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2/13/23, 11:02 PM Mental Health and Psychiatric Nursing NCLEX Practice Questions Nursing Test Bank (700+ Questions)
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Mental Health and Psychiatric

Nursing NCLEX Practice Questions
Nursing Test Bank (700+ Questions)
UPDATED ON NOVEMBER 24, 2022 BY MATT VERA BSN, R.N.
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2/13/23, 11:02 PM Mental Health and Psychiatric Nursing NCLEX Practice Questions Nursing Test Bank (700+ Questions) - Nurseslabs
Welcome to your ultimate NCLEX practice questions and nursing test bank for mental health and
psychiatric nursing. For this nursing test bank, test your knowledge on the concepts of mental
health and psychiatric disorders. This quiz aims to help students and registered nurses grasp and
master mental health and psychiatric nursing concepts.
Mental Health and Psychiatric Nursing Test

Banks
In this section, you’ll find the NCLEX practice questions and quizzes for mental health and
psychiatric nursing. This nursing test bank set includes 700+ practice questions divided into
comprehensive quizzes for mental health and psychiatric nursing and a special set of questions
for common psychiatric disorders. Use these nursing test banks to augment or as an alternative to
ATI and Quizlet.
Quizzes included in this guide are:
1. Comprehensive Mental Health & Psychiatric Nursing NCLEX Practice | Quiz #1: 75
Questions
Questions
Questions
4. Psychiatric Assessment and Fundamentals of Mental Health & Psychiatric Nursing | Quiz
#4: | 50 Questions
5. Psychiatric Medications NCLEX Practice | Quiz #5: 75 Questions
6. Alzheimer’s, Delirium, and Dementia NCLEX Practice | Quiz #6: 65 Questions
7. Anxiety Disorders NCLEX Practice | Quiz #7: 75 Questions

8. Schizophrenia NCLEX Practice | Quiz #8: 65 Questions
9. Substance Abuse and Abuse NCLEX Practice | Quiz #9: 55 Questions
10. Personality and Mood Disorders NCLEX Practice | Quiz #10: 110 Questions
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1. Comprehensive Mental Health and Psychiatric Nursing NCLEX Practice |

Quiz #1: 75 Questions
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Comprehensive Mental Health and Psychiatric

Nursing NCLEX Practice | Quiz #1: 75 Questions
Welcome to the first comprehensive mental health and psychiatric nursing practice quiz covering
different mental health disorders. There are 75 practice questions in this set, and please be sure
to read the rationales!
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37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72
73 74 75
Correct Incorrect
1. Question
Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam
(Serax). Before administering the medication, nurse Gina should be prepared for which common
adverse effect?
A. Seizures
B. Shivering
C. Anxiety
D. Chest pain
Incorrect
Correct Answer: A. Seizures
Seizures are the most common serious adverse effect of using flumazenil to reverse
benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic
antidepressant and benzodiazepine overdose. Benzodiazepine reversal has correlations
with seizures. Seizures may happen more frequently in patients who have been on
benzodiazepines for long-term sedation or in patients who are showing signs of severe
tricyclic antidepressant overdose. The required dosage of Flumazenil should be measured
and prepared by the practitioners to manage seizures. Flumazenil use requires caution in
patients relying on a benzodiazepine for seizure control.
Option B: Shivering is not an adverse effect of flumazenil. Monitor the patient for
the possible return of sedation, mostly in those who are tolerant of benzodiazepines.
Patients should have monitoring for respiratory depression, benzodiazepine
withdrawal, and other residual effects of benzodiazepines for at least 2 hours.
Option C: Anxiety is a rare adverse effect for people using flumazenil. Flumazenil
has some associations with precipitation of seizures in patients with benzodiazepine
dependence with a history of seizures. Flumazenil overdose is extremely rare. There
is no precise antidote for flumazenil toxicity. In mild to severe toxicity, symptomatic
and supportive treatment should be a consideration.
Option D: An overdose of flumazenil in a patient who is not a chronic
benzodiazepine user would not be expected. Chronic benzodiazepines users may
experience withdrawal with abrupt discontinuation of the drug. Administration of
benzodiazepines or barbiturates may be necessary for seizure control.
2. Question
Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a
client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
C. Identify anxiety-causing situations.
D. Eat only three meals per day.
Incorrect
Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to stress and underlying
issues. The client must identify anxiety-causing situations that stimulate the bulimic
behavior and then learn new ways of coping with the anxiety. Bulimia nervosa is a
condition that occurs most commonly in adolescent females, characterized by indulgence
in binge-eating, and inappropriate compensatory behaviors to prevent weight gain.
Option A: Controlling shopping for large amounts of food isn’t a goal early in
treatment. It is important to educate patients who abuse laxatives that these
medications work in the gastrointestinal tract after the areas where caloric
absorption has occurred primarily. It is crucial to inform patients that a period of
edema and weight gain may follow up to several weeks after discontinuation of
purging behavior.
Option B: Managing eating impulses and replacing them with adaptive coping
mechanisms can be integrated into the plan of care after initially addressing stress
and underlying issues. The primary objective of treatment is a cessation of the
binging and purging behavior. Selective serotonin reuptake inhibitors such as
fluoxetine, citalopram, and sertraline have shown to reduce symptoms of bulimia
nervosa. Fluoxetine is the only FDA approved medication for bulimia nervosa. It
appears that a higher dose (60 mg) is significantly better than a placebo in
decreasing the frequency of binge and vomiting episodes.
Option D: Eating three meals per day isn’t a realistic goal early in treatment.
Patients with bulimia nervosa who purge by vomiting often brush their teeth
immediately after purging, which can accelerate dental erosion. The clinician should
instruct the patients who persist in vomiting to rinse their mouths with water or
fluoride rather than brushing their teeth within 30 minutes of each episode. Consider
consulting a dentist to address dental issues associated with vomiting.
3. Question
A female client who’s at high risk for suicide needs close supervision. To best ensure the client’s
safety, Nurse Mary should:
A. Check the client frequently at irregular intervals throughout the night.
B. Assure the client that the nurse will hold in confidence anything the client says.
C. Repeatedly discuss previous suicide attempts with the client.
D. Disregard decreased communication by the client because this is common with

suicidal clients.
Incorrect
Correct Answer: A. Check the client frequently at irregular intervals throughout the
night
Checking the client frequently but at irregular intervals prevents the client from predicting
when observation will take place and altering behavior in a misleading way at these times.
Once the patient is deemed to be at risk for suicide, then intervention steps must be
initiated right away. The individual must not be left alone. Enlist the help of a support
person while at home. The suicidal individual must be treated in a safe and secure place.
In addition, the place has to be monitored.
Option B: This may encourage the client to try to manipulate the nurse or seek
attention for having a secret suicide plan. Assessing the individual’s judgment is
critical. One should try and determine how the individual can handle stress. Does he
or she have an impairment in decision making? Does the individual know that
jumping in front of a train is dangerous? Reflect empathy and concern. Offer a hand
to help. Provide the patient with confidence that he or she can overcome the issues.
Option C: This may reinforce suicidal ideas. Help develop internal coping strategies
(e.g., exercise, journaling, reading, developing a hobby). Utilize the help of
healthcare professionals to follow up on therapy. Once the individual is safe as an
inpatient or outpatient, a formal treatment plan should be established. The next step
is to refer all patients deemed to be at higher risk for suicide to a mental health
counselor as soon as possible. Every state has laws and procedures regarding this
process which must be incorporated into the clinical practice when addressing
individuals at high suicide risk.
Option D: Decreased communication is a sign of withdrawal that may indicate the
client has decided to commit suicide; the nurse shouldn’t disregard it. In some
cases, assessment of the mental status may provide a clue to the individual’s
potential for self-harm. Depressed patients will often tend to appear unclean and
unkempt. The clothing may not be ironed or dirty. The risk of suicide is often high in
people who appear very anxious or depressed. The patient may exhibit a flat affect
or no emotions at all. Some depressed patients may develop hallucinations that may
be telling him or her to kill themselves. The majority of these hallucinations are
auditory.
4. Question
Which of the following drugs should Nurse Mary prepare to administer to a client with a toxic
acetaminophen (Tylenol) level?
A. Deferoxamine mesylate (Desferal)
B. Succimer (Chemet)
C. Flumazenil (Romazicon)
D. Acetylcysteine (Mucomyst)
Incorrect
Correct Answer: D. Acetylcysteine (Mucomyst)
The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic
metabolites to nontoxic metabolites. Acetaminophen (N-acetyl-para-aminophenol,
paracetamol, APAP) toxicity is common primarily because the medication is so readily
available, and there is a perception that it is very safe. More than 60 million Americans
consume acetaminophen on a weekly basis. All patients with high levels of acetaminophen
need admission and treatment with N-acetyl-cysteine (NAC). This agent is fully protective
against liver toxicity if given within 8 hours after ingestion.
Option A: Deferoxamine mesylate is the antidote for iron intoxication. Desferal is
indicated for the treatment of acute iron intoxication and chronic iron overload due to
transfusion-dependent anemias. Desferal is an adjunct to, and not a substitute for,
standard measures used in treating acute iron intoxication, which may include the
following: induction of emesis with syrup of ipecac; gastric lavage; suction and
maintenance of a clear airway; control of shock with intravenous fluids, blood,
oxygen, and vasopressors; and correction of acidosis.
Option B: Succimer is an antidote for lead poisoning. Succimer is an oral heavy
metal chelating agent used to treat lead and heavy metal poisoning. Succimer has
been linked to a low rate of transient serum aminotransferase elevations during
therapy, but its use has not been linked to cases of clinically apparent liver injury
with jaundice. Succimer does not significantly chelate essential metals such as zinc,
copper, or iron, and its specificity, safety and oral availability make it preferable to
other chelating agents for treating lead poisoning such as Ca-EDTA which must be
given intravenously and dimercaprol (British anti-Lewisite [BAL) which requires
intramuscular administration.
Option C: Flumazenil reverses the sedative effects of benzodiazepines. Flumazenil
is a benzodiazepine antagonist. Flumazenil is also indicated for the management
and treatment of benzodiazepine overdose in adults. It is useful in reversing coma
due to benzodiazepine overdose. Flumazenil is more effective in reversing sedation
or coma in patients with benzodiazepine intoxication rather than in patients with
multiple drug overdoses.
5. Question
A male client is admitted to the substance abuse unit for alcohol detoxification. Which of the
following medications is Nurse Alice most likely to administer to reduce the symptoms of alcohol
withdrawal?
A. Naloxone (Narcan)
B. Haloperidol (Haldol)
C. Magnesium sulfate
D. Chlordiazepoxide (Librium)
Incorrect
Correct Answer: D. Chlordiazepoxide (Librium)

Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol
withdrawal. Chlordiazepoxide is a long-acting benzodiazepine and is an FDA approved
medication for adults with mild-moderate to severe anxiety disorder, preoperative
apprehension and anxiety, and withdrawal symptoms of acute alcohol use disorder.
Chlordiazepoxide has anti-anxiety, sedative, appetite-stimulating, and weak analgesic
actions. It binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel
complex and enhances GABA’s inhibitory effects.
Option A: Naloxone (Narcan) is administered for narcotic overdose. Naloxone is
indicated for the treatment of opioid toxicity, specifically to reverse respiratory
depression from opioid use. It is useful in accidental or intentional overdose and
acute or chronic toxicity. Naloxone is a pure, competitive opioid antagonist with a
high affinity for the mu-opioid receptor, allowing for reversal of the effects of opioids.
The onset of action varies depending on the route of administration but can be as
fast as one minute when delivered intravenously (IV) or intraosseous (IO).
Option B: Haloperidol (Haldol) may be given to treat clients with psychosis, severe
agitation, or delirium. Haloperidol is a first-generation (typical antipsychotic) which
exerts its antipsychotic action by blocking dopamine D2 receptors in the brain. When
72% of dopamine receptors are blocked, this drug achieves its maximal effect.
Haloperidol is not selective for the D2 receptor. It also has noradrenergic,
cholinergic, and histaminergic blocking action. The blocking of these receptors is
associated with various side effects.
Option C: Magnesium sulfate and other anticonvulsant medications are only
administered to treat seizures if they occur during withdrawal. Magnesium sulfate
administration can be oral (PO), intramuscular (IM), intraosseous (IO), or
intravenous (IV). For every 1 gram of magnesium sulfate, it contains 98.6 mg or
8.12Eq of elemental magnesium. Magnesium sulfate can be combined with
dextrose 5% or water to make intravenous solutions.
6. Question
During postprandial monitoring, a female client with bulimia nervosa tells the nurse, “You can sit
with me, but you’re just wasting your time. After you had sat with me yesterday, I was still able to
purge. Today, my goal is to do it twice.” What is the nurse’s best response?
A. “I trust you not to purge.”
B. “How are you purging and when do you do it?”
C. “Don’t worry. I won’t allow you to purge today.”
D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes
after you eat.”
Incorrect
Correct Answer: D. “I know it’s important for you to feel in control, but I’ll monitor
you for 90 minutes after you eat.”
This response acknowledges that the client is testing limits and that the nurse is setting
them by performing postprandial monitoring to prevent self-induced emesis. Clients with
bulimia nervosa need to feel in control of the diet because they feel they lack control over
all other aspects of their lives. Since recovery involves patients having to face their
deepest, most painful, and traumatic thoughts and emotions, supporting them as they go
through treatment can be emotionally challenging for nurses. This emotional challenge can
be exacerbated when the patient has also been diagnosed with Obsessive-Compulsive
Disorder (OCD), depression, or substance abuse, as these may require more intensive
one-to-one support.
Option A: Because their therapeutic relationships with caregivers are less important
than their need to purge, they don’t fear betraying the nurse’s trust by engaging in
the activity. They commonly plot to purge and rarely share their secrets about it. As
this might take nurses out of their comfort zone or clinical remit, worksheets are
available for nurses to use in efforts to help patients challenge and overcome their
obsessive and ritualistic behaviors and to adopt a more flexible perspective in day-
to-day life.6 These can be supplemented by nurses familiarising themselves with the
detailed guidelines and resources offered by NICE.
Option B: Learning motivational interviewing techniques can help facilitate
communication with those who might be resistant to discussing topics related to
food, weight, and recovery. Such techniques can help develop the skills of empathic
understanding, rolling with resistance, and gently assisting patients to make their
own, autonomous decision to work towards recovery. Often, the aim is to help
patients learn new and healthier ways of coping, and nurses can achieve this
through a mix of emotional support, education, and signposting.
Option C: An authoritarian or challenging response may trigger a power struggle
between the nurse and client. Assisting patients to remain strong and adhere to
treatment requires nurses to develop a relationship that is caring, empathetic and
trusting, and in line with the person-centered approach to care. Patients affected by
eating disorders require individualized support to better understand their condition,

rediscover their identity, learn to accept themselves, enhance a positive body image
and sense of self-worth, and achieve a balance in their lives so that they can move
towards better health and wellbeing.
7. Question
A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse,
“It felt so wonderful to get high.” Which of the following is the most appropriate response?
A. “If you continue to talk like that, I’m going to stop speaking to you.”
B. “You told me you got fired from your last job for missing too many days after taking
drugs all night.”
C. “Tell me more about how it felt to get high.”
D. “Don’t you know it’s illegal to use drugs?”
Incorrect
Correct Answer: B. “You told me you got fired from your last job for missing too
many days after taking drugs all night.”
Confronting the client with the consequences of substance abuse helps to break through
denial. Present reality by spending time with the client to facilitate reality orientation
because your physical presence is the reality. Be simple, direct, and concise when
speaking to the client. Talk with the client about concrete or familiar things; avoid
ideological or theoretical discussions. The client’’s ability to process abstractions or
complexities is impaired.
Option A: Making threats isn’t an effective way to promote self-disclosure or
establish a rapport with the client. Motivational counseling works according to the
idea that motivation for change is dynamic rather than static. Professional uses may
influence change by developing a therapeutic relationship to increase therapeutic
alliance, developing insight, and coping skills to resolve ambivalence, and change
health-related behavior.
Option C: Although the nurse should encourage the client to discuss feelings, the
discussion should focus on how the client felt before, not during, an episode of
substance abuse. Encouraging elaboration about his experience while getting high
may reinforce the abusive behavior. Persons may withdraw from their environment
with regressive behavior, fail to engage with others, or even notice physical illness
and pain. Social exclusion and homelessness may ensue. In the longer term,
psychosis and its potential disruption of the capacity to fulfill social roles can result in
further burdens.
Option D: The client undoubtedly is aware that drug use is illegal; a reminder to this
effect is unlikely to alter behavior. Drug addiction exacerbates social alienation and
increases potential for violent lashing out and low self-esteem, along with poor
coping skills. Under these circumstances, emotional, social, or symptom-related
cues can provoke recourse to available substances and suicidal ideation. They may
also contribute to psychosocial instability, self-image issues, and achievement
motivation. In some cases, social hostility and rejection may result.
8. Question
For a female client with anorexia nervosa, Nurse Jimmy is aware that which goal takes the
highest priority?
A. The client will establish adequate daily nutritional intake.
B. The client will make a contract with the nurse that sets a target weight.
C. The client will identify self-perceptions about body size as unrealistic.
D. The client will verbalize the possible physiological consequences of self-starvation.
Incorrect
Correct Answer: A. The client will establish adequate daily nutritional intake.
According to Maslow’s hierarchy of needs, all humans need to meet basic physiological
needs first. Because a client with anorexia nervosa eats little or nothing, the nurse must
first plan to help the client meet this basic, immediate physiological need. Treatment for
anorexia nervosa is centered on nutrition rehabilitation and psychotherapy. Refeeding

syndrome can occur following prolonged starvation. As the body utilizes glucose to
produce molecules of adenosine triphosphate (ATP), it depletes the remaining stores of
phosphorus. Also, glucose entry into cells is mediated by insulin and occurs rapidly
following long periods without food. Both cause electrolyte abnormalities such as
hypophosphatemia and hypokalemia, triggering cardiac and respiratory compromise.
Patients should be followed carefully for signs of refeeding syndrome and electrolytes
closely monitored.
Option B: Recovery from an eating disorder can be a long process that requires not
only a qualified team of professionals but also the love and support of family and
friends. It is not uncommon for someone who suffers from an eating disorder to feel
uncertain about their progress or for their loved ones to feel disengaged from the
treatment process. These potential roadblocks may lead to feelings of ambivalence,
limited progress, and treatment dropout.
Option C: Anorexia nervosa is a psychiatric disease in which patients restrict their
food intake relative to their energy requirements through eating less, exercising
more, and/or purging food through laxatives and vomiting. Despite being severely
underweight, they do not recognize it and have distorted body images. They can
develop complications from being underweight and purging food. Diagnose by
history, physical, and lab work that rules out other conditions that can make people
lose weight. Treatment includes gaining weight (sometimes in a hospital if severe),
therapy to address body image, and management of complications from
malnourishment.
Option D: The nurse may give lesser priority to goals that address long-term plans,
self-perception, and potential complications. Eating disorders can affect every organ
system in the body, and people struggling with an eating disorder need to seek
professional help. The earlier a person with an eating disorder seeks treatment, the
greater the likelihood of physical and emotional recovery.
9. Question
When interviewing the parents of an injured child, which of the following is the strongest indicator
that child abuse may be a problem?
A. The injury isn’t consistent with the history or the child’s age.
B. The mother and father tell different stories regarding what happened.
C. The family is poor.
D. The parents are argumentative and demanding with emergency department

personnel.
Incorrect
Correct Answer: A. The injury isn’t consistent with the history or the child’s age.
When the child’s injuries are inconsistent with the history given or impossible because of
the child’s age and developmental stage, the emergency department nurse should be
suspicious that child abuse is occurring. Physical indicators may include injuries to a child
that are severe, occur in a pattern or occur frequently. These injuries range from bruises to
broken bones to burns or unusual lacerations. The child may present for care unrelated to
the abuse, and the abuse may be found incidentally.
Option B: The parents may tell different stories because their perception may be
different regarding what happened. If they change their story when different health
care workers ask the same question, this is a clue that child abuse may be a
problem. Physical abuse should be considered in the evaluation of all injuries of
children. A thorough history of present illness is important to make a correct
diagnosis. Important aspects of the history-taking involve gathering information
about the child’s behavior before, during, and after the injury occurred. History-
taking should include the interview of each caretaker separately and the verbal
child, as well. The parent or caretaker should be able to provide their history without
interruptions in order not to be influenced by the physician’s questions or
interpretations.
Option C: Child abuse occurs in all socioeconomic groups. All races, ethnicities,
and socioeconomic groups are affected by child abuse with boys and adolescents
more commonly affected. Infants tend to have increased morbidity and mortality with
physical abuse. Multiple factors increase a child’s risk of abuse. These include risks
at an individual level (child’s disability, unmarried mother, maternal smoking or
parent’s depression); risks at a familial level (domestic violence at home, more than
two siblings at home); risks at a community level (lack of recreational facilities); and
societal factors (poverty).
Option D: Parents may argue and be demanding because of the stress of having an
injured child. To diagnose a patient with child maltreatment is difficult since the
victim may be nonverbal or too frightened or severely injured to talk. Also, the
perpetrator will rarely admit to the injury, and witnesses are uncommon. Physicians
will see children of maltreatment in a range of ways that include the perpetrators
may be concerned that the abuse is severe and bring in the patient for medical care.
10. Question
For a female client with anorexia nervosa, nurse Rose plans to include the parents in therapy
sessions along with the client. What fact should the nurse remember to be typical of parents of
clients with anorexia nervosa?
A. They tend to overprotect their children.
B. They usually have a history of substance abuse.
C. They maintain emotional distance from their children.
D. They alternate between loving and rejecting their children.
Incorrect
Correct Answer: A. They tend to overprotect their children.
Clients with anorexia nervosa typically come from a family with parents who are controlling
and overprotective. These clients use eating to gain control of an aspect of their lives.
Similarly, issues like anxiety, depression, and addiction can also run in families, and have
also been found to increase the chances that a person will develop an eating disorder.
Many people with anorexia report that, as children, they always followed the rules and felt
there was one “right way” to do things.
Option B: Substance abuse and eating disorders frequently co-occur, with up to
50% of individuals with eating disorders who abuse alcohol or illicit drugs, a rate five
times higher than the general population. Substance abuse problems may begin
before or during an eating disorder, or even after recovery. Those struggling with co-
occurring substance use and disordered eating should speak with a trained
professional who can understand, diagnose, and treat both substance use disorders
and eating disorders.
Option C: Loneliness and isolation are some of the hallmarks of anorexia; many
with the disorder report having fewer friends and social activities, and less social
support. Whether this is an independent risk factor or linked to other potential

causes (such as social anxiety) isn’t clear.
Option D: Eating disorders are complex and affect all kinds of people. Risk factors
for all eating disorders involve a range of biological, psychological, and sociocultural
issues. These factors may interact differently in different people, so two people with
the same eating disorder can have very diverse perspectives, experiences, and
symptoms. Still, researchers have found broad similarities in understanding some of
the major risks for developing eating disorders.
11. Question
In the emergency department, a client with facial lacerations states that her husband beat her with
a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake
nurse, who will evaluate the continued threat of violence. Suddenly the client’s husband arrives,
shouting that he wants to “finish the job.” What is the first priority of the health care worker who
witnesses this scene?
A. Remaining with the client and staying calm.
B. Calling a security guard and another staff member for assistance.
C. Telling the client’s husband that he must leave at once.
D. Determining why the husband feels so angry.
Incorrect
Correct Answer: B. Calling a security guard and another staff member for
assistance.
The health care worker who witnesses this scene must take precautions to ensure
personal as well as client safety but shouldn’t attempt to manage a physically aggressive
person alone. Therefore, the first priority is to call a security guard and another staff
member. Domestic violence is defined as a pattern of abusive behaviors by one partner
against another in an intimate relationship such as marriage, dating, family, or cohabitation.
In this definition, domestic violence takes many forms, including physical aggression or
assault, sexual abuse, emotional abuse, controlling or domineering behavior, intimidation,

stalking, passive/covert abuse, and economic deprivation.
Option A: After doing this, the health care worker should inform the husband what is
expected, speaking in concise statements, and maintaining a firm but calm
demeanor. This approach makes it clear that the health care worker is in control and
may diffuse the situation until the security guard arrives. Nurses can play an
important role in working toward the creation of a violence-free community but they
must first become informed. They must then insist the organizations in which they
work to accept this responsibility and work together to create environments that
support people experiencing domestic violence.
Option C: Telling the husband to leave would probably be ineffective because of his
agitated and irrational state. Although the exact rates are widely disputed, especially
within the United States, there is a large body of cross-cultural evidence that women
are subjected to domestic violence significantly more often than men. In addition,
there is broad consensus that women are more often subjected to severe forms of
abuse and are more likely to be injured by an abusive partner. According to a report
by the United States Department of Justice, a survey of 16,000 Americans showed
22.1 percent of women and 7.4 percent of men reported being physically assaulted
by a current or former spouse, cohabiting partner, boyfriend, girlfriend, or date in
their lifetime.
Option D: Exploring his anger doesn’t take precedence over safeguarding the client
and staff. Gender roles and expectations play a role in abusive situations, and
exploring these roles and expectations can be helpful in addressing abusive
situations. Likewise, it can be helpful to explore factors such as race, class, religion,
sexuality, and philosophy. However, studies investigating whether sexist attitudes
are correlated with domestic violence have shown conflicting results.
12. Question
Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary.
Which intervention is also important?
A. Fill out the client’s menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least
2 hours after each meal.
C. Let the client choose her own food. If she eats everything she orders, then stay with
her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but she should keep a
strict calorie count.
Incorrect
Correct Answer: C. Let the client choose her own food. If she eats everything she
orders, then stay with her for 1 hour after each meal
Allowing the client to select her own food from the menu will help her feel some sense of
control. Assisting patients to remain strong and adhere to treatment requires nurses to
develop a relationship that is caring, empathetic and trusting, and in line with the person-
centered approach to care. Patients affected by eating disorders require individualized
support to better understand their condition, rediscover their identity, learn to accept
themselves, enhance a positive body image and sense of self-worth, and achieve a
balance in their lives so that they can move towards better health and wellbeing.
Option A: She must then eat 100% of what she selected. During the early stages of
treatment when patients are still new to recovery, they look to nurses to provide
them with a highly structured environment, which sometimes involves nurses
making food and behavioral decisions on their behalf. While this might not be an
ongoing issue for primary care nurses, they may still be required to offer decisive
advice on these areas. Here, it is imperative that nurses offer such advice with a
clear message that patients have the power to make these decisions themselves.
Option B: Remaining with the client for at least 1 hour after eating will prevent
purging. As treatment progresses, patients eventually grow to appreciate nurses
who act as role models and educate them on how to normalize their diet and
involvement in social activities. Towards the end of treatment, nurses become more
of a support system, encouraging the patient to move forward autonomously, while
providing them with guidance on where to seek help if it is needed.
Option D: Bulimic clients should only be allowed to eat food provided by the dietary
department. From awareness of the eating disorder to recovery maintenance, the
role of the primary care nurse evolves, but what doesn’t change is the positive
influence nurses can have on those with an eating disorder. With the skills of
listening, empathy, adaptability, and communication, primary care nurses can assist
in identifying at-risk individuals and optimizing the delivery of a multidisciplinary and

holistic approach to care.
13. Question
Nurse Mary is assigned to care for a suicidal client. Initially, which is the nurse’s highest care
priority?
A. Assessing the client’s home environment and relationships outside the hospital.
B. Exploring the nurse’s own feelings about suicide.
C. Discussing the future with the client.
D. Referring the client to a clergyperson to discuss the moral implications of suicide.
Incorrect
Correct Answer: B. Exploring the nurse’s own feelings about suicide.
The nurse’s values, beliefs, and attitudes toward self-destructive behavior influence
responses to a suicidal client; such responses set the overall mood for the nurse-client
relationship. Therefore, the nurse initially must explore personal feelings about suicide to
avoid conveying negative feelings to the client.
Option A: Assessment of the client’s home environment and relationships may
reveal the need for family therapy; however, conducting such an assessment isn’t a
nursing priority. A clear and complete evaluation and clinical interview provide the
information upon which to base a suicide intervention. Although risk factors offer
major indications of the suicide danger, nothing can substitute for a focused patient
inquiry. However, although all the answers a patient gives may be inclusive, a
therapist often develops a visceral sense that his or her patient is going to commit
suicide. The clinician’s reaction counts and should be considered in the intervention.
Option C: Discussing the future and providing anticipatory guidance can help the
client prepare for future stress, but this isn’t a priority. If suicidal ideation is present,
the next question must be about any plans for suicidal acts. The general formula is
that more specific plans indicate greater danger. Although vague threats, such as a
threat to commit suicide sometime in the future, are the reason for concern,
responses indicating that the person has purchased a gun, has ammunition, has
made out a will, and plans to use the gun are more dangerous. The plan demands
further questions. If the person envisions a gun-related death, determine whether he
or she has the weapon or access to it.
Option D: Referring the client to a clergyperson may increase the client’s trust or
alleviate guilt; however, it isn’t the highest priority. The only way to prevent suicides
is to work in an interprofessional team that includes a mental health nurse,
psychiatrist, the primary care provider, social worker, and nurse practitioner.
Practitioners must work with the patient’s family and friends, as well as with the
other patients who knew the client.
14. Question
A 24-year old client with anorexia nervosa tells the nurse, “When I look in the mirror, I hate what I
see. I look so fat and ugly.” Which strategy should the nurse use to deal with the client’s distorted
perceptions and feelings?
A. Avoid discussing the client’s perceptions and feelings.
B. Focus discussions on food and weight.
C. Avoid discussing unrealistic cultural standards regarding weight.
D. Provide objective data and feedback regarding the client’s weight and
attractiveness.
Incorrect
Correct Answer: D. Provide objective data and feedback regarding the client’s
weight and attractiveness
By focusing on reality, this strategy may help the client develop a more realistic body image
and gain self-esteem. Anorexia nervosa is an eating disorder defined by restriction of
energy intake relative to requirements, leading to a significantly low body weight. Patients
will have an intense fear of gaining weight and distorted body image with the inability to
recognize the seriousness of their significantly low body weight. The mental health nurse
should educate the patient on changes in behavior, easing stress, and overcoming any
emotional issues.
Option A: This is inappropriate because discussing the client’s perceptions and
feelings wouldn’t help her to identify, accept, and work through them. Since recovery
involves patients having to face their deepest, most painful, and traumatic thoughts
and emotions, supporting them as they go through treatment can be emotionally
challenging for nurses. This emotional challenge can be exacerbated when the
patient has also been diagnosed with Obsessive-Compulsive Disorder (OCD),
depression, or substance abuse, as these may require more intensive one-to-one
support.
Option B: Focusing discussions on food and weight would give the client attention
for not eating. During the early stages of treatment when patients are still new to
recovery, they look to nurses to provide them with a highly structured environment,
which sometimes involves nurses making food and behavioral decisions on their
behalf. While this might not be an ongoing issue for primary care nurses, they may
still be required to offer decisive advice on these areas. Here, it is imperative that
nurses offer such advice with a clear message that patients have the power to make
these decisions themselves.
Option C: This is inappropriate because recognizing unrealistic cultural standards
wouldn’t help the client establish more realistic weight goals. Furthermore, learning
motivational interviewing techniques can help facilitate communication with those
who might be resistant to discussing topics related to food, weight, and recovery.
Such techniques can help develop the skills of empathic understanding, rolling with
resistance, and gently assisting patients to make their own, autonomous decision to
work towards recovery. Often, the aim is to help patients learn new and healthier
ways of coping, and nurses can achieve this through a mix of emotional support,
education, and signposting.
15. Question
Nurse Alice is caring for a client being treated for alcoholism. Before initiating therapy with
disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of
the following products?
A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese
Incorrect
Correct Answer: B. Aftershave lotion
Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse
drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of
acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences
noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a
reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to
avoid products containing alcohol such as aftershave lotions. Close monitoring of adverse
events is necessary, in particular, in patients with polysubstance abuse. Patients taking
disulfiram require monitoring for signs and symptoms of hepatitis, including fatigue,
weakness, anorexia, nausea, vomiting, jaundice, malaise, and dark urine.
Option A: Disulfiram is one of three drugs approved by the FDA for the treatment of
alcohol dependence. It is a second-line option (acamprosate and naltrexone are
first-line treatments) in patients with sufficient physician supervision. Disulfiram is
safe and efficient in supervised short-term and long-term treatment of individuals
dependent on alcohol but who are motivated to discontinue alcohol use.
Option C: Disulfiram irreversibly inhibits aldehyde dehydrogenase (ALDH1A1) by
competing with nicotinamide adenine dinucleotide (NAD) at the cysteine residue in
the active site of the enzyme. ALDH1A1 is a hepatic enzyme of the major oxidative
pathway of alcohol metabolism converting ethanol to acetaldehyde. At therapeutic
doses of disulfiram, alcohol consumption results in increased serum acetaldehyde,
causing diaphoresis, palpitations, facial flushing, nausea, vertigo, hypotension, and
tachycardia.
Option D: Patients receiving metronidazole, paraldehyde, alcohol, or alcohol-
containing preparations (sauces, cough mixtures, vinegar) should not receive
disulfiram and should be educated in advance to avoid a disulfiram-alcohol reaction.
Never administer to a patient if alcohol use is suspected or without the patient’s
consent and understanding of disulfiram-alcohol reaction.
16. Question
Nurse Harry is developing a plan of care for a client with anorexia nervosa. Which action should
the nurse include in the plan?
A. Restrict visits with the family until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.
Incorrect
Correct Answer: C. Set up a strict eating plan for the client.
Establishing a consistent eating plan and monitoring the client’s weight is important for this
disorder. Establish a minimum weight goal and daily nutritional requirements. Malnutrition
is a mood-altering condition, leading to depression and agitation and affecting cognitive
function and decision making. Improved nutritional status enhances thinking ability,
allowing initiation of psychological work. Make a selective menu available, and allow the
patient to control choices as much as possible. Patient who gains confidence in himself
and feels in control of the environment is more likely to eat preferred foods.
Option A: The family should be included in the client’s care. Involve patients in
setting up or carrying out a program of behavior modification. Provide a reward for
weight gain as individually determined; ignore the loss. It provides a structured
eating situation while allowing the patient some control in choices. Behavior
modification may be effective in mild cases or for short-term weight gain.
Option B: The client should be monitored during meals — not given privacy.
Provide one-to-one supervision and have a patient with bulimia remain in the day
room area with no bathroom privileges for a specified period (2 hr) following eating,
if contracting is unsuccessful. Prevents vomiting during and after eating. Patients
may desire food and use a binge-purge syndrome to maintain weight. Note: Patients
may purge for the first time in response to the establishment of a weight gain
program.
Option D: Exercise must be limited and supervised. Monitor exercise programs and
set limits on physical activities. Chart activity and level of work (pacing and so on).
Moderate exercise helps in maintaining muscle tone, weight and combating

depression; however, patients may exercise excessively to burn calories.
17. Question
Nurse Taylor is aware that the victims of domestic violence should be assessed for what important
information?
A. Reasons they stay in the abusive relationship (for example, lack of financial
autonomy and isolation).
B. Readiness to leave the perpetrator and knowledge of resources.
C. Use of drugs or alcohol.
D. History of previous victimization.
Incorrect
Correct Answer: B. Readiness to leave the perpetrator and knowledge of resources.
Victims of domestic violence must be assessed for their readiness to leave the perpetrator
and their knowledge of the resources available to them. Nurses can then provide the
victims with information and options to enable them to leave when they are ready. Training
and support programs for clinicians and administrative staff have been shown to improve
identification of women experiencing domestic violence and referral to advocacy services.
Use of a domestic violence advocate in the ED resulted in a higher incidence of detection
of incidents of acute violence than the data reported in the literature.
Option A: The reasons they stay in the relationship are complex and can be
explored at a later time. Reportedly, at least 40% of domestic violence victims never
contact the police. Of female victims of domestic violence homicide, 44% had visited
an ED within 2 years of their murder.
Option C: The use of drugs or alcohol is irrelevant. Since substance abuse may
develop or worsen as a result of domestic violence, it is appropriate to consider
domestic violence when evaluating a patient for alcohol intoxication, drug toxicity, or
drug overdose. A family history of alcohol and drug abuse or similar history in the
patient’s partner is also an important risk factor.
Option D: There is no evidence to suggest that previous victimization results in a
person’s seeking or causing abusive relationships. The frequency and severity of
previous attacks indicate the degree of present danger. Threats are as important as
any actual injury. The presence of weapons in the home is a risk factor. In addition
to threats and physical abuse, relationships with high risk for injury or death
commonly feature exaggerated forms of coercion and manipulation to maintain the
partner’s dependence. This may result in the Stockholm syndrome.
18. Question
A male client is hospitalized with fractures of the right femur and right humerus sustained in a
motorcycle accident. Police suspect the client was intoxicated at the time of the accident.
Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to
drinking heavily for years. During hospitalization, the client periodically complains of tingling and
numbness in the hands and feet. Nurse Gian realizes that these symptoms probably result from:
A. Acetate accumulation
B. Thiamine deficiency
C. Triglyceride buildup.
D. A below-normal serum potassium level
Incorrect
Correct Answer: B. Thiamine deficiency
Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis,
which results from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and
excessive alcohol intake. Treatment includes reducing alcohol intake, correcting nutritional
deficiencies through diet and vitamin supplements, and preventing such residual
disabilities as foot and wrist drop.
Option A: When thiamine stores are depleted (which takes about 4 weeks after
stopping intake), symptoms start to appear. When evaluating for thiamine deficiency,
the typical history may include poor nutritional intake, excessive alcohol intake, or
the patient belonging to the special populations of individuals previously mentioned
(pregnant women, recipients of bariatric surgery, patients with prolonged diuretic
use, anyone with poor overall nutritional status, etc.).
Option C: Initial symptoms of B1 deficiency include anorexia, irritability, and
difficulties with short-term memory. With prolonged thiamine deficiency, patients may
endorse loss of sensation in the extremities, symptoms of heart failure including
swelling of the hands or feet and chest pain related to demand ischemia, or feelings
of vertigo, double vision, and memory loss. Additionally, close friends and family of
the patient may describe confusion or symptoms of confabulation.
Option D: Detection of thiamine deficiency relies on relevant history and physical
exam findings and follow up with laboratory testing for confirmation. Functional
enzymatic assay of transketolase activity is the activity of transketolase measured
before and after the addition of thiamine pyrophosphate; >25% stimulation response
is abnormal. Measurement of thiamine or the phosphorylated esters of thiamine in
serum or blood using high-performance liquid chromatography is used. Urine
studies exist but are not a reliable test for the evaluation of total body thiamine.
19. Question
A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder,
which allegedly happened when the child fell down the stairs. Which action should make the nurse
suspect that the child was abused?
A. The child cries uncontrollably throughout the examination.
B. The child pulls away from contact with the physician.
C. The child doesn’t cry when the shoulder is examined.
D. The child doesn’t make eye contact with the nurse.
Incorrect
Correct Answer: C. The child doesn’t cry when the shoulder is examined.
A characteristic behavior of abused children is the lack of crying when they undergo a
painful procedure or are examined by a healthcare professional. Therefore, the nurse
should suspect child abuse. Physical abuse may include beating, shaking, burning, and
biting. The threshold for defining corporal punishment as abuse is unclear. Rib fractures
are found to be the most common finding associated with physical abuse. Any child
younger than two years old for whom there is a concern of physical abuse should have a
skeletal survey. Additionally, any sibling younger than two years of age of an abused child
should also have a skeletal survey. A skeletal survey consists of 21 dedicated views, as
recommended by the American College of Radiology.
Option A: The World Health Organization (WHO) defines child maltreatment as “all
forms of physical and emotional ill-treatment, sexual abuse, neglect, and
exploitation that results in actual or potential harm to the child’s health, development
or dignity.” There are four main types of abuse: neglect, physical abuse,
psychological abuse, and sexual abuse. Abuse is defined as an act of commission
and neglect is defined as an act of omission in the care leading to potential or actual
harm.
Option B: Physical abuse should be considered in the evaluation of all injuries of
children. A thorough history of present illness is important to make a correct
diagnosis. Important aspects of the history-taking involve gathering information
about the child’s behavior before, during, and after the injury occurred. History-
taking should include the interview of each caretaker separately and the verbal
child, as well. The parent or caretaker should be able to provide their history without
interruptions in order not to be influenced by the physician’s questions or
interpretations.
Option D: The second most common type of child abuse after neglect is physical
abuse. Eighty percent of abusive fractures occur in non-ambulatory children,
particularly in children younger than 18 months of age. The most important risk
factor for abusive skeletal injury is age. There is no fracture pathognomonic for
abuse, but there are some fractures that are more suggestive of abuse. These
include posterior or lateral rib fractures and “corner” or “bucket handle” fractures,
which occur at the ends of long bones and which result from a twisting mechanism.
Other highly suspicious fractures are sternal, spinal and scapular fractures.
20. Question
When planning care for a client who has ingested phencyclidine (PCP), nurse Wayne is aware
that the following is the highest priority?
A. Client’s physical needs
B. Client’s safety needs
C. Client’s psychosocial needs
D. Client’s medical needs
Incorrect
Correct Answer: B. Client’s safety needs
The highest priority for a client who has ingested PCP is meeting safety needs of the client
as well as the staff. Drug effects are unpredictable and prolonged, and the client may lose
control easily. Phencyclidine (PCP) is a dissociative anesthetic that is a commonly used
recreational drug. PCP is a crystalline powder that can be ingested orally, injected
intravenously, inhaled, or smoked. PCP is available as a powder, crystal, liquid, and tablet.
It produces both stimulation and depression of the CNS. PCP is a non-competitive
antagonist to the NMDA receptor, which causes analgesia, anesthesia, cognitive defects,
and psychosis.
Option A: Depending on the dose and route of administration, PCP can have a
wide range of central nervous system (CNS) manifestations. Emergency department
providers should become familiar with how to manage patients with PCP toxicity
since rhabdomyolysis, hypoglycemia, seizures, hypertensive crisis, coma, and
trauma are several of the complications that can arise with PCP use
Option C: PCP blocks the uptake of dopamine and norepinephrine, leading to
sympathomimetic effects such as hypertension, tachycardia, bronchodilation, and
agitation. PCP can also cause sedation, muscarinic, and nicotinic signs by binding
to acetylcholine receptors and GABA receptors. Sigma receptor stimulation by PCP
causes lethargy and coma.
Option D: Most patients survive PCP intoxication with supportive care. Airway,
breathing, circulation, and hemodynamic monitoring are essential to the care of
patients with PCP toxicity. Intubation with ventilatory support may be required for
airway protection. Gastrointestinal decontamination is generally unnecessary in PCP
ingestions; however, activated charcoal may be beneficial with a massive ingestion
of PCP or a dangerous coingestion. Activated charcoal therapy should only be

started within one hour from the time of ingestion. The activated charcoal dose is 1
g/kg, with a maximum dose of 50 g.
21. Question
The nurse is aware that the outcome criteria would be appropriate for a child diagnosed with
oppositional defiant disorder?
A. Accept responsibility for own behaviors.
B. Be able to verbalize own needs and assert rights.
C. Set firm and consistent limits with the client.
D. Allow the child to establish his own limits and boundaries.
Incorrect
Correct Answer: A. Accept responsibility for own behaviors
Children with oppositional defiant disorder frequently violate the rights of others. They are
defiant, disobedient, and blame others for their actions. Accountability for their actions
would demonstrate progress for the oppositional child. Oppositional defiant disorder (ODD)
is a type of childhood disruptive behavior disorder that primarily involves problems with the
self-control of emotions and behaviors. According to the Diagnostic and Statistical Manual
of Mental Disorders, Fifth Edition (DSM-5), the main feature of ODD is a persistent pattern
of angry or irritable mood, argumentative or defiant behavior, or vindictiveness toward
others.
Option B: This is incorrect as the oppositional child usually, focuses on his own
needs. Temperamental factors such as irritability, impulsivity, poor frustration,
tolerance, and high levels of emotional reactivity are commonly associated with
ODD. While not all children diagnosed with ODD show callous and unemotional
traits, it has been shown that such traits are highly heritable and may be seen more
frequently in a subset of children with more significant disruptive behaviors.
Option C: Treatment of oppositional defiant disorder is multimodal and should

involve the patient, family, school, and community. Identifying and treating
comorbidities (like ADHD, depression, and anxiety) and modifiable risk factors (such
as bullying and learning difficulties) should be done. Treatment may also vary based
on whether oppositional behavior primarily occurs in specific contexts or if the
behavior is pervasive and thus requires more intensive treatment.
Option D: This is not an outcome criterion but an intervention. Parent Management
Training or PMT is based on the principles of social learning theory and is the main
treatment for oppositional behaviors. The guiding principle in PMT is the use of
operant conditioning (using the role of positive reinforcement in changing behaviors)
to decrease unwanted behaviors and promote prosocial behaviors. Methods include
teaching parents to identify problem behaviors as well as positive interactions and to
apply punishment or reinforcement as appropriate.
22. Question
A male client is found sitting on the floor of the bathroom in the day treatment clinic with moderate
lacerations on both wrists. Surrounded by broken glass, he sits staring blankly at his bleeding
wrists while staff members call for an ambulance. How should Nurse Anuktakanuk approach her
initially?
A. Enter the room quietly and move beside him to assess his injuries.
B. Call for staff back-up before entering the room and restraining him.
C. Move as much glass away from him as possible and sit next to him quietly.
D. Approach him slowly while speaking in a calm voice, calling his name, and telling
him that the nurse is here to help him.
Incorrect
Correct Answer: D. Approach her slowly while speaking in a calm voice, calling her
name, and telling her that the nurse is here to help her
Ensuring the safety of the client and the nurse is the priority at this time. Therefore, the
nurse should approach the client cautiously while calling her name and talking to her in a
calm, confident manner. Nursing’s hands-on approach to patient care and our ability to
create therapeutic connections with patients enables us to pick up on key cues. Identifying
these cues starts with understanding that suicidal behaviors are neither considered an
illness nor a condition, but rather a complex set of behaviors that actually exists on a
continuum that ranges from ideas/thoughts to eventual actions.
Option A: The nurse should keep in mind that the client shouldn’t be startled or
overwhelmed. After explaining that the nurse is there to help, the nurse should
observe the client’s response carefully. The promotion of a care environment that is
safe and conducive to their full recovery is essential in carrying out comprehensive
care in mental health. The first step is qualified listening, but it cannot be immersed
in a bigoted discourse, full of judgment. One must consider that not always the
person is willing to express or externalize what they really feel, and so a new
challenge to the health professional emerges, which is the careful observation of the
reality of the patient and the listening of silence when the person is not willing to
talk.
Option B: If the client shows signs of agitation or confusion or poses a threat, the
nurse should retreat and request assistance. For the care to surpass the technical
focus, the psychological care and the continuous observation of patients and family
members are also necessary, aiming to prioritize the communication in accordance
with the qualified listening, as these patients are often insecure. It is important to
highlight that all people who attempted suicide should receive professional care due
to the emotional fragility in which they find themselves. The competence of the
emergency team is saving lives, considering not only the physical aspects but also
the psychological aspects involved in the process of caring
Option C: The nurse shouldn’t attempt to sit next to the client or examine injuries
without first announcing the nurse’s presence and assessing the dangers of the
situation. There are some essential behaviors that nursing can use to meet a person
who attempted suicide or has suicidal ideation, namely: listen carefully, be
empathetic, convey non-verbal messages of acceptance, express respect for the
opinion of another, talk honestly, show concern, and focus on the feelings of the
person. The mere interaction with the patient has a great potential to calm down,
prevent, or minimize the severity and intensity of the symptoms. Still, the team
should try to establish a bond of trust from the start, whereas, on the other hand, the
idea that the patient attempted suicide to manipulate others should be abandoned.
23. Question
A female client with anorexia nervosa describes herself as “a whale.” However, the nurse’s
assessment reveals that the client is 5′ 8″ (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering
the client’s unrealistic body image, which intervention should nurse Angel be included in the plan
of care?
A. Asking the client to compare her figure with magazine photographs of women her
age.
B. Assigning the client to group therapy in which participants provide realistic feedback
about her weight.
C. Confronting the client about her actual appearance during one-on-one sessions,
scheduled during each shift.
D. Telling the client of the nurse’s concern for her health and desire to help her make
decisions to keep her healthy.
Incorrect
Correct Answer: D. Telling the client of the nurse’s concern for her health and desire
to help her make decisions to keep her healthy
A client with anorexia nervosa has an unrealistic body image that causes consumption of
little or no food. Therefore, the client needs assistance with making decisions about health.
Respond (confront) with reality when a patient makes unrealistic statements. The patient
may be denying the psychological aspects of their own situation and is often expressing a
sense of inadequacy and depression.
Option A: Instead of protecting the client’s health, option A may serve to make the
client defensive and more entrenched in her unrealistic body image. Allow the
patient to draw a picture of self. It provides an opportunity to discuss the patient’s
perception of self and body image and realities of an individual situation.
Option B: Encourage personal development program, preferably in a group setting.
Provide information about the proper application of makeup and grooming. Learning
about methods to enhance personal appearance may be helpful to a long-range
sense of self-esteem and image. Feedback from others can promote feelings of self-
worth.
Option C: Establish a therapeutic nurse-patient relationship. Within a helping
relationship, the patient can begin to trust and try out new thinking and behaviors.
Assist the patient to assume control in areas other than dieting and weight loss such
as management of their own daily activities, work, and leisure choices. Feelings of
personal ineffectiveness, low self-esteem, and perfectionism are often part of the
problem. The patient feels helpless to change and requires assistance to problem-
solve methods of control in life situations.
24. Question
Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of
social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126
beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client
exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. Nurse
Melinda should suspect:
A. A postoperative infection
B. Alcohol withdrawal
C. Acute sepsis.
D. Pneumonia.
Incorrect
Correct Answer: B. Alcohol withdrawal
The client’s vital signs and hallucinations suggest delirium tremens or alcohol withdrawal
syndrome. Alcohol withdrawal symptoms occur when patients stop drinking or significantly
decrease their alcohol intake after long-term dependence. Withdrawal has a broad range of
symptoms from mild tremors to a condition called delirium tremens, which results in
seizures and could progress to death if not recognized and treated promptly.
Option A: GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter
in the central nervous center. GABA has particular binding sites available for
ethanol, thus increasing the inhibition of the central nervous system when present.
Chronic ethanol exposure to GABA creates constant inhibition or depressant effects
on the brain. Ethanol also binds to glutamate, which is one of the excitatory amino
acids in the central nervous system. When it binds to glutamate, it inhibits the
excitation of the central nervous system, thus worsening the depression of the brain.
Option C: Alcohol withdrawal can range from very mild symptoms to the severe
form, which is named delirium tremens. The hallmark is autonomic dysfunction
resulting from the excitation of the central nervous system. Mild signs/symptoms can
arise within six hours of alcohol cessation. If symptoms do not progress to more
severe symptoms within 24 to 48 hours, the patient will likely recover.
Option D: Although pneumonia may arise as postoperative complications; it
wouldn’t cause this client’s signs and symptoms and typically would occur later in
the postoperative course. Mild symptoms can be insomnia, tremulousness,
hyperreflexia, anxiety, gastrointestinal upset, headache, palpitations. Moderate
symptoms include alcohol withdrawal seizures (rum fits) that can occur 12 to 24
hours after cessation of alcohol and are typically generalized in nature. There is a
3% incidence of status epilepticus in these patients. About 50% of patients who
have had a withdrawal seizure will progress to delirium tremens.
25. Question
Clonidine (Catapres) can be used to treat conditions other than hypertension. Nurse Sally is aware
that the following conditions might the drug be administered?
A. Phencyclidine (PCP) intoxication
B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal
Incorrect
Correct Answer: C. Opiate withdrawal
Clonidine is used as adjunctive therapy in opiate withdrawal. Symptomatic treatment in
opioid withdrawal includes loperamide for diarrhea, promethazine for nausea/vomiting, and
ibuprofen for myalgia. Clonidine can be given to reduce blood pressure. Opioid withdrawal
syndrome is a life-threatening condition resulting from opioid dependence. Opioids are a

group of drugs used for the management of severe pain. They are also commonly used as
psychoactive substances around the world.
Option A: Benzodiazepines and neuroleptic agents are typically used to treat PCP
intoxication. Benzodiazepines are the preferred medication for chemical sedation in
patients with PCP toxicity. Lorazepam 2 to 4 mg intravenous (IV) or intramuscular
(IM), or diazepam 5 to 10 mg IV or IM are recommended. Benzodiazepines are also
the first-line treatment for PCP-induced hypertension and seizures. Hyperthermia
from PCP toxicity is due to psychomotor agitation and can be successfully treated
with benzodiazepines as well.
Option B: Benzodiazepines, such as chlordiazepoxide (Librium), and neuroleptic
agents, such as haloperidol, are used to treat alcohol withdrawal. The hallmark of
management for severe symptoms is the administration of long-acting
benzodiazepines. The most commonly used benzodiazepines are intravenous
diazepam (Valium) or intravenous lorazepam (Ativan) for management. Patients with
severe withdrawal symptoms may require escalating doses and intensive care level
monitoring.
Option D: Antidepressants and medications with dopaminergic activity in the brain,
such as fluoxetine (Prozac), are used to treat cocaine withdrawal. Central nervous
system (CNS) stimulants like cocaine and amphetamine can also produce
withdrawal symptoms. Like opioids, the withdrawal symptoms are mild and not life-
threatening. Often the individual will develop marked depression, excessive sleep,
hunger, dysphoria, and severe psychomotor retardation but all vital functions are
well preserved. Recovery is usually slow, and depression can last for several weeks.
26. Question
A male client with a history of cocaine addiction is admitted to the coronary care unit for evaluation
of substernal chest pain. The electrocardiogram (ECG) shows a 1-mm ST-segment elevation of
the anteroseptal leads and T-wave inversion in leads V3 to V5. Considering the client’s history of
drug abuse, nurse Greg expects the physician to prescribe:
A. Lidocaine (Xylocaine).
B. Procainamide (Pronestyl).
C. Nitroglycerin (Nitro-Bid IV).
D. Epinephrine.
Incorrect
Correct Answer: C. Nitroglycerin (Nitro-Bid IV).
The elevated ST segments in this client’s ECG indicate myocardial ischemia. To reverse
this problem, the physician is most likely to prescribe an infusion of nitroglycerin to dilate
the coronary arteries. Nitroglycerin is a vasodilatory drug used primarily to provide relief
from anginal chest pain. Although nitroglycerin has a vasodilatory effect in both arteries and
veins, the profound desired effects caused by nitroglycerin are primarily due to
venodilation. Venodilation causes pooling of blood within the venous system, reducing
preload to the heart, which causes a decrease in cardiac work, reducing anginal symptoms
secondary to demand ischemia.
Option A: Lidocaine, formerly also referred to as lignocaine, is an amide local
anesthetic agent. The drug is commonly used for local anesthesia, often in
combination with epinephrine (which acts as a vasopressor and extends its duration
of action at a site by opposing the local vasodilatory effects of lidocaine).
Option B: Procainamide is a cardiac drug that may be indicated for this client at
some point but isn’t used for coronary artery dilation. Procainamide is a medication
used in the management and treatment of ventricular arrhythmias, supraventricular
arrhythmias, atrial flutter, atrial fibrillation, AV nodal reentrant tachycardia, and Wolf-
Parkinson-White syndrome. It is a Class 1A antiarrhythmic agent.
Option D: If a cocaine user experiences ventricular fibrillation or asystole, the
physician may prescribe epinephrine. However, this drug must be used with caution
because cocaine may potentiate its adrenergic effects. Epinephrine is one of the
most commonly used agents in a variety of settings as it functions as medication
and hormone. It is currently FDA-approved for various situations, including
emergency treatment of type 1 hypersensitivity reactions including anaphylaxis,
induction, and maintenance of mydriasis during intraocular surgeries, and
hypotension due to septic shock.
27. Question
A 14-year-old client was brought to the clinic by her mother. Her mother expresses concern about
her daughter’s weight loss and constant dieting. Nurse Kris conducts a health history interview.
Which of the following comments indicates that the client may be suffering from anorexia nervosa?
A. “I like the way I look. I just need to keep my weight down because I’m a cheerleader.”
B. “I don’t like the food my mother cooks. I eat plenty of fast food when I’m out with my
friends.”
C. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to
other girls.”
D. “I do diet around my periods; otherwise, I just get so bloated.”
Incorrect
Correct Answer: C. “I just can’t seem to get down to the weight I want to be. I’m so
fat compared to other girls.”
Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get
down to a “desirable weight” is characteristic of the disorder. Feeling inadequate when
compared to peers indicates poor self-esteem. Anorexia is also more common among
teenagers. Still, people of any age can develop this eating disorder, though it’s rare in
those over 40. Teens may be more at risk because of all the changes their bodies go
through during puberty. They may also face increased peer pressure and be more sensitive
to criticism or even casual comments about weight or body shape.
Option A: Most clients with anorexia nervosa don’t like the way they look, and their
self-perception may be distorted. A girl with cachexia may perceive herself to be
overweight when she looks in the mirror. Some people with anorexia may have
obsessive-compulsive personality traits that make it easier to stick to strict diets and
forgo food despite being hungry. They may have an extreme drive for perfectionism,
which causes them to think they’re never thin enough. And they may have high
levels of anxiety and engage in restrictive eating to reduce it.
Option B: Preferring fast food over healthy food is common in this age-group.
Although it’s not yet clear which genes are involved, there may be genetic changes
that make some people at higher risk of developing anorexia. Some people may
have a genetic tendency toward perfectionism, sensitivity, and perseverance — all
traits associated with anorexia.
Option D: Because of the absence of body fat necessary for proper hormone
production, amenorrhea is common for a client with anorexia nervosa. Patients will
report symptoms such as amenorrhea, cold intolerance, constipation, extremity

edema, fatigue, and irritability. They may describe restrictive behaviors related to
food like calorie counting or portion control, and purging methods, for example, self-
induced vomiting or use of diuretics or laxatives.
28. Question
Nurse Fey is aware that the drug of choice for treating Tourette syndrome?
A. Fluoxetine (Prozac)
B. Fluvoxamine (Luvox)
C. Haloperidol (Haldol)
D. Paroxetine (Paxil)
Incorrect
Correct Answer: C. Haloperidol (Haldol)
Haloperidol is the drug of choice for treating Tourette syndrome. Antipsychotic medications
have been the most extensively studied. Haloperidol and pimozide are the first-generation
antipsychotics with the most data showing efficacy in reducing tic severity. However, their
use is limited by potentially severe side effects such as sedation, acute dystonia, and other
drug-induced movement disorders like weight gain, and prolonged QTc interval (pimozide).
Option A: Fluoxetine has FDA-approval for major depressive disorder (age eight
and older), obsessive-compulsive disorder (age seven and older), panic disorder,
bulimia, binge eating disorder, premenstrual dysphoric disorder, bipolar depression
(as an adjunct with olanzapine also known as Symbyax), and treatment-resistant
depression when used in combination with olanzapine.
Option B: Fluvoxamine is used to treat obsessive-compulsive disorder (OCD). It
helps decrease persistent/unwanted thoughts (obsessions) and urges to perform
repeated tasks (compulsions such as hand-washing, counting, checking) that
interfere with daily living. Fluvoxamine is known as a selective serotonin reuptake
inhibitor (SSRI). This medication works by helping to restore the balance of a certain
natural substance (serotonin) in the brain.
Option D: Paroxetine is a selective serotonin reuptake inhibitor (SSRI), and, as
such, is identified as an antidepressant. It is FDA approved for major depressive
disorder (MDD), obsessive-compulsive disorder (OCD), social anxiety disorder
(SAD), panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety
disorder (GAD), and premenstrual dysphoric disorder (PMDD), vasomotor
symptoms associated with menopause.
29. Question
A male client tells the nurse he was involved in a car accident while he was intoxicated. What
would be the most therapeutic response from nurse Julia?
A. “Why didn’t you get someone else to drive you?”
B. “Tell me how you feel about the accident.”
C. “You should know better than to drink and drive.”
D. “I recommend that you attend an Alcoholics Anonymous meeting.”
Incorrect
Correct Answer: B. “Tell me how you feel about the accident.”
An open-ended statement or question is the most therapeutic response. It encourages the
widest range of client responses, makes the client an active participant in the conversation,
and shows the client that the nurse is interested in his feelings. mix open-ended questions
with focus questions. Open-ended questions may allow the patient to express their
thoughts and feelings, and focused questions allow the interviewer to obtain important
details with yes or no answers in a more time-efficient manner.
Option A: Asking the client why he drove while intoxicated can make him feel
defensive and intimidated. The first question posed in the interview is often open-
ended. For example, “What is the main reason you seek medical assistance today?”
This provides an opportunity for the interviewer to allow the patient to share their
concerns, and the interviewer can show he or she is actively listening. This includes
listening without judgment and displaying concern for the patient during
communication.
Option C: A judgmental approach isn’t therapeutic. During the interview, meaningful
questions inquired positively will reduce defensiveness from the patient. Often this
can be accomplished by suggesting or sharing a common behavior associated with
the actions of the patient. For example, the interviewer may convey the commonality
for people to consume alcohol when under stress. It then becomes acceptable to
inquire if this is also occurring with the patient. The patient may feel a sense of trust
and therefore share pertinent information.
Option D: By giving advice, the nurse suggests that the client isn’t capable of
making decisions, thus fostering dependency. At the conclusion of the patient
interview, an appropriate transition statement to begin the physical exam may be, “Is
there anything else that you would like to share with me before I start the physical
examination?” This statement serves 2 purposes. First, it elicits any additional
information the patient deems necessary, and second, it signals a transition to the
physical exam. Lastly, before concluding the interview, it is important to discuss the
probable follow-up plan and further treatment. In the outpatient setting, this may
include admission to the hospital or going home and returning for a follow-up
appointment at a designated time.
30. Question
A male adult client voluntarily admits himself to the substance abuse unit. He confesses that he
drinks one (1) qt or more of vodka each day and uses cocaine occasionally. Later that afternoon,
he begins to show signs of alcohol withdrawal. What are some early signs of this condition?
A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above 101° F (38.3° C), and pruritus
C. Hypertension, diaphoresis, and seizures
D. Diaphoresis, tremors, and nervousness
Incorrect
Correct Answer: D. Diaphoresis, tremors, and nervousness
Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic hallucinosis, and
alcohol withdrawal delirium (formerly delirium tremens). Signs of alcohol withdrawal include
diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure
and pulse rate, sleep disturbance, and irritability.
Option A: Although diarrhea may be an early sign of alcohol withdrawal,
tachycardia — not bradycardia — is associated with alcohol withdrawal. Alcohol
withdrawal symptoms occur when patients stop drinking or significantly decrease
their alcohol intake after long-term dependence. Withdrawal has a broad range of
symptoms from mild tremors to a condition called delirium tremens, which results in
seizures and could progress to death if not recognized and treated promptly.
Option B: Dehydration and an elevated temperature may be expected, but a
temperature above 101° F indicates an infection rather than alcohol withdrawal.
Pruritus rarely occurs in alcohol withdrawal. Alcohol withdrawal can range from very
mild symptoms to the severe form, which is named delirium tremens. The hallmark
is autonomic dysfunction resulting from the excitation of the central nervous system.
Mild signs/symptoms can arise within six hours of alcohol cessation. If symptoms do
not progress to more severe symptoms within 24 to 48 hours, the patient will likely
recover.
Option C: If withdrawal symptoms remain untreated, seizures may arise later.
Withdrawal seizures can typically be managed with benzodiazepines as well, but
may require adjunct therapy with phenytoin, barbiturates, and may even require
intubation and sedation with propofol (Diprivan), ketamine (Ketalar), or in the most
severe cases dexmedetomidine (Precedex).
31. Question
When monitoring a female client recently admitted for treatment of cocaine addiction, nurse Aaron
notes sudden increases in the arterial blood pressure and heart rate. To correct these problems,
the nurse expects the physician to prescribe:
A. Norepinephrine (Levophed) and Lidocaine (Xylocaine)
B. Nifedipine (Procardia) and Lidocaine.
C. Nitroglycerin (Nitro-Bid IV) and Esmolol (Brevibloc)
D. Nifedipine and Esmolol
Incorrect
Correct Answer: D. Nifedipine and Esmolol
This client requires a vasodilator, such as nifedipine, to treat hypertension, and a beta-
adrenergic blocker, such as esmolol, to reduce the heart rate. Nifedipine is a calcium
channel blocker that belongs to the dihydropyridine subclass. It is primarily used as an
antihypertensive and antianginal medication. Esmolol (esmolol hydrochloride) is an
intravenous cardioselective beta-1 adrenergic antagonist. Esmolol is FDA-approved for
short-term duration use in control of supraventricular tachycardia, such as a rapid
ventricular rate in patients with atrial fibrillation or atrial flutter.
Option A: Norepinephrine’s predominant use is as a peripheral vasoconstrictor.
Specifically, the FDA has approved its use for blood pressure control in specific
acute hypotensive states, as well as being a potential adjunct in the treatment of
cardiac arrest with profound hypotension.
Option B: Lidocaine, an antiarrhythmic, isn’t indicated because the client doesn’t
have an arrhythmia. The drug is commonly used for local anesthesia, often in
combination with epinephrine (which acts as a vasopressor and extends its duration
of action at a site by opposing the local vasodilatory effects of lidocaine).
Option C: Although nitroglycerin may be used to treat coronary vasospasm, it isn’t
the drug of choice in hypertension. Nitroglycerin is a vasodilatory drug used primarily
to provide relief from anginal chest pain. Nitroglycerin has been FDA approved since
2000 and was first sold by Pfizer under the brand name Nitrostat. It is currently FDA
approved for the acute relief of an attack or acute prophylaxis of angina pectoris
secondary to coronary artery disease.
32. Question
A 25 –year old client experiencing alcohol withdrawal is upset about going through detoxification.
Which of the following goals is a priority?
A. The client will commit to a drug-free lifestyle.
B. The client will work with the nurse to remain safe.
C. The client will drink plenty of fluids daily.
D. The client will make a personal inventory of strength.
Incorrect
Correct Answer: B. The client will work with the nurse to remain safe.
The priority goal in alcohol withdrawal is maintaining the client’s safety. Alcohol withdrawal
can range from very mild symptoms to the severe form, which is named delirium tremens.
The hallmark is autonomic dysfunction resulting from the excitation of the central nervous
system. Mild signs/symptoms can arise within six hours of alcohol cessation. If symptoms
do not progress to more severe symptoms within 24 to 48 hours, the patient will likely
recover.
Option A: Delirium tremens is the most severe form of alcohol withdrawal, and its
hallmark is that of an altered sensorium with significant autonomic dysfunction and
vital sign abnormalities. It includes visual hallucinations, tachycardia, hypertension,
hyperthermia, agitation, and diaphoresis. Symptoms of delirium tremens can last up
to seven days after alcohol cessation and may last even longer.
Option C: The diagnosis of alcohol withdrawal can be made by taking an excellent
history and performing a thorough physical examination. It is a clinical diagnosis
based on mild, moderate, or severe symptoms. Patients with suspicion for alcohol
withdrawal should be evaluated for other underlying disease processes such as
dehydration, infection, cardiac issues, electrolyte abnormalities, gastrointestinal
bleeding, and traumatic injury. Laboratory studies (electrolytes, blood counts) may
be drawn, but will likely be nondiagnostic.
Option D: Patients with prolonged altered sensorium or significant renal
abnormalities should have an evaluation for the potential ingestion of another toxic
alcohol. Patients who become financially strapped due to alcoholism could ingest
other alcohols to become intoxicated. These can include isopropyl alcohol,
commonly known as rubbing alcohol, which can lead to acidemia without ketosis as
well as hemorrhagic gastritis.
33. Question
A male client is admitted to a psychiatric facility by court order for evaluation for antisocial
personality disorder. This client has a long history of initiating fights and abusing animals and
recently was arrested for setting a neighbor’s dog on fire. When evaluating this client for the
potential for violence, nurse Perry should assess for which behavioral clues?
A. A rigid posture, restlessness, and glaring
B. Depression and physical withdrawal
C. Silence and noncompliance
D. Hypervigilance and talk of past violent acts
Incorrect
Correct Answer: A. A rigid posture, restlessness, and glaring
Behavioral clues that suggest the potential for violence include a rigid posture,
restlessness, glaring, a change in usual behavior, clenched hands, overtly aggressive
actions, physical withdrawal, noncompliance, overreaction, hostile threats, recent alcohol
ingestion or drug use, talk of past violent acts, inability to express feelings, repetitive
demands and complaints, argumentativeness, profanity, disorientation, inability to focus
attention, hallucinations or delusions, paranoid ideas or suspicions, and somatic
complaints.
Option B: Before performing a comprehensive psychiatric assessment of the
patient, a careful history and physical examination is necessary. “The DSM-5
diagnostic criteria for Antisocial Personality Disorder. A pervasive pattern of
disregard for and violation of the rights of others, since age 15 years, as indicated
by three (or more) of the following: failure to conform to social norms concerning
lawful behaviors, such as performing acts that are grounds for arrest; deceitfulness,
repeated lying, use of aliases, or conning others for pleasure or personal profit;
Impulsivity or failure to plan; Irritability and aggressiveness, often with physical fights
or assaults; reckless disregard for the safety of self or others; consistent
irresponsibility, failure to sustain consistent work behavior, or honor monetary
obligations; lack of remorse, being indifferent to or rationalizing having hurt,
mistreated, or stolen from another person.
Option C: Of those children with conduct disorder, 25% of girls and 40% of boys will
meet the diagnostic criteria for antisocial personality disorder. Boys exhibit
symptoms earlier than girls, who often only elicit these symptoms in puberty.
Children who do not develop conduct disorder and progress to the age of 15 without
antisocial behaviors will not develop ASPD.
Option D: Antisocial personality disorder, although a chronic condition with a lifelong
presentation, has had moderations shown with advancing ages, with the mean
remitted age of 35 years old. Those with less baseline symptomatology showed
better-remitted rates. Studies in the past revealed remission rates of 12 to 27% and
27 to 31% rates of improvement, but not remitted. Crime rates and severity reflect
this relation as well, with peak crime statistics in late teens and higher severity of
crimes at younger ages.
34. Question
A male client is brought to the psychiatric clinic by family members, who tell the admitting nurse
that the client repeatedly drives while intoxicated despite their pleas to stop. During an interview
with the nurse Linda, which statement by the client most strongly supports a diagnosis of
psychoactive substance abuse?
A. “I’m not addicted to alcohol. In fact, I can drink more than I used to without being
affected.”
B. “I only spend half of my paycheck at the bar.”
C. “I just drink to relax after work.”
D. “I know I’ve been arrested three times for drinking and driving, but the police are just
trying to hassle me.”
Incorrect
Correct Answer: D. “I know I’ve been arrested three times for drinking and driving,
but the police are just trying to hassle me.”
According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition,
diagnostic criteria for psychoactive substance abuse include a maladaptive pattern of such
use, indicated either by continued use despite knowledge of having a persistent or
recurrent social, occupational, psychological, or physical problem caused or exacerbated
by substance abuse or recurrent use in dangerous situations (for example, while driving).
For this client, psychoactive substance dependence must be ruled out; criteria for this
disorder include a need for increasing amounts of the substance to achieve intoxication
(option A), increased time and money spent on the substance (option B), inability to fulfill
role obligations (option C), and typical withdrawal symptoms.
Option A: A shortened version of the term used in the ICD-10 – Mental and
behavioral disorders due to psychoactive substance use. The term encompasses
acute intoxication, harmful use, dependence syndrome, withdrawal state, withdrawal
state with delirium, psychotic disorder, and amnesic syndrome. For a particular
substance, these conditions may be grouped together as, for example, alcohol
disorders, cannabis use disorders, stimulant use disorders. Psychoactive substance
use disorders are defined as being of clinical relevance; the term ‘psychoactive
substance use problems’ is a broader one, which includes conditions and events not
necessarily of clinical relevance.
Option B: Production, distribution, sale, or non-medical use of many psychoactive
drugs is either controlled or prohibited outside legally sanctioned channels by law.
Psychoactive drugs have different degrees of restriction of availability, depending on
their risks to health and therapeutic usefulness, and classified according to a
hierarchy of schedules at both national and international levels. At the international
level, there are international drug conventions concerned with the control of
production and distribution of psychoactive drugs: the 1961 Single Convention on
Narcotic Drugs, amended by a 1972 Protocol; the 1971 Convention on Psychotropic
Substances; the 1988 Convention Against Illicit Traffic in Narcotic Drugs and
Psychotropic Substances.
Option C: It is an essential characteristic of the dependence syndrome that either
substance taking or a desire to take a particular substance should be present; the
subjective awareness of compulsion to use drugs is most commonly seen during
attempts to stop or control substance use. This diagnostic requirement would
exclude, for instance, surgical patients given opiate drugs for the relief of pain and
who may show signs of an opiate withdrawal state when drugs are not given, but
who have no desire to continue taking drugs.
35. Question
A female client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing
assessment reveals that the client’s wrists are scratched from a recent suicide attempt. Based on
this finding, the nurse Lenny should formulate a nursing diagnosis of:
A. Ineffective individual coping related to feelings of guilt.
B. Situational low self-esteem related to feelings of loss of control.
C. Risk for violence: Self-directed related to impulsive mutilating acts.
D. Risk for violence: Directed toward others related to verbal threats.
Incorrect
Correct Answer: C. Risk for violence: Self-directed related to impulsive mutilating
acts.
The predominant behavioral characteristic of the client with borderline personality disorder
is impulsiveness, especially of a physically self-destructive sort. The observation that the
client has scratched wrists doesn’t substantiate the other options. Borderline personality
disorder (BPD) is 1 of 4 Cluster-B disorders that include borderline, antisocial, narcissistic,
and histrionic. Borderline personality disorder (BPD) is characterized by hypersensitivity to
rejection and resulting instability of interpersonal relationships, self-image, affect, and
behavior
Option A: Inappropriate, intense anger, or difficulty controlling anger, for example,
frequent displays of temper, constant anger, recurrent physical fights. A careful
history and physical exam should be performed before performing a comprehensive
psychiatric assessment. There are structured diagnostic screening tools used to
assess personality disorders and specifically borderline personality disorder, for
example, the Zanarini Rating Scale for Borderline Personality Disorder.
Option B: There is identity disturbance which is a markedly and persistently
unstable self-image or sense of self. Borderline personality disorder is multifactorial
in etiology. There is a genetic predisposition. Twin studies show over 50% heritability
(greater than that for major depression). Twin studies performed in 2000 and 2008
both demonstrated higher concordance of the rate of borderline personality disorder

for monozygotic versus dizygotic twins.
Option D: Self-injurious behavior, boundary issues, and frequent suicidal threats
present therapeutic challenges specific to the treatment of patients with borderline
personality disorder. High rates of comorbid substance abuse may also confound
the treatment of borderline personality disorder patients.
36. Question
A male client recently admitted to the hospital with sharp, substernal chest pain suddenly
complains of palpitations. Nurse Ryan notes a rise in the client’s arterial blood pressure and a
heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine
recently after previously denying use of the drug. The nurse concludes that the client is at high risk
for which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
D. Panic disorder
Incorrect
Correct Answer: A. Coronary artery spasm
Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial
infarction, dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death.
Cocaine blocks reuptake of norepinephrine, epinephrine, and dopamine, causing an
excess of these neurotransmitters at postsynaptic receptor sites. Cocaine and its
metabolites may cause arterial vasoconstriction hours after use. Epicardial coronary
arteries are especially vulnerable to these effects, leading to a decreased myocardial
oxygen supply.
Option B: Consequently, the drug is more likely to cause tachyarrhythmias than
bradyarrhythmias. Cocaine-induced central sympathetic stimulation and direct
cardiac effects may lead to tachycardia, hypertension, and coronary or cerebral

artery vasoconstriction leading to myocardial infarction and stroke.
Option C: Although neurobehavioral deficits are common in neonates born to
cocaine users, they are rare in adults. CNS reactions may be more excitatory than
depressant. In its mild form, the patient may display anxiety, restlessness, and
excitement. Full-body tonic-clonic seizures may result from moderate to severe CNS
stimulation. These seizures are often followed by CNS depression, with death
resulting from respiratory failure and/or asphyxiation if concomitant emesis is
present.
Option D: As craving for the drug increases, a person who’s addicted to cocaine
typically experiences euphoria followed by depression, not panic disorder.
Cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines
to decrease CNS sympathetic outflow. However, there is a risk of over-sedation and
respiratory depression with escalating and numerous doses of benzodiazepines,
which is often necessary. Non-dihydropyridine calcium channel blockers such as
diltiazem and verapamil have shown the ability to reduce hypertension reliably, but
not tachycardia.
37. Question
A male client is being admitted to the substance abuse unit for alcohol detoxification. As part of the
intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his
last drink six (6) hours before admission. Based on this response, nurse Lorena should expect
early withdrawal symptoms to:
A. Begin after seven (7) days.
B. Not occur at all because the time period for their occurrence has passed.
C. Begin anytime within the next one (1) to two (2) days.
D. Begin within two (2) to seven (7) days.
Incorrect
Correct Answer: C. Begin anytime within the next one (1) to two (2) days
Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped
drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to
7 days — after the last drink. Moderate symptoms include alcohol withdrawal seizures (rum
fits) that can occur 12 to 24 hours after cessation of alcohol and are typically generalized in
nature. There is a 3% incidence of status epilepticus in these patients. About 50% of
patients who have had a withdrawal seizure will progress to delirium tremens.
Option A: Mild signs/symptoms can arise within six hours of alcohol cessation. If
symptoms do not progress to more severe symptoms within 24 to 48 hours, the
patient will likely recover. However, the time to presentation and range of symptoms
can vary greatly depending on the patient, their duration of alcohol dependence, and
volume typically ingested.
Option B: Most cases should be described by their severity of symptoms, not the
time since their last drink. Noting the time of their last drink is essential in any patient
with an alcohol dependence history who may be presenting with other complaints.
Mild symptoms can be insomnia, tremulousness, hyperreflexia, anxiety,
gastrointestinal upset, headache, palpitations.
Option D: Delirium tremens is the most severe form of alcohol withdrawal, and its
38. Question
Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing
intervention is most appropriate for this client?
A. Providing one-on-one supervision during meals and for one (1) hour afterward.
B. Letting the client eat with other clients to create a normal mealtime atmosphere.
C. Trying to persuade the client to eat and thus restore nutritional balance.
D. Giving the client as much time to eat as desired.
Incorrect
Correct Answer: A. Providing one-on-one supervision during meals and for one (1)
hour afterward.
Because the client with anorexia nervosa may discard food or induce vomiting in the
bathroom, the nurse should provide one-on-one supervision during meals and for 1 hour
afterward. Provide one-to-one supervision and have a patient with bulimia remain in the
day room area with no bathroom privileges for a specified period (1 hr) following eating, if
contracting is unsuccessful. Prevents vomiting during and after eating. The patient may
desire food and use a binge-purge syndrome to maintain weight. Note: The patient may
purge for the first time in response to the establishment of a weight gain program.
Option B: This wouldn’t be therapeutic because other clients may urge the client to
eat and give attention for not eating. Supervise the patient during mealtimes and for
a specified period after meals (usually one hour). It prevents vomiting during or after
eating.
Option C: This would reinforce control issues, which are central to this client’s
underlying psychological problem. Establish a minimum weight goal and daily
nutritional requirements. Malnutrition is a mood-altering condition, leading to
depression and agitation and affecting cognitive function and decision making.
Improved nutritional status enhances thinking ability, allowing initiation of
psychological work.
Option D: Instead of giving the client unlimited time to eat, the nurse should set
limits and let the client know what is expected. Make a selective menu available,
and allow the patient to control choices as much as possible. Patient who gains
confidence in himself and feels in control of the environment is more likely to eat
preferred foods. Be alert to choices of low-calorie foods and beverages; hoarding
food; disposing of food in various places, such as pockets or wastebaskets. Patients
will try to avoid taking in what is viewed as excessive calories and may go to great
lengths to avoid eating.
39. Question
A female client begins to experience alcoholic hallucinosis. Nurse Joy is aware that the best
nursing intervention at this time?
A. Keeping the client restrained in bed.
B. Checking the client’s blood pressure every 15 minutes and offering juices.
C. Providing a quiet environment and administering medication as needed and

prescribed.
D. Restraining the client and measuring blood pressure every 30 minutes.
Incorrect
Correct Answer: C. Providing a quiet environment and administering medication as
needed and prescribed.
Manifestations of alcoholic hallucinosis are best treated by providing a quiet environment
for reducing stimulation and administering prescribed central nervous system depressants
in dosages that control symptoms without causing oversedation. Encourage the patient to
rest by controlling minimal interpersonal contact with the patient. Decrease environmental
stimuli with controlled lighting, and provide a calm, quiet private room. The individualized,
symptom-triggered approach to benzodiazepine use satisfies the need to use medication
only when needed and may also reduce inpatient hospital stays. Benzodiazepines
stimulate GABA receptors causing a decrease in neuronal activity resulting in sedation.
Option A: Although bed rest is indicated, restraints are unnecessary unless the
client poses a danger to himself or others. Also, restraints may increase agitation
and make the client feel trapped and helpless when hallucinating. Present reality
without challenging or escalating the patient’s anxiety and thought disturbances.
Build a therapeutic rapport with the patient by providing relief from his or her
symptoms and meeting physiologic and safety needs. Meet the patient’s needs
promptly to reduce the risk of violence or aggression. Do not approach the patient
with loose items that the patient could grab if he or she becomes agitated, such as a
clipboard or dangling ID badge or phone.
Option B: Offering juice is appropriate, but measuring blood pressure every 15
minutes would interrupt the client’s rest. The nurse also documents the patient’s vital
signs, looking for an upward trend indicating increased withdrawal symptoms. On a
scale of 0 (none) to 3 (severe), the nurse then rates key signs and symptoms such
as nausea/vomiting; tremors; diaphoresis; anxiety; agitation; tactile, auditory, and
visual disturbances; headache; and orientation.
Option D: To avoid overstimulating the client, the nurse should check blood
pressure every 2 hours. As direct caregivers, nurses are ideally positioned to
improve patient outcomes by using the symptom-triggered approach. Based on an
objective withdrawal severity scale, a symptom-triggered approach provokes faster

and more-effective relief of withdrawal symptoms than treatment based on clinicians’
subjective judgment alone.
40. Question
Nurse Bella is aware that assessment finding is most consistent with early alcohol withdrawal?
A. Heart rate of 120 to 140 beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mmHg
D. Blood pressure of 140/80 mmHg
Incorrect
Correct Answer: A. Heart rate of 120 to 140 beats/minute
Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol
withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different
stages. Hypertension typically occurs in early withdrawal. Hypotension, although rare
during the early withdrawal stages, may occur in later stages. Hypotension is associated
with cardiovascular collapse and most commonly occurs in clients who don’t receive
treatment. The nurse should monitor the client’s vital signs carefully throughout the entire
alcohol withdrawal process.
Option B: Delirium tremens is the most severe form of alcohol withdrawal, and its
Option C: Alcohol withdrawal can range from very mild symptoms to the severe
form, which is named delirium tremens. The hallmark is autonomic dysfunction
resulting from the excitation of the central nervous system. Mild signs/symptoms can
arise within six hours of alcohol cessation. If symptoms do not progress to more
severe symptoms within 24 to 48 hours, the patient will likely recover.
Option D: Patients should be kept calm in a controlled environment to try to reduce
the risks of progression from mild symptoms to hallucinations. With mild to moderate
symptoms, patients should receive supportive therapy in the form of intravenous
rehydration, correction of electrolyte abnormalities, and have comorbid conditions as
listed above ruled out.
41. Question
Nurse Amy is aware that the client is at highest risk for suicide?
A. One who appears depressed frequently thinks of dying and gives away all personal
possessions.
B. One who plans a violent death and has the means readily available.
C. One who tells others that he or she might do something if life doesn’t get better
soon.
D. One who talks about wanting to die.
Incorrect
Correct Answer: B. One who plans a violent death and has the means readily
available.
The client at highest risk for suicide is one who plans a violent death (for example, by
gunshot, jumping off a bridge, or hanging), has a specific plan (for example, after the
spouse leaves for work), and has the means readily available (for example, a rifle hidden in
the garage). Several suicide-related demographic factors often occur in the same person.
For example, if a male police officer with major depression and a significant problem with
alcohol commits suicide using his service revolver (which, unfortunately, happens not
infrequently), 5 risk factors are involved: sex, occupation, depression, alcohol, and gun
availability.
Option A: A host of thoughts and behaviors are associated with self-destructive

acts. Although many assume that people who talk about suicide will not follow
through with it, the opposite is true; a threat of suicide can lead to the completed act,
and suicidal ideation is highly correlated with suicidal behaviors.
Option C: They are without hope and therefore cannot foresee things ever
improving; they also view themselves as helpless in 2 ways: (1) they cannot help
themselves, and all their efforts to liberate themselves from the sea of depression in
which they are drowning are to no avail; and (2) no one else can help them.
Option D: A client who talks about wanting to die or attempting suicide is considered
at a lower risk for suicide because this behavior typically serves to alert others that
the client is contemplating suicide and wishes to be helped. Determine whether the
person has any thoughts of hurting him or herself. Suicidal ideation is highly linked
to completed suicide. Some inexperienced clinicians have difficulty asking this
question. They fear the inquiry may be too intrusive or that they may provide the
person with an idea of suicide. In reality, patients appreciate the question as
evidence of the clinician’s concern. A positive response requires further inquiry.
42. Question
Nurse Penny is aware that the following medical conditions are commonly found in clients with
bulimia nervosa?
A. Allergies
B. Cancer
C. Diabetes mellitus
D. Hepatitis A
Incorrect
Correct Answer: C. Diabetes mellitus
Bulimia nervosa can lead to many complications, including diabetes, heart disease, and
hypertension. Girls and young women with type 1 diabetes have about twice the risk of
developing eating disorders as their peers without diabetes. This may be because of the
weight changes that can occur with insulin therapy and good metabolic control and the
extra attention people with diabetes must pay to what they eat.
Option A: The most common features of eating disorders in girls and young women
with type 1 diabetes are dissatisfaction with their body weight and shape and desire
to be thinner; dieting or manipulation of insulin doses to control weight; and, binge
eating. Researchers estimate that 10–20 percent of girls in their mid-teen years and
30–40 percent of late teenaged girls and young adult women with diabetes skip or
alter insulin doses to control their weight.
Option B: In people with diabetes, eating disorders can lead to poor metabolic
control and repeated hospitalizations for dangerously high or low blood sugar.
Chronic poor blood sugar control leads to long-term complications, such as eye,
kidney, and nerve damage. Diabulimia is a media-coined term that refers to an
eating disorder in a person with diabetes, typically type I diabetes, wherein the
person purposefully restricts insulin in order to lose weight. Some medical
professionals use the term ED-DMT1, Eating Disorder-Diabetes Mellitus Type 1,
which is used to refer to any type of eating disorder comorbid with type 1 diabetes.
Option D: The human body is surprisingly resilient and people with diabulimia often
manage to function with much higher blood sugars than should be possible. Thus,
the major consequences of diabulimia or ED-DMT1 are usually related to prolonged
elevated blood sugar. These complications can be severe and irreversible, so proper
treatment and early detection are critical. High blood sugar causes the body to
produce certain enzymes and hormones that negatively affect the immune system
and reduce the body’s defense against infection. This risk of infection plus slowed
healing heightens a person’s chance of developing gangrene, sepsis, or a bone
infection.
43. Question
Kellan, a high school student is referred to the school nurse for suspected substance abuse.
Following the nurse’s assessment and interventions, what would be the most desirable outcome?
A. The student discusses conflicts over drug use.
B. The student accepts a referral to a substance abuse counselor.
C. The student agrees to inform his parents of the problem.
D. The student reports increased comfort with making choices.
Incorrect
Correct Answer: B. The student accepts a referral to a substance abuse counselor
All of the outcomes stated are desirable; however, the best outcome is that the student
would agree to seek the assistance of a professional substance abuse counselor. The
basic goal for a client in any substance abuse treatment setting is to reduce the risk of
harm from continued use of substances. The greatest degree of harm reduction would
obviously result from abstinence, however, the specific goal for each individual client is
determined by his consumption pattern, the consequences of his use, and the setting in
which the brief intervention is delivered.
Option A: Primary care providers find many brief intervention techniques effective in
addressing the substance abuse issues of clients who are unable or unwilling to
access specialty care. Examples of brief interventions include asking clients to try
nonuse to see if they can stop on their own, encouraging interventions directed
toward attending a self-help group (e.g., Alcoholics Anonymous [AA] or Narcotics
Anonymous [NA]), and engaging in brief, structured, time-limited efforts to help
pregnant clients stop using.
Option C: The clinician can use brief interventions to motivate particular behavioral
changes at each stage of this process. For example, in the contemplation stage, a
brief intervention could help the client weigh the costs and benefits of change. In the
preparation stage, a similar brief intervention could address the costs and benefits
of various change strategies (e.g., self-change, brief treatment, intensive treatment,
self-help group attendance). In the action stage, brief interventions can help
maintain motivation to continue on the course of change by reinforcing personal
decisions made at earlier stages.
Option D: To consider change, clients at the precontemplation stage must have
their awareness raised. To resolve their ambivalence, clients in the contemplation
stage must be helped to choose positive change over their current circumstances.
Clients in the preparation stage need help in identifying potential change strategies
and choosing the most appropriate ones. Clients in the action stage need help to
carry out and comply with the change strategies.
44. Question
A male client who reportedly consumes one (1) qt of vodka daily is admitted for alcohol
detoxification. To try to prevent alcohol withdrawal symptoms, Dr. Smith is most likely to prescribe
which drug?
A. Clozapine (Clozaril)
B. Thiothixene (Navane)
C. Lorazepam (Ativan)
D. Lithium carbonate (Eskalith)
Incorrect
Correct Answer: C. Lorazepam (Ativan)
The best choice for preventing or treating alcohol withdrawal symptoms is lorazepam, a
benzodiazepine. Lorazepam is a benzodiazepine medication developed by DJ Richards. It
went on the market in the United States in 1977. Lorazepam has common use as the
sedative and anxiolytic of choice in the inpatient setting owing to its fast (1 to 3 minute)
onset of action when administered intravenously. Lorazepam is also one of the few
sedative-hypnotics with a relatively clean side effect profile. ff-label (non-FDA-approved)
uses for Lorazepam include rapid tranquilization of the agitated patient, alcohol withdrawal
delirium, alcohol withdrawal syndrome, insomnia, panic disorder, delirium, chemotherapy-
associated anticipatory nausea and vomiting (adjunct or breakthrough), as well as
psychogenic catatonia.
Option A: Clozapine is an FDA-approved atypical antipsychotic drug for treatment-
resistant schizophrenia.[1] The definition of treatment-resistant schizophrenia is
persistent or moderate delusions or hallucinations after failing two trials of
antipsychotic medicines. Clozapine is part of a group of drugs known as second-
generation antipsychotics or atypical antipsychotics.[1] Antipsychotic drugs are vital
in treating the core symptoms of schizophrenia: hallucinations and delusions.
Option B: Thiothixene is used to treat the symptoms of schizophrenia (a mental
illness that causes disturbed or unusual thinking, loss of interest in life, and strong or
inappropriate emotions). Thiothixene is in a group of medications called
conventional antipsychotics. It works by decreasing abnormal excitement in the

brain.
Option D: Lithium was the first mood stabilizer and is still the first-line treatment
option, but is underutilized because it is an older drug. Lithium is a commonly
prescribed drug for a manic episode in bipolar disorder as well as maintenance
therapy of bipolar disorder in a patient with a history of a manic episode. The
primary target symptoms of lithium are mania and unstable mood. Lithium is also
prescribed for major depressive disorder as an adjunct therapy, bipolar disorder
without a history of mania, treatment of vascular headaches, and neutropenia.
These are off-label uses, meaning they are not FDA-approved. Patients with rapid
cycling and mixed state types of bipolar disorder generally do less well on lithium.
45. Question
A male client is being treated for alcoholism. After a family meeting, the client’s spouse asks the
nurse about ways to help the family deal with the effects of alcoholism. Nurse Lily should suggest
that the family join which organization?
A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous
Incorrect
Correct Answer: A. Al-Anon
Al-Anon is an organization that assists family members to share common experiences and
increase their understanding of alcoholism. Al?Anon members come to understand
problem drinking as a family illness that affects everyone in the family. By listening to Al?
Anon members speak at Al?Anon meetings, they can hear how they came to understand
their own role in this family illness. This insight put them in a better position to play a
positive role in the family’s future.
Option B: Make Today Count is a support group for people with life-threatening or
chronic illnesses. MTC is a mutual support group for persons with terminal illnesses.
Organized in 1974, it is part of what some have called the “happy death movement.”
This movement seeks to make death more humane and less technological.
Option C: Emotions Anonymous is a support group for people experiencing
depression, anxiety, or similar conditions. Emotions Anonymous International (EAI)
is a nonprofit organization that facilitates the ongoing efforts of an international
fellowship of men and women who desire to improve their emotional well-being. EA
members come together in weekly meetings for the purpose of working toward
recovery from any sort of emotional difficulties. EA members are of diverse ages,
races, economic status, social and educational backgrounds. The only requirement
for membership is a desire to become well emotionally.
Option D: Alcoholics Anonymous is an organization that helps alcoholics recover by
using a twelve-step program. Alcoholics Anonymous is an international fellowship of
men and women who have had a drinking problem. It is nonprofessional, self-
supporting, multiracial, apolitical, and available almost everywhere. There are no
age or education requirements. Membership is open to anyone who wants to do
something about their drinking problem.
46. Question
A female client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote
the client’s physical health, nurse Tair should plan to:
A. Severely restrict the client’s physical activities.
B. Weigh the client daily, after the evening meal.
C. Monitor vital signs, serum electrolyte levels, and acid-base balance.
D. Instruct the client to keep an accurate record of food and fluid intake.
Incorrect
Correct Answer: C. Monitor vital signs, serum electrolyte levels, and acid-base
balance
An anorexic client who requires hospitalization is in poor physical condition from starvation
and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac
abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client’s vital
signs, serum electrolyte level, and acid-base balance is crucial.
Option A: Restricting the client’s physical activities may worsen anxiety. Clients with
anorexia appear slow, lethargic, and fatigued; they may be emaciated depending on
the amount of weight loss; clients with bulimia may be underweight or overweight
but are generally close to expected body weight for age and size.
Option B: This is incorrect because a weight obtained after breakfast is more
accurate than one obtained after the evening meal. When clients can eat, a diet of
1200 to 1500 calories per day is ordered, with gradual increases in calories until
clients are ingesting adequate amounts for height, activity level, and growth needs;
the nurse is responsible for monitoring meals and snacks and often initially will sit
with a client during eating at a table away from other clients; after each meal or
snack, clients may be required to remain in view of staff for 1 to 2 hours to ensure
that they do not empty the stomach by vomiting.
Option D: This would reward the client with attention for not eating and reinforce the
control issues that are central to the underlying psychological problem; also, the
client may record food and fluid intake inaccurately. The nurse can help clients begin
to recognize emotions such as anxiety or guilt by asking them to describe how they
are feeling and allowing adequate time for response.
47. Question
Kevin is remanded by the courts for psychiatric treatment. His police record, which dates to his
early teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped
out of school at age 16 and has been living on his own since then. His history suggests
maladaptive coping, which is associated with:
A. Antisocial personality disorder
B. Borderline personality disorder
C. Obsessive-compulsive personality disorder
D. Narcissistic personality disorder
Incorrect
Correct Answer: A. Antisocial personality disorder
The client’s history of delinquency, running away from home, vandalism, and dropping out
of school are characteristic of antisocial personality disorder. This maladaptive coping
pattern is manifested by a disregard for societal norms of behavior and an inability to relate
meaningfully to others. Antisocial personality disorder (ASPD) is a deeply ingrained and
rigid dysfunctional thought process that focuses on social irresponsibility with exploitive,
delinquent, and criminal behavior with no remorse. Disregard for and the violation of others’
rights are common manifestations of this personality disorder, which displays symptoms
that include failure to conform to the law, inability to sustain consistent employment,
deception, manipulation for personal gain, and incapacity to form stable relationships.
Option B: In borderline personality disorder, the client exhibits mood instability, poor
self-image, identity disturbance, and labile affect. Borderline personality disorder
(BPD) is 1 of 4 Cluster-B disorders that include borderline, antisocial, narcissistic,
and histrionic. Borderline personality disorder (BPD) is characterized by
hypersensitivity to rejection and resulting instability of interpersonal relationships,
self-image, affect, and behavior.
Option C: Obsessive-compulsive personality disorder is characterized by a
preoccupation with impulses and thoughts that the client realizes are senseless but
can’t control. Obsessive-compulsive disorder (OCD) is often a disabling condition
consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To
reduce the anxiety and distress associated with these thoughts, the patient may
employ compulsions or rituals. These rituals may be personal and private, or they
may involve others to participate; the rituals are to compensate for the ego-dystonic
feelings of the obsessional thoughts and can cause a significant decline in function.
Option D: Narcissistic personality disorder is marked by a pattern of self-
involvement, grandiosity, and demand for constant attention. Narcissistic personality
disorder (NPD) is a pattern of grandiosity, need for admiration, and lack of empathy
per the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). The
disorder is classified in the dimensional model of “Personality Disorders.”NPD is
highly comorbid with other disorders in mental health.
48. Question
Macoy and Helen seek emergency crisis intervention because he slapped her repeatedly the night
before. The husband indicates that his childhood was marred by an abusive relationship with his
father. When intervening with this couple, nurse Gerry knows they are at risk for repeated violence
because the husband:
A. Has only moderate impulse control.
B. Denies feelings of jealousy or possessiveness.
C. Has learned violence as an acceptable behavior.
D. Feels secure in his relationship with his wife.
Incorrect
Correct Answer: C. Has learned violence as an acceptable behavior
Family violence usually is a learned behavior, and violence typically leads to further
violence, putting this couple at risk. Unfortunately, each form of family violence begets
interrelated forms of violence, and the “cycle of abuse” is often continued from exposed
children into their adult relationships, and finally to the care of the elderly. Domestic
violence is thought to be underreported. Domestic violence affects the victim, families, co-
workers, and community. It causes diminished psychological and physical health,
decreases the quality of life, and results in decreased productivity.
Option A: Repeated slapping may indicate poor, not moderate, impulse control.
According to the CDC, 1 in 4 women and 1 in 7 men will experience physical
violence by their intimate partner at some point during their lifetimes. About 1 in 3
women and nearly 1 in 6 men experience some form of sexual violence during their
lifetimes. Intimate partner violence, sexual violence, and stalking are high, with
intimate partner violence occurring in over 10 million people each year.
Option B: At least 5 million acts of domestic violence occur annually to women aged
18 years and older, with over 3 million involving men. While most events are minor,
for example grabbing, shoving, pushing, slapping, and hitting, serious and
sometimes fatal injuries do occur. Approximately 1.5 million intimate partner female
rapes and physical assaults are perpetrated annually, and approximately 800,000
male assaults occur. About 1 in 5 women have experienced completed or attempted
rape at some point in their lives. About 1% to 2% of men have experienced

completed or attempted rape.
Option D: Violent people commonly are jealous and possessive and feel insecure in
their relationships. While the research is not definitive, a number of characteristics
are thought to be present in perpetrators of domestic violence. Abusers tend to be
possessive, jealous, suspicious, and paranoid. Approximately one-third of women
and one-fifth of men will be victims of abuse. The most common sites of injuries are
the head, neck, and face. Clothes may cover injuries to the body, breasts, genitals,
rectum, and buttocks. One should be suspicious if the history is not consistent with
the injury.
49. Question
A client whose husband just left her has a recurrence of anorexia nervosa. Nurse Vic caring for
her realizes that this exacerbation of anorexia nervosa results from the client’s effort to:
A. Manipulate her husband.
B. Gain control of one part of her life.
C. Commit suicide.
D. Live up to her mother’s expectations.
Incorrect
Correct Answer: B. Gain control of one part of her life
By refusing to eat, a client with anorexia nervosa is unconsciously attempting to gain
control over the only part of her life she feels she can control. Assist the patient to confront
changes associated with puberty and sexual fears. Provide sex education as necessary.
Encourage personal development program, preferably in a group setting. Provide
information about the proper application of makeup and grooming. Learning about methods
to enhance personal appearance may be helpful to a long-range sense of self-esteem and
image. Feedback from others can promote feelings of self-worth.
Option A: This eating disorder doesn’t represent an attempt to manipulate others or

live up to their expectations (although anorexia nervosa has a high incidence in
families that emphasize achievement). Assist the patient to assume control in areas
other than dieting and weight loss such as management of their own daily activities,
work, and leisure choices. Feelings of personal ineffectiveness, low self-esteem,
and perfectionism are often part of the problem. The patient feels helpless to change
and requires assistance to problem-solve methods of control in life situations.
Option C: The client isn’t attempting to commit suicide through starvation; rather, by
refusing to eat, she is expressing feelings of despair, worthlessness, and
hopelessness. Help the patient formulate goals for self (not related to eating) and
create a manageable plan to reach those goals, one at a time, progressing from
simple to more complex. Patients need to recognize the ability to control other areas
in life and may need to learn problem-solving skills to achieve this control. Setting
realistic goals fosters success.
Option D: Encourage patients to take charge of their own lives in a more healthful
way by making their own decisions and accepting self as she or he is at this moment
(including inadequacies and strengths). Patient often does not know what she or he
may want for themselves. Parents (mother) often make decisions for the patient.
Patient may also believe she or he has to be the best in everything and holds self-
responsible for being perfect.
50. Question
A male client has approached the nurse asking for advice on how to deal with his alcohol
addiction. Nurse Sally should tell the client that the only effective treatment for alcoholism is:
A. Psychotherapy
B. Total abstinence
C. Alcoholics Anonymous (AA)
D. Aversion therapy
Incorrect
Correct Answer B. Total abstinence
Total abstinence is the only effective treatment for alcoholism. For people who have severe
alcohol use disorder, this is a key step. The goal is to stop drinking and give the body time
to get the alcohol out of the system. That usually takes a few days to a week.
Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive
therapies that can support the client in his efforts to abstain.
Option A: With alcohol use disorder, controlling your drinking is only part of the
answer. You also need to learn new skills and strategies to use in everyday life.
Psychologists, social workers, or alcohol counselors can teach you how to change
the behaviors that make you want to drink; deal with stress and other triggers; build
a strong support system; and set goals and reach them.
Option C: Group therapy or a support group can help during rehab and help the
client stay on track as life gets back to normal. Group therapy, led by a therapist,
can give the client the benefits of therapy along with the support of other members.
Support groups aren’t led by therapists. Instead, these are groups of people who
have alcohol use disorder. Examples include Alcoholics Anonymous, SMART
Recovery, and other programs. The peers can offer understanding and advice and
help keep the client accountable. Many people stay in groups for years.
Option D: Aversion therapy is a type of behavioral therapy that involves repeatedly
pairing an unwanted behavior with discomfort. For example, a person undergoing
aversion therapy to stop smoking might receive an electrical shock every time they
view an image of a cigarette. The goal of the conditioning process is to make the
individual associate the stimulus with unpleasant or uncomfortable sensations.
51. Question
Which nursing intervention would be most appropriate if a male client develops orthostatic
hypotension while taking amitriptyline (Elavil)?
A. Consulting with the physician about substituting a different type of antidepressant.
B. Advising the client to sit up for 1 minute before getting out of bed.
C. Instructing the client to double the dosage until the problem resolves.
D. Informing the client that this adverse reaction should disappear within 1 week.
Incorrect
Correct Answer: B. Advising the client to sit up for 1 minute before getting out of
bed.
To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should
advise the client to sit up for 1 minute before getting out of bed. Amitriptyline is FDA
approved medication to treat depression in adults. Secondary to its alpha-adrenergic
receptor blockade, it can cause orthostatic hypotension, dizziness, and sedation. It can
also cause heart rate variability, slow intracardiac conduction, induce various arrhythmias,
and cause QTc (corrected QT) prolongation.
Option A: Orthostatic hypotension commonly occurs with tricyclic antidepressant
therapy. Cardiac symptoms include tachycardia, hypotension, conduction
abnormalities include QTc prolongation. Amitriptyline is in the tricyclic antidepressant
(TCA) drug classification and acts by blocking the reuptake of both serotonin and
norepinephrine neurotransmitters. The three-ring central structure, along with a side
chain, is the basic structure of tricyclic antidepressants. Amitriptyline is a tertiary
amine and has strong binding affinities for alpha-adrenergic, histamine (H1), and
muscarinic (M1) receptors. It is more sedating and has increased anticholinergic
properties compared to other TCAs.
Option C: In these cases, the dosage may be reduced or the physician may
prescribe nortriptyline, another tricyclic antidepressant. Once the patient is stable,
amitriptyline should be continued for three months or longer to prevent relapse of
depression. In cases of therapy cessation, the clinician should gradually taper to
avoid withdrawal. Amitriptyline administration comes in various forms, the most
common being oral form. The initial dose recommended for depression is 25 mg/day
at bedtime, as it can be sedating.
Option D: Orthostatic hypotension disappears only when the drug is discontinued.
The most commonly encountered side effects of amitriptyline include weight gain,
gastrointestinal symptoms like constipation, xerostomia, dizziness, headache, and
somnolence. Patients on amitriptyline can have anticholinergic, antihistaminic, and
alpha-adrenergic blocking effects. It may not be appropriate for patients with cardiac
problems.
52. Question
Mr. Cruz visits the physician’s office to seek treatment for depression, feelings of hopelessness,
poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making
decisions. The client states that these symptoms began at least 2 years ago. Based on this report,
the nurse Tiffany suspects:
A. Cyclothymic disorder.
B. Atypical affective disorder.
C. Major depression.
D. Dysthymic disorder.
Incorrect
Correct Answer: D. Dysthymic disorder.
Dysthymic disorder is marked by feelings of depression lasting at least 2 years,
accompanied by at least two of the following symptoms: sleep disturbance, appetite
disturbance, low energy or fatigue, low self-esteem, poor concentration, difficulty making
decisions, and hopelessness. These symptoms may be relatively continuous or separated
by intervening periods of normal mood that last a few days to a few weeks.
Option A: Cyclothymic disorder is a chronic mood disturbance of at least 2 years’
duration marked by numerous periods of depression and hypomania. It is currently
classified under the umbrella of bipolar mood disorders. It is a chronic disease that
must be present for at least two years in order to be diagnosable in adults and over
1 year in children and adolescents. As with many other psychiatric disorders, it must
lead to dysfunction and stress in order to be classified as a disorder and must not be
concurrent or caused by another general medical condition or substance use
disorder.
Option B: Atypical affective disorder is characterized by manic signs and
symptoms. Affective disorders may include manic (elevated, expansive, or irritable
mood with hyperactivity, pressured speech, and inflated self-esteem) or depressive
(dejected mood with disinterest in life, sleep disturbance, agitation, and feelings of
worthlessness or guilt) episodes, and often combinations of the two.
Option C: Major depression is a recurring, persistent sadness or loss of interest or

pleasure in almost all activities, with signs and symptoms recurring for at least 2
weeks. The investigation into depressive symptoms begins with inquiries of the
neurovegetative symptoms which include changes in sleeping patterns, appetite,
and energy levels. Positive responses should elicit further questioning focused on
evaluating for the presence of the symptoms which are diagnostic of major
depression.
53. Question
After taking an overdose of phenobarbital (Barbita), Mario is admitted to the emergency

department. Dr. Trinidad prescribes activated charcoal (Charcocaps) to be administered by mouth
immediately. Before administering the dose, the nurse verifies the dosage ordered. What is the
usual minimum dose of activated charcoal?
A. 5 g mixed in 250 ml of water
B. 15 g mixed in 500 ml of water
C. 30 g mixed in 250 ml of water
D. 60 g mixed in 500 ml of water
Incorrect
Correct Answer: C. 30 g mixed in 250 ml of water
The usual adult dosage of activated charcoal is 5 to 10 times the estimated weight of the
drug or chemical ingested, or a minimum dose of 30 g, mixed in 250 ml of water. Doses
less than this will be ineffective; doses greater than this can increase the risk of adverse
reactions, although toxicity doesn’t occur with activated charcoal, even at the maximum
dose. Activated charcoal is widely used in Emergency Departments to treat many types of
toxic ingestions. Its use significantly prevents the absorption of many toxic drugs and other
poisons if given early post-ingestion.
Option A: An oral suspension of activated charcoal (AC) should merit consideration
in poisonings when there is an indication for gastrointestinal decontamination of an
ingested toxin, and the clinician can administer activated charcoal within 1 hour of
ingestion. When the dose of the ingested toxin is known, experts recommend
activated charcoal at a 10 to 1 ratio of activated charcoal to the ingested toxin. This
ratio may be impractical to achieve when the patient has ingested large doses of a
toxin.
Option B: When the amount of toxin ingested is unknown, or it is impractical to
achieve a 10 to 1 ratio in large dose toxic ingestions, SDAC should be administered
at a dose of 1g/kg of body weight or using a simplified age-based dosing scheme.
Formulations have been attempted to increase the palatability of activated charcoal,
which is black and has a gritty texture. Ready-to-use aqueous suspensions of
activated charcoal are available in 15 g, 25 g, and 50 g doses as well as
formulations premixed with sorbitol.
Option D: Pulmonary aspiration and a resulting aspiration pneumonitis are the most
concerning risks of administration of activated charcoal. Aspiration from emesis and
misplaced nasogastric tubes for activated charcoal administration can lead to severe
respiratory compromise and even death. Therefore, an adequate airway
assessment must take place before the administration of activated charcoal.
54. Question
What herbal medication for depression, widely used in Europe, is now being prescribed in the
United States?
A. Ginkgo biloba
B. Echinacea
C. St. John's wort
D. Ephedra
Incorrect
Correct Answer: C. St. John’s wort
St. John’s wort has been found to have serotonin-elevating properties, similar to
prescription antidepressants. St. John’s Wort (Hypericum perforatum) is commonly used to
treat mild-to-moderate depression. Several bioactive compounds have been identified in
St. John’s Wort that work synergistically to provide its antidepressant and anti-inflammatory
attributes. St. John’s Wort was more efficacious than standard antidepressant therapy in
patients with mild-to-moderate depression.
Option A: Ginkgo biloba is prescribed to enhance mental acuity. Ginkgo biloba is
commonly used to improve memory and cognition in the elderly suffering from
impaired cerebral circulation. Mitochondrial dysfunction is one theory proposed as
the leading cause of cognitive decline. The two main components in Gingko biloba
leaves are flavonoids and terpenes tri lactones. Together, these compounds
enhance and protect mitochondrial function and scavenge reactive molecules like
hydroxyl and peroxyl radicals, nitric oxide, and superoxide ions.
Option B: Echinacea has immune-stimulating properties. Echinacea is known as an
immunostimulant, boosting both innate and specific immunity. It has also
demonstrated anti-viral, anti-inflammatory, and antimicrobial effects. Intracellular
bactericidal activity and enhanced phagocytosis were also observed. A randomized,
double-blind study of 473 patients virologically confirmed with influenza infection,
showed Echinacea was as effective as oseltamivir with fewer adverse events and
reduced risk.
Option D: Ephedra is a naturally occurring stimulant that is similar to ephedrine.
Ephedra is a medicinal preparation from the plant Ephedra sinica. Several additional
species belonging to the genus Ephedra have traditionally been used for a variety of
medicinal purposes, and are a possible candidate for the Soma plant of Indo-Iranian
religion.
55. Question
Cely with manic episodes is taking lithium. Which electrolyte level should the nurse check before
administering this medication?
A. Calcium
B. Sodium
C. Chloride
D. Potassium
Incorrect
Correct Answer: B. Sodium
Lithium is chemically similar to sodium. If sodium levels are reduced, such as from
sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of
toxicity. Clients taking lithium shouldn’t restrict their intake of sodium and should drink
adequate amounts of fluid each day. It is also important to monitor patients for dehydration
and lower the dose when there are signs of infection, excessive sweating, or diarrhea.
Toxic levels are when the drug level is more than 2 mEq/L.
Option A: Lithium modifies sodium transport in nerve and muscle cells. It alters the
metabolism of neurotransmitters, specifically catecholamines, and serotonin. It may
alter intracellular signaling via second messenger systems by inhibition of inositol
monophosphate. This inhibition, in turn, affects neurotransmission through the
phosphatidylinositol secondary messenger system.
Option C: Before starting treatment with lithium, it is essential to get kidney function
tests and thyroid function tests. In patients above 50 years of age, an
electrocardiogram is also necessary. Repeat these tests once or twice a year in
patients on lithium therapy. Because lithium is associated with weight gain, it is
important to weigh a patient before starting treatment. It is also beneficial to
determine if the patient has prediabetes, diabetes, or dyslipidemia.
Option D: The other electrolytes are important for normal body functions but sodium
is most important to the absorption of lithium. Monitoring of therapeutic levels
includes trough plasma levels drawn 8 to 12 hours after the last dose. The
therapeutic range is 1.0 to 1.5 mEq/L for acute treatment and 0.6 to 1.2 mEq/L for
chronic therapy. Monitoring should be done every 1 to 2 weeks until reaching the
desired therapeutic levels. Then, check lithium levels every 2 to 3 months for six
months.
56. Question
Nurse Josefina is caring for a client who has been diagnosed with delirium. Which statement
about delirium is true?
A. It's characterized by an acute onset and lasts about 1 month.
B. It's characterized by a slowly evolving onset and lasts about 1 week.
C. It's characterized by a slowly evolving onset and lasts about 1 month.
D. It's characterized by an acute onset and lasts hours to a number of days.
Incorrect
Correct Answer: D. It’s characterized by an acute onset and lasts hours to a number
of days
Delirium has an acute onset and typically can last from several hours to several days.
Delirium, also known as the acute confusional state, is a clinical syndrome that usually
develops in the elderly. It is characterized by an alteration of consciousness and cognition
with reduced ability to focus, sustain, or shift attention.
Option A: It develops over a short period and fluctuates during the day. The clinical
presentation can vary, but usually, it flourishes with psychomotor behavioral
disturbances such as hyperactivity or hypoactivity with increased sympathetic
activity and impairment in sleep duration and architecture. It is caused by a medical
condition, substance intoxication, or withdrawal in addition to the medication side
effects, as well as; it is no better explained by another preexisting, involving, or
established neurocognitive disorder.
Option B: Delirium can be a life-threatening emergency. Affected patients require
an appropriate evaluation with history taking, physical, and neurologic examination
and laboratory tests. Physical examination should evaluate head-to-toe and vital
signs to determine any possible cause. Neurologic examination should focus on
evaluating new focal findings that suggest an intracranial cause, for example, a
stroke.
Option C: Only 12% to 35% of delirium cases are recognized. The first thing one
has to do is determine the patient’s baseline mental status and the acuity of the
symptom presentation, delirium presents over hours to days. This step requires a
knowledgeable informant to obtain the history. Although, it is necessary for the
diagnosis to know if the disturbance in mental status started alone or with other
symptoms as dyspnea or dysuria or with medication changes.
57. Question
Edward, a 66-year-old client with slight memory impairment and poor concentration, is diagnosed
with primary degenerative dementia of the Alzheimer’s type. Early signs of this dementia include
subtle personality changes and withdrawal from social interactions. To assess for progression to
the middle stage of Alzheimer’s disease, the nurse should observe the client for:
A. Occasional irritable outbursts.
B. Impaired communication.
C. Lack of spontaneity.
D. Inability to perform self-care activities.
Incorrect
Correct Answer: B. Impaired communication.
Signs of advancement to the middle stage of Alzheimer’s disease include exacerbated
cognitive impairment with obvious personality changes and impaired communication, such
as inappropriate conversation, actions, and responses. Symptoms of Alzheimer’s disease
depend on the stage of the disease. Alzheimer’s disease is classified into preclinical or
presymptomatic, mild, and dementia-stage depending on the degree of cognitive
impairment. These stages are different from the DSM-5 classification of Alzheimer’s
disease.
Option A: Neuropsychiatric symptoms like apathy, social withdrawal, disinhibition,
agitation, psychosis, and wandering are also common in the mid to late stages.
However, other than occasional irritable outbursts and lack of spontaneity, the client
is usually cooperative and exhibits socially appropriate behavior.
Option C: Initially, memory impairment may be the only cognitive deficit in a client
with Alzheimer’s disease. During the early stage of this disease, subtle personality
changes may also be present. In the early stages, impairment in executive
functioning ranges from subtle to significant. This is followed by language disorder
and impairment of visuospatial skills. The initial and most common presenting
symptom is episodic short-term memory loss with relative sparing of long-term
memory and can be elicited in most patients even when not the presenting
symptom.
Option D: During the late stage, the client can’t perform self-care activities and may
become mute. Difficulty performing learned motor tasks (dyspraxia), olfactory
dysfunction, sleep disturbances, extrapyramidal motor signs like dystonia, akathisia,
and parkinsonian symptoms occur late in the disease. This is followed by primitive
reflexes, incontinence, and total dependence on caregivers.
58. Question
Isabel with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at

bedtime. The nurse should tell the client that:
A. This medication may be habit-forming and will be discontinued as soon as the client
feels better.
B. This medication has no serious adverse effects.
C. The client should avoid eating such foods as aged cheeses, yogurt, and chicken
livers while taking the medication.
D. This medication may initially cause tiredness, which should become less
bothersome over time.
Incorrect
Correct Answer: D. This medication may initially cause tiredness, which should
become less bothersome over time.
Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and
usually decreases as tolerance develops. Since imipramine acts on various receptors in
the body, it presents with adverse effects on some organs and systems. In the central and
autonomic nervous system, the antihistaminic effects of imipramine can lead to dizziness,
sedation, confusion, delirium, seizures, increased appetite, and weight gain.
Option A: Antidepressants aren’t habit forming and don’t cause physical or
psychological dependence. However, after a long course of high-dose therapy, the
dosage should be decreased gradually to avoid mild withdrawal symptoms. It is

highly recommended to closely monitor patients for their clinical condition, their
response to the medication, and during periods of dose adjustment. Family and
caregivers should be encouraged to observe their patients and to contact their
psychiatrist if needed. The therapeutic index of TCAs is narrow. Therefore, regular
drug monitoring is required to ensure the therapeutic blood level and, at the same
time, to avoid toxic effects of imipramine.
Option B: Serious adverse effects, although rare, include myocardial infarction,
heart failure, and tachycardia. Extreme precautions are necessary, especially in a
patient with cardiovascular disease, including conduction defects, tachycardia, acute
myocardial infarction, and hepatic impairment. When coadministering imipramine
with a MOAI, it can lead to fatal hypertensive crises or seizures. When imipramine is
co-ingested with SSRI, it can cause serotonin syndrome.
Option C: Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken
livers, are necessary for a client taking a monoamine oxidase inhibitor, not a tricyclic
antidepressant. The risk of developing toxicity from imipramine and other tricyclics is
greater upon increasing the dose. An overdose of imipramine can result in serious
side effects, mainly cardiac dysrhythmia, critical hypotension, convulsions, coma,
confusion, hyperactive reflexes, and hypothermia. Imipramine has type 1
antiarrhythmic effects as it blocks the fast sodium channel on the myocardium.
Therefore, this will lead to inhibition of depolarization of the heart action potential,
which will result in QRS prolongation, which can lead to cardiac arrhythmia.
59. Question
Kathleen is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the
client’s physical health, the nurse should plan to:
A. Severely restrict the client's physical activities.
B. Weigh the client daily, after the evening meal.
C. Monitor vital signs, serum electrolyte levels, and acid-base balance.
D. Instruct the client to keep an accurate record of food and fluid intake.
Incorrect
Correct Answer: C. Monitor vital signs, serum electrolyte levels, and acid-base
balance.
An anorexic client who requires hospitalization is in poor physical condition from starvation
and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac
abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client’s vital
signs, serum electrolyte level, and acid-base balance is crucial. Work-up includes a
thorough medical history (comprehensive review of systems, family and social history,
medications including non-prescribed, past medical and psychiatric history, prior abuse)
and physical exam (looking for complications above).
Option A: This may worsen anxiety. Treatment for anorexia nervosa is centered on
nutrition rehabilitation and psychotherapy. Outpatient treatment includes intensive
therapy (2 to 3 hours per weekday) and partial hospitalization (6 hours per day).
Pediatric patients benefit from family-based psychotherapy to explore underlying
dynamics and restructure the home environment.
Option B: This is incorrect because a weight obtained after breakfast is more
accurate than one obtained after the evening meal. Diagnose by history, physical,
and lab work that rules out other conditions that can make people lose weight.
Treatment includes gaining weight (sometimes in a hospital if severe), therapy to
address body image, and management of complications from malnourishment.
Option D: This would reward the client with attention for not eating and reinforce the
control issues that are central to the underlying psychological problem; also, the
client may record food and fluid intake inaccurately. Patient and family education is
key to preventing high morbidity. The dietitian should educate the family on the
importance of nutrition and limiting exercise. The mental health nurse should
educate the patient on changes in behavior, easing stress, and overcoming any
emotional issues.
60. Question
Celia with a history of polysubstance abuse is admitted to the facility. She complains of nausea
and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection,
pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the
following withdrawals?
A. Alcohol withdrawal
B. Cannabis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal
Incorrect
Correct Answer: D. Opioid withdrawal
The symptoms listed are specific to opioid withdrawal. According to Diagnostic and
Statistical Manual of Mental Disorders (DSM–5) criteria, signs and symptoms of opioid
withdrawal include lacrimation or rhinorrhea, piloerection “goose flesh,” myalgia, diarrhea,
nausea/vomiting, pupillary dilation and photophobia, insomnia, autonomic hyperactivity
(tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia), and
yawning. Opioid withdrawal syndrome is a life-threatening condition resulting from opioid
dependence. Opioids are a group of drugs used for the management of severe pain. They
are also commonly used as psychoactive substances around the world.
Option A: Alcohol withdrawal would show elevated vital signs. Alcohol withdrawal
symptoms occur when patients stop drinking or significantly decrease their alcohol
intake after long-term dependence. Withdrawal has a broad range of symptoms from
mild tremors to a condition called delirium tremens, which results in seizures and
could progress to death if not recognized and treated promptly. Alcohol withdrawal
can range from very mild symptoms to the severe form, which is named delirium
tremens. The hallmark is autonomic dysfunction resulting from the excitation of the
central nervous system. Mild signs/symptoms can arise within six hours of alcohol
cessation.
Option B: There is no real withdrawal from cannabis. Cannabis is considered by the
Food and Drug Administration, along with heroin and peyote, as a schedule I drug. It
has no accepted medical purpose and has a high potential for abuse. The mental
status of the individual is a critical part of the exam and can point at the phase of
cannabis use. Intoxication can include euphoria, anxiety, uncontrollable laughter,
increased appetite, inattentiveness, forgetfulness, restlessness, tachycardia,
conjunctival injection, and dry mouth. And less commonly may include delusions,
hallucinations, and derealization.
Option C: Symptoms of cocaine withdrawal include depression, anxiety, and
agitation. Central nervous system (CNS) stimulants like cocaine and amphetamine
can also produce withdrawal symptoms. Like opioids, the withdrawal symptoms are
mild and not life-threatening. Often the individual will develop marked depression,
excessive sleep, hunger, dysphoria, and severe psychomotor retardation but all vital
functions are well preserved. Recovery is usually slow, and depression can last for
several weeks.
61. Question
Mr. Garcia, an attorney who throws books and furniture around the office after losing a case, is
referred to the psychiatric nurse in the law firm’s employee assistance program. Nurse Beatriz
knows that the client’s behavior most likely represents the use of which defense mechanism?
A. Regression
B. Projection
C. Reaction-formation
D. Intellectualization
Incorrect
Correct Answer: A. Regression
An adult who throws temper tantrums, such as this one, is displaying regressive behavior,
or behavior that is appropriate at a younger age. Adapting one’s behavior to earlier levels
of psychosocial development. For example, a stressful event may cause an individual to
regress to bed-wetting after they have already outgrown this behavior.
Option B: In projection, the client blames someone or something other than the
source. Attributing one’s own maladaptive inner impulses to someone else. For
example, someone who commits an episode of infidelity in their marriage may then
accuse their partner of infidelity or may become more suspicious of their partner.
Option C: In reaction formation, the client acts in opposition to his feelings.
Replacing one’s initial impulse toward a situation or idea with the opposite impulse.
This defense mechanism may be present in someone who teases or insults a
romantic interest whom they like. Conversely, reaction formation may be present in
someone who is overly kind to someone whom they dislike.
Option D: In intellectualization, the client overuses rational explanations or abstract

thinking to decrease the significance of a feeling or event. The development of
patterns of excessive thinking or over-analyzing, which may increase the distance
from one’s emotions. For example, someone who is diagnosed with a terminal
illness does not show emotion after the diagnosis is given but instead starts to
research every source they can find about the illness.
62. Question
Nurse Anne is caring for a client who has been treated long term with antipsychotic medication.
During the assessment, Nurse Anne checks the client for tardive dyskinesia. If tardive dyskinesia
is present, Nurse Anne would most likely observe:
A. Abnormal movements and involuntary movements of the mouth, tongue, and face.
B. Abnormal breathing through the nostrils accompanied by a “thrill.”
C. Severe headache, flushing, tremors, and ataxia.
D. Severe hypertension, migraine headache.
Incorrect
Correct Answer: A. Abnormal movements and involuntary movements of the mouth,
tongue, and face.
Tardive dyskinesia is a severe reaction associated with long-term use of antipsychotic
medication. The clinical manifestations include abnormal movements (dyskinesia) and
involuntary movements of the mouth, tongue (flycatcher tongue), and face. Tardive
dyskinesia (TD) is a syndrome which includes a group of iatrogenic movement disorders
caused due to a blockade of dopamine receptors. The movement disorders include
akathisia, dystonia, buccolingual stereotypy, myoclonus, chorea, tics, and other abnormal
involuntary movements which are commonly caused by the long-term use of typical
antipsychotics.
Option B: Tardive dyskinesia presents clinically as stereotypical involuntary
movements of the tongue, neck and facial muscles, truncal musculature, and limbs.
Buccolingual movements including masticatory muscles are characterized by lip-

smacking, tongue protrusion, perioral movements, chewing movements, or puffing
of cheeks.
Option C: However, tardive dyskinesia is seen in patients who have had chronic
exposure to dopamine D2 receptor blockade and rarely seen in patients who have
been exposed to antipsychotics for less than three to six months. Diagnosis of acute
or chronic dyskinesias may be challenging without a careful history. A thorough
history of movement disorders and medication history will aid in making an accurate
diagnosis of tardive dyskinesia.
Option D: Tardive dyskinesia is caused due to long-term exposure to first and
second-generation neuroleptics, certain antidepressants, lithium, and some
antiemetic medications. Typically, the first-generation antipsychotics with increased
dopamine D2 receptor affinity are affiliated with a higher risk of causing permanent
abnormal involuntary movements.
63. Question
Dennis has a lithium level of 2.4 mEq/L. The nurse immediately would assess the client for which
of the following signs or symptoms?
A. Weakness
B. Diarrhea
C. Blurred vision
D. Fecal incontinence
Incorrect
Correct Answer: C. Blurred vision
At lithium levels of 2 to 2.5 mEq/L the client will experience blurred vision, muscle twitching,
severe hypotension, and persistent nausea and vomiting. Intoxication degree is of utmost
importance for understanding lithium toxicity diagnosis and management. The severity of
lithium toxicity is often divided into the following three grades: mild, moderate, and severe.
In mild, there is nausea, vomiting, lethargy, tremor, and fatigue (Serum lithium
concentration between 1.5-2.5 mEq/L).
Option A: Symptoms of intoxication include coarse tremor, hyperreflexia,
nystagmus, and ataxia. Patients often show varying consciousness levels, ranging
from mild confusion to delirium. Although the neurological symptoms are mostly
reversible, some reports indicate that symptoms might persist for 12 months and
never resolve.
Option B: With levels between 1.5 and 2 mEq/L the client experiencing vomiting,
diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion.
Symptoms typically occur within 1 hour of ingestion and are more common in the
acute overdose setting. To determine the extent of lithium toxicity, one must
determine the ingested amount, time of ingestion, whether there are coingestants,
and if the ingestion was intentional or unintentional. It is worth noting that lithium
toxicity signs do not often conform to the measured lithium level.
Option D: At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal
incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular
collapse, and death. Renal toxicity is more common in patients on chronic lithium
treatment. Toxicity includes impaired urinary concentrating ability, nephrogenic
diabetes insipidus (the most common cause of drug-induced NDI), sodium-losing
nephritis, nephrotic syndrome along other manifestations.
64. Question
Nurse Jannah is monitoring a male client who has been placed in restraints because of violent
behavior. Nurse determines that it will be safe to remove the restraints when:
A. The client verbalizes the reasons for the violent behavior.
B. The client apologizes and tells the nurse that it will never happen again.
C. No acts of aggression have been observed within 1 hour after the release of two of
the extremity restraints.
D. The administered medication has taken effect.
Incorrect
Correct Answer: C. No acts of aggression have been observed within 1 hour after
the release of two of the extremity restraints.
The best indicator that the behavior is controlled if the client exhibits no signs of aggression
after partial release of restraints. When the patient is no longer a danger to themselves or
others, the restraints should be removed immediately. The Occupational Safety and Health
Administration (OSHA) stated that 75% of annual assaults in the workplace occur in the
healthcare and social service fields. As reported in the National Crime Victimization Survey,
healthcare workers face a 20% higher chance of being victimized in the workplace when
compared to other workers.
Option A: The impetus to administer restraint and seclusion protocol is to obviate
potential violence and potentiate harm reduction. Hazards to be avoided include
both harm to the patient and the caretaker. This danger encompasses both
nonviolent and violent risks. Healthcare providers are encouraged to always remain
vigilant. Violence history remains the best predictor for future violence. The classic
escalation of patient violence progresses from anger, resistance, and finally to
confrontation. Signs of impending violent behavior include provocative behavior,
posturing, pacing, angry demeanor, and aggressive acts.
Option B: Once an agitated patient has been identified, staff must give the patient
the opportunity to calm down before physical intervention. Often, agitated but
cooperative patients will be amenable to verbal de-escalation. Guidelines
recommend an honest and straightforward approach with the implementation of
friendly gestures proves most beneficial in the setting of an agitated patient.
Following fruitless de-escalation techniques, emergency seclusion and restraint can
be indicated.
Option D: This does not ensure that the client has controlled the behavior.
Document appropriate clinical indications and have a standardized checklist
prepared for staff to monitor and supply patient needs effectively. Numerous deaths
and adverse patient outcomes have been reported due to inappropriate restraint
placement and negligent monitoring. After restraint placement, patients should be
reevaluated every hour and moved at regular intervals to prevent sequelae such as
pressure ulcers, rhabdomyolysis, and paresthesias.
65. Question
Nurse Irish is aware that Ritalin is the drug of choice for a child with ADHD. The side effects of the
following may be noted by the nurse:
A. Increased attention span and concentration.
B. Increase in appetite.
C. Sleepiness and lethargy.
D. Bradycardia and diarrhea.
Incorrect
Correct Answer: A. Increased attention span and concentration
The medication has a paradoxical effect that decreases hyperactivity and impulsivity
among children with ADHD. Methylphenidate is FDA-approved for the treatment of
attention deficit hyperactivity disorder (ADHD) in children and adults and as a second-line
treatment for narcolepsy in adults. Children with a diagnosis of ADHD should be at least six
years of age or older before being started on this medication. The treatment of both ADHD
and narcolepsy have significantly better outcomes when used concurrently with
nonpharmacologic therapies (i.e., social skills training in ADHD or sleep hygiene measures
in narcolepsy).
Option B: Patients are more prone to become easily agitated, irritable, or
depressed and go through mood swings/lability). While many of the common side
effects can be relieved by adjusting the dosage or avoidance of an afternoon or
evening dose, some require treatment emergently to prevent complications. While it
rarely occurs, priapism is a medical emergency that requires immediate attention.
Option C: Insomnia and nervousness are the most commonly reported adverse
effects in patients on methylphenidate. Other frequent side effects mainly involve the
CNS (dizziness, headache, tics, restlessness/akathisia), gastrointestinal
(nausea/vomiting, dry mouth, decreased appetite, weight loss, abdominal pain), and
cardiovascular systems (tachycardia, and palpitations).
Option D: Side effects of Ritalin include anorexia, insomnia, diarrhea, and irritability.
It is important to note that there have been reported cases of sudden death in both
children and adults with a pre-existing structural cardiac abnormality. Stroke and
myocardial infarction also have been observed in adults. Due to the risk of such fatal
side effects, it is advisable to avoid methylphenidate in patients with a structural

cardiac abnormality, cardiomyopathy, or arrhythmias.
66. Question
Kitty, a 9-year-old child has a 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
Incorrect
Correct Answer: C. Moderate
The child with moderate mental retardation has an I.Q. of 35- 50. According to the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis
of intellectual disability requires deficits in intellectual function, deficits in adaptive function,
and onset before the age of 18. The IQ test is widely used to assess the intellectual
function of individuals. IQ test derives from Stanford-Binet Intelligence Scales, used for
school placement in France.
Option A: Profound Mental retardation has an I.Q. of below 20. Lewis Terman
adapted the test to measure general intelligence. Scores were reported as “mental
age” divided by chronological age, multiplied by 100. The current version of the IQ
test is standardized, and two standard deviations below the test taker’s group are
calculated as IQ of 70. An IQ of 70 or below suggests an intellectual disability
diagnosis.
Option B: Mild mental retardation has an I.Q. of 50-70. However, it is no longer a
standard to classify intellectual disability by IQ score alone. For instance, if an
individual has IQ below 70, but has a good adaptive function, the subject does not
have an intellectual disability. On the other side, individuals with a normal, or even
higher than normal IQ, may manifest severe deficits in adaptive functions and are,
therefore, classified as having an intellectual disability.
Option D: Severe mental retardation has an I.Q. of 20-35. In turn, the current
diagnosis of intellectual disability also considers a person’s adaptive function. The
Adaptive Behaviour Assessment System can measure adaptive function. It
encompasses the social and practical domain. Adaptive function measures ability in
communication, social participation, and independent living.
67. Question
The therapeutic approach in the care of Armand an autistic child includes 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.
Incorrect
Correct Answer: D. Rearrange the environment to activate the child
The child with autistic disorder does not want change. Maintaining a consistent
environment is therapeutic. Autism spectrum disorders (ASD) are a group of rapidly
growing disabilities. They are characterized by repetitive patterns of behavior, interests, or
activities, problems in social interactions. These children become distressed when their
surrounding environment is changed because their adaptive capabilities are minimal. The
symptoms are present from early childhood and affect daily functioning.
Option A: Angry outburst can be re-channeling through safe activities. Therapies in
the areas of language, speech, social skills development, occupational, and sensory
integration may all be used according to the needs of the individual child. Loss of
language, skills related to social interaction, and self-care are delirious, and the
affected children face ongoing problems in certain areas and require long-term care.
Option B: Acceptance enhances a trusting relationship. Helpful strategies include

encouraging families to tell their own stories, thus assisting with emotional
processing. The focus should be on strengthening protective factors such as
increasing parents’ communication skills, behavioral management, and providing
psycho-education for extending parents’ understanding of their child’s condition and
developmental challenges.
Option C: Ensure safety from self-destructive behaviors like headbanging and hair-
pulling. Other helpful strategies include connecting with others with the same
disease, developing an alliance, caring for one’s self, and becoming an advocate.
Recommendations for health care providers include understanding the common
problems faced by parents, building parent-to-parent connections, and encouraging
a good relationship with parents and their children.
68. Question
Jeremy is brought to the emergency room by friends who state that he took something an hour
ago. He is actively hallucinating, agitated, with irritated nasal septum.
A. Heroin
B. Cocaine
C. LSD
D. Marijuana
Incorrect
Correct Answer: B. Cocaine
The manifestations indicate intoxication with cocaine, a CNS stimulant. CNS reactions may
be excitatory then depressant. In its mild form, the patient may display anxiety,
restlessness, and excitement. Full-body tonic-clonic seizures may result from moderate to
severe CNS stimulation. These seizures are often followed by CNS depression, with death
resulting from respiratory failure and/or asphyxiation if concomitant emesis is present.
Option A: Intoxication with heroine is manifested by euphoria then impairment in

judgment, attention and the presence of pupillary constriction. The intended effects
of heroin misuse are those classically associated with any opioid effects. These are
analgesia, euphoria, and often alleviation of opioid withdrawal symptoms. All other
effects of heroin could be considered adverse. Respiratory depression is likely the
most concerning adverse effect, leading to death in an increasing number of
misusers. The extreme physiologic dependence also represents a major concern in
those who misuse heroin.
Option C: Intoxication with hallucinogen like LSD is manifested by grandiosity,
hallucinations, synesthesia, and increase in vital signs. Adverse effects are
extremely subjective, with significant variability and unpredictability. One patient may
experience a positive effect filled with bright hallucinations, sights and sensations,
increased awareness owing to mind expansion, and marked euphoria. The positive
spectrum of effects is colloquially called a “good trip.”
Option D: Intoxication with Marijuana, a cannabinoid is manifested by sensation of
slowed time, conjunctival redness, social withdrawal, impaired judgment, and
hallucinations. The most common emergency caused by marijuana ingestion is a
panic attack. Other common adverse effects include dizziness, dry mouth, nausea,
disorientation, euphoria, confusion, sedation, increased heart rate, and breathing
problems. Marijuana is classified as a Schedule I substance by the FDA, and
therefore is not accepted for medical use and has a high abuse potential from a
federal point of view. As a result, doctors cannot prescribe marijuana, but in states
that allow its use to treat medical conditions, doctors may be able to certify its use.
69. Question
Nurse Pauline is aware that Dementia unlike delirium is characterized by:
A. Slurred speech
B. Insidious onset
C. Clouding of consciousness
D. Sensory perceptual change
Incorrect
Correct Answer: B. insidious onset
Dementia has a gradual onset and progressive deterioration. It causes pronounced
memory and cognitive disturbances. The pathophysiology of dementia is not understood
completely. Most types of dementia, except vascular dementia, are caused by the
accumulation of native proteins in the brain. History must be obtained from the patient and
their family members. Patients may present with symptoms of change in behavior, getting
lost in familiar neighborhoods, memory loss, mood changes, aggression, social withdrawal,
self-neglect, cognitive difficulty, personality changes, difficulty performing tasks,
forgetfulness, difficulty in communication, vulnerability to infections, loss of independence,
etc., A detailed history should include past medical, family, drug, and alcohol history.
Option A: Physical examination should evaluate head-to-toe and vital signs to
determine any possible cause. Neurologic examination should focus on evaluating
new focal findings that suggest an intracranial cause, for example, a stroke. The
dopamine excess contributes to hyperactive delirium and is related to decreased
acetylcholine. The dopaminergic and cholinergic pathways overlap in the brain. This
explains why dopamine receptors impact acetylcholine levels and explain the clinical
manifestations of delirium, including hyperactive and hypoactive forms. The
imbalance between neurotransmitters and the cholinergic pathway may result in
delirium.
Option C: Acetylcholine is a very important neurotransmitter in attention and
consciousness. It is known, acetylcholine acts as a modulator in sensory and
cognitive input, so an impairment in the route leads to developing symptoms of
hypoactive or hyperactive delirium, including inattention, disorganized thinking, and
perceptual disturbances. Cholinergic pathways project from basal forebrain and
pontomesencephalon to interneurons in the striatum and finally targets throughout
the cortex.
Option D: This is also a characteristic of delirium. The DSM-5 defines delirium as
the presence of all the following criteria: disturbance in attention and awareness that
develops acutely and tends to fluctuate in severity; at least one additional
disturbance in cognition; disturbances not better explained by preexisting dementia;
disturbances that do not occur in the context of a severely reduced level of arousal
or coma; or evidence of an underlying organic cause or causes.
70. Question
A 35-year-old female has intense fear of riding an elevator. She claims “ As if I will die inside.” The
client is suffering from:
A. Agoraphobia
B. Social phobia
C. Claustrophobia
D. Xenophobia
Incorrect
Correct Answer: C. Claustrophobia
Claustrophobia is fear of closed space. Claustrophobia is a type of specific phobia, where
one has a fear of closed spaces. Examples of closed spaces are engine rooms, MRI
machines, elevators, etc. Those with specific phobias generally will report avoidance
behaviors regarding the particular object or situation that triggers their fear. The fear can be
expressed as a danger of harm, disgust, or experience of the physical symptoms in a
phobic scenario. physical symptoms include, but are not limited to, difficulty breathing,
trembling, sweating, tachycardia, dry mouth, and chest pain. Emotional symptoms include,
but are not limited to, feeling overwhelming anxiety or fear, fear of losing control, feeling an
intense need to leave the situation, the understanding of the fear as irrational, but an
inability to overcome it.
Option A: Agoraphobia is fear of open space or being a situation where escape is
difficult. Agoraphobia is the anxiety that occurs when one is in a public or crowded
place, from which a potential escape is difficult, or help may not be readily available.
It is characterized by the fear that a panic attack or panic-like symptoms may occur
in these situations. Individuals with agoraphobia, therefore, strive to avoid such
situations or locations. In the currently-used DSM-5, agoraphobia is considered a
distinct diagnosis that can occur independently of other diagnoses, such as
generalized anxiety disorder or panic disorder. In the DSM-5, it is defined as
“marked fear or anxiety about actual or anticipated exposure of public spaces, with
the symptoms of fear or anxiety occurring most of the time in at least two of five
common, different situations.”
Option B: Social phobia is fear of performing in the presence of others in a way that
will be humiliating or embarrassing. Social anxiety disorder (SAD) is characterized
by excessive fear of embarrassment, humiliation, or rejection when exposed to
possible negative evaluation by others when engaged in a public performance or

social interactions. It is also known as social phobia. With the publication of DSM-5,
the diagnostic criteria for SAD have been broadened from previous editions to
include fear of acting in a way or show anxiety symptoms that offend others or lead
to rejection in addition to fear of humiliation or embarrassment. Additionally, the
latest edition of DSM removed the generalized subtype and added the “performance
only” specifier.
Option D: Xenophobia is fear of strangers. Xenophobia, or fear of strangers, is a
broad term that may be applied to any fear of someone who is different from us.
Hostility towards outsiders is often a reaction to fear. It typically involves the belief
that there is a conflict between an individual’s ingroup and an outgroup. Xenophobia
often overlaps with forms of prejudice including racism and homophobia, but there
are important distinctions. Where racism, homophobia, and other forms of
discrimination are based on specific characteristics, xenophobia is usually rooted in
the perception that members of the outgroup are foreign to the ingroup community.
71. Question
Nurse Myrna develops a counter-transference 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 nonverbal behavior.
D. The client feels angry towards the nurse who resembles his mother.
Incorrect
Correct Answer: A. Revealing personal information to the client
Counter-transference is an emotional reaction of the nurse on the client based on her
unconscious needs and conflicts. Countertransference is defined as redirection of a
psychotherapist’s feelings toward a client – or, more generally, as a therapist’s emotional
entanglement with a client. Just as transference is the concept of a client redirecting
feelings meant for others onto the therapist, countertransference is the reaction to a client’s
transference, in which the counselor projects his or her feelings unconsciously onto the
client. How countertransference is used in therapy can make it either helpful or
problematic.
Option B: It is important for the therapist to understand the role that of transference
and countertransference, and deal with those emotions in such a way that the core
of the counseling relationship is not shattered by these feelings. Once
countertransference is recognized, it is important that the therapist acknowledge
and work through those feelings.
Option C: This is a therapeutic approach. The idea of countertransference — the
counselor’s unconscious feelings that emerge as a result of working with the client
— is most often attributed to Sigmund Freud, who was the first to name the
phenomenon and caution other analysts to manage it within themselves. Some
suggest that categorizing countertransference as part of the “psychodynamic
approach” has made its understanding more difficult, particularly with the rise of
other counseling styles that may not emphasize self-awareness and exploration.
Option D: This is a transference reaction where a client has an emotional reaction
towards the nurse based on her past. Signs of countertransference in therapy can
include a variety of behaviors, including excessive self-disclosure on the part of the
therapist or an inappropriate interest in irrelevant details from the life of the person in
treatment. A therapist who acts on their feelings toward the person being treated or
that person’s situation or engages in behavior not appropriate to the treatment
process may not be effectively managing countertransference.
72. Question
Tristan is on Lithium and has suffered from diarrhea and vomiting. What should the nurse in-
charge do first:
A. Recognize this as a drug interaction.
B. Give the client Cogentin.
C. Reassure the client that these are common side effects of lithium therapy.
D. Hold the next dose and obtain an order for a stat serum lithium level.
Incorrect
Correct Answer: D. Hold the next dose and obtain an order for a stat serum lithium
level
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium
should be withheld and a test is done to validate the observation. Monitoring of therapeutic
levels includes trough plasma levels drawn 8 to 12 hours after the last dose. The
therapeutic range is 1.0 to 1.5 mEq/L for acute treatment and 0.6 to 1.2 mEq/L for chronic
therapy. Monitoring should be done every 1 to 2 weeks until reaching the desired
therapeutic levels. Then, check lithium levels every 2 to 3 months for six months. It is also
important to monitor patients for dehydration and lower the dose when there are signs of
infection, excessive sweating, or diarrhea. Toxic levels are when the drug level is more
than 2 mEq/L.
Option A: The manifestations are not due to drug interaction. Lithium has a very
narrow therapeutic index, and toxic levels are when the drug is above 2 mEq/L,
which is very close to its therapeutic range. Lithium toxicity can cause interstitial
nephritis, arrhythmia, sick sinus syndrome, hypotension, T wave abnormalities, and
bradycardia. Rarely, toxicity can cause pseudotumor cerebri and seizures. Lithium
toxicity has no antidote.
Option B: Cogentin is used to manage the extrapyramidal symptom side effects of
antipsychotics. Benztropine is used to treat symptoms of Parkinson’s disease or
involuntary movements due to the side effects of certain psychiatric drugs
(antipsychotics such as chlorpromazine/haloperidol). Benztropine belongs to a class
of medication called anticholinergics that work by blocking a certain natural
substance (acetylcholine). This helps decrease muscle stiffness, sweating, and the
production of saliva, and helps improve walking ability in people with Parkinson’s
disease.
Option C: The common side effects of Lithium are fine hand tremors, nausea,
polyuria, and polydipsia. Lithium can cause several adverse effects. Typically the
side effects are dose-related. Treatment for lithium toxicity is primarily hydration and
to stop the drug. Give hydration with normal saline, which will also enhance lithium
excretion. Avoid all diuretics. If the patient has severe renal dysfunction or failure, or
severely altered mental status, then start with hemodialysis. 20 to 30 mg of
propranolol given 2 to 3 times per day may help reduce tremors.
73. Question
Nurse Sarah ensures a therapeutic environment for all the clients. Which of the following best
describes a therapeutic milieu?
A. A therapy that rewards adaptive behavior.
B. A cognitive approach to change behavior.
C. A living, learning or working environment.
D. A permissive and congenial environment.
Incorrect
Correct Answer: C. A living, learning or working environment.
A therapeutic milieu refers to a broad conceptual approach in which all aspects of the
environment are channeled to provide a therapeutic environment for the client. The six
environmental elements include structure, safety, norms; limit setting, balance, and unit
modification. A therapeutic milieu is a structured environment that creates a safe, secure
place for people who are in therapy. It is the therapeutic environment that supports the
individual in their process toward recovery and wellness. This milieu involves not just the
provision of safe physical surroundings, but also of supportive therapists and staff.
Option A: Behavioral approach in psychiatric care is based on the premise that
behavior can be learned or unlearned through the use of reward and punishment.
The behavioral approach is a form of therapy that focuses on current behaviors and
problems, along with what changes can be made to remove behaviors that are
causing difficulties. The core of the behavioral approach is that people learn from
their environment and problems are caused by learned behaviors that aren’t
effective. The goal of this approach to therapy is to reinforce behaviors that are
effective while working to eliminate behaviors that aren’t wanted or are causing
conflicts or problems.
Option B: Cognitive approach to change behavior is done by correcting distorted
perceptions and irrational beliefs to correct maladaptive behaviors. Cognitive theory
is an approach to psychology that attempts to explain human behavior by
understanding your thought processes. For example, a therapist is using principles

of cognitive theory when they teach you how to identify maladaptive thought
patterns and transform them into constructive ones.
Option D: This is not congruent with therapeutic milieu. The use of a therapeutic
milieu is part of what is formally known as milieu therapy. This emerged in response
to earlier approaches to community care which took a more custodial approach to
treatment. People who were in inpatient or community care settings were provided
basic care but rarely allowed to participate in their own treatment. Eventually, the
idea of the therapeutic community emerged in which all dimensions of the
individual’s environment have the potential to have therapeutic benefits.
74. Question
Anthony is very hostile toward one of the staff for no apparent reason. He is manifesting:
A. Splitting
B. Transference
C. Countertransference
D. Resistance
Incorrect
Correct Answer: B. Transference
Transference is a positive or negative feeling associated with a significant person in the
client’s past that are unconsciously assigned to another. Transference occurs when a
person redirects some of their feelings or desires for another person to an entirely different
person. Transference can also happen in a healthcare setting. For example, transference
in therapy happens when a patient attaches anger, hostility, love, adoration, or a host of
other possible feelings onto their therapist or doctor. Therapists know this can happen.
They actively try to monitor it.
Option A: Splitting is a defense mechanism commonly seen in a client with
personality disorder in which the world is perceived as all good or all bad Failing to
reconcile both positive and negative attributes into a whole understanding of a

person or situation, resulting in all-or-none thinking. Splitting is commonly
associated with borderline personality disorder.
Option C: Countertransference is a phenomenon where the nurse shifts feelings
assigned to someone in her past to the patient. Countertransference, which occurs
when a therapist transfers emotions to a person in therapy, is often a reaction to
transference, a phenomenon in which the person in treatment redirects feelings for
others onto the therapist.
Option D: Resistance is the client’s refusal to submit himself to the care of the
nurse. Clients are sometimes resistant because the counselor is asking them to deal
with an undesired agenda. Resistance means we’re working on the wrong problem,
a problem that the client doesn’t care to work on. Counselors need to connect with
the client in order to find the right problem.
75. Question
Marielle, 17 years old was sexually attacked while on her way home from school. She is brought
to the hospital by her mother. Rape is an example of which type of crisis:
A. Situational
B. Adventitious
C. Developmental
D. Internal
Incorrect
Correct Answer: B. Adventitious
Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life. An
adventitious crisis can be triggered by a major natural disaster, a man-made disaster, or a
crime of violence. Therefore, a tsunami or earthquake can result in an adventitious crisis.
Childbirth, the death of a pet, or a leg amputation can cause a situational crisis.
Option A: Situational crisis is from an external source that upsets one’s

psychological equilibrium. These sudden and unexpected crises include accidents
and natural disasters. Getting in a car accident, experiencing a flood or earthquake,
or being the victim of a crime are just a few types of situational crises.
Option C: These occur as part of the process of growing and developing through
various periods of life. Sometimes a crisis is a predictable part of the life cycle, such
as the crisis described in Erikson’s stages of psychosocial development.
Option D: Developmental and internal crises are the same. They are transitional or
developmental periods in life. A crisis can sometimes be quite obvious, such as a
person losing his or her job, getting divorced, or being involved in some type of
accident. In other cases, a personal crisis might be less apparent but can still lead to
dramatic changes in behavior and mood.
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32 thoughts on “Mental Health and Psychiatric Nursing

NCLEX Practice Questions Nursing Test Bank (700+
Questions)”
Eyas
February 19, 2021 at 2:17 PM
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great hard work i’m speechless… Wish you all the good luck and i wish I could help you
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Reply
Matt Vera, BSN, R.N.

July 18, 2021 at 8:48 PM
Thank you so much for your kind words :)
Reply
grace
March 8, 2021 at 8:42 PM
Thank you so much for this! Great help really..lots of love to you all!
Reply
Marie Michelle
March 8, 2021 at 11:12 PM
This site is helpful. Good job 👏

Thank you Nurseslabs
Reply
Sharon
March 14, 2021 at 12:48 AM
After completing the quiz, results do not populate and there is no rationale as you go
through each question, so you cannot learn.
Reply

March 15, 2021 at 3:02 AM
Hello, after the quiz, click on the “Quiz Summary” button then “Finish Quiz” button. It
should give you the option to review the questions and the rationales (by clicking “View
Questions”).
Reply
Annette lgidimba
March 17, 2021 at 6:35 AM
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March 28, 2021 at 8:24 AM
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the struggle.
Reply
Yashvardhan
May 26, 2021 at 11:00 AM
Last year MCQ’s are better to understand,this year there is no option for print the MCQ
this is a negative aspect.otherwise it is best questions collections ever
Reply

June 7, 2021 at 12:49 AM
We’re working on a way to have the questions printed.
Reply
Yashvardhan
August 6, 2021 at 6:15 PM
Please install print option very fast,it exam time,we have not enough time to right all
these questions,ln 2020 there is easy to print all the questions in pdf format.

August 10, 2021 at 4:09 PM
You can print these questions or the webpage by clicking on the Quiz Summary >
Finish Quiz > View Questions > Then go to File > Print > Save as PDF.
Martine
May 28, 2021 at 3:23 AM
I never thought practicing the content of the Psychiatric Nursing questions here would
help me succeed in my certification exam. Now, I am a Psychiatric Mental Health -Board
Certified (PMH-BC). Thank you for preparing those questions, it is a great site for reviews.
Reply

June 7, 2021 at 12:48 AM
Congratulations! :)
Reply
nitha
June 1, 2021 at 4:04 AM
I am in doubt of 43rd question of anxiety disorder

question asking the side effect of Ritalin- the correct answer here is increased attention
span and concentration. This is actually the therapeutic effect of this medication. As far as
I know, the main side effect is sleeplessness. therefore, this medication should be given
before noon to avoid sleeping problems.
please check and let me know too
thank you
Reply
Anette
June 18, 2021 at 11:39 AM
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ade
Hi!
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Reply
K.R.GODARA JAT
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Reply
ade
August 27, 2021 at 12:48 PM
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Tony
September 28, 2021 at 7:12 AM
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Thanks you for your incredible work.
Reply
ade
October 1, 2021 at 12:57 PM
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Nick
October 29, 2021 at 8:19 AM
It is quite helpful rather than reading a text book. This help to get use of how the questions
should be tackled.
Reply
stellah
February 4, 2022 at 2:00 PM
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Reply
Debby
February 12, 2022 at 11:43 AM
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March 27, 2022 at 8:32 PM
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March 28, 2022 at 12:26 PM
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Jonathan Mutua
April 24, 2022 at 12:48 PM
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Mina
June 5, 2022 at 5:29 AM
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Zee
June 30, 2022 at 9:02 AM
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Miriam
January 27, 2023 at 2:39 PM
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2/13/23, 11:02 PM Mental Health and Psychiatric Nursing NCLEX Practice Questions Nursing Test Bank (700+ Questions)

700+ Questions) - Nurseslabs

Mental Health and Psychiatric

Mental Health and Psychiatric Nursing Test

Quizzes included in this guide are:

7. Anxiety Disorders NCLEX Practice | Quiz #7: 75 Questions

NOTICE TO ALL USERS

1. Comprehensive Mental Health and Psychiatric Nursing NCLEX Practice |

Comprehensive Mental Health and Psychiatric

Your time: 00:00:03

You have reached 0 of 75 point(s), (0%)

Congratulations, you have completed this quiz!

A. Avoid shopping for large amounts of food.

B. Control eating impulses.

C. Identify anxiety-causing situations.

D. Eat only three meals per day.

A. Check the client frequently at irregular intervals throughout the night.

C. Repeatedly discuss previous suicide attempts with the client.

D. Disregard decreased communication by the client because this is common with

A. Deferoxamine mesylate (Desferal)

Correct Answer: D. Chlordiazepoxide (Librium)

A. “I trust you not to purge.”

B. “How are you purging and when do you do it?”

C. “Don’t worry. I won’t allow you to purge today.”

eating disorders require individualized support to better understand their condition,

C. “Tell me more about how it felt to get high.”

D. “Don’t you know it’s illegal to use drugs?”

A. The client will establish adequate daily nutritional intake.

C. The client will identify self-perceptions about body size as unrealistic.

D. The client will verbalize the possible physiological consequences of self-starvation.

anorexia nervosa is centered on nutrition rehabilitation and psychotherapy. Refeeding

C. The family is poor.

D. The parents are argumentative and demanding with emergency department

A. They tend to overprotect their children.

B. They usually have a history of substance abuse.

C. They maintain emotional distance from their children.

D. They alternate between loving and rejecting their children.

support. Whether this is an independent risk factor or linked to other potential

A. Remaining with the client and staying calm.

B. Calling a security guard and another staff member for assistance.

C. Telling the client’s husband that he must leave at once.

D. Determining why the husband feels so angry.

assault, sexual abuse, emotional abuse, controlling or domineering behavior, intimidation,

in identifying at-risk individuals and optimizing the delivery of a multidisciplinary and

B. Exploring the nurse’s own feelings about suicide.

C. Discussing the future with the client.

D. Referring the client to a clergyperson to discuss the moral implications of suicide.

A. Avoid discussing the client’s perceptions and feelings.

B. Focus discussions on food and weight.

C. Avoid discussing unrealistic cultural standards regarding weight.

B. Provide privacy during meals.

C. Set up a strict eating plan for the client.

D. Encourage the client to exercise, which will reduce her anxiety.

Moderate exercise helps in maintaining muscle tone, weight and combating

B. Readiness to leave the perpetrator and knowledge of resources.

C. Use of drugs or alcohol.

D. History of previous victimization.

D. A below-normal serum potassium level

A. The child cries uncontrollably throughout the examination.

B. The child pulls away from contact with the physician.

C. The child doesn’t cry when the shoulder is examined.

D. The child doesn’t make eye contact with the nurse.

A. Client’s physical needs

B. Client’s safety needs