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1. 1.A client is fearful of driving and enters a behavioral a. Biofeedback
therapy
program to help him overcome his anxiety. Using
systematic
desensitization, he is able to drive down a familiar
street without
experiencing a panic attack. The nurse should recog-
nize that to
continue positive results, the client should partici-
pate in which of
the following?
a. Biofeedback
b. Therapist modeling
c. Frequent pacing
d. Positive reinforcement
2. 2. A nurse is counseling a client following the death d. "I still don't feel up to re-
of the client's turning to work."
partner 8 months ago. Which of the following client
statements Rationale: 8 months too long
indicates maladaptive grieving? Maladaptive Grief: . Distort-
a. "I am so sorry for the times I was angry with my ed or exaggerated grief re-
partner." sponse - unable to
b. "I like looking at his personal items in the closet." perform activities of daily liv-
c. "I find myself thinking about my partner often." ing.
d. "I still don't feel up to returning to work."
RISK FACTORS FOR MAL-
ADAPTIVE GRIEVING
ÏÏBeing dependent upon the
deceased
ÏÏUnexpected death at a
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young age, through vio-
lence, or by a socially unac-
ceptable manner
ÏÏInadequate coping skills or
lack of social support
ÏÏPre-existing mental health
issues, such as depression or
substance use disorder
3. 3./21 A nurse in an inpatient mental health facility is d. High fever (Complication ’
assessing a agranulocytosis)
client who has schizophrenia and is taking haloperi-
dol (antipsychotic, Other complications: Acute
1st gen). dystonia, Pseudoparkinson-
Which of the following clinical findings is the nurse's ism, Akathisia, Tardive dyski-
priority? nesia,
a. Headache Neuroendocrine effects (Gy-
b. Insomnia (sedation) necomastia, Weight gain,
c. Urinary hesitancy (Complication ’ ANTIcholinergic Menstrual irregularities),
effects) NMS,
d. High fever (Complication ’ agranulocytosis) Orthostatic Hypotension, Se-
dation, Sexual dysfunction,
Skin effects, Liver impair-
ment
4. 4. A nurse is planning care for a client who has obses- c. Thought Stopping (say
sive "stop" when compulsive be-
compulsive disorder. Which of the following recom- haviors arise & substitute
mendations w/ positive thought)
should the nurse include in the client's plan of care?
a. Reality Orientation therapy (re-orient to reality)
b. Operant Conditioning (receives positive rewards
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for positive behavior)
c. Thought Stopping (say "stop" when compulsive
behaviors arise & substitute
w/ positive thought)
d. Validation Therapy (acknowledging pt's feelings)
5. 5. A nurse is caring for a client who is in the manic c. Avoid power struggles by
phase of remaining neutral (do not
bipolar disorder. Which of the following actions react
should the personally to pt's comments)
nurse take?
a. Provide in depth explanation of nursing expecta-
tions
(inability to focus - give concise explanations)
b. Encourage the client to participate in group activi-
ties
(decrease stimulation)
c. Avoid power struggles by remaining neutral (do
not react
personally to pt's comments)
d. Allow the client to set limits for his behavior (nurse
sets limits)
6. 6. A nurse is providing behavioral therapy for a client d. "Snap a rubber band on
who has your wrist when you think
OCD. The client repeatedly checks that the doors are about
locked at checking the locks."
night. Which of the following instructions should the
nurse give Thought stopping: teach pt
the client when using thought stopping technique? to say "stop" when negative
a. "Keep a journal of how often you check the locks thoughts/compulsive be-
each haviors arise & substitute
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night." positive thought - goal forpt
b. "Ask a family member to check the locks for you at use command silently over
night." time
c. "Focus on abdominal breathing whenever you go
to
check the locks."
d. "Snap a rubber band on your wrist when you think
about
checking the locks."
7. 7. A nurse is caring for a client who has a cocaine use b. Fatigue
disorder.
Which of the following manifestations should the
nurse expect
the client to have during withdrawal?
a. Hand tremors (Intoxication)
b. Fatigue
c. Seizures (Intoxication)
d. Rapid speech
Rationale: Pg: 97 WITHDRAWAL MANIFESTATIONS-
ÏDepression, fatigue, craving, excess sleeping or
insomnia, dramatic unpleasant dreams, psychomo-
tor retardation, agitation ÏNot life-threatening, but
possible occurrence of suicidal ideation
Cocaine = STIMULANT ’ OPPOSITE of HEROIN
ÏWithdrawal = opposite effects
8. 8. A nurse is reviewing the medical record of a client a. WBC count
who is taking
clozapine. For which of the following findings should
the nurse
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1. 1.A client is fearful of driving and enters a behavioral a. Biofeedback
therapy
program to help him overcome his anxiety. Using
systematic
desensitization, he is able to drive down a familiar
street without
experiencing a panic attack. The nurse should recog-
nize that to
continue positive results, the client should partici-
pate in which of
the following?
a. Biofeedback
b. Therapist modeling
c. Frequent pacing
d. Positive reinforcement
2. 2. A nurse is counseling a client following the death d. "I still don't feel up to re-
of the client's turning to work."
partner 8 months ago. Which of the following client
statements Rationale: 8 months too long
indicates maladaptive grieving? Maladaptive Grief: . Distort-
a. "I am so sorry for the times I was angry with my ed or exaggerated grief re-
partner." sponse - unable to
b. "I like looking at his personal items in the closet." perform activities of daily liv-
c. "I find myself thinking about my partner often." ing.
d. "I still don't feel up to returning to work."
RISK FACTORS FOR MAL-
ADAPTIVE GRIEVING
ÏÏBeing dependent upon the
deceased
ÏÏUnexpected death at a
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young age, through vio-
lence, or by a socially unac-
ceptable manner
ÏÏInadequate coping skills or
lack of social support
ÏÏPre-existing mental health
issues, such as depression or
substance use disorder
3. 3./21 A nurse in an inpatient mental health facility is d. High fever (Complication ’
assessing a agranulocytosis)
client who has schizophrenia and is taking haloperi-
dol (antipsychotic, Other complications: Acute
1st gen). dystonia, Pseudoparkinson-
Which of the following clinical findings is the nurse's ism, Akathisia, Tardive dyski-
priority? nesia,
a. Headache Neuroendocrine effects (Gy-
b. Insomnia (sedation) necomastia, Weight gain,
c. Urinary hesitancy (Complication ’ ANTIcholinergic Menstrual irregularities),
effects) NMS,
d. High fever (Complication ’ agranulocytosis) Orthostatic Hypotension, Se-
dation, Sexual dysfunction,
Skin effects, Liver impair-
ment
4. 4. A nurse is planning care for a client who has obses- c. Thought Stopping (say
sive "stop" when compulsive be-
compulsive disorder. Which of the following recom- haviors arise & substitute
mendations w/ positive thought)
should the nurse include in the client's plan of care?
a. Reality Orientation therapy (re-orient to reality)
b. Operant Conditioning (receives positive rewards
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for positive behavior)
c. Thought Stopping (say "stop" when compulsive
behaviors arise & substitute
w/ positive thought)
d. Validation Therapy (acknowledging pt's feelings)
5. 5. A nurse is caring for a client who is in the manic c. Avoid power struggles by
phase of remaining neutral (do not
bipolar disorder. Which of the following actions react
should the personally to pt's comments)
nurse take?
a. Provide in depth explanation of nursing expecta-
tions
(inability to focus - give concise explanations)
b. Encourage the client to participate in group activi-
ties
(decrease stimulation)
c. Avoid power struggles by remaining neutral (do
not react
personally to pt's comments)
d. Allow the client to set limits for his behavior (nurse
sets limits)
6. 6. A nurse is providing behavioral therapy for a client d. "Snap a rubber band on
who has your wrist when you think
OCD. The client repeatedly checks that the doors are about
locked at checking the locks."
night. Which of the following instructions should the
nurse give Thought stopping: teach pt
the client when using thought stopping technique? to say "stop" when negative
a. "Keep a journal of how often you check the locks thoughts/compulsive be-
each haviors arise & substitute
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night." positive thought - goal forpt
b. "Ask a family member to check the locks for you at use command silently over
night." time
c. "Focus on abdominal breathing whenever you go
to
check the locks."
d. "Snap a rubber band on your wrist when you think
about
checking the locks."
7. 7. A nurse is caring for a client who has a cocaine use b. Fatigue
disorder.
Which of the following manifestations should the
nurse expect
the client to have during withdrawal?
a. Hand tremors (Intoxication)
b. Fatigue
c. Seizures (Intoxication)
d. Rapid speech
Rationale: Pg: 97 WITHDRAWAL MANIFESTATIONS-
ÏDepression, fatigue, craving, excess sleeping or
insomnia, dramatic unpleasant dreams, psychomo-
tor retardation, agitation ÏNot life-threatening, but
possible occurrence of suicidal ideation
Cocaine = STIMULANT ’ OPPOSITE of HEROIN
ÏWithdrawal = opposite effects
8. 8. A nurse is reviewing the medical record of a client a. WBC count
who is taking
clozapine. For which of the following findings should
the nurse
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