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1. The nurse is caring for a patient with an addictive disorder who is currently drug-free. The patient is experiencing repeated occurrences of vivid, frightening images and thoughts. Which term would the nurse use to document this finding?
1. Tolerance
2. Flashbacks
3. Withdrawal
4. Synergistic effect |
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2. Which condition would the nurse be most concerned about when caring for a patient who abuses alcohol?
1. Cirrhosis of the liver
2. Suicidal potential
3. Wernicke's encephalopathy
4. Korsakoff's psychosis |
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3. The nurse is caring for four patients. Which patient should be seen first, based upon substance-abuse risk potential?
1. Female patient of Caucasian descent
2. Female patient of Japanese descent
3. Male patient of Native American descent
4. Male patient of African American descent |
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4. Which patient response to the question, “Have you ever drunk more alcohol or used more drugs than you meant to?” should immediately cause the nurse to assess further?
1. “No, I have never used drugs or alcohol.”
2. “I have drunk alcohol before but have never let myself get drunk.”
3. “I figured you'd ask me about that.”
4. “Yes, I did that once and will never do it again.” |
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5. Which patient behaviors should the nurse suspect as related to alcohol withdrawal?
1. Hyperalert state, jerky movements, easily startled
2. Tachycardia, diaphoresis, elevated blood pressure
3. Peripheral vascular collapse, electrolyte imbalance
4. Paranoid delusions, fever, fluctuating levels of consciousness |
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1. Which female patient should the nurse recognize as having the highest risk to have or develop bulimia nervosa? The one who:
1. grew up in an underserved area.
2. lives in a society influenced by Eastern cultural beliefs.
3. is 20 years old.
4. is African-American. |
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2. The nurse is caring for a 16-year-old female patient with anorexia nervosa. What should the initial nursing intervention be upon the patient's admission to the unit?
1. Build a therapeutic relationship.
2. Increase the patient's caloric consumption.
3. Involve the patient in group therapy to build a support group.
4. Self-assess to decrease tendencies towards authoritarianism. |
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3. The nurse is caring for a patient with bulimia. Which nursing intervention is appropriate?
1. Monitoring patient on bathroom trips after eating.
2. Allow patient extensive private time with family members.
3. Provide meals whenever the patient requests them.
4. Encourage patient to select foods that she likes. |
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4. The nurse is admitting a patient who weighs 100 pounds, is 66 inches tall, and is below ideal body weight. The patient's blood pressure is 130/80 mm Hg, pulse is 72 beats per minute, potassium is 2.5 mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands are visibly shaking, and her parotid gland is enlarged. The patient states, “I am really worked up about coming to this unit.” What is the priority nursing diagnosis?
1. Powerlessness
2. Risk for injury
3. Imbalanced nutrition: Less than body requirements
4. Anxiety |
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5. The nurse is planning care for a patient with an eating disorder. What outcomes are appropriate? Select all that apply.
1. The patient will experience a decrease in depression.
2. The patient will identify four methods to control anxiety.
3. The patient will collect different kinds of cookbooks.
4. The patient will identify two people to contact if suicidal thoughts occur. |
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1. A patient complains that most staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her “mixed-up feelings” about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it “makes the numbness stop.” Given this presentation, you would deduce that this patient most likely has which personality disorder?
1. Histrionic
2. Borderline
3. Dependent
4. Schizotypal |
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2. Which statement about persons with personality disorders is accurate?
1. They, unlike those with mood or psychotic disorders, are at very low risk of suicide.
2. They tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them.
3. They are believed to be purely psychological disorders, that is, disorders arising from psychological rather than neurological or other physiological abnormalities.
4. Their symptoms are not as disabling as most other mental disorders; therefore, their care tends to be less challenging and complicated for staff. |
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3. A patient shows the nurse multiple fresh, serious (but non-life-threatening) self-inflicted cuts on her forearm. Which response would be most therapeutic?
1. Convey empathy and explore issues that led to the self-injury as you administer first-aid to the wounds.
2. Care for the wounds, then search the patient for sharp objects, and place the patient on one-to-one observation or in seclusion for her own safety.
3. Recognizing that the self-injury is, at its heart, a maladaptive attempt to obtain attention, extinguish the behavior by minimizing the attention paid to it.
4. Maintain a neutral demeanor while dressing the wounds, and then assign the patient to write a list of circumstances that led to the injury before discussing it further. |
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4. A patient is flirting with a peer and is overheard asking him to intercede with staff so that she will be given privileges to leave the inpatient mental health unit. Later she offers a backrub to a nurse if that nurse will give her the prn sedation at 9:00 pm that is not ordered until 10:00 pm. Which response(s) to such behaviors would be most therapeutic? Select all that apply.
1. Label the behavior as undesirable, and explore with the patient more effective ways to meet her needs.
2. By role-playing, demonstrate other approaches the patient could use to meet her needs.
3. Advise the other patients that this patient is being manipulative and that they should ignore the patient when she behaves this way.
4. Bargain with the patient to determine a reasonable compromise regarding how much of such behavior is acceptable before the patient crosses the line.
5. Explain that such behavior is unacceptable, and give the patient specific examples of consequences that will be enacted if the behavior continues.
6. Ignore the behavior for the time being so the patient will find it unrewarding and in turn seek other, and hopefully more adaptive, ways to meet her needs. |
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5. A patient becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic? Select all that apply.
1. Place the patient in seclusion for 1 hour to allow him to de-escalate.
2. Tell the patient that any further outbursts will result in a loss of privileges.
3. Offer to help the patient learn how to operate his music player and headset.
4. Explore with the patient how he was feeling as he worked with the music player.
5. Point out the consequences of such behavior, and note that it cannot be tolerated.
6. Limit the patient's exposure to frustrating experiences until he attains improved coping skills.
7. Encourage the patient to recognize signs of mounting tension and seek assistance. |
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1. The nurse is caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm?
1. Constricted pupils
2. Dry mouth
3. Decrease in heart rate
4. Sudden drop in blood pressure |
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2. If it is determined that a patient will benefit from guided imagery, what teaching should the nurse provide?
1. Focus on a visual object or sound.
2. Become acutely aware of your breathing pattern.
3. Envision an image of a place that is peaceful.
4. Develop deep abdominal breathing. |
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3. A patient is going to undergo biofeedback. Which patient statement requires further teaching by the nurse?
1. “This will measure my muscle activity, heart rate, and blood pressure.”
2. “It will help me recognize how my body responds to stress.”
3. “I will feel a small shock of electricity if I tell a lie.”
4. “The instruments will know if my skin temperature changes.” |
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4. A patient has told the nurse that she knows she is going to lose her job, which scares her because she needs to work to pay her bills. Which nursing response reflects the positive stress response of problem solving?
1. “What are your plans to find a new job?”
2. “Can you call your parents to support you during this time?”
3. “Is it possible that this job loss is an opportunity to find a better paying job?”
4. “I'm sure everything will turn out just fine.” |
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5. The nurse is caring for four patients. Which patient would be at highest risk for psychosocial compromise? The patient who has experienced:
1. the death of a friend.
2. a divorce.
3. a recent job layoff.
4. the death of a spouse. |
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1. Since learning that he will have a trial pass to a new group home tomorrow, Bill's usual behavior has changed. He has started to pace rapidly, has become very distracted, and is breathing rapidly. He has trouble focusing on anything other than the group home issue and complains that he suddenly feels very nauseated. Which initial nursing response is most appropriate for Bill's level of anxiety?
1. “You seem anxious. Would you like to talk about how you are feeling?”
2. “If you do not calm down, I will have to give you prn medicine to calm you.”
3. “Bill, slow down. Listen to me. You are safe. Take a nice, deep breath…”
4. “We can delay the visit to the group home if that would help you calm down.” |
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2. A patient, who seems to be angry when his family again fails to visit as promised, tells the nurse that he is fine and that the visit wasn't important to him anyway. When the nurse suggests that perhaps he might be disappointed or even a little angry that the family has again let him down, the patient responds that it is his family that is angry, not him, or else they would have visited. What defense mechanism(s) is this patient using to deal with his feelings? Select all that apply.
1. Rationalization
2. Introjection
3. Projection
4. Regression
5. Denial
6. Dissociation |
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3. John, a construction worker, is on duty when a wall under construction suddenly falls, crushing a number of co-workers. Shaken initially, he seems to be coping well with the tragedy but later begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about this situation is most accurate?
1. John is experiencing posttraumatic stress disorder (PTSD) and requires therapy.
2. John has acute stress disorder and should be treated with antianxiety medications.
3. John is experiencing anxiety and grief and should be monitored for PTSD symptoms.
4. John is experiencing mild anxiety and a normal grief reaction; no intervention is needed. |
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4. A variety of medications are used in the treatment of severe anxiety disorders. Which class of medication used to treat anxiety is potentially addictive?
1. Benzodiazepines
2. Selective serotonin reuptake inhibitors (SSRIs)
3. Beta-blockers
4. Antihistamines
5. Buspirone |
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5. An older adult in the outpatient internal medicine clinic complains of feeling a sense of dread and fearfulness without apparent cause. It has been growing steadily worse and is to the point where it is interfering with the patient's sleep and volunteer work. After a brief interview and cursory physical exam, the APRN diagnoses the patient with generalized anxiety disorder and suggests a referral to the mental health clinic. Which response(s) by the clinic nurse would be appropriate? Select all that apply.
1. Complete a neurological history and neurological examination.
2. Examine the patient's extremities for edema, and listen to her lungs.
3. Observe the patient's respirations, and obtain a pulse oximetry reading.
4. Review the patient's current medications, and observe the patient's gait.
5. Suggest that a battery of blood tests, including a CBC, be ordered and reviewed.
6. Ask the APRN to review the nurse's findings before ordering the referral. |
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1. A patient states she has been ill for several months with stomach pain, headache, and dizziness. A review of records shows that she has been tested repeatedly for various conditions, yet no clinical diagnosis has been found. She states her pain is “10 out of 10” on a scale of 1 to 10. She has been treated in the past for anxiety and depression. Which condition should the nurse anticipate?
1. Hypochondriasis
2. Somatization
3. Conversion disorder
4. Body dysmorphic disorder |
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2. The nurse is caring for a patient who has experienced the onset of a headache and has no history of headaches. When talking with the nurse, the patient states, “I am sure this is a brain tumor.” Which condition should the nurse anticipate?
1. Hypochondriasis
2. Somatization
3. Conversion disorder
4. Body dysmorphic disorder |
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3. A patient presents to the emergency department with a sudden onset of lower paralysis. Although the patient's wife is hysterical, the patient himself is calm and unemotional. All organic causes for the paralysis have been ruled out. Which condition should the nurse anticipate?
1. Hypochondriasis
2. Somatization
3. Conversion disorder
4. Body dysmorphic disorder |
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4. A patient has been diagnosed with Munchausen's syndrome. Which behavior should the nurse anticipate?
1. Tendency to frequent the same caregiver and use the emergency department at night
2. Exaggeration of symptoms with the intent of becoming eligible for disability compensation
3. Inability to recall important information related to a recent rape attempt
4. Attempts to make oneself ill and going from one hospital to another to call attention to oneself |
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5. The nurse is planning care for a patient with a somatoform disorder. Which intervention(s) would be appropriate? Select all that apply.
1. Have patient direct requests to varying nurses so they will become familiar with the patient's needs.
2. Objectively explain that the patient's symptoms are not real.
3. Teach assertive communication.
4. Shift focus from somatic concerns to feelings.
5. Spend time with patient only when summoned. |
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