NUR 448 Exam 1 Guide With
Complete Solution
1. M, age 26 months, is very negativistic. He refuses to have anything to do
with toilet training and shouts "No!" all the time. His mother asks what
might be the matter with M. The nurse can assess M as dealing with the
psychosocial crisis of
a. autonomy versus shame and doubt
b. initiative versus guilt
c. industry versus inferiority
d. trust versus mistrust - ANSWER A
2. Steve is M's 4-year-old brother. He sometimes grabs toys away from M,
saying "I want that!" Using Freudian theory the nurse can interpret this
behavior as a product of impulses originating in the
a. ego
b. id
c. superego
d. preconscious - ANSWER B
3. A client mentions, "I'm going to be engaging in cognitive therapy. What
can I expect from the sessions?" Which remark would the nurse, framing a
reply, find inappropriate to include?
,a. "The therapist will be active and questioning."
b. "You may be given homework assignments."
c. "The therapist will help you look at ideas and beliefs you have about
yourself."
d. "The goal is to increase your subjectivity about the thoughts that govern
your behavior." - ANSWER D
4. Two psychotic clients on the inpatient unit fight whenever they are
together in the same room. During a team meeting, one nurse suggests the
safety of the two clients is of paramount importance and that their treatment
plans should call for both to be placed in seclusion to keep them from
injuring each other. What is the significance of this suggestion?
a. It violates the civil rights of the two clients.
b. It reinforces the autonomy of the two clients.
c. It reveals that the nurse values the principle of justice.
d. It represents the intentional tort of battery. - ANSWER A
5. In a treatment team planning meeting a nurse states her concern about
whether the staff is behaving ethically in using restraint to prevent one client
from engaging in self-mutilative behavior when the care plan for another
self-mutilating client calls for one-on-one supervision. The ethical principle
that should govern the situation is
a. beneficence
b. autonomy
c. fidelity
, d. justice - ANSWER D
6. A client tells the nurse, "When I saw my therapist yesterday, he made
sexual advances. He stroked my breast and suggested that he will give me a
pass to leave the hospital if I will meet him at his apartment." What action
should the nurse take?
a. None. Psychiatric clients are not reliable.
b. Report the client's statements to the unit nurse manager.
c. Discuss the statements with the medical director.
d. Call the state medical board. - ANSWER B
7. J became aggressive, struck another client, and required seclusion. Which
of the following would be an appropriate way to document this event?
a. "Client apparently doesn't like client X as evidenced by his striking client X
when client attempted to leave day room to go to bathroom. Seclusion
necessary at 2:15 pm. Plan: Maintain seclusion for 8 hours and keep this
client and client X away from each other for 24 hours."
b. "Seclusion ordered by Dr. at 2:15 pm when voices told the client to hit
another client."
c. "Client pacing, shouting at people not present in the environment.
Chlorpromazine 50 mg p.o. at 1 pm with no effect by 2 pm. At 2:15 pm client
shouted that he would punch the first person who got near him, then struck
client X on the jaw with his fist as client X walked out of day room to go to
bathroom. Client physically restrained by staff and placed in seclusion by
order of Dr."
Complete Solution
1. M, age 26 months, is very negativistic. He refuses to have anything to do
with toilet training and shouts "No!" all the time. His mother asks what
might be the matter with M. The nurse can assess M as dealing with the
psychosocial crisis of
a. autonomy versus shame and doubt
b. initiative versus guilt
c. industry versus inferiority
d. trust versus mistrust - ANSWER A
2. Steve is M's 4-year-old brother. He sometimes grabs toys away from M,
saying "I want that!" Using Freudian theory the nurse can interpret this
behavior as a product of impulses originating in the
a. ego
b. id
c. superego
d. preconscious - ANSWER B
3. A client mentions, "I'm going to be engaging in cognitive therapy. What
can I expect from the sessions?" Which remark would the nurse, framing a
reply, find inappropriate to include?
,a. "The therapist will be active and questioning."
b. "You may be given homework assignments."
c. "The therapist will help you look at ideas and beliefs you have about
yourself."
d. "The goal is to increase your subjectivity about the thoughts that govern
your behavior." - ANSWER D
4. Two psychotic clients on the inpatient unit fight whenever they are
together in the same room. During a team meeting, one nurse suggests the
safety of the two clients is of paramount importance and that their treatment
plans should call for both to be placed in seclusion to keep them from
injuring each other. What is the significance of this suggestion?
a. It violates the civil rights of the two clients.
b. It reinforces the autonomy of the two clients.
c. It reveals that the nurse values the principle of justice.
d. It represents the intentional tort of battery. - ANSWER A
5. In a treatment team planning meeting a nurse states her concern about
whether the staff is behaving ethically in using restraint to prevent one client
from engaging in self-mutilative behavior when the care plan for another
self-mutilating client calls for one-on-one supervision. The ethical principle
that should govern the situation is
a. beneficence
b. autonomy
c. fidelity
, d. justice - ANSWER D
6. A client tells the nurse, "When I saw my therapist yesterday, he made
sexual advances. He stroked my breast and suggested that he will give me a
pass to leave the hospital if I will meet him at his apartment." What action
should the nurse take?
a. None. Psychiatric clients are not reliable.
b. Report the client's statements to the unit nurse manager.
c. Discuss the statements with the medical director.
d. Call the state medical board. - ANSWER B
7. J became aggressive, struck another client, and required seclusion. Which
of the following would be an appropriate way to document this event?
a. "Client apparently doesn't like client X as evidenced by his striking client X
when client attempted to leave day room to go to bathroom. Seclusion
necessary at 2:15 pm. Plan: Maintain seclusion for 8 hours and keep this
client and client X away from each other for 24 hours."
b. "Seclusion ordered by Dr. at 2:15 pm when voices told the client to hit
another client."
c. "Client pacing, shouting at people not present in the environment.
Chlorpromazine 50 mg p.o. at 1 pm with no effect by 2 pm. At 2:15 pm client
shouted that he would punch the first person who got near him, then struck
client X on the jaw with his fist as client X walked out of day room to go to
bathroom. Client physically restrained by staff and placed in seclusion by
order of Dr."
