Mental Health & Psychiatric

Nursing NCLEX Practice

Exam (Quiz #5: 25 Questions)
UPDATED ON OCTOBER 6, 2023 BY MATT VERA BSN, R.N.

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1. Question
Nurse Greta is aware that the following is classified as an Axis I disorder by the
Diagnosis and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR) is:

A. Obesity

B. Borderline personality disorder

C. Major depression

D. Hypertension

Incorrect
Correct Answer: C. Major depression
The DSM-IV-TR classifies major depression as an Axis I disorder. Axis I
disorders tend to be the most commonly found in the public. They include
anxiety disorders, such as panic disorder, social anxiety disorder, and post-
 traumatic stress disorder. Other examples of Axis I disorders are as follows:
Dissociative disorders. Eating disorders (anorexia nervosa, bulimia nervosa,
etc.) Mood disorders (major depression, bipolar disorder, etc.) Published by the
American Psychiatric Association, the DSM is the mental health bible of sorts.
The DSM-IV organized all psychiatric disorders and other problems into five
different categories or axes.
Option A: Obesity was in Axis III. DSM-IV approached psychiatric
assessment and organization of biopsychosocial information using a
multi-axial formulation (American Psychiatric Association, 2013b). There
were five different axes. Axis I consisted of mental health and substance
use disorders (SUDs); Axis II was reserved for personality disorders and
mental retardation; Axis III was used for coding general medical
conditions; Axis IV was to note psychosocial and environmental problems
(e.g., housing, employment); and Axis V was an assessment of overall
functioning known as the GAF.
Option B: Mental disorders are diagnosed according to a manual
published by the American Psychiatric Association called the Diagnostic
and Statistical Manual of Mental Disorders. A diagnosis under the fourth
edition of this manual, which was often referred to as simply the DSM-IV,
had five parts, called axes. Each axis of this multi-axial system gave a
different type of information about the diagnosis. Borderline personality
disorder as an Axis II. Axis II provided information about personality
disorders and mental retardation.
Option D: Hypertension was in Axis III. Axis III provided information about
any medical conditions that were present which might impact the
patient’s mental disorder or its management. General Medical Condition
(GMC) Axis III is for reporting current general medical conditions that are
potentially relevant to the understanding or management of the
individual’s mental disorder. The purpose of recording General Medical
Conditions on Axis III is to encourage thoroughness in
evaluation/assessment and to enhance communication among
healthcare providers. Axis III also ensures that medical or physical
conditions that can directly or indirectly influence management and
treatment are not forgotten.

2. Question
Katrina, a newly admitted is extremely hostile toward a staff member she has just met,
without apparent reason. According to Freudian theory, the nurse should suspect that
the client is experiencing which of the following phenomena?

A. Intellectualization

B. Transference
 C. Triangulation

D. Splitting

Incorrect
Correct Answer: B. Transference
Transference is the unconscious assignment of negative or positive feelings
evoked by a significant person in the client’s past to another person.
Transference occurs when a person redirects some of their feelings or desires
for another person to an entirely different person. Transference can also happen
in a healthcare setting. For example, transference in therapy happens when a
patient attaches anger, hostility, love, adoration, or a host of other possible
feelings onto their therapist or doctor. Therapists know this can happen. They
actively try to monitor it.
Option A: Intellectualization is a defense mechanism in which the client
avoids dealing with emotions by focusing on facts. The development of
patterns of excessive thinking or over-analyzing, which may increase the
distance from one’s emotions. For example, someone who is diagnosed
with a terminal illness does not show emotion after the diagnosis is given
but instead starts to research every source they can find about the
illness.
Option C: Triangulation refers to conflicts involving three family
members. Triangulation or triangling is defined in the AAMFT Family
Therapy Glossary as the “process that occurs when a third person is
introduced into a dyadic relationship to balance either excessive
intimacy, conflict, or distance and provide stability in the system” (Evert
et al. 1984 p. 32).
Option D: Splitting is a defense mechanism commonly seen in clients
with personality disorder in which the world is perceived as all good or all
bad. Failing to reconcile both positive and negative attributes into a
whole understanding of a person or situation, resulting in all-or-none
thinking. Splitting is commonly associated with a borderline personality
disorder.

3. Question
An 83-year-old male client is in extended care facility is anxious most of the time and
frequently complains of a number of vague symptoms that interfere with his ability to
eat. These symptoms indicate which of the following disorders?

A. Conversion disorder
 B. Hypochondriasis

C. Severe anxiety

D. Sublimation

Incorrect
Correct Answer: B. Hypochondriasis
Complaints of vague physical symptoms that have no apparent medical causes
are characteristic of clients with hypochondriasis. In many cases, the GI system
is affected. Hypochondriasis, which is now known as illness anxiety disorder,
and the other somatic symptom disorders (e.g., factitious disorder, conversion
disorder) are among the most difficult and most complex psychiatric disorders
to treat in the general medical setting. On the basis of many new developments
in this field, the DMS-5 has revised diagnostic criteria to facilitate clinical care
and research. While illness anxiety disorder is included in the category of
“somatic symptom and related disorders” it continues to have much overlap
with obsessive-compulsive disorder and related illness.
Option A: Conversion disorders are characterized by one or more
neurologic symptoms. Conversion disorder is a mental condition in which
a person has blindness, paralysis, or other nervous system (neurologic)
symptoms that cannot be explained by medical evaluation. People who
have conversion disorder are not making up their symptoms in order to
obtain shelter, for example (malingering). They are also not intentionally
injuring themselves or lying about their symptoms just to become a
patient (factitious disorder). Some health care providers falsely believe
that conversion disorder is not a real condition and may tell people that
the problem is all in their head. But this condition is real. It causes
distress and cannot be turned on and off at will.
Option C: The client’s symptoms don’t suggest severe anxiety. People
with anxiety disorders frequently have intense, excessive and persistent
worry and fear about everyday situations. Often, anxiety disorders
involve repeated episodes of sudden feelings of intense anxiety and fear
or terror that reach a peak within minutes (panic attacks).
Option D: A client experiencing sublimation channels maladaptive
feelings or impulses into socially acceptable behavior. Transforming
one’s anxiety or emotions into pursuits that are considered by societal or
cultural norms to be more useful. This defense mechanism may be
present in someone who channels their aggression and energy into
playing sports.

4. Question
Charina, a college student who frequently visited the health center during the past year
with multiple vague complaints of GI symptoms before course examinations. Although
physical causes have been eliminated, the student continues to express her belief that
she has a serious illness. These symptoms are typically of which of the following
disorders?

A. Conversion disorder

B. Depersonalization

C. Hypochondriasis

D. Somatization disorder

Incorrect
Correct Answer: C. Hypochondriasis
Hypochondriasis, in this case, is shown by the client’s belief that she has a
serious illness, although pathologic causes have been eliminated. The
disturbance usually lasts at least 6 with identifiable life stressor such as, in this
case, course examinations. Hypochondriasis, which is now known as illness
anxiety disorder, and the other somatic symptom disorders (e.g., factitious
disorder, conversion disorder) are among the most difficult and most complex
psychiatric disorders to treat in the general medical setting. On the basis of
many new developments in this field, the DMS-5 has revised diagnostic criteria
to facilitate clinical care and research. While illness anxiety disorder is included
in the category of “somatic symptom and related disorders” it continues to have
much overlap with obsessive-compulsive disorder and related illness.
Option A: Conversion disorders are characterized by one or more
neurologic symptoms. Hypochondriasis, which is now known as illness
anxiety disorder, and the other somatic symptom disorders (e.g.,
factitious disorder, conversion disorder) are among the most difficult and
most complex psychiatric disorders to treat in the general medical
setting. On the basis of many new developments in this field, the DMS-5
has revised diagnostic criteria to facilitate clinical care and research.
While illness anxiety disorder is included in the category of “somatic
symptom and related disorders” it continues to have much overlap with
obsessive-compulsive disorder and related illness.
Option B: Depersonalization refers to persistent recurrent episodes of
feeling detached from one’s self or body. Depersonalization is described
as feeling disconnected or detached from one’s self. Individuals may
report feeling as if they are an outside observer of their own thoughts or
body, and often report feeling a loss of control over their thoughts or
actions.
Option D: Somatoform disorders generally have a chronic course with
 few remissions. The Diagnostic and Statistical Manual for Mental
Disorders, Fifth Edition (DSM-5) category of Somatic Symptom Disorders
and Other Related Disorders represents a group of disorders
characterized by thoughts, feelings, or behaviors related to somatic
symptoms. This category represents psychiatric conditions because the
somatic symptoms are excessive for any medical disorder that may be
present.

5. Question
Nurse Daisy is aware that the following pharmacologic agents are sedative-hypnotic
medication is used to induce sleep for a client experiencing a sleep disorder is:

A. triazolam (Halcion)

B. paroxetine (Paxil)

C. fluoxetine (Prozac)

D. risperidone (Risperdal)

Correct
Correct Answer: A. triazolam (Halcion)
Triazolam is one of a group of sedative-hypnotic medications that can be used
for a limited time because of the risk of dependence. Triazolam is used on a
short-term basis to treat insomnia (difficulty falling asleep or staying asleep).
Triazolam is in a class of medications called benzodiazepines. It works by
slowing activity in the brain to allow sleep. Triazolam comes as a tablet to take
by mouth. It is usually taken as needed at bedtime but not with or shortly after a
meal. Triazolam may not work well if it is taken with food.
Option B: Paroxetine is a serotonin-specific reuptake inhibitor used for
treatment of depression, panic disorder, and obsessive-compulsive
disorder. It is FDA approved for major depressive disorder (MDD),
obsessive-compulsive disorder (OCD), social anxiety disorder (SAD),
panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety
disorder (GAD), and premenstrual dysphoric disorder (PMDD),
vasomotor symptoms associated with menopause.
Option C: Fluoxetine is a serotonin-specific reuptake inhibitor used for
depressive disorders and obsessive-compulsive disorders. Fluoxetine
has FDA-approval for major depressive disorder (age eight and older),
obsessive-compulsive disorder (age seven and older), panic disorder,
bulimia, binge eating disorder, premenstrual dysphoric disorder, bipolar
 depression (as an adjunct with olanzapine also known as Symbyax), and
treatment-resistant depression when used in combination with
olanzapine.
Option D: Risperidone is indicated for psychotic disorders. The long-
acting risperidone injection has been approved for the use of
schizophrenia and maintenance of bipolar disorder (as monotherapy or
adjunctive to valproate or lithium) in adults. Risperidone has also been
used for augmentation of antidepressant therapy in the treatment of
non-psychotic unipolar depression. In addition to irritability associated
with autism, risperidone has also been used for social impairment,
stereotypical behaviors, cognitive problems, and hyperactivity in autism.

6. Question
Aldo, with a somatoform pain disorder may obtain secondary gain. Which of the
following statements refers to a secondary gain?

A. It brings some stability to the family.

B. It decreases the preoccupation with the physical illness.

C. It enables the client to avoid some unpleasant activity.

D. It promotes emotional support or attention for the client.

Incorrect
Correct Answer: D. It promotes emotional support or attention for the
client
Secondary gain refers to the benefits of the illness that allow the client to
receive emotional support or attention. Secondary gain refers to the external
benefits that may be derived as a result of having symptoms. For example, the
patient whose sudden onset of paresis (primary gain) causes his or her spouse
to stay in an otherwise failing relationship (secondary gain).
Option A: A dysfunctional family may disregard the real issue, although
some conflict is relieved. Patients who experience unexplained physical
symptoms often strongly maintain the belief that their symptoms have a
physical cause despite evidence to the contrary. These beliefs are based
on false interpretation of symptoms. Additionally, patients may minimize
the involvement of psychiatric factors in the initiation, maintenance, or
exacerbation of their physical symptoms.
Option B: Somatoform pain disorder is a preoccupation with pain in the
 absence of physical disease. Pain disorder is fairly common. Although
the pain is associated with psychological factors at its onset (e.g.,
unexplained chronic headache that began after a significant stressful life
event), its onset, severity, exacerbation, or maintenance may also be
associated with a general medical condition. Pain is the focus of the
disorder, but psychological factors are believed to play the primary role in
the perception of pain.
Option C: Primary gain enables the client to avoid some unpleasant
activity. A decrease in anxiety (gain) from an unconscious defensive
operation, which then causes a physical or conversion symptom, e.g. an
arm is voluntarily paralyzed because it was used to hurt somebody,
thereby allaying guilt and anxiety.

7. Question
David is diagnosed with panic disorder with agoraphobia and is talking with the nurse
in-charge about the progress made in treatment. Which of the following statements
indicates a positive client response?

A. “I went to the mall with my friends last Saturday”

B. “I’m hyperventilating only when I have a panic attack”

C. “Today I decided that I can stop taking my medication”

D. “Last night I decided to eat more than a bowl of cereal”

Correct
Correct Answer: A. “I went to the mall with my friends last Saturday”
Clients with panic disorder tend to be socially withdrawn. Going to the mall is a
sign of working on avoidance behaviors. Panic disorder and panic attacks are
two of the most common problems seen in the world of psychiatry. Panic
disorder is a separate entity than a panic disorder although it is characterized
by recurrent, unexpected panic attacks. Panic attacks are defined by the
Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as “an
abrupt surge of intense fear or discomfort” reaching a peak within minutes.
Option B: Hyperventilating is a key symptom of panic disorder. Teaching
breathing control is a major intervention for clients with panic disorder.
Breathing training is a method of reducing panic symptomatology by
utilizing capnometry biofeedback to decrease the number of episodes of
hyperventilation. Several of these slow breathing techniques have been
shown to benefit patients with asthma and hypertension.
 Hyperventilation reduction can help patients with cardiovascular disease.
Option C: The client taking medications for panic disorder; such as
tricyclic antidepressants and benzodiazepines, must be weaned off these
drugs. Antidepressants and benzodiazepines are the mainstays of
pharmacologic treatment. Among the different classes of
antidepressants, selective serotonin reuptake inhibitors (SSRIs) are
recommended over monoamine oxidase inhibitors and tricyclic
antidepressants.
Option D: Most clients with panic disorder with agoraphobia don’t have
nutritional problems. It is important for a provider to inform the patient
about the symptoms that he may suffer from if he is diagnosed with the
disorder. If a patient is not aware of these symptoms it is probable that he
would fear his condition more and would tend to get frequent attacks.
Pharmacotherapy and cognitive-behavioral therapy should be discussed
with the patients so that they can understand the treatment options for
the condition that they have.

8. Question
The effectiveness of monoamine oxidase (MAO) inhibitor drug therapy in clients with
posttraumatic stress disorder can be demonstrated by which of the following client
self–reports?

A. “I’m sleeping better and don’t have nightmares”.

B. “I’m not losing my temper as much”.

C. “I’ve lost my craving for alcohol”.

D. "I’ve lost my phobia for water”.

Incorrect
Correct Answer: A. “I’m sleeping better and don’t have nightmares”
MAO inhibitors are used to treat sleep problems, nightmares, and intrusive
daytime thoughts in individuals with posttraumatic stress disorder. An
examination of the available literature supports the efficacy of monoamine
oxidase inhibitors (MAOIs) in treating posttraumatic stress disorder (PTSD).
This effect may or may not be independent of the response of symptoms of
major depression; there is suggestive but inconclusive evidence supporting
both.
Option B: Monoamine oxidase inhibitors (MAOIs) were first introduced in
 the 1950s. They are a separate class from other antidepressants, treating
different forms of depression as well as other nervous system disorders
such as panic disorder, social phobia, and depression with atypical
features.
Option C: Furthermore, examples of neurological disorders that can
benefit from MAOIs are patients with Parkinson disease as well as those
diagnosed with multiple system atrophy. Multiple system atrophy is a
neurodegenerative disease that includes symptoms affecting movement
as well as blood pressure.
Option D: MAO inhibitors aren’t used to help control flashbacks or
phobias or to decrease the craving for alcohol. Monoamine oxidase
inhibitors are responsible for blocking the monoamine oxidase enzyme.
The monoamine oxidase enzyme breaks down different types of
neurotransmitters from the brain: norepinephrine, serotonin, dopamine,
as well as tyramine. MAOIs inhibit the breakdown of these
neurotransmitters thus, increasing their levels and allowing them to
continue to influence the cells that have been affected by depression.

9. Question
Mark, with a diagnosis of generalized anxiety disorder, wants to stop taking his
lorazepam (Ativan). Which of the following important facts should nurse Betty discuss
with the client about discontinuing the medication?

A. Stopping the drug may cause depression.

B. Stopping the drug increases cognitive abilities.

C. Stopping the drug decreases sleeping difficulties.

D. Stopping the drug can cause withdrawal symptoms.

Incorrect
Correct Answer: D. Stopping the drug can cause withdrawal symptoms
Stopping anti-anxiety drugs such as benzodiazepines can cause the client to
have withdrawal symptoms. Lorazepam, like other benzodiazepine medications,
is a highly addictive medication. Great care is necessary when prescribing
lorazepam at high doses or prolonged durations, particularly in patients with a
history of substance use disorder or concurrent opioid prescriptions.
Option A: Lorazepam and other benzodiazepines have increased risk of
abuse, misuse, and dependence these medications are contraindicated
 in the patient who is actively using illicit substances and drugs. Except
for use in Alcohol withdrawal disorder symptoms and for detoxifications
Lorazepam and other benzodiazepines are contraindicated in patients
with h/o alcohol dependence and abuse and not in remission. Increased
risk of fatality with the combined use of alcohol and lorazepam in
overdose, including death.
Option B: Lorazepam can cause CNS and respiratory depression in
overdose. It can lead to hypotension, ataxia, confusion, coma, and can be
fatal. Concurrent use of benzodiazepines and opioids may result in
profound sedation, respiratory depression, coma, and death.
Concomitant prescribing of benzodiazepines and opioids must be
reserved for patients for whom alternative treatment options are
inadequate. Dosage and duration of lorazepam must be limited to the
minimum required.
Option C: Stopping a benzodiazepine doesn’t tend to decrease sleeping
difficulties. If administered to patients who on chronic benzodiazepine
therapy, the sudden interruption of benzodiazepine antagonism by
flumazenil can induce benzodiazepine withdrawal, including seizures.
Flumazenil has minimal effects on benzodiazepine-induced respiratory
depression, and suitable ventilatory support should be available in
treating acute benzodiazepine overdose.

10. Question
Jennifer, an adolescent who is depressed and reported by her parents as having
difficulty in school is brought to the community mental health center to be evaluated.
Which of the following other health problems would the nurse suspect?

A. Anxiety disorder

B. Behavioral difficulties

C. Cognitive impairment

D. Labile moods

Incorrect
Correct Answer: B. Behavioral difficulties
Adolescents tend to demonstrate severe irritability and behavioral problems
rather than simply a depressed mood. A failure to follow the expected trajectory
of social-emotional development can lead to undetected mental and emotional
 health problems. Adverse childhood experiences can alter development
significantly. Thus, alongside screening for child development, actively
screening for family dysfunction and supporting families in establishing a
healthy nurturing environment is vital.
Option A: Anxiety disorder is more commonly associated with small
children rather than with adolescents. By having a thorough knowledge
of developmental pathways and adverse childhood experiences, and
having a close follow up established with families in the medical home,
pediatricians and medical professionals are in a prime position to identify
risk factors and developmental delays timely.
Option C: Cognitive impairment is typically associated with delirium or
dementia. Medical professionals taking care of children should begin with
identifying and addressing the family’s concerns, asking open-ended
questions regarding social-emotional milestones and intentionally
observing parent-child interaction and child’s interaction with the
environment including themselves. While examining the patient, they
should observe age-appropriate developmental interaction. They should
give teenagers the opportunity to engage in health visits in a private and
safe environment without a caregiver.
Option D: Labile mood is more characteristic of a client with cognitive
impairment or bipolar disorder. The American Academy of Pediatrics
(AAP) and Bright Futures Guidelines for Health Supervision of Infants,
Children, and Adolescents emphasize active screening for developmental
delays and environmental risk factors on top of clinical surveillance. This
includes the use of standardized screening tools for social-emotional
development and for environmental risks appropriate to the risk level of
the population you serve.

11. Question
Ricardo, an outpatient in a psychiatric facility is diagnosed with dysthymic disorder.
Which of the following statements about dysthymic disorder is true?

A. It involves a mood range from moderate depression to hypomania.

B. It involves a single manic depression.

C. It’s a form of depression that occurs in the fall and winter.

D. It’s a mood disorder similar to major depression but of mild to

moderate severity.
 Correct
Correct Answer: D. It’s a mood disorder similar to major depression but of
mild to moderate severity
Dysthymic disorder is a mood disorder similar to major depression but it
remains mild to moderate in severity. Persistent depressive disorder is a newly
coined term in the DSM-5 to capture what was originally known as dysthymia
and chronic major depression. This disorder has been poorly understood, and
its classification has evolved due to the complicated and ever-evolving nature of
the nosology of depressive disorders. It was not until the DSM-III that dysthymic
disorder was defined as a mild chronic depression lasting longer than 2 years.
Option A: Cyclothymic disorder is a mood disorder characterized by a
mood range from moderate depression to hypomania. Cyclothymia is a
primary mood disorder that is, by definition, characterized by episodes
that do not meet the criteria for hypomania or major depression. It is
currently classified under the umbrella of bipolar mood disorders. It is a
chronic disease that must be present for at least two years in order to be
diagnosable in adults and over 1 year in children and adolescents.
Option B: Bipolar I disorder is characterized by a single manic episode
with no past major depressive episodes. Bipolar 1 disorder has been
frequently associated with serious medical and psychiatric comorbidity,
early mortality, high levels of functional disability and compromised
quality of life. The necessary feature of bipolar 1 disorder involves the
occurrence of at least one-lifetime manic episode, although depressive
episodes are common.
Option C: Seasonal Affective Disorder is a form of depression occurring
in the fall and winter. Unlike people with classic depression, who typically
eat less and sleep more, people with SAD eat more and sleep more,
much like animals hibernating for the winter. Many patients with SAD do
not realize that they have depression, because they are not necessarily
depressed with regard to their mood. Nevertheless, they feel tired and
less interested in things and have increased sleep and appetite, thus
meeting the clinical depression criteria.

12. Question
The nurse is aware that the following ways in vascular dementia different from
Alzheimer’s disease is:

A. Vascular dementia has a more abrupt onset.

B. The duration of vascular dementia is usually brief.

C. Personality change is common in vascular dementia.

 D. The inability to perform motor activities occurs in vascular dementia.

Incorrect
Correct Answer: A. Vascular dementia has a more abrupt onset.
Vascular dementia differs from Alzheimer’s disease in that it has a more abrupt
onset and runs a highly variable course. VD is distinguished from other forms of
dementia in that it results from brain ischemia, although the temporal
relationship to the ischemic event may be subtle or go unnoticed. There are
various subtypes and multiple terms to describe the vascular pathology and
affected brain tissue, such as multi-infarct dementia, small vessel disease or
Binswanger disease, strategic infarct dementia, hypoperfusion dementia,
hemorrhagic dementia, hereditary vascular dementia, and AD with
cardiovascular disease
Option B: The duration of delirium is usually brief. Dementia is a
syndrome of chronic progressive cognitive decline resulting in functional
impairment. In the Diagnostic Manual of Mental Disorders, Fifth Edition
(DSM-V), cognitive decline is quantified as deficits in one or more
domains (e.g., memory, executive function, visuospatial, language,
attention). Second, only to Alzheimer’s disease (AD), vascular dementia
(VD) is one of the most common causes of dementia affecting the elderly
(aged greater than 65 years), with a variable presentation and
unpredictable disease progression.
Option C: Personality change is common in Alzheimer’s disease. A
thorough history should be obtained from the patient, focusing on
cognitive and functional deficits, onset, and progression of symptoms.
Interviewing family members and caregivers is important as patients with
cognitive decline rarely have insight into their cognitive and functional
limitations.
Option D: The inability to carry out motor activities is common in
Alzheimer’s disease. Caregivers may report an abrupt or stepwise onset
of cognitive decline, or the appearance of symptoms may be subtle
without connection to an ischemic event. The functional assessment
should evaluate for impairments in instrumental activities of daily living
(IADLs), such as cooking, driving, and financial and medication
management, and basic activities of daily living (ADLs), such as dressing,
bathing, and toileting. Additionally, patient’s past medical history, current
medications, and surgical history should be obtained. Regarding physical
examination, one should assess patients for focal neurologic deficits.

13. Question
Loretta, a newly admitted client was diagnosed with delirium and has a history of
hypertension and anxiety. She had been taking digoxin, furosemide (Lasix), and
diazepam (Valium) for anxiety. This client’s impairment may be related to which of the
following conditions?
 A. Infection

B. Metabolic acidosis

C. Drug intoxication

D. Hepatic encephalopathy

Incorrect
Correct Answer: C. Drug intoxication
This client was taking several medications that have a propensity for producing
delirium; digoxin (a digitalis glycoside), furosemide (a thiazide diuretic), and
diazepam (a benzodiazepine). Precipitating factors usually vary among the
population. However, drugs are the most important factor. There are many
drugs related to delirium, especially sedative-hypnotic agents and
anticholinergic, but opioid analgesics (especially meperidine),
nonbenzodiazepines, sedatives, hypnotics, antihistamines (especially first
generation), alcohol, anticholinergics, anticonvulsants, tricyclic antidepressants,
histamine H2-receptor blockers, antiparkinsonian agents, antipsychotics
(especially low-potency typical antipsychotics), barbiturates, digoxin, and
antibiotics have been reported as well. The risk increases as high as four and a
half times if the patient consumes three or more drugs (polypharmacy), and the
medication is psychoactive.
Option A: Among other precipitating factors are surgery, anesthesia,
high pain levels, anemia, infections, acute illness, and acute exacerbation
of chronic illness. The nature of delirium is transient, but it can persist in
patients with predisposing factors. A systematic review showed that
hospital delirium persisted at hospital discharge in 45% of cases, and
one month later in 33% of cases.
Option B: There are two groups of risk factors related to delirium:
predisposing and precipitant factors. The most common predisposing
factors are older age (older than 70 years), dementia (often not
recognized clinically), functional disabilities, male gender, poor vision and
hearing, and mild cognitive impairment. Alcohol use disorder and
laboratory abnormalities have been associated with an increased risk.
Option D: Sufficient supporting data don’t exist to suspect the other
options as causes. Delirium is a medical condition complex to
understand; a single factor can cause it; however, it is not the common
course. The multifactorial model has been accepted as an interaction of a
vulnerable patient with predisposing factors, exposed to noxious insults
or precipitant factors.
14. Question
Nurse Ron enters a client’s room, the client says, “They’re crawling on my sheets! Get
them off my bed!” Which of the following assessments is the most accurate?

A. The client is experiencing aphasia.

B. The client is experiencing dysarthria.

C. The client is experiencing a flight of ideas.

D. The client is experiencing visual hallucination.

Correct
Correct Answer: D. The client is experiencing visual hallucination
The presence of a sensory stimulus correlates with the definition of a
hallucination, which is a false sensory perception. Visual hallucinations involve
seeing things that aren’t there. The hallucinations may be of objects, visual
patterns, people, or lights. Hallucinations, defined as the perception of an
object or event (in any of the 5 senses) in the absence of an external stimulus,
are experienced by patients with conditions that span several fields (e.g.,
psychiatry, neurology, and ophthalmology). When noted by nonpsychiatrists,
visual hallucinations, one type of sensory misperception, often trigger requests
for psychiatric consultation, although visual hallucinations are not
pathognomonic of a primary psychiatric illness.
Option A: Aphasia refers to a communication problem. Aphasia is an
impairment of language, affecting the production or comprehension of
speech and the ability to read or write. Aphasia is always due to injury to
the brain-most commonly from a stroke, particularly in older individuals.
But brain injuries resulting in aphasia may also arise from head trauma,
from brain tumors, or from infections.
Option B: Dysarthria is a difficulty in speech production. Dysarthria is a
motor speech disorder in which the muscles that are used to produce
speech are damaged, paralyzed, or weakened. The person with
dysarthria cannot control their tongue or voice box and may slur words.
Motor speech disorders like dysarthria result from damage to the
nervous system. Many neuromuscular conditions (diseases that affect
the nerves controlling certain muscles) can result in dysarthria. In
dysarthria, the muscles used to speak become damaged, paralyzed, or
weakened.
Option C: Flight of ideas is rapidly shifting from one topic 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 be
disorganized and incoherent. It is part of the DSM-5 criteria for Manic
episodes.

15. Question
Which of the following descriptions of a client’s experience and behavior can be
assessed as an illusion?

A. The client tries to hit the nurse when vital signs must be taken.

B. The client says, “I keep hearing a voice telling me to run away”.

C. The client becomes anxious whenever the nurse leaves the bedside.

D. The client looks at the shadow on a wall and tells the nurse she sees
frightening faces on the wall.

Correct
Correct Answer: D. The client looks at the shadow on a wall and tells the
nurse she sees frightening faces on the wall.
Minor memory problems are distinguished from dementia by their minor
severity and their lack of significant interference with the client’s social or
occupational lifestyle. The psychological concept of illusion is defined as a
process involving an interaction of logical and empirical considerations.
Common usage suggests that an illusion is a discrepancy between one’s
awareness and some stimulus.
Option A: In psychology, the term aggression refers to a range of
behaviors that can result in both physical and psychological harm to
yourself, others, or objects in the environment. This type of behavior
centers on harming another person either physically or mentally. It can be
a sign of an underlying mental health disorder, a substance use disorder,
or a medical disorder.
Option B: 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. Nonpsychotic disorders known to be associated with auditory
hallucinations are mood disorders, trauma-related, substance-related,
neurological, personality, as well as their occurrence in “healthy”
individuals.
Option C: Other options would be included in the history data but don’t
 directly correlate with the client’s lifestyle. Anxiety is linked to fear and
manifests as a future-oriented mood state that consists of a complex
cognitive, affective, physiological, and behavioral response system
associated with preparation for the anticipated events or circumstances
perceived as threatening. Pathological anxiety is triggered when there is
an overestimation of perceived threat or an erroneous danger appraisal
of a situation which leads to excessive and inappropriate responses.

16. Question
During a conversation with Nurse John with a client, he observes that the client shifts
from one topic to the next on a regular basis. Which of the following terms describes
this disorder?

A. Flight of ideas

B. Concrete thinking

C. Ideas of reference

D. Loose association

Incorrect
Correct Answer: D. Loose association
Loose associations are conversations that constantly shift in topic. Loose
associations don’t necessarily start in a cogently, then become loose. A
manifestation of a thought disorder whereby the patient’s responses do not
relate to the interviewer’s questions, or one paragraph, sentence, or phrase is
not logically connected to those that occur before or after.
Option A: Flight of ideas is characterized by a conversation that’s
disorganized from the onset. 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 be disorganized and incoherent. It is part of
the DSM -5 criteria for Manic episodes.
Option B: Concrete thinking implies highly definitive thought processes.
Concrete thinking is reasoning that’s based on what you can see, hear,
feel, and experience in the here and now. It’s sometimes called literal
thinking, because it’s reasoning that focuses on physical objects,
immediate experiences, and exact interpretations.
Option C: Ideas of reference or delusions of reference involve a person
 having a belief or perception that irrelevant, unrelated or innocuous
things in the world are referring to them directly or have special personal
significance. The two are clearly distinguished in psychological literature.

17. Question
Francis tells the nurse that her coworkers are sabotaging the computer. When the
nurse asks questions, the client becomes argumentative. This behavior shows
personality traits associated with which of the following personality disorders?

A. Antisocial

B. Histrionic

C. Paranoid

D. Schizotypal

Incorrect
Correct Answer: C. Paranoid
Because of their suspiciousness, paranoid personalities ascribe malevolent
activities to others and tend to be defensive, becoming quarrelsome and
argumentative. Paranoid personality disorder (PPD) is one of a group of
conditions called “Cluster A” personality disorders which involve odd or
eccentric ways of thinking. People with PPD also suffer from paranoia, an
unrelenting mistrust and suspicion of others, even when there is no reason to be
suspicious.
Option A: Clients with antisocial personality disorder can also be
antagonistic and argumentative but are less suspicious than paranoid
personalities. Antisocial personality disorder (ASPD) is a deeply ingrained
and rigid dysfunctional thought process that focuses on social
irresponsibility with exploitive, delinquent, and criminal behavior with no
remorse. Disregard for and the violation of others’ rights are common
manifestations of this personality disorder, which displays symptoms that
include failure to conform to the law, inability to sustain consistent
employment, deception, manipulation for personal gain, and incapacity to
form stable relationships.
Option B: Clients with histrionic personality disorder are dramatic, not
suspicious and argumentative. Histrionic personality disorder, or
dramatic personality disorder, is a psychiatric disorder distinguished by a
pattern of exaggerated emotionality and attention-seeking behaviors.
 Histrionic personality disorder falls within the “Cluster B” of personality
disorders. Cluster B personality disorders include conditions such as
narcissistic personality disorder, borderline personality disorder, and
antisocial personality disorder. These personality disorders are
commonly described as dramatic, excitable, erratic, or volatile.
Option D: Clients with schizoid personality disorder are usually detached
from others and tend to have eccentric behavior. The schizoid
personality type was made official in DSM III in 1980, to describe persons
experiencing significant ineptitude in forming meaningful social
relationships. Isolation is a salient feature in the history of a schizoid
patient. Rarely do they have close relationships, and often they will
choose to participate in occupations that are solitary in nature. They
infrequently experience strong emotion, express little to no desire for
sexual activity with a partner, and tend to be ambivalent to criticism or
praise.

18. Question
Which of the following interventions is important for a Cely experiencing a paranoid
personality disorder taking olanzapine (Zyprexa)?

A. Explain effects of serotonin syndrome.

B. Teach the client to watch for extrapyramidal adverse reactions.

C. Explain that the drug is less effective if the client smokes.

D. Discuss the need to report paradoxical effects such as euphoria.

Incorrect
Correct Answer: C. Explain that the drug is less effective if the client
smokes.
Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes.
Olanzapine is a second-generation (atypical) antipsychotic medication.
Olanzapine also has approval for use with fluoxetine, a selective serotonin
reuptake inhibitor (SSRI), in patients with episodes of depression associated
with bipolar disorder type 1 and treatment-resistant depression.
Option A: Serotonin syndrome occurs with clients who take a
combination of antidepressant medications. Serotonin syndrome is a
potentially life-threatening condition precipitated by the use of
serotonergic drugs. It may be a consequence of therapeutic medication
 use, accidental interactions between medications or recreational drugs,
or intentional overdose. Symptoms can range from mild to fatal and
classically include altered mental status, autonomic dysfunction, and
neuromuscular excitation.
Option B: Extrapyramidal adverse reactions aren’t a problem. However,
the client should be aware of adverse effects such as tardive dyskinesia.
Olanzapine’s mechanism of action also lends itself to directly causing
adverse reactions associated with the dopaminergic blockade. Patients
taking olanzapine have a risk of developing akathisia, extrapyramidal
symptoms, tardive dyskinesia, and neuroleptic malignant syndrome.
However, the risk of developing these side effects is lesser than first-
generation antipsychotics due to the loose association and quick
dissociation of olanzapine with the D2 receptors.
Option D: Olanzapine doesn’t cause euphoria. One of the most common
adverse effects of olanzapine is the potential for gaining weight.
Olanzapine causes an increase in appetite leading to hyperphagia with a
consequence of weight gain. Therefore, it should be used cautiously in
patients who are obese, have little control over their food intake, and do
not exercise regularly to combat weight gain.

19. Question
Nurse Alexandra notices other clients on the unit avoiding a client diagnosed with
antisocial personality disorder. When discussing appropriate behavior in group therapy,
which of the following comments is expected about this client by his peers?

A. Lack of honesty

B. Belief in superstition

C. Show of temper tantrums

D. Constant need for attention

Correct
Correct Answer: A. Lack of honesty
Clients with antisocial personality disorder tend to engage in acts of dishonesty,
shown by lying. Antisocial personality disorder (ASPD) is a deeply ingrained and
rigid dysfunctional thought process that focuses on social irresponsibility with
exploitive, delinquent, and criminal behavior with no remorse. Disregard for and
the violation of others’ rights are common manifestations of this personality
disorder, which displays symptoms that include failure to conform to the law,
 inability to sustain consistent employment, deception, manipulation for personal
gain, and incapacity to form stable relationships.
Option B: Clients with schizotypal personality disorder tend to be
superstitious. It is unlikely that a person with a schizoid personality
disorder will present in the clinical setting of his own volition unless
prompted by family, or as a result of a co-occurring disorder, such as
depression. As with most personality disorders, the behavior is in
synchrony with the ego, and thus the patient does not acknowledge the
need to adapt his or her behavior.
Option C: Histrionic personality disorder, or dramatic personality
disorder, is a psychiatric disorder distinguished by a pattern of
exaggerated emotionality and attention-seeking behaviors. Histrionic
personality disorder falls within the “Cluster B” of personality disorders.
Cluster B personality disorders include conditions such as narcissistic
personality disorder, borderline personality disorder, and antisocial
personality disorder. These personality disorders are commonly
described as dramatic, excitable, erratic, or volatile. Specifically, people
with histrionic personality disorder typically present as flirtatious,
seductive, charming, manipulative, impulsive, and lively.
Option D: Clients with histrionic personality disorders tend to overreact
to frustrations and disappointments, have temper tantrums, and seek
attention. People with a histrionic personality disorder may feel
underappreciated or disregarded when they are not the center of
attention. These people are typically the life of the party and have a
“larger than life” presence. They may be vibrant, enchanting, overly
seductive, or inappropriately sexual with most of the people they meet,
even when they are not sexually attracted to them. People presenting
with a histrionic personality disorder may demonstrate rapidly shifting
and shallow emotions that others may perceive as insincere.

20. Question
Tommy, with a dependent personality disorder, is working to increase his self-esteem.
Which of the following statements by Tommy shows teaching was successful?

A. “I’m not going to look just at the negative things about myself”.

B. “I’m most concerned about my level of competence and progress”.

C. “I’m not as envious of the things other people have as I used to be”.

D. “I find I can’t stop myself from taking over things others should be doing”.
 Incorrect
Correct Answer: A. “I’m not going to look just at the negative things about
myself”
As the clients make progress on improving self-esteem, self-blame and
negative self-evaluation will decrease. Dependent personality disorder (DPD) is
a type of anxious personality disorder. People with DPD often feel helpless,
submissive or incapable of taking care of themselves. They may have trouble
making simple decisions. But, with help, someone with a dependent personality
can learn self-confidence and self-reliance.
Option B: Clients with dependent personality disorder tend to feel fragile
and inadequate and would be extremely unlikely to discuss their level of
competence and progress. People with DPD have an overwhelming need
to have others take care of them. Often, a person with DPD relies on
people close to them for their emotional or physical needs. Others may
describe them as needy or clingy.
Option C: These clients focus on self and aren’t envious or jealous.
People with DPD may believe they can’t take care of themselves. They
may have trouble making everyday decisions, such as what to wear,
without others’ reassurance.
Option D: Individuals with dependent personality disorders don’t take
over situations because they see themselves as inept and inadequate.
Statistics show that roughly 10% of adults have a personality disorder.
Less than 1% of adults meet the criteria for DPD. More women than men
tend to have DPD.

21. Question
Norma, a 42-year-old client with a diagnosis of chronic undifferentiated schizophrenia
lives in a rooming house that has a weekly nursing clinic. She scratches while she tells
the nurse she feels creatures eating away at her skin. Which of the following
interventions should be done first?

A. Talk about his hallucinations and fears.

B. Refer him for anticholinergic adverse reactions.

C. Assess for possible physical problems such as rash.

D. Call his physician to get his medication increased to control his

psychosis.
 Incorrect
Correct Answer: C. Assess for possible physical problems such as rash
Clients with schizophrenia generally have poor visceral recognition because
they live so fully in their fantasy world. They need to have an in-depth
assessment of physical complaints that may spill over into their delusional
symptoms. Over half of the patients have significant comorbidities, both
psychiatric and medical, making it one of the leading causes of disability
worldwide. The diagnosis correlates with a 20% reduction in life expectancy,
with up to 40% of deaths attributed to suicide.
Option A: Talking with the client won’t provide an assessment of his
itching. A thorough risk assessment must also be undertaken to
determine the risk of harm to self and others. The first schizophrenic
episode usually occurs during early adulthood or late adolescence.
Individuals often lack insight at this stage; therefore few will present
directly to seek help for their psychotic symptoms.
Option B: Itching isn’t an adverse reaction of antipsychotic drugs.
Common presentations include a relative noticing social withdrawal,
personality changes or uncharacteristic behavior; deliberate self-harm or
suicide attempts; calling the police to report their delusional symptoms
or referral via the criminal justice system. The use of screening tools such
as COPS (Criteria of Prodromal Syndromes), SIPS (Structured Interview
for Prodromal Syndromes) and PACE (Personal Assessment and Crisis
Evaluation Clinic) has been shown to increase the detection rate of
schizophrenia in premorbid states although there is controversy
surrounding indicating treatment at this stage.
Option D: Calling the physician to get the client’s medication increased
doesn’t address his physical complaints. After conducting a full
psychiatric history, it is imperative to conduct a thorough systems review
and a mental state examination where appearance, behavior, mood,
speech, cognition, and insight need to be assessed, alongside
determining evidence of perceptual delusions or formal thought
disorders.

22. Question
Ivy, who is in the psychiatric unit is copying and imitating the movements of her primary
nurse. During recovery, she says, “I thought the nurse was my mirror. I felt connected
only when I saw my nurse.” This behavior is known by which of the following terms?

A. Modeling

B. Echopraxia

C. Ego-syntonicity
 D. Ritualism

Incorrect
Correct Answer: B. Echopraxia
Echopraxia is the copying of another’s behaviors and is the result of the loss of
ego boundaries. The involuntary imitation of the movements of another person.
Echopraxia is a feature of schizophrenia (especially the catatonic form),
Tourette syndrome, and some other neurologic diseases. From echo + the
Greek praxia meaning action.
Option A: Modeling is the conscious copying of someone’s behaviors.
Modeling is one way in which behavior is learned. When a person
observes the behavior of another and then imitates that behavior, he or
she is modeling the behavior. This is sometimes known as observational
learning or social learning. Modeling is a kind of vicarious learning in
which direct instruction need not occur.
Option C: Ego-syntonicity refers to behaviors that correspond with the
individual’s sense of self. Thoughts, wishes, impulses, and behavior are
said to be ego-syntonic when they form no threat to the ego and can be
acted upon without interference from the superego.
Option D: Ritualism behaviors are repetitive and compulsive. Ritualism is
a concept developed by American sociologist Robert K. Merton as a part
of his structural strain theory. It refers to the common practice of going
through the motions of daily life even though one does not accept the
goals or values that align with those practices.

23. Question
Jun approaches the nurse and tells that he hears a voice telling him that he’s evil and
deserves to die. Which of the following terms describes the client’s perception?

A. Delusion

B. Disorganized speech

C. Hallucination

D. Idea of reference
 Incorrect
Correct Answer: C. Hallucination
Hallucinations are sensory experiences that are misrepresentations of reality or
have no basis in reality. Hallucinations are sensations that appear to be real but
are created within the mind. Examples include seeing things that are not there,
hearing voices or other sounds, experiencing body sensations like crawling
feelings on the skin, or smelling odors that are not there.
Option A: Delusions are beliefs not based on reality. 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.
Option B: Disorganized speech is characterized by jumping from one
topic to the next or using unrelated words. Disorganized speech is
characterized by a collection of speech abnormalities that can make a
person’s verbal communication difficult or impossible to comprehend. It
is a symptom of schizophrenia.
Option D: An idea of reference is a belief that an unrelated situation
holds special meaning for the client. An idea of reference—sometimes
called a delusion of reference—is the false belief that irrelevant
occurrences or details in the world relate directly to oneself. Ideas of
reference are variations on this behavior, and occur when a person
believes something is referring to them when it is not. For example, a
person shopping in a store might see two strangers laughing and believe
that they are laughing at him or her when in reality the other two people
do not even notice the person. Some mental health professionals believe
this thought error is a type of cognitive bias.

24. Question
Mike is admitted to a psychiatric unit with a diagnosis of undifferentiated
schizophrenia. Which of the following defense mechanisms is probably used by Mike?

A. Projection

B. Rationalization

C. Regression

D. Repression
 Incorrect
Correct Answer: C. Regression
Regression, a return to earlier behavior to reduce anxiety, is the basic defense
mechanism in schizophrenia. Adapting one’s behavior to earlier levels of
psychosocial development. For example, a stressful event may cause an
individual to regress to bed-wetting after they have already outgrown this
behavior.
Option A: Projection is a defense mechanism in which one blames others
and attempts to justify actions; it’s used primarily by people with
paranoid schizophrenia and delusional disorder. Attributing one’s own
maladaptive inner impulses to someone else. For example, someone who
commits an episode of infidelity in their marriage may then accuse their
partner of infidelity or may become more suspicious of their partner.
Option B: Rationalization is a defense mechanism used to justify one’s
action. The justification of one’s behavior through attempts at a rational
explanation. This defense mechanism may be present in someone who
steals money but feels justified in doing so because they needed the
money more than the person from whom they stole.
Option D: Repression is the basic defense mechanism in the neuroses;
it’s an involuntary exclusion of painful thoughts, feelings, or experiences
from awareness. Subconsciously blocking ideas or impulses that are
undesirable. This defense mechanism may be present in someone who
has no recollection of a traumatic event, even though they were
conscious and aware during the event.

25. Question
Rocky has started taking haloperidol (Haldol). Which of the following instructions is
most appropriate for Ricky before taking haloperidol?

A. Should report feelings of restlessness or agitation at once.

B. Use sunscreen outdoors on a year-round basis.

C. Be aware you’ll feel increased energy taking this drug.

D. Avoid eating sugar-free sweets.

Incorrect
Correct Answer: A. Should report feelings of restlessness or agitation at
once
Haloperidol is a first-generation (typical) antipsychotic medication that is used
widely around the world. Food and Drug Administration (FDA) approved the use
of haloperidol is for schizophrenia, Tourette syndrome (control of tics and vocal
utterances in adults and children), hyperactivity (which may present as
impulsivity, difficulty maintaining attention, severe aggressivity, mood instability,
and frustration intolerance), severe childhood behavioral problems (such as
combative, explosive hyperexcitability), intractable hiccups. It is a typical
antipsychotic because it works on positive symptoms of schizophrenia, such as
hallucinations and delusions.
Option A: Agitation and restlessness are adverse effects of haloperidol
and can be treated with anticholinergic drugs. Due to the blockade of the
dopamine pathway in the brain, typical antipsychotic medications such
as haloperidol have correlations with extrapyramidal side effects.
Option B: Haloperidol isn’t likely to cause photosensitivity or control
essential hypertension. Due to potential side effects development,
patients receiving haloperidol require monitoring, especially when
receiving the intramuscular form. It can be easily monitored by taking
blood levels. It has a therapeutic range of 2 to 15 ng/ml in serum. Blood
levels should be monitored at 12-hour or 24-hour intervals or after the
last dose of haloperidol use in a patient.
Option C: Although the client may experience increased concentration
and activity, these effects are due to a decrease in symptoms, not the
drug itself. Haloperidol is a first-generation (typical antipsychotic) which
exerts its antipsychotic action by blocking dopamine D2 receptors in the
brain. When 72% of dopamine receptors are blocked, this drug achieves
its maximal effect. Haloperidol is not selective for the D2 receptor. It also
has noradrenergic, cholinergic, and histaminergic blocking action. The
blocking of these receptors is associated with various side effects.
Option D: Haloperidol may produce anticholinergic side effects such as
dry mouth, hence the health care provider will teach the client
interventions to relieve symptoms such as chewing a sugarless hard
candy or gum.

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