Pre-Board Exam Drill: Psychiatric Nursing B

This is a 30 point Pre-Board Exam Drill on Psychiatric Nursing Set B.

Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!

1. The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is:
a.)benztropine (Cogentin). 
b.)diphenhydramine (Benadryl). 
c.)propranolol (Inderal). 
d.)haloperidol (Haldol).

2. The nurse is providing care for a female client with a history of schizophrenia who is experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What's the nurse's best action? 
a.)Administer the haloperidol orally if the client agrees to take it. 
b.)Call the physician to clarify whether the haloperidol should be given orally or I.M.
c.)Call the physician to clarify the order because the dosage is too high. 
d.)Withhold haloperidol because it may worsen hallucinations.


3. The nurse is providing care to a client with catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should: 
a.)ask the client which activity he would prefer to do first. 
b.)negotiate a time when the client will perform activities.
c.)tell the client specifically and concisely what needs to be done. 
d.)prepare the client ahead of time for the activity.


4. Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)? 
a.)Monthly blood tests will be necessary.
b.)Report a sore throat or fever to the physician immediately. 
c.)Blood pressure must be monitored for hypertension. 
d.)Stop the medication when symptoms subside.


5. A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? 
a.)Calcium
b.)Sodium 
c.)Chloride 
d.)Potassium


6. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate? 
a.)"I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
b.)"I find it hard to believe 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."


7. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which finding should alert the nurse that the client is experiencing pseudoparkinsonism? 
a.)Restlessness, difficulty sitting still, pacing 
b.)Involuntary rolling of the eyes
c.)Tremors, shuffling gait, masklike face 
d.)Extremity and neck spasms, facial grimacing, jerky movements


8. A 54-year-old female was found unconscious on the floor of her bathroom with self-inflicted wrist lacerations. An ambulance was called and the client was taken to the emergency department. When she was stable, the client was transferred to the inpatient psychiatric unit for observation and treatment with antidepressants. Now that the client is feeling better, which nursing intervention is most appropriate? 
a.)Observing for extrapyramidal symptoms 
b.)Beginning a therapeutic relationship 
c.)Canceling any no-suicide contracts
d.)Continuing suicide precautions


9. A 26-year-old male reports losing his sight in both eyes. He's diagnosed as having a conversion disorder and is admitted to the psychiatric unit. Which nursing intervention would be most appropriate for this client?
a.)Not focusing on his blindness 
b.)Providing self-care for him 
c.)Telling him that his blindness isn't real 
d.)Teaching eye exercises to strengthen his eyes


10. A client has a diagnosis of borderline personality disorder. She has attached herself to one nurse and refuses to speak with other staff members. She tells the nurse that the other nurses are mean, withhold her medication, and mistreat her. The staff is discussing this problem at their weekly conference. Which intervention would be most appropriate for the nursing staff to implement? 
a.)Provide an unstructured environment for the client.
b.)Rotate the nurses who are assigned to the client. 
c.)Ignore the client's behaviors. 
d.)Bend unit rules to meet the client's needs.


11. A client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink 6 hours before admission. Based on this response, the nurse should expect early withdrawal symptoms to: 
a.)not occur at all because the time period for their occurrence has passed.
b.)begin anytime within the next 1 to 2 days. 
c.)begin within 2 to 7 days. 
d.)begin after 7 days.


12. The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous (AA) meetings. When the client asks the nurse what he must do to become a member, the nurse should respond: 
a.)You must first stop drinking. 
b.)Your physician must refer you to this program.
c.)Admit you're powerless over alcohol and that you need help. 
d.)You must bring along a friend who will support you.


13. The nurse is assessing a 15-year-old female who is being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find? 
a.)Tachycardia 
b.)Warm, flushed extremities
c.)Parotid gland tenderness 
d.)Coarse hair growth


14. The nurse is assessing an adult's developmental stage. The nurse should consider: a.)height and weight. 
b.)blood pressure.
c.)previous problem-solving strategies. 
d.)pulse rate.


15. Which of the following factors would have the most influence on the outcome of a crisis situation? 
a.)Age
b.)Previous coping skills 
c.)Self-esteem 
d.)Perception of the problem


16. The nurse is caring for an elderly client in a long-term care facility. The client has a history of attempted suicide. The nurse observes the client giving away personal belongings and has heard the client express feelings of hopelessness to other residents. Which intervention should the nurse perform first? 
a.)Setting aside time to listen to the client
b.)Removing items that the client could use in a suicide attempt 
c.)Communicating a nonjudgmental attitude 
d.)Referring the client to a mental health professional


17. The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder? 
a.)Wearing tight-fitting clothing 
b.)Increased blood pressure 
c.)Oily skin
d.)Excessive and ritualized exercise


18. A high school student is referred to the school nurse for suspected substance abuse. Following the nurse's assessment and interventions, what would be the most desirable outcome? 
a.)The student discusses conflicts over drug use.
b.)The student accepts a referral to a substance abuse counselor. 
c.)The student agrees to inform his parents of the problem. 
d.)The student reports increased comfort with making choices.

19. The nurse is using drawing, puppetry, and other forms of play therapy while treating a terminally ill, school-age child. The purpose of these techniques is to help the child: a.)internalize his feelings about death and dying. 
b.)accept responsibility for his situation.
c.)express feelings that he can't articulate. 
d.)have a good time while he's in the hospital.

20. The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client?
a.)Abstinence is the basis for successful treatment. 
b.)Attendance at Alcoholics Anonymous (AA) meetings every day will cure alcoholism. 
c.)For treatment to be successful, family members must participate. 
d.)An occasional social drink is acceptable behavior for the alcoholic.


21. A client exhibits the following defining characteristics: denial of problems that are evident to others, expressions of shame or guilt, perceptions of self as being unable to deal with events, and projection of blame or responsibility for problems onto others. How would a nurse diagnose this client? 
a.)Anxiety
b.)Chronic low self-esteem 
c.)Ineffective denial 
d.)Ineffective individual coping


22. What herbal medication for depression, widely used in Europe, is now being introduced in the Philippines and in the United States? 
a.)Ginkgo biloba 
b.)Echinacea
c.)St. John's wort 
d.)Ephedra


23. The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? 
a.)Fill out the client's menu and make sure she eats at least half of what's on her tray. 
b.)Let the client eat her meals in private then engage her in social activities for at least 2 hours after each meal.
c.)Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal. 
d.)Let the client eat food brought in by the family if she chooses, but keep a strict calorie count.


24. A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? 
a.)"I like the way I look. I just need to keep my weight down because I'm a cheerleader." 
b.)"I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends."
c.)"I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." 
d.)"I do diet around my periods, otherwise I just get so bloated.”


25. Which psychological or personality factors are most likely to predispose an individual to medication abuse?
a.)Low self-esteem and unresolved rage 
b.)Desire to inflict pain upon oneself 
c.)Obsessive-compulsive disorder 
d.)Codependency


26. A client chronically complains of being unappreciated and misunderstood by others. She's argumentative and sullen. She always blames others for her failure to complete work assignments. She expresses feelings of envy toward people she perceives as more fortunate. She voices exaggerated complaints of personal misfortune. The client most likely suffers from which of the following personality disorders? 
a.)Dependent personality
b.)Passive-aggressive personality 
c.)Avoidant personality disorder 
d.)Obsessive-compulsive disorder


27. A client diagnosed with depression tells the nurse, "I won't allow myself to cry because it upsets the whole family when I cry." This is an example of: 
a.)manipulation. 
b.)insight.
c.)rationalization. 
d.)repression.


28. A client diagnosed with major depression has started taking amitriptyline (Elavil), a tricyclic antidepressant. What's a common adverse effect of this drug? 
a.)Weight loss
b.)Dry mouth 
c.)Increased blood pressure 
d.)Muscle spasms


29. A client has received treatment for depression for 3 weeks. Which behavior suggests that the client is recovering from depression?
a.)The client talks about the difficulties of returning to college after discharge. 
b.)The client spends most of the day sitting alone in the corner of the room. 
c.)The client wears a hospital gown instead of street clothes. 
d.)The client shows no emotion when visitors leave.



30. A client in the manic phase of bipolar disorder constantly belittles other clients and demands special favors from the nurses. Which nursing intervention would be most appropriate for this client? 
a.)Ask other clients and staff members to ignore the client's behavior.
b.)Set limits with consequences for belittling or demanding behavior. 
c.)Offer the client an antianxiety drug when belittling or demanding behavior occurs. 
d.)Offer the client a variety of stimulating activities to distract him from belittling or making demands of others.