Test Bank for Psychiatric-Mental Health Nursing, 8th Edition (Chapters 1-24)
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Page 1
1. The nurse is assessing the factors contributing to the well-being of a newly admitted
client. Which of the following would the nurse identify as having a positive impact on
the individual's mental health?
A) Not needing others for companionship
B) The ability to effectively manage stress
C) A family history of mental illness
D) Striving for total self-reliance
Ans: B
Feedback:
Individual factors influencing mental health include biologic makeup, autonomy,
independence, self-esteem, capacity for growth, vitality, ability to find meaning in life,
emotional resilience or hardiness, sense of belonging, reality orientation, and coping or
stress management abilities. Interpersonal factors such as intimacy and a balance of
separateness and connectedness are both needed for good mental health, and therefore a
healthy person would need others for companionship. A family history of mental illness
could relate to the biologic makeup of an individual, which may have a negative impact
on an individual's mental health, as well as a negative impact on an individual's
interpersonal and socialñcultural factors of health. Total self-reliance is not possible,
and a positive social/cultural factor is access to adequate resources.
2. Which of the following statements about mental illness are true? Select all that apply.
A) Mental illness can cause significant distress, impaired functioning, or both.
B) Mental illness is only due to social/cultural factors.
C) Social/cultural factors that relate to mental illness include excessive dependency
on or withdrawal from relationships.
D) Individuals suffering from mental illness are usually able to cope effectively with
daily life.
E) Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Ans: A, D, E
Feedback:
Mental illness can cause significant distress, impaired functioning, or both. Mental
illness may be related to individual, interpersonal, or social/cultural factors. Excessive
dependency on or withdrawal from relationships are interpersonal factors that relate to
mental illness. Individuals suffering from mental illness can feel overwhelmed with
daily life. Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Psychiatric-Mental Health Nursing 8th edition by Videbeck Test Bank
Chapter 1
1. The nurse is assessing the factors contributing to the well-being of a newly admitted
client. Which of the following would the nurse identify as having a positive impact on
the individual's mental health?
A) Not needing others for companionship
B) The ability to effectively manage stress
C) A family history of mental illness
D) Striving for total self-reliance
Ans: B
Feedback:
Individual factors influencing mental health include biologic makeup, autonomy,
independence, self-esteem, capacity for growth, vitality, ability to find meaning in life,
emotional resilience or hardiness, sense of belonging, reality orientation, and coping or
stress management abilities. Interpersonal factors such as intimacy and a balance of
separateness and connectedness are both needed for good mental health, and therefore a
healthy person would need others for companionship. A family history of mental illness
could relate to the biologic makeup of an individual, which may have a negative impact
on an individual's mental health, as well as a negative impact on an individual's
interpersonal and socialñcultural factors of health. Total self-reliance is not possible,
and a positive social/cultural factor is access to adequate resources.
2. Which of the following statements about mental illness are true? Select all that apply.
A) Mental illness can cause significant distress, impaired functioning, or both.
B) Mental illness is only due to social/cultural factors.
C) Social/cultural factors that relate to mental illness include excessive dependency
on or withdrawal from relationships.
D) Individuals suffering from mental illness are usually able to cope effectively with
daily life.
E) Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Ans: A, D, E
Feedback:
Mental illness can cause significant distress, impaired functioning, or both. Mental
illness may be related to individual, interpersonal, or social/cultural factors. Excessive
dependency on or withdrawal from relationships are interpersonal factors that relate to
mental illness. Individuals suffering from mental illness can feel overwhelmed with
daily life. Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Psychiatric-Mental Health Nursing 8th edition by Videbeck Test Bank
Chapter 1
Page 1
1. The nurse is assessing the factors contributing to the well-being of a newly admitted
client. Which of the following would the nurse identify as having a positive impact on
the individual's mental health?
A) Not needing others for companionship
B) The ability to effectively manage stress
C) A family history of mental illness
D) Striving for total self-reliance
Ans: B
Feedback:
Individual factors influencing mental health include biologic makeup, autonomy,
independence, self-esteem, capacity for growth, vitality, ability to find meaning in life,
emotional resilience or hardiness, sense of belonging, reality orientation, and coping or
stress management abilities. Interpersonal factors such as intimacy and a balance of
separateness and connectedness are both needed for good mental health, and therefore a
healthy person would need others for companionship. A family history of mental illness
could relate to the biologic makeup of an individual, which may have a negative impact
on an individual's mental health, as well as a negative impact on an individual's
interpersonal and socialñcultural factors of health. Total self-reliance is not possible,
and a positive social/cultural factor is access to adequate resources.
2. Which of the following statements about mental illness are true? Select all that apply.
A) Mental illness can cause significant distress, impaired functioning, or both.
B) Mental illness is only due to social/cultural factors.
C) Social/cultural factors that relate to mental illness include excessive dependency
on or withdrawal from relationships.
D) Individuals suffering from mental illness are usually able to cope effectively with
daily life.
E) Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Ans: A, D, E
Feedback:
Mental illness can cause significant distress, impaired functioning, or both. Mental
illness may be related to individual, interpersonal, or social/cultural factors. Excessive
dependency on or withdrawal from relationships are interpersonal factors that relate to
mental illness. Individuals suffering from mental illness can feel overwhelmed with
daily life. Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Psychiatric-Mental Health Nursing 8th edition by Videbeck Test Bank
Chapter 1
1. The nurse is assessing the factors contributing to the well-being of a newly admitted
client. Which of the following would the nurse identify as having a positive impact on
the individual's mental health?
A) Not needing others for companionship
B) The ability to effectively manage stress
C) A family history of mental illness
D) Striving for total self-reliance
Ans: B
Feedback:
Individual factors influencing mental health include biologic makeup, autonomy,
independence, self-esteem, capacity for growth, vitality, ability to find meaning in life,
emotional resilience or hardiness, sense of belonging, reality orientation, and coping or
stress management abilities. Interpersonal factors such as intimacy and a balance of
separateness and connectedness are both needed for good mental health, and therefore a
healthy person would need others for companionship. A family history of mental illness
could relate to the biologic makeup of an individual, which may have a negative impact
on an individual's mental health, as well as a negative impact on an individual's
interpersonal and socialñcultural factors of health. Total self-reliance is not possible,
and a positive social/cultural factor is access to adequate resources.
2. Which of the following statements about mental illness are true? Select all that apply.
A) Mental illness can cause significant distress, impaired functioning, or both.
B) Mental illness is only due to social/cultural factors.
C) Social/cultural factors that relate to mental illness include excessive dependency
on or withdrawal from relationships.
D) Individuals suffering from mental illness are usually able to cope effectively with
daily life.
E) Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Ans: A, D, E
Feedback:
Mental illness can cause significant distress, impaired functioning, or both. Mental
illness may be related to individual, interpersonal, or social/cultural factors. Excessive
dependency on or withdrawal from relationships are interpersonal factors that relate to
mental illness. Individuals suffering from mental illness can feel overwhelmed with
daily life. Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Psychiatric-Mental Health Nursing 8th edition by Videbeck Test Bank
Chapter 1
Page 2
3. Which of the following are true regarding mental health and mental illness?
A) Behavior that may be viewed as acceptable in one culture is always unacceptable
in other cultures.
B) It is easy to determine if a person is mentally healthy or mentally ill.
C) In most cases, mental health is a state of emotional, psychological, and social
wellness evidenced by satisfying interpersonal relationships, effective behavior
and coping, positive self-concept, and emotional stability.
D) Persons who engage in fantasies are mentally ill.
Ans: C
Feedback:
What one society may view as acceptable and appropriate behavior, another society may
see that as maladaptive, and inappropriate. Mental health and mental illness are difficult
to define precisely. In most cases, mental health is a state of emotional, psychological,
and social wellness evidenced by satisfying interpersonal relationships, effective
behavior and coping, positive self-concept, and emotional stability. Persons who engage
in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy
is an individual factor that may contribute to mental illness.
4. A client grieving the recent loss of her husband asks if she is becoming mentally ill
because she is so sad. The nurse's best response would be,
A) ìYou may have a temporary mental illness because you are experiencing so much
pain.î
B) ìYou are not mentally ill. This is an expected reaction to the loss you have
experienced.î
C) ìWere you generally dissatisfied with your relationship before your husband's
death?î
D) ìTry not to worry about that right now. You never know what the future brings.î
Ans: B
Feedback:
Mental illness includes general dissatisfaction with self, ineffective relationships,
ineffective coping, and lack of personal growth. Additionally the behavior must not be
culturally expected. Acute grief reactions are expected and therefore not considered
mental illness. False reassurance or overanalysis does not accurately address the client's
concerns.
3. Which of the following are true regarding mental health and mental illness?
A) Behavior that may be viewed as acceptable in one culture is always unacceptable
in other cultures.
B) It is easy to determine if a person is mentally healthy or mentally ill.
C) In most cases, mental health is a state of emotional, psychological, and social
wellness evidenced by satisfying interpersonal relationships, effective behavior
and coping, positive self-concept, and emotional stability.
D) Persons who engage in fantasies are mentally ill.
Ans: C
Feedback:
What one society may view as acceptable and appropriate behavior, another society may
see that as maladaptive, and inappropriate. Mental health and mental illness are difficult
to define precisely. In most cases, mental health is a state of emotional, psychological,
and social wellness evidenced by satisfying interpersonal relationships, effective
behavior and coping, positive self-concept, and emotional stability. Persons who engage
in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy
is an individual factor that may contribute to mental illness.
4. A client grieving the recent loss of her husband asks if she is becoming mentally ill
because she is so sad. The nurse's best response would be,
A) ìYou may have a temporary mental illness because you are experiencing so much
pain.î
B) ìYou are not mentally ill. This is an expected reaction to the loss you have
experienced.î
C) ìWere you generally dissatisfied with your relationship before your husband's
death?î
D) ìTry not to worry about that right now. You never know what the future brings.î
Ans: B
Feedback:
Mental illness includes general dissatisfaction with self, ineffective relationships,
ineffective coping, and lack of personal growth. Additionally the behavior must not be
culturally expected. Acute grief reactions are expected and therefore not considered
mental illness. False reassurance or overanalysis does not accurately address the client's
concerns.
Page 3
5. The nurse consults the DSM for which of the following purposes?
A) To devise a plan of care for a newly admitted client
B) To predict the client's prognosis of treatment outcomes
C) To document the appropriate diagnostic code in the client's medical record
D) To serve as a guide for client assessment
Ans: D
Feedback:
The DSM provides standard nomenclature, presents defining characteristics, and
identifies underlying causes of mental disorders. It does not provide care plans or
prognostic outcomes of treatment. Diagnosis of mental illness is not within the
generalist RN's scope of practice, so documenting the code in the medical record would
be inappropriate.
6. Which would be a reason for a student nurse to use the DSM?
A) Identifying the medical diagnosis
B) Treat clients
C) Evaluate treatments
D) Understand the reason for the admission and the nature of psychiatric illnesses.
Ans: D
Feedback:
Although student nurses do not use the DSM to diagnose clients, they will find it a
helpful resource to understand the reason for the admission and to begin building
knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis,
treating, and evaluating treatments are not a part of the nursing process.
7. The legislation enacted in 1963 was largely responsible for which of the following shifts
in care for the mentally ill?
A) The widespread use of community-based services
B) The advancement in pharmacotherapies
C) Increased access to hospitalization
D) Improved rights for clients in long-term institutional care
Ans: A
Feedback:
The Community Mental Health Centers Construction Act of 1963 accomplished the
release of individuals from long-term stays in state institutions, the decrease in
admissions to hospitals, and the development of community-based services as an
alternative to hospital care.
5. The nurse consults the DSM for which of the following purposes?
A) To devise a plan of care for a newly admitted client
B) To predict the client's prognosis of treatment outcomes
C) To document the appropriate diagnostic code in the client's medical record
D) To serve as a guide for client assessment
Ans: D
Feedback:
The DSM provides standard nomenclature, presents defining characteristics, and
identifies underlying causes of mental disorders. It does not provide care plans or
prognostic outcomes of treatment. Diagnosis of mental illness is not within the
generalist RN's scope of practice, so documenting the code in the medical record would
be inappropriate.
6. Which would be a reason for a student nurse to use the DSM?
A) Identifying the medical diagnosis
B) Treat clients
C) Evaluate treatments
D) Understand the reason for the admission and the nature of psychiatric illnesses.
Ans: D
Feedback:
Although student nurses do not use the DSM to diagnose clients, they will find it a
helpful resource to understand the reason for the admission and to begin building
knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis,
treating, and evaluating treatments are not a part of the nursing process.
7. The legislation enacted in 1963 was largely responsible for which of the following shifts
in care for the mentally ill?
A) The widespread use of community-based services
B) The advancement in pharmacotherapies
C) Increased access to hospitalization
D) Improved rights for clients in long-term institutional care
Ans: A
Feedback:
The Community Mental Health Centers Construction Act of 1963 accomplished the
release of individuals from long-term stays in state institutions, the decrease in
admissions to hospitals, and the development of community-based services as an
alternative to hospital care.
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Page 4
8. Which one of the following is a result of federal legislation?
A) Making it easier to commit people for mental health treatment against their will.
B) Making it more difficult to commit people for mental health treatment against
their will.
C) State mental institutions being the primary source of care for mentally ill persons.
D) Improved care for mentally ill persons.
Ans: B
Feedback:
Commitment laws changed in the early 1970s, making it more difficult to commit
people for mental health treatment against their will. Deinstitutionalization
accomplished the release of individuals from long-term stays in state institutions.
Deinstitutionalization also had negative effects in that some mentally ill persons are
subjected to the revolving door effect, which may limit care for mentally ill persons.
9. The goal of the 1963 Community Mental Health Centers Act was to
A) ensure patients' rights for the mentally ill.
B) deinstitutionalize state hospitals.
C) provide funds to build hospitals with psychiatric units.
D) treat people with mental illness in a humane fashion.
Ans: B
Feedback:
The 1963 Community Mental Health Centers Act intimated the movement toward
treating those with mental illness in a less restrictive environment. This legislation
resulted in the shift of clients with mental illness from large state institutions to care
based in the community. Answer choices A, C, and D were not purposes of the 1963
Community Mental Health Centers Act.
10. The creation of asylums during the 1800s was meant to
A) improve treatment of mental disorders.
B) provide food and shelter for the mentally ill.
C) punish people with mental illness who were believed to be possessed.
D) remove dangerous people with mental illness from the community.
Ans: B
Feedback:
The asylum was meant to be a safe haven with food, shelter, and humane treatment for
the mentally ill. Asylums were not used to improve treatment of mental disorders or to
punish mentally ill people who were believed to be possessed. The asylum was not
created to remove the dangerously mentally ill from the community.
8. Which one of the following is a result of federal legislation?
A) Making it easier to commit people for mental health treatment against their will.
B) Making it more difficult to commit people for mental health treatment against
their will.
C) State mental institutions being the primary source of care for mentally ill persons.
D) Improved care for mentally ill persons.
Ans: B
Feedback:
Commitment laws changed in the early 1970s, making it more difficult to commit
people for mental health treatment against their will. Deinstitutionalization
accomplished the release of individuals from long-term stays in state institutions.
Deinstitutionalization also had negative effects in that some mentally ill persons are
subjected to the revolving door effect, which may limit care for mentally ill persons.
9. The goal of the 1963 Community Mental Health Centers Act was to
A) ensure patients' rights for the mentally ill.
B) deinstitutionalize state hospitals.
C) provide funds to build hospitals with psychiatric units.
D) treat people with mental illness in a humane fashion.
Ans: B
Feedback:
The 1963 Community Mental Health Centers Act intimated the movement toward
treating those with mental illness in a less restrictive environment. This legislation
resulted in the shift of clients with mental illness from large state institutions to care
based in the community. Answer choices A, C, and D were not purposes of the 1963
Community Mental Health Centers Act.
10. The creation of asylums during the 1800s was meant to
A) improve treatment of mental disorders.
B) provide food and shelter for the mentally ill.
C) punish people with mental illness who were believed to be possessed.
D) remove dangerous people with mental illness from the community.
Ans: B
Feedback:
The asylum was meant to be a safe haven with food, shelter, and humane treatment for
the mentally ill. Asylums were not used to improve treatment of mental disorders or to
punish mentally ill people who were believed to be possessed. The asylum was not
created to remove the dangerously mentally ill from the community.
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Page 5
11. The major problems with large state institutions are: Select all that apply.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asylum.
C) clients were geographically isolated from family and community.
D) increasing financial costs to individual residents.
Ans: A, C
Feedback:
Clients were often far removed from the local community, family, and friends because
state institutions were usually in rural or remote settings. Choices B and D were not
major problems associated with large state instructions.
12. A significant change in the treatment of people with mental illness occurred in the 1950s
when
A) community support services were established.
B) legislation dramatically changed civil commitment procedures.
C) the Patient's Bill of Rights was enacted.
D) psychotropic drugs became available for use.
Ans: D
Feedback:
The development of psychotropic drugs, or drugs used to treat mental illness, began in
the 1950s. Answer choices A, B, and C did not occur in the 1950s.
13. Before the period of the enlightenment, treatment of the mentally ill included
A) creating large institutions to provide custodial care.
B) focusing on religious education to improve their souls.
C) placing the mentally ill on display for the public's amusement.
D) providing a safe refuge or haven offering protection.
Ans: C
Feedback:
In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and
ridiculing the mentally ill, who were seen as animals, less than human. Custodial care
was not often provided as persons who were considered harmless were allowed to
wander in the countryside or live in rural communities, and more dangerous lunatics
were imprisoned, chained, and starved. In early Christian times, primitive beliefs and
superstitions were strong. The mentally ill were viewed as evil or possessed. Priests
performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted
with offenders burned at the stake. It was not until the period of enlightenment when
persons who were mentally ill were offered asylum as a safe refuge or haven offering
protection at institutions.
11. The major problems with large state institutions are: Select all that apply.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asylum.
C) clients were geographically isolated from family and community.
D) increasing financial costs to individual residents.
Ans: A, C
Feedback:
Clients were often far removed from the local community, family, and friends because
state institutions were usually in rural or remote settings. Choices B and D were not
major problems associated with large state instructions.
12. A significant change in the treatment of people with mental illness occurred in the 1950s
when
A) community support services were established.
B) legislation dramatically changed civil commitment procedures.
C) the Patient's Bill of Rights was enacted.
D) psychotropic drugs became available for use.
Ans: D
Feedback:
The development of psychotropic drugs, or drugs used to treat mental illness, began in
the 1950s. Answer choices A, B, and C did not occur in the 1950s.
13. Before the period of the enlightenment, treatment of the mentally ill included
A) creating large institutions to provide custodial care.
B) focusing on religious education to improve their souls.
C) placing the mentally ill on display for the public's amusement.
D) providing a safe refuge or haven offering protection.
Ans: C
Feedback:
In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and
ridiculing the mentally ill, who were seen as animals, less than human. Custodial care
was not often provided as persons who were considered harmless were allowed to
wander in the countryside or live in rural communities, and more dangerous lunatics
were imprisoned, chained, and starved. In early Christian times, primitive beliefs and
superstitions were strong. The mentally ill were viewed as evil or possessed. Priests
performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted
with offenders burned at the stake. It was not until the period of enlightenment when
persons who were mentally ill were offered asylum as a safe refuge or haven offering
protection at institutions.
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Page 6
14. The first training of nurses to work with persons with mental illness was in 1882 in
which state?
A) California
B) Illinois
C) Massachusetts
D) New York
Ans: C
Feedback:
The first training for nurses to work with persons with mental illness was in 1882 at
McLean Hospital in Belmont, Massachusetts.
15. What is meant by the term ìrevolving door effectî in mental health care?
A) An overall reduction in incidence of severe mental illness
B) Shorter and more frequent hospital stays for persons with severe and persistent
mental illness
C) Flexible treatment settings for mentally ill
D) Most effective and least expensive treatment settings
Ans: B
Feedback:
The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are
quickly discharged into the community where services are not adequate; without
adequate community services, clients become acutely ill and require rehospitalization.
The revolving door effect does not refer to flexible treatment settings for mentally ill.
Even though hospitalization is more expensive than outpatient treatment, if utilized
appropriately could result in stabilization and less need for emergency department visits
and/or rehospitalization. The revolving door effect does not relate to the incidence of
severe mental illness.
14. The first training of nurses to work with persons with mental illness was in 1882 in
which state?
A) California
B) Illinois
C) Massachusetts
D) New York
Ans: C
Feedback:
The first training for nurses to work with persons with mental illness was in 1882 at
McLean Hospital in Belmont, Massachusetts.
15. What is meant by the term ìrevolving door effectî in mental health care?
A) An overall reduction in incidence of severe mental illness
B) Shorter and more frequent hospital stays for persons with severe and persistent
mental illness
C) Flexible treatment settings for mentally ill
D) Most effective and least expensive treatment settings
Ans: B
Feedback:
The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are
quickly discharged into the community where services are not adequate; without
adequate community services, clients become acutely ill and require rehospitalization.
The revolving door effect does not refer to flexible treatment settings for mentally ill.
Even though hospitalization is more expensive than outpatient treatment, if utilized
appropriately could result in stabilization and less need for emergency department visits
and/or rehospitalization. The revolving door effect does not relate to the incidence of
severe mental illness.
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Page 7
16. Which of the following statements is true of treatment of people with mental illness in
the United States today?
A) Substance abuse is effectively treated with brief hospitalization.
B) Financial resources are reallocated from state hospitals to community programs
and support.
C) Only 25% of people needing mental health services are receiving those services.
D) Emergency department visits by persons who are acutely disturbed are declining.
Ans: C
Feedback:
Only one in four (25%) adults needing mental health care receives the needed services.
Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in
the current managed care environment. Money saved by states when state hospitals were
closed has not been transferred to community programs and support. Although people
with severe and persistent mental illness have shorter hospital stays, they are admitted to
hospitals more frequently. In some cities, emergency department visits for acutely
disturbed persons have increased by 400% to 500%.
17. Which of the following is the priority of the Healthy People 2020 objectives for mental
health?
A) Improved inpatient care
B) Primary prevention of emotional problems
C) Stress reduction and management
D) Treatment of mental illness
Ans: D
Feedback:
The objectives are to increase the number of people who are identified, diagnosed,
treated, and helped to live healthier lives. The objectives also strive to decrease rates of
suicide and homelessness, to increase employment among those with serious mental
illness, and to provide more services both for juveniles and for adults who are
incarcerated and have mental health problems. Answer choices A, B, and C are not
priorities of Healthy People 2020.
16. Which of the following statements is true of treatment of people with mental illness in
the United States today?
A) Substance abuse is effectively treated with brief hospitalization.
B) Financial resources are reallocated from state hospitals to community programs
and support.
C) Only 25% of people needing mental health services are receiving those services.
D) Emergency department visits by persons who are acutely disturbed are declining.
Ans: C
Feedback:
Only one in four (25%) adults needing mental health care receives the needed services.
Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in
the current managed care environment. Money saved by states when state hospitals were
closed has not been transferred to community programs and support. Although people
with severe and persistent mental illness have shorter hospital stays, they are admitted to
hospitals more frequently. In some cities, emergency department visits for acutely
disturbed persons have increased by 400% to 500%.
17. Which of the following is the priority of the Healthy People 2020 objectives for mental
health?
A) Improved inpatient care
B) Primary prevention of emotional problems
C) Stress reduction and management
D) Treatment of mental illness
Ans: D
Feedback:
The objectives are to increase the number of people who are identified, diagnosed,
treated, and helped to live healthier lives. The objectives also strive to decrease rates of
suicide and homelessness, to increase employment among those with serious mental
illness, and to provide more services both for juveniles and for adults who are
incarcerated and have mental health problems. Answer choices A, B, and C are not
priorities of Healthy People 2020.
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Page 8
18. Which is a positive aspect of treating clients with mental illness in a community-based
care?
A) ìYou will not be allowed to go out with your friends while in the program.î
B) ìYou will have to have supervision when you want to go anywhere else in the
community.î
C) ìYou will be able to live in your own home while you still see a therapist
regularly.î
D) ìYou will have someone in your home at all times to ask questions if you have any
concerns.î
Ans: C
Feedback:
Clients can remain in their communities, maintain contact with family and friends, and
enjoy personal freedom that is not possible in an institution. Full-time home care is not
included in community-based programs.
19. One of the unforeseen effects of the movement toward community mental health
services is
A) fewer clients suffering from persistent mental illnesses.
B) an increased number of hospital beds available for clients seeking treatment.
C) an increased number of admissions to available hospital services.
D) Longer hospital stays for people needing mental health services.
Ans: C
Feedback:
Although people with severe and persistent mental illness have shorter hospital stays,
they are admitted to hospitals more frequently. Although deinstitutionalization reduced
the number of public hospital beds by 80%, the number of admissions to those beds
correspondingly increased by 90%. The number of individuals with mental illness did
not change.
20. Which is included in Healthy People 2020 objectives?
A) To decrease the incidence of mental illness
B) To increase the number of people who are identified, diagnosed, treated, and
helped to live healthier lives
C) To provide mental health services only in the community
D) To decrease the numbers of people who are being treated for mental illness
Ans: B
Feedback:
One of the Healthy People 2020 objectives is to increase the number of people who are
identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to
decrease the incidence of mental illness. At this time, the focus is on ensuring that
persons with mental illness are receiving needed treatment. It may not be possible or
desirable to provide mental health services only in the community.
18. Which is a positive aspect of treating clients with mental illness in a community-based
care?
A) ìYou will not be allowed to go out with your friends while in the program.î
B) ìYou will have to have supervision when you want to go anywhere else in the
community.î
C) ìYou will be able to live in your own home while you still see a therapist
regularly.î
D) ìYou will have someone in your home at all times to ask questions if you have any
concerns.î
Ans: C
Feedback:
Clients can remain in their communities, maintain contact with family and friends, and
enjoy personal freedom that is not possible in an institution. Full-time home care is not
included in community-based programs.
19. One of the unforeseen effects of the movement toward community mental health
services is
A) fewer clients suffering from persistent mental illnesses.
B) an increased number of hospital beds available for clients seeking treatment.
C) an increased number of admissions to available hospital services.
D) Longer hospital stays for people needing mental health services.
Ans: C
Feedback:
Although people with severe and persistent mental illness have shorter hospital stays,
they are admitted to hospitals more frequently. Although deinstitutionalization reduced
the number of public hospital beds by 80%, the number of admissions to those beds
correspondingly increased by 90%. The number of individuals with mental illness did
not change.
20. Which is included in Healthy People 2020 objectives?
A) To decrease the incidence of mental illness
B) To increase the number of people who are identified, diagnosed, treated, and
helped to live healthier lives
C) To provide mental health services only in the community
D) To decrease the numbers of people who are being treated for mental illness
Ans: B
Feedback:
One of the Healthy People 2020 objectives is to increase the number of people who are
identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to
decrease the incidence of mental illness. At this time, the focus is on ensuring that
persons with mental illness are receiving needed treatment. It may not be possible or
desirable to provide mental health services only in the community.
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Page 9
21. A client diagnosed with a mild anxiety disorder has been referred to treatment in a
community mental health center. Treatment most likely provided at the center includes
A) medical management of symptoms.
B) daily psychotherapy.
C) constant staff supervision.
D) psychological stabilization.
Ans: A
Feedback:
Community mental health centers focus on rehabilitation, vocational needs, education,
and socialization, as well as on management of symptoms and medication. Daily
therapies, constant supervision, and stabilization require a more acute care inpatient
setting.
22. Which of the following is defined as an advanced-level function in the practice area of
psychiatric mental health nursing?
A) Case management
B) Counseling
C) Evaluation
D) Health teaching
Ans: C
Feedback:
Advanced-level functions are psychotherapy, prescriptive authority, consultation and
liaison, evaluation, and program development and management. Case management,
counseling, and health teaching are basic-level functions in the practice area of
psychiatric mental health nursing.
23. Psychiatric nursing became a requirement in nursing education in which year?
A) 1930
B) 1940
C) 1950
D) 1960
Ans: C
Feedback:
It was not until 1950 that the National League for Nursing, which accredits nursing
programs, required schools to include an experience in psychiatric nursing.
21. A client diagnosed with a mild anxiety disorder has been referred to treatment in a
community mental health center. Treatment most likely provided at the center includes
A) medical management of symptoms.
B) daily psychotherapy.
C) constant staff supervision.
D) psychological stabilization.
Ans: A
Feedback:
Community mental health centers focus on rehabilitation, vocational needs, education,
and socialization, as well as on management of symptoms and medication. Daily
therapies, constant supervision, and stabilization require a more acute care inpatient
setting.
22. Which of the following is defined as an advanced-level function in the practice area of
psychiatric mental health nursing?
A) Case management
B) Counseling
C) Evaluation
D) Health teaching
Ans: C
Feedback:
Advanced-level functions are psychotherapy, prescriptive authority, consultation and
liaison, evaluation, and program development and management. Case management,
counseling, and health teaching are basic-level functions in the practice area of
psychiatric mental health nursing.
23. Psychiatric nursing became a requirement in nursing education in which year?
A) 1930
B) 1940
C) 1950
D) 1960
Ans: C
Feedback:
It was not until 1950 that the National League for Nursing, which accredits nursing
programs, required schools to include an experience in psychiatric nursing.
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24. A new graduate nurse has accepted a staff position at an inpatient mental health facility.
The graduate nurse can expect to be responsible for basic-level functions, including
A) providing clinical supervision.
B) using effective communication skills.
C) adjusting client medications.
D) directing program development.
Ans: B
Feedback:
Basic-level functions include counseling, milieu therapy, self-care activities,
psychobiologic interventions, health teaching, case management, and health promotion
and maintenance. Advanced-level functions include psychotherapy, prescriptive
authority for drugs, consultation and liaison, evaluation, program development and
management, and clinical supervision.
25. Which one of the following is one of the American Nurses Association standards of
practice for psychiatricñmental health nursing?
A) Prescriptive authority is granted to psychiatricñmental health registered nurses.
B) All aspects of Standard 5: Implementation may be carried out by
psychiatricñmental health registered nurses.
C) Some aspects of Standard 5: Implementation may only be carried out by
psychiatricñmental health advanced practice nurses.
D) Psychiatricñmental health advanced practice nurses are the only ones who may
provide milieu therapy.
Ans: C
Feedback:
Prescriptive authority is used by psychiatricñmental health advanced practice registered
nurses in accordance with state and federal laws and regulations. Standards 5DñG are
advanced practice interventions and may be performed only by the psychiatricñmental
health advanced practice registered nurse. Psychiatricñmental health registered nurses
may provide milieu therapy according to Standard 5C . This is not restricted to
psychiatricñmental health advanced practice nurses.
24. A new graduate nurse has accepted a staff position at an inpatient mental health facility.
The graduate nurse can expect to be responsible for basic-level functions, including
A) providing clinical supervision.
B) using effective communication skills.
C) adjusting client medications.
D) directing program development.
Ans: B
Feedback:
Basic-level functions include counseling, milieu therapy, self-care activities,
psychobiologic interventions, health teaching, case management, and health promotion
and maintenance. Advanced-level functions include psychotherapy, prescriptive
authority for drugs, consultation and liaison, evaluation, program development and
management, and clinical supervision.
25. Which one of the following is one of the American Nurses Association standards of
practice for psychiatricñmental health nursing?
A) Prescriptive authority is granted to psychiatricñmental health registered nurses.
B) All aspects of Standard 5: Implementation may be carried out by
psychiatricñmental health registered nurses.
C) Some aspects of Standard 5: Implementation may only be carried out by
psychiatricñmental health advanced practice nurses.
D) Psychiatricñmental health advanced practice nurses are the only ones who may
provide milieu therapy.
Ans: C
Feedback:
Prescriptive authority is used by psychiatricñmental health advanced practice registered
nurses in accordance with state and federal laws and regulations. Standards 5DñG are
advanced practice interventions and may be performed only by the psychiatricñmental
health advanced practice registered nurse. Psychiatricñmental health registered nurses
may provide milieu therapy according to Standard 5C . This is not restricted to
psychiatricñmental health advanced practice nurses.
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Page 11
26. Which of the following is a standard of professional performance?
A) Assessment
B) Education
C) Planning
D) Implementation
Ans: B
Feedback:
Education is a standard of professional performance. Other standards of professional
performance include the quality of practice, professional practice evaluation,
collegiality, collaboration, ethics, research, resource utilization, and leadership.
Assessment, planning, and implementation are components of the nursing process, not
standards of professional performance.
27. Which of the following is a standard of practice?
A) Quality of care
B) Outcome identification
C) Collegiality
D) Performance appraisal
Ans: B
Feedback:
Standards of practice include assessment, diagnosis, outcomes identification, planning,
implementation, coordination of care, health teaching and health promotion, and milieu
therapy. The standards of professional performance include quality of practice,
education, professional practice evaluation, collegiality, collaboration, ethics, research,
resource utilization, and leadership.
26. Which of the following is a standard of professional performance?
A) Assessment
B) Education
C) Planning
D) Implementation
Ans: B
Feedback:
Education is a standard of professional performance. Other standards of professional
performance include the quality of practice, professional practice evaluation,
collegiality, collaboration, ethics, research, resource utilization, and leadership.
Assessment, planning, and implementation are components of the nursing process, not
standards of professional performance.
27. Which of the following is a standard of practice?
A) Quality of care
B) Outcome identification
C) Collegiality
D) Performance appraisal
Ans: B
Feedback:
Standards of practice include assessment, diagnosis, outcomes identification, planning,
implementation, coordination of care, health teaching and health promotion, and milieu
therapy. The standards of professional performance include quality of practice,
education, professional practice evaluation, collegiality, collaboration, ethics, research,
resource utilization, and leadership.
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28. A student appears very nervous on the first day of clinical in a psychiatric setting. The
student reviews the instructor's guidelines and appropriately takes which of the
following actions? Select all that apply.
A) Tells the client about personal events and interests
B) Discusses the anxious feelings with the instructor
C) Assumes that the client's unwillingness to talk to a student nurse is a personal
insult or failure
D) Builds rapport with the patient before asking personal questions
E) Consults the instructor if a shocking situation arises
F) Gravitates to clients that the student may know personally
Ans: B, D, E
Feedback:
Listening carefully, showing genuine interest, and caring about the client are extremely
important rather than speaking about oneself. The student must deal with his or her own
anxiety about approaching a stranger to talk about very sensitive and personal issues.
Student nurses should not see the client's unwillingness to talk to a student nurse as a
personal insult or behavior. Being available and willing to listen are often all it takes to
begin a significant interaction with someone. Questions involving personal matters
should not be the first thing a student says to the client. These issues usually arise after
some trust and rapport have been established. The nursing instructor and staff are
always available to assist if the client is shocking or distressing to the student. If the
student recognizes someone he or she knows, it is usually best for the student to talk
with the client and reassure him or her about confidentiality. The client should be
reassured that the student will not read the client's record and will not be assigned to
work with the client.
29. The appropriate action for a student nurse who says the wrong thing is to
A) pretend that the student nurse did not say it.
B) restate it by saying, ìThat didn't come out right. What I meant was...î
C) state that it was a joke.
D) ignore the error, since no one is perfect.
Ans: B
Feedback:
No one magic phrase can solve a client's problems; likewise, no single statement can
significantly worsen them. Listening carefully, showing genuine interest, and caring
about the client are extremely important. A nurse who possesses these elements but says
something that sounds out of place can simply restate it by saying, ìThat didn't come out
right. What I meant wasÖî Pretending that the student nurse did not say it, stating that it
was a joke, and ignoring the error are not likely to help the student nurse build and
maintain credibility with the client.
28. A student appears very nervous on the first day of clinical in a psychiatric setting. The
student reviews the instructor's guidelines and appropriately takes which of the
following actions? Select all that apply.
A) Tells the client about personal events and interests
B) Discusses the anxious feelings with the instructor
C) Assumes that the client's unwillingness to talk to a student nurse is a personal
insult or failure
D) Builds rapport with the patient before asking personal questions
E) Consults the instructor if a shocking situation arises
F) Gravitates to clients that the student may know personally
Ans: B, D, E
Feedback:
Listening carefully, showing genuine interest, and caring about the client are extremely
important rather than speaking about oneself. The student must deal with his or her own
anxiety about approaching a stranger to talk about very sensitive and personal issues.
Student nurses should not see the client's unwillingness to talk to a student nurse as a
personal insult or behavior. Being available and willing to listen are often all it takes to
begin a significant interaction with someone. Questions involving personal matters
should not be the first thing a student says to the client. These issues usually arise after
some trust and rapport have been established. The nursing instructor and staff are
always available to assist if the client is shocking or distressing to the student. If the
student recognizes someone he or she knows, it is usually best for the student to talk
with the client and reassure him or her about confidentiality. The client should be
reassured that the student will not read the client's record and will not be assigned to
work with the client.
29. The appropriate action for a student nurse who says the wrong thing is to
A) pretend that the student nurse did not say it.
B) restate it by saying, ìThat didn't come out right. What I meant was...î
C) state that it was a joke.
D) ignore the error, since no one is perfect.
Ans: B
Feedback:
No one magic phrase can solve a client's problems; likewise, no single statement can
significantly worsen them. Listening carefully, showing genuine interest, and caring
about the client are extremely important. A nurse who possesses these elements but says
something that sounds out of place can simply restate it by saying, ìThat didn't come out
right. What I meant wasÖî Pretending that the student nurse did not say it, stating that it
was a joke, and ignoring the error are not likely to help the student nurse build and
maintain credibility with the client.
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Page 1
1. Chapter 2.The nurse is assessing a patient suffering a head injury as a result of an
altercation with two other individuals. The patient has difficulty accurately reporting the
events of the altercation and appears very emotional during the assessment. The nurse
suspects which part of the brain received the greatest amount of injury?
A) Cerebrum
B) Cerebellum
C) Medulla
D) Amygdala
Ans: A
Feedback:
The frontal lobes of the cerebrum control the organization of thought, body movement,
memories, emotions, and moral behavior. The cerebellum is located below the cerebrum
and is the center for coordination of movements and postural adjustments. The medulla,
located at the top of the spinal cord, contains vital centers for respiration and
cardiovascular functions. The hippocampus and amygdala are involved in emotional
arousal and memory.
2. An abnormality of which of the following structures of the cerebrum would be
associated with schizophrenia?
A) Parietal lobes
B) Frontal lobe
C) Occipital lobe
D) Temporal lobes
Ans: B
Feedback:
Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit
hyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations of
taste and touch and assist in spatial orientation. The temporal lobes are centers for the
senses of smell and hearing and for memory and emotional expression. The occipital
lobe assists in coordinating language generation and visual interpretation, such as depth
perception.
1. Chapter 2.The nurse is assessing a patient suffering a head injury as a result of an
altercation with two other individuals. The patient has difficulty accurately reporting the
events of the altercation and appears very emotional during the assessment. The nurse
suspects which part of the brain received the greatest amount of injury?
A) Cerebrum
B) Cerebellum
C) Medulla
D) Amygdala
Ans: A
Feedback:
The frontal lobes of the cerebrum control the organization of thought, body movement,
memories, emotions, and moral behavior. The cerebellum is located below the cerebrum
and is the center for coordination of movements and postural adjustments. The medulla,
located at the top of the spinal cord, contains vital centers for respiration and
cardiovascular functions. The hippocampus and amygdala are involved in emotional
arousal and memory.
2. An abnormality of which of the following structures of the cerebrum would be
associated with schizophrenia?
A) Parietal lobes
B) Frontal lobe
C) Occipital lobe
D) Temporal lobes
Ans: B
Feedback:
Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit
hyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations of
taste and touch and assist in spatial orientation. The temporal lobes are centers for the
senses of smell and hearing and for memory and emotional expression. The occipital
lobe assists in coordinating language generation and visual interpretation, such as depth
perception.
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Page 2
3. A patient with bipolar disorder asks the nurse, ìWhy did I get this illness? I don't want to
be sick.î The nurse would best respond with,
A) ìPeople who develop mental illnesses often had very traumatic childhood
experiences.î
B) ìThere is some evidence that contracting a virus during childhood can lead to
mental disorders.î
C) ìSometimes people with mental illness have an overactive immune system.î
D) ìWe don't fully understand the cause, but mental illnesses do seem to run in
families.î
Ans: D
Feedback:
Current theories and studies indicate that several mental disorders may be linked to a
specific gene or combination of genes, but that the source is not solely genetic;
nongenetic factors also play important roles. A compromised immune system could
contribute to the development of a variety of illnesses, particularly in populations
already genetically at risk. Maternal exposure to a virus during critical fetal
development of the nervous system may contribute to mental illness.
4. Which of the following statements about the neurobiologic causes of mental illness is
most accurate?
A) Genetics and heredity can explain all causes of mental illness.
B) Viral infection has been proven to be the cause of schizophrenia.
C) There is no evidence that the immune system is related to mental illness.
D) Several mental disorders may be linked to genetic and nongenetic factors.
Ans: D
Feedback:
Current theories and studies indicate that several mental disorders may be linked to a
specific gene or combination of genes, but that the source is not solely genetic;
nongenetic factors also play important roles. Most studies involving viral theories have
focused on schizophrenia, but so far none has provided specific or conclusive evidence.
A compromised immune system could contribute to the development of a variety of
illnesses, particularly in populations already genetically at risk. So far, efforts to link a
specific stressor with a specific disease have been unsuccessful. When the inflammatory
response is critically involved in illnesses such as multiple sclerosis or lupus
erythematosus, mood dysregulation and even depression are common.
3. A patient with bipolar disorder asks the nurse, ìWhy did I get this illness? I don't want to
be sick.î The nurse would best respond with,
A) ìPeople who develop mental illnesses often had very traumatic childhood
experiences.î
B) ìThere is some evidence that contracting a virus during childhood can lead to
mental disorders.î
C) ìSometimes people with mental illness have an overactive immune system.î
D) ìWe don't fully understand the cause, but mental illnesses do seem to run in
families.î
Ans: D
Feedback:
Current theories and studies indicate that several mental disorders may be linked to a
specific gene or combination of genes, but that the source is not solely genetic;
nongenetic factors also play important roles. A compromised immune system could
contribute to the development of a variety of illnesses, particularly in populations
already genetically at risk. Maternal exposure to a virus during critical fetal
development of the nervous system may contribute to mental illness.
4. Which of the following statements about the neurobiologic causes of mental illness is
most accurate?
A) Genetics and heredity can explain all causes of mental illness.
B) Viral infection has been proven to be the cause of schizophrenia.
C) There is no evidence that the immune system is related to mental illness.
D) Several mental disorders may be linked to genetic and nongenetic factors.
Ans: D
Feedback:
Current theories and studies indicate that several mental disorders may be linked to a
specific gene or combination of genes, but that the source is not solely genetic;
nongenetic factors also play important roles. Most studies involving viral theories have
focused on schizophrenia, but so far none has provided specific or conclusive evidence.
A compromised immune system could contribute to the development of a variety of
illnesses, particularly in populations already genetically at risk. So far, efforts to link a
specific stressor with a specific disease have been unsuccessful. When the inflammatory
response is critically involved in illnesses such as multiple sclerosis or lupus
erythematosus, mood dysregulation and even depression are common.
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Page 3
5. Which of the following is an inhibitory neurotransmitter?
A) Dopamine
B) GABA
C) Norepinephrine
D) Epinephrine
Ans: B
Feedback:
GABA is the major inhibitory neurotransmitter in the brain and has been found to
modulate other neurotransmitter systems rather than to provide a direct stimulus.
Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.
6. Which of the following is a neuromodulator?
A) Neuropeptides
B) Glutamate
C) Dopamine
D) GABA
Ans: A
Feedback:
Neuropeptides are neuromodulators. Glutamate and dopamine are excitatory
neurotransmitters. GABA is an inhibitory neurotransmitter.
7. A nurse is leading a medication education group for patients with depression. A patient
states he has read that herbal treatments are just as effective as prescription medications.
The best response is,
A) ìWhen studies are published they can be trusted to be accurate.î
B) ìWe need to look at the research very closely to see how reliable the studies are.î
C) ìYour prescribed medication is the best for your condition, so you should not read
those studies.î
D) ìSwitching medications will alter the course of your illness. It is not advised.î
Ans: B
Feedback:
Often, reports in the media regarding new research and studies are confusing,
contradictory, or difficult for clients and their families to understand. The nurse must
ensure that clients and families are well informed about progress in these areas and must
also help them to distinguish between facts and hypotheses. The nurse can explain if or
how new research may affect a client's treatment or prognosis. The nurse is a good
resource for providing information and answering questions.
5. Which of the following is an inhibitory neurotransmitter?
A) Dopamine
B) GABA
C) Norepinephrine
D) Epinephrine
Ans: B
Feedback:
GABA is the major inhibitory neurotransmitter in the brain and has been found to
modulate other neurotransmitter systems rather than to provide a direct stimulus.
Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.
6. Which of the following is a neuromodulator?
A) Neuropeptides
B) Glutamate
C) Dopamine
D) GABA
Ans: A
Feedback:
Neuropeptides are neuromodulators. Glutamate and dopamine are excitatory
neurotransmitters. GABA is an inhibitory neurotransmitter.
7. A nurse is leading a medication education group for patients with depression. A patient
states he has read that herbal treatments are just as effective as prescription medications.
The best response is,
A) ìWhen studies are published they can be trusted to be accurate.î
B) ìWe need to look at the research very closely to see how reliable the studies are.î
C) ìYour prescribed medication is the best for your condition, so you should not read
those studies.î
D) ìSwitching medications will alter the course of your illness. It is not advised.î
Ans: B
Feedback:
Often, reports in the media regarding new research and studies are confusing,
contradictory, or difficult for clients and their families to understand. The nurse must
ensure that clients and families are well informed about progress in these areas and must
also help them to distinguish between facts and hypotheses. The nurse can explain if or
how new research may affect a client's treatment or prognosis. The nurse is a good
resource for providing information and answering questions.
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Page 4
8. The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the
patient,
A) ìHave you ever had an allergic reaction to radioactive dye?î
B) ìHave you had anything to eat in the last 24 hours?î
C) ìDoes your insurance cover the cost of this scan?î
D) ìAre you anxious about being in tight spaces?î
Ans: D
Feedback:
The person undergoing an MRI must lie in a small, closed chamber and remain
motionless during the procedure, which takes about 45 minutes. Those who feel
claustrophobic or have increased anxiety may require sedation before the procedure.
PET scans require radioactive substances to be injected into the bloodstream. A patient
is not required to fast before brain imaging studies. Verifying insurance benefits is not a
primary role of the nurse.
9. How should the nurse respond to a family member who asks how Alzheimer's disease is
diagnosed?
A) It is impossible to know for certain that a person has Alzheimer's disease until the
person dies and his or her brain can be examined via autopsy.
B) Positron emission tomography (PET) scans can identify the amyloid plaques and
tangles of Alzheimer's disease in living clients.
C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate
decreased cerebral blood flow.
D) It will be necessary for the patient to undergo positron emission tomography
(PET) scans regularly for a long period of time to know if the patient has
Alzheimer's disease.
Ans: B
Feedback:
Positron emission tomography (PET) scans can identify the amyloid plaques and tangles
of Alzheimer's disease in living clients. These conditions previously could be diagnosed
only through autopsy. Some persons with schizophrenia also demonstrate decreased
cerebral blood flow. A limitation of PET scans is that the use of radioactive substances
limits the number of times a person can undergo these tests.
8. The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the
patient,
A) ìHave you ever had an allergic reaction to radioactive dye?î
B) ìHave you had anything to eat in the last 24 hours?î
C) ìDoes your insurance cover the cost of this scan?î
D) ìAre you anxious about being in tight spaces?î
Ans: D
Feedback:
The person undergoing an MRI must lie in a small, closed chamber and remain
motionless during the procedure, which takes about 45 minutes. Those who feel
claustrophobic or have increased anxiety may require sedation before the procedure.
PET scans require radioactive substances to be injected into the bloodstream. A patient
is not required to fast before brain imaging studies. Verifying insurance benefits is not a
primary role of the nurse.
9. How should the nurse respond to a family member who asks how Alzheimer's disease is
diagnosed?
A) It is impossible to know for certain that a person has Alzheimer's disease until the
person dies and his or her brain can be examined via autopsy.
B) Positron emission tomography (PET) scans can identify the amyloid plaques and
tangles of Alzheimer's disease in living clients.
C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate
decreased cerebral blood flow.
D) It will be necessary for the patient to undergo positron emission tomography
(PET) scans regularly for a long period of time to know if the patient has
Alzheimer's disease.
Ans: B
Feedback:
Positron emission tomography (PET) scans can identify the amyloid plaques and tangles
of Alzheimer's disease in living clients. These conditions previously could be diagnosed
only through autopsy. Some persons with schizophrenia also demonstrate decreased
cerebral blood flow. A limitation of PET scans is that the use of radioactive substances
limits the number of times a person can undergo these tests.
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Page 5
10. A patient is being seen in the crisis unit reporting that poison letters are coming in the
mail. The patient has no history of psychiatric illness. Which of the following
medications would the patient most likely be started on?
A) Aripiprazole (Abilify)
B) Risperidone (Risperdal Consta)
C) Fluphenazine (Prolixin)
D) Fluoxetine (Prozac)
Ans: A
Feedback:
New-generation antipsychotics are preferred over conventional antipsychotics because
they control symptoms without some of the side effects. Injectable antipsychotics, such
as Risperdal Consta, are indicated after the client's condition is stabilized with oral
doses of these medications. Prozac is an antidepressant and is not indicated to relieve of
psychotic symptoms.
11. Which one of the following types of antipsychotic medications is most likely to produce
extrapyramidal effects?
A) Atypical antipsychotic drugs
B) First-generation antipsychotic drugs
C) Third-generation antipsychotic drugs
D) Dopamine system stabilizers
Ans: B
Feedback:
The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2,
D3, and D4. This makes them effective in treating target symptoms but also produces
many extrapyramidal side effects because of the blocking of the D2 receptors. Newer,
atypical or second-generation antipsychotic drugs are relatively weak blockers of D2,
which may account for the lower incidence of extrapyramidal side effects. The third
generation of antipsychotics, called dopamine system stabilizers, is being developed.
These drugs are thought to stabilize dopamine output that results in control of symptoms
without some of the side effects of other antipsychotic medications.
10. A patient is being seen in the crisis unit reporting that poison letters are coming in the
mail. The patient has no history of psychiatric illness. Which of the following
medications would the patient most likely be started on?
A) Aripiprazole (Abilify)
B) Risperidone (Risperdal Consta)
C) Fluphenazine (Prolixin)
D) Fluoxetine (Prozac)
Ans: A
Feedback:
New-generation antipsychotics are preferred over conventional antipsychotics because
they control symptoms without some of the side effects. Injectable antipsychotics, such
as Risperdal Consta, are indicated after the client's condition is stabilized with oral
doses of these medications. Prozac is an antidepressant and is not indicated to relieve of
psychotic symptoms.
11. Which one of the following types of antipsychotic medications is most likely to produce
extrapyramidal effects?
A) Atypical antipsychotic drugs
B) First-generation antipsychotic drugs
C) Third-generation antipsychotic drugs
D) Dopamine system stabilizers
Ans: B
Feedback:
The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2,
D3, and D4. This makes them effective in treating target symptoms but also produces
many extrapyramidal side effects because of the blocking of the D2 receptors. Newer,
atypical or second-generation antipsychotic drugs are relatively weak blockers of D2,
which may account for the lower incidence of extrapyramidal side effects. The third
generation of antipsychotics, called dopamine system stabilizers, is being developed.
These drugs are thought to stabilize dopamine output that results in control of symptoms
without some of the side effects of other antipsychotic medications.
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Page 6
12. A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily.
The patient asks the nurse how this medicine works. The nurse explains that the
mechanism by which the olanzapine controls the patient's psychotic symptoms is
believed to be
A) increasing the amount of serotonin and norepinephrine in the brain.
B) decreasing the amount of an enzyme that breaks down neurotransmitters.
C) normalizing the levels of serotonin, norepinephrine, and dopamine.
D) blocking dopamine receptors in the brain.
Ans: D
Feedback:
The major action of all antipsychotics in the nervous system is to block receptors for the
neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin
and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks
down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters
such as serotonin, norepinephrine, acetylcholine, and dopamine.
13. A patient with depression has been taking paroxetine (Paxil) for the last 3 months and
has noticed improvement of symptoms. Which of the following side effects would the
nurse expect the patient to report?
A) A headache after eating wine and cheese
B) A decrease in sexual pleasure during intimacy
C) An intense need to move about
D) Persistent runny nose
Ans: B
Feedback:
Sexual dysfunction can result from enhanced serotonin transmission associated with
SSRI use. Headache caused by hypertension can result when combining MAOIs with
foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause
less weight gain than other antidepressants. Dry mouth and nasal passages are common
anticholinergic side effects associated with all antidepressants. An intense need to move
about (akathisia) is an extrapyramidal side effect that would be expected of an
antipsychotic medication. Furthermore, sedation is a common side effect of Paxil.
12. A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily.
The patient asks the nurse how this medicine works. The nurse explains that the
mechanism by which the olanzapine controls the patient's psychotic symptoms is
believed to be
A) increasing the amount of serotonin and norepinephrine in the brain.
B) decreasing the amount of an enzyme that breaks down neurotransmitters.
C) normalizing the levels of serotonin, norepinephrine, and dopamine.
D) blocking dopamine receptors in the brain.
Ans: D
Feedback:
The major action of all antipsychotics in the nervous system is to block receptors for the
neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin
and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks
down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters
such as serotonin, norepinephrine, acetylcholine, and dopamine.
13. A patient with depression has been taking paroxetine (Paxil) for the last 3 months and
has noticed improvement of symptoms. Which of the following side effects would the
nurse expect the patient to report?
A) A headache after eating wine and cheese
B) A decrease in sexual pleasure during intimacy
C) An intense need to move about
D) Persistent runny nose
Ans: B
Feedback:
Sexual dysfunction can result from enhanced serotonin transmission associated with
SSRI use. Headache caused by hypertension can result when combining MAOIs with
foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause
less weight gain than other antidepressants. Dry mouth and nasal passages are common
anticholinergic side effects associated with all antidepressants. An intense need to move
about (akathisia) is an extrapyramidal side effect that would be expected of an
antipsychotic medication. Furthermore, sedation is a common side effect of Paxil.
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14. Which one of the following drugs should the nurse expect the patient to require serum
level monitoring?
A) Anticonvulsants
B) Wellbutrin
C) Lithium
D) Prozac
Ans: C
Feedback:
Toxicity is closely related to serum lithium levels and can occur at therapeutic doses.
For clients taking lithium and the anticonvulsants, monitoring blood levels periodically
is important.
15. Which of the following disorders are extrapyramidal symptoms that may be caused by
antipsychotic drugs? Select all that apply.
A) Akathisia
B) Pseudoparkinsonism
C) Neuroleptic malignant syndrome
D) Dystonia
E) Anticholinergic effects
F) Breast tenderness in men and women
Ans: A, B, D
Feedback:
Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia.
Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an
idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast
tenderness in men and women is also a potential side effect of antipsychotic drugs that
cause elevated prolactin levels, but it is not an extrapyramidal symptom.
16. Which of the following antidepressant drugs is a preferred drug for clients at high risk
of suicide?
A) Tranylcypromine (Parnate)
B) Sertraline (Zoloft)
C) Imipramine (Tofranil)
D) Phenelzine (Nardil)
Ans: B
Feedback:
SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who
are potentially suicidal or highly impulsive because they carry no risk of lethal
overdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil are
MAOIs. Tofranil is a cyclic compound.
14. Which one of the following drugs should the nurse expect the patient to require serum
level monitoring?
A) Anticonvulsants
B) Wellbutrin
C) Lithium
D) Prozac
Ans: C
Feedback:
Toxicity is closely related to serum lithium levels and can occur at therapeutic doses.
For clients taking lithium and the anticonvulsants, monitoring blood levels periodically
is important.
15. Which of the following disorders are extrapyramidal symptoms that may be caused by
antipsychotic drugs? Select all that apply.
A) Akathisia
B) Pseudoparkinsonism
C) Neuroleptic malignant syndrome
D) Dystonia
E) Anticholinergic effects
F) Breast tenderness in men and women
Ans: A, B, D
Feedback:
Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia.
Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an
idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast
tenderness in men and women is also a potential side effect of antipsychotic drugs that
cause elevated prolactin levels, but it is not an extrapyramidal symptom.
16. Which of the following antidepressant drugs is a preferred drug for clients at high risk
of suicide?
A) Tranylcypromine (Parnate)
B) Sertraline (Zoloft)
C) Imipramine (Tofranil)
D) Phenelzine (Nardil)
Ans: B
Feedback:
SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who
are potentially suicidal or highly impulsive because they carry no risk of lethal
overdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil are
MAOIs. Tofranil is a cyclic compound.
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17. The nurse knows that the client understands the rationale for dietary restrictions when
taking MAOI when the client makes which of the following statements?
A) ìI am now allergic to foods that are high in the amino acid tyramine such as aged
cheese, organ meats, wine, and chocolate.î
B) ìCertain foods will cause me to have sexual dysfunction when I take this
medication.î
C) ìFoods that are high in tyramine will reduce the medication's effectiveness.î
D) ìI should avoid foods that are high in the amino acid tyramine such as aged
cheese, meats, and chocolate because this drug causes the level of tyramine to go
up to dangerous levels.î
Ans: D
Feedback:
Because the enzyme MAO is necessary to break down the tyramine in certain foods, its
inhibition results in increased serum tyramine levels, causing severe, hypertension,
hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias.
Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common
side effect of MAOIs. There is no evidence that foods high in tyramine will increase
sexual dysfunction or reduce the medication's effectiveness.
18. A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated
since beginning the medication. Which of the following actions is indicated initially?
A) Instruct the client to stop the medication for a few days to see if the nausea goes
away.
B) Reassure the client that this is an expected side effect that will improve with time.
C) Suggest that the client take the medication with food.
D) Tell the client to contact the physician for a change in medication.
Ans: C
Feedback:
Taking selective serotonin reuptake inhibitors with food usually eliminates nausea.
There is a delayed therapeutic response to antidepressants. The client should not stop
taking the drug. It would be appropriate to reassure the client that this is an expected
side effect that will improve with time, but that would not be done initially. A change in
medication may be indicated if the nausea is intolerable or persistent, but that would not
be done initially.
17. The nurse knows that the client understands the rationale for dietary restrictions when
taking MAOI when the client makes which of the following statements?
A) ìI am now allergic to foods that are high in the amino acid tyramine such as aged
cheese, organ meats, wine, and chocolate.î
B) ìCertain foods will cause me to have sexual dysfunction when I take this
medication.î
C) ìFoods that are high in tyramine will reduce the medication's effectiveness.î
D) ìI should avoid foods that are high in the amino acid tyramine such as aged
cheese, meats, and chocolate because this drug causes the level of tyramine to go
up to dangerous levels.î
Ans: D
Feedback:
Because the enzyme MAO is necessary to break down the tyramine in certain foods, its
inhibition results in increased serum tyramine levels, causing severe, hypertension,
hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias.
Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common
side effect of MAOIs. There is no evidence that foods high in tyramine will increase
sexual dysfunction or reduce the medication's effectiveness.
18. A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated
since beginning the medication. Which of the following actions is indicated initially?
A) Instruct the client to stop the medication for a few days to see if the nausea goes
away.
B) Reassure the client that this is an expected side effect that will improve with time.
C) Suggest that the client take the medication with food.
D) Tell the client to contact the physician for a change in medication.
Ans: C
Feedback:
Taking selective serotonin reuptake inhibitors with food usually eliminates nausea.
There is a delayed therapeutic response to antidepressants. The client should not stop
taking the drug. It would be appropriate to reassure the client that this is an expected
side effect that will improve with time, but that would not be done initially. A change in
medication may be indicated if the nausea is intolerable or persistent, but that would not
be done initially.
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19. In planning for a client's discharge, the nurse must know that the most serious risk for
the client taking a tricyclic antidepressant is which of the following?
A) Hypotension
B) Narrow-angle glaucoma
C) Seizures
D) Suicide by overdose
Ans: D
Feedback:
Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken
in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in
anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention,
dry nasal passages, and blurred near vision. More severe anticholinergic effects such as
agitation, delirium, and ileus may occur, particularly in older adults. Other common side
effects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clients
may develop tolerance to anticholinergic effects (such as orthostatic hypotension and
worsening of narrow-angle glaucoma, but these side effects are common reasons that
clients discontinue drug therapy. The risk of seizures is increased by bupropion, which
is a different type of antidepressant.
20. A client with severe and persistent mental illness has been taking antipsychotic
medication for 20 years. The nurse observes that the client's behavior includes repetitive
movements of the mouth and tongue, facial grimacing, and rocking back and forth. The
nurse recognizes these behaviors as indicative of
A) extrapyramidal side effects
B) loss of voluntary muscle control
C) posturing
D) tardive dyskinesia
Ans: D
Feedback:
The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a
syndrome of permanent involuntary movements, is most commonly caused by the long-
term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible
movement disorders induced by antipsychotic or neuroleptic medication. The client's
behavior is not a loss of voluntary control or posturing.
19. In planning for a client's discharge, the nurse must know that the most serious risk for
the client taking a tricyclic antidepressant is which of the following?
A) Hypotension
B) Narrow-angle glaucoma
C) Seizures
D) Suicide by overdose
Ans: D
Feedback:
Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken
in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in
anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention,
dry nasal passages, and blurred near vision. More severe anticholinergic effects such as
agitation, delirium, and ileus may occur, particularly in older adults. Other common side
effects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clients
may develop tolerance to anticholinergic effects (such as orthostatic hypotension and
worsening of narrow-angle glaucoma, but these side effects are common reasons that
clients discontinue drug therapy. The risk of seizures is increased by bupropion, which
is a different type of antidepressant.
20. A client with severe and persistent mental illness has been taking antipsychotic
medication for 20 years. The nurse observes that the client's behavior includes repetitive
movements of the mouth and tongue, facial grimacing, and rocking back and forth. The
nurse recognizes these behaviors as indicative of
A) extrapyramidal side effects
B) loss of voluntary muscle control
C) posturing
D) tardive dyskinesia
Ans: D
Feedback:
The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a
syndrome of permanent involuntary movements, is most commonly caused by the long-
term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible
movement disorders induced by antipsychotic or neuroleptic medication. The client's
behavior is not a loss of voluntary control or posturing.
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21. A client is seen in the clinic with clinical manifestations of an inability to sit still and a
rigid posture. These side effects would be correctly identified as which of the following?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Dystonia
D) Akathisia
Ans: D
Feedback:
Akathisia is reported by the client as an intense need to move about. The client appears
restless or anxious and agitated, often with a rigid posture or gain and a lack of
spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary
movements of the tongue, facial and neck muscles, upper and lower extremities, and
truncal musculature. Tongue thrusting and protruding, lip smacking, blinking,
grimacing, and other excessive unnecessary facial movements are characteristic.
Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity,
high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity
and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases,
laryngospasm and respiratory difficulties.
22. Which of the following is a term used to describe the occurrence of the eye rolling back
in a locked position, which occurs with acute dystonia?
A) Opisthotonus
B) Oculogyric crisis
C) Torticollis
D) Pseudoparkinsonism
Ans: B
Feedback:
Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which
occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head
back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis,
opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is
drug-induced parkinsonism and is often referred to by the generic label of
extrapyramidal side effects.
21. A client is seen in the clinic with clinical manifestations of an inability to sit still and a
rigid posture. These side effects would be correctly identified as which of the following?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome
C) Dystonia
D) Akathisia
Ans: D
Feedback:
Akathisia is reported by the client as an intense need to move about. The client appears
restless or anxious and agitated, often with a rigid posture or gain and a lack of
spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary
movements of the tongue, facial and neck muscles, upper and lower extremities, and
truncal musculature. Tongue thrusting and protruding, lip smacking, blinking,
grimacing, and other excessive unnecessary facial movements are characteristic.
Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity,
high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity
and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases,
laryngospasm and respiratory difficulties.
22. Which of the following is a term used to describe the occurrence of the eye rolling back
in a locked position, which occurs with acute dystonia?
A) Opisthotonus
B) Oculogyric crisis
C) Torticollis
D) Pseudoparkinsonism
Ans: B
Feedback:
Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which
occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head
back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis,
opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is
drug-induced parkinsonism and is often referred to by the generic label of
extrapyramidal side effects.
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23. Which of the following medications rarely causes extrapyramidal side effects (EPS)?
A) Ziprasidone (Geodon)
B) Chlorpromazine (Thorazine)
C) Haloperidol (Haldol)
D) Fluphenazine (Prolixin)
Ans: A
Feedback:
First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical
antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol,
and Prolixin are all first-generation antipsychotic drugs.
24. Which of the following increases the risk for neuroleptic malignant syndrome (NMS)?
A) Overhydration
B) Intake of vitamins
C) Dehydration
D) Vegetarian diet
Ans: C
Feedback:
Dehydration, poor nutrition, and concurrent medical illness all increase the risk for
NMS. Overhydration is opposite of dehydration and would therefore not increase the
risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would
improve nutritional status. Vegetarian diet would not relate to NMS.
25. Which of the following was the first nonstimulant medication specifically designed and
tested for ADHD?
A) Methylphenidate (Ritalin)
B) Amphetamine (Adderall)
C) Atomoxetine (Strattera)
D) Pemoline (Cylert)
Ans: C
Feedback:
Strattera was the first nonstimulant medication specifically designed and tested for
ADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin),
amphetamine (Adderall), and pemoline (Cylert).
23. Which of the following medications rarely causes extrapyramidal side effects (EPS)?
A) Ziprasidone (Geodon)
B) Chlorpromazine (Thorazine)
C) Haloperidol (Haldol)
D) Fluphenazine (Prolixin)
Ans: A
Feedback:
First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical
antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol,
and Prolixin are all first-generation antipsychotic drugs.
24. Which of the following increases the risk for neuroleptic malignant syndrome (NMS)?
A) Overhydration
B) Intake of vitamins
C) Dehydration
D) Vegetarian diet
Ans: C
Feedback:
Dehydration, poor nutrition, and concurrent medical illness all increase the risk for
NMS. Overhydration is opposite of dehydration and would therefore not increase the
risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would
improve nutritional status. Vegetarian diet would not relate to NMS.
25. Which of the following was the first nonstimulant medication specifically designed and
tested for ADHD?
A) Methylphenidate (Ritalin)
B) Amphetamine (Adderall)
C) Atomoxetine (Strattera)
D) Pemoline (Cylert)
Ans: C
Feedback:
Strattera was the first nonstimulant medication specifically designed and tested for
ADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin),
amphetamine (Adderall), and pemoline (Cylert).
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26. Which of the following is the primary consideration with clients taking antidepressants?
A) Decreased mobility
B) Emotional changes
C) Suicide
D) Increased sleep
Ans: C
Feedback:
Suicide is always a primary consideration when treating clients with depression.
27. Which of the following would not be included as a symptom of drug-induced
parkinsonism?
A) Stooped posture
B) Cogwheel rigidity
C) Drooling
D) Tachycardia
Ans: D
Feedback:
Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are all
symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include
mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse
pill-rolling movements of the thumb and fingers while at rest.
28. Which drug classification is the primary medication treatment for schizophrenia?
A) Anticoagulants
B) Antidepressants
C) Antimanics
D) Antipsychotics
Ans: D
Feedback:
Antipsychotic drugs are the primary medical treatment for clients diagnosed with
schizophrenia and are also used in psychotic episodes of acute mania, psychotic
depression, and drug-induced psychosis.
26. Which of the following is the primary consideration with clients taking antidepressants?
A) Decreased mobility
B) Emotional changes
C) Suicide
D) Increased sleep
Ans: C
Feedback:
Suicide is always a primary consideration when treating clients with depression.
27. Which of the following would not be included as a symptom of drug-induced
parkinsonism?
A) Stooped posture
B) Cogwheel rigidity
C) Drooling
D) Tachycardia
Ans: D
Feedback:
Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are all
symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include
mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse
pill-rolling movements of the thumb and fingers while at rest.
28. Which drug classification is the primary medication treatment for schizophrenia?
A) Anticoagulants
B) Antidepressants
C) Antimanics
D) Antipsychotics
Ans: D
Feedback:
Antipsychotic drugs are the primary medical treatment for clients diagnosed with
schizophrenia and are also used in psychotic episodes of acute mania, psychotic
depression, and drug-induced psychosis.
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29. A client on the unit suddenly cries out in fear. The nurse notices that the client's head is
twisted to one side, his back is arched, and his eyes have rolled back in their sockets.
The client has recently begun drug therapy with haloperidol (Haldol). Based on this
assessment, the first action of the nurse would be to
A) get a stat. order for a serum drug level.
B) hold the client's medication until the symptoms subside.
C) place an urgent call to the client's physician.
D) give a PRN dose of benztropine (Cogentin) IM.
Ans: D
Feedback:
The client is having an acute dystonic reaction; the treatment is anticholinergic
medication. Dystonia is most likely to occur in the first week of treatment, in clients
younger than 40 years, in males, and in those receiving high-potency drugs such as
Haldol. Immediate treatment with anticholinergic drugs usually brings rapid relief.
30. One week after beginning therapy with thiothixene (Navane), the client demonstrates
muscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinase
level, stupor, and incontinence. The nurse should notify the physician because these
symptoms are indicative of
A) acute dystonic reaction.
B) extrapyramidal side effects.
C) neuroleptic malignant syndrome.
D) tardive dyskinesia.
Ans: C
Feedback:
The client demonstrates all the classic signs of neuroleptic malignant syndrome.
Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with
difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.
Extrapyramidal side effects are reversible movement disorders induced by antipsychotic
or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic
side effect of antipsychotic medications characterized by abnormal, involuntary
movements, such as blinking, chewing, and grimacing.
29. A client on the unit suddenly cries out in fear. The nurse notices that the client's head is
twisted to one side, his back is arched, and his eyes have rolled back in their sockets.
The client has recently begun drug therapy with haloperidol (Haldol). Based on this
assessment, the first action of the nurse would be to
A) get a stat. order for a serum drug level.
B) hold the client's medication until the symptoms subside.
C) place an urgent call to the client's physician.
D) give a PRN dose of benztropine (Cogentin) IM.
Ans: D
Feedback:
The client is having an acute dystonic reaction; the treatment is anticholinergic
medication. Dystonia is most likely to occur in the first week of treatment, in clients
younger than 40 years, in males, and in those receiving high-potency drugs such as
Haldol. Immediate treatment with anticholinergic drugs usually brings rapid relief.
30. One week after beginning therapy with thiothixene (Navane), the client demonstrates
muscle rigidity, a temperature of 103∞F, an elevated serum creatinine phosphokinase
level, stupor, and incontinence. The nurse should notify the physician because these
symptoms are indicative of
A) acute dystonic reaction.
B) extrapyramidal side effects.
C) neuroleptic malignant syndrome.
D) tardive dyskinesia.
Ans: C
Feedback:
The client demonstrates all the classic signs of neuroleptic malignant syndrome.
Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with
difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.
Extrapyramidal side effects are reversible movement disorders induced by antipsychotic
or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic
side effect of antipsychotic medications characterized by abnormal, involuntary
movements, such as blinking, chewing, and grimacing.
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31. A client with bipolar disorder has been taking lithium, and today his serum blood level
is 2.0 mEq/L. What effects would the nurse expect to see?
A) Constipation and postural hypotension
B) Fever, muscle rigidity, and disorientation
C) Nausea, diarrhea, and confusion
D) None; the serum level is in therapeutic range
Ans: C
Feedback:
Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more
than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity
with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea,
vomiting, drowsiness, muscle weakness, and lack of coordination.
32. For a client taking clozapine (Clozaril), which of the following symptoms should the
nurse report to the physician immediately as it may be indicative of a potentially fatal
side effect?
A) Inability to stand still for 1 minute
B) Mild rash
C) Photosensitivity reaction
D) Sore throat and malaise
Ans: D
Feedback:
Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic
drugs, but it has the potentially fatal side effect of agranulocytosis. This develops
suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia.
This side effect may not be manifested immediately and can occur up to 24 weeks after
the initiation of therapy. Any symptoms of infection must be investigated immediately.
Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and
leukopenia. Mild rash and photosensitivity reaction are not serious side effects.
33. A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse
evaluates that the dose is appropriate when the patient reports
A) feeling sleepy and less energetic.
B) weight gain of 7 pounds in the last 6 months.
C) minimal mood swings.
D) increased feelings of self-worth.
Ans: C
Feedback:
Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's
mood, preventing or minimizing the highs and lows that characterize bipolar illness, and
treating acute episodes of mania. Weight gain is a common side effect, and fatigue and
lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar
disorder, which should diminish with effective treatment.
31. A client with bipolar disorder has been taking lithium, and today his serum blood level
is 2.0 mEq/L. What effects would the nurse expect to see?
A) Constipation and postural hypotension
B) Fever, muscle rigidity, and disorientation
C) Nausea, diarrhea, and confusion
D) None; the serum level is in therapeutic range
Ans: C
Feedback:
Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more
than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity
with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea,
vomiting, drowsiness, muscle weakness, and lack of coordination.
32. For a client taking clozapine (Clozaril), which of the following symptoms should the
nurse report to the physician immediately as it may be indicative of a potentially fatal
side effect?
A) Inability to stand still for 1 minute
B) Mild rash
C) Photosensitivity reaction
D) Sore throat and malaise
Ans: D
Feedback:
Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic
drugs, but it has the potentially fatal side effect of agranulocytosis. This develops
suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia.
This side effect may not be manifested immediately and can occur up to 24 weeks after
the initiation of therapy. Any symptoms of infection must be investigated immediately.
Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and
leukopenia. Mild rash and photosensitivity reaction are not serious side effects.
33. A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse
evaluates that the dose is appropriate when the patient reports
A) feeling sleepy and less energetic.
B) weight gain of 7 pounds in the last 6 months.
C) minimal mood swings.
D) increased feelings of self-worth.
Ans: C
Feedback:
Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's
mood, preventing or minimizing the highs and lows that characterize bipolar illness, and
treating acute episodes of mania. Weight gain is a common side effect, and fatigue and
lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar
disorder, which should diminish with effective treatment.
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Page 15
34. When the client experiences facial flushing, a throbbing headache, nausea and vomiting
after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this
is due to which of the following?
A) A mild side effect of the medication.
B) The intended therapeutic result.
C) An idiosyncratic reaction
D) A severe allergy to the medication.
Ans: B
Feedback:
Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with
alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol,
symptoms begin to appear: facial and body flushing from vasodilation, a throbbing
headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These
symptoms are not mild side effects because these are very uncomfortable symptoms.
These symptoms would not be an idiosyncratic reaction because this is the expected
reaction. These symptoms are not indicative of a severe allergy to the medication.
35. When the client asks the nurse how long it will take before the SSRI antidepressant
medication will be effective, which of the following replies is most accurate and
therapeutic?
A) ìThis is a good medication! It will be effective within 20 minutes of the first dose.î
B) ìYou will have gradual improvement in symptoms over the next few weeks, but
the changes may be so subtle that you may not notice them for a while. It is
important for you to keep taking the medication.î
C) ìIt will probably take months for the medication to work. In the meantime, you
should work on improving your attitude.î
D) ìIf you believe it will work, then it will. You have to have faith!î
Ans: B
Feedback:
SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of these
drugs are an ìinitiating eventî and that eventual therapeutic effectiveness results when
neurons respond more slowly, making serotonin available at the synapses. The
medication will not be effective within 20 minutes of the first dose, and it will not likely
take months for the medication. Attitude and faith will improve with the medication's
effectiveness.
34. When the client experiences facial flushing, a throbbing headache, nausea and vomiting
after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this
is due to which of the following?
A) A mild side effect of the medication.
B) The intended therapeutic result.
C) An idiosyncratic reaction
D) A severe allergy to the medication.
Ans: B
Feedback:
Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with
alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol,
symptoms begin to appear: facial and body flushing from vasodilation, a throbbing
headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These
symptoms are not mild side effects because these are very uncomfortable symptoms.
These symptoms would not be an idiosyncratic reaction because this is the expected
reaction. These symptoms are not indicative of a severe allergy to the medication.
35. When the client asks the nurse how long it will take before the SSRI antidepressant
medication will be effective, which of the following replies is most accurate and
therapeutic?
A) ìThis is a good medication! It will be effective within 20 minutes of the first dose.î
B) ìYou will have gradual improvement in symptoms over the next few weeks, but
the changes may be so subtle that you may not notice them for a while. It is
important for you to keep taking the medication.î
C) ìIt will probably take months for the medication to work. In the meantime, you
should work on improving your attitude.î
D) ìIf you believe it will work, then it will. You have to have faith!î
Ans: B
Feedback:
SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of these
drugs are an ìinitiating eventî and that eventual therapeutic effectiveness results when
neurons respond more slowly, making serotonin available at the synapses. The
medication will not be effective within 20 minutes of the first dose, and it will not likely
take months for the medication. Attitude and faith will improve with the medication's
effectiveness.
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Page 16
36. A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the
nurse is indicated?
A) Call the physician for an increase in dosage.
B) Do not give the next dose, and call the physician.
C) Increase fluid intake for the next week.
D) No intervention is necessary at this time.
Ans: D
Feedback:
The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L
are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic.
Answers A, B, and C are not appropriate interventions for the given lithium level.
37. A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to
medication regimen. The nurse should assess for which of the following common
contributors to nonadherence?
A) The patient is symptom-free and therefore does not need to adhere to the
medication regimen.
B) The patient cannot clearly see the instructions written on the prescription bottle.
C) The patient dislikes the weight gain associated with antipsychotic therapy.
D) The patient sells the antipsychotics to addicts in the neighborhood.
Ans: C
Feedback:
Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally
balanced diets; this pattern decreases the likelihood that they can minimize potential
weight gain or lose excess weight. Antipsychotics should be taken regularly and not
omitted when free of symptoms. Antipsychotics do not adversely affect vision, nor do
they have addictive potential.
38. Which of the following side effects of lithium are frequent causes of noncompliance?
Select all that apply.
A) Metallic taste in the mouth
B) Weight gain
C) Acne
D) Thirst
E) Lethargy
Ans: B, E
Feedback:
Lethargy and weight gain are difficult to manage or minimize and frequently lead to
noncompliance.
36. A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the
nurse is indicated?
A) Call the physician for an increase in dosage.
B) Do not give the next dose, and call the physician.
C) Increase fluid intake for the next week.
D) No intervention is necessary at this time.
Ans: D
Feedback:
The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L
are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic.
Answers A, B, and C are not appropriate interventions for the given lithium level.
37. A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to
medication regimen. The nurse should assess for which of the following common
contributors to nonadherence?
A) The patient is symptom-free and therefore does not need to adhere to the
medication regimen.
B) The patient cannot clearly see the instructions written on the prescription bottle.
C) The patient dislikes the weight gain associated with antipsychotic therapy.
D) The patient sells the antipsychotics to addicts in the neighborhood.
Ans: C
Feedback:
Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally
balanced diets; this pattern decreases the likelihood that they can minimize potential
weight gain or lose excess weight. Antipsychotics should be taken regularly and not
omitted when free of symptoms. Antipsychotics do not adversely affect vision, nor do
they have addictive potential.
38. Which of the following side effects of lithium are frequent causes of noncompliance?
Select all that apply.
A) Metallic taste in the mouth
B) Weight gain
C) Acne
D) Thirst
E) Lethargy
Ans: B, E
Feedback:
Lethargy and weight gain are difficult to manage or minimize and frequently lead to
noncompliance.
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Page 17
39. The nurse is educating a patient and family about strategies to minimize the side effects
of antipsychotic drugs. Which of the following should be included in the plan? Select all
that apply.
A) Drink plenty of fruit juice.
B) Developing an exercise program is important.
C) Increase foods high in fiber.
D) Laxatives can be used as needed.
E) Use sunscreen when outdoors.
F) For missed doses, take double the dose at the next scheduled time.
Ans: B, C, E
Feedback:
Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client
should avoid calorie-laden beverages and candy because they promote dental caries,
contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or
relieve constipation include exercising and increasing water and bulk-forming foods in
the diet. Stool softeners are permissible, but the client should avoid laxatives. The use of
sunscreen is recommended because photosensitivity can cause the client to sunburn
easily. If the client forgets a dose of antipsychotic medication, he or she can take the
missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the
next dose is due, the client can omit the forgotten dose.
40. The nurse has completed health teaching about dietary restrictions for a client taking a
monoamine oxidase inhibitor. The nurse will know that teaching has been effective by
which of the following client statements?
A) ìI'm glad I can eat pizza since it's my favorite food.î
B) ìI must follow this diet or I will have severe vomiting.î
C) ìIt will be difficult for me to avoid pepperoni.î
D) ìNone of the foods that are restricted are part of a regular daily diet.î
Ans: C
Feedback:
Pepperoni is one of the foods containing tyramine, so it must be avoided. Particular
concern to this client is the potential life-threatening hypertensive crisis if the client
ingests food that contains tyramine. Answer choices A, B, and D are inappropriate
statements toward effective teaching for the client receiving a monoamine oxidase
inhibitor.
39. The nurse is educating a patient and family about strategies to minimize the side effects
of antipsychotic drugs. Which of the following should be included in the plan? Select all
that apply.
A) Drink plenty of fruit juice.
B) Developing an exercise program is important.
C) Increase foods high in fiber.
D) Laxatives can be used as needed.
E) Use sunscreen when outdoors.
F) For missed doses, take double the dose at the next scheduled time.
Ans: B, C, E
Feedback:
Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client
should avoid calorie-laden beverages and candy because they promote dental caries,
contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or
relieve constipation include exercising and increasing water and bulk-forming foods in
the diet. Stool softeners are permissible, but the client should avoid laxatives. The use of
sunscreen is recommended because photosensitivity can cause the client to sunburn
easily. If the client forgets a dose of antipsychotic medication, he or she can take the
missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the
next dose is due, the client can omit the forgotten dose.
40. The nurse has completed health teaching about dietary restrictions for a client taking a
monoamine oxidase inhibitor. The nurse will know that teaching has been effective by
which of the following client statements?
A) ìI'm glad I can eat pizza since it's my favorite food.î
B) ìI must follow this diet or I will have severe vomiting.î
C) ìIt will be difficult for me to avoid pepperoni.î
D) ìNone of the foods that are restricted are part of a regular daily diet.î
Ans: C
Feedback:
Pepperoni is one of the foods containing tyramine, so it must be avoided. Particular
concern to this client is the potential life-threatening hypertensive crisis if the client
ingests food that contains tyramine. Answer choices A, B, and D are inappropriate
statements toward effective teaching for the client receiving a monoamine oxidase
inhibitor.
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Page 18
41. When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will
tell the client to avoid which of the following foods?
A) Broad beans
B) Citrus fruit
C) Egg products
D) Fried foods
Ans: A
Feedback:
Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beans
contain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine-
containing foods.
41. When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will
tell the client to avoid which of the following foods?
A) Broad beans
B) Citrus fruit
C) Egg products
D) Fried foods
Ans: A
Feedback:
Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beans
contain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine-
containing foods.
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Subject
Nursing