Behavioral Evolve Questions PDF

Pass CCRN Evolve Questions - Behavioral-1
1. Which of the following is an important aspect of care after a drug overdose?

a. Informing the patient that suicide is the unforgivable sin
b. A psychiatric consult
c. Restraints
d. Limiting visitors who could bring in drugs
Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Correct answer: b
Rationale: Not to be punitive and judgmental is important. A psychiatric consult would ensure that
the reasons for the overdose have been explored and additional therapy prescribed if necessary.
Test-Taking Strategy: Option a is an example of applying your values to someone else. Restraints
and visitor restriction are not standard therapies for a patient with a drug overdose, but psychiatric
consultation is. Choose option b.
<System> Behavioral/Psychosocial
<Level> Synthesis/Evaluation

2. An appropriate action for a confused patient may include which of the following?
a. Remove the television and radio.
b. Ask the family to bring in family pictures and familiar objects for the room.
c. Use soft restraints to keep the patient in bed.
d. Keep the lights on all the time.

Correct answer: b
Rationale: Asking the family to bring in familiar objects and pictures and encouraging frequent
family visitation and reorientation are helpful with a confused patient.
Test-Taking Strategy: Restraints should be used only to prevent the patient from self-injury, so
eliminate option c. Lights should be kept on through dusk to prevent shadows that may be
misinterpreted by the confused patient, but lights should be turned off at night to maintain
circadian rhythms. Eliminate option d. Removal of the television and radio would not be necessary.
Eliminate option a and choose option b.
<Level> Application/Analysis

3. Which of the following actions would be appropriate to prevent a patient’s feelings of

powerlessness?
a. Tell the patient that you will fill out his or her diet request form.
b. Ask the patient what he or she would like to eat but fill out the diet request according to what
you feel would be best.
c. Ask the patient what he or she would like to eat and complete the diet request form according
to the stated desires.
d. Complete the diet request form without mentioning it to the patient.

Correct answer: c
Rationale: Support the patient’s sense of control by encouraging the patient's involvement in
decision making related to treatment, such as what to eat and when to bathe. If he or she is well
enough to read and write, allow the patient to complete the form.
Test-Taking Strategy: Look for the option that gives the patient the most control. Choose option c.

4. When a patient is asked about how she usually deals with stress, she responds, “I pray a lot.”
What would be the most appropriate response?
a. Obtain a Bible for the patient.
b. Give her times of the services in the chapel.
c. Offer to call her pastor or a representative of pastoral care.
d. Ignore the comment.

Correct answer: c
Rationale: If prayer comforts her, support this healthy coping method. Besides offering to provide
her pastor, priest, rabbi, other religious leader, or the hospital chaplain, you may pray with her if
you are comfortable doing so.
Test-Taking Strategy: Eliminate option d immediately because you would like to support this
coping method. Options a and b may be helpful, but option c is more appropriate.

5. What are the most commonly prescribed anxiolytics used in the critical care setting?
a. Benzodiazepines
b. Opioids
c. Barbiturates
d. Phenothiazines

Correct answer: a
Rationale: Benzodiazepines cause sedation and some degree of amnesia. They are less likely than
the other agents listed to cause significant side effects.
Test-Taking Strategy: Consider your experience. Diazepam (Valium), lorazepam (Ativan), and
alprazolam (Xanax) are the drugs that you see used most often for anxiety. Choose option a.
<Level> Knowledge/Comprehension

6. When is denial after a myocardial infarction most beneficial?

a. During the first 72 hours
b. Immediately after discharge
c. A month after discharge
d. When there are recurrent cardiac symptoms

Correct answer: a
Rationale: Denial during the first 72 hours limits catecholamine release and decreases myocardial
oxygen demand and ectopy potential.
Test-Taking Strategy: Option d is eliminated easily. You would never want the patient to deny the
seriousness of cardiac symptoms. Of the other options, choose denial as beneficial (or at least less
harmful) early after the myocardial infarction. Choose option a.

7. A patient refuses to allow the nurse to give him a sedative. If the nurse threatens to restrain
him to administer the sedative, it constitutes which of the following?
a. Threat
b. Assault
c. Battery
d. Malpractice

Correct answer: b
Rationale: Assault is to threaten a patient with bodily harm.
Test-Taking Strategy: Malpractice is professional negligence that results in injury to the patient.
Eliminate option d. Battery is the unlawful use of force. It is more than a threat. Battery requires
that you actually use force rather than just threaten to use force. Eliminate option c. Assault is a
specific type of threat. Choose option b.

8. The nurse senses that a patient is fearful about having a cardiac catheterization later today.
Which of the following would be the best initial action?
a. Fully explain the procedure.
b. Ask a patient who has had a cardiac catheterization to talk to your patient.
c. Reassure your patient that it is relatively fast and simple.
d. Encourage the patient to express his or her fears.

Correct answer: d
Rationale: Having the patient explore and express fears would help you to plan interventions to
reassure the patient.
Test-Taking Strategy: Fully explaining the procedure actually may increase the patient's fear, so
eliminate option a. Getting another patient to talk to your patient may not be possible and may
increase your patient’s fear, so eliminate option b. Reassurance without discussion would block
communication, so eliminate option c. Choose option d.

9. A patient’s family is very anxious. Which of the following is the most important intervention
in allaying the family's anxiety?
a. Letting family members stay in the room whenever they want
b. Providing fresh coffee and having restrooms and telephone available
c. Keeping them informed regarding changes in the patient’s status
d. Letting them participate in providing care for the patient

Correct answer: c
Rationale: The most important family intervention is to provide current information about their
loved one.
Test-Taking Strategy: Anxiety usually is relieved by information. Choose option c.

10. Monitor alarms, continuous lighting, frequent measurement of vital signs, and nurses talking
may cause which of the following?
a. Sensory deprivation
b. Sensory overload
c. Powerlessness
d. Depression

Correct answer: b
Rationale: These may cause sensory overload, which is an overload of nonmeaningful stimuli.
They also may cause sleep deprivation.
Test-Taking Strategy: Imagine yourself lying in bed experiencing all of this. You probably would
feel overwhelmed and overloaded. Choose option b.

11. When a patient described by family as “generally pleasant and well adjusted” becomes
dependent and demanding when physically ill, it is an example of which of the following?
a. Denial
b. Compensation
c. Repression
d. Regression

Correct answer: d
Rationale: Regression is the defense mechanism in which a patient goes back to an earlier level of
emotional development.
Test-Taking Strategy: Connect the word dependent with regression to childlike behavior. Choose
option d.

12. A patient experiencing alcohol withdrawal syndrome describes the swirls in the wallpaper as
being worms. This is an example of which of the following?
a. Delusion
b. Hallucination
c. Illusion
d. Visual impairment

Correct answer: c
Rationale: An illusion is a misperception or misinterpretation of an actual external stimulus.
Illusions and hallucinations (a perception that has no actual external stimulus) are common during
alcohol withdrawal syndrome.
Test-Taking Strategy: Consider that swirls could be misinterpreted as worms, so there is an actual
external stimulus. Choose option c.

13. Which of the following is caused by the release of epinephrine during a stressful situation?
a. Decrease in oxygen consumption
b. Slowing of the release of glucose into the bloodstream
c. Dilation of blood vessels
d. Increase in blood pressure

Correct answer: d
Rationale: Epinephrine is a neurotransmitter for the sympathetic nervous system. Epinephrine
causes an increase in heart rate, contractility, and conductivity; vasoconstriction;
bronchodilation; pupil dilation; stimulation of glycogenolysis and gluconeogenesis to mobilize
glucose; and redistribution of blood flow from nonessential to essential organs (i.e., heart and
brain).
Test-Taking Strategy: Oxygen consumption increases, glucose is mobilized, and blood vessels
are constricted.

14. Which of the following would not occur during a stressful situation?
a. Hypersalivation
b. Hyperventilation
c. Increased muscle tension
d. Palpitations

Correct answer: a
Rationale: Oral and gastrointestinal secretions are reduced with sympathetic nervous system
stimulation.
Test-Taking Strategy: Remember that atropine is an anticholinergic agent, so it blocks the
parasympathetic nervous system. A drug that blocks the parasympathetic nervous system
produces the same or similar effects as a drug that stimulates the sympathetic nervous system, so
that would be dry mouth.

15. A patient arrives in the emergency department at 10:30 AM with severe chest pain. He has ST
segment elevation in leads V3 to V6. He has been given morphine for pain and is being evaluated
for fibrinolytic therapy. The family arrives in the waiting room. Which type of crisis is the family
experiencing?
a. Maturational
b. Situational
c. Adventitious
d. This is not a crisis.

Correct answer: b
Rationale: Situational crises follow an external event or experience and the associated losses and
changes. A life-threatening illness in a loved one is a situational crisis.
Test-Taking Strategy: Maturational crises arise as a result of growth and development and involve
changes in self-concept and roles. Adventitious crises follow accidental or uncommon events
leading to major environmental changes, such as natural disasters.

16. The patient had a cardiac arrest last night and was resuscitated successfully. The night nurse
reports that he has been unwilling to communicate and looked away when she is in the room. He
now states, “I was in a bright tunnel last night.” Which would be the best response?
a. Ignore the comment because it was probably lack of oxygen.
b. Review his medication record for the last 24 hours.
c. Discuss a psychiatric consult with the attending physician.
d. Encourage him to talk about the experience.

Correct answer: d
Rationale: Patients need to talk about a near-death experience. Listen nonjudgmentally. Patients
often are afraid that you will think that they are confused or mentally ill.
Test-Taking Strategy: None
<Level> Synthesis/Evaluation

17. An 81-year-old woman has been in the critical care unit for 6 days. She has become
increasingly confused over the last 24 hours. Which of the following would be an appropriate
intervention?
a. Arrange for periods of uninterrupted sleep.
b. Arrange for a psychiatric consult.
c. Request a prescription for sedation.
d. Request that she be transferred out of the critical care unit.

Correct answer: a
Rationale: The most likely cause of the confusion is sleep deprivation, and the most appropriate
intervention is to ensure that she gets uninterrupted sleep.

18. Joking and frequently changing the topic are characteristic of which level of anxiety?
a. Mild
b. Moderate
c. Severe
d. Panic

Correct answer: b
Rationale: Mild anxiety is characterized by a heightened awareness and increased problem-solving
abilities. Moderate anxiety is characterized by an increase in heart rate and respiratory rate, dry
mouth, palpitations, rapid speech, frequent changes of topic, inappropriate humor, and jittering.
Severe anxiety is characterized by distorted perception, hyperventilation, tachycardia, urinary
frequency, tremors, and pupil dilation. Panic is characterized by fear of dying, dyspnea, chest pain,
vomiting, inability to speak, and distorted perception of the situation.
Test-Taking Strategy: Consider some behaviors that you have seen during a resuscitation.
Though inappropriate, joking and laughing are commonly used in this situation to relieve the
stress felt. You could probably consider the anxiety that you feel during a resuscitation as more
than mild and less than severe (unless it were your first resuscitation perhaps).

19. A patient has been told that he has terminal cancer, but he continues to talk confidently of
recovery. Which defense mechanism does this behavior demonstrate?
a. Sublimation
b. Projection
c. Substitution
d. Denial

Correct answer: d
Rationale: Denial is the inability to face reality. Denial often follows the shock and disbelief stage
in the death and dying process.
Test-Taking Strategy: His response is inconsistent with the facts which describes denial.

20. A patient has been told that he has terminal cancer, but he continues to talk confidently of
recovery. Which of the following would not be appropriate for this patient?
a. Encouraging expression of fears and concerns
b. Confrontation regarding his prognosis
c. Provision of adequate analgesia
d. Allowing open visiting hours for family members

Correct answer: b
Rationale: Confronting the patient about his prognosis is not appropriate. Do not support his
denial, but do not remove hope.
Test-Taking Strategy: Hope has an important therapeutic effect, and option b would cause
elimination of that important therapeutic effect and likely cause an adversarial interaction.

21. A 65-year-old man is scheduled for surgery and is very anxious. He tells the nurse that he
believes that he will die if he goes to surgery. Which of the following is the most appropriate
immediate action?
a. Reassure him but notify the surgeon.
b. Ask if he would like to see his family.
c. Tell him that everyone feels that way about surgery.
d. Ask a member of pastoral service to visit him.

Correct answer: a
Rationale: Anxiety is expected when a patient is going to surgery, but a feeling of impending
doom and death is not expected. Listen to the patient, reassure him of the safety of surgery, but also
discuss the patient’s comment with the surgeon and the anesthesiologist. They may opt to cancel
surgery until the patient is more confident of the outcome. Although options b and d may be
appropriate, they can follow the reassurance and notification of the surgeon. Option c demeans the
patient’s concerns.

22. Which of the following often is reported after a near-death experience?

a. Intolerance to the inadequacy of others
b. Loss of religious beliefs
c. Loss of the fear of death
d. Desire for death

Correct answer: c
Rationale: Many patients report the loss of the fear of death after a near-death experience. They
also may report an increase in tolerance of others and an increase in religious beliefs.

23. Which of the following interventions would not be helpful for a patient who is experiencing
sensory overload?
a. Limiting family visitation
b. Darkening the room at bedtime
c. Decreasing the volume on the cardiac monitor
d. Avoiding unnecessary conversation

Correct answer: a
Rationale: Sensory overload is an overload of nonmeaningful stimuli. Darkening the room,
especially at bedtime, decreasing the volume of noises, including the beeping of the cardiac
monitor, and avoiding unnecessary conversation such as chitchat are helpful. Family visitation
should not be limited because it is a meaningful stimulus.
Test-Taking Strategy: Remember that it is possible to have sensory overload and sensory
deprivation simultaneously.

24. A 27-year-old woman is brought to the emergency department after taking 28 oxycodone
(Percodan) and 40 diazepam (Valium). She is unable to report the dosage of the drugs and is
lethargic. She says that she just wants to die. The friend that brought her in says that her husband
has been seeing someone else and has asked her for a divorce. When assessing the seriousness of
the suicide attempt, which of these factors would be the most important?
a. Age
b. Number of children
c. Social support system
d. Lethality of the method

Correct answer: d
Rationale: In this case, there was a lethal attempt. If someone had not brought her to the
emergency department promptly, these drugs certainly would have caused respiratory cessation
and death.
Test-Taking Strategy: Note that the only option that has a physiologic effect is option d.

25. After the death of his mother in the critical care unit, a 25-year-old man locks himself in the
bathroom and sobs. Which of the following is the most appropriate action?
a. Try talking to him through the door, reassuring him that his mother did not suffer.
b. Leave him alone.
c. Send for security to open the door.
d. Stay close by and occasionally let him know you are available.

Correct answer: d
Rationale: He is not sure how to handle the situation and has isolated himself to try to sort things
out. Be supportive but do not push yourself on him.

26. A patient has just returned from the cardiac catheterization laboratory. She had an
angioplasty for occlusion of her right coronary artery. She still has femoral artery and vein
sheaths in place. The patient begins to cry and tells the nurse, “I don’t know what’s the matter; it
all seems so bad.” Which of the following is most appropriate at this time?
a. Reassure her by telling her that she will be fine.
b. Change the subject.
c. Tell her that the physician will be there soon to talk to her.
d. Let her know that her feelings are normal.

Correct answer: d
Rationale: These feelings of fear are normal. Blanket reassurance is not appropriate, and
avoiding the issue by changing the subject or turning it over to the physician is not appropriate.
Spend some time with the patient and allow her to express her fears.

27. Asking a severely depressed person about his suicidal thoughts and feelings would do which
of the following?
a. Ascertain whether the person has a specific plan for suicide
b. Identify patients who have thought of suicide so they may be put on suicide watch
c. Worsen the degree of depression
d. Plant the idea of suicide

Correct answer: a
Rationale: Merely thinking of suicide does not mean that it has been seriously considered. A
specific lethal plan indicates a serious threat of suicide. Asking about suicide does not plant the
idea. The significantly depressed patient probably already has considered suicide.

28. A family is distressed over a loved one’s critical condition after being in a motor vehicle
collision. Which of the following interventions would be least helpful?
a. Assist family members in organizing the next few hours and days.
b. Facilitate the family’s efforts to find others for support.
c. Help family members identify coping strategies used successfully in the past.
d. Reassure them that everything will work out the way it is supposed to.

Correct answer: d
Rationale: Option d is an example of false reassurance; plus you would have no idea of how
things are “supposed” to work out for this patient and family.
Test-Taking Strategy: All the options except d are active interventions helping the family do
something concrete. Option d does not help the family actually accomplish anything; it is a
nontherapeutic platitude.

29. Which of the following statements about anxiety is correct?

a. Anxiety frequently escalates to panic.
b. Anxiety and fear are synonymous.
<option c>The patient often does not know the cause of the anxiety.
<option d>There are no effective ways to deal with anxiety.

Correct answer: c
Rationale: Anxiety is a vague uneasiness accompanied by tension and helplessness and often the
patient cannot pinpoint a cause. A specific cause can usually be identified for fear. An anxiety
disorder is when anxiety has been present for at least 6 months; there are both short-term and
long-term methods of treatment.

30. A patient has disorganized thoughts, auditory hallucinations, and insists on being addressed
as “Mr. President.” Which of the following is the patient’s most likely diagnosis?
a. A psychotic episode
b. Depression
c. Mania
d. Anxiety

Correct answer: a
Rationale: Bizarre behavior, disorganized thoughts, and the presence of delusions are classic
signs of psychosis. The person with mania does not have hallucinations, which distinguishes it
from psychosis.

31. A patient has a history of mania and is on anticonvulsant medication. How do these drugs
help with this disorder?
a. Cause slight sedation
b. Prevent seizures
c. Reduce neuropathic pain
d. Regulate mood

Correct answer: d
Rationale: Anticonvulsants are used to improve mood stability in patients with mania or bipolar
disorder.
Test-Taking Strategy: Eliminate option b because the patient does not have seizures. Eliminate
option c because the patient does not have pain. Choose option d because it is most closely
related to the question; mania is a mood disturbance.

32. Which of the following describes the most effective communication technique for a patient
with psychosis?
a. Ask only “yes” or “no” questions.
b. Avoid asking opinion questions.
c. Be direct and forthright.
d. Keep sentences short and simple.

Correct answer: d
Rationale: The patient with psychosis will have aberrant speech patterns and grossly
disorganized behavior and will not be able to track long and complex sentences.
Test-Taking Strategy: Think of the person “out of touch with reality” and how best to
communicate; short simple sentences are more likely to be comprehended than long complex
ones.

33. A patient is having auditory hallucinations. The nurse should respond to these hallucinations
by:
a. acknowledging that the patient may hear something but the nurse does not.
b. allowing the patient to believe in the hallucinations to keep him or her calm.
c. informing the patient that the nurse also hears the same things.
d. telling the patient that he or she cannot possibly be hearing the sounds.

Correct answer: a
Rationale: It is important to acknowledge the patient’s reality while reinforcing orientation to
person, place, time, and events.
Test-Taking Strategy: The only option listed that respects the patient’s experiences while trying
to give the patient a sense of reality is option a.

34. A patient has been admitted for a third suicide attempt. Which of the following is not a
priority for assessment?
a. Co-conspirators
b. Injury
c. Intent
d. Lethality

Correct answer: a
Rationale: The major items to assess about suicide attempts are injury, intent, and lethality.
Patients rarely have co-conspirators for suicide unless it is assisted suicide for terminal illness.
Test-Taking Strategy: Focus on the patient; options b, c, and d are related to the patient whereas
option a is not related specifically to this patient.

35. Which of the following is a disorder that causes repeated anxiety-producing thoughts and
memories related to previous experiences?
a. Common panic disorder
b. Generalized anxiety disorder
c. Obsessive-compulsive disorder
d. Posttraumatic stress disorder

Correct answer: d
Rationale: Posttraumatic stress disorder (PTSD) arises from traumatic events and produces
anxiety due to repeated stressful memories and intrusive thoughts about the experience.
Test-Taking Strategy: Relate words in the stem and the options (“previous” and “post”) to help
you choose the right answer.

36. A patient with a history of bipolar disorder is prescribed metoprolol (Lopressor). Which of
the following is the rationale for the use of this drug in this patient?
a. Augment antipsychotic medications
b. Block catecholamine effects
c. Reduce stress on the heart
d. Sedate the patient

Correct answer: b
Rationale: Beta-blockers inhibit the stimulation of the beta receptors; specifically metoprolol
inhibits beta1 stimulation, which will lower the patient’s heart rate.
Test-Taking Strategy: Consider other uses for this drug. It is also used after a myocardial
infarction to decrease the effects of catecholamines on the myocardium and decrease the oxygen
requirements of the myocardium.

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Pass CCRN Evolve Questions - Behavioral-1

1. Which of the following is an important aspect of care after a drug overdose?

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

3. Which of the following actions would be appropriate to prevent a patient’s feelings of

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

Copyright © 2014 by Mosby, an imprint of Elsevier, Inc. All rights reserved.

6. When is denial after a myocardial infarction most beneficial?

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22. Which of the following often is reported after a near-death experience?

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29. Which of the following statements about anxiety is correct?

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