Ateneo de Zamboanga University

College of Nursing

PSYCHIATRIC NURSING NCLEX TEST BANK

PSYCH ASSESSMENT OF MENTAL HEALTH B. Emotional affect

C. Independence need
1. Marco approached Nurse Trisha asking for D. Aggressive behavior
advice on how to deal with his alcohol
addiction. Nurse Trisha should tell the client 8. Nurse Claire is caring for a client diagnosed
that the only effective treatment for alcoholism with bulimia. The most appropriate initial goal
is: for a client diagnosed with bulimia is?
A. Psychotherapy A. Encourage to avoid food.
B. Alcoholics Anonymous (A.A.) B. Identify anxiety-causing situations.
C. Total abstinence C. Eat only three meals a day.
D. Aversion Therapy D. Avoid shopping for plenty of groceries.

2. Nurse Hazel is caring for a male client who 9. Nurse Tony was caring for a 41-year-old
experiences false sensory perceptions with no female client. Which behavior by the client
basis in reality. This perception is known as: indicates adult cognitive development?
A. Hallucinations A. Generates new levels of awareness.
B. Delusions B. Assumes responsibility for her actions.
C. Loose associations C. Has maximum ability to solve problems and
D. Neologisms learn new skills.
D. Her perception is based on reality.
3. Nurse Monet is caring for a female client who
has suicidal tendencies. When accompanying 10. A neuromuscular blocking agent is
the client to the restroom, Nurse Monet administered to a client before ECT therapy.
should… The nurse should carefully observe the client
A. Give her privacy. for:
B. Allow her to urinate. A. Respiratory difficulties
C. Open the window and allow her to get some B. Nausea and vomiting
fresh air. C. Dizziness
D. Observe her. D. Seizures

4. A client is experiencing an anxiety attack. 11. A 75-year-old client is admitted to the

The most appropriate nursing intervention hospital with the diagnosis of dementia of the
should include? Alzheimer’s type and depression. The symptom
A. Turning on the television. that is unrelated to depression would be?
B. Leaving the client alone. A. Apathetic response to the environment.
C. Staying with the client and speaking in short B. “I don’t know” answer to questions.
sentences. C. Shallow of labile affect.
D. Ask the client to play with other clients. D. Neglect of personal hygiene.

5. A female client is admitted with a diagnosis 12. Nurse Trish is working in a mental health
of delusions of grandeur. This diagnosis facility; the nurse’s priority nursing intervention
reflects a belief that one is: for a newly admitted client with bulimia nervosa
A. Being Killed. would be:
B. Highly famous and important. A. Teach the client to measure I & O.
C. Responsible for an evil world. B. Involve the client in planning daily meals.
D. Connected to the client unrelated to oneself. C. Observe the client during meals.
D. Monitor the client continuously.
6. A 20-year-old client was diagnosed with
dependent personality disorder. Which 13. Nurse Patricia is aware that the major health
behavior is not most likely to be evidence of complication associated with intractable
ineffective individual coping? anorexia nervosa would be:
A. Recurrent self-destructive behavior. A. Cardiac dysrhythmias resulting in cardiac arrest.
B. Avoiding relationships. B. Glucose intolerance resulting in protracted
C. Showing interest in solitary activities. hypoglycemia.
D. Inability to make choices and decisions without C. Endocrine imbalance causing cold amenorrhea.
advice. D. Decreased metabolism causing cold
intolerance.
7. A male client is diagnosed with a schizotypal
personality disorder. Which signs would this 14. Nurse Anna can minimize agitation in a
client exhibit during a social situation? disturbed client by:
A. Paranoid thoughts A. Increasing stimulation.
B. Limiting unnecessary interaction. hospitalized with severe anxiety, the nurse in
C. Increasing appropriate sensory perception. charge should?
D. Ensuring constant client and staff contact. A. Encourage the staff to have frequent interaction
with the client.
15. A 39-year-old mother with obsessive- B. Share an activity with the client.
compulsive disorder has become immobilized C. Give client feedback on behavior.
by her elaborate hand washing and walking D. Respect client’s need for personal space.
rituals. Nurse Trish recognizes that the basis of
O.C. disorder is often: 22. Nurse Naomi would expect a child with a
A. Problems with being too conscientious diagnosis of reactive attachment disorder to:
B. Problems with anger and remorse A. Have a more positive relationship with the father
C. Feelings of guilt and inadequacy than the mother.
D. Feeling of unworthiness and hopelessness B. Cling to mother & cry on separation.
C. Be able to develop only superficial relationships
16. Mario is complaining to other clients about with others.
not being allowed by staff to keep food in his D. Have been physically abused.
room. Which of the following interventions
would be most appropriate? 23. When teaching parents about childhood
A. Allowing a snack to be kept in his room. depression Nurse Victoria should say?
B. Reprimanding the client. A. It may appear acting out behavior.
C. Ignoring the client's behavior. B. Does not respond to conventional treatment.
D. Setting limits on the behavior C. Is short on duration & resolves easily.
D. Looks almost identical to adult depression.
17. Conney with borderline personality disorder
who is to be discharged soon threatens to “do 24. A 60-year-old female client who lives alone
something” to herself if discharged. Which of tells the nurse at the community health center “I
the following actions by the nurse would be really don’t need anyone to talk to”. The TV is
most important? my best friend. The nurse recognizes that the
A. Ask a family member to stay with the client at client is using the defense mechanism known
home temporarily. as?
B. Discuss the meaning of the client’s statement A. Displacement
with her. B. Projection
C. Request an immediate extension for the client. C. Sublimation
D. Ignore the client's statement because it’s a sign D. Denial
of manipulation.
25. When working with a male client suffering
18. Joey, a client with antisocial personality phobia about black cats, Nurse Michelle should
disorder belches loudly. A staff member asks anticipate that a problem for this client would
Joey, “Do you know why people find you be?
repulsive?” This statement most likely would A. Anxiety when discussing phobia.
elicit which of the following client reactions? B. Anger toward the feared object.
A. Defensiveness C. Denying that the phobia exists.
B. Embarrassment D. Distortion of reality when completing daily
C. Shame routines.
D. Remorsefulness
26. Linda is pacing the floor and appears
19. Which of the following approaches would be extremely anxious. The duty nurse approaches
most appropriate to use with a client suffering in an attempt to alleviate Linda’s anxiety. The
from narcissistic personality disorder when most therapeutic question by the nurse would
discrepancies exist between what the client be?
states and what actually exists? A. Would you like to watch TV?
A. Rationalization B. Would you like me to talk with you?
B. Supportive confrontation C. Are you feeling upset now?
C. Limit setting D. Ignore the client.
D. Consistency
27. Nurse Penny is aware that the symptoms
20. Cely is experiencing alcohol withdrawal that distinguish post-traumatic stress disorder
exhibits tremors, diaphoresis, and from other anxiety disorder would be:
hyperactivity. Blood pressure is 190/87 mmHg A. Avoidance of situation & certain activities that
and pulse is 92 bpm. Which of the medications resemble the stress.
would the nurse expect to administer? B. Depression and a blunted affect when
A. naloxone (Narcan) discussing the traumatic situation.
B. benztropine (Cogentin) C. Lack of interest in family & others.
C. lorazepam (Ativan) D. Re-experiencing the trauma in dreams or
D. haloperidol (Haldol) flashbacks.

21. To establish an open and trusting 28. Nurse Benjie is communicating with a male
relationship with a female client who has been client with substance-induced persisting
dementia; the client cannot remember facts and That’s literal you know”. These statements
fills in the gaps with imaginary information. illustrate:
Nurse Benjie is aware that this is typical of? A. Neologisms
A. Flight of ideas B. Echolalia
B. Associative looseness C. Flight of ideas
C. Confabulation D. Loosening of association
D. Concretism
36. A long-term goal for a paranoid male client
29. Nurse Joey is aware that the signs & who has unjustifiably accused his wife of
symptoms that would be most specific for having many extramarital affairs would be to
diagnosis anorexia are? help the client develop:
A. Excessive weight loss, amenorrhea & A. Insight into his behavior
abdominal distension B. Better self-control
B. Slow pulse, 10% weight loss & alopecia C. Feeling of self-worth
C. Compulsive behavior, excessive fears & nausea D. Faith in his wife
D. Excessive activity, memory lapses & an
increased pulse 37. Nurse Tina is caring for a client with
delirium and states that “look at the spiders on
30. Nurse Monette is aware that extremely the wall”. What should the nurse respond to the
depressed clients seem to do best in settings client?
where they have: A. “You’re having hallucination, there are no
A. Multiple stimuli spiders in this room at all”
B. Routine Activities B. “I can see the spiders on the wall, but they are
C. Minimal decision making not going to hurt you”
D. Varied Activities C. “Would you like me to kill the spiders”
D. “I know you are frightened, but I do not see
31. To further assess a client’s suicidal spiders on the wall”
potential. Nurse Katrina should be especially
alert to the client expression of: 38. Nurse Jonel is providing information to a
A. Frustration & fear of death community group about violence in the family.
B. Anger & resentment Which statement by a group member would
C. Anxiety & loneliness indicate a need to provide additional
D. Helplessness & hopelessness information?
A. “Abuse occurs more in low-income families”.
32. A nursing care plan for a male client with B. “Abusers are often jealous or self-centered”.
bipolar I disorder should include: C. “Abusers use fear and intimidation”.
A. Providing a structured environment. D. “Abusers usually have poor self-esteem”.
B. Designing activities that will require the client to
maintain contact with reality. 39. Nurse Seymonne is caring for a client with
C. Engaging the client in conversing about current depression who has not responded to
affairs. antidepressant medication. The nurse
D. Touching the client provides assurance. anticipates what treatment procedure may be
prescribed?
33. When planning care for a female client using A. Neuroleptic medication
ritualistic behavior, Nurse Gina must recognize B. Short term seclusion
that the ritual: C. Psychosurgery
A. Helps the client focus on the inability to deal D. Electroconvulsive therapy
with reality.
B. Helps the client control the anxiety. 40. Mario is admitted to the emergency room
C. Is under the client’s conscious control. with drug-included anxiety related to over
D. Is used by the client primarily for secondary ingestion of prescribed antipsychotic
gains. medication. The most important piece of
information the nurse in charge should obtain
34. A 32-year-old male graduate student, who initially is the:
has become increasingly withdrawn and A. Length of time on the med.
neglectful of his work and personal hygiene, is B. Name of the ingested medication & the amount
brought to the psychiatric hospital by his ingested.
parents. After detailed assessment, a diagnosis C. Reason for the suicide attempt.
of schizophrenia is made. It is unlikely that the D. Name of the nearest relative & their phone
client will demonstrate: number.
A. Low self-esteem
B. Concrete thinking ANXIETY DISORDERS & STRESS
C. Effective self-boundaries
D. Weak ego 41. Chuck is a 20-year-old student diagnosed
with obsessive-compulsive behavior. A
35. A 23-year-old client who has been admitted psychiatrist prescribes clomipramine
with a diagnosis of schizophrenia says to the (Anafranil) to treat his condition. Nurse
nurse “Yes, it’s march, March is a little woman”.
Nicolette understands the rationale for this B. Positive and negative
treatment is that the clomipramine: C. Undesirable and harmful
A. Increases dopamine levels D. Predictable and controllable
B. Increases serotonin levels
C. Decreases norepinephrine levels 48. During a community visit, volunteer nurses
D. Decreases GABA levels teach stress management to the participants.
The nurses will most likely advocate which
42. A nurse at Medical Center is developing a belief as a method of coping with stressful life
care plan for a female client with post-traumatic events?
stress disorder. Which of the following would A. Avoidance of stress is an important goal for
she do initially? living.
A. Instruct the client to use distraction techniques to B. Control over one's response to stress is
cope with flashbacks. possible.
B. Encourage the client to put the past in proper C. Most people have no control over their level of
perspective. stress.
C. Encourage the client to verbalize thoughts and D. Significant others are important to provide care
feelings about the trauma. and concern.
D. Avoid discussing the traumatic event with the
client. 49. Genevieve only attends social events when
a family member is also present. She exhibits
43. A group of community nurses sees and behavior typical of which anxiety disorder?
plans care for various clients with different A. Agoraphobia
types of problems. Which of the following B. Generalized anxiety disorder
clients would they consider the most vulnerable C. Obsessive-compulsive disorder
to post-traumatic stress disorder? D. Post-traumatic stress disorder
A. An eight (8)-year-old boy with asthma who has
recently failed a grade in school. 50. Mr. Johnson was recently admitted to a
B. A 20-year-old college student with DM who psychiatric unit because of severe obsessive-
experienced date rape. compulsive behavior. Which initial response by
C. A 40-year-old widower who has recently lost his the nurse would be most therapeutic for him?
wife to cancer. A. Accepting the client's ritualistic behaviors.
D. A wife of an individual with a severe substance B. Challenging the client's need for rituals.
abuse problem. C. Expressing concern about the harmfulness of
the client's rituals.
44. Which outcome is most appropriate for D. Limiting the client's rituals that are excessive.
Francis who has a dissociative disorder?
A. Francis will deal with uncomfortable emotions 51. Nurse Kerrick observes Toni who is
on a conscious level. hospitalized on an eating disorder unit during
B. Francis will modify stress with the use of mealtimes and for 1 hour after eating. An
relaxation techniques. explanation for this intervention is:
C. Francis will identify his anxiety responses. A. To develop a trusting relationship.
D. Francis will use problem-solving strategies B. To maintain focus on the importance of nutrition.
when feeling stressed. C. To prevent purging behaviors.
D. To reinforce the behavioral contact.
45. Marty is pacing and complains of racing
thoughts. Nurse Lally asks the client if 52. Marlyn is diagnosed with anorexia nervosa
something upsetting happened, and Marty’s and is admitted to the special eating disorder
response is vague and not focused on the unit. The initial treatment priority for her is:
question. Nurse Lally assess Marty’s level of A. To determine her current body image.
anxiety as: B. To identify family interaction patterns.
A. Mild C. To initiate a refeeding program.
B. Moderate D. To promote the client's independence.
C. Severe
D. Panic 53. Which of the following attitudes from a
nurse would hinder a discussion with an
46. Nurse Martha is teaching her students about adolescent client about sexuality?
anxiety medications; she explains that A. Accepting
benzodiazepines affect which brain chemical? B. Matter-of-fact
A. Acetylcholine C. Moralistic
B. Gamma-aminobutyric acid (GABA) D. Non Judgemental
C. Norepinephrine
D. Serotonin 54. Nurse Wayne is planning a
psychoeducational discussion for a group of
47. Mandy, a nurse who works at Nurseslabs adolescent clients with anorexia nervosa.
Rehabilitation Center is assessing a client for Which of the following topics would Nurse
recent stressful life events. She recognizes that Wayne select to enhance understanding about
stressful life events are both: central issues in this disorder?
A. Desirable and growth-promoting A. Anger management
B. Parental expectations B. A state of well-being where a person can realize
C. Peer pressure and substance abuse his own abilities can cope with normal stresses of
D. Self-control and self-esteem life and work productively.
C. Is the promotion of mental health, prevention of
55. Nurse Gina understands that her client mental disorders, nursing care of patients during
Glenda who is bulimic feels shame and guilt illness and rehabilitation.
over binge eating and purging. This disorder is D. Absence of mental illness.
therefore considered:
A. Ego-distorting 60. Letty says, “Give me ten (10) minutes to
B. Ego-dystonic recall the name of our college professor who
C. Ego-enhancing failed many students in our anatomy class.”
D. Ego-syntonic She is operating on her:
A. Subconscious
56. During a mother’s class, the nurse who is B. Conscious
teaching the participants on stress C. Unconscious
management is questioned about the use of D. Ego
alternative treatments, such as herbal therapy
and therapeutic touch. She explains that the 61. The superego is that part of the psyche that:
advantage of these methods would include all A. Uses defensive function for protection.
of the following except: B. Is impulsive and without morals.
A. They are congruent with many cultural belief C. Determines the circumstances before making
systems. decisions.
B. They encourage the consumer to take an active D. The censoring portion of the mind.
role in health management.
C. They promote interrelationships within the mind- 62. Primary level of prevention is exemplified
body-spirit. by:
D. They usually work better than traditional A. Helping the client resume self-care.
medical practice. B. Ensuring the safety of a suicidal client in the
institution.
57. David is preoccupied with numerous bodily C. Teaching the client stress management
complaints even after a careful diagnostic techniques.
workup reveals no physiologic problems. D. Case finding and surveillance in the community.
Which nursing intervention would be
therapeutic for him? 63. Situation: In a home visit done by the nurse,
A. Acknowledge that the complaints are real to the she suspects that the wife and her child are
client, and refocus the client on other concerns and victims of abuse. Which of the following is the
problems. most appropriate for the nurse to ask?
B. Challenge the physical complaints by A. “Are you being threatened or hurt by your
confronting the client with the normal diagnostic partner?”
findings. B. “Are you frightened of your partner?”
C. Ignore the client's complaints, but request that C. “Is something bothering you?”
the client keeps a list of all symptoms. D. “What happens when you and your partner
D. Listen to the client's complaints carefully, and argue?”
question him about specific symptoms.
64. Freud explains anxiety as:
58. Nurse Kenzo is teaching a client about A. Strives to gratify the needs for satisfaction and
sertraline (Zoloft), which has been prescribed security.
for depression. A significant side effect is an B. Conflict between id and superego.
interference with sexual arousal by inhibiting C. A hypothalamic-pituitary-adrenal reaction to
erectile function. How should Nurse Kenzo stress.
approach this topic? D. A conditioned response to stressors.
A. Nurse Kenzo should avoid mentioning the
sexual side effects to prevent the client from having 65. The following are the appropriate nursing
anxiety about potential erectile problems. diagnosis for the client except:
B. Nurse Kenzo should advise the client to report A. Ineffective individual coping
any changes in sexual functioning in case B. Alteration in comfort, pain
medication adjustments are needed. C. Altered role performance
C. Nurse Kenzo should explain that the client's D. Impaired social interaction
sexual desire will probably decrease while on this
medication. 66. A nurse may encounter children with mental
D. Nurse Kenzo should tell the client that sexual disorders. Her knowledge of these various
side effects are expected, but that they will disorders is vital. When planning school
decrease when his depression lifts. interventions for a child with a diagnosis of
attention deficit hyperactivity disorder, a guide
59. Mental health is defined as: to remember is to:
A. The ability to distinguish what is real from what A. Provide as much structure as possible for the
is not. child.
B. Ignore the child’s overactivity.
 C. Encourage the child to engage in any play
activity to dissipate energy. 74. The primary nursing intervention in working
D. Remove the child from the classroom when with a client with moderate stage dementia is
disruptive behavior occurs. ensuring that the client:
A. Receives adequate nutrition and hydration.
67. The child with conduct disorder will likely B. Will reminisce to decrease isolation.
demonstrate: C. Remains in a safe and secure environment.
A. Easy distractibility to external stimuli. D. Independently performs self-care.
B. Ritualistic behaviors
C. Preference for inanimate objects. 75. Dementia, unlike delirium, is characterized
D. Serious violations of age related norms. by:
A. Slurred speech
68. The parents express apprehensions on their B. Insidious onset
ability to care for their maladaptive child. The C. Clouding of consciousness
nurse identifies what nursing diagnosis: D. Sensory perceptual change
A. Hopelessness
B. Altered parenting role 76. Unlike psychophysiologic disorder Linda
C. Altered family process may be best managed with:
D. Ineffective coping A. Medical regimen
B. Milieu therapy
69. The nurse assigned to the detoxification C. Stress management techniques
unit attends to various patients with substance- D. Psychotherapy
related disorders. A 45 years old male revealed
that he experienced a marked increase in his PSYCH MEDICATIONS
intake of alcohol to achieve the desired effect.
This indicates: 77. Jose is diagnosed with amphetamine
A. Withdrawal psychosis and was admitted to the emergency
B. Tolerance room. Nurse Ronald would most likely prepare
C. Intoxication to administer which of the following
D. Psychological dependence medication?
A. Librium
70. The client admitted for alcohol B. Valium
detoxification develops increased tremors, C. Ativan
irritability, hypertension, and fever. The nurse D. Haldol
should be alert for impending:
A. Delirium tremens 78. Josefina is to be discharged on a regimen of
B. Korsakoff’s syndrome lithium carbonate. In the teaching plan for
C. Esophageal varices discharge the nurse should include:
D. Wernicke’s syndrome A. Advising the client to watch the diet carefully.
B. Suggesting that the client take the pills with
71. Another client is brought to the emergency milk.
room by friends who state that he took C. Reminding the client that a CBC must be done
something an hour ago. He is actively once a month.
hallucinating, agitated, with an irritated nasal D. Encouraging the client to have blood levels
septum. checked as ordered.
A. Heroin
B. Cocaine 79. The psychiatrist orders lithium carbonate
C. LSD 600 mg p.o t.i.d for a female client. Nurse
D. Marijuana Katrina would be aware that the teaching about
the side effects of this drug were understood
72. A client is admitted with needle tracks on when the client state, “I will call my doctor
his arm, stuporous and with pinpoint pupil will immediately if I notice any:
likely be managed with: A. Sensitivity to bright light or sun.
A. naltrexone (Revia) B. Fine hand tremors or slurred speech.
B. naloxone hydrochloride (Narcan) C. Sexual dysfunction or breast enlargement.
C. disulfiram (Antabuse) D. Inability to urinate or difficulty when urinating.
D. methadone (Dolophine)
80. Tranylcypromine sulfate (Parnate) is
73. An old woman was brought for evaluation prescribed for a depressed client who has not
due to the hospital for evaluation due to responded to the tricyclic antidepressants.
increasing forgetfulness and limitations in daily After teaching the client about the medication,
function. The daughter revealed that the client Nurse Marian evaluates that learning has
used her toothbrush to comb her hair. She is occurred when the client states, “I will avoid:
manifesting: A. Citrus fruit, tuna, and yellow vegetables.”
A. Apraxia B. Chocolate milk, aged cheese, and yogurt”
B. Aphasia C. Green leafy vegetables, chicken, and milk.”
C. Agnosia D. Whole grains, red meats, and carbonated
D. Amnesia soda.”.
 D. divalproex (Depakote) and lithium (Lithobid)
81. Nurse Judy knows that statistics show that
in adolescent suicidal behavior: 88. Aira has taken amitriptyline HCL (Elavil) for
A. Females use more dramatic methods than 3 days, but now complains that it “doesn’t help”
males. and refuses to take it. What should the nurse
B. Males account for more attempts than do say or do?
females. A. Withhold the drug.
C. Females talk more about suicide before B. Record the client’s response.
attempting it. C. Encourage the client to tell the doctor.
D. Males are more likely to use lethal methods D. Suggest that it takes a while before seeing the
than are females. results.

82. Nurse Maureen knows that the non- 89. Which medications have been found to help
antipsychotic medication used to treat some reduce or eliminate panic attacks?
clients with schizoaffective disorder is: A. Antidepressants
A. phenelzine (Nardil) B. Anticholinergics
B. chlordiazepoxide (Librium) C. Antipsychotics
C. lithium carbonate (Lithane) D. Mood stabilizers
D. imipramine (Tofranil)
90. David with paranoid schizophrenia
83. When developing an initial nursing care plan repeatedly uses profanity during an activity
for a male client with a Bipolar I disorder (manic therapy session. Which response by the nurse
episode) nurse Ron should plan to? would be most appropriate?
A. Isolate his gym time. A. "Your behavior won't be tolerated. Go to your
B. Encourage his active participation in unit room immediately."
programs. B. "You're just doing this to get back at me for
C. Provide foods, fluids, and rest. making you come to therapy."
D. Discourage his participation in programs. C. "Your cursing is interrupting the activity. Take
time out in your room for 10 minutes."
84. Grace is exhibiting withdrawn patterns of D. "I'm disappointed in you. You can't control
behavior. Nurse Johnny is aware that this type yourself even for a few minutes."
of behavior eventually produces a feeling of:
A. Repression 91. Nurse Amy is providing care for a male
B. Loneliness client undergoing opiate withdrawal. Opiate
C. Anger withdrawal causes severe physical discomfort
D. Paranoia and can be life-threatening. To minimize these
effects, opiate users are commonly detoxified
85. Which information is most important for the with:
nurse Trinity to include in a teaching plan for a A. Barbiturates
male schizophrenic client taking clozapine B. Amphetamines
(Clozaril)? C. Methadone
A. Monthly blood tests will be necessary. D. Benzodiazepines
B. Report a sore throat or fever to the physician
immediately. 92. Nurse Jen is caring for a male client with
C. Blood pressure must be monitored for manic depression. The plan of care for a client
hypertension. in a manic state would include:
D. Stop the medication when symptoms subside. A. Offering high-calorie meals and strongly
encouraging the client to finish all food.
86. Ricky with chronic schizophrenia takes B. Insisting that the client remain active through
neuroleptic medication and is admitted to the the day so that he’ll sleep at night.
psychiatric unit. Nursing assessment reveals C. Allowing the client to exhibit hyperactive,
rigidity, fever, hypertension, and diaphoresis. demanding, manipulative behavior without setting
These findings suggest which life-threatening limits.
reaction: D. Listening attentively with a neutral attitude and
A. Tardive dyskinesia avoiding power struggles.
B. Dystonia
C. Neuroleptic malignant syndrome 93. Ramon is admitted for detoxification after a
D. Akathisia. cocaine overdose. The client tells the nurse that
he frequently uses cocaine but that he can
87. Nurse Krina knows that the following drugs control his use if he chooses. Which coping
have been known to be effective in treating mechanism is he using?
obsessive-compulsive disorder (OCD): A. Withdrawal
A. benztropine (Cogentin) and diphenhydramine B. Logical thinking
(Benadryl). C. Repression
B. chlordiazepoxide (Librium) and diazepam D. Denial
(Valium)
C. fluvoxamine (Luvox) and clomipramine
(Anafranil)
94. Rudolf is admitted for an overdose of B. 3 to 5 days
amphetamines. When assessing the client, the C. 6 to 8 days
nurse should expect to see: D. 10 to 14 days
A. Tension and irritability
B. Slow pulse 101. The nurse is assessing a client who has
C. Hypotension just been admitted to the emergency
D. Constipation department. Which signs would suggest an
overdose of an antianxiety agent?
95. The nurse is aware that the side effect of A. Combativeness, sweating, and confusion
electroconvulsive therapy that a client may B. Agitation, hyperactivity, and grandiose ideation
experience: C. Emotional lability, euphoria, and impaired
A. Loss of appetite memory
B. Postural hypotension D. Suspiciousness, dilated pupils, and increased
C. Confusion for a time after treatment blood pressure
D. Complete loss of memory for a time
102. Within a few hours of alcohol withdrawal,
96. Miranda, a psychiatric client is to be nurse John should assess the male client for
discharged with orders for haloperidol (Haldol) the presence of:
therapy. When developing a teaching plan for A. Disorientation, paranoia, tachycardia
discharge, the nurse should include cautioning B. Tremors, fever, profuse diaphoresis
the client against: C. Irritability, heightened alertness, jerky
A. Driving at night. movements
B. Staying in the sun. D. Yawning, anxiety, convulsions
C. Ingesting wines and cheeses.
D. Taking medications containing aspirin. 103. The nurse understands that the therapeutic
effects of typical antipsychotic medications are
97. In preparing a female client for associated with which neurotransmitters
electroconvulsive therapy (ECT), Nurse Michelle change?
knows that succinylcholine (Anectine) will be A. Decreased dopamine level
administered for which therapeutic effect? B. Increased acetylcholine level
A. Short-acting anesthesia C. Stabilization of serotonin
B. Decreased oral and respiratory secretions D. Stimulation of GABA
C. Skeletal muscle paralysis
D. Analgesia 104. Tony refuses his evening dose of
Haloperidol (Haldol), then becomes extremely
98. Nurse Gina is aware that the dietary agitated in the dayroom while other clients are
implications for a client in manic phase of watching television. He begins cursing and
bipolar disorder is: throwing furniture. Nurse Oliver first action is
A. Serve the client a bowl of soup, buttered French to:
bread, and apple slices. A. Check the client’s medical record for an order
B. Increase calories, decrease fat and decrease for an as-needed I.M. dose of medication for
protein. agitation.
C. Give the client pieces of cut-up steak, carrots, B. Place the client in full leather restraints.
and an apple. C. Call the attending physician and report the
D. Increase calories, carbohydrates, and protein. behavior.
D. Remove all other clients from the dayroom.
99. Alfred was newly diagnosed with anxiety
disorder. The physician prescribed buspirone 105. Junnel, who is manic, but not yet on
(BuSpar). The nurse is aware that the teaching medication, comes to the drug treatment center.
instructions for newly prescribed buspirone The nurse would not let this client join the
should include which of the following? group session because:
A. A warning about the drug's delayed therapeutic A. The client is disruptive.
effect, which is from 14 to 30 days. B. The client is harmful to self.
B. A warning about the incidence of neuroleptic C. The client is harmful to others.
malignant syndrome (NMS). D. The client needs to be on medication first.
C. A reminder of the need to schedule blood work
in 1 week to check blood levels of the drug. 106. Which of the following best explains why
D. A warning that immediate sedation can occur tricyclic antidepressants are used with caution
with a resultant drop in pulse. in elderly patients?
A. Central Nervous System effects
100. A client seeks care because she feels B. Cardiovascular system effects
depressed and has gained weight. To treat her C. Gastrointestinal system effects
atypical depression, the physician prescribes D. Serotonin syndrome effects
tranylcypromine sulfate (Parnate), 10 mg by
mouth twice per day. When this drug is used to 107. A client refuses to remain on psychotropic
treat atypical depression, what is its onset of medications after discharge from an inpatient
action? psychiatric unit. Which information should the
A. 1 to 2 days
community health nurse assess first during the 114. Francis who is addicted to cocaine
initial follow-up with this client? withdraws from the drug. Nurse Ron should
A. Income level and living arrangements. expect to observe:
B. Involvement of family and support systems. A. Hyperactivity
C. Reason for inpatient admission. B. Depression
D. Reason for refusal to take medications. C. Suspicion
D. Delirium
108. Important teaching for women in their
childbearing years who are receiving ALZHEIMER’S, DELIRIUM, & DEMENTIA
antipsychotic medications includes which of
the following? 115. When taking a health history from a female
A. Increased incidence of dysmenorrhea while client who has a moderate level of cognitive
taking the drug. impairment due to dementia, the nurse would
B. Occurrence of incomplete libido due to expect to note the presence of:
medication adverse effects. A. Accentuated premorbid traits
C. Continuing previous use of contraception during B. Enhance intelligence
periods of amenorrhea. C. Increased inhibitions
D. Instruction that amenorrhea is irreversible. D. Hypervigilance

109. Discharge instructions for a male client 116. Nurse Isabelle enters the room of a client
receiving tricyclic antidepressants include with a cognitive impairment disorder and asks
which of the following information? what day of the week it is; what the date, month,
A. Restrict sodium intake. and year are; and where the client is. The nurse
B. Don’t consume alcohol. is attempting to assess:
C. Discontinue if dry mouth and blurred vision A. Confabulation.
occur. B. Delirium.
D. Restrict fluid. C. Orientation.
D. Perseveration.
110. Nurse Fred is assessing a client who has
just been admitted to the ER department. Which 117. A student nurse was asked which of the
signs would suggest an overdose of an following best describes dementia. Which of the
antianxiety agent? following best describes the condition?
A. Suspiciousness, dilated pupils, and incomplete A. Memory loss occurring as part of the natural
BP consequence of aging.
B. Agitation, hyperactivity, and grandiose ideation B. Difficulty coping with physical and psychological
C. Combativeness, sweating, and confusion change.
D. Emotional lability, euphoria, and impaired C. Severe cognitive impairment that occurs rapidly.
memory D. Loss of cognitive abilities, impairing ability to
perform activities of daily living.
111. Barbara with bipolar disorder is being
treated with lithium for the first time. Nurse 118. Which of the following will Nurse Dory use
Clint should observe the client for which when communicating with a client who has
common adverse effect of lithium? cognitive impairment?
A. Polyuria A. Complete explanations with multiple details.
B. Seizures B. Pictures or gestures instead of words.
C. Constipation C. Stimulating words and phrases to capture the
D. Sexual dysfunction client's attention.
D. Short words and simple sentences.
112. Which medication can control the
extrapyramidal effects associated with 119. Mrs. Mendoza is a 75-year-old client who
antipsychotic agents? has dementia of the Alzheimer’s type and
A. Clorazepate (Tranxene) confabulates. The nurse understands that this
B. Amantadine (Symmetrel) client:
C. Doxepin (Sinequan) A. Denies confusion by being jovial.
D. Perphenazine (Trilafon) B. Pretends to be someone else.
C. Rationalizes various behaviors.
113. Propanolol (Inderal) is used in the mental D. Fills in memory gaps with fantasy.
health setting to manage which of the following
conditions? 120. Which ability should Nurse Rebecca expect
A. Antipsychotic-induced akathisia and anxiety. from a client in the mild stage of dementia of
B. Obsessive-compulsive disorder (OCD) to the Alzheimer’s type?
reduce ritualistic behavior. A. Remembering the daily schedule.
C. Delusions for clients suffering from B. Recalling past events.
schizophrenia. C. Coping the anxiety.
D. The manic phase of bipolar illness as a mood D. Solving problems of daily living.
stabilizer.
121. Mrs. Jordan is an elderly client diagnosed
with Alzheimer’s disease. She becomes
agitated and combative when a nurse B. Fearfulness of being alone at night.
approaches to help with morning care. The C. Increased complaints of physical ailments.
most appropriate nursing intervention in this D. Problems with preparing a meal or balancing
situation would be to: her checkbook.
A. Tell the client firmly that it is time to get dressed.
B. Obtain assistance to restrain the client for 128. During the home visit of a client with
safety. dementia, the nurse notes that an adult
C. Remain calm and talk quietly to the client. daughter persistently corrects her father’s
D. Call the doctor and request an order for misperceptions of reality, even when the father
sedation. becomes upset and anxious. Which
intervention should the nurse teach the
122. Which goal is a priority for a client with a caregiver?
DSM-IV-TR diagnosis of delirium and the A. Anxiety-reducing measures
nursing diagnosis acute confusion related to B. Positive reinforcement
recent surgery secondary to traumatic hip C. Reality orientation techniques
fracture? D. Validation techniques
A. The client will complete activities of daily living.
B. The client will maintain safety. 129. The nurse describes a client as anxious.
C. The client will remain oriented. Which of the following statements about
D. The client will understand communication. anxiety is true?
A. Anxiety is usually pathological.
123. Which of the following is not included in B. Anxiety is directly observable.
the care plan of a client with a moderate C. Anxiety is usually harmful.
cognitive impairment involving dementia of the D. Anxiety is a response to a threat.
Alzheimer’s type?
A. Daily structured schedule. SCHIZOPHRENIA
B. Positive reinforcement for performing activities
of daily living. 130. Nurse Dorothy is evaluating care of a client
C. Stimulating environment. with schizophrenia; the nurse should keep
D. Use of validation techniques. which point in mind?
A. Frequent reassessment is needed and is based
124. In clients with a cognitive impairment on the client's response to treatment.
disorder, the phenomenon of increased B. The family does not need to be included in the
confusion in the early evening hours is called: care because the client is an adult.
A. Aphasia. C. The client is too ill to learn about his illness.
B. Agnosia. D. Relapse is not an issue for a client with
C. Sundowning. schizophrenia.
D. Confabulation.
131. Gio told his nurse that the FBI is
125. 80-year-old Mr. Stevens is accompanied to monitoring and recording his every movement
the clinic by his son, who tells the nurse that and that microphones have been placed in the
the client’s constant confusion, incontinence, unit walls. Which action would be the most
and tendency to wander are intolerable. The therapeutic response?
client was diagnosed with chronic cognitive A. Confront the delusional material directly by
impairment disorder. Which nursing diagnosis telling Gio that this simply is not so.
is most appropriate for the client’s son? B. Tell Gio that this must seem frightening to him
A. Risk for other-directed violence. but that you believe he is safe here.
B. Disturbed sleep pattern. C. Tell Gio to wait and talk about these beliefs in
C. Caregiver role strain. his one-on-one counseling sessions.
D. Social isolation. D. Isolate Gio when he begins to talk about these
beliefs.
126. Which of the following outcome criteria is
appropriate for the client with dementia? 132. Which of the following client behaviors
A. The client will return to an adequate level of documented in Gio’s chart would validate the
self-functioning. nursing diagnosis of Risk for other-directed
B. The client will learn new coping mechanisms to violence?
handle anxiety. A. Gio's description of being endowed with
C. The client will seek out resources in the superpowers.
community for support. B. Frequent angry outburst noted toward peers
D. The client will follow an established schedule for and staff.
activities of daily living. C. Refusal to eat cafeteria food.
D. Refusal to join in group activities.
127. A family member expresses concern to a
nurse about behavioral changes in an elderly 133. Nurse Winona educates the family about
aunt. Which would cause the nurse to suspect a symptom management for when the
cognitive impairment disorder? schizophrenic client becomes upset or anxious.
A. Decreased interest in activities that she once Which of the following would Nurse Winona
enjoyed. state be helpful?
 A. Call the therapist to request a medication 139. A client tells the nurse that psychotropic
change. medicines are dangerous and refuses to take
B. Encourage the use of learned relaxation them. Which intervention should the nurse use
techniques. first?
C. Request that the client be hospitalized until the A. Ask the client about any previous problems with
crisis is over. psychotropic medications.
D. Wait before the anxiety worsens before B. Ask the client if an injection is preferable.
intervening. C. Insist that the client takes medication as
prescribed.
134. Drogo, who has had auditory D. Withhold the medication until the client is less
hallucinations for many years, tells Nurse suspicious.
Khally that the voices prevent his participation
in a social skills training program at the 140. Upon Sam’s admission for acute
community health center. Which intervention is psychiatric hospitalization, Nurse Jona
most appropriate? documents the following: Client refuses to
A. Let Drogo analyze the content of the voices. bathe or dress, remains in the room most of the
B. Advise Drogo to participate in the program when day, speaks infrequently to peers or staff.
the voices cease. Which nursing diagnosis would be the priority
C. Advise Drogo to take his medications as at this time?
prescribed. A. Anxiety
D. Teach Drogo to use thought-stopping B. Decisional conflict
techniques. C. Self-care deficit
D. Social isolation
135. Cersei is diagnosed as having
disorganized schizophrenia. Which behaviors 141. Which statement is correct about a 25-
would Nurse Sansa most likely assess in the year-old client with newly diagnosed
client? schizophrenia?
A. Absence of acute symptoms impaired role A. Age of onset is typical for schizophrenia.
function. B. Age of onset is later than usual for
B. Extreme social withdrawal, odd mannerisms, schizophrenia.
and behavior. C. Age of onset is earlier than usual for
C. Psychomotor immobility; presence of waxy schizophrenia.
flexibility. D. Age of onset follows no predictable pattern in
D. Suspiciousness toward others increased schizophrenia.
hostility.
142. Which factor is associated with increased
136. Jaime has a diagnosis of schizophrenia risk for schizophrenia?
with negative symptoms. In planning care for A. Alcoholism
the client, Nurse Brienne would anticipate a B. Adolescent pregnancy
problem with: C. Overcrowded schools
A. Auditory hallucinations D. Poverty
B. Bizarre behaviors
C. Ideas of reference 143. The nurse is caring for a client with
D. Motivation for activities schizophrenia. Which of the following
outcomes is the least desirable?
137. The family of a schizophrenic client asks A. The client spends more time by himself.
the nurse if there is a genetic cause of this B. The client doesn’t engage in delusional thinking.
disorder. To answer the family, which fact C. The client doesn’t harm himself or others.
would the nurse cite? D. The client demonstrates the ability to meet his
A. Conclusive evidence indicates a specific gene own self-care needs.
transmits the disorder.
B. Incidence of this disorder is variable in all 144. The nurse formulates a nursing diagnosis
families. of Impaired verbal communication for a client
C. There is a little evidence that genes play a role with schizotypal personality disorder. Based on
in transmission. this nursing diagnosis, which nursing
D. Genetic factors can increase the vulnerability for intervention is most appropriate?
this disorder. A. Helping the client to participate in social
interactions.
138. Ramsay is diagnosed with schizophrenia B. Establishing a one-on-one relationship with the
paranoid type and is admitted to the psychiatric client.
unit of Medical Center. Which of the following C. Establishing alternative forms of
nursing interventions would be most communication.
appropriate? D. Allowing the client to decide when he wants to
A. Establishing a non-demanding relationship. participate in verbal communication with the nurse.
B. Encouraging involvement in group activities.
C. Spending more time with Ramsay. 145. Since admission 4 days ago, a client has
D. Waiting until Ramsay initiates interaction. refused to take a shower, stating, “There are
poison crystals hidden in the showerhead.
They’ll kill me if I take a shower.” Which nursing 151. The etiology of schizophrenia is best
action is most appropriate? described by:
A. Dismantling the showerhead and showing the A. Genetics due to a faulty dopamine receptor.
client that there is nothing in it. B. Environmental factors and poor parenting.
B. Explaining that other clients are complaining C. Structural and neurobiological factors.
about the client’s body odor. D. A combination of biological, psychological, and
C. Asking a security officer to assist in giving the environmental factors.
client a shower.
D. Accepting these fears and allowing the client to 152. A client with schizophrenia who receives
take a sponge bath. fluphenazine (Prolixin) develops
pseudoparkinsonism and akinesia. What drug
146. A client with paranoid personality disorder would the nurse administer to minimize
is admitted to a psychiatric facility. Which extrapyramidal symptoms?
remark by the nurse would best establish A. benztropine (Cogentin)
rapport and encourage the client to confide in B. dantrolene (Dantrium)
the nurse? C. clonazepam (Klonopin)
A. “I get upset once in a while, too.” D. diazepam (Valium)
B. “I know just how you feel. I’d feel the same way
in your situation.” 153. A client with a diagnosis of paranoid
C. “I worry, too, when I think people are talking schizophrenia comments to the nurse, “How do
about me.” I know what is really in those pills?” Which of
D. “At times, it’s normal not to trust anyone.” the following is the best response?
A. Say, “You know it’s your medicine.”
147. How soon after chlorpromazine (Thorazine) B. Allow him to open the individual wrappers of the
administration should the nurse expect to see a medication.
client’s delusional thoughts and hallucinations C. Say, “Don’t worry about what is in the pills. It’s
eliminated? what is ordered.”
A. Several minutes D. Ignore the comment because it’s probably a
B. Several hours joke.
C. Several days
D. Several weeks 154. A client tells the nurse that people from
Mars are going to invade the earth. Which
148. A client is about to be discharged with a response by the nurse would be most
prescription for the antipsychotic agent therapeutic?
haloperidol (Haldol), 10 mg by mouth twice per A. “That must be frightening to you. Can you tell
day. During a discharge teaching session, the me how you feel about it?”
nurse should provide which instruction to the B. “There are no people living on Mars.”
client? C. “What do you mean when you say they’re going
A. Take the medication 1 hour before a meal. to invade the earth?”
B. Decrease the dosage if signs of illness D. “I know you believe the earth is going to be
decrease. invaded, but I don’t believe that.”
C. Apply sunscreen before being exposed to the
sun. 155. A client with schizophrenia tells the nurse
D. Increase the dosage up to 50 mg twice per day he hears the voices of his dead parents. To help
if signs of illness don’t decrease. the client ignore the voices, the nurse should
recommend that he:
149. A client with paranoid schizophrenia A. Sit in a quiet, dark room and concentrate on the
repeatedly uses profanity during an activity voices.
therapy session. Which response by the nurse B. Listen to a personal stereo through headphones
would be most appropriate? and sing along with the music.
A. “Your behavior won’t be tolerated. Go to your C. Call a friend and discuss the voices and his
room immediately.” feelings about them.
B. “You’re just doing this to get back at me for D. Engage in strenuous exercise.
making you come to therapy.”
C. “Your cursing is interrupting the activity. Take 156. A client with schizophrenia is receiving
time out in your room for 10 minutes.” antipsychotic medication. Which nursing
D. “I’m disappointed in you. You can’t control diagnosis may be appropriate for this client?
yourself even for a few minutes.” A. Ineffective protection related to blood dyscrasias
B. Urinary frequency related to adverse effects of
150. Which of the following is one of the antipsychotic medication
advantages of the newer antipsychotic C. Risk for injury related to a severely decreased
medication risperidone (Risperdal)? level of consciousness
A. The absence of anticholinergic effects. D. Risk for injury related to electrolyte disturbances
B. A lower incidence of extrapyramidal effects.
C. Photosensitivity and sedation. 157. A client with persistent, severe
D. No incidence of neuroleptic malignant schizophrenia has been treated with
syndrome. phenothiazines for the past 17 years. Now the
client’s speech is garbled as a result of drug-
induced rhythmic tongue protrusion. What is D. Alcohol
another name for this extrapyramidal
symptom? 163. A client, age 36, with paranoid
A. Dystonia schizophrenia believes the room is bugged by
B. Akathisia the Central Intelligence Agency and that his
C. Pseudoparkinsonism roommate is a foreign spy. The client has never
D. Tardive dyskinesia had a romantic relationship, has no contact
with family members, and hasn’t been
158. A client with a history of medication employed in the last 14 years. Based on
noncompliance is receiving outpatient Erikson’s theories, the nurse should recognize
treatment for chronic undifferentiated that this client is in which stage of psychosocial
schizophrenia. The physician is most likely to development?
prescribe which medication for this client? A. Autonomy versus shame and doubt
A. chlorpromazine (Thorazine) B. Generativity versus stagnation
B. imipramine (Tofranil) C. Integrity versus despair
C. lithium carbonate (Lithane) D. Trust versus mistrust
D. fluphenazine decanoate (Prolixin Decanoate)
164. The nurse is teaching a psychiatric client
159. The nurse is assigned to a client with about her prescribed drugs, chlorpromazine,
catatonic schizophrenia. Which intervention and benztropine. Why is benztropine
should the nurse include in the client’s plan of administered?
care? A. To reduce psychotic symptoms.
A. Meeting all of the client’s physical needs. B. To reduce extrapyramidal symptoms.
B. Giving the client an opportunity to express C. To control nausea and vomiting.
concerns. D. To relieve anxiety.
C. Administering lithium carbonate (Lithonate) as
prescribed. 165. A client is admitted to the psychiatric unit
D. Providing a quiet environment where the client with a tentative diagnosis of psychosis. Her
can be alone. physician prescribes the phenothiazine
thioridazine (Mellaril) 50 mg by mouth three
160. Propranolol (Inderal) is used in the mental times per day. Phenothiazines differ from
health setting to manage which of the following central nervous system (CNS) depressants in
conditions? their sedative effects by producing:
A. Antipsychotic-induced akathisia and anxiety. A. Deeper sleep than CNS depressants.
B. The manic phase of bipolar illness as a mood B. Greater sedation than CNS depressants.
stabilizer. C. A calming effect from which the client is easily
C. Delusions for clients suffering from aroused.
schizophrenia. D. More prolonged sedative effects, making the
D. Obsessive-compulsive disorder (OCD) to client more difficult to arouse
reduce ritualistic behavior.
166. A woman is admitted to the psychiatric
161. Every day for the past 2 weeks, a client emergency department. Her significant other
with schizophrenia stands up during group reports that she has difficulty sleeping, has
therapy and screams, “Get out of here right poor judgment, and is incoherent at times. The
now! The elevator bombs are going to explode client’s speech is rapid and loose. She reports
in 3 minutes!” The next time this happens, how being a special messenger from the Messiah.
should the nurse respond? She has a history of depressed mood for which
A. “Why do you think there is a bomb in the she has been taking an antidepressant. The
elevator?” nurse suspects which diagnosis?
B. “That is the same thing you said in yesterday’s A. Schizophrenia
session.” B. Paranoid personality
C. “I know you think there are bombs in the C. Bipolar illness
elevator, but there aren’t.” D. Obsessive-compulsive disorder (OCD)
D. “If you have something to say, you must do it
according to our group rules.” 167. A client with paranoid schizophrenia is
admitted to the psychiatric unit of a hospital.
162. A 26-year-old client is admitted to the Nursing assessment should include careful
psychiatric unit with acute onset of observation of the client’s:
schizophrenia. His physician prescribes the A. Thinking, perceiving, and decision-making skills
phenothiazine chlorpromazine (Thorazine), 100 B. Verbal and nonverbal communication processes
mg by mouth four times per day. Before C. Affect and behavior
administering the drug, the nurse reviews the D. Psychomotor activity
client’s medication history. Concomitant use of
which drug is likely to increase the risk of 168. Which information is most important for
extrapyramidal effects? the nurse to include in a teaching plan for a
A. guanethidine (Ismelin) schizophrenic client taking clozapine (Clozaril)?
B. droperidol (Inapsine) A. Monthly blood tests will be necessary.
C. lithium carbonate (Lithonate)
 B. Report a sore throat or fever to the physician 175. A client diagnosed with schizoaffective
immediately. disorder is suffering from schizophrenia with
C. Blood pressure must be monitored for elements of which of the following disorders?
hypertension. A. Personality disorder
D. Stop the medication when symptoms subside. B. Mood disorder
C. Thought disorder
169. Positive symptoms of schizophrenia D. Amnestic disorder
include which of the following?
A. Flat affect, avolition, and anhedonia 176. When teaching the family of a client with
B. Somatic delusions, echolalia, and a flat affect schizophrenia, the nurse should provide which
C. Waxy flexibility, alogia, and apathy information?
D. Hallucinations, delusions, and disorganized A. Relapse can be prevented if the client takes the
thinking medication.
B. Support is available to help family members
170. A client with chronic schizophrenia meet their own needs.
receives 20 mg of fluphenazine decanoate C. Improvement should occur if the client has a
(Prolixin Decanoate) by I.M. injection. Three stimulating environment.
days later, the client has muscle contractions D. Stressful family situations can precipitate a
that contort the neck. This client is exhibiting relapse in the client.
which extrapyramidal reaction?
A. Dystonia 177. A client is admitted to the psychiatric unit
B. Akinesia with active psychosis. The physician diagnoses
C. Akathisia schizophrenia after ruling out several other
D. Tardive dyskinesia conditions. Schizophrenia is characterized by:
A. Loss of identity and self-esteem.
171. Hormonal effects of the antipsychotic B. Multiple personalities and decreased self-
medications include which of the following? esteem.
A. Polydipsia and dysmenorrhea C. Disturbances in affect, perception, and thought
B. Dysmenorrhea and increased vaginal bleeding content and form.
C. Retrograde ejaculation and gynecomastia D. Persistent memory impairment and confusion.
D. Akinesia and dysphasia
178. The nurse is providing care to a client with
172. An agitated and incoherent client, age 29, a catatonic type of schizophrenia who exhibits
comes to the emergency department with extreme negativism. To help the client meet his
complaints of visual and auditory basic needs, the nurse should:
hallucinations. The history reveals that the A. Ask the client which activity he would prefer to
client was hospitalized for paranoid do first.
schizophrenia from ages 20 to 21. The B. Negotiate a time when the client will perform
physician prescribes haloperidol (Haldol), 5 mg activities.
I.M. The nurse understands that this drug is C. Tell the client specifically and concisely what
used for this client to treat: needs to be done.
A. Dyskinesia D. Prepare the client ahead of time for the activity.
B. Dementia
C. Psychosis PERSONALITY AND MOOD DISORDERS
D. Tardive dyskinesia
179. The nursing diagnosis that would be most
173. Yesterday, a client with schizophrenia appropriate for a 22-year old client who uses
began treatment with haloperidol (Haldol). ritualistic behavior would be:
Today, the nurse notices that the client is A. Ineffective coping
holding his head to one side and complaining B. Impaired adjustment
of neck and jaw spasms. What should the nurse C. Personal identity disturbance
do? D. Sensory/perceptual alterations
A. Assume that the client is posturing.
B. Tell the client to lie down and relax. 180. Rendell is admitted in an acute psychiatric
C. Evaluate the client for adverse reactions to unit at Medical Center. He suddenly tells Nurse
haloperidol. Matt about his plans for suicide. The nurse’s
D. Put the client on the list for the physician to see priority is to:
tomorrow. A. Allow the client time alone for reflection.
B. Encourage the client to use problem solving.
174. Which non-antipsychotic medication is C. Follow agency protocol for suicide precautions.
used to treat some clients with schizoaffective D. Stimulate the client's interest in activities.
disorder?
A. phenelzine (Nardil) 181. Clara is under evaluation for imminent
B. chlordiazepoxide (Librium) suicide risk, which information given by her
C. lithium carbonate (Lithane) would be most significant?
D. imipramine (Tofranil) A. At least a 2-year history of feeling depressed
more days than not.
B. Divorced from spouse six (6) months ago.
 C. Feeling loss of energy and appetite. C. The individual typically remains in the
D. Reference to suicide as best solution to mainstream of society, although he has problems in
identified problems. social and occupational roles.
D. The individual usually seeks treatment willingly
182. Nurse Rica is teaching a client and her for symptoms that are personally distressful.
family about the causes of depression. Which
of the following causative factors should the 188. Angela has a history of conflict-filled
nurse emphasize as the most significant? relationships. Despite an expressed desire for
A. Brain structure abnormalities friends, she acts in ways that tend to alienate
B. Chemical imbalance people. Which nursing intervention would be
C. Social environment important for Angela?
D. Recessive gene transmission A. Establish a therapeutic relationship in which the
nurse uses role-modeling and role-playing for
183. In a day treatment program, a manic client appropriate behaviors.
is creating considerable chaos, behaving in a B. Help the client to select friends who are kind
dominating and manipulative way. Which and extra caring.
nursing intervention is most appropriate? C. Point out that the client acts in ways that
A. Allow the peer group to intervene. alienate others.
B. Describe acceptable behavior and set realistic D. Recognize that this client is unlikely to change
limits with the client. and therefore intervention is inappropriate.
C. Recommend that the client is hospitalized for
treatment. 189. Crisis intervention carried out to the client
D. Tell the client that his behavior is inappropriate. has this primary goal:
A. Assist the client to express her feelings.
184. Ralph is admitted to Medical Center with B. Help her identify her resources.
the diagnosis of bipolar disorder, a single C. Support her adaptive coping skills.
manic episode. Which of the following D. Help her return to her pre-rape level of function.
behaviors would the nurse expect to assess?
A. Apathy, poor insight, and poverty of ideas. 190. Five months after the incident the client
B. Anxiety, somatic complaints, and insomnia. complains of difficulty to concentrate, poor
C. Elation, hyperactivity, and impaired judgment. appetite, inability to sleep and guilt. She is
D. Social isolation, delusional thinking, and clang likely suffering from:
associations. A. Adjustment disorder
B. Somatoform Disorder
185. The community nurse is following up on C. Generalized Anxiety Disorder
Mrs. Jenner who was hospitalized at D. Post-traumatic disorder
Nurseslabs Medical Center due to depressive
disorder, not otherwise specified, following the 191. Anxiety is caused by:
death of her spouse. In reviewing the client’s A. An objective threat.
chart, the nurse notes that Mrs. Jenner has an B. A subjectively perceived threat.
Axis II diagnosis of dependent personality C. Hostility turned to the self.
disorder. Which behavior would the nurse D. Masked depression.
anticipate in this client?
A. Difficulty making decisions, lack of self- 192. It would be most helpful for the nurse to
confidence. deal with a client with severe anxiety by:
B. Grandiose thinking, attention-seeking behaviors. A. Give specific instructions using speak in concise
C. Odd mannerisms, speech, and behaviors. statements.
D. Unstable moods and impulsive behaviors. B. Ask the client to identify the cause of her
anxiety.
186. Santino is hospitalized at Nurseslabs C. Explain in detail the plan of care developed.
Medical Center following a suicide attempt. His D. Urge the client to focus on what the nurse is
history reveals a previous diagnosis of schizoid saying.
personality disorder. Which of the following
behaviors would be atypical of a client with this 193. Mrs. B is diagnosed with borderline
disorder? personality disorder and has a nursing
A. Actions designed to please the nurse. diagnosis of Risk for self-directed violence,
B. Limited expressions of feelings and emotions. which is related to the client’s self-mutilation
C. Odd ideas and mannerisms. behavior (burning arms with cigarettes). Which
D. Reluctance to join group activities. client behavior would indicate a positive
outcome of intervention?
187. Which statement about an individual with a A. Mrs. B denies feelings of wanting to harm
personality disorder is true? anyone.
A. Psychotic behavior is common during acute B. Mrs. B expresses feelings of anger towards
episodes. others.
B. Prognosis for recovery is good with therapeutic C. Mrs. B requests cigarettes at appropriate times.
intervention. D. Mrs. B tells the nurse about wanting to burn
herself.
194. Barbara is a client with a borderline B. The patient’s rights were explained to him.
personality disorder. She is defensive and C. The staff observed confidentiality.
emotionally labile and often becomes suddenly D. The staff carried out less restrictive measures
and explosively angry. When interacting with but were unsuccessful.
her, you as a nurse would:
A. Point out how angry Barbara is becoming, and 201. The charge nurse of a psychiatric unit is
confront the behavior. planning the client assignment for the day. The
B. Take a calm, quiet, and non-confrontational most appropriate staff to be assigned to a client
approach, and avoid arguing with Barbara. with a potential for violence is which of the
C. Tell Barbara to calm down and to avoid following:
becoming explosive or restraints will be used. A. A timid nurse
D. Use a gentle touch and a caring approach to B. A mature, experienced nurse
calm Barbara. C. An inexperienced nurse
D. A soft-spoken nurse
195. Nurse Danita is working with clients who
have personality disorders. Which of the 202. The client says to the nurse “Pray for me”
following techniques would the nurse use to and entrusts her wedding ring to the nurse. The
deal with her own feelings that interfere with nurse knows that this may signal which of the
therapeutic performance? following:
A. Active listening techniques A. Anxiety
B. Challenging the client's assertions B. Suicidal ideation
C. Forming social relations C. Major depression
D. Seeking peer or supervisor direction D. Hopelessness

196. Clients who are suspicious primarily use 203. Which of the following interventions
projection for which purpose: should be prioritized in the care of the suicidal
A. Deny reality. client?
B. To deal with feelings and thoughts that are not A. Remove all potentially harmful items from the
acceptable. client’s room.
C. To show resentment towards others. B. Allow the client to express feelings of
D. Manipulate others. hopelessness.
C. Note the client’s capabilities to increase self-
197. Situation: A 42-year-old male client, is esteem.
admitted to the ward because of bizarre D. Set a “no suicide” contract with the client.
behaviors. He was given a diagnosis of
schizophrenia paranoid type. The client should 204. The client is concerned about his coming
have achieved the developmental task of: discharge, manifested by being unusually sad.
A. Trust vs. Mistrust Which is the most therapeutic approach by the
B. Industry vs. Inferiority nurse?
C. Generativity vs. Stagnation A. “You are much better than when you were
D. Ego integrity vs. Despair admitted so there’s no reason to worry.”
B. “What would you like to do now that you’re
198. A teenage girl is diagnosed to have about to go home?”
borderline personality disorder. Which C. “You seem to have concerns about going
manifestations support the diagnosis? home.”
A. Lack of self-esteem, strong dependency needs, D. “Aren’t you glad that you’re going home soon?”
and impulsive behavior.
B. Social withdrawal, inadequacy, sensitivity to 205. Knowledge and skills in the care of violent
rejection and criticism. clients is vital in the psychiatric unit. A nurse
C. Suspicious, hypervigilance and coldness. observes that a client with a potential for
D. Preoccupation with perfectionism, orderliness, violence is agitated, pacing up and down the
and need for control. hallway and making aggressive remarks. Which
of the following statements is most appropriate
199. The client joins a support group and to make to this patient?
frequently preaches against abuse, is A. What is causing you to become agitated?
demonstrating the use of: B. You need to stop that behavior now.
A. Denial C. You will need to be restrained if you do not
B. Reaction formation change your behavior.
C. Rationalization D. You will need to be placed in seclusion.
D. Projection
206. A client with schizotypal personality
200. The client jumps up and throws a chair out disorder is sitting in a puddle of urine. She’s
of the window. He was restrained after his playing in it, smiling, and softly singing a
behavior can no longer be controlled by the child’s song. Which action would be best?
staff. Which of these documentations indicates A. Admonish the client for not using the bathroom.
the safeguarding of the patient’s rights? B. Firmly tell the client that her behavior is
A. There was a doctor’s order for unacceptable.
restraints/seclusion.
 C. Ask the client if she’s ready to get cleaned up me? How could God do this to me?” This
now. reaction is one of:
D. Help the client to the shower, and change the A. Depression
bedclothes. B. Denial
C. Anger
207. A client with avoidant personality disorder D. Bargaining
says occupational therapy is boring and
doesn’t want to go. Which action would be 213. Which of the following characteristics is
best? expected for a client with paranoid personality
A. State firmly that you’ll escort him to OT. disorder who receives bad news?
B. Arrange with OT for the client to do a project on A. The client is overly dramatic after hearing the
the unit. facts.
C. Ask the client to talk about why OT is boring. B. The client focuses on self to not become over-
D. Arrange for the client not to attend OT until he is anxious.
feeling better. C. The client responds from a rational, objective
point of view.
208. A young woman is brought to the D. The client doesn’t spend time thinking about the
emergency room appearing depressed. The information.
nurse learned that her child died a year ago due
to an accident. The initial nursing diagnosis is 214. Which of the following types of behavior is
dysfunctional grieving. The statement of the expected from a client diagnosed with a
woman that supports this diagnosis is: paranoid personality disorder?
A. “I feel envious of mothers who have toddlers” A. Eccentric
B. “I haven’t been able to open the door and go B. Exploitative
into my baby’s room “ C. Hypersensitive
C. “I watch other toddlers and think about their play D. Seductive
activities and I cry.”
D. “I often find myself thinking of how I could have 215. Which of the following interventions is
prevented the death." important for a client with paranoid personality
disorder taking olanzapine (Zyprexa)?
209. The client said “I can’t even take care of A. Explain effects of serotonin syndrome.
my baby. I’m good for nothing.” Which is the B. Teach the client to watch for extrapyramidal
appropriate nursing diagnosis? adverse reactions.
A. Ineffective individual coping related to loss. C. Explain that the drug is less effective if the client
B. Impaired verbal communication related to smokes.
inadequate social skills. D. Discuss the need to report paradoxical effects
C. Low esteem related to failure in role such as euphoria.
performance.
D. Impaired social interaction related to repressed 216. A client with antisocial personality is trying
anger. to convince a nurse that he deserves special
privileges and that an exception to the rules
210. A 27-year-old writer is admitted for the should be made for him. Which of the following
second time accompanied by his wife. He is responses is the most appropriate?
demanding, arrogant, talks fast, and A. “I believe we need to sit down and talk about
hyperactive. Initially, the nurse should plan this this.”
for a manic client: B. “Don’t you know better than to try to bend the
A. Set realistic limits to the client’s behavior. rules?”
B. Repeat verbal instructions as often as needed. C. “What you’re asking me to do is unacceptable.”
C. Allow the client to get out feelings to relieve D. “Why don’t you bring this request to the
tension. community meeting?”
D. Assign a staff to be with the client at all times to
help maintain control. 217. A client with borderline personality
disorder is admitted to the unit after slashing
211. The client is arrogant and manipulative. In his wrist. Which of the following goals is most
ensuring a therapeutic milieu, the nurse does important after promoting safety?
one of the following: A. Establish a therapeutic relationship with the
A. Agree on a consistent approach among the staff client.
assigned to the client. B. Identify whether splitting is present in the client’s
B. Suggest that the client take a leading role in the thoughts.
social activities. C. Talk about the client’s acting out and self-
C. Provide the client with extra time for one on one destructive tendencies.
sessions. D. Encourage the client to understand why he
D. Allow the client to negotiate the plan of care. blames others.

212. A widow age 28, whose husband died one 218. A hospitalized client, diagnosed with a
(1) year ago due to AIDS, has just been told that borderline personality disorder, consistently
she has AIDS. Panky says to the nurse, “Why breaks the unit’s rules. This behavior should be
confronted because it will help the client:
A. Control anger D. Perceptual.
B. Reduce anxiety
C. Set realistic goals 224. You need to assess whether a patient who
D. Become more self-aware has a mood disorder is ready for discharge.
Which statement would indicate readiness for
219. The client with antisocial personality discharge?
disorder: A. Right now, I can't bathe myself or dress myself,
A. Suffers from a great deal of anxiety. but I feel good about that.
B. Is generally unable to postpone gratification. B. Going home will be fun, but if it isn't fun, I can
C. Rapidly learns by experience and punishment. always make my mother help me or tell her to do
D. Has a great sense of responsibility toward so. She better help me.
others. C. I will take my medicines as I should and know to
call the number you gave me if I have bad
220. A nurse is orienting a new client to the unit thoughts.
when another client rushes down the hallway D. Taking care of myself is important, but it's okay if
and asks the nurse to sit down and talk. The I don't want to do anything.
client requesting the nurse’s attention is
extremely manipulative and uses socially 225. An angry patient is in the community room.
acting-out behaviors when demands are unmet. She picks up a chair and uses it to hit another
The nurse should: patient on the head. When you come into the
A. Suggest that the client requesting attention community room, what should your first
speak with another staff member. response to the patient holding the chair be?
B. Leave the new client and talk with the other A. Are you crazy? Hitting people can hurt them!
client to avoid precipitating acting out behavior. B. Hitting others is unacceptable. Please put the
C. Tell the interrupting client to sit down and be chair completely down on the floor.
patient, stating, “I’ll be back as soon as possible.” C. How would you like it if I hit you over the head
D. Introduce the two clients and suggest that the with a chair?
client join the new client and the nurse on the tour. D. You're in big trouble now. It's probably prison
you are looking at!
QUIZLET
226. A 22-year-old female is admitted to the unit
221. A 48-year-old Hispanic woman is seen by a following a suicide attempt. She has a 2-week
psychiatric clinical nurse specialist after history of depression as well as a history of
receiving a call by her son. According to the abusing multiple substances and anorexia
son, since his father's death 7 months ago, his nervosa. What is your first nursing priority?
mother has lost 30 pounds and can't sleep. A. Socialization.
During her initial visit, the patient states, 'My B. Contracting for eating behavior.
husband talks to me in his visits, but his words C. Safety.
make no sense to me. I don't understand what D. Administering the Beck depression scale.
he wants me to do.' What is an appropriate
nursing diagnosis? 227. Gerald was admitted to the psychiatric
A. Ineffective denial. acute care unit because he stood in the center
B. Bipolar mood disorder. of a main two-way street in his underwear and a
C. Hyper-religiosity. T-shirt, shouting, 'I am being held against my
D. Grieving. will. I have personal rights.' Gerald was
diagnosed with bipolar disorder, manic type.
222. Your neighbor's husband comes to talk to Which of the following interventions will add to
you. He says his wife has not left the house in 2 everyone's safety in the acute care
weeks, has a flat mood, and has lost interest in environment?
her usual activities. You recognize these as the A. Have hectic surroundings.
primary symptoms of B. Have consistent unit routines.
A. Depression. C. Minimize staff interventions.
B. Schizophrenia. D. Medicate the patient only if he has private health
C. Suicidal ideation. insurance.
D. Bipolar manic episodes.
228. Your patient has just been physically
223. Your patient is ready for discharge after a cleaned up after slicing his left arm 8 times. To
30-day hospitalization for manic depression. show an appropriate evaluative response,
About 30 minutes before his discharge, his which of the following would be your best
roommate comes to you and says, 'He is talking statement?
crazy.' When you ask your patient how he is A. I could care less if you cut yourself. It doesn't
feeling, he states, 'I feel like Superman. I can do hurt me.
anything. I can fly home today and then become B. If you wouldn't cut yourself, you would have a
a U.S. Senator.' Which type of mania-related much happier life.
symptoms is this patient exhibiting? C. You are lucky someone found you in time. Now
A. Social. you can help us make you better.
B. Cognitive. D. The behavior of cutting is not acceptable.
C. Behavioral.
229. A 21-year-old patient has a diagnosis of 236. Your patient has just shown you some
schizophrenia and is stuporous, yet exhibits fresh, self-inflicted, superficial cuts-eight of
sudden, excessive motor activity with repetitive them going up and down his right arm. What is
sit-ups. What is this behavior called? your initial intervention based on infection
A. Delusional. control principles?
B. Hallucinogenic. A. Send the patient back to his room as part of
C. Paranoid. behavioral modification.
D. Catatonic B. Suture the cuts using a large-bore needle and
nondissolving sutures.
230. Which of the following patients is at risk for C. Cleanse the wounds with soap and water.
depression? D. Administer tetanus toxoid injection
A. A patient with history of diabetes mellitus. intramuscularly.
B. A patient with a depressive genetic
predisposition.
C. A patient who recently bought a puppy.
D. A patient who had only 6 hours of sleep last
night due to watching a TV movie.

231. Once a patient is diagnosed with a major

depressive episode, the primary nursing
intervention should be associated with
A. Safety.
B. Pharmacology.
C. Administration of gastric lavage.
D. Hemodialysis.

232. Which of the following statements would

indicate a depressed mood?
A. I can't wait to go to the ballgame today; it should
be fun.
B. I feel sad today, just like yesterday.
C. I feel like going to the gym for a workout today,
then maybe to a movie.
D. Since it's raining outside, how about a game of
chess?

233. Which of the following is a common

symptom of a major depressive episode?
A. Loss of hearing.
B. Increased energy.
C. Hopelessness.
D. Recurrent thoughts of well-being.

234. A patient who is psychotic has a formed

bowel movement on the floor of his room. How
should you clean up this excrement?
A. Use a thick diaper or pad.
B. Wear gloves and use some paper towels or toilet
paper.
C. Wear gloves, use toilet paper, and wash the
area with a 1:10 bleach solution.
D. Wear a gown, shoe covers, mask, and
chemotherapy-impervious gloves, and wash the
area with an ammonia with bleach 1:1 solution.

235. patient is extremely agitated and is

throwing body fluids at anyone who comes near
him. What is the best way to protect yourself as
you and others physically restrain the patient?
A. Wash your clothes within 30 minutes of
becoming soiled with body fluids.
B. Wear protective eyewear and a face shield.
C. Check that your tetanus and hepatitis B titers are
within normal limits.
D. Wear a gown over your clothes and shoe
covers.