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QUIZ # 3 (150 ITEMS) Name:_________________________ Yr/Sec:_____________ Date:_________ Score:______

INSTRUCTIONS: Encircle the letter of the correct answer. 1. Accompanied by her husband, a patient seeks admission to the labor and delivery area. The client states that she is in labor, and says she attended the hospital clinic for prenatal care. Which question should the nurse ask her first? a. Do you have any chronic illness? b. Do you have any allergies? c. What is your expected due date? d. Who will be with you during labor? 2. A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions? a. Every 5 minutes b. Every 15 minutes c. Every 30 minutes d. Every 60 minutes 3. A patient is in last trimester of pregnancy. Nurse Jane should instruct her to notify her primary health care provider immediately if she notices: a. Blurred vision b. Hemorrhoids c. Increased vaginal mucus d. Shortness of breath on exertion 4. The nurse in charge is reviewing a patients prenatal history. Which finding indicates a genetic risk factor? a. The patient is 25 years old b. The patient has a child with cystic fibrosis c. The patient was exposed to rubella at 36 weeks gestation d. The patient has a history of preterm labor at 32 weeks gestation 5. A adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by; a. Return preovulatory basal body temperature b. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle c. 3 full days of elevated basal body temperature and clear, thin cervical mucus d. Breast tenderness and mittelschmerz 6. During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, the nurse in charge should instruct the client to push the control button at which time? a. At the beginning of each fetal movement b. At the beginning of each contraction c. After every three fetal movements d. At the end of fetal movement 7. When evaluating a clients knowledge of symptoms to report during her pregnancy, which statement would indicate to the nurse in charge that the client understands the information given to her? a. Ill report increased frequency of urination. b. If I have blurred or double vision, I should call the clinic immediately. c. If I feel tired after resting, I should report it immediately. d. Nausea should be reported immediately. 8. When assessing a client during her first prenatal visit, the nurse discovers that the client had a reduction mammoplasty. The mother indicates she wants to breast-feed. What information should the nurse give to this mother regarding breast-feeding success? a. Its contraindicated for you to breast-feed following this type of surgery. b. I support your commitment; however, you may have to supplement each feeding with formula. c. You should check with your surgeon to determine whether breast-feeding would be possible. d. You should be able to breast-feed without difficulty. 9. Following a precipitous delivery, examination of the clients vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client? a. Applying cold to limit edema during the first 12 to 24 hours b. Instructing the client to use two or more peripads to cushion the area c. Instructing the client on the use of sitz baths if ordered d. Instructing the client about the importance of perineal (Kegel) exercises

10. A client makes a routine visit to the prenatal clinic. Although shes 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Diaz diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: a. an empty gestational sac. b. grapelike clusters. c. a severely malformed fetus. d. an extrauterine pregnancy. 11. After completing a second vaginal examination of a client in labor, the nursemidwife determines that the fetus is in the right occiput anterior position and at 1 station. Based on these findings, the nurse-midwife knows that the fetal presenting part is: a. 1 cm below the ischial spines. b. directly in line with the ischial spines. c. 1 cm above the ischial spines. d. in no relationship to the ischial spines. 12. Which of the following would be inappropriate to assess in a mother whos breast-feeding? a. The attachment of the baby to the breast. b. The mothers comfort level with positioning the baby. c. Audible swallowing. d. The babys lips smacking 13. During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation, which procedure is used to detect fetal anomalies? a. Amniocentesis. b. Chorionic villi sampling. c. Fetoscopy. d. Ultrasound 14. A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate? a. The fetus should be delivered within 24 hours. b. The client should repeat the test in 24 hours. c. The fetus isnt in distress at this time. d. The client should repeat the test in 1 week. 15. A client whos 36 weeks pregnant comes to the clinic for a prenatal checkup. To assess the clients preparation for parenting, the nurse might ask which question? a. Are you planning to have epidural anesthesia? b. Have you begun prenatal classes? c. What changes have you made at home to get ready for the baby?

d. Can you tell me about the meals you typically eat each day? 16. A client whos admitted to labor and delivery has the following assessment findings: gravida 2 para 1, estimated 40 weeks gestation, contractions 2 minutes apart, lasting 45 seconds, vertex +4 station. Which of the following would be the priority at this time? a. Placing the client in bed to begin fetal monitoring. b. Preparing for immediate delivery. c. Checking for ruptured membranes. d. Providing comfort measures. 17. Nurse Roy is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first? a. Change the clients position. b. Prepare for emergency cesarean section. c. Check for placenta previa. d. Administer oxygen. 18. The nurse in charge is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client? a. Risk for deficient fluid volume related to hemorrhage b. Risk for infection related to the type of delivery c. Pain related to the type of incision d. Urinary retention related to periurethral edema 19. Which change would the nurse identify as a progressive physiological change in postpartum period? a. Lactation b. Lochia c. Uterine involution d. Diuresis 20. A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the clients complaint of vaginal bleeding? a. Placenta previa b. Abruptio placentae c. Ectopic pregnancy d. Spontaneous abortion

21. A client with type 1 diabetes mellitus whos a multigravida visits the clinic at 27 weeks gestation. The nurse should instruct the client that for most pregnant women with type 1 diabetes mellitus: a. Weekly fetal movement counts are made by the mother. b. Contraction stress testing is performed weekly. c. Induction of labor is begun at 34 weeks gestation. d. Nonstress testing is performed weekly until 32 weeks gestation 22. When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to: a. Prevent seizures b. Reduce blood pressure c. Slow the process of labor d. Increase dieresis 23. Whats the approximate time that the blastocyst spends traveling to the uterus for implantation? a. 2 days b. 7 days c. 10 days d. 14 weeks 24. After teaching a pregnant woman who is in labor about the purpose of the episiotomy, which of the following purposes stated by the client would indicate to the nurse that the teaching was effective? a. Shortens the second stage of labor b. Enlarges the pelvic inlet c. Prevents perineal edema d. Ensures quick placenta delivery 25. A primigravida client at about 35 weeks gestation in active labor has had no prenatal care and admits to cocaine use during the pregnancy. Which of the following persons must the nurse notify? a. Nursing unit manager so appropriate agencies can be notified b. Head of the hospitals security department c. Chaplain in case the fetus dies in utero d. Physician who will attend the delivery of the infant 26. When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following? a. The vaccine prevents a future fetus from developing congenital anomalies b. Pregnancy should be avoided for 3 months after the immunization c. The client should avoid contact with children

diagnosed with rubella d. The injection will provide immunity against the 7-day measles. 27. A client with eclampsia begins to experience a seizure. Which of the following would the nurse in charge do first? a. Pad the side rails b. Place a pillow under the left buttock c. Insert a padded tongue blade into the mouth d. Maintain a patent airway 28. While caring for a multigravida client in early labor in a birthing center, which of the following foods would be best if the client requests a snack? a. Yogurt b. Cereal with milk c. Vegetable soup d. Peanut butter cookies 29. The multigravida mother with a history of rapid labor who us in active labor calls out to the nurse, The baby is coming! which of the following would be the nurses first action? a. Inspect the perineum b. Time the contractions c. Auscultate the fetal heart rate d. Contact the birth attendant 30. While assessing a primipara during the immediate postpartum period, the nurse in charge plans to use both hands to assess the clients fundus to: a. Prevent uterine inversion b. Promote uterine involution c. Hasten the puerperium period d. Determine the size of the fundus 31. Ms. Castro is newly-promoted to a patient care manager position. She updates her knowledge on the theories in management and leadership in order to become effective in her new role. She learns that some managers have low concern for services and high concern for staff. Which style of management refers to this? a. Organization Man b. Impoverished Management c. Country Club Management d. Team Management 32. Her former manager demonstrated passion for serving her staff rather than being served. She takes time to listen, prefers to be a teacher first before being a leader, which is characteristic of a. Transformational leader b. Transactional leader

c. Servant leader d. Charismatic leader 33. On the other hand, Ms. Castro notices that the Chief Nurse Executive has charismatic leadership style. Which of the following behaviors best describes this style? a. Possesses inspirational quality that makes followers gets attracted of him and regards him with reverence b. Acts as he does because he expects that his behavior will yield positive results c. Uses visioning as the core of his leadership d. Matches his leadership style to the situation at hand. 34. Which of the following conclusions of Ms. Castro about leadership characteristics is TRUE? a. There is a high correlation between the communication skills of a leader and the ability to get the job done. b. A manager is effective when he has the ability to plan well. c. Assessment of personal traits is a reliable tool for predicting a managers potential. d. There is good evidence that certain personal qualities favor success in managerial role. 35. She reads about Path Goal theory. Which of the following behaviors is manifested by the leader who uses this theory? a. Recognizes staff for going beyond expectations by giving them citations b. Challenges the staff to take individual accountability for their own practice c. Admonishes staff for being laggards. d. Reminds staff about the sanctions for non performance. 36. One leadership theory states that leaders are born and not made, which refers to which of the following theories? a. Trait b. Charismatic c. Great Man d. Situational 37. She came across a theory which states that the leadership style is effective dependent on the situation. Which of the following styles best fits a situation when the followers are selfdirected, experts and are matured individuals? a. Democratic b. Authoritarian c. Laissez faire d. Bureaucratic

38. She surfs the internet for more information about leadership styles. She reads about shared leadership as a practice in some magnet hospitals. Which of the following describes this style of leadership? a. Leadership behavior is generally determined by the relationship between the leaders personality and the specific situation b. Leaders believe that people are basically good and need not be closely controlled c. Leaders rely heavily on visioning and inspire members to achieve results d. Leadership is shared at the point of care. 39. Ms. Castro learns that some leaders are transactional leaders. Which of the following does NOT characterize a transactional leader? a. Focuses on management tasks b. Is a caretaker c. Uses trade-offs to meet goals d. Inspires others with vision 40. She finds out that some managers have benevolent-authoritative style of management. Which of the following behaviors will she exhibit most likely? a. Have condescending trust and confidence in their subordinates b. Gives economic or ego awards c. Communicates downward to the staff d. Allows decision making among subordinates 41. Harry is a Unit Manager I the Medical Unit. He is not satisfied with the way things are going in his unit. Patient satisfaction rate is 60% for two consecutive months and staff morale is at its lowest. He decides to plan and initiate changes that will push for a turnaround in the condition of the unit. Which of the following actions is a priority for Harry? a. Call for a staff meeting and take this up in the agenda. b. Seek help from her manager. c. Develop a strategic action on how to deal with these concerns. d. Ignore the issues since these will be resolved naturally. 42. She knows that there are external forces that influence changes in his unit. Which of the following is NOT an external force? a. Memo from the CEO to cut down on electrical consumption b. Demands of the labor sector to increase wages c. Low morale of staff in her unit d. Exacting regulatory and accreditation standards

43. After discussing the possible effects of the low patient satisfaction rate, the staff started to list down possible strategies to solve the problems head-on. Should they decide to vote on the best change strategy, which of the following strategies is referred to this? a. Collaboration b. Majority rule c. Dominance d. Compromise 44. One staff suggests that they review the pattern of nursing care that they are using, which is described as a: a. job description b. system used to deliver care c. manual of procedure d. rules to be followed 45. Which of the following is TRUE about functional nursing? a. Concentrates on tasks and activities b. Emphasizes use of group collaboration c. One-to-one nurse-patient ratio d. Provides continuous, coordinated and comprehensive nursing services 46. Functional nursing has some advantages, which one is an EXCEPTION? a. Psychological and sociological needs are emphasized. b. Great control of work activities. c. Most economical way of delivering nursing services. d. Workers feel secure in dependent role 47. He raised the issue on giving priority to patient needs. Which of the following offers the best way for setting priority? a. Assessing nursing needs and problems b. Giving instructions on how nursing care needs are to be met c. Controlling and evaluating the delivery of nursing care d. Assigning safe nurse: patient ratio 48. Which of the following is the best guarantee that the patients priority needs are met? a. Checking with the relative of the patient b. Preparing a nursing care plan in collaboration with the patient c. Consulting with the physician d. Coordinating with other members of the team 49. When Harry uses team nursing as a care delivery system, he and his team need to assess the priority of care for a group of patients, which of the following should be a priority? a. Each patient as listed on the worksheet b. Patients who needs least care

c. Medications and treatments required for all patients d. Patients who need the most care 50. She is hopeful that her unit will make a big turnaround in the succeeding months. Which of the following actions of Harry demonstrates that he has reached the third stage of change? a. Wonders why things are not what it used to be b. Finds solutions to the problems c. Integrate the solutions to his day-to-day activities d. Selects the best change strategy 51. Julius is a newly-appointed nurse manager of The Good Shepherd Medical Center, a tertiary hospital located within the heart of the metropolis. He thinks of scheduling planning workshop with his staff in order to ensure an effective and efficient management of the department. Should he decide to conduct a strategic planningworkshop, which of the following is NOT a characteristic of this activity? a. Long-term goal-setting b. Extends to 3-5 years in the future c. Focuses on routine tasks d. Determines directions of the organization 52. Which of the following statements refer to the vision of the hospital? a. The Good Shepherd Medical Center is a trendsetter in tertiary health care in the Philippines in the next five years Goal b. The officers and staff of The Good Shepherd Medical Center believe in the unique nature of the human person c. All the nurses shall undergo continuing competency training program. d. The Good Shepherd Medical Center aims to provide a patient-centered care in a total healing environment. 53. The statement, The Good Shepherd Medical Center aims to provide patientcentered care in a total healing environment refers to which of the following? a. Vision b. Goal c. Philosophy d. Mission 54. Julius plans to revisit the organizational chart of the department. He plans to create a new position of a Patient Educator who has a coordinating relationship with the head nurse in the unit. Which of the following will likely depict this organizational relationship? a. Box b. Solid line

c. Broken line d. Dotted line 55. He likewise stresses the need for all the employees to follow orders and instructions from him and not from anyone else. Which of the following principles does he refer to? a. Scalar chain b. Discipline c. Unity of command d. Order 56. Julius orients his staff on the patterns of reporting relationship throughout the organization. Which of the following principles refer to this? a. Span of control b. Hierarchy c. Esprit d corps d. Unity of direction 57. He emphasizes to the team that they need to put their efforts together towards the attainment of the goals of the program. Which of the following principles refers to this? a. Span of control b. Unity of direction c. Unity of command d. Command responsibility 58. Julius stresses the importance of promoting esprit d corps among the members of the unit. Which of the following remarks of the staff indicates that they understand what he pointed out? a. Lets work together in harmony; we need to be supportive of one another b. In order that we achieve the same results; we must all follow the directives of Julius and not from other managers. c. We will ensure that all the resources we need are available when needed. d. We need to put our efforts together in order to raise the bar of excellence in the care we provide to all our patients. 59. He discusses the goal of the department. Which of the following statements is a goal? a. Increase the patient satisfaction rate b. Eliminate the incidence of delayed administration of medications c. Establish rapport with patients. d. Reduce response time to two minutes. 60. He wants to influence the customary way of thinking and behaving that is shared by the members of the department. Which of the following terms refer to this? a. Organizational chart b. Cultural network

c. Organizational structure d. Organizational culture 61. He asserts the importance of promoting a positive organizational culture in their unit. Which of the following behaviors indicate that this is attained by the group? a. Proactive and caring with one another b. Competitive and perfectionist c. Powerful and oppositional d. Obedient and uncomplaining 62. Stephanie is a new Staff Educator of a private tertiary hospital. She conducts orientation among new staff nurses in her department. Joseph, one of the new staff nurses, wants to understand the channel of communication, span of control and lines of communication. Which of the following will provide this information? a. Organizational structure b. Policy c. Job description d. Manual of procedures 63. Stephanie is often seen interacting with the medical intern during coffee breaks and after duty hours. What type of organizational structure is this? a. Formal b. Informal c. Staff d. Line 64. She takes pride in saying that the hospital has a decentralized structure. Which of the following is NOT compatible with this type of model? a. Flat organization b. Participatory approach c. Shared governance d. Tall organization 65. Centralized organizations have some advantages. Which of the following statements are TRUE? 1. Highly cost-effective 2. Makes management easier 3. Reflects the interest of the worker 4. Allows quick decisions or actions. a. 1 & 2 b. 2 & 4 c. 2, 3& 4 d. 1, 2, & 4

66. Stephanie delegates effectively if she has authority to act, which is BEST defined as: a. having responsibility to direct others b. being accountable to the organization c. having legitimate right to act d. telling others what to do 67. Regardless of the size of a work group, enough staff must be available at all times to accomplish certain purposes. Which of these purposes is NOT included? a. Meet the needs of patients b. Provide a pair of hands to other units as needed c. Cover all time periods adequately. d. Allow for growth and development of nursing staff. 68. Which of the following guidelines should be least considered in formulating objectives for nursing care? a. Written nursing care plan b. Holistic approach c. Prescribed standards d. Staff preferences 69. Stephanie considers shifting to transformational leadership. Which of the following statements best describes this type of leadership? a. Uses visioning as the essence of leadership. b. Serves the followers rather than being served. c. Maintains full trust and confidence in the subordinates d. Possesses innate charisma that makes others feel good in his presence. 70. As a manager, she focuses her energy on both the quality of services rendered to the patients as well as the welfare of the staff of her unit. Which of the following management styles does she adopt? a. Country club management b. Organization man management c. Team management d. Authority-obedience management 71. Which nursing intervention is best for facilitating communication with a psychiatric client who speaks a foreign language? a. Rely on nonverbal communication. b. Select symbolic pictures as aids. c. Speak in universal phrases. d. Use the services of an interpreter.

72. The nurse explains to a mental health care technician that a clients obsessive-compulsive behaviors are related to unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement? a. Behavioral theory b. Cognitive theory c. Interpersonal theory d. Psychoanalytic theory 73. The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety? a. I guess youre worried about something, arent you? b. Can I get you some medication to help calm you? c. Have you been pacing for a long time? d. I notice that youre pacing. How are you feeling? 74. A client with obsessive-compulsive disorder is hospitalized on an inpatient unit. Which nursing response is most therapeutic? a. Accepting the clients obsessive-compulsive behaviors b. Challenging the clients obsessivecompulsive behaviors c. Preventing the clients obsessive-compulsive behaviors d. Rejecting the clients obsessive-compulsive behaviors 75. A 45-year-old woman with a history of depression tells a nurse in her doctors office that she has difficulty with sexual arousal and is fearful that her husband will have an affair. Which of the following factors would the nurse identify as least significant in contributing to the clients sexual difficulty? a. Education and work history b. Medication used c. Physical health status d. Quality of spousal relationship 76. Which nursing intervention is most appropriate for a client with anorexia nervosa during initial hospitalization on a behavioral therapy unit? a. Emphasize the importance of good nutrition to establish normal weight. b. Ignore the clients mealtime behavior and focus instead on issues of dependence and independence. c. Help establish a plan using privileges and restrictions based on compliance with refeeding. d. Teach the client information about the longterm physical consequence of anorexia.

77. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful? a. The parents reinforce increased decision making by the client. b. The parents clearly verbalize their expectations for the client. c. The client verbalizes that family meals are now enjoyable. d. The client tells her parents about feelings of low-self-esteem. 78. The nurse is working with a client with a somatoform disorder. Which client outcome goal would the nurse most likely establish in this situation? a. The client will recognize signs and symptoms of physical illness. b. The client will cope with physical illness. c. The client will take prescribed medications. d. The client will express anxiety verbally rather than through physical symptoms. 79. Which method would a nurse use to determine a clients potential risk for suicide? a. Wait for the client to bring up the subject of suicide. b. Observe the clients behavior for cues of suicide ideation. c. Question the client directly about suicidal thoughts. d. Question the client about future plans. 80. A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed thought processes related to difficulty concentrating, secondary to flight of ideas. Which of the following outcome criteria would indicate improvement in the client? a. The client verbalizes feelings directly during treatment. b. The client verbalizes positive self statement. c. The client speaks in coherent sentences. d. The client reports feelings calmer. 81. A client tells a nurse. Everyone would be better off if I wasnt alive. Which nursing diagnosis would be made based on this statement? a. Disturbed thought processes b. Ineffective coping c. Risk for self-directed violence d. Impaired social interaction

82. Which information is most essential in the initial teaching session for the family of a young adult recently diagnosed with schizophrenia? a. Symptoms of this disease imbalance in the brain. b. Genetic history is an important factor related to the development of schizophrenia. c. Schizophrenia is a serious disease affecting every aspect of a persons functioning. d. The distressing symptoms of this disorder can respond to treatment with medications. 83. A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes related to the clients delusional perceptions would the nurse establish? a. The client will demonstrate realistic interpretation of daily events in the unit. b. The client will perform daily hygiene and grooming without assistance. c. The client will take prescribed medications without difficulty. d. The client will participate in unit activities. 84. A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command hallucinations. Which of the following is the priority nursing diagnosis? a. Anxiety b. Impaired social interaction c. Disturbed sensory-perceptual alteration (auditory) d. Risk for other-directed violence 85. A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his stressful marriage and difficult job. Which defense mechanisms is this client using? a. Displacement b. Projection c. Rationalization d. Sublimation 86. An 11-year-old child diagnosed with conduct disorder is admitted to the psychiatric unit for treatment. Which of the following behaviors would the nurse assess? a. Restlessness, short attention span, hyperactivity b. Physical aggressiveness, low stress tolerance disregard for the rights of others c. Deterioration in social functioning, excessive anxiety and worry, bizarre behavior d. Sadness, poor appetite and sleeplessness, loss of interest in activities

87. The nurse understands that if a client continues to be dependent on heroin throughout her pregnancy, her baby will be at high risk for: a. Mental retardation. b. Heroin dependence. c. Addiction in adulthood. d. Psychological disturbances. 88. The emergency department nurse is assigned to provide care for a victim of a sexual assault. When following legal and agency guidelines, which intervention is most important? a. Determine the assailants identity. b. Preserve the clients privacy. c. Identify the extent of injury. d. Ensure an unbroken chain of evidence. 89. Which factor is least important in the decision regarding whether a victim of family violence can safely remain in the home? a. The availability of appropriate community shelters b. The nonabusing caretakers ability to intervene on the clients behalf c. The clients possible response to relocation d. The familys socioeconomic status 90. The nurse would expect a client with early Alzheimers disease to have problems with: a. Balancing a checkbook. b. Self-care measures. c. Relating to family members. d. Remembering his own name 91. Which nursing intervention is most appropriate for a client with Alzheimers disease who has frequent episodes emotional lability? a. Attempt humor to alter the client mood. b. Explore reasons for the clients altered mood. c. Reduce environmental stimuli to redirect the clients attention. d. Use logic to point out reality aspects. 92. Which neurotransmitter has been implicated in the development of Alzheimers disease? a. Acetylcholine b. Dopamine c. Epinephrine d. Serotonin

93. Which factors are most essential for the nurse to assess when providing crisis intervention foe a client? a. The clients communication and coping skills b. The clients anxiety level and ability to express feelings c. The clients perception of the triggering event and availability of situational supports d. The clients use of reality testing and level of depression 94. The nurse considers a clients response to crisis intervention successful if the client: a. Changes coping skills and behavioral patterns. b. Develops insight into reasons why the crisis occurred. c. Learns to relate better to others. d. Returns to his previous level of functioning. 95. Two nurses are co-leading group therapy for seven clients in the psychiatric unit. The leaders observe that the group members are anxious and look to the leaders for answers. Which phase of development is this group in? a. Conflict resolution phase b. Initiation phase c. Working phase d. Termination phase 96. Group members have worked very hard, and the nurse reminds them that termination is approaching. Termination is considered successful if group members: a. Decide to continue. b. Elevate group progress c. Focus on positive experience d. Stop attending prior to termination. 97. The nurse is teaching a group of clients about the mood-stabilizing medications lithium carbonate. Which medications should she instruct the clients to avoid because of the increased risk of lithium toxicity? a. Antacids b. Antibiotics c. Diuretics d. Hypoglycemic agents 98. When providing family therapy, the nurse analyzes the functioning of healthy family systems. Which situations would not increase stress on a healthy family system? a. An adolescents going away to college b. The birth of a child c. The death of a grandparent d. Parental disagreement

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99. A client taking the monoamine oxidase inhibitor (MAOI) antidepressant isocarboxazid (Marplan) is instructed by the nurse to avoid which foods and beverages? a. Aged cheese and red wine b. Milk and green, leaf vegetables c. Carbonated beverages and tomato products d. Lean red meats and fruit juices 100. Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurse should: a. Assess skin color and sclera b. Assess the radial pulse c. Take the clients blood pressure d. Ask the client to void 101. The nurse understands that electroconvulsive therapy is primary used in psychiatric care for the treatment of: a. Anxiety disorders. b. Depression. c. Mania. d. Schizophrenia. 102. A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the medications listed below. Which medication would cause the nurse to express concern and therefore initiate further teaching? a. Acetaminophen (Tylenol) b. Diphenhydramine (Benadryl) c. Furosemide (Lasix) d. Isosorbide dinitrate (Isordil) 103. The nurse is administering a psychotropic drug to an elderly client who has history of benign prostatic hypertrophy. It is most important for the nurse to teach this client to: a. Add fiber to his diet. b. Exercise on a regular basis. c. Report incomplete bladder emptying d. Take the prescribed dose at bedtime. 104. The nurse correctly teaches a client taking the benzodiazepine oxazepam (Serax) to avoid excessive intake of: a. Cheese b. Coffee c. Sugar d. Shellfish 105. The nurse provides a referral to Alcoholics Anonymous to a client who describes a 20-year history of alcohol abuse. The primary function of this group is to: a. Encourage the use of a 12-step program. b. Help members maintain sobriety. c. Provide fellowship among members. d. Teach positive coping mechanisms.

106. Which client outcome is most appropriately achieved in a community approach setting in psychiatric nursing? a. The client performs activities of daily living and learns about crafts. b. The clients is able to prevent aggressive behavior and monitors his use of medications. c. The client demonstrates self-reliance and social adaptation. d. The client experience experiences anxiety relief and learns about his symptoms. 107. A client with panic disorder experiences an acute attack while the nurse is completing an admission assessment. List the following interventions according to their level of priority. a. Remain with the client. b. Encourage physical activity. c. Encourage low, deep breathing. d. Reduce external stimuli. e. Teach coping measures. 108. The doctor has prescribed haloperidol (Haldol) 2.5 mg. I.M. for an agitated client. The medication is labeled haloperidol 10 mg/2 ml. The nurse prepares the correct dose by drawing up how many milliliters in the syringe? a. 0.3 b. 0.4 c. 0.5 d. 0.6 109. The nurse enters the room of a client with a cognitive impairment disorder and asks what day of the week it is: what the date, month, and year are; and where the client is. The nurse is attempting to assess: a. Confabulation b. Delirium c. Orientation d. Perseveration 110. Which of the following will the nurse use when communicating with a client who has a cognitive impairment? a. Complete explanations with multiple details b. Picture or gestures instead of words c. Stimulating words and phrases to capture the clients attention d. Short words and simple sentences 111. A 75-year-old client has dementia of the Alzheimers type and confabulates. The nurse understands that this client: a. Denies confusion by being jovial. b. Pretends to be someone else. c. Rationalizes various behaviors. d. Fills in memory gaps with fantasy.

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112. An elderly client with Alzheimers disease becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to: a. Tell the client family that it is time to get dressed. b. Obtain assistance to restrain the client for safety. c. Remain calm and talk quietly to the client. d. Call the doctor and request an order for sedation. 113. In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called: a. Aphasia b. Agnosia c. Sundowning d. Confabulation 114. Which of the following outcome criteria is appropriate for the client with dementia? a. The client will return to an adequate level of self-functioning. b. The client will learn new coping mechanisms to handle anxiety. c. The client will seek out resources in the community for support. d. The client will follow an establishing schedule for activities of daily living. 115. The school guidance counselor refers a family with an 8-year-old child to the mental health clinic because of the childs frequent fighting in school and truancy. Which of the following data would be a priority to the nurse doing the initial family assessment? a. The childs performance in school b. Family education and work history c. The familys perception of the current problem d. The teachers attempts to solve the problem 116. The parents of a young man with schizophrenia express feelings of responsibility and guilt for their sons problems. How can the nurse best educate the family? a. Acknowledge the parents responsibility. b. Explain the biological nature of schizophrenia. c. Refer the family to a support group d. Teach the parents various ways they must change. 117. The nurse collecting family assessment data asks. Who is in your family and where do they live? which of the following is the nurse attempting o identify? a. Boundaries b. Ethnicity

c. Relationships d. Triangles 118. According to the family systems theory, which of the following best describes the process of differentiation? a. Cooperative action among members of the family b. Development of autonomy within the family c. Incongruent massages wherein the recipient is a victim d. Maintenance of system continuity or equilibrium 119. The nurse is interacting with a family consisting of a mother, a father, and a hospitalized adolescent who has a diagnosis of alcohol abuse. The nurse analyzes the situation and agrees with the adolescents view about family rules. Which intervention is most appropriate? a. The nurse should align with the adolescent, who is the family scapegoat. b. The nurse should encourage the parents to adopt more realistic rules. c. The nurse should encourage the adolescent to comply with parental rules. d. The nurse should remain objective and encourage mutual negotiation of issues. 120. A 16-year-old girl has retuned home following hospitalization for treatment of anorexia nervosa. The parents tell the family nurse performing a home visit that their child has always done everything to please them and they cannot understand her current stubbornness about eating. The nurse analyzes the family situation and determines it is characteristic of which relationship style? a. Differentiation b. Disengagement c. Enmeshment d. Scapegoating 121. An infection in a central venous access device is not eliminated by giving antibiotics through the catheter. How would bacterial glycocalyx contribute to this? a. It protects the bacteria from antibiotic and immunologic destruction. b. Glycocalyx neutralizes the antibiotic rendering it ineffective. c. It competes with the antibiotic for binding sites on the microbe. d. Glycocalyx provides nutrients for microbial growth.

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122. Central venous access devices are beneficial in pediatric therapy because: a. They dont frighten children. b. Use of the arms is not restricted. c. They cannot be dislodged. d. They are difficult to see. 123. How can central venous access devices (CVADs) be of value in a patient receiving chemotherapy who has stomatitis and severe diarrhea? a. The chemotherapy can be rapidly completed allowing the stomatitis and diarrhea to resolve. b. Crystalloid can be administered to prevent dehydration. c. Concentrated hyperalimentation fluid can be administered through the CVAD. d. The chemotherapy dose can be reduced. 124. Some central venous access devices (CVAD) have more than one lumen. These multi lumen catheters: a. Have an increased risk of infiltration. b. Only work a short while because the small bore clots off. c. Are beneficial to patient care but are prohibitively expensive. d. Allow different medications or solutions to be administered simultaneously. 125. Some institutions will not infuse a fat emulsion, such as Intralipid, into central venous access devices (CVAD) because: a. Lipid residue may accumulate in the CVAD and occlude the catheter. b. If the catheter clogs, there is no treatment other than removal and replacement. c. Lipids are necessary only in the most extreme cases to prevent essential fatty acid (EFA) deficiency. d. Fat emulsions are very caustic. 126. A male patient needs a percutaneously inserted central catheter (PICC) for prolonged IV therapy. He knows it can be inserted without going to the operating room. He mentions that, at least the doctor wont be wearing surgical garb, will he? How will the nurse answer the patient? a. You are correct. It is a minor procedure performed on the unit and does not necessitate surgical attire. b. To decrease the risk of infection, the doctor inserting the PICC will wear a cap, mask, and sterile gown and gloves. c. It depends on the doctors preference. d. Most doctors only wear sterile gloves, not a cap, mask, or sterile gown.

127. A male patient is to receive a percutaneously inserted central catheter (PICC). He asks the nurse whether the insertion will hurt. How will the nurse reply? a. You will have general anesthesia so you wont feel anything. b. It will be inserted rapidly, and any discomfort is fleeting. c. The insertion site will be anesthetized. Threading the catheter through the vein is not painful. d. You will receive sedation prior to the procedure. 128. What volume of air can safely be infused into a patient with a central venous access device (CVAD)? a. It is dependent on the patients weight and height. b. Air entering the patient through a CVAD will follow circulation to the lungs where it will be absorbed and cause no problems. c. It is dependent on comorbidities such as asthma or chronic obstructive lung disease. d. None. 129. Kent a new staff nurse asks her preceptor nurse how to obtain a blood sample from a patient with a portacath device. The preceptor nurse teaches the new staff nurse: a. The sample will be withdrawn into a syringe attached to the portacath needle and then placed into a vacutainer. b. Portacath devices are not used to obtain blood samples because of the risk of clot formation. c. The vacutainer will be attached to the portacath needle to obtain a direct sample. d. Any needle and syringe may be utilized to obtain the sample. 130. What is the purpose of tunneling (inserting the catheter 2-4 inches under the skin) when the surgeon inserts a Hickman central catheter device? Tunneling: a. Increases the patients comfort level. b. Decreases the risk of infection. c. Prevents the patients clothes from having contact with the catheter d. Makes the catheter less visible to other people. 131. The primary complication of a central venous access device (CVAD) is: a. Thrombus formation in the vein. b. Pain and discomfort. c. Infection. d. Occlusion of the catheter as the result of an intra-lumen clot.

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132. Nurse Blessy is doing some patient education related to a patients central venous access device. Which of the following statements will the nurse make to the patient? a. These type of devices are essentially risk free. b. These devices seldom work for more than a week or two necessitating replacement. c. The dressing should only the changed by your doctor. d. Heparin in instilled into the lumen of the catheter to decrease the risk of clotting. 133. The chemotherapeutic DNA alkylating agents such as nitrogen mustards are effective because they: a. Cross-link DNA strands with covalent bonds between alkyl groups on the drug and guanine bases on DNA. b. Have few, if any, side effects. c. Are used to treat multiple types of cancer. d. Are cell cycle-specific agents. 134. Hormonal agents are used to treat some cancers. An example would be: a. Thyroxine to treat thyroid cancer. b. ACTH to treat adrenal carcinoma. c. Estrogen antagonists to treat breast cancer. d. Glucagon to treat pancreatic carcinoma. 135. Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because: a. The patients hemoglobin and hematocrit are normal. b. Red blood cells are affected first. c. Folic acid levels are normal. d. The current white cell count is not affected by chemotherapy. 136. Currently, there is no way to prevent myelosuppression. However, there are medications available to elicit a more rapid bone marrow recovery. An example is: a. Epoetin alfa (Epogen, Procrit). b. Glucagon. c. Fenofibrate (Tricor). d. Lamotrigine (Lamictal). 137. Estrogen antagonists are used to treat estrogen hormone-dependent cancer, such as breast carcinoma. Androgen antagonists block testosterone stimulation of androgendependent cancers. An example of an androgen-dependent cancer would be: a. Prostate cancer. b. Thyroid cancer. c. Renal carcinoma. d. neuroblastoma.

138. Serotonin release stimulates vomiting following chemotherapy. Therefore, serotonin antagonists are effective in preventing and treating nausea and vomiting related to chemotherapy. An example of an effective serotonin antagonist antiemetic is: a. ondansetron (Zofran). b. fluoxetine (Prozac). c. paroxetine (Paxil). d. sertraline (Zoloft). 139. Methotrexate, the most widely used antimetabolite in cancer chemotherapy does not penetrate the central nervous system (CNS). To treat CNS disease this drug must be administered: a. Intravenously. b. Subcutaneously. c. Intrathecally. d. By inhalation. 140. Methotrexate is a folate antagonist. It inhibits enzymes required for DNA base synthesis. To prevent harm to normal cells, a fully activated form of folic acid known as leucovorin (folinic acid; citrovorum factor) can be administered. Administration of leucovorin is known as: a. Induction therapy. b. Consolidation therapy. c. Pulse therapy. d. Rescue therapy. 141. A male Patient is undergoing chemotherapy may also be given the drug allopurinol (Zyloprim, Aloprim). Allopurinol inhibits the synthesis of uric acid. Concomitant administration of allopurinol prevents: a. Myelosuppression. b. Gout and hyperuricemia. c. Pancytopenia. d. Cancer cell growth and replication 142. Superficial bladder cancer can be treated by direct instillation of the antineoplastic antibiotic agent mitomycin (Mutamycin). This process is termed: a. Intraventricular administration. b. Intravesical administration. c. Intravascular administration. d. Intrathecal administration. 143. The most common dose-limiting toxicity of chemotherapy is: a. Nausea and vomiting. b. Bloody stools. c. Myelosuppression. d. Inability to ingest food orally due to stomatitis and mucositis.

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144. Chemotherapy induces vomiting by: a. Stimulating neuroreceptors in the medulla. b. Inhibiting the release of catecholamines. c. Autonomic instability. d. Irritating the gastric mucosa. 145. Myeloablation using chemotherapeutic agents is useful in cancer treatment because: a. It destroys the myelocytes (muscle cells). b. It reduces the size of the cancer tumor. c. After surgery, it reduces the amount of chemotherapy needed. d. It destroys the bone marrow prior to transplant. 146. Anticipatory nausea and vomiting associated with chemotherapy occurs: a. Within the first 24 hours after chemotherapy. b. 1-5 days after chemotherapy. c. Before chemotherapy administration. d. While chemotherapy is being administered. 147. Medications bound to protein have the following effect: a. Enhancement of drug availability. b. Rapid distribution of the drug to receptor sites. c. The more drug bound to protein, the less available for desired effect.

d. Increased metabolism of the drug by the liver. 148. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug may be absorbed. This process is known as: a. Hepatic clearance. b. Total clearance. c. Enterohepatic cycling. d. First-pass effect. 149. An adult patient has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this patient for: a. Increased therapeutic effects of Drug A. b. Increased adverse effects of Drug B. c. Decreased therapeutic effects of Drug A. d. Decreased therapeutic effects of Drug B. 150. Epinephrine is administered to a female patient. The nurse should expect this agent to rapidly affect: a. Adrenergic receptors. b. Muscarinic receptors. c. Cholinergic receptors. d. Nicotinic receptors.