NCLEX Practice Exam for Psychiatric Nursing 3

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1. Which is the best indicator of success in the long term management of the client?

  1. His symptoms are replaced by indifference to his feelings
  2. He participates in diversionary activities.
  3. He learns to verbalize his feelings and concerns
  4. He states that his behavior is irrational.

2. Situation: A young woman is brought to the emergency room appearing depressed. The nurse learned that her child died a year ago due to an accident. The initial nursing diagnosis is dysfunctional grieving. The statement of the woman that supports this diagnosis is:

  1. “I feel envious of mothers who have toddlers”
  2. “I haven’t been able to open the door and go into my baby’s room “
  3. “I watch other toddlers and think about their play activities and I cry.”
  4. “I often find myself thinking of how I could have prevented the death.

3. The client said “I can’t even take care of my baby. I’m good for nothing.” Which is the appropriate nursing diagnosis?

  1. Ineffective individual coping related to loss.
  2. Impaired verbal communication related to inadequate social skills.
  3. Low esteem related to failure in role performance
  4. Impaired social interaction related to repressed anger.

4. The following medications will likely be prescribed for the client EXCEPT:

  1. Prozac
  2. Tofranil
  3. Parnate
  4. Zyprexa

5. Which is the highest priority in the post ECT care?

  1. Observe for confusion
  2. Monitor respiratory status
  3. Reorient to time, place and person
  4. Document the client’s response to the treatment

6. Situation: A 27 year old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant talked fast and hyperactive. Initially the nurse should plan this for a manic client:

  1. set realistic limits to the client’s behavior
  2. repeat verbal instructions as often as needed
  3. allow the client to get out feelings to relieve tension
  4. assign a staff to be with the client at all times to help maintain control

7. An activity appropriate for the client is:

  1. table tennis
  2. painting
  3. chess
  4. cleaning

8. The client is arrogant and manipulative. In ensuring a therapeutic milieu, the nurse does one of the following:

  1. Agree on a consistent approach among the staff assigned to the client.
  2. Suggest that the client take a leading role in the social activities
  3. Provide the client with extra time for one on one sessions
  4. Allow the client to negotiate the plan of care

9. 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
  4. Applying mechanical restraints

10. A client on Lithium has diarrhea and vomiting. What should the nurse do first:

  1. Recognize this as a drug interaction
  2. Give the client Cogentin
  3. Reassure the client that these are common side effects of lithium therapy
  4. Hold the next dose and obtain an order for a stat serum lithium level

11. Situation: A widow age 28, whose husband died one year ago due to AIDS, has just been told that she has AIDS. Pamela says to the nurse, “Why me? How could God do this to me?” This reaction is one of:

  1. Depression
  2. Denial
  3. anger
  4. bargaining

12. The nurse’s therapeutic response is:

  1. “I will refer you to a clergy who can help you understand what is happening to you.”
  2. “ It isn’t fair that an innocent like you will suffer from AIDS.”
  3. “That is a negative attitude.”
  4. “It must really be frustrating for you. How can I best help you?”

13. One morning the nurse sees the client in a depressed mood. The nurse asks her “What are you thinking about?” This communication technique is:

  1. focusing
  2. validating
  3. reflecting
  4. giving broad opening

14. The client says to the nurse ” Pray for me” and entrusts her wedding ring to the nurse. The nurse knows that this may signal which of the following:

  1. anxiety
  2. suicidal ideation
  3. Major depression
  4. Hopelessness

15. Which of the following interventions should be prioritized in the care of the suicidal client?

  1. Remove all potentially harmful items from the client’s room.
  2. Allow the client to express feelings of hopelessness.
  3. Note the client’s capabilities to increase self esteem.
  4. Set a “no suicide” contract with the client.

16. Situation: A 14 year old male was admitted to a medical ward due to bronchial asthma after learning that his mother was leaving soon for U.K. to work as nurse. The client has which of the following developmental focus:

  1. Establishing relationship with the opposite sex and career planning.
  2. Parental and societal responsibilities.
  3. Establishing ones sense of competence in school.
  4. Developing initial commitments and collaboration in work

17. The personality type of Ryan is:

  1. conforming
  2. dependent
  3. perfectionist
  4. masochistic

18. The nurse ensures a therapeutic environment for the client. Which of the following best describes a therapeutic milieu?

  1. A therapy that rewards adaptive behavior
  2. A cognitive approach to change behavior
  3. A living, learning or working environment.
  4. A permissive and congenial environment

19. Included as priority of care for the client will be:

  1. Encourage verbalization of concerns instead of demonstrating them through the body
  2. Divert attention to ward activities
  3. Place in semi-fowlers position and render O2 inhalation as ordered
  4. Help her recognize that her physical condition has an emotional component

20. The client is concerned about his coming discharge, manifested by being unusually sad. Which is the most therapeutic approach by the nurse?

  1. “You are much better than when you were admitted so there’s no reason to worry.”
  2. “What would you like to do now that you’re about to go home?”
  3. “You seem to have concerns about going home.”
  4. “Aren’t you glad that you’re going home soon?”

21. Situation: The nurse may encounter clients with concerns on sexuality. The most basic factor in the intervention with clients in the area of sexuality is:

  1. Knowledge about sexuality.
  2. Experience in dealing with clients with sexual problems
  3. Comfort with one’s sexuality
  4. Ability to communicate effectively

22. Which of the following statements is true for gender identity disorder?

  1. It is the sexual pleasure derived from inanimate objects.
  2. It is the pleasure derived from being humiliated and made to suffer
  3. It is the pleasure of shocking the victim with exposure of the genitalia
  4. It is the desire to live or involve in reactions of the opposite sex

23. The sexual response cycle in which the sexual interest continues to build:

  1. Sexual Desire
  2. Sexual arousal
  3. Orgasm
  4. Resolution

24. The inability to maintain the physiologic requirements in sexual intercourse is:

  1. Sexual Desire Disorder
  2. Sexual Arousal Disorder
  3. Orgasm Disorder
  4. Sexual Pain disorder

25. The nurse asks a client to roll up his sleeves so she can take his blood pressure. The client replies “If you want I can go naked for you.” The most therapeutic response by the nurse is:

  1. “You’re attractive but I’m not interested.”
  2. “You wouldn’t be the first that I will see naked.”
  3. “I will report you to the guard if you don’t control yourself.”
  4. “I only need access to your arm. Putting up your sleeve is fine.”
Answers and Rationales
  1. Answer: (C) He learns to verbalize his feelings and concerns
    C. The client is encouraged to talk about his feelings and concerns instead of using body symptoms to manage his stressors. A. The client is encouraged to acknowledge feelings rather than being indifferent to her feelings. B. Participation in activities diverts the client’s attention away from his bodily concerns but this is not the best indicator of success. D. Help the client recognize that his physical symptoms occur because of or are exacerbated by specific stressor, not as irrational.
  2. Answer: (B) “I haven’t been able to open the door and go into my baby’s room “
    This indicates denial. This defense is adaptive as an initial reaction to loss but an extended, unsuccessful use of denial is dysfunctional. A. This indicates acknowledgement of the loss. Expressing feelings openly is acceptable. C. This indicates the stage of depression in the grieving process. D. Remembering both positive and negative aspects of the deceased love one signals successful mourning.
  3. Answer: (C) Low esteem related to failure in role performance
    This indicates the client’s negative self evaluation. A sense of worthlessness may accompany depression. A,B and D are not relevant. The cues do not indicate inability to use coping resources, decreased ability to transmit/process symbols, nor insufficient quality of social exchange
  4. Answer: (D) Zyprexa
    This is an antipsychotic. A. This is a SSRI antidepressant. B. This antidepressant belongs to the Tricyclic group. C. This is a MAOI antidepressant.
  5. Answer: (B) Monitor respiratory status
    A side effect of ECT which is life threatening is respiratory arrest. A and C. Confusion and disorientation are side effects of ECT but these are not the highest priority.
  6. Answer: (A) set realistic limits to the client’s behavior
    The manic client is hyperactive and may engage in injurious activities. A quiet environment and consistent and firm limits should be set to ensure safety. B. Clear, concise directions are given because of the distractibility of the client but this is not the priority. C. The manic client tend to externalize hostile feelings, however only non-destructive methods of expression should be allowed D. Nurses set limit as needed. Assigning a staff to be with the client at all times is not realistic.
  7. Answer: (D) cleaning
    The client’s excess energy can be rechanelled through physical activities that are not competitive like cleaning. This is also a way to dissipate tension. A. Tennis is a competitive activity which can stimulate the client.
  8. Answer: (A) Agree on a consistent approach among the staff assigned to the client.
    A consistent firm approach is appropriate. This is a therapeutic way of to handle attempts of exploiting the weakness in others or create conflicts among the staff. Bargaining should not be allowed. B. This is not therapeutic because the client tends to control and dominate others. C. Limits are set for interaction time. D. Allowing the client to negotiate may reinforce manipulative behavior.
  9. Answer: (A) Taking a directive role in verbalizing feelings
    The client has the right to be free from unnecessary restraints. Verbalization of feelings or “talking down” in a non-threatening environment is helpful to relieve the client’s anger. B. This is a threatening approach. C and D. Seclusion and application restraints are done only when less restrictive measures have failed to contain the client’s anger.
  10. Answer: (D) Hold the next dose and obtain an order for a stat serum lithium level
    Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is used to manage the extra pyramidal symptom side effects of antipsychotics. C. The common side effects of Lithium are fine hand tremors, nausea, polyuria and polydipsia.
  11. Answer: (C) anger
    Anger is experienced as reality sets in. This may either be directed to God, the deceased or displaced on others. A. Depression is a painful stage where the individual mourns for what was lost. B. Denial is the first stage of the grieving process evidenced by the statement “No, it can’t be true.” The individual does not acknowledge that the loss has occurred to protect self from the psychological pain of the loss. D. In bargaining the individual holds out hope for additional alternatives to forestall the loss, evidenced by the statement “If only…”
  12. Answer: (D) ”It must really be frustrating for you. How can I best help you?”
    This response reflects the pain due to loss. A helping relationship can be forged by showing empathy and concern. A. This is not therapeutic since it passes the buck or responsibility to the clergy. B. This response is not therapeutic because it gives the client the impression that she is right which prevents the client from reconsidering her thoughts. C. This statement passes judgment on the client.
  13. Answer: (D) giving broad opening
    Broad opening technique allows the client to take the initiative in introducing the topic. A,B and C are all therapeutic techniques but these are not exemplified by the nurse’s statement.
  14. Answer: (B) suicidal ideation
    The client’s statement is a verbal cue of suicidal ideation not anxiety. While suicide is common among clients with major depression, this occurs when their depression starts to lift. Hopelessness indicates no alternatives available and may lead to suicide, the statement and non verbal cue of the client indicate suicide.
  15. Answer: (A) Remove all potentially harmful items from the client’s room.
    Accessibility of the means of suicide increases the lethality. Allowing patient to express feelings and setting a no suicide contract are interventions for suicidal client but blocking the means of suicide is priority. Increasing self esteem is an intervention for depressed clients bur not specifically for suicide.
  16. Answer: (A) Establishing relationship with the opposite sex and career planning.
    The client belongs to the adolescent stage. The adolescent establishes his sense of identity by making decisions regarding familial, occupational and social roles. The adolescent emancipates himself from the family and decides what career to pursue, what set of friends to have and what value system to uphold. B. This refers to the middle adulthood stage concerned with transmitting his values to the next generation to ensure his immortality through the perpetuation of his culture. C. This reflects school age which is concerned with the pursuit of knowledge and skills to deal with the environment both in the present and in the future. D. The stage of young adulthood is concerned with development of intimate relationship with the opposite sex, establishment of a safe and congenial family environment and building of one’s lifework.
  17. Answer: (B) dependent
    A client with dependent personality is predisposed to develop asthma. A. The conforming non-assertive client is predisposed to develop hypertension because of the tendency to repress rage. C. The perfectionist and compulsive tend to develop migraine. D. The masochistic, self sacrificing type are prone to developrheumatoid arthritis.
  18. Answer: (C) A living, learning or working environment.
    A therapeutic milieu refers to a broad conceptual approach in which all aspects of the environment are channeled to provide a therapeutic environment for the client. The six environmental elements include structure, safety, norms, limit setting, balance and unit modification. A. Behavioral approach in psychiatric care is based on the premise that behavior can be learned or unlearned through the use of reward and punishment. B. Cognitive approach to change behavior is done by correcting distorted perceptions and irrational beliefs to correct maladaptive behaviors. D. This is not congruent with therapeutic milieu.
  19. Answer: (C) Place in semi-fowlers position and render O2 inhalation as ordered
    Since psychopysiologic disorder has organic basis, priority intervention is directed towards disease-specific management. Failure to address the medical condition of the client may be a life threat. A and B. The client has physical symptom that is adversely affected by psychological factors. Verbalization of feelings in a non threatening environment and involvement in relaxing activities are adaptive way of dealing with stressors. However, these are not the priority. D. Helping the client connect the physical symptoms with the emotional problems can be done when the client is ready.
  20. Answer: (C) “You seem to have concerns about going home.”
    This statement reflects how the client feels. Showing empathy can encourage the client to talk which is important as an alternative more adaptive way of coping with stressors.. A. Giving false reassurance is not therapeutic. B. While this technique explores plans after discharge, it does not focus on expression of feelings. D. This close ended question does not encourage verbalization of feelings.
  21. Answer: (C) Comfort with one’s sexuality
    The nurse must be accepting, empathetic and non-judgmental to patients who disclose concerns regarding sexuality. This can happen only when the nurse has reconciled and accepted her feelings and beliefs related to sexuality. A,B and D are important considerations but these are not the priority.
  22. Answer: (D) It is the desire to live or involve in reactions of the opposite sex
    Gender identity disorder is a strong and persistent desire to be the other sex. A. This is fetishism. B. This refers to masochism. C. This describes exhibitionism.
  23. Answer: (B) Sexual arousal
    Sexual arousal or excitement refers to attaining and maintaining the physiologic requirements for sexual intercourse. A. Sexual Desire refers to the ability, interest or willingness for sexual stimulation. C. Orgasm refers to the peak of the sexual response where the female has vaginal contractions for the female and ejaculatory contractions for the male. D. Resolution is the final phase of the sexual response in which the organs and the body systems gradually return to the unaroused state.
  24. Answer: (B) Sexual Arousal Disorder
    This describes sexual arousal disorder. A. Sexual Desire Disorder refers to the persistent and recurrent lack of desire or willingness for sexual intercourse. C. Orgasm Disorder is the inability to complete the sexual response cycle because of the inability to achieve an orgasm. D. Sexual Pain Disorder is characterized by genital pain before, during or after sexual intercourse.
  25. Answer: (D) “I only need access to your arm. Putting up your sleeve is fine.”
    The nurse needs to deal with the client with sexually connotative behavior in a casual, matter of fact way. A and B. These responses are not therapeutic because they are challenging and rejecting. C. Threatening the client is not therapeutic.

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