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. O Ask the client directly about her living arrangements. B. O Question whether the client brought someone with her. C. Elicit her home address during the mental status exam. D. Avoid discussing her living arrangements during care.

A. Ask the client directly about her living arrangements If the PN suspects the client is homeless, the best way to obtain the information is to ask the client directly (A) SO care and social services can be provided. (B, C, and D) do not obtain direct information from the client.

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 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 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.

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 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.

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

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 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.

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.

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? A. O Client autonomy. B. O The therapeutic community. C. The nurse-client relationship. D. O The multidisciplinary mental health team.

B. The therapeutic community. A therapeutic community (B) provides ways to increase a client's utilization of the social environment by providing therapeutic experiences. (A, B, and C) participate in the therapeutic milieu but do not best describe the client's engagement in therapeutic experiences.

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.

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. O Thoughts of harming her infant. B. O Personal hygiene neglect. C. O Outbursts of anger. D. O Disinterest in her husband.

A. Thoughts of harming her infant.

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."

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 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.

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? A. O Impaired memory. B. O Clear awareness of surrounding. . O Unrelated to a specific cause. D. Acute onset of symptoms.

D. Acute onset of symptoms.

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? A. O If someone is a victim of circumstances, unhealthy coping is often beyond one's control. B. O Each adult is responsible for one's own behaviors, including unhealthy behaviors. C. O Significant life-style changes are easier followed if professional guidance is sought. D. O The first step is to focus on changing attitudes and behaviors of significant others.

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

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 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? A. O "Everything will work out ok for you." B. O "The group appreciated your comments today." C. "You will feel better as your treatment continues." D. O "You need to help yourself by thinking positive."

B. "The group appreciated your comments today." The most therapeutic and positive statement provides feedback about the client's interactions with others (B), which tells the client that he is recognized and allows him to connect with the group in the here and now. (A and C) are clichÃOs and are not therapeutic. (D) is advice giving, which is non-therapeutic.

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? A. An anxiety reaction. B. O A situational crisis. C. O A maturational crisis. D. O An adjustment disorder.

B. A situational crisis. A situational crisis occurs when a life event upsets an individual's psychosocial equilibrium. Loss of a job can give rise to a situational crisis (B). (A, C, and D) do not depict this client's situation.

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 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?

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.

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? A. O Provide her with a reflection of her apparent unhappiness and uncertainty about pregnancy. B. O Tell her that spousal abuse can be supported by evidence of old fractures seen on x-rays. C. Encourage her to share incidents of past abuse SO her personal safety can be addressed. Incorrect D. O Share with client that her situation is not unique and abuse often increases with pregnancy.

D. Share with the client that her situation is not unique and abuse often increases with pregnancy. Fear, guilt, and embarrassment prevent women from sharing information about family violence. Letting the client know that the injuries associated with abuse often increase during pregnancy and that her situation is experienced by others (D) may overcome the strong tendency to deny abuse. Although (B and C) provide factual information, it may threaten the client or increase her fear and minimize seeking help. The interpretation that the client is unhappy and unsure about her pregnancy (A), though possibly true, does not address the client's risk for abuse, which should be addressed directly.

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. Correct B. O Direct the client to come to the clinic for mother-baby care instructions. C. O Ask the client if she has been experiencing any hallucinations. D. Determine if the client is feeling sad and having suicidal thoughts.

A. Tell the charge nurse to come to the phone and talk with the client. The client is exhibiting signs of a maturational crisis related to the role changes required by the birth of the infant. Crisis intervention is indicated, so the PN should ask the charge nurse to talk with the client (A). (B, C, and D) could be considered if (A) proves ineffective.

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. B. OBenzodiazepines. C. O Glucose solution. D. O Haloperidol (Haldol).

A. Thiamine

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? A. O Amenorrhea. B. O Dental erosion. C. O Thin, brittle hair. D. O Clubbing of the fingers.

B. Dental erosion. A client with bulimia often denies binging and purging with induced vomiting that causes erosion of tooth enamel (B), which should be reported for evaluation by the treatment team. (A, C, and D) are more common with anorexia, not bulimia.

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. A. Decrease environmental stimuli. B. O Ensure the environment is safe. C. O Respect the client's personal space. D. O Encourage the client to express feelings.

B. Ensure the environment is safe. Safety (B) is the highest priority for a client who is experiencing severe anxiety, which places him at high risk for self-injury related to the increased non-goal directed motor activity, distorted perceptions, and disordered thought. (A, C, and D) may be indicated, but the client's safety has the highest priority.

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? A. O Echolalia. B. O Ideas of reference. C. • Delusions of infidelity. D. Auditory hallucinations.

B. Ideas of reference Ideas of reference (B) are misinterpretations of the verbalizations or actions of others that the client gives suspicious personal meanings to these behaviors. This behavior does not reflect (A, C, or D).

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? A. Read to the client from the daily newspaper to promote orientation. B. O Sit with the client in silence several times a day. C. O Ask the client questions about the thoughts that he is having. D. O Use therapeutic touch by placing a hand on the client's arm occasionally.

B. Sit with the client in silence several times a day. This severely withdrawn client should be accepted and met "at the client's own level," with silence. Short contact and the use of silence are helpful to minimize the client's anxiety (B). (A and C) may be ineffective. Touch (D) is often perceived as threatening and is not recommended.

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? A. O Mental illness runs in families and effects many family members. B. O Comparing yourself with others doesn't help you and only makes things worse. C. O About 50% of the population between the age of 15 and 55 have had a psychiatric disorder. D. Remember you are not to blame for your psychiatric illness and hospitalization. Incorrect

C. About 50% of the population between the age of 15 and 55 have had a psychiatric disorder. Mental health disorders are common in the United States with about one in five adults diagnosed with a mental health disorder. Explaining the extent of mental illness (C) to the client may assist the client to understand his illness, offer hope, and reduce his feelings of isolation. (A) provides the client with some information for insight but may not be supportive. (B and D) are not supportive and do not offer information to help the client understand mental illness.

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? A. O Mild. B. O Panic. C. O Severe. D. Moderate.

C. Severe Severe anxiety (C) is characterized by greatly narrowed perceptual field, difficulty with problem solving, selective attention (focus on one detail), and selective inattention (block out threatening stimuli). Mild to moderate levels of anxiety on the continuum are characterized by the client being alert, attentive, and a focused perception that facilitates an optimal state for problem solving and learning. This client is not exhibiting signs and symptoms of (A, B, or C).

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? A. Fear related to physiologic responses to leaving the home. Incorrect B. O Self-esteem disturbance related to inability to leave home. C. O Social isolation related to avoidance behavior as evidenced by inability to go out of doors. D. O Altered thought processes related to panic attacks when she thinks of leaving the house.

C. Social isolation related to avoidance behavior as evidenced by inability to go out of doors. When caring for this client, the PN should consider the nursing diagnosis, social isolation (C), which best describes the client's findings that are consistent with agoraphobic or fear of leaving home or going outdoors. (A, B, and C) are less accurate descriptions of the client's condition or symptoms.

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? A. O Affective responses. B. O Social responses. Incorrect C. O Physiological responses. D. O Biopsychosocial responses.

D. Biopsychosocial responses. Appraisal of a stressor is the processing and comprehension of stressful situations that takes place on many levels, specifically cognitive, affective, physiological, behavioral, and social (D). Limiting the client's self analysis (A, B, or C) may omit an important variable that needs further intervention.

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? A. Excess salivation and drooling. B. Muscle rigidity and restlessness. Incorrect C. O Polyuria and extreme hand tremors. D. O Orthostatic hypotension and constipation.

D. Orthostatic hypotension and constipation. Clomipramine (Anafranil) is a tricyclic antidepressant with anticholinergic side effects, such as orthostatic hypotension and constipation (D). (A) are extrapyramidal syndrome side effects of some antipsychotic medications. (B) is indicative of neuroleptic malignant syndrome related to antipsychotic medications. (C) are signs of lithium toxicity.

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? A. O Initiate a conversation about the client's suicidal ideations and plans. B. O Describe diagnostic laboratory results to the client. C. Ask the client if he would like to talk to another nurse. D. Record these findings in the medical record under the DSM IV Axis IV. Correct

D. Record these findings in the medical record under the DSM IV Axis IV. The DSM Axis IV includes psychosocial and environmental stressors that are directly or indirectly related to death of a family member, health problems in a family, inadequate social support, adjustment to life-cycle transition, inadequate finances, and or marital difficulties. It is best to record the observed client behaviors in the medical records as responses for the DSM IV Axis IV classification. (A, B, and C) are unlikely to yield any additional information until the client's condition improves.

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? A. O Assign client to dust and sweep unit floors. B. Have client write thoughts and feelings in a journal. Incorrect C. O Contract with client to focus only on positive topics. D. O Schedule occupational therapy and unit activities for client.

D. Schedule occupational therapy and unit activities for this client. Distraction and engagement in productive tasks, such as occupational therapy (OT) and unit activities, provide opportunities for the client to socialize and interact with others and limits his time for self-absorption and self-criticism (D). (A, B, and C) are solo activities that allow the client time to ruminate over his past.

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? A. O Physical and social losses. B. Feelings of guilt or frustration. C. O Mastery of physical motor skills. D. O Sense of freedom in the community.

D. Sense of freedom in the community. According to Erikson, the young adult is in the intimacy-versus-isolation stage of development. This is the time in which he can participate in the social roles of young adulthood, so encouraging the client to talk about his sense of adult freedom and responsibility (D) addresses his adjustment in this stage of development. (A, B, and C) do not focus on the young adult's developmental tasks.