NCLEX COMPREHENSIVE MENTAL HEALTH AND PSYCHIATRIC
NURSING EXAM 2024: 75 QUESTIONS WITH 100% CORRECT
ANSWERS AND RATIONALES. TOP PRIORITY QUESTIONS (VERIFIED)
A psychotic client reports to the evening nurse that the day nurse put somethingsuspicious
in his water with his medication. The nurse replies, “You’re worried about your
medication?” The nurse’s communication is:
o A. An example of presenting reality
o B. Reinforcing the client’s delusions
o C. Focusing on emotional content
o D. A non-therapeutic technique called mind-reading
Incorrect
Correct Answer: C. Focusing on emotional content
The nurse should help the client focus on the emotional content rather than delusional
material. Sometimes during a conversation, patients mention something particularly
important. When this happens, nurses can focus on their statement, prompting patients to
discuss it further. Patients don’t always have anobjective perspective on what is relevant
to their case; as impartial observers, nurses can more easily pick out the topics to focus on.
• Option A: Presenting reality isn’t helpful because it can lead to confrontation
and disengagement. It’s frequently useful for nurses to summarize what patients
have said after the fact. This demonstrates to patients that the nurse was
listening and allows the nurse to document conversations. Ending a summary
with a phrase like “Does that sound correct?” gives patients explicit permission
to make corrections if they’renecessary.
• Option B: Agreeing with the client and supporting his beliefs are reinforcing
delusions. Patients often ask nurses for advice about what theyshould do about
particular problems or in specific situations. Nurses can ask patients what they
think they should do, which encourages patients tobe accountable for their own
actions and helps them come up with solutions themselves.
• Option D: Mind reading isn’t therapeutic. Similar to active listening, askingpatients
for clarification when they say something confusing or ambiguous
, is important. Saying something like “I’m not sure I understand. Can you
explain it to me?” helps nurses ensure they understand what’s actually
being said and can help patients process their ideas more thoroughly
1. 2. Question
A client is admitted to the inpatient unit of the mental health center with a diagnosis
of paranoid schizophrenia. He’s shouting that the government ofFrance is trying to
assassinate him. Which of the following responses
is most appropriate?
• A. “I think you’re wrong. France is a friendly country and an ally of the UnitedStates.
Their government wouldn’t try to kill you.”
• B. “I find it hard to believe that a foreign government or anyone else istrying to
hurt you. You must feel frightened by this.”
• C. “You’re wrong. Nobody is trying to kill you.”
• D. “A foreign government is trying to kill you? Please tell me more about it.”
Incorrect
Correct Answer: B. “I find it hard to believe that a foreign government or
anyone else is trying to hurt you. You must feel frightened by this.”
Responses should focus on reality while acknowledging the client’s feelings.
Sometimes during a conversation, patients mention something particularly
important. When this happens, nurses can focus on their statement, prompting
patients to discuss it further. Patients don’t always have an objective perspective
on what is relevant to their case; as impartial observers, nurses can more easily
pick out the topics to focus on.
• Option A: Arguing with the client or denying his belief isn’t therapeutic. By
using nonverbal and verbal cues such as nodding and saying “I see,” nurses
can encourage patients to continue talking. Active listening involves
showing interest in what patients have to say, acknowledging that you’re
listening and understanding, and engaging with them throughout the
conversation. Nurses can offer general leads such as “What happened
next?” to guide the conversation or propel it forward.
, • Option C: Arguing can also inhibit development of a trusting relationship.
Continuing to talk about delusions may aggravate the psychosis. It’s
frequently useful for nurses to summarize what patients have said after the
fact. This demonstrates to patients that the nurse was listening and allows
the nurse to document conversations. Ending a summary with a phrase like
“Does that sound correct?” gives patients explicit permission to make
corrections if they’re necessary.
• Option D: Asking the client if a foreign government is trying to kill him
may increase his anxiety level and can reinforce his delusions. Voicing
doubt can be a gentler way to call attention to the incorrect or delusional
2. 3. Question
A client receiving haloperidol (Haldol) complains of a stiff jaw and difficultyswallowing.
The nurse’s first action is to:
• A. Reassure the client and administer as needed lorazepam (Ativan) I.M.
• B. Administer as needed dose of benztropine (Cogentin) I.M. as ordered.
• C. Administer as needed dose of benztropine (Cogentin) by mouth as
ordered.
• D. Administer as needed dose of haloperidol (Haldol) by mouth.
Incorrect
Correct Answer: B. Administer as needed dose of benztropine (Cogentin)
I.M. as ordered.
The client is most likely suffering from muscle rigidity due to haloperidol. I.M.
benztropine should be administered to prevent asphyxia or aspiration. The
extrapyramidal symptoms are muscular weakness or rigidity, a generalized or
localized tremor that may be characterized by the akinetic or agitation types of
movements, respectively. Haloperidol overdose is also associated with ECG
changes known as torsade de pointes, which may cause arrhythmia or cardiac
arrest.
• Option A: Lorazepam treats anxiety, not extrapyramidal effects. Lorazepam
is a benzodiazepine medication developed by DJ Richards. It went on the
market in the United States in 1977. Lorazepam has common use as the
, sedative and anxiolytic of choice in the inpatient setting owing to its fast (1to 3
minute) onset of action when administered intravenously. Lorazepam is also one of
the few sedative-hypnotics with a relatively clean side effect profile. Lorazepam is
FDA approved for short-term (4 months) relief of anxiety symptoms related to
anxiety disorders, anxiety-associated insomnia, anesthesia premedication in adults
to relieve anxiety, or to produce sedation/amnesia, and treatment of status
epilepticus.
• Option C: Benztropine belongs to the synthetic class of muscarinic receptor
antagonists (anticholinergic drugs). Thus, it has a structure similar to that of
diphenhydramine and atropine. However, it is long-acting so thatits administration
can be with less frequency than diphenhydramine. It also induces less CNS
stimulation effect compared to that of trihexyphenidyl, making it a preferable
drug of choice for geriatric patients.
• Option D: Another dose of haloperidol would increase the severity of the
reaction. Since there is no specific antidote, supportive treatment is the mainstay
of haloperidol toxicity. If a patient develops signs and symptomsof toxicities, the
clinician should consider gastric lavage or induction of emesis as soon as possible,
followed by the administration of activated charcoal. Maintenance of Airway,
Breathing, and circulation are the most important factors for survival.
3. 4. Question
The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The
client appears to be listening to someone who isn’t visible. Hegestures, shouts angrily, and stops
shouting in mid-sentence. Which nursing intervention is the most appropriate?
• A. Approach the client and touch him to get his attention.
• B. Encourage the client to go to his room where he’ll experience fewer
distractions.
• C. Acknowledge that the client is hearing voices but make it clear thatthe nurse
doesn’t hear these voices.
• D. Ask the client to describe what the voices are saying.
NURSING EXAM 2024: 75 QUESTIONS WITH 100% CORRECT
ANSWERS AND RATIONALES. TOP PRIORITY QUESTIONS (VERIFIED)
A psychotic client reports to the evening nurse that the day nurse put somethingsuspicious
in his water with his medication. The nurse replies, “You’re worried about your
medication?” The nurse’s communication is:
o A. An example of presenting reality
o B. Reinforcing the client’s delusions
o C. Focusing on emotional content
o D. A non-therapeutic technique called mind-reading
Incorrect
Correct Answer: C. Focusing on emotional content
The nurse should help the client focus on the emotional content rather than delusional
material. Sometimes during a conversation, patients mention something particularly
important. When this happens, nurses can focus on their statement, prompting patients to
discuss it further. Patients don’t always have anobjective perspective on what is relevant
to their case; as impartial observers, nurses can more easily pick out the topics to focus on.
• Option A: Presenting reality isn’t helpful because it can lead to confrontation
and disengagement. It’s frequently useful for nurses to summarize what patients
have said after the fact. This demonstrates to patients that the nurse was
listening and allows the nurse to document conversations. Ending a summary
with a phrase like “Does that sound correct?” gives patients explicit permission
to make corrections if they’renecessary.
• Option B: Agreeing with the client and supporting his beliefs are reinforcing
delusions. Patients often ask nurses for advice about what theyshould do about
particular problems or in specific situations. Nurses can ask patients what they
think they should do, which encourages patients tobe accountable for their own
actions and helps them come up with solutions themselves.
• Option D: Mind reading isn’t therapeutic. Similar to active listening, askingpatients
for clarification when they say something confusing or ambiguous
, is important. Saying something like “I’m not sure I understand. Can you
explain it to me?” helps nurses ensure they understand what’s actually
being said and can help patients process their ideas more thoroughly
1. 2. Question
A client is admitted to the inpatient unit of the mental health center with a diagnosis
of paranoid schizophrenia. He’s shouting that the government ofFrance is trying to
assassinate him. Which of the following responses
is most appropriate?
• A. “I think you’re wrong. France is a friendly country and an ally of the UnitedStates.
Their government wouldn’t try to kill you.”
• B. “I find it hard to believe that a foreign government or anyone else istrying to
hurt you. You must feel frightened by this.”
• C. “You’re wrong. Nobody is trying to kill you.”
• D. “A foreign government is trying to kill you? Please tell me more about it.”
Incorrect
Correct Answer: B. “I find it hard to believe that a foreign government or
anyone else is trying to hurt you. You must feel frightened by this.”
Responses should focus on reality while acknowledging the client’s feelings.
Sometimes during a conversation, patients mention something particularly
important. When this happens, nurses can focus on their statement, prompting
patients to discuss it further. Patients don’t always have an objective perspective
on what is relevant to their case; as impartial observers, nurses can more easily
pick out the topics to focus on.
• Option A: Arguing with the client or denying his belief isn’t therapeutic. By
using nonverbal and verbal cues such as nodding and saying “I see,” nurses
can encourage patients to continue talking. Active listening involves
showing interest in what patients have to say, acknowledging that you’re
listening and understanding, and engaging with them throughout the
conversation. Nurses can offer general leads such as “What happened
next?” to guide the conversation or propel it forward.
, • Option C: Arguing can also inhibit development of a trusting relationship.
Continuing to talk about delusions may aggravate the psychosis. It’s
frequently useful for nurses to summarize what patients have said after the
fact. This demonstrates to patients that the nurse was listening and allows
the nurse to document conversations. Ending a summary with a phrase like
“Does that sound correct?” gives patients explicit permission to make
corrections if they’re necessary.
• Option D: Asking the client if a foreign government is trying to kill him
may increase his anxiety level and can reinforce his delusions. Voicing
doubt can be a gentler way to call attention to the incorrect or delusional
2. 3. Question
A client receiving haloperidol (Haldol) complains of a stiff jaw and difficultyswallowing.
The nurse’s first action is to:
• A. Reassure the client and administer as needed lorazepam (Ativan) I.M.
• B. Administer as needed dose of benztropine (Cogentin) I.M. as ordered.
• C. Administer as needed dose of benztropine (Cogentin) by mouth as
ordered.
• D. Administer as needed dose of haloperidol (Haldol) by mouth.
Incorrect
Correct Answer: B. Administer as needed dose of benztropine (Cogentin)
I.M. as ordered.
The client is most likely suffering from muscle rigidity due to haloperidol. I.M.
benztropine should be administered to prevent asphyxia or aspiration. The
extrapyramidal symptoms are muscular weakness or rigidity, a generalized or
localized tremor that may be characterized by the akinetic or agitation types of
movements, respectively. Haloperidol overdose is also associated with ECG
changes known as torsade de pointes, which may cause arrhythmia or cardiac
arrest.
• Option A: Lorazepam treats anxiety, not extrapyramidal effects. Lorazepam
is a benzodiazepine medication developed by DJ Richards. It went on the
market in the United States in 1977. Lorazepam has common use as the
, sedative and anxiolytic of choice in the inpatient setting owing to its fast (1to 3
minute) onset of action when administered intravenously. Lorazepam is also one of
the few sedative-hypnotics with a relatively clean side effect profile. Lorazepam is
FDA approved for short-term (4 months) relief of anxiety symptoms related to
anxiety disorders, anxiety-associated insomnia, anesthesia premedication in adults
to relieve anxiety, or to produce sedation/amnesia, and treatment of status
epilepticus.
• Option C: Benztropine belongs to the synthetic class of muscarinic receptor
antagonists (anticholinergic drugs). Thus, it has a structure similar to that of
diphenhydramine and atropine. However, it is long-acting so thatits administration
can be with less frequency than diphenhydramine. It also induces less CNS
stimulation effect compared to that of trihexyphenidyl, making it a preferable
drug of choice for geriatric patients.
• Option D: Another dose of haloperidol would increase the severity of the
reaction. Since there is no specific antidote, supportive treatment is the mainstay
of haloperidol toxicity. If a patient develops signs and symptomsof toxicities, the
clinician should consider gastric lavage or induction of emesis as soon as possible,
followed by the administration of activated charcoal. Maintenance of Airway,
Breathing, and circulation are the most important factors for survival.
3. 4. Question
The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The
client appears to be listening to someone who isn’t visible. Hegestures, shouts angrily, and stops
shouting in mid-sentence. Which nursing intervention is the most appropriate?
• A. Approach the client and touch him to get his attention.
• B. Encourage the client to go to his room where he’ll experience fewer
distractions.
• C. Acknowledge that the client is hearing voices but make it clear thatthe nurse
doesn’t hear these voices.
• D. Ask the client to describe what the voices are saying.
