A1 PASSERS TRAINING, RESEARCH, Which of the following comments indicates chronic undifferentiated schizophrenia.

rentiated schizophrenia. student would agree to seek the

REVIEW and DEVELOPMENT that the client may be suffering from The nurse should assign highest priority to assistance of a professional substance
COMPANY anorexia which nursing abuse counselor.
PSYCHIATRIC NURSING nervosa? diagnosis? 5. A man is brought to the hospital by his
COMPREHENSIVE EXAM A. "I like the way I look. I just need to keep A. Anxiety wife, who states that for the past week her
my weight down because I'm a B. Impaired verbal communication husband has
cheerleader." C. Disturbed thought processes refused all meals and accused her of
1. A client with a history of substance B. "I don't like the food my mother cooks. I D. Self-care deficient: Dressing/grooming trying to poison him. During the initial
abuse has been attending Alcoholics eat plenty of fast food when I'm out with Rationale: For this client, the highest- interview, the client's
Anonymous meetings regularly in the my friends." priority nursing diagnosis is Anxiety speech, only partly comprehensible,
psychiatric unit. One afternoon, the client C. "I just can't seem to get down to the (severe to panic-level), reveals that his thoughts are controlled by
tells the nurse, "I'm not going to those weight I want to be. I'm so fat compared to manifested by the client's extreme delusions that he
meetings anymore. I'm not like the rest of other girls." withdrawal and attempt to protect himself is possessed by the devil. The physician
those people. I'm not a drunk. "What is the D. "I do diet around my periods; otherwise, from the diagnoses paranoid schizophrenia.
most appropriate response? I just get so bloated." environment. The nurse must act Schizophrenia is
A. "If you aren't an alcoholic, why do you Rationale: Low self-esteem is the highest immediately to reduce anxiety and protect best described as a disorder characterized
keep drinking and ending up in the risk factor for anorexia nervosa. Constant the client and others by:
hospital?" dieting to from possible injury. Impaired verbal A. disturbed relationships related to an
B. "It's your decision. If you don't want to get down to a "desirable weight" is communication, manifested by inability to communicate and think clearly.
go, you don't have to." characteristic of the disorder. Feeling noncommunicativeness; B. severe mood swings and periods of low
C. "You seem upset about the meetings." inadequate when Disturbed thought processes, evidenced to high activity.
D. "You have to go to the meetings. It's compared to peers indicates poor self- by inability to understand the situation; C. multiple personalities, one of which is
part of your treatment plan." esteem. Most clients with anorexia and Self-care more destructive than the others.
Rationale: The substance abuser uses nervosa don't like the deficient: Dressing/grooming, evidenced D. auditory and tactile hallucinations.
the substance to cope with feelings and way they look, and their self-perception by a disheveled appearance, are Rationale: Schizophrenia is best
may deny the may be distorted. A girl with cachexia may appropriate nursing described as one of a group of psychotic
abuse. Asking if the client is upset about perceive diagnoses but aren't the highest priority. reactions
the meetings encourages the client to herself to be overweight when she looks in 4. A high school student is referred to the characterized by disturbed relationships
identify and deal the mirror. Preferring fast food over school nurse for suspected substance with others and an inability to
with feelings instead of covering them up. healthy food is abuse. Following communicate and think
Arguing with the client about the common in this age-group. Because of the the nurse's assessment and interventions, clearly. Schizophrenic thoughts, feelings,
substance abuse absence of body fat necessary for proper what would be the most desirable and behavior commonly are evidenced by
(option A) or insisting that the client attend hormone outcome? withdrawal,
the meetings (option D) wouldn't help the production, amenorrhea is common in a A. The student discusses conflicts over fluctuating moods, disordered thinking,
client identify client with anorexia nervosa. drug use. and regressive tendencies. Severe mood
resistance to treatment. Option B isn't 3. A man with a 5-year history of multiple B. The student accepts a referral to a swings and
therapeutic behavior because it plays psychiatric admissions is brought to the substance abuse counselor. periods of low to high activity are typical of
down the importance emergency C. The student agrees to inform his bipolar disorder. Multiple personality,
of attending meetings. department by the police. He was found parents of the problem. sometimes
2. A 15-year-old client is brought to the wandering the streets disheveled, D. The student reports increased comfort confused with schizophrenia, is a
clinic by her mother. Her mother shoeless, and with making choices dissociative personality disorder, not a
expresses concern about confused. Based on his previous medical Rationale: All of the outcomes stated are psychotic illness. Many
her daughter's weight loss and constant records and current behavior, he is desirable; however, the best outcome is schizophrenic clients have auditory
dieting. The nurse conducts a health diagnosed with that the hallucinations; tactile hallucinations are
history interview. more common in
organic or toxic disorders.
6. Clients receiving monoamine oxidase approval. Pointing out mistakes can make lethargy. Lithium doesn't cause weakness, D. "You're having a panic attack. I'll stay
inhibitor antidepressants must avoid a client defensive. The client-nurse tremor, urine retention, anxiety, here with you
tyramine, a relationship isn't restlessness, sleep Rationale: During a panic attack, the
compound found in which of the following the place for the nurse to offer advice or disturbance, constipation, or ataxia. nurse's best approach is to orient the
foods? an opinion. It also isn't the place for the 11. When caring for an adolescent client client to what is
A. Aged cheese and Chianti wine nurse to diagnosed with depression, the nurse happening and provide reassurance that
B. Green leafy vegetables verbalize her own feelings. The client should remember the client won't be left alone. The anxiety
C. Figs and cream cheese needs assistance in developing coping that depression manifests differently in level is likely to
D. Fruits and yellow vegetables skills, not someone adolescents and adults. In an adolescent, increase and the panic attack is likely to
Rationale: Aged cheese and Chianti wine to solve problems for him signs and continue if the client is told to calm down
contain high concentrations of tyramine. 9. A client with paranoid type symptoms of depression are likely to (as in option A),
The other schizophrenia becomes angry and tells include: asked the reasons for the attack (as in
foods listed are low in tyramine the nurse to leave him A. helplessness, hopelessness, option B), or left alone (as in option C
7. During the assessment stage, a client alone. The nurse should: hypersomnolence, and anorexia. 13. Which foods are contraindicated for a
with schizophrenia leaves his arm in the A. tell him that she'll leave for now but will B. truancy, a change of friends, social client taking tranylcypromine (Parnate)?
air after the return soon. withdrawal, and oppositional behavior. A. Whole grain cereals and bagels
nurse has taken his blood pressure. His B. ask him if it's okay if she sits quietly C. curfew breaking, stealing from family B. Chicken livers, Chianti wine, and beer
action shows evidence of: with him. members, truancy, and oppositional C. Oranges and vodka
A. somatic delusions. C. ask him why he wants to be left alone. behavior. D. Chicken, rice, and apples
B. waxy flexibility. D. tell him that she won't let anything D. hypersomnolence, obsession with body Rationale: A client taking a monoamine
C. neologisms. happen to him. image, and valuing of peers' opinions oxidase inhibitor antidepressant, such as
D. nihilistic delusions Rationale: If the client tells the nurse to Rationale: In adolescents, depression tranylcypromine (Parnate), shouldn't eat
Rationale: The correct answer is waxy leave, the nurse should leave but let the typically manifests as truancy, a change of foods containing tyramine. Such foods
flexibility, which is defined as retaining any client know that friends, social include chicken
position that she'll return so that he doesn't feel withdrawal, and oppositional behavior. In livers, Chianti wine, beer, ale, aged game
the body has been placed in. Somatic abandoned. Not heeding the client's adults, it usually produces helplessness, meats, broad beans, aged cheeses, sour
delusions involve a false belief about the request can agitate him hopelessness, cream,
functioning of the further. Also, challenging the client isn't hypersomnolence, and anorexia. Drug use avocados, yogurt, pickled herring, yeast
body. Neologisms are invented therapeutic and may increase his anger. may lead to curfew breaking, stealing, extract, chocolate, excessive caffeine,
meaningless words. Nihilistic delusions False truancy, and vanilla, and soy
are false ideas about self, reassurance isn't warranted in this oppositional behavior. Adolescents sauce. The client also must refrain from
others, or the world situation. normally display hypersomnolence, an taking cold and hay fever preparations that
8. Which of the following statements 10. The physician orders lithium carbonate obsession with body contain
accurately describes therapeutic (Lithonate) for a client who's in the manic image, and valuing of peers' opinions. vasoconstrictive agents.
communication? phase of 12. During the admission assessment, a 14. Which is the drug of choice for treating
A. Offering advice and your opinion bipolar disorder. During lithium therapy, client with a panic disorder begins to Tourette syndrome?
B. Not verbalizing your feelings the nurse should watch for which adverse hyperventilate and A. fluoxetine (Prozac)
C. Avoiding advice, judgment, false reactions? says, "I'm going to die if I don't get out of B. fluvoxamine (Luvox)
reassurance, and approval A. Weakness, tremor, and urine retention here right now!" What is the nurse's best C. haloperidol (Haldol)
D. Telling the client how to cope B. Anxiety, restlessness, and sleep response? D. paroxetine (Paxil
Rationale: The goal of therapeutic disturbance A. "Just calm down. You're getting overly Rationale: Haloperidol is the drug of
communication is to help the client C. Constipation, lethargy, and ataxia anxious." choice for treating Tourette syndrome.
develop insight and skills D. Nausea, diarrhea, tremor, and lethargy B. "What do you think is causing your Prozac, Luvox, and
to solve his own problems. This is done by Rationale: The most common adverse panic attack?" Paxil are antidepressants and aren't used
avoiding advice, judgment, false effects of lithium are nausea, diarrhea, C. "You can rest alone in your room until to treat Tourette syndrome.
reassurance, and tremor, and you feel better."
Which of the following etiologic factors awareness. Repression is the B. The nurse and client evaluate and during each shift
predispose a client to Tourette syndrome? unconscious exclusion of painful episodes modify the goals of the relationship. D. Telling the client of the nurse's concern
15. Low doses of central nervous system from awareness. C. The nurse and client discuss their for her health and desire to help her make
(CNS) depressants produce an initial 17. A client visits the physician's office to feelings about terminating the relationship. decisions to
excitatory seek treatment for depression, feelings of D. The nurse and client explore each keep her healthy
response. This reaction is caused by: hopelessness, poor appetite, insomnia, other's expectations of the relationship. Rationale: A client with anorexia nervosa
A. a stimulating effect on the CNS. fatigue, low self-esteem, poor Rationale: The therapeutic nurse-client has an unrealistic body image that causes
B. the depression of acetylcholine. concentration, and difficulty relationship consists of four phases: consumption of little or no food. Therefore,
C. the stimulation of dopamine by making decisions. The client states that preinteraction, the client needs assistance with making
depressant drugs. these symptoms began at least 2 years introduction or orientation, working, and decisions
D. inhibitory synapses in the brain being ago. Based on termination. During the working phase, the about health. Instead of protecting the
depressed before excitatory synapses. this report, the nurse suspects: nurse and client's health, options A, B, and C may
Rationale: Excitation can occur when A. cyclothymic disorder. client evaluate and refine the goals serve to make the
inhibitory synapses are depressed. The B. atypical affective disorder. established during the orientation phase. client defensive and more entrenched in
other options are C. major depression. In addition, major her unrealistic body image.
incorrect because depressants don't D. dysthymic disorder. therapeutic work takes place and insight is 20. The nurse is caring for a client, a
stimulate the CNS or dopamine and don't Rationale: Dysthymic disorder is marked integrated into a plan of action. The Vietnam veteran, who exhibits signs and
depress by feelings of depression lasting at least 2 orientation phase symptoms of
acetylcholine. years, involves assessing the client, formulating posttrauma syndrome. Signs and
16.Upon returning home from work, a accompanied by at least two of the a contract, exploring feelings, and symptoms of posttrauma syndrome
young man discovers that his mother has following symptoms: sleep disturbance, establishing include:
been in a serious appetite disturbance, expectations about the relationship. A. hyperalertness and sleep disturbances.
automobile accident. Initially, he responds low energy or fatigue, low self-esteem, During the termination phase, the nurse B. memory loss of traumatic event and
to the news by stating, "No, I don't believe poor concentration, difficulty making prepares the client somatic distress.
it. It can't be decisions, and for separation and explores feelings about C. feelings of hostility and violent
true." Which defense mechanism is he hopelessness. These symptoms may be the end of the relationship behavior.
using? relatively continuous or separated by 19. A client with anorexia nervosa D. sudden behavioral changes and
A. Introjection intervening periods describes herself as "a whale." However, anorexia
B. Suppression of normal mood that last a few days to a the nurse's Rationale: Signs and symptoms of
C. Denial few weeks. Cyclothymic disorder is a assessment reveals that the client is 5′ 8" posttrauma syndrome include
D. Repression chronic mood (1.7 m) tall and weighs only 90 lb (40.8 hyperalertness, sleep
Rationale: Denial is the avoidance of disturbance of at least 2 years' duration kg). disturbances, exaggerated startle, survival
reality by ignoring or refusing to marked by numerous periods of Considering the client's unrealistic body guilt, and memory impairment. Also, the
acknowledge unpleasant depression and image, which intervention should be client relives
incidents. This defense mechanism is hypomania. Atypical affective disorder is included in the plan the traumatic event through dreams and
used to allay anxiety immediately after a characterized by manic signs and of care? recollections. Hostility, violent behavior,
stressful event. symptoms. Major A. Asking the client to compare her figure and anorexia
Introjection is an intense form of depression is a recurring, persistent with magazine photographs of women her aren't usual signs or symptoms of
identification in which one incorporates the sadness or loss of interest or pleasure in age posttraumatic stress disorder.
values or qualities of almost all activities, B. Assigning the client to group therapy in 21. A client is admitted to the psychiatric
another person or group into one's own with signs and symptoms recurring for at which participants provide realistic unit with a diagnosis of conversion
ego structure. Suppression is the least 2 weeks. feedback about her disorder. Since
conscious analog of 18. What occurs during the working phase weight witnessing the beating of his wife at
repression. A person intentionally uses of the nurse-client relationship? C. Confronting the client about her actual gunpoint, he has been unable to move his
suppression to consciously exclude A. The nurse assesses the client's needs appearance during one-on-one sessions, arms, complaining
material from and develops a plan of care. scheduled
that they are paralyzed. When planning schizophrenia? psychomotor behavior. Loss of identity C. Withhold the next dose and repeat the
the client's care, the nurse should focus A. Extreme social impairment sometimes occurs but is only one laboratory test.
on: B. Suspicious delusions characteristic of the D. Continue to administer the medication
A. helping the client identify and verbalize C. Waxy flexibility disorder. Multiple personalities typify as ordered.
feelings about the incident. D. Elevated affect multiple personality disorder, a Rationale: The serum lithium level should
B. convincing the client that his arms Rationale: Disorganized type dissociative personality be maintained between 1 and 1.4 mEq/L
aren't paralyzed. schizophrenia (formerly called disorder. Mood disorders are commonly during the
C. developing rehabilitation strategies to hebephrenia) is characterized by accompanied by increased or decreased acute manic phase; therefore, the nurse
help the client learn to live with the extreme social impairment, marked self-esteem. should continue to administer the
disability. inappropriate affect, silliness, grimacing, Schizophrenia doesn't cause a medication as ordered.
D. talking about topics other than the posturing, and disturbance in sensorium, although the Unless the client has signs or symptoms
beating to avoid causing anxiety. fragmented delusions and hallucinations. client may exhibit of lithium toxicity, the nurse has no need
Rationale: In conversion disorder, the A client with a paranoid disorder typically confusion, disorientation, and memory to call the
client represses and converts emotional exhibits impairment during the acute phase. physician, withhold the medication, or
conflicts into suspicious delusions, such as a belief that 24. The nurse who uses self-disclosure repeat the laboratory test. Nonetheless,
motor, sensory, or visceral symptoms with evil forces are after him. Waxy flexibility, a should: the nurse should
no physiologic cause. Interventions should condition in A. refocus on the client's experience as continue to monitor the client's serum
focus on which the client's limbs remain fixed in quickly as possible. lithium level and watch for indications of
helping the client identify the underlying uncomfortable positions for long periods, B. allow the client to ask questions about toxicity if the level
emotional problem. A client with characterizes the nurse's experience. begins to rise
conversion disorder catatonic schizophrenia. Elevated affect is C. discuss the nurse's experience in 26. A client has been severely depressed
can't be convinced that the physical associated with schizoaffective disorder. detail. since her husband died 6 months ago. Her
problem isn't real; attempts to convince 23. A client is admitted to the psychiatric D. have the client explain his or her physician
him may lead him to unit with active psychosis. The physician perception of what the nurse has revealed. prescribes amitriptyline (Elavil), 50 mg by
seek other health care providers who may diagnoses Rationale: The nurse's self-disclosure mouth daily. Before administering
accept the reality of his symptoms. schizophrenia after ruling out several other should be brief and to the point so that the amitriptyline, the
Treating the conditions. Schizophrenia is characterized interaction can nurse reviews the client's medical history.
physical symptoms as long-term or by: be refocused on the client's experience. Which preexisting condition would require
permanent may encourage the client to A. loss of identity and self-esteem. Because the client is the focus of the cautious use
maintain them. B. multiple personalities and decreased nurse-client of this drug?
Ignoring the cause of the symptoms would self-esteem. relationship, the discussion shouldn't dwell A. Hiatal hernia
prevent the client from dealing with his C. disturbances in affect, perception, and on the nurse's own experience B. Hypernatremia
feelings about thought content and form. 25. A client is admitted to the local C. Hepatic disease
his wife's beating. D. persistent memory impairment and psychiatric facility with bipolar disorder in D. Hypokalemia
22. A client with disorganized type confusion the manic phase. Rationale: Conditions requiring cautious
schizophrenia has been hospitalized for Rationale: The Diagnostic and Statistic The physician decides to start the client on use of amitriptyline include pregnancy,
the past 2 years on a Manual of Mental Disorders, 4th edition, lithium carbonate (Lithonate) therapy. One breast-feeding,
unit for chronic mentally ill clients. The defines week after suicidal tendencies, cardiovascular
client's behavior is labile and fluctuates schizophrenia as a disturbance in multiple this therapy starts, the nurse notes that disease, and impaired hepatic function.
from childishness psychological processes that affects the client's serum lithium level is 1 mEq/L. Hiatal hernia,
and incoherence to loud yelling to slow but thought content What should hypernatremia, and hypokalemia don't
appropriate interaction. The client needs and form, perception, affect, sense of self, the nurse do? affect amitriptyline therapy
assistance volition, relationship to the external world, A. Call the physician immediately to report 27. The nurse is caring for a client with
with all activities of daily living. Which and the laboratory result. hypochondriasis. Which behavior would
behavior is characteristic of disorganized B. Observe the client closely for signs and the nurse be
type symptoms of lithium toxicity. most likely to encounter?
A. Ready acceptance of the physician's in caring for any suicidal client. The nurse prepare the client for termination. The Rationale: The nurse should prepare a
explanation that all medical and laboratory can address the client's hopelessness, client's ability to tolerate the end of a client for ECT in a manner similar to that
tests are ineffective relationship shouldn't for general
normal coping, and spiritual distress later in dictate its timing. Because many clients anesthesia. For example, the client should
B. Expression of fear of dying after being therapy have had negative experiences when receive nothing by mouth for 8 hours
diagnosed with advanced breast cancer 29. What herbal medication for ending before ECT to
C. Expression of fear of colorectal cancer depression, widely used in Europe, is now relationships, the nurse can use reduce the risk of vomiting and aspiration.
following 3 days of constipation being prescribed in the termination of the nurse-client relationship Also, the nurse should have the client void
D. Lack of concern about having a serious United States? to prepare the client before
disease A. Ginkgo biloba for and work the client through positive treatment to decrease the risk of
Rationale: The client with B. Echinacea termination experiences with others. involuntary voiding during the procedure;
hypochondriasis is preoccupied with C. St. John's wort 31. The nurse at a substance abuse remove any full
having a serious disease. She D. Ephedra center answers the phone. A probation dentures, glasses, or jewelry to prevent
may convince herself that a relatively Rationale: St. John's wort has been found officer asks if a client breakage or loss; and make sure the client
minor symptom, such as constipation, is a to have serotonin-elevating properties, is in treatment. The nurse responds, "No, is wearing a
sign of a serious similar to the client you're looking for isn't here." hospital gown or loose-fitting clothing to
disorder. The client's fear of serious illness prescription antidepressants. Ginkgo Which of the allow unrestricted movement. Usually,
persists, even after a physician reassures biloba is prescribed to enhance mental following statements best describes the these preparations
her that all acuity. Echinacea nurse's response? aren't indicated for a client undergoing
medical and laboratory tests are normal. has immune-stimulating properties. A. Correct because she didn't give out physical therapy, neurologic examination,
The fear of dying after receiving a Ephedra is a naturally occurring stimulant information about the client or cardiac stress
diagnosis of that is similar to B. A violation of confidentiality because testing
advanced breast cancer wouldn't be ephedrine. she informed the officer that the client 33. A client tells the nurse that the
considered hypochondriasis. A client with 30. When should the nurse introduce wasn't there television newscaster is sending a secret
hypochondriasis information about the end of the nurse- C. A breech of the principle of veracity message to her. The
shows an exaggerated level of anxiety, client relationship? because the nurse is misleading the nurse suspects the client is experiencing:
rather than a lack of concern about having A. During the orientation phase officer A. a delusion.
a serious B. As the goals of the relationship are D. Illegal because she's withholding B. flight of ideas.
disease or illness. reached information from law enforcement agents C. ideas of reference.
28. After an upsetting divorce, a client C. At least one or two sessions before the Rationale: The nurse violated D. a hallucination.
threatens to commit suicide with a last meeting confidentiality by informing the officer that Rationale: Ideas of reference refers to the
handgun and is D. When the client can tolerate it the client wasn't in mistaken belief that neutral stimuli have
involuntarily admitted to the psychiatric Rationale: Preparation for ending the treatment. Even with law enforcement special
unit with major depression. Which nursing nurse-client relationship should begin agents, the nurse must be a client meaning to the individual such as the
diagnosis takes during the advocate and protect television newscaster sending a message
highest priority for this client? orientation phase, when the limits of the the client's confidentiality. Information can directly to the
A. Hopelessness related to recent divorce relationship are established. Termination be legally withheld when a court order isn't individual. A delusion is a false belief.
B. Ineffective individual coping related to should also be in place. Flight of ideas is a speech pattern in which
inadequate stress management discussed as goals are achieved and the 32. Nursing preparations for a client the client skips
C. Spiritual distress related to conflicting relationship nears an end. Although the undergoing electroconvulsive therapy from one unrelated subject to another. A
thoughts about suicide and sin nurse should (ECT) resemble those hallucination is a sensory perception, such
D. Risk for violence: Self-directed related remind the client that only one or two used for as hearing
to planning to commit suicide by handgun sessions are left, the nurse must not wait A. physical therapy. voices and seeing objects, that only the
Rationale: Although all of these options until then to B. neurologic examination. client experiences.
may apply to this client, safety is the C. general anesthesia.
nurse's first priority D. cardiac stress testing.
34. A client in an acute care mental health B. Mood disorder D. Standing up for your rights while message. Appearance refers to the way a
program refuses his morning dose of an C. Thought disorder respecting the rights of others person looks. Kinesics involves body
oral D. Amnestic disorder Rationale: The basic element of assertive language or
antipsychotic medication and believes he's Rationale: According to the DSM-IV, behavior includes the ability to express movement. Proxemics is the use of spatial
being poisoned. The nurse should schizoaffective disorder refers to clients your feelings relationships (the distance between
respond by taking suffering from and thoughts while respecting the rights of people) during
which of the following actions? schizophrenia with elements of a mood others. Options A and B describe interaction to communicate meaning.
A. Administering the medication by disorder, either mania or depression. The aggressive behavior, 41. The nurse is caring for a client who
injection prognosis is and option C describes passive behavior. has been diagnosed with hypochondriasis.
B. Omitting the dose and trying again the generally better than for the other types of 39. Which psychosocial influence has The client
next day schizophrenia, but it's worse than the been causally related to the development attributes his cough to tuberculosis. A
C. Crushing the medication and putting it prognosis for a of aggressive chest X-ray and skin test are negative for
in his food mood disorder alone. Option A is incorrect behavior and conduct disorder? tuberculosis. The
D. Consulting with the physician about a because personality disorders and A. An overbearing mother client begins to complain about the
plan of care. psychotic illness B. Rejection by peers sudden onset of chest pain. How should
Rationale: To determine a plan of care for aren't listed together on the same axis. C. A history of schizophrenia in the family the nurse react
clients who are noncompliant with Option C is incorrect because D. Low socioeconomic status initially?
medications, the schizophrenia is a major Rationale: Studies indicate that children A. Let the client know the nurse
nurse should consult with the physician. thought disorder and the question asks for who are rejected by their peers are more understands his fears of serious illness.
Unless the client presents a danger to elements of another disorder. Clients with likely to B. Encourage the client to discuss his fear
himself or others, schizoaffective disorder aren't suffering behave aggressively. Aggression and of having a serious illness.
medications can't be forced on a client. from schizophrenia and an amnestic conduct disorder are represented in all C. Report the complaint of chest pain to
Intentionally deceiving or misleading a disorder socioeconomic the physician.
client violates the 37. Which of the following medications groups. Schizophrenia and an overbearing D. Determine if the illness is fulfilling a
therapeutic relationship. would the nurse expect the physician to mother haven't been associated with psychological need for the client.
35. Nursing care for a client after order to reverse a aggression or Rationale: Because of the risk of missing
electroconvulsive therapy (ECT) should dystonic reaction? conduct disorder. an actual medical problem, any new
include A. prochlorperazine (Compazine) 40. The nurse has been caring for a client symptoms
A. nothing by mouth for 24 hours after the B. diphenhydramine (Benadryl) with chronic paranoid schizophrenia for reported by a client with hypochondriasis
treatment because of the anesthetic C. haloperidol (Haldol) several should be reported to the physician. The
agent. D. midazolam (Versed) months, including several one-to-one other
B. bed rest for the first 8 hours after a Rationale: Diphenhydramine, 25 to 50 mg sessions. During one session, the client interventions are appropriate after the
treatment. I.M. or I.V., would quickly reverse this seems more nurse has determined that the client
C. assessment of short-term memory loss. condition. anxious than usual, speaking rapidly and doesn't have a serious
D. no special care. Prochlorperazine and haloperidol are both loudly as the session starts. This behavior medical disorder.
Rationale: The nurse must assess the capable of causing dystonia, not reversing indicates a 42. Additive central nervous system (CNS)
level of short-term memory loss. The client it. possible change in which form of depression can occur when combining a
might need to Midazolam would make this client drowsy. communication? sedativehypnotic
be reoriented. The client can get out of 38. Assertive behavior involves which of A. Appearance with which of the following drugs?
bed and eat as soon as he feels the following elements? B. Kinesics A. methylphenidate (Ritalin)
comfortable. A. Saying what is on your mind at the C. Paralanguage B. cocaine
36. A client diagnosed with schizoaffective expense of others D. Proxemics C. amitriptyline (Elavil)
disorder is suffering from schizophrenia B. Expressing an air of superiority Rationale: Paralanguage is the use of D. amphetamine (Adderall)
with elements C. Avoiding unpleasant situations and vocal effects, such as tone and tempo, to Rationale: Additive effects occur with
of which of the following disorders? circumstances convey a concomitant use of CNS depressants,
A. Personality disorder antihistamines,
antidepressants, and antipsychotics. Elavil Rationale: Lithium carbonate, an incessantly. She becomes extremely D. ensure safety by initiating suicide
is an antidepressant and the only correct antimania drug, is used to treat clients with anxious whenever the earthquake is precautions.
answer. All cyclical mentioned and must Rationale: The nurse's first priority is to
the other drugs are classified as schizoaffective disorder, a psychotic leave the room if people talk about it. The keep a suicidal client safe and alive.
stimulants. disorder once classified under nurse suspects that she has: Although
43. Which statement about somatoform schizophrenia that causes A. phobic disorder. establishing a rapport and promoting trust
pain disorder is accurate? affective symptoms, including maniclike B. conversion disorder. are important in psychiatric nursing,
A. The pain is intentionally fabricated by activity. Lithium helps control the affective C. posttraumatic stress disorder (PTSD). neither is the
the client to receive attention. component of D. adjustment disorder. highest priority. Using restraints is
B. The pain is real to the client, even this disorder. Phenelzine is a monoamine Rationale: PTSD may occur in survivors inappropriate and could be interpreted as
though there may not be an organic oxidase inhibitor prescribed for clients who of earthquakes and other events outside punishment of the
etiology for the pain. don't the range of client or a convenience for the nurse.
C. The pain is less than would be respond to other antidepressant drugs usual human experience. Typically, the Trying to communicate in writing is also
expected from what the client identifies as such as imipramine. Chlordiazepoxide, an victim repeatedly relives the event inappropriate
the underlying antianxiety mentally and exhibits because the client can hear.
disorder. agent, generally is contraindicated in numbed emotional responsiveness and 48. Which of the following is an example
D. The pain is what would be expected psychotic clients. Imipramine, primarily difficulty concentrating. PTSD also may of the role of the psychiatric nurse in
from what the client identifies as the considered an cause an inability primary
underlying disorder antidepressant agent, is also used to treat to function in daily life, memory prevention?
Rationale: In a somatoform pain disorder, clients with agoraphobia and those impairment, chronic anxiety, insomnia, A. Handling crisis intervention in an
the client has pain even though a thorough undergoing and hyperalertness. In a outpatient setting
diagnostic cocaine detoxification. phobic disorder, the client fears an object B. Visiting a client's home to discuss
work-up reveals no organic cause. The 45. Which of the following medical or situation that doesn't present any real medication management
nurse must recognize that the pain is real conditions is commonly found in clients danger. C. Conducting a postdischarge support
to the client. By with bulimia nervosa? Conversion disorder typically causes group
refusing to believe that the client is in pain, A. Allergies changes or losses in physical function that D. Providing sexual education classes for
the nurse impedes the development of a B. Cancer suggest a adolescents
therapeutic C. Diabetes mellitus physical disorder but actually are Rationale: The psychiatric nurse
relationship based on trust. While D. Hepatitis A expressions of a psychological conflict. In participates in primary, secondary, and
somatoform pain offers the client Rationale: Bulimia nervosa can lead to adjustment disorder, tertiary prevention
secondary gains, such as many complications, including diabetes, the stressor usually is less severe than in activities. Primary prevention includes
attention or avoidance of an unpleasant heart disease, PTSD and is within the range of usual providing sexual education classes for
activity, the pain isn't intentionally and hypertension. The eating disorder isn't experience. adolescents and
fabricated by the client. typically associated with allergies, cancer, 47. A client is transferred to the locked education programs that promote mental
Even if a pathological cause of the pain or hepatitis psychiatric unit from the emergency health and prevent future psychiatric
can be identified, the pain is often in A. department after episodes.
excess of what 46. A client who lost her home and dog in attempting suicide by taking 200 Secondary prevention involves treatment
would normally be expected. an earthquake tells the admitting nurse at acetaminophen (Tylenol) tablets. Now the to reduce psychiatric problems (for
44. Which nonantipsychotic medication is the client is awake and example, handling
used to treat some clients with community health center that she finds it alert but refuses to speak with the nurse. crisis intervention in an outpatient setting,
schizoaffective harder and harder to "feel anything." She In this situation, the nurse's first priority is administering and supervising medication
disorder? says she can't to: regimens,
A. phenelzine (Nardil) concentrate on the simplest tasks, fears A. establish a rapport to foster trust. and participating in the therapeutic milieu).
B. chlordiazepoxide (Librium) losing control, and thinks about the B. place the client in full leather restraints. Tertiary prevention involves helping clients
C. lithium carbonate (Lithane) earthquake C. try to communicate with the client in who are
D. imipramine (Tofranil) writing.
recovering from psychiatric illness; should focus on the client's feelings, rather D. To help the client participate in group minutes) and removing potentially
activities directed toward providing than the content of the hallucination. therapy dangerous objects. Continuous
aftercare and rehabilitation 50. A client with schizophrenia tells the Rationale: A client with panic disorder observation is more effective
are part of this role. Conducting a nurse he hears the voices of his dead typically confines movements to than physical restraints, which are
postdischarge support group is a tertiary parents. To help increasingly smaller reserved for clients who are physically
prevention activity. the client ignore the voices, the nurse areas to avoid confronting fears, which violent and out of
49. The nurse is caring for a client with should recommend that he: may dominate the client's life and limit control.
schizophrenia who experiences auditory A. sit in a quiet, dark room and everyday activities. 53. Nursing care for a client with
hallucinations. concentrate on the voices. The overall goal of care is to help the schizophrenia must be based on valid
The client appears to be listening to B. listen to a personal stereo through client function within the environment as psychiatric and nursing
someone who isn't visible. He gestures, headphones and sing along with the effectively as theories. The nurse's interpersonal
shouts angrily, and music. possible. Panic disorder with agoraphobia communication with the client and specific
stops shouting in mid-sentence. Which C. call a friend and discuss the voices and doesn't impair the ability to perform self- nursing
nursing intervention is the most his feelings about them. care activities. interventions must be:
appropriate? D. engage in strenuous exercise. Controlling symptoms isn't the overall A. clearly identified with boundaries and
A. Approach the client and touch him to Rationale: Increasing the amount of goal; furthermore, helping the client specifically defined roles.
get his attention. auditory stimulation, such as by listening function effectively will B. warm and nonthreatening.
B. Encourage the client to go to his room to music through help control symptoms. Although C. centered on clearly defined limits and
where he'll experience fewer distractions. headphones, may make it easier for the participation in group therapy may help the expression of empathy.
C. Acknowledge that the client is hearing client to focus on external sounds and client control D. flexible enough for the nurse to adjust
voices but make it clear that the nurse ignore internal symptoms, encouraging such participation the plan of care as the situation warrants.
doesn't hear sounds from auditory hallucinations. isn't the overall goal of nursing care. Rationale: A flexible plan of care is
these voices. Option A would make it harder for the 52. A client is receiving treatment for needed for any client who behaves in a
D. Ask the client to describe what the client to ignore the severe depression. When evaluating the suspicious,
voices are saying. hallucinations. Talking about the voices, client for suicidal withdrawn, or regressed manner or who
Rationale: By acknowledging that the as in option C, would encourage the client ideation, the nurse checks for: has a thought disorder. Because such a
client hears voices, the nurse conveys to focus on A. suicidal thoughts or plans. client
acceptance of the them. Option D is incorrect because B. further deterioration in self-worth. communicates at different levels and is in
client. By letting the client know that the exercise alone wouldn't provide enough C. hoarding of prized possessions. control of himself at various times, the
nurse doesn't hear the voices, the nurse auditory stimulation D. the need for physical restraints. nurse must be
avoids to drown out the voices. Rationale: Suicidal ideation refers to able to adjust nursing care as the situation
reinforcing the hallucination. The nurse 51. A client diagnosed as having panic thoughts or plans of suicide. To assess for warrants. The nurse's role should be clear;
shouldn't touch the client with disorder with agoraphobia is admitted to these, the nurse however,
schizophrenia without the inpatient should ask directly if the client is thinking the boundaries or limits of this role should
advance warning. The hallucinating client psychiatric unit. Until her admission, she about or planning suicide. Common be flexible enough to meet client needs.
may believe that the touch is a threat or had been a virtual prisoner in her home for indicators of an Because a
act of 5 weeks, increased risk for suicide include giving client with schizophrenia fears closeness
aggression and respond violently. Being afraid to go outside even to buy food. away prized possessions and lifting of and affection, a warm approach may be
alone in his room encourages the client to When planning care for this client, what is depression, not too threatening.
withdraw and the nurse's further deterioration in self-worth. If the Expressing empathy is important, but
may promote more hallucinations. The overall goal? client has suicidal ideation or is at high risk centering interventions on clearly defined
nurse should provide an activity to distract A. To help the client perform self-care for suicide, the limits is
the client. By activities staff should ensure a safe environment, impossible because the client's situation
asking the client what the voices are B. To help the client function effectively in such as by conducting frequent checks may change without warning
saying, the nurse is reinforcing the her environment (every 15
hallucination. The nurse C. To help control the client's symptoms
54. A client diagnosed with major B. exploring the purpose of the ritualistic Rationale: According to the Diagnostic 59. A client exhibits the following defining
depression has started taking amitriptyline behavior. and Statistical Manual of Mental characteristics: denial of problems that are
HCl (Elavil), a C. setting consistent limits on the ritualistic Disorders, 4th edition, evident to
tricyclic antidepressant. What is a behavior if it harms the client or others. diagnostic criteria for psychoactive others, expressions of shame or guilt,
common adverse effect of this drug? D. using problem solving to help the client substance abuse include a maladaptive perceptions of self as being unable to deal
A. Weight loss manage anxiety more effectively. pattern of such use, with events, and
B. Dry mouth Rationale: Client safety is the paramount indicated either by continued use despite projection of blame or responsibility for
C. Hypertension concern and must be maintained. knowledge of having a persistent or problems onto others. How would a nurse
D. Muscle spasms Therefore, setting recurrent social, diagnose this
Rationale: Tricyclic antidepressants can consistent limits on potentially harmful occupational, psychological, or physical client?
have anticholinergic adverse effects, with ritualistic behavior takes highest priority. problem caused or exacerbated by A. Anxiety
dry mouth Although the substance abuse or B. Chronic low self-esteem
being the most common. Hypotension other options are important, they take recurrent use in dangerous situations (for C. Ineffective denial
would be expected, rather than lower priority. For instance, helping the example, while driving). For this client, D. Ineffective individual coping
hypertension. Weight gain client identify how psychoactive Rationale: The defining characteristics
— not loss — is typical when taking this the ritualistic behavior interferes with daily substance dependence must be ruled out; are those of Chronic low self-esteem. The
medication. Muscle spasms aren't an activities increases the client's motivation criteria for this disorder include a need for definition of
adverse effect of for using increasing this diagnosis is negative self-evaluation,
tricyclic antidepressants more effective coping behavior. Exploring amounts of the substance to achieve along with negative feelings about self or
55. Drug therapy with thioridazine the purpose of the ritualistic behavior intoxication (option A), increased time and capabilities,
(Mellaril) shouldn't exceed a daily dose of helps the client money spent on which may be directly or indirectly
800 mg to prevent see this behavior as an attempt to control the substance (option B), inability to fulfill expressed. Anxiety, Denial, and Ineffective
which adverse reaction? anxiety. As the client learns new ways to role obligations (option C), and typical individual coping all
A. Hypertension manage withdrawal have different sets of defining
B. Respiratory arrest anxiety, the ritualistic behavior is likely to symptoms. characteristics.
C. Tourette syndrome decrease. 58. A client is undergoing treatment for an 60. Tourette syndrome is characterized by
D. Retinal pigmentation 57. A client is brought to the psychiatric anxiety disorder. Such a disorder is the presence of multiple motor and vocal
Rationale: Retinal pigmentation may clinic by family members, who tell the considered chronic tics. A vocal
occur if the thioridazine dosage exceeds admitting nurse and generalized when excessive anxiety tic that involves repeating one's own
800 mg per day. that the client repeatedly drives while and worry about two or more life sounds or words is known as:
The other options don't occur as a result intoxicated despite their pleas to stop. circumstances exist for .
of exceeding this dose. During an interview at least A. echolalia.
56. A client with obsessive-compulsive with the nurse, which statement by the A. 2 months. B. palilalia.
disorder and ritualistic behavior must client most strongly supports a diagnosis B. 12 months. C. apraxia.
brush the hair back of psychoactive C. 6 months. D. aphonia.
from his forehead 15 times before carrying substance abuse? D. 4 months. Rationale: Palilalia is defined as the
out any activity. The nurse notices that the A. "I'm not addicted to alcohol. In fact, I Rationale: For generalized anxiety repetition of sounds and words. Echolalia
client's hair can drink more than I used to without disorder, the diagnostic criteria listed in is the act of
is thinning and the skin on the forehead is being affected." the Diagnostic and repeating the words of others. Apraxia is
irritated — possible effects of this ritual. B. "I only spend half of my paycheck at the Statistic Manual of Mental Disorders, 4th the inability to carry out motor activities,
When planning bar." edition, include unrealistic or excessive and aphonia is
the client's care, the nurse should assign C. "I just drink to relax after work." anxiety and the inability to speak.
highest priority to: D. "I know I've been arrested three times worry about two or more life 61. A 26-year-old client is admitted to the
A. helping the client identify how the for drinking and driving, but the police are circumstances for 6 months or more, psychiatric unit with acute onset of
ritualistic behavior interferes with daily just trying to during which time these schizophrenia. His
activities. hassle me." concerns exist on a majority of days.
physician prescribes the phenothiazine activity. Diazepam, a benzodiazepine hospitalized for paranoid schizophrenia health care workers ask the same
chlorpromazine (Thorazine), 100 mg by ./drug, is administered to reduce anxiety. from ages 20 to 21. The physician question, this is a clue that child abuse
mouth four times 63. A client with paranoid schizophrenia prescribes haloperidol may be a problem.
per day. Before administering the drug, has been experiencing auditory (Haldol), 5 mg I.M. The nurse understands Child abuse occurs in all socioeconomic
the nurse reviews the client's medication hallucinations for many that this drug is used in this client to treat: groups. Parents may argue and be
history. years. One approach that has proven to A. dyskinesia. demanding because
Concomitant use of which drug is likely to be effective for hallucinating clients is to: B. dementia. of the stress of having an injured child.
increase the risk of extrapyramidal A. take an as-needed dose of C. psychosis. 66. Which of the following statements is a
effects? psychotropic medication whenever they D. tardive dyskinesia. guideline to help nurses avoid liability?
A. guanethidine (Ismelin) hear voices. Rationale: By treating psychosis, A. Follow every physician's order.
B. droperidol (Inapsine) B. practice saying "Go away" or "Stop" haloperidol, an antipsychotic drug, B. Do what the client desires even though
C. lithium carbonate (Lithonate) when they hear voices. decreases agitation. you may disagree.
D. alcohol C. sing loudly to drown out the voices and Haloperidol is used to treat dyskinesia in C. Practice within the scope of the Nurse
Rationale: When administered with any provide a distraction. clients with Tourette syndrome and to treat Practice Act.
phenothiazine, droperidol may increase D. go to their room until the voices go dementia in D. Obtain malpractice insurance.
the risk of away. elderly clients. Tardive dyskinesia may Rationale: The Nurse Practice Act
extrapyramidal effects. The other options Rationale: Researchers have found that occur after prolonged haloperidol use; the outlines acceptable standards for nursing.
are incorrect. some clients can learn to control client should be Practicing within
62. A client with schizophrenia who bothersome monitored for this adverse reaction. those guidelines will protect the nurse
receives fluphenazine (Prolixin) develops hallucinations by telling the voices to go 65. When interviewing the parents of an from liability. The client doesn't know
pseudoparkinsonism and akinesia. What away or stop. Taking an as needed dose injured child, which of the following is the standards of care and
drug would the nurse administer to of psychotropic strongest isn't responsible for the nurse's actions.
minimize medication whenever the voices arise may indicator that child abuse may be a Physicians may not be aware of guidelines
extrapyramidal symptoms? lead to overmedication and put the client problem? for nurses
A. benztropine (Cogentin) at risk for A. The injury isn't consistent with the and delegate inappropriate treatment or
B. dantrolene (Dantrium) adverse effects. Because the voices aren't history or the child's age. practice for the nurse. Insurance won't
C. clonazepam (Klonopin) likely to go away permanently, the client B. The mother and father tell different prevent a liability
D. diazepam (Valium) must learn to stories regarding what happened. suit, but only assist the nurse if a suit
Rationale: Benztropine is an deal with the hallucinations without relying C. The family is poor. would be filed.
anticholinergic drug administered to on drugs. Although distraction is helpful, D. The parents are argumentative and 67. In group therapy, a client who has
reduce extrapyramidal adverse singing loudly demanding with emergency department used I.V. heroin every day for the past 14
effects in the client taking antipsychotic may upset other clients and would be personnel. years says, "I
drugs. It works by restoring the equilibrium socially unacceptable after the client is Rationale: When the child's injuries are don't have a drug problem. I can quit
between the discharged. inconsistent with the history given or whenever I want. I've done it before."
neurotransmitters acetylcholine and Hallucinations are most bothersome in a impossible Which defense
dopamine in the central nervous system quiet environment when the client is alone, because of the child's age and mechanism is the client using?
(CNS). Dantrolene, so sending developmental stage, the emergency A. Denial
a hydantoin drug that reduces the the client to his room would increase, department nurse should be B. Obsession
catabolic processes, is administered to rather than decrease, the hallucinations. suspicious that child abuse is occurring. C. Compensation
alleviate the symptoms 64. An agitated and incoherent client, age The parents may tell different stories D. Rationalization
of neuroleptic malignant syndrome, a 29, comes to the emergency department because their Rationale: A client who states that he or
potentially fatal adverse effect of with perception may be different regarding she doesn't have a drug problem and can
antipsychotic drugs. complaints of visual and auditory what happened. If they change their story quit using
Clonazepam, a benzodiazepine drug that hallucinations. The history reveals that the when different drugs at any time — despite evidence to
depresses the CNS, is administered to client was the contrary — is denying the drug
control seizure addiction. Obsession
isn't a defense mechanism. In D. Encouraging the client to express her system, and history, can be done after the D. Schizophreniform disorder
compensation, the client emphasizes feelings at meal times client is medically stable. Rationale: In delusional disorder of the
positive attributes to Rationale: Restricting access to food 71. How long after amitriptyline (Elavil) erotomanic type, the client has an erotic
compensate for negative ones. In except at specified times prevents the therapy begins can the nurse expect the delusion of
rationalization, the client justifies client from eating client to show being loved by another person and tries to
behaviors by faulty logic. when she feels anxious, guilty, or improved psychological symptoms? contact the object of the delusion through
68. A husband and wife seek emergency depressed; this, in turn, decreases the A. 2 to 4 days such
crisis intervention because he slapped her association between B. 4 to 6 days behaviors as sending gifts, calling, and
repeatedly these emotions and food. Telling the client C. 6 to 8 days stalking. The object of the undesired
the night before. The husband indicates she may become sick or die may reinforce D. 10 to 14 days attention may be a
that his childhood was marred by an her Rationale: Because tricyclic complete stranger and usually is of higher
abusive relationship behavior because illness or death may be antidepressants have long half-lives, a status. In a delusional disorder of the
with his father. When intervening with this her goal. Paying special attention to rituals noticeable response may not jealous type, the
couple, the nurse knows they are at risk and occur for 10 to 14 days; a full response client has a delusion that the sexual
for repeated emotions associated with meals also may take up to 30 days. partner is unfaithful. In a psychotic
violence because the husband: would reinforce undesirable behavior. 72. Before the nurse administers the first disorder, a delusion of
A. has only moderate impulse control. Encouraging the dose of lithium carbonate (Lithonate) to a suspicion occurs within the context of a
B. denies feelings of jealousy or client to express feelings at meal times client, she close relationship. The individual may
possessiveness. would increase the association between reviews information about the drug. Which believe that
C. has learned violence as an acceptable emotions and statement accurately someone has an inappropriate or sexual
behavior. food; instead, the nurse should encourage describes the metabolism and excretion of interest in him. Schizophreniform disorder
D. feels secure in his relationship her to express feelings at other times lithium? involves
Rationale: Family violence usually is a 70. Which of the following is the priority A. It's metabolized in the liver and bizarre delusions and hallucinations of
learned behavior, and violence typically when assessing a suicidal client who has excreted in the feces. less than 6 months' duration.
leads to further ingested a B. It's metabolized and excreted by the 74. Which of the following signs should the
violence, putting this couple at risk. handful of unknown pills? kidneys. nurse expect in a client with known
Repeated slapping may indicate poor, not A. Determining if the client was trying to C. It isn't metabolized and is excreted amphetamine
moderate, impulse harm himself unchanged by the kidneys. overdose?
control. Violent people commonly are B. Determining if the client had a support D. It's metabolized in the liver and A. Hypotension
jealous and possessive and feel insecure system excreted by the kidneys B. Tachycardia
in their C. Determining if the client's physical Rationale: Lithium isn't metabolized and C. Hot, dry skin
relationships. condition is life-threatening is excreted unchanged by the kidneys. D. Constricted pupils
69. A client with delusional thinking shows D. Determining if the client has a history of 73. A client continues to stalk a man Rationale: Amphetamines are central
a lack of interest in eating at meal times. suicide attempts whom she met briefly 3 years ago. She nervous system stimulants. They cause
She states Rationale: If the client's physical condition believes he loves sympathetic
that she is unworthy of eating and that her is life-threatening, the priority is to treat the her and eventually will marry her and has stimulation, including hypertension,
children will die if she eats. Which nursing medical been sending him cards and gifts. When tachycardia, vasoconstriction, and
action condition. Any compromise to the client's she violates a hyperthermia. Hot, dry skin
would be most appropriate for this client? airway, breathing, or circulation must be restraining order he has obtained, a judge is seen with anticholinergic agents such as
A. Telling the client that she may become addressed orders her to undergo a 10-day psychiatric jimsonweed. Pupils will be dilated, not
sick and die unless she eats immediately. It's also imperative to evaluation. constricted.
B. Paying special attention to the client's determine the time of ingestion because What is the most probable psychiatric
rituals and emotions associated with this may determine diagnosis for this client? 75. Which of the following is an
meals treatment. The psychiatric evaluation, A. Delusional disorder — jealous type example of a negative
C. Restricting the client's access to food which includes intent to harm oneself, B. Induced psychotic disorder symptom of schizophrenia?
except at specified meal and snack times adequate support C. Delusional disorder — erotomanic type a. Delusions
b. Disorganized speech d. Don't intervene - the patients need a 82. While providing information for the c. Delusions of grandeur and hyperactivity
c. Flat affect little bit of room family of a d. Alteration of appetite and sleep pattern
d. Catatonic behavior in which to work out differences patient with schizophrenia, you should Situation: A client is admitted to the
76. The patient tells you that a "voice" Situation: John is admitted with a be sure to hospital. During the
keeps laughing diagnosis of paranoid inform them about which of the assessment the nurse notes that the client
at him and tells him he must crawl on schizophrenia. following has not slept
his hands and 79. You're reaching a community group characteristics of the disorder? for a week. The client is talking rapidly,
knees like a dog. Which of the about a. Relapse can be prevented if the patient and throwing his
following would be the schizophrenia disorders. You explain takes arms around randomly.
most appropriate response? the different types medication 86. When writing an assessment of a
a. "They are imaginary voices and we're of schizophrenia and delusional b. Support is available to help family client with mood
here to make disorders. You also members meet disorder, the nurse should specify:
them go, away." explain that, unlike schizophrenia, their own needs a. How flat the client's affect
b. "If it makes you feel better, do what the delusional disorders: c. Improvement should occur if the b. How suicidal the client is
voices tell a. Tend to begin in early childhood patient's c. How grandiose the client is
you." b. Affect more men than women environment is carefully maintained d. How the client is behaving
c. "The voices can't hurt you here in the c. Affect more women than men d. Stressful situations in the family in the 87. It is an apprehensive anticipation of
hospital" d. May be related to certain medical family can an unknown
d. "Even though I don't hear the voices, I conditionsa precipitate a relapse in the patient danger:
understand that 80. A patient with schizophrenia 83. While caring for John, the nurse a. Fear
you do." (catatonic type) is knows that John b. Anxiety
77. A 23-year-old patient is receiving mute and can't perform activities of may have trouble with: c. Antisocial
antipsychotic daily living. The a. Staff who are cheerful d. Schizoid
medication to treat his schizophrenia. patient stares out the window for b. Simple direct sentences 88. It is an, emotional response to a
He's hours. What is your c. Multiple commands consciously
experiencing some motor first priority in this situation? d. Violent behaviors recognized threat.
abnormalities called a. Assist the patient with feeding 84 Which nursing diagnosis is most a. Fear
extrapyramidal effects. Which of the b. Assist the patient with showering and likely to be b. Anxiety
following tasks for associated with a person who has a c. Antisocial
extrapyramidal effects occurs most hygiene medical diagnosis d. Schizoid
frequently in c. Reassure the patient about safely, and of schizophrenia, paranoid type? 89. All but one is an example of
younger make patients? try to orient a. Fear of being along situational crisis:
a. Akathisia him to his surroundings b. Perceptual disturbance related to a. Menstruation
b. Akinesia d. Encourage, socialization with peers, delusion of b. Role changes
c. Dystonia and provide a 253 c. Rape
d. Pseudoparkinsonism stimulating environment persecution d. Divorce
78. Which of the following should you 81. Which of the following would you c. Social isolation related to impaired 90. What would be the highest priority
do next? suspect in a ability to trust in formulating a
a. Firmly redirect the patient to her patient receiving Chlorpromazine d. Impaired social skills related to nursing care plan for this client?
room to discuss the (Thorazine) who inadequate developed a. Isolate the client until he or she adjusts
incident complains of a sore throat and has a superego to 'the
b. Call the assistance and place the fever? 85. Which of the following behaviors hospital
patient in locked a. An allergic reaction can the nurse b. Provide nutritious food and a quite
seclusion b. Jaundice anticipate with this client? place to rest
c. Help the patient look for her purse c. Dyskinesia a. Negative cognitive distortions c. Protect the client and others from harm
d. Agranulocytosis b. Impaired psychomotor development d. Create a structured environment
Situation: Wendell, 24 year-old student b. Exercising 1 hour before bedtime to divorce. The patient is sitting in a chair, a. "I feel angry when I hear that tone of
with a primary promote sleep rocking back voice"
sleep disorder, is unable to initiate c. Importance of steeping whenever the and forth. Which is the best response b. "You make me so angry when you
maintenance of client tires for the nurse to talked to me that
sleep. Primary sleep disorders may be d. Drinking warm milk before bed to make? way."
categorized as induce sleep a. "You must stop crying so that we can c. "Are you trying to make me angry?"
dyssomnias or parasomnias. 94. Examples of dyssomnia includes: discuss your d. "Why do you use that condescending
91. The nurse is caring for a client who a. Insomnia, hypersomnia, narcolepsy feelings about the divorce." tone of voice
complains; of b. Sleepwalking, nightmare b. "Once you find a job, you will feel much with me?"
fat?gue, inability to concentrate, and c. Snoring while sleeping better and 100. A 35 year-old client tells the nurse
palpitations. The d. Non-rapid eye movement more secure." that he never
client stales that she has been Situation: The following questions refer to c. "I can see how upset you are. Let's disagrees with anyone and that he has
experiencing these therapeutic sit in the office so loved everyone
symptoms for the past 6 months. communication. that we can talk about how you're he's ever known. What would be the
Which factor in the 254 feeling." nurse's best
client’s history has most likely 95. When preparing to conduct group d. "Once you have a lawyer looking out for response to this client?
contributed to.these therapy, the your a. "How do you manage to do that?"
symptoms? nurse keeps in mind that the optimal interests, you will feel better." b. "That's hard to believe. Most people
a. History of recent fever number of clients 98. A client on the unit tells the nurse couldn't to that."
b. Shift work in a group would be: that his wife's c. "What do you do with your feelings of
c. Hyperthyroidism a. 6 to 8 nagging really gets on his nerves. He dissatisfaction
d. Fear b. 10 to 12 asks the nurse if or anger?"
92. If Wendell complains of c. 3 to 5 she will talk with his wife about d. "How did you come to adopt such a
experiencing an d. Unlimited nagging during their way of
overwhelming urge to sleep and states 96. What occurs during the working family session tomorrow afternoon.
that he's been phase of the-nurseclient Which of the
falling asleep while studying and relationship? following would be most therapeutic
reports that these a. The nurse assesses the client's needs response to
episodes occur about 5 times daily and develops a client?
Wendell is most plan of care a. "Tell me more specifically about her
likely experiencing which sleep b. The nurse and client together complaints"
disorder? evaluate and modify b. "Can you think why she might nag you
a. Breathing-related sleep disorder the goals of the relationship so much?"
b. Narcolepsy c. The nurse and client discuss their c. "I'll help you think about how to
c. Primary hypersomnia feelings about bring this up
d. Circadian rhythm disorder terminating the relationship yourself tomorrow."
93. The nurse is preparing a teaching d. The nurse and client explore each d. "Why do you want me to initiate this
plan for a client other's expectations discussion in
diagnosed with primary insomnia. of-the relationship tomorrow's session rather than you?"
Which of the 97. A 42 year-old homemaker arrives at 99. The nurse is working with a client
following teaching topics should be the emergency who has just
included in the department with uncomfortable crying stimulated her anger by using a
plan? and anxiety. condescending tone of
a. Eating unlimited spicy foods, and Her husband of 17 years has recently voice. Which of the following
limiting caffeine and asked her for a responses by the nurse
alcohol would be the most therapeutic?