16.

A 60-year-old client is hospitalized after complaining of difficulty

sleeping, extreme apprehension, shortness of breath, and a sense of
impending doom. Which response by the nurse would be best?

a. “You have nothing to worry about. You’re in a safe place. Try to relax.”

b. “Has anything happened recently that may have triggered these

feelings?”

c. “We’ve given you a medication that will help to decrease these feelings
of anxiety.”

d. “Take some deep breaths and try to calm down.”

17. A 26-year-old male client is admitted to an inpatient psychiatric hospital

after having been picked up by the local police while walking around the
neighborhood at night without shoes in the snow. He appears confused and
disoriented. Which of the following actions should take priority?

a. Stabilize the client’s medical needs

b. Stabilize the client’s psychological needs

c. Attempt to locate the nearest family members to get an accurate

history

d. Arrange a transfer to the nearest medical facility

18. What occurs during the work phase of the nurse-client relationship?

a. The nurse identifies the client’s needs and develops a care plan

b. The nurse and client together evaluate and modify the goals of the
relationship

c. The nurse and client discuss their feelings about terminating the
relationship

d. The nurse and client explore each other’s expectations of the

relationship

19. The optimal number of clients in a group for group therapy would be:

a. 6 to 8

b. 10 to 12

c. 3 to 5

d. Unlimited

20. A therapeutic nurse-client relationship begins with the nurse’s:

 a. Sincere desire to help others

b. Acceptance of others

c. Self-awareness and understanding

d. Sound knowledge of psychiatric nursing

21. The nurse is caring for a client who’s deliberately starving herself to
become as thin as possible. What’s the appropriate diagnosis for this client?

a. Anorexia nervosa

b. Eating disorder

c. Bulimia nervosa

d. Genu valgum

22. The nurse is monitoring a client diagnosed with anorexia nervosa. In

addition to monitoring the client’s eating, the nurse should perform which
action after meals?

a. Weigh the client

 b. Prevent the client from using the bathroom for 2 hours after eating

c. Tell the client to lie down for 2 hours after eating

d. Instruct the client to get plenty of exercise

23. The nurse is caring for a client who has been binge eating. Which
description of the client’s behavior is most appropriate?

a. The client has been slowly consuming a large amount of food over 3
hours

b. The client has been rapidly consuming large amount of food

c. The client became extremely hungry and then consumed a large

amount of food

d. The client is extremely thin but still highly concerned about her weight

24. The nurse is caring for a client with bulimia. What physical findings would
the nurse expect?

a. Parotid and salivary gland swelling, pharyngitis

 b. Facial ecchymosis, bruised knuckles, and excessive torso fat stores

c. Depression, parotid gland swelling

d. Depression, bruised knuckles

25. The nurse is caring for a client diagnosed with bulimia and notices
Russell’s sign. What finding did the nurse observe?

a. Dental enamel erosions

b. Facial ecchymosis

c. Pharyngitis

d. Bruised knuckles

26. The nurse is caring for a client who has bulimia. What would be the most
common metabolic complication for this client?

a. Metabolic alkalosis

b. Respiratory alkalosis
 c. Respiratory acidosis

d. Metabolic acidosis

27. The nurse is caring for a client who has bulimia. Which treatment option
is most effective?

a. Antidepressants

b. Cognitive therapy

c. Antidepressants and cognitive therapy

d. Total parenteral nutrition and antidepressant

28. The nurse is caring for several clients who have eating disorders. Based
on appearance, how would the nurse distinguish bulimic clients from
anorectic clients?

a. By their teeth

b. By body size and weight

c. By looking for Mallory-Weiss tears

 d. The clients are indistinguishable upon physical examination

29. The nurse is caring for a bulimic client and an anorectic client. What
cognitive characteristics would be similar in these clients?

a. Perfectionism, preoccupation with food

b. Relaxed personality, preoccupation with food

c. No similarities

d. Preoccupation with exercise

30. The nurse is caring for a client who has an eating disorder. Which nursing
interventions would be appropriate for this client?

a. Weigh the client once or twice per week, and contract for amount of
food to be eaten

b. Weigh the client daily, and allow the client to use the bathroom one-
half hour after eating

c. Provide one-on-one support before meals

d. Contract amount of food to be eaten, and weigh the client twice daily
31. The nurse is caring for a client who’s sarcastic and critical and often
expresses feelings that are the opposite of what he’s actually feeling. This
client is exhibiting which type of behavior?

a. Passive

b. Aggressive

c. Passive-aggressive

d. Assertive

32. The nurse is teaching a client about the antidepressant drug fluoxetine
(Prozac). Which statement is true of this drug?

a. The therapeutic effect may not be seen for 3 to 4 weeks.

b. Fluoxetine doesn’t cause orthostatic hypotension

c. Fluoxetine should be stopped immediately if adverse reactions occur

d. The client should avoid exposure to the sun because of photosensitivity

reactions
33. The nurse is teaching a client receiving a monoamine oxidase inhibitor
(MAOI) about his drug therapy. The client demonstrates understanding by
expressing the need to avoid tyramine-containing foods and stating that
even moderate amounts of tyramine must be avoided to prevent
hypertensive crisis. The nurse asks the patient to list specific tyramine-
containing foods. The client would be correct in naming which of the
following foods?

A. Swiss cheese

b. Cream cheese

c. Milk

e. Ice cream

34. When caring for a client who’s receiving lithium, the nurse should
monitor the client for which adverse effect?

a. Hypertension

b. Fine hand tremors

c. Weight loss

d. Fluid retention
35. A client on antipsychotic drugs begins to exhibit bizarre facial and tongue
movements. Based on these findings, the client is most likely exhibiting signs
and symptoms ofwhich disorder?

a. Akinesia

b. Pseudoparkinsonism

c. Tardive dyskinesia

d. Oculogyric crisis

36. Electroconvulsive therapy (ECT) is most effective in treating which

disorder?

a. Schizophrenia

b. Major depression

c. Dissociative disorder

d. Seizure disorder

37. When preparing the client and his family for ECT, the nurse should alert
them about which adverse effect?
 a. Permanent memory loss

b. Temporary memory loss

c. Brain damage

d. Increased intracranial pressure

38. Which nursing diagnosis would be most appropriate for a client who has
undergone the full course of ECT?

a. Impaired verbal communication related to the effects of ECT

b. Noncompliance related to knowledge deficit

c. Disturbed thought processes related to adverse effects of ECT

d. Fear related to the unknown

39. Which nursing intervention is most appropriate when planning care for a
client with anorexia nervosa?

a. Have the client weigh herself and record her weight

 b. Have the client record her food intake herself after she has eaten

c. Remain with the client during mealtimes and observe her for 2 hours
after eating

d. Recommend that the client not eat snacks so that she’ll be able to eat
at mealtime

40. The nurse is evaluating an elderly client for dementia. Which of the
following is primary symptom of dementia?

a. Psychosis

b. Memory loss

c. Neurosis

d. Loss of impulse control

41. At a group therapy session a client tearfully tells the other members, “I
just lost my job this week.” What is the nurse leader’s most appropriate
response?

a. Ask the client to consider the reasons this may have occurred

b. Quietly observe how the group responds to the client’s statement

 c. Gently suggest that the client check the help-wanted advertisements
in the local paper

d. Request that the group help the client reflect on how the dismissal may
have been prevented

42. A 44-year-old client is unable to function since her husband asked for a
divorce 2 weeks ago. She is brought to the crisis intervention center by a
friend. What type of crisis reflects this situation?

a. Social

b. Situational

c. Maturational

d. Developmental

43. A client is diagnosed with a borderline personality disorder. What is a

realistic initial intervention for this client?

a. Establish clear boundaries

b. Explore job possibilities with the nurse

 c. Initiate discussion of feelings of being victimized

d. Spend one hour twice a day discussing problems with the nurse

44. A nurse educator is leading a class on supporting middle-aged adults who

are experiencing midlife crisis. What should the nurse include as the most
significant factor in the development of this type of crisis?

a. The perception of their life situation

b. Many role changes that alter their experiences at this time

c. The anticipation of negative changes associated with old age

d. Lack of support from family members who are busy with their own lives

45. What is the priority goal when planning care for a client in crisis?

a. Referring the client for occupational therapy

b. Restoring the client’s psychologic equilibrium

c. Scheduling the client for follow-up counseling

 d. Having the client gain insight into the problem

46. A client’s admitting history indicates signs of akathisia. What clinical

finding should the nurse expect when assessing for akathisia?

a. Facial tics

b. Motor restlessness

c. Maintaining a body position for hours

d. Repeating the movements of another person

47. A client is diagnosed with generalized anxiety disorder. For what behavior
should the nurse assess a client to determine the effectiveness of therapy?

a. Participates in activities

b. Learns how to avoid anxiety

c. Takes medication as prescribed

d. Identifies when anxiety is developing

48. A nurse is caring for a client with a generalized anxiety disorder. Which
factor should be assessed to determine the client’s present status?

a. Memory

b. Behavior

c. Judgment

d. Responsiveness

49. A client arrives at the mental health clinic disheveled, agitated, and
demanding that the nurse “do something to end this feeling.” Evident?

a. Feelings of panic

b. Suicidal tendencies

c. Narcissistic ideation

d. Demanding personality

50. A client’s severe anxiety and panic are often considered to be

“contagious.” What action should be taken when a nurse’s personal feelings
of anxiety are increasing?
 a. Refocus the conversation on some pleasant topics

b. Say to the client, “Calm down. You are making me anxious, too.”

c. Say, “Another staff member is coming in. I will leave and return later.”

d. Remain quiet so that personal feelings of anxiety do not become

apparent to the client.

51. In what situation should a nurse anticipate that a client will experience a
phobic reaction?

a. Seeking attention from others

b. Thinking about the feared object

c. Coming into contact with the feared object

d. Being exposed to an unfamiliar environment

52. A nurse is interviewing a client with a phobia. Which treatment should

the nurse inform the client has the highest success rate?

a. Insight therapy to determine the origin of the fear

 b. Systematic desensitization using relaxation techniques

c. Psychotherapy aimed at rearranging psychotic thought processes

d. Psychoanalytic exploration of repressed conflicts of an earlier

developmental phase

53. A nurse speaks with a client who just experienced a panic attack. Which
statement is most therapeutic when addressing the client’s concerns?

a. “I would have been upset, too.”

b. “You are concerned that this might happen again.”

c. “Episodes like this can be upsetting even though they do end.”

d. “Your family must have thought you were having a heart attack.

54. The parents of an adolescent who is experiencing posttraumatic stress

disorder have decided to care for their child at home. What is the priority
intervention that the home health nurse must include in the plan of care?

a. Encourage the parents to keep their child within the home environment
 b. Help the parents identify their child’s problems that cause them to be
fearful

c. Assist the parents to understand that their child may avoid emotional
attachments

d. Discuss with the parents their feelings of ambivalence about what their
child is enduring.

55. A client with a general anxiety disorder says to the nurse, “What can I do
to prevent overreacting to stress?” What is the nurse’s best response?

a. “Hone your problem-solving skills.”

b. “Improve your time management skills.”

c. “Ignore situations that you cannot change.”

d. “Develop a wide variety of coping strategies.”

56. How should a nurse expect a client’s anxiety to be manifested

physiologically?

a. Constricted pupils

b. Narrowed bronchioles
 c. Decreased blood pressure

d. Increased blood glucose level

57. What is an appropriate way a nurse can help a client to decrease

anxiety?

a. Avoid unpleasant events

b. Prolong exposure to fearful situations

c. Acquire skills with which to face stressful events

d. Introduce an element of pleasure into fearful situations

58. A client comes to a mental health center with severe anxiety evidenced
by crying, wringing the hands, and pacing. What should be the first nursing
intervention?

a. Stay physically close to the client

b. Gently ask what is bothering the client

 c. Tell the client to try to relax by sitting quietly

d. Involve the client in a nonthreatening activity

59. A nurse considers that in a conversion disorder pseudo neurologic

symptoms such as paralysis or blindness:

a. Are unconscious methods for getting attention

b. Will subside if the client is helped to focus on getting healthy

c. Are generally necessary for the client to cope with a stressful situation

d. Will usually resolve when the client learns to cope with ongoing family
conflicts

60. An anxious client reports experiencing pain in the abdomen and feeling
empty and hollow. A diagnostic workup reveals no physical causes of these
clinical findings. What term best reflects what the client is experiencing?

a. Dissociation

b. Somatization

c. Stress response
 d. Anxiety reaction

61. A client newly diagnosed with a conversion disorder is manifesting

paralysis of a leg. The nurse can expect this client to:

a. Demonstrate a spread of paralysis to other body parts

b. Require continuous psychiatric treatment to maintain independent

functioning

c. Recover the use of the affected leg but, under stress, again develop
similar symptoms

d. Follow an unpredictable emotional course in the future, depending on

exposure to stress

62. A nurse is caring for a client who has a diagnosis of conversion disorder
with paralysis of the lower extremities. Which is the most therapeutic nursing
intervention?

a. Encouraging the client to try to walk

b. Explaining to the client that there is nothing wrong

c. Avoiding focusing on the client’s physical symptoms

 d. Helping the client follow through with the physical therapy plan

63. What characteristic of anxiety is associated with a diagnosis of

conversion disorder?

a. Free floating

b. Relieved by the symptom

c. Consciously felt by the client

d. Projected onto the environment

64. What characteristic uniquely associated with psychophysiologic disorders

differentiates disorders?

a. Emotional cause

b. Feeling of illness

c. Restriction of activities

d. Underlying pathophysiology
65. A client believes that doorknobs are contaminated and refuses to touch
them, except with a paper tissue. What nursing intervention is most
therapeutic for this client?

a. Supply the client with paper tissues to help functioning until anxiety is
reduced

b. Have the client scrub the doorknobs with a strong antiseptic so that
tissues are no longer needed

c. Encourage the client to touch doorknobs by removing all available

paper tissue until learning how to manage the situation

d. Explain to the client that the idea about doorknobs being contaminated
is part of the illness, so precautions are not necessary.