Psychiatric Nursing Practice Quiz #13 (50 Questions)

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Mental Health and Psychiatric Nursing NCLEX Practice Exam 13

How comprehensive is your knowledge about Psychiatric Drugs? This 50-item exam is all about the therapeutic uses, side-effects, adverse effects, and dosages of different psychiatric drugs. The questions in this exam will test your nursing knowledge about the various Psychiatric medications and their uses.

We also recommend you to try and answer all exams on our NCLEX page!

EXAM TIP: Do your part, pray to God, and never pull other people down, then everything else will go smooth.

The real test is not whether you avoid this failure, because you won’t. It’s whether you let it harden or shame you into inaction, or whether you learn from it; whether you choose to persevere.
~ Barack Obama

Topics

Topics or concepts included in this exam are:

  • Psychiatric Nursing
  • Psychiatric Drugs

Guidelines

  • 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.

Questions

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Psychiatric Nursing Practice Quiz #13 (50 Questions)

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1. Which nursing intervention would be most appropriate if a male client develops orthostatic hypotension while taking amitriptyline (Elavil)?

A. Consulting with the physician about substituting a different type of antidepressant.
B. Advising the client to sit up for 1 minute before getting out of bed.
C. Instructing the client to double the dosage until the problem resolves.
D. Informing the client that this adverse reaction should disappear within 1 week.

2. Mr. Cruz visits the physician’s office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse Tiffany suspects:

A. Cyclothymic disorder.
B. Atypical affective disorder.
C. Major depression.
D. Dysthymic disorder.

3. After taking an overdose of phenobarbital (Barbita), Mario is admitted to the emergency department. Dr. Trinidad prescribes activated charcoal (Charcocaps) to be administered by mouth immediately. Before administering the dose, the nurse verifies the dosage ordered. What is the usual minimum dose of activated charcoal?

A. 5 g mixed in 250 ml of water
B. 15 g mixed in 500 ml of water
C. 30 g mixed in 250 ml of water
D. 60 g mixed in 500 ml of water

4. What herbal medication for depression, widely used in Europe, is now being prescribed in the United States?

A. Ginkgo biloba
B. Echinacea
C. St. John’s wort
D. Ephedra

5. Cely with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication?

A. Calcium
B. Sodium
C. Chloride
D. Potassium

6. Nurse Josefina is caring for a client who has been diagnosed with delirium. Which statement about delirium is true?

A. It’s characterized by an acute onset and lasts about 1 month.
B. It’s characterized by a slowly evolving onset and lasts about 1 week.
C. It’s characterized by a slowly evolving onset and lasts about 1 month.
D. It’s characterized by an acute onset and lasts hours to a number of days.

7. Edward, a 66-year-old client with slight memory impairment and poor concentration, is diagnosed with primary degenerative dementia of the Alzheimer’s type. Early signs of this dementia include subtle personality changes and withdrawal from social interactions. To assess for progression to the middle stage of Alzheimer’s disease, the nurse should observe the client for:

A. Occasional irritable outbursts.
B. Impaired communication.
C. Lack of spontaneity.
D. Inability to perform self-care activities.

8. Isabel with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that:

A. This medication may be habit forming and will be discontinued as soon as the client feels better.
B. This medication has no serious adverse effects.
C. The client should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication.
D. This medication may initially cause tiredness, which should become less bothersome over time.

9. Kathleen is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client’s physical health, the nurse should plan to:

A. Severely restrict the client’s physical activities.
B. Weigh the client daily, after the evening meal.
C. Monitor vital signs, serum electrolyte levels, and acid-base balance.
D. Instruct the client to keep an accurate record of food and fluid intake.

10. Celia with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?

A. Alcohol withdrawal
B. Cannabis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal

11. Mr. Garcia, an attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm’s employee assistance program. Nurse Beatriz knows that the client’s behavior most likely represents the use of which defense mechanism?

A. Regression
B. Projection
C. Reaction-formation
D. Intellectualization

12. Nurse Anne is caring for a client who has been treated long term with antipsychotic medication. During the assessment, Nurse Anne checks the client for tardive dyskinesia. If tardive dyskinesia is present, Nurse Anne would most likely observe:

A. Abnormal movements and involuntary movements of the mouth, tongue, and face.
B. Abnormal breathing through the nostrils accompanied by a “thrill.”
C. Severe headache, flushing, tremors, and ataxia.
D. Severe hypertension, migraine headache

13. Dennis has a lithium level of 2.4 mEq/L. The nurse immediately would assess the client for which of the following signs or symptoms?

A. Weakness
B. Diarrhea
C. Blurred vision
D. Fecal incontinence

14. Nurse Jannah is monitoring a male client who has been placed in restraints because of violent behavior. Nurse determines that it will be safe to remove the restraints when:

A. The client verbalizes the reasons for the violent behavior.
B. The client apologizes and tells the nurse that it will never happen again.
C. No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints.
D. The administered medication has taken effect.

15. Nurse Irish is aware that Ritalin is the drug of choice for a child with ADHD. The side effects of the following may be noted by the nurse:

A. Increased attention span and concentration
B. Increase in appetite
C. Sleepiness and lethargy
D. Bradycardia and diarrhea

16. Kitty, a 9 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification:

A. Profound
B. Mild
C. Moderate
D. Severe

17. The therapeutic approach in the care of Armand an autistic child include the following EXCEPT:

A. Engage in diversionary activities when acting-out
B. Provide an atmosphere of acceptance
C. Provide safety measures
D. Rearrange the environment to activate the child

18. Jeremy is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum.

A. Heroin
B. Cocaine
C. LSD
D. Marijuana

19. Nurse Pauline is aware that Dementia unlike delirium is characterized by:

A. Slurred speech
B. Insidious onset
C. Clouding of consciousness
D. Sensory perceptual change

20. A 35-year-old female has intense fear of riding an elevator. She claims “ As if I will die inside.” The client is suffering from:

A. Agoraphobia
B. Social phobia
C. Claustrophobia
D. Xenophobia

21. Nurse Myrna develops a counter-transference reaction. This is evidenced by:

A. Revealing personal information to the client
B. Focusing on the feelings of the client.
C. Confronting the client about discrepancies in verbal or nonverbal behavior
D. The client feels angry towards the nurse who resembles his mother.

22. Tristan is on Lithium has suffered from diarrhea and vomiting. What should the nurse in-charge do first:

A. Recognize this as a drug interaction
B. Give the client Cogentin
C. Reassure the client that these are common side effects of lithium therapy
D. Hold the next dose and obtain an order for a stat serum lithium level

23. Nurse Sarah ensures a therapeutic environment for all the client. Which of the following best describes a therapeutic milieu?

A. A therapy that rewards adaptive behavior
B. A cognitive approach to change behavior
C. A living, learning or working environment.
D. A permissive and congenial environment

24. Anthony is very hostile toward one of the staff for no apparent reason. He is manifesting:

A. Splitting
B. Transference
C. Countertransference
D. Resistance

25. Marielle, 17 years old was sexually attacked while on her way home from school. She is brought to the hospital by her mother. Rape is an example of which type of crisis:

A. Situational
B. Adventitious
C. Developmental
D. Internal

26. Nurse Greta is aware that the following is classified as an Axis I disorder by the Diagnosis and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) is:

A. Obesity
B. Borderline personality disorder
C. Major depression
D. Hypertension

27. Katrina, a newly admitted is extremely hostile toward a staff member she has just met, without apparent reason. According to Freudian theory, the nurse should suspect that the client is experiencing which of the following phenomena?

A. Intellectualization
B. Transference
C. Triangulation
D. Splitting

28. An 83-year-old male client is in extended care facility is anxious most of the time and frequently complains of a number of vague symptoms that interfere with his ability to eat. These symptoms indicate which of the following disorders?

A. Conversion disorder
B. Hypochondriasis
C. Severe anxiety
D. Sublimation

29. Charina, a college student who frequently visited the health center during the past year with multiple vague complaints of GI symptoms before course examinations. Although physical causes have been eliminated, the student continues to express her belief that she has a serious illness. These symptoms are typically of which of the following disorders?

A. Conversion disorder
B. Depersonalization
C. Hypochondriasis
D. Somatization disorder

30. Nurse Daisy is aware that the following pharmacologic agents are sedative-hypnotic medication is used to induce sleep for a client experiencing a sleep disorder is:

A. Triazolam (Halcion)
B. Paroxetine (Paxil)
C. Fluoxetine (Prozac)
D. Risperidone (Risperdal)

31. Aldo, with a somatoform pain disorder may obtain secondary gain. Which of the following statement refers to a secondary gain?

A. It brings some stability to the family
B. It decreases the preoccupation with the physical illness
C. It enables the client to avoid some unpleasant activity
D. It promotes emotional support or attention for the client

32. David is diagnosed with panic disorder with agoraphobia is talking with the nurse in-charge about the progress made in treatment. Which of the following statements indicates a positive client response?

A. “I went to the mall with my friends last Saturday”
B. “I’m hyperventilating only when I have a panic attack”
C. “Today I decided that I can stop taking my medication”
D. “Last night I decided to eat more than a bowl of cereal”

33. The effectiveness of monoamine oxidase (MAO) inhibitor drug therapy in client with posttraumatic stress disorder can be demonstrated by which of the following client self–reports?

A. “I’m sleeping better and don’t have nightmares”
B. “I’m not losing my temper as much”
C. “I’ve lost my craving for alcohol”
D. “I’ve lost my phobia for water”

34. Mark, with a diagnosis of generalized anxiety disorder wants to stop taking his lorazepam (Ativan). Which of the following important facts should nurse Betty discuss with the client about discontinuing the medication?

A. Stopping the drug may cause depression
B. Stopping the drug increases cognitive abilities
C. Stopping the drug decreases sleeping difficulties
D. Stopping the drug can cause withdrawal symptoms

35. Jennifer, an adolescent who is depressed and reported by his parents as having difficulty in school is brought to the community mental health center to be evaluated. Which of the following other health problems would the nurse suspect?

A. Anxiety disorder
B. Behavioral difficulties
C. Cognitive impairment
D. Labile moods

36. Ricardo, an outpatient in psychiatric facility is diagnosed with dysthymic disorder. Which of the following statement about dysthymic disorder is true?

A. It involves a mood range from moderate depression to hypomania
B. It involves a single manic depression
C. It’s a form of depression that occurs in the fall and winter
D. It’s a mood disorder similar to major depression but of mild to moderate severity

37. The nurse is aware that the following ways in vascular dementia different from Alzheimer’s disease is:

A. Vascular dementia has more abrupt onset
B. The duration of vascular dementia is usually brief
C. Personality change is common in vascular dementia
D. The inability to perform motor activities occurs in vascular dementia

38. Loretta, a newly admitted client was diagnosed with delirium and has history of hypertension and anxiety. She had been taking digoxin, furosemide (Lasix), and diazepam (Valium) for anxiety. This client’s impairment may be related to which of the following conditions?

A. Infection
B. Metabolic acidosis
C. Drug intoxication
D. Hepatic encephalopathy

39. Nurse Ron enters a client’s room, the client says, “They’re crawling on my sheets! Get them off my bed!” Which of the following assessment is the most accurate?

A. The client is experiencing aphasia
B. The client is experiencing dysarthria
C. The client is experiencing a flight of ideas
D. The client is experiencing visual hallucination

40. Which of the following descriptions of a client’s experience and behavior can be assessed as an illusion?

A. The client tries to hit the nurse when vital signs must be taken
B. The client says, “I keep hearing a voice telling me to run away”
C. The client becomes anxious whenever the nurse leaves the bedside
D. The client looks at the shadow on a wall and tells the nurse she sees frightening faces on the wall.

41. During conversation of Nurse John with a client, he observes that the client shift from one topic to the next on a regular basis. Which of the following terms describes this disorder?

A. Flight of ideas
B. Concrete thinking
C. Ideas of reference
D. Loose association

42. Francis tells the nurse that her coworkers are sabotaging the computer. When the nurse asks questions, the client becomes argumentative. This behavior shows personality traits associated with which of the following personality disorder?

A. Antisocial
B. Histrionic
C. Paranoid
D. Schizotypal

43. Which of the following interventions is important for a Cely experiencing with paranoid personality disorder taking olanzapine (Zyprexa)?

A. Explain effects of serotonin syndrome
B. Teach the client to watch for extrapyramidal adverse reaction
C. Explain that the drug is less effective if the client smokes
D. Discuss the need to report paradoxical effects such as euphoria

44. Nurse Alexandra notices other clients on the unit avoiding a client diagnosed with antisocial personality disorder. When discussing appropriate behavior in group therapy, which of the following comments is expected about this client by his peers?

A. Lack of honesty
B. Belief in superstition
C. Show of temper tantrums
D. Constant need for attention

45. Tommy, with dependent personality disorder is working to increase his self-esteem. Which of the following statements by the Tommy shows teaching was successful?

A. “I’m not going to look just at the negative things about myself”
B. “I’m most concerned about my level of competence and progress”
C. “I’m not as envious of the things other people have as I used to be”
D. “I find I can’t stop myself from taking over things other should be doing”

46. Norma, a 42-year-old client with a diagnosis of chronic undifferentiated schizophrenia lives in a rooming house that has a weekly nursing clinic. She scratches while she tells the nurse she feels creatures eating away at her skin. Which of the following interventions should be done first?

A. Talk about his hallucinations and fears
B. Refer him for anticholinergic adverse reactions
C. Assess for possible physical problems such as rash
D. Call his physician to get his medication increased to control his psychosis

47. Ivy, who is on the psychiatric unit is copying and imitating the movements of her primary nurse. During recovery, she says, “I thought the nurse was my mirror. I felt connected only when I saw my nurse.” This behavior is known by which of the following terms?

A. Modeling
B. Echopraxia
C. Ego-syntonicity
D. Ritualism

48. Jun approaches the nurse and tells that he hears a voice telling him that he’s evil and deserves to die. Which of the following terms describes the client’s perception?

A. Delusion
B. Disorganized speech
C. Hallucination
D. Idea of reference

49. Mike is admitted to a psychiatric unit with a diagnosis of undifferentiated schizophrenia. Which of the following defense mechanisms is probably used by Mike?

A. Projection
B. Rationalization
C. Regression
D. Repression

50. Rocky has started taking haloperidol (Haldol). Which of the following instructions is most appropriate for Ricky before taking haloperidol?

A. Should report feelings of restlessness or agitation at once
B. Use a sunscreen outdoors on a year-round basis
C. Be aware you’ll feel increased energy taking this drug

Answers and Rationale

Gauge your performance by counter checking your answers to the answers below. Learn more about the question by reading the rationale. If you have any disputes or questions, please direct them to the comments section.

1. Answer: B. Advising the client to sit up for 1 minute before getting out of bed.

  • Option B: To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed.
  • Option A: Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy.
  • Option C: In these cases, the dosage may be reduced or the physician may prescribe nortriptyline, another tricyclic antidepressant.
  • Option D: Orthostatic hypotension disappears only when the drug is discontinued.

2. Answer: D. Dysthymic disorder.

  • Option D: Dysthymic disorder is marked by feelings of depression lasting at least 2 years, accompanied by at least two of the following symptoms: sleep disturbance, appetite disturbance, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, and hopelessness. These symptoms may be relatively continuous or separated by intervening periods of normal mood that last a few days to a few weeks.
  • Option A: Cyclothymic disorder is a chronic mood disturbance of at least 2 years’ duration marked by numerous periods of depression and hypomania.
  • Option B: Atypical affective disorder is characterized by manic signs and symptoms.
  • Option C: Major depression is a recurring, persistent sadness or loss of interest or pleasure in almost all activities, with signs and symptoms recurring for at least 2 weeks.

3. Answer: C. 30 g mixed in 250 ml of water

  • Option C: The usual adult dosage of activated charcoal is 5 to 10 times the estimated weight of the drug or chemical ingested, or a minimum dose of 30 g, mixed in 250 ml of water. Doses less than this will be ineffective; doses greater than this can increase the risk of adverse reactions, although toxicity doesn’t occur with activated charcoal, even at the maximum dose.

4. Answer: C. St. John’s wort

  • Option C: St. John’s wort has been found to have serotonin-elevating properties, similar to prescription antidepressants.
  • Option A: Ginkgo biloba is prescribed to enhance mental acuity.
  • Option B: Echinacea has immune-stimulating properties.
  • Option D: Ephedra is a naturally occurring stimulant that is similar to ephedrine.

5. Answer: B. Sodium

  • Option B: Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn’t restrict their intake of sodium and should drink adequate amounts of fluid each day.
  • Options A, C, and D: The other electrolytes are important for normal body functions but sodium is most important to the absorption of lithium.

6. Answer: D. It’s characterized by an acute onset and lasts hours to a number of days

  • Option D: Delirium has an acute onset and typically can last from several hours to several days.

7. Answer: B. Impaired communication.

  • Option B: Signs of advancement to the middle stage of Alzheimer’s disease include exacerbated cognitive impairment with obvious personality changes and impaired communication, such as inappropriate conversation, actions, and responses.
  • Options A and C: Initially, memory impairment may be the only cognitive deficit in a client with Alzheimer’s disease. During the early stage of this disease, subtle personality changes may also be present.  However, other than occasional irritable outbursts and lack of spontaneity, the client is usually cooperative and exhibits socially appropriate behavior.
  • Option D: During the late stage, the client can’t perform self-care activities and may become mute.

8. Answer: D. This medication may initially cause tiredness, which should become less bothersome over time.

  • Option D: Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and usually decreases as tolerance develops.
  • Option A: Antidepressants aren’t habit forming and don’t cause physical or psychological dependence. However, after a long course of high-dose therapy, the dosage should be decreased gradually to avoid mild withdrawal symptoms.
  • Option B: Serious adverse effects, although rare, include myocardial infarction, heart failure, and tachycardia.
  • Option C: Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine oxidase inhibitor, not a tricyclic antidepressant.

9. Answer: C. Monitor vital signs, serum electrolyte levels, and acid-base balance.

  • Option C: An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client’s vital signs, serum electrolyte level, and acid-base balance is crucial.
  • Option A: This may worsen anxiety.
  • Option B: This is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal.
  • Option D: This would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.

10. Answer: D. Opioid withdrawal

  • Option D: The symptoms listed are specific to opioid withdrawal.
  • Option A: Alcohol withdrawal would show elevated vital signs.
  • Option B: There is no real withdrawal from cannabis.
  • Option C: Symptoms of cocaine withdrawal include depression, anxiety, and agitation.

11. Answer: A. Regression

  • Option A: An adult who throws temper tantrums, such as this one, is displaying regressive behavior, or behavior that is appropriate at a younger age.
  • Option B: In projection, the client blames someone or something other than the source.
  • Option C: In reaction formation, the client acts in opposition to his feelings.
  • Option D: In intellectualization, the client overuses rational explanations or abstract thinking to decrease the significance of a feeling or event.

12. Answer: A. Abnormal movements and involuntary movements of the mouth, tongue, and face.

  • Option A: Tardive dyskinesia is a severe reaction associated with long-term use of antipsychotic medication. The clinical manifestations include abnormal movements (dyskinesia) and involuntary movements of the mouth, tongue (flycatcher tongue), and face.

13. Answer: C. Blurred vision

  • Option C: At lithium levels of 2 to 2.5 mEq/L the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting.
  • Options A and B: With levels between 1.5 and 2 mEq/L the client experiencing vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion.
  • Option D: At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death.

14. Answer: C. No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints.

  • Option C: The best indicator that the behavior is controlled if the client exhibits no signs of aggression after partial release of restraints.
  • Options A, B, and D: These do not ensure that the client has controlled the behavior.

15. Answer: A. increased attention span and concentration

  • Option A: The medication has a paradoxical effect that decreases hyperactivity and impulsivity among children with ADHD.
  • Options B, C, and D: Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability.

16. Answer: C. Moderate

  • Option C: The child with moderate mental retardation has an I.Q. of 35- 50.
  • Option A: Profound Mental retardation has an I.Q. of below 20;
  • Option B: Mild mental retardation 50-70 and;
  • Option D: Severe mental retardation has an I.Q. of 20-35.

17. Answer: D. Rearrange the environment to activate the child

  • Option D: The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic.
  • Option A: Angry outburst can be re-channeling through safe activities.
  • Option B: Acceptance enhances a trusting relationship.
  • Option C: Ensure safety from self-destructive behaviors like head banging and hair pulling.

18. Answer: B. cocaine

  • Option B: The manifestations indicate intoxication with cocaine, a CNS stimulant.
  • Option A: Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction.
  • Option C: Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, synesthesia, and increase in vital signs.
  • Option D: Intoxication with Marijuana, a cannabinoid is manifested by sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment, and hallucinations.

19. Answer: B. insidious onset

  • Option B: Dementia has a gradual onset and progressive deterioration. It causes pronounced memory and cognitive disturbances.
  • Options A, C, and D: These are all characteristics of delirium.

20. Answer: C. Claustrophobia

  • Option C: Claustrophobia is fear of closed space.
  • Option A: Agoraphobia is fear of open space or being a situation where escape is difficult.
  • Option B: Social phobia is fear of performing in the presence of others in a way that will be humiliating or embarrassing.
  • Option D: Xenophobia is fear of strangers.

21. Answer: A. Revealing personal information to the client

  • Option A: Counter-transference is an emotional reaction of the nurse on the client based on her unconscious needs and conflicts.
  • Options B and C: These are therapeutic approaches.
  • Option D: This is transference reaction where a client has an emotional reaction towards the nurse based on her past.

22. Answer: D. Hold the next dose and obtain an order for a stat serum lithium level

  • Option D: Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation.
  • Option A: The manifestations are not due to drug interaction.
  • Option B. Cogentin is used to manage the extrapyramidal symptom side effects of antipsychotics.
  • Option C: The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.

23. Answer: C. A living, learning or working environment.

  • Option C: A therapeutic milieu refers to a broad conceptual approach in which all aspects of the environment are channeled to provide a therapeutic environment for the client. The six environmental elements include structure, safety, norms; limit setting, balance and unit modification.
  • Option A: Behavioral approach in psychiatric care is based on the premise that behavior can be learned or unlearned through the use of reward and punishment.
  • Option B: Cognitive approach to change behavior is done by correcting distorted perceptions and irrational beliefs to correct maladaptive behaviors.
  • Option D: This is not congruent with therapeutic milieu.

24. Answer: B. Transference

  • Option B: Transference is a positive or negative feeling associated with a significant person in the client’s past that are unconsciously assigned to another
  • Option A: Splitting is a defense mechanism commonly seen in a client with personality disorder in which the world is perceived as all good or all bad
  • Option C: Countertransference is a phenomenon where the nurse shifts feelings assigned to someone in her past to the patient
  • Option D: Resistance is the client’s refusal to submit himself to the care of the nurse

25. Answer: B. Adventitious

  • Option B: Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life.
  • Option A: Situational crisis is from an external source that upset one’s psychological equilibrium.
  • Options C and D: These are the same. They are transitional or developmental periods in life.

26. Answer: C. Major depression

  • Option C: The DSM-IV-TR classifies major depression as an Axis I disorder.
  • Option B: Borderline personality disorder as an Axis II;
  • Options A and D: Obesity and hypertension, Axis III.

27. Answer: B. Transference

  • Option B: Transference is the unconscious assignment of negative or positive feelings evoked by a significant person in the client’s past to another person.
  • Option A: Intellectualization is a defense mechanism in which the client avoids dealing with emotions by focusing on facts.
  • Option C: Triangulation refers to conflicts involving three family members.
  • Option D: Splitting is a defense mechanism commonly seen in clients with personality disorder in which the world is perceived as all good or all bad.

28. Answer: B. Hypochondriasis

  • Option B: Complaints of vague physical symptoms that have no apparent medical causes are characteristic of clients with hypochondriasis. In many cases, the GI system is affected.
  • Option A: Conversion disorders are characterized by one or more neurologic symptoms.
  • Option C: The client’s symptoms don’t suggest severe anxiety.
  • Option D: A client experiencing sublimation channels maladaptive feelings or impulses into socially acceptable behavior.

29. Answer: C. Hypochondriasis

  • Option C: Hypochondriasis, in this case, is shown by the client’s belief that she has a serious illness, although pathologic causes have been eliminated. The disturbance usually lasts at least 6 with identifiable life stressor such as, in this case, course examinations.
  • Option A: Conversion disorders are characterized by one or more neurologic symptoms.
  • Option B: Depersonalization refers to persistent recurrent episodes of feeling detached from one’s self or body.
  • Option D: Somatoform disorders generally have a chronic course with few remissions.

30. Answer: A. Triazolam (Halcion)

  • Option A: Triazolam is one of a group of sedative-hypnotic medication that can be used for a limited time because of the risk of dependence.
  • Option B: Paroxetine is a serotonin-specific reuptake inhibitor used for treatment of depression panic disorder, and obsessive-compulsive disorder.
  • Option C: Fluoxetine is a serotonin-specific reuptake inhibitor used for depressive disorders and obsessive-compulsive disorders.
  • Option D: Risperidone is indicated for psychotic disorders.

31. Answer: D. It promotes emotional support or attention for the client

  • Option D: Secondary gain refers to the benefits of the illness that allow the client to receive emotional support or attention.
  • Option C: Primary gain enables the client to avoid some unpleasant activity.
  • Option A: A dysfunctional family may disregard the real issue, although some conflict is relieved.
  • Option B: Somatoform pain disorder is a preoccupation with pain in the absence of physical disease.

32. Answer: A. “I went to the mall with my friends last Saturday”

  • Option A: Clients with panic disorder tend to be socially withdrawn. Going to the mall is a sign of working on avoidance behaviors.
  • Option B: Hyperventilating is a key symptom of panic disorder. Teaching breathing control is a major intervention for clients with panic disorder.
  • Option C: The client taking medications for panic disorder; such as tricyclic antidepressants and benzodiazepines, must be weaned off these drugs.
  • Option D: Most clients with panic disorder with agoraphobia don’t have nutritional problems.

33. Answer: A. “I’m sleeping better and don’t have nightmares”

  • Option A: MAO inhibitors are used to treat sleep problems, nightmares, and intrusive daytime thoughts in individual with posttraumatic stress disorder.
  • Options B, C, and D: MAO inhibitors aren’t used to help control flashbacks or phobias or to decrease the craving for alcohol.

34. Answer: D. Stopping the drug can cause withdrawal symptoms

  • Option D: Stopping anti-anxiety drugs such as benzodiazepines can cause the client to have withdrawal symptoms.
  • Options A, B, and C: Stopping a benzodiazepine doesn’t tend to cause depression, increase cognitive abilities, or decrease sleeping difficulties.

35. Answer: B. Behavioral difficulties

  • Option B: Adolescents tend to demonstrate severe irritability and behavioral problems rather than simply a depressed mood.
  • Option A: Anxiety disorder is more commonly associated with small children rather than with adolescents.
  • Option C: Cognitive impairment is typically associated with delirium or dementia.
  • Option D: Labile mood is more characteristic of a client with cognitive impairment or bipolar disorder.

36. Answer: D. It’s a mood disorder similar to major depression but of mild to moderate severity

  • Option D: Dysthymic disorder is a mood disorder similar to major depression but it remains mild to moderate in severity.
  • Option A: Cyclothymic disorder is a mood disorder characterized by a mood range from moderate depression to hypomania.
  • Option B: Bipolar I disorder is characterized by a single manic episode with no past major depressive episodes.
  • Option C: Seasonal Affective Disorder is a form of depression occurring in the fall and winter.

37. Answer: A. Vascular dementia has more abrupt onset

  • Option A: Vascular dementia differs from Alzheimer’s disease in that it has a more abrupt onset and runs a highly variable course.
  • Option B: The duration of delirium is usually brief.
  • Option C: Personality change is common in Alzheimer’s disease.
  • Option D: The inability to carry out motor activities is common in Alzheimer’s disease.

38. Answer: C. Drug intoxication

  • Option C: This client was taking several medications that have a propensity for producing delirium; digoxin (a digitalis glycoside), furosemide (a thiazide diuretic), and diazepam (a benzodiazepine).
  • Options A, B, and D: Sufficient supporting data don’t exist to suspect the other options as causes.

39. Answer: D. The client is experiencing visual hallucination

  • Option D: The presence of a sensory stimulus correlates with the definition of a hallucination, which is a false sensory perception.
  • Option A: Aphasia refers to a communication problem.
  • Option B: Dysarthria is difficulty in speech production.
  • Option C: Flight of ideas is rapid shifting from one topic to another.

40. Answer: D. The client looks at the shadow on a wall and tells the nurse she sees frightening faces on the wall.

  • Option D: Minor memory problems are distinguished from dementia by their minor severity and their lack of significant interference with the client’s social or occupational lifestyle.
  • Options A, B, and C: Other options would be included in the history data but don’t directly correlate with the client’s lifestyle.

41. Answer: D. Loose association

  • Option D: Loose associations are conversations that constantly shift in topic. Loose associations don’t necessarily start in a cogently, then becomes loose.
  • Option A: Flight of ideas is characterized by conversation that’s disorganized from the onset.
  • Option B: Concrete thinking implies highly definitive thought processes.

42. Answer: C. Paranoid

  • Option C: Because of their suspiciousness, paranoid personalities ascribe malevolent activities to others and tent to be defensive, becoming quarrelsome and argumentative.
  • Option A: Clients with antisocial personality disorder can also be antagonistic and argumentative but are less suspicious than paranoid personalities.
  • Option B: Clients with histrionic personality disorder are dramatic, not suspicious and argumentative.
  • Option D: Clients with schizoid personality disorder are usually detached from other and tend to have eccentric behavior.

43. Answer: C. Explain that the drug is less effective if the client smokes

  • Option C: Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes.
  • Option A: Serotonin syndrome occurs with clients who take a combination of antidepressant medications.
  • Options B and D: Olanzapine doesn’t cause euphoria, and extrapyramidal adverse reactions aren’t a problem. However, the client should be aware of adverse effects such as tardive dyskinesia.

44. Answer: A. Lack of honesty

  • Option A: Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown by lying.
  • Option B: Clients with schizotypal personality disorder tend to be superstitious.
  • Options C and D: Clients with histrionic personality disorders tend to overreact to frustrations and disappointments, have temper tantrums, and seek attention.

45. Answer: A. “I’m not going to look just at the negative things about myself”

  • Option A: As the clients make progress on improving self-esteem, self-blame and negative self-evaluation will decrease. Clients with dependent personality disorder tend to feel fragile and inadequate and would be extremely unlikely to discuss their level of competence and progress. These clients focus on self and aren’t envious or jealous. Individuals with dependent personality disorders don’t take over situations because they see themselves as inept and inadequate.

46. Answer: C. Assess for possible physical problems such as rash

  • Option C: Clients with schizophrenia generally have poor visceral recognition because they live so fully in their fantasy world. They need to have as in-depth assessment of physical complaints that may spill over into their delusional symptoms.
  • Options A, B, and D: Talking with the client won’t provide as an assessment of his itching, and itching isn’t as adverse reaction of antipsychotic drugs, calling the physician to get the client’s medication increased doesn’t address his physical complaints.

47. Answer: B. Echopraxia

  • Option B: Echopraxia is the copying of another’s behaviors and is the result of the loss of ego boundaries.
  • Option A: Modeling is the conscious copying of someone’s behaviors.
  • Option C: Ego-syntonicity refers to behaviors that correspond with the individual’s sense of self.
  • Option D: Ritualism behaviors are repetitive and compulsive.

48. Answer: C. Hallucination

  • Option C: Hallucinations are sensory experiences that are misrepresentations of reality or have no basis in reality.
  • Option A: Delusions are beliefs not based on reality.
  • Option B: Disorganized speech is characterized by jumping from one topic to the next or using unrelated words.
  • Option D: An idea of reference is a belief that an unrelated situation holds special meaning for the client.

49. Answer: C. Regression

  • Option C: Regression, a return to earlier behavior to reduce anxiety, is the basic defense mechanism in schizophrenia.
  • Option A: Projection is a defense mechanism in which one blames others and attempts to justify actions; it’s used primarily by people with paranoid schizophrenia and delusional disorder.
  • Option B: Rationalization is a defense mechanism used to justify one’s action.
  • Option D: Repression is the basic defense mechanism in the neuroses; it’s an involuntary exclusion of painful thoughts, feelings, or experiences from awareness.

50. Answer: A. Should report feelings of restlessness or agitation at once

  • Option A: Agitation and restlessness are adverse effect of haloperidol and can be treated with anticholinergic drugs.
  • Option B: Haloperidol isn’t likely to cause photosensitivity or control essential hypertension.
  • Option C: Although the client may experience increased concentration and activity, these effects are due to a decrease in symptoms, not the drug itself.

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1 COMMENT

  1. Options A & B of Question # 12 are the same. Same goes with Options C & D of Question # 13 in the practice mode of Psychiatric Nursing Practice Quiz #13 (50 Questions).

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