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1. After 4 days on the inpatient psychiatric unit, a client on suicidal precautions tells the nurse, “Hey, look! I was feeling pretty depressed for a while, but I’m certainly not going to kill myself.” What is the nurse’s best response to this statement?

• “You do seem to be feeling better.”
• “We should talk some more about this.”
• “We have to observe you until you are better.”
• “I don’t understand what you mean by killing yourself.”

2. What should a nurse include in the initial plan of care for a client with the long-standing, obsessive-compulsive behavior of hand washing?

• Determine the purpose of the ritualistic behavior.
• Limit the time allowed for the ritualistic behavior.
• Suggest a symptom substitution technique to refocus the ritualistic behavior.
• Develop a routine schedule of activities to reduce the need for the ritualistic behavior.

3. What should a nurse consider when planning care for a client who is using ritualistic behavior?

• Nurses must attempt to limit the ritualistic behavior.
• Clients need to realize that ritualistic behavior serves no purpose.
• Nurses should try to divert the ritual immediately after it is started.
• Clients do not want to repeat the ritual but feel compelled to do so.

4. A nurse moves into the working phase of a therapeutic relationship with a depressed client who has a history of suicide attempts. What question should the nurse ask the client when exploring alternative coping strategies?

• “How have you managed your problems in the past?”
• “What do you feel you have learned from this suicide attempt?”
• “How will you manage the next time your problems start piling up?”
• “Were there other things going on in your life that made you want to die?”

5. A client with a diagnosis of major depression refuses to participate in unit activities because of being “just too tired.” What is the nurse’s best approach?

• Plan one rest period during each activity.
• Explain why the staff believes the activities are therapeutic.
• Encourage the client to express negative feelings about the activities.
• Accept the client’s feelings about activities calmly, while setting firm limits.

6. A client whose depression is beginning to lift remains aloof from the other clients on the mental health unit. How can a nurse help the client to participate in an activity?

• Find solitary pursuits that the client can enjoy.
• Speak to the client about the importance of entering into activities.
• Ask the health care provider to speak to the client about participating.
• Invite another client to take part in a joint activity with the nurse and the client.

7. A nurse considers that in a conversion disorder pseudoneurologic symptoms such as paralysis or blindness:

• are unconscious methods for getting attention.
• will subside if the client is helped to focus on getting healthy.
• are generally necessary for the client to cope with a stressful situation.
• will usually resolve when the client learns to cope with ongoing family conflicts.

8. What characteristic of anxiety is associated with a diagnosis of conversion disorder?

• Free floating
• Relieved by the symptom
• Consciously felt by the client
• Projected onto the environment

9. Hospitalization or day-treatment centers are often indicated for the treatment of a client with an obsessive-compulsive disorder because these settings:

• prevent the client from completing rituals.
• allow the staff to exert control over the client’s activities.
• resolve the client’s anxiety because decision making is minimal.
• provide the neutral environment the client needs to work through conflicts.

10. A client is admitted to the mental health unit after attempting suicide. When a nurse approaches, the client is tearful and silent. What is the nurse’s best initial intervention?

• Observe the behavior, record it, and notify the health care provider.
• Sit quietly next to the client and wait for the client to start speaking.
• Say, “You are crying. That means you feel badly about attempting suicide and really want to live.”
• Say, “I see you are tearful. Tell me about what is going on in your life, and we can work on helping you.”

11. A depressed client states, “I am no good. I’m better off dead.” What is the priority nursing intervention?

• Stating, “I think you’re good; you should think of living.”
• Alerting the staff to schedule 24-hour observation of the client
• Responding, “I will stay with you until you are less depressed.”
• Unobtrusively removing those articles that may be used in a suicide attempt

12. During a special meeting to discuss the unexpected suicide of a recently discharged client, a nurse overhears another client moan softly, “I’m next. Oh, my God, I’m next. They couldn’t protect that person, and they can’t protect me.” What is the nurse’s most therapeutic response?

• “That person was a lot sicker than you are.”
• “You seem to be afraid you will hurt yourself.”
• “It’s different. The other person was home, while you are here.”
• “There is no need to worry. We will protect you even after you are discharged.”

13. A depressed older client has not been eating well since admission to the hospital. The client repeatedly states, “No one cares.” What is the nurse’s most appropriate response?

• “We all care about you; now please eat.”
• “We all care about you; you have to eat to stay alive.”
• “I care about you. What are some foods you especially like?”
• “I care about you. Will you please eat some of this food for me?”

14. A client comes to a mental health center with severe anxiety evidenced by crying, wringing the hands, and pacing. What should be the first nursing intervention?

• Stay physically close to the client.
• Gently ask what is bothering the client.
• Tell the client to try to relax by sitting quietly.
• Involve the client in a nonthreatening activity.

15. A nurse is assigned to care for a depressed client on a day when the client seems more withdrawn and depressed than usual. Which nursing intervention is most appropriate?

• Remain visible to the client.
• Involve the client in group activities.
• Spend a few extra minutes with the client throughout the day.
• Ask the client if it would help if you both sat together for a while.

16. A client with major depression that includes psychotic features tells the nurse, “All my relatives have been killed because I have been sinful and need to be punished.” What is the primary focus of nursing interventions?

• Protect the client against any suicidal impulses.
• Support the client’s interest in the outside world.
• Help the client manage the concern for family members.
• Reassure the client that past behaviors are not being punished.

17. What characteristic uniquely associated with psychophysiologic disorders differentiates them from somatoform disorders?

• Emotional cause
• Feeling of illness
• Restriction of activities
• Underlying pathophysiology

18. A client believes that doorknobs are contaminated and refuses to touch them, except with a paper tissue. What nursing intervention is most therapeutic for this client?

• Supply the client with paper tissues to help functioning until anxiety is reduced.
• Have the client scrub the doorknobs with a strong antiseptic so that tissues are no longer needed.
• Encourage the client to touch doorknobs by removing all available paper tissue until learning how to manage the situation.
• Explain to the client that the idea about doorknobs being contaminated is part of the illness, so precautions are not necessary.

19. What is a therapeutic nursing action when caring for a depressed client?

• Playing a game of chess with the client
• Allowing the client to make personal decisions
• Sitting down next to the client at frequent intervals
• Providing the client with frequent periods of time for reflection

20. A nurse is planning care for a depressed client. Which approach is most therapeutic?

• Allowing the client time to complete activities
• Helping the client focus on the family support system
• Encouraging the client to perform menial, repetitious tasks
• Telling the client repeatedly that the staff views the client as worthwhile

21. A client with the diagnosis of bipolar disorder, depressive episode, has been hospitalized on a psychiatric unit for 1 week. What is the most appropriate activity for this client?

• Complete a jigsaw puzzle alone.
• Play a game of cards with several other clients.
• Talk with the nurse several times during the day.
• Engage in a game of Ping-Pong with another client.

22. A nurse is developing a care plan for a client with an obsessive-compulsive behavior disorder. Which nursing intervention will most likely increase the clients anxiety?

• Helping the client understand the nature of the anxiety
• Limiting the client’s ritualistic acts to three times a day
• Involving the client in establishing the therapeutic plan
• Providing the client with a nonjudgmental environment

23. A nurse is caring for a client with a somatoform disorder. What should the nurse anticipate that this client will do?

• Redirect the conversation with the nurse to physical symptoms.
• Monopolize conversations about the anxiety being experienced.
• Write down conversations to assist in remembering information.
• Start a conversation asking the nurse to recommend palliative care.

24. A nurse sits with a depressed client twice a day, although there is little verbal communication. One afternoon, the client asks, “Do you think they’ll ever let me out of here?” What is the nurse’s best reply?

• “We should ask your doctor.”
• “Everyone says you’re doing fine.”
• “Do you think you are ready to leave?”
• “How do you feel about leaving here?”

25. A nurse is caring for a client diagnosed with an obsessive-compulsive disorder. What is the basis for the obsessions and compulsions?

• Unconscious control of unacceptable feelings
• Conscious use of this method to punish themselves
• Acceptance of voices that tell them the doorknobs are unclean
• Fulfillment of a need to punish others by carrying out an annoying procedure

26. A nurse is working with a client with a major depressive episode. What is a long-term goal for this client?

• Talk openly about the depressed feelings.
• Identify and use new defense mechanisms.
• Discuss the unconscious source of the anger.
• Verbalize realistic perceptions of self and others.

27. A client newly diagnosed with a conversion disorder is manifesting paralysis of a leg. The nurse can expect this client to:

• demonstrate a spread of paralysis to other body parts.
• require continuous psychiatric treatment to maintain independent functioning.
• recover the use of the affected leg but, under stress, again develop similar symptoms.
• follow an unpredictable emotional course in the future, depending on exposure to stress.

28. An anxious client reports experiencing pain in the abdomen and feeling empty and hollow. A diagnostic workup reveals no physical causes of these clinical findings. What term best reflects what the client is experiencing?

• Dissociation
• Somatization
• Stress response
• Anxiety reaction

29. A depressed client is concerned about many fears that are upsetting and frightening and expresses a feeling of having committed the “unpardonable sin.” What is the nurse’s most therapeutic response?

• “Your family loves you very much.”
• “You do understand that you really are not a bad person.”
• “You know these feelings are in your imagination and are not true.”
• Your thoughts are part of your illness and will change as you improve.”

30. Which is the best nursing intervention during the working ph ase of the therapeutic relationship to meet the needs of individuals who demonstrate obsessive-compulsive behavior?

• Restricting their movements
• Calling attention to the behavior
• Keeping them busy to distract them
• Supporting rituals while setting realistic limits

31. A client who is being admitted to the mental health unit with bipolar disorder is depressed, avoids eye contact, responds in a very low voice, and is tearful. What is most therapeutic for a nurse to say during the assessment interview?

• “You’ll find that you’ll get better faster if you try to help us to help you.”
• “Hold my hand. I know you are frightened. I will not allow anyone to harm you.”
• “I’m your nurse. I’ll take you to the day room as soon as I get some information.”
• “I know this is difficult, but as soon as we are finished, I’ll take you to your room.”

32. A nurse is discharging a client from the mental health unit who has been treated for major depression. Which statement is most therapeutic at this time?

• “I am going to miss you; we have become good friends.”
• “I know you are really going to be all right when you go home.”
• “Call the contact number you were given if you have an emergency.”
• “This is my phone number; call me to let me know how you are doing.”

33. A nurse is caring for a client who has a diagnosis of conversion disorder with paralysis of the lower extremities. Which is the most therapeutic nursing intervention?

• Encouraging the client to try to walk
• Explaining to the client that there is nothing wrong
• Avoiding focusing on the client’s physical symptoms
• Helping the client follow through with the physical therapy plan

34. A client is admitted to the mental health unit because of a progressively increasing depression over the past month. What clinical finding does a nurse expect during the initial assessment of the client?

• Elated affect related to reaction formation
• Loose associations related to thought disorder
• Physical exhaustion resulting from decreased physical activity
• Diminished verbal expression caused by slowed thought processes

35. A client is admitted to the psychiatric hospital after many self-inflicted nonlethal injuries over the last month. Which level of suicidal behavior is reflective of the client’s behavior?

• Threats
• Gestures
• Attempts
• Ideations

36. A frail, depressed client frequently paces the halls, becoming physically tired from the activity. What action should the nurse take to help reduce this activity?

• Have the client perform simple, repetitive tasks.
• Ask the client’s health care provider to prescribe a sedative.
• Restrain the client in a chair, thus reducing the opportunity to pace.
• Place the client in a single room, thus limiting pacing to a smaller area.

37. A client is using ritualistic behaviors. Why should a nurse allow the client ample time for the performance of the ritual?

• Denial of this activity may precipitate panic levels of anxiety.
• Anger turned inward on the self should be allowed to be expressed.
• Successful performance of independent activities enhances self-esteem.
• Ample time provides an opportunity to point out the inappropriate behavior.

38. A withdrawn client refuses to get out of bed and becomes upset when asked to do so. What nursing action is most therapeutic?

• Require the client to get out of bed.
• Stay with the client until the client calms down.
• Give the client the prn antipsychotic that is prescribed.
• Leave the client alone in bed for as long as the client wishes.

39. A client with a history of obsessive-compulsive behaviors has a marked decrease in symptoms and expresses a wish to obtain a part-time job. On the day of a job interview the client arrives at the mental health center displaying signs of anxiety. What is the nurse’s best response to the client’s behavior?

• “I know you’re anxious, but by forcing yourself to go to the interview, you may conquer your fear.”
• “If going to an interview makes you this anxious, it seems as though you’re not ready to go back to work.”
• “It must be that you really don’t want that job after all. I think you should reconsider going to the interview.”
• “Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you there.”

40. On the second day after admission, a suicidal client asks a nurse, “Why am I being watched around the clock, and why can’t I walk around the entire unit?” Which reply is most appropriate?

• “Why do you think we are observing you?”
• “What makes you think we are observing you?”
• “We are concerned that you might try to harm yourself.”
• “We are following your doctor’s orders, so there must be a reason.”

41. A nurse is caring for a client with an obsessive-compulsive personality disorder that involves rituals. What should the nurse conclude about the ritual?

• Has a purpose but is useless
• Is performed after long urging
• Appears to be performed willingly
• Seems illogical but is needed by the person

42. What is the priority discharge criterion for a client who is using ritualistic behaviors?

• Verbalizes positive aspects about the self
• Follows the rules of the therapeutic milieu
• Intervenes to maintain increasing anxiety at a manageable level
• Recognizes that hallucinations occur at times of extreme anxiety

43. A nurse stops by the room of a tearful, newly admitted depressed client and offers to walk with the client to the evening meal. The client looks intently at the nurse, saying nothing. What is the nurse’s best response?

• “I’ll be at the desk if you need me.”
• “You must tell me what you are feeling now.”
• “We will walk together to dinner when you calm down.”
• “It may be very difficult for you to be on a psychiatric unit.”

44. A nurse plans to evaluate a newly admitted depressed client’s potential for suicide. What is the best approach to obtain this information?

• Question the client about plans for the future.
• Inquire whether the client is now considering suicide.
• Discuss suicide with other clients while the client is in the group.
• Ask family members whether the client has ever attempted suicide.

45. Which activity is most appropriate for a nurse to introduce to a depressed client during the early part of hospitalization?

• Board game
• Project involving drawing
• Small aerobic exercise group
• Card game with three other clients

46. A nurse has been assigned to work with a depressed client on a one-to-one basis. The next morning the client refuses to get out of bed, stating, “I’m too sick to be helped, and I don’t want to be bothered.” What is the nurse’s best response?

• “You will not feel better unless you make the effort to get up and get dressed.”
• “I know you will feel better again if you could just make an attempt to help yourself.”
• “Everyone feels this way in the beginning as they confront their feelings. I’ll sit down with you.”
• “I know you don’t feel like getting up, but you may feel better if you do. Let me help you get started.”

47. What is most appropriate for a nurse to say when interviewing a newly admitted depressed client whose thoughts focus on feelings of worthlessness and failure?

• “Tell me how you feel about yourself.”
• “Tell me what has been bothering you.”
• “Why do you feel so bad about yourself?”
• “What can we do to help you while you are here?”

48. A nurse is preparing to care for a client who engages in ritualistic behavior. What should the plan of care include?

• Redirect energy into activities to help others.
• Teach the client that the behavior is not serving a realistic purpose.
• Administer antianxiety medications that block out the memory of internal fears.
• Help the client to understand that the behavior is caused by maladaptive coping to increased anxiety.

49. What is an appropriate way a nurse can help a client to decrease anxiety?

• Avoid unpleasant events.
• Prolong exposure to fearful situations.
• Acquire skills with which to face stressful events.
• Introduce an element of pleasure into fearful situations.

50. A nurse is caring for a client who uses ritualistic behavior. What common antiobsessional medication does the nurse anticipate will be prescribed?

• Benztropine
• Amantadine
• Fluvoxamine
• Diphenhydramine