NCLEX Sample Questions for Psychiatric Nursing 5

1. Which nursing intervention is best for facilitating communication with a psychiatric client who speaks a foreig a. Rely on nonverbal communication. b. Select symbolic pictures as aids. c. Speak in universal phrases. d. Use the services of an interpreter.

2. The nurse explains to a mental health care technician that a clients obsessive-compulsive behaviors are related superego (or conscience). On which of the following theories does the nurse base this statement? a. Behavioral theory b. Cognitive theory c. Interpersonal theory d. Psychoanalytic theory

3. The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his a. I guess youre worried about something, arent you? b. Can I get you some medication to help calm you? c. Have you been pacing for a long time? d. I notice that youre pacing. How are you feeling?

4. A client with obsessive-compulsive disorder is hospitalized on an inpatient unit. Which nursing response is mo a. Accepting the clients obsessive-compulsive behaviors b. Challenging the clients obsessive-compulsive behaviors c. Preventing the clients obsessive-compulsive behaviors d. Rejecting the clients obsessive-compulsive behaviors

5. A 45-year-old woman with a history of depression tells a nurse in her doctors office that she has difficulty wit affair. Which of the following factors would the nurse identify as least significant in contributing to the clients s a. Education and work history b. Medication used c. Physical health status d. Quality of spousal relationship

6. Which nursing intervention is most appropriate for a client with anorexia nervosa during initial hospitalization a. Emphasize the importance of good nutrition to establish normal weight. b. Ignore the clients mealtime behavior and focus instead on issues of dependence and independence. c. Help establish a plan using privileges and restrictions based on compliance with refeeding. d. Teach the client information about the long-term physical consequence of anorexia.

7. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would a. The parents reinforce increased decision making by the client. b. The parents clearly verbalize their expectations for the client. c. The client verbalizes that family meals are now enjoyable. d. The client tells her parents about feelings of low-self-esteem.

8. The nurse is working with a client with a somatoform disorder. Which client outcome goal would the nurse mo a. The client will recognize signs and symptoms of physical illness. b. The client will cope with physical illness. c. The client will take prescribed medications. d. The client will express anxiety verbally rather than through physical symptoms. 9. Which method would a nurse use to determine a clients potential risk for suicide? a. Wait for the client to bring up the subject of suicide. b. Observe the clients behavior for cues of suicide ideation. c. Question the client directly about suicidal thoughts. d. Question the client about future plans.

10. A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed thought processe ideas. Which of the following outcome criteria would indicate improvement in the client? a. The client verbalizes feelings directly during treatment. b. The client verbalizes positive self statement. c. The client speaks in coherent sentences. d. The client reports feelings calmer.

11. A client tells a nurse. Everyone would be better off if I wasnt alive. Which nursing diagnosis would be ma a. Disturbed thought processes

b. Ineffective coping c. Risk for self-directed violence d. Impaired social interaction

12. Which information is most essential in the initial teaching session for the family of a young adult recently dia a. Symptoms of this disease imbalance in the brain. b. Genetic history is an important factor related to the development of schizophrenia. c. Schizophrenia is a serious disease affecting every aspect of a persons functioning. d. The distressing symptoms of this disorder can respond to treatment with medications.

13. A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes rela establish? a. The client will demonstrate realistic interpretation of daily events in the unit. b. The client will perform daily hygiene and grooming without assistance. c. The client will take prescribed medications without difficulty. d. The client will participate in unit activities.

14. A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command h diagnosis? a. Anxiety b. Impaired social interaction c. Disturbed sensory-perceptual alteration (auditory) d. Risk for other-directed violence

15. A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his stressful ma client using? a. Displacement b. Projection c. Rationalization d. Sublimation

16. An 11-year-old child diagnosed with conduct disorder is admitted to the psychiatric unit for treatment. Which a. Restlessness, short attention span, hyperactivity b. Physical aggressiveness, low stress tolerance disregard for the rights of others c. Deterioration in social functioning, excessive anxiety and worry, bizarre behavior d. Sadness, poor appetite and sleeplessness, loss of interest in activities

17. The nurse understands that if a client continues to be dependent on heroin throughout her pregnancy, her bab a. Mental retardation. b. Heroin dependence. c. Addiction in adulthood. d. Psychological disturbances.

18. The emergency department nurse is assigned to provide care for a victim of a sexual assault. When following important? a. Determine the assailants identity. b. Preserve the clients privacy. c. Identify the extent of injury. d. Ensure an unbroken chain of evidence.

19. Which factor is least important in the decision regarding whether a victim of family violence can safely rema a. The availability of appropriate community shelters b. The nonabusing caretakers ability to intervene on the clients behalf c. The clients possible response to relocation d. The familys socioeconomic status 20. The nurse would expect a client with early Alzheimers disease to have problems with: a. Balancing a checkbook. b. Self-care measures. c. Relating to family members. d. Remembering his own name

21. Which nursing intervention is most appropriate for a client with Alzheimers disease who has frequent episod a. Attempt humor to alter the client mood. b. Explore reasons for the clients altered mood. c. Reduce environmental stimuli to redirect the clients attention. d. Use logic to point out reality aspects. 22. Which neurotransmitter has been implicated in the development of Alzheimers disease? a. Acetylcholine

b. Dopamine c. Epinephrine d. Serotonin

23. Which factors are most essential for the nurse to assess when providing crisis intervention foe a client? a. The clients communication and coping skills b. The clients anxiety level and ability to express feelings c. The clients perception of the triggering event and availability of situational supports d. The clients use of reality testing and level of depression 24. The nurse considers a clients response to crisis intervention successful if the client: a. Changes coping skills and behavioral patterns. b. Develops insight into reasons why the crisis occurred. c. Learns to relate better to others. d. Returns to his previous level of functioning.

25. Two nurses are co-leading group therapy for seven clients in the psychiatric unit. The leaders observe that the answers. Which phase of development is this group in? a. Conflict resolution phase b. Initiation phase c. Working phase d. Termination phase

26. Group members have worked very hard, and the nurse reminds them that termination is approaching. Termin a. Decide to continue. b. Elevate group progress c. Focus on positive experience d. Stop attending prior to termination.

27. The nurse is teaching a group of clients about the mood-stabilizing medications lithium carbonate. Which me the increased risk of lithium toxicity? a. Antacids b. Antibiotics c. Diuretics d. Hypoglycemic agents

28. When providing family therapy, the nurse analyzes the functioning of healthy family systems. Which situatio a. An adolescents going away to college b. The birth of a child c. The death of a grandparent d. Parental disagreement

29. A client taking the monoamine oxidase inhibitor (MAOI) antidepressant isocarboxazid (Marplan) is instructe a. Aged cheese and red wine b. Milk and green, leaf vegetables c. Carbonated beverages and tomato products d. Lean red meats and fruit juices

30. Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurse should: a. Assess skin color and sclera b. Assess the radial pulse c. Take the clients blood pressure d. Ask the client to void

31. The nurse understands that electroconvulsive therapy is primary used in psychiatric care for the treatment of: a. Anxiety disorders. b. Depression. c. Mania. d. Schizophrenia.

32. A client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the medications list concern and therefore initiate further teaching? a. Acetaminophen (Tylenol) b. Diphenhydramine (Benadryl) c. Furosemide (Lasix) d. Isosorbide dinitrate (Isordil)

33. The nurse is administering a psychotropic drug to an elderly client who has history of benign prostatic hypert to: a. Add fiber to his diet.

b. Exercise on a regular basis. c. Report incomplete bladder emptying d. Take the prescribed dose at bedtime.

34. The nurse correctly teaches a client taking the benzodiazepine oxazepam (Serax) to avoid excessive intake of a. Cheese b. Coffee c. Sugar d. Shellfish

35. The nurse provides a referral to Alcoholics Anonymous to a client who describes a 20-year history of alcohol a. Encourage the use of a 12-step program. b. Help members maintain sobriety. c. Provide fellowship among members. d. Teach positive coping mechanisms.

36. Which client outcome is most appropriately achieved in a community approach setting in psychiatric nursing a. The client performs activities of daily living and learns about crafts. b. The clients is able to prevent aggressive behavior and monitors his use of medications. c. The client demonstrates self-reliance and social adaptation. d. The client experience experiences anxiety relief and learns about his symptoms.

37. A client with panic disorder experiences an acute attack while the nurse is completing an admission assessme priority. a. Remain with the client. b. Encourage physical activity. c. Encourage low, deep breathing. d. Reduce external stimuli. e. Teach coping measures.

38. The doctor has prescribed haloperidol (Haldol) 2.5 mg. I.M. for an agitated client. The medication is labeled by drawing up how many milliliters in the syringe? a. 0.3 b. 0.4 c. 0.5 d. 0.6

39. The nurse enters the room of a client with a cognitive impairment disorder and asks what day of the week it i The nurse is attempting to assess: a. Confabulation b. Delirium c. Orientation d. Perseveration

40. Which of the following will the nurse use when communicating with a client who has a cognitive impairment a. Complete explanations with multiple details b. Picture or gestures instead of words c. Stimulating words and phrases to capture the clients attention d. Short words and simple sentences 41. A 75-year-old client has dementia of the Alzheimers type and confabulates. The nurse understands that this a. Denies confusion by being jovial. b. Pretends to be someone else. c. Rationalizes various behaviors. d. Fills in memory gaps with fantasy.

42. An elderly client with Alzheimers disease becomes agitated and combative when a nurse approaches to help intervention in this situation would be to: a. Tell the client family that it is time to get dressed. b. Obtain assistance to restrain the client for safety. c. Remain calm and talk quietly to the client. d. Call the doctor and request an order for sedation.

43. In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening a. Aphasia b. Agnosia c. Sundowning d. Confabulation

44. Which of the following outcome criteria is appropriate for the client with dementia?

a. The client will return to an adequate level of self-functioning. b. The client will learn new coping mechanisms to handle anxiety. c. The client will seek out resources in the community for support. d. The client will follow an establishing schedule for activities of daily living.

45. The school guidance counselor refers a family with an 8-year-old child to the mental health clinic because of the following data would be a priority to the nurse doing the initial family assessment? a. The childs performance in school b. Family education and work history c. The familys perception of the current problem d. The teachers attempts to solve the problem

46. The parents of a young man with schizophrenia express feelings of responsibility and guilt for their sons pro a. Acknowledge the parents responsibility. b. Explain the biological nature of schizophrenia. c. Refer the family to a support group d. Teach the parents various ways they must change.

47. The nurse collecting family assessment data asks. Who is in your family and where do they live? which of a. Boundaries b. Ethnicity c. Relationships d. Triangles

48. According to the family systems theory, which of the following best describes the process of differentiation? a. Cooperative action among members of the family b. Development of autonomy within the family c. Incongruent massages wherein the recipient is a victim d. Maintenance of system continuity or equilibrium

49. The nurse is interacting with a family consisting of a mother, a father, and a hospitalized adolescent who has and agrees with the adolescents view about family rules. Which intervention is most appropriate? a. The nurse should align with the adolescent, who is the family scapegoat. b. The nurse should encourage the parents to adopt more realistic rules. c. The nurse should encourage the adolescent to comply with parental rules.

d. The nurse should remain objective and encourage mutual negotiation of issues.

50. A 16-year-old girl has retuned home following hospitalization for treatment of anorexia nervosa. The parents has always done everything to please them and they cannot understand her current stubbornness about eating. Th characteristic of which relationship style? a. Differentiation b. Disengagement c. Enmeshment d. Scapegoating

Answer and Rationale- NCLEX Sample Questions for Psychiatric Nursing 5

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1. D. An interpreter will enable the nurse to better assess the clients problems and concerns. Nonverbal communic clients problems and concerns, the assistance of an interpreter is essential. The use of symbolic pictures and univ needs of the client; however these are insufficient to assess the client with a psychiatric problem. 2. D. Psychoanalytic is based on Freuds beliefs regarding the importance of unconscious motivation for behavior an Behavioral cognitive and interpersonal theories do not emphasize unconscious conflicts as the basis for symptom 3. D. By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answe option B, the nurse is intervening before accurately assessing the problem. Option C, which also encourages a ye is the reason for his pacing. 4. A. A client with obsessive-compulsive behavior uses this behavior to decrease anxiety. Accepting this behavior as treatment plan is developed, other nursing responses may also be acceptable. The remaining answer choices will 5. A. Education and work history would have the least significance in relation to the clients sexual problem. Age, he influence on sexual expression. 6. C. Inpatient treatment of a client with anorexia usually focuses initially on establishing a plan for refeeding to com accomplished through behavioral therapy, which uses a system of rewards and reinforcements to assist in establi client about the long-term physical consequences of anorexia maybe appropriate at a later time in the treatment behavior continually to evaluate treatment effectiveness. 7. A. One of the core issues concerning the family of a client with anorexia is control. The familys acceptance of the family intervention. Although the remaining options may occur during the process of therapy they would not nec dependence and independence are not addressed in these responses. 8. D. The client with a somatoform disorder displaces anxiety onto physical symptoms. The ability to express anxiety remaining responses do not indicate any positive change toward increased coping with anxiety. 9. C. Directly questioning a client about suicide is important to determine suicide risk. The client may not bring up th wishing not to be discovered, and his lack of trust in staff. Behavioral cues are important, but direct questioning is the client that the nurse is not comfortable with the subject of suicide and, therefore, the client may be reluctant 10. C. A client exhibiting flight of ideas typically has a continuous speech flow and jumps from one topic to another. S

concentration has improved and his thoughts are no longer racing. The remaining options do not relate directly to 11. C. The nurse should take any nurse statements indicating suicidal thoughts seriously and further assess for other seriousness of the clients statement. 12. D. This statement provides accurate information and an element of hope for the family of a schizophrenic client. the empathic response the family needs after just learning about the diagnosis. These facts can become part of th 13. A. A client with schizophrenia, paranoid type, has distorted perceptions and views people, institutions, and aspec outcome for someone with delusional perceptions would be to have a realistic interpretation of daily events. The necessarily have impairments affecting hygiene and grooming skills. Although taking medications and participatin intervention, these responses are not related to client perceptions. 14. D. A client with these symptoms would have poor impulse control and would therefore be prone to acting-out be remaining nursing diagnoses may apply to the client with mania; however, the priority diagnosis would be risk for 15. C. Rationalization is the defense mechanism that involves offering excuses for maladaptive behavior. The client is stressors. This is a common defense mechanism used by clients with substance abuse problems. None of the rem 16. B. Physical aggressiveness, low stress tolerance, and a disregard for the rights of others are common behaviors in and hyperactivity are typical behaviors in a client with attention deficit hyperactivity disorder. Deterioration in so are typical in schizophrenic disorders. Sadness, poor appetite, sleeplessness, and loss of interest in activities are b 17. B. Babies born to heroin-dependent women are also heroin-dependent and need to go through withdrawal. Ther 18. D. Establishing an unbroken chain of evidence is essential in order to ensure that the prosecution of the perpetra privacy and identify the extent of injury. However, it is essential that the nurse follow legal and agency guidelines enforcement, not the nurse. 19. D. Socioeconomic status is not a reliable predictor of abuse in the home, so it would be the least important consid violence. The availability of appropriate community shelters and the ability of the nonabusing caretaker to interve safety decisions. The clients response to possible relocation (if the client is a competent adult) would be the mos being treated as a competent person can help a client feel less like a victim. 20. A. In the early stage of Alzheimers disease, complex tasks (such as balancing a checkbook) would be the first cogn relating to family members, and difficulty remembering ones own name are all areas of cognitive decline that oc 21. C. The client with Alzheimers disease can have frequent episode of labile mood, which can best be handled by de attention. An over stimulating environment may cause the labile mood, which will be difficult for the client to und ability to respond to either humor or logic. The client lacks any insight into his or her own behavior and therefore 22. A. A relative deficiency of acetylcholine is associated with this disorder. The drugs used in the early stages of Alzh brain. The remaining neurotransmitters have not been implicated in Alzheimers disease. 23. C. The most important factors to determine in this situations are the clients perception of the crisis event and the basic needs. Although the nurse should assess the other factors, they are not as essential as determining why the needs. 24. D. Crisis intervention is based on the idea that a crisis is a disturbance in homeostasis (steady state). The goal is to functioning. The remaining answer choices are not considered the primary outcome of crisis intervention, althoug 25. B. Increased anxiety and uncertainly characterize the initiation phase in group therapy. Group members are more 26. A. As the group progresses into the working phase, group members assume more responsibility for the group. Th in a group are indicators that the group is active and involved. The remaining answer choices would indicate the g 27. C. The use of diuretics would cause sodium and water excretion, which would increase the risk of lithium toxicity. fluid intake and to maintain normal intake of sodium. Concurrent use of any of the remaining medications will no 28. D. In a functional family, parents typically do not agree on all issues and problems. Open discussion of thoughts a system stress. The remaining answer choices are life transitions that are expected to increase family stress. 29. A. Aged cheese and red wines contain the substance tyramine which, when taken with an MAOI, can precipitate a contain significant amounts of tyramine and, therefore, are not restricted. 30. C. Because chlorpromazine (Thorazine) can cause a significant hypotensive effect (and possible client injury), the standing) before administering this drug. If the client had taken the drug previously, the nurse would also need to

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drug side affect; however, based on the information given here, there is no evidence that the client has received retention, asking the client to avoid will not alter this anticholinergic effect. B. The onset of action of the SSRI antidepressant paroxetine occurs around 3 to 4 weeks after drug therapy begin time. Continuing to take the drug is important for this client. B. Over-the-counter medications used for allergies and cold symptoms are contraindicated because they will incr hypertensive crisis. None of the remaining medications will increase the sympathomimetic response and, therefo C. Urinary retention is a common anticholinergic side effect of psychotic medications, and the client with benign p Adding fiber to ones diet and exercising regularly are measures to counteract another anticholinergic effect, con prescribed, taking the medication at night may or may not be important. However, it would have nothing to do w B. Coffee contains caffeine, which has a stimulating effect on the central nervous system that will counteract the remaining foods is contraindicated. B. The primary purpose of Alcoholics Anonymous is to help members achieve and maintain sobriety. Although ea attendance at Alcoholics Anonymous, the primary purpose is directed toward sobriety of members. C. A therapeutic community is designed to help individuals assume responsibility for themselves, to learn how to manner. The remaining answer choices may be outcomes of psychiatric treatment, but the use of a therapeutic c and cooperative adaptation to being with others. ADCBE. The nurse should remain with the client to provide support and promote safety. Reducing external stimul decrease anxiety. Encouraging the client to use slow, deep breathing will help promote the bodys relaxation resp nervous system. Encouraging physical activity will help him to release energy resulting from the heightened anxie breathing under control. Teaching coping measures will help the client learn to handle anxiety; however, this can he is better able to focus. C. Set up the problem as follows: 2.5mg/10mg = Xml/2ml X=0.5ml C. The initial, most basic assessment of a client with cognitive impairment involves determining his level of orient assess for confabulation and perseveration in a client with cognitive impairment; but the questions in this situatio cognitive impairment; however, other symptoms are necessary to establish this diagnosis. D. Short words and simple sentence minimize client confusion and enhance communication. Complete explanatio increase confusion in a client with short attention span and difficulty with comprehension. Although pictures and communication. D. Confabulation is a communication device used by patients with dementia to compensate for memory gaps. Th C. Maintaining a calm approach when intervening with an agitated client is extremely important. Telling the client especially if the nurse touches him. Restraints are a last resort to ensure client safety and are inappropriate in thi interfere with CNS functioning and may contribute to the clients confusion. C. Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment may be seen in this client. D. Following established activity schedules is a realistic expectation for clients with dementia. All of the remaining than can be realistically expected of clients with this disorder. C. The familys perception of the problem is essential because change in any one part of a family system affects a family has been affected by the current problems related to the school system and the nurse would be interested attempts to solve the problem are relevant and may be assessed; however, priority would be given to the family history may be relevant, but are not a priority. B. Te parents are feeling responsible and this inappropriate self-blame can be limited by supplying them with the patients responsibility is neither accurate nor helpful to the parents and would only reinforce their feelings of gu the parents self-blame directly instead of making a referral for this problem. Teaching the parents various ways t although parents can learn about schizophrenia and what is helpful and not helpful, the approach suggested in th A. Family boundaries are parameters that define who is inside and outside the system. The best method of obtain to be members. The question asked by the nurse would not elicit information about the familys ethnicity or cultu B. Differentiation is the process of becoming an individual developing autonomy while staying in contact with the

not refer to differentiation, although individuals who have a high level of differentiation would be able to accomp recipient is a victim describe double-bind communication. Maintenance of system continuity or equilibrium is hom 49. D. The nurse who wishes to be helpful to the entire family must remain neutral. Taking sides in a conflict situation problem resolution. If the nurse aligned with the adolescent, then the nurse would be blaming the parents for the situation. Learning to negotiate conflict is a function of a healthy family. Encouraging the parents to adopt more r not give the family an opportunity to try to resolve problems on their own. 50. C. Enmeshment is a fusion or overinvolvement among family members whereby the expectation exists that all me parents is an example of how enmeshment affects development in many cases, a child who develops anorexia ne remaining options are not appropriate to the situation described.