PSYCH C487 | Psych Review Questions & Answers/Rationale | complete Test BankPsych Review Questions & Answers/Rationale | complete Test Bank (2020) Lippincott's Q&A Review for NCLEX-RN® | (Lippincott's Review for Nclex-Rn) (2020)
Lippincott's Q&A Review for NCLEX-RN® | (Lippincott's Review for Nclex-Rn)
1.	The nurse is planning care with a Mexican-American client who is diagnosed with depression. The client believes in “mal ojo” (the evil eye), and uses treatment by a root healer. The nurse should do which of the following?
1. Avoid talking to the client about the root healer.
2. Explain to the client that Western medicine has a scientific, not mystical, basis.
3. Explain that such beliefs are superstitious and should be forgotten.
4. Involve the root healer in a consultation with the client, physician and nurse.
2.	After a period of unsuccessful treatment with Elavil (amitriptyline), a woman diagnosed with depression is switched to Parnate (tranylcypromine). Which statement by the client indicates the client understands the side effects of Parnate?
1. “I need to increase my intake of sodium.”
2. “I must refrain from strenuous exercise.”
3. “I must refrain from eating aged cheese or yeast products.”
4. “I should decrease my intake of foods containing sugar.”
3.	A client is scheduled for the first electroconvulsive therapy (ECT) treatment in the morning. The client has been unable to sleep, but at 10 p.m. refused to take Restoril as the nurse suggested. The client is still unable to sleep at 11:15 p.m. In what order should the nurse do the following?
1. Sit quietly with the client
2. Encourage the use of Restoril.
3. Offer use of MP3 player with relaxing music.
4. Discuss specific concerns.
4.	The client is receiving 6 mg of selegiline transdermal system (Emsam) every 24 hours for major depression. The nurse should judge teaching about Emsam to be effective when the client makes which statement?
1. “I need to avoid using the sauna at the gym.”
2. “I can cut the patch and use a smaller piece.”
3. “I need to wait until the next day to put on a new patch if it falls off.”
4. “I might gain at least 10 lb from Emsam.”
5.	A client has been taking 30 mg of duloxetine hydrochloride (Cymbalta) twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a 6-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first?
1. Refer the client to the dual diagnosis program at the clinic.
2. Share the information at the next interdisciplinary treatment conference.
3. Report the client’s beer consumption to the physician.
4. Teach the client relaxation exercises to perform before bedtime.
6.	A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The physician prescribed 75 mg of venlafaxine extended release (Effexor XR) to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerfully greets the nurse. He appears to be relaxed and joins the group for community meeting before supper. What should the nurse interpret as the most likely cause of the client’s behavior?
1. The Effexor is helping the client’s symptoms of depression significantly.
2. The client’s sudden improvement calls for close observation by the staff.
3. The staff can decrease their observation of the client.
4. The client is nearing discharge due to the improvement of his symptoms.
7.	The nurse is conducting an intake interview with an Asian American female who reports sadness, physical and mental fatigue, anxiety, and sleep disturbance. Prior to the client’s time with the physician, it is important for the nurse to obtain information about the client’s use of which of the following? Select all that apply.
2. Herbal medicine.
3. Breathing exercise.
5. Folk healer.
8.	The client is taking 50 mg of lamotrigine (Lamictal) daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do?
1. Report the rash to the physician.
2. Explain that the rash is a temporary adverse effect.
3. Give the client an ice pack for his arm.
4. Question the client about recent sun exposure.
9.	The nurse is reviewing the laboratory report with the client’s lithium level taken that morning prior to administering the 5 p.m. dose of lithium. The lithium level is 1.8 mEq/ L. The nurse should:
1. Administer the 5 p.m. dose of lithium.
2. Hold the 5 p.m. dose of lithium.
3. Give the client 8 oz (236 mL) of water with the lithium.
4. Give the lithium after the client’s supper.
10.	A nurse is conducting a psychoeducational group for family members of clients hospitalized with depression. Which family member’s statement indicates a need for additional teaching?
1. “My husband will slowly feel better as his medicine takes effect over the next 2 to 4 weeks.”
2. “My wife will need to take her antidepressant medicine and go to group to stay well.”
3. “My son will only need to attend outpatient appointments when he starts to feel depressed again.”
4. “My mother might need help with grocery shopping, cooking, and cleaning for a while.”
11.	The nurse is distinguishing between delusions experienced by a client diagnosed with major depression with psychotic features and the delusions of a client diagnosed with schizophrenia. The essential difference is:
1. Major depression delusions are more likely to be negative than schizophrenic delusions.
2. Major depression delusions clear up less quickly than schizophrenic delusions.
3. Major depression delusions are more likely than schizophrenic delusions to require long-acting depot antipsychotic medication given intramuscularly.
4. Major depression delusions are more mood congruent than schizophrenic delusions.
12.	A 16-year-old client is prescribed 10 mg of paroxetine (Paxil) at bedtime for major depression. The nurse should instruct the client and parents to monitor the client closely for which adverse effect?
13.	The nurse is assessing the outcomes of care for a client who has an Axis I diagnosis of major depression. Following the initiation of treatment, arrange the symptoms in chronological order from the one that improves first to the one that improves last.
1. Self esteem
3. Energy level
14.	A client who has had three episodes of recurrent endogenous depression within the past 2 years states to the nurse, “I want to know why I’m so depressed.” Which of the following statements by the nurse is most helpful?
1. “I know you’ll get better with the right medication.”
2. “Let’s discuss possible reasons underlying your depression.”
3. “Your depression is most likely caused by a brain chemical imbalance.”
4. “Members of your family seem very supportive of you.”
15.	A client diagnosed with major depression spends most of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse is most therapeutic?
1. Wait for the client to begin the conversation.
2. Initiate contact with the client frequently.
3. Sit outside the client’s room.
4. Question the client until he responds.
16.	The client exhibits a flat affect, psychomotor retardation, and depressed mood. The nurse attempts to engage the client in an interaction but the client does not respond to the nurse. Which response by the nurse is most appropriate?
1. “I’ll sit here with you for 15 minutes.”
2. “I’ll come back a little bit later to talk.”
3. “I’ll find someone else for you to talk with.”
4. “I’ll get you something to read.”
17.	After a few minutes of conversation, a female client who is depressed wearily asks the nurse, “Why pick me to talk to? Go talk to someone else.” Which of the following replies by the nurse is best?
1. “I’m assigned to care for you today, if you’ll let me.”
2. “You have a lot of potential, and I’d like to help you.”
3. “I’ll talk to someone else later.”
4. “I’m interested in you and want to help you.”
18.	A client is receiving paroxetine (Paxil) 20 mg every morning. After taking the first three doses, the client tells the nurse that the medication upsets his stomach. Which of the following instructions should the nurse give to the client?
1. “Take the medication an hour before breakfast.”
2. “Take the medication with some food.”
3. “Take the medication at bedtime.”
4. “Take the medication with 4 oz of orange juice.”
19.	The physician orders fluoxetine (Prozac) orally every morning for a 72-year-old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse?
4. Dry mouth.
20.	Which of the following statements by a client taking trazodone (Desyrel) as prescribed by the physician indicates to the nurse that further teaching about the medication is needed?
1. “I will continue to take my medication after a light snack.”
2. “Taking Desyrel at night will help me to sleep.”
3. “My depression will be gone in about 5 to 7 days.”
4. “I won’t drink alcohol while taking Desyrel.”
21.	A 62-year-old female client with severe depression and psychotic symptoms is scheduled for electroconvulsive therapy (ECT) tomorrow morning. The client’s daughter asks the nurse, “How painful will the treatment be for Mom?” The nurse should respond by saying which of the following?
1. “Your mother will be given something for pain before the treatment.”
2. “The physician will make sure your mother doesn’t suffer needlessly.”
3. “Your mother will be asleep during the treatment and will not be in pain.”
4. “Your mother will be able talk to us and tell us if she’s in pain.”
22.	A client who experienced sleep disturbances, feelings of worthlessness, and an inability to concentrate for the past 3 months was fired from her job a month ago. The client tells the nurse, “My boss was wonderful! He was understanding and a really nice man.” The nurse interprets the client’s statement as representing the defense mechanism of reaction formation. Which of the following would be the best response by the nurse?
1. “But, I don’t understand, wasn’t he the one who fired you?”
2. “Tell me more about having to work while not being able to sleep or concentrate.”
3. “It must have been hard to leave a boss like that.”
4. “It sounds like he would hire you back if you asked.”
23.	During a group session, a client who is depressed tells the group that he lost his job. Which of the following responses by the nurse is best?
1. “It must have been very upsetting for you.”
2. “Would you tell us about your job.”
3. “You’ll find another job when you’re better.”
4. “You were probably too depressed to work.”
24.	During an interaction with the nurse, a client states, “My husband has supported me every time I’ve been hospitalized for depression. He’ll leave me this time. I’m an awful wife and mother. I’m no good. Nothing I do is right.” Based on this information, which of the following nursing diagnoses should the nurse identify when developing the client’s plan of care?
1. Impaired social interaction related to unsatisfactory relationships as evidenced by withdrawal.
2. Chronic low self-esteem related to lack of self-worth as evidenced by negative statements.
3. Risk for self-directed violence related to feelings of guilt as evidenced by statements of suicidal ideation.
4. Ineffective coping related to hospitalizations as evidenced by impaired judgment.
25.	A male client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming and hygiene. Which of the following nursing actions is most appropriate?
1. Explaining the importance of hygiene to the client.
2. Asking the client if he is ready to shower.
3. Waiting until the client’s family can participate in the client’s care.
4. Stating to the client that it’s time for him to take a shower.
26.	A client who is depressed states, “I’m an awful person. Everything about me is bad. I can’t do anything right.” Which of the following responses by the nurse is most therapeutic?
1. “Everybody around here likes you.”
2. “I can see many good qualities in you.”
3. “Let’s discuss what you’ve done correctly.”
4. “You were able to bathe today.”
27.	When developing the teaching plan for the family of a client with severe depression who is to receive electroconvulsive therapy (ECT), which of the following information should the nurse include?
1. Some temporary confusion and disorientation immediately after a treatment is common.
2. During an ECT treatment session, the client is at risk for aspiration.
3. Clients with severe depression usually do not respond to ECT.
4. The client will not be able to breathe independently during a treatment.
28.	Which of the following comments indicates that a client understands the nurse’s teaching about sertraline (Zoloft)?
1. “Zoloft will probably cause me to gain weight.”
2. “This medicine can cause delayed ejaculations.”
3. “Dry mouth is a permanent side effect of Zoloft.”
4. “I can take my medicine with St. John’s wort.”
29.	The client with recurring depression will be discharged from the psychiatric unit. Which suggestion to the family is best to help them prepare for the client’s return home?
1. Discourage visitors while the client is at home.
2. Provide for a schedule of activities outside the home.
3. Involve the client in usual at-home activities.
4. Encourage the client to sleep as much as possible.
30.	A client with major depression is to be discharged home tomorrow. When preparing the client’s discharge plan, which of the following areas is most important for the nurse to review with the client?
1. Future plans for going back to work.
2. A conflict encountered with another client.
3. Results of psychological testing.
4. Medication management with outpatient follow-up.
31.	A client with major depression and psychotic features is admitted involuntarily to the hospital. He will not eat because his “bowels have turned to jelly,” which the client states is punishment for his wickedness. The client requests to leave the hospital. The nurse denies the request because commitment papers have been initiated by the physician. Which of the following should the nurse identify as a criterion for the client to be legally committable?
1. Evidence of psychosis.
2. Being gravely disabled.
3. Risk of harm to self or others.
4. Diagnosis of mental illness.
32.	The client who has been taking venlafaxine (Effexor) 25 mg P.O. three times a day for the past 2 days states, “This medicine isn’t doing me any good. I’m still so depressed.” Which of the following responses by the nurse is most appropriate?
1. “Perhaps we’ll need to increase your dose.”
2. “Let’s wait a few days and see how you feel.”
3. “It takes about 2 to 4 weeks to receive the full effects.”
4. “It’s too soon to tell if your medication will help you.”
33.	The client states to the nurse, “I take citalopram (Celexa) 40 mg every day like my physician prescribed. I have also been taking St. John’s wort 750 mg daily for the past 2 weeks.” Which of the following indicate that the client is developing serotonin syndrome? Select all that apply.
34.	When teaching the client with atypical depression about foods to avoid while taking phenelzine (Nardil), which of the following should the nurse include?
1. Roasted chicken.
3. Fresh fish.
35.	A client is taking phenelzine (Nardil) 15 mg P.O. three times a day. The nurse is about to administer the 1 p.m. dose when the client tells the nurse that about having a throbbing headache. Which of the following should the nurse do first?
1. Give the client an analgesic ordered p.r.n.
2. Call the physician to report the symptom.
3. Administer the client’s next dose of phenelzine.
4. Obtain the client’s vital signs.
36.	A female client with severe depression and weight loss has not eaten since admission to the hospital 2 days ago. Which of the following approaches should the nurse include when developing this client’s plan of care to ensure that she eats?
1. Serving the client her meal trays in her room.
2. Sitting with the client and spoon-feeding if required.
3. Calling the family to bring the client food from home.
4. Explaining the importance of nutrition in recovery.
37.	After administering a prescribed medication to a client who becomes restless at night and has difficulty falling asleep, which of the following nursing actions is most appropriate?
1. Sitting quietly with the client at the bedside until the medication takes effect.
2. Engaging the client in interaction until the client falls asleep.
3. Reading to the client with the lights turned down low.
4. Encouraging the client to watch television until the client feels sleepy.
38.	Which of the following behaviors exhibited by a client with depression should lead the nurse to determine that the client is ready for discharge?
1. Interactions with staff and peers.
2. Sleeping for 4 hours in the afternoon and 4 hours at night.
3. Verbalization of feeling in control of self and situations. 4. Statements of dissatisfaction over not being able to perform at work.
39.	The client with major depression and suicidal ideation has been taking bupropion (Wellbutrin) 100 mg P.O. four times daily for 5 days. Assessment reveals the client to be somewhat less withdrawn, able to perform activities of daily living with minimal assistance, and eating 50% of each meal. At this time, the nurse should monitor the client specifically for which of the following behaviors?
1. Seizure activity.
2. Suicide attempt.
3. Visual disturbances.
4. Increased libido.
40.	Which of the following outcomes should the nurse include in the initial plan of care for a client who is exhibiting psychomotor retardation, withdrawal, minimal eye contact, and unresponsiveness to the nurse’s questions?
1. The client will initiate interactions with peers.
2. The client will participate in milieu activities.
3. The client will discuss adaptive coping techniques.
4. The client will interact with the nurse.
41.	When preparing a teaching plan for a client about imipramine (Tofranil), which of the following substances should the nurse tell the client to avoid while taking the medication?
1. Caffeinated coffee.
4. Artificial tears.
42.	The client with depression who is taking imipramine (Tofranil) states to the nurse, “My doctor wants me to have an electrocardiogram (ECG) in 2 weeks, but my heart is fine.” Which response by the nurse is most appropriate?
1. “It’s routine practice to have ECGs periodically because there is a slight chance that the drug may affect the heart.”
2. “It’s probably a precautionary measure because I’m not aware that you have a cardiac condition.”
3. “Try not to worry too much about this. Your doctor is just being very thorough in monitoring your condition.”
4. “You had an ECG before you were prescribed imipramine and the procedure will be the same.”
43.	When assessing a client who is receiving tricyclic antidepressant therapy, which of the following should alert the nurse to the possibility that the client is experiencing anticholinergic effects? Analyze
1. Tremors and cardiac arrhythmias.
2. Sedation and delirium.
3. Respiratory depression and convulsions.
4. Urine retention and blurred vision.
44.	A client with depression who is taking doxepin (Sinequan) 100 mg P.O. at bedtime has dizziness on arising. Which of the following suggestions is most appropriate?
1. “Try taking a hot shower.”
2. “Get up slowly and dangle your feet before standing.”
3. “Stay in bed until you are feeling better.”
4. “You need to limit the fluids you drink.
45.	The MD orders mirtazapine (Remeron) 30 mg P.O. at bedtime for a client with depression. The nurse should:
1. Give the medication as ordered.
2. Question the physician’s order.
3. Request to give the medication in the morning.
4. Give the medication in three divided doses.
46.	A client taking mirtazapine (Remeron) is sad about a 20 lb weight gain over the past 3 months. The client says, “I stopped taking my Remeron 15 days ago. I don’t want to get depressed again, but I feel bad about my weight.” Which response by the nurse is most appropriate?
1. “Focusing on diet and exercise alone should control your weight.”
2. “Your depression is much better now, so your medication is helping you.”
3. “Look at all the positive things that have happened to you since you started Remeron.”
4. “I hear how difficult this is for you and will help you approach the doctor about it.”
47.	When developing a teaching plan for a client about medications prescribed for depression, which of the following is most important for the nurse to include?
1. Pharmacokinetics of the medication.
2. Current research related to the medication.
3. Management of common adverse effects.
4. Dosage regulation and adjustment.
48.	The client with severe major depression has been taking Lexapro 10 mg (escitalopram) daily for the past 2 weeks. Which of the following should the nurse monitor most closely at this time?
1. Suicidal ideation.
4. Energy level.
49.	A client taking paroxetine (Paxil) 40 mg P.O. every morning tells the nurse that her mouth “feels like cotton.” Which of the following statements by the client necessitates further assessment by the nurse?
1. “I’m sucking on ice chips.”
2. “I’m using sugarless gum.”
3. “I’m sucking on sugarless candy.”
4. “I’m drinking 12 glasses of water every day.”
50.	The client with depression has been consistent with taking 12.5 mg of paroxetine (Paxil) extended release daily. The nurse judges the client to be benefiting from this drug therapy when the client demonstrates which of the following behaviors? Select all that apply.
1. Takes 2-hour evening naps daily.
2. Completes homework assignments.
3. Decreases pacing.
4. Increases somatization.
5. Verbalizes feelings.
51.	A client with major depression has sleep & appetite disturbances, a flat affect and is withdrawn. He has been taking fluvoxamine (Luvox) 50 mg twice daily for 5 days. Which is most important to report to the next shift?
1. Client’s flat affect.
2. Client’s interacting with a visitor.
3. Client sleeping from 11 p.m. to 6 a.m.
4. Client spending the entire evening in her room.
52.	Which of the following is the best predictor of a client’s favorable response to the choice of an antidepressant?
1. The drug’s side effect profile.
2. The client’s age at diagnosis.
3. The cost of the medication.
4. A favorable response by a family member.
53.	A nurse is educating a client who has dysthymia about possible treatment for the disorder. Which response by the nurse is most appropriate?
1. “Antidepressants, particularly the SSRI group, offer you the best treatment for your dysthymia.”
2. “Doctors recommend that clients with dysthymia receive electroconvulsive therapy (ECT) to treat their disorder.”
3. “Because you have a mild, though long-lasting dysthymic mood, psychotherapy can usually bring improvement with less likelihood of the need for medication.”
4. “Since your dysthymia indicates a long-lasting mild depression, long-term psychoanalysis is best for you.”
54.	A client is brought to the hospital by police & admitted involuntarily. She is diagnosed with bipolar disorder, manic phase. The MD orders lithium 300 mg three times a day. The client refuses her morning dose of lithium. The nurse should next:
1. Force the client to take the lithium because of the client’s involuntarily admission status.
2. Contact the physician to change the lithium order to be given intramuscularly.
3. Inform the client that she retains the right to refuse medication despite her involuntary admission.
4. Tell the client that certain privileges will be revoked if she does not take the medication.
55.	A young adult diagnosed with bipolar disorder has been managing the disorder effectively with meds and treatment for several years. She suddenly becomes manic. The nurse reviews the medication record. Which of these may have contributed to the development of his manic state?
1. Elavil (amitriptyline).
3. BuSpar (buspirone).
4. Neurotonin (gabapentin).
56.	The client with acute mania has been admitted to the inpatient unit voluntarily. The nurse approaches the client with medication to be taken orally as ordered by the physician. The client states, “I don’t need that stuff.” Which response by the nurse is best?
1. “You can’t refuse to take this medication.”
2. “If you don’t take it orally, I’ll give you a shot.”
3. “The medication will help you feel calmer.”
4. “I’ll get you some written information about the medication.”
57.	A nurse observes a male client who is hyperactive and intrusive sitting very close to a female client with his arm around her shoulders. The nurse hears the male client tell a sexually explicit joke. The nurse approaches the client and asks him to walk down the hallway. Which of the following statements by the nurse should benefit the client?
1. “She will not want to be around you with that kind of talk.”
2. “Telling sexual jokes and touching others is not permitted here.”
3. “You need to be careful about what you say to other people.”
4. “I think a time-out in your room would be appropriate now.”
58.	A client states to a nurse, “Hey sweetie, you’re looking good today.” Which of the following responses by the nurse is best?
1. “Thank you for being so kind and thoughtful.”
2. “I know you are only teasing me.”
3. “My name is Molly, and I am a nurse on the unit today.” 4. “I am not here to receive compliments from clients.”
59.	A client with acute mania fails to respond to a nurse’s interventions to decrease his agitation. The nurse has attempted to defuse the client’s anger, but the client refuses to participate in interventions that would lower anxiety. Which action should the nurse take next?
1. Seclude the client.
2. Restrain the client.
3. Medicate the client.
4. Control the client.
60.	The client with mania is irritable and insulting to a nursing assistant. The nursing assistant states, “I can’t believe Mark is so rude. Shouldn’t he be overly happy?” Which of the following responses by the nurse should help the nursing assistant understand the client’s behavior?
1. “It’s our responsibility to listen to him even though we might not like what he’s saying.”
2. “We must reprimand Mark for doing that because there is no reason for him to behave like that.”
3. “I will go and speak to him about his behavior and make sure he understands that he needs to control what he is saying.”
4. “I know it’s difficult but Mark is a client whose irritable mood is a symptom of his mania.”
61.	Which milieu activity should the nurse recommend to a client with acute mania? Select all that apply.
1. Scheduled rest periods. 2
2. Relaxation exercises.
3. Listening to soft music.
4. Watching television.
5. Aerobic exercises.
62.	A nurse is assessing a client experiencing hypomania who wants to stop her mood stabilizing medication because she is “feeling good,” has a high energy level and thinks she is productive at work. Which response by the nurse is most appropriate?
1. “Maybe you really don’t need your medication anymore.”
2. “If you stop your medication, your behavior will quickly spiral out of control.”
3. “I believe you were hospitalized the last time you stopped your medication.”
4. “Why don’t you cut your medication dosage in half for a while and see how you respond?”
63.	The client with acute mania is prescribed 600 mg of lithium (lithium carbonate) P.O. three times per day. The physician also orders 5 mg of haloperidol (Haldol) P.O. at bedtime. Which action should the nurse take?
1. Administer the medication as ordered.
2. Question the physician about the order.
3. Administer the Haldol, but not the lithium.
4. Consult with the nursing supervisor before administering the medications.
64.	The client with an Axis I diagnosis of bipolar disorder, manic phase, states to the nurse, “I’m the Queen of England. Bow before me.” The nurse interprets this statement as important to document as which of the following areas of the mental status examination?
1. Psychomotor behavior.
2. Mood and affect.
3. Attitude toward the nurse.
4. Thought content.
65.	The client is laughing and telling jokes to a group of clients. Suddenly, the client is crying and talking about a death in the family. A moment later, the client is laughing and joking again. The nurse should:
1. Call the psychiatrist for an order for Ativan as needed.
2. Place the client in seclusion and call the psychiatrist for an order for the seclusion.
3. Ignore the client’s behavior in order not to give the client too much attention.
4. Ask the client to come to a quiet area to talk to the nurse individually.
66.	A client with acute mania exhibits euphoria, pressured speech, and flight of ideas. The client has been talking to the nurse nonstop for 5 minutes and lunch has arrived on the unit. Which of the following should the nurse do next?
1. Excuse self while telling the client to come to the dining room for lunch.
2. Tell the client he needs to stop talking because it’s time to eat lunch.
3. Do not interrupt the client but wait for him to finish talking.
4. Walk away and approach the client in a few minutes before the food gets cold.
67.	A female client with acute mania brings six suitcases and three shopping bags of personal belongings on admission to the unit. When informed that some of the suitcases and bags need to be returned home with her husband because of a lack of storage space, the client begins to use profanity against the nurse. Which of the following responses by the nurse is most therapeutic?
1. “You’re acting inappropriately.”
2. “I won’t tolerate your talking to me like that.”
3. “Swearing and profanity are unacceptable here.”
4. “We don’t want to put you in seclusion yet.”
68.	The husband of a client who is experiencing acute mania and is swearing and using profanity apologizes to the nurse for his wife’s behavior. Which of the following replies by the nurse is most therapeutic?
1. “This must be difficult for you.”
2. “It’s okay. We’ve heard worse.”
3. “How long has she been like this?”
4. “She needs some medication.”
69.	The nurse overhears a client with acute mania who is euphoric and flirtatious attempting to be sexually inappropriate with other clients by talking about a sexual exploit to a group of clients seated at a table. Which of the following should the nurse do next?
1. Continue walking down the hall, ignoring the conversation.
2. Speak to the client later in private while saying nothing at this time.
3. Tell the client others may not want to hear about sex, and invite him to play a game of ping-pong.
4. Inform the client that if he continues to talk about sex no one will want to be around him.
70.	The client with acute mania states to the nurse, “I’m the prince of peace and can save the world. Those against me will find me and take me to another world. They will come. I know it.” The client is beginning to scan the room and starts to repeat his delusion. Which of the following responses by the nurse is most therapeutic?
1. “Describe the people who will come.”
2. “The staff and I will protect you.”
3. “You are not the prince of peace. Your name is Joe.”
4. “Let’s walk around the unit for a while.”
71.	A client with bipolar disorder, manic phase, is scheduled for a chest radiograph. Before taking the client to the radiology department, the nurse should:
1. Give a thorough explanation of the procedure.
2. Explain the procedure in simple terms.
3. Call security to be on standby for possible problems.
4. Cancel the appointment until the client can go unescorted.
72.	A client exhibiting euphoria, hyperactivity, and distractibility cannot remain seated at mealtimes long enough to eat an adequate amount of food. When developing the client’s plan of care, the nurse anticipates providing the client with “finger food” to eat while moving about the unit. Which of the following foods should the nurse include in the client’s plan of care?
1. Bacon, lettuce, and tomato sandwich.
3. Ice cream cone.
4. Cut-up vegetables.
73.	The client with bipolar disorder, manic phase, appears at the nurse’s station wearing a transparent shirt, miniskirt, high heels, 10 bracelets, and 8 necklaces. Her makeup is overdone and she is not wearing underwear. A pair of inverted underpants is on her head. The nurse should:
1. Tell the client to dress appropriately while out of her room.
2. Ask the client to put on hospital pajamas until she can dress appropriately.
3. Instruct the client to go to her room and change clothes.
4. Escort the client to her room and assist with choosing appropriate attire.
74.	A client diagnosed with bipolar disorder and experiencing acute mania states to the nurse, “Where is my son? I love Lucy. Rain, rain go away. Dogs eat dirt.” Another client approaches the nurse and says, “Man, is he ever nuts! He’s driving me crazy with all his weird talk.” Which response by the nurse to the second client is most appropriate?
1. “I agree. He’s a little hard to take sometimes.”
2. “Just walk away and leave him alone. There is nothing else you can do.”
3. “I realize his behavior bothers you, but he can’t control it right now.”
4. “I’ll give him some medication so he won’t bother you.”
75.	The client with mania is skipping up and down the hallway practically running into other clients. The nurse should include which of the following activities in the client’s plan of care?
1. Leading a group activity.
2. Watching television.
3. Reading the newspaper.
4. Cleaning the dayroom tables.
76.	A client admitted to the nursing unit with bipolar disorder, manic phase, is accompanied by his wife. The wife states that her husband has been overly energetic and happy, talking constantly, purchasing many unneeded items, and sleeping about 4 hours a night for the past 5 days. When completing the client’s daily assessment, the nurse should be especially alert for which of the following findings?
77.	The wife of a client with bipolar disorder, manic phase, states to the nurse, “He’s acting so crazy. What did he do to get this way?” The nurse bases the response on the understanding of which of the following about this disorder?
1. It is caused by underlying psychological difficulties.
2. It is caused by disturbed family dynamics in the client’s early life.
3. 3. It is the result of an imbalance of chemicals in the brain.
4. It is the result of a genetic inheritance from someone in the family.
78.	A client experiencing acute mania has been taking lithium carbonate 600 mg P.O. three times daily for 14 days. The client’s serum lithium level is 1.8 mEq/ L. The nurse should:
1. Call the health care provider, hold next dose of lithium and push fluids.
2. Call the health care provider, start an IV and put client on bed rest.
3. Call the health care provider, then transfer client to a medical intensive care unit.
4. Inform the client that the lithium level is within normal limits.
79.	A client diagnosed with bipolar disorder asks the nurse why it is necessary to have a serum lithium level drawn every 3 to 4 months. The nurse’s response should be based on which of the following?
1. To monitor compliance with the medication.
2. To prevent toxicity related to the drug’s therapeutic range.
3. To monitor the client’s white blood cell count.
4. To comply with the drug manufacturer’s requirements.
80.	The physician orders determination of the serum lithium level tomorrow for a client with bipolar disorder, manic phase, who has been receiving lithium 300 mg P.O. three times daily for the past 5 days. At which of the following times should the nurse plan to have the blood specimen obtained?
1. Before bedtime.
2. After lunch.
3. Before breakfast.
4. During the afternoon.
81.	A client will be discharged on lithium carbonate 600 mg three times daily. When teaching the client and his family about lithium therapy, the nurse determines that teaching has been effective if the client and family state that they will notify the prescribing health care provider immediately if which of the following occur? Select all that apply.
2. Muscle weakness.
4. Fine hand tremor.
82.	After the nurse teaches a client with bipolar disorder about lithium therapy, which of the following client statements indicates the need for additional teaching?
1. “It’s important to keep using a regular amount of salt in my diet.”
2. “It’s okay to double my next dose of lithium if I forget a dose.”
3. “I should drink about 8 to 10 eight-ounce glasses of water each day.”
4. “I need to take my medicine at the same time each day.”
83.	A client with acute mania is to receive lithium carbonate 600 mg P.O. three times daily and 2 mg of haloperidol (Haldol) P.O. at bedtime. The nurse should:
1. Refuse to give the medications as ordered.
2. Give the lithium only.
3. Request a decreased dosage of lithium.
4. Give the medications as ordered.
84.	After the nurse teaches a client about bipolar disorder, which of the following statements indicates that the client has developed insight about the diagnosis?
1. “I enjoy feeling high. I don’t need much sleep then and get really creative.”
2. “My medicine really helped me. I know I won’t need it in about another week.”
3. “I’m cured now. I was really wild for a while even though I got into trouble.”
4. “I know I’m getting sick when I don’t need much sleep and start buying things.”
85.	During morning community meeting, a client with bipolar disorder, manic phase, interrupts others to the point where no one can finish their statements. The nurse should tell the client:
1. “Please stop interrupting others. You can speak when it’s your turn.”
2. “Stop talking. It’s time for you to leave the meeting.”
3. “If you can’t control yourself, we’ll have to take action.”
4. “Please behave like an adult. Your behavior is childish.”
86.	The physician orders valproic acid (Depakene) for a client with bipolar disorder who has achieved limited success with lithium carbonate (Lithane). Which of the following should the nurse include in the client’s medication teaching plan?
1. Follow-up blood tests are unnecessary.
2. The tablet can be crushed if necessary.
3. Drowsiness and upset stomach are common side effects.
4. Consumption of a moderate amount of alcohol is safe.
87.	The client with bipolar disorder, manic phase, has a valproic acid (Depakote) level of 15 μg/ mL. Which of the following client behaviors should the nurse judge to be due to this level of valproic acid? Select all that apply.
5. Flight of ideas.
88.	The client with rapid-cycling bipolar disorder who is about to receive his 5 p.m. dose of carbamazepine (Tegretol) tells the nurse he has a sore throat and chills. Which of the following should the nurse do next?
1. Administer the dose of carbamazepine.
2. First, give the client acetaminophen (Tylenol) as ordered p.r.n.
3. Report the symptoms to the physician in the morning.
4. Call the physician to report the symptoms.
89.	A client’s wife states, “I don’t know what to do sometimes. It’s so hard having a husband with a mental illness like bipolar disorder.” After talking with the client’s wife about her feelings and difficulties, which of the following actions is most appropriate?
1. Suggest that the wife see her physician.
2. Give the wife information about a support group.
3. Recommend that the wife talk with her close friend.
4. Have the wife share her feelings with her husband.
90.	The client with bipolar disorder is approaching discharge after being hospitalized with her first episode of acute mania. The client’s husband asks the nurse what he can do to help her. Which of the following recommendations for the husband should the nurse anticipate including in the teaching plan?
1. Help the client to be free from worry and anxiety.
2. Communicate openly and offer support.
3. Relieve the client of all responsibilities.
4. Remind the client to control her symptoms.
91.	The client with bipolar disorder states to the nurse, “I guess the medication does help me after all. When I stopped taking it, I started to have trouble sleeping and my thoughts were racing.” The nurse should tell the client:
1. “I’m happy you realize that you started to get symptoms when you stopped your medication.”
2. “Although it took a long time, you finally do understand that you need your medication.”
3. “Why didn’t you go to the community mental health center for help?”
4. “Didn’t your family tell you that you were getting sick again?”
92.	92. A client who is acutely manic and very anxious begins to pace, bump into furniture, and preach loudly. The nurse should:
1. Walk with the client until he calms down.
2. Tell the client to go to his room.
3. Ask the client to sit in on a group therapy session.
4. Administer haloperidol (Haldol) ordered p.r.n.
93.	A client experiencing a manic episode has been talking loudly, pacing the unit and trying to draw other clients into debates about the value of self-determination. Arrange in order the steps a nurse should take to help calm this client.
94.	The client with bipolar disorder, manic phase, states, “You’re looking good. I’m taking you out to dinner.” Which of the following replies by the nurse is most therapeutic?
1. “I don’t want to go out to dinner.”
2. “I can’t go out to dinner with you.”
3. “It doesn’t matter how I look, the answer is no.”
4. “I’m Chris Smith, a nurse working on this unit.”
95.	After the nurse administers haloperidol (Haldol) 5 mg P.O. to a client with acute mania, the client refuses to lie down on her bed, runs out on the unit, pushes clients in her vicinity out of the way, and screams threatening remarks to the staff. Which of the following should the nurse do next?
1. Follow the client and ask her to calm down.
2. Tell the client to lie down on the sofa in the community room.
3. Seclude the client and use restraints if necessary.
4. Tell the staff to ignore the client’s remarks.
96.	As the nurse is turning off the television, a client with bipolar disorder, manic phase, says, “I want the television on so I can watch the late show. I’m not tired and you can’t tell me what to do. I want it on!” The nurse should tell the client:
1. “I’ll let you watch television just this once. Don’t tell anyone about this.”
2. “I’ll turn the television off when you get sleepy. Don’t ask me to do this again.”
3. “Television hours are from 7 to 10 p.m. It’s 10 p.m., and the television goes off so everyone can sleep.”
4. “The television goes off at 10 p.m. I’ve been telling you this for the past three evenings.”
97.	The nurse manager in the emergency department (ED) is conducting an in-service for the nursing staff about screening clients for suicide. One of the nurses states, “Questioning adolescents about suicide will only increase their thinking about self-harm and they would not admit it to me anyhow.” How should the nurse manager respond?
1. “You could be correct. Let’s assess only adults because they’ll be more honest.”
2. “We will limit the assessment to adolescents with psychiatric diagnoses.”
3. “It’s a myth that talking about suicide leads to suicide attempts. Adolescents will disclose suicidal thoughts when asked directly.”
4. “If you think the adolescent is not telling you the truth, you can question the parents.”
98.	When assessing a client for suicidal risk, which of the following methods of suicide should the nurse identify as most lethal?
1. Aspirin overdose.
2. Use of a gun.
99.	The nurse manager overhears two staff members talking in the snack room. One of the staff members states, “Her superficial cuts are just a means of getting our attention. She never should have been admitted. I hope she’s out of here soon.” Which of the following responses by the nurse manager is most appropriate?
1. “It’s our job to help her no matter how we feel about her or what she did. She’ll be discharged soon.”
2. “I won’t tolerate that kind of discussion from my staff. Now, it is time for you to go back to work.”
3. “I know it’s hard to understand, but we need to do the best we can even though she’ll be back.”
4. “No matter what the intent, all suicidal behavior is serious and deserves our serious consideration.”
100.	The history of a female client who has just been admitted to the unit and is very depressed reveals a weight loss of 10 lb in 2 weeks, sleeping 3 hours a night, and poor hygiene. The client states, “I’m no good to anyone. Everyone would be better off without me.” Which of the following questions should the nurse ask first?
1. “What do you mean?”
2. “Are you thinking about hurting yourself?”
3. “Doesn’t your family care about you?”
4. “What happened to make you think that?”
101.	When developing the plan of care for a client with suicidal ideation, developing goals to address which of the following is a priority?
102.	Which of the following questions should the nurse ask to best determine the seriousness of a client’s suicidal ideation?
1. “How are you planning on harming yourself?”
2. “Have you made out a will?”
3. “Does your family know you’re here?”
4. “How long have you been thinking about harming yourself?”
103.	The nursing assistant states to the nurse, “My client talks about how awful and useless she is. Sometimes she sounds angry for no reason. I’m tired of listening to her.” Which of the following responses by the nurse is most appropriate?
1. “I’ll switch your assignment to someone who’s less depressed and less tiring.”
2. “It’s important for you to listen to her because she needs to verbalize how she is feeling.”
3. “Don’t worry about it. I know you haven’t done anything to make her angry.”
4. “Clients with depression are hard to deal with, but don’t take what they say seriously.”
104.	A client states, “I’m so tired of living and just want to end it all.” Which of the following responses is most therapeutic?
1. “I’ll walk with you to your room so that you can get some rest.”
2. “Perhaps after your son visits you’ll feel better about things.”
3. “You’re in a lot of pain now but you will feel better. I’m here to help you.”
4. “You are very depressed right now and want to die but you need to focus on life.”
105.	A client who was recently discharged from the psychiatric unit telephones the unit to speak to the nurse. The client states that she took her children to the neighbors’ house and has turned on the gas to kill herself. She is home alone and gives the nurse her address. Which of the following actions should the nurse do next?
1. Refer the caller to a 24-hour suicide hotline.
2. Tell the caller that another nurse will telephone the police.
3. Ask the caller whether she telephoned her physician.
4. Instruct the caller to telephone her family for help.
106.	A client walks into the clinic and tells the nurse she wants to die because her boyfriend broke up with her. The client states, “I’ll show him, he’ll be sorry.” The nurse notes which of the following as the underlying theme and method to deal with the client?
1. Sadness— ask client to reveal how long she has felt this way.
2. Escape— ask client to indicate from what she wants to escape.
3. Loneliness— ask client to state who she believes to be her friends.
4. Retaliation— ask client about her specific plans to harm herself and/ or her boyfriend.
107.	The client has been hospitalized for major depression and suicidal ideation. Which of the following statements indicates to the nurse that the client is improving?
1. “I couldn’t kill myself because I don’t want to go to hell.”
2. “I don’t think about killing myself as much as I used to.”
3. “I’m of no use to anyone anymore.”
4. “I know my kids don’t need me anymore since they’re grown.”
108.	The client states to the nurse at the outpatient clinic, “I don’t feel ready to go back to work. It’s only been a week since I left the hospital.” Assessment reveals a flat affect, disheveled appearance, poor posture, and minimal eye contact during interaction. The nurse asks the client whether he is thinking about harming himself. The client tells the nurse he has a loaded revolver at home and will probably use it. Which of the following should the nurse do next?
1. Tell the client to go and remove the gun from his home.
2. Ask the client to call the nurse every hour when he gets home.
3. Ask the client to promise not to harm himself.
4. Initiate plans for hospitalization immediately.
109.	The widow of a client who successfully completed suicide tearfully says, “I feel guilty because I’m so angry at him for killing himself. It must have been what he wanted.” After assisting the widow with dealing with her feelings, which of the following is most helpful?
1. Referring her to a group for survivors of suicide.
2. Encouraging her to receive counseling from a chaplain.
3. Providing her with the local suicide hotline number.
4. Suggesting she receive individual therapy by the nurse.
110.	The husband of a client to be discharged from the hospital after an episode of major depression and a suicide attempt asks, “What can I do if she tries to kill herself again?” Which of the following responses is most appropriate?
1. “Don’t worry. She’ll be okay as long as she takes her medication.”
2. “She told me she wants to live so I don’t think she’ll try again.”
3. “Let’s talk about some behavioral clues and resources that can help.”
4. “Tell her about your concern and just take care of her.”
111.	A client with depression is exhibiting a brighter affect, ability to attend to hygiene and grooming tasks, and beginning participation in group activities. The nurse asks the client to identify three of her strengths. After much hesitation and thinking, the client can state she is usually a nice person, a good cook, and a hard worker. Which of the following should the nurse do next?
1. Ask the client to identify an additional three strengths.
2. Volunteer the client to lead the cooking group later in the day.
3. Educate the client about the importance of medication.
4. Reinforce the client for identifying and sharing her strengths.
112.	The friend of a client with depression and suicidal ideation asks the nurse, “How should I act around her?” Which of the following responses by the nurse is best?
1. “Try to cheer her up.”
2. “Be caring and genuine.”
3. “Control your expressions.”
4. “Avoid asking how she’s feeling.”
113.	113. A client with depression and suicidal ideation voices feelings of self-doubt and powerlessness and is very dependent on the nurse for most aspects of her care. According to Erikson’s stages of growth and development, the nurse determines the client to be manifesting problems in which of the following stages?
1. Trust versus mistrust.
2. Autonomy versus shame/ doubt.
3. Initiative versus guilt.
4. Industry versus inferiority.
114.	A 68-year-old client has improved with medication and treatment and no longer experiences suicidal ideation. She can manage her diabetic care and understands her diet requirements. She will be discharged to live alone in her apartment. Visits by which of the following caregivers are most important for the nurse to arrange before the client’s discharge?
1. Psychiatric home care nurse.
2. Medical social worker.
3. Her minister.
4. Occupational therapist.
115.	A client who overdosed on barbiturates is being transferred to the inpatient psychiatric unit from the intensive care unit. Assessing the client for which of the following needs should be a priority for the nurse receiving the client in the intensive care unit?
116.	A client is brought to the psychiatric unit from the emergency department (ED) escorted by ED staff and a security officer. The client’s shoulder is bandaged and his arm is in a sling because of a self-inflicted gunshot wound to his shoulder. Later, the client’s wife follows with a bag of her husband’s belongings. Which of the following nursing actions is most appropriate at this time?
1. Tell the wife to take her husband’s things home because he is suicidal.
2. Instruct the wife to unpack the bag and put her husband’s things in the dresser.
3. Ask the wife whether the bag contains anything dangerous. 4. Inspect the bag and its contents in the presence of the client and his wife.
117.	A suicidal client is placed in the seclusion room and given lorazepam (Ativan) because she tried to harm herself by banging her head against the wall. After 10 minutes, the client starts to bang her head against the wall in the seclusion room. Which of the following should the nurse do next?
1. Tell the client to stop doing that and act like a responsible adult.
2. Place the client in leather restraints.
3. Call the physician for additional medication orders.
4. Instruct a staff member to sit in the room with the client.
118.	118. A client lives in a group home and visits the community mental health center regularly. During one visit with the nurse, the client states, “The voices are telling me to hurt myself again.” Which of the following questions by the nurse is most important to ask?
1. “When do you hear the voices?”
2. “Are you going to hurt yourself?”
3. “How long have you heard the voices?”
4. “Why are the voices starting again?”
119.	A 20-year-old client diagnosed with paranoid schizophrenia is recovering from his first psychotic break. Before discharge from the hospital, the client becomes depressed and states, “I don’t want this illness. I’m about to begin my junior year in college.” Which of the following issues would be most important for the nurses to address at this time?
1. Disturbed thought process.
2. Disturbed sensory perceptions.
3. Communication problems.
4. Potential for medication non-compliance.
120.	The nurse is teaching two nursing assistants who are new to the inpatient unit about caring for a client who is suicidal. The nurse determines that additional teaching is needed when which of the following statements is made?
1. “I need to check the client precisely at 15-minute intervals.”
2. “Documenting suicide checks is absolutely necessary.”
3. “Clients on one-to-one suicide precautions can never be left alone.”
4. “All clients using razors must be supervised by staff.”
121.	Which of the following activities should the nurse recommend to the client on an inpatient unit when thoughts of suicide occur?
1. Keeping track of feelings in a journal.
2. Reading a magazine.
3. Talking with the nurse.
4. Playing a card game with other clients.
122.	Which of the following amounts of medications is appropriate for a client who is being treated with imipramine (Tofranil) on an outpatient basis for recurring depression and suicidal ideation to have at one time?
1. A 30-day supply.
2. A 21-day supply.
3. A 14-day supply.
4. A 7-day supply.
123.	The client with recurrent depression and suicidal ideation tells the nurse, “I can’t afford this medicine anymore. I know I’ll be okay without it.” The nurse should:
1. Inform the physician of the client’s statement.
2. Ask the social worker to find assistance for the client.
3. Schedule a follow-up appointment in 3 months.
4. Ask the client whether a family member could help.
124.	A client is suicidal and not responding to the antidepressants prescribed to him over the last 2 months. This morning, after talking to his wife, the client verbally agrees to electroconvulsive therapy (ECT), but refuses to sign the consent form saying it is “evil.” The nurse should:
1. Proceed with treatment because he has given verbal consent.
2. Have his wife sign the consent form as next of kin.
3. Inform his wife that his refusal to sign means treatment must be withheld unless the client later signs the document or a court hearing is held.
4. Tell the client that he will not be released from the hospital as soon as originally promised due to his refusal.
125.	Which of the following reactions to learning about a diagnosis of being HIV positive would put the client at the greatest need of intervention by the nurse?
1. A person who is angry, hostile, and alienated from their family.
2. A person obsessed with cleanliness and showers many times a day.
3. A person unable to make decisions, who is helpless and tearful.
4. A person who says “I have found a solution for this mess.”
126.	Which of the following represents a breach of the nursing Code of Ethics regarding the rights of clients in psychiatric care situations?
1. Nurse discusses client’s care with out-of-town family members that the client has formally indicated are allowed to know about the client’s hospital care.
2. Nurse discusses the client’s history and hospital course of treatment with a consulting physician.
3. Nurse discusses with a friend the progress of a local celebrity being cared for at the hospital.
4. Nurse discusses the client’s care with the admission coordinator of a retirement home that the client plans to enter after discharge from the hospital.
127.	A client diagnosed with schizophrenia for the last two years tells the nurse who has brought the morning medications “That is not my pill! My pill is blue, not green.” The nurse should tell the client?
1. “Go ahead and take it. You can trust me. I am watching out for your safety and well being.”
2. “I know I took the correct medication out of the Pyxis. Don’t you trust me?”
3. “Don’t worry, your medication is generic and sometimes the manufacturers change the color of the pills without letting us know.”
4. “I will go back and check the drawer as well as telephone the pharmacy to check about any possible changes in the medication color.”
128.	A client who took an overdose of Tylenol in a suicide attempt is transferred overnight to the psychiatric inpatient unit from the intensive care unit. The night shift nurse called the physician on call to obtain initial orders. The physician ordered the typical routine medications for clients on this unit: Milk of Magnesia, Maalox and Tylenol as needed. Prior to implementing the orders, the nurse should?
1. Ask the physician about holding all the client’s PM orders.
2. Question the physician about the Tylenol order.
3. Request an order for a medication to relieve agitation.
4. Suggest the physician write an order for intravenous fluids.
129.	When developing appropriate assignments for the staff, which of the following clients should the nurse manager judge to be at highest risk for suicide completion?
1. An 85-year-old Caucasian man who lives alone after his wife’s death.
2. A 34-year-old single Hispanic woman who has recently been diagnosed with cancer.
3. A 15-year-old African American woman whose boyfriend broke up with her.
4. A 52-year-old Asian man who was terminated from his job because of downsizing.
130.	130. When developing staff assignments for the unit, the nurse manager should determine that which of the following clients needs one-to-one staff supervision?
1. The client who is sometimes preoccupied with death.
2. The client who tries to elope from the unit but is ambivalent about suicide.
3. The client who is impulsive and holds her breath until she faints.
4. The client who cannot sign a no-harm contract because of hallucinations.