PSYCHIATRIC NURSING

1. A mother says to the nurse, "When my baby had asthma 5 years ago, I thought he
was going to die." What. would be most appropriate for the nurse to say?
a. "What made you think that the baby was going to die?"
b. "What did you do?"
c. "You thought the baby was dying?"
d. "What were some of your feelings at that time?"
2. One effective way for a nurse to start an interaction with a client who is silent is to:
a. Tell the client something about himself or herself and hope that the client does
the same.
b. Remain silent, waiting for the client to bring up a topic.
c. Bring up a controversial topic to elicit the client's response.
d. Introduce a neutral topic, giving the client a broad opening.
3. Which is an example of limit setting as an effective nursing intervention in ritualistic
hand washing behavior?
a. "I don't want you to wash your hands so often anymore"
b. "If you continue to wash your hands so frequently, the skin on your hands will
break down"
c. "You may wash your hands before the group therapy"
d. "The Doctor wrote an order that you are to stop washing your hands so often"
4. Which nursing intervention is effective when clients are severely anxious?
a. Encourage group participation
b. Give detailed instructions before treatment procedures
c. Impart information succinctly and concretely
d. Increase opportunities for decision making
5. A new nurse is assigned to take the clients for an outing. A client with an antisocial
disorder approaches the nurse and says "I like you. I'm glad you'll be the one to
take us out. My doctor told me that I can go too." Which initial response by the
nurse is best?
a. "Since I am new here) and not familiar with unit routine, I will go check
with the staff and be back."
b. "It's a beautiful day, and I'm glad that you have ground privileges now."
c. "When did the doctor tell you that."
d. "You seem pleased."
6. The nurse needs to do ongoing assessment when a client is on haloperidol (Haldol)
because of which significant side effects? Select all that apply.
a. Diarrhea
b. Urinary Retention
c. Constipation
d. Decreased Appetite
e. Orthostatic Hypotension
f. Elevated Blood Pressure
7. A client whose significant other recently died shows signs of grief resolution when
he or she:
a. Wants to enter into another relationship soon.
b. Talks of both the positive and negative aspects of their relationship.
c. Makes up for deficiencies in the relationship saying "Things would have been
better if we had only had more time"
d. Expressed anger towards the deceased.
8. A client says to his mother, "You are controlling me" The mother asks the nurse
what he may have meant. What is the best response by the nurse?
a. "He is upset and thinks you are taking charge of him"
b. "He resents always having to meet your expectations"
c. "I can't tell you. You will have to ask him".
d. "I think you can ask your son that Do you want me to stay with you while you
ask him?"
9. The nurse will look for what likely outcome of methadone treatment for heroin
abuse and dependence?
a. Sedation
b. Euphoria
c. Neuritis
d. Blocking of the euphoric effect of heroin and elimination
10. The nurse observes for signs of heroin withdrawal, which may include:
a. Rhinorrhea, sneezing and high fever
b. Pupillary dilation, diaphoresis and weight loss
c. Pupillary constriction, vomiting and pruritus
d. Choreiform movements and frequents lip wetting
11. Several staff members voice their frustrations about a client’s constant questions,
such a " Should I go to that dayroom or should I stay in my rooms" and Should i
have a cup of tea ort a cup of coffee?" Which interpretation about this behavior will
help the nursing staff deal effectively?
a. The client's inability to make decisions reflects a basic anxiety about making a
mistake and being a failure.
b. The client's indecisiveness is aimed at testing the staff's reaction and
acceptance of him or him
c. The client's dependence on others staff) is a symptom that needs to be
interrupted by firm limit setting.
d. The client's need to ask question is a bid for attention.
12. After seeing a number of doctors for nonspecific complaints of chest pains, with no
conclusive findings of organic disease a client is referred to a local mental health
center. The client has read extensively about coronary disease and talks
continuously about the symptom sin great detail. Which approach by the nurse
would be best when meeting this client for the first time?
a. Allow the client to describe the physical problems to become familiar with
them.
b. Comment on a neutral topic instead of using the usual conversation opener of
"How are you today?"
c. Give the client a simple but direct explanation of the physiological basis for the
symptoms. d)
d. Let the client know that the nurse is familiar with the psychogenic problems and
guide the discussion to
13. The difficult has explained a therapeutic diet to a client. To ensure learning
occurred, the nurse should do which of the following?
a. Repeat the details of the diet once or twice more.
b. Listen to comments from the client.
c. Ask another nurse to verify the client understands the diet.
d. Refer the client to a nutritionist.
14. A nurse is trying to establish whether a client who appears unconscious can
communicate. Which of the following would be the best approach for the nurse to
use?
a. Ask open-ended questions
b. Ask then client to blink once or twice in response to questions
c. Observe for facial grimaces during verbal stimuli from the nurse
d. Assess for response to painful stimuli
15. A client who is legally blind has been admitted to the cardiac unit. Which of the
following actions by the nurse would be best to promote adjustment to the
environment?
a. Speak lowly and in a low-pitched voice while facing the client.
b. Post a sign on the door indicating the client is blind.
c. Explain unit noises and physical surroundings.
d. Give clear, concise, simple instructions to the client.
16. The home care nurse has asked the client tom demonstrate self-injection
technique. In doing so, the nurse is primarily attempting to determine which of the
following?
a. The number of home visits that will be required.
b. Other support services the client will need.
 c. The quality of the client-teaching plan.
d. The client’s ability to perform the skill.
17. Which of the following teaching strategies should the nurse choose as being most
likely to be effective when providing health instruction to an adolescent client?
a. Lecturer format
b. Professionally made videos
c. Client contracting
d. Role play
18. A nurse is evaluating a client's ability to change then surgical dressing before
discharge. During the demonstration, the nurse notices the clients has not
performed the procedure correctly. The most appropriate action of the nurse would
be to do which of the following?
a. Immediately change the dressing again to demonstrate correct technique.
b. Praise the client for aspects of the procedure done accurately and correct
the client's mistakes.
c. Praise the client for steps completed correctly and refer the client to home care
for follow up.
d. Explain kindly that the procedure was performed incorrectly and have the client
repeat the procedure.
19. When beginning to present information about heart disease to a client newly
diagnosed with heart disease, which of the following is most important for the nurse
to do first?
a. Find out what the client knows or has heard about the disorder.
b. Consult with the physician to determine content based on individual severity of
disease.
c. Have a family member or significant other present who can reinforce diet and
exercise tips.
d. Proceed from simple to complete to complex concepts when discussing
pathophysiology.
20. During the nursing assessment of an elderly female client, the nurse enhances
communication by doing which of the following?
a. Speaking loudly and using many gestures
b. Interviewing the client quickly to conserve the client's energy
c. Interviewing the client with family present to verify responses to questions
d. Restating terms or phrases in different ways if the client does not
understand
21. The nurse would use which of the following statements when trying to encourage a
client to express her feelings and allow the nurse to genuinely respond to those
feelings?
a. "You mentioned that you broke your leg last year. Can you tell me more about
how that happened "
b. "You shared with me a lot of information about your history of depression. It
sounds as though medication alone may not be controlling your symptoms as
you hoped."
c. "You mentioned that your back pain has never gone away since your
surgery. How difficult has it been to adapt to having pain during everyday
activities."
d. "You told me that you have had asthma since you were 11 years old and that
medication therapy requires adjustment every 8 to 10 months or so. Is that
right?"
22. Which of the following is the best approach for a nurse to use to encourage a client
to express feelings and to develop increased awareness about what those feelings
are?
a. Challenge the client
b. Offer reassurance
c. Suggest coping strategies
d. Offer empathy
23. While talking with a client, the client tells the nurse "You are just like my mother;
you don't trust me or like me. You and she wish I were dead." The nurse interprets
this statement as indicating which of the following processes?
 a. Psychosis
b. Countertransference
c. Transference
d. Projection
24. The nurse is preparing to explain an upcoming procedure to a 72-year-old English-
speaking Latino client. The nurse determines that the best way to verbally
communicate with this client is to.
a. Speak quickly and avoid eye contact, which could be perceived as threatening.
b. Speak slowly and provide brief and simple explanations
c. Get an interpreter or family member to interpret for the nurse as needed.
d. Give very complete explanation of all information.
25. The nurse observes a client who is fidgeting, wringing the hands, and has body
tenseness and wrinkled brow. What is the best way for the nurse to interpret these
nonverbal cues?
a. Say "You look tense. Can you tell me if something is making you afraid or
nervous?"
b. Ask "You look upset. Would you like some medication to help you become more
calm?"
c. Say "You look worried, is something bothering you?"
d. Ask "Why are you so nervous and jumpy?"
26. A nurse floating to the nursing unit learns during intershift reports that a client
suffered disfiguring injuries in an accident a week ago. What is best way for the
nurse to prepare for the first encounter with this client?
a. Learn about the client's support system (family, friends, religion)
b. Obtain the specifics of the disfigurement to better con troll first reactions
by the nurse
c. Review all medications and treatment procedures prior to meeting the client
d. Have all supplies and equipment ready to be able to provide efficient care
27. The nurse enters a client's room to obtain an admission history, moves the chair to
the top of the bed by the client's head, and sits down to better hear the client. The
client draws back and moves to the opposite side of the bed. What is the best
response by the nurse?
a. Move the chair a foot or two away from the bed and observe the clients.
b. Say "I will come back later when you are ready to talk to me"
c. Ignore the behavior and continue with the interview, observing the client for
depression.
d. Lean over and touch the client to convey reassurance
28. The nurse who has a heavy work assignment for the day due to high client census
sees that a client is crying. Which of the following would be the best way for the
nurse to convey a willingness to be with the client for
a. State "Let's talk while I change your colostomy bag."
b. Ask "Would you like to talk?" from the doorway, and go in if the client say yes.
c. Pull up a chair, sit down, and state, "I see something is bothering you. Do you
want to talk?"
d. State "I'll be back later and we can talk about what is troubling you at the
moment."
29. A client asks about a new diagnostic test with which the nurse is unfamiliar. What is
the best nursing responses?
a. "I don't know much about that procedure, but I will find out and bring you
information about it."
b. "The technicians in the radiology department will explain then procedure to you
when you go for the rest."
c. "It is your doctor’s responsibility to explain that procedure to you. Would you like
me to telephone they doctor?"
d. "I can't explain that now, but I'll get back to you later after all the morning
medications are distributed."
30. A client can understand only minimal English, and no interpreter is available. What
alternative measures can be the nurse use to enhance communication?
a. Speak loudly to the client
b. Use a paper and pencil to write questions and information
 c. Use pictures and nonverbal cues to communicate
d. Speak more slowly and face the client
31. A client has been on the nursing unit for a few weeks because of complications
after surgery, including the next for extensive wound care. During the last dressing
change before discharge to home with home health services, the client becomes
angry with the nurse and says, "You don't have to be so careful. I'm being sent
home anyway!" Which of the following responses by the nurse would be
therapeutic? Select all that apply
a. "I hear frustration or perhaps anger in your voice. Can you tell me more
about how you are feeling right
b. "Many people who have been in the hospital for an extended period have
mixed feelings about going home. Can you tell me how you are feeling
about discharge?"
c. "It sounds as though you are nervous about going home, but the wound care
nurse who will see you also uses excellent technique. I'm sure your wound will
continue to heal."
d. "Just because you are going home doesn't still require strict technique during a
dressing change. Do you have any questions about your wound care, after
discharge?"
e. "Do you have any concerns about what will happen after discharge that
you would like to talk about?"
32. A nurse is providing care to a client admitted to the hospital with a diagnosis of
acute anxiety disorder. The client says to the nurse, "I have a secret that I want to
tell you. You won't tell anyone about it will you?" The appropriate nursing response
would be which of the following?
a. "No, I won't tell anyone."
b. "I cannot promise to keep a secret."
c. "If you tell me the secret, I will tell it to your doctor."
d. "If you tell me the secret, I will need to document it in your record."
33. A community health nurse visits a client at home. The client states, "I haven't slept
at all the las': couple of nights." Which response by the nurse illustrates a
therapeutic technique for this client?
a. “Go on.”
b. "Sleeping?"
c. "You are having difficulty sleeping?"
d. "Sometimes, I have trouble sleeping too."
34. A client admitted to the mental health unit is experiencing disturbed thought
process and believes that the food being poisoned. Which communication
technique would a nurse plan to use to encourage the client to eat?
a. Using open ended questions and silence
b. Focusing on self-disclosure regarding food preferences
c. Lis possible reasons in the care plan that the client may not want to eat
d. Offering opinions about necessity of adequate nutrition
35. A 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." The appropriate response is which of
the following?
a. "I cannot discuss any client situation with you."
b. "If you want to know about Carol, you need to ask her yourself."
c. "I'm not supposed to discuss this, but because you are my neighbor, I can tell
you that she is doing great!" d)
d. "I'm not supposed to discuss this, but because you are my neighbor, I can tell
you that she really has some problems!"
36. The client says to the nurse, "I'm going to die, and I wish my family would stop
hoping for a cure! I get so angry when they carry on like this. After all, I'm the one
who's dying." The therapeutic response by the nurse is:
a. "Have you shared your feelings with your family?"
b. "I think we should talk more about your anger with your family."
c. "You're feeling angry that your family continues to hope for you to be
cured?"
 d. "Well, it sounds like your being pretty pessimistic. After all, years ago, people
died of pneumonia."
37. A nurse is working with a client who has sought counseling after trying to rescue a
neighbor involved in a house fire. Despite the client's efforts, the neighbor died.
Which action does the nurse engage in with the client 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 the client's perception or appraisal of the neighbor's death
d. Inquiring about and examining the client's feelings that may block
adaptive coping
38. All treatment team members are seen equally important in helping clients meet
their treatment goals. This type of therapy approach is:
a. Milieu therapy.
b. Interpersonal therapy
c. Behavior modification
d. Rational emotive therapy
39. A client who is delusional says to a nurse, "The federal guards were sent to kill
me." The nurse best response is:
a. "I don't believe this is true."
b. "The guards are not out to kill you."
c. "What makes you think the guards were sent to hurt you?"
d. "I don't know anything about the guards. Do you feel afraid that people
are trying to hurt you?"
40. Nurse is conducting a group therapy session, and a client with a manic disorder is
monopolizing the group. The appropriate nursing action is which of the following?
a. Ask the client to leave
b. Refer the client to another group
c. Tell the client to stop monopolizing
d. Thank the client for the contribution and tell him or her to allow others a
chance to contribute.
41. The nurse is discharging a client with a history of command hallucinations to harm
self or others. The nurse provides instructions to the client about interventions for
hallucination and anxiety and determines that the client understands the
instructions if the client states:
a. "My medication won't make me anxious."
b. "I'll go to support group and talk so that I don't hurt anyone."
c. "I won't get anxious or hear things if I get enough sleep and eat well."
d. "I can call my therapist when I'm hallucinating so that I can talk about my
feelings and plans and not hurt.
42. A nurse is caring for a male client diagnosed with catatonic stupor. The client is
lying on the bed with his body Pulled into a fetal position. The appropriate nursing
intervention is which of the following?
a. Ask direct questions to encourage talking.
b. Leave the client alone and intermittently check on him
c. Sit beside the client in silence with occasional open-ended questions.
d. Take the client into the dayroom with other clients so that they can help watch
him.
43. The spouse of a client admitted to the mental health unit for alcohol withdrawal
says to a nurse." I should get out of this bad situation." The most helpful response
by the nurse would be:
a. "Why don't you tell your husband about this?"
b. "What do you find difficult about this situation?"
c. "This is not the best time to make that decision."
d. "I agree with you. You should get out of this situation."
44. Select the appropriate interventions for caring for a client in alcohol withdrawal.
Select all that apply.
(1) Monitor vital signs.
 (2) Maintain NPO status.
(3) Provide a safe environment.
(4) Address hallucinations therapeutically -
(5) Provide stimulation in the environment
(6) Provide reality orientation as appropriate.
a. 1,2,5,6
b. 1,3,4,6
c. 2,3,4,5
d. 2,5
45. 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,
confused, and at times physically immobile. These behaviors are interpreted by
nurse as:
a. Signs of depression
b. Normal reactions to a devastating event
c. Evidence that the client is high suicide risk
d. Indicative of need for hospital admission
46. A nurse is conducting an initial assessment on a client's perception of the
precipitating event that led to the crisis, the appropriate question to ask is:
a. "With whom do you live?"
b. "Who is available to help you?"
c. "What leads you to seek help now?"
d. "What do you usually do to feel better?"
47. A nurse observes that a client with a potential for violence is agitated, pacing up
and down the hallway, and is making aggressive and belligerent gestures t other
clients. Which statement would be appropriate to make 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."
48. A nurse has been observing a client closely who has been displaying aggressive
behavior displayed by the client is escalating. Which nursing intervention is least
helpful to this client at this time?
a. Initiate confinement measures.
b. Acknowledge the client's behavior.
c. Assist the client to an area that is quiet.
d. Maintain a safe distance with the client.
49. A client is admitted to the mental health unit after an attempt of suicide by hanging.
A nurse's most important aspect of care is to maintain client safety. This is
accomplished best by:
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 a staff member to the client who will remain with the client at all
times.
d. Admitting the client to a seclusion room where all potentially dangerous articles
are removed.
50. A female victim of a sexual assault is being seen in the crisis center. The client
states that she still feels "as though rape just happened yesterday," even though it
has been a few months since the incident. The appropriate nursing response is
which of the following?
a. "You need to try to be realistic. The rape did not just occur."
b. "It will take some time to get over these feelings about your rape."
c. "Tell me more about the incident that causes you to feel like rape just
occurred."
d. "What do you think that you can do to alleviate some of your fears about being
raped again?"
51. A depressed client verbalizes feeling of low self-esteem and self-worth typified by
statements such as I'm such a failure. I can't do anything right." The best nursing
response would be to:
a. Tell the client that it is not true, that we all have a purpose in life.
b. Identify recent behaviors or accomplishments that demonstrate the
client's sills.
c. Reassure the client that you know how the client is feeling and that things will
get better.
d. Remain with the client and sit in silence; this will encourage the client to
verbalize feelings.
52. A nurse is caring for a suicidal client. The appropriate nursing intervention in
dealing with this client is to:
a. Demonstrate confidence in the client's ability to deal with stressors.
b. Provide hope and reassurance that the problems will resolve themselves.
c. Display an attitude of detachment, confrontation, and efficiency:
d. Provide authority, action, and participation.
53. A client comes to the emergency department after an assault and is extremely
agitated, trembling, and hyperventilating. The appropriate initial nursing action
would be to:
a. Encourage the client to discuss the assault.
b. Place the client in a quiet room alone to decrease stimulation.
c. Remain with the client until anxiety decreases.
d. Begin to teach relaxation techniques,
54. A nurse is developing a plan of care for a client experiencing anxiety after the loss
of a job. The client is verbalizing concerns regarding the ability to meet role
expectations and financial obligations. The appropriate nursing diagnosis for this
client is:
a. Dysfunctional family process
b. Risk for anxiety
c. Disturbed thought process
d. Ineffective coping
55. A client arrives in the emergency department in a crisis state. The client shows sign
of profound anxiety and is unable to focus on anything but the object of the crisis
and the impact on self. The initial nursing assessment would focus on:
a. The object of the crisis
b. The presence of support systems
c. The physical condition of the client
d. The client's coping mechanisms
56. A nurse is performing an admission on a client at high-risk suicide. The nurse
should prepare to ask the client which assessment question to elicit data related to
this risk?
a. "Why were your attempts at suicide unsuccessful in the past?" b)
b. "Do you have a plan to commit suicide?"
c. "How many times have you attempted suicide in the past?"
d. "What are you feeling right now?"
57. A mental health nurse in a psychiatric unit is meeting with a client who has a long
history of acting out and violent behavior. The client also is known to have abused
drugs on numerous occasions. During the session the client says to the nurse, "I'm
feeling much better now, and I'm ready to go straight." Which response by the
nurse would be therapeutic?
a. "Tell me what makes you feel that you are ready?"
b. "You have said this many times before!"
c. "I have not seen any changes in you to believe that you are ready to go
straight."
d. "I'm so glad to hear you talking this way. I will let your doctor know."
58. During a therapy session with a client with paranoid disorder, the client says to the
nurse, "You look so nice today. I love how you do your hair." Which response by the
nurse would be therapeutic?
a. Thank you for noticing. I just bought this new perfume."
b. "My hair has been a mess. I really needed to have it done."
 c. "Your comments are inappropriate."
d. "We are not here to discuss how I look or smell. We are here to talk about you."
59. A hospitalized client is receiving clozapine (Clozaril) for the treatment of
schizophrenic disorder. The nurse determines that the client may be having an
adverse reaction to the medication if abnormalities are noted on which of the
following laboratory studies?
a. Cholesterol level
b. Blood urea nitrogen

c. Platelet count
d. White blood cell (WBC) count
60. A client recently admitted to the hospital in the manic phase of bipolar disorder is
dehydrated, unkempt, taking antipsychotic medications, and is complaining of
abdominal fullness and discomfort. The nurse determines that: which of the
following is an appropriate intervention for these complains?
a. Teach self-grooming skills.
b. Reward cleanliness with unit privileges.
c. Encourage frequent fluid intake and high-fiber diet.
d. Monitor the adequacy of the antipsychotic dosage.
61. A mental health unit nurse is talking to a client who has been diagnosed with
posttraumatic stress disorder. During the conversation, the nurse notes that the
client is exhibiting a paranoid stare and that he begins to pace and fidget. The
appropriate nursing intervention would be to:
a. Allow the client to pace.
b. Share the observation with the client and help the client to recognize his
feelings
c. Escort the client to a quiet room.
d. Change the conversation to a less threatening subject.
62. A nurse is monitoring a client who has been placed in restraints because of violent
behavior. The nurse determines that it will be safe to remove the restraints when:
a. The client verbalizes the reason for the violent behavior.
b. The client apologizes and tells the nurse that it will never happen again.
c. No acts of aggression have been observed within 1 hour after the release
of two of the extremity restraints.
d. Administered medication has taken effect.
63. The best nursing intervention for a client diagnosed with dementia with SUN
DOWN Syndrome is having increase restlessness, insomnia, and anxiety during
the night:
a. Decrease environmental stimulus and out a computerized bar code medical
alert bracelet.
b. Decrease environmental stimulus and cold bed bath
c. Decrease environmental stimulus, no TV, radio and decrease lights
d. Decrease environmental stimulus and massage.
64. A client is admitted to the hospital. During the assessment, the nurse notes that the
client has not slept for a week. The client is talking rapidly and throwing his arms
around randomly. What would be the highest priority in formulating a nursing care
plan for this client?
a. Isolate the client until he adjusts to the hospital
b. Provide nutritious food and a quiet place to rest
c. Protect the client and others from harm
d. Create a structured environment
65. A client has been very despondent, withdrawn, and apathetic for about 6 months.
Recently, the client began to attend outpatient clinic for treatment of depressive
disorder. Fluoxetine HCL (Prozac) is prescribed, and after 3 days the client shows
improvement. What is the most appropriate nursing intervention at this time?
a. Encourage the client to interact with other clients
b. Assess the client's knowledge about the medication
c. Evaluate the potential for self-destructive behavior
d. Discuss long term plan for discharge and follow-up
66. A nurse caring a teenager with anorexia who plans to implement intervention using
behavior modification model would institute which of the following action?
a. Encouraging the client to express her feelings until she gains insight about her
distorted perception.
b. Role playing the client's interactions with her parents in a therapy session.
c. Providing the client with frequent high calorie and protein diet.
d. Restricting the client's privileges until she gains 3 Ibs.
67. The nurse is administering antidepressant medication to clients. What is the major
difference between selected serotonin reuptake inhibitor and tricyclic
antidepressants?
a. SSRIs are more effective than TCAs in relieving depressive symptoms
b. SSRIs have more sedative effects than TCAs
c. TCAs are lethal in over dose while SSRs are relatively safe
d. TCAs have fewer cardiovascular effects than SSRIs
68. When assessing a crisis situation, the nurse realizes that which of the following
important factors are helpful in positively resolving crisis? Select all that apply
a. Behavioral reinforcement
b. Perception of the event
c. Catharsis
d. Raising self-esteem
e. Coping mechanisms
f. Situational support
69. You are assessing a client on chlorpromazine (thorazine) for extrapyramidal side
effects. EPS includes which of the following? Select all that apply.
a. Acute dystonia
b. Akathisia
c. Amenorrhea
d. Breast secretions
e. Dyskinesia
f. Parkinsonism
g. Sexual Dysfunction
70. The waiting time between stopping MAOI and setting a tricyclic antidepressant is
which of the following?
a. At least 4 weeks
b. Determined by taking a MAOI blood level
c. Between 4 and 6 weeks
d. Determined by the half-life of the MAOI
71. When providing nursing care for the alcoholic client, the nurse realizes that all of
the following goals will need to be met. Put the goals in the order you would expect
them to be met from short range to long range
a. The client will acknowledge alcohol dependence and need for treatment 2
b. The client will rebuild damaged interpersonal relationships 5
c. The client will identify alternative strategies for managing anxieties 3
d. The client will implement alternative strategies for managing anxiety 4
e. The client's withdrawal from alcohol will be managed successfully 1
72. The nurse cares for a client diagnosed with Korsakoff psychosis. The nurse
determines that the client's diet is appropriate if the client increases his intake of
which of the following foods?
a. Folic acid
b. Vitamin
c. Carrot
d. Liver (organ meats, pork, whole grains, nuts, legumes, eggs, milk)
73. A client taking trifluoperazine (Stelazine) should be instructed to notify if he
experiences:
a. Nasal stuffiness
b. Heat intolerance
c. Right upper quadrant pain
d. Drowsiness
74. Protective processes to prevent mental illness include the following except:
a. Enhance self esteem
 b. Support relationship
c. Taking new opportunities for growth
d. Maintenance of usual life patterns during stress
75. According to Freud a child who idolizes and imitates her mother is noted in which
stage of development?
a. Oral
b. Anal
c. Phallic
d. Latency
76. Mania is a defense mechanism against painful experience of depression among
bipolar patients. This defense mechanism known as:
a. Undoing
b. Reaction formation
c. Regression
d. Displacement
77. According to the neurotransmitter theory, an excess of serotonin, norepinephrine
and dopamine results in:
a. Depression
b. Manic disorder
c. Somatoform disorder
d. Anxiety disorder
78. The following are most predictive of suicide except:
a. Helplessness
b. Hopelessness
c. Worthlessness
d. Loss of self-esteem
79. Bleuler's 4 As of schizophrenia are the following except:
a. Affective disturbance, autism, associate looseness
a. Autism, ambivalence, apathy
b. Ambivalence, affective disturbance, looseness of association
c. Autism, affective disturbance, ambivalence
80. You are forming a music therapy with a withdrawn patient as one of your
participants. What would be an appropriate guideline for this activity?
a. Set limits on disruptive behavior of the withdrawn patient.
b. Arrange furniture in a semi-circle or around a table.
c. Do not touch withdrawn patients without warning.
d. This patient should not be included in the group.
81. You would like to assess the judgment ability of your client. How would you do it?
a. "Please deduct 3 continuously from 50"
b. "You witnessed a 4-year-old boy being hit by a taxi. What would you do?"
c. "What do you think is your problem?"
d. "Do you know where you are now?"
Situation: Gary, age 4, is brought to the emergency room by his mother. He has a
skull fracture and multiple body bruises. You suspect child abuse.
82. Carefully assessing the situation, you would observe and find out:
a. The age of the mother
b. The interaction between Gary and his mother
c. The time the accident occurred
d. The presence of other siblings in the family
83. Before you can establish effective working relationship with the mother, which of
the following is most important for you to do?
a. Identify referral sources for abusive care givers
b. Carefully review the family profile.
c. Learn to deal with negative feelings about abusive caregivers.
d. Identify personal feelings regarding child abuse.
Situation: Henry, 16-year-old boy, is admitted to an inpatient psychiatric unit with
the diagnosis of conduct disorder. Reportedly, he has been running away from
home, skipping classes, stealing from his elder brother's wallet because he is also
into illegal drugs. His family has done everything yet to no avail.
84. You would expect Henry to be doing which of the following behaviors the first few
days of treatment?
a. Expressing the desire to be alone most of the time
b. Teasing and complimenting to bait the staff
c. Displaying good interpersonal skills
d. Manifesting depressed and withdrawn behavior
85. This behavior is primarily Henry's way of:
a. Avoiding or expressing feelings of anger or depression.
b. Denying his lack of social and intellectual abilities.
c. Showing how a normal teenager behaves.
d. Attempting to socialize to make friends.
86. The most appropriate action for Henry's early treatment would be to:
a. Allow the client to use abusive language until he is able to regain some control.
b. Have the client's friends visit daily.
c. Matter of fact attitude and setting definite limit on his acting-out behavior.
d. Have the client discuss with you why his family is upset with him.
Situation: Hero is a 4-year-old male, only child of an executive couple, who is
hospitalized with a diagnosis of autism. They have a very busy schedule and are
frustrated with the amount of time required to care for Hero.
87. Which of the following Hero's behavior you observed upon admission that would
confirm that he is an autistic child?
a. Hero's below average intelligence
b. He dislikes routine.
c. He lacks interest in inanimate objects.
d. He is unresponsive to others.
88. The parents give the nurse a detailed history of Hero's behavior. Which of the
following information on would be most useful for the nurse to know in designing
his care?
a. He has an intense interest in strong color.
b. He likes flying animals.
c. He is preoccupied with moving objects.
d. He lacks verbal communication skills.
89. You are interested in helping Hero to feel more secured. The most appropriate
intervention would be to:
a. Discourage peer group.
b. Provide consistent care by 1 or 2 nurses.
c. Allow him to control his own eating and sleeping patterns.
d. Administer Ritalin.
90. A Schizophrenic client is receiving Haloperidol 10mg BID and Biperidine HCI 2mg
prn. While giving Biperidine, you have to assess mental status. What is the best
rationale?
a. Biperidine is a CNS depressant.
b. Worsening of psychotic symptoms may occur.
c. Client my develop tolerance. d)
d. Client may hoard the drug.
91. Of the following descriptions of roles assumed by nurses, which one is unique to
the mental health and psychiatric nurse?
a. Serves as an advocate on behalf of clients and their families.
b. Coordinates diverse aspects of care by working with other members of the
healthcare team.
c. Strives to assists client to communicate and relate to others more
effectively.
d. Provides direct client care, including administering medications and treatments
and promoting self-care
92. In the communication process, feedback refers to:
a. Originator of the message
 b. Setting in which communication takes place
c. Response of the receiver to the sender
d. Information transmitted
93. The following statements about therapeutic nurse-client relationship are true
except:
a. The relationship has clearly defined boundaries.
b. The relationship considers social needs of both participants.
c. The relationship is directed toward specific goals.
d. The relationship is focused on the client's needs and problems.

94. Getting acquainted and developing trust and open communication characterize
which phase of the nurse-client relationship?
a. Orientation
b. Working
c. Termination
d. Evaluation
95. Which of the following topics would be inappropriate topic to raise during the
orientation phase of the nurse-client relationship?
a. Exploration of the client's inadequate coping mechanisms.
b. Conditions for termination of the relationship.
c. The client's perception of the reason for hospitalization.
d. Clarification of the roles of nurse and client.
96. Whether or not to administer medications to a psychotic client who refuses them
because he or she believes they are poison is an example of which legal/ethical
issue?
a. Using authority in the nurse-client relationship.
b. Exhibiting unconditional positive regard.
c. Encountering a conflict of interest over client's rights.
d. Maintaining role parameters of the nurse-client relationship.
97. Which of the following suggestions made by staff members reflects the best
potential solution to the problem of client's noncompliance?
a. Take away privileges until the client complies with the treatment program.
b. Have the client's psychiatrist and primary nurse explore options with the client
about taking the medications.
c. Have the client's family meet with the staff to decide whether or not the
client should be forced to take medications.
d. Consider discharge because the client does not qualify for commitment
proceedings.
98. The nurse is teaching a recently diagnosed diabetic client how to take prescribed
insulin. The client is having difficulty concentrating on what the nurse says. His
respirations are becoming shallow and more rapid, and he is beginning to fidget,
crossing and uncrossing his arms and picking at his cuticles. His blood sugar level
is within normal range. What degree of anxiety is the most likely experiencing?
a. Mild
b. Moderate
c. Severe
d. Panic
99. Which of the following clients would be most vulnerable to experiencing post-
traumatic stress disorder.
a. Wife of a chronic alcoholic
b. College student who experienced date rape
c. Child who fails a grade in school
d. Husband who has recently lost his wife to cancer
100. The nurse evaluates treatment for a somatoform disorder as successful if a
client:
a. Practices self-medication rather than change healthcare providers.
b. Recognizes that physical symptoms increase his level of anxiety.
 c. Researches treatment protocols for various illnesses.
d. Verbalizes anxiety directly rather than displaces It.
101. When thinking about alcohol and drug abuse, the nurse is aware that:
a. Most poly drug abusers also abuse alcohol
b. Most alcoholics become poly drug abuses
c. Addictive individuals tend to use hostile abusive behavior
d. An unhappy childhood is a causative factor in many addiction
102. The nurse knows that dementia of the Alzheimer's type is characterized by:
a. Aggressive acting out behavior
b. Hypoxia of selected areas of brain tissue
c. Periodic remission and exacerbations
d. Areas of brain called senile plaques
103. A male client is diagnosed with a schizoid personality disorder. Nursing
intervention should be appropriately directed toward:
a. Helping the client enter into group recreational activities
b. Convincing the client that the hospital staff is trying to help
c. Helping the client learn to trust the staff through selected experiences
d. Arranging the hospital environment so that the client's contact with other clients
is limited
104. Methyphenidate [Ritalin] tid is prescribed to a child with attention deficit
hyperactivity disorder. The nurse knows that the first daily dose should be given.
a. Before breakfast
b. Just breakfast
c. Immediately before lunch
d. As soon as the child awakens
105. A client in the hyperactive phase of a mood disorder [bipolar type] is
receiving lithium carbonate. The nurse notes that the client's lithium blood level is
1.8mEq/L. It would be most appropriate for the nurse to:
a. Continue the usual dose of lithium and note any adverse reactions
b. Discontinue the drug until the lithium serum drops to 0.4 mEq/L
c. Notify the physician immediately, since the serum level of lithium may be
toxic
d. Ask the physician to increase the dose of lithium, since the serum level is too
low.
106. Soon after admission of depressed client, the nurse needs to evaluate the
potential for suicide. The best approach to gain this information would be:
a. Asking the client about plans for future
b. Asking the clients about suicide while in the group
c. Asking the family if the client has ever attempted suicide
d. Asking the if suicide was ever or is now being considered
107. A nurse is attempting to understand the behavior of an elderly client
diagnosed with vascular dementia, the nurse recognize that the client is probably:
a. Not capable of using any defense mechanisms
b. Using one method of defense for every situation
c. Making exaggerated use of old, familiar mechanism
d. Attempting to develop new defense mechanism to meet the current situation
108. The most therapeutic environment for the clients with bulimia nervosa would
be one that is:
a. Controlling
b. Focused on food
c. Empathetic
d. Based on realistic limits
109. During the early of hospitalization of a depressed client, an activity that
would be most appropriate would be;
a. Game of trivial pursuit
b. Small dance therapy group
c. Project involving drawing
d. Card game with three other clients
110. A person with an antisocial personality disorder has difficulty relating to
others. Because the person has never learned to:
 a. Count to others
b. Be dependent with others
c. Empathize with others
d. Communicate with others socially
111. A young narcotic addict client had surgery to repair a laceration of the heart
cause by a bullet. The client is receiving methadone hydrochloride, which:
a. Allows symptoms free termination of narcotic addition
b. Convert narcotic use from an illicit to a legally controlled drug
c. Provide post-operative pain control without causing narcotic dependence
d. Counteracts the depressive effects of a long-term opiate use on cardiac and
thoracic muscles
112. A bedridden client with chronic illness expresses anger through urinary
incontinence. The nurse should:
a. Limit the client's fluids intake in the evening
b. Provide television or radio for client when alone
c. Frequent ask if the client needs the bed pan to void
d. Create an environment that prevents sensory monotony
113. The most helpful approach in the meeting the needs of an elderly client
hospitalized with the diagnosis of dementia of the Alzheimer's type is:
a. Providing a nutritious diet high in carbohydrates and proteins.
b. Simplifying the environment as much as possible while eliminating needs
for choices
c. Developing a consistent nursing plan with fixed time schedules to provide for
physical and emotional needs.
d. Developing a nursing plan with time schedules convenient to the client and to
provide for physical and emotional needs.
114. The nurse should observe the autistic child for sign of:
a. Not wanting to eat
b. Crying for attention
c. Catatonic like rigidity
d. Enjoying being with people
115. Individuals with antisocial personality disorders:
a. Suffer from great deal of anxiety,
b. Are generally unable to postpone gratification
c. Rapidly learns by experience and punishment
d. Have a great sense of responsibility towards others
116. A client with schizophrenia has just been admitted to the hospital. When
working with this client initially the nurses most therapeutic action would be to:
a. Use diversional activity and involve the client in occupational therapy
b. Build trust and demonstrate acceptance by spending some time with
client
c. Delay one to one interaction until medication reduce the psychotic symptoms
d. Involve the client in multiple small group discussion to distract attention from the
fantasy world
117. The major difference between anorexia nervosa and bulimia nervosa is that,
the individual with bulimia nervosa:
a. Is obese and attempting to lose weight
b. Has distorted body images and sees the body as fat.
c. Recognizes that there is a problem but is helpful to correct it.
d. Is struggling with a conflict of dependence versus independence
118. When Methadone Hydrochloride dosage is lowered, the surgical client who
is addicted to narcotics must be observed close for evidence of:
a. Piloerection, lack of interest in the surroundings
b. Agitation, attempts to escape from the hospital
c. Skin dryness, scratching under the incisional dressing
d. Lethargy, refusal to participate in therapeutic exercise.
119. An elderly confused client with socially aggressive behavior needs an
environment that:
a. Can be manipulated
b. Allows freedom of expression
 c. Is mainly group oriented
d. Provides control by setting limits
120. The nurse is developing a nursing care plan for a depressed client. The
most therapeutic approach would be:
a. Allowing for the client's slowness when planning activities
b. Helping the client focus on family strengths and support system
c. Encouraging the client to perform menial tasks to meet the need for punishment
d. Repeating again and again that the staff views the client as worth-while and
important
121. A psychiatric client is to be discharged with prescription to Haloperidol
(Haldol) therapy. when developing a teaching plan for discharge, the nurse should
include cautioning the client against:
a. Driving at night
b. Staying in the sun
c. Ingesting wines and cheeses
d. Taking medications containing ASA
122. A client on a maintenance dose of lithium therapy develops hand tremors;
muscle hyperirritability, and mental confusion. The nurse should:
a. Withhold the medication, obtain blood lithium and call physician
b. Check the nausea, vomiting, thirst, and polyuria before administering the next
dose of lithium
c. Expect these side effects, administer the medication as ordered, and note these
findings in the record.
d. Withhold the medication, check the BP, and, if within normal limits, administer
the correct dosage,
123. A male client who has delusion of persecution and auditory hallucinations is
admitted for psychiatric evaluation after stabbing a friend. Later, the nurse on the
unit greets the client by saying, "good evening. How are you?" The client, who has
been referring to himself as "man," answers, " The man is bad," This is an example
of:
a. Dissociation
b. Transference
c. Displacement
d. Reaction formation
124. The major reason for treating a severe emotional disorder with tranquilizer is
to:
a. Reduce neurotic symptoms
b. Prevent secondary complications
c. Prevent destructiveness of the client
d. Make the client more amenable to psychotherapy
SITUATION: Karen, age 16 is withdrawn and non-communicative. She spends most
of her time lying on her bed.
125. Which nursing intervention would be the most appropriate way to help Karen
accept the realities of daily living?
a. Assist her to care for personal hygiene needs
b. Encourage her to keep up with school studies
c. Encourage her to join other clients in group singing
d. Leave her alone when there appears to be a disinterest in the activities in hand
126. Which Is the best plan of nursing intervention to encourage Karen to talk?
a. Try to get her to discuss feelings
b. Focus on non-threatening subjects
c. Ask simple questions that require answers
d. Sit and look through magazines with her.
127. Which of the ff. is an important aspect of nursing intervention when caring
for Karen?
a. Help keep her oriented to reality
b. Involve her in activities throughout the day
c. Encourage her to discuss why mixing with other people is avoided
 d. Help her understand that it is harmful to withdraw from situations
128. One day Karen suddenly walks up to the nurse and shouts, "You think you're
so damned perfect and good. I think you stink!" Which response should the nurse
make?
a. "You seem angry with me."
b. "Stink? I don't understand."
c. "Boy, you're in a bad mood."
d. "I can't be all that bad; can I?"

SITUATION: Sarah, age 45, has paranoid schizophrenia.

129. Sarah refused to eat for 36 hrs. She believes that the voice of her dead
father has commanded her to atone for her sins by fasting for 40 days. Which
nursing intervention might interrupt Sarah's delusional system?
a. Tell her that she has nothing to atone for
b. Ask her to repeat exactly what the voice said
c. Ask the physician to write an order for tube feedings
d. Suggest other means of atonement that maybe less damaging.
130. Sarah has been awake for several nights. She did not have an interrupted
sleep pattern prior to a transfer from a private to a four-bed room three days ago.
Sarah's sleeplessness maybe related to which of the ff. stimuli?
a. Fear of the other clients
b. Worry about family at Home
c. Watching for an opportunity to escape
d. Trying to work out emotional problem
131. While the nurse is talking with another client Sarah comes up and yells, "I
hate you! You are talking about me again.” And throws a glass juice at the nurse.
Which is the best nursing approach?
a. Understand Sarah’s behavior and say, “You hate me? Tell me about that.”
b. Ignore both the behavior and Sarah, clean up the juice, and talk to her when
she is better.
c. Remove Sarah to an isolation room because she needs to have limits placed on
her behavior
d. Verbalize feelings of annoyance as an example to Sarah that it is more
acceptable that it is more acceptable to verbalize feelings than to act out.
132. Sarah approaches the nurse and states, "I am hearing voices that are
saying bad things about me." Which of the ff. intervention should the nurse make?
a. Simply state, "I don't hear the voices."
b. Suggest she join other clients playing cards
c. Encourage Sarah not to listen to what the voice are saying
d. State, "the staff understands that you are frightened and will stay with you
while the voices are speaking."
SITUATION: Harold, age 23, is a regressed, emotionally disturbed client.
133. Harold is seen openly masturbating. Which nursing action would be most
appropriate?
a. Restraint his hands
b. Put Harold in seclusion
c. Not react to the behavior
d. State that such behavior is unacceptable
134. Harold uses his hand to eat "arroz caldo" and other soft foods. Which
intervention should the nurse make?
a. Place a spoon in his hand and suggest it to be used
b. Ignore the behavior and observe several additional meals before intervening
c. Remove the food and say, "You can't have anything until you use your spoon."
d. Say in a joking way, "Well, I guess fingers were made before forks."
135. Harold voids on the floor. The nurse should make which of the ff. actions?
a. Make Harold mop the floor
b. Restrict his fluids throughout the day
 c. Frequently toilet Harold with supervision
d. Withhold privileges each time Harold voids on the floor.
SITUATION: Mark, age 31 is suffering from schizophrenia. Currently he is
experiencing psychotic episode.
136. Mark expresses the belief that the "Barangay Tanod" is out to kill him. Which
of the ff. terms best illustrate what Mark is experiencing?
a. An illusion
b. A delusion
c. Autistic thinking
d. A hallucination
137. Mark refuses to eat because he believes that the food is being poisoned.
Which of the ff. is the most appropriate initial nursing intervention? a)
a. Taste the food in Mark's presence
b. Suggest that the food be brought in from home
c. Convince Mark that the food is not poisoned
d. Tell Mark that tube feedings will be started if he does not begin to eat.
138. Which statement should the nurse make in order to pursue the matter of
Mark's belief about poisoned food?
a. "Why do you think the food is poisoned?"
b. "You feel someone wants to poison you?"
c. "Your feeling is a symptom of your illness."
d. "You'll be safe with me. I won't let anyone poison you."
SITUATION: Judy, age 19, has just been admitted to hospital. She has a bipolar
disorder and in the manic phase of illness.
139. Three new nurses are being oriented to the unit. Judy comes up to them and
says, "Welcome to, the funny farm, I am Jojo the head Yoyo." Which of the ff.
describes what is happening to Judy?
a. She is trying to fill the "life of the party" role
b. She is looking for attention from the new staff
c. She is unable to distinguish fantasy from reality
d. She is anxious over the arrival of the new nurses
140. Judy becomes vulgar and profane. What should the nurse do?
a. State, "We do not like that kind of talk around here."
b. Ignore it since the client is using it only to get attention
c. Recognize the language as part of the illness but set limits on it.
d. State, “When you talk in an acceptable way, we will talk to you."
141. Judy is hyperactive and elated. What could the nurse do to redirect her?
a. Ask her to guide other clients as they clean their rooms
b. Encourage her to tear pictures out of magazines for a scrap book
c. Suggest that she initiate social activities on the unit for the client group
d. Provide her with a pencil and paper and encourage her to write a short story.
142. After caring for a terminally ill client for several weeks, the nurse becomes
increasingly aware of a need to get away from this assignment. The best initial
action by the nurse would be:
a. Request vacation time for a few days
b. Seek support from other nurses from the unit
c. Withdraw emotional involvement with the client
d. Stay with the client and try to work through feelings
143. A client with dementia often assaults the nursing staff, and the staff decides
to develop a plan that will. make this client's personal care less of a problem. The
plan should include:
a. Limiting staff time with the client
b. An outline of the consequences for uncooperative behavior
c. Identification of nursing staff members whom the client prefers.
d. The client's likes and dislikes for use as a reward or punishment
144. The nurse should first discuss terminating the nurse-client relationship with a
client during the:
 a. Working phase when the client brings it up
b. Orientation phase when a contract is established
c. Working phase when the client shows some progress
d. Termination phase when discharge plans are being made.
145. According to Erickson, a young adult must accomplish the task associated
with the stage known as:
a. Initiative versus Guilt
b. Intimacy versus Isolation
c. Industry versus Intimacy
d. Generativity versus Stagnation
146. According to Erickson, an individual who fails to master the maturational
crisis of adolescence will most often:
a. Rebel at parental orders
b. Experience role confusion
c. Be interpersonally isolated
d. Use drugs and alcohol to escape
147. A nurse recognizes that a father's sexual abuse of a 13 year old daughter
was probably motivated by his:
a. Need to control
b. Feelings of anger
c. Unfulfilled sexual needs
d. Unmet emotional needs
148. The nurse is aware that in the working phase of the nurse-patient
relationship, clients:
a. Often focus the conversation on the nurse
b. Accept limits and initiate topics for discussion
c. Commonly exhibit testing behaviors such as flirtation and lateness
d. May repress emotionally charged material to avoid shocking the nurse
149. A male client is preparing to leave the hospital and return to college. When
saying good bye, he hugs and kisses the nurse on the check. The nurse most
appropriate response would be to:
a. Hug the client in return
b. Wish him well with his studies
c. Smile at the client and say nothing
d. Encourage him to come and say "hello" periodically.
150. A female client, who has been told by her physician that she has CA, tells
the nurse that she believes the physician made an error, she does not have CA,
and she is not going to die. The nurse evaluates that the client is experiencing the
stage of death and dying known as:
a. Anger
b. Shock
c. Bargaining
d. Acceptance
151. A terminally 76-year-old client is very quiet and unwilling to have visitors.
During the initial contact with the client, the nurse should:
a. Attempt to understand what the death and dying process means to the client
b. Avoid talking about the client’s condition unless the client initiates the
discussion
c. Ascertain how much pain the client is experiencing and what medications have
been ordered.
d. Explore the extent to which the client is aware of the prognosis and the
client's feeling about the situation.
152. The nurse is aware that a child's emotional problems usually occurs as a
result of:
a. Rejection by the parents
b. Family pathologic factors
c. Authoritarian parenting style
d. Overbearing over-protectiveness
153. When taking with a female client who displays many of the emotional and
psychologic symptoms associated with a panic disorder, the nurse should:
 a. Describe for her the possible reasons for anxiety
b. Use short simple sentences and a firm authoritative voice
c. Ask many questions, because she probably is not going to volunteer much
information Suggest that she refrain from crying, because most of the time
crying makes matter worse.
154. The client is admitted to the hospital because of incapacitating obsessive-
compulsive behavior. The statement that best describes how clients with
obsessive-compulsive behavior view this disorder would be:
a. "It is not my fault that I act this way; the devil makes me do it."
b. "I know there is no reason to do these things, but I can't help myself."
c. "The things I do take a little time, but they make me a productive person."
d. "I don't know why everyone is upset with me. I'm doing nothing wrong."
155. The most critical factor for the nurse to determine during crisis intervention
would be the client's:
a. Developmental history
b. Available situational support
c. Underlying unconscious conflict
d. Willingness to restructure the personality
156. When counseling the 20-year-old parent of a 13-month-old, the nurse should
expect the defense mechanism most often used by the physically abusive parent
is:
a. Idealization
b. Transference
c. Manipulation
d. Displacement
157. Before helping a client, who has been sexually assaulted, the nurse should
recognize that the rapist is motivated by feeling of:
a. Passion
b. Hostility
c. Inadequacy
d. Incompetence
158. The nurse discusses the plan of care with a depressed client whose
husband has recently died. The nurse recognizes it would be most helpful to:
a. Encourage the client to talk about and plan for the future
b. Involve the client in group outdoor games each morning
c. Motivate the client to interact with male client and the staff
d. Talk with the client about her husband and the details of his death
159. While taking health history from a client who has a moderate level of
cognitive impairment due to dementia, the nurse would expect to note the presence
of: a)
a. Hypervigilance
b. Increased inhibition
c. Enhanced intelligence
d. Accentuated premorbid traits
160. By recognizing common behaviors exhibited by the client who has a
diagnosis of schizophrenia, the nurse can anticipate:
a. Disorientation, forgetfulness, and anxiety
b. Grandiosity, arrogance, and distractibility
c. Withdrawal, regressed behavior, and lack of social skills
d. Slumped posture, pessimistic outlook, and flight of ideas.
161. A 25 yr. old male client is being treated for schizophrenic disorder. The client
accuses the nurse and the physicians of being homosexuals. This behavior
indicates that the client is:
a. Attempting to keep the focus off his own problems
b. Trying to embarrass those perceived as authority figures
c. Having difficulty handling unacceptable feelings about himself
d. Exploring emotionally charged reactions to threatening situations.
162. A male client in a mental health facility is tugging on his ear during a unit
meeting. When the nurse comments about it, the client replies, “You know, it’s hat
microchips those foreign agents implanted in my ear. They are trying to control my
 thoughts and deed.” Based on this statement the nurse should recognize that the
client is experiencing:
a. Illusions
b. Hallucinations
c. Delusional thoughts
d. Neologistic thinking
163. The nurse recognizes that paranoid delusions usually are related to the
defense mechanism of:
a. Projection
b. Regression
c. Repression
d. Identification
164. During a one-to-one interaction with a client with schizophrenia, paranoid
type, the client says to the nurse, "I figured out how foreign agents have infiltrated
the news media. They want to shut me up." This statement can best be described
as:
a. A nihilistic delusion
b. A delusion of grandeur
c. An auditory hallucination
d. An over evaluation of the self
165. The nurse notices a male client sitting alone in the corner smiling and talking
to himself. Realizing that that the client is hallucinating, the nurse should:
a. Ask the client why he is smiling
b. Leave the client alone until he stops talking
c. Invite the client to help to decorate the day room
d. Tell the client it is not good for him to talk to himself
166. To increase the self-esteem of a client with schizophrenia, the nurse should
plan to:
a. Reward healthy behaviors
b. Identify various means of coping
c. Encourage good hygiene and grooming
d. Explain the diagnosis and treatment plan
167. The nurse planning to establish a trusting relationship with a client who is
using paranoid ideation should begin by:
a. Seeking the client out frequently to spend long blocks of time together
b. Sitting in the unit and observing the client's behavior throughout the day.
c. Being available on the unit frequently but waiting for the client to
approach
d. Calling the client into the office to establish a contract for regular therapy
session.
168. A client with schizophrenia, paranoid type, is delusional, withdrawn, and
negativistic, the nurse should plan to:
a. Explain to the client the benefits of a group activity
b. Matter of factly invite the client to play table tennis
c. Encourage the client to become involved in group activities
d. Mention to the client that the psychiatrist has ordered increased activity
169. A factor that might place a young person in a high-risk category for
substance abuse would be:
a. Curiosity and daring attitude
b. Occasional periods of depression
c. Loss of a parent through death or separation
d. Typical stresses associated with adolescence
170. The nurse is aware that the defense mechanism commonly used by clients
who are alcoholics is:
a. Denial
b. Projection
c. Displacement
d. Compensation
171. Within a few hours of alcohol withdrawal, the nurse should assess a client
for the presence of:
 a. Yawning, anxiety, convulsion
b. Tremors, fever, profuse diaphoresis
c. Disorientation, paranoia, tachycardia
d. Irritability, heightened alertness, jerky movements
172. A client is given antipsychotic drugs. The nurse is aware that all the
extrapyramidal effects associated with these drugs the one causing the most
concern would be:
a. Akathesia
b. Tardive dyskinesia.
c. Parkinsonian syndrome
d. An acute dystonic reaction
173. A client with an organic mental disorder becomes increasingly agitated and
abusive. The physician orders Haldol. The nurse should assess the client for
untoward effects including:
a. Jaundice and vomiting
b. Tardive dyskinesia and nausea
c. Hiccups and postural hypotension:
d. Parkinsonism and agranulocytosis
174. After a client has been receiving a new neuroleptic drug, the nurse observes
extrapyramidal symptoms and anticipates that the physician will limit these side
effects by prescribing:
a. Zolpidem (Ambien)
b. Hydroxyzine (Atarax)
c. Dandrolene (Dantrium)
d. Benztropine mesylate (Cogentin)
175. The treatment in crisis intervention centers is specifically intended to help
clients
a. Return to prior levels of functioning
b. Understand the dynamics underlying symptoms
c. Make long-range plans for the future
d. Accept their illness
176. A client who is elderly has dementia related to cerebral arteriosclerosis says
to the nurse "I'm going to the university today be their guest lecturer on
aerodynamics." Which response by the nurse would be most therapeutic?
a. “Do you know that you are in the hospital now?"
b. "Are you saying that you would like to be asked to give a lecture at the
university?"
c. "How about watching a movie on television instead?"
d. "It's more important that you don't tire yourself out."
177. A client begins having auditory hallucinations. When the nurse approaches,
the client whispers, "Did you hear that terrible man? He is scary!" Which would be
the best response for the nurse to make initially?
a. "What is he saying? "
b. "I didn't hear anything What scary things is he saying?"
c. "Who is he? Do you know him?"
d. "I didn't hear a man's voice, but you look scared"
178. A 35-year-old married clerk had surgery for ulcerative colitis 3 days ago. The
physical symptoms have abated, but the client continues to complain angrily and to
be demanding of the nursing staff, making numerous requests such as to open or
close the windows and to bring fresh water. The nurse needs to understand that
this behavior might be saying:
a. "You aren't doing your job"
b. 'I am alone and helpless and need to depend on you to take care of me
when I need you"
c. "Everyone needs attention"
d. "I'm going to get even with you for thinking I'm crank by making your work"
179. The nurse is aware that the main function of confabulation serves in clients,
especially those with dementia, is to;
a. Impress Others
b. Protect their self esteem
 c. Control others by distance maneuvers
d. Maintain a sense of humor
180. A 19-year-old client is brought to the emergency department because the
client slashed both wrists. Win the nurse's first concern?
a. Stabilization of physical condition
b. Determination of Antecedent, causal factors relevant to the wrist slashing
c. Reduction of Anxiety
d. Obtaining a detailed nursing history
181. A client who is agitated begins to shout insults and threats at others, and
starts demolishing the reception room. What is the best response or action by the
nurse?
a. Firmly set limits on the behavior
b. Allow the client to continue, because the clients is seeking tom express herself
or himself
c. Tell the client he or she is trying to intimidate other clients
d. Let the client know that he or she is does not need to express anger at the
nurse by demolishing the recreation room
182. A client looks at a mirror and cries out "Look like a bird. My face is no longer
me." Which would be the best response by the nurse?
a. "Which bird?"
b. "That must be a distressing experience; you face doesn't look different to me"
c. "Maybe It was the light at that particular time. Would you like to use another
mirror?"
d. "What makes you think that your face looks like a bird?"
183. A 10-year-old child diagnosed with acute leukemia, terminal stage, asks the
nurse one morning "I am going to die, aren't I? What would be the most appropriate
response by the nurse?
a. "No, you're not. You are getting the latest treatment available and you have a
very good doctor. Your white count was better yesterday"
b. "We are all going to die sometime"
c. "What did the doctor tell you?"
d. I don't know. You have a serious illness. Do you have feelings that you
want to talk about now?"
184. The nurse finds a client who is elderly and has Alzheimer's in the hallway at
4:00a.m, trying to open the door to the fire escape. Which response by the nurse
would probably indicate the most accurate assessment of the situation?
a. "You look confused. Would you like to sit down and talk with me?"
b. "That door leads to the fire escape. Why do you want to go outside now?"
c. "This is the fire escape door. Are you looking for the bathroom?"
d. "Something seems to be bothering you. Let's go back to your room and talk
about it."
185. Since the death of her infant, a woman has lost weight, will not eat spends
most of her time immobile, and speaks only in monosyllabic responses. She pays
little attention to her appearance Once afternoon, this client comes to lunch with
her hair combed and traces of lipstick. What could the nurse say to reinforce this
change of behavior?
a. "What happened? You combed your hair!"
b. "This is the first time I've seen you look so good"
c. "You must be feeling better. You look much better"
d. "I see that your hair is combed and you have lipstick"
186. While the nurse is interviewing a teenage client, the client says. "I suppose
you have to tell my parents everything." What would be the best response by the
nurse?
a. "What are you going to tell me that is so secret that I can't tell your parents?"
b. "If you tell me you are going to do something to hurt yourself, I will have
to tell your parents, but I will not tell you first before I tell them"
c. "Everything you tell me is confidential. I will not tell your parents anything."
d. "Everything you tell me I will need to tell your parents. They have a right to
know."
187. Which nursing intervention is inappropriate with a person who is
experiencing anger?
a. Stating observation of the expected anger
b. Assisting the person to describe the feelings
c. Helping the person find out what preceded the anger
d. Helping the person refrain from expressing anger verbally
188. The nurse discovers a client crouched in a corner, looking pale and
frightened and holding a gushing wrist wound. A razor is nearby on the floor. What
should the nurse do first?
a. Sit down on the floor, next to the client, and in quiet reassuring tone say, "You
seem frightened. Can I help?"
b. Ask the aide to watch the client and run to get the doctor.
c. Apply pressure on the wrist, saying to the client, "You are hurt. I will help
you."
d. Go back down the hall to get the emergency cart
189. A man is hospitalized following a car accident in which his wife died, and he
is unable to attend the funeral due to his severe chest injuries. What would the
nurse consider in forecasting this surviving spouse's potential for difficulty with grief
resolution?
a. Feelings of anger toward the hospital staff for keeping him hospitalized during
the funeral.
b. Feelings of anger toward himself for having been injured but not killed in the
accident.
c. His inability to participate in the cultural rituals of grief, wherein the really
of his wife's death is
d. His preoccupation with his own physical distress at this time.
190. An important part of the nursing care for a client with dementia would be;
a. Minimizing regression
b. Correcting memory loss
c. Rehabilitating toward independent functioning
d. Preventing further deterioration
191. A 52-year-old client who appears lucid learns that after surgery, he will wake
up in the recovery room without his thick glasses and hearing aid. He immediately
states that without these he will be confused and upset. The nurse determines that
the client is trying to say that he. a)
a. Has periods of confusion and may have a psychiatric problem
b. Is psychologically dependent on the hearing aid
c. Needs the hearing aid and glasses to correctly perceive what is going
around him, and misperception will cause confusion
d. Needs the hearing aid and glasses correctly because he wants to be sure
people are taking proper care of him.
192. A client relates angrily to the nurse that his wife says he is selfish. Which
would be the most helpful response by the nurse?
a. "That's juts her opinion"
b. "I don't think you're that' selfish"
c. "Everybody is a little bit selfish"
d. "You sound angry-tell me more about what went on"
193. When a client has a dementia, it is most important that then nurse plan the
daily activities to:
a. Be highly structured
b. Be changed each day to meet the client's needs for variety
c. Be simplified as much as possible to avoid problems with decision making
d. Provide many opportunities for making choices to stimulate the client's
involvement and interest
194. A client has a somatoform disorder, paralysis of the arm. It would not be
helpful for the nurse to use logic and reason to divert this client's attention from this
physical state because:
a. The client is not in contact with reality and thus is unable to "hear" or
understand the nurse.
 b. The client may need the symptoms to handle feelings of guilt or
aggression.
c. The nature of the client's particular illness makes the clients suspicious of all
medical personnel.
d. Paralysis of the arm has become a habitual response to stress.
195. When a client's behavior is considered abnormal, the nurse firsts needs to:
a. Ignore the client
b. Serve as a role model
c. Point out the client's disturbed behavior
d. Focus on the feelings communicated by the client's behavior.
196. To relate therapeutically with a client who is dependent on alcohol. It is
important that the nurse base care on the understanding that alcohol dependence.
a. Is hereditary
b. Is due to lack of willpower and true remorse
c. Results in always breaking promises
d. Cannot be cured
197. A client uses repetitive handwashing. To help the client use less maladaptive
means of handling stress, the nurse could
a. Provide varied activities on the unit, because change in routine can break this
ritualistic pattern
b. Give the client unit assignments that do not require perfection.
c. Tell the client of changes in routine at the last minute to avoid build-up of anxiety
d. Provide an activity in which positive accomplishment can occur so the
client can gain recognition.
198. Two days after mastectomy, a woman is crying and saying, "My husband
won't love me anymore" The nurse is aware that this statement might stem from:
a. The woman's deep insecurity about her marriage
b. Preexisting marital disharmony
c. The woman's concern about her body and a resultant change in her beliefs
about her own self-worth.
d. A momentary fear about her husband' fidelity.
199. A teenage client says to the nurse "I want you to go tell the teenager I am
sick and I am to be allowed to do what I want." What is the nurse's best response?
a. "Certainly, you are sick and need some relaxation of rules in the classroom"
b. "I am glad you recognize you are sick"
c. "No, you are expected to follow the rules of the classroom"
d. "All teachers are too strict. I agree some rules need to be relaxed"
200. A mother really talks about her daughter, who is mentally retarded, "She's
really an inspiration to me, do you know what I mean?" Which would be the most
appropriate initial comment by the nurse?
a. "What makes her an inspiration."
b. "It seems to be important to you to find something positive about her."
c. "No explain more about what you mean."
d. "Tell me more about her."