A 48-year-old Hispanic woman is seen by a psychiatric clinical nurse specialist after

receiving a call by her son. According to the son, since his father's death 7 months ago,
his mother has lost 30 pounds and can't sleep. During her initial visit, the patient states,
'My husband talks to me in his visits, but his words make no sense to me. I don't
understand what he wants me to do.' What is an appropriate nursing diagnosis?
A. Ineffective denial.
B. Bipolar mood disorder.
C. Hyper-religiosity.
D. Grieving.

Your neighbor's husband comes to talk to you. He says his wife has not left the house in
2 weeks, has a flat mood, and has lost interest in her usual activities. You recognize
these as the primary symptoms of

A. Depression.
B. Schizophrenia.
C. Suicidal ideation.
D. Bipolar manic episodes.

Your patient is ready for discharge after a 30-day hospitalization for manic depression.
About 30 minutes before his discharge, his roommate comes to you and says, 'He is
talking crazy.' When you ask your patient how he is feeling, he states, 'I feel like
Superman. I can do anything. I can fly home today and then become a U.S. Senator.'
Which type of mania-related symptoms is this patient exhibiting?
A. Social.
B. Cognitive.
C. Behavioral.
D. Perceptual.

Which statement would indicate readiness for discharge?

A. Right now, I can't bathe myself or dress myself, but I feel good about that.
B. Going home will be fun, but if it isn't fun, I can always make my mother help me or tell
her to do so. She better help me.
C. I will take my medicines as I should and know to call the number you gave me if I
have bad thoughts.
D. Taking care of myself is important, but it's okay if I don't want to do anything.

An angry patient is in the community room. She picks up a chair and uses it to hit
another patient on the head. When you come into the community room, what should
your first response to the patient holding the chair be?

A. Are you crazy? Hitting people can hurt them!

B. Hitting others is unacceptable. Please put the chair completely down on the floor.
C. How would you like it if I hit you over the head with a chair?
D. You're in big trouble now. It's probably prison you are looking at!
A 22-year-old female is admitted to the unit following a suicide attempt. She has a 2-
week history of depression as well as a history of abusing multiple substances and
anorexia nervosa. What is your first nursing priority?
A. Socialization.
B. Contracting for eating behavior.
C. Safety.
D. Administering the Beck depression scale.

Gerald was admitted to the psychiatric acute care unit because he stood in the center of
a main two-way street in his underwear and a T-shirt, shouting, 'I am being held against
my will. I have personal rights.' Gerald was diagnosed with bipolar disorder, manic type.
Which of the following interventions will add to everyone's safety in the acute care
environment?
A. Have hectic surroundings.
B. Have consistent unit routines.
C. Minimize staff interventions.
D. Medicate the patient only if he has private health insurance.
.
Your patient has just been physically cleaned up after slicing his left arm 8 times. To
show an appropriate evaluative response, which of the following would be your best
statement?
A. I could care less if you cut yourself. It doesn't hurt me.
B. If you wouldn't cut yourself, you would have a much happier life.
C. You are lucky someone found you in time. Now you can help us make you better.
D. The behavior of cutting is not acceptable.

A 22-year-old female was admitted to the mental health unit with major depression and
suicidal ideation. She has a history of cutting her wrists intermittently throughout the last
2 years. On days 1 and 2, the patient stays in her room and eats only 20% of her meals.
On day 3, she eats 80% of her meals and is talking to others in group. The nurse should
consider that the patient is

A. Showing improvement.
B. Highly suicidal.
C. Exhibiting mood swings.
D. In need of electroshock therapy.

A 21-year-old patient has a diagnosis of schizophrenia and is stuporous, yet exhibits

sudden, excessive motor activity with repetitive sit-ups. What is this behavior called?
A. Delusional.
B. Hallucinogenic.
C. Paranoid.
D. Catatonic.
A 16-year-old girl is admitted for her first psychotic break. Her parents feel very guilty.
What is your best nursing response?

A. No one really knows the cause of schizophrenia. It is not your fault and is not due to
anything you did in the past. It is important to understand this, to support your daughter,
and to find support for yourselves.
B. Does anyone in your family have schizophrenia, as this disease is known to be
genetic?
C. You may feel bad now, but there are so many other bad things out there, such as
cancer and paralysis.
D. Let me share with you some websites to help you deal with your guilt.

A physical indicator of possible abuse in a battered woman would be a fracture of the

distal bones, such as the skull, face, or extremities.

A. TRUE
B. FALSE

Which of the following statements indicates that your patient, who has schizophrenia, is
ready to manage a relapse?
A. I will think of a plan of action before I get these racing thoughts again.
B. I will not drink alcohol and will exercise daily. This will help me stay well.
C. If I start feeling badly and don't sleep very much, then I will tell my friend Sandy and
talk to her. She or I will call my therapist.
D. When I feel stressed, I will sit near my bed and wait to feel better.

Your patient has a diagnosis of schizophrenia and believes that his thoughts are
broadcast from his head. What is the most appropriate nursing diagnosis?

A. Risk for self-directed violence.

B. Disturbed sensory perception.
C. Impaired verbal communication.
D. Disturbed thought processes.

As a nurse, you wish to reinforce functional behavior in your schizophrenic patient.

Which intervention will accomplish reinforcement?

A. Praise the patient for reality-based perceptions and cessation of acting-out

behaviors.
B. Educate the patient about the symptoms of schizophrenia.
C. Facilitate learning about the importance of medication compliance using written
materials for reinforcing medication use.
D. Focus on the feelings of delusion to reinforce reality and decrease false beliefs by
talking to the patient.
Your patient is preoccupied with perfection and control, has difficulty relaxing, exhibits
rule-conscious behavior, and cannot discard anything. What type of personality disorder
does this behavior reflect?

A. Antisocial personality.
B. Obsessive-compulsive personality.
C. Manic behavior.
D. Anxiety disorder.
.
Which of the following questions is appropriate to assess for disturbances in a patient's
relationships?
A. What are your main worries?
B. Have you ever used alcohol or illegal drugs?
C. How has your appetite been in the past month?
D. What do you talk about with friends?

Which type of therapy helps patients with personality disorders explore ways to enjoy
themselves and increase their socialization skills?

A. Occupational therapy.
B. Recreational therapy.
C. Music therapy.
D. Medication therapy.

Which of the following symptoms of alcohol detoxification would you be most concerned
about?
A. Vitamin and mineral depletion.
B. Diaphoresis.
C. Increased heart rate.
D. Hallucinations and delusions.

What is the priority nursing intervention to help orient a patient who has Alzheimer's
disease?
A. Post a schedule in the dining room of daily activities.
B. Use an overhead loudspeaker to announce upcoming events.
C. Provide a daily routine and easy-to-read clocks.
D. Have the patient live alone in a private room.

.
You are caring for a patient and pour out his evening risperidone (Risperdal) 2 mg
tablet. The pill falls on the countertop. What is your next intervention?
A. Pick the pill up from the counter and place it in a cup.
B. Wash the pill off with alcohol and place it in a cup.
C. Discard the pill and repour the medication.
D. Call the patient up to the pill line to receive his medication.
Your patient has just shown you some fresh, self-inflicted, superficial cuts-eight of them
going up and down his right arm. What is your initial intervention based on infection
control principles?
A. Send the patient back to his room as part of behavioral modification.
B. Suture the cuts using a large-bore needle and nondissolving sutures.
C. Cleanse the wounds with soap and water.
D. Administer tetanus toxoid injection intramuscularly.
.
A hypomanic patient tells you that she has been 'picking up energy from my car engine
and car CD player' while driving and has received five speeding tickets in the past 6
months. What would be one effective intervention to avoid fast driving?

A. Make a contract not to drive more than 55 miles per hour and drive with the CD
played turned off.
B. Call the local police and alert them to the patient's car license plate number and the
make and model of her car.
C. Ask the patient to "hand over the keys" to you, and tell her that now she must use a
cab or other public transportation until your next session.
D. Share with the patient that she cannot drink and drive.

Patients who require close surveillance due to the potential for safety hazards give up
the right of
A. Continued confusion.
B. Decision making.
C. Social contact.
D. Privacy.

What is the best way to protect yourself as you and others physically restrain the
patient?
A. Wash your clothes within 30 minutes of becoming soiled with body fluids.
B. Wear protective eyewear and a face shield.
C. Check that your tetanus and hepatitis B titers are within normal limits.
D. Wear a gown over your clothes and shoe covers.

A patient who is psychotic has a formed bowel movement on the floor of his room. How
should you clean up this excrement?
A. Use a thick diaper or pad.
B. Wear gloves and use some paper towels or toilet paper.
C. Wear gloves, use toilet paper, and wash the area with a 1:10 bleach solution.
D. Wear a gown, shoe covers, mask, and chemotherapy-impervious gloves, and wash
the area with an ammonia with bleach 1:1 solution.

Your patient is scheduled for a one-on-one therapy session. Upon his entry into your
office, you note that the patient has a cough, is sweating, is coughing up a small amount
of blood, and has a fever. What is your initial intervention regarding infection control?
A. Wash all of the patient's sheets and clothes.
B. Place a mask on the patient and yourself.
C. Take the patient's temperature.
D. Place resuscitation equipment in the patient's room.

You have just given your patient an intramuscular injection of fluphenazine (Prolixin)
with a syringe that does not have a safety lock. What is your next step?
A. Recap the needle.
B. Snap the needle off and place it in the needle box.
C. Immediately place the syringe in a nearby impermeable container.
D. Clip the needle off with a syringe needle cutter (SNC).

In an inpatient acute psychiatric unit, it is important to shut and lock the unit door behind
you.

A. TRUE
B. FALSE

You drive up to the house of your patient, who is known to have schizophrenia with
manic episodes. This is your fifth visit. On this occasion, the patient is sitting on his front
porch in a rocking chair with a shotgun in his arms. What should your next intervention
be?

A. Beep your car horn to get your patient's attention.

B. Yell your patient's name out your car window and wave at him to say hello.
C. Keep driving in a path that is going away from the patient's house.
D. Stop the car in the patient's driveway and call your boss on your cell phone.

Your patient, who is in a community psychiatric program, shows up at your home

peeping through your kitchen window. You also noticed the patient yesterday when you
went to the grocery story and the hairdresser. You believe he is stalking you. What
should you do?

A. Call the local police and report your suspicion of stalking.

B. Call the patient's spouse and discuss his behavior.
C. Invite the patient to have a cup of coffee with you at a local café to discuss his
behavior.
D. Wait until the patient's next group meeting to discuss his stalking behavior.

. You are the new nurse on this case; the previous nurse has retired. The previous
nurse has stated in her care plan that the patient will let the nurse in the house only if
the nurse carries a public health-issued blue bag and wears black pants. You are
scheduled to visit this patient tomorrow. What should you do?
A. Call the patient and tell her that you are a new nurse and will be wearing white pants.
B. Show up as scheduled carrying only a stethoscope, vial, alcohol wipe, and
medication syringe.
C. Show up as scheduled with a police officer.
D. Telephone the patient, introduce yourself, and show up carrying a blue bag and
wearing black pants.

Your patient has an admitting diagnosis of alcohol withdrawal syndrome. You receive a
phone call at the nurses' station from a person who says he is the patient's minister and
wants to know if the patient 'fell off the wagon again' and when visitation hours are.
What is your best response?

A. Yes, the patient drank too much, but he should be fine in a few days. Visiting hours
are 9 A.M. to 6 P.M.
B. We do not give out any information. Visitation hours in the hospital are from 9 A.M. to
6 P.M. daily.
C. Please pray for the patient; he is in bad shape. You can visit him anytime between 9
A.M. and 6 P.M. daily.
D. Please contact the hospital's chief executive officer, who can give you the information
you are requesting.

Your patient has been hospitalized for acute alcohol withdrawal. It is the fifth day, and
he is having visual hallucinations followed by a seizure. What is the most likely source
of the patient's problem?
A. Autonomic dysreflexia (AD).
B. A brain tumor.
C. Sleep deprivation.
D. Delirium tremens (DTs).

Which of the following assessments is used to confirm alcohol intake?

A. Pupil dilation.
B. Serum sample.
C. Hair shaft analysis.
D. Sputum sample.

Which of the following questions is most appropriate to ask in screening for a potential
problem of high alcohol intake?

A. Have you felt you should cut down on your alcohol consumption?
B. Do you enjoy getting smashed?
C. Have you ever thought about killing someone?
D. In the last week, have you had a glass of wine?

Your patient in the Emergency Department has a diagnosis of acute alcohol withdrawal
syndrome (AWS). He is acting euphoric, yet shy. The APN has prescribed the following
care: CAGE questionnaire, serum for toxicology, IV of D5 1/2 NS and 1 amp
multivitamin (MVI) at 75 mL/h, neuro check q 1 h. What is your first priority?
A. Administer the CAGE questionnaire.
B. Start the IV.
C. Do the neuro check.
D. Obtain a serum blood sample.

Your patient sees you at a preplanned postoperative visit 4 weeks after being
hospitalized for acute alcohol withdrawal. Upon questioning, she states that her
husband is abusive, so she drinks to 'drown out his yelling.' The patient also complains
of depression and severe pain in the epigastric region that radiates to her back and has
been constant since yesterday. She has vomited twice in the past 12 hours. What is
your first priority?

A. Refer her immediately for treatment of depression.

B. Call social services and report spousal abuse.
C. Assess her for pancreatitis.
D. Administer a test or scale that assesses alcohol withdrawal.

Prolonged alcohol ingestion can cause disorders of the liver such as

A. Pancreatitis.
B. Hypomagnesemia.
C. Cirrhosis.
D. Colitis

Adolescent suicide has increased over the past and is among the top five causes of
death in U.S. adolescents.
A. TRUE
B. FALSE

Alcohol tolerance develops as a result of the central nervous system's adaptive

mechanisms.
A. TRUE
B. FALSE

Your patient experienced alcohol withdrawal syndrome and now admits he 'needs help.'
Which of the following is the most appropriate resource to which you should direct the
patient?
A. Reach to Recovery.
B. Alcoholics Anonymous.
C. Depression support group.
D. Suicide support group.
B. Alcoholics Anonymous.

.
Which of the following is a common symptom of a major depressive episode?
A. Loss of hearing.
B. Increased energy.
C. Hopelessness.
D. Recurrent thoughts of well-being.
Which of the following statements would indicate a depressed mood?
A. I can't wait to go to the ballgame today; it should be fun.
B. I feel sad today, just like yesterday.
C. I feel like going to the gym for a workout today, then maybe to a movie.
D. Since it's raining outside, how about a game of chess?

Which of the following medical conditions has similar signs and symptoms as those
seen in a major depressive episode?
A. Pancreatitis.
B. Cholecystitis.
C. Tuberculosis.
D. Hypothyroidism.

Once a patient is diagnosed with a major depressive episode, the primary nursing
intervention should be associated with

A. Safety.
B. Pharmacology.
C. Administration of gastric lavage.
D. Hemodialysis.

A 35-year-old male patient has been brought to your hospital unit after making a suicide
attempt at his workplace. Which of the following interventions can you legally
implement?
A. Call the patient's girlfriend and inform her of his admission and visiting hours.
B. Physically search the patient for weapons and harmful materials.
C. Call the patient's boss at work and report him as in need of extended medical leave.
D. Place the patient in four-point restraints and begin an IV for sedation.
.
Your patient has just received his sixth electroconvulsant therapy outpatient treatment.
He tells you that he plans to drive himself home because his wife is working at her part-
time job today. What is your best response?
A. Be careful and drive slowly.
B. You need to wait 30 minutes and then you will be safe to drive.
C. Let me take your vital signs; if they are stable, then you can drive.
D. You cannot drive. I can call you a cab, or would you prefer to call your wife or
someone for a ride home?

Which of the following patients is at risk for depression?

A. A patient with history of diabetes mellitus.
B. A patient with a depressive genetic predisposition.
C. A patient who recently bought a puppy.
D. A patient who had only 6 hours of sleep last night due to watching a TV movie.
A patient has been admitted to your unit with a drug overdose, and you need to assess
for acidosis and hypoxemia. Which test should you perform?
A. Complete blood count (CBC).
B. Serum electrolytes.
C. Partial thromboplastin time (PTT).
D. Arterial blood gases (ABG).

Which of the following is an example of a bite/sting that can cause a poison exposure?
A. Butterfly.
B. Grass seed.
C. Jellyfish.
D. Fly.

When a patient shares with a psychiatrist that he plans to harm a specific person and
includes the person's name, the health professional must notify the intended identified
victim. What is this rule called?

A. Seclusion and restraints rule.

B. Voluntary commitment rule.
C. Right to treatment rule.
D. Duty to warn rule.

When documenting the behavior of a patient with a mental health diagnosis, which chart
entry includes the patient's action and responses?

A. The patient is less expressive today in group therapy.

B. The patient appears to drift in and out of reality.
C. The patient is wearing shorts and a sleeveless top even though it's January and
wintertime. When asked about her clothing choices, she states, "The devil told me what
to wear. To make things different, I need an exorcism."
D. The patient is wearing pants and a long-sleeved shirt, is appropriately dressed for
group therapy, and refrains from sleeping as she did in last group sessions.
C. The patient is wearing shorts and a sleeveless top even though it's January and
wintertime. When asked about her clothing choices, she states, "The devil told me what
to wear. To make things different, I need an exorcism."

.
During a group session, one patient states that he will be released soon because he is
superior to his therapist, who is a female. This is an example of which bias or prejudice?
A. Racism.
B. Sexism.
C. Ageism.
D. Neonatalism.