PSYCH LECTURE

NUR 147

1. This refers to the practice of reducing emphasis on mental health care from inpatient
facilities to community treatment centers
A. Sanitarium
B Managed Care
C. Deinstitutionalization
D. Primary Care

2. This BOOK emphasized that the treatment of persons with mental illness should focus on
psychosocial strengths and needs

A. Mental Health Nursing Management

B Interpersonal Relations in Nursing
C. Nursing Therapy
D. interpersonal Techniques. The Crux of Psychiatric Nursing

3. Which Neurotransmitter is both excitatory and inhibitory and what does it regulate?
A Epinephrine- Fight or flight response
B Glutamate - Major neurotoxic effects at high levels
C. Acetylcholine - Regulates sleep/wakefulness, and signals muscles to become
alert.
D. Dopamine - Complex movements, motivation, cognition, regulation of emotional
response

4. What are the 2 Neurotransmitters that are Inhibitory and what does each regulate ?
Select All that apply
A. Dopamine -Complex movements, motivation, cognition, regulation of emotional response
B Norepinephrine - Attention, learning, memory, sleep/wakefulness, moods
C. Glutamate - Major neurotoxic effects at high levels.
D. Serotonin - Food intake, sleep/wakefulness, temp. pain, sexual behaviors and emotions
E. GABA - Regulates other Neurotransmitters
5. The nurse is teaching a client taking an MAOI about foods with tyramine that he br she
should avoid. Which statement indicates that the client needs further teaching?
A. "I'm so glad l can have pizza as long as don't order pepperoni.
B. "I will be able to eat cottage cheese without worrying.
C. "I will have to avoid drinking nonalcoholic beer."
D. "l can eat green beans on this diet.

6. A client who has been depressed and suicidal started taking a tricyclic antidepressant 2
weeks ago and is now ready to leave the hospital to go home. Which is a concern for the
nurse as discharge plans are finalized?
A. The client may need a prescription for diphenhydramine (Benadryl) to use for side effects
B. The nurse will evaluate the risk for suicide by Overdose of the tricyclic
antidepressant.
C. The nurse will need to include teaching regarding the signs of neuroleptic malignant
syndrome.
D The client will need regular laboratory work to monitor therapeutic drug levels.

7. The risk of experiencing serotonin syndrome when SSRIS are given with monoamine
oxidase inhibitors such as phenelzine (Nardil). Serotonin syndrome is best characterized in
which of the following?
A. A productive cough and bradycardia
B. Hypotension and urinary retention
C. Muscle rigidity and high fever
D. Tea-colored urine and constipation

8. Which theorist believed that a corrective interpersonal relationship with the therapist was
the primary mode of treatment?
A. Sigmund Freud
B. William Glasser
C. Hildegard Peplau
D. Harry Stack Sullivan

9. Erickson's stage of psychosocial development in which social relationships develop and

productivity increases.

A. Initiative vs guilt
10. Emily is talking to her 6-year-old sister Julia. She asks why the sun shines so bright?
Julia answered that it always keeps her warm. What stage in the cognitive theory of
development explains this?

D. Preoperational

11. Which are specific tasks of the working phase of a therapeutic relationship? Select all
that apply.

B. Encourage expression of feelings.

D. Facilitate behavior change.
E. Promote self-esteem.

12. Trust may develop in the nurse-client relationship when the nurse

B. Uses consistency in approaching the client.

13. Confidentiality means respecting the client's right to keep his or her information private.
When can the nurse share information about the client? Select all that apply

A. The client threatens to harm a family member.

C. The client gives written permission.
D. The client's legal guardian asks for information.

14. Which example of a therapeutic communication technique would be effective in the

planning phase of the nursing process?

A. "We've discussed past coping skills. Let's see if these coping skills can be
effective now."

15. A client tells the nurse, "I feel bad because my mother does not want me to return home
after I leave the hospital." Which nursing response is therapeutic?

D. "You feel that your mother does not want you to come back home?"
16. A client's younger daughter is ignoring curfew. The client states, "Im afraid she will get
pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about
life?" This is an example of which Communication block?

C. Making stereotyped comments

17. During a counseling session with a patient who was diagnosed with depression, the
patient state my husband doesn't love me anymore" Which response by the healthcare
provider therapeutic communication?

C. "What happened to make you think your husband doesn't love you anymore?

18. Days after admission for depression, a 54-year-old female client approaches the nurse
and says."I know I have cancer of the uterus. Can't you let me stay in bed and have some
peace before I die responding. The nurse must keep that in mind.

B. Thoughts of disease are common in depressed clients.

19. When your patient is given a diagnosis of cancer, his first statement is "What did I ever
do that God iS punishing me?" This is an example of:
A. maladaptive coping.
B behavioral emotionalism.
C. spiritual distress.
D. spiritual maladaptation.

20. Gemma, 47 years old has been told by her physician that she has untreatable
metastatic carcinoma. She tells the nurse that she believes the physician has made an error
and that she does not have cancer and is not going to die The nurse evaluates that the
client is experiencing the first stage of death and dying
known as:
A. anger
B.denial
C. bargaining
D. acceptance
21. Mike becomes depressed. unable to talk after knowing that he has terminal cancer in
the colon. You are the nurse of the patient Mike. Which of the following statements could
you use to determine the support system of the patient?
A. "You are grieving. That's a normal response to possible impending death.
B. "Who in your life should really want to know what you've just heard from the doctor?"
"Denying that you have cancer is a normal grieving process according to Kubler-Ross.
D. "Would you like to talk to me about what you have heard from the doctor?"

22. The nurse observes that the client is pacing, agitated, and presenting aggressive
gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these
observations, what is the nurse's immediate priority of care?

A. Provide safety for the client and other clients on the unit

23. A client is pacing in the hallway with clenched fists and a flushed face. She is yeling and
swearing. In which phase of the aggression cycle is she?

C. Escalation

24 In her physical assessment. Marco suspects that Jil might be experiencing.

A. sexual and emotional abuse.
B. physical abuse and neglect.
C. physical and sexual abuse.
D. emotional neglect

25. To obtain information from Jill when she refuses to talk about her bruises, the best
intervention a nurse safely implement will be.
A. Play therapy.
B. Milieu therapy
C. Crisis intervention
D. Family therapy

26. The nurse iS aware that abuse of whatever type is on the rise in this society. In cases of
rape, Marco knows that the most likely reason for that abuse is because of:
A. Too much alcohol and behavior out of control
B. No sexual relations with opposite sex for a long time
C. Induced by poverty conditions and economic deprivation.
D. Expression of power and dominance by seXual aggression
27. When a nurse suspect that your patient is a victim of domestic violence, you need to
know that patient's risK for violence increases when.
A. They seek medical treatment.
B. They plan to remove themselves from abusive environment.
C. They seek law enforcement intervention.
D. They experience their first violent attack.

26. A female client comes to an urgent care clinic and says, "I've just been raped." What
should the nurse do?
A. Allow the client to express whatever she wants.
B. Ask the client if staff can call a friend or family member for her.
E. Stay with the client until someone else arrives to be with her.

29. The following are the diagnostic criteria in post-traumatic stress disorder, EXCEPT:
A. Recurrent, involuntary. and intrusive distressing memories.
B. Dissociative reactions
C. Persistent negative emotional state, eg., excessive fear, horror, or guilt
D. Persistent, intrusive, unwanted, recurrent, and uncontrollable thought impulses causing
marked anxiety and distress.

30. The nurse admitting a client suspected of dissociative amnesia would report which of
the following manifestations?

B. The client's inability to recall personal information.

31. A nurse working in a mental health clinic knows that cognitive behavioral therapy (CBT)
may be used to treat anxiety disorders, including phobias, with which of the following
approaches?
A. Electroshock treatment combined with group therapy.
B. Gradual and increased exposure to an object or situation
C. Inpatient treatment in a rehabilitation facility
D. Pharmacologic therapy with risperidone
32. A patient on a psychiatric unit approaches a nurse in the hallway. He is anxious, dizzy,
and short of breath. The nurse should

C. take the patient to a quiet area.

33. Which is the desired outcome in conducting desensitization:

D. The client will be able to overcome his disabling fear.

34. Which of the following is TRUE about the therapies and medication treatment for
anxiety?
A. It prevents the person from being exposed to the anxiety-causing situation
B. Therapies and drugs do not cure anxiety, but they only help the person to control and
manage the symptoms
C. The therapies and drugs are very much effective in Curing or treating all types of anxiety
disorders
D. Relaxation techniques are more effective than drug therapies when anxiety level
increases.

35. Teresa Kinulbaan has been taught by the psychiatric nurse positive reframing during her
session to decrease her anxiety symptoms. Which of the following statements made by
Teresa indicates understanding of the therapy?

A. "My heart is pounding. I think, i'm going to die now.

B. i can stand this. This is just another anxiety attack. It will go away.
C. "i Think this is very difficult. I could not possibly overcome this.
D. "i just have to take my medicine even if l can manage my symptoms.

36. A client Is unwilling to go out of the house for fear of "making a fool of myself in public."
Because of this fear, the client remains homebound. Based on these data, which mental
health disorder is the client Experiencing?

B. Social phobia
31. A 35-year-old male has intense fear of riding an elevator. He claims, "As if I will die
inside." This has affected his studies The client is suffering from:

C. Claustrophobia

38 Generalized Anxiety Disorder (GAD) is a pervasive condition in which the sufferer

experiences

B. Continual apprehension and anxiety about future events.

39. Which would be an appropriate intervention for a client with OCD who has a ritual of
excessive constant cleaning?
A. A structured schedule of activities throughout the day
B. Intense psychotherapy sessions daily
C. Interruption of rituals with distracting activities
D. Negative consequences for ritual performance

40. interventions for a client with OCD would include. Select all that apply.
A. encouraging the client to verbalize feelings.
B. helping the client avoid obsessive thinking.
C. planning with the client to limit rituals.
D. teaching relaxation exercises to the client.
E. telling the client to tolerate any anxious feelings.

41. Clients with OCD often have exposure/response prevention therapy. Which statement
by the client would indicate positive outcomes for this therapy?
A. "l am able to avoid obsessive thinking."
B. "I can tolerate the anxiety caused by obsessive thinking.
C. "I no longer have any anxiety when I have obsessive thoughts."
D. "I no longer feel a compulsion to perform rituals."

42. The client with OCD has counting and checking rituals that prolong attempts to perform
activities of daily living. The nurse knows that interrupting the client's ritual to assist in faster
task completion will likely result in
A. a burst of increased anxiety
B. gratitude for the nurse's assistance.
C. relief from stopping the ritual.
D. symptoms of depression or suicidality

SITUATION Schizophrenia is a chronic debilitating psychiatric disorder. It is not well

understood and probably
consists of se veral separate illnesses. As a nurse. you are expected to determine its nature
and clarify health
misconceptions of the patients.

43. Anne Lee, a young businesswoman, has been brought to the psychiatric facility
because her parents are very worried about her condition. Her mother states that she is
having hallucinations and delusions. After Conducting an assessment, the doctor diagnosed
Anne Lee to have schizophrenia. After knowing the Client's diagnosis, it is important for the
nurse to educate the client's family about the diagnosis. Which among the following should
the nurse include in the initial teaching for the family?

A. That the symptoms of this disease are due to imbalance in the brain's structure alone.
B. Genetic history is the only important factor related to the development of schizophrenia.
C. Schizophrenia is not serious disease and does not affect every aspect of a person's
functioning.
D. The distressing symptoms of this disorder can respond to treatment with medications.

44 The nurse caring for Anne Lee who is diagnosed with schizophrenia paranoid type is
designing a plan of Care for the client addressing the client's delusion! perception. Which
among the following statements should the nurse consider as the goal of care of the client?
A. Anne Lee will demonstrate realistic interpretation of daily events in the unit.
B. Anne Lee will perform daily hygiene and grooming without asSIstance.
C. Anne Lee will take prescribed medications without difficulty
D. Anne Lee will participate in unit activities.

45. During the first day of Anne Lee's admission in the institution, she is suspicious of the
health care staff and other clients of the psychiatric institution. In order to establish a
therapeutic relationship with the client, the nurse best plan of action would be to:
A. Initiate conversations with Leah whenever she becomes agitated.
B. Set aside specific times each day for conversations with her.
C. Allow her to initiate conversations when she feels ready for them.
D. Plan conversations with her at frequent but unspecified times during the day

46. The family of a client with schizophrenia asks the nurse about the difference between
conventional and atypical antipsychotic medications. The nurse's answer is based on which
of the following?
A, Atypical antipsychotics are newer medications but act in the same ways as conventional
antipsychotics
B. Conventional antipsychotics are dopamine antagonist, atypical antipsychotics inhibit the
reuptake of serotonin. Effects. dopamine antagonists.
C. Conventional antipsychotics have serious side effects; atypical antipsychotics have
virtually no side
D. Atypical antipsychotics are dopamine and serotonin antagonists; conventional
antipsychotics are only dopamine antagonist.

47. The nurse is planning discharge teaching for a client taking Clozapine (Clozaril). Which
of the following is essential to include?
A. Caution the client not to be outdoors in sunshine without protective clothing.
B. Remind the client to go to the lab to have blood drawn fora white cell count.
C. Instruct the client about dietary restrictions.
D. Give the client a chart to record a daily pulse rate.

48. The nurse is caring for a client who has been taking Fluphenazine (Prolixin) for 2 days.
The client suddenly cries out, his neck twists to one side, and his eyes appear to rol back in
the sockets. The nurse finds the following PRN medications ordered for the client. Which
one should the nurse administer?
A. Haloperidol (Haldol) 5 mg. IM, PRN for extreme agitation
B. Fluphenazine (Prolixin) 2 mg. PO, tid, PRN
C. Diphenhydramine (Benadryl) 25 mg, IM, PRN
D. Risperidone (Risperdal) 5 mg. IM, PRN

49. Which of the following statements would indicate the family teaching about
schizophrenia has been effective?
A. "If our son takes his medication properly, he won't have another psychotic episode.
B. "I guess we'll have to face the fact that our daughter will eventually be institutionalized."
C. "It's a relief to find out that we did not cause our son's schizophrenia.
D. "It is a shame our daughter will never be able to have children."
50. The nurse learns at report that a newly admitted manic patient is demonstrating
grandiosity. Which statement would be most consistent with this symptom?
A. "I can't do anything anymore."
B. "I'm the world's most astute financier.
C. "I can understand why my wife is upset that I overspend."
D. "I can't understand where all the money in Our family goes

51. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that
include exaggerated physical activity, agitation, insomnia, and anorexia?
A. Risk for injury
B. Chronic low self-esteem
C. Noncompliance
D. Insomnia

52. Which statement by the patient would indicate the need for additional education
regarding the prescribed lithium treatment regimen?
A. I will restrict my daily salt intake.
B. l will take my medications with food."
C "I Will have my blood drawn on schedule"
D. "|will drink 8 to 12 glasses of liquids daily."

53. Which outcomes would be appropriate to determine early favorable response to

antidepressant medication?
A. The patient will complete own self-care activities.
B. The patient will demonstrate assertive communication skills.
C The patient will describe signs and symptoms of major depression.
D. The patient will make plans to attend one community social activity a week.

54. A patient who has a history of bipolar disorder recently underwent orthopedic
surgery and was discharged to return home. When visited by the home care nurse, the
nurse documented the following: slow and soft speech; sad facial expression; and
patient crying when describing extreme fatigue, low mood, and the feeling that he will
never get well. He has refused to bathe and perform ADLs for several days. Which
nursing diagnosis would be appropriate?
A. Self-care deficit secondary to possible depression
B Situational low self-esteem related to immobility
C. Deficient knowledge related to depression and surgery
D. Disturbed thought processes related to bipolar disorder

55. The nurse caring for an extremely withdrawn patient with depression wants to assist her
to become more interactive. The best approach would be to say:
A. "I know you'Il feel better if you leave your room.
B. You look so gloomy sitting here all by yourself."
C. "Let's explore how it feels to sit alone here all day and feel sad."
D. "i need another person for a card game, and l'd like you to be my partner.

56. What information concerning amitriptyline (Elavil) 50 mg TID would the nurse give the
patient regarding the expected outcome of this medication therapy?
A. "Complying with this therapy will cure your depression.'
B. "This medication is expected to improve brain chemical imbalance.
C. "Amitriptyline will help re-establish your ability to think clearly again.
D. Elavil will be particularly effective at assisting you in regaining your independence."

57. Which principle should the nurse apply when planning care for a patient who is
diagnosed with bipolar disorder and currently in the manic phase?
A. Manic patients respond well to peer pressure.
B. Decreasing stimulation tends to diminish symptoms.
C. Increasing stimulation tends to encourage the patient to focus.
D. Detailed activities will facilitate the patient's ability to self-control behavior.

58. Which approach listed in the plan of care of a suicidal patient is considered a cognitive
technique?
A. Intense psychotherapy to deal with childhood issues.
B. Group therapy with patients with similar problems.
C. Limitation of negative thought patterns and increase of realistic self-evaluation.
D. Inclusion of significant others and family in the plan of care.

59. Clients with a schizotypal personality disorder are most likely to benefit from which
nursing intervention?
A. Cognitive restructuring techniques
B Improving community functioning
C. Providing emotional support
D. Teaching social skills

60. When interviewing any client with a personality disorder, the nurse would assess for
which?
A. Ability to charm and manipulate people.
B. Desire for interpersonal relationships
C. Disruption in some aspects of his or her life
D. Increased need for approval from others

61. the most important short-term goal for the client who tries to manipulate others would be
to
A. acknowledges own behavior.
B. express feelings verbally.
C. stop initiating arguments.
D. sustains lasting relationships.

62. A young, handsome man with a diagnosis of antisocial personality disorder is being
discharged from the hospital next week. He asks the nurse for her phone number so that he
can call her for a date. The nurse's best response would be:
A. "We are not permitted to date clients.
B. "No, you are a client and I am a nurse.
C. "I like you, but our relationship is professional."
D. "It's against my professional ethics to date clients."

63. When caring for a client with a diagnosis of schizotypal personality disorder, the nurse
should
A. Set limits on manipulative behavior.
B. encourage participation in group therapy.
C. Respect the client's needs for social isolation.
D. Understand that seductive behavior is expected.
64. A nurse is orienting a new client to the unit when another client rushes down the hallway
and asks the nurse to sit down and talk. The client requesting the nurse's attention is
extremely manipulative and uses socially acting-out behaviors when demands are unmet.
The nurse should:
A. Suggest that the client requesting attention speak with another staff member.
B. Leave the new client and talk with the other client to avoid precipitating acting out
behavior
C. Tell the interrupting client to sit down and be patient. stating. "Il be back as soon
as possible.
D. Introduce the two clients and suggest that the client join the new client and the nurse on
the tour

65. A client with a diagnosis of narcissistic personality disorder has been given a day pass
from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client
telephones the nurse in charge of the unit and says '6 o'clock is too early. I feel like coming
back at 7:30." The nurse would be most therapeutic by telling the client to:
A. Return immediately, to demonstrate control.
B. Return on time or restrictions will be imposed
C. come back at 6:45, as a compromise to set limits.
D. Come back as soon as possible or the police will be sent.

66. Which of the following behaviors by a client with dependent personality disorder shows
the client has made progress toward the goal of increasing problem-solving skills?
A. The client is courteous.
B. The client asks questions.
C. The client stops acting out.
D. The client controls emotions.

67. A client with schizotypal personality disorder is sitting in a puddle of urine. She's playing
in it. smiling, and softly singing a child's song. Which action would be best?
A. Admonish the client for not using the bathroom.
B. Firmiy tell the client that her behavior is unacceptable.
C. Ask the client if she's ready to get cleaned up now.
D. Help the client to the shower and change the bedclothes.
68.A client with avoidant personality disorder says ocCupational therapy is boring and
doesn't want to go. Which action would be best?
A. State firmly that you'll escort him to OT.
B. Arrange with OT for the client to do a project on the unit
C. Ask the client to talk about why OT is boring.
D. Arrange for the client not to attend OT until he is feeling better.

69. A nurse discusses job possibilities with a client with schizoid personality disorder. Which
suggestion by the nurse would be helpful?
A. You can work in a family restaurant part-time on the weekend and holidays."
B"Maybe your friend could get you that customer service job where you work only on the
weekends."
C. "Your idea of applying for the position of filing and organizing records is worth
pursuing.
D. "Being an introvert limits the employment opportunities you can pursue."

70.When assessing a client diagnosed with impulse control disorder, the nurse
observes violent, aggressive, and assaultive behavior. Which of the following
assessment data is the nurse also likely to find? Select all that apply.

A. The client functions well in other areas of his life

B The degree of aggressiveness is out of proportion to the stressor
C. The violent behavior is most often justified by the stressor
D. The client has a history of parental alcoholism and chaotic, abusive family ite.
E The client has no remorse about the inability to control his anger.

71. The spouse of a client admitted to the mental health unit for alcohol withdrawal says to
the get out of this bad situation" The most helpful response by the nurse would be.
A. "l agree with you. You should get out of this situation.
B. "What do you find difficult about this situation?"
C. "Why don't you tell your husband about this?
D. "This is not the best time to make that decision.

72. The nurse determines that the wife of an alcoholic client is benefiting from attending Al-
Anon group when she hears the wife say:
B. "I no longer feel thatI deserve the beatings my husband inflicts on me
73. The client has been hospitalized and is participating in a substance abuse therapy
group session. On discharge, the client has consented to participate in AA community
groups. The nurse is monitoring the client's response to the substance abuse sessions.
Which statement by the client best indicates that the client has developed effective coping
response styles and has processed information effectively for seit- use?

C. "Im looking forward to leaving here. I know thatI will miss all of you. So, l'm happy
and I'm sad, I'm excited and T'm scared. I know that I have to work hard to be strong
and that everyone isn't going to be as helpful as you people

74. Which medication is commonly used in treatment programs for heroin abusers to
produce a non euphoric state and to replace heroin use?
A. diazepam
B. carbamazepine
C. clonidine
D. methadone

75. Nurse Christine is teaching an adolescent health class about the dangers of inhalant
abuse; the nurse warns about the possibility of:
A. contracting an infectious disease, such as hepatitis or AIDS
B. recurrent flashback events
C. psychological dependen ce after initial use
D. sudden death from cardiac or respiratory depression

76. The mother of a teen with an eating disorder expresses a concern that the family is
responsible for the problem. Which question will best help the nurse identify another
influence that is likely to have played a role in the teenager's eating disorder?

D "Is your daughter interested in clothes and fashion?"

77. The nurse is identifying outcomes for a teenager diagnosed with anorexia nervosa.
VWhich outcome has the greatest impact on long-term prognosis?
A. Verbalize underlying psychological issues.
B. Demonstrate effective coping skills related to conflict management
C. Demonstrate improvement in body imagine reflecting a realistic viewpoint.
D. consume adequate calories appropriate for age, height, and metabolic needs.

78. A 16-year-old patient has anorexia nervosa. Which term used to describe the menstrual
history is characteristic of this disorder?
A. Amenorrhea
B. Dysmenorrhea
C. Premenstrual syndrome
D. Heavy menstrual flow

79. The nurse is caring for a patient who is being treated for comorbid eating and affective
disorders. For which medication would the nurse expect to prepare a patient teaching plan?
A. Fluoxetine (Prozac)
B. Diazepam (Valium)
C. Lorazepam (Ativan)
D. Lithium

80. Which intervention best monitors the health status of a patient newly admitted for a
diagnosis Of bulimia nervosa?
A. Scheduling a bone mineral density screening.
B. Performing a portable electrocardiogram (ECG)
C. Obtaining a urine sample for a urine analysis.
D. Arranging for a serum potassium level to be drawn

81. The nurse is caring for a client with a conversion disorder. Which finding will the nurse
expect during assessment?
A. Extreme distress over the physical symptom
B. Indifference about the physical symptom
C. Labile mood
D. Multiple physical complaints
82. Which statement would indicate that teaching about somatic symptom disorder has
been effective?
A. "The doctor believes l am faking my symptoms."
B. "if l try harder to control my symptoms. I will feel better.
C. "I will feel better when I begin handling stress more effectively.
D. "Nothing will help me feel better physically."

83. Emotion-focused coping strategies are designed to accomplish which outcome?

A. Helping the client manage difficult situations more effectively.
B. Helping the client manage the intensity of symptoms.
C. Teaching the client, the relationship between stress and physical symptoms
D. Relieving the client's physical symptoms

84. The client's family asks the nurse,"What is illness anxiety disorder?" The best response
by the nurse is. "illness anxiety disorder is?
A. a persistent preoccupation with getting a serious disease."
B. an illness not fully explained by a diagnosed medical condition.
C. characterized bya variety of symptoms over a number of years.
D. the eventual result of excessive worrying about diseases."

85. A client with somatic symptom disorder has been attending group therapy. Which
statement indicates therapy is having a positive outcome for this client?
A. "I feel better physically just from getting a chance to talk.
B. "I haven't said much, but I get a lot from listening to others."
C. "l shouldn't complain too much; my problems aren't as bad as others.
D. "The other people in this group have emotional problems."

86. Teaching for methylphenidate (Ritalin) should include which information?

A. Give the medication after meals.
B. Give the medication when the child becomes overactive
C. Increase the child's fluid intake when he or she is taking the medication.
D. Check the child's temperature daily.

87. The nurse would expect to see all the following symptoms in a child with ADHD, except
A. distractibility and forgetfulness.
B. excessive running, climbing, and fidgeting.
C. moody, sullen, and pouting behavior
88. The nurse is teaching a 12-year-old with intellectual disability about medications. Which
intervention is essential?
A. Speak slowly and distinctly.
B. Teach the information to the parents only.
C Use pictures rather than printed words
D. Validate client understanding of teaching.

89. The nurse is assessing an adult client with ADD. The nurse expects which of the
following to be present?
A. Difficulty remembering appointments
B. Falling asleep at work.
C. Problems getting started on a project.
D. Lack of motivation to do tasks

90. The nurse recognizes which as a common behavioral sign of autism ?

A. Clinging behavior toward parents
B. Creative imaginative play with peers
C. Early language development
D. Indifference to being hugged or held.

91. A nurse assessing a client with ED would expect which finding?

A. Blaming others for provoking angry outbursts.
B. Difficulty coping with ordinary life stressors
C. Lack of remorse for aggressive behavior.
D. Premeditated aggressive outbursts to get what the client wants.

92 Parents of a child with ODD are referred toa parent management training program. The
parents ask the nurse what to expect from these sessions. The best response by the nurse
is
A. This is a method of parenting that involves negotiation of responsibilities with your child.
B. "This is a support group for parents to discuSs the difficulties they are having with their
children.
C. "You will have a chance to learn how to manage ail of your child's negative behaviors.
D You will learn behavior management techniques to use at home with your child."
93. The nurse has completed teaching sessions for parents about conduct disorder. Which
statement indicates a need for further teaching?
A. "Being consistent with rules at home will probably be a real challenge for me and my
child.
B. "It helps to know that these problems will get better as my child gets older.
C. "Real progress for our child is likely to take several weeks or even months.
D. "We need to set up a system of rewards and consequences for our child's behaviors."

94. Which behavior is normal adolescent behavior?

A. Being critical of self and others
B. Defiant, negative, and depressed behavior.
C. Frequent hypochondriacal complaints.
D. Unwillingness to assume greater autonomy

95. An effective nursing intervention for the impulsive and aggressive behaviors that
accompany conduct disorder is
A. assertiveness training.
B. Consistent limit setting.
C. negotiation of rules.
D. open expression of feelings.

96. The nurse is talking with a woman who is worried that her mother has Alzheimer
disease. The nurse knows that the first sign of dementia is
A. disorientation to person, place, or time.
B. memory loss that is more than ordinary forgetfulness
C. inability to perform self-care tasks without assistance
D. variable with different people.

97. The nurse has been teaching a caregiver about donepezil (Aricept). The nurse knows
that teaching has been effective when the caregiver makes which statement?
A. "Let's hope this medication will stop the Alzheimer disease from progressing any further.
B "It is important to take this medication on an empty stomach."
C. "TN be eager to see if this medication makes any improvement in concentration.
D. "This medication will slow the progress of Alzheimer disease temporarily."
98. Which statement by the caregiver of a client newly diagnosed with dementia requires
further intervention by the nurse?
A. " will remind Mother of things she has forgotten."
B. "I will keep Mother busy with favorite activities as long as she can particıpate.
C. "I Will try to find new and different things to do every day."
D. "I will encourage Mother to talk about her friends and family."

99. Which statement indicates the caregiver's accurate knowledge about the needs of a
parent at the onset of the moderate stage of dementia?
A. "I Need to give my parent a bath at the same time every day."
B. "I need to postpone any vacations for 5 years.
C. "I need to spend time with my parent doing things we both enjoy.
D. "I need to stay with my parent 24 hours a day for supervision."

100. Which of the following interventions is most appropriate in helping a client with early-
stage dementia complete ADLS?
A. Allow enough time for the client to complete ADLS as independently as possible.
B. Provide the client with a written list of all the steps needed to complete ADLS.
C. Plan to provide step-by-step prompting to complete the ADLS.
D. Tell the client to finish ADLS before breakfast or the nursing assistant will do them.