Psychiatric Mental Health Nursing
NCLEX Review Questions Set 1 GRADE
A+ SOLUTIONS
A 48-year-old Hispanic woman is seen by a psychiatric clinical nurse
specialist after receiving a call by her son. According to the son,
since his father's death 7 months ago, his mother has lost 30 pounds
and can't sleep. During her initial visit, the patient states, 'My
husband talks to me in his visits, but his words make no sense to me.
I don't understand what he wants me to do.' What is an appropriate
nursing diagnosis?
A. Ineffective denial.
B. Bipolar mood disorder.
C. Hyper-religiosity.
D. Grieving.
D. Grieving.
Reason: Grieving may be characterized by weight loss, sleep
disturbances, and messages from beyond.
Your neighbor's husband comes to talk to you. He says his wife has
not left the house in 2 weeks, has a flat mood, and has lost interest
in her usual activities. You recognize these as the primary symptoms
of
A. Depression.
B. Schizophrenia.
C. Suicidal ideation.
D. Bipolar manic episodes.
A. Depression.
Reason: Depressed mood and anhedonia (loss of interest or pleasure in
activities) are the primary symptoms of major depression.
Your patient is ready for discharge after a 30-day hospitalization
for manic depression. About 30 minutes before his discharge, his
roommate comes to you and says, 'He is talking crazy.' When you ask
your patient how he is feeling, he states, 'I feel like Superman. I
can do anything. I can fly home today and then become a U.S.
Senator.' Which type of mania-related symptoms is this patient
exhibiting?
A. Social.
,B. Cognitive.
C. Behavioral.
D. Perceptual.
B. Cognitive.
Reason: Cognitive symptoms include inflated self-esteem and
grandiosity.
You need to assess whether a patient who has a mood disorder is ready
for discharge. Which statement would indicate readiness for discharge?
A. Right now, I can't bathe myself or dress myself, but I feel good
about that.
B. Going home will be fun, but if it isn't fun, I can always make my
mother help me or tell her to do so. She better help me.
C. I will take my medicines as I should and know to call the number
you gave me if I have bad thoughts.
D. Taking care of myself is important, but it's okay if I don't want
to do anything.
C. I will take my medicines as I should and know to call the number
you gave me if I have bad thoughts.
Reason: Verbalization of a plan for help and demonstration of care
are realistic discharge criteria.
An angry patient is in the community room. She picks up a chair and
uses it to hit another patient on the head. When you come into the
community room, what should your first response to the patient
holding the chair be?
A. Are you crazy? Hitting people can hurt them!
B. Hitting others is unacceptable. Please put the chair completely
down on the floor.
C. How would you like it if I hit you over the head with a chair?
D. You're in big trouble now. It's probably prison you are looking at!
B. Hitting others is unacceptable. Please put the chair completely
down on the floor.
Reason: Use words to indicate your lack of acceptance of the
patient's behavior in a nonthreatening voice or tone.
A 22-year-old female is admitted to the unit following a suicide
attempt. She has a 2-week history of depression as well as a history
of abusing multiple substances and anorexia nervosa. What is your
first nursing priority?
A. Socialization.
B. Contracting for eating behavior.
C. Safety.
D. Administering the Beck depression scale.
, C. Safety.
Reason: Safety is the major principle underlying psychiatric nursing.
Gerald was admitted to the psychiatric acute care unit because he
stood in the center of a main two-way street in his underwear and a
T-shirt, shouting, 'I am being held against my will. I have personal
rights.' Gerald was diagnosed with bipolar disorder, manic type.
Which of the following interventions will add to everyone's safety in
the acute care environment?
A. Have hectic surroundings.
B. Have consistent unit routines.
C. Minimize staff interventions.
D. Medicate the patient only if he has private health insurance.
B. Have consistent unit routines.
Reason: Quiet environments with consistent routines will help calm
patients and add to safety.
Your patient has just been physically cleaned up after slicing his
left arm 8 times. To show an appropriate evaluative response, which
of the following would be your best statement?
A. I could care less if you cut yourself. It doesn't hurt me.
B. If you wouldn't cut yourself, you would have a much happier life.
C. You are lucky someone found you in time. Now you can help us make
you better.
D. The behavior of cutting is not acceptable.
D. The behavior of cutting is not acceptable.
Reason: Focus on the behavior, not the person. Be neutral, but not
indifferent.
A 22-year-old female was admitted to the mental health unit with
major depression and suicidal ideation. She has a history of cutting
her wrists intermittently throughout the last 2 years. On days 1 and
2, the patient stays in her room and eats only 20% of her meals. On
day 3, she eats 80% of her meals and is talking to others in group.
The nurse should consider that the patient is
A. Showing improvement.
B. Highly suicidal.
C. Exhibiting mood swings.
D. In need of electroshock therapy.
A. Showing improvement.
Reason: The patient improvement is based on increased socialization
and increased appetite.
NCLEX Review Questions Set 1 GRADE
A+ SOLUTIONS
A 48-year-old Hispanic woman is seen by a psychiatric clinical nurse
specialist after receiving a call by her son. According to the son,
since his father's death 7 months ago, his mother has lost 30 pounds
and can't sleep. During her initial visit, the patient states, 'My
husband talks to me in his visits, but his words make no sense to me.
I don't understand what he wants me to do.' What is an appropriate
nursing diagnosis?
A. Ineffective denial.
B. Bipolar mood disorder.
C. Hyper-religiosity.
D. Grieving.
D. Grieving.
Reason: Grieving may be characterized by weight loss, sleep
disturbances, and messages from beyond.
Your neighbor's husband comes to talk to you. He says his wife has
not left the house in 2 weeks, has a flat mood, and has lost interest
in her usual activities. You recognize these as the primary symptoms
of
A. Depression.
B. Schizophrenia.
C. Suicidal ideation.
D. Bipolar manic episodes.
A. Depression.
Reason: Depressed mood and anhedonia (loss of interest or pleasure in
activities) are the primary symptoms of major depression.
Your patient is ready for discharge after a 30-day hospitalization
for manic depression. About 30 minutes before his discharge, his
roommate comes to you and says, 'He is talking crazy.' When you ask
your patient how he is feeling, he states, 'I feel like Superman. I
can do anything. I can fly home today and then become a U.S.
Senator.' Which type of mania-related symptoms is this patient
exhibiting?
A. Social.
,B. Cognitive.
C. Behavioral.
D. Perceptual.
B. Cognitive.
Reason: Cognitive symptoms include inflated self-esteem and
grandiosity.
You need to assess whether a patient who has a mood disorder is ready
for discharge. Which statement would indicate readiness for discharge?
A. Right now, I can't bathe myself or dress myself, but I feel good
about that.
B. Going home will be fun, but if it isn't fun, I can always make my
mother help me or tell her to do so. She better help me.
C. I will take my medicines as I should and know to call the number
you gave me if I have bad thoughts.
D. Taking care of myself is important, but it's okay if I don't want
to do anything.
C. I will take my medicines as I should and know to call the number
you gave me if I have bad thoughts.
Reason: Verbalization of a plan for help and demonstration of care
are realistic discharge criteria.
An angry patient is in the community room. She picks up a chair and
uses it to hit another patient on the head. When you come into the
community room, what should your first response to the patient
holding the chair be?
A. Are you crazy? Hitting people can hurt them!
B. Hitting others is unacceptable. Please put the chair completely
down on the floor.
C. How would you like it if I hit you over the head with a chair?
D. You're in big trouble now. It's probably prison you are looking at!
B. Hitting others is unacceptable. Please put the chair completely
down on the floor.
Reason: Use words to indicate your lack of acceptance of the
patient's behavior in a nonthreatening voice or tone.
A 22-year-old female is admitted to the unit following a suicide
attempt. She has a 2-week history of depression as well as a history
of abusing multiple substances and anorexia nervosa. What is your
first nursing priority?
A. Socialization.
B. Contracting for eating behavior.
C. Safety.
D. Administering the Beck depression scale.
, C. Safety.
Reason: Safety is the major principle underlying psychiatric nursing.
Gerald was admitted to the psychiatric acute care unit because he
stood in the center of a main two-way street in his underwear and a
T-shirt, shouting, 'I am being held against my will. I have personal
rights.' Gerald was diagnosed with bipolar disorder, manic type.
Which of the following interventions will add to everyone's safety in
the acute care environment?
A. Have hectic surroundings.
B. Have consistent unit routines.
C. Minimize staff interventions.
D. Medicate the patient only if he has private health insurance.
B. Have consistent unit routines.
Reason: Quiet environments with consistent routines will help calm
patients and add to safety.
Your patient has just been physically cleaned up after slicing his
left arm 8 times. To show an appropriate evaluative response, which
of the following would be your best statement?
A. I could care less if you cut yourself. It doesn't hurt me.
B. If you wouldn't cut yourself, you would have a much happier life.
C. You are lucky someone found you in time. Now you can help us make
you better.
D. The behavior of cutting is not acceptable.
D. The behavior of cutting is not acceptable.
Reason: Focus on the behavior, not the person. Be neutral, but not
indifferent.
A 22-year-old female was admitted to the mental health unit with
major depression and suicidal ideation. She has a history of cutting
her wrists intermittently throughout the last 2 years. On days 1 and
2, the patient stays in her room and eats only 20% of her meals. On
day 3, she eats 80% of her meals and is talking to others in group.
The nurse should consider that the patient is
A. Showing improvement.
B. Highly suicidal.
C. Exhibiting mood swings.
D. In need of electroshock therapy.
A. Showing improvement.
Reason: The patient improvement is based on increased socialization
and increased appetite.
