Mental Health Psychiatric Nursing NCLEX Challenge Exam Quiz 1 50 Questions

Mental Health & Psychiatric Nursing
NCLEX Challenge Exam (Quiz #1: 50

Questions)
UPDATED ON OCTOBER 17, 2023
BY MATT VERA BSN, R.N.
Variety of Mobile Products

Fast and friendly delivery from all your
mobile items at your doorstep.
Hi! You are currently in the quiz page. If you’re done with this quiz,
please check out the other exams by clicking here to go back to
the Mental Health and Psychiatric Nursing test bank page.
Quiz Guidelines
https://nurseslabs.com/quizzes/nclex-psychiatric-quiz-1/ 4/9/24, 8 54 PM
Page 1 of 102
:
Before you start, here are some examination guidelines and reminders you must read:
1. Practice Exams: Engage with our Practice Exams to hone your skills in a
supportive, low-pressure environment. These exams provide immediate
feedback and explanations, helping you grasp core concepts, identify
improvement areas, and build confidence in your knowledge and abilities.
2. Challenge Exams: Take our Challenge Exams to test your mastery and
readiness under simulated exam conditions. These exams offer a rigorous
question set to assess your understanding, prepare you for actual examinations,
and benchmark your performance.
You’re given 2 minutes per item.
For Challenge Exams, click on the “Start Quiz” button to start the quiz.
3. Complete the quiz: Ensure that you answer the entire quiz. Only after you’ve
answered every item will the score and rationales be shown.
4. Learn from the rationales: After each quiz, click on the “View Questions”
button to understand the explanation for each answer.
5. Free access: Guess what? Our test banks are 100% FREE. Skip the hassle – no
sign-ups or registrations here. A sincere promise from Nurseslabs: we have not
and won’t ever request your credit card details or personal info for our practice
questions. We’re dedicated to keeping this service accessible and cost-free,
especially for our amazing students and nurses. So, take the leap and elevate
your career hassle-free!
6. Share your thoughts: We’d love your feedback, scores, and questions! Please
share them in the comments below.
Results
28 of 50 Questions answered correctly
Your time: 00:12:29
You have reached 28 of 50 point(s), (56%)
Average score 0%
Page 2 of 102
:
Your score 56%
Categories
Not categorized 56%
Awesome, you’ve completed the quiz!
Where are the rationales? Please click the View Questions button below to
review your answers and read through the rationales for each question.
You can also post your score in this challenge exam in our leaderboards.
maximum of 50 points
Pos. Name Entered on Points Result

February 10, 2024
1 nedum 50 100 %
7:20 AM
November 5, 2023
2 Mark Lee 50 100 %
8:33 PM
January 18, 2024

3 AKHIL.V 50 100 %
6:04 PM
4 KOBE UY April 9, 2024 8:08 PM 50 100 %
December 2, 2023
5 RUKIA AJABO 50 100 %
1:02 AM
November 16, 2023

6 M Waqas wani 50 100 %
3:00 AM
October 12, 2023
Page 3 of 102
:
7 AriSade 12:27 PM 50 100 %
March 21, 2024 7:50

8 EroticDiscoHeat 50 100 %
PM
March 19, 2024 3:31

9 TAJAMUL BASHIR 50 100 %
PM
March 25, 2024 10:33

10 top1 50 100 %
PM
March 1, 2024 3:51

11 Tisha 50 100 %
AM
November 26, 2023

12 Usama Khan Marw 50 100 %
7:04 PM
January 28, 2024 9:11

13 Janzel 50 100 %
PM
March 20, 2024 10:42

14 Arthur Gallano 50 100 %
PM
November 16, 2023

15 Jawaher 50 100 %
4:02 AM
January 27, 2024

16 paul kipsang 50 100 %
10:45 PM
December 2, 2023
17 Jeff Blackwell 50 100 %
5:43 AM
March 1, 2024 9:24

18 LiLi 50 100 %
PM
November 8, 2023
19 Hazrah 50 100 %
3:42 AM
20 kc April 1, 2024 9:08 PM 50 100 %
Would you like to submit your quiz result to the leaderboard?
Name: Name E-Mail: E-Mail
Send
Page 4 of 102
:
Send
View Questions
1 point(s)
1. Question
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
Correct
Correct Answer: A. Seizures
Seizures are the most common serious adverse effect of using
Page 5 of 102
:
flumazenil to reverse benzodiazepine overdose. The effect is magnified
if the client has a combined tricyclic antidepressant and benzodiazepine
overdose. Benzodiazepine reversal has correlations with seizures.
Seizures may happen more frequently in patients who have been on
benzodiazepines for long-term sedation or in patients who are showing
signs of severe tricyclic antidepressant overdose. The required dosage
of Flumazenil should be measured and prepared by the practitioners to
manage seizures. Flumazenil use requires caution in patients relying on
a benzodiazepine for seizure control.
Option B: Shivering is not an adverse effect of flumazenil.
Monitor the patient for the possible return of sedation, mostly in
those who are tolerant of benzodiazepines. Patients should have
monitoring for respiratory depression, benzodiazepine
withdrawal, and other residual effects of benzodiazepines for at
least 2 hours.
Option C: Anxiety is a rare adverse effect for people using
flumazenil. Flumazenil has some associations with precipitation of
seizures in patients with benzodiazepine dependence with a
history of seizures. Flumazenil overdose is extremely rare. There
is no precise antidote for flumazenil toxicity. In mild to severe
toxicity, symptomatic and supportive treatment should be a
consideration.
Option D: An overdose of flumazenil in a patient who is not a
chronic benzodiazepine user would not be expected. Chronic
benzodiazepines users may experience withdrawal with abrupt
discontinuation of the drug. Administration of benzodiazepines or
barbiturates may be necessary for seizure control.
1 point(s)
2. Question
Page 6 of 102
:
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.
Correct
Correct Answer: C. Identify anxiety-causing situations
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. Bulimia nervosa is a condition that occurs most
commonly in adolescent females, characterized by indulgence in binge-
eating, and inappropriate compensatory behaviors to prevent weight
gain.
Option A: Controlling shopping for large amounts of food isn’t a
goal early in treatment. It is important to educate patients who
abuse laxatives that these medications work in the
gastrointestinal tract after the areas where caloric absorption has
occurred primarily. It is crucial to inform patients that a period of
Page 7 of 102
:
edema and weight gain may follow up to several weeks after
discontinuation of purging behavior.
Option B: Managing eating impulses and replacing them with
adaptive coping mechanisms can be integrated into the plan of
care after initially addressing stress and underlying issues. The
primary objective of treatment is a cessation of the binging and
purging behavior. Selective serotonin reuptake inhibitors such as
fluoxetine, citalopram, and sertraline have shown to reduce
symptoms of bulimia nervosa. Fluoxetine is the only FDA
approved medication for bulimia nervosa. It appears that a higher
dose (60 mg) is significantly better than a placebo in decreasing
the frequency of binge and vomiting episodes.
Option D: Eating three meals per day isn’t a realistic goal early in
treatment. Patients with bulimia nervosa who purge by vomiting
often brush their teeth immediately after purging, which can
accelerate dental erosion. The clinician should instruct the
patients who persist in vomiting to rinse their mouths with water
or fluoride rather than brushing their teeth within 30 minutes of
each episode. Consider consulting a dentist to address dental
issues associated with vomiting.
1 point(s)
3. Question
A female client who’s at high risk for suicide needs close supervision. To best
ensure the client’s safety, Nurse Mary should:
A. Check the client frequently at irregular intervals throughout

the night.
Page 8 of 102
:
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 with suicidal clients.
Correct
Correct Answer: A. Check the client frequently at irregular intervals
throughout the night
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. Once the patient is deemed
to be at risk for suicide, then intervention steps must be initiated right
away. The individual must not be left alone. Enlist the help of a support
person while at home. The suicidal individual must be treated in a safe
and secure place. In addition, the place has to be monitored.
Option B: This may encourage the client to try to manipulate the
nurse or seek attention for having a secret suicide plan.
Assessing the individual’s judgment is critical. One should try and
determine how the individual can handle stress. Does he or she
have an impairment in decision making? Does the individual know
that jumping in front of a train is dangerous? Reflect empathy and
concern. Offer a hand to help. Provide the patient with
confidence that he or she can overcome the issues.
Option C: This may reinforce suicidal ideas. Help develop internal
Page 9 of 102
:
coping strategies (e.g., exercise, journaling, reading, developing a
hobby). Utilize the help of healthcare professionals to follow up
on therapy. Once the individual is safe as an inpatient or
outpatient, a formal treatment plan should be established. The
next step is to refer all patients deemed to be at higher risk for
suicide to a mental health counselor as soon as possible. Every
state has laws and procedures regarding this process which must
be incorporated into the clinical practice when addressing
individuals at high suicide risk.
Option D: Decreased communication is a sign of withdrawal that
may indicate the client has decided to commit suicide; the nurse
shouldn’t disregard it. In some cases, assessment of the mental
status may provide a clue to the individual’s potential for self-
harm. Depressed patients will often tend to appear unclean and
unkempt. The clothing may not be ironed or dirty. The risk of
suicide is often high in people who appear very anxious or
depressed. The patient may exhibit a flat affect or no emotions at
all. Some depressed patients may develop hallucinations that may
be telling him or her to kill themselves. The majority of these
hallucinations are auditory.
1 point(s)
4. Question
Which of the following drugs should Nurse Mary prepare to administer to a
client with a toxic acetaminophen (Tylenol) level?
A. Deferoxamine mesylate (Desferal)
Page 10 of 102
:
B. Succimer (Chemet)
C. Flumazenil (Romazicon)
D. Acetylcysteine (Mucomyst)
Incorrect
Correct Answer: D. Acetylcysteine (Mucomyst)
The antidote for acetaminophen toxicity is acetylcysteine. It enhances
conversion of toxic metabolites to nontoxic metabolites. Acetaminophen
(N-acetyl-para-aminophenol, paracetamol, APAP) toxicity is common
primarily because the medication is so readily available, and there is a
perception that it is very safe. More than 60 million Americans consume
acetaminophen on a weekly basis. All patients with high levels of
acetaminophen need admission and treatment with N-acetyl-cysteine
(NAC). This agent is fully protective against liver toxicity if given within 8
hours after ingestion.
Option A: Deferoxamine mesylate is the antidote for iron
intoxication. Desferal is indicated for the treatment of acute iron
intoxication and chronic iron overload due to transfusion-
dependent anemias. Desferal is an adjunct to, and not a
substitute for, standard measures used in treating acute iron
intoxication, which may include the following: induction of emesis
with syrup of ipecac; gastric lavage; suction and maintenance of a
clear airway; control of shock with intravenous fluids, blood,
oxygen, and vasopressors; and correction of acidosis.
Page 11 of 102
:
Option B: Succimer is an antidote for lead poisoning. Succimer is
an oral heavy metal chelating agent used to treat lead and heavy
metal poisoning. Succimer has been linked to a low rate of
transient serum aminotransferase elevations during therapy, but
its use has not been linked to cases of clinically apparent liver
injury with jaundice. Succimer does not significantly chelate
essential metals such as zinc, copper, or iron, and its specificity,
safety and oral availability make it preferable to other chelating
agents for treating lead poisoning such as Ca-EDTA which must
be given intravenously and dimercaprol (British anti-Lewisite
[BAL) which requires intramuscular administration.
Option C: Flumazenil reverses the sedative effects of
benzodiazepines. Flumazenil is a benzodiazepine antagonist.
Flumazenil is also indicated for the management and treatment of
benzodiazepine overdose in adults. It is useful in reversing coma
due to benzodiazepine overdose. Flumazenil is more effective in
reversing sedation or coma in patients with benzodiazepine
intoxication rather than in patients with multiple drug overdoses.
1 point(s)
5. Question
A male client is admitted to the substance abuse unit for alcohol detoxification.
Which of the following medications is Nurse Alice most likely to administer to
reduce the symptoms of alcohol withdrawal?
A. Naloxone (Narcan)
B. Haloperidol (Haldol)
Page 12 of 102
:
C. Magnesium sulfate
D. Chlordiazepoxide (Librium)
Incorrect
Correct Answer: D. Chlordiazepoxide (Librium)
Chlordiazepoxide (Librium) and other tranquilizers help reduce the
symptoms of alcohol withdrawal. Chlordiazepoxide is a long-acting
benzodiazepine and is an FDA approved medication for adults with mild-
moderate to severe anxiety disorder, preoperative apprehension and
anxiety, and withdrawal symptoms of acute alcohol use disorder.
Chlordiazepoxide has anti-anxiety, sedative, appetite-stimulating, and
weak analgesic actions. It binds to benzodiazepine receptors at the
GABA-A ligand-gated chloride channel complex and enhances GABA’s
inhibitory effects.
Option A: Naloxone (Narcan) is administered for narcotic
overdose. Naloxone is indicated for the treatment of opioid
toxicity, specifically to reverse respiratory depression from opioid
use. It is useful in accidental or intentional overdose and acute or
chronic toxicity. Naloxone is a pure, competitive opioid antagonist
with a high affinity for the mu-opioid receptor, allowing for
reversal of the effects of opioids. The onset of action varies
depending on the route of administration but can be as fast as
one minute when delivered intravenously (IV) or intraosseous
(IO).
Option B: Haloperidol (Haldol) may be given to treat clients with
psychosis, severe agitation, or delirium. Haloperidol is a first-
generation (typical antipsychotic) which exerts its antipsychotic
Page 13 of 102
:
action by blocking dopamine D2 receptors in the brain. When
72% of dopamine receptors are blocked, this drug achieves its
maximal effect. Haloperidol is not selective for the D2 receptor. It
also has noradrenergic, cholinergic, and histaminergic blocking
action. The blocking of these receptors is associated with various
side effects.
Option C: Magnesium sulfate and other anticonvulsant
medications are only administered to treat seizures if they occur
during withdrawal. Magnesium sulfate administration can be oral
(PO), intramuscular (IM), intraosseous (IO), or intravenous (IV).
For every 1 gram of magnesium sulfate, it contains 98.6 mg or
8.12Eq of elemental magnesium. Magnesium sulfate can be
combined with dextrose 5% or water to make intravenous
solutions.
1 point(s)
6. Question
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 had 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?”
Page 14 of 102
:
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.”
Correct
Correct Answer: D. “I know it’s important for you to feel in control,
but I’ll monitor you for 90 minutes after you eat.”
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. Clients with bulimia nervosa need to feel in control
of the diet because they feel they lack control over all other aspects of
their lives. Since recovery involves patients having to face their deepest,
most painful, and traumatic thoughts and emotions, supporting them as
they go through treatment can be emotionally challenging for nurses.
This emotional challenge can be exacerbated when the patient has also
been diagnosed with Obsessive-Compulsive Disorder (OCD),
depression, or substance abuse, as these may require more intensive
one-to-one support.
Option A: Because their therapeutic relationships with caregivers
are less important than their need to purge, they don’t fear
betraying the nurse’s trust by engaging in the activity. They
commonly plot to purge and rarely share their secrets about it. As
this might take nurses out of their comfort zone or clinical remit,
worksheets are available for nurses to use in efforts to help
patients challenge and overcome their obsessive and ritualistic
behaviors and to adopt a more flexible perspective in day-to-day
life.6 These can be supplemented by nurses familiarising
Page 15 of 102
:
themselves with the detailed guidelines and resources offered by
NICE.
Option B: Learning motivational interviewing techniques can help
facilitate communication with those who might be resistant to
discussing topics related to food, weight, and recovery. Such
techniques can help develop the skills of empathic
understanding, rolling with resistance, and gently assisting
patients to make their own, autonomous decision to work towards
recovery. Often, the aim is to help patients learn new and
healthier ways of coping, and nurses can achieve this through a
mix of emotional support, education, and signposting.
Option C: An authoritarian or challenging response may trigger a
power struggle between the nurse and client. Assisting patients
to remain strong and adhere to treatment requires nurses to
develop a relationship that is caring, empathetic and trusting, and
in line with the person-centered approach to care. Patients
affected by eating disorders require individualized support to
better understand their condition, rediscover their identity, learn
to accept themselves, enhance a positive body image and sense
of self-worth, and achieve a balance in their lives so that they can
move towards better health and wellbeing.
1 point(s)
7. Question
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?
Page 16 of 102
:
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?”
Correct
Correct Answer: B. “You told me you got fired from your last job for
missing too many days after taking drugs all night.”
Confronting the client with the consequences of substance abuse helps
to break through denial. Present reality by spending time with the client
to facilitate reality orientation because your physical presence is the
reality. Be simple, direct, and concise when speaking to the client. Talk
with the client about concrete or familiar things; avoid ideological or
theoretical discussions. The client’’s ability to process abstractions or
complexities is impaired.
Option A: Making threats isn’t an effective way to promote self-
disclosure or establish a rapport with the client. Motivational
counseling works according to the idea that motivation for
change is dynamic rather than static. Professional uses may
influence change by developing a therapeutic relationship to
Page 17 of 102
:
increase therapeutic alliance, developing insight, and coping skills
to resolve ambivalence, and change health-related behavior.
Option C: 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. Persons may withdraw from
their environment with regressive behavior, fail to engage with
others, or even notice physical illness and pain. Social exclusion
and homelessness may ensue. In the longer term, psychosis and
its potential disruption of the capacity to fulfill social roles can
result in further burdens.
Option D: The client undoubtedly is aware that drug use is illegal;
a reminder to this effect is unlikely to alter behavior. Drug
addiction exacerbates social alienation and increases potential for
violent lashing out and low self-esteem, along with poor coping
skills. Under these circumstances, emotional, social, or symptom-
related cues can provoke recourse to available substances and
suicidal ideation. They may also contribute to psychosocial
instability, self-image issues, and achievement motivation. In
some cases, social hostility and rejection may result.
1 point(s)
8. Question
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.
Page 18 of 102
:
B. The client will make a contract with the nurse that sets a target
weight.
Learn more
C. The client will identify self-perceptions about body size as

unrealistic.
D. The client will verbalize the possible physiological consequences

of self-starvation.
Correct
Correct Answer: A. The client will establish adequate daily
nutritional intake.
According to Maslow’s hierarchy of needs, all humans need to meet
basic physiological needs first. Because a client with anorexia nervosa
eats little or nothing, the nurse must first plan to help the client meet this
basic, immediate physiological need. Treatment for anorexia nervosa is
centered on nutrition rehabilitation and psychotherapy. Refeeding
syndrome can occur following prolonged starvation. As the body utilizes
glucose to produce molecules of adenosine triphosphate (ATP), it
depletes the remaining stores of phosphorus. Also, glucose entry into
cells is mediated by insulin and occurs rapidly following long periods
without food. Both cause electrolyte abnormalities such as
hypophosphatemia and hypokalemia, triggering cardiac and respiratory
compromise. Patients should be followed carefully for signs of refeeding
syndrome and electrolytes closely monitored.
Option B: Recovery from an eating disorder can be a long
process that requires not only a qualified team of professionals
Page 19 of 102
:
but also the love and support of family and friends. It is not
uncommon for someone who suffers from an eating disorder to
feel uncertain about their progress or for their loved ones to feel
disengaged from the treatment process. These potential
roadblocks may lead to feelings of ambivalence, limited progress,
and treatment dropout.
Option C: Anorexia nervosa is a psychiatric disease in which
patients restrict their food intake relative to their energy
requirements through eating less, exercising more, and/or purging
food through laxatives and vomiting. Despite being severely
underweight, they do not recognize it and have distorted body
images. They can develop complications from being underweight
and purging food. Diagnose by history, physical, and lab work that
rules out other conditions that can make people lose weight.
Treatment includes gaining weight (sometimes in a hospital if
severe), therapy to address body image, and management of
complications from malnourishment.
Option D: The nurse may give lesser priority to goals that
address long-term plans, self-perception, and potential
complications. Eating disorders can affect every organ system in
the body, and people struggling with an eating disorder need to
seek professional help. The earlier a person with an eating
disorder seeks treatment, the greater the likelihood of physical
and emotional recovery.
1 point(s)
9. Question
When interviewing the parents of an injured child, which of the following is the
strongest indicator that child abuse may be a problem?
Page 20 of 102
:
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.
Incorrect
Correct Answer: A. The injury isn’t consistent with the history or
the child’s age.
When the child’s injuries are inconsistent with the history given or
impossible because of the child’s age and developmental stage, the
emergency department nurse should be suspicious that child abuse is
occurring. Physical indicators may include injuries to a child that are
severe, occur in a pattern or occur frequently. These injuries range from
bruises to broken bones to burns or unusual lacerations. The child may
present for care unrelated to the abuse, and the abuse may be found
incidentally.
Option B: The parents may tell different stories because their
perception may be different regarding what happened. If they
change their story when different health care workers ask the
same question, this is a clue that child abuse may be a problem.
Page 21 of 102
:
Physical abuse should be considered in the evaluation of all
injuries of children. A thorough history of present illness is
important to make a correct diagnosis. Important aspects of the
history-taking involve gathering information about the child’s
behavior before, during, and after the injury occurred. History-
taking should include the interview of each caretaker separately
and the verbal child, as well. The parent or caretaker should be
able to provide their history without interruptions in order not to
be influenced by the physician’s questions or interpretations.
Option C: Child abuse occurs in all socioeconomic groups. All
races, ethnicities, and socioeconomic groups are affected by
child abuse with boys and adolescents more commonly affected.
Infants tend to have increased morbidity and mortality with
physical abuse. Multiple factors increase a child’s risk of abuse.
These include risks at an individual level (child’s disability,
unmarried mother, maternal smoking or parent’s depression);
risks at a familial level (domestic violence at home, more than two
siblings at home); risks at a community level (lack of recreational
facilities); and societal factors (poverty).
Option D: Parents may argue and be demanding because of the
stress of having an injured child. To diagnose a patient with child
maltreatment is difficult since the victim may be nonverbal or too
frightened or severely injured to talk. Also, the perpetrator will
rarely admit to the injury, and witnesses are uncommon.
Physicians will see children of maltreatment in a range of ways
that include the perpetrators may be concerned that the abuse is
severe and bring in the patient for medical care.
1 point(s)
10. Question
Page 22 of 102
:
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.
Correct
Correct Answer: A. They tend to overprotect their children.
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. Similarly, issues like anxiety,
depression, and addiction can also run in families, and have also been
found to increase the chances that a person will develop an eating
disorder. Many people with anorexia report that, as children, they always
followed the rules and felt there was one “right way” to do things.
Option B: Substance abuse and eating disorders frequently co-
occur, with up to 50% of individuals with eating disorders who
abuse alcohol or illicit drugs, a rate five times higher than the
general population. Substance abuse problems may begin before
Page 23 of 102
:
or during an eating disorder, or even after recovery. Those
struggling with co-occurring substance use and disordered
eating should speak with a trained professional who can
understand, diagnose, and treat both substance use disorders
and eating disorders.
Option C: Loneliness and isolation are some of the hallmarks of
anorexia; many with the disorder report having fewer friends and
social activities, and less social support. Whether this is an
independent risk factor or linked to other potential causes (such
as social anxiety) isn’t clear.
Option D: Eating disorders are complex and affect all kinds of
people. Risk factors for all eating disorders involve a range of
biological, psychological, and sociocultural issues. These factors
may interact differently in different people, so two people with the
same eating disorder can have very diverse perspectives,
experiences, and symptoms. Still, researchers have found broad
similarities in understanding some of the major risks for
developing eating disorders.
1 point(s)
11. Question
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.
Page 24 of 102
:
B. Calling a security guard and another staff member for assistance.
C. Telling the client’s husband that he must leave at once.
D. Determining why the husband feels so angry.
Incorrect
Correct Answer: B. Calling a security guard and another staff
member for assistance.
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. Therefore, the first priority
is to call a security guard and another staff member. Domestic violence
is defined as a pattern of abusive behaviors by one partner against
another in an intimate relationship such as marriage, dating, family, or
cohabitation. In this definition, domestic violence takes many forms,
including physical aggression or assault, sexual abuse, emotional abuse,
controlling or domineering behavior, intimidation, stalking,
passive/covert abuse, and economic deprivation.
Option A: After doing this, the health care worker should inform
the husband what is expected, speaking in concise statements,
and maintaining a firm but calm demeanor. This approach makes
it clear that the health care worker is in control and may diffuse
the situation until the security guard arrives. Nurses can play an
important role in working toward the creation of a violence-free
community but they must first become informed. They must then
Page 25 of 102
:
insist the organizations in which they work to accept this
responsibility and work together to create environments that
support people experiencing domestic violence.
Option C: Telling the husband to leave would probably be
ineffective because of his agitated and irrational state. Although
the exact rates are widely disputed, especially within the United
States, there is a large body of cross-cultural evidence that
women are subjected to domestic violence significantly more
often than men. In addition, there is broad consensus that women
are more often subjected to severe forms of abuse and are more
likely to be injured by an abusive partner. According to a report by
the United States Department of Justice, a survey of 16,000
Americans showed 22.1 percent of women and 7.4 percent of
men reported being physically assaulted by a current or former
spouse, cohabiting partner, boyfriend, girlfriend, or date in their
lifetime.
Option D: Exploring his anger doesn’t take precedence over
safeguarding the client and staff. Gender roles and expectations
play a role in abusive situations, and exploring these roles and
expectations can be helpful in addressing abusive situations.
Likewise, it can be helpful to explore factors such as race, class,
religion, sexuality, and philosophy. However, studies investigating
whether sexist attitudes are correlated with domestic violence
have shown conflicting results.
1 point(s)
12. Question
Nurse Mary is caring for a client with bulimia. Strict management of dietary
intake is necessary. Which intervention is also important?
Page 26 of 102
:
A. Fill out the client’s menu and make sure she eats at least half of
what is on her tray.
B. Let the client eat her meals in private. Then engage her in social
activities for at least 2 hours after each meal.
C. Let the client choose her own food. If she eats everything she
orders, then stay with her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but
she should keep a strict calorie count.
Correct
Correct Answer: C. Let the client choose her own food. If she eats
everything she orders, then stay with her for 1 hour after each meal
Allowing the client to select her own food from the menu will help her
feel some sense of control. Assisting patients to remain strong and
adhere to treatment requires nurses to develop a relationship that is
caring, empathetic and trusting, and in line with the person-centered
approach to care. Patients affected by eating disorders require
individualized support to better understand their condition, rediscover
their identity, learn to accept themselves, enhance a positive body
image and sense of self-worth, and achieve a balance in their lives so
that they can move towards better health and wellbeing.
Option A: She must then eat 100% of what she selected. During
Page 27 of 102
:
the early stages of treatment when patients are still new to
recovery, they look to nurses to provide them with a highly
structured environment, which sometimes involves nurses
making food and behavioral decisions on their behalf. While this
might not be an ongoing issue for primary care nurses, they may
still be required to offer decisive advice on these areas. Here, it is
imperative that nurses offer such advice with a clear message
that patients have the power to make these decisions themselves.
Option B: Remaining with the client for at least 1 hour after eating
will prevent purging. As treatment progresses, patients eventually
grow to appreciate nurses who act as role models and educate
them on how to normalize their diet and involvement in social
activities. Towards the end of treatment, nurses become more of
a support system, encouraging the patient to move forward
autonomously, while providing them with guidance on where to
seek help if it is needed.
Option D: Bulimic clients should only be allowed to eat food
provided by the dietary department. From awareness of the
eating disorder to recovery maintenance, the role of the primary
care nurse evolves, but what doesn’t change is the positive
influence nurses can have on those with an eating disorder. With
the skills of listening, empathy, adaptability, and communication,
primary care nurses can assist in identifying at-risk individuals
and optimizing the delivery of a multidisciplinary and holistic
approach to care.
1 point(s)
13. Question
Nurse Mary is assigned to care for a suicidal client. Initially, which is the nurse’s
highest care priority?
Page 28 of 102
:
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.
Incorrect
Correct Answer: B. Exploring the nurse’s own feelings about
suicide.
The nurse’s values, beliefs, and attitudes toward self-destructive
behavior influence responses to a suicidal client; such 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.
Option A: Assessment of the client’s home environment and
relationships may reveal the need for family therapy; however,
conducting such an assessment isn’t a nursing priority. A clear
and complete evaluation and clinical interview provide the
information upon which to base a suicide intervention. Although
risk factors offer major indications of the suicide danger, nothing
can substitute for a focused patient inquiry. However, although all
Page 29 of 102
:
the answers a patient gives may be inclusive, a therapist often
develops a visceral sense that his or her patient is going to
commit suicide. The clinician’s reaction counts and should be
considered in the intervention.
Option C: Discussing the future and providing anticipatory
guidance can help the client prepare for future stress, but this
isn’t a priority. If suicidal ideation is present, the next question
must be about any plans for suicidal acts. The general formula is
that more specific plans indicate greater danger. Although vague
threats, such as a threat to commit suicide sometime in the
future, are the reason for concern, responses indicating that the
person has purchased a gun, has ammunition, has made out a
will, and plans to use the gun are more dangerous. The plan
demands further questions. If the person envisions a gun-related
death, determine whether he or she has the weapon or access to
it.
Option D: Referring the client to a clergyperson may increase the
client’s trust or alleviate guilt; however, it isn’t the highest priority.
The only way to prevent suicides is to work in an interprofessional
team that includes a mental health nurse, psychiatrist, the
primary care provider, social worker, and nurse practitioner.
Practitioners must work with the patient’s family and friends, as
well as with the other patients who knew the client.
1 point(s)
14. Question
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?
Page 30 of 102
:
A. Avoid discussing the client’s perceptions and feelings.
B. Focus discussions on food and weight.
C. Avoid discussing unrealistic cultural standards regarding weight.
D. Provide objective data and feedback regarding the client’s

weight and attractiveness.
Correct
Correct Answer: D. Provide objective data and feedback regarding
the client’s weight and attractiveness
By focusing on reality, this strategy may help the client develop a more
realistic body image and gain self-esteem. Anorexia nervosa is an eating
disorder defined by restriction of energy intake relative to requirements,
leading to a significantly low body weight. Patients will have an intense
fear of gaining weight and distorted body image with the inability to
recognize the seriousness of their significantly low body weight. The
mental health nurse should educate the patient on changes in behavior,
easing stress, and overcoming any emotional issues.
Option A: This is inappropriate because discussing the client’s
perceptions and feelings wouldn’t help her to identify, accept,
and work through them. Since recovery involves patients having
to face their deepest, most painful, and traumatic thoughts and
emotions, supporting them as they go through treatment can be
Page 31 of 102
:
emotionally challenging for nurses. This emotional challenge can
be exacerbated when the patient has also been diagnosed with
Obsessive-Compulsive Disorder (OCD), depression, or substance
abuse, as these may require more intensive one-to-one support.
Option B: Focusing discussions on food and weight would give
the client attention for not eating. During the early stages of
treatment when patients are still new to recovery, they look to
nurses to provide them with a highly structured environment,
which sometimes involves nurses making food and behavioral
decisions on their behalf. While this might not be an ongoing
issue for primary care nurses, they may still be required to offer
decisive advice on these areas. Here, it is imperative that nurses
offer such advice with a clear message that patients have the
power to make these decisions themselves.
Option C: This is inappropriate because recognizing unrealistic
cultural standards wouldn’t help the client establish more realistic
weight goals. Furthermore, learning motivational interviewing
techniques can help facilitate communication with those who
might be resistant to discussing topics related to food, weight,
and recovery. Such techniques can help develop the skills of
empathic understanding, rolling with resistance, and gently
assisting patients to make their own, autonomous decision to
work towards recovery. Often, the aim is to help patients learn
new and healthier ways of coping, and nurses can achieve this
through a mix of emotional support, education, and signposting.
1 point(s)
15. Question
Nurse Alice is caring for a client being treated for alcoholism. Before initiating
therapy with disulfiram (Antabuse), the nurse teaches the client that he must
Page 32 of 102
:
read labels carefully on which of the following products?
A. Carbonated beverages
B. Aftershave lotion
C. Toothpaste
D. Cheese
Incorrect
Correct Answer: B. Aftershave lotion
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 to avoid products containing alcohol
such as aftershave lotions. Close monitoring of adverse events is
necessary, in particular, in patients with polysubstance abuse. Patients
taking disulfiram require monitoring for signs and symptoms of hepatitis,
including fatigue, weakness, anorexia, nausea, vomiting, jaundice,
malaise, and dark urine.
Option A: Disulfiram is one of three drugs approved by the FDA
Page 33 of 102
:
for the treatment of alcohol dependence. It is a second-line
option (acamprosate and naltrexone are first-line treatments) in
patients with sufficient physician supervision. Disulfiram is safe
and efficient in supervised short-term and long-term treatment of
individuals dependent on alcohol but who are motivated to
discontinue alcohol use.
Option C: Disulfiram irreversibly inhibits aldehyde dehydrogenase
(ALDH1A1) by competing with nicotinamide adenine dinucleotide
(NAD) at the cysteine residue in the active site of the enzyme.
ALDH1A1 is a hepatic enzyme of the major oxidative pathway of
alcohol metabolism converting ethanol to acetaldehyde. At
therapeutic doses of disulfiram, alcohol consumption results in
increased serum acetaldehyde, causing diaphoresis, palpitations,
facial flushing, nausea, vertigo, hypotension, and tachycardia.
Option D: Patients receiving metronidazole, paraldehyde, alcohol,
or alcohol-containing preparations (sauces, cough mixtures,
vinegar) should not receive disulfiram and should be educated in
advance to avoid a disulfiram-alcohol reaction. Never administer
to a patient if alcohol use is suspected or without the patient’s
consent and understanding of disulfiram-alcohol reaction.
1 point(s)
16. Question
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.
Page 34 of 102
:
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.
Correct
Correct Answer: C. Set up a strict eating plan for the client.
Establishing a consistent eating plan and monitoring the client’s weight
is important for this disorder. Establish a minimum weight goal and daily
nutritional requirements. Malnutrition is a mood-altering condition,
leading to depression and agitation and affecting cognitive function and
decision making. Improved nutritional status enhances thinking ability,
allowing initiation of psychological work. Make a selective menu
available, and allow the patient to control choices as much as possible.
Patient who gains confidence in himself and feels in control of the
environment is more likely to eat preferred foods.
Option A: The family should be included in the client’s care.
Involve patients in setting up or carrying out a program of
behavior modification. Provide a reward for weight gain as
individually determined; ignore the loss. It provides a structured
eating situation while allowing the patient some control in
choices. Behavior modification may be effective in mild cases or
for short-term weight gain.
Option B: The client should be monitored during meals — not
given privacy. Provide one-to-one supervision and have a patient
with bulimia remain in the day room area with no bathroom
Page 35 of 102
:
privileges for a specified period (2 hr) following eating, if
contracting is unsuccessful. Prevents vomiting during and after
eating. Patients may desire food and use a binge-purge syndrome
to maintain weight. Note: Patients may purge for the first time in
response to the establishment of a weight gain program.
Option D: Exercise must be limited and supervised. Monitor
exercise programs and set limits on physical activities. Chart
activity and level of work (pacing and so on). Moderate exercise
helps in maintaining muscle tone, weight and combating
depression; however, patients may exercise excessively to burn
calories.
1 point(s)
17. Question
Nurse Taylor is aware that the victims of domestic violence should be assessed
for what important information?
A. Reasons they stay in the abusive relationship (for example, lack of

financial autonomy and isolation).
B. Readiness to leave the perpetrator and knowledge of resources.
C. Use of drugs or alcohol.
D. History of previous victimization.
Page 36 of 102
:
Incorrect
Correct Answer: B. Readiness to leave the perpetrator and
knowledge of resources.
Victims of domestic violence must be assessed for their readiness to
leave the perpetrator and their knowledge of the resources available to
them. Nurses can then provide the victims with information and options
to enable them to leave when they are ready. Training and support
programs for clinicians and administrative staff have been shown to
improve identification of women experiencing domestic violence and
referral to advocacy services. Use of a domestic violence advocate in
the ED resulted in a higher incidence of detection of incidents of acute
violence than the data reported in the literature.
Option A: The reasons they stay in the relationship are complex
and can be explored at a later time. Reportedly, at least 40% of
domestic violence victims never contact the police. Of female
victims of domestic violence homicide, 44% had visited an ED
within 2 years of their murder.
Option C: The use of drugs or alcohol is irrelevant. Since
substance abuse may develop or worsen as a result of domestic
violence, it is appropriate to consider domestic violence when
evaluating a patient for alcohol intoxication, drug toxicity, or drug
overdose. A family history of alcohol and drug abuse or similar
history in the patient’s partner is also an important risk factor.
Option D: There is no evidence to suggest that previous
victimization results in a person’s seeking or causing abusive
relationships. The frequency and severity of previous attacks
indicate the degree of present danger. Threats are as important
as any actual injury. The presence of weapons in the home is a
risk factor. In addition to threats and physical abuse, relationships
with high risk for injury or death commonly feature exaggerated
Page 37 of 102
:
forms of coercion and manipulation to maintain the partner’s
dependence. This may result in the Stockholm syndrome.
1 point(s)
18. Question
A male client is hospitalized with fractures of the right femur and right humerus
sustained in a motorcycle accident. Police suspect the client was intoxicated at
the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2%
(200 mg/dl). The client later admits to drinking heavily for years. During
hospitalization, the client periodically complains of tingling and numbness in the
hands and feet. Nurse Gian realizes that these symptoms probably result from:
A. Acetate accumulation
B. Thiamine deficiency
C. Triglyceride buildup.
D. A below-normal serum potassium level
Incorrect
Correct Answer: B. Thiamine deficiency
Numbness and tingling in the hands and feet are symptoms of
peripheral polyneuritis, which results from inadequate intake of vitamin
Page 38 of 102
:
B1 (thiamine) secondary to prolonged and excessive alcohol intake.
Treatment includes reducing alcohol intake, correcting nutritional
deficiencies through diet and vitamin supplements, and preventing such
residual disabilities as foot and wrist drop.
Option A: When thiamine stores are depleted (which takes about
4 weeks after stopping intake), symptoms start to appear. When
evaluating for thiamine deficiency, the typical history may include
poor nutritional intake, excessive alcohol intake, or the patient
belonging to the special populations of individuals previously
mentioned (pregnant women, recipients of bariatric surgery,
patients with prolonged diuretic use, anyone with poor overall
nutritional status, etc.).
Option C: Initial symptoms of B1 deficiency include anorexia,
irritability, and difficulties with short-term memory. With
prolonged thiamine deficiency, patients may endorse loss of
sensation in the extremities, symptoms of heart failure including
swelling of the hands or feet and chest pain related to demand
ischemia, or feelings of vertigo, double vision, and memory loss.
Additionally, close friends and family of the patient may describe
confusion or symptoms of confabulation.
Option D: Detection of thiamine deficiency relies on relevant
history and physical exam findings and follow up with laboratory
testing for confirmation. Functional enzymatic assay of
transketolase activity is the activity of transketolase measured
before and after the addition of thiamine pyrophosphate; >25%
stimulation response is abnormal. Measurement of thiamine or
the phosphorylated esters of thiamine in serum or blood using
high-performance liquid chromatography is used. Urine studies
exist but are not a reliable test for the evaluation of total body
thiamine.
Page 39 of 102
:
1 point(s)
19. Question
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.
Incorrect
Correct Answer: C. The child doesn’t cry when the shoulder is
examined.
A characteristic behavior of abused children is the lack of crying when
they undergo a painful procedure or are examined by a healthcare
professional. Therefore, the nurse should suspect child abuse. Physical
abuse may include beating, shaking, burning, and biting. The threshold
for defining corporal punishment as abuse is unclear. Rib fractures are
found to be the most common finding associated with physical abuse.
Any child younger than two years old for whom there is a concern of
physical abuse should have a skeletal survey. Additionally, any sibling
Page 40 of 102
:
younger than two years of age of an abused child should also have a
skeletal survey. A skeletal survey consists of 21 dedicated views, as
recommended by the American College of Radiology.
Option A: The World Health Organization (WHO) defines child
maltreatment as “all forms of physical and emotional ill-treatment,
sexual abuse, neglect, and exploitation that results in actual or
potential harm to the child’s health, development or dignity.”
There are four main types of abuse: neglect, physical abuse,
psychological abuse, and sexual abuse. Abuse is defined as an
act of commission and neglect is defined as an act of omission in
the care leading to potential or actual harm.
Option B: Physical abuse should be considered in the evaluation
of all injuries of children. A thorough history of present illness is
important to make a correct diagnosis. Important aspects of the
history-taking involve gathering information about the child’s
behavior before, during, and after the injury occurred. History-
taking should include the interview of each caretaker separately
and the verbal child, as well. The parent or caretaker should be
able to provide their history without interruptions in order not to
be influenced by the physician’s questions or interpretations.
Option D: The second most common type of child abuse after
neglect is physical abuse. Eighty percent of abusive fractures
occur in non-ambulatory children, particularly in children younger
than 18 months of age. The most important risk factor for abusive
skeletal injury is age. There is no fracture pathognomonic for
abuse, but there are some fractures that are more suggestive of
abuse. These include posterior or lateral rib fractures and
“corner” or “bucket handle” fractures, which occur at the ends of
long bones and which result from a twisting mechanism. Other
highly suspicious fractures are sternal, spinal and scapular
fractures.
Page 41 of 102
:
1 point(s)
20. Question
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
Correct
Correct Answer: B. Client’s safety needs
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. Phencyclidine
(PCP) is a dissociative anesthetic that is a commonly used recreational
drug. PCP is a crystalline powder that can be ingested orally, injected
intravenously, inhaled, or smoked. PCP is available as a powder, crystal,
liquid, and tablet. It produces both stimulation and depression of the
CNS. PCP is a non-competitive antagonist to the NMDA receptor, which
causes analgesia, anesthesia, cognitive defects, and psychosis.
Page 42 of 102
:
Option A: Depending on the dose and route of administration,
PCP can have a wide range of central nervous system (CNS)
manifestations. Emergency department providers should become
familiar with how to manage patients with PCP toxicity since
rhabdomyolysis, hypoglycemia, seizures, hypertensive crisis,
coma, and trauma are several of the complications that can arise
with PCP use
Option C: PCP blocks the uptake of dopamine and
norepinephrine, leading to sympathomimetic effects such as
hypertension, tachycardia, bronchodilation, and agitation. PCP
can also cause sedation, muscarinic, and nicotinic signs by
binding to acetylcholine receptors and GABA receptors. Sigma
receptor stimulation by PCP causes lethargy and coma.
Option D: Most patients survive PCP intoxication with supportive
care. Airway, breathing, circulation, and hemodynamic monitoring
are essential to the care of patients with PCP toxicity. Intubation
with ventilatory support may be required for airway protection.
Gastrointestinal decontamination is generally unnecessary in PCP
ingestions; however, activated charcoal may be beneficial with a
massive ingestion of PCP or a dangerous coingestion. Activated
charcoal therapy should only be started within one hour from the
time of ingestion. The activated charcoal dose is 1 g/kg, with a
maximum dose of 50 g.
1 point(s)
21. Question
The nurse is aware that the outcome criteria would be appropriate for a child
diagnosed with oppositional defiant disorder?
Page 43 of 102
:
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.
Incorrect
Correct Answer: A. Accept responsibility for own behaviors
Children with oppositional defiant disorder frequently violate the rights
of others. They are defiant, disobedient, and blame others for their
actions. Accountability for their actions would demonstrate progress for
the oppositional child. Oppositional defiant disorder (ODD) is a type of
childhood disruptive behavior disorder that primarily involves problems
with the self-control of emotions and behaviors. According to the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5), the main feature of ODD is a persistent pattern of angry or
irritable mood, argumentative or defiant behavior, or vindictiveness
toward others.
Option B: This is incorrect as the oppositional child usually,
focuses on his own needs. Temperamental factors such as
irritability, impulsivity, poor frustration, tolerance, and high levels
of emotional reactivity are commonly associated with ODD. While
not all children diagnosed with ODD show callous and
Page 44 of 102
:
unemotional traits, it has been shown that such traits are highly
heritable and may be seen more frequently in a subset of children
with more significant disruptive behaviors.
Option C: Treatment of oppositional defiant disorder is
multimodal and should involve the patient, family, school, and
community. Identifying and treating comorbidities (like ADHD,
depression, and anxiety) and modifiable risk factors (such as
bullying and learning difficulties) should be done. Treatment may
also vary based on whether oppositional behavior primarily
occurs in specific contexts or if the behavior is pervasive and thus
requires more intensive treatment.
Option D: This is not an outcome criterion but an intervention.
Parent Management Training or PMT is based on the principles of
social learning theory and is the main treatment for oppositional
behaviors. The guiding principle in PMT is the use of operant
conditioning (using the role of positive reinforcement in changing
behaviors) to decrease unwanted behaviors and promote
prosocial behaviors. Methods include teaching parents to identify
problem behaviors as well as positive interactions and to apply
punishment or reinforcement as appropriate.
1 point(s)
22. Question
A male client is found sitting on the floor of the bathroom in the day treatment
clinic with moderate lacerations on both wrists. Surrounded by broken glass, he
sits staring blankly at his bleeding wrists while staff members call for an
ambulance. How should Nurse Anuktakanuk approach her initially?
A. Enter the room quietly and move beside him to assess his injuries.
Page 45 of 102
:
B. Call for staff back-up before entering the room and restraining
him.
C. Move as much glass away from him as possible and sit next to him
quietly.
D. Approach him slowly while speaking in a calm voice, calling

his name, and telling him that the nurse is here to help him.
Correct
Correct Answer: D. Approach her slowly while speaking in a calm
voice, calling her name, and telling her that the nurse is here to help
her
Ensuring the safety of the client and the nurse is the priority at this time.
Therefore, the nurse should approach the client cautiously while calling
her name and talking to her in a calm, confident manner. Nursing’s
hands-on approach to patient care and our ability to create therapeutic
connections with patients enables us to pick up on key cues. Identifying
these cues starts with understanding that suicidal behaviors are neither
considered an illness nor a condition, but rather a complex set of
behaviors that actually exists on a continuum that ranges from
ideas/thoughts to eventual actions.
Option A: The nurse should keep in mind that the client shouldn’t
be startled or overwhelmed. After explaining that the nurse is
there to help, the nurse should observe the client’s response
carefully. The promotion of a care environment that is safe and
conducive to their full recovery is essential in carrying out
Page 46 of 102
:
comprehensive care in mental health. The first step is qualified
listening, but it cannot be immersed in a bigoted discourse, full of
judgment. One must consider that not always the person is willing
to express or externalize what they really feel, and so a new
challenge to the health professional emerges, which is the careful
observation of the reality of the patient and the listening of
silence when the person is not willing to talk.
Option B: If the client shows signs of agitation or confusion or
poses a threat, the nurse should retreat and request assistance.
For the care to surpass the technical focus, the psychological
care and the continuous observation of patients and family
members are also necessary, aiming to prioritize the
communication in accordance with the qualified listening, as
these patients are often insecure. It is important to highlight that
all people who attempted suicide should receive professional care
due to the emotional fragility in which they find themselves. The
competence of the emergency team is saving lives, considering
not only the physical aspects but also the psychological aspects
involved in the process of caring
Option C: The nurse shouldn’t attempt to sit next to the client or
examine injuries without first announcing the nurse’s presence
and assessing the dangers of the situation. There are some
essential behaviors that nursing can use to meet a person who
attempted suicide or has suicidal ideation, namely: listen
carefully, be empathetic, convey non-verbal messages of
acceptance, express respect for the opinion of another, talk
honestly, show concern, and focus on the feelings of the person.
The mere interaction with the patient has a great potential to calm
down, prevent, or minimize the severity and intensity of the
symptoms. Still, the team should try to establish a bond of trust
from the start, whereas, on the other hand, the idea that the
patient attempted suicide to manipulate others should be
Page 47 of 102
:
abandoned.
1 point(s)
23. Question
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.
Correct
Correct Answer: D. Telling the client of the nurse’s concern for her
health and desire to help her make decisions to keep her healthy
Page 48 of 102
:
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. Respond (confront) with reality
when a patient makes unrealistic statements. The patient may be
denying the psychological aspects of their own situation and is often
expressing a sense of inadequacy and depression.
Option A: Instead of protecting the client’s health, option A may
serve to make the client defensive and more entrenched in her
unrealistic body image. Allow the patient to draw a picture of self.
It provides an opportunity to discuss the patient’s perception of
self and body image and realities of an individual situation.
Option B: Encourage personal development program, preferably
in a group setting. Provide information about the proper
application of makeup and grooming. Learning about methods to
enhance personal appearance may be helpful to a long-range
sense of self-esteem and image. Feedback from others can
promote feelings of self-worth.
Option C: Establish a therapeutic nurse-patient relationship.
Within a helping relationship, the patient can begin to trust and
try out new thinking and behaviors. Assist the patient to assume
control in areas other than dieting and weight loss such as
management of their own daily activities, work, and leisure
choices. Feelings of personal ineffectiveness, low self-esteem,
and perfectionism are often part of the problem. The patient feels
helpless to change and requires assistance to problem-solve
methods of control in life situations.
1 point(s)
24. Question
Eighteen hours after undergoing an emergency appendectomy, a client with a
Page 49 of 102
:
reported history of social drinking displays these vital signs: temperature,
101.6° F (38.7° C); heart rate, 126 beats/minute; respiratory rate, 24
breaths/minute; and blood pressure, 140/96 mm Hg. The client exhibits gross
hand tremors and is screaming for someone to kill the bugs in the bed. Nurse
Melinda should suspect:
A. A postoperative infection
B. Alcohol withdrawal
C. Acute sepsis.
D. Pneumonia.
Correct
Correct Answer: B. Alcohol withdrawal
The client’s vital signs and hallucinations suggest delirium tremens or
alcohol withdrawal syndrome. Alcohol withdrawal symptoms occur when
patients stop drinking or significantly decrease their alcohol intake after
long-term dependence. Withdrawal has a broad range of symptoms
from mild tremors to a condition called delirium tremens, which results in
seizures and could progress to death if not recognized and treated
promptly.
Option A: GABA (gamma-aminobutyric acid) is the major
inhibitory neurotransmitter in the central nervous center. GABA
Page 50 of 102
:
has particular binding sites available for ethanol, thus increasing
the inhibition of the central nervous system when present.
Chronic ethanol exposure to GABA creates constant inhibition or
depressant effects on the brain. Ethanol also binds to glutamate,
which is one of the excitatory amino acids in the central nervous
system. When it binds to glutamate, it inhibits the excitation of
the central nervous system, thus worsening the depression of the
brain.
Option C: Alcohol withdrawal can range from very mild
symptoms to the severe form, which is named delirium tremens.
The hallmark is autonomic dysfunction resulting from the
excitation of the central nervous system. Mild signs/symptoms
can arise within six hours of alcohol cessation. If symptoms do
not progress to more severe symptoms within 24 to 48 hours, the
patient will likely recover.
Option D: Although pneumonia may arise as postoperative
complications; it wouldn’t cause this client’s signs and symptoms
and typically would occur later in the postoperative course. Mild
symptoms can be insomnia, tremulousness, hyperreflexia,
anxiety, gastrointestinal upset, headache, palpitations. Moderate
symptoms include alcohol withdrawal seizures (rum fits) that can
occur 12 to 24 hours after cessation of alcohol and are typically
generalized in nature. There is a 3% incidence of status
epilepticus in these patients. About 50% of patients who have
had a withdrawal seizure will progress to delirium tremens.
1 point(s)
25. Question
Clonidine (Catapres) can be used to treat conditions other than hypertension.
Nurse Sally is aware that the following conditions might the drug be
Page 51 of 102
:
administered?
A. Phencyclidine (PCP) intoxication
B. Alcohol withdrawal
C. Opiate withdrawal
D. Cocaine withdrawal
Correct
Correct Answer: C. Opiate withdrawal
Clonidine is used as adjunctive therapy in opiate withdrawal.
Symptomatic treatment in opioid withdrawal includes loperamide for
diarrhea, promethazine for nausea/vomiting, and ibuprofen for myalgia.
Clonidine can be given to reduce blood pressure. Opioid withdrawal
syndrome is a life-threatening condition resulting from opioid
dependence. Opioids are a group of drugs used for the management of
severe pain. They are also commonly used as psychoactive substances
around the world.
Option A: Benzodiazepines and neuroleptic agents are typically
used to treat PCP intoxication. Benzodiazepines are the preferred
medication for chemical sedation in patients with PCP toxicity.
Lorazepam 2 to 4 mg intravenous (IV) or intramuscular (IM), or
diazepam 5 to 10 mg IV or IM are recommended.
Page 52 of 102
:
Benzodiazepines are also the first-line treatment for PCP-induced
hypertension and seizures. Hyperthermia from PCP toxicity is due
to psychomotor agitation and can be successfully treated with
benzodiazepines as well.
Option B: Benzodiazepines, such as chlordiazepoxide (Librium),
and neuroleptic agents, such as haloperidol, are used to treat
alcohol withdrawal. The hallmark of management for severe
symptoms is the administration of long-acting benzodiazepines.
The most commonly used benzodiazepines are intravenous
diazepam (Valium) or intravenous lorazepam (Ativan) for
management. Patients with severe withdrawal symptoms may
require escalating doses and intensive care level monitoring.
Option D: Antidepressants and medications with dopaminergic
activity in the brain, such as fluoxetine (Prozac), are used to treat
cocaine withdrawal. Central nervous system (CNS) stimulants like
cocaine and amphetamine can also produce withdrawal
symptoms. Like opioids, the withdrawal symptoms are mild and
not life-threatening. Often the individual will develop marked
depression, excessive sleep, hunger, dysphoria, and severe
psychomotor retardation but all vital functions are well preserved.
Recovery is usually slow, and depression can last for several
weeks.
1 point(s)
26. Question
A male client with a history of cocaine addiction is admitted to the coronary
care unit for evaluation of substernal chest pain. The electrocardiogram (ECG)
shows a 1-mm ST-segment elevation of 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:
Page 53 of 102
:
A. Lidocaine (Xylocaine).
B. Procainamide (Pronestyl).
C. Nitroglycerin (Nitro-Bid IV).
D. Epinephrine.
Correct
Correct Answer: C. Nitroglycerin (Nitro-Bid IV).
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.
Nitroglycerin is a vasodilatory drug used primarily to provide relief from
anginal chest pain. Although nitroglycerin has a vasodilatory effect in
both arteries and veins, the profound desired effects caused by
nitroglycerin are primarily due to venodilation. Venodilation causes
pooling of blood within the venous system, reducing preload to the
heart, which causes a decrease in cardiac work, reducing anginal
symptoms secondary to demand ischemia.
Option A: Lidocaine, formerly also referred to as lignocaine, is an
amide local anesthetic agent. The drug is commonly used for
local anesthesia, often in combination with epinephrine (which
acts as a vasopressor and extends its duration of action at a site
by opposing the local vasodilatory effects of lidocaine).
Page 54 of 102
:
Option B: Procainamide is a cardiac drug that may be indicated
for this client at some point but isn’t used for coronary artery
dilation. Procainamide is a medication used in the management
and treatment of ventricular arrhythmias, supraventricular
arrhythmias, atrial flutter, atrial fibrillation, AV nodal reentrant
tachycardia, and Wolf-Parkinson-White syndrome. It is a Class 1A
antiarrhythmic agent.
Option D: 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. Epinephrine is one of the most commonly
used agents in a variety of settings as it functions as medication
and hormone. It is currently FDA-approved for various situations,
including emergency treatment of type 1 hypersensitivity
reactions including anaphylaxis, induction, and maintenance of
mydriasis during intraocular surgeries, and hypotension due to
septic shock.
1 point(s)
27. Question
A 14-year-old client was 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.”
Page 55 of 102
:
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.”
Correct
Correct Answer: C. “I just can’t seem to get down to the weight I
want to be. I’m so fat compared to other girls.”
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. Anorexia is also more common among teenagers. Still,
people of any age can develop this eating disorder, though it’s rare in
those over 40. Teens may be more at risk because of all the changes
their bodies go through during puberty. They may also face increased
peer pressure and be more sensitive to criticism or even casual
comments about weight or body shape.
Option A: Most clients with anorexia nervosa don’t like the way
they look, and their self-perception may be distorted. A girl with
cachexia may perceive herself to be overweight when she looks in
the mirror. Some people with anorexia may have obsessive-
compulsive personality traits that make it easier to stick to strict
diets and forgo food despite being hungry. They may have an
extreme drive for perfectionism, which causes them to think
Page 56 of 102
:
they’re never thin enough. And they may have high levels of
anxiety and engage in restrictive eating to reduce it.
Option B: Preferring fast food over healthy food is common in
this age-group. Although it’s not yet clear which genes are
involved, there may be genetic changes that make some people
at higher risk of developing anorexia. Some people may have a
genetic tendency toward perfectionism, sensitivity, and
perseverance — all traits associated with anorexia.
Option D: Because of the absence of body fat necessary for
proper hormone production, amenorrhea is common for a client
with anorexia nervosa. Patients will report symptoms such as
amenorrhea, cold intolerance, constipation, extremity edema,
fatigue, and irritability. They may describe restrictive behaviors
related to food like calorie counting or portion control, and
purging methods, for example, self-induced vomiting or use of
diuretics or laxatives.
1 point(s)
28. Question
Nurse Fey is aware that the drug of choice for treating Tourette syndrome?
A. Fluoxetine (Prozac)
B. Fluvoxamine (Luvox)
C. Haloperidol (Haldol)
Page 57 of 102
:
D. Paroxetine (Paxil)
Incorrect
Correct Answer: C. Haloperidol (Haldol)
Haloperidol is the drug of choice for treating Tourette syndrome.
Antipsychotic medications have been the most extensively studied.
Haloperidol and pimozide are the first-generation antipsychotics with
the most data showing efficacy in reducing tic severity. However, their
use is limited by potentially severe side effects such as sedation, acute
dystonia, and other drug-induced movement disorders like weight gain,
and prolonged QTc interval (pimozide).
Option A: Fluoxetine has FDA-approval for major depressive
disorder (age eight and older), obsessive-compulsive disorder
(age seven and older), panic disorder, bulimia, binge eating
disorder, premenstrual dysphoric disorder, bipolar depression (as
an adjunct with olanzapine also known as Symbyax), and
treatment-resistant depression when used in combination with
olanzapine.
Option B: Fluvoxamine is used to treat obsessive-compulsive
disorder (OCD). It helps decrease persistent/unwanted thoughts
(obsessions) and urges to perform repeated tasks (compulsions
such as hand-washing, counting, checking) that interfere with
daily living. Fluvoxamine is known as a selective serotonin
reuptake inhibitor (SSRI). This medication works by helping to
restore the balance of a certain natural substance (serotonin) in
the brain.
Option D: Paroxetine is a selective serotonin reuptake inhibitor
(SSRI), and, as such, is identified as an antidepressant. It is FDA
approved for major depressive disorder (MDD), obsessive-
Page 58 of 102
:
compulsive disorder (OCD), social anxiety disorder (SAD), panic
disorder, posttraumatic stress disorder (PTSD), generalized
anxiety disorder (GAD), and premenstrual dysphoric disorder
(PMDD), vasomotor symptoms associated with menopause.
1 point(s)
29. Question
A male client tells the nurse he was involved in a car accident while he was
intoxicated. What would 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 Alcoholics Anonymous meeting.”
Correct
Correct Answer: B. “Tell me how you feel about the accident.”
An open-ended statement or question 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. mix open-ended questions with focus
Page 59 of 102
:
questions. Open-ended questions may allow the patient to express their
thoughts and feelings, and focused questions allow the interviewer to
obtain important details with yes or no answers in a more time-efficient
manner.
Option A: Asking the client why he drove while intoxicated can
make him feel defensive and intimidated. The first question posed
in the interview is often open-ended. For example, “What is the
main reason you seek medical assistance today?” This provides
an opportunity for the interviewer to allow the patient to share
their concerns, and the interviewer can show he or she is actively
listening. This includes listening without judgment and displaying
concern for the patient during communication.
Option C: A judgmental approach isn’t therapeutic. During the
interview, meaningful questions inquired positively will reduce
defensiveness from the patient. Often this can be accomplished
by suggesting or sharing a common behavior associated with the
actions of the patient. For example, the interviewer may convey
the commonality for people to consume alcohol when under
stress. It then becomes acceptable to inquire if this is also
occurring with the patient. The patient may feel a sense of trust
and therefore share pertinent information.
Option D: By giving advice, the nurse suggests that the client
isn’t capable of making decisions, thus fostering dependency. At
the conclusion of the patient interview, an appropriate transition
statement to begin the physical exam may be, “Is there anything
else that you would like to share with me before I start the
physical examination?” This statement serves 2 purposes. First, it
elicits any additional information the patient deems necessary,
and second, it signals a transition to the physical exam. Lastly,
before concluding the interview, it is important to discuss the
probable follow-up plan and further treatment. In the outpatient
setting, this may include admission to the hospital or going home
Page 60 of 102
:
and returning for a follow-up appointment at a designated time.
1 point(s)
30. Question
A male adult client voluntarily admits himself to the substance abuse unit. He
confesses that he drinks one (1) qt or more of vodka each day and uses cocaine
occasionally. Later that afternoon, he begins to show signs of alcohol
withdrawal. What are some early signs of this condition?
A. Vomiting, diarrhea, and bradycardia
B. Dehydration, temperature above 101° F (38.3° C), and pruritus
C. Hypertension, diaphoresis, and seizures
D. Diaphoresis, tremors, and nervousness
Correct
Correct Answer: D. Diaphoresis, tremors, and nervousness
Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic
hallucinosis, and alcohol 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.
Page 61 of 102
:
Option A: Although diarrhea may be an early sign of alcohol
withdrawal, tachycardia — not bradycardia — is associated with
alcohol withdrawal. Alcohol withdrawal symptoms occur when
patients stop drinking or significantly decrease their alcohol
intake after long-term dependence. Withdrawal has a broad
range of symptoms from mild tremors to a condition called
delirium tremens, which results in seizures and could progress to
death if not recognized and treated promptly.
Option B: Dehydration and an elevated temperature may be
expected, but a temperature above 101° F indicates an infection
rather than alcohol withdrawal. Pruritus rarely occurs in alcohol
withdrawal. Alcohol withdrawal can range from very mild
Option C: If withdrawal symptoms remain untreated, seizures
may arise later. Withdrawal seizures can typically be managed
with benzodiazepines as well, but may require adjunct therapy
with phenytoin, barbiturates, and may even require intubation and
sedation with propofol (Diprivan), ketamine (Ketalar), or in the
most severe cases dexmedetomidine (Precedex).
1 point(s)
31. Question
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
Page 62 of 102
:
prescribe:
A. Norepinephrine (Levophed) and Lidocaine (Xylocaine)
B. Nifedipine (Procardia) and Lidocaine.
C. Nitroglycerin (Nitro-Bid IV) and Esmolol (Brevibloc)
D. Nifedipine and Esmolol
Incorrect
Correct Answer: D. Nifedipine and Esmolol
This client requires a vasodilator, such as nifedipine, to treat
hypertension, and a beta-adrenergic blocker, such as esmolol, to reduce
the heart rate. Nifedipine is a calcium channel blocker that belongs to
the dihydropyridine subclass. It is primarily used as an antihypertensive
and antianginal medication. Esmolol (esmolol hydrochloride) is an
intravenous cardioselective beta-1 adrenergic antagonist. Esmolol is
FDA-approved for short-term duration use in control of supraventricular
tachycardia, such as a rapid ventricular rate in patients with atrial
fibrillation or atrial flutter.
Option A: Norepinephrine’s predominant use is as a peripheral
vasoconstrictor. Specifically, the FDA has approved its use for
blood pressure control in specific acute hypotensive states, as
well as being a potential adjunct in the treatment of cardiac arrest
Page 63 of 102
:
with profound hypotension.
Option B: Lidocaine, an antiarrhythmic, isn’t indicated because
the client doesn’t have an arrhythmia. The drug is commonly
used for local anesthesia, often in combination with epinephrine
(which acts as a vasopressor and extends its duration of action at
a site by opposing the local vasodilatory effects of lidocaine).
Option C: Although nitroglycerin may be used to treat coronary
vasospasm, it isn’t the drug of choice in hypertension.
Nitroglycerin is a vasodilatory drug used primarily to provide relief
from anginal chest pain. Nitroglycerin has been FDA approved
since 2000 and was first sold by Pfizer under the brand name
Nitrostat. It is currently FDA approved for the acute relief of an
attack or acute prophylaxis of angina pectoris secondary to
coronary artery disease.
1 point(s)
32. Question
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.
Page 64 of 102
:
D. The client will make a personal inventory of strength.
Incorrect
Correct Answer: B. The client will work with the nurse to remain
safe.
The priority goal in alcohol withdrawal is maintaining the client’s safety.
Alcohol withdrawal can range from very mild symptoms to the severe
form, which is named delirium tremens. The hallmark is autonomic
dysfunction resulting from the excitation of the central nervous system.
Mild signs/symptoms can arise within six hours of alcohol cessation. If
symptoms do not progress to more severe symptoms within 24 to 48
hours, the patient will likely recover.
Option A: Delirium tremens is the most severe form of alcohol
withdrawal, and its hallmark is that of an altered sensorium with
significant autonomic dysfunction and vital sign abnormalities. It
includes visual hallucinations, tachycardia, hypertension,
hyperthermia, agitation, and diaphoresis. Symptoms of delirium
tremens can last up to seven days after alcohol cessation and
may last even longer.
Option C: The diagnosis of alcohol withdrawal can be made by
taking an excellent history and performing a thorough physical
examination. It is a clinical diagnosis based on mild, moderate, or
severe symptoms. Patients with suspicion for alcohol withdrawal
should be evaluated for other underlying disease processes such
as dehydration, infection, cardiac issues, electrolyte
abnormalities, gastrointestinal bleeding, and traumatic injury.
Laboratory studies (electrolytes, blood counts) may be drawn,
but will likely be nondiagnostic.
Option D: Patients with prolonged altered sensorium or
Page 65 of 102
:
significant renal abnormalities should have an evaluation for the
potential ingestion of another toxic alcohol. Patients who become
financially strapped due to alcoholism could ingest other alcohols
to become intoxicated. These can include isopropyl alcohol,
commonly known as rubbing alcohol, which can lead to acidemia
without ketosis as well as hemorrhagic gastritis.
1 point(s)
33. Question
A male client is admitted to a psychiatric facility by court order for evaluation for
antisocial personality disorder. This client has a long history of initiating fights
and abusing animals and recently was arrested for setting a neighbor’s dog on
fire. When evaluating this client for the potential for violence, nurse Perry
should assess for which behavioral clues?
A. A rigid posture, restlessness, and glaring
B. Depression and physical withdrawal
C. Silence and noncompliance
D. Hypervigilance and talk of past violent acts
Incorrect
Page 66 of 102
:
Correct Answer: A. A rigid posture, restlessness, and glaring
Behavioral clues that suggest the potential for violence include a rigid
posture, restlessness, glaring, a change in usual behavior, clenched
hands, overtly aggressive actions, physical withdrawal, noncompliance,
overreaction, hostile threats, recent alcohol ingestion or drug use, talk of
past violent acts, inability to express feelings, repetitive demands and
complaints, argumentativeness, profanity, disorientation, inability to
focus attention, hallucinations or delusions, paranoid ideas or
suspicions, and somatic complaints.
Option B: Before performing a comprehensive psychiatric
assessment of the patient, a careful history and physical
examination is necessary. “The DSM-5 diagnostic criteria for
Antisocial Personality Disorder. A pervasive pattern of disregard
for and violation of the rights of others, since age 15 years, as
indicated by three (or more) of the following: failure to conform to
social norms concerning lawful behaviors, such as performing
acts that are grounds for arrest; deceitfulness, repeated lying,
use of aliases, or conning others for pleasure or personal profit;
Impulsivity or failure to plan; Irritability and aggressiveness, often
with physical fights or assaults; reckless disregard for the safety
of self or others; consistent irresponsibility, failure to sustain
consistent work behavior, or honor monetary obligations; lack of
remorse, being indifferent to or rationalizing having hurt,
mistreated, or stolen from another person.
Option C: Of those children with conduct disorder, 25% of girls
and 40% of boys will meet the diagnostic criteria for antisocial
personality disorder. Boys exhibit symptoms earlier than girls,
who often only elicit these symptoms in puberty. Children who do
not develop conduct disorder and progress to the age of 15
without antisocial behaviors will not develop ASPD.
Option D: Antisocial personality disorder, although a chronic
condition with a lifelong presentation, has had moderations
Page 67 of 102
:
shown with advancing ages, with the mean remitted age of 35
years old. Those with less baseline symptomatology showed
better-remitted rates. Studies in the past revealed remission rates
of 12 to 27% and 27 to 31% rates of improvement, but not
remitted. Crime rates and severity reflect this relation as well, with
peak crime statistics in late teens and higher severity of crimes at
younger ages.
1 point(s)
34. Question
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 than I used
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.”
Page 68 of 102
:
Incorrect
Correct Answer: D. “I know I’ve been arrested three times for
drinking and driving, but the police are just trying to hassle me.”
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
despite knowledge of having a persistent or recurrent social,
occupational, psychological, or physical problem caused or exacerbated
by substance abuse or recurrent use in dangerous situations (for
example, while driving).
For this client, psychoactive substance dependence must be ruled out;
criteria for this disorder include a need for increasing amounts of the
substance to achieve intoxication (option A), increased time and money
spent on the substance (option B), inability to fulfill role obligations
(option C), and typical withdrawal symptoms.
Option A: A shortened version of the term used in the ICD-10 –
Mental and behavioral disorders due to psychoactive substance
use. The term encompasses acute intoxication, harmful use,
dependence syndrome, withdrawal state, withdrawal state with
delirium, psychotic disorder, and amnesic syndrome. For a
particular substance, these conditions may be grouped together
as, for example, alcohol disorders, cannabis use disorders,
stimulant use disorders. Psychoactive substance use disorders
are defined as being of clinical relevance; the term ‘psychoactive
substance use problems’ is a broader one, which includes
conditions and events not necessarily of clinical relevance.
Option B: Production, distribution, sale, or non-medical use of
many psychoactive drugs is either controlled or prohibited
outside legally sanctioned channels by law. Psychoactive drugs
have different degrees of restriction of availability, depending on
their risks to health and therapeutic usefulness, and classified
Page 69 of 102
:
according to a hierarchy of schedules at both national and
international levels. At the international level, there are
international drug conventions concerned with the control of
production and distribution of psychoactive drugs: the 1961
Single Convention on Narcotic Drugs, amended by a 1972
Protocol; the 1971 Convention on Psychotropic Substances; the
1988 Convention Against Illicit Traffic in Narcotic Drugs and
Psychotropic Substances.
Option C: It is an essential characteristic of the dependence
syndrome that either substance taking or a desire to take a
particular substance should be present; the subjective awareness
of compulsion to use drugs is most commonly seen during
attempts to stop or control substance use. This diagnostic
requirement would exclude, for instance, surgical patients given
opiate drugs for the relief of pain and who may show signs of an
opiate withdrawal state when drugs are not given, but who have
no desire to continue taking drugs.
1 point(s)
35. Question
A 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.
Page 70 of 102
:
C. Risk for violence: Self-directed related to impulsive mutilating
acts.
D. Risk for violence: Directed toward others related to verbal threats.
Incorrect
Correct Answer: C. Risk for violence: Self-directed related to
impulsive mutilating acts.
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. Borderline personality disorder
(BPD) is 1 of 4 Cluster-B disorders that include borderline, antisocial,
narcissistic, and histrionic. Borderline personality disorder (BPD) is
characterized by hypersensitivity to rejection and resulting instability of
interpersonal relationships, self-image, affect, and behavior
Option A: Inappropriate, intense anger, or difficulty controlling
anger, for example, frequent displays of temper, constant anger,
recurrent physical fights. A careful history and physical exam
should be performed before performing a comprehensive
psychiatric assessment. There are structured diagnostic
screening tools used to assess personality disorders and
specifically borderline personality disorder, for example, the
Zanarini Rating Scale for Borderline Personality Disorder.
Option B: There is identity disturbance which is a markedly and
persistently unstable self-image or sense of self. Borderline
personality disorder is multifactorial in etiology. There is a genetic
predisposition. Twin studies show over 50% heritability (greater
Page 71 of 102
:
than that for major depression). Twin studies performed in 2000
and 2008 both demonstrated higher concordance of the rate of
borderline personality disorder for monozygotic versus dizygotic
twins.
Option D: Self-injurious behavior, boundary issues, and frequent
suicidal threats present therapeutic challenges specific to the
treatment of patients with borderline personality disorder. High
rates of comorbid substance abuse may also confound the
treatment of borderline personality disorder patients.
1 point(s)
36. Question
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 for
which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
C. Neurobehavioral deficits
Page 72 of 102
:
D. Panic disorder
Incorrect
Correct Answer: A. Coronary artery spasm
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. Cocaine and its
metabolites may cause arterial vasoconstriction hours after use.
Epicardial coronary arteries are especially vulnerable to these effects,
leading to a decreased myocardial oxygen supply.
Option B: Consequently, the drug is more likely to cause
tachyarrhythmias than bradyarrhythmias. Cocaine-induced
central sympathetic stimulation and direct cardiac effects may
lead to tachycardia, hypertension, and coronary or cerebral artery
vasoconstriction leading to myocardial infarction and stroke.
Option C: Although neurobehavioral deficits are common in
neonates born to cocaine users, they are rare in adults. CNS
reactions may be more excitatory than depressant. In its mild
form, the patient may display anxiety, restlessness, and
excitement. Full-body tonic-clonic seizures may result from
moderate to severe CNS stimulation. These seizures are often
followed by CNS depression, with death resulting from respiratory
failure and/or asphyxiation if concomitant emesis is present.
Option D: As craving for the drug increases, a person who’s
addicted to cocaine typically experiences euphoria followed by
depression, not panic disorder. Cardiovascular toxicity and
agitation are best-treated first-line with benzodiazepines to
Page 73 of 102
:
decrease CNS sympathetic outflow. However, there is a risk of
over-sedation and respiratory depression with escalating and
numerous doses of benzodiazepines, which is often necessary.
Non-dihydropyridine calcium channel blockers such as diltiazem
and verapamil have shown the ability to reduce hypertension
reliably, but not tachycardia.
1 point(s)
37. Question
A male client is being admitted to the substance abuse unit for alcohol
detoxification. As part of the intake interview, the nurse asks him when he had
his last alcoholic drink. He says that he had his last drink six (6) hours before
admission. Based on this response, nurse Lorena should expect early
withdrawal symptoms to:
A. Begin after seven (7) days.
B. Not occur at all because the time period for their occurrence has
passed.
C. Begin anytime within the next one (1) to two (2) days.
D. Begin within two (2) to seven (7) days.
Page 74 of 102
:
Incorrect
Correct Answer: C. Begin anytime within the next one (1) to two (2)
days
Acute withdrawal symptoms from alcohol may begin 6 hours after the
client has stopped drinking and peak 1 to 2 days later. Delirium tremens
may occur 2 to 4 days — even up to 7 days — after the last drink.
Moderate symptoms include alcohol withdrawal seizures (rum fits) that
can occur 12 to 24 hours after cessation of alcohol and are typically
generalized in nature. There is a 3% incidence of status epilepticus in
these patients. About 50% of patients who have had a withdrawal
seizure will progress to delirium tremens.
Option A: Mild signs/symptoms can arise within six hours of
alcohol cessation. If symptoms do not progress to more severe
symptoms within 24 to 48 hours, the patient will likely recover.
However, the time to presentation and range of symptoms can
vary greatly depending on the patient, their duration of alcohol
dependence, and volume typically ingested.
Option B: Most cases should be described by their severity of
symptoms, not the time since their last drink. Noting the time of
their last drink is essential in any patient with an alcohol
dependence history who may be presenting with other
complaints. Mild symptoms can be insomnia, tremulousness,
hyperreflexia, anxiety, gastrointestinal upset, headache,
palpitations.
Option D: Delirium tremens is the most severe form of alcohol
Page 75 of 102
:
1 point(s)
38. Question
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 one

(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.
Correct
Correct Answer: A. Providing one-on-one supervision during meals
and for one (1) hour afterward.
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. Provide one-to-one
supervision and have a patient with bulimia remain in the day room area
with no bathroom privileges for a specified period (1 hr) following eating,
Page 76 of 102
:
if contracting is unsuccessful. Prevents vomiting during and after eating.
The patient may desire food and use a binge-purge syndrome to
maintain weight. Note: The patient may purge for the first time in
response to the establishment of a weight gain program.
Option B: This wouldn’t be therapeutic because other clients
may urge the client to eat and give attention for not eating.
Supervise the patient during mealtimes and for a specified period
after meals (usually one hour). It prevents vomiting during or after
eating.
Option C: This would reinforce control issues, which are central
to this client’s underlying psychological problem. Establish a
minimum weight goal and daily nutritional requirements.
Malnutrition is a mood-altering condition, leading to depression
and agitation and affecting cognitive function and decision
making. Improved nutritional status enhances thinking ability,
allowing initiation of psychological work.
Option D: Instead of giving the client unlimited time to eat, the
nurse should set limits and let the client know what is expected.
Make a selective menu available, and allow the patient to control
choices as much as possible. Patient who gains confidence in
himself and feels in control of the environment is more likely to
eat preferred foods. Be alert to choices of low-calorie foods and
beverages; hoarding food; disposing of food in various places,
such as pockets or wastebaskets. Patients will try to avoid taking
in what is viewed as excessive calories and may go to great
lengths to avoid eating.
1 point(s)
39. Question
A female client begins to experience alcoholic hallucinosis. Nurse Joy is aware
Page 77 of 102
:
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.
Incorrect
Correct Answer: C. Providing a quiet environment and
administering medication as needed and prescribed.
Manifestations of alcoholic hallucinosis are best treated by providing a
quiet environment for reducing stimulation and administering prescribed
central nervous system depressants in dosages that control symptoms
without causing oversedation. Encourage the patient to rest by
controlling minimal interpersonal contact with the patient. Decrease
environmental stimuli with controlled lighting, and provide a calm, quiet
private room. The individualized, symptom-triggered approach to
benzodiazepine use satisfies the need to use medication only when
needed and may also reduce inpatient hospital stays. Benzodiazepines
Page 78 of 102
:
stimulate GABA receptors causing a decrease in neuronal activity
resulting in sedation.
Option A: 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. Present reality
without challenging or escalating the patient’s anxiety and
thought disturbances. Build a therapeutic rapport with the patient
by providing relief from his or her symptoms and meeting
physiologic and safety needs. Meet the patient’s needs promptly
to reduce the risk of violence or aggression. Do not approach the
patient with loose items that the patient could grab if he or she
becomes agitated, such as a clipboard or dangling ID badge or
phone.
Option B: Offering juice is appropriate, but measuring blood
pressure every 15 minutes would interrupt the client’s rest. The
nurse also documents the patient’s vital signs, looking for an
upward trend indicating increased withdrawal symptoms. On a
scale of 0 (none) to 3 (severe), the nurse then rates key signs and
symptoms such as nausea/vomiting; tremors; diaphoresis;
anxiety; agitation; tactile, auditory, and visual disturbances;
headache; and orientation.
Option D: To avoid overstimulating the client, the nurse should
check blood pressure every 2 hours. As direct caregivers, nurses
are ideally positioned to improve patient outcomes by using the
symptom-triggered approach. Based on an objective withdrawal
severity scale, a symptom-triggered approach provokes faster
and more-effective relief of withdrawal symptoms than treatment
based on clinicians’ subjective judgment alone.
Page 79 of 102
:
1 point(s)
40. Question
Nurse Bella is aware that assessment finding is most consistent with early
alcohol withdrawal?
A. Heart rate of 120 to 140 beats/minute
B. Heart rate of 50 to 60 beats/minute
C. Blood pressure of 100/70 mmHg
D. Blood pressure of 140/80 mmHg
Incorrect
Correct Answer: A. Heart rate of 120 to 140 beats/minute
Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign
of alcohol withdrawal. Blood pressure may be labile throughout
withdrawal, fluctuating at different stages. Hypertension typically occurs
in early withdrawal. Hypotension, although rare during the early
withdrawal stages, may occur in later stages. Hypotension is associated
with cardiovascular collapse and most commonly occurs in clients who
don’t receive treatment. The nurse should monitor the client’s vital signs
carefully throughout the entire alcohol withdrawal process.
Option B: Delirium tremens is the most severe form of alcohol
Page 80 of 102
:
Option C: Alcohol withdrawal can range from very mild
Option D: Patients should be kept calm in a controlled
environment to try to reduce the risks of progression from mild
symptoms to hallucinations. With mild to moderate symptoms,
patients should receive supportive therapy in the form of
intravenous rehydration, correction of electrolyte abnormalities,
and have comorbid conditions as listed above ruled out.
1 point(s)
41. Question
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.
Page 81 of 102
:
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.
Incorrect
Correct Answer: B. One who plans a violent death and has the
means readily available.
The client at highest risk for suicide is one who plans a violent death (for
example, by gunshot, jumping off a bridge, or hanging), has a specific
plan (for example, after the spouse leaves for work), and has the means
readily available (for example, a rifle hidden in the garage). Several
suicide-related demographic factors often occur in the same person.
For example, if a male police officer with major depression and a
significant problem with alcohol commits suicide using his service
revolver (which, unfortunately, happens not infrequently), 5 risk factors
are involved: sex, occupation, depression, alcohol, and gun availability.
Option A: A host of thoughts and behaviors are associated with
self-destructive acts. Although many assume that people who
talk about suicide will not follow through with it, the opposite is
true; a threat of suicide can lead to the completed act, and
suicidal ideation is highly correlated with suicidal behaviors.
Option C: They are without hope and therefore cannot foresee
Page 82 of 102
:
things ever improving; they also view themselves as helpless in 2
ways: (1) they cannot help themselves, and all their efforts to
liberate themselves from the sea of depression in which they are
drowning are to no avail; and (2) no one else can help them.
Option D: A client who talks about wanting to die or attempting
suicide is considered at a lower risk for suicide because this
behavior typically serves to alert others that the client is
contemplating suicide and wishes to be helped. Determine
whether the person has any thoughts of hurting him or herself.
Suicidal ideation is highly linked to completed suicide. Some
inexperienced clinicians have difficulty asking this question. They
fear the inquiry may be too intrusive or that they may provide the
person with an idea of suicide. In reality, patients appreciate the
question as evidence of the clinician’s concern. A positive
response requires further inquiry.
1 point(s)
42. Question
Nurse Penny is aware that the following medical conditions are commonly
found in clients with bulimia nervosa?
A. Allergies
B. Cancer
C. Diabetes mellitus
Page 83 of 102
:
D. Hepatitis A
Correct
Correct Answer: C. Diabetes mellitus
Bulimia nervosa can lead to many complications, including diabetes,
heart disease, and hypertension. Girls and young women with type 1
diabetes have about twice the risk of developing eating disorders as
their peers without diabetes. This may be because of the weight
changes that can occur with insulin therapy and good metabolic control
and the extra attention people with diabetes must pay to what they eat.
Option A: The most common features of eating disorders in girls
and young women with type 1 diabetes are dissatisfaction with
their body weight and shape and desire to be thinner; dieting or
manipulation of insulin doses to control weight; and, binge eating.
Researchers estimate that 10–20 percent of girls in their mid-teen
years and 30–40 percent of late teenaged girls and young adult
women with diabetes skip or alter insulin doses to control their
weight.
Option B: In people with diabetes, eating disorders can lead to
poor metabolic control and repeated hospitalizations for
dangerously high or low blood sugar. Chronic poor blood sugar
control leads to long-term complications, such as eye, kidney,
and nerve damage. Diabulimia is a media-coined term that refers
to an eating disorder in a person with diabetes, typically type I
diabetes, wherein the person purposefully restricts insulin in
order to lose weight. Some medical professionals use the term
ED-DMT1, Eating Disorder-Diabetes Mellitus Type 1, which is
used to refer to any type of eating disorder comorbid with type 1
diabetes.
Page 84 of 102
:
Option D: The human body is surprisingly resilient and people
with diabulimia often manage to function with much higher blood
sugars than should be possible. Thus, the major consequences of
diabulimia or ED-DMT1 are usually related to prolonged elevated
blood sugar. These complications can be severe and irreversible,
so proper treatment and early detection are critical. High blood
sugar causes the body to produce certain enzymes and
hormones that negatively affect the immune system and reduce
the body’s defense against infection. This risk of infection plus
slowed healing heightens a person’s chance of developing
gangrene, sepsis, or a bone infection.
1 point(s)
43. Question
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.
Page 85 of 102
:
D. The student reports increased comfort with making choices.
Correct
Correct Answer: B. The student accepts a referral to a substance
abuse counselor
All of the outcomes stated are desirable; however, the best outcome is
that the student would agree to seek the assistance of a professional
substance abuse counselor. The basic goal for a client in any substance
abuse treatment setting is to reduce the risk of harm from continued use
of substances. The greatest degree of harm reduction would obviously
result from abstinence, however, the specific goal for each individual
client is determined by his consumption pattern, the consequences of
his use, and the setting in which the brief intervention is delivered.
Option A: Primary care providers find many brief intervention
techniques effective in addressing the substance abuse issues of
clients who are unable or unwilling to access specialty care.
Examples of brief interventions include asking clients to try
nonuse to see if they can stop on their own, encouraging
interventions directed toward attending a self-help group (e.g.,
Alcoholics Anonymous [AA] or Narcotics Anonymous [NA]), and
engaging in brief, structured, time-limited efforts to help pregnant
clients stop using.
Option C: The clinician can use brief interventions to motivate
particular behavioral changes at each stage of this process. For
example, in the contemplation stage, a brief intervention could
help the client weigh the costs and benefits of change. In the
preparation stage, a similar brief intervention could address the
costs and benefits of various change strategies (e.g., self-
change, brief treatment, intensive treatment, self-help group
Page 86 of 102
:
attendance). In the action stage, brief interventions can help
maintain motivation to continue on the course of change by
reinforcing personal decisions made at earlier stages.
Option D: To consider change, clients at the precontemplation
stage must have their awareness raised. To resolve their
ambivalence, clients in the contemplation stage must be helped
to choose positive change over their current circumstances.
Clients in the preparation stage need help in identifying potential
change strategies and choosing the most appropriate ones.
Clients in the action stage need help to carry out and comply with
the change strategies.
1 point(s)
44. Question
A male client who reportedly consumes one (1) qt of vodka daily is admitted for
alcohol detoxification. To try to prevent alcohol withdrawal symptoms, Dr. Smith
is most likely to prescribe which drug?
A. Clozapine (Clozaril)
B. Thiothixene (Navane)
C. Lorazepam (Ativan)
D. Lithium carbonate (Eskalith)
Page 87 of 102
:
Correct
Correct Answer: C. Lorazepam (Ativan)
The best choice for preventing or treating alcohol withdrawal symptoms
is lorazepam, a benzodiazepine. Lorazepam is a benzodiazepine
medication developed by DJ Richards. It went on the market in the
United States in 1977. Lorazepam has common use as the sedative and
anxiolytic of choice in the inpatient setting owing to its fast (1 to 3
minute) onset of action when administered intravenously. Lorazepam is
also one of the few sedative-hypnotics with a relatively clean side effect
profile. ff-label (non-FDA-approved) uses for Lorazepam include rapid
tranquilization of the agitated patient, alcohol withdrawal delirium,
alcohol withdrawal syndrome, insomnia, panic disorder, delirium,
chemotherapy-associated anticipatory nausea and vomiting (adjunct or
breakthrough), as well as psychogenic catatonia.
Option A: Clozapine is an FDA-approved atypical antipsychotic
drug for treatment-resistant schizophrenia.[1] The definition of
treatment-resistant schizophrenia is persistent or moderate
delusions or hallucinations after failing two trials of antipsychotic
medicines. Clozapine is part of a group of drugs known as
second-generation antipsychotics or atypical antipsychotics.[1]
Antipsychotic drugs are vital in treating the core symptoms of
schizophrenia: hallucinations and delusions.
Option B: Thiothixene is used to treat the symptoms of
schizophrenia (a mental illness that causes disturbed or unusual
thinking, loss of interest in life, and strong or inappropriate
emotions). Thiothixene is in a group of medications called
conventional antipsychotics. It works by decreasing abnormal
excitement in the brain.
Option D: Lithium was the first mood stabilizer and is still the
first-line treatment option, but is underutilized because it is an
Page 88 of 102
:
older drug. Lithium is a commonly prescribed drug for a manic
episode in bipolar disorder as well as maintenance therapy of
bipolar disorder in a patient with a history of a manic episode. The
primary target symptoms of lithium are mania and unstable mood.
Lithium is also prescribed for major depressive disorder as an
adjunct therapy, bipolar disorder without a history of mania,
treatment of vascular headaches, and neutropenia. These are off-
label uses, meaning they are not FDA-approved. Patients with
rapid cycling and mixed state types of bipolar disorder generally
do less well on lithium.
1 point(s)
45. Question
A male client is being treated for alcoholism. After a family meeting, the client’s
spouse asks the nurse about ways to help the family deal with the effects of
alcoholism. Nurse Lily should suggest that the family join which organization?
A. Al-Anon
B. Make Today Count
C. Emotions Anonymous
D. Alcoholics Anonymous
Page 89 of 102
:
Incorrect
Correct Answer: A. Al-Anon
Al-Anon is an organization that assists family members to share
common experiences and increase their understanding of alcoholism.
Al?Anon members come to understand problem drinking as a family
illness that affects everyone in the family. By listening to Al?Anon
members speak at Al?Anon meetings, they can hear how they came to
understand their own role in this family illness. This insight put them in a
better position to play a positive role in the family’s future.
Option B: Make Today Count is a support group for people with
life-threatening or chronic illnesses. MTC is a mutual support
group for persons with terminal illnesses. Organized in 1974, it is
part of what some have called the “happy death movement.” This
movement seeks to make death more humane and less
technological.
Option C: Emotions Anonymous is a support group for people
experiencing depression, anxiety, or similar conditions. Emotions
Anonymous International (EAI) is a nonprofit organization that
facilitates the ongoing efforts of an international fellowship of
men and women who desire to improve their emotional well-
being. EA members come together in weekly meetings for the
purpose of working toward recovery from any sort of emotional
difficulties. EA members are of diverse ages, races, economic
status, social and educational backgrounds. The only requirement
for membership is a desire to become well emotionally.
Option D: Alcoholics Anonymous is an organization that helps
alcoholics recover by using a twelve-step program. Alcoholics
Anonymous is an international fellowship of men and women who
have had a drinking problem. It is nonprofessional, self-
supporting, multiracial, apolitical, and available almost
everywhere. There are no age or education requirements.
Page 90 of 102
:
Membership is open to anyone who wants to do something about
their drinking problem.
1 point(s)
46. Question
A female client is admitted to the psychiatric clinic for treatment of anorexia
nervosa. To promote the client’s physical health, nurse Tair should plan to:
A. Severely restrict the client’s physical activities.
B. Weigh the client daily, after the evening meal.
C. Monitor vital signs, serum electrolyte levels, and acid-base

balance.
D. Instruct the client to keep an accurate record of food and fluid

intake.
Correct
Correct Answer: C. Monitor vital signs, serum electrolyte levels,
and acid-base balance
An anorexic client who requires hospitalization is in poor physical
condition from starvation and may die as a result of arrhythmias,
hypothermia, malnutrition, infection, or cardiac abnormalities secondary
Page 91 of 102
:
to electrolyte imbalances. Therefore, monitoring the client’s vital signs,
serum electrolyte level, and acid-base balance is crucial.
Option A: Restricting the client’s physical activities may worsen
anxiety. Clients with anorexia appear slow, lethargic, and fatigued;
they may be emaciated depending on the amount of weight loss;
clients with bulimia may be underweight or overweight but are
generally close to expected body weight for age and size.
Option B: This is incorrect because a weight obtained after
breakfast is more accurate than one obtained after the evening
meal. When clients can eat, a diet of 1200 to 1500 calories per
day is ordered, with gradual increases in calories until clients are
ingesting adequate amounts for height, activity level, and growth
needs; the nurse is responsible for monitoring meals and snacks
and often initially will sit with a client during eating at a table away
from other clients; after each meal or snack, clients may be
required to remain in view of staff for 1 to 2 hours to ensure that
they do not empty the stomach by vomiting.
Option D: This would reward the client with attention for not
eating and reinforce the control issues that are central to the
underlying psychological problem; also, the client may record
food and fluid intake inaccurately. The nurse can help clients
begin to recognize emotions such as anxiety or guilt by asking
them to describe how they are feeling and allowing adequate time
for response.
1 point(s)
47. Question
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
Page 92 of 102
:
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 disorder
Correct
Correct Answer: A. Antisocial personality disorder
The client’s history of delinquency, running away from home, vandalism,
and dropping out of school are characteristic 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. Antisocial personality disorder (ASPD) is a deeply ingrained and
rigid dysfunctional thought process that focuses on social
irresponsibility with exploitive, delinquent, and criminal behavior with no
remorse. Disregard for and the violation of others’ rights are common
manifestations of this personality disorder, which displays symptoms
that include failure to conform to the law, inability to sustain consistent
employment, deception, manipulation for personal gain, and incapacity
to form stable relationships.
Page 93 of 102
:
Option B: In borderline personality disorder, the client exhibits
mood instability, poor self-image, identity disturbance, and labile
affect. Borderline personality disorder (BPD) is 1 of 4 Cluster-B
disorders that include borderline, antisocial, narcissistic, and
histrionic. Borderline personality disorder (BPD) is characterized
by hypersensitivity to rejection and resulting instability of
interpersonal relationships, self-image, affect, and behavior.
Option C: Obsessive-compulsive personality disorder is
characterized by a preoccupation with impulses and thoughts
that the client realizes are senseless but can’t control. Obsessive-
compulsive disorder (OCD) is often a disabling condition
consisting of bothersome intrusive thoughts that elicit a feeling of
discomfort. To reduce the anxiety and distress associated with
these thoughts, the patient may employ compulsions or rituals.
These rituals may be personal and private, or they may involve
others to participate; the rituals are to compensate for the ego-
dystonic feelings of the obsessional thoughts and can cause a
significant decline in function.
Option D: Narcissistic personality disorder is marked by a pattern
of self-involvement, grandiosity, and demand for constant
attention. Narcissistic personality disorder (NPD) is a pattern of
grandiosity, need for admiration, and lack of empathy per the
Diagnostic and Statistical Manual of Mental Disorders (DSM–5).
The disorder is classified in the dimensional model of “Personality
Disorders.”NPD is highly comorbid with other disorders in mental
health.
1 point(s)
48. Question
Macoy and Helen seek emergency crisis intervention because he slapped her
Page 94 of 102
:
repeatedly the night before. The husband indicates that his childhood was
marred by an abusive relationship with his father. When intervening with this
couple, nurse Gerry knows they are at risk for repeated violence because the
husband:
A. Has only moderate impulse control.
B. Denies feelings of jealousy or possessiveness.
C. Has learned violence as an acceptable behavior.
D. Feels secure in his relationship with his wife.
Correct
Correct Answer: C. Has learned violence as an acceptable behavior
Family violence usually is a learned behavior, and violence typically leads
to further violence, putting this couple at risk. Unfortunately, each form
of family violence begets interrelated forms of violence, and the “cycle
of abuse” is often continued from exposed children into their adult
relationships, and finally to the care of the elderly. Domestic violence is
thought to be underreported. Domestic violence affects the victim,
families, co-workers, and community. It causes diminished psychological
and physical health, decreases the quality of life, and results in
decreased productivity.
Option A: Repeated slapping may indicate poor, not moderate,
Page 95 of 102
:
impulse control. According to the CDC, 1 in 4 women and 1 in 7
men will experience physical violence by their intimate partner at
some point during their lifetimes. About 1 in 3 women and nearly 1
in 6 men experience some form of sexual violence during their
lifetimes. Intimate partner violence, sexual violence, and stalking
are high, with intimate partner violence occurring in over 10
million people each year.
Option B: At least 5 million acts of domestic violence occur
annually to women aged 18 years and older, with over 3 million
involving men. While most events are minor, for example
grabbing, shoving, pushing, slapping, and hitting, serious and
sometimes fatal injuries do occur. Approximately 1.5 million
intimate partner female rapes and physical assaults are
perpetrated annually, and approximately 800,000 male assaults
occur. About 1 in 5 women have experienced completed or
attempted rape at some point in their lives. About 1% to 2% of
men have experienced completed or attempted rape.
Option D: Violent people commonly are jealous and possessive
and feel insecure in their relationships. While the research is not
definitive, a number of characteristics are thought to be present
in perpetrators of domestic violence. Abusers tend to be
possessive, jealous, suspicious, and paranoid. Approximately
one-third of women and one-fifth of men will be victims of abuse.
The most common sites of injuries are the head, neck, and face.
Clothes may cover injuries to the body, breasts, genitals, rectum,
and buttocks. One should be suspicious if the history is not
consistent with the injury.
1 point(s)
49. Question
Page 96 of 102
:
A client whose husband just left her has a recurrence of anorexia nervosa.
Nurse Vic 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.
Correct
Correct Answer: B. Gain control of one part of her life
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. Assist the patient to confront changes associated with puberty
and sexual fears. Provide sex education as necessary. Encourage
personal development program, preferably in a group setting. Provide
information about the proper application of makeup and grooming.
Learning about methods to enhance personal appearance may be
helpful to a long-range sense of self-esteem and image. Feedback from
others can promote feelings of self-worth.
Option A: This eating disorder doesn’t represent an attempt to
manipulate others or live up to their expectations (although
Page 97 of 102
:
anorexia nervosa has a high incidence in families that emphasize
achievement). Assist the patient to assume control in areas other
than dieting and weight loss such as management of their own
daily activities, work, and leisure choices. Feelings of personal
ineffectiveness, low self-esteem, and perfectionism are often part
of the problem. The patient feels helpless to change and requires
assistance to problem-solve methods of control in life situations.
Option C: The client isn’t attempting to commit suicide through
starvation; rather, by refusing to eat, she is expressing feelings of
despair, worthlessness, and hopelessness. Help the patient
formulate goals for self (not related to eating) and create a
manageable plan to reach those goals, one at a time, progressing
from simple to more complex. Patients need to recognize the
ability to control other areas in life and may need to learn
problem-solving skills to achieve this control. Setting realistic
goals fosters success.
Option D: Encourage patients to take charge of their own lives in
a more healthful way by making their own decisions and
accepting self as she or he is at this moment (including
inadequacies and strengths). Patient often does not know what
she or he may want for themselves. Parents (mother) often make
decisions for the patient. Patient may also believe she or he has
to be the best in everything and holds self-responsible for being
perfect.
1 point(s)
50. Question
A male client has 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:
Page 98 of 102
:
A. Psychotherapy
B. Total abstinence
C. Alcoholics Anonymous (AA)
D. Aversion therapy
Correct
Correct Answer B. Total abstinence
Total abstinence is the only effective treatment for alcoholism. For
people who have severe alcohol use disorder, this is a key step. The goal
is to stop drinking and give the body time to get the alcohol out of the
system. That usually takes a few days to a week. Psychotherapy,
attendance at AA meetings, and aversion therapy are all adjunctive
therapies that can support the client in his efforts to abstain.
Option A: With alcohol use disorder, controlling your drinking is
only part of the answer. You also need to learn new skills and
strategies to use in everyday life. Psychologists, social workers, or
alcohol counselors can teach you how to change the behaviors
that make you want to drink; deal with stress and other triggers;
build a strong support system; and set goals and reach them.
Option C: Group therapy or a support group can help during
rehab and help the client stay on track as life gets back to normal.
Group therapy, led by a therapist, can give the client the benefits
Page 99 of 102
:
of therapy along with the support of other members. Support
groups aren’t led by therapists. Instead, these are groups of
people who have alcohol use disorder. Examples include
Alcoholics Anonymous, SMART Recovery, and other programs.
The peers can offer understanding and advice and help keep the
client accountable. Many people stay in groups for years.
Option D: Aversion therapy is a type of behavioral therapy that
involves repeatedly pairing an unwanted behavior with
discomfort. For example, a person undergoing aversion therapy
to stop smoking might receive an electrical shock every time they
view an image of a cigarette. The goal of the conditioning process
is to make the individual associate the stimulus with unpleasant or
uncomfortable sensations.
Score Exciting Deals on Shopee
Page 100 of 102
:
Shopee
Bamboo 7ber toothbrush soft bristles (Charcoal

toothbrush)
Ad Shopee
Page 101 of 102
:
ABOUT PRIVACY DISCLAIMER CONTACT
© 2024 Nurseslabs | Ut in Omnibus Glorificetur Deus!
Page 102 of 102
:

Mental Health Psychiatric Nursing NCLEX Challenge Exam Quiz 1 50 Questions

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Mental Health Psychiatric Nursing NCLEX Challenge Exam Quiz 1 50 Questions

Uploaded by

Copyright:

Available Formats

Mental Health & Psychiatric Nursing

NCLEX Challenge Exam (Quiz #1: 50

Variety of Mobile Products

Your time: 00:12:29

You have reached 28 of 50 point(s), (56%)

Awesome, you’ve completed the quiz!

Pos. Name Entered on Points Result

January 18, 2024

4 KOBE UY April 9, 2024 8:08 PM 50 100 %

November 16, 2023

October 12, 2023

March 21, 2024 7:50

March 19, 2024 3:31

March 25, 2024 10:33

March 1, 2024 3:51

November 26, 2023

January 28, 2024 9:11

March 20, 2024 10:42

November 16, 2023

January 27, 2024

March 1, 2024 9:24

20 kc April 1, 2024 9:08 PM 50 100 %

Would you like to submit your quiz result to the leaderboard?

Name: Name E-Mail: E-Mail

A. Avoid shopping for large amounts of food.

B. Control eating impulses.

C. Identify anxiety-causing situations.

D. Eat only three meals per day.

A. Check the client frequently at irregular intervals throughout

C. Repeatedly discuss previous suicide attempts with the client.

D. Disregard decreased communication by the client because this is

A. Deferoxamine mesylate (Desferal)

A. “I trust you not to purge.”

B. “How are you purging and when do you do it?”

C. “Tell me more about how it felt to get high.”

D. “Don’t you know it’s illegal to use drugs?”

A. The client will establish adequate daily nutritional intake.

C. The client will identify self-perceptions about body size as

D. The client will verbalize the possible physiological consequences

B. The mother and father tell different stories regarding what

C. The family is poor.

D. The parents are argumentative and demanding with emergency

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.

A. Remaining with the client and staying calm.

C. Telling the client’s husband that he must leave at once.

D. Determining why the husband feels so angry.

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

B. Focus discussions on food and weight.

C. Avoid discussing unrealistic cultural standards regarding weight.

D. Provide objective data and feedback regarding the client’s

C. Set up a strict eating plan for the client.

D. Encourage the client to exercise, which will reduce her anxiety.

A. Reasons they stay in the abusive relationship (for example, lack of

B. Readiness to leave the perpetrator and knowledge of resources.

C. Use of drugs or alcohol.

D. History of previous victimization.

D. A below-normal serum potassium level

A. The child cries uncontrollably throughout the examination.