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PMH-BC practice questions

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Question 1Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse is caring for a patient who has just been told of a terminal diagnosis and responds by saying, 'The lab must have mixed up my results.' Which defense mechanism is the patient demonstrating?

  1. Denial Correct answer.
  2. Projection
  3. Sublimation
  4. Regression

Explanation

Denial is an unconscious refusal to accept a reality that causes anxiety, expressed here by rejecting the diagnosis itself. Projection would involve attributing one's own unacceptable feelings to others, and sublimation or regression do not fit refusing to accept the news.

Question 2Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A patient with obsessive-compulsive disorder repeatedly washes their hands to reduce overwhelming anxiety. In psychoanalytic terms, this behavior is best described as which type of defense?

  1. Introjection
  2. Compensation
  3. Undoing Correct answer.
  4. Rationalization

Explanation

Undoing is a defense in which a person uses a ritualized act to cancel out or neutralize an unacceptable thought or feeling. Handwashing rituals that symbolically neutralize anxiety are the classic example of undoing.

Question 3Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

According to Erikson's psychosocial theory, which developmental task is central to adolescence?

  1. Generativity versus stagnation
  2. Intimacy versus isolation
  3. Identity versus role confusion Correct answer.
  4. Trust versus mistrust

Explanation

Erikson placed identity versus role confusion in adolescence, when the central task is forming a coherent sense of self. Trust versus mistrust belongs to infancy, intimacy versus isolation to young adulthood, and generativity versus stagnation to middle adulthood.

Question 4Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A 72-year-old patient recently widowed expresses regret that he never mentored younger colleagues and feels his life has had little meaning. Which Erikson stage is most consistent with this presentation?

  1. Industry versus inferiority
  2. Autonomy versus shame and doubt
  3. Ego integrity versus despair Correct answer.
  4. Generativity versus stagnation

Explanation

Ego integrity versus despair is the late-life task of reviewing one's life and finding it meaningful; unresolved regret and despair signal difficulty with this stage. The content involves an older adult reviewing a lifetime, not a midlife focus on mentoring per se.

Question 5Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

In Peplau's theory of interpersonal relations, which phase occurs when the nurse and patient first meet and begin to clarify the problem?

  1. Termination
  2. Orientation Correct answer.
  3. Exploitation
  4. Working

Explanation

Peplau's orientation phase is the initial period in which nurse and patient meet, establish trust, and identify the problem. The working phase follows, and termination is the resolution phase at the end of the relationship.

Question 6Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse practicing according to Peplau's model recognizes that the patient has begun to independently use newly learned coping strategies and needs less direction. This behavior best indicates the patient is in which phase?

  1. Exploitation Correct answer.
  2. Orientation
  3. Resolution
  4. Identification

Explanation

In the exploitation (working) phase the patient actively uses the relationship and available resources to pursue goals with increasing independence. Identification involves initial selective relating to the nurse, while resolution is the ending phase.

Question 7Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which nursing theorist is most associated with the concept that the environment and the nurse's care of the patient's surroundings are central to recovery, emphasizing fresh air, light, warmth, and cleanliness?

  1. Hildegard Peplau
  2. Dorothea Orem
  3. Florence Nightingale Correct answer.
  4. Martha Rogers

Explanation

Nightingale's environmental theory holds that manipulating the physical environment supports the body's natural healing processes. Peplau focused on interpersonal process, Orem on self-care, and Rogers on unitary human beings.

Question 8Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

According to Orem's self-care deficit theory, the nurse's action of partially assisting a patient who can perform some but not all self-care activities is best described as which system?

  1. Mutually exclusive
  2. Wholly compensatory
  3. Partly compensatory Correct answer.
  4. Supportive-educative

Explanation

Orem described three nursing systems: wholly compensatory, partly compensatory, and supportive-educative. When both nurse and patient participate in care, the partly compensatory system applies.

Question 9Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which assumption is foundational to the recovery model of mental health care?

  1. Symptoms must fully resolve before recovery is possible
  2. Recovery follows a fixed, predictable timeline
  3. People can live meaningful lives despite ongoing symptoms Correct answer.
  4. Recovery is defined primarily by symptom remission

Explanation

The recovery model holds that people with mental illness can lead satisfying, meaningful lives even with persistent symptoms, and that recovery is a personal process rather than mere symptom elimination. It emphasizes hope, empowerment, and person-driven goals.

Question 10Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse uses cognitive behavioral therapy principles with a patient who believes 'If I make one mistake, everyone will think I'm worthless.' Which technique directly targets this cognition?

  1. Token economy
  2. Systematic desensitization
  3. Free association
  4. Cognitive restructuring Correct answer.

Explanation

Cognitive restructuring identifies distorted automatic thoughts and tests them against evidence to develop more balanced cognitions. The belief described is a cognitive distortion amenable to this technique.

Question 11Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

In classical conditioning terms, a patient who develops anxiety each time they enter a hospital elevator after once having a panic attack in an elevator is demonstrating which phenomenon?

  1. Operant extinction
  2. Negative reinforcement
  3. Observational learning
  4. Stimulus generalization Correct answer.

Explanation

Stimulus generalization occurs when a response conditioned to one stimulus is elicited by similar stimuli; the elevator context has become associated with the panic response. The response is classically conditioned, not operantly reinforced.

Question 12Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse applies a behavioral contract with a patient in which the patient earns agreed privileges for attending group therapy. Which principle underlies this intervention?

  1. Psychoanalytic transference
  2. Classical conditioning
  3. Operant conditioning Correct answer.
  4. Humanistic self-actualization

Explanation

Behavioral contracts use operant conditioning, in which consequences shape the frequency of a behavior. Earning privileges contingent on attending group reinforces that behavior.

Question 13Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which statement best reflects the central premise of the humanistic approach associated with Carl Rogers?

  1. Thought content is determined by neurotransmitter activity
  2. Behavior is shaped primarily by unconscious conflict
  3. Unconditional positive regard supports growth toward self-actualization Correct answer.
  4. Maladaptive behavior results from faulty reinforcement schedules

Explanation

Rogers's person-centered approach holds that genuineness, empathy, and unconditional positive regard create conditions for clients to grow toward self-actualization. The other options reflect psychodynamic, behavioral, and biologic frameworks, respectively.

Question 14Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse employs motivational interviewing with a patient who is ambivalent about stopping alcohol use. Which nurse statement is most consistent with this approach?

  1. 'What concerns you most about your drinking right now?' Correct answer.
  2. 'You need to stop drinking or you will be discharged.'
  3. 'Drinking is destroying your health and your family.'
  4. 'I have decided you should attend AA meetings daily.'

Explanation

Motivational interviewing uses open-ended, evocative questions to elicit the patient's own reasons for change and to explore ambivalence without confrontation. The other statements are directive, confrontational, or impose the nurse's agenda.

Question 15Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which concept from psychodynamic theory describes a patient redirecting toward the nurse feelings originally associated with an important figure from the patient's past?

  1. Resistance
  2. Working through
  3. Countertransference
  4. Transference Correct answer.

Explanation

Transference is the patient's unconscious redirection of past relational feelings onto the clinician. Countertransference is the clinician's own emotional reaction to the patient, which is the reverse direction.

Question 16Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse notices feeling unusually irritated with a manipulative patient and recognizes this as a personal reaction that could impair care. In psychodynamic terms, this is best identified as which phenomenon?

  1. Transference
  2. Resistance
  3. Splitting
  4. Countertransference Correct answer.

Explanation

Countertransference is the clinician's emotional response shaped by the clinician's own past experiences and conflicts. Recognizing it allows the nurse to seek supervision and prevent it from distorting care.

Question 17Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which theorist developed the interpersonal theory of suicide, proposing that thwarted belongingness and perceived burdensomeness combine with acquired capability to produce suicidal behavior?

  1. Aaron Beck
  2. Sigmund Freud
  3. Albert Bandura
  4. Thomas Joiner Correct answer.

Explanation

Joiner's interpersonal theory of suicide identifies thwarted belongingness and perceived burdensomeness as proximal causes, with acquired capability needed to enact lethal self-harm. The other theorists are associated with cognitive therapy, psychoanalysis, and social learning, respectively.

Question 18Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse explains to a patient that thoughts, feelings, and behaviors are interconnected and that changing one can influence the others. This is the core premise of which framework?

  1. Psychoanalytic theory
  2. Biologic theory
  3. Humanistic theory
  4. Cognitive behavioral theory Correct answer.

Explanation

Cognitive behavioral theory rests on the reciprocal relationship among cognitions, emotions, and behaviors, making cognition a target for change. The other frameworks emphasize unconscious process, self-actualization, or physiologic mechanisms.

Question 19Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A patient with depression reports, 'I'm a total failure, and nothing will ever get better.' Which cognitive distortion is most evident in this statement?

  1. Personalization
  2. Magnification
  3. Mind reading
  4. Overgeneralization Correct answer.

Explanation

Overgeneralization draws broad, absolute conclusions from limited evidence, as in 'nothing will ever get better.' The sweeping, absolute language signals this distortion rather than the others.

Question 20Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which statement accurately describes the concept of self-efficacy in Bandura's social cognitive theory?

  1. It is the sum of external reinforcements received over time
  2. It is an inherited trait that remains stable across situations
  3. It is the belief in one's capability to execute actions needed to reach a goal Correct answer.
  4. It is the unconscious drive toward self-actualization

Explanation

Self-efficacy is a person's belief in their capacity to organize and execute the actions required to attain a goal, and it can be strengthened through mastery experiences, modeling, and persuasion. It is not fixed or purely a product of reinforcement.

Question 21Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse is choosing a theoretical framework for a patient with a chronic mental illness who wants to build a meaningful life in the community despite residual symptoms. Which framework best aligns with this goal?

  1. Behavioral theory focused on extinguishing symptoms
  2. Psychoanalytic theory focused on early childhood conflict
  3. Biologic theory focused solely on medication adherence
  4. Recovery-oriented framework emphasizing hope and community integration Correct answer.

Explanation

A recovery orientation prioritizes hope, empowerment, person-driven goals, and community integration even when symptoms persist. This matches the patient's stated aim of building a meaningful life with residual symptoms.

Question 22Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which nursing theory emphasizes that the nurse helps the patient meet self-care requisites when the patient is unable to do so independently?

  1. Rogers's science of unitary human beings
  2. Neuman's systems model
  3. Peplau's interpersonal theory
  4. Orem's self-care deficit theory Correct answer.

Explanation

Orem's theory centers on self-care requisites and the nurse's role in compensating for or supporting self-care when a deficit exists. The other theories focus on energy fields, interpersonal process, or system stability, respectively.

Question 23Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse applying the Neuman systems model assesses which dimension as the primary focus of intervention?

  1. The patient's response to environmental stressors and system stability Correct answer.
  2. The patient's self-care agency
  3. The patient's developmental stage alone
  4. The patient's unconscious conflicts

Explanation

Neuman's systems model views the client as a system responding to internal and external stressors, with nursing aimed at maintaining or restoring system stability. The other options describe psychodynamic, Orem, and developmental foci.

Question 24Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which principle is foundational to trauma-informed care in psychiatric nursing?

  1. Minimizing patient choice to maintain control
  2. Ensuring physical and emotional safety and avoiding retraumatization Correct answer.
  3. Requiring patients to recount traumatic events in detail
  4. Focusing primarily on symptom suppression

Explanation

Trauma-informed care prioritizes safety, trustworthiness, choice, collaboration, and empowerment, and it actively avoids practices that could retraumatize. Forcing detailed recounting or minimizing choice conflicts with these principles.

Question 25Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse on an inpatient unit uses a consistent behavioral contract and structured milieu to reinforce adaptive behavior. Which theoretical foundation most directly informs this practice?

  1. Psychoanalytic interpretation
  2. Interpersonal theory
  3. Operant conditioning Correct answer.
  4. Humanistic self-actualization

Explanation

A structured milieu with contingent reinforcement reflects operant conditioning, in which consequences shape behavior. The consistent use of consequences for adaptive behavior is the defining feature.

Question 26Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

Which nursing theorist is best known for identifying the four phases of the nurse-patient relationship, including orientation, working, and termination?

  1. Sister Callista Roy
  2. Dorothea Orem
  3. Hildegard Peplau Correct answer.
  4. Martha Rogers

Explanation

Peplau's interpersonal theory frames the nurse-patient relationship as a structured process unfolding through identifiable phases that culminate in resolution and termination. Her model is the classic source for phase-based descriptions of the therapeutic relationship in psychiatric nursing.

Question 27Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A patient states, 'I am worthless and always will be.' A nurse using Beck's cognitive model identifies this as which type of cognitive error?

  1. Overgeneralization Correct answer.
  2. Catastrophizing
  3. Personalization
  4. Mind reading

Explanation

Overgeneralization draws a sweeping, permanent conclusion from limited evidence, as in moving from a single perceived failure to a global judgment of worthlessness. Beck's model holds that such distorted automatic thoughts maintain depressive symptoms and are targets for cognitive restructuring.

Question 28Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

In a family therapy framework, which concept describes how a change in one family member's behavior inevitably alters the functioning of the other members?

  1. Homeostasis
  2. Triangulation
  3. Circular causality Correct answer.
  4. Differentiation of self

Explanation

Circular causality holds that events in a family are reciprocal, so each member's behavior both influences and is influenced by the others rather than being caused in a simple linear way. This systems premise underlies interventions aimed at altering interaction patterns rather than blaming an identified patient.

Question 29Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse leading a group notices that members have begun openly challenging one another and expressing disagreement about group norms. In Tuckman's model, the nurse interprets this as which stage, and what is the appropriate response?

  1. Norming; step back because the group has already established cohesion
  2. Performing; allow full autonomy because the group is working productively
  3. Forming; provide more structure because members are still orienting to the group
  4. Storming; help the group process conflict constructively so it can move toward cohesion Correct answer.

Explanation

Tuckman's model describes storming as the stage of interpersonal conflict and resistance as members negotiate roles and norms. The leader's task is to surface and work through the conflict rather than suppress it, which allows the group to progress to norming and performing.

Question 30Theories, Principles, and Practice of Psychiatric-Mental Health Nursing

A nurse is selecting a theoretical framework for a patient whose illness is understood as arising from repeated reinforcement of maladaptive behaviors within the patient's social environment. Which framework most directly guides assessment of the antecedents and consequences maintaining those behaviors?

  1. Psychoanalytic theory
  2. Behavioral theory Correct answer.
  3. Humanistic theory
  4. Existential theory

Explanation

Behavioral theory explains behavior in terms of observable antecedents and consequences, making functional assessment of the conditions that maintain a behavior the central analytic task. This framework supports interventions such as reinforcement schedules and skills training rather than insight-oriented exploration.

Question 31Assessment, Diagnosis, and Treatment Planning

A client reports feeling 'empty and numb' for most of the past two years, with brief periods of normal mood lasting no more than a few weeks. Which specifier best captures this longitudinal pattern in a depressive disorder diagnosis?

  1. With atypical features
  2. With melancholic features
  3. With anxious distress
  4. With persistent depressive pattern Correct answer.

Explanation

A chronic course with only brief euthymic intervals (weeks, not months) reflects the persistent depressive pattern used to characterize long-standing depressive illness. Specifiers like anxious distress and melancholic features describe symptom quality, not duration of the overall course.

Question 32Assessment, Diagnosis, and Treatment Planning

Which screening instrument is specifically designed to detect bipolar spectrum illness and is commonly used to reduce misdiagnosis of depression?

  1. AUDIT
  2. PHQ-9
  3. GAD-7
  4. MDQ Correct answer.

Explanation

The Mood Disorder Questionnaire is a validated self-report screen for bipolar spectrum symptoms, including lifetime manic or hypomanic experiences. The PHQ-9 and GAD-7 target depression and anxiety severity, and the AUDIT screens for alcohol use.

Question 33Assessment, Diagnosis, and Treatment Planning

A client with schizophrenia has been stable on antipsychotic therapy for six months. The PMH-BC nurse is developing the treatment plan and should prioritize which element to support long-term recovery?

  1. Restricting family involvement to protect confidentiality
  2. Reducing the antipsychotic dose without prescriber input
  3. Scheduling routine metabolic monitoring Correct answer.
  4. Discontinuing psychosocial rehabilitation once symptoms resolve

Explanation

Second-generation antipsychotics carry substantial metabolic risk, so routine monitoring of weight, glucose, and lipids is a core treatment-planning priority. Dose changes require prescriber collaboration, family involvement supports recovery, and psychosocial rehabilitation should continue after symptom remission.

Question 34Assessment, Diagnosis, and Treatment Planning

During an intake assessment, a client describes hearing voices commenting on their behavior for the past three months and shows disorganized speech. Which diagnostic category is most consistent with these findings?

  1. Brief psychotic disorder
  2. Delusional disorder
  3. Schizoaffective disorder
  4. Schizophrenia Correct answer.

Explanation

Continuous psychotic symptoms lasting at least one month with functional decline and disorganization are consistent with schizophrenia. Brief psychotic disorder lasts less than one month, delusional disorder lacks prominent hallucinations and disorganization, and schizoaffective disorder requires concurrent mood episodes.

Question 35Assessment, Diagnosis, and Treatment Planning

Which assessment finding is most characteristic of delirium and helps distinguish it from dementia?

  1. Stable impairment across the day
  2. Insidious onset over several years
  3. Acute onset with fluctuating attention Correct answer.
  4. Preserved level of consciousness

Explanation

Delirium is marked by acute onset and fluctuating attention and awareness, which distinguishes it from the gradual, stable decline typical of dementia. Consciousness is impaired in delirium, and onset is sudden rather than insidious.

Question 36Assessment, Diagnosis, and Treatment Planning

A client with major depressive disorder is being evaluated for treatment. Which factor most strongly indicates the need to consider electroconvulsive therapy?

  1. Severe depression with active suicidal intent and refusal of food Correct answer.
  2. Recent improvement with a first-line SSRI
  3. Comorbid generalized anxiety disorder
  4. Mild depressive symptoms with good response to therapy

Explanation

ECT is indicated for severe depression with imminent risk, such as active suicidal intent or life-threatening refusal of intake, or when rapid response is needed. It is not a first-line option for mild symptoms or when first-line medication is working.

Question 37Assessment, Diagnosis, and Treatment Planning

The PMH-BC nurse is assessing a client for serotonin syndrome after a new medication was added. Which cluster of findings should raise the highest concern?

  1. Sedation, weight gain, and dry mouth
  2. Tremor, hunger, and diaphoresis
  3. Hyperreflexia, clonus, and agitation Correct answer.
  4. Bradycardia, hypothermia, and constipation

Explanation

Serotonin syndrome classically presents with neuromuscular hyperactivity (clonus, hyperreflexia), autonomic instability, and altered mental status such as agitation. Bradycardia and constipation are not characteristic, and sedation with weight gain suggests other causes.

Question 38Assessment, Diagnosis, and Treatment Planning

A client presents with elevated mood, decreased need for sleep, and increased goal-directed activity for five days, requiring no hospitalization and without psychosis. What is the most appropriate diagnosis?

  1. Bipolar II disorder, hypomanic episode Correct answer.
  2. Major depressive disorder
  3. Bipolar I disorder, manic episode
  4. Cyclothymic disorder

Explanation

A hypomanic episode lasts at least four days, is not severe enough to cause marked impairment or require hospitalization, and lacks psychosis, which fits bipolar II disorder when depressive episodes are also present. A manic episode requires at least seven days or hospitalization.

Question 39Assessment, Diagnosis, and Treatment Planning

Which laboratory test is essential before initiating lithium therapy?

  1. Renal function tests Correct answer.
  2. Serum amylase
  3. Liver function tests
  4. Prostate-specific antigen

Explanation

Lithium is renally excreted and can cause nephrogenic effects, so baseline renal function and thyroid studies are required before starting therapy. Liver enzymes, amylase, and PSA are not standard pre-lithium assessments.

Question 40Assessment, Diagnosis, and Treatment Planning

A client with an eating disorder is being assessed. Which finding most strongly suggests anorexia nervosa rather than bulimia nervosa?

  1. Dental enamel erosion
  2. Recurrent binge-eating episodes
  3. Significantly low body weight Correct answer.
  4. Self-induced vomiting after meals

Explanation

Anorexia nervosa is distinguished by significantly low body weight relative to developmental norms, whereas bulimia nervosa typically occurs at normal or near-normal weight. Binge eating, purging, and enamel erosion can occur in both conditions.

Question 41Assessment, Diagnosis, and Treatment Planning

Which assessment approach best supports accurate diagnosis of PTSD in a client who minimizes symptoms?

  1. Relying solely on the client's self-report at intake
  2. Deferring trauma screening until the client raises the topic
  3. Asking a single yes-or-no question about trauma history
  4. Using a validated structured interview and collateral information Correct answer.

Explanation

Validated structured interviews combined with collateral information improve detection of PTSD, especially when clients minimize or avoid trauma disclosure. Single questions, self-report alone, and waiting for the client to raise trauma risk missing the diagnosis.

Question 42Assessment, Diagnosis, and Treatment Planning

A client with alcohol use disorder is being assessed for withdrawal risk. Which finding most strongly predicts severe withdrawal requiring medically supervised detoxification?

  1. A history of prior withdrawal seizures Correct answer.
  2. A family history of hypertension
  3. Occasional weekend drinking
  4. Recent completion of an outpatient program

Explanation

A prior history of withdrawal seizures or delirium tremens is a strong predictor of severe withdrawal and warrants medically supervised detoxification. Occasional drinking, family history of hypertension, and prior outpatient treatment do not predict withdrawal severity.

Question 43Assessment, Diagnosis, and Treatment Planning

Which symptom is considered a core feature of autism spectrum disorder in the diagnostic criteria?

  1. Auditory hallucinations in childhood
  2. Periodic episodes of elevated mood
  3. Recurrent obsessions with contamination
  4. Persistent deficits in social communication and interaction Correct answer.

Explanation

Autism spectrum disorder is defined by persistent deficits in social communication and interaction plus restricted, repetitive patterns of behavior. Contamination obsessions, mood elevation, and hallucinations are features of other conditions.

Question 44Assessment, Diagnosis, and Treatment Planning

A client with ADHD is being evaluated for pharmacologic treatment. Which baseline assessment is most important before starting a stimulant?

  1. Serum electrolytes
  2. Routine EEG
  3. Bone density scan
  4. Cardiovascular assessment including blood pressure and heart rate Correct answer.

Explanation

Stimulants can increase blood pressure and heart rate, so baseline cardiovascular assessment is essential before initiation. EEG, electrolytes, and bone density are not standard pre-stimulant evaluations.

Question 45Assessment, Diagnosis, and Treatment Planning

During a mental status examination, a client states, 'The radio is broadcasting my thoughts to the whole city.' Which term best describes this finding?

  1. Thought broadcasting Correct answer.
  2. Derailment
  3. Thought insertion
  4. Ideas of reference

Explanation

Thought broadcasting is the delusional belief that one's thoughts are accessible to others, often described as being transmitted or heard. Thought insertion involves beliefs that thoughts are placed by an outside force, and ideas of reference involve interpreting neutral events as personally meaningful.

Question 46Assessment, Diagnosis, and Treatment Planning

A client with bipolar disorder on lithium presents with coarse tremor, ataxia, vomiting, and confusion. Which action should the PMH-BC nurse take first?

  1. Administer the next scheduled lithium dose
  2. Hold the lithium and notify the prescriber immediately Correct answer.
  3. Encourage increased fluid intake and continue the medication
  4. Document the findings and reassess in 24 hours

Explanation

These findings suggest lithium toxicity, which requires holding the medication and immediate prescriber notification for evaluation and possible dialysis. Continuing the drug or delaying action could worsen toxicity.

Question 47Assessment, Diagnosis, and Treatment Planning

Which element is required in a sound psychiatric diagnosis according to the nursing process?

  1. A comprehensive biopsychosocial assessment Correct answer.
  2. The client's stated preference alone
  3. A family member's opinion of the client
  4. A single symptom reported by the client

Explanation

Accurate diagnosis requires a comprehensive biopsychosocial assessment integrating history, mental status, medical factors, and social context. A single symptom, preference alone, or family opinion is insufficient.

Question 48Assessment, Diagnosis, and Treatment Planning

A client presents with excessive worry across multiple domains for eight months, along with muscle tension and sleep disturbance, without panic attacks. Which diagnosis is most likely?

  1. Generalized anxiety disorder Correct answer.
  2. Obsessive-compulsive disorder
  3. Social anxiety disorder
  4. Panic disorder

Explanation

Generalized anxiety disorder involves pervasive, difficult-to-control worry across multiple domains for at least six months with symptoms such as muscle tension and sleep disturbance. Panic disorder requires recurrent panic attacks, social anxiety is situation-specific, and OCD involves obsessions and compulsions.

Question 49Assessment, Diagnosis, and Treatment Planning

Which screening tool is most appropriate for detecting cognitive impairment in an older adult during a routine psychiatric assessment?

  1. Mini-Mental State Examination Correct answer.
  2. CAGE questionnaire
  3. Columbia Suicide Severity Rating Scale
  4. Young Mania Rating Scale

Explanation

The MMSE is a brief cognitive screen assessing orientation, memory, attention, and language. CAGE screens for alcohol use, the C-SSRS assesses suicide risk, and the YMRS measures mania severity.

Question 50Assessment, Diagnosis, and Treatment Planning

A client with borderline personality disorder reports recurrent self-harm. Which treatment approach has the strongest evidence base for reducing self-harm behavior?

  1. As-needed antipsychotics alone
  2. Unstructured supportive counseling
  3. Dialectical behavior therapy Correct answer.
  4. Long-term benzodiazepine monotherapy

Explanation

Dialectical behavior therapy is the most evidence-supported psychosocial treatment for reducing self-harm in borderline personality disorder. Benzodiazepines, unstructured counseling, and antipsychotics alone lack comparable evidence.