NCLEX Practice Questions On Psychiatric Nursing

1. A female client who's at high risk for suicide needs close supervision. To best ensure the client's safety. Nurse Mary should:

Check the client frequently at irregular intervals throughout the night

Assure the client that the nurse will hold in confidence anything the client says

Repeatedly discuss previous suicide attempts with the client

Disregard decreased communication by the client because this is common with suicidal clients

Checking the client frequently but at irregular intervals prevents the client from predicting when observation will take place and altering behavior in a misleading way at these times.Option B may encourage the client to try to manipulate the nurse or seek attention for having a secret suicide plan.Option C may reinforce suicidal ideas.Option D: Decreased communication is a sign of withdrawal that may indicate the client has decided to commit suicide; the nurse shouldn’t disregard it.

Explanation

Checking the client frequently but at irregular intervals prevents the client from predicting when observation will take place and altering behavior in a misleading way at these times.Option B may encourage the client to try to manipulate the nurse or seek attention for having a secret suicide plan.Option C may reinforce suicidal ideas.Option D: Decreased communication is a sign of withdrawal that may indicate the client has decided to commit suicide; the nurse shouldn’t disregard it.

2. Which of the following drugs should Nurse Mary prepare to administer to a client with a toxic acetaminophen (Tylenol) level?

Deferoxamine mesylate (Desferal)

Succimer (Chemet)

Flumazenil (Romazicon)

Acetylcysteine (Mucomyst)

The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic metabolites to nontoxic metabolites.Option A: Deferoxamine mesylate is the antidote for iron intoxication.Option B: Succimer is an antidote for lead poisoning.Option C: Flumazenil reverses the sedative effects of benzodiazepines.

Explanation

The antidote for acetaminophen toxicity is acetylcysteine. It enhances conversion of toxic metabolites to nontoxic metabolites.Option A: Deferoxamine mesylate is the antidote for iron intoxication.Option B: Succimer is an antidote for lead poisoning.Option C: Flumazenil reverses the sedative effects of benzodiazepines.

3. During postprandial monitoring. a female client with bulimia nervosa tells the nurse. "You can sit with me. but you're just wasting your time. After you had 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?

“I trust you not to purge.”

“How are you purging and when do you do it?”

“Don’t worry. I won’t allow you to purge today.”

“I know it’s important for you to feel in control. but I’ll monitor you for 90 minutes after you eat.”

This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial 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.Option A: Because their therapeutic relationships with caregivers are less important than their need to purge. they don’t fear betraying the nurse’s trust by engaging in the activity. They commonly plot to purge and rarely share their secrets about it.Options B and C: An authoritarian or challenging response may trigger a power struggle between the nurse and client.

Explanation

This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial 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.Option A: Because their therapeutic relationships with caregivers are less important than their need to purge. they don’t fear betraying the nurse’s trust by engaging in the activity. They commonly plot to purge and rarely share their secrets about it.Options B and C: An authoritarian or challenging response may trigger a power struggle between the nurse and client.

4. Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to:

Avoid shopping for large amounts of food

Control eating impulses

Identify anxiety-causing situations

Eat only three meals per day

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.Option A: Controlling shopping for large amounts of food isn’t a goal early in treatment.Option B: Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues.Option D: Eating three meals per day isn’t a realistic goal early in treatment.

Explanation

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.Option A: Controlling shopping for large amounts of food isn’t a goal early in treatment.Option B: Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues.Option D: Eating three meals per day isn’t a realistic goal early in treatment.

5. Flumazenil (Romazicon) has been ordered for a male client who has overdosed on oxazepam (Serax). Before administering the medication. nurse Gina should be prepared for which common adverse effect?

Seizures

Shivering

Anxiety

Chest pain

Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose.Options B. C. and D: Less common adverse effects include shivering. anxiety. and chest pain.

Explanation

Seizures are the most common serious adverse effect of using flumazenil to reverse benzodiazepine overdose. The effect is magnified if the client has a combined tricyclic antidepressant and benzodiazepine overdose.Options B. C. and D: Less common adverse effects include shivering. anxiety. and chest pain.

6. For a female client with anorexia nervosa. Nurse Jimmy is aware that which goal takes the highest priority?

The client will establish adequate daily nutritional intake

The client will make a contract with the nurse that sets a target weight

The client will identify self-perceptions about body size as unrealistic

The client will verbalize the possible physiological consequences of self-starvation

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.Options B. C. and D: The nurse may give lesser priority to goals that address long-term plans. self-perception. and potential complications.

Explanation

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.Options B. C. and D: The nurse may give lesser priority to goals that address long-term plans. self-perception. and potential complications.

7. A male client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is Nurse Alice most likely to administer to reduce the symptoms of alcohol withdrawal?

Naloxone (Narcan)

Haloperidol (Haldol)

Magnesium sulfate

Chlordiazepoxide (Librium)

Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal.Option A: Naloxone (Narcan) is administered for narcotic overdose.Option B: Haloperidol (Haldol) may be given to treat clients with psychosis. severe agitation. or delirium.Option C: Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

Explanation

Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal.Option A: Naloxone (Narcan) is administered for narcotic overdose.Option B: Haloperidol (Haldol) may be given to treat clients with psychosis. severe agitation. or delirium.Option C: Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

8. For a female client with anorexia nervosa. nurse Rose 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?

They tend to overprotect their children

They usually have a history of substance abuse

They maintain emotional distance from their children

They alternate between loving and rejecting their children

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.The characteristics described in options B. C. and D isn’t typical of parents of children with anorexia.

Explanation

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.The characteristics described in options B. C. and D isn’t typical of parents of children with anorexia.

9. When interviewing the parents of an injured child. which of the following is the strongest indicator that child abuse may be a problem?

The injury isn’t consistent with the history or the child’s age

The mother and father tell different stories regarding what happened

The family is poor

The parents are argumentative and demanding with emergency department personnel

When the child’s injuries are inconsistent with the history given or impossible because of the child’s age and developmental stage. the emergency department nurse should be suspicious that child abuse is occurring.Option B: The parents may tell different stories because their perception may be different regarding what happened. If they change their story when different health care workers ask the same question. this is a clue that child abuse may be a problem.Option C: Child abuse occurs in all socioeconomic groups.Option D: Parents may argue and be demanding because of the stress of having an injured child.

Explanation

When the child’s injuries are inconsistent with the history given or impossible because of the child’s age and developmental stage. the emergency department nurse should be suspicious that child abuse is occurring.Option B: The parents may tell different stories because their perception may be different regarding what happened. If they change their story when different health care workers ask the same question. this is a clue that child abuse may be a problem.Option C: Child abuse occurs in all socioeconomic groups.Option D: Parents may argue and be demanding because of the stress of having an injured child.

10. A male client admitted to the psychiatric unit for treatment of substance abuse says to the nurse. "It felt so wonderful to get high." Which of the following is the most appropriate response?

“If you continue to talk like that. I’m going to stop speaking to you.”

“You told me you got fired from your last job for missing too many days after taking drugs all night.”

“Tell me more about how it felt to get high.”

“Don’t you know it’s illegal to use drugs?”

Confronting the client with the consequences of substance abuse helps to break through denial.Option A: Making threats isn’t an effective way to promote self-disclosure or establish a rapport with the client.Option C: Although the nurse should encourage the client to discuss feelings. the discussion should focus on how the client felt before. not during. an episode of substance abuse. Encouraging elaboration about his experience while getting high may reinforce the abusive behavior.Option D: The client undoubtedly is aware that drug use is illegal; a reminder to this effect is unlikely to alter behavior.

Explanation

Confronting the client with the consequences of substance abuse helps to break through denial.Option A: Making threats isn’t an effective way to promote self-disclosure or establish a rapport with the client.Option C: Although the nurse should encourage the client to discuss feelings. the discussion should focus on how the client felt before. not during. an episode of substance abuse. Encouraging elaboration about his experience while getting high may reinforce the abusive behavior.Option D: The client undoubtedly is aware that drug use is illegal; a reminder to this effect is unlikely to alter behavior.