Psychiatric Nursing Reviewer
To try to prevent
1. A female client who’s at high risk for
suicide needs close supervision. To
ensure the client’s safety, Nurse Mary
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
Answer: A. Checking the client
frequently but at irregular intervals
prevents the client from predicting when
observation will take place and altering
behavior in a misleading way at these
times.
2. 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?
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?”
Answer: B. Confronting the client with
the consequences of substance abuse
helps to break through denial. Although
the nurse should encourage the client to
discuss feelings, the discussion should
focus on how the client felt before, not
during, an episode of substance abuse.
Encouraging elaboration about his
experience while getting high may
reinforce the abusive behavior.
3. A male client who reportedly consumes
1 qt of vodka daily is admitted for
alcohol detoxification.
alcohol withdrawal symptoms, Dr. Smith
is most likely to prescribe which drug?
a. Clozapine
b. Thiothixene
c. Lorazepam
d. Lithium carbonate
Answer: C. The best choice for
preventing or treating alcohol withdrawal
symptoms is lorazepam, a
benzodiazepine. Clozapine and
thiothixene are antipsychotic agents,
and lithium carbonate is an antimanic
agent; these drugs aren’t used to
manage alcohol withdrawal syndrome.
4. A male client with a history of cocaine
addiction is admitted to the coronary
care unit for evaluation of substernal
chest pain. The ECG shows a 1 mm ST
segment elevation the anteroseptal
leads and T wave inversion in leads V3
to V5. Considering the client’s history of
drug abuse, nurse Greg expects the
physician to prescribe:
a. Lidocaine
b. Procainamide
c. Nitroglycerin
d. Epinephrine
Answer: C. the elevated ST segments in
this client’s ECG indicate myocardial
ischemia. To reverse this problem, the
physician is most likely to prescribe an
infusion of nitroglycerin to dilate the
coronary arteries. Lidocaine and
procainamide are cardiac drugs that
may be indicated for this client at some
point but aren’t used for coronary artery
dilation. If a cocaine user experiences
ventricular fibrillation or asystole, the
physician may prescribe epinephrine.
However, this drug must be used with
caution because cocaine may potentiate
its adrenergic effects.
5. Kellan, a high school student is referred
to the school nurse for suspected
substance abuse. Following the nurse’s
assessment and interventions, what
would be the most desirable outcome?
 a. The student discusses conflicts over
drug use
b. The student accepts a referral to a
substance abuse counselor
c. The student agrees to inform his
parents of the problem
d. The student reports increased
comfort with making choice
Answer: B
6. Nurse Penny is aware that the following
medical conditions is commonly found in
clients with bulimia nervosa?
a. Allergies
b. Cancer
c. Diabetes mellitus
d. Hepatitis a
Answer: C. Bulimia nervosa can lead to
many complications, including diabetes,
heart disease, and hypertension. The
eating disorder isn’t typically associated
with allergies, cancer, or hepatitis A.
7. 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:
a. Norepinephrine and lidocaine
b. Nifedipine and lidocaine
c. Nitroglycerin and esmolol
d. Nifedipine and esmolol
Answer: D. This client requires a
vasodilator, such as nifedipine, to treat
hypertension, and a beta- adrenergic
blocker, such as esmolol, to reduce the
heart rate. Lidocaine, an antiarrhythmic,
isn’t indicated because the client doesn’t
have an arrhythmia. Although
Nitroglycerin may be used to treat
coronary vasospasm, it isn’t the drug of
choice in hypertension.
8. Nurse Amy is aware that the client is at
highest risk for suicide?
a. One who appears depressed,
frequently thinks of dying, and gives
away all personal possessions.
b. One who plans a violent death and
has the means readily available
c. One who tells others that he or she
might do something if life doesn’t
get better soon.
d. One who talks about wanting to die
Answer: B. A client who gives away
possessions, thinks about death, or
talks about wanting to die or attempting
suicide is considered at a lower risk for
suicide because this behavior typically
serves to alert other that the client is
contemplating suicide and wishes to be
helped.
9. The female client with borderline
personality disorder is admitted to the
psychiatric unit. Initial nursing
assessment reveals that the client’s
wrists are scratched from a recent
suicide attempt. Based on this finding,
the nurse, Lenny, should formulate a
nursing diagnosis of:
a. Ineffective individual coping related
to feelings of guilt
b. Situational low self- esteem related
to feelings of loss of control
c. Risk for violence: self- directed
related to impulsive mutilating acts
d. Risk for violence: directed toward
others related to verbal threats
Answer: C. The predominant behavioral
characteristic of the client with
borderline personality disorder is
impulsiveness, especially of a physically
self- destructive sort. The observation
that the client has scratched wrists
doesn’t substantiate the other options.
10. A male client approached the nurse
asking for advice on how to deal with his
alcohol addiction. Nurse Sally should tell
the client that the only effective
treatment for alcoholism is:
a. Psychotherapy
b. Total abstinence
c. Alcoholics anonymous
d. Aversion therapy
Answer: B. Total abstinence is the only
effective treatment for alcoholism. The
 rest are all adjunctive therapies that can
support the client in his efforts to abstain
11. 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
Answer: C. A characteristic behavior of
abused children is lack of crying when
they undergo a painful procedure or are
examined by a health care professional.
12. A client whose husband just left her has
a recurrence of anorexia nervosa. The
nurse caring for her realizes that this
exacerbation of anorexia nervosa
results from the client’s effort to:
a. Manipulate her husband
b. Gain control of one part of her life
c. Commit suicide
d. Live up to her mother’s expectations
Answer: B. by refusing to eat, a client
with anorexia nervosa is unconsciously
attempting to gain control over the only
part of her life she feels she can control.
13. When planning care for a client who has
ingested phencyclidine (PCP), Nurse
Wayne is aware that 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
Answer: B. The highest priority for a
client who has ingested PCP is meeting
safety needs of the client as well as the
staff. Drug effects are unpredictable and
prolonged, and the client may lose
control easily.
14. A male client tells the nurse he was
involved in a car accident while he was
intoxicated. What should be the most
therapeutic response from Nurse Julia?
a. Why didn’t you get someone else to
drive you?
b. Tell me how you feel about the
accident
c. You should know better than to
drink and drive
d. I recommend that you attend an
alcoholic anonymous meeting
Answer: B. An open- ended statement
or questions is the most therapeutic
response. It encourages the widest
range of client responses, makes the
client an active participant in the
conversation, and shows the client that
the nurse is interested in his feelings.
15. A 25- year old client experiencing
alcohol withdrawal is upset about going
through detoxification. Which of the
following goals is a priority?
a. The client will commit to a drug- free
lifestyle
b. The client will work with the nurse to
remain safe
c. The client will drink plenty of fluids
daily
d. The client will make a personal
inventory of strength
Answer: B. The priority goal in alcohol
withdrawal is maintaining the client’s
safety.
16. Nurse Mary 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 house 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
Answer: C. Allowing the client to select
her own food from the menu will help
her feel some sense of control. She
must then eat 100% of what she
selected. Remaining with the client for at
least 1 hour after eating will prevent
purging.
17. Nurse Harry 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
Answer: C. Establishing a consistent
eating plan and monitoring the client’s
weight are important for this disorder.
The family should be included in the
client’s care. The client should be
monitored during meals- not given
privacy. Exercise must be limited and
supervised.
18. A male client recently admitted to the
hospital with sharp, substernal chest
pain suddenly complains of palpitations.
Nurse Ryan notes a rise in the client’s
arterial blood pressure and a heart rate
of 144 beats/ minute. On further
questioning, the client admits to having
used cocaine recently after previously
denying use of the drug. The nurse
concludes that the client is at high risk of
which complication of cocaine use?
a. Coronary artery spasm
b. Bradyarrhythmias
c. Neurobehavioral deficits
d. Panic disorder
Answer: A. Cocaine use may cause
such cardiac complications as coronary
artery spasm, myocardial infarction,
dilated cardiomyopathy, acute heart
failure, endocarditis, and sudden death.
Cocaine blocks reuptake of
norepinephrine, epinephrine, and
dopamine, causing an excess of these
neurotransmitters at postsynaptic
receptor sites. Consequently, the drug is
more likely to cause tachyarrhythmias
than bradyarrhythmias. Although
neurobehavioral deficits are common in
neonates born to cocaine users, they
are rare in adults. As craving for the
drug increases, a person who’s addicted
to cocaine typically experiences
euphoria followed by depression, not
panic disorder.
19. For a female client with anorexia
nervosa, Nurse Rose 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
Answer: A. Clients with anorexia
nervosa typically come from a family
with parents who are controlling and
overprotective. These clients use eating
to gain control of an aspect of their lives.
20. Nurse Alice us 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
c. Toothpaste
d. Cheese
Answer: B. Disulfiram may be given to
clients with chronic alcohol abuse who
wish to curb impulse drinking. Disulfiram
works by blocking the oxidation of
alcohol, inhibiting the conversion of
acetaldehyde to acetate. As
acetaldehyde builds up in the blood, the
client experiences noxious and
uncomfortable symptoms. Even alcohol
rubbed onto the skin can produce a
reaction. The client receiving disulfiram
must be taught to read ingredient labels
carefully avoiding products containing
alcohol such as aftershave lotions.
21. Flumazenil (romazicon) has been
ordered for a male client who has
overdosed on oxazepam (Serax).
Before administering the medication,
Nurse Gina should be prepared for
which common adverse effect?
a. Seizures
b. Shivering
c. Anxiety
d. chest pain
Answer: A. Seizures are the most
common serious adverse effect of using
flumazenil to reverse benzodiazepine
overdose. The effect is magnified if the
client has a combined tricyclic
antidepressant and benzodiazepine
overdose. Less common adverse effects
include shivering, anxiety, and chest
pain.
22. Nurse Tamara 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
Answer: C. Bulimic behavior is generally
a maladaptive coping response to stress
and underlying issues. The client must
identify anxiety- causing situations that
stimulate the bulimic behavior and then
learn new ways of coping with the
anxiety.
23. The nurse is aware that the 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
Answer: A. children with oppositional
defiant disorder frequently violate the
rights of others. They are defiant,
disobedient, and blame other for their
actions. Accountability for their actions
would demonstrate progress for the
oppositional child.
24. During postprandial monitoring, a
female 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”
Answer: D. This response
acknowledges that the client is testing
limits and that the nurse is setting them
by performing postprandial monitoring to
prevent self- induced emesis.
25. Nurse Mary 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
Answer: B. The nurse’s values, beliefs,
and attitudes toward self- destructive
behavior influence responses to a
suicidal client; such as responses set
the overall mood for the nurse- client
relationship. Therefore, the nurse
initially must explore personal feelings
about suicide to avoid conveying
negative feelings to the client.
26. 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:
a. Antisocial personality disorder
b. Borderline personality disorder
c. Obsessive- compulsive personality
disorder
d. Narcissistic personality
Answer: A. The client’s history of
delinquency, running away from home,
vandalism, and dropping out of school
are characteristics of antisocial
personality disorder. This maladaptive
coping pattern is manifested by a
disregard for societal norms of behavior
and an inability to relate meaningfully to
others. In borderline personality
disorder, the client exhibits mood
instability, poor self- image, identity
disturbance, and labile affect.
Obsessive- compulsive personality
disorder is characterized by a
preoccupation with impulses and
thought that the client realizes are
senseless but can’t control. Narcissistic
personality disorder is marked by a
pattern of self- involvement, grandiosity,
and demand for constant attention.
27. Clonidine (catapres) can be used to
treat conditions other than hypertension.
Nurse Sally is aware that the following
conditions might the drug be
administered?
a. Phencyclidine (PCP) intoxication
b. Alcohol withdrawal
c. Opiate withdrawal
d. Cocaine withdrawal
Answer: C. Clonidine is used as
adjunctive therapy in opiate withdrawal.
Benzodiazepines, such as
chlordiazepoxide, and neuroleptic
agents, such as haloperidol, are used to
treat alcohol withdrawal, and treat PCP
intoxication. Antidepressants and
medications with dopaminergic activity
in the brain, such as fluoxetine (Prozac),
are used to treat cocaine withdrawal.
28. Which of the following drugs should
Nurse Mary prepare to administer to a
client with a toxic acetaminophen
(Tylenol) level?
a. Deferoxamine mesylate
b. Succimer
c. Flumazenil
d. Acetylcysteine
Answer: D. The antidote for
acetaminophen toxicity is
acetylcysteine. It enhances conversion
of toxic metabolites to nontoxic
metabolites. Deferoxamine mesylate is
the antidote for iron intoxication.
Succimer is an antidote for lead
poisoning. Flumazenil reverses the
sedative effects of benzodiazepines.
29. For a female client with anorexia
nervosa, Nurse Jimmy is aware that
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
Answer: A. According to Maslow’s
Hierarchy of Needs, all human need to
meet basic physiological needs first.
30. A 14- year- old client is brought to the
clinic by her mother. Her mother
expresses concern about her daughter’s
weight loss and constant dieting. Nurse
Kris conducts a health history interview.
Which of the following comments
indicates that the client may be suffering
from anorexia nervosa?
a. I like the way I look. I just need to
keep my weight down because I’m a
cheerleader
b. I don’t like the food my mother
cooks. I eat plenty of fast food when
I’m out with my friends
c. I just can’t seem to get down to the
weight I want to be. I’m so fat
compared to other girls
d. I do diet around my periods;
otherwise, I just get so bloated.
Answer: C. Low self- esteem is the
highest risk factor for anorexia nervosa.
Constant dieting to get down to a
“desirable weight” is characteristic of the
disorder. Feeling inadequate when
compared to peers indicates poor self-
esteem. Most clients with anorexia
nervosa don’t like the way they look,
and their self- perception may be
distorted.
31. A 24- year old 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
d. Provide objective data and feedback
regarding the client’s weight and
attractiveness
Answer: D. by focusing on reality, this
strategy may help the client develop a
more realistic body image and gain self-
esteem.
32. Nurse Helen is assigned to care for a
client with anorexia nervosa. Initially,
which nursing intervention is most
appropriate for this client?
a. Providing one- on- one supervision
during meals and for 1 hour
afterward
b. Letting the client eat with other
clients to create a normal mealtime
atmosphere
c. Trying to persuade the client to eat
and thus restore nutritional balance
d. Giving the client as much time to eat
as desired
Answer: A. Because the client with
anorexia nervosa may discard food or
induce vomiting in the bathroom, the
nurse should provide one- on- one
supervision during meals and for 1 hour
afterward.
33. A female 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 nurse
Angel 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
Answer: D. A client with anorexia
nervosa has an unrealistic body image
that causes consumption of little or no
food. Therefore, the client needs
assistance with making decisions about
health. Instead of protecting the client’s
health, options A, B, and C may serve to
make the client defensive and more
entrenched in her unrealistic body
image.
34. 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 for assistance
c. Telling the client’s husband that he
must leave at once
d. Determining why the husband feels
so angry
Answer: The health care worker who
witnesses this scene must take
precautions to ensure personal as well
as client safety, but shouldn’t attempt to
manage a physically aggressive person
alone.
35. A female client begins to experience
alcoholic hallucinosis. Nurse Joy is
aware that the best nursing intervention
at this time?
a. Keeping the client restrained in bed
b. Checking the client’s blood pressure
every 15 minutes and offering juices
c. Providing a quiet environment and
administering medication as needed
and prescribed
d. Restraining the client and
measuring blood pressure every 30
minutes
Answer: C. Manifestations of alcoholic
hallucinosis are best treated by
providing a quiet environment to reduce
stimulation and administering prescribed
central nervous system depressants in
dosages that control symptoms without
causing over sedation. Although bed
rest is indicated, restraints are
unnecessary unless the client poses a
danger to himself or others. Also
restraints may increase agitation and
make the client feel trapped and
helpless when hallucinating. Offering
juice is appropriate, but measuring
blood pressure every 15 minutes would
interrupt the client’s rest. To avoid
overstimulating the client, the nurse
should check blood pressure every 2
hours.
36. A male adult client voluntarily admits
himself to the substance abuse unit. He
confesses that he drinks 1 qt or more of
vodka each day and uses cocaine
occasionally. Later that afternoon, he
bigns to show signs of alcohol
withdrawal. What are some early signs
of this condition?
a. Vomiting, diarrhea, and bradycardia
b. Dehydration, temperature abouve
101 F (38.3), and pruritus
c. Hypertension, diaphoresis, and
seizures
 d. Diaphoresis, tremors, and despite knowledge of having a
nervousness persistent or recurrent social,
occupational, psychological, or physical
Answer: D. Alcohol withdrawal problem caused or exacerbated by
syndrome includes alcohol withdrawal, substance abuse or recurrent use in
alcoholic hallucinosis, and alcohol dangerous situations.
withdrawal delirium (formerly delirium
tremens). Signs of alcohol withdrawal
include diaphoresis, tremors,
nervousness, nausea, vomiting,
malaise, increased blood pressure and
pulse rate, sleep disturbance, and
irritability. Although diarrhea may be an
early sign of alcohol withdrawal,
tachycardia- not bradycardia- is
associated with alcohol withdrawal.
Dehydration and an elevated
temperature may be expected, but a
temperature above 101 F indicates
infection rather than alcohol withdrawal.
Pruritus rarely occurs in alcohol
withdrawal. If withdrawal symptoms
remain untreated, seizures may arise
later.

37. A male client is brought to the

psychiatric clinic by family members,
who tell the admitting nurse that the
client repeatedly drives while intoxicated
despite their pleas to stop. During an
interview with the nurse Linda, which
statement by the client most strongly
supports a diagnosis of psychoactive
substance abuse?
a. I’m not addicted to alcohol. In fact, I
can drink more that I use to without
being affected
b. I only spend half of my paycheck at
the bar
c. I just drink to relax after work
d. I know I’ve been arrested three
times for drinking and driving, but
the police are just trying to hassle
me.

Answer: D. According to the Diagnostic

and Statistical Manual of Mental
Disorders, 4th edition, diagnostic criteria
for psychoactive substance abuse
include a maladaptive pattern of such
use, indicated either by continued use