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NCLEX Comprehensive Mental
Health and Psychiatric Nursing
Practice Quiz 3: 75 Questions &
Answers 2024/25 Update
1. 1. Question
A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, “You’re worried about your medication?” The nurse’s communication is: o A. An example of presenting reality o B. Reinforcing the client’s delusions o C. Focusing on emotional content o D. A non-therapeutic technique called mind-reading Incorrect Correct Answer: C. Focusing on emotional content The nurse should help the client focus on the emotional content rather than delusional material. Sometimes during a conversation, patients mention something particularly important. When this happens, nurses can focus on their statement, prompting patients to discuss it further. Patients don’t always have an objective perspective on what is relevant to their case; as impartial observers, nurses can more easily pick out the topics to focus on. Option A: Presenting reality isn’t helpful because it can lead to confrontation and disengagement. It’s frequently useful for nurses to summarize what patients have said after the fact. This demonstrates to patients that the nurse was listening and allows the nurse to document conversations. Ending a summary with a
phrase like “Does that sound correct?” gives patients explicit permission to make corrections if they’re necessary. Option B: Agreeing with the client and supporting his beliefs are reinforcing delusions. Patients often ask nurses for advice about what they should do about particular problems or in specific situations. Nurses can ask patients what they think they should do, which encourages patients to be accountable for their own actions and helps them come up with solutions themselves. Option D: Mind reading isn’t therapeutic. Similar to active listening, asking patients for clarification when they say something confusing or ambiguous is important. Saying something like “I’m not sure I understand. Can you explain it to me?” helps nurses ensure they understand what’s actually being said and can help patients process their ideas more thoroughly
2. 2. Question
A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He’s shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate? A. “I think you’re wrong. France is a friendly country and an ally of the United States. Their government wouldn’t try to kill you.” B. “I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.” C. “You’re wrong. Nobody is trying to kill you.” D. “A foreign government is trying to kill you? Please tell me more about it.” Incorrect Correct Answer: B. “I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.” Responses should focus on reality while acknowledging the client’s feelings. Sometimes during a conversation, patients mention something particularly important. When this happens, nurses can focus on their statement, prompting patients to discuss it further. Patients don’t always have an objective perspective on what is relevant to their
The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. The extrapyramidal symptoms are muscular weakness or rigidity, a generalized or localized tremor that may be characterized by the akinetic or agitation types of movements, respectively. Haloperidol overdose is also associated with ECG changes known as torsade de pointes, which may cause arrhythmia or cardiac arrest. Option A: Lorazepam treats anxiety, not extrapyramidal effects. Lorazepam is a benzodiazepine medication developed by DJ Richards. It went on the market in the United States in 1977. Lorazepam has common use as the sedative and anxiolytic of choice in the inpatient setting owing to its fast (1 to 3 minute) onset of action when administered intravenously. Lorazepam is also one of the few sedative-hypnotics with a relatively clean side effect profile. Lorazepam is FDA approved for short-term ( months) relief of anxiety symptoms related to anxiety disorders, anxiety-associated insomnia, anesthesia premedication in adults to relieve anxiety, or to produce sedation/amnesia, and treatment of status epilepticus. Option C: Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drugs). Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long-acting so that its administration can be with less frequency than diphenhydramine. It also induces less CNS stimulation effect compared to that of trihexyphenidyl, making it a preferable drug of choice for geriatric patients. Option D: Another dose of haloperidol would increase the severity of the reaction. Since there is no specific antidote, supportive treatment is the mainstay of haloperidol toxicity. If a patient develops signs and symptoms of toxicities, the clinician should consider gastric lavage or induction of emesis as soon as possible, followed by the administration of activated charcoal. Maintenance of Airway, Breathing, and circulation are the most important factors for survival.
4. 4. Question
The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn’t visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate?
A. Approach the client and touch him to get his attention. B. Encourage the client to go to his room where he’ll experience fewer distractions. C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t hear these voices. D. Ask the client to describe what the voices are saying. Incorrect Correct Answer: C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t hear these voices. By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn’t hear the voices, the nurse avoids reinforcing the hallucination. Auditory hallucinations are the sensory perceptions of hearing voices without an external stimulus. This symptom is particularly associated with schizophrenia and related psychotic disorders but is not specific to it. Auditory hallucinations are one of the major symptoms of psychosis. Option A: The nurse shouldn’t touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Option B: Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. Option D: By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client’s feelings, rather than the content of the hallucination.
5. 5. Question
A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to: A. Take an as-needed dose of psychotropic medication whenever they hear voices.
A client with catatonic schizophrenia is mute, can’t perform activities of daily living, and stares out the window for hours. What is the nurse’s first priority? A. Assist the client with feeding B. Assist the client with showering C. Reassure the client about safety D. Encourage socialization with peers Incorrect Correct Answer: A. Assist the client with feeding According to Maslow’s hierarchy of needs, the need for food is among the most important. The initial management includes supportive measures such as IV fluids and even nasogastric tubes given that patients with catatonia are susceptible to malnutrition, dehydration, pneumonia, etc. The key is early identification of catatonia in a patient with schizophrenia and initiation of treatment. Option B: Catatonia again is a complex combination of psychomotor abnormalities and mood and thought processes. There are at least forty different signs and symptoms that have been associated with catatonia. The Diagnostic and Statistical Manual V has criteria for catatonia with specifiers, including that for schizophrenia. Option C: Features of catatonia had been described since the 1800s with prominent physicians such as Kahlbaum and even Kraepelin, who defined catatonia within the larger definition of dementia praecox.[2] There are several theories behind the same as catatonia can be part of a larger psychiatric or neurological illness. Kahlbaum has ultimately been credited with the understanding that symptoms such as stupor and catalepsy were part of a larger syndrome of psychomotor abnormalities, which he termed as “catatonia.” This can be a part of a larger schizophrenic illness or even a bipolar affective illness or medical illness. Option D: Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging. The epidemiology of catatonic schizophrenia can be multivariate. It is said that about 10% of patients in psychiatric inpatient services have catatonic features.[7] On the one hand, the older school of
psychiatry associated schizophrenia with catatonia, while newer epidemiological studies show that 20% of patients with catatonia have schizophrenia, and about 45% have symptoms of mood disorders and medical illness.
7. 7. Question
A client tells the nurse that the television newscaster is sending a secret message to her. The nurse suspects the client is experiencing: A. A delusion B. Flight of ideas C. Ideas of reference D. Hallucination Incorrect Correct Answer: C. Ideas of reference Ideas of reference refers to the mistaken belief that neutral stimuli have special meaning to the individual such as the television newscaster sending a message directly to the individual. In people with bipolar disorder, mania and hypomania can comprise various symptoms, from reckless spending to sexual promiscuity. In addition, some more subtle symptoms may also occur, such as the belief held by some patients that everything occurring around them is related somehow to them when in fact it isn’t. This symptom is known as ideas of reference. Option A: A delusion is a false belief. Delusions are defined as fixed, false beliefs that conflict with reality. Despite contrary evidence, a person in a delusional state can’t let go of their convictions. Delusions are often reinforced by the misinterpretation of events. Many delusions also involve some level of paranoia. For example, someone might contend that the government is controlling our every move via radio waves despite evidence to the contrary. Option B: Flight of ideas is a speech pattern in which the client skips from one unrelated subject to another. A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may
heatstroke or other unwanted effects, such as dizziness, dry mouth, blurred vision, and constipation, while you are taking a phenothiazine. Option C: Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. Option D: The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
9. 9. Question
A client who has been hospitalized with disorganized type schizophrenia for 8 years can’t complete activities of daily living (ADLs) without staff direction and assistance. The nurse formulates a nursing diagnosis of Self-care deficit: Dressing/grooming related to inability to function without assistance. What is an appropriate goal for this client? A. “Client will be able to complete ADLs independently within 1 month.” B. “Client will be able to complete ADLs with only verbal encouragement within 1 month.” C. “Client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month.” D. “Client will be able to complete ADLs with complete assistance within 1 month.” Incorrect Correct Answer: C. “Client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month.” The client’s disorganized personality and history of hospitalization have affected the ability to perform self-care activities. Disorganized schizophrenia is one of the five subtypes of schizophrenia. It is characterized by disorganized behavior and speech and includes
disturbance in emotional expression. Hallucinations and delusions are less pronounced with disorganized schizophrenia, though there is evidence of these symptoms occurring. Option A: Interventions should be directed at helping the client complete ADLs with the assistance of staff members, who can provide needed structure by helping the client select grooming items and clothing. This goal promotes realistic independence. Assistance with life skills can help individuals with disorganized schizophrenia improve social interactions and increase daily living skills, with a goal of increasing independence. Option B: As the client improves and achieves the established goal, the nurse can set new goals that focus on the client completing ADLs with only verbal encouragement and, ultimately, completing them independently. Individuals with disorganized schizophrenia benefit from ongoing contact with the family. Support to educate the family about treatment and how to support a family member with schizophrenia is crucial. Family support increases family member’s understanding of the disorder and helps family members develop coping strategies. Option D: The client’s condition doesn’t indicate a need for complete assistance, which would only foster dependence. Assistance with daily living skills, educational attainment, employment services, and family support plays a key role in improving the course of the disease for individuals diagnosed with disorganized schizophrenia.
10. 10. Question
The nurse is planning care for a client admitted to the psychiatric unit with a diagnosis of paranoid schizophrenia. Which nursing diagnosis should receive the highest priority? A. Risk for violence toward self or others B. Imbalanced nutrition: Less than body requirements C. Ineffective family coping D. Impaired verbal communication Incorrect Correct Answer: A. Risk for violence toward self or others
B. He can easily mix the medication in his wife’s food if she stops taking it. C. His wife can be given a long-acting medication that is administered every 1 to 4 weeks. D. His wife knows she must take her medication as prescribed to avoid future hospitalizations. Incorrect Correct Answer: C. His wife can be given a long-acting medication that is administered every 1 to 4 weeks. Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks. These agents are useful for noncompliant clients because the client receives the injection at the outpatient clinic. When schizophrenia is diagnosed, antipsychotic medication is most typically prescribed. This can be given as a pill, a patch, or an injection. There are long-term injections that have been developed which could eliminate the problems of a patient not regularly taking their medication (called “medication noncompliance”). Option A: A client has the right to refuse medication, but this issue isn’t the focus of discussion at this time. Someone with schizophrenia may not recognize that their behavior, hallucinations, or delusions are unusual or unfounded. This can cause a person to stop taking antipsychotic medication, stop participating in therapy, or both, which can result in a relapse into active phase psychosis. Option B: Medication should never be hidden in food or drink to trick the client into taking it; besides destroying the client’s trust, doing so would place the client at risk for overmedication or under medication because the amount administered is hard to determine. While antipsychotic medication is effective in treating the positive symptoms of schizophrenia, it does not address negative symptoms.8 In addition, these drugs can have unwanted side effects including weight gain, drowsiness, restlessness, nausea, vomiting, low blood pressure, dry mouth, and lowered white blood cell count. Option D: Assuming the client knows she must take the medication to avoid future hospitalizations would be unrealistic. Psychotherapy also plays an important role in the treatment of schizophrenia. Cognitive-behavioral therapy has been shown to help patients develop and retain social skills, alleviate comorbid
anxiety and depression symptoms, cope with trauma in their past, improve relationships with family and friends, and support occupational recovery.
12. 12. Question
Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by: A. Decreasing the anxiety causing muscle rigidity. B. Blocking the cholinergic activity in the central nervous system (CNS). C. Increasing the level of acetylcholine in the CNS. D. Increasing norepinephrine in the CNS. Incorrect Correct Answer: B. Blocking the cholinergic activity in the central nervous system (CNS). This is the action of Cogentin. Benztropine antagonizes acetylcholine and histamine receptors. In the CNS and smooth muscles, benztropine exerts its action through competing with acetylcholine at muscarinic receptors. Consequently, it reduces central cholinergic effects by blocking muscarinic receptors that appear to improve the symptoms of Parkinson disease. Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations. Option A: Anxiety doesn’t cause extrapyramidal effects. Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drug). Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long- acting so that its administration can be with less frequency than diphenhydramine. It also induces less CNS stimulation effect compared to that of trihexyphenidyl, making it a preferable drug of choice for geriatric patients. Option C: Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. It is also useful for drug-induced extrapyramidal symptoms and the prevention of dystonic reactions and acute treatment of dystonic
Option A: Dopamine receptor agonists stimulate dopamine receptors and thereby reduce rigidity. Bromocriptine is a dopamine receptor agonist that has selective agonist activity on D2 dopamine receptors while simultaneously acting as a partial antagonist for D1 dopamine receptors.[12] Dopamine agonism has variable effects depending on the target tissue. In Parkinson disease, bromocriptine binds directly to striatal dopamine D receptors, stimulating locomotion and attenuating the bradykinetic symptoms caused by the degeneration of dopaminergic nigrostriatal neurons. Option B: Parkinson disease (PD) is a progressive neurological disorder characterized by resting tremor, rigidity, akinesia or bradykinesia, and postural instability due to the loss of dopaminergic neurons in the substantia nigra. Although levodopa is an effective treatment of PD, with chronic use, there is a decline in efficacy and motor complications. Option C: They don’t affect norepinephrine or acetylcholine. Bromocriptine is a medication currently used in the management and treatment of Type II diabetes mellitus. It is an ergot alkaloid derivative in the dopamine D2 agonist class of drugs. This discussion reviews the indications, contraindications, and mechanism of action for bromocriptine as a valuable agent in the management for Type II diabetes mellitus, as well as its more traditional uses in Parkinson’s disease, acromegaly, and pituitary prolactinomas.
14. 14. Question
Most antipsychotic medications exert the following effects on the central nervous system (CNS)? A. Stimulates the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors. B. Sedate the CNS by stimulating serotonin at the synaptic cleft. C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. D. Depress the CNS by stimulating the release of acetylcholine. Incorrect
Correct Answer: C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. The exact mechanism of antipsychotic medication action is unknown, but appears to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. The first- generation antipsychotics work by inhibiting dopaminergic neurotransmission. Their effectiveness is best when they block about 72% of the D2 dopamine receptors in the brain. They also have noradrenergic, cholinergic, and histaminergic blocking action. Option A: Second-generation antipsychotics work by blocking D dopamine receptors as well as serotonin receptor antagonist action. the 5-HT2A subtype of serotonin receptor is most commonly involved. Second-generation antipsychotics are serotonin-dopamine antagonists and are also known as atypical antipsychotics. The Food and Drug Administration (FDA) has approved 12 atypical antipsychotics as of the year 2016. They are risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone, asenapine, lurasidone, iloperidone, cariprazine, brexpiprazole, and clozapine. Option B: First and second-generation antipsychotics (except clozapine) are indicated for the treatment of an acute episode of psychoses as well as maintenance therapy of schizophrenia and schizoaffective disorders. First-generation antipsychotics are better for treating positive symptoms of schizophrenia, e.g., hallucinations, delusions, among others. They also decrease the risk of a repeat episode of psychosis. Second-generation antipsychotics treat both positive symptoms and negative symptoms of schizophrenia, e.g., withdrawal, ambivalence, among others, and are known to reduce relapse rates. Option D: They don’t sedate the CNS by stimulating serotonin, and they don’t stimulate neurotransmitter action or acetylcholine release. First-generation antipsychotics are effective in the treatment of acute mania with psychotic symptoms. All second- generation antipsychotics except clozapine can also be used as a treatment of symptoms of acute mania. Antipsychotics are used with mood stabilizers like lithium, valproic acid, or carbamazepine initially, and then after symptoms stabilize can be gradually decreased and withdrawn.
15. 15. Question
rarely associated with schizophrenia. Illusion, a misrepresentation of a “real” sensory stimulus—that is, an interpretation that contradicts objective “reality” as defined by general agreement. For example, a child who perceives tree branches at night as if they are goblins may be said to be having an illusion.
16. 16. Question
Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction? A. prochlorperazine (Compazine) B. diphenhydramine (Benadryl) C. haloperidol (Haldol) D. midazolam (Versed) Incorrect Correct Answer: B. diphenhydramine (Benadryl) Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. An acute dystonic reaction is characterized by involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures. The symptoms may be reversible or irreversible and can occur after taking any dopamine receptor-blocking agents. Treatment of acute dystonic reaction centers around balancing the disrupted dopaminergic-cholinergic balance in the basal ganglia and discontinuation of the offending agent. The most commonly available drugs in the emergency setting for the treatment of acute dystonic reaction are diphenhydramine and benztropine. Option A: Prochlorperazine can be used to treat both acute psychotic episodes and chronic mental illnesses. As a first- generation antipsychotic, the drug is better at treating positive symptoms than negative ones, including delusions, hallucinations, agitation, and disorganized speech and behavior. Option C: Haloperidol is capable of causing dystonia, not reversing it. Due to the blockade of the dopamine pathway in the brain, typical antipsychotic medications such as haloperidol have correlations with extrapyramidal side effects. The extrapyramidal symptoms are muscular weakness or rigidity, a generalized or localized tremor that may be characterized by the akinetic or
agitation types of movements, respectively. Haloperidol overdose is also associated with ECG changes known as torsade de pointes, which may cause arrhythmia or cardiac arrest. Option D: Midazolam would make this client drowsy. Midazolam can be used for anxiolysis and hypnosis during the maintenance phase of general anesthesia and is also superior to thiopental in the maintenance of anesthesia because of the less need for adjunct medications. Midazolam is used as an adjunct medication to regional and local anesthesia for a wide range of diagnostic and therapeutic procedures and has greater patient and physician acceptance.
17. 17. Question
A schizophrenic client states, “I hear the voice of King Tut.” Which response by the nurse would be most therapeutic? A. “I don’t hear the voice, but I know you hear what sounds like a voice.” B. “You shouldn’t focus on that voice.” C. “Don’t worry about the voice as long as it doesn’t belong to anyone real.” D. “King Tut has been dead for years.” Incorrect Correct Answer: A. “I don’t hear the voice, but I know you hear what sounds like a voice.” This response states reality about the client’s hallucination. Voicing doubt can be a gentler way to call attention to the incorrect or delusional ideas and perceptions of patients. By expressing doubt, nurses can force patients to examine their assumptions. Option B: Sometimes during a conversation, patients mention something particularly important. When this happens, nurses can focus on their statement, prompting patients to discuss it further. Patients don’t always have an objective perspective on what is relevant to their case; as impartial observers, nurses can more easily pick out the topics to focus on. Option C: For patients experiencing sensory issues or hallucinations, it can be helpful to ask about them in an encouraging, non-judgmental way. Phrases like “What do you
