PSYCHIATRIC NURSING (MAY 2022 PNLE)

1. Inpatient psychiatric care focuses on all the following EXCEPT:

a. brief interventions.
b. discharge planning.
c. independent living skills.
d. symptom management.

2. The overall goal of psychiatric rehabilitation is for the client to gain

a. control of symptoms.
b. freedom from hospitalization.
c. management of anxiety.
d. recovery from the illness.

3. A client tells the nurse, “My biggest problem right now is trying to deal with a divorce. I
didn’t want a divorce and I still don’t. But it is happening anyway!” Which of the following
responses by the nurse will convey empathy?
a. “Can you tell me about it?”
b. “I’m so sorry. No wonder you’re upset.”
c. “Sounds like it has been a difficult time.”
d. “You must be devastated.”

4. Client: “I had an accident.” Nurse: “Tell me about your accident.” This is an example of
which therapeutic communication technique?
a. Making observations
b. Offering self
c. General lead
d. Reflection

5. “Earlier today you said you were concerned that your son was still upset with you. When I
stopped by your room about an hour ago, you and your son seemed relaxed and smiling
as you spoke to each other. How did things go between the two of you?” This is an
example of which therapeutic communication technique?
a. Consensual validation
b. Encouraging comparison
c. Accepting
d. General lead

6. “Why do you always complain about the night nurse? She is a nice woman and a fine
nurse and has five kids to support. You’re wrong when you say she is noisy and uncaring.”
This example reflects which nontherapeutic technique?
a. Requesting an explanation
b. Defending
c. Disagreeing
d. Advising

7. “How does Jerry make you upset?” is a nontherapeutic communication technique because
it
a. gives a literal response.
 b. indicates an external source of the emotion.
c. interprets what the client is saying.
d. is just another stereotyped comment.

8. Which of the following is a concrete message?

a. “Help me put this pile of books on Marsha’s desk.”
b. “Get this out of here.”
c. “When is she coming home?”
d. “They said it is too early to get in.”

9. Which client statement would indicate self-efficacy?

a. “I like to get several opinions before deciding a course of action.”
b. “I know if I can learn to relax, I will feel better.”
c. “I’m never sure if I’m making the right decision.”
d. “No matter how hard I try to relax, something always comes up.”

10.Assessment data about the client’s speech patterns are categorized in which of the
following areas?
a. History
b. General appearance and motor behavior
c. Sensorium and intellectual processes
d. Self-concept

11.When the nurse is assessing whether the client’s ideas are logical and make sense, the
nurse is examining which of the following areas?
a. Thought content
b. Thought process
c. Memory
d. Sensorium

12.To assess the client’s ability to concentrate, the nurse would instruct the client to do
which?
a. Explain what “a rolling stone gathers no moss” means.
b. Name the last three presidents.
c. Repeat the days of the week backward.
d. Talk about what a typical day is like.

13.The client tells the nurse “I never do anything right. I make a mess of everything. Ask
anyone; they’ll tell you the same thing.” The nurse recognizes these statements as
examples of
a. emotional issues.
b. negative thinking.
c. poor problem-solving.
d. relationship difficulties.

14.The client who is involuntarily committed to an inpatient psychiatric unit loses which right?
a. Right to freedom
b. Right to refuse treatment
c. Right to sign legal documents
 d. The client loses no rights

15.The nurse gives the client quetiapine (Seroquel) in error when olanzapine (Zyprexa) was
ordered. The client has no ill effects from the quetiapine. In addition to making a
medication error, the nurse has committed which?
a. Malpractice
b. Negligence
c. Unintentional tort
d. None of the above

16.Which of the following give cues to the nurse that a client may be grieving for a loss?
a. Sad affect, anger, anxiety, and sudden changes in mood
b. Thoughts, feelings, behavior, and physiologic complaints
c. Hallucinations, panic level of anxiety, and sense of impending doom
d. Complaints of abdominal pain, diarrhea, and loss of appetite

17.Situations that are considered risk factors for complicated grief are
a. inadequate support and old age.
b. childbirth, marriage, and divorce.
c. death of a spouse or child, death by suicide, and sudden and unexpected death.
d. inadequate perception of the grieving crisis.

18.Physiologic responses of complicated grieving include

a. tearfulness when recalling significant memories of the lost one.
b. impaired appetite, weight loss, lack of energy, and palpitations.
c. depression, panic disorders, and chronic grief.
d. impaired immune system, increased serum prolactin level, and increased mortality rate
from heart disease.

19.Which is an example of assertive communication?

a. “I wish you would stop making me angry.”
b. “I feel angry when you walk away when I’m talking.”
c. “You never listen to me when I’m talking.”
d. “You make me angry when you interrupt me.”

20.Which statement about anger is true?

a. Expressing anger openly and directly usually leads to arguments.
b. Anger results from being frustrated, hurt, or afraid.
c. Suppressing anger is a sign of maturity.
d. Angry feelings are a negative response to a situation.

21.Which type of drugs requires cautious use with potentially aggressive clients?
a. Antipsychotic medications
b. Benzodiazepines
c. Mood stabilizers
d. Lithium

22.The nurse observes a client muttering to himself and pounding his fist in his other hand
while pacing in the hallway. Which principle should guide the nurse’s action?
 a. Only one nurse should approach an upset client to avoid threatening the client.
b. Clients who can verbalize angry feelings are less likely to become physically
aggressive.
c. Talking to a client with delusions is not helpful, because the client has no ability to
reason.
d. Verbally aggressive clients often calm down on their own if staff members don’t bother
them.

23.Which is the best action for the nurse to take when assessing a child who might be
abused?
a. Confront the parents with the facts, and ask them what happened.
b. Consult with a professional member of the health team about making a report.
c. Ask the child which parent caused this injury.
d. Say or do nothing; the nurse has only suspicions, not evidence.

24.Which is true about domestic violence between same-sex partners?

a. Such violence is less common than that between heterosexual partners.
b. The frequency and intensity of violence are greater than between heterosexual
partners.
c. Rates of violence are about the same as between heterosexual partners.
d. None of the above.

25.Which assessment finding might indicate elder self-neglect?

a. Hesitancy to talk openly with nurse
b. Inability to manage personal finances
c. Missing valuables that are not misplaced
d. Unusual explanations for injuries

26.Which type of child abuse can be most difficult to treat effectively?

a. Emotional
b. Neglect
c. Physical
d. Sexual

27. Women in battering relationships often remain in those relationships as a result of faulty
or incorrect beliefs. Which belief is valid?
a. If she tried to leave, she would be at increased risk for violence.
b. If she would do a better job of meeting his needs, the violence would stop.
c. No one else would put up with her dependent clinging behavior.
d. She often does things that provoke the violent episodes.

28.Which statement by the caregiver of a client newly diagnosed with dementia requires
further intervention by the nurse?
a. “I will remind Mother of things she has forgotten.”
b. “I will keep Mother busy with favorite activities as long as she can participate.”
c. “I will try to find new and different things to do every day.”
d. “I will encourage Mother to talk about her friends and family.”
29.Which statement indicates the caregiver’s accurate knowledge about the needs of a parent
at the onset of the moderate stage of dementia?
a. “I need to give my parent a bath at the same time every day.”
b. “I need to postpone any vacations for 5 years.”
c. “I need to spend time with my parent doing things we both enjoy.”
d. “I need to stay with my parent 24 hours a day for supervision.”

30.Which of the following interventions is most appropriate in helping a client with early-
stage dementia complete ADLs?
a. Allow enough time for the client to complete ADLs as independently as possible.
b. Provide the client with a written list of all the steps needed to complete ADLs.
c. Plan to provide step-by-step prompting to complete the ADLs.
d. Tell the client to finish ADLs before breakfast or the nursing assistant will do them.

31.A client with late moderate-stage dementia has been admitted to a long-term care facility.
Which nursing intervention will help the client maintain optimal cognitive function?
a. Discuss pictures of children and grandchildren with the client.
b. Do word games or crossword puzzles with the client.
c. Provide the client with a written list of daily activities.
d. Watch and discuss the evening news with the client.

32.The nurse observes a client who is becoming increasingly upset. He is rapidly pacing,
hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high-
pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into
his other hand. The nurse identifies his anxiety level as
a. mild.
b. moderate.
c. severe.
d. panic.

33.When assessing a client with anxiety, the nurse’s questions should be

a. avoided until the anxiety is gone.
b. open-ended.
c. postponed until the client volunteers information.
d. specific and direct.

34.The best goal for a client learning a relaxation technique is that the client will
a. confront the source of anxiety directly.
b. experience anxiety without feeling overwhelmed.
c. report no episodes of anxiety.
d. suppress anxious feelings.

35.A client with GAD states, “I have learned that the best thing I can do is to forget my
worries.” How would the nurse evaluate this statement?
a. The client is developing insight.
b. The client’s coping skills have improved.
c. The client needs encouragement to verbalize feelings.
d. The client’s treatment has been successful.
36.The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly
and rapidly, and using elaborate hand gestures. The nurse concludes that the client is
demonstrating which?
a. Aggression
b. Anger
c. Anxiety
d. Psychomotor agitation

37.A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times
a day. After 3 days of therapy, the client says, “My hands are shaking.” Which is the best
response by the nurse?
a. “Fine motor tremors are an early effect of lithium therapy that usually subsides in a
few weeks.”
b. “It is nothing to worry about unless it continues for the next month.”
c. “Tremors can be an early sign of toxicity, but we’ll keep monitoring your lithium level
to make sure you’re OK.”
d. “You can expect tremors with lithium. You seem very concerned about such a small
tremor.”

38.What are the most common types of side effects from SSRIs?
a. Dizziness, drowsiness, and dry mouth
b. Convulsions and respiratory difficulties
c. Diarrhea and weight gain
d. Jaundice and agranulocytosis 739

39.The nurse observes that a client with depression sat at a table with two other clients
during lunch. Which is the best feedback the nurse could give the client?
a. “Do you feel better after talking with others during lunch?”
b. “I’m so happy to see you interacting with other clients.”
c. “I see you were sitting with others at lunch today.”
d. “You must feel much better than you were a few days ago.”

40.What is the rationale for a person taking lithium to have enough water and salt in his or
her diet?
a. Salt and water are necessary to dilute lithium to avoid toxicity.
b. Water and salt convert lithium into a usable solute.
c. Lithium is metabolized in the liver, necessitating increased water and salt
d. Lithium is a salt that has greater affinity for receptor sites than sodium chloride.

41.A client says to the nurse, “You are the best nurse I’ve ever met. I want you to remember
me.” What is an appropriate response by the nurse?
a. “Thank you. I think you are special too.”
b. “I suspect you want something from me. What is it?”
c. “You probably say that to all your nurses.”
d. “Are you thinking of suicide?”

42.A client lives in a group home and visits the community mental health center regularly.
During one visit with the nurse, the client states, “The voices are telling me to hurt myself
again.” Which of the following questions by the nurse is most important to ask?
 a. “When do you hear the voices?”
b. “Are you going to hurt yourself?”
c. “How long have you heard the voices?”
d. “Why are the voices starting again?”

43. A client with mania begins dancing around the day room. When she twirled her skirt in
front of the male clients, it was obvious she had no underwear on. The nurse distracts her
and takes her to her room to put 740 on underwear. The nurse acted as she did to
a. minimize the client’s embarrassment about her present behavior
b. keep her from dancing with other clients.
c. avoid embarrassing the male clients who are watching.
d. teach her about proper attire and hygiene.

44.A client who has been stabilized on medications for several months is at the clinic for a
medication check. During a conversation with the nurse, the client suddenly jumps up,
begins pacing, and wrings her hands. What should the nurse do first?
a. Walk with the client to help decrease her anxiety.
b. Discuss productive ways to solve her problems causing anxiety.
c. Share observations about her anxiety-related behaviors.
d. Ask the client about the sources of her anxiety.

45.A client states that she hears God's voice telling her that she has sinned and needs to
punish herself? Which response by the nurse is most important?
a. “How do you think you will be punished?”
b. “Please tell staff when you think you need to punish yourself.”
c. “What exactly do you think you have done to be punished?”
d. “Let's talk about your strengths.”

46.A newly admitted client diagnosed with paranoid schizophrenia is pacing rapidly and
wringing his hands. He states that another client is out to get him. Then he says, “Protect
me, select me, reject me.” The nurse should next:
a. Administer his oral PRN lorazepam (Ativan) and haloperidol (Haldol).
b. Place the client in temporary seclusion before he has a chance to hurt others.
c. Call the primary health care provider for a prescription for restraints.
d. Ask the other clients to leave the immediate area.

47.A client diagnosed with dementia wanders the halls of the locked nursing unit during the
day. To ensure the client's safety while walking in the halls, the nurse should do
which of the following?
a. Administer PRN haloperidol (Haldol) to decrease the need to walk.
b. Assess the client's gait for steadiness.
c. Restrain the client in a geriatric chair.
d. Administer PRN lorazepam (Ativan) to provide sedation.

48.A client with early dementia exhibits disturbances in her mental awareness and orientation
to reality. The nurse should expect to assess a loss of ability in which of the following
other areas?
a. Speech.
b. Judgment.
 c. Endurance.
d. Balance.

49.The client with dementia states to the nurse, “I know you. You're Margaret, the girl who
lives down the street from me.” Which of the following responses by the nurse is most
therapeutic?
a. “Mrs. Jones, I'm Rachel, a nurse here at the hospital.”
b. “Now Mrs. Jones, you know who I am.”
c. “Mrs. Jones, I told you already, I'm Rachel and I don't live down the street.”
d. “I think you forgot that I'm Rachel, Mrs. Jones.”

50.The client with Alzheimer's disease may have delusions about being harmed by staff and
others. When the client expresses fear of being killed by staff, which of the following
responses is most appropriate?
a. “What makes you think we want to kill you?”
b. “We like you too much to want to kill you.”
c. “You are in the hospital. We are nurses trying to help you.”
d. “Oh, don't be so silly. No one wants to kill you here.”

SITUATION: Shane, 26 years old, is aloof in relating with other patients and members of the
staff. She claims that the medications being given to her are meant to poison her. She is also
suspicious about the food being served for her.

51.Basically, Shane is suspicious because of her inability to develop a sense of:

a. Intimacy
b. Generativity
c. Trust
d. Initiative

52.Shane utilizes projection by being suspicious, This means that she:

a. Unconsciously refuses to accept feeling, thought or impulse and attributes it to
someone else
b. Justifies behaviour, attitudes and feelings with excuses
c. Involuntary refuses to acknowledge reality
d. Involuntarily excludes wishes, impulses, memories and feelings from awareness

53.Which of these nursing approaches is MOST appropriate for the nurse to begin with?
a. Engage Marina for at least one hour in a one-to-one interaction daily
b. Invite her to socialize with other patients
c. Make self-available while maintaining distance until patient shows readiness to interact
d. Refer her for activity therapy

54.When she resists 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 of the drug
c. Have the same nurse, who she interacts with regularly, administer the drug
d. Request the doctor to give her medication

55.Another reason why she refuses to take Thorazine is because she complains of robot like
movement and slurred speech. The nurse’s action is:
a. Decrease the dosage of thorazine
b. Explain the extrapyramidal side effects and administer Benadryl
 c. Avoid giving foods that are rich in tyramine
d. Withhold medication until referral is made to the doctor

SITUATION: Most people exist in a state of equilibrium despite the occurrence of crisis
situations. Although some were not able to recover and coping mechanisms are down. The
following questions refer to this.

56.Melrose, a nursing graduate, has hailed her NLE for the 5th time. He now refuses to go out
from his room and is complaining of difficulty eating, sleeping working. His reaction is
considered:
a. A pathologic response to grief
b. A crisis caused by traumatic stress
c. A non-crisis situation
d. A crisis of anticipated life transitions

57.Nurse Allan is caring for Ms. Melrose, his goal in crisis intervention is to provide the client:
a. Problem-solving techniques and structured activities
b. An insight-oriented analytic approach
c. Medication to sedate the client
d. Non-directive techniques such as free association

58.When working with a client in crisis, which of the following is the MOST important?
a. Assisting the client in determining what is similar about this crisis to the previous crises
in his life
b. Remaining focused on the client’s immediate problem
c. Obtaining a complete assessment of the client’s past history
d. Determining whether the client may have a part on the occurrence of this crisis

59.A crisis intervention nurse meets a young client who was admitted after attempting
suicide by slashing his wrist. The nurse’s initial goal at this time is to:
a. Determining the precipitating event, determine how many people are involved in the
incident and determine how angry the client is
b. Determine if the client has intermediate support system, determine what the people in
the support system think of the client cutting wrist and determine the level of the
anger of the client
c. Determine the precipitating event, determine if the client has an immediate support
system and assess the likelihood of the immediate recurrence of the suicidal act
d. Assess the likelihood of the suicidal act, determine what made the client angry then
determine the angry the client is

60.A spouse of a bedridden cancer client cries and tells the nurse, “It is so hard seeing him
suffering while I cannot do anything.” The nurse knows that the client has which type of
crisis?
a. Maturational crisis
b. Situational crisis
c. Social crisis
d. Adventitious crisis