NCLEX Practice Exam for Psychiatric Nursing 4

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1. Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway and making aggressive remarks. Which of the following statements is most appropriate to make to this patient?

  1. What is causing you to become agitated?
  2. You need to stop that behavior now.
  3. You will need to be restrained if you do not change your behavior.
  4. You will need to be placed in seclusion.

2. The nurse closely observes the client who has been displaying aggressive behavior. The nurse observes that the client’s anger is escalating. Which approach is least helpful for the client at this time?

  1. Acknowledge the client’s behavior
  2. Maintain a safe distance from the client
  3. Assist the client to an area that is quiet
  4. Initiate confinement measures

3. The charge nurse of a psychiatric unit is planning the client assignment for the day. The most appropriate staff to be assigned to a client with a potential for violence is which of the following:

  1. A timid nurse
  2. A mature experienced nurse
  3. an inexperienced nurse
  4. a soft spoken nurse

4. The nurse exemplifies awareness of the rights of a client whose anger is escalating by:

  1. Taking a directive role in verbalizing feelings
  2. Using an authoritarian, confrontational approach
  3. Putting the client in a seclusion room
    Applying mechanical restraints

5. The client jumps up and throws a chair out of the window. He was restrained after his behavior can no longer be controlled by the staff. Which of these documentations indicates the safeguarding of the patient’s rights?

  1. There was a doctor’s order for restraints/seclusion
  2. The patient’s rights were explained to him.
  3. The staff observed confidentiality
  4. The staff carried out less restrictive measures but were unsuccessful.

6. Situation: Clients with personality disorders have difficulties in their social and occupational functions.
Clients with personality disorder will most likely:

  1. recover with therapeutic intervention
  2. respond to antianxiety medication
  3. manifest enduring patterns of inflexible behaviors
  4. Seek treatment willingly from some personally distressing symptoms

7. A client tends to be insensitive to others, engages in abusive behaviors and does not have a sense of remorse. Which personality disorder is he likely to have?

  1. Narcissistic
  2. Paranoid
  3. Histrionic
  4. Antisocial

8. The client joins a support group and frequently preaches against abuse, is demonstrating the use of:

  1. denial
  2. reaction formation
  3. rationalization
  4. projection

9. A teenage girl is diagnosed to have borderline personality disorder. Which manifestations support the diagnosis?

  1. Lack of self esteem, strong dependency needs and impulsive behavior
  2. social withdrawal, inadequacy, sensitivity to rejection and criticism
  3. Suspicious, hypervigilance and coldness
  4. Preoccupation with perfectionism, orderliness and need for control

10. The plan of care for clients with borderline personality should include:

  1. Limit setting and flexibility in schedule
  2. Giving medications to prevent acting out
  3. Restricting her from other clients
  4. Ensuring she adheres to certain restrictions

11. Situation: A 42 year old male client, is admitted in the ward because of bizarre behaviors. He is given a diagnosis of schizophrenia paranoid type. The client should have achieved the developmental task of:

  1. Trust vs. mistrust
  2. Industry vs. inferiority
  3. Generativity vs. stagnation
  4. Ego integrity vs. despair

12. Clients who are suspicious primarily use projection for which purpose:

  1. deny reality
  2. to deal with feelings and thoughts that are not acceptable
  3. to show resentment towards others
  4. manipulate others

13. The client says “ the NBI is out to get me.” The nurse’s best response is:

  1. “The NBI is not out to catch you.”
  2. “I don’t believe that.”
  3. “I don’t know anything about that. You are afraid of being harmed.”
  4. “ What made you think of that.”

14. The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting:

  1. tardive dyskinesia
  2. Pseudoparkinsonism
  3. akinesia
  4. dystonia

15. The client is very hostile toward one of the staff for no apparent reason. The client is manifesting:

  1. Splitting
  2. Transference
  3. Countertransference
  4. Resistance

16. Situation: An 18 year old female was sexually attacked while on her way home from work. She is brought to the hospital by her mother. Rape is an example of which type of crisis:

  1. Situational
  2. Adventitious
  3. Developmental
  4. Internal

17. During the initial care of rape victims the following are to be considered EXCEPT:

  1. Assure privacy.
  2. Touch the client to show acceptance and empathy
  3. Accompany the client in the examination room.
  4. Maintain a non-judgmental approach.

18. The nurse acts as a patient advocate when she does one of the following:

  1. She encourages the client to express her feeling regarding her experience.
  2. She assesses the client for injuries.
  3. She postpones the physical assessment until the client is calm
  4. Explains to the client that her reactions are normal

19. Crisis intervention carried out to the client has this primary goal:

  1. Assist the client to express her feelings
  2. Help her identify her resources
  3. Support her adaptive coping skills
  4. Help her return to her pre-rape level of function

20. Five months after the incident the client complains of difficulty to concentrate, poor appetite, inability to sleep and guilt. She is likely suffering from:

  1. Adjustment disorder
  2. Somatoform Disorder
  3. Generalized Anxiety Disorder
  4. Post traumatic disorder

21. Situation: A 29 year old client newly diagnosed with breast cancer is pacing, with rapid speech headache and inability to focus with what the doctor was saying. The nurse assesses the level of anxiety as:

  1. Mild
  2. Moderate
  3. Severe
  4. Panic

22. Anxiety is caused by:

  1. an objective threat
  2. a subjectively perceived threat
  3. hostility turned to the self
  4. masked depression

23. It would be most helpful for the nurse to deal with a client with severe anxiety by:

  1. Give specific instructions using speak in concise statements.
  2. Ask the client to identify the cause of her anxiety.
  3. Explain in detail the plan of care developed
  4. Urge the client to focus on what the nurse is saying

24. Which of the following medications will likely be ordered for the client?”

  1. Prozac
  2. Valium
  3. Risperdal
  4. Lithium

25. Which of the following is included in the health teachings among clients receiving Valium?:

  1. Avoid foods rich in tyramine.
  2. Take the medication after meals.
  3. It is safe to stop it anytime after long term use.
  4. Double up the dose if the client forgets her medication.
Answers and Rationales
  1. Answer: (A) What is causing you to become agitated?
    In a non-violent aggressive behavior, help the client identify the stressor or the true object of hostility. This helps reveal unresolved issues so that they may be confronted. B. Pacing is a tension relieving measure for an agitated client. C. This is a threatening statement that can heighten the client’s tension. D. Seclusion is used when less restrictive measures have failed.
  2. Answer: (D) Initiate confinement measures
    The proper procedure for dealing with harmful behavior is to first try to calm patient verbally. . When verbal and psychopharmacologic interventions are not adequate to handle the aggressiveness, seclusion or restraints may be applicable. A, B and C are appropriate approaches during the escalation phase of aggression.
  3. Answer: (B) A mature experienced nurse
    The unstable, aggressive client should be assigned to the most experienced nurse. A, C and D. A shy, inexperienced, soft spoken nurse may feel intimidated by the angry patient.
  4. Answer: (A) Taking a directive role in verbalizing feelings
    Taking a directive role in the client’s verbalization of feelings can deescalate the client’s anger. B. A confrontational approach can be threatening and adds to the client’s tension. C and D. Use of restraints and isolation may be required if less restrictive interventions are unsuccessful.
  5. Answer: (D) The staff carried out less restrictive measures but were unsuccessful.
    This documentation indicates that the client has been placed on restraints after the least restrictive measures failed in containing the client’s violent behavior.
  6. Answer: (C) manifest enduring patterns of inflexible behaviors
    Personality disorders are characterized by inflexible traits and characteristics that are lifelong. A and D. This disorder is manifested by life-long patterns of behavior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not recover from therapeutic intervention. B. Medications are generally not recommended for personality disorders.
  7. Answer: (D) Antisocial
    These are the characteristics of an individual with antisocial personality. A. Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others. B. Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening. C. Individuals with histrionic have excessive emotionality, and attention-seeking behaviors.
  8. Answer: (B) reaction formation
    Reaction formation is the adoption of behavior or feelings that are exactly opposite of one’s true emotions. A. Denial is refusal to accept a painful reality. C. Rationalization is attempting to justify one’s behavior by presenting reasons that sounds logical. D. Projection is attributing of one’s behaviors and feelings to another person.
  9. Answer: (A) Lack of self esteem, strong dependency needs and impulsive behavior
    These are the characteristics of client with borderline personality. B. This describes the avoidant personality. C. These are the characteristics of a client with paranoid personality D. This describes the obsessive compulsive personality
  10. Answer: (D) Ensuring she adheres to certain restrictions
    The client is manipulative. The client must be informed about the policies, expectations, rules and regulation upon admission. A. Limits should be firmly and consistently implemented. Flexibility and bargaining are not therapeutic in dealing with a manipulative client. B. There is no specific medication prescribed for this condition. C. This is not part of the care plan. Interaction with other clients are allowed but the client should be observed and given limits in her attempt to manipulate and dominate others.
  11. Answer: (D) Ego integrity vs. despair
    The client belongs to the middle adulthood stage (30 to 65 yrs.) The developmental task generativity is characterized by concern and care for others. It is a productive and creative stage. (A) Infancy stage (0 – 18 mos.) is concerned with gratification of oral needs (B) School Age child (6 – 12 yrs.) is characterized by acquisition of school competencies and social skills (C) Late adulthood ( 60 and above) Concerned with reflection on the past and his contributions to others and face the future.
  12. Answer: (B) to deal with feelings and thoughts that are not acceptable
    Projection is a defense mechanism where one attributes ones feelings and inadequacies to others to reduce anxiety. A. This is not true in all instances of projection C and D. This focuses on the self rather than others
  13. Answer: (C) “I don’t know anything about that. You are afraid of being harmed.”
    This presents reality and acknowledges the clients feeling A and B. are not therapeutic responses because these disagree with the client’s false belief and makes the client feel challenged D. unnecessary exploration of the false
  14. Answer: (B) Pseudoparkinsonism
    Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle rigidity A. Tardive dyskinesia is manifested by lip smacking, wormlike movement of the tongue C. Akinesia is characterized by feeling of weakness and muscle fatigue D. Dystonia is manifested by torticollis and rolling back of the eyes
  15. Answer: (B) Transference
    Transference is a positive or negative feeling associated with a significant person in the client’s past that are unconsciously assigned to another A. Splitting is a defense mechanism commonly seen in a client with personality disorder in which the world is perceived as all good or all bad C. Counterttransference is a phenomenon where the nurse shifts feelings assigned to someone in her past to the patient D. Resistance is the client’s refusal to submit himself to the care of the nurse
  16. Answer: (B) Adventitious
    Adventitious crisis is a crisis involving a traumatic event. It is not part of everyday life. A. Situational crisis is from an external source that upset ones psychological equilibrium C and D. Are the same. They are transitional or developmental periods in life
  17. Answer: (B) Touch the client to show acceptance and empathy
    The client finds touch intrusive and therefore should be avoided. A. Privacy is one of the rights of a victim of rape. C.The client is anxious. Accompanying the client in a quiet room ensures safety and offers emotional support. D. Guilt feeling is common among rape victims. They should not be blamed.
  18. Answer: (C) She postpones the physical assessment until the client is calm
    The nurse acts as a patient advocate as she protects the client from psychological harm A. The nurse acts a a counselor B. The nurse acts as a technician D. This exemplifies the role of a teacher
  19. Answer: (D) Help her return to her pre-rape level of function
    The goal of crisis intervention to help the client return to her level of function prior to the crisis. A,B and C are interventions or strategies to attain the goal
  20. Answer: (D) Post traumatic disorder
    Post traumatic stress disorder is characterized by flashback, irritability, difficulty falling asleep and concentrating following an extremely traumatic event. This lasts for more that one month A. Adjustment disorder is the maladaptive reaction to stressful events characterized by anxiety, depression and work or social impairments. This occurs within 3 months after the event B. Somatoform disorders are anxiety related disorders characterized by presence of physical symptoms without demonstrable organic basis C. Generalized anxiety disorder is characterized by chronic, excessive anxiety for at least 6 months
  21. Answer: (C) Severe
    The client’s manifestations indicate severe anxiety. A Mild anxiety is manifested by slight muscle tension, slight fidgeting, alertness, ability to concentrate and capable of problem solving. B. Moderate muscle tension, increased vital signs, periodic slow pacing, increased rate of speech and difficulty in concentrating are noted in moderate anxiety. D. Panic level of anxiety is characterized immobilization, incoherence, feeling of being overwhelmed and disorganization
  22. Answer: (B) a subjectively perceived threat
    Anxiety is caused by a subjectively perceived threat A. Fear is caused by an objective threat C. A depressed client internalizes hostility D. Mania is due to masked depression
  23. Answer: (A) Give specific instructions using speak in concise statements.
    The client has narrowed perceptual field. Lengthy explanations cannot be followed by the client. B. The client will not be able to identify the cause of anxiety C and D. The client has difficulty concentrating and will not be able to focus.
  24. Answer: (B) Valium
    Antianxiety A. Antidepressant C. Antipsychotic D. Antimanic
  25. Answer: (B) Take the medication after meals.
    Antianxiety medications cause G.I. upset so it should be taken after meals. A. This is specific for antidepressant MAOI. Taking tyramine rich food can cause hypertensive crisis. C. Valium causes dependency. In which case, the medication should be gradually withdrawn to prevent the occurrence of convulsion. D The dose of Valium should not be doubled if the previous dose was not taken. It can intensify the CNS depressant effects.