ESSENTIALS OF PSYCHIATRIC NURSING,
3RD EDITION
MARY ANN BOYD; REBECCA LUEBBERT
TEST BANK
1 — Chapter & Subtopic: Chapter 1 — Foundations of
Psychiatric Nursing, Therapeutic Relationship
Type: Clinical scenario
Stem: A 28-year-old man with panic disorder arrives for an
outpatient appointment visibly shaking and stating, “I can't
breathe.” As the nurse begins an initial therapeutic interaction,
which response best demonstrates therapeutic communication
to reduce acute panic?
Options:
A. “Calm down — you’re safe here; take deep breaths.”
B. “Tell me what you mean by ‘can't breathe’; describe your
symptoms.”
C. “I can stay with you and we’ll breathe together slowly.”
D. “You need medication; let me call the doctor.”
Correct Answer: C
Rationale — Correct: C models the therapeutic relationship by
,offering presence and a concrete, anxiety-reducing intervention
(coached breathing), which helps the patient regain control.
(Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 1:
Therapeutic Relationship).
Rationales — Incorrect:
A. Directive “Calm down” is minimising and can increase
distress; it’s not collaborative.
B. Asking for a description is assessment-focused but may be
overwhelming during an acute panic attack.
D. Automatically escalating to medication ignores immediate
supportive interventions and shared decision making.
NCLEX/HESI applicability: Demonstrates therapeutic
communication and safety in psychiatric emergencies
(Psychosocial Integrity; Safety).
Teaching Point: Presence + guided breathing calms acute panic.
2 — Chapter & Subtopic: Chapter 2 — Psychiatric Assessment &
Diagnostic Reasoning, Mental Status Exam
Type: Application
Stem: During a mental status exam, the nurse notes a patient’s
speech is rapid, pressured, and the patient jumps between
topics with loose associations. Which diagnostic consideration is
most consistent with these findings?
Options:
A. Major depressive disorder with psychotic features
B. Manic episode associated with bipolar disorder
,C. Generalized anxiety disorder
D. Schizophrenia, residual phase
Correct Answer: B
Rationale — Correct: Pressured, rapid speech and flight of
ideas/loose associations are classic signs of mania; these
findings support consideration of a manic episode. (Essentials of
Psychiatric Nursing, 3rd Ed. — Chapter 2: Mental Status Exam).
DSM-5-TR (2022) criteria support mania features.
Rationales — Incorrect:
A. Depression with psychosis more commonly has slowed
speech and negative mood, not pressured speech.
C. GAD may cause worry and restlessness but not pressured
speech and flight of ideas.
D. Schizophrenia’s residual phase typically has blunted affect
and disorganized thinking but the described acute pressured
speech fits mania better.
NCLEX/HESI applicability: Links psychiatric assessment findings
to diagnostic reasoning (Psychosocial Integrity; Clinical
Judgment).
Teaching Point: Pressured speech + flight of ideas suggests
mania.
3 — Chapter & Subtopic: Chapter 3 — Psychopharmacology,
Antidepressants & Monitoring
Type: Conceptual recall
Stem: A nurse teaches a patient prescribed an SSRI about
, expected time to therapeutic effect. What is the most accurate
teaching point?
Options:
A. “You should feel full relief within 24–48 hours.”
B. “Improvement may begin in 1–2 weeks, with full effect in 4–6
weeks.”
C. “If you don’t feel better in 3 days, stop the medicine.”
D. “SSRIs usually take at least 6 months before any benefit is
seen.”
Correct Answer: B
Rationale — Correct: SSRIs often show early improvement in 1–
2 weeks with maximal therapeutic effect by 4–6 weeks; patients
should be counselled about this timeline. (Essentials of
Psychiatric Nursing, 3rd Ed. — Chapter 3: Antidepressant
Monitoring). APA practice guidelines (most recent) agree.
Rationales — Incorrect:
A. 24–48 hours is too short for full relief.
C. Stopping after 3 days risks withdrawal and nonadherence.
D. Six months is longer than typical onset of antidepressant
effect; maintenance duration differs from onset.
NCLEX/HESI applicability: Pharmacologic education and
adherence counselling (Physiological Integrity —
Pharmacological Therapies).
Teaching Point: Antidepressants take weeks—set realistic
expectations.
3RD EDITION
MARY ANN BOYD; REBECCA LUEBBERT
TEST BANK
1 — Chapter & Subtopic: Chapter 1 — Foundations of
Psychiatric Nursing, Therapeutic Relationship
Type: Clinical scenario
Stem: A 28-year-old man with panic disorder arrives for an
outpatient appointment visibly shaking and stating, “I can't
breathe.” As the nurse begins an initial therapeutic interaction,
which response best demonstrates therapeutic communication
to reduce acute panic?
Options:
A. “Calm down — you’re safe here; take deep breaths.”
B. “Tell me what you mean by ‘can't breathe’; describe your
symptoms.”
C. “I can stay with you and we’ll breathe together slowly.”
D. “You need medication; let me call the doctor.”
Correct Answer: C
Rationale — Correct: C models the therapeutic relationship by
,offering presence and a concrete, anxiety-reducing intervention
(coached breathing), which helps the patient regain control.
(Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 1:
Therapeutic Relationship).
Rationales — Incorrect:
A. Directive “Calm down” is minimising and can increase
distress; it’s not collaborative.
B. Asking for a description is assessment-focused but may be
overwhelming during an acute panic attack.
D. Automatically escalating to medication ignores immediate
supportive interventions and shared decision making.
NCLEX/HESI applicability: Demonstrates therapeutic
communication and safety in psychiatric emergencies
(Psychosocial Integrity; Safety).
Teaching Point: Presence + guided breathing calms acute panic.
2 — Chapter & Subtopic: Chapter 2 — Psychiatric Assessment &
Diagnostic Reasoning, Mental Status Exam
Type: Application
Stem: During a mental status exam, the nurse notes a patient’s
speech is rapid, pressured, and the patient jumps between
topics with loose associations. Which diagnostic consideration is
most consistent with these findings?
Options:
A. Major depressive disorder with psychotic features
B. Manic episode associated with bipolar disorder
,C. Generalized anxiety disorder
D. Schizophrenia, residual phase
Correct Answer: B
Rationale — Correct: Pressured, rapid speech and flight of
ideas/loose associations are classic signs of mania; these
findings support consideration of a manic episode. (Essentials of
Psychiatric Nursing, 3rd Ed. — Chapter 2: Mental Status Exam).
DSM-5-TR (2022) criteria support mania features.
Rationales — Incorrect:
A. Depression with psychosis more commonly has slowed
speech and negative mood, not pressured speech.
C. GAD may cause worry and restlessness but not pressured
speech and flight of ideas.
D. Schizophrenia’s residual phase typically has blunted affect
and disorganized thinking but the described acute pressured
speech fits mania better.
NCLEX/HESI applicability: Links psychiatric assessment findings
to diagnostic reasoning (Psychosocial Integrity; Clinical
Judgment).
Teaching Point: Pressured speech + flight of ideas suggests
mania.
3 — Chapter & Subtopic: Chapter 3 — Psychopharmacology,
Antidepressants & Monitoring
Type: Conceptual recall
Stem: A nurse teaches a patient prescribed an SSRI about
, expected time to therapeutic effect. What is the most accurate
teaching point?
Options:
A. “You should feel full relief within 24–48 hours.”
B. “Improvement may begin in 1–2 weeks, with full effect in 4–6
weeks.”
C. “If you don’t feel better in 3 days, stop the medicine.”
D. “SSRIs usually take at least 6 months before any benefit is
seen.”
Correct Answer: B
Rationale — Correct: SSRIs often show early improvement in 1–
2 weeks with maximal therapeutic effect by 4–6 weeks; patients
should be counselled about this timeline. (Essentials of
Psychiatric Nursing, 3rd Ed. — Chapter 3: Antidepressant
Monitoring). APA practice guidelines (most recent) agree.
Rationales — Incorrect:
A. 24–48 hours is too short for full relief.
C. Stopping after 3 days risks withdrawal and nonadherence.
D. Six months is longer than typical onset of antidepressant
effect; maintenance duration differs from onset.
NCLEX/HESI applicability: Pharmacologic education and
adherence counselling (Physiological Integrity —
Pharmacological Therapies).
Teaching Point: Antidepressants take weeks—set realistic
expectations.
