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    Exam Review

    1. A client with bipolar disorder taking lithium returns from a walk outside and reports feeling shaky and dizzy. The nurse suspects the client is experiencing a toxic reaction to the lithium and immediately notifies the:
      A)
      Nurse manager.
      B)
      Psychiatric nurse.
      C)
      Psychiatrist.
      D)
      Recreation therapist.
    2. Which disorder is characterized by pervasive mistrust and suspiciousness of others?
      A)
      Paranoid personality disorder.
      B)
      Dependent personality disorder.
      C)
      Schizoid personality disorder.
      D)
      Histrionic personality disorder.
    3. Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder?
      A)
      Insisting that others follow the rules of the unit.
      B)
      Having a tantrum if not getting enough attention.
      C)
      Wondering why others are being friendly to them.
      D)
      Getting others to make decisions for them.
    4. A client with antisocial personality disorder is begging to use the phone to call his wife, even though it is against the unit rules. The client begs, "It is just this once, and she will be so hurt if I don't call her." What is the most appropriate response by the nurse?
      A)
      "You cannot call because you need to focus on your recovery while you are here, not your wife."
      B)
      "I will get in trouble with my supervisor if I let you call."
      C)
      "You may not use the phone to call your wife."
      D)
      "Only to help your wife, you can call this time."
    Page 1 of 13

    Exam Review

    1. What is the main reason why periodic team meetings are important when caring for a client with antisocial personality disorder?
      A)
      Team consistency is important to prevent manipulation by the client.
      B)
      The team needs to consider updating treatment recommendations as the client improves.
      C)
      Rotating team members need to be apprised of the care planned for the client.
      D)
      Staff frustrations in caring for the client need to be processed.
    2. A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." What would be the most appropriate response by the nurse?
      A)
      "I cannot be your friend. We need to be clear on that."
      B)
      "You feel others don't understand you?"
      C)
      "I'm glad you feel comfortable with me."
      D)
      "I'm here to help you, just as all the staff members are."
    3. A nurse is teaching a client with borderline personality disorder to reshape thinking patterns. What is an example of a cognitive restructuring technique that would be helpful for this client?
      A)
      "Express needs using 'I' statements."
      B)
      "Learn to look at situations realistically rather than assuming the worst."
      C)
      "When negative thoughts begin, tell yourself 'stop.'"
      D)
      "Recognize negative thoughts and replace them with positive ones."
    4. Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder?
      A)
      The client cries loudly whenever requests are denied.
      B)
      The client shows no remorse when accidentally breaking another client's bracelet.
      C)
      The client talks about three failed marriages.
      D)
      The client fears criticism from others, including staff.
    Page 2 of 13

    Exam Review

    1. When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success?
      A)
      Conducting regular assessments so the treatment can be changed when necessary.
      B)
      Collaborating with the client when establishing treatment goals.
      C)
      Educating the client on the importance of complying with treatment interventions.
      D)
      Evaluating the client's understanding of the etiology of the prescribed medications.
    2. A client has been diagnosed with depression. He asks the nurse what imbalances influence depression. Which of the following best explains the neurochemical processes responsible for depression?
      A)
      Decreased glucocorticoid activity.
      B)
      Increased activity of dopamine.
      C)
      Decreased serotonin and norepinephrine activity.
      D)
      Potentiating of the kindling process.
    3. A family member tells the nurse, "I am concerned about my brother. He has been acting very different lately." Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the brother has bipolar disorder?
      A)
      Intense focus.
      B)
      Showing low self-esteem.
      C)
      Taking unnecessary risks.
      D)
      Sleeping more.
    4. A client is admitted for major depression. The client has stated that nothing seems to bring him pleasure anymore. What should the nurse expect to find during the assessment?
      A)
      Changes in sleep pattern, fatigue, and grandiose mood.
      B)
      Depressed mood, guilt, and pressured speech.
      C)
      Difficulty focusing, feelings of helplessness, and flight of ideas.
      D)
      Anhedonia, feelings of worthlessness, and difficulty focusing.
    Page 3 of 13

    Exam Review

    1. A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?
      A)
      Immediately after a family visit.
      B)
      Approximately two weeks after starting antidepressant medication.
      C)
      During the first few days after admission.
      D)
      On the anniversary of significant life events in the client's life.
    2. A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?
      A)
      Decrease the client's environmental stimuli.
      B)
      Give the client feedback about their behavior.
      C)
      Tell the client about hospital rules and policies.
      D)
      Introduce the client to other staff on the unit.
    3. A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. What would be the most therapeutic response by the nurse?
      A)
      "Do you have reservations about going to therapy?"
      B)
      "Medications help your brain function better, but the therapy helps you achieve lasting behavior change."
      C)
      "Both are recommended. Since your insurance covers both, that is the best plan for you."
      D)
      "The effects of medications will not last forever. You will need to eventually learn to function without them."
    4. A client who has been discharged home on citalopram calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions?
      A)
      "Make an appointment to change to a different medication."
      B)
      "Skip a dose if drowsiness is excessive."
      C)
      "Take the medication at night."
      D)
      "Be patient while this early side effect subsides."
    Page 4 of 13

    Exam Review

    1. A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see?
      A)
      None; the serum level is in therapeutic range.
      B)
      Fever, muscle rigidity, and disorientation.
      C)
      Nausea, diarrhea, and confusion.
      D)
      Constipation and postural hypotension.
    2. Which of the following neurochemical influences is a probable cause of substance abuse?
      A)
      Stimulation of dopamine pathways in the brain.
      B)
      Excessive serotonin activity in the central nervous system.
      C)
      Inhibition of GABA in the brain.
      D)
      Imbalances of serotonin and norepinephrine in the brain.
    3. A client is being discharged from treatment for addiction to cocaine. Which statement made by the client would cause the most concern for the nurse?
      A)
      "I can still hang out with my old friends. I am just not going to use."
      B)
      "Shooting baskets helps me not think about getting high."
      C)
      "I am going to take up a new hobby. It's time to start something new."
      D)
      "I'm not very comfortable with being alone yet."
    4. A client asks the nurse, "What will happen if I drink while taking disulfiram?" What is the best response by the nurse?
      A)
      "You will not want to drink while taking disulfiram. It reduces the cravings."
      B)
      "You will not get any effect from the alcohol you drink."
      C)
      "Disulfiram will reverse the effects of alcohol."
      D)
      "You will experience a severe reaction, including a throbbing headache and vomiting."
    Page 5 of 13

    Exam Review

    1. A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include?
      A)
      "Unlike heroin, methadone is nonaddicting."
      B)
      "Methadone will meet the physical need for opiates without producing cravings for more."
      C)
      "Methadone will produce a high similar to heroin."
      D)
      "People taking methadone run the same risks associated with IV drug use as those taking heroin."
    2. A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit "cold turkey." What would be the best response by the nurse?
      A)
      "It is not safe to stop drinking suddenly without medicine."
      B)
      "You sound really motivated. Come in and we will help you find a treatment center."
      C)
      "After a few days of rest, you should feel much better as long as you do not drink anything."
      D)
      "You will likely feel anxious and get a severe headache. Treat these symptoms with acetaminophen and rest and come in if they do not get better in 3-5 days."
    3. An intoxicated client was admitted for trauma treatment last night at 2:00 a.m. (0200). When should the nurse expect to be alert for withdrawal symptoms?
      A)
      About 2:00 a.m. (0200) tomorrow (24 hours after drinking stopped).
      B)
      About 2:00 a.m. (0200) of hospital day three (72 hours after drinking stopped).
      C)
      About 2:00 a.m. (0200) of hospital day two (48 hours after drinking stopped).
      D)
      Between 8:00 and 10:00 a.m. (0800 and 1000) today (6-8 hours after drinking stopped).
    4. The nurse is assessing a client's risk factors for developing a substance abuse disorder. Which family characteristic would the nurse identify as the most significant risk factor?
      A)
      Overprotective parents.
      B)
      One parent who is an alcoholic.
      C)
      Parents who practiced strict discipline.
      D)
      Being raised in an urban area.
    Page 6 of 13