Psych Exam 2 Review Questions – Flashcards
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A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier? a) strong ego boundaries and abstract thinking b) ataxia and akinesia c) stupor, muscle rigidity, and negativism d) substance abuse and cachexia
answer
C
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The client hears the word "match". The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? a) word salad b) clang association c) loose association d) ideas of reference
answer
C
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A client is diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? a) identify with the person speaking b) imitate the nurse's movements c) alleviate alogia d) alleviate avolition
answer
A
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To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? a) reinforce the perceptual distortions until the client develops new defenses b) provide an unstructured environment c) avoid making connections between anxiety-producing situations and hallucinations d) distract the client's attention
answer
D
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A client, diagnosed with paranoid schizophrenia, states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? a) "I find that hard to believe." b) "What would make you think such a thing?" c) "I know your roommate. He would do no such thing." d) "I can see why you feel that way."
answer
A
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A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? a) Paroxetine (Paxil) b) Carbamazepine (Tegretol) c) Benztropine (Cogentin) d) Lorazepam (Ativan)
answer
C
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Tony, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. What is the initial nursing intervention for Tony? a) give him an injection of Thorazine b) ensure a safe environment for him and others c) place him in restraints d) order him a nutritious diet
answer
B
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The primary goal in working with an actively psychotic, suspicious client would be? a) promote interaction with others b) decrease his anxiety and increase trust c) improve his relationship with his parents d) encourage participation in therapy activities
answer
B
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The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO BID; 2 mg benztropine PO BID PRN. Why is the chlorpromazine ordered? a) to reduce extrapyramidal symptoms b) to prevent neuroleptic malignant syndrome c) to decrease psychotic symptoms d) to induce sleep
answer
C
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The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO BID; 2 mg benztropine PO BID PRN. Because benztropine was ordered on a PRN basis, which of the following assessments by the nurse would convey a need for this medication? a) the client's level of agitation increases b) the client complains of a sore throat c) the client's skin has a yellowish cast d) the client develops tremors and a shuffling gait
answer
D
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Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is? a) "That's ridiculous, Clint. No one is going to hurt you." b) "The CIA isn't interested in people like you, Clint." c) "Why do you think the CIA wants to kill you?" d) "I know you believe that, Clint, but it's really hard for me to believe."
answer
D
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Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clint's belief is an example of? a) delusion of persecution b) delusion of reference c) delusion of control or influence d) delusion of grandeur
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A
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The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing? a) somatic delusions b) catatonic stupor c) auditory hallucinations d) pseudoparkinsonism
answer
C
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The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to? a) ask the client to describe his physical symptoms b) ask the client to describe what he is hearing c) administer a dose of benztropine d) call the physician for additional orders
answer
B
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When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a) provide large motor activities to relieve the client's pent-up tension b) administer a dose of PRN chlorpromazine to keep the client calm c) call for sufficient help to control the situation safely d) convey to the client that his behavior is unacceptable and will not be permitted
answer
C
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The primary focus of family therapy for clients with schizophrenia and their families is? a) to discuss concrete problem solving and adaptive behaviors for coping with stress b) to introduce the family to others with the same problem c) to keep the client and family in touch with the health care system d) to promote family interaction and increase understanding of the illness
answer
D
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An individual experienced the death of a parent 2 years ago. This individual has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes this individual's problem? a) post-trauma syndrome R/T parent's death b) anxiety (severe) R/T parent's death c) coping, ineffective, R/T parent's death d) grieving, complicated, R/T parent's death
answer
D
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When teaching about the tricyclic group of antidepressant medications, which information should the nurse include? a) strong or aged cheese should not be eaten while taking this group of medications b) the full therapeutic potential of tricyclics may not be reached for 4 weeks c) long-term use may result in physical dependence d) tricyclics should not be given with anti-anxiety agents
answer
B
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A client has been diagnosed with major depression. The psychiatrist prescribes Paroxetine (Paxil). Which of the following medication information should the nurse include in discharge teaching? a) do not eat chocolate while taking this medication b) the medication may cause priapism c) the medication should not be discontinued abruptly d) the medication may cause photosensitivity
answer
C
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Which is a misconception about suicide? a) 8 out of 10 individuals who commit suicide give warnings about their intentions b) most suicidal individuals are very ambivalent about their feelings about suicide c) most individuals commit suicide by taking an overdose of drugs d) initial mood improvement can precipitate suicide
answer
C
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A client, with a history of a suicide attempt, has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? a) provide the client with a safe and structured environment b) isolate the client from all stressful situations that may precipitate a suicide attempt c) observe the client continuously to prevent self-harm d) assist the client to develop more effective coping mechanisms
answer
D
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The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse's priority intervention? a) discuss strategies for the management of anxiety, anger, and frustration b) provide opportunities for increasing the client's self-worth, morale, and control c) place client on suicide precautions with one-to-one observation d) explore experiences that affirm self-worth and self-efficacy
answer
C
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A suicidal client with a history of manic behavior is admitted to the ED. The client's diagnosis is documented as Bipolar I Disorder: Current Episode Depressed. What is the rationale for this diagnosis instead of a diagnosis of Major Depressive Disorder? a) the physician does not believe the client is suffering from major depression b) the client has experienced a manic episode in the past c) the client does not exhibit psychotic symptoms d) there is no history of major depression in the client's family
answer
B
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In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis? a) risk for injury related to excessive hyperactivity b) disturbed sleep pattern related to manic hyperactivity c) imbalanced nutrition, less than body requirements, related to inadequate intake d) situational low self-esteem related to embarrassment secondary to high-risk behaviors
answer
A
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A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client? a) do not skimp on dietary sodium intake b) have serum lithium levels checked every 6 months c) limit fluid intake to 1 L per day d) adjust the dose if you feel out of control
answer
A
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Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student's crisis? a) the time of year in which the event occurred b) the presence of support systems c) a lack of adequate coping mechanisms d) the individual's family birth order
answer
C
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For the past three days, a student has skipped classes, cried constantly, experienced panic attacks, and is now exhibiting difficulty with short-term memory. In her assessment of this student, what crucial information should the nurse initially obtain prior to planning interventions? a) the student's description of the precipitating stressor b) the student's usual ability to cope with stress c) the student's available support system d) the student's access to community resources
answer
A
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Margaret, age 68, is a widow of 6 months. Since her husband dies, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with major depressive disorder. The priority nursing diagnosis for Margaret would be? a) imbalanced nutrition: less than body requirements b) complicated grieving c) risk for suicide d) social isolation
answer
C
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The physician orders sertraline (Zoloft) 50 mg PO BID for Margaret, a 68 year old woman with major depressive disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a) "Cheer up, Margaret. You have so much to be happy about." b) "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c) "I'll report that to the physician, Margaret. Maybe he will order something different." d) "Try not to dwell on your symptoms, Margaret. Why don't you join the others down in the dayroom?"
answer
B
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The goal of cognitive therapy with depressed clients is to? a) identify and change dysfunctional patterns of thinking b) resolve the symptoms and initiate or restore adaptive family functioning c) alter the neurotransmitters that are creating the depressed mood d) provide feedback from peers who are having similar experiences
answer
A
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Education for the client who is taking MAOI's should include which of the following? a) fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity b) lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2-4 weeks c) short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment d) tyramine-restricted diet, prohibitive concurrent use of OTC medications without physician notification
answer
D
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In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? (Select all that apply) a) don't eat chocolate while taking this medication b) keep taking this medication, even if you don't feel it is helping, it sometimes takes a while to take effect c) don't take this medication with the migraine drugs "triptans" d) go to the lab each week to have your blood drawn for therapeutic level of this drug e) this drug causes a high degree of sedation, so take it just before bedtime
answer
B, C
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A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? (Select all that apply) a) slumped posture b) delusional thinking c) feelings of despair d) feels best early in the morning and worse as the day progresses e) anorexia
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A, B, C, E
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A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? a) blue cheese, red wine, raisins b) black beans, garlic, pears c) pork, shellfish, egg yolks d) milk, peanuts, tomatoes
answer
A
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A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a) "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." b) "I can understand how you must feel." c) "Those feelings are a normal part of the grief response." d) "Just think about the good times that you had while he was alive."
answer
C
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A newly admitted depressed client isolates herself in her room and just sits and stares into space. How best might the nurse begin an initial therapeutic relationship with this client? a) say, "Come with me. I will go with you to group therapy." b) make frequent short visits to her room and sit with her c) offer to introduce her to the other clients d) help her to identify stressors in her life that precipitate crises
answer
B
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John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideations, and has been seeing the psychiatric nurse every 3 days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from his nurse at each visit. Today he comes to the clinic in a cheerful mood, much different than he seemed just 3 days ago. How might the nurse assess this behavioral change? a) the sertraline is finally taking effect b) he is no longer in need of antidepressant medication c) he has completed the grief response over the loss of his wife d) he may have decided to carry out his suicide plan
answer
D
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Margaret, a 68 year old widow, is brought to the emergency department by her sister in law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister in law reports that Margaret quit taking her medication a few month ago, thinking she didn't need it anymore. She is agitated, pacing, demanding, and speaking very loudly. Her sister in law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. The priority nursing diagnosis for Margaret is? a) imbalanced nutrition: less than body requirements related to not eating b) risk for injury related to hyperactivity c) disturbed sleep pattern related to agitation d) ineffective coping related to denial of depression
answer
B
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Margaret, age 68, is diagnosed with Bipolar I Disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to? a) sit with her during meals to ensure that she eats everything on her tray b) have her sister in law bring all her food from home because she knows Margaret's likes and dislikes c) provide high calorie, nutritious finger foods and snacks that Margaret can eat "on the run" d) tell Margaret that she will be on room restriction until she starts gaining weight
answer
C
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The physician orders lithium carbonate 600 mg TID for a newly diagnosed client with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is? a) 1.0-1.5 mEq/L b) 10-15 mEq/L c) 0.5-1.0 mEq/L d) 5-10 mEq/L
answer
A
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Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply) a) olanzepine (Zyprexa) b) paroxetine (Paxil) c) carbamazepine (Tegretol) d) lamotrigine (Lamictal) e) tranylcypromine (Parnate)
answer
A, C, D
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Margaret, a 68 year old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the emergency department by her sister in law. Margaret yells, "My sister in law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of? a) delusion of grandeur b) delusion of persecution c) delusion of reference d) delusion of control or influence
answer
B
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The most common co-morbid condition in children with bipolar disorder is? a) schizophrenia b) substance disorders c) oppositional defiant disorder d) attention-deficit/hyperactivity disorder
answer
D
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A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? a) fever, sore throat, malaise b) tinnitus, severe diarrhea, ataxia c) occipital headache, palpitations, chest pain d) skin rash, marked rise in blood pressure, bradycardia
answer
B
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A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a) tell the client she cannot wear this outfit while she is in the hospital b) do nothing and allow her to learn from the responses of her peers c) quietly walk with her back to her room and help her change into something more appropriate d) explain to her that if she wears this outfit she must remain in her room
answer
C
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The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. a) disturbed sleep pattern evidenced by sleeping only 4-5 hours per night b) risk for injury related to manic hyperactivity c) impaired social interaction evidenced by manipulation of others d) imbalanced nutrition: less than body requirements evidenced by loss of weight and poor skin turgor
answer
B, D, A, C
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A child with bipolar disorder also has ADHD. How would these co-morbid conditions most likely be treated? a) no medication would be given for either condition b) medication would be given for both conditions simultaneously c) the bipolar condition would be stabilized first before medication for the ADHD would be given d) the ADHD would be treated before consideration of the bipolar disorder
answer
C
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Which of the following is a correct assumption regarding the concept of crisis? a) crises occur only in individuals with psychopathology b) the stressful event that precipitates crisis is seldom identifiable c) a crisis situation contains the potential for psychological growth or deterioration d) crises are chronic situations that recur many times during an individual's life
answer
C
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Crises occur when an individual? a) is exposed to a precipitating stressor b) perceives a stressor to be threatening c) has no support systems d) experiences a stressor and perceives coping strategies to be ineffective
answer
D
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Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called? a) crisis resulting from traumatic stress b) maturational/developmental crisis c) dispositional crisis d) crisis of anticipated life transitions
answer
A
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Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. The most appropriate crisis intervention with Amanda would be to? a) encourage her to recognize how lucky she is to be alive b) discuss stages of grief and feelings associated with each c) identify community resources that can help Amanda d) suggest that she find a place to live that provides a storm shelter
answer
B
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Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. This type of crisis is called? a) crisis resulting from traumatic stress b) maturational/developmental crisis c) dispositional crisis d) crisis reflecting psychopathology
answer
C
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Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. The most appropriate nursing intervention with Jenny would be to? a) make arrangements for her to start attending Alateen meetings b) help her identify the positive things in her life and recognize that her situation could be a lot worse than it is c) teach her about the effects of alcohol on the body and that it can be hereditary d) refer her to a psychiatrist for private therapy to learn to deal with her home situation
answer
A
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Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. This type of crisis is called? a) crisis resulting from traumatic stress b) dispositional crisis c) psychiatric emergency d) maturational/developmental crisis
answer
D
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Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. The most appropriate nursing intervention with Ginger would be to? a) suggest she move to a college closer to home b) work with Ginger on unresolved dependency issues c) help her find someone in the college town from whom she could seek assistance rather than calling her mother regularly d) recommend that the college physician prescribe an anti-anxiety medication for Ginger
answer
B
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Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become more and more despondent. Her husband has become very concerned, and takes her to the local mental health center. This type of crisis is called? a) dispositional crisis b) crisis of anticipated life transitions c) psychiatric emergency d) crisis resulting from traumatic stress
answer
B
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Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become more and more despondent. Her husband has become very concerned, and takes her to the local mental health center. The most appropriate nursing intervention with Marie would be to? a) refer her to her family physician for a complete physical examination b) suggest she seek outside employment now that her children have left home c) identify convenient support systems for times when she is feeling particularly despondent d) begin grief work and assist her to recognize areas of self-worth separate and apart from her children
answer
D
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The desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety is? a) the individual will experience no anxiety b) the individual will demonstrate hope for the future c) the individual will maintain anxiety at manageable level d) the individual will verbalize acceptance of self as worthy
answer
C
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Andrew, a New York City firefighter, and his entire unit responded to the terrorist attacks at the World Trade Center. Working as a team, he and his best friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured, but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't!" This statement by Andrew suggests that he is experiencing? a) spiritual distress b) night terrors c) survivor's guilt d) suicidal ideation
answer
C
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Andrew, a New York City firefighter, and his entire unit responded to the terrorist attacks at the World Trade Center. Working as a team, he and his best friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured, but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't!" Intervention with Andrew would include? a) encouraging expression of feelings b) anti-anxiety medications c) participation in a support group d) a and c e) all of the above
answer
E
