Psychiatric Nursing Exam 1

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This test will challenge your skills regarding the concept of Psychiatric Nursing! Are you up for the challenge? Get ready! But first read the directions below:

All test questions will be shown in one page
All test questions are randomly arranged
All choices are randomly arranged
Rationales will be given after the quiz (be sure to read them!)

Psychiatric Nursing Quiz 1

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This test will challenge your skills regarding the concept of Psychiatric Nursing. >All test questions will be shown in one page >All test questions are randomly arranged >All choices are randomly arranged >Rationales will be given after the quiz (be sure to read them!) Start

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Question 1

Which of the following medications will likely be ordered for a client with anxiety?

	Prozac
	Valium
	Risperdal
	Lithium

Question 2

Crisis intervention carried out to the client has this primary goal:

	Support her adaptive coping skills
	Help her identify her resources
	Assist the client to express her feelings
	Help her return to her pre-rape level of function

Question 2 Explanation:The goal of crisis intervention to help the client return to her level of function prior to the crisis.

Question 3

The nurse exemplifies awareness of the rights of a client whose anger is escalating by:

	Using an authoritarian, confrontational approach
	Putting the client in a seclusion room
	Applying mechanical restraints
	Taking a directive role in verbalizing feelings

Question 3 Explanation:Taking a directive role in the client’s verbalization of feelings can deescalate the client’s anger. A confrontational approach can be threatening and adds to the client’s tension. Use of restraints and isolation may be required if less restrictive interventions are unsuccessful.

Question 4

A client tends to be insensitive to others, engages in abusive behaviors and does not have a sense of remorse. Which personality disorder is he likely to have?

	Narcissistic
	Histrionic
	Antisocial
	Paranoid

Question 4 Explanation:These are the characteristics of an individual with antisocial personality. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. Individuals with histrionic have excessive emotionality, and attention-seeking behaviors.

Question 5

Five months after the incident the client complains of difficulty to concentrate, poor appetite, inability to sleep and guilt. She is likely suffering from:

	Post traumatic disorder
	Somatoform Disorder
	Generalized Anxiety Disorder
	Adjustment disorder

Question 5 Explanation:Post traumatic stress disorder is characterized by flashback, irritability, difficulty falling asleep and concentrating following an extremely traumatic event. This lasts for more that one month A. Adjustment disorder is the maladaptive reaction to stressful events characterized by anxiety, depression and work or social impairments. This occurs within 3 months after the event.

Question 6

The client jumps up and throws a chair out of the window. He was restrained after his behavior can no longer be controlled by the staff. Which of these documentations indicates the safeguarding of the patient’s rights?

	The staff carried out less restrictive measures but were unsuccessful.
	The staff observed confidentiality
	The patient’s rights were explained to him.
	There was a doctor’s order for restraints/seclusion

Question 6 Explanation:The staff carried out less restrictive measures but were unsuccessful. This documentation indicates that the client has been placed on restraints after the least restrictive measures failed in containing the client’s violent behavior.

Question 7

The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting:

	dystonia
	Pseudoparkinsonism
	akinesia
	tardive dyskinesia

Question 7 Explanation:Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle rigidity

Question 8

Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway and making aggressive remarks.Which of the following statements is most appropriate to make to this patient?

	What is causing you to become agitated?
	You will need to be placed in seclusion.
	You need to stop that behavior now.
	You will need to be restrained if you do not change your behavior.

Question 8 Explanation:In a non-violent aggressive behavior, help the client identify the stressor or the true object of hostility. This helps reveal unresolved issues so that they may be confronted.

Question 9

Anxiety is caused by:

	an objective threat
	masked depression
	hostility turned to the self
	a subjectively perceived threat

Question 9 Explanation:Anxiety is caused by a subjectively perceived threat

Question 10

A teenage girl is diagnosed to have borderline personality disorder. Which manifestations support the diagnosis?

	Suspicious, hypervigilance and coldness
	social withdrawal, inadequacy, sensitivity to rejection and criticism
	Preoccupation with perfectionism, orderliness and need for control
	Lack of self esteem, strong dependency needs and impulsive behavior

Question 10 Explanation:Lack of self esteem, strong dependency needs and impulsive behavior

Question 11

It would be most helpful for the nurse to deal with a client with severe anxiety by:

	Explain in detail the plan of care developed
	Urge the client to focus on what the nurse is saying
	Give specific instructions using speak in concise statements.
	Ask the client to identify the cause of her anxiety.

Question 11 Explanation:Give specific instructions using speak in concise statements. The client has narrowed perceptual field. Lengthy explanations cannot be followed by the client.

Question 12

The charge nurse of a psychiatric unit is planning the client assignment for the day. The most appropriate staff to be assigned to a client with a potential for violence is which of the following:

	an inexperienced nurse
	A mature experienced nurse
	A timid nurse
	a soft spoken nurse

Question 12 Explanation:The unstable, aggressive client should be assigned to the most experienced nurse. A shy, inexperienced, soft spoken nurse may feel intimidated by the angry patient.

Question 13

The client is very hostile toward one of the staff for no apparent reason. The client is manifesting:

	Transference
	Resistance
	Splitting
	Countertransference

Question 13 Explanation:Transference is a positive or negative feeling associated with a significant person in the client’s past that are unconsciously assigned to another

Question 14

The plan of care for clients with borderline personality should include:

	Limit setting and flexibility in schedule
	Giving medications to prevent acting out
	Restricting her from other clients
	Ensuring she adheres to certain restrictions

Question 14 Explanation:The client is manipulative. The client must be informed about the policies, expectations, rules and regulation upon admission.

Question 15

The client says “ the NBI is out to get me.” The nurse’s best response is:

	“I don’t know anything about that. You are afraid of being harmed.”
	“I don’t believe that.”
	“The NBI is not out to catch you.”
	“ What made you think of that.”

Question 15 Explanation:This presents reality and acknowledges the clients feeling

Question 16

Clients who are suspicious primarily use projection for which purpose:

	deny reality
	to deal with feelings and thoughts that are not acceptable
	to show resentment towards others
	manipulate others

Question 16 Explanation:Projection is a defense mechanism where one attributes ones feelings and inadequacies to others to reduce anxiety.

Question 17

The nurse closely observes the client who has been displaying aggressive behavior. The nurse observes that the client’s anger is escalating. Which approach is least helpful for the client at this time?

	Initiate confinement measures
	Acknowledge the client’s behavior
	Maintain a safe distance from the client
	Assist the client to an area that is quiet

Question 17 Explanation:The proper procedure for dealing with harmful behavior is to first try to calm patient verbally. When verbal and psychopharmacologic interventions are not adequate to handle the aggressiveness, seclusion or restraints may be applicable. Other choices are appropriate approaches during the escalation phase of aggression.

Question 18

The client joins a support group and frequently preaches against abuse, is demonstrating the use of:

	reaction formation
	rationalization
	denial
	projection

Question 18 Explanation:Reaction formation is the adoption of behavior or feelings that are exactly opposite of one’s true emotions. Denial is refusal to accept a painful reality. Rationalization is attempting to justify one’s behavior by presenting reasons that sounds logical. Projection is attributing of one’s behaviors and feelings to another person.

Question 19

The nurse acts as a patient advocate when she does one of the following:

	She postpones the physical assessment until the client is calm
	Explains to the client that her reactions are normal
	She assesses the client for injuries.
	She encourages the client to express her feeling regarding her experience.

Question 19 Explanation:The nurse acts as a patient advocate as she protects the client from psychological harm

Question 20

Situation: A 29 year old client newly diagnosed with breast cancer is pacing, with rapid speech headache and inability to focus with what the doctor was saying.The nurse assesses the level of anxiety as:

	Panic
	Mild
	Moderate
	Severe

Question 20 Explanation:The client’s manifestations indicate severe anxiety.Mild anxiety is manifested by slight muscle tension, slight fidgeting, alertness, ability to concentrate and capable of problem solving.Moderate muscle tension, increased vital signs, periodic slow pacing, increased rate of speech and difficulty in concentrating are noted in moderate anxiety.Panic level of anxiety is characterized immobilization, incoherence, feeling of being overwhelmed and disorganization

Question 21

Which of the following is included in the health teachings among clients receiving Valium?:

	Double up the dose if the client forgets her medication.
	Avoid foods rich in tyramine.
	Take the medication after meals.
	It is safe to stop it anytime after long term use.

Question 21 Explanation:Antianxiety medications cause G.I. upset so it should be taken after meals.

Question 22

Situation: A 42 year old male client, is admitted in the ward because of bizarre behaviors. He is given a diagnosis of schizophrenia paranoid type.The client should have achieved the developmental task of:

	Trust vs. mistrust
	Ego integrity vs. despair
	Generativity vs. stagnation
	Industry vs. inferiority

Question 22 Explanation:The client belongs to the middle adulthood stage (30 to 65 yrs.) The developmental task generativity is characterized by concern and care for others. It is a productive and creative stage.

Question 23

During the initial care of rape victims the following are to be considered EXCEPT:

	Assure privacy.
	Maintain a non-judgmental approach.
	Touch the client to show acceptance and empathy
	Accompany the client in the examination room.

Question 23 Explanation:The client finds touch intrusive and therefore should be avoided. Privacy is one of the rights of a victim of rape. The client is anxious. Accompanying the client in a quiet room ensures safety and offers emotional support. Guilt feeling is common among rape victims. They should not be blamed.

Question 24

Situation: An 18 year old female was sexually attacked while on her way home from work. She is brought to the hospital by her mother.Rape is an example of which type of crisis:

	Developmental
	Adventitious
	Internal
	Situational

Question 24 Explanation:Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life.

Question 25

Situation: Clients with personality disorders have difficulties in their social and occupational functions. Clients with personality disorder will most likely:

	manifest enduring patterns of inflexible behaviors
	respond to antianxiety medication
	recover with therapeutic intervention
	Seek treatment willingly from some personally distressing symptoms

Question 25 Explanation:Personality disorders are characterized by inflexible traits and characteristics that are lifelong. This disorder is manifested by life-long patterns of behavior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not recover from therapeutic intervention. Medications are generally not recommended for personality disorders.

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