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    Exam Review

    1. A nurse is evaluating the effectiveness of interventions for a client with schizophrenia who is experiencing negative symptoms. Which of the following client statements indicates that the interventions have been effective?
      A)
      "I remembered to shower and get dressed before breakfast."
      B)
      "The voices are quieter today than they were yesterday."
      C)
      "I'm not sure what day it is or why I'm here.”
      D)
      "I took my antipsychotic as prescribed last night."
    2. A nurse is assessing a client who has bipolar disorder and is taking lithium carbonate. Which of the following findings should the nurse recognize as an early indication of lithium toxicity?
      A)
      Polydipsia and urinary retention
      B)
      Generalized seizures and hypotension
      C)
      Fine hand tremors and gastrointestinal upset
      D)
      Severe hand tremors and confusion
    3. A nurse is planning a teaching for a group of clients about defense mechanisms. Which of the following information should the nurse include?(Select All that Apply.)
      (SATA)
      A)
      Adaptive defense mechanisms are typically seen in individuals with mature functioning.
      B)
      Maladaptive defense mechanisms have been shown to improve mental well-being.
      C)
      Adaptive defense mechanisms help a person to accept a situation and transform it into something less stressful.
      D)
      Individuals develop certain defense mechanisms based on neurological and psychological growth as they age.
      E)
      Defense mechanisms help a client positively deal with their stress.
      F)
      Defense mechanisms and coping strategies are the same and can be used interchangeably.
    4. A nurse is reviewing the laboratory results of a client who is prescribed lithium 300 mg three times daily. The client’s serum lithium level is 1.4 mEq/L. Which of the following actions should the nurse take?
      A)
      Encourage the client to increase sodium intake.
      B)
      Document the result and reassess in 4 hours.
      C)
      Notify the provider and hold the next dose.
      D)
      Continue administering the medication as prescribed.
    Page 1 of 14

    Exam Review

    1. The psychiatric ED triage nurse evaluates four clients. Based on the severity and urgency of suicidality, which client should be prioritized for immediate intervention?
      A)
      A 22-year-old college student with a history of a previous suicide attempt two months ago. The client expresses feelings of hopelessness and states, "I don't see things getting better," but denies any current plan or intent to harm themselves.
      B)
      A 45-year-old recently laid off from work who reports intense feelings of hopelessness and has a specific plan to overdose on medications. They have gathered the pills and state they "just need the courage to go through with it."
      C)
      A 35-year-old diagnosed with major depressive disorder who reports feeling like a burden to family members. They admit to having vague suicidal thoughts, with a history of prior ideation but no attempts. They express ambivalence and are open to discussing coping strategies.
      D)
      A 30-year-old with bipolar disorder, currently in a manic episode, expressing grandiosity and impulsivity. While they deny suicidal thoughts now, they have a history of multiple suicide attempts during previous manic phases.
    2. A nurse is caring for a client who has been diagnosed with schizophrenia. The client has been wearing the same clothes for the past week and appears unkempt and unbathed. Which of the following statements should the nurse make to the client?
      A)
      "This is it! You are getting a bath! There are three of us here to bathe you!"
      B)
      "I’m going to ignore your lack of self-care because it is an aspect of the disorder."
      C)
      "It is now time for you to bathe. Do you want to wear the red or green shirt?"
      D)
      "Do you really think it is ok not to bathe? What is going on with you?"
    3. A staff nurse completes orientation to a psychiatric unit. This nurse should expect to perform which of the following interventions?(Select All that Apply.)
      (SATA)
      A)
      Prescribe psychotropic medications.
      B)
      Establish the client's diagnosis.
      C)
      Establish the client's goals.
      D)
      Individualize nursing care plans.
      E)
      Establish therapeutic relationships.
      F)
      Conduct mental health assessments.
    4. A nurse is evaluating client understanding following teaching about lithium therapy for bipolar disorder. Which of the following statements by the client should alert the nurse to the need for further teaching?
      A)
      "I will limit my time in the sun to avoid getting dehydrated."
      B)
      "If I get the flu and can't eat or drink much, I'll keep taking my lithium as prescribed."
      C)
      "I know I need to avoid a low-sodium diet while taking lithium."
      D)
      "I’ll make sure to have my lithium blood level checked every few months."
    Page 2 of 14

    Exam Review

    1. A nurse is caring for a client who has bipolar disorder and is in the manic phase. The client says he is bored. Which of the following activities is appropriate for the nurse to suggest to this client?
      A)
      Participating in a basketball game in the gym
      B)
      Joining a group discussion about a local election
      C)
      Watching a video with a group in the day room
      D)
      Walking with the nurse in the courtyard
    2. A nurse is reviewing laboratory results for a client and notes a serum lithium level of 1.6 mEq/L. Which of the following manifestations should the nurse expect the client to report?
      A)
      Lip smacking and tongue thrusting
      B)
      Fever and fluctuating blood pressure
      C)
      Blurred vision and jerking motor movements
      D)
      GI discomfort and poor coordination
    3. According to Melinda Walker, RN, from Johns Hopkins Hospital, which nursing intervention is most appropriate for a patient immediately after undergoing Electroconvulsive Therapy (ECT) for Major Depressive Disorder (MDD)?
      A)
      Provide detailed information about the next scheduled ECT session.
      B)
      Monitor vital signs and assess for any signs of confusion or disorientation.
      C)
      Encourage the patient to perform vigorous physical activities to regain energy.
      D)
      Administer the next scheduled antidepressant.
    4. A nurse is talking with a client who has schizophrenia. Suddenly the client states, "I'm frightened. Do you hear that? The voices are telling me to do terrible things." Which of the following responses by the nurse is appropriate?
      A)
      "Why do you think you are hearing the voices?"
      B)
      "You need to tell the voices to leave you alone.”
      C)
      "You need to understand that there are no voices."
      D)
      "What are the voices telling you to do?"
    Page 3 of 14

    Exam Review

    1. A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of mild toxicity?
      A)
      Urinary retention
      B)
      Hyperactivity
      C)
      Constipation
      D)
      Muscle weakness
    2. A nurse is assessing a client who is receiving treatment with multiple antipsychotic medications and who suddenly became ill. Findings include blood pressure changes, hyperpyrexia, and diaphoresis. The nurse should recognize that which of the following adverse effects may be occurring?
      A)
      Tardive dyskinesia
      B)
      Neuroleptic malignant syndrome
      C)
      Pseudoparkinsonism
      D)
      Acute dystonia
    3. A nurse is caring for a client diagnosed with somatic symptom disorder who reports chest pain. Laboratory results and ECG are within normal limits, and the client has no cardiac history. Which of the following nursing actions is most appropriate at this time?
      A)
      Acknowledge the client’s concerns and redirect focus to coping strategies.
      B)
      Encourage the client to minimize attention to physical symptoms.
      C)
      Refer the client for immediate psychiatric evaluation.
      D)
      Reassure the client that nothing is physically wrong.
    4. A nurse is monitoring several clients prescribed first-generation antipsychotics. Which of the following clients requires the most immediate assessment for extrapyramidal symptoms (EPS)?
      A)
      A client who verbalizes feelings of worthlessness and guilt
      B)
      A client who reports a dry mouth and constipation
      C)
      A client who is sleeping more during the day and eating less
      D)
      A client who is unable to sit still and appears increasingly agitated
    Page 4 of 14

    Exam Review

    1. A nurse is preparing the environment for a newly admitted client with a documented history of self-injurious behaviors (SIBs) in a secure inpatient mental health unit. Which of the following environmental modifications is most essential in reducing the client’s risk of harm?
      A)
      Providing the client with padded clothing and shoes to minimize injury during agitation.
      B)
      Removing all bedside tables from the client’s room to eliminate surfaces for self-injury.
      C)
      Allowing the client controlled access to personal electronic devices for distraction.
      D)
      Ensuring that all sharp objects and breakable items are securely removed from the client’s environment.
    2. A nurse is assessing a client with schizophrenia who is hearing voices. The client states, “They keep telling me to do something bad to myself.” Which of the following actions should the nurse take first?
      A)
      Ask the client, “Can you tell me exactly what the voices are telling you to do?”
      B)
      Remind the client that the voices are not real and encourage distraction techniques.
      C)
      Escort the client to a quiet room and encourage deep breathing.
      D)
      Notify the provider of the hallucination and request a medication adjustment.
    3. A nurse is assessing a client who is receiving treatment with multiple antipsychotic medications and who suddenly became ill. Findings include blood pressure changes, hyperpyrexia, and diaphoresis. The nurse should recognize that which of the following adverse effects may be occurring?
      A)
      Tardive dyskinesia
      B)
      Neuroleptic malignant syndrome
      C)
      Pseudoparkinsonism
      D)
      Acute dystonia
    4. A nurse is caring for a client diagnosed with somatic symptom disorder who reports chest pain. Laboratory results and ECG are within normal limits, and the client has no cardiac history. Which of the following nursing actions is most appropriate at this time?
      A)
      Acknowledge the client’s concerns and redirect focus to coping strategies.
      B)
      Encourage the client to minimize attention to physical symptoms.
      C)
      Refer the client for immediate psychiatric evaluation.
      D)
      Reassure the client that nothing is physically wrong.
    Page 5 of 14

    Exam Review

    1. A nurse is monitoring several clients prescribed first-generation antipsychotics. Which of the following clients requires the most immediate assessment for extrapyramidal symptoms (EPS)?
      A)
      A client who verbalizes feelings of worthlessness and guilt
      B)
      A client who reports a dry mouth and constipation
      C)
      A client who is sleeping more during the day and eating less
      D)
      A client who is unable to sit still and appears increasingly agitated
    2. A nurse is preparing the environment for a newly admitted client with a documented history of self-injurious behaviors (SIBs) in a secure inpatient mental health unit. Which of the following environmental modifications is most essential in reducing the client’s risk of harm?
      A)
      Providing the client with padded clothing and shoes to minimize injury during agitation.
      B)
      Removing all bedside tables from the client’s room to eliminate surfaces for self-injury.
      C)
      Allowing the client controlled access to personal electronic devices for distraction.
      D)
      Ensuring that all sharp objects and breakable items are securely removed from the client’s environment.
    3. A nurse is assessing a client with schizophrenia who is hearing voices. The client states, “They keep telling me to do something bad to myself.” Which of the following actions should the nurse take first?
      A)
      Ask the client, “Can you tell me exactly what the voices are telling you to do?”
      B)
      Remind the client that the voices are not real and encourage distraction techniques.
      C)
      Escort the client to a quiet room and encourage deep breathing.
      D)
      Notify the provider of the hallucination and request a medication adjustment.
    4. A nurse is caring for a client who has bipolar disorder and is taking lithium. The client reports blurred vision and ataxia. Which of the following actions should the nurse take?
      A)
      Withhold the medication.
      B)
      Administer the next dose as prescribed.
      C)
      Prepare to administer propranolol.
      D)
      Plan to administer levothyroxine.
    Page 6 of 14