Answer Choices:
a. Refer the patient’s requests to identified staff.
b. Explore the patient’s feelings of fear and inferiority.
c. Provide negative reinforcement for negative behavior.
d. Ignore, rather than confront, inappropriate behavior.
Answer:
a. Refer the patient’s requests to identified staff.
Question: A patient’s care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?
Answer Choices:
a. Aloofness, haughtiness, suspicion
b. Darting eyes, tilted head, mumbling to self
c. Elevated mood, hyperactivity, distractibility
d. Performing rituals, avoiding open places
Answer:
B
Question: A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for what primary purpose? a. Maintaining patients’ concentration and attention b. Shifting the patients’ focus from food to psychotherapy c. Focusing on weight control mechanisms and food preparation d. Processing the heightened anxiety associated with eating
Answer Choices:
a. Maintaining patients’ concentration and attention
b. Shifting the patients’ focus from food to psychotherapy
c. Focusing on weight control mechanisms and food preparation
d. Processing the heightened anxiety associated with eating
Answer:
D
Question: The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and their role in recovery. Which type of therapy should the nurse recommend? A. Psychoeducational B. Psychoanalytic C. Transactional D. Family
Answer Choices:
A) Psychoeducational
B) Psychoanalytic
C) Transactional
D) Family
Answer:
A
Question: A patient diagnosed with schizophrenia believes evil spirits are being summoned by a local minister and verbally threatens to bomb a local church. What principle governs the proper action in this situation?
Answer Choices:
a. Need for authorization
b. Duty to warn and protect
c. Patient right to confidentiality
d. Patient’s right to self-actualization
Answer:
b. Duty to warn and protect
Question: The spouse of a patient who experiences delusions asks the nurse, “Are there any circumstances under which the treatment team is justified in violating the patient’s right to confidentiality?” What is the nurse’s best response?
Answer Choices:
a. “We can’t violate that confidence under any circumstances.”
b. “The duty to protect the patient from themselves.”
c. “We are only obliged to answer questions asked by the police.”
d. “We would act if the patient threatened the life of another person.”
Answer:
d. “We would act if the patient threatened the life of another person.”
Question: The partner of a patient diagnosed with schizophrenia says, “I don’t understand why childhood experiences have anything to do with this disabling illness.” Which nurse’s response will best help the partner understand the condition?
Answer Choices:
a. “Psychological stress is actually at the root of most mental disorders.”
b. “We know now that all mental illnesses are the result of genetic factors.”
c. “It must be frustrating for you that your spouse is sick so much of the time, isn’t it?”
d. “Research has shown schizophrenia has a biological basis, though environmental and psychological influences. Helping the partner understand the importance of his or her role as a caregiver is also important. Empathy is important but does not increase the spouse’s level of knowledge about the cause of the patient’s condition. Not all mental illnesses are the result of genetic factors. Psychological stress is not at the root of most mental disorders.”
Answer:
D. “Research has shown schizophrenia has a biological basis, though environmental and psychological influences. Helping the partner understand the importance of his or her role as a caregiver is also important. Empathy is important but does not increase the spouse’s level of knowledge about the cause of the patient’s condition. Not all mental illnesses are the result of genetic factors. Psychological stress is not at the root of most mental disorders.”
Question: A nurse in the emergency department tells an adult, “Your mother had a serious stroke.” The adult tearfully says, “Who will take care of me now?” Which term best describes this behavior?
Answer Choices:
a. Histrionic
b. Dependent
c. Narcissistic
d. Borderline
Answer:
b. Dependent
Question: Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa?
Answer Choices:
a. Carefree flexibility
b. Rigidity, perfectionism
c. Open displays of emotion
d. High spirits and optimism
Answer:
B
Question: The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention “Monitor for complications of refeeding.” Which body system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Central nervous d. Cardiovascular
Answer Choices:
a. Renal
b. Endocrine
c. Central nervous
d. Cardiovascular
Answer:
D
Question: An advanced practice nurse recommends that a patient has the right to voluntarily admit to an admission to be voluntarily hospitalized when reporting audio hallucinations. A patient’s admission status is changed from involuntary to voluntary after the patient’s hallucinations subside after medication is started.
Answer Choices:
a. A tort is a civil wrong against a person that violates his or her rights.
b. An advanced practice nurse recommends that a patient has a history of danger to self and others be voluntarily hospitalized when reporting audio hallucinations.
c. A patient’s admission status is changed from involuntary to voluntary after the patient’s hallucinations subside after medication is started.
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent any possible violence because the unit is short staffed.
Answer:
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent any possible violence because the unit is short staffed.
Question: A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to α1-receptors because the patient may experience what effect?
Answer Choices:
a. Increased psychotic symptoms
b. Severe appetite disturbance
c. Orthostatic hypotension
d. Hypertensive crisis
Answer:
c. Orthostatic hypotension
Question: What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others?
Answer Choices:
a. The patient will identify when feeling angry.
b. The patient will use manipulation only to get legitimate needs met.
c. The patient will acknowledge manipulative behavior when it is called to their attention.
d. The patient will accept fulfillment of their requests within an hour rather than immediately.
Answer:
c. The patient will acknowledge manipulative behavior when it is called to their attention.
Question: A patient diagnosed with schizophrenia has taken antipsychotic medication for three days. The patient is diaphoretic, drooling, and has difficulty swallowing. By 4:00 pm, vital signs are body temperature, 102.8° F; pulse, 110 beats/min; respirations, 26 breaths per minute; and blood pressure, 150/90 mm Hg. Select the nurse’s best analysis and action. A. Agranulocytosis. Institute reverse isolation. B. Tardive dyskinesia. Withhold the next dose of medication. C. Cholestatic jaundice. Begin a high-protein, low-fat diet. D. Neuroleptic malignant syndrome. Immediately notify the health care provider.
Answer Choices:
A) Agranulocytosis. Institute reverse isolation.
B) Tardive dyskinesia. Withhold the next dose of medication.
C) Cholestatic jaundice. Begin a high-protein, low-fat diet.
D) Neuroleptic malignant syndrome. Immediately notify the health care provider.
Answer:
D
Question: What assessment findings mark the prodromal stage of schizophrenia? A. Withdrawal, magical thinking, poor concentration, and perceptual disturbances B. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting C. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility D. Loose associations, concrete thinking, and echolalia neologisms
Answer Choices:
A) Withdrawal, magical thinking, poor concentration, and perceptual disturbances
B) Auditory hallucinations, ideas of reference, thought insertion, and broadcasting
C) Stereotyped behavior, echopraxia, echolalia, and waxy flexibility
D) Loose associations, concrete thinking, and echolalia neologisms
Answer:
A
Question: Which statement is a nurse most likely to hear from a patient diagnosed with anorexia nervosa?
Answer Choices:
a. “I would be happy if I could lose 20 more pounds.”
b. “My parents don’t pay much attention to me.”
c. “I’m thin for my height.”
d. “I have nice eyes.”
Answer:
A
Question: A patient diagnosed with schizophrenia tells the nurse, “The CIA is monitoring us through the electrical wires in this room. See that wall, they watch everything from behind there.” Which response by the nurse would be most therapeutic? a. “That’s right, with technological era, the CIA…” b. “It sounds like you’re concerned about your privacy.” c. “The CIA is prohibited from operating in health care facilities.” d. “You have lost touch with reality, which is a symptom of your illness.”
Answer Choices:
a. “That’s right, with technological era, the CIA…”
b. “It sounds like you’re concerned about your privacy.”
c. “The CIA is prohibited from operating in health care facilities.”
d. “You have lost touch with reality, which is a symptom of your illness.”
Answer:
B
Question: A patient diagnosed with schizophrenia says, “High heat. Last time here. Did you get a coat?” What type of verbalization is evident? A. Neologism B. Idea of reference C. Thought broadcasting D. Associative looseness
Answer Choices:
A) Neologism
B) Idea of reference
C) Thought broadcasting
D) Associative looseness
Answer:
D
Question: A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse’s best response. A. “Why are you laughing?” B. “Please share the joke with me.” C. “I don’t think I said anything funny.” D. “You are laughing. Tell me what’s happening.”
Answer Choices:
A) “Why are you laughing?”
B) “Please share the joke with me.”
C) “I don’t think I said anything funny.”
D) “You are laughing. Tell me what’s happening.”
Answer:
D
Question: A person’s partner filed charges of battery. The person has a long history of acting-out behaviors and several arrests. Which statement by the person suggests an antisocial personality disorder?
Answer Choices:
a. “I have a quick temper, but I can usually keep it under control.”
b. “I’ve done some stupid things in my life, but I’ve learned a lesson.”
c. “I’m feeling terrible about the way my behavior has hurt my family.”
d. “I get tired of being nagged. They deserved the beating.”
Answer:
d. “I get tired of being nagged. They deserved the beating.”
Question: An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should implement what intervention to assess patient safety?
Answer Choices:
a. Assess lung sounds and extremities.
b. Suggest the use of an aerobic exercise program.
c. Positively reinforce the patient for the weight gain.
d. Establish a higher goal for weight gain the next week.
Answer:
A