Mental health practice questions

Question 1

The nurse in the inpatient psychiatric unit notes that a client with schizophrenia is wearing a heavy winter coat on a hot afternoon, has a strong body odor, and has not changed clothes in 4 days. Which of the following interventions should the nurse include in the client's plan of care?

Accepted Answer

C: Set a daily time for hygiene and guide the client through each step of bathing and dressing. Schizophrenia is a long-term mental illness that affects how a person thinks, feels and behaves.

Disorganized behavior and avolition in schizophrenia often show up as poor hygiene and clothing that does not fit the weather. A heavy coat on a hot day is also a physical risk, because it can lead to overheating, and some antipsychotic medications already make it harder to regulate body temperature.

Structure is what helps. A set time each day for hygiene builds a routine, and guiding the client through each step (turn on the water, wash, rinse, dry, choose clothes for today's weather) makes a task that feels overwhelming manageable. The nurse offers two or three suitable choices of clothing so the client keeps some control.

Question 2

A 36-year-old client with posttraumatic stress disorder related to military combat is admitted to a medical unit for IV antibiotics to treat cellulitis of the leg. The client arrives with a service dog that is trained to wake the client from nightmares and to calm the client during panic attacks. Which response by the nurse is most appropriate?

Accepted Answer

C: "Your dog may stay in the room with you, and you will need to arrange for its feeding and care.". A service dog is a dog individually trained to do work or perform tasks for a person with a disability, and that includes psychiatric conditions such as posttraumatic stress disorder. Under the Americans with Disabilities Act, a service dog is allowed to stay with the client in the client's room and in other areas open to the public. It can be excluded only from areas where it would compromise a sterile environment, such as an operating room, or if it is out of control or not housebroken.

The hospital is not responsible for caring for the dog, so the client arranges its feeding, walks, and care, usually with family or a friend. Staff may ask only whether the dog is required because of a disability and what task it has been trained to perform. For this client, the dog's ability to interrupt nightmares and calm panic supports care.

Question 3

The spouse of a 40-year-old client with major depressive disorder says to the nurse, "I'm afraid to ask her if she is thinking about suicide. Won't that put the idea in her head?" Which response by the nurse is most appropriate?

Accepted Answer

B: "Asking directly does not cause suicidal thoughts, and many people feel relief to talk about them.". The belief that asking about suicide plants the idea is a common myth. Research shows that asking directly does not increase suicidal thinking. For many people it brings relief, because someone has finally named what they are going through, and it opens the door to getting help.

Family members are often the first to notice changes, so the nurse teaches the spouse to ask in plain words, such as "Are you thinking about killing yourself?", to listen without judging, and to know what to do with a yes: stay with the client, remove access to means, and call 988 or the treatment team.

Question 4

The evening before a first electroconvulsive therapy (ECT) treatment, the nurse reviews the prescriptions for a 67-year-old client with severe major depressive disorder. Which prescription should the nurse question?

Accepted Answer

A: Lorazepam 1 mg orally at bedtime tonight for sleep. Electroconvulsive therapy works by producing a brief generalized seizure under general anesthesia and a muscle relaxant. The seizure has to be long enough to be therapeutic. Benzodiazepines such as lorazepam are anticonvulsants. They raise the seizure threshold and shorten the seizure, which can make the treatment fail or require a higher electrical dose.

For that reason, benzodiazepines are held or kept to the lowest dose before ECT, especially the night before, and the provider may choose a different medication for sleep. Anticonvulsants, which raise the seizure threshold, and lithium, which raises the risk of prolonged seizures and confusion after ECT, are also reviewed before treatment.

Question 5

A 47-year-old client admitted to the inpatient psychiatric unit with major depressive disorder tells the nurse during the evening medication pass, "My family would be better off without me around." Which response by the nurse is most appropriate?

Accepted Answer

C: "Are you thinking about killing yourself?". A statement that others would be better off without the client is an indirect expression of suicidal thinking. The nurse responds by asking clearly and directly about suicide, using the word itself. Asking does not plant the idea or raise risk, and most clients feel relief when someone names what they have been thinking. The answer tells the nurse whether a full suicide risk assessment of plan, intent and access to means is needed next and guides the level of observation.

Question 6

The parent of a 2-year-old who swallowed some of a grandparent's blood pressure pills earlier today sits by the crib crying and says, "This is all my fault. How could I let this happen?" The child is now stable. Which response by the nurse is most therapeutic?

Accepted Answer

B: "You're feeling very guilty about what happened. Tell me what's going through your mind.". The parent is overwhelmed with guilt, and the most therapeutic response acknowledges that feeling and gives the parent room to talk about it. Reflecting the guilt shows the parent has been heard without judgment, and an open invitation lets the nurse understand what the parent is struggling with.

Teaching about safe storage is important and will come, but a parent who is consumed by guilt cannot take in information yet. Once the feeling has been acknowledged, the nurse can move on to practical steps with a parent who is ready to listen.

Question 7

Place the types of hallucination in order from the most common to the least common as the nurse would expect to encounter them.

Accepted Answer

1: Auditory; 2: Visual; 3: Tactile. Auditory hallucinations are the most common by a wide margin, and they are the type most likely to turn up in an item about a client with schizophrenia. Visual hallucinations come second. Tactile come third, and they should make the nurse think about a chemical cause such as withdrawal as well as about a functional psychosis. Knowing the order is useful because it tells the nurse what to expect, and an unexpected type is a cue rather than a curiosity. A client seeing things without hearing anything, especially an older adult, is a client whose physical condition needs looking at.

Question 8

On the day of discharge, a client who was admitted for depression says to the nurse, "You're the only one who really understands me. Can I have your cell phone number so I can call you when I get home?" Which of the following would be an appropriate response for the nurse to make?

Accepted Answer

C: "I'm glad our talks helped. Let's look at who you can call after discharge.". The nurse-client relationship is a therapeutic, professional relationship with a clear end at discharge. Giving out a personal phone number or promising personal contact crosses a professional boundary. It can create dependence on one person and leaves the client without real support when the nurse is not available.

The best response accepts the client's feelings, acknowledges the work they did together, and turns the conversation toward the client's own support system: the outpatient therapist, the crisis line, family and friends, and peer support groups.

Question 9

A client with Wernicke-Korsakoff syndrome tells the nurse in detail about working a full shift at the factory this morning. The client has been hospitalized for 6 days and retired 20 years ago. Which understanding should guide the nurse's response?

Accepted Answer

A: The client believes the story is true and is not attempting to deceive the nurse. Confabulation is the brain patching a hole in memory, and the patch is as real to the client as any genuine memory. Put plainly, the lies for these clients are just as real as reality. The word "lies" is misleading, because lying requires knowing the truth and choosing to say something else. This client does not know the truth. The story is what the client honestly remembers.

Once you understand that, the nursing response follows. You do not correct the client, because correcting it will not work and will only cause distress, and you do not agree with it either, because agreeing reinforces it. You redirect to something real that the client can do right now.

Question 10

The nurse is reviewing a shift note about a client on the psychiatric unit. Which findings indicate the client is psychotic? Select all that apply.

Accepted Answer

A: Client states the staff have implanted a device in his neck to record him; C: Client heard laughter at the nurses' station and said the voices were plotting against him; E: Client states he is the person who designed the hospital and owns the building. Three findings in this note show a break with reality. The device implanted in the neck is a paranoid, somatic style delusion and it is fixed and false. The laughter at the nurses' station was real, and what makes that finding psychotic is the fixed persecutory belief the client has built on it. Owning and designing the hospital is a grandiose delusion. The other two findings are a sleep problem and a low mood, and neither involves losing touch with what is real.

Mental health practice questions.