1. A nurse is caring for a client who is experiencing a panic attack.
Which of the following actions should the nurse take first?
a) Administer anti-anxiety medication as prescribed b) Assist the client
to a quiet and calm environment c) Encourage the client to discuss their
feelings of anxiety d) Stay with the client and offer reassurance
Answer: d) Stay with the client and offer reassurance
Rationale: The first priority during a panic attack is to ensure the client
feels safe and supported. The nurse should stay with the client and
provide reassurance to help alleviate the overwhelming anxiety. While
the other options may be helpful, ensuring the client feels grounded
and secure is the initial intervention.
2. A nurse is caring for a client diagnosed with depression. Which of
the following should the nurse include in the plan of care?
a) Encourage the client to make a list of their problems and discuss
them b) Offer high-energy activities to promote involvement c) Establish
a regular routine and encourage small, achievable goals d) Allow the
client to make decisions regarding medication administration
Answer: c) Establish a regular routine and encourage small, achievable
goals
Rationale: Clients with depression often experience difficulties with
motivation and concentration. Establishing a structured routine and
breaking tasks into small, manageable goals can help increase their
sense of accomplishment and provide a sense of control. Encouraging
them to make decisions about their medication can be empowering,
but is not the main priority for the plan of care.
,3. A client with schizophrenia is prescribed an antipsychotic
medication. The nurse should monitor the client for which of the
following side effects?
a) Weight loss b) Tinnitus c) Extrapyramidal symptoms (EPS) d)
Increased blood pressure
Answer: c) Extrapyramidal symptoms (EPS)
Rationale: Antipsychotic medications can cause extrapyramidal
symptoms, which include tremors, rigidity, bradykinesia, and tardive
dyskinesia. These symptoms are associated with the drug's effect on the
central nervous system and should be monitored closely.
4. A nurse is caring for a client who is being discharged after treatment
for alcohol use disorder. Which of the following statements indicates
the need for further teaching?
a) "I will attend a support group meeting once a week." b) "I can drink
socially in moderation after a year of sobriety." c) "I will continue
attending therapy to help prevent relapse." d) "I will avoid situations
where alcohol is present."
Answer: b) "I can drink socially in moderation after a year of sobriety."
Rationale: Clients recovering from alcohol use disorder are advised to
avoid alcohol entirely, even after extended periods of sobriety.
Moderation is not recommended as it increases the risk of relapse.
Ongoing therapy and support group attendance are essential
components of recovery.
5. A nurse is assessing a client with a history of bulimia nervosa.
Which of the following findings is most characteristic of this disorder?
, a) Low body weight b) Binge eating followed by purging c) A history of
excessive exercise d) Preoccupation with food, but not eating large
amounts
Answer: b) Binge eating followed by purging
Rationale: Bulimia nervosa is characterized by episodes of binge eating,
followed by behaviors to prevent weight gain, such as vomiting or
excessive use of laxatives (purging). While excessive exercise can be a
feature, the hallmark of bulimia is the cycle of binge eating and purging.
6. A nurse is caring for a client who is experiencing mania. Which of
the following interventions should the nurse prioritize?
a) Set limits on the client’s behavior b) Allow the client to make
decisions about their treatment c) Encourage the client to engage in
physical activity d) Administer a sedative as prescribed
Answer: a) Set limits on the client’s behavior
Rationale: In clients experiencing mania, setting clear and consistent
limits on behaviors is essential to prevent harm to the client or others.
Clients with mania often have poor impulse control and may exhibit
risky behaviors. While medications and physical activity can be helpful,
setting limits is the primary intervention.
7. A nurse is providing teaching to a client about selective serotonin
reuptake inhibitors (SSRIs) for the treatment of depression. Which of
the following should the nurse include in the teaching?
a) "It may take 1-2 weeks for the medication to show effectiveness." b)
"You may experience sedation when you start taking the medication." c)
"SSRIs are only effective for short-term treatment of depression." d)
Which of the following actions should the nurse take first?
a) Administer anti-anxiety medication as prescribed b) Assist the client
to a quiet and calm environment c) Encourage the client to discuss their
feelings of anxiety d) Stay with the client and offer reassurance
Answer: d) Stay with the client and offer reassurance
Rationale: The first priority during a panic attack is to ensure the client
feels safe and supported. The nurse should stay with the client and
provide reassurance to help alleviate the overwhelming anxiety. While
the other options may be helpful, ensuring the client feels grounded
and secure is the initial intervention.
2. A nurse is caring for a client diagnosed with depression. Which of
the following should the nurse include in the plan of care?
a) Encourage the client to make a list of their problems and discuss
them b) Offer high-energy activities to promote involvement c) Establish
a regular routine and encourage small, achievable goals d) Allow the
client to make decisions regarding medication administration
Answer: c) Establish a regular routine and encourage small, achievable
goals
Rationale: Clients with depression often experience difficulties with
motivation and concentration. Establishing a structured routine and
breaking tasks into small, manageable goals can help increase their
sense of accomplishment and provide a sense of control. Encouraging
them to make decisions about their medication can be empowering,
but is not the main priority for the plan of care.
,3. A client with schizophrenia is prescribed an antipsychotic
medication. The nurse should monitor the client for which of the
following side effects?
a) Weight loss b) Tinnitus c) Extrapyramidal symptoms (EPS) d)
Increased blood pressure
Answer: c) Extrapyramidal symptoms (EPS)
Rationale: Antipsychotic medications can cause extrapyramidal
symptoms, which include tremors, rigidity, bradykinesia, and tardive
dyskinesia. These symptoms are associated with the drug's effect on the
central nervous system and should be monitored closely.
4. A nurse is caring for a client who is being discharged after treatment
for alcohol use disorder. Which of the following statements indicates
the need for further teaching?
a) "I will attend a support group meeting once a week." b) "I can drink
socially in moderation after a year of sobriety." c) "I will continue
attending therapy to help prevent relapse." d) "I will avoid situations
where alcohol is present."
Answer: b) "I can drink socially in moderation after a year of sobriety."
Rationale: Clients recovering from alcohol use disorder are advised to
avoid alcohol entirely, even after extended periods of sobriety.
Moderation is not recommended as it increases the risk of relapse.
Ongoing therapy and support group attendance are essential
components of recovery.
5. A nurse is assessing a client with a history of bulimia nervosa.
Which of the following findings is most characteristic of this disorder?
, a) Low body weight b) Binge eating followed by purging c) A history of
excessive exercise d) Preoccupation with food, but not eating large
amounts
Answer: b) Binge eating followed by purging
Rationale: Bulimia nervosa is characterized by episodes of binge eating,
followed by behaviors to prevent weight gain, such as vomiting or
excessive use of laxatives (purging). While excessive exercise can be a
feature, the hallmark of bulimia is the cycle of binge eating and purging.
6. A nurse is caring for a client who is experiencing mania. Which of
the following interventions should the nurse prioritize?
a) Set limits on the client’s behavior b) Allow the client to make
decisions about their treatment c) Encourage the client to engage in
physical activity d) Administer a sedative as prescribed
Answer: a) Set limits on the client’s behavior
Rationale: In clients experiencing mania, setting clear and consistent
limits on behaviors is essential to prevent harm to the client or others.
Clients with mania often have poor impulse control and may exhibit
risky behaviors. While medications and physical activity can be helpful,
setting limits is the primary intervention.
7. A nurse is providing teaching to a client about selective serotonin
reuptake inhibitors (SSRIs) for the treatment of depression. Which of
the following should the nurse include in the teaching?
a) "It may take 1-2 weeks for the medication to show effectiveness." b)
"You may experience sedation when you start taking the medication." c)
"SSRIs are only effective for short-term treatment of depression." d)
