1. The nurse is planning activities for a client who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client?
a. Ping pong
2. A client is admitted to the hospital with a diagnosis of major depression, severe, single episode. The nurse assesses the client and identifies a nursing diagnosis of imbalanced nutrition related to poor nutritional intake. The most appropriate nursing intervention related to this diagnosis is:
a. Explain to the client the importance of a good nutritional intake
b. Weight the client 3 times per week before breakfast
c. Report the nutritional concern to the psychiatrist and obtain a nutritional consultation as soon as possible.
d. Consult with the nutritionist, offer the client several small meals per day, and schedule brief nursing interactions with the client during these times.
3. In planning activities for the depressed client, especially during the early stages of hospitalization, which of the following plans is best?
a. Provide an activity that is quiet and solitary to avoid increased fatigue, such as working on a puzzle or reading a book.
b. Plan nothing until the client asks to participate in milieu.
c. Offer the client a menu of daily activities and insist the client participate in all of them
d. Provide a structured daily program of activities and encourage the client to participate.
4. The depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as “I’m such a failure… I can’t do anything right!” The best nursing response would be:
a. To tell the client this is not true; that we all have a purpose in life.
b. To remain with the client and sit in silence; this will encourage the client to verbalize feelings
c. To reassure the client that you know how the client is feeling and that things will get better
d. To identify recent behaviors or accomplishments that demonstrates skill ability.
5. A client with a diagnosis of major depression, recurrent with psychotic features is admitted to the mental health unit. To create a safe environment for the client, the nurse most importantly devises a plan of care that deals specifically with the client’s:
a. Disturbed thought processes
b. Imbalanced nutrition
c. Self-care deficit
d. Deficient knowledge
6. A depressed client is ready for discharge. The nurse feels comfortable that the client has a good understanding of the disease process when the client states:
a. “I’ll never let this happen to me again. I won’t let my boss or my job or my family get to me!”
b. “It’s important for me to eat well, exercise, and to take my medication. If I begin to lose my appetite or not sleep well, I’ve got to get in to see my doctor.”
c. “I’ve learned that I’m a good person and that I am worthy of giving and receiving love. I don’t need anyone; I have myself to rely on!”
d. “I don’t know what happened to me. I’ve always been able to make decisions for myself and for my business. I don’t ever want to feel so weak or vulnerable again!”
7. The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. The symptom presented by the client that requires the nurse’s immediate intervention is the client’s:
a. Outlandish behaviors and inappropriate dress
b. Grandiose delusions of being a royal descendent of King Arthur.
c. Nonstop physical activity and poor nutritional intake
d. Constant, incessant talking that includes sexual innuendoes and teasing the staff
8. The nurse reviews the activity schedule for the day and plans which activity for the manic client?
a. Brown-bag luncheon and book review
c. Paint-by-number activity
d. Deep breathing and progressive relaxation group
9. A hospitalized client is being considered for ECT. The client appears calm, but the family is anxious. The client’s mother begins to cry and states “My son’s brain will be destroyed. How can the doctor do this to him?” The nurses best response is:
a. “It sounds as though you need to speak with the psychiatrist”
b. “Your son has decided to have this treatment. You should be supportive to him.”
c. “Perhaps you’d like to see the ECT room and speak to the staff.”
d. “It sounds as though you have some concerns about the ECT procedure. Why don’t we sit down together and discuss any concerns you may have.”
10. The manic client announces to everyone in the dayroom that a stripper is coming to perform this evening. When the nurse firmly states that this will not happen, the manic client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, the nurse determines that the most appropriate action would be to:
a. With assistance, escort the manic client to her room and administer Haldol as prescribed if needed
b. Tell the client that smoking privileges are revoked for 24 hours
c. Orient the client to time, person, and place
d. Tell the client that the behavior is not appropriate.
11. Select all nursing interventions for a hospitalized client with mania who is exhibiting manipulative behavior.
a. Communicate expected behaviors to the client
b. Enforce rules and inform the client the he or she will not be allowed to attend group therapy sessions.
c. Ensure that the client knows that he or she is not in charge of the nursing unit
d. Be clear with the client regarding the consequences of exceeding limits set regarding behavior.
Assist the client in testing out alternative behaviors for obtaining needs
12. A woman comes into the ER in a severe state of anxiety following a car accident. The most appropriate nursing intervention is to:
a. Remain with the client
b. Put the client in a quiet room
c. Teach the client deep breathing
d. Encourage the client to talk about their feelings and concern.
13. When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. The most appropriate maintenance goal should focus on which of the following?
a. Continued contact with a crisis counselor
b. Identifying anxiety-producing situations
c. Ignoring feelings of anxiety
d. Eliminating all anxiety from daily situations
14. The nurse is monitoring a client who abuses alcohol for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for delirium tremors?
a. Hypertension, changes in LOC, hallucinations
b. Hypotension, ataxia, hunger
c. Stupor, agitation, muscular rigidity
d. Hypotension, coarse hand tremors, agitation
15. The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse “I should get out of this bad situation.” The most helpful response by the nurse would be:
a. “I 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.”
16. The nurse determines that the wife of an alcoholic client is benefiting from attending Al-Anon group when she hears the wife say:
a. “My attendance at the meetings has helped me to see that I provoke my husband’s violence.”
b. “I no longer feel that I deserve the beatings my husband inflicts on me.”
c. “I can tolerate my husband’s destructive behavior now that I know they are common with alcoholics.”
d. “I enjoy attending the meetings because they get me out of the house and away from my husband.”
17. The client has been hospitalized and is participating in a substance abuse therapy group sessions. 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 self use?
a. “I know I’m ready to be discharged. I feel I can say ‘no’ and leave a group of friends if they are drinking… ‘No Problem.’”
b. “This group has really helped a lot. I know it will be different when I go home. But I’m sure that my family and friends will all help me like the people in this group have… They’ll all help me… I know they will… They won’t let me go back to my old ways.”
c. “I’m looking forward to leaving here. I know that I will miss all of you. So, I’m happy and I’m sad, I’m excited and I’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.”
d. “I’ll keep all my appointments; go to all my AA groups; I’ll do everything I’m supposed to… Nothing will go wrong that way.”
18. A hospitalized client with a history of alcohol abuse tells the nurse, “I am leaving now. I have to go. I don’t want anymore treatment. I have things that I have to do right away.” The client has not been discharged. In fact, the client is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client’s concerns with the client, the client dresses and begins to walk out of the hospital room. The most important nursing action is to:
a. Restrain the client until the physician can be reached
b. Call security to block all areas
c. Tell the client that the client cannot return to this hospital again if the client leaves now.
d. Call the nursing supervisor.
19. Select the appropriate interventions for caring for the client in alcohol withdrawal.
a. Monitor vital signs
b. Provide stimulation in the environment
c. Maintain NPO status
d. Provide reality orientation as appropriate
e. Address hallucinations therapeutically
20. Which of the following nursing actions would be included in a care plan for a client with PTSD who states the experience was “bad luck”?
a. Encourage the client to verbalize the experience
b. Assist the client in defining the experience
c. Work with the client to take steps to move on with his life
d. Help the client accept positive and negative feelings
21. Which of the following psychological symptoms would the nurse expect to find in a hospitalized client who is the only survivor of a train accident?
22. Which of the following communication guidelines should the nurse use when talking with a client experiencing mania?
a. Address the client in a light and joking manner
b. Focus and redirect the conversation as necessary
c. Allow the client to talk about several different topic
d. Ask only open ended questions to facilitate conversations
23. What information is important to include in the nutritional counseling of a family with a member who has bipolar disorder?
a. If sufficient roughage isn’t eaten while taking lithium, bowel problems will occur.
b. If the intake of carbohydrates increases, the lithium level increases.
c. If the intake of calories is reduced, the lithium level will increase
d. If the intake of sodium increases, the lithium level will decrease.
24. In conferring with the treatment team, the nurse should make which of the following recommendations for a client who tells the nurse that everyday thoughts of suicide are present?
a. A no-suicide contract
b. Weekly outpatient therapy
c. A second psychiatric opinion
d. Intensive inpatient treatment
25. Which of the following short term goals is most appropriate for a client with bipolar disorder who is having difficulty sleeping?
a. Obtain medication for sleep
b. Work on solving a problem
c. Exercise before bedtime
d. Develop a sleep ritual