This applies to questions 1,2 & 3.

During his intake interview, Mark, age 25, described his behavior as: “I
have to change my clothes 20 times before work and chew each bite I eat 24 times. I have to go up and
down the stairs before it feels right”

1. The nurse counsels the family not to prevent or call attention to Mark’s compulsive acts. The rationale
for this is, Preventing or attending to compulsive acts may increase the client’s:

The correct answer is: Anxiety

2. A recurring thought that cannot be dismissed from consciousness is a/an:

The correct answer is: Obsession

3. The objective of doing relaxation techniques is for the client to:

The correct answer is: Gain increased sense of control of himself

4. Mikasa, 35 years old, single and unemployed was diagnosed as undifferentiated schizophrenia. She is
appeared disheveled, wearing torn, dirty clothing, and had a foul body odor. She experienced
hallucinations and claimed that the voices would tell her to “jump from a window”. The nursing
diagnosis related to Mikasa’s hallucination is:

The correct answer is: Potential for self-inflicted injury

5. Which of these nursing responses is therapeutic for patient Mikasa?

The correct answer is: “It must be frightening for you to be hearing those voices. Tell me more about
them.”

6. Eren, 24 years old, single and unemployed was diagnosed as having a borderline personality disorder.
Upon assessment Eren appears melancholic, with numerous blade scars in his radial area, and has
verbalized problems coping from his recent termination at work. Nurse Armin ensures that the
therapeutic communication and relationship must be observed in dealing with Eren because most
borderline patients uses _____________ as defense mechanism?

The correct answer is: Splitting

7. Which statement made by the nurse during a therapy session demonstrates a need for further
instruction regarding effective therapeutic communication techniques?

The correct answer is: “Why did you get so angry when she ignored you?”

8. The nurse assigned to care for the client with a diagnosis of histrionic personality disorder expects to
observe which characteristics and behaviours.

The correct answer is: Likes to be the center of attention, exaggerated emotional expression, little
tolerance for frustration

9. The nurse assigned to care for the client with a diagnosis of anti-social personality disorder expects to
observe which characteristics and behaviours?

The correct answer is: Tries to intimidate others, manipulative, lacks empathy, break rules

10. Patient Arthur, a 35-year-old standup comedian, comes to the clinic after having a fever, dyspnea
and cough. After a thorough assessment and diagnostic tests it has been ruled out that he has
pneumonia. Arthur claimed that the reason for his cough was frequent aspiration. Later, it was observed
that Arthur can’t control his outburst of laughing and crying eventually causing him to choke. The nurse
knows that the affect depicted by the patient is _____?

The correct answer is: Pseudobulbar Affect

11. A client states, “I just don’t know what to do about the situation with my parents,” and the nurse
replies, “I’m sure you will do the right thing.” Which summary is true regarding the nurse’s response?

The correct answer is: The response devalues the client’s feelings and gives false reassurance

12. A client who is diagnosed with breast cancer asks the nurse, “Am I going to die?” Which statement
by the nurse promotes a therapeutic relationship?

The correct answer is: “People with cancer experience fear of dying; tell me about your concerns.”
13. A client is newly admitted to the mental unit with a diagnosis of schizophrenia with persecutory
delusions. Which nursing interventions should the nurse include in the client’s care plan with regard to
the delusional thinking?

The correct answer is: Focus on reality and verbally reinforce it

14. A client recently diagnosed with schizophrenia is hospitalized. The client appears distraught and says
to the nurse, “The voices are bad today...they are so angry with me.” Which of the following is the best
response by the nurse?

The correct answer is: “What are the voices saying to you?”

15. A young client is diagnosed with major depressive disorder. Three weeks prior, the client’s fiancé
broke off their engagement, claiming the client was “too fat and ugly.” During a one-on-one interaction
with the nurse, the client says, “My fiancé is really wonderful and is not to blame for calling off the
engagement. I look awful and I’m not much good for anything.” What is the best response by the nurse?

The correct answer is: “Tell me how you felt when your fiancé broke up with you?”

16. Which client best demonstrates recovery associated with a mental illness?

The correct answer is: One who lives, works, and is involved with family and friends to the highest level
of ability

17. Which client statement demonstrates mental health well-being when considering stress and
anxiety?

The correct answer is: “You should identify and then avoid those things that cause you stress and
anxiety.”

18. Which of the following disorder is associated with maladaption during the Infancy Stage, according
to Sigmund Freud?

The correct answer is: Narcissistic

19. Which of the following disorder is not associated with maladaption during the Infancy Stage,
according to Sigmund Freud?

The correct answer is: Antisocial

20. The person who coined the term Schizophrenia?

The correct answer is: Bleuler

21. The first to introduced the first theory of personality development was?

The correct answer is: Sullivan

22. A client who is diagnosed with breast cancer asks the nurse, “Am I going to die?” Which statement
by the nurse promotes a therapeutic relationship?

The correct answer is: “People with cancer experience fear of dying; tell me about your concerns.”

23. A client recently admitted to an inpatient unit for treatment of alcoholism says to the nurse, “I only
came here to get away from my nagging spouse. Sometime I think my spouse is the one who should be
here. I can stop drinking anytime I want.” The nurse recognizes that the client is exhibiting which of the
following defense mechanisms?

The correct answer is: Denial and projection

24. An elderly client at the end of life is visited by family members. One begins to cry and asks the nurse,
“Will you please stay for a few minutes?” The nurse has other clients to care for as well. Which
statement by the nurse is the most helpful?

The correct answer is: “I can stay and sit with you if you would like.”

25. A client with schizophrenia says to the nurse, “The world turns as the world turns on a ball at the
beach. But all the world’s a stagecoach and I took the bus home.” The nurse recognizes this statement
as an example of which of the following? The correct answer is: Loose associations
1. Positive symptoms associated with schizophrenia include delusions and hallucinations. Which of the
following is an example of a delusion?

The correct answer is: The client claims that the FBI is following him.

2. . During morning assessments, the nurse finds that a client who has been taking chlorpromazine
(Thorazine) has signs of dystonia and torticollis. The nurse should give priority to:

The correct answer is: Administering prescribed anti-Parkinson medication

3. A male client on the psychiatric unit becomes upset and breaks a chair when a visitor does not show
up. The first nursing intervention should be:

The correct answer is: Set limits and restrict the client’s behavior

4. A client has the diagnosis of cognitive disorder – Wernicke’s Encephalopathy disease. The client is
constantly making up stories that are untrue. This characteristic of the disease is called:

The correct answer is: Confabulation

5. A 20-year-old male client is admitted to the psychiatric unit with a diagnosis of schizophrenia, acute
episode. He is having auditory hallucinations and seems disoriented to time and place. The nurse knows
that a hallucination can be explained as a(n):

The correct answer is: Sensory experience without foundation in reality

6. The nurse is caring for a 75-year-old widow admitted to the psychiatric hospital by her daughter, who
became concerned when her mother began to talk in a confused manner about her husband who has
been dead for seven years. In the hospital, especially at night, the client wanders into the other clients’
rooms looking for her husband. What is the most appropriate action for the nurse to take when this
woman wanders into the rooms of the other clients?

The correct answer is: Take her by the hand and guide her back to her room

7. Three days after admission for treatment of Valium addiction, a young woman briefly left the hospital
to talk to a visitor. Her psychiatrist has threatened to discharge her for noncompliance with the
treatment program. The client seems very despondent, refusing to get out of bed. The evening nurse
finds the client crying, “I’ve screwed everything up. It’s hopeless. It’s no use.” In responding to the client,
which of the following would be most appropriate?

The correct answers are: “You sound like you’re feeling very sad, Are you thinking about harming
yourself?”

8. The morning after admission for withdrawal from alcohol, a client is restless, tremulous, and
somewhat agitated. The nurse should take which of these actions at this time?

The correct answer is: Observe her behavior closely

9. While a client is taking chlorpromazine (Thorazine), he should be observed for which of these
symptoms?

The correct answer is: Pseudoparkinsonism

10. A 23-year-old premedical student is admitted to a psychiatric hospital in a withdrawn, catatonic

state. For two days prior to admission, she remained in one position without moving or speaking. On the
unit, she continues to exhibit waxy flexibility as she sits all day. What is the first priority for the nurse
during the initial phase of hospitalization?

The correct answer is: Watch for edema and cyanosis of the extremities

11. Which drug is use for Aversion Therapy?

The correct answer is: Antabuse

12. A woman has been having auditory hallucinations. When the nurse approaches her, she whispers,
“Did you hear that terrible man? He is scary!” Which would be the best response for the nurse to take
initially?

The correct answer is: “I didn’t hear a man’s voice, but you look scared.”
13. A young woman who is fearful of getting into elevators is admitted. Two days after admission, she is
scheduled for group therapy sessions that meet on the sixth floor. Her room is on the second floor. The
other clients and the nurse go to the sixth floor on the elevator. The client starts trembling and refuses
to get on the elevator. Which action is most therapeutic for the nurse to take?

The correct answer is: Assign someone to walk up the stairs with her

14. It is a behavior therapy developed by the psychiatrist Joseph Wolpe, used when a phobia or anxiety
disorder is maintained by gradual exposure to the source.

The correct answer is: Desensitization

15. A 40-year-old man is admitted to the psychiatric unit for treatment of anxiety neurosis. For several
weeks, he has had increasingly frequent periods of palpitations, sweating, chest pain, and choking. His
nursing diagnosis is “severe anxiety, stressor unidentified.” Which of these measures is appropriate
during the client’s attacks?

The correct answer is: Supporting and protecting him

16. A young man who is admitted with antisocial behavior seeks the attention of a young, attractive
nurse, and he finds many excuses to involve the nurse in conversation. The nurse should have which of
these understandings of this situation?

The correct answer is: The nurse is responsible for maintaining a therapeutic relationship with him.

17. A client says to the nurse, “I have something to tell you because I know you can keep a secret.” To
respond to his statement, the nurse should make which of these remarks?

The correct answer is: “I cannot promise that I can keep your secret.”

18. A nurse is caring for a client with phobia who is being treated for the condition. The client is
introduced to short periods of exposure to the phobic object while in relaxed state. The nurse
understands that this form of behaviour modification can be best described as:

The correct answer is: Systematic desensitization

19. The nurse is providing information to a client with the use of disulfiram (antabuse) for the treatment
of alcohol abuse. The nurse understands that this form of therapy works on what principle?

The correct answer is: Aversion Therapy

20. The nurse confirms that Dennis is manifesting auditory hallucination. The appropriate nursing
diagnosis she identifies is;

The correct answer is: Sensory perceptual alteration

21. The nursing management of anxiety related with post-traumatic stress disorder includes all of the
following EXCEPT:

The correct answer is: Reassure client’s safety while touching client

22. It is the act of touching or rubbing one’s genitals up against non-consenting person in a sexual
manner.

The correct answer is: Frotteurism

23. It is an paraphilia in which a patient gains sexual arousal by dressing in a manner opposite to sex?

The correct answer is: Transvetism

24. It is a sexual paraphilia characterized by getting an arousal by watching unsuspecting person who is
disrobing, naked or having sex?

The correct answer is: Voyeurism

25. Cecilia is persistently feeling restless, worried and feeling as if something dreadful is going to
happen. She fears being alone in places and situations where she thinks that no one might come to
rescue her just in case something happens to her. Cecilia is demonstrating:

The correct answer is: agoraphobia

1. In working with a client in crisis, the nurse recognizes that there are four balancing factors that
determine if an individual will enter a crisis state. Which of the following is a balancing factor?

The correct answer is: How the person perceives the event.

2. The nurse working with a client using crisis intervention understands that crisis intervention is
different from traditional Freudian therapy in that crisis intervention focuses on?

The correct answer is: An immediate problem as perceived by the client.

3. When caring for a client in crisis the nurse assists the client in asking for help from others by role
modeling because clients in crisis?

The correct answer is: Often are overwhelmed, feel isolated, and may be unable to ask help on their
own.

4. A 50-year-old client comes to the outpatient crisis unit after several people in his family have been
involved in an auto accident. He is somewhat disorganized, anxious, and jumps from one subject to the
next. The nurse uses which of the following as the most effective approach?

The correct answer is: Assists the client to focus on the problem, providing direction for him to identify
the problem and immediate alternatives.

5. A 23-year-old client whose life partner died recently from complications of AIDS has just found out
that he is HIV-positive. He has been referred to the outpatient crisis unit from his doctor’s office because
he “shut down” after finding out his HIV status. The nurse meets with the client, provides comfort
measures, and begins the assessment. An immediate priority is to evaluate if the client?

The correct answer is: Is at risk for self-directed violence.

6. A young client in his 20s frequently engages in high-risk behaviors including driving his car at excessive
speeds, drinking excessively, and engaging in high-risk sexual behaviors. The nurse assessing this client
suspects that?

The correct answer is: He may be experiencing unconscious suicidal ideations.

7. The nursing staff of the psychiatric inpatient unit maintains a safe milieu by monitoring the
whereabouts of clients at all times. A client with suicidal ideations and feeling unable to contract for his
or her own safety is considered at high risk for self-directed violence. The nursing staff must be prepared
to implement?

The correct answer is: Constant observation.

8. A 52-year-old client who was admitted to the hospital 5 days ago with major depression and suicidal
ideation is now preparing for discharge. Which of the following statements by the client demonstrates
she has met one of her outcome/evaluation measure? “When I go home:

The correct answer is: I have a list of people that I can call if I start to feel poorly.”

9. When working with a depressed client with suicidal ideation, the nurse understands that the client
may be overwhelmed by personal problems. Keeping this in mind, the nurse assists the client in coping
by?

The correct answer is: Encouraging the client to make a list of problems from most urgent to least
urgent.

10. In teaching the family of a client with suicidal ideations how to help care for the person at home, the
nurse includes which of the following priority interventions with the family?

The correct answer is: Inform the family about warning signs the client may exhibit that indicate the
client may be struggling and to eliminate guns and other weapons from the home.

11. The nurse should plan to do which of the following in order for a client to have the greatest benefit
from treatment on an acute inpatient psychiatric unit?

The correct answer is: With the client, establish and implement a plan of care and evaluate outcomes.
12. The nurse knows that the client attended group therapy from 10:30 A.M. to 11:30 A.M. At 11:45
A.M., the client says, “I am not going to eat lunch; I am going to take a nap.” The nurse’s best response
would be to?

The correct answer is: Ask the client to sit for a few minutes to discuss this.

13. The nurse is conducting discharge teaching for a client taking tranylcypromine (Parnate). The nurse
determines that the client understands the instructions given if the client refrains from eating which of
the following favorite foods?

The correct answer is: Salami

14. A client is admitted to a secure psychiatric inpatient unit for the treatment of bipolar I disorder. The
nurse begins the intake assessment but the client stands up and begins to walk around the room and
shouts, “You can’t do this to me! Do you know whom I am?” The best action of the nurse at this time
focuses on?

The correct answer is: Providing self and client with a safe environment.

15. The nurse observes that a depressed client visited the coffee shop this afternoon and sat at a table
with two other clients on the unit. The best feedback the nurse can give to the client would be?

The correct answer is: “It is good to see you sitting in the coffee shop with others this afternoon”

16. Before an anxious client begins treatment with benzodiazepines it is most important to assess the
client’s?

The correct answer is: Use of alcohol or other central nervous system depressant agents.

17. A physician has just told a client that surgery will be required to treat a health problem. After the
physician leaves, the client reports feeling angry, tense, and shaky. The nurse notes that the client’s
palms are sweaty and the pupils are dilated. The nurse should assess the client’s stage of anxiety as?

The correct answer is: Alarm

18. The nursing assessment indicates a client is experiencing a panic attack. The client is unable to
understand directions and is preoccupied with thoughts of danger. Which of the following would be the
most appropriate nursing diagnosis?

The correct answer is: Altered thought processes.

19. Which of the following would be the most appropriate goal for a client who has been diagnosed as
having generalized anxiety disorder?

The correct answer is: The client will display the ability to cope with milk anxiety.

20. A client who has receiving an anxiolytic medication is reluctant to participate in group therapy. The
client states, “The pills I am taking will take care of my stress. I don’t need to talk about my problems.”
In response to the client’s statement the nurse should explain that?

The correct answer is: Medications relieve symptoms, but do not change the source of the anxiety.

21. A client state, “I am always late for everything because I can’t leave my house without checking
every door and window to make sure it is locked. If I don’t make sure everything is locked I get so
worried and I have to go back home. I can’t seem to stop my behavior.” The nurse should encourage this
client to?

The correct answer is: Adjust the personal schedule to allow time for the ritual.

22. The most appropriate nursing action for a client experiencing a panic attack is to?

The correct answer is: Allow the client to determine the amount of stress that can be tolerate

23. Which of the following is the most appropriate nursing diagnosis for a client with pain disorder who
is homebound and unable to work for the past 5 years?

The correct answer is: Impaired role performance.

24. A client who developed a glove anesthesia of the right (dominant) hand was unable to play in the
piano competition yesterday. The consequence of the symptom, not having to perform, is best
described as?

The correct answer is: Primary gain

25. Which of the following would be an outcome criterion for a client with body dysmorphic disorder,
who is preoccupied with the size of her ears?

The correct answer is: Client will explore possible explanations for dissatisfaction with body image.

26. A female with a 15-year history of somatization disorder is to be discharged from her first psychiatric
hospitalization. Which statement would indicate that nursing care has been effective?

The correct answer is: “I see now that when I get stressed, my body speaks for me.”

27. A client treated for hypochondriasis has an upsetting phone conversation with her husband and
subsequently requests an analgesic. “My head is killing me, and I know there is a tumor in there
somewhere or it wouldn’t hurt like this.” The nurse’s best response is?

The correct answer is: “I’ll get your medication and then let’s talk about what just happened.”

28. While taking the nursing history, a client with body dysmorphic disorder complains that his jaw line
“still isn’t right” after three surgeries. He adds that it took five surgeons to finally fix his nose. The most
appropriate nursing diagnosis is:

The correct answer is: Body image disturbance.

29. A client with pain disorder is likely to reveal in the nursing history?

The correct answer is: Pain originated after physical trauma.

30. A client is assessed as having bilateral stocking anesthesia. The most important goal of care is that
the client will?

The correct answer is: Explore how his life is affected by being unable to walk.

31. The nurse working with a client who has a dissociative disorder understands that this disorder is
likely to begin as a?

The correct answer is: Protective defense against anxiety.

32. A priority nursing intervention for a person recently admitted to an inpatient unit with a dissociative
disorder is?

The correct answer is: Creation of a calm, safe environment.

33. The nurse assessing a client with dissociative identity disorder (DID) is most likely to note?

The correct answer is: History of headaches.

34. A client with DID is admitted after an overdose of alcohol and benzodiazepines, claiming that
another alter “did it.” The priority nursing diagnosis is?

The correct answer is: Risk for self-directed violence.

35. A client is brought to the emergency after a brutal physical assault. Although oriented and coherent,
she cannot remember the assault or events surrounding it. The priority intervention is to provide?

The correct answer is: Physical comfort and safety.

36.The nurse would look for which of the following characteristics that reflect the attitude toward
treatment of most individuals diagnosed with personality disorders? These individuals usually?

The correct answer is: Avoid treatment related to the tendency to externalize the cause of problems in
living.

37.Which nursing outcome would indicate that a client with a nursing diagnosis of Risk for self-
mutilation due to feelings of abandonment related to the ending of a close relationship has improved?

The correct answer is: Client verbalizes fear of abandonment in a realistic way.
38.During your interaction with a client diagnosed with antisocial personality disorder, the client keeps
asking where you live, whom you date, and other personal information. The client states the reason for
this is, “I just want to get to know you better. You’re the only one I can really talk to.” The most effective
nursing response is?

The correct answer is: “Let’s talk about my purpose in working with you and your feelings about it.”

39.A client comes in for her psychiatric appointment wearing a cocktail dress and theatrical makeup. She
announces dramatically and flirtatiously that she needs to be seen immediately as she is experiencing
overwhelming psychological distress. The most likely axis II diagnosis would be?

The correct answer is: Histrionic personality disorder.

40. A client diagnosed with antisocial personality disorder tells Nurse A, “You’re a much better nurse
than Nurse B said you were.” The client then tells Nurse B, “Nurse A is upset with you for some reason.”
To Nurse C, the client states, “I think you’re great, but Nurse A sad she saw you make three mistakes this
morning.” This interaction can best be described as an attempt to?

The correct answer is: Manipulate the staff.

41. While talking with a client diagnosed with schizophrenia, you notice the client loses eye contact with
you and starts staring at the wall. The client is making facial grimaces. The most appropriate nursing
intervention would be to?

The correct answer is: Ask the client directly, “What are you seeing on the wall?”

42. A client taking antipsychotic medications for treatment of schizophrenia complains to the nurse of
feeling nervous. The nurse notices that the client is pacing the long hallway and is unable to remain still
even when other clients are talking with him. This client is most likely experiencing?

The correct answer is: Akathisia

43. A client is exhibiting symptoms that are characteristic of schizophrenia, but is also exhibiting manic
behaviors. The client’s most likely diagnosis is?

The correct answer is: Schizoaffective disorder.

44. A male client on the unit has a diagnosis of paranoid-type schizophrenia. The new mental health care
worker on this unit approaches the nurse and asks about the best way to work with this client. the nurse
replies?

The correct answer is: “Avoid touching this client and invading personal space.”

45. What nursing diagnosis is most likely to be associated with a client diagnosed as having
schizophrenia, residual type?

The correct answer is: Social isolation.

46.What nursing diagnosis is most likely to be associated with a client diagnosed as having
schizophrenia, disorganized type?

The correct answer is: Impaired verbal communication.

47.Which of the following statements is correct in regards to the Abnormal and Involuntary Movement
Scale (AIMS)?

The correct answer is: A rating on the AIMS of zero indicates absence of abnormal involuntary
movements.

48. The nurse instructs the client about addiction. The nurse determines that the client understands the
instructions given when the client says?

The correct answer is: “Addiction is a medical illness.”

49. A client says he takes a drink every morning to calm his nerves and stop his tremors. The nurse
realizes that the client is at risk for?

The correct answer is: Physical dependence.

50. A young female presents for her school checkup. She denies any medical problems or taking any
medications, but she does acknowledge daily laxative use. As the school nurse, what other symptoms or
problems would you expect to find?

The correct answer is: Abnormal eating patterns.

1. A female client who’s at high risk for suicide needs close supervision. To best ensure the client’s
safety, Nurse Mary should:

The correct answer is: Check the client frequently at irregular intervals throughout the night

2. 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?

The correct answer is: Chlordiazepoxide (Librium)

3. A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, “It
felt so wonderful to get high.” Which of the following is the most appropriate response?

The correct answer is: “You told me you got fired from your last job for missing too many days after
taking drugs all night.”

4. Nurse Mary is assigned to care for a suicidal client. Initially, which is the nurse’s highest care priority?

The correct answer is: Exploring the nurse’s own feelings about suicide

5. Nurse Alice is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram
(Antabuse), the nurse teaches the client that he must read labels carefully on which of the following
products?

The correct answer is: Aftershave lotion

6. Nurse Taylor is aware that the victims of domestic violence should be assessed for what important
information?

The correct answer is: Readiness to leave the perpetrator and knowledge of resources

7. A male adult client voluntarily admits himself to the substance abuse unit. He confesses that he drinks
one (1) qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to
show signs of alcohol withdrawal. What are some early signs of this condition?

The correct answer is: Diaphoresis, tremors, and nervousness

8. When monitoring a female client recently admitted for treatment of cocaine addiction, nurse Aaron
notes sudden increases in the arterial blood pressure and heart rate. To correct these problems, the
nurse expects the physician to prescribe:

The correct answer is: Nifedipine and Esmolol

9. Kevin is remanded by the courts for psychiatric treatment. His police record, which dates to his early
teenage years, includes delinquency, running away, auto theft, and vandalism. He dropped out of school
at age 16 and has been living on his own since then. His history suggests maladaptive coping, which is
associated with:

The correct answer is: Antisocial personality disorder

10. A patient with a diagnosis of major depression who has attempted suicide says to the nurse, “I
should have died! I’ve always been a failure. Nothing ever goes right for me.” Which response
demonstrates therapeutic communication?

The correct answer is: “You’ve been feeling like a failure for a while?”

11. When the community health nurse visits a patient at home, the patient states, “I haven’t slept the
last couple of nights.” Which response by the nurse illustrates a therapeutic communication response to
this patient?

The correct answer is: “You’re having difficulty sleeping?”

12. A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the
locked exit door shouting. “Let me out. There’s nothing wrong with me. I don’t belong here.” What
defense mechanism is the patient implementing?

The correct answer is: Denial

13. On review of the patient’s record, the nurse notes the admission was voluntary. Based on this
information, the nurse anticipates which patient behavior?

The correct answer is: A willingness to participate in the planning of the care and treatment plan.

14. A patient admitted voluntarily for the treatment of an anxiety disorder demands to be released from
the hospital. Which action should the nurse take INITIALLY?

The correct answer is: Contact the patient’s health care provider (HCP).

15. When reviewing the admission assessment, the nurse notes that a patient was admitted to the
mental health unit involuntarily. Based on this type of admission, the nurse should provide which
intervention for this patient?

The correct answer is: Monitor closely for harm to self or others.

16. In planning activities for the depressed client, especially during the early stages of hospitalization,
which of the following plans is best?

The correct answer is: Provide a structured daily program of activities and encourage the client to
participate.

17. The depressed client verbalizes feelings of low self-esteem and self-worth typified by statements
such as “I’m such a failure… I can’t do anything right!” The best nursing response would be:

The correct answer is: To identify recent behaviors or accomplishments that demonstrates skill ability.

18. The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. The
symptom presented by the client that requires the nurse’s immediate intervention is the client’s:

The correct answer is: Nonstop physical activity and poor nutritional intake

SITUATION: Petra is a middle aged woman who has gone through a very bad divorce. She is extremely
depressed, locks herself in her room, and cannot go to work. She tried to kill herself by cutting her
wrists, but unsuccessful because the cuts are not deep enough. She ends up at a hospital emergency
room and was transferred to the psychiatric ward. Her sister has a conference with the doctor and
agrees Petra should have ECT. Her sister is amazed that when she goes to visit Petra she cannot
remember the names of her children. She has even walked out into the hall naked. Her sister is worried
that she made the wrong call. As it happens, several days after the ECT Petra started to smile and talk
with her sister about how well things are going. She doesn’t remember why she had the problem in the
first place. Petra’s sister wonders if her sister’s memory is going to be permanently affected.

19. Petra’s asks the nurse about the preparations for ECT. Which of the following statements if made by
the nurse would indicate understanding about ECT preparations?

The correct answer is: “Preparation is similar to that of undergoing minor surgery”

20. When a patient does not improve with antidepressant medication, the physician orders
electroconvulsive therapy. ECT’s exact mechanism of action is:

The correct answer is: Unknown

21. What is the most common side effect of ECT?

The correct answer is: Confusion and memory loss

22. Which of the following medications is given before ECT to prevent aspiration?

The correct answer is: Atropine

23. Which of the following complaints should the nurse addresses initially after ECT?

The correct answer is: “I can’t breathe”

24. Which of the following clients would most likely be found to be the best candidate for ECT?

The correct answer is: A severely malnourished depressed client at risk for medical complications

25. The efficacy of ECT is linked to the production of which of the following kinds of seizure?

The correct answer is: Grand mal

26. A severely depressed client who is pregnant and at risk of malnutrition tells you that she is going to
be scheduled for ECT. From your understanding of ECT today, you realize that this client:

The correct answer is: Could possibly have ECT if the benefits outweigh the potential dangers of the
procedure

27. Nurse Allan recognizes that the focus of milieu therapy is to:

The correct answer is: Manipulate the environment to bring about positive changes in behavior

28. During discussion, Nurse Hannah encourages the client to voice out their ideas or opinions while
respecting the rights of others. Nurse Hannah is using what type of therapeutic modality?

The correct answer is: Assertiveness training

SITUATION: Electroconvulsive therapy (ECT) is a treatment for severe mental illness in which a brief
application of electric stimulus is used to produce a generalized seizure. As often occurs with new
therapies, ECT was used for a variety of disorders, frequently in high doses and for long periods. Many of
these efforts proved ineffective, and some even harmful.

29. A hospitalized client is being considered for ECT. The client appears calm, but the family is anxious.
The client’s mother begins to cry and states, “My son’s brain will be fried, how can the doctor do this to
him?” What is the nurse’s best response?

The correct answer is: “It sounds as though you have some concerns about the procedure, why don’t’
we sit down and discuss any concerns you may have”

30. A neuromuscular blocking agent is administered to a client before ECT therapy. The nurse should
carefully observe the client for which of the following?

The correct answer is: Respiratory difficulties

31. Which of the following interventions is the highest priority during the post ECT care?

The correct answer is: Monitor respiratory status

32. A client in the inpatient psychiatric unit had been prescribed a MAIO antidepressant recently, and it
was unsuccessful in relieving the depression. After one week, the physician prescribed a serotonin
reuptake inhibitor. When the medication nurse approaches the client to give the drug, she notices some
changes in the client's mental status. The client is very agitated and is complaining of muscle spasms,
abdominal cramps, nausea and a headache. She is sweating and shivering at the same time. What is the
most appropriate next action of the nurse?

The correct answer is: Hold the medication and notify the physician immediately.

33. The nurse is checking the laboratory results on a client who is on lithium for symptoms associated
with bipolar disorder. The nurse observes that the lithium level is higher than normal but not yet toxic.
Which of the following behaviors on the part of the client would most likely account for this elevated
lithium level?

The correct answer is: Starting on a salt-free or low salt diet.

SITUATION: A 39-year-old married woman with 2 children, ages 16 and 12 years was electively admitted
for treatment of worsening depression. She had a 5-year history of recurrent severe depressive
episodes; there had been no history of mental health problems prior to this. She had been an in-patient
for most of the last 5 years, and had been required to be on a one-on-one nursing care because of self-
directed violence, which included cutting and trying to set herself on fire.

34. Which of the following nursing interventions is a priority when assessing a client for suicide?

The correct answer is: Assess the client for suicidal risk, method, and ability to carry out the plan
35. A diagnosis of major depressive disorder has been made. The client asks the nurse what is the
difference between a major depression and a bipolar disorder. The most appropriate response by the
nurse is:

The correct answer is: “Major depression is a depressed mood state that requires antidepressant
medication while bipolar disorder is an upward swing of mood that requires mood stabilizers for
treatment”

36. A patient who is being treated for depression has been taking Imipramine (Tofranil) for five days. The
patient complained about not feeling better. Which of the following statements is appropriate?

The correct answer is: “The drug takes 2-3 weeks to become effective”

37. A client is taking phenelzine (Nardil) as his medication. Which of the following would the nurse
anticipate as possible issue for the client’s adherence to this medication regimen?

The correct answer is: It requires adherence to strict diet

38. Which of the following is a priority to include in the plan of care for a client taking fluoxetine
(Prozac)?

The correct answer is: Wait for 2 weeks after taking a MAOI before starting Prozac

39. Tricyclic Antidepressants achieve their effects by:

The correct answer is: Blocking cholinergic receptors

40. A patient who began taking a tricyclic antidepressant was given instructions regarding its use. Which
of these comments would indicate that the patient understands the information?

The correct answer is: “I will chew sugarless candy if I experience drying of my mouth”

41. When distinguishing whether a client is suffering from depression or anxiety, the nurse recognizes
that the following would not be present in anxious clients, except?

The correct answer is: Seeing some prospect for the future

42. Nurse Daniel is preparing to care for a client with major depression. Assessing which of the following
would be the priority nursing intervention for this client?

The correct answer is: Risk for suicide

43. Which of the following is the priority nursing intervention to encourage a depressed client discuss
any suicidal thoughts?

The correct answer is: Encourage to verbalize feelings

44. While assessing the defense mechanisms used by the client, the nurse recognizes the client’s use of
defense mechanisms as adaptive when the:

The correct answer is: Mechanism used decreases anxiety.

45. When talking to the nurse about his decision to drop out of school and marry his girlfriend who is
pregnant, a young college student says, “It’s really the best decision. It is important for a child to have
two parents.” The nurse recognizes that the client is using the defense mechanism known as:

The correct answer is: Intellectualization

46. A 7-year-old has been diagnosed as having acute myelogenous leukemia. The physician has
discussed the diagnosis with the parents and told them that their son has only a few months to live.
While the parents are sitting in the lounge after visiting their child, they both have a severe argument
over something trivial. The nurse should help them recognize that they are using the defense
mechanism of:

The correct answer is: Displacement

SITUATION: Adaptation and coping are a natural part of life. Crisis occurs when there is perceived
challenge or threat that overwhelms the capacity of the individual to cope effectively with the event. A
crisis disrupts the life of the individual experiencing the event.
47. The following except one are true about crisis:

The correct answer is: A crisis is same as psychiatric emergency

48. A 13-year-old that has become increasingly withdrawn and uninterested in her schoolwork comes to
the clinic. Nurse Daniel notes that her behavior coincides with her pubertal changes. Which type of crisis
is the girl experiencing?

The correct answer is: Maturational crisis

49. Which approach by the nurse is best when responding to a client in crisis?

The correct answer is: Problem-solving approach

50. Crisis is described as self-limiting; that is, the crisis does not last indefinitely but usually exists for:

The correct answer is: 4-6 weeks 6 months

1. Mental health is defined as :

CORRECT ANSWER: B. A state of well being where a person can realize his own abilities, can cope

with normal stresses of life and work productively.

RATIONALE: Mental health is a positive state where an individual has self awareness and self

acceptance, the ability to cope with life stresses, can set realistic goals, has interdependence without

losing one's independence, is satisfied with interpersonal relationship and fulfills

2. The following are characteristics of a mentally health person except:

CORRECT ANSWER: C. Always feels relaxed despite stressors.

RATIONALE: A mentally healthy person does not always feel relaxed though he can tolerate life

stresses, appropriately handle anxiety and experience failure without devastation.

3. Mental health and psychiatric nursing is the:

CORRECT ANSWER: D. Promotion of optimal mental health, and early diagnosis, treatment and

rehabilitation of the mentally ill.

RATIONALE: Mental Health and Psychiatric Nursing is an interpersonal process that includes the

promotive, preventive, curative and rehabilitative aspects of care of the individual, family or
community.

4. The mind structure that focuses on reality principle by distinguishing fantasy from what exist in the

environment is:

CORRECT ANSWER: B. ego

RATIONALE: The ego operates on the reality principle and meets and interacts with the outside world.
The Id is the unconscious reservoir of primitive drives and is dominated by the pleasure principle. The
superego acts as a censoring force and is composed of morals and values.

5. The ability to recall the name of one's classmate in high school who went out with you most of the

time is a manifestation of the:

CORRECT ANSWER: A. Subconscious

RATIONALE: Subconscious are memories that can be recalled to consciousness with some effort.

Consciousness is a state of awareness. Unconsciousness consist of memories and conflicts that cannot

be recalled at will and are said to be repressed.

6. According to Freud a child who idolizes and imitates her mother is noted in which stage of

development?

CORRECT ANSWER: C. Phallic

RATIONALE: The resolution of the Electra complex occurs in the phallic stage and this entails

incestuous feelings towards the father and identification of the girl with the same sex parent.

7. Protective processes to prevent mental illness include the following except:

CORRECT ANSWER: D. maintenance of usual life patterns during stress

RATIONALE: Maintenance of the usual life patterns during stress indicates difficulty in adjusting to

changes in life that disturb one's equilibrium. The other choices indicate characteristics of a mentally

healthy individual who achieves self actualization.

8. A model that emphasizes the importance of interpersonal relationship and communication on

CORRECT ANSWER: B. Sullivan

RATIONALE: The interpersonal theory by Sullivan is based on the assumption that interpersonal
relationships facilitate development of the self system. Faulty patterns of relating interfere with
maturity and security. Piaget views intellectual development as a result of a constant interaction
between environmental influences and genetically determined attributes. Glasser who proposed the
reality therapy model cited that psychological needs must be met responsibly and within the context
of reality. Selye's stress model assumes that inadequate handling of stress can lead to physical and
mental illness

9. A 5 year old division chief teaches his assistant techniques in the company's business dealings.

Which of the following statements best describes the chief's behavior?

CORRECT ANSWER: A. his behavior is expected in his developmental stage

RATIONALE: The chief is in the middle adult stage where an individual's task is generativity. Adult

behavior that reflects mastery of this stage is passing on one's good traits to the next generation and

other societal responsibilities.

10. Which of the following behaviors exemplifies the use of rationalization?

CORRECT ANSWER: C. A student who fails a quiz claims that the lectures were not sufficient.

RATIONALE: In rationalization one attempts to justify one's behavior. Choice A is an example of

compensation where one overemphasizes a desirable trait to cover up a weakness. Choice B is
channeling one's instinctual drives into acceptable activities known as sublimation. Choice D is
reaction formation where one shows an exact opposite of what one feels.

11. Situation: One of the basic tools that the nurse uses in dealing with her client is the therapeutic

use of the self. The therapeutic use of self is best described as:

CORRECT ANSWER: C. The ability to establish relatedness and structure nursing interventions.

RATIONALE: The nurse uses aspects of the self to help clients grow, change and heal. The nurse's

personal strengths, understanding of human behavior, and the nurse's clinical skills are essential in

meeting the client's needs.

12. A client tells the nurse "I'm going to kill myself tonight but don't tell the others about it." When the

nurse responds "I can't keep the promise not to tell as this involves your safety" reflects an essential

characteristic of the nurse that must be established early in the therapeutic relationship as:

CORRECT ANSWER: C. Trustworthiness

RATIONALE: Trustworthiness is when the nurse is consistent in her words and actions and can be
relied on what she says. Acceptance is avoiding judgment of the client no matter what the behavior is.

Genuineness is when the nurse is authentic when interacting with the patient. Concreteness is being

specific and realistic, not theoretical in her response to the client

13. The general feelings or emotional reference the nurse uses in organizing her knowledge about the

world are referred to as:

CORRECT ANSWER: A. Attitudes

RATIONALE: Attitudes refer to how one views people and the world which may affect how the nurse
will express her feelings and how she will behave towards others. Values are abstract standards that
give the person a notion of right and wrong. Beliefs are ideas that one holds to be true. Culture
consists of socially learned behaviors, values and beliefs transmitted from one generation to another.

14. Which behavior by the nurse would be least effective in helping the client to achieve growth:

CORRECT ANSWER: A. Completing a task for the client instead of repeatedly prompting him to finish it.

RATIONALE: Completing task for the client is ineffective and may interfere in the client’s ability to
achieve goals. Adjusting to the client’s pace avoids frustration. Making self available to the client,
listening and skillfully observing the client makes him feel important and gives him encouragement to
complete a task or achieve goals.

15. The psychiatric nurse's role in tertiary prevention is:

CORRECT ANSWER: D. Rehabilitation programs to prevent the crippling effects of illness

RATIONALE: Rehabilitation is aimed at optimizing the function of the patient and preventing the

disability caused by the illness. A and C belong to the secondary level of prevention while B is primary

level of prevention.

16. Situation: The nurse engages the client in a corrective interpersonal experience. During the
assessment process the nurse:

CORRECT ANSWER: D. Uses a system of data collection

RATIONALE: A system of data collection that includes mental status examination, history taking
through interview and observation leads to a more precise documentation. This serves as a well-
founded basis in planning the care of the client.

17. In dealing with the client's problems, the nurse prioritizes the nursing diagnosis according to:

CORRECT ANSWER: C. life threatening potential

RATIONALE: Nursing diagnosis is the identification of the patient's problem based on the conclusion of
the client's behaviors and verbalizations. The safety of the client is a prime consideration in
emergency situations like suicide, aggression, and other destructive behaviors. These serve as a basis
for planning interventions to protect the client and in negotiating a no harm contract with the client.

18. The nurse ensures an accepting atmosphere in the unit where the client can relax and secure in

sharing thoughts and feelings is assuming the role of a:

CORRECT ANSWER: B. milieu therapist

RATIONALE: As a creator of a therapeutic milieu the nurse creates an environment where a client feels
secure and a client that encourages improvement and positive change in behavior. As a socializing
agent the nurse helps the client improve their social skills and participate in group activities. The
nurse informs the client about his rights and upholds these rights in her role as a patient advocate.
The nurse as a technician does the activities of assessment, documentation, administration of
medications and carrying out treatments.

19. An appropriate topic to be discussed in the working phase of the nurse-client relationship is:

CORRECT ANSWER: B. The client's problems and coping are explored.

RATIONALE: Problem solving occurs in the working phase of the nurse-client relationship. The client
who has learned to trust the nurse may be encouraged to share her problems and concerns and
alternative behaviors and techniques are explored. A summary of the relationship and the client's
growth are done in the termination phase. The client's perception of her illness is part of the initial
assessment done in the orientation phase. Setting the time, place and duration of each meeting are
part of the contract set at the start of the relationship.

20. A newly admitted client shouts at the staff she has just met for no apparent reason. The client is

likely manifesting:

CORRECT ANSWER: A. Transference

RATIONALE: Transference is one of the impasses in the nurse client relationship where positive and

negative feelings associated with a significant other in the client's past is unconsciously assigned to

another person like the nurse.

21. Situation: Various treatment modalities and interventions may be utilized for clients with
psychosocial concerns.

CORRECT ANSWER: D. "We can discuss this together with the staff and other patients."

RATIONALE: Therapeutic community calls for a group effort. A joint planning and decision making

among the patients and staff is done. The other choices do not indicate group effort and open

communication in the community.

22. The nurse gives an extra privilege to a client who regularly participates in ward activities is an

example of:

CORRECT ANSWER: B. Aversion therapy

RATIONALE: Behavior modification is a treatment modality that consists of rewarding good behavior
with physical reinforcers while withholding these reinforcers if a maladaptive behavior occurs. Role
modeling is where a nurse performs certain behaviors that the client can emulate. Aversion therapy is
the use of unpleasant or noxious stimuli to change inappropriate behavior. Logotherapy focuses on
searching for meaning in the client's life.

23. Which of the following best describes the patient's benefit from group therapy?

CORRECT ANSWER: D. The patient can learn how their behavior affect others

RATIONALE: Group therapy offers a venue for interpersonal learning or learning about oneself in

relation to others. Choices A and D are benefits that may be attained on an individual as well as group

setting. Effective group leaders focus on group process and encourage participation of group members

and do not focus on only one member.

24. A member of group therapy who actively seeks control thru incessant talking is a :

CORRECT ANSWER: A. monopolizer

RATIONALE: A monopolizer takes control by dominating the discussion. A complainer discourages

positive work and vents anger. A moralist serves as the judge of the right and the wrong. A seducer

attempts to gain personal attention.

25. In counseling the nurse does one of the following:

CORRECT ANSWER: C. Helps clients enhance coping by discussing their concerns.

RATIONALE: Counseling is a form of supportive psychotherapy in which the nurse offers guidance or
assistance to the client in viewing options to problems that are discussed by the client in the context
of the nurse-client relationship geared at health promotion. Rewarding the client for adaptive
behavior is achieved in behavior therapy. Educating parents on how to handle a hyperactive client is
done though educational group therapy. Referral is not a form of therapy.

26. Situation: The management of clients with various psychosocial concerns may be facilitated by the
nurse's communication skills. When attempting to engage the client in conversation which technique is
most effective?

CORRECT ANSWER: C. Broad opening

RATIONALE: Broad opening technique indicates that the client takes the lead in the interaction. In a

client who is hesitant in interacting this technique may stimulate him to take the initiative.

27. During a one on one interaction with the nurse the client states, "I'm worried about going home."

The nurse responds, "I'd rather you wouldn't worry." This response by the nurse is:

CORRECT ANSWER: C. Non-therapeutic because the nurse is passing judgment on the client.

RATIONALE: The nurse is not therapeutic because she is disapproving the client. The nurse should

not pass judgment on the client

28. A withdrawn client asks the nurse, "Do you think they'll ever let me out of here?" The nurse's best

reply would be:

CORRECT ANSWER: D. "You have the feeling that you might not leave?"

RATIONALE: Directing back to the client her feelings is reflecting technique. This makes the client
aware of what she feels that may pave the way to verbalization. Choice A gives advice which implies
that only the nurse knows what is best for the client. Choice D is a false reassurance which attempts
to dispel the client's anxiety disregards the client's feeling. Choice C demands the client to explain and
may intimidate the client.

29. The nurse initiates conversation with the client by saying "Is there something you would like to talk

about?" but the nurse has her arms crossed and is looking at another client. Which of the following

describes the nurse's approach?

CORRECT ANSWER: A. There is incongruence between her verbal and non-verbal communication.

RATIONALE: The nurse is using the verbal communication technique of broad opening that invites

the client to take the initiative but her crossed arms and lack of eye contact is incongruent with the
verbal message. The nurse is non-verbally distancing herself from the client.

30. Which of the following behaviors of the nurse reflect empathy?

CORRECT ANSWER: C. Listens to what is said and understands how the client feels

RATIONALE: Empathy is the ability of the nurse to perceive the meanings and the feelings of the

client and to communicate that understanding to the client.

31. Situation: A female client age 40, was admitted because of bouts of sweating, nervousness and

selective inattention. This has progressed for the past 3 months.

What is the initial responsibility of the nurse?

CORRECT ANSWER: D. Assess her level of anxiety

RATIONALE: The initial responsibility of the nurse is to begin an assessment of the patient's needs.

The patient's physiologic responses, recurring thoughts, feelings and behaviors are cues to the client's

problem areas that will lead to planning appropriate interventions.

32. The client is likely manifesting what level of anxiety?

CORRECT ANSWER: B. moderate

RATIONALE: The client has moderate anxiety. Other physiologic manifestations of moderate anxiety
include muscle tension, pounding pulse dry mouth, high pitch voice and faster rate of speech.
Psychological responses of moderate anxiety are increased irritability, narrowing of perceptual field,
and easy distractibility but the individual can focus with assistance.

33. The nurse does the SOAP recording. The following are objective manifestations of anxiety except:

CORRECT ANSWER: A. The client said "I can't sleep well."

RATIONALE: The inability to sleep as claimed by the client's is a subjective manifestation of anxiety.

34. Stress management techniques include the following except:

CORRECT ANSWER: A. problem solving

RATIONALE: Problem solving is a technique where a nurse helps the client explore possibilities and
find solutions to his problem. The rest of the choices are techniques to reduce anxiety. Imagery is the
use of fantasy to relieve anxiety. Progressive muscle relaxation uses a process of tensing and releasing
groups of muscles starting from the facial muscles and moving down to the body to the muscles in the
feet. Meditation involves focusing attention and self-regulation

35. The nurse engages the client in problem solving. The client says, “I know that my work and family

concerns upset me.” The next statement the nurse makes in guiding the client do problem solving is:

CORRECT ANSWER: A. "What have you tried to solve it?"

RATIONALE: This attempts to assess the problem-solving techniques previously tried that may help
the nurse in guiding the client identify alternative solutions to the problem. Choice B helps the client
identify new coping strategies after assessment is done. Choice C and D give advice and do not allow
the client to have a role in the problem-solving process that makes the client feel helpless and not in
control.

36. Situation: A 35 year old homemaker goes to the clinic and talks about having lost everything after
the husband, 42 years old, leaves her for a much younger woman. The husband's behavior may reflect a
developmental concern of:

CORRECT ANSWER: C. generativity vs. stagnation

RATIONALE: This stage refers to middle adulthood stage where one confronts mortality for the first
time that leads to reevaluation of life's goals and purposes in life. In generativity this individual
attempts to ensure his immortality by transmitting his values to the next generation. Persons who had
previously unexamined lives often find themselves in a state of crisis as in the case of this husband.

37. When the woman was asked to talk about her husband she remarked, "Let's talk about it later" is

utilizing what defense mechanism?

CORRECT ANSWER: D. suppression

RATIONALE: Suppression is a conscious attempt to exclude from conscious awareness unacceptable

thoughts and feelings.

38. Which of the following is true of crisis?

CORRECT ANSWER: B. A crisis for one may not be a crisis for another.

RATIONALE: Crisis is highly individualized. People vary in their appraisal of events, their ability to
cope, coping resources and support system so that what maybe a crisis for one may not be a crisis for
another. Crisis is a state of disequilibrium where the usual coping patterns fail in dealing with the
present problem. A crisis state affecting an individual usually also affects the significant others who
constitute his support system. A crisis is not seen as an illness but an upset in the steady state of the
system in which there is massive amount of anxiety.

39. The following questions may be included when assessing a client in crisis:

1. "What are your feelings about the situation?"

2. "Have you experienced any similar situation in the past?"

3. "Who can be helpful to you?"

4. "What were your childhood conflicts?"

CORRECT ANSWER: C. 1,2,and 3

RATIONALE: Nursing assessment of a client in crisis includes the precipitating event and circumstance,
the client's perception of the event, past experience of similar event and coping measures in the past,
the client's strength and support system. Crisis intervention does not focus on any unresolved
conflicts that occurred in the past but rather on the present problem.

40. During the course of therapy, the woman agrees to join a support group. After listening to

someone who talked about her marital problem during the group session she remarks "I didn't think

anyone else had a problem like mine", reflects a curative factor of group therapy:

CORRECT ANSWER: D. Universality

RATIONALE: Universality assists participants in recognizing common experiences. Altruism is finding

meaning through helping others. Existential factors refer to having control over the quality of one's
life. Catharsis is expressing openly one's suppressed feelings.

41. Situation : Ann, 23 years old is very talkative, moves about a lot and is irritable. Impression : Bipolar
Mood Disorder, manic phase. The elevated, expansive emotional response in a manic client is a
disturbance in:

CORRECT ANSWER: A. Mood

RATIONALE: Mood disorder is a disturbance in the prevailing emotional state of a client. Bipolar
disorder involves extreme mood swings from episodes of mania to episodes of depression. Mood
refers to the client's pervasive, enduring emotional state while affect is an outward expression of an
emotional state and is temporary. Affect does not prevail and therefore it is an inappropriate term to
refer to the pervasive emotional state that occurs in mania.

42. The best primary prevention for mood disorders is :

CORRECT ANSWER: A. expression of feelings

RATIONALE: Depression occurs when hostility is turned inwards. On the other hand mania is a

defense against an underlying depression. A manic client externalizes his hostility to the environment.

The best primary prevention of mood disorder is verbalization of feelings.

43. During assessment the client frequently switches topics but the nurse can still follow the client's

thought pattern is manifesting:

CORRECT ANSWER: D. flight of ideas

RATIONALE: Flight of ideas is characterized from jumping from one topic to another but the client can
still be followed. Word salad is a jumble of words put together. Circumstantiality is talking around the
topic with inclusion of unnecessary details that delays the meeting of a goal. Looseness of association
is fragmented thought without logical sequence resulting to incoherent speech.

44. When planning a therapeutic milieu for a hyperactive client the nurse considers which of the

following activities?

CORRECT ANSWER: A. making her bed

RATIONALE: Making her bed is a safe activity to dissipate the excessive energy of a manic patient. It is
not therapeutic to engage the client in competitive activities nor initiate group activities because these
are stimulating activities. Bingo requires concentration which the client does not have the capability to
sustain.

45. The following medications maybe given to the client except:

CORRECT ANSWER: D. Tofranil

RATIONALE: Tofranil is an antidepressant. Lithium Carbonate is an antimanic drug. Epival and

Tegretol are anticonvulsants but may also be used to manage mania.

46. Situation: A 30 year old woman, single is admitted to the psychiatric unit after being increasingly

withdrawn and eating and sleeping poorly after she has become burdened of her family problems and

demotion in her work. Relatives claimed that she attempted suicide by cutting her wrist.

Which of the following has the highest priority in the nursing care of the client?

CORRECT ANSWER: B. Monitor the client's whereabouts.

RATIONALE: The highest priority is given to keeping the client safe from self harm.Monitoring the

client will ensure safety as this will prevent the possibility of overlooking attempts for self harm. This

communicates a message of concern. The other interventions are also appropriate for a depressed

suicidal client but are not priority.

47. Indecision, inability to concentrate, loss of interest pessimism and self depreciation noted in a

depressed client are alterations in:

CORRECT ANSWER: C. cognition

RATIONALE: The indecision, inability to concentrate, loss of interest, pessimism and self depreciation
are cognitive manifestations of depression. Alterations in activity among the depressed may either be
psychomotor retardation or agitation. Alterations in perception include delusions and hallucinations
which are congruent with the depressed mood of the client. Alteration in affect include sadness,
apathy, despondency, anger, guilt, helplessness and hopelessness.

48. The nurse's initial approach in caring for a patient with major depression would be to:

CORRECT ANSWER: B. Actively listen to the client

RATIONALE: A depressed client needs to express her angry feelings within appropriate limits. This

helps resolve anger that is turned to the self engaged in by the depressed and suicidal client. Placing

demands on a depressed client who has psychomotor retardation as in making decisions and group

activities and cheerful activities are not therapeutic.

49. In planning care for a client with endogenous depression, the nurse considers engaging the client

in activities:

CORRECT ANSWER: C. Towards the afternoon

RATIONALE: Endogenous depression is associated with alterations in the neurochemicals nor

epinephrine and serotonin. Its diurnal variation indicates that clients are more depressed in the early
part of the day and are more accessible for activities towards the afternoon. These clients respond
well to antidepressants.

50. The client says “I'm not good in anything. I’ve always been a failure." Which of the following

responses is best for the client’s statement ?

CORRECT ANSWER: C. "Let’s work on your strengths."

RATIONALE: The client’s statement indicates low esteem. Focusing on the client’s strength

enhances self worth. Choice A is not therapeutic because it disapproving and gives false reassurance.

Choice B explores the client’s negative view of himself. Choice D disregards the client’s concern.

51. The client is withdrawn and spends most of the time on bed. The client refuses to join activities

that require social exchange. The appropriate nursing diagnosis for this client behavior is:

CORRECT ANSWER: C. Impaired social interaction

RATIONALE: A depressed client has difficulty in relationship and tend to be solitary. While this poor

social skill is directly linked to the client's feeling of worthlessness the clues indicate impaired social

interaction.

52. Which nurse's action would be therapeutic:

CORRECT ANSWER: B. Stay at the bedside at short but frequent intervals.

RATIONALE: Offering to stay with the client at short but frequent interval communicates that the
patient is important. This makes the nurse available during a time when the patient feels comfortable
with initiating a dialogue.

53. Which behavior would the nurse expect to see in a patient following ECT?

CORRECT ANSWER: A. Loss of short term memory

RATIONALE: An expected outcome post ECT is short term memory impairment. The client may also

be mildly confused and briefly disoriented.

54. The client asks the nurse about the purpose of ECT. The nurse responds that ECT will:

CORRECT ANSWER: A. Relieve the symptoms of severe depression

RATIONALE: ECT relieves symptoms of depression by causing changes in the monoamine

neurotransmitter system similar to the changes caused by antidepressant drugs. It does not
potentiate the therapeutic effects of psychotropic drugs.

55. The client who is on Tofranil (Imipramine), comments "I've been taking it for a week but I still feels

sad and hopeless." Which statement by the nurse is correct about the medication?

CORRECT ANSWER: A. It takes 2 to 3 weeks before the medication has its effect.

RATIONALE: The therapeutic effect of Tofranil, a tricyclic antidepressant, takes 3 to 4 weeks.

56. Situation: Ann, 18 years old, is admitted to the psychiatric unit because of behavioral changes.

The verbalization if made by a client indicates psychosis?

CORRECT ANSWER: A. ' I just heard the voices telling me to scratch my face.'

RATIONALE: Psychosis is the inability to distinguish what is real from what is not. The client's

manifestation is hallucination, a false sensory perception. Choice B describes compulsion noted in

Obsessive Compulsive disorder, a neurosis or abnormal anxiety. Choice C indicates hopelessness that

may be noted among depressed clients. Choice D may indicate antisocial personality disorder.

57. Ann is noted to assume a far away look and mumbles to self. The nurse is likely experiencing:

CORRECT ANSWER: C. hallucination

RATIONALE: Talking to self behavior may indicate auditory hallucination. Illusion is a

misinterpretation of an external stimuli. Delusion is a false fixed belief. Depersonalization is the
feeling of unreality of the self.

58. Ann says "You'll kill me. Go away" Which is a therapeutic response

CORRECT ANSWER: B. Ann I'm your nurse

RATIONALE: Presenting reality to a delusional client is the therapeutic response. Choice A is

challenging. Choice C is not therapeutic because it explores the false content. Choice D reinforces the

false.

59. Ann has progressively withdrawn from relationships. This reaction may be a result of the following

except: CORRECT ANSWER: A. self punishment

RATIONALE: The client with schizophrenia has difficulty in social relationship may be due to positive

signs like delusions and hallucinations, loss of ego boundaries, low esteem and lack of confidence.

60. The nurse conducts remotivation therapy for the purpose of:

CORRECT ANSWER: A. assisting a regressed client to socialize

RATIONALE: Remotivation also called conversation therapy is a form of socializing activity through

group interaction about a topic associated with the real world. Choice B is the goal of recreational

therapy. Choice C refer to vocational therapy. Choice C refers to bibliotherapy

61. Situation: Jose, 57 y/o, is admitted to the psychiatric ward due to aggressive behavior. The nurse

was doing an assessment when the client became agitated. Which is an appropriate documentation
made by the nurse regarding the patient's behavior?

CORRECT ANSWER: C. When asked to talk about his family the client was noted to pace and with a

clenched fist remarked “I’ll get back at them.”

RATIONALE: Recording of the client's behavior must be accurate, objective and describe the

behavior. It should include potential triggers of aggression to alert the staff.

62. When responding to a verbally abusive client it is important for the nurse to:

CORRECT ANSWER: D. Remain calm and firm

RATIONALE: Remaining calm and firm when the client is verbally abusive provides a low level of

stimuli to the client that provides a feeling of safety and security.

63. In encouraging verbal expression of the feelings the nurse therapeutically says:

CORRECT ANSWER: A. What has caused you to feel angry?

RATIONALE: This helps the client identify the true object of his hostility. Helping the client identify

this in a non threatening manner may help reveal unresolved issues so they may be confronted.

64. When he was asked to be seated for his vital signs to be checked, he threw a chair across the

room. Four staff members were needed to control and restrain him. The nurse identifies which

appropriate nursing diagnosis:

CORRECT ANSWER: D. Ineffective individual coping related to poor defensive function

RATIONALE: The client's behavior indicates that he can be physically harmful to others.

65. Which goal is most appropriate for this nursing diagnosis?

CORRECT ANSWER: B. The patient will verbalize anger rather than act out.

RATIONALE: The goal in dealing with a potentially violent client is to be able to express his
anger/feelings in way that will not be harmful to self and others.

66. The nurse's initial action when dealing with an assaultive client is to:

CORRECT ANSWER: B. Restore the patient's self control and prevent further loss of control.

RATIONALE: Restoring the client's self control may be done initially by talking down the client. When
this approach fails medications may be used. When these fail, seclusion or mechanical restraints may
be necessary.

67. Situation: Carlo is diagnosed to have schizoid personality. Which of the following behaviors may be
noted in the patient:

CORRECT ANSWER: C. cold, introvert, lacks desire for close relationship

RATIONALE: Schizoid personality disorder is characterized by a pervasive pattern of detachment

from social relationships and a restricted range emotional expression in interpersonal settings. Choice
A describes histrionic personality disorder. Choice B is paranoid personality disorder while Choice D
describes narcissistic personality disorder.

68. Known etiology of personality disorders include:

CORRECT ANSWER: D. all of them

RATIONALE: The development of personality disorders is a combination of biological, psychological,

behavioral and socio-cultural factors.

69. Identification is one of the defense mechanisms used among clients with personality disorders.

This mechanism: CORRECT ANSWER: A. Integrates some ways of a significant other.

RATIONALE: Persons with personality disorder may model their actions after those around them,

particularly their parents. Choice B describes sublimation. Choice C is regression. Choice D is undoing.

70. The nursing diagnosis that may be identified in a client with schizoid personality disorders may

include the following except:

CORRECT ANSWER: D. Perceptual alteration

RATIONALE: Perceptual alteration is not noted in a client with personality disorder. Personality
disorders are characterized by inflexible and dysfunctional traits that impair their social and
occupational function. Clients with schizoid personality use intellectualization when these patients
describe emotional and interpersonal experiences in an impersonal way.

71. Carlo withdraws from everyone. A therapeutic approach for Carlo is:

CORRECT ANSWER: C. Include Carlo when the nurse initiates conversation with the patient’s

RATIONALE: The client has a pervasive lack of desire for involvement with others. The nurse should

promote socialization initially by building trust then slowly involving the patient in milieu and group

activities.

72. Situation 7 - Vina, a 28 year old movie starlet who was caught by the narcotics command during a

shabu session. She voluntarily submitted herself for rehabilitation

The best level of prevention in dealing with problems on drug abuse is:

CORRECT ANSWER: A. Primary

RATIONALE: Primary level of prevention includes education and information dissemination regarding

the effects of dangerous drugs. This involves altering the causative factors before they have the

opportunity to cause drug abuse problems.