Try our free mental health nursing questions. These practice test questions are based on the ANCC Psychiatric Mental Health Certification exam. This is a very challenging examination which will assess the clinical skills and knowledge of registered nurses in the psychiatric mental health specialty. This is also known as the ANCC PMHNP exam. Start your test prep now with our free psychiatric mental health nursing test questions.
Mental Health Nursing Questions
A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective?
“I understand that the event I experienced, and how I deal with it, and my support system, all affect my disease process.”
“I have learned to avoid stressful situations as a way to decrease emotional pain.”
“So, natural opioid release during the trauma caused my body to become ‘addicted.’”
“Because of the trauma, I have a negative perception of the world and feel hopeless."
Option B: Avoiding situations as a way to decrease emotional pain is an example of a learned, not psychosocial, cause of PTSD.
Option C: The release of natural opioids during a traumatic event is an example of a biological, not psychosocial, cause of PTSD.
Option D: Having a negative perception of the world because of a traumatic event is an example of a cognitive, not psychosocial, cause of PTSD.
A client diagnosed with social phobia has an outcome that states, “Client will voluntarily participate in group activities with peers by day 3.” Which would be an appropriate intrapersonal intervention by the nurse to assist the client to achieve this outcome?
Offer PRN lorazepam (Ativan) 1 hour before group begins.
Attend group with client to assist in decreasing anxiety.
Encourage discussion about fears related to socialization.
Role-play scenarios that may occur in group to decrease anxiety.
OPTION A: Offering PRN lorazepam (Ativan) before group is an example of a biological, not intrapersonal, intervention.
OPTION B. Attending the group with the client is an example of an interpersonal, not intrapersonal, intervention.
OPTION D: Role-playing a scenario that may occur is a behavioral, not intrapersonal, intervention.
Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder?
Encourage the client to evaluate the power of distorted thinking.
Ask the client to include his or her family in scheduled therapy sessions.
Discuss the overuse of ego defense mechanisms and their impact on anxiety.
Teach the client about the effect of blood lactate level as it relates to the client’s panic attacks.
OPTION A: Encouraging the client to evaluate the power of distorted thinking is based on a cognitive, not psychodynamic, perspective.
OPTION B: Asking the client to include his or her family in scheduled therapy sessions is based on an interpersonal, not psychodynamic, perspective.
OPTION D: Teaching the client the effects of blood lactate on anxiety is based on the biological, not psychodynamic, perspective.
In which situation would the nurse suspect a medical diagnosis of social phobia?
A client abuses marijuana daily and avoids social situations because of fear of humiliation.
An 8-year-old child isolates from adults because of fear of embarrassment, but has good peer relationships in school.
A client diagnosed with Parkinson’s disease avoids social situations because of embarrassment regarding tremors and drooling.
A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.
OPTION A: A client cannot be diagnosed with social phobia when under the influence of substances such as marijuana. It would be unclear if the client is experiencing the fear because of the mood altering substance or a true social phobia.
OPTION B: Children can be diagnosed with social phobias. However, in children, there must be evidence of the capacity for age-appropriate social relationships with familiar people, and the anxiety must occur in peer and adult interactions.
OPTION C: If a general medical condition or another mental disorder is present, the social phobia must be unrelated. If the fear is related to the medical condition, the client cannot be diagnosed with a social phobia.
A client leaving home for the first time in a year arrives in the psychiatric in-patient unit wearing a surgical mask and white gloves and crying, “The germs in here are going to kill me.” Which nursing diagnosis addresses this client’s problem?
Social isolation R /T fear of germs AEB continually refusing to leave the home.
Fear of germs R /T obsessive-compulsive disorder, resulting in dysfunctional isolation.
Ineffective coping AEB dysfunctional isolation R /T unrealistic fear of germs.
Anxiety R /T the inability to leave home, resulting in dysfunctional fear of germs.
OPTION B: Obsessive-compulsive disorder is a medical diagnosis and cannot be used in any component of the nursing diagnosis format. Nursing diagnoses are functional client problems that fall within the scope of nursing practice. Also missing from this nursing diagnosis are the signs and symptoms, or AEB, component of the problem.
OPTION C: The etiology (R /T) and signs and symptoms (AEB) are out of order in this nursing diagnostic statement.
OPTION D: The inability to leave home is a sign or symptom, which is the third component of the nursing diagnosis format (AEB) not the cause of the problem (R /T statement).
The nurse has received the evening report. Which client would the nurse need to assess first?
A newly admitted client with a history of panic attacks.
A client who slept 2 to 3 hours last night because of flashbacks.
A client pacing the halls and stating that his anxiety is an 8/10.
A client diagnosed with generalized anxiety disorder awaiting discharge.
OPTION A: A client newly admitted with a panic attack history does not command the immediate attention of the nurse. If the client presents with signs and symptoms of panic, the nurse’s priority would then shift to this client.
OPTION B: The nurse would assess a client experiencing flashbacks during the night, but this assessment would not take priority at this time over the other clients described.
OPTION D: A client with generalized anxiety disorder awaiting discharge does not command the immediate attention of the nurse. To meet the criteria for discharge, this client should be in stable mental condition.
A client diagnosed with obsessive-compulsive disorder has been hospitalized for the last 4 days. Which intervention would be a priority at this time?
Notify the client of the expected limitations on compulsive behaviors.
Reinforce the use of learned relaxation techniques.
Allow the client the time needed to complete the compulsive behaviors.
Say “stop” to the client as a thought-stopping technique.
OPTION A: The nurse would include, not notify, the client when making decisions to limit compulsive behaviors. To be successful, the client and the treatment team must be involved with the development of the plan of care.
OPTION C: By day 4, the nurse, with the client’s input, should begin setting limits on the compulsive behaviors.
OPTION D: The client, not the nurse, should say the word “stop” as a technique to limit obsessive thoughts and behaviors.
During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, “I’m thinking about suicide.” Which nursing intervention takes priority?
Teach the client relaxation techniques.
Ask the client, “Do you have a plan to commit suicide?”
Call the physician to obtain a PRN order for an anxiolytic medication.
Encourage the client to participate in group activities.
OPTION A: Although it is important to teach the client relaxation techniques, this is not the current priority. The client has expressed suicidal ideations, and the priority is to assess the suicide plan further.
OPTION C: The nurse may want to call the physician to obtain a PRN order for anxiolytic medications; however, a thorough physical evaluation and further assessment of suicidal ideations need to occur before calling the physician.
OPTION D: It is important for the client to participate in group activities. However, the nurse’s first priority is assessing suicidal ideations and developing a plan to intervene quickly and appropriately to maintain client safety.
Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid?
Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects.
Encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks.
Encourage the client to monitor for signs and symptoms of anxiety to determine need for additional buspirone (BuSpar) PRN.
Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.
OPTION A: Alcohol consumption is contraindicated while taking any psychotropic medication; however, buspirone (BuSpar) does not depress the central nervous system, and so there is no additive effect.
OPTION C: Buspirone (BuSpar) is not effective in PRN dosing because of the length of time it takes to begin working. Benzodiazepines have a quick onset of effect and are used PRN.
OPTION D: No current lab tests
A nurse is assessing a client in the mental health clinic. The client has a long history of being a loner and has few social relationships. This client’s father has been diagnosed with schizophrenia. The nurse would suspect that this client is in what phase in the development of schizophrenia?
Phase I—schizoid personality.
Phase II—prodromal phase.
Phase IV—residual phase.
OPTION B: Characteristics of the prodromal phase include social withdrawal; impairment in role functioning; eccentric behaviors; neglect of personal hygiene and grooming; blunted or inappropriate affect; disturbances in communication; bizarre ideas; unusual perceptual experiences; and lack of initiative, interests, or energy. The length of this phase varies; it may last for many years before progressing to schizophrenia. The symptoms presented in the question are not reflective of the prodromal phase of the development of schizophrenia.
OPTION C: In the active phase of schizophrenia, psychotic symptoms are prominent. Two or more of the following symptoms must be present for a significant portion of time during a 1-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (affective flattening, alogia, or avolition). The client in the question does not present with these symptoms.
OPTION D: Schizophrenia is characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness. Symptoms during the residual phase are similar to those of the prodromal phase, with flat affect and impairment in role function being prominent. There is no indication in the question that the client has recently experienced an active phase of schizophrenia.
The nurse is assessing a client diagnosed with disorganized schizophrenia. Which symptoms should the nurse expect the client to exhibit?
Markedly regressive, primitive behavior, and extremely poor contact with reality. Affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme.
Marked abnormalities in motor behavior manifested in extreme psychomotor retardation with pronounced decreases in spontaneous movements and activity. Waxy flexibility is exhibited.
The client is exhibiting delusions of persecution or grandeur. Auditory hallucinations related to a persecutory theme are present. The client is tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive.
The client has a history of active psychotic symptoms, but prominent psychotic symptoms are currently not exhibited.
OPTION B: When a client is diagnosed with catatonic, not disorganized, schizophrenia, he or she is likely to exhibit marked abnormalities in motor behavior manifested in extreme psychomotor retardation with pronounced decreases in spontaneous movements and activity. Waxy flexibility also is exhibited.
OPTION C: When a client is exhibiting delusions of persecution or grandeur and auditory hallucinations related to a persecutory theme, he or she is likely to be diagnosed with paranoid, not disorganized, schizophrenia. The client is likely to be tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive.
OPTION D: When a client has a history of active psychotic symptoms, but is currently not exhibiting prominent psychotic symptoms, he or she is likely to be diagnosed with residual, not disorganized, schizophrenia.
The nurse is performing an admission assessment on a client diagnosed with paranoid schizophrenia. To receive the most accurate assessment information, which should the nurse consider?
This client will be able to make a significant contribution to history data collection.
Much data will need to be gained by reviewing old records and talking with family members and significant others.
Assessment of this client will be simple because of the commonly occurring nature of the disease process of schizophrenia.
The nurse will refer to the client’s global assessment of functioning score to determine client problems and nursing interventions.
OPTION A: Clients experiencing active symptoms of paranoid schizophrenia are seldom able to make a significant contribution to their history because of thought disorder and communication problems.
OPTION C: Assessment of a client diagnosed with schizophrenia is a complex, not simple, process. The nurse must gather as much information as possible to gain a total symptomatic clinical picture of the client. This is difficult because of the client’s thought and communication deficits.
OPTION D: The global assessment of functioning is one area of assessment that the nurse must explore. It is related to the client’s ability to function. This assessment score does not solely determine client problems and nursing interventions.
The nurse is reviewing lab results for a client diagnosed with a thought disorder who is taking clozapine (Clozaril) 25 mg QD. The following values are documented: RBC 4.7 million/mcL, WBC 2000/mcL, and TSH 1.3 mc-IU. Which would the nurse expect the physician to order based on these values?
“Levothyroxine sodium (Synthroid) 150 mcg QD.”
“Ferrous sulfate (Feosol) 100 mg tid.”
“Discontinue clozapine (Clozaril).”
“Discontinue clozapine (Clozaril) and start levothyroxine sodium (Synthroid) 150 mcg QD.”
OPTION A: Levothyroxine sodium (Synthroid) is used as replacement or substitution therapy in diminished or absent thyroid function. TSH is thyroid- stimulating hormone. An increased TSH indicates low thyroid functioning. The normal range of TSH is 0.35 to 5.5 mc-IU. This client’s TSH level is within normal range, so this medication should not be indicated.
OPTION B: This client’s red blood cell (RBC) count is 4.7 million/mcL, which is within the normal range for male (4.6 to 6) and female (4 to 5) values. Because these values do not indicate anemia, the nurse would not expect replacement iron (ferrous sulfate [Feosol]) to be ordered.
OPTION D: The first part of this choice is correct, but the second part is incorrect. This client’s TSH level is normal, so levothyroxine sodium (Synthroid) would not be indicated.
The client has a long history of schizophrenia, which has been controlled by haloperidol (Haldol). During an admission assessment resulting from an exacerbation of the disease, the nurse notes continuous restlessness and fidgeting. Which medication would the nurse expect the physician to prescribe for this client?
Fluphenazine decanoate (Prolixin Decanoate).
Benztropine mesylate (Cogentin)
Akathisia, which is uncontrollable restlessness, is an extrapyramidal side effect of antipsychotic medications.
OPTION A: Continuous restlessness and fidgeting (akathisia) is the extrapyramidal side effect caused by the use of antipsychotic drugs such as haloperidol (Haldol). If an increased dose of haloperidol (Haldol) is prescribed, the symptom of akathisia would increase, not decrease.
OPTION B: Continuous restlessness and fidgeting (akathisia) is the extrapyramidal side effect caused by the use of antipsychotic drugs such as fluphenazine decanoate (Prolixin Decanoate). If fluphenazine decanoate (Prolixin Decanoate) is prescribed, the symptom of akathisia would increase, not decrease.
OPTION C: Continuous restlessness and fidgeting (akathisia) is the extrapyramidal side effect caused by the use of antipsychotic drugs such as clozapine (Clozaril). If clozapine (Clozaril) is prescribed, the symptom of akathisia would increase, not decrease.
The nurse is educating the family of a client diagnosed with schizophrenia about the importance of medication compliance. Which statement indicates that learning has occurred?
“After stabilization, the relapse rate is high, even if antipsychotic medications are taken regularly.”
“My brother will have only about a 30% chance of relapse if he takes his medications consistently.”
“Because the disease is multifaceted, taking antipsychotic medications has little effect on relapse rates.”
“Because schizophrenia is a chronic disease, taking antipsychotic medications has have little effect on relapse rates.”
OPTION A: Without drug treatment, the relapse rate of a client diagnosed with schizophrenia can be 70% to 80%. With continuous antipsychotic drug treatment, this rate can be reduced to 30%.
OPTION C: Schizophrenia is a multifaceted disease; however, antipsychotic medications are very effective in treating the symptoms of schizophrenia and can reduce the relapse rate if taken consistently.
OPTION D: Schizophrenia is a chronic disease; however, research has shown that if antipsychotic medications are taken consistently, relapse rates decrease.