NR 326 CMS Exam
What is Nurse John likely to note in a male client being admitted for alcohol
withdrawal?
A. Perceptual disorders
B. Impending coma
C. Recent alcohol intake
D. Depression with mutism
Option A: Frightening visual hallucinations are especially common in clients
experiencing alcohol withdrawal
June has agreed to take amitriptyline HCL (Elavil) for 3 days, but now complains
that it “doesn’t help” and refuses to take it. What should the nurse say or do?
A. Withhold the drug
B. Record the client’s response
C. Encourage client to tell the physician
D. Suggest that it takes awhile before seeing the results.
Option D: The client needs a specific response; that it takes 2 to 3 weeks (a delayed
effect) until the therapeutic blood level is reached.
In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle
knows that succinylcholine (Anectine) will be administered for which therapeutic
effect?
A. Short acting anesthesia
B. Decreased oral and respiratory secretions
C. Skeletal muscle paralysis
D. Analgesia
Option C: Succinylcholine (Anectine)is a depolarizing muscle relaxant causing
paralysis. It is used to reduce the intensity of muscle contractions during the convulsive
stage, thereby reducing the risk of bone fractures or dislocation
Nurse Gina is aware that the dietary implications for a client in manic phase of
bipolar disorder is:
A. Serve the client a bowl of soup
B. Increase calories, decrease fat, and decrease carbohydrates
C. Give the client pieces of cut up steak, potatoes, peas
D. Increase calories, increase carbohydrates, and increase protein
Option D: This client needs increased protein for tissue building and increased calories
to replace what is burned up (usually via carbohydrates); preferable, portable d/t acute
mania sx
Potatoes- does not indicate if portable
What parental behavior toward a child during an admission procedure should
cause Nurse Ron to suspect child abuse?
A. Flat affect
B. Expressing guilt
C. Acting overly solicitous toward the child
D. Ignoring the child
Option C: Acting overly solicitous (overly concerned, mindful, anxiously concerned)
toward the child
,This behavior is an example of reaction formation, a coping mechanism.
Nurse Lynnette notices that a female client with obsessive-compulsive disorder
washes her hands for long periods each day. How should the nurse respond to
this compulsive behavior?
A. By designating times during which the client can focus on the behavior
B. By urging the client to reduce the frequency of the behavior as rapidly as
possible
C. By calling attention to, or attempting to prevent the behavior
D. By discouraging the client from verbalizing anxieties
CORRECT - Option A: The nurse should designate times during which the client can
focus on the compulsive behavior or obsessive thoughts.
Option B: The nurse should urge the client to reduce the frequency of the compulsive
behavior gradually, not rapidly.
Option C: She shouldn’t call attention to, or try to prevent the behavior. Trying to prevent
the behavior may cause pain and terror to the client.
Option D: The nurse should encourage the client to verbalize anxieties to help distract
attention from the compulsive behavior.
After seeking help at an outpatient mental health clinic, Ruby, who was raped
while walking her dog, is diagnosed with posttraumatic stress disorder (PTSD).
Three months later, Ruby returns to the clinic, complaining of fear, loss of
control, and helpless feelings. Which nursing intervention is most appropriate for
Ruby?
A. Recommending a high protein, low-fat diet
B. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle
C. Allowing the client time to heal
D. Exploring the meaning of the traumatic event with the client
CORRECT - Option D: The client with PTSD needs encouragement to examine and
understand the meaning of the traumatic event and consequent losses. Otherwise,
symptoms may worsen and the client may become depressed or engage in self-
destructive behavior such as substance abuse.
Option A: A special diet isn’t indicated unless the client also has an eating disorder or a
nutritional problem.
Option B: The physician may prescribe antianxiety agents or antidepressants cautiously
to avoid dependence; sleep medication is rarely appropriate.
Option C: The client must explore the meaning of the event and won’t heal without this,
no matter how much time passes. Behavioral techniques, such as relaxation therapy,
may help decrease the client’s anxiety and induce sleep. Exposure therapy may also be
indicated.
Meryl, age 19, is highly dependent on her parents and fears leaving home to go
away to college. Shortly before the semester starts, she complains that her legs
are paralyzed and is rushed to the emergency department. When physical
examination rules out a physical cause for her paralysis, the physician admits her
to the psychiatric unit where she is diagnosed with conversion disorder. Meryl
asks the nurse, “Why has this happened to me?” What is the nurse’s best
response?
, A. “You’ve developed this paralysis so you can stay with your parents. You must
deal with the conflict if you want to walk again.”
B. “It must be awful not to be able to move your legs. You may feel better if you
realize the problem is psychological, not physical.”
C. “Your problem is real but there is no physical basis for it. We’ll work on what is
going on in your life and why it’s happened.”
D. “It isn’t uncommon for someone with your personality to develop a conversion
disorder during times of stress.”
CORRECT - Option C: The nurse must be honest with the client by telling her that the
paralysis has no physiologic cause while also conveying empathy and acknowledging
that her symptoms are real. The client will benefit from psychiatric treatment, which will
help her understand the underlying cause of her symptoms. After the psychological
conflict is resolved, her symptoms will disappear.
Option A: Telling her that she has developed paralysis to avoid leaving her parents or
that her personality caused her disorder wouldn’t help her understand and resolve the
underlying conflict.
Option B: Saying that it must be awful not to be able to move her legs wouldn’t answer
the client’s question; knowing that the cause is psychological wouldn’t necessarily make
her feel better.
Nurse Trina knows that the following drugs have been known to be effective in
treating obsessive-compulsive disorder (OCD):
A. Benztropine (Cogentin) and diphenhydramine (Benadryl)
B. Chlordiazepoxide (Librium) and Diazepam (Valium)
C. Fluvoxamine (Luvox) and Clomipramine (Anafril)
D. Divalproex (Depakote) and Lithium (Lithobid)
CORRECT - Option C: The antidepressants fluvoxamine and clomipramine have been
effective in the treatment of OCD.
Option B: Librium and Valium may be helpful in treating anxiety related to OCD but
aren’t drugs of choice to treat the illness.
Options A and D: The other medications mentioned aren’t effective in the treatment of
OCD.
Alfred was newly diagnosed with anxiety disorder. The physician prescribed
buspirone (BuSpar). The nurse is aware that the teaching instructions for newly
prescribed buspirone should include which of the following?
A. A warning about the drug’s delayed therapeutic effect, which is from 14-30
days
B. A warning about the incidence of neuroleptic malignant syndrome (NMS)
C. A reminder of the need to schedule blood work in 1 week to check blood levels
of the drug
D. A warning that immediate sedation can occur with a resultant drop in pulse
CORRECT - Option A: The client should be informed that the drug’s therapeutic effect
might not be reached for 14 to 30 days. The client must be instructed to continue taking
the drug as directed.
Option B: NMS hasn’t been reported with this drug, but tachycardia is frequently
reported.
Option C: Blood level checks aren’t necessary
What is Nurse John likely to note in a male client being admitted for alcohol
withdrawal?
A. Perceptual disorders
B. Impending coma
C. Recent alcohol intake
D. Depression with mutism
Option A: Frightening visual hallucinations are especially common in clients
experiencing alcohol withdrawal
June has agreed to take amitriptyline HCL (Elavil) for 3 days, but now complains
that it “doesn’t help” and refuses to take it. What should the nurse say or do?
A. Withhold the drug
B. Record the client’s response
C. Encourage client to tell the physician
D. Suggest that it takes awhile before seeing the results.
Option D: The client needs a specific response; that it takes 2 to 3 weeks (a delayed
effect) until the therapeutic blood level is reached.
In preparing a female client for electroconvulsive therapy (ECT), Nurse Michelle
knows that succinylcholine (Anectine) will be administered for which therapeutic
effect?
A. Short acting anesthesia
B. Decreased oral and respiratory secretions
C. Skeletal muscle paralysis
D. Analgesia
Option C: Succinylcholine (Anectine)is a depolarizing muscle relaxant causing
paralysis. It is used to reduce the intensity of muscle contractions during the convulsive
stage, thereby reducing the risk of bone fractures or dislocation
Nurse Gina is aware that the dietary implications for a client in manic phase of
bipolar disorder is:
A. Serve the client a bowl of soup
B. Increase calories, decrease fat, and decrease carbohydrates
C. Give the client pieces of cut up steak, potatoes, peas
D. Increase calories, increase carbohydrates, and increase protein
Option D: This client needs increased protein for tissue building and increased calories
to replace what is burned up (usually via carbohydrates); preferable, portable d/t acute
mania sx
Potatoes- does not indicate if portable
What parental behavior toward a child during an admission procedure should
cause Nurse Ron to suspect child abuse?
A. Flat affect
B. Expressing guilt
C. Acting overly solicitous toward the child
D. Ignoring the child
Option C: Acting overly solicitous (overly concerned, mindful, anxiously concerned)
toward the child
,This behavior is an example of reaction formation, a coping mechanism.
Nurse Lynnette notices that a female client with obsessive-compulsive disorder
washes her hands for long periods each day. How should the nurse respond to
this compulsive behavior?
A. By designating times during which the client can focus on the behavior
B. By urging the client to reduce the frequency of the behavior as rapidly as
possible
C. By calling attention to, or attempting to prevent the behavior
D. By discouraging the client from verbalizing anxieties
CORRECT - Option A: The nurse should designate times during which the client can
focus on the compulsive behavior or obsessive thoughts.
Option B: The nurse should urge the client to reduce the frequency of the compulsive
behavior gradually, not rapidly.
Option C: She shouldn’t call attention to, or try to prevent the behavior. Trying to prevent
the behavior may cause pain and terror to the client.
Option D: The nurse should encourage the client to verbalize anxieties to help distract
attention from the compulsive behavior.
After seeking help at an outpatient mental health clinic, Ruby, who was raped
while walking her dog, is diagnosed with posttraumatic stress disorder (PTSD).
Three months later, Ruby returns to the clinic, complaining of fear, loss of
control, and helpless feelings. Which nursing intervention is most appropriate for
Ruby?
A. Recommending a high protein, low-fat diet
B. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle
C. Allowing the client time to heal
D. Exploring the meaning of the traumatic event with the client
CORRECT - Option D: The client with PTSD needs encouragement to examine and
understand the meaning of the traumatic event and consequent losses. Otherwise,
symptoms may worsen and the client may become depressed or engage in self-
destructive behavior such as substance abuse.
Option A: A special diet isn’t indicated unless the client also has an eating disorder or a
nutritional problem.
Option B: The physician may prescribe antianxiety agents or antidepressants cautiously
to avoid dependence; sleep medication is rarely appropriate.
Option C: The client must explore the meaning of the event and won’t heal without this,
no matter how much time passes. Behavioral techniques, such as relaxation therapy,
may help decrease the client’s anxiety and induce sleep. Exposure therapy may also be
indicated.
Meryl, age 19, is highly dependent on her parents and fears leaving home to go
away to college. Shortly before the semester starts, she complains that her legs
are paralyzed and is rushed to the emergency department. When physical
examination rules out a physical cause for her paralysis, the physician admits her
to the psychiatric unit where she is diagnosed with conversion disorder. Meryl
asks the nurse, “Why has this happened to me?” What is the nurse’s best
response?
, A. “You’ve developed this paralysis so you can stay with your parents. You must
deal with the conflict if you want to walk again.”
B. “It must be awful not to be able to move your legs. You may feel better if you
realize the problem is psychological, not physical.”
C. “Your problem is real but there is no physical basis for it. We’ll work on what is
going on in your life and why it’s happened.”
D. “It isn’t uncommon for someone with your personality to develop a conversion
disorder during times of stress.”
CORRECT - Option C: The nurse must be honest with the client by telling her that the
paralysis has no physiologic cause while also conveying empathy and acknowledging
that her symptoms are real. The client will benefit from psychiatric treatment, which will
help her understand the underlying cause of her symptoms. After the psychological
conflict is resolved, her symptoms will disappear.
Option A: Telling her that she has developed paralysis to avoid leaving her parents or
that her personality caused her disorder wouldn’t help her understand and resolve the
underlying conflict.
Option B: Saying that it must be awful not to be able to move her legs wouldn’t answer
the client’s question; knowing that the cause is psychological wouldn’t necessarily make
her feel better.
Nurse Trina knows that the following drugs have been known to be effective in
treating obsessive-compulsive disorder (OCD):
A. Benztropine (Cogentin) and diphenhydramine (Benadryl)
B. Chlordiazepoxide (Librium) and Diazepam (Valium)
C. Fluvoxamine (Luvox) and Clomipramine (Anafril)
D. Divalproex (Depakote) and Lithium (Lithobid)
CORRECT - Option C: The antidepressants fluvoxamine and clomipramine have been
effective in the treatment of OCD.
Option B: Librium and Valium may be helpful in treating anxiety related to OCD but
aren’t drugs of choice to treat the illness.
Options A and D: The other medications mentioned aren’t effective in the treatment of
OCD.
Alfred was newly diagnosed with anxiety disorder. The physician prescribed
buspirone (BuSpar). The nurse is aware that the teaching instructions for newly
prescribed buspirone should include which of the following?
A. A warning about the drug’s delayed therapeutic effect, which is from 14-30
days
B. A warning about the incidence of neuroleptic malignant syndrome (NMS)
C. A reminder of the need to schedule blood work in 1 week to check blood levels
of the drug
D. A warning that immediate sedation can occur with a resultant drop in pulse
CORRECT - Option A: The client should be informed that the drug’s therapeutic effect
might not be reached for 14 to 30 days. The client must be instructed to continue taking
the drug as directed.
Option B: NMS hasn’t been reported with this drug, but tachycardia is frequently
reported.
Option C: Blood level checks aren’t necessary
