FINAL COACHING

PSYCHIATRIC NURSING
Prepared by: Prof. Lester Lintao
Take One Nursing

Situation: Miss dela Cruz, a teacher, is brought to the hospital by an ambulance with strangulation marks on the neck,
broken jaw and lacerations to her face. According to her, this was not the first time that she was beaten by her husband,
a successful lawyer.

1. Initially, the nurse identifies which one of the following nursing diagnoses?
a. Injury
b. Decreased cardiac input
c. Potential for infection
d. Altered tissue perfusion

2. Women are more vulnerable to home violence because of one of the following reasons:
a. They are socially and financially dependent on men.
b. Because of their parenting role.
c. Because of their ethnic backgrounds.
d. They possess below average mental ability.

3. Which of the following is not a coping device abused women use?

a. Assertiveness
b. Self-blame
c. Rationalization
d. Somatization

Situation: Nelson, 26 years old, was admitted to the detoxification unit of the hospital. Nelson is an alcoholic.

4. Which of the following are not signs of alcohol intoxification?

a. Vomiting, unconsciousness
b. Slurred speech, unsteady gait
c. Pupil dilation, seizures
d. Hypotension, bradycardia

5. When alcoholics have blackouts, they experience:

a. Unconsciousness and inability to sense development
b. An episode where they function without awareness
c. Functioning well in the environment and knowledge of what happens
d. Inability to function in the environment but intact memory

6. What anxiolytics can be used for alcohol withdrawal?

a. Chlorpromazine (Thorazine)
b. Chlordiazepoxide (Librium)
c. Lithium Carbonate
d. Amitriptyline (Elavil)

7. If Nelson takes Disulfiram (Antabuse), the nurse should instruct him to avoid which of the following?
a. Milk
b. Mouthwash
c. Colas
d. Wheat bread
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8. The basis for the effectiveness of alcohol abuse treatment is based on:
a. Abstinence from alcohol
b. Forming interpersonal relationships
c. Attending alcoholics anonymous
d. Ability to volunteer in community works

Situation: Penny Marcos is a 48-year-old who worked for a postal office until 3 weeks ago her daughter accompanied her
to a psychiatric unit because she already lost 30 lbs. during the past 4 mos. Her daughter further described that her mother
is having a poor appetite, being isolative, having hard time to sleep and verbalizing thoughts with suicidal overtones. She
was prescribed amitriptyline 25 mg TID. She has improved slightly and relapsed into a deeper depression and lately has
begun to verbalize suicidal thoughts. Based on her poor response to antidepressants and her suicidal thoughts, a course
of 6 ECT treatments was prescribed.

9. Before Penny will begin to have electroconvulsive therapy (ECT), the nurse should tell her that:
a. Pre-medications will be given.
b. With new methods of administration, treatment is totally safe.
c. It is better not to talk about it, but you can ask any question you like.
d. There may be some permanent memory loss as a result of the treatment.

10. When the nurse is explaining the procedure to Penny, she should emphasize that:
a. Answers to any questions will be provided
b. A period of amnesia will follow the treatment
c. The treatments will make the client feel better
d. The client will not be alone during the treatment

11. A side effect of ECT that client may experience is:

a. Loss of appetite
b. Postural hypotension
c. Complete loss of memory for a time
d. Coronary artery disease

12. Succinylcholine (Anectine) given immediately preceding ECT produces which of the following?
a. Muscle relaxation (paralysis)
b. Anesthesia
c. Decreased amounts of secretions (decreased possibility of aspiration)
d. Convulsive activity

Situation: Mr. Rosales, 33 years old, a salesman, was admitted by his wife due to behavioral changes. He was observed to
be very irritable, have loud rapid speech, hyperactive, and jumps from one topic to another.

13. Mr. Rosales’ behavior is indicative of mood disorder specifically:

a. Major Depressive Disorder
b. Bipolar
c. Cyclothymia
d. Dysthymia

14. Which of the following psychodynamics explains the behavior of Mr. Rosales?
a. Experience of loss at early life
b. A pessimistic view about life
c. Massive denial of depression
d. Persistent unsuccessful resolution of conflicts

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15. Which of the following nursing diagnosis is appropriate for Mr. Rosales?
a. Altered Sensory Perception related to excessive neurochemicals
b. Impaired speech related to cognitive deterioration
c. Risk for injury towards others related to hyperactivity
d. Altered activity related to altered sensory perception

16. Mr. Rosales kept on standing up and monopolizing the activity therapy. What problem will arise from these behaviors?
a. Self-care deficit
b. Altered thought process
c. Inappropriate affect
d. Impaired social interaction

17. When a manic client starts to boss around other clients and creates conflict, what behavior does these situations
indicate?
a. Aggression
b. Manipulation
c. Depression
d. Elation

Situation: Ella, is a 45 year old, well-educated, intelligent female who has been in and out of therapy for a long time ( 15
to 20 years). She grew up in a province with two brothers and a very physically and emotionally abusive father. Ella reports
that, when she was quite young, her mother left home and did not return for several years. Ella left home at age 17 and
was married twice and divorce shortly after each marriage. She has attempted suicide many times and commented that
her life is so futile that she would rather be dead.

18. The statement that would be most appropriate for the nurse to use in interviewing a newly admitted, depressed client
like Ella, whose thoughts focus on unworthiness and failure would be:
a. “Tell me how you feel about yourself.”
b. “Tell me what has been bothering you.”
c. “Why do you feel so bad about yourself?”
d. “What can we do to help you during your stay with us?”

19. After admission, the nurse needs to evaluate Ella’s potential for suicide. The approach that would best gain this
information would be to ask:
a. Ella about her future plans
b. Ella whether suicide is now being considered
c. Family members whether Ella has ever attempted suicide
d. Other clients about suicide while Ella is in the group

20. The action by the nurse that would be most appropriate when Ella said, “I am no good. I’m better off dead.” would
be:
a. Stating, “I think you’re good; you should think of living.”
b. Alerting the staff to provide 24-hour observation of the client
c. Responding, “I will stay with you until you are less depressed.”
d. Unobtrusively removing those articles that could be use for suicide attempt.

21. A positive nursing action when caring for a depressed client like Ella is to:
a. Play a game of chess with the client
b. Allow the client to make personal decisions
c. Sit down next to the client as often as possible
d. Provide the client with frequent periods of thinking time

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22. Nurse Joy is assigned to care for Ella on the day when Ella seems more withdrawn and depressed than usual. It would
be most appropriate for Nurse Joy to:
a. Remain visible to the client
b. Get the client involved in group activities
c. Ask the client, “May I sit down next to you for a while?”
d. Periodically spend a few minutes with the client throughout the day

23. When Nurse Joy sits next to Ella and begins to talk, Ella says to the nurse, “I’m stupid and useless. Talk with the other
people who are important.” It would be most therapeutic for Nurse Joy to respond:
a. “Everyone is important.”
b. “You feel that you are not important.”
c. “Why do you feel you are not important?”
d. “I want to talk with you because you are important.”

Situation: Donnalyn, 6 years old, the youngest of four daughters of Mr. and Mrs. Santiago was brought to the emergency
room with bruises all over h body and lacerations on her face.

24. During the initial interview with the parent, they gave a typical description of an abused child when they say that
Donnalyn:
a. Has always been different from her sisters
b. Does not show respect for elders
c. Tends to lie frequently
d. Always displays temper tantrums

25. An appropriate nursing diagnosis based on initial assessment upon admission is:
a. Impaired skin integrity
b. Potential for infection
c. Altered physical mobility
d. Altered tissue perfusion

26. According to Freud, the psychosocial development stage of Donnalyn is:

a. Phallic
b. Oral
c. Anal
d. Genital

27. A nursing intervention which would help abusive parents is:

a. Allow them to relate the history of child abuse in their family
b. Instruct them on how they can encourage their children to obey them
c. Teach them to handle angry behavior before it gets out of control
d. Explain to them that as the child grows older, their needs differ

28. One of the following indicates that the abusive parents are responding to the treatment:
a. Recognizes that the child has distinct stages of growth and development
b. Able to express their own frustrations and anxieties
c. Recognize that their needs are secondary to their child's needs
d. Start to talk about the child's mistakes realistically

29. 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.
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Situation: Mrs. Santos was brought by her daughter to a psychiatric unit. Her daughter said that they noticed lately that
her mother seemed to be more forgetful and would ask the same question over and over and often relate same story
several times. And early this morning, they visited her mother in her house and found her looking very tired, dressed in a
wrinkled dress that looked soiled and couldn’t remember what she had eaten for breakfast that’s why they decided to
bring her to the psychiatric unit. Mrs. Santos is diagnosed with Alzheimer’s disease.

30. In making a plan of care for a client with Alzheimer’s, which of the following is should be the priority goal?
a. The client will maintain an adequate balance of activity and rest, nutrition,
hydration, and elimination
b. The client will feel supported and respected
c. The client will function as independently as possible given his or her limitations
d. The client will be free of injury.

31. All of the following behaviors can be seen to a client with dementia, except:
a. Loss of long-term memory
b. Sudden acute confusion
c. Change in personality traits
d. Loss of language abilities

32. In taking care of client with dementia that needs a long-term care, the nurse should know that which of the following
interventions will help the client to maintain optimal cognitive functioning?
a. Discuss pictures of children and grandchildren with the client
b. Do word games or crossword puzzles with the client
c. Provide the client with a written list of daily activities
d. Read a newspaper and discuss it with the client

33. The nurse should know that which of the following will best define the Alzheimer’s disease?
a. A slowly progressive neurologic condition characterized by tremor, rigidity, bradykinesia and postural
instability.
b. A progressive brain disorder that has an abrupt onset followed by rapid changes in functioning
c. A degenerative brain disease that particularly affects the frontal and temporal lobes of the brain
d. A progressive brain disorder; that has gradual onset but causes an increasing decline in functioning

34. Which of the following is/are the appropriate intervention for a confused client, except:
a. Providing a trusting relationship
b. Doing reality orientation when the client is confused
c. Giving activities that are varied
d. none of the above

Situation: Marlene, 35 years old, has difficulty falling asleep, with poor appetite which started after being terminated from
work

35. A relevant information about crisis is it:

a. Is not caused by a stressful event
b. Can result to personality disorganization
c. Can not lead to personal growth
d. Is a pathological state

36. An initial nursing diagnosis would be:

a. Altered family process
b. Impaired adjustment
c. Ineffective individual coping
d. Altered thought process

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37. Maturational crisis can be prevented through:
a. Family therapy
b. Milieu therapy
c. Anticipatory guidance
d. Group therapy

38. When helping a person in crisis, it is helpful to remember that the one who solves the problem is the:
a. Nurse
b. Client / patient
c. Psychiatrist
d. Family

Situation: A cashier in a grocery store, Thelma, 25-year-old, was sexually abused by a tricycle driver while on her way home
from work one evening. She was brought to the ER with bruises all over the body.

39. Illustrating her initial interaction with Thelma, she was crying uncontrollably and appears to be very anxious. The
nurse therapeutically communicates with her by saying one of the following statements:
a. “You are very upset, calm yourself first.”
b. “I know something terrible and horrifying happened to you.”
c. “Would you like to relate to me what happened?”
d. “Can you identify who did this to you?”

40. For victims of several abuse like Thelma, the nurse can help her lower her level of anxiety by doing which one of the
following?
a. Assessing her family history
b. Identify Thelma’s coping mechanisms
c. Allowing Thelma to express her feelings and concerns
d. Utilizing her knowledge of human sexuality

41. A relevant nursing diagnosis that Nurse Isabel identified would be which one of the following?
a. Defensive coping
b. Anxiety, moderate
c. Ineffective individual coping
d. Self-esteem disturbance

42. Crisis intervention is carried out for Thelma with the following short-term goal:
a. Help Thelma express her reactions and feeling about the sexual assault
b. Assist her to regain her self-worth
c. Assist Thelma recognize her life
d. Help Thelma identify the significant others in her life]

Situation: Margie, 15 years old, who is 5’8” tall and weigh 90 pounds was brought to a mental health facility. Her parents
said she is an avid ballet dancer and believes that she has to lose more weight to achieve the figure she wants. She often
stays in her room and performs excessive exercise even in the middle of the night. She already lost a lot of weight. She is
diagnosed

Situation: Experts discuss the importance of sexuality to a person’s self-esteem. Disorders on this aspect of personality
would greatly influence how a person may act.

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43. Which of the following complications is most likely the cause for a 35-year-old male client who complains to the nurse
that he has an orgasm quickly?
a. Fear of intimacy
b. Premature ejaculation
c. Sexual aversion disorder
d. Hypoactive sexual desire disorder

44. Research performed on sexual disorders has shown that victims of sexual abuse have a tendency to experience which
of the following results?
a. Have higher hormonal levels
b. Remain celibate throughout life
c. Become sex offenders themselves
d. Have normal sexual experiences throughout life

45. A 32-year-old client who engages in voyeurism has come to the hospital for treatment so his family and friends don’t
find out. The nurse planning care for this client should include which of the following?
a. Encourage the client to inform his family and friends so that he isn’t living a lie.
b. Suggest individual therapy to discuss socially unacceptable behavior
c. Develop the care plan without input from the client
d. Evaluate the client’s defense mechanism

46. A 38-year-old woman was returning home from the store late one evening and was sexually assaulted. When she’s
brought to the emergency department, she’s crying. Which of the following concerns for this client should be the best
nurse’s first priority?
a. Filing a police report
b. Calling the client’s family
c. Encouraging the client to enroll in a self-defense class
d. Remaining with the client and assisting her through the crisis.

47. Which of the following nursing diagnoses is most appropriate for a client with sexual masochism?
a. Risk for self-mutilation
b. Ineffective role performance
c. Ineffective coping
d. Risk for other-directed violence

Situation: Ben, a 14-year-old student, was brought by his parents to a mental health center because his parents cannot
control him anymore. He is usually involved in physical fights and already smoking and drinking. His parents are always
called to go to the guidance counselor of Ben’s school because he is involved in vandalism, destruction of school
properties and he also has low grades. Recently, he was caught stealing chocolates in a supermarket. He is diagnosed
with conduct disorder.

48. In dealing to a client with Conduct disorder like Ben, the nurse should know that which of the following is an
effective nursing intervention for the impulsive and aggressive behaviors that accompany conduct disorder?
a. Assertiveness training
b. Consistent limit setting
c. Negotiation of rules
d. Open expression of feelings

49. Which of the following is the priority intervention for a client with conduct disorder?
a. Promoting social interaction
b. Decreasing violence
c. Improving coping skills
d. Providing client and family education

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50. The nurse should be aware that children with persistent conduct disorder are prone to develop which personality
disorder of an adult?
a. Borderline personality disorder
b. Paranoid personality disorder
c. Antisocial personality disorder
d. Histrionic personality disorder

51. All of the following are true about conduct disorder, except:
a. People with conduct disorder have more empathy to others
b. It is frequently associated with early onset of drinking and smoking
c. It is more common to boys than girls
d. Poor parenting is one of the risk factors for conduct disorder

52. Which of the following is an acceptable characteristic of adolescents?

a. Highly ambivalent toward parents
b. Poor relationship with peers
c. Frequent hypochondriacal complaints
d. Unwillingness to assume greater autonomy

Situation: For more than a month now, Jelai 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.

53. Jelai has a lot of irrational thoughts. The Goal therapy is to modify her:
a. Communication
b. Cognition
c. Observation
d. Perception

54. Cognitive therapy is indicated for Jelai when she is already able to handle anxiety reactions. Which of the following
should the nurse implement?
a. Assist her in recognizing irrational beliefs and thoughts
b. Help find meaning in her behavior
c. Provide positive reinforcement for acceptable behavior
d. Administer anxiolytic

55. Being in contact with reality and environment is a function of the:

a. Conscience
b. Ego
c. Id
d. Super ego

56. Jelai is demonstrating:

a. Acrophobia
b. Claustrophobia
c. Agoraphobia
d. Xenophobia

Situation: Miko Mira, a 69 year old retired truck driver, has been very dependent for some time. After careful assessment,
it is determined that Miko Mira is depressed. TCA is given to him as an anti-depressant.

57. Which of the following TCA side effects would be a special concern for Miko Mira?
a. Mania
b. Amenorrhea
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 c. Dry mouth
d. Urinary retention

58. Other side effects that might be a concern for Miko Mira’s nurse is:
a. Undiagnosed narrowed angle glaucoma
b. A diagnosis of diabetes mellitus
c. A history of herpes
d. Cataracts

59. During the first day of treatment of TCA, you expect:

a. An improvement in muscle control
b. Anticholinergic side effects.
c. An improvement in mood
d. Signs of toxicity

60. After he has been started on a tricyclic antidepressant. Nurse Patty teaches him to expect to notice a significant change
in the depression within:
a. 12 to 26 hours
b. 2 to 3 weeks
c. 4 to 6 days
d. 5 to 6 weeks

Situation: Benjie, a client with a hyperactive phase of a mood disorder, bipolar type, is receiving lithium carbonate. The
nurse notes the client’s lithium blood level is 1.8meq/L.

61. It would be most appropriate for the nurse to:

a. Continue the usual dose of lithium and note any adverse reaction
b. Hold the drug and notify the physician immediately because the blood lithium level is toxic
c. Discontinue the drug until the serum lithium level drops to 0.5meq/L
d. Ask the physician to increase the dose of lithium because the blood lithium level is too low

62. While taking care of a client who is receiving lithium carbonate, it is important for the nurse to:
a. Monitor the client’s blood level regularly
b. Test the client’s urine weekly
c. Withhold the client’s other medications for 1 week
d. Restrict client’s sodium intake

63. Which of the following statements true of Lithium?

a. Lithium is naturally occurring element
b. Lithium has always been used for treatment schizophrenia
c. Lithium level should be taken one per month after patient is stabilized
d. A mild hand tremor is an early side affect

64. Which of the following cognitive disorders is characterized by a disturbance of consciousness and a change in cognition
that develops rapidly over a short period?
a. Alzheimer’s disease
b. Amnesia
c. Delirium
d. Dementia

65. A nurse places an object in the hand of a client with Alzheimer’s disease and asks the client to identify the object.
Which of the following terms represents the client’s inability to name the object?
a. Agnosia
b. Aphasia
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 c. Apraxia
d. Perseveration

66. A 20-year-old client is admitted to the hospital with a diagnosis of schizophrenia. During the initial assessment, he
points to the nurse’s stethoscope and say it’s a snake. Which of the following terms describes this phenomenon?
a. Abstraction
b. Delusion
c. Hallucination
d. Illusion

67. A client with schizophrenia tells the nurse, “I can hear voices; they are telling me that I’m evil and I must die.” The
nurse knows that the client is experiencing:
a. A delusion
b. Ideas of reference
c. Flight of ideas
d. A hallucination

68. Magielyn, who is being cheated by her boyfriend for many times says, “I hate him and I want to let him go every time
he hurts me, but I can’t because I love him.” This is an example of:
a. Reaction formation
b. Ambivalence
c. Acting out
d. Delusion

NON-SITUATIONAL

69. One day while watching TV, the patient suddenly runs over and states to announcer, “I told you already, I am not a
homosexual.” This behavior is best described as
a. Hallucination
b. An idea of reference
c. Introjection
d. Labeling

70. One afternoon, the nurse hears the client says, “It is Dave who gave the cave to Gabe, who is brave.” The nurse
suspects that the client is doing:
a. Clang association
b. Verbigeration
c. Word salad
d. Neologism

71. A client who is depressed and having no pleasure or joy in life is experiencing:
a. Flat affect
b. Anhedonia
c. Agnosia
d. Apathy

72. The so-called “battle cry” of adolescents are:

a. Play or isolation
b. Freedom or rebellion
c. Work or stagnation
d. Freedom or intimacy

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73. Children’s judgments are based on the norms and expectations of the group. This is a characteristic of which level in
Kohlberg’s Moral Development Theory?
a. Preconventional Morality
b. Conventional Morality
c. Postconventional Morality
d. Any of the above

74. Surgery can be very traumatic for a child. The nurse, when performing preoperative preparation, knows that according
to Piaget’s stages of cognitive development, children will experience the greatest fear during the:
a. Sensorimotor stage
b. Preoperational stage
c. Formal operational stage
d. Concrete operational stage

75. According to Piaget’s theory, one characteristics of the preoperational period is:
a. Object permanence
b. Animism
c. Conservation
d. Moral idealism

76. According to Freud, understanding a person should involve which action?

a. Modifying behavior by manipulating the environment
b. Using desensitization
c. Uncovering past events
d. Using family therapy

77. When a boy of 5 years old shows extreme attachment to his mother, he is likely to be undergoing which stage of
psychosexual development?
a. Oedipal complex
b. Latent stage
c. Phallic stage
d. Pre-genital stage

78. Serotonin has been associated with depression because it plays which of the following roles?
a. It plays a role in cerebral function
b. It has a proposed role in mood states
c. It is found widely in the hippocampus
d. It regulates the sleep and wakefulness cycle

79. In evaluating the effectiveness of teaching a client with depression, the client demonstrates understanding of
depressive symptoms if the client states the symptoms are a result of:
a. Excessive serotonin activity in the central nervous system (CNS)
b. Insufficient serotonin activity in the CNS
c. Excessive dopamine activity in the CNS
d. Insufficient dopamine activity in the CNS

80. Which of the following mental disorder is associated with the gamma-aminobutyric acid (GABA) complex?
a. Alzheimer’s
b. Anxiety
c. Depression
d. Posttraumatic stress disorder

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81. After several meetings, the nurse realizes that she has not been able to establish a therapeutic relationship with the
patient. What action should be a priority in this situation?
a. Refer the patient to another nurse or another unit
b. Do a self-assessment on interactions with the patient
c. Limit the amount of time with this particular patient
d. Ask the unit manager to change nursing assignment

82. During the initial interview with a client, the nurse begins to feel uncomfortable and realizes the client’s behaviors
and mannerisms remind the nurse of her abusive mother. The nurse realizes this phenomena is known as:
a. Transference
b. Countertransference
c. Denial
d. Reaction formation

83. The nurse is preparing the client for the termination phase of the nurse-client relationship. The nurse prepares to
implement which nursing task appropriate for this phase?
a. Planning short-term goals
b. Making appropriate referrals
c. Developing realistic solutions
d. Identifying expected outcomes

84. Unresolved feelings related to loss most likely may be recognized during which phase of the therapeutic nurse-client
relationship?
a. Working
b. Trusting
c. Orientation
d. Termination

85. The nurse is aware that transference is the:

a. Nurse’s partly unconscious or conscious emotional reaction to the client
b. Process used to find equilibrium between oneself and one’s environment
c. Client’s unconscious assignment to the nurse of feelings originally meant for others
d. Proves of auto-diagnosis or self-awareness that develops and expands with psychotherapy

86. Which of the following communication technique is MOST effective in dealing with covert communication?
A. Validation
B. Evaluation
C. Listening
D. Clarification

87. Which of the following is most important in fostering a positive relationship?

A. The nurse must fully share the patient’s feelings before she can develop her goal for her nursing care.
B. The nurse recognizes that some patients regress when confronted with illness
C. The nurse functions as a positive role model to encourage health oriented patient behavior.
D. Needs to understand that patients may test her before he can accept and trust her.

88. When the nurse starts to feel sorry for the client and tries to compensate by trying to please him or her is starting to
develop which of the following?
a. Empathy
b. Sympathy
c. Acceptance
d. Avoidance

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89. When the nurse is calling the client by name, spending time with the client, and responding openly, the nurse conveys:
a. Acceptance
b. Empathy
c. Positive regard
d. Genuine Interest

90. For most nurses, the most difficult part of the nurse-client relationship is:
a. Remaining therapeutic and professional at all times
b. Being able to understand and accept the client’s behavior
c. Developing awareness of self and the professional role in the relationship
d. Accepting responsibility in identifying and evaluating the real needs of the client

91. Which of the following numbers of members in a therapy group ideal? *

a. 1 to 4 members
b. 8 to 10 members
c. 4 to 7 members
d. 10 to 15 members

92. The therapist role that a nurse would assume if she were designated as a group leader for a group therapy session
would be
a. Role model for effective communication
b. Clarifier and validator of patient responses
c. Facilitator and interpreter
d. All of the above

93. Nursing interventions that are appropriate during electroconvulsive therapy include the following, except:
a. Have the consent from signed
b. Ask the patient to drink 1 glass of water before the procedure
c. Remove hairpins and dentures of the patient
d. Observe the patient closely after the treatment until the patient is oriented and steady.

94. What is the most effective technique in treating a client with phobia?
a. confrontation to determine if the fear is based on reality
b. immediate exposure to the feared situation
c. distraction each time the client complains of the fearful situation
d. gradual desensitization by controlled exposure to the feared situation

95. On discharge after treatment for alcoholism, a client plans to take disulfiram (Antabuse) as prescribed. When teaching
the client about this drug, the nurse emphasizes the need to:
a. avoid all products containing alcohol.
b. adhere to concomitant vitamin B therapy.
c. return for monthly blood drug level monitoring.
d. limit alcohol consumption to a moderate level.

96. One of the outcomes of play therapy is to enable children to:

a. Act out feelings in a constructive manner
b. Learn to talk openly about themselves
c. Learn how to give and receive feedback
d. Learn problem-solving skills

97. Which of the following statements best describes the key advantage using groups in psychotherapy?
a. Decreases the focus on the individual
b. Fosters the physician-client relationship
c. Confronts individuals with their shortcomings
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 d. Fosters a new learning environment

98. The nurse-therapist utilizing cognitive therapy in working with a 35-year-old woman diagnosed with depression.
The focus of his approach to therapy is to:
a. Learn to intellectualize feelings
b. Learn to focus on thought, not feeling
c. Replace concrete thinking with abstract
d. Replace irrational, negative thinking

99. The most important advantage a depressed client gains from a group therapy is:
a. Improved social interactions and focus on other’s problems
b. Improved reality orientation
c. Greater insights into problems through the concept of universality
d. Greater insight and knowledge of self through feedback provided by group members

100. The use of stories, pictures and other media to recall the memories and elderly prompting her to verbalize
feelings is known as:
a. Reminiscent therapy
b. Psychodrama therapy
c. Story-telling therapy
d. Recreational therapy

101. Alcohol detoxification is based on which type of therapy? *

a. Biomedical therapy
b. Pharmacotherapy
c. Aversion therapy
d. Psychoanalysis

102. The physician has ordered imipramine (Tofranil), 75 mg tid, for a client. An appropriate nursing action when giving
this drug is to:
a. Avoid administration of barbiturates or steroid with this drug.
b. Warn the client not to eat cheese, fermenting products, and chicken liver.
c. Observe the client for increased tolerance so that the therapeutic dosage is maintained.
d. Have the client checked for intraocular pressure and provide instructions to watch for symptoms of glaucoma.

103. A psychiatric client is to be discharged with orders for haloperidol (Haldol) therapy. When developing a teaching
plan for discharge, the nurse should include cautioning the client against:
a. Driving at night
b. Staying in the sun
c. Ingesting wines and cheeses
d. Taking medications containing aspirin

104. Drugs such as trihexyphenidyl (Artane), biperiden (Akineton), or benztropine (Cogentin) is often prescribed in
conjunction with:
a. Barbiturates
b. Antidepressants
c. Antianxiety agents/anxiolytics
d. Antipsychotic agents/neuroleptics

105. Photosensitization is a side effect associated with the use of:

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 a. Sertraline HCl (Zoloft)
b. Lithium carbonate (Lithane)
c. Methyphenidate hydrochloride (Ritalin)
d. Chlorpromazine hydrochloride (Thorazine)

106. An extrapyramidal symptom that is a potentially irreversible side effect of antipsychotic drugs is;
a. Torticollis
b. Oculogyric crisis
c. Tardive dyskinesia
d. Pseudoparkinsonism

107. Haloperidol (Haldol) 5 mg tid is ordered for a patient with schizophrenia. Two days later, the patient complains of
“tight jaws and a stiff neck.” The nurse should recognize that these complaints are:
a. Common side effects of antipsychotic medications that will diminish over time.
b. Early symptoms of extrapyramidal reactions to the medication.
c. Psychosomatic complaints resulting from a delusional system.
d. Permanent side effects of Haldol.

108. A patient with a history of alcoholism is brought to the emergency room in an agitated state. He is vomiting and
diaphoretic. He says he had his last drink five hours ago. The nurse would expect to administer which of the following
medications?
a. Chlordiazepoxide hydrochloride (Librium)
b. Methadone hydrochloride (Dolophine)
c. Disulfiram (Antabuse)
d. Naloxone hydrochloride (Narcan)

109. While teaching the patient the nurse explains the purpose of antipsychotic drugs. These medications have been
proven to be effective in:
a. Curing symptoms
b. Controlling symptoms
c. Preventing psychosis
d. Curing mental illness

110. The nurse promptive reports which symptom when the patient is taking psychotic medications?
a. Mild rash
b. Dry mouth
c. Sore throat
d. Photosensitivity

111. The nurse is providing patient to the patient who has just diagnosed with major depression and prescribed
amitriptyline (Elavil) 50 mg hs. The patient is instructed that medication will take effect.
a. Immediately
b. In about 36 hours
c. In 14-21 days
d. In about a month

112. Blood levels are drawn on the patient who has been taking Lithium for about six months. The present level is 2.1
mEq/L. The nurse evaluate this level as:
a. Therapeutic
b. Below therapeutic
c. Potentially dangerous
d. Fatally toxic

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113. The nurse assesses increasing restless, agitation, swinging of legs, and pacing in the patient who has been talking
Thorazine 400 mg daily. The nursing evaluation is:
a. EPS
b. NMS
c. Dystonia
d. Akathisia

114. 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?
a. Potato chips
b. Salami
c. Chicken
d. Oat cereal

115. Lorazepam (Ativan) is primarily effective in treating which of the following?

a. Hallucinations
b. Delusions
c. Anxiety
d. Incoherent speech

116. Which classification of psychotropic drugs includes sertraline (Zoloft)?

a. Tricyclic antidepressants
b. Monoamine oxidase inhibitors
c. Phenothiazines
d. Selective serotonin reuptake inhibitors

117. Three days after a client is started on a tricyclic antidepressant, the client still exhibits signs of agitation, anxiety,
and restlessness. What is the most likely explanation for this?
a. The client is not taking the medication
b. The client is not responding to the medication
c. Therapeutic effects of these agents occur in 2 to 3 weeks
d. The dosage is too small to be effective

118. As part of a teaching plan on lithium carbonate, clients are instructed to have lithium levels determined every 1
to 3 months when they are outpatients. Which statement best describes the reason for this?
a. Lithium carbonate can produce potassium and magnesium depletion
b. Triglyceride levels can increase as the lithium level increases
c. Lithium carbonate in large quantities produces sedation resulting in safety risks
d. A narrow margin of safety exists between therapeutic and toxic levels of lithium carbonate

119. A client is receiving monoamine oxide inhibitors (MAOs) as part of the treatment. Which food would be most
important for the nurse to stress to avoid?
a. Organ meats
b. Sardines
c. Shellfish
d. Legumes

120. A patient receiving lithium carbonate complains of blurred vision and appears confused. The nurse also notices
that the client is having difficulty maintaining balance. Which of these nursing actions are appropriate?
a. Administer a PRN anti-parkinsonism drug and hold all other drugs
b. Take the client's vital signs and administer high-potassium foods
c. Hold the client's next dose of medication and notify the physician immediately
d. Sit with client to talk and teach the side effects of lithium
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121. The drug of choice for anxiety disorders is:
a. Zoloft
b. Valium
c. Disulfiram
d. Librium

122. When working with the client in crisis, which of the following is most important?
a. Obtaining a complete assessment of the client’s past history
b. Remaining focused on the immediate problem
c. Determining whether the client may have had a part in the emergence of the crisis
d. Assisting the client to identify what is similar about this crisis to other crises in the client’s life

123. 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:
a. Often are overwhelmed, feel isolated, and may be unable to ask for help on their own
b. Lose their ability to act autonomously
c. Have an external locus of control
d. Feel guilty

124. Which of the following is the best approach for the nurse to use in crisis counseling?
a. Reassuring
b. Passive listening
c. Explore early life experiences
d. Active, with focus on current situation

125. The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that
the admission nurse has documented that the client is experiencing anxiety as a result of a situational crisis. The nurse
determines that this type of crisis could be caused by:
a. Experiencing menarche
b. A death of a loved one
c. A storm that destroyed a client’s home
d. A pending retirement

126. The nurse is conducting an initial assessment on a client in crises. When assessing the client’s perception of the
precipitating event that led to the crisis, the appropriate question to ask is:
a. “With whom do you live?”
b. “Who is available to help you?”
c. “What leads you seek help now?”
d. “What do you usually do to feel better?”

127. The nurse is developing a plan of care for the client in a crisis state. When developing the plan, the nurse considers
which of the following?
a. A crisis state indicates that the individual is suffering from a mental illness.
b. A crisis state indicates that the individual is suffering from an emotional illness.
c. Presenting symptoms in a crisis situation are similar for all individuals experiencing a crisis.
d. A client’s response to a crisis is individualized and what constitutes a crisis for one person may not constitute
a crisis for another.

128. Rape victims develop phobia as a defense reaction to the incident such as fear of being alone. This is known as
one of the following:
a. Mysophobia
b. Agoraphobia
c. Monophobia
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 d. Claustrophobia

129. A client is admitted to a mental health unit for treatment of psychotic behavior. The client is at the locked exit
door and is shouting. “Let me out. There’s nothing wrong with me. I don’t belong here” The nurse analyzes this
behavior as:
a. Denial
b. Projection
c. Regression
d. Rationalization

130. They are used in everyday situations, mostly unconsciously. Of the following, who uses displacement as a defense
mechanism?
a. Nurse Orly is specially kind and courteous to a patient whom he had a fight with and filed a complaint against
him the other day.
b. Nurse Mimi, after being reprimanded by the head nurse shouts at the nursing aide for accidentally knocking
over the patient’s milk
c. Nurse Jen who is thinking too much about her promotion that it interferes with her work. She chooses to set
her thoughts aside until she finishes her duty
d. Nurse Ayo who gave the wrong dosage of medication to a patient, points the finger at the physician for having
bad handwriting

131. The most common defense mechanism is:

a. Denial
b. Regression
c. Introjection
d. Rationalization

132. The supervisor reprimands the nurse in charge of the nursing unit because the charge nurse has not adhered to
the unit budget. Later that afternoon, the charge nurse accuses the nursing staff of wasting supplies. This behavior is
an example of:
a. Denial
b. Repression
c. Suppression
d. Displacement

133. Benny, a male college student, who is smaller than average and unable to participate in sports, becomes the life
of the party and a stylish dresser. This is an example of the defense mechanism of:
a. Introjection
b. Compensation
c. Sublimation \
d. Reaction Formation

134. A nurse should know that sublimation is a defense mechanism that helps the individual:
a. Act out in reverse something already done or thought
b. Return to an earlier, less mature, stage of development
c. Channel unacceptable sexual desires into socially approved behavior
d. Exclude from consciousness things that are psychologically disturbing

135. After his teammates told Karl that he has a resemblance to a famous basketball player, Karl started trying to
imitate the player’s mannerisms and style in playing. Karl is using which defense mechanism?
a. Idealization
b. Identification
c. Introjection
d. Substitution
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136. Mrs. Martin is too sad to eat and started to act unusual after the death of her husband. She is diagnosed of having
major depression. During a one on one interaction with the nurse, Mrs. Martin says, “I don’t cry because I don’t want
my children to see me crying.” The nurse needs to be aware that the client is using:
a. Suppression
b. Repression
c. Undoing
d. Rationalization

137. After not passing the board exams, Oma told a friend, “I was not able to concentrate well on answering the test
questions because I had a terrible headache then.”
a. Denial
b. Projection
c. Rationalization
d. Intellectualization

138. Assessment data of children with autism includes the following, except:
a. Social interaction impairment
b. Aggression towards people
c. Delay in language development
d. Stereotypic behavior

139. A 3-year-old client has been diagnosed with attention deficit/hyperactivity disorder (ADHD). Which medication is
most likely to be prescribed?
a. Amitriptyline (Elavil)
b. Paroxetene (Paxil)
c. Methylphenidate (Ritalin)
d. Pemoline (Cyclert)

140. When planning the discharge of a client with chronic anxiety, the nurse directs the goal at promoting a safe
environment at home. The appropriate maintenance goal should focus on which of the following?
a. Ignoring feelings of anxiety
b. Identifying anxiety-producing situations.
c. Continued contact with a crisis counselor
d. Eliminating all anxiety from daily situations

141. A woman comes into the emergency in a severe state of anxiety following a car accident. The appropriate nursing
intervention is to:
a. Remain with client.
b. Put a client in a quiet room.
c. Teach the client deep breathing.
d. Encourage the client to talk about their feelings and concerns.

142. A client is admitted to a medical nursing unit with a diagnosis of acute blindness. Many tests are performed, and
there seems to be no organic reason why his client cannot see. The nurse later learns that the client became blind
after witnessing a hit-and-run car accident, when a family of three was killed. The nurse suspects that the client may
be experiencing a:
a. Psychosis
b. Repression
c. Conversion disorder
d. Dissociative disorder

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143. A nurse is assessing a client diagnosed with dependent personality disorder. Which of the following characteristics
is a major component of this disorder?
a. Abrasive disorder
b. Indifferent to others
c. Manipulative of others
d. Overreliance on others

144. A patient with a Borderline Personality Disorder is most likely to demonstrate:

a. Apathy
b. Introspection
c. Disappointment
d. Impulsivity

145. Which of the following best explains common responses of clients with antisocial personality disorders?
a. low self-esteem and poor impulse control
b. distance and aloofness
c. extreme guilt and dependency on others for approval
d. selfishness and a lack of concern for others

146. A client has the diagnosis of histrionic personality disorder. When assessing this client, the nurse should expect
that the client’s behavior would be:
a. Boastful and egotistical
b. Dramatic and theatrical
c. Rigid and perfectionist
d. Aggressive and manipulative

147. The client is admitted for evaluation of aggressive behavior and diagnosed with antisocial personality disorder. A
key part of the care of such clients is:
a. Setting realistic limits
b. Encouraging the client to express remorse for behavior
c. Minimizing interactions with other clients
d. Encouraging the client to act out feelings of rage

148. Which of the following nursing interventions would be appropriate for a patient with avoidant personality
disorder?
a. Provide opportunities for exploration
b. Help identify patient strengths
c. Encourage to lead a group therapy
d. Do limit-setting for manipulative behavior

149. The nurse is aware that as anxiety increases, one’s concept of reality alters. Therefore, when caring for a client
with a generalized anxiety disorders, the nurse’s first intervention should be to:
a. Have the client verbalize feelings of anxiety.
b. Administer the PRN medication ordered by the physician.
c. Remove as many stimuli from the client’s environment as possible.
d. Have the client list the relief behaviors that are used to reduce anxiety.

150. Those individuals who demonstrate obsessive-compulsive behavior can best be treated by:
a. Restricting their movements
b. Calling attention to their behavior
c. Keeping them busy to distract them.
d. Supporting but limiting their behavior.

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