A 22 year old client is being admitted with a diagnosis of brief psychotic disorder. Which
finding would the nurse expect to find during the admission interview that is consistent
with the client's diagnosis?
A. Current treatment for pneumonia
B. Regular use of alcohol or marijuana
C. Evidence of delusions or hallucinations
D. History of chronic depression - ansC
A 62 years 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 would correctly
respond her by saying which of the following?
A. Your mother will be given something for pain before treatment
B. the physician will make sure your mother does not suffer needlessly
C. your mother will be asleep during the treatment and will not be in pain
D. your mother will able to talk to us and tell us if she is in pain - ansC
A client comes to the emergency room. The client is profusely perspiring, breathing
rapidly, and having dizziness and palpitations. Cardiac problems are assessed and
ruled out. The client's diagnosis is a panic attack. The client states, "I thought I would
die." What is the nurse's best response?
A. "It was very frightening for you."
B. "We would not have let you die."
C. "I would have felt the same way."
D. "But you are ok now." - ansA
A client diagnosed with major depression spends the majority of the day lying in bed
with the sheet pulled over his head . Which of the following approaches by the nurse
would be most therapeutic?
A. Wait for the client to start the conversation
B. initiate verbal contact with the client frequently especially during patient checks
C. sit outside the client's room
D. question the client until he responds - ansB
A client diagnosed with major depressive disorder has the nursing diagnosis of
disturbed sleep pattern. When developing a plan of care for this client which nursing
actions are more appropriate? select all that apply
A. determine sleep patterns prior to hospitalization
,B. discourage sleeping during the day
C. record and limit caffeinated drinks
D. reinforce reality thinking
E. encourage measures that aid in relaxation - ansA, B, C, E
A client diagnosed with schizophrenia has been hospitalized for 2 days and still believes
his food is poisoned. The client's partner is asking how he can still be paranoid after
being in the hospital for 2 days. What does the nurse accurately conclude?
A. The wife's inquiry is reasonable
B. Education about her husband's medication is needed
C. Her expectations of her husband are realistic
D. An increase in the client's medications is indicated - ansB
A client has an Axis I diagnosis of major depression. Which of the following features
would be most crucial for the nurse to assess?
A. sleep disturbance
B. feelings of worthlessness
C. difficulty with concentration
D. suicidal ideation - ansD
A client is being discharged after hospitalization for a suicide attempt. Which question
asked by the nurse assess the learned prevention and future coping strategies of the
client?
A. "how did you try to kill yourself?
B. do you have the phone number of the suicide prevention center?
C. what skills can you utilize if you experience problem again?
D. why did you think life was not worth living? - ansC (asking the client directly
regarding what skills he or she could utilize if similar problems occurred in the future
provides the client with an opportunity to reflect on learned behaviors and to determine
a plan for future prevention)
A client is in a withdrawn catatonic state and exhibits waxy flexibility. During the initial
phase of hospitalization for this client, the nurse's first priority is:
A. watch for edema and cyanosis of the extremities
B. encourage the client to discuss concerns that leads to the catatonic state
C. provide a warm nurturing relationship with therapeutic use of touch
D. identify the predisposing factors in the illness - ansA
A client is newly prescribed tramadol hydrochloride (Ultram) for chronic pain. The client
is also taking fluoxetine (Prozac) 40 mg daily for depression. Which statement by the
nurse accurately explains the interactions between the two drugs?
,A. there is no major concern with this drug combination
B. tramadol hydrochloride may decrease the effectiveness of fluoxetine
C. this drug combination can increase the risk of serotonin syndrome
D. SSRIs should not be taken within 14 days of the last dose of tramadol hydrochloride -
ansC
A client is pacing and wringing his hands. He answers, "I just need to walk," when the
nurse asks what he is feeling. Which response by the nurse is most therapeutic?
A. "You need to sit down and relax."
B. "Are you feeling anxious?"
C. "Is something bothering you?"
D. "You must be experiencing a problem now." - ansB
A client is receiving Paroxetine (Paxil) 20 mg everyday. After taking the first three doses
the client tells the nurse that the medication upsets his stomach. Which of the following
instructions would the nurse give to the client?
A. Take the medication hour before eating
B. Take the medication with some food.
C. take the medication at bedtime
D. take the medication with 4 ounces of orange juice. - ansB
A client is remaining in his room because he believes that the staff want to harm him.
What care plan outcome is most realistic?
A. Within 2 days, client will completed activities of daily living
B. Within 3 days the client will participate in recreation with other clients
C. Within 4 days, the client will demonstrate an absence of verbal aggression
D. Within 5 days the client will seek out staff to talk about feelings - ansC
A client is scheduled for discharge and will be taking phenobarbital (Luminal) for an
extended period. A nurse would place highest priority on teaching the client which of the
following points that directly related to the client safety?
A. take the medication only with the meals
B. take the medication at the same time each day
C. use a dose container to help prevent missed dose
D. avoid drinking alcohol while taking this medicine - ansD
A client jumps when spoken to and report feeling uneasy. The client states, "It is as if
something bad is going to happen." What should the nurse do from first to last?
A. Teach problem solving techniques
B. Ask the client to deep breathe for 2 minutes
C. Discuss the client's feelings in more depth
, D. Reduce environmental stimuli. - ansD, B, C, A
A client on Haloperidol (Haldol) is complaining of restlessness and internal jumpiness.
Which medicine should the nurse administer to reduce these symptoms?
A. Lorazepam (Ativan)
B. Benztropine (Cogentin)
C. Trazodone (Desyrel)
D. Olanzapine (Zyprexa) - ansB
A client perceives that her roommate's stuffed animal is her own dog at home. The
nurse notes the client's misperception of reality is improving when the client says:
A. Jan's stuffed dog looks somewhat like my dog
B. Jan's dog and my dog could be twins
C. I wish Jan had not had my dog stuffed
D. I guess Jan needs a dog as much as I do. - ansA
A client receiving tricyclic antidepressants arrives at the mental health clinic. which
observation would indicate that the client is following medication plan correctly?
A. client reports not going to work for this past week
B. client arrives clinic neat and appropriate in appearance
C. client complain of not bong able to do anything anymore
D. client is sleeping for 12 hours per night and 3-4 hours during day - ansB
A client recently diagnosed with depression tells a nurse that she is 2 months pregnant
and is reluctant to take an antidepressant medication. The client ask what other
treatment options are available. Which type of therapy should a nurse recommend as
an alternate treatment for depression?
A. client centered therapy
B. gestalt therapy
C. therapeutic touch therapy
D. cognitive behavioral therapy - ansD
A client reports becoming involved with legislation that promotes gun safety after the
death of a child by accidental shooting. Which defense mechanism is the client
exhibiting?
A. sublimation (sublimation involves redirecting unacceptable feelings or drives into an
acceptable channel)
B. identification(Identification involves taking an attributes and characteristics of
someone admired)
C. denial(denial is the refuse to accept a painful reality by pretending that it did not
happen )
finding would the nurse expect to find during the admission interview that is consistent
with the client's diagnosis?
A. Current treatment for pneumonia
B. Regular use of alcohol or marijuana
C. Evidence of delusions or hallucinations
D. History of chronic depression - ansC
A 62 years 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 would correctly
respond her by saying which of the following?
A. Your mother will be given something for pain before treatment
B. the physician will make sure your mother does not suffer needlessly
C. your mother will be asleep during the treatment and will not be in pain
D. your mother will able to talk to us and tell us if she is in pain - ansC
A client comes to the emergency room. The client is profusely perspiring, breathing
rapidly, and having dizziness and palpitations. Cardiac problems are assessed and
ruled out. The client's diagnosis is a panic attack. The client states, "I thought I would
die." What is the nurse's best response?
A. "It was very frightening for you."
B. "We would not have let you die."
C. "I would have felt the same way."
D. "But you are ok now." - ansA
A client diagnosed with major depression spends the majority of the day lying in bed
with the sheet pulled over his head . Which of the following approaches by the nurse
would be most therapeutic?
A. Wait for the client to start the conversation
B. initiate verbal contact with the client frequently especially during patient checks
C. sit outside the client's room
D. question the client until he responds - ansB
A client diagnosed with major depressive disorder has the nursing diagnosis of
disturbed sleep pattern. When developing a plan of care for this client which nursing
actions are more appropriate? select all that apply
A. determine sleep patterns prior to hospitalization
,B. discourage sleeping during the day
C. record and limit caffeinated drinks
D. reinforce reality thinking
E. encourage measures that aid in relaxation - ansA, B, C, E
A client diagnosed with schizophrenia has been hospitalized for 2 days and still believes
his food is poisoned. The client's partner is asking how he can still be paranoid after
being in the hospital for 2 days. What does the nurse accurately conclude?
A. The wife's inquiry is reasonable
B. Education about her husband's medication is needed
C. Her expectations of her husband are realistic
D. An increase in the client's medications is indicated - ansB
A client has an Axis I diagnosis of major depression. Which of the following features
would be most crucial for the nurse to assess?
A. sleep disturbance
B. feelings of worthlessness
C. difficulty with concentration
D. suicidal ideation - ansD
A client is being discharged after hospitalization for a suicide attempt. Which question
asked by the nurse assess the learned prevention and future coping strategies of the
client?
A. "how did you try to kill yourself?
B. do you have the phone number of the suicide prevention center?
C. what skills can you utilize if you experience problem again?
D. why did you think life was not worth living? - ansC (asking the client directly
regarding what skills he or she could utilize if similar problems occurred in the future
provides the client with an opportunity to reflect on learned behaviors and to determine
a plan for future prevention)
A client is in a withdrawn catatonic state and exhibits waxy flexibility. During the initial
phase of hospitalization for this client, the nurse's first priority is:
A. watch for edema and cyanosis of the extremities
B. encourage the client to discuss concerns that leads to the catatonic state
C. provide a warm nurturing relationship with therapeutic use of touch
D. identify the predisposing factors in the illness - ansA
A client is newly prescribed tramadol hydrochloride (Ultram) for chronic pain. The client
is also taking fluoxetine (Prozac) 40 mg daily for depression. Which statement by the
nurse accurately explains the interactions between the two drugs?
,A. there is no major concern with this drug combination
B. tramadol hydrochloride may decrease the effectiveness of fluoxetine
C. this drug combination can increase the risk of serotonin syndrome
D. SSRIs should not be taken within 14 days of the last dose of tramadol hydrochloride -
ansC
A client is pacing and wringing his hands. He answers, "I just need to walk," when the
nurse asks what he is feeling. Which response by the nurse is most therapeutic?
A. "You need to sit down and relax."
B. "Are you feeling anxious?"
C. "Is something bothering you?"
D. "You must be experiencing a problem now." - ansB
A client is receiving Paroxetine (Paxil) 20 mg everyday. After taking the first three doses
the client tells the nurse that the medication upsets his stomach. Which of the following
instructions would the nurse give to the client?
A. Take the medication hour before eating
B. Take the medication with some food.
C. take the medication at bedtime
D. take the medication with 4 ounces of orange juice. - ansB
A client is remaining in his room because he believes that the staff want to harm him.
What care plan outcome is most realistic?
A. Within 2 days, client will completed activities of daily living
B. Within 3 days the client will participate in recreation with other clients
C. Within 4 days, the client will demonstrate an absence of verbal aggression
D. Within 5 days the client will seek out staff to talk about feelings - ansC
A client is scheduled for discharge and will be taking phenobarbital (Luminal) for an
extended period. A nurse would place highest priority on teaching the client which of the
following points that directly related to the client safety?
A. take the medication only with the meals
B. take the medication at the same time each day
C. use a dose container to help prevent missed dose
D. avoid drinking alcohol while taking this medicine - ansD
A client jumps when spoken to and report feeling uneasy. The client states, "It is as if
something bad is going to happen." What should the nurse do from first to last?
A. Teach problem solving techniques
B. Ask the client to deep breathe for 2 minutes
C. Discuss the client's feelings in more depth
, D. Reduce environmental stimuli. - ansD, B, C, A
A client on Haloperidol (Haldol) is complaining of restlessness and internal jumpiness.
Which medicine should the nurse administer to reduce these symptoms?
A. Lorazepam (Ativan)
B. Benztropine (Cogentin)
C. Trazodone (Desyrel)
D. Olanzapine (Zyprexa) - ansB
A client perceives that her roommate's stuffed animal is her own dog at home. The
nurse notes the client's misperception of reality is improving when the client says:
A. Jan's stuffed dog looks somewhat like my dog
B. Jan's dog and my dog could be twins
C. I wish Jan had not had my dog stuffed
D. I guess Jan needs a dog as much as I do. - ansA
A client receiving tricyclic antidepressants arrives at the mental health clinic. which
observation would indicate that the client is following medication plan correctly?
A. client reports not going to work for this past week
B. client arrives clinic neat and appropriate in appearance
C. client complain of not bong able to do anything anymore
D. client is sleeping for 12 hours per night and 3-4 hours during day - ansB
A client recently diagnosed with depression tells a nurse that she is 2 months pregnant
and is reluctant to take an antidepressant medication. The client ask what other
treatment options are available. Which type of therapy should a nurse recommend as
an alternate treatment for depression?
A. client centered therapy
B. gestalt therapy
C. therapeutic touch therapy
D. cognitive behavioral therapy - ansD
A client reports becoming involved with legislation that promotes gun safety after the
death of a child by accidental shooting. Which defense mechanism is the client
exhibiting?
A. sublimation (sublimation involves redirecting unacceptable feelings or drives into an
acceptable channel)
B. identification(Identification involves taking an attributes and characteristics of
someone admired)
C. denial(denial is the refuse to accept a painful reality by pretending that it did not
happen )
