Pre-Board Exam Drill: Psychiatric Nursing C

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

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. An inpatient psychiatric client suddenly becomes loud and visibly anxious. What's the best action for the nurse to take? 
a.)Summon help and escort the client to his room. 
b.)Face the client squarely and say, "You must be quiet." 
c.)Say, "Calm down; you're safe here." 
d.)Say, "Let's go talk in your room."


2. A voluntary client on an inpatient psychiatric unit has a history of auditory hallucinations and self-aggression. The nurse is talking with the client when the client suddenly jumps up and says, to no one in particular, "Get away from me." What's the nurse's best response? 
a.)Escort the client to his room. 
b.)Say, "I won't let them harm you." 
c.)Sit quietly until the client becomes calm.
d.)Ask, "Who are you talking to?"


3. A 35-year-old voluntary client suddenly begins yelling, throws a chair, and exhibits extreme agitation. Which of the following would be most important for the nurse to consider when planning an intervention? 
a.)Because the client is a voluntary admission, restraints can't be used. 
b.)The family must be called for permission to restrain the client.
c.)Restraint should be used as a last resort. 
d.)Restraint can't be initiated until the physician is called.


4. Before forcing a client to take a medication, the nurse should give priority to:
a.)the client's danger to self or others. 
b.)what the "voices" are saying to the client. 
c.)whether the client's admission was voluntary. 
d.)the client's insight into the illness.


5. A client was admitted to the hospital 2 days ago for disrupting a town meeting, shouting religious delusions, and fighting with police. The client now refuses to take prescribed haloperidol (Haldol), saying, "I don't want it." Which response by the nurse would be best? 
a.)"It will help you feel better." 
b.)"You must take it or get an injection." 
c.)"What are you afraid of?"
d.)"You sound concerned."


6. A client has been prescribed 75 mg of amitriptyline (Elavil) at bedtime and 15 mg of phenelzine (Nardil) three times per day. Which nursing action takes priority? 
a.)Teaching the client about the adverse effects
b.)Calling the physician and questioning the order 
c.)Instituting dietary restrictions 
d.)Taking baseline vital signs



7. A client on an inpatient psychiatric unit has been taking a tricyclic antidepressant without satisfactory results, so the physician changes to a monoamine oxidase (MAO) inhibitor. In evaluating the physician's order, the nurse must first be sure:
a.)adequate time has elapsed between discontinuing the first medication and beginning the second. 
b.)the MAO inhibitor is begun at the same dosage as the tricyclic antidepressant. 
c.)the client isn't suicidal. 
d.)the client isn't allergic to cheese.


8. A client reports no improvement in mood since beginning a regimen of 15 mg of tranylcypromine (Parnate) twice per day 1 week ago. Which of the following is the best nursing action?
a.)Say to the client, "The medication may need up to 4 weeks to take effect." b.)Say to the client, "You should feel the effects any day now." 
c.)Consult with the physician about a dosage adjustment. 
d.)Consult with the physician about a change of medication.


9. A client who has been hospitalized with depression is about to be discharged with a prescription of phenelzine (Nardil). In planning for discharge, the nurse should have a teaching plan that emphasizes: 
a.)getting adequate rest. 
b.)avoiding smoking.
c.)avoiding red wine. 
d.)taking the drug with food or milk.


10. The physician prescribes a monoamine oxidase (MAO) inhibitor for a client. Which of the following nursing diagnostic categories would be most appropriate to focus on during client teaching?
a.)Risk for injury 
b.)Disturbed thought processes 
c.)Deficient fluid volume 
d.)Disturbed sleep pattern


11. A nurse is teaching clients in an outpatient clinic about monoamine oxidase (MAO) inhibitors. The nurse would best evaluate the clients' understanding of how their medications work by noting:
a.)food selections. 
b.)fluid intake. 
c.)potential for self-harm. 
d.)level of anxiety.


12. A hospitalized client taking 30 mg of tranylcypromine (Parnate) twice per day complains of a stiff neck and headache. Which action would be best for the nurse to take? 
a.)Note the complaints as usual adverse effects.
b.)Withhold the next dose of medication. 
c.)Administer an analgesic, as needed and as prescribed. 
d.)Help the client relax.


13. A client avoids leaving home to shop for groceries or complete other errands. At times the client feels "crazy" because of her fear. The client seeks out her neighbor, a nurse, for help. The nurse's assessment is phobic reaction. Which of the following statements about a phobia is true? 
a.)The condition is a persistent, intrusive image that seems senseless to the person.
b.)It's important not to force the person to face the phobic object or situation. c.)The phobic condition can be cured by hypnosis. 
d.)It's necessary to agree with the client's assessment that the phobia is silly.


14. A 76-year-old widowed mother of six is admitted to a long-term care facility with a diagnosis of organic mental disorder. Which of the following approaches would be most helpful for the nurse in meeting the client's needs? 
a.)Make sure the client completes tasks that she begins. 
b.)Maintain a gentle approach that doesn't set limits. 
c.)Give the client alternative choices in making decisions.
d.)Simplify the environment as much as possible.


15. Which of the following snacks would be best for a client with anorexia nervosa who requires a high-protein, high-calorie diet? 
a.)Chicken soup and crackers 
b.)Doughnut and orange juice
c.)Egg salad and peanuts 
d.)Cashews and strawberries


16. What's the most appropriate nursing diagnosis for a client exhibiting obsessive-compulsive behavior?
a.)Ineffective coping 
b.)Imbalanced nutrition: Less than body requirements 
c.)Imbalanced nutrition: More than body requirements 
d.)Interrupted family processes
.

17. A 28-year-old accountant is admitted to the neurologic unit after a sudden onset of blindness the day before an important project is due for her boss. After preliminary evaluation and testing yields no positive findings, the physician's initial reaction is that the client may be demonstrating which defense mechanism? 
a.)Repression 
b.)Transference 
c.)Reaction formation
d.)Conversion


18. A client with bipolar disorder, manic phase, who usually dresses conservatively, appears at breakfast with brightly colored cheeks, wearing a miniskirt, sheer blouse, and designer boots. Which of the following actions should the nurse take to deal with the client's attire?
a.)Redirect the client to her room and help her put on her more customary clothing. b.)Allow her the freedom to wear what she prefers for now. 
c.)Remind the client of the dress code and the consequences of violation. 
d.)Tell the client what to wear and advise her that she has lost the privilege of choosing her wardrobe.


19. What's the most effective intervention for handling a client with an antisocial personality? 
a.)Reason with the client.
b.)Set limits with the client. 
c.)Ignore the client. 
d.)Agree with the client.


20. A client on the nursing unit, charged with child abuse, doesn't speak to the staff when approached. Which response by the nurse would be best? 
a.)"If you need me, I'll be in the nurses' station." 
b.)"You need to come to grips with what has happened." 
c.)"Not speaking to the staff won't help your situation."
d.)"Admission to a psychiatric unit can be very difficult."


21. After refusing to eat for 4 days, a 17-year-old college freshman is referred to the inpatient eating disorders unit of a general hospital. Her affect is flat, her eyes downcast, and her long blonde hair dull and limp. Her clothes hang loosely on her body, and she appears sullen and frightened. Her weight on admission is 89 lb (40.4 kg); her normal weight is 114 lb (52 kg). Which of the following assessments would best enable the nurse to develop a specific nursing diagnosis? 
a.)Family history, including genograms 
b.)Psychiatric history, including all hospital admissions 
c.)Cardiac and respiratory history
d.)Weight loss history and general condition of skin, hair, and nails


22. A client is admitted for a suspected eating disorder. Which of the following statements would indicate that the client may be suffering from anorexia nervosa? a.)"I've gained 3 pounds in the last month." 
b.)"I eat loads of spinach and yellow vegetables each day."
c.)"I'm a perfectionist, and I work hard to get A's." 
d.)"I binge frequently in the morning and feel fat."


23. Which of the following nursing interventions would be included in the care of a client with anorexia nervosa as therapy progresses? 
a.)Let the client eat alone to avoid embarrassment. 
b.)Weigh the client once a week in the same clothing.
c.)Monitor the client for self-destructive tendencies. 
d.)Praise the client for "looking better," and remind the client that she isn't "too fat."


24. A client with a personality disorder exhibits manipulative behavior. Care planning for this client should include: 
a.)freedom to do as the client chooses when behavior improves. 
b.)limitations per unit rules without restrictions for broken rules. 
c.)reasonable expectations with varying limits.
d.)verbal reinforcement when the client functions within established limits.


25. A 40-year-old woman is brought to the hospital by her husband, who states that she has refused to eat or get out of bed for 2 days. The woman says that she's tired all the time and doesn't feel up to going to work. Her admitting diagnosis is major depression. Which question would be most appropriate for the admitting nurse to ask? 
a.)"What has been troubling you?" 
b.)"Why do you dislike yourself?"
c.)"How do you feel about your life?" 
d.)"What can we do to help?"

26. A 24-year-old secretary is transferred to your psychiatric unit. Her husband says that she has been overeating and that she vomits soon after she eats. Her weight stays about the same, at 96 lb (44 kg). In planning care for the client, the nurse should anticipate which medical diagnosis? 
a.)Anorexia nervosa
b.)Bulimia 
c.)Klein-Levin syndrome 
d.)Dysthymia


27. For a client with bulimia, which assessment is least important in the care plan? a.)Observe the client after eating for 1 hour. 
b.)Note the client's intake. 
c.)Note changes in appetite.
d.)Note changes in respiratory rate.


28. A client with personality disorder gets along poorly with the immediate family. The client's manipulative behavior most likely shows a failure to develop: 
a.)intimate relationships.
b.)trust. 
c.)industry. 
d.)feelings of guilt.


29. A 32-year-old client is admitted to the unit. She states, "I'm a well-known, wealthy designer," and begins to order the nurses to prepare her bath while she orders her tray and telephones her colleagues. Her husband states that she's too busy to eat and sleep and is losing weight. Her admitting diagnosis is bipolar disorder, manic phase. For which of the following events should the nurse plan?
a.)Erratic and unpredictable behavior if challenged 
b.)Boredom and the need for minute-to-minute activities 
c.)Rapid mood changes from elation to depression 
d.)One-to-one treatment to occupy the client's time


30. A 32-year-old lawyer is admitted to the neurologic unit with a sudden onset of blindness the night before an important case is scheduled to go to trial. Tests reveal no physical findings. Which of the following is the best assessment of the client's anxiety? a.)It's diffuse and free floating. 
b.)It's consciously experienced.
c.)It's localized and relieved by the blindness. 
d.)It's projected onto the environment.