PSYCHIATRIC/MENTAL HEALTH NURSING
EXAM LATEST UPDATE QUESTIONS and
ANSWERS GRADED A+ WITH ASSURED
SUCCESS
A client who is on the third day of detoxification therapy becomes agitated and restless. What are the
signs and symptoms that indicate impending alcohol withdrawal delirium? (Select all that apply.) -
CORRECT ANSWER-Diaphoresis
Tachycardia
,Hypertension
A client is lonely and extremely depressed, and the health care provider prescribes a tricyclic
antidepressant. The client asks the nurse what the medication will do. What is the best response by the
nurse? - CORRECT ANSWER-"The medication will increase your appetite and make you feel better."
A client with a diagnosis of panic disorder who had a panic attack on the previous day says to the nurse,
"That was a terrible feeling I had yesterday. I'm so afraid to talk about it." What is the most therapeutic
response by the nurse? - CORRECT ANSWER-"What were you doing yesterday when you first noticed
the feeling?"
A client believes that doorknobs are contaminated and refuses to touch them except with a paper
tissue. What nursing intervention will be most therapeutic for this client? - CORRECT ANSWER-
Supplying the client with tissues to maintain function until the anxiety eases
A client in the mental health clinic has a phobia about closed spaces. Which desensitization method
should the nurse expect to be used successfully with this client? - CORRECT ANSWER-Imagery
What treatment should a nurse anticipate will be prescribed for a client with severe, persistent,
intractable depression and suicidal ideation? - CORRECT ANSWER-Electroconvulsive therapy
An older adult, accompanied by family members, is admitted to a long-term care facility with symptoms
of dementia. During the admission procedure the initial statement by the nurse most helpful to this
client is: - CORRECT ANSWER-"Don't be afraid. I'm your nurse, and everyone here in the hospital is
here to help you."
An older depressed person at an independent living facility constantly complains about her health
problems to anyone who will listen. One day the client says, "I'm not going to any more activities. All
these old crabby people do is talk about their problems." What defense mechanism does the nurse
conclude that the client is using? - CORRECT ANSWER-Projection
A client with alcohol dependence problem asks whether the nurse can see the bugs that are crawling on
the bed. What is the nurse's initial reply? - CORRECT ANSWER-"No, I don't see any bugs."
,A client is responding within an hour of receiving naloxone to combat respiratory depression from an
overdose of heroin. Why should a nurse continue to closely monitor this client's status? - CORRECT
ANSWER-Symptoms of the heroin overdose may return after the naloxone is metabolized.
A client tells the nurse, "The voices say I'll be safe only if I stay in this room, wear these clothes, and
avoid stepping on the cracks between the floor tiles." What is the best initial response by the nurse? -
CORRECT ANSWER-"I understand that these voices are real to you, but I want you to know that I don't
hear them."
A parent of a 17-year-old girl who has been hospitalized for extremely disturbed acting-out behavior
leaves a gift for the daughter but says, "I'm too busy to visit today." The daughter becomes upset and
tearful after being given the message and opening the package. What does the nurse conclude that the
parent's actions represent? - CORRECT ANSWER-Double-bind message
A client with schizophrenia is admitted to a psychiatric unit. The client is talking while walking in the hall,
is unkempt, and obviously has not washed in several days. What should the nurse say when trying to
help this client shower? - CORRECT ANSWER-"I'll help you take your shower now."
When a client is expressing severe anxiety by sobbing in the fetal position on her bed, the nurse's
priority is: - CORRECT ANSWER-Ensuring a safe therapeutic milieu
A nurse is caring for several clients who are going through withdrawal from alcohol. The primary reason
for the ingestion of alcohol by clients with a history of alcohol abuse is that they: - CORRECT ANSWER-
Are dependent on it
A nurse is caring for a client with the diagnosis of alcohol withdrawal delirium. Which action is most
appropriate for the nurse to implement? - CORRECT ANSWER-Assuring the client that the symptoms
are part of the withdrawal syndrome
A 30-year-old woman reports to the mental health clinic on the recommendation of her primary health
care provider. She has been unable to carry out everyday activities because of increased pain in her
lower back and legs. Numerous neurological and orthopedic workups indicate that her symptoms seem
excessive when compared with the physical problems shown on physical examination and repeated
MRIs and x-rays. She says that no one understands how difficult it has been to care for her 32-year-old
husband, who has an inoperable brain tumor and is undergoing chemotherapy. In light of the history
and symptoms, what disorder should the nurse suspect? - CORRECT ANSWER-Conversion
, A client is admitted to the hospital because of incapacitating obsessive-compulsive behavior. The
statement that best describes how clients with obsessive-compulsive behavior view this disorder is: -
CORRECT ANSWER-"I know there's no reason to do these things, but I can't help myself."
A client with schizophrenia is demonstrating waxy flexibility. Which intervention is the best way to
manage the possible outcome of this behavior? - CORRECT ANSWER-Passive range-of-motion
exercises three times a day for effective joint health
A client has been on the psychiatric unit for several days. The client arouses anxiety and frustration in
the staff and manipulates them so well that staff members are afraid to approach the client. One
morning the client shouts at the nurse, "You've worked it so I can't go for a walk with the group today.
You're as cunning as a fox. I hate you! Get out, or I'll hit you!" What is the best response by the nurse? -
CORRECT ANSWER-"I don't like hearing your threats, but tell me more about your feelings."
An adult client confides to a clinic nurse, "I fantasize about having sex with children, and I get the urge to
do it, too." What is the most appropriate response by the nurse? - CORRECT ANSWER-Asking the
client, "Have you ever acted on these thoughts?"
In her eighth month of pregnancy, a 24-year-old client is brought to the hospital by the police, who were
called when she barricaded herself in a ladies' restroom of a restaurant. During admission the client
shouts, "Don't come near me! My stomach is filled with bombs, and I'll blow up this place if anyone
comes near me." The nurse concludes that the client is exhibiting: - CORRECT ANSWER-Delusional
thinking
A man is admitted to the psychiatric unit after attempting suicide. The client's history reveals that his
first child died of sudden infant death syndrome 2 years ago, that he has been unable to work since the
death of the child, and that he has attempted suicide before. When talking with the nurse he says, "I
hear my son telling me to come over to the other side." What should the nurse conclude that the client
is experiencing? - CORRECT ANSWER-Command hallucination
A nurse recalls that language development in the autistic child resembles: - CORRECT ANSWER-
Echolalia
EXAM LATEST UPDATE QUESTIONS and
ANSWERS GRADED A+ WITH ASSURED
SUCCESS
A client who is on the third day of detoxification therapy becomes agitated and restless. What are the
signs and symptoms that indicate impending alcohol withdrawal delirium? (Select all that apply.) -
CORRECT ANSWER-Diaphoresis
Tachycardia
,Hypertension
A client is lonely and extremely depressed, and the health care provider prescribes a tricyclic
antidepressant. The client asks the nurse what the medication will do. What is the best response by the
nurse? - CORRECT ANSWER-"The medication will increase your appetite and make you feel better."
A client with a diagnosis of panic disorder who had a panic attack on the previous day says to the nurse,
"That was a terrible feeling I had yesterday. I'm so afraid to talk about it." What is the most therapeutic
response by the nurse? - CORRECT ANSWER-"What were you doing yesterday when you first noticed
the feeling?"
A client believes that doorknobs are contaminated and refuses to touch them except with a paper
tissue. What nursing intervention will be most therapeutic for this client? - CORRECT ANSWER-
Supplying the client with tissues to maintain function until the anxiety eases
A client in the mental health clinic has a phobia about closed spaces. Which desensitization method
should the nurse expect to be used successfully with this client? - CORRECT ANSWER-Imagery
What treatment should a nurse anticipate will be prescribed for a client with severe, persistent,
intractable depression and suicidal ideation? - CORRECT ANSWER-Electroconvulsive therapy
An older adult, accompanied by family members, is admitted to a long-term care facility with symptoms
of dementia. During the admission procedure the initial statement by the nurse most helpful to this
client is: - CORRECT ANSWER-"Don't be afraid. I'm your nurse, and everyone here in the hospital is
here to help you."
An older depressed person at an independent living facility constantly complains about her health
problems to anyone who will listen. One day the client says, "I'm not going to any more activities. All
these old crabby people do is talk about their problems." What defense mechanism does the nurse
conclude that the client is using? - CORRECT ANSWER-Projection
A client with alcohol dependence problem asks whether the nurse can see the bugs that are crawling on
the bed. What is the nurse's initial reply? - CORRECT ANSWER-"No, I don't see any bugs."
,A client is responding within an hour of receiving naloxone to combat respiratory depression from an
overdose of heroin. Why should a nurse continue to closely monitor this client's status? - CORRECT
ANSWER-Symptoms of the heroin overdose may return after the naloxone is metabolized.
A client tells the nurse, "The voices say I'll be safe only if I stay in this room, wear these clothes, and
avoid stepping on the cracks between the floor tiles." What is the best initial response by the nurse? -
CORRECT ANSWER-"I understand that these voices are real to you, but I want you to know that I don't
hear them."
A parent of a 17-year-old girl who has been hospitalized for extremely disturbed acting-out behavior
leaves a gift for the daughter but says, "I'm too busy to visit today." The daughter becomes upset and
tearful after being given the message and opening the package. What does the nurse conclude that the
parent's actions represent? - CORRECT ANSWER-Double-bind message
A client with schizophrenia is admitted to a psychiatric unit. The client is talking while walking in the hall,
is unkempt, and obviously has not washed in several days. What should the nurse say when trying to
help this client shower? - CORRECT ANSWER-"I'll help you take your shower now."
When a client is expressing severe anxiety by sobbing in the fetal position on her bed, the nurse's
priority is: - CORRECT ANSWER-Ensuring a safe therapeutic milieu
A nurse is caring for several clients who are going through withdrawal from alcohol. The primary reason
for the ingestion of alcohol by clients with a history of alcohol abuse is that they: - CORRECT ANSWER-
Are dependent on it
A nurse is caring for a client with the diagnosis of alcohol withdrawal delirium. Which action is most
appropriate for the nurse to implement? - CORRECT ANSWER-Assuring the client that the symptoms
are part of the withdrawal syndrome
A 30-year-old woman reports to the mental health clinic on the recommendation of her primary health
care provider. She has been unable to carry out everyday activities because of increased pain in her
lower back and legs. Numerous neurological and orthopedic workups indicate that her symptoms seem
excessive when compared with the physical problems shown on physical examination and repeated
MRIs and x-rays. She says that no one understands how difficult it has been to care for her 32-year-old
husband, who has an inoperable brain tumor and is undergoing chemotherapy. In light of the history
and symptoms, what disorder should the nurse suspect? - CORRECT ANSWER-Conversion
, A client is admitted to the hospital because of incapacitating obsessive-compulsive behavior. The
statement that best describes how clients with obsessive-compulsive behavior view this disorder is: -
CORRECT ANSWER-"I know there's no reason to do these things, but I can't help myself."
A client with schizophrenia is demonstrating waxy flexibility. Which intervention is the best way to
manage the possible outcome of this behavior? - CORRECT ANSWER-Passive range-of-motion
exercises three times a day for effective joint health
A client has been on the psychiatric unit for several days. The client arouses anxiety and frustration in
the staff and manipulates them so well that staff members are afraid to approach the client. One
morning the client shouts at the nurse, "You've worked it so I can't go for a walk with the group today.
You're as cunning as a fox. I hate you! Get out, or I'll hit you!" What is the best response by the nurse? -
CORRECT ANSWER-"I don't like hearing your threats, but tell me more about your feelings."
An adult client confides to a clinic nurse, "I fantasize about having sex with children, and I get the urge to
do it, too." What is the most appropriate response by the nurse? - CORRECT ANSWER-Asking the
client, "Have you ever acted on these thoughts?"
In her eighth month of pregnancy, a 24-year-old client is brought to the hospital by the police, who were
called when she barricaded herself in a ladies' restroom of a restaurant. During admission the client
shouts, "Don't come near me! My stomach is filled with bombs, and I'll blow up this place if anyone
comes near me." The nurse concludes that the client is exhibiting: - CORRECT ANSWER-Delusional
thinking
A man is admitted to the psychiatric unit after attempting suicide. The client's history reveals that his
first child died of sudden infant death syndrome 2 years ago, that he has been unable to work since the
death of the child, and that he has attempted suicide before. When talking with the nurse he says, "I
hear my son telling me to come over to the other side." What should the nurse conclude that the client
is experiencing? - CORRECT ANSWER-Command hallucination
A nurse recalls that language development in the autistic child resembles: - CORRECT ANSWER-
Echolalia
