This is an examination about the concepts of Psychiatric Nursing! This 50-item psychiatric nursing exam will help you review and challenge your nursing knowledge about Psychiatric Nursing. If you are taking the board examination or nurse licensure examination or even the NCLEX, then this practice exam is just right for you!
- Read each question carefully and choose the best answer.
- You are given 1 minute and 20 seconds for each question.
- Answers & Rationale are given below. Be sure to read them!
1. Flumazenil (Romazicon) has been ordered for a client who has overdosed on oxazepam (Serax). Before administering the medication, the nurse should be prepared for which common adverse effect?
D. Chest pain
2. The nurse is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:
A. avoid shopping for large amounts of food.
B. control eating impulses.
C. identify anxiety-causing situations.
D. eat only three meals per day.
3. A client who’s at high risk for suicide needs close supervision. To best ensure the client’s safety, the nurse should:
A. check the client frequently at irregular intervals throughout the night.
B. assure the client that the nurse will hold in confidence anything the client says.
C. repeatedly discuss previous suicide attempts with the client.
D. disregard decreased communication by the client because this is common in suicidal clients.
4. Which of the following drugs should the nurse prepare to administer to a client with a toxic acetaminophen (Tylenol) level?
A. deferoxamine mesylate (Desferal)
B. succimer (Chemet)
C. flumazenil (Romazicon)
D. acetylcysteine (Mucomyst)
5. A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal?
A. naloxone (Narcan)
B. haloperidol (Haldol)
C. magnesium sulfate
D. chlordiazepoxide (Librium)
6. During postprandial monitoring, a client with bulimia nervosa tells the nurse, “You can sit with me, but you’re just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice.” What is the nurse’s best response?
A. “I trust you not to purge.”
B. “How are you purging and when do you do it?”
C. “Don’t worry. I won’t allow you to purge today.”
D. “I know it’s important for you to feel in control, but I’ll monitor you for 90 minutes after you eat.”
7. A 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?
A. “If you continue to talk like that, I’m going to stop speaking to you.”
B. “You told me you got fired from your last job for missing too many days after taking drugs all night.”
C. “Tell me more about how it felt to get high.”
D. “Don’t you know it’s illegal to use drugs?”
8. For a client with anorexia nervosa, which goal takes the highest priority?
A. The client will establish adequate daily nutritional intake.
B. The client will make a contract with the nurse that sets a target weight.
C. The client will identify self-perceptions about body size as unrealistic.
D. The client will verbalize the possible physiological consequences of self-starvation.
9. When interviewing the parents of an injured child, which of the following is the strongest indicator that child abuse may be a problem?
A. The injury isn’t consistent with the history or the child’s age.
B. The mother and father tell different stories regarding what happened.
C. The family is poor.
D. The parents are argumentative and demanding with emergency department personnel.
10. For a client with anorexia nervosa, the nurse plans to include the parents in therapy sessions along with the client. What fact should the nurse remember to be typical of parents of clients with anorexia nervosa?
A. They tend to overprotect their children.
B. They usually have a history of substance abuse.
C. They maintain emotional distance from their children.
D. They alternate between loving and rejecting their children.
11. In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client’s husband arrives, shouting that he wants to “finish the job.” What is the first priority of the health care worker who witnesses this scene?
A. Remaining with the client and staying calm
B. Calling a security guard and another staff member for assistance
C. Telling the client’s husband that he must leave at once
D. Determining why the husband feels so angry
12. The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?
A. Fill out the client’s menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal.
C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.
13. The nurse is assigned to care for a suicidal client. Initially, which is the nurse’s highest care priority?
A. Assessing the client’s home environment and relationships outside the hospital
B. Exploring the nurse’s own feelings about suicide
C. Discussing the future with the client
D. Referring the client to a clergyperson to discuss the moral implications of suicide
14. A client with anorexia nervosa tells the nurse, “When I look in the mirror, I hate what I see. I look so fat and ugly.” Which strategy should the nurse use to deal with the client’s distorted perceptions and feelings?
A. Avoid discussing the client’s perceptions and feelings.
B. Focus discussions on food and weight.
C. Avoid discussing unrealistic cultural standards regarding weight.
D. Provide objective data and feedback regarding the client’s weight and attractiveness.
15. The nurse 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?
A. Carbonated beverages
B. Aftershave lotion
16. The nurse is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?
A. Restrict visits with the family until the client begins to eat.
B. Provide privacy during meals.
C. Set up a strict eating plan for the client.
D. Encourage the client to exercise, which will reduce her anxiety.
17. Victims of domestic violence should be assessed for what important information?
A. Reasons they stay in the abusive relationship (for example, lack of financial autonomy and isolation)
B. Readiness to leave the perpetrator and knowledge of resources
C. Use of drugs or alcohol
D. History of previous victimization
18. A client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. The nurse realizes that these symptoms probably result from:
A. acetate accumulation.
B. thiamine deficiency.
C. triglyceride buildup.
D. a below-normal serum potassium level
19. A parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse suspect that the child was abused?
A. The child cries uncontrollably throughout the examination.
B. The child pulls away from contact with the physician.
C. The child doesn’t cry when the shoulder is examined.
D. The child doesn’t make eye contact with the nurse.
20. When planning care for a client who has ingested phencyclidine (PCP), which of the following is the highest priority?
A. Client’s physical needs
B. Client’s safety needs
C. Client’s psychosocial needs
D. Client’s medical needs
21. Which outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder?
A. Accept responsibility for own behaviors.
B. Be able to verbalize own needs and assert rights.
C. Set firm and consistent limits with the client.
D. Allow the child to establish his own limits and boundaries.
22. A client is found sitting on the floor of the bathroom in the day treatment clinic with moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at her bleeding wrists while staff members call for an ambulance. How should the nurse approach her initially?
A. Enter the room quietly and move beside her to assess her injuries.
B. Call for staff back-up before entering the room and restraining her.
C. Move as much glass away from her as possible and sit next to her quietly.
D. Approach her slowly while speaking in a calm voice, calling her name, and telling her that the nurse is here to help her.
23. A client with anorexia nervosa describes herself as “a whale.” However, the nurse’s assessment reveals that the client is 5′ 8″ (1.7 m) tall and weighs only 90 lb (40.8 kg). Considering the client’s unrealistic body image, which intervention should be included in the plan of care?
A. Asking the client to compare her figure with magazine photographs of women her age
B. Assigning the client to group therapy in which participants provide realistic feedback about her weight
C. Confronting the client about her actual appearance during one-on-one sessions, scheduled during each shift
D. Telling the client of the nurse’s concern for her health and desire to help her make decisions to keep her healthy
24. Eighteen hours after undergoing an emergency appendectomy, a client with a reported history of social drinking displays these vital signs: temperature, 101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross hand tremors and is screaming for someone to kill the bugs in the bed. The nurse should suspect:
A. a postoperative infection.
B. alcohol withdrawal.
C. acute sepsis.
25. Clonidine (Catapres) can be used to treat conditions other than hypertension. For which of the following conditions might the drug be administered?
A. Phencyclidine (PCP) intoxication
B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal
26. One of the goals for a client with anorexia nervosa is that the client will demonstrate increased individual coping by responding to stress in constructive ways. Which of the following actions is the best indicator that the client is working toward meeting the goal?
A. The client drinks 4 L of fluid per day.
B. The client paces around the unit most of the day.
C. The client keeps a journal and discusses it with the nurse.
D. The client talks almost constantly with friends by telephone.
27. The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond:
A. “You must first stop drinking.”
B. “Your physician must refer you to this program.”
C. “Admit you’re powerless over alcohol and that you need help.”
D. “You must bring along a friend who will support you.”
28. An attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm’s employee assistance program. The nurse knows that the client’s behavior most likely represents the use of which defense mechanism?
29. After completing chemical detoxification and a 12-step program to treat crack addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future?
A. “I’m never going to use crack again.”
B. “I know what I have to do. I have to limit my crack use.”
C. “I’m going to take 1 day at a time. I’m not making any promises.”
D. “I will substitue crack for something else”
30. The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to:
A. accurately describe the amount consumed.
B. underestimate the amount consumed.
C. overestimate the amount consumed.
D. deny any consumption of alcohol.
31. The nurse is assessing a 15-year-old female who’s being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find?
B. Warm, flushed extremities
C. Parotid gland tenderness
D. Coarse hair growth
32. A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is:
A. impending coma.
B. manipulating behavior.
D. perceptual disorders.
33. The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder?
A. Wearing tight-fitting clothing
B. Increased blood pressure
C. Oily skin
D. Excessive and ritualized exercise
34. A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals?
A. Alcohol withdrawal
B. Cannibis withdrawal
C. Cocaine withdrawal
D. Opioid withdrawal
35. A client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. Although she is 5′ 8″ (1.7 m) tall and weighs only 103 lb (46.7 kg), she talks incessantly about how fat she is. Which measure should the nurse take first when caring for this client?
A. Teach the client about nutrition, calories, and a balanced diet.
B. Establish a trusting relationship with the client.
C. Discuss cultural stereotypes regarding thinness and attractiveness.
D. Explore the reasons why the client doesn’t eat.
36. A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see:
A. tension and irritability.
B. slow pulse.
37. Which of the following drugs may be abused because of tolerance and physiologic dependence.
A. lithium (Lithobid) and divalproex (Depakote).
B. verapamil (Calan) and chlorpromazine (Thorazine)
C. alprazolam (Xanax) and phenobarbital (Luminal)
D. clozapine (Clozaril) and amitriptyline (Elavil)
38. Which of the following groups are considered to be at highest risk for suicide?
A. Adolescents, men over age 45, and persons who have made previous suicide attempts
B. Teachers, divorced persons, and substance abusers
C. Alcohol abusers, widows, and young married men
D. Depressed persons, physicians, and persons living in rural areas
39. Tourette syndrome is characterized by the presence of multiple motor and vocal tics. A vocal tic that involves repeating one’s own sounds or words is known as:
40. A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. The nurse expects the assessment to
A. unpredictable behavior and intense interpersonal relationships.
B. inability to function as a responsible parent.
C. somatic symptoms.
D. coldness, detachment, and lack of tender feelings.
41. A client with disorganized type schizophrenia has been hospitalized for the past 2 years on a unit for chronic mentally ill clients. The client’s behavior is labile and fluctuates from childishness and incoherence to loud yelling to slow but appropriate interaction. The client needs assistance with all activities of daily living. Which behavior is characteristic of disorganized type schizophrenia?
A. Extreme social impairment
B. Suspicious delusions
C. Waxy flexibility
D. Elevated affect
42. The nurse is providing care for a female client with a history of schizophrenia who’s experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What is the nurse’s best action?
A. Administer the haloperidol orally if the client agrees to take it.
B. Call the physician to clarify whether the haloperidol should be given orally or I.M.
C. Call the physician to clarify the order because the dosage is too high.
D. Withhold haloperidol because it may worsen hallucinations.
43. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. 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.
44. A 24-year-old client is experiencing an acute schizophrenic episode. He has vivid hallucinations that are making him agitated. The nurse’s best response at this time would be to:
A. take the client’s vital signs.
B. explore the content of the hallucinations.
C. tell him his fear is unrealistic.
D. engage the client in reality-oriented activities.
45. Which medication can control the extrapyramidal effects associated with antipsychotic agents?
A. perphenazine (Trilafon)
B. doxepin (Sinequan)
C. amantadine (Symmetrel)
D. clorazepate (Tranxene)
46. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:
A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying “Go away” or “Stop” when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.
47. A dystonic reaction can be caused by which of the following medications?
A. diazepam (Valium)
B. haloperidol (Haldol)
C. amitriptyline (Elavil)
D. clonazepam (Klonopin)
48. While pacing in the hall, a client with paranoid schizophrenia runs to the nurse and says, “Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. Give me back my soul!” How should the nurse respond during the early stage of the therapeutic process?
A. “I’m a nurse. I’m not poisoning you. It’s against the nursing code of ethics.”
B. “I’m a nurse, and you’re a client in the hospital. I’m not going to harm you.”
C. “I’m not poisoning you. And how could I possibly steal your soul?”
D. “I sense anger. Are you feeling angry today?”
49. 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 of France 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 United States. Their government wouldn’t try to kill you.”
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.”
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.”
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