WGU D449
Objective Assessment
(2 Full Exams Set)
(Psychiatric and Mental Health Nursing)
Actual Questions with Verified Answers
Pass the Exam with Confidence
What You Will Get:
➢140 Questions with correct answers.
➢Expert Rationales included.
➢D449 OA Review
,Preview Pages Below
Get the Complete PDF
After Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
,Table of Contents
D449 OA EXAM SET 1 ....................................................................... 2
D449 OA EXAM SET 2 ..................................................................... 42
D449 OA Review ............................................................................. 80
D449 OA EXAM SET 1
1. A 34-year-old client is brought to the emergency department by family members who
report she has not left her home in 3 months. She states, "I can't go to the grocery store
because I might get trapped and not be able to escape." During the assessment, the
nurse observes the client is trembling and diaphoretic when discussing leaving the
house. Which nursing diagnosis should the nurse prioritize?
A. Ineffective coping related to inadequate stress management
B. Fear related to being in situations where escape may be difficult
C. Social isolation related to altered thought processes
D. Risk for injury related to hyperventilation and panic episodes
Correc Answer:B
Expert Rationale:
This client is exhibiting classic signs of agoraphobia, characterized by intense fear of
being in situations where escape might be difficult or help unavailable. The client's
specific statement about being "trapped and not able to escape" directly aligns with the
diagnostic criteria for agoraphobia. While social isolation (C) is a consequence, it is
secondary to the underlying fear. Ineffective coping (A) is too vague and doesn't
address the specific phobic nature. Risk for injury (D) is not the primary concern at this
stage. The nurse should prioritize addressing the fear response to guide therapeutic
interventions such as gradual exposure therapy and cognitive-behavioral techniques.
, 2. A 28-year-old client with a severe phobia of flying has been referred for implosion
therapy. During the first session, the therapist asks the client to vividly imagine being on
a turbulent flight while simultaneously describing the experience in detail. The client
becomes extremely anxious and asks to stop. Which response by the therapist is most
appropriate?
A. "We can stop now and try again next week with a less intense scenario."
B. "Let's take a break and practice deep breathing before continuing."
C. "I understand this is difficult, but we need to continue through the anxiety to break
the fear cycle."
D. "Perhaps exposure therapy is too advanced; let's switch to medication management
instead."
Correc Answer:C
Expert Rationale:
Implosion therapy (flooding) is a behavioral intervention that involves intense,
prolonged exposure to the feared stimulus or situation to extinguish the conditioned
fear response. Unlike systematic desensitization, which uses gradual exposure, implosion
therapy exposes the client to the maximum anxiety-provoking stimulus from the start.
The therapist must maintain the exposure without allowing avoidance behaviors, as
escape would reinforce the phobic response. Stopping (A) or switching approaches (D)
undermines the therapeutic goal. While breathing techniques (B) are useful adjuncts, the
core principle of flooding is sustained exposure until anxiety naturally habituates. The
therapist should provide support while encouraging continuation.
3. A 42-year-old client with obsessive-compulsive disorder (OCD) is observed washing
her hands for the 15th time in the past hour. When the nurse approaches, the client
says, "I know this doesn't make sense, but I can't stop. If I don't wash, something terrible
will happen." Which statement best explains the underlying psychodynamic mechanism
driving this behavior?
A. The handwashing serves as a displacement of unconscious aggressive impulses
toward others.
B. The ritual temporarily reduces anxiety through negative reinforcement of the
compulsive behavior.
Objective Assessment
(2 Full Exams Set)
(Psychiatric and Mental Health Nursing)
Actual Questions with Verified Answers
Pass the Exam with Confidence
What You Will Get:
➢140 Questions with correct answers.
➢Expert Rationales included.
➢D449 OA Review
,Preview Pages Below
Get the Complete PDF
After Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
,Table of Contents
D449 OA EXAM SET 1 ....................................................................... 2
D449 OA EXAM SET 2 ..................................................................... 42
D449 OA Review ............................................................................. 80
D449 OA EXAM SET 1
1. A 34-year-old client is brought to the emergency department by family members who
report she has not left her home in 3 months. She states, "I can't go to the grocery store
because I might get trapped and not be able to escape." During the assessment, the
nurse observes the client is trembling and diaphoretic when discussing leaving the
house. Which nursing diagnosis should the nurse prioritize?
A. Ineffective coping related to inadequate stress management
B. Fear related to being in situations where escape may be difficult
C. Social isolation related to altered thought processes
D. Risk for injury related to hyperventilation and panic episodes
Correc Answer:B
Expert Rationale:
This client is exhibiting classic signs of agoraphobia, characterized by intense fear of
being in situations where escape might be difficult or help unavailable. The client's
specific statement about being "trapped and not able to escape" directly aligns with the
diagnostic criteria for agoraphobia. While social isolation (C) is a consequence, it is
secondary to the underlying fear. Ineffective coping (A) is too vague and doesn't
address the specific phobic nature. Risk for injury (D) is not the primary concern at this
stage. The nurse should prioritize addressing the fear response to guide therapeutic
interventions such as gradual exposure therapy and cognitive-behavioral techniques.
, 2. A 28-year-old client with a severe phobia of flying has been referred for implosion
therapy. During the first session, the therapist asks the client to vividly imagine being on
a turbulent flight while simultaneously describing the experience in detail. The client
becomes extremely anxious and asks to stop. Which response by the therapist is most
appropriate?
A. "We can stop now and try again next week with a less intense scenario."
B. "Let's take a break and practice deep breathing before continuing."
C. "I understand this is difficult, but we need to continue through the anxiety to break
the fear cycle."
D. "Perhaps exposure therapy is too advanced; let's switch to medication management
instead."
Correc Answer:C
Expert Rationale:
Implosion therapy (flooding) is a behavioral intervention that involves intense,
prolonged exposure to the feared stimulus or situation to extinguish the conditioned
fear response. Unlike systematic desensitization, which uses gradual exposure, implosion
therapy exposes the client to the maximum anxiety-provoking stimulus from the start.
The therapist must maintain the exposure without allowing avoidance behaviors, as
escape would reinforce the phobic response. Stopping (A) or switching approaches (D)
undermines the therapeutic goal. While breathing techniques (B) are useful adjuncts, the
core principle of flooding is sustained exposure until anxiety naturally habituates. The
therapist should provide support while encouraging continuation.
3. A 42-year-old client with obsessive-compulsive disorder (OCD) is observed washing
her hands for the 15th time in the past hour. When the nurse approaches, the client
says, "I know this doesn't make sense, but I can't stop. If I don't wash, something terrible
will happen." Which statement best explains the underlying psychodynamic mechanism
driving this behavior?
A. The handwashing serves as a displacement of unconscious aggressive impulses
toward others.
B. The ritual temporarily reduces anxiety through negative reinforcement of the
compulsive behavior.
