WGU D449 Psychiatric and Mental Health Nursing
Comprehensive Objective Assessment-Solved
1.A nurse is assessing a client who reports hearing voices when no one is present.
Which term best describes this finding?
A. Delusion
B. Illusion
C. Hallucination
D. Confabulation
Rationale: A hallucination is a sensory perception that occurs without an external
stimulus.
2.Which client statement is most consistent with a delusion of persecution?
A. “I am the most important person in the world.”
B. “The television is sending me special messages.”
C. “The neighbors are secretly trying to poison me.”
D. “I hear someone calling my name.”
Rationale: Persecutory delusions involve false beliefs that others are attempting to
harm, control, or conspire against the individual.
3.A client with major depressive disorder says, “Everyone would be better off if I
were dead.” What is the nurse's priority response?
A. “You should focus on the positive things in your life.”
B. “Do you have friends who can support you?”
C. “Why do you think everyone would be better off?”
D. “Are you thinking about killing yourself?”
Rationale: Directly assessing suicidal thoughts is appropriate and does not increase
suicide risk. Safety assessment takes priority.
4.Which finding is most characteristic of mania?
A. Social withdrawal
B. Psychomotor retardation
C. Decreased need for sleep
D. Persistent feelings of worthlessness
Rationale: Mania commonly involves elevated or irritable mood, increased energy,
pressured speech, racing thoughts, impulsivity, and decreased need for sleep.
5.A client taking lithium reports severe diarrhea, vomiting, coarse tremors, and
difficulty walking. What should the nurse suspect?
,A. Expected therapeutic effects
B. Mild anxiety
C. Lithium toxicity
D. Serotonin syndrome
Rationale: Significant gastrointestinal symptoms, coarse tremor, ataxia, confusion,
and neurologic changes can indicate lithium toxicity and require prompt
intervention.
6.Which laboratory value is particularly important to monitor in a client receiving
lithium therapy?
A. Hemoglobin
B. Platelet count
C. Serum lithium level
D. Serum amylase
Rationale: Lithium has a narrow therapeutic range, so serum levels must be
monitored to prevent toxicity.
7.A client taking clozapine develops fever and a sore throat. Which action should
the nurse take?
A. Reassure the client that this is expected.
B. Encourage increased physical activity.
C. Notify the provider and obtain an appropriate blood count.
D. Administer the next dose early.
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and sore
throat can indicate infection associated with low neutrophil levels.
8.Which medication is commonly used as an opioid antagonist in the treatment of
opioid use disorder?
A. Disulfiram
B. Acamprosate
C. Naltrexone
D. Diazepam
Rationale: Naltrexone blocks opioid receptors and can reduce the rewarding effects
of opioids.
9.A client experiencing alcohol withdrawal is at greatest risk for which complication?
A. Hypothermia
B. Seizures and delirium tremens
C. Severe bradycardia
D. Hypoglycemia only
Rationale: Severe alcohol withdrawal can progress to seizures, hallucinations,
autonomic instability, and delirium tremens.
10.Which medication class is commonly used to manage acute alcohol withdrawal?
, A. Stimulants
B. Antipsychotics only
C. Benzodiazepines
D. SSRIs
Rationale: Benzodiazepines reduce CNS hyperexcitability and are commonly used to
prevent withdrawal seizures and severe withdrawal symptoms.
11.A client experiencing panic disorder reports chest tightness and shortness of
breath. What should the nurse do first?
A. Leave the client alone to decrease stimulation.
B. Ask the client to describe childhood experiences.
C. Remain with the client and use calm, brief communication.
D. Encourage the client to make important decisions.
Rationale: During acute panic, the nurse should provide a calm presence, reduce
environmental stimulation, and use simple communication.
12.Which statement by a client demonstrates an understanding of cognitive-
behavioral therapy (CBT)?
A. “My therapist will tell me exactly what decisions to make.”
B. “I will learn to identify and challenge unhelpful thoughts.”
C. “Therapy will focus exclusively on my childhood.”
D. “I won't need to participate actively in therapy.”
Rationale: CBT focuses on identifying maladaptive thoughts and behaviors and
developing healthier patterns.
13.Which behavior is most characteristic of obsessive-compulsive disorder (OCD)?
A. Persistent elevated mood
B. Repeated handwashing to reduce anxiety about contamination
C. Flashbacks after trauma
D. Alternating episodes of mania and depression
Rationale: Obsessions are intrusive thoughts, while compulsions are repetitive
behaviors or mental acts performed to reduce distress.
14.A client with PTSD repeatedly experiences distressing memories of a traumatic
event. What is this symptom called?
A. Echolalia
B. Perseveration
C. Intrusion/re-experiencing
D. Flight of ideas
Rationale: PTSD can involve intrusive memories, nightmares, flashbacks, and
psychological or physiologic distress related to reminders of the trauma.
15.Which intervention is most appropriate when caring for a client experiencing
Comprehensive Objective Assessment-Solved
1.A nurse is assessing a client who reports hearing voices when no one is present.
Which term best describes this finding?
A. Delusion
B. Illusion
C. Hallucination
D. Confabulation
Rationale: A hallucination is a sensory perception that occurs without an external
stimulus.
2.Which client statement is most consistent with a delusion of persecution?
A. “I am the most important person in the world.”
B. “The television is sending me special messages.”
C. “The neighbors are secretly trying to poison me.”
D. “I hear someone calling my name.”
Rationale: Persecutory delusions involve false beliefs that others are attempting to
harm, control, or conspire against the individual.
3.A client with major depressive disorder says, “Everyone would be better off if I
were dead.” What is the nurse's priority response?
A. “You should focus on the positive things in your life.”
B. “Do you have friends who can support you?”
C. “Why do you think everyone would be better off?”
D. “Are you thinking about killing yourself?”
Rationale: Directly assessing suicidal thoughts is appropriate and does not increase
suicide risk. Safety assessment takes priority.
4.Which finding is most characteristic of mania?
A. Social withdrawal
B. Psychomotor retardation
C. Decreased need for sleep
D. Persistent feelings of worthlessness
Rationale: Mania commonly involves elevated or irritable mood, increased energy,
pressured speech, racing thoughts, impulsivity, and decreased need for sleep.
5.A client taking lithium reports severe diarrhea, vomiting, coarse tremors, and
difficulty walking. What should the nurse suspect?
,A. Expected therapeutic effects
B. Mild anxiety
C. Lithium toxicity
D. Serotonin syndrome
Rationale: Significant gastrointestinal symptoms, coarse tremor, ataxia, confusion,
and neurologic changes can indicate lithium toxicity and require prompt
intervention.
6.Which laboratory value is particularly important to monitor in a client receiving
lithium therapy?
A. Hemoglobin
B. Platelet count
C. Serum lithium level
D. Serum amylase
Rationale: Lithium has a narrow therapeutic range, so serum levels must be
monitored to prevent toxicity.
7.A client taking clozapine develops fever and a sore throat. Which action should
the nurse take?
A. Reassure the client that this is expected.
B. Encourage increased physical activity.
C. Notify the provider and obtain an appropriate blood count.
D. Administer the next dose early.
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and sore
throat can indicate infection associated with low neutrophil levels.
8.Which medication is commonly used as an opioid antagonist in the treatment of
opioid use disorder?
A. Disulfiram
B. Acamprosate
C. Naltrexone
D. Diazepam
Rationale: Naltrexone blocks opioid receptors and can reduce the rewarding effects
of opioids.
9.A client experiencing alcohol withdrawal is at greatest risk for which complication?
A. Hypothermia
B. Seizures and delirium tremens
C. Severe bradycardia
D. Hypoglycemia only
Rationale: Severe alcohol withdrawal can progress to seizures, hallucinations,
autonomic instability, and delirium tremens.
10.Which medication class is commonly used to manage acute alcohol withdrawal?
, A. Stimulants
B. Antipsychotics only
C. Benzodiazepines
D. SSRIs
Rationale: Benzodiazepines reduce CNS hyperexcitability and are commonly used to
prevent withdrawal seizures and severe withdrawal symptoms.
11.A client experiencing panic disorder reports chest tightness and shortness of
breath. What should the nurse do first?
A. Leave the client alone to decrease stimulation.
B. Ask the client to describe childhood experiences.
C. Remain with the client and use calm, brief communication.
D. Encourage the client to make important decisions.
Rationale: During acute panic, the nurse should provide a calm presence, reduce
environmental stimulation, and use simple communication.
12.Which statement by a client demonstrates an understanding of cognitive-
behavioral therapy (CBT)?
A. “My therapist will tell me exactly what decisions to make.”
B. “I will learn to identify and challenge unhelpful thoughts.”
C. “Therapy will focus exclusively on my childhood.”
D. “I won't need to participate actively in therapy.”
Rationale: CBT focuses on identifying maladaptive thoughts and behaviors and
developing healthier patterns.
13.Which behavior is most characteristic of obsessive-compulsive disorder (OCD)?
A. Persistent elevated mood
B. Repeated handwashing to reduce anxiety about contamination
C. Flashbacks after trauma
D. Alternating episodes of mania and depression
Rationale: Obsessions are intrusive thoughts, while compulsions are repetitive
behaviors or mental acts performed to reduce distress.
14.A client with PTSD repeatedly experiences distressing memories of a traumatic
event. What is this symptom called?
A. Echolalia
B. Perseveration
C. Intrusion/re-experiencing
D. Flight of ideas
Rationale: PTSD can involve intrusive memories, nightmares, flashbacks, and
psychological or physiologic distress related to reminders of the trauma.
15.Which intervention is most appropriate when caring for a client experiencing
