PSYCHIATRIC NURSING

1. A patient is brought to the hospital by his officemates because he kept on blaming his immediate
superior of getting him fired from his job. Ethical problems may arise when diagnosing psychiatric
patients because of:

a. Inadequate communication skills

b. Self-doubt

c. Lack of compassion

d. Subjectivity

2. An accepting attitude requires being:

a. In control of tendency to blame

b. Tolerant to the fault of others

c. Aware of one’s biases

d. Non-judgmental

3. Considering that a man is by nature social, it is best for the nurse to gain self-awareness by:

a. Participating in intensive group experience

b. Individual psychotherapy

c. Hypnotherapy

d. Writing an autobiography for self-introspection

4. The nurse has achieved self-awareness in which of the following verbalizations?

a. With the patient’s tone of voice and stare, I got reminded of how my father would be so angry and this
made me anxious

b. Every time people around me yell, I feel upset and withdrawn

c. I thought it was rude for the patient to yell, hence I kept quiet

d. When the patient yelled at me, I became speechless

5. During the orientation of new staff to the mental health unit, the nurse states, “I’m not sure how I’ll
react when faced with a violent client.” Which response by the nurse manager would enhance the
nurse’s self-awareness?

a. “How would you go about de-escalating a violent individual?”

b. “Have you had a negative experience with a violent individual?

c. “Describe what you would do when the client becomes aggressive.”

d. “Think about how you usually respond to angry or aggressive people.”

6. Self-awareness, knowledge and understanding of human behavior and communication skills define
what is essential in caring for patients for every nurse to be able to demonstrate:

a. Positive self-projection

b. Assertiveness

c. Therapeutic use of self

d. Self-mastery

7. The nurse is caring for multiple clients with unpredictable and often dangerous behaviors on a mental
health unit. Which is the nurse’s best method for managing the safety of multiple clients?

a. Monitor client medication effectiveness

b. Develop a trusting relationship with clients

c. Document client behavior that is disturbing

d. Keep clients separated as much as possible

8. In tending to mental health patients, the role of psychiatric nurse is to help them understand “what”
they are doing and “why” are they doing it. The nurse strives to accomplish which of the following while
engaged in a nurse-client relationship?

a. Authoritarian figure

b. Rapport building

c. Evaluation of interventions

d. Development of social relationship

9. A client is admitted to the impatient psychiatric unit. After the assessment and admission procedures
were completed, the nurse states, “I’ll try to be available to talk with you when needed and will spend
time with you each morning from 10:00 until 10:30 in a specific corner of the dayroom.” What is the
main rationale for communicating these planned nursing interventions?

a. To attempt to establish a trusting relationship

b. To provide a structured environment for the client

c. To instill hope in the client

d. To provide time for completing nursing responsibilities

10. Which statements best describes a therapeutic relationship?

a. The focus is on the client; problems are discussed by the nurse and client; solutions are
implemented by the client.

b. The focus shifts from nurse to client; advice is given by both parties; solutions are implemented by
each.

c. The focus is socialization; mutual needs are met; feelings are shared.

d. The focus is the creation of a partnership whereby each member is concerned with growth and
satisfaction of the other.

11. The nurse is administering psychotropic medication to a patient. The patient refused to take the
medication. Which of the following situations would guide the nurse when a patient refuse medication?

a. A patient cannot refuse his medication regardless of his medical diagnosis

b. A patient needs a court order to allow him to refuse his medication

c. A patient can refuse a medication if he has not been deemed incompetent by legal formal procedures

d. A patient may refuse the medications only if hi attending physician agrees

12. On review of the client’s record, the nurse notes that the admission was voluntary. Based on this
information, the nurse plans care anticipating which client behavior?

a. Fearfulness regarding treatment measures

b. Anger and aggressiveness directed toward others

c. An understanding of the pathology and symptoms of the diagnosis

d. A willingness to participate in the planning of the care and treatment plan

13. The client who is involuntarily committed to an inpatient psychiatric unit loses which right?

a. Right to freedom

b. Right to refuse treatment

c. Right to sign legal documents

d. Right to confidentiality

14. When reviewing the admission assessment, the nurse notes that a client was admitted to the mental
health unit involuntarily. Based on this type of admission, the nurse should provide which intervention
for this client?

a. Monitor closely for harm to self or others.

b. Assist in completing an application for admission.

c. Supply the client with written information about her or his mental health problem.

d. Provide an opportunity for the family to discuss why they felt the admission was needed

15. The nurse calls security and has physical restraints applied to a client who was admitted voluntarily
when the client becomes verbally abusive, demanding to be discharged from the hospital. Which
represents the possible legal ramifications for the nurse associated with these interventions?

a. Libel and slander

b. Battery and false imprisonment

c. Assault and slander

d. Libel and False imprisonment

16. A client admitted voluntarily for treatment of an anxiety problem demands to be released from the
hospital. Which action should the nurse take initially?

a. Contact the client’s health care provider (HCP).

b. Call the client’s family to arrange for transportation.

c. Attempt to persuade the client to stay “for only a few more days.”
d. Tell the client that leaving would likely result in an involuntary commitment.

17. A hospitalized client with a history of alcohol misuse tells the nurse, “I am leaving now. I have to go. I
don’t want any more treatment. I have things that I have to do right away.” The client has not been
discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse
discusses the client’s concerns with the client, the client dresses and begins to walk out of the hospital
room. What action should the nurse take?

a. Call the nursing supervisor.

b. Call security to block all exit areas.

c. Restrain the client until the primary health care provider (PHCP) can be reached.

d. Tell the client that the client cannot return to this hospital again if the client leaves now.

18. The most important role of psychiatric nurses as a member of a team is to:

a. carry out medical orders

b. meet the needs for the physical and mental well-being of the client

c. coordinated the psychological care and management of clients

d. keeps a constant monitoring of the clients

19. The multidisciplinary team decides to implement behavior modification with a client. Which of the
following nursing actions is of primary importance during this time?

a. Confirm that all staff members understand and comply with the treatment plan

b. Ensure that the potent reinforcers (rewards) are important to the client

c. Establish a fixed interval schedule for reinforcement

d. Establish mutual agreed upon, realistic goals

20. A client is participating in a therapy group and focuses on viewing all team members as equally
important in helping the clients meet their goals. The nurse is implementing which therapeutic
approach?

a. Milieu therapy

b. Interpersonal therapy
c. Behavior modification

d. Gestalt therapy

21. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The
neighbor says to the nurse, “How is Carol doing? She is my best friend and is seen at your clinic every
week.” Which is the most appropriate nursing response?

a. “I cannot discuss any client situation with you.”

b. “If you want to know about Carol, you need to ask her yourself.”

c. “Only because you’re worried about a friend, I’ll tell you that she is improving.”

d. “Being her friend, you know she is having a difficult time and deserves her privacy.”

22. When the client who is experiencing persecutory delusions is released from the seclusion room, he
approaches the nurse and requests assistance to escape from the psychiatric unit. Which of the following
actions would be most appropriate?

a. Encourage the client to verbalize the delusions

b. Logically explain the nature of the delusions to the client

c. Attempt to learn the meaning of the delusions to the client

d. Point out the false beliefs present in the patient’s delusions

23. A client experiencing paranoid delusions tells a nurse that “The foreigner who lives next to me wants
to kill me.” Which nursing response is most therapeutic to assist the client experiencing paranoid
delusions?

a. “Do you feel afraid that people are trying to hurt you?”

b. “That’s not true. I’m sure your neighbor is a nice person.”

c. “What makes you think your neighbor wants to kill you?”

d. “You believe that your foreign neighbor really wants to kill you?”

24. A nurse attempts to explain to a client who has been experiencing paranoid delusions that laboratory
blood work has been ordered. The client begins to shout, “You all just want to drain my blood. Get away
from me!” Which nursing response is most therapeutic?
a. “I’ll leave and come back later when you are calmer.”

b. “What makes you think that I want to drain your blood?”

c. “You know I am not going to hurt you; I am here to help you!”

d. “It must be extremely frightening to think others want to hurt you.”

25. A client who is experiencing paranoid delusions asks a nurse to turn off the television stating, “It
controls my thoughts.” Which is the most appropriate intervention by the nurse?

a. Refuse the request in order to show control over the client.

b. Refuse the request to avoid supporting the client’s delusions.

c. Comply with the request in order to lessen the client’s concerns/fears.

d. Comply with the request to show an understanding of the client’s concerns/fears.

26. The nurse is evaluating a client diagnosed with paranoid schizophrenia who reports hearing a voice
that says, “Do not remove your hat because they will be able to read your mind.” Which response by the
nurse is the most therapeutic?

a. “Who are ‘they’?”

b. “Why would someone want to read your mind?”

c. “I do not believe that anyone can read another’s mind.”

d. “It must be very frightening to believe that someone can read your mind.”

27. A nurse is evaluating a client experiencing paranoid delusions. The client states, “Two men wearing
gray shirts keep coming into the dayroom and watching me.” Which of the nurse’s responses is most
therapeutic when communicating to a client with paranoid delusions?

a. “What makes you think they are interested in you?”

b. “I don’t believe you have anything to worry about.”

c. “Ignore them, and let’s select a movie to watch after dinner.”

d. “Those are maintenance personnel discussing the room remodeling.”

28. The nurse observes that a client with a potential for violence is agitated, pacing up and down the
hallway, and making aggressive and belligerent gestures at other clients. Which statement would be
most appropriate to make to this client?

a. “You need to stop that behavior now.”

b. “You will need to be placed in seclusion.”

c. “You seem restless; tell me what is happening.”

d. “You will need to be restrained if you do not change your behavior.”

29. The physician recommends that a client have a partial bowel resections and an ileostomy. Later, the
client’s says to the nurse, “The doctor of mine surely likes to play big. I’ll bet the more he can cut, the
better he likes it.” Which of the following replies by the nurse would be most therapeutic?

a. “What do you mean by that statement”

b. “I can tell you more about the surgery if you would like”

c. “Aren’t you being a bit hard on him? He’s trying to help you”

d. “Does the remark have something to do with the operation he wants you to

have?”

30. A newly admitted client describes her mission in life as one of saving her son by eliminating the
“provocative sluts” of the world. There are several attractive young women on the unit. What would be
the most important action of the nurse?

a. Ask the client for her definition of “provocative sluts.”

b. Ask the young female clients on the unit to dress less provocatively.

c. Ask the client to discuss her concerns in the next group session.

d. Ask the client to inform the staff if she has negative thoughts about other clients.

31. A client becomes increasingly morose and irritable after being told that she has cancer. She is rude to
visitors and pushes nurses away when they attempt to give her medications and treatments. Which of
the following would the nurse do when the client has a hostile outburst?

a. Offer the client positive reinforces each time she cooperates

b. Encourage the client to discuss her immediate concerns and feelings

c. Encourage the client to direct her anger at staff members instead of her visits

d. Continue with the assigned tasks and duties as though nothing has happened

32. In which situation is a client at risk for delayed or inhibited grief?

a. When a client’s family expects the client to maintain normalcy

b. When a client experiences denial during the first week after the loss

c. When a client experiences anger toward the deceased within the first month after the loss

d. When a client experiences preoccupation with the deceased for more than 1 years after the loss

33. Which of the following situations will the nurse consider as a risk factor for complicated grief?

a. Having a family member admitted and intubated in the ICU for a severe case of COVID 19

b. Death of a spouse by suicide

c. Death of an abusive ex-husband

d. Death of several community leaders from COVID 19

34. The client becomes physically with frequent crying episodes, intense feelings of worthlessness, and
loss of appetite on the 9th death anniversary of her spouse. What should be the nurse’s focus when
counseling the client?

a. Anticipatory grief

b. Abbreviated grief

c. Disenfranchised grief

d. Dysfunctional grief

35. Physiologic responses of complicated grieving include

a. tearfulness when recalling significant memories of the lost one.

b. impaired appetite, weight loss, lack of energy, and palpitations.

c. depression, panic disorders, and chronic grief.

d. impaired immune system, increased serum prolactin level, and increased mortality rate from heart
disease.

36. The nurse is conducting an initial assessment of client in crisis. What is the most appropriate
question for the nurse to ask?

a. “What leads you to seek help?”

b. “Who is available to help you?”

c. “What do you usually do to feel better?”

d. “With whom do you live?”

37. A client expresses feelings of hopelessness and helplessness about her husband being diagnosed
with severe COVID 19 and her inability to care for him. Of the following issues, which would be the best
for the client to focus on first?

a. Her husband’s present illness

b. her past losses of significant others

c. her loneliness and despair

d. her future loss of her husband

38. The nurse in the emergency department is caring for a young female victim of sexual assault. The
client’s physical assessment is complete, and physical evidence has been collected. The nurse notes that
the client is withdrawn, distracted, tremulous, and bewildered at times. How should the nurse interpret
these behaviors?

a. Signs of depression

b. Reactions to a devastating event

c. Evidence that the client is a high suicide risk

d. Indicative of the need for hospital admission

39. A crisis intervention nurse meets a young client who was admitted after attempting suicide by
slashing his wrist. The nurse’s initial goal at this time is to:

a. Determining the precipitating event, determine how many people are involved in the incident and
determine how angry the client is
b. Determine if the client has intermediate support system, determine what the people in the support
system think of the client cutting wrist and determine the level of the anger of the client

c. Determine the precipitating event, determine if the client has an immediate support system, and
assess the likelihood of the immediate recurrence of the suicidal act

d. Assess the likelihood of the suicidal act, determine what made the client angry then determine the
angry the client is

40. The nurse is working with a client who, despite making a heroic effort, was unable to rescue a
neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the
working phase of the nurse– client relationship?

a. Exploring the client’s ability to function

b. Exploring the client’s potential for self-harm

c. Inquiring about the client’s appraisal of why the rescue was unsuccessful

d. Inquiring about and examining the client’s feelings for any that may block adaptive coping

41. A client came to the crisis center for assistance after he was accidentally involved in the Tokhang
operations in Tondo, Manila where he witnessed one of his close friends killed by the police. The client
says he has been feeling very anxious since that incident happened. The nurse working with the client
chooses which of the following to help him cope with the experience?

a. Arrange for his priest to visit with him

b. Advise him to avoid going near the area until he is able to cope up

c. Send him to the emergency department for further evaluation because he is experiencing a crisis,
which is an emergency.

d. Create an opportunity to him to talk about his experience, ask him about how he has coped thus far,
and explore enhanced coping skill

42. The nurse is caring for a client in crisis has the goal of providing the client:

a. Stress management and problem-solving techniques

b. An insight-oriented analytic approach

c. Medication to sedate the client

d. Non-directive techniques such as free association

43. The young adult after being robbed is attending counseling sessions to address anxiety issues. What
is the nurse’s best response when the client asks, “When will things get better for me?”

a. “These types of crises are self-limiting, and usually things are better in 4 to 6 weeks.”

b. “Try not to worry; it is best for you to think about the future and not focus on the past.”

c. “Being assaulted is traumatic; in time the anxiety will lessen, and you’ll feel more in control.”

d. “By using the skills you’re learning, the goal for you is to feel better or be back to normal in about 6
weeks.”

44. The nurse observes the client, who has a history of aggressive behavior toward others, swearing and
kicking the furniture in the dayroom. Based on the client’s behavior, nursing intervention should focus
on?

a. De-escalate the client’s agitation

b. Eliminate the source of agitation

c. Assess the client’s agitation level

d. Provide for a safe, therapeutic milieu.

45. Which nursing interventions is considered inappropriate for a hospitalized client with mania who is
exhibiting manipulative behavior?

a. Communicate expected behaviors to the client.

b. Assist the client in identifying ways of setting limits on personal behaviors.

c. Follow through about the consequences of behavior in a nonpunitive manner.

d. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups.

46. The effective use of limit setting with hyperactive clients requires all of the following except:

a. Providing a consistent, structured environment so the client knows what is expected of him or her

b. Specific limits to be used must be understood and agreed upon by all staff members on all shifts

c. The client’s requests for greater freedom should be granted to evaluate the progress that has been
made
d. Consequences should be direct results of behaviour that are perceived by the client as negative
outcomes

47. A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly
states that this is inappropriate and will not be allowed, the client becomes verbally abusive and
threatens physical violence to the nurse. Based on the analysis of this situation, which intervention
should the nurse implement?

a. Place the client in seclusion for 30 minutes.

b. Tell the client that the behavior is inappropriate.

c. Escort the client to their room, with the assistance of other staff.

d. Tell the client that their telephone privileges are revoked for 24 hours.

48. The nurse has been closely observing a client who has been displaying aggressive behaviors. The
nurse observes that the behavior displayed by the client is escalating. Which nursing intervention is NOT
helpful to this client at this time?

a. Initiate confinement measure

b. Acknowledge the client’s behavior.

c. Assist the client to an area that is quiet.

d. Maintain a safe distance from the client.

49. The nurse manager is discussing management of the aggressive client. Which statement best stresses
important information about the use of physical restraints?

a. “The hospital administration is reluctant to have staff rely on physical restraints for legal reasons.”

b. “The use of physical restraints has a highly negative emotional impact on the client and should be
avoided if possible.”

c. “Physical restraints can be used only after all other de-escalating strategies have failed to control the
behavior.”

d. “We use physical restraints when the client is disinterested or unwilling to control his or her aggressive
behavior.”
50. The client has been violent toward other clients on a mental health unit, and interventions have
failed. During the application of restraints, which action by the team leader will gain the greatest
cooperation from the client?

a. Showing sympathy by apologizing for the need to restrain the client

b. Professionally explaining why and how the restraints will be applied

c. Affording the client one last opportunity to avoid restraints by “behaving”

d. Offering to remove the restraints as soon as the client can “control the anger”

51. Which behavior observed by the nurse indicates a suspicion that a depressed adolescent client may
be suicidal?

a. The adolescent gives away a DVD and a cherished autographed picture of a performer.

b. The adolescent runs out of the therapy group, swearing at the group leader, and to her room.

c. The adolescent becomes angry while speaking on the telephone and slams

d. The adolescent gets angry with her roommate when the roommate borrows the client’s clothes
without asking.

52. The police arrive at the emergency department with a client who has lacerated both wrists. Which is
the initial nursing action?

a. Administer an antianxiety agent.

b. Assess and treat the wound sites.

c. Secure and record a detailed history.

d. Encourage and assist the client to ventilate feelings.

53. The nurse is planning care for a client being admitted to the nursing unit who attempted suicide.
Which priority nursing intervention should the nurse include in the plan of care?

a. One-to-one suicide precautions

b. Suicide precautions with 30-minute checks

c. Checking the whereabouts of the client every 15 minutes

d. Asking the client to report suicidal thoughts immediately

54. A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can
best ensure client safety by which action?

a. Requesting that a peer remain with the client at all times.

b. Removing the client’s clothing and placing the client in a hospital gown.

c. Assigning to the client a staff member who will remain with the client at all times.

d. Admitting the client to a seclusion room where all potentially dangerous articles are removed.

55. When planning the discharge of a client with chronic anxiety, which is the most appropriate
maintenance goal?

a. Suppressing feelings of anxiety

b. Identifying anxiety-producing situations

c. Continuing contact with a crisis counselor

d. Eliminating all anxiety from daily situations

56. When assessing a client with anxiety, the nurse’s questions should be

a. avoided until the anxiety is gone.

b. open-ended.

c. postponed until the client volunteers information.

d. specific and direct.

57. The best goal for a client learning a relaxation technique is that the client will

a. confront the source of anxiety directly.

b. experience anxiety without feeling overwhelmed.

c. report no episodes of anxiety.

d. suppress anxious feelings.

58. Which would be the best intervention for a client having a panic attack?

a. Involve the client in a physical activity.

b. Offer a distraction such as music.

c. Remain with the client.

d. Teach the client a relaxation technique.

59. Before an anxious client begins treatment with benzodiazepines it is most important to assess the
client’s:

a. situational and social support

b. level of motivation for treatment

c. stressors and use of coping mechanism

d. use of alcohol or other CNS depressant agents

60. A client is scheduled for discharge and will be taking phenobarbital for an extended period. The
nurse would place highest priority on teaching the client which point that directly relates to client
safety?

a. Take the medication only with meals.

b. Take the medication at the same time each day.

c. Avoid drinking alcohol while taking this medication.

d. Use a dose container to help prevent missed doses.

61. A client diagnosed with general anxiety disorder is placed on clonazepam (Klonopin) and buspirone
(BuSpar). Which client statement indicates teaching has been effective?

a. The client verbalizes that the clonazepam is to be used for long term therapy in conjunction with
buspirone.

b. The client verbalized that buspirone can cause sedation and should be taken at night.

c. The client verbalizes that clonazepam is to be used short term until the buspirone takes effect within 4
to 6 weeks.

d. The client verbalizes the tolerance could result with the long term use of buspirone.

62. A client who has been taking buspirone for 1 month returns to the clinic for a follow-up assessment.
The nurse determines that the medication is effective if the absence of which manifestation has
occurred?

a. Paranoid thought process

b. Rapid heartbeat or anxiety

c. Alcohol withdrawal symptoms

d. Thought broadcasting or delusions

63. A client who is receiving an anxiolytic medication is reluctant participate in group therapy. The client
states. “The pills I am taking will take care of my stress. I don’t need to talk about my problems.” In
response to the client’s statement the nurse should explain that:

a. “group therapy is the treatment of choice for anxiety”

b. “medications relieve symptoms, but do not change the source of anxiety”

c. “the medications will not work unless the client participates in group therapy”

d. “the client will need to attend group therapy only until the medication becomes effective”

64. Which is true about clients with illness anxiety disorder?

a. They may interpret normal body sensations as signs of disease.

b. They often exaggerate or fabricate physical symptoms for attention.

c. They do not show signs of distress about their physical symptoms.

d. All of the above.

65. A patient comes into the clinic with nausea, constipation, and excruciating stomach pain. Over a
period of several years, this patient has come in two or three times a month with same report, but
multiple diagnostic tests have consistently yielded negative results for physical disorders. What is the
priority nursing intervention for this patient?

1. Advocate for the patient to have a psychiatric consultation

2. Make appointments as soon as possible with same health care provider for continuity of care

3. Perform a physical assessment to identify and physical abnormalities

4. Assess for concurrent symptoms of depression and anxiety

66. The symptoms of paralysis in a conversion disorder provides the following primary gain:

a. Relieves anxiety and guilt

b. Serves to get the attention which the ego-ideal desires

c. Supports the superego

d. Resolves conflicts experienced in the oral stage

67. The nurse who cares for a client in a fugue state is most likely to note:

a. A history of childhood trauma

b. coexisting depression

c. wandering behavior

d. selective amnesia

68. A patient reports episodic depersonalization experiences. Which of the following is an appropriate
goal of care?

a. The client will describe three stress management techniques by day 2.

b. The client will report no suicidal thoughts by week 1.

c. The client will create a chart of all personalities by week 1.

d. The client will state five characters of the different personalities by day 2.

69. A 10—year-old who was sexually abused by a family member experiences flashbacks of a
disagreement with that adult and the resulting sexual assault. Which suggestion should the nurse make
to the parents in order to help minimize this reaction?

a. Have the child avoid arguments with adults until this reaction is unlearned.

b. Ask the physician to prescribe a medication to minimize the child’s aggressiveness.

c. Adults in your family should learn to recognize and diffuse arguments effectively.

d. You and your child should regularly discuss bad memories to decrease their effect.

70. A client has been diagnosed with of obsessive-compulsive disorder constantly does repetitive
cleaning. The nurse knows that this behavior is probably most basically an attempt to:

a. Decrease the anxiety to a tolerable level

b. Focus attention on non-threatening tasks

c. Control others

d. Decrease time available for interaction with people

71. A client with OCD is admitted to the hospital due to ritualistic hand washing that occupies several
hours each day. The skin on the client’s hands is red and cracked, with evidence of minor bleeding. The
goal for this client is

a. decreasing the time spent washing hands.

b. eliminating the hand washing rituals.

c. providing milder soap for hand washing.

d. providing good skin care.

72. A client with OCD gives the home health nurse a bottle of clomipramine. The nurse notes that the
medication has not been taken by the client in 2 months. Which behavior observed in the client would
validate noncompliance with this medication?

a. Complaints of insomnia

b. Complaints of hunger and fatigue

c. A pulse rate less than 60 beats per minute

d. Frequent hand washing with hot, soapy water

73. Which would be an appropriate intervention for a client with OCD who has a ritual of excessive
constant cleaning?

a. A structured schedule of activities throughout the day

b. Intense psychotherapy sessions daily

c. Interruption of rituals with distracting activities

d. Negative consequences for ritual performance

74. The client with OCD has counting and checking rituals that prolong attempts to perform activities of
daily living. The nurse knows that interrupting the client’s ritual to assist in faster task completion will
likely result in
 a. Burst of increased anxiety.

b. gratitude for the nurse’s assistance.

c. relief from stopping the ritual.

d. symptoms of depression or suicidality.

75. Clients with OCD often have exposure/response prevention therapy. Which statement by the client
would indicate positive outcomes for this therapy?

a. “I am able to avoid obsessive thinking.”

b. “I can tolerate the anxiety caused by obsessive thinking.”

c. “I no longer have any anxiety when I have obsessive thoughts.”

d. “I no longer feel a compulsion to perform rituals.”

76. In conjunction with pharmacologic treatment, which therapy has been proven effective for
obsessive-compulsive disorder?

a. Group therapy

b. Interpersonal therapy

c. Aversion therapy

d. Cognitive-behavioral therapy

77. A client is admitted with a recent history of severe anxiety following a home invasion and robbery.
During the initial assessment interview, which statement by the client should indicate to the nurse the
possible diagnosis of post-traumatic stress disorder?

a. “I’m afraid of spiders.”

b. “I see his face everywhere I go.”

c. “I don’t want anything to eat now.”

d. “I have to wash my hands over and over again many times.”

78. When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa,
a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on
which purpose of this approach?

a. Providing a supportive environment

b. Examining intrapsychic conflicts and past issues

c. Emphasizing social interaction with clients who withdraw

d. Helping the client to examine dysfunctional thoughts and beliefs

79. A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a 2-bed room. A
newly admitted client will be assigned to this client’s room. Which client would be the best choice as a
roommate for the client with anorexia nervosa?

a. A client with pneumonia

b. A client undergoing diagnostic tests

c. A client who thrives on managing others

d. A client who could benefit from the client’s assistance at mealtime

80. Treating clients with anorexia nervosa with a selective serotonin reuptake inhibitor antidepressant
such as fluoxetine (Prozac) may present which problem?

a. Clients object to the side effect of weight gain.

b. Fluoxetine can cause appetite suppression and weight loss

c. Fluoxetine can cause clients to become giddy and silly.

d. Clients with anorexia get no benefit from fluoxetine.

81. A client with anorexia nervosa is a member of a predischarge support group. The client verbalizes
that she would like to buy some new clothes, but her finances are limited. Group members have brought
some used clothes to the client to replace the client’s old clothes. The client believes that the new
clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse
evaluate this behavior?

a. Normal behavior

b. Evidence of the client’s disturbed body image

c. Regression as the client is moving toward the community

d. Indicative of the client’s ambivalence about hospital discharge

82. The nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client
diagnosed with bulimia is to:

a. Avoid shopping for large amounts of food

b. Control eating impulses

c. Identify anxiety- causing situations

d. Eat only three meals per day

83. The client tells the nurse she has been vomiting after meals. Which of the following responses by
the nurse would be most appropriate?

a. “You know it is not good for you to throw-up your meals because you will hurt your body.”

b. “You are already so thin. Why would you want to vomit your meals?”

c. “It seems like this is difficult for you and that you really don’t want to be throwing up.”

b. “Vomiting is unhealthy for you. It is important not to lose nutrients for the health of the body.”

84. A client with bulimia is learning to use the technique of self-monitoring. Which intervention by the
nurse would be most beneficial for this client?

a. Ask the client to write about all feelings and experiences related to food.

b. Assist the client in making daily meal plans for 1 week.

c. Encourage the client to ignore feelings and impulses related to food.

d. Teach the client about nutrition content and calories of various foods.

85. The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the
client is making positive progress?

a. The client can identify calorie content for each meal.

b. The client identifies healthy ways of coping with anxiety.

c. The client spends time resting in her room after meals.

d. The client verbalizes knowledge of former eating patterns as unhealthy.

 86. Using interpersonal theory, which statement is true regarding development of paranoid personality
disorder?

a. Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients
with schizophrenia

b. Clients diagnosed with paranoid personality disorder frequently have been scapegoats and subjected
to parental antagonism and harassment.

c. There is an alteration in the ego development so that the ego is unable to balance the id and superego

d. During the anal stage of development, the client diagnosed with paranoid personality disorder has
problems with control within his or her environment.

87. The nurse understands that client with paranoid personality likely to have experienced:

a. Little affection or approval during the childhood years

b. Tragic loss of a significant other

c. Problems with communication during the toddler years

d Recognition for accomplishments only in early childhood

88. Which of these nursing approaches is MOST appropriate for the nurse to begin with Shane, 26 years
old, is aloof in relating with other patients and members of the staff. She claims that the medications
being given to her are meant to poison her. She is also suspicious about the food being served for her

a. Engage Marina for at least one hour in a one-to-one interaction daily

b. Invite her to socialize with other patients

c. Make self-available while maintaining distance until patient shows readiness to interact

d. Refer her for activity therapy

89. A client diagnosed with antisocial personality disorder demands, at midnight, to speak to the billing
department. Which nursing statement is appropriate?

a. “I realize you’re upset; however, this is not the appropriate time deal with the billing personnel.”

b. “Let me give you a sleeping pill to help you put your mind at ease.”

c. “It’s midnight, and you are disturbing the other clients.”

d. “I will document your concerns in your chart for the morning shift to discuss with the ethics
committee.”
 90. While working with a client who is withdrawn and disconnected which of the following is an
appropriate short-term goal?

a. The client will attend one group meeting accompanied by a staff members within 1 week

b. the client will voluntarily lead the unit community meeting by discharge from the hospital

c. the client will be more connected to the unit in 3 days

d. the client will attend many of the unit group meetings by discharge from the hospital

91. The client with borderline personality disorder states to the nurse, “Hey, you know what! You are
my favorite nurse. That night nurse sure doesn’t understand me the way you do.” Which response by the
nurse is most therapeutic?

a. “Hang in there. I won’t enjoy coming to work as much after you are discharged.”

b. “I’m glad you’re comfortable with me. Which night nurse doesn’t understand you?”

c. “It’s been a pleasure working with you. Tomorrow you’ll be discharged; I’m glad you will be able to
return home.”

c. “You are my favorite patient; I’ll really miss caring for you when you are

92. A client is unwilling to go to his church because his ex-girlfriend goes there and he feels that she will
laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains
homebound. The home care nurse develops a plan of care that addresses which personality disorder?

a. Avoidant

b. Borderline

c. Schizotypal

d. Obsessive-compulsive

93. The nurse is developing the plan of care for the client with schizoid personality disorder. Which
primary outcome should the nurse include?

a. Recognizes limits

b. Able to cope and control emotions

c. Validates ideas before taking action

d. Able to function effectively in the community

 94. While talking with the client diagnosed with schizophrenia, you notice the client lose eye contact
with you starts staring at the wall. The client is making facial grimaces. The most appropriate nursing
intervention would be:

a. Introduce a different topic

b. administer to the client the ordered haloperidol decanoate

c. ask the client directly, “what are you seeing on the wall?”

d. Redirect the client’s attention to continue your conversation.

95. When planning care for the patient on antipsychotic drug therapy, which of the following is the
priority goal?

a. Prevent side effects of the medication.

b. Promote adherence to the medication regimen.

c. Monitor for hallucinations.

d. Establish a consistent sleep-wake cycle.

96. A client with schizophrenia has been started on medication therapy with clozapine. The nurse
should assess the results of which laboratory study to monitor for adverse effects from this medication?

a. Platelet count

b. Blood glucose level

c. Liver function studies

d. White blood cell count

97. A client with a history of medication noncompliance is receiving outpatient treatment for chronic
undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client?

a. Chlorpromazine (Thorazine)

b. Imipramine (Tofranil)

c. Lithium carbonate (Lithane)

d. Fluphenazine decanoate (Prolixin decanoate)

 98. Which physician order would the nurse question for a client who has stated, “I’m allergic to
phenothiazines?”

a. Haldol, 5 mg PO bid

b. Abilify, 10 mg PO bid

c. Prolixin, 5 mg PO tid

d. Risperdal, 2 mg bid

99. An 85 year-old client has become agitated and physically aggressive after having a stroke with right-
sided weakness. The client is started on risperidone (Risperidal) PO 0.5 mg qhs. Which is an appropriate
nursing diagnosis for this client?

a. Risk for falls R/T right-sided weakness and sedation from risperidone (Risperidal)

b. Activity intolerance R/T right-sided weakness

c. Disturbed thought process R?T acting-out behaviors

d. Anxiety R/T change in health status and dependence on others

100. A patient receiving pharmacological treatment for a psychotic disorder exhibits restlessness and
sits down for only a few minutes at a time. The nurse would recognize this behavior

a. Needs to be further assessed to rule out a medication side effect

b. is common to psychotic patients as a form of agitation

c. result from internal conflicts the patient is experiencing

d. will subside as the patient improves