D449 Objective Assessment – WGU Psychiatric & Mental
Health OA – (2026) Actual Questions & Study Guide |
Guarantee Pass
Welcome to this comprehensive WGU D449 Psychiatric & Mental Health objective assessment review. This
resource contains 200 actual-style questions covering therapeutic communication, psychiatric disorders,
psychopharmacology, suicide risk assessment, defense mechanisms, legal/ethical issues, and mental health
nursing interventions. Each question includes the correct answer (in italics) and a short rationale (≤3 lines).
Use this exam to prepare for your WGU OA and strengthen your psychiatric nursing knowledge.
Key Topics Covered
• Therapeutic Communication – Active listening, empathy, clarification, reflection, silence, therapeutic vs
non-therapeutic responses
• Psychiatric Disorders – Major depressive disorder, bipolar disorder (mania/depression), schizophrenia,
generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), PTSD, personality
disorders (borderline, antisocial)
• Psychopharmacology – SSRIs, SNRIs, antipsychotics (typical/atypical), lithium, anticonvulsants (mood
stabilizers), benzodiazepines, MAOIs, side effects (EPS, NMS, serotonin syndrome, agranulocytosis)
• Suicide Risk Assessment – Risk factors, protective factors, suicide precautions, no-harm contracts, safety
planning
• Defense Mechanisms – Denial, projection, rationalization, displacement, regression, sublimation, reaction
formation
• Legal & Ethical Issues – Informed consent, involuntary commitment, confidentiality, HIPAA, duty to
protect (Tarasoff), patient rights
• Crisis Intervention & De-escalation – De-escalation techniques, seclusion, restraints (legal/ethical), anger
management
,• Substance Use Disorders – Alcohol, opioids, stimulants; withdrawal syndromes, detoxification,
medications (naltrexone, methadone, buprenorphine, disulfiram)
• Eating Disorders – Anorexia nervosa, bulimia nervosa, binge-eating disorder; medical complications,
refeeding syndrome
Questions 1–200
1. A client with major depressive disorder tells the nurse, "I'm a failure. I can't do anything right."
Which response is most therapeutic?
A) "You shouldn't feel that way; you have many strengths."
B) "It sounds like you're feeling really down about yourself right now."
C) "Let's list your recent accomplishments."
D) "Why do you feel like a failure?"
Answer B: "It sounds like you're feeling really down about yourself right now."
Rationale: Reflection validates the client's feeling without arguing or false reassurance. Avoid "why"
questions.
2. A client with schizophrenia tells the nurse, "The voices are telling me to hurt myself." What is the
priority nursing action?
A) Ask the client what the voices are saying in detail
B) Implement suicide precautions and notify the provider
C) Tell the client to ignore the voices
D) Administer a PRN antipsychotic
Answer B: Implement suicide precautions and notify the provider
Rationale: Command hallucinations to self-harm require immediate safety interventions (constant
observation, environment safety).
3. A client with bipolar disorder in a manic episode is pacing rapidly, talking loudly, and making
grandiose statements. Which intervention is most appropriate?
A) Place the client in seclusion
B) Provide a quiet, low-stimulation environment
C) Confront the client about the grandiose statements
D) Assign a group of staff to restrain the client
Answer B: Provide a quiet, low-stimulation environment
,Rationale: Reducing environmental stimuli helps decrease agitation and manic behavior. Restraints are a
last resort.
4. A client with borderline personality disorder has a history of self-mutilation (cutting). The client
says, "I want to cut myself." Which intervention should the nurse implement first?
A) Restrict the client to her room
B) Assess the intensity of the urge and review the safety plan
C) Apply soft wrist restraints
D) Administer a PRN sedative
Answer B: Assess the intensity of the urge and review the safety plan
Rationale: First, assess the risk and use de-escalation, including reviewing alternative coping strategies.
5. A client with alcohol use disorder is admitted for detoxification. The last drink was 8 hours ago.
Which assessment finding is most likely first?
A) Seizure activity
B) Anxiety, tremors, and diaphoresis
C) Delirium tremens (DTs)
D) Hallucinations
Answer B: Anxiety, tremors, and diaphoresis
Rationale: Early alcohol withdrawal (6-12 hours) includes tremors, anxiety, and tachycardia. DTs occur at
48-72 hours.
6. A client on a psychiatric unit tells the nurse, "I'm going to kill myself tonight." What is the nurse's
priority action?
A) Document the statement and tell the next shift
B) Place the client on one-to-one observation and notify the provider
C) Tell the client that this behavior will not be tolerated
D) Remove all sharp objects from the unit
Answer B: Place the client on one-to-one observation and notify the provider
Rationale: Immediate safety interventions include constant observation, removing means, and provider
notification.
, 7. A client with social anxiety disorder is prescribed paroxetine (SSRI). Which statement indicates
understanding?
A) "I should feel better within 24 hours."
B) "It may take 4-6 weeks for the full effect."
C) "I can stop the medication once I feel less anxious."
D) "This medication is addictive like Xanax."
Answer B: "It may take 4-6 weeks for the full effect."
Rationale: SSRIs have delayed onset; full therapeutic effect takes several weeks. They are not addictive.
8. A client with schizophrenia has been taking haloperidol for 2 weeks and now presents with a stiff
neck, fever, and confusion. Which condition does the nurse suspect?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome (NMS)
C) Acute dystonia
D) Serotonin syndrome
Answer B: Neuroleptic malignant syndrome (NMS)
Rationale: NMS presents with fever, rigidity, altered mental status, and autonomic instability; a medical
emergency.
9. A client with major depressive disorder is started on fluoxetine. The client says, "I feel even more
tired and nauseous now." Which response is most appropriate?
A) "The medication is not working; we need to switch it."
B) "These side effects often improve after the first week or two. Try taking it with food."
C) "You should stop taking it immediately."
D) "That means the medication is not right for you."
Answer B: "These side effects often improve after the first week or two. Try taking it with food."
Rationale: Early side effects (nausea, fatigue) are common and often transient; encourage adherence.
10. A client with bipolar disorder is taking lithium. The client reports hand tremors and increased
thirst. What should the nurse do first?
A) Hold the next dose of lithium
B) Check the client's lithium level
C) Administer a beta-blocker for tremors
Health OA – (2026) Actual Questions & Study Guide |
Guarantee Pass
Welcome to this comprehensive WGU D449 Psychiatric & Mental Health objective assessment review. This
resource contains 200 actual-style questions covering therapeutic communication, psychiatric disorders,
psychopharmacology, suicide risk assessment, defense mechanisms, legal/ethical issues, and mental health
nursing interventions. Each question includes the correct answer (in italics) and a short rationale (≤3 lines).
Use this exam to prepare for your WGU OA and strengthen your psychiatric nursing knowledge.
Key Topics Covered
• Therapeutic Communication – Active listening, empathy, clarification, reflection, silence, therapeutic vs
non-therapeutic responses
• Psychiatric Disorders – Major depressive disorder, bipolar disorder (mania/depression), schizophrenia,
generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), PTSD, personality
disorders (borderline, antisocial)
• Psychopharmacology – SSRIs, SNRIs, antipsychotics (typical/atypical), lithium, anticonvulsants (mood
stabilizers), benzodiazepines, MAOIs, side effects (EPS, NMS, serotonin syndrome, agranulocytosis)
• Suicide Risk Assessment – Risk factors, protective factors, suicide precautions, no-harm contracts, safety
planning
• Defense Mechanisms – Denial, projection, rationalization, displacement, regression, sublimation, reaction
formation
• Legal & Ethical Issues – Informed consent, involuntary commitment, confidentiality, HIPAA, duty to
protect (Tarasoff), patient rights
• Crisis Intervention & De-escalation – De-escalation techniques, seclusion, restraints (legal/ethical), anger
management
,• Substance Use Disorders – Alcohol, opioids, stimulants; withdrawal syndromes, detoxification,
medications (naltrexone, methadone, buprenorphine, disulfiram)
• Eating Disorders – Anorexia nervosa, bulimia nervosa, binge-eating disorder; medical complications,
refeeding syndrome
Questions 1–200
1. A client with major depressive disorder tells the nurse, "I'm a failure. I can't do anything right."
Which response is most therapeutic?
A) "You shouldn't feel that way; you have many strengths."
B) "It sounds like you're feeling really down about yourself right now."
C) "Let's list your recent accomplishments."
D) "Why do you feel like a failure?"
Answer B: "It sounds like you're feeling really down about yourself right now."
Rationale: Reflection validates the client's feeling without arguing or false reassurance. Avoid "why"
questions.
2. A client with schizophrenia tells the nurse, "The voices are telling me to hurt myself." What is the
priority nursing action?
A) Ask the client what the voices are saying in detail
B) Implement suicide precautions and notify the provider
C) Tell the client to ignore the voices
D) Administer a PRN antipsychotic
Answer B: Implement suicide precautions and notify the provider
Rationale: Command hallucinations to self-harm require immediate safety interventions (constant
observation, environment safety).
3. A client with bipolar disorder in a manic episode is pacing rapidly, talking loudly, and making
grandiose statements. Which intervention is most appropriate?
A) Place the client in seclusion
B) Provide a quiet, low-stimulation environment
C) Confront the client about the grandiose statements
D) Assign a group of staff to restrain the client
Answer B: Provide a quiet, low-stimulation environment
,Rationale: Reducing environmental stimuli helps decrease agitation and manic behavior. Restraints are a
last resort.
4. A client with borderline personality disorder has a history of self-mutilation (cutting). The client
says, "I want to cut myself." Which intervention should the nurse implement first?
A) Restrict the client to her room
B) Assess the intensity of the urge and review the safety plan
C) Apply soft wrist restraints
D) Administer a PRN sedative
Answer B: Assess the intensity of the urge and review the safety plan
Rationale: First, assess the risk and use de-escalation, including reviewing alternative coping strategies.
5. A client with alcohol use disorder is admitted for detoxification. The last drink was 8 hours ago.
Which assessment finding is most likely first?
A) Seizure activity
B) Anxiety, tremors, and diaphoresis
C) Delirium tremens (DTs)
D) Hallucinations
Answer B: Anxiety, tremors, and diaphoresis
Rationale: Early alcohol withdrawal (6-12 hours) includes tremors, anxiety, and tachycardia. DTs occur at
48-72 hours.
6. A client on a psychiatric unit tells the nurse, "I'm going to kill myself tonight." What is the nurse's
priority action?
A) Document the statement and tell the next shift
B) Place the client on one-to-one observation and notify the provider
C) Tell the client that this behavior will not be tolerated
D) Remove all sharp objects from the unit
Answer B: Place the client on one-to-one observation and notify the provider
Rationale: Immediate safety interventions include constant observation, removing means, and provider
notification.
, 7. A client with social anxiety disorder is prescribed paroxetine (SSRI). Which statement indicates
understanding?
A) "I should feel better within 24 hours."
B) "It may take 4-6 weeks for the full effect."
C) "I can stop the medication once I feel less anxious."
D) "This medication is addictive like Xanax."
Answer B: "It may take 4-6 weeks for the full effect."
Rationale: SSRIs have delayed onset; full therapeutic effect takes several weeks. They are not addictive.
8. A client with schizophrenia has been taking haloperidol for 2 weeks and now presents with a stiff
neck, fever, and confusion. Which condition does the nurse suspect?
A) Tardive dyskinesia
B) Neuroleptic malignant syndrome (NMS)
C) Acute dystonia
D) Serotonin syndrome
Answer B: Neuroleptic malignant syndrome (NMS)
Rationale: NMS presents with fever, rigidity, altered mental status, and autonomic instability; a medical
emergency.
9. A client with major depressive disorder is started on fluoxetine. The client says, "I feel even more
tired and nauseous now." Which response is most appropriate?
A) "The medication is not working; we need to switch it."
B) "These side effects often improve after the first week or two. Try taking it with food."
C) "You should stop taking it immediately."
D) "That means the medication is not right for you."
Answer B: "These side effects often improve after the first week or two. Try taking it with food."
Rationale: Early side effects (nausea, fatigue) are common and often transient; encourage adherence.
10. A client with bipolar disorder is taking lithium. The client reports hand tremors and increased
thirst. What should the nurse do first?
A) Hold the next dose of lithium
B) Check the client's lithium level
C) Administer a beta-blocker for tremors
