1.

A 24-year-old lady presented with sudden onset chest pain like heart attack,
palpitations lasting for about 20 minutes. There has been previous recurrent episode
of same. She says there were 3 similar episodes last month:
a. Acute psychosis
b. Panic attack
c. Post-traumatic stress disorder
d. Mania
Rationale:
Panic disorder is defined by the presence of recurrent and unpredictable panic attacks, which
are distinct episodes of intense fear and discomfort associated with a variety of physical
symptoms like chest pain, fear of impending doom, palpitations, sweating, trembling,
paranesthesias, GI distress etc.

2. Management of violent patient in psychiatry is treated with all EXCEPT:

a. BZD b. CBT
c. ECT d. Haloperidol
Rationale:

Management of violent patient in psychiatry is:

 Physical restraint (only if necessary)
 Give injection of haloperidol (5mg IM/IV) with or without lorazepam (2 m IV).
Repeat every 2 hours if necessary.
 Hospitalization: referral to psychiatric services for further management.
 In acute cases, ECT can also be used.
Please note, CBT is not doe in any of the acute psychiatric illness including depression.

3. Negative symptoms of schizophrenia are all EXCEPT:

a. Overactivity b. Anhedonia
c. Alogia d. Apathy
Rationale:
Negative symptoms of schizophrenia:
 Affect flattening/blunting
 Alogia (poverty of speech/content)
 Avolition/apathy (lack of interest/motivation)
 Anhedonia (a sociality)
 Lack of attention.

4. A patient is brought to your clinic with complaint of unrealistic behavior from

last 5–6 months. Family members mentioned about loss of his wife few years back. They
also mentioned about his talking behavior in absence of everyone and sometimes
muttering to himself loudly inside his room. The most likely diagnosis is
 a. Major depression b. Schizophrenia
c. Conversion disorder d. Delusion
5. A schizophrenia patient refuses to take drugs, because he complains that he is
persistently hearing people talking in spite of taking the medications. Which
drug will be most suitable for his condition?

a. Chlorpromazine b. Clozapine
c. Risperidone d. Fluphenazine
Rationale:
Clozapine is a reserve drug for resistant schizophrenia. It has least extrapyramidal
side effects (ex-tardive dyskinesia). Major side effects of clozapine is agranulocytosis,
sedation, sialorrhea, weight gain.

6. A 13 year young boy is brought by his parents with history of frequent fighting
at school, disciplinary problems, stealing money, assaulting his batch mates and being
weak in studies. What is the most appropriate diagnosis for this child:
a. Attention deficit hyperactivity disorder
b. Conduct disorder
c. Autism
d. Nothing abnormal (teenage phenomenon)

7. What would be the choice of initial treatment when a 65-year-old man with
carotid artery stenosis develops severe depression and hypersomnia:
a. Amitriptyline b. Doxepin
c. Nortriptyline d. Phenelzine
Rationale:
Elderly patients are often sensitive to the hypotensive, sedative and anticholinergic
effects of antidepressants, and this patient is at special risk for hypotension because of his
carotid artery stenosis. Nortryptiline is least likely to cause these side effects.

8. A 40 year man is diagnosed with terminally ill cancer. He is not able to digest the
fact. He previously indulged with his children like playing with his daughter, dropping
her at school, but now he is not pleasurable in such events. He even stopped meeting
friends and has difficulty in sleeping also. What could be the possible diagnosis:
a. Post traumatic stress disorder
b. Adjustment disorder
c. Major depression
d. Sleep disorder

9. All are true about Dementia EXCEPT:

a. Impaired memory
 b. Loss of consciousness
c. Normal wake-sleep cycle
d. Deterioration of personality
Rationale:
Impairments in dementia:
 Abstract thinking
 Memory (recent>remote)
 Intellectual function
 Judgment
 Continence (fecal and urinary)
 Impulse control (catastrophic reaction)
 Personality and personal care

10. Marco approached Nurse Trisha asking for advice on how to deal with his alcohol
addiction. Nurse Trisha should tell the client that the only effective treatment for
alcoholism is:

A. Psychotherapy
B. Alcoholics Anonymous (A.A.)
C. Total abstinence
D. Aversion Therapy

11. Nurse Hazel is caring for a male client who experience false sensory perceptions
with no basis in reality. This perception is known as:

A. Hallucinations
B. Delusions
C. Loose associations
D. Neologisms

Rationale:

Hallucinations are visual, auditory, gustatory, olfactory perceptions that are not based on any
reality.

12. Nurse Monet is caring for a female client who has suicidal tendency. When
accompanying the client to the restroom, Nurse Monet should…
A. Give her privacy
B. Allow her to urinate
C. Open the window and allow her to get some fresh air
D. Observe her

Rationale

It is important to observe the acutely suicidal client. The client should be watched for clues
like discussing suicidal thoughts, talking about death, etc.

13. Nurse Maureen is developing a plan of care for a female client

with anorexia nervosa. Which action should the nurse include in the plan?

A. Provide privacy during meals

B. Set-up a strict eating plan for the client
C. Encourage client to exercise to reduce anxiety
D. Restrict visits with the family

Rationale:

In anorexia nervosa, setting up a fixed eating plan and monitoring the changes in weight are
important,

14. A client is experiencing anxiety attack. The most appropriate nursing intervention
should include:

A. Turning on the television

B. Leaving the client alone
C. Staying with the client and speaking in short sentences
D. Ask the client to play with other clients

Rationale:
The first focus is to stay around the client, keeping calm, focusing on decreasing the stimulus,
speaking in short sentences, and medicate the patient as needed.

15. A female client is admitted with a diagnosis of delusions of GRANDEUR. This

diagnosis reflects a belief that one is:

A. Being Killed
B. Highly famous and important
C. Responsible for evil world
D. Connected to client unrelated to oneself

Rationale:

A delusion of grandeur is a false or unusual belief about one's greatness. A person may
believe, for instance, that they are famous, can end world wars, or that they are immortal. 

16. A male client is diagnosed with schizotypal personality disorder. Which signs would
this client exhibit during social situation?

A. Paranoid thoughts
B. Emotional affect
C. Independence need
D. Aggressive behavior

Rationale:

Excessive social anxiety in such individuals leads to paranoid thoughts.

17. Nurse Claire is caring for a client diagnosed with bulimia. The most appropriate
initial goal for a client diagnosed with bulimia is?
A. Encourage to avoid foods
B. Identify anxiety causing situations
C. Eat only three meals a day
D. Avoid shopping plenty of groceries

Rationale:

In bulimia disorder is a maladaptive coping response to stress and underlying issues. The
client should identify anxiety causing situation that stimulate the bulimic behavior and then
learn new ways of coping with the anxiety.

18. Nurse Tony was caring for a 41-year-old female client. Which behavior by the client
indicates adult cognitive development?

A. Generates new levels of awareness

B. Assumes responsibility for her actions
C. Has maximum ability to solve problems and learn new skills
D. Her perception is based on reality

Rationale:

An adult age 31 to 45 generates new level of awareness.

19. A neuromuscular blocking agent is administered to a client before ECT therapy.

The Nurse should carefully observe the client for…

A. Respiratory difficulties
B. Nausea and vomiting
C. Dizziness
D. Seizures

Rationale:
Succinylcholine produces respiratory depression as it inhibits contractions of respiratory
muscles.

20. A 75-year-old client is admitted to the hospital with the diagnosis of dementia of the
Alzheimer’s type and depression. The symptom that is unrelated to depression would
be?

A. Apathetic response to the environment

B. “I don’t know” answer to questions
C. Shallow of labile effect
D. Neglect of personal hygiene

Rationale:

A prime symptom of depression is that there is very little or no emotional involvement.

Hence, alteration in affect is also minimal.

21. Nurse Trish is working in a mental health facility; the nurse’s priority nursing
intervention for a newly admitted client with bulimia nervosa would be…

A. Teach client to measure I & O

B. Involve client in planning daily meal
C. Observe client during meals
D. Monitor client continuously

Rationale:

Monitoring the client continuously is vital in case of bulimia nervosa because they often hide
food or force vomiting.

22. Nurse Patricia is aware that the major health complication associated with
intractable anorexia nervosa would be…
A. Cardiac dysrhythmias resulting to cardiac arrest
B. Glucose intolerance resulting in protracted hypoglycemia
C. Endocrine imbalance causing cold amenorrhea
D. Decreased metabolism causing cold intolerance

Rationale:

The patients of anorexia nervosa have a severe deficiency of sodium and potassium which are
of prime importance for the normal functioning of heart. Hence, cardiac dysrhythmias are a
major health complication associated with intractable anorexia nervosa.

23. Nurse Anna can minimize agitation in a disturbed client by:

A. Increasing stimulation
B. limiting unnecessary interaction
C. increasing appropriate sensory perception
D. ensuring constant client and staff contact

Rationale:

Once the interaction is limited, it decreases stimulation and agitation of the patient. Hence,
limiting interaction is the appropriate thing to do.

24. A 39-year-old mother with obsessive-compulsive disorder has become immobilized

by her elaborate hand washing and walking rituals. Nurse Trish recognizes that the
basis of O.C. disorder is often:

A. Problems with being too conscientious

B. Problems with anger and remorse
C. Feelings of guilt and inadequacy
D. Feeling of unworthiness and hopelessness

Rationale:
When a person maintains an absolute set pattern of behavior, it is aimed at controlling guilt
and inadequacy in OCD.

25. Mario is complaining to other clients about not being allowed by staff to keep food
in his room. Which of the following interventions would be most appropriate?

A. Allowing a snack to be kept in his room

B. Reprimanding the client
C. Ignoring the client’s behavior
D. Setting limits on the behavior

Rationale:

A consistent approach by the staff to set limits on the client’s manipulative behavior is
necessary to help in controlling the dysfunctional behavior of the client.

26. Conney with borderline personality disorder who is to be discharged soon threatens
to “do something” to herself if discharged. Which of the following actions by the nurse
would be most important?

A. Ask a family member to stay with the client at home temporarily

B. Discuss the meaning of the client’s statement with her
C. Request an immediate extension for the client
D. Ignore the client’s statement because it’s a sign of manipulation

Rationale:

The statement given by the client is suicidal in nature. Hence, it is the duty of the nurse to
assess any suicidal statement and discuss it with the client to determine its meaning.
27. Joey a client with antisocial personality disorder belches loudly. A staff member
asks Joey, “Do you know why people find you repulsive?” this statement most likely
would elicit which of the following client reaction?

A. Defensiveness
B. Embarrassment
C. Shame
D. Remorsefulness

Rationale:

Because of the belittling nature of the questions, the client is likely to feel defensive as it is a
natural tendency to counterattack the threat to self-image.

28. Which of the following approaches would be most appropriate to use with a client
suffering from narcissistic personality disorder when discrepancies exist between what
the client states and what actually exist?

A. Rationalization
B. Supportive confrontation
C. Limit setting
D. Consistency

Rationale:

It is important to use supportive confrontation to point out the discrepancies between what is
stated by the client and what actually is. This is done to increase responsibility for self.

29. Cely is experiencing alcohol withdrawal exhibits tremors, diaphoresis,

and hyperactivity. Blood pressure is 190/87 mmHg and pulse is 92 bpm. Which of the
medications would the nurse expect to administer?

A. Naloxone 
B. Benztropine
C. Lorazepam
D. Haloperidol 

Rationale:

The withdrawal symptoms occur as a result of rebound phenomenon when the sedation of
CNS from alcohol decreases. In such cases, benzodiazepines like lorazepam help.

30. Which of the following foods would the nurse Trish eliminate from the diet of a
client in alcohol withdrawal?

A. Milk
B. Orange Juice
C. Soda
D. Regular Coffee

Rationale:

Caffeine acts as psychomotor stimulant and causes anxiety and agitation. Coffee can lead to
tremors or wakefulness.

31. Which of the following would Nurse Hazel expect to assess for a client who is
exhibiting late signs of heroin withdrawal?

A. Yawning & diaphoresis

B. Restlessness & Irritability
C. Constipation & steatorrhea
D. Vomiting and Diarrhea

Rationale:

Late signs of heroin withdrawal: Vomiting, diarrhea, fever, nausea, abdominal cramps,
muscle spasm
32. To establish an open and trusting relationship with a female client who has been
hospitalized with severe anxiety, the nurse in charge should?

A. Encourage the staff to have frequent interaction with the client

B. Share an activity with the client
C. Give client feedback on behavior
D. Respect client’s need for personal space

Rationale:

Encroaching personal space of a patient increases feeling of threat and increases anxiety.

33. A client taking the monoamine oxidase inhibitor (MAOI) antidepressant

isocarboxazid is instructed by the nurse to avoid which foods and beverages?

A. Aged cheese and red wine

B. Milk and green, leafy vegetables
C. Carbonated beverages and tomato products
D. Lean red meats and fruit juices

Rationale:

Aged cheese and red wines contain the substance tyramine which, when taken with an
MAOI, can precipitate a hypertensive crisis.

34. Prior to administering chlorpromazine to an agitated client, the nurse should:

A. Assess skin color and sclera

B. Assess the radial pulse
C. Take the client’s blood pressure
D. Ask the client to void

Rationale:
Because chlorpromazine can cause a significant hypotensive effect (and possible client
injury), the nurse must assess the client’s blood pressure (lying, sitting, and standing) before
administering this drug.

35. The nurse understands that electroconvulsive therapy is primarily used in

psychiatric care for the treatment of:

A. Anxiety disorders.
B. Depression.
C. Mania.
D. Schizophrenia.

Rationale:

Electroconvulsive therapy (ECT) can provide relief for patients with severe depression who
have not been able to feel better with other treatments. In some severe cases where rapid
response is necessary or medications cannot be used safely, ECT can even be a first-line
intervention.

36. A client taking the MAOI phenelzine 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
B. Diphenhydramine 
C. Furosemide
D. Isosorbide dinitrate

Rationale:

Over-the-counter medications used for allergies and cold symptoms are contraindicated
because they will increase the sympathomimetic effects of MAOIs, possibly causing a
hypertensive crisis.
37. The nurse is administering a psychotropic drug to an elderly client who has a
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.

Rationale:

Urinary retention is a common anticholinergic side effect of psychotic medications, and the
client with benign prostatic hypertrophy would have increased risk for this problem.

38. The nurse correctly teaches a client taking the Benzodiazepine Oxazepam (Serax) to
avoid excessive intake of:

A. Cheese
B. Coffee
C. Sugar
D. Shellfish

Rationale:

Coffee contains caffeine, which has a stimulating effect on the central nervous system that
will counteract the effect of the antianxiety medication oxazepam. 

39. 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.
Rationale:

The primary purpose of Alcoholics Anonymous is to help members achieve and maintain
sobriety.

40. 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 client 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.

Rationale:

A therapeutic community is designed to help individuals assume responsibility for

themselves, to learn how to respect and communicate with others, and to interact in a positive
manner.