NCLEX Mental Health Challenge Exam |
Psychiatric Nursing Questions and
Verified Answers
1. 1. Question
Flumazenil (Romazicon) has been ordered for a male client who has overdosed
on oxazepam (Serax). Before administering the medication, nurse Gina should be
prepared for which common adverse effect?
A. Seizures
B. Shivering
C. Anxiety
D. Chest pain
Correct Answer: A. Seizures
Seizures are the most common serious adverse effect of using flumazenil to
reverse benzodiazepine overdose. The effect is magnified if the client has a
combined tricyclic antidepressant and benzodiazepine overdose. Benzodiazepine
reversal has correlations with seizures. Seizures may happen more frequently in
patients who have been on benzodiazepines for long-term sedation or in patients
who are showing signs of severe tricyclic antidepressant overdose. The required
dosage of Flumazenil should be measured and prepared by the practitioners to
manage seizures. Flumazenil use requires caution in patients relying on a
benzodiazepine for seizure control.
Administration of benzodiazepines or barbiturates may be necessary for
seizure control.
2. 2. Question
Nurse Tamara is caring for a client diagnosed with bulimia. The most
appropriate initial goal for a client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
Page 1 of 60
, C. Identify anxiety-causing situations.
D. Eat only three meals per day.
Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to stress and
underlying issues. The client must identify anxiety-causing situations that
stimulate the bulimic behavior and then learn new ways of coping with the
anxiety. Bulimia nervosa is a condition that occurs most commonly in adolescent
females, characterized by indulgence in binge-eating, and inappropriate
compensatory behaviors to prevent weight gain.
3. 3. Question
A female client who’s at high risk for suicide needs close supervision. To best
ensure the client’s safety, Nurse Mary should:
A. Check the client frequently at irregular intervals throughout the night.
B. Assure the client that the nurse will hold in confidence anything the client
says.
C. Repeatedly discuss previous suicide attempts with the client.
D. Disregard decreased communication by the client because this is common
with suicidal clients.
Correct Answer: A. Check the client frequently at irregular intervals
throughout the night
Checking the client frequently but at irregular intervals prevents the client from
predicting when observation will take place and altering behavior in a misleading
way at these times. Once the patient is deemed to be at risk for suicide, then
intervention steps must be initiated right away. The individual must not be left
alone. Enlist the help of a support person while at home. The suicidal individual
must be treated in a safe and secure place. In addition, the place has to be
monitored.
4. 4. Question
Which of the following drugs should Nurse Mary prepare to administer to a client
with a toxic acetaminophen (Tylenol) level?
A. Deferoxamine mesylate (Desferal)
Page 2 of 60
, B. Succimer (Chemet)
C. Flumazenil (Romazicon)
D. Acetylcysteine (Mucomyst)
Correct
Correct
Correct Answer: D. Acetylcysteine (Mucomyst)
The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion
of toxic metabolites to nontoxic metabolites. Acetaminophen (N-acetyl-para-
aminophenol, paracetamol, APAP) toxicity is common primarily because the
medication is so readily available, and there is a perception that it is very safe.
More than 60 million Americans consume acetaminophen on a weekly basis. All
patients with high levels of acetaminophen need admission and treatment with
N-acetyl-cysteine (NAC). This agent is fully protective against liver toxicity if given
within 8 hours after ingestion.
5. 5. Question
A male client is admitted to the substance abuse unit for alcohol detoxification.
Which of the following medications is Nurse Alice most likely to administer to
reduce the symptoms of alcohol withdrawal?
A. Naloxone (Narcan)
B. Haloperidol (Haldol)
C. Magnesium sulfate
D. Chlordiazepoxide (Librium)
Correct
Correct
Correct Answer: D. Chlordiazepoxide (Librium)
Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of
alcohol withdrawal. Chlordiazepoxide is a long-acting benzodiazepine and is an
FDA approved medication for adults with mild-moderate to severe anxiety
disorder, preoperative apprehension and anxiety, and withdrawal symptoms of
acute alcohol use disorder. Chlordiazepoxide has anti-anxiety, sedative, appetite-
stimulating, and weak analgesic actions. It binds to benzodiazepine receptors at
Page 3 of 60
, the GABA-A ligand-gated chloride channel complex and enhances GABA’s
inhibitory effects.
antagonist with a high affinity for the mu-opioid receptor, allowing for reversal
of the effects of opioids. The onset of action varies depending on the route of
administration but can be as fast as one minute when delivered intravenously
(IV) or intraosseous (IO).
6. 6. Question
During postprandial monitoring, a female client with bulimia nervosa tells the
nurse, “You can sit with me, but you’re just wasting your time. After you had sat
with me yesterday, I was still able to purge. Today, my goal is to do it twice.”
What is the nurse’s best response?
A. “I trust you not to purge.”
B. “How are you purging and when do you do it?”
C. “Don’t worry. I won’t allow you to purge today.”
D. “I know it’s important for you to feel in control, but I’ll monitor you for 90
minutes after you eat.”
Correct
Correct
Correct Answer: D. “I know it’s important for you to feel in control, but I’ll
monitor you for 90 minutes after you eat.”
This response acknowledges that the client is testing limits and that the nurse is
setting them by performing postprandial monitoring to prevent self-induced
emesis. Clients with bulimia nervosa need to feel in control of the diet because
they feel they lack control over all other aspects of their lives. Since recovery
involves patients having to face their deepest, most painful, and traumatic
thoughts and emotions, supporting them as they go through treatment can be
emotionally challenging for nurses. This emotional challenge can be exacerbated
when the patient has also been diagnosed with Obsessive-Compulsive Disorder
(OCD), depression, or substance abuse, as these may require more intensive one-
to-one support.
Option A: Because their therapeutic relationships with caregivers are less
important than their need to purge, they don’t fear betraying the nurse’s trust
by engaging in the activity. They commonly plot to purge and rarely share
Page 4 of 60
Psychiatric Nursing Questions and
Verified Answers
1. 1. Question
Flumazenil (Romazicon) has been ordered for a male client who has overdosed
on oxazepam (Serax). Before administering the medication, nurse Gina should be
prepared for which common adverse effect?
A. Seizures
B. Shivering
C. Anxiety
D. Chest pain
Correct Answer: A. Seizures
Seizures are the most common serious adverse effect of using flumazenil to
reverse benzodiazepine overdose. The effect is magnified if the client has a
combined tricyclic antidepressant and benzodiazepine overdose. Benzodiazepine
reversal has correlations with seizures. Seizures may happen more frequently in
patients who have been on benzodiazepines for long-term sedation or in patients
who are showing signs of severe tricyclic antidepressant overdose. The required
dosage of Flumazenil should be measured and prepared by the practitioners to
manage seizures. Flumazenil use requires caution in patients relying on a
benzodiazepine for seizure control.
Administration of benzodiazepines or barbiturates may be necessary for
seizure control.
2. 2. Question
Nurse Tamara is caring for a client diagnosed with bulimia. The most
appropriate initial goal for a client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
Page 1 of 60
, C. Identify anxiety-causing situations.
D. Eat only three meals per day.
Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to stress and
underlying issues. The client must identify anxiety-causing situations that
stimulate the bulimic behavior and then learn new ways of coping with the
anxiety. Bulimia nervosa is a condition that occurs most commonly in adolescent
females, characterized by indulgence in binge-eating, and inappropriate
compensatory behaviors to prevent weight gain.
3. 3. Question
A female client who’s at high risk for suicide needs close supervision. To best
ensure the client’s safety, Nurse Mary should:
A. Check the client frequently at irregular intervals throughout the night.
B. Assure the client that the nurse will hold in confidence anything the client
says.
C. Repeatedly discuss previous suicide attempts with the client.
D. Disregard decreased communication by the client because this is common
with suicidal clients.
Correct Answer: A. Check the client frequently at irregular intervals
throughout the night
Checking the client frequently but at irregular intervals prevents the client from
predicting when observation will take place and altering behavior in a misleading
way at these times. Once the patient is deemed to be at risk for suicide, then
intervention steps must be initiated right away. The individual must not be left
alone. Enlist the help of a support person while at home. The suicidal individual
must be treated in a safe and secure place. In addition, the place has to be
monitored.
4. 4. Question
Which of the following drugs should Nurse Mary prepare to administer to a client
with a toxic acetaminophen (Tylenol) level?
A. Deferoxamine mesylate (Desferal)
Page 2 of 60
, B. Succimer (Chemet)
C. Flumazenil (Romazicon)
D. Acetylcysteine (Mucomyst)
Correct
Correct
Correct Answer: D. Acetylcysteine (Mucomyst)
The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion
of toxic metabolites to nontoxic metabolites. Acetaminophen (N-acetyl-para-
aminophenol, paracetamol, APAP) toxicity is common primarily because the
medication is so readily available, and there is a perception that it is very safe.
More than 60 million Americans consume acetaminophen on a weekly basis. All
patients with high levels of acetaminophen need admission and treatment with
N-acetyl-cysteine (NAC). This agent is fully protective against liver toxicity if given
within 8 hours after ingestion.
5. 5. Question
A male client is admitted to the substance abuse unit for alcohol detoxification.
Which of the following medications is Nurse Alice most likely to administer to
reduce the symptoms of alcohol withdrawal?
A. Naloxone (Narcan)
B. Haloperidol (Haldol)
C. Magnesium sulfate
D. Chlordiazepoxide (Librium)
Correct
Correct
Correct Answer: D. Chlordiazepoxide (Librium)
Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of
alcohol withdrawal. Chlordiazepoxide is a long-acting benzodiazepine and is an
FDA approved medication for adults with mild-moderate to severe anxiety
disorder, preoperative apprehension and anxiety, and withdrawal symptoms of
acute alcohol use disorder. Chlordiazepoxide has anti-anxiety, sedative, appetite-
stimulating, and weak analgesic actions. It binds to benzodiazepine receptors at
Page 3 of 60
, the GABA-A ligand-gated chloride channel complex and enhances GABA’s
inhibitory effects.
antagonist with a high affinity for the mu-opioid receptor, allowing for reversal
of the effects of opioids. The onset of action varies depending on the route of
administration but can be as fast as one minute when delivered intravenously
(IV) or intraosseous (IO).
6. 6. Question
During postprandial monitoring, a female client with bulimia nervosa tells the
nurse, “You can sit with me, but you’re just wasting your time. After you had sat
with me yesterday, I was still able to purge. Today, my goal is to do it twice.”
What is the nurse’s best response?
A. “I trust you not to purge.”
B. “How are you purging and when do you do it?”
C. “Don’t worry. I won’t allow you to purge today.”
D. “I know it’s important for you to feel in control, but I’ll monitor you for 90
minutes after you eat.”
Correct
Correct
Correct Answer: D. “I know it’s important for you to feel in control, but I’ll
monitor you for 90 minutes after you eat.”
This response acknowledges that the client is testing limits and that the nurse is
setting them by performing postprandial monitoring to prevent self-induced
emesis. Clients with bulimia nervosa need to feel in control of the diet because
they feel they lack control over all other aspects of their lives. Since recovery
involves patients having to face their deepest, most painful, and traumatic
thoughts and emotions, supporting them as they go through treatment can be
emotionally challenging for nurses. This emotional challenge can be exacerbated
when the patient has also been diagnosed with Obsessive-Compulsive Disorder
(OCD), depression, or substance abuse, as these may require more intensive one-
to-one support.
Option A: Because their therapeutic relationships with caregivers are less
important than their need to purge, they don’t fear betraying the nurse’s trust
by engaging in the activity. They commonly plot to purge and rarely share
Page 4 of 60
