NCLEX RN Mental Health and Psychiatric Nursing Test
bank with answers & Rationale
(Psychiatric Medications)
1. David with paranoid schizophrenia repeatedly uses profanity during an activity therapy session.
Which response by the nurse would be most appropriate?
A. "Your behavior won't be tolerated. Go to your room immediately."
B. "You're just doing this to get back at me for making you come to therapy."
C. "Your cursing is interrupting the activity. Take time out in your room for 10
minutes."
D. "I'm disappointed in you. You can't control yourself even for a few minutes."
Correct Answer: C. “Your cursing is interrupting the activity. Take time out in your room for 10
minutes.”
The nurse should set limits on client behavior to ensure a comfortable environment for all clients.
Maintain a consistent approach, employ consistent expectations, and provide a structured environment.
Clear and consistent limits and expectations minimize the potential for the client’s manipulation of staff.
Option A: The nurse should accept hostile or quarrelsome client outbursts within limits without
becoming personally offended. Use a calm and firm approach. This provides structure and control
for a client who is out of control. Use short, simple, and brief explanations or statements. A short
attention span limits understanding to small pieces of information.
Option B: This is incorrect because it implies that the client’s actions reflect feelings toward the staff
instead of the client’s own misery. Remain neutral as possible; Do not argue with the client. The
client can use inconsistencies and value judgments as justification for arguing and escalating mania.
Redirect agitation and potentially violent behaviors with physical outlets in an area of low
stimulation (e.g., punching bag). This can help to relieve pent-up hostility and relieve muscle tension.
Option D: Judgmental remarks may decrease the client’s self-esteem. Maintain a firm, calm, and
neutral approach at all times. These behaviors by the staff can escalate environmental stimulation
and, consequently, manic activity. Once the manic client is out of control, seclusion might be
required, which can be traumatic to the manic individual as well as the staff.
2. Nurse Mickey 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.
,Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client
must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of
coping with the anxiety. Be mindful of the patient’s distorted thinking ability. This allows the caregiver to
have more realistic expectations of the patient and provide appropriate information and support. Listen
to or avoid challenging irrational, illogical thinking. Present reality concisely and briefly. It is difficult to
respond logically when thinking ability is physiologically impaired. The patient needs to hear reality, but
challenging the patient leads to distrust and frustration. Even though the patient may gain weight, she
or he may continue to struggle with attitudes or behaviors typical of eating disorders, major depression,
or alcohol dependence for a number of years.
Option A: Make a selective menu available, and allow the patient to control choices as much as
possible. Patient who gains confidence in herself and feels in control of the environment is more
likely to eat preferred foods. Involve the patient in setting up or carrying out a program of behavior
modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides
structured eating situations while allowing the patient some control in choices. Behavior
modification may be effective in mild cases or for short-term weight gain.
Option B: Supervise the patient during mealtimes and for a specified period after meals (usually one
hour). This prevents vomiting during or after eating. Use a consistent approach. Sit with the patient
while eating; present and remove food without persuasion and comment. Promote a pleasant
environment and record intake. Patient detects urgency and may react to pressure. Any comment
that might be seen as coercion provides focus on food. When staff responds in a consistent manner,
the patient can begin to trust staff responses. The single area in which the patient has exercised
power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat.
Structuring meals and decreasing discussions about food will decrease power struggles with the
patient and avoid manipulative games.
Option D: Provide smaller meals and supplemental snacks, as appropriate. Gastric dilation may
occur if refeeding is too rapid following a period of starvation dieting. Note: The patient may feel
bloated for 3–6 weeks while the body adjusts to food intake. Be alert to choices of low-calorie foods
and beverages; hoarding food; disposing of food in various places, such as pockets or wastebaskets.
The patient will try to avoid taking in what is viewed as excessive calories and may go to great
lengths to avoid eating.
3. Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her
hands for long periods each day. How should the nurse respond to this compulsive behavior?
A. By designating times during which the client can focus on the behavior.
B. By urging the client to reduce the frequency of the behavior as rapidly as possible.
C. By calling attention to or attempting to prevent the behavior.
D. By discouraging the client from verbalizing anxieties.
Correct Answer: A. By designating times during which the client can focus on the behavior.
,The nurse should designate times during which the client can focus on compulsive behavior or obsessive
thoughts. Gradually limit the amount of time allotted for ritualistic behavior as the client becomes more
involved in unit activities. Anxiety is minimized when the client is able to replace ritualistic behaviors
with more adaptive ones.
Option B: The nurse should urge the client to reduce the frequency of the compulsive behavior
gradually, not rapidly. During the beginning of treatment, allow plenty of time for rituals. Do not be
judgmental or verbalize disapproval of the behavior. To deny the client this activity can precipitate
panic level of anxiety.
Option C: She shouldn’t call attention to or try to prevent the behavior. Trying to prevent the
behavior may cause pain and terror to the client. Support and encourage the client’s efforts to
explore the meaning and purpose of the behavior. The client may be unaware of the relationship
between emotional problems and compulsive behaviors. Recognition and acceptance of problems
are important before a change can occur.
Option D: The nurse should encourage the client to verbalize anxieties to help distract attention
from the compulsive behavior. Encourage the recognition of situations that provoke obsessive
thoughts or ritualistic behaviors. Recognition of precipitating factors is the first step in teaching the
client to interrupt escalation of anxiety.
4. In recognizing common behaviors exhibited by a male client who has a diagnosis of
schizophrenia, nurse Josie can anticipate:
A. Slumped posture, pessimistic outlook, and flight of ideas
B. Grandiosity, arrogance, and distractibility
C. Withdrawal, regressed behavior, and lack of social skills
D. Disorientation, forgetfulness, and anxiety
Correct Answer: C. Withdrawal, regressed behavior, and lack of social skills
These are the classic behaviors exhibited by clients with a diagnosis of schizophrenia. Traditionally,
symptoms have divided into two main categories: positive symptoms which include hallucinations,
delusions, and formal thought disorders, and negative symptoms such as anhedonia, poverty of speech,
and lack of motivation.
Option A: Negative symptoms refer to reduced or lack of ability to function normally. For example,
the person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact,
doesn’t change facial expressions, or speaks in a monotone). Also, the person may lose interest in
everyday activities, socially withdraw or lack the ability to experience pleasure.
Option B: Delusions are false beliefs that are not based in reality. For example, you think that you’re
being harmed or harassed; certain gestures or comments are directed at you; you have exceptional
ability or fame; another person is in love with you, or a major catastrophe is about to occur.
Delusions occur in most people with schizophrenia.
, Option D: Disorganized thinking is inferred from disorganized speech. Effective communication can
be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may
include putting together meaningless words that can’t be understood, sometimes known as word
salad.
5. Nurse Judy knows that statistics show that in adolescent suicidal behavior:
A. Females use more dramatic methods than males.
B. Males account for more attempts than do females.
C. Females talk more about suicide before attempting it.
D. Males are more likely to use lethal methods than are females.
Correct Answer: D. Males are more likely to use lethal methods than are females
This finding is supported by research; females account for 90% of suicide attempts but males are three
times more successful because of methods used. Suicide represents the tenth leading cause of death in
the United States and the third leading cause of death for children, adolescents, and young adults. In
2014, there were 42,773 suicides in the United States.
Option A: Of the 9.4 million adults with serious thoughts of suicide, 2.7 million reported they had
made suicide plans, and 1.1 million made a nonfatal suicide attempt. Among the 1.1 million adults
who attempted suicide in the past year, 0.9 million reported making suicide plans, and 0.2 million
did not make suicide plans.
Option B: Nearly one-third of adults who had serious thoughts of suicide made suicide plans, and
about 1 in 9 adults who had serious thoughts of suicide made a suicide attempt. In other words,
more than two-thirds of adults in 2014 who had serious thoughts of suicide did not make suicide
plans, and 8 out of 9 adults who had serious thoughts of suicide did not attempt suicide.
Option C: A study of the association between the provision of mental health services and suicide
rates found that removing ligature points (places where things like ropes could be attached to) was
associated with significant reductions in the overall psychiatric inpatient suicide rate and in the rate
of inpatient suicide by hanging. Similarly, assessing other available sources of self-destructive
implements such as pills and guns is critical.
6. Richard is admitted with a diagnosis of schizotypal personality disorder. Which signs would this
client exhibit during social situations?
A. Aggressive behavior
B. Paranoid thoughts
C. Emotional affect
D. Independence needs
Correct Answer: B. Paranoid thoughts
