A 10-year-old is brought to the clinic for assessment. During the interview, the nurse
learns that the child has been the victim of domestic violence. Which of the following
messages would the nurse expect to hear in the assessment of the child due to the child’s
experience of abuse?
Standard Text: Select all that apply.
1. It is appropriate to love the people you hit.
2. Violence does not resolve conflict.
3. If you are small and weak, you deserve to be hit.
4. Violence is appropriate if the end result is good.
5. People who love you don”t hit you.
Answer:
The nurse is caring for an older client with depression who has begun having trouble
sleeping. In addition to antidepressants, a safe, nonpharmacologic and potentially
effective adjunctive treatment for insomnia in persons with a diagnosis of depression is:
1. Medical meditation.
2. Watching TV.
3. Progressive relaxation.
4. Alternate-nostril breathing.
Answer:
A client asks the nurse for help in learning to relax. The client claims to know about
meditation and understands it is supposed to help a person relax but every time the
client tries to meditate, the client is easily distracted. Considering the four major
requirements that facilitate successful meditation practice, the nurse advises the client
to:
Standard Text: Select all that apply.
1. Focus on one word, object, or symbol to look at or think about if the client finds it
helpful.
2. Find a position that will be comfortable to hold for a while.
3. Find a quiet place away from distractions.
4. Have a religious belief in order for meditation to be successful.
5. Pay attention to “how well the client is doing at meditating.”
Answer:
In treating clients with prolonged anxiety, the nurse knows it is most important to:
1. Teach communication skills.
2. Explore old and ineffective coping strategies.
3. Encourage the expression of anger.
4. Help clients use anxiety to increase self-awareness and develop coping strategies.
Answer:
A client tells the nurse, “My therapist stroked my face and asked me to come to his
house for a romantic evening.” What action should the nurse take?
1. Call the police.
2. Immediately report the client’s claims to the appropriate authority.
3. Discuss the statements with the medical director.
4. Do nothing, as psychiatric clients often are unreliable.
Answer:
A client presents with an inability to make decisions and function independently. The
nurse knows these symptoms are indicative of which of the following disorders?
1. Dependent personality disorder
2. Paranoid personality disorder
3. Schizotypal personality disorder
4. Schizoid personality disorder
Answer:
A client tells visiting family that a test was done to see how the client’s brain was
functioning. The family asks the nurse if there really is such a test. The nurse realizes
that the client had which type of test?
1. Computerized tomography (CT)
2. Positron emission test (PET)
3. Single photon-emission computed tomography (SPECT)
4. Magnetic resonance imaging (MRI)
Answer:
A hospitalized client with a mood disorder is assessed to be high risk for suicide. The
nurse should intervene by:
1. Encouraging repetitive discussions of suicidal ruminations.
2. Removing dangerous objects from the client’s room.
3. Evaluating suicide intention every three days.
4. Using a strict regular schedule for client observation.
Answer:
What is the recommendation for environmental safety when clients have poor
judgment?
1. Use measures to decrease agitation.
2. Schedule ADLs at a regular time daily.
3. Turn the temperature down on the hot water heater.
4. Provide aids to assist with orientation.
Answer:
The nursing student is studying the psychoanalytic theory. The student knows that
which one of the following statements is not consistent with the psychoanalytic theory?
1. The structural model of the mind contends that the id, ego, and superego have
specific interrelated functions.
2. Psychic determinism means that no behavior is accidental.
3. Psychoanalysis deals with the conscious mind.
4. Psychoanalytic therapy focuses on a dynamic view of mental phenomena rather than
on the classification of illness.
Answer:
The client received aripiprazole (Abilify) on admission to the inpatient unit with a
diagnosis of schizophrenia, paranoid type. Which of the following would the nurse note
as a sign that the aripiprazole is becoming effective?
1. The client paces in the hall and engages in solitary activities most of the day.
2. The client sleeps for shorter periods of time during the day.
3. The client establishes eye contact and remains in conversation with the nurse for
longer periods.
4. The client eats only the food that is in its original container such as individual
packages of crackers.
Answer:
The nurse’s priority intervention for a newly hospitalized suicidal client is to:
1. Obtain a no-suicide contract for the day.
2. Have the client write a list of the client’s weaknesses.
3. Require the client to participate in the goals group.
4. Request the client to describe previous stressors.
Answer:
You are a nurse manager of an ICU in a local hospital and have lost two nurses on your
staff. One nurse quit and the other nurse is receiving treatment in a center for alcohol
abuse. What type of group would you recommend to your staff before considering a
transfer or quitting?
1. Nurse-to-nurse support group
2. Nurse storytelling group
3. Nurse bibliotherapy group
4. Nurse Alcoholics Anonymous group
Answer:
A nurse reviews the chart of a client seen at the nursing clinic for treatment of tension
headache. Which client complaint did the nurse enter into the nursing record?
1. “When the music plays so loud, my head starts to pound.”
2. “My whole cheek hurts, and it feels like I have bruising under my eye.”
3. “Usually there is just this steady pressure around my entire head.”
4. “I can tell it’s coming on; sometimes I vomit before it hits.”
Answer:
When planning sessions for a group of battered women, which stage of group
development would it be most appropriate for the nurse to lead a discussion regarding
legal solutions and alternative living arrangements?
1. Forming
2. Norming
3. Storming
4. Performing
Answer:
The nursing assistant verbalizes to the psychiatric nurse that normal people don”t have
mental disorders. Which approach by the nurse would be best?
1. Instruct the nursing assistant that anyone can have a mental health problem.
2. Alert the nursing manager of the nursing assistant’s remark.
3. Refer the nursing assistant back to the psychiatric orientation materials.
4. Ignore the comment; the nurse has no responsibility in this situation.
Answer: