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1. A nurse is teaching clients in a medication education group about side effects of medications. Which drug will cause a heightened skin reaction to sunlight?

• Lithium
• Sertraline
• Methylphenidate
• Chlorpromazine

2. A nurse is working with a married woman who has come to the emergency department several times with injuries that appear to be related to domestic violence. While talking with the nurse manager, a nurse expresses disgust that the woman returns to the same situation. What is the nurse manager’s best response?

• “She must not have the financial resources to leave her husband.”
• “Most woman attempt to leave about six times before they are able to do so.”
• “There is nothing the staff can do because people are free to choose their own life.”
• “These women should be told how foolish they are to remain in their current situation.”

3. A client with schizophrenia is taking benztropine (Cogentin) in conjunction with an antipsychotic. The client tells a nurse, “Sometimes I forget to take the Cogentin.” What should the nurse teach the client to do if this happens again?

• Use 2 pills at the next regularly scheduled dose.
• Notify the health care provider about the missed dose immediately.
• Take a dose as soon as possible, up to 2 hours before the next dose.
• Skip the dose, and then take the next regularly scheduled dose 2 hours early.

4. A nurse is caring for a client who abruptly withdrew from barbiturate use. What should the nurse anticipate that the client may experience?

• Ataxia
• Seizures
• Diarrhea
• Urticaria

5. A client is scheduled for a 6-week electroconvulsive therapy (ECT) treatment program. What intervention is important during the 6-week course of treatment?

• Provision of tyramine-free meals
• Avoidance of exposure to the sun
• Maintenance of a steady sodium intake
• Elimination of benzodiazepines for nighttime sedation

6. A nurse is caring for a preschool-age child with a history of physical and sexual abuse. What is the most advantageous therapy for this child?

• Play
• Group
• Family
• Psychodrama

7. A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks?

• Lithium
• Diazepam
• Fluvoxamine
• Fluphenazine

8. What is an initial client objective in relation to anger management?

• Expressing remorse over aggressive actions
• Taking responsibility for the hostile behavior
• Developing alternative methods to release feelings
• Teaching others how to avoid triggering the angry behavior

9. A nurse is teaching clients about dietary restrictions when taking a monoamine oxidase inhibitor (MAOI). What response does the nurse tell them to anticipate if they do not follow these restrictions?

• Occipital headaches
• Generalized urticaria
• Severe muscle spasms
• Sudden drop in blood pressure

10. What is the prognosis for a normal productive life for a child diagnosed with autism?

• Dependent on an early diagnosis
• Often related to the child’s overall temperament
• Ensured as long as the child attends a school tailored to meet needs
• Unlikely because of interference with so many parameters of functioning

11. A nurse is evaluating the medication regimens of a group of clients to determine whether the therapeutic level has been achieved. For which medication should the nurse review the client’s serum blood level?

• Sertraline (Zoloft)
• Lorazepam (Ativan)
• Olanzapine (Zyprexa)
• Valproic acid (Depakene)

12. What is the most important information a nurse should teach to prevent relapse in a client with a psychiatric illness?

• Develop close support systems
• Create a stress-free environment
• Refrain from activities that cause anxiety
• Follow the prescribed medication regimen

13. A client has been receiving escitalopram (Lexapro) for treatment of a major depressive episode. On the fifth day of therapy the client refuses the medication stating, “It doesn’t help, so what’s the use of taking it?” What is the nurse’s best response?

• “Sometimes it takes 1 to 4 weeks to see an improvement.”
• “It takes 6 to 8 weeks for this medication to have an effect.”
• “I’ll talk to your health care provider about increasing the dose. That may help.”
• “You should have felt a response by now. I’ll notify your health care provider immediately.”

14. Imipramine (Tofranil), 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when administering this medication?

• Tell the client that barbiturates and steroids will not be prescribed.
• Warn the client not to eat cheese, fermenting products, and chicken liver.
• Monitor the client for increased tolerance and report if the dosage is no longer effective.
• Have the client checked for increased intraocular pressure and teach about symptoms of glaucoma.

15. A nurse works with school-age children who have a conduct disorder, childhood-onset type. The nurse considers that these children are at risk for progressing to an additional disorder during adolescence. For signs of which disorder should the nurse assess their present behavior?

• Oppositional defiant
• Antisocial personality
• Pervasive developmental
• Attention deficit hyperactivity

16. For what most common characteristic of autism should a nurse assess a child suspected of having this disorder?

• Responds to any stimulus.
• Responds to physical contact.
• Seems unresponsive to the environment.
• Interacts with children rather than adults.

17. A 6-year-old child with autism is nonverbal and has limited eye contact. What should a nurse do initially to promote social interaction?

• Encourage the child to sing songs with the nurse
• Engage in parallel play while sitting next to the child.
• Provide opportunities for the child to play with other children.
• Use therapeutic holding when the child does not respond to verbal interactions.

18. A client is receiving doxepin (Silenor). For which most dangerous side effect of tricyclic antidepressants should a nurse monitor the client?

• Mydriasis
• Dry mouth
• Constipation
• Urinary retention

19. A client with type 1 diabetes is diagnosed with a psychosis and is to receive haloperidol (Haldol). Which response should a nurse anticipate with this drug combination?

• Depressed respirations
• Intensified action of both drugs
• Decreased control of the diabetes
• Increased danger of extrapyramidal side effects

20. A client with depression is to receive fluoxetine (Prozac). What precaution should the nurse consider when initiating treatment with this drug?

• It must be given with milk and crackers to avoid hyperacidity and discomfort.
• Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis.
• Blood levels may not be sufficient to cause noticeable improvement for 2 to 4 weeks.
• Blood levels should be obtained weekly for 3 months to monitor for appropriate levels.

21. A primary nurse observes that a client has become jaundiced after 2 weeks of antipsychotic drug therapy. The primary nurse continues to administer the antipsychotic until the health care provider can be consulted. What does the nurse manager conclude concerning this situation?

• Jaundice is sufficient reason to discontinue the antipsychotic.
• The blood level of antipsychotics must be maintained once established.
• Jaundice is a benign side effect of antipsychotics that has little significance.
• The prescribed dose for the antipsychotic should have been reduced by the nurse.

22. A client with mild Alzheimer disease has been taking galantamine (Razadyne), and the health care provider prescribes paroxetine (Paxil) for depression. For what effect should a nurse assess the client when these medications are taken concurrently?

• Allergic
• Dystonic
• Additive
• Extrapyramidal

23. For which clinical indication should a nurse observe a child suspected of being autistic?

• Lack of eye contact
• Crying for attention
• Catatonic-like rigidity
• Engaging in parallel play

24. A nurse considers that autism is a form of a pervasive devel­ opmental disorder (PDD). Which factor unique to autism differentiates it from other forms of PDD?

• Has less severe linguistic handicaps
• Has an early onset before 36 months of age
• Is the only form that does not include seizures
• Is the only form that does not include mental retardation

25. A nurse is assessing a child suspected of having autism. At what age does the nurse determine that the signs of autism initially may be evident?

• 2 years of age
• 6 years of age
• 6 months of age
• 1 to 3 months of age

26. Chlordiazepoxide (Librium) 100 mg PO per hour is prescribed for a client with a Clinical Institute Withdrawal Assessment (CIWA) score of 25. The client had 300 mg in 3 hours and is still displaying acute alcohol withdrawal symptoms. What is the next nursing action?

• Inform the client that the limit of chlordiazepoxide has been reached.
• Administer chlordiazepoxide as indicated by the client’s CIWA score.
• Request a prescription for another medication to replace the chlordiazepoxide.
• Inform the health care provider that the maximum dose of chlordiazepoxide has been reached.

27. A client is receiving lithium. What is an important nursing intervention while this medication is being administered?

• Restrict the client’s daily sodium intake.
• Test the client’s urine specific gravity weekly.
• Monitor the client’s drug blood level regularly.
• Withhold the client’s other medications for several days.

28. A nurse is planning care for a group of hospitalized children. Which age group does the nurse anticipate will have the most problem with separation anxiety?

• 12 to 18 years
• 5 to 11 and 1/2 years
• 6 to 30 months
• 36 to 59 months

29. A nurse uses behavior modification to foster toilet training efforts in a cognitively impaired child. What reward should the nurse provide to reinforce appropriate use of the toilet?

• Candy bar
• Piece of fruit
• Hug with praise
• Choice of rewards

30. In conjunction with which classification of medication are trihexyphenidyl, biperiden (Akineton), or benztropine (Cogentin) often prescribed?

• Anxiolytics
• Barbiturates
• Antipsychotics
• Antidepressants

31. A depressed client has been prescribed a tricyclic antidepressant. How long should the nurse inform the client it will take before noticing a significant change in the depression?

• 4 to 6 days
• 2 to 4 weeks
• 5 to 6 weeks
• 12 to 16 hours

32. A client with dementia has been cared for by the spouse for 5 years. During the last month the client has become agitated and aggressive and is incontinent of urine and feces. What is the priority nursing care while this client is in an inpatient mental health facility?

• Managing the behavior
• Preventing further deterioration
• Focusing on the needs of the spouse
• Establishing an elimination retraining program

33. An 8-year-old child is diagnosed with oppositional defiant disorder. What behavior should the nurse identify that supports this diagnosis?

• Is easily distracted
• Argues with adults
• Lies to obtain favors
• Initiates physical fights

34. A 10-year-old child who was diagnosed with autism at the age of 3 attends a school for developmentally disabled chil­ dren and lives with the parents. The child has frequent episodes of self-biting behavior, banging the head, and needing help with feeding and toileting. The priority nursing goal for this child is “The child will:

• control repetitive behaviors.”
• be able to feed independently.”
• remain safe from self-inflicted injury.”
• develop control of urinary elimination.”

35. Olanzapine (Zyprexa) is prescribed for a client with bipolar disorder, manic episode. What cautionary advice should the nurse give the client?

• Sit up slowly.
• Report double vision.
• Expect increased salivation.
• Take the medication on an empty stomach.

36. An adolescent with a conduct disorder is receiving behavioral therapy to attempt to limit activities that violate societal norms. A specific outcome criterion unique for adolescents with this problem is “The client will:

• exhibit increased impulse control.”
• identify two positive personal attributes.”
• demonstrate respect for the rights of others.”
• use age-appropriate play activities with at least one peer.”

37. A client with chronic undifferentiated schizophrenia is receiving an antipsychotic medication. For which potentially irreversible extrapyramidal side effect should a nurse monitor the client?

• Torticollis
• Oculogyric crisis
• Tardive dyskinesia
• Pseudoparkinsonism

38. A nurse is teaching a client and family about the characteristics of dementia of the Alzheimer type. What characteristic should the nurse include?

• Periodic exacerbations
• Aggressive acting-out behavior
• Hypoxia of selected areas of brain tissue
• Areas of brain destruction called senile plaques

39. A nurse administers an antipsychotic to a client. For which common manageable side effect should the nurse assess the client?

• Jaundice
• Melanocytosis
• Drooping eyelids
• Unintentional tremors

40. An adolescent with the diagnosis of conduct disorder since the age of 9 is placed in a residential facility. The adolescent has a history of fighting, stealing, vandalizing property, and running away from home. The adolescent is aggressive, has no friends, and has been suspended from school repeatedly. What is the nurse’s priority when developing a plan of care?

• Preventing violence
• Encouraging insight
• Supporting self-esteem
• Promoting social interaction

41. A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the primary nurse, “Which of the prescribed medications will be most helpful for reducing psychotic signs and symptoms?” What should the nurse respond?

• Citalopram (Celexa)
• Ziprasidone (Geodon)
• Benztropine (Cogentin)
• Acetaminophen with hydrocodone (Lortab)

42. A client in the hyperactive phase of a mood disorder, bipolar type, is receiving lithium. A nurse identifies that the client’s lithium blood level is 1.8 mEq/L. What is the most appropriate nursing action?

• Continue the usual dose of lithium and note any adverse reactions.
• Discontinue the drug until the lithium serum level drops to 0.5 mEq/L.
• Ask the health care provider to increase the dose of lithium because the blood lithium level is too low.
• Hold the drug and notify the health care provider immediately because the blood lithium level may be toxic.

43. A health care provider prescribes haloperidol (Haldol) for a client. What should the nurse teach the client to avoid while taking this medication?

• Driving at night
• Staying in the sun
• Ingesting aged cheeses
• Taking medications containing aspirin

44. A child in the first grade is murdered, and counseling is planned for the other children in the school. What should a nurse identify first before assessing a child’s response to a crisis?

• Developmental level of the child
• Quality of the child’s peer relationships
• Child’s perception of the crisis situation
• Child’s communication patterns with family members

45. What medication should the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines ?

• Lithium
• Flumazenil
• Methadone
• Chlorpromazine

46. A nurse is educating a client who is taking clozapine (Clozaril) for paranoid schizophrenia. What should the nurse emphasize about the side effects of clozapine?

• Risk for falls
• Inability to sit still
• Increase in temperature
• Dizziness upon standing

47. A client with a psychosis is receiving olanzapine (Zydis). What is important for a nurse to consider when administering this drug?

• It can be given intramuscularly.
• A special tyramine-free diet is required.
• It dissolves instantly after oral administration.
• An empty stomach increases its effectiveness.

48. A monoamine oxidase inhibitor (MAOI) is prescribed. What should the nurse include in the teaching plan about what to avoid when taking this drug?

• Ingesting aged cheeses
• Prolonged exposure to the sun
• Engaging in active physical exercise
• Over-the-counter antihistamine drugs

49. A nurse leads an assertiveness training program for a group of clients. Which client statement demonstrates that the treatment has been effective?

• “I know I should put the needs of others before mine.”
• “I won’t stand for it, so I told my boss he’s a jerk and to get off my back.”
• “It annoys me when people call me ‘Dearie,’ so I told him not to do it anymore.”
• “It is easier for me to agree up front and then just do enough so that no one notices.”

50. A nurse is conducting a mini-mental status examination on an older client. What should the nurse ask the client to do when testing short-term memory?

• Subtract serial 7s from 100.
• Copy one simple geometric figure.
• State three random words mentioned earlier in the exam.
• Name two common objects when the nurse points to them.