NSG 526 Exam 3 – Advanced Psychiatric Mental Health Nursing
1.
A PMHNP evaluates a 34-year-old client who reports persistent sadness, loss of interest in hobbies,
insomnia, fatigue, impaired concentration, and feelings of worthlessness for the past five weeks. Which
diagnosis is most consistent with these findings?
A. Persistent depressive disorder
B. Bipolar II disorder
C. Major depressive disorder
D. Cyclothymic disorder
Answer: C
Rationale: Major depressive disorder requires five or more depressive symptoms, including depressed
mood or anhedonia, present for at least two weeks and causing functional impairment.
2.
During a Mental Status Examination, which assessment best evaluates abstract reasoning?
A. Asking the client to repeat three unrelated words immediately
B. Determining orientation to person, place, time, and situation
C. Asking the client to explain the meaning of the proverb, "A stitch in time saves nine."
D. Having the client perform serial sevens
Answer: C
Rationale: Interpreting proverbs assesses abstract thinking, whereas serial sevens assess attention and
concentration.
3.
A client taking lithium reports worsening nausea, coarse hand tremors, confusion, and difficulty walking.
What is the PMHNP's priority action?
A. Reassure the client these are expected effects.
B. Encourage increased caffeine intake.
C. Increase the lithium dosage.
D. Hold the medication, obtain a serum lithium level, and notify the healthcare provider immediately.
Answer: D
Rationale: These findings suggest lithium toxicity and require immediate evaluation.
, 4.
Which therapeutic communication response is most appropriate when a client states, "No one
understands what I'm going through"?
A. "Everything will get better."
B. "You shouldn't feel that way."
C. "Tell me more about what this experience has been like for you."
D. "I know exactly how you feel."
Answer: C
Rationale: Open-ended responses encourage expression and strengthen the therapeutic relationship.
5.
A client diagnosed with schizophrenia hears voices commanding them to harm themselves. What is the
nurse's highest priority?
A. Discuss medication side effects.
B. Complete discharge paperwork.
C. Assess the client's immediate safety and implement suicide precautions while notifying the
treatment team.
D. Encourage participation in group therapy.
Answer: C
Rationale: Command hallucinations involving self-harm require immediate safety assessment and
intervention.
6.
Which neurotransmitter is most strongly associated with the positive symptoms of schizophrenia?
A. Serotonin
B. GABA
C. Acetylcholine
D. Dopamine
Answer: D
1.
A PMHNP evaluates a 34-year-old client who reports persistent sadness, loss of interest in hobbies,
insomnia, fatigue, impaired concentration, and feelings of worthlessness for the past five weeks. Which
diagnosis is most consistent with these findings?
A. Persistent depressive disorder
B. Bipolar II disorder
C. Major depressive disorder
D. Cyclothymic disorder
Answer: C
Rationale: Major depressive disorder requires five or more depressive symptoms, including depressed
mood or anhedonia, present for at least two weeks and causing functional impairment.
2.
During a Mental Status Examination, which assessment best evaluates abstract reasoning?
A. Asking the client to repeat three unrelated words immediately
B. Determining orientation to person, place, time, and situation
C. Asking the client to explain the meaning of the proverb, "A stitch in time saves nine."
D. Having the client perform serial sevens
Answer: C
Rationale: Interpreting proverbs assesses abstract thinking, whereas serial sevens assess attention and
concentration.
3.
A client taking lithium reports worsening nausea, coarse hand tremors, confusion, and difficulty walking.
What is the PMHNP's priority action?
A. Reassure the client these are expected effects.
B. Encourage increased caffeine intake.
C. Increase the lithium dosage.
D. Hold the medication, obtain a serum lithium level, and notify the healthcare provider immediately.
Answer: D
Rationale: These findings suggest lithium toxicity and require immediate evaluation.
, 4.
Which therapeutic communication response is most appropriate when a client states, "No one
understands what I'm going through"?
A. "Everything will get better."
B. "You shouldn't feel that way."
C. "Tell me more about what this experience has been like for you."
D. "I know exactly how you feel."
Answer: C
Rationale: Open-ended responses encourage expression and strengthen the therapeutic relationship.
5.
A client diagnosed with schizophrenia hears voices commanding them to harm themselves. What is the
nurse's highest priority?
A. Discuss medication side effects.
B. Complete discharge paperwork.
C. Assess the client's immediate safety and implement suicide precautions while notifying the
treatment team.
D. Encourage participation in group therapy.
Answer: C
Rationale: Command hallucinations involving self-harm require immediate safety assessment and
intervention.
6.
Which neurotransmitter is most strongly associated with the positive symptoms of schizophrenia?
A. Serotonin
B. GABA
C. Acetylcholine
D. Dopamine
Answer: D
