid

110. A client diagnosed with schizoaffective disorder is admitted for
schizophrenia. The nurse asks the client, "Do you receive special
social skills training. Which information should be taught by the
messages from certain sources, such as the television or radio?"
nurse?
Which potential symptom of this disorder is the nurse assessing?
A. The side effects of medications
A. Thought insertion
B. Deep breathing techniques to decrease stress
B. Paranoid delusions
C. How to make eye contact when communicating
C. Magical thinking
D. How to be a leader
D. Delusions of reference
111. A 16-year-old-client diagnosed with paranoid schizophrenia
114. A client diagnosed with schizophrenia tells a nurse, "The
experiences command hallucinations to harm others. The client's
'Shopatouliens' took my shoes out of my room last night." Which is an
parents ask a nurse, "Where do the voices come from?" Which is the
appropriate charting entry to describe this client's statement?
appropriate nursing reply?

A. "The client is experiencing command hallucinations."

A. "Your child has a chemical imbalance of the brain which leads to
B. "The client is expressing a neologism."
altered thoughts."
C. "The client is experiencing a paranoid delusion."
B. "Your child's hallucinations are caused by medication interactions."
D. "The client is verbalizing a word salad."
 Which nursing intervention would be most appropriate when caring
115. During an admission assessment, a nurse asks a client diagnosed for an acutely agitated client diagnosed with paranoid schizophrenia?
with schizophrenia, "Have you ever felt that certain objects or
persons have control over your behavior?" The nurse is assessing for A. Provide neon lights and soft music.
which type of thought disruption? B. Maintain continual eye contact throughout the interview.
C. Use therapeutic touch to increase trust and rapport.
A. Delusions of persecution D. Provide personal space to respect the client's boundaries.
B. Delusions of influence
C. Delusions of reference 119. Which nursing behavior will enhance the establishment of a
D. Delusions of grandeur trusting relationship with a client diagnosed with schizophrenia?
116. A client diagnosed with schizophrenia states, "Can't you hear
him? It's the devil. He's telling me I'm going to hell." Which is the A. Establishing personal contact with family members.
most appropriate nursing reply? B. Being reliable, honest, and consistent during interactions.
C. Sharing limited personal information.
A. "Did you take your medicine this morning?" D. Sitting close to the client to establish rapport.
B. "You are not going to hell. You are a good person."
C. "I'm sure the voices sound scary. The devil is not talking to you. 120. A client diagnosed with paranoid schizophrenia states, "My
This is part of your illness." psychiatrist is out to get me. I'm sad that the voice is telling me to
D. "The devil only talks to people who are receptive to his influence." stop him." What symptom is the client exhibiting, and what is the
nurse's legal responsibility related to this symptom?
117. A client diagnosed with psychosis NOS (not otherwise specified)
tells a nurse about voices telling him to kill the president. Which A. Magical thinking; administer an antipsychotic medication
nursing diagnosis should the nurse prioritize for this client? B. Persecutory delusions; orient the client to reality
C. Command hallucinations; warn the psychiatrist
A. Disturbed sensory perception D. Altered thought processes; call an emergency treatment team
B. Altered thought processes meeting
C. Risk for violence: directed toward others
D. Risk for injury 121. Which statement should indicate to a nurse that an individual is
experiencing a delusion?
118. A client who hears voices telling him to kill someone is at risk for
responding and reacting to the command hallucination. Other risk A. "There's an alien growing in my liver."
factors for violence include aggressive body language, verbal B. "I see my dead husband everywhere I go."
aggression, catatonic excitement, and rage reactions. C. "The IRS may audit my taxes."
D. "I'm not going to eat my food. It smells like brimstone."
 125. A client diagnosed with chronic schizophrenia presents in an
122. A client diagnosed with schizophrenia is slow to respond and emergency department (ED) with uncontrollable tongue movements,
appears to be listening to unseen others. Which medication should a stiff neck, and difficulty swallowing. The nurse would expect the
nurse expect a physician to order to address this type of symptom? physician to recognize which condition and implement which
treatment?
A. Haloperidol (Haldol) to address the negative symptom A. Neuroleptic malignant syndrome and treat by discontinuing
B. Clonazepam (Klonopin) to address the positive symptom antipsychotic medications
C. Risperidone (Risperdal) to address the positive symptom B. Agranulocytosis and treat by administration of clozapine (Clozaril)
D. Clozapine (Clozaril) to address the negative symptom C. Extrapyramidal symptoms and treat by administration of
benztropine (Cogentin)
123. A client is diagnosed with schizophrenia. A physician orders D. Tardive dyskinesia and treat by discontinuing antipsychotic
haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and medications
zolpidem (Ambien) 10 mg HS. Which client behavior would warrant
the nurse to administer benztropine? 126. After taking chlorpromazine (Thorazine) for 1 month, a client
presents to an emergency department (ED) with severe muscle
A. Tactile hallucinations rigidity, tachycardia, and a temperature of 105 F (40.5C). The nurse
B. Tardive dyskinesia expects the physician to recognize which condition and implement
C. Restlessness and muscle rigidity which treatment?
D. Reports of hearing disturbing voices
A. Neuroleptic malignant syndrome and treat by discontinuing
124. A nurse is caring for a client who is experiencing a flat affect, Thorazine and administering dantrolene (Dantrium)
paranoid delusions, anhedonia, anergia, neologisms, and echolalia. B. Neuroleptic malignant syndrome and treat by increasing Thorazine
Which statement correctly differentiates the client's positive and dosage and administering an antianxiety medication
negative symptoms of schizophrenia? C. Dystonia and treat by administering trihexyphenidyl (Artane)
D. Dystonia and treat by administering bromocriptine (Parlodel)
A. Paranoid delusions, anhedonia, and anergia are positive symptoms
of schizophrenia. 127. A client diagnosed with schizophrenia takes an antipsychotic
B. Paranoid delusions, neologisms, and echolalia are positive agent daily. Which assessment finding should a nurse immediately
symptoms of schizophrenia. report to the client's attending psychiatrist?
C. Paranoid delusions, anergia, and echolalia are negative symptoms
of schizophrenia. A. Respirations of 22/minute
D. Paranoid delusions, flat affect, and anhedonia are negative B. Weight gain of 8 pounds in 2 months
symptoms of schizophrenia. C. Temperature of 104F (40C)
D. Excessive salivation
 diagnosed with schizophrenia has allergies to penicillin,
128. An aging client diagnosed with chronic schizophrenia takes an prochlorperazine (Compazine), and bee stings. Based on this
antipsychotic and a beta-adrenergic blocking agent (propranolol) for assessment data, which antipsychotic medication would be
hypertension. Understanding the combined side effects of these contraindicated?
drugs, which statement by a nurse is most appropriate? A. Haloperidol (Haldol), because it is used only in elderly patients
B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin
A. "Make sure you concentrate on taking slow, deep, cleansing C. Risperidone (Risperdal), because it exacerbates symptoms of
breaths." depression
B. "Watch your diet and try to engage in some regular physical D. Thioridazine (Mellaril), because of cross-sensitivity among
activity." phenothiazines
C. "Rise slowly when you change position from lying to sitting or
sitting to standing." 132. A college student has quit attending classes, isolates self due to
D. "Wear sunscreen and try to avoid midday sun exposure." hearing voices, and yells accusations at fellow students. Based on this
information, which nursing diagnosis should the nurse prioritize?
129. A client diagnosed with schizophrenia is prescribed clozapine
(Clozaril). Which client symptoms related to the side effects of this A. Altered thought processes R/T hearing voices AEB increased
medication should prompt a nurse to intervene immediately? anxiety
B. Risk for other-directed violence R/T yelling accusations
A. Sore throat, fever, and malaise C. Social isolation R/T paranoia AEB absence from classes
B. Akathisia and hypersalivation D. Risk for self-directed violence R/T depressed mood
C. Akinesia and insomnia
D. Dry mouth and urinary retention 133. A client has been recently admitted to an inpatient psychiatric
unit. Which intervention should the nurse plan to use to reduce the
130. If clozapine (Clozaril) therapy is being considered, the nurse client's focus on delusional thinking?
should evaluate which laboratory test to establish a baseline for
comparison in order to recognize a potentially life-threatening side A. Present evidence that supports the reality of the situation
effect? B. Focus on feelings suggested by the delusion
C. Address the delusion with logical explanations
A. White blood cell count D. Explore reasons why the client has the delusion
B. Liver function studies
C. Creatinine clearance 134. A client states, "I hear voices that tell me that I am evil." Which
D. Blood urea nitrogen outcome related to these symptoms should the nurse expect this
client to accomplish by discharge?
131. During an admission assessment, a nurse notes that a client
A. The client will verbalize the reason the voices make derogatory A. Somatic delusions
statements. B. Social isolation
B. The client will not hear auditory hallucinations. C. Gustatory hallucinations
C. The client will identify events that increase anxiety and illicit D. Flat affect
hallucinations. E. Clang associations
D. The client will positively integrate the voices into the client's
personality structure. 138. Laboratory results reveal decreased levels of prolactin in a client
diagnosed with schizophrenia. When assessing the client, which
135. A newly admitted client has taken thioridazine (Mellaril) for 2 symptoms should a nurse expect to observe? (Select all that apply.)
years with good symptom control. Symptoms exhibited on admission
included paranoid delusions and hallucinations. The nurse should A. Apathy
recognize which potential cause for the return of these symptoms? B. Social withdrawal
C. Anhedonia
A. The client has developed tolerance to the antipsychotic D. Auditory hallucinations
medication. E. Delusions
B. The client has not taken the medication with food.
C. The client has not taken the medication as prescribed. 139. The nurse is talking with a client. The client abruptly says to the
D. The client has combined alcohol with the medication. nurse, “The moon is full. Astronauts walk on the moon. Walking is a
good health habit.” The client’s behavior MOST likely indicates?
136. Which of the following components should a nurse recognize as
an integral part of a rehabilitative program when planning care for a. Flight of ideas
clients diagnosed with schizophrenia? (Select all that apply.) b. Neologisms
c. Word salad
A. Group therapy d. Dissociation
B. Medication management
C. Deterrent therapy 140. Which of the following classifications of medications would
D. Supportive family therapy be MOST often used for clients with schizophrenia?
E. Social skills training
a. Neuroleptics
137. A nurse is administering risperidone (Risperdal) to a client b. Anxiolytics
diagnosed with schizophrenia. The therapeutic effect of this c. Anti-depressants
medication would most effectively address which of the following d. Mood stabilizers
symptoms? (Select all that apply.)
 b. A persecutory delusion.
141. Post-procedure nursing interventions for electroconvulsive c. A somatic delusion.
therapy include? d. An erotomanic delusion.

a. Applying hard restraints if seizure occurs 146. Which symptom experienced by a client diagnosed with
b. Remaining with client until oriented schizophrenia would predict a less positive prognosis?
c. Expecting long-term memory loss
d. Expecting client to sleep for 4 to 6 hours a. Having little or no interest in work or social activities.
b. Continuously repeating what has been said.
142. A client with bipolar disorder is reluctant to take lithium c. Thinking the TV is controlling his or her behavior.
(Lithane) as prescribed. The MOST therapeutic response by the nurse d. Hearing hostile voices.
to his refusal is?
147. What type of symptoms mainly characterize paranoid
a. “You need to take your medicine, this is how you get well.” schizophrenia?
b. “I can see that you are uncomfortable right now, I’ll wait until a. Negative symptoms
tomorrow.” b. Catatonic symptoms
c. “If you refuse your medicine, we’ll just have to give you a shot.” c. Positive symptoms
d. “What is it about the medicine that you don’t like?” d. Residual symptoms

143. A client diagnosed with schizophrenia is experiencing anhedonia. 148. At what phase of schizophrenia does one begin to isolate
Which nursing diagnosis addresses concerns regarding this client’s oneself, lose interest in activities, and become clumsy?
problem?
a. The prodromal phase
a. Risk for suicide. b. The residual phase
b. Disturbed thought processes. c. The active phase
c. Disturbed sensory perception. d. The recovery phase
d. Impaired verbal communication.
149. Which of the 5 domains of negative symptoms of schizophrenia
145. A client on an in-patient psychiatric unit refuses to take does the following question assess: “Is the patient actively engaged
medications because, “The pill has a special code written on it that with hobbies and productive activity during the day?”
will make it poisonous.” What kind of delusion is this client
experiencing? A. Psychomotor activity
B. Motivation
a. A grandiose delusion. C. Social activity
D. Communication A. 10%
E. Emotion/affect B. 20%
C. 50%
150. Diagnostic distinctions between schizophrenia, bipolar disorder D. 75%
type I, other forms of bipolar spectrum disorder are supported by:
154. A client diagnosed with a thought disorder is experiencing clang
A. Genome-wide association studies that link specific genetic markers associations. Which nursing diagnosis reflects this client's problem?
to specific disorders a. Impaired verbal communication.
B. Symptoms that unambiguously distinguish one form of mental b. Risk for violence.
disorder from the others c. Ineffective health maintenance.
C. Categorical diagnostic rules established by consensus d. Disturbed sensory perception.
D. None of the above; there are no reliable ways to differentiate one
disorder from another 155. A client states, "I can't go into my bathroom because there is a
demon in the tub." Which nursing diagnosis reflects this client's
151. Negative symptoms of schizophrenia are often confused with problem?

A. Anhedonia a. Self-care deficit.

B. Dysthymia b. Ineffective health maintenance.
C. Confusion c. Disturbed sensory perception.
D. Dysregulation d. Disturbed thought processes.
E. None of the above
156. A client diagnosed with a thought disorder has body odor and
152. For a DSM-5 diagnosis of schizoaffective disorder, specific mood halitosis and is disheveled. Which nursing diagnosis reflects this
symptoms must be present for at least what proportion of the total client's problem?
illness duration?
A. 25% a. Social isolation.
B. 33% b. Impaired home maintenance.
C. 50% c. Interrupted family processes.
D. 67% d. Self-care deficit.
E. 75%
157. client's family is having a difficult time accepting the client's
153. What is the estimated concordance rate of schizophrenic illness diagnosis of schizophrenia, and this has led to family conflict. Which
in monozygotic twins? nursing diagnosis reflects this problem?
 A. Impaired home maintenance. outcome related to this client's problem should the nurse expect the
B. Interrupted family processes. client to achieve?
C. Social isolation.
D. Disturbed thought processes. A. The client will maintain anxiety at a reasonable level by day 2.
B. The client will take antipsychotic medications by discharge.
158. A client diagnosed with paranoid schizophrenia tells the nurse C. The client will communicate to staff any paranoid thoughts by
about three previous suicide attempts. Which nursing diagnosis day
would take priority and reflect this client's problem? D. The client will take responsibility for self-care by day

A. Risk for altered sensory perception. 162. A client states to the nurse, "I see headless people walking down
B. Disturbed thought processes. the hall at night." Which nursing response is appropriate?
C. Risk for suicide.
D. Violence: directed toward others. a. "What makes you think there are headless people here?"
b. "Now let's think about this. A headless person would not be able to
159. A client has the nursing diagnosis of impaired home maintenance walk down the hall."
R/T regression. Which behavior confirms this diagnosis? C. "It must be frightening. I realize this is real to you, but there are no
a. The client fails to take antipsychotic medications. headless people here."
b. The client states, "I haven't bathed in a week." d. "I don't see those people you are talking about."
c. The client lives in an unsafe and unclean environment.
d. The client states, "You can't draw my blood without crayons." 163. Which of the following client statements demonstrates the
major symptoms of schizophrenia?
160. Which outcome should the nurse expect from a client diagnosed
with schizophrenia who is hearing and seeing things others do not A "I had too much to drink last night, started feeling all-powerful, and
hear and see? stupidly drove my truck into a tree."
B "I've been depressed ever since our house was destroyed by fire."
A. The client will recognize distortions of reality by discharge. C "'A stitch in time saves nine' means that prevention is easier than
B. The client will demonstrate the ability to trust by day 2. fixing a real problem."
C. The client will recognize delusional thinking by day 3. D "You can read my mind. This light of mine will shine, fine; blinding
D. The client will experience no auditory hallucinations by world will end at nine."
discharge
164. A family member asks you, "As both of my siblings have
161. A client admitted to an in-patient setting has not been compliant schizophrenia, why are my brother's symptoms so different from my
with antipsychotic medications prescribed for schizophrenia. Which sister's? He withdraws when there's a change in his environment or
routine. She starts cursing and yelling about the Mafia and the CIA
when I do something that's less than perfect." Based on your change my medication?"
knowledge, your response should address: C "I'm going to look for a job where I can use my college degree but
have less day-to-day stress."
A The many differences in the presentation of schizophrenia. D "Next month, my sister and I are going to write a grant proposal for
B The significance of paranoid content in the differential diagnosis of a psychiatric day treatment/social center."
paranoid schizophrenia. E "I have designed a weekly schedule so that I can get tasks done and
C The typical progression of symptoms within an individual over time. have planned time to relax."
D The effect of gender on clinical presentation in schizophrenia.
167. You have presented your client with written aftercare
165. Which family member statements demonstrate recognition of medication directions: "Take one capsule three times per day." Your
the effects of social pressures associated with schizophrenia? (Select client informs you that she has reviewed the material. Which
all that apply.) response specifically addresses your concerns about adherence?

A "If my family member would just move in with me, it would be a lot A "If you forget one dose, you can double the next one."
easier for me to maintain my household and care for my children." B "Do you understand everything?"
B "It would be great if my family member could identify somebody to C "This medication really works best if you take one capsule three
trust and believe when that person says, 'Your symptoms are worse. times per day."
Let's go to the psychiatrist.'" D "What might get in the way of your taking your medications?"
C "I'll attend a support group, but I'm afraid my family member will
not go...s/he would rather try to 'pass' as not mentally ill." 168. The client with schizophrenia is preparing for discharge. To
D "I'm going to help my family member figure out what to tell other minimize relapse, what is the most important feature of planning the
family members, friends, and business associates about why he's client's aftercare?
been on medical leave."
E "I used to protect my family member from a lot of the interpersonal A. Identification of two new ways to bolster self-esteem
conflicts in the family, but we need to express our emotions more B. Ensuring that the client lists three potential sources of social
openly." support
C. An accurate description of the medication regimen with a specific
166. Which client statements demonstrate acknowledgment of the plan for obtaining refills
effects of psychological pressures associated with schizophrenia? D. Identification of three new methods of spending leisure time.
(Select all that apply?
169. While you are employed as a charge nurse on an inpatient
A "I just want to get back to what I was doing and put this whole psychiatric unit, you recognize that you are choosing to spend less
episode behind me." time interacting with the clients with schizophrenia. Your first action
B "If I can't stand the side effects, how will I ask my prescriber to is:
 172. You overhear a family member discussing medication adherence
A Discussing your observation with your clinical supervisor. with your client. Which of the following statements do you want to
B Requesting a transfer to another unit. encourage the family member to reiterate?
C Forcing yourself to interact with the clients with schizophrenia. A "Your children are getting tired of watching you get sick every time
D Reflecting on your behavior. you stop your meds."
B "If you stop taking your medication, I'll take custody of your
170. A peer approaches you and shares her frustration with her older children."
brother, who has had multiple hospitalizations with schizophrenia. C "You should let these health care providers get you well. Why do
"He used to show interest in me, but since his discharge 5 days ago, you fight that?"
he just stares into space. I cannot get a reaction out of him." Which of D "Your support group encourages you to make healthy choices.
the following statements impart accurate information? (Select all that Taking your meds is a healthy thing you can do every day, just like
apply.) brushing your teeth."

A "Have you confronted him with this?" 173. During a private conversation, a client with borderline
B "He may be demonstrating flattening of affect and anhedonia." personality disorder asks the nurse to keep his secret and then
C "He may have sedation or masked facial expressions from his displays multiple, self-inflicted, superficial lacerations on the
medications." forearms. What is the nurse's best response?
D "Maybe he's depressed about having a chronic illness."
E "It's sad when a loved one does not have any feelings." a. "That's it! You're on suicide precautions."
b. "I'm going to tell your physician. Do you want to tell me why you
171. A nurse is designing a relapse-prevention inpatient group for did that?"
clients with schizophrenia. Which statement addresses a main c. "Tell me what type of instrument you used. I'm concerned about
category of nursing activities? infection."
d. "The team needs to know when something important occurs in
A "We're going to discuss current events." treatment. I need to tell the others, but let's talk about it first."
B "Let's go around the room and have each person say something
positive about our group." 174. In a toddler, which of the following injuries is most likely the
C "If you can increase your self-assessment skills, you'll be able to tell result of child abuse?
when you're getting more stressed."
D "We will go around the room and each person will state a personal A. hematoma on the occipital region of the head
goal for today." B. A 1-inch forehead laceration
C. Several small, dime-sized circular burns on the child's back
D. A small isolated bruise on the right lower extremity
175. An unemployed woman, age 24, seeks help because she feels D. "We are not here to discuss how I look or smell. We are here to
depressed and abandoned and doesn’t know what to do with her life. talk about you."
She says she has quit her last five jobs because her coworkers didn’t
like her and didn’t train her adequately. Last week, her boyfriend 178. The nurse is monitoring a client with a diagnosis of
broke up with her after she drove his car into a tree after an schizophrenia. The nurse notes that the client's emotional responses
argument. The client’s initial diagnosis is borderline personality to situations occurring throughout the day are incongruent with the
disorder. Which nursing observations support this diagnosis? tone of the situation. The nurse should document the findings using
which description of the client's behavioral response?
A. Flat affect, social withdrawal, and unusual dress
B. Suspiciousness, hypervigilance, and emotional coldness A. Flat affect
C. Lack of self-esteem, strong dependency needs, and impulsive B. Bizarre affect
behavior C. Blunted affect
D. Insensitivity to others, sexual acting out, and violence D. Inappropriate affect

176. The nurse in the mental health unit is performing an assessment 179. A mental health nurse notes that a client with schizophrenia is
in a client who has a history of multiple somatic complaints involving exhibiting an immobile facial expression and a blank look. Which
several organ systems. Diagnostic studies revealed no organic should the nurse document in the client's record?
pathology. The care plan developed for this client will reflect that the
client is experiencing which disorder? A. The client has a flat affect.
B. The client has an inappropriate affect.
A. Depression C. The client is exhibiting bizarre behavior.
B. Schizophrenia D. The client's emotional responses exhibit a blunted affect.
C. Somatization disorder
D. Obsessive-compulsive disorder 180. A hospitalized client is receiving clozapine (Clozaril) for the
treatment of a schizophrenic disorder. The nurse determines that the
177. During a therapy session with a client with paranoid disorder, client may be having an adverse reaction to the medication if
the client says to the nurse, "You look so nice today. I love how you abnormalities are noted on which laboratory study?
do your hair, and I love that perfume you're wearing." Which
response by the nurse would be therapeutic? A. Platelet count
B. Cholesterol level
A. "Your comment is inappropriate." C. Blood urea nitrogen
B. "Thank you for noticing. I just bought this new perfume." D. White blood cell (WBC) count
C. "My hair has been a mess. I really needed to have it done."
181. A client has been prescribed disulfiram (Antabuse). Before giving 184. The family of a client with schizophrenia asks the nurse about
the client the first dose of this medication, what should the the difference between conventional and atypical antipsychotic
psychiatric home health nurse determine? medications. The nurse's answer is based on which of the following?

A. If there is a history of hyperthyroidism a. Atypical antipsychotics are newer medications but act in the same
B. When the last full meal was consumed ways as conventional antipsychotics.
C. If there is a history of diabetes insipidus b. Conventional antipsychotics are dopamine antagonists; atypical
D. When the last alcoholic drink was consumed antipsychotics inhibit the reuptake of serotonin
182. A home care nurse making an initial home visit notes that a c. Conventional antipsychotics have serious side effects; atypical
client is taking donepezil hydrochloride (Aricept). The nurse questions antipsychotics have virtually no side effects
the client's spouse about a history of which disorder that is treated d. Atypical antipsychotics are dopamine and serotonin antagonists;
with this medication? conventional antipsychotics are only dopamine antagonists
A. Dementia
B. Schizophrenia 185. The nurse is planning discharge teaching for a client taking
C. Seizure disorder clozapine (Clozaril). Which of the following is essential to include?
D. Obsessive-compulsive disorder
a. Caution the client not to be outdoors in the he sunshine without
183. The night nurse reported to the nurse manager that a client was protective clothing
admitted to the mental health unit after attacking his father with an b. Remind the client to go to the lab to have blood drawn for a WBC
iron for interrupting him at his computer. During nursing rounds, this count
client interrupts the nurse manager and says, "I need to get out of c. Instruct the client about dietary restrictions
here, so I can work on my computer project to save the world!" d. Give the client a chart to record a daily pulse rate
Which statement is a therapeutic response by the nurse manager?
186. Nurse is caring for a client who has been taking fluphenazine
A. "I will be able to talk with you in 15 minutes after I complete (Prolixin) for 2 days. The client suddenly cries out, his neck twists to
nursing rounds." one side, and his eyes appear to roll back in the sockets. The nurse
B. "You have a project to save the world? I'd really like to hear finds the following PRN medication for the client. Which one should
about that after I finish rounds." the nurse administer?
C. "Well, sit right down and eat your breakfast. You're not going
to save the world on an empty stomach." a. Benztropine (Cogentin), 2mg PO, bid, PRN
D. "You hurt your father because of these thoughts, and you b. Fluphenazine (Prolixin), 2mg, PO, tid, PRN
won't leave here until you can control yourself better." c. Haloperidol (Haldol), 5mg IM, PRN extreme agitation
d. Diphenhydramine (Benadryl), 25mg IM, PRN
187. Which of the following statements would indicate that family
teaching about schizophrenia had been effective? 191. A teaching plan for the client taking an antipsychotic medication
will include which of the following? (Select all that apply)
a. "If our son takes his medications properly, he won't have another
psychotic episode." a. Apply sunblock before going outdoors
b. "I guess we'll have to face the fact that our daughter will eventually b. Drink sugar free beverages for dry mouth
be institutionalized." c. Have serum blood levels drawn once a month
c. "It's a relief to find out that we did not cause our son's d. Rise slowly from a sitting position
schizophrenia." e. Skip any dose that is not taken on time
d. "It's a shame our daughter will never be able to have children." f. Take medication with food to avoid nausea

188. When the client describes fear of leaving his apartment as well 192. Which of the following are considered to be positive signs of
as the desire to get out and meet others, it is called schizophrenia? (Select all that apply)

a. ambivalence a. Anhedonia
b. anhedonia b. Delusions
c. alogia c. Hallucinations
d. avoidance d. Disorganized thinking
e. Illusions
189. The client who hesitates 30 seconds before responding to any f. Social withdrawal
question is described as having
193.Mental health is defined as:
a. blunted affect
A. The ability to distinguish what is real from what is not.
b. latency of response
c. paranoid delusions B. A state of well-being where a person can realize his own abilities
d. poverty of speech can cope with normal stresses of life and work productively.
C. Is the promotion of mental health, prevention of mental disorders,
nursing care of patients during illness and rehabilitation
190. The overall goal of psychiatric rehabilitation is for the client to
D. Absence of mental illness
gain
194. Which of the following describes the role of a technician?
a. control of symptoms A. Administers medications to a schizophrenic patient.
b. freedom from hospitalization B. The nurse feeds and bathes a catatonic client
c. management of anxiety C. Coordinates diverse aspects of care rendered to the patient
d. recovery from illness D. Disseminates information about alcohol and its effects.
195. Liza says, “Give me 10 minutes to recall the name of our college 200. What would be the best approach for a wife who is still living with her
professor who failed many students in our anatomy class.” She is operating abusive husband?
on her:
A. Subconscious A. “Here’s the number of a crisis center that you can call for help .”
B. Conscious B. “Its best to leave your husband.”
C. Unconscious C. “Did you discuss this with your family?”
D. Ego D. “ Why do you allow yourself to be treated this way”

196. The superego is that part of the psyche that: 201. Which comment about a 3 year old child if made by the parent may
A. Uses defensive function for protection. indicate child abuse?
B. Is impulsive and without morals.
C. Determines the circumstances before making decisions. A. “Once my child is toilet trained, I can still expect her to have some”
D. The censoring portion of the mind. B. “When I tell my child to do something once, I don’t expect to have
to tell”
197. Primary level of prevention is exemplified by: C. “My child is expected to try to do things such as, dress and feed.”
A. Helping the client resume self care. D. “My 3 year old loves to say NO.”
B. Ensuring the safety of a suicidal client in the institution.
C. Teaching the client stress management techniques
202. The primary nursing intervention for a victim of child abuse is:
D. Case finding and surveillance in the community A. Assess the scope of the problem
198. Situation: In a home visit done by the nurse, she suspects that the wife B. Analyze the family dynamics
and her child are victims of abuse. Which of the following is the most C. Ensure the safety of the victim
appropriate for the nurse to ask? D. Teach the victim coping skills

A. “Are you being threatened or hurt by your partner? 203. Situation: A 30 year old male employee frequently complains of low
B. “Are you frightened of you partner” back pain that leads to frequent absences from work. Consultation and tests
C. “Is something bothering you?” reveal negative results. The client has which somatoform disorder?
D. “What happens when you and your partner argue?” A. Somatization Disorder
B. Hypochondriaisis
199. The wife admits that she is a victim of abuse and opens up about her C. Conversion Disorder
persistent distaste for sex. This sexual disorder is: D. Somatoform Pain Disorder

A. Sexual desire disorder 204. Freud explains anxiety as:

B. Sexual arousal Disorder A. Strives to gratify the needs for satisfaction and security
C. Orgasm Disorder B. Conflict between id and superego
D. Sexual Pain Disorder C. A hypothalamic-pituitary-adrenal reaction to stress
 D. A conditioned response to stressors D. Serious violations of age related norms.

205. The following are appropriate nursing diagnosis for the client EXCEPT: 210. Ritalin is the drug of choice for chidren with ADHD. The side effects of
A. Ineffective individual coping the following may be noted:
B. Alteration in comfort, pain
C. Altered role performance A. increased attention span and concentration
D. Impaired social interaction B. increase in appetite
C. sleepiness and lethargy
206. The following statements describe somatoform disorders: D. bradycardia and diarrhea
A. Physical symptoms are explained by organic causes 211. School phobia is usually treated by:
B. It is a voluntary expression of psychological conflicts
C. Expression of conflicts through bodily symptoms A. Returning the child to the school immediately with family support.
D. Management entails a specific medical treatment B. Calmly explaining why attendance in school is necessary
C. Allowing the child to enter the school before the other children
207. What would be the best response to the client’s repeated complaints D. Allowing the parent to accompany the child in the classroom
of pain:
A. “I know the feeling is real tests revealed negative results.” 212. A 10-year old child has very limited vocabulary and interaction skills.
B. “I think you’re exaggerating things a little bit.” She has an I.Q. of 45. She is diagnosed to have Mental retardation of this
C. “Try to forget this feeling and have activities to take it off your classification:
mind” A. Profound
D. “So tell me more about the pain” B. Mild
C. Moderate
208. Situation: A nurse may encounter children with mental disorders. Her D. Severe
knowledge of these various disorders is vital. When planning school
interventions for a child with a diagnosis of attention deficit hyperactivity 213. The nurse teaches the parents of a mentally retarded child regarding
disorder, a guide to remember is to: her care. The following guidelines may be taught except:
A. overprotection of the child
A. provide as much structure as possible for the child B. patience, routine and repetition
B. ignore the child’s overactivity. C. assisting the parents set realistic goals
C. encourage the child to engage in any play activity to dissipate D. giving reasonable compliments
energy
D. remove the child from the classroom when disruptive behavior 214. The parents express apprehensions on their ability to care for their
occurs maladaptive child. The nurse identifies what nursing diagnosis:
209. The child with conduct disorder will likely demonstrate: A. hopelessness
A. Easy distractibility to external stimuli. B. altered parenting role
B. Ritualistic behaviors C. altered family process
C. Preference for inanimate objects. D. ineffective coping
215. A 5 year old boy is diagnosed to have autistic disorder. Which of the B. Alpha
following manifestations may be noted in a client with autistic disorder? C. Beta
D. Zeta
A. argumentativeness, disobedience, angry outburst 222. Which of the following months matches with an infant first having the
B. intolerance to change, disturbed relatedness, stereotypes ability to sit-up independently?
C. distractibility, impulsiveness and overactivity A. 4 months
D. aggression, truancy, stealing, lying B. 6 months
C. 8 months
216. The therapeutic approach in the care of an autistic child include the D. 10 months
following EXCEPT:
A. Engage in diversionary activities when acting -out 223. Object permanence for toddlers develops in this age range?
B. Provide an atmosphere of acceptance A. 5-10 months
C. Provide safety measures B. 10-14 months
D. Rearrange the environment to activate the child C. 12-24 months
D. 15-24 months
217. According to Piaget a 5 year old is in what stage of development:
A. Sensory motor stage 224. Which of the following matches the definition: attributing of our own
B. Concrete operations unwanted trait onto another person?
C. Pre-operational A. Compensation
D. Formal operation B. Projection
C. Rationalization
219. Which of the following is not one of the key steps in the grief process? D. Dysphoria
A. Denial
B. Anger 225. Which of the following matches the definition: the justification of
C. Bargaining behaviors using reason other than the real reason?
D. Rejection A. Compensation
B. Projection
220. Which of the following matches the definition: covering up a weakness C. Rationalization
by stressing a desirable or stronger trait? D. Dysphoria
A. Compensation
B. Projection 226. Which of the following matches the definition: response to severe
C. Rationalization emotion stress resulting in involuntary disturbance of physical functions?
D. Dysphoria A. Conversion disorder
B. Depressive reaction
221. Which of the following waveforms is most commonly found with light C. Bipolar disorder
sleepers? D. Alzheimer’s disease
A. Theta
227. Which of the following waveforms is most commonly found when you C. Transitional sleep
are awake? D. REM absence
A. Theta
B. Alpha 234. Which of the following best describes a person that is unable to tell you
C. Beta were there hand or foot is?
D. Zeta
A. Autotopagnosia
228. The REM sleep cycle occur approximately every ____ minutes? B. Cataplexy
A. 45 C. Ergophobia
B. 60 D. Anosognosia
C. 75
D. 90 235. Which of the following is not a characteristic of a panic disorder?
A. Nausea
229. Which of the following reflexes is not found at birth? B. Excessive perspiration
C. Urination
A. Babinski D. Chest pain
B. Palmar
C. Moro 236. Which of the following categories would a 70 year old adult be placed
D. Flexion in?
230. Parallel play for toddlers develops in this age range? A. Intimacy vs. Isolation
B. Generativitiy vs. Stagnation
A. 5-10 months C. Integrity vs. Despair
B. 10-14 months D. Longevity vs. Guilt
C. 12-24 months
D. 24-48 months 237. Which of the following categories would a 60 year old adult be placed
in?
231. Which of the following is not a sign of anxiety?
A. Dyspnea A. Intimacy vs. Isolation
B. Hyperventilation B. Generativitiy vs. Stagnation
C. Moist mouth C. Integrity vs. Despair
D. GI symptoms D. Longevity vs. Guilt

232. Which of the following best describes a person that is completely 238. Which of the following categories would a 20 year old adult be placed
awake falling asleep spontaneously? in?

A. Cataplexy A. Intimacy vs. Isolation

B. Narcolepsy B. Generativitiy vs. Stagnation
 C. Integrity vs. Despair 243. A patient admitted to a mental health unit for treatment of psychotic
D. Longevity vs. Guilt behavior spends hours at the locked exit door shouting. “Let me out. There’s
nothing wrong with me. I don’t belong here.” What defense mechanism is
239. Which of the following describes a person using words that have no the patient implementing?
known meaning?
A. Neologisms A. Denial
B. Neolithic B. Projection
C. Verbalism C. Regression
D. Delusional blocking D. Rationalization

240. A patient with a diagnosis of major depression who has 244. A patient diagnosed with terminal cancer says to the nurse “I’m going
attempted suicide says to the nurse, “I should have died! I’ve always been a to die, and I wish my family would stop hoping for a cure! I get so angry
failure. Nothing ever goes right for me.” Which response demonstrates when they carry on like this. After all, I’m the one who’s dying.” Which
therapeutic communication? response by the nurse is therapeutic?

A. “You have everything to live for.” A. “Have you shared your feelings with your family?”
B. “Why do you see yourself as a failure?” B. “I think we should talk more about your anger with your family.”
C. “Feeling like this is all part of being depressed.” C. “You’re feeling angry that your family continues to hope for you to
D. “You’ve been feeling like a failure for a while?” be cured?”
D. “You are probably very depressed, which is understandable with
241. When the community health nurse visits a patient at home, the such a diagnosis.”
patient states, “I haven’t slept the last couple of nights.” Which response by
the nurse illustrates a therapeutic communication response to this patient. 245. On review of the patients record, the nurse notes the admission was
voluntary. Based on this information, the nurse anticipates which patient
A. “I see.” behavior?
B. “Really?” A. Fearfulness regarding treatment measures.
C. “You’re having difficulty sleeping?” B. Anger and aggressiveness directed toward others.
D. “Sometimes, I have trouble sleeping too.” C. An understanding of the pathology and symptoms of the diagnosis.
242. A patient experiencing disturbed thought processes believes that his D. A willingness to participate in the planning of the care and
food is being poisoned. Which communication technique should the use to treatment plan.
encourage the patient to eat? 246. A patient admitted voluntarily for treatment of an anxiety disorder
demands to be released from the hospital. Which action should the nurse
A. Using open-ended questions and silence take INITIALLY?
B. Sharing personal preference regarding food choices
C. Documenting reasons why the patient does not want to eat A. Contact the patient’s health care provider (HCP).
D. Offering opinions about the necessity of adequate nutrition B. Call the patient’s family to arrange for transportations.
C. Attempt to persuade the patient to stay for only a few more days.
 D. Tell the patient that leaving would likely result in an involuntary 250. The nurse calls security and has physical restraints applied when a
commitment. client who was admitted voluntarily becomes both physically and verbally
abusive while demanding to be discharged from the hospital. Which
247. When reviewing the admission assessment, the nurse notes that a represents the possible legal ramifications for the nurse associated with
patient was admitted to the mental health unity involuntarily. Based on this these interventions? Select all that apply.
type of admission, the nurse should provide which intervention for this
patient? A. Libel
B. Battery
A. Monitor closely for harm to self or others. C. Assault
B. Assist in completing an application for admission. D. Slander
C. Supply the patient with written information about their mental E. False Imprisonment
illness. 251. The nurse in the mental health unit recognizes which of the following
D. Provide an opportunity for the family to discuss why they felt the as therapeutic communication techniques? Select all that apply.
admission was needed. A. Restating
B. Listening
248. The nurse is preparing a patient for the termination phase of the nurse- C. Asking the patient “Why?”
patient relationship. The nurse prepares to implement which nursing task D. Maintaining neutral responses
that is MOST APPROPRIATE for this phase? E. Providing acknowledgment and feedback
F. Giving advice and approval or disapproval
A. Planning short-term goals 252. A patient being seen in the emergency department immediately after
B. Making appropriate referrals being sexually assaulted appears calm and controlled. The nurse analyzes
C. Developing realistic solutions this behavior as indicating which defense mechanism?
D. Identifying expected outcomes A. Denial
B. Projection
249. The nurse employed in a mental health clinic is greeted by a neighbor C. Rationalization
in a local grocery store. The neighbors says to the nurse, “How is D. Intellectualization
Mary doing? She is my best friend and is seen at your clinic every week.” 253. A patient’s unresolved feelings related to loss would be MOST LIKELY
Which is the MOST APPROPRIATE nursing response? observed during which phase of the therapeutic nurse-patient relationship?
A. Trusting
A. “I can not discuss any patient situation with you.” B. Working
B. “If you want to know about Mary, you need t ask her yourself.” C. Orientation
C. “Only because you’re worried about a friend, I’ll tell you that she is D. Termination
improving.” E.
D. “Being her friend, you know she is having a difficult time and 254. Which statement demonstrates the BEST understanding of the nurse’s
deserves her privacy.” role regarding ensuring that each client’s rights are respected?

A. “Autonomy is the fundamental right of each and every client.”

 B. “A patient’s rights are guaranteed by both state and federal laws.” A. Reflecting
C. “Being respectful and concerned will ensure that I’m attentive to my B. Making observations
patient’s rights.” C. Formulating a plan of action
D. “Regardless of the patient’s conditions, all nurses have the duty to D. Giving recognition
respect patient rights.”
258. Nurse Patrick is interviewing a newly admitted psychiatric client. Which
nursing statement is an example of offering a “general lead”?
255. Which therapeutic communication technique is being used in this A. “Do you know why you are here?”
nurse-client interaction? B. “Are you feeling depressed or anxious?”
 Client: “When I get angry, I get into a fistfight with my wife or I take C. “Yes, I see. Go on.”
it out on the kids.” D. “Can you chronologically order the events that led to your
 Nurse: “I notice that you are smiling as you talk about this physical admission?”
violence.”
259. A nurse states to a client, “Things will look better tomorrow after a
A. Encouraging comparison good night’s sleep.” This is an example of which communication technique?
B. Exploring A. The therapeutic technique of “giving advice”
C. Formulating a plan of action B. The therapeutic technique of “defending”
D. Making observations C. The nontherapeutic technique of “presenting reality”
D. The nontherapeutic technique of “giving false reassurance”
256. Which therapeutic communication technique is being used in this
nurse-client interaction? 260. A client diagnosed with post-traumatic stress disorder is admitted to an
inpatient psychiatric unit for evaluation and medication stabilization. Which
 Client: “My father spanked me often.” therapeutic communication technique used by the nurse is an example of a
 Nurse: “Your father was a harsh disciplinarian.” broad opening?
A. Restatement
B. Offering general leads A. “What occurred prior to the rape, and when did you go to the
C. Focusing emergency department?”
D. Accepting B. “What would you like to talk about?”
C. “I notice you seem uncomfortable discussing this.”
257. Which therapeutic communication technique is being used in this D. “How can we help you feel safe during your stay here?”
nurse-client interaction?
261. A nurse is assessing a client diagnosed with schizophrenia for the
 Client: “When I am anxious, the only thing that calms me down is presence of hallucinations. Which therapeutic communication technique
alcohol.” used by the nurse is an example of making observations?
 Nurse: “Other than drinking, what alternatives have you explored to
decrease anxiety?” A. “You appear to be talking to someone I do not see.”
B. “Please describe what you are seeing.”
 C. “Why do you continually look in the corner of this room?” C. To evaluate the client’s behavior
D. “If you hum a tune, the voices may not be so distracting.” D. To give the client critical information

262. A nurse maintains an uncrossed arm and leg posture. This nonverbal 266. A client who frequently exhibits angry outbursts is diagnosed with
behavior is reflective of which letter of the SOLER acronym for active antisocial personality disorder. Which appropriate feedback should a nurse
listening? provide when this client experiences an angry outburst?

A. S A. “Why do you continue to alienate your peers by your angry

B. O outbursts?”
C. L B. “You accomplish nothing when you lose your temper like that.”
D. E C. “Showing your anger in that manner is very childish and
E. R insensitive.”
D. “During group, you raised your voice, yelled at a peer, left, and
263. An instructor is correcting a nursing student’s clinical worksheet. Which slammed the door.”
instructor statement is the best example of effective feedback?
A. “Why did you use the client’s name on your clinical worksheet?” 267. A client diagnosed with dependant personality disorder states, “Do you
B. “You were very careless to refer to your client by name on your think I should move from my parent’s house and get a job?” Which nursing
clinical worksheet.” response is most appropriate?
C. “Surely you didn’t do this deliberately, but you breached
confidentiality by using the client’s name.” A. “It would be best to do that in order to increase independence.”
D. “It is disappointing that after being told, you’re still using client B. “Why would you want to leave a secure home?”
names on your worksheet.” C. “Let’s discuss and explore all of your options.”
D. “I’m afraid you would feel very guilty leaving your parents.”
264. After assertiveness training, a formerly passive client appropriately
confronts a peer in group therapy. The group leader states, “I’m so proud of 268. When interviewing a client, which nonverbal behavior should a nurse
you for being assertive. You are so good!” Which communication technique employ?
has the leader employed? A. Maintaining indirect eye contact with the client
B. Providing space by leaning back away from the client
A. The nontherapeutic technique of giving approval C. Sitting squarely, facing the client
B. The nontherapeutic technique of interpreting D. Maintaining open posture with arms and legs crossed
C. The therapeutic technique of presenting reality
D. The therapeutic technique of making observations 269. A mother rescues two of her four children from a house fire. In the
emergency department, she cries, “I should have gone back in to get them. I
265. What is the purpose of a nurse providing appropriate feedback? should have died, not them.” What is the nurse’s best response?

A. To give the client good advice A. “The smoke was too thick. You couldn’t have gone back in.”
B. To advise the client on appropriate behaviors
 B. “You’re feeling guilty because you weren’t able to save your C. “Your mother seems like an understanding person. I’ll help you
children.” approach her.”
C. “Focus on the fact that you could have lost all four of your children.” D. “You feel that your mother does not want you to come back
D. “It’s best if you try not to think about what happened. Try to move home?”
on.”
273. A client’s younger daughter is ignoring curfew. The client states, “I’m
270. A newly admitted client diagnosed with obsessive-compulsive disorder afraid she will get pregnant.” The nurse responds, “Hang in there. Don’t you
(OCD) washes hands continually. This behavior prevents unit activity think she has a lot to learn about life?” This is an example of which
attendance. Which nursing statement best addresses this situation? communication block?

A. “Everyone diagnosed with OCD needs to control their ritualistic A. Requesting an explanation
behaviors.” B. Belittling the client
B. “It is important for you to discontinue these ritualistic behaviors.” C. Making stereotyped comments
C. “Why are you asking for help if you won’t participate in unit D. Probing
therapy?” E.
D. “Let’s figure out a way for you to attend unit activities and still wash 274. Which nursing statement is a good example of the therapeutic
your hands.” communication technique of giving recognition?
271. Which example of a therapeutic communication technique would be
effective in the planning phase of the nursing process? A. “You did not attend group today. Can we talk about that?”
B. “I’ll sit with you until it is time for your family session.”
A. “We’ve discussed past coping skills. Let’s see if these coping skills C. “I notice you are wearing a new dress and you have washed your
can be effective now.” hair.”
B. “Please tell me in your own words what brought you to the D. “I’m happy that you are now taking your medications. They will
hospital.” really help.”
C. “This new approach worked for you. Keep it up.” E.
D. “I notice that you seem to be responding to voices that I do not 275. A client is struggling to explore and solve a problem. Which nursing
hear.” statement would verbalize the implication of the client’s actions?

272. A client tells the nurse, “I feel bad because my mother does not want A. “You seem to be motivated to change your behavior.”
me to return home after I leave the hospital.” Which nursing response is B. “How will these changes affect your family relationships?”
therapeutic? C. “Why don’t you make a list of the behaviors you need to change.”
D. “The team recommends that you make only one behavioral change
A. “It’s quite common for clients to feel that way after a lengthy at a time.”
hospitalization.” 276. The nurse asks a newly admitted client, “What can we do to help you?”
B. “Why don’t you talk to your mother? You may find out she doesn’t What is the purpose of this therapeutic communication technique?
feel that way.” A. To reframe the client’s thoughts about mental health treatment
B. To put the client at ease
 C. To explore a subject, idea, experience, or relationship 280. After fasting from 10 p.m. the previous evening, a client finds out that
D. To communicate that the nurse is listening to the conversation the blood test has been canceled. The client swears at the nurse and states,
“You are incompetent!” Which is the nurse’s best response?
277. A student nurse tells the instructor, “I’m concerned that when a client
asks me for advice I won’t have a good solution.” Which should be the A. “Do you believe that I was the cause of your blood test being canceled?”
nursing instructor’s best response? B. “I see that you are upset, but I feel uncomfortable when you swear at
A. “It’s scary to feel put on the spot by a client. Nurses don’t always me.”
have the answer.” C. “Have you ever thought about ways to express anger appropriately?”
B. “Remember, clients, not nurses, are responsible for their own D. “I’ll give you some space. Let me know if you need anything.”
choices and decisions.”
C. “Just keep the client’s best interests in mind and do the best that 281. During a nurse-client interaction, which nursing statement may belittle
you can.” the client’s feelings and concerns?
D. “Set a goal to continue to work on this aspect of your practice.” A. “Don’t worry. Everything will be alright.”
B. “You appear uptight.”
278. A student nurse is learning about the appropriate use of touch when C. “I notice you have bitten your nails to the quick.”
communicating with clients diagnosed with psychiatric disorders. Which D. “You are jumping to conclusions.”
statement by the instructor best provides information about this aspect of
therapeutic communication? 282. A client on an inpatient psychiatric unit tells the nurse, “I should have
died because I am totally worthless.” In order to encourage the client to
A. “Touch carries a different meaning for different individuals.” continue talking about feelings, which should be the nurse’s initial
B. “Touch is often used when deescalating volatile client situations.” response?
C. “Touch is used to convey interest and warmth.”
D. “Touch is best combined with empathy when dealing with anxious A. “How would your family feel if you died?”
clients.” B. “You feel worthless now, but that can change with time.”
C. “You’ve been feeling sad and alone for some time now?”
279. Which nursing statement is a good example of the therapeutic D. “It is great that you have come in for help.”
communication technique of focusing?
283. Which nursing response is an example of the nontherapeutic
A. “Describe one of the best things that happened to you this week.” communication block of requesting an explanation?
B. “I’m having a difficult time understanding what you mean.”
C. “Your counseling session is in 30 minutes. I’ll stay with you until A. “Can you tell me why you said that?”
then.” B. “Keep your chin up. I’ll explain the procedure to you.”
D. “You mentioned your relationship with your father. Let’s discuss C. “There is always an explanation for both good and bad behaviors.”
that further.” D. “Are you not understanding the explanation I provided?”
284. A client states, “You won’t believe what my husband said to me during C. Reflection and the defense mechanism of projection
visiting hours. He has no right treating me that way.” Which nursing D. Encouraging descriptions of perceptions and the defense
response would best assess the situation that occurred? mechanism of displacement

288. Which of the following individuals are communicating a

A. “Does your husband treat you like this very often?”
message? (Select all that apply.)
B. “What do you think is your role in this relationship?”
C. “Why do you think he behaved like that?” A. A mother spanking her son for playing with matches
D. “Describe what happened during your time with your husband.”
285. Which therapeutic communication technique should the nurse use B. A teenage boy isolating himself and playing loud music
when communicating with a client who is experiencing auditory
hallucinations? C. A biker sporting an eagle tattoo on his biceps

A. “My sister has the same diagnosis as you and she also hears voices.” D. A teenage girl writing, “No one understands me”
B. “I understand that the voices seem real to you, but I do not hear any
voices.” E. A father checking for new e-mail on a regular basis
C. “Why not turn up the radio so that the voices are muted.” 289. Adam is a 20-year-old student diagnosed of having obsessive-
D. “I wouldn’t worry about these voices. The medication will make compulsive behavior. A psychiatrist prescribes clomipramine (Anafranil) to
them disappear.” treat his condition. Nurse Anna understands the rationale for this treatment
is that the clomipramine:
286. Which nursing statement is a good example of the therapeutic A. increases dopamine levels.
communication technique of offering self? B. increases serotonin levels.
C. decreases norepinephrine levels.
A. “I think it would be great if you talked about that problem during D. decreases GABA levels.
our next group session.” 290. Nurse Sarah is developing a care plan for a female client with post-
B. “Would you like me to accompany you to your electroconvulsive traumatic stress disorder. Which of the following would she do initially?
therapy treatment?”
C. “I notice that you are offering help to other peers in the milieu.” A. Instruct the client to use distraction techniques to cope with
D. “After discharge, would you like to meet me for lunch to review flashbacks.
your outpatient progress?” B. Encourage the client to put the past in proper perspective.

287. A client slammed a door on the unit several times. The nurse responds, C. Encourage the client to verbalize thoughts and feelings about the
“You seem angry.” The client states, “I’m not angry.” What therapeutic trauma.
communication technique has the nurse employed and what defense
D. Avoid discussing the traumatic event with client.
mechanism is the client unconsciously demonstrating?
291. A group of community nurses sees and plans care for various clients
A. Making observations and the defense mechanism of suppression with different types of problems. Which of the following clients would they
B. Verbalizing the implied and the defense mechanism of denial consider the most vulnerable to post-traumatic stress disorder?
A. An 8 year-old boy with asthma who has recently failed a grade in school A. Accepting the client’s ritualistic behaviors
B. A 20 year-old college student with DM who experienced date rape
B. Challenging the client’s need for rituals
C. A 40 year-old widower who has recently lost his wife to cancer
D. A wife of an individual with a severe substance abuse problem C. Expressing concern about the harmfulness of the client’s rituals
292. Which outcome is most appropriate for Francis who has a dissociative
disorder? D. Limiting the client’s rituals that are excessive

A. Francis will deal with uncomfortable emotions on a conscious level. 297. Nurse Vicky is assessing a newly admitted client for symptoms of post-
B. Francis will modify stress with the use of relaxation techniques. traumatic stress disorder (PTSD). Which symptoms are typically seen with
C. Francis will identify his anxiety responses. this diagnosis? Select all that apply.
D. Francis will use problem-solving strategies when feeling stressed. A. Anger with numbing of other emotions
293. The psychiatric nurse uses cognitive-behavioral techniques when B. Exaggerated startle response
working with a client who experiences panic attacks. Which of the following C. Feeling that one is having a heart attack
techniques are common to this theoretical framework? Select all that apply. D. Frequent thoughts about contamination
A. Administering anti-anxiety medication as prescribed E. Frequent nightmares
B. Encouraging the client to restructure thoughts F. Survivor’s guilt
C. Helping the client to use controlled relaxation breathing 298. Jordanne is a client with a fear of air travel. She is being treated in a
D. Helping the client examine evidence of stressors mental institution for phobic disorder. The treatment method involves
E. Questioning the client about early childhood relationships systematic desensitization. The nurse would consider the treatment
F. Teaching the client about anxiety and panic successful if:
294. Marty is pacing and complains of racing thoughts. Nurse Lally asks the A. Jordanne plans a trip requiring air travel.
client if something upsetting happened, and Marty’s response is vague and B. Jordanne takes a short trip in an airplane.
not focused on the question. Nurse Lally assess Marty’s level of anxiety as: C. Jordanne recognizes the unrealistic nature of the fear of riding on
A. mild. airplanes.
B. moderate. D. Jordanne verbalizes a decreased fear about air travel.
C. severe. 299. Nurse Kerrick observes Toni who is hospitalized on an eating disorder
D. panic. unit during mealtimes and for 1 hour after eating. An explanation for this
295. Nurse Martha is teaching her students about anxiety medications, she intervention is:
explains that benzodiazepines affect which brain chemical? A. to develop trusting relationship.
A. Acetylcholine B. to maintain focus on importance of nutrition.
B. Gamma-aminobutyric acid (GABA) C. to prevent purging behaviors.
C. Norepinephrine D. to reinforce the behavioral contact.
D. Serotonin 300. Marlyn is diagnosed of anorexia nervosa and is admitted in the special
296. Mr. Johnson is newly admitted to a psychiatric unit because of severe eating disorder unit. The initial treatment priority for her is:
obsessive compulsive behavior. Which initial response by the nurse would A. to determine her current body image.
be most therapeutic for him?
 B. to identify family interaction patterns. 305. The psychoanalytic theory explains the etiology of anorexia nervosa as:
C. to initiate a refeeding program.
A. the achievement of secondary gain through control of eating.
D. to promote the client’s independence.
B. a conflict between mother and child over separation and
individualization.
301. The nurse evaluates the treatment of Mrs. Montez with somatoform
C. family dynamics that lead to enmeshment of members.
disorder as successful if:
D. the incorporation of thinness as an ideal body image.
A. Mrs. Montez practices self-medication rather than changing health 306. The school nurse assesses for anorexia nervosa in an adolescent girl.
care providers. Which of the following findings are characteristic of this disorder? Select all
B. Mrs. Montez recognizes that physical symptoms increase anxiety that apply.
level.
A. Bradycardia
C. Mrs. Montez researches treatment protocols for various illnesses.
B. Hypotension
D. Mrs. Montez verbalizes anxiety directly rather than displacing it.
C. Chronic pain in one or more sites
D. Fear of having a serious illness
302. Which of the following attitudes from a nurse would hinder a
E. Irregular or absent menses
discussion with an adolescent client about sexuality?
F. Refusal to maintain minimally normal weight
A. Accepting 307. During a mother’s class, the nurse who is teaching the participants on
B. Matter-of-fact stress management is questioned about the use of alternative treatments,
C. Moralistic such as herbal therapy and therapeutic touch. She explains that the
D. Non-judgemental advantage of these methods would include all of the following except:

A. they are congruent with many cultural belief systems.

303. Nurse David is planning a psychoeducational discussion for a group of
B. they encourage the consumer to take an active role in health
adolescent clients with anorexia nervosa. Which of the following topics
management.
would Nurse David select to enhance understanding about central issues in
C. they promote interrelationships within the mind-body-spirit.
this disorder?
D. they usually work better than traditional medical practice.
A. Anger management
B. Parental expectations 308. Nurse Kenzo is teaching a client about sertraline (Zoloft), which has
C. Peer pressure and substance abuse been prescribed for depression. A significant side effect is interference with
D. Self-control and self-esteem sexual arousal by inhibiting erectile function. How should the Nurse
304. Nurse Ginia understands that her client Glenda who is bulimic feels Kenzo approach this topic?
shame and guilt over binge eating and purging. This disorder is therefore
A. Nurse Kenzo should avoid mentioning the sexual side effects to
considered:
prevent the client from having anxiety about potential erectile
A. ego-distorting. problems.
B. ego-dystonic.
B. Nurse Kenzo should advise the client to report any changes in sexual
C. ego-enhancing.
functioning in case medication adjustments are needed.
D. ego-syntonic.
 C. Nurse Kenzo should explain that the client’s sexual desire will A. Call the therapist to request a medication change.
probably decrease while on this medication.
B. Encourage the use of learned relaxation techniques.
D. Nurse Kenzo should tell the client that sexual side effects are
expected, but that they will decrease when his depression lifts. C. Request that the client be hospitalized until the crisis is over.

309. Nurse Dorothy is evaluating care of a client with schizophrenia, the D. Wait before the anxiety worsens before intervening.
nurse should keep which point in mind? 313. Drogo who has had auditory hallucinations for many years tells Nurse
A. Frequent reassessment is needed and is based on the client’s Khally that the voices prevents his participation in a social skills training
response to treatment. program at the community health center. Which intervention is most
B. The family does not need to be included in the care because the appropriate?
client is an adult. A. Let Drogo analyze the content of the voices.
C. The client is too ill to learn about his illness. B. Advise Drogo to participate in the program when the voices cease.
D. Relapse is not an issue for a client with schizophrenia. C. Advise Drogo to take his medications as prescribed.
D. Teach Drogo to use thought stopping techniques.
310. Gio told his nurse that the FBI is monitoring and recording his every 314. Cersei is diagnosed as having disorganized schizophrenia. Which
movement and that microphones have been plated in the unit walls. Which behaviors would Nurse Sansa most likely assess in the client?
action would be the most therapeutic response?
A. Absence of acute symptoms, impaired role function
A. Confront the delusional material directly by telling Gio that this B. Extreme social withdrawal, odd mannerisms and behavior
simply is not so. C. Psychomotor immobility; presence of waxy flexibility
B. Tell Gio that this must seem frightening to him but that you believe D. Suspiciousness toward others, increased hostility
he is safe here.
C. Tell Gio to wait and talk about these beliefs in his one-on-one 315. Jaime has a diagnosis of schizophrenia with negative symptoms. In
counselling sessions. planning care for the client, Nurse Brienne would anticipate a problem with:
D. Isolate Gio when he begins to talk about these beliefs.
A. auditory hallucinations.
311. Which of the following client behaviors documented in Gio’s chart B. bizarre behaviors.
would validate the nursing diagnosis of Risk for other-directed violence? C. ideas of reference.
D. motivation for activities.
A. Gio’s description of being endowed with superpowers
B. Frequent angry outburst noted toward peers and staff 316. The family of a schizophrenic client asks the nurse if there is a genetic
C. Refusal to eat cafeteria food cause of this disorder. To answer the family, which fact would the nurse
D. Refusal to join in group activities cite?

312. Nurse Winona educates the family about symptom management for A. Conclusive evidence indicates a specific gene transmits the disorder.
when the schizophrenic client becomes upset or anxious. Which of the B. Incidence of this disorder is variable in all families.
following would Nurse Winona state is helpful?
 C. There is a little evidence that genes play a role in transmission. B. Age of onset is later than usual for schizophrenia.

D. Genetic factors can increase the vulnerability for this disorder. C. Age of onset is earlier than usual for schizophrenia.

317. Ramsay is diagnosed with schizophrenia paranoid type and is admitted D. Age of onset follows no predictable pattern in schizophrenia.
in the psychiatric unit of Medical Center. Which of the following nursing
321. Which factor is associated with increased risk for schizophrenia?
interventions would be most appropriate?
A. Alcoholism
A. Establishing a non-demanding relationship
B. Adolescent pregnancy
B. Encouraging involvement in group activities
C. Overcrowded schools
C. Spending more time with Ramsay
D. Poverty
D. Waiting until Ramsay initiates interaction
322. Nurse Arya assesses for evidence of positive symptoms of
318. A client tells the nurse that psychotropic medicines are dangerous and
schizophrenia in a newly admitted client. Which of the following symptoms
refuses to take them. Which intervention should the nurse use first?
are considered positive evidence? Select all that apply.
A. Ask the client about any previous problems with psychotropic
A. Anhedonia
medications.
B. Delusions
B. Ask the client if an injection is preferable.
C. Flat affect
C. Insist that the client take medication as prescribed.
D. Hallucinations
D. Withhold the medication until client is less suspicious.
E. Loose associations
319. Upon Sam’s admission for acute psychiatric hospitalization, Nurse Jona
documents the following: Client refuses to bathe or dress, remains in room F. Social withdrawal
most of the day, speaks infrequently to peers or staff. Which nursing
diagnosis would be the priority at this time? 323. A client with schizophrenia is referred for psychosocial rehabilitation.
Which of the following are typical of this type of program? Select all that
A. Anxiety apply.
B. Decisional conflict A. Analyzing family issues and past problems
C. Self-care deficit B. Developing social skills and supports
D. Social isolation C. Learning how to live independently in a community
320. Which statement is correct about a 25-year-old client with newly D. Learning job skills for employment
diagnosed schizophrenia?
E. Treating family members affected by the illness
A. Age of onset is typical for schizophrenia.
 F. Participating in in-depth psychoanalytical counselling 327. The depressed client verbalizes feelings of low self-esteem and self-
worth typified by statements such as “I’m such a failure… I can’t do anything
324. The nurse is planning activities for a client who has bipolar disorder
right!” The best nursing response would be:
with aggressive social behavior. Which of the following activities would be
most appropriate for this client? A. To tell the client this is not true; that we all have a purpose in life.

A. Ping pong B. To remain with the client and sit in silence; this will encourage the client
to verbalize feelings
B. Writing
C. To reassure the client that you know how the client is feeling and that
C. Chess
things will get better
D. Basketball
D. To identify recent behaviors or accomplishments that demonstrates skill
325. A client is admitted to the hospital with a diagnosis of major ability.
depression, severe, single episode. The nurse assesses the client and
328. A client with a diagnosis of major depression, recurrent with psychotic
identifies a nursing diagnosis of imbalanced nutrition related to poor
features is admitted to the mental health unit. To create a safe environment
nutritional intake. The most appropriate nursing intervention related to this
for the client, the nurse most importantly devises a plan of care that deals
diagnosis is:
specifically with the client’s:
A. Explain to the client the importance of a good nutritional intake
A. Disturbed thought processes
B. Weight the client 3 times per week before breakfast
B. Imbalanced nutrition
C. Report the nutritional concern to the psychiatrist and obtain a
C. Self-care deficit
nutritional consultation as soon as possible.
D. Deficient knowledge
D. Consult with the nutritionist, offer the client several small meals per
day, and schedule brief nursing interactions with the client during 329. A depressed client is ready for discharge. The nurse feels comfortable
these times. that the client has a good understanding of the disease process when the
client states:
326. In planning activities for the depressed client, especially during the
early stages of hospitalization, which of the following plans is best? A. “I’ll never let this happen to me again. I won’t let my boss or my job
or my family get to me!”
A. Provide an activity that is quiet and solitary to avoid increased
fatigue, such as working on a puzzle or reading a book. B. “It’s important for me to eat well, exercise, and to take my
medication. If I begin to lose my appetite or not sleep well, I’ve got
B. Plan nothing until the client asks to participate in milieu.
to get in to see my doctor.”
C. Offer the client a menu of daily activities and insist the client
C. “I’ve learned that I’m a good person and that I am worthy of giving
participate in all of them
and receiving love. I don’t need anyone; I have myself to rely on!”
D. Provide a structured daily program of activities and encourage the
client to participate.
 D. “I don’t know what happened to me. I’ve always been able to make
decisions for myself and for my business. I don’t ever want to feel so
weak or vulnerable again!”

330. The nurse assesses a client with the admitting diagnosis of bipolar
affective disorder, mania. The symptom presented by the client that
requires the nurse’s immediate intervention is the client’s:

A. Outlandish behaviors and inappropriate dress

B. Grandiose delusions of being a royal descendent of King Arthur.

C. Nonstop physical activity and poor nutritional intake

D. Constant, incessant talking that includes sexual innuendoes and

teasing the staff
 B. Tell the client that smoking privileges are revoked for 24 hours

C. Orient the client to time, person, and place

D. Tell the client that the behavior is not appropriate.

344. Select all nursing interventions for a hospitalized client with mania
who is exhibiting manipulative behavior.
341. The nurse reviews the activity schedule for the day and plans which
activity for the manic client? A. Communicate expected behaviors to the client

A. Brown-bag luncheon and book review B. Enforce rules and inform the client the he or she will not be allowed
to attend group therapy sessions.
B. Tetherball
C. Ensure that the client knows that he or she is not in charge of the
C. Paint-by-number activity
nursing unit
D. Deep breathing and progressive relaxation group
D. Be clear with the client regarding the consequences of exceeding
342. A hospitalized client is being considered for ECT. The client appears limits set regarding behavior.
calm, but the family is anxious. The client’s mother begins to cry and states
E. Assist the client in testing out alternative behaviors for obtaining
“My son’s brain will be destroyed. How can the doctor do this to him?” The
needs
nurses best response is:
345. A woman comes into the ER in a severe state of anxiety following a car
A. “It sounds as though you need to speak with the psychiatrist”
accident. The most appropriate nursing intervention is to:
B. “Your son has decided to have this treatment. You should be
A. Remain with the client
supportive to him.”
B. Put the client in a quiet room
C. “Perhaps you’d like to see the ECT room and speak to the staff.”
C. Teach the client deep breathing
D. “It sounds as though you have some concerns about the ECT
procedure. Why don’t we sit down together and discuss any D. Encourage the client to talk about their feelings and concern.
concerns you may have.”
346. When planning the discharge of a client with chronic anxiety, the nurse
343. The manic client announces to everyone in the dayroom that a stripper directs the goals at promoting a safe environment at home. The most
is coming to perform this evening. When the nurse firmly states that this will appropriate maintenance goal should focus on which of the following?
not happen, the manic client becomes verbally abusive and threatens
A. Continued contact with a crisis counselor
physical violence to the nurse. Based on the analysis of this situation, the
nurse determines that the most appropriate action would be to: B. Identifying anxiety-producing situations
A. With assistance, escort the manic client to her room and administer C. Ignoring feelings of anxiety
Haldol as prescribed if needed
D. Eliminating all anxiety from daily situations
 response to the substance abuse sessions. Which statement by the client
best indicates that the client has developed effective coping response styles
347. The nurse is monitoring a client who abuses alcohol for signs of alcohol
and has processed information effectively for self use?
withdrawal. Which of the following would alert the nurse to the potential
for delirium tremors? A. “I know I’m ready to be discharged. I feel I can say ‘no’ and leave a
group of friends if they are drinking… ‘No Problem.’”
A. Hypertension, changes in LOC, hallucinations
B. “This group has really helped a lot. I know it will be different when I
B. Hypotension, ataxia, hunger
go home. But I’m sure that my family and friends will all help me like
C. Stupor, agitation, muscular rigidity the people in this group have… They’ll all help me… I know they
will… They won’t let me go back to my old ways.”
D. Hypotension, coarse hand tremors, agitation
C. “I’m looking forward to leaving here. I know that I will miss all of
348. The spouse of a client admitted to the mental health unit for alcohol you. So, I’m happy and I’m sad, I’m excited and I’m scared. I know
withdrawal says to the nurse “I should get out of this bad situation.” The that I have to work hard to be strong and that everyone isn’t going
most helpful response by the nurse would be: to be as helpful as you people.”
A. “I agree with you. You should get out of this situation.” D. “I’ll keep all my appointments; go to all my AA groups; I’ll do
B. “What do you find difficult about this situation?” everything I’m supposed to… Nothing will go wrong that way.”

C. “Why don’t you tell your husband about this?” 351. A hospitalized client with a history of alcohol abuse tells the nurse, “I
am leaving now. I have to go. I don’t want anymore treatment. I have things
D. “This is not the best time to make that decision.” that I have to do right away.” The client has not been discharged. In fact, the
349. The nurse determines that the wife of an alcoholic client is benefiting client is scheduled for an important diagnostic test to be performed in 1
from attending Al-Anon group when she hears the wife say: hour. After the nurse discusses the client’s concerns with the client, the
client dresses and begins to walk out of the hospital room. The most
A. “My attendance at the meetings has helped me to see that I important nursing action is to:
provoke my husband’s violence.”
A. Restrain the client until the physician can be reached
B. “I no longer feel that I deserve the beatings my husband inflicts on
me.” B. Call security to block all areas

C. “I can tolerate my husband’s destructive behavior now that I know C. Tell the client that the client cannot return to this hospital again if
they are common with alcoholics.” the client leaves now.

D. “I enjoy attending the meetings because they get me out of the D. Call the nursing supervisor.
house and away from my husband.” 352. Select the appropriate interventions for caring for the client in alcohol
350. The client has been hospitalized and is participating in a substance withdrawal.
abuse therapy group sessions. On discharge, the client has consented to A. Monitor vital signs
participate in AA community groups. The nurse is monitoring the client’s
 B. Provide stimulation in the environment B. If the intake of carbohydrates increases, the lithium level increases.

C. Maintain NPO status C. If the intake of calories is reduced, the lithium level will increase

D. Provide reality orientation as appropriate D. If the intake of sodium increases, the lithium level will decrease.

E. Address hallucinations therapeutically 357. In conferring with the treatment team, the nurse should make which of
the following recommendations for a client who tells the nurse that
353. Which of the following nursing actions would be included in a care plan
everyday thoughts of suicide are present?
for a client with PTSD who states the experience was “bad luck”?
A. A no-suicide contract
A. Encourage the client to verbalize the experience
B. Weekly outpatient therapy
B. Assist the client in defining the experience
C. A second psychiatric opinion
C. Work with the client to take steps to move on with his life
D. Intensive inpatient treatment
D. Help the client accept positive and negative feelings
358. Which of the following short term goals is most appropriate for a client
354. Which of the following psychological symptoms would the nurse expect
with bipolar disorder who is having difficulty sleeping?
to find in a hospitalized client who is the only survivor of a train accident?
A. Obtain medication for sleep
A. Denial
B. Work on solving a problem
B. Indifference
C. Exercise before bedtime
C. Perfectionism
D. Develop a sleep ritual
D. Trust
359. Nurse Rob has observed a co worker arriving to work drunk at least
355. Which of the following communication guidelines should the nurse use
three times in the past month. Which action by Nurse Rob would best
when talking with a client experiencing mania?
ensure client safety and obtain necessary assistance for the co worker?
A. Address the client in a light and joking manner
A. Ignore the co worker’s behavior, and frequently assess the clients
B. Focus and redirect the conversation as necessary assigned to the co worker.

C. Allow the client to talk about several different topic B. Make general statements about safety issues at the next staff
meeting.
D. Ask only open ended questions to facilitate conversations
C. Report the coworker’s behavior to the appropriate supervisor.
356. What information is important to include in the nutritional counseling
of a family with a member who has bipolar disorder? D. Warn the co worker that this practice is unsafe.

A. If sufficient roughage isn’t eaten while taking lithium, bowel

problems will occur.
360. Elsa is being treated in a chemical dependency unit. She tells the nurse C. Gastrointestinal symptoms, such as nausea and vomiting
that she only uses drugs when under stress and therefore does not have a
D. Respiratory symptoms, such as cough and sore throat
substance problem. Which defense mechanism is the client using?
364. Nurse Wilma is teaching a client about disulfiram (Antabuse), which the
A. Compensation
client is taking to deter his use of alcohol. She explains that using alcohol
B. Denial when taking this medication can result in:

C. Suppression A. abdominal cramps and diarrhea.

D. Undoing B. drowsiness and decreased respiration.

361. Nurse Tara is teaching a community group about substance abuse. She C. flushing, vomiting, and dizziness.
explains that a genetic component has been implicated with which of the
D. increased pulse and blood pressure.
following commonly abused substances?
365. The nurse administers bromocriptine (Parlodel) to Bryan who is
A. Alcohol
undergoing detoxification for amphetamine abuse. The rationale for this
B. Barbiturates medication is to:

C. Heroin A. aid in GABA inhibition.

D. Marijuana B. prevent norepinephrine excess.

362. Nurse Julie recommends that the family of a client with substance- C. restore depleted dopamine levels.
related disorder attend a support group, such as Al Anon and Alateen. The
D. treat psychotic symptoms.
purpose of these groups is to help family members understand the problem
and to: 366. Which medication is commonly used in treatment programs for heroin
abusers to produce a non euphoric state and to replace heroin use?
A. change the problem behaviors of the abuser.
A. diazepam
B. learn how to assist the abuser in getting help.
B. carbamazepine
C. maintain focus on changing their own behaviors.
C. clonidine
D. prevent substance problems in vulnerable family members.
D. methadone
363. Ryan who is a chronic alcohol abuser is being assessed by Nurse Gina.
Which problems are related to thiamin deficiency? 367. Nurse Christine is teaching an adolescent health class about the
dangers of inhalant abuse; the nurse warns about the possibility of:
A. Cardiovascular symptoms, such as decreased hemoglobin and
hematocrit levels A. contracting an infectious disease, such as hepatitis or AIDS
B. CNS symptoms, such as ataxia and peripheral neuropathy B. recurrent flashback events
 C. psychological dependence after initial use B. Dopamine depletion

D. sudden death from cardiac or respiratory depression C. Serotonin inhibition

368. The newly hired nurse at Medical Center is assessing a client who D. Norepinephrine rebound
abuses barbiturates and benzodiazepine. The nurse would observe for
372. Kendall, the sister of a client with a substance-related disorder, tells
evidence of which withdrawal symptoms?
the nurse she calls out sick for her sister Kylie occasionally when the latter
A. Anxiety, tremors, and tachycardia has too much to drink and cannot work. this behavior can be described as:

B. Respiratory depression, stupor, and bradycardia A. caretaking.

C. Muscle aches, cramps, and lacrimation B. codependent.

D. Paranoia, depression, and agitation C. helpful.

369. The community nurse practicing primary prevention of alcohol abuse D. supportive.
would target which groups for educational efforts?
373. During an initial assessment of a client admitted to a substance abuse
A. Adolescents in their late teens and young adults in their early unit for detoxification and treatment, the nurse asks questions to determine
twenties patterns of use of substances. Which of the following questions are most
appropriate at this time? Select all that apply.
B. Elderly men who live in retirement communities
A. How long have you used substances?
C. Women working in careers outside the home
B. How often do you use substances?
D. Women working in the home
C. How do you get substances into your body?
370. Johnette is reviewing her lessons in Pharmacology. She is aware that
the general classification of drugs belonging to the opioid category is D. Do you feel bad or guilty about your use of substances?
analgesic and:
E. How much of each substances do you use?
A. depressant.
F. Have you ever felt you should cut down substance use?
B. hallucinogenic.
G. What substances do you use?
C. stimulant.
374) The nursing diagnosis that would be most appropriate for a 22-year
D. tranquilizing. old client who uses ritualistic behavior would be:

371. When a client abuses a CNS depressant, withdrawal symptoms will be A. Ineffective coping
caused by which of the following?
B. Impaired adjustment
A. Acetylcholine excess
C. personal identity disturbance
 D. Sensory/perceptual alterations A. Controlling anxiety

375) A psychiatrist prescribes an anti-obsessional agent for a client who is B. terminating the session on time
using ritualistic behavior. A common anti-anxiety medication used for this
C. Accepting the psychiatric diagnosis
type of client would be:
379. A client with a diagnosis of borderline personality disorder has negative
A. Fluvoxamine (Luvox)
feelings toward the other clients on the unit and considers them all to be
B. Benztropine (Cogentin) “bad.” The nurse understands this defense is known as:

C. Amantadine (Symmetrel) A. Splitting

D. Diphenhydramine (Benadryl) B. Ambivalence

376) A 20-year old college student has been brought to the psychiatric C. Passive aggression
hospital by her parents. Her admitting diagnosis is borderline personality
D. Reaction formation
disorder. When talking with the parents, which information would the nurse
expect to be included in the client’s history? Select all that apply. 380. The client with antisocial personality disorder:
A. Impulsiveness A. Suffers from a great deal of anxiety
B. Lability of mood B. Is generally unable to postpone gratification
C. Ritualistic behavior C. Rapidly learns by experience and punishment
D. psychomotor retardation D. Has a great sense of responsibility toward others
E. self-destructive behavior 381) A person with antisocial personality disorder has difficulty relating to
others because of never having learned to:
377) A hospitalized client, diagnosed with a borderline personality disorder,
consistently breaks the unit’s rules. This behavior should be confronted A. Count on others
because it will help the client:
B. Empathize with others
A. Control anger
C. Be dependent on others
B. reduce anxiety
D. Communicate with others socially
C. Set realistic goals
382) A young, handsome man with a diagnosis of antisocial personality
D. Become more self-aware disorder is being discharged from the hospital next week. He asks the nurse
for her phone number so that he can call her for a date. The nurse’s best
378) When working with the nurse during the orientation phase of the
response would be:
relationship, a client with a borderline personality disorder would probably
have the most difficulty in: A. “We are not permitted to date clients.”
 B. “No, you are a client and I am a nurse.” C. come back at 6:45, as a compromise to set limits

C. “I like you, but our relationship is professional.” D. Come back as soon as possible or the police will be sent

D. “It’s against my professional ethics to date clients.” 386) An adult client with a borderline personality disorder become
nauseated and vomits immediately after drinking after drinking 2 ounces of
383) When caring for a client with a diagnosis of schizotypal personality
shampoo as a suicide gesture. The most appropriate initial response by the
disorder, the nurse should:
nurse would be to:
A. Set limits on manipulative behavior
A. Promptly notify the attending physician
B. encourage participation in group therapy
B. Immediately initiate suicide precautions
C. Respect the client’s needs for social isolation
C. Sit quietly with the client until nausea and vomiting subsides
D. Understand that seductive behavior is expected.
D. Assess the client’s vital signs and administer syrup of ipecac
384) A nurse is orienting a new client to the unit when another client rushes
387) A nurse notices that a client is mistrustful and shows hostile behavior.
down the hallway and asks the nurse to sit down and talk. The client
Which of the following types of personality disorder is associated with these
requesting the nurse’s attention is extremely manipulative and uses socially
characteristics?
acting-out behaviors when demands are unmet. The nurse should:
A. Antisocial
A. Suggest that the client requesting attention speak with another staff
member B. Avoidant

B. Leave the new client and talk with the other client to avoid C. Borderline
precipitating acting out behavior
D. Paranoid
C. Tell the interrupting client to sit down and be patient, stating, “I’ll
388) Which of the following statements is typical for a client diagnosed with
be back as soon as possible.”
a personality disorder?
D. Introduce the two clients and suggest that the client join the new
A. “I understand you’re the one to blame.”
client and the nurse on the tour
B. “I must be seen first; it’s not negotiable.”
385) A client with a diagnosis of narcissistic personality disorder has been
given a day pass from the psychiatric hospital. The client is due to return at C. “I see nothing humorous in this situation.”
6pm. At 5pm the client telephones the nurse in charge of the unit and says
“6 o’clock is too early. I feel like coming back at 7:30.” The nurse would be D. “I wish someone would select the outfit for me.”
most therapeutic by telling the client to: 16) Which of the following characteristics is expected for a client with
A. Return immediately, to demonstrate control paranoid personality disorder who receives bad news?

B. Return on time or restrictions will be imposed A. The client is overly dramatic after hearing the facts
 B. The client focuses on self to not become over-anxious A. Lack of honesty

C. The client responds from a rational, objective point of view B. Belief in superstitions

D. The client doesn’t spend time thinking about the information. C. Show of temper tantrums

389) Which of the following types of behavior is expected from a client D. Constant need for attention
diagnosed with a paranoid personality disorder?
393) Which of the following characteristics or client histories substantiates a
A. Eccentric diagnosis of antisocial personality disorder?

B. exploitative A. Delusional thinking

C. Hypersensitive B. Feelings of inferiority

D. Seductive C. Disorganized thinking

390) Which of the following interventions is important for a client with D. Multiple criminal charges
paranoid personality disorder taking olanzapine (Zyprexa)?
394) A client with borderline personality disorder is admitted to the unit
A. Explain effects of serotonin syndrome after slashing his wrist. Which of the following goals is most important after
promoting safety?
B. Teach the client to watch for extrapyramidal adverse reactions
A. Establish a therapeutic relationship with the client
C. Explain that the drug is less effective if the client smokes
B. Identify whether splitting is present in the client’s thoughts
D. Discuss the need to report paradoxical effects such as euphoria.
C. Talk about the client’s acting out and self-destructive tendencies.
391) A client with antisocial personality is trying to convince a nurse that he
deserves special privileges and that an exception to the rules should be D. Encourage the client to understand why he blames others
made for him. Which of the following responses is the most appropriate?
395) Which of the following characteristics or situations is indicated when a
A. “I believe we need to sit down and talk about this.” client with borderline personality disorder has a crisis?

B. “Don’t you know better than to try to bend the rules?” A. Antisocial behavior

C. “What you’re asking me to do is unacceptable.” B. Suspicious behavior

D. “Why don’t you bring this request to the community meeting?” C. Relationship problems

392) A nurse notices other clients on the unit avoiding a client diagnosed D. Auditory hallucinations
with antisocial personality disorder. When discussing appropriate behavior
396) Which of the following assessment findings is seen in a client
in group therapy, which of the following comments is expected about this
diagnosed with borderline personality disorder?
client by his peers?
A. Abrasions in various healing stages
 B. intermittent episodes of hypertension C. Engage in daytime activities to stimulate wakefulness

C. Alternating tachycardia and bradycardia D. Have the client attend group therapy on a daily basis

D. Mild state of euphoria with disorientation 401) A nurse is assessing a client diagnosed with dependent personality
disorder. Which of the following characteristics is a major component to this
397) In planning care for a client with borderline personality disorder, a
disorder?
nurse must be aware that this client is prone to develop which of the
following conditions? A. Abrasive to others

A. Binge eating B. Indifferent to others

B. Memory loss C. Manipulative of others

C. Cult membership D. Overreliance on others

D. Delusional thinking 402) Which of the following information must be included for the family of a
client diagnosed with dependent personality disorder?
398) Which of the following statements is expected from a client with
borderline personality disorder with a history of dysfunctional relationships? A. Address coping skills

A. “I won’t get involved in another relationship.” B. Explore panic attacks

B. “I’m determined to look for the perfect partner.” C. Promote exercise programs

C. “I’ve decided to use better communication skills.” D. Decrease aggressive outbursts

D. “I’m going to be an equal partner in a relationship.” 403) Which of the following behaviors by a client with dependent
personality disorder shows the client has made progress toward the goal of
399) Which of the following conditions is likely to coexist in clients with a
increasing problem solving skills?
diagnosis of borderline personality disorder?
A. The client is courteous
A. Avoidance
B. The client asks questions
B. Delirium
C. The client stops acting out
C. Depression
D. The client controls emotions
D. Disorientation
404) A client with schizotypal personality disorder is sitting in a puddle of
400) Which of the following nursing interventions has priority for a client
urine. She’s playing in it, smiling, and softly singing a child’s song. Which
with borderline personality disorder?
action would be best?
A. Maintain consistent and realistic limits
A. Admonish the client for not using the bathroom
B. Give instructions for meeting basic self-care needs
 B. Firmly tell the client that her behavior is unacceptable D. The client has a history of parental alcoholism and chaotic, abusive
family life.
C. Ask the client if she’s ready to get cleaned up now
E. The client has no remorse about the inability to control his anger.
D. Help the client to the shower, and change the bedclothes.
408. Mr. Warren, an attorney who throws books and furniture around the
405) A client with avoidant personality disorder says occupational therapy is
office after losing a case is referred to the psychiatric nurse in the law firm’s
boring and doesn’t want to go. Which action would be best?
employee assistance program. Nurse Lorraine knows that the client’s
A. State firmly that you’ll escort him to OT. behavior most likely represents the use of which defense mechanism?

B. Arrange with OT for the client to do a project on the unit. A. Projection

B. Regression
C. Ask the client to talk about why OT is boring C. Intellectualization
D. Arrange for the client not to attend OT until he is feeling better D. Reaction-formation

406) A nurse discusses job possibilities with a client with schizoid personality 409. Brent is admitted to a psychiatric unit with a diagnosis of
disorder. Which suggestion by the nurse would be helpful? undifferentiated schizophrenia. Which of the following defense mechanisms
is probably used by Brent?
A. “You can work in a family restaurant part-time on the weekend and
holidays.” A. Regression
B. Repression
B. “Maybe your friend could get you that customer service job where C. Projection
you work only on the weekends.” D. Rationalization
C. “Your idea of applying for the position of filing and organizing 410. Nurse Raffy recognizes that paranoid delusions usually are related to
records is worth pursuing.” the defense mechanism of:
D. “Being an introvert limits the employment opportunities you can A. Regression
pursue.” B. Repression
407) When assessing a client diagnosed with impulse control disorder, the C. Identification
nurse observes violent, aggressive, and assaultive behavior. Which of the D. Projection
following assessment data is the nurse also likely to find? Select all that 411. Nurse Lucas is aware that the defense mechanism commonly used by
apply. clients who are alcoholics is:
A. The client functions well in other areas of his life. A. Displacement
B. The degree of aggressiveness is out of proportion to the stressor. B. Compensation
C. Denial
C. The violent behavior is mist often justified by the stressor. D. Projection
412. 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. Sublimation
B. Displacement
C. Projection
D. Rationalization