This NCLEX exam has 50 questions that cover Psychiatric Drugs: their therapeutic uses, side-effects, adverse effects, and dosages. The questions in this exam will challenge your nursing knowledge about the various Psychiatric medications and their uses. Accomplish this and do well on your NCLEX!
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Successful people do what unsuccessful people are not willing to do. Don’t wish it were easier; wish you were better.
~ Jim Rohn
Topics or concepts included in this exam are:
- Psychiatric Nursing
- Psychiatric Drugs
- Read each question carefully and choose the best answer.
- You are given one minute per question. Spend your time wisely!
- Answers and rationales (if any) are given below. Be sure to read them.
- If you need more clarifications, please direct them to the comments section.
In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz. You are given 1 minute per question.
Psychiatric Nursing Practice Quiz #12 (50 Questions)
Practice Mode: This is an interactive version of the Text Mode. All questions are given on a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.
Psychiatric Nursing Practice Quiz #12 (50 Questions)
In Text Mode: All questions and answers are given for reading and answering at your own pace. You can also copy this exam and make a printout.
1. Mr. Marquez reports of losing his job, not being able to sleep at night, and feeling upset with his wife. Nurse John responds to the client, “You may want to talk about your employment situation in group today.” The Nurse is using which therapeutic technique?
2. Tony refuses his evening dose of Haloperidol (Haldol), then becomes extremely agitated in the dayroom while other clients are watching television. He begins cursing and throwing furniture. Nurse Oliver first action is to:
A. Check the client’s medical record for an order for an as-needed I.M. dose of medication for agitation.
B. Place the client in full leather restraints.
C. Call the attending physician and report the behavior.
D. Remove all other clients from the dayroom.
3. Tina who is manic, but not yet on medication, comes to the drug treatment center. The nurse would not let this client join the group session because:
A. The client is disruptive.
B. The client is harmful to self.
C. The client is harmful to others.
D. The client needs to be on medication first.
4. Dervid, an adolescent boy was admitted for substance abuse and hallucinations. The client’s mother asks Nurse Armando to talk with his husband when he arrives at the hospital. The mother says that she is afraid of what the father might say to the boy. The most appropriate nursing intervention would be to:
A. Inform the mother that she and the father can work through this problem themselves.
B. Refer the mother to the hospital social worker.
C. Agree to talk with the mother and the father together.
D. Suggest that the father and son work things out.
5. What is Nurse John likely to note in a male client being admitted for alcohol withdrawal?
A. Perceptual disorders.
B. Impending coma.
C. Recent alcohol intake.
D. Depression with mutism.
6. Aira has taken amitriptyline HCL (Elavil) for 3 days, but now complains that it “doesn’t help” and refuses to take it. What should the nurse say or do?
A. Withhold the drug.
B. Record the client’s response.
C. Encourage the client to tell the doctor.
D. Suggest that it takes awhile before seeing the results.
7. Dervid, an adolescent has a history of truancy from school, running away from home and “borrowing” other people’s things without their permission. The adolescent denies stealing, rationalizing instead that as long as no one was using the items, it was all right to borrow them. It is important for the nurse to understand the psychodynamically, this behavior may be largely attributed to a developmental defect related to the:
D. Oedipal complex
8. In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle knows that succinylcholine (Anectine) will be administered for which therapeutic effect?
A. Short-acting anesthesia
B. Decreased oral and respiratory secretions.
C. Skeletal muscle paralysis.
9. Nurse Gina is aware that the dietary implications for a client in manic phase of bipolar disorder is:
A. Serve the client a bowl of soup, buttered French bread, and apple slices.
B. Increase calories, decrease fat, and decrease protein.
C. Give the client pieces of cut-up steak, carrots, and an apple.
D. Increase calories, carbohydrates, and protein.
10. What parental behavior toward a child during an admission procedure should cause Nurse Ron to suspect child abuse?
A. Flat affect
B. Expressing guilt
C. Acting overly solicitous toward the child.
D. Ignoring the child.
11. Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her hands for long periods each day. How should the nurse respond to this compulsive behavior?
A. By designating times during which the client can focus on the behavior.
B. By urging the client to reduce the frequency of the behavior as rapidly as possible.
C. By calling attention to or attempting to prevent the behavior.
D. By discouraging the client from verbalizing anxieties.
12. After seeking help at an outpatient mental health clinic, Ruby who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby?
A. Recommending a high-protein, low-fat diet.
B. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle.
C. Allowing the client time to heal.
D. Exploring the meaning of the traumatic event with the client.
13. Meryl, age 19, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. Meryl asks the nurse, “Why has this happened to me?” What is the nurse’s best response?
A. “You’ve developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again.”
B. “It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical.”
C. “Your problem is real but there is no physical basis for it. We’ll work on what is going on in your life to find out why it’s happened.”
D. “It isn’t uncommon for someone with your personality to develop a conversion disorder during times of stress.”
14. Nurse Krina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD):
A. benztropine (Cogentin) and diphenhydramine (Benadryl).
B. chlordiazepoxide (Librium) and diazepam (Valium)
C. fluvoxamine (Luvox) and clomipramine (Anafranil)
D. divalproex (Depakote) and lithium (Lithobid)
15. Alfred was newly diagnosed with anxiety disorder. The physician prescribed buspirone (BuSpar). The nurse is aware that the teaching instructions for newly prescribed buspirone should include which of the following?
A. A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days.
B. A warning about the incidence of neuroleptic malignant syndrome (NMS).
C. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug.
D. A warning that immediate sedation can occur with a resultant drop in pulse.
16. Richard with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:
A. Insomnia and an inability to concentrate.
B. Severe anxiety and fear.
C. Depression and weight loss.
D. Withdrawal and failure to distinguish reality from fantasy.
17. Which medications have been found to help reduce or eliminate panic attacks?
18. A client seeks care because she feels depressed and has gained weight. To treat her atypical depression, the physician prescribes tranylcypromine sulfate (Parnate), 10 mg by mouth twice per day. When this drug is used to treat atypical depression, what is its onset of action?
A. 1 to 2 days
B. 3 to 5 days
C. 6 to 8 days
D. 10 to 14 days
19. A 65 years old client is in the first stage of Alzheimer’s disease. Nurse Patricia should plan to focus this client’s care on:
A. Offering nourishing finger foods to help maintain the client’s nutritional status.
B. Providing emotional support and individual counseling.
C. Monitoring the client to prevent minor illnesses from turning into major problems.
D. Suggesting new activities for the client and family to do together.
20. The nurse is assessing a client who has just been admitted to the emergency department. Which signs would suggest an overdose of an antianxiety agent?
A. Combativeness, sweating, and confusion
B. Agitation, hyperactivity, and grandiose ideation
C. Emotional lability, euphoria, and impaired memory
D. Suspiciousness, dilated pupils, and increased blood pressure
21. The nurse is caring for a client diagnosed with antisocial personality disorder. The client has a history of fighting, cruelty to animals, and stealing. Which of the following traits would the nurse be most likely to uncover during assessment?
A. History of gainful employment
B. Frequent expression of guilt regarding antisocial behavior
C. Demonstrated ability to maintain close, stable relationships
D. A low tolerance for frustration
22. Nurse Amy is providing care for a male client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with:
23. Nurse Cristina is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:
C. Loose associations
24. Nurse Marco is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?
A. Restricts visits with the family and friends until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.
25. Tim is admitted with a diagnosis of delusions of grandeur. The nurse is aware that this diagnosis reflects a belief that one is:
A. Highly important or famous.
B. Being persecuted
C. Connected to events unrelated to oneself
D. Responsible for the evil in the world.
26. Nurse Jen is caring for a male client with manic depression. The plan of care for a client in a manic state would include:
A. Offering high-calorie meals and strongly encouraging the client to finish all food.
B. Insisting that the client remain active through the day so that he’ll sleep at night.
C. Allowing the client to exhibit hyperactive, demanding, manipulative behavior without setting limits.
D. Listening attentively with a neutral attitude and avoiding power struggles.
27. Ramon is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but that he can control his use if he chooses. Which coping mechanism is he using?
B. Logical thinking
28. Richard is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?
A. Aggressive behavior
B. Paranoid thoughts
C. Emotional affect
D. Independence needs
29. Nurse Mickey is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
C. Identify anxiety-causing situations
D. Eat only three meals per day.
30. Rudolf is admitted for an overdose of amphetamines. When assessing the client, the nurse should expect to see:
31. Nicolas is experiencing hallucinations tells the nurse, “The voices are telling me I’m no good.” The client asks if the nurse hears the voices. The most appropriate response by the nurse would be:
A. “It is the voice of your conscience, which only you can control.”
B. “No, I do not hear your voices, but I believe you can hear them”.
C. “The voices are coming from within you and only you can hear them.”
D. “Oh, the voices are a symptom of your illness; don’t pay any attention to them.”
32. The nurse is aware that the side effect of electroconvulsive therapy that a client may experience:
A. Loss of appetite
B. Postural hypotension
C. Confusion for a time after treatment
D. Complete loss of memory for a time
33. A dying male client gradually moves toward resolution of feelings regarding impending death. Basing care on the theory of Kubler-Ross, Nurse Trish plans to use nonverbal interventions when assessment reveals that the client is in the:
A. Anger stage
B. Denial stage
C. Bargaining stage
D. Acceptance stage
34. The outcome that is unrelated to a crisis state is:
A. Learning more constructive coping skills
B. Decompensation to a lower level of functioning.
C. Adaptation and a return to a prior level of functioning.
D. A higher level of anxiety continuing for more than 3 months.
35. Miranda a psychiatric client is to be discharged with orders for haloperidol (Haldol) therapy. When developing a teaching plan for discharge, the nurse should include cautioning the client against:
A. Driving at night
B. Staying in the sun
C. Ingesting wines and cheeses
D. Taking medications containing aspirin
36. Jen a nursing student is anxious about the upcoming board examination but is able to study intently and does not become distracted by a roommate’s talking and loud music. The student’s ability to ignore distractions and to focus on studying demonstrates:
A. Mild-level anxiety
B. Panic-level anxiety
C. Severe-level anxiety
D. Moderate-level anxiety
37. When assessing a premorbid personality characteristics of a client with a major depression, it would be unusual for the nurse to find that this client demonstrated:
C. Diverse interest
D. Over meticulousness
38. Nurse Krina recognizes that the suicidal risk for depressed client is greatest:
A. As their depression begins to improve
B. When their depression is most severe
C. Before nay type of treatment is started
D. As they lose interest in the environment
39. Nurse Kate would expect that a client with vascular dementia would experience:
A. Loss of remote memory related to anoxia
B. Loss of abstract thinking related to emotional state
C. Inability to concentrate related to decreased stimuli
D. Disturbance in recalling recent events related to cerebral hypoxia.
40. Josefina is to be discharged on a regimen of lithium carbonate. In the teaching plan for discharge the nurse should include:
A. Advising the client to watch the diet carefully
B. Suggesting that the client take the pills with milk
C. Reminding the client that a CBC must be done once a month.
D. Encouraging the client to have blood levels checked as ordered.
41. The psychiatrist orders lithium carbonate 600 mg p.o t.i.d for a female client. Nurse Katrina would be aware that the teaching about the side effects of this drug were understood when the client state, “I will call my doctor immediately if I notice any:
A. Sensitivity to bright light or sun
B. Fine hand tremors or slurred speech
C. Sexual dysfunction or breast enlargement
D. Inability to urinate or difficulty when urinating
42. Nurse Mylene recognizes that the most important factor necessary for the establishment of trust in a critical care area is:
43. When establishing an initial nurse-client relationship, Nurse Hazel should explore with the client the:
A. Client’s perception of the presenting problem.
B. Occurrence of fantasies the client may experience.
C. Details of any ritualistic acts carried out by the client
D. Client’s feelings when external; controls are instituted.
44. Tranylcypromine sulfate (Parnate) is prescribed for a depressed client who has not responded to the tricyclic antidepressants. After teaching the client about the medication, Nurse Marian evaluates that learning has occurred when the client states, “I will avoid:
A. Citrus fruit, tuna, and yellow vegetables.”
B. Chocolate milk, aged cheese, and yogurt”
C. Green leafy vegetables, chicken, and milk.”
D. Whole grains, red meats, and carbonated soda.”
45. Nurse John is aware that most crisis situations should resolve in about:
A. 1 to 2 weeks
B. 4 to 6 weeks
C. 4 to 6 months
D. 6 to 12 months
46. Nurse Judy knows that statistics show that in adolescent suicidal behavior:
A. Females use more dramatic methods than males
B. Males account for more attempts than do females
C. Females talk more about suicide before attempting it
D. Males are more likely to use lethal methods than are females
47. David with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?
A. “Your behavior won’t be tolerated. Go to your room immediately.”
B. “You’re just doing this to get back at me for making you come to therapy.”
C. “Your cursing is interrupting the activity. Take time out in your room for 10 minutes.”
D. “I’m disappointed in you. You can’t control yourself even for a few minutes.”
48. Nurse Maureen knows that the non-antipsychotic medication used to treat some clients with schizoaffective disorder is:
A. Monthly blood tests will be necessary.
B. Report a sore throat or fever to the physician immediately.
C. Blood pressure must be monitored for hypertension.
D. Stop the medication when symptoms subside.
50. Ricky with chronic schizophrenia takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction:
A. Tardive dyskinesia.
C. Neuroleptic malignant syndrome.
Answers & Rationale
Here are the answers and rationale for this exam. Counter check your answers to those below and tell us your scores. If you have any disputes or need more clarification to a certain question, please direct them to the comments section.
1. Answer: D. Focusing
- Option D: The nurse is using focusing by suggesting that the client discuss a specific issue.
- Options A, B, and C: The nurse didn’t restate the question, make observation, or ask further question (exploring).
2. Answer: D. Remove all other clients from the dayroom.
- Option D: The nurse’s first priority is to consider the safety of the clients in the therapeutic setting.
- Options A, B, and C: The other actions are appropriate responses after ensuring the safety of other clients.
3. Answer: A. The client is disruptive.
- Option A: Group activity provides too much stimulation, which the client will not be able to handle (harmful to self) and as a result will be disruptive to others.
4. Answer: C. Agree to talk with the mother and the father together.
- Option C: By agreeing to talk with both parents, the nurse can provide emotional support and further assess and validate the family’s needs.
5. Answer: A. Perceptual disorders.
- Option A: Frightening visual hallucinations are especially common in clients experiencing alcohol withdrawal.
6. Answer: D. Suggest that it takes awhile before seeing the results.
- Option D: The client needs a specific response; that it takes 2 to 3 weeks (a delayed effect) until the therapeutic blood level is reached.
7. Answer: C. Superego
- Option C: This behavior shows a weak sense of moral consciousness. According to Freudian theory, personality disorders stem from a weak superego.
8. Answer: C. Skeletal muscle paralysis.
- Option C: Anectine is a depolarizing muscle relaxant causing paralysis. It is used to reduce the intensity of muscle contractions during the convulsive stage, thereby reducing the risk of bone fractures or dislocation.
9. Answer: D. Increase calories, carbohydrates, and protein.
- Option D: This client increased protein for tissue building and increased calories to replace what is burned up (usually via carbohydrates).
10. Answer: C. Acting overly solicitous toward the child.
- Option C: This behavior is an example of reaction formation, a coping mechanism.
11. Answer: A. By designating times during which the client can focus on the behavior.
- Option A: The nurse should designate times during which the client can focus on the compulsive behavior or obsessive thoughts.
- Option B: The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly.
- Option C: She shouldn’t call attention to or try to prevent the behavior. Trying to prevent the behavior may cause pain and terror to the client.
- Option D: The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.
12. Answer: D. Exploring the meaning of the traumatic event with the client.
- Option D: The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse.
- Option A: A special diet isn’t indicated unless the client also has an eating disorder or a nutritional problem.
- Option B: The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate.
- Option C: The client must explore the meaning of the event and won’t heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client’s anxiety and induce sleep.
13. Answer: C. “Your problem is real but there is no physical basis for it. We’ll work on what is going on in your life to find out why it’s happened.”
- Option C: The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear.
- Option A: Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn’t help her understand and resolve the underlying conflict.
- Option B: Saying that it must be awful not to be able to move her legs wouldn’t answer the client’s question; knowing that the cause is psychological wouldn’t necessarily make her feel better.
14. Answer: C. fluvoxamine (Luvox) and clomipramine (Anafranil)
- Option C: The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.
- Option B: Librium and Valium may be helpful in treating anxiety related to OCD but aren’t drugs of choice to treat the illness.
- Options A and D: The other medications mentioned aren’t effective in the treatment of OCD.
15. Answer: A. A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days.
- Option A: The client should be informed that the drug’s therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed.
- Option B: NMS hasn’t been reported with this drug, but tachycardia is frequently reported.
- Option C: Blood level checks aren’t necessary.
16. Answer: B. Severe anxiety and fear.
- Option B: Phobias cause severe anxiety (such as a panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia, and elevated blood pressure.
- Options A and C: Insomnia, an inability to concentrate, and weight loss are common in depression.
- Option D: Withdrawal and failure to distinguish reality from fantasy occur in schizophrenia.
17. Answer: A. Antidepressants
- Option A: Tricyclic and monoamine oxidase (MAO) inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks isn’t clearly understood.
- Option B: Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but don’t relieve the anxiety itself.
- Option C: Antipsychotic drugs are inappropriate because clients who experience panic attacks aren’t psychotic.
- Option D: Mood stabilizers aren’t indicated because panic attacks are rarely associated with mood changes.
18. Answer: B. 3 to 5 days
- Option B: Monoamine oxidase inhibitors, such as tranylcypromine, have an onset of action of approximately 3 to 5 days. A full clinical response may be delayed for 3 to 4 weeks. The therapeutic effects may continue for 1 to 2 weeks after discontinuation.
19. Answer: B. Providing emotional support and individual counseling.
- Option B: Clients in the first stage of Alzheimer’s disease are aware that something is happening to them and may become overwhelmed and frightened. Therefore, nursing care typically focuses on providing emotional support and individual counseling.
- Options A, C, and D: The other options are appropriate during the second stage of Alzheimer’s disease when the client needs continuous monitoring to prevent minor illnesses from progressing into major problems and when maintaining adequate nutrition may become a challenge. During this stage, offering nourishing finger foods helps clients to feed themselves and maintain adequate nutrition.
20. Answer: C. Emotional lability, euphoria, and impaired memory
- Option C: Signs of antianxiety agent overdose include emotional lability, euphoria, and impaired memory.
- Option A: Phencyclidine overdose can cause combativeness, sweating, and confusion.
- Option B: Amphetamine overdose can result in agitation, hyperactivity, and grandiose ideation.
- Option D: Hallucinogen overdose can produce suspiciousness, dilated pupils, and increased blood pressure.
21. Answer: D. A low tolerance for frustration
- Option D: Clients with an antisocial personality disorder exhibit a low tolerance for frustration, emotional immaturity, and a lack of impulse control.
- Option A: They commonly have a history of unemployment, miss work repeatedly, and quit work without other plans for employment.
- Option B: They don’t feel guilty about their behavior and commonly perceive themselves as victims. They also display a lack of responsibility for the outcome of their actions.
- Option C: Because of a lack of trust in others, clients with antisocial personality disorder commonly have difficulty developing stable, close relationships.
22. Answer: C. Methadone
- Option C: Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn’t have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine.
- Options A, B, and D: Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.
23. Answer: B. Hallucinations
- Option B: Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality.
- Option A: Delusions are false beliefs, rather than perceptions, that the client accepts as real.
- Option C: Loose associations are rapid shifts among unrelated ideas.
- Option D: Neologisms are bizarre words that have meaning only to the client.
24. Answer: C. Set up a strict eating plan for the client.
- Option C: Establishing a consistent eating plan and monitoring the client’s weight are very important in this disorder.
- Option A: The family and friends should be included in the client’s care.
- Option B: The client should be monitored during meals-not given privacy.
- Option D: Exercise must be limited and supervised.
25. Answer: A. Highly important or famous.
- Option A: A delusion of grandeur is a false belief that one is highly important or famous.
- Option B: A delusion of persecution is a false belief that one is being persecuted.
- Options C and D: A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.
26. Answer: D. Listening attentively with a neutral attitude and avoiding power struggles.
- Option D: The nurse should listen to the client’s requests, express willingness to seriously consider the request, and respond later. The nurse shouldn’t try to restrain the client when he feels the need to move around as long as his activity isn’t harmful.
- Option A: High-calorie finger foods should be offered to supplement the client’s diet, if he can’t remain seated long enough to eat a complete meal. The nurse shouldn’t be forced to stay seated at the table to finish a meal.
- Option B: The nurse should encourage the client to take short daytime naps because he expends so much energy.
- Option C: The nurse should set limits in a calm, clear, and self-confident tone of voice.
27. Answer: D. Denial
- Option D: Denial is unconscious defense mechanism in which emotional conflict and anxiety is avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable.
- Option A: Withdrawal is a common response to stress, characterized by apathy.
- Option B: Logical thinking is the ability to think rationally and make responsible decisions, which would lead the client admitting the problem and seeking help.
- Option C: Repression is suppressing past events from the consciousness because of guilty association.
28. Answer: B. Paranoid thoughts
- Option B: Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts.
- Option A: Aggressive behavior is uncommon, although these clients may experience agitation with anxiety.
- Option C: Their behavior is emotionally cold with a flattened affect, regardless of the situation.
- Option D: These clients demonstrate a reduced capacity for close or dependent relationships.
29. Answer: C. Identify anxiety-causing situations
- Option C: Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety.
30. Answer: A. Tension and irritability
- Option A: An amphetamine is a nervous system stimulant that is subject to abuse because of its ability to produce wakefulness and euphoria. An overdose increases tension and irritability.
- Options B and C: These are incorrect because amphetamines stimulate norepinephrine, which increase the heart rate and blood flow.
- Option D: Diarrhea is a common adverse effect so option D in is incorrect.
31. Answer: B. “No, I do not hear your voices, but I believe you can hear them”.
- Option B: The nurse, demonstrating knowledge and understanding, accepts the client’s perceptions even though they are hallucinatory.
32. Answer: C. Confusion for a time after treatment
- Option C: The electrical energy passing through the cerebral cortex during ECT results in a temporary state of confusion after treatment.
33. Answer: D. Acceptance stage
- Option D: Communication and intervention during this stage are mainly nonverbal, as when the client gestures to hold the nurse’s hand.
34. Answer: D. A higher level of anxiety continuing for more than 3 months.
- Option D: This is not an expected outcome of a crisis because by definition a crisis would be resolved in 6 weeks.
35. Answer: B. Staying in the sun
- Option B: Haldol causes photosensitivity. Severe sunburn can occur on exposure to the sun.
36. Answer: D. Moderate-level anxiety
- Option D: A moderately anxious person can ignore peripheral events and focuses on central concerns.
37. Answer: C. Diverse interest
- Option C: Before onset of depression, these clients usually have very narrow, limited interest.
38. Answer: A. As their depression begins to improve
- Option A: At this point, the client may have enough energy to plan and execute an attempt.
39. Answer: D. Disturbance in recalling recent events related to cerebral hypoxia.
- Option D: Cell damage seems to interfere with registering input stimuli, which affects the ability to register and recall recent events; vascular dementia is related to multiple vascular lesions of the cerebral cortex and subcortical structure.
40. Answer: D. Encouraging the client to have blood levels checked as ordered.
- Option D: Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because there is only a small range between therapeutic and toxic levels.
41. Answer: B. Fine hand tremors or slurred speech
- Option B: These are common side effects of lithium carbonate.
42. Answer: D. Presence
- Option D: The constant presence of a nurse provides emotional support because the client knows that someone is attentive and available in case of an emergency.
43. Answer: A. Client’s perception of the presenting problem.
- Option A: The nurse can be most therapeutic by starting where the client is, because it is the client’s concept of the problem that serves as the starting point of the relationship.
44. Answer: B. Chocolate milk, aged cheese, and yogurt’”
- Option B: These high-tyramine foods, when ingested in the presence of an MAO inhibitor, cause a severe hypertensive response.
45. Answer: B. 4 to 6 weeks
- Option B: Crisis is self-limiting and lasts from 4 to 6 weeks.
46. Answer: D. Males are more likely to use lethal methods than are females
- Option D: This finding is supported by research; females account for 90% of suicide attempts but males are three times more successful because of methods used.
47. Answer: C. “Your cursing is interrupting the activity. Take time out in your room for 10 minutes.”
- Option C: The nurse should set limits on client behavior to ensure a comfortable environment for all clients.
- Option A: The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended.
- Option B: This is incorrect because it implies that the client’s actions reflect feelings toward the staff instead of the client’s own misery.
- Option D: Judgmental remarks may decrease the client’s self-esteem.
48. Answer: C. lithium carbonate (Lithane)
- Option C: Lithium carbonate, an antimanic drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including manic-like activity. Lithium helps control the affective component of this disorder.
- Option A: Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don’t respond to other antidepressant drugs such as imipramine.
- Option B: Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients.
- Option D: Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and that undergoing cocaine detoxification.
49. Answer: B. Report a sore throat or fever to the physician immediately.
- Option B: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine.
- Option A: Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/μl, the medication must be stopped.
- Option C: Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension.
- Option D: The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.
50. Answer: C. Neuroleptic malignant syndrome.
- Option C: The client’s signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment.
- Option A: Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles.
- Option B: Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.
- Option D: Akathisia causes restlessness, anxiety, and jitteriness.
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Recommended Books and Resources
Selected NCLEX-RN review books:
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- Mosby's Comprehensive Review of Nursing for NCLEX-RN – This book has helped nurses pass the NCLEX exam for over 60 years. Practice with over 600 alternative item question formats.
- Lippincott Q&A Review for NCLEX-RN – A different approach to NCLEX-RN review.
- Prioritization, Delegation, and Assignment: Practice Exercises for the NCLEX Examination – An NCLEX review book that focuses on prioritization, delegation, and patient assignment.