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Substance Abuse, Eating disorders

and Impulse control


disorders
1. An unemployed woman, age 24,
seeks help because she feels
depressed and abandoned and doesn't
know what to do with her life.
She says she has quit her last five
jobs because her coworkers didn't
like her and didn't train her
adequately. Last week, her boyfriend
broke up with her after she drove his
car into a tree after an
argument. The client's initial diagnosis
is borderline personality
disorder. Which nursing observations
support this diagnosis?
A. Flat affect, social withdrawal, and
unusual dress
B. Suspiciousness, hypervigilance, and
emotional coldness
C. Lack of self-esteem, strong
dependency needs, and
impulsive behavior
D. Insensitivity to others, sexual
acting out, and violence
2.In a toddler, which of the following
injuries is most likely the result
of child abuse?
A. A hematoma on the occipital region
of the head
B. A 1-inch forehead laceration
C. Several small, dime-sized circular
burns on the child's back
D. A small isolated bruise on the right
lower extremity
3. A client is admitted to the
emergency department after being
found
unconscious. Her blood pressure is
82/50 mm Hg. She is 5 4" (1.6 m)
tall, weighs 79 lb (35.8 kg), and
appears dehydrated and emaciated.
After regaining consciousness, she
reports that she has had trouble

eating lately and can't remember what


she ate in the last 24 hours.
She also states that she has had
amenorrhea for the past year. She is
convinced she is fat and refuses food.
The nurse suspects that she
has:
A. bulimia nervosa.
B. anorexia nervosa.
C. depression.
D. schizophrenia.
4. A 15-year-old girl with anorexia has
been admitted to a mental
health unit. She refuses to eat. Which
of the following statements is
the best response from the nurse?
A. "You don't have to eat. It's your
choice."
B. "I hope you'll eat your food by
mouth. Tube feedings and
I.V. lines can be uncomfortable."
C. "Why do you think you're fat?
You're underweight. Here look in
the mirror."
D. "You really look terrible at this
weight. I hope you'll eat."
5. A client with a history of substance
abuse has been attending
Alcoholics Anonymous meetings
regularly in the psychiatric unit. One
afternoon, the client tells the nurse,
"I'm not going to those meetings
anymore. I'm not like the rest of those
people. I'm not a drunk. "What
is the most appropriate response?
A. "If you aren't an alcoholic, why do
you keep drinking and ending up
in the hospital?"
B. "It's your decision. If you don't
want to go, you don't have to."
C. "You seem upset about the
meetings."
D. "You have to go to the meetings.
It's part of your treatment plan."

6. A client is admitted to the inpatient


adolescent unit after being
arrested for attempting to sell cocaine
to an undercover police officer.
The nurse plans to write a behavioral
contract. To best promote
compliance, the contract should be
written:
A. abstractly.
B. by the client alone.
C. jointly by the client and nurse.
D. jointly by the physician and nurse.
7. During which phase of alcoholism is
loss of control and physiologic
dependence evident?
A. Prealcoholic phase
B. Early alcoholic phase
C. Crucial phase
D. Chronic phase
8. Which of the following is important
when restraining a violent client?
A. Have three staff members present,
one for each side of the body
and one for the head.
B. Always tie restraints to side rails.
C. Have an organized, efficient team
approach after the
decision is made to restrain the client.
D. Secure restraints to the gurney
with knots to prevent escape.
9. A client who's actively hallucinating
is brought to the hospital by
friends. They say that the client used
either lysergic acid diethylamide
(LSD) or angel dust (phencyclidine
[PCP]) at a concert. Which of the
following common assessment
findings indicates that the client may
have ingested PCP?
A. Dilated pupils
B. Nystagmus
C. Paranoia
D. Altered mood

10. A severely dehydrated teenager


admitted to the hospital with
hypotension and tachycardia
undergoes evaluation for electrolyte
disturbances. Her history includes
anorexia nervosa and a 20-lb (9.1kg) weight loss in the last month. She
is 5 7" (1.7 m) tall and weighs
80 lb (36.3 kg). Which nursing
intervention takes highest priority?
A. Initiating caloric and nutritional
therapy as ordered
B. Instituting behavioral modification
therapy as ordered
C. Addressing the client's low selfesteem
D. Regularly monitoring vital signs and
weight
11. A client tells the nurse that he is
having suicidal thoughts every
day. In conferring with the treatment
team, the nurse should make
which of the following
recommendations?
A. A no-suicide contract
B. Weekly outpatient therapy
C. A second psychiatric opinion
D. Intensive inpatient treatment
12. Which of the following etiologic
factors predispose a client to
Tourette syndrome?
A. No known etiology
B. Abnormalities in brain
neurotransmitters, structural changes
in basal ganglia and caudate nucleus,
and genetics
C. Abnormalities in the structure and
function of the ventricles
D. Environmental factors and birthrelated trauma

13. A client is admitted for


detoxification after a cocaine
overdose. The
client tells the nurse that he
frequently uses cocaine but he can
control
his use if he chooses. Which coping
mechanism is he using?
A. Withdrawal
B. Logical thinking
C. Repression
D. Denial
14. An 16-year-old boy is admitted to
the facility after acting out his
aggressions inappropriately at school.
Predisposing factors to the
expression of aggression include:
A. violence on television.
B. passive parents.
C. an internal locus of control.
D. a single-parent family
15. A client is brought to the
emergency department after being
beaten by her husband, a prominent
attorney. The nurse caring for
this client understands that:
A. open boundaries are common in
violent families.
B. violence usually results from a
power struggle.
C. domestic violence and abuse span
all socioeconomic classes.
D. violent behavior is a genetic trait
passed from one generation to the
next.
16. On discharge after treatment for
alcoholism, a client plans to take
disulfiram (Antabuse) as prescribed.
When teaching the client about
this drug, the nurse emphasizes the
need to:
A. avoid all products containing
alcohol.
B. adhere to concomitant vitamin B
therapy.

C. return for monthly blood drug level


monitoring.
D. limit alcohol consumption to a
moderate level.
17. During a private conversation, a
client with borderline personality
disorder asks the nurse to keep his
secret and then displays multiple,
self-inflicted, superficial lacerations on
the forearms. What is the
nurse's best response?
A. "That's it! You're on suicide
precautions."
B. "I'm going to tell your physician. Do
you want to tell me why you
did that?"
C. "Tell me what type of instrument
you used. I'm concerned about
infection."
D. "The team needs to know when
something important occurs
in treatment. I need to tell the others,
but let's talk about it
first."
18. The nurse is providing care for a
client undergoing opiate
withdrawal. Opiate withdrawal causes
severe physical discomfort and
can be life-threatening. To minimize
these effects, opiate users are
commonly detoxified with:
A. barbiturates.
B. amphetamines.
C. methadone.
D. benzodiazepines.
19. The nurse is caring for a client
who she believes has been abusing
opiates. Assessment findings in a
client abusing opiates such as
morphine include:
A. dilated pupils and slurred speech.
B. rapid speech and agitation.
C. dilated pupils and agitation.
D. euphoria and constricted pupils.

20. Which of the following signs


should the nurse expect in a client
with known amphetamine overdose?
A. Hypotension
B. Tachycardia
C. Hot, dry skin
D. Constricted pupils
21. A client is admitted to the
psychiatric unit with a diagnosis of
alcohol intoxication and suspected
alcohol dependence. Other
assessment findings include an
enlarged liver, jaundice, lethargy, and
rambling, incoherent speech. No other
information about the client is
available. After the nurse completes
the initial assessment, what is the
first priority?
A. Instituting seizure precautions,
obtaining frequent vital
signs, and recording fluid intake and
output
B. Checking the client's medical
records for health history information
C. Attempting to contact the client's
family to obtain more information
about the client
D. Restricting fluids and leaving the
client alone to "sleep off" the
episode
22. Which nursing action is best when
trying to diffuse a client's
impending violent behavior?
A. Helping the client identify and
express feelings of anxiety
and anger
B. Involving the client in a quiet
activity to divert attention
C. Leaving the client alone until the
client can talk about feelings
D. Placing the client in seclusion
23. The nurse is working with a client
who abuses alcohol. Which of
the following facts should the nurse
communicate to the client?

A. Abstinence is the basis for


successful treatment.
B. Attendance at Alcoholics
Anonymous meetings every day will
cure
alcoholism.
C. For treatment to be successful,
family members must participate.
D. An occasional social drink is
acceptable behavior for the alcoholic
24. Which psychosocial influence has
been causally related to the
development of aggressive behavior
and conduct disorder?
A. An overbearing mother
B. Rejection by peers
C. A history of schizophrenia in the
family
D. Low socioeconomic status
25. In group therapy, a client who has
used I.V. heroin every day for
the past 14 years says, "I don't have a
drug problem. I can quit
whenever I want. I've done it before."
Which defense mechanism is
the client using?
A. Denial
B. Obsession
C. Compensation
D. Rationalization
26. A client with a history of cocaine
addiction is admitted to the
coronary care unit for evaluation of
substernal chest pain. The
electrocardiogram (ECG) shows a 1mm ST-segment elevation the
anteroseptal leads and T-wave
inversion in leads V3 to V5.
Considering
the client's history of drug abuse, the
nurse expects the physician to
prescribe:
A. lidocaine (Xylocaine).
B. procainamide (Pronestyl).
C. nitroglycerin (Nitro-Bid IV).

D. epinephrine.
27. A 15-year-old client is brought to
the clinic by her mother. Her
mother expresses concern about her
daughter's weight loss and
constant dieting. The nurse conducts a
health history interview. Which
of the following comments indicates
that the client may be suffering
from anorexia nervosa?
A. "I like the way I look. I just need to
keep my weight down because
I'm a cheerleader."
B. "I don't like the food my mother
cooks. I eat plenty of fast food
when I'm out with my friends."
C. "I just can't seem to get down to
the weight I want to be.
I'm so fat compared to other girls."
D. "I do diet around my periods;
otherwise, I just get so bloated."
28. Which is the drug of choice for
treating Tourette syndrome?
A. fluoxetine (Prozac)
B. fluvoxamine (Luvox)
C. haloperidol (Haldol)
D. paroxetine (Paxil)
29. The client tells the nurse he was
involved in a car accident while he
was intoxicated. What would be the
most therapeutic response from
the nurse?
A. "Why didn't you get someone else
to drive you?"
B. "Tell me how you feel about the
accident."
C. "You should know better than to
drink and drive."
D. "I recommend that you attend an
Alcoholics Anonymous meeting."
30. A client voluntarily admits himself
to the substance abuse unit. He
confesses that he drinks 1 qt or more
of vodka each day and uses

cocaine occasionally. Later that


afternoon, he begins to show signs of
alcohol withdrawal. What are some
early signs of this condition?
A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above
101 F (38.3 C), and pruritus
C. Hypertension, diaphoresis, and
seizures
D. Diaphoresis, tremors, and
nervousness
31. When monitoring a client recently
admitted for treatment of
cocaine addiction, the nurse notes
sudden increases in the arterial
blood pressure and heart rate. To
correct these problems, the nurse
expects the physician to prescribe:
A. norepinephrine (Levophed) and
lidocaine (Xylocaine).
B. nifedipine (Procardia) and lidocaine.
C. nitroglycerin (Nitro-Bid IV) and
esmolol (Brevibloc).
D. nifedipine and esmolol
32. A client experiencing alcohol
withdrawal is upset about going
through detoxification. Which of the
following goals is a priority?
A. The client will commit to a drugfree lifestyle.
B. The client will work with the nurse
to remain safe.
C. The client will drink plenty of fluids
daily.
D. The client will make a personal
inventory of strengths
33. A client is admitted to a
psychiatric facility by court order for
evaluation for antisocial personality
disorder. This client has a long
history of initiating fights and abusing
animals and recently was
arrested for setting a neighbor's dog
on fire. When evaluating this

client for the potential for violence,


the nurse should assess for which
behavioral clues?
A. A rigid posture, restlessness, and
glaring
B. Depression and physical withdrawal
C. Silence and noncompliance
D. Hypervigilance and talk of past
violent acts
34. A client is brought to the
psychiatric clinic by family members,
who
tell the admitting nurse that the client
repeatedly drives while
intoxicated despite their pleas to stop.
During an interview with the
nurse, which statement by the client
most strongly supports a
diagnosis of psychoactive substance
abuse?
A. "I'm not addicted to alcohol. In
fact, I can drink more than I used to
without being affected."
B. "I only spend half of my paycheck
at the bar."
C. "I just drink to relax after work."
D. "I know I've been arrested three
times for drinking and
driving, but the police are just trying
to hassle me."
35. A client with borderline personality
disorder is admitted to the
psychiatric unit. Initial nursing
assessment reveals that the client's
wrists are scratched from a recent
suicide attempt. Based on this
finding, the nurse should formulate a
nursing diagnosis of:
A. Ineffective individual coping related
to feelings of guilt.
B. Situational low self-esteem related
to feelings of loss of control.
C. Risk for violence: Self-directed
related to impulsive
mutilating acts.

D. Risk for violence: Directed toward


others related to verbal threats.
36. A client recently admitted to the
hospital with sharp, substernal
chest pain suddenly complains of
palpitations. The nurse notes a rise
in the client's arterial blood pressure
and a heart rate of 144
beats/minute. On further questioning,
the client admits to having used
cocaine recently after previously
denying use of the drug. The nurse
concludes that the client is at high risk
for which complication of
cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
D. Panic disorder
37. A client is being admitted to the
substance abuse unit for alcohol
detoxification. As part of the intake
interview, the nurse asks him
when he had his last alcoholic drink.
He says that he had his last drink
6 hours before admission. Based on
this response, the nurse should
expect early withdrawal symptoms to:
A. begin after 7 days.
B. not occur at all because the time
period for their occurrence has
passed.
C. begin anytime within the next 1 to
2 days.
D. begin within 2 to 7 days.
38. The nurse is assigned to care for a
client with anorexia nervosa.
Initially, which nursing intervention is
most appropriate for this client?
A. Providing one-on-one supervision
during meals and for 1
hour afterward
B. Letting the client eat with other
clients to create a normal mealtime
atmosphere

C. Trying to persuade the client to eat


and thus restore nutritional
balance
D. Giving the client as much time to
eat as desired
39. A client begins to experience
alcoholic hallucinosis. What is the
best nursing intervention at this time?
A. Keeping the client restrained in bed
B. Checking the client's blood pressure
every 15 minutes and offering
juices
C. Providing a quiet environment and
administering medication
as needed and prescribed
D. Restraining the client and
measuring blood pressure every 30
minutes
40. Which assessment finding is most
consistent with early alcohol
withdrawal?
A. Heart rate of 120 to 140
beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mm Hg
D. Blood pressure of 140/80 mm Hg
41. Which client is at highest risk for
suicide?
A. One who appears depressed,
frequently thinks of dying, and gives
away all personal possessions
B. One who plans a violent death and
has the means readily
available
C. One who tells others that he or she
might do something if life
doesn't get better soon
D. One who talks about wanting to die
42. Which of the following medical
conditions is commonly found in
clients with bulimia nervosa?
A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A

43. A high school student is referred


to the school nurse for suspected
substance abuse. Following the
nurse's assessment and interventions,
what would be the most desirable
outcome?
A. The student discusses conflicts over
drug use.
B. The student accepts a referral to a
substance abuse
counselor.
C. The student agrees to inform his
parents of the problem.
D. The student reports increased
comfort with making choices.
44. A client who reportedly consumes
1 qt of vodka daily is admitted
for alcohol detoxification. To try to
prevent alcohol withdrawal
symptoms, the physician is most likely
to prescribe which drug?
A. clozapine (Clozaril)
B. thiothixene (Navane)
C. lorazepam (Ativan)
D. lithium carbonate (Eskalith)
45. A client is being treated for
alcoholism. After a family meeting, the
client's spouse asks the nurse about
ways to help the family deal with
the effects of alcoholism. The nurse
should suggest that the family join
which organization?
A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous
46. A client is admitted to the
psychiatric clinic for treatment of
anorexia nervosa. To promote the
client's physical health, the nurse
should plan to:
A. severely restrict the client's
physical activities.
B. weigh the client daily, after the
evening meal.

C. monitor vital signs, serum


electrolyte levels, and acid-base
balance.
D. instruct the client to keep an
accurate record of food and fluid
intake.
47. A young man is remanded by the
courts for psychiatric treatment.
His police record, which dates to his
early teenage years, includes
delinquency, running away, auto theft,
and vandalism. He dropped out
of school at age 16 and has been
living on his own since then. His
history suggests maladaptive coping,
which is associated with:
A. antisocial personality disorder.
B. borderline personality disorder.
C. obsessive-compulsive personality
disorder.
D. narcissistic personality disorder.
48. A husband and wife seek
emergency crisis intervention because
he
slapped her repeatedly the night
before. The husband indicates that
his childhood was marred by an
abusive relationship with his father.
When intervening with this couple, the
nurse knows they are at risk for
repeated violence because the
husband:
A. has only moderate impulse control.
B. denies feelings of jealousy or
possessiveness.
C. has learned violence as an
acceptable behavior.
D. feels secure in his relationship with
his wife.
49. A client whose husband just left
her has a recurrence of anorexia
nervosa. The nurse caring for her
realizes that this exacerbation of
anorexia nervosa results from the
client's effort to:
A. manipulate her husband.

B. gain control of one part of her life.


C. commit suicide.
D. live up to her mother's
expectations.
50. A client has approached the nurse
asking for advice on how to deal
with his alcohol addiction. The nurse
should tell the client that the only
effective treatment for alcoholism is:
A. psychotherapy.
B. total abstinence.
C. Alcoholics Anonymous (AA).
D. aversion therapy.
51. Flumazenil (Romazicon) has been
ordered for a client who has
overdosed on oxazepam (Serax).
Before administering the medication,
the nurse should be prepared for
which common adverse effect?
A. Seizures
B. Shivering
C. Anxiety
D. Chest pain
52. The nurse is caring for a client
diagnosed with bulimia. The most
appropriate initial goal for a client
diagnosed with bulimia is to:
A. avoid shopping for large amounts of
food.
B. control eating impulses.
C. identify anxiety-causing situations.
D. eat only three meals per day.
53. A client who's at high risk for
suicide needs close supervision. To
best ensure the client's safety, the
nurse should:
A. check the client frequently at
irregular intervals throughout
the night.
B. assure the client that the nurse will
hold in confidence anything the
client says.
C. repeatedly discuss previous suicide
attempts with the client.

D. disregard decreased communication


by the client because this is
common in suicidal clients.
54. Which of the following drugs
should the nurse prepare to
administer to a client with a toxic
acetaminophen (Tylenol) level?
A. deferoxamine mesylate (Desferal)
B. succimer (Chemet)
C. flumazenil (Romazicon)
D. acetylcysteine (Mucomyst)
55. A client is admitted to the
substance abuse unit for alcohol
detoxification. Which of the following
medications is the nurse most
likely to administer to reduce the
symptoms of alcohol withdrawal?
A. naloxone (Narcan)
B. haloperidol (Haldol)
C. magnesium sulfate
D. chlordiazepoxide (Librium)
56. During postprandial monitoring, a
client with bulimia nervosa tells
the nurse, "You can sit with me, but
you're just wasting your time.
After you sat with me yesterday, I was
still able to purge. Today, my
goal is to do it twice." What is the
nurse's best response?
A. "I trust you not to purge."
B. "How are you purging and when do
you do it?"
C. "Don't worry. I won't allow you to
purge today."
D. "I know it's important for you to
feel in control, but I'll
monitor you for 90 minutes after you
eat."
57. A client admitted to the psychiatric
unit for treatment of substance
abuse says to the nurse, "It felt so
wonderful to get high." Which of
the following is the most appropriate
response?

A. "If you continue to talk like that,


I'm going to stop speaking to you."
B. "You told me you got fired from
your last job for missing too
many days after taking drugs all
night."
C. "Tell me more about how it felt to
get high."
D. "Don't you know it's illegal to use
drugs?"
58. For a client with anorexia nervosa,
which goal takes the highest
priority?
A. The client will establish adequate
daily nutritional intake.
B. The client will make a contract with
the nurse that sets a target
weight.
C. The client will identify selfperceptions about body size as
unrealistic.
D. The client will verbalize the possible
physiological consequences of
self-starvation.
59. When interviewing the parents of
an injured child, which of the
following is the strongest indicator
that child abuse may be a problem?
A. The injury isn't consistent with the
history or the child's age.
B. The mother and father tell different
stories regarding what
happened.
C. The family is poor.
D. The parents are argumentative and
demanding with emergency
department personnel.
60. For a client with anorexia nervosa,
the nurse plans to include the
parents in therapy sessions along with
the client. What fact should the
nurse remember to be typical of
parents of clients with anorexia
nervosa?

A. They tend to overprotect their


children.
B. They usually have a history of
substance abuse.
C. They maintain emotional distance
from their children.
D. They alternate between loving and
rejecting their children.
61. In the emergency department, a
client with facial lacerations
states that her husband beat her with
a shoe. After the health care
team repairs her lacerations, she waits
to be seen by the crisis intake
nurse, who will evaluate the continued
threat of violence. Suddenly the
client's husband arrives, shouting that
he wants to "finish the job."
What is the first priority of the health
care worker who witnesses this
scene?
A. Remaining with the client and
staying calm
B. Calling a security guard and
another staff member for
assistance
C. Telling the client's husband that he
must leave at once
D. Determining why the husband feels
so angry
62. The nurse is caring for a client
with bulimia. Strict management of
dietary intake is necessary. Which
intervention is also important?
A. Fill out the client's menu and make
sure she eats at least half of
what is on her tray.
B. Let the client eat her meals in
private. Then engage her in social
activities for at least 2 hours after
each meal.
C. Let the client choose her own food.
If she eats everything
she orders, then stay with her for 1
hour after each meal.
D. Let the client eat food brought in by
the family if she chooses, but

she should keep a strict calorie count.


63. The nurse is assigned to care for a
suicidal client. Initially, which is
the nurse's highest care priority?
A. Assessing the client's home
environment and relationships outside
the hospital
B. Exploring the nurse's own feelings
about suicide
C. Discussing the future with the client
D. Referring the client to a
clergyperson to discuss the moral
implications of suicide
64. A client with anorexia nervosa tells
the nurse, "When I look in the
mirror, I hate what I see. I look so fat
and ugly." Which strategy
should the nurse use to deal with the
client's distorted perceptions and
feelings?
A. Avoid discussing the client's
perceptions and feelings.
B. Focus discussions on food and
weight.
C. Avoid discussing unrealistic cultural
standards regarding weight.
D. Provide objective data and
feedback regarding the client's
weight and attractiveness.
65. The nurse is caring for a client
being treated for alcoholism. Before
initiating therapy with disulfiram
(Antabuse), the nurse teaches the
client that he must read labels
carefully on which of the following
products?
A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese
66. The nurse is developing a plan of
care for a client with anorexia
nervosa. Which action should the
nurse include in the plan?

A. Restrict visits with the family until


the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the
client.
D. Encourage the client to exercise,
which will reduce her anxiety.
67. Victims of domestic violence
should be assessed for what
important information?
A. Reasons they stay in the abusive
relationship (for example, lack of
financial autonomy and isolation)
B. Readiness to leave the perpetrator
and knowledge of
resources
C. Use of drugs or alcohol
D. History of previous victimization
68. A client is hospitalized with
fractures of the right femur and right
humerus sustained in a motorcycle
accident. Police suspect the client
was intoxicated at the time of the
accident. Laboratory tests reveal a
blood alcohol level of 0.2% (200
mg/dl). The client later admits to
drinking heavily for years. During
hospitalization, the client periodically
complains of tingling and numbness in
the hands and feet. The nurse
realizes that these symptoms probably
result from:
A. acetate accumulation.
B. thiamine deficiency.
C. triglyceride buildup.
D. a below-normal serum potassium
level
69. A parent brings a preschooler to
the emergency department for
treatment of a dislocated shoulder,
which allegedly happened when
the child fell down the stairs. Which
action should make the nurse
suspect that the child was abused?

A. The child cries uncontrollably


throughout the examination.
B. The child pulls away from contact
with the physician.
C. The child doesn't cry when the
shoulder is examined.
D. The child doesn't make eye contact
with the nurse.
70. When planning care for a client
who has ingested phencyclidine
(PCP), which of the following is the
highest priority?
A. Client's physical needs
B. Client's safety needs
C. Client's psychosocial needs
D. Client's medical needs
71. Which outcome criteria would be
appropriate for a child diagnosed
with oppositional defiant disorder?
A. Accept responsibility for own
behaviors.
B. Be able to verbalize own needs and
assert rights.
C. Set firm and consistent limits with
the client.
D. Allow the child to establish his own
limits and boundaries.
72. A client is found sitting on the
floor of the bathroom in the day
treatment clinic with moderate
lacerations on both wrists. Surrounded
by broken glass, she sits staring
blankly at her bleeding wrists while
staff members call for an ambulance.
How should the nurse approach
her initially?
A. Enter the room quietly and move
beside her to assess her injuries.
B. Call for staff back-up before
entering the room and restraining her.
C. Move as much glass away from her
as possible and sit next to her
quietly.
D. Approach her slowly while speaking
in a calm voice, calling

her name, and telling her that the


nurse is here to help her.
73. A client with anorexia nervosa
describes herself as "a whale."
However, the nurse's assessment
reveals that the client is 5 8" (1.7
m) tall and weighs only 90 lb (40.8
kg). Considering the client's
unrealistic body image, which
intervention should be included in the
plan of care?
A. Asking the client to compare her
figure with magazine photographs
of women her age
B. Assigning the client to group
therapy in which participants provide
realistic feedback about her weight
C. Confronting the client about her
actual appearance during one-onone
sessions, scheduled during each shift
D. Telling the client of the nurse's
concern for her health and
desire to help her make decisions to
keep her healthy
74. Eighteen hours after undergoing
an emergency appendectomy, a
client with a reported history of social
drinking displays these vital
signs: temperature, 101.6 F (38.7
C); heart rate, 126 beats/minute;
respiratory rate, 24 breaths/minute;
and blood pressure, 140/96 mm
Hg. The client exhibits gross hand
tremors and is screaming for
someone to kill the bugs in the bed.
The nurse should suspect:
A. a postoperative infection.
B. alcohol withdrawal.
C. acute sepsis.
D. pneumonia.
75. Clonidine (Catapres) can be used
to treat conditions other than
hypertension. For which of the
following conditions might the drug be
administered?

A. Phencyclidine (PCP) intoxication


B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal
76. One of the goals for a client with
anorexia nervosa is that the
client will demonstrate increased
individual coping by responding to
stress in constructive ways. Which of
the following actions is the best
indicator that the client is working
toward meeting the goal?
A. The client drinks 4 L of fluid per
day.
B. The client paces around the unit
most of the day.
C. The client keeps a journal and
discusses it with the nurse.
D. The client talks almost constantly
with friends by telephone.
77. The nurse in the substance abuse
unit is trying to encourage a
client to attend Alcoholics Anonymous
meetings. When the client asks
the nurse what he must do to become
a member, the nurse should
respond:
A. "You must first stop drinking."
B. "Your physician must refer you to
this program."
C. "Admit you're powerless over
alcohol and that you need
help."
D. "You must bring along a friend who
will support you."
78. An attorney who throws books and
furniture around the office after
losing a case is referred to the
psychiatric nurse in the law firm's
employee assistance program. The
nurse knows that the client's
behavior most likely represents the
use of which defense mechanism?
A. Regression
B. Projection

C. Reaction-formation
D. Intellectualization
79. After completing chemical
detoxification and a 12-step program
to
treat crack addiction, a client is being
prepared for discharge. Which
remark by the client indicates a
realistic view of the future?
A. "I'm never going to use crack
again."
B. "I know what I have to do. I have
to limit my crack use."
C. "I'm going to take 1 day at a time.
I'm not making any
promises."
D. "I will substitue crack for something
else"
80. The nurse is assessing a client on
admission to the chemical
dependency unit for alcohol
detoxification. When the nurse asks
about
alcohol use, this client is most likely
to:
A. accurately describe the amount
consumed.
B. underestimate the amount
consumed.
C. overestimate the amount
consumed.
D. deny any consumption of alcohol.
81. The nurse is assessing a 15-yearold female who's being admitted
for treatment of anorexia nervosa.
Which clinical manifestation is the
nurse most likely to find?
A. Tachycardia
B. Warm, flushed extremities
C. Parotid gland tenderness
D. Coarse hair growth
82. A 38-year-old client is admitted
for alcohol withdrawal. The most

common early sign or symptom that


this client is likely to experience
is:
A. impending coma.
B. manipulating behavior.
C. suppression.
D. perceptual disorders.
83. The nurse is caring for an
adolescent female who reports
amenorrhea, weight loss, and
depression. Which additional
assessment finding would suggest that
the woman has an eating
disorder?
A. Wearing tight-fitting clothing
B. Increased blood pressure
C. Oily skin
D. Excessive and ritualized exercise
84. A client with a history of
polysubstance abuse is admitted to
the
facility. She complains of nausea and
vomiting 24 hours after
admission. The nurse assesses the
client and notes piloerection,
pupillary dilation, and lacrimation. The
nurse suspects that the client is
going through which of the following
withdrawals?
A. Alcohol withdrawal
B. Cannibis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal
85. A client is admitted to the
psychiatric unit with a diagnosis of
anorexia nervosa. Although she is 5
8" (1.7 m) tall and weighs only
103 lb (46.7 kg), she talks incessantly
about how fat she is. Which
measure should the nurse take first
when caring for this client?
A. Teach the client about nutrition,
calories, and a balanced diet.
B. Establish a trusting relationship
with the client.

C. Discuss cultural stereotypes


regarding thinness and attractiveness.
D. Explore the reasons why the client
doesn't eat.
86. A client is admitted for an
overdose of amphetamines. When
assessing this client, the nurse should
expect to see:
A. tension and irritability.
B. slow pulse.
C. hypotension.
D. constipation.
87. Which of the following drugs may
be abused because of tolerance
and physiologic dependence.
A. lithium (Lithobid) and divalproex
(Depakote).
B. verapamil (Calan) and
chlorpromazine (Thorazine)
C. alprazolam (Xanax) and
phenobarbital (Luminal)
D. clozapine (Clozaril) and
amitriptyline (Elavil)

88. Which of the following groups are


considered to be at highest risk
for suicide?
A. Adolescents, men over age 45, and
persons who have made
previous suicide attempts
B. Teachers, divorced persons, and
substance abusers
C. Alcohol abusers, widows, and
young married men
D. Depressed persons, physicians, and
persons living in rural areas
89. Tourette syndrome is
characterized by the presence of
multiple
motor and vocal tics. A vocal tic that
involves repeating one's own
sounds or words is known as:
A. echolalia.
B. palilalia.
C. apraxia.
D. aphonia.