Name:

:____________________________________ Score
__________
Date
__________ :
Direction: Select the correct answer among the choices
given and place it in the answer sheet provided.

STRICTLY NO ERASURES AND SUPERIMPOSITIONS

During an assessment interview, a depressed 15-year-old girl .1

states that she "can't sleep at night. The nurse begins to explore
factors that contribute to this situation by asking if the girl is
sexually active. The girl changes the subject. What should the
nurse suspect based on the client's response to the assessment
?question

a. Sexual abuse c. Spiritual distress

.b. Narcolepsy d. Pain disorder

RATIONALE: Victims of sexual abuse commonly refuse to

talk about the abuse or change the subject because they
have been threatened by their abuser. Although there
may be other explanations for the adolescent's inability
to sleep at night, such as noise, anxiety, spiritual
distress, pain, or other disturbance, adolescents are
typically willing to discuss these factors as contributors
to their inability to sleep. An adolescent with narcolepsy
would experience brief periods of deep sleep followed by
periods of feeling refresh and wouldn't complain of being
.unable to sleep at night

A client, age 20, is being treated for depression. During a .2

conversation with a nurse, the client states that her father raped
her when she was 7 years old. She says she has nightmares
about the experience and sometimes relives it. She also reveals
:that she fears older men. Thw nurse suspects that the client has

a. posttraumatic stress disorder (PTSD), delayed

onset. c. Anxiety disorder

b. multiple personality
disorder d. Schizophrenia
RATIONALE: The client's memory of a traumatic childhood
incident and her current signs and
symptoms( nightmares, flashbacks, and related fears)
suggest that she has PTSD with delayed onset. The client
doesn't occasionally lose track of her movements and
actions, flashbacks, these aren't psychotic episodes, as in
.schizophrenia

A nurse knows that a physician has orders the liquid form of .3

the drug chlorpromazine (Thorazine) rather than the tablet form
:because the liquid

a. has a more predictable onset of action. c.

.produces fewer drug interactions

b. produces fewer anticholinergic effects. d. has a longer

.duration of action

RATIONALE: A liquid phenothiazine preparation will

produce effects in 2-4 hours. The onset with tablets is
.unpredictable

During periods of extreme stress a client may experience .4

elevated blood pressure, dilated pupils, and increased
respiration. These unconscious responses originate in which part
?of the brain

a. Limbic system c. Reticular activating system

b. Hypothalamus d. Somatic nervous system

RATIONALE: The hypothalamus regulates the

unconscious responses associated with fight-or-flight
response of the autonomic nervous system. The limbic
system, located in the middle of the brain, is responsible
for emotional expression, learning, and memory. The
reticular activating system, which projects from the
brainstem to the thalamus, controls sleeping and
wakefulness. The somatic nervous system provides
.voluntary control over skeletal muscles

A client is in the manic phase of bipolar disorder. To help the .5

:client maintain adequate nutrition, the nurse should plan to

a. provide large, attractive

meals c. provide a stimulating mealtime
environment
b. offer finger foods and sandwiches d.
let the client choose his favourite foods

RATIONALE: Finger foods and sandwiches help maintain

adequate nutrition and provide calories for this client's
high energy level. During the manic phase, the client
can't still for large meals. Providing a stimulating
mealtime environment is incorrect because a quiet
mealtime environment is more beneficial than a
stimulating one. Letting the client choose his favourite
food s is inappropriate because this client has a short
.attention span and has trouble making choices

Teaching for women of childbearing years who are receiving .5

?antipsychotic medications includes which statement

.a. This medication may result in heightened libido

b. Incidence of dysmenorrhea may increase while taking this

.drug

c. Continue previous contraceptive use even if you're

.experiencing amenorrhea

.d. Amenorrhea is irreversible

RATIONALE: Women may experience amenorrhea, which

is reversible, while taking antipsychotics because
amenorrhea doesn't indicate cessation of ovulation the
client who experiences amenorrhea can still become
pregnant. She should be instructed to continue
contraceptive use even when experiencing amenorrhea.
Dysmenorrhea isn't an adverse effect of an
antipsychotics, and the depressant generally decrease
.libido

A client with a diagnosis of paranoid schizophrenia is admitted .6

to the inpatient unit of the mental health center. He's shouting
that the government of France is trying to assassinate him.
?Which response is most appropriate

a. "I think you're wrong. France is a friendly country. The French

"French government wouldn't try to kill you

b. " I don't see evidence that a foreign government or

anyone else is trying to hurt you. You must feel
".frightened by this

".c. " You're wrong. Nobody is trying to kill you

d. A foreign government is trying to kill you? Please tell me more
".about it

RATIONALE: Responses should focus on reality while

acknowledging the client's feelings. It isn't therapeutic
for the nurse to argue with client or deny his belief.
Arguing can also inhibit development of a trusting
relationship. Continuing to talk about delusion may
aggravate the client's psychosis. Asking the client if a
foreign government is trying to kill him may increase his
.anxiety level and can reinforce his delusion

A client with a history of heroin addiction is admitted to the .7

hospital intensive care unit with a diagnosis of opioid drug
overdose. While talking with a nurse, the client's father states
that he's going to have his son declared legally incompetent.
?Which response by the nurse is most therapeutic

a. " Your son is ill and can't make decisions about himself
".and his safety right now, but this situation is temporary

b. "You don't have the right to declare your son incompetent. He

".has rights, too

c. " If you become your son's guardian, you'll be responsible for

".his finances and for paying for his treatment

d. " If you become your son's guardian, you'll be responsible for

".his finances and paying for his treatment

RATIONALE: The client is temporarily unable to make

decisions about his health care and safety. After
receiving emergency care and treatment, he'll probably
be able to safely manage his daily affairs. The nurse's
reference to the client's constitutional rights isn't a
.therapeutic response

:Positive symptoms of schizophrenia include .8

a. hallucinations, delusions, and disorganized

.thinking

.b. Somatic delusions, echolalia, and a flat affect

.c. waxy flexibility, alogia, and apathy

.d. flat affect, avolition, and anhedonia

RATIONALE: The positive symptoms of schizophrenia-
hallucinations, delusion, and disorganize thinking- are
distortions of normal functioning. A flat affect, alogia,
apathy, avolition, and anhedonia refer to the negative
symptoms. Negative symptoms characterize the
.diminution or loss of normal function

A client seeking help at a community mental health center .9

complains of fatigue, sensitivity to criticism, decrease libido, and
feeling self- conscious. He also has aches and pains. A nursing
:diagnosis for this client might include

.a. Delayed growth and development

.b. Ineffective role performance

.c. Posttrauma syndrome

.d. Situational low self-esteem

RATIONALE: All symptoms define a disturbance in self-

esteem. There isn't enough information to determine
delayed growth and development. The client's complaints
don't involve his ability to perform in his roles.
Posttrauma syndrome occurs after experiencing a
traumatic event and doesn't coincide with the data
.obtained from this client

During the admission interview, a client reports that she .10

frequently has nightmare and memories of a rape that occurred
3 years earlier. She feels depressed and asks the nurse, " Do you
think I will ever get better? I don't know what is wrong with me. "
:The nurse's most supportive response would be

a. " It sounds like you have some unresolved pain about

the trauma. Take time while you're here to talk and allow
".yourself to heal

b. " I'm not sure what is wrong, but the medication will help you
".soon enough

c. " It's important for you to talk with your physician about an
".issue such as this

".d. Don't feel bad; the treatment will help you

RATIONALE: In this statement, the nurse acknowledges

the client's traumatic experience and pain and
encourages the client to talk. A nurse who tells the client
that she doesn't know what is wrong but that medication
will help ignores the client's need for reassurance.
Referring the client to the physician indicates that the
nurse isn't capable of helping the client deal with
therapeutic issues. Telling the client not to feel bad could
make the client feel guilty for being upset about the
.trauma

During an extremely busy shift on the psychiatric unit, a .11

newly graduated nurse approaches the charge nurse and states,
" I'm having a hard time taking care of mentally ill people. What
can I do to handle this stress?" The charge nurse's best response
:is

".a. " Try to take some deep breaths whenever you feel anxious

".b. " Maybe you should attend some stress-reduction courses

".c. " Just ignore situations you can't change

d. " Maybe we could schedule a time to discuss this

".further

RATIONALE: Suggesting to set a time for a more detailed

discussion acknowledges that the charge nurse is
concerned about what the new graduate has told her and
provides an opportunity to explore and address the
.problem at a more appropriate time

A client with schizophrenia tells the nurse, " My intestines are .12
rotted from the worms chewing on them. " This statement
:indicates a

a. Delusion of persecution c. somatic delusion

b. Delusion of grandeur. D. jealous delusion

RATIONALE: Somatic delusion focus on bodily functions or

systems and commonly include delusion s about foul odor
emissions, insect infestations, internal parasites, and
misshapen parts. Delusion of persecution are morbid
beliefs that one is being mistreated and harassed by
unified enemies. Delusion of grandeur are gross
exaggerations of one's importance, wealth, power, or
talents. Jealous delusion are delusions that one's spouse
.or lover is unfaithful

Nursing care for a client with schizophrenia must be based on .13

valid psychiatric and nursing theories. A nurse's interpersonal
communication with the client and specific nursing interventions
:must be

a. clearly identified, with boundaries and specifically defined

.roles

.b. warm and nonthreatening

.c. centered on clearly defined limits and expression of empathy

d. flexible enough for the nurse to adjust the care plan as

.the situation warrants

RATIONALE: A flexible care plan is needed for any client

who behaves suspicious, withdrawn, or regressed manner
.or who has a though disorder

A nurse is assigned to care for a client with dependent .14

personality disorder. Which intervention should the nurse include
?in this client's care plan to promote independence

.a. Spending long periods of unscheduled time with the client

b. Scheduling competitive activities so the client can test his

.skills

c. Helping the client identify preferences, such as

.choosing with clothing to wear

.d. Avoiding discussion of the client's feelings of helpless

RATIONALE: Helping the client identify preferences

promotes development of independent decision-making
skills, which the client with dependent personality
.disorder lacks

A client is about to be discharged with a prescription for the .15

antipsychotic agent haloperidol (Haldol) , 10mg by mouth twice
per day. During a discharge teaching session, a nurse should
?provide which instruction to the client

.a. Take the medication 1 hour before a meal

.b. Decrease the dosage if signs of illness decrease

.c. Apply a sunscreen before exposure to the sun

d. Increase the dosage up to 50 mg twice per day if signs of

.illness don't decrease
RATIONALE: Because haloperidol can cause
photosensitivity and precipitate severe sunburn, the
nurse instruct the client to apply a sunscreen before
exposure to the sun. The nurse also should teach the
client to take haloperidol with meals-not 1 hour before-
and should instruct the client not to decrease or increase
.the dosage unless a physician orders the change

The client with a posttraumatic stress disorder has been .16

complaining of headaches. A physician orders magnetic
resonance imaging (MRI) of the brain in order to rule out organic
disorder. The client later tells a nurse, "I'm not going into that
?tunnel!" Which response by the nurse is most therapeutic

a. " This is the only way the physician can tell there's anything
".physically wrong

".b. "Many people feel the same way about having an MRI

c. "If you take several deep breaths and close your eyes, you'll
".do just fine

d. "I can tell you're really afraid. Can you tell me about
"?your fear

RATIONALE: The client is experiencing intense fear.

Rather than reasoning with the client, the nurse should
use the refusal as an opportunity to learn more about
feelings. Acknowledging the client's fear and asking him
.to describe his feelings is the most therapeutic response

When doing discharge planning for a hospitalized client with .17

impulse control disorder, a nurse explains how family members
can participate effectively in the client's ongoing care. What
?instruction should the nurse include

a. " After every explosive outburst, reevaluate and change the

".approach you use

b. "Recognize initial anger symptoms as soon as possible and

".have him take medication

c. " Consistently reward positive behaviour and reinforce

".consequences of negative behaviour

d. "Persuade him to go to an emergency department and request

".medication
RATIONALE: Consistency in rewarding positive behaviour
and reinforcing consequences of negative behaviour is
essential if the family is going to help the client learn to
control angry feelings, outbursts, and actions. Changing
the approach after every angry outbursts isn't
appropriate; the inconsistency of this approach isn't in
.the client's best approach

A female client is admitted to the emergency department .18

after being sexually assaulted. The nurse notes that the client is
sitting calmly and quietly in the examination room and
recognizes this behaviour as a protective defense mechanism.
?What defense mechanism is the client excibiting

a. Intellectualization

b. Denial

c. Regression

d. Displacement

RATIONALE: Denial is a protective and adaptive reaction

to increase anxiety. It involves consciously disowning
intolerable thoughts and impulses. The response is
commonly seen in victims of sexual abuse. In
intellectualization, the client attempts to avoid
expressing emotions associated with the stressful
.situations by using logic, analysis, and reasoning

A physician orders a tricyclic antidepressant for a client who .19

has suffered an acute myocardial infarction (MI) within the
?previous 6 months. Which action should the nurse take

.a. Administer the medication as ordered

.b. Discontinue the medication

.c. Question the physician about the order

d. Inform the client that he should discuss his MI with the

.physician

RATIONALE: Cardiovascular toxicity is a problem with

antidepressants, and the nurse should question the use
of these drugs in a client with cardiac disease.
Administering the medication would be an act of
negligence. A nurse can't discontinue a medication
without the physician's order. It's the nurse
responsibility, not client's, to discuss question of care
.with the physician

Which response demonstrates that the parents of a child with .20

newly diagnosed schizophrenia understand their child's
?diagnosis

a. "We'll watch him swallow his daily pills and call the physician
".if he doesn't

b. " As long as we're understanding and supportive, he'll

".eventually be fine

c. " The illness is a result of drug abuse during early

".adolescence

d. " His grandfather is an alcoholic. Being around him caused our

".son to have this problem

RATIONALE: Treatment for schizophrenia involves taking

medication on a consistent basis. These
parents demonstrate on an understanding of they'll
need to take an active role in monitoring their child's
.medication therapy

A client stalks a man she met briefly 3 years earlier. She .21
believes he loves her and eventually will marry her and she has
been sending him cards and gifts. When she violates a
restraining order he has obtained, a judge orders her to undergo
a 10-day psychiatric evaluation. What is the most probable
.psychiatric diagnosis for this client

.a. Delusion disorder- jealous type

.b. Induced psychotic disorder

.c. Delusion disorder- erotomanic type

.d. Schizophreniform disorder

RATIONALE: In delusion disorder of the erotomanic type,

the client has an erotic delusion of being loved by
another person and tries to contact the object of the
delusion through such behaviours as sending gifts,
calling, and stalking. The object of the undesired
attention may be a complete stranger or someone the
.client knows, and usually is of higher status
When teaching the family of a client with schizophrenia, the .22
?nurse should provide which information

.a. Relapse can be prevented if the client takes his medication

b. Support is available to help family members meet their

.own needs

c. Improvement should occur if the client is provided with a

.stimulating environment

.d. Stressful family situations can precipitate a relapse

RATIONALE: Because family members of a client with

schizophrenia face difficult situations and great stress,
the nurse inform them of support services that can help
them cope with such problems. The nurse should also
teach clients' family members that medication can't
prevent relapses and that environmental stimuli may
.precipitate symptoms

A client with chronic schizophrenia receives 20 mg of .23

fluphenazine decanoate ( prolixin decanoate) by I.M. injection.
Three days later, the client has muscle contractions that contort
?his neck. This client is exhibiting which extrapyramidal reaction

a. Dystonia

b. Akinesia

c. Akathisia

d. Tardive dyskinesia

RATIONALE: Dystonia, a common extrapyramidal reaction

to fluphenazine decanoate , manifests as muscle spasm in
tongue, face, neck, back, and sometimes the legs.
Akinesia refers to decreased or absent movement;
akathesia, to restlessness or inability to sit still; and
tardive dyskinesia, to abnormal muscle movements,
.particularly around the mouth

A client is in the first stage of alzheimer's disease. The nurse .24

:should plan to focus this client's care on

a. offering nourishing finger foods to help maintain the client's

.nutritional status

.b. providing emotional support and individual counselling

c. monitoring the client to prevent minor illness from turning into
.major problems

d. suggesting new activities for the client and family to enjoy

.together

RATIONALE: Clients first stage of alzheimer's disease are

aware that something is happening to them and may
become overwhelmed and frightened. Therefore, nursing
care typically focuses on providing emotional support and
.individual counselling

A client is admitted to the psychiatric unit with acute onset of .25

schizophrenia. His physician orders the phenothiazine
chlorpromazine ( Thorazine), 100 mg by mouth four times per
day. Before administering the drug, a nurse reviews the client's
medication history. Concomitant use of which drug is likely to
?increase the risk of extrapyramidal effects

(a. Guanethidine (Ismelin

(b. Droperidol (Inapsine

(c. Lithium carbonate (Lithonate

d. alcohol

RATIONALE: When administerd with any phenothiazine,

droperidol may increase the risk of extrapyramidal
effects. Guanethidine, Lithium carbonate and alcohol
.don't increase the risk of extrapyramidal effects

:The goal of crisis intervention is .26

.a. to solve the client's problems for him

.b. psychological resolution of the immediate crisis

.c. to establish a basis for long-term therapy

.d. to provide a basis for admission to an acute care facility

RATIONALE: The goal of crisis intervention is to resolve

the immediate problem. The client must learn to resolve
his own issues. Although some clients do enter long-term
.therapy isn't the goal of crisis intervention

A client visits a physician's office to seek treatment for .27

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 earlier. Based on this report, the nurse suspects

a. cyclothymic disorder. c. major

.depression

b. atypical affective disorder. d. dysthymic

.disorder

RATIONALE: Dysthymic disorder is characterized by

feelings of depression lasting 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 episodes of
.normal mood that last a few days to few weeks

A client admitted to the unit is visibly anxious. When .28

assessing this client, the nurse should expect to see which
cardiovascular effect produced by the sympathetic nervous
?system

a. Syncope c. Increase heart

rate

b. Decrease blood pressure d. Decrease pulse rate

RATIONALE: Sympathetic cardiovascular responses to

stress include increased heart rate, cardiac contractility,
and cardiac output, increased blood pressure; peripheral
vasoconstriction. Syncope is a response to a
.parasympathetic stimulation

A client with schizophrenia tells a nurse he hears the voices of .29

his dead parents. To help the client ignore the voices, the nurse
:should recommend that he

.a. sit in a quiet, dark room and concentrate on the voices

b. listen to a personal stereo through headphones and

.sing along with the music

.c. call a friend and discuss the voices and hi feeling about them

.d. engage in strenuous exercise

RATIONALE: Increasing the amount of auditory ( for

example, by listening to music through headphones) may
help the client focus on external sounds and ignore
internal sounds from auditory hallucinations.
Concentrating on the voices would make it harder for the
.client ignore the hallucinations

A clinic client with agoraphobia must go to a laboratory to .30

have blood drawn. The client is terrified, stating, " I know I can't
handle being in the waiting room." What is the nurse's most
?therapeutic response

a. " You've come a long way in therapy. I'm sure you'll do just
".fine

b. "I'll arrange for you to be the first client and we'll talk
".about it afterward

c. " It sounds like you've had bad experiences having your blood
".drawn

".d. " The procedure takes only a few minutes. Then you go home

RATIONALE: Scheduling the client as the first

appointment and arranging to talk him after having his
blood drawn is a practical intervention that provides the
client with the opportunity to express his feelings
.afterward

An adolescent becomes increasingly withdrawn, is irritable .31

with family members, and has been getting lower grades in
school. After giving away a stereo and some favourite clothes,
the adolescent is brought to the community mental health
:agency for evaluation. This adolescent is at risk for

a. suicide c. school phobia

b. anorexia nervosa d. schizophrenia

RATIONALE: Changes in academic performance and

familial communications, social withdrawal, and giving
away treasured possessions suggest that this adolescent
is contemplating suicide. Anorexia nervosa would cause
weigh loss and other related symptoms. This adolescent's
signs and symptoms don't suggest fear of school and
.they typify depression, not schizophrenia

When interviewing the parents of an injured child, which sign .32

?is the strongest indicator that child abuse may be a problem
a. The injury isn't consistent with the child's history or
.age

.b. The parents offer consistent explanations for the injury

.c. The family is poor and the mother and father isn't married

d. The parents are argumentative and demanding with

.personnel

RATIONALE: When the child's injuries are inconsistent

with the history given or if the injuries couldn't have
occurred naturally or accidentally because of the child's
age and developmental stage, the emergency department
.nurse should suspect child abuse

A client can tells a nurse that the television is sending her a .33
:secret message. The nurse suspects the client is experiencing

a. a delusion c. ideas of reference

b. flight of ideas d. a hallucination

RATIONALE: Ideas of reference refers to the mistaken

belief that neutral stimuli have special meaning to an
individual, such as the television newscaster sending a
message directly to her. A delusion is a false belief. Flight
of ideas is a speech pattern in which the client skips from
one unrelated subject to another. A hallucination is a
sensory perception, such as hearing voices and seeing
.objects, that only the client experiences

Which statement should be included when teaching clients .34

?about monoamine oxidase (MAO) inhibitors

a. Don't take any prescribed or over-the-counter

medications without consulting a physician and
.pharmacist

.b. Avoid strenuous activity because of the drug's cardiac effects

.c. Have blood levels screened weekly for leukopenia

d. Don't take an MAO inhibitor with aspirin or nonsteroidal anti-

.(inflammatory drugs (NSAIDs

RATIONALE: When combined with a number of drugs MAO

inhibitors can cause life threatening hypertensive crisis.
It's imperative that a client using MAO inhibitors check
with his physician and pharmacist before taking any
.other medications

A client with major depression sleeps 18 to 20 hours per day, .35

shows no interest in activities he previously enjoyed and reports
a 17-lb (7.7-kg) weight loss over the past month. Because this is
the client's first hospitalization, the physician is most likely to
:order

(a. phenelzine ( Nardil) c. nortriptyline (Pamelor

(b. thiothixene ( Narvane) d. trifluoperazine (Stelazine

RATIONALE: Nortriptyline, a trycyclic antidepressant, is

used in first-time drug therapy because it causes few
anticholinergic and sedative adverse effects. Phenelzine
isn't ordered initially because it may cause many adverse
effects and necessitates dietary restrictions. Thiothixene
and trifluoperazine are antipsychotic agents and
therefore inappropriate wuth the client with
.uncomplicated depression

A husband and wife seek emergency crisis intervention .36

because he slapped her repeatedly the night before. The
husband indicates that his childhood was marred by an abusive
relationship with his father. To assess for the likelihood of
further violence and abuse, the nurse should determine that the
:husband

.a. has moderate impulse control

.b. trusts his wife and supports her independence

.c. has learned violence as an acceptable behaviour

.d. feels secure in his relationship with his wife

RATIONALE: Family violence is usually a learned

behaviour. This couple is at risk for further violence.
Poor, not moderate, impulse control indicates a risk for
more violence. Violent people generally are jealous and
.possessive and feel insecure in their relationships

A physician orders carbamazepine (Tegretol) for a client with .37

the diagnosis of intermittent explosive disorder. Which blood
study should be performed before discharge as a baseline for
?identifying adverse effects of the medication

.a. Fasting blood glucose. c. Electrolyte tests

b. Complete blood count (CBC). d. Cholesterol
.studies

RATIONALE: Because carbamazepine can cause

immunosupression, the nurse should have a CBC
performed before discharge. Carbamazepine doesn't tent
to alter fasting blood sugar. Electrolyte tests aren't
normally performed because this drug doesn't alter
electrolytes unless the client experiences overdose.
Cholesterol studies aren't needed because of this drug
.doesn't affect cholesterol

A group therapy, a client who has used I.V. heroin every day .38
for the past 14 years says, " I don't have a drug problem. I can
quit whenever I want. I've done it before." Which defense
?mechanism is the client using

a. Denial c. Compensation

b. Identification d. Rationalization

RATIONALE: A client who states that he doesn't have a

drug problem and can quit using drugs at any time-
despite evidence to the contrary- is denying drug
.addiction

A voluntary client in a facility decides to leave the unit before .39

treatment is complete. To detain the client, the nurse refuses to
:return the client's personal effects. This action is an example of

.a. false imprisonment. c. slander

.b. limit setting. D. violation of confidentiality

RATIONALE: Confirming a voluntary client against his will

may be considered false imprisonment. Limit setting is a
technique used with clients who are manipulative to limit
manipulative behaviour toward nurses and other clients.
Slander is oral defamation of character. The nurse hasn't
given out any information about the client, so
.confidentiality hasn't been violated

A client with bipolar disorder is taking lithium carbonate .40

( Eskalith) 300 mg t.i.d. His lithium level is 2.7 meq/L. In
assessing the client at his clinic visit, the nurse finds no evidence
of lithium toxicity. The first assessment question the nurse
:should ask before ordering another blood test is
a. whether the client is embarrassed or afraid to report
.medication problems

b. whether the client is experiencing depression and having

.suicidal ideation

c. whether the client understands why he's taking this

.medication

.d. when the client took his last dose of lithium

RATIONALE: Normal lithium level range from 0.6 to 1.2

mEq/L. This client's lithium level is extremely high. The
nurse needs to determine when the client took a dose of
lithium in relation to having his blood drawn because the
test results may have been affected if the client had his
.blood drawn too soon after his last dose

One of the goals for a client with anorexia nervosa is for the .41
client to demonstrate increased individual coping by responding
stress in constructive ways. Which action is the best indicator
?that the client is working toward meeting the goal

.a. The client drinks 4 L of fluid per day

.b. The client paces around the unit most of the day

c. The client keeps a journal and discusses it with the

.nurse

.d. The client talks almost constantly with friends by telephone

RATIONALE: The client is moving toward meeting the goal

because recording and discussing feelings is a
constructive way to manage stress. Although physical
activity can reduce stress, the anorexic client is more
.likely to use pacing to burn calories and lose weight

A client is admitted for alcohol withdrawal. The client's last .42

drink was 2 hours before admission. Which finding indicates to
?the nurse that he is beginning active alcohol withdrawal

a. impending coma c. irritability

b. manipulating behaviour d. perceptual disorders

RATIONALE: Anxiety, irritability, and agitation are

generally the first indications of active alcohol
withdrawal; they can begin within a few hours of
cessation of drinking. Perceptual disorders, especially
frightening visual hallucinations, are very common with
alcohol withdrawal and usually occur on the second day
.of withdrawal

A client reports losing his job, not being able to sleep at night, .43
and feeling upset with his wife. The nurse respond s, "You may
want to talk about your employment situation in group today. "
?The nurse is using which therapeutic technique

a. restating c. exploring

b. making observations d. focusing

RATIONALE: The nurse is using focusing by suggesting

that the client discus a specific issue. She didn't restate
the question ( restating technique) or ask further
questions ( exploring technique), and didn't make an
.observation

A nurse refers a client with severe anxiety to a psychiatric for .44

medication evaluation. The physician is most likely to order
?which psychotropic drug regimen on a short-term basis

a. Alprazolam (Xanax), 0.25 mg orally three times per

.day

.b. Benztropine (Cogentin), 2 mg orally twice per day

.c. Chlorpromazine ( Thorazine), 25 mg orally three times per day

.d. Clozapine ( Clorazil), 200 mg orally twice per day

RATIONALE: Alprazolam's antianxiety properties make it

the most appropriate medication for this client.
Benztropine is an antiparkinsonian agent used to control
the extrapyramidal effects of such antipsychotic agents
as chlorpromazine hydrochloride and thioridazine
hydrochloride. Chlorpromazine is used to control the
severe symptoms seen in clients with psychosis.
Clozapine is used to manage symptoms of schizophrenia
.in client's who don't respond to other antipsychotic drugs

A well-known client suffers a psychotic break and is admitted .45

to the psychiatric unit. A large group of reporters with cameras is
camped out in the hospital parking lot. As a nurse walks to the
employee parking after her shift, a reporter asks if she knows
anything about the client's condition. What is the most
?appropriate response
".a. " I didn't have an opportunity to assess this client

".b. " All I can say is that the client is safe and stable

".c. " Get away from me and don't take any pictures

".d. " I can't answer your questions

RATIONALE: Telling the reporter that she can't respond to

the question is the most appropriate response by the
nurse. All information, including a client's admission to
the hospital, is protected by the client's right to
.confidentiality

?Which is the drug of choice for treating Tourette syndrome .46

(a. Fluoxetine ( Prozac

(b. Fluvoxamine ( Luvox

(c. Haloperidol ( Haldol

(d. Paroxetine ( Paxil

RATIONALE: Haloperidol is the drug of choice for treating

Tourette syndrome. Fluoxetine, Fluvoxamine, and
paroxetine are antidepressants and aren't used to
.Tourette syndrome

A client with delusional thinking who is overweight and tends .47

to eat when stressed shows a lack of interest in eating at meal
times. She states that she is unworthy of eating and that her
children will die if she eats. Which nursing action is most
?appropriate for this client
a. Telling the client that she may become sick and die unless she
.eats

b. Paying special attention to the client's meal-related rituals and

.emotions

c. Restricting the client's access to food except at

.specified meal and snack times

.d. Encouraging the client to express her feelings at meal times

RATIONALE: Restricting access to food, except at

specified times, prevents the client from eating when she
feels anxiety, guilty, or depressed; this, in turn,
decreases her association of these emotions with food.
Telling the client she may become sick or die may
reinforce her behaviour; illness or death may be her goal.
Paying special attention to this client's meal-related
rituals and emotions would reinforce her undesirable
.behaviour

A nurse works in a suicide crisis clinic. The clients she should .48
consider to represent the higher risk for suicide are those who
:state

a. " I gave my clothes away because I'm depressed and think

".about death a lot

b. " I'm thinking of driving my car into a tree on the way

".home

c. " If my life doesn't get better, I might take matters into my

".own hands

".d. " I'm always thinking about dying

RATIONALE: The client at higher risk for suicide is one

who plans a violent death, has a specific plan and has the
means readily available. A client who gives away
possession, thinks about death, or talks about wanting to
die or attempting suicide is considered at a lower risk for
suicide because this behaviour typically serves to alert
others that the client is contempting suicide and wishes
.to be helped

Which nursing intervention is most important when .49

?restraining a violent client

a. Reviewing facility policy regarding how long the client may be

.restrained

b. Preparing an as-needed dose of the client's psychotropic

.medication

c. Checking that the restraints have been applied

.correctly

.d. Asking if the client needs to use the bathroom or if is thirsty

RATIONALE: A nurse must determine whether the

restraints have been applied correctly to make sure that
the adequate padding has been used. The nurse should
document the client's response and status carefully after
.the restraints are applied
A nurse is caring for a client with schizophrenia. Which .50
?outcome requires revising the client's care plan

.a. The client spends more time by himself

.b. The client doesn't engage in delusional thinking

.c. The client doesn't harm himself or others

d. The client demonstrates the ability to meet his own self-care

.needs

RATIONALE: The client with schizophrenia is commonly

socially isolated and withdrawn; therefore, having the
client spend more time by himself wouldn't be a desirable
outcome. Rather, a desirable outcome would specify that
the client spend more time with other clients staff on
.unit

A client is caring for a client with bipolar disorder. The care .51
:plan for a client in a manic state would

a. offering high-calorie meals and strongly encouraging the client

.to finish all his food

b. insisting that the client remain active through remain active

.through the day so that he'll sleep at night

c. allowing the client to exhibit hyperactive, demanding,

.manipulative behaviour without setting limits

d. Listening attentively to the client's requests with a

.neutral attitude, and avoiding power struggles

RATIONALE: The nurse should listen to the client's

requests, express willingness to seriously consider each
request. The nurse should encourage the client to take
short daytime naps because he expends so much energy.
High-calorie finger foods should be offered to supplement
the client's diet if he can't remain seated long enough to
.eat a complete meal

Teaching for women of childbearing years who are receiving .52

? antipsychotic medications include which statement

.a. This medication may result in heightened libido

b. Incidence of dysmenorrhea may increase while taking this

.drug
c. Continue previous contraceptive use even if you're
.experiencing amenorrhea

.d. Amenorrhea is irreversible

RATIONALE: Women may experiencing amenorrhea, which

is reversible, while taking antipsychotics because
amenorrhea doesn't indicate cessation of ovulation the
client who experiences amenorrhea can still become
pregnant. She should be instructed to continue
.contraceptive use even when experiencing amenorrhea

A nurse is assigned to care for a client with dependent .53

personality disorder. Which intervention should the nurse include
?in this client's care plan to promote independence

a. Spending long periods of unscheduled time with the client

b. Scheduling competitive activities so the client can test his

skills

c. Helping the client identify preferences, such as

choosing which clothing to wear

d. Avoiding discussion of the client's feelings of helplessness

RATIONALE: Helping the client identify preferences

promotes development of independent decision-making
skills which the client dependent personality disorder
lacks. To demonstrate that she is available during set
times in a structured relationship, the nurse should spend
scheduled, not unscheduled, time with client and should
.set limits on the amount of time she spends with him

A nurse is in the dining room and overhears a new nurse tell a .54
client with body dysmorphic disorder that she's much too thin
and must eat more before she can go home. The client bursts
into tears and runs out of the dining room. What is the best way
?for the nurse to address this situation

a. Ask the new nurse how much she knows about the client's
.specific diagnosis

b. Inform the new nurse that she handled the situation in an

.inappropriate manner

c. Ask the new nurse why she made that statement to the
.client
d. Ask the new nurse to refrain from speaking with this client in
.the future

RATIONALE: Because the client is safe, this situation is an

opportunity for the more experienced nurse to guide the
new nurse and act as a mentor. Asking about the new
nurse's rationale for her statement creates an
opportunity for her to expand her critical thinking skills
and improve her ability to relate to clients with unique
.needs

A client with major depression is taking tranylcypromine .55

sulphate ( Parnate), a monoamine oxidase ( MAO) inhibitor. The
nurse understands that additional teaching is needed when the
?client expresses he ate which food

a. Free-range poultry c. Aged cheese

b. Whole grain bread d. Fresh fish

RATIONALE: When taking an MAO inhibitor, the child

should avoid consuming high-tyramine foods, such as
aged cheese, because the interaction may cause life-
threatening hypertensive crisis. Therefore, a client who
reports eating aged cheese requires additional teaching.
The client may safely consume low-tyramine foods, such
.as poultry, whole grain bread, and fresh fish

Before the nurse administers the first dose of lithium .56

carbonate (Lithonate) to a client, she reviews information about
the drug. Which statement accurately describes the metabolism
?and excretion of lithium

.a. It's metabolize in the liver and excreted in the feces

.b. It's metabolized and excreted by the kidneys

c. It isn't metabolized and is excreted unchanged by the

.kidneys

.d. It's metabolized in the liver and excreted by the kidneys

RATIONALE: Lithium isn't metabolized and is excreted

.unchanged by the kidneys

Which effects do most antipsychotics medications exert on .57

?(the central nervous system (CNS
a. They stimulate the CNS by blocking postsynaptic dopamine,
.norepinephrine, and serotonin receptors

b. They sedate the CNS by stimulating serotonin at the synaptic

.cleft

c. They depress the CNS by blocking the postsynaptic

.transmission of dopamine, serotonin, and norepinephrine

d. They depress the CNS by stimulating the release of

.acetylcholine

RATIONALE: The exact mechanism of antipsychotic

medication action is unknown, but these drugs appear to
depress the CNS by blocking the transmission of three
neurotransmitters: dopamine, serotonin, norepinephrine.
Antipsychotics don't sedate the CNS by stimulating
serotonin, and they stimulate neurotransmitter action or
.acetylcholine release

A client with tentative diagnosis of psychosis is admitted to .58

the psychiatric unit. A physician orders the phenothiazine
thioridazine 50 mg by mouth three times per day. Phenothiazines
differ from central nervous system ( CNS) depressants in their
:sedative effects by producing

.a. deeper sleep than CNS depressants

.b. greater sedation than CNS depressants

.c. a calming effect from which the client is easily aroused

d. more prolonged sedative effects, making the client more

.difficult to arouse

RATIONALE: Shortly after phenothiazine administration, a

quieting and calming effect occurs, but the client is
aroused, alert and responsive and has a good motor
.coordination

A nursing supervisor notices that a previously effective nurse .59

has been preoccupied and distant for several days and is having
difficulty focusing on her clients' needs. What should the
?supervisor say to the nurse

a. " I think you need to spend more time worrying about your
"clients
b. " I've noticed you seem to be preoccupied. Would you
"?like to talk

"?c. " Do you feel your current assignment is too demanding

d. " What is going on with you? You've always done so well

".before

RATIONALE: Observing that the nurse seems asking if

she'd like to talk is a supportive and encouraging
approach that allows the nurse to identify and address
the problem in a collaborative manner. Suggesting that
the nurse should spend more time worrying about her
client's in accusatory, parental, and states a problem of
.which the nurse may already be aware

A client is admitted for an overdose of amphetamines. When .60

:assessing this client, the nurse should expect to see

a. tension and irritability

b. slow pulse

c. hypotension

d. constipation

RATIONALE: Amphetamines are nervous system stimulant

that are subject to abuse because of their ability to
produce wakefulness and euphoria. An overdose
increases tension and irritability. Amphetamines
stimulate norepinephrine , which increases the heart rate
and blood flow. Diarrhea, not constipation is a common
.adverse effect

A client found sitting on the floor of the bathroom in the day .61
treatment clinic has moderate lacerations on both wrist.
Surrounded by broken glass, she sits staring blankly at the
laceration.What is the most important action for the nurse to
?take next to the client

a. Enter the room quietly and move next to the client to assess
.her injuries

b. Call for staff back-up before entering the room and restraining
.the client

.c. Sit quietly next to her

d. Approach the client slowly speaking in a calm voice,
calling by her name, and telling her that the nurse is
.there to help her

RATIONALE: Ensuring the safety of the client and the

nurse is the priority at this time. Therefore, the nurse
should approach the client cautiously while calling her
name and talking to her calm, confident manner. The
nurse should keep in mind that the client shouldn't be
startled or overwhelmed. After explaining she is there to
help, the nurse should carefully observe the client's
.response

A client is diagnosed with anxiety disorder is ordered .62

buspirone (BuSpar). Teaching instructions for buspirone should
:include

a. a warning that immediate sedation can occur with a resultant

.drop in pulse

b. a reminder of the need to schedule blood work 1 week after

.initiating therapy to check blood levels of the drug

c. a warning about medication-related incidence of

.neuroleptic malignant syndrome

d. a warning about the drug's delayed therapeutic effect,

.which occurs in 14 to 30 days

RATIONALE: The client should be informed that the

drug's therapeutic effect might not be achieved for 14 to
30 days. The client must be instructed to continue taking
the drug as directed. Tachycardia, not bradycardia, is
reported effect of buspirone. Blood level check aren't
necessary. Neuroleptic malignant syndrome hasn't been
.reported with this drug

A client on the behavioural health unit tells a nurse that she .63
experiences palpitations, trembling, and nausea while travelling
alone, outside her home. These symptoms have severely limited
the client's ability to function and have caused her to avoid
leaving home whenever possible. The nurse recognizes that this
?client has symptoms of what disorder

a. Thanatophobia c. Hodophobia

b. Aerophobia d. Agoraphobia
RATIONALE: Agoraphobia is a phobia, or fear, and
avoidance of open spaces accompanied by the concern
that escape to safety would be difficult or embarrassing.
Agoraphobia is commonly accompanied by physical
symptoms, such as palpitations, trembling, nausea and
shortness of breath. It's also commonly accompanied or
preceded by panic attacks. Thanatophobia is the fear of
death; aerophobia, the fear of air; and hodophobia, the
.fear of travelling

A client with agoraphobia has been symptom-free for 4 .64

:months. Classic signs and symptoms of phobias include

.a. insomnia and an inability to concentrate

.b. severe anxiety and fear

.c. depression and weight loss

.d. withdrawal and failure to distinguish reality from fantasy

RATIONALE: Phobias cause severe anxiety ( such as panic

attack) that is out of proportion the threat that the
feared object or situation represents. Physical signs and
symptoms of phobias include profuse sweating, poor
motor control, tachycardia, and elevated blood pressure.
Insomnia, an inability to concentrate, and weight loss are
.common in depression

A client with Alzheimer's disease has a nursing diagnosis of .65

Risk for injury relate to memory loss, wandering, and
disorientation. To prevent injury, which nursing intervention
?should appear in this client's care plan

.a. Provide the client with detailed instructions

.b. Keep the client sedated whenever possible

c. Remove potential hazards from the client's

.environment

.d. Use restraints at all times

RATIONALE: By removing potential environmental

hazards, such as bottles of hydrogen peroxide and
benzoin, the nurse can help prevent injury to the client.
For client with Alzheimer's disease, the nurse should
provide single, simple instructions rather than many
.detailed instructions
A client is admitted to the inpatient adolescent unit after .66
being arrested for attempting to sell cocaine to an undercover
police officer. A behaviour contract is planned. To promote client
compliance the nurse should anticipate that the contract will be
:written

.a. by the nurse alone

.b. by the client alone

.c. jointly by the client and the nurse

.d. jointly by the physician and the nurse

RATIONALE: A contract written jointly by the client and

the nurse most successfully promotes cooperation and
consistent behaviour. The most effective contract- and
the type least likely to allow for manipulation and
misinterpretation- describes the behavioural terms as
.concretely as possible

A client is admitted to the emergency department with the .67

chest pain, palpitations, vertigo and diaphoresis. When initial
assessment indicates no physiological basis for three complaints,
the client is referred to a psychiatric clinical nurse-specialist.
After determining that the client has experienced four similar
episodes in the past month, the nurse specialist suspects that
:the client has

a. panic depression c. schizophrenia

b. depression d. obsessive-compulsive disorder

RATIONALE: This client has classic signs and symptoms of

panic disorder, which results from acute anxiety. Panic
disorder also may cause dyspnea, choking, feelings of
unreality, hot and cold flashes, and shaking or trembling.
Panic disorder is confirmed by a history of three or more
panic attacks within 3 weeks that are unrelated to
.extreme physical exertion or life-threatening situations

A nurse in a psychiatric inpatient unit is caring for a client with .68

generalized anxiety disorder. As part of the client's treatment,
the psychiatrists orders lorazepam ( Ativan ), 1 mg by mouth
three times per day. During lorazepam therapy, the nurse should
:remind the client to

.a. avoid caffeine. c. stay out of the sun

.b. avoid aged cheese. d. maintain an adequate salt intake

RATIONALE: Ingesting 500 mg or more of caffeine can

significantly alter the anxiolytic effects of lorazepam.
Other dietary restrictions are unnecessary. Staying out of
the sun sunscreens is required when taking
phenothiazine. An adequate salt intake is necessary for
.clients receiving lithium

A client who takes neuroleptic medication for treatment of .69

chronic schizophrenia is admitted to the psychiatric unit. Nursing
assessment reveals rigidity, fever, hypertension, and
diaphoresis. Which life-threatening reaction do these findings
?suggest

a. Tardive dyskinesia c. Neuroleptic malignant

syndrome

b. Dystonia d. Akathisia

RATIONALE: The client's sign and symptoms suggest

neuroleptic syndrome, a life-threatening reaction to
neuroleptic medication that requires immediate
treatment. Tardive dyskinesia causes involuntary
movements of the tongue, mouth and muscles of the
face, arms, and legs. Dystonia is characterized by cramps
and rigidity of the tongue, face, neck, and back muscles.
.Akathisia causes restlessness, anxiety, and jitteriness

A nurse is working on a unit with individuals who have eating .70

disorders. She is interviewing a new female client. The client has
lost a significant amount of weight over the past months and
complains of being " sick to my stomach" when around food. The
client reports that she hasn't menstruated in 3 months. What is
?the priority nursing intervention

.a. Giving the client her newly ordered antidepressant medication

.b. Requesting an order for a pregnancy test

.c. Involving the client in group activities

.d. Requesting an as-needed medication for gastric distress

RATIONALE: Although amenorrhea and gastric distress

are common with anorexia nervosa, ruling out pregnancy
is a priority. Treatment for this client will likely involve
medication, and many psychopharmacologic agents have
.the potential to harm a developing fetus
:Silence in therapeutic communication is .71

.a. a means of disapproval

.b. to be avoided because it indicates intolerance and anger

c. a means of communicating patience and allowing the

.client space in which to respond

.d. not therapeutic

RATIONALE: Silence- one of the most difficult therapeutic

techniques-conveys acceptance and gives the client an
opportunity to reflect. It doesn't convey disapproval,
intolerance or anger unless accompanied by hostile
.gestures

:Propanolol ( Inderal) is used in the mental health setting to .72

.a. treat antipsychotic-induced akathisia and anxiety

.b. stabilize mood in the manic phase of bipolar illness

.c. alleviate delusions for clients suffering from schizophrenia

d. reduce ritualistic behaviour in clients with obsessive-

. (compulsive disorder (OCD

RATIONALE: Propanolol, a potent beta- adrenergic

blocker, produces a sedating effect; therefore, it's used
to treat antipsychotic-induced akathisia and anxiety.
Lithium (Lithobid) is used to stabilize clients with bipolar
disorder. Antipsychotic are used to treat delusions. Some
.antidepressants have been effective in treating OCD
A depressed client in the psychiatric unit hasn't been getting .73
adequate rest and sleep. To encourage restful sleep at night, the
:nurse should

a. Talk with the client for a long time at night to reduce his
.anxiety

.b. Encourage environmental stimulation during the evening

c. Gently but firmly set limits on how much time the client
.spends in bed during the day

d. Encourage the client to take an antianxiety agent as needed

.at bedtime
RATIONALE: Setting limits on how much time the client
may spend in bed and what time the client must get up in
the morning lets him know what is expected of him while
conveying genuine concern for him. Talking the client for
a long time at night would interfere sleep and give the
client attention for not sleeping. Encouraging
environmental stimulation in the evening would
discourage rest and sleep at night. While most
antianxiety agents have sedative adverse effects, they
.aren't intended for use as sleep inducing agents

A client is diagnosed with antisocial personality disorder asks .74

the nurse if he can have an additional smoke break because he's
?anxious. Which response by the nurse is best

".a. " I have a few minutes. I'll take you

".b. " I'm sorry but I can't take you. I'm busy

c. " Smoking is harmful to your health. I don't want contribute to

".your bad habits

d. " Clients are permitted to smoke at designed times.

".You have to follow rules

RATIONALE: Consistency is essential when dealing

with antisocial clients. They disregard social norms
and don't believe the rules apply on them. Agreeing
to give the client a smoke break would be
detrimental to the client because it reinforces the
client's acting-out behaviours. He nurse assaying
she is too busy avoids the client's attempt to
manipulate. Telling the client that she won't allow
the extra smoke break because smoking is harmful
is inappropriate because the nurse is lecturing the
.client

Which nursing intervention is most helpful for a client .75

?experiencing a panic attack

a. Encouraging the client identify what precipitated the

.attack

b. Promoting the client's interaction with others to reduce

.anxiety through diversion

c. Staying with the client and remaining calm,

.confident, and reassuring
d. Reassuring intolerable stimuli by encouraging the client
.to stay in the room alone until his anxiety abates

RATIONALE: A panic-stricken client requires the

assistance of a calm person who can provide
support and direction. This approach particularly
important because the client already feels
frightened and out of control. Having someone
remain with the client helps prevent him from
feeling isolated and deserted. Encouraging the
client to identify what precipitated the attack is
futile because the client's level of anxiety prevents
.him from focusing on precipitating factors

The client reports severe pain in the back and joints. .76
Upon reviewing the client's history, the nurse notes a
diagnosis of depression and frequent hospitalization for
somatic illness. What should the nurse encourage the
:client to do

a. Tell the physician about the pain so that it's cause

.can be determined

b. Remember all his previous " health problems" that

.weren't real

.c. Try to get more rest and use relaxation technique

.d. Ignore the pain and focus on happy things

RATIONALE: Initially, a nurse should treat all symptoms as

indicators of possible pathology because a history of
psychophysiologic illness doesn't rule out a purely physical
.illness as a cause of a client's current symptoms
A nurse is preparing a delusional client for a computed .77
tomography scan of the brain to rule out an organic etiology. As the
nurse accompanies the client to the radiology department, he looks
around anxiously and states, " The FBI is coming to kill me." What is
?the nurse's best response
".a. " The FBI isn't here

".b. " You're illness is causing you to hear voices

".c. " It sounds like you're frightened

".d. " No one can hurt you here

RATIONALE: Even though the client's thinking processes are

distorted and irrational, his feelings are very real. The
 nurse should intervene by emphasizing with his emotions.
Assuring the client that the FBI isn't present, telling the
client that his illness is causing him to hear voices, telling
him that o one can hurt him appeal to the logical reasoning
.his illness has impaired
A nurse is working with a group of parents whose .78
children have died from cystic fibrosis. The group is talking
about " acceptance ". Two parents discuss their
unwillingness to accept their son's death. The nurse
:should

.a. these parents are still in denial about their child's death

b. these parents need to get more support from others in

.the group

c. some individuals get " stuck " in particular stages of grief

.and need help in moving forward

d. some individuals find the idea of " accepting" the

.death of a loves one unachievable

RATIONALE: Although acceptance is considered to be the

final stage of grief, some deaths, including out-of-life cycle
deaths, may never be accepted. To insist that a parent
should work toward this goal wouldn't likely be helpful.
Rather it would be beneficial for the nurse to explore the
.parent's relationship with their deceased child
A nurse is caring for a client whose on close observation .79
for suicide. When accompanying this client to he bathroom,
:the nurse should

.a. give him privacy in the bathroom

.b. allow him to shave

.c. open the window and allow him to get some fresh air

.d. observe him

RATIONALE: The nurse has the responsibility to

continuously observe the acutely suicidal client. The need
for observation precludes the patient's right to privacy. The
nurse should watch for clues, such as communicating
suicidal thoughts, threats, and messages; hoarding
.medications; and talking about death
Important teaching for a client receiving risperidone .80
:(Risperdal) should include advising the client to
a. maintain a therapeutic level by doubling a dose if he
.misses a dose

b. be sure to take drug with a meal because it can severely

.irritate the stomach

.c. discontinue the drug if he gains weight

d. notify the physician if he notices an increase in

.bruising

RATIONALE: Bruising may indicate blood dyscracias, so

notifying the physician about increased bruising is very
important. The client shouldn't double the drug dose. This
drug doesn't irritate the stomach, and weight gain isn't
.adverse effect of risperidone therapy
Parents tell a nurse that they haven't met their goal of .81
home management of their son with schizoaffective
disorder. They report that the client poses a threat to their
safety. Based on this information, what recommendation
?should the nurse make

a. Evaluate the client for voluntary admission to a

.mental health facility

b. Discuss what the family can do to chemically restrain

.the client at home

c. Tell the parents that the client's behaviour

.releases them for the duty of care

d. Arrange for respite care; family members could be

.aggravating the client's condition

RATIONALE: A voluntary admission is preferred approach

because it involves having the client recognize existing
problems and facilitates the client treatment. Chemical
restrains would violate the client's rights to freedom from
.the use of restrains and seclusion
What medication would probably be ordered for the acutely .82
?aggressive client with schizophrenia
a. Chlorpromazine ( Thorazine ) c. Lithium carbonate
(( Lithonate
b. Haloperidol ( Haldol ) d. Amitriptyline
(( Elavil
RATIONALE: Haloperidol is administered I.M. or I.V. is the
durg of choice for acute aggressive psychotic behaviour.
Chlorpromazine is also a antipsychotic drug; however, it
causes more pronounced sedation that haloperidol. Lithium
carbonate is useful in bipolar disorder; and amitriptyline is
.used for depression
A nurse assessing a client who is a pilot for an commuter airline. .83
This client tells the nurse that he uses illegal drugs for recreational
purposes every weekend. Using the ethical principle of
nonmaleficence to guide her interaction with the client, what should
?the nurse say
a. " Using drugs to relax and unwind jeopardizes your health and
".your ability to make decisions
b. " You're lucky that you haven't been randomly drug tested and
".found have positive urine
c. " I want you to think about how an error in judgement
".could cause a serious accident
d. : There's a problem with you choosing to use drugs as a way to
".cope with the stressors you experienced
RATIONALE: Because her statement refers to those who
could be harmed as a result of pilot's drug use, the nurse's
suggestion that the client consider how an error judgment
could result in a serious accident reflects the principle of
.( nonmaleficence ( the obligation to do to no harm
:Schizophrenia is caused by .84
.a. genetic factors leading to a faulty dopamine receptor
.b. environmental factors and poor parenting
.c. structural and neurobiological factors
d. a combination of biologic, psychologic, and
environmental factors
RATIONALE: A combination of biologic, psychologic, and
environmental factors is thought to cause schizophrenia.
Studies of twins and adopted siblings have strongly
implicated a genetic predisposition for schizophrenia;
.however, a reliable genetic marker hasn't be determined
Which concept is most important for a nurse to communicate to .85
a client to signed an informed consent for electroconvulsive therapy
?( ( ECT
.a. " You'll be offered a strong sedative before the procedure
".b. " This therapy will provide excellent symptom relief
c. " You may experience a complete loss of memory after the
".treatment
d. " You may experience a time of confusion after the
".treatment
RATIONALE: the nurse should explain to the client that he
may experience a time of confusion following ECT as a
result of electricity passing through the cerebral cortex and
disrupting impulses. Although it's true that the client will be
offered a sedative, communicating this information isn't an
.essential component of informed consent
Emergency restraints or seclusion may be implemented without .86
?a physician's order under which condition
a. When licensed practitioner will do face-to-face
.assessment within 1 hour
.b. Never
.c. If a voluntary client wants to leave against medical advice
.d. When a child is acting out
RATIONALE: In a emergency, a client who is a threat to
himself or others may be restrained without an order. If
restraints are initiated without an order the client assess
within 1 hour of application by a licensed, independent
.practitioner
A nurse is caring for a client with antisocial personality disorder. .87
Which statement is most appropriate for the nurse to make when
?explaining unit rules and expectations to this client
a. "The other members of the health care team and I would like you
".to attend a group therapy each day
b. " You'll find you condition will improve much more quickly if you
".attend group therapy each day
".c. "You'll be expected to attend a group therapy each day
".d. "Please try to attend group therapy each day
RATIONALE: Rules and explanations must be brief and clear
and leave little room for misinterpretation. A client with
antisocial personality disorder tends to disregard rules and
authority and to be socially irresponsible. The words " You'll
be expected to attend group therapy each day" are concise
and concrete and convey precisely what the client is
.expected to
A nurse is working with a client who abuses alcohol. Which fact .88
?should the nurse communicate to the client
.a. Abstinence is the basis for successful treatment
b. Daily attendance at Alcoholics Anonymous ( AA) meeting will
.cure alcoholism
c. For treatment to be successful, family members must
.participate
.d. An alcoholic may enjoy an occasional social drink
RATIONALE: Attendance at AA helps some individuals
maintain strict abstinence from alcohol, which is the
foundation of any treatment for alcoholism. Participation in
treatment by the family is beneficial to both the client and
.the family but isn't essential
A client in the second stage of Alzheimer's disease appears to .89
be in pain. Which question by the nurse would best elicit
?information about the pain
"?a. "Where do you hurt
"?b. "Can you describe the pain
"?c. "Where is your pain located
"?d. "Do you hurt?" ( pause) " Do you hurt
RATIONALE: When speaking to a client with
Alzheimer's disease, the nurse should use close- ended
questions ( those that the client can answer with "yes" or
"no") whenever possible, avoid questions that requires the
client to make choices. Also repeating question aids
.comprehension
A client comes to the emergency department after being attack .90
and sexually assaulted. What is the most accurate nursing
?diagnosis for this client
a. Rape- trauma syndrome c. Anxiety
b. Fear d. Hopelessness
RATIONALE: The nursing diagnosis Rape- trauma syndrome
refers to acute and long- term phases experienced by the
victim of sexual assault. Specific nursing interventions can
be planned on the basis of this diagnosis. A rape victim may
also experienced fear, anxiety, and hopelessness; however,
these aren't the most accurate nursing diagnosis for this
.client
When discharging a client after treatment for a dystonic .91
reaction, an emergency department nurse must ensure that the
:client understands
.a. results of treatment are rapid and dramatic but may not last
.b. although uncomfortable, this reaction isn't serious
.c. the client shouldn't buy drugs on the street
d. the client must take benztropine ( Cogentin) as ordered
.to prevent return of symptoms
RATIONALE: An oral anticholinergic agent such as
benztropine is commonly ordered to control and
prevent the return of symptoms. Dystonic reactions are
typically acute and reversiblr. Dystonic reactions can be
.life-threatening when airway patency is compromised
Which nursing intervention is most appropriate if a client .92
develops orthostatic hypontension while taking amitrptyline
?(( Elavil
a. Consulting 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 halve the dosage until the problem
.resolves
d. Informing the client that this adverse reaction disappear within 1
.week
RATIONALE: To minimize the effects of amitriptyline-
induced hypotension, the nurse should advise the client to
sit up 1 minute before getting out of bed. Orthostatic
hypotension commonly occurs with tricyclic depressant
therapy. In this cases, the physician may decrease the
dosage or order notriptyline, another tricyclic
.antidepressant
A client who is victim of domestic violence tells the nurse she is .93
contemplating leaving the relationship. Which assessment should
?be the priority for the nurse
.a. Reasons for remaining in the abusive relationship
b. Readiness to leave the perpetrator and knowledge of
.helpful resources
.c. Use of drugs or alcohol to cope with victimization
.d. History of previous victimization
RATIONALE: Victims of domestic violence must be assessed
for their readiness to leave the perpetrator and their
knowledge of the resources available to them. Nurses may
then provide the victims with information and options to
.enable them to leave when they're ready
A nurse is working on the psychiatric unit is preparing to .94
administer a medication to an elderly client. Which statement
?describes how elderly clients react to medications
.a. They're at increased risk for adverse effects
.b. They tolerate medication better because they're less active
.c. They metabolize medications quickly
d. They need higher doses to elicit comparable medication
.response
RATIONALE: As individuals age, their liver metabolize drugs
slowly. Cumulative effects can occur and increased the risk
of adverse effects. Elderly clients typically need lower doses
than younger clients, not higher. Level of activity typically
,doesn't affect a person's reaction to medication
A nurse is administering total parenteral nutrition ( TPN ) to a .95
client hospitalized with severe anorexia nervosa. Which laboratory
?finding would alert the nurse to a potential problem
a. Elevated glucose levels. c. Elevated phosphate
.level
b. Decreased magnesium level d. Decreased CD4
.cell counts
RATIONALE: A decreased magnesium level indicates
continued malnutrition problems; the prescribing physician
or an advanced practice nurse would have to adjust the
chemical composition of TPN. The elevated glucose levels
are expected in a client receiving TPN because of the high
.concentration of glucose being administered
A nurse is teaching a new staff members about groups .96
considered at highest risk for suicide. Which group should the nurse
?emphasize
a. Adolescents, men older than age 45, and persons who
.made previous suicide attempts
.b. Teachers, divorced persons, substance abusers
.c. Alcohol abusers, widows, and young married men
.d. Depressed persons, physician, and persons living in rural area
RATIONALE: Studies of those who commit suicide reveal the
following higher risk groups: Adolescents, men older than
age 45, and persons who made previous suicide attempts;
divorced, widowed, and separated persons; professionals,
such as physicians, dentist and attorneys; students;
.unemployed persons; persons who are depressed
A physician orders naltexone ( ReVia) for a client participating in .97
an outpatient drug and alcohol rehabilitation program. Which action
reflects the nurse's knowledge about this medication and the
?client's informed consent
.a. Writing down medication information for the client
b. Telling this client about the problems other the clients have had
.with the drug
.c. Talking about how this drug prevents aggressive behaviour
.d. Discussing the health risk related to this medication
RATIONALE: A nurse is mindful of the principal of informed
consent when she discussed medication- related health risk
with the client. The client has the right to adequate
information about the drug as it relates to the treatment of
.his condition
Which nursing statement is most effective when the nurse is .98
?trying to defuse a client's impending violent behaviour
a. " Let's talk about what happened to make you this
".angry
".b. " This is a good time for you to play cards with me
".c. Do you feel you need to be alone in your room
".d. " The crisis team and I will escort you to the seclusion room
RATIONALE: In many instances, the nurse can defuse
impending violence by helping the client identify an express
his feelings of anger and anxiety. This approach may help
the client verbalized his feelings rather than act on them.
Close interaction activity may place the nurse at risk for
.injury should the client suddenly become violent
After learning that a roommate is HIV-positive, a client asks a .99
nurse about moving to another room on the psychiatric unit
because he has no longer feels " safe ". What should the nurse do
?first
.a. Move the client to another room
.b. Ask the client to describe his fears
.c. Move the client's roommate to a private room
d. Explain that such a move wouldn't be therapeutic for the client
.or for his roommate
RATIONALE: To intervene effectively, the nurse must first
understand his fears. After exploring his fears, the nurse
may move the client or roommate or explain why such
.,move wouldn't be therapeutic, as needed
A nurse is evaluating a client's electrocardiogram ( ECG ). .100
?Which ECG change can result from amitriptyline ( Elavil) therapy
a. Presence of U waves c. Widening QT interval
b. Depressed ST segment d. Prolonged PR interval
RATIONALE: Amitriptyline therapy can cause a conduction
delay, demonstrated by a widening QT interval on the ECG.
U waves, a depressed segment, and a prolonged PR interval
.aren't typically by amitriptyline therapy
:Set 2
1. C. Total abstinence is the only effective treatment for alcoholism.
2. A. Hallucinations are visual, auditory, gustatory, tactile or olfactory perceptions
that have no basis in reality.
3. D. The Nurse has a responsibility to observe continuously the acutely
suicidal client. The Nurse should watch for clues, such as communicating suicidal
thoughts, and messages; hoarding medications and talking about death.
4. B. Establishing a consistent eating plan and monitoring client’s weight are
important to this disorder.
5. C. Appropriate nursing interventions for an anxiety attack include using short
sentences, staying with the client, decreasing stimuli, remaining calm and medicating
as needed.
6. B. Delusion of grandeur is a false belief that one is highly famous and important.
7. D. Individual with dependent personality disorder typically shows indecisiveness
submissiveness and clinging behavior so that others will make decisions with them.
8. A. Clients with schizotypal personality disorder experience excessive social
anxiety that can lead to paranoid thoughts.
9. B. Bulimia disorder generally is a maladaptive coping response to stress and
underlying issues. The client should identify anxiety causing situation that stimulate
the bulimic behavior and then learn new ways of coping with the anxiety.
10. A. An adult age 31 to 45 generates new level of awareness.
11. A. Neuromuscular Blocker, such as SUCCINYLCHOLINE (Anectine) produces
respiratory depression because it inhibits contractions of respiratory muscles.
12. C. With depression, there is little or no emotional involvement therefore little
alteration in affect.
13. D. These clients often hide food or force vomiting; therefore they must be
carefully monitored.
14. A. These clients have severely depleted levels of sodium and potassium
because of their starvation diet and energy expenditure, these electrolytes are
necessary for cardiac functioning.
15. B. Limiting unnecessary interaction will decrease stimulation and agitation.
16. C. Ritualistic behavior seen in this disorder is aimed at controlling guilt and
inadequacy by maintaining an absolute set pattern of behavior.
17. D. The nurse needs to set limits in the client’s manipulative behavior to help the
client control dysfunctional behavior. A consistent approach by the staff is necessary
to decrease manipulation.
18. B. Any suicidal statement must be assessed by the nurse. The nurse should
discuss the client’s statement with her to determine its meaning in terms of suicide.
19. A. When the staff member ask the client if he wonders why others find him
repulsive, the client is likely to feel defensive because the question is belittling. The
natural tendency is to counterattack the threat to self image.
20. B. The nurse would specifically use supportive confrontation with the client to
point out discrepancies between what the client states and what actually exists to
increase responsibility for self.
21. C. The nurse would most likely administer benzodiazepine, such as lorazepan
(ativan) to the client who is experiencing symptom: The client’s experiences
symptoms of withdrawal because of the rebound phenomenon when the sedation of
the CNS from alcohol begins to decrease.
22. D. Regular coffee contains caffeine which acts as psychomotor stimulants and
leads to feelings of anxiety and agitation. Serving coffee top the client may add to
tremors or wakefulness.
23. D. Vomiting and diarrhea are usually the late signs of heroin withdrawal, along
with muscle spasm, fever, nausea, repetitive, abdominal cramps and backache.
24. D. Moving to a client’s personal space increases the feeling of threat, which
increases anxiety.
25. A. Environmental (MILIEU) therapy aims at having everything in the client’s
surrounding area toward helping the client.
26. C. Children who have experienced attachment difficulties with primary caregiver
are not able to trust others and therefore relate superficially
27. A. Children have difficulty verbally expressing their feelings, acting out behavior,
such as temper tantrums, may indicate underlying depression.
28. D. The autistic child repeat sounds or words spoken by others.
29. D. The client statement is an example of the use of denial, a defense that blocks
problem by unconscious refusing to admit they exist.
30. A. Discussion of the feared object triggers an emotional response to the object.
31. B. The nurse presence may provide the client with support & feeling of control.
32. D. Experiencing the actual trauma in dreams or flashback is the major symptom
that distinguishes post traumatic stress disorder from other anxiety disorder.
33. C. Confabulation or the filling in of memory gaps with imaginary facts is a
defense mechanism used by people experiencing memory deficits.
34. A. These are the major signs of anorexia nervosa. Weight loss is excessive (15%
of expected weight).
35. C. Dental enamel erosion occurs from repeated self-induced vomiting.
36. B. Depression usually is both emotional & physical. A simple daily routine is the
best, least stressful and least anxiety producing.
37. D. The expression of these feeling may indicate that this client is unable to
continue the struggle of life.
38. A. Structure tends to decrease agitation and anxiety and to increase the client’s
feeling of security.
39. B. The rituals used by a client with 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 nurse facilitates communication with the client by sitting
in silence, asking open-ended question and pausing to provide opportunities for the
client to respond.
45. D. When hallucination is present, the nurse should reinforce reality with the
client.
46. A. Personal characteristics of abuser include low self-esteem, immaturity,
dependence, insecurity and jealousy.
47. D. A short acting skeletal muscle relaxant such as succinylcholine (Anectine) is
administered during this procedure to prevent injuries during seizure.
48. C. Recognizing situations that produce anxiety allows the client to prepare to
cope with anxiety or avoid specific stimulus.
49. D. Electroconvulsive therapy is an effective treatment for depression that has not
responded to medication.
50. B. In an emergency, lives saving facts are obtained first. The name and the
amount of medication ingested are of outmost important in treating this potentially life
threatening situation.
II.
1. C. When the nurse and client agree to work together, a contract should be
established, the length of the relationship should be discussed in terms of its
ultimate termination.
2. B. The nurse should initiate brief, frequent contacts throughout the day to let the
client know that he is important to the nurse. This will positively affect the client’s
self-esteem.
3. D. The client with depression is preoccupied, has decreased energy, and is
unable to make decisions. The nurse presents the situation, “It’s time for a
shower”, and assists the client with personal hygiene to preserve his dignity and
self-esteem.
4. C. Foods high in tyramine, those that are fermented, pickled, aged, or smoked
must be avoided because when they are ingested in combination with MAOIs a
hypertensive crisis will occur.
5. A. Anticholinergic effects, which result from blockage of the parasympathetic
(craniosacral) nervous system including urine retention, blurred vision, dry mouth
& constipation.
6. B. Dysthymia is a less severe, chronic depression diagnosed when a client has
had a depressed mood for more days than not over a period of at least 2 years.
Client with dysthymic disorder benefit from psychotherapeutic approaches that
assist the client in reversing the negative self image, negative feelings about the
future.
7. D. Flight of ideas is speech pattern of rapid transition from topic to topic, often
without finishing one idea. It is common in mania.
8. B. The client with mania is very active & needs to have this energy channeled in
a constructive task such as cleaning or tidying the room.
9. C. A crucial factor is determining the lethality of a method is the amount of time
that occurs between initiating the method & the delivery of the lethal impact of the
method.
10. D. The statement “I don’t think about killing myself as much as I used to.”
Indicates a lessening of suicidal ideation and improvement in the client’s
condition.
11. A. Using exercise bicycle is appropriate for the client who becomes very
anxious when thoughts of suicidal occur.
12. C. The drug of choice for a client experiencing extra pyramidal side
effects from haloperidol (Haldol) is benztropine mesylate (cogentin) because of
its anti cholinergic properties.
13. D. Allowing the client to be the first to open the cart & take a tray presents
the client with the reality that the nurses are not touching the food & tray, thereby
dispelling the delusion.
14. B. Although all the actions indicate improvement, the ability to initiate
simple activities without directions indicates the most improvement in the
catatonic behaviors.
15. A. Psychoeducational groups for families develop a support network.
They provide education about the biochemical etiology of psychiatric disease to
reduce, not increase family guilt.
16. C. Attending activity with the nurse assists the client to become involved
with others slowly. The client with schizotypal personality disorder needs support,
kindness & gentle suggestion to improve social skills & interpersonal relationship.
17. C. An individual with personality disorder usually is not hospitalized
unless a coexisting Axis I psychiatric disorder is present. Generally, these
individuals make marginal adjustments and remain in society, although they
typically experience relationship and occupational problems related to their
inflexible behaviors. Personality disorders are chronic lifelong patterns of
behavior; acute episodes do not occur. Psychotic behavior is usually not
common, although it can occur in either schizotypal personality disorder or
borderline personality disorder. Because these disorders are enduring and
evasive and the individual is inflexible, prognosis for recovery is unfavorable.
Generally, the individual does not seek treatment because he does not perceive
problems with his own behavior. Distress can occur based on other people’s
reaction to the individual’s behavior.
18. D. The nurse would explain the negative reactions of others towards the
client’s behaviors to make the clients aware of the impact of his seductive
behaviors on others.
19. B. The nurse would use role-playing to teach the client appropriate
responses to others and in various situations. This client dramatizes events,
drawn attention to self, and is unaware of and does not deal with feelings. The
nurse works to help the client clarify true feelings & learn to express them
appropriately.
20. C. Antiseptic mouthwash often contains alcohol & should be kept in
locked area, unless labeling clearly indicates that the product does not contain
alcohol.
21. D. Monitoring of vital signs provides the best information about the client’s
overall physiologic status during alcohol withdrawal & the physiologic response to
the medication used.
22. A. After administering naloxone (Narcan) the nurse should monitor the
client’s respiratory status carefully, because the drug is short acting & respiratory
depression may recur after its effects wear off.
23. B. The best measure to determine a client’s progress in rehabilitation is
the number of drug- free days he has. The longer the client is free of drugs, the
better the prognosis is.
24. D. Barbiturates are CNS depressants; the nurse would be especially alert
for the possibility of respiratory failure. Respiratory failure is the most likely cause
of death from barbiturate over dose.
25. B. The feeling of bugs crawling under the skin is termed as formication,
and is associated with cocaine use.
26. D. The nurse would prepare to administer an antipsychotic medication
such as Haldol to a client experiencing amphetamine psychosis to decrease
agitation & psychotic symptoms, including delusions,hallucinations & cognitive
impairment.
27. C. An acid environment aids in the excretion of PCP. The nurse will
definitely give the client with PCP intoxication cranberry juice to acidify the urine
to a ph of 5.5 & accelerate excretion.
28. A. The nurse would facilitate progressive review of the accident and its
consequence to help the client integrate feelings & memories and to begin the
grieving process.
29. B. The nurse instructs the nursing assistant to invite the client to lunch &
accompany him to the dinning room to decrease manipulation, secondary gain,
dependency and reinforcement of negative behavior while maintaining the
client’s worth.
30. C. This provides support until the individuals coping mechanisms and
personal support systems can be immobilized.
31. C. Resolving a loss is a slow, painful, continuous process until a mental
image of the dead person, almost devoid of negative or undesirable features
emerges.
32. A. A moderate level of cognitive impairment due to dementia is
characterized by increasing dependence on environment & social structure and
by increasing psychologic rigidity with accentuated previous traits & behaviors.
33. C. This action maintains for as long as possible, the clients
intellectual functions by providing anopportunity to use them.
34. A. Individuals with anorexia often display irritability, hospitality, and a
depressed mood.
35. D. Depressed clients demonstrate decreased communication because of
lack of psychic or physical energy.
36. C. The client in a manic episode of the illness often neglects basic needs,
these needs are a priority to ensure adequate nutrition, fluid, and rest.
37. B. The withdrawn pattern of behavior presents the individual from
reaching out to others for sharingthe isolation produces feeling of loneliness.
38. A. The nurse’s response is not therapeutic because it does not recognize
the client’s needs but tries to make the client feel guilty for being demanding.
39. B. The client must recognize the existence of the sub personalities so that
interpretation can occur.
40. D. An aloof, detached, withdrawn posture is a means of protecting the self
by withdrawing and maintaining a safe, emotional distance.
41. C. The usual age of onset of schizophrenia is adolescence or early
childhood.
42. A. Somatic delusion is a fixed false belief about one’s body.
43. C. These are the classic behaviors exhibited by clients with a diagnosis of
schizophrenia.
44. D. The fetal position represents regressed behavior. Regression is a way
of responding to overwhelming anxiety.
45. B. This provides a stimulus that competes with and reduces hallucination.
46. D. Auditory hallucinations are most troublesome when environmental
stimuli are diminished and there are few competing distractions.
47. A. Projection is a mechanism in which inner thoughts and feelings are
projected onto the environment, seeming to come from outside the self rather
than from within.
48. B. This will help the client develop self-esteem and reduce the use of
paranoid ideation.
49. B. Denial is a method of resolving conflict or escaping unpleasant realities
by ignoring their existence.
50. C. Alcohol is a central nervous system depressant. These symptoms are
the body’s neurologic adaptation to the withdrawal of alcohol.