1. A client with schizophrenia is prescribed haloperidol (Haldol). The
nurse understands that the client needs to be monitored for which of
the following side effects?
A) Weight loss
B) Hypotension
C) Photosensitivity
D) Extrapyramidal symptoms (EPS)
Answer: D) Extrapyramidal symptoms (EPS)
Rationale:
Haloperidol is a typical antipsychotic medication, and one of its
common side effects is extrapyramidal symptoms (EPS), which include
tremors, rigidity, and tardive dyskinesia. These symptoms occur due to
the drug's dopamine-blocking action in the brain.
2. A client with depression is being started on fluoxetine (Prozac), a
selective serotonin reuptake inhibitor (SSRI). Which of the following
statements by the client indicates an understanding of the
medication?
A) "I can stop the medication as soon as I feel better."
B) "I should expect to feel better in a couple of days."
C) "It may take several weeks to start feeling better."
D) "I will stop drinking caffeine while on this medication."
Answer: C) "It may take several weeks to start feeling better."
Rationale:
SSRIs such as fluoxetine typically take 2-4 weeks to show therapeutic
effects. Clients should be educated that the medication may not provide
,immediate relief, and they should not stop the medication suddenly or
without consulting their healthcare provider.
3. A nurse is conducting a mental status examination on a client
diagnosed with major depressive disorder. Which of the following is
the best indicator of the client's mood?
A) “I feel sad and hopeless.”
B) “I have trouble concentrating at work.”
C) “I have trouble sleeping and have no appetite.”
D) “I feel like I don’t want to live anymore.”
Answer: A) “I feel sad and hopeless.”
Rationale:
The best indicator of mood is the client’s own description of how they
feel. In this case, the statement “I feel sad and hopeless” directly
describes the client’s mood, which is a hallmark symptom of
depression.
4. A nurse is working with a client diagnosed with bipolar disorder.
The client is in the manic phase of the illness. Which of the following
is the priority nursing intervention?
A) Offer the client a quiet environment to rest.
B) Provide frequent orientation to time, place, and person.
C) Set limits on excessive, intrusive behaviors.
D) Encourage the client to participate in group therapy.
Answer: C) Set limits on excessive, intrusive behaviors.
Rationale:
During a manic episode, clients may engage in impulsive, intrusive, and
,sometimes dangerous behaviors. The priority intervention is to set clear
limits to prevent harm and promote safety, while also maintaining a
calm, structured environment.
5. A nurse is caring for a client who is experiencing a panic attack.
Which of the following interventions is most appropriate during the
acute phase of a panic attack?
A) Encourage the client to lie down and rest.
B) Tell the client to focus on their breathing and use grounding
techniques.
C) Administer an antianxiety medication immediately.
D) Ask the client to describe the specific fear or anxiety they are
experiencing.
Answer: B) Tell the client to focus on their breathing and use
grounding techniques.
Rationale:
During a panic attack, the most effective intervention is to help the
client regulate their breathing and use grounding techniques to distract
them from overwhelming feelings. This can help reduce the intensity of
the panic attack and calm the client down.
6. A nurse is teaching a client with post-traumatic stress disorder
(PTSD) about the use of prazosin (Minipress). Which of the following
statements by the client indicates an understanding of the
medication?
A) “This medication will help me feel less anxious.”
B) “This medication will help me sleep better by reducing nightmares.”
, C) “This medication will reduce my muscle tension.”
D) “This medication will help me focus during the day.”
Answer: B) “This medication will help me sleep better by reducing
nightmares.”
Rationale:
Prazosin is an alpha-blocker that is sometimes used off-label to reduce
nightmares and improve sleep in clients with PTSD. It does not directly
treat anxiety, muscle tension, or focus, so option B is correct.
7. A nurse is caring for a client who is receiving electroconvulsive
therapy (ECT) for severe depression. Which of the following pre-
procedure nursing interventions is most important?
A) Administering a sedative medication to the client.
B) Ensuring the client is NPO for at least 8 hours.
C) Providing information about the procedure to the family.
D) Verifying that informed consent is signed.
Answer: D) Verifying that informed consent is signed.
Rationale:
Informed consent is a critical aspect of the ECT procedure. The client
must be fully informed of the risks, benefits, and alternatives to the
treatment before proceeding. While other interventions are also
important, obtaining informed consent is the priority.
8. A nurse is assessing a client who is diagnosed with anorexia
nervosa. The nurse understands that the primary characteristic of
anorexia nervosa is:
nurse understands that the client needs to be monitored for which of
the following side effects?
A) Weight loss
B) Hypotension
C) Photosensitivity
D) Extrapyramidal symptoms (EPS)
Answer: D) Extrapyramidal symptoms (EPS)
Rationale:
Haloperidol is a typical antipsychotic medication, and one of its
common side effects is extrapyramidal symptoms (EPS), which include
tremors, rigidity, and tardive dyskinesia. These symptoms occur due to
the drug's dopamine-blocking action in the brain.
2. A client with depression is being started on fluoxetine (Prozac), a
selective serotonin reuptake inhibitor (SSRI). Which of the following
statements by the client indicates an understanding of the
medication?
A) "I can stop the medication as soon as I feel better."
B) "I should expect to feel better in a couple of days."
C) "It may take several weeks to start feeling better."
D) "I will stop drinking caffeine while on this medication."
Answer: C) "It may take several weeks to start feeling better."
Rationale:
SSRIs such as fluoxetine typically take 2-4 weeks to show therapeutic
effects. Clients should be educated that the medication may not provide
,immediate relief, and they should not stop the medication suddenly or
without consulting their healthcare provider.
3. A nurse is conducting a mental status examination on a client
diagnosed with major depressive disorder. Which of the following is
the best indicator of the client's mood?
A) “I feel sad and hopeless.”
B) “I have trouble concentrating at work.”
C) “I have trouble sleeping and have no appetite.”
D) “I feel like I don’t want to live anymore.”
Answer: A) “I feel sad and hopeless.”
Rationale:
The best indicator of mood is the client’s own description of how they
feel. In this case, the statement “I feel sad and hopeless” directly
describes the client’s mood, which is a hallmark symptom of
depression.
4. A nurse is working with a client diagnosed with bipolar disorder.
The client is in the manic phase of the illness. Which of the following
is the priority nursing intervention?
A) Offer the client a quiet environment to rest.
B) Provide frequent orientation to time, place, and person.
C) Set limits on excessive, intrusive behaviors.
D) Encourage the client to participate in group therapy.
Answer: C) Set limits on excessive, intrusive behaviors.
Rationale:
During a manic episode, clients may engage in impulsive, intrusive, and
,sometimes dangerous behaviors. The priority intervention is to set clear
limits to prevent harm and promote safety, while also maintaining a
calm, structured environment.
5. A nurse is caring for a client who is experiencing a panic attack.
Which of the following interventions is most appropriate during the
acute phase of a panic attack?
A) Encourage the client to lie down and rest.
B) Tell the client to focus on their breathing and use grounding
techniques.
C) Administer an antianxiety medication immediately.
D) Ask the client to describe the specific fear or anxiety they are
experiencing.
Answer: B) Tell the client to focus on their breathing and use
grounding techniques.
Rationale:
During a panic attack, the most effective intervention is to help the
client regulate their breathing and use grounding techniques to distract
them from overwhelming feelings. This can help reduce the intensity of
the panic attack and calm the client down.
6. A nurse is teaching a client with post-traumatic stress disorder
(PTSD) about the use of prazosin (Minipress). Which of the following
statements by the client indicates an understanding of the
medication?
A) “This medication will help me feel less anxious.”
B) “This medication will help me sleep better by reducing nightmares.”
, C) “This medication will reduce my muscle tension.”
D) “This medication will help me focus during the day.”
Answer: B) “This medication will help me sleep better by reducing
nightmares.”
Rationale:
Prazosin is an alpha-blocker that is sometimes used off-label to reduce
nightmares and improve sleep in clients with PTSD. It does not directly
treat anxiety, muscle tension, or focus, so option B is correct.
7. A nurse is caring for a client who is receiving electroconvulsive
therapy (ECT) for severe depression. Which of the following pre-
procedure nursing interventions is most important?
A) Administering a sedative medication to the client.
B) Ensuring the client is NPO for at least 8 hours.
C) Providing information about the procedure to the family.
D) Verifying that informed consent is signed.
Answer: D) Verifying that informed consent is signed.
Rationale:
Informed consent is a critical aspect of the ECT procedure. The client
must be fully informed of the risks, benefits, and alternatives to the
treatment before proceeding. While other interventions are also
important, obtaining informed consent is the priority.
8. A nurse is assessing a client who is diagnosed with anorexia
nervosa. The nurse understands that the primary characteristic of
anorexia nervosa is:
