1. Which is the most important assessment data for a nurse to gather from the client in crisis?
The client’s work habits
Any significant physical health data
A history of emotional problems in the family
The client’s perception of the circumstances surrounding the crisis
2. A staff member tells a nurse that an older client gets irritable when asked to assist with activities of daily living. On what general information about older adults should the nurse base a response?
Decreased ability to cope
Loss of ability to cooperate
Ambivalence toward authority
Difficulty performing step procedures
3. A nurse reminds a client that it is time for group therapy. The client responds by yelling at the nurse, “You are always telling me what to do, just like my father!” What defense mechanism is the client using?
Regression
Transference
Reaction formation
Cognitive distortion
4. What is the most difficult initial task when developing a nurse-client relationship?
Remaining therapeutic and professional
Being able to understand and accept a client’s behavior
Developing an awareness of self and the professional role in the relationship
Accepting responsibility for identifying and evaluating the real needs of a client
5. A person mowing the lawn is badly disfigured by the lawn mower blade. According to Erikson’s theory, which age will demonstrate the greatest risk of longer-term psychological effects?
11-year-old
35-year-old
55-year-old
70-year-old
6. A client with the diagnosis of paranoid schizophrenia throws a chair across the room and starts screaming at the other clients. Several of these clients have frightened expressions, one starts to cry, and another begins to pace. A nurse removes the agitated client from the room. What should the nurse remaining in the room do next?
Continue the unit’s activities as if nothing happened.
Arrange a unit meeting to discuss what just happened.
Refocus clients’ negative comments to more positive topics.
Have a private talk with the clients who cried or started to pace.
7. As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join because “I have nothing to talk about.” What is the best response by the nurse?
“Maybe tomorrow you will feel more like talking.”
“Could you start off by talking about your family?”
“A person like you has a great deal to offer the group.”
“You feel you will not be accepted unless you have something to say?”
8. A psychiatric unit uses a behavioral approach to determine a client’s level of privileges. Which factor should a nurse use to determine an increase in privileges?
Statements that the depression is lifting
An improvement in short-term memory
Performing hygiene activities independently
Verbalizing a desire to change the response to stress
9. During a group meeting a client tells everyone, “I am afraid of my impending discharge from the hospital.” What is the most appropriate response by the nurse facilitator?
“You ought to be happy that you’re leaving.”
“Maybe you’re not ready to be discharged yet.”
“Maybe others in the group have similar feelings that they would share.”
“How many in the group feel that this member is ready to be discharged?”
10. A nurse greets a client who had been experiencing delusions of persecution and auditory hallucinations by saying, “Good evening. How are you?” The client, who has been referring to himself as “man,” answers, “The man is bad.” Of what is this an example?
Dissociation
Transference
Displacement
Identification
11. On which generally accepted concept of personality development should a nurse base care?
By 2 years of age the personality is firmly set.
The personality is capable of modification throughout life.
The capacity for personality change decreases rapidly after adolescence.
By the end of the first 6 years of life the personality has reached its adult parameters.
12. What is the most important tool a nurse brings to the therapeutic nurse-client relationship?
Oneself and a desire to help
Knowledge of psychopathology
Advanced communication skills
Years of experience in psychiatric nursing
13. Before discharge of an anxious client, the nurse should teach the family that anxiety can be recognized as:
a totally unique feeling.
fears specifically related to the total environment.
consciously motivated actions, thoughts, and wishes.
a pattern of emotional and behavioral responses to stress.
14. A nurse is aware that a co-worker’s mother died 16 months ago. The co-worker cries every time someone says the word “mother” or if the mother’s name is mentioned. What does the nurse conclude about this behavior?
It is an expected response.
Most people cry when their mother dies.
The co-worker may need help with grieving.
The co-worker was extremely attached to the mother.
15. Which individual is coping with issues concerning dependence versus independence?
Infant
Toddler
School-age child
Preschool-age child
16. A health care provider orders “Restraints prn” for a client who has a history of violent behavior. What is the nurse’s responsibility concerning this order?
Ask that the order indicate the type of restraint.
Recognize that prn orders for restraints are unacceptable.
Implement the restraint order when the client begins to act out.
Ensure that the entire staff is aware of the order for the restraint.
17. A male nurse is caring for a client. The client states, “You know, I’ve never had a male nurse before.” What is the nurse’s best reply?
“Does it bother you to have a male nurse?”
“How do you feel about having a male nurse?”
“There aren’t many male nurses. We are a minority.”
“You sound upset. I will get a female nurse to care for you.”
18. The parents of a toddler who was recently diagnosed with moderate retardation discuss their child’s future independent functioning. What should the nurse conclude?
They accept the child’s diagnosis.
Denial is being used as a defense.
They want to explore their child’s limitations.
Intellectualization helps them put the diagnosis into perspective.
19. A Latino client with schizophrenia is admitted to a mental health unit in an aggravated and disheveled state after failing to take prescribed medications for the last 5 days. When developing a plan of care that incorporates the clients cultural background, the nurse gives priority to:
the meaning and attention the client places on the future.
the clients need to control care to ensure desired outcomes.
inclusion of the family in the plan of care with the client’s permission.
20. A nurse must consider a child’s cognitive level of development when providing preoperative teaching. At which stage of Piaget’s cognitive theory should the nurse anticipate a child will experience the greatest fear of surgery?
Sensorimotor
Preoperational
Formal operational
Concrete operational
21. A client with diabetes mellitus is able to discuss in detail the diabetic metabolic process while eating a piece of chocolate cake. What defense mechanism does the nurse identify when evaluating this behavior?
Projection
Dissociation
Displacement
Intellectualization
22. In response to a question posed during a group meeting, the nurse explains that the superego is that part of the self that says:
“I like what I want.”
“I want what I want.”
“I should not want that.”
“I can wait for what I want.”
23. A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be “bad.” Which defense was the client using when this statement was made?
Splitting
Ambivalence
Passive aggression
Reaction formation
24. A parent of a 13-year-old adolescent who was recently diagnosed with Hodgkin disease tells a nurse, “I don’t want my child to know the diagnosis.” How should the nurse respond?
“It is best if your child knows the diagnosis.”
“Did you know the cure rate for Hodgkin disease is high?”
“Would you like someone with Hodgkin disease to talk with you?”
“Let’s talk about your feeling regarding your child’s diagnosis.”
25. Which relationship is of most concern to the nurse because of its importance in the formation of the personality?
Peer
Sibling
Spousal
Parent-child
26. At a group therapy session a client tearfully tells the other members, “I just lost my job this week.” What is the nurse leader’s most appropriate response?
Ask the client to consider the reasons this may have occurred.
Quietly observe how the group responds to the client’s statement.
Gently suggest that the client check the help-wanted advertisements in the local paper.
Request that the group help the client reflect on how the dismissal may have been prevented.
27. A client on the psychiatric unit asks a nurse about psychiatric advance directives (PADs). What information should form the basis of the nurse’s response?
The appointment of a surrogate decision maker is unnecessary.
A client is permitted to dictate what treatments will be given during future hospitalizations.
The need for involuntary admissions is eliminated when a client is a threat to self or others.
A client is allowed to consent or refuse potential psychiatric treatments if a future incapacitating mental health crisis occurs.
28. A 6-year-old child is diagnosed with type 1 diabetes. Considering the child’s cognitive developmental level, which explanation of the illness is most appropriate?
“Diabetes is caused by not having any insulin in your body.”
“Diabetes will require you to take insulin shots for the rest of your life.”
“You will be taught how to give yourself insulin now that you have diabetes.”
“Taking insulin for your diabetes is like getting new batteries for your superhero toys.”
29. Incidents of child molestation often are revealed years later when the victim is an adult. Which defense mechanism reflects this situation?
Isolation
Repression
Regression
Introjection
30. A nurse educator is leading a class on supporting middle- aged adults who are experiencing midlife crisis. What should the nurse include as the most significant factor in the development of this type of crisis?
The perception of their life situation
Many role changes that alter their experiences at this time
The anticipation of negative changes associated with old age
Lack of support from family members who are busy with their own lives
31. An extremely anxious client enters a crisis center and asks a nurse for help. Which response best reflects the nurse’s role in crisis intervention?
“Tell me what you have done to help yourself.”
“I will be here for you to help you figure things out.”
“I understand that in the past you have had problems.”
“Tell me about the things that are bothering you the most.”
32. A nurse encourages a client to join a self-help group after being discharged from a mental health facility. What is the purpose of having people work in a group?
Support
Confrontation
Psychotherapy
Self-awareness
33. A nurse is interviewing an 8-year-old girl who was admitted to the pediatric unit. Which statement by the child needs to be explored?
“Wow! This place has bright colors.”
“Is my mother allowed to visit me tonight?”
“Those boys are so cute. I hope their room is next to mine!
“I am scared about being here. Can you stay with me awhile?”
34. In the process of development the individual strives to maintain, protect, and enhance the integrity of the self. The nurse determines that this usually is accomplished through the use of:
affective reactions.
withdrawal patterns.
ritualistic behaviors.
defense mechanisms.
35. At what age does Freud’s phallic stage of psychosexual development compare with Erikson’s psychosocial phase of initiative versus guilt?
Adolescence
6 to 12 years
3 to 6 years
4. Birth to 1 year
36. A client with a history of violence is becoming increasingly agitated. Which nursing intervention will most likely increase the risk of acting out behavior?
Being assertive
Responding early
Providing choices
Teaching relaxation
37. An older adult tells the nurse, “I regret many of the choices I have made during my life.” Which of Erikson’s developmental conflicts does the nurse identify that the client has probably failed to accomplish?
Ego integrity versus despair
Identity versus role confusion
Generativity versus stagnation
Autonomy versus shame and doubt
38. A physician is admitted to the psychiatric unit of a community hospital. The client, who was restless, loud, aggressive, and resistive during the admission procedure, states, “I will take my own blood pressure.” What is the nurse’s most therapeutic response?
“Right now you are just another client.”
“If you would rather, I’m sure you will do it correctly.”
“I will get the attendants to assist me if you do not cooperate.”
“I am sorry, but I cannot allow that because I must take your blood pressure.”
39. A client diagnosed with major depression tells a nurse, “No matter what I do, everything turns out bad.” The nurse concludes that this is an example of:
using a cognitive distortion.
seeking sympathy from the nurse.
regressing to an earlier developmental level.
avoiding responsibility for previous behavior.
40. A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include?
Repression
Transference
Manipulation
Displacement
41. Which statement best describes the practice of psychiatric nursing?
Helps people with present or potential mental health problems
Ensures clients’ legal and ethical rights by being a client advocate
Focuses interpersonal skills on people with physical or emotional problems
Acts in a therapeutic way with people who are diagnosed as having a mental disorder
42. A nurse concludes that a client is using displacement. Which behavior has the nurse identified?
Ignoring unpleasant aspects of reality
Resisting any demands made by others
Using imaginative activity to escape reality
Directing pent-up emotions to other than the primary source
43. A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. What defense mechanism should the nurse determine that the client is using?
Introjection
Sublimation
Compensation
Reaction formation
44. What is the priority goal when planning care for a client in crisis?
Referring the client for occupational therapy
Restoring the client’s psychologic equilibrium
Scheduling the client for follow-up counseling
Having the client gain insight into the problem
45. A nurse is planning to teach a client about self-care. What level of anxiety will best enhance the clients learning abilities?
Mild
Panic
Severe
Moderate
46. After a child’s visit to a health care provider, a parent tells the nurse, “I am very upset. An antidepressant was prescribed for my child.” What is the nurse’s best response?
“Tell me more about what’s bothering you.”
“Weren’t you told why your child needs an antidepressant?”
“You need to speak with the health care provider about your concern.”
“Are you sure it’s an antidepressant and not a drug for attention deficit disorder?”
47. A 44-year-old client is unable to function since her husband asked for a divorce 2 weeks ago. She is brought to the crisis intervention center by a friend. What type of crisis reflects this situation?
Social
Situational
Maturational
Developmental
48. What should a nurse conclude that a client is doing when using the defense mechanism of sublimation?
Acting out in reverse something already done or thought
Returning to an earlier, less mature stage of development
Channeling unacceptable impulses into socially approved behavior
Excluding from consciousness thoughts that are psychologically disturbing
49. A client is scheduled for several diagnostic studies. Which behavior best indicates to the nurse that the client has received adequate preparation?
Requests that the tests be reexplained
Checks the appointment card repeatedly
Arrives early and waits quietly to be called for the tests
Paces up and down the hallway the morning of the tests
50. A client is diagnosed with a borderline personality disorder. What is a realistic initial intervention for this client?
Establish clear boundaries.
Explore job possibilities with the nurse.
Initiate discussion of feelings of being victimized.
Spend one hour twice a day discussing problems with the nurse.
