Sample Questions and Answers
A client with borderline personality disorder engages in self-harm behaviors. What is the priority nursing intervention?
A) Focus on building the client’s self-esteem.
B) Teach the client to suppress emotions.
C) Establish a safety plan and provide close monitoring.
D) Avoid discussing the self-harm to prevent reinforcement.
Answer: C
A client with PTSD is hypervigilant and reports difficulty concentrating. What is the most appropriate nursing intervention?
A) Encourage the client to focus on past traumatic events.
B) Provide a structured environment and reduce stimuli.
C) Avoid discussing the trauma to prevent distress.
D) Encourage the client to confront all triggers immediately.
Answer: B
Which client statement suggests they may be at risk for suicide?
A) “I’m feeling much better now, so you don’t need to worry.”
B) “I sometimes feel down, but it’s not a big deal.”
C) “I’m ready to start making some changes in my life.”
D) “I think I’ll talk to my family about how I’ve been feeling.”
Answer: A
A nurse is caring for a client with dissociative identity disorder (DID). What is the primary focus of nursing care?
A) Encourage integration of the client’s personalities.
B) Teach the client to suppress alternate identities.
C) Provide safety and assist with coping strategies.
D) Avoid discussing the client’s different identities.
Answer: C
A client is diagnosed with mild Alzheimer’s disease. Which intervention is most effective at this stage?
A) Provide frequent reorientation to time and place.
B) Use validation therapy to address delusions.
C) Encourage participation in memory-enhancing activities.
D) Focus on safety measures to prevent wandering.
Answer: C
A nurse is providing care for a client with somatic symptom disorder. What is the priority nursing intervention?
A) Focus on the physical symptoms the client reports.
B) Encourage the client to focus on activities rather than symptoms.
C) Explain that the physical symptoms are not real.
D) Provide reassurance that the symptoms will resolve quickly.
Answer: B
A client in alcohol withdrawal is at risk for which life-threatening complication?
A) Hypertensive crisis.
B) Seizures.
C) Renal failure.
D) Cardiac tamponade.
Answer: B
A client with bipolar disorder is prescribed lamotrigine. Which adverse effect requires immediate intervention?
A) Weight gain.
B) Drowsiness.
C) Skin rash.
D) Tremors.
Answer: C
Which nursing intervention is most effective for a client experiencing auditory hallucinations?
A) Encourage the client to ignore the voices.
B) Help the client identify triggers for the hallucinations.
C) Teach the client to engage in reality-based activities.
D) Validate the hallucinations to build trust.
Answer: C
A client with schizophrenia is prescribed risperidone. Which symptom indicates the medication is effective?
A) The client reports decreased anxiety.
B) The client exhibits improved social interactions.
C) The client no longer experiences hallucinations.
D) The client’s sleep pattern improves.
Answer: C
A nurse is assessing a client with opioid use disorder. Which symptom is most indicative of withdrawal?
A) Hypotension.
B) Pinpoint pupils.
C) Muscle aches and diarrhea.
D) Euphoria.
Answer: C
A client with major depressive disorder is admitted with severe weight loss. What is the nurse’s priority?
A) Encourage participation in group therapy.
B) Assess the client’s nutritional status and intake.
C) Focus on improving the client’s mood.
D) Provide education on healthy eating habits.
Answer: B
Which intervention is most appropriate for a client experiencing paranoid delusions?
A) Confront the delusions directly to clarify reality.
B) Avoid challenging the delusions to reduce anxiety.
C) Encourage the client to discuss the delusions in detail.
D) Help the client identify evidence supporting the delusions.
Answer: B
A client with anxiety asks the nurse about using deep breathing exercises. How should the nurse respond?
A) “Deep breathing is only effective for mild anxiety.”
B) “This technique can help reduce your anxiety levels.”
C) “It’s better to focus on medications rather than techniques.”
D) “Deep breathing is not effective for managing anxiety.”
Answer: B
A nurse is educating a client with OCD about the use of exposure and response prevention (ERP) therapy. Which statement indicates understanding?
A) “I will face situations that trigger my compulsions but not perform the ritual.”
B) “This therapy helps me avoid situations that cause anxiety.”
C) “I will need to use medications during this therapy.”
D) “ERP focuses on understanding the root cause of my compulsions.”
Answer: A
A nurse is caring for a client with depression who reports no motivation to attend therapy sessions. What is the best nursing response?
A) “You should force yourself to go even if you don’t want to.”
B) “Let’s discuss what’s making it difficult for you to attend.”
C) “It’s okay to skip therapy if you don’t feel like going.”
D) “Skipping therapy might make your depression worse.”
Answer: B
A client diagnosed with panic disorder states, “I feel like I’m having a heart attack during my panic attacks.” What is the nurse’s best response?
A) “Your feelings are valid. Let’s discuss ways to cope with this.”
B) “It’s impossible to have a heart attack during a panic attack.”
C) “You need to ignore these feelings and focus on something else.”
D) “Have you tried lying down during the attacks to calm yourself?”
Answer: A
A client is receiving ECT (electroconvulsive therapy) for severe depression. What is the most common side effect the nurse should monitor for?
A) Short-term memory loss.
B) Muscle rigidity.
C) Persistent headache.
D) Nausea and vomiting.
Answer: A
A nurse is planning care for a client with antisocial personality disorder. Which intervention is the most appropriate?
A) Enforce rules and set clear consequences for behavior.
B) Focus on building a close, trusting relationship.
C) Encourage the client to discuss personal feelings openly.
D) Ignore manipulative behavior to discourage it.
Answer: A
Which sign is most indicative of serotonin syndrome in a client taking selective serotonin reuptake inhibitors (SSRIs)?
A) Hypothermia.
B) Muscular rigidity.
C) Respiratory depression.
D) Hyperreflexia and agitation.
Answer: D
A client with OCD is spending hours washing their hands. What is the best initial nursing action?
A) Allow the client to continue the behavior.
B) Redirect the client to another activity.
C) Set a time limit for handwashing.
D) Explain that the behavior is irrational.
Answer: C
A nurse is assessing a client for signs of anorexia nervosa. Which physical finding is most characteristic of this disorder?
A) Increased blood pressure.
B) Lanugo (fine body hair).
C) Hyperactive bowel sounds.
D) Obesity in the abdominal area.
Answer: B
A client with major depressive disorder begins taking fluoxetine. What should the nurse include in discharge teaching?
A) “You will notice improvement within the first two days.”
B) “Contact your provider if you experience increased suicidal thoughts.”
C) “It is safe to stop this medication suddenly if you feel better.”
D) “Avoid eating foods high in tyramine while on this medication.”
Answer: B
A client with schizophrenia is prescribed clozapine. Which lab result should the nurse monitor closely?
A) Platelet count.
B) White blood cell count.
C) Hemoglobin levels.
D) Potassium levels.
Answer: B
A client with alcohol use disorder is experiencing delirium tremens (DTs). What is the nurse’s priority intervention?
A) Provide a calm and quiet environment.
B) Administer prescribed benzodiazepines.
C) Encourage oral fluid intake.
D) Monitor for signs of withdrawal seizures.
Answer: B
A client with PTSD reports frequent nightmares. Which intervention is most appropriate?
A) Suggest avoiding discussing the trauma.
B) Recommend deep breathing exercises before bed.
C) Refer the client for eye movement desensitization and reprocessing (EMDR).
D) Encourage the client to stay awake to avoid nightmares.
Answer: C
A nurse is assessing a client with opioid intoxication. Which clinical manifestation is expected?
A) Dilated pupils and tachycardia.
B) Respiratory depression and pinpoint pupils.
C) Agitation and increased blood pressure.
D) Tremors and hyperreflexia.
Answer: B
A client with schizophrenia exhibits echolalia. What does this behavior involve?
A) Repeating words or phrases spoken by others.
B) Speaking in a made-up language.
C) Using words inappropriately or out of context.
D) Rhyming words in a nonsensical manner.
Answer: A
A client reports being unable to leave the house due to fear of public spaces. What is the most likely diagnosis?
A) Panic disorder.
B) Social anxiety disorder.
C) Agoraphobia.
D) Generalized anxiety disorder.
Answer: C
Which therapeutic communication technique is most appropriate for a client experiencing a hallucination?
A) “I hear the voices too, but they aren’t real.”
B) “Tell me more about what you’re experiencing.”
C) “You don’t need to worry about the voices.”
D) “I don’t hear the voices, but I understand they’re real to you.”
Answer: D
A client with depression is prescribed amitriptyline. Which adverse effect should the nurse monitor for?
A) Urinary retention.
B) Bradycardia.
C) Hyperglycemia.
D) Hearing loss.
Answer: A
A nurse is caring for a client with borderline personality disorder who exhibits splitting behavior. What is the best intervention?
A) Encourage the client to express their feelings openly.
B) Assign one consistent staff member to care for the client.
C) Rotate staff assignments frequently to avoid attachment.
D) Set clear and consistent boundaries with all staff.
Answer: D
Which is a priority nursing intervention for a client experiencing acute mania?
A) Encourage the client to participate in group activities.
B) Provide high-calorie finger foods and drinks.
C) Allow the client to engage in high-energy physical activities.
D) Focus on discussing the client’s feelings and emotions.
Answer: B
A client with generalized anxiety disorder is prescribed buspirone. Which statement indicates understanding?
A) “I can take this medication only when I feel anxious.”
B) “It may take several weeks before I notice an improvement.”
C) “I need to avoid all dairy products while taking this medication.”
D) “This medication may cause dependence, so I should use it sparingly.”
Answer: B
A client experiencing withdrawal from benzodiazepines is at risk for which serious complication?
A) Hypertensive crisis.
B) Seizures.
C) Hypokalemia.
D) Bradycardia.
Answer: B
Which statement by a client demonstrates insight into their obsessive-compulsive disorder (OCD)?
A) “I know my rituals are excessive, but I feel powerless to stop them.”
B) “I don’t think my behavior is a problem; it’s just who I am.”
C) “I only perform rituals when I feel stressed or anxious.”
D) “I have no control over my compulsions, so I don’t try to stop them.”
Answer: A
A nurse is teaching a client with bipolar disorder about lithium therapy. What is essential to include?
A) “Avoid foods high in sodium while on this medication.”
B) “Drink 2–3 liters of water daily to maintain hydration.”
C) “You can stop the medication once your symptoms improve.”
D) “This medication has no side effects if taken as prescribed.”
Answer: B
A nurse is assessing a client with major depressive disorder. Which symptom should the nurse prioritize?
A) Low energy levels.
B) Feelings of hopelessness.
C) Suicidal ideation.
D) Weight loss.
Answer: C
A client with schizophrenia is experiencing a flat affect. What is the best nursing approach?
A) Encourage the client to engage in lively group activities.
B) Use short, clear statements and provide consistent routines.
C) Avoid interacting with the client to prevent overstimulation.
D) Focus on discussing emotional topics to elicit a response.
Answer: B
A client with depression states, “Nothing matters anymore.” What is the nurse’s priority response?
A) “Do you feel like hurting yourself or ending your life?”
B) “Why do you feel that way?”
C) “You should try to think positively.”
D) “Tell me about things you used to enjoy.”
Answer: A
A nurse is developing a care plan for a client with Alzheimer’s disease. Which intervention is most appropriate for addressing memory loss?
A) Use written signs and labels to identify common items.
B) Avoid discussing past events to prevent confusion.
C) Repeatedly quiz the client to improve memory retention.
D) Provide complete assistance to avoid frustration.
Answer: A
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