Psychiatric/Mental Health Practice Exam

A female client arrives in the clinic carrying a duffle bag and is wearing torn and dirty clothes. She tells the practical nurse (PN) she has no place to go. The PN takes her vital signs and observes leg ulcers on both lower extremities. What additional information should the practical nurse obtain to determine if she is homeless?

A. Ask the client directly about her living arrangements

A client diagnosed with Stage 3 Alzheimer's disease is experiencing difficulty toileting appropriately. What instruction is best for the practical nurse (PN) to provide the family?

A. Label the client's bathroom door.

The practical nurse (PN) is caring for a male client with schizophrenia who is exhibiting forgetfulness, disinterest in activities, and difficulty completing tasks. Which intervention should the PN implement?

A. Provide a structured schedule of activities on the unit.

A 19-year-old calls the clinic and tells the practical nurse (PN) that since bringing her newborn infant home, she has felt apathetic, fatigued, and helpless. She states, "I don't know what's expected of me." What action is most important for the PN to take?

A. Tell the charge nurse to come to the phone and talk with the client.

A man who has been admitted numerous times for alcohol detoxification is found wandering in the street and is unable to identify himself or his home address. He is manifesting ataxia, nystagmus, and confusion and has a blood alcohol level (BAL) of 0.29%. Which prescribed medication should the practical nurse (PN) administer to prevent Korsakoff's psychosis?

A. Thiamine

Which finding should the practical nurse (PN) report immediately when talking with a new mother who is diagnosed with postpartum depression with psychotic features?

A. Thoughts of harming her infant.

The nurse who is leading a group therapy session is called to manage a unit emergency and assigns the practical nurse (PN) as the leather of the group. During the therapeutic session, a client challenges the PN as the leader. Which response should the practical nurse (PN) communicate?

A. You are saying that I should not be the leader?

A male client with depression is unresponsive and preoccupied with guilt and hopelessness. Which statement should the practical nurse (PN) use that provides therapeutic feedback to the client?

B. "The group appreciated your comments today."

A male client arrives at the mental health clinic complaining of insomnia, irritability, increased tension, and headaches. He tells the practical nurse that the symptoms began a week ago after he lost his job, and he is concerned that he may have to relocate his family. Which stressor is this client experiencing?

B. A situational crisis.

The practical nurse (PN) is caring for a client with bulimia who continues to deny purging. Which finding should the PN report to the RN?

B. Dental erosion.

A female client tells the practical nurse (PN) that she wants to lead a healthier, more balanced life style. She asks the PN how she should begin the process of self-exploration. Which message should the PN convey?

B. Each adult is responsible for one's own behaviors, including unhealthy behaviors.

A male client is admitted to the hospital with distorted sensory perceptions, disordered thoughts, and an increase in non-goal directed motor activity. The client does not respond to the practical nurse's (PN) calming efforts.

B. Ensure the environment is safe.

The practical nurse (PN) is taking the blood pressure of a middle-aged male who is involved with his children's sports teams as a coach and referee. While establishing a nurse-client relationship, the client tells the PN that he hires and trains teenagers to work part-time in his restaurant. Which psychosocial development stage is the client experiencing?

B. Generativity.

The practical nurse (PN) is assessing a newly admitted client with paranoid schizophrenia who is hypervigilant and who constantly scans the environment. The client tells the PN, "I saw those two doctors in the hall talking about me." What descriptive terminology should the PN document to describe the client's thought process?

B. Ideas of reference

The practical nurse (PN) is inquiring about coping strategies with a male client who is admitted for alcohol abuse. The client tells the PN that his job skills and communication skills are his best assets and support. Which additional information should the PN obtain about maladaptive mechanisms?

B. Self indulgence

What approach is best for the practical nurse (PN) to use when establishing a relationship with a severely socially withdrawn male client diagnosed with schizophrenia?

B. Sit with the client in silence several times a day.

Which part of the client's plan of care is the practical nurse (PN) implementing when plans are used to increase a male client's participation in his own care and social environment?

B. The therapeutic community.

The practical nurse (PN) is caring for a male client who is admitted for schizophrenia and observes that his thoughts do not flow logically and he uses invented words. How should the PN document this behavior?

B. Uses neologisms and tangential expressions.

A client with schizophrenia approaches the practical nurse (PN) and says, "The voices are bothering me. They're yelling and telling me I'm bad. Can't you hear them?" Which response should the PN provide?

C. "I can't hear the voices, but I can see that you're upset."

When the mother of a young child is diagnosed with HIV, she asks the practical nurse (PN), "who will take care of my children if I die soon?" What response is best for the PN to provide?

C. "This is an important consideration, but you may live until they are grown up or even longer."

A male client is admitted with major depression and tells the practical nurse (PN) that he feels like a freak since he is being admitted to a psychiatric unit in the hospital. He feels like he is the only one with this problem. Which information should the PN provide the client?

C. About 50% of the population between the age of 15 and 55 have had a psychiatric disorder.

A male client with dementia who lives in an extended care facility is placed in a wheelchair each day and positioned in the hall where he kicks people who walk past him Which intervention should the practical nurse (PN) implement?

C. Call him by name until he focuses his attention.

The practical nurse (PN) assesses a client with a poor self-concept. This client is most likely to demonstrate which behaviors?

C. Escalation of anxiety.

A client with delusions of persecution has been refusing all the hospital meals for the last 3 days and tells the practical nurse that the food contains poison. What action should the PN implement?

C. Provide foods in the original closed containers.

A practical nurse (PN) is reinforcing the steps for a dressing change for a male client who has a leg ulcer. When the client tries to change the dressing, he says he is inadequate, incompetent, and feels helpless. Which problem should the PN recognize that the client is exhibiting?

C. Self-esteem disturbance.

A client who is admitted for surgery seems to focus only on his immediate concerns and asks the practical nurse (PN) to repeat everything that is said over again. The client seems to follow directions but asks for assistance when filling out admission forms and checklists. He apologizes to the PN often and says he did not hear all of the instructions. This client is experiencing which level of anxiety?

C. Severe

The practical nurse (PN) is answering questions that the mother and her teenage daughter who is admitted with anorexia nervosa are asking about hospitalization. Which statement by the client's mother indicates to the PN that she understands this disease?

C. She sees herself as being very fat even though she is severely underweight.

A woman tells the practical nurse (PN) that for the past 6 months she has been terrified of leaving home. Whenever she thinks about going outdoors her heart pounds, she shakes and cries, and feels dizzy. Based on these findings, which nursing diagnosis should the practical nurse (PN) consider when caring for this client?

C. Social isolation related to avoidance behavior as evidenced by inability to go out of doors.

An older client who is hospitalized with pneumonia becomes disoriented and confused 2 days after admission. Which factor should the practical nurse (PN) identify to differentiate that the client is experiencing delirium, not dementia?

D. Acute onset of symptoms.

Which nursing intervention is best to help a female client with progressive memory deficit?

D. Assist the client to perform simple tasks by giving step-by-step directions.

A practical nurse (PN) is interacting with a female client who is discussing her divorce as a stressor. What areas should be explored with the client to gather the most relevant information?

D. Biopsychosocial responses.

During a prenatal visit, a client who is in the second trimester of pregnancy tells the practical nurse (PN) that she is using cocaine. What information about cocaine is most important for the PN to provide the client?

D. Cocaine can cause miscarriage or premature onset of labor.

The practical nurse (PN) is caring for a female client with chronic psychosis who repeatedly tells the PN that her arm is missing and she cannot participate in the group activities. Which response should the PN offer when providing reality validation to the client?

D. Do you mean, it feels like your arm is missing?

Which finding should the practical nurse (PN) identify in a 10-year-old client who is diagnosed with attention deficit hyperactivity disorder (ADHD)?

D. Inability to concentrate long enough to complete school work.

An older male client who has vision and hearing problems is admitted after a combative incident with his caregivers. Which intervention should the practical nurse (PN) implement when providing basic care?

D. Obtain the client's attention and consent before starting care.

When implementing the plan of care for a client who is recovering from an overdose of clomipramine (Anafranil), the practical nurse (PN) recognizes that it is essential to monitor the client for which side effects?

D. Orthostatic hypotension and constipation.

During the admission interview to an inpatient psychiatric unit, the practical nurse (PN) asks a male client who is admitted with depression about recent life events that precipitated his admission. The client remains silent, looks at the floor, and does not answer any of the PN's questions. Which intervention is best for the PN to implement?

D. Record these findings in the medical record under the DSM IV Axis IV.

A male client who is hospitalized for depression ruminates over poor financial decisions that he made in the past and calls himself "stupid". Which strategy should the practical nurse (PN) implement to limit the amount of time the client spends on negative self-evaluation?

D. Schedule occupational therapy and unit activities for this client.

A 20-year-old male client who is admitted to the mental health unit for adjustment disorder is telling the practical nurse (PN) that he wants to find an apartment, but he is afraid he does not make enough money to move out of his parent's home. Using Erikson's theory of psychosocial development, which developmental stage should the PN explore with this client?

D. Sense of freedom in the community.

During a routine prenatal visit, the practical nurse (PN) is assessing a pregnant female client who expresses fears of spousal abuse. Which information should the PN provide to facilitate client disclosure?

D. Share with the client that her situation is not unique and abuse often increases with pregnancy.