ANSWERS HIGHLITED REVISED FOR 2025/2026
1. A nurse is planning overall strategies to address problems for a client who has borderline
personality disorder. Which of the following strategies is the priority for the nurse to incorporate in
the plan of care?
a. discuss the appropriate use of assertive behavior with the client
b. encourage the client to attend weekly support group meetings
c. assist the client to maintain awareness of her thoughts and feelings
d. implement measures to prevent intentional self-inflicted injury
- Ans: d - implement measures to prevent intentional self-inflicted injury
2. A nurse is admitting a client who has generalized anxiety disorder. Which of the following actions
should the nurse plan to take first?
a. Provide the client with a quiet environment
b. Determine how the client handles stress.
c. Teach the client to use guided imagery.
d. Ask the client to identify her strengths
- Ans: b - Determine how the client handles stress.
3. A nurse is conducting an admission interview with a client who is experiencing mania. Which of the
following should the nurse report to the provider?
a. States that he hasn't bathed in 2 days
b. Reports eating twice in the past two weeks.
c. Makes inappropriate sexual comments.
d. Speaks in rhyming sentences.
- Ans: c - Makes inappropriate sexual comments.
4. A nurse is planning care for a client who has obsessive-compulsive disorder. Which of the following
recommendation should the nurse include in the clients plan of care?
, a. Validation therapy
b. Thought stopping
c. Operant conditioning
d. Reality orientation therapy
- Ans: b - Thought stopping
5. A nurse is caring for a client who has bipolar disorder and is experiencing a manic episode. Which of
the following actions should the nurse take?
a. Encourage the client to join group activities
b. Dim the lights in the clients room
c. Provide detailed explanations to the client
d. Administer methylphenidate
- Ans: b - Dim the lights in the clients room
6. A nurse is leading a crisis intervention group for adolescents who witnessed the suicide of a
classmate. Which of the following actions should the nurse take first?
a. Initiate referrals
b. Review community resources
c. Identify prior coping skills
d. Discuss the importance of confidentiality
- Ans: c - Identify prior coping skills
7. A nurse overhears a client saying "I am a spy, a spy for the FBI. I am an I, an eye for an eye in the
sky. Sky is up high." The nurse should document the clients statement as which of the following
speech alterations?
a. Echolalia
b. Word salad
c. Neologism
d. Clang association
- Ans: d - Clang association