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2/13/23, 11:03 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, 11:03 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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2. Comprehensive Mental Health and Psychiatric Nursing NCLEX Practice |

Quiz #2: 75 Questions
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Comprehensive Mental Health and Psychiatric

Nursing NCLEX Practice | Quiz #2: 75 Questions
This is the second part of the comprehensive mental health and psychiatric nursing practice quiz.
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Correct Incorrect
1. Question
Which nursing intervention is best for facilitating communication with a psychiatric client who
speaks a foreign language?
A. Rely on nonverbal communication
B. Select symbolic pictures as aids
C. Speak in universal phrases
D. Use the services of an interpreter
Incorrect
Correct Answer: D. Use the services of an interpreter
An interpreter will enable the nurse to better assess the client’s problems and concerns.
Language barriers pose challenges in terms of achieving high levels of satisfaction among
medical professionals and patients, providing high- quality healthcare and maintaining
patient safety. To address these challenges, many larger healthcare institutions offer
interpreter services to improve healthcare access, patient satisfaction, and communication.
Option A: Nonverbal communication is important; however for the nurse to fully
determine the client’s problems and concerns, the assistance of an interpreter is
essential. Language barriers have negative implications for the delivery of
healthcare and patient satisfaction. One study showed that among patients who
received treatment from nurses who did not speak the local language, 30% had
difficulty understanding medical instructions, 30% had a problem with the reliability
of information, and 50% believed that the language barrier contributed to errors.
Option B: Online translation tools such as Google Translate and MediBabble
present possible solutions for overcoming these challenges. Further studies on the
implications of language barriers and the effectiveness of online translation tools are
recommended. Furthermore, new updates with more medical phrases for Google
Translate and with more languages included for MediBabble application are
recommended.
Option C: The use of universal phrases may assist the nurse in understanding the
basic needs of the client; however these are insufficient to assess the client with a
psychiatric problem. Some healthcare organizations use online translation tools
such as Google Translate and MediBabble to address the challenges of language
barriers. These tools are free and easy to access, and they contribute to improving
healthcare delivery, patient safety, and increase (up to 92%) the satisfaction of both
medical professionals and patients.
2. Question
The nurse explains to a mental health care technician that a client’s obsessive-compulsive
behaviors are related to an unconscious conflict between id impulses and the superego (or
conscience). On which of the following theories does the nurse base this statement?
A. Behavioral theory
B. Cognitive theory
C. Interpersonal theory
D. Psychoanalytic theory
Incorrect
Correct Answer: D. Psychoanalytic theory
Psychoanalytic is based on Freud’s beliefs regarding the importance of unconscious
motivation for behavior and the role of the id and superego in opposition to each other.
Psychoanalysis is defined as a set of psychological theories and therapeutic methods
which have their origin in the work and theories of Sigmund Freud . The primary
assumption of psychoanalysis is the belief that all people possess unconscious thoughts,
feelings, desires, and memories. The aim of psychoanalysis therapy is to release
repressed emotions and experiences, i.e., make the unconscious conscious. It is only
having a cathartic (i.e., healing) experience can the person be helped and “cured.”
Option A: Behaviorism, also known as behavioral psychology, is a theory of
learning based on the idea that all behaviors are acquired through conditioning.
Conditioning occurs through interaction with the environment. Behaviorists believe
that our responses to environmental stimuli shape our actions. According to this
school of thought, behavior can be studied in a systematic and observable manner
regardless of internal mental states. According to this perspective, only observable
behavior should be considered—cognitions, emotions, and moods are far too

subjective.
Option B: 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. The
assumption of cognitive theory is that thoughts are the primary determinants of
emotions and behavior. Information processing is a common description of this
mental process. Theorists compare the way the human mind functions to a
computer.
Option C: Interpersonal theory emphasizes the importance of various
developmental stages—infancy, childhood, the juvenile era, preadolescence, early
adolescence, late adolescence, and adulthood. Like Freud and Jung, Sullivan
(1953b) saw personality as an energy system. Energy can exist either as tension
(potentiality for action) or as actions themselves (energy transformations). Energy
transformations transform tensions into either covert or overt behaviors and are
aimed at satisfying needs and reducing anxiety.
3. Question
The nurse observes a client pacing in the hall. Which statement by the nurse may help the client
recognize his anxiety?
A. “I guess you’re worried about something, aren’t you?
B. “Can I get you some medication to help calm you?”
C. “Have you been pacing for a long time?”
D. “I notice that you’re pacing. How are you feeling?”
Incorrect
Correct Answer: D. “I notice that you’re pacing. How are you feeling?”
By acknowledging the observed behavior and asking the client to express his feelings the
nurse can best assist the client to become aware of his anxiety. Recognition acknowledges
a patient’s behavior and highlights it without giving an overt compliment. A compliment can
sometimes be taken as condescending, especially when it concerns a routine task like
making the bed. However, saying something like “I noticed you took all of your
medications” draws attention to the action and encourages it without requiring a
compliment.
Option A: The nurse is offering an interpretation that may or may not be accurate;
the nurse is also asking a question that may be answered by a “yes” or “no”
response, which is not therapeutic. Therapeutic communication is often most
effective when patients direct the flow of conversation and decide what to talk about.
To that end, giving patients a broad opening such as “What’s on your mind today?”
or “What would you like to talk about?” can be a good way to allow patients an
opportunity to discuss what’s on their mind.
Option B: The nurse is intervening before accurately assessing the problem. By
using nonverbal and verbal cues such as nodding and saying “I see,” nurses can
encourage patients to continue talking. Active listening involves showing interest in
what patients have to say, acknowledging that you’re listening and understanding,
and engaging with them throughout the conversation. Nurses can offer general
leads such as “What happened next?” to guide the conversation or propel it forward.
Option C: This statement encourages a “yes” or “no” response, avoids focusing on
the client’s anxiety, which is the reason for his pacing. Observations about the
appearance, demeanor, or behavior of patients can help draw attention to areas that
might pose a problem for them. Observing that they look tired may prompt patients
to explain why they haven’t been getting much sleep lately; making an observation
that they haven’t been eating much may lead to the discovery of a new symptom.
4. Question
A client with obsessive-compulsive disorder is hospitalized in an inpatient unit. Which nursing

response is most therapeutic?
A. Accepting the client’s obsessive-compulsive behaviors.
B. Challenging the client’s obsessive-compulsive behaviors.
C. Preventing the client’s obsessive-compulsive behaviors.
D. Rejecting the client’s obsessive-compulsive behaviors.
Incorrect
Correct Answer: A. Accepting the client’s obsessive-compulsive behaviors
A client with obsessive-compulsive behavior uses this behavior to decrease anxiety.
Accepting this behavior as the client’s attempt to feel secure is therapeutic. When a
specific treatment plan is developed, other nursing responses may also be acceptable.
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 B: In The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5,
which was published by the American Psychiatric Association (APA) in 2013,
Obsessive-Compulsive Disorder sits under its own category of Obsessive-
Compulsive and Related Disorders. Obsessions are defined as intrusive thoughts or
urges that cause significant distress; the patient attempts to neutralize this distress
by diverting thoughts or performing rituals. Compulsions are actions the patient feels
pressured to do in response to the anxiety/distress producing obsessions or to
prevent an uncomfortable situation from occurring. These compulsions may be
illogical or excessive.
Option C: The most common obsessions include fears of contamination, fears of
aggression/harm, sexual fears, religious fears, and need to make things “just right.”
The compensatory compulsions for these obsessions include washing and cleaning,
checking, reassurance-seeking, repeating, and ordering, and arranging. As OCD
has the possibility of hindering one’s social growth and development, the WHO lists
OCD as one of the ten most disabling conditions by financial loss and a decrease in
quality of life.
Option D: Those who have OCD have a 7% risk of Tourette syndrome and a 20%
chance of developing tics. As the treatment for OCD involves selective serotonin
reuptake inhibitors (SSRIs) and possible antipsychotics, adverse effects of these
medications including but not limited to weight gain, tardive dyskinesia, and
dystonia, must also be monitored.
5. Question
A 45-year-old woman with a history of depression tells a nurse in her doctor’s office that she has
difficulty with sexual arousal and is fearful that her husband will have an affair. Which of the
following factors would the nurse identify as least significant in contributing to the client’s sexual
difficulty?
A. Education and work history
B. Medication used
C. Physical health status
D. Quality of spousal relationship
Incorrect
Correct Answer: A. Education and work history
Education and work history would have the least significance in relation to the client’s
sexual problem. Depression, performance anxiety, and other sexual disorders can be
strong contributing factors even when organic causes also exist. While having a sexual
dysfunction can feel isolating, it’s actually fairly common. About 40 percent of women
experience some type of sexual dysfunction, such as FSIAD, in their life.
Option B: Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant,
may cause FSIAD. Female sexual arousal disorder occurs when the body doesn’t
respond to sexual stimulation. If you’re undergoing chemotherapy or radiation, you
may experience FSIAD. Likewise, a recent surgery may interfere with arousal and
sexual stimulation.
Option C: While FSIAD can affect any woman, older women seem to experience it
more. Because FSIAD is a newly defined term according to the DSM-5, studies on
its actual occurrence haven’t yet been published. A 2009 study found that 3.3
percent of participants between the ages of 18 and 44 had female sexual arousal
disorder, while 7.5 percent of participants between the ages of 45 and 64
experienced it.
Option D: You might have trouble getting aroused if the stimulation you receive from
yourself or your partner isn’t sufficient. Arousal sets off a series of events in the
body: Blood flow to the tissues around the vaginal opening and clitoris increases,
causing swelling. The vagina produces natural lubricant. Studies on female sexual
arousal disorder show that low sexual desire and problems with sexual arousal vary
widely by age, cultural setting, duration of symptoms, and presence of distress.
6. Question
Which nursing intervention is most appropriate for a client with anorexia nervosa during initial
hospitalization on a behavioral therapy unit?
A. Emphasize the importance of good nutrition to establish normal weight.
B. Ignore the client’s mealtime behavior and focus instead on issues of dependence
and independence.
C. Help establish a plan using privileges and restrictions based on compliance with
refeeding.
D. Teach the client information about the long-term physical consequence of anorexia.
Incorrect
Correct Answer: C. Help establish a plan using privileges and restrictions based on
compliance with refeeding.
Inpatient treatment of a client with anorexia usually focuses initially on establishing a plan
for refeeding to combat the effects of self-induced starvation. Refeeding is accomplished
through behavioral therapy, which uses a system of rewards and reinforcements to assist
in establishing weight restoration. Treatment for anorexia nervosa is centered on nutrition
rehabilitation and psychotherapy. Refeeding, nutritional plans, and weight restoration are
crucial parts of the medical stabilization process which is necessary in order to proceed
with treatment and eventually achieve recovery. There are many serious and deadly
complications that arise during the refeeding process which is why medical supervision is
of the utmost importance.
Option A: Anorexia nervosa is a serious eating disorder which has a very high
morbidity. The disorder is usually managed with an interprofessional team that
consists of a psychiatrist, dietitian, social worker, internist, endocrinologist,
gastroenterologist, and nurses. The disorder cannot be prevented and there is no

cure. Hence patient and family education is key to preventing the high morbidity.
The dietitian should educate the family on the importance of nutrition and limiting
exercise.
Option B: The nurse needs to assess the client’s mealtime behavior continually to
evaluate treatment effectiveness. Remission in AN varies. Three-fourths of patients
treated in out-patient settings remit within 5 years and the same percentage
experience intermediate-good outcomes (including weight gain). Relapse is more
common in patients who are older with a longer duration of disease or lower body
fat/weight at the end of treatment, have comorbid psychiatric disorders, or receive
therapy outside of a specialized clinic. Patients who achieve partial remission often
develop another form of the eating disorder (ex. bulimia nervosa or unspecified
eating disorder).
Option D: Emphasizing nutrition and teaching the client about the long-term
physical consequences of anorexia may be appropriate at a later time in the
treatment program. For adults, cognitive behavioral therapy — specifically enhanced
cognitive behavioral therapy — has been shown to help. The main goal is to
normalize eating patterns and behaviors to support weight gain. The second goal is
to help change distorted beliefs and thoughts that maintain restrictive eating.
7. Question
A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the
following would indicate that the therapy was successful?
A. The parents reinforce increased decision making by the client.
B. The parents clearly verbalize their expectations for the client.
C. The client verbalizes that family meals are now enjoyable.
D. The client tells her parents about feelings of low self-esteem.
Incorrect
Correct Answer: A. The parents reinforce increased decision making by the client.
One of the core issues concerning the family of a client with anorexia is control. The
family’s acceptance of the client’s ability to make independent decisions is key to
successful family intervention. Reinforce the importance of parents as a couple who have
rights of their own. The focus on the child with anorexia is very intense and often is the only
area around which the couple interacts. The couple needs to explore their own relationship
and restore the balance within it to prevent its disintegration.
Option B: Identify patterns of interaction. Encourage each family member to speak
for self. Do not allow two members to discuss a third without that member’s
participation. Helpful information for planning interventions. The enmeshed, over-
involved family members often speak for each other and need to learn to be
responsible for their own words and actions.
Option C: Make a selective menu available, and allow the patient to control choices
as much as possible. Patient who gains confidence in herself and feels in control of
the environment is more likely to eat preferred foods. 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. Provides structured eating situations
while allowing the patient some control in choices. Behavior modification may be
effective in mild cases or for short-term weight gain.
Option D: Encourage the patient to express anger and acknowledge when it is
verbalized. Important to know that anger is part of self and as such is acceptable.
Expressing anger may need to be taught to the patient because anger is generally
considered unacceptable in the family, and therefore the patient does not express it.
Although the remaining options may occur during the process of therapy they would
not necessarily indicate a successful outcome; the central family issues of
dependence and independence are not addressed in these responses.
8. Question
The nurse is working with a client with a somatoform disorder. Which client outcome goal would
the nurse most likely establish in this situation?
A. The client will recognize signs and symptoms of physical illness.
B. The client will cope with physical illness.
C. The client will take prescribed medications.
D. The client will express anxiety verbally rather than through physical symptoms.
Incorrect
Correct Answer: D. The client will express anxiety verbally rather than through
physical symptoms.
The client with a somatoform disorder displaces anxiety into physical symptoms. The ability
to express anxiety verbally indicates a positive change toward improved health. These
disorders should be considered early in the evaluation of patients with unexplained
symptoms to prevent unnecessary interventions and testing. Up to 50 percent of primary
care patients present with physical symptoms that cannot be explained by a general
medical condition. Some of these patients meet criteria for somatoform disorders.
Option A: The unexplained symptoms of somatoform disorders often lead to
general health anxiety; frequent or recurrent and excessive preoccupation with
unexplained physical symptoms; inaccurate or exaggerated beliefs about somatic
symptoms; difficult encounters with the health care system; disproportionate
disability; displays of strong, often negative emotions toward the physician or office
staff; unrealistic expectations; and, occasionally, resistance to or noncompliance
with diagnostic or treatment efforts. These behaviors may result in more frequent
office visits, unnecessary laboratory or imaging tests, or costly and potentially
dangerous invasive procedures.
Option B: The challenge in working with somatoform disorders in the primary care
setting is to simultaneously exclude medical causes for physical symptoms while
considering a mental health diagnosis. The diagnosis of a somatoform disorder
should be considered early in the process of evaluating a patient with unexplained
physical symptoms. Appropriate nonpsychiatric medical conditions should be
considered, but over-evaluation and unnecessary testing should be avoided.
Option C: Studies supporting the effectiveness of pharmacologic interventions
targeting specific somatoform disorders are limited. Antidepressants are commonly
used to treat depressive or anxiety disorders and may be part of the approach to
treating the comorbidities of somatoform disorders. Antidepressants such as
fluvoxamine (Luvox, brand not available) for treating body dysmorphic disorder, and
St. John’s wort for treating somatization and undifferentiated somatoform disorders
have been proposed.
9. Question
Which method would a nurse use to determine a client’s potential risk for suicide?
A. Wait for the client to bring up the subject of suicide.
B. Observe the client’s behavior for cues of suicide ideation.
C. Question the client directly about suicidal thoughts.
D. Question the client about future plans.
Incorrect
Correct Answer: C. Question the client directly about suicidal thoughts.
Directly questioning a client about suicide is important to determine suicide risk. 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. 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 A: The client may not bring up this subject for several reasons, including
guilt regarding suicide, wishing not to be discovered, and his lack of trust in staff.
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.
Option B: Behavioral cues are important, but direct questioning is essential to
determine suicide risk. 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: Indirect questions convey to the client that the nurse is not comfortable
with the subject of suicide and, therefore, the client may be reluctant to discuss the
topic. Determine what the patient believes his or her suicide would achieve. This
suggests how seriously the person has been considering suicide and the reason for
death. For example, some believe that their suicide would provide a way for family
or friends to realize their emotional distress. Others see their death as a relief from
their own psychic pain. Still others believe that their death would provide a heavenly
reunion with a departed loved one. In any scenario, the clinician has another gauge
of the seriousness of the planning.
10. Question
A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed thought
processes related to difficulty concentrating, secondary to flight of ideas. Which of the following
outcome criteria would indicate improvement in the client?
A. The client verbalizes feelings directly during treatment.
B. The client verbalizes a positive “self” statement.
C. The client speaks in coherent sentences.
D. The client reports feelings calmer.
Incorrect
Correct Answer: C. The client speaks in coherent sentences
A client exhibiting flight of ideas typically has a continuous speech flow and jumps from one
topic to another. Speaking in coherent sentences is an indicator that the client’s
concentration has improved and his thoughts are no longer racing. The defining
characteristics of mania are increased talkativeness, rapid speech, decreased the need for
sleep (unlike depression or anxiety in which the need for sleep exists, but there is an
inability to sleep), racing thoughts, distractibility, increase in goal-directed activity, and
psychomotor agitation.
Option A: Some other hallmarks of mania are an elevated or expansive mood,
mood lability, impulsivity, irritability, and grandiosity. If the individual experiencing
these symptoms requires hospitalization, then this period automatically qualifies as
true mania and not hypomania, even if the symptoms are present for less than one
week.
Option B: Mania must be distinguished from heightened energy and altered
functioning that arises from substance use, medical conditions or other causes.
Mania is a “natural” state which is the characteristic of bipolar I disorder. A single
manic phase is sufficient to make the diagnosis of bipolar I disorder, although most
cases of bipolar I also involve hypomanic and depressed episodes.
Option D: Many families bring their loved ones to the emergency room due to the
excessive behavioral changes they have noticed over a brief period. Patients amid a
manic phase commonly engage in goal-directed activities that may result in harmful
consequences, such as spending excessive money, starting businesses
unprepared, traveling, or promiscuity.
11. Question
A client tells a nurse. “Everyone would be better off if I wasn’t alive.” Which nursing diagnosis
would be made based on this statement?
A. Disturbed thought processes
B. Ineffective coping
C. Risk for self-directed violence
D. Impaired social interaction
Incorrect
Correct Answer: C. Risk for self-directed violence

The nurse should take any nurse statements indicating suicidal thoughts seriously and
further assess for other risk factors. The early identification and appropriate treatment of
mental disorders is an important prevention strategy – especially given the relevant
contribution of depression and other psychiatric problems to suicidal behavior. Equally
important is early identification and treatment for people with alcohol and substance abuse
problems.
Option A: A variety of stressful events or circumstances can put people at increased
risk of harming themselves including the loss of loved ones, interpersonal conflicts
with family or friends, and legal or work-related problems. To act as precipitating
factors for suicide, though, they must happen to someone who is predisposed or
otherwise especially vulnerable to self-harm. The early identification and appropriate
treatment of mental disorders is an important prevention strategy – especially given
the relevant contribution of depression and other psychiatric problems to suicidal
behavior. Equally important is early identification and treatment for people with
alcohol and substance abuse problems.
Option B: People who are suicidal generally express difficulty in solving problems.
Behavioral therapy approaches are designed to probe underlying factors and to help
patients develop problem-solving skills. While conclusive answers are not yet
known, there is some evidence to suggest that behavioral therapy approaches are
effective in reducing suicidal thoughts and behavior.
Option D: Certain social and environmental factors also increase the likelihood of
suicide. Rates of suicide, for instance, are higher during economic recessions and
periods of high unemployment. They are also higher during periods of social
disintegration, political instability, and social collapse.
12. Question
Which information is the most essential in the initial teaching session for the family of a young
adult recently diagnosed with schizophrenia?
A. Symptoms of this disease imbalance in the brain.
B. Genetic history is an important factor related to the development of schizophrenia.
C. Schizophrenia is a serious disease affecting every aspect of a person’s functioning.
D. The distressing symptoms of this disorder can respond to treatment with

medications.
Incorrect
Correct Answer: D. The distressing symptoms of this disorder can respond to
treatment with medications.
This statement provides accurate information and an element of hope for the family of a
schizophrenic client. For the initial treatment of acute psychosis, it is recommended to
commence an oral second-generation antipsychotic (SGA) such as aripiprazole,
olanzapine, risperidone, quetiapine, asenapine, lurasidone, sertindole, ziprasidone,
brexpiprazole, molindone, iloperidone, etc. Sometimes, if clinically needed, alongside a
benzodiazepine such as diazepam, clonazepam, or lorazepam to control behavioral
disturbances and non-acute anxiety. First-generation antipsychotics (FGA) like
trifluoperazine, Fluphenazine, haloperidol, pimozide, sulpiride, flupentixol, chlorpromazine,
etc. are not commonly used as the first line but can be used.
Option A: There are also arguments that schizophrenia is a neurodevelopmental
disorder based on abnormalities present in the cerebral structure, an absence of
gliosis suggesting in utero changes, and the observation that motor and cognitive
impairments in patients precede the illness onset.
Option B: Several studies postulate that the development of schizophrenia results
from abnormalities in multiple neurotransmitters, such as dopaminergic,
serotonergic, and alpha-adrenergic hyperactivity or glutaminergic and GABA
hypoactivity. Genetics also play a fundamental role – there is a 46% concordance
rate in monozygotic twins and a 40% risk of developing schizophrenia if both
parents are affected. The gene neuregulin (NGR1) which is involved in glutamate
signaling and brain development has been implicated, alongside dysbindin
(DTNBP1) which helps glutamate release, and catecholamine O-methyltransferase
(COMT) polymorphism, which regulates dopamine function.
Option C: Although the remaining statements are true, they do not provide the
empathic response the family needs after just learning about the diagnosis. These
facts can become part of the ongoing teaching. The first schizophrenic episode
usually occurs during early adulthood or late adolescence. Individuals often lack
insight at this stage; therefore few will present directly to seek help for their
psychotic symptoms. Common presentations include a relative noticing social
withdrawal, personality changes, or uncharacteristic behavior; deliberate self-harm
or suicide attempts; calling the police to report their delusional symptoms, or referral
via the criminal justice system.
13. Question
A nurse is working with a client who has schizophrenia, paranoid type. Which of the following
outcomes related to the client’s delusional perceptions would the nurse establish?
A. The client will demonstrate realistic interpretation of daily events in the unit.
B. The client will perform daily hygiene and grooming without assistance.
C. The client will take prescribed medications without difficulty.
D. The client will participate in unit activities.
Incorrect
Correct Answer: A. The client will demonstrate realistic interpretation of daily events
in the unit.
A client with schizophrenia, paranoid type, has distorted perceptions and views people,
institutions, and aspects of the environment as plotting against him. The desired outcome
for someone with delusional perceptions would be to have a realistic interpretation of daily
events. Unlike DSM-5, ICD-10 further subcategories schizophrenia based on the key
presenting symptoms as either paranoid schizophrenia, hebephrenic schizophrenia,
catatonic schizophrenia, undifferentiated schizophrenia, post-schizophrenic depression,
residual schizophrenia, and simple schizophrenia.
Option B: The client with a distorted perception of the environment would not
necessarily have impairments affecting hygiene and grooming skills. A thorough risk
assessment must also be undertaken to determine the risk of harm to self and
others. The first schizophrenic episode usually occurs during early adulthood or late
adolescence. Individuals often lack insight at this stage; therefore few will present
directly to seek help for their psychotic symptoms.
Option C: For the initial treatment of acute psychosis, it is recommended to
commence an oral second-generation antipsychotic (SGA) such as aripiprazole,
olanzapine, risperidone, quetiapine, asenapine, lurasidone, sertindole, ziprasidone,

brexpiprazole, molindone, iloperidone, etc. Sometimes, if clinically needed,
alongside a benzodiazepine such as diazepam, clonazepam or lorazepam to control
behavioral disturbances and non-acute anxiety. First generation antipsychotic (FGA)
like trifluoperazine, Fluphenazine, haloperidol, pimozide, sulpiride, flupentixol,
chlorpromazine, etc. are not commonly used as the first line but can be used.
Option D: Although taking medications and participating in unit activities may be
appropriate outcomes for nursing intervention; these responses are not related to
client perceptions. Cognitive-behavioral therapy (CBT) and the use of art and drama
therapies help counteract the negative symptoms of the disease, improve insight,
and assist relapse prevention.
14. Question
A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and
command hallucinations. Which of the following is the priority nursing diagnosis?
A. Anxiety
B. Impaired social interaction
C. Disturbed sensory-perceptual alteration (auditory)
D. Risk for other-directed violence
Incorrect
Correct Answer: D. Risk for other-directed violence
A client with these symptoms would have poor impulse control and would therefore be
prone to acting-out behavior that may be harmful to either himself or others. All of the
remaining nursing diagnoses may apply to the client with mania; however, the priority
diagnosis would be risk for violence. Mania, or a manic phase, is a period of 1 week or
more in which a person experiences a change in normal behavior that drastically affects
their functioning.
Option A: The defining characteristics of mania are increased talkativeness, rapid

speech, decreased the need for sleep (unlike depression or anxiety in which the
need for sleep exists, but there is an inability to sleep), racing thoughts,
distractibility, increase in goal-directed activity, and psychomotor agitation. Some
other hallmarks of mania are an elevated or expansive mood, mood lability,
impulsivity, irritability, and grandiosity. If the individual experiencing these symptoms
requires hospitalization, then this period automatically qualifies as true mania and
not hypomania, even if the symptoms are present for less than one week.
Option B: Many families bring their loved ones to the emergency room due to the
excessive behavioral changes they have noticed over a brief period. Patients amid a
manic phase commonly engage in goal-directed activities that may result in harmful
consequences, such as spending excessive money, starting businesses
unprepared, traveling, or promiscuity. Many patients engage in property damage or
even harm themselves or others through verbal or physical assaults. They may also
become highly aggressive, agitated, or irritable.
Option C: Mania also commonly presents with psychotic features, which include
delusions or hallucinations. Many patients endorse grandiose delusions, believing
they are high-level operatives such as spies, government officials, members of
secret agencies, or that they are knowledgeable professionals (even when they
have no such background). These individuals may also experience auditory or visual
hallucinations, which only present when they are in the manic phases.
15. Question
A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his
stressful marriage and difficult job. Which defense mechanisms is this client using?
A. Displacement
B. Projection
C. Rationalization
D. Sublimation
Incorrect
Correct Answer: C. Rationalization
Rationalization is the defense mechanism that involves offering excuses for maladaptive
behavior. The client is defending his substance abuse by providing reasons related to life
stressors. This is a common defense mechanism used by clients with substance abuse
problems.
Option A: Displacement is transferring one’s emotional burden or emotional
reaction from one entity to another. This defense mechanism may be present in
someone who has a stressful day at work and then lashes out against their family at
home.
Option B: Projection is 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 D: Sublimation is transforming one’s anxiety or emotions into pursuits that
are considered by societal or cultural norms to be more useful. This defense
mechanism may be present in someone who channels their aggression and energy
into playing sports.
16. Question
An 11-year-old child diagnosed with conduct disorder is admitted to the psychiatric unit for
treatment. Which of the following behaviors would the nurse assess?
A. Restlessness, short attention span, hyperactivity.
B. Physical aggressiveness, low-stress tolerance, disregard for the rights of others.
C. Deterioration in social functioning, excessive anxiety, and worry, bizarre behavior.
D. Sadness, poor appetite and sleeplessness, loss of interest in activities.
Incorrect
Correct Answer: B. Physical aggressiveness, low-stress tolerance disregard for the
rights of others
Physical aggressiveness, low-stress tolerance, and a disregard for the rights of others are
common behaviors in clients with conduct disorders. Conduct disorder (CD) is classified in
the spectrum of disruptive behavior disorders which also includes the diagnosis of
oppositional defiant disorder (ODD). Exhibits a pattern of behavior that violates the rights of
others and disregards social norms.
Option A: Restlessness, short attention span, and hyperactivity are typical
behaviors in a client with attention deficit hyperactivity disorder. Attention Deficit-
Hyperactivity Disorder (ADHD) is a psychiatric condition that has long been
recognized as affecting children’s ability to function. Individuals suffering from this
disorder show patterns of developmentally inappropriate levels of inattentiveness,
hyperactivity, or impulsivity.
Option C: Deterioration in social functioning, excessive anxiety and worry and
bizarre behaviors are typical in schizophrenic disorders. Derived from the Greek
‘schizo’ (splitting) and ‘phren’ (mind) with the term first coined by Eugen Bleuler in
1908, schizophrenia is a functional psychotic disorder characterized by the
presence of delusional beliefs, hallucinations, and disturbances in thought,
perception, and behavior.
Option D: Sadness, poor appetite, sleeplessness, and loss of interest in activities
are behaviors commonly seen in depressive disorders. Depression is a mood
disorder that causes a persistent feeling of sadness and loss of interest. The
common features of all depressive disorders are sadness, emptiness, or irritable
mood, accompanied by somatic and cognitive changes that significantly affect the
individual’s capacity to function.
17. Question
The nurse understands that if a client continues to be dependent on heroin throughout her
pregnancy, her baby will be at high risk for:A. Mental retardation
A. Mental retardation
B. Heroin dependence
C. Addiction in adulthood
D. Psychological disturbances
Incorrect
Correct Answer: B. Heroin dependence
Babies born to heroin-dependent women are also heroin-dependent and need to go
through withdrawal. Heroin use during pregnancy can result in neonatal abstinence
syndrome (NAS). NAS occurs when heroin passes through the placenta to the fetus during
pregnancy, causing the baby to become dependent, along with the mother. Symptoms
include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhea,
vomiting, and possibly death. There is no evidence to support any of the remaining answer
choices.
Option A: NAS requires hospitalization and treatment with medication (often
morphine) to relieve symptoms; the medication is gradually tapered off until the baby
adjusts to being opioid-free. Methadone maintenance combined with prenatal care
and a comprehensive drug treatment program can improve many of the outcomes
associated with untreated heroin use for both the infant and mother, although infants
exposed to methadone during pregnancy typically require treatment for NAS as well.
Option C: A NIDA-supported clinical trial demonstrated that buprenorphine
treatment of opioid-dependent mothers is safe for both the unborn child and the
mother. Once born, these infants require less morphine and shorter hospital stays
compared to infants born of mothers on methadone maintenance treatment.23
Research also indicates that buprenorphine combined with naloxone (compared to a
morphine taper) is equally safe for treating babies born with NAS, further reducing
side effects experienced by infants born to opioid-dependent mothers.
Option D: Depending on the drug the baby is withdrawing from, common signs are:
excessive crying, tremors, and jitteriness; poor feeding, vomiting, and swallowing;
inability to settle and sleep; or trouble with breathing. If you are treated with
methadone or buprenorphine during pregnancy, your
18. Question
The emergency department nurse is assigned to provide care for a victim of a sexual assault.
When following legal and agency guidelines, which intervention is most important?
A. Determine the assailant’s identity
B. Preserve the client’s privacy
C. Identify the extent of an injury
D. Ensure an unbroken chain of evidence
Incorrect
Correct Answer: D. Ensure an unbroken chain of evidence
Establishing an unbroken chain of evidence is essential in order to ensure that the
prosecution of the perpetrator can occur. Explain the forensic specimens you plan to
collect; inform the client that they can be used for identification and prosecution of the
rapist, for example blood, combing pubic hairs, semen samples, skin from underneath
nails.
Option A: Arrange for support follow-up: crisis counseling, group therapy, individual
therapy, rape counselor, or a support group. Many individuals carry with them
constant emotional distress and trauma. Depression and suicidal ideation are
frequent sequelae of rape. As soon as the intervention is carried out, the less
complicated the recovery may be.
Option B: The nurse will also need to preserve the client’s privacy and identify the
extent of an injury. However, it is essential that the nurse follows legal and agency
guidelines for preserving evidence. Provide strict confidentiality. The client’s situation
is not to be talked over with anyone other than the medical staff involved unless the
client gives consent to it.
Option C: Identifying the assailant is the job of law enforcement, not the nurse.
Approach the client in a nonjudgmental manner. Nurses’ attitudes can have an
important therapeutic impact. Displays of shock, horror, disgust, or disbelief are not
appropriate. Never use judgmental language.
19. Question
Which factor is least important in the decision regarding whether a victim of family violence can
safely remain in the home?
A. The availability of appropriate community shelters.
B. The non-abusing caretaker’s ability to intervene on the client’s behalf.
C. The client’s possible response to relocation.
D. The family’s socioeconomic status.
Incorrect
Correct Answer: D. The family’s socioeconomic status
Socioeconomic status is not a reliable predictor of abuse in the home so that it would be
the least important consideration in deciding issues of safety for the victim of family
violence. Family and domestic violence (including child abuse, intimate partner abuse, and
elder abuse) is a common problem in the United States. Family and domestic health
violence are estimated to affect 10 million people in the United States every year. It is a
national public health problem, and virtually all healthcare professionals will at some point
evaluate or treat a patient who is a victim of some form of domestic or family violence.
Option A: 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 and family
violence includes a range of abuse including economic, physical, sexual, emotional,
and psychological toward children, adults, and elders. If the patient elects to leave
their current situation, information for referral to a local domestic violence shelter to
assist the victim should be given.
Option B: The ability of the non-abusing caretaker to intervene on the client’s behalf
are important factor when making safety decisions. Patients that have suffered
domestic violence may or may not want a referral. Many are fearful of their lives and
financial well-being and hence may be weighing the tradeoff in leaving the abuser
leading to loss of support and perhaps the responsibility of caring for children alone.
The healthcare provider needs to assure the patient that the decision is voluntary
and that the provider will help regardless of the decision. The goal is to make
resources accessible, safe, and to enhance support.
Option C: The client’s response to possible relocation (if the client is a competent
adult) would be the most important factor to consider; feelings of empowerment and
being treated as a competent person can help a client feel less like a victim. If the
patient does not want to go to a shelter, provide telephone numbers for domestic
violence or crisis hotlines and support services for potential later use. Provide the
patient with instructions but be mindful that written materials may pose a danger
once the patient returns home.
20. Question
The nurse would expect a client with early Alzheimer’s disease to have problems with:
A. Balancing a checkbook
B. Self-care measures
C. Relating to family members
D. Remembering his own name
Incorrect
Correct Answer: A. Balancing a checkbook
In the early stage of Alzheimer’s disease, complex tasks (such as balancing a checkbook)
would be the first cognitive deficit to occur. Alzheimer’s disease (AD) is the most common
type of dementia, accounting for at least two-thirds of cases of dementia in people age 65
and older. Alzheimer’s disease is a neurodegenerative disease with insidious onset and
progressive impairment of behavioral and cognitive functions including memory,
comprehension, language, attention, reasoning, and judgment.
Option B: 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.
Option C: In the early stages, impairment in executive functioning ranges from

subtle to significant. This is followed by language disorder and impairment of
visuospatial skills. Neuropsychiatric symptoms like apathy, social withdrawal,
disinhibition, agitation, psychosis, and wandering are also common in the mid to late
stages.
Option D: 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. 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.
21. Question
Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has
frequent episodes of emotional lability?
A. Attempt humor to alter the client's mood.
B. Explore reasons for the client’s altered mood.
C. Reduce environmental stimuli to redirect the client’s attention.
D. Use logic to point out reality aspects.
Incorrect
Correct Answer: C. Reduce environmental stimuli to redirect the client’s attention.
The client with Alzheimer’s disease can have frequent episodes of labile mood, which can
best be handled by decreasing a stimulating environment and redirecting the client’s
attention. Maintain a nice quiet neighborhood. Noise, crowds, the crowds are usually the
excessive sensory neurons and can increase interference.
Option A: The client with Alzheimer’s disease loses the cognitive ability to respond
to either humor or logic. Assess the level of cognitive disorders such as a change to
orientation to people, places and times, range, attention, thinking skills. It provides
the basis for the evaluation or comparison that will come and influencing the choice
of intervention.
Option B: An over-stimulating environment may cause a labile mood, which will be
difficult for the client to understand. Maintain consistent scheduling with allowances
for patient’s specific needs, and avoid frustrating situations and overstimulation. It
prevents patient agitation, erratic behaviors, and combative reactions. Scheduling
may need revision to show respect for the patient’s sense of worth and to facilitate
the completion of tasks.
Option D: The client lacks any insight into his or her own behavior and therefore will
be unaware of any causative factors. Assist with establishing cues and reminders for
patient’s assistance. Assists patients with early AD to remember the location of
articles and facilitates some orientation.
22. Question
Which neurotransmitter has been implicated in the development of Alzheimer’s disease?
A. Acetylcholine
B. Dopamine
C. Epinephrine
D. Serotonin
Incorrect
Correct Answer: A. Acetylcholine
A relative deficiency of acetylcholine is associated with this disorder. The drugs used in the
early stages of Alzheimer’s disease will act to increase available acetylcholine in the brain.
The remaining neurotransmitters have not been implicated in Alzheimer’s disease.
Cholinergic neurons located in the basal forebrain, including the neurons that form the
nucleus basalis of Meynert, are severely lost in Alzheimer’s disease (AD). AD is the most
ordinary cause of dementia affecting 25 million people worldwide. The hallmarks of the
disease are the accumulation of neurofibrillary tangles and amyloid plaques.
Option B: Acetylcholine (ACh) was the first neurotransmitter to be identified. ACh is
the neurotransmitter used by all cholinergic neurons, which has a very important role
in the peripheral and central nervous systems. All pre- and postganglionic
parasympathetic neurons and all preganglionic sympathetic neurons use ACh as a
neurotransmitter. In addition, part of the postganglionic sympathetic neurons also
uses ACh as a neurotransmitter.
Option C: Given its widespread distribution in the brain, it is not surprising that
cholinergic neurotransmission is responsible for modulating important neural
functions. The cholinergic system is involved in critical physiological processes,
such as attention, learning, memory, stress response, wakefulness and sleep, and
sensory information.
Option D: It has been demonstrated that the cholinergic system plays a role in the
learning process. Moreover, published data indicate that ACh is involved in memory.
Further studies have demonstrated that endogenous acetylcholine is important for
modulation of acquisition, encoding, consolidation, reconsolidation, extinction, and
retrieval of memory.
23. Question
Which factors are the most essential for the nurse to assess when providing crisis intervention for
a client?
A. The client’s communication and coping skills.
B. The client’s anxiety level and ability to express feelings.
C. The client’s perception of the triggering event and availability of situational supports.
D. The client’s use of reality testing and level of depression.
Incorrect
Correct Answer: C. The client’s perception of the triggering event and availability of
situational supports
The most important factors to determine in these situations are the client’s perception of
the crisis event and the availability of support (including family and friends) to provide basic
needs. Crisis intervention is a short-term management technique designed to reduce
potential permanent damage to an individual affected by a crisis. A crisis is defined as an
overwhelming event, which can include divorce, violence, the passing of a loved one, or
the discovery of a serious illness.
Option A: A successful intervention involves obtaining background information on
the patient, establishing a positive relationship, discussing the events, and providing
emotional support. SAFER-R is a common intervention model used, which consists
of stabilization, acknowledgment, facilitate understanding, encouragement, recovery,
and referral. SAFER-R helps patients return to their mental baseline following a
crisis.
Option B: In these cases, psychological crisis intervention is necessary to prevent
traumatized victims from developing illnesses. It also alleviates stress upon
healthcare workers so that they can continue helping others. Another major concern
is what coping strategies are most effective. Social support and problem-solving
planning are effective coping mechanisms that are frequently used by school staff
following a crisis.
Option D: Although the nurse should assess the other factors, they are not as
essential as determining why the client considers this a crisis and whether he can
meet his present needs. The use of humor, emotional support, planning, and
acceptance also correlate with superior mental health outcomes compared to
substance abuse and denial. Positive coping mechanisms, such as the ones listed
above, are reported to be effective in crisis management, and with crisis intervention
services in place, people will be better equipped to handle unexpected events.
24. Question
The nurse considers a client’s response to crisis intervention successful if the client:
A. Changes coping skills and behavioral patterns.
B. Develops insight into reasons why the crisis occurred.
C. Learns to relate better to others.
D. Returns to his previous level of functioning.
Incorrect
Correct Answer: D. Returns to his previous level of functioning.
Crisis intervention is based on the idea that a crisis is a disturbance in homeostasis (steady
state). The goal is to help the client return to a previous level of equilibrium in functioning.
Based on prior studies, it is evident that crisis intervention plays a significant role in
enhancing outcomes in psychiatric cases. Community Mental Health Centers and local
government agencies often have crisis intervention teams that provide support to the local
community at times of mental health crisis. These teams can also be helpful at times of
natural or man-made emergencies.
Option A: Another major concern is what coping strategies are most effective.
Social support and problem-solving planning are effective coping mechanisms that
are frequently used by school staff following a crisis. The use of humor, emotional
support, planning, and acceptance also correlate with superior mental health
outcomes compared to substance abuse and denial. Positive coping mechanisms,
such as the ones listed above, are reported to be effective in crisis management,
and with crisis intervention services in place, people will be better equipped to
handle unexpected events.
Option B: Based on prior studies, it is evident that crisis intervention plays a
significant role in enhancing outcomes in psychiatric cases. Community Mental
Health Centers and local government agencies often have crisis intervention teams
that provide support to the local community at times of mental health crisis. These
teams can also be helpful at times of natural or man-made emergencies. Crisis
intervention teams often assess and triage the situation and can diffuse the situation
and triage for urgent attention of medical or mental health personnel in emergency
or community care settings. They can call upon local police and other community
resources for additional support.
Option C: There are many approaches to integrating crisis intervention, and a
member of the healthcare team can complete each step. First responders can triage
and assess the situation and administer psychological first aid as needed to victims
of a traumatic event to prevent any long-term mental health problems. This
approach allows immediate access to crisis intervention, which will facilitate care
and lead to improved outcomes. In a hospital setting, the needs of a patient in crisis
should be well communicated throughout the management team.
25. Question
Two nurses are co-leading group therapy for seven clients in the psychiatric unit. The leaders
observe that the group members are anxious and look to the leaders for answers. Which phase of
development is this group in?
A. Conflict resolution phase
B. Initiation phase
C. Working phase
D. Termination phase
Incorrect
Correct Answer: B. Initiation phase
Increased anxiety and uncertainty characterize the initiation phase in group therapy. Group
members are more self-reliant during the working and termination phases. During the
beginning phase of group therapy, issues arise around topics such as orientation,
beginners’ anxiety, and the role of the leader. The purpose of the group is articulated,
working conditions of the group are established, members are introduced, a positive tone is
set for the group, and group work begins. This phase may last from 10 minutes to a
number of months. In a revolving group, this orientation will happen each time a new
member joins the group.
Option A: The group is a forum where clients interact with others. In this give and
take of therapy, clients receive feedback that helps them rethink their behaviors and
move toward productive changes. The leader helps group members by allocating
time to address the issues that arise, by paying attention to relations among group
members, and by modeling a healthy interactional style that combines honesty with
compassion.
Option C: The group in its middle phase encounters and accomplishes most of the
actual work of therapy. During this phase, the leader balances content, which is the
information and feelings overtly expressed in the group, and process, which is how
members interact in the group. The therapy is in both the content and process. Both
contribute to the connections between and among group members, and it is those
connections that are therapeutic.
Option D: Termination is a particularly important opportunity for members to honor
the work they have done, to grieve the loss of associations and friendships, and to
look forward to a positive future. Group members should learn and practice saying
“good?bye,” understanding that it is necessary to make room in their lives for the
next “hello.”
26. Question
Group members have worked very hard, and the nurse reminds them that termination is
approaching. Termination is considered successful if group members:
A. Decide to continue
B. Elevate group progress
C. Focus on positive experience
D. Stop attending prior to termination
Incorrect
Correct Answer: A. Decide to continue
As the group progresses into the working phase, group members assume more
responsibility for the group. The leader becomes more of a facilitator. Comments about
behavior in a group are indicators that the group is active and involved. In this phase, the
LPN and client evaluate the client’s response to treatment and explore the meaning of the
relationship and what goals have been achieved. Discussing the achievements, how the
client and LPN feel about concluding the relationship, and plans for the future are an
important part of the termination phase.
Option B: Termination of a meaningful nurse-client relationship should be final in
any setting. To provide the client with even a hint that the relationship will continue is
inappropriate, unprofessional, and unethical; for example, the LPN informs the client
that he/she may contact the client on social media to check on their condition after
discharge.
Option C: Corresponding to the implementation phase of the nursing process, the
working phase focuses on self-direction and self-management to whatever extent
possible in promoting the client’s health and wellbeing; for example, the LPN
provides information and teaching to a client with diabetes about both the
importance of proper nutrition and how eating healthy will benefit the client long term
with regards to blood glucose levels. Because of teaching, the client decides not to
eat the chocolate bar and chooses to eat the apple instead.
Option D: When the client stops attending the group, termination is considered
unsuccessful. Every nurse-client relationship, regardless of circumstance, is based
on trust, respect, and professional integrity. It requires the appropriate use of
authority or power. The LPN must work with the client toward achieving the client’s
goals and ensure that the client receives safe competent care. The LPN utilizes a
caring attitude and behaviors to meet the needs of the client.
27. Question
The nurse is teaching a group of clients about the mood-stabilizing medications lithium carbonate.
Which medications should she instruct the clients to avoid because of the increased risk of lithium
toxicity?
A. Antacids
B. Antibiotics
C. Diuretics
D. Hypoglycemic agents
Incorrect
Correct Answer: C. Diuretics
The use of diuretics would cause sodium and water excretion, which would increase the
risk of lithium toxicity. Clients taking lithium carbonate should be taught to increase their
fluid intake and to maintain normal intake of sodium. 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.
Option A: Antacids are a combination of various compounds with various salts of
calcium, magnesium, and aluminum as the active ingredients. The antacids act by
neutralizing the acid in the stomach and by inhibiting pepsin, which is a proteolytic
enzyme. Each of these cationic salts has a characteristic pharmacological property
that determines its clinical use.
Option B: The pharmacology behind antibiotics includes destroying the bacterial
cell by either preventing cell reproduction or changing a necessary cellular function
or process within the cell. Antimicrobial agents are classically grouped into 2 main
categories based on their in vitro effect on bacteria: bactericidal and bacteriostatic.
Option D: FDA approved indications for the use of oral hypoglycemic drugs include
type 2 diabetes mellitus. Non-FDA approved indications of oral hypoglycemic drugs,
such as metformin, are for the prevention of type 2 diabetes mellitus, treatment of
gestational diabetes mellitus, treatment of polycystic ovary syndrome (PCOS) with
menstrual irregularities, and prevention of ovarian hyperstimulation syndrome in
PCOS patients undergoing intracytoplasmic sperm injection (ICSI) or in vitro
fertilization (IVF), and management of antipsychotic-induced weight gain.
28. Question
When providing family therapy, the nurse analyzes the functioning of healthy family systems.
Which situations would not increase stress on a healthy family system?
A. An adolescent’s going away to college
B. The birth of a child
C. The death of a grandparent
D. Parental disagreement
Incorrect
Correct Answer: D. Parental disagreement
In a functional family, parents typically do not agree on all issues and problems. Open
discussion of thoughts and feelings is healthy, and parental disagreement should not cause
system stress. Families that eat together regularly communicate (as long as the phones
and TVs are turned off). They like to share feelings with each other and cue into each
other’s feelings. Put-downs and sarcasm is rare.
Option A: 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.
Option B: Developmental crises 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 C: If you are coping with a crisis, whether it’s emotional or situational, there
are things that you can do to help ensure your psychological and physical well-being
during this difficult time of your life. It’s important to lean on friends, family, and loved
ones during a crisis, but you should also seek professional help if you need it.
Consider talking to your doctor about what you are dealing with.
29. Question
A client taking the monoamine oxidase inhibitor (MAOI) antidepressant isocarboxazid (Marplan) is
instructed by the nurse to avoid which foods and beverages?
A. Aged cheese and red wine
B. Milk and green, leafy vegetables
C. Carbonated beverages and tomato products
D. Lean red meats and fruit juices
Incorrect
Correct Answer: A. Aged cheese and red wine
Aged cheese and red wines contain the substance tyramine which, when taken with an
MAOI, can precipitate a hypertensive crisis. Monoamine oxidase inhibitors (MAOIs) were
first introduced in the 1950s. They are a separate class from other antidepressants,
treating different forms of depression as well as other nervous system disorders such as
panic disorder, social phobia, and depression with atypical features. MAOIs prevent the
breakdown of tyramine found in the body as well as certain foods, drinks, and other
medications. Patients that take MAOIs and consume tyramine-containing foods or drinks
will exhibit high serum tyramine level.
Option B: These are foods rich in iron. A high level of tyramine can cause a sudden
increase in blood pressure, called the tyramine pressor response. Even though it is
rare, a high tyramine level can trigger a cerebral hemorrhage, which can even result
in death. Eating foods with high tyramine can trigger a reaction that can have
serious consequences. Patients should know that tyramine can increase with the
aging of food; they should be encouraged to have foods that are fresh instead of
leftovers or food prepared hours earlier.
Option C: Carbonated beverages are unhealthy and tomato products are high in
sodium. Eating foods with high tyramine can trigger a reaction that can have serious
consequences. Patients should know that tyramine can increase with the aging of
food; they should be encouraged to have foods that are fresh instead of leftovers or
food prepared hours earlier. Examples of high levels of tyramine in food are types of
fish, as well as types of meat, including sausage, turkey, liver, and salami.
Option D: Lean red meats are rich in protein and fruit juices are rich in fiber. Also,
certain fruits can contain tyramine like overripe fruits, avocados, bananas, raisins, or
figs. Further examples are cheeses, alcohol, and fava beans; all of these should be
avoided even after two weeks of stopping MAOIs. Anyone taking MAOIs is at risk for
an adverse hypertensive reaction, with accompanying morbidity.
30. Question
Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurse should:
A. Assess skin color and sclera
B. Assess the radial pulse
C. Take the client’s blood pressure
D. Ask the client to void
Incorrect
Correct Answer: C. Take the client’s blood pressure
Because chlorpromazine (Thorazine) can cause a significant hypotensive effect (and
possible client injury), the nurse must assess the client’s blood pressure (lying, sitting, and
standing) before administering this drug. When administered as intramuscular or
intravenous injections, it may cause hypotension and headache. Prolonged use of
chlorpromazine may cause corneal deposits and lens opacity. It may prolong the QT
interval.
Option A: If the client had taken the drug previously, the nurse would also need to
assess the skin color and sclera for signs of jaundice, a possible drug side effect;
however, based on the information given here, there is no evidence that the client
has received chlorpromazine before.
Option B: The hepatic P450 enzyme CYP2D6 metabolizes the drug, and its half-life
is approximately 30 hours. It gets excreted from the body via urine and in bile.
Studies have shown the correlation between chlorpromazine’s therapeutic level and
the improvement of the psychiatric symptoms. Researchers have noted that the
patients receiving chronic treatment with chlorpromazine have lower plasma levels
as compared to the patients acutely treated on an oral dose of chlorpromazine.
Option D: Although the drug can cause urine retention, asking the client to avoid will
not alter this anticholinergic effect. Chlorpromazine is a low-potency antipsychotic
that mainly causes non-neurologic side effects. It is highly lipid-soluble and stored in
body fats, thus very slow to be removed from the body. Being a low-potency typical
antipsychotic, it primarily causes dry mouth, dizziness, urine retention, blurred
vision, and constipation by blocking the muscarinic receptors. There is a risk of
angle-closure glaucoma in the elderly. It also causes sedation due to the blockade of
histamine H1 receptors.
31. Question
The nurse understands that electroconvulsive therapy is primarily used in psychiatric care for the
treatment of:
A. Anxiety disorders
B. Depression
C. Mania
D. Schizophrenia
Incorrect
Correct Answer: B. Depression
Electroconvulsive therapy (ECT) can provide relief for patients with severe depression who
have not been able to feel better with other treatments. In some severe cases where rapid
response is necessary or medications cannot be used safely, ECT can even be a first-line
intervention. ECT consists of a series of sessions, typically three times a week, for two to
four weeks. ECT is indicated in patients with treatment-resistant depression or severe
major depression that impairs activities of daily living. The definition of treatment-resistant
depression is depression that is unresponsive to multiple antidepressant medication trials.
Option A: Suicidal ideation is rapidly relieved by ECT, and complete resolution was
seen in 38% of patients after one week, 61% of patients after two weeks and in 81%
of patients with the completion of ECT. ECT is also recommended for patients that
have exhibited a favorable response to ECT previously. ECT is a relatively safe and
low-risk procedure that is helpful in the treatment of depression, suicidality, severe
psychosis, food refusal secondary to depression, and catatonia.
Option C: There are also suggestions for ECT as a treatment for suicidality, severe
psychosis, food refusal secondary to depression, and catatonia. Bipolar depressive
and manic patients can also receive treatment with ECT. ECT may have a safer
profile than antidepressants or antipsychotics in debilitated, elderly, pregnant, and
breastfeeding patients.
Option D: In a patient under intravenous sedation or general anesthesia,
electroconvulsive therapy (ECT) uses an electric current to create a generalized
cerebral seizure. Although it is primarily utilized to treat patients with severe
depression, patients with schizophrenia, schizoaffective disorder, catatonia,

neuroleptic malignant syndrome, and bipolar disorder may also benefit.
32. Question
A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the
medications listed below. Which medication would cause the nurse to express concern and
therefore initiate further teaching?
A. Acetaminophen (Tylenol)
B. Diphenhydramine (Benadryl)
C. Furosemide (Lasix)
D. Isosorbide dinitrate (Isordil)
Incorrect
Correct Answer: B. Diphenhydramine (Benadryl)
Over-the-counter medications used for allergies and cold symptoms are contraindicated
because they will increase the sympathomimetic effects of MAOIs, possibly causing a
hypertensive crisis. In general, SSRIs, SNRIs, TCAs, bupropion, mirtazapine, St. John’s
Wort and sympathomimetic amines, including stimulants, are contraindicated with MAOIs.
Tramadol, meperidine, dextromethorphan, and methadone are contraindicated in patients
on MAOIs as they are at high risk for causing serotonin syndrome.
Option A: Acetaminophen (APAP) is considered a non-opioid analgesic and
antipyretic agent used to treat pain and fever. Clinicians can use it for their patients
as a single agent for mild to moderate pain and in combination with an opioid
analgesic for severe pain. Acetaminophen, also called N-acetyl para-aminophenol or
paracetamol, is one of the most widely used over-the-counter analgesic and
antipyretic agents. Although its exact mechanism of action remains unclear, it is
historically categorized along with NSAIDs because it inhibits the cyclooxygenase
(COX) pathways.
Option C: The Food and Drug Administration (FDA) has approved the use of
furosemide in the treatment of conditions with volume overload and edema
secondary to congestive heart failure exacerbation, liver failure, or renal failure
including the nephrotic syndrome. Furosemide inhibits tubular reabsorption of
sodium and chloride in the proximal and distal tubules, as well as in the thick
ascending loop of Henle by inhibiting sodium-chloride cotransport system resulting
in excessive excretion of water along with sodium, chloride, magnesium, and
calcium.
Option D: Isosorbide is a nitrate that exerts its pharmacologic effect by releasing
nitric oxide (NO), an endothelium-derived relaxing factor (EDRF).NO is
endogenously produced in the endothelium to dilate the blood vessels. It is for the
prevention or treatment of angina pectoris resulting from coronary artery disease;
however, it is not recommended for use once the anginal episode has started
because the onset of action is not sufficiently rapid enough to abort an acute anginal
event. In the latter case, glyceryl trinitrate is preferable.
33. Question
The nurse is administering a psychotropic drug to an elderly client who has a history of benign
prostatic hypertrophy. It is most important for the nurse to teach this client to:
A. Add fiber to his diet.
B. Exercise on a regular basis.
C. Report incomplete bladder emptying.
D. Take the prescribed dose at bedtime.
Incorrect
Correct Answer: C. Report incomplete bladder emptying
Urinary retention is a common anticholinergic side effect of psychotic medications, and the
client with benign prostatic hypertrophy would have increased risk for this problem. First-
generation antipsychotics (FGAs) are associated with significant extrapyramidal side
effects. Anticholinergic adverse effects like dry mouth, constipation, urinary retention are
common with low potency dopamine receptor antagonists like chlorpromazine, thioridazine.
Option A: Neuroleptic malignant syndrome is a rare but fatal adverse effect that can
occur at any time during treatment with FGAs. The onset of symptoms is over 24 to
72 hours with increased temperature, severe muscular rigidity, confusion, agitation,
elevation in white blood cell count, elevated creatinine phosphokinase
concentrations, elevated liver enzymes, myoglobinuria, and acute renal failure.
Option B: Adding fiber to one’s diet and exercising regularly are measures to
counteract another anticholinergic effect, constipation. Second-generation
antipsychotics (SGAs) have a decreased risk of extrapyramidal side effects as
compared to first-generation antipsychotics. SGAs are associated with significant
weight gain and the development of metabolic syndrome.
Option D: Depending on the specific medication and how it is prescribed, taking the
medication at night may or may not be important. However, it would have nothing to
do with urinary retention in this client. The FDA recommends monitoring personal
and family history of diabetes mellitus, dyslipidemia, weight, and height, waist
circumference, blood pressure, fasting plasma glucose, and fasting lipid profile for
all patients.
34. Question
The nurse correctly teaches a client taking the Benzodiazepine Oxazepam (Serax) to avoid
excessive intake of:
A. Cheese
B. Coffee
C. Sugar
D. Shellfish
Incorrect
Correct Answer: B. Coffee
Coffee contains caffeine, which has a stimulating effect on the central nervous system that
will counteract the effect of the antianxiety medication oxazepam. None of the remaining
foods is contraindicated. These drugs may act as depressants to the CNS, specifically
inhibiting respiratory drive. Therefore, careful monitoring of all vitals, especially blood
pressure and respiratory rate, should be performed after the administration of
benzodiazepines. Waveform capnography, if available, should be seriously considered to
monitor respiratory status.
Option A: The FDA strongly reminds providers that extreme care should be taken
when administering benzodiazepines with other central nervous system depressants
such as alcohol, barbiturates, and opioids. The activated charcoal administration is
contraindicated in benzodiazepine (BZ) ingestion toxicity/overdose. This is due
primarily to altered mental status commonly associated with BZ overdose, which
lends itself to aspiration of the activated charcoal.
Option C: Flumazenil is a GABA-A receptor antagonist, acting to reverse the
sedative effects of benzodiazepines. Flumazenil functions through competitive
inhibition of the alpha-gamma subunit of the GABA-A receptor. Administration of
flumazenil should be carried out judiciously, as it may precipitate withdrawal
seizures. Of note, one multi-center trial found that patients with excessive
benzodiazepine ingestion could become “re-sedated” after flumazenil began to wear
off.
Option D: Contraindications include known hypersensitivity to benzodiazepines and
angle-closure glaucoma. Glaucoma occurs when the intraocular pressure rises,
thereby causing compression of the optic nerve near the posterior surface of the
eye. This compression of the lamina cribrosa can lead to axonal damage with
subsequent disruption of anterograde and retrograde axonal transport. This results
in numerous issues, including ocular pain, nausea/vomiting, blurred vision, an
intraocular pressure greater than 21 mmHg, edema of the corneal epithelium, and
non-reactive pupils.
35. Question
The nurse provides a referral to Alcoholics Anonymous to a client who describes a 20-year history
of alcohol abuse. The primary function of this group is to:
A. Encourage the use of a 12-step program.
B. Help members maintain sobriety.
C. Provide fellowship among members.
D. Teach positive coping mechanisms.
Incorrect
Correct Answer: B. Help members maintain sobriety.
The primary purpose of Alcoholics Anonymous is to help members achieve and maintain
sobriety. 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.
Option A: Alcoholism and drug addiction are often referred to as ” substance abuse”
or “chemical dependency.” Alcoholics and nonalcoholics are, therefore, sometimes
introduced to AA and encouraged to attend AA meetings. AA members share their
experience with anyone seeking help with a drinking problem; they give person-to-
person service or “sponsorship” to the alcoholic coming to AA from any source. The
AA program, set forth in the Twelve Steps, offers the alcoholic a way to develop a
satisfying life without alcohol. This program is discussed at AA group meetings.
Option C: Only those with a drinking problem may attend closed meetings or
become AA members. People with problems other than alcoholism are eligible for
AA membership only if they have a drinking problem, too. According to AA traditions,
the only qualification for membership is a desire to stop drinking.
Option D: Although each of the remaining answer choices may be an outcome of
attendance at Alcoholics Anonymous, the primary purpose is directed toward
sobriety of members. Open AA meetings, which anyone can attend, are usually
“speaker meetings,” at which a member of AA will tell their story—what it was like,
what happened, and what it’s like now. Most AA meetings, however, are closed
meetings for members only.
36. Question
Which client outcome is most appropriately achieved in a community approach setting in

psychiatric nursing?
A. The client performs activities of daily living and learns about crafts.
B. The client is able to prevent aggressive behavior and monitors his use of
medications.
C. The client demonstrates self-reliance and social adaptation.
D. The client experiences anxiety relief and learns about his symptoms.
Incorrect
Correct Answer: C. The client demonstrates self-reliance and social adaptation.
A therapeutic community is designed to help individuals assume responsibility for
themselves, to learn how to respect and communicate with others, and to interact in a
positive manner. The therapeutic community (TC) is an intensive and comprehensive
treatment model developed for use with adults that has been modified successfully to treat
adolescents with substance use disorders.
Option A: The core goal of TCs has always been to promote a more holistic lifestyle
and to identify areas for change such as negative personal behaviors–social,
psychological, and emotional–that can lead to substance use. Residents make
these changes by learning from fellow residents, staff members, and other figures of
authority.
Option B: The theoretical framework for the TC model considers substance use a
symptom of much broader problems and, in a residential setting, uses a holistic
treatment approach that has an impact on every aspect of a resident’s life.
Residents are distinguished along dimensions of psychological dysfunction and
social deficits. The community provides habilitation, in which some TC residents
develop socially productive lifestyles for the first time in their lives, and rehabilitation,
in which other residents are helped to return to a previously known and practiced or
rejected healthy lifestyle (De Leon, 1994).
Option D: The remaining answer choices may be outcomes of psychiatric
treatment, but the use of a therapeutic community approach is concerned with the
promotion of self-reliance and cooperative adaptation to being with others. Part of
the ecological approach to treatment in the TC is the creation of a safe and nurturing
environment, within which adolescents can begin to experience healthy living. It is
important for the staff of the TC to understand what type of home, neighborhood,
and social environment from which each adolescent comes. Many adolescents
enrolled in the TC come from unsafe physical and psychological environments; the
characteristics of the home and neighborhood do not facilitate healthy living, and
many risk factors may be environmental.
37. Question
A client with panic disorder experiences an acute attack while the nurse is completing an
admission assessment. List the following interventions according to their level of priority.
View Answers: Student Correct
 Reduce external stimuli
 Encourage low, deep breathing
 Teach coping measures
 Remain with the client
 Encourage physical activity
Incorrect
The correct order is shown above.
Panic disorder and panic attacks are two of the most common problems seen in the world
of psychiatry. Panic disorder is a separate entity than a panic disorder although it is
characterized by recurrent, unexpected panic attacks. Panic attacks are defined by the
Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as “an abrupt surge of
intense fear or discomfort” reaching a peak within minutes. Four or more of a specific set of
physical symptoms accompany a panic attack. These symptoms include; palpitations,
pounding heart, or accelerated heart rate, sweating, trembling or shaking, sensations of
shortness of breath or smothering, feelings of choking, chest pain or discomfort, nausea or

abdominal distress, feeling dizzy, unsteady, light-headedness, or faint, chills or heat
sensations, paresthesias (numbness or tingling sensations), derealization (feelings of
unreality) or depersonalization (being detached from oneself), fear of losing control or
“going crazy”, and fear of dying.
The nurse should remain with the client to provide support and promote safety. The
main approaches to the treatment of panic disorder include both psychological and
pharmacological interventions. Psychological interventions consist of cognitive-
behavioral therapy.
Reducing external stimuli, including dimming lights and avoiding crowded areas, will
help decrease anxiety. It is important for a provider to inform the patient about the
symptoms that he may suffer from if he is diagnosed with the disorder. If a patient is
not aware of these symptoms it is probable that he would fear his condition more
and would tend to get frequent attacks. The pharmacotherapy and cognitive-
behavioral therapy should be discussed with the patients so that they can
understand the treatment options for the condition that they have.
Encouraging the client to use slow, deep breathing will help promote the body’s
relaxation response, thereby interrupting stimulation from the autonomic nervous
system. Breathing training is a method of reducing panic symptomatology by
utilizing capnometry biofeedback to decrease the number of episodes of
hyperventilation. Several of these slow breathing techniques have been shown to
benefit patients with asthma and hypertension. Hyperventilation reduction can help
patients with cardiovascular disease.
Encouraging physical activity will help him to release energy resulting from the
heightened anxiety state; this should be done only after the client has brought his
breathing under control. The patient needs a thorough education on the disorder
and understands that the symptoms are not life-threatening. The patient needs to be
told about the different treatments available and the need for compliance. Plus, the
pharmacist should caution the patient against the use of alcohol or recreational
drugs. The patient should be taught to recognize the triggers and avoid them.
Teaching coping measures will help the client learn to handle anxiety; however, this
can only be accomplished when the client’s panic has dissipated and he is better
able to focus. Anxiety and stress-reduction techniques can lower adverse outcomes
in cardiovascular illness by decreasing sympathetic activity.
38. Question
The doctor has prescribed haloperidol (Haldol) 2.5 mg. I.M. for an agitated client. The medication
is labeled haloperidol 10 mg/2 ml. The nurse prepares the correct dose by drawing up how many
milliliters in the syringe?
A. 0.3
B. 0.4
C. 0.5
D. 0.6
Incorrect
Correct Answer: C. 0.5
Set up the problem as follows: 2.5mg/10mg = Xml/2ml X=0.5ml. Haloperidol is a first-
generation (typical) antipsychotic medication that is used widely around the world. Food
and Drug Administration (FDA) approved the use of haloperidol is for schizophrenia,
Tourette syndrome (control of tics and vocal utterances in adults and children),
hyperactivity (which may present as impulsivity, difficulty maintaining attention, severe
aggressivity, mood instability, and frustration intolerance), severe childhood behavioral
problems (such as combative, explosive hyperexcitability), intractable hiccups. It is a typical
antipsychotic because it works on positive symptoms of schizophrenia, such as
hallucinations and delusions.
Option A: Haloperidol is used widely in different countries. It is available in various
forms; the oral route is the most common. For the oral administration, it is available
as a tablet form and oral concentrate form. It is also available in a nasal spray
formulation. Haloperidol lactate is used as a short-acting parenteral solution
available for use intramuscularly and intravenously. Haloperidol decanoate is
available for long-acting intramuscular preparation.
Option B: Haloperidol in psychosis: In this instance, the oral and intramuscular
forms can be used. For moderate symptomatology: 0.5 to 2 mg 2 to 3 times a day
orally. In some resistant cases, up to 30 mg/day may be necessary. For prompt
control of acute agitation, an intramuscular injection can be given as a 2 to 5 mg
dose every 4 to 8 hours. The maximum intramuscular dose is 20 mg/day.
Option D: Haloperidol in schizophrenia: In moderately severe patients, dosing is 0.5
to 2 mg haloperidol orally 2 to 3 times a day. It should not exceed 30 mg daily in
case of severe cases. To control acute agitation in a schizophrenic patient, dosing is

2 to 5 mg haloperidol intramuscularly every 4 to 8 hours.
39. Question
The nurse enters the room of a client with a cognitive impairment disorder and asks what day of
the week it is: what the date, month, and year are; and where the client is. The nurse is attempting
to assess:
A. Confabulation
B. Delirium
C. Orientation
D. Perseveration
Incorrect
Correct Answer: C. Orientation
The initial, most basic assessment of a client with cognitive impairment involves
determining his level of orientation (awareness of time, place, and person). Interviews to
assess memory, behavior, mood and functional status (especially complex actions such as
driving and managing money are best conducted with the patient alone, so that family
members or companions cannot prompt the patient. Information can also be gleaned from
the patient’s behavior on arrival in the doctor’s office and interactions with staff.
Option A: Confabulation is a type of memory error in which gaps in a person’s
memory are unconsciously filled with fabricated, misinterpreted, or distorted
information. When someone confabulates, they are confusing things they have
imagined with real memories. Cognitive impairment in older adults has a variety of
possible causes, including medication side effects, metabolic and/or endocrine
derangements, delirium due to intercurrent illness, depression and dementia, with
Alzheimer’s dementia being most common. Some causes, like medication side
effects and depression, can be reversed with treatment. Others, such as Alzheimer’s
disease, cannot be reversed, but symptoms can be treated for a period of time and
families can be prepared for predictable changes.
Option B: Delirium is a type of cognitive impairment; however, other symptoms are
necessary to establish this diagnosis. 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. 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.
Option D: The nurse may also assess for perseveration in a client with cognitive
impairment, but the questions in this situation would not elicit the symptom
response. Many people who are developing or have dementia do not receive a
diagnosis. One study showed that physicians were unaware of cognitive impairment
in more than 40 percent of their cognitively impaired patients. Another study found
that more than half of patients with dementia had not received a clinical cognitive
evaluation by a physician. The failure to evaluate memory or cognitive complaints is
likely to hinder treatment of underlying disease and comorbid conditions, and may
present safety issues for the patient and others. In many cases, the cognitive
problem will worsen over time.
40. Question
Which of the following will the nurse use when communicating with a client who has a cognitive
impairment?
A. Complete explanations with multiple details
B. Picture or gestures instead of words
C. Stimulating words and phrases to capture the client’s attention
D. Short words and simple sentences
Incorrect
Correct Answer: D. Short words and simple sentences
Short words and simple sentences minimize client confusion and enhance communication.
Frequently orient the client to reality and surroundings. Allow the client to have familiar
objects around him or her; use other items, such as a clock, a calendar, and daily
schedules, to assist in maintaining reality orientation.
Option A: Use simple explanations and face-to-face interaction when
communicating with the client. Do not shout messages into the client’s ear.
Speaking slowly and in a face-to-face position is most effective when
communicating with an elderly individual experiencing a hearing loss.
Option B: Although pictures and gestures may be helpful, they would not substitute
for verbal communication. Teach prospective caregivers how to orient the client to
time, person, place, and circumstances, as required. These caregivers will be
responsible for client safety after discharge from the hospital.
Option C: Complete explanations with multiple details and stimulating words and
phrases would increase confusion in a client with short attention span and difficulty
with comprehension. Give positive feedback when thinking and behavior are
appropriate, or when the client verbalizes that certain ideas expressed are not
based in reality. Positive feedback increases self-esteem and enhances the desire
to repeat appropriate behavior.
41. Question
A 75-year-old client has dementia of the Alzheimer’s type and confabulates. The nurse
understands that this client:
A. Denies confusion by being jovial
B. Pretends to be someone else
C. Rationalizes various behaviors
D. Fills in memory gaps with fantasy
Incorrect
Correct Answer: D. Fills in memory gaps with fantasy
Confabulation is a communication device used by patients with dementia to compensate
for memory gaps. Confabulation is a type of memory error in which gaps in a person’s
memory are unconsciously filled with fabricated, misinterpreted, or distorted information.
When someone confabulates, they are confusing things they have imagined with real
memories. A person who is confabulating is not lying. They are not making a conscious or
intentional attempt to deceive. Rather, they are confident in the truth of their memories
even when confronted with contradictory evidence.The remaining answer choices are
incorrect.
Option A: Dementia is a syndrome – usually of a chronic or progressive nature – in
which there is deterioration in cognitive function (i.e. the ability to process thought)
beyond what might be expected from normal aging. It affects memory, thinking,
orientation, comprehension, calculation, learning capacity, language, and judgment.
Consciousness is not affected. The impairment in cognitive function is commonly
accompanied and occasionally preceded, by deterioration in emotional control,
social behavior, or motivation.
Option B: Dementia results from a variety of diseases and injuries that primarily or
secondarily affect the brain, such as Alzheimer’s disease or stroke. Dementia is one
of the major causes of disability and dependency among older people worldwide. It
can be overwhelming, not only for the people who have it, but also for their carers
and families. There is often a lack of awareness and understanding of dementia,
resulting in stigmatization and barriers to diagnosis and care. The impact of
dementia on carers, family, and society at large can be physical, psychological,
social, and economic.
Option C: Although age is the strongest known risk factor for dementia, it is not an
inevitable consequence of aging. Further, dementia does not exclusively affect older
people – young onset dementia (defined as the onset of symptoms before the age
of 65 years) accounts for up to 9% of cases. Studies show that people can reduce
their risk of dementia by getting regular exercise, not smoking, avoiding harmful use
of alcohol, controlling their weight, eating a healthy diet, and maintaining healthy
blood pressure, cholesterol, and blood sugar levels. Additional risk factors include
depression, low educational attainment, social isolation, and cognitive inactivity.
42. Question
An elderly client with Alzheimer’s disease becomes agitated and combative when a nurse
approaches to help with morning care. The most appropriate nursing intervention in this situation
would be to:
A. Tell the client family that it is time to get dressed.
B. Obtain assistance to restrain the client for safety.
C. Remain calm and talk quietly to the client.
D. Call the doctor and request an order for sedation.
Incorrect
Correct Answer: C. Remain calm and talk quietly to the client.
Maintaining a calm approach when intervening with an agitated client is extremely
important. Divert attention to a client when agitated or dangerous behaviors like getting out
of bed by climbing the fence bed. Eliminate or minimize sources of hazards in the
environment. Maintain security by avoiding a confrontation that could improve the behavior
or increase the risk for injury.
Option A: Telling the client firmly that it is time to get dressed may increase his
agitation, especially if the nurse touches him. Assess the degree of impaired ability
of competence, emergence of impulsive behavior, and a decrease in visual
perception. Impairment of visual perception increases the risk of falling. Identify
potential risks in the environment and heighten awareness so that caregivers are
more aware of the danger.
Option B: Restraints are a last resort to ensure client safety and are inappropriate
in this situation. Assess the patient’s surroundings for hazards and remove them. AD
decreases awareness of potential dangers, and disease progression coupled with a
hazardous environments that could lead to accidents. Help the people closest to
identify the risk of hazards that may arise. An impaired cognitive and perceptual
disorder are beginning to experience the trauma as a result of the inability to take
responsibility for basic security capabilities or evaluating a particular situation.
Option D: Sedation should be avoided, if possible because it will interfere with CNS
functioning and may contribute to the client’s confusion. During the middle and later
stages of AD, the patient must not be left unattended. Patients with AD have
impaired thinking and cannot rationalize cause and effect. This can result in
wandering outside without clothes on, exposure to extreme cold or heat, and may
cause dehydration in the long run.
43. Question
In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the
early evening hours is called:
A. Aphasia
B. Agnosia
C. Sundowning
D. Confabulation
Incorrect
Correct Answer: C. Sundowning
Sundowning is a common phenomenon that occurs after daylight hours in a client with a
cognitive impairment disorder. The term “sundowning” refers to a state of confusion
occurring in the late afternoon and spanning into the night. Sundowning can cause a
variety of behaviors, such as confusion, anxiety, aggression or ignoring directions.
Sundowning can also lead to pacing or wandering. The other options are incorrect
responses, although all may be seen in this client.
Option A: Aphasia is a condition that robs you of the ability to communicate. It can
affect your ability to speak, write and understand language, both verbal and written.
Aphasia typically occurs suddenly after a stroke or a head injury. But it can also
come on gradually from a slow-growing brain tumor or a disease that causes
progressive, permanent damage (degenerative). The severity of aphasia depends
on a number of conditions, including the cause and the extent of the brain damage.
Option B: Agnosia is a rare disorder whereby a patient is unable to recognize and
identify objects, persons, or sounds using one or more of their senses despite
otherwise normally functioning senses. The deficit cannot be explained by memory,
attention, language problems, or unfamiliarity to the stimuli. Usually, one of the

sensory modalities is affected.
Option D: Confabulation is a type of memory error in which gaps in a person’s
memory are unconsciously filled with fabricated, misinterpreted, or distorted
information. When someone confabulates, they are confusing things they have
imagined with real memories. a person who is confabulating is not lying. They are
not making a conscious or intentional attempt to deceive. Rather, they are confident
in the truth of their memories even when confronted with contradictory evidence.
44. Question
Which of the following outcome criteria is appropriate for the client with dementia?
A. The client will return to an adequate level of self-functioning.
B. The client will learn new coping mechanisms to handle anxiety.
C. The client will seek out resources in the community for support.
D. The client will follow an establishing schedule for activities of daily living.
Incorrect
Correct Answer: D. The client will follow an establishing schedule for activities of
daily living.
Following established activity schedules is a realistic expectation for clients with dementia.
Frequently orient the client to reality and surroundings. Allow the client to have familiar
objects around him or her; use other items, such as a clock, a calendar, and daily
schedules, to assist in maintaining reality orientation. Teach prospective caregivers how to
orient the client to time, person, place, and circumstances, as required. These caregivers
will be responsible for client safety after discharge from the hospital.
Option A: Assess and identify the patient’s previous history of grooming and
bathing, and attempt to maintain similar care. This promotes familiarity with routine
bathing time and type of bath or shower and lessens further confusion and agitation.
Instruct the patient in activity with a short step-by-step method; do not rush the
patient. This promotes self-esteem and feelings of accomplishment; rushing the

patient causes frustration.
Option B: Assist in defining problems and use of techniques to cope and solve
problems. This provides support for problem solving and management of the
family’s fatigue and chronic stress. Provide an opportunity for the family to express
concerns and lack of control of the situation to provide an opportunity for the family
to express concerns and lack of control of the situation.
Option C: All of the remaining outcome statements require a higher level of
cognitive ability than can be realistically expected of clients with this disorder.
Identify possible support systems and ability to participate in social activities.
Community resources are available for clients and families dealing with stages of AD
that provide information and assistance. Provide diversional activities as appropriate
for functional ability. Provide rest and sleep periods; avoid situations that cause
frustration, agitation, or sensory overload.
45. Question
The school guidance counselor refers a family with an 8-year-old child to the mental health clinic
because of the child’s frequent fighting in school and truancy. Which of the following data would be
a priority to the nurse doing the initial family assessment?
A. The child’s performance in school
B. Family education and work history
C. The family’s perception of the current problem
D. The teacher’s attempt to solve the problem
Incorrect
Correct Answer: C. The family’s perception of the current problem
The family’s perception of the problem is essential because change in any one part of a
family system affects all other parts and the system as a whole. Each member of the family
has been affected by the current problems related to the school system and the nurse
would be interested in the data. Research indicates at-risk youth are more likely to
experience emotional and psychological problems. Young people who are often truant from
school represent a group of at-risk youth, but one for which mental health issues are
understudied.
Option A: The child’s performance in school and the teacher’s attempts to solve the
problem are relevant and may be assessed; however, priority would be given to the
family’s perception of the problem. Truancy is a serious problem that affects most
school districts in the U.S. Research on truancy can be challenging because there is
not a uniform definition of truancy and statistics on truancy rates are lacking and/or
inconsistently reported across school districts. Psychological research reports a high
prevalence of mental health problems among youths characterized as school
refusers. School refusers demonstrate symptoms of mood disorders such as
depression and dysthymia, anxiety disorders such as generalized anxiety,
separation anxiety, and panic disorder, and disruptive behavior disorders such as
oppositional defiant, attention deficit hyperactivity disorder (ADHD) and conduct
disorders.
Option B: The family education and work history may be relevant, but are not a
priority. Generally, truancy is defined as unauthorized, intentional absence from
compulsory schooling. It is estimated that thousands of youth in the U.S. are absent
from school each day. For example, recent statistics on truancy in Los Angeles
County and Colorado indicate truancy rates greater than 10 percent, with the
highest rates in urban high schools. Comparable statistics corroborating high rates
of truancy can also be found in other jurisdictions.
Option D: Truancy appears to be a risk factor for a life-course trajectory toward
more negative behaviors. As Garry observed, truancy may be the beginning of a
lifetime of problems among students who routinely skip school, including poor
standardized test performance, high school dropout, a stressed family life, difficulties
in emotional/psychological functioning, drug use, and progression to both juvenile
delinquency and adult criminal offending. Related research has also documented a
link between truancy and later problems with employment, adult crime and
incarceration.
46. Question
The parents of a young man with schizophrenia express feelings of responsibility and guilt for their
son’s problems. How can the nurse best educate the family?
A. Acknowledge the parent’s responsibility.
B. Explain the biological nature of schizophrenia.
C. Refer the family to a support group.
D. Teach the parents various ways they must change.
Incorrect
Correct Answer: B. Explain the biological nature of schizophrenia.
The parents are feeling responsible and this inappropriate self-blame can be limited by
supplying them with the facts about the biological basis of schizophrenia. Schizophrenia is
a psychiatric disorder, which is characterized by slow functional deterioration and episodes
of relapse or acute exacerbation of psychotic symptoms. The mean age of onset in early
adulthood, deterioration in patients’ activities of daily living and ability to sustain
employment, and the propensity of the disorder to affect insight leave many patients
requiring assistance and care for an extended period of time.
Option A: Acknowledging the patient’s responsibility is neither accurate nor helpful
to the parents and would only reinforce their feelings of guilt. Caregivers of patients
with childhood-onset chronic psychiatric disorders such as autism spectrum
disorders, who are usually the parents, realize at an early stage that there will be a
responsibility for them to care for their child for the rest of their lives in most cases.
They, therefore, tend to adapt accordingly as the child grows up and experience a
comparatively slow change to their lives and expectations regarding their ill child.
Option C: Support groups are useful; however, the nurse needs to handle the
parents’ self-blame directly instead of making a referral for this problem. Patients
with schizophrenia can often have a normal childhood and adolescence before
suddenly, unexpectedly, and often dramatically becoming ill. Because of the age of
onset, care responsibilities are suddenly thrust upon mostly parents, even before
they have come to terms with the shock of the sudden, dramatic onset of the illness.
It often comes at a time when they would expect their child to gain independence
and when they themselves are at an age when retirement could have been
considered. The lowering of expectation for the future of their child, along with the
new, long-term care responsibilities, tends to weigh heavily on these parents,
requiring a dramatic adjustment to their lives and subjecting them to unique
symptoms and behaviors, which become increasingly difficult to manage, especially
for people of their age.
Option D: Teaching the parents various ways to change would reinforce the
parental assumption of blame; although parents can learn about schizophrenia and
what is helpful and not helpful, the approach suggested in this option implies the
parents’ behavior is at fault. Caring for family members with schizophrenia subjects
caregivers to mostly negative experiences, which in turn negatively impact the
caregivers themselves. These negative aspects experienced by patients’ relatives
as a consequence of their caregiving role are collectively known as ‘burden’.
Attempts have been made in the literature to better define ‘burden’ as the existence
of serious psychosocial and emotional problems, difficulties or negative events,
stressful situations or significant life changes that influence the family member of an
ill relative.
47. Question
The nurse collecting family assessment data asks. “Who is in your family and where do they live?”
Which of the following is the nurse attempting to identify?
A. Boundaries
B. Ethnicity
C. Relationships
D. Triangles
Incorrect
Correct Answer: A. Boundaries
Family boundaries are parameters that define who is inside and outside the system. The
best method of obtaining this information is asking the family directly who they consider to
be members. Every system has ways of including and excluding elements so that the line
between those within the system and those outside of the system is clear to all. If a family
is permeable and has vague boundaries it is considered “open.” Open boundary systems
allow elements and situations outside the family to influence it. It may even welcome
external influences. Closed boundary systems isolate its members from the environment
and seem isolated and self-contained. No family system is completely closed or completely
open.
Option B: Ethnicity is a broader term than race. The term is used to categorize
groups of people according to their cultural expression and identification.
Commonalities such as racial, national, tribal, religious, linguistic, or cultural origin
may be used to describe someone’s ethnicity.
Option C: The relationship between two people or groups is the way in which they
feel and behave towards each other. A relationship is a close connection between
two people, especially one involving romantic or sexual feelings.
Option D: Triangulation or triangling is defined in the AAMFT Family Therapy
Glossary as the “process that occurs when a third person is introduced into a dyadic
relationship to balance either excessive intimacy, conflict, or distance and provide
stability in the system” (Evert et al. 1984 p. 32). This concept is associated with
Murray Bowen (1978) who saw triangulation as a way to reduce anxiety in a dyadic
relationship.
48. Question
According to the family systems theory, which of the following best describes the process of
differentiation?
A. Cooperative action among members of the family.
B. Development of autonomy within the family.
C. Incongruent messages wherein the recipient is a victim.
D. Maintenance of system continuity or equilibrium.
Incorrect
Correct Answer: B. Development of autonomy within the family
Differentiation is the process of becoming an individual developing autonomy while staying
in contact with the family system. “The ability to be in emotional contact with others yet still
autonomous in one’s own emotional functioning is the essence of the concept of
differentiation.” (Kerr & Bowen. 1988) “Differentiation is a product of a way of thinking that
translates into a way of being….Such changes are reflected in the ability to be in emotional
contact with a difficult, emotionally charged problem and not feel compelled to preach
about what others “should” do, not rush in to “fix” the problem and not pretend to be
detached by emotionally insulating oneself.” (Kerr & Bowen 1988).
Option A: Cooperative action among family members does not refer to
differentiation, although individuals who have a high level of differentiation would be
able to accomplish cooperative action. Bowen’s concept of ‘differentiation of self’
forms the basis of a systems understanding of maturity. The concept of
differentiation can be confusing but, put simply, it refers to the ability to think as an
individual while staying meaningfully connected to others. It describes the varying
capacity each person has to balance their emotions and their intellect, and to
balance their need to be attached with their need to be a separate self. Bowen
proposed that the best way to grow a more solid self was in the relationships that
make up our original families; running away from difficult family members would only
add to the challenges in managing relationship upsets.
Option C: Incongruent messages in which the recipient is a victim describe double-
bind communication. In communication, sometimes people say things that are
contradictory to their non-verbal communication cues. When a person’s words don’t
match what he or she is feeling or thinking, the communication is said to be
incongruent.
Option D: Maintenance of system continuity or equilibrium is homeostasis. It’s not
an easy theory to grasp, as it focuses on the big-picture patterns of a system rather
than the narrower view of what causes difficulties for one individual. These ideas
invite us to see the world through the lens of each family member rather than just
from our own subjective experience; they don’t allow room for simply seeing victims
and villains in our relationship networks. Seeing the system takes people beyond
blame to seeing the relationship forces that set people on their different paths. This
way of seeing our life challenges avoids fault-finding and provides a unique path to
maturing throughout our adult lives.
49. Question
The nurse is interacting with a family consisting of a mother, a father, and a hospitalized
adolescent who has a diagnosis of alcohol abuse. The nurse analyzes the situation and agrees
with the adolescent’s view about family rules. Which intervention is most appropriate?
A. The nurse should align with the adolescent, who is the family scapegoat.
B. The nurse should encourage the parents to adopt more realistic rules.
C. The nurse should encourage the adolescent to comply with parental rules.
D. The nurse should remain objective and encourage mutual negotiation of issues.
Incorrect
Correct Answer: D. The nurse should remain objective and encourage mutual
negotiation of issues.
The nurse who wishes to be helpful to the entire family must remain neutral. Taking sides in
a conflict situation in a family will not encourage negotiation, which is important for problem
resolution. Nurses who choose collaboration as their conflict resolution strategy incorporate
others’ ideas into their own; while the result may not be as half-and-half as with the
compromising method, the solution still has aspects of everyone’s opinions and input,
increasing group buy-in and general satisfaction with the final decision.
Option A: If the nurse aligned with the adolescent, then the nurse would be blaming
the parents for the child’s current problem; this would not help the family’s situation.
Learning to negotiate conflict is a function of a healthy family.
Option B: Instead of adopting a “me vs. you” mentality, nurses approaching
interpersonal conflict resolution from a compromising mentality aim to reach a
solution that makes both sides at least partially happy. By doing so, both sides leave
with something they want and are able to move forward with implementing a
solution.
Option C: Encouraging the parents to adopt more realistic rules or the adolescent to
comply with parental rules does not give the family an opportunity to try to resolve
problems on their own. Nurses who choose to use obliging as their main conflict
resolution strategy are people-pleasers. They’re fine accommodating other ideas
even at the expense of shelving or de-prioritizing their own. This can be helpful
when it moves the best solution forward, but it can also be dangerous because it
may lead to a case where an individual withholds valid convictions or opinions just
to “keep the peace.”
50. Question
A 16-year-old girl has returned home following hospitalization for treatment of anorexia nervosa.
The parents tell the family nurse performing a home visit that their child has always done
everything to please them and they cannot understand her current stubbornness about eating.
The nurse analyzes the family situation and determines it is characteristic of which relationship
style?
A. Differentiation
B. Disengagement
C. Enmeshment
D. Scapegoating
Incorrect
Correct Answer: C. Enmeshment
Enmeshment is a fusion or over involvement among family members whereby the
expectation exists that all members think and act alike. The child who always acts to
please her parents is an example of how enmeshment affects development in many cases,
a child who develops anorexia nervosa exerts control only in the area of eating behavior.
Enmeshed families are families in which the individual is expected to give up their own
needs and desires. In enmeshed families, there is a total lack of boundaries, which usually
leads to codependent relationships and a dysfunctional family.
Option A: Differentiation is the process of becoming an individual developing
autonomy while staying in contact with the family system. “The ability to be in
emotional contact with others yet still autonomous in one’s own emotional
functioning is the essence of the concept of differentiation.” (Kerr & Bowen. 1988)
“Differentiation is a product of a way of thinking that translates into a way of being.
Such changes are reflected in the ability to be in emotional contact with a difficult,
emotionally charged problem and not feel compelled to preach about what others
“should” do, not rush in to “fix” the problem and not pretend to be detached by
emotionally insulating oneself.” (Kerr & Bowen 1988).
Option B: The lines of responsibility and authority are strictly enforced and must be
followed; however, they are not necessarily communicated or explained. Access to
all family members, especially parents or those in authority, is limited. Appropriate

communication and expression across subsystems (e.g., children to parents) is
stifled.
Option D: In Family Systems theory, scapegoating in a dysfunctional family system
is understood to be fueled by unconscious processes whereby the family displaces
their own collective psychological difficulties and complexes onto a specific family
member. ‘The Scapegoat’ is one of the roles ‘assigned’ to a child growing up in a
dysfunctional family system (I say more about this process in my answer to question
2). The scapegoating typically (but not always) begins in childhood and often
continues into and throughout adulthood, although the role may be passed around
to different family members at times.
51. Question
Nurse Greta is aware that the following is classified as an Axis I disorder by the Diagnosis and
Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) is:
A. Obesity
B. Borderline personality disorder
C. Major depression
D. Hypertension
Incorrect
Correct Answer: C. Major depression
The DSM-IV-TR classifies major depression as an Axis I disorder. Axis I disorders tend to
be the most commonly found in the public. They include anxiety disorders, such as panic
disorder, social anxiety disorder, and post-traumatic stress disorder. Other examples of
Axis I disorders are as follows: Dissociative disorders. Eating disorders (anorexia nervosa,
bulimia nervosa, etc.) Mood disorders (major depression, bipolar disorder, etc.) Published
by the American Psychiatric Association, the DSM is the mental health bible of sorts. The
DSM-IV organized all psychiatric disorders and other problems into five different categories
or axes.
Option A: Obesity was in Axis III. DSM-IV approached psychiatric assessment and
organization of biopsychosocial information using a multi-axial formulation
(American Psychiatric Association, 2013b). There were five different axes. Axis I
consisted of mental health and substance use disorders (SUDs); Axis II was
reserved for personality disorders and mental retardation; Axis III was used for
coding general medical conditions; Axis IV was to note psychosocial and
environmental problems (e.g., housing, employment); and Axis V was an
assessment of overall functioning known as the GAF.
Option B: Mental disorders are diagnosed according to a manual published by the
American Psychiatric Association called the Diagnostic and Statistical Manual of
Mental Disorders. A diagnosis under the fourth edition of this manual, which was
often referred to as simply the DSM-IV, had five parts, called axes. Each axis of this
multi-axial system gave a different type of information about the diagnosis.
Borderline personality disorder as an Axis II. Axis II provided information about
personality disorders and mental retardation.
Option D: Hypertension was in Axis III. Axis III provided information about any
medical conditions that were present which might impact the patient’s mental
disorder or its management. General Medical Condition (GMC) Axis III is for
reporting current general medical conditions that are potentially relevant to the
understanding or management of the individual’s mental disorder. The purpose of
recording General Medical Conditions on Axis III is to encourage thoroughness in
evaluation/assessment and to enhance communication among healthcare providers.
Axis III also ensures that medical or physical conditions that can directly or indirectly
influence management and treatment are not forgotten.
52. Question
Katrina, a newly admitted is extremely hostile toward a staff member she has just met, without
apparent reason. According to Freudian theory, the nurse should suspect that the client is
experiencing which of the following phenomena?
A. Intellectualization
B. Transference
C. Triangulation
D. Splitting
Incorrect
Correct Answer: B. Transference
Transference is the unconscious assignment of negative or positive feelings evoked by a
significant person in the client’s past to another person. 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: Intellectualization is a defense mechanism in which the client avoids
dealing with emotions by focusing on facts. 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.
Option C: Triangulation refers to conflicts involving three family members.
Triangulation or triangling is defined in the AAMFT Family Therapy Glossary as the
“process that occurs when a third person is introduced into a dyadic relationship to
balance either excessive intimacy, conflict, or distance and provide stability in the
system” (Evert et al. 1984 p. 32).
Option D: Splitting is a defense mechanism commonly seen in clients 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 a borderline personality disorder.
53. Question
An 83-year-old male client is in extended care facility is anxious most of the time and frequently
complains of a number of vague symptoms that interfere with his ability to eat. These symptoms
indicate which of the following disorders?
A. Conversion disorder
B. Hypochondriasis
C. Severe anxiety
D. Sublimation
Incorrect
Correct Answer: B. Hypochondriasis
Complaints of vague physical symptoms that have no apparent medical causes are
characteristic of clients with hypochondriasis. In many cases, the GI system is affected.
Hypochondriasis, which is now known as illness anxiety disorder, and the other somatic
symptom disorders (e.g., factitious disorder, conversion disorder) are among the most
difficult and most complex psychiatric disorders to treat in the general medical setting. On
the basis of many new developments in this field, the DMS-5 has revised diagnostic criteria
to facilitate clinical care and research. While illness anxiety disorder is included in the
category of “somatic symptom and related disorders” it continues to have much overlap
with obsessive-compulsive disorder and related illness.
Option A: Conversion disorders are characterized by one or more neurologic
symptoms. Conversion disorder is a mental condition in which a person has
blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be
explained by medical evaluation. People who have conversion disorder are not
making up their symptoms in order to obtain shelter, for example (malingering). They
are also not intentionally injuring themselves or lying about their symptoms just to
become a patient (factitious disorder). Some health care providers falsely believe
that conversion disorder is not a real condition and may tell people that the problem
is all in their head. But this condition is real. It causes distress and cannot be turned
on and off at will.
Option C: The client’s symptoms don’t suggest severe anxiety. People with anxiety
disorders frequently have intense, excessive and persistent worry and fear about
everyday situations. Often, anxiety disorders involve repeated episodes of sudden
feelings of intense anxiety and fear or terror that reach a peak within minutes (panic
attacks).
Option D: A client experiencing sublimation channels maladaptive feelings or
impulses into socially acceptable behavior. Transforming one’s anxiety or emotions
into pursuits that are considered by societal or cultural norms to be more useful.
This defense mechanism may be present in someone who channels their
aggression and energy into playing sports.
54. Question
Charina, a college student who frequently visited the health center during the past year with
multiple vague complaints of GI symptoms before course examinations. Although physical causes
have been eliminated, the student continues to express her belief that she has a serious illness.
These symptoms are typically of which of the following disorders?
A. Conversion disorder
B. Depersonalization
C. Hypochondriasis
D. Somatization disorder
Incorrect
Correct Answer: C. Hypochondriasis
Hypochondriasis, in this case, is shown by the client’s belief that she has a serious illness,
although pathologic causes have been eliminated. The disturbance usually lasts at least 6
with identifiable life stressor such as, in this case, course examinations. Hypochondriasis,
which is now known as illness anxiety disorder, and the other somatic symptom disorders
(e.g., factitious disorder, conversion disorder) are among the most difficult and most
complex psychiatric disorders to treat in the general medical setting. On the basis of many
new developments in this field, the DMS-5 has revised diagnostic criteria to facilitate
clinical care and research. While illness anxiety disorder is included in the category of
“somatic symptom and related disorders” it continues to have much overlap with
obsessive-compulsive disorder and related illness.
Option A: Conversion disorders are characterized by one or more neurologic
symptoms. Hypochondriasis, which is now known as illness anxiety disorder, and
the other somatic symptom disorders (e.g., factitious disorder, conversion disorder)
are among the most difficult and most complex psychiatric disorders to treat in the
general medical setting. On the basis of many new developments in this field, the
DMS-5 has revised diagnostic criteria to facilitate clinical care and research. While
illness anxiety disorder is included in the category of “somatic symptom and related
disorders” it continues to have much overlap with obsessive-compulsive disorder
and related illness.
Option B: Depersonalization refers to persistent recurrent episodes of feeling
detached from one’s self or body. Depersonalization is described as feeling
disconnected or detached from one’s self. Individuals may report feeling as if they
are an outside observer of their own thoughts or body, and often report feeling a loss
of control over their thoughts or actions.
Option D: Somatoform disorders generally have a chronic course with few
remissions. The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition
(DSM-5) category of Somatic Symptom Disorders and Other Related Disorders
represents a group of disorders characterized by thoughts, feelings, or behaviors
related to somatic symptoms. This category represents psychiatric conditions
because the somatic symptoms are excessive for any medical disorder that may be
present.
55. Question
Nurse Daisy is aware that the following pharmacologic agents are sedative-hypnotic medication is
used to induce sleep for a client experiencing a sleep disorder is:
A. triazolam (Halcion)
B. paroxetine (Paxil)
C. fluoxetine (Prozac)
D. risperidone (Risperdal)
Incorrect
Correct Answer: A. triazolam (Halcion)
Triazolam is one of a group of sedative-hypnotic medications that can be used for a limited
time because of the risk of dependence. Triazolam is used on a short-term basis to treat
insomnia (difficulty falling asleep or staying asleep). Triazolam is in a class of medications
called benzodiazepines. It works by slowing activity in the brain to allow sleep. Triazolam
comes as a tablet to take by mouth. It is usually taken as needed at bedtime but not with or
shortly after a meal. Triazolam may not work well if it is taken with food.
Option B: Paroxetine is a serotonin-specific reuptake inhibitor used for treatment of
depression, panic disorder, and obsessive-compulsive disorder. 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.
Option C: Fluoxetine is a serotonin-specific reuptake inhibitor used for depressive
disorders and obsessive-compulsive disorders. 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 D: Risperidone is indicated for psychotic disorders. The long-acting
risperidone injection has been approved for the use of schizophrenia and
maintenance of bipolar disorder (as monotherapy or adjunctive to valproate or
lithium) in adults. Risperidone has also been used for augmentation of
antidepressant therapy in the treatment of non-psychotic unipolar depression. In
addition to irritability associated with autism, risperidone has also been used for
social impairment, stereotypical behaviors, cognitive problems, and hyperactivity in
autism.
56. Question
Aldo, with a somatoform pain disorder may obtain secondary gain. Which of the following
statements refers to a secondary gain?
A. It brings some stability to the family.
B. It decreases the preoccupation with the physical illness.
C. It enables the client to avoid some unpleasant activity.
D. It promotes emotional support or attention for the client.
Incorrect
Correct Answer: D. It promotes emotional support or attention for the client
Secondary gain refers to the benefits of the illness that allow the client to receive emotional
support or attention. Secondary gain refers to the external benefits that may be derived as
a result of having symptoms. For example, the patient whose sudden onset of paresis
(primary gain) causes his or her spouse to stay in an otherwise failing relationship
(secondary gain).
Option A: A dysfunctional family may disregard the real issue, although some
conflict is relieved. Patients who experience unexplained physical symptoms often
strongly maintain the belief that their symptoms have a physical cause despite
evidence to the contrary. These beliefs are based on false interpretation of
symptoms. Additionally, patients may minimize the involvement of psychiatric factors
in the initiation, maintenance, or exacerbation of their physical symptoms.
Option B: Somatoform pain disorder is a preoccupation with pain in the absence of
physical disease. Pain disorder is fairly common. Although the pain is associated
with psychological factors at its onset (e.g., unexplained chronic headache that
began after a significant stressful life event), its onset, severity, exacerbation, or
maintenance may also be associated with a general medical condition. Pain is the
focus of the disorder, but psychological factors are believed to play the primary role
in the perception of pain.
Option C: Primary gain enables the client to avoid some unpleasant activity. A
decrease in anxiety (gain) from an unconscious defensive operation, which then
causes a physical or conversion symptom, e.g. an arm is voluntarily paralyzed

because it was used to hurt somebody, thereby allaying guilt and anxiety.
57. Question
David is diagnosed with panic disorder with agoraphobia and is talking with the nurse in-charge
about the progress made in treatment. Which of the following statements indicates a positive client
response?
A. “I went to the mall with my friends last Saturday”
B. “I’m hyperventilating only when I have a panic attack”
C. “Today I decided that I can stop taking my medication”
D. “Last night I decided to eat more than a bowl of cereal”
Incorrect
Correct Answer: A. “I went to the mall with my friends last Saturday”
Clients with panic disorder tend to be socially withdrawn. Going to the mall is a sign of
working on avoidance behaviors. Panic disorder and panic attacks are two of the most
common problems seen in the world of psychiatry. Panic disorder is a separate entity than
a panic disorder although it is characterized by recurrent, unexpected panic attacks. Panic
attacks are defined by the Diagnostic and Statistical Manual of Mental Health Disorders
(DSM) as “an abrupt surge of intense fear or discomfort” reaching a peak within minutes.
Option B: Hyperventilating is a key symptom of panic disorder. Teaching breathing
control is a major intervention for clients with panic disorder. Breathing training is a
method of reducing panic symptomatology by utilizing capnometry biofeedback to
decrease the number of episodes of hyperventilation. Several of these slow
breathing techniques have been shown to benefit patients with asthma and
hypertension. Hyperventilation reduction can help patients with cardiovascular
disease.
Option C: The client taking medications for panic disorder; such as tricyclic
antidepressants and benzodiazepines, must be weaned off these drugs.
Antidepressants and benzodiazepines are the mainstays of pharmacologic

treatment. Among the different classes of antidepressants, selective serotonin
reuptake inhibitors (SSRIs) are recommended over monoamine oxidase inhibitors
and tricyclic antidepressants.
Option D: Most clients with panic disorder with agoraphobia don’t have nutritional
problems. It is important for a provider to inform the patient about the symptoms that
he may suffer from if he is diagnosed with the disorder. If a patient is not aware of
these symptoms it is probable that he would fear his condition more and would tend
to get frequent attacks. Pharmacotherapy and cognitive-behavioral therapy should
be discussed with the patients so that they can understand the treatment options for
the condition that they have.
58. Question
The effectiveness of monoamine oxidase (MAO) inhibitor drug therapy in clients with
posttraumatic stress disorder can be demonstrated by which of the following client self–reports?
A. “I’m sleeping better and don’t have nightmares”.
B. “I’m not losing my temper as much”.
C. “I’ve lost my craving for alcohol”.
D. "I’ve lost my phobia for water”.
Incorrect
Correct Answer: A. “I’m sleeping better and don’t have nightmares”
MAO inhibitors are used to treat sleep problems, nightmares, and intrusive daytime
thoughts in individuals with posttraumatic stress disorder. An examination of the available
literature supports the efficacy of monoamine oxidase inhibitors (MAOIs) in treating
posttraumatic stress disorder (PTSD). This effect may or may not be independent of the
response of symptoms of major depression; there is suggestive but inconclusive evidence
supporting both.
Option B: Monoamine oxidase inhibitors (MAOIs) were first introduced in the 1950s.
They are a separate class from other antidepressants, treating different forms of
depression as well as other nervous system disorders such as panic disorder, social
phobia, and depression with atypical features.
Option C: Furthermore, examples of neurological disorders that can benefit from
MAOIs are patients with Parkinson disease as well as those diagnosed with multiple
system atrophy. Multiple system atrophy is a neurodegenerative disease that
includes symptoms affecting movement as well as blood pressure.
Option D: MAO inhibitors aren’t used to help control flashbacks or phobias or to
decrease the craving for alcohol. Monoamine oxidase inhibitors are responsible for
blocking the monoamine oxidase enzyme. The monoamine oxidase enzyme breaks
down different types of neurotransmitters from the brain: norepinephrine, serotonin,
dopamine, as well as tyramine. MAOIs inhibit the breakdown of these
neurotransmitters thus, increasing their levels and allowing them to continue to
influence the cells that have been affected by depression.
59. Question
Mark, with a diagnosis of generalized anxiety disorder, wants to stop taking his lorazepam
(Ativan). Which of the following important facts should nurse Betty discuss with the client about
discontinuing the medication?
A. Stopping the drug may cause depression.
B. Stopping the drug increases cognitive abilities.
C. Stopping the drug decreases sleeping difficulties.
D. Stopping the drug can cause withdrawal symptoms.
Incorrect
Correct Answer: D. Stopping the drug can cause withdrawal symptoms
Stopping anti-anxiety drugs such as benzodiazepines can cause the client to have
withdrawal symptoms. Lorazepam, like other benzodiazepine medications, is a highly
addictive medication. Great care is necessary when prescribing lorazepam at high doses or
prolonged durations, particularly in patients with a history of substance use disorder or
concurrent opioid prescriptions.
Option A: Lorazepam and other benzodiazepines have increased risk of abuse,
misuse, and dependence these medications are contraindicated in the patient who
is actively using illicit substances and drugs. Except for use in Alcohol withdrawal
disorder symptoms and for detoxifications Lorazepam and other benzodiazepines
are contraindicated in patients with h/o alcohol dependence and abuse and not in
remission. Increased risk of fatality with the combined use of alcohol and lorazepam
in overdose, including death.
Option B: Lorazepam can cause CNS and respiratory depression in overdose. It
can lead to hypotension, ataxia, confusion, coma, and can be fatal. Concurrent use
of benzodiazepines and opioids may result in profound sedation, respiratory
depression, coma, and death. Concomitant prescribing of benzodiazepines and
opioids must be reserved for patients for whom alternative treatment options are
inadequate. Dosage and duration of lorazepam must be limited to the minimum
required.
Option C: Stopping a benzodiazepine doesn’t tend to decrease sleeping difficulties.
If administered to patients who on chronic benzodiazepine therapy, the sudden
interruption of benzodiazepine antagonism by flumazenil can induce
benzodiazepine withdrawal, including seizures. Flumazenil has minimal effects on
benzodiazepine-induced respiratory depression, and suitable ventilatory support
should be available in treating acute benzodiazepine overdose.
60. Question
Jennifer, an adolescent who is depressed and reported by her parents as having difficulty in
school is brought to the community mental health center to be evaluated. Which of the following
other health problems would the nurse suspect?
A. Anxiety disorder
B. Behavioral difficulties
C. Cognitive impairment
D. Labile moods
Incorrect
Correct Answer: B. Behavioral difficulties
Adolescents tend to demonstrate severe irritability and behavioral problems rather than
simply a depressed mood. A failure to follow the expected trajectory of social-emotional
development can lead to undetected mental and emotional health problems. Adverse
childhood experiences can alter development significantly. Thus, alongside screening for
child development, actively screening for family dysfunction and supporting families in
establishing a healthy nurturing environment is vital.
Option A: Anxiety disorder is more commonly associated with small children rather
than with adolescents. By having a thorough knowledge of developmental pathways
and adverse childhood experiences, and having a close follow up established with
families in the medical home, pediatricians and medical professionals are in a prime
position to identify risk factors and developmental delays timely.
Option C: Cognitive impairment is typically associated with delirium or dementia.
Medical professionals taking care of children should begin with identifying and
addressing the family’s concerns, asking open-ended questions regarding social-
emotional milestones and intentionally observing parent-child interaction and child’s
interaction with the environment including themselves. While examining the patient,
they should observe age-appropriate developmental interaction. They should give
teenagers the opportunity to engage in health visits in a private and safe
environment without a caregiver.
Option D: Labile mood is more characteristic of a client with cognitive impairment or
bipolar disorder. The American Academy of Pediatrics (AAP) and Bright Futures
Guidelines for Health Supervision of Infants, Children, and Adolescents emphasize
active screening for developmental delays and environmental risk factors on top of
clinical surveillance. This includes the use of standardized screening tools for social-
emotional development and for environmental risks appropriate to the risk level of
the population you serve.
61. Question
Ricardo, an outpatient in a psychiatric facility is diagnosed with dysthymic disorder. Which of the
following statements about dysthymic disorder is true?
A. It involves a mood range from moderate depression to hypomania.
B. It involves a single manic depression.
C. It’s a form of depression that occurs in the fall and winter.
D. It’s a mood disorder similar to major depression but of mild to moderate severity.
Incorrect
Correct Answer: D. It’s a mood disorder similar to major depression but of mild to
moderate severity
Dysthymic disorder is a mood disorder similar to major depression but it remains mild to
moderate in severity. Persistent depressive disorder is a newly coined term in the DSM-5 to
capture what was originally known as dysthymia and chronic major depression. This
disorder has been poorly understood, and its classification has evolved due to the
complicated and ever-evolving nature of the nosology of depressive disorders. It was not
until the DSM-III that dysthymic disorder was defined as a mild chronic depression lasting
longer than 2 years.
Option A: Cyclothymic disorder is a mood disorder characterized by a mood range
from moderate depression to hypomania. Cyclothymia is a primary mood disorder
that is, by definition, characterized by episodes that do not meet the criteria for
hypomania or major depression. 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.
Option B: Bipolar I disorder is characterized by a single manic episode with no past
major depressive episodes. Bipolar 1 disorder has been frequently associated with
serious medical and psychiatric comorbidity, early mortality, high levels of functional
disability and compromised quality of life. The necessary feature of bipolar 1
disorder involves the occurrence of at least one-lifetime manic episode, although
depressive episodes are common.
Option C: Seasonal Affective Disorder is a form of depression occurring in the fall
and winter. Unlike people with classic depression, who typically eat less and sleep
more, people with SAD eat more and sleep more, much like animals hibernating for
the winter. Many patients with SAD do not realize that they have depression,
because they are not necessarily depressed with regard to their mood.
Nevertheless, they feel tired and less interested in things and have increased sleep
and appetite, thus meeting the clinical depression criteria.
62. Question
The nurse is aware that the following ways in vascular dementia different from Alzheimer’s
disease is:
A. Vascular dementia has a more abrupt onset.
B. The duration of vascular dementia is usually brief.
C. Personality change is common in vascular dementia.
D. The inability to perform motor activities occurs in vascular dementia.
Incorrect
Correct Answer: A. Vascular dementia has a more abrupt onset.
Vascular dementia differs from Alzheimer’s disease in that it has a more abrupt onset and
runs a highly variable course. VD is distinguished from other forms of dementia in that it
results from brain ischemia, although the temporal relationship to the ischemic event may
be subtle or go unnoticed. There are various subtypes and multiple terms to describe the
vascular pathology and affected brain tissue, such as multi-infarct dementia, small vessel
disease or Binswanger disease, strategic infarct dementia, hypoperfusion dementia,
hemorrhagic dementia, hereditary vascular dementia, and AD with cardiovascular disease
Option B: The duration of delirium is usually brief. Dementia is a syndrome of
chronic progressive cognitive decline resulting in functional impairment. In the
Diagnostic Manual of Mental Disorders, Fifth Edition (DSM-V), cognitive decline is
quantified as deficits in one or more domains (e.g., memory, executive function,
visuospatial, language, attention). Second, only to Alzheimer’s disease (AD),
vascular dementia (VD) is one of the most common causes of dementia affecting
the elderly (aged greater than 65 years), with a variable presentation and
unpredictable disease progression.
Option C: Personality change is common in Alzheimer’s disease. A thorough history
should be obtained from the patient, focusing on cognitive and functional deficits,
onset, and progression of symptoms. Interviewing family members and caregivers is
important as patients with cognitive decline rarely have insight into their cognitive
and functional limitations.
Option D: The inability to carry out motor activities is common in Alzheimer’s
disease. Caregivers may report an abrupt or stepwise onset of cognitive decline, or
the appearance of symptoms may be subtle without connection to an ischemic
event. The functional assessment should evaluate for impairments in instrumental
activities of daily living (IADLs), such as cooking, driving, and financial and
medication management, and basic activities of daily living (ADLs), such as
dressing, bathing, and toileting. Additionally, patient’s past medical history, current
medications, and surgical history should be obtained. Regarding physical
examination, one should assess patients for focal neurologic deficits.
63. Question
Loretta, a newly admitted client was diagnosed with delirium and has a history of hypertension and
anxiety. She had been taking digoxin, furosemide (Lasix), and diazepam (Valium) for anxiety. This
client’s impairment may be related to which of the following conditions?
A. Infection
B. Metabolic acidosis
C. Drug intoxication
D. Hepatic encephalopathy
Incorrect
Correct Answer: C. Drug intoxication
This client was taking several medications that have a propensity for producing delirium;
digoxin (a digitalis glycoside), furosemide (a thiazide diuretic), and diazepam (a
benzodiazepine). Precipitating factors usually vary among the population. However, drugs
are the most important factor. There are many drugs related to delirium, especially
sedative-hypnotic agents and anticholinergic, but opioid analgesics (especially
meperidine), nonbenzodiazepines, sedatives, hypnotics, antihistamines (especially first
generation), alcohol, anticholinergics, anticonvulsants, tricyclic antidepressants, histamine
H2-receptor blockers, antiparkinsonian agents, antipsychotics (especially low-potency
typical antipsychotics), barbiturates, digoxin, and antibiotics have been reported as well.
The risk increases as high as four and a half times if the patient consumes three or more
drugs (polypharmacy), and the medication is psychoactive.
Option A: Among other precipitating factors are surgery, anesthesia, high pain
levels, anemia, infections, acute illness, and acute exacerbation of chronic illness.
The nature of delirium is transient, but it can persist in patients with predisposing
factors. A systematic review showed that hospital delirium persisted at hospital
discharge in 45% of cases, and one month later in 33% of cases.
Option B: There are two groups of risk factors related to delirium: predisposing and
precipitant factors. The most common predisposing factors are older age (older than
70 years), dementia (often not recognized clinically), functional disabilities, male
gender, poor vision and hearing, and mild cognitive impairment. Alcohol use
disorder and laboratory abnormalities have been associated with an increased risk.
Option D: Sufficient supporting data don’t exist to suspect the other options as
causes. Delirium is a medical condition complex to understand; a single factor can
cause it; however, it is not the common course. The multifactorial model has been
accepted as an interaction of a vulnerable patient with predisposing factors,
exposed to noxious insults or precipitant factors.
64. Question
Nurse Ron enters a client’s room, the client says, “They’re crawling on my sheets! Get them off my
bed!” Which of the following assessments is the most accurate?
A. The client is experiencing aphasia.
B. The client is experiencing dysarthria.
C. The client is experiencing a flight of ideas.
D. The client is experiencing visual hallucination.
Incorrect
Correct Answer: D. The client is experiencing visual hallucination
The presence of a sensory stimulus correlates with the definition of a hallucination, which
is a false sensory perception. Visual hallucinations involve seeing things that aren’t there.
The hallucinations may be of objects, visual patterns, people, or lights. Hallucinations,
defined as the perception of an object or event (in any of the 5 senses) in the absence of
an external stimulus, are experienced by patients with conditions that span several fields
(e.g., psychiatry, neurology, and ophthalmology). When noted by nonpsychiatrists, visual
hallucinations, one type of sensory misperception, often trigger requests for psychiatric
consultation, although visual hallucinations are not pathognomonic of a primary psychiatric
illness.
Option A: Aphasia refers to a communication problem. Aphasia is an impairment of
language, affecting the production or comprehension of speech and the ability to
read or write. Aphasia is always due to injury to the brain-most commonly from a
stroke, particularly in older individuals. But brain injuries resulting in aphasia may
also arise from head trauma, from brain tumors, or from infections.
Option B: Dysarthria is a difficulty in speech production. Dysarthria is a motor
speech disorder in which the muscles that are used to produce speech are
damaged, paralyzed, or weakened. The person with dysarthria cannot control their
tongue or voice box and may slur words. Motor speech disorders like dysarthria
result from damage to the nervous system. Many neuromuscular conditions
(diseases that affect the nerves controlling certain muscles) can result in dysarthria.
In dysarthria, the muscles used to speak become damaged, paralyzed, or
weakened.
Option C: Flight of ideas is rapidly shifting from one topic to another. A nearly
continuous flow of accelerated speech with abrupt changes from topic to topic that
are usually based on understandable associations, distracting stimuli, or plays on
words. When severe, speech may be disorganized and incoherent. It is part of the
DSM-5 criteria for Manic episodes.
65. Question
Which of the following descriptions of a client’s experience and behavior can be assessed as an
illusion?
A. The client tries to hit the nurse when vital signs must be taken.
B. The client says, “I keep hearing a voice telling me to run away”.
C. The client becomes anxious whenever the nurse leaves the bedside.
D. The client looks at the shadow on a wall and tells the nurse she sees frightening
faces on the wall.
Incorrect
Correct Answer: D. The client looks at the shadow on a wall and tells the nurse she
sees frightening faces on the wall.
Minor memory problems are distinguished from dementia by their minor severity and their
lack of significant interference with the client’s social or occupational lifestyle. The
psychological concept of illusion is defined as a process involving an interaction of logical
and empirical considerations. Common usage suggests that an illusion is a discrepancy
between one’s awareness and some stimulus.
Option A: In psychology, the term aggression refers to a range of behaviors that
can result in both physical and psychological harm to yourself, others, or objects in
the environment. This type of behavior centers on harming another person either
physically or mentally. It can be a sign of an underlying mental health disorder, a
substance use disorder, or a medical disorder.
Option B: Auditory hallucinations are the sensory perceptions of hearing voices
without an external stimulus. This symptom is particularly associated with
schizophrenia and related psychotic disorders but is not specific to it. Auditory
hallucinations are one of the major symptoms of psychosis. Nonpsychotic disorders
known to be associated with auditory hallucinations are mood disorders, trauma-
related, substance-related, neurological, personality, as well as their occurrence in
“healthy” individuals.
Option C: Other options would be included in the history data but don’t directly
correlate with the client’s lifestyle. Anxiety is linked to fear and manifests as a future-
oriented mood state that consists of a complex cognitive, affective, physiological,
and behavioral response system associated with preparation for the anticipated
events or circumstances perceived as threatening. Pathological anxiety is triggered

when there is an overestimation of perceived threat or an erroneous danger
appraisal of a situation which leads to excessive and inappropriate responses.
66. Question
During a conversation with Nurse John with a client, he observes that the client shifts from one
topic to the next on a regular basis. Which of the following terms describes this disorder?
A. Flight of ideas
B. Concrete thinking
C. Ideas of reference
D. Loose association
Incorrect
Correct Answer: D. Loose association
Loose associations are conversations that constantly shift in topic. Loose associations
don’t necessarily start in a cogently, then become loose. A manifestation of a thought
disorder whereby the patient’s responses do not relate to the interviewer’s questions, or
one paragraph, sentence, or phrase is not logically connected to those that occur before or
after.
Option A: Flight of ideas is characterized by a conversation that’s disorganized from
the onset. A nearly continuous flow of accelerated speech with abrupt changes from
topic to topic that are usually based on understandable associations, distracting
stimuli, or plays on words. When severe, speech may be disorganized and
incoherent. It is part of the DSM -5 criteria for Manic episodes.
Option B: Concrete thinking implies highly definitive thought processes. Concrete
thinking is reasoning that’s based on what you can see, hear, feel, and experience in
the here and now. It’s sometimes called literal thinking, because it’s reasoning that
focuses on physical objects, immediate experiences, and exact interpretations.
Option C: Ideas of reference or delusions of reference involve a person having a

belief or perception that irrelevant, unrelated or innocuous things in the world are
referring to them directly or have special personal significance. The two are clearly
distinguished in psychological literature.
67. Question
Francis tells the nurse that her coworkers are sabotaging the computer. When the nurse asks
questions, the client becomes argumentative. This behavior shows personality traits associated
with which of the following personality disorders?
A. Antisocial
B. Histrionic
C. Paranoid
D. Schizotypal
Incorrect
Correct Answer: C. Paranoid
Because of their suspiciousness, paranoid personalities ascribe malevolent activities to
others and tend to be defensive, becoming quarrelsome and argumentative. Paranoid
personality disorder (PPD) is one of a group of conditions called “Cluster A” personality
disorders which involve odd or eccentric ways of thinking. People with PPD also suffer from
paranoia, an unrelenting mistrust and suspicion of others, even when there is no reason to
be suspicious.
Option A: Clients with antisocial personality disorder can also be antagonistic and
argumentative but are less suspicious than paranoid personalities. 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: Clients with histrionic personality disorder are dramatic, not suspicious
and argumentative. Histrionic personality disorder, or dramatic personality disorder,
is a psychiatric disorder distinguished by a pattern of exaggerated emotionality and
attention-seeking behaviors. Histrionic personality disorder falls within the “Cluster
B” of personality disorders. Cluster B personality disorders include conditions such
as narcissistic personality disorder, borderline personality disorder, and antisocial
personality disorder. These personality disorders are commonly described as
dramatic, excitable, erratic, or volatile.
Option D: Clients with schizoid personality disorder are usually detached from
others and tend to have eccentric behavior. The schizoid personality type was made
official in DSM III in 1980, to describe persons experiencing significant ineptitude in
forming meaningful social relationships. Isolation is a salient feature in the history of
a schizoid patient. Rarely do they have close relationships, and often they will
choose to participate in occupations that are solitary in nature. They infrequently
experience strong emotion, express little to no desire for sexual activity with a
partner, and tend to be ambivalent to criticism or praise.
68. Question
Which of the following interventions is important for a Cely experiencing a paranoid personality
disorder taking olanzapine (Zyprexa)?
A. Explain effects of serotonin syndrome.
B. Teach the client to watch for extrapyramidal adverse reactions.
C. Explain that the drug is less effective if the client smokes.
D. Discuss the need to report paradoxical effects such as euphoria.
Incorrect
Correct Answer: C. Explain that the drug is less effective if the client smokes.
Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine is a
second-generation (atypical) antipsychotic medication. Olanzapine also has approval for
use with fluoxetine, a selective serotonin reuptake inhibitor (SSRI), in patients with
episodes of depression associated with bipolar disorder type 1 and treatment-resistant
depression.
Option A: Serotonin syndrome occurs with clients who take a combination of
antidepressant medications. Serotonin syndrome is a potentially life-threatening
condition precipitated by the use of serotonergic drugs. It may be a consequence of
therapeutic medication use, accidental interactions between medications or
recreational drugs, or intentional overdose. Symptoms can range from mild to fatal
and classically include altered mental status, autonomic dysfunction, and
neuromuscular excitation.
Option B: Extrapyramidal adverse reactions aren’t a problem. However, the client
should be aware of adverse effects such as tardive dyskinesia. Olanzapine’s
mechanism of action also lends itself to directly causing adverse reactions
associated with the dopaminergic blockade. Patients taking olanzapine have a risk
of developing akathisia, extrapyramidal symptoms, tardive dyskinesia, and
neuroleptic malignant syndrome. However, the risk of developing these side effects
is lesser than first-generation antipsychotics due to the loose association and quick
dissociation of olanzapine with the D2 receptors.
Option D: Olanzapine doesn’t cause euphoria. One of the most common adverse
effects of olanzapine is the potential for gaining weight. Olanzapine causes an
increase in appetite leading to hyperphagia with a consequence of weight gain.
Therefore, it should be used cautiously in patients who are obese, have little control
over their food intake, and do not exercise regularly to combat weight gain.
69. Question
Nurse Alexandra notices other clients on the unit avoiding a client diagnosed with antisocial
personality disorder. When discussing appropriate behavior in group therapy, which of the
following comments is expected about this client by his peers?
A. Lack of honesty
B. Belief in superstition
C. Show of temper tantrums
D. Constant need for attention
Incorrect
Correct Answer: A. Lack of honesty
Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown by
lying. 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: Clients with schizotypal personality disorder tend to be superstitious. It is
unlikely that a person with a schizoid personality disorder will present in the clinical
setting of his own volition unless prompted by family, or as a result of a co-occurring
disorder, such as depression. As with most personality disorders, the behavior is in
synchrony with the ego, and thus the patient does not acknowledge the need to
adapt his or her behavior.
Option C: Histrionic personality disorder, or dramatic personality disorder, is a
psychiatric disorder distinguished by a pattern of exaggerated emotionality and
attention-seeking behaviors. Histrionic personality disorder falls within the “Cluster
B” of personality disorders. Cluster B personality disorders include conditions such
as narcissistic personality disorder, borderline personality disorder, and antisocial
personality disorder. These personality disorders are commonly described as
dramatic, excitable, erratic, or volatile. Specifically, people with histrionic personality
disorder typically present as flirtatious, seductive, charming, manipulative, impulsive,
and lively.
Option D: Clients with histrionic personality disorders tend to overreact to
frustrations and disappointments, have temper tantrums, and seek attention. People
with a histrionic personality disorder may feel underappreciated or disregarded when
they are not the center of attention. These people are typically the life of the party
and have a “larger than life” presence. They may be vibrant, enchanting, overly
seductive, or inappropriately sexual with most of the people they meet, even when
they are not sexually attracted to them. People presenting with a histrionic
personality disorder may demonstrate rapidly shifting and shallow emotions that
others may perceive as insincere.
70. Question
Tommy, with a dependent personality disorder, is working to increase his self-esteem. Which of
the following statements by Tommy shows teaching was successful?
A. “I’m not going to look just at the negative things about myself”.
B. “I’m most concerned about my level of competence and progress”.
C. “I’m not as envious of the things other people have as I used to be”.
D. “I find I can’t stop myself from taking over things others should be doing”.
Incorrect
Correct Answer: A. “I’m not going to look just at the negative things about myself”
As the clients make progress on improving self-esteem, self-blame and negative self-
evaluation will decrease. Dependent personality disorder (DPD) is a type of anxious
personality disorder. People with DPD often feel helpless, submissive or incapable of
taking care of themselves. They may have trouble making simple decisions. But, with help,
someone with a dependent personality can learn self-confidence and self-reliance.
Option B: Clients with dependent personality disorder tend to feel fragile and
inadequate and would be extremely unlikely to discuss their level of competence
and progress. People with DPD have an overwhelming need to have others take
care of them. Often, a person with DPD relies on people close to them for their
emotional or physical needs. Others may describe them as needy or clingy.
Option C: These clients focus on self and aren’t envious or jealous. People with
DPD may believe they can’t take care of themselves. They may have trouble making
everyday decisions, such as what to wear, without others’ reassurance.
Option D: Individuals with dependent personality disorders don’t take over
situations because they see themselves as inept and inadequate. Statistics show
that roughly 10% of adults have a personality disorder. Less than 1% of adults meet
the criteria for DPD. More women than men tend to have DPD.
71. Question
Norma, a 42-year-old client with a diagnosis of chronic undifferentiated schizophrenia lives in a

rooming house that has a weekly nursing clinic. She scratches while she tells the nurse she feels
creatures eating away at her skin. Which of the following interventions should be done first?
A. Talk about his hallucinations and fears.
B. Refer him for anticholinergic adverse reactions.
C. Assess for possible physical problems such as rash.
D. Call his physician to get his medication increased to control his psychosis.
Incorrect
Correct Answer: C. Assess for possible physical problems such as rash
Clients with schizophrenia generally have poor visceral recognition because they live so
fully in their fantasy world. They need to have an in-depth assessment of physical
complaints that may spill over into their delusional symptoms. Over half of the patients
have significant comorbidities, both psychiatric and medical, making it one of the leading
causes of disability worldwide. The diagnosis correlates with a 20% reduction in life
expectancy, with up to 40% of deaths attributed to suicide.
Option A: Talking with the client won’t provide an assessment of his itching. A
thorough risk assessment must also be undertaken to determine the risk of harm to
self and others. The first schizophrenic episode usually occurs during early
adulthood or late adolescence. Individuals often lack insight at this stage; therefore
few will present directly to seek help for their psychotic symptoms.
Option B: Itching isn’t an adverse reaction of antipsychotic drugs. Common
presentations include a relative noticing social withdrawal, personality changes or
uncharacteristic behavior; deliberate self-harm or suicide attempts; calling the police
to report their delusional symptoms or referral via the criminal justice system. The
use of screening tools such as COPS (Criteria of Prodromal Syndromes), SIPS
(Structured Interview for Prodromal Syndromes) and PACE (Personal Assessment
and Crisis Evaluation Clinic) has been shown to increase the detection rate of
schizophrenia in premorbid states although there is controversy surrounding

indicating treatment at this stage.
Option D: Calling the physician to get the client’s medication increased doesn’t
address his physical complaints. After conducting a full psychiatric history, it is
imperative to conduct a thorough systems review and a mental state examination
where appearance, behavior, mood, speech, cognition, and insight need to be
assessed, alongside determining evidence of perceptual delusions or formal thought
disorders.
72. Question
Ivy, who is in the psychiatric unit is copying and imitating the movements of her primary nurse.
During recovery, she says, “I thought the nurse was my mirror. I felt connected only when I saw
my nurse.” This behavior is known by which of the following terms?
A. Modeling
B. Echopraxia
C. Ego-syntonicity
D. Ritualism
Incorrect
Correct Answer: B. Echopraxia
Echopraxia is the copying of another’s behaviors and is the result of the loss of ego
boundaries. The involuntary imitation of the movements of another person. Echopraxia is a
feature of schizophrenia (especially the catatonic form), Tourette syndrome, and some
other neurologic diseases. From echo + the Greek praxia meaning action.
Option A: Modeling is the conscious copying of someone’s behaviors. Modeling is
one way in which behavior is learned. When a person observes the behavior of
another and then imitates that behavior, he or she is modeling the behavior. This is
sometimes known as observational learning or social learning. Modeling is a kind of
vicarious learning in which direct instruction need not occur.
Option C: Ego-syntonicity refers to behaviors that correspond with the individual’s

sense of self. Thoughts, wishes, impulses, and behavior are said to be ego-syntonic
when they form no threat to the ego and can be acted upon without interference
from the superego.
Option D: Ritualism behaviors are repetitive and compulsive. Ritualism is a concept
developed by American sociologist Robert K. Merton as a part of his structural strain
theory. It refers to the common practice of going through the motions of daily life
even though one does not accept the goals or values that align with those practices.
73. Question
Jun approaches the nurse and tells that he hears a voice telling him that he’s evil and deserves to
die. Which of the following terms describes the client’s perception?
A. Delusion
B. Disorganized speech
C. Hallucination
D. Idea of reference
Incorrect
Correct Answer: C. Hallucination
Hallucinations are sensory experiences that are misrepresentations of reality or have no
basis in reality. Hallucinations are sensations that appear to be real but are created within
the mind. Examples include seeing things that are not there, hearing voices or other
sounds, experiencing body sensations like crawling feelings on the skin, or smelling odors
that are not there.
Option A: Delusions are beliefs not based on reality. Delusions are defined as fixed,
false beliefs that conflict with reality. Despite contrary evidence, a person in a
delusional state can’t let go of their convictions. Delusions are often reinforced by
the misinterpretation of events. Many delusions also involve some level of paranoia.
Option B: Disorganized speech is characterized by jumping from one topic to the

next or using unrelated words. Disorganized speech is characterized by a collection
of speech abnormalities that can make a person’s verbal communication difficult or
impossible to comprehend. It is a symptom of schizophrenia.
Option D: An idea of reference is a belief that an unrelated situation holds special
meaning for the client. An idea of reference—sometimes called a delusion of
reference—is the false belief that irrelevant occurrences or details in the world relate
directly to oneself. Ideas of reference are variations on this behavior, and occur
when a person believes something is referring to them when it is not. For example, a
person shopping in a store might see two strangers laughing and believe that they
are laughing at him or her when in reality the other two people do not even notice
the person. Some mental health professionals believe this thought error is a type of
cognitive bias.
74. Question
Mike is admitted to a psychiatric unit with a diagnosis of undifferentiated schizophrenia. Which of

the following defense mechanisms is probably used by Mike?
A. Projection
B. Rationalization
C. Regression
D. Repression
Incorrect
Correct Answer: C. Regression
Regression, a return to earlier behavior to reduce anxiety, is the basic defense mechanism
in schizophrenia. 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 A: Projection is a defense mechanism in which one blames others and

attempts to justify actions; it’s used primarily by people with paranoid schizophrenia
and delusional disorder. 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 B: Rationalization is a defense mechanism used to justify one’s action. The
justification of one’s behavior through attempts at a rational explanation. This
defense mechanism may be present in someone who steals money but feels
justified in doing so because they needed the money more than the person from
whom they stole.
Option D: Repression is the basic defense mechanism in the neuroses; it’s an
involuntary exclusion of painful thoughts, feelings, or experiences from awareness.
Subconsciously blocking ideas or impulses that are undesirable. This defense
mechanism may be present in someone who has no recollection of a traumatic
event, even though they were conscious and aware during the event.
75. Question
Rocky has started taking haloperidol (Haldol). Which of the following instructions is most
appropriate for Ricky before taking haloperidol?
A. Should report feelings of restlessness or agitation at once.
B. Use sunscreen outdoors on a year-round basis.
C. Be aware you’ll feel increased energy taking this drug.
D. Avoid eating sugar-free sweets.
Incorrect
Correct Answer: A. Should report feelings of restlessness or agitation at once
Haloperidol is a first-generation (typical) antipsychotic medication that is used widely
around the world. Food and Drug Administration (FDA) approved the use of haloperidol is
for schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and
children), hyperactivity (which may present as impulsivity, difficulty maintaining attention,
severe aggressivity, mood instability, and frustration intolerance), severe childhood
behavioral problems (such as combative, explosive hyperexcitability), intractable hiccups. It
is a typical antipsychotic because it works on positive symptoms of schizophrenia, such as
hallucinations and delusions.
Option A: Agitation and restlessness are adverse effects of haloperidol and can be
treated with anticholinergic drugs. Due to the blockade of the dopamine pathway in
the brain, typical antipsychotic medications such as haloperidol have correlations
with extrapyramidal side effects.
Option B: Haloperidol isn’t likely to cause photosensitivity or control essential
hypertension. Due to potential side effects development, patients receiving
haloperidol require monitoring, especially when receiving the intramuscular form. It
can be easily monitored by taking blood levels. It has a therapeutic range of 2 to 15
ng/ml in serum. Blood levels should be monitored at 12-hour or 24-hour intervals or
after the last dose of haloperidol use in a patient.
Option C: Although the client may experience increased concentration and activity,
these effects are due to a decrease in symptoms, not the drug itself. 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 D: Haloperidol may produce anticholinergic side effects such as dry mouth,
hence the health care provider will teach the client interventions to relieve symptoms
such as chewing a sugarless hard candy or gum.
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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
with anything ❤️❤️❤️❤️❤️❤️
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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ade
August 27, 2021 at 12:48 PM
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September 28, 2021 at 7:12 AM
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Thanks you for your incredible work.
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ade
October 1, 2021 at 12:57 PM
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October 29, 2021 at 8:19 AM
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Reply
stellah
February 4, 2022 at 2:00 PM
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Reply
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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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April 24, 2022 at 12:48 PM
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June 5, 2022 at 5:29 AM
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Zee
June 30, 2022 at 9:02 AM
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January 27, 2023 at 2:39 PM
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2/13/23, 11:03 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:

NOTICE TO ALL USERS

2. Comprehensive Mental Health and Psychiatric Nursing NCLEX Practice |

Comprehensive Mental Health and Psychiatric

Your time: 00:01:09

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

Congratulations, you have completed this quiz!

A. Rely on nonverbal communication

B. Select symbolic pictures as aids

C. Speak in universal phrases

D. Use the services of an interpreter

behavior should be considered—cognitions, emotions, and moods are far too

A. “I guess you’re worried about something, aren’t you?

B. “Can I get you some medication to help calm you?”

C. “Have you been pacing for a long time?”

D. “I notice that you’re pacing. How are you feeling?”

A client with obsessive-compulsive disorder is hospitalized in an inpatient unit. Which nursing

A. Accepting the client’s obsessive-compulsive behaviors.

B. Challenging the client’s obsessive-compulsive behaviors.

C. Preventing the client’s obsessive-compulsive behaviors.

D. Rejecting the client’s obsessive-compulsive behaviors.

A. Education and work history

C. Physical health status

D. Quality of spousal relationship

A. Emphasize the importance of good nutrition to establish normal weight.

gastroenterologist, and nurses. The disorder cannot be prevented and there is no

A. The parents reinforce increased decision making by the client.

B. The parents clearly verbalize their expectations for the client.

C. The client verbalizes that family meals are now enjoyable.

D. The client tells her parents about feelings of low self-esteem.

A. The client will recognize signs and symptoms of physical illness.

B. The client will cope with physical illness.

C. The client will take prescribed medications.

A. Wait for the client to bring up the subject of suicide.

B. Observe the client’s behavior for cues of suicide ideation.

C. Question the client directly about suicidal thoughts.

D. Question the client about future plans.

A. The client verbalizes feelings directly during treatment.

B. The client verbalizes a positive “self” statement.

C. The client speaks in coherent sentences.

D. The client reports feelings calmer.

A. Disturbed thought processes

C. Risk for self-directed violence

D. Impaired social interaction

Correct Answer: C. Risk for self-directed violence

A. Symptoms of this disease imbalance in the brain.

B. Genetic history is an important factor related to the development of schizophrenia.

C. Schizophrenia is a serious disease affecting every aspect of a person’s functioning.

D. The distressing symptoms of this disorder can respond to treatment with

C. The client will take prescribed medications without difficulty.

D. The client will participate in unit activities.

olanzapine, risperidone, quetiapine, asenapine, lurasidone, sertindole, ziprasidone,

B. Impaired social interaction

C. Disturbed sensory-perceptual alteration (auditory)

D. Risk for other-directed violence

Option A: The defining characteristics of mania are increased talkativeness, rapid

A. Restlessness, short attention span, hyperactivity.

B. Physical aggressiveness, low-stress tolerance, disregard for the rights of others.

C. Deterioration in social functioning, excessive anxiety, and worry, bizarre behavior.

D. Sadness, poor appetite and sleeplessness, loss of interest in activities.