- Psychiatric Drugs
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- Rationales or explanations are given after.
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- Read each question carefully and always choose the best answer.
- To add to the challenge, you are given one minute per question. A total of 60 minutes for this exam.
Psychiatric Nursing Quiz 1
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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 need to stop that behavior now.
You will need to be restrained if you do not change your behavior.
You will need to be placed in seclusion.
Question 1 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.
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?
Acknowledge the client’s behavior
Maintain a safe distance from the client
Assist the client to an area that is quiet
Initiate confinement measures
Question 2 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.
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:
A timid nurse
A mature experienced nurse
an inexperienced nurse
a soft spoken nurse
Question 3 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.
The nurse exemplifies awareness of the rights of a client whose anger is escalating by:
Taking a directive role in verbalizing feelings
Using an authoritarian, confrontational approach
Putting the client in a seclusion room
Applying mechanical restraints
Question 4 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.
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?
There was a doctor’s order for restraints/seclusion
The patient’s rights were explained to him.
The staff observed confidentiality
The staff carried out less restrictive measures but were unsuccessful.
Question 5 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.
Situation: Clients with personality disorders have difficulties in their social and occupational functions. Clients with personality disorder will most likely:
recover with therapeutic intervention
respond to antianxiety medication
manifest enduring patterns of inflexible behaviors
Seek treatment willingly from some personally distressing symptoms
Question 6 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.
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?
Question 7 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.
The client joins a support group and frequently preaches against abuse, is demonstrating the use of:
Question 8 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.
A teenage girl is diagnosed to have borderline personality disorder. Which manifestations support the diagnosis?
Lack of self esteem, strong dependency needs and impulsive behavior
social withdrawal, inadequacy, sensitivity to rejection and criticism
Suspicious, hypervigilance and coldness
Preoccupation with perfectionism, orderliness and need for control
Question 9 Explanation:
Lack of self esteem, strong dependency needs and impulsive behavior
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 10 Explanation:
The client is manipulative. The client must be informed about the policies, expectations, rules and regulation upon admission.
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
Industry vs. inferiority
Generativity vs. stagnation
Ego integrity vs. despair
Question 11 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.
Clients who are suspicious primarily use projection for which purpose:
to deal with feelings and thoughts that are not acceptable
to show resentment towards others
Question 12 Explanation:
Projection is a defense mechanism where one attributes ones feelings and inadequacies to others to reduce anxiety.
The client says “ the FBI is out to get me.” The nurse’s best response is:
“The FBI is not out to catch you.”
“I don’t believe that.”
“I don’t know anything about that. You are afraid of being harmed.”
“What made you think of that.”
Question 13 Explanation:
This presents reality and acknowledges the clients feeling.
The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting:
Question 14 Explanation:
Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle rigidity
The client is very hostile toward one of the staff for no apparent reason. The client is manifesting:
Question 15 Explanation:
Transference is a positive or negative feeling associated with a significant person in the client’s past that are unconsciously assigned to another
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:
Question 16 Explanation:
Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life.
During the initial care of rape victims the following are to be considered EXCEPT:
Touch the client to show acceptance and empathy
Accompany the client in the examination room.
Maintain a non-judgmental approach.
Question 17 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.
The nurse acts as a patient advocate when she does one of the following:
She encourages the client to express her feeling regarding her experience.
She assesses the client for injuries.
She postpones the physical assessment until the client is calm
Explains to the client that her reactions are normal
Question 18 Explanation:
The nurse acts as a patient advocate as she protects the client from psychological harm
Crisis intervention carried out to the client has this primary goal:
Assist the client to express her feelings
Help her identify her resources
Support her adaptive coping skills
Help her return to her pre-rape level of function
Question 19 Explanation:
The goal of crisis intervention to help the client return to her level of function prior to the crisis.
Five months after the incident the client complains of difficulty to concentrate, poor appetite, inability to sleep and guilt. She is likely suffering from:
Generalized Anxiety Disorder
Post traumatic disorder
Question 20 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.
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:
Question 21 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
Anxiety is caused by:
an objective threat
a subjectively perceived threat
hostility turned to the self
Question 22 Explanation:
Anxiety is caused by a subjectively perceived threat
It would be most helpful for the nurse to deal with a client with severe anxiety by:
Give specific instructions using speak in concise statements.
Ask the client to identify the cause of her anxiety.
Explain in detail the plan of care developed
Urge the client to focus on what the nurse is saying
Question 23 Explanation:
Give specific instructions using speak in concise statements. The client has narrowed perceptual field. Lengthy explanations cannot be followed by the client.
Which of the following medications will likely be ordered for a client with anxiety?
Which of the following is included in the health teachings among clients receiving Valium?:
Avoid foods rich in tyramine.
Take the medication after meals.
It is safe to stop it anytime after long term use.
Double up the dose if the client forgets her medication.
Question 25 Explanation:
Antianxiety medications cause G.I. upset so it should be taken after meals.
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There are 25 questions to complete.