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PSYCHIATRIC NURSING
Prepared By: Prof. Kenneth Arzadon
NAME:

1. You are caring for George, 35-year-old professional soccer d. Rationalization

player who lost his left limb in a vehicular accident last year.
His mother died of heart disease 7 months after and her 6. A client comes to day treatment intoxicated, but says he is
wife filed for a divorce 2 weeks ago. He is recently admitted not. The nurse identifies that the client is exhibiting
due to alcohol intoxication. During endorsement, George symptoms of:
whispered, “I just can’t bear it anymore. I want it all to be a. Denial
over.” Which of the following interventions would be b. Reaction formation
significant in dealing with George? c. Projection
a. Avoid talking to George regarding his suicidal d. Transference
intentions as this will drive him further to commit
suicide 7. An effective nursing intervention for the impulsive and
b. Directly ask George if he plans to hurt himself aggressive behaviors that accompany conduct disorder is:
c. George is depressed following multiple losses; a. Assertiveness training
acknowledge his feelings towards missing her mom b. Consistently set limits
and help on how he could possibly communicate with c. Negotiation of rules
his wife d. Open expression of feelings
d. Allow George to have time for himself so that he may
reflect regarding his future decisions. 8. A nurse knows that the first sign of dementia is:
a. Intermittent disorientation to person, place, or time
2. Mr. Lanzones constantly bends rules to meet his needs and b. Memory loss that is more than ordinary
then get angry when other patients and staff confront him forgetfulness
on his behavior. He threatens patients and manipulates c. Inability to perform self-care tasks without assistance
staff to get what he wants. Which is the best nursing d. Variable with different people
approach to use with Mr. Lanzones?
a. Administer PRN medication every time Mr. Lanzones 9. “I told you that I do not want to talk about my boss now;
does not follow the rules maybe tomorrow.” What defense mechanism is the patient
b. Ignore his behavior and privately tell the other using?
patients to let Mr. Lanzones switch the television a. Denial
channels as much as he wants b. Suppression
c. Encourage the other staff to take turns watching Mr. c. Reaction formation
Lanzones d. Repression
d. Set firm limits for Mr. Lanzones and be
consistent in confronting behaviors and 10. “I don’t have my list of goals because my pen ran out of
enforcing unit rules ink.” What defense mechanism is the patient using?
a. Suppression
3. A client with paranoid personality disordered is hospitalized b. Reaction formation
for physically threatening his wife because he suspects her c. Repression
of having an affair with a coworker. He is currently showing d. Rationalization
signs of manipulative behaviors such as shouting and
cursing at the nurses. Which of the following approaches 11. A female client has asked the nurse what she should do
would the nurse employ with this client? about leaving her husband. The nurse replies, “I think you
a. Authoritarian should divorce your husband because it is just too
b. Parental stressful.” This is an ineffective communication technique
c. Matter of fact for which reason?
d. Controlling a. It demands an explanation from the client
b. It disagrees with the client’s actions
4. During the initial interview with a client, the nurse begins to c. It belittles the client’s feelings
feel uncomfortable and realizes the client’s behaviors and d. It tells the client how to solve her problem
mannerism of her remind the nurse of her abusive mother.
The nurse realizes the phenomenon is known as: 12. When a client purposefully attempts to embarrass a nurse
a. Transference by making a sexually explicit comment, the best response
b. Counter-transference by the nurse is to:
c. Denial a. Clarify the intention of the client
d. Reaction formation b. Leave the situation altogether
c. Refuse to talk with the client any further
5. Despite knowing his husband’s indecent extramarital d. Continue to interact as if the comments did not cause
affairs, Mrs. Dela Cruz states never fails to prepare embarrassment
breakfast for him and says, “My husband is such a good
man. I love him.” What defense mechanism is the patient 13. A client who is unable to cope with the sudden loss of a job
using? and who is feeling confused and unable to make decisions
a. Suppression is said to be experiencing which of the following?
b. Reaction formation a. Adventitious crisis
c. Repression b. Maturational crisis
 c. Situational crisis 21. Which of the following questions would the nurse use to
d. Social crisis best determine the seriousness of a client suicidal ideation?
a. “How are you planning on harming yourself?”
14. In assessing a client in crisis, it is important for the nurse b. “Have you made out of a will?”
to first assist the client to identify: c. “Does your family know you’re here?”
a. The client’s feelings regarding a certain event d. “How long have you been thinking about harming
b. The nature of the event and how it will affect the yourself?”
financial status of the client in the future
c. Others who might be affected by the event 22. The husband of a client to be discharged from the hospital
d. An immediate action plan after an episode of major depression and a suicide attempt
asks, “What can I do if she tries to kill herself again?” Which
15. A client came to the crisis center for assistance after he was of the following responses would be most appropriate?
involved in clean-up efforts following a shooting at a local a. “Don’t worry, she’ll be okay as long as she takes her
high school. The client says he has been feeling very medication”
anxious since his involvement in these efforts. The nurse b. “She told me she wants to live so I don’t think she’ll
working with the client chooses which of the following to try again”
help him cope with the experience? c. “Let’s talk about some behavioral clues and
a. Arrange for his priest to visit with him resources that can help”
b. Advise him to avoid going near the school for at least d. “Tell her about your concern and just take care of her”
90 days
c. Send him to the emergency department for further 23. In tending to mental health patients, the role of psychiatric
evaluation because he is experiencing a crisis, which nurse is to help them “what” they are doing and “why” are
is an emergency. they doing it. The nurse strives to accomplish which of the
d. Create an opportunity to him to talk about his following while engaged in a nurse-client relationship?
experience, ask him about how he has coped a. The nurse is regarded as a beneficent authority
thus far, and explore enhanced coping skills b. Rapport is built in a non-judgemental
atmosphere
16. The priority nursing diagnosis for a client with suicidal c. Behavioral management techniques are done based
ideations and intent is: on theories of personality
a. Risk for violence, self-directed d. The nurse helps the client understand the
b. Ineffective individual coping psychodynamics of their condition
c. Hopelessness
d. Defensive coping 24. A woman has a verbal altercation with her boss at work.
She meekly accepts his harsh words. That night, she picks
17. In working with a client in crisis, the nurse recognizes that a fight with her husband. Which of the following defense
there are four balancing factors that determine if an mechanism is being used by this woman?
individual will enter a crisis state. Which of the following is a. displacement
a balancing factor? b. acting out
a. How the person perceives the event c. reaction formation
b. When, where and how the situation happened d. projection
c. How close the person is to the event
d. How many times the person has been exposed to the 25. A 24-year-old woman lives with her mother, whom she
event intensely dislikes. She feels embarrassed by this, and
compensates by hovering over her mother, attending to her
18. A 50-year-old client comes to the outpatient crisis unit after every need. Which of the following defense mechanisms is
several people in his family have been involved in an auto being used by this woman?
accident. He is somewhat disorganized, anxious, and jumps a. displacement
from one subject to the next. The nurse uses which of the b. acting out
following as the most effective approach? c. reaction formation
a. Allows the client to continue in his disjointed efforts to d. rationalization
discuss the events that preceded the accident
b. Sends the client to the chapel to gather to gather his 26. The nurse working with a client using crisis intervention
thoughts understands that crisis intervention is different from
c. Assist the client to focus on the problem, traditional Freudian Therapy in that crisis intervention
providing direction for him to identify the focuses on:
problem and immediate alternatives a. Unconscious processes that are the goal of personality
d. Requests a one-time anxiolytic for the client to change.
alleviate his anxiety b. An immediate problem as perceived by the
client with a short-term goal of problem
19. Primary nursing interventions effective for the impulsive, resolution
egocentric, and aggressive behaviors of children with c. Past experiences with a goal of self-actualization
conduct disorders are: d. Pathology as the underlying reason for inadequate
a. Limit setting and consistency coping
b. Open communication and flexible approach
c. Open expression of feelings 27. Ms. Young, a victim of incest, no longer remembers the
d. Assertiveness training reason she always hated the uncle who molested her. To
protect herself from painful thought, Ms. Young uses which
20. The history of a female client who has just been admitted of the following ego defense mechanism?
to the unit and is very depressed reveals a weight loss of a. Denial
10 pounds in 2 weeks, sleeping 3 hours a night, and poor b. Repression
hygiene. The client states, “I’m no good to anyone. c. Supression
Everyone would be better off without me” Which of the d. Dissociation
following questions would the nurse ask first?
a. “What do you mean?” 28. A writer of mystery novels who has never had legal
b. “Are you thinking about hurting yourself?” problems jokes about his “dark sides” and his hidden
c. “Doesn’t your family care for you?” fantasies about leading an exciting life of crime. Which of
d. “What happened to make you think that?” the following defense mechanism is being used by this
man?
a. Compensation
 b. Sublimation d. One who talks about wanting to die
c. Substitution
d. Introjections 37. A client admitted to the psychiatric inpatient unit following
expressed suicidal ideations tell the nurse the next day that
29. A man crashes his car into another vehicle by accident. He she feels fine, is at peace, and wants to go home now. The
feels extremely guilty and, in order to avoid these feelings nurse understands that the client:
of self-reproach, he explains in meticulous detail to anyone a. Has resolved her feelings and is no longer at risk for
listening all of the steps leading up to his accident. Which self-harm
of the following defense mechanism is he displaying? b. Is probably ready to be discharged to home since the
a. Sublimation suicidal intent has been resolved
b. Repression c. Remains at risk, may have sufficient psychic
c. Intellectualization energy to act out on the suicidal ideation, and
d. Acting out requires further assessment
d. Has reached a realistic self-appraisal of the serious
30. Madam Ming, a 34 year old working woman, cheated nature of her suicidal intentions
someone in a business transaction and reduced her guilt by
saying that, “everyone does it.” What kind of defense 38. The nursing staff of the psychiatric inpatient unit maintains
mechanism is she representing? a safe milieu by monitoring the where about of the clients
a. Repression at all times. A client with suicidal ideations and feeling
b. Displacement unable to contract for his or her own safety is considered at
c. Projection high risk for self-directed violence. The nursing staff must
d. Rationalization be prepared to implement:
a. Checks client consistently every 2 hours
31. A 42-year-old man comes to the emergency room with the b. Constant observation
chief complaint that “the men are following me.” He also c. Having a roommate assigned to the client
complains of hearing a voice telling him to hurt others. He d. Having the client were a special ID bracelet
tells the examiner that the news anchorman gives him
special messages about the state of the world every night 39. Behaviors and actions that would suggest that a patient has
through the TV. This last belief is an example of which of reached the escalation phase of Assault cycle would include
the following findings? all of the following EXCEPT:
a. Grandiose delusion a. Readiness to retaliate
b. Illusion b. Throwing of items
c. Loose association c. Clenched fists
d. Idea of reference d. Increased respiratory rate

32. 32-year-old woman is seen in an outpatient clinic for the 40. Learning and understanding the phases of the assault cycle
chief complaint of a depressed mood for 4 months. During will help nurses respond to patterns of escalating behaviour
the interview, she gives very long, complicated explanations appropriately. The goal of all interventions based on the
and many unnecessary details before finally answering the assault cycle is to:
original questions. This style of train of thought is an a. Restraint and Seclusion without injury
example of which finding? b. Patient will return to pre-crisis state
a. Loose association c. Show firm but supportive control by care providers
b. Circumstantiality d. Strengthen patient’s control of feelings and
c. Neologism impulses
d. Perseveration
41. A male patient tells Nurse Veronica: “I want you to be my
33. A client with a diagnosis of schizophrenia is speaking in a girlfriend.” Nurse Veronica could appropriately respond by
group by putting rhyming words that have no meaning saying:
together. This speech pattern is known as: a. “This should be last time that you’d tell that thing to
a. echopraxia me. I am your nurse and you are my patient.”
b. echolalia b. “I am not closing my doors to anyone, but we could
c. clang association try to be intimate after you are fully discharged.”
d. neologism c. "I can't be your girlfriend, but let's talk about
making new friends at home."
34. The nurse assesses a client to be at risk for self-multilation d. “May I know the reason?”
and implements a safety contact with the client. Which of
the following client behaviors would indicate that the 42. Which of the clients is at highest risk for suicide?
contract is working? a. One who appears depressed, frequently thinks of
a. The client withdraws to his room when feeling dying, and gives away all personal possessions
overwhelmed b. One who plans a violent death and has the
b. The client notifies staff when anxiety is means readily available
increasing c. One who tells others that he or she might do
c. The client suppresses his feelings when angry something if life doesn't get better soon
d. The client displaces his feeling onto the physician d. One who talks about wanting to die

35. A client in an acute psychiatric hospital unit tells the nurse 43. During an interaction with the nurse, the clients states that
about his plans for suicide. The nurse’s priority is to: her “life has gone down the tubes” since her divorce 6
a. Allow the client time alone for reflection months ago. Afterwards, she lost her job and apartment
b. Encourage the client to use problem solving and then she “took those pills to sleep and not wake up.”
c. Follow agency protocol for suicide precautions From these data, the nurse would identify which of the
d. Stimulate the client’s interest in activities following nursing diagnoses as the priority?
a. Low self esteem related to losses
36. Which of the clients is at highest risk for suicide? b. Risk for self-directed violence related to suicide
a. One who appears depressed, frequently thinks of attempt
dying, and gives away all personal possessions c. Ineffective coping related to hopelessness
b. One who plans a violent death and has the d. Powerlessness related to helplessness
means readily available
c. One who tells others that he or she might do
something if life doesn't get better soon
44. A client states to the nurse, “I’m thinking about ending it 52. Which of the following is true about clients with
all.” Which response by the nurse would be an example of Hypochondriasis?
therapeutic communication? a. They excessively worry about having a serious
a. “Your attitude will hamper your recovery.” illness
b. “Wasn’t your wife just here during visiting hours?” b. They often attribute physical symptoms of a disease
c. “Why would you like to do something like that?” to sorcery
d. “You must be feeling very sad right now.” c. They do not show signs of distress about their physical
symptoms
45. Which among the following is NOT a criteria in the diagnosis d. All the above are true statements
of mental illness?
a. Having a defiant behaviour 53. A client who developed numbness in the right hand could
b. Unsatisfying relationships not play the piano at a scheduled recital. The consequence
c. Behavior that is not culturally expected of the symptom, not having to perform and consequently
d. Ineffective coping with life events getting the attention of his family is best described as:
a. Emotion focused coping
46. The nurse helps a client practice various technique of b. Phobia
assertive communication and gives positive feedback for c. Malingering
improvement of passive-aggressive interactions. This d. Secondary gain
intervention would occur in which phase of the nurse-client
relationship? 54. In bulimia nervosa, the client typically responds to
a. Pre-interaction phase increased levels of anxiety by:
b. Orientation phase a. Rigidly controlling what he or she eats
c. Working phase b. Binging and purging
d. Termination phase c. Overeating
d. Consuming alcohol
47. On an in-patient psychiatric unit, the goals of therapy has
been met, but the client cries and states, “I have to keep 55. During an assessment interview the client tells the nurse, “I
coming back to therapy to handle my anger better.” This can’t stop worrying about my makeup. I can’t go anywhere
interaction occurs in which phase of the nurse-client or do anything unless my makeup is fresh and perfect. I
relationship? wash my face and put on fresh makeup at least once and
a. Pre-interaction phase sometimes twice an hour.” This behavior is most likely a
b. Orientation phase sign of a(n):
c. Working phase a. Acute stress disorder
d. Termination phase b. Generalized anxiety disorder
c. Obsessive-compulsive disorder
48. On an in-patient psychiatric unit, the nurse explores her d. Panic disorder
own feelings about working with a woman who has allowed
her husband to abuse her and her children physically and 56. When assessing an apparently anxious client, questions
verbally. This interaction would occur, in which phase of the about anxiety should be:
nurse-client relationship? a. Abstract and nonthreatening
a. Pre-interaction phase b. Avoided until the anxiety disappears
b. Orientation phase c. Avoided until the client brings up the subject
c. Working phase d. Specific and direct
d. Termination phase
57. Which of the following would be the best nursing action for
49. The nurse explores any personal misconceptions or a client who is having a panic attack?
prejudices before caring for a client. This action is one of a. Stay with the client
the tasks that occur in a stage of the nurse-client b. Teach the client to recognize signs of a panic attack
relationship. What is the nurse’s major task in this stage? c. Instruct the client to remain alone until the symptoms
a. Determining why the client sought help. subside
b. Exploring self. d. Involve the client in a physical activity
c. Assisting the patient in behavioural change.
d. Establishing and preparing the client for the reality of 58. The nursing assessment indicates a client is experiencing a
separation. panic attack. The client is unable to understand directions
and is preoccupied with thoughts of danger. Which of the
50. A client on an in-patient unit states, “They’re putting rat following would be the most appropriate nursing diagnosis?
poison in my food.” Which intervention would assist this a. Altered health maintenance
client to be medication adherent while on the in-patient b. Altered thought process
psychiatric unit? c. Ineffective individual coping
a. Remind he patient that the psychiatrist ordered the d. Impaired communications
medication for him or her
b. Maintain the same routine for medication 59. A client states, “I am always late for everything because I
administration can’t leave my house without checking every door and
c. Use liquid medication to avoid cheeking window to make sure it is locked. If I don’t make sure
d. Keep medication in sealed packages and open everything is locked I get so worried and I have to go back
them in front of the client home. I can’t seem to stop my behavior.” The nurse should
encourage this client to:
51. The nurse is working with a client with anorexia nervosa. a. Adjust the personal schedule to allow time for
Even though the client has been eating all her meals and the ritual
snacks, her weight has remained unchanged for 1 week. b. Explore childhood experiences that may have led to
Which of the following interventions is indicated? the behavior
a. Supervise the client closely for 2 hours after c. Remain at home until the symptoms subside
meals and snacks d. Stop worrying about the locks
b. Increase the daily caloric intake from 1,500 to 2,000
calories 60. A client with generalized anxiety disorder states, “I now
c. Increase the client’s food intake know the best thing for me to do is just to try to forget my
d. Request an order from the physician for Fluoxetine worries.” How should the nurse evaluate this statement?
a. The client is developing insight
b. The client’s coping skills are improving
 c. The client needs to be encouraged to verbalize 69. Which of the following groups of characteristics would the
feelings nurse expect to see in the client with schizophrenia?
d. The nurse-client relationship should be terminated a. Loose associations, grandiose delusions, and
auditory hallucinations
61. Another patient has been taking antipsychotic drugs for b. Periods of hyperactivity and irritability alternating with
years. You notice that he begins to grind his teeth and depression
moves and smacks his lips frequently. Your assessment c. Delusions of jealousy and persecution, paranoia, and
would include: mistrust
a. Oculogyric crisis d. Sadness, apathy, feelings of worthlessness, anorexia,
b. Gustatory hallucinations and weight loss
c. Tardive dyskinesia
d. Neuroleptic malignant syndrome 70. Mr. Nunes was discharged about a month ago.
Unfortunately, there were no realistic options for him but to
62. Which of the side effects of antipsychotic drugs is most return to Batanes. He does not have appointments to see a
lethal? What are the major signs and symptoms of this side community mental health nurse on a weekly basis. He
effect? complains of hearing voices and admits during one of his
a. Oculogyric crisis appointments that he is not taking his medication. Which of
b. Gustatory hallucinations the following medication strategies would best suit a patient
c. Tardive dyskinesia in Mr. Nunes’ situation?
d. Neuroleptic malignant syndrome a. Chlorpromazine once per day at the clinic
b. Haloperidol decanoate once every 2 weeks
63. The serum parameters for a therapeutic response to lithium c. Fluphenazine 5 mg TID given to the hotel manager to
are: administer
a. 0.2 to 0.6 mEq/L d. Electroconvulsive therapy
b. 0.6 to 1.2 mEq/L
c. 1 to 1.6 mEq/L 71. You notice that a patient receiving chlorpromazine cannot
d. 2 to 3 mEq/L sit still in his group activity. He continuously. He
continuously gets up and has to be reminded to sit down.
64. Schizophrenia may be associated with elevated levels of: He complains, “My legs are on fire. I just can’t sit here
a. Norepinephrine anymore.” You realize:
b. Dopamine a. That he is experiencing akathesia
c. Serotonin b. That he is having a kinesthetic hallucination
d. Acetylcholine c. That he is experiencing a parkinsonian effect
d. That he is trying to confrontation of his own feelings
65. A client with OCD, who was admitted early yesterday in group
morning, must make his bed 22 times before he can have
breakfast. Because of his behavior, the client missed having 72. A pregnant client in her third trimester is started on
breakfast yesterday with other client’s. Which of the chlorpromazine (Thorazine) 25 mg four times daily. Which
following actions would the nurse institute to help the client of the following instructions would be most important for
be on time for breakfast? the nurse to include in the client’s teaching plan?”
a. Tell the client to make his bed one time only a. “Do not drive, because there is a possibility of seizures
b. Wake the client an hour earlier to perform his occurring”
ritual b. “Avoid going out in the sun without a sunscreen
c. Insist that the client stop his activity when it’s time for with an SPF of 25”
breakfast c. “Stop the medication immediately if constipation
d. Advise the client to have breakfast first before making occurs”
his bed d. “Tell your doctor if you experience an increase in blood
pressure”
66. The client with OCD is taking clomipramine (Anafranil) for
his disorder. The nurse would expect the client to exhibit 73. In addition to experiencing paranoid delusions, a client is
side effects similar to those of which of the following withdrawn, unkempt, and unmotivated to get out of bed.
medications? Which of the following medications would the nurse expect
a. Fluoxetine (Prozac) to be most beneficial for the client’s symptoms?
b. Sertraline (Zoloft) a. Haloperidol (Haldol)
c. Imipramine (Tofranil) b. Chlorpromazine (Thorazine)
d. Fluvoxamine (Luvox) c. Olonzapine (Zyprexa)
d. Trihexyphenidyl (Artane)
67. A nurse is caring for a client with a phobia who is being
treated for the condition. The client is introduced to short 74. The client is being admitted to the inpatient psychiatric unit.
periods of exposure to the phobic object while in a relaxed You determine that which of the following must be present
state. The nurse understands that this form of behavior in order to be diagnosed with major depression?
modification can best be described as: a. Coining of new words
a. Systemic desensitization b. Hearing voices that others cannot hear
b. Self-control therapy c. Loss of appetite for more than 3 days
c. Milieu therapy d. Loss of interest in previously enjoyed
d. Aversion therapy activities and inability to sleep

68. The nurse is assessing a normal appearing 6-year-old 75. A suicidal client is placed in the seclusion room and given
brought to the ER by the mother who reports that the child lorazepam (Ativan) because she tried to harm herself by
vomits every time she eats. The child’s history reveals no banging her head against the wall. After 10 minutes, the
positive findings as well as several previous similar visits. client starts to bang her head against the wall in the
The mother is very concerned and insists that the child be seclusion room. Which of the following would the nurse do
admitted for a full GI workup. The nurse reports this as next?
possible: a. Tell the client stop doing that and act like a responsible
a. anxiety disorder adult
b. bulimia nervosa b. Place the client in leather restraints
c. Munchausen’s syndrome by proxy c. Call the physician for additional medication orders
d. Conversion Disorder d. Instruct a staff member to sit in the room with the
client
 dramatic displays of emotion, she boasted about her career
76. Among the following patients, who would the nurse identify as an actress in a local theater group. During a private
as being more at risk for an episode of major depression? conversation, a friend inquired about the rumors that she
a. “Michael, a 16 year old, who has been struggling in was having some difficulties in her marriage. In an outburst
school, in making only C’s and D’s” of anger, she denied any problems and claimed that her
b. “Lauren. A 13 year old , who has was upset over not marriage was “as wonderful and charming as ever.” Shortly
being chosen as a cheerleader” thereafter, while drinking her second martini, she fainted
c. “Cody, a 10 year old, who has never liked school and and had to be taken home. What kind of personality
basically has few friends” disorder is this?
d. “Mark, a 35 year old, unmarried, who lost his a. Schizotypal personality disorder
job” b. Borderline personality disorder
c. Narcissistic personality disorder
77. The nurse is teaching a client and family about phenelzine d. Histrionic personality disorder
(Nardil). Which of the following foods would the nurse urge
the client to avoid? 85. Manny, a 27 year old referee, whom over a period of at
a. Eggs least 6 months, recurrent, intense sexually arousing
b. Chicken fantasies, sexual urges, or behaviors involving the act of
c. Bread being humiliated, beaten, bound, or otherwise made to
d. Aged cheese suffer. For what paraphilia is this diagnostic criterion for?
a. Sexual sadism
78. The nurse is conducting discharge teaching for a client b. Sexual masochism
taking tranylcypromine (parnate). The nurse determines c. Fetishism
that the client understands the instructions given if the d. Sexual sadomasochism
client refrains from eating which of the following favorite
foods? 86. The nurse would assess for which of the following
a. potato chips characteristics in a client with narcissistic personality
b. sardines disorder?
c. chicken a. Entitlement
d. oat meal b. Fear of abandonment
c. Hypersensitivity
79. Paroxetine (Paxil) has been prescribed for a client with d. Suspiciousness
major depression. The nurse instructs the client to watch
for which of the following outcomes? 87. During a home visit, the nurse discovers that the client is
a. Constipation less verbal, less active, less responsive to directions,
b. Increased appetite severely anxious, and more stuporous. The nurse interprets
c. Increased flatulence these findings as indicating that the client is having an
d. Sexual dysfunction exacerbation of which of the following types of
schizophrenia?
80. A client is exhibiting symptoms that are characteristic of a. Disorganized
schizophrenia, but is also exhibiting manic behaviors. This b. Paranoid
client’s most likely diagnosis is: c. Undifferentiated
a. schizophrenifrom disorder d. Catatonic
b. brief psychotic disorder
c. shared psychotic disorder 88. A client diagnosed with personality disorder insists that a
d. schizoaffective disorder grandmother, through reincarnation, has come back to life
as a pet kitten. The though process described is reflective
81. A co-worker, new to the chemical dependency unit, of which personality disorder?
questions the use of thiamine for all clients being treated a. Passive-aggressive personality disorder
for an alcohol problem. The nurse responds base on the b. Schizoid personality disorder
understanding that thiamine is used for which of the c. Borderline personality disorder
following reasons? d. Schizotypal personality disorder
a. It prevents the development of Wernicke’s
encephalopathy 89. A 35-year-old client is being interviewed by the nurse. The
b. It decreases client’s withdrawal symptoms client’s history indicates that she has few friends, fears
c. It aids clients in regaining their strength sooner criticism and rejection from others and withholds
d. It promotes elimination of alcohol from the body faster information about her thoughts and feelings because she
anticipates a negative reaction. Based on the data, the
82. A client tells the nurse that he “sees sounds and hears nurse suspects that the client may have which of following
colors” when he uses lysergic diethylamide (LSD). The personality disorder?
nurse interprets this information as indicating that the client a. Schizotypal
has experienced which of the following? b. Paranoid
a. Impaired judgment c. Avoidant
b. Synesthesia d. Schizoid
c. Flashback
d. Panic 90. A client who had been living with her family after her
boyfriend of 4 weeks told her to leave is admitted to the
83. During a group therapy session in the psychiatric unit, a sub acute unit complaining of feeling empty and lonely,
client constantly interrupts with impulsive behavior and being unable to sleep, and hardly eating for the past week.
exaggerated stories that cast her as a hero or princess. She Her arms are scarred from frequent self multilation. The
also manipulates the group with attention-seeking nurse interprets these findings as indicating which of the
behaviors, such as sexual comments and angry outbursts. following personality disorder?
The nurse realizes that these behaviors are typical of: a. Antisocial personality disorder
a. Paranoid personality disorder. b. Avoidant personality disorder
b. Avoidant personality disorder. c. Borderline personality disorder
c. Histrionic personality disorder. d. Compulsive personality disorder
d. Borderline personality disorder.
91. The client has been diagnosed with bipolar I disorder.
84. Donna danced into the party and immediately became the Lithium carbonate (Lithium) 300 mg q.i.d. has the client
center of attention. With sweeping gestures of her arms and
 says, “My hands are shaking.” Your best response to the
client is: 98. Pranko, a 40 year old patient shows an abnormal motor
a. “These fine motor tremors can be an early behavior such as akathisia and echolalia. He also has unique
effect of the lithium. The tremors should words often part of a delusional system and experiences
subside after the first few weeks of taking the lapses of illusions and hallucinations. Nurse Kiano is
lithium.” knowledgeable that patient Pranko is showing signs and
b. “You do not have to worry about that yet. If it is still symptoms of:
happening next week, then we will worry about your a. Personality disorder
hands shaking.” b. Bipolar disorder
c. “The tremors are an early warning sign of lithium c. Dissociative disorder
toxicity, but you need to continue to take the d. Schizophrenia
medication. We will continue to take the medication.
We will continue to monitor your blood to be sure you 99. A patient with diagnosis of hypochondriasis has made
are taking enough lithium to treat your bipolar I multiple clinic visits and undergone diagnostic tests for
disorder.” “cancer” with no evidence of organic disease. Today he
d. “You can expect hand tremors when you begin to take declares, “I have a brain tumor. I can feel it growing. My
lithium. They will go away soon. Why are you so appointment is tomorrow, but I can’t wait!” What is the
concerned about such a small tremor?” most therapeutic response?
a. Present reality: “Sir you have been seen many times
92. Clients with a histrionic personality disorder are most likely in this clinic and had many diagnostic tests. The result
to benefit from which of the following nursing have always been negative.”
interventions? b. Encourage expression of feelings “Let me spend some
a. Cognitive behavioural therapy time with you. Tell me about what you are feeling and
b. Improving community functioning why you think you have a brain tumor.”
c. Providing emotional support c. Set boundaries: “Sir, I will take your vital signs,
d. Teaching social skills but then I am going to call your case manager
so that you can discuss the schedule
93. A client with delirium is attempting to remove the appointment.”
intravenous tubing from his arm, saying to the nurse, “Get d. Respect the patient wishes: “Sir, sit down and I will
off me! Go away!” The client is experiencing which of the make sure that you see thee health care provider right
following? away. Don’t worry, we will take care of you.
a. Delusions
b. Hallucinations 100. A client is admitted to a medical nursing unit with a
c. Illusions diagnosis of acute blindness after being involved in an hit-
d. Disorientation and-run accident. When diagnostic testing cannot identify
any organic reason why this client cannot see, a mental
94. A client recently released from prison for embezzlement, health consult is prescribes. The nurse plans care based on
has a history of blaming others for his problems and which condition that should be the focus of this consult?
becoming defensive and angry when criticized. He has a. Psychosis
expressed no remorse for his actions or any response to his b. Repression
conviction. He claims his actions were justified since his c. Conversion disorder
employer did not treat him fairly. He is displaying d. Dissociative disorder
characteristics of which personality disorder?
a. Narcissistic 101. Which statement explains the etiology of obsessive-
b. Histrionic compulsive disorder (OCD) from a psychoanalytic theory
c. Antisocial perspective?
d. Borderline a. Individuals diagnosed with obsessive-
compulsive disorder have weak and
95. A client who is receiving an anxiolytic medication is underdeveloped egos.
reluctant participate in group therapy. The client b. Obsessive and compulsive behaviors are caused by a
states,”The pills I am taking will take care of my stress. I sudden anxiety that resolves quickly.
don’t need to talk about my problems.” In response to the c. Individuals diagnosed with obsessive-compulsive
client’s statement the nurse should explain that: disorder have strong and well-developed egos.
a. group therapy is the treatment of choice for anxiety d. Abnormalities in various regions of the brain have
b. medications relieve symptoms, but do not been implicated in the cause of OCD.
change the source of anxiety
c. the client will need to attend group therapy only until 102. A client diagnosed with posttraumatic stress disorder states
the medication becomes effective to the nurse, “All those wonderful people died, and yet I
d. the medications will not work unless the client was allowed to live.” Which is the client experiencing?
participates in group therapy a. Denial
b. Social isolation
96. The nurse who assess the client in a fugue state is most c. Anger
likely to note: d. Survivor’s guilt
a. A history of childhood trauma
b. Coexisting depression 103. All of the following would be an expected assessment client
c. Exposure to a major stressor in clients diagnosed with posttraumatic stress disorder,
d. Selective amnesia EXCEPT:
a. Dissociative events
97. James, 18 years old, was admitted to the psychiatric unit b. Detachment or estrangement from others
with a diagnosis of conduct disorder. During the third week c. Excessive attachment and dependence towards
on the unit he says to you; “I was thinking about what others
you’ve said about hurting others. I think some of that is d. Avoidance of activities that are associated with the
getting me nervous, but I want to talk to you about it.” This trauma.
statement best indicates which phase of the nurse patient
relationship? 104. Which assessment data would support a physician’s
a. Initiating diagnosis of an anxiety disorder in a client?
b. Working a. A client experiences severe levels of anxiety that lasts
c. Terminating for 2 months
d. Orienting
 b. A client experiences increased levels of anxiety d. Remind the client to wear sunscreen to address
that affect functioning in more than one area of photosensitivity
life over a 6 month period.
c. A client experiences severe levels of anxiety that lasts 111. A nursing student is studying delirium. Which of the
for 2 weeks following statements indicate that learning has occurred?
d. A client experiences severe levels of anxiety that a. “The symptoms of delirium develops over a
resolves withing 24 – 48 hours and reoccur in 2 short time.”
months b. “Delirium permanently affects the ability to learn new
information.”
105. An anxious client is restless and has narrowed perceptions. c. “Symptoms of delirium include the development of
Which of the following would appropriately be prescribed to aphasia, apraxia, and agnosia.”
address these symptoms? d. “Delirium doesn’t affect a patient’s consciousness.”
a. Clonazepam (Klonopin)
b. Lithium Carbonate (Lithium) 112. A client with a long history of bulimia nervosa is seen in the
c. Clozapine (Clozaril) emergency department. The client is restless, and has dry
d. Oxazepam (Serax) mucous membranes. Which is most likely the cause of this
client’s symptoms?
106. A client diagnosed with general anxiety disorder is placed a. Mood disorders which often accompany the diagnosis
on clonazepam (Klonopin) and buspirone (BuSpar). Which of bulimia nervosa
client statement indicates teaching has been effective? b. The client presents with symptoms of hypochondriasis
a. The client verbalizes that the clonazepam is to be secondary to bulimia
used for long term therapy in conjunction with c. Vomiting, which may lead to dehydration and
buspirone. electrolyte imbalance
b. The client verbalized that buspirone can cause d. Binging, which causes abdominal discomfort
sedation and should be taken at night.
c. The client verbalizes that clonazepam is to 113. A client diagnosed with anorexia nervosa has a nursing
be used short term until the buspirone takes diagnosis of imbalanced nutrition; less than body
effect within 4 to 6 weeks. requirements. Which long-term outcome addresses client
d. The client verbalizes the tolerance could result problem improvement?
with the long term use of buspirone. a. The client’s body mass index will be 20 by the
6-month follow-up appointment.
107. In which situation would benzodiazepines be prescribed b. The client will be free of signs and symptoms of
appropriately? malnutrition and dehydration.
a. Long-term treatment of posttraumatic stress disorder, c. The client will use one healthy coping mechanism
convulsive disorder, and schizophrenia during a time of stress by discharge.
b. Short-term treatment of generalized anxiety d. The client will state an understanding of a previous
disorder, alcohol withdrawal, and pre- dependency role by the 3-month follow-up
operative sedation appointment.
c. Short-term treatment of obsessive-compulsive
disorder, skeletal muscle spasms, and essential 114. A client on an in-patient psychiatric unit has been diagnosed
hypertension with bulimia nervosa. The client states, “I’m going to the
d. Long-term treatment of panic disorder, alcohol bathroom and will be back in a few minutes.” The nurses
dependence, and bipolar affective disorder: manic response must be:
episode a. “Thanks for checking in”
b. “I will accompany you to the bathroom.”
108. A client is diagnosed with hypochondriasis. Which of the c. “Let me know when you get back to the day room.”
following assessment data validate this diagnosis? d. “I’ll stand outside your door to give you privacy.”

i. Preoccupation with disease process and organ 115. A client diagnosed with an eating disorder has a nursing
function. diagnosis of low self-esteem. Which nursing intervention
ii. Long history of “doctor shopping.” would address this client’s problem?
iii. Physical symptoms are ignored a. Offer independent decision-making
iv. Depression and obsessive-compulsive traits opportunities.
are common. b. Review previous successful coping strategies.
v. Social and occupational functioning may be c. Provide a quiet environment with decreases
impaired. stimulation.
a. All except iv d. Allow the client to remain in a dependent role
b. All except ii throughout treatment.
c. All except iii
d. All except v 116. Which medication is used most often in the treatment of
clients diagnosed with anorexia nervosa?
109. A client is suspected to be experiencing a conversion a. Fluphenazine (Prolixin)
disorder. Which of the following would the nurse expect to b. Clozapine (Clozaril)
assess? c. Flouxetine (Prozac)
a. The client usually fakes a physical discomfort d. Methylphenidate (Ritalin)
b. The client’s laboratory values are abnormal
c. Physical symptoms are explained by a physiologic 117. Using interpersonal theory, which statement is true
cause regarding development of paranoid personality disorder?
d. A lack of concern toward the alteration in a. Studies have revealed a higher incidence of paranoid
function personality disorder among relatives of clients with
schizophrenia
110. A client diagnosed with hypochondriasis is prescribed b. Clients diagnosed with paranoid personality
clonazepam (Klonopin) for underlying anxiety. Which disorder frequently have been scapegoats and
should be included in this client’s teaching plan? subjected to parental antagonism and
a. Monitor for hypertension harassment.
b. Administer the medication to the client at night to c. There is an alteration in the ego development so that
avoid daytime sedation the ego is unable to balance the id and superego
c. Encourage the client to avoid drinking alcohol
while taking the medication
 d. During the anal stage of development, the client Nurse: “When are you going to your next diabetes
diagnosed with paranoid personality disorder has education program?”
problems with control within his or her environment. This is a non-therapeutic response because the nurse has:
a. Used testing to evaluate the client’s insight
118. A client diagnosed with borderline personality disorder coyly b. Changed the topic
request diazepam (Valium). When the physician refuses, c. Exhibited an egocentric focus
the client becomes angry and demands to see another d. Advised the client what to do
physician. What defense mechanism is the client using?
a. Undoing 127. Which of the following are examples of a therapeutic
b. Splitting communication response?
c. Altruism a. “Don’t’ worry – everybody has a bad day
d. Reaction Formation occasionally.”
b. “I don’t think your mother will appreciate that
119. A client diagnosed with antisocial personality disorder behaviour.”
demands, at midnight, to speak to the billing department. c. “That sounds like a great idea.”
Which nursing statement is appropriate? d. “What might you do the next time you’re
a. “I realize you’re upset; however, this is not the feeling angry.”
appropriate time to explore your concerns.”
b. “Let me give you a sleeping pill to help you put your 128. A client has a prescription for Haloperidol, 5 mg orally two
mind at ease.” times a day, as ordered by the physician. The client is
c. “It’s midnight, and you are disturbing the other suspicious and refuses to take the medication. The nurse
clients.” says, “If you don’t want to take this pill, I’ll get an order to
d. “I will document your concerns in your chart for the give you and injection.” The nurse’s statement is an
morning shift to discuss with the ethics committee.” example of:
a. Assault
120. A client who has been depressed and suicidal started taking b. Battery
a tricyclic antidepressant 2 weeks ago and is now ready to c. Malpractice
leave the hospital to go home. Which of the following is a d. Unintentional tort
concern for the nurse as discharged plans are finalized?
a. The client may need prescription for 129. A hospitalized client is delusional, yelling, “The world is
diphenhydramine (Benadryl) to use for side effects coming to an end. We must all run to safety!” When other
b. The nurse will evaluate the risk for suicide clients complain that this client is loud and annoying, the
by overdose of the tricyclic antidepressant. nurse decides to put the client in seclusion. The client has
c. The nurse will need to include teaching regarding made no threatening gesture or statements to anyone. The
the signs of neuroleptic malignant syndrome. nurse action is an example of:
d. The client will need regular laboratory work to a. Assault
monitor therapeutic drug levels. b. False imprisonment
c. Malpractice
121. The signs of lithium toxicity include which of the following? d. Negligence
a. Sedation, fever, restlessness
b. Psychomotor agitation, insomnia, increased thirst 130. Which among the following is NOT a criteria in the diagnosis
c. Elevated white blood cell count, sweating, of mental illness?
confusion a. Having a defiant behaviour
d. Severe vomiting, diarrhea, weakness b. Unsatisfying relationships
c. Behavior that is not culturally expected
122. The nurse is caring for a client with schizophrenia who is d. Ineffective coping with life events
taking haloperidol (Haldol). The client complains of
restlessness, cannot sit still, and has muscle stiffness. Of 131. In assessing an adolescent client for depression, the nurse
the following PRN medications, which would the nurse recognizes depression in adolescents is often:
administer? a. Similar in symptomatology to depression in adult
a. Lower dose of Haloperidol (Haldol) clients
b. Diphenhydramine (Benadryl) b. Often masked by aggressive behaviors
c. Propranolol (Inderal) c. Situational and not as serious as depression in
d. Trazodone adults
d. A sign that the child should be hospitalized
123. Clients taking which of the following types of psychotropic
medications need close monitoring of their cardiac status? 132. A client has bipolar and is in a state of mania. He is in
a. Antidepressants inpatient setting and tells the nurse that he is here because
b. Antipsychotics he said he would stay but now has decided to leave the unit
c. Mood stabilizers later today and shall never come back. The nurse shall:
d. Stimulants a. Notify the police about the clients intention
b. Develop a plan with the client’s wife
124. Which of the following are specific tasks on the working c. Develop a contract for safety with the client
phase of a therapeutic relationship? d. Notify the supervisor on the nursing unit
a. Begin planning for termination
b. Encourage expression of feelings 133. While teaching about sertraline (Zoloft), you explain to the
c. Establish a nurse-client contract client that in order for the medication to be effective it
d. Introspection should be taken:
a. Twice daily
125. Confidentiality means respecting the client’s right to keep b. Only with food
her information private. When can the nurse share the c. Before meals
information about the client? d. As prescribed
a. The client threatens to harm herself
b. The client is aggressive 134. A nursing student reports to the nurse that he has observed
c. The client is discharged to the parent’s care several types of behaviour among patients. Which patient
d. The client admits to domestic abuse needs priority assessment?
a. A patient who is demonstrating clang associations
126. Client: “I was so upset about my sister ignoring my pain b. A patient who is verbalizing ideas of reference
when I broke my leg. “
 c. A patient who is having command a. All client’s taking valproic acid need periodic valproic
hallucinations acid levels drawn
d. A patient who is using neologism b. Fluozetine can decrease the effectiveness of the
valproic acid
135. A client with somatization disorder has been attending c. A decrease in the level of valproic acid could
group therapy. Which of the following statements indicate explain the increase in manic symptoms
that therapy is having a positive outcome for this client? d. The valproic acid level is needed before a short course
a. “I feel better physically just from getting a of lorazepam (Ativan) for agitation is ordered
chance to talk”
b. “I haven’t said much, but I get a lot from listening 142. Which of the following would the nurse expect to include as
to others” a priority in the plan of care for a client with delirium based
c. “I shouldn’t complain too much; my problems on the nurse’s understanding about the disturbances
aren’t as bad as others” associated with the disorder?
d. “The other people in this group have emotional a. Identifying self and making sure that the nurse
problems” has the client’s attention
b. Eliminating the client’s napping in the daytime as
136. Which of the following statements would indicate that much as possible
teaching about somatization disorder has been effective? c. Engaging the client in reminiscing with relatives or
a. “The doctor believes I am faking my symptoms.” visitors
b. “If I try harder to control my symptoms, I will feel d. Avoiding arguing with a suspicious client about
better” perceptions of reality
c. “I will feel better when I begin handling
stress more effectively” 143. The personality structures of id, ego, and superego were
d. “Nothing will help me feel better physically” described by
a. Sigmund Freud
137. A client with acute mania exhibits euphoria, pressured b. Hildegard Peplau
speech, and flight of ideas. The client has been talking to c. Frederick Perls
the nurse nonstop for 5 minutes and lunch has arrived on d. Harry Stack Sullivan
the unit. Which of the following would the nurse do next?
a. Excuse self while telling the client to come to 144. The client who falsely believes that everyone is out to get
the dining room for lunch him of her is experiencing a(n)
b. Tell the client the needs to stop talking because it’s a. Delusion
time to eat lunch b. Hallucination
c. Do not interrupt the client but wait from him to finish c. Illusion
talking d. Loose association
d. Walk away and approach the client in a few minutes
before the food gets cold 145. Which of the four classes of medications used for panic
disorders is considered the safest because of low incidence
138. A female client with acute mania brings six suitcases and of side effects and lacks of physiologic dependence?
three shopping bags of personal belongings on admission a. Benzodiazepines
to the unit. On being informed that some of the suitcases b. Tricyclics
and bags will need to be returned home with her husband c. Monoamine oxidase inhibitors
because of a lack of storage space, the client begins to d. Selective serotonin reuptake inhibitors
swear and use profanity against the nurse. Which of the
following responses by the nurse would be most 146. The nurse is planning discharge teaching for a client taking
therapeutic? clozapine (Clozaril). Which of the following is essential to
a. “You are acting very inappropriate” include?
b. “I will not tolerate your talking to me like that” a. Caution the client not to be outdoors in the
c. “Swearing and profanity are unacceptable sunshine without protective clothing
here” b. Remind the client to go to the lab to have
d. “We don’t want to put you in seclusion yet” blood drawn for a white blood cell count
c. Instruct the client about dietary restrictions
139. The client with mania is skipping up and down the hallway d. Give the client a chart to record a daily pulse rate
practically running into other clients. Which of the following
activities would the nurse expect to include in the client’s 147. The nurse is caring for a client who has been taking
plan of care? fluphenazine (Prolixim) for 2 days. The client suddenly cries
a. Leading a group activity out, his neck twists to one side, and his eyes appear to roll
b. Watching television back in the sockets. The nurse finds the following PRN
c. Reading the newspaper medication ordered for the client. Which one should the
d. Cleaning the dayroom tables nurse administer?
a. Benztropine (Cogentin) 2mg PO, bid, PRN
140. A client has been receiving a haloperidol (Haldol) for 2 days b. Fluphenazine (Prolixin) 2mg PO, tid, PRN
develops muscular rigidity, altered consciousness, a c. Haloperidol (Haldol) 5mg IM, PRN extreme
temperature of 103 degrees F (39.4 degree C), and trouble agitation
breathing on day 3. The nurse interprets these findings as d. Diphenhydramine (Benadryl) 25mg IM, PRN
indicating which of the following?
a. Neuroleptic malignant syndrome 148. What is the rationale for a person taking lithium to have
b. Tardive dyskinesia enough water and salt in his or her diet?
c. Extrapyramidal side effects a. Salt and water are necessary to dilute lithium to
d. Drug-induced parkinsonism avoid toxicity
b. Water and salt convert lithium into a usable solute.
141. A client admitted with a diagnosis of schizoaffective c. Lithium is metabolized in the liver, necessitating
disorder, manic phase who is currently taking fluoxetine increased water and salt
(Prozac), valproic acid (Depakote) and olanzepine d. Lithium is a salt that has greater affinity for
(Zyprexa) as ordered has had an increase in manic receptor sites than sodium chloride
symptoms in the last week. The psychiatrist orders a
valproic acid blood level to be drawn stat. the nurse 149. A client is started on fluphenazine decanoate (Prolixin
understands the rationale for this order as which of the decanoate). The nurse is aware that the primary advantage
following? of this medication is that:
 a. There are no side effects a. “My experience, how I deal with it, and my
b. It has a long-lasting effect support system all affect my disease
c. It is safe to use during pregnancy process.”
d. There is less need for laboratory monitoring b. “There is overstimulation of a part of the brain
called amygdala.”
150. A client diagnosed with post traumatic disorder is close to c. “Natural opioid release during the trauma cause
discharge. Which client statement would indicate that my body to become addicted.”
teaching about the psychosocial cause of post traumatic d. “Because of the trauma, I have a negative
stress disorder was effective? perception of the world and feel hopeless.”