NR 326 Final Exam – 80 Multiple-Choice Questions
with Rationales- Chamberlain
AGGRESSION, ANGER & DE-ESCALATION (~4 questions)
1. A nurse is caring for a client who is shouting, pacing, and clenching fists. Which is
the nurse's priority intervention?
A. Call for a show of force
B. Administer a PRN injection
C. Use de-escalation techniques
D. Place the client in restraints
Answer: C
Rationale: De-escalation is the first priority. The nurse should use a calm voice, give the
client space, offer choices, and set limits before considering restraints or medication.
2. Which client is at the highest risk for aggressive behavior?
A. A client with a history of violence
B. A client who paces in the hallway
C. A client who refuses to attend group therapy
D. A client who sleeps excessively
Answer: A
Rationale: The single best predictor of future violence is a past history of violence.
3. The nurse is de-escalating an agitated client. Place the following steps in the
correct order:
• Offer choices
• Give the client personal space
• Set firm limits on unacceptable behavior
• Acknowledge the client's feelings
A. 2, 4, 1, 3
B. 1, 2, 3, 4
C. 4, 1, 3, 2
D. 3, 2, 4, 1
,Answer: A
Rationale: De-escalation begins with giving space, then acknowledging feelings, offering
choices, and finally setting firm limits.
4. A client in the milieu screams, "Everyone is against me!" The nurse's best initial
response is:
A. "You need to calm down immediately."
B. "I can see you are upset. Let's go to a quieter area to talk."
C. "If you don't stop screaming, I will call security."
D. "Why do you think everyone is against you?"
Answer: B
Rationale: Acknowledging feelings and offering to move to a quieter area is a
de-escalation technique. Arguing, threatening, or asking "why" is non-therapeutic.
INVOLUNTARY VS. VOLUNTARY ADMISSIONS (~4 questions)
5. A voluntary client requests discharge. The nurse should:
A. Allow the client to leave immediately
B. Explain that the physician must evaluate the client for up to 5 days before discharge
C. Contact security to prevent the client from leaving
D. Ignore the request until the physician rounds
Answer: B
Rationale: In Illinois, a voluntary client who requests discharge can be held for up to 5
days for evaluation. The physician must assess whether the client meets criteria for
involuntary admission.
6. Which statement is true about involuntary admission?
A. The client signs themselves into the hospital
B. A petition and a certificate from a qualified examiner are required
C. The client has no right to refuse treatment
D. The client may leave at any time
Answer: B
Rationale: Involuntary admission requires legal documentation: a petition and a
certificate from a qualified examiner.
, 7. When can a provider override a client's right to refuse medication?
A. When the client has a history of non-adherence
B. When the client is an imminent danger to self or others
C. When the family requests medication
D. When the nurse disagrees with the client's decision
Answer: B
Rationale: The right to refuse medication can be overridden only in an emergency when
the client poses an immediate danger to self or others, using a Restriction of Rights
form.
8. A 16-year-old is brought to the emergency department by parents who request
admission. The adolescent refuses. Which statement is correct?
A. The adolescent cannot be admitted against their will
B. The parents can sign for a voluntary admission
C. Only a court can admit a minor
D. The adolescent's wishes are the only factor
Answer: B
Rationale: For minors, a parent or guardian can sign for voluntary admission. If the minor
refuses and is dangerous, an involuntary petition may be filed.
CRISIS (~3 questions)
9. A client loses their job and home within one week. The client has no prior history
of mental illness and is overwhelmed. This type of crisis is classified as:
A. Maturational crisis
B. Situational crisis
C. Traumatic stress crisis
D. Psychiatric emergency
Answer: B
Rationale: A situational crisis arises from an unexpected external stressor (job loss,
divorce, illness). The client's usual coping mechanisms are inadequate.
10. A crisis that results from a natural disaster or violent crime is called:
A. Maturational crisis
B. Situational crisis
C. Traumatic stress crisis
D. Developmental crisis
with Rationales- Chamberlain
AGGRESSION, ANGER & DE-ESCALATION (~4 questions)
1. A nurse is caring for a client who is shouting, pacing, and clenching fists. Which is
the nurse's priority intervention?
A. Call for a show of force
B. Administer a PRN injection
C. Use de-escalation techniques
D. Place the client in restraints
Answer: C
Rationale: De-escalation is the first priority. The nurse should use a calm voice, give the
client space, offer choices, and set limits before considering restraints or medication.
2. Which client is at the highest risk for aggressive behavior?
A. A client with a history of violence
B. A client who paces in the hallway
C. A client who refuses to attend group therapy
D. A client who sleeps excessively
Answer: A
Rationale: The single best predictor of future violence is a past history of violence.
3. The nurse is de-escalating an agitated client. Place the following steps in the
correct order:
• Offer choices
• Give the client personal space
• Set firm limits on unacceptable behavior
• Acknowledge the client's feelings
A. 2, 4, 1, 3
B. 1, 2, 3, 4
C. 4, 1, 3, 2
D. 3, 2, 4, 1
,Answer: A
Rationale: De-escalation begins with giving space, then acknowledging feelings, offering
choices, and finally setting firm limits.
4. A client in the milieu screams, "Everyone is against me!" The nurse's best initial
response is:
A. "You need to calm down immediately."
B. "I can see you are upset. Let's go to a quieter area to talk."
C. "If you don't stop screaming, I will call security."
D. "Why do you think everyone is against you?"
Answer: B
Rationale: Acknowledging feelings and offering to move to a quieter area is a
de-escalation technique. Arguing, threatening, or asking "why" is non-therapeutic.
INVOLUNTARY VS. VOLUNTARY ADMISSIONS (~4 questions)
5. A voluntary client requests discharge. The nurse should:
A. Allow the client to leave immediately
B. Explain that the physician must evaluate the client for up to 5 days before discharge
C. Contact security to prevent the client from leaving
D. Ignore the request until the physician rounds
Answer: B
Rationale: In Illinois, a voluntary client who requests discharge can be held for up to 5
days for evaluation. The physician must assess whether the client meets criteria for
involuntary admission.
6. Which statement is true about involuntary admission?
A. The client signs themselves into the hospital
B. A petition and a certificate from a qualified examiner are required
C. The client has no right to refuse treatment
D. The client may leave at any time
Answer: B
Rationale: Involuntary admission requires legal documentation: a petition and a
certificate from a qualified examiner.
, 7. When can a provider override a client's right to refuse medication?
A. When the client has a history of non-adherence
B. When the client is an imminent danger to self or others
C. When the family requests medication
D. When the nurse disagrees with the client's decision
Answer: B
Rationale: The right to refuse medication can be overridden only in an emergency when
the client poses an immediate danger to self or others, using a Restriction of Rights
form.
8. A 16-year-old is brought to the emergency department by parents who request
admission. The adolescent refuses. Which statement is correct?
A. The adolescent cannot be admitted against their will
B. The parents can sign for a voluntary admission
C. Only a court can admit a minor
D. The adolescent's wishes are the only factor
Answer: B
Rationale: For minors, a parent or guardian can sign for voluntary admission. If the minor
refuses and is dangerous, an involuntary petition may be filed.
CRISIS (~3 questions)
9. A client loses their job and home within one week. The client has no prior history
of mental illness and is overwhelmed. This type of crisis is classified as:
A. Maturational crisis
B. Situational crisis
C. Traumatic stress crisis
D. Psychiatric emergency
Answer: B
Rationale: A situational crisis arises from an unexpected external stressor (job loss,
divorce, illness). The client's usual coping mechanisms are inadequate.
10. A crisis that results from a natural disaster or violent crime is called:
A. Maturational crisis
B. Situational crisis
C. Traumatic stress crisis
D. Developmental crisis
