Essentials of Psychiatric Mental Health Nursing
– Varcarolis – Comprehensive Practice Exam
SECTION I: FOUNDATIONS OF PSYCHIATRIC-MENTAL HEALTH NURSING
Chapter 1: Practicing the Science and Art of Psychiatric Nursing
1. A nurse is developing a plan of care focused on recovery for a patient living in
the community with serious and persistent mental illness. Which outcome would
best reflect the recovery model?
A. The patient will deny suicidal ideation within 3 months
B. The patient will report a sense of well-being within 3 months
C. The patient will take medications exactly as prescribed
D. The patient will attend all clinic appointments on time
Correct Answer: B
Rationale: The recovery model emphasizes managing symptoms, reducing
psychosocial disability, and improving role performance. Its goal is to empower
individuals with mental illness to achieve a sense of meaning and satisfaction in
life and function at the highest possible level of wellness. Denying suicidal
ideation, taking medications, and attending appointments focus on the traditional
medical model rather than recovery. Recovery-oriented care prioritizes the
patient's subjective experience of well-being and functional improvement.
2. A nurse is working on a psychiatric unit and observes a colleague making
derogatory comments about a patient's appearance during shift report. Which
response by the nurse best demonstrates patient advocacy?
A. "This is a psychiatric hospital; we expect patients to behave bizarrely."
B. "Let's all show acceptance by wearing lots of makeup too."
C. "Your comments are inconsiderate and inappropriate. Keep the report
objective."
D. "Our patients need our help to learn behaviors that will help them get along in
society."
, Correct Answer: D
Rationale: Accepting patients' needs for self-expression and seeking to
teach skills that contribute to their well-being demonstrate respect and are
important parts of advocacy. The oncoming nurse must take action to ensure
others are not prejudiced against the patient. Humor can be appropriate within
the privacy of a shift report but never at the expense of respect for patients.
Judging the off-going nurse critically will create conflict. Nurses must show
compassion for each other.
3. A nurse assesses a newly admitted patient diagnosed with major depressive
disorder. Which statement is an example of "attending"?
A. "We all have stress in life. Being in a psychiatric hospital is not the end of the
world."
B. "Tell me why you felt you had to be hospitalized to receive treatment for your
depression."
C. "You will feel better after we get some antidepressant medication started for
you."
D. "I'd like to sit with you for a while, so you may feel more comfortable."
Correct Answer: D
Rationale: Attending behaviors include active listening, maintaining eye
contact, and being physically present with the patient. Offering to sit with the
patient demonstrates a caring, non-judgmental presence that encourages the
patient to share feelings. Giving advice, probing for reasons, and making promises
about medication are not examples of attending.
4. A patient asks a nurse, "What are neurotransmitters? My doctor says mine are
out of balance." What is the nurse's best response?
A. "Neurotransmitters are chemicals that pass messages between brain cells."
B. "Neurotransmitters are hormones that control your emotions."
,C. "They are the same as the medications you are taking."
D. "You should ask your doctor for more information about that."
Correct Answer: A
Rationale: Neurotransmitters are chemical substances that transmit
signals across synapses between neurons. They are essential for brain function,
including mood regulation, cognition, and behavior. Understanding this basic
concept helps patients make sense of psychopharmacological treatment.
Referring the patient only to the doctor does not meet the nurse's teaching
responsibility.
5. A nurse explains multiaxial diagnoses to a psychiatric technician. Which
information is accurate?
A. It is a template for treatment planning.
B. Nursing and medical diagnoses are included.
C. Assessments of several aspects of functioning are included.
D. It incorporates the framework of the DSM-5.
Correct Answer: C
Rationale: The multiaxial system of the DSM-IV-TR required assessment
beyond the primary psychiatric diagnosis, including relevant medical conditions,
psychosocial and environmental problems, and global assessment of functioning.
While the DSM-5 has transitioned to a non-axial system, understanding multiaxial
assessment remains important for comprehensive evaluation.
6. A patient is hospitalized for depression and suicidal ideation after their spouse
asks for a divorce. Select the nurse's most caring comment.
A. "Let's discuss healthy means of coping when you have suicidal feelings."
B. "I understand why you're so depressed. When I got divorced, I was devastated
too."
C. "You should forget about your marriage and move on with your life."
D. "How did you get so depressed that hospitalization was necessary?"
, Correct Answer: A
Rationale: The nurse's communication should evidence caring and a
commitment to work with the patient. This commitment lets the patient know
the nurse will help. Offering to discuss healthy coping strategies is therapeutic
and future-oriented. Self-disclosure of the nurse's own divorce is inappropriate;
giving advice is not therapeutic; probing into why hospitalization was necessary is
judgmental.
7. A nurse wants to use evidence-based practice (EBP) to improve patient
outcomes on a psychiatric unit. Which action should the nurse take first?
A. Search for the best available research evidence
B. Formulate a clear clinical question about the problem
C. Apply the evidence to patient care
D. Evaluate the outcomes of the practice change
Correct Answer: B
Rationale: The first step in the evidence-based practice process is to
formulate a clear, focused clinical question using a format such as PICO
(Population, Intervention, Comparison, Outcome). This guides the subsequent
steps of searching for evidence, critically appraising it, applying it, and evaluating
outcomes.
8. A patient in the community asks a psychiatric mental health nurse, "What does
your title mean?" The nurse responds best by answering:
A. "Don't be afraid; it means I'm here to help, not hurt, you."
B. "Psychiatric mental health nurses care for people with mental illnesses."
C. "We have the specialized skills needed to care for those with mental illnesses."
D. "The nurses who work in mental health facilities have that title."
Correct Answer: C
– Varcarolis – Comprehensive Practice Exam
SECTION I: FOUNDATIONS OF PSYCHIATRIC-MENTAL HEALTH NURSING
Chapter 1: Practicing the Science and Art of Psychiatric Nursing
1. A nurse is developing a plan of care focused on recovery for a patient living in
the community with serious and persistent mental illness. Which outcome would
best reflect the recovery model?
A. The patient will deny suicidal ideation within 3 months
B. The patient will report a sense of well-being within 3 months
C. The patient will take medications exactly as prescribed
D. The patient will attend all clinic appointments on time
Correct Answer: B
Rationale: The recovery model emphasizes managing symptoms, reducing
psychosocial disability, and improving role performance. Its goal is to empower
individuals with mental illness to achieve a sense of meaning and satisfaction in
life and function at the highest possible level of wellness. Denying suicidal
ideation, taking medications, and attending appointments focus on the traditional
medical model rather than recovery. Recovery-oriented care prioritizes the
patient's subjective experience of well-being and functional improvement.
2. A nurse is working on a psychiatric unit and observes a colleague making
derogatory comments about a patient's appearance during shift report. Which
response by the nurse best demonstrates patient advocacy?
A. "This is a psychiatric hospital; we expect patients to behave bizarrely."
B. "Let's all show acceptance by wearing lots of makeup too."
C. "Your comments are inconsiderate and inappropriate. Keep the report
objective."
D. "Our patients need our help to learn behaviors that will help them get along in
society."
, Correct Answer: D
Rationale: Accepting patients' needs for self-expression and seeking to
teach skills that contribute to their well-being demonstrate respect and are
important parts of advocacy. The oncoming nurse must take action to ensure
others are not prejudiced against the patient. Humor can be appropriate within
the privacy of a shift report but never at the expense of respect for patients.
Judging the off-going nurse critically will create conflict. Nurses must show
compassion for each other.
3. A nurse assesses a newly admitted patient diagnosed with major depressive
disorder. Which statement is an example of "attending"?
A. "We all have stress in life. Being in a psychiatric hospital is not the end of the
world."
B. "Tell me why you felt you had to be hospitalized to receive treatment for your
depression."
C. "You will feel better after we get some antidepressant medication started for
you."
D. "I'd like to sit with you for a while, so you may feel more comfortable."
Correct Answer: D
Rationale: Attending behaviors include active listening, maintaining eye
contact, and being physically present with the patient. Offering to sit with the
patient demonstrates a caring, non-judgmental presence that encourages the
patient to share feelings. Giving advice, probing for reasons, and making promises
about medication are not examples of attending.
4. A patient asks a nurse, "What are neurotransmitters? My doctor says mine are
out of balance." What is the nurse's best response?
A. "Neurotransmitters are chemicals that pass messages between brain cells."
B. "Neurotransmitters are hormones that control your emotions."
,C. "They are the same as the medications you are taking."
D. "You should ask your doctor for more information about that."
Correct Answer: A
Rationale: Neurotransmitters are chemical substances that transmit
signals across synapses between neurons. They are essential for brain function,
including mood regulation, cognition, and behavior. Understanding this basic
concept helps patients make sense of psychopharmacological treatment.
Referring the patient only to the doctor does not meet the nurse's teaching
responsibility.
5. A nurse explains multiaxial diagnoses to a psychiatric technician. Which
information is accurate?
A. It is a template for treatment planning.
B. Nursing and medical diagnoses are included.
C. Assessments of several aspects of functioning are included.
D. It incorporates the framework of the DSM-5.
Correct Answer: C
Rationale: The multiaxial system of the DSM-IV-TR required assessment
beyond the primary psychiatric diagnosis, including relevant medical conditions,
psychosocial and environmental problems, and global assessment of functioning.
While the DSM-5 has transitioned to a non-axial system, understanding multiaxial
assessment remains important for comprehensive evaluation.
6. A patient is hospitalized for depression and suicidal ideation after their spouse
asks for a divorce. Select the nurse's most caring comment.
A. "Let's discuss healthy means of coping when you have suicidal feelings."
B. "I understand why you're so depressed. When I got divorced, I was devastated
too."
C. "You should forget about your marriage and move on with your life."
D. "How did you get so depressed that hospitalization was necessary?"
, Correct Answer: A
Rationale: The nurse's communication should evidence caring and a
commitment to work with the patient. This commitment lets the patient know
the nurse will help. Offering to discuss healthy coping strategies is therapeutic
and future-oriented. Self-disclosure of the nurse's own divorce is inappropriate;
giving advice is not therapeutic; probing into why hospitalization was necessary is
judgmental.
7. A nurse wants to use evidence-based practice (EBP) to improve patient
outcomes on a psychiatric unit. Which action should the nurse take first?
A. Search for the best available research evidence
B. Formulate a clear clinical question about the problem
C. Apply the evidence to patient care
D. Evaluate the outcomes of the practice change
Correct Answer: B
Rationale: The first step in the evidence-based practice process is to
formulate a clear, focused clinical question using a format such as PICO
(Population, Intervention, Comparison, Outcome). This guides the subsequent
steps of searching for evidence, critically appraising it, applying it, and evaluating
outcomes.
8. A patient in the community asks a psychiatric mental health nurse, "What does
your title mean?" The nurse responds best by answering:
A. "Don't be afraid; it means I'm here to help, not hurt, you."
B. "Psychiatric mental health nurses care for people with mental illnesses."
C. "We have the specialized skills needed to care for those with mental illnesses."
D. "The nurses who work in mental health facilities have that title."
Correct Answer: C
