PSYCHITRY UWORLD DRILLS

PSYCHITRY UWORLD DRILLS

251-350

251) A client on a medical unit recently received a diagnosis of end-stage renal disease and was told of the need to go on dialysis. This morning the client was found in the bathroom trying to commit suicide by hanging using hospital gown ties. The client was stabilized and transferred to the psychiatric unit. Which of the following is the highest priority nursing action for this client?

• Assess the client’s risk for another suicide attempt
• Encourage the client to express current feelings about the medical diagnosis
• Place the client in the private room near the nurses’ station
• Provide continuous one-to-one observation with client

252) The nurse cares for a client who just had surgical excision and biopsy of a tumor. The biopsy result show that the tumor is malignant, but the client has not yet been informed by the health care provider. The client asks the nurse, ”Am I going to die?” Which statement by the nurse is appropriate?

• “I know how anxious you must be. Watching some television might help you relax.”
• “Tell me more about your thought and feelings regarding the situation.”
• “The biopsy result shows that you have cancer, but many cancers are treatable.”
• “Waiting for test result can be stressful. I am sorry I cannot tell you more.”

253) The nurse working on the inpatient psychiatric unit is preparing to administer 9:00 AM medications to a client. The medication record is shown in the exhibit. On assessment, the client tremulous, exhibits muscle rigidity, and has a temperature of 101.1 F (38.4 C). Which action should the nurse take?

Allergies: None

Medications Time

Haloperidol: 5 mg orally, twice a day 0900, 2100

Hydrochlorothiazide: 25 mg orally, daily 0900

Omeprazole: 20 mg orally, daily 0900

Acetaminophen: 650 mg orally, PRN Every 4 hours

• Give all medications, including acetaminophen, and reassess in 30 minutes
• Hold the haloperidol, give acetaminophen, and reassess in 30 minutes
• Hold the haloperidol and notify the health care provider (HCP) immediately
• Hold the hydrochlorothiazide and notify the HCP immediately

254) The nurse is caring for a client admitted with serotonin syndrome after taking tramadol.Which assessment findings does the nurse expect to find? Select all that apply.

• Absent deep tendon reflexes
• Cold, clammy skin
• Muscle rigidity
• Restlessness and agitation
• Sinus tachycardia

255) A client at 9 weeks gestation arrives at the clinic for an initial obstetric appointment. The nurse reviews the client’s medical history and obtains a list of current medications. The nurse recognizes that which of the following medications should be clarified with the health care provider immediately? Select all that apply.

• Albuterol
• Doxycyline
• Insulin aspart
• Isotretinoin

• Levothyroxine
• Lisinopril

256) A client with seizure disorder is prescribed a moderately high dose of phenytoin. Which teaching topic should the nurse discuss with this client?

• Diet high in iron
• Good oral care and dental follow-up
• Shaving with an electric razor
• Use of sunglasses for eye protection

257) The nurse is educating a client in preparation for discharge from the hospital when the client breaks down crying, saying that the health care provider thinks she is crazy because he diagnosed her with a functional disorder. Which statement would be the best reply to this client?

• “Functional disorder is a general diagnosis for a genuine medical issue that medical

science does not yet fully understand.”

• “I am very sorry to hear this, but are you sure that’s what he meant?”
• “The health care provider does not know what he’s talking about. I’ll give you the

information my health care provider used.”

• “Why do you think he said that?”

258) The parent of a child diagnosed with attention-deficit hyperactivity disorder (ADHD), predominantly inattentive type, says to the nurse, “ I hate the idea of my child taking a drug that’s a stimulant. How will I know that the methylphenidate is even working?” Which is the best response by the nurse

• “Methylphenidate is generally a safe and effective drug for children with ADHD.”
• “Methylphenidate will increase the levels of neurotransmitters in your child’s brain.”
• “You should see your child’s school grades improve.”
• “Your child should be able to more easily complete school assignment and other tasks.”

259) A nursing home client with major depressive disorder reports difficulty going to sleep until late at night. The client gets up, paces the hallway, wrings the hands, and appears teary. What interventions should be included in the client’s nursing care plan? Select all that apply.

• Allow the client to receive at least 20 minutes of natural sunlight each day
• Encourage the client to take naps during the day to make up for lost sleep
• Have the client engage in strenuous physical exercise just before bedtime
• Spend time with the client in a quiet environment just before bedtime
• Suggest that the client take a warm bath before going to bed

260) The nurse reinforces teaching for a client newly prescribed buspirone for generalized anxiety disorder. Which client statement indicates that teaching has been effective?

• “Driving is not recommended until I stop taking this medication.”
• “If I experience a panic attack I should take an extra dose of medication.”
• “It will be 2-4 weeks before I feel the full effect of this medication.”
• “Withdrawal symptoms will occur if I abruptly stop taking this medication.”

261) The nurse is working in the emergency department. Which client should the nurse see first?

• 12-year-old with severe neck muscle spasms who is taking haloperidol for Tourette

syndrome

• 80-year-old with irritability and agitation who has taken alprazolam for 2 weeks
• Client taking clozapine who has sudden onset of high fever, diaphoresis, and change in

mental status

• Client taking olanzapine who has dry mouth, blurry vision, and constipation

262) The registered nurse is counseling the parent of a child recently diagnosed with attention- deficit hyperactivity disorder (ADHD), combined type. Which statement by the parent requires an intervention?

• ”I should offer a choice between 2 things for my child’s or meals.”
• “I will need to advocate for an individualized educational plan for my child.”
• “My child will outgrow this disorder around age 20.”
• “When talking with my child, I should not be multi-asking.”

263) The partner of a client with borderline personality disorder calls the clinic and reports coming home from work to find the client with self-inflicted superficial cuts to the arm. The partner tells the nurse, “My partner does something like this every time I have to go away on business. My partner is not serious about doing something really harmful, just trying to stop me from going away. ”What is the best response by the nurse?

• ”Are you still going to take your business trip?”
• “It sounds like you are having a difficult time coping with your partner’s behavior.”
• “Your partner is most likely doing it for attention, so it’s best to just ignore it.”
• “Your partner needs to be seen in the clinic today.”

264) The nurse prepares to administer clozapine to a client with schizophrenia. Which client statement would require priority investigation before administering the medication?

• ”I have gained a few pounds since I started this medication.”
• “I have had a score throat for 3 days and feel feverish today.”
• “I have noticed increased salivation and drooling.”
• “I often fell sleepy when I like this medication.”

265) A client on the locked unit of an inpatient psychiatric hospital says to a nurse on the evening shift, “During the day they let me out to go to the gift shop. You’re my favorite nurse; I know you’ll be a good sport and give me a pass.” What is the best response by the nurse?

• ”The gift shop is not even open right now.”
• “I guess the day shift staff needs to be reminded of the rules.”
• “What do you want to get from the gift shop?”
• “You do not have privileges for leaving the unit. I cannot give you a pass.”

266) The emergency department registered nurse is triaging a client for the risk of suicide. The client had thoughts of self-injury yesterday but is not sure today. Which of the following would be considered a known risk factor for suicide in this client? Select all that apply.

• Constantly hearing voices saying client is worthless
• Deliberately took an overdose 1 year ago
• Has a gun at home
• Married with 3 children
• Participation in religious activities
• Unemployed and unable to find a job

267) A client with bipolar disorder is admitted to the psychiatric unit with acute mania and dehydration. Which prescription does the nurse question?

• Administer zolpidem at bedtime as needed for insomnia
• Continue prescribed home dose of 300 mg lithium PO every 8 hours
• Give haloperidol and lorazepam IM together for aggressive behavior
• Infuse 500 mL normal saline IV bolus over 1 hour

268) A behavioral health clinic nurse assesses a 23-year-old client who started taking paroxetine

• weeks ago. Which statement made by the client is most important for the nurse to

investigate?

• “I don’t have much of an appetite since starting this medication.”

• “I have a lot more energy, but I’m feeling just s depressed.”
• “I have been feeling dizzy when I walk around at home.”
• “I have experienced frequent headaches lately.”

269) The nurse is caring for a new mother whose infant has been diagnosed with Down syndrome. The client says to the nurse, “I’m so worried. My husband is so devastated that he won’t even look at the baby. “What is the best response by the nurse?

• “Both of you will benefit from supportive counseling.”
• “How are you feeling about your baby?”
• “I will have the doctor speak to your husband.”
• “why do you think your husband feels this way?”

270) A client who is diagnosed with breast cancer asks the nurse, “Am I going to die?” Which statement by the nurse promotes a therapeutic relationship

• “Cancer is no longer a death sentence; you may live for many years.”
• “I will asks the chaplain to talk to you sometime today.”
• “People with cancer experience fear of dying; tell me about your concerns.”
• “Tell me about your life and hopes for the future.”

271) Which statement made by the nurse during a therapy session demonstrates a need for further instruction regarding effective therapeutic communication techniques?

• “I don’t understand what you mean. Can you give me an example?”
• “It is doubtful the president is out to get you.”
• “Tell me more about the day your child died.”
• “Why did you get so angry when she ignored you?”

272) A client with a diagnosis of antisocial personality disorder was given a 2-hour pass to leave the hospital. The client returned to the unit 15 minutes past curfew and did not sign in. The next day, this behavior is brought up in a group meeting. The client says, “It’s all the nurse’s fault. The nurse was right there and did not remind me to sign in.” What is the best response by the nurse?

• “I’m sorry. I should have reminded you to sign in.”
• “It is not my fault that you forgot to sign in.”
• “It is your responsibility to sign in when you return from a pass.”
• “You were late coming back from your pass. Is that why you did not sign in?”

273) A nurse is admitting a child and observes multiple irregular bruises. Which action should the nurse take next?

• Ask parents to leave the room during the admission process
• Continue with a detailed interview and physical examination
• Notify the charge nurse and the social worker
• Promise not to tell anyone if the child reveals abuse

274) The nurse cares for a client who has a do-not-resuscitate prescription, and notes extensive skin mottling and vital signs consistent with impending death. The client’s spouse states, “I hope my spouse can hang on a little longer; our anniversary is in 2days,” What response by the nurse is appropriate?

• “Tell me about your favorite anniversary memory that you shared.”
• “That would be very special, but please understand that it may not happen.”
• “We never know; death happens in its own time despite what we may want.”
• “Your spouse’s body is shutting down and the time is near; I will stay here with you.”

275) The nurse is caring for a client newly admitted with an acute manic episode of bipolar disorder. The nurse identifies which dinner selection as the most appropriate to promote client nutrition?