Care of Clients with Maladaptive Patterns of Behavior

(Acute and Chronic)

MODULE 1 TO 23

Module #1
1. A mental health nurse who exercises supervision over other nurses in providing
coordination of care to a client diagnosed with a mental disorder is performing which
particular role?
Answer: Case Manager
Rationale: A nurse performing the case manager role performs leadership and
management functions such as coordinating care with other nurses in the unit and
planning care together with nurses under her and the client.

2. The nurse is teaching a client important life skills that can be useful around the house
when he leaves the mental health facility. The nurse is performing which function?
Answer: Milieu Therapy
Rationale: Milieu Therapy involves teaching client’s life skills which are important for
their return to normal life or reintegration to society.

3. An individual who prefers to be alone and isolated may be at risk for mental disorders
because which factor affecting mental health is impaired?
Answer: Interpersonal factors
Rationale: Interpersonal factors include intimacy and connectedness which individuals
who prefer to be isolated or alone lack

4. According to the American Psychiatric Association, which is not a possible cause of

mental disorder:
Answer: A complete family
Rationale: The American Psychiatric Association states that mental disorders are
associated with present distress such as a painful symptom, a disability, increased risk
of suffering death, pain or a loss of freedom.

5. According to the World Health Organization, health involves wellness of the following
human aspects, EXCEPT:
Answer: Economic
Rationale: The American Psychiatric Association states that mental disorders
associated with present distress such as a painful symptom, a disability, increased risk
of suffering death, pain or a loss of freedom.
6. A nurse who is directly responsible for providing care to an individual client such as
administering medication or teaching a life skill is performing which vital role of the
mental health nurse?
Answer: Care Provider
Rationale: The Care Provider roles involves direct patient care such as bedside care
and administering medications

7. The nurse advises a client to join yoga classes as a method to relieve stress would
be fulfilling the function of:
Answer: Counseling
Rationale: Counseling involves the providing stress management techniques to client

8. When a client presents at the Emergency Room with peculiar behaviors and a strong
desire for self - harm, the diagnosis of the specific mental disorder of that client will
have to be based on:
Answer: Criteria from DSM V
Rationale: The DSM V contains a list of specific criteria for the diagnosis of mental
disorders

9. A client develops a trusting relationship with a nurse he pictures as his brother. The
nurse helps the client feed himself as he functions as a:
Answer: Surrogate
Rationale: A surrogate assumes roles that have been assigned by the patient, based on
significant past relationships, in this case the nurse becomes the brother to the client.

10. Nurse C is investigating the effect of a new antipsychotic medication administered to

the Schizophrenic clients in Pavilion 3 of a psychiatric unit. He is playing the role of:
Answer: Researcher
Rationale: Nurse C is a researcher currently investigating the effects of antipsychotic
medication. This means that data is being collected and analysis of this data will follow.

Module #2
1. Benjamin Rush, the father of modern psychiatry utilized all of the following in the
treatment of mental illness except:
Answer: Trephining
Rationale: Trephining was utilized in the ancient times and was never a treatment used
by Benjamin Rush in the enlightenment period.
2. Dorothea Dix emphasized that all the following should be provided by an asylum
except:
Answer: Medication
Rationale: Medications designed to treat mental disorders have not yet been developed
during the time Dorothea Dix began a campaign to improve care provided by asylums in
the United States.

3. In the 1950’s, this was the first medication developed to treat mania:
Answer: Lithium
Rationale: Lithium was the first medication created to treat mania or hyperactive
episodes in the 1950’s.

4. In the late 1700’s this facility was developed to provide a safe environment for people
with mental illness:
Answer: Asylum
Rationale: Pinel and Tuke created the concept of the asylum as a place where people
with mental illness are provided refuge and safe care.

5. Aristotle theorized that the imbalance of 4 elements caused mental illness EXCEPT
which one:
Answer: Food
Rationale: Aristotle only identified water, blood, yellow bile and black bile as the 4
elements which control emotions

6. This refers to the practice of reducing emphasis on mental health care from inpatient
facilities to community treatment centers:
Answer: Deinstitutionalization
Rationale: Deinstitutionalization is the shift from institutional care in state hospital
settings to community facilities of patients with mental illness/disorders.

7. He had written the book, “The Mind That Found Itself”, from his experiences as a
depressed client in 1908.
Answer: Clifford Beers
Rationale: Clifford Beers is the author of “The Mind That Found Itself”. Tuke and Pinel
are instrumental in the creation of asylum and Blueler is a psychiatrist who coined the
term schizophrenia.

8. This organization began the requirement for related learning experience in the
psychiatric setting for students:
Answer: National League for Nursing
Rationale: The National League for Nursing, in 1950 the National League for Nursing
required schools to include an experience in psychiatric nursing.

9. During the ancient times, persons with mental illness who exhibit behaviors that harm
others were:
Answer: Imprisoned
Rationale: In the ancient times, people with mental illness who exhibit violent behaviors
were imprisoned, whipped or burned at the stake for fear they were possessed.

10. This book emphasized that the treatment of persons with mental illness should
focus on psychosocial strengths and needs:
Answer: Nursing Therapy
Rationale: Mellow’s 1968 work Nursing Therapy described the approach of focusing on
the client’s psychosocial strengths and needs which suited those with severe mental
illness.

Module #3
1. This theory of development focuses on the erogenous zones of the body.
Answer: Psychosexual Theory
Rationale: Psychosexual theory asserts that sexual impulses and desires motivate
human behavior according to age. Cognitive theory explains that a series of stages
based on age with the child at each successive stage demonstrating a higher level of
functioning. Interpersonal theory was developed by Harry Stack Sullivan and is based
on the belief that human interaction with significant others determine the sense of self
and security that motivates behavior. Psychosocial theory explains that psychosocial
development is sequential and each stage is dependent on the completion of the
previous stage and life task.

2. Under Eriksson’s Psychosocial Theory, an individual who expresses a sense of

satisfaction with his decisions and actions in life is under which stage?
Answer: Ego Integrity vs. Despair
Rationale: Positive resolution of the stage Ego Integrity vs. Despair involves reflection,
acceptance and satisfaction of life decisions in the past.

3. This theory postulates that sexuality and sexual energy play a major factor on how an
individual acts and behaves towards others and the environment:
Answer: Psychosexual Theory
Rationale: Freud’s Psychosexual Theory postulates that sexual energy or libido is the
driving force behind human behavior.

4. A child proudly displays to his mother the good marks he obtained during activities
while in school. Based on Erikson’s Psychosocial Theory, the child belongs to what
stage?
Answer: Industry vs. Inferiority
Rationale: Taking pleasure in accomplishments is an indicator of positive resolution
under the stage Industry vs. Inferiority in the Psychosocial Theory.

5. An adult who engages in nail biting behaviors during stressful situations may have
unresolved issues during which stage of psychosexual engagement?
Answer: Oral Stage
Rationale: Nail biting during stressful situations is indicative of poor coping and
unresolved issues during the Oral Stage under the Psychosexual Theory.

6. Under Maslow’s Hierarchy of Needs, an individual who at work has not

fulfilled/achieve which stage?
Answer: Esteem Needs
Rationale: Displaying constant self – pity, questioning his own life decisions and craving
for constant praise indicates inability to meet an individual’s Esteem Needs.

7. An individual who has decided to marry his/her partner is in what stage under the
Psychosocial Theory:
Answer: Young Adult
Rationale: Young Adults form loving relationships and meaningful attachments to others.
Middle Adults are being creative and productive, establishing the next generation.
Preschool Beginning development of a conscience, learning to manage conflict and
anxiety and Toddlers achieve a sense of control and free will.

8. Toilet training children is performed at this stage of the Psychosexual Theory:

Answer: Anal Stage
Rationale: Toilet training is performed in the Anal Stage as a means to develop self –
control.

9. Jojo, an 8-year-old boy, wants his piggy bank full by Christmas, so he tells his dad
every day to give him coins. This is a characteristic of one of Piaget’s Cognitive stages:
Answer: Concrete Operations
Rationale: Jojo is under the age bracket 6-12 years and begins to apply positive
resolution by applying logical thinking, that include arithmetical operations.

10. A child who begins to build a group of friends in school and around the
neighborhood is now under which cognitive stage of development?
Answer: Concrete Operations Stage
Rationale: Socialization and developing friendships are hallmarks of successful
resolution of the Concrete Operations Stage under the Piaget’s Cognitive Stages of
Development.

Module #4
1. A nurse who is able to adequately determine what the client is feeling through
listening from the client and sensing the true meaning of the client’s words is practicing
which component of therapeutic relationship?
Answer: Empathy
Rationale: Empathy is - the ability of the nurse to perceive the meanings and feelings of
the client and to communicate that understanding to the client through listening and
sensing.

2. This refers to a nurse’s personal set of standards about what is right and wrong when
dealing with the client or other members of the healthcare team is:
Answer: Values
Rationale: Values are abstract standards that give a person a sense of right and wrong
and establish a code of conduct for living.

3. When the nurse who aims to build trust with the client is conscious about his/her
words being translated into action is practicing?
Answer: Congruence
Rationale: Congruence occurs when words said by the nurse or client match with their
actions, this builds trust.

4. The nurse who patiently cares for his/her client and does not judge the client based
on displayed behaviors is displaying which important component of the therapeutic
relationship?
Answer: Acceptance
Rationale: Avoiding judgments of the person, no matter what the behavior, is
acceptance
5. When a nurse caring for a client with a mental illness/disorder has a good grasp of
his/her own attitude, values, beliefs and feelings, the nurse has achieved:
Answer: Self – awareness
Rationale: Self – awareness refers to an understanding of one’s own values, beliefs,
thoughts, feelings, attitudes, motivations, prejudices, strengths, and limitations and how
these qualities affect others.

6. These are ideas that the nurse holds to be true when caring for the client with a
mental illness/disorder:
Answer: Beliefs
Rationale: Beliefs are ideas that one holds to be true.

7. A nurse who displays actions that are inconsistent with his/her words and display
unexpected behaviors is not able to build:
Answer: Trust
Rationale: Building trust is achieved when the client believes that the nurse will be
consistent in his or her words and actions and can be relied on to do what he or she
says. Some behaviors the nurse can exhibit to help build the client’s trust include being
friendly, caring, interested, understanding, and consistent; keeping promises; and
listening to and being honest with the client.

8. Effective therapeutic use of self by the nurse requires that the nurse must be:
Answer: Responds to the client according to the client’s needs
Rationale: Being able to respond to the client according to his/her needs is an indication
that the nurse has been able to employ therapeutic use of self.

9. Appreciating the client as a person who has specific needs and worthy of respect is
displaying which component?
Answer: Positive Regard
Rationale: Positive regard is where the nurse appreciates the client as a unique,
worthwhile human being can respect the client regardless of his or her behavior,
background, or lifestyle.

10. Effective therapeutic use of self can only be achieved when the nurse has:
Answer: Self – awareness
Rationale: Therapeutic use of self is achieved by developing self-awareness and
beginning to understand his or her attitudes, the nurse can begin to use aspects of his
or her personality, experiences, values, feelings, intelligence, needs, coping skills, and
perceptions to establish relationships with clients.
Module #5
1. During the course of the interaction, the nurse shares to the client that they have the
same favorite color and food to establish a closer working relationship between the two
of them. This is an example of the use of:
Answer: Self - disclosure
Rationale: Self – disclosure is where the nurse reveals personal information such as
biographical information and personal ideas, thoughts, and feelings about oneself to
clients to improve rapport between the nurse and client.

2. A client shows resistance to the nurse during the interaction due to past negative
experience
with another nurse. The client ignores the nurse during the interaction and does not
participate in therapy. This phenomenon is known as:
Answer: Transference
Rationale: Transference occurs when the client unconsciously transfers to the nurse the
feelings he/she has for others. Resistance by the client to interaction and participation
with the new nurse is due to negative experiences with a past nurse is an example of
transference.

3. When the client begins to show positive self – regard, this phase has already been
reached:
Answer: Termination
Rationale: The Termination Phase is reached once the client shows positive changes in
how he/she views him/herself.

4.Nurse Angelo has started working on building a therapeutic relationship with an

identified client. During the course of the initial interaction, the client states that he is not
comfortable talking about his line of work. Nurse Angelo replies that he will not force the
client to talk about things he does not want to talk about. This is an example of:
Answer: Confidentiality
Rationale: Confidentiality is respecting the client’s right to keep private any information
about his or her mental and physical health and related care and information. Nurse
Angelo is ensuring confidentiality by not forcing the client to talk about information the
client does not want to talk about.

5. The nurse is listening attentively to the client to ensure proper assessment and begin
building rapport between the two of them is performing a task in which phase:
Answer: Orientation Phase
Rationale: Active learning is important to ensure that the nurse is able to rapport and
trust with the client and to obtain accurate assessment findings during the Orientation
Phase.

6. A client who has become more open and warmer when communicating with the nurse
is now in which phase:
Answer: Working - Exploitation
Rationale: The client who displays changes in the manner of communication such as
being more open and flexible towards the nurse is now in the Working – Exploitation
phase of the therapeutic relationship.

7. The nurse who is reviewing the client’s medical history and list of medications is
performing tasks in which phase:
Answer: Orientation Phase
Rationale: A thorough review of the client’s background information including past
medical history is a task that the nurse performs during the Orientation Phase.

8. When Nurse Sam outlines to his client his specific responsibilities during the initial
phases of therapeutic relationship, he is performing:
Answer: Nurse – Client Contract
Rationale: A Nurse – Client Contract outlines the responsibilities of the nurse and client,
it should state the time, place and length of sessions, the time frame, the treatment plan
and those involved as well as specific responsibilities of both parties.

9. The client who is able to link certain stressors which are causing to his problematic
behaviors is now in which phase:
Answer: Working – Problem Identification
Rationale: During the Working – Problem Identification Phase, the client is participating
in identifying problems and their possible causes.

10. Expectation setting between the nurse and client occurs in which phase of the
therapeutic relationship:
Answer: Orientation Phase
Rationale: During the orientation phase, the nurse establishes roles, the purpose of
meeting, and the parameters of subsequent meetings; identifies the client’s problems;
sets and clarifies expectations between both parties.

Module #6
1. The nurse is talking to a client. The client abruptly says to the nurse, “The moon is
full. Astronauts walk on the moon. Walking is a good health habit.” The client’s behavior
most likely indicates:
Answer: Flight of Ideas
Rationale: The client’s verbalization reflects flight of ideas which are rapid flow of
thoughts characterized by fast talking with unrelated topics

2. A client on an in-patient psychiatric ward refuses to take medications because, “The

pill has a special code written on it that will make it poisonous.” What kind of delusion is
the client experiencing?
Answer: A persecutory delusion
Rationale: The client’s statement reflects excessive suspicion and fear of being
poisoned which are characteristic behaviors exhibited in a persecutory delusion.

3. Patient Rodney states “I am the president of the Philippines!” This statement

indicates what type of delusion?
Answer: Grandiose
Rationale: The client’s declaration of being the President of the Philippines reflects a
grandiose delusion where he believes that he is greater, more powerful, influential than
who he really is.
4. Patient Betty is currently admitted to a mental health facility. While joining an art
therapy session, the patient suddenly laughed out aloud, ran to a corner and began
crying. As the nurse on duty, you would recognize this affect as:
Answer: Labile
Rationale: A labile affect is reflected by sudden, unexplained changes in behaviors and
expression which were exhibited by the client when she laughed out aloud and then
began crying soon after.

5. The nurse is conducting an ongoing assessment of a client with schizophrenia. While

performing the interview, the client suddenly stood up from the chair, smiled and began
running around calling out the name of his wife. The nurse interprets that the client has
a:
Answer: Visual Hallucination
Rationale: The client is exhibiting a visual hallucination when he suddenly begins
running around and calling out his wife.

6. When in an assessment interview a client suddenly stops talking, opens his mouth
and walks to a corner, this disturbance in the thought process in interpreted by the
nurse as:
Answer: Blocked
Rationale: A blocked thought process is exhibited when the client suddenly stops
responding to an interview/conversation and seeks isolation.

7. Nurse Elwood notices that his client who is in bed has one arm raised and one leg
flexed for over an hour interprets this to indicate that the client has/is in:
Answer: Waxy Flexibility
Rationale: A waxy flexibility occurs when a client hardens or maintains a posture or
position over time even when it is awkward or uncomfortable.

8. Michelle’s mother told Nurse Calvin that two days prior to her daughter’s admission,
she noticed that she keeps on smiling when she talked about her failure to pass the
training for call center agent. The nurse recognize this as:
Answer: Inappropriate affect
Rationale: Smiling connotes a happy emotion and not a failure. The client exhibits an
inappropriate affect which is a disharmony between a stimulus and an emotional
reaction.

9. Being able to change one’s behavior and decisions based on sound interpretation of
the situation is:
Answer: Judgment
Rationale: Judgment refers to the ability to reach a logical decision and situation
correctly to adapt to one’s behavior and decisions accordingly.

10. A client admitted at the mental health facility, has been shouting out aloud claiming
that he is the “one true god”, is likely undergoing an:
Answer: Religious Delusion
Rationale: The client calling himself the one true god is exhibiting symptoms of a
religious delusion where an individual has false beliefs with a religious or spiritual
content.

Module #7
1.When a nurse asks the client questions that seek to go deeper into a particular topic
or idea is utilizing which therapeutic communication technique:
Answer: Exploring
Rationale: Exploring allows the nurse to delve further into specific ideas or actions of the
client.
2. Which therapeutic communication technique is being used in this nurse-client
interaction?
Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
Answer: Formulating a plan of action
Rationale: Formulating a plan of action is asking the client to consider kinds of behavior
likely to be appropriate in future situations.

3. Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing

statement is an example of offering a “general lead”?
Answer: “Yes, I see. Go on.”
Rationale: General leads are designed to give client’s the encouragement to continue.

4. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient

psychiatric unit for evaluation and medication stabilization. Which therapeutic
communication technique used by the nurse is an example of a broad opening?
Answer: “What would you like to talk about?”
Rationale: Broad openings allow the client to take the initiative in introducing the topic
that he/she wants to talk about.

5. A nurse is assessing a client diagnosed with schizophrenia for the presence of

hallucinations. Which therapeutic communication technique used by the nurse is an
example of making observations?
Answer: “You appear to be talking to someone I do not see.”
Rationale: Making observations is where the nurse verbalizes, he/she perceives what
the client is doing.

6. When interviewing a client, which nonverbal behavior should a nurse employ?

Answer: Sitting squarely, facing the client
Rationale: Sitting squarely and facing the client ensures that there is proper eye contact
between the client and the nurse during the interview session.

7. In terminating the therapeutic relationship with Mario prior to his discharge, Nurse
Arianne should do one of the following:
Answer: Allow him to express his feelings about leaving the hospital
Rationale: Making the client verbalize his feelings is therapeutic, exploring and focusing
are useful for Mario.
8. When the nurse asks the client to make a brief comparison of his/her actions, the
therapeutic technique being employed is:
Answer: Encouraging Comparison
Rationale: Encouraging comparison is where a nurse will ask the client to verbalize
similarities and differences which the nurse then notes.

9. A male nurse is caring for a client. The client states, “You know, I’ve never had a male
nurse before.” The nurse’s best reply would be:
Answer: “How do you feel about having a male nurse?”
Rationale: This is exploring, and the nurse is examining the issue more carefully to
better understand the client.

10. When formulating goals of care for the client with a mental illness/disorder, these
must be:
Answer: Client-centered
Rationale: Goals of care are created jointly by the nurse and client but these are based
on the needs of the client and are essentially client – centered.

Module #8
1. A nursing instructor is teaching Electroconvulsive therapy to students. Which
response by the students indicates that learning has occurred?
Answer: “ECT induces a grand mal seizure.”
Rationale: Electroconvulsive therapy is the induction of a grand mal seizure through the
application of electrical current to the brain for the purpose of decreasing depression.

2. After receiving two of nine electroconvulsive therapy (ECT) treatments, a client

states, "I can't even remember eating breakfast, so I want to stop the ECT treatments."
Which is the most appropriate nursing reply?
Answer: "It is within your right to discontinue the treatments, but let's talk about
your concerns."
Rationale: The client has the right to terminate treatment. This nursing reply
acknowledges this right but focuses on the client's concerns so that the nurse can
provide needed information.

3. Immediately after an initial electroconvulsive therapy (ECT) treatment a client states,

"I'm not hungry and just want to stay in bed and sleep." Based on this information,
which is the most appropriate nursing intervention?
Answer: Allow the client to remain in bed.
Rationale: Immediately after electroconvulsive therapy a nurse should monitor pulse,
respirations, and blood pressure every 15 minutes for the first hour, during which time
the client should remain in bed.

4. A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to

a client's electroconvulsive therapy (ECT) treatment. What is the rationale for
administering this medication?
Answer: Robinul decreases secretions to prevent aspiration during the ECT
procedure.
Rationale: Glycopyrrolate (Robinul) is the standard preoperative medication given prior
to ECT treatments to decrease secretions and prevent aspiration.

5. A nursing instructor is teaching about the medications given prior to and during
electroconvulsive therapy (ECT) treatments. Which student statement indicates that
learning has occurred?
Answer: "Thiopental sodium (Pentothal) is a short-acting anesthesia to render the
client unconscious."
Rationale: In order to render a client unconscious during the ECT procedure, an
anesthesiologist administers intravenously, a short-acting anesthetic like thiopental
sodium (Pentothal).

6. Immediately after electroconvulsive therapy, in which position should a nurse place

the client?
Answer: On his or her side to prevent aspiration
Rationale: The nurse should place a client who has received electroconvulsive therapy
on his or her side to prevent aspiration. After the treatment, most clients will awaken
within 10 to 15 minutes and will be confused and disoriented. Some clients will sleep for
1 to 2 hours. All clients require close observation following treatment.

7. After receiving two of nine electroconvulsive therapy (ECT) treatments, a client

states, "I can't even remember eating breakfast, so I want to stop the ECT treatments."
Which is the most appropriate nursing reply?
Answer: “It is within your right to discontinue the treatments, but let's talk about
your concerns."
Rationale: The client has the right to terminate treatment. This nursing reply
acknowledges this right but focuses on the client's concerns so that the nurse can
provide needed information.

8. What is considered as the gold standard for confirmation of seizure in ECT?

Answer: Electroencephalogram (EEG)
Rationale: An Electroencephalogram (EEG) is used throughout the procedure to record
electrical activity in the brain including episodes of seizures.

9. The most persistent adverse effect of Electroconvulsive Therapy is:

Answer: Retrograde Amnesia
Rationale: Clients develop retrograde amnesia (trouble remembering memories before
treatment) over a period of time, these problems usually resolve within a few months
after completion of therapy.

10.The most common indication of Electroconvulsive Therapy is:

Answer: Major depression
Rationale: ECT is mainly used to treat major/severe depression particularly when
accompanied by detachment from reality (psychosis), a desire to commit suicide or
refusal to eat.

TERM 2

Module 9
1. The nurse is planning to utilize bibliotherapy for a client with a mild mood –
related condition. The nurse selects a few books regarding yoga and stress – relief.
This type of bibliotherapy is called:
Answer: Prescriptive Bibliotherapy
Rationale: Prescriptive Bibliotherapy involves the use of specific self – help reading
materials and workbooks to address a variety of mental health concerns.

2. A form of group therapy which uses the family as a therapeutic tool for the client
the dynamics of his/her psychopathology and develop problem – solving skills as a
group.
Answer: Family Therapy
Rationale: Family Therapy is A form of group therapy in which the client and his or her
family members participate. The goals include understanding how family dynamics
contribute to the client’s psychopathology, mobilizing the family’s inherent strengths and
functional resources, restructuring maladaptive family behavioral styles, and
strengthening family problem-solving behaviors.

3. During this stage of Remotivation Therapy, the nurse asks the client questions
which are about the relatedness of the current therapy session to life:
Answer: Appreciation of the Work of the World
Rationale: Appreciation of the Work of the World is the which step involves life – related
questions based from the poem/story/song utilized by the therapist during the therapy
session.

4. A kind of therapy which features a therapist allowing the client to express

him/herself through singing, composing songs or just listening to them.
Answer: Music Therapy
Rationale: During Music Therapy, a qualified musical therapist provides the indicated
treatment including creating, singing, moving to, and/or listening to music.

5. A nurse selected a teenage novel for the bibliotherapy of an adolescent with a

mild depression. This type of bibliotherapy is:
Answer: Creative Bibliotherapy
Rationale: Creative bibliotherapy utilizes imaginative literature—novels, short stories,
poetry, plays, and biographies—to improve psychological well-being.

6. A client is placed in a structured facility with a small number of patients and

provided therapy designed to develop life skills and functional behavior. This therapy is:
Answer: Milieu Therapy
Rationale: Milieu Therapy is a treatment approach where clients are immersed in a
small, structured community focused on helping them develop skills and behaviors
that’ll enable them to live healthier lives in a larger society.

7. A nurse therapists brings the child who has just experienced physical abuse to a
playground and allows the child to freely play with all the different toys with only limited
instruction is using which type of play therapy:
Answer: Nondirective Play Therapy
Rationale: Nondirective Play Therapy based on the principle that children can resolve
their own issues given the right conditions and the freedom to play with limited
instruction and supervision.

8. This type of therapy allows the client to express him/herself through creativity
and creative works which are helpful for those suffering from intense trauma:
Answer: Art Therapy
Rationale: Art therapy allows people to express feelings on any subject through creative
work rather than with speech, it is believed to be particularly helpful for those who feel
out of touch with their emotions or feelings. Individuals experiencing difficulty discussing
or remembering painful experiences may also find art therapy especially beneficial.
9. When the nurse therapist choose a specific set of play things to elicit a desired
response from a traumatized child is using which type of play therapy:
Answer: Directive Play
Rationale: Directive Play Therapy uses more input from the therapist to help speed up
results such as choosing particular toys or kinds of plays.

10. This therapy involves simultaneously engaging the body, mind, and spirit in
healing mental health issues, moving beyond problematic life patterns, and overcoming
traumatic life experiences:
Answer: Psychospiritual Therapy
Rationale: Psychospiritual therapy (PST) is an approach that incorporates religion and
spirituality into psychotherapy. For centuries, this has been done in many settings, and
across different religions. All religions view morality as sets of objective truth. When
religious people commit to certain moral regulations and standards, it will bring about a
positive behavior including in terms of health.

Module 10
1. The nurse is teaching a client taking an MAOI about foods with Tyramine that he or
she should avoid. Which of the following statements indicates that the client needs
further teaching?
A. “I’m so glad I can have pizza as long as I don’t order pepperoni.”
B. “I will be able to eat cottage cheese without worrying.”
C. “I will have to avoid drinking nonalcoholic beer.”
D. “I can eat green beans on this diet.”
Answer: B
Cheese is a tyramine – rich food which can trigger a hypertensive crisis
in clients who are taking MAOI’s to manage their depressive disorder.

2. A client who has been depressed and suicidal started taking a tricyclic antidepressant
2 weeks ago and is now ready to leave the hospital to go home. Which of the following
is a concern for the nurse as discharge plans are finalized?
A. The client may need a prescription for diphenhydramine (Benadryl) to use for side
effects.
B. The nurse will evaluate the risk for suicide by overdose of the tricyclic
antidepressant. C. The nurse will need to include teaching regarding the
signs of neuroleptic malignant syndrome.
D. The client will need regular laboratory work to monitor therapeutic drug levels.
Answer: B
Rationale: Clients may develop tolerance to the effect of the medication leading to
discontinuance of therapy. This discontinuance leads to the re-emergence of depressive
behaviors which can lead to suicidal attempts.

3. The signs of lithium toxicity include which of the following?

A. Sedation, fever, restlessness
B. Psychomotor agitation, insomnia, increased thirst
C. Elevated WBC count, sweating, confusion
D. Severe vomiting, diarrhea, weakness
Answer: D
Rationale: Classic signs of lithium toxicity include: severe diarrhea, vomiting,
drowsiness, muscle weakness, and lack of coordination.

4. Which of the following is a concern for children taking stimulants for ADHD for several
years?
A. Dependence on the drug
B. Insomnia
C. Growth suppression
D. Weight Gain
Answer: C
Rationale: Weight and growth suppression is the most common long – term problem in
children undergoing stimulant therapy for ADHD.

5. The nurse is caring for a client with schizophrenia who is taking haloperidol
(Haldol). The client complains of restlessness, cannot sit still, and has muscle
stiffness. Of the following prn medications, which will the nurse administer? A.
Haloperidol (Haldol) 5 mg p.o.
B. Benztropine (Cogentin) 2 mg p.o.
C. Propranolol (Inderal) 20 mg p.o.
D. Trazodone 50 mg p.o.
Answer: B
Rationale: The client is suffering symptoms of akathisia which is treated with
Benztropine (Congentin).
6. Client teaching for lamotrigine (Lamictal) should include which of the
following? A. Eat a well-balanced diet to avoid weight gain.
B. Report any rashes to your doctor immediately.
C. Take each dose with food to avoid nausea.
D. This drug may cause psychological dependence.
Answer: B
Rationale: The appearance of rashes is indicative of an ongoing adverse reaction/side
effect of Lamotrigine therapy.

7. Which of the following physician orders would the nurse question for a client who has
stated
“I’m allergic to phenothiazines?”
A. Haldol 5 mg p.o. bid
B. Navane 10 mg p.o. bid
C. Prolixin 5 mg p.o.tid
D. Risperdal 2 mg bid
Answer: C
Rationale: Prolixin is an antipsychotic phenothiazine medication which the client is
allergic to.

8. Clients taking which of the following types of psychotropic medications need close
monitoring of their cardiac status?
A. Antidepressants
B. Antipsychotics
C. Mood stabilizers
D. Stimulants
Answer: A
Rationale: Antidepressants, specifically MAOI’s, have cardiac side effects such as
hypertension, tachycardia and cardiac dysrhythmias.

9. What is the major side effect of Selective Serotonin Reuptake Inhibitor (Prozac)?
A. Loss of sexual desire
B. Weight loss
C. Loss of hair
D. Weight gain
Answer: A
Rationale: Loss of sexual desire or sexual dysfunction is a common, major side effect of
SSRI therapy.

10. Antipsychotics do which of the following?

A. Alleviate major positive symptoms (such as thought disorder and hallucinations)
B. Alleviate major negative symptoms (such as social withdrawal)
C. Reducing the burden of institutional care
D. All of the above
Answer: D
 Antipsychotic medications are designed to achieve all the alleviation of major
positive and negative symptoms as well as reduce hospitalization times.

Module 11
1. A client who abuses alcohol and illegal drugs tells a nurse that he only uses
substances because of his stressful marriage and difficult job. Which defense
mechanisms is this client using? A. Sublimation
B. Displacement
C. Projection
D. Rationalization
Answer: D
Rationale: Rationalization is the defense mechanism that involves offering excuses for
maladaptive behavior. The client is defending his substance abuse by providing reasons
related to life stressors. This is a common defense mechanism used by clients with
substance abuse problems.

2. Mr. Cruz, an attorney who throws books and furniture around the office after losing a
case, is referred to the psychiatric nurse for assistance. Nurse Alvin knows that the
client’s behavior most likely represents the use of which defense mechanism?
A. Projection
B. Regression
C. Intellectualization
D. Reaction-formation
Answer: B
Rationale: An adult who throws temper tantrums, such the case of Mr. Cruz, is
displaying regressive behavior, or behavior that is appropriate at a younger age.

3. Nurse Lucas is aware that the defense mechanism commonly used by clients who
are alcoholics is:
A. Displacement
B. Compensation
C. Denial
D. Projection
Answer: C
Rationale: Denial is a method of resolving conflict or escaping unpleasant realities by
ignoring their existence.

4. A rape victim testifying in court suddenly loses her voice when asked to recount to
event is displaying which defense mechanism:
A. Conversion
B. Repression
C. Displacement
D. Suppression
Answer: A
Rationale: Conversion is expression of an emotional conflict through the development of
a physical symptom, usually sensorimotor in nature.

5. Forcing thoughts to remain unconscious in order to avoid the anxiety that would result
if they were conscious is the definition of which defense mechanism?
A. Denial
B. Isolation
C. Regression
D. Repression
Answer: D
Rationale: Excluding emotionally painful or anxiety-provoking thoughts and feelings
from conscious awareness.

Situation for numbers 6-8. Trent and Elisa have been dating for two years. Elisa breaks
up with Trent because he cheated on her with Anna. Elisa tells her friend Angela about
Trent, but she tells her without showing any emotion. Trent continues to call Elisa and
treat her as he did when they were going out. Anna, who did not know about Elisa, tells
Trent that she is glad that he feels guilty for hurting Elisa. She also tells him that it will
take a long time to get over the guilt.

6. Elisa is using ___________ as a defense mechanism.

A.Repression
B.Denial
C. Projection
D. Isolation
Answer: D
Rationale: Isolation is where a person separates ideas or feelings from the rest of their
thoughts.

7. Trent is using ___________ as a defense mechanism.

A. Repression
B. Denial
C. Projection
D. Isolation
Answer: B
Rationale: Denial is a failure to acknowledge an unbearable condition; failure to admit
the reality of a situation, or how one enables the problem to continue.

8. Anna is using ___________ as a defense mechanism.

A. Repression
B. Denial
C. Projection
D. Isolation
Answer: C
Projection is an unconscious blaming of unacceptable inclinations or thoughts on an
external object.

9. A corrupt politician who constantly attends mass and donates large amounts of
money to his parish is exhibiting which defense mechanism?
A. Undoing
B. Repression
C. Denial
D. Projection
Answer: A
Rationale: Undoing is where a person is exhibiting acceptable behavior to make up for
or negate unacceptable behavior.

10. The student who is failing in class and hates the teacher constantly says positive
things about the teacher to his friends is using which defense mechanism?
A. Projection
B. Sublimation
C. Displacement
D. Reaction Formation
Answer: D
Rationale: Reaction formation is acting the opposite of what one thinks or feels.

Module 12
1. While caring for a male client with a mental illness, the nurse notices that the client
has suddenly become quiet after seeing a physician walk by with a syringe, the client
then becomes agitated, is not responsive to the nurse and runs to a corner of his room
and hides in fear. Based on the nurse’s assessment, the client is in which level of
anxiety?
A. Moderate Anxiety
B. Severe Anxiety
C. Panic Anxiety
D. Mild Anxiety
Answer: C
Rationale: The client is displaying symptoms indicative of Panic Anxiety such as mutism
(suddenly become quiet), agitation, flight where he runs to a corner and delusions of
persecution when he hides in fear inside his room.

2. 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 Anxiety
B. Moderate Anxiety
C. Severe Anxiety
D. Panic Anxiety
Answer: C
Rationale: Severe Anxiety is a an anxiety where panic and more primitive survival skills
take over, cognitive skills decrease significantly, the person has trouble thinking and
reasoning, manifestations include: vital signs increase, restless, irritable, angry, cannot
complete tasks, feels dread or horror, crying, trembling, chest pain, nausea, vomiting

3. Which of the following would be the best intervention for a client having a panic
attack? A. Involve the client in a physical activity.
B. Offer a distraction such as music.
C. Remain with the client.
D. Teach the client a relaxation technique
Answer: C
Rationale: A client in a panic attack has no coherent thought. This prevents the client
from learning information or performing effective coping. During the stage, the primary
consideration is to ensure the safety of the client by remaining with the client and
preventing injury to the client as a result of the flight response.

4. 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
Answer: D
Rationale: Clients experiencing anxiety exhibits narrowed or distorted perception and
cognitive deficits. The client develops poor comprehension which prevents the client
from answering questions correctly. The nurse’s questions, therefore, must be clear,
concise and direct to allow the client to provide a fast and easy answer without the need
for further introspection.

5. A client resorting to fantasizing and delusions during an anxious event is

experiencing which type of adaptive behavior:
A. Negative Adaptive Behaviors
B. Positive Adaptive Behaviors
C. Delusional Adaptive Behaviors
D. Panic Adaptive Behaviors
Answer: A
Rationale: Negative Adaptive Behaviors is coping that results in maladaptive behaviors
such as tension headaches, pain syndromes, and stress-related responses that reduce
the efficiency of the immune system, hallucinations and delusions

6. Which of the following is an appropriate intervention for a client experiencing a severe

anxiety:
A. Teach relaxation techniques
B. Walk with client if he/she is restless and agitated
C. Confining the client to the room
D. Offer the client a distraction such as music
Answer: B
Rationale: Clients in severe anxiety become restless, agitated and have trouble
thinking. In order to ensure safety, the nurse must walk with the client if he/she is pacing
or walking around.

7. This type of anxiety allows the person to build health coping skills and engage in goal
– oriented activities:
A. Panic Anxiety
B. Severe Anxiety
C. Moderate Anxiety
D. Mild Anxiety
Answer: D
Rationale: Mild Anxiety is a sensation that something is different or needs special
attention, this type motivates people to make changes or engage in goal - directed
activity.
8. During this stage of the response stress, the client begins to exhibit agitation,
clenching of the fist and anger:
A. Exhaustion Stage
B. Alarm Stage
C. Resistance Stage
D. General Anxious Stage
Answer: C
Rationale: The Resistance Stage is where the client begins to show the fight, flight or
freese response as the muscles begin to receive more blood supply.

9. Refocusing the client who is experiencing a moderate anxiety can be achieved

through:
A. Guided imagery
B. Physical activity
C. Restraining the client
D. Confining the client to his room
Answer: A
Rationale: One of the best methods to refocus clients is through guided, calm imagery.
This allows the client to reflect and visualize healthier coping alternatives with the help
of guidance from the nurse.

10. An anxious client who is able to use deep breathing and relaxation techniques has:
A. Negative Adaptive Behaviors
B. Positive Adaptive Behaviors
C. Acceptable Adaptive Behaviors
D. Positive Coping
Answer: B
Rationale: Deep breathing and relaxation techniques are examples of positive coping
which a client with positive adaptive behavior.

Module 13
1. The nurse working with a client during a flashback says, “I know you’re scared, but
you’re in a safe place. Do you see the bed in your room? Do you feel the chair you’re
sitting on?” The nurse is using which of the following techniques?
A. Distraction
B. Reality orientation
C. Relaxation
D. Grounding
Answer: D
Rationale: Grounding techniques remind the client that he or she is in the present, as an
adult, and is safe.

2. A client in the emergency department is suspected of having been raped. The patient
is withdrawn, confused and at times physically withdrawn. As the nurse on duty, you
realize that these behaviors are:
A. Signs of the patients increased risk of suicide
B. An indication for the client’s need for admission
C. Signs of depression
D. Normal reactions to rape or sexual assault
Answer: D
Rationale: These symptoms are normal for a patient who has been through such a
traumatic event. During the acute phase of rape crisis, the patient can display a wide
variety of emotional responses. The patient should be observed closely, but the patient
may not need to be admitted to the hospital. The patient is not necessarily suicidal or
depressed at this point.

3. A child was abducted and raped. Which personal reaction by the nurse could
interfere with the child’s care? A. Anger
B. Concern
C. Compassion
D. Empathy
Answer: A
Rationale: Feelings of empathy, concern and compassion are helpful. Anger, on the
other hand, may make objectivity difficult for the nurse. This prevents the client from
trusting the nurse.

4. A person was abducted and raped at gunpoint by an unknown assailant. Which

among the following best indicates that the person is in the immediate and initial stage
of rape trauma?
A. Decreased motor activity
B. Confusion and disbelief
C. Fears and phobias
D. Flashbacks and dreams
Answer: B
Rationale: Shock, emotional numbness, confusion, disbelief, restlessness and agitation
are signs indicating the victim is in the immediate and initial stage of rape trauma.
Flashbacks and dreams are long – term effects the victim displays.
5. A woman abducted and raped at gunpoint is displaying confusion, talks rapidly in
disconnected phrases and is unable to concentrate and make simple decisions. As the
nurse, you know that a rape victim’s anxiety will be in which level?
A. Weak
B. Mild
C. Moderate D. Severe
Answer: D
Rationale: Anxiety is the result of a personal threat to the victim’s safety and security. In
this case, the symptoms of the victim reflect severe anxiety.

6. Initial intervention for a rape victim should focus on:

A. Oxygenation
B. Hydration
C. Safety and Security
D. STD Prophylaxis
Answer: C
Rationale: The immediate intervention provided inside the emergency room should be
geared towards ensuring the safety and security of the rape victim.

7. During the initial care of a rape victim, the following are to be considered EXCEPT:
A. Assure privacy
B. Touch the client to show acceptance and empathy
C. Accompany the victim to the examination room
D. Maintain a non – judgmental approach
Answer: B
Rationale: Rape victims will find touching by other people as intrusive, therefore it must
be avoided when caring for them.

8. A client is brought to an emergency department after being violently raped. Which

nursing action is appropriate?
A. Discourage the client from discussing the event as this may lead to further emotional
trauma.
B. Remain non-judgmental and actively listen to the client's description of the event.
C. Meet the client's self-care needs by assisting with showering and perineal care.
D. Provide cues, based on police information, to encourage further description of the
event.
Answer: B
Rationale: The most appropriate nursing action is to remain non-judgmental and actively
listen to the client's description of the event. It is important to also communicate to the
victim that he or she is safe and that it is not his or her fault. Nonjudgmental listening
provides an avenue for client catharsis needed in order to begin the process of healing.
9. A college student was raped when out on a date. After several weeks of crisis
intervention therapy, which client statement should indicate to a nurse that the student
is handling this situation in a healthy manner?
A. "I know that it was not my fault."
B. "My boyfriend has trouble controlling his sexual urges."
C. "If I don't put myself in a dating situation, I won't be at risk."
D. "Next time I will think twice about wearing a sexy dress."
Answer: A
Rationale: The client who realizes that sexual assault was not her fault is handling the
situation in a healthy manner. The nurse should provide non-judgmental listening and
communicate statements that instill trust and validate self-worth.

10. A man who rapes his neighbour for the sheer thrill of the act and to meet a sexual
urge is which type of rapist? A. Sexual Sadist
B. Exploitive predators
C. Inadequate men
D. Displacement of anger and rage
Answer: B
Rationale: Exploitive predators are those rapists who impulsively use their victims for
objects of gratification.

11. A kindergarten student is frequently violent toward other children. A school nurse
notices bruises and burns on the child's face and arms. What other symptoms
should indicate to the nurse that the child might have been physically abused? A.
The child shrinks at the approach of adults.
B. The child begs or steals food or money.
C. The child is frequently absent from school.
D. The child is delayed in physical and emotional development.
Answer: A
Rationale: The nurse should determine that a child who shrinks at the approach of
adults in addition to having bruises and burns might be a victim of abuse. Whether or
not the adult intended to harm the child, maltreatment should be considered.

12. Nathan, a 12-year-old child, complains to the school nurse about nausea and
dizziness. While assessing the child, the nurse notices a black eye that looks like an
injury. This is the third time in 1 month that the child has visited the nurse. Each time,
the child provides vague explanations for various injuries. Which of the following is the
school nurse’s priority intervention?
A. Contact the child’s parents and ask about the child’s injury.
B. Encourage the child to be truthful with her.
C. Question the teacher about the parent’s behavior.
D. Report suspicion of abuse to the proper authorities.
Answer: D
Rationale: The nurse is obligated to report suspicion of child abuse to the appropriate
protective services. Failure to do so can risk further endangerment of the child, and
failure to report is a violation on the part of the nurse to protect the child from further
harm.

13. Nurse Jessel is observing 8-year-old Andrea during a community visit. Which of
the following findings would lead the nurse to suspect that Andrea is a victim of
sexual abuse? A. The child is fearful of the caregiver and other adults.
B. The child has a lack of peer relationships.
C. The child has self-injurious behavior.
D. The child has an interest in things of a sexual nature.
Answer: D
Rationale: An 8-year-old child is in the latency phase of development; in this stage, the
child’s interest in peers, activities, and school is the priority. Interest in sex and things of
a sexual nature would occur appropriately during the age of puberty, not at this time. A
child who is the victim of sexual abuse, however, may show an unusual interest in sex.
The assessments in the other answer choices may indicate abuse, but not necessarily
sexual abuse.

14. Nathaniel is studying about abuse for the upcoming exam. For her to fully instill
the topic, she should know that the priority nursing intervention for a child or elder
victim of abuse is: A. Assess the scope of the abuse problem.
B. Analyze family dynamics.
C. Implement measures to ensure the victim’s safety.
D. Teach appropriate coping skills.
Answer: C
Rationale: The priority intervention when a child or elderly person is involved in a
situation of abuse is establishing the safety of the victim. This prevents further harm
from abuse and encourages trust and cooperation with the nurse.

15. Nurse Rica is assessing a parent who abused her child. Which of the following
risk factors would the nurse expect to find in this case? A. Flexible role functioning
between parents
B. History of the parent having been abused as a child
C. Single-parent home situation
D. Presence of parental mental illness
Answer: B
Rationale: One of the most important risk factors is a history of childhood abuse in the
parent who abuses. Family violence including child abuse follows a multigenerational
pattern.

16. In a home visit to a family of three: a mother, father, and their child, the mother tells
the community nurse that the father (who is not present) had hit the child on several
occasions when he was drinking. The mother further explains that she has talked her
husband into going to an alcoholics support group. She asks the nurse not to interfere,
so her husband won’t get angry and refuse treatment. Which of the following is the best
response of the nurse?
A. The nurse agrees not to interfere if the husband attends an alcoholics support group
meeting that evening.
B. The nurse commends the mother’s efforts and agrees to let her handle things.
C. The nurse commends the mother’s efforts and also contacts protective
services.
D. The nurse confronts the mother’s failure to protect the child.
Answer: C
Rationale: The nurse would validate and reinforce the mother’s efforts to seek help;
however, the nurse must also report the abuse to the appropriate protective services.
The priority is to maintain the child’s safety.

17. Mrs. Smith, 70 years old, was admitted to the emergency department of Valley River
Medical Center with a fractured arm. She explains to the nurse that her injury resulted
when she provoked her drunken son, who then pushed her. Which of the following best
describes the nurse’s understanding of the mother’s explanation?
A. Mrs. Smith’s explanation is appropriate acceptance of her responsibility.
B. Mrs. Smith’s explanation is an atypical reaction of an abused woman.
C. Mrs. Smith’s explanation is evidence that the woman may be an abuser as well as a
victim.
D. Mrs. Smith’s explanation is a typical response of a victim accepting blame for
the abuser.
Answer: D
Rationale: Self-blame is a common psychological response to a woman who is a victim
of abuse. In this situation, the message that violence occurred because the woman
provoked the abuser is accepted and owned by the victim; however, the victim is not
responsible for the violence.
18. Which situation would Nurse Sally identify as placing a client at high risk for
caregiver abuse?
A. Cristina, an elderly adult’s child, quits her job to move in and care for a
parent with severe dementia.
B. Mr. Yu, an elderly man with severe heart disease, resides in a personal care
home and is frequently visited by his adult child.
C. Mrs. Rosales, an elderly parent with limited mobility, lives alone and receives
help from several adult children.
D. Rhea cares for her husband who is in early stages of Alzheimer’s disease and
has a network of available support persons.
Answer: A
Rationale: In this situation, Cristina has given up her usual role as well as moved her
place of residence to care for her parents. Caring for someone with severe dementia is
very stressful, requiring almost 24-hour vigilance to ensure safety and meet needs. This
situation places the caregiver at high risk for stress and abuse.

19. The interventions common to treatment plans for abuse survivors include
which of the following? Select all that apply.
A. Establish trust and rapport.
B. Identify areas of control.
C. Remove the client from home.
D. Support the client in the decisions he/she makes.
E. Encourage the client to pursue legal action.
Answer: A, B, D
Rationale: Identifying areas of control empowers the client. Supporting the client in the
decisions he/she makes empowers the client and enhances the client’s current
problem-solving ability. Establishing trust and rapport provides the client with an ally.

20. Nurse Trent, a community nurse, is conducting a home visit on Mrs. Meyer, a 75
year old client, who lives with an adult male child. Upon entering the house, Nurse Trent
notes the house is filthy with disarranged furniture, unwashed laundry with rodents
present. As a community nurse, Nurse Trent knows that this form of elderly is:
A. Neglect Abuse
B. Psychosocial Abuse
C. Physical Abuse
D. Material Abuse
Answer: A
Rationale: Neglect Abuse includes poor hygiene, lacking needed medications,
dirty/smelly environment, rashes/sores/lice, untreated condition, lacking clothing.
Module 14
1. 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
Answer: B
Rationale: Relaxation techniques help the individual to reduce anxiety to manageable
levels and cope more effectively with anxiety – inducing objects or situations.

2. Which of the following would be the initial intervention for a client having a panic
attack? A. Involve the client in a physical activity.
B. Offer a distraction such as music.
C. Remain with the client.
D. Teach the client a relaxation technique.
Answer: C
Rationale: Immediate intervention by the nurse on a client experiencing a panic attack is
to ensure safety and comfort by ensuring privacy, placing the client in a safe
environment and remaining with the client during the duration of the panic attack.

3. A child being constantly bullied in school has developed an aversion to going to

school exhibited by excessive drowsiness while preparing for school, crying and temper
tantrums in the morning and not wanting to go to school. This behavior is an example
of:
A. Primary Gain
B. Secondary Gain
C. Panic Attack
D. School Phobia
Answer: A
Rationale: Primary gain occurs when the individual performs specific activities that
reduce anxiety such as when the child does not want to go to school because being in
school leads to anxiety because of the possibility of bullying.

4. While assessing an out – patient client with a panic disorder, the nurse
completes a thorough health history and physical examination. Which of the following is
most significant for this client?
A. Compulsive behavior
B. Sense of impending doom
C. Fear of flying
D. Predictable episodes
Answer: B
Rational: The feeling of overwhelming and uncontrollable doom is characteristic of a
panic attack. Panic disorder is an anxiety disorder characterized by recurrent
unexpected panic attacks. Panic attacks are sudden periods of intense fear that may
include palpitations, sweating, tremors and shortness of breath among other physical
symptoms.

5. A client experiencing a panic attack would display which physical symptom?

A. Fear of dying
B. Depersonalization
C. Palpitations and abdominal distress
D. Restlessness and pacing
Answer: C
Rationale: Palpitations and abdominal distress are physical symptoms of a panic attack.
Fear of dying is an affective not a physical symptom. Depersonalization is an alteration
in perception or experience so that one feels temporarily lost. Restlessness and pacing
are behavioral symptoms.

6. You are caring for a man who has a fear of the outside world. He only comes outside
when accompanied by his wife. Based on this situation, the man is likely experiencing:
A. Social Phobia
B. Agoraphobia
C. Claustrophobia
D. Hypochondriasis
Answer: B
Rationale: The patient is suffering from agoraphobia. Agoraphobia is the fear of open
spaces and the fear of being trapped in a situation they may not be able to escape. It
also includes a sense of helplessness or embarrassment if an attack occurs. This leads
to a reduction in social or professional interactions.
7. Jordan is a client with a fear of air travel. He is being treated for phobic disorder. The
treatment method involves systematic desensitization. The nurse would consider the
treatment successful if:
A. Jordan plans a trip requiring air travel.
B. Jordan takes a short trip in an airplane.
C. Jordan recognizes the unrealistic nature of the fear of riding on airplanes.
D. Jordan verbalizes a decreased fear about air travel.
Answer: B
Rationale: Systematic desensitization is a behavioral technique in which the client with a
specific phobia is gradually able to work through hierarchical fears until the most fearful
situation is encountered. In this case, the most fearful thing is riding an airplane for a
long period of time.

8. Social anxiety disorder is:

A. Excessive worry bouts triggered by object or situation
B. Anxiety and discomfort from being embarrassed
C. Intense anxiety from separation with significant others
D. A persistent fear of heights
Answer: B
Rationale: Social anxiety disorder is a significant anxiety and discomfort about being
embarrassed, humiliated, rejected or looked down on in social interactions

9. One important issue in therapy for specific phobias is to address:

A. Ensure the individual never comes in contact with the phobic event or situation
B. The phobic beliefs that sufferers hold about their phobic event or situation
C. The individual has ample opportunity to talk about the phobic event
D. That any dreams about the phobic event or situation are analyzed
Answer: B
Rationale: Phobias are intense, illogical beliefs that specific, objects, animals or
situations cause fear and anxiety.

10. A nurse who is planning a quick remedy to her male client’s phobia plans to
introduce him to the fear – inducing stimuli during the first session of therapy. This
treatment is known as:
A. Desensitization
B. Systematic Desensitization
C. Behavior Desensitization
D. Flooding Desensitization
Answer: D
Rationale: Flooding is a form of rapid desensitization through direct confrontation with
the phobia – inducing an object or situation.

Module 15
1. Fred has a diagnosis of schizophrenia with negative symptoms. In planning
care for the client, Nurse Mae would anticipate a problem with:
A. Auditory hallucinations.
B. Bizarre behaviors.
C. Ideas of reference.
 D. Motivation for activities.
Answer: D
Rationale: In a client demonstrating negative symptoms of schizophrenia, avolition, or
the lack of motivation for activities, is a common problem.

2. Nurse Elwood assesses for evidence of positive symptoms of schizophrenia

in a newly admitted client. Which of the following symptoms are considered positive
evidence? Select all that apply.
A. Anhedonia
B. Delusions
C. Flat affect
D. Hallucinations
E. Loose associations
F. Social withdrawal
Answer: B, D, E
Rationale: Positive symptoms are overt, observable, visible behaviors which are
exhibited by clients with schizophrenia.

3. A client tells the nurse that psychotropic medicines are dangerous and refuses to take
them.
Which intervention should the nurse use first?
A. Ask the client about any previous problems with psychotropic medications.
B. Ask the client if an injection is preferable.
C. Insist that the client takes medication as prescribed.
D. Withhold the medication until the client is less suspicious.
Answer: A
Rationale: The nurse needs to clarify the client’s previous experience with psychotropic
medication in order to understand the meaning of the client’s statement.

4. Lance told his nurse that the CIA is monitoring and recording his every movement
and that microphones have been placed in his room walls. Which action would be the
most therapeutic response?
A. Confront the delusional material directly by telling Gio that this simply is not so.
B. Tell Gio that this must seem frightening to him but that you believe he is safe
here.
C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions.
D. Isolate Gio when he begins to talk about these beliefs.
Answer: B
Rationale: The nurse must realize that these perceptions are very real to the client.
Acknowledging the client’s feelings provides support; explaining how the nurse sees the
situation in a different way provides reality orientation.
5. Upon John’s admission for schizophrenia, Nurse Divine documents the following:
Client refuses to bathe or dress, remains in room most of the day, speaks infrequently to
peers or staff. Which nursing diagnosis would be the priority at this time?
A. Anxiety
B. Decisional conflict
C. Self-care deficit
D. Social isolation
Answer: D
Rationale: These behaviors indicate the client’s withdrawal from others and possible
fear or mistrust of relationships.

6. Which statement is correct about a 25-year-old client with newly diagnosed

schizophrenia? A. Age of onset is typical for schizophrenia.
B. Age of onset is later than usual for schizophrenia.
C. Age of onset is earlier than usual for schizophrenia.
D. Age of onset follows no predictable pattern in schizophrenia.
Answer: A
Rationale: The primary age of onset for schizophrenia is late adolescence through
young adulthood (ages 15 to 25). Paranoid schizophrenia may sometimes have a later
onset. All of the other options are incorrect.

7. The family of a schizophrenic client asks the nurse if there is a genetic cause of this
disorder.
To answer the family, which fact would the nurse cite?
A. Conclusive evidence indicates a specific gene transmits the disorder.
B. Incidence of this disorder is variable in all families.
C. There is a little evidence that genes play a role in transmission.
D. Genetic factors can increase the vulnerability for this disorder.
Answer: D
Rationale: Research shows that family history statistically increases the risk for
development of schizophrenia.

8. Client M arrived in the ER poorly kempt and speaking to an “alien” she calls “Broot”.
After 2 months of hospitalization, client M was discharged. She is now able to take care
of herself and her hallucinations disappeared. Client M’s psychotic disorder is:
A. Schizophrenia
B. Schizophreniform
C. Schizoaffective
D. Shared Psychosis
Answer: B
Rationale: In a schizophreniform disorder, the client experiences the symptoms of
schizophrenia for at least 1 month and either recover from it before 6 months.

9. Folie a deux is synonymous to what type of psychotic disorder?

A. Brief Psychotic Disorder
B. Schizophreniform
C. Schizoaffective
D. Shared Psychosis
Answer: D
Rationale: Folie a deux is a French terminology for shared psychosis.

10. A schizophrenic client is manifesting a bizarre delusion. Which of the

following is an example of bizarre delusion? i. Jealous delusion ii. Dorian Gray iii.
Religious delusion iv. Somatic delusion
A. i, ii
B. i, ii, iii
C. i, iv
D. ii,iii, iv
Answer: D
Rationale: All delusions given, except jealous delusions are all considered bizarre.

Module 16
1. A young, handsome man with a diagnosis of antisocial personality disorder is being
discharged from the hospital next week. He asks the nurse for her phone number so
that he can call her for a date. The nurse’s best response would be:
A. “We are not permitted to date clients.”
B. “No, you are a client and I am a nurse.”
C. “I like you, but our relationship is professional.”
D. “It’s against my professional ethics to date clients.”
Answer: C
Rationale: This accepts the client as a person of worth rather than being cold or
implying rejection. However, the nurse maintains a professional rather than a social
role.
2. A client with avoidant personality disorder says occupational therapy is boring and
doesn’t want to go. Which action would be best?
A. State firmly that you’ll escort him to OT.
B. Arrange with OT for the client to do a project on the unit.
C. Ask the client to talk about why OT is boring
D. Arrange for the client not to attend OT until he is feeling better
Answer: A
Rationale: If given the chance, a client with avoidant personality disorder typically elects
to remain immobilized. The nurse should insist that the client participates in OT.

3. A nurse notices other clients on the unit avoiding a client diagnosed with antisocial
personality disorder. When discussing appropriate behavior in group therapy, which of
the following comments is expected about this client by his peers?
A. Lack of honesty
B. Belief in superstitions
C. Show of temper tantrums
D. Constant need for attention
Answer: A
Rationale: Clients with antisocial personality disorder tend to engage in acts of
dishonesty as shown by lying.

4. Which of the following information must be included for the family of a client
diagnosed with dependent personality disorder?
A. Address coping skills
B. Explore panic attacks
C. Promote exercise programs
D. Decrease aggressive outbursts
Answer: A
Rationale: The family needs information about coping skills to help the client learn to
handle stress.

5. Which of the following characteristics is expected for a client with paranoid

personality disorder who receives bad news?
A. The client is overly dramatic after hearing the facts
B. The client focuses on self to not become over-anxious
C. The client responds from a rational, objective point of view D. The client
doesn’t spend time thinking about the information.
Answer: C
Rationale: Clients with paranoid personality disorder are affectively restricted, appear
unemotional, and appear rational and objective.

6. A hospitalized client, diagnosed with a borderline personality disorder, consistently

breaks the unit’s rules. This behavior should be confronted because it will help the
client:
A. Control anger
B. Reduce anxiety
C. Set realistic goals
D. Become more self-aware
Answer: D
Rationale: Client’s must first become aware of their behavior before they can change it.
Occurs after the client is aware of the behavior and has a desire to change the
behavior.

7. Which of the following types of behavior is expected from a client diagnosed with a
paranoid personality disorder?
A. Eccentric
B. Exploitative
C. Hypersensitive
D. Seductive
Answer: C
Rationale: People with paranoid personality disorders are hypersensitive to perceived
threats.

8. An adult client with a borderline personality disorder become nauseated and vomits
immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The
most appropriate initial response by the nurse would be to:
A. Promptly notify the attending physician
B. Immediately initiate suicide precautions
C. Sit quietly with the client until nausea and vomiting subsides
D. Assess the client’s vital signs and administer syrup of ipecac
Answer: C
Rationale: This intervention demonstrates the nurse’s caring presence which is vital for
this client.

9. A client with schizotypal personality disorder is sitting in a puddle of urine. She’s

playing in it, smiling, and softly singing a child’s song. Which action would be best?
A. Admonish the client for not using the bathroom
B. Firmly tell the client that her behavior is unacceptable
C. Ask the client if she’s ready to get cleaned up now
D. Help the client to the shower, and change the bedclothes.
Answer: D
Rationale: A client with schizotypal personality disorder can experience high levels of
anxiety and regress to childlike behaviors. This client may require help needing self-
care needs. The client may not respond to the other options or those options may
generate more anxiety.

10. Which of the following behaviors by a client with dependent personality disorder
shows the client has made progress toward the goal of increasing problem solving
skills?
A. The client is courteous
B. The client asks questions
C. The client stops acting out
D. The client controls emotions
Answer: B
Rationale: The client with a dependent personality disorder is passive and tries to
please others. By asking questions, the client is beginning to gather information, the first
step of decision making.

TERM 3

MODULE 17
1. Using cognitive-behavioral therapy, which treatment would be appropriate for a client
with depression?
A. Challenging negative thinking
B. Encouraging analysis of dreams
C. Prescribing antidepressant medications
D. Using ultraviolet light therapy
Rationale: Cognitive-behavioral therapy includes identifying and challenging a client’s
negative cognitions. The belief is that these negative thoughts influence the feelings and
behaviors of depression.

2. Nurse Alvin teaches the family of a client with major depressive disorder. Which of the
following information should be included in the teaching? Select all that apply.
A. Depression is characterized by sadness, feelings of hopelessness, and
decreased self-worth
B. It is common for a pressed individual to have thoughts of suicide.
C. Attempts to cheer up a person with depression are often helpful.
D. Talk therapy, along with antidepressant medications, is usually the treatment.
E. Someone with depression may be preoccupied with spending money and too busy to
sleep.
F. Encourage a person with depression to keep a regular routine of activity and
rest.
Rationale: These statements about major depressive disorders provide correct
information and will be helpful to the client’s family.

3. Which of the following would best indicate to the nurse that a depressed client
is improving? A. Reduced levels of anxiety.
B. Changes in vegetative signs such as insomnia, anorexia
C. Compliance with medications.
D. Requests to talk to the nurse.
Rationale: Vegetative signs such as insomnia, anorexia, psychomotor retardation,
constipation, diminished libido, and poor concentration are biological responses to
depression. Improvement in these signs indicates a lifting of the depression.

4. A client is diagnosed with major depressive disorder, is withdrawn and rarely

communicates with others. Which nursing diagnosis should a nurse assign to this client
to address a behavioral symptom of this disorder?
A. Altered communication R/T feelings of worthlessness AEB anhedonia
B. Social isolation R/T poor self-esteem AEB secluding self in room
C. Altered thought processes R/T hopelessness AEB persecutory delusions
D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia
Rationale: A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding
self in room addresses a behavioral symptom of major depressive disorder. Other
behavioral symptoms include psychomotor retardation, virtually nonexistent
communication, maintaining a fetal position, and no personal hygiene and/or grooming.

5. A nurse assesses a client suspected of having major depressive disorder. Which

client symptom does not support this diagnosis?
A. The client is disheveled and malodorous.
B. The client refuses to interact with others. C. The client is
unable to feel any pleasure.
D. The client has maxed-out charge cards and exhibits promiscuous
behaviors. Rationale: The nurse should assess that a client who has maxed-
out credit cards and exhibits promiscuous behavior would be exhibiting manic
symptoms. According to the DSM-IV-TR, these symptoms would rule out the
diagnosis of major depressive disorder.

6. Kathleen, age 68, is a widow of 6 months. Since her husband died, her sister reports
that Kathleen has become socially withdrawn, has lost weight, and does little more each
day than visit the cemetery where her husband was buried. She told her sister today
that she "didn't have anything more to live for." She has been hospitalized with major
depressive disorder. The PRIORITY nursing diagnosis for Kathleen would be:
A. Altered Thought Process
B. Complicated Grieving
C. Risk for Suicide
D Social Isolation
Rationale: This client is indicating thoughts of suicide. Safety should always be
considered the priority with other diagnoses being addressed after the initial threat has
passed.

7. A patient diagnosed with bipolar disorder is dressed in a red leotard & brightly
colored scarves. The patient says, "I'll punch you, munch you, crunch you" while
twirling & shadowboxing. Then the patient says gaily, do you like my scarves? Here,
they are my gift to you. How should the nurse document the patient’s mood? A.
Labile and euphoric
B. Irritable and belligerent
C. Highly suspicious and arrogant
D. Excessively happy and confident
Rationale: The patient has demonstrated angry behavior & pleasant, happy behavior
within seconds of each other. Excessive happiness indicates euphoria. Mood swings
are often rapid & seemingly without understandable reason in patients who are manic.
These swings are documented as labile. Irritability, belligerence, excessive happiness &
confidence are not entirely correct terms for the patient's mood. A high level of suspicion
is not evident.

8. A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for
1 year, presents in an emergency department with severe diarrhea, blurred vision, and
tinnitus. How should the nurse interpret these symptoms?
A. Symptoms indicate consumption of foods high in tyramine.
B. Symptoms indicate lithium carbonate discontinuation syndrome.
C. Symptoms indicate the development of lithium carbonate tolerance.
D. Symptoms indicate lithium carbonate toxicity.
Rationale: The symptoms exhibited by the client are indicative of lithium carbonate
toxicity which include severe diarrhea, blurred vision and tinnitus.

9. A client is diagnosed with bipolar disorder: manic phase. Which nursing

intervention would be implemented to achieve the outcome of "Client will gain 2
lbs by the end of the week?" A. Provide clients with high-calorie finger
foods throughout the day.
B. Accompany clients to the cafeteria to encourage adequate dietary consumption.
C. Initiate total parenteral nutrition to meet dietary needs.
D. Teach the importance of a varied diet to meet nutritional needs.
Rationale: Providing high calorie finger foods ensures that a client in mania is able to
obtain needed nutrition. During mania, individuals rarely have the focus to consume a
full meal. Small, frequent feedings are therefore the best option.

10. A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric
unit. Which is the priority outcome for this client?
A. The client will accomplish activities of daily living independently by discharge.
B. The client will verbalize feelings during group sessions by discharge.
C. The client will remain safe throughout hospitalization.
D. The client will use problem solving to cope adequately after discharge.
Rationale: Bipolar clients are at high – risk for personal injury during the manic phase.
Ensuring the client’s safety is the initial priority for these clients upon admission.

MODULE 18
1. A newly admitted client is diagnosed with post – traumatic stress disorder. Which
behavioral symptom would the nurse expect to assess?
A. Recurrent, distressing flashbacks
B. Intense fear, helplessness and horror
C. Diminished participation in significant activities
D. Detachment or estrangement from others
Rationale: Diminished participation in significant activities is a behavioral symptom of
PTSD. Recurrent, distressing flashbacks are emotional symptoms of PTSD. Intense
fear, helplessness and horror are cognitive symptoms while detachment or
estrangement from others is an interpersonal symptom.

2. When planning the care of a client experiencing post – traumatic stress disorder, the
nurse identifies which of the following as an appropriate goal? The client will report:
A. A decrease in hearing voices
B. Spending less time on ritualistic behaviour
C. Having more energy
D. A decrease in flashbacks and nightmares
Rationale: The target clinical manifestation for a client with PTSD is flashbacks and
nightmares. These are the most common complaints that clients with PTSD report.

3. A nurse at North Medical Center is developing a care plan for a female client with
post-traumatic stress disorder. Which of the following would she do initially?
A. Instruct the client to use distraction techniques to cope with flashbacks.
B. Encourage the client to put the past in proper perspective.
C. Encourage the client to verbalize thoughts and feelings about the trauma.
D. Avoid discussing the traumatic event with client
Rationale: Planning care for a client with post-traumatic stress disorder would involve
helping the client to verbalize thoughts and feelings about the trauma. This will help the
client work through the strong emotions connected with the trauma and, therefore foster
the belief that she is able to cope. Avoiding discussion and using distraction techniques
would be inappropriate. Option B may be possible later, after the client is able to
verbalize strong emotions.

4. A group of community nurses sees and plans care for various clients with different
types of problems.
Which of the following clients would they consider the most vulnerable to post-traumatic
stress disorder?
A. An 8 year-old boy with asthma who has recently failed a grade in school
B. A 20 year-old college student with DM who experienced date rape
C.A 40 year-old widower who has recently lost his wife to cancer
D.A wife of an individual with a severe substance abuse problem
Rationale: Post-traumatic stress disorder is caused by the experience of severe,
specific trauma. Rape is a severely traumatic event. Although the situations in options
A, C, and D are certainly stressful, they are not at the level of severe trauma.

5. The nurse is talking with a PTSD client who just had a beautiful bouquet of roses
delivered. Suddenly the client becomes tearful and stares out the window. The client
has a history of sexual abuse. Which of the following should the nurse include in the
plan of care for this client?
A. Tell the client that the sexual abuse was in the past
B. Tell the client to relax and enjoy the roses
C. Assess if the client is having a flashback
D. Give the client some alone time and return later
Rationale: Clients who have experienced a traumatic event such as sexual abuse may
experience flashbacks. The triggers for these flashbacks may be visual, auditory, tactile,
or olfactory.

6. Nurse Vicky is assessing a newly admitted client for symptoms of post-traumatic

stress disorder (PTSD). Which symptoms are typically NOT seen in clients with this
diagnosis?
A. Frequent thoughts of contamination
B. Excessively surprised and startled
C. Anger with numbing of other emotions
D. Frequent nightmares
Rationale: Frequent thoughts of contamination are exhibited in clients with obsessive -
compulsive disorder and not PTSD.

7. The nurse caring for a PTSD client knows that this diagnosis is what type of disorder?
A. Anger
B. Anxiety
C. Depressive
D. Phobia
Rationale: Posttraumatic stress disorder (PTSD) is an emotional illness that is classified
as an anxiety disorder and usually develops as a result of a terribly frightening, life-
threatening, or otherwise highly unsafe experience.

8. Children experiencing PTSD may exhibit which of the following signs and symptoms
A. Delayed growth spurt
B. Hives
C. Bedwetting
D. Hearing Loss
Rationale: In very young children, symptoms of PTSD can include the following:-
Bedwetting, when they had learned how to use a toilet before- Forgetting how or being
unable to speak- Acting out the scary event during playtime- Being unusually clingy with
a parent or other adult

9. All of the following are re-experiencing symptoms in PTSD EXCEPT:

A. Nightmares
B. Difficulty Sleeping
C. Frightening Thoughts
D. Flashbacks
Rationale: Difficulty Sleeping is an arousal and reactivity symptom.
10. Boy, a fruit vendor who lost his wife in a vehicular accident while they were on their
way home in a vehicular accident two weeks appears so fearful and severely anxious is
likely to be diagnosed with:
A. Acute Stress Disorder
B. Post-Traumatic Stress Disorder
C. Adjustment disorder
D. None of the above
Rationale: A client with ASD develops of severe anxiety, dissociative, and other
symptoms that occurs within one month after exposure to an extreme traumatic stressor

MODULE 19
1. A woman is 5'7", 160 lbs, and wears a size 8 shoe. She says, "My feet are huge. I've
asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to
make her feet look smaller and, in social settings, conceals both feet under a table or
chair. Which problem is likely?
A. Social anxiety disorder
B. Body dysmorphic disorder
C. Separation anxiety disorder
D. Obsessive-compulsive disorder due to a medical condition
Rationale: Body Dysmorphic Disorder is a recurrent and constant preoccupation with an
imagined or exaggerated defect in physical appearance.

2. A client with obsessive-compulsive disorder is hospitalized in an inpatient unit. Which

nursing response is most therapeutic?
A. Accepting the client’s obsessive-compulsive behaviors
B. Challenging the client’s obsessive-compulsive behaviors
C. Preventing the client’s obsessive-compulsive behaviors
D. Rejecting the client’s obsessive-compulsive behaviors
Rationale: A client with obsessive-compulsive behavior uses this behavior to decrease
anxiety. Accepting this behavior as the client’s attempt to feel secure is therapeutic.
When a specific treatment plan is developed, other nursing responses may also be
acceptable.

3. What intervention does the nurse implement to enable the client with repetitive
behavior to complete daily activities?
A. Involve the family in the therapy
B. Increase stimulus to distract client
C. Give the client as much time he wants in a therapy
D. Direct and guide the client in a therapy
Rationale: Directing and guiding a client in a therapy will distract him/her from anxiety
provoking thoughts that will induce a repetitive behaviour.

4. Akara, a 20-year-old female client believes that doorknobs are contaminated and
refuses to touch them, except with a paper tissue. Akara has symptoms of a client with:
A. Obsessive-Compulsive Disorder
B. Hoarding Disorder
C. Body Dysmorphic Disorder
D. Excoriation Disorder
Rationale: Contamination is often an obsession in Obsessive-Compulsive Disorder
which makes client wash hands frequently that leads to skin irritation.

5. Miss K, a celebrity socialite spends 4 hours every day to check on her body. She
claims that she has “small butt” and that part of her lacks curves that must be enhanced
so she can flaunt her body. Miss K is manifesting what disorder?
A. Obsessive-Compulsive Disorder
B. Hoarding Disorder
C. Body Dysmorphic Disorder
D. Excoriation Disorder
Rationale: Preoccupation of an “imagined” defect that causes a client to spend an hour
or more on thoughts and behaviors relating to the “defect” is common for clients with
BDD.

6. Habit reversal as a therapy is used in clients with:

A. Obsessive-Compulsive Disorder
B. Hoarding Disorder
C. Body Dysmorphic Disorder
D. Excoriation Disorder
Rationale: Habit reversal training eases stress when the client has triggers. Skin picking
will be prevented as the hands of the client are given material to hold or squeeze to
divert attention.

7. A client in the psychiatric ER admitted a client with baldness. The client appears
socially impaired and admits to pull her hair to relieve her tension that started 2 years
ago when her boyfriend died. Which of the following best describes her condition?
A. Obsessive-Compulsive Personality Disorder
B. Hoarding Disorder
C. Trichotillomania
D. Body Dysmorphic Disorder
Rationale: The client feels a compulsion to pull hair and feelings of satisfaction from the
act in Trichotillomania. This act of the client is a coping mechanism as she experienced
a great deal of anxiety when she lost a loved one.

8. A nurse in the Psych unit is assigned to a client with OCD. The nurse identifies
all of the following manifestations of OCD clients except: A. Arranging & Re-
arranging
B. Hearing voices in a silence place
C. Waking up in at night several times to check if doors are locked
D. Making sure clothes are inside the closet are color coded
Rationale: Auditory hallucination is not a manifestation of OCD but of psychotic illness
like schizophrenia wherein a client loses touch with reality.

9. Which of the following is a behavioral symptom of a client with OCD?

A. Doubting one’s memory
B. Intense Fear
C. Checking rituals D. Scrupulosity
Rationale: B is a symptom of PTSD, A & D are symptoms of OCD, but only C is a
behavioral symptom.
10. Marky loves to go to the mall with his friends. But often, he has the tendency to
avoid the lines on the floor tiles which makes him odd among his friends. Avoiding the
lines as Marky steps on the floor is a: A. Obsession
B. Compulsion
C. Illusion
D. Gratification
Rationale: Compulsion is a repetitive behavior done to prevent distress when there is an
obsession.

MODULE 20
1. The nurse is working with a client with a somatic symptom disorder. Which client
outcome goal would the nurse most likely establish in this situation?
A. The client will recognize signs and symptoms of physical illness.
B. The client will cope with physical illness.
C. The client will take prescribed medications.
D. The client will express emotional conflicts verbally rather than covert it through
physical symptoms.
Rationale: The client with a somatoform disorder displaces conflicts and anxiety into
physical symptoms. The ability to express anxiety verbally indicates a positive change
toward improved health.

2. Which outcome is most appropriate for Angelo who has a

dissociative disorder? A. Angelo will deal with uncomfortable
emotions on a conscious level.
B. Angelo will modify stress with the use of relaxation techniques.
C. Angelo will identify his anxiety responses.
D. Angelo will use problem-solving strategies when feeling stressed.
Rationale: Dissociative disorders occur when traumatic events are beyond an
individual’s recall because these memories have been “blocked” from conscious
awareness. Bringing the feelings associated with these events into conscious
awareness and coping with these feelings will decrease the need for dissociation.

3. The nurse evaluates the treatment of Mrs. Reyes with somatic symptom disorder
as successful if: A. Mrs. Reyes practices self-medication rather than changing health
care providers.
B. Mrs. Reyes recognizes that physical symptoms increase anxiety level.
C. Mrs. Reyes researches treatment protocols for various illnesses.
D. Mrs. Reyes verbalizes anxiety directly rather than displacing it.
Rationale: Mrs. Reyes with somatic symptom disorder unconsciously displaces anxiety
onto physical symptoms. The ability to recognize and verbalize anxious feelings directly
rather than displacing them is a criterion of treatment success.

4. A newly admitted client is diagnosed with Dissociative Identity Disorder. Which

nursing intervention is a priority for the client?
A. Teach new coping skills to replace dissociative behaviors
B. Identify relationships between subpersonalities and work with each equally
C. Establish an atmosphere of safety and security
D. Process events associated with the origins of the disorder
Rationale: In clients with dissociative disorders, it is a priority of the nurse to establish
an atmosphere of safety and security in which trust can be established so that a client
would feel comfortable to discuss past traumatic events.
5. Which of the following clinical manifestations would the nurse expect to assess in a
client with Depersonalization Disorder?
A. Mechanical, dreamy and detached feelings
B. Ambivalence
C. A loss of reality testing ability
D. Anger
Rationale: A client with Depersonalization Disorder experiences a persistent,recurrent
feeling of being detached from his/her body or mental process.

6. The nurse admitting a client with suspected Dissociative Amnesia would report which
of the following manifestations?
A. The amnesia is a result of prolonged substance abuse
B. The client’s inability to recall personal information
C. The amnesia has its etiology in a medical condition
D. The client exhibits common forgetfulness
Rationale: A client with Dissociative Amnesia is unable to recall familiar personal
information that is beyond mere forgetfulness only.

7. Clients diagnosed with Dissociative Disorder commonly use which defense

mechanism?
A. Suppression
B. Repression
C. Denial
D. Dissociation
Rationale: An individual with dissociative disorder disconnects with reality from their
thoughts, feelings, actions to cope up with stressful situations.

8. Mapping is a part of the therapy in what type of dissociative disorder?

A. Dissociative Amnesia
B. Dissociative Fugue
C. Dissociative Identity Disorder
D. Depersonalization Disorder
Rationale: Mapping is an exercise designed to look for alters in DID to analyze their
relationship with one another. Dissociative amnesia can be accompanied by fugue
wherein the client temporarily lose their personal identity and wanders off.

9. Which of the following is an adjunctive therapy in Dissociative Disorders?

A. Psychotherapy
B. Anxiolytics
C. Antidepressants
D. Music Therapy
Rationale: Music Therapy is not a primary treatment in all mental disorders but an
adjunct therapy.

10. Seizure may occur in what somatic related disorder?

A. Conversion Disorder
B. Illness Anxiety Disorder
C. Somatic Symptom Disorder
D. Pseudocyesis

Rationale: Clients develop neurological symptoms that can't be traced back to a medical
cause in a Conversion Disorder.

MODULE 21
1. Nurse Gigi is caring for a client diagnosed with bulimia. The most appropriate initial
goal for a client diagnosed with bulimia is to:
A. Avoid shopping for large amounts of food
B. Control eating impulses
C. Identify anxiety-causing situations
D. Eat only three meals per day
Rationale: Bulimic behavior is generally a maladaptive coping response to stress and
underlying issues. The client must identify anxiety-causing situations that stimulate
bulimic behavior and then learn new ways of coping with the anxiety.

2. During postprandial glucose monitoring, a female client with bulimia nervosa tells the
nurse, “You can sit with me, but you’re just wasting your time. After you sat with me
yesterday, I was still able to purge. Today, my goal is to do it twice.” What is the nurse’s
best response?
A. “I trust you not to purge.”
B. “How are you purging and when do you do it?”
C. “Don’t worry. I won’t allow you to purge today.”
D. “I know it’s important for you to feel in control, but I’ll monitor you for 90
minutes after you eat.”
Rationale: This response acknowledges that the client is testing limits and that the
nurse is setting them by performing postprandial glucose monitoring to prevent self-
induced emesis. Clients with bulimia nervosa need to feel in control of the diet because
they feel they lack control over all other aspects of their lives.

3. For a female client with anorexia nervosa, Nurse Brad is aware that which goal takes
the highest priority?
A. The client will establish adequate daily nutritional intake
B. The client will make a contract with the nurse that sets a target weight
C. The client will identify self-perceptions about body size as unrealistic
D. The client will verbalize the possible physiological consequences of self-starvation
Rationale: According to Maslow’s hierarchy of needs, all humans need to meet basic
physiological needs first. Because a client with anorexia nervosa eats little or nothing,
the nurse must first plan to help the client meet this basic, immediate physiological
need.

4. For a female client with anorexia nervosa, Nurse Irene plans to include the parents in
therapy sessions along with the client. What fact should the nurse remember to be
typical of parents of clients with anorexia nervosa?
A. They tend to overprotect their children
B. They usually have a history of substance abuse
C. They maintain emotional distance from their children
D. They alternate between loving and rejecting their children
Rationale: Clients with anorexia nervosa typically come from a family with parents who
are controlling and overprotective. These clients use eating to gain control of an aspect
of their lives.
5. Nurse Jackie is caring for a client with bulimia. Strict management of dietary intake is
necessary. Which intervention is also important?
A. Fill out the client’s menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least
2 hours after each meal
C. Let the client choose her own food. If she eats everything she orders, then stay
with her for 1 hour after each meal
D. Let the client eat food brought in by the family if she chooses, but she should keep a
strict calorie count.
Rationale: Allowing the client to select her own food from the menu will help her feel
some sense of control.

6. A 27-year old client with anorexia nervosa tells the nurse, “When I look in the mirror, I
hate what I see. I look so fat and ugly.” Which strategy should the nurse use to deal with
the client’s distorted perceptions and feelings?
A. Avoid discussing the client’s perceptions and feelings
B. Focus discussions on food and weight
C. Avoid discussing unrealistic cultural standards regarding weight
D. Provide objective data and feedback regarding the client’s weight and
attractiveness Rationale: By focusing on reality, this strategy may help the client
develop a more realistic body image and gain self esteem.

7. Nurse Angelo is developing a plan of care for a client with anorexia nervosa. Which
action should the nurse include in the plan?
A. Restrict visits with the family until the client begins to eat
B. Provide privacy during meals
C. Set up a strict eating plan for the client
D. Encourage the client to exercise, which will reduce her anxiety
Rationale: Establishing a consistent eating plan and monitoring the client’s weight are
important for this disorder.

8. A 19-year-old client was brought to the clinic by her mother. Her mother expresses
concern about her daughter’s weight loss and constant dieting. Nurse Kathleen
conducts a health history interview. Which of the following comments indicates that the
client may be suffering from anorexia nervosa?
A. “I like the way I look. I just need to keep my weight down because I’m a cheerleader.”
B. “I don’t like the food my mother cooks. I eat plenty of fast food when I’m out with my
friends.”
C. “I just can’t seem to get down to the weight I want to be. I’m so fat compared to
other girls.”
D. “I do diet around my periods; otherwise, I just get so bloated.”
Rationale: Low self-esteem is the highest risk factor for anorexia nervosa. Constant
dieting to get down to a “desirable weight” is characteristic of the disorder. Feeling
inadequate when compared to peers indicates poor self-esteem.

9. Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which
nursing intervention is most appropriate for this client?
A. Providing one-on-one supervision during meals and for one (1) hour afterward
B. Letting the client eat with other clients to create a normal mealtime atmosphere
C. Trying to persuade the client to eat and thus restore nutritional balance
D. Giving the client as much time to eat as desired
Rationale: Because the client with anorexia nervosa may discard food or induce
vomiting in the bathroom, the nurse should provide one-on-one supervision during
meals and for 1 hour afterward.

10. A nurse observes dental deterioration when assessing a client diagnosed with
bulimia nervosa. What explains this assessment finding?
A. The emesis produced during purging is acidic and corrodes the tooth enamel.
B. Purging causes the depletion of dietary calcium.
C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene
leads to dental caries.
Rationale: The nurse recognizes that dental deterioration has resulted from the acidic
emesis produced during purging that corrodes the tooth enamel. Excessive vomiting
may also lead to dehydration and electrolyte imbalance.
MODULE 22
1. Nurse Alvin has observed a co-worker arriving to work drunk at least three times in
the past month. Which action by Nurse Alvin would best ensure client safety and obtain
necessary assistance for the co-worker?
A. Ignore the co- worker’s behavior, and frequently assess the clients assigned to the
co-worker.
B. Make general statements about safety issues at the next staff meeting.
C. Report the coworker’s behavior to the appropriate supervisor.
D. Warn the co-worker that this practice is unsafe.
Rationale: The nurse is obligated by ethical considerations of client safety, as well as by
nurse practice acts in many states, to report substance abuse in health care workers.
Most healthcare facilities have an employee assistance program to help workers with
substance abuse problems.

2. Nurse Aly is teaching a client about Disulfiram (Antabuse), which the client is taking
to deter his use of alcohol. She explains that using alcohol when taking this medication
can result in: A. Abdominal cramps and diarrhea.
B. Drowsiness and decreased respiration.
C. Flushing, vomiting, and dizziness.
Rationale: Disulfiram (Antabuse) prevents complete alcohol metabolism in the body.
Therefore when alcohol is consumed, the client has a hypersensitivity reaction.
Flushing, vomiting, and dizziness are associated with the incomplete breakdown of
alcohol metabolites.

3. The community nurse practicing primary prevention of alcohol abuse would target
which groups for educational efforts?
A. Adolescents in their late teens and young adults in their early twenties
B. Elderly men who live in retirement communities
C. Women working in careers outside the home
D. Women working in the home
Rationale: High-risk groups for alcohol abuse include individuals between ages 18 and
25 and the unemployed.

4. Which medication is commonly used in treatment programs for heroin abusers to

produce a non-euphoric state and to replace heroin use?
A. Diazepam
B. Carbamazepine
C. Clonidine
D. Methadone
Rationale: Methadone maintenance programs are used to provide a heroin-depleted
individual with a medically controlled dose of methadone to produce a non - euphoric
state that will prevent withdrawal symptoms. This method of treatment is advocated to
help heroin abusers avoid criminal activities associated with obtaining heroin; it also
prevents diseases associated with I.V. use of heroin.

5. Nurse Niko recommends that the family of a client with substance-related disorder
attend a support group. The purpose of these groups is to help family members
understand the problem and to: A. Change the problem behaviors of the abuser.
B. Learn how to assist the abuser in getting help.
C. Maintain focus on changing their own behaviors.
D. Prevent substance problems in vulnerable family members.
Rationale: Family support groups emphasize the importance of changing one’s own
behavior rather than trying to change the behavior of the individual with a substance
abuse problem.

MODULE 23
1. A child diagnosed with intellectual disability (ID) is under the supervision of Nurse
Tasha. The nurse is aware that the signs and symptoms of mild ID include which of the
following?
A. Few communication skills
B. Lateness in walking
C. Mental age of a toddler
D. Noticeable developmental delays
Rationale: Mild intellectual disability is minimally noticeable in young children, with one
of the signs being a delay in achieving developmental milestones, such as walking at a
later stage.

2. Ritalin is the drug of choice for children with ADHD. The side effects of the following
may be noted:
A. Increased attention span and concentration
B. Increase in appetite
C. Sleepiness and lethargy
D. Bradycardia and diarrhea
Rationale: The medication has a paradoxical effect that decreases hyperactivity and
impulsivity among children with ADHD.
3. A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q.
of 45. She is diagnosed to have Mental retardation of this classification:
A. Profound
B. Mild
C. Moderate
D. Severe
Rationale: The child with moderate mental retardation has an I.Q. of 35-51.

4. The nurse teaches the parents of a mentally retarded child regarding her care. The
following guidelines may be taught except: A. Overprotection of the child
B. Patience, routine, and repetition
C. Assisting the parents set realistic goals
D. Giving reasonable compliments
Rationale: The child with mental retardation should not be overprotective but need
protection from injury and the teasing of other children.

5. Intellectual Disability (Mental Retardation) is usually diagnosed before age 18 years

and characterized by?
A. Average IQ and lack of parental involvement
B. Low IQ and problems with daily living
C. Low IQ and lack of parental involvement
D. Average IQ and problems with daily living
Rationale: Intellectual Disability (Mental Retardation) is characterized by below-average
intelligence or mental ability and a lack of skills necessary for day-to-day living.

6. The parents of Alexa, a child with attention deficit hyperactivity disorder, tell the nurse
they have tried everything to calm their child and nothing has worked. Which action by
the nurse is most appropriate initially?
A. Actively listen to the parents’ concern before planning interventions.
B. Encourage the parents to discuss these issues with the mental health team.
C. Provide literature regarding the disorder and its management.
D. Tell the parents they are overreacting to the problem.
Rationale: The nurse would encourage parents to fully discuss and describe their
perception of the problem in order to assess the family system before determining
appropriate interventions.

7. Nurse Daya, a school nurse, is meeting with the school and health treatment team
about a child who has been receiving methylphenidate (Ritalin) for two (2) months. The
meeting is to evaluate the results of the child’s medication use. Which behavior change
noted by the teacher will help determine the medication’s effectiveness? A. Decrease
repetitive behaviors
B. Decreased signs of anxiety
C. Increased depressed mood
D. Increased ability to concentrate on tasks
Rationale: Methylphenidate (Ritalin) is used as a method of treatment of ADHD.
Evidence of increased ability to concentrate on tasks while taking this medication would
establish the drug’s effectiveness.

8. The school nurse assesses Brook, a child newly diagnosed with attention deficit
hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of
the disorder? Select all that apply.
A. Constant fidgeting and squirming
B. Excessive fatigue and somatic complaints
C. Difficulty paying attention to details D. Easily distracted
E. Running away
F. Talking constantly, even when inappropriate
Rationale: These behaviors are all characteristic of ADHD and indicate that the child is
inattentive, hyperactive, and impulsive. Options B and E are signs of emotional distress
in a child and could be associated with a number of different psychiatric diagnoses.
9. The community nurse visits the home of George, a child recently diagnosed with
autism. The parents express feelings of shame and guilt about having somehow caused
this problem. Which statement by the nurse would best help alleviate parental guilt?
A. “Autism is a rare disorder. Your other children shouldn’t be affected.”
B. “The specific cause of autism is unknown. However, it is known to be
associated with problems in the structure of and chemicals in the brain.”
C. “Sometimes a lack of prenatal care can be the cause of autism.”
D. “Although autism is genetically inherited if you didn’t have testing you could not have
known this would happen.”
Rationale: This statement is factual and does not cast blame on anything the parents
did or did not do. This non –judgmental attitude relieves parental guilt.

10. A 5-year-old boy is diagnosed to have autism. Which of the following manifestations
may be noted in a client with autism?
A. Argumentative, disobedience, angry outburst
B. Intolerance to change, disturbed relatedness, stereotypes
C. Distractibility, impulsiveness, and overactivity
D. Aggression, truancy, stealing, lying
Rationale: Intolerance to change, disturbed relatedness, stereotypes are manifestations
of autism