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Principles of Mental Health
1.During a client’s admission, the nurse realizes the boundaries of the nurse-client relationship have blurred when the nurse sees the following occur:
Allowing the client to hold the nurse’s hand during a procedure
The nurse agrees to keep a secret shared by the client
The nurse asks the client about their religion
The nurse focuses the conversation on the client
2. A client has been involuntarily admitted to an inpatient behavioral health unit. During this admission which of the following right dose the client still retain? (Select all that apply)
The right to refuse medications
The right to keep all personal items
The right to informed consent
The right to choose the nurse assigned to them
The right to leave upon request
3. According to Maslow’s hierarchy of needs, which of the following client actions would be considered most basic?
A client feels lonely and is seeking to share life experiences
A client begins to realize his or her full potential
A client is role-playing a situation with a nurse to practice assertiveness skills
A client seeks shelter at a center for battered woman
4. A newly admitted male client has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for further education about the use of restraints?
If his behavior warrants restraints, he will need to be monitored closely the entire time he’s restrained
If he is restrained, be sure he is offered food and fluids regularly
I’ll call the primary provider and get an as needed (prn) seclusion/restraint order
Remember that physical restraints are our last resort
5. Which of the following presents a liability concern for the Licensed Practical Nurse?
Restraining a combative client who is stabbing himself with a pencil
Reporting threats of violence made by a client against his employer
Calling the psychiatric nurse practitioner to clarify an order for an antipsychotic
Placing a client who talks constantly and loudly into a secluded room alone
6. A female client staggers to day treatment smelling strongly of alcohol. When questioned, which response by the client reflects the use of rationalizations as a defense mechanism?
I have not drunk anything in the last day
I can’t worry about that problem right now
I have to drink to relax to come to day treatment
Why does it matter to you if I drink
7. A client involuntarily admitted to a psychiatric until after calling a friend and saying “I’ve got a gun and I’m going to shoot myself, “which of the following rights has the client lost while admitted?
The right to communicate with family members
Freedom of speech
The right to refuse medications
The right to leave the hospital without medical approval
8. A nurse is reviewing a client chart and reads the following: “Adam is focused on his belief that the government is following him. He mentioned multiple times that he believed the interview was being recorded by CIA. “The nurse recognizes with component of the Mental Status Exam (MSE) is being evaluated?
Mood and Affect
Appearance
Thought Content
Emotional Stability
9. A client who is experiencing acute alcohol intoxication is being admitted to the unit. Which of the following best describes the approach that should be taken when working with this client?
Remain nonjudgmental
Avoid the topic of alcohol use when asking questions
Provide sympathetic support
Express disapproval of the substance abuse
10. The nurse is working on an inpatient psychiatric unit. Which of the following shows an understand of a therapeutic milieu?
Allowing client to watch TV pass the scheduled time
Orienting client to their right and responsibilities
Having the client decide when group therapy will occur
Refusing a client time to pray
11. A 22-year-old college student is admitted to a hospital following a suicide attempt and state, “No one will ever love a loser like me.” According to the Erikson’s theory of personality development, a nurse should recognize a deficit in which developmental stage?
Trust versus mistrust
Ego integrity versus despair
Intimacy versus isolation
Initiative versus guilt
12. A nurse counsels a widow whose husband died 4 years ago. The widow says, “if I’d done more, he would still be alive.” Select the nurse’s therapeutic response.
I understand how you feel after such a significant loss
That was a long time ago. Your husband would want you to move on with your life
I am sure you did a very good job of caring for him, especially since he was sick so long
You husband was 82 years old with sever chronic obstructive pulmonary disease
13. The theory of interpersonal relationships developed by Hildegard Peplau was strongly influenced by the Interpersonal Relationship Theory of which following theorist?
Sigmund Freud
Erik Erikson
Harry Stack Sullivan
Jean Piaget
14. A client on an inpatient psychiatric unit is suffering from major depression. He has poor appetite and poverty of speech. Which response by the nurse demonstrates offering self?
I know just how you feel, I have had several traumatic things happen in my life
I would like to sit with you for a while to help you get comfortable talking to me
Why don’t you just tell me why you are refusing to eat or talk?
If I were in your situation, I would not want to eat either
15. A brother calls to the speak to his sister who has been admitted to the psychiatric unit. The nurse connects him to the community phone and the sister is summoned. Later the nurse realizes that the brother was not on the client’s approval call list. What law has the nurse broken?
The notional Alliance for the Mentally III Act
The Tarasoff Ruling
The Health Insurance Portability and Accountability Act
The Good Samaritan Law
16. The following question. “If you had a fever and vomiting for 3 days, what would you do?” represents which section of the mental status examination?
Behavior
Cognition
Affect and mood
Perceptual disturbances
17. A nurse is preparing to administer ziprasidone 10 mg IM every 6 hr. Available is ziprasidone 20 mg/mL. How many mL should the nurse administer per dose?
0.25
0.5
1
1.5
18. Disulfiram (Antabuse) is a medication used for which type of treatment?
A mild sedative for insomnia
To decrease the side effects of antipsychotic medications
A mood stabilizer
Aversion therapy for alcoholics
19. A nurse overhears a coworker ask a client, “This is your third admission. Why did you stop taking your medication?” Which statement to the coworker would identify the concern with using “why” questions?
Asking “why” may have implied criticism and could have the effect of making the client feel defensive.
Asking “why” may invite the client to shar thoughts and feelings regarding the client’s non-adherence.”
Asking “why” can recognize and acknowledge the client’s reasons for his or her action
Asking “why” can focus the client on the topic to gain further specific information
20. According to Freud, which statement should a nurse associate with predominance of the superego?
No one is looking, so I will take three cigarettes from Mom’s pack
I don’t ever cheat on test; it is wrong
I think I may skip school today; I need a break
Dad wont’s miss this little bit of vodka
21. A client admitted yesterday believes the window blinds are snakes trying to get in the room. The client is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?
A benzodiazepine, such as lorazepam
A prostaglandin analogs, such as latanoprost
A monoamine oxidase inhibitor, such as phenazine
A narcotic analgesic, such as codeine
22. The nurse believe that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility?
By asking directly if the client has ever had a problem with alcohol
By holistically assessing the client, using the Clinical Institute Withdrawal Assessment scale
By using a screening tool such as the CAGE questionnaire
By referring the client for physician evaluation
23. When communication with a client, using techniques such as paraphrasing restating, reflecting and exploring are used for what purpose?
Completing the Mental Status Exam (MSE)
Clarifying verbal communication
Presenting reality to delusional client
Conducting a physical assessment
25. A nurse is educating a client about the difference between mental health and mental illness. Which statement by the client reflects an accurate understanding of mental health?
Mental health is the absence of any stressors
Mental health is the successful adaptation to stressors
Mental health is inconsistency between thought, feelings, and behavior
Mental health is a diagnostic category in the DSM-5.
26. A client is ready for discharge from an alcohol abuse recovery program. Which of following outpatient support would be appropriate? (Select all that apply.)
A 12-step recovery program such as AA
Individual therapy
Group therapy for family
Commuter assistance
Medication compliance
27. A client states. “My father spanked me often.” Which therapeutic response would be an example of restating?
Tell me more about that
I’m sure it was in your best interest
Your father was a harsh disciplinarian
Why were you spanked so much
28. A client who is experiencing acute alcohol intoxication is being admitted to the unit. Which of the following best describes the approach that should be taken when working with this client?
Remain nonjudgmental
Addiction
Withdrawal
Tolerance
29. Which intervention by a psychiatric nurse best reflects the ethical principle of autonomy?
The nurse stays with a client who is demonstrating a high level of anxiety
The nurse suggests that two clients who were fighting be restricted to the unit
The nurse explores alternative solutions with a client, who then makes a choice
The nurse intervenes when a self-mutilating client attempts to harm self
30. A client on substance use disorder states, “I used to be able to get a buzz with a few beers. Now it takes a six-pack.” The nurse recognizes this statements as an example which condition associated with substance use disorders?
Addiction
Withdrawal
Tolerance
Intoxication
31. A nurse is preparing to administer imipramine 200 mg PO daily divided equally every 12 hr. The amount available is imipramine 25 mg tablets. How many tablets should the nurse administer with each dose?
2
3
4
5
32. A client with known history of chronic alcohol use, reports last drink was at 12:00 noon the prior day. The nurse anticipates for withdrawal symptoms to peak:
Within 2-4 days of cessation
Within a few hours of cessation
Within 1-2 day of cessation
If they have not started, they will not
33. There is one bed available on an inpatient psychiatric unit. The nurse should advocate for emergency commitment of which individual?
An individual who is persistently mentally ill and was evicted from an apartment
An individual treated in the emergency department for generalized anxiety disorder
An individual who is delusional and has a plan to kill his wife
An individual who rates mood 4/10 and is participating in a no-harm safety plan
34. A client is prescribed lorazepam (Ativan) 0.5 mg four times a day and 1 mg prn q8h. The maximum daily dose of lorazepam should not exceed 4 mg daily. This client would be able to receive___prn doses as the maximum number of prn lorazepam doses.
1
2
3
4
35. A nurse is planning care of a newly admitted client who has a history of alcohol use disorder. The client states that his last drink was six hours ago. Which of the following goals is the highest priority?
The client will acknowledge alcohol dependence and need for treatment
The client will rebuild damaged interpersonal relationships
The client will implement alternative strategies for managing anxiety
The client will withdrawal from alcohol without complications
36. Alicia is flirting with peers on the unit and offers her nurse a backrub in exchange for receiving her 10:00pm Xanax an hour early. Which response (s) to such behaviors would be most therapeutic?
Advise the other client that Alicia is being manipulative and that they should ignore her when she behaves that way.
Bargain with Alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line.
Explain that such behavior is unacceptable and give Alicia specific examples of consequences that will be enacted if the behavior continues
Ignore the behavior for the time being so Alicia will find it unrewarding and in turn seek other, and hopefully more adaptive, way to meet her needs
37. A nurse is caring for a client who has a history of alcohol use disorder and has been hospitalized for detoxification. The nurse enters the room and finds the client shouting in a terrified voice, “Get these bugs of me!” Which of the following responses by the nurse is appropriate?
I’m sure that the bugs you see will not harm you
Tell me more about the bugs you see in your room
I don’t see any bugs, but you seem very frightened
Why do you think there are bugs on you
38 A 17-year-old client asks a nurse conducting an assessment interview, “Why should I tell you anything? You’ll just tell my parents whatever you find out.” The nurse’s best reply would be which of the following?
That isn’t tree. What you tell us is private and held in strict confidence. Your parents have no right to know
Yes, your parents may find out what you say, but it is important that they know about your problems
What you say about feelings are private, but some things, like suicidal thinking must be reported to the treatment team
It sounds as though you are not ready to work on your problems
39. The concept of false imprisonment is one that has legal implications for healthcare providers and is violation of client rights. Which of the following is not considered false imprisonment?
Intent to confine to a specific area
Indefensible use of seclusion or restraints
Detaining a client who is voluntary admission without justification to do so
Providing client access to a quiet are in the unit
40. Which communication technique would yield positive outcome 3ihtin context of a therapeutic relationship?
Making value judgements
Giving approval
Asking “why”
Summarizing
41. In a psychiatric inpatient setting, the nurse observes an adolescent client’s peer calling the client names. In this context, which statement by the nurse exemplifies the concept of empathy?
I can see that you are upset. I am here to listen if you would like to talk
Your peers are being insensitive. I would be upset also
I used to be called names as a child. I know it can hurt feeling
I get angry when people are treated cruelly
42. A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson’s theory, which developmental task should a nurse assist the client to accomplish?
Establishing the ability to control emotional reactions
Establishing a strong sense of ethics and character structure
Establishing and maintaining self-esteem
Establishing a career, personal relationships, and societal connections
45. A client is admitted for acute alcohol withdrawal. Which of the following clinical manifestations are associated with acute alcohol withdrawal?
Myopia, hypothermia, and elevated mood
Bradycardia, hypotension, and drowsiness
Decreased reflexes, somnolence, and hypothermia
Tachycardia, paranoid delusions, and elevated blood pressure
46. A nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a “general lead”?
Do you know why you are here
Are you feeling depressed or anxious?
Yes, I see Go on
Can you chronologically order the events that led to your admission?
47. Cocaine is a center nervous system stimulant. Which of the following symptoms would a nurse recognize as intoxication from use of cocaine? (Select all that Apply.)
Constricted pupils
Decreased blood pressure
Insomnia
Elevated heart rate
Depressed mood
48. All client have a right to privacy and confidentiality. However, if a client makes any type of threat to harm another person, nurse have a legal obligation to alert that person of the threat that was made. This is known as the duty to warn. Although each state may have different wording, in general the duty to warn includes the same criteria. Which of the following not included in the duty to warn?
Assessing and predicting the client’s danger or violence toward a third party
Identification of the person or person or persons being threatened
Calling the local news to report the threat
Taking the appropriate action to protect the intended victim
49. Which nontherapeutic communication technique is used in the following example? Client: “I am really upset about being discharged.” Nurse: Why? You should be happy to leave”
Minimizing feelings
Now that I’ve detoxed, my recovery is complete
I understand the goal is to decrease my drinking
I will only need to attend one meeting a week to prevent relapse
50. A client who continues to use alcohol states “I can’t stop drinking. Every time I try to stop, I feel terrible and get sweaty and sick.” The nurse understands the client is describing which of the following?
Addiction
Withdrawal
Intoxication
Enabling
51. A student nurse tells the instructor, “I’m concerned that when a client asks me for advice, I won’t have a good solution.” Which should be the nursing instructor’s best repose?
It’s scary to feel put on the spot by a client. Nurses don’t always have the answer
Remember, clients, not nurses, are responsible for their own choices and decisions
Just keep the client’s best interests in mind and do best that you can
Set a goal to continue to work on this aspect of your practice
52. A nurse evaluated a client who participated reluctantly, answered questions with minimal responses, and rarely made eye contact. What data should be included when documenting the evaluation?
Only data obtained from the client’s verbal responses
The observation that the client was uncooperative
Analysis of why the client did not respond openly during the interview
A description of the client’s behavior during the interview
53. A client has received education on alcohol use disorder recovery. Which statement by the client indicates that learning has occurred?
Now that I’ve detoxed, my recovery is complete
I understand the goal is to decrease my drinking
I will only need to attend one meeting a week to prevent relapse
I realize that recovery is a lifelong process which will come in steps
54. Each client has their own individual medical record. Nurses enter data into this record daily during a client’s inpatient stay. Which of the following statements accurately describes the purpose of the medical record? (Select all that apply.)
A legal record of the client’s treatment
A communication tool
A tool to measure client outcomes
A tool for nurses to express opinions
A tool to document unit staffing issues
56. A nurse is preparing to administer clozapine 300 mg PO daily to a client who has schizophrenia. The amount available is clozapine 200 mg tablets. How many tablets should the nurse administer?
0.5
1.5
2
2.5
58. A nurse is teaching a group of clients regarding the use of naltrexone (ReVia) in treating alcoholism. What should be included about the effectiveness of this drug?
It prevents withdrawal symptoms
It diminishes alcohol cravings
It diminishes feelings of anxiety
It improve mood
59. A voluntarily hospitalized client tells the nurse, “Get me the forms for discharge against medical advice so I can leave now.” What is the nurse best respond?
I can’t give you those forms without your health care provider’s knowledge
I’ll get the forms for you right now and bring them to your room
Since you signed your consent for treatment, you may leave if you desire
I will get them for you, but let’s talk about your decision to leave the hospital
60. A nurse enters the room of an elderly client and notices a try of uneaten food on the bedside table. The client states, “oh, don’t bother with me. I do not have much time left in this would. And I don’t have much to live for anyway.” Which response by the nurse would be considered non-therapeutic?
You don’t have much to live?
Now, you don’t mean that
Can you tell me what you mean by “you don’t have much time left?”
Are feeling as though you are ready to die?
61. Which of the following client would meet the criteria for an involuntary admission?
A client who has a previous suicide attempt
A client who is homeless
A client who has threatened to harm their sister
A client who cannot afford medication
62. A male client frequently inquiries about the female student nurse’s boyfriend, social activities, and school experiences. Which action by the student nursing would be appropriate?
The student requests assignment to a client of the same gender as the student
The student limits sharing personal information and stresses the client-centered focus of the conversation
The student shares information to make the therapeutic relationship more equal
The student explains that if he persists in focusing on her, she cannot work with him
63. A nurse is working with a newly admitted client explaining the unit rules and daily schedule. Which of the following describes a consistent routine and a daily structure?
Hospital policy
Meaningful rounding
Therapeutic milieu
Recovery model
64. All client have legal right. Clients who have been admitted to a psychiatric facility, whether voluntarily or involuntarily have the same legal rights as any other client. Which of the following are legal rights of all clients? (Select all that apply.)
The right to treatment
The right to refuse treatment
The right to informed consent
The right to jeopardize the safety of others
The right to least restrictive form of restraint
65. During a nurse-client interaction, which nursing statement may belittle the client’s feelings and concerns?
Don’t worry. Everything will be alright
You appear uptight, through you’ve stated, “I’m fine”
I notice you have bitten your nails to the quick
Tell me more about your feelings
66. A client is admitted with a diagnosis of Major Depressive Disorder and Alcohol Abuse disorder. Which of the following defines the client’s diagnoses?
Co-dependency
Dual diagnosis
Addiction
Relapse
68. A client disclose several concerns and associated feelings. If the nurse wishes to seek clarification, which comment would be most appropriate?
What are the common elements here?
Tell me again about your experiences
Am I correct in understanding that your feeling upset?
Tell me everything from the beginning
69. A nurse is caring for a client who is prescribed haloperidol 4 mg orally on admission. An oral suspension of haloperidol 2 mg/mL is reviewed from the pharmacy. What amount of the oral suspension should the nurse administer to the client?
0.5
1
1.5
2
70. A nurse is reviewing a client’s chart and reads the following: He appeared unshaven with unkempt hair. His clothes were clean and ironed. Adam appeared to be underweighted for his height. The nurse recognizes which component of the Mental Status Exam (MSE) is being evaluated?
Behavior
Mood and affect
Appearance
Cognition
71. An inpatient psychiatric physician treating clients selects different treatment options for those without insurance. Which violation of an ethical principle should a nurse recognize in situation?
Autonomy
Beneficence
Non-maleficence
Justice
73. A client with history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical appearance support the suspicion tha that the client has relapsed?
Intense nausea
Dry mouth
Acute paranoia
Increased appetite
74. A nurse is admitting a client to an alcohol abuse program. The client states. “I’m here because of my boss haves part of my job to go to parties and drink with clients.” The client’s statement is an example of which of the following defense mechanisms?
Reaction-formation
Denial
Suppression
Rationalization
75. A nurse says to a client. “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
The therapeutic technique of giving advice
The therapeutic technique of defending
The nontherapeutic technique of presenting reality
The nontherapeutic technique of giving reassurance
76. A client on a psychiatric unit tells the nurse, “I am all alone in the world now, and I have no reason to live.” Which repose by the nurse would encourage further communication by the client?
You sound like your feeling lonely and frightened
Why do you think that suicide is the answer to you loneliness?
I live by myself and know it can be very lonely and frightening
Just hag in there and you’ll see; things will work out
78. A nurse is preparing to administer haloperidol 75 mg IM per week. Available is haloperidol decanoate 100mg/mL for injection. How many mL should the nurse administer per dose?
0.25
0.75
1.25
1.5
79. Which of the following statements best indicates a client is utilizing an individualized relapse prevention plan as part of recovery from alcohol dependence?
I can stay sober on my own, without a support system because I am strong-willed
I have to work on my own recovery once a week
I need to identify what situations I have difficulty handling
I limit myself. I only go to the bars to socialize with other people
80. During an intake interview, which question would assist the nurse in gathering data about the client’s judgment?
Do you know what day and season it is now?
On a scale of 1 to 10, how would you rate your stress level?
What does the phrase “a rolling stone gathers no moss” mean to you?
If you found a stamped, addressed envelope in the street, what would you do?
90. A nurse say to preparing to administer diphenhydramine 50 mg PO every 6 hr to a client who has acute dystonia. Available is diphenhydramine 25 mg tablets. How many tablets should the nurse administer per dose?
0.5
1
1.5
2
91. Which theories established the foundation for the professional practice of psychiatric nursing?
Harry Stack Sullivan
Hildegard Peplau
Erik Erikson
Ivan Pavlov
100. A Mexican American client puts a picture of the Virgin Marry on the bedside table. Under which section of the assessment should the nurse document this behavior?
Ethnicity
Culture
Verbal communication
Non-verbal communication
101. A client thought to be cheeking/pocketing their medication is prescribed lithium syrup 900mg bid. The syrup contains 300 mg of lithium per 5 mL. At 0800, how many milliliters would the nurse administer?
7.5
10
15
20
102

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