PNLE PRACTICE QUESTIONS: lost interest in her usual activities. You recognize these as the
PSYCHIATRIC NURSING primary symptoms of
A. Depression.
1. The nurse in the psychiatric ward informed the male client B. Schizophrenia.
that he will be attending the 9:00 AM group therapy sessions. C. Suicidal ideation.
The client tells the nurse that he must wash his hands from D. Bipolar manic episodes.
9:00 AM to 9:30 AM each day and therefore he cannot attend.
Which concept does the nursing staff need to keep in mind in
planning nursing intervention for this client? Rationale:
A. Depression underlines ritualistic behavior Depressed mood and anhedonia (loss of interest or pleasure in
B. Fear and tensions are often expressed in disguised form activities) are the primary symptoms of major depression.
through symbolic processes.
C. Ritualistic behavior makes others uncomfortable. 5. Your patient is ready for discharge after a 30-day
D. Unmet needs are discharged through ritualistic behavior. hospitalization for manic depression. About 30 minutes before
his discharge, his roommate comes to you and says, 'He is
Rationale: talking crazy.' When you ask your patient how he is feeling, he
Anxiety is generated by group therapy at 9:00 AM. The states, 'I feel like Superman. I can do anything. I can fly home
ritualistic behavioral defense of hand washing decreases today and then become a U.S. Senator.' Which type of mania-
anxiety by avoiding group therapy. related symptoms is this patient exhibiting?
A. Social.
2. The nurse assesses the health condition of the female client. B. Cognitive.
The client tells the nurse that she discovered a lump in the C. Behavioral.
breast last year and hesitated to seek medical advice. The D. Perceptual.
nurse understands that women who tend to delay seeking
medical advice after discovering the disease are displaying Rationale:
what common defense mechanism? Cognitive symptoms include inflated self-esteem and
A. Intellectualization grandiosity
B. Suppression
C. Repression 6. You need to assess whether a patient who has a mood
D. Denial disorder is ready for discharge. Which statement would
indicate readiness for discharge?
Rationale: A. Right now, I can't bathe myself or dress myself, but I feel
Denial is a very strong defense mechanism used to allay the good about that.
emotional effects of discovering a potential threat. Although B. Going home will be fun, but if it isn't fun, I can always
denial has been found to be an effective mechanism for make my mother help me or tell her to do so. She better help
survival in some instances, such as during natural disasters, it me.
may in greater pathology in a woman with potential breast C. I will take my medicines as I should and know to call the
carcinoma number you gave me if I have bad thoughts.
D. Taking care of myself is important, but it's okay if I don't
3. A 48-year-old Hispanic woman is seen by a psychiatric want to do anything.
clinical nurse specialist after receiving a call by her son.
According to the son, since his father's death 7 months ago, his Rationale:
mother has lost 30 pounds and can't sleep. During her initial Verbalization of a plan for help and demonstration of care are
visit, the patient states, 'My husband talks to me in his visits, realistic discharge criteria.
but his words make no sense to me. I don't understand what he
wants me to do.' What is an appropriate nursing diagnosis? 7. An angry patient is in the community room. She picks up a
A. Ineffective denial. chair and uses it to hit another patient on the head. When you
B. Bipolar mood disorder. come into the community room, what should your first
C. Hyper-religiosity. response to the patient holding the chair be?
D. Grieving. A. Are you crazy? Hitting people can hurt them!
B. Hitting others is unacceptable. Please put the chair
Rationale: completely down on the floor.
Grieving may be characterized by weight loss, sleep C. How would you like it if I hit you over the head with a
disturbances, and messages from beyond. chair?
D. You're in big trouble now. It's probably prison you are
looking at!
4. Your neighbor's husband comes to talk to you. He says his
wife has not left the house in 2 weeks, has a flat mood, and has Rationale:
,Use words to indicate your lack of acceptance of the patient's
behavior in a nonthreatening voice or tone. Rationale:
The patient improvement is based on increased socialization
8. A 22-year-old female is admitted to the unit following a and increased appetite.
suicide attempt. She has a 2-week history of depression as
well as a history of abusing multiple substances and anorexia 12. A 21-year-old patient has a diagnosis of schizophrenia and
nervosa. What is your first nursing priority? is stuporous, yet exhibits sudden, excessive motor activity
A. Socialization. with repetitive sit-ups. What is this behavior called?
B. Contracting for eating behavior. A. Delusional.
C. Safety. B. Hallucinogenic.
D. Administering the Beck depression scale. C. Paranoid.
D. Catatonic.
Rationale:
Safety is the major principle underlying psychiatric nursing. Rationale:
Catatonic schizophrenia occurs suddenly and includes motor
9. Gerald was admitted to the psychiatric acute care unit immobility or excessive motor activity.
because he stood in the center of a main two-way street in his
underwear and a T-shirt, shouting, 'I am being held against my 13. A 16-year-old girl is admitted for her first psychotic break.
will. I have personal rights.' Gerald was diagnosed with Her parents feel very guilty. What is your best nursing
bipolar disorder, manic type. Which of the following response?
interventions will add to everyone's safety in the acute care A. No one really knows the cause of schizophrenia. It is not
environment? your fault and is not due to anything you did in the past. It is
A. Have hectic surroundings. important to understand this, to support your daughter, and to
B. Have consistent unit routines. find support for yourselves.
C. Minimize staff interventions. B. Does anyone in your family have schizophrenia, as this
D. Medicate the patient only if he has private health insurance. disease is known to be genetic?
C. You may feel bad now, but there are so many other bad
Rationale: things out there, such as cancer and paralysis.
Quiet environments with consistent routines will help calm D. Let me share with you some websites to help you deal with
patients and add to safety. your guilt.
10. Your patient has just been physically cleaned up after Rationale:
slicing his left arm 8 times. To show an appropriate evaluative Schizophrenia has a multifocal origin and its cause may
response, which of the following would be your best include a genetic component. Support is needed for both
statement? patients and caregivers.
A. I could care less if you cut yourself. It doesn't hurt me.
B. If you wouldn't cut yourself, you would have a much 14. A physical indicator of possible abuse in a battered woman
happier life. would be a fracture of the distal bones, such as the skull, face,
C. You are lucky someone found you in time. Now you can or extremities.
help us make you better. A. TRUE
D. The behavior of cutting is not acceptable. B. FALSE
Rationale: Rationale:
Focus on the behavior, not the person. Be neutral, but not Musculoskeletal fractures and sprains, especially of distal
indifferent. versus proximal bones, are indications of battering. Also
assess for dislocated shoulders and old fractures.
11. A 22-year-old female was admitted to the mental health
unit with major depression and suicidal ideation. She has a 15. Which of the following statements indicates that your
history of cutting her wrists intermittently throughout the last patient, who has schizophrenia, is ready to manage a relapse?
2 years. On days 1 and 2, the patient stays in her room and eats A. I will think of a plan of action before I get these racing
only 20% of her meals. On day 3, she eats 80% of her meals thoughts again.
and is talking to others in group. The nurse should consider B. I will not drink alcohol and will exercise daily. This will
that the patient is help me stay well.
A. Showing improvement. C. If I start feeling badly and don't sleep very much, then I will
B. Highly suicidal. tell my friend Sandy and talk to her. She or I will call my
C. Exhibiting mood swings. therapist.
D. In need of electroshock therapy.
, D. When I feel stressed, I will sit near my bed and wait to feel Rationale:
better. Asking what the patient talks about with family or friends and
what types of activities he or she engages in can help assess
Rationale: relationships.
Managing a relapse includes a plan of action, involvement of a
friend or family member, and, after identification of signs, 20. Which type of therapy helps patients with personality
notification of a therapist. disorders explore ways to enjoy themselves and increase their
socialization skills?
16. Your patient has a diagnosis of schizophrenia and believes A. Occupational therapy.
that his thoughts are broadcast from his head. What is the most B. Recreational therapy.
appropriate nursing diagnosis? C. Music therapy.
A. Risk for self-directed violence. D. Medication therapy.
B. Disturbed sensory perception.
C. Impaired verbal communication. Rationale:
D. Disturbed thought processes. Recreational therapy helps patients explore ways to enjoy
themselves without using alcohol or drugs and strengthens
Rationale: social skills.
Thought broadcasting and thought withdrawal are disturbed
thought processes. 21. Which of the following symptoms of alcohol
detoxification would you be most concerned about?
17. As a nurse, you wish to reinforce functional behavior in A. Vitamin and mineral depletion.
your schizophrenic patient. Which intervention will B. Diaphoresis.
accomplish reinforcement? C. Increased heart rate.
A. Praise the patient for reality-based perceptions and D. Hallucinations and delusions.
cessation of acting-out behaviors.
B. Educate the patient about the symptoms of schizophrenia. Rationale:
C. Facilitate learning about the importance of medication Hallucinations and delusions can result in problems with
compliance using written materials for reinforcing medication safety and possibly lead to suicide.
use.
D. Focus on the feelings of delusion to reinforce reality and 22. What is the priority nursing intervention to help orient a
decrease false beliefs by talking to the patient. patient who has Alzheimer's disease?
A. Post a schedule in the dining room of daily activities.
Rationale: B. Use an overhead loudspeaker to announce upcoming
Reinforcement by praise increases functional behavior. events.
C. Provide a daily routine and easy-to-read clocks.
18. Your patient is preoccupied with perfection and control, D. Have the patient live alone in a private room.
has difficulty relaxing, exhibits rule-conscious behavior, and
cannot discard anything. What type of personality disorder Rationale:
does this behavior reflect? Daily routines and large clocks help patients' functional status.
A. Antisocial personality.
B. Obsessive-compulsive personality. 23. You are caring for a patient and pour out his evening
C. Manic behavior. risperidone (Risperdal) 2 mg tablet. The pill falls on the
D. Anxiety disorder. countertop. What is your next intervention?
A. Pick the pill up from the counter and place it in a cup.
Rationale: B. Wash the pill off with alcohol and place it in a cup.
Obsessive-compulsive disorder is a personality disorder that C. Discard the pill and repour the medication.
includes perfection, control, procrastination, excessive D. Call the patient up to the pill line to receive his medication.
devotion to work, difficulty relaxing, rule-conscious behavior,
and inability to discard anything. Rationale:
The pill is contaminated once dropped, so for infection control
19. Which of the following questions is appropriate to assess purposes you discard it and repour the medication.
for disturbances in a patient's relationships?
A. What are your main worries? 24. Your patient has just shown you some fresh, self-inflicted,
B. Have you ever used alcohol or illegal drugs? superficial cuts-eight of them going up and down his right
C. How has your appetite been in the past month? arm. What is your initial intervention based on infection
D. What do you talk about with friends? control principles?
PSYCHIATRIC NURSING primary symptoms of
A. Depression.
1. The nurse in the psychiatric ward informed the male client B. Schizophrenia.
that he will be attending the 9:00 AM group therapy sessions. C. Suicidal ideation.
The client tells the nurse that he must wash his hands from D. Bipolar manic episodes.
9:00 AM to 9:30 AM each day and therefore he cannot attend.
Which concept does the nursing staff need to keep in mind in
planning nursing intervention for this client? Rationale:
A. Depression underlines ritualistic behavior Depressed mood and anhedonia (loss of interest or pleasure in
B. Fear and tensions are often expressed in disguised form activities) are the primary symptoms of major depression.
through symbolic processes.
C. Ritualistic behavior makes others uncomfortable. 5. Your patient is ready for discharge after a 30-day
D. Unmet needs are discharged through ritualistic behavior. hospitalization for manic depression. About 30 minutes before
his discharge, his roommate comes to you and says, 'He is
Rationale: talking crazy.' When you ask your patient how he is feeling, he
Anxiety is generated by group therapy at 9:00 AM. The states, 'I feel like Superman. I can do anything. I can fly home
ritualistic behavioral defense of hand washing decreases today and then become a U.S. Senator.' Which type of mania-
anxiety by avoiding group therapy. related symptoms is this patient exhibiting?
A. Social.
2. The nurse assesses the health condition of the female client. B. Cognitive.
The client tells the nurse that she discovered a lump in the C. Behavioral.
breast last year and hesitated to seek medical advice. The D. Perceptual.
nurse understands that women who tend to delay seeking
medical advice after discovering the disease are displaying Rationale:
what common defense mechanism? Cognitive symptoms include inflated self-esteem and
A. Intellectualization grandiosity
B. Suppression
C. Repression 6. You need to assess whether a patient who has a mood
D. Denial disorder is ready for discharge. Which statement would
indicate readiness for discharge?
Rationale: A. Right now, I can't bathe myself or dress myself, but I feel
Denial is a very strong defense mechanism used to allay the good about that.
emotional effects of discovering a potential threat. Although B. Going home will be fun, but if it isn't fun, I can always
denial has been found to be an effective mechanism for make my mother help me or tell her to do so. She better help
survival in some instances, such as during natural disasters, it me.
may in greater pathology in a woman with potential breast C. I will take my medicines as I should and know to call the
carcinoma number you gave me if I have bad thoughts.
D. Taking care of myself is important, but it's okay if I don't
3. A 48-year-old Hispanic woman is seen by a psychiatric want to do anything.
clinical nurse specialist after receiving a call by her son.
According to the son, since his father's death 7 months ago, his Rationale:
mother has lost 30 pounds and can't sleep. During her initial Verbalization of a plan for help and demonstration of care are
visit, the patient states, 'My husband talks to me in his visits, realistic discharge criteria.
but his words make no sense to me. I don't understand what he
wants me to do.' What is an appropriate nursing diagnosis? 7. An angry patient is in the community room. She picks up a
A. Ineffective denial. chair and uses it to hit another patient on the head. When you
B. Bipolar mood disorder. come into the community room, what should your first
C. Hyper-religiosity. response to the patient holding the chair be?
D. Grieving. A. Are you crazy? Hitting people can hurt them!
B. Hitting others is unacceptable. Please put the chair
Rationale: completely down on the floor.
Grieving may be characterized by weight loss, sleep C. How would you like it if I hit you over the head with a
disturbances, and messages from beyond. chair?
D. You're in big trouble now. It's probably prison you are
looking at!
4. Your neighbor's husband comes to talk to you. He says his
wife has not left the house in 2 weeks, has a flat mood, and has Rationale:
,Use words to indicate your lack of acceptance of the patient's
behavior in a nonthreatening voice or tone. Rationale:
The patient improvement is based on increased socialization
8. A 22-year-old female is admitted to the unit following a and increased appetite.
suicide attempt. She has a 2-week history of depression as
well as a history of abusing multiple substances and anorexia 12. A 21-year-old patient has a diagnosis of schizophrenia and
nervosa. What is your first nursing priority? is stuporous, yet exhibits sudden, excessive motor activity
A. Socialization. with repetitive sit-ups. What is this behavior called?
B. Contracting for eating behavior. A. Delusional.
C. Safety. B. Hallucinogenic.
D. Administering the Beck depression scale. C. Paranoid.
D. Catatonic.
Rationale:
Safety is the major principle underlying psychiatric nursing. Rationale:
Catatonic schizophrenia occurs suddenly and includes motor
9. Gerald was admitted to the psychiatric acute care unit immobility or excessive motor activity.
because he stood in the center of a main two-way street in his
underwear and a T-shirt, shouting, 'I am being held against my 13. A 16-year-old girl is admitted for her first psychotic break.
will. I have personal rights.' Gerald was diagnosed with Her parents feel very guilty. What is your best nursing
bipolar disorder, manic type. Which of the following response?
interventions will add to everyone's safety in the acute care A. No one really knows the cause of schizophrenia. It is not
environment? your fault and is not due to anything you did in the past. It is
A. Have hectic surroundings. important to understand this, to support your daughter, and to
B. Have consistent unit routines. find support for yourselves.
C. Minimize staff interventions. B. Does anyone in your family have schizophrenia, as this
D. Medicate the patient only if he has private health insurance. disease is known to be genetic?
C. You may feel bad now, but there are so many other bad
Rationale: things out there, such as cancer and paralysis.
Quiet environments with consistent routines will help calm D. Let me share with you some websites to help you deal with
patients and add to safety. your guilt.
10. Your patient has just been physically cleaned up after Rationale:
slicing his left arm 8 times. To show an appropriate evaluative Schizophrenia has a multifocal origin and its cause may
response, which of the following would be your best include a genetic component. Support is needed for both
statement? patients and caregivers.
A. I could care less if you cut yourself. It doesn't hurt me.
B. If you wouldn't cut yourself, you would have a much 14. A physical indicator of possible abuse in a battered woman
happier life. would be a fracture of the distal bones, such as the skull, face,
C. You are lucky someone found you in time. Now you can or extremities.
help us make you better. A. TRUE
D. The behavior of cutting is not acceptable. B. FALSE
Rationale: Rationale:
Focus on the behavior, not the person. Be neutral, but not Musculoskeletal fractures and sprains, especially of distal
indifferent. versus proximal bones, are indications of battering. Also
assess for dislocated shoulders and old fractures.
11. A 22-year-old female was admitted to the mental health
unit with major depression and suicidal ideation. She has a 15. Which of the following statements indicates that your
history of cutting her wrists intermittently throughout the last patient, who has schizophrenia, is ready to manage a relapse?
2 years. On days 1 and 2, the patient stays in her room and eats A. I will think of a plan of action before I get these racing
only 20% of her meals. On day 3, she eats 80% of her meals thoughts again.
and is talking to others in group. The nurse should consider B. I will not drink alcohol and will exercise daily. This will
that the patient is help me stay well.
A. Showing improvement. C. If I start feeling badly and don't sleep very much, then I will
B. Highly suicidal. tell my friend Sandy and talk to her. She or I will call my
C. Exhibiting mood swings. therapist.
D. In need of electroshock therapy.
, D. When I feel stressed, I will sit near my bed and wait to feel Rationale:
better. Asking what the patient talks about with family or friends and
what types of activities he or she engages in can help assess
Rationale: relationships.
Managing a relapse includes a plan of action, involvement of a
friend or family member, and, after identification of signs, 20. Which type of therapy helps patients with personality
notification of a therapist. disorders explore ways to enjoy themselves and increase their
socialization skills?
16. Your patient has a diagnosis of schizophrenia and believes A. Occupational therapy.
that his thoughts are broadcast from his head. What is the most B. Recreational therapy.
appropriate nursing diagnosis? C. Music therapy.
A. Risk for self-directed violence. D. Medication therapy.
B. Disturbed sensory perception.
C. Impaired verbal communication. Rationale:
D. Disturbed thought processes. Recreational therapy helps patients explore ways to enjoy
themselves without using alcohol or drugs and strengthens
Rationale: social skills.
Thought broadcasting and thought withdrawal are disturbed
thought processes. 21. Which of the following symptoms of alcohol
detoxification would you be most concerned about?
17. As a nurse, you wish to reinforce functional behavior in A. Vitamin and mineral depletion.
your schizophrenic patient. Which intervention will B. Diaphoresis.
accomplish reinforcement? C. Increased heart rate.
A. Praise the patient for reality-based perceptions and D. Hallucinations and delusions.
cessation of acting-out behaviors.
B. Educate the patient about the symptoms of schizophrenia. Rationale:
C. Facilitate learning about the importance of medication Hallucinations and delusions can result in problems with
compliance using written materials for reinforcing medication safety and possibly lead to suicide.
use.
D. Focus on the feelings of delusion to reinforce reality and 22. What is the priority nursing intervention to help orient a
decrease false beliefs by talking to the patient. patient who has Alzheimer's disease?
A. Post a schedule in the dining room of daily activities.
Rationale: B. Use an overhead loudspeaker to announce upcoming
Reinforcement by praise increases functional behavior. events.
C. Provide a daily routine and easy-to-read clocks.
18. Your patient is preoccupied with perfection and control, D. Have the patient live alone in a private room.
has difficulty relaxing, exhibits rule-conscious behavior, and
cannot discard anything. What type of personality disorder Rationale:
does this behavior reflect? Daily routines and large clocks help patients' functional status.
A. Antisocial personality.
B. Obsessive-compulsive personality. 23. You are caring for a patient and pour out his evening
C. Manic behavior. risperidone (Risperdal) 2 mg tablet. The pill falls on the
D. Anxiety disorder. countertop. What is your next intervention?
A. Pick the pill up from the counter and place it in a cup.
Rationale: B. Wash the pill off with alcohol and place it in a cup.
Obsessive-compulsive disorder is a personality disorder that C. Discard the pill and repour the medication.
includes perfection, control, procrastination, excessive D. Call the patient up to the pill line to receive his medication.
devotion to work, difficulty relaxing, rule-conscious behavior,
and inability to discard anything. Rationale:
The pill is contaminated once dropped, so for infection control
19. Which of the following questions is appropriate to assess purposes you discard it and repour the medication.
for disturbances in a patient's relationships?
A. What are your main worries? 24. Your patient has just shown you some fresh, self-inflicted,
B. Have you ever used alcohol or illegal drugs? superficial cuts-eight of them going up and down his right
C. How has your appetite been in the past month? arm. What is your initial intervention based on infection
D. What do you talk about with friends? control principles?
