Mental Health Nursing
A nurse approaches a depressed client who has just been admitted to the psychiatric unit and says,
"Hello! I'm Andrea, your nurse. I'll introduce you and help you settle in with the others here. We'll also
talk about anything that concerns you." These statements establish the nurse-client relationship by:
1 Providing a theme
2 Defining boundaries
3 Identifying problems
4 Initiating the working phase
To help establish a therapeutic nurse-client relationship, the mental health nurse uses various
communication techniques to convey a willingness to listen and a genuine desire to view the client and
his or her needs in a respectful manner. What is the primary underlying principle guiding this process?
1 Caring is the underlying component of nursing that promotes client care.
2 Understanding of the psychosocial effects of a specific mental illness is vital to client care.
3 Each client has a right to appropriate care directed towards both the client's strengths and
weaknesses.
4 The nurse initiates and maintains the nurse-client relationship so as to be therapeutic in its nature.
A nurse on the psychiatric unit is conducting group therapy with clients who have diagnoses of polydrug
abuse. This is a closed group. Four sessions have been held, and the group is now in the working phase.
Which strategy is most beneficial for the nurse facilitator to use during the next session?
1Providing a balance between support and skillful therapeutic confrontation
2Continuing to be a supportive role model by using approved leadership behaviors
3Teaching about the effects of drugs and alcohol on the body by using educational materials
4Encouraging the group to rotate the leadership role among group members to enhance their selfesteem.
A client who has schizophrenia is receiving a phenothiazine antipsychotic medication. Which serious
client responses to the medication should the nurse immediately report to the practitioner? Select all
that apply.
1 Akathisia
2 Shuffling gait
3Yellow sclerae
4 Photosensitivity
5 Involuntary tongue movements.
A 65-year-old client is receiving amitriptyline (Elavil). What is the most important recommendation for
the nurse to make to this client concerning this medication?
1Obtain a complete cholesterol and lipid profile.
2Have an eye examination to check for glaucoma.
3Check the temperature daily for nighttime increases.
4Assess for excessive sweating and possible weight loss
The nurse's role in maintaining or promoting the health of the older adult should be based on the
principle that:
1Some physiological changes that occur as a result of aging are reversible.
2Thoughts of impending death are frequent and depressing to most older adults.
3Older adults can better accept the dependent state that chronic illness often causes.
4There is a strong correlation between successful retirement and maintaining health.
A nurse is teaching a client about tricyclic antidepressants. Which potential side effects should the nurse
include? Select all that apply.
1 Dry mouth
2 Drowsiness
3 Constipation
4 Severe hypertension
5 Orthostatic hypotension.
When talking with a client in crisis, the crisis intervention nurse should first:
1 Assist the client in deciding what will be done and how it will be done.
2 Identify problems for the client, putting them in the proper perspective
3 Explain that the center has helped many clients with the same problem.
4Explore the client's religious and cultural beliefs to ensure that interventions support the client's
values.
An older woman who has been a widow for 20 years comes to the community health center with a
vague list of complaints. Her only child, a son, died at birth. She has lived alone since her husband's
death and performs all of her own daily tasks of living. She had a very active social life in the past but has
outlived many of her friends and family members. When taking this client's health history, it is
important for the nurse to ask:
1 "Do you feel alone?"
2 "Do you still miss your husband?"
3"What unfulfilled hopes do you have?"
4"How did you feel when your son died?.
A young adult being treated for substance abuse asks the nurse about methadone. The nurse responds
that methadone is useful in the treatment of opioid addiction because it:
1 Is a nonaddictive drug
2 Has an effect of longer duration
3 Does not produce a cumulative effect
4 Carries little risk of psychological dependence
The parents of a toddler with recently diagnosed moderate cognitive impairment state, "My child should
be able to attend college with help and medication." What should the nurse conclude?
1 They accept the child's diagnosis.
2 Denial is being used as a defense.
3 They want to explore their child's limitations.
4 Intellectualization helps them put the diagnosis into perspective.
A mother and her three young children arrive at the mental health clinic. The woman says that she is
seeking help in leaving her husband. She reports that he has been beating her for years but just started
hitting the children. What is the best initial action by the nurse?
1 Arranging for a staff member to watch the children so the mother and nurse can talk
2 Calling a facility where the mother and her children will be safe until the crisis is resolved
3 Determining whether the mother is ambivalent about this decision before making permanent plans
4 Suggesting that the mother and her husband return for couples counseling so the marriage can be
saved.
After helping a neighborhood family through a crisis situation, an executive asks the nurse to come to
his business to discuss with the employees the principles of maintaining mental health in today's world.
What is the nurse's primary consideration before deciding the approach or content for the discussion?
1 Involving employees in the initial planning for the session
2 Exploring the available physical facilities and audiovisual equipment
3 Planning for employees to share personal experiences and how they avoid mental illness
4 Assessing the mental health of the employees by administering a mental status examination
A client on the psychiatric unit is undergoing a pretreatment evaluation for electroconvulsive therapy
(ECT). Because of the client's profoundly depressed behavior, the nurse doubts that the client can
provide informed consent. What should the nurse's initial intervention be?
1 Consulting with the hospital's legal staff and following their recommendation
2 Having the client verbalize her understanding and the outcomes of the procedure
3 Asking the client to sign the consent form because the client has not been declared incompetent
4 Suggesting to the health care provider that a family member sign the consent form for the client.
The registered nurse managing the care of four clients is determining individual priorities. Place the
following clients in order of priority, with 1 as the highest priority.
1 A depressed client who shares with her roommate that she is “very happy today”
2 A manic client who has spent the last 8 hours refusing liquids and pacing around the unit
3 A client whose auditory hallucinations are telling her, “They’re going to get you.”
4 A cognitively impaired older adult who believes that her dead husband will visit today
A young client who has become a mother for the first time is showing signs of being anxious about her
new parenting role. With the nurse's encouragement, she joins the new mothers' support group at the
local YMCA. What kind of prevention does this activity reflect?
1 Primary prevention
2 Tertiary prevention
3 Secondary prevention
4 Therapeutic prevention
In preparation for medication administration, the nurse is reviewing the results of diagnostic laboratory
tests on a newly admitted client. In light of this information, the initial nursing intervention is:
1 Checking the client's temperature every 4 hours
2 Holding the morning dose of clozapine (Clozaril)
3 Educating the client on the need for additional iron in this diet
4 Assessing the client for the presence of diarrhea or constipation
Survivors of a major earthquake are being interviewed on admission to the hospital. The nurse notes
that they exhibit a flattened affect, make minimal eye contact, and speak in a monotone. These
behaviors are indicative of the defense mechanism known as:
1 Isolation
2 Splitting
3 Introjection
4Compensation.
A client in the mental health clinic who has been seeing a therapist for more than 6 months begins to
talk and act like a therapist who is analyzing coworkers. What defense mechanism does the nurse
identify?
1 Undoing
2 Projection
3 Introjection
4 Intellectualization.
When helping a client cope with a crisis, the health care provider should follow the principles of
intervention. Place the following interventions in order of their priority.
Correct
1 Intervening immediately
2 Stabilizing the client
3 Facilitating understanding of the event
4 Using the available resources
5 Encouraging self-reliance
What action should the nurse take when it becomes apparent that communication between the nurse
and the client is consistently superficial?
1 Assessing the client's ability to understand the nurse's questions
2 Evaluating how actively the nurse has been listening to the client
3 Reinforcing to the client how important sharing is for successful recovery
4 Reviewing how the questioning techniques are being utilized by the client.
A female client has terminal cancer. Her family members are concerned because she appears to be
accepting less and less responsibility for her own care. What should the nurse do to help family
members plan for the client's care?
1 Encourage them to accept her regression until she can cope more effectively.
2 Explain that her anger is normal and identify ways to deal with the behavior.
3 Point out that denial is an expected response and generally is only temporary.
4 Assist them in identifying coping strategies to give her more control over the situation.
A nurse overhears a client in a mental health hospital talking on the unit telephone. The conversation
concerns a "fix" to be brought to the unit during visiting hours. The nurse knows that the client, who has
a history of drug use, has a contract with the practitioner promising not to use street drugs while being
treated in the inpatient unit. What is the best nursing intervention?
1 Phoning the client's practitioner and asking how the situation should be handled
2 Calling an immediate staff meeting to share the information and develop a plan for intervention
3 Calling security to make certain that hospital policies are enforced to maintain a safe environment
4 Confronting the client regarding the telephone conversation, then reporting the incident to the
practitioner.
Erik Erikson posited life as a sequence of achievements. Place the levels of development in their order of
achievement according to Erikson's theory.
Correct
1 Industry versus inferiority
2 Identity versus role confusion
3 Intimacy versus isolation
4 Generativity versus stagnation
5 Integrity versus despair
A nurse educator is leading a class on supporting middle-aged adults who are experiencing midlife
crises. What should the nurse include as the most significant factor in the development of this type of
crisis?
1 The perception of their life situation
2 Many role changes that alter their experiences at this time
3 The anticipation of negative changes associated with old age
4 Lack of support from family members who are busy with their own lives
A nurse on the psychiatric unit is conducting group therapy with clients who have diagnoses of polydrug
abuse. This is a closed group. Four sessions have been held, and the group is now in the working phase.
Which strategy is most beneficial for the nurse facilitator to use during the next session?
1 Providing a balance between support and skillful therapeutic confrontation
2 Continuing to be a supportive role model by using approved leadership behaviors
3 Teaching about the effects of drugs and alcohol on the body by using educational materials
4 Encouraging the group to rotate the leadership role among group members to enhance their selfesteem.
A client is admitted voluntarily to a mental health unit. The client arrives on the unit and realizes that
smoking is not permitted on the unit. At 2 am the client demands to leave the hospital because of the
restriction on smoking. What should the nurse's first intervention be?
1 Allowing the client to leave
2 Calling the client's primary health care provider
3 Asking the client to submit a formal "72-hour letter" for release
4 Telling the client that the client's status will be changed to involuntary.
Why should the nurse question a prescription for a benzodiazepine for an individual experiencing acute
grief?
1 The depression is magnified and the risk of suicide increases.
2 Brain activity is suppressed and the risk of depression increases.
3 Lethargy results, and it prevents the return to interpersonal activity.
4 The period of denial is extended and the grieving process is suppressed
Which nursing activities are specifically focused on achieving Healthy People 2010's mental health
objectives? Select all that apply.
1 Providing suicide screening for a senior citizens group
2 Initiating outpatient services for homeless schizophrenic adults
3 Offering care for mental health clients with major health conditions
4 Teaching stress-management techniques to those housed in the local jail
5 Advocating for culturally competent mental health care within each state
A health care provider prescribes haloperidol (Haldol) for a client. What should the nurse teach the
client to avoid while taking this medication?
1 Driving at night
2 Staying in the sun
3 Ingesting aged cheeses
4 Taking medications containing aspirin
An antianxiety medication is prescribed for an extremely anxious client. The client says, "I'm afraid to
take these pills because I heard they're addictive." The nurse teaches the client that antianxiety
medications:
1 Rarely cause dependence when the dosage is controlled
2 May require increases in dosage but rarely cause dependence
3 Usually result in psychological but not physiological dependence
4 Have the potential for physiological and psychological dependence
A 13-year-old boy who recently was suspended from school for consistently bullying other children is
brought to the pediatric mental health clinic by his mother. The child is assessed by the psychiatrist and
referred to a psychologist for psychological testing. The day after the tests are completed, the mother
returns to the clinic and asks the nurse for results of the tests. The nurse should:
1 Refer the mother to the psychiatrist.
2 Explain to the mother the results of the tests.
3 Suggest that the mother call the psychologist.
4 Teach the mother about the tests that were administered.
A client has been undergoing lithium therapy since bipolar disorder was diagnosed. The client restates
the following instructions regarding management and labwork results to be available for his 6-month
follow up visit. In light of this information the nurse will:
1 Correct the instructions regarding sodium consumption.
2 Share that the diagnostic testing will also include an ECG.
3 Feel confident the client understands the instructions and the importance of compliance.
4 Reintroduce the information because the client has incorrectly restated most of the instructions
A client on the psychiatric unit who is receiving high-dosage risperidone (Risperdal) is exhibiting tremors
of the hands. What should be the nurse's first intervention?
1 Withholding the medication
2 Telling the client it is transitory
3 Giving the client finger exercises
4 Contacting the health care provider.
A psychiatric nurse understands that a situational crisis usually resolves within:
1 1 to 4 days
2 2 to 3 weeks
3 1 to 2 months
4 2 to 6 months.
A nurse is educating a client who is taking clozapine (Clozaril) for paranoid schizophrenia. What should
the nurse emphasize about the side effects of clozapine?
1 Risk for falls
2 Inability to sit still
3 Increase in temperature
4 Dizziness upon standing.
A 24-year-old secretary who is pregnant for the first time receives from her boyfriend a check for $500
enclosed in a letter saying that he has left town. The client is upset, feels at the end of her rope, and
calls the crisis intervention center for help. What reason does the nurse identify for the client to be
experiencing a crisis?
1 The client is under a great deal of stress.
2 The client is going to have to raise her child alone.
3 The client's boyfriend left her when she was pregnant.
4 The client's past methods of adapting are ineffective for this situation.
The parents of an 11-month-old infant with failure to thrive are referred to the crisis intervention clinic.
What is the primary crisis intervention that the nurse should use?
1 Problem-solving
2 Prescriptive work
3 Analytical therapy
4 Exploratory therapy.
A nurse is creating a therapy group for low-functioning clients. Which client is the most appropriate
member?
1 A 77-year-old man with anxiety and mild dementia
2 A 52-year-old woman with alcoholism and an antisocial personality
3 A 38-year-old woman whose depression is responding to medication
4 A 28-year-old man with bipolar disorder who is in a hypermanic state.
A nurse is conducting a group therapy session. Why is a group setting especially conducive to therapy?
1 It provides a new learning environment.
2 It decreases the focus on the individual.
3 It fosters one-on-one personal relationships.
4 It confronts individual members with their shortcomings.
A nurse is intervening with a client who is having a crisis. What is the nurse's concern after the initial
crisis issues have been addressed?
1 Nature of the precipitating factor
2 Impact of the situation on significant others
3 Client's ability to cope with successive crises
4 Client's potential to perform activities of daily living.
A woman who is emotionally and physically abused by her husband calls a crisis hotline for help. The
nurse works with the client to develop a plan for safety. What should be included in the safety plan?
Select all that apply.
1 Limiting contact with the abuser
2 Determining a safe place to go in an emergency
3 Memorizing the domestic violence hotline number
4 Obtaining a bank loan to finance leaving the abuser
5 Arranging for a family member to assist her in leaving.
How should a nurse characterize a sudden terrorist act that causes the deaths of thousands of adults
and children and negatively affects their families, friends, communities, and the nation?
1 Recurring
2 Situational
3 Maturational
4 Adventitious.
A nurse is teaching clients about dietary restrictions during monoamine oxidase inhibitor (MAOI)
therapy. What response does the nurse tell them to anticipate if they do not follow these restrictions?
1 Occipital headaches
2 Generalized urticaria
3 Severe muscle spasms
4 Sudden drop in blood pressure.
A psychiatric nurse is working at a community mental health clinic. Which activity demonstrates that the
nurse knows the importance of engaging in effective self-awareness?
1 Discussing with unit staff the role played by formal religion in personal happiness
2 Becoming aware of the cultural practices of the Hispanic clients served by the clinic
3 Refusing to engage in a discussion regarding alternative views on physician-assisted suicide
4 Accepting a client's decision to refuse electroconvulsive therapy as a treatment for chronic
depression.
When managing the milieu, client autonomy and the need for therapeutic limit setting are concepts that
often are in conflict. Which nursing intervention best minimizes this conflict?
1 Establishing unit rules that are appropriate and explained thoroughly
2 Tailoring unit rules to be flexible and individually centered
3 Encouraging the client to be autonomous in decisions affecting the milieu
4 Supporting client autonomy by providing a predictable, stable environment.
The psychiatrist is concerned that one of the clients receiving haloperidol (Haldol) may be developing
neuroleptic malignant syndrome. When assessing the client for this syndrome, for which clinical
manifestations should the nurse monitor the client?
1 Jaundice and malaise
2 Tremors and seizures
3 Diaphoresis and hyperpyrexia
4 Dry skin and hyperbilirubinemia.
When having a conversation with a nurse, an older client states, "I've lived a good life. I don't want to
die, but I accept it as a part of life." What developmental stage, according to Erikson, has the client
completed?
1 Identity
2 Integrity
3 Acceptance
4 Generativity.
Which assessment question will provide the best information regarding a client's risk for waking in the
night and interrupted sleep related to lifestyle choices?
1"Do you consider yourself a deep sleeper?"
2"Do you smoke cigarettes, cigars, or a pipe?"
3"Do you adhere to a regular bedtime routine?"
4"Do you keep the television on when you're falling asleep?
The nurse is involved in a therapeutic relationship with a depressed client. Which question and/or
statement, asked by the nurse, is appropriate for stage 1 of this relationship? Select all that apply.
1"I'm here to talk with you about how you've been feeling."
2 "How do you feel about keeping a journal regarding how you are feeling?"
3 "Are you experiencing any suicidal or homicidal thought?"
4 "Are you open to the prospect of being prescribed antidepressant medication?"
5"What we talk about will be shared only with your treatment team.
A nurse teaches dietary guidelines to a client who will be receiving tranylcypromine sulfate (Parnate), a
monoamine oxidase inhibitor (MAOI). The client compiles a list of foods to avoid. Which foods included
on the list indicate that the teaching has been effective? Select all that apply.
1 French fries
2 Pepperoni pizza
3 Bologna sandwich
4 Hamburger on a bun
5 Hash brown potatoes.
A nurse in a long-term care facility is caring for a bedridden client with multiple chronic illnesses.
Although usually continent, the client expresses anger through urinary incontinence. What should the
nurse do to best address this situation?
1 Offer the client a bedpan every 2 hours.
2 Encourage the client to watch more television.
3 Decrease the client's fluid intake in the evening.
4 Assist the client in setting realistic short-term goals.
A nurse is reviewing Axis IV of the DSM-V to determine specific client needs. On what client data is the
nurse focusing? Select all that apply.
1 Problems with permanent housing
2 The existence of cognitive impairment
3 The Global Assessment of Functioning score
4 Dysfunction related to family support system
5 Psychiatric diagnosis for current hospitalization.
A client states, "I get down on myself when I make a mistake." In a cognitive therapy approach, which
nursing interventions are most appropriate? Select all that apply.
1 Teaching the client relaxation exercises to diminish stress
2 Exploring with the client past experiences that have caused distress
3 Providing the client with mastery experiences designed to boost self-esteem
4 Encouraging the client to replace these negative thoughts with positive thoughts
5 Helping the client modify the belief that anything less than perfection is unacceptable.
Which interventions are considered within the scope of practice for the basic psychiatric nurse? Select
all that apply.
1 Holding a weekly therapy group that focuses on stress management
2 Role modeling appropriate social boundaries for schizophrenic clients
3 Acting as a mental health consultant for a local geriatric long-term care facility
4 Adjusting the dosage of a prescribed antidepressant for a chronically depressed client
5 Managing the outpatient care for a group of clients with newly diagnosed bipolar disorder.
A depressed client is receiving paroxetine (Paxil). The nurse monitors this client for the side effects
associated with this drug. Select all that apply.
1 Sexual dysfunction
2 Depressed respiration
3 Insomnia and restlessness
4 Hypertension or hypotension
5 Irregular menses or secondary amenorrhea.
A client with schizophrenia is receiving intramuscular injections of fluphenazine decanoate (Prolixin
Decanoate). After therapy is initiated, dystonia develops. What clinical manifestations does the nurse
document during the assessment? Select all that apply.
1 Akathisia
2 Torticollis
3 Shuffling gait
4 Masklike facies
5 Oculogyric crisis.
A client experiencing a tremendously stressful situation says, "My baby was diagnosed with terminal
cancer 2 months ago. I'm either crying or walking around like I'm in a dream. I can't believe this is
happening. What did we do to deserve something so horrible? The doctors can transplant almost every
human organ, but they can't stop my baby from dying. I'm so angry. Most days I just want to take my
child and run away." The nurse determines that the client is mainly expressing:
1 Anger
2 Denial
3 Avoidance
4 Anticipatory grief.
A nurse is caring for a man who has inoperable cancer of the pancreas. His wife is trying to cope with the
diagnosis. Place the wife's statements in order as the woman progresses through the grieving process,
from the first stage to the last.
Correct
1 I want him to get a second opinion.
2 He shouldn’t have gotten this because he doesn't smoke or drink.
3 His grandchildren need to get to know him
4 All I do is cry, because I can't live without him.
5 If he can't be cured, I just want him to be comfortable.
A client with diabetes mellitus is able to discuss in detail the diabetic metabolic process while eating a
piece of chocolate cake. What defense mechanism does the nurse identify when evaluating this
behavior?
1 Projection
2 Dissociation
3 Displacement
4 Intellectualization.
A nurse is working with children who have been sexually abused by a family member. What
overwhelming feelings do these children usually express? Select all that apply.
1 Guilt
2 Anger
3 Revenge
4 Disbelief
5 Self-blame.
Oral chlordiazepoxide (Librium) 100 mg/ hr is prescribed for a client with a Clinical Institute Withdrawal
Assessment (CIWA) score of 25. The client has had 300 mg in 3 hours but is still displaying acute alcohol
withdrawal symptoms. What is the next nursing action?
1 Informing the client that the limit of chlordiazepoxide has been reached
2 Administering chlordiazepoxide as indicated by the client's CIWA score
3 Requesting a prescription for another medication to replace the chlordiazepoxide
4 Informing the health care provider that the maximum dose of chlordiazepoxide has been reached.
The following data is recorded during the assessment of a client being treated in the emergency
department for minor injuries resulting from a mugging and robbery. In light of this information, the
nurse initially:
1 Encourages the client to breathe deeply to minimize anxious feelings
2 Explains that feeling anxious is a common response to such an experience
3 Keeps the auditory and visual stimuli in the client's environment to a minimum
4 Assigns unlicensed assistive personnel to remain with the client to prevent falls.
The nurse is planning therapeutic group sessions for regressed long-term clients. The nurse understands
that these clients need to:
1 Experience a structured setting.
2 Learn how to confront interpersonal conflict.
3 Develop the sense that they can control the group.
4 Have opportunities for an expression of deep feelings.
A client with psychosis is receiving olanzapine (Zyprexa, Zydis). What is important for the nurse to
consider when administering this drug?
1 It may not be given intramuscularly.
2 A special tyramine-free diet is required.
3 It dissolves instantly after oral administration.
4 An empty stomach increases its effectiveness
An older client whose family has been visiting him in the psychiatric unit is visibly angry and says to the
nurse, "My daughter-in-law says they can't take me home until the doctor lets me go. She doesn't
understand how important this is to me; she's not from our culture." What should the nurse do?
1 Ignore the statement for the present.
2 Say, "You feel she doesn't want you at home."
3 Reflect on the client's feelings about the cultural differences.
4 Respond, "The doctor is the one who makes decisions about discharge.
A 19-year-old woman, arrested for assault and robbery, has a history of truancy and prostitution but is
unconcerned that her behavior has caused emotional distress to others. The diagnosis of antisocial
personality disorder is made. According to psychoanalytical theory, the client’s lack of remorse and
repetitive behavior probably are related to an underdeveloped:
1 Id
2 Ego
3 Superego
4 Limbic system.
Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic therapy. What signs and
symptoms of this syndrome should the nurse identify? Select all that apply.
Jaundice
Diaphoresis
Hyperrigidity
Hyperthermia
Photosensitivity.
A nurse at the mental health clinic is counseling a client who has lost three jobs and four roommates in
the last 6 months. The client states that sometimes she has problems interacting with people. What is
the most appropriate response by the nurse?
1"Let's focus on the future rather than on these past experiences."
2"That's a lot of changes. Tell me what happened with your roommates."
3"It must be distressing to have had to adapt to these changes. Tell me how you did it."
4"Tell me more about some of the specific problems you've experienced with these people.
A nurse may best assist abusing parents in altering their behavior toward their abused 2-year-old child
by helping them:
1 Recognize what behavior is appropriate for a toddler.
2 Learn appropriate ways of punishing a toddler's inappropriate behavior.
3 Identify the specific ways in which the toddler's behavior provokes frustration.
4 Ignore the toddler's negative nondestructive behavior while supporting acceptable behavior.
A male long-distance jumper improves his distance by 3½ inches (7 cm) and earns the praise of his
coach, but on another day, when he does not reach his mark, he forcefully kicks the door of his locker.
What defense mechanism does his outburst demonstrate?
1 Anger
2 Projection
3 Displacement
4 Rationalization.
Lithium is prescribed for a client with bipolar disorder experiencing a manic episode. When teaching the
client about this medication, the nurse should emphasize that lithium:
1 Cannot be taken safely with any other antipsychotic medications
2 Can be taken safely with diuretics if the potassium level is maintained
3 Should be discontinued and the practitioner notified if depression occurs
4 Should temporarily be stopped and the practitioner notified if diarrhea results.
Although upset by a young client's continual complaints about all aspects of care, the nurse ignores
them and attempts to divert the conversation. Immediately after this exchange with the client, the
nurse discusses with a friend the various stages of development of young adults. Which defense
mechanism is the nurse is using?
1 Sublimation
2 Substitution
3 Identification
4 Intellectualization.
A client with schizophrenia who has type II (negative) symptoms is prescribed risperidone (Risperdal).
Which outcomes indicate that the medication has minimized these symptoms? Select all that apply.
1 There is less agitation.
2 There are fewer delusions.
3 More interest is shown in unit activities.
4 The client reports that the hallucinations have stopped.
5 The client performs activities of daily living independently.
For which adverse effect should the nurse continually assess a client who is receiving valproic acid
(Depakene)?
1 Yellow sclerae
2 Motor restlessness
3 Ringing in the ears
Torsion of the neck
A nurse is caring for a 20-year-old client. According to Erikson's developmental psychosocial theory,
what is expected by 20 years of age?
1 Having the capacity for love and a commitment to work
2 Being creative and productive and having concern for others
3 Having a coherent sense of self and plans for self-actualization
4 Accepting the worth, integrity, and uniqueness of one's past and present life.
A client who had to be cut out of a car after a motor vehicle collision has no visible physical effects from
the ordeal. The client responds to the emergency department nurse's questions factually in a soft voice
with a composed manner. This behavior may indicate that the client:
1 Is controlling the expression of feelings
2 Has repressed the details of the accident
3 Has blocked out the events of the last few hours
4 Is experiencing the reorganization phase of the trauma experience.
A nurse administers prescribed anxiolytics to clients with severe emotional disorders. What is the goal of
this treatment?
1 Reduces antisocial symptoms
2 Limits secondary complications
3 Prevents destructiveness by the client
4 Makes the client more amenable to psychotherapy.
A client is admitted to the acute medical unit for severe amphetamine intoxication. Which medications
should a nurse anticipate will be prescribed to counteract the effects of stimulant intoxication? Select all
that apply.
1 Diazepam
2 Propranolol
3 Benztropine
4 Bupropion
5 Amitriptyline
A public health nurse makes a home visit to a family after the birth of a third child. The other children
are 1 and 3 years old, and both have developmental delays. What must the nurse initially identify to
work effectively with this family?
1 The extended family members
2 The family members' marital relationships
3 Who makes the decisions that affect the family
4 Influences on the decisions that the family may make.
A nurse at the crisis intervention center asks a new female client, who has come because her husband is
planning a divorce, her reasons for seeking help. The client responds by describing her first meeting with
her husband, when they were both teenagers. What is the most therapeutic response by the nurse?
1 "You're avoiding talking about the divorce."
2 "And now your husband is asking for a divorce."
3 "What does this have to do with your situation now?"
Incorrect4 "Would you like to tell me more about the early years?"
A small fire has been set in the dayroom garbage can by a client who is currently demonstrating manic
behavior. Place the following nursing interventions in the appropriate order to best ensure client and
milieu safety.
1. Move all clients to a safe, controlled area.
2. Activate the unit's fire alarm system.
3. Place the manic client in a quiet environment with low stimulation.
4. Administer appropriate medications as prescribed if indicated.
When presenting a workshop on adolescent suicide, a community health nurse identifies risk factors.
Select all that apply.
1 Victim of family violence
2 Limited or strained family finances
3 Member of a single parent household
4 Dependence on alcohol, drugs, or both
5 Uncertainty related to sexual orientation
6 Repeated demonstration of poor impulse control.
A client with a diagnosis of paranoid schizophrenia throws a chair across the room and starts screaming
at the other clients. Several of these clients have frightened expressions, one starts to cry, and another
begins to pace. A nurse removes the agitated client from the room. What should the nurse remaining in
the room do next?
1 Continue the unit's activities as if nothing has happened.
2 Arrange a unit meeting to discuss what has just happened.
3 Refocus clients' negative comments to more positive topics.
4 Have a private talk with the clients who cried and started to pace.
A female adolescent in group therapy tells the other group members that while out on a pass she used
marijuana because her boyfriend made her smoke it. What defense mechanism is the client using?
1 Denial
2 Undoing
3 Projection
4 Displacement.
A group of clients from a psychiatric unit, accompanied by staff members, are going to a professional
baseball game. The purpose of visits into the community under the supervision of staff members is:
1 Helping clients adjust to stressors in the community
2 Helping clients return to reality under controlled conditions
3 Observing the clients' abilities to cope with a more complex society
4 Broadening the clients' experiences by providing exposure to cultural activities.
When caring for a newly admitted depressed client, a nurse arranges for a staff member to remain with
the client continuously. What information supports the nurse's decision to institute this precaution?
Select all that apply.
1 Refusal to eat any food
2 Inability to concentrate
3 Agitated pacing in the hall
4 History of suicide attempts
5 Statements that life is not worth living.
The nurse is planning care for a confused, delusional client. What should be included in the plan to
render it as therapeutic as possible?
1 Minimizing stimuli by maintaining a quiet environment
2 Encouraging realistic activity based on the client's ability
3 Understanding that these adaptations make differentiating fantasy from reality difficult
4 Demonstrating that the client is worthy of receiving care by providing physical hygiene.
A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly
instructs other clients in how to dress, what to eat, and where to sit. The nurse should intervene
because these behaviors eventually will cause the other clients to feel:
1 Angry
2 Dependent
3 Inadequate
4 Ambivalent.
The nurse is interviewing a female adolescent with anorexia nervosa who is malnourished and severely
underweight. The nurse concludes that the client is experiencing secondary gains from her behavior
when she says:
1 "I'm as big as a house."
2 "I get straight A's in school."
3 "My mother keeps trying to get me to eat."
4 "My hair is beginning to fall out in clumps.
A client with schizophrenia is observed sitting alone quietly talking to herself. She appears sad and is
tearful. Place the following nursing assessment questions in the appropriate order to best ensure client
safety.
Correct
1.“Are you hearing voices?”
2.“What are the voices telling you?”
3.“Are you thinking about hurting yourself or someone else?”
4.“What do you usually do to make the voices stop?
After treatment an adolescent with a history of schizophrenia improves and is to be discharged. The
parents tell the nurse that they are concerned about how to respond "if he starts to act crazy." What is
the most therapeutic response by the nurse?
1 Teaching the parents how to respond to their child's bizarre behavior
2 Assuring the parents that they are capable of controlling their child's behavior
3 Referring the parents to a self-help group of parents with schizophrenic children
4 Having the parents discuss mutual concerns with their child before the discharge date.
A client has been in the alcohol detoxification unit for 5 days. In the evening the client complains of
numbness and tingling in the feet and legs. What is the most appropriate nursing intervention?
1 Massaging the client's legs with lotion
2 Emphasizing the need to rest and keep the legs elevated
3 Keeping the bed linens off the client's legs with a mechanical aid
4 Monitoring the progression of symptoms and assessing the pedal pulses frequently
Shortly after admission an adolescent falls to the floor and exhibits tonic-clonic movements. There is no
verbal response, but a nurse observes that the client is still chewing gum. What should the nurse do
next?
1 Remove the chewing gum.
2 Document the observation.
3 Send another client for help.
4 Insert a tongue blade between the teeth
A client with the diagnosis of borderline personality disorder has been exhibiting manipulative,
inappropriate behavior and consistently attempting to take advantage of the other clients. What should
the nurse consider first before confronting the client?
1 The last time medication was given
2 The depth of their working relationship
3 The client's ability to be empathic toward others
4 The degree of self-awareness exhibited by the client.
When the nurse is managing the care of an acutely depressed client, which intervention demonstrates
that the nurse recognizes the client's fundamental mental health need?
1 Role modeling a hopeful attitude regarding life and the future
2 Sharing that life has presented depressing situations for all of us at times
3 Devoting time with the client and trying to focus on happy, positive memories
4 Identifying the client's personal strengths and designing interventions to highlight them.
A client on a psychiatric unit who has been hearing voices is receiving a neuroleptic medication for the
first time. The client takes the cup of water and the pill and stares at them. What is the most therapeutic
statement the nurse can make?
1 "You have to take your medicine."
2 "This is the medication that your doctor ordered."
3 "This will help you not to hear the voices. It will only work if you take it."
4 "There must be a reason that you don't want to take your medicine."
A client tells the nurse, "I used to believe that I was God, but now I know that that's not true." What is
the best response by the nurse?
1 "You really believed that?"
2 "Many people have this delusion."
3 "This is a sign you are getting better."
4 "What caused you to think you were God?"
A client with a dissociative identity disorder is to be discharged after a 2-week hospitalization. The
nurse, evaluating the effectiveness of the short-term therapy, expects the client to verbalize:
1 The ability to deal openly with feelings
2 That many of the personalities can be ignored
3 The need for long-term outpatient psychotherapy
4 That the personalities serve no protective purpose.
A 13-year-old student visits the school nurse numerous times over the course of several weeks. The
student has reported, "I worry about my parents because I don't want them to get a divorce. They tell
me that they're happy, but I can't stop worrying. I'm having trouble sleeping, I'm always tired, and my
grades have dropped." Which condition does the nurse consider that this student may be experiencing?
1 Panic disorder
2 Separation anxiety
3 Generalized anxiety
4 Acute stress disorder.
How can the nurse best assist a client with an obsessive-compulsive disorder to decrease the use of
ritualistic behavior?
1 By providing repetitive activities that require little thought
2 By attempting to limit situations that will worsen the anxiety
3 By getting the client involved in activities that will provide distraction
4 By suggesting that the client perform menial tasks to hide feelings of guilt.
A male client with a diagnosis of antisocial personality disorder is admitted to the mental health
hospital. What is the priority nursing intervention?
1 Encouraging interactions with others
Presenting a united, consistent staff approach
3 Assuming a nurturing, forgiving tone in disputes
4 Using seclusion when manipulative behaviors are exhibited.
During an assessment interview the client reports overwhelming, irresistible attacks of sleep. Which
sleep disorder does the nurse conclude that the client is experiencing?
1 Insomnia
2 Narcolepsy
3 Sleep terror
4 Sleep apnea.
A male client with paranoid schizophrenia is losing weight, reluctant to eat, and voicing concerns about
being poisoned. What is the best intervention by the nurse?
1 Allowing the client to open canned or prepackaged food
2 Restricting the client to his room until he has gained 2 lb
3 Explaining that the food has been x-rayed by the staff and is safe
4 Having one of the staff members personally taste the food before each meal.
A client has been on the psychiatric unit for several days. The client arouses anxiety and frustration in
the staff and manipulates them so well that staff members are afraid to approach the client. One
morning the client shouts at the nurse, "You've worked it so I can't go for a walk with the group today.
You're as cunning as a fox. I hate you! Get out, or I'll hit you!" What is the best response by the nurse?
1 "Tell me what I did to upset you."
2 "Go ahead and try to hit me if you need to."
3 "I don't like hearing your threats, but tell me more about your feelings."
4 "You're being rude and your behavior is stopping me from wanting to be with you."
It is determined that a staff nurse has a drug abuse problem. As an initial intervention, the staff nurse
should be:
1 Counseled by the staff psychiatrist
2 Dismissed from the job immediately
3 Referred to the employee assistance program
4 Forced to promise to abstain from drugs in the future.
A client with an obsessive-compulsive disorder completes a compulsive ritual and says to the nurse,
"Boy, you must really think I'm weird." What is the most appropriate response by the nurse?
1"Are you weird?"
2 "Do you really think I feel that way?"
3 "It sounds like you're concerned about my feelings toward you."
4 "You do have a serious problem, but I don't think that you're weird."
A client is admitted to a psychiatric hospital with the diagnosis of schizoid personality disorder. Which
initial nursing intervention is a priority for this client?
1 Helping the client enter into group recreational activities
2 Convincing the client that the hospital staff is trying to help
3 Helping the client learn to trust the staff through selected experiences
4 Arranging the client's contact with others so it is limited while she is in the hospital
A client with a history of depression tells the nurse about planning to retire from work next year. What
common dynamic about retirement should the nurse consider when interacting with this client?
1 It is damaging to self-esteem.
2 It is a developmental task of significance.
3 It is a negative event associated with the concept of aging.
4 It is a milestone that is eagerly anticipated by most older people.
A client with agoraphobia becomes increasingly anxious, often panics, and can no longer leave the
house. The client is admitted to the psychiatric unit of the local hospital. What is a realistic short-term
nursing objective for this client?
1 Feeling safe in the unit
2 Increasing self-esteem
3 Going out unaccompanied
4 Feeling comfortable in groups.
A client comes to the mental health clinic for treatment of a phobia of large dogs. The nurse should
anticipate that this client will demonstrate:
1 Fear of discussing the phobia
2 Resentment toward the feared object
3 Inadequate impulse control when threatened
4 Distortion of reality when discussing the phobia.
A nurse is assessing an older adult with the diagnosis of dementia. Which manifestations are expected in
this client? Select all that apply.
1 Resistance to change
2 Inability to recognize familiar objects
3 Preoccupation with personal appearance
4 Inability to concentrate on new activities or interests
5 Tendency to dwell on the past and ignore the present.
For a nurse assessing disturbed children, the clue most indicative of severe emotional problems is the
child's:
1 Physical complaints
2 Behavioral outbursts
3 Inadequate school performance
4 Lack of response to the environment.
A client with schizophrenia has been experiencing hallucinations. During what client behaviors should
the nurse expect the hallucinations to be more frequent?
1 Rest
2 Playing sports
3 Watching television
4 Interacting with others.
A client with the diagnosis of borderline personality disorder has been exhibiting manipulative,
inappropriate behavior and consistently attempting to take advantage of the other clients. What should
the nurse consider first before confronting the client?
1 The last time medication was given
2 The depth of their working relationship
3 The client's ability to be empathic toward others
4 The degree of self-awareness exhibited by the client.
An adult is found to have schizotypal personality disorder. How should a nurse describe the client's
behavior?
1 Rigid and controlling
2 Submissive and immature
3 Arrogant and attention-seeking
4 Introverted and emotionally withdrawn.
A client with cancer is told by a health care provider that the cancer has metastasized to other organs
and is untreatable. The client tells the nurse, "I think they made a mistake. I don't think I have cancer. I
feel too good to be dying." Which stage of grief does the nurse conclude that the client is experiencing?
1 Anger
2 Denial
3 Bargaining
4 Acceptance.
A psychiatric unit uses a behavioral approach to determine a client's level of privileges. Which factor
should a nurse use to determine whether an increase in privileges is warranted?
1 Stating that the depression is lifting
2 Performing hygiene activities independently
3 Showing improvement in short-term memory
4 Verbalizing a desire to change the response to stress.
During a nurse-client interaction in the mental health clinic, a client states that there has been a lot of
"stress relation" lately. What does the nurse conclude that this statement reflects?
1 Echolalia
2 Anamnesis
3 Echopraxia
4 Neologism.
A female client in the psychiatric unit has been monopolizing a group discussion about prenatal care for
more than 10 minutes, sharing her feelings about the way in which her husband has treated her. The
nurse conducts a quick assessment of the group and finds that about half of the clients are inattentive.
Which is the most appropriate nursing intervention?
1 Gently telling the client that she is taking up too much of the group's time
2 Saying nothing and waiting for one of the group members to interrupt the monopolizer
3 Thanking the client for sharing her feelings and asking what the other group members have on their
minds
4 Confronting the client by stating that half of the group's members are obviously no longer interested
in her topic.
A parent whose daughter is killed in a school bus accident tearfully tells the nurse, "My daughter was
just getting over the chickenpox and didn't want to go to school, but I insisted that she go. It's my fault
that she's dead." How should the nurse anticipate that perceiving a death as preventable will likely
influence the grieving process?
1 The loss may be easier to understand and accept.
2 The mourner may experience pathological grief.
3 Bereavement may be of greater intensity and duration.
4 The grieving process may progress to a psychiatric illness.
A nurse concludes that a 6-year-old child who has attained an acceptable level of psychosocial
development has achieved Erikson's developmental conflicts related to trust, autonomy, and:
1 Identity
2 Industry
3 Intimacy
4 Initiative.
A nurse is teaching a client about tricyclic antidepressants. Which potential side effects should the nurse
include? Select all that apply.
1 Dry mouth
2 Drowsiness
3 Constipation
4 Severe hypertension
5 Orthostatic hypotension.
A client with depression has not responded to a tricyclic antidepressant and outpatient
electroconvulsive therapy (ECT). The health care provider prescribes selegiline (Eldepryl), and the nurse
teaches the client about food to be avoided while taking this medication. Which foods identified by the
client allow the nurse to conclude that the instructions have been understood? Select all that apply.
1 Fresh fish
2 Aged cheese
3 Fried chicken
4 Chocolate drinks
5 Leafy vegetables.
A 3-year-old child is brought to the emergency department by the mother, who reports that her child
fell down the stairs and sustained injuries to the right arm and leg. During the physical assessment the
nurse identifies a number of old bruises on the child's back, buttocks, and upper arms. What should the
nurse say to the child to obtain additional information?
1 "Why did you fall down the stairs?"
2 "Did you really fall down those stairs?"
3 "Show me how you fell down the stairs."
4 "Your mommy must have told you to say you fell down the stairs."
A nurse is counseling a recently widowed client, who says, "His death has complicated my life even more
than the hassles he caused when he was alive!" The nurse realizes the client is having difficulty with the
grieving process and nurse concludes that the relationship with the husband was probably:
1 Loving
2 Long-term
3 Ambivalent
4 Subservient.
A client is admitted for treatment of obsessive-compulsive disorder that is interfering with activities of
daily living. Which medication should the nurse anticipate the health care provider will prescribe?
1 Benztropine (Cogentin)
2 Amantadine (Symmetrel)
3 Clomipramine (Anafranil)
4 Diphenhydramine (Benadryl).
A client asks the nurse, "Because I'm so comfortable talking with you, can we go out for coffee and
movie after I get discharged?" To maintain the boundaries of a therapeutic relationship, how will the
nurse respond?
1 "I'm flattered but that would be professionally unethical."
2 "You feel connected to me now; that will change once you are discharged."
3 "The attention I've giving you is directed towards getting you better; it isn't social."
4 "A social life is important so as your nurse let's talk about how you can form friendships.".
One afternoon the nurse on the unit overhears a young female client having an argument with her
boyfriend. A while later the client complains to the nurse that dinner is always late and the meals are
terrible. The nurse identifies the defense mechanism that the client is using as:
1 Projection
2 Dissociation
3 Displacement
4 Intellectualization.
One morning, during the working phase of a therapeutic relationship after several sessions in which
difficult issues were discussed, the client suddenly becomes very hostile. What is the most appropriate
interpretation of this behavior by the nurse?
1 The client is exercising assertiveness, which implies improvement.
2 Flare-ups often occur even when there is a positive working relationship.
3 Hostility is being used as a defense because previous self-disclosure has raised anxiety.
4 The behavior is a form of regression, which implies some deterioration in the client's condition.
A single mother of two children who recently lost her job because her company is downsizing comes to
the emergency department. The woman does not know what to do and is in crisis. The most critical
factor for the nurse to determine during crisis intervention is the client's:
1 Developmental history
2 Available situational supports
3 Underlying unconscious conflict
4 Willingness to restructure the personality.
A woman is brought to the emergency department by her husband. He is upset and says, "She fainted in
the kitchen. I'm so worried about her, because she's going to kill herself if she keeps this up." A history is
obtained from the husband, and the vital signs and physical assessment data are collected by the nurse.
What should the nurse do next?
1 Offer her a small sandwich.
2 Auscultate the abdomen for bowel sounds.
3 Administer oxygen by way of nasal cannula.
4 Obtain a blood specimen for serum electrolytes.
A client and the client's spouse are presented with electroconvulsive therapy (ECT) as a treatment
option instead of pharmacotherapy after the client experiences adverse effects of medication therapy.
The nurse meets with them to discuss the procedure. What should the nurse's first action be?
1 Allowing the client and family members to voice feelings, myths, and fantasies about ECT
2 Clarifying misconceptions and emphasizing the therapeutic value of the procedure for the depressed
individual
3 Providing them with a brochure about the treatment and scheduling another time to review and
answer their questions
4 Completing a detailed medical and psychiatric history and then starting family and client teaching at
their level of comprehension.
When talking with a client who has alcoholism, the nurse notes that the client becomes irritable, makes
excuses, and blames family and friends for the drinking problem. Which defense mechanisms does the
nurse conclude that the client is using? Select all that apply.
1 Projection
2 Suppression
3 Sublimation
4 Identification
5 Rationalization.
Although upset by a young client's continual complaints about all aspects of care, the nurse ignores
them and attempts to divert the conversation. Immediately after this exchange with the client, the
nurse discusses with a friend the various stages of development of young adults. Which defense
mechanism is the nurse is using?
1 Sublimation
2 Substitution
3 Identification
4 Intellectualization.
What is the most appropriate response by a nurse to a parent's question about childhood suicide?
1 "Suicide threats in children should be taken seriously."
2 "Children do not have readily available means to kill themselves."
3 "Children younger than age 6 may threaten but don't attempt suicide."
4 "Suicide attempts in young children are manipulative behaviors to control their parents."
An executive, busy at work, receives a phone call from a friend relating bad news. The woman makes a
conscious effort to put this information out of her mind and continues to work at the task at hand. The
next day she remembers that her friend telephoned her but is unable to recall the message. Which
defense mechanism does this behavior represent?
1 Regression
2 Suppression
3 Passive aggression
4 Reaction formation.
A nurse is planning to teach a client about self-care. What level of anxiety will best enhance the client's
learning abilities?
1 Mild
2 Panic
3 Severe
4 Moderate.
It is most helpful to the nurse who is attempting to apply the principles of mental health to consider
that:
1 People with emotional illnesses can empathize easily with others.
2 Emotionally ill people will initially reject psychological support.
3 Mental illness is characterized by signs and symptoms of socially inappropriate behavior.
4 Emotional health is promoted when there is a sense of mastery of self and the environment.
Which assessment question will provide the best information regarding a client's risk for waking in the
night and interrupted sleep related to lifestyle choices?
1 "Do you consider yourself a deep sleeper?"
2 "Do you smoke cigarettes, cigars, or a pipe?"
3 "Do you adhere to a regular bedtime routine?"
4 "Do you keep the television on when you're falling asleep?"
For which adverse effect should the nurse continually assess a client who is receiving valproic acid
(Depakene)?
1 Yellow sclerae
2 Motor restlessness
3 Ringing in the ears
4 Torsion of the neck.
In a mental health day treatment program, a psychiatric nurse is assessing a client's activity level. The
client starts to walk swiftly around the room while rubbing the hands together. What should the nurse
conclude that the client is exhibiting?
1 Tardive dyskinesia
2 Withdrawal syndrome
3 Psychomotor agitation
4 Psychophysiological insomnia.
A neuromuscular blocking agent is administered to a client before electroconvulsive therapy. At this
time, the nurse should monitor the client for:
1 Seizures
2 Vomiting
3 Loss of memory
4 Respiratory difficulties.
At a staff meeting, while discussing the return of one of the staff nurses from a drug rehabilitation
program, one nurse states, "I don't know why we are wasting time on this. We all know that addicts go
back to using drugs as soon as the pressure increases." What is the nurse manager's best response?
1 "It's hard, but it is our professional obligation to work with these individuals."
2 "It's important for us to share our feelings about staff members with problems."
3 "I guess you feel somewhat guilty that you failed to recognize that this nurse was addicted."
4 "I don't think you should work with this staff member, because you have such negative feelings."
A hospice nurse is caring for a dying client and his wife. What factor will be a major determinant in the
mourning outcome for the wife?
1 Duration of the relationship shared by the couple
2 Age of the wife at the time of the husband's death
3 Health of the surviving spouse at the time of the death
4 Importance of the deceased person as a source of support.
A nurse on the mental health unit is caring for a newly admitted client. What is the most important
aspect of the therapeutic contract with this client?
1 Determining the time for meetings with the client
2 Helping the client define treatment goals and expectations
3 Helping the client determine the frequency and duration of meetings
4 Explaining the professional responsibilities of the nurse to the client.
Windows in the recreation room of the adolescent unit have been found broken on numerous
occasions. After a group discussion one of the adolescents provides sound evidence that another
adolescent has broken them. What nursing action involves an assertive intervention?
1 Knocking on the door of the culprit's room and asking to talk about the situation
2 Confronting the culprit openly in the group and using a controlled voice while maintaining eye contact
3 Using a trusting approach and implying that the staff doubts the culprit's involvement but requests a
written denial
4 Approaching the culprit when alone and, after making eye contact, inquiring about his involvement
in these incidents.
Which goal specific to a client with impaired verbal communication related to a psychological barrier
should be documented in the client's clinical record?
1 Freedom from injury
2 Engaging independently in solitary craft activities
3 Identifying the consequences of acting-out behavior
4 Interacting appropriately with others in the therapeutic milieu.
When leading the first session of a newly formed group of clients in a mental health clinic, the nurse
notes that group members frequently assume self-serving roles. The nurse understands that:
1 Early group development involves these behaviors.
2 Some group members will need to be placed in another group.
3 Certain group members may be emerging to control attention seekers.
4 The group is attempting to reconcile conflicting viewpoints among its members.
After several interactions with a client, the nurse at the mental health clinic identifies a pattern of
withdrawal and nonparticipation in situations requiring communication with others. In which area
should the nurse expect the client to have difficulty?
1 Personal identity
2 Social interaction
3 Sensory perception
4 Verbal communication.
What is the most appropriate intervention for the nurse to implement after finding a disturbed client in
bed in the fetal position?
1 Sitting down in a chair by the client and saying, "I'm here to spend time with you."
2 Touching the client gently on the shoulder and saying, "I'm going to sit with you for a while."
3 Going to the client and saying, "I'll be waiting for you in the community room, so please get up and
join me."
4 Leaving the client alone because the behavior demonstrates that the client has regressed too far to
benefit from talking with the nurse.
The nurse manager of a mental health unit regularly includes effective boundary-setting as a topic for
the monthly staff in-service education sessions. What is the primary principle behind this decision?
1 Staff members are at risk for problems with boundary-setting.
2 Nurses are caring people who are willing to make exceptions for needy clients.
3 Staff members may have trouble establishing boundaries with manipulative clients.
4 Mental health clients often demonstrate difficulties establishing healthy boundaries.
A married woman is brought to the emergency department of a local hospital. Her eyes are swollen
shut, and she has a bruise on her neck. She reports that she is being beaten by her husband. How does
the nurse expect the husband to behave when he arrives at the emergency department?
1 Fearful
2 Confused
3 Charming
4 Indifferent.
To begin to establish a therapeutic relationship with a withdrawn, reclusive client, the nurse must:
1 Help the client keep anxiety to a minimum.
2 Protect the client from self-destructive tendencies.
3 Ascertain what topics are of most interest to the client.
4 Obtain a complete history from the family before talking with the client.
A client with mild Alzheimer disease has been taking galantamine (Razadyne), and the health care
provider prescribes paroxetine (Paxil) for depression. For what effect should a nurse assess the client
when these medications are taken concurrently?
1 Allergic
2 Dystonic
3 Additive
4 Extrapyramidal.
What is the most important information for a nurse to teach to prevent relapse in a client with a
psychiatric illness?
1 The need to develop a close support system
2 The need to create a stress-free environment
3 The need to refrain from activities that cause anxiety
4 The need to follow the prescribed medication regimen.
A nurse is working with a client who has emotional problems. During what stage of the therapeutic
nurse-client relationship does the nurse anticipate that most of the client's problem-solving will occur?
1 Working stage
2 Planning stage
3 Orientation stage
4 Termination stage.
A child has been found to have acute myelogenous leukemia. The practitioner has discussed the
diagnosis and prognosis with the parents. Later, after visiting their child, the parents have a bitter
argument. The nurse identifies the defense mechanism of:
1 Denial
2 Projection
3 Displacement
4 Compensation.
With the client's permission, the nurse should inform the family about what is happening. The main
reason for this action is that informed families:
1 Ease the client's anxiety
2 Are better equipped to assist the client
3 Appear more relaxed with the situation
4 Commonly cause fewer nursing problems.
The husband of a woman who has been sexually assaulted arrives at the hospital after being called by
the police. After reassuring him about his wife's condition, the nurse should give priority to:
1 Arranging for the rape counselor to meet with the wife
2 Discussing with him his own feelings about the situation
3 Helping him understand how his wife feels about the situation
4 Making him comfortable until the practitioner has finished examining his wife.
A client with a history of violence is becoming increasingly agitated. Which nursing intervention will
most likely increase the risk of acting-out behavior?
1 Being assertive
2 Responding early
3 Providing choices
4 Teaching relaxation.
A high school student reports to the school health nurse that the prescribed antidepressant is no longer
needed and should be discontinued. What is the best response by the nurse?
1 Seeking further information
2 Encouraging the student to discuss it with the practitioner
3 Emphasizing the importance of continuing the medication
4 Recommending that the student stop the medication for several days to determine whether it is still
needed.
How can a nurse in the mental health clinic best prepare a client for termination of their therapeutic
relationship?
1 Periodically summarizing the client's progress during the working phase
2 Stating that if the client feels it is necessary, their collaboration may be extended
3 Telling the client during their first meeting how long their entire therapeutic relationship will last
4 Encouraging an exploration of feelings during the termination phase about the relationship's ending.
A client is receiving haloperidol (Haldol) for agitation, and the nurse is monitoring the client for side
effects. Which response identified by the nurse is unrelated to an extrapyramidal tract effect?
1 Akathisia
2 Opisthotonos
3 Oculogyric crisis
4 Hypertensive crisis.
A nurse develops a relationship with a client who has bipolar disorder with episodes of mania. The nurse
concludes that their therapeutic interaction has entered the working stage when the client:
1 Identifies goals for the client-nurse interaction
2 Explores the effect of bipolar behavior on the family
3 Expresses ambivalence about meeting with the nurse
4 Informs the nurse that other family members are bipolar.
A nurse approaches a depressed client who has just been admitted to the psychiatric unit and says,
"Hello! I'm Andrea, your nurse. I'll introduce you and help you settle in with the others here. We'll also
talk about anything that concerns you." These statements establish the nurse-client relationship by:
1 Providing a theme
2 Defining boundaries
3 Identifying problems
4 Initiating the working phase.
A nurse anticipates that most clients with phobias will use the defense mechanisms of:
1 Dissociation and denial
2 Introjection and sublimation
3 Projection and displacement
4 Substitution and reaction formation.
A client has been receiving fluphenazine for several months. For which side effects should the nurse
assess the client? Select all that apply.
1 Tremors
2 Excess salivation
3 Rambling speech
4 Reluctance to converse
5 Minimal use of nonverbal expression
6 Uncoordinated movement of extremities.
A nurse in the mental health clinic has been working regularly with a client. What client behaviors
indicate that trust in the nurse has developed? Select all that apply.
1 Attends a weekly self-help group
2 Demonstrates decreased muscle tension
3 Initiates conversation with others in the waiting room
4 Maintains direct eye contact when talking with the nurse.
A client with a diagnosis of borderline personality disorder (BPD) has negative feelings toward the other
clients on the unit and considers them all "bad." Which defense is the client using when identifying the
other clients?
1 Splitting
2 Ambivalence
3 Passive aggression
4 Reaction formation.
A client with bipolar disorder has been admitted for alcohol detoxification, and laboratory tests are
performed. Which results should prompt the nurse to notify the admitting health care provider? Select
all that apply.
1 Lithium level: 1.2 mEq/L
2 Blood urea nitrogen: 25 mg/dL
3 Hemocrit: 47%
4 Serum sodium: 140 mEq/L
5 Serum albumin: 2.9 g/dL
6 Prothrombin time: 13.9 seconds.
What is the basic therapeutic tool used by the nurse to foster a client's psychological coping?
1 Self
2 Milieu
3 Helping process
4 Client's intellect.
A nurse is conducting the sixth and final session of crisis intervention with a client in a community health
center. Evaluation demonstrates that the client has not yet resolved her crisis issues. What is the most
acceptable intervention by the nurse?
1 Discharging the client on time whether or not the crisis has been fully resolved
2 Agreeing to continue the treatment until the client feels that the crisis has been resolved
3 Providing the client with additional information and referral regarding other community resources
4 Focusing on the client's underlying personality conflicts in preparation for referral to long-term
therapy.