Exam Review

The nurse is educating clients about recovery from alcohol abuse. Which statement by the client indicates that learning has occurred?
A)
I realize that recovery is a lifelong process that comes in steps.
B)
Once I have detoxed, my recovery is complete.
C)
I understand that the goal of my recovery is to decrease my drinking.
D)
Al-Anon can assist me in my recovery process.
A client with bipolar disorder is refusing to take mood stabilizers due to weight gain. To increase the patient’s adherence to a medication regimen, what measures could the nurse teach the client? (SELECT ALL THAT APPLY)
(SATA)
A)
Have cut vegetables prepared for a snack instead of chips or cookies.
B)
Extended-release forms of medications have fewer side effects when dissolved in water.
C)
Weigh yourself once in the morning and once in the evening using the same scale.
D)
Drink flavored water instead of soft drinks.
E)
Walk 30 minutes per day, 5 days per week.
A client with major depressive disorder has been taking fluoxetine, an SSRI, for 5 weeks. During the first outpatient visit, the client smiles and states, “I feel like a great weight is off my chest.” How should the nurse interpret this behavior change?
A)
The client’s behavioral change is expected after the time period of medication.
B)
The client may have worked out details of their suicide plan.
C)
The medication dosage should be decreased and a mood stabilizer added.
D)
The medication has potentiated serotonin syndrome.
A nurse is teaching the parents of a child who has ADHD about methylphenidate. Which of the following statements should the nurse include in the teaching?
A)
This medication might increase the amount of saliva your child produces.
B)
Administer the medication at bedtime.
C)
Your child might gain weight while taking this medication.
D)
Restrict your child’s intake of caffeine while she is taking this medication.

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Exam Review

A nurse is preparing to administer fluoxetine 40 mg PO daily. The amount available is fluoxetine 20 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer:2 mL
A fifteen-year-old was referred to the adolescent mental health clinic after being arrested for prostitution. The client’s parents reported that they have run away several times and are abusive towards them. The nurse should anticipate that the diagnosis will be:
A)
Childhood depression
B)
Oppositional Defiant Disorder
C)
Conduct Disorder
D)
Autism Spectrum Disorder
The spouse of a client who is diagnosed with an alcohol use disorder requests information from the nurse about support groups to help the family cope with the effects of the client’s drinking on the family. Which statement by the spouse would suggest the teaching has been effective? The spouse states:
A)
We can call Alcoholics Anonymous (AA) and go to a closed meeting to see what happens inside.
B)
We should wait until the client is ready to stop drinking before the family goes to support meetings.
C)
The family can go to Al-Anon meetings for support.
D)
Support groups are an option for the client, not the family.
A client diagnosed with bipolar disorder is experiencing a severe depressive episode. Which client behavior would alert the nurse to the highest priority intervention? The client:
A)
Is not responding to other clients on the unit.
B)
Is refusing to take their prescribed mood stabilizer.
C)
Angrily argues with another client stating, “God is dead.”
D)
States, “There is no future when you feel so depressed.”

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Exam Review

A client is to receive a continuous Heparin infusion at s00 units per hour. Pharmacy supplies Heparin in a concentration of 25,000 units per 250mL of NSS. Calculate the rate at which the nurse should set the infusion pump.
Correct Answer:5 mL/hour
A nurse is providing care for a client who is malnourished and appears exhausted. What data would cause the nurse to suspect the client is a victim of human trafficking? The client:
A)
Is from another state and says they are here on a long vacation.
B)
Has a cell phone that is not working in the emergency department.
The nurse is caring for a client with alcohol use disorder. Which of the following nursing interventions is appropriate for a client to prevent Korsakoff’s syndrome?
A)
Encouraging the client to consume foods high in vitamin B1.
B)
Implementing strict bed rest to conserve energy.
C)
Restricting fluid intake to prevent water intoxication.
D)
Administering thiamine supplements as prescribed.
During intake assessment, the nurse is most likely to hear a client with major depressive disorder say which of the following statements about depression? (SELECT ALL THAT APPLY)
A)
I’d rather be dead than living like this. I do not want to be alive.
B)
If I can just keep ignoring feelings.
C)
I deserve to be this way. I’ve not accomplished anything important in my life.
D)
This is a bad episode, but I will be well soon.
E)
I am determined to fight this episode and get through it.

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Exam Review

The rationale for the nurse needing to be aware of their own feelings while working with the family experiencing domestic violence is best explained as:
A)
Strong negative feelings interfere with assessment and judgment.
B)
Awareness protects one’s own mental health.
C)
Positive feelings promote the development of sympathy for clients.
D)
Strong positive feelings lead to underinvolvement with the victim.
A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. When teaching the client about food interactions with the medication, which foods will the nurse caution the client to avoid?
A)
Apple pie and coffee
B)
A bagel with cream cheese and tea
C)
Pepperoni pizza and red wine
D)
Potato chips and diet cola
A nurse is caring for a client who has a binge-eating disorder. Which of the following statements should the nurse expect from this client?
A)
I feel so defeated and want to hide after I have binged.
B)
I am able to control the pace of my bingeing when I start getting full.
C)
My binges usually start off with feeling hungry.
D)
I binge to reward myself for completing difficult tasks.
A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe?
A)
Bizarre speech patterns
B)
Generates conflict among the staff
C)
Social isolation
D)
Suspiciousness of others

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Exam Review

A nurse is caring for a 22-year-old female client who has bulimia nervosa and frequently self-induces vomiting. Which of the following findings should the nurse expect? (SELECT ALL THAT APPLY)
A)
Amenorrhea
B)
Dental erosion
C)
Dry oral mucosa
D)
Icteric sclera
E)
Presence of lanugo
A patient in an abusive relationship is hospitalized with abdominal and head trauma caused by their partner. The partner sends flowers to the patient and pizzas for all the staff. Via video chat, the partner tearfully begs the patient to forgive them and not press charges. The partner states, “I just want you, me, and the kids to be together. You know you do too.” What conclusions can the nurse make about this scenario? (Select All That Apply)
A)
The patient’s partner’s act of sending flowers is an example of undoing.
B)
The patient and partner are in the honeymoon phase of intimate partner violence.
C)
The patient has a submissive personality and depression.
D)
Since the injuries have caused hospitalization, the patient will end the relationship.
E)
The partner may be trying to manipulate the staff by buying pizza.
A nurse is teaching the parents of a school-age child who has ADHD about atomoxetine. Which of the following instructions should the nurse include in the teaching?
A)
Expect hyperactivity as a common adverse effect.
B)
Give the dose in the morning to help prevent insomnia.
C)
Avoid crowds due to the increased risk for infection.
D)
Limit caloric intake to prevent excessive weight gain.
In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe?
A)
Stable and satisfactory relationships.
B)
Little tolerance for being alone.
C)
Predictability.
D)
Controlled anger.

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Exam Review

The nurse is planning a psycho-education group for clients diagnosed with borderline personality disorder. The nurse understands that which aspect of group intervention is most essential initially to establish a trusting nurse-patient relationship?
A)
Promoting activities that encourage self-reflection.
B)
Conveying an accepting attitude.
C)
Identifying community resources.
D)
Providing positive feedback.
A client presents to the Emergency Department (ED) after ingesting phencyclidine (PCP). Characteristic behaviors of an individual who has ingested PCP include:
A)
Sedated, heightened senses, withdrawn.
B)
Heightened sensory perceptions, nystagmus, hypotension.
C)
Grandiose delusions, hypotension, quiet.
D)
Violence, psychomotor agitation, hypertension.
The nurse understands that which factors are central to the dynamic of intimate partner violence?
A)
Emotional injury and learned helplessness.
B)
Poor communication and social isolation.
C)
Power and control.
D)
Erratic relationships and vulnerability.
When a client with a personality disorder uses self-destructive behavior as a way of getting needs met, the staff observe the behavior closely because:
A)
It is required to ensure the safety of the client and others.
B)
It indulges the client’s wishes.
C)
It provides an outlet for feelings of anger and frustration.
D)
The client’s anger and anxiety will be decreased if staff assume responsibility for the client’s behavior.

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