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Being Killed
c. The client identifies anxiety producing situations sentences, staying with the client,
d. The client maintains contact with a crisis decreasing stimuli, remaining calm and
counselor medicating as needed.
49. Nurse Tina is caring for a client with 6. B. Delusion of grandeur is a false belief that
depression who has not responded to one is highly famous and important.
antidepressant medication. The nurse 7. D. Individual with dependent personality
anticipates that what treatment procedure disorder typically shows
may be prescribed?
indecisiveness submissiveness and clinging
a. Neuroleptic medication
behavior so that others will make decisions
b. Short term seclusion
with them.
c. Psychosurgery
d. Electroconvulsive therapy
8. A. Clients with schizotypal personality tendency is to counterattack the threat to
disorder experience excessive social anxiety self image.
that can lead to paranoid thoughts. 20. B. The nurse would specifically use
9. B. Bulimia disorder generally is a supportive confrontation with the client to
maladaptive coping response to stress and point out discrepancies between what the
underlying issues. The client should identify client states and what actually exists to
anxiety causing situation that stimulate the increase responsibility for self.
bulimic behavior and then learn new ways 21. C. The nurse would most likely administer
of coping with the anxiety. benzodiazepine, such as lorazepan (ativan)
10. A. An adult age 31 to 45 generates new to the client who is experiencing symptom:
level of awareness. The client’s experiences symptoms of
11. A. Neuromuscular Blocker, such as withdrawal because of the rebound
SUCCINYLCHOLINE (Anectine) produces phenomenon when the sedation of the CNS
respiratory depression because it inhibits from alcohol begins to decrease.
contractions of respiratory muscles. 22. D. Regular coffee contains caffeine which
12. C. With depression, there is little or no acts as psychomotor stimulants and leads
emotional involvement therefore little to feelings of anxiety and agitation. Serving
alteration in affect. coffee top the client may add to tremors or
13. D. These clients often hide food or force wakefulness.
vomiting; therefore they must be carefully 23. D. Vomiting and diarrhea are usually the
monitored. late signs of heroin withdrawal, along with
14. A. These clients have severely depleted muscle spasm, fever, nausea, repetitive,
levels of sodium and potassium because of abdominal cramps and backache.
their starvation diet and energy 24. D. Moving to a client’s personal space
expenditure, these electrolytes are increases the feeling of threat, which
necessary for cardiac functioning. increases anxiety.
15. B. Limiting unnecessary interaction will 25. A. Environmental (MILIEU) therapy aims at
decrease stimulation and agitation. having everything in the client’s
16. C. Ritualistic behavior seen in this disorder surrounding area toward helping the client.
is aimed at controlling guilt and inadequacy 26. C. Children who have experienced
by maintaining an absolute set pattern of attachment difficulties with primary
behavior. caregiver are not able to trust others and
17. D. The nurse needs to set limits in the therefore relate superficially
client’s manipulative behavior to help the 27. A. Children have difficulty verbally
client control dysfunctional behavior. A expressing their feelings, acting out
consistent approach by the staff is behavior, such as temper tantrums, may
necessary to decrease manipulation. indicate underlying depression.
18. B. Any suicidal statement must be 28. D. The autistic child repeat sounds or
assessed by the nurse. The nurse should words spoken by others.
discuss the client’s statement with her to 29. D. The client statement is an example of
determine its meaning in terms of suicide. the use of denial, a defense that blocks
19. A. When the staff member ask the client if problem by unconscious refusing to admit
he wonders why others find him repulsive, they exist.
the client is likely to feel defensive because 30. A. Discussion of the feared object triggers
the question is belittling. The natural an emotional response to the object.
31. B. The nurse presence may provide the nurse facilitates communication with the
client with support & feeling of control. client by sitting in silence, asking open-
32. D. Experiencing the actual trauma in ended question and pausing to provide
dreams or flashback is the major symptom opportunities for the client to respond.
that distinguishes post traumatic stress 45. D. When hallucination is present, the
disorder from other anxiety disorder. nurse should reinforce reality with the
33. C. Confabulation or the filling in of memory client.
gaps with imaginary facts is a 46. A. Personal characteristics of abuser
defense mechanismused by people include low self-esteem, immaturity,
experiencing memory deficits. dependence, insecurity and jealousy.
34. A. These are the major signs of anorexia 47. D. A short acting skeletal muscle relaxant
nervosa. Weight loss is excessive (15% of such as succinylcholine (Anectine) is
expected weight). administered during this procedure to
35. C. Dental enamel erosion occurs from prevent injuries during seizure.
repeated self-induced vomiting. 48. C. Recognizing situations that produce
36. B. Depression usually is both emotional & anxiety allows the client to prepare to cope
physical. A simple daily routine is the best, with anxiety or avoid specific stimulus.
least stressful and least anxiety producing. 49. D. Electroconvulsive therapy is an effective
37. D. The expression of these feeling may treatment for depression that has not
indicate that this client is unable to responded to medication.
continue the struggle of life. 50. B. In an emergency, lives saving facts are
38. A. Structure tends to decrease agitation obtained first. The name and the amount of
and anxiety and to increase the client’s medication ingested are of outmost
feeling of security. important in treating this potentially life
39. B. The rituals used by a client with threatening situation.
obsessive compulsive disorder help control
the anxiety level by maintaining a set
pattern of action.
40. C. A person with this disorder would not
have adequate self-boundaries.
41. D. Loose associations are thoughts that are
presented without the logical connections
usually necessary for the listening to
interpret the message.
42. C. Helping the client to develop feeling of
self worth would reduce the client’s need to
use pathologic defenses.
43. B. Open ended questions and silence are
strategies used to encourage clients to
discuss their problem in descriptive manner.
44. C. Clients who are withdrawn may be
immobile and mute, and require consistent,
repeated interventions. Communication
with withdrawn clients requires much
patience from the nurse.The
the following approaches by the
nurse would be the most therapeutic?
a. Question the client until he responds
b. Initiate contact with the client frequently
c. Sit outside the clients room
d. Wait for the client to begin the conversation
3. Joe who is very depressed exhibits
psychomotor retardation, a flat affect and
apathy. The nursein charge observes Joe to
be in need of grooming and hygiene. Which
of the following nursing actions would be
most appropriate?
a. Waiting until the client’s family can
participate in the client’s care
b. Asking the client if he is ready to take
shower
c. Explaining the importance of hygiene to the
client
d. Stating to the client that it’s time for him to
take a shower
4. When teaching Mario with a typical
depression about foods to avoid while
taking phenelzine(Nardil), which of the
following would the nurse in charge
include?
a. Roasted chicken
b. Fresh fish
c. Salami
d. Hamburger
5. When assessing a female client who is
Psychiatric Nursing
receiving tricyclic antidepressant therapy,
Practice Test Part 2
which of the following would alert the
1. Nurse Tony should first discuss terminating
nurse to the possibility that the client is
the nurse-client relationship with a client
experiencing anticholinergic effects?
during the:
a. Urine retention and blurred vision
a. Termination phase when discharge plans are
b. Respiratory depression and convulsion
being made.
c. Delirium and Sedation
b. Working phase when the client shows some
d. Tremors and cardiac arrhythmias
progress.
6. For a male client with dysthymic disorder,
c. Orientation phase when a contract is
which of the following approaches
established.
would the nurseexpect to implement?
d. Working phase when the client brings it up.
a. ECT
2. Malou is diagnosed with major depression
b. Psychotherapeutic approach
spends majority of the day lying in bed with
c. Psychoanalysis
the sheet pulled over his head. Which of
d. Antidepressant therapy
7. Danny who is diagnosed with bipolar c. Watching TV
disorder and acute mania, states the nurse, d. Reading comics
“Where is my daughter? I love Louis. Rain, 12. When developing the plan of care for a
rain go away. Dogs eat dirt.” The client receiving haloperidol, which of the
nurse interprets these statements as following medications would nurse Monet
indicating which of the following? anticipate administering if the client
a. Echolalia developed extra pyramidal side effects?
b. Neologism a. Olanzapine (Zyprexa)
c. Clang associations b. Paroxetine (Paxil)
d. Flight of ideas c. Benztropine mesylate (Cogentin)
8. Terry with mania is skipping up and down d. Lorazepam (Ativan)
the hallway practically running into other 13. Jon a suspicious client states that “I know
clients. Which of the you nurses are spraying my food with
following activities would the nurse in poison as you take it out of the cart.” Which
charge expect to include in Terry’s plan of of the following would be the best response
care? of the nurse?
a. Watching TV a. Giving the client canned supplements until
b. Cleaning dayroom tables the delusion subsides
c. Leading group activity b. Asking what kind of poison the client
d. Reading a book suspects is being used
9. When assessing a male client for suicidal c. Serving foods that come in sealed packages
risk, which of the following methods of d. Allowing the client to be the first to open the
suicide would the nurse identify as most cart and get a tray
lethal? 14. A client is suffering from catatonic
a. Wrist cutting behaviors. Which of the following would the
b. Head banging nurse use to determine that the medication
c. Use of gun administered PRN have been most
d. Aspirin overdose effective?
10. Jun has been hospitalized for major a. The client responds to verbal directions to
depression and suicidal ideation. Which of eat
the following statements indicates to the b. The client initiates simple activities without
nurse that the client is improving? direction
a. “I’m of no use to anyone anymore.” c. The client walks with the nurse to her room
b. “I know my kids don’t need me anymore d. The client is able to move all extremities
since they’re grown.” occasionally
c. “I couldn’t kill myself because I don’t want to 15. Nurse Hazel invites new client’s parents to
go to hell.” attend the psycho educational program for
d. “I don’t think about killing myself as much families of the chronically mentally ill. The
as I used to.” program would be most likely to help the
11. Which of the following activities would family with which of the following issues?
Nurse Trish recommend to the client who a. Developing a support network with other
becomes very anxious when thoughts of families
suicide occur? b. Feeling more guilty about the client’s illness
a. Using exercise bicycle c. Recognizing the client’s weakness
b. Meditating
d. Managing their financial concern and 20. Joy has entered the chemical dependency
problems unit for treatment of alcohol
16. When planning care for Dory with dependency. Which of the following client’s
schizotypal personality disorder, which of possession will the nurse most likely place
the following would help the client become in a locked area?
involved with others? a. Toothpaste
a. Attending an activity with the nurse b. Shampoo
b. Leading a sing a long in the afternoon c. Antiseptic wash
c. Participating solely in group activities d. Moisturizer
d. Being involved with primarily one to 21. Which of the following assessment would
one activities provide the best information about the
17. Which statement about an individual with a client’s physiologic response and the
personality disorder is true? effectiveness of the medication prescribed
a. Psychotic behavior is common during acute specifically for alcohol withdrawal?
episodes a. Sleeping pattern
b. Prognosis for recovery is good with b. Mental alertness
therapeutic intervention c. Nutritional status
c. The individual typically remains in the d. Vital signs
mainstream of society, although he has 22. After administering naloxone (Narcan), an
problems in social and occupational roles opioid antagonist, Nurse Ronald should
d. The individual usually seeks treatment monitor the female client carefully for which
willingly for symptoms that are personally of the following?
distressful. a. Respiratory depression
18. Nurse John is talking with a client who has b. Epilepsy
been diagnosed with antisocial personality c. Kidney failure
about how to socialize d. Cerebral edema
during activities without being 23. Which of the following would nurse Ronald
seductive. Nurse John would focus the use as the best measure to determine a
discussion on which of the following areas? client’s progress in rehabilitation?
a. Discussing his relationship with his mother a. The way he gets along with his parents
b. Asking him to explain reasons for his b. The number of drug-free days he has
seductive behavior c. The kinds of friends he makes
c. Suggesting to apologize to others for his d. The amount of responsibility his job entails
behavior 24. A female client is brought by ambulance to
d. Explaining the negative reactions of others the hospital emergency room after taking
toward his behavior an overdose of barbiturates is
19. Tina with a histrionic personality disorder is comatose. Nurse Trish would be especially
melodramatic and responds to others and alert for which of the following?
situations in an exaggerated manner. Nurse a. Epilepsy
Trish would recommend which of the b. Myocardial Infarction
following activities for Tina? c. Renal failure
a. Baking class d. Respiratory failure
b. Role playing 25. Joey who has a chronic user of cocaine
c. Scrap book making reports that he feels like he has
d. Music group cockroaches crawling under his skin. His
arms are red because of scratching. The b. Invite the client to lunch and accompany him
nurse in charge interprets these findings as to the dining room
possibly indicating which of the following? c. Inform the client that he has 10 minutes to
a. Delusion get to the dining room for lunch
b. Formication d. Take the client a lunch tray and let the client
c. Flash back eat in his room
d. Confusion 30. The initial nursing intervention for the
26. Jose is diagnosed with amphetamine significant-others during shock phase of a
psychosis and was admitted in the grief reaction should be focused on:
emergency room. Nurse Ronald would most a. Presenting full reality of the loss of the
likely prepare to administer which of the individuals
following medication? b. Directing the individual’s activities at this
a. Librium time
b. Valium c. Staying with the individuals involved
c. Ativan d. Mobilizing the individual’s support system
d. Haldol 31. Joy’s stream of consciousness is occupied
27. Which of the following liquids would nurse exclusively with thoughts of her father’s
Leng administer to a female client who is death. Nurse Ronald should plan to help Joy
intoxicated with phencyclidine (PCP) to through this stage of grieving, which is
hasten excretion of the chemical? known as:
a. Shake a. Shock and disbelief
b. Tea b. Developing awareness
c. Cranberry Juice c. Resolving the loss
d. Grape juice d. Restitution
28. When developing a plan of care for a 32. When taking a health history from a female
female client with acute stress disorder who client who has a moderate level of cognitive
lost her sister in a car accident. Which of impairment due to dementia, the nurse
the following would the nurse expect to would expect to note the presence of:
initiate? a. Accentuated premorbid traits
a. Facilitating progressive review of the b. Enhance intelligence
accident and its consequences c. Increased inhibitions
b. Postponing discussion of the accident until d. Hyper vigilance
the client brings it up 33. What is the priority care for a client with a
c. Telling the client to avoid details of the dementia resulting from AIDS?
accident a. Planning for remotivational therapy
d. Helping the client to evaluate her sister’s b. Arranging for long term custodial care
behavior c. Providing basic intellectual stimulation
29. The nursing assistant tells nurse Ronald d. Assessing pain frequently
that the client is not in the dining room for 34. Jerome who has eating disorder often
lunch. Nurse Ronald would direct the exhibits similar symptoms. Nurse Lhey
nursing assistant to do which of the would expect an adolescent client with
following? anorexia to exhibit:
a. Tell the client he’ll need to wait until supper a. Affective instability
to eat if he misses lunch b. Dishered, unkempt physical appearance
c. Depersonalization and derealization
d. Repetitive motor mechanisms childhood abuse. The most appropriate
35. The primary nursing diagnosis for a female short term client outcome would be:
client with a medical diagnosis of major a. Verbalizing the need for anxiety medications
depression would be: b. Recognizing each existing personality
a. Situational low self-esteem related to altered c. Engaging in object-oriented activities
role d. Eliminating defense mechanisms and phobia
b. Powerlessness related to the loss of idealized 40. A 25 year old male is admitted to a mental
self health facility because of inappropriate
c. Spiritual distress related to depression behavior. The client has been hearing
d. Impaired verbal communication related to voices, responding to imaginary
depression companions and withdrawing to his room
36. When developing an initial nursing care for several days at a time. Nurse Monette
plan for a male client with a Bipolar I understands that the withdrawal is a
disorder (manic episode) nurse Ron should defense against the client’s fear of:
plan to? a. Phobia
a. Isolate his gym time b. Powerlessness
b. Encourage his active participation in unit c. Punishment
programs d. Rejection
c. Provide foods, fluids and rest 41. When asking the parents about the onset of
d. Encourage his participation in programs problems in young client with the diagnosis
37. Grace is exhibiting withdrawn patterns of of schizophrenia, Nurse Linda would expect
behavior. Nurse Johnny is aware that this that they would relate the client’s
type of behavior eventually produces difficulties began in:
feeling of: a. Early childhood
a. Repression b. Late childhood
b. Loneliness c. Adolescence
c. Anger d. Puberty
d. Paranoia 42. Jose who has been hospitalized with
38. One morning a female client on the schizophrenia tells Nurse Ron, “My heart
inpatient psychiatric service complains to has stopped and my veins have turned to
nurse Hazel that she has been waiting for glass!” Nurse Ron is aware that this is an
over an hour for someone to accompany example of:
her to activities. Nurse Hazel replies to the a. Somatic delusions
client “We’re doing the best we can. There b. Depersonalization
are a lot of other people on the unit who c. Hypochondriasis
needs attention too.” This statement shows d. Echolalia
that the nurse’s use of: 43. In recognizing common behaviors exhibited
a. Defensive behavior by male client who has a diagnosis of
b. Reality reinforcement schizophrenia, nurse Josie can anticipate:
c. Limit-setting behavior a. Slumped posture, pessimistic out look and
d. Impulse control flight of ideas
39. A nursing diagnosis for a male client with a b. Grandiosity, arrogance and distractibility
diagnosed multiple personality disorder is c. Withdrawal, regressed behavior and lack of
chronic low self-esteem probably related to social skills
d. Disorientation, forgetfulness and anxiety
44. One morning, nurse Diane finds a disturbed d. Not placing any demands on the client
client curled up in the fetal position in the 49. Nurse Gerry is aware that the defense
corner of the dayroom. The most accurate mechanism commonly used by clients who
initial evaluation of the behavior would be are alcoholics is:
that the client is: a. Displacement
a. Physically ill and experiencing abdominal b. Denial
discomfort c. Projection
b. Tired and probably did not sleep well last d. Compensation
night 50. Within a few hours of alcohol withdrawal,
c. Attempting to hide from the nurse nurse John should assess the male client
d. Feeling more anxious today for the presence of:
45. Nurse Bea notices a female client sitting a. Disorientation, paranoia, tachycardia
alone in the corner smiling and talking to b. Tremors, fever, profuse diaphoresis
herself.Realizing that the client is c. Irritability, heightened alertness, jerky
hallucinating. Nurse Bea should: movements
a. Invite the client to help decorate the d. Yawning, anxiety, convulsions
dayroom
b. Leave the client alone until he stops talking
Answers and Rationale
c. Ask the client why he is smiling and talking
Psychiatric Nursing
d. Tell the client it is not good for him to talk to
himself
Practice Test Part 2
46. When being admitted to a mental health 1. C. When the nurse and client agree to work
facility, a young female adult tells Nurse together, a contract should be established,
Mylene that the voices she hears frighten the length of the relationship should be
her. Nurse Mylene understands that the discussed in terms of its ultimate termination.
client tends to hallucinate more vividly: 2. B. The nurse should initiate brief, frequent
a. While watching TV contacts throughout the day to let the client
b. During meal time know that he is important to the nurse. This
a. Agree with the client’s painful feelings cessation or reduction of prolonged moderate
or heavy use of opiates.
b. Challenge the accuracy of the client’s belief
4. B. Whether there is a suicide plan is a
c. Deny that the situation is hopeless
criterion when assessing the client’s
d. Present a cheerful attitude
determination to make another attempt.
48. A client with major depression has not
5. A. Rapists are believed to harbor and act out
verbalized problem areas to staff or peers
hostile feelings toward all women through the
since admission to a psychiatric unit. Which
act of rape.
activity should the nurse recommend to 6. C. These children often have nonsexual needs
help this client express himself? met by individual and are powerless to
a. Art therapy in a small group refuse.Ambivalence results in self-blame and
b. Basketball game with peers on the unit also guilt.
c. Reading a self-help book on depression 7. B. The client’s anger over the abortion is
d. Watching movie with the peer group shifted to the staff and the hospital because
49. The home health psychiatric nurse visits a she is unable to deal with the abortion at this
recently discharged after a prolong stay in 8. A. Personal internal strength and supportive
individuals are critical factors that can be
a state hospital. The client lives in a
employed to assist the individual to cope with
boarding home, reports no family
a crisis.
involvement, and has little social
9. D. Crisis intervention group helps client
interaction. The nurse plan to refer the
reestablish psychologic equilibrium by
client to a day treatment program in order
assisting them to explore new alternatives for
to help him with:
coping. It considers realistic situations using
a. Managing his hallucinations
rational and flexible problem solving methods.
b. Medication teaching 10. C. This would document that the client feels
c. Social skills training comfortable enough to discuss the problems
d. Vocational training that have motivated the behavior.
50. Which activity would be most appropriate
for a severely withdrawn client?
11. C. The most successful therapy for people 21. D. Diarrhea is a common physiological
with phobias involves behavior modification response to stress and anxiety.
techniques using desensitization. 22. B. The parasympathetic nervous system
12. A. Perceptual field is a key indicator of would produce incomplete G.I. motility
anxiety level because the perceptual fields resulting in hyperactive bowel sounds,
narrow as anxiety increases. possibly leading to diarrhea.
13. D. One of the symptoms of autistic child 23. C. The antidepressants fluvoxamine and
displays a lack of responsiveness to clomipramine have been effective in the
others. There is little or no extension to the treatment of OCD.
external environment. 24. A. Phobias cause severe anxiety (such as
14. B. Somatic delusions focus on bodily panic attack) that is out of proportion to the
functions or systems and commonly include threat of the feared object or
delusion about foul odor emissions, insect situation. Physical signs and symptoms of
manifestations, internal parasites and phobias include profuse sweating, poor motor
misshapen parts. control, tachycardia and elevated B.P.
15. D. A client with borderline personality 25. D. In many instances, the nurse can diffuse
displays a pervasive pattern of unpredictable impending violence by helping the client
behavior, mood and self image. Interpersonal identify and express feelings of anger and
relationships may be intense and unstable and anxiety. Such statement as “What happened
behavior may be inappropriate and impulsive. to get you this angry?” may help the client
16. A. Propranolol is a potent beta adrenergic verbalizes feelings rather than act on them.
blocker and producing a sedating effect, 26. B. When speaking to a client with Alzheimer’s
therefore it is used to treat antipsychotic disease, the nurse should use close-ended
induced akathisia and anxiety. questions.Those that the client can answer
17. B. Amantadine is an anticholinergic drug used with “yes” or “no” whenever possible and
to relive drug-induced extra pyramidal avoid questions that require the client to
adverse effects such as muscle weakness, make choices. Repeating the question aids
involuntary muscle movements, comprehension.
pseudoparkinsonism and tar dive dyskinesia. 27. A. The nurse should prepare a client for ECT
18. D. MAOI antidepressants when combined with in a manner similar to that for general
a number of drugs can cause life-threatening anesthesia.
hypertensive crisis. It’s imperative that a 28. C. Aged cheese and Chianti wine contain high
client checks with his physician and concentrations of tyramine.
pharmacist before taking any other 29. D. ECT commonly causes transitory short and
medications. long term memory loss and confusion,
19. B. Panic is the most severe level of especially in geriatric clients. It rarely results
anxiety. During panic attack, the client in permanent short and long term memory
experiences a decrease in the perceptual loss.
field, becoming more focused on self, less 30. A. Polyuria commonly occurs early in the
aware of surroundings and unable to process treatment with lithium and could result in
information from the environment. The fluid volume deficit.
decreased perceptual field contributes to 31. D. Signs of anxiety agent overdose include
impaired attention andinability to concentrate. emotional lability, euphoria and impaired
20. A. The emergency nurse must establish memory.
rapport and trust with the anxious client 32. B. Drinking alcohol can potentiate the
before using therapeutic touch. Touching an sedating action of tricyclic
anxious client may actually increase anxiety. antidepressants. Dry mouth and blurred
vision are normal adverse effects of tricyclic care, but hey are not applicable to this
antidepressants. situation.
33. C. Women may experience amenorrhea, 38. C. The concept that behavior is motivated and
which is reversible, while taking has meaning comes from the psychodynamic
antipsychotics. Amenorrhea doesn’t indicate framework. According to this perspective,
cessation of ovulation thus, the client can still behavior arises from internal wishes or needs.
be pregnant. Much of what motivates behavior comes from
34. D. The first are for assessment would be the the unconscious. The remaining responses do
client’s reason for refusing medication. The not address the internal forces thought to
client may not understand the purpose for the motivate behavior.
medication, may be experiencing distressing 39. C. The client is demonstrating faulty thought
side effects, or may be concerned about the processes that are negative and that govern
cost of medicine. In any case, the nurse his behavior in his work situation – issues
cannot provide appropriate intervention that are typically examined using a cognitive
before assessing the client’s problem with the theory approach. Issues involving learned
medication. The patient’s income level, living behavior are best explored through behavior
arrangements, and involvement of family and theory, not cognitive theory. Issues involving
support systems are relevant issues following ego development are the focus
determination of the client’s reason for of psychoanalytic theory. Option 4 is incorrect
refusing medication. The nurse providing because there is no evidence in this situation
follow-up care would have access to the that the client has conflictual relationships in
client’s medical record and should already the work environment.
know the reason for inpatient admission. 40. D. Anxiety is a response to a threat arising
35. A. Excess dopamine is thought to be the from internal or external stimuli.
chemical cause for psychotic thinking. The 41. A. Systematic desensitization is a behavioral
typical antipsychotics act to block dopamine therapy technique that helps clients with
receptors and therefore decrease the amount irrational fears and avoidance behavior to
of neurotransmitter at the synapses. The face the thing they fear, without experiencing
typical antipsychotics do not increase anxiety. There is no attempt to promote
acetylcholine, stabilize serotonin, stimulate insight with this procedure, and the client will
GABA. not be taught to substitute one fear for
36. B. The TCAs affect norepinephrine as well as another. Although the client’s anxiety may
other neurotransmitters, and thus have decrease with successful confrontation of
significant cardiovascular side effects. irrational fears, the purpose of the procedure
Therefore, they are used with caution in is specifically related to performing activities
elderly clients who may have increased risk that typically are avoided as part of the
factors for cardiac problems because of their phobic response.
age and other medical conditions. The 42. B. A client with antisocial personality disorder
remaining side effects would apply to any typically has frequent episodes of acting
client taking a TCA and are not particular to impulsively with poor ability to delay self-
an elderly person. gratification. Therefore, decreased frequency
37. B. Cognitive thinking therapy focuses on the of impulsive behaviors would be evidence of
client’s misperceptions about self, others and improvement. Charming behavior when
the world that impact functioning and around authority figures and statements
contribute to symptoms. Using medications to indicating no remorse are examples of
alter neurotransmitter activity is a symptoms typical of someone with this
psychobiologic approach to treatment. The disorder and would not indicate successful
other answer choices are frameworks for treatment. Self-satisfaction would be viewed
as a positive change if the client expresses positive beliefs that are realistic and hopeful.
low self-esteem; however this is not a Agreeing with the client’s feelings and
characteristic of a client with antisocial presenting a cheerful attitude are not
personality disorder. consistent with a cognitive approach and
43. D. In autoimmune disorders, stress and the would not be helpful in this situation. Denying
response to stress can exacerbate symptoms. the client’s feelings is belittling and may
Stress management techniques can help the convey that the nurse does not understand
client reduce the psychological response to the depth of the client’s distress.
stress, which in turn will help reduce the 48. A. Art therapy provides a nonthreatening
physiologic stress response. This will afford vehicle for the expression of feelings, and use
the client an increased sense of control over of a small group will help the client become
his symptoms. The nurse can address the comfortable with peers in a group setting.
remaining answer choices in her teaching Basketball is a competitive game that
about the client’s disease and treatment; requires energy; the client with major
however, knowledge alone will not help the depression is not likely to participate in this
client to manage his stress effectively enough activity. Recommending that the client read a
to control symptoms. self-help book may increase, not decrease his
44. D. Disregard for established rules of society is isolation. Watching movie with a peer group
the most common characteristic of a client does not guarantee that interaction will occur;
with antisocial personality disorder. Attention therefore, the client may remain isolated.
to detail and order is characteristic of 49. C. Day treatment programs provide clients
someone with obsessive compulsive disorder. with chronic, persistent mental illness training
Bizarre mannerisms and thoughts are in social skills, such as meeting and greeting
characteristics of a client with schizoid or people, asking questions or directions, placing
schizotypal disorder. Submissive and an order in a restaurant, taking turns in a
dependent behaviors are characteristic of group setting activity. Although management
someone with a dependent personality. of hallucinations and medication teaching may
45. D. The client with anorexia typically feels also be part of the program offered in a day
powerless, with a sense of having little control treatment, the nurse is referring the client in
over any aspect of life besides eating this situation because of his need for
behavior. Often, parental expectations and socialization skills. Vocational training
standards are quite high and lead to the generally takes place in a rehabilitation
clients’ sense of guilt over not measuring up. facility; the client described in this situation
46. A. One of the core issues concerning the would not be a candidate for this service.
family of a client with anorexia is control. The 50. A. The best approach with a withdrawn client
family’s acceptance of the client’s ability to is to initiate brief, nondemanding activities on
make independent decisions is key to a one-to-one basis. This approach gives the
successful family intervention. Although the nurse an opportunity to establish a trusting
remaining options may occur during the relationship with the client. A board game
process of therapy, they would not necessarily with a group clients or playing a team sport in
indicate a successful outcome; the central the gym may overwhelm a severely
family issues of dependence and withdrawn client. Watching TV is a solitary
independence are not addresses on these activity that will reinforce the client’s
responses. withdrawal from others.
47. B. Use of cognitive techniques allows the
nurse to help the client recognize that this
negative beliefs may be distortions and that,
by changing his thinking, he can adopt more