Cordillera Career Development College

Psychiatric Nursing
Midterm Exam

1. Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting?

a. I Acute renal failure
a. II 75
b. III Bipolar disorder I, mixed
c. IV Loss of disability benefits 2
months ago
d. V None
b. I Schizophrenia, paranoid type
a. II Death of spouse last year
b. III 60
c. IV None
d. V Diabetes, type 2

c. I Polysubstance dependence
a. II Narcissistic Personality Disorder
b. III 90
c. IV Hyperlipidemia
d. V Charges pending for assault
d. I Major Depression
a. II Avoidant Personality Disorder
b. III Hypertension
c. IV Home destroyed by hurricane
last year
d. V 80

2. A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it:
a. focuses on plans for treatment.
b. includes nursing and medical diagnoses.
c. classifies problems in multiple areas of functioning.
d. uses the framework of a specific biopsychosocial theory.
3. The psychiatric nurse addresses axis I of the DSM as the focus of treatment but must also consider
physical health problems that may affect treatment. Which axis contains the desired information?
a. II
b. III

c. IV
d. V

4. A score of 100 in the GAF under the DSM-IV-TR indicates that the person:
a. Has absent or minimal symptoms
b. Has superior functioning in a wide range of activities
c. Has no more than everyday problems or concerns
d. All of the above
5. Your patient suspected with depression has a GAF score of 9. Which of the following areas should you
prioritize first when giving care to this patient?
a. Safety
b. Interaction with other patients

c. Personal hygiene
d. None of the above

6. The nurse reviews records in preparation for working with the patient.in which phase of the nursepatient relationship is this?
a. Termination
b. Orientation

c. Pre-orientation
d. Working

7. During the nurses conversation with the client, the client states, I have no reason to be sad. I have a
great job and a wonderful wife and family. Which of the following comments would be best for the
nurse to make at this time?
a. Why do you think youre depressed?
b. Think about how fortunate you are.
c. You have many positive qualities.
d. Depression can be caused by a chemical imbalance in the brain
8. A 23 y/o man was voluntarily admitted to the inpatient unit with a diagnosis of paranoid schizophrenia.
As the nurse approaches the client, he says, If you come any closer, Ill die. This is an example of:
a. Hallucination
b. Delusion

c. Illusion
d. Idea of reference

9. A client taking trifluoperazine exhibits severe extrapyramidal symptoms, a temperature of 105 degrees
Fahrenheit and diaphoresis. The nurse suspects neuroleptic malignant syndrome. The best action is to
a. Administer the parkinsonian medication as
ordered
b. Stop the neuroleptic medication

c. Withhold fluids
d. Administer an anti-anxiety medication as
ordered

10. A client whom Nardil was prescribed for depression is brought to the ER with severe occipital
headaches after eating pepperoni pizza for lunch. Which of the following interpretations is it important
for the nurse tomake regarding these findings?
a. Allergic reaction related to ingestion of processed food
b. Hypertensive crisis related to drug and food reaction

c. Panic anxiety related to unresolved issues

d. Conversion disorder related to uncontrolled anxiety
11. In teaching a client about her new anti-anxiety medication, alprazolam (Xanax), the nurse should
include which of the following?
a. Caution the client to avoid foods with tyramine
b. Caution the client not to drink alcoholic beverages
c. Instruct the client to take the Xanax 1 hour after meals
d. Instruct the client to double up a dose if she forgets to take her medication
12. In discussing the use of monoamine oxidase inhibitors with the client, the nurse emphasizes that the
biggest complication with this class of drug is:
a. Blood dyscrasia
b. Hypertensive crisis

c. Extrapyramidal effects
d. Neuroleptic malignant syndrome

13. A client states, I can hear the other clients talking about me and laughing. The most appropriate
nursing response is:
a. You must be hearing voices again
b. What are they saying?

c. You must feel terrible when you hear

that.
d. Im sorry, I dont hear any voices.

14. The nurse evaluates a client who is having trouble completing a sentence before quickly moving on to
the next topic and sentence. What is the client experiencing?
a. Confabulation
b. Flight of ideas

c. Illusion
d. Word salad

15. When teaching a group of clients about anti-anxiety medications, the nurse explains that
benzodiazepines affect which brain chemical?
a. Acetylcholine
b. Gamma-Aminobutyric Acid(GABA)

c. Norepinephrine
d. Serotonin

16. A client who is on lithium therapy is visited by the home health nurse to have blood drawn for routine
lithium level. The nurse assesses that the client is apathetic, has difficulty responding to questions,
walks with unsteady gait and has fine hand tremors. Which of the following would the nurse suspect
the client is experiencing?
a. An expected reaction to lithium therapy
b. Pseudoparkinsonism caused by lithium
therapy

c. A medical problem unrelated to lithium

therapy
d. Toxic effects of elevated lithium levels

17. A client is diagnosed of major depression. Which is a medication that the nurse will expect to
administer?
a. Thorazine
b. Sertraline

c. Diphenhydramine
d. Haloperidol

18. Which information would be most important for the nurse to teach a client taking Nardil, a MAOI drug?
a. The need to avoid foods and beverages containing tyramine
b. The importance of maintaining regular follow up visits
c. The drugs possible adverse effects, such as hypertension
d. The rationale for the therapeutic effect of mood elevation
19. While assessing a client who is taking haloperidol, the nurse notes a temperature of 38.9 degrees
Centigrade, BP of 180/92 and profuse diaphoresis. Which side effect should the nurse suspect?
a. Agranulocytosis
b. Extrapyramidal reaction

c. hepatotoxicity
d. neuroleptic Malignant Syndrome

20. The nurse correctly teaches a client who is taking benzodiazepine to avoid excessive intake of:
a. cheese
b. coffee

c. sugar
d. shellfish

21. To prevent the occurrence of lithium toxicity, the nurse should teach the client to maintain adequate
intake of:
a. fruits and vegetables
b. low fat foods

c. protein and vitamin C

d. water and sodium

22. The nurse should know that MAOI antidepressants can interact adversely with which drug?

a. Aspirin
b. Acetaminophen

c. Meperidine
d. Norepinephrine

23. Which neurotransmitter has been implicated in the development of Alzheimers disease?
a. Acetylcholine
b. Dopamine

c. Epinephrine
d. Serotonin

24. The anxious client is often given tranquilizers to help control the level of anxiety. When taking a major
tranquilizer such as phenothiazine, which of the following symptoms should be reported to the
physician immediately.
a. Dry mouth
b. Drowsiness

c. Orthostatic hypotension
d. Tardive dyskinesia

25. Your client is placed on diazepam (Valium) to treat anxiety. Which of the following should be included in
your teaching?
a. Take the drug with milk or food to decrease
b. If you are drowsy, stop taking the drug
c. Do not use alcohol while on duty
d. The drug can be given during the last trimester of pregnancy
26. The nurse is caring for a 58 y/o male client diagnosed with paranoid schizophrenia. When the client
says, the earth and the roof of the house rule the political structure with particles of rain, the nurse
recognizes this as:
a. Tangentiality
b. Perseveration

c. Loose association
d. Thought blocking

27. A 34 y/o male client who is being maintained on MAOI phenelzine (Nardil) is experiencing a
hypertensive crisis. The physician writes all of the following orders for the client. Which one should the
nurse carry out first?
a. Administer short acting anti-hypertensive medication
b. Monitor V/S
c. Use external cooling measures to control hyperpyrexia
d. Discontinue phenelzine
28. One of the goals of crisis intervention with a suicidal adolescent is to:
a. Prevent the adolescent from embarrassing himself
b. Show the adolescent how to cope with his life situation
c. Assess the adolescent to consider other options for coping with situation
d. Change the adolescents situation, thereby eliminating the need for suicide
29. A woman enters a crisis center and implores the nurse on duty to help her. Which of the following is
most important for the nurse to assess first?
a. The womans family history
b. What she wants the nurse to do for her
c. The womans perception of her situation

d. What shes willing to do to resolve her

problem

30. A client begins having auditory hallucination. 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 didnt hear anything. What scary thing is he saying?
c. Who is he? Do you know him?
d. I didnt hear a mans voice, but you look scared.
31. Which of the following drugs needs a WBC level checked regularly?
a. Lithane
b. Clozaril

c. Tofranil
d. Diazepam

32. After 3 days of taking haloperidol, the client shows an inability to sit still, is restless and fidgety, and
paces around the unit. Of the following extrapyramidal adverse reactions, the client is showing signs of:
a. Dystonia
b. Akathisia

c. Parkinsonism
d. Tardive dyskinesia

33. After 10 days of lithium therapy, the clients lithium level is 1.0 mEq/L. The nurse knows that this value
indicates which of the following?
a. A laboratory error
b. An anticipated therapeutic blood level of
the drug

c. An atypical client response to the drug

d. A toxic level

34. What is an important health teaching for a patient taking in Disulfiram(Antabuse)?

a. Avoid beverages and food containing

alcohol

b. Avoid tyramine containing food

c. take medication every 4 hours
d. none of the above

35. Ben is assigned in a psychiatric ward; he notices that one of the patients would follow every move he
would make. When he moves his hand, the patient would also move his hand. This is:
a. Waxy flexibility
b. Echolalia

c. Perseveration
d. Echopraxia

36. During an interview, Rona notices that the clients response is similar to what she says. This is:
a. Waxy flexibility
b. Echolalia

c. Perseveration
d. Echopraxia

37. While making rounds, Mary noticed one of her clients saying the following line: I have money, want to
study. Daddy wants honey, honey honey beeThis is an example of?
a. Neologism
b. Word salad

c. Flight of ideas
d. Clang association

38. A person seeing a design on the floor thought it was a fossil, this is an example of:
a. Illusion
b. Delusion

c. Hallucination
d. Idea of reference

39. I have heard my mother say I will not take this medication. It was found out that Joshs mother was
already dead 10 years ago. This is an example of:
a. Illusion
b. Delusion

c. Hallucination
d. Idea of reference

40. The most prevalent neurotransmitter is:

a. Acetylcholine
b. GABA

c. Dopamine
d. Serotonin

41. Dopamine, a neurotransmitter, is synthesized by what dietary amino acid?

a. Glutamate
b. Tyramine

c. Tryptophan
d. Tyrosine

42. All the following are excitatory neurotransmitters except:

a. Dopamine
b. Norepinephrine

c. GABA
d. Epinephrine

43. Psychotropic medications should be decreased gradually.

a. True

b. False

44. Refers to the temporary return of symptoms usually occurring because of abrupt discontinuation of a
psychotropic drug.
a. True

b. False

45. It is a turning point in an individuals life that produces an overwhelming emotional response.
a. Stressor
b. Stimuli

c. Perseverance
d. Crisis

46. Crisis intervention is self limiting and it usually exists for:

a. 2-3 weeks
b. 1-2 weeks

c. 3-4 weeks
d. 4-5 weeks

47. The only neurotransmitter with both excitatory and inhibitory action.
a. Acetylcholine
b. Dopamine

c. Histamine
d. Serotonin

48. A 40 y/o woman newly admitted to the psychiatric unit says, Are there any doctors here who can take
the radio out of my brain? then she strikes herself in the head saying, Somebody has to help me. I
cant take this any longer. Which action is the most appropriate at this time?
a. Alert the guards that the patient may become agitated and ask them to watch her closely
b. Approach the patient with 2 other staff nurses, and ask them to watch her closely
c. Go near the patient and say, I understand you think there is a radio in your brain. How did that
happen?
d. Sit next to the patient and say, Im a nurse, I saw you hitting your head. Can you tell me what you
are experiencing right now?
49. A patient tells the nurse, Im too depressed to talk to you. Leave me alone. Which of the following
responses by the nurse would be most therapeutic?
a. Ill be back in two hours
b. Why are you so depressed?

c. Ill sit here with you for a moment

d. Call me when you feel like talking to me

50. A client recently diagnosed with cancer says to the nurse, Im still going to smoke. The nurses best
response to this client would be:
a. I cant believe you would still want to
smoke

b. When did you start smoking?

c. Lets talk more about this.
d. Im sure you family will be upset.

51. When assessing the patients thought content, the nurse should primarily focus on:
a. Delusions
b. Complex fantasies and self absorption
c. Objective data elicited from the patients psychiatric history
d. Illusion
52. When you are visiting a place for the first time but you feel that you have been in that place before is
known as:
a. Amnesia
b. Jamais vu

c. Dj vu
d. Echopraxia

53. Formication is an example of what type of hallucination?

a. Auditory
b. Tactile

c. Gustatory
d. hypnopompic

54. All of the following are appropriate health teachings for patients taking in lithium except:
a. It is best taken after meals
b. Patient must increase sodium and water intake
c. Exercises and other activities which will help the patient perspire is encouraged
d. Antipsychotic medications are given in the first 2 weeks during lithium therapy
55. The mother of a manic patient asks you why the patient is taking in both an antipsychotic medication
and lithium. The best response of the nurse is:
a. Lithium is a weak drug. It needs an antipsychotic medication which can be given simultaneously to
address manic symptoms of the patient
b. Antipsychotic medications potentiate lithium and thus increasing the effects of lithium
c. The antipsychotic medication addresses a different symptom in the patient that is why it is given
together with lithium
d. It is necessary that an anti-psychotic medication is given to address symptoms of mania in the first
2 weeks.