Psychiatric Nursing Exam He is actively hallucinating, agitated, with irritated nasal

1. Situation: The nurse assigned in the detoxification septum.

unit attends to various patients with substance-related
a) Heroin
disorders. A 45 years old male revealed that he
b) cocaine
experienced a marked increase in his intake of alcohol
c) LSD
to achieve the desired effect This indicates:
d) Marijuana
a) withdrawal
The manifestations indicate intoxication with cocaine, a CNS
b) tolerance
stimulant.
c) intoxication
d) psychological dependence A. Intoxication with heroine is manifested by euphoria then
impairment in judgment, attention and the presence of
tolerance refers to the increase in the amount of the papillary constriction.
substance to achieve the same effects.
C. Intoxication with hallucinogen like LSD is manifested by
A. Withdrawal refers to the physical signs and symptoms that grandiosity, hallucinations, synesthesia and increase in vital
occur when the addictive substance is reduced or withheld. signs
B. Intoxication refers to the behavioral changes that occur D. Intoxication with Marijuana, a cannabinoid is manifested
upon recent ingestion of a substance. by sensation of slowed time, conjunctival redness, social
D. Psychological dependence refers to the intake of the withdrawal, impaired judgment and hallucinations
substance to prevent the onset of withdrawal symptoms. 5. A client is admitted with needle tracts on his arm,
2. The client admitted for alcohol detoxification stuporous and with pin point pupil will likely be
develops increased tremors, irritability, hypertension managed with:
and fever. The nurse should be alert for impending: a) Naltrexone (Revia)
a) delirium tremens b) Narcan (Naloxone)
b) Korsakoff’s syndrome c) Disulfiram (Antabuse)
c) esophageal varices d) Methadone (Dolophine)
d) Wernicke’s syndrome Narcan is a narcotic antagonist used to manage the CNS
Delirium Tremens is the most extreme central nervous system depression due to overdose with heroin.
irritability due to withdrawal from alcohol A. This is an opiate receptor blocker used to relieve the
B. This refers to an amnestic syndrome associated with craving for heroine
chronic alcoholism due to a deficiency in Vit. B C. Disulfiram is used as a deterrent in the use of alcohol.
C. This is a complication of liver cirrhosis which may be D. Methadone is used as a substitute in the withdrawal from
secondary to alcoholism. heroine
D. This is a complication of alcoholism characterized by 6. Situation: An old woman was brought for evaluation
irregularities of eye movements and lack of coordination.
due to the hospital for evaluation due to increasing
3. The care for the client places priority to which of the forgetfulness and limitations in daily function. The
following: daughter revealed that the client used her toothbrush
to comb her hair. She is manifesting:
a) Monitoring his vital signs every hour
b) Providing a quiet, dim room a) apraxia
c) Encouraging adequate fluids and nutritious b) aphasia
foods c) agnosia
d) Administering Librium as ordered d) amnesia

Pulse and blood pressure are usually elevated during This is the inability to recognize objects.
withdrawal, Elevation may indicate impending delirium
A. Apraxia is the inability to execute motor activities despite
tremens
intact comprehension.
B. Client needs quiet, well lighted, consistent and secure
B. Aphasia is the loss of ability to use or understand words.
environment. Excessive stimulation can aggravate anxiety
and cause illusions and hallucinations. D. Amnesia is loss of memory.

C. Adequate nutrition with supplement of Vit. B should be 7. She tearfully tells the nurse “I can’t take it when she
ensured. accuses me of stealing her things.” Which response by
D. Sedatives are used to relieve anxiety. the nurse will be most therapeutic?

4. Another client is brought to the emergency room by

friends who state that he took something an hour ago.
 a) ” Don’t take it personally. Your mother does not
mean it.”
b) “Have you tried discussing this with your
mother?”
c) “This must be difficult for you and your
mother.”
d) “Next time ask your mother where her things
were last seen.”
This reflecting the feeling of the daughter that shows
empathy.
A and D. Giving advise does not encourage verbalization.
B. This response does not encourage verbalization of feelings.
8. The primary nursing intervention in working with a
client with moderate stage dementia is ensuring that
the client:
a) receives adequate nutrition and hydration
b) will reminisce to decrease isolation
c) remains in a safe and secure environment
d) independently performs self-care
9. She says to the nurse who offers her breakfast, “Oh
no, I will wait for my husband. We will eat together”
The therapeutic response by the nurse is:
a) “Your husband is dead. Let me serve you your
breakfast.”
b) “I’ve told you several times that he is dead. It’s
time to eat.”
c) “You’re going to have to wait a long time.”
d) “What made you say that your husband is alive?
The client should be reoriented to reality and be focused on
the here and now.
B. This is not a helpful approach because of the short-term
memory of the client.
C. This indicates a pompous response. D. The cognitive
limitation of the client makes the client incapable of giving
explanation.
10. Dementia unlike delirium is characterized by:
a) slurred speech
b) insidious onset
c) clouding of consciousness
d) sensory perceptual change
Dementia has a gradual onset and progressive deterioration.
It causes pronounced memory and cognitive disturbances.
A, C and D are all characteristics of delirium.
11. Situation: A 17-year-old gymnast is admitted to the
hospital due to weight loss and dehydration secondary
to starvation. Which of the following nursing diagnoses
will be given priority for the client?
a) altered self-image
b) fluid volume deficit
c) altered nutrition less than body requirements
d) altered family process
Fluid volume deficit is the priority over altered nutrition since
the situation indicates that the client is dehydrated.
A and D are psychosocial needs of a client with anorexia
nervosa but they are not the priority.
12. What is the best intervention to teach the client
when she feels the need to starve?
a) Allow her to starve to relieve her anxiety
b) Do a short-term exercise until the urge passes
c) Approach the nurse and talk out her feelings
d) Call her mother on the phone and tell her how
she feels
The client with anorexia nervosa uses starvation as a way of
managing anxiety. Talking out feelings with the nurse is an
adaptive coping.
A. Starvation should not be encouraged. Physical safety is a
priority. Without adequate nutrition, a life threatening
situation exists.
B. The client with anorexia nervosa is preoccupied with losing
weight due to disturbed body image. Limits should be set on
attempts to lose more weight.
D. The client may have a domineering mother which causes
the client to feel ambivalent. The client will not discuss her
feelings with her mother.
13. The client with anorexia nervosa is improving if:
a) She eats meals in the dining room.
b) Weight gain
c) She attends ward activities.
d) She has a more realistic self-concept.
Weight gain is the best indication of the client’s improvement.
The goal is for the client to gain 1-2 pounds per week.
(A)The client may purge after eating.
(C) Attending an activity does not indicate improvement in
nutritional state.
(D) Body image is a factor in anorexia nervosa but it is not an
indicator for improvement.
14. The characteristic manifestation that will
differentiate bulimia nervosa from anorexia nervosa is
that bulimic individuals
a) have episodic binge eating and purging
b) have repeated attempts to stabilize their weight
c) have peculiar food handling patterns
d) have threatened self-esteem
Bulimia is characterized by binge eating which is
characterized by taking in a large amount of food over a short
period of time.
B and C are characteristics of a client with anorexia nervosa
D. Low esteem is noted in both eating disorders
15. A nursing diagnosis for bulimia nervosa is
powerlessness related to feeling not in control of eating
habits. The goal for this problem is:
a) Patient will learn problem solving skills
 b) Patient will have decreased symptoms of
anxiety.
c) Patient will perform self-care activities daily.
d) Patient will verbalize how to set limits on
others.
If the client learns problem solving skills, she will gain a sense
of control over her life.
(B) Anxiety is caused by powerlessness.
(C) Performing self-care activities will not decrease one’s
powerlessness
(D) Setting limits to control imposed by others is a necessary
skill but problem-solving skill is the priority.
16. In the management of bulimic patients, the
following nursing interventions will promote a
therapeutic relationship EXCEPT:
a) Establish an atmosphere of trust
b) Discuss their eating behavior.
c) Help patients identify feelings associated with
binge-purge behavior
d) Teach patient about bulimia nervosa
The client is often ashamed of her eating behavior. Discussion
should focus on feelings.
A, C and D promote a therapeutic relationship
17. Situation: A 35-year-old male has intense fear of
riding an elevator. He claims “As if I will die inside.” This
has affected his studies. The client is suffering from:
a) agoraphobia
b) social phobia
c) Claustrophobia
d) Xenophobia
Claustrophobia is fear of closed space.
A. Agoraphobia is fear of open space or being a situation
where escape is difficult.
B. Social phobia is fear of performing in the presence of
others in a way that will be humiliating or embarrassing.
D. Xenophobia is fear of strangers.
18. Initial intervention for the client should be to:
a) Encourage to verbalize his fears as much as he
wants.
b) Assist him to find meaning to his feelings in
relation to his past.
c) Establish trust through a consistent approach.
d) Accept her fears without criticizing.
The client cannot control her fears although the client knows
it’s silly and can joke about it.
A. Allow expression of the client’s fears but he should focus on
other productive activities as well.
B and C. These are not the initial interventions.
19. The nurse develops a countertransference reaction.
This is evidenced by:
a) Revealing personal information to the client
b) Focusing on the feelings of the client.
c) Confronting the client about discrepancies in
verbal or non-verbal behavior
d) The client feels angry towards the nurse who
resembles his mother.
A. Countertransference is an emotional reaction of the nurse
on the client based on her unconscious needs and conflicts.
B and C. These are therapeutic approaches.
D. This is transference reaction where a client has an
emotional reaction towards the nurse based on her past.
20. Which is the desired outcome in conducting
desensitization:
a) The client verbalizes his fears about the
situation
b) The client will voluntarily attend group therapy
in the social hall.
c) The client will socialize with others willingly
d) The client will be able to overcome his disabling
fear.
The client will overcome his disabling fear by gradual
exposure to the feared object.
A, B and C are not the desired outcome of desensitization.
21. Which of the following should be included in the
health teachings among clients receiving Valium:
a) Avoid taking CNS depressant like alcohol.
b) There are no restrictions in activities.
c) Limit fluid intake.
d) Any beverage like coffee may be taken
Valium is a CNS depressant. Taking it with other CNS
depressants like alcohol; potentiates its effect.
B. The client should be taught to avoid activities that require
alertness.
C. Valium causes dry mouth so the client must increase her
fluid intake.
D. Stimulants must not be taken by the client because it can
decrease the effect of Valium.
22. Situation: A 20-year-old college student is admitted
to the medical ward because of sudden onset of
paralysis of both legs. Extensive examination revealed
no physical basis for the complaint. The nurse plans
intervention based on which correct statement about
conversion disorder?
a) The symptoms are conscious effort to control
anxiety
b) The client will experience high level of anxiety in
response to the paralysis.
c) The conversion symptom has symbolic meaning
to the client
d) A confrontational approach will be beneficial for
the client.
The client uses body symptoms to relieve anxiety.
A. The condition occurs unconsciously.
B. The client is not distressed by the lost or altered body
function.
D. The client should not be confronted by the underlying
cause of his condition because this can aggravate the client’s
anxiety.
23. Nina reveals that the boyfriend has been pressuring
her to engage in premarital sex. The most therapeutic
response by the nurse is:
a) “I can refer you to a spiritual counselor if you
like.”
b) “You shouldn’t allow anyone to pressure you
into sex.”
c) “It sounds like this problem is related to your
paralysis.”
d) “How do you feel about being pressured into
sex by your boyfriend?”
Focusing on expression of feelings is therapeutic. The central
force of the client’s condition is anxiety.
A. This is not therapeutic because the nurse passes the
responsibility to the counselor.
B. Giving advice is not therapeutic.
C. This is not therapeutic because it confronts the underlying
cause.
24. Malingering is different from somatoform disorder
because the former:
a) Has evidence of an organic basis.
b) It is a deliberate effort to handle upsetting
events
c) Gratification from the environment are
obtained.
d) Stress is expressed through physical symptoms.
Malingering is a conscious simulation of an illness while
somatoform disorder occurs unconscious.
A. Both disorders do not have an organic or structural basis.
C. Both have primary gains.
D. This is a characteristic of somatoform disorder.
25. Unlike psychophysiologic disorder Linda may be best
managed with:
a) medical regimen
b) milieu therapy
c) stress management techniques
d) psychotherapy
Stress management techniques is the best management of
somatoform disorder because the disorder is related to stress
and it does not have a medical basis.
A.This disorder is not supported by organic pathology so no
medical regimen is required.
B and D. Milieu therapy and psychotherapy may be used a
therapeutic modalities but these are not the best.
Psychiatric Nursing Exam
1. A client expresses to the nurse that she constantly
feels irritated and loses her temper. During the course
of the interview, the nurse finds that the client takes
care of her mother who was confined to bed following a
stroke. The client struggles to balance caring for her
family and her mother. Which nursing diagnosis would
the nurse most likely identify for this client?
a) Compromised family adjustment
b) Caregiver role strain
c) Ineffective coping
d) Anxiety
2. A middle-aged woman's father has passed away, and
her mother requires physical and emotional help due to
disabilities. The woman is married and raising two
children, along with working full time. All of the factors
described are
a) Stressors
b) Demands
c) Illnesses
d) Stimuli
3. An adolescent entering high school voices anxiety
over changing schools. Stating anxiety is an act of
a) Valuation
b) Adaptation
c) Evaluation
d) Reaction
4. You are the nurse caring for a 72-year-old female
who is recovering from abdominal surgery on the
Medical Surgical unit. The surgery was very stressful and
prolonged and you note on the chart that her blood
sugars are elevated yet she in not been diagnosed with
diabetes. To what do you attribute this elevation in
blood sugars?
a) It is a result of antidiuretic hormone.
b) She must have had diabetes prior to surgery.
c) She has become a diabetic from the abdominal
surgery.
d) The blood sugars are probably a result of the
"fight-or-flight" reaction.
5. You walk into your patients' room and find her
sobbing uncontrollably. When you ask what the
problem is your patient responds "I am so scared. I have
never known anyone who goes into a hospital and
comes out alive." On this patient's care plan, you note a
nursing diagnosis of "Ineffective coping related to
stress". What is the best outcome you can expect for
this patient?
a) Patient will avoid stressful situations.
b) Patient will start anti-anxiety agent.
c) Patient will adapt relaxation techniques to
reduce stress.
d) Patient will be stress free.
6. The nurse would recognize that short-term things by using a stuffed animal to act as a trusted
pharmacological treatment may be appropriate if an friend. Which technique does this action best describe?
anxious patient's nursing diagnoses includes which of
a) Ventriloquism
the following?
b) Humor
a) Social isolation c) Storytelling
b) Decisional conflict d) Third-party communication
c) Disturbed sleep pattern
12. A nurse is working in a therapeutic counseling
d) Defensive coping
relationship with a client who has a mental illness.
7. A nurse is caring for a client who has been sexually When discussing the terms of the relationship, at which
abused. Which of the following interventions should the point is it appropriate to bring up the termination of the
nurse implement to establish rapport and to relationship?
demonstrate safety?
a) Just before terminating the relationship
a) Respond to shocking information by ignoring or b) At the beginning of the therapeutic counseling
disregarding the account relationship
b) Delay treatment until the client can talk about c) After the client has discussed essential elements
the situation of the work
c) Let the client spend time alone in a quiet area d) During the evaluation phase of the nursing care
d) Assess the client's stress level before plan
performing procedures
13. The nurse is caring for a client who is a doctor in a
8. A 30-year-old client with anxiety and depression is general hospital. He complains about the stressful
undergoing therapeutic counseling with a nurse. The condition of his job. Lately, he has become increasingly
client shares a lot of information with the nurse about susceptible to colds, headaches, muscular tension,
his personal life. Which of the following actions by the excessive tiredness, and many other symptoms. At what
nurse demonstrates healthy and appropriate boundary stage of stress is the client?
setting?
a) Secondary stage
a) The nurse sets a time limit of 45 minutes for a b) Exhaustion stage
discussion with the client c) Alarm stage
b) The nurse arranges to meet the client at a d) Resistance stage
coffee shop to finish the conversation when
14. A nurse has given her client a nursing diagnosis of
time is up
Anxiety because of her behavior when she found out
c) The nurse tells the client about her own feelings
that she was pregnant. Which of the following
of depression
interventions would be most appropriate for this type
d) The female nurse agrees to keep a client's
of nursing diagnosis? Select all that apply.
secret about his attraction to her
a) Assist with admitting the client to the
9. Which of the following actions become barriers to the
psychiatric unit
nurse-client communication? Select all that apply.
b) Encourage the client to talk
a) Asking the client, "Why?" c) Maintain a calm demeanor
b) Using open-ended questions d) Reassure the client that she is safe
c) Providing false reassurance e) Assist the client with identifying coping
d) Active listening mechanisms
e) Giving approval
15. A 51-year-old client is getting ready to undergo a
10. You are beginning a therapeutic relationship with a cardiac catheterization and is very anxious about the
client who has been admitted to the correctional facility procedure. Which intervention can the nurse provide
that you work at. She is a Type I diabetic who will be that will most likely help this client to remain calm?
incarcerated for approximately 4 months. When will
a) Tell the client that he will receive sedative
you begin to plan for the termination phase of this
medications so he will not be alert during the
relationship?
procedure
a) During the introductory phase b) Have the client's family sit next to him during
b) In 3 months the procedure
c) 2 weeks prior to release c) Explain what the client will see, hear, feel and
d) During the working phase experience during the procedure in terms that
he can understand
11. While caring for a child who has come from an
abusive home, a nurse tries to get the child to discuss
 d) Give the client literature about the procedure
ahead of time so that he can read about the
process
16. A nurse is caring for a 20-year-old client with
testicular cancer. The client has expressed feelings of
anxiety related to his diagnosis and appears restless and
agitated every time the nurse tries to talk with him.
Which intervention would be the most appropriate for
the nurse to help this client with anxiety?
a) Offer information about support groups
b) Explain that the client most likely needs
antidepressants to get him through this time
c) Offer to have the provider talk with the client
about his diagnosis
d) Tell the client that he will feel better if he talks
about it
17. A nurse is working with a client to use biofeedback
as a method of controlling anxiety. Which of the
following outcomes would most likely result from
correct use of this mechanism?
a) The client being able to recognize that he
suffers from anxiety
b) A resolution of the client's anxiety symptoms
c) An ability to recognize and control the body's
stress response
d) A form of sedation that is calming when an
anxiety attack occurs
18. The nurse is preparing a presentation on stress and
anxiety. Which of the following is included as part of
this presentation? Select all that apply.
a) Severe anxiety does not lead to psychosis
b) Severe anxiety can lead to suicidal thoughts
c) Prolonged anxiety can cause illness
d) Stress can cause anxiety
e) Anxiety can be motivating and increase learning
19. A client who has been diagnosed with anxiety tells
the nurse that his thoughts contribute to his problems.
Which information can the nurse give the client that is
true about automatic negative thoughts?
a) When you continue to struggle with anxiety,
you are not putting enough effort into changing
b) How you think about the world determines how
you feel and behave
c) Everything happens for a reason, and good will
come out of the experience
d) Persons with anxiety must accept that things
are the way they are
20. A client is suffering from stress and anxiety and is
being seen at a healthcare clinic for help and
management. Which best describes the initial physical
effects of stress and anxiety in the body? Select all that
apply.
a) Increased heart rate
b) Pinpoint pupils
c) Changes in appetite
d) Increased respiratory rate
e) Vasodilation
21. A client who is being prepared for surgery is
experiencing severe anxiety about the procedure.
Which of the following interventions could the nurse
employ to decrease this client's anxiety levels? Select all
that apply.
a) Administer sedative medications to help the
client sleep
b) Provide reassurance by answering the client's
questions
c) Ask the client to help with certain tasks, such as
starting an IV
d) Employ music therapy or aromatherapy if
available
e) Encourage the client's own coping mechanisms
22. An emergency department nurse is working with a
client who sought care for a sudden panic attack. The
client tells the nurse that she feels like she is dying and
is sweating and shaking. Which statement by the nurse
is best?
a) You are not in a medical emergency, but you
are having an abnormal fight-or-flight response
b) I have panic attacks too, and they are terrible
c) It is time to calm down now because you are
finally in the hospital
d) This is nothing serious and is related to stress
23. A client is scheduled for surgery and admits that he
has never been so anxious in his life. Which of the
following symptoms are common for a client in this
situation? Select all that apply.
a) Nausea
b) Headache
c) Blurry vision
d) Chest pain
e) Tachycardia
24. A nurse is caring for a client who is hospitalized in a
very busy unit. The client complains to the nurse that it
is too noisy to sleep and that he is not getting rest.
Which of the following nursing interventions is most
appropriate to better help this client sleep?
a) Help the client to choose foods on the menu
that promote sleep, such as broccoli
b) Encourage the client to verbalize his sleep
difficulties
c) Evaluate for the appropriate timing of client
care tasks
d) Provide instructions to the client about the
importance of going to bed and getting up at
the same time every day
25. A client with anxiety disorder is in a state of panic c) Help the client to learn about other
after becoming injured while outside. The nurse caring complementary or alternative treatments
for this client would most likely observe which available
behaviors? Select all that apply. d) Plan for a home health nurse to visit the client
daily to watch the client perform the relaxation
a) The client is moody
techniques
b) The client is disorganized
c) The client has a loss of rational thought 30. The nurse is caring for a client with generalized
d) The client demonstrates fear anxiety disorder requiring treatment. Which of the
e) The client needs direction to focus following treatments does the nurse anticipate the
client will need? Select all that apply.
26. A client is experiencing an anxiety attack. The nurse
reviews the client's home medications and notes that
they take an anti-anxiety medication. Which of the
a) Psychoanalysis
following medications is likely prescribed to this client?
b) SSRI medications
a) Amitryptiline c) BuSpar (buspirone)
b) Alprazolam d) Cognitive behavioral therapy
c) Alendronate e) Antipsychotic medications
d) Amiodarone
31. According to Erikson's developmental theory, when
27. A client presents to the emergency department with planning care for a 47-year-old client, which
an anxiety attack, stating that he has had multiple developmental task should a nurse identify as
attacks over the last six months. The client is appropriate for this client?
hyperventilating, so the nurse administers a
a) To develop a basic trust in others
benzodiazepine to help with the acute attack. The nurse
b) To achieve a sense of self-confidence and
anticipates that the client will begin to take which of the
recognition from others
following medications on a regular basis to help with
c) To reflect back on life events to derive pleasure
the anxiety?
and meaning
a) Fentanyl d) To achieve established life goals and consider
b) Famotidine the welfare of future generations
c) Furosemide
32. A nurse observes a 3-year-old client willingly sharing
d) Fluoxetine
candy with a sibling. According to Peplau, which
28. A nurse is working with a client who is having sleep psychological stage of development should the nurse
difficulties at night. The nurse recommends that the determine that this child has completed?
client keep a sleep diary and write down the times he
a) "Learning to count on others"
goes to bed, the times he gets up and how many times
b) "Learning to delay satisfaction"
he awakens each night. The nurse can best describe the
c) "Identifying oneself"
purpose of keeping a sleep diary as which of the
d) "Developing skills in participation"
following?
33. A 12-year-old girl becomes hysterical every time she
a) Assisting the client with making up all of his lost
strikes out in softball, falls down when roller-skating, or
sleep
loses when playing games. According to Peplau's
b) Determining the client's type of sleep disorder
interpersonal theory, in which stage of development
c) Helping the client to discover if he is a morning
should the nurse identify a need for improvement?
person
d) Helping the client see how to improve his sleep a) "Learning to count on others"
b) "Learning to delay satisfaction"
29. A case management nurse is reviewing the chart for
c) "Identifying oneself"
a client in a psychiatric hospital who has been
d) "Developing skills in participation"
diagnosed with panic disorder. The client is anxious and
irritable. The nurse has done teaching on relaxation 34. According to Peplau, a nurse who provides an
techniques, but the client requires close monitoring due abandoned child with parental guidance and praise
to lack of adherence to the regimen. Which action of following small accomplishments is serving which
the case manager will most likely support this client therapeutic role?
best?
a) The role of technical expert
a) Call to inform the provider that the client most b) The role of resource person
likely needs surgery c) The role of surrogate
b) Arrange for the client to be committed to long- d) The role of leader
term inpatient care
35. A physically healthy, 35-year-old single client lives
with parents who provide total financial support.
According to Erikson's theory, which developmental
task should a nurse assist the client to accomplish?
a) Establishing the ability to control emotional
reactions
b) Establishing a strong sense of ethics and
character structure
c) Establishing and maintaining self-esteem
d) Establishing a career, personal relationships,
and societal connections
36. A married, 26-year-old client works as a
schoolteacher. She and her husband have just had their
first child. A nurse should recognize that this client is
successfully accomplishing which stage of Erikson's
developmental theory?
a) Industry versus inferiority
b) Identity versus role confusion
c) Intimacy versus isolation
d) Generativity versus stagnation
37. A 10-year-old child wins the science fair competition
and is chosen as a cheerleader for the basketball team.
A nurse should recognize that this child is in the process
of successfully accomplishing which stage of Erikson's
developmental theory?
a) Industry versus inferiority
b) Identity versus role confusion
c) Intimacy versus isolation
d) Generativity versus stagnation
38. A 29-year-old client living with parents has few
interpersonal relationships. The client states, "I have
trouble trusting people." Based on Erikson's
developmental theory, which should the nurse
recognize as a true statement about this client?
a) The client has not progressed beyond the trust
versus mistrust developmental stage.
b) Developmental deficits in earlier life stages
have impaired the client's adult functioning.
c) The client cannot move to the next
developmental stage until mastering all earlier
stages.
d) The client's developmental problems began in
the intimacy versus isolation stage.
39. Which statement describes achievement of Erikson's
generativity versus stagnation developmental stage?
a) "I've been a girl scout leader for troop 259 for 7
years."
b) "I feel great that I could pay for my bike with my
paper route money."
c) "My parents are so pleased that John and I are
going to be married."
d) "I've had a very full life. I'm not afraid to leave
this world."
40. A nursing instructor is teaching about the
application of Peplau's theory to nursing care. Which
student statement indicates that learning has occurred?
a) "The nurse assumes the role of a parenting
figure instructing the client in good health
practices."
b) "The nurse is concerned more about
psychosocial functioning than physiological
functioning."
c) "The nurse bases the client care plan on
standardized nursing approaches and physician
orders."
d) "The nurse applies principles of human relations
to the problems that arise at all levels of
experience."
41. According to Peplau, treatment of client symptoms
should involve which nursing action?
a) Establishing a therapeutic nurse-client
relationship
b) Using the technique of desensitization
c) Challenging clients' negative thoughts
d) Uncovering clients' past experiences
42. A nurse is working with a client who suffers from
depression. The client has started taking medications
and is engaged in group therapy, but still tells the nurse,
"I do not like myself. I am annoying, even to me." Which
activities can the nurse suggest that would most likely
increase this client's self-concept? Select all that apply.
a) Remind the client not to compare self to others
b) Teach the client how to be mindful of negative
thoughts
c) Have the client recognize personal strengths
d) Ask if the client has any friends
e) List three things that the nurse likes about the
client
43. A client in the psychiatric unit has been diagnosed
with severe, intractable depression and is preparing to
undergo electroconvulsive therapy (ECT). Which best
describes the role of the nurse during ECT? Select all
that apply.
a) Notify the provider immediately if the client is
confused following the procedure
b) Prepare the client for applying EEG leads to the
head
c) Note the location of resuscitative equipment on
the nursing unit in case of need
d) Record the length of time of the client's seizure
e) Administer oxygen as needed
44. A client who has developed depression after
experiencing chronic back pain is being seen at the
acute care clinic. Which best describes how the nurse
would demonstrate psychoeducation when working
with this client?
 a) Teaching the client about the effects of their c) Do you hear voices or have hallucinations?
mental health issue so it can be better managed d) Have you been having trouble sleeping?
b) Helping the client to find a support group for
50. A client is diagnosed with major depressive disorder.
people who suffer from back pain
Which nursing diagnosis should a nurse assign to this
c) Administering medications that will relieve
client to address a behavioral symptom of this disorder?
some of the back pain
d) Providing information to the client about an a) Altered communication R/T feelings of
upcoming research study based on the effects worthlessness AEB anhedonia
of pain and depression b) Social isolation R/T poor self-esteem AEB
secluding self in room
45. A nurse is assisting a client who has undergone
c) Altered thought processes R/T hopelessness
electroconvulsive therapy for treatment of severe
AEB persecutory delusions
depression. Following the procedure, the client
d) Altered nutrition: less than body requirements
develops postictal agitation. Based on the nurse's
R/T high anxiety AEB anorexia
knowledge of this condition, the nurse would expect to
see which of the following? 51. A nurse assesses a client suspected of having major
depressive disorder. Which client symptom would
a) Coma
eliminate this diagnosis?
b) Hyperactivity and mania
c) Limb contractures a) The client is disheveled and malodorous.
d) Incoherence, disorientation, and motor b) The client refuses to interact with others.
restlessness c) The client is unable to feel any pleasure.
d) The client has maxed-out charge cards and
46. A 30-year-old client has been diagnosed with major
exhibits promiscuous behaviors.
depressive disorder. Which nutrition guideline should
the nurse give to this client that could help with some 52. A nurse reviews the laboratory data of a client
symptoms of depression? suspected of having major depressive disorder. Which
laboratory value would potentially rule out this
a) Fluids such as water and sugar-free juice are
diagnosis?
preferred over caffeinated beverages
b) The best diet for depression is the Western diet a) Thyroid-stimulating hormone (TSH) level of 6.2
c) Some free radicals in the diet combat harmful U/mL
antioxidants b) Potassium (K+) level of 4.2 mEq/L
d) The client should increase carbohydrate intake c) Sodium (Na+) level of 140 mEq/L
and limit fats d) Calcium (Ca2+) level of 9.5 mg/dL
47. An 11-year-old boy has been diagnosed with 53. What is the rationale for a nurse to perform a full
depression after his parents' divorce. The nurse physical health assessment on a client admitted with a
understands that depression in children of this age most diagnosis of major depressive disorder?
commonly manifests as:
a) The attention during the assessment is
a) Poor blood glucose control beneficial in decreasing social isolation.
b) Whining b) Depression can generate somatic symptoms
c) Low self esteem that can mask actual physical disorders.
d) Pouting c) Physical health complications are likely to arise
from antidepressant therapy.
48. A nurse is caring for a client has undergone ECT for
d) Depressed clients avoid addressing physical
the treatment of severe depression and has developed
health and ignore medical problems.
some complications afterward. Which of the following is
a physical side effect that has been associated with 54. A client who has been taking buspirone (BuSpar) as
ECT? prescribed for 2 days is close to discharge. Which
statement indicates to the nurse that the client has an
a) Muscle soreness
understanding of important discharge teaching?
b) Peripheral edema
c) Rash on the face and trunk a. "I cannot drink any alcohol with this
d) Bradycardia medication."
b. "It is going to take 2 to 3 weeks in order
49. A nurse is performing depression screenings in the
for me to begin to feel better."
community. Which question would most likely be
c. "This drug causes physical dependence
included in this screening?
and I need to strictly follow doctor's
a) Do you believe that others are talking or orders."
thinking about you?
b) Are you trying to lose weight?
 d. "I can't take this medication with food.
It needs to be taken on an empty
stomach."
55. A client is admitted to the psychiatric unit with a
diagnosis of major depression. The client is unable to
concentrate, has no appetite, and is experiencing
insomnia. Which should be included in this client's plan
of care?
a. A simple, structured daily schedule with
limited choices of activities
b. A daily schedule filled with activities to
promote socialization
c. A flexible schedule that allows the client
opportunities for decision making
d. A schedule that includes mandatory
activities to decrease social isolation
56. The nurse is caring for a 14-year-old client. The
client's mother informs the nurse that the client told
her that he wants to kill himself. What is the priority?
a) Ask the mother to leave while the nurse
completes a psych assessment
b) Ask the client why he feels like he wants to die
c) Consult the child psychiatrist
d) Do not leave the client alone
57. The provider has finished seeing four clients in the
emergency room. The nurse should first assess the
client with which condition?
a) Suicidal ideation
b) Persistent back pain
c) Injury to the right leg with obvious deformity
d) Fishing hook lodged in his forehead
58. A client with suicidal ideation is undergoing
dialectical behavior therapy. The nurse should educate
the client to expect which type of treatment?
a) An inpatient, solitary program
b) A 12-step program in the community
c) ECT in conjunction with outpatient therapy
d) Both individual and group counseling
59. A client with depression has been taken to the
emergency department by a friend after making
statements that he was contemplating suicide. The
provider has ordered that the client be admitted for
inpatient treatment but the client refuses. Which of the
following best explains the client's rights in this
situation?
a) The client, if competent, has the right to refuse
inpatient treatment
b) The client does not have the right to refuse
treatment and should be placed in restraints
c) The client may refuse inpatient treatment but
must agree to outpatient therapy
d) The client is not safe and the nurse should fill
out a petition to legally keep the client
60. A psych nurse is floated to the emergency room to
help with the number of psych clients that are being
triaged. The psych nurse knows to see the client with
which of the following first?
a) State of mania, thinks bugs are crawling all over
b) Severe depression and has not eaten for a 2
days
c) Depression with suicidal ideation
d) ETOH of 200 mg/dl
61. Which of the following situations are risk factors for
suicide? Select all that apply.
a) The client has an adequate support system
b) The client has a history of suicide attempts
c) The client is under 10 years of age
d) The client is terminally ill
e) The client has been consistently rejected by
peers
62. A client with a history of severe depression and
anxiety is in the hospital after attempting suicide. Which
evidence would most likely be seen that indicates a
crisis in a person with a mental illness? Select all that
apply.
a) The client has not slept for several nights in a
row
b) The client is socially withdrawn
c) The client is unable to concentrate
d) The client has increased interest in personal
hygiene
e) The client is crying
63. Common symptoms of impending suicide include
which of the following? Select all that apply.
a) Giving away belongings
b) Sudden improvement in a depressed client
c) Canceling social engagements
d) Interacting with peers
e) Changing a will
64. The nurse is leading group therapy in a behavioral
health unit. Which client concerns the nurse the most?
a) The client with anorexia meticulously arranging
food on the tray, who has not eaten a bite
b) The client with severe depression who reports a
sudden and profound improvement in mood
c) The client on lithium who has discussed the
desire to get pregnant
d) The client with a history of schizophrenia whose
father passed last week, and who refuses to get
out of bed
65. A client is undergoing behavioral therapy through
counseling for manic behaviors exhibited during
episodes of bipolar disorder. Which best describes how
cognitive-behavioral therapy is used as treatment for a
client with bipolar disorder?
 a) The client studies a book about thoughts vs.
behavior and implements the ideas
b) The client meets with a group to discuss
thoughts and feelings
c) The client works at changing personal thoughts
to impact actions
d) The client initiates a 12-step program to
incorporate a change-through-leading approach
66. client with bipolar disorder is seeking treatment for
co-occurring substance abuse disorder. During the
initial assessment and treatment process, the nurse
notes the development of countertransference. Which
best describes an example of this response?
a) The client blames the nurse for her bipolar
disorder
b) The client compares the nurse to her mother
c) The client determines that her substance abuse
disorder was caused by the bipolar disorder
d) The nurse feels irritated because the client
reminds the nurse of her sister
67. A client who has been diagnosed with bipolar
disorder is seeking treatment during the manic phase of
illness. Based on the nurse's knowledge of this mental
state, the nurse understands that which of the following
is likely during this phase?
a) The client is at risk of destructive behaviors
because of her manic mood
b) The client is more likely to develop chronic
illnesses, including lung disease and obesity
c) The client is at risk of suicide during the manic
phase
d) The client is not at high risk and her safety is not
threatened
68. A nurse is caring for a client with bipolar disorder
who is frequently manic. What describes the most
appropriate psychotherapy for a client with this
condition? Select all that apply.
a) Family focused therapy
b) Electroconvulsive therapy
c) Cognitive-behavior therapy
d) 12-step programs
e) Interpersonal and social rhythm therapy
69. A client with a history of bipolar disorder has been
brought in to the hospital because the client was
running through a neighborhood without any clothes
on. Which of the following is evidence that the client is
voluntarily willing to be admitted to the hospital? Select
all that apply.
a) The situation is an emergency
b) The client is not a danger to himself or others
c) The client has a court order
d) The client states that he is willing to follow the
regimen of the facility
e) The client agrees to follow orders
70. A client is undergoing a clinical interview as part of
diagnostic testing for bipolar disorder. Which best
describes why a clinical interview would be conducted?
a) To test the client's memory function
b) To determine how much the client perceives
and cognitively understands
c) To assess the client's psychiatric and family
background
d) To measure the client's IQ level
71. Which of the following are potential nursing
interventions for a client with bipolar disorder? Select
all that apply.
a) Give detailed step-by-step instructions for ADLs
b) Encourage a daily routine
c) Minimize environmental stimuli
d) Assess for suicide risk
e) Put client valuables in a safe place
72. A nurse is caring for a client who has been
diagnosed with bipolar disorder, type I. Which best
describes the difference between bipolar type I and
type II?
a) Bipolar I is associated with alternating mania
and depression, while bipolar II is a continuous
state of hypomania
b) Bipolar I leads to extreme depression, while
bipolar II causes more subdued depression
c) Bipolar I describes mania or the high feeling of
the disease, while bipolar II describes the
depressed state
d) Bipolar I is associated with alternating mania
and depression, while bipolar II is associated
with hypomania and depression
Psychiatric Nursing Exam
1. A client with a diagnosis of depression who has
attempted suicide says to the nurse, "I should have
died. I've always been a failure. Nothing ever goes
right for me." Which response by the nurse
demonstrates therapeutic communication?
a) "You have everything to live for."
b) "Why do you see yourself as a failure?"
c) "Feeling like this is all part of being
depressed."
d) "You've been feeling like a failure for a
while?"
2. The nurse visits a client at home. The client
states, "I haven't slept at all the last couple of
nights." Which response by the nurse
demonstrates therapeutic communication?
a) "I see."
b) "Really?"
c) "You're having difficulty sleeping?"
d) "Sometimes I have trouble sleeping too."
3. A client experiencing disturbed thought
processes believes that his food is being poisoned.
Which communication technique should the nurse
use to encourage the client to eat?
a) Using open-ended questions and silence
b) Sharing personal preference regarding food
choices
c) Documenting reasons why the client does
not want to eat
d) Offering opinions about the necessity of
adequate nutrition
4. A client admitted voluntarily for treatment of an
anxiety disorder demands to be released from the
hospital. Which action should the nurse take
initially?
a) Contact the client's health care provider
(HCP).
b) Call the client's family to arrange for
transportation.
c) Attempt to persuade the client to stay "for
only a few more days."
d) Tell the client that leaving would likely
result in an involuntary commitment.
5. When reviewing the admission assessment, the nurse
notes that a client was admitted to the mental health
unit involuntarily. Based on this type of admission, the
nurse should provide which intervention for this client?
1. Monitor closely for harm to self or others.
2. Assist in completing an application for
admission.
3. Supply the client with written information
about his or her mental illness.
4. Provide an opportunity for the family to discuss
why they felt the admission was needed.
6. When a client is admitted to an inpatient mental
health unit with the diagnosis of anorexia nervosa, a
cognitive behavioral approach is used as part of the
treatment plan. The nurse plans care based on which
purpose of this approach?
a) Providing a supportive environment
b) Examining intrapsychic conflicts and past issues
c) Emphasizing social interaction with clients who
withdraw
d) Helping the client to examine dysfunctional
thoughts and beliefs
7. A client is preparing to attend a mN for the first time.
The nurse should tell the client that which is the first
step in this 12-step program?
a) Admitting to having a problem
b) Substituting other activities for gambling
c) Stating that the gambling will be stopped
d) Discontinuing relationships with people who
gamble
8. A client says to the nurse, "The federal guards were
sent to kill me." Which is the best response by the nurse
to the client's concern?
a) "I don't believe this is true."
b) "The guards are not out to kill you."
c) "Do you feel afraid that people are trying to
hurt you?"
d) "What makes you think the guards were sent to
hurt you?"
9. A client diagnosed with delirium becomes disoriented
and confused at night. Which intervention should the
nurse implement initially?
a) Move the client next to the nurses' station.
b) Use an indirect light source and turn off the
television.
c) Keep the television and a soft light on during
the night.
d) Play soft music during the night, and maintain a
well-lit room.
10. A client is admitted to the mental health unit with a
diagnosis of depression. The nurse should develop a
plan of care for the client that includes which
intervention?
a) Encouraging quiet reading and writing for the
first few days
b) Identification of physical activities that will
provide exercise
c) No socializing activities, until the client asks to
participate in milieu
d) A structured program of activities in which the
client can participate
11. A client diagnosed with terminal cancer says to the
nurse, "I'm going to die, and I wish my family would
stop hoping for a cure! I get so angry when they carry
on like this. After all, I'm the one who's dying." Which
response by the nurse is therapeutic?
a) "Have you shared your feelings with your
family?"
b) "I think we should talk more about your anger
with your family."
c) "You're feeling angry that your family continues
to hope for you to be cured?"
d) "You are probably very depressed, which is
understandable with such a diagnosis."
12. On review of the client's record, the nurse notes
that the admission was voluntary. Based on this
information, the nurse plans care anticipating which
client behavior?
a) Fearfulness regarding treatment measures
b) Anger and aggressiveness directed toward
others
c) An understanding of the pathology and
symptoms of the diagnosis
d) A willingness to participate in the planning of
the care and treatment plan
13. Recognizing the frequency of depression among the
American population, the nurse should advocate for
which mental health promotion intervention?
a. Including discussions on depression as part of
school health classes
b. Providing regular depression screening for
adolescent and teenage students
c. Increasing the number of community-based
depression hotlines available to the public
d. Encouraging senior centers to provide
information on accessing community
depression resources
14. Which statement made by a patient demonstrates a
healthy degree of resilience? Select all that apply.
a. "I try to remember not to take other people's
bad moods personally."
b. "I know that if I get really mad I'll end up being
depressed."
c. "I really feel that sometimes bad things are
meant to happen."
d. "I've learned to calm down before trying to
defend my opinions."
e. "I know that discussing issues with my boss
would help me get my point across."
15. Epidemiological studies contribute to improvements
in care for individuals with mental disorders by:
a. Providing information about effective nursing
techniques.
b. Identifying risk factors that contribute to the
development of a disorder.
c. Identifying individuals in the general population
who will develop a specific disorder.
d. Identifying which individuals will respond
favorably to a specific treatment.
16. Which statement demonstrates the nurse's
understanding of the effect of environmental factors on
a patient's mental health?
a) "I'll need to assess how the patient's family
views mental illness."
b) "There is a history of depression in the patient's
extended family."
c) "I'm not familiar with the patient's Japanese's
cultural view on suicide."
d) "The patient's ability to pay for mental health
services needs to be assessed."
17. Which statement about mental illness is true?
a. Mental illness is a matter of individual
nonconformity with societal norms.
b. Mental illness is present when irrational and
illogical behavior occurs.
c. Mental illness changes with culture, time in
history, political systems, and the groups
defining it.
d. Mental illness is evaluated solely by considering
individual control over behavior and appraisal
of reality.
18. When considering stigmatization, which statement
made by the nurse demonstrates a need for immediate
intervention by the nurse manager?
a. "Depression seems to be a real problem among
the teenage population."
b. "My experience has been that the Irish have a
problem with alcohol use."
c. "Women are at greater risk for developing
suicidal thoughts then acting on them."
d. "We've admitted several military veterans with
posttraumatic stress disorder this month."
19. When discussing therapy options, the nurse should
provide information about interpersonal therapy to
which patient? Select all that apply.
a. The teenager who is the focus of bullying at
school
b. The older woman who has just lost her life
partner to cancer
c. The young adult who has begun demonstrating
hoarding tendencies
d. The adolescent demonstrating aggressive verbal
and physical tendencies
e. The middle-aged adult who recently discovered
her partner has been unfaithful
20. When considering the suggestions of Hildegard
Peplau, which activity should the nurse regularly engage
in to ensure that the patient stays the focus of all
therapeutic conversations?
a. Assessing the patient for unexpressed concerns
and fears
b. Evaluating the possible need for additional
training and education
c. Reflecting on personal behaviors and personal
needs
d. Avoiding power struggles with the manipulative
patient
21. Which action reflects therapeutic practices
associated with operant conditioning?
a. Encouraging a parent to read to their children
to foster a love for learning
b. Encouraging a patient to make daily journal
entries describing their feelings
 c. Suggesting to a new mother that she spend 27. Which drug group calls for nursing assessment for
time cuddling her newborn often during the day development of abnormal movement disorders among
d. Acknowledging a patient who is often verbally individuals who take therapeutic dosages?
aggressive for complimenting a picture another
a) SSRIs
patient drew
b) antipsychotics
22. A male patient reports to the nurse, "I'm told I have c) benzodiazepines
memories of childhood abuse stored in my unconscious d) tricyclic antidepressants
mind. I want to work on this." Based on this statement,
what information should the nurse provide the patient?
28. The nurse administers each of the following drugs to
a. To seek the help of a trained therapist to help
various patients. The patient who should be most
uncover and deal with the trauma associated
carefully assessed for fluid and electrolyte imbalance is
with those memories.
the one receiving:
b. How to use a defense mechanism such as
suppression so that the memories will be less a) lithium (Eskalith)
threatening. b) clozapine (Clozaril)
c. Psychodynamic therapy will allow the surfacing c) diazepam (Valium)
of those unconscious memories to occur in just d) amitriptyline
a few sessions.
d. Group sessions are valuable to identify
underlying themes of the memories being
suppressed.
29. Which nursing intervention demonstrates the
23. A nurse is assessing a patient who graduated at the ethical principle of beneficence?
top of his class but now obsesses about being
incompetent in his new job. The nurse recognizes that a. Refusing to administer a placebo to a patient.
this patient may benefit from the following type of b. Attending an in-service on the operation of the
psychotherapy: new IV infusion pumps
c. Providing frequent updates to the family of a
a. Interpersonal patient currently in surgery
b. Operant conditioning d. Respecting the right of the patient to make
c. Behavioral decisions about whether or not to have
d. Cognitive-behavioral electroconvulsive therapy
24. Which question should the nurse ask when 30. According to Maslow's hierarchy of needs, the most
assessing for what Sullivan's Interpersonal Theory basic needs category for nurses to address is:
identifies as the most painful human condition?
a. physiological
a. "Is self-esteem important to you?" b. safety
b. "Do you think of yourself as being lonely?" c. love and belonging
c. "What do you do to manage your anxiety?" d. self-actualization
d. "Have you ever been diagnosed with
depression?" 31. When considering facility admissions for mental
healthcare, what characteristic is unique to a voluntary
25. Linda is terrified of spiders and cannot explain why. admission?
Because she lives in a wooded area, she would like to
overcome this overwhelming fear. Her nurse a. The patient poses no substantial threat to
practitioner suggests which therapy? themselves or to others
b. The patient has the right to seek legal counsel
a. Behavioral c. A request in writing is required before
b. Biofeedback admission
c. Aversion d. A mental illness has been previously diagnosed
d. Systematic desensitization
32. In an outpatient psychiatric clinic, a nurse notices
26. Besides antianxiety agents, which classification of that a newly admitted young male patient smiles when
drugs is also commonly given to treat anxiety and he sees her. One day the young man tells the nurse,
anxiety disorders? "You are pretty like my mother." The nurse recognizes
a) Antipsychotics that the male is exhibiting:
b) Mood stabilizers a. Transference
c) Antidepressants b. Id expression
d) Cholinesterase inhibitors c. Countertransference
 d. A cognitive distortion a. The mother of an unconscious patient saying
okay to surgery
33. Which drug group calls for nursing assessment for
b. Care given to a heroin overdose victim
development of abnormal movement disorders among
c. Immobilizing a patient who has refused to take
individuals who take therapeutic dosages?
medication
a. SSRIs d. Signing general intake paperwork with specific
b. antipsychotics parameters
c. benzodiazepines
38. Based on Maslow's hierarchy of needs, physiological
d. tricyclic antidepressants
needs for a restrained patient include: Select all that
34. A patient is telling a tearful story. The nurse listens apply.
empathically and responds therapeutically with:
a. Private toileting, oral hydration
a. "The next time you find yourself in a similar b. Checking the tightness of the restraints
situation, please call me." c. Therapeutic communication
b. "I am sorry this situation made you feel so d. Maintaining a patent airway
badly. Would you like some tea?"
39. What assessment question is focused on identifying
c. "Let's devise a plan on how you will react next
a long-term consequence of chronic stress on physical
time in a similar situation."
health?
d. "I am sorry that your friend was so thoughtless.
You should be treated better." a. "Do you have any problems with sleeping well?"
b. "How many infections have you experienced in
35. You realize that your patient who is being treated
the past 6 months?"
for a major depressive disorder requires more teaching
c. "How much moderate exercise do you engage
when she makes the following statement:
in on a regular basis?"
a. "I have been on this antidepressant for 3 days. I d. "What management techniques to you regularly
realize that the full effect may not happen for a use to manage your stress?"
period of weeks."
40. Which nursing assessments are directed at
b. "I am going to ask my nurse practitioner to
monitoring a patient's fight-or-flight response? Select all
discontinue my Prozac today and let me start
that apply.
taking a monoamine oxidase inhibitor
tomorrow." a. Blood pressure
c. "I may ask to have my medication changed to b. Heart rate
Wellbutrin due to the problems I am having c. Respiratory rate
being romantic with my wife." d. Abdominal pain
d. "I realize that there are many antidepressants e. Dilated pupils
and it might take a while until we find the one
41. When considering stress, what is the primary goal of
that works best for me."
making daily entries into a personal journal?
36. A nurse makes a post on a social media page about
a. Providing a distraction from the daily stress
his peer taking care of a patient with a crime-related
b. Expressing emotions to manage stress
gunshot wound in the emergency department. He does
c. Identifying stress triggers
not use the name of the patient. The nurse:
d. Focusing on one's stress
a. Has not violated confidentiality laws because he
did not use the patient's name.
b. Cannot be held liable for violating
confidentiality laws because he was not the
primary nurse for the patient.
c. Has violated confidentiality laws and can be
held liable.
d. Cannot be held liable because postings on a
social media site are excluded from
confidentiality laws.

37. Implied consent occurs when no verbal or written

agreement takes place prior to a caregiver delivering
treatment. Which of the following examples represents
implied consent?

Psychiatric Nursing Exam
1. A moderately depressed client who was hospitalized
2 days ago suddenly begins smiling and reporting that
the crisis is over. The client says to the nurse, "I'm finally
cured." How should the nurse interpret this behavior as
a cue to modify the treatment plan?
 Increasing the level of suicide precautions
2.Which are the most likely characteristics of a client
who abuses alcohol? Select all that apply.
 Male gender
 Abuses drugs as well as alcohol
 History of at least one suicide attempt
3. The nurse is performing an assessment on a client
being admitted with a diagnosis of alcohol dependence
who reports it's been 6 hours since the last drink. The
information supports which assumption about the
appearance of withdrawal symptoms?
 Signs may appear at any time.
4. The nurse reviewing a client's diagnostic results
recognizes that which is a possible positive indication
for a diagnosis of schizophrenia?
 Atrophy of the lateral and/or third ventricles of
the brain
5. The client diagnosed with mild depression says to the
nurse, "I haven't had an appetite at all for the last few
weeks." Which response by the nurse best assesses the
client's nutritional issue?
 "You haven't had an appetite at all?"
6. The mental health nurse is meeting with a client who
has a long history of abusing drugs. During the session
the client says to the nurse, "I'm feeling much better
now, and I'm ready to go straight." Which response by
the nurse would be therapeutic?
 "Tell me what makes you feel that you are
ready."
7. The nurse visits a client at home. The client states, "I
haven't slept at all the last couple of nights." Which
response by the nurse demonstrates therapeutic
communication?
 "You're having difficulty sleeping?"
8. The nurse is planning relapse prevention information
for a client diagnosed with schizophrenia. The nurse
understands that it is important to ensure which
primary intervention?
 Including the client's support system in the
teaching
9. A depressed client who appeared sullen, distraught,
and hopeless a few days ago now suddenly appears
calm, relaxed, and more energetic. Which is the nurse's
best initial action with regard to the client's altered
demeanor?
 Engage the client in one-to-one supervision,
share with the client the observations that have
been assessed, and ask whether the client is
thinking about suicide.
10. Which statement by the nurse indicates a need for
further teaching concerning family violence?
 "Abusers are more often from low-income
families."
11. When planning the discharge of a client with chronic
anxiety, the nurse directs the goals at promoting a safe
environment at home. Which is the most appropriate
maintenance goal?
 Identifying anxiety-producing situations
12. A client is participating in a therapy group and
focuses on viewing all team members as equally
important in helping the clients to meet their goals. The
nurse is implementing which therapeutic approach?
 Milieu therapy
13. The nurse is caring for a client with a diagnosis of
agoraphobia. Which statement made by the client
would support this diagnosis?
 "I'd be sure to have a panic attack if I left my
house."
14. The nurse is creating a plan of care for the client
who is upset following the loss of a job and is
verbalizing concerns regarding the ability to meet
financial obligations. Which problem is the basis of the
client's concerns?
 Inability to meet role expectations
15. The nurse is working with a client who is
demonstrating delusional thinking. The client says to
the nurse, "The leaders of a religious cult are being sent
to assassinate me." Which is the best response by the
nurse?
 "I don't know about a religious cult. Are you
afraid that people are trying to hurt you?"
16. During a nursing interview, a client says, "My
daughter was murdered. I can't help wondering if her
husband killed her, but he's been eliminated as a
suspect." Which statement is a therapeutic nursing
response?
  "Have you shared your concerns with the The client is lying on the bed in a fetal position. Which is
police?" the most appropriate nursing intervention?

17. The nurse should include which information in the
medication teaching plan for a client diagnosed with
schizophrenia?
 Coffee, tea, and soda consumption should be
limited.
 Sit beside the client in silence with occasional
open-ended questions.
26. The nurse is caring for a client with anorexia
nervosa. Which behavior is characteristic of this
disorder and reflects anxiety management?

18. A client experiencing a great deal of stress and
anxiety is being taught to use self-control therapy.
Which statement by the client indicates a need for
further teaching about the therapy?
 "This form of therapy provides a negative
reinforcement when the stimulus is produced."
19. Soon after an assault, a client is assessed in the
emergency department with behavior that is associated
with severe anxiety. Which client behaviors support this
level of anxiety?
 Is pacing while describing the situation using a
rapid speech pattern
20. The nurse is planning to formulate a psychotherapy
group. Several clients are interested in attending the
session. The nurse plans the group, based on which
management principle?
 Observing rigid rules and regulations
27. A nursing student is assisting with the care of a
client with a chronic mental illness. The nurse informs
the student that a behavior modification approach
(operant conditioning) will be used in treatment for the
client. Which statement by the student indicates a need
for further information about the therapy?
 "It uses negative reinforcement."
28. The mother of a teenage client states that her
daughter, diagnosed with an anxiety disorder, "eats
nothing but junk food, has never liked going to school,
and hangs out with the wrong crowd." What discharge
instruction will be most effective in helping the mother
to manage her daughter's condition?
 Restrict the amount of chocolate and caffeine
products in the home.

 The group should be limited to no more than 10 29. Which behavior demonstrated by a client diagnosed
members. with depression indicates a need for suicide
precautions?
21. The nurse is creating a plan of care for a client
diagnosed with depression whose food intake is poor.  Asks about how to get a will notarized
The nurse should include which interventions in the
30. The nurse has been closely observing a client who
plan of care? Select all that apply.
has been displaying aggressive behaviors. The nurse
 1.Assist the client in selecting foods from the observes that the behavior displayed by the client is
food menu. escalating. Which nursing intervention is most helpful to
 2.Offer high-calorie fluids throughout the day this client at this time? Select all that apply.
and evening.
 Acknowledge the client's behavior.
 4.Offer small high-calorie, high-protein snacks
 Assist the client to an area that is quiet.
during the day and evening.
 Maintain a safe distance from the client.
22. The client with a diagnosis of dependent personality
disorder is most likely to have problems coping with
which situation?

 Making decisions about living arrangements

after discharge

23. Which client is at greatest risk for committing

suicide?

 A client with metastatic cancer

24. Which pre-electroconvulsive therapy intervention

will the nurse implement for a hospitalized client?

 Assure that an electrocardiogram is performed

within 24 hours.

25. The nurse is caring for a client just admitted to the

mental health unit and diagnosed with catatonic stupor.

Psychiatric Nursing Exam
1. Situation: A nurse may encounter children with
mental disorders. Her knowledge of these various
disorders is vital. When planning school interventions
for a child with a diagnosis of attention deficit
hyperactivity disorder, a guide to remember is to:
A. provide as much structure as possible
for the child
B. ignore the child's overactivity.
C. encourage the child to engage in any
play activity to dissipate energy
D. remove the child from the classroom
when disruptive behavior occurs
Decrease stimuli for behavior control thru an environment
that is free of distractions, a calm non -confrontational
approach and setting limit to time allotted for activities.
B. The child will not benefit from a lenient approach.
C. Dissipate energy through safe activities.
D. This indicates that the classroom environment lacks
structure.
2. Ritalin is the drug of choice for children with ADHD.
The side effects of the following may be noted:
A. increased attention span and
concentration
B. increase in appetite
C. sleepiness and lethargy
D. bradycardia and diarrhea
The medication has a paradoxic effect that decrease
hyperactivity and impulsivity among children with ADHD.
B, C, D. Side effects of Ritalin include anorexia, insomnia,
diarrhea and irritability.
3. The therapeutic approach in the care of an autistic
child include the following EXCEPT:
A. Engage in diversionary activities when acting -out
B. Provide an atmosphere of acceptance
C. Provide safety measures
D. Rearrange the environment to activate the child
The child with autistic disorder does not want change.
Maintaining a consistent environment is therapeutic.
A. Angry outburst can be rechanneled through safe activities.
B. Acceptance enhances a trusting relationship.
C. Ensure safety from self-destructive behaviors like head
banging and hair pulling.
4. A 5-year-old boy is diagnosed to have autistic
disorder. Which of the following manifestations may be
noted in a client with autistic disorder?
A. argumentativeness, disobedience,
angry outburst
B. intolerance to change, disturbed
relatedness, stereotypes
C. distractibility, impulsiveness and over
activity
D. aggression, truancy, stealing, lying
These are manifestations of autistic disorder.
A. These manifestations are noted in Oppositional
Defiant Disorder, a disruptive disorder among children.
C. These are manifestations of Attention Deficit Disorder
D. These are the manifestations of Conduct Disorder
DSM-V criteria for ADHD
A. A persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning
or development, as characterized by either
B. Six or more symptoms of inattentive or hyperactive-
impulsive symptoms for children up to age 16, or five or
more for age 17 and older. Symptoms have been
present for at least 6 months and are inappropriate for
developmental level. Several hyperactive-impulsive
symptoms were present prior to age 12.
C. Several inattentive or hyperactive-impulsive
symptoms are present in two or more settings (e.g., at
home, school, or work; with friends or relatives; in other
activities).
D. There is clear evidence that the symptoms interfere
with, or reduce the quality of, social, academic, or
occupational functioning.
E. The symptoms do not occur exclusively during the
course of schizophrenia or another psychotic disorder
and are not better explained by another mental
disorder.
Inattentive Examples for ADHD
*Fails to give close attention to details
*Difficulty sustaining attention in tasks or play
*Avoids, dislikes tasks that require sustained mental
effort
*Often does not seem to listen
*Poor follow through to activities
*Difficulty with organization
*Loses things necessary for tasks
*Easily distracted
*Forgetful
Hyperactivity Examples for ADHD
*Fidgets
*Trouble staying in seat
*Runs about or climbs excessively and inappropriately
*Difficulty playing quietly
*Always on the "go"
*Talks excessively
Impulsivity Examples for ADHD
*Blurts out answers before question is completed
*Difficulty waiting for turn
*Interrupts or intrudes on others
Screening and Diagnosis for ADHD
*Usually brought for evaluation when behaviors
interfere with school when it Interferes with the daily
functioning of teachers or parents" (Maternal Child...)
*Complete history evaluation done
*Testing on child
*Questionnaires administered to parents, caregivers,
teachers:
*Child Behavior checklist
*Connors-Wells Self-Report scales
*Conner’s' Rating Scales
*ADHD Rating Scale-IV
Treatment for ADHD
*Management is a collaborative effort
*Multimodal Therapy including;
*Pharmacotherapy
*Behavioral Interventions, such as:
*Behavior Modification techniques
*Cognitive behavior therapy
*Patient, Parent, Caregiver education
*Coaching and skills-training programs
*School/community resources and accommodations
Pharmacological Therapies for ADHD
*STIMULANT Medications
(SIDE EFFECTS: Insomnia, nervousness, agitation,
palpitations, anorexia, weight loss, changes in BP/pulse,
impaired growth rates)
*Ritalin
*Concerta
*Metadate CD
*Focalin
*Dexedrine
*Adderall
*Daytrana
*Vyvanse
*NONSTIMULANT Medication
(SIDE EFFECTS: Suicide, hepatic damage)
*atomoxetine (Strattera)
*selective norepinephrine reuptake inhibitor
What are the goals of medications for ADHD?
*Improve impulse control
*ability to concentrate
*decrease distractibility
*About 80 percent of children who need medication for
ADHD still need it as teenagers. Over 50 percent need
medication as adults.
Cornerstone medication for ADHD/ADD
*Methylphenidate (Ritalin)
*Daily dosage above 60 mg not recommended.
Estimated dose range .3-.6 mg/kg/dose
SIDE EFFECTS: Insomnia, decreased appetite, weight
loss, headache, irritability, stomachache, and rebound
agitation or exaggeration of pre-medication symptoms
as it is wearing off.
*Works quickly (within 30-60 minutes).
*Use cautiously in patients with marked anxiety, motor
tics or with family history of Tourette syndrome, or
history of substance abuse.
*Don't use if glaucoma or on MAOI
*Effective in 70-80% of children 4) Saliency

*Approved for 6yo+ *Consequences should be meaningful and noticeable to

child

Stimulant medication for ADHD/ADD that is approved

for 3 yo? Four Hallmarks of effective psychosocial interventions
within behavioral plans
Dextroamphetamine (Dexedrine)
1) Consistency
*Stimulant
*All caregivers/teachers must adhere and administer
*Give last dose in early afternoon
the behavior plan consistently
SIDE EFFECTS: appetite suppression, insomnia
2) Immediacy
*full drug effect takes 2 days
*Feedback and consequences must be administered
*Approved for 3+ immediately

3) Specificity

amphetamine (Adderall) *Caregivers/teachers must be explicit about behaviors

being targeted
*Stimulant: Schedule II Medication
4) Saliency
*Used for ADHA and Narcolepsy
*Consequences should be meaningful and noticeable to
*Can be abused as a performance enhancer (both child
physical and cognitive) and effect of euphoria.

*Side Effects and Assessment

What are the main side effects of the medications used
*Monitor LFTs for ADHD/ADD?
*Hyper or Hypotension from vagal stimulation, Insomnia
Raynauds phenomen, tachycardia
Decreased appetite
*Erectile dysfunction/priapism
Weight loss
*Insomnia and increased alertness
Headache
*appetite suppression
Inhibits Growth
*may take 2 weeks for full effect

*Approved for 3yo +

Behavior Management Plan for ADHD/ADD

*Minimize environmental distractions

*Four Hallmarks of effective psychosocial interventions

within behavioral plans

1) Consistency

*All caregivers/teachers must adhere and administer

the behavior plan consistently

2) Immediacy

*Feedback and consequences must be administered

immediately

3) Specificity

*Caregivers/teachers must be explicit about behaviors

being targeted
 6. The nurse is planning care for a client who has a
phobic disorder manifested by a fear of elevators.
Psychiatric Nursing Exam Which goal would need to be accomplished first?
1. The client with anorexia nervosa is improving if:
A. The client demonstrates the relaxation
A. She eats meals in the dining room.
response when asked.
B. Weight gain
B. verbalizes the underlying cause of the disorder.
C. She attends ward activities.
C. rides the elevator in the company of the nurse.
D. She has a more realistic self-concept.
D. role plays the use of an elevator
it is the best indication of the client's improvement. The goal
is for the client to gain 1-2 pounds per week.
7.The nurse is caring for a female client who was
admitted for Anorexia Nervosa. The nurse enters the
clients room and notes that the client is engaged in
2. A nursing diagnosis for bulimia nervosa is
rigorous push-ups. Which nursing action is most
powerlessness related to feeling not in control of eating
appropriate?
habits. The goal for this problem is:
A. Interrupt the client and weigh her immediately
A. Patient will learn problem solving skills
B. Interrupt the client and offer to take her for a
B. Patient will have decreased symptoms of
walk
anxiety.
C. Allow the client to complete her exercise
C. Patient will perform self-care activities daily.
program
D. Patient will verbalize how to set limits on
D. Tell the client that she is not allowed to exercise
others
rigorously.
This will help the patient gain a sense of control in life.
The rigorous pushups can be really harmful to her health. The
nurse must provide for appropriate exercise and place limits
on rigorous activities. weighing the client immediately after
3.The nurse develops a countertransference reaction. reinforces the client’s preoccupation with weight
This is evidenced by:

A. Revealing personal information to the client

B. Focusing on the feelings of the client. Psychiatric Nursing Exam
1. A hospitalized client is started on phenelzine for the
C. Confronting the client about discrepancies in
treatment of depression. The nurse should instruct the
verbal or non-verbal behavior
client that which foods are acceptable to consume while
D. The client feels angry towards the nurse who
taking this medication? Select all that apply.
resembles his mother.
A. Countertransference is an emotional reaction of the nurse a) Figs
on the client based on her unconscious needs and conflicts b) Yogurt
c) Crackers
d) Aged cheese
4. ___________________ techniques is the best e) Tossed salad
management of somatoform disorder because the f) Oatmeal raisin cookies
disorder is related to _____________ and it does not 2. A client with schizophrenia has been started on
have a medical basis medication therapy with clozapine. The nurse should
Stress management techniques are the best management of assess the results of which laboratory study to monitor
somatoform disorders because the disorder is related to for adverse effects from this medication?
stress/anxiety
a) Platelet count
b) Blood glucose level
c) Liver function tests
5. A client with panic disorder experiences an acute
d) White blood cell count
attack while the nurse is completing an admission
assessment. List the following interventions according 3. A client is admitted with a recent history of severe
to their level of priority. anxiety following a home invasion and robbery. During
the initial assessment interview, which statement by
a. Remain with the client.
the client would indicate to the nurse the possible
b. Encourage physical activity.
diagnosis of posttraumatic stress disorder? Select all
c. Encourage low, deep breathing.
that apply.
d. Reduce external stimuli.
e. Teach coping measures a) "I'm afraid of spiders."
 b) "I keep reliving the robbery."
c) "I see his face everywhere I go."
d) "I don't want anything to eat now."
e) "I might have died over a few dollars in my
pocket."
f) "I have to wash my hands over and over again
many times."
4. A client with anorexia nervosa is a member of a
predischarge support group. The client verbalizes that
she would like to buy some new clothes, but her
finances are limited. Group members have brought
some used clothes to the client to replace the client's
old clothes. The client believes that the new clothes
were much too tight and has reduced her calorie intake
to 800 calories daily. How should the nurse evaluate
this behavior?
a) Normal behavior
b) Evidence of the client's disturbed body image
c) Regression as the client is moving toward the
community
d) Indicative of the client's ambivalence about
hospital discharge
5. A client is unwilling to go out of the house for fear of
"making a fool of myself in public." Because of this fear,
the client remains homebound. Based on these data,
which mental health disorder is the client experiencing?
a) Agoraphobia
b) Social phobia
c) Claustrophobia
d) Hypochondriasis
6. A client is admitted to the mental health unit with a
diagnosis of depression. The nurse should develop a
plan of care for the client that includes which
intervention?
a) Encouraging quiet reading and writing for the
first few days
b) Identification of physical activities that will
provide exercise
c) No socializing activities, until the client asks to
participate in milieu
d) A structured program of activities in which the
client can participate
7. When a client is admitted to an inpatient mental
health unit with the diagnosis of anorexia nervosa, a
cognitive behavioral approach is used as part of the
treatment plan. The nurse understands that which is
the purpose of this approach?
a) Providing a supportive environment
b) Examining intrapsychic conflicts and past issues
c) Emphasizing social interaction with clients who
withdraw
d) Helping the client to examine dysfunctional
thoughts and beliefs
8. Which are characteristics of the termination stage of
group development? Select all that apply.
a) The group evaluates the experience.
b) The real work of the group is accomplished.
c) Group interaction involves superficial
conversation.
d) Group members become acquainted with each
other.
e) Some structuring of group norms, roles, and
responsibilities takes place.
f) The group explores members' feelings about
the group and the impending separation.
9. The nurse employed in a mental health unit of a
hospital is the leader of a group psychotherapy session.
What is the nurse's role during the termination stage of
group development?
a) Acknowledging that the group has identified
goals
b) Encouraging the accomplishment of the group's
work
c) Acknowledging the contributions of each group
member
d) Encouraging members to become acquainted
with one another
10. Which statement demonstrates the best
understanding of the nurse's role regarding ensuring
that each client's rights are respected?
a) "Autonomy is the fundamental right of each
and every client."
b) "A client's rights are guaranteed by both state
and federal laws."
c) "Being respectful and concerned will ensure
that I'm attentive to my client's rights."
d) "Regardless of the client's condition, all nurses
have the duty to respect client rights."
11. The nurse is working with a client who despite
making a heroic effort was unable to rescue a neighbor
trapped in a house fire. Which client focused action
should the nurse engage in during the working phase of
the nurse-client relationship?
a) Exploring the client's ability to function
b) Exploring the client's potential for self-harm
c) Inquiring about the client's perception or
appraisal of why the rescue was unsuccessful
d) Inquiring about and examining the client's
feelings for any that may block adaptive coping
12. A client's unresolved feelings related to loss would
be most likely observed during which phase of the
therapeutic nurse-client relationship?
a) Trusting
b) Working
c) Orientation
d) Termination
13. The nurse in the mental health unit recognizes
which as being therapeutic communication techniques?
Select all that apply.
a) Restating
b) Listening
c) Asking the client, "Why?"
d) Maintaining neutral responses
e) Providing acknowledgment and feedback
f) Giving advice and approval or disapproval
14. The nurse is providing care to a client admitted to
the hospital with a diagnosis of acute anxiety disorder.
The client says to the nurse, "I have a secret that I want
to tell you. You won't tell anyone about it, will you?"
What is the most appropriate nursing response?
a) "No, I won't tell anyone."
b) "I cannot promise to keep a secret."
c) "It depends on what the secret is about."
d) "If you tell me the secret, I may need to
document it."
15. A client diagnosed with terminal cancer says to the
nurse, "I'm going to die, and I wish my family would
stop hoping for a cure! I get so angry when they carry
on like this. After all, I'm the one who's dying." Which
response by the nurse is therapeutic?
a) "Have you shared your feelings with your
family?"
b) "I think we should talk more about your anger
with your family."
c) "You're feeling angry that your family continues
to hope for you to be cured?"
d) "You are probably very depressed, which is
understandable with such a diagnosis."
Psychiatric Nursing Exam
1. The nurse is working at a community clinic that
specializes in assisting patients who need medication
and therapy for mental health disorders. Which patient
is the most likely candidate for depot antipsychotic
therapy?
a. Older man with psychosis secondary to dementia
who lives with his daughter
b. Homeless veteran with schizophrenia who
occasional sleeps in a nearby shelter
c. Housewife with bipolar disorder who is prone to
psychotic features during the manic phase
d. Student with recently diagnosed schizophrenia
who lives at home with his parents
2. The nurse is caring for patients who have
schizophrenia. In addition to medication,
multidisciplinary nondrug therapies are available. What
is the nurse's most important role in helping the
patients to benefit from this comprehensive approach?
a. Help identify patients who would benefit from
conventional psychotherapy.
b. Refer patients to a psychiatric nurse specialist for
education about the disease.
c. Suggest that patients talk to vocational
specialists for additional training.
d. Establish a therapeutic relationship with patients
and encourage participation.
3. A patient with a diagnosis of hypochondriasis has
made multiple clinic visits and undergone diagnostic
tests for “cancer,” with no evidence of organic disease.
Today he declares, “I have a brain tumor. I can feel it
growing. My
appointment is tomorrow, but I can’t wait!” What is the
most therapeutic response?
a. Present reality: “Sir, you have been seen many
times in this clinic and had many diagnostic tests.
The results have always been negative.”
b. Encourage expression of feelings: “Let me spend
some time with you. Tell me about what you are
feeling and why you think you have a brain
tumor.”
c. Set boundaries: “Sir, I will take your vital signs,
but then I am going to call your case manager so
that you can discuss the scheduled
appointment.”
d. Respect the patient's wishes: “Sir, sit down and I
will make sure that you see the health care
provider right away. Don’t worry; we will take
care of you.”
4. A patient who was recently diagnosed with
conversion disorder is experiencing a sudden loss of
vision after witnessing a violent fight between her
husband and adult-age son. What is the priority
therapeutic approach to use with this patient?
a. Reassure her that her blindness is temporary and
will resolve with time.
b. Gently point out that she seems to be able to see
well enough to function independently.
c. Encourage expression of feelings and link
emotional trauma to the blindness.
d. Teach ways to cope with blindness, such as
methodically arranging personal items.
5. The charge nurse is reviewing the assignment sheet
for an acute psychiatric
unit. Which experienced team member should be
reassigned?
a. Male LVN assigned to an older male patient with
chronic depression and excessive rumination
b. Young male psychiatric nursing assistant
assigned to a female adolescent with anorexia
nervosa
c. Female RN assigned to a newly admitted female
patient who has command hallucinations and
delusions of persecution
d. Older female RN with medical-surgical
experience assigned to a male patient with
Alzheimer disease
6. The nurse arrives home and finds that a neighbor's
(Jane’s) house is on fire. A
fireman is physically restraining Jane as she screams and
thrashes around to
get free to run back into the house. What is the nurse's
best action?
 a. Make eye contact and encourage Jane to
verbalize feelings.
b. Physically restrain Jane so that the fireman can
resume his job.
c. Use a firm tone of voice and give Jane simple
commands.
d. Use a gentle persuading tone and ask Jane to be
calm.
7. There is a patient on the medical-surgical unit who
has been there for several
months. He is hostile, rude, and belligerent, and no one
likes to interact with
him. How should the charge nurse handle the
assignment?
a. Rotate the assignment schedule so that no one
has to care for him more than once or twice a
week.
b. Pair a float nurse and a nursing student and
assign the patient to that team because they will
have a fresh perspective toward the patient.
c. Identify two or three experienced nurses as
primary caregivers and develop a plan that
includes psychosocial interventions.
d. Assign self as primary caregiver and role-model
how patients should be treated.
8. The charge nurse is reviewing medication
prescriptions for several patients
on the acute psychiatric unit. Which prescription is the
nurse most likely to
question?
a. Fluoxetine for a middle-aged patient with
depression
b. Chlorpromazine for a young patient with
schizophrenia
c. Loxapine for an older adult patient with
dementia and psychosis
d. Lorazepam for a young patient with generalized
anxiety disorder
9. A patient diagnosed with paranoid schizophrenia tells
the nurse that, “Dr.
Smith has killed several other patients, and now he is
trying to kill me.” What
is the best response?
a. “I have worked here a long time. No one has
died. You are safe here.”
b. “What has Dr. Smith done to make you think he
would like to kill you?”
c. “All of the staff, including Dr. Smith, are here to
ensure your safety.”
d. “Whenever you are concerned or nervous, talk
to me or any of the nurses.”
10. A nursing student reports to the nurse that he has
observed several types of behavior among the patients.
Which patient needs priority assessment?
a. A patient who is having command hallucinations
b. A patient who is demonstrating clang
associations
c. A patient who is verbalizing ideas of reference
d. A patient who is using neologisms
11. The nurse is talking to the primary caregiver of
Martha, who was diagnosed 8 years ago with Alzheimer
disease. The caregiver says, “We love Martha, but my
daughter needs help with her kids, and my husband's
health is poor. I really need help.” Which member of the
health care team should the nurse consult first?
a. Health care provider to review long-term
prognosis and new treatments for Alzheimer
disease
b. Psychiatric clinical nurse specialist to design
behavioral modification therapies for Martha
c. Clinical psychologist to assess for major
depression and need for treatment for the
caregiver
d. Social worker to identify and arrange placement
for Martha in an acceptable nursing home
12. The patient has a panic disorder, and it appears that
he is having some problems controlling his anxiety.
Which symptoms are cause for greatest concern?
a. His heart rate is increased, and he reports chest
tightness.
b. He demonstrates tachypnea and carpopedal
spasms.
c. He is pacing to and fro and pounding his fists
together.
d. He is muttering to himself and is easily startled.
13. The nurse is interviewing a patient with suicidal
ideations and a history of
major depression. Which comment is cause for greatest
concern?
a. “I have had problems with depression most of
my adult life.”
b. “My father and my brother both committed
suicide.”
c. “My wife is having health problems, and she
relies on me.”
d. “I am afraid to kill myself, and I wished I had
more courage.”
14. A patient comes into the walk-in clinic and tells the
nurse that he would like
to be admitted to an alcohol rehabilitation program.
Which question is the
most important to ask?
a. “What made you decide to enter a program at
this time?”
b. “How much alcohol do you usually consume in a
day?”
c. “When was the last time you had a drink?”
d. “Have you been in a rehabilitation program
before?”
15. The nurse is working with a health care provider
who recently started treating patients with depression.
Which action by the provider would prompt the nurse
to intervene?
a. Tells patient and family that it may take 4 to 8
weeks before the antidepressant medication
begins to relieve symptoms
b. Prescribes 3 months of antidepressants for a
patient newly diagnosed with depression and
gives a 3-month follow-up appointment
 c. Instructs the patient that the initial dose is low
but will gradually be increased to reach a
maintenance dosage
d. Tells the patient and the family to watch for and
immediately report anxiety, agitation,
irritability, or suicidal thoughts
16. A patient on the acute psychiatric unit develops
neuroleptic malignant syndrome. Which task should be
delegated to the psychiatric nursing assistant (PNA)?
a. Wiping the patient's body with cool moist
towels
b. Monitoring and interpreting vital signs every 15
minutes
c. Attaching the patient to the electrocardiogram
(ECG) monitor
d. Transporting the patient to the medical
intensive care unit
17. A newly graduated nurse has just started working at
the acute psychiatric unit. Which patient would be the
best to assign to this nurse?
a. Patient who is frequently admitted for
borderline personality disorder and suicidal
gesture
b. Patient admitted yesterday for disorganized
schizophrenia and psychosis
c. Patient newly admitted to determine
differential diagnosis of depression, dementia,
or delirium
d. Patient newly diagnosed with major depression
and rumination about loss and suicide
18. Which task can be delegated to a medical-surgical
unlicensed assistive personnel (UAP) who has been
temporarily floated to the acute psychiatric unit to
help?
a. Performing one-to-one observation of a patient
who is suicidal
b. Assisting the occupational therapist to conduct
a craft class
c. Accompanying an older adult patient who
wanders on a walk outside
d. Assisting the medication nurse who is having
problems with a patient
19. The nurse has identified a patient who may be a
candidate for substance addiction treatment. Which
health care team member should the nurse contact to
increase the likelihood of a successful long-term
outcome?
a. Call a social worker who can locate an
immediately available treatment program.
b. Call admissions to obtain patient's voluntary
consent to enter treatment program.
c. Consult a pharmacist about medication therapy
to counter addiction.
d. Contact the health care provider to initiate
admission to a medical detoxification unit.
20. The team must apply restraints to a combative
patient to prevent harm to
others or to self. Which action requires the charge
nurse's intervention?
a. Psychiatric nursing assistant uses a quick-
release knot to tie restraints.
b. Health care provider (HCP) secures the restraint
to the side rail.
c. RN checks the pulses distal to the restraints.
d. LPN/LVN explains to the patient why he is being
restrained.
21. A well-known celebrity is admitted to the psychiatric
unit. Several RNs from other units drop by and express
an interest in seeing the patient. What is the best
response?
a. “Please be discreet and do not interrupt the
work flow.”
b. “How did you find out that the patient was
admitted to this unit?”
c. “Please wait. I need to call the nursing
supervisor about this request.”
d. “I’m sorry; the patient has asked that only
family be allowed to visit.”
22. An LPN/LVN complains to the charge nurse that she
is always assigned to
the same patient with chronic depression. What should
the charge nurse do?
1. Look at the assignment sheet and see if there is any
way to switch
assignments with another LPN/LVN.
423
2. Tell her to care for the patient today but that her
request will be considered
for future assignments.
3. Remind her that continuity of care and patient-
centered care are the
primary goals.
4. Explain that patients with chronic conditions are
more likely to fall under
the LPN/LVN scope of practice.
23. Which person is displaying behaviors that most
strongly suggest the need for additional screening for
possible substance abuse?
a. Person with cancer progressively needs more
pain medication to achieve relief
b. College student reports occasionally smoking
marijuana during semester break
c. Stay-at-home mom reports drinking while her
kids are in school and after they go to bed
d. Person with a fractured leg reports taking
opioids and tapering off when pain subsides
24. The emergency department (ED) nurse is calling to
report on a patient who will be admitted to the acute
psychiatric unit. He has a history of bipolar disorder and
was in an altercation that resulted in the death of
another. He has contusions, abrasions, and minor
lacerations. What is the priority question that the
receiving nurse should ask?
a. “When will the patient be transferred?”
b. “Will a police officer be with him while he is on
the unit?”
c. “Why isn’t the patient being admitted to the
trauma unit?”
 d. “What is the patient's current mood and
behavior?”
25. A patient needs clonazepam 0.25 mg PO. The
pharmacy delivers lorazepam 2-mg tablets. A nursing
student asks the nurse if clonazepam and lorazepam are
interchangeable or if they are the same drug. Place the
following steps in the correct sequence so that the
nurse can teach the nursing student how to prevent
medication errors.
a. Advise the pharmacy of any corrections as
appropriate.
b. Recognize that “look-alike, sound-alike” drugs
increase the chances of error.
c. Consult a medication book to verify the purpose
of the drugs and generic and brand names.
d. Check the original medication order to verify
what was prescribed.
e. Write an incident report, as appropriate, if a
system error is occurring.
f. Call the health care provider (HCP) for
clarification of the order as appropriate.
_____, _____, _____, _____, _____, _____
b, d, c, f, a, e (2,4,3,6,1,5)
26. The vital signs of a 23-year-old man with no known
health problems are unexpectedly abnormal. When the
nurse mentions the vital signs, he says, “Well, I was a
little nervous, so I smoked four or five cigarettes right
before I came into the clinic.” Which vital signs would
be consistent with the patient's use of cigarettes?
a. Blood pressure of 90/60 mm Hg; pulse of 60
beats/min
b. Temperature of 100.6°F (38.1°C); respirations of
40 breaths/min
c. Blood pressure of 140/90 mm Hg; pulse of 120
beats/min
d. Temperature of 97.4°F (36.3°C); respirations of
12 breaths/min
27. A patient is displaying muscle spasms of the tongue,
face, and neck, and his eyes are locked in an upward
gaze. He has been prescribed haloperidol. What is the
priority action by the nurse?
a. Maintain eye contact and stay with him until
the spasms pass.
b. Place the patient on aspiration precautions until
the spasms subside.
c. Obtain an order for intramuscular or IV
diphenhydramine.
d. Obtain an order for and administer an
antiseizure medication.
28. Several patients are taking antipsychotic
medications and are having medication side effects.
Place the following patients in priority order for
additional assessment and appropriate interventions,
with 1 being the most critical and 4 being the least.
a. A patient who is taking trifluoperazine and has a
temperature of 103.6°F (39.8°C) with
tachycardia, muscular rigidity, and dysphagia
b. A patient who is taking fluphenazine and has
dry mouth and dry eyes, urinary hesitancy,
constipation, and photosensitivity
c. A patient who is taking loxapine and has a
protruding tongue with lip smacking and spastic
facial distortions
d. A patient who is taking clozapine and reports a
sore throat, fever, malaise, and flulike
symptoms that began about 6 weeks ago after
starting the new antipsychotic medication;
white blood cell count is 2000/mm3 (2.0 ×
109/L) _____, _____, _____, _____
a,d,c,b (1,4,3,2)
29. The patient tells the nurse that he drinks 3 or 4
servings of alcohol every day. He also reports frequently
taking acetaminophen for stress-related headaches.
Based on this information, which laboratory test results
are the most important to follow up on?
a. Renal function tests
b. Liver function tests
c. Cardiac enzymes
d. Serum electrolytes
30. The nurse is reviewing the principle of “least
restrictive” interventions with the staff. Place the
following interventions in the correct order, with 1
being the least restrictive and 6 being the most
restrictive.
a. Escort the patient to a quiet room for a time
out.
b. Restrain the patient's arms and legs with soft
cloth restraints.
c. Verbally instruct the patient to stop the
unacceptable behavior (i.e., yelling, arguing)
and move to another part of the day room.
d. Accompany the patient out into the garden
courtyard.
e. Restrain the patient's upper extremities with
wrist restraints.
f. Place the patient in isolation room with
psychiatric nursing assistant observing.
_____, _____, _____, _____, _____, _____
c, d, a, f, e, b (3, 4, 1, 6, 5, 2)
31. The home health nurse is reviewing the plan of care
for a 62-year-old patient who lives with his wife at
home. The health care provider (HCP) recently
prescribed rivastigmine twice daily for the patient.
Based on this information, what additional assessment
would the nurse plan to perform first?
a. Assess for psychotic features, such as
hallucinations.
b. Perform a comprehensive pain assessment.
c. Assess for cognitive deficits and memory loss.
d. Observe for fine and gross motor deficits.
32. Which behavior would be the most problematic and
require vigilance to prevent danger to self or others?
a. Avolition
b. Echolalia
c. Motor agitation
d. Stupor
33. A patient comes in to the clinic with nausea,
constipation, and “excruciating stomach pain.” Over a
period of several years, this patient has come in two or
three times a month with the same report, but multiple
diagnostic tests have consistently yielded negative
results for physical disorders. What is the priority
nursing intervention for this patient?
a. Advocate for the patient to have a psychiatric
consultation.
b. Make appointment as soon as possible with
same health care provider (HCP) for continuity
of care.
c. Perform a physical assessment to identify any
physical abnormalities.
d. Assess for concurrent symptoms of depression
or anxiety.
34. An older man was admitted for palliative care of
terminal pancreatic cancer. His wife stated, “We don’t
want hospice; he wants treatment.” The patient
requested discharge and home health visits. Several
hours after discharge, the man committed suicide with a
gun. Which people should participate in a root cause
analysis of this sentinel event? Select all that apply.
a. The wife and all immediate family members
b. Only the health care provider (HCP) who
discharged the patient
c. Any nurse who cared for the patient during
hospitalization
d. The case manager who arranged home visits for
the patient
e. Only the nurse who discharged the patient
f. All HCPs who were involved in the care of the
patient
35. An adolescent girl is admitted to the medical-
surgical unit for diagnostic evaluation and nutritional
support related to anorexia nervosa. She is mildly
dehydrated, her potassium level is 3.5 mEq/L (3.5
mmol/L), and she has experienced weight loss of more
than 25% within the past 3 months. What is the primary
collaborative goal?
a. Assist her to increase feelings of control.
b. Decrease power struggles over eating.
c. Resolve dysfunctional family roles.
d. Restore normal nutrition and weight.
36. In caring for a patient who is admitted to a medical
surgical unit for treatment of anorexia nervosa, which
task can be delegated to unlicensed assistive personnel
(UAP)?
a. Sitting with the patient during meals and for 1
to 1½ hours after meals
b. Observing for and reporting ritualistic behaviors
related to food
c. Obtaining special food for the patient when she
requests it
d. Weighing the patient daily and reinforcing that
she is underweight
37. Nurse B frequently asks to be assigned to care for
patients who require opioids for pain; drug counts
involving Nurse B frequently show discrepancies. Nurse
A suspects that Nurse B may have a substance abuse
problem. Based on the ethical principle of negligence,
what should Nurse A do first?
a. Talk to Nurse B and give counsel about the
ethical issues of taking patients’ medications.
b. Continue to assess Nurse B's behavior for other
signs and symptoms of abuse.
c. Work closely with Nurse B to give support and
help to reduce stress of workload.
d. Report facts to the nursing supervisor to include
date, time, circumstance, and behaviors.
38. A male-to-female transgender patient (transwoman)
is admitted to an acute care psychiatric unit for
depression and suicidal ideations. On her arrival, several
other patients display suspicion and contempt and
verbal harassment is directed toward the woman. What
should the charge nurse do first?
a. Isolate the patient and explain that the action is
meant for her safety and privacy.
b. Make a general announcement to all patients
and staff that bullying will not be tolerated.
c. Assess the patient's reaction to the comments
and nonverbal behaviors.
d. Gently suggest that the patient could
temporarily adopt natal gender appearance.
39. You arrive home and find that the house of your
neighbor (Jane) is on fire. A fireman is physically
restraining her from running back into the house. What
is the best response?
a. Jane, come and sit in my house until this is over
with
b. Jane, calm down and let the fireman do his job
c. Jane, look at me and hold my hand
d. Jane, tell me why you are struggling so hard
40. An LPN complains to you that she is always assigned
to the same patient with chronic depression. What
should you do?
a. Look at the assignment sheet and see if there is
any way to switch assignments with another
LPN
b. Tell her to care for the patient today, but that
you will remember the request for future
assignments
c. Remind her that continuity of care and patient-
centered care are the primary goals
d. Explain that patients with chronic conditions are
more likely to fall under the LPN scope of
practice

Psychiatric Nursing Exam
Personality disorder
1. A client with obsessive-compulsive disorder (OCD) is
in the hospital after having been diagnosed with a
chronic illness. Which best describes what the nurse
would see in this client while trying to provide care?
a) Anxiety because they have no control over their
illness
b) Questioning so much that the nurse has
difficulty leaving the room
c) Requesting help with minor tasks and
portraying a helpless role
d) Refusing to trust the nurse and acting paranoid
Rationale: (A)- A person with an obsessive-compulsive
disorder (OCD) may feel frustrated with their diagnosis when
they are unable to control their health or symptoms. The
nurse can best help this client by providing many details
about his treatment and helping to have a small element of
control in certain areas.
2. A 23-year-old client is being seen for treatment
after purposely cutting the skin on her arm. The
client has impulsive behavior, is angry, and has been
losing friends because of intense and needy
behavior. Which type of personality disorder does
this best describe?
a) Borderline personality disorder
b) Antisocial personality disorder
c) Histrionic personality disorder
d) Schizotypal personality disorder
Rationale: (A)- A borderline personality disorder is
manifested by varying degrees of moodiness, neediness, and
self-image. The client with a borderline personality disorder
has mood instability and is often emotionally unstable in his
or her behavior and relationships. The condition can also lead
to acute psychotic episodes that can be dangerous, such as
when a client purposely self-mutilates.
3. A 23-year-old client is being seen for treatment
after purposely cutting the skin on her arm. The
client has impulsive behavior, is angry, and has been
losing friends because of intense and needy
behavior. Which type of personality disorder does
this best describe?
a. Borderline personality disorder
b. Antisocial personality disorder
c. Histrionic personality disorder
d. Schizotypal personality disorder
4. A client with schizoaffective disorder has been
admitted to the inpatient mental health center of
the hospital. The client tells the nurse that he hears
voices telling him to leave the hospital. Which
response from the nurse is best?
a. I do not hear anything, but I can see how you
may feel worried about being in the hospital
right now
b. You know that those voices aren't real, don't
you?
c. Why don't we go to the game room and see
what is happening there today?
d. I do not hear anything, but you cannot leave the
hospital
5. Which of the following are ways nurses create
barriers to therapeutic communication? Select all
that apply.
a. Using clichés
b. Active listening
c. Changing the subject
d. Making eye contact
e. Offering support
6. A client has been diagnosed with antisocial
personality disorder and becomes very angry with
the nurse and is starting to become aggressive.
Which principle of management would most likely
be implemented in this situation?
a. Remain calm and put space between the nurse
and the client
b. change the client that the nurse is competent in
self-defense
c. Promise the client that he will not be harmed if
he cooperates
d. Have the client stay in a private room that can
be locked
7. Piaget's stages are: stage: birth to 18-24 months
a. Preoperational stage: 2 to 7 years
b. Concrete operational stage: 7 to 11 years
c. Formal operational stage: ages 12 and up
Psychiatric Nursing Exam
Exam for Schizophrenia
1. Nurse Dorothy is evaluating care of a client with
schizophrenia, the nurse should keep which point in
mind?
a) Frequent reassessment is needed and is based
on the client’s response to treatment.
b) The family does not need to be included in the
care because the client is an adult.
c) The client is too ill to learn about his illness.
d) Relapse is not an issue for a client with
schizophrenia.
2. Gio told his nurse that the FBI is monitoring and
recording his every movement and that microphones
have been plated in the unit walls. Which action would
be the most therapeutic response?
a) Confront the delusional material directly by
telling Gio that this simply is not so.
b) Tell Gio that this must seem frightening to him
but that you believe he is safe here.
c) Tell Gio to wait and talk about these beliefs in
his one-on-one counselling sessions.
d) Isolate Gio when he begins to talk about these
beliefs.
3. Which of the following client behaviors documented
in Gio’s chart would validate the nursing diagnosis of
Risk for other-directed violence?
a) Gio’s description of being endowed with
superpowers
b) Frequent angry outburst noted toward peers
and staff
c) Refusal to eat cafeteria food
d) Refusal to join in group activities
4. Nurse Winona educates the family about symptom
management for when the schizophrenic client
becomes upset or anxious. Which of the following
would Nurse Winona state is helpful?
a) Call the therapist to request a medication
change.
b) Encourage the use of learned relaxation
techniques.
c) Request that the client be hospitalized until the
crisis is over.
d) Wait before the anxiety worsens before
intervening.
5. Drogo who has had auditory hallucinations for many
years tells Nurse Khally that the voices prevents his
participation in a social skills training program at the
community health center. Which intervention is most
appropriate?
a) Let Drogo analyze the content of the voices.
b) Advise Drogo to participate in the program
when the voices cease.
c) Advise Drogo to take his medications as
prescribed.
d) Teach Drogo to use thought stopping
techniques.
6. Cersei is diagnosed as having disorganized
schizophrenia. Which behaviors would Nurse Sansa
most likely assess in the client?
a) Absence of acute symptoms, impaired role
function
b) Extreme social withdrawal, odd mannerisms
and behavior
c) Psychomotor immobility; presence of waxy
flexibility
d) Suspiciousness toward others, increased
hostility
7. Jaime has a diagnosis of schizophrenia with negative
symptoms. In planning care for the client, Nurse
Brienne would anticipate a problem with:
a) auditory hallucinations.
b) bizarre behaviors.
c) ideas of reference.
d) motivation for activities.
8. The family of a schizophrenic client asks the nurse if
there is a genetic cause of this disorder. To answer the
family, which fact would the nurse cite?
a) Conclusive evidence indicates a specific gene
transmits the disorder.
b) Incidence of this disorder is variable in all
families.
c) There is a little evidence that genes play a role
in transmission.
d) Genetic factors can increase the vulnerability
for this disorder.
9. Ramsay is diagnosed with schizophrenia paranoid
type and is admitted in the psychiatric unit of Medical
Center. Which of the following nursing interventions
would be most appropriate?
a) Establishing a non-demanding relationship
b) Encouraging involvement in group activities
c) Spending more time with Ramsay
d) Waiting until Ramsay initiates interaction
10. A client tells the nurse that psychotropic medicines
are dangerous and refuses to take them. Which
intervention should the nurse use first?
a) Ask the client about any previous problems with
psychotropic medications.
b) Ask the client if an injection is preferable.
c) Insist that the client take medication as
prescribed.
d) Withhold the medication until client is less
suspicious.
11. Upon Sam’s admission for acute psychiatric
hospitalization, Nurse Jona documents the following:
Client refuses to bathe or dress, remains in room most
of the day, speaks infrequently to peers or staff. Which
nursing diagnosis would be the priority at this time?
a) Anxiety
b) Decisional conflict
c) Self-care deficit
d) Social isolation
12. Which statement is correct about a 25-year-old
client with newly diagnosed schizophrenia?
a) Age of onset is typical for schizophrenia.
b) Age of onset is later than usual for
schizophrenia.
c) Age of onset is earlier than usual for
schizophrenia.
d) Age of onset follows no predictable pattern in
schizophrenia.
13. Which factor is associated with increased risk for
schizophrenia?
a) Alcoholism
b) Adolescent pregnancy
c) Overcrowded schools
d) Poverty
14. Nurse Arya assesses for evidence of positive
symptoms of schizophrenia in a newly admitted client.
Which of the following symptoms are considered
positive evidence? Select all that apply.
a) Anhedonia
b) Delusions
c) Flat affect
d) Hallucinations
e) Loose associations
f) Social withdrawal
15. A client with schizophrenia is referred for
psychosocial rehabilitation. Which of the following are
typical of this type of program? Select all that apply.
a) Analyzing family issues and past problems
b) Developing social skills and supports
c) Learning how to live independently in a
community
d) Learning job skills for employment
e) Treating family members affected by the illness
f) Participating in in-depth psychoanalytical
counselling
Psychiatric Nursing Exam
SCHIZOPHRENIA QUESTIONS
1. The nurse is caring for a client with schizophrenia.
Which of the following outcomes is the least desirable?
A. The client spends more time by himself.
B. The client doesn't engage in delusional thinking.
C. The client doesn't harm himself or others.
D. The client demonstrates the ability to meet his
own self-care needs.
2. The nurse formulates a nursing diagnosis of Impaired
verbal communication for a client with schizotypal
personality disorder. Based on this nursing diagnosis,
which nursing intervention is most appropriate?
A. Helping the client to participate in social
interactions
B. Establishing a one-on-one relationship with the
client
C. Establishing alternative forms of
communication
D. Allowing the client to decide when he wants to
participate in verbal communication with the
nurse
3. Since admission 4 days ago, a client has refused to
take a shower, stating, "There are poison crystals
hidden in the shower head. They'll kill me if I take a
shower." Which nursing action is most appropriate?
A. Dismantling the showerhead and showing the
client that there is nothing in it
B. Explaining that other clients are complaining
about the client's body odor
C. Asking a security officer to assist in giving the
client a shower
D. Accepting these fears and allowing the client to
take a sponge bath
4. Drug therapy with thioridazine (Mellaril) shouldn't
exceed a daily dose of 800 mg to prevent which adverse
reaction?
A. Hypertension
B. Respiratory arrest
C. Tourette syndrome
D. Retinal pigmentation
5.A client with paranoid personality disorder is admitted
to a psychiatric facility. Which remark by the nurse
would best establish rapport and encourage the client
to confide in the nurse?
A. "I get upset once in a while, too."
B. "I know just how you feel. I'd feel the same way
in your situation."
C. "I worry, too, when I think people are talking
about me."
D. "At times, it's normal not to trust anyone."
6. How soon after chlorpromazine (Thorazine)
administration should the nurse expect to see a client's
delusional thoughts and hallucinations eliminated?
A. Several minutes
B. Several hours
C. Several days
D. Several weeks
7.A client is about to be discharged with a prescription
for the antipsychotic agent haloperidol (Haldol), 10 mg
by mouth twice per day. During a discharge teaching
session, the nurse should provide which instruction to
the client?
A. Take the medication 1 hour before a meal.
B. Decrease the dosage if signs of illness decrease.
C. Apply a sunscreen before being exposed to the
sun.
D. Increase the dosage up to 50 mg twice per day
if signs of illness don't decrease.
8. A client with paranoid schizophrenia repeatedly uses
profanity during an activity therapy session. Which
response by the nurse would be most appropriate?
A. "Your behavior won't be tolerated. Go to your
room immediately."
B. "You're just doing this to get back at me for
making you come to therapy."
C. "Your cursing is interrupting the activity. Take
time out in your room for 10 minutes."
D. "I'm disappointed in you. You can't control
yourself even for a few minutes."
9.Which of the following is one of the advantages of the
newer antipsychotic medication risperidone
(Risperdal)?
A. The absence of anticholinergic effects
B. A lower incidence of extrapyramidal effects
C. Photosensitivity and sedation
D. No incidence of neuroleptic malignant
syndrome
10.The etiology of schizophrenia is best described by:
A. genetics due to a faulty dopamine receptor.
B. environmental factors and poor parenting.
C. structural and neurobiological factors.
D. a combination of biological, psychological, and
environmental factors.
11.A client with schizophrenia who receives
fluphenazine (Prolixin) develops pseudoparkinsonism
and akinesia. What drug would the nurse administer to
minimize extrapyramidal symptoms?
A. benztropine (Cogentin)
B. dantrolene (Dantrium)
C. clonazepam (Klonopin)
D. diazepam (Valium)
12.A client with a diagnosis of paranoid schizophrenia
comments to the nurse, "How do I know what is really
in those pills?" Which of the following is the best
response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of
the medication.
C. Say, "Don't worry about what is in the pills. It's
what is ordered."
D. Ignore the comment because it's probably a
joke.
13.A client tells the nurse that people from Mars are
going to invade the earth. Which response by the nurse
would be most therapeutic?
A. "That must be frightening to you. Can you tell
me how you feel about it?"
B. "There are no people living on Mars."
C. "What do you mean when you say they're going
to invade the earth?"
D. "I know you believe the earth is going to be
invaded, but I don't believe that."
14.A client with schizophrenia tells the nurse he hears
the voices of his dead parents. To help the client ignore
the voices, the nurse should recommend that he:
A. sit in a quiet, dark room and concentrate on the
voices.
B. listen to a personal stereo through headphones
and sing along with the music.
C. call a friend and discuss the voices and his
feelings about them.
D. engage in strenuous exercise.
15.A client with schizophrenia is receiving antipsychotic
medication. Which nursing diagnosis may be
appropriate for this client?
A. Ineffective protection related to blood
dyscrasias
B. Urinary frequency related to adverse effects of
antipsychotic medication
C. Risk for injury related to a severely decreased
level of consciousness
D. Risk for injury related to electrolyte
disturbances
16.A client with persistent, severe schizophrenia has
been treated with phenothiazines for the past 17 years.
Now the client's speech is garbled as a result of drug-
induced rhythmic tongue protrusion. What is another
name for this extrapyramidal symptom?
A. Dystonia
B. Akathisia
C. Pseudoparkinsonism
D. Tardive dyskinesia
17.The nurse is assigned to a client with catatonic
schizophrenia. Which intervention should the nurse
include in the client's plan of care?
A. Meeting all of the client's physical needs
B. Giving the client an opportunity to express
concerns
C. Administering lithium carbonate (Lithonate) as
prescribed
D. Providing a quiet environment where the client
can be alone
18.A client with a history of medication noncompliance
is receiving outpatient treatment for chronic
undifferentiated schizophrenia. The physician is most
likely to prescribe which medication for this client?
A. chlorpromazine (Thorazine)
B. imipramine (Tofranil)
C. lithium carbonate (Lithane)
D. fluphenazine decanoate (Prolixin Decanoate)
19.Propranolol (Inderal) is used in the mental health
setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood
stabilizer
C. Delusions for clients suffering from
schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce
ritualistic behavior
20.Every day for the past 2 weeks, a client with
schizophrenia stands up during group therapy and
screams, "Get out of here right now! The elevator
bombs are going to explode in 3 minutes!" The next
time this happens, how should the nurse respond?
A. "Why do you think there is a bomb in the
elevator?"
B. "That is the same thing you said in yesterday's
session."
C. "I know you think there are bombs in the
elevator, but there aren't."
D. "If you have something to say, you must do it
according to our group rules."
21.A 26-year-old client is admitted to the psychiatric
unit with acute onset of schizophrenia. His physician
prescribes the phenothiazine chlorpromazine
(Thorazine), 100 mg by mouth four times per day.
Before administering the drug, the nurse reviews the
client's medication history. Concomitant use of which
drug is likely to increase the risk of extrapyramidal
effects?
A. guanethidine (Ismelin)
B. droperidol (Inapsine)
C. lithium carbonate (Lithonate)
D. alcohol
22.A client, age 36, with paranoid schizophrenia
believes the room is bugged by the Central Intelligence
Agency and that his roommate is a foreign spy. The
client has never had a romantic relationship, has no
contact with family members, and hasn't been
employed in the last 14 years. Based on Erikson's
theories, the nurse should recognize that this client is in
which stage of psychosocial development?
A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust
23.During a group therapy session in the psychiatric
unit, a client constantly interrupts with impulsive
behavior and exaggerated stories that cast her as a hero
or princess. She also manipulates the group with
attention-seeking behaviors, such as sexual comments
and angry outbursts. The nurse realizes that these
behaviors are typical of:
A. paranoid personality disorder.
B. avoidant personality disorder.
C. histrionic personality disorder.
D. borderline personality disorder.
24.The nurse is teaching a psychiatric client about her
prescribed drugs, chlorpromazine and benztropine.
Why is benztropine administered?
A. To reduce psychotic symptoms
B. To reduce extrapyramidal symptoms
C. To control nausea and vomiting
D. To relieve anxiety
25.A client is admitted to the psychiatric unit with a
tentative diagnosis of psychosis. Her physician
prescribes the phenothiazine thioridazine (Mellaril) 50
mg by mouth three times per day. Phenothiazines differ
from central nervous system (CNS) depressants in their
sedative effects by producing:
A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily
aroused.
D. more prolonged sedative effects, making the
client more difficult to arouse.
26.A woman is admitted to the psychiatric emergency
department. Her significant other reports that she has
difficulty sleeping, has poor judgment, and is incoherent
at times. The client's speech is rapid and loose. She
reports being a special messenger from the Messiah.
She has a history of depressed mood for which she has
been taking an antidepressant. The nurse suspects
which diagnosis?
A. Schizophrenia
B. Paranoid personality
C. Bipolar illness
D. Obsessive-compulsive disorder (OCD)
27.A client with paranoid schizophrenia is admitted to
the psychiatric unit of a hospital. Nursing assessment
should include careful observation of the client's:
A. thinking, perceiving, and decision-making skills.
B. verbal and nonverbal communication
processes.
C. affect and behavior.
A. D psychomotor activity.
28.Which information is most important for the nurse
to include in a teaching plan for a schizophrenic client
taking clozapine (Clozaril)?
A. Monthly blood tests will be necessary.
B. Report a sore throat or fever to the physician
immediately.
C. Blood pressure must be monitored for
hypertension.
D. Stop the medication when symptoms subside.
29.Important teaching for clients receiving antipsychotic
medication such as haloperidol (Haldol) includes which
of the following instructions?
A. Use sunscreen because of photosensitivity.
B. Take the antipsychotic medication with food.
C. Have routine blood tests to determine levels of the
medication.
D. Abstain from eating aged cheese.
30.Positive symptoms of schizophrenia include which of
the following?
A. Hallucinations, delusions, and disorganized thinking
B. Somatic delusions, echolalia, and a flat affect
C. Waxy flexibility, alogia, and apathy
D. Flat affect, avolition, and anhedonia
31.A client with chronic schizophrenia receives 20 mg of
fluphenazine decanoate (Prolixin Decanoate) by I.M.
injection. Three days later, the client has muscle
contractions that contort the neck. This client is
exhibiting which extrapyramidal reaction?
A. Dystonia
B. Akinesia
C. Akathisia
D Tardive dyskinesia
32.Hormonal effects of the antipsychotic medications
include which of the following?
A. Retrograde ejaculation and gynecomastia
B. Dysmenorrhea and increased vaginal bleeding
C .Polydipsia and dysmenorrhea
D. Akinesia and dysphasia
33.A client is unable to get out of bed and get dressed
unless the nurse prompts every step. This is an example
of which behavior?
A. Word salad
B. Tangential
C. Perseveration
D. Avolition
33.An agitated and incoherent client, age 29, comes to
the emergency department with complaints of visual
and auditory hallucinations. The history reveals that the
client was hospitalized for paranoid schizophrenia from
ages 20 to 21. The physician prescribes haloperidol
(Haldol), 5 mg I.M. The nurse understands that this drug
is used for this client to treat:
A. dyskinesia.
B. dementia.
C. psychosis.
D. tardive dyskinesia.
34.Yesterday, a client with schizophrenia began
treatment with haloperidol (Haldol). Today, the nurse
notices that the client is holding his head to one side
and complaining of neck and jaw spasms. What should
the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to
haloperidol.
D. Put the client on the list for the physician to see
tomorrow.
35.A client receiving fluphenazine decanoate (Prolixin
Decanoate) therapy develops pseudoparkinsonism. The
physician is likely to prescribe which drug to control this
extrapyramidal effect?
A. phenytoin (Dilantin)
B. amantadine (Symmetrel)
C. benztropine (Cogentin)
D. diphenhydramine (Benadryl)
36.Important teaching for a client receiving risperidone
(Risperdal) would include advising the client to:
A. double the dose if missed to maintain a therapeutic
level.
B. be sure to take the drug with a meal because it's very
irritating to the stomach.
C. discontinue the drug if the client reports weight gain.
D. notify the physician if the client notices an increase in
bruising
37.A client is admitted to the psychiatric hospital with a
diagnosis of catatonic schizophrenia. During the
physical examination, the client's arm remains
outstretched after the nurse obtains the pulse and
blood pressure, and the nurse must reposition the arm.
This client is exhibiting:
A. suggestibility.
B. negativity.
C. waxy flexibility.
D. retardation
38.A client with borderline personality disorder
becomes angry when he is told that today's
psychotherapy session with the nurse will be delayed 30
minutes because of an emergency. When the session
finally begins, the client expresses anger. Which
response by the nurse would be most helpful in dealing
with the client's anger?
A. "If it had been your emergency, I would have made
the other client wait."
B. "I know it's frustrating to wait. I'm sorry this
happened."
C. "You had to wait. Can we talk about how this is
making you feel right now?"
D. "I really care about you and I'll never let this happen
again."
39.A client begins clozapine (Clozaril) therapy after
several other antipsychotic agents fail to relieve her
psychotic symptoms. The nurse instructs her to return
for weekly white blood cell (WBC) counts to assess for
which adverse reaction?
A. Hepatitis
B. Infection
C. Granulocytopenia
D Systemic dermatitis
40.Which non-antipsychotic medication is used to treat
some clients with schizoaffective disorder?
A. phenelzine (Nardil)
B. chlordiazepoxide (Librium)
C. lithium carbonate (Lithane)
D. imipramine (Tofranil)
41.A client diagnosed with schizoaffective disorder is
suffering from schizophrenia with elements of which of
the following disorders?
A. Personality disorder
B. Mood disorder
C. Thought disorder
D. Amnestic disorder
42.When teaching the family of a client with
schizophrenia, the nurse should provide which
information?
A. Relapse can be prevented if the client takes the
medication.
B. Support is available to help family members meet
their own needs.
C. Improvement should occur if the client has a
stimulating environment.
D. Stressful family situations can precipitate a relapse in
the client
43.A client is admitted to the psychiatric unit with active
psychosis. The physician diagnoses schizophrenia after
ruling out several other conditions. Schizophrenia is
characterized by:
A. loss of identity and self-esteem.
B. multiple personalities and decreased self-esteem.
C. disturbances in affect, perception, and thought
content and form.
D. persistent memory impairment and confusion.
44.The nurse is providing care to a client with a
catatonic type of schizophrenia who exhibits extreme
negativism. To help the client meet his basic needs, the
nurse should:
A. ask the client which activity he would prefer to do
first.
B. negotiate a time when the client will perform
activities.
C. tell the client specifically and concisely what needs to
be done.
D. prepare the client ahead of time for the activity
45.The nurse is caring for a client who experiences false
sensory perceptions with no basis in reality. These
perceptions are known as:
A. delusions.
B. hallucinations.
C. loose associations.
D. neologisms.
46.The nurse is aware that antipsychotic medications
may cause which of the following adverse effects?
A. Increased production of insulin
B. Lower seizure threshold
C. Increased coagulation time
D Increased risk of heart failure
47.A client is admitted with a diagnosis of delusions of
grandeur. This diagnosis reflects a belief that one is:
A. highly important or famous.
B. being persecuted.
C. connected to events unrelated to oneself.
D. responsible for the evil in the world.
48.A man with a 5-year history of multiple psychiatric
admissions is brought to the emergency department by
the police. He was found wandering the streets
disheveled, shoeless, and confused. Based on his
previous medical records and current behavior, he is
diagnosed with chronic undifferentiated schizophrenia.
The nurse should assign the highest priority to which
nursing diagnosis?
A. Anxiety
B. Impaired verbal communication
C. Disturbed thought processes
D. Self-care deficit: Dressing/grooming
49.A client's medication order reads, "Thioridazine
(Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The
nurse should:
A. administer the medication as prescribed.
B. question the physician about the order.
C. administer the order for 200 mg P.O. q.i.d. but not for
100 mg P.O. p.r.n.
D. administer the medication as prescribed but observe
the client closely for adverse effects.
Dementia & delirium
1. A student nurse was asked which of the following
best describes dementia. Which of the following best
describes the condition?
A. Memory loss occurring as part of the natural
consequence of aging
B. Difficulty coping with physical and psychological
change
C. Severe cognitive impairment that occurs rapidly
D. Loss of cognitive abilities, impairing ability to perform
activities of daily living
2. Which of the following will Nurse Dory use when
communicating with a client who has cognitive
impairment.
A. Complete explanations with multiple details
B. Pictures or gestures instead of words
C. Stimulating words and phrases to capture the client's
attention
D. Short words and simple sentences
3. Mrs. Mendoza is a 75-year-old client who has
dementia of the Alzheimer's type and confabulates. The
nurse understands that this client:
A. Denies confusion by being jovial.
B. Pretends to be someone else.
C. Rationalizes various behaviors.
D. fills in memory gaps with fantasy.
4. Which ability should Nurse Rebecca expect from a
client in the mild stage of dementia of the Alzheimer's
type?
A. Remembering the daily schedule
B. Recalling past events
C. Coping the anxiety
D. Solving problems of daily living
5. 82-year-old Mr. Robeson together with his daughter
arrived at the medical-surgical unit for diagnostic
confirmation and management of probable delirium.
Which statement by the client's daughter best supports
the diagnosis?
A. "Maybe it's just caused by aging. This usually
happens by age 82."
B. "The changes in his behavior came on so quickly! I
wasn't sure what was happening."
C. "Dad just didn't seem to know what he was doing. He
would forget what he had for breakfast."
D. "Dad has always been so independent. He's lived
alone for years since mom died."
6. Mrs. Jordan is an elderly client diagnosed with
Alzheimer's disease. She becomes agitated and
combative when a nurse approaches to help with
morning care. The most appropriate nursing
intervention in this situation would be to:
A. tell the client firmly that it is time to get dressed.
B. obtain assistance to restrain the client for safety.
C. remain calm and talk quietly to the client.
D. call the doctor and request an order for sedation.
7. Which goal is a priority for a client with a DSM-IV-TR
diagnosis of delirium and the nursing diagnosis Acute
confusion related to recent surgery secondary to
traumatic hip fracture?
A. The client will complete activities of daily living.
B. The client will maintain safety.
C. The client will remain oriented.
D. The client will understand communication.
8. Which of the following is not included in the care of
plan of a client with a moderate cognitive impairment
involving dementia of the Alzheimer's type?
A. Daily structured schedule
B. Positive reinforcement for performing activities of
daily living
C. Stimulating environment
D. Use of validation techniques
9. In clients with a cognitive impairment disorder, the
phenomenon of increased confusion in the early
evening hours is called:
A. Aphasia.
B. Agnosia.
C. Sundowning.
D. Confabulation.
10. Which of the following outcome criteria is
appropriate for the client with dementia?
A. The client will return to an adequate level of self-
functioning.
B. The client will learn new coping mechanisms to
handle anxiety.
C. The client will seek out resources in the community
for support.
D. The client will follow an established schedule for
activities of daily living.
11. During the home visit of a client with dementia, the
nurse notes that an adult daughter persistently corrects
her father's misperceptions of reality, even when the
father becomes upset and anxious. Which intervention
should the nurse teach the caregiver?
A. Anxiety-reducing measures
B. Positive reinforcement
C. Reality orientation techniques
D. Validation techniques
12. Mr. Lim who is diagnosed with moderate dementia
has frequent catastrophic reactions during shower time.
Which of the following interventions should be
implemented in the plan of care? Select all that apply.
A. Assign consistent staff members to assist the client.
B. Accomplish the task quickly, with several staff
members assisting.
C. Schedule the client's shower at the same time of day.
D. Sedate the client 30 minutes prior to showering.
E. Tell the client to remain calm while showering.
F. Use a calm, supportive, quiet manner when assisting
the client.
Psychiatric Nursing Exam
Depression
1.A nurse is caring for a client who was diagnosed with
depression and anxiety three years ago. The client
currently has prescriptions for four different
medications for control of symptoms. Which nursing
intervention is most appropriate to reduce the risks
associated with taking many different medications in
this situation?
a) Help the client to organize the medications and
make a list of their uses and side effects
b) Tell the client that he should never take over-the-
counter medications when using this many
prescription drugs
c) Have the client contact the provider and ask to be
changed to an all-in-one drug instead of taking 4
different kinds
d) Make an appointment for the client to meet with
a dietitian to discuss the nutritional effects of
taking this many drug
2.A nurse is assisting a client who has undergone
electroconvulsive therapy for treatment of severe
depression. Following the procedure, the client
develops postictal agitation. Based on the nurse’s
knowledge of this condition, the nurse would expect to
see which of the following?
a) Hyperactivity and mania
b) Coma
c) Limb contractures
d) Incoherence, disorientation, and motor
restlessness
3.A client in the psychiatric unit has been diagnosed
with severe, intractable depression and is preparing to
undergo electroconvulsive therapy (ECT). Which best
describes the role of the nurse during ECT? Select all
that apply.
a) Prepare the client for applying EEG leads to the
head
b) Notify the provider immediately if the client is
confused following the procedure
c) Note the location of resuscitative equipment on
the nursing unit in case of need
d) Administer oxygen as needed
e) Record the length of time of the client’s seizure
4.A nurse is working with a client who suffers from
depression. The client has started taking medications
and is engaged in group therapy, but still tells the nurse,
“I do not like myself. I am annoying, even to me.” Which
activities can the nurse suggest that would most likely
increase this client’s self-concept? Select all that apply.
a) Have the client recognize personal strengths
b) Teach the client how to be mindful of negative
thoughts
c) Ask if the client has any friends
d) Remind the client not to compare self to others
e) List three things that the nurse likes about the
client
5.A nurse is counseling a client who has been diagnosed
with depression to attend a support group as part of
treatment. Which best describes how the nurse would
explain what to expect for the client?
a) A presentation where group members watch an
audiovisual demonstration
b) A small group where the client will have to
facilitate the discussion between members
c) A large group of up to 50 people meeting and
mingling together
d) A small group where the client may need to talk
about his or her mental health issues
6.A client who has developed depression after
experiencing chronic back pain is being seen at the
acute care clinic. Which best describes how the nurse
would demonstrate psychoeducation when working
with this client?
a) Helping the client to find a support group for
people who suffer from back pain
 b) Providing information to the client about an
upcoming research study based on the effects
of pain and depression
c) Administering medications that will relieve
some of the back pain
d) Teaching the client about the effects of their
mental health issue so it can be better managed
7. A 30-year-old client has been diagnosed with major
depressive disorder. Which nutrition guideline should
the nurse give to this client that could help with some
symptoms of depression?
a) Fluids such as water and sugar-free juice are
preferred over caffeinated beverages
b) The best diet for depression is the Western diet
c) The client should increase carbohydrate intake
and limit fats
d) Some free radicals in the diet combat harmful
antioxidants
8.A nurse is performing depression screenings in the
community. Which question would most likely be
included in this screening?
a) Do you hear voices or have hallucinations?
b) Do you believe that others are talking or
thinking about you?
c) Have you been having trouble sleeping?
d) Are you trying to lose weight?
9.A nurse is caring for a client has undergone ECT for
the treatment of severe depression and has developed
some complications afterward. Which of the following is
a physical side effect that has been associated with
ECT?
a) Bradycardia
b) Rash on the face and trunk
c) Muscle soreness
d) Peripheral edema
10.An 11-year-old boy has been diagnosed with
depression after his parents’ divorce. The nurse
understands that depression in children of this age most
commonly manifests as:
a) Whining
b) Low self esteem
c) Poor blood glucose control
d) Pouting
Psychiatric Nursing Exam
1. A client is suffering from stress and anxiety and is
being seen at a healthcare clinic for help and
management. Which best describes the initial physical
effects of stress and anxiety in the body? Select all that
apply.
A) Increased heart rate
B) Pinpoint pupils
C) Vasodilation
D) Changes in appetite
E) Increased respiratory rate
2. A client is experiencing stress response syndrome
after losing his job where he had worked for 21 years.
What describes the difference between stress response
syndrome and clinical depression?
A) Stress response syndrome causes hopelessness and
loss of interest in activities, but not suicidal ideation
such as with clinical depression
B) Stress response syndrome often appears after a life-
threatening event, while clinical depression appears
after a life-changing event
C) Stress response syndrome involves an increase in
pulse, blood pressure and breathing rate, while clinical
depression involves a decrease in these vital signs
D) Stress response syndrome typically lasts for months
to years, while clinical depression may last for several
weeks
3. A client is being seen for care at her primary care
clinic. The client tells the nurse that she has difficulty
sleeping because of nightmares. Identify which
description best explains the difference between night
terrors and nightmares.
A) Night terrors are frightening but are not
remembered by the client, while nightmares can be
easily remembered
B) Night terrors cause a person to sleep walk while
nightmares usually result in thrashing in bed
C) Night terrors result in the person waking up while
nightmares result in the person staying asleep
D) Night terrors are the sign of a more significant
mental illness while nightmares are considered benign
4. A 6-year-old child has been brought in for care and
treatment after suffering from physical abuse by her
father. The child is experiencing a post-traumatic fight-
or-flight response. Which signs or symptoms would the
nurse most likely expect to initially see in this client?
A) Crying and screaming
B) Dissociation
C) Somnolence
D) Stuttering and refusal to respond to caregivers
5. A nurse is caring for a client with bipolar disorder
who is frequently manic. What describes the most
appropriate psychotherapy for a client with this
condition? Select all that apply.
A) Cognitive-behavior therapy
B) 12-step programs
C) Interpersonal and social rhythm therapy
D) Family focused therapy
E) Electroconvulsive therapy
6. A client with bipolar disorder is seeking treatment for
co-occurring substance abuse disorder. During the
initial assessment and treatment process, the nurse
notes the development of countertransference. Which
best describes an example of this response?
A) The nurse feels irritated because the client reminds
the nurse of her sister
B) The client compares the nurse to her mother
C) The client blames the nurse for her bipolar disorder
D) The client determines that her substance abuse
disorder was caused by the bipolar disorder
7. A client who has developed depression after
experiencing chronic back pain is being seen at the
acute care clinic. Which best describes how the nurse
would demonstrate psychoeducation when working
with this client?
A) Teaching the client about the effects of their mental
health issue so it can be better managed
B) Helping the client to find a support group for people
who suffer from back pain
C) Administering medications that will relieve some of
the back pain
D) Providing information to the client about an
upcoming research study based on the effects of pain
and depression
8. A nurse is assisting a client who has undergone
electroconvulsive therapy for treatment of severe
depression. Following the procedure, the client
develops postictal agitation. Based on the nurse’s
knowledge of this condition, the nurse would expect to
see which of the following?
A) Incoherence, disorientation, and motor restlessness
B) Hyperactivity and mania
C) Limb contractures
D) Coma
9. A nurse is working with a client who suffers from
depression. The client has started taking medications
and is engaged in group therapy, but still tells the nurse,
“I do not like myself. I am annoying, even to me.” Which
activities can the nurse suggest that would most likely
increase this client’s self-concept? Select all that apply
A) Teach the client how to be mindful of negative
thoughts
B) List three things that the nurse likes about the client
C) Ask if the client has any friends
D) Have the client recognize personal strengths
E) Remind the client not to compare self to others
10. A nurse is caring for a client who was diagnosed
with depression and anxiety three years ago. The client
currently has prescriptions for four different
medications for control of symptoms. Which nursing
intervention is most appropriate to reduce the risks
associated with taking many different medications in
this situation?
A) Help the client to organize the medications and make
a list of their uses and side effects
B) Have the client contact the provider and ask to be
changed to an all-in-one drug instead of taking 4
different kinds
C) Tell the client that he should never take over-the-
counter medications when using this many prescription
drugs
D) Make an appointment for the client to meet with a
dietitian to discuss the nutritional effects of taking this
many drug
11. A client in the psychiatric unit has been diagnosed
with severe, intractable depression and is preparing to
undergo electroconvulsive therapy (ECT). Which best
describes the role of the nurse during ECT? Select all
that apply.
A) Prepare the client for applying EEG leads to the head
B) Note the location of resuscitative equipment on the
nursing unit in case of need
C) Record the length of time of the client’s seizure
D) Administer oxygen as needed
E) Notify the provider immediately if the client is
confused following the procedure
12. Positive symptoms of schizophrenia
 Hallucinations
 Delusions
 Disorganized speech
 Bizarre behavior
13. Negative symptoms of schizophrenia
 Decreased emotional range
 Loss of interest
 Lack of inertia
14.A nurse is caring for a client with schizophrenia who
tells her he believes that everyone else in the inpatient
unit is secretly laughing at him behind his back. Which
response by the nurse is best?
A) There are some people here who are laughing but I
do not think they are laughing at you.
B) Did you hear someone say something about you?
C) Do you think they do not like you?
D) They are probably just laughing about someone else.
15. A 50-year-old client with schizophrenia is being seen
by the mental health nurse. The client is demonstrating
signs of altered thought processes. Which
communication pattern would most be associated with
schizophrenia or psychosis? Select all that apply.
A) Word salad
B) Poverty of speech
C) Flight of ideas
D) Neologisms
E) Clanging
16. A client with catatonic schizophrenia is in the
hospital on the mental health unit. The client has not
moved for three days. Which of the following nursing
interventions best demonstrates that the nurse is
upholding the client’s safety in this situation?
A) Perform range of motion exercises and apply
sequential compression devices
B) Administer methylphenidate to control behavior
C) Place the client in seclusion until the catatonia has
resolved
D) Start an IV to administer a bolus of normal saline
solution
17. Cluster A personality disorders
 Odd & eccentric
 Schizoid
 Schizotypical
 Paranoid
18. Cluster C personality disorders
 Anxious & fearful
 Obsessive-compulsive
 Avoidant
 Dependant
19. Apraxia
 Difficulty with motor tasks
20. Aphasia
 difficulty with speech
21. Agnosia 28. Symptoms of alcohol withdrawal
 Difficulty with recognition  Tremor
22 Anomia  Anxiety
 Difficulty with naming  N/V
 Insomnia
23. A 68-year-old client is being seen because of  Hypertension
problems with memory loss. Which best describes an  Diaphoresis
example of the difference between normal memory  Hallucinations
changes with aging versus dementia?  Seizures
A) Normal memory aging involves recollective memory 29. Delirium Tremens
decline while dementia involves reconstructive memory  Medical emergency
decline  3-10 days after last drink
B) Normal memory changes may be noted as occasional  Confusion/disorintation
forgetfulness while dementia results in rapid loss of all  Agitation
things familiar  High fever
C) Normal memory loss affects interpersonal skills while  Autonomic instability
dementia affects social skills  Seizures
D) Normal memory loss involves forgetting short term  Deadly
memories while dementia involves forgetting long term 30. Nursing interventions for alcohol withdrawal
memories  Frequent assessments
 Seizures and fall precautions
24. Which medical condition has been shown to cause
 Reorient as needed
dementia in some adults?
 Maintain safety
A) Lyme disease
 Self-harm assessment
B) Trichomonas
 Long-term therapy
C) Varicella
31. Medications for alcohol withdrawal
D) Tuberculosis
 Benzos
 Antiemetics
25. A 14-year-old teen has been hospitalized for acute
exacerbation of ADHD symptoms. The nurse tries to  Thiamine
help the client to engage with others on the unit. Which  B12
of the following interventions would be most  Disulfiram
appropriate for supporting social interaction for this
client? 32. Which of the following situations best describes
A) Help the child join a structured game with other acute grief?
children A) A person is suddenly overwhelmed and starts to cry
B) Bring the client to sit with another teen who is when she sees a picture of her deceased friend
playing a video game B) A nurse sits with a client while he cries over the
C) Have the client sit and talk with another client in a death of his father
one-to-one setting C) A client feels extreme pain over the death of a child
D) Avoid social interactions until the ADHD symptoms four months earlier
are under control D) A client commits suicide because he can no longer
handle the sadness of a break up
26. A nurse is helping a client who has been developing
dementia. The client expresses fears about his condition 33. A nurse is caring for a woman whose mother died
to the nurse. Which nursing interventions would be six months ago and who is grieving over the loss. The
most appropriate in this case? Select all that apply. nurse assesses the woman for any signs of complicated
A) Help orient the client to reality grief patterns. Based on the nurse’s understanding of
B) Gently provide assistance with communication when this condition, the nurse knows to look for what signs
needed that indicate complicated grief? Select all that apply.
C) Use simple, short words A) A complete focus on the deceased person
D) Support and reassure the client B) An increase in sexual activity
E) Avoid activities that tax the client's memory C) A lack of trust in others
27. A client with Alzheimer’s disease has had difficulties D) Feelings of detachment from the world
eating and is not getting enough nutrients in his diet. E) Lack of emotion such as crying or sorrow
The client’s daughter asks the nurse if there is anything
that can be done to improve his nutrition intake. Which 34. Who is at high risk for suicide?
recommendation should the nurse give?  Personal of family history
A) Use more salt when cooking and serving food  Mental health disorders
B) Help the client choose his own eating utensils  Terminal illness
C) Provide stand-by assistance when the client eats to  Physical disabilities
offer support  Elderly and adolescents
D) Limit calories to have better control of behavior 35. Signs of impending suicide attempt
 Giving away prized possesions
  Changing will/life insurance b) aphasia
 Loss of interest in life c) agnosia
 Asking about methods d) amnesia
 Notes to loved ones
 Sudden massive improvements in mood 7. She tearfully tells the nurse “I can’t take it when she
accuses me of stealing her things.” Which response by
the nurse will be most therapeutic?
Psychiatric Nursing 2
1. Situation : The nurse assigned in the detoxification a) ”Don’t take it personally. Your mother does not
unit attends to various patients with substance-related mean it.”
disorders. A 45 years old male revealed that he b) “Have you tried discussing this with your
experienced a marked increase in his intake of alcohol mother?”
to achieve the desired effect This indicates: c) “This must be difficult for you and your
mother.”
a) withdrawal d) “Next time ask your mother where her things
b) tolerance were last seen.”
c) intoxication
d) psychological dependence 8. The primary nursing intervention in working with a
client with moderate stage dementia is ensuring that
2. The client admitted for alcohol detoxification the client:
develops increased tremors, irritability, hypertension
and fever. The nurse should be alert for impending: a) receives adequate nutrition and hydration
b) will reminisce to decrease isolation
a) delirium tremens c) remains in a safe and secure environment
b) Korsakoff’s syndrome d) independently performs self care
c) esophageal varices
d) Wernicke’s syndrome 9. She says to the nurse who offers her breakfast, “Oh
no, I will wait for my husband. We will eat together”
3. The care for the client places priority to which of the The therapeutic response by the nurse is:
following:
a) “Your husband is dead. Let me serve you your
a) Monitoring his vital signs every hour breakfast.”
b) Providing a quiet, dim room b) “I’ve told you several times that he is dead. It’s
c) Encouraging adequate fluids and nutritious time to eat.”
foods c) “You’re going to have to wait a long time.”
d) Administering Librium as ordered d) “What made you say that your husband is alive?

4. Another client is brought to the emergency room by 10. Dementia unlike delirium is characterized by:
friends who state that he took something an hour ago.
He is actively hallucinating, agitated, with irritated nasal a) slurred speech
septum. b) insidious onset
c) clouding of consciousness
a) Heroin d) sensory perceptual change
b) cocaine
c) LSD 11. Situation: A 17 year old gymnast is admitted to the
d) marijuana hospital due to weight loss and dehydration secondary
to starvation. Which of the following nursing diagnoses
5. A client is admitted with needle tracts on his arm, will be given priority for the client?
stuporous and with pin point pupil will likely be
managed with: a) altered self-image
b) fluid volume deficit
a) Naltrexone (Revia) c) altered nutrition less than body requirements
b) Narcan (Naloxone) d) altered family process
c) Disulfiram (Antabuse)
d) Methadone (Dolophine) 12. What is the best intervention to teach the client
when she feels the need to starve?
6. Situation: An old woman was brought for evaluation
due to the hospital for evaluation due to increasing a) Allow her to starve to relieve her anxiety
forgetfulness and limitations in daily function. The b) Do a short term exercise until the urge passes
daughter revealed that the client used her toothbrush c) Approach the nurse and talk out her feelings
to comb her hair. She is manifesting: d) Call her mother on the phone and tell her how
she feels
a) apraxia
13. The client with anorexia nervosa is improving if:

a) She eats meals in the dining room.
b) Weight gain
c) She attends ward activities.
d) She has a more realistic self concept.
14. The characteristic manifestation that will
differentiate bulimia nervosa from anorexia nervosa is
that bulimic individuals
a) have episodic binge eating and purging
b) have repeated attempts to stabilize their weight
c) have peculiar food handling patterns
d) have threatened self-esteem
15. A nursing diagnosis for bulimia nervosa is
powerlessness related to feeling not in control of eating
habits. The goal for this problem is:
a) Patient will learn problem solving skills
b) Patient will have decreased symptoms of
anxiety.
c) Patient will perform self care activities daily.
d) Patient will verbalize how to set limits on
others.
16. In the management of bulimic patients, the
following nursing interventions will promote a
therapeutic relationship EXCEPT:
a) Establish an atmosphere of trust
b) Discuss their eating behavior.
c) Help patients identify feelings associated with
binge-purge behavior
d) Teach patient about bulimia nervosa
17. Situation: A 35 year old male has intense fear of
riding an elevator. He claims “ As if I will die inside.” This
has affected his studies The client is suffering from:
a) agoraphobia
b) social phobia
c) Claustrophobia
d) xenophobia
18. Initial intervention for the client should be to:
a) Encourage to verbalize his fears as much as he
wants.
b) Assist him to find meaning to his feelings in
relation to his past.
c) Establish trust through a consistent approach.
d) Accept her fears without criticizing.
19. The nurse develops a countertransference reaction.
This is evidenced by:
a) Revealing personal information to the client
b) Focusing on the feelings of the client.
c) Confronting the client about discrepancies in
verbal or non-verbal behavior
d) The client feels angry towards the nurse who
resembles his mother.
20. Which is the desired outcome in conducting
desensitization:
a) The client verbalize his fears about the situation
b) The client will voluntarily attend group therapy
in the social hall.
c) The client will socialize with others willingly
d) The client will be able to overcome his disabling
fear.
21. Which of the following should be included in the
health teachings among clients receiving Valium:
a) Avoid taking CNS depressant like alcohol.
b) There are no restrictions in activities.
c) Limit fluid intake.
d) Any beverage like coffee may be taken
22. Situation: A 20 year old college student is admitted
to the medical ward because of sudden onset of
paralysis of both legs. Extensive examination revealed
no physical basis for the complaint. The nurse plans
intervention based on which correct statement about
conversion disorder?
a) The symptoms are conscious effort to control
anxiety
b) The client will experience high level of anxiety in
response to the paralysis.
c) The conversion symptom has symbolic meaning
to the client
d) A confrontational approach will be beneficial for
the client.
23. Nina reveals that the boyfriend has been pressuring
her to engage in premarital sex. The most therapeutic
response by the nurse is:
a) “I can refer you to a spiritual counselor if you
like.”
b) “You shouldn’t allow anyone to pressure you
into sex.”
c) “It sounds like this problem is related to your
paralysis.”
d) “How do you feel about being pressured into
sex by your boyfriend?”
24. Malingering is different from somatoform disorder
because the former:
a) Has evidence of an organic basis.
b) It is a deliberate effort to handle upsetting
events
c) Gratification from the environment are
obtained.
d) Stress is expressed through physical symptoms.
25. Unlike psychophysiologic disorder Linda may be best
managed with:
a) medical regimen
b) milieu therapy
c) stress management techniques
d) psychotherapy
 Anxiety Disorders and Stress: 75 Questions
1. Question
Chuck is a 20-year-old student diagnosed with
obsessive-compulsive behavior. A psychiatrist
prescribes clomipramine (Anafranil) to treat his
condition. Nurse Nicolette understands the rationale for
this treatment is that the clomipramine:
A. Increases dopamine levels
B. Increases serotonin levels
C. Decreases norepinephrine levels
D. Decreases GABA levels
2. Question
A nurse at Nurseslabs Medical Center is developing a
care plan for a female client with post-traumatic stress
disorder. Which of the following would she do initially?
A. Instruct the client to use distraction techniques to
cope with flashbacks.
B. Encourage the client to put the past in proper
perspective.
C. Encourage the client to verbalize thoughts and
feelings about the trauma.
D. Avoid discussing the traumatic event with the client.
3. Question
A group of community nurses sees and plans care for
various clients with different types of problems. Which
of the following clients would they consider the most
vulnerable to post-traumatic stress disorder?
A. An eight (8)-year-old boy with asthma who has
recently failed a grade in school.
B. A 20-year-old college student with DM who
experienced date rape.
C. A 40-year-old widower who has recently lost his wife
to cancer.
D. A wife of an individual with a severe substance abuse
problem.
4. Question
Which outcome is most appropriate for Francis who has
a dissociative disorder?
A. Francis will deal with uncomfortable emotions on a
conscious level.
B. Francis will modify stress with the use of relaxation
techniques.
C. Francis will identify his anxiety responses.
D. Francis will use problem-solving strategies when
feeling stressed.
5. Question
The psychiatric nurse uses cognitive-behavioral
techniques when working with a client who experiences
panic attacks. Which of the following techniques are
common to this theoretical framework? Select all that
apply.
A. Administering anti-anxiety medication as prescribed.
B. Encouraging the client to restructure thoughts.
C. Helping the client to use controlled relaxation
breathing.
D. Helping the client examine evidence of stressors.
E. Questioning the client about early childhood
relationships.
F. Teaching the client about anxiety and panic.
6. Question
Marty is pacing and complains of racing thoughts. Nurse
Lally asks the client if something upsetting happened,
and Marty's response is vague and not focused on the
question. Nurse Lally assess Marty's level of anxiety as:
A. Mild
B. Moderate
C. Severe
D. Panic
7. Question
Nurse Martha is teaching her students about anxiety
medications; she explains that benzodiazepines affect
which brain chemical?
A. Acetylcholine
B. Gamma-aminobutyric acid (GABA)
C. Norepinephrine
D. Serotonin
8. Question
Mandy, a nurse who works at Nurseslabs Rehabilitation
Center is assessing a client for recent stressful life
events. She recognizes that stressful life events are
both:
A. Desirable and growth-promoting
B. Positive and negative
C. Undesirable and harmful
D. Predictable and controllable
9. Question
During a community visit, volunteer nurses teach stress
management to the participants. The nurses will most
likely advocate which belief as a method of coping with
stressful life events?
A. Avoidance of stress is an important goal for living.
B. Control over one's response to stress is possible.
C. Most people have no control over their level of
stress.
D. Significant others are important to provide care and
concern.
10. Question
Genevieve only attends social events when a family
member is also present. She exhibits behavior typical of
which anxiety disorder?
A. Agoraphobia
B. Generalized anxiety disorder
C. Obsessive-compulsive disorder
D. Post-traumatic stress disorder
11. Question
Mr. Johnson was recently admitted to a psychiatric unit
because of severe obsessive-compulsive behavior.
Which initial response by the nurse would be most
therapeutic for him?
A. Accepting the client's ritualistic behaviors.
B. Challenging the client's need for rituals.
C. Expressing concern about the harmfulness of the
client's rituals.
D. Limiting the client's rituals that are excessive.
12. Question
Nurse Vicky is assessing a newly admitted client for
symptoms of post-traumatic stress disorder (PTSD).
Which symptoms are typically seen with this diagnosis?
Select all that apply.
A. Anger with numbing of other emotions.
B. Exaggerated startle response.
C. Feeling that one is having a heart attack.
D. Frequent thoughts about contamination.
E. Frequent nightmares.
F. Survivor's guilt.
13. Question
Jordanne is a client with a fear of air travel. She is being
treated in a mental institution for phobic disorder. The
treatment method involves systematic desensitization.
The nurse would consider the treatment successful if:
A. Jordanne plans a trip requiring air travel.
B. Jordanne takes a short trip on an airplane.
C. Jordanne recognizes the unrealistic nature of the fear
of riding on airplanes.
D. Jordanne verbalizes a decreased fear of air travel.
14. Question
Nurse Kerrick observes Toni who is hospitalized on an
eating disorder unit during mealtimes and for 1 hour
after eating. An explanation for this intervention is:
A. To develop a trusting relationship.
B. To maintain focus on the importance of nutrition.
C. To prevent purging behaviors.
D. To reinforce the behavioral contact.
15. Question
Marlyn is diagnosed with anorexia nervosa and is
admitted to the special eating disorder unit. The initial
treatment priority for her is:
A. To determine her current body image.
B. To identify family interaction patterns.
C. To initiate a refeeding program.
D. To promote the client's independence.
16. Question
The nurse evaluates the treatment of Mrs. Montez with
somatoform disorder as successful if:
A. Mrs. Montez practices self-medication rather than
changing health care providers.
B. Mrs. Montez recognizes that physical symptoms
increase anxiety level.
C. Mrs. Montez researches treatment protocols for
various illnesses.
D. Mrs. Montez verbalizes anxiety directly rather than
displacing it.
17. Question
Which of the following attitudes from a nurse would
hinder a discussion with an adolescent client about
sexuality?
A. Accepting
B. Matter-of-fact
C. Moralistic
D. Non Judgemental
18. Question
Nurse Wayne is planning a psychoeducational
discussion for a group of adolescent clients with
anorexia nervosa. Which of the following topics would
Nurse Wayne select to enhance understanding about
central issues in this disorder?
A. Anger management
B. Parental expectations
C. Peer pressure and substance abuse
D. Self-control and self-esteem
19. Question
Nurse Gina understands that her client Glenda who is
bulimic feels shame and guilt over binge eating and
purging. This disorder is therefore considered:
A. Ego-distorting
B. Ego-dystonic
C. Ego-enhancing
D. Ego-syntonic
20. Question
The psychoanalytic theory explains the etiology of
anorexia nervosa as:
A. The achievement of secondary gain through control
of eating.
B. A conflict between mother and child over separation
and individualization.
C. Family dynamics that lead to enmeshment of
members.
D. The incorporation of thinness as an ideal body image.
21. Question
The school nurse assesses for anorexia nervosa in an
adolescent girl. Which of the following findings are
characteristic of this disorder? Select all that apply.
A. Bradycardia
B. Hypotension
C. Chronic pain in one or more sites
D. Fear of having a serious illness
E. Irregular or absent menses
F. Refusal to maintain a minimally normal weight
22. Question
Mr. Bartowski who is newly diagnosed with rheumatoid
arthritis asks the community nurse how stress can affect
his disease. The nurse would explain that:
A. The psychological experience of stress will not affect
symptoms of physical disease.
B. Psychological stress can cause painful emotions,
which are harmful to a person with an illness.
C. Stress can overburden the body's immune system,
and therefore one can experience increased symptoms.
D. The body's stress response is stimulated when there
are major disruptions in one's life.
23. Question
During a mother's class, the nurse who is teaching the
participants on stress management is questioned about
the use of alternative treatments, such as herbal
therapy and therapeutic touch. She explains that the
advantage of these methods would include all of the
following except:
A. They are congruent with many cultural belief
systems.
B. They encourage the consumer to take an active role
in health management.
C. They promote interrelationships within the mind-
body-spirit.
D. They usually work better than traditional medical
practice.
24. Question
David is preoccupied with numerous bodily complaints
even after a careful diagnostic workup reveals no
physiologic problems. Which nursing intervention
would be therapeutic for him?
A. Acknowledge that the complaints are real to the
client, and refocus the client on other concerns and
problems.
B. Challenge the physical complaints by confronting the
client with the normal diagnostic findings.
C. Ignore the client's complaints, but request that the
client keeps a list of all symptoms.
D. Listen to the client's complaints carefully, and
question him about specific symptoms.
25. Question
Nurse Kenzo is teaching a client about sertraline
(Zoloft), which has been prescribed for depression. A
significant side effect is an interference with sexual
arousal by inhibiting erectile function. How should
Nurse Kenzo approach this topic?
A. Nurse Kenzo should avoid mentioning the sexual side
effects to prevent the client from having anxiety about
potential erectile problems.
B. Nurse Kenzo should advise the client to report any
changes in sexual functioning in case medication
adjustments are needed.
C. Nurse Kenzo should explain that the client's sexual
desire will probably decrease while on this medication.
D. Nurse Kenzo should tell the client that sexual side
effects are expected, but that they will decrease when
his depression lifts.
26. Question
Mental health is defined as:
A. The ability to distinguish what is real from what is
not.
B. A state of well-being where a person can realize his
own abilities can cope with normal stresses of life and
work productively.
C. Is the promotion of mental health, prevention of
mental disorders, nursing care of patients during illness
and rehabilitation.
D. Absence of mental illness.
27. Question
Which of the following describes the role of a
technician?
A. Administers medications to a schizophrenic patient.
B. The nurse feeds and bathes a catatonic client.
C. Coordinates diverse aspects of care rendered to the
patient.
D. Disseminates information about alcohol and its
effects.
28. Question
Letty says, "Give me ten (10) minutes to recall the name
of our college professor who failed many students in
our anatomy class." She is operating on her:
A. Subconscious
B. Conscious
C. Unconscious
D. Ego
29. Question
The superego is that part of the psyche that:
A. Uses defensive function for protection.
B. Is impulsive and without morals.
C. Determines the circumstances before making
decisions.
D. The censoring portion of the mind.
30. Question
Primary level of prevention is exemplified by:
A. Helping the client resume self-care.
B. Ensuring the safety of a suicidal client in the
institution.
C. Teaching the client stress management techniques.
D. Case finding and surveillance in the community.
31. Question
Situation: In a home visit done by the nurse, she
suspects that the wife and her child are victims of
abuse. Which of the following is the most appropriate
for the nurse to ask?
A. "Are you being threatened or hurt by your partner?"
B. "Are you frightened of your partner?"
C. "Is something bothering you?"
D. "What happens when you and your partner argue?"
32. Question
The wife admits that she is a victim of abuse and opens
up about her persistent distaste for sex. This sexual
disorder is:
A. Sexual desire disorder
B. Sexual arousal disorder
C. Orgasm disorder
D. Sexual Pain Disorder
33. Question
What would be the best approach for a wife who is still
living with her abusive husband?
A. "Here's the number of a crisis center that you can call
for help ."
B. "It's best to leave your husband."
C. "Did you discuss this with your family?"
D. " Why do you allow yourself to be treated this way."
34. Question
Which comment about a 3-year-old child if made by the
parent may indicate child abuse?
A. "Once my child is toilet trained, I can still expect her
to have some."
B. "When I tell my child to do something once, I don't
expect to have to tell."
C. "My child is expected to try to do things such as dress
and feed."
D. "My three (3)-year-old loves to say NO."
35. Question
The primary nursing intervention for a victim of child
abuse is:
A. Assess the scope of the problem.
B. Analyze the family dynamics.
C. Ensure the safety of the victim.
D. Teach the victim coping skills.
36. Question
Situation: A 30-year-old male employee frequently
complains of low back pain that leads to frequent
absences from work. Consultation and tests reveal
negative results. The client has which somatoform
disorder?
A. Somatization Disorder
B. Hypochondriasis
C. Conversion Disorder
D. Somatoform Pain Disorder
37. Question
Freud explains anxiety as:
A. Strives to gratify the needs for satisfaction and
security.
B. Conflict between id and superego.
C. A hypothalamic-pituitary-adrenal reaction to stress.
D. A conditioned response to stressors.
38. Question
The following are the appropriate nursing diagnosis for
the client except:
A. Ineffective individual coping
B. Alteration in comfort, pain
C. Altered role performance
D. Impaired social interaction
39. Question
The following statements describe somatoform
disorders:
A. Physical symptoms are explained by organic causes.
B. It is a voluntary expression of psychological conflicts.
C. Expression of conflicts through bodily symptoms.
D. Management entails a specific medical treatment.
40. Question
What would be the best response to the client's
repeated complaints of pain:
A. "I know the feeling is real tests revealed negative
results."
B. "I think you're exaggerating things a little bit."
C. "Try to forget this feeling and have activities to take it
off your mind."
D. "So tell me more about the pain."
41. Question
Situation: A nurse may encounter children with mental
disorders. Her knowledge of these various disorders is
vital. When planning school interventions for a child
with a diagnosis of attention deficit hyperactivity
disorder, a guide to remember is to:
A. Provide as much structure as possible for the child.
B. Ignore the child's overactivity.
C. Encourage the child to engage in any play activity to
dissipate energy.
D. Remove the child from the classroom when
disruptive behavior occurs.
42. Question
The child with conduct disorder will likely demonstrate:
A. Easy distractibility to external stimuli.
B. Ritualistic behaviors
C. Preference for inanimate objects.
D. Serious violations of age-related norms.
43. Question
Ritalin is the drug of choice for children with ADHD.
Which of the following side effects may be noted?
A. Increased attention span and concentration
B. Increase in appetite
C. Sleepiness and lethargy
D. Bradycardia and diarrhea
44. Question
School phobia is usually treated by:
A. Returning the child to the school immediately with
family support.
B. Calmly explaining why attendance in school is
necessary.
C. Allowing the child to enter the school before the
other children.
D. Allowing the parent to accompany the child in the
classroom.
45. Question
A 10-year-old child has very limited vocabulary and
interaction skills. She has an I.Q. of 45. She is diagnosed
to have Mental retardation of this classification:
A. Profound
B. Mild
C. Moderate
D. Severe
46. Question
The nurse teaches the parents of a mentally retarded
child regarding her care. The following guidelines may
be taught except:
A. Overprotection of the child.
B. Patience, routine, and repetition.
C. Assisting the parents set realistic goals.
D. Giving reasonable compliments.
47. Question
The parents express apprehensions on their ability to
care for their maladaptive child. The nurse identifies
what nursing diagnosis:
A. Hopelessness
B. Altered parenting role
C. Altered family process
D. Ineffective coping
48. Question
A 5-year-old boy is diagnosed to have an autistic
disorder. Which of the following manifestations may be
noted in a client with autistic disorder?
A. Argumentativeness, disobedience, angry outburst
B. Intolerance to change, disturbed relatedness,
stereotypes
C. Distractibility, impulsiveness, and overactivity
D. Aggression, truancy, stealing, lying
56. Question
49. Question Situation: An old woman was brought for evaluation
The therapeutic approach in the care of an autistic child due to the hospital for evaluation due to increasing
includes the following except: forgetfulness and limitations in daily function. The
A. Engage in diversionary activities when acting -out. daughter revealed that the client used her toothbrush
B. Provide an atmosphere of acceptance. to comb her hair. She is manifesting:
C. Provide safety measures. A. Apraxia
D. Rearrange the environment to activate the child. B. Aphasia
C. Agnosia
50. Question D. Amnesia
According to Piaget, a 5-year-old is at what stage of
development: 57. Question
A. Sensorimotor stage She tearfully tells the nurse "I can't take it when she
B. Concrete operations accuses me of stealing her things." Which response by
C. Pre-operational the nurse will be most therapeutic?
D. Formal operation A. "Don't take it personally. Your mother does not mean
it."
51. Question B. "Have you tried discussing this with your mother?"
Situation: The nurse assigned to the detoxification unit C. "This must be difficult for you and your mother."
attends to various patients with substance-related D. "Next time ask your mother where her things were
disorders. A 45 years old male revealed that he last seen."
experienced a marked increase in his intake of alcohol
to achieve the desired effect. This indicates: 58. Question
A. Withdrawal The primary nursing intervention in working with a
B. Tolerance client with moderate stage dementia is ensuring that
C. Intoxication the client:
D. Psychological dependence A. Receives adequate nutrition and hydration.
B. Will reminisce to decrease isolation.
52. Question C. Remains in a safe and secure environment.
The client admitted for alcohol detoxification develops D. Independently performs self-care.
increased tremors, irritability, hypertension, and fever.
The nurse should be alert for impending: 59. Question
A. Delirium tremens She says to the nurse who offers her breakfast, "Oh no, I
B. Korsakoff's syndrome will wait for my husband. We will eat together" The
C. Esophageal varices therapeutic response by the nurse is:
D. Wernicke's syndrome A. "Your husband is dead. Let me serve you your
breakfast."
53. Question B. "I've told you several times that he is dead. It's time
The care for the client places priority on which of the to eat."
following: C. "You're going to have to wait a long time."
A. Monitoring his vital signs every hour. D. "What made you say that your husband is alive
B. Providing a quiet, dim room.
C. Encouraging adequate fluids and nutritious foods. 60. Question
D. Administering Librium as ordered. Dementia, unlike delirium, is characterized by:
A. Slurred speech
54. Question B. Insidious onset
Another client is brought to the emergency room by C. Clouding of consciousness
friends who state that he took something an hour ago. D. Sensory perceptual change
He is actively hallucinating, agitated, with an irritated
nasal septum. 61. Question
A. Heroin Situation: A 17-year-old gymnast is admitted to the
B. Cocaine hospital due to weight loss and dehydration secondary
C. LSD to starvation. Which of the following nursing diagnoses
D. Marijuana will be given priority for the client?
A. Altered self-image
55. Question B. Fluid volume deficit
A client is admitted with needle tracks on his arm, C. Altered nutrition less than body requirements
stuporous and with pinpoint pupil will likely be D. Altered family process
managed with:
A. naltrexone (Revia) 62. Question
B. naloxone hydrochloride (Narcan) What is the best intervention to teach the client when
C. disulfiram (Antabuse) she feels the need to starve?
D. methadone (Dolophine) A. Allow her to starve to relieve her anxiety.
B. Do a short-term exercise until the urge passes.
C. Approach the nurse and talk out her feelings.
D. Call her mother on the phone and tell her how she
feels.
63. Question
The client with anorexia nervosa is improving if:
A. She eats meals in the dining room.
B. Weight gain
C. She attends ward activities.
D. She has a more realistic self-concept.
64. Question
The characteristic manifestation that will differentiate
bulimia nervosa from anorexia nervosa is that bulimic
individuals:
A. Have episodic binge eating and purging.
B. Have repeated attempts to stabilize their weight.
C. Have peculiar food handling patterns.
D. Have threatened self-esteem.
65. Question
A nursing diagnosis for bulimia nervosa is
powerlessness related to feeling not in control of eating
habits. The goal for this problem is:
A. Patient will learn problem-solving skills.
B. Patient will have decreased symptoms of anxiety.
C. Patient will perform self-care activities daily.
D. Patient will verbalize how to set limits on others.
66. Question
In the management of bulimic patients, the following
nursing interventions will promote a therapeutic
relationship except:
A. Establish an atmosphere of trust.
B. Discuss their eating behavior.
C. Help patients identify feelings associated with binge-
purge behavior.
D. Teach the patient about bulimia nervosa.
67. Question
Situation: A 35-year-old male has an intense fear of
riding an elevator. He claims " As if I will die inside." This
has affected his studies The client is suffering from:
A. Agoraphobia
B. Social phobia
C. Claustrophobia
D. Xenophobia
68. Question
Situation: A 24-year-old female has an intense fear of
spiders. Initial intervention for the client should be to:
A. Encourage to verbalize her fears as much as she
wants.
B. Assist her to find meaning to her feelings in relation
to her past.
C. Establish trust through a consistent approach.
D. Accept her fears without criticizing.
69. Question
The nurse develops a countertransference reaction. This
is evidenced by:
A. The client feels angry towards the nurse who
resembles his mother.
B. Focusing on the feelings of the client.
C. Confronting the client about discrepancies in verbal
or non-verbal behavior.
D. Revealing personal information to the client.
70. Question
Which is the desired outcome in conducting
desensitization:
A. The client verbalizes his fears about the situation.
B. The client will voluntarily attend group therapy in the
social hall.
C. The client will socialize with others willingly.
D. The client will be able to overcome his disabling fear.
71. Question
Which of the following should be included in the health
teachings among clients receiving Valium:
A. Avoid taking CNS depressants like alcohol.
B. There are no restrictions in activities.
C. Limit fluid intake.
D. Any beverage like coffee may be taken.
72. Question
Situation: A 20-year-old college student is admitted to
the medical ward because of sudden onset of paralysis
of both legs. Extensive examination revealed no physical
basis for the complaint. The nurse plans intervention
based on which correct statement about conversion
disorder?
A. The symptoms are conscious effort to control
anxiety.
B. The client will experience a high level of anxiety in
response to the paralysis.
C. The conversion symptom has symbolic meaning to
the client.
D. A confrontational approach will be beneficial for the
client.
73. Question
Nikki reveals that the boyfriend has been pressuring her
to engage in premarital sex. The most therapeutic
response by the nurse is:
A. "I can refer you to a spiritual counselor if you like."
B. "You shouldn't allow anyone to pressure you into
sex."
C. "It sounds like this problem is related to your
paralysis."
D. "How do you feel about being pressured into sex by
your boyfriend?"
74. Question
Malingering is different from somatoform disorder
because the former:
A. Has evidence of an organic basis.
B. It is a deliberate effort to handle upsetting events.
C. Gratification from the environment is obtained.
D. Stress is expressed through physical symptoms.
75. Question
Unlike psychophysiologic disorder Linda may be best
managed with:
A. Medical regimen
B. Milieu therapy
C. Stress management techniques
D. Psychotherapy d) Helping the client examine evidence of stressors
e) Questioning the client about early childhood
Stress, Anxiety, Eating & Mind-Body Disorders relationships
f) Teaching the client about anxiety and panic
1. Adam is a 20-year-old student diagnosed of having
obsessive-compulsive behavior. A psychiatrist 6. Marty is pacing and complains of racing thoughts.
prescribes clomipramine (Anafranil) to treat his Nurse Lally asks the client if something upsetting
condition. Nurse Anna understands the rationale for happened, and Marty’s response is vague and not
this treatment is that the clomipramine: focused on the question. Nurse Lally assess Marty’s
level of anxiety as:
a) increases dopamine levels.
b) increases serotonin levels. a) mild.
c) decreases norepinephrine levels. b) moderate.
d) decreases GABA levels. c) severe.
d) panic.
2. Nurse Sarah is developing a care plan for a female
client with post-traumatic stress disorder. Which of the 7. Nurse Martha is teaching her students about anxiety
following would she do initially? medications, she explains that benzodiazepines affect
which brain chemical?
a) Instruct the client to use distraction techniques
to cope with flashbacks. a) Acetylcholine
b) Encourage the client to put the past in proper b) Gamma-aminobutyric acid (GABA)
perspective. c) Norepinephrine
c) Encourage the client to verbalize thoughts and d) Serotonin
feelings about the trauma.
d) Avoid discussing the traumatic event with 8. Nurse Mandy is assessing a client for recent stressful
client. life events. She recognizes that stressful life events are
both:
3. A group of community nurses sees and plans care for
various clients with different types of problems. Which a) desirable and growth-promoting.
of the following clients would they consider the most b) positive and negative.
vulnerable to post-traumatic stress disorder? c) undesirable and harmful.
d) predictable and controllable.
a) An 8 year-old boy with asthma who has recently
failed a grade in school 9. During a community visit, volunteer nurses teach
b) A 20 year-old college student with DM who stress management to the participants. The nurses will
experienced date rape most likely advocate which belief as a method of coping
c) A 40 year-old widower who has recently lost his with stressful life events?
wife to cancer
d) A wife of an individual with a severe substance a) Avoidance of stress is an important goal for
abuse problem living.
b) Control over one’s response to stress is
4. Which outcome is most appropriate for Francis who possible.
has a dissociative disorder? c) Most people have no control over their level of
stress.
a) Francis will deal with uncomfortable emotions d) Significant others are important to provide care
on a conscious level. and concern.
b) Francis will modify stress with the use of
relaxation techniques. 10. Genevieve only attends social events when a family
c) Francis will identify his anxiety responses. member is also present. She exhibits behavior typical of
d) Francis will use problem-solving strategies when which anxiety disorder?
feeling stressed.
a) Agoraphobia
5. The psychiatric nurse uses cognitive-behavioral b) Generalized anxiety disorder
techniques when working with a client who experiences c) Obsessive-compulsive disorder
panic attacks. Which of the following techniques are d) Post-traumatic stress disorder
common to this theoretical framework? Select all that
apply. 11. Mr. Johnson is newly admitted to a psychiatric unit
because of severe obsessive compulsive behavior.
a) Administering anti-anxiety medication as Which initial response by the nurse would be most
prescribed therapeutic for him?
b) Encouraging the client to restructure thoughts
c) Helping the client to use controlled relaxation a) Accepting the client’s ritualistic behaviors
breathing b) Challenging the client’s need for rituals
 c) Expressing concern about the harmfulness of
the client’s rituals
d) Limiting the client’s rituals that are excessive
12. Nurse Vicky is assessing a newly admitted client for
symptoms of post-traumatic stress disorder (PTSD).
Which symptoms are typically seen with this diagnosis?
Select all that apply.
a) Anger with numbing of other emotions
b) Exaggerated startle response
c) Feeling that one is having a heart attack
d) Frequent thoughts about contamination
e) Frequent nightmares
f) Survivor’s guilt
13. Jordanne is a client with a fear of air travel. She is
being treated in a mental institution for phobic
disorder. The treatment method involves systematic
desensitization. The nurse would consider the
treatment successful if:
a) Jordanne plans a trip requiring air travel.
b) Jordanne takes a short trip in an airplane.
c) Jordanne recognizes the unrealistic nature of
the fear of riding on airplanes.
d) Jordanne verbalizes a decreased fear about air
travel.
14. Nurse Kerrick observes Toni who is hospitalized on
an eating disorder unit during mealtimes and for 1 hour
after eating. An explanation for this intervention is:
a) to develop trusting relationship.
b) to maintain focus on importance of nutrition.
c) to prevent purging behaviors.
d) to reinforce the behavioral contact.
15. Marlyn is diagnosed of anorexia nervosa and is
admitted in the special eating disorder unit. The initial
treatment priority for her is:
a) to determine her current body image.
b) to identify family interaction patterns.
c) to initiate a refeeding program.
d) to promote the client’s independence.
16. The nurse evaluates the treatment of Mrs. Montez
with somatoform disorder as successful if:
a) Mrs. Montez practices self-medication rather
than changing health care providers.
b) Mrs. Montez recognizes that physical symptoms
increase anxiety level.
c) Mrs. Montez researches treatment protocols
for various illnesses.
d) Mrs. Montez verbalizes anxiety directly rather
than displacing it.
17. Which of the following attitudes from a nurse would
hinder a discussion with an adolescent client about
sexuality?
a) Accepting
b) Matter-of-fact
c) Moralistic
d) Nonjudgemental
18. Nurse David is planning a psychoeducational
discussion for a group of adolescent clients with
anorexia nervosa. Which of the following topics would
Nurse David select to enhance understanding about
central issues in this disorder?
a) Anger management
b) Parental expectations
c) Peer pressure and substance abuse
d) Self-control and self-esteem
19. Nurse Ginia understands that her client Glenda who
is bulimic feels shame and guilt over binge eating and
purging. This disorder is therefore considered:
a) ego-distorting.
b) ego-dystonic.
c) ego-enhancing.
d) ego-syntonic.
20. The psychoanalytic theory explains the etiology of
anorexia nervosa as:
a) the achievement of secondary gain through
control of eating.
b) a conflict between mother and child over
separation and individualization.
c) family dynamics that lead to enmeshment of
members.
d) the incorporation of thinness as an ideal body
image.
21. The school nurse assesses for anorexia nervosa in an
adolescent girl. Which of the following findings are
characteristic of this disorder? Select all that apply.
a) Bradycardia
b) Hypotension
c) Chronic pain in one or more sites
d) Fear of having a serious illness
e) Irregular or absent menses
f) Refusal to maintain minimally normal weight
22. Mr. Bartowski who is newly diagnosed with
rheumatoid arthritis asks the community nurse how
stress can affect his disease. The nurse would explain
that:
a) the psychological experience of stress will not
affect symptoms of physical disease.
b) psychological stress can cause painful emotions,
which are harmful to a person with an illness.
c) stress can overburden the body’s immune
system, and therefore one can experience
increased symptoms.
d) the body’s stress response is stimulated when
there are major disruptions in one’s life.
23. During a mother’s class, the nurse who is teaching
the participants on stress management is questioned
about the use of alternative treatments, such as herbal 2. Rachel is being treated in a chemical dependency
therapy and therapeutic touch. She explains that the unit. She tells the nurse that she only uses drugs when
advantage of these methods would include all of the under stress and therefore does not have a substance
following except: problem. Which defense mechanism is the client using?

a) they are congruent with many cultural belief A. Undoing

systems.
b) they encourage the consumer to take an active
role in health management.
c) they promote interrelationships within the
mind-body-spirit.
d) they usually work better than traditional
medical practice.
24. David is preoccupied with numerous bodily
complaints even after a careful diagnostic workup
reveals no physiologic problems. Which nursing
intervention would be therapeutic for him?
a) Acknowledge that the complaints are real to the
client, and refocus the client on other concerns
and problems.
b) Challenge the physical complaints by
confronting the client with the normal
diagnostic findings.
c) Ignore the client’s complaints, but request that
the client keep a list of all symptoms.
d) Listen to the client’s complaints carefully, and
question him about specific symptoms.
25. Nurse Kenzo is teaching a client about sertraline
(Zoloft), which has been prescribed for depression. A
significant side effect is interference with sexual arousal
by inhibiting erectile function. How should the Nurse
Kenzo approach this topic?
a) Nurse Kenzo should avoid mentioning the
sexual side effects to prevent the client from
having anxiety about potential erectile
problems.
b) Nurse Kenzo should advise the client to report
any changes in sexual functioning in case
medication adjustments are needed.
c) Nurse Kenzo should explain that the client’s
sexual desire will probably decrease while on
this medication.
d) Nurse Kenzo should tell the client that sexual
side effects are expected, but that they will
decrease when his depression lifts.
B. Compensation
C. Denial
D. Suppression
3. Nurse Chelsey is teaching a community group about
substance abuse. She explains that a genetic
component has been implicated in which of the
following commonly abused substances?
A. Heroin
B. Alcohol
C. Marijuana
D. Barbiturates
4. Nurse Michael recommends that the family of a client
with substance-related disorder attend a support group,
such as Al-Anon and Alateen. The purpose of these
groups is to help family members understand the
problem and to:
A. Maintain focus on changing their own behaviors
B. Learn how to assist the abuser in getting help
C. Prevent substance problems in vulnerable family
members
D. Change the problem behaviors of the abuser
5. 5. Nurse Christine is teaching a client about disulfiram
(Antabuse), which the client is taking to deter his use of
alcohol. She explains that using alcohol when taking this
medication can result in:
A. Increased pulse and blood pressure
B. Abdominal cramps and diarrhea
C. Drowsiness and decreased respiration
D. Flushing, vomiting, and dizziness

Substance abuse disorders

1.Nurse James has observed a co-worker arriving to
work drunk at least three times in the past month.
Which action by Nurse James would best ensure client
safety and obtain necessary assistance for the co-
worker?

A. Warn the co-worker that this practice is unsafe

B. Report the coworker’s behavior to the appropriate
supervisor
C. Make general statements about safety issues at the
next staff meeting
D. Ignore the co worker’s behavior, and frequently
assess the clients assigned to the co-worker
 Psychiatric Nursing 2
Substance Related Disorders
1. The nurse understands that the essential difference
between substance abuse and substance dependence is
that substance dependence:
1. includes characteristics of tolerance and
withdrawal.
2. includes characteristics of adverse consequences
and repeated use.
3. produces less severe symptoms than that of
abuse.
4. requires long-term treatment in a hospital-based
program.
2. The sister of a client with a substance-related
disorder tells the nurse that she calls out sick for the
client occasionally when he has too much to drink and
cannot work. This behavior can be described as:
1. caretaking.
2. codependent.
3. helpful.
4. supportive.
3. When a client abuses a CNS depressant, withdrawal
symptoms will be caused by which of the following?
1. Acetylcholine excess
2. Dopamine depletion
3. Serotonin inhibition
4. Norepinephrine rebound
4. The general classification of drugs belonging to the
opioid category is analgesic and:
1. depressant.
2. hallucinogenic.
3. stimulant.
4. tranquilizing.
5. The community nurse practicing primary prevention
of alcohol abuse would target which groups for
educational efforts?
1. Adolescents in their late teens and young adults
in their early twenties
2. Elderly men who live in retirement communities
3. Women working in careers outside the home
4. Women working in the home
6. A staff nurse has observed a coworker arriving to
work drunk at least three times in the past month.
Which action by the nurse would best ensure client
safety and obtain necessary assistance for the
coworker?
1. Ignore the coworker's behavior, and frequently
assess the clients assigned to the coworker.
2. Make general statements about safety issues at
the next staff meeting.
3. Report the coworker's behavior to the
appropriate supervisor.
4. Warn the coworker that this practice is unsafe.
7. A client being treated in a chemical dependency unit
tells the nurse that he only uses drugs when under
stress and therefore does not have a substance
problem. Which defense mechanism is the client using?
1. Compensation
2. Denial
3. Suppression
4. Undoing
8. The nurse is teaching a community group about
substance abuse. She explains that a genetic
component has been implicated with which of the
following commonly abused substances?
1. Alcohol
2. Barbiturates
3. Heroin
4. Marijuana
9. The nurse recommends that the family of a client
with a substance-related disorder attend a support
group, such as Alanon or Alateen. The purpose of these
groups is to help family members understand the
problem and to:
1. change the problem behaviors of the abuser.
2. learn how to assist the abuser in getting help.
3. maintain focus on changing their own
behaviors.
4. prevent substance problems in vulnerable
family members.
10. The nurse is assessing a client who is a chronic
alcohol abuser. Which problems are related to thiamin
deficiency?
1. Cardiovascular symptoms, such as decreased
hemoglobin and hematocrit levels
2. CNS symptoms, such as ataxia and peripheral
neuropathy
3. Gastrointestinal symptoms, such as nausea and
vomiting
4. Respiratory symptoms, such as cough and sore
throat
11. When assessing a client who abuses barbiturates
and benzodiazepine, the nurse would observe for
evidence of which withdrawal symptoms?
1. Anxiety, tremors, and tachycardia
2. Respiratory depression, stupor, and bradycardia
3. Muscle aches, cramps, and lacrimation
4. Paranoia, depression, and agitation
12. When teaching an adolescent health class about the
dangers of inhalant abuse, the nurse warns about the
possibility of:
1. contracting an infectious disease, such as
hepatitis or AIDS
2. recurrent flashback events
3. psychological dependence after initial use
4. sudden death from cardiac or respiratory
depression
13. Which medication is commonly used in treatment
programs for heroin abusers to produce a noneuphoric
state and to replace heroin use?
1. diazepam
2. carbamazepine
3. clonidine
4. methadone
14. The nurse administers bromocriptine (Parlodel) to a
client undergoing detoxification for amphetamine
abuse. The rationale for this medication is to:
1. aid in GABA inhibition.
2. prevent norepinephrine excess.
3. restore depleted dopamine levels.
4. treat psychotic symptoms.
15. The nurse is teaching a client about disulfiram
(Antabuse), which the client is taking to deter his use of
alcohol. She explains that using alcohol when taking this
medication can result in:
1. abdominal cramps and diarrhea.
2. drowsiness and decreased respiration.
3. flushing, vomiting, and dizziness.
4. increased pulse and blood pressure.
16. During an initial assessment of a client admitted to a
substance abuse unit for detoxification and treatment,
the nurse asks questions to determine patterns of use
of substances. Which of the following questions are
most appropriate at this time? Select all that apply.
1. How long have you used substances?
2. How often do you use substances?
3. How do you get substances into your body?
4. Do you feel bad or guilty about your use of
substances?
5. How much of each substance do you use?
6. Have you ever felt you should cut down
substance use?
7. What substances do you use?
8.
Exam for Psychiatric Nursing
1. Mental health is defined as:
1. The ability to distinguish what is real from what
is not.
2. A state of well-being where a person can realize
his own abilities can cope with normal stresses
of life and work productively.
3. Is the promotion of mental health, prevention
of mental disorders, nursing care of patients
during illness and rehabilitation
4. Absence of mental illness
2. Which of the following describes the role of a
technician?
1. Administers medications to a schizophrenic
patient.
2. The nurse feeds and bathes a catatonic client
3. Coordinates diverse aspects of care rendered to
the patient
4. Disseminates information about alcohol and its
effects.
3. Liza says, “Give me 10 minutes to recall the name of
our college professor who failed many students in our
anatomy class.” She is operating on her:
1. Subconscious
2. Conscious
3. Unconscious
4. Ego
4. The superego is that part of the psyche that:
1. Uses defensive function for protection.
2. Is impulsive and without morals.
3. Determines the circumstances before making
decisions.
4. The censoring portion of the mind.
5. Primary level of prevention is exemplified by:
1. Helping the client resume self care.
2. Ensuring the safety of a suicidal client in the
institution.
3. Teaching the client stress management
techniques
4. Case finding and surveillance in the community
6. Situation: In a home visit done by the nurse, she
suspects that the wife and her child are victims of
abuse. Which of the following is the most appropriate
for the nurse to ask?
1. “Are you being threatened or hurt by your
partner?
2. “Are you frightened of you partner”
3. “Is something bothering you?”
4. “What happens when you and your partner
argue?”
7. The wife admits that she is a victim of abuse and
opens up about her persistent distaste for sex. This
sexual disorder is:
1. Sexual desire disorder
2. Sexual arousal Disorder
3. Orgasm Disorder
4. Sexual Pain Disorder
8. What would be the best approach for a wife who is
still living with her abusive husband?
1. “Here’s the number of a crisis center that you
can call for help .”
2. “Its best to leave your husband.”
3. “Did you discuss this with your family?”
4. “ Why do you allow yourself to be treated this
way”
9. Which comment about a 3 year old child if made by
the parent may indicate child abuse?
1. “Once my child is toilet trained, I can still expect
her to have some”
2. “When I tell my child to do something once, I
don’t expect to have to tell”
3. “My child is expected to try to do things such
as, dress and feed.”
4. “My 3 year old loves to say NO.”
10. The primary nursing intervention for a victim of
child abuse is:
1. Assess the scope of the problem
 2. Analyze the family dynamics 3. encourage the child to engage in any play
3. Ensure the safety of the victim activity to dissipate energy
4. Teach the victim coping skills 4. remove the child from the classroom when
disruptive behavior occurs
11. Situation: A 30 year old male employee frequently
complains of low back pain that leads to frequent 17. The child with conduct disorder will likely
absences from work. Consultation and tests reveal demonstrate:
negative results. The client has which somatoform
disorder? 1. Easy distractibility to external stimuli.
2. Ritualistic behaviors
1. Somatization Disorder 3. Preference for inanimate objects.
2. Hypochondriaisis 4. Serious violations of age related norms.
3. Conversion Disorder
4. Somatoform Pain Disorder 18. Ritalin is the drug of choice for chidren with ADHD.
The side effects of the following may be noted:
12. Freud explains anxiety as:
1. increased attention span and concentration
1. Strives to gratify the needs for satisfaction and 2. increase in appetite
security 3. sleepiness and lethargy
2. Conflict between id and superego 4. bradycardia and diarrhea
3. A hypothalamic-pituitary-adrenal reaction to
stress 19. School phobia is usually treated by:
4. A conditioned response to stressors
1. Returning the child to the school immediately
13. The following are appropriate nursing diagnosis for with family support.
the client EXCEPT: 2. Calmly explaining why attendance in school is
necessary
1. Ineffective individual coping 3. Allowing the child to enter the school before
2. Alteration in comfort, pain the other children
3. Altered role performance 4. Allowing the parent to accompany the child in
4. Impaired social interaction the classroom

14. The following statements describe somatoform 20. A 10 year old child has very limited vocabulary and
disorders: interaction skills. She has an I.Q. of 45. She is diagnosed
to have Mental retardation of this classification:
1. Physical symptoms are explained by organic
causes 1. Profound
2. It is a voluntary expression of psychological 2. Mild
conflicts 3. Moderate
3. Expression of conflicts through bodily 4. Severe
symptoms
4. Management entails a specific medical 21. The nurse teaches the parents of a mentally
treatment retarded child regarding her care. The following
guidelines may be taught except:
15. What would be the best response to the client’s
repeated complaints of pain: 1. overprotection of the child
2. patience, routine and repetition
1. “I know the feeling is real tests revealed 3. assisting the parents set realistic goals
negative results.” 4. giving reasonable compliments
2. “I think you’re exaggerating things a little bit.”
3. “Try to forget this feeling and have activities to 22. The parents express apprehensions on their ability
take it off your mind” to care for their maladaptive child. The nurse identifies
4. “So tell me more about the pain” what nursing diagnosis:

16. Situation: A nurse may encounter children with 1. hopelessness

mental disorders. Her knowledge of these various 2. altered parenting role
disorders is vital. When planning school interventions 3. altered family process
for a child with a diagnosis of attention deficit 4. ineffective coping
hyperactivity disorder, a guide to remember is to:
23. A 5 year old boy is diagnosed to have autistic
1. provide as much structure as possible for the disorder. Which of the following manifestations may be
child noted in a client with autistic disorder?
2. ignore the child’s overactivity.
 1. argumentativeness, disobedience, angry
outburst 5) A 75 year old client is admitted to the hospital with
2. intolerance to change, disturbed relatedness, the diagnosis of dementia of the Alzheimer’s type and
stereotypes depression. The symptom that is unrelated to
3. distractibility, impulsiveness and overactivity depression would be?
4. aggression, truancy, stealing, lying
1. Apathetic response to the environment
24. The therapeutic approach in the care of an autistic 2. “I don’t know” answer to questions
child include the following EXCEPT: 3. Shallow of labile effect
4. Neglect of personal hygiene
1. Engage in diversionary activities when acting -
out 6) The client with confusion says to the nurse, “I haven’t
2. Provide an atmosphere of acceptance had anything to eat all day long. When are they going to
3. Provide safety measures bring breakfast?” The nurse saw the client in the day
4. Rearrange the environment to activate the child room eating breakfast with other clients 30 minutes
before this conversation. Which response would be best
25. According to Piaget a 5 year old is in what stage of for the nurse to make?
development:
1. “You know you had breakfast 30 minutes ago.”
1. Sensory motor stage 2. “I am so sorry that they didn’t get you
2. Concrete operations breakfast. I’ll report it to the charge nurse.”
3. Pre-operational 3. “I’ll get you some juice and toast. Would you
4. Formal operation like something else?”
4. “You will have to wait a while; lunch will be
here in a little while.”
Exam for Psychiatric Nursing
Alzheimer’s Disease 7) The nurse is caring for a client with stage III
1) The client with Alzheimer’s disease is being assisted Alzheimer’s disease. A characteristic of this stage is:
with activities of daily living when the nurse notes that
the client uses her toothbrush to brush her hair. The 1. Memory loss
nurse is aware that the client is exhibiting: 2. Failing to recognize familiar objects
3. Wandering at night
1. Agnosia 4. Failing to communicate
2. Apraxia
3. Anomia 8) The primary nursing intervention in working with a
4. Aphasia client with moderate stage dementia is ensuring that
the client:
2) A client with Alzheimer’s disease is awaiting
placement in a skilled nursing facility. Which long-term 1. receives adequate nutrition and hydration
plans would be most therapeutic for the client? 2. will reminisce to decrease isolation
3. remains in a safe and secure environment
1. Placing mirrors in several locations in the home 4. independently performs self care
2. Placing a picture of herself in her bedroom
3. Placing simple signs to indicate the location of 9) During the evaluation of the quality of home care for
the bedroom, bathroom, and so on a client with Alzheimer’s disease, the priority for the
4. Alternating healthcare workers to prevent nurse is to reinforce which statement by a family
boredom member?

3) The client with dementia is experiencing confusion 1. At least 2 full meals a day is eaten.
late in the afternoon and before bedtime. The nurse is 2. We go to a group discussion every week at our
aware that the client is experiencing what is known as: community center.
3. We have safety bars installed in the bathroom
1. Chronic fatigue syndrome and have 24 hour alarms on the doors.
2. Normal aging 4. The medication is not a problem to have it
3. Sundowning taken 3 times a day.
4. Delusions
10) Signs of Alzheimer’s include which of these
4) Which age group has the highest rate of Alzheimer’s symptoms?
cases reported?
1. Loss of memory
1. 85 and older 2. Increase in irritability
2. 74 to 84 3. Restlessness
3. 65 to 74 4. All of the above
4. 55 to 65
11) Which neurotransmitter has been implicated in the
development of Alzheimer’s disease? 18) Rosana is in the second stage of Alzheimer’s disease
who appears to be in pain. Which question by Nurse
1. Acetylcholine Jenny would best elicit information about the pain?
2. Dopamine
3. Epinephrine “Where is your pain located?”
4. Serotonin “Do you hurt? (pause) “Do you hurt?”
“Can you describe your pain?”
12) Alzheimer’s is an INSIDIOUS disease. This means: “Where do you hurt?”
19) Rosana is in the second stage of Alzheimer’s disease
1. that it is terminal who appears to be in pain. Which question by Nurse
2. that is can be cured Jenny would best elicit information about the pain?
3. that it sneaks up on a person over time
4. that it only affects the elderly 1. “Where is your pain located?”
5. none of the above 2. “Do you hurt? (pause) “Do you hurt?”
3. “Can you describe your pain?”
13) Edward, a 66 year old client with slight memory 4. “Where do you hurt?”
impairment and poor concentration is diagnosed with
primary degenerative dementia of the Alzheimer’s type. 20) How is Alzheimer’s diagnosed?
Early signs of this dementia include subtle personality
changes and withdrawal from social interactions. To 1. Mental-status tests
assess for progression to the middle stage of 2. Blood tests
Alzheimer’s disease, the nurse should observe the client 3. Neurological tests
for: 4. All of the above

1. Occasional irritable outbursts. 21) The usual span of years that Alzheimer’s may
2. Impaired communication. progress in the patient is:
3. Lack of spontaneity.
4. Inability to perform self-care activities. 1. three to five years
2. two to twenty years
14) Which of the following is not directly related with 3. fifty to sixty years
Alzheimer’s disease? 4. 6 months to one year
5. eight to ten years
1. Senile plaques
2. Diabetes mellitus 22) Scientists believe that _________________ develop
3. Tangles in the brain of an Alzheimer’s patient, and may be a
4. Dementia cause of the disease.

15) Alzheimer’s is the most common form of which of 1. cholesterols

these? 2. tumors
3. ruptured blood vessels
1. Malnutrition 4. plaques and tangles
2. Dementia
3. Fatigue 23) To encourage adequate nutritional intake for a
4. Psychosis female client with Alzheimer’s disease, the nurse
should:
16) Which nursing intervention is most appropriate for a
client with Alzheimer’s disease who has frequent 1. stay with the client and encourage him to eat.
episodes emotional lability? 2. help the client fill out his menu.
3. give the client privacy during meals.
1. Attempt humor to alter the client mood. 4. fill out the menu for the client.
2. Explore reasons for the client’s altered mood.
3. Reduce environmental stimuli to redirect the 24) A 93 year-old female with a history of Alzheimer’s
client’s attention. Disease gets admitted to an Alzheimer’s unit. The
4. Use logic to point out reality aspects. patient has exhibited signs of increased confusion and
limited stability with gait. Moreover, the patient is
17) Which of the following is the most common cause of refusing to use a w/c. Which of the following is the most
dementia among elderly persons? appropriate course of action for the nurse?

1. Parkinson’s disease 1. Recommend the patient remain in her room at

2. Multiple sclerosis all times.
3. Amyotrophic lateral sclerosis (Lou Gerhig’s 2. Recommend family members bring pictures to
disease) the patient’s room.
4. Alzheimer’s disease
 3. Recommend a speech therapy consult to the 3. Remain calm and talk quietly to the client.
doctor. 4. Call the doctor and request an order for
4. Recommend the patient attempt to walk sedation.
pushing the w/c for safety.
25) The doctor has prescribed Exelon (rivastigmine) for 32) Thomas Elison is a 79 year old man who is admitted
the client with Alzheimer’s disease. Which side effect is with diagnosis of dementia. The doctor orders a series
most often associated with this drug? of laboratory tests to determine whether Mr. Elison’s
dementia is treatable. The nurse understands that the
1. Urinary incontinence most common cause of dementia in this population is:
2. Headaches
3. Confusion 1. AIDS
4. Nausea 2. Alzheimer’s disease
3. Brain tumors
26) A patient with Stage One Alzheimers might exhibit 4. Vascular disease
these behaviors:
33) A patient who has been admitted to the medical
1. forgetting names unit with new-onset angina also has a diagnosis of
2. missing appointments Alzheimer’s disease. Her husband tells you that he
3. getting lost while driving rarely gets a good night’s sleep because he needs to be
4. all of the above sure she does not wander during the night. He insists on
5. none of the above checking each of the medications you give her to be
sure they are the same as the ones she takes at home.
27) Which of the following diseases has not been Based on this information, which nursing diagnosis is
directly linked with Bell’s palsy? most appropriate for this patient?

1. AIDS 1. Decreased Cardiac Output related to poor

2. Diabetes myocardial contractility
3. Lyme disease 2. Caregiver Role Strain related to continuous
4. Alzheimer’s disease need for providing care
3. Ineffective Therapeutic Regimen Management
28) The symptom of dementia that involved a more related to poor patient memory
confused state after dark is called: 4. Risk for Falls related to patient wandering
behavior during the night
1. dark retreat
2. sundowning 34) Physiologically, what happens to the brain as
3. agitation Alzheimer’s progresses?
4. dark reaction
1. Tissue swells
29) Which of these is the strongest risk factor for 2. Fluid collects
developing the Alzheimer’s disease? 3. Many cells die
4. Brain-stem atrophies
1. Heredity
2. Age 35) The nurse is aware that the following ways in
3. Exposure to toxins vascular dementia different from Alzheimer’s disease is:
4. None of the above
1. Vascular dementia has more abrupt onset
30) The priority of care for a client with Alzheimer’s 2. The duration of vascular dementia is usually
disease is brief
3. Personality change is common in vascular
1. Help client develop coping mechanism dementia
2. Encourage to learn new hobbies and interest 4. The inability to perform motor activities occurs
3. Provide him stimulating environment in vascular dementia
4. Simplify the environment to eliminate the need
to make chores 36) A 65 years old client is in the first stage of
Alzheimer’s disease. Nurse Patricia should plan to focus
31) An elderly client with Alzheimer’s disease becomes this client’s care on:
agitated and combative when a nurse approaches to
help with morning care. The most appropriate nursing 1. Offering nourishing finger foods to help
intervention in this situation would be to: maintain the client’s nutritional status.
2. Providing emotional support and individual
1. Tell the client family that it is time to get counseling.
dressed. 3. Monitoring the client to prevent minor illnesses
2. Obtain assistance to restrain the client for from turning into major problems.
safety.
 4. Suggesting new activities for the client and
family to do together. 1. Deterioration of nasal septum
2. Acute fluid and electrolyte imbalances
37) A nurse caring to a client with Alzheimer’s disease 3. Extra pyramidal tract symptoms
overheard a family member say to the client, “if you 4. Esophageal varices
pee one more time, I won’t give you any more food and
drinks”. What initial action is best for the nurse to take? 3. A tentative diagnosis of opiate addiction, Nurse
Candy should assess a recently hospitalized client for
1. Take no action because it is the family member signs of opiate withdrawal. These signs would include:
saying that to the client
2. Talk to the family member and explain that 1. Rhinorrhea, convulsions, subnormal
what she/he has said is not appropriate for the temperature
client 2. Nausea, dilated pupils, constipation
3. Give the family member the number for an 3. Lacrimation, vomiting, drowsiness
Elder Abuse Hot line 4. Muscle aches, papillary constriction, yawning
4. Document what the family member has said
4. A 48 year old male client is brought to the psychiatric
38) Alzheimer’s disease is the secondary diagnosis of a emergency room after attempting to jump off a bridge.
client admitted with myocardial infarction. Which The client’s wife states that he lost his job several
nursing intervention should appear on this client’s plan months ago and has been unable to find another job.
of care? The primary nursing intervention at this time would be
to assess for:
1. Perform activities of daily living for the client to
decease frustration. 1. A past history of depression
2. Provide a stimulating environment. 2. Current plans to commit suicide
3. Establish and maintain a routine. 3. The presence of marital difficulties
4. Try to reason with the client as much as 4. Feelings of excessive failure
possible.
5. Before helping a male client who has been sexually
39) As the manager in a long-term-care (LTC) facility, assaulted, nurse Maureen should recognize that the
you are in charge of developing a standard plan of care rapist is motivated by feelings of:
for residents with Alzheimer’s disease. Which of these
nursing tasks is best to delegate to the LPN team 1. Hostility
leaders working in the facility? 2. Inadequacy
3. Incompetence
1. Check for improvement in resident memory 4. Passion
after medication therapy is initiated.
2. Use the Mini-Mental State Examination to 6. When working with children who have been sexually
assess residents every 6 months. abused by a family member it is important for the nurse
3. Assist residents to toilet every 2 hours to to understand that these victims usually are
decrease risk for urinary intolerance. overwhelmed with feelings of:
4. Develop individualized activity plans after
consulting with residents and family. 1. Humiliation
2. Confusion
40) The nurse would expect a client with early 3. Self blame
Alzheimer’s disease to have problems with: 4. Hatred

1. Balancing a checkbook. 7. Joy who has just experienced her second

2. Self-care measures. spontaneous abortion expresses anger towards her
3. Relating to family members. physician, the hospital and the “rotten nursing care”.
4. Remembering his own name When assessing the situation, the nurse recognizes that
the client may be using the coping mechanism of:
Psychiatric Nursing Practice Exam 3
1. Projection
1. Francis who is addicted to cocaine withdraws from 2. Displacement
the drug. Nurse Ron should expect to observe: 3. Denial
4. Reaction formation
1. Hyperactivity
2. Depression 8. The most critical factor for nurse Linda to determine
3. Suspicion during crisis intervention would be the client’s:
4. Delirium
1. Available situational supports
2. Nurse John is aware that a serious effect of inhaling 2. Willingness to restructure the personality
cocaine is? 3. Developmental theory
 4. Underlying unconscious conflict
9. Nurse Trish suggests a crisis intervention group to a
client experiencing a developmental crisis. These groups
are successful because the:
1. Crisis intervention worker is a psychologist and
understands behavior patterns
2. Crisis group supplies a workable solution to the
client’s problem
3. Client is encouraged to talk about personal
problems
4. Client is assisted to investigate alternative
approaches to solving the identified problem
10. Nurse Ronald could evaluate that the staff’s
approach to setting limits for a demanding, angry client
was effective if the client:
1. Apologizes for disrupting the unit’s routine
when something is needed
2. Understands the reason why frequent calls to
the staff were made
3. Discuss concerns regarding the emotional
condition that required hospitalizations
4. No longer calls the nursing staff for assistance
11. Nurse John is aware that the therapy that has the
highest success rate for people with phobias would be:
1. Psychotherapy aimed at rearranging
maladaptive thought process
2. Psychoanalytical exploration of repressed
conflicts of an earlier development phase
3. Systematic desensitization using relaxation
technique
4. Insight therapy to determine the origin of the
anxiety and fear
12. When nurse Hazel considers a client’s placement on
the continuum of anxiety, a key in determining the
degree of anxiety being experienced is the client’s:
1. Perceptual field
2. Delusional system
3. Memory state
4. Creativity level
13. In the diagnosis of a possible pervasive
developmental autistic disorder. The nurse would find it
most unusual for a 3 year old child to demonstrate:
1. An interest in music
2. An attachment to odd objects
3. Ritualistic behavior
4. Responsiveness to the parents
14. Malou with schizophrenia tells Nurse Melinda, “My
intestines are rotted from worms chewing on them.”
This
statement indicates a:
1. Jealous delusion
2. Somatic delusion
3. Delusion of grandeur
4. Delusion of persecution
15. Andy is admitted to the psychiatric unit with a
diagnosis of borderline personality disorder. Nurse
Hilary should expects the assessment to reveal:
1. Coldness, detachment and lack of tender
feelings
2. Somatic symptoms
3. Inability to function as responsible parent
4. Unpredictable behavior and intense
interpersonal relationships
16. PROPRANOLOL (Inderal) is used in the mental health
setting to manage which of the following conditions?
1. Antipsychotic – induced akathisia and anxiety
2. Obsessive – compulsive disorder (OCD) to
reduce ritualistic behavior
3. Delusions for clients suffering from
schizophrenia
4. The manic phase of bipolar illness as a mood
stabilizer
17. Which medication can control the extra pyramidal
effects associated with antipsychotic agents?
1. Clorazepate (Tranxene)
2. Amantadine (Symmetrel)
3. Doxepin (Sinequan)
4. Perphenazine (Trilafon)
18. Which of the following statements should be
included when teaching clients about monoamine
oxidase inhibitor (MAOI) antidepressants?
1. Don’t take aspirin or nonsteroidal anti-
inflammatory drugs (NSAIDs)
2. Have blood levels screened weekly for
leucopenia
3. Avoid strenuous activity because of the cardiac
effects of the drug
4. Don’t take prescribed or over the counter
medications without consulting the physician
19. Kris periodically has acute panic attacks. These
attacks are unpredictable and have no apparent
association with a specific object or situation. During an
acute panic attack, Kris may experience:
1. Heightened concentration
2. Decreased perceptual field
3. Decreased cardiac rate
4. Decreased respiratory rate
20. Initial interventions for Marco with acute anxiety
include all except which of the following?
1. Touching the client in an attempt to comfort
him
2. Approaching the client in calm, confident
manner
 3. Encouraging the client to verbalize feelings and 27. Nursing preparation for a client undergoing
concerns electroconvulsive therapy (ECT) resemble those used
4. Providing the client with a safe, quiet and for:
private place
21. Nurse Jessie is assessing a client suffering from 1. General anesthesia
stress and anxiety. A common physiological response to 2. Cardiac stress testing
stress and anxiety is: 3. Neurologic examination
4. Physical therapy
1. Uticaria
2. Vertigo 28. Jose who is receiving monoamine oxidase inhibitor
3. Sedation antidepressant should avoid tyramine, a compound
4. Diarrhea found in which of the following foods?

22. When performing a physical examination on a 1. Figs and cream cheese

female anxious client, nurse Nelli would expect to find 2. Fruits and yellow vegetables
which of the following effects produced by the 3. Aged cheese and Chianti wine
parasympathetic system? 4. Green leafy vegetables

1. Muscle tension 29. Erlinda, age 85, with major depression undergoes a
2. Hyperactive bowel sounds sixth electroconvulsive therapy (ECT) treatment. When
3. Decreased urine output assessing the client immediately after ECT, the nurse
4. Constipation expects to find:

23. Which of the following drugs have been known to
be effective in treating obsessive-compulsive disorder
(OCD)?
1. Divalproex (depakote) and Lithium (lithobid)
2. Chlordiazepoxide (Librium) and diazepam
(valium)
3. Fluvoxamine (Luvox) and clomipramine
(anafranil)
4. Benztropine (Cogentin) and diphenhydramine
(benadryl)
24. Tony with agoraphobia has been symptom-free for 4
months. Classic signs and symptoms of phobia include:
1. Severe anxiety and fear
2. Withdrawal and failure to distinguish reality
from fantasy
3. Depression and weight loss
4. Insomnia and inability to concentrate
25. Which nursing action is most appropriate when
trying to diffuse a client’s impending violent behavior?
1. Place the client in seclusion
2. Leaving the client alone until he can talk about
his feelings
3. Involving the client in a quiet activity to divert
attention
4. Helping the client identify and express feelings
of anxiety and anger
26. Rosana is in the second stage of Alzheimer’s disease
who appears to be in pain. Which question by Nurse
Jenny would best elicit information about the pain?
1. “Where is your pain located?”
2. “Do you hurt? (pause) “Do you hurt?”
3. “Can you describe your pain?”
4. “Where do you hurt?”
1. Permanent short-term memory loss and
hypertension
2. Permanent long-term memory loss and
hypomania
3. Transitory short-term memory loss and
permanent long-term memory loss
4. Transitory short and long term memory loss and
confusion
30. Barbara with bipolar disorder is being treated with
lithium for the first time. Nurse Clint should observe the
client for which common adverse effect of lithium?
1. Polyuria
2. Seizures
3. Constipation
4. Sexual dysfunction
31. Nurse Fred is assessing a client who has just been
admitted to the ER department. Which signs would
suggest an overdose of an antianxiety agent?
1. Suspiciousness, dilated pupils and incomplete
BP
2. Agitation, hyperactivity and grandiose ideation
3. Combativeness, sweating and confusion
4. Emotional lability, euphoria and impaired
memory
32. Discharge instructions for a male client receiving
tricyclic antidepressants include which of the following
information?
1. Restrict fluids and sodium intake
2. Don’t consume alcohol
3. Discontinue if dry mouth and blurred vision
occur
4. Restrict fluid and sodium intake
33. Important teaching for women in their childbearing
years who are receiving antipsychotic medications
includes which of the following?
1. Increased incidence of dysmenorrhea while
taking the drug
2. Occurrence of incomplete libido due to
medication adverse effects
3. Continuing previous use of contraception during
periods of amenorrhea
4. Instruction that amenorrhea is irreversible
34. A client refuses to remain on psychotropic
medications after discharge from an inpatient
psychiatric unit. Which information should the
community health nurse assess first during the initial
follow-up with this client?
1. Income level and living arrangements
2. Involvement of family and support systems
3. Reason for inpatient admission
4. Reason for refusal to take medications
The client’s employer expects the client to return to
work following inpatient treatment. The client tells the
nurse, “I’m no good. I’m a failure”. According to
cognitive theory, these statements reflect:
1. Learned behavior
2. Punitive superego and decreased self-esteem
3. Faulty thought processes that govern behavior
4. Evidence of difficult relationships in the work
environment
40. The nurse describes a client as anxious. Which of the
following statement about anxiety is true?
1. Anxiety is usually pathological
2. Anxiety is directly observable
3. Anxiety is usually harmful
4. Anxiety is a response to a threat
41. A client with a phobic disorder is treated by
systematic desensitization. The nurse understands that
this approach will do which of the following?

35. The nurse understands that the therapeutic effects 1. Help the client execute actions that are feared
of typical antipsychotic medications are associated with 2. Help the client develop insight into irrational
which neurotransmitter change? fears
3. Help the client substitutes one fear for another
1. Decreased dopamine level 4. Help the client decrease anxiety
2. Increased acetylcholine level
3. Stabilization of serotonin 42. Which client outcome would best indicate
4. Stimulation of GABA successful treatment for a client with an antisocial
personality disorder?
36. Which of the following best explains why tricyclic
antidepressants are used with caution in elderly 1. The client exhibits charming behavior when
patients? around authority figures
2. The client has decreased episodes of impulsive
1. Central Nervous System effects behaviors
2. Cardiovascular system effects 3. The client makes statements of self-satisfaction
3. Gastrointestinal system effects 4. The client’s statements indicate no remorse for
4. Serotonin syndrome effects behaviors

37. A client with depressive symptoms is given
prescribed medications and talks with his therapist
about his belief that he is worthless and unable to cope
with life. Psychiatric care in this treatment plan is based
on which framework?
43. The nurse is caring for a client with an autoimmune
disorder at a medical clinic, where alternative medicine
is used as an adjunct to traditional therapies. Which
information should the nurse teach the client to help
foster a sense of control over his symptoms?

1. Behavioral framework 1. Pathophysiology of disease process

2. Cognitive framework 2. Principles of good nutrition
3. Interpersonal framework 3. Side effects of medications
4. Psychodynamic framework 4. Stress management techniques

38. A nurse who explains that a client’s psychotic 44. Which of the following is the most distinguishing
behavior is unconsciously motivated understands that feature of a client with an antisocial personality
the client’s disordered behavior arises from which of disorder?
the following?
1. Attention to detail and order
1. Abnormal thinking 2. Bizarre mannerisms and thoughts
2. Altered neurotransmitters 3. Submissive and dependent behavior
3. Internal needs 4. Disregard for social and legal norms
4. Response to stimuli
45. Which nursing diagnosis is most appropriate for a
39. A client with depression has been hospitalized for client with anorexia nervosa who expresses feelings of
treatment after taking a leave of absence from work. guilt about not meeting family expectations?
 "Yes, I see. Go on."
1. Anxiety
2. Disturbed body image 2.A nurse states to a client, "Things will look better
3. Defensive coping tomorrow after a good night's sleep." This is an example
4. Powerlessness of which communication technique?
The nontherapuetic technique of giving false
46. A nurse is evaluating therapy with the family of a reassurance
client with anorexia nervosa. Which of the following
would indicate that the therapy was successful? 3.A client diagnosed with post-traumatic stress disorder
is admitted to an inpatient psychiatric unit for
1. The parents reinforced increased decision evaluation and medication stabilization. Which
making by the client therapeutic communication technique used by the
2. The parents clearly verbalize their expectations nurse is an example of broad opening?
for the client "what would you like to talk about?"
3. The client verbalizes that family meals are now
enjoyable 4.An instructor is correcting a nursing student's clinical
4. The client tells her parents about feelings of worksheet. Which instructor statement is the best
low-self esteem example of effective feedback?

47. A client with dysthymic disorder reports to a nurse
that his life is hopeless and will never improve in the
future. How can the nurse best respond using a
cognitive approach?
1. Agree with the client’s painful feelings
2. Challenge the accuracy of the client’s belief
3. Deny that the situation is hopeless
4. Present a cheerful attitude
48. A client with major depression has not verbalized
problem areas to staff or peers since admission to a
psychiatric unit. Which activity should the nurse
recommend to help this client express himself?
A. "Why did you use the client's name on your clinical
worksheet?"
B. "You were very careless to refer to your client by
name on your clinical worksheet."
C. "Surely you didn't do this deliberately, but you
breeched confidentiality by using the client's name."
D. "It is disappointing that after being told, you're still
using client names on your worksheet."
5.After assertiveness training, a formerly passive client
appropriately confronts a peer in group therapy. The
group leader states, "I'm so proud of you for being
assertive. You are so good!" Which communication
technique has the leader employed?

1. Art therapy in a small group A. The nontherapeutic technique of giving approval

2. Basketball game with peers on the unit B. The nontherapeutic technique of interpreting
3. Reading a self-help book on depression C. The therapeutic technique of presenting reality
4. Watching movie with the peer group D. The therapeutic technique of making observations
49. The home health psychiatric nurse visits a client
with chronic schizophrenia who was recently discharged 6.A client is diagnosed with dependent personality
after a prolong stay in a state hospital. The client lives in disorder states, "Do you think I should move from a
a boarding home, reports no family involvement, and parent's house and get a job?" Which nursing response
has little social interaction. The nurse plan to refer the is most appropriate?
client to a day treatment program in order to help him "Let's discuss and explore all of your options"
with:
7.When Interviewing a client, which nonverbal behavior
1. Managing his hallucinations should a nurse employ?
2. Medication teaching Sitting squarely, facing the client
3. Social skills training
4. Vocational training 8.A mother rescues two of her four children from a
house fire. In the emergency department, she cries, "I
50. Which activity would be most appropriate for a should have gone back in to get them. I should have
severely withdrawn client? died, not them." What is the nurses best response?
The smoke was too thick, you couldn't have gone back
1. Art activity with a staff member in.
2. Board game with a small group of clients
3. Team sport in the gym 9.A newly admitted client diagnosed with obsessive
4. Watching TV in the dayroom compulsive disorder washes hands continually. This
behavior presents unit activity attendance. Which
nursing statement best addresses the situation.
NSG 232 "Let's figure out a way for you to attend unit activities
1.The nurse is interviewing a newly admitted client. and still wash your hands"
Which nursing statement is an example of offering a
general lead?
10.Which example of therapeutic communication
technique would be effective in the planning phase of
the nursing process?
"We've discussed past coping skills. Let's see if these
comping skills can be effective now."
11.A student nurse tells the instructor, "I am concerned
that when a client asks me for advice I won't have a
good solution." Which should be the nursing instructor's
best response?
"Remember, clients, not nurses are responsible for their
own choices and decisions
12.Which nursing statement is a good example of the
therapeutic communication technique of focusing?
Your counseling session is in 30 minutes. I'll stay with
you until then.
13.During a nurse-client interaction, which nursing
statement may belittle the client's feelings and
concerns?
You are jumping to conclusions
14.Which nursing response is an example of the
nontherapeutic communication black of requesting an
explanation
"Can you tell me why you said that?"
Mental Health Nursing evolve
1.A client comes to the clinic after losing all of his
personal belongings in a hurricane. The nurse notes that
the client is coping ineffectively. Which is the least
realistic goal for this client?
The client will stop blaming himself for the lack of
insurance
2.The nurse is caring for a client diagnosed with
catatonic stupor. The client is lying on the bed, with the
body pulled into a fetal position. The appropriate
nursing intervention is which?
Sit beside the client in silence and verbalize occasional
open-ended questions.
3.The nurse is reviewing the health care record of a
client admitted to the psychiatric unit. The nurse notes
that the admission nurse has documented that the
client is experiencing anxiety as a result of a situational
crisis. The nurse should determine that this type of crisis
could be caused by which?
The death of a loved one
4.Which data indicates to the nurse that a client may be
experiencing ineffective coping following the loss of her
spouse?
Constantly neglects personal grooming
5.Which client is most likely at risk to become a victim
of elder abuse?
A 90-year-old woman with advanced Parkinson's
disease
6.The nurse is assigned to care for a client who is
agitated. On entering the room, the client screams,
"Why don't you just leave me alone?" The nurse should
make which therapeutic response to the client?
"I can see that you are upset. I'll be back in a few
minutes to see how you are doing."
7.The nurse is providing care to a client admitted to the
hospital with a diagnosis of anxiety disorder. The nurse
is talking with the client, and the client says, "I have a
secret that I want to tell you. You won't tell anyone
about it, will you?" Which is the appropriate nursing
response?
"I can see that you are upset. I'll be back in a few
minutes to see how you are doing."
8.A client is admitted to a psychiatric unit for treatment
of a psychotic disorder. The client is at the locked exit
door and is shouting, "Let me out! There's nothing
wrong with me! I don't belong here!" The nurse
identifies this behavior as which?
denial
9.The nurse is assigned to care for a client experiencing
disturbed thought processes. The nurse is told that the
client believes that the food is being poisoned. Which
communication technique should the nurse plan to use
to encourage the client to eat?
open-ended questions and silence
10.The nurse is assisting with the data collection on a
client admitted to the psychiatric unit. After review of
the data obtained, the nurse should identify which as a
priority concern?
The client's report of self-destructive thoughts
11.A client says to the nurse, "I'm going to die, and I
wish my family would stop hoping for a 'cure'! I get so
angry when they carry on like this! After all, I'm the one
who's dying." Which therapeutic response should the
nurse make to the client?
You're feeling angry that your family continues to hope
for you to be 'cured'?"
12.A long-term care resident with a history of paranoid
schizophrenia refuses to eat and tells the nurse that she
believes that someone is poisoning the food. The nurse
should make which appropriate response to the client?
"It must be frightening to you. Has something made you
feel that your food is poisoned?"
13.Laboratory work is prescribed for a client who has
been experiencing delusions. When the laboratory
technician approaches the client to obtain a specimen
of the client's blood, the client begins to shout, "You're
all vampires. Let me out of here!" The nurse present at
the time should respond by stating which?
"Are you fearful and think that others may want to hurt
you?"
14.The nurse is assigned to care for a client admitted to
the hospital after sustaining an injury from a house fire.
The client attempted to save a neighbor involved in the
fire, but despite the client's efforts, the neighbor died.
Which action should the nurse take to enable the client
to work through the meaning of the crisis?
Inquiring about the client's feelings that may affect
coping
15.The nurse receives a telephone call from a male
client who states that he wants to kill himself and has a
bottle of sleeping pills in front of him. Which would be
the best response by the nurse?
Keep the client talking and signal to another staff
member to send help to the client.
17.SELECT ALL THAT APPLY
The nurse is working with an older client who has a
diagnosis of depression. To work most effectively with
this client, the nurse recalls that which information is
accurate regarding depression and the older client?
Select all that apply.
Suicide is a frequent cause of death among the older
population.
Some indications of dementia may actually originate as
depression.
Depression in an older person is likely to have physical
manifestations.
18.The nurse is caring for a client with schizophrenia
who states, "I decided not to take my medication
because I realize that it really can't help me. Only I can
help me." Which nursing response should be
therapeutic?
Do you recall needing to be hospitalized because you
stopped your medication?"
19.The nurse enters a client's room, and the client
immediately demands to be released from the hospital.
On review of the client's record, the nurse notes that
the client was admitted 2 days ago for treatment of an
anxiety disorder and that the admission was a voluntary
admission. The nurse reports the findings to the
registered nurse (RN) and expects that the RN will take
which action?
Contact the health care provider (HCP).
dance at a long-term care facility. The nurse should use
which piece of information when approaching the client
about this behavior?
Individuals with Alzheimer's disease have difficulty
tolerating excess stimulation and changes in routine.
24.The nurse notices a "paranoid stare" during a
conversation with the client diagnosed with
posttraumatic stress disorder (PTSD). The client then
begins to fidget and gets up to pace around the room.
Which action by the nurse would be most beneficial?
Share the observation with the client and help the client
recognize his or her feelings.
25.The nurse working in a mental health unit hears that
a client has been experiencing "flashbacks." The nurse
interprets that this client is exhibiting a sign of which
condition?
Posttraumatic stress disorder (PTSD)
26.A confused and disoriented client is admitted to the
psychiatric unit diagnosed with posttraumatic stress
disorder (PTSD). The nurse initially plans to take which
action with this client?
Accept the client as a person and make the client feel
safe.
27.A client with delirium becomes agitated and
confused at night. The best initial intervention by the
nurse is which?
Use a night light and turn off the television.
28.The licensed practical nurse is assisting the
registered nurse in admitting a client with an
exacerbation of schizophrenia and knows that which
signs/symptoms displayed by the client are considered
positive symptoms? Select all that apply.
Hallucinations
Delusions
Neologisms

20.A client is admitted to the psychiatric nursing unit.

When collecting data from the client, the nurse notes
that the client was admitted on an involuntary status.
Based on this type of admission, the nurse expects
which?
The client presents a harm to self.

21.The nurse in a psychiatric unit is assigned to care for

a client admitted to the unit 2 days ago. On review of
the client's record, the nurse notes that the admission
was a voluntary admission. Based on this type of
admission, the nurse should expect which?
The client will participate in the treatment plan

22.The nurse is preparing a client for the termination

phase of the nurse-client relationship. Which task
should the nurse appropriately plan for this phase?
Assist in making appropriate referrals

23.A client with Alzheimer's disease became very

agitated when a group of children came to sing and

Exam for Psychiatric Nursing
1.A client begins experiencing physical symptoms
believed to be caused by psychological distress. This
client is most likely experiencing which disorder?
1. Pain disorder
2. Somatization
3. Conversion disorder
4. Body dysmorphic disorder
2.An unemployed woman, age 24, seeks help because
she feels depressed and abandoned and doesn't know
what to do with her life. Last week, her boyfriend broke
up with her after she drove his car into a tree after an
argument. The client's initial diagnosis is borderline
personality disorder. Which nursing observations
support this diagnosis?
1. Flat affect, social withdrawal, and unusual dress
2. Suspiciousness, hypervigilance, and emotional
coldness
3. Lack of self-esteem, strong dependency needs, and
impulsive behavior
4. Insensitivity to others, sexual acting out, and violence
3.Which of the following indications is the appropriate
use for electroconvulsive therapy (ECT)?
1. Severe agitation
2. Antisocial behavior
3. Noncompliance with treatment
4. Major depression with psychotic features
5.The nurse is teaching a client about the
antidepressant amitriptyline (Elavil). Which points
should she include in her teaching plan?
Select all that apply:
1. Smoking may lower the drug level.
2. Avoid prolonged exposure to the sun.
3. Avoid drinking grapefruit juice because it interferes
with the drug's metabolism.
4. The drug's effects may not be seen for 4 weeks.
5. Increase fluid and fiber intake to prevent
constipation.
6.A client with delusional thinking shows a lack of
interest in eating at meal times. She states that she is
unworthy of eating and that her children will die if she
eats. Which nursing action would be appropriate for
this client?
1. Telling the client that she may become sick and die
unless she eats
2. Paying special attention to the client's rituals and
emotions associated with meals
3. Restricting the client's access to food except at
specified meal and snack times
4. Encouraging the client to express her feelings at meal
times
7.The nurse is assigned to care for a client with
dependent personality disorder. Which intervention
should the nurse expect in this client's plan of care to
promote independence?
1. Spending long periods of unscheduled time with the
client
2. Scheduling competitive activities so the client can test
skills
3. Helping the client identify preferences, such as
choosing which clothing item to wear
4. Avoiding discussing the client's feelings of
helplessness
8.A 75-year-old client who was admitted to the hospital
with a stroke informs the nurse that he doesn't want to
be kept alive with machines. He wants to make sure
that everyone knows his wishes. Which action should
the nurse take?
1. Contact the social services department to make
arrangements for the client to complete a living will.
2. Notify the physician so that he can place a do-not-
resuscitate order on the client's medical record.
3. Make arrangements for the client to receive
information about advance directives.
4. Explain that his condition is stable, so he doesn't
need to be concerned at this time.
9.On admission to the inpatient psychiatric unit, a
client's facial expression indicates severe panic. The
client repeatedly states, "I know the police are going to
shoot me. They found out that I'm the child of the
devil." What should the nurse say to initiate a
therapeutic relationship with the client?
1. "You certainly look stressed. Can you tell me about
the upsetting events that have occurred in your life
recently?"
2. "Hello, my name is ___. I'm a nurse, and I'll care for
you when I'm on duty. Should I call you ___, or do you
prefer something else?"
3. "You're having very frightening thoughts. I'll help you
find ways to cope with this scary thinking."
4. "Hello, ___. I'm going to be caring for you while I'm
on duty. You look very frightened, but I'm sure you'll
feel better by tomorrow."
10.A client is transferred to the locked psychiatric unit
from the emergency department after attempting
suicide by taking 200 acetaminophen (Tylenol) tablets.
Now the client is awake and alert but refuses to speak
with the nurse. In this situation, the nurse's first priority
is to:
1. establish a rapport to foster trust.
2. place the client in full leather restraints.
3. try to communicate with the client in writing.
4. ensure safety by initiating suicide precautions.
11.A client with paranoid personality disorder is
admitted to a psychiatric facility. Which remark by the
nurse would best establish trust and rapport and
encourage the client to confide in the nurse?
1. "I get upset once in a while, too."
2. "I know just how you feel. I'd feel the same way in
your situation."
3. "I worry, too, when I think people are talking about
me."
4. "At times, it's normal not to trust anyone."
12.The nurse receives a physician's order to administer
1,000 ml of normal saline solution I.V. over 8 hours to a
client who recently had a stroke. What should the drip
rate be if the drop factor of the tubing is 15 gtt/ml?
31. 1000ml / 480 minutes x 15 drops/ml = 31 gtt/min.
13.A child, age 5, is diagnosed with mycoplasmal
pneumonia and has a persistent productive cough.
When monitoring the child's respirations, the nurse
should keep in mind that children normally use which
muscles to breathe?
1. Accessory
2. Thoracic
3. Abdominal
4. Intercostal
14.A client with herpes zoster is prescribed acyclovir
(Zovirax), 200 mg by mouth every 4 hours while awake.
The nurse should inform the client that this drug may
cause:
1. palpitations.
2. dizziness.
3. diarrhea.
4. metallic taste.
15.An 8-year-old client has tested positive for West Nile
virus infection. The nurse suspects the client has the
severe form of the disease when she recognizes which
signs and symptoms?
1. Fever, rash, and malaise
2. Anorexia, nausea, and vomiting
3. Fever, muscle weakness, and change in mental status
4. Fever, lymphadenopathy, and rash
16.A client is recovering in the labor and delivery area
after delivering a 6-lb, 3-oz boy. On assessment, the
nurse finds that the client's fundus is firm and located
two fingerbreadths below the umbilicus. Although she
didn't have an episiotomy, her perineal pad reveals a
steady trickle of blood. What is the probable cause of
these assessment findings?
1. A boggy uterus
2. Normal involution
3. A vaginal laceration
4. A clotting problem
17.Which action should a nurse recommend be included
in a plan of care for clients diagnosed with
schizophrenia and are on antipsychotic medication?
1) limit fluid intake to prevent peripheral edema
2) frequent tooth brushing to prevent gingival
hyperplasia
3) document visual and auditory hallucinations
4) limit caloric and fat intake to minimize weight gain
Psychiatric Nursing Practice Test 8
1.A woman is admitted to the psychiatric emergency
department. Her significant other reports that she has
difficulty sleeping, has poor judgment, and is incoherent
at times. The client's speech is rapid and loose. She
reports being a special messenger from the Messiah.
She has a history of depressed mood for which she has
been taking an antidepressant. The nurse suspects
which diagnosis?
Bipolar illness
2. A 26-year-old client is admitted to the psychiatric unit
with acute onset of schizophrenia. His physician
prescribes the phenothiazine chlorpromazine
(Thorazine), 100 mg by mouth four times per day.
Before administering the drug, the nurse reviews the
client's medication history. Concomitant use of which
drug is likely to increase the risk of extrapyramidal
effects?
Droperidol (Inapsine)
3. Propranolol (Inderal) is used in the mental health
setting to manage which of the following conditions?
Antipsychotic-induced akathisia and anxiety
4. A client with schizophrenia who receives
fluphenazine (Prolixin) develops pseudoparkinsonism
and akinesia. What drug would the nurse administer to
minimize extrapyramidal symptoms?
Benztropine (Cogentin)
5.The etiology of schizophrenia is best described by:
A combination of biological, psychological, and
environmental factors.
6. Which of the following is one of the advantages of
the newer antipsychotic medication risperidone
(Risperdal)?
A lower incidence of extrapyramidal effects
7. A client with a diagnosis of paranoid schizophrenia
comments tothe nurse, "How do I know what is really in
those pills?" Which of the following is the best
response?
Allow him to open the individual wrappers of the
medication.
8.A client's medication order reads, "Thioridazine
(Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The
nurse should:
Question the physician about the order.
9The nurse is assigned to a client with catatonic
schizophrenia. Which intervention should the nurse
include in the client's plan of care?
Meeting all of the client's physical needs
10Since admission 4 days ago, a client has refused to
take a shower, stating, "There are poison crystals
hidden in the showerhead. They'll kill me if I take a
shower." Which nursing action is most appropriate?
Accepting these fears and allowing the client to take a
sponge bath
11. Which information is most important for the nurse
to include in a teaching plan for a schizophrenic client
taking clozapine (Clozaril)?
Report a sore throat or fever to the physician
immediately.
12The nurse is providing care to a client with a catatonic
type of schizophrenia who exhibits extreme negativism.
To help the client meet his basic needs, the nurse
should:
Tell the client specifically and concisely what needs to
be done.
13A client with paranoid schizophrenia is admitted to
the psychiatric unit of a hospital. Nursing assessment
should include careful observation of the client's:
Thinking, perceiving, and decision-making skills.
14A client is admitted to the psychiatric unit with a
tentative diagnosis of psychosis. Her physician
prescribes the phenothiazine thioridazine (Mellaril) 50
mg by mouth three times per day. Phenothiazines differ
from central nervous system (CNS) depressants in their
sedative effects by producing:
A calming effect from which the client is easily aroused.
15The nurse is caring for a client who experiences false
sensory perceptions with no basis in reality. These
perceptions are known as:
Hallucinations
16An agitated and incoherent client, age 29, comes to
the emergency department with complaints of visual
and auditory hallucinations. The history reveals that the
client was hospitalized for paranoid schizophrenia from
ages 20 to 21. The physician prescribes haloperidol
(Haldol), 5 mg I.M. The nurse understands that this drug
is used in this client to treat:
Psychosis
17The nurse is caring for a client with schizophrenia.
Which of the following outcomes is the least desirable?
The client spends more time by himself.
18A client with borderline personality disorder becomes
angry when he is told that today's psychotherapy
session with the nurse will be delayed 30 minutes
because of an emergency. When the session finally
begins, the client expresses anger. Which response by
the nurse would be most helpful in dealing with the
client's anger?
"You had to wait. Can we talk about how this is making
you feel right now?"
19A client is unable to get out of bed and get dressed
unless the nurse prompts every step. This is an example
of which behavior?
Avolition
20. Positive symptoms of schizophrenia include which of
the following?
Hallucinations, delusions, and disorganized thinking
21A client tells the nurse that people from Mars are
going to invade the earth. Which response by the nurse
would be most therapeutic?
"That must be frightening to you. Can you tell me how
you feel about it?"
22. How soon after chlorpromazine (Thorazine)
administration should the nurse expect to see a client's
delusional thoughts and hallucinations eliminated?
Several weeks
23.Important teaching for clients receiving antipsychotic
medication such as haloperidol (Haldol) includes which
of the following instructions?
Use sunscreen because of photosensitivity.
24. Every day for the past 2 weeks, a client with
schizophrenia stands up during group therapy and
screams, "Get out of here right now! The elevator
bombs are going to explode in 3 minutes!" The next
time this happens, how should the nurse respond?
"I know you think there are bombs in the elevator, but
there aren't."
25. A client with schizophrenia is receiving antipsychotic
medication. Which nursing diagnosis may be
appropriate for this client?
Ineffective protection related to blood dyscrasias
26. A client with paranoid personality disorder is
admitted to a psychiatric facility. Which remark by the
nurse would best establish rapport and encourage the
client to confide in the nurse?
“I get upset once in a while, too."
27Important teaching for a client receiving risperidone
(Risperdal) would include advising the client to:
Notify the physician if the client notices an increase in
bruising.
28A client with schizophrenia tells the nurse he hears
the voices of his dead parents. To help the client ignore
the voices, the nurse should recommend that he:
Listen to a personal stereo through headphones and
sing along with the music.
29Yesterday, a client with schizophrenia began
treatment with haloperidol (Haldol). Today, the nurse
notices that the client is holding his head to one side
and complaining of neck and jaw spasms. What should
the nurse do?
Evaluate the client for adverse reactions to haloperidol.
30. A client diagnosed with schizoaffective disorder is
suffering from schizophrenia with elements of which of
the following disorders?
Mood disorder
31During a group therapy session in the psychiatric unit,
a client constantly interrupts with impulsive behavior
and exaggerated stories that cast her as a hero or
princess. She also manipulates the group with attention-
seeking behaviors, such as sexual comments and angry
outbursts. The nurse realizes that these behaviors are
typical of:
Histrionic personality disorder.
32The nurse is aware that antipsychotic medications
may cause which of the following adverse effects?
Lower seizure threshold
33A client is admitted to the psychiatric hospital with a
diagnosis of catatonic schizophrenia. During the
physical examination, the client's arm remains
outstretched after the nurse obtains the pulse and
blood pressure, and the nurse must reposition the arm.
This client is exhibiting:
Waxy flexibility.
34A client with chronic schizophrenia receives 20 mg of
fluphenazine decanoate (Prolixin Decanoate) by I.M.
injection. Three days later, the client has muscle
contractions that contort the neck. This client is
exhibiting which extrapyramidal reaction?
Dystonia
35A client is about to be discharged with a prescription
for the antipsychotic agent haloperidol (Haldol), 10 mg
by mouth twice per day. During a discharge teaching
session, the nurse should provide which instruction to
the client?
Apply a sunscreen before being exposed to the sun.
36A client receiving fluphenazine decanoate (Prolixin
Decanoate) therapy develops pseudoparkinsonism. The
physician is likely to prescribe which drug to control this
extrapyramidal effect?
Amantadine (Symmetrel)
37Drug therapy with thioridazine (Mellaril) shouldn't
exceed a daily dose of 800 mg to prevent which adverse
reaction?
Retinal pigmentation
38A client with persistent, severe schizophrenia has
been treated with phenothiazines for the past 17 years.
Now the client's speech is garbled as a result of drug-
induced rhythmic tongue protrusion. What is another
name for this extrapyramidal symptom?
Tardive dyskinesia
39The nurse is teaching a psychiatric client about her
prescribed drugs, chlorpromazine and benztropine.
Why is benztropine administered?
To reduce extrapyramidal symptoms
40A client with paranoid schizophrenia repeatedly uses
profanity during an activity therapy session. Which
response by the nurse would be most appropriate?
"Your behavior won't be tolerated. Go to your room
immediately."
41. Hormonal effects of the antipsychotic medications
include which of the following?
Retrograde ejaculation and gynecomastia
42. The nurse formulates a nursing diagnosis of
Impaired verbal communication for a client with
schizotypal personality disorder. Based on this nursing
diagnosis, which nursing intervention is most
appropriate?
Establishing a one-on-one relationship with the client
43. Which nonantipsychotic medication is used to treat
some clients with schizoaffective disorder?
Lithium carbonate (Lithane)
44. When teaching the family of a client with
schizophrenia, the nurse should provide which
information?
Support is available to help family members meet their
own needs.
45. A client is admitted with a diagnosis of delusions of
grandeur. This diagnosis reflects a belief that one is:
Highly important or famous
46. A client, age 36, with paranoid schizophrenia
believes the room is bugged by the Central Intelligence
Agency and that his roommate is a foreign spy. The
client has never had a romantic relationship, has no
contact with family members, and hasn't been
employed in the last 14 years. Based on Erikson's
theories, the nurse should recognize that this client is in
which stage of psychosocial development?
Trust versus mistrust
47. A client with a history of medication noncompliance
is receiving outpatient treatment for chronic
undifferentiated schizophrenia. The physician is most
likely to prescribe which medication for this client?
Fluphenazine decanoate (Prolixin Decanoate)
48. A client begins clozapine (Clozaril) therapy after
several other antipsychotic agents fail to relieve her
psychotic symptoms. The nurse instructs her to return
for weekly white blood cell (WBC) counts to assess for
which adverse reaction?
Granulocytopenia

49. A man with a 5-year history of multiple psychiatric

admissions is brought to the emergency department by
the police. He was found wandering the streets
disheveled, shoeless, and confused. Based on his
previous medical records and current behavior, he is
diagnosed with chronic undifferentiated schizophrenia.
The nurse should assign highest priority to which
nursing diagnosis?
Anxiety

50. A client is admitted to the psychiatric unit with

active psychosis. The physician diagnoses schizophrenia
after ruling out several other conditions. Schizophrenia
is characterized by:
Disturbances in affect, perception, and thought content
and form.