Situation: The nurse is interviewing a handsome man. He is intelligent and very charming. When asked about his family, he states he has been married four times. He says three of those marriages were "shotgun" weddings. He states he never really loved any of his wives. He doesn't know much about his three children. "I've lost track," he states.
1. If a patient is very resistant in taking responsibility of his action and asks, "Can you just give me some medication?" the best response is:
a. "The medication has too many side effects."
b. You don't want to take medication, do you?"
c. Medication is given only as a East resort."
d. "There is no medication specific for your condition."
2. The patient asks the nurse, "What is this therapy for anyway. I just don't understand it." the best reply is:
a. "It keeps you from being put on medications."
b. "It helps you to change others in the family."
c. "The purpose of therapy is to help you change."
d. "No one but professionals can really understand
3. For patient in group therapy, the goal is:
a. Exchanging information and ideas
b. Developing insight by relating to others
c. Learning that everyone has problemsd. All of the above
4. In planning care for the patient with a personality disorder, the nurse realizes that this patient will most likely:
a. Not need long-term therapy
b. Not require medication
c. Require anti-anxiety medication
d. Resist any change in behavior
5. The person with an antisocial personality is participating in therapy while a patient at a psychiatric hospital. The nurse’s expectations are that he will:
a. Make a complete recovery
b. Make significant changes
c. Begin the slow process of change
d. Make few changes, if any
6. One of the reasons that persons with antisocial personalities may marry repeatedly or get into trouble with legal authorities is:
a. They usually just don't care
b. They are borderline mentally retarded
c. They are too psychotic to see what’s going on
d. They do not learn from past mistakes
7. The nurse recognizes that these are traits of:
a. Bipolar disorder
b. Alcoholic personality
c. Antisocial personality
d. Borderline personalitySituation: The patient with bipolar disorder is pacing continuously and is skipping meals.
8. Blood levels are drawn on the patient who has been taking Lithium for about six months. The present level is 2.1 meq/L. The nurse evaluates this level as:
a. Therapeutic
b. Below therapeutic
c. Potentially dangerous
d. Fatally toxic
9. The priority in working with patient a thought disorder is:
a. Get him to understand what you're saying
b. Get him to do his ADLs
c. Reorient him to reality
d. Administer antipsychotic medications
10. The most recent Lithium level on bipolar patient indicates a drop non-therapeutic level. What associated behavior does the nurse assess?
a. Ataxia
b. Confusion
c. Hyperactivity
d. Lethargy
11. Adequate fluid intake for a patient on Lithium is:
a. 1,000 ml per day
b. 1,500 ml per day
c. 2,000 ml per day
d. 3,600 ml per day
12. The physician orders Lithium carbonate for the bipolar patient. The nurse is aware that:
a. The patient should be put on a special diet
b. The medication should be given only at night
c. A salt-free should be provided for the patient
d. The drug level should be monitored regularly
13. The nursing plan should emphasize:
a. Offering him finger foods
b. Telling him he must sit down and eat
c. Serving food in his room and staying with him
d. Telling him to order fast food of he wants to eatSituation: Anna, 25 years old was raped six months ago states, "I just can't seem to get over this. My husband and I don't even have sex anymore. What can I do?"
14. Supportive therapy to the rape victim is directed at overwhelming feeling that the victim experiences just after the rape has occurred?
a. Guilt
b. Rage
c. Damaged
d. Despair
15. Anna asks, "Why do I need to have pelvic exam?" The nurse explains:
a. "To make sure you're not pregnant."
b. "To see if you got an infection."
c. "To make sure you were really raped."
d. "To gather legal evidence that is required."
16. In providing support therapy, the nurse explains that rape has nothing to do with sexual desires or heeds. The two most common elements in rape are:
a. Guilt and shame
b. Shame and jealousy
c. Embarrassment and envy
d. Power and anger
17. The rape victim will not talk, is withdrawn and depressed. The defensive mechanism being used is:
a. Rationalization
b. Denial
c. Repression
d. Regression
18. The composite picture of rape victim reveals that most victimized women are:
a. Secretaries
b. Elderly
c. Students
d. Professionals
19. The best intervention is:
a. Tell her it just takes a long time
b. Ask her if her husband is angry
c. Refer her and her husband to sex therapy
d. Tell her she is suffering PTSD
Situation: Obsessions are recurring thoughts that become prevalent in the consciousness and may be considered as senseless or repulsive white compulsion are the repetitive acts that follow obsessive thoughts.
20. To understand the meaning of the cleaning rituals, the nurse must realize:
a. The patient cannot help herself
b. The patient cannot change
c. Rituals relieve intense anxiety
d. Medications cannot help
21. Upon admission to the hospital the patient increases the ritual behavior at bedtime. She cannot sleep. The treatment plan should include:
a. Recommending a sedative medication
b. Modifying the routine to diminish her bedtime anxiety
c. Reminding her to perform rituals early in the evening
d. Limit the amount of time she spends washing her hands
22. A patient has been diagnosed with a personality disorder with .compulsive traits. Of the following behavior's, which one would you expect the patient to exhibit?a. Inability to make decisionsb. Spontaneous playfulness
c. Inability to alter plansd. Insistence that things be done his way
23. The patient will not be able
to stop her compulsive washing routines until she:a. Acq
uires more superegob. Recognizes the behavior is unrealisticc. No longer needs them to manage her feelings of anxiety
d. Regains contact with reality
24. A 48-year-old female patient is brought to the hospital by her husband because her behavior is blocking her ability to meet her family's needs. She has uncontrollable and constant desire to scrub her hands, the walls, floors and sofa. She keeps repeating," Everything is dirty." This is an example of:
a. Compulsion
b. Obsessionc. Delusiond. Hallucination
25. The female patient is preoccupied with rules and regulations. She becomes upset if others do not follow her lead and adhere to the rules exactly. This is a characteristic of which of the following personality?
a. Compulsive
b. Borderline
c. Antisocial
d. Schizoid
26. In planning care focused on decreasing the patient's anxiety, what plan should the nurse have in regards to the rituals?
a. Encourage the routines
b. Ignore rituals
c. Work with her to develop limits of behavior
d. Restrain her from the rituals
27. After the patient entered the hospital she began to increase her ritualistic hand washing at bedtime and could; not sleep. The nurse plans care around the fact that this patient needs:
a. A substitute activity to relieve anxiety
b. Medication for sleeping
c. Anti-anxiety medication such as Xanax
d. More scheduled activities during the day
28. The patient states, "I know all this scrubbing is silly but I can’t help it:'', this statement indicates that the patient does not recognize:
a. What she is doing
b. Why she is cleaning
c. Her level of anxiety
d. Need for medication
Situation: Substance, abuse is a common, growing health problem in this country.
29. The nurse is monitoring a drug abuser who states he was given cocaine and heroine that war cut with cornstarch or some other kind of powder. He states, "It was really bad stuff." Which complication is most threatening to this patient?
a. Endocarditis
b. Gangrene
c. Pulmonary abscess
d. Pulmonary embolism
30. The chronic drug abuser is suffering lymphedema in all extremities, but particularly in the arm where the drug was obviously injected. There is severe obstruction of veins and lymphatics. The nurse suspects the patient used:
a. A dull, contaminated needle
b. A needle contaminated with AIDS
c. Contaminated drugs
d. Cocaine mixed with uncut heroin
31. The nurse is assessing a heroin user who injected the drug into an artery instead of a vein. Which complication is the nurse most likely to expect?
a. Infection
b. Cardiac dysrhythmias
c. Gangrene
d. Thrombophlebitis
32. The nurse is assessing a 16-year-old patient for drug abuse. The patient is incoherent. Because she notes irritation of eyes, nose and mouth, she suspects inhalants. Which sign is most indicative of inhalant abuse?
a. Vomiting
b. Bad breath
c. Bad trip
d. Sudden fear
33. An impaired nurse has been admitted for treatment of Demerol addiction. She asks, "When will the withdrawal begin?" the best response is:
a. "It varies, with each individual."
b. "There is no way to tell."
c. "Withdrawal begins soon after the last dose."
d. "It depends upon how well the Demerol works."
34. The patient has a blood pressure of 180/100, heart rate of 120, associated with extreme restlessness. He is very suspicious of the hospital environment and actions of healthcare workers. The nurse should confront this patient on abuse of;
a. Marijuana
b. Cocaine
c. Barbiturates
d. Tranquilizers
35. The nursing interventions most effective in working with substance dependent patients are:
a. Firm and directive
b. Instillation of values
c. Helpful and advisory
d Subjective and non-judgmental
36. An adolescent patient has bloodshot eyes, a voracious appetite (especially for junk foods), and a dry mouth. Which drug of abuse would the nurse most likely suspect?
a. Marijuana
b. Amphetamines
c. Barbiturates
d. Anxiolytics
Situation: Defense mechanisms are unconscious intrapsychic process implemented to cope with anxiety. The use of some of these mechanisms is healthy, while she use of others is unhealthy.
37. A patient cries and curls in a fetal position refusing to move or talk. This is an example of:
a. Regression
b. Suppression
c. Conversion
d. Sublimation
38. A person who expands sexual energy in a nonsexual, socially accepted way is using the coping mechanism of.
a. Projection
b. Conversion
c. Sublimation
d. Compensation
39. "The reason I did not do well on the exam is that I was tired." This is an example of:
a. Rationalization
b. Projection
c. Compensation
d. Substitution
40. An unattractive girl becomes a very good student. This is an example of:a. displacement
b. Regression
c. Compensation
d. Projection
41. A patient has been sharing a painful experience of sexual abuse during his childhood. Suddenly he stops and says, “l can't remember any more." The nurse assesses his behavior as:
a. Stubbornness
b. Forgetfulness
c. Blocking
d. Transference
42. The patient has a phobia about walking down in dark halls. The nurse recognizes that the coping mechanism usually associated with phobia is:
a. Compensation
b. Denial
c. Conversion
d. Displacement
43. The patient is denying that he is an alcoholic He states that his wife is an alcoholic. The defense mechanism he is utilizing is: v
a. Sublimation
b. Projection
c. Suppression
d. Displacement
Situation: Ms. Dwane, 17 years old, is admitted with anorexia nervosa. You have been assigned to sit with her while she eats her dinner. Ms. Dwane says "My primary nurse trusts me. I don't see why you don't."
44. Which observation of the client with anorexia nervosa indicates the client is improving?
a. The client eats meats in the dining room
b. The client gains one pound per week
c. The client attends group therapy sessions
d. The client has a more realistic self-concept
45. The nurse is caring for a client with anorexia nervosa who is to be placed on behavioral modification. Which is appropriate to include in (he nursing care plan?
a. Remind the client frequently to eat all the food served on the tray
b. Increased phone calls allowed for client by one per day for each pound gained
c. Include the family of the client in therapy sessions two times per week
d. Weigh the client each day at 6:00 am in hospital gown and slippers after she voids
46. A nursing intervention based on the behavior modification model of treatment for anorexia nervosa would be:
a. Role playing the client's interaction with her parents
b. Encouraging the client to vent her feelings through exercise
c. Providing a high-calorie, high protein diet with between meals snacks
d. Restricting the client's privileges until she gains three pounds
47. While admitting Ms. Dwane, the nurse discovers a bottle of pills that Ms. Dwane calls antacids. She takes them because her stomach hurts. The nurse's best initial response is:
a. Tell me more about your stomach pain
b. These do not look like antacids. I need to get an order for you to have them
c. Tell me more about you drug use
d. Some girls take pills to help them lose weight
48. The primary objective in the treatment of the hospitalized anorexic client is to:
a. Decrease the client's anxiety
b. Increase the insight into the disorder
c. Help the mother to gain control
d. Get the client to ea and gain weight
49. Your best response for Ms. Dwane is:
a. I do trust you, but I was assigned to be with you
b. It sounds as if you are manipulating me
c. Ok, when I return, you should have eaten everything
d. Who is your primary nurse?
Situation: The nurse suspects a client is denying his feelings of anxiety
50. The nurse is monitoring a patient who is experiencing increasing anxiety related to recent accident. She notes an increase in vital signs from 130/70 to 160/30, pulse rate of 120, respiration
36. He is having difficulty communicating. His level of anxiety is:
a. Mild
b. Moderate
c. Severe
d. Panic
51. The patient who suffers panic attacks is prescribed a medication for short-term therapy. The nurse prepares to administer.
a. Elavil
b. Librium
c. Xanax
d. Mellaril
52. In attempting to control a patient who is suffering panic attack, the nursing priority is:
a. Provide safelyb. Hold the patientc. Describe crisis in detail
d. Demonstrate ADLs frequently
53. Which assessment would the nurse most likely find in a person who is suffering increased anxiety?
a. Increasing BP, increasing heart rate and respirations
b. Decreasing BP, heart rate and respirations
c. Increased BP and decreased respirations
d. Increased respirations and decreased heart rate
54. A patient who suffers an acute anxiety disorder approaches the nurse and while clutching at his shirt states "I think I'm having a heart attack." The priority nursing action is:
a. Reassure him he is OK
b. Take vital signs stat
c. Administer Valium IM
d. Administer Xanax PO
55. In teaching stress management, the goal of therapy is to:
a. Get rid of the major stressor
b. Change lifestyle completely
c. Modify responses to stress
d. Learn new ways of thinking
56. Another client walks in to the mental health outpatient center and States, "I've had it. I can't go on any longer. You've got to help me. "The nurse asks the client to be seated in a private interview room. Which action should the nurse take next?
a. Reassure the client that someone will help him soon
b. Assess the client's insurance coverage
c. Find out more about what is happening to the client
d. Call the client's family to come and provide support
57. Mr. Juan is admitted for panic attack. He frequently experiences shortness of breath, palpitations, nausea, diaphoresis, and terror. What should the nurse include in the care plan for Mr. Juan? When he is shaving a panic attack?
a. Calm reassurance, deep breathing and medications as ordered
b. Teach Mr. Juan problem solving in relation to his anxiety
c. Explain the physiologic responses of anxiety
d. Explore alternate methods for dealing with the cause of his anxiety
58. Ms. Wendy is pacing about the unit and wringing his hands. She is breathing rapidly and complains of palpitations and nausea, and she has difficulty focusing on what the nurse is saying. She says she is having a heart attack but refuses to rest. The nurse would interpret her level of anxiety as:
a. Mild
b. Moderate
c. Severe
d. Panic
59. When assessing this client, the nurse must be particularly alert to:
a. Restlessness
b. Tapping of the feet
c. Wringing of the hands
d. His or her own anxiety level
Situation: Raul aged 70 was recently admitted to a nursing home because of confusion, disorientation, and negativistic behavior. Her family states that Raul is in good health. Raul asks you, "Where am I?"
60. Another patient, Mr. Pat, has been brought to the psychiatric unit and is pacing up and down the hall. The nurse is to admit him to the hospital. To establish a nurse-client relationship, which approach should the nurse try first?
a. Assign someone to watch Mr. Pat until he is calm
b. Ask Mr. Pat to sit down and orient him to the nurse's name and the need for information
c. Check Mr. Pat's vital signs, ask him about allergies, and call the physician for sedation
d. Explain the importance of accurate assessment data to Mr. Pat .
61. If Raul will say "I'm so afraid! Where I am? Where is my family'?" How should the nurse respond?
a. "You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is one hour from now"
b. "You know were you are. You were admitted here 2 weeks ago. Don’t worry your family will be back soon."
c. "I just told you that you're in the hospital and your family will be here soon."
d. "The name of the hospital is on the sigh over the door. Let's go read it again."
62. Raul has had difficulty sleeping since admission. Which of the following would be the best intervention?
a. Provide him with glass of warm milk
b. Ask the physician for a mild sedative
c. Do not allow Raul to take naps during the day
d. Ask him family what they prefer
63. Which activity would you engage in Raul at the nursing home?
a. Reminiscence groups
b. Sing-along
d. Discussion groups
c. Exercise class
64. Which of the following would be an appropriate strategy in reorienting a confused client to where her room is?
a. Place pictures of her family on the bedside stand
b. Put her name in large letters on her forehead
c. Remind the client where her room is
d. Let the other residents know where the client’s room is
65. The best response for the nurse to make is:
a. Don't worry, Raul. You're safe here
b. Where do you think you are?
c. What did your family tell you?
d. You're at the community nursing home
Situation: The police bring a patient to the emergency department. He has been locked in his apartment for the past 3 days, making frequent calls to the police and emergency services and stating that people are trying to kill him.
66. A client on an inpatient psychiatric unit refuses to eat and states that the staff is poisoning her food. Which action should the nurse include in the client's care plan?
a. Explain to the client that the staff can be trusted
b. Show the client that others eat the food without harm
c. Offer the client factory-sealed foods and beverages
d. Institute behavioral modification with privileges dependent on intake
67. The client tells the nurse that he can't eat because his food has been poisoned. This statement is an indication of which of the following?
a. Paranoia
b. Delusion of persecution
c. Hallucination
d. Illusion
68. The client on antipsychotic drugs begins to exhibit signs and symptoms of which disorder?
a. Akinesia
b. Pseudoparkinsonism
c. Tardive dyskinesia
d. Oculogyric crisis
69. During a patient history, a patient state that she used to believe she was God. But she knows this isn't true. Which of the following would be your best response?"
a. "Does it bother you that you used to believe that about yourself?"
b. "Your thoughts are now more appropriate"
c. "Many people have these delusions."
d. "What caused you to think you were God?"
70. The nurse is caring for a client who is experiencing auditory hallucination. What would be most crucial for the nurse to assess?
a. Possible hearing impairment
b. Family history of psychosis
c. Content of the hallucination
d. Otitis media
71. A patient with schizophrenia reports that the newscaster on the radio has a divine message especially for her. You would interpret this as indicating.
a. Loose of associations
b. Delusion of reference
c. Paranoid speech
d. Flight of ideas
72. What type of delusions is the patient experiencing?
a. Persecutory
b. Grandiose
c. Jealous
d. Somatic
Situation: Helen, with a diagnosis of disorganized schizophrenia is creating a disturbance in the day room. She is yelling and pointing at another patient, accusing him to stealing her purse. Several patients are in the day room when this incident starts.
73. The nurse is preparing to care for a client diagnosed with catatonic schizophrenia. In anticipation of this client's arrival, what should the nurse do?a. Notify security
b. Prepare a magnesium sulfate drip
c. Place a specialty mattress overlay on the bed
d. Communicable the client's nothing-by-mouth status to the dietary department
74. The nurse is caring for a client whom she suspects is paranoid. How would the nurse confirm this assessment?
a. indirect questioning
b. Direct questioning
c. Les-ad-in-sentences
d. Open-ended sentences
75. Which of the following is an example of a negative symptom of schizophrenia?
a. Delusions
b. Disorganized speech
c. Flat affect
d. Catatonic behavior
76. The patient tells you that a "voice" keeps laughing at him and tells him he must crawl on his hands and knees like a dog. Which of the following would be the most appropriate response?
a. "They are imaginary voices and we're here to make them go, away."
b. "If it makes you feel better, do what the voices tell you."
c. "The voices can't hurt you here in the hospital"
d. "Even though I don't hear the voices, I understand that you do."
77. A 23-year-old patient is receiving antipsychotic medication to treat his schizophrenia. He's experiencing some motor abnormalities called extrapyramidal effects. Which of the following extrapyramidal effects occurs most frequently in younger make patients?
a. Akathisia
b. Akinesia
c. Dystonia
d. Pseudoparkinsonism
78. Which of the following should you do next?
a. Firmly redirect the patient to her room to discuss the incident
b. Call the assistance and place the patient in locked seclusionc
. Help the patient look for her purse
d. Don't intervene - the patients need a little bit of room in which to work out differences
Situation: John is admitted with a diagnosis of paranoid schizophrenia.
79. You're reaching a community group about schizophrenia disorders. You explain the different types of schizophrenia and delusional disorders. You also explain that, unlike schizophrenia, delusional disorders:
a. Tend to begin in early childhood
b. Affect more men than women
c. Affect more women than men
d. May be related to certain medical conditionsa
80. A patient with schizophrenia (catatonic type) is mute and can't perform activities of daily living. The patient stares out the window for hours. What is your first priority in this situation?
a. Assist the patient with feeding
b. Assist the patient with showering and tasks for hygiene
c. Reassure the patient about safely, and try to orient him to his surroundings
d. Encourage, socialization with peers, and provide a stimulating environment
81. Which of the following would you suspect in a patient receiving Chlorpromazine (Thorazine) who complains of a sore throat and has a fever?
a. An allergic reaction
b. Jaundicec
. Dyskinesia
d. Agranulocytosis
82. While providing information for the family of a patient with schizophrenia, you should be sure to inform them about which of the following characteristics of the disorder?
a. Relapse can be prevented if the patient takes medication
b. Support is available to help family members meet their own needs
c. Improvement should occur if the patient's environment is carefully maintained
d. Stressful situations in the family in the family can precipitate a relapse in the patient
83. While caring for John, the nurse knows that John may have trouble with:
a. Staff who are cheerful
b. Simple direct sentencesc. Multiple commands
d. Violent behaviors
84 Which nursing diagnosis is most likely to be associated with a person who has a medical diagnosis of schizophrenia, paranoid type?
a. Fear of being along
b. Perceptual disturbance related to delusion of persecution
c. Social isolation related to impaired ability to trust
d. Impaired social skills related to inadequate developed superego
85. Which of the following behaviors can the nurse anticipate with this client?
a. Negative cognitive distortions
b. Impaired psychomotor development
c. Delusions of grandeur and hyperactivity
d. Alteration of appetite and sleep pattern
Situation: A client is admitted to the hospital. During the assessment the nurse notes that the client has not slept for a week. The client is talking rapidly, and throwing his arms around randomly.
86. When writing an assessment of a client with mood disorder, the nurse should specify:
a. How flat the client's affect
b. How suicidal the client is
c. How grandiose the client is
d. How the client is behaving
87. It is an apprehensive anticipation of an unknown danger:
a. Fear
b. Anxiety
c. Antisocial
d. Schizoid
88. It is an, emotional response to a consciously recognized threat.
a. Fear
b. Anxiety
c. Antisocial
d. Schizoid
89. All but one is an example of situational crisis:
a. Menstruation
b. Role changes
c. Rape
d. Divorce
90. What would be the highest priority in formulating a nursing care plan for this client?
a. Isolate the client until he or she adjusts to 'the hospital
b. Provide nutritious food and a quite place to rest
c. Protect the client and others from harm
d. Create a structured environment
Situation: Wendell, 24 year-old student with a primary sleep disorder, is unable to initiate maintenance of sleep. Primary sleep disorders may be categorized as dyssomnias or parasomnias.
91. The nurse is caring for a client who complains; of fat?gue, inability to concentrate, and palpitations. The client stales that she has been experiencing these symptoms for the past 6 months. Which factor in the client’s history has most likely contributed to.these symptoms?
a. History of recent fever
b. Shift work
c. Hyperthyroidism
d. Fear
92. If Wendell complains of experiencing an overwhelming urge to sleep and states that he's been falling asleep while studying and reports that these episodes occur about 5 times daily Wendell is most likely experiencing which sleep disorder?
a. Breathing-related sleep disorder
b. Narcolepsy
c. Primary hypersomnia
d. Circadian rhythm disorder
93. The nurse is preparing a teaching plan for a client diagnosed with primary insomnia. Which of the following teaching topics should be included in the plan?
a. Eating unlimited spicy foods, and limiting caffeine and alcohol
b. Exercising 1 hour before bedtime to promote sleep
c. Importance of steeping whenever the client tires
d. Drinking warm milk before bed to induce sleep
94. Examples of dyssomnia includes:
a. Insomnia, hypersomnia, narcolepsy
b. Sleepwalking, nightmare
c. Snoring while sleeping
d. Non-rapid eye movementSituation: The following questions refer to therapeutic communication.
95. When preparing to conduct group therapy, the nurse keeps in mind that the optimal number of clients in a group would be:
a. 6 to 8
b. 10 to 12
c. 3 to 5
d. Unlimited
96. What occurs during the working phase of the-nurse-client relationship?
a. The nurse assesses the client's needs and develops a plan of care
b. The nurse and client together evaluate and modify the goals of the relationship
c. The nurse and client discuss their feelings about terminating the relationship
d. The nurse and client explore each other's expectations of-the relationship
97. A 42 year-old homemaker arrives at the emergency department with uncomfortable crying and anxiety. Her husband of 17 years has recently asked her for a divorce. The patient is sitting in a chair, rocking back and forth. Which is the best response for the nurse to make?
a. "You must stop crying so that we can discuss your feelings about the divorce."
b. "Once you find a job, you will feel much better and more secure."
c. "I can see how upset you are. Let's sit in the office so that we can talk about how you're feeling."
d. "Once you have a lawyer looking out for your interests, you will feel better."
98. A client on the unit tells the nurse that his wife's nagging really gets on his nerves. He asks the nurse if she will talk with his wife about nagging during their family session tomorrow afternoon. Which of the following would be most therapeutic response to client?
a. "Tell me more specifically about her complaints"
b. "Can you think why she might nag you so much?"
c. "I'll help you think about how to bring this up yourself tomorrow."
d. "Why do you want me to initiate this discussion in tomorrow's session rather than you?"
99. The nurse is working with a client who has just stimulated her anger by using a condescending tone of voice. Which of the following responses by the nurse would be the most therapeutic?
a. "I feel angry when I hear that tone of voice"
b. "You make me so angry when you talked to me that way."
c. "Are you trying to make me angry?
"d. "Why do you use that condescending tone of voice with me?"
100. A 35 year-old client tells the nurse that he never disagrees with anyone and that he has loved everyone he's ever known. What would be the nurse's best response to this client?
a. "How do you manage to do that?"
b. "That's hard to believe. Most people couldn't to that."
c. "What do you do with your feelings of dissatisfaction or anger?"
d. "How did you come to adopt such a way of
1. An observation consistent with complete-airway obstruction is:
a. Loud crowing when attempting to speak
b. Inability to cough
c. Wheezes on auscultation
d. Gradual
2. The nurse assesses the client's home environment for the safe use crutches. Which one of the following would pose the greatest hazard to the client's safe use of crutches at home?
a. A 4-year old cocker spaniel
b. Scatter rugs
c. Snack tables d. Diet high in fat
3. A patient who has kaposis sarcoma has all of the following nursing diagnoses. To which one should the nurse give priority?
a. Altered thought processes related to lesions
b. Altered with maintenance related to non compliance
c. Defensive coping related to loss of boundaries
d. Hopelessness, related to inability to control disease process
4. Which of the following statements, if made by a patient who has had a basal cell carcinoma removed, would indicate to the nurse the need for further instruction?
a. "I will use sunscreen with at least a sun protection factor (SPF) of 15.”
b. "I will use tanning booths rather than sunbathing from now on."
c. "I will stay out of the sun between 10:00 AM and 2:00 PM"
d. "I will wear a broad - brimmed heat when I am in the sun"
5. A patient who has a diagnosis is metastatic cancer of the kidney is told by the physician that the kidney needs to be removed. The patient asks the nurse. "What should I do?" Which of the following responses by the nurse would be most therapeutic?
a. "Let's talk about your options."
b. "You need to follow the doctor's advice."
c. "What does your family want you to do."
d. "I wouldn't have the surgery done without a second opinion.
6. Which of these groups should a nurse target when planning a community education presentation about testicular cancer?
a. Day care providers
b. Senior citizens
c. Middle - aged men
d. High - school students
7. A woman reports all of the following data when giving his history to a nurse. Which one would indicate a risk factor for developing cancer of cervix?
a. Diet high in fat
b. Exposure to pesticides
c. "What does your family want you to do."
d. "I wouldn't have the surgery done without a second opinion."
8. A nurse is planning a community education presentation about testicular cancer. The large groups should be men aged:
a. 20 to 39 years
b. 40 to 49 years
c. 50 to 64 years
d. 65 years and older
9. A 10-year-old boy who is in the terminal stages of Duchenne muscular dystrophy is being cared for at home. When evaluating for major complications of this disease, a nurse would give priority to assessing which of the following body systems?
a. Integumentary
b. Neurological
c. Respiratory
d. Gastrointestinal
10. Which of the following conditions, reported to a nurse by a 20 year old male patient, would indicate a risk for development of testicular cancer?
a. Genital Herpes
b. Undescended testicle
c. Measles
d. Hydrocele
11. A client has been diagnosed as having bladder cancer, and a cystectomy and an ileal conduit are scheduled. Preoperatively, the nurse plans to:
a. Limit fluid intake for 24 hours
b. Teach muscle tightening exercises
c. Teach the procedure for irrigation of the stoma
d. Provide cleansing enemas and laxatives as ordered
12. To gain access to a vein and an artery, an external shunt may be used for clients who require hemodialysis. The most serious problem with an external shunt is.
a. Septicemia
b. Clot-formation
c. Exsanguination
d. Sclerosis of vessels
13. A client has been diagnosed as having bladder cancer, and a cystectomy and an ileal conduit are scheduled. Preoperatively, the nurse plans to:
a. Limit fluid intake for 24 hours
b. Teach the procedure for irrigation of the stoma
c. Teach muscle-tightening exercises
d. Provide cleansing enemas and laxatives as ordered
14. Intramedullary nailing is used in the treatment of:
a. Slipped epiphysis of the femur
b. Fracture of shaft of the femur
c. Fracture of the neck of the femur
d. Intertrochanteric fracture of the femur
15. The nurse should know that, following a fracture of the neck of the femur, the desirable position for the
a. Internal rotation with extension of the knee
b. Internal rotation with flexion of the knee and hip
c. External rotation with flexion of the knee and hip
d. External rotation with extension of the knee and hip
16. A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by:
a. Stimulating the cerebral cortex
b. Blocking the action of cholinesterase
c. Replacing deficient neurotransmitters
d. Accelerating transmission along neural swaths1
7. A client with myasthenia gravis ask the nurse why the disease has occurred. The nurse bases the reply on the knowledge that there is:
a. A genetic in the production acetylcholine
b. A reduced amount of neurotransmitter acetylcholine
c. A decreased number of functioning acetylcholine receptor sites
d. An inhibition of the enzyme ACHE leaving the end plates folded
18. A client with an inflamed sciatic nerve is to have a conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit the nurse should
a. Maintain the same dial setting everyday
b. Turn the machine several times a day for 10 to 20 minutes
c. Adjust the TENS dial until the client perceives pain relief and comfort
d. Apply the color-coded electrodes anywhere it is comfortable for the client
19. Although no cause has been determined for scleroderma, it is thought to be caused by:
a. Autoimmunity
b. Ocular motility
c. Increased amino acid metabolism
d. Defective sebaceous gland formation
20. The nurse must help the client with pemphigus vulgaris deal with the resulting:
a. Infertility
b. Paralysis
c. Skin lesions
d. Impaired digestion
21. The nurse should explain to the client with psoriasis that treatment usually involves:
a. Avoiding exposure to the sum
b. Topical application of steroids
c. Potassium permanganate baths
d. Debridement of necrotic plaques
22. The nurses should assess a client with psoriasisa. Pruritic lesionsb. Multiple petechiaec. Shiny, scaly lesionsd. Erythematous macules23. A urine specimen for ketones should be removed from a client's retention catheter by:
a. Disconnecting the catheter and draining it into a clean container
b. Cleansing the drainage valve and removing it from the catheter bag
c. Wiping the catheter with alcohol and draining it into a sterile test tube
d. Using a sterile syringe to remove it from clamped, cleansed catheter
24. Following an abdominal cholecystectomy, the nurse should assess for signs of respiratory complications because the:
a. Incision is in close proximity to the diaphragm
b. Length of time required for surgery is prolonged
c. Client's resistance is lowered because of bile in the blood
d. Bloodstream is invaded by microorganisms from the biliary tract
25. The nurse assess the client with cholecystitis for the development of obstructive jaundice, which would be evidenced by:
a. Inadequate absorption of fat-soluble K
b. Light amber urine, dark brown stools, yellow skin
c. Dark-colored urine, clay colored stools, itchy skin
d. Straw-colored urine, putty-colored stools, yellow sclerae
26. A client with cholelithiasis experience discomfort after ingesting fatty foods because.
a. Fatty foods are hard to digest
b. Bile flow into the intestine is obstructed
c. The liver is manufacturing inadequate bile
d. There is inadequate closure of the Ampulla of Vater
27. The chief complaint in a client with Vincent's Angina is:
a. Chest pain
b. Shortness of breath
c. Shoulder discomfort
d. Bleeding oral ulcerations
28. Clients with fractured mandibles usually have them immobilized with wires. The life-threatening problem that can develop postoperatively is:
a. Infection
b. Vomiting
c. Osteomyelitis
d. Bronchospasm
29. As a result of fractured ribs, the client may develop:
a. Scoliosis
b. Paradoxical respiration
c. Obstructive lung-disease
d. Hernation of the diaphragm
30. A client has a bone marrow aspiration performed, immediately after the procedure, the nurse should:
a. Position the client on the affected side
b. Begin frequent monitoring of vital signs
c. Cleanse the site with an antiseptic solution
d. Briefly apply pressure over the aspiration site
31. Following a bilateral lumbar sympathectomy a client has a sudden drop in blood pressure but no. evidence of bleeding. The nurse recognizes that this is most likely caused by:
a. An inadequate fluid intake
b. The after effects of anesthesia
c. A reallocation of the blo6d supply
d. An increased level of epinephrine
32. The occurrence of chronic illness is greatest in:
a. Older adult
b. Adolescents
c. Young children
d. Middle-aged adults
33. A client with full-thickness burns on the chest has a skin graft. During the 1s124 hours after a skin graft, care of the donor site includes immediately reporting.
a. Small amount of yellowish green oozing
b. A moderate area of serosanguinous oozing
c. Epithelialization under the non-adherent dressing
d. Separation of the edges of the non-adherent dressing
34. During peritoneal dialysis the nurse observes that drainage of dialysate from the peritoneal cavity has ceased before the required amount has drained out The nurse should assist the client to:
a. Turn from side to side
b. Drink 8 ounces of water
c. Deep breathe and cough
d. Periodically rotate the catheter
35. A client has ear surgery. An early response that may be associated with possible damage to the motor branch of the facial nerve is:
a. A bitter metallic state
b. Dryness of the lips and mouth
c. A sensation of pain behind the ear
d. An inability to wrinkle the forehead
36. After a prostatectomy, a client complains of painful bladder spasms. To limit these spasms the nurse should:
a. Administer a narcotic every 4 hours
b. irrigate the Foley catheter with 60 ml of normal saline
c. Encourage the client not to contract his muscles as if he were voiding
d. Advance the catheter to relieve the pressure against the prostatic fossa
37. After 1 week a client with acute renal failure moves, into the diuretic phase. During this phase the client must be carefully assessed for signs of:
a. Hypovolemia
b. Hyperkalemia
c. Metabolic acidosis
d. Chronic renal failure
38. The nurse checks for hypocalcemia by placing a blood pressure cuff on a client's arm and inflating it. After about 3 minutes the client develops carpopedial spasm. The nurse records this finding as a positive:
a. Homan's sign
b. Romberg sign ]
c. Chvostek's skin
d. Trosseau's sign
39. A nurse stops at the scene of an accident and finds a man with a deep laceration on his hand, a fractured am and leg, and abdominal pain. The nurse wraps the man's hand in soiled cloth and drives him to the nearest hospital. The nurse is:
a. Negligent and can be sued for malpractice
b. Practicing under guidelines of the Nurse Practice Act
c. Protected for these actions, in most states, buy the Good Samaritan Law
d. Treating a health problem that can and should be handled by a physician
40. A client is scheduled for a below-the-knee amputation of the right leg. Legally, the client may not sign the operative consent if:
a. Ambivalent feelings regarding operation are present
b. Any sedative type of medication has recently been administration
c. A discussion of alternative with 2 physicians have not been performed and recorded
d. A complete history and physical have not been performed
41. The nurse is assigned to check a client's continuous bladder irrigation. Which one of the following solution is normally used for continuous or intermittent bladder and catheter irrigations?
a. Hydrogen peroxide
b. Bacteriostatic water
c. Sterile normal saline
d. Plain water
42. When continuous bladder irrigation is used following prostate surgery, the rate of flow is adjusted:
a. To run at 60 drops per minutes
b. According to the client's oral intake
c. To maintain an output of 500 ml every 8 hours
d. To keep the drainage to light pink
43. The nurse is assigned to teach a class in health behaviors to young man. Which of the following can be stated as a probably cause of cancer of the penis?
a. A diet high in acidic foods
b. Poor personal hygiene
c. Exercise
d. Circumcision
44. The nurse is assigned to give perineal care to an uncircumcised male client. Which of the following is correct?
a. The anal area is washed at a separate time
b. The foreskin is retracted and the area beneath the foreskin is cleansed
c. The foreskin should not be retracted except by a physician
d. The scrotum is carefully washed with sterile normal saline
45. A female nurse is assigned to obtain a history from & client with a urinary tract problem an sexual dysfunction. Which of the following statements might place the client more at ease and willing to give a. history of his problem?
a. "When dud you first notice this problem?
b. "Why do you think you have a problem?"
c. "Do you think you sexual dysfunction is psychological?"
d. "Does your sexual dysfunction seem to be related to your urinary tract problem?"
46. A client is scheduled for an ultrasound examination of the prostate. To describe the procedure to the client, the nurse should plan to relate that:
a. The procedure is performed using a cystoscope
b. A probe will be inserted into the rectum
c. A flat disk is placed on the abdomen
d. This procedure uses x-rays to produce a visual image
47. To effectively teach men the importance of testicular self-examination, the nurse should know that testicular carcinoma:
a. Rarely metastasizes
b. Has a high incidence of early metastasis
c. Cannot be detected by laboratory tests
d. Must first be biopsied to confirm the diagnosis
48. A nurse is assigned to instruct a client in the method of testicular self-examination. The instruction should include mention that the best time to perform this task is:
a. Immediately after getting out of bed in the morning
b. Immediately before going to bed
c. In the morning after breakfast
d. After a warm bath or shower
49. Mr. Dorn has vasectomy. He asks the nurse why he just use a method of birth control because today he, had a sterilization procedure. The most correct answer is:
a. The sperm count will not be negative until his testosterone level decrease
b. Some minor surgery usually is necessary to ensure sterilization
c. Some live sperm will be present in the ejaculatory fluid for a period of time
d. Even though a vasectomy is performed, a condom is still recommended for 1 to 2 years
50. A client is scheduled for a cystectomy and asks the nurse what the physician will be able to see during the procedure. The most correct reply is the:
a. Kidney and ureters
b. Bladder and rectum
c. Prostate and ureters
d. Urethra and bladder
51. Nurse assistant attending a nursing conference hears that one of her clients has hydrocele. She asks the nurse how this condition is treated. The most common response is:
a. Usually the problem requires more medical or surgical intervention
b. Surgery may be necessary to correct the problem
c. Wearing a scrotal support usually corrects She problem
d. Drug therapy usually helps control the collection of fluid
52. The nurse is participating in a health class for young women. One subject is cancer of the ovary. Which of the following statements is correct?
a. Early symptoms of cancer of the ovary are vague
b. This type of cancer has a high cure rate
c. Chemotherapy is not used for treating ovarian cancer
d. The most prominent early symptoms is an irregular menstrual cycle
53. The nurse is asked to discuss the signs and symptoms of vaginitis caused by the fungus candida albicans with Ms. Barrows. Which one of the following is a usual sign and symptoms of this infection?
a. Pain high in the abdomen
b. Intensive vaginal and perineal itching
c. Decrease in urinary output
d. High fever
54. The nurse prepares to give Ms. Edwards a vaginal suppository, which is inserted by means of a special applicator supplied with the drug. Which one of the following is correct?
a. Ask the client to void prior to inserting the suppository
b. Lubricate the tip of the suppository with petroleum jelly
c. Insert the applicator tip gently and with an upward and forward motion
d. Insert the applicator approximately ½ inch and depress the plunger
55. The nurse is assigned to give Ms. Milton perineal care. When cleansing the perineum, the cotton ball or wash cloth is gently directed:
a. Side to side across the labia majora
b. Downward from the pubic area to the anus
c. Upward from the anus to the pubic area
d. Prom the urinary meatus to the vagina
56. The nurse is assigned to administer a vaginal irrigation (douche). Which of the following is correct?
a. The irrigation is best administered with the client standing in a bathtub
b. Before inserting, the nozzle is lubricated with petroleum jelly
c. The temperature of the solution should be between 80°F and 84°F
d. The nozzle is inserted downward and backward within the vagina
57. The nurse is assigned to teach health-seeking behaviors to young women. One topic the nurse plans to includes is the importance of the Pap test, which is used mainly to detect:
a. Ovarian cyst
b. Patency of the fallopian tube
c. Cervical cancer
d. Uterine infections
58. The physician asks the nurse to position a client for a vaginal examination. Which of the following position is normally used for this type of examination?
a. Lithotomy position
b. Sim's position
c. Dorsal recumbent position
d. Left lateral position
59. Ms. Hull has had an electrocauterization of her cervix for chronic cervicitis. Following the procedure the nurse should instruct Ms. Hull to:
a. Douche the next day to remove debris and blood cloth
b. Avoid straining and heavy lifting until the physician permits this activity
c. Stay in bed for the next 5 days
d. Return in bed for the next 5 days
60. The nursing assistant is assigned to give Ms. Bailey, who has had an abdominal hysterectomy, a sitz bath. She is instructed to use the special sitz bath tub. She asks the nurse why the regular bath tub cannot be used. The most correct reply is based on the fact that a regular bath tab:
a. Is more slippery and is dangerous when used for surgical clients
b. Cannot supply water that is of the desired temperature for this procedure
c. Applies heat to the legs and alters the desired effect of heat directed to the pelvic region
d. Cannot be kept as clean as a special sitz bath tub
61. The physician asks the nurse to describe the laparoscopy procedure for sterilization to Ms. Bruce. Which of the following is part of a correct explanation of this procedure?
a. Two small abdominal incisions are made to introduce the instrument
b. Hospitalization for 4 to 5 days is normally required
c. This procedure is performed vaginally
d. This procedure requires the consent of the sexual partner
62. The nurse is asked to plan a health teaching program for women of child-bearing age with genital herpes. Which one of the following should the nurse include in a teaching session?
a. The physician will prescribe an antiviral drug as a pregnancy is confirmed
b. Genital herpes in the mother-has no effect on the infant
c. Wait until the infection has been cured before becoming pregnant
d. If pregnant, in form the physician of a history of genital herpes
63. Ms. Manning is scheduled for Papanicolaou test (Pap Smear) at the time of the next visit to the physician's office. Which one of the following instructions should the nurse give to Ms. Manning?
a. Do not douche for 2 to 3 days before this test
b. Do not drink coffee or alcoholic beverages for 2 days before this test
c. It will be necessary to fast from midnight the night before the test
d. Bring a sanitary napkin with you because bleeding usually occurs after this week
64. The nurse obtains a health history from Ms. Reeves who states that she usually has symptoms when she ovulates. If Ms. Reeves has a normal menstrual cycle, how many days after ovulation should menstruation begin?
a. 3 days
b. 7 days
c. 14 days
d. 21 days
65. The physician asks the nurse to discuss the use of an oral contraceptive with Ms. Sheppard. The nurse should instruct Ms. Sheppard that oral contraceptive:
a. Are taken at the same time each day, preferably in the evening
b. Must be taken on an empty stomach
c. Are started on the first day of menstruation
d. Are best taken in the morning before breakfast
66. Ms. Dodd has been told by her physician that she has genital warts, which are caused by a human .papilloma-virus-infection. She asks the nurse if there is any danger or problems associated with this condition. The most correct response-is based on the fact that genital warts:
a. Can be treated with an antibiotic, such as penicillin or tetracycline
b. Appear to increase the risk of cancer of the vulva, vagina, and cervix
c. Can be prevented of the individual takes birth control pills
d. Are of no danger and need not be treated
67. Which of the following are included in the instructions for a client having a pelvic examination?
a. Self-administer an enema or take a laxative for 2 nights prior to the examination
b. Void immediately before the examination
c. Douche the day before the examination
d. Do not eat or drink fluids after midnight
68. The nurse is assigned to teach young women attending a gynecology clinic. The physician suggests that the nurse include explaining ways to prevent toxic shock syndrome. Which one of the following suggestions can be included in this teaching session?
a. Avoid using super absorbed tampons
b. Take a diuretic at the onset of menstruation
c. Avoid the use of large sanitary pads
d. Use a tampon on(y during the night
69. Which of the following solutions would be best for the nurse to use when cleaning the inner cannula of a tracheostomy tube?
a. IsopropyI alcohol
b. Sodium hydrochloride
c. Hydrogen peroxide
d. Providone-iodine
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