NUR 104 Exam 3
1. A client with a psychiatric disorder was voluntarily admitted
and now wishes to be discharged from the hospital, against
medical advice. Which aspect would be most important for
the nurse to determine in this situation?
A. ability to care for self
B. degree of danger to self and others
C. level of psychosis
D. intended compliance with aftercare: B. degree of danger to
self and others
2. The nurse in a psychiatric unit has formed a therapeutic
relationship with a client with a borderline personality
disorder. When the client is readmitted to the unit for a suicide
attempt, the nurse exclaims to another staff nurse, "Why?
Everything was going well. How could they do this to me?"
What response by the staff nurse reflects an understanding
of the client's borderline disorder? A. "I know what you
,mean.You put a lot of energy into working with our client. It
must be disappointing to have the client do something like
this."
B. "I could have told you this would happen. A client like this
one always gets you in the end."
C. "Clients with borderline disorder act out to relieve anxiety,
and something must have provoked a great deal of anxiety."
D. "I know what you mean. I hope this will teach you not to get
so involved with a client's welfare.": C. "Clients with borderline
disorder act out to relieve anxiety, and something must have
provoked a great deal of anxiety."
3. The nurse is creating a nurse-client contract for a client in
an outpatient cognitive-behavioral therapy (CBT) program.
What are valid examples of in- formation the nurse would
include in the contract? Select all that apply.
A.There will be ten sessions in total taking place at the clinic
on Tuesdays from
2-3 p.m. weekly.
,B. If you are more than 15 minutes late, you will not be able to
join the session that week.
C. No information will be shared outside the treatment team
without your permission.
D. Weekly assignments in the CBT workbook will be due at
the beginning of the next session.
E. Parking is available on the west side of the building, and
the bus stop number is 1234.: A. There will be ten sessions in
total taking place at the clinic on Tuesdays from 2-3 p.m. weekly.
B. If you are more than 15 minutes late, you will not be able to join
the session that week.
C. No information will be shared outside the treatment team without
your permission.
, D. Weekly assignments in the CBT workbook will be due at the
beginning of the next session.
4. A client refuses the evening dose of haloperidol and then
becomes extreme- ly agitated in the day room while other
clients are watching television. The client begins cursing and
throwing furniture. The nurse's first action is to:
A. check the client's medical record for an order for an as-
needed dose of medication for agitation.
B. place the client in full leather restraints.
C. call the physician and report the behavior.
D. remove all other clients from the day room.: D. remove all
other clients from the day room.
5. A client with long-term body-focused repetitive behaviors
including tri- chotillomania (hair pulling) finds support
through an online website.The client begins to attend local
meetings and realizes that a nurse from the clinic also
1. A client with a psychiatric disorder was voluntarily admitted
and now wishes to be discharged from the hospital, against
medical advice. Which aspect would be most important for
the nurse to determine in this situation?
A. ability to care for self
B. degree of danger to self and others
C. level of psychosis
D. intended compliance with aftercare: B. degree of danger to
self and others
2. The nurse in a psychiatric unit has formed a therapeutic
relationship with a client with a borderline personality
disorder. When the client is readmitted to the unit for a suicide
attempt, the nurse exclaims to another staff nurse, "Why?
Everything was going well. How could they do this to me?"
What response by the staff nurse reflects an understanding
of the client's borderline disorder? A. "I know what you
,mean.You put a lot of energy into working with our client. It
must be disappointing to have the client do something like
this."
B. "I could have told you this would happen. A client like this
one always gets you in the end."
C. "Clients with borderline disorder act out to relieve anxiety,
and something must have provoked a great deal of anxiety."
D. "I know what you mean. I hope this will teach you not to get
so involved with a client's welfare.": C. "Clients with borderline
disorder act out to relieve anxiety, and something must have
provoked a great deal of anxiety."
3. The nurse is creating a nurse-client contract for a client in
an outpatient cognitive-behavioral therapy (CBT) program.
What are valid examples of in- formation the nurse would
include in the contract? Select all that apply.
A.There will be ten sessions in total taking place at the clinic
on Tuesdays from
2-3 p.m. weekly.
,B. If you are more than 15 minutes late, you will not be able to
join the session that week.
C. No information will be shared outside the treatment team
without your permission.
D. Weekly assignments in the CBT workbook will be due at
the beginning of the next session.
E. Parking is available on the west side of the building, and
the bus stop number is 1234.: A. There will be ten sessions in
total taking place at the clinic on Tuesdays from 2-3 p.m. weekly.
B. If you are more than 15 minutes late, you will not be able to join
the session that week.
C. No information will be shared outside the treatment team without
your permission.
, D. Weekly assignments in the CBT workbook will be due at the
beginning of the next session.
4. A client refuses the evening dose of haloperidol and then
becomes extreme- ly agitated in the day room while other
clients are watching television. The client begins cursing and
throwing furniture. The nurse's first action is to:
A. check the client's medical record for an order for an as-
needed dose of medication for agitation.
B. place the client in full leather restraints.
C. call the physician and report the behavior.
D. remove all other clients from the day room.: D. remove all
other clients from the day room.
5. A client with long-term body-focused repetitive behaviors
including tri- chotillomania (hair pulling) finds support
through an online website.The client begins to attend local
meetings and realizes that a nurse from the clinic also
