Psychiatric – Mental Health Nursing Final Coaching

(Ricky Vanguardia)

1. The nurse leading parent education classes bases instruction on Erikson’s developmental stages. It
follows that the nurse will plan to instruct the parents that a helpful strategy to foster a child’s
initiative would be to:
a. Offer several different options for dressing and encourage the child to select one of them.
b. Allow the child to help wash the unbreakable dishes used to serve breakfast.
c. Provide one-on-one parent child time each evening before bed.
d. Enroll the child in a weekend, age-appropriate sports program.

2. Which of the following responses would the nurse expect from a 12-year-old regarding stealing?
a. You are never allowed to steal.
B. You go to jail is you steal someone else’s things.
c. My parents would punish me if I was caught stealing.
d. Stealing food when you don’t have anything to eat is alright.

3. A nursing diagnosis of hopelessness would be considered for an individual who:

a. Was consistently overprotected by family members
b. Was raised by parents who were strict disciplinarians
c. Had inconsistent, unpredictable physical care as an infant
d. As a teenager always felt unaccepted by his social peers

4. An adolescent has been a consistently, poor academic student due to a learning disorder. Which
statement overheard by the nurse would support the possibility of a problem with the developmental
stage competence versus inferiority?
a. It’s too hard to get good grades.
b. I’ll never be able to get into a good college.
c. My parents are disappointed that I do so poorly in school.
d. I don’t want people to know I can barely read or write.

5. A parent is concerned with the interpersonal skills of her 12-year-old son. Based on interpersonal
theory, the nurse asks:
a. Does your son belong to team or club with friends or classmates?
b. Does he feel bad when he does something he knows he shouldn’t do?
c. How does he tend to act when he doesn’t get exactly what he wants?
d. How confident is he in situations that are generally unfamiliar for him?

6. The parents of an 8-year-old are attempting to help their child comprehend new information.
Which intervention suggested by the nurse shows an understanding of the cognitive development
theory for this age group?
a. The use of drawing and illustrations
b. Comparing the child’s experiences to the new material
c. Encouraging the child to talk about this new information
d. Asking the child to give a reason for how they feel about new information

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7. According to Piaget, which of the following would the nurse consider normal when assessing a 6-
year-old?
a. Playing with an imaginary friend
b. Talking about their best friend
c. Enjoying putting puzzles together
d. Knowing it’s wrong to tell a lie

8. Which developmental level would be characterized by a child being able to focus, to coordinate,
and to imagine a series of events?
a. Preoperational
b. Concrete operational
c. Formal operational
d. Postoperational

9. Which strategy will the nurse include in the plan of care for a 6-year-old child for whom operant
conditioning has been recommended?
a. Periodically asking the child to attempt to solve increasingly difficult puzzles
b. Consistently offering praise when the child puts his dirty clothes in the hamper
c. Expecting the child to rinse and to place his dirty dishes in the sink
d. Conditioning the child to expect punishment when he misbehaves

10. A child who has been physically abused becomes emotionally distorted when told that the parent
will no longer be allowed to visit. Which principle of social learning theory is most likely for the child’s
response?
a. The child views the abuse to be more desirable than the parent leaving.
b. The parent has fostered a fear in the child that increases when they are apart.
c. The child believes that he is responsible for the parent now being punished.
d. The parent has likely told the child that he deserved the abuse as a punishment.

11. A patient who was savagely attacked by a bear has no memory of the event. Which statement
best explains the patients inability to remember the attack?
a. The woman lost consciousness and was not cognitively aware of what happened during the attack
b. The brain has produced a chemical anemia that will repress the memories of the attack
indefinitely.
c. The patient is unconsciously using a defense mechanism to protect against the repeated memory
of the attack.
d. It is a temporary suppression of the attack; her memory will return when she is physically and
emotionally ready to handle the memories.

12. Which assessment finding exhibited by a patient being assessed for posttraumatic stress disorder
(PTSD) would be considered a defining behavior and support such a diagnosis?
a. Can describe the attack in great detail
b. Experiences dramatic swings in affect
c. Describes vivid flashbacks of being attacked
d. Is preoccupied with the need to tell someone about the attack

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13. What is the basis for assessing a male patient who is agoraphobic for panic attacks?
a. Men are more likely to experience panic attacks.
b. An overwhelming number of agoraphobic patients also have panic attacks.
c. Patients are often unaware that the symptoms they are experiencing are those of panic.
d. Panic attacks are generally the cause of a patient developing phobias like agoraphobia.

14. Discharge preparation for a patient includes the administration of the Hamilton Anxiety Scale
(HAS). When asked by the patient to explain the purpose of the assessment the nurse responds:
a. It is an assessment tool used to evaluate the symptoms of anxiety.
b. The tool is used to help confirm the diagnosis of anxiety disorder.
c. This tool helps determine if your symptoms have improved with treatment.
d. It helps identify the presence of any other disorder associated with anxiety.

15. A patient is admitted for treatment for persistent, severe anxiety. Which nursing diagnosis would
help effectively direct patient care?
a. Disturbed sensory perception related to narrowed perceptual field
b. Risk for injury related to closed perception
c. Hopelessness related to total loss of control
d. Risk for other-directed violence related to combative behavior

16. The patient was an awkward child who was ridiculed by his father for his inability to catch a ball.
As an adult, the patient developed panic attacks at the time his company established after-work team
sporting activities. Which data discussed during the nursing interview provides insight to the possible
cause of this anxiety disorder when applying the behavioral model?
a. He always avoids sports because Im short and not the least bit athletic.
b. When in fifth grade, the patient caused his team to lose the big softball game.
c. The company he works for places tremendous emphasis of successful team work.
d. As a child he wore a leg brace that prevented him from participating in school sports.

17. The nurse is working with the family of a patient with obsessive-compulsive disorder (OCD).
Which concept should the nurse incorporate in the teaching plan?
a. The thoughts, images, and impulses are voluntary.
b. The family should pay immediate attention to symptoms.
c. The thoughts, images, and impulses tend to worsen with stress.
d. OCD is a chronic disorder that does not respond to treatment.

18. Which question would assist the nurse in determining whether the patient has been experiencing
anxiety?
a. Have you had difficulty concentrating lately?
b. Have you been feeling sad and especially lonely?
c. Do you have a history of failed personal relationships?
d. Do you frequently experience difficulty controlling your anger?

19. The nurse working with patients diagnosed with posttraumatic stress disorder (PTSD) is aware of
the need to intervene early in order to de-escalate a patients increasing anxiety level. Which patient
behavior is likely an early indication of escalating anxiety?

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a. Talking rapidly
b. Pacing around the unit
c. Staring out the window
d. Refusing to go to therapy

20. The nurse has been working with a patient who experiences anxiety. Which intervention should
the nurse implement initially when the patient is observed pacing and wring her hands?
a. Asking how she has managed anxiety effectively in the past
b. Distracting her by offering to help her make a telephone call
c. Asking her what she believes is causing her increased anxiety
d. Teaching her to take deep, relaxing breaths to manage the anxiety

21. The nurse is working with a patient with an anxiety disorder whose treatment includes cognitive
behavioral therapy. Which statement by the patient gives the nurse reason to assume that the
patient has an understanding of the basis of this type of therapy?
a. My abusive childhood has resulted in my overreaction to stress.
b. My delusional thoughts of extreme anxiety are what cause my panic attacks.
c. My brain chemistry causes me to overreact to common stress by getting so anxious.
d. I’ve learned to react to my daily stress by having anxious thoughts and panic attacks.

22. Which verbal intervention would the nurse use when helping a patient who is experiencing severe
to panic-level anxiety?
a. I will stay with you to make sure you remain safe.
b. First, you must stop pacing and wringing your hands.
c. How can I help you get control of yourself and this anxiety?
d. Can you tell me what was happening just before you got upset?

23. The nurse notes that a patient being treated for an anxiety disorder is becoming more anxious
sitting in a congested, noisy room waiting to see the therapist. Which intervention will the nurse
implement initially to assist the patient in de-escalating his anxiety?
a. Offering to reschedule the patients appointment
b. Taking the patient to an unoccupied interview room
c. Notifying the therapist of the need to see the patient stat
d. Requesting oral prn anxiolytic medication for the patient

24. A patient is ordered medication therapy to manage the symptoms of anxiety disorder. Which
statement by the patient indicates an understanding of the typical classification of medication
prescribed for this disorder?
a. Tricyclic antidepressants are particular good for panic attacks.
b. I have to give up beer while taking monamine oxidase inhibitors (MAOIs).
c. Selective serotonin reuptake inhibitors (SSRIs) help with panic attacks as well.
d. Benzodiazepines are usually effective when taken for chronic anxiety like mine.

25. A patient with OCD tells the nurse, Thinking these thoughts and doing all my rituals is beyond
being silly. I have few friends and I know others laugh behind my back. I sometimes think I can

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control things, but I always find I can’t. I don’t know if I can continue to live this way. Which
assessment question shows the nurse has an understanding of this patient’s priority risk?
a. Are you feeling hopeless?
b. Do you think you are socially isolated?
c. Have you been thinking about hurting yourself?
d. Do the rituals affect how you feel about yourself?

26. Which question would the nurse performing an admission interview for a patient with suspected
dissociative amnesia disorder identify as a priority?
a. What help would you like us to give you?
b. Are you experiencing a high level of anxiety?
c. Do you find rituals make you feel more comfortable?
d. How would you describe your childhood memories?

27. Which nursing assessment finding would support a diagnosis of somatoform disorder?
a. Patient reports a family history of depression
b. The onset of symptoms beginning at age 38
c. An abnormality of the patients left heart ventricle
d. Complaints of diarrhea and an erratic menstrual cycle

28. To differentiate between somatoform and conversion disorders, the nurse will direct the
assessment to determine the presence of the critical defining factor associated with conversion
disorder. Which is true about a conversion reaction?
a. Symptoms are generally associated with pain or sexual function.
b. Symptoms are not accounted for by a medical condition.
c. Symptoms are precipitated by psychological factors.
d. Symptoms are under the patients voluntary control.

29. A diagnosis of dissociative identity disturbance has been identified for a patient who has stated
that he is unable to distinguish between himself and his surroundings. What is an appropriate
outcome for this patient?
a. Refers to himself as the patient
b. Identifies the onset of increasing anxiety
c. Uses manipulative behaviors to meet needs
d. Displays ability to suppress feelings of dissatisfaction

30. A patient comes to the ED stating that he suddenly became deaf. It is determined that his wife
has recently asked for a divorce. What is the basis for the possibility that this patient is experiencing
a conversion disorder?
a. Inventing the symptom helps in diverting attention from the marital problems.
b. Such a traumatic life change is likely to result in some form of mental illness.
c. The loss is a protective mechanism to help deal with overwhelming anxiety.
d. Men often exhibit this disorder since it is more accepted than showing sadness.

31. A patient reports severe pain during intercourse since being sexually assaulted three years ago.
What is the first step in confirming the diagnosis of a pain disorder?

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a. Evaluating the patients understanding of the emotional effects of the assault
b. Asking the patient to keep a journal of her feelings regarding the assault
c. Assessing the patient for posttraumatic stress disorder
d. Ruling out a physical cause of the pain

32. A patient has developed an acute loss of hearing and is diagnosed with a conversion disorder.
Which nursing diagnosis would be most appropriate?
a. Hearing impairment
b. Panic-level anxiety
c. Disturbed sensory perception
d. Denial due to a medical condition

33. A patient experiencing the sudden onset of blindness is diagnosed with a conversion disorder.
Which nursing intervention would be most therapeutic?
a. Suggesting to the patient that this is possibly malingering
b. Assisting him to make an appointment with an ophthalmologist
c. Providing nursing care in a supportive but matter-of-fact manner
d. Providing an occupational therapy consult to address the needs of a blind person

34. A patient is being evaluated for the diagnosis of hypochondriasis. Which assessment observation
of the patient would serve to confirm this diagnosis?
a. Reports, Pain in my back is certainly from a spinal tumor.
b. Patient expresses no concern over her sudden loss of hearing.
c. Patient shows insight into the role stress plays in the illness.
d. Reports, I don’t like doctors and so I haven’t been to one in years.

35. A patient who inaccurately believes he has stomach cancer is recommended cognitive theory to
help address this false believe. Which intervention is most consistent with a cognitive theory
approach?
a. Continuing to challenge the patient about the rationality of his belief
b. Assisting him to reinterpret the meaning of the sensations his body is creating
c. Urging him to have a second opinion consult with another medical specialist
d. Rewarding him with praise and acceptance when he states, I do not have cancer.

36. The ED nurse is caring for a patient with a dissociative fugue. Which assessment finding would
support this diagnosis?
a. Reports of pain in both legs and abdomen
b. An inability to recall how and when he arrived in this city
c. Change in voice and attitude suggesting two distinct personality states
d. Inability to see since witnessing an accident that resulted in two deaths

37. A nurse interviews a 17-year-old patient and notes these assessment data: excessive grooming,
checking in the mirror, and preoccupation with perceived physical imperfections. The nurse suspects:
a. Hypochondriasis
b. Factitious disorder
c. Somatoform disorder

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d. Body dysmorphic disorder

38. The nurse reinforces the recommendation of group therapy for a patient with a somatization
disorder. What knowledge is this recommendation based upon?
a. Group therapy is the one therapy of choice for this anxiety disorder.
b. Group therapy is therapist driven and managed to eliminate stress on the patients.
c. The group will support the patient in all complaints of physical illness as well as emotional distress.
d. This therapy allows the patient to learn what has successfully worked for other patients with the
disorder.

39. A family member asks the nurse about possible medications to treat somatization disorders.
Which statement by the nurse shows an understanding of the recognized medication therapy for this
disorder?
a. Hypnotics, taken appropriately will help with your major complaints.
b. Lithium will require regular monitoring to assure therapeutic blood levels.
c. Antidepressant therapy may take several weeks to bring about symptom relief.
d. Anticonvulsants are often used to treat the side effects of these type of disorders

40. A patient has a somatization disorder. Which statement by the patient would indicate a need for
additional patient teaching?
a. I have learned that my family can be a support system.
b. I will let my therapist know if I think suicidal thoughts.
c. Drinking strong coffee really helps me combat my fatigue.
d. Nicotine makes my heart race, so I need to stop smoking.

41. The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity.
Which statement would be most consistent with this symptom?
a. I can’t do anything anymore.
b. I’m the worlds most astute financier.
c. I can understand why my wife is upset that I overspend.
d. I can’t understand where all the money in our family goes.

42. The nurse will base a discussion of dysthymia on the fact that the condition:
a. Typically has an acute onset
b. Involves delusional thinking
c. Is chronic low-level depression
d. Does not include suicidal ideation

43. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include
exaggerated physical activity, agitation, insomnia, and anorexia?
a. Risk for injury
b. Chronic low self-esteem
c. Noncompliance
d. Insomnia

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44. A patient has been admitted with a diagnosis of atypical depression. In planning interventions,
the nurse would expect to consider the characteristic symptom of:
a. Seasonal episodes
b. Leaden paralysis
c. Psychomotor agitation
d. Increased depression in the morning

45. An inappropriately dressed patient has not slept for 3 days while making excessive, expensive
long-distance phone calls. When the patient can be heard singing loudly in the examining room, the
nurse makes initial plans to focus on:
a. Assessing needs for food, liquids, and rest
b. Setting strict limits on dress and behavior
c. Conducting an in-depth suicide assessment
d. Obtaining a complete psychosocial assessment

46. Which statement by the patient would indicate the need for additional education regarding the
prescribed lithium treatment regimen?
a. I will restrict my daily salt intake.
b. I will take my medications with food.
c. I will have my blood drawn on schedule.
d. I will drink 8 to 12 glasses of liquids daily.

47. The nurse would evaluate that patient education regarding lithium therapy for an individual with
bipolar disorder as effective if the patient states:
a. I can stop my lithium when I feel better.
b. I can continue with my diuretic and cardiac medications.
c. I will probably need to take the lithium for the rest of my life.
d. I will taper my lithium when a therapeutic serum level is achieved.

48. A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department
with a list of medications he is taking. Which of the medications on the list would require re-
evaluation of lithium dosage?
a. HydroDIURIL daily
b. Navane bid
c. Ativan at bedtime
d. Cefobid daily

49. Which outcomes would be appropriate to determine early favorable response to antidepressant
medication?
a. The patient will complete own self-care activities.
b. The patient will demonstrate assertive communication skills.
c. The patient will describe signs and symptoms of major depression.
d. The patient will make plans to attend one community social activity a week.

50. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine
the patients:

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a. Mood and affect
b. Activity level
c. Cognitive ability to understand information about the medication
d. Support network and its members willingness to participate in treatment

51. A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior observed
in the patient supports that diagnosis?
a. Uses a rhyming form of speech
b. Refuses to eat any unwrapped foods
c. Laughs when watching a sad movie
d. Maintains an immobilized state for hours

52. What would be an appropriate short-term outcome for a patient diagnosed with residual
schizophrenia who exhibits ambivalence?
a. Decide their own daily schedule.
b. Decide which unit groups they will attend.
c. Choose which clinic staff member to work with.
d. Choose between two outfits to wear each morning.

53. What is the priority nursing diagnosis for a catatonic patient?

a. Ineffective coping
b. Impaired physical mobility
c. Impaired social interaction
d. Risk for deficient fluid volume

54. Which nursing diagnosis is appropriate for a patient who insists being called Your Highness and
demonstrates loosely associated thoughts?
a. Risk for violence
b. Defensive coping
c. Impaired memory
d. Disturbed thought processes

55. Which initial short-term outcome would be appropriate for a patient who was admitted expressing
delusional thoughts?
a. Accept that delusion is illogical.
b. Distinguish external boundaries.
c. Explain the basis for the delusions.
d. Engage in reality-oriented conversation.

56. Which of the following interventions should the nurse plan to use to reduce patient focus on
delusional thinking?
a. Confronting the delusion
b. Refuting the delusion with logic
c. Exploring reasons the patient has the delusion
d. Focusing on feelings suggested by the delusion

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57. Which assessment observation supports a patients diagnosis of disorganized schizophrenia?
a. Reports suicidal ideations
b. Last relapse was 6 years ago
c. Consistent inappropriate laughing
d. Believes that the government is out to get me

58. A patient tried to gouge out his eye in response to auditory hallucinations commanding, If thine
eye offends thee, pluck it out. The nurse would analyze this behavior as indicating:
a. Derealization
b. Inappropriate affect
c. Impaired impulse control
d. Inability to manage anger

59. An appropriate intervention for a patient with an identified nursing diagnosis of situational low
self-esteem would be:
a. Providing large muscle activities to relieve stress
b. Attempting to determine triggers to hallucinations
c. Engaging patient in activities designed to permit success
d. Encouraging verbalization of feelings in a safe environment

60. A 19-year-old patient is admitted for the second time in 9 months and is acutely psychotic with a
diagnosis of undifferentiated schizophrenia. The patient sits alone rubbing her arms and smiling. She
tells the nurse her thoughts cause earthquakes and that the world is burning. The nurse assesses the
primary deficit associated with the patients condition as:
a. Social isolation
b. Disturbed thinking
c. Altered mood states
d. Poor impulse control

61. When analyzing the behaviors of a 23-year-old who meets the criteria for antisocial personality
disorder, the nurse recognizes that which nursing diagnosis would be pertinent to his care?
a. Risk for self-mutilation
b. Disturbed personal identity
c. Impaired social interaction
d. Social isolation

62. Which observation is supportive of a diagnosis of avoidant personality disorder?

a. Talks about my three failed marriages
b. Cries loudly whenever requests are denied
c. Fears criticism from others, including staff
d. Shows no remorse when accidentally breaking another patients bracelet

63. Which behavior is supportive of a diagnosis of dependent personality disorder?

a. Perceives personal behavior to be embarrassing
b. Believes they are incapable of functioning independently
c. Tends to exaggerate the potential dangers of ordinary situations

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d. Demands excessive attention from others whenever in a group situation

64. When planning care for a patient with antisocial personality disorder, which consideration has
greatest importance?
a. Addressing the demand for constant attention
b. Teaching coping skills related to frustration tolerance
c. Identifying behaviors related to well-developed superegos
d. Managing the manipulative behaviors resulting from a charming persona

65. When a patient diagnosed with borderline personality disorder experiences the death of a beloved
parent, which characteristic response will the nurse anticipate?
a. Denies the death for a protracted period of time
b. Exhibits several different psychotic thought processes
c. Expresses extreme anger and rage by burning the parents clothes
d. Becomes uncharacteristically helpful and attends to the funeral arrangements

66. A 27-year-old woman diagnosed with borderline personality disorder displays a labile affect,
impulsivity, frequent angry outbursts, and difficulty tolerating her angry feelings without self-injury. A
priority nursing diagnosis for this patient is:
a. Anxiety
b. Risk for self-mutilation
c. Risk for other-directed violence
d. Ineffective coping

67. Which outcome has priority for a patient with borderline personality disorder being discharged
from an outpatient treatment environment?
a. Patient demonstrates control over self-destructive impulses.
b. Patient can identify symptoms that indicate a need for psychotherapy.
c. Patient demonstrates an understanding of the importance of medication compliance.
d. Patient actively participates in a community 12-step group related to relevant care.

68. A patient who is diagnosed with schizoid personality disorder is isolative, does not speak to her
peers, and sits through the community meeting without speaking. Her mother describes her as shy
and having few friends. Which would be an appropriate nursing diagnosis for this patient?
a. Anxiety related to a new environment as evidenced by isolation and not talking with peers
b. Ineffective coping related to new environment as evidenced by isolation and minimal interaction
with others
c. Impaired social interaction related to unfamiliar environment as evidenced by isolation and not
talking with peers
d. Disturbed thought processes related to a new environment as evidenced by isolation and minimal
interactions with others

69. The nurse is careful to provide a quiet, comfortable, safe environment when conducting an
assessment interview. What is the reason this is particularly important when working with a patient
believed to be exhibiting characteristics of a personality disorder?
a. These patients are generally experiencing chronic depression and are severely impaired socially.

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b. A high stimulus environment will cause the patient to exhibit exacerbated behaviors that are loud
and attention seeking.
c. The patient is easily intimidated and may become so withdrawn that the assessment will be
difficult if not impossible to complete.
d. This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into
anger when the patient feels threatened.

70. When facilitating change in the behavior of a patient diagnosed with a personality disorder, which
intervention will have the greatest impact on success?
a. Collaborating with the patient when establishing treatment goals
b. Educating the patient to the importance of complying with treatment interventions
c. Evaluating the patients understanding of the etiology of the prescribed medications
d. Conducting regular assessments so the treatment can be changed when necessary

71. The mother of a teen with an eating disorder expresses a concern that the family is responsible
for the problem. Which question will best help the nurse identify another influence that is likely to
have played a role in the teenagers eating disorder?
a. Does she have an after-school job?
b. Does she have access to nutritious foods?
c. Is there a family history of underweight adults?
d. Is your daughter interested in clothes and fashion?

72. Long-term prognosis for eating disorders is improved dramatically when treatment includes long-
term cognitive-behavioral therapy. What statement provides the best explanation to the patient for
this component to the treatment plan?
a. This will help you identify a healthy, weight restoration diet.
b. Medication alone will not help you from relapsing back to your old habits.
c. In order to manage your disorder, you have to understand the root problems.
d. Prognosis has been proven to be much better with both medication and therapy.

73. The nurse is identifying outcomes for a teenager diagnosed with anorexia nervosa. Which
outcome has the greatest impact on long-term prognosis?
a. Verbalize underlying psychological issues.
b. Demonstrate effective coping skills related to conflict management.
c. Demonstrate improvement in body imagine reflecting a realistic viewpoint.
d. Consume adequate calories appropriate for age, height, and metabolic needs.

74. The nurse observes a distorted thinking pattern in a teenage patient diagnosed with an eating
disorder. Which statement characterizes personalization by the patient?
a. Ive got to be thin to get a good job.
b. There is no such thing as a healthy carbohydrate.
c. My mother and dad fight all the time because Im fat.
d. My whole family will be disgraced if I dont get into a good college.

75. A 16-year-old patient has anorexia nervosa. Which term used to describe the menstrual history is
characteristic of this disorder?

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a. Amenorrhea
b. Dysmenorrhea
c. Premenstrual syndrome
d. Heavy menstrual flow

76. A 14-year-old patient newly admitted to the eating disorders unit refuses to eat meals and angrily
shouts at the nurse, You cant make me eat! Ill do whatever I want to do. Which nursing intervention
demonstrates an understanding of the priority safety issue for this anorexic patient?
a. Placing the patients favorite low calorie beverages in open view
b. Assigning a staff member to one-on-one observation of the patient
c. Unlocking the patients bathroom only at specific times during the day
d. Explaining to the patient that they will be required to keep an eating journal

77. A nursing intervention that will be planned to occur early in the nurse-patient relationship with a
patient with an eating disorder is:
a. Using confrontation to attack denial
b. Placing the patient in a therapeutic group
c. Formulating a therapeutic nurse-patient alliance
d. Attacking enmeshment by separating patient and family

78. A patient is being assessed for a binge-eating associated eating disorder. Which assessment
question is directed towards collecting data on the most commonly abused substance among this
patient population?
a. How much alcohol do you drink on a weekly basis?
b. Do you use amphetamines to help control your weight?
c. Do you rely on laxatives to control your bowel movements?
d. How many packs of cigarettes do you smoke on a daily basis?

79. The nurse is caring for a patient who is being treated for comorbid eating and affective disorders.
For which medication would the nurse expect to prepare a patient teaching plan?
a. Fluoxetine (Prozac)
b. Diazepam (Valium)
c. Lorazepam (Ativan)
d. Lithium

80. The nurse manager on the psychiatric unit was explaining to the new staff the differences
between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics:
a. Remain in the system longer
b. Act more quickly to reduce delusions
c. Produce fewer extrapyramidal effects
d. Are risk free for neuroleptic malignant syndrome (NMS)

81. The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol
(Haldol) develops a:
a. 30 mm Hg decrease in blood pressure reading
b. Respiratory rate of 24 respirations per minute

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c. Temperature reading of 104 F
d. Pulse rate of 70 beats per minute

82. A patient taking fluphenazine (Prolixin) complains of dry mouth and blurred vision. What would
the nurse assess as the likely cause of these symptoms?
a. Decreased dopamine at receptor sites
b. Blockade of histamine
c. Cholinergic blockade
d. Adrenergic blocking

83. Which behavior displayed by a patient receiving a typical antipsychotic medication would be
assessed as displaying behaviors characteristic of tardive dyskinesia (TD)?
a. Grimacing and lip smacking
b. Falling asleep in the chair and refusing to eat lunch
c. Experiencing muscle rigidity and tremors
d. Having excessive salivation and drooling

84. When the nurse realizes that a patient diagnosed with schizophrenia is not taking the prescribed
oral haloperidol (Haldol), which intervention would promote medication compliance?
a. Instructing the patient to have friends monitor his medications
b. Beginning administration of haloperidol (Haldol) decanoate
c. Writing instructions in detail for the patient to follow
d. Changing haloperidol to an atypical antipsychotic

85. When asked how tricyclic antidepressants affect neurotransmitter activity, the nurse should
respond that they:
a. Decrease available dopamine.
b. Increase availability of norepinephrine and serotonin.
c. Make available increased amounts of monoamine oxidase.
d. Increase the effects of the chemical gamma-aminobutyric acid.

86. A severely depressed patient has been prescribed clomipramine (Anafranil). For which medication
side effects should the patient be monitored?
a. Excess salivation and drooling
b. Muscle rigidity and restlessness
c. Polyuria and coarse hand tremors
d. Orthostatic hypotension and constipation

87. Which of these statements made by a patient taking the MAOI phenelzine (Nardil) would warrant
further instruction?
a. I often forget to wear sunscreen when I go outside.
b. I need to restrict the amount of sodium in my diet.
c. I should not use over-the-counter cold medications.
d. I usually order liver and onions when my wife and I eat out.

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88. Which patient complaint should receive priority from a patient who is taking the MAOI
tranylcypromine (Parnate)?
a. I haven’t had a bowel movement in 2 days.
b. Will you take my temperature? I feel too warm.
c. I get a headache when I drank several cups of coffee.
d. My legs get stiff when I sit in the chair for any length of time.

89. Sertraline (Zoloft) has been prescribed for a patient with symptoms of a major depression. Which
factor was probably most important in the physicians decision to use an SSRI?
a. Good side-effect profile
b. Less expense for the patient
c. Increase in medication compliance
d. Rapid rate of absorption from the GI tract

90. Which statement made by a patient who will be maintained on lithium following discharge will
require further instruction by the nurse?
a. I will have my blood work done regularly.
b. When I get home, I may go on a salt-free diet.
c. I have learned not to restrict my intake of water.
d. I understand some people gain weight on lithium.

91. Which intervention best reflects the nursing role regarding effective implementation of behavioral
therapy goals?
a. Administering the prescribed medications accurately
b. Interacting effectively with members of the health care team
c. Being aware of all the patient related therapeutic modalities
d. Evaluating patient behaviors to reward economic tokens appropriately

92. A new nurse asks the mentor, How can I be sure Im developing a therapeutic environment for
my unit? The mentor uses as a basis for the response the fact that a therapeutic milieu is
characterized by:
a. Rigid adherence to timelines and unit routine
b. Relaxation of boundaries when doing so is accepted by all
c. The focus of the staff is directed to the most critically disturbed patients
d. Specific patient-centered goals are established mutually by patient and staff

93. To plan care for a patient with a psychiatric disorder, the nurse keeps in mind that the primary
nursing role related to therapeutic activities is:
a. Assisting the patient in accomplishing the activity
b. Ensuring that the patient will comply with the rules of the activity
c. Ensuring that the patient can accomplish the activity in a timely manner
d. Providing a support system for the patient if they fail to complete the activity
94. Which statement would the nurse use to describe the primary purpose of boundaries?
a. Boundaries define responsibilities and duties to ones self in relation to others.
b. Boundaries determine objectives of the various working stage of the relationship.
c. Boundaries differentiate the assumed roles of both the nurse and of the patient.

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d. Boundaries prevent undesired material from emerging during the interaction.

95. Which action will best facilitate the development of trust between a nurse and patient?
a. Responding positively to the patients demands
b. Following through with whatever was promised
c. Clarifying with the patient whenever there is doubt
d. Staying available to the patient for the entire shift

96. Which statement best defines the nurses initial role as the patients source of help in addressing
interpersonal problems?
a. I’ll work with your doctor to help you get better.
b. I’ll be working with you to help solve your marital troubles.
c. Your medications will help you feel better as soon as they take effect.
d. You will be expected to attend the group activities while you are here.

97. The nurse is determining whether the patients needs could be best met in a task or a process
group. The decision is based on the understanding that a task group focuses on:
a. Content issues
b. The here and now
c. Communication styles
d. Relations among the members

98. The treatment team was engaged in planning how group therapy could be included as a part of
the structured daily activities of the unit. A new team member asked, Why is it so important to
include group therapy for the patients? The most accurate response would be based on the
assumption that:
a. Hidden agendas frequently surface in group sessions.
b. Some persons do not relate well on an individual basis.
c. Group therapy is far more cost-effective for the patients.
d. Psychopathology has its source in disordered relationships.

99. Which patient would the group co-leaders determine is demonstrating Yaloms therapeutic factor
termed universality?
a. Patient A, who states he realizes he is not the only person who has a problem with loneliness
b. Patient B, who displays dysfunctional interaction patterns learned in his family of origin
c. Patient C, who states he finally feels a strong sense of belonging
d. Patient D, who openly expresses his anger about his work

100. A nurse, leading an inpatient group dealing with womens issues, identifies a patient who is
assuming the role of aggressor. Which behavior characterizes this role?
a. Attempting to manipulate others
b. Mediating conflicts and disagreements
c. Criticizing the contributions of others
d. Seeking a position between contending sides

*****END OF EXAMINATION*****

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