1. Situation : The nurse assigned in the detoxification unit attends to various patients with substance-related disorders.

A 45 years old male revealed that he experienced a marked increase in his intake of alcohol to achieve the desired effect This indicates: a. withdrawal b. tolerance c. intoxication d. psychological dependence

c. This must be difficult for you and your mother. d. Next time ask your mother where her things were last seen.

8. The primary nursing intervention in working with a client with moderate stage dementia is ensuring that the client: a. receives adequate nutrition and hydration b. will reminisce to decrease isolation c. remains in a safe and secure environment d. independently performs self care

2. The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension and fever. The nurse should be alert for impending: a. delirium tremens b. Korsakoffs syndrome c. esophageal varices d. Wernickes syndrome

9. She says to the nurse who offers her breakfast, Oh no, I will wait for my husband. We will eat together The therapeutic response by the nurse is: a. Your husband is dead. Let me serve you your breakfast. b. Ive told you several times that he is dead. Its time to eat. c. Youre going to have to wait a long time. d. What made you say that your husband is alive?

3. The care for the client places priority to which of the following: 10. Dementia unlike delirium is characterized by: a. Monitoring his vital signs every hour b. Providing a quiet, dim room c. Encouraging adequate fluids and nutritious foods d. Administering Librium as ordered a. slurred speech b. insidious onset c. clouding of consciousness d. sensory perceptual change

4. Another client is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with irritated nasal septum. a. Heroin b. cocaine c. LSD d. marijuana

11. Situation: A 17 year old gymnast is admitted to the hospital due to weight loss and dehydration secondary to starvation. Which of the following nursing diagnoses will be given priority for the client? a. altered self-image b. fluid volume deficit c. altered nutrition less than body requirements d. altered family process

5. A client is admitted with needle tracts on his arm, stuporous and with pin point pupil will likely be managed with: a. Naltrexone (Revia) b. Narcan (Naloxone) c. Disulfiram (Antabuse) d. Methadone (Dolophine)

12. What is the best intervention to teach the client when she feels the need to starve? a. Allow her to starve to relieve her anxiety b. Do a short term exercise until the urge passes c. Approach the nurse and talk out her feelings d. Call her mother on the phone and tell her how she feels

6. Situation: An old woman was brought for evaluation due to the hospital for evaluation due to increasing forgetfulness and limitations in daily function. The daughter revealed that the client used her toothbrush to comb her hair. She is manifesting: a. apraxia b. aphasia c. agnosia d. amnesia

13. The client with anorexia nervosa is improving if: a. She eats meals in the dining room. b. Weight gain c. She attends ward activities. d. She has a more realistic self concept.

7. She tearfully tells the nurse I cant take it when she accuses me of stealing her things. Which response by the nurse will be most therapeutic? a. Dont take it personally. Your mother does not mean it. b. Have you tried discussing this with your mother?

14. The characteristic manifestation that will differentiate bulimia nervosa from anorexia nervosa is that bulimic individuals a. have episodic binge eating and purging b. have repeated attempts to stabilize their weight c. have peculiar food handling patterns d. have threatened self-esteem

15. A nursing diagnosis for bulimia nervosa is powerlessness related to feeling not in control of eating habits. The goal for this problem is: a. Patient will learn problem solving skills b. Patient will have decreased symptoms of anxiety. c. Patient will perform self care activities daily. d. Patient will verbalize how to set limits on others.

22. Situation: A 20 year old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Extensive examination revealed no physical basis for the complaint. The nurse plans intervention based on which correct statement about conversion disorder? a. The symptoms are conscious effort to control anxiety b. The client will experience high level of anxiety in response to the paralysis. c. The conversion symptom has symbolic meaning to the client d. A confrontational approach will be beneficial for the client.

16. In the management of bulimic patients, the following nursing interventions will promote a therapeutic relationship EXCEPT: a. Establish an atmosphere of trust b. Discuss their eating behavior. c. Help patients identify feelings associated with binge-purge behavior d. Teach patient about bulimia nervosa

23. Nina reveals that the boyfriend has been pressuring her to engage in premarital sex. The most therapeutic response by the nurse is: a. I can refer you to a spiritual counselor if you like. b. You shouldnt allow anyone to pressure you into sex. c. It sounds like this problem is related to your paralysis. d. How do you feel about being pressured into sex by your boyfriend?

17. Situation: A 35 year old male has intense fear of riding an elevator. He claims As if I will die inside. This has affected his studies The client is suffering from: a. agoraphobia b. social phobia c. Claustrophobia d. xenophobia

24. Malingering is different from somatoform disorder because the former: a. Has evidence of an organic basis. b. It is a deliberate effort to handle upsetting events c. Gratification from the environment are obtained. d. Stress is expressed through physical symptoms.

18. Initial intervention for the client should be to: a. Encourage to verbalize his fears as much as he wants. b. Assist him to find meaning to his feelings in relation to his past. c. Establish trust through a consistent approach. d. Accept her fears without criticizing.

25. Unlike psychophysiologic disorder Linda may be best managed with: a. medical regimen b. milieu therapy c. stress management techniques d. psychotherapy

19. The nurse develops a countertransference reaction. This is evidenced by: a. Revealing personal information to the client b. Focusing on the feelings of the client. c. Confronting the client about discrepancies in verbal or non-verbal behavior d. The client feels angry towards the nurse who resembles his mother. Answer: (B) tolerance tolerance refers to the increase in the amount of the substance to achieve the same effects. A. Withdrawal refers to the physical signs and symptoms that occur when the addictive substance is reduced or withheld. B. Intoxication refers to the behavioral changes that occur upon recent ingestion of a substance. D. Psychological dependence refers to the intake of the substance to prevent the onset of withdrawal symptoms. Answer: (A) delirium tremens Delirium Tremens is the most extreme central nervous system irritability due to withdrawal from alcohol B. This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B C. This is a complication of liver cirrhosis which may be secondary to alcoholism . D. This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination. Answer: (A) Monitoring his vital signs every hour Pulse and blood pressure are usually elevated during withdrawal, Elevation may indicate impending delirium tremens B. Client needs quiet, well lighted, consistent and secure environment. Excessive stimulation can aggravate anxiety and cause illusions and hallucinations. C. Adequate nutrition with sulpplement of Vit. B should be ensured. D. Sedatives are used to relieve anxiety. Answer: (B) cocaine The manifestations indicate intoxication with cocaine, a CNS stimulant. A. Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. C. Intoxication with hallucinogen like LSD is manifested by grandiosity,

20. Which is the desired outcome in conducting desensitization: a. The client verbalize his fears about the situation b. The client will voluntarily attend group therapy in the social hall. c. The client will socialize with others willingly d. The client will be able to overcome his disabling fear.

21. Which of the following should be included in the health teachings among clients receiving Valium: a. Avoid taking CNS depressant like alcohol. b. There are no restrictions in activities. c. Limit fluid intake. d. Any beverage like coffee may be taken

hallucinations, synesthesia and increase in vital signs D. Intoxication with Marijuana, a cannabinoid is manifested by sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment and hallucinations. Answer: (B) Narcan (Naloxone) Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. A. This is an opiate receptor blocker used to relieve the craving for heroine C. Disulfiram is used as a deterrent in the use of alcohol. D. Methadone is used as a substitute in the withdrawal from heroine Answer: (C) agnosia This is the inability to recognize objects. A. Apraxia is the inability to execute motor activities despite intact comprehension. B. Aphasia is the loss of ability to use or understand words. D. Amnesia is loss of memory. Answer: (C) This must be difficult for you and your mother. This reflecting the feeling of the daughter that shows empathy. A and D. Giving advise does not encourage verbalization. B. This response does not encourage verbalization of feelings. Answer: (C) remains in a safe and secure environment Safety is a priority consideration as the clients cognitive ability deteriorates.. A is appropriate interventions because the clients cognitive impairment can affect the clients ability to attend to his nutritional needs, but it is not the priority B. Patient is allowed to reminisce but it is not the priority. D. The client in the moderate stage of Alzheimers disease will have difficulty in performing activities independently Answer: (A) Your husband is dead. Let me serve you your breakfast. The client should be reoriented to reality and be focused on the here and now.. B. This is not a helpful approach because of the short term memory of the client. C. This indicates a pompous response. D. The cognitive limitation of the client makes the client incapable of giving explanation. Answer: (B) insidious onset Dementia has a gradual onset and progressive deterioration. It causes pronounced memory and cognitive disturbances. A,C and D are all characteristics of delirium. Answer: (B) fluid volume deficit Fluid volume deficit is the priority over altered nutrition (A) since the situation indicates that the client is dehydrated. A and D are psychosocial needs of a client with anorexia nervosa but they are not the priority. Answer: (C) Approach the nurse and talk out her feelings The client with anorexia nervosa uses starvation as a way of managing anxiety. Talking out feelings with the nurse is an adaptive coping. A. Starvation should not be encouraged. Physical safety is a priority. Without adequate nutrition, a life threatening situation exists. B. The client with anorexia nervosa is preoccupied with losing weight due to disturbed body image. Limits should be set on attempts to lose more weight. D. The client may have a domineering mother which causes the client to feel ambivalent. The client will not discuss her feelings with her mother. Answer: (B) Weight gain Weight gain is the best indication of the clients improvement. The goal is for the client to gain 1-2 pounds per week. (A)The client may purge after eating. (C) Attending an activity does not indicate improvement in nutritional state. (D) Body image is a factor in anorexia nervosa but it is not an indicator for improvement. Answer: (A) have episodic binge eating and purging Bulimia is characterized by binge eating which is characterized by taking in a large amount of food over a short period of time. B and C are characteristics of a client with anorexia nervosa D. Low esteem is noted in both eating disorders Answer: (A) Patient will learn problem solving skills if the client learns problem solving skills she will gain a sense of control over her life. (B) Anxiety is caused by powerlessness. (C) Performing self care activities will not decrease ones powerlessness (D) Setting limits to control imposed by others is a necessary skill but problem solving skill is the priority. Answer: (B) Discuss their eating behavior. The client is often ashamed of her eating behavior. Discussion should focus on feelings. A,C and D promote a therapeutic relationship

Answer: (C) Claustrophobia Claustrophobia is fear of closed space. A. Agoraphobia is fear of open space or being a situation where escape is difficult. B. Social phobia is fear of performing in the presence of others in a way that will be humiliating or embarrassing. D. Xenophobia is fear of strangers. Answer: (D) Accept her fears without criticizing. The client cannot control her fears although the client knows its silly and can joke about it. A. Allow expression of the clients fears but he should focus on other productive activities as well. B and C. These are not the initial interventions. Answer: (A) Revealing personal information to the client A. Countertransference is an emotional reaction of the nurse on the client based on her unconscious needs and conflicts. B and C. These are therapeutic approaches. D. This is transference reaction where a client has an emotional reaction towards the nurse based on her past. Answer: (D) The client will be able to overcome his disabling fear. The client will overcome his disabling fear by gradual exposure to the feared object. A,B and C are not the desired outcome of desensitization. Answer: (A) Avoid taking CNS depressant like alcohol. Valium is a CNS depressant. Taking it with other CNS depressants like alcohol; potentiates its effect. B. The client should be taught to avoid activities that require alertness. C. Valium causes dry mouth so the client must increase her fluid intake. D. Stimulants must not be taken by the client because it can decrease the effect of Valium. Answer: (C) The conversion symptom has symbolic meaning to the client the client uses body symptoms to relieve anxiety. A. The condition occurs unconsciously. B. The client is not distressed by the lost or altered body function. D. The client should not be confronted by the underlying cause of his condition because this can aggravate the clients anxiety. Answer: (D) How do you feel about being pressured into sex by your boyfriend? Focusing on expression of feelings is therapeutic. The central force of the clients condition is anxiety. A. This is not therapeutic because the nurse passes the responsibility to the counselor. B. Giving advice is not therapeutic. C. This is not therapeutic because it confronts the underlying cause. Answer: (B) It is a deliberate effort to handle upsetting events Malingering is a conscious simulation of an illness while somatoform disorder occurs unconscious. A. Both disorders do not have an organic or structural basis. C. Both have primary gains. D. This is a characteristic of somatoform disorder. Answer: (C) stress management techniques Stree management techniques is the best management of somatoform disorder because the disorder is related to stress and it does not have a medical basis. A. This disorder is not supported by organic pathology so no medical regimen is required. B and D. Milieu therapy and psychotherapy may be used a therapeutic modalities but these are not the best.