A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command hallucinations. Which of the following is the priority nursing diagnosis?
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Question 2 of 99
Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?
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Question 3 of 99
Mental health is defined as:
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Question 4 of 99
Which nursing diagnosis should the nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?
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Question 5 of 99
Which nursing response is an example of the nontherapeutic communication block of requesting an explanation?
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Question 6 of 99
Jestoni with chronic renal failure (CRF) is admitted to the urology unit. The nurse is aware that the diagnostic test are consistent with CRF if the result is:
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Question 7 of 99
The biopsy of Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at increased risk for excessive bleeding primarily because of:
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Question 8 of 99
Stacy's mother states to the nurse that it is hard to see Stacy with no hair. The best response for the nurse is:
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Question 9 of 99
As a patient diagnosed with a mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario?
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Question 10 of 99
A group is in the working phase. One member states, That is the stupidest thing Ive ever heard. Everyone whines and tells everyone else what to do. This group is a waste of my time. Which initial action by the group leader would be most therapeutic?
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Question 11 of 99
Nurse Michelle should know that the drainage is normal 4 days after a sigmoid colostomy when the stool is:
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Question 12 of 99
What is a basic assumption of Freud's psychoanalytic theory?
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Question 13 of 99
A 75-year-old client has dementia of the Alzheimer's type and confabulates. The nurse understands that this client:
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Question 14 of 99
A psychiatric-mental health advanced practice registered nurse is applying some of the principles of Jungian psychology to the care of a client with social anxiety disorder. What action by the nurse would best exemplify Jung's model?
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Question 15 of 99
Which information about atomoxetine should be included in a lesson plan about pharmacological treatments for ADHD?
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Question 16 of 99
What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate:
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Question 17 of 99
The care for the client places priority on which of the following:
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Question 18 of 99
A nurse wants to enhance growth of a patient by showing positive regard. The nurses action most likely to achieve this goal is:
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Question 19 of 99
What is an important role of the nurse with regard to residents opposing plans to establish a group home or residential facility in their neighborhood?
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Question 20 of 99
JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedure/surgery includes the following, EXCEPT:
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Question 21 of 99
Norma asks for information about osteoarthritis. Which of the following statements about osteoarthritis is correct?
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Question 22 of 99
Which cognitive mode, according to Harry Stack Sullivan, begins in early childhood as the child begins to connect experiences in sequence?
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Question 23 of 99
The nurse is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury?
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Question 24 of 99
Dr. Elisabeth Kbler-Ross theory about facing death consists of a process of (number) stages.
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Question 25 of 99
When under stress, a client routinely uses alcohol to excess. When the client's husband finds her drunk, the husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial?
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Question 26 of 99
A psychiatric-mental health nurse is reading an article about various theorists who rejected some of Freud's basic ideas. The article describes a theorist who challenged many of Freud's concepts, including the belief that women felt disadvantaged because of their genital organs. The nurse is most likely reading about which theorist?
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Question 27 of 99
Which factors are the most essential for the nurse to assess when providing crisis intervention for a client?
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Question 28 of 99
School phobia is usually treated by:
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Question 29 of 99
A psychiatric nurse is planning activities aimed at secondary prevention of mental illness. Which activity would be most appropriate to develop?
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Question 30 of 99
What is the primary rationale for a nursing assessment of a client's nonverbal communication?
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Question 31 of 99
Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. Which of the following observation would prompt you to call the doctor?
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Question 32 of 99
It is also the nurse's function to determine when infection is developing in the surgical incision. The perioperative nurse should observe for what signs of impending infection?
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Question 33 of 99
Which intervention best demonstrates that a nurse correctly understands the cultural needs of a hospitalized Asian American patient diagnosed with a mental illness?
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Question 34 of 99
Randy has undergone kidney transplant, what assessment would prompt Nurse Katrina to suspect organ rejection?
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Question 35 of 99
Which client is the nurse most likely to admit to an inpatient facility for self-destructive behaviors?
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Question 36 of 99
Which response indicates that the student has evaluated a 3-year-old's behavior appropriately?
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Question 37 of 99
A 16-year-old girl has returned home following hospitalization for treatment of anorexia nervosa. The parents tell the family nurse performing a home visit that their child has always done everything to please them and they cannot understand her current stubbornness about eating. The nurse analyzes the family situation and determines it is characteristic of which relationship style?
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Question 38 of 99
Situation: A widow age 28, whose husband died one year ago due to AIDS, has just been told that she has AIDS. Pamela says to the nurse, 'Why me? How could God do this to me?' This reaction is one of:
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Question 39 of 99
Nurse Bea is assessing a male client with heart failure. The breath sounds commonly auscultated in clients with heart failure are:
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Question 40 of 99
Instructions for a client with systemic lupus erythematosus (SLE) would include information about which of the following blood dyscrasias?
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Question 41 of 99
A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient's vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected?
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Question 42 of 99
Andrea, the charge nurse, spoke to the director of nursing about one of the staff nurses having a crisis. The nurse suggested a crisis intervention group to the staff nurse. Crisis intervention groups are successful because:
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Question 43 of 99
A male client suspected of having colorectal cancer will require which diagnostic study to confirm the diagnosis?
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Question 44 of 99
Which of the following is the highest level need according to Maslow (1934)?
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Question 45 of 99
While monitoring a male client several hours after a motor vehicle accident, which assessment data suggest increasing intracranial pressure?
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Question 46 of 99
In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill?
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Question 47 of 99
Which of the following are considered the positive signs of schizophrenia?
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Question 48 of 99
Honey, a 23-year old client complains of substernal chest pain and states that her heart feels like "it's racing out of the chest". She reports no history of cardiac disorders. The nurse attaches her to a cardiac monitor and notes sinus tachycardia with a rate of 136beats/minutes. Breath sounds are clear and the respiratory rate is 26 breaths/minutes. Which of the following drugs should the nurse question the client about using?
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Question 49 of 99
Virgie with a positive Mantoux test result will be sent for a chest X-ray. The nurse is aware that which of the following reasons this is done?
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Question 50 of 99
A client asks the nurse, 'Do you think I should leave my husband?' The nurse responds, 'You aren't sure if you should leave your husband?' The nurse is using which therapeutic technique?
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Question 51 of 99
Nurse Sarah is caring for clients on the surgical floor and has just received report from the previous shift. Which of the following clients should the nurse see first?
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Question 52 of 99
Patients on an inpatient psychiatric unit can earn off-unit privileges for daily use of socially appropriate behavior. This is an example of employing which concept of behavior modification?
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Question 53 of 99
The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements?
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Question 54 of 99
Important to the effectiveness of any type of treatment are the patient's:
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Question 55 of 99
Which nursing statement reflects a common characteristic of a client diagnosed with paranoid personality disorder?
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Question 56 of 99
The patient and the nurse have agreed on problems to be addressed during a short course of outpatient therapy. At the beginning of the appointment, the patient states, 'I'd like to work on the issue of relationships today.' Which assessment can be made?
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Question 57 of 99
Why would the nurse continually observe the behavior of the client during both the physical exam and the psychosocial assessment?
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Question 58 of 99
A patient has talked constantly throughout the group therapy session, often repeating the same comments. Other members were initially attentive then became bored, inattentive, and finally sullen. Which comment by the nurse leader would be most effective?
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Question 59 of 99
Which finding is the nurse most likely to assess in a child diagnosed with separation anxiety disorder?
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Question 60 of 99
A female client arrives at the emergency department with chest and stomach pain and a report of black tarry stool for several months. Which of the following order should the nurse Oliver anticipate?
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Question 61 of 99
Counseling is a field that requires licensing. This licensing is provided by:
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Question 62 of 99
Records Management and Archives Office of the DOH is responsible for implementing its policies on record disposal. You know that your institution is covered by this policy if:
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Question 63 of 99
After receiving a dose of penicillin, a client develops dyspnea and hypotension. Nurse Celestina suspects the client is experiencing anaphylactic shock. What should the nurse do first?
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Question 64 of 99
The nurse would associate the fight-or-flight response with which neurotransmitter?
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Question 65 of 99
Capillary glucose monitoring is being performed every 4 hours for a client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Mariner should expect the dose's:
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Question 66 of 99
A 45-year-old woman with a history of depression tells a nurse in her doctor's office that she has difficulty with sexual arousal and is fearful that her husband will have an affair. Which of the following factors would the nurse identify as least significant in contributing to the client's sexual difficulty?
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Question 67 of 99
What is the best intervention to teach the client when she feels the need to starve?
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Question 68 of 99
A white patient of German descent rocks back and forth, grimaces, and rubs both temples. What is the nurse's best action?
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Question 69 of 99
Your manic patient is being discharged on lithium. Which of the following would NOT be in the teaching plan?
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Question 70 of 99
A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience?
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Question 71 of 99
When caring for a young child, Nurse Andrea realizes that trust is a normal part of growth and further development. Trust is primary in which age group according to Erikson?
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Question 72 of 99
What best describes a task-oriented group?
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Question 73 of 99
A client with shortness of breath has decreased to absent breath sounds on the right side, from the apex to the base. Which of the following conditions would best explain this?
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Question 74 of 99
A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the medications listed below. Which medication would cause the nurse to express concern and therefore initiate further teaching?
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Question 75 of 99
What should a nurse do when faced with a suspected case of human trafficking?
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Question 76 of 99
A nurse is reading a journal article that reviews the various theories of human behavior and mental illness. One of the theories described states that all human beings have the potential for goodness and that therapy helps clients explore their own ability to develop self-worth. The nurse is reading about which theory?
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Question 77 of 99
A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?
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Question 78 of 99
Mr. Mendoza who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. To help the client avoid pressure ulcers, Nurse Celia should:
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Question 79 of 99
A black patient, originally from Haiti, has a diagnosis of major depressive disorder. A colleague tells the nurse, "This patient often looks down and is reluctant to share feelings. However, I've observed the patient spontaneously interacting with other black patients." Select the nurse's best response.
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Question 80 of 99
What health instruction will enhance regulation of a colostomy (defecation) of clients?
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Question 81 of 99
A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of
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Question 82 of 99
A female client tells nurse Nikki that she has been working hard for the last 3 months to control her type 2 diabetes mellitus with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:
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Question 83 of 99
The act of purging or purification of emotions is known as:
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Question 84 of 99
Nurse Michelle is caring for an elderly female with osteoporosis. When teaching the client, the nurse should include information about which major complication:
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Question 85 of 99
A nurse is meeting with a crisis support group. In efforts to help patients identify with one another, the nurse explains which of the following about the crisis experience?
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Question 86 of 99
Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects?
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Question 87 of 99
A patient with bipolar disorder has a long history of both hospitalizations and incarcerations. The patient has no permanent residence and has infrequent contact with his family. Upon admission to the inpatient psychiatric unit for stabilization, the nurse documents all of the following in the record. Which of the following data most suggests a positive outcome for this patient?
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Question 88 of 99
A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to
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Question 89 of 99
Which of the following statements indicates that the speaker is missing an important aspect of a mentally health life?
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Question 90 of 99
Terence suffered form burn injury. Using the rule of nines, which has the largest percent of burns?
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Question 91 of 99
The adult child of a patient diagnosed with major depression asks, Do you think depression and physical illness are connected? Since my fathers death, my mother has had shingles and the flu, but shes usually not one who gets sick. Which answer by the nurse best reflects current knowledge about psychoneuroimmunology?
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Question 92 of 99
Which approach to therapy is most effective when planning for a client with negative thinking?
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Question 93 of 99
Heberden's nodes are a common sign of osteoarthritis. Which of the following statement is correct about this deformity?
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Question 94 of 99
A nurse is assessing a client who experiences occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How would the nurse interpret the client's behaviors?
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Question 95 of 99
Joy is occupied exclusively with thoughts of her fathers death. Although Joy is preoccupied with his death, she is still planning to purchase a gift for his birthday, which would have been in two more weeks. Dr. Leone advises the nurse to assist Joy through this stage of grief, which is known as:
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Question 96 of 99
The primary nursing intervention for a victim of child abuse is:
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Question 97 of 99
Which of the following should be included in the health teachings among clients receiving Valium:
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Question 98 of 99
Which of the following medications is used for treatment in mental health disorders?
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Question 99 of 99
Which assessment finding most clearly indicates that a patient may be experiencing a mental illness?
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