PSYCHIATRIC NURSING

1. The most effective nursing intervention for a severely

anxious client who is pacing vigorously would be to:

a. Instruct her to sit down and quit pacing

b. Place her in bed to reduce stimuli and allow rest
c. Allow her to walk until she becomes physically tired
d. Give her PRN medication and walk with her at a gradually
slowing pace

2. Which of the following is accurate about benzodiazepines: "

a. It act on the cause of diagnosis

b. Used anesthetics, anticonvulsants, and muscle relaxants
c. Has less problem of dependence and withdrawal
d. Started at a high dose then gradually decreased

3. The nurse has been interviewing a client who has not been
able to discuss any feelings. This day, 5 minutes before the
time is over, the client begins to talk about important feelings.
The intervention is to:

a. Go over the agreed-upon time, as the client is finally able to discuss

important feelings.
b. Tell the client that it is time to end the session now, but another
nurse will discuss his feelings with him.
c. Set at extra meeting time a little later to discuss these feelings.
d. End just as agreed, but tell the client these are very
important feelings and he can continue tomorrow.

4. ln working with a depressed client, the nurse should

understand that depression is most directly related to a
person's:

a. Experiencing poor interpersonal relationships with other.

b. Remembering his traumatic childhood.
c. Having experienced a sense of loss.
d. Stage in life.

5. Three days after admission for depression, a 54-year-old

female client approaches the nurse and says; "I know I have
cancer of the uterus. Can't you let me stay in bed and have
some peace before I die?" In responding, the nurse must keep
in mind that:
a. The client must be post-menopausal
b. Thoughts of disease are common in depressed clients.
c. Clients suffering from depression can be demanding, making many
request of the nurse.
d. Antidepressant medications frequently cause vaginal spotting.

6 A client makes a suicide attempt on the evening shift. The

staff intervenes in time to prevent harm. In assessing the
situation, the most important rationale for the staff to discuss
the incident is that:

a. They need to reenact the attempt so that they understand exactly

what happened.
b. The staff needs to file an incident report so that the hospital
administration is kept informed.
c. The staff needs to discuss the client's behavior to determine
what cues, in his behavior might have warned them that he
was contemplating suicide.
d. Because the client made one suicide attempt, there is high
probability he will make a second .attempt in the immediate future

7.A client with the diagnosis of manic episode is racing around

the psychiatric unit trying to organize games with the clients.
An appropriate nursing intervention is to:

a. Have the client play Ping-Pong.

b. Suggest video exercises with the other clients.
c. Take the client outside for a walk.
d. Do nothing, as organizing a game is considered therapeutic.

8. The primary nurse is performing an admission assessment

on a client admitted with pneumonia. When should the nurse
begin discharge planning for this client?

a. The day after discharge

b. When the client's condition is stabilized
c. At the admission time
d. When the physician writes the discharge order

9. A nurse enters a client's roams and the client is demanding

release from the hospital. Tile nurse renews the client's record
and notes that the client was admitted 2 days ago for
treatment of an anxiety disorder and that the admission was
voluntary. Which of the following actions will the nurse take?

a. Tell the client that discharge is not possible at this time.

b. Call the client's family
c. Contact the physician
d. Persuade the client to stay a few more days

10.When teaching a patient who has a diagnosis of

schizophrenia about successful independent living in the
community, a nurse should encourage the patient to:

a. Establish a structured daily routine

b. Spend time alone
c. Ran a program of self-fulfillment
d. Discontinue medication when symptoms disappear

11. A patient who has a borderline personality disorder praise

one nurse and asserts that all other staff members are
terrible. The praised nurse should respond by:

a. Showing appreciation for the patient's positive evaluation

b. Providing reassuring information about the patient's psychological
integrity
c. Maintaining objectivity regarding the patient's remarks
d. Conveying acceptance of the patient's need for a false belief system

12. The physician orders flouxetine (Prozac) orally every

morning for a 72-year-dd a client with depression. The nurse
would expect the physician to order which of the following
dosages for this client?

a. 0.5 mg
b. 10 mg
c. 25 mg
d. 30 mg

13. A client who is depressed states, "I am an awful person.

Everything about me is bad. I can't do anything right." Which
of the following responses by the nurse would be most
therapeutic?

a. "Everybody around here likes you."

b. "I can see many good qualities about you." .
c. "Let's discuss what you haw done correctly."
d. "You were able to bathe daily."

14. The nurse denies the request of a dient with major

depression and psychotic features, admitted involuntarily, to
leave the hospital because commitment papers have been
initiated by the physician. Which of the following would the
nurse identify as a criterion for the client to be legally
committable?

a. Evidence of psychosis
b. Being gravely disabled
c. Risk of harm to self or others
d. Diagnosis of mental illness

15.When preparing a teaching plan for a client about

imipranine (Tofranil), which of the following substances will
the nurse tell the client to avoid while taking the .medication?

a. Caffeinated coffee
b. Sunscreen
c. Alcohol
d. Artificial tears

16. A client with bipolar behavior manic phase is exhibiting

euphoria, hyperactivlty, and distractibility. He is unable to
remain seated during mealtime Song enough to eat
adequately. Which of the following "finger foods" would most
benefit this client?

a. Bacon, lettuce, and tomato sandwich

b. Cheeseburger
c. tee cream cone
d. Cut-up vegetables

17. A client with acute mania has been taking lithium (Lithium
Carbonate) 600 mg PO three times daily for 14 days. The nurse
analyzes the client's serum lithium level, noting that it is
therapeutic when the level is within which of the following
ranges?

a. 0.5 to 1.5mEq/L
b. 1.6to2.5mEq/L
c. 2.6 to 3.2 mEq/L
d. 3.3 to 4.0 rnEq/L

18. A patient who has begun taking a tricyclic antidepressant

is given instructions regarding its use. Which of the following'
comments would indicate that the patient understands the
information?
a. "I like active exercise, but I won't be able to do it while I'm on this
medication."
b. "This medicine will make my ears ring, but I guess i can tolerate
that."
c. "I won't eat cheese if one of my visitors bring me some."
d. "I don't feel any better, but I've only been taking the
medicine for a week."

19. Diazepam (Valium) is prescribed for a patient with low back

pain. The desired therapeutic action of valiurn in this situation
is to:

a. Reduce anxiety levels

b. Eliminate pain sensation
c. Suppress the inflammatory process
d. Lessen muscle spasticity

30. A patient is brought to the psychiatric unit. Which of the

following activities the registered nurse rather than the
licensed practical nurse would perform?

a. Administering a stat dose of lorazepam (Ativan) 2 mg

intramuscularity (IM)
b. Admitting the patient to the psychiatric unit
c. Asking the patient whether he hears voices other people do
not hear
d. Drawing a blood sample for a lithium level

16. A 32-year-old woman is admitted to a psychiatric unit for

evaluation after terrorizing her co-worker with a knife. She is
verbally .abusive. One afternoon, she starts hitting another
female patient without any apparent provocation. The other
patient is removed from her presence. Which of the following
statements by the nurse would be appropriate handling of the
patient's behavior?

a. "Why did you hit that patient?"

b. "You will have to stay in the seclusion room to keep you away from
other patients."
c. "Hitting others is dangerous. I am not going to allow you to
repeat this behavior."
d. "I am going to discuss your behavior with other patients at the next
ward meeting." .

17. A patient refuses to sit in a chair offered by the nurse

during a ward meeting. The patient claims that, "They are
trying to destroy me. They have planted a bomb under this
chair." He accuses the nurse as being "one of them." Which of
the following approaches would be most helpful in dealing with
patient's delusional system?

a. Sit on the chair to prove that the chair is safe.

b. Tell the patient, "No one is trying to destroy you and I am certainly
not one of those who you think want to kill you."
c. Allow the patient to select his/her own chair.
d. Ask the patient, "Why do you think anyone would plot to destroy
you."

17. A patient refuses to sit in a chair offered by the nurse

during a ward meeting. The patient claims that, "They are
trying to destroy me. They have planted a bomb under this
chair." He accuses the nurse as being "one of them." Which of
the following approaches would be most helpful in dealing with
patient's delusional system?

a. Sit on the chair to prove that the chair is safe.

b. Tell the patient, "No one is trying to destroy you and I am certainly
not one of those who you think want to kill you."
c. Allow the patient to select his/her own chair.
d. Ask the patient, "Why do you think anyone would plot to destroy
you."

18. When a pediatric nurse tries to take an admission history

on a 3-year-old, the child's mother burst into tears and cannot
answer any questions. Which of the following actions should
the nurse take?

a. Continue to take the history.

b. Encourage the mother to verbalize her fears concerning her
child's illness.
c. Ask the mother to assist in the admission physical assessment.
d. Ask the mother to join her husband in the waiting room.

19. A patient who is diagnosed with an eating disorder

describes herseif as "a very fat person." Which of the following
responses by the nurse would be MOST appropriate?

a. "You don't look fat at all."

b "Why do you say you are fat?"
c. "I don't understand why you think you are fat."
d. "You seem to think you are fat but \ see you as very thin."
20. During an acute psychotic episode, patients can become
frightened of their own ^ bizarre sensory experiences. They
also fear losing control over their own impulses. Which of the
following nursing interventions would help a patient to feel
less frightened?

a. Assure the patient that his/her sensory experiences wilt disappear,

in no time.
b. Let the patient know that the staff will assist him/her in
maintaining control.
c. Keep the patient in a well-lighted; stimulating environment at all
times.
d. Keep potentially harmful objects out of patient's reach.

21.When developing the plan of care for a client receiving

haloperidol; which of the following medications would the
nurse anticipate administering if the client developed
extrapyramidat sidejeffiects?

a. Lorazepam (Ativan)
b. Benztripine mesylate (Cogentin)
c. Paroxetine (Paxil)
d. Olanzapine (Zyprexia)

22. Nursing Licensure and Practice are regulated by:

a. Nursing Practice Law

b. Board of Nursing
c. Professional Regulations Commission
d. All of the above

23. While documenting on a client's patient care flow sheet the

nurse notices that she made a mistake? How-should the nurse
proceed?

a. Use correction fluid and continue to document

b. Draw a single line through the entry
c. Cross out error completely
d. Erase error

24. Which of the following would be most critical when caring

for a client who is experiencing delirium?

a. Controlling behavior symptoms with low-dose psychotropics.

b. Correcting the underlying causative condition or illness.
c. Manipulating the environment to increase orientation.
d. Decreasing or discounting any nonessential medications

25.A client with panic disorder should be monitored for the

existence of which of the following other psychosocial
problems?

a. Attention deficit hyperacidity disorder (ADHD)

b. Developmental disability
c. Dissociative behavior
d. Substance abuse

26. Which of the following nursing interventions is given

priority in a care plan for a person having panic disorder?

a. Tell the client to take deep breaths.

b. Have the client talk about the anxiety.
c. Encourage the client to verbalize feelings.
d. Ask the client about the cause of the attack.

27. Which of the following interventions should the nurse

initially implement when caring for a client with panic
disorder?

a. Make the client role-play the panic attack.

b. Assist the client to develop an exercise program.
c. Teach the client to identify cognitive distortions.
d. Teach the client to identify sources of anxiety.

28. Which of the following statements is typical of a client with

social phobia?

a. "Without people around, I just feel so lost."

b. "There is nothing wrong with my behavior."
c "I like to be the center of attention."
d. "I knew I can’t accept that award for my brother."

29. Which of the following behavior modification techniques is

useful in the treatment of the phobias?

a. Aversion therapy
b. Irritation or modeling
c. Positive reinforcement
d. Systematic desensitization
30.A client suspected of haying a posttraumatic stress disorder
should assessed for which of the following problems?

a. Eating disorder
b. Schizophrenia
c. Suicide
d. "Sundown" syndrome

31. Which of the following psychological symptoms would the

nurse expect to find in a hospitalized client who is the only
survivor of a train accident?

a. Denial
b. Indifference
c. Perfectionism
d. Trust

32. Which of the following client statements indicates an

understanding of survivor guilt?

a. "I think I can see the purpose of my survival”

b. "I can't help but feel that everything is their fault."
c. "I new understand why I'm not able to forgive myself."
d. "I wish I could stop sabotaging my family relationships"

33. The effectiveness of monoamine oxidase (MAO) inhibitor

drug therapy in a client with posttraumatic stress disorder can
be demonstrated by which of the following client self-reports?

a. "I'm sleeping better and don’t have nightmares”

b. "I'm not losing my temper as much."
c. "I've lost my craving for alcohol."
d. "I've lost my phobia for water."

34. Which of the following findings should the nurse expect

when talking about school to a child diagnosed with a
generalized anxiety disorder?

a. The child has been fighting with peers for the past month.
b. The child can't stop lying to parents and teachers.
c. The child has gained 15 pounds in the past month.
d. The child expresses concerns about grades.

37. A client with paranoid personality disorder tells a nurse of

his decision to stop talking to his wife. Which of the following
areas should be assessed?

a. The client's doubts about the partner's loyalty.

b. The client's need to be alone and have time for self.
c. The client's decision to separate from the marital partner.
d. The client's fears about becoming too much like the partner.

38. The wife of the client diagnosed with paranoid personality

disorder tells the client she wants a divorce. When discussing
this situation with the couple, which of the following factors
would help the nurse form a care plan for this couple?

a. Denied grief
b. Intense jealousy
c. Exploitation of others
d. Self-destructive tendencies

30. Which of the following short-term goals for a client with an

antisocial personality disorder and a history of polysubstance
abuse?

a. Develop goals for personal improvement.

b. Identify situations that are out of the client's control.
c. Encourage the client to identify traumatic life events.
d. Learn to express feelings in a nondestructive manner.

41. Which of the following goals is most appropriate for a

client with antisocial personality disorder with a high risk .for
violence directed at others?

a. The client will discuss the desire to hurt others rather than act.
b. The client will be given something to destroy to displace the anger.
c. The client will develop a list of resources to use when anger
escalates.
d. The client will understand the difference between anger and
physical symptoms.

41. Which of the following characteristics or situations is

indicated when a client with borderline personality disorders
has a crisis?

a. Antisocial behavior
b. Suspicious behavior
c. Relationship problems
d. Auditory hallucinations
42. A schizophrenic client tells his primary nurse that he's
scheduled to meet the King of Samoa at a special time, making
it impossible for the client to leave his room for dinner. Which
of the following responses by the nurse is most appropriate?

a. "It's meal time. Let's go so you can eat."

b. "The King of Samoa told me to take you to dinner”
c. "Your physician expects you to follow the unit's schedule."
d. "People who don't eat, on this unit aren't being cooperative."

43.A Client diagnosed with schizophrenia several years ago

tells the nurse that he feels "very sad." The nurse observes
that he's smiling when he says it. Which of the following terms
best describes the nurse's observation?

a. Inappropriate affect
b. Extrapyramidal
c. Insight
d. Inappropriate mood

44. Which of the following conditions or characteristics is

related to the cluster of symptoms associated with
disorganized schizophrenia?

a. Odd beliefs
b. Flat affect
c. Waxy flexibility
d. Systematized delusions

45. A client approaches a nurse and tells her that he hears a

voice telling him that he's evil and deserves to die. Which of
the following terms describes the client's perception?

a. Delusion
b. Disorganized speech
c. Hallucinations
d. Idea of reference

46. Which of the following numbers of members in a therapy

group is ideal?

a. 1 to 4
b. 4 to 7
c. 7 to 10
d. 10-to15
47. Which of the following nursing diagnosis is most
appropriate for a client with acute schizophrenic reaction?

a. Social isolation related to impaired ability to trust

b. Impaired mobility related to fear of hostile impulses
c. Disturbed steep patterns related to impaired thinking ability
d. Risk for other-directed violence related to perceptual distortions

48. A client tells a nurse voices are telling him to do "terrible

things." Which of the following actions is part of the initial
therapy?

a. Find out what the voices are telling him.

b. Let him go to his room to decrease his anxiety.
c. Begin talking to the client about an unrelated topic.
d. Tell the client the voices aren't real.

49. A client is preoccupied with his belief that the CIA has been
planning to take him away to save the agency from his
influence. These delusions are a defense against which of the
following underlying feelings?

a. Aggression
b. Guilt
c. Inferiority
d. Persecution

50.1n preparation for discharge, a client diagnosed with

schizophrenia was taught self-symptom management as part
of a relapse prevention program. Which of the following
statements indicates a client understands symptom
monitoring?

a. "When I hear voices, I become afraid I’ll relapse."

b. "My parents aren't involved enough to be aware if I begin to
relapse."
c. "My family is more protected from stress if J keep them out of my
illness process."
d. "When I'm feeling stressed, I go to a quiet room by myself and do
imagery."

51. A client diagnosed with schizophrenia has been taking

haloperidol (Haldol) for 1 week when a nurse observes that the
client's eyeball is fixated on the ceiling. Which of the following
specific conditions is the client exhibiting?
a. Akathisia
b. Neuroleptic malignant syndrome
c. Oculogyric crisis
d. Tardive dyskinesia

52. Which of the following interventions is important for a

client who engages in sexual act with animals (zoophilia)?

a. Place the client is the seclusion room.

b. Assess triggers that stimulate the behaviors.
c. Have the primary health care provide order and antidepressant
medication.
d. Counsel the client not to discuss his sexual behaviors with anyone.

53. A 38-year-old woman was returning home from the store

late one evening and was sexually assaulted. When she's
brought to the emergency department, she's crying. Which of
the following concerns for this client should be the nurse's first
priority?

a. Filing a police report

b. Calling the client's family
c. Encouraging the client to enroll in a self-defense class
d. Remaining with the client and assisting her through the crisis

54. Which of the following therapies may be used with a client

who admits to frottage?

a. Electroconvulsive therapy
b. Relaxation therapy
c. Administration of psychotic agents
d. Positive reinforcement and group therapy

55. When working with a client with paraphiliac disorder, which

of the following goals is appropriate for the client?

a. To attend all meetings on the unit

b. To use triggers to initiate sexual behaviors
c. To inform his employer of the reason for hospitalization
d. To verbalize appropriate methods to meet sexual upon discharge

56. When assessing rooms for clients, the nurse should not
place which of the following clients with a client who has a
diagnosis of sexual sadism?

a. A client with a diagnosis of sexual masochism

b. A client with a diagnosis of voyeurism
c. A client who's an exhibitionist
d. A client who's a homosexual

57. The nurse is obtaining a health history from a client when

he states he has been diagnosed with voyeurism. The nurse
knows which of the following actions is characteristic of a
voyeur?

a. Observing others while they disrobe

b. Wearing clothing of the opposite sex
c. Rubbing against a no consenting person
d. Using rubber sheeting for sexual arousal

58. Which of the following definitions best describes

necrophilia?

a. Obscene phone calling

b. Sexual activity with animals
c. Sexual activity with corpses
d. Sexual arousal by contact with urine

59. A 39-year-ofd mate wishes to undergo a sex-reassignment

operation, because 'he feels trapped in his male body. Which
of the following actions is the next step the client should take
if he wants to have the operations?

a. Tell his family and friends

b. Attend psychotherapy
c. Visit transsexual bars
d. See a surgeon

60. A 35-year-old male who has been married-for 10 years

arrives in the psychiatric clinic stating, "I can't live this lie any
more. I wish I were a woman, I don't want my wife. I need a
man." Which of the following initial actions would be most
appropriate from the nurse?

a. Call the primary health care provider.

b. Encourage the client to speak to his wife.
c. Have the client admitted.
d. Sit down with the client, and talk about his feelings.

61 A female client enjoys wearing men's clothing. Her sister

tells the nurse that the client wishes a sexual reassignment
operation. The client tells the nurse she just wants to be left.
Which of the following initial nursing interventions is most
appropriate?

a. Allow the client to deal with her sister.

b. Encourage the client to verbalize her feelings.
c. Tell the client's sister to mind her own business.
d. Encourage the client to continue doing what is comfortable for her.

62. A client in a psychiatric unit has been identified as peeping

Tom. What's the medical term for the client's disorder?

a. Voyeurism
b. Gender identity disorder
c. Pedophilia
d. Fetishism

63. A client with anorexia nervosa has started taking flouxetine

hydrochloride (Prozac). Which of the following adverse
reactions complicates the treatment of this eating disorder?

a. Drowsiness
b. Dry mouth
c. Light-headedness
d. Nausea

64. Mental health is defined as:

a. A disturbance in a person's thoughts, feelings and behavior.

b. A state of well-being where a person can realize his or her own
abilities, to cope with the normal stresses of life and work productively.

c. A science which deals with measures employed to promote mental

health, to reduce the incidence of mental illness through preservation
and early treatment.
d. is concerned with the promotion of mental health, prevention of
mental disorders, and the nursing care of patients during mental
illness and rehabilitation.

65. The following are nursing responsibilities in mental health

promotion except:

a. Participate in the promotion of mental health among families and

the community
b. Help people in the community understand basic emotional needs
c. Teach parents the Importance of providing emotional support to
their children
d. Be aware of the potential causes of breakdown and when necessary
take possible preventive action

66. A nurse works in a mental health facility that a therapeutic

community (milieu) to client. Which of the following
statements describes the nurse's role in this facility?

a. Primary caregiver
b. Member of the milieu
c. Supervision more than counseling
d. Distinctly seperate from the psychiatrist

67. A community mental health nurse visits a client diagnosed

with paranoid schizophrenia. When she arrives at his house, he
calls for Satan, shouts at her, and tells her to back away.
Which of the following interventions has priority?

a. use his phone and call the police

b. remain safe by leaving the house
c. talk to him In a calm voice to reduce his agitation
d. remind him who she is and that she has nothing to fear