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. The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable?
A. The client spends more time by himself.
B. The client doesn’t engage in delusional thinking.
C. The client doesn’t harm himself or others.
D. The client demonstrates the ability to meet his own self-care needs.
2. The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate?
A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Establishing alternative forms of communication
D. Allowing the client to decide when he wants to participate in verbal communication with the nurse
3. Since admission 4 days ago, a client has refused to take a shower, stating, “There are poison crystals hidden in the showerhead. They’ll kill me if I take a shower.” Which nursing action is most appropriate?
A. Dismantling the showerhead and showing the client that there is nothing in it
B. Explaining that other clients are complaining about the client’s body odor
C. Asking a security officer to assist in giving the client a shower
D. Accepting these fears and allowing the client to take a sponge bath
4. Drug therapy with thioridazine (Mellaril) shouldn’t exceed a daily dose of 800 mg to prevent which adverse reaction?
B. Respiratory arrest
C. Tourette syndrome
D. Retinal pigmentation
5. A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse?
A. “I get upset once in a while, too.”
B. “I know just how you feel. I’d feel the same way in your situation.”
C. “I worry, too, when I think people are talking about me.”
D. “At times, it’s normal not to trust anyone.”
6. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client’s delusional thoughts and hallucinations eliminated?
A. Several minutes
B. Several hours
C. Several days
D. Several weeks
7. A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client?
A. Take the medication 1 hour before a meal.
B. Decrease the dosage if signs of illness decrease.
C. Apply a sunscreen before being exposed to the sun.
D. Increase the dosage up to 50 mg twice per day if signs of illness don’t decrease.
8. A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?
A. “Your behavior won’t be tolerated. Go to your room immediately.”
B. “You’re just doing this to get back at me for making you come to therapy.”
C. “Your cursing is interrupting the activity. Take time out in your room for 10 minutes.”
D. “I’m disappointed in you. You can’t control yourself even for a few minutes.”
9. Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)?
A. The absence of anticholinergic effects
B. A lower incidence of extrapyramidal effects
C. Photosensitivity and sedation
D. No incidence of neuroleptic malignant syndrome
10. The etiology of schizophrenia is best described by:
A. genetics due to a faulty dopamine receptor.
B. environmental factors and poor parenting.
C. structural and neurobiological factors.
D. a combination of biological, psychological, and environmental factors.
11. A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
A. benztropine (Cogentin)
B. dantrolene (Dantrium)
C. clonazepam (Klonopin)
D. diazepam (Valium)
12. A client with a diagnosis of paranoid schizophrenia comments tothe nurse, “How do I know what is really in those pills?” Which of the following is the best response?
A. Say, “You know it’s your medicine.”
B. Allow him to open the individual wrappers of the medication.
C. Say, “Don’t worry about what is in the pills. It’s what is ordered.”
D. Ignore the comment because it’s probably a joke.
13. A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic?
A. “That must be frightening to you. Can you tell me how you feel about it?”
B. “There are no people living on Mars.”
C. “What do you mean when you say they’re going to invade the earth?”
D. “I know you believe the earth is going to be invaded, but I don’t believe that.”
14. A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he:
A. sit in a quiet, dark room and concentrate on the voices.
B. listen to a personal stereo through headphones and sing along with the music.
C. call a friend and discuss the voices and his feelings about them.
D. engage in strenuous exercise.
15. A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?
A. Ineffective protection related to blood dyscrasias
B. Urinary frequency related to adverse effects of antipsychotic medication
C. Risk for injury related to a severely decreased level of consciousness
D. Risk for injury related to electrolyte disturbances
16. A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client’s speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom?
D. Tardive dyskinesia
17. The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client’s plan of care?
A. Meeting all of the client’s physical needs
B. Giving the client an opportunity to express concerns
C. Administering lithium carbonate (Lithonate) as prescribed
D. Providing a quiet environment where the client can be alone
18. A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client?
A. chlorpromazine (Thorazine)
B. imipramine (Tofranil)
C. lithium carbonate (Lithane)
D. fluphenazine decanoate (Prolixin Decanoate)
19. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
20. Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, “Get out of here right now! The elevator bombs are going to explode in 3 minutes!” The next time this happens, how should the nurse respond?
A. “Why do you think there is a bomb in the elevator?”
B. “That is the same thing you said in yesterday’s session.”
C. “I know you think there are bombs in the elevator, but there aren’t.”
D. “If you have something to say, you must do it according to our group rules.”
21. A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client’s medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects?
A. guanethidine (Ismelin)
B. droperidol (Inapsine)
C. lithium carbonate (Lithonate)
22. A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn’t been employed in the last 14 years. Based on Erikson’s theories, the nurse should recognize that this client is in which stage of psychosocial development?
A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust
23. During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of:
A. paranoid personality disorder.
B. avoidant personality disorder.
C. histrionic personality disorder.
D. borderline personality disorder.
24. The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered?
A. To reduce psychotic symptoms
B. To reduce extrapyramidal symptoms
C. To control nausea and vomiting
D. To relieve anxiety
25. A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:
A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily aroused.
D. more prolonged sedative effects, making the client more difficult to arouse.
26. A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client’s speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis?
B. Paranoid personality
C. Bipolar illness
D. Obsessive-compulsive disorder (OCD)
27. A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client’s:
A. thinking, perceiving, and decision-making skills.
B. verbal and nonverbal communication processes.
C. affect and behavior.
D. psychomotor activity.
28. Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)?
A. Monthly blood tests will be necessary.
B. Report a sore throat or fever to the physician immediately.
C. Blood pressure must be monitored for hypertension.
D. Stop the medication when symptoms subside.
29. Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions?
A. Use sunscreen because of photosensitivity.
B. Take the antipsychotic medication with food.
C. Have routine blood tests to determine levels of the medication.
D. Abstain from eating aged cheese.
30. Positive symptoms of schizophrenia include which of the following?
A. Hallucinations, delusions, and disorganized thinking
B. Somatic delusions, echolalia, and a flat affect
C. Waxy flexibility, alogia, and apathy
D. Flat affect, avolition, and anhedonia
31. A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction?
D. Tardive dyskinesia
32. Hormonal effects of the antipsychotic medications include which of the following?
A. Retrograde ejaculation and gynecomastia
B. Dysmenorrhea and increased vaginal bleeding
C. Polydipsia and dysmenorrhea
D. Akinesia and dysphasia
33. A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior?
A. Word salad
34. An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat:
D. tardive dyskinesia.
35. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow.
36. A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect?
A. phenytoin (Dilantin)
B. amantadine (Symmetrel)
C. benztropine (Cogentin)
D. diphenhydramine (Benadryl)
37. Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:
A. double the dose if missed to maintain a therapeutic level.
B. be sure to take the drug with a meal because it’s very irritating to the stomach.
C. discontinue the drug if the client reports weight gain.
D. notify the physician if the client notices an increase in bruising.
38. A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client’s arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting:
C. waxy flexibility.
39. A client with borderline personality disorder becomes angry when he is told that today’s psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client’s anger?
A. “If it had been your emergency, I would have made the other client wait.”
B. “I know it’s frustrating to wait. I’m sorry this happened.”
C. “You had to wait. Can we talk about how this is making you feel right now?”
D. “I really care about you and I’ll never let this happen again.”
40. A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?
D. Systemic dermatitis
41. Which nonantipsychotic medication is used to treat some clients with schizoaffective disorder?
A. phenelzine (Nardil)
B. chlordiazepoxide (Librium)
C. lithium carbonate (Lithane)
D. imipramine (Tofranil)
42. A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders?
A. Personality disorder
B. Mood disorder
C. Thought disorder
D. Amnestic disorder
43. When teaching the family of a client with schizophrenia, the nurse should provide which information?
A. Relapse can be prevented if the client takes the medication.
B. Support is available to help family members meet their own needs.
C. Improvement should occur if the client has a stimulating environment.
D. Stressful family situations can precipitate a relapse in the client.
44. A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other
conditions. Schizophrenia is characterized by:
A. loss of identity and self-esteem.
B. multiple personalities and decreased self-esteem.
C. disturbances in affect, perception, and thought content and form.
D. persistent memory impairment and confusion.
45. The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should:
A. ask the client which activity he would prefer to do first.
B. negotiate a time when the client will perform activities.
C. tell the client specifically and concisely what needs to be done.
D. prepare the client ahead of time for the activity.
46. The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:
C. loose associations.
47. The nurse is aware that antipsychotic medications may cause which of the following adverse effects?
A. Increased production of insulin
B. Lower seizure threshold
C. Increased coagulation time
D. Increased risk of heart failure
48. A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is:
A. highly important or famous.
B. being persecuted.
C. connected to events unrelated to oneself.
D. responsible for the evil in the world.
49. A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign highest priority to which nursing diagnosis?
B. Impaired verbal communication
C. Disturbed thought processes
D. Self-care deficient: Dressing/grooming
50. A client’s medication order reads, “Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n.” The nurse should:
A. administer the medication as prescribed.
B. question the physician about the order.
C. administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n.
D. administer the medication as prescribed but observe the client closely for adverse effects.
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