front 1 A nurse on an acute unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing action should the nurse include in the client’s plan of care? | back 1 Implement one on one observation during meals |
front 2 The nurse recognizes that patients with schizophrenia suffer from cognitive symptoms. Which of the following demonstrates these symptoms? | back 2 Cognitive symptoms inhibit them to utilize judgment |
front 3 The nurse in the unit is discussing legal terms. The nurse described that defamation of character occurs when a provider makes a false statement that causes some degree of harm to an individual. She is aware that by doing this should be charged with, which of the following? | back 3 slander |
front 4 A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. The newly licensed nurse sees the client exhibiting lip smacking, tongue fasciculations. The newly licensed nurse understands that she is documenting: | back 4 tardive dyskinesia |
front 5 The nurse is doing a physical assessment on the client that was recently admitted to the behavioral unit. Which assessment finding is most associated with bulimia nervosa? | back 5 prominent parotid glands |
front 6 When talking with a patient diagnosed with schizophrenia, the healthcare provider notes the patient continually states, "I'm the man with a plan,yes I am." The healthcare provider will document this behavior as which of the following? | back 6 Clang associations |
front 7 A nurse is conducting an in-service on crisis management. Which of the following would be an example of a client experiencing a maturational crisis? | back 7 death of mother |
front 8 The nurse in the unit is doing discharge instructions with a bipolar client. When the nurse is teaching the client in regard to lithium, she ensures that patient verbalizes: | back 8 "I need to take lithium with food." |
front 9 A nurse is monitoring a client who has schizophrenia ad is receiving treatment with fluphenazine hydrochloride. Which of the following findings is an indication of neuroleptic malignant syndrome that the nurse should report to the provider? Select all that apply | back 9 rigidity Hyperpyrexia Fluctuations in blood pressure |
front 10 The nurse educator is teaching new nurse's regarding Alzheimer's disease. Which of the following symptoms can the patient display? Select all that apply. | back 10 agnosia apraxia aphasia |
front 11 A nurse is caring for a young adult client who says he is experiencing increased anxiety and an inability to concentrate. Which of the following anxiety levels is the client exhibiting? | back 11 severe |
front 12 A nurse is assessing a client who is receiving treatment with Risperidone. Some of the findings include blood pressure changes, hyperpyrexia, and diaphoresis. The nurse should recognize that, which of the following adverse effects may be occurring? | back 12 Neuroleptic malignant syndrome |
front 13 A nurse is teaching a client who has a new prescription for disulfiram to treat alcohol use disorder. Which of the following statements by the client indicates an understanding o the teaching? | back 13 "I should check the labels of my skin-care products, medications, and food for alcohol." |
front 14 The health care provider has prescribed valproic acid (Depakene) for a client with bipolar disorder who has achieved limited success with lithiumcarbonate (Lithane). The nurse should instruct the client about which of the following? | back 14 Tachycardia and upset stomach are common side effects. Follow-up blood test such as BUN and Creatinine are always necessary. Follow-up blood test such as LFT's are necessary while on this medication |
front 15 A client is experiencing depression; another client is diagnosed with cyclothemia. The nursing student understands that these clients are exhibiting similar characteristics. Select all that apply? | back 15 Avolution |
front 16 A nurse is caring for a client who is taking amitriptyline. The nurse should monitor for which of the following adverse effects? | back 16 Orthostatic hypotension |
front 17 During group therapy, a client diagnosed with somatization pain disorder monopolizes the group by discussing back pain. Which nursing statement is an appropriate response in this situation? | back 17 "I can tell this is bothering you. Let's briefly discuss this further after group." |
front 18 A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply.) | back 18 Hypertension Fever Seizures Restlessness |
front 19 A nurse is conducting a class for group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? | back 19 A non-suicide contract decreases the client's risk for suicide |
front 20 The nurse is checking the laboratory values for a client admitted with anorexia nervosa. Which of the following are common laboratory findings associated with anorexia? | back 20 Hypokalemia, hypoalbuminemia, and increase cholesterol level. |
front 21 The nurse is receiving a client to the behavioral unit with a personality disorder. The nurse will document which of the following as characteristics of an Antisocial personality? | back 21 Lack of empathy, manipulative, and charming. |
front 22 The nurse in the behavioral unit is performing a physical assessment of a client with Anorexia. Which physical assessment finding is most associated with Anorexia Nervosa? (Select all that apply) | back 22 Yellowed skin acrocyanosis lanugo mottled cool extremities |
front 23 The nurse administers each of the following medications to various clients on the behavioral health unit. The nurse knows that the client who should be most carefully monitored for fluid and electrolyte imbalance is the one receiving: | back 23 lithium |
front 24 A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is very short-staffed, and the client frequently fights with other clients. The nurse's actions are an example of which of the following torts? | back 24 False imprisonment |
front 25 A nurse is conducting an in-service on crisis management. Which of the following would be an example of a client experiencing adventitious crisis? | back 25 intended plane crash and riots |
front 26 A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? | back 26 The client had a motor vehicle crash last year and sustained a head injury. |
front 27 The nurse is working in the emergency department and is conducting an assessment on a client with opioid intoxication. Which of the following is the nurse documenting? | back 27 Slurred speech, impaired judgement and memory |
front 28 A nurse is teaching a client who has agoraphobia about systematic desensitization. Which of the following comments should the nurse include in the teaching? | back 28 "You will slowly be exposed to increasing levels of public spaces." |
front 29 A nurse in an acute mental health facility is planning care for a client who has Obsessive Compulsive Disorder (OCD). Which of the following actions should the nurse include in the plan of care? | back 29 Instruct the client to practice thought stopping |
front 30 A nurse is assessing a client who has schizophrenia. Which of the following statements by the client should the nurse recognize as an erotomaniac delusion? | back 30 "I have only met Jenny twice, but I know she loves me." |
front 31 The nurse is working in the detox unit. She is aware that which of the following are consistent with delirium? (Select all that apply). | back 31 A medical emergency Reversible acute onset |
front 32 A nurse is caring for a client who has schizophrenia .The client sates" Aliens came into my room last night and took a sample of my blood." Which of the following should the nurse make? | back 32 "Do you mean to say a laboratory technician drew your blood last night." |
front 33 The nurse is working in the behavioral unit. The nurse is aware that which of the following demonstrates the ethical principle of beneficence? | back 33 Providing frequent updates to the family of a patient currently in surgery. |
front 34 A nurse is assessing a client who has schizophrenia and takes haloperidol 3 times daily. The client has developed involuntary writhing movements of the tongue and constant lip smacking. The nurse should identify that these manifestations indicate which of the following adverse effects of haloperidol? | back 34 Tardive dyskinesia |
front 35 A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client at risk for conversion disorder? | back 35 Death of a child 2 months ago. |
front 36 A nurse is teaching a newly licensed nurse about reporting suspected child abuse. Which of the following statements indicates an understanding by the newly licensed nurse? | back 36 If suspicion of abuse exists then reporting is mandatory." |
front 37 A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and flat affect. The nurse should anticipate a prescription of which of the following medications? | back 37 Risperidone |
front 38 A patient in a support group says, "I'm tired of being sick. Everyone always helps me, but I will be glad when I can help someone else". This statement reflects, which of the following defense mechanisms? | back 38 Alturism |
front 39 A nurse is planning care for a client who has completed detoxification from opioids abuse disorder. The nurse should plan to teach about which of the following medications? | back 39 Naltrexone |
front 40 During admission, the client describes feeling depressed, "for as long as I can remember." The nurse understands this symptom is indicative of what type of depression? | back 40 Major depressive disorder |
front 41 During a home visit, a client who is 75 years of age tells the community health nurse, "Lately I'm getting forgetful about things. For one thing, I cannot remember names. Do you think I am getting Alzheimer disease?" Which of the following responses by the nurse is the most therapeutic? | back 41 "Tell me more about your forgetfulness. It isn't usual for forgetfulness to occur." |
front 42 A nurse is caring for a client who is depressed and refuses to participate in group therapy or perform activities of daily living. Which of the following statements should the nurse make to the client? | back 42 "I will assist you in getting out of bed and getting dressed." |
front 43 A nurse is caring for a client who has post-traumatic stress disorder (PTSD). Which of the following actions by the client indicates the current treatment plan is effective? | back 43 The client reports techniques she uses to promote sleep. |
front 44 The nurse is reviewing the medical record and noticed that the clients history have under subjective data: "My throat is painful". From the list below, Which medication is most likely to cause fatal agranulocytosis? | back 44 Clozapine |
front 45 A client with a diagnosis of borderline personality disorder is admitted with self-inflicted scratches on her forearms. The nurse is assessing the client's suicidal plan. It is important to assess which of the following? Select all that apply. | back 45 Presence of suicidal plan. "Expressions that everything will be well soon" Access to the means for enforcing the suicidal plan. Self-harm behaviors of razor blade cuts. Expressions that her life "isn't worth anything." |
front 46 Which therapeutic communication technique is being used in the following example: Client: Every time I get angry, I wind up getting into a fistfight with my wife." Nurse: You express your anger through physical violence directed at you family." | back 46 Restating |
front 47 A client diagnosed with schizophrenia is experiencing anhedonia. The nurse understands that the client is exhibiting which of the following? | back 47 Lack of pleasure a negative symptom |
front 48 A nurse is providing teaching to a client who has a new prescription form disulfiram for the management of alcohol dependence. Which of the following dietary items should the nurse instruct the client to avoid? | back 48 Pure vanilla extract |
front 49 A home health nurse is speaking to a group of acute care nurses about
domestic violence. Which of the following statements by one of the
acute | back 49 "I have heard that abusers think of themselves as important and have high self esteem. |
front 50 The nurse taking care of the schizophrenic client in the unit and hears the client having verbigeration. Which of the following will you point out? | back 50 The hall and tall the ball, the hall and tall the ball |
front 51 A nurse is caring for a client who has schizophrenia. Which of the following client statements indicates word salad? | back 51 "Option, contrary, moose, allergic." |
front 52 A nurse is conducting a group therapy session for several clients. The group is laughing at a joke one of the clients told, when a client who is schizophrenic jumps up and runs out of the room yelling, "You are all making fun of me!" The nurse should identify this behavior as which of the following characteristics of schizophrenia? | back 52 Ideas of reference |
front 53 A nurse is communicating with a newly admitted client. Which of the following is a barrier to therapeutic communication? | back 53 Offering advice |
front 54 A nurse in an emergency department is assessing a client for suspected cocaine intoxication. Which of the following findings should the nurse expect? | back 54 Dilated pupils, chest pain. |
front 55 A client is admitted with diagnosis of dementia (Alzheimer type). Which nursing intervention is the priority when caring for the client? | back 55 Ensure environment is safe to prevent injury. |
front 56 A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply). | back 56 Attempts to convince other clients to give him their belongings. Blames others for his past and current problems. |
front 57 A nurse in an emergency department is caring for a female adolescent who has a diagnosis of bulimia nervosa and had a fainting episode during a ballet performance. Which of the following statements by the mother acknowledges her daughter's diagnosis? | back 57 "She won't let me take the trash from her room. I'm concerned about what she has in there." |
front 58 A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? | back 58 "I may feel drowsy for a few weeks after starting this medication." |
front 59 A nurse is instructing a client on toxicity of using lithium carbonate for their bipolar disorder. The nurse provides the following teaching that lithium may cause polyuria and muscle weakness. Which other sign of toxicity should the nurse include in the teaching? | back 59 Tinnitus of the ears is a possible indication of early lithium toxicity. |
front 60 A nurse is caring for a client who has post-traumatic stress disorder (PTSD). Which of the following actions by the client indicates the current treatment plan is effective? | back 60 The client reports techniques she uses to promote sleep. |
front 61 A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check for? (Select all that apply). | back 61 Sodium level Thyroid hormone assay Creatinine level |
front 62 The nurse is receiving a client to the behavioral unit with a personality disorder. The nurse will document which of the following as characteristics of a Narcissistic personality? | back 62 Arrogance need for consistent admiration, self-importance. |
front 63 A nurse is conducting an in-service on crisis management. Which of the following would be an example of a client experiencing a situational/adventitious crisis? | back 63 Rape and losing a job |
front 64 A nurse is assessing a client who experienced a sexual assault 3 months ago. Which of the following findings should the nurse report to the provider as an indication of rape-trauma syndrome? | back 64 Report of intense guilt |
front 65 The nurse is teaching a client being discharge home with a prescription of Phenelzine. Which of the following interactions will the nurse be mostly concerned when discussing a meal plan with the client? | back 65 Avocados |
front 66 A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? | back 66 Ensure that the client swallows medication. |
front 67 A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? | back 67 "I am here to provide care and cannot accept this form you." |
front 68 An 18-year-old woman is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa. A cognitive behavioral approach is used as part of her treatment plan. A nurse understands that the purpose of this approach is to: | back 68 Help the client identify and examine dysfunctional thoughts and beliefs |
front 69 A nurse in an outpatient mental health clinic is interviewing a client who has schizophrenia and appears to be experiencing auditory hallucinations. Which of the following actions should the nurse take first? | back 69 Explore what the voices are saying to the client. |
front 70 A client with schizophrenia is unable to get out of bed and get dressed unless the nurse prompts him to do so. This is an example of which behavior? | back 70 Avolition |
front 71 A nurse is planning care for the termination phase of a nurse- client
relationship. Which of the following actions should the nurse include
in the | back 71 Discussing ways to use new behaviors. |
front 72 A client is coming into the ER with signs of alcohol withdrawal. Which of the following medications would the nurse anticipate to administer, as per physicians orders? | back 72 Chlordiaxepoxide |
front 73 A nurse is administering risperidone (Risperdal) to a client who is scheduled to be discharged. Before discharge, which of the following should the nurse teach the client? | back 73 Get up slowly when changing positions |
front 74 A nurse is caring for a client who is dying. The client says, "My mother died in the hospital, but I did not get there before she died." Which type of crisis is the family experiencing? | back 74 Both maturational and situational |
front 75 A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? | back 75 "Stop screaming and walk with me outside." |