Powerhouse Training & Review Center

Psychiatric Nursing
MASTERY EXAM 1
Name and School: __________________________________ Score: _____________
Instructions: Please write the LETTER of your choice on the blank space provided beside each number. Use
CAPITAL LETTERS. Strictly NO ERASURES or ALTERATIONS allowed.

1. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water
with his medication. The nurse replies, "You're worried about your medication?" The nurse's
communication is:
A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.
2. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid
schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the
following responses is most appropriate?
A. "I think you're wrong. France is a friendly country and an ally of the United States. Their
government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you.
You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."
3. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
4. A client with borderline personality disorder becomes angry when he is told that today's psychotherapy
session with the nurse will be delayed 30 minutes because of an emergency. When the session finally
begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with
the client's anger?
A. "If it had been your emergency, I would have made the other client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you feel right now?"
D. "I really care about you and I'll never let this happen again."
5. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's
delusional thoughts and hallucinations eliminated
A. Several minutes
B. Several hours
C. Several days
D. Several weeks
6. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first
action is to:
A. reassure the client and administer as needed lorazepam (Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.
7. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really
in those pills?" Which of the following is the best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke.
8. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client
appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in
mid-sentence. Which nursing intervention is the most appropriate?
A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.

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 C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't
hear these voices.
D. Ask the client to describe what the voices are saying.
9. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse
notices that the client is holding his head to one side and complaining of neck and jaw spasms. What
should the nurse do?
A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow
10. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One
approach that has proven to be effective for hallucinating clients is to:
A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying "Go away" or "Stop" when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.
11. A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the
window for hours. What is the nurse's first priority?
A. Assist the client with feeding.
B. Assist the client with showering.
C. Reassure the client about safety.
D. Encourage socialization with peers.
12. A client tells the nurse that the television newscaster is sending a secret message to her. The nurse
suspects the client is experiencing:
A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.
13. The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine)
rather than the tablet form because the liquid:
A. has a more predictable onset of action.
B. produces fewer anticholinergic effects.
C. produces fewer drug interactions.
D. has a longer duration of action.
14. A client who has been hospitalized with disorganized type schizophrenia for 8 years can't complete
activities of daily living (ADLs) without staff direction and assistance. The nurse formulates a nursing
diagnosis of Self-care deficient: Dressing/grooming related to inability to function without assistance.
What is an appropriate goal for this client?
A. "Client will be able to complete ADLs independently within 1 month."
B. "Client will be able to complete ADLs with only verbal encouragement within 1 month."
C. "Client will be able to complete ADLs with assistance in organizing grooming items and
clothing within 1 month."
D. "Client will be able to complete ADLs with complete assistance within 1 month."

15. The nurse is planning care for a client admitted to the psychiatric unit with a diagnosis of paranoid
schizophrenia. Which nursing diagnosis should receive the highest priority?
A. Risk for violence toward self or others
B. Imbalanced nutrition: Less than body requirements
C. Ineffective family coping
D. Impaired verbal communication
16. The nurse is preparing for the discharge of a client who has been hospitalized for paranoid schizophrenia.
The client's husband expresses concern over whether his wife will continue to take her daily prescribed
medication. The nurse should inform him that:

A. his concern is valid but his wife is an adult and has the right to make her own decisions.
B. he can easily mix the medication in his wife's food if she stops taking it.
C. his wife can be given a long-acting medication that is administered every 1 to 4 weeks.
D. his wife knows she must take her medication as prescribed to avoid future
hospitalizations.
17. Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug
exerts its effect by:
A. decreasing the anxiety causing muscle rigidity.
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 B. blocking the cholinergic activity in the central nervous system (CNS).
C. increasing the level of acetylcholine in the CNS.
D. increasing norepinephrine in the CNS.
18. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid
schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the
following responses is most appropriate?
A. "I think you're wrong. France is a friendly country and an ally of the United States. Their
government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you.
You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."
19. A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by
antipsychotic medication by:
A. blocking dopamine receptors in the central nervous system (CNS).
B. blocking acetylcholine in the CNS.
C. activating norepinephrine in the CNS.
D. activating dopamine receptors in the CNS.
20. Most antipsychotic medications exert which of following effects on the central nervous system (CNS)?
A. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin
receptors.
B. Sedate the CNS by stimulating serotonin at the synaptic cleft.
C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and
norepinephrine.
D. Depress the CNS by stimulating the release of acetylcholine.
21. A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia.
During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is
characteristic of:
A. delusion.
B. looseness of association.
C. illusion.
D. hallucination.
22. Which of the following medications would the nurse expect the physician to order to reverse a dystonic
reaction?
A. prochlorperazine (Compazine)
B. diphenhydramine (Benadryl)
C. haloperidol (Haldol)
D. midazolam (Versed)

23. A schizophrenic client states, "I hear the voice of King Tut." Which response by the nurse would be most
therapeutic?
A. "I don't hear the voice, but I know you hear what sounds like a voice."
B. "You shouldn't focus on that voice."
C. "Don't worry about the voice as long as it doesn't belong to anyone real."
D. "King Tut has been dead for years."
24. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water
with his medication. The nurse replies, "You're worried about your medication?" The nurse's
communication is:
A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.
25. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client
appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in
mid-sentence. Which nursing intervention is the most appropriate?
A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.
C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't
hear these voices.
D. Ask the client to describe what the voices are saying
26. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which
findings should alert the nurse that the client is experiencing pseudoparkinsonism?
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 A. Restlessness, difficulty sitting still, and pacing
B. Involuntary rolling of the eyes
C. Tremors, shuffling gait, and masklike face
D. Extremity and neck spasms, facial grimacing, and jerky movements
27. For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride
(Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate
of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg.
Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome.
What steps should the nurse take?
A. Give the next dose of fluphenazine, call the physician, and monitor vital signs.
B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs.
C. Give the next dose of fluphenazine and restrict the client to the room to decrease
stimulation.
D. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase
the client's fluid intake.
28. A schizophrenic client with delusions tells the nurse, "There is a man wearing a red coat who's out to get
me." The client exhibits increasing anxiety when focusing on the delusions. Which of the following would
be the best response?
A. "This subject seems to be troubling you. Let's walk to the activity room."
B. "Describe the man who's out to get you. What does he look like?"
C. "There is no reason to be afraid of that man. This hospital is very secure."
D. "There is no need to be concerned with a man who isn't even real."
29. Important teaching for women in their childbearing years who are receiving antipsychotic medications
includes which of the following?
A. Occurrence of increased libido due to medication adverse effects
B. Increased incidence of dysmenorrhea while taking the drug
C. Continuing previous use of contraception during periods of amenorrhea
D. Instruction that amenorrhea is irreversible

30. A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates
that the client has been taking neuroleptic medication for many years. Assessment reveals unusual
movements of the tongue, neck, and arms. Which condition should the nurse suspect?
A. Tardive dyskinesia
B. Dystonia
C. Neuroleptic malignant syndrome
D. Akathisia
31. What medication would probably be ordered for the acutely aggressive schizophrenic client?
A. chlorpromazine (Thorazine)
B. haloperidol (Haldol)
C. lithium carbonate (Lithonate)
D. amitriptyline (Elavil)
32. A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client
exhibit during social situations?
A. Aggressive behavior
B. Paranoid thoughts
C. Emotional affect
D. Independence needs
33. During the initial interview, a client with schizophrenia suddenly turns to the empty chair beside him and
whispers, "Now just leave. I told you to stay home. There isn't enough work here for both of us!" What is
the nurse's best initial response?
A. "When people are under stress, they may see things or hear things that others don't. Is
that what just happened?"
B. "I'm having a difficult time hearing you. Please look at me when you talk."
C. "There is no one else in the room. What are you doing?"
D. "Who are you talking to? Are you hallucinating?"
34. The definition of nihilistic delusions is:
A. a false belief about the functioning of the body.
B. belief that the body is deformed or defective in a specific way.
C. false ideas about the self, others, or the world
D. the inability to carry out motor activities.

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 35. A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity,
tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of
antipsychotic therapy?
A. Agranulocytosis
B. Extrapyramidal effects
C. Anticholinergic effects
D. Neuroleptic malignant syndrome (NMS)
36. The nurse formulates a nursing diagnosis of Impaired social interaction related to disorganized thinking
for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing
intervention takes highest priority?
A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Exploring the effects of the client's behavior on social interactions
D. Developing a schedule for the client's participation in social interactions
37. A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that
the client is experiencing:
A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.
38. A client with delusional thinking shows a lack of interest in eating at meal times. She states that she is
unworthy of eating and that her children will die if she eats. Which nursing action would be most
appropriate for this client?
A. Telling the client that she may become sick and die unless she eats
B. Paying special attention to the client's rituals and emotions associated with meals
C. Restricting the client's access to food except at specified meal and snack times
D. Encouraging the client to express her feelings at meal times
39. Which of the following groups of characteristics would the nurse expect to see in the client with
schizophrenia?
A. Loose associations, grandiose delusions, and auditory hallucinations
B. Periods of hyperactivity and irritability alternating with depression
C. Delusions of jealousy and persecution, paranoia, and mistrust
D. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss
40. The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client
receiving an antipsychotic. The medication the client will likely receive is:
A. Benztropine (Cogentin).
B. diphenhydramine (Benadryl).
C. propranolol (Inderal).
D. haloperidol (Haldol).
41. A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with
other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his
hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How
should the nurse manage this situation?
A. Ask the client to sit still or leave the room because he is distracting the other clients.
B. Ask the client if he is nervous or anxious about something.
C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
D. Administer an as needed dose of haloperidol to decrease agitation.
42. A man is brought to the hospital by his wife, who states that for the past week her husband has refused
all meals and accused her of trying to poison him. During the initial interview, the client's speech, only
partly comprehensible, reveals that his thoughts are controlled by delusions that he is possessed by the
devil. The physician diagnoses paranoid schizophrenia. Schizophrenia is best described as a disorder
characterized by:
A. disturbed relationships related to an inability to communicate and think clearly.
B. severe mood swings and periods of low to high activity.
C. multiple personalities, one of which is more destructive than the others.
D. auditory and tactile hallucinations.
43. A client has a history of chronic undifferentiated schizophrenia. Because she has a history of
noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate)
injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?
A. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms
that occur
B. Sitting up for a few minutes before standing to minimize orthostatic hypotension
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 C. Notifying the physician if her thoughts don't normalize within 1 week
D. Expecting symptoms of tardive dyskinesia to occur and to be transient
44. A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit.
Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which
life-threatening reaction:
A. tardive dyskinesia.
B. dystonia.
C. neuroleptic malignant syndrome.
D. akathisia.

45. While looking out the window, a client with schizophrenia remarks, "That school across the street has
creatures in it that are waiting for me." Which of the following terms best describes what the creatures
represent?
A. Anxiety attack
B. Projection
C. Hallucination
D. Delusion
46. A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them."
This statement indicates a:
A. delusion of persecution.
B. delusion of grandeur.
C. somatic delusion.
D. jealous delusion.
47. During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has
taken his blood pressure. His action shows evidence of:
A. somatic delusions.
B. waxy flexibility.
C. neologisms.
D. nihilistic delusions.
48. A client with paranoid type schizophrenia becomes angry and tells the nurse to leave him alone. The
nurse should
A. tell him that she'll leave for now but will return soon.
B. ask him if it's okay if she sits quietly with him.
C. ask him why he wants to be left alone.
D. tell him that she won't let anything happen to him
49. Nursing care for a client with schizophrenia must be based on valid psychiatric and nursing theories. The
nurse's interpersonal communication with the client and specific nursing interventions must be:
A. clearly identified with boundaries and specifically defined roles.
B. warm and nonthreatening.
C. centered on clearly defined limits and expression of empathy.
D. flexible enough for the nurse to adjust the plan of care as the situation warrants.
50. When discharging a client after treatment for a dystonic reaction, the emergency department nurse must
ensure that the client understands which of the following?
A. Results of treatment are rapid and dramatic but may not last.
B. Although uncomfortable, this reaction isn't serious.
C. The client shouldn't buy drugs on the street.
D. The client must take benztropine (Cogentin) as prescribed to prevent a return of
symptoms.
51. Which of the following statements best describes a mentally healthy individual?
a. Has ability to make decisions
b. Does not exhibit physical and emotional problems
c. Has self-acceptance and can meet his own basic needs
d. Has absence of anxiety and happy
52. The most important role of the Psychiatric nurse as a member of the team is to:
a. carry out medical orders
b. meet the needs for the physical and mental well-being of the client
c. coordinate the psychological care and management of clients
d. keep a constant monitoring of the clients
53. A male college student who wants to become an athlete but fails becomes a well know
n writer. This is an example of:
A. Compensation B. Projection C. Reaction Formation D. Sublimation

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 54. A client has just begun to discuss important feelings when the time of the interview is up. The next day, when
the nurse meets with the client at the agreed upon time, the initial intervention would be to say:
a. “Good morning, how are you today?”
b. “Yesterday you were talking about some very important feelings. Let’s continue.”
c. “What would you like to talk about today?”
d. Nothing and wait for the client to introduce a topic.
55. A new staff nurse is on orientation tour with the head nurse. A client approaches her and says, “I don’t
belong here. Please try to get me out.” The staff nurse’s best response would be:
a. “What would you do if you were out of the hospital?”
b. “I am new staff member, and I’m on tour. I’ll come back and talk with you later.”
c. “I think you should talk with the head nurse about that.”
d. “I can’t do anything about that.”
56. The most effective nursing intervention for a severely anxious client who is pacing vigorously would be to:
a. Instruct her to sit down and quit pacing
b. Place her in bed to reduce stimuli and allow rest.
c. Allow her to talk until she becomes physically tired.
d. Give her PRN medication and walk with her at a gradual slowing pace.
57. It is in this level of anxiety where cognitive capacity diminishes. Focus becomes limited and client experiences
tunnel of vision. Physical signs of anxiety become more pronounced.
a. Severe C. Mild
b. Panic D. Moderate
58. Antianxiety medications should be used with extreme caution because long term use, according to research,
can lead to:
a. Parkinsonian like syndrome C. Hepatic failure
b. Hypertensive crisis D. Addiction
59. A client is suffering from Rape trauma syndrome following a rape by an unknown assailant. One of the
primary goals of nursing care for this client would be to:
a. establish a safe, supportive environment C. deal with the client’s anxiety
b. control aggressive behavior D. discuss the client’s nightmares and reactions
60. A client’s deafness has been diagnosed as Conversion disorder. Nursing interventions should be guided by
which one of the following?
a. The client will probably express much anxiety about her deafness and require much reassurance
b. The client will have little or no awareness of the psychogenic cause of her deafness
c. The client’s need for the symptom should be respected; thus, secondary gains should be allowed
d. The defense mechanisms of suppression and rationalization are involved in creating the
symptom.
61. A female client has just received the diagnosis of Hypochondriasis. This client continually focuses on GI
problems and constantly rings for a nurse to meet her every demand. The best nursing approach is to:
a. Ignore the demands because the nurse knows it is not necessary to respond
b. Assign various staff members to work with the client so no staff member will become negative
c. Anticipate the client’s demands and spend time with her even though she does not demand it
d. Provide for the client’s basic needs, but do not respond to every demand, which reinforces
secondary gains
62. The psychodynamics of depression is:
a. lax super-ego C. internalized hostility feelings
b. weak super-ego D. id dominance
63. In working with a depressed client, the nurse should understand that depression is most directly related to a
person’s:
a. Experiencing poor interpersonal relationships with others
b. Having experienced a sense of loss
c. Remembering his traumatic childhood
d. Stage in life
64. When a depressed client becomes more active and there is evidence that her mood has lifted, an appropriate
goal to add to the nursing care plan is to:
a. Encourage her to go home for the weekend C. Monitor her whereabouts at all times
b. Move her to a room with three other clients D. Begin to explore the reasons she
became depressed

65. The nurse is assigned to a client who is potentially suicidal. Of the following nursing objectives, which one is
the most important?
a. Observe the client closely at all times
b. Recognize a continued desire to commit suicide
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 c. Involve the client in activities with others to mobilize him
d. Provide a safe environment to protect the client
66. When assessing a client for possible suicide, an important clue would be if the client:
a. is hostile and sarcastic to the staff
b. identifies with problems expressed by other clients
c. seems satisfied and detached
d. begins to talk about leaving the hospital
67. A client with the diagnosis of manic episode is setting up chairs in the group therapy room. An appropriate
nursing intervention is to:
a. have the client play table tennis
b. suggest video exercises with the other clients
c. Take the clients outside
d. Do nothing, as organizing the chairs is considered therapeutic
68. A client has the diagnosis of manic episode. Her disruptive behavior on the unit has been increasingly
annoying to the other clients. One intervention by the nurse might be to:
a. tell the client she is annoying others and confine her to her room
b. ignore the client’s behavior, realizing it is consistent with her illness
c. set limits on the client’s behavior and be consistent in approach
d. explain to the client that her behavior is unacceptable
69. While working with an alcoholic client, the most important approach by the nurse would be to:
a. maintain a nonjudgmental attitude toward the client
b. establish strict guidelines of behavior
c. explicitly outline expectations of the client
d. set up a working nurse-client relationship
70. A client is admitted with a diagnosis of delirium tremens. He is exhibiting marked tremors, hallucinations,
tachycardia, and is perspiring profusely. The first nursing intervention is to:
a. Start an IV with Vitamin B complex supplement as ordered
b. Administer valium IM as ordered
c. Control the environment with a quiet, single room, side-rails up, and soft lights
d. Get baseline VS
71. A client is admitted with Wernicke’s encephalopathy. The nurse anticipates that the first physicians orders
will include:
a. Ordering an MRI
b. Administering a steroid medication, such as Decadron
c. Giving Thiamine 100mg IM STAT
d. Ordering an EEG
72. Nurse Rap attended a group study concerning a client who has the diagnosis of Cognitive disorder,
Alzheimer’s disease. The client is constantly making up stories that are untrue. This characteristic of the
disease is called:
a. Senility C. Lability
b. Confabulation D. Memory loss
73. When the nurse is talking with a Schizophrenic client, she suddenly says, “I’m frightened, do you hear that?
Terrible things.” Which initial response by the nurse would be most appropriate?
a. “I don’t hear anything.” C. “I don’t hear anything but you seem frightened.”
b. “Who is saying terrible things to you?” D. “What is he saying to you?”
74. The best explanation for the term Depersonalization as seen in Schizophrenics, is:
a. The client cannot tolerate personal relationships
b. The client personalizes all threats and uses projection
c. A flight from reality related to oneself or the environment
d. A mechanism seen in Chronic Schizophrenia
75. Lilia, 48 y/o, thinks she is being followed by soldiers to kill her. What thought disorder does this indicate?
a. Ideas of reference C. Delusion of persecution
b. Flight of ideas D. Delusion of grandeur
76. Which of these nursing approaches is MOST appropriate for the nurse to begin with Marina?
a. Engage her for at least 1hr. in one to one interaction daily
b. Invite her to socialize with other patients
c. Make self-available while maintaining distance until she shows readiness to interact
d. Refer her for activity therapy

77. When Marina refuses to take her medication, it is best to:

a. let her read the drug literature to convince her that it is therapeutic
b. force her to take the drug to maintain therapeutic effectiveness
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 c. have the same nurse, who she interacts with regularly, administer the drug
d. request the doctor to give it to her
78. A50 yr. old male client has a history of many hospitalizations for Schizophrenic disorder. He has been on long-
term Phenothiazines (Thorazine), 400 mg/ day. The nurse assessing this client observes that he demonstrates
jerky choreiform movements, lip smacking, neck and back tonic contractions. The nurse concludes that the
client develop:
a. Tardive dyskinesia C. Dystonia
b. Parkinsonism D. Akathisia
79. A client comes to the emergency room with complaints of headache and vomiting. Upon interview, the client
says she is taking the drug Parnate. The nurse would continue the assessment by first asking:
a. The dose of Parnate she is taking C. What foods she has been eating
b. If she recently had flu symptoms D. What other medication she is taking
80. A client is to take Lithium regularly after she is discharged from the hospital. The nursing care plan includes
discharge planning. The most important information to impart to the client and his family is that the client
should:
a. Have an adequate intake of sodium C. Have a limited intake of sodium
b. Limit his fluid intake D. Not eat foods that have a high tyramine content
81. Carlo is acting out hostile and aggressive feeling by kicking the chairs in the room. The MOST effective way to
deal with Carlo’s behavior is to initially:
a. set limits on the behavior by verbal command
b. administer prn tranquilizer
c. remove the chairs from the room
d. restrain the patient and place him in the “isolation room”
82. One of the patients in the unit tells the nurse that she is the best nurse in the hospital and then tells the nurse
she is cruel when the nurse sets limits on his behavior. The nurse interprets this behavior as:
A. Denial C. Splitting
B. Rationalization D. Projection
83. Nurse Richard, a newly hired staff in the psychiatric ward was seen scolding the patient by the head nurse. He
was called to report to the head nurse. After speaking with the head nurse, Richard was eager to change his
attitude towards his clients. Which of the following did the head nurse told him as the most therapeutic
approach for a patient on a behavioral modification ward?
a. if the client is agitated, discuss the feelings especially anger
b. insist to stop obscene language by verbal command
c. give client support and positive feedback for controlling use of obscene language
d. provide a punching bag as an alternative to express upset emotions
84. Jim would count pencils in a mug over and over with the thought that stopping could result in something bad
happening. These are many things Jim seems he has to do to keep himself from feeling:
a. Confused C. excited
b. Suspicious D. anxious
85. All of these are therapeutic interventions for Jim EXCEPT:
a. impose limits every time the behavior becomes repetitive
b. establish a routine for him
c. assign task that can be done repetitively
d. facilitate self-expression
86. According to crisis theory, the minimal long-term goal in crisis intervention is:
a. relief of acute symptoms C. restoration of the functioning level
b. relief of panic level anxiety D. reorganization and reordering of the
personality
Situation: Rosa, 17y/o college student, was referred for weight loss of 48lbs. Diagnosis: Anorexia Nervosa
87. assessment data will most likely reveal:
a. persistent eating for at least one month C. recurrent episodes of binge eating
b. intense fear of becoming obese D. awareness that eating pattern is normal
88. The appropriate nursing diagnosis for Rosa is:
a. Imbalanced Nutrition: More than Body requirements C. Disturbed Body Image
b. Ineffective Coping D. Risk for Injury directed to self
89. After lunch, Barbie was observed to purge in the bathroom. What would be the appropriate nursing
intervention?
a. Observe Barbie for 24 hrs. for any incidence of purging
b. Tell Barbie that she’ll be forced to eat soon after purging
c. Tell Barbie that she’ll be given extra food tray
d. Barbie must be observed two hours after each meal
90. The nurse knows that purging behavior in Bulimic patients will lead to which fatal complication?
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 a. Dental carries C. rupture of the esophagus
b. Electrolyte imbalances D. Hypotension

Situation: Roland, 45 y/o laborer has sexual fantasies to children who are far younger than his own age. He was
also put to jail twice for assaulting and molesting a 10y/o child in their neighborhood.
91. Roland’s behavior is a manifestation of:
a. Incest C. Zoophilia
b. Pedophilia D. Exhibitionism
92. The appropriate nursing diagnosis for Roland is:
a. Altered sexuality pattern C. Social Isolation
b. Altered family process D. Sexual dysfunction

93. The characteristics of typical sex offenders are:

a. confident, isolated, sensitive C. low self-esteem, abuses alcohol, dependent
b. high self-esteem, confident, independent D. stable mood, low-self esteem, shy
94. The IQ assessment of a child who is mentally retarded is between 55 and 68. This degree of intellectual
improvement would be considered:
a. Mild C. Severe
b. Moderate ` D. Profound
95. Hyperactive children particularly those with Attention deficit disorders are prone to accidents. Nursing
actions should focus on personal safety like:
a. encouraging the child to ask others about safety rules C. give specific instructions one at a
time
b. let somebody accompany the child all the time D. instructing the child ways to protect
him

Situation: Rhoda, 28 y/o is admitted in the psychiatric unit. She demonstrated inappropriate affect, disorganized
speech, and prefers to giggle in one corner of the room. Diagnosis: Disorganized Schizophrenia
96. During the admission interview when the nurse asked “what did you eat this morning?” Rhoda answered
“food”. This is:
a. flight of ideas C. concrete associations
b. looseness of association D. clang association
97. The nurse is aware that the nursing diagnosis for her is:
a. Altered Sensory Perception C. Ineffective individual coping
b. Disturbed Thought Process D. Risk for violence directed to others

Situation: Jose, a 6y/o child is refusing to go to school.

98. Jose is likely to experience:
a. Shyness C. Fear
b. School phobia D. separation Anxiety
99. The task that starts to be developed at age 6 according to Erikson is:
a. Autonomy vs. shame and doubt C. Trust vs. mistrust
b. Industry vs. inferiority D. Initiative vs. guilt
100. Which among the following is not typical of autistic clients?
a. Echolalia C. ritualistic behavior
b. no eye contact D. responsiveness to parents

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