MISAMIS UNIVERSITY

COLLEGE OF NURSING

IN-HOUSE REVIEW PROGRAM

NAME: ________________________________ DATE: _________

SECTION: ______________________________ SCORE: ________

EVALUATION EXAMINATION IN PSYCHIATRIC & MENTAL HEALTH NURSING

INSTRUCTIONS: This questionnaire contains 100 ITEMS. Read the questions thoroughly and
carefully then choose the LETTER of the correct answer.

SITUATION 1 – Among patients with psychiatric a. avoid the patient until the behaviors cease.
conditions, communication is the means by which the b. demand firmly that the patient cease all inappropriate
nurse initiates, maintains, and terminates a therapeutic touching.
relationship. c. ask the patient to explain why the innuendoes occur.
1. When considering communication, what is the initial task for d. explain that the behavior is inappropriate & must stop.
a nurse responsible for the care of a newly admitted patient? 8. A patient experiencing a loss of reality believes in the angry
a. Providing an introduction that includes one's name and voices in her head. The nurse will respond to a newly admited
professional role patient who is experiencing auditory hallucinations. The
b. Self-assessing for possible barriers to effective nurse initially makes which response?
communication with the patient a. "There are no voices in your head."
c. Conveying respect and caring when engaging in the b. "Try to ignore them by listening to your favorite music."
initial nurse–patient conversation c. "I am not hearing those voices, but I know you do."
d. Allowing the patient to determine the focus of the initial d. "Just listen to my voice to distract yourself."
nurse–patient communication 9. During a team meeting the RN who is experiencing a
2. A new patient is assigned to the nurse, who begins countertransference reaction to a patient would state:
communication. The nurse's initial statement is: a. "He reminds me so much of my sweet uncle."
a. "Welcome to our unit. My name is David, and I will be b. "That patient asked me out to dinner."
your RN today. Do you have any questions? I will not c. "I think the team needs to discuss how best to manage
discuss what we talk about with anyone else." the patient's manipulative behaviors."
b. "My name is Ann, and I will be your nurse this evening. d. "I believe it's okay to cry."
Where would you like to start?" 10. The new RN is having difficulty knowing how to terminate a
c. "Hello! What is your name? My name is Bruce, and we relationship with patients. The preceptor states:
will work together on your discharge goals. You may tell a. "If the relationship has been short, termination may not
me anything you would like, because everything you tell be necessary."
me will not be repeated." b. "Just say good-bye and good luck."
d. "My name is Sally, and I will be working with you today. c. "Thank the patient for working with you, and say how
I will be sharing our discussion with the care team here you valued the experience."
only. By what name may I address you?" d. "Try to move through the termination phase as quickly
3. The patient asks, "Why are there so many questions asked as possible."
of me?" The most therapeutic response by the nurse is:
a. "So we can help solve your problems here." SITUATION 3 – Today, people with mental illness receive
b. "Questions are asked to know the concerns you have." treatment in a variety of settings. The following questions
c. "It is important that you and I become friends." deal with the range of treatment settings available for
d. "We are required to ask you questions as part of your those with mental illness.
therapy." 11. A patient requires limit-setting by the RN. In accomplishing
4. A patient discloses a history of chronic trauma to the student this intervention, the RN will say:
nurse. The student therapeutically responds: a. "You are not following the rules."
a. "I think everything will be okay." b. "Here are the unit rules; let's review them."
b. "This is difficult to talk about; I'm here to help." c. "Your behavior is bad."
c. "How long did that go on?" d. "How many times must I repeat the unit rules?"
d. "I know you will be feeling better soon!" 12. To best achieve implementation of balance on an inpatient
5. A patient in an outpatient program asks the nurse if he can acute-care unit, the RN will say to the patient:
keep a secret. The nurse replies: a. "Are you feeling suicidal?"
a. "I am not able to keep a secret, because I share our b. "How about taking a walk with the group now?"
work together with the health care team here." c. "Did you sleep well last night?"
b. "Please tell me first, and then I will decide." d. "When will your family arrive today?"
c. "I will only tell your secret if it involves harming others." 13. A new nurse will best ensure that the therapeutic
d. "Yes, I can keep a secret." environment is healthy when he or she verbalizes:
a. "I want to always avoid conflict in the workplace."
SITUATION 2 –Although important in all nursing b. "I believe the team should make important decisions for
specialties, the therapeutic relationship is especially the patient."
crucial to the success of interventions with clients c. "I don't think the patients should be busy with activities
requiring psychiatric care because the therapeutic on the unit."
relationship and the communication within it serve as the d. "I’ll closely monitor my personal values and beliefs."
underpinning for treatment and success. 14. The characteristics of a therapeutic milieu are constantly
6. A newly admitted patient is depressed and fears her husband being changed as a result of demands created by which
will ask for a divorce. She begins to cry during the initial treatment-related factor?
assessment interview. An effective nursing strategy would a. The severity of the symptoms displayed by the patients
be to: b. The short hospital stays of today's mentally ill patients
a. postpone the assessment for later. c. The different treatment goals
d. The degree of aggression demonstrated by the patients
b. avoid comment on her tears, and continue the 15. With the implementation of the concepts of therapeutic
assessment. community, what is the rationale upon which decision
c. stop and offer her a tissue. making is based?
d. ask her why her husband wants to divorce her. a. Daily group meetings serve as the forum for all patients
7. A newly admitted patient continually touches the nursing to be involved in the decision-making process.
staff members and makes sexual innuendoes when b. Any decision that affects the therapeutic nature of the
interactions are attempted. The initial therapeutic manner of community is made by the health care team.
managing such behavior is to:

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 c. Patients whose cognitive function is affected by their b. "I'm attending a seminar on teaching relaxation
mental health diagnosis are excluded from the unit's techniques to the anxious patient."
decision-making process. c. "I've been reading some of the latest research on the
d. The privilege to be included in decision making is earned possible causes of depression."
by the individual patient through compliance with his or d. "I understand the impact chronic mental illness has on
her treatment plan. relationships and family."
25. What is the role of the DSM-V in the care of a psychiatric
SITUATION 4 – Some clients with psychiatric disorders patient?
display hostile or physically aggressive behavior that a. Diagnosing criteria c. Care-planning framework
represents a challenge to nurses and other staff members. b. Effective interventions d. Treatment reimbursement
16. A patient with a history of aggressive behavior begins pacing
while talking on the telephone. The RN suspects that the SITUATION 6 – Schizophrenia affects thought processes
patient is in the triggering phases of the assault cycle and and content, perception, emotion, behavior, and social
implements which intervention? functioning; however, it affects each individual differently.
a. Continues to observe the patient and note additional The degree of impairment in both the acute or psychotic
behavioral changes phase and the chronic or long-term phase varies greatly;
b. Alerts the other staff members that the patient is likely thus, so do the needs of and the nursing interventions for
to act out each affected client.
c. Using a calm voice, asks the patient to end the 26. Which inheritable factor presents the greatest risk for the
conversation immediately development of schizophrenia?
d. Asks the patient to stop pacing or hang up the phone a. Both parents affected c. Sibling affected
17. The priority nursing intervention when working with a patient b. Fraternal twin affected d. Grandparent affected
who has entered the escalation phase of the assault cycle is 27. Which modification to a person's personality is most
to: associated with schizophrenia?
a. call for the staff's help immediately. a. Change c. Splitting
b. call the patient by name while letting him/her know that b. Deterioration d. Hypersensitivity
the staff is there to help. 28. Which criterion is required for a diagnosis of delusional
c. administer PRN antianxiety medications by mouth. disorder?
d. assist the patient to identify and eliminate the trigger a. Current history of substance abuse
causing the anger. b. Presence of prominent hallucinations
18. Which nursing intervention is most appropriate for the post- c. No previous diagnosis of schizophrenia
crisis depression phase of the assault cycle? d. Existence of delusions for at least 2 months
a. Asking "Can we talk about what triggered your angry 29. A patient experiencing delusions is noted to have more
behavior?" anxiety and difficulty with attention following 2 days on the
b. Applying physical restraints when deemed necessary inpatient unit. Which nursing intervention would be most
c. Directing the client to "Go to your room & calm down" helpful for the patient?
d. Providing perscribed medication a. Walking with a group of staff and other patients off the
19. Meeting the immediate safety needs of an aggressive patient unit
is based on which principle of care? b. Listening to music or reading
a. The safety of the milieu must be achieved by any means c. Discussing treatment goals for the inpatient stay
available. d. Participating in a noncompetitive creative activity
b. The least restrictive option is implemented. 30. Knowing that a patient is demonstrating positive symptoms
c. Patients in seclusion and/or restraints require intensive of schizophrenia has a role in predicting the patient's:
nursing care. a. risk for relapse.
d. Safety is a right of all patients. b. response to prescribed medication.
20. What factors determine when seclusion of an aggressive c. return to precrisis function.
patient is terminated? d. reluctance to adhere to the treatment plan.
a. The patient's expressed wishes and assurances
b. Nursing judgment and facility protocols SITUATION 7 – The primary medical treatment for
c. Staff consensus and patient behavior schizophrenia is psychopharmacology.
d. Patient's ability to self-manage behavior and assured
milieu safety
31. The multidisciplinary team discusses the patient's negative
SITUATION 5 – Nursing philosophies often describe the symptoms of schizophrenia. The nurse expects which
person or individual as a biopsychosocial being who medication to be ordered?
possesses unique characteristics and responds to others a. Prolixin (fluphenazine) c. Seroquel (quetiapine)
and the world in various and diverse ways. This view of b. Haldol (haloperidol) d. Thorazine (chlorpromazine)
the individual as unique requires nurses to assess each 32. When an older adult is prescribed an antipsychotic
person and his or her responses to plan and provide medication, which intervention has priority regarding the
nursing care that is personally meaningful. patient's safety?
21. Beyond being warm and caring, the most important attribute a. Wearing sunglasses when outdoors
for the psychiatric-mental health nurse to possess in order b. Changing from a sitting to standing position slowly
to provide quality nursing care is: c. Being frequently monitored for suicidal ideations
a. patience. d. Avoiding foods with high fat content
b. a sense of humor. 33. What aspect of traditional antipsychotic medication therapy
c. self-care patterns. is most responsible for a patient's medication nonadherence
d. knowledge of psychopathology. and resulting rehospitalization?
22. When considering community education for the most a. The cost of the medication
common mental health disorder, which topic will the nurse b. The need for frequent blood tests
plan to present? c. The biases against such medications
a. How compulsive ritual behaviors are best managed d. The occurrence of EPSEs.
b. How relaxation techniques positively affect chronic 34. There is an anticholinergic effect on the peripheral nervous
anxiety system resulting from the effects of some antipsychotic
c. Recognizing the early signs of depression medication. Tachycardia, constipation, and urinary hesitation
d. Recognizing the signs and symptoms of opioid overdose are the result of this effect on which cranial nerve (CN)?
23. The nurse responds to a patient's concerns associated with a. CN III b. CN VII c. CN IX d. CN X
his visual hallucinations by stating, "Mr. Jones, I know the 35. Prior to administering Clozaril (clozapine) and at regular
visions are real to you but I can't see them. That must be intervals during treatment, the nurse will evaluate the
very frightening to you. " The response demonstrates the patient's:
nurse's attempt to address the hallucinations by: a. electroencephalogram (EEG).
a. strengthening the patient's self esteem. b. electrocardiogram (ECG).
b. responding to the patient in a calm, matter-of-fact c. lipids.
manner. d. complete blood count (CBC).
c. treating the patient as an individual.
d. providing the patient with a connection to reality. SITUATION 8 – Depression is a mood disorder that robs
24. Which statement demonstrates an understanding of the the person of joy, self-esteem, and energy. It interferes
fundamental basis that psychiatric nursing is built upon? with relationships and occupational productivity.
a. "I really find fulfillment when working with the mentally
ill population." 36. Growth hormone assessment is a frequently used biologic
diagnostic tool to diagnosis depression in which population?

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 a. Children c. Middle-aged adults c. The behaviors have increased in severity since onset 2
b. Adolescents d. Older adults weeks ago.
37. A 70-year-old man comes to the clinic for his annual physical d. The patient has been abusing alcohol consistently since
exam and influenza vaccine. He shares that his "life has no onset of symptoms.
meaning," he "feels tired all the time," and "has lost all hope 47. Manic individuals attempt to control others and to achieve
for the future." The initial nursing intervention is to: their goals through:
a. ask him to stay in the clinic until a mental health a. displaying tantrumlike behavior.
professional arrives to further assess him. b. physically aggressive behavior.
b. alert the physician that he may be depressed and c. manipulatively praising others.
require inpatient treatment. d. threatening to physically harm themselves.
c. further assess his concerns and history of psychiatric 48. Which nursing intervention is likely to be most helpful in
issues. providing adequate nutrition while the patient is experiencing
d. note that the patient is experiencing expected aging acute mania?
processes. a. Provide nutrient-rich finger foods so the patient can eat
38. The challenge to the nurse inherent in establishing and while walking and talking.
maintaining a working relationship with a severely depressed b. Offer only liquids that are rich in calories.
patient is the patient's: c. Make food available to the patient knowing he or she will
a. receptivity in the relationship. eat when hungry.
b. gratitude for the time and effort spent. d. Insist that the patient join the other patients on the unit
c. withdrawal from and disinterest in the relationship. during mealtimes.
d. marked signs of improvement noted early on. 49. A patient in acute mania is inappropriately humorous.
39. A patient has just completed his/her sixth electroconvulsive Patients and staff are laughing at the patient's expense and
therapy. Which intervention is most important for the nurse embarrassment. The nurse should immediately:
to implement? a. distract the patient to engage in another activity apart
a. Observe for disorientation. from the group.
b. Ask the patient to state his/her name. b. confront the group to stop the disrespectful behavior.
c. Monitor the patient's respiratory status. c. join the group, and further assess the situation.
d. Document the length of the seizure activity. d. consult the multidisciplinary team to determine the
40. A depressed patient who originally responded to a failure by behavioral consequences for the staff.
stating, "I can't do anything right" is overheard telling a staff 50. What is the initial intervention implemented by the nurse
member, "I've learned that everyone makes mistakes." This when managing a manic patient whose behavior is disrupting
is an example of: a group therapy session?
a. thought reprogramming. c. a sense of personal worth. a. Setting behavioral limits for the patient that are
b. positive self-esteem. d. effective problem solving. appropriate and well defined
b. Remaining involved with the patient while
SITUATION 9 – Several antidepressants are used to treat demonstrating a calm demeanor
depression and nurses need to be knowledgeable of the c. Communicating with the patient using brief, simple
indications and contraindications of each type of drug. statements
41. Which side effect of MAOI therapy will the nurse be particular d. Removing the patient from the group to deescalate the
concerned about when this classification of antidepressants situation
is precribed to a patient?
a. Orthostatic hypotension resulting in falls SITUATION 11 – Lithium is used to treat bipolar disorder.
b. Hypertension-induced strokes It is helpful for bipolar mania and can partially or
c. Hypertensive crisis resulting from eating tyramine-rich completely eradicate cycling toward bipolar depression.
foods 51. Medication teaching regarding lithium is regarded as
d. Drug-induced reflex tachycardia successful when the nurse hears the patient state:
42. Which breakfast selections demonstrate that a patient a. "Potassium can be dangerous in my diet."
understands the nurse's dietary instructions while taking b. "My body treats lithium just like salt."
monoamine oxidase inhibitor (MAOI) antidepressants? c. "A multivitamin each day will be important."
a. Bacon, eggs, cheddar cheese, and avocado slices in a d. "I won't have to see the doctor for 3 months."
flour tortilla 52. The patient who will require further teaching while on lithium
b. Banana slices and raisins in whole-grain cereal with milk would state:
c. Blueberry pancakes with yogurt a. "I know I need to eat and drink sensibly."
d. Oatmeal with almonds and milk b. "My dietician appointment is next week."
43. A patient comes to the clinic for a 4-week follow-up after c. "My last lithium level was 0.6."
starting Prozac (fluoxetine). The highest priority question the d. "I am really enjoying my aerobics dance class."
nurse will ask is: 53. The patient refuses lithium for acute mania but is agreeable
a. "How have you been doing?" to another medication. The nurse will expect the prescriber
b. "Who brought you to the clinic today?" to order:
c. "Has your stomach felt uncomfortable?" a. lithium despite the patient's refusal.
d. "Have you experienced thoughts of hurting yourself?" b. a selective serotonin reuptake inhibitor (SSRI).
44. It has been determined that a patient is experiencing life- c. an anticonvulsant.
threatening toxicity related to TCA use. Which intervention d. a monoamine oxidase inhibitor (MAOI).
will the nurse anticipate? 54. Which assessment question will the nurse ask to help identify
a. Frequently assessing for suicidal ideations the cause of a patient's decreased lithium levels?
b. Administering an acetylcholinesterase inhibitor a. "How much coffee do you drink daily?"
c. Inserting an indwelling urinary catheter b. "How much salt do you consume daily?"
d. Preparing the patient for an EEG c. "Have you been prescribed a daily diuretic medication?"
45. A chronically depressed patient tells the nurse, "My d. "Have you been taking any antiiflammatory
antidepressant just doesn't seem to be working as well as it medications?"
did." What is the nurse's initial assessment intervention? 55. A patient's lithium level is 2.3 mEq/L. Which nursing
a. Determining whether the patient has been taking the intervention will the nurse be prepared to implement when
medication as prescribed ordered?
b. Asking the patient how long he or she has been taking a. Managing the administration of parenteral NSS
this particular antidepressant b. Increasing the daily dose of lithium
c. Determining if the patient has been experiencing any c. Limiting the patient's intake of sodium
physical side effects d. Preparing to administer an oral diuretic
d. Asking the patient to describe what he or she means by
"not working as well" SITUATION 12 – Nurses encounter anxious clients and
families in a wide variety of situations such as before
SITUATION 10 - People with bipolar disorder cycle surgery and in emergency departments, intensive care
between mania, normalcy, and depression. They also may units, offices, and clinics. First and foremost, the nurse
cycle only between mania and normalcy or between must assess the person’s anxiety level because that
depression and normalcy. determines what interventions are likely to be effective.
46. Which assessment data would be inconsistent with a 56. When a patient enters into the exhaustion stage of anxiety,
diagnosis of mania? the nurse is aware that the most serious outcome to the
a. The patient is demonstrating severe irritability. patient is:
b. Family report that the mood change occurred gradually a. death. c. disorganized personality.
over a 5-day period. b. psychosis. d. aggressive behavior.

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57. Which group activity would benefit individuals experiencing 67. The nurse expects to closely monitor which laboratory data
anxiety disorders while attending a community mental health when working with the binging-purging type of bulimic?
clinic program? a. Hypocalcemia c. Hypokalemia
a. Cooking lessons c. A budget seminar b. Hypernatremia d. Hypervolemia
b. Exercise classes d. Visiting a museum 68. A patient experiencing an eating disorder is reluctant to step
58. It is most important for the nurse to include which teaching on the scale for weighing this morning. He says, "I just drank
point with a patient who is currently experiencing a panic juice for breakfast, so I don't want to weigh today." The
attack? nurse responds:
a. "There is nothing physically wrong with you; you are just a. "It is okay to postpone your weighing if you will also eat
frightened right now because of all the anxiety you are some solid food to go with the juice for breakfast."
feeling." b. "We can weigh you tomorrow instead. Don't forget to
b. Touch the patient lightly on the arm and say, "What's wait before you eat breakfast, though."
the matter?" c. "I will have to ask the team what to do in this case and
c. "You are safe. I am here." get back to you with the decision."
d. "You may feel as though you are having a heart attack, d. "It is weigh day today. Please step on the scale."
but it is your anxiety causing your chest pain." 69. Which characteristic is consistent with those individuals who
59. Which statement indicates that the patient with an anxiety engage in the vomiting-purging form of anorexia nervosa?
disorder has developed a healthy coping strategy for dealing a. Avoids social situations where eating is involved
with sleep difficulties? b. Adopts a rigid personal exercise program
a. "One or two beers really help me get to sleep." c. Was overweight before the eating disorder began
b. "I will call the doctor if I need more pills to sleep at d. Demonstrates competitive personality traits
night." 70. During binge eating, the bulimic patient is most likely to
c. "My neighbors are always available to talk to me through consume what type of food?
the night; I can call them anytime." a. Low calorie c. High fiber
d. "The student nurse taught me how to use relaxation b. High carbohydrate d. Low fat
techniques at bedtime, and I will continue to use those
at home." SITUATION 15 - Suicide is an act of desperation. Most
60. The nurse notes that a patient is often late to meals because individuals do not want to die; they just do not know how
of time needed to perform rituals before eating. In working to go on living with their psychic and/or physical pain.
with such a patient, the nurse should: Suicide is a global problem, and according to the World
a. announce to the patient, "your meal will be here in 30 Health Organization (WHO), in the last 45 years suicide
minutes." rates have increased by 60% worldwide.
b. hold the meal, and alert the group leader of the patient's 71. The psychiatric nurse should be well aware that suicide is
late arrival to the next scheduled therapy group. classified as a:
c. give the patient liquid meals to drink while performing a. Behaviour c. Secondary Gain
the rituals. b. Psychiatric Disorder d. Emotion
d. remind the patient that the rituals are not helpful in 72. Which patient statement indicates that a patient may be a
recovery from the anxiety. safety risk to self or others?
a. I really hate being here.
SITUATION 13 –Anxiety can be treated with anxiolytic b. When do staff check patient rooms?
medications. Most of these drugs are benzodiazepines, c. All the rules here are ridiculous.
which are commonly prescribed for anxiety. d. Which staff are scheduled for tomorrow?
61. An individual has taken Valium (diazepam) for the past 4 73. In assessing an ER patient who reports taking an overdose
years and is considering discontinuing the medication. What of aspirin (ASA), what is the best answer for the nurse to
information should the nurse reinforce for the patient? request in assessing the patient?
a. "Anxiety seldom gets better without medication." a. “How long have you been depressed?”
b. "Diazepam should not be discontinued abruptly." b. “Describe your support system.”
c. "Buspirone is a better choice when anxiety also occurs." c. “When did you take the pills and how many?”
d. "It is important to remember not to mix alcohol with d. “Are you willing to be hospitalized?”
diazepam." 74. What is the most accurate rationale when planning care for
62. An individual taking benzodiazepines should be taught to suicidal patients in an inpatient setting?
avoid: a. Suicidal attempts are not likely to occur if there is a
a. dairy products. c. grapefruit juice. consistent team approach.
b. leafy green vegetables. d. aspirin. b. Aggressive behaviors on the unit indicate a need for
63. When prescribed a benzodiazepine, a patient is considered staff education.
to be at risk for falls mostly because of what common c. A completely safe milieu eliminates the chance of
medication-related side effect? suicidal behavior.
a. Ataxia c. Lassitude d. There are safety risks in any plan of care that
b. Dysarthria d. Retrograde amnesia promotes responsibility and growth.
64. What is the most serious symptom of benzodiazepine 75. Which is correct regarding care of the suicidal patient?
withdrawal? a. The more specific the plan, the more likely the patient
a. Visual hallucinations c. Cardiac arrest will attempt suicide.
b. Convulsions d. Respiratory arrest b. Teens and elderly persons rarely have suicidal ideation.
65. The nurse learns that a patient prescribed a benziodiazepine c. Patients who survive suicide attempts rarely try again.
for anxiety has been self-medicating with over-the-counter d. Discussion of suicidal thoughts enhances aggressive
antacids for reccuring indigestion. Which statement will the thinking
nurse make to initially assess the patient?
a. "Do you believe your antianxiety medicine has been SITUATION 16 - Stress is common in our lives, but when
working as effectively?" stress is prolonged and increased it may be experienced
b. "Could the indigestion be related to your anxiety more as distress, which is a negative experience. When
issues?" stress becomes chronic it can cause physiological harm
c. "When did the indigestion first present as a problem?" and emotional difficulties.
d. "How many doses of antacids do you usually take each
day?" 76. What factor exerts the greatest influence on the degree to
which various life events upset a specific individual?
SITUATION 14 – Eating disorders can be viewed on a a. The individual’s perception of the event
continuum, with clients with anorexia eating too little or b. The individual’s degree of spirituality
starving themselves and clients with bulimia eating c. The effect of the individual’s health-sustaining
chaotically. behaviors
66. What approach would be most effective in helping a patient d. The amount of social support available to the individual
diagnosed with an eating disorder and hospitalized for 77. A client who is experiencing great stress associated with a
extremely low weight who’s been found sneaking diet pills? disturbing new diagnosis asks the nurse, “Do you think
a. Education about the health risks & dangers of diet pills saying a prayer would help?” The answer the nurse should
b. Discussion concerning the patient's fears of losing give is
control when complying with the weight gain a. “Of course you may pray if you wish. I’ll leave you
recommended alone.”
c. Discussion concerning the fears or worries generated in b. “At the moment we should continue the stress
the family about current health status assessment.”
d. Confrontation of the patient in sneaking the diet pills and c. “Shall I call the chaplain for you?”
extreme thinness

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 d. “If you find comfort in prayer, I’d encourage you to c. lamotrigine (Lamictal).
pray.” d. clonazepam (Klonopin).
78. An effective stress-reduction technique a nurse might teach 89. An outcome for a manic client during the acute phase that
an individual with performance anxiety is would indicate that the treatment plan was successful would
a. assertiveness. c. diaphragmatic breathing. be that the client
b. journal keeping. d. restructuring priorities. a. reports racing thoughts. c. is highly distractible.
79. A nurse teaches a client a technique for examining negative b. is free of injury. d. ignores food and fluid.
thoughts and restating them in positive ways. This technique 90. When a hyperactive manic client expresses the intent to
is called strike another client, the initial nursing intervention would be
a. guided imagery. c. wishful thinking. to
b. cognitive reframing. d. confrontational assertion. a. question the client’s motive.
80. Myla, a 29-year-old patient admitted with anxiety, states, b. set verbal limits.
“my counselor keeps talking about my stressors. What c. initiate physical confrontation.
exactly are stressors?” Your best response to the patient d. prepare the client for seclusion.
would be:
a. “Stressors are events that happen that threaten your SITUATION 19 - It is impossible to convey adequately the
current functioning and require you to adapt.” personal pain and suffering experienced by an individual
b. “Stressors are complicated neuro stimuli that cause going through a severe depressive episode. All races, all
mental illness.” ages, and both genders are susceptible to depressive
c. “It’s best if you ask questions like that of your provider episodes, although some individuals are more vulnerable
for a complete answer.” than others.
d. “Instead of focusing on what stressors are, let’s
explore your coping skills.” 91. Assessment of the thought processes of a client diagnosed
with depression is most likely to reveal
SITUATION 17 - Schizophrenia is a devastating brain a. good memory and concentration.
disease that targets young people in their teens or early b. delusions of persecution.
twenties at the beginning of their productive lives. It c. self-deprecatory ideation.
profoundly disrupts an individual’s ability to perceive d. sexual preoccupation.
reality accurately, to think clearly, to use language 92. Which nursing diagnosis would be least useful for a
appropriately, to experience normal emotions, or to depressed client who shows psychomotor retardation?
engage in normal social/occupational experiences. a. Constipation
b. Death anxiety
81. Schizophrenia is best characterized as c. Activity intolerance
a. split personality. d. Self-care deficit: bathing/hygiene
b. multiple personalities. 93. When the nurse remarks to a depressed client, “I see you
c. ambivalent personality. are trying not to cry. Tell me what is happening.” The nurse
d. deteriorating personality. should be prepared to
82. Which of the following would be assessed as a negative a. wait quietly for the client to reply.
symptom of schizophrenia? b. prompt the client if the reply is slow.
a. Anhedonia c. repeat the question if the client does not answer
b. Hostility promptly.
c. Agitation d. review the client’s medical record to support the
d. Hallucinations client’s response.
83. When a client diagnosed with schizophrenia hears voices 94. A client prescribed a monamine oxidase inhibitor (MOA) has
saying that he is a horrible human being, the nurse can a pass to go out to lunch. Given a choice of the following
correctly assume that the hallucination entrees, the client can safely eat
a. is a projection of the client’s own feelings. a. avocado salad plate.
b. derives from neuronal impulse misfiring. b. fruit and cottage cheese plate.
c. is a retained memory fragment. c. kielbasa and sauerkraut.
d. may signal seizure onset. d. liver and onion sandwich.
84. Which side effect of antipsychotic medication is generally 95. Which statement about antidepressant medications, in
nonreversible? general, can serve as a basis for client and family teaching?
a. Anticholinergic effects a. Onset of action is from 1 to 6 weeks.
b. Pseudoparkinsonism b. They tend to be more effective for men.
c. Dystonic reaction c. Recent memory impairment is commonly observed.
d. Tardive dyskinesia d. They often cause the client to have diurnal variation.
85. A client diagnosed with paranoid schizophrenia refuses food,
stating the voices are saying the food is contaminated and SITUATION 20 - Anxiety is a universal human experience
deadly. A therapeutic response for the nurse would be to which no one is a stranger. It is the most basic of
a. “You are safe here in the hospital; nothing bad will emotions. Dysfunctional behavior is often a defense
happen to you.” against anxiety.
b. “The voices are wrong about the hospital food. It is not
contaminated.” 96. The major distinction between fear and anxiety is that fear
c. “I understand that the voices are very real to you, but a. is a universal experience; anxiety is neurotic.
I do not hear them.” b. enables constructive action; anxiety is dysfunctional.
d. “Other people are eating the food, and nothing is c. is a psychological experience; anxiety is a physiological
happening to them.” experience.
d. is a response to a specific danger; anxiety is a
SITUATION 18 - Bipolar spectrum disorders are among response to an unknown danger.
the most serious of the mental health disorders and rank 97. The initial nursing action for a newly admitted anxious client
sixth among the world’s most disabling illnesses. Bipolar is to
disorders are chronic, recurrent, and life-threatening a. assess the client’s use of defense mechanisms.
illnesses that require lifetime monitoring. b. assess the client’s level of anxiety.
c. limit environmental stimuli.
86. Which behavior would be most characteristic of a client d. provide antianxiety medication.
during a manic episode? 98. Selective inattention is first noted when experiencing anxiety
a. Going rapidly from one activity to another that is
b. Taking frequent rest periods and naps during the day a. mild.
c. Being unwilling to leave home to see other people b. moderate.
d. Watching others intently and talking little c. severe.
87. A bipolar client tells the nurse, “I have the finest tenor voice d. panic.
in the world. The three tenors who do all those TV concerts 99. An important question to ask during the assessment of a
are going to retire because they can’t compete with me.” The client diagnosed with anxiety disorder is
nurse would make the assessment that the client is a. “How often do you hear voices?”
displaying b. “Have you ever considered suicide?”
a. flight of ideas. c. limit testing. c. “How long has your memory been bad?”
b. distractibility. d. grandiosity. d. “Do your thoughts always seem jumbled?”
88. The first-line drug used to treat mania is 100. A possible outcome criterion for a client diagnosed with
a. lithium carbonate (Lithium). anxiety disorder is
b. carbamazepine (Tegretol). a. Client demonstrates effective coping strategies.

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b. Client reports reduced hallucinations.
c. Client reports feelings of tension and fatigue. END OF EXAMINATION
d. Client demonstrates persistent avoidance behaviors.
TIME FINISHED: _________