Comprehensive Mental Health and
Psychiatric Nursing NCLEX Practice
Quiz #1: 75 Questions
1. Question
Flumazenil (Romazicon) has been ordered for a male client who
has overdosed on oxazepam (Serax). Before administering the
medication, nurse Gina should be prepared for which common
adverse effect?
o A. Seizures
o B. Shivering
o C. Anxiety
o D. Chest pain
Correct Answer: A. Seizures
Seizures are the most common serious adverse effect of using
flumazenil to reverse benzodiazepine overdose. The effect is
magnified if the client has a combined tricyclic antidepressant
and benzodiazepine overdose. Benzodiazepine reversal has
correlations with seizures. Seizures may happen more frequently
in patients who have been on benzodiazepines for long-term
sedation or in patients who are showing signs of severe tricyclic
antidepressant overdose. The required dosage of Flumazenil
should be measured and prepared by the practitioners to manage
seizures. Flumazenil use requires caution in patients relying on a
benzodiazepine for seizure control.
Option B: Shivering is not an adverse effect of
flumazenil. Monitor the patient for the possible return
of sedation, mostly in those who are tolerant of
benzodiazepines. Patients should have monitoring for
respiratory depression, benzodiazepine withdrawal,
and other residual effects of benzodiazepines for at
least 2 hours.
Option C: Anxiety is a rare adverse effect for people
using flumazenil. Flumazenil has some associations
, with precipitation of seizures in patients with
benzodiazepine dependence with a history of seizures.
Flumazenil overdose is extremely rare. There is no
precise antidote for flumazenil toxicity. In mild to
severe toxicity, symptomatic and supportive
treatment should be a consideration.
Option D: An overdose of flumazenil in a patient who
is not a chronic benzodiazepine user would not be
expected. Chronic benzodiazepines users may
experience withdrawal with abrupt discontinuation of
the drug. Administration of benzodiazepines or
barbiturates may be necessary for seizure control.
2. 2. Question
Nurse Tamara is caring for a client diagnosed with bulimia. The
most appropriate initial goal for a client diagnosed with bulimia
is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
C. Identify anxiety-causing situations.
D. Eat only three meals per day.
Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to
stress and underlying issues. The client must identify anxiety-
causing situations that stimulate the bulimic behavior and then
learn new ways of coping with the anxiety. Bulimia nervosa is a
condition that occurs most commonly in adolescent females,
characterized by indulgence in binge-eating, and inappropriate
compensatory behaviors to prevent weight gain.
Option A: Controlling shopping for large amounts of
food isn’t a goal early in treatment. It is important to
educate patients who abuse laxatives that these
medications work in the gastrointestinal tract after the
areas where caloric absorption has occurred primarily.
It is crucial to inform patients that a period of edema
, and weight gain may follow up to several weeks after
discontinuation of purging behavior.
Option B: Managing eating impulses and replacing
them with adaptive coping mechanisms can be
integrated into the plan of care after initially
addressing stress and underlying issues. The primary
objective of treatment is a cessation of the binging
and purging behavior. Selective serotonin reuptake
inhibitors such as fluoxetine, citalopram, and
sertraline have shown to reduce symptoms of bulimia
nervosa. Fluoxetine is the only FDA approved
medication for bulimia nervosa. It appears that a
higher dose (60 mg) is significantly better than a
placebo in decreasing the frequency of binge and
vomiting episodes.
Option D: Eating three meals per day isn’t a realistic
goal early in treatment. Patients with bulimia nervosa
who purge by vomiting often brush their teeth
immediately after purging, which can accelerate
dental erosion. The clinician should instruct the
patients who persist in vomiting to rinse their mouths
with water or fluoride rather than brushing their teeth
within 30 minutes of each episode. Consider
consulting a dentist to address dental issues
associated with vomiting.
3. 3. Question
A female client who’s at high risk for suicide needs close
supervision. To best ensure the client’s safety, Nurse Mary
should:
A. Check the client frequently at irregular
intervals throughout the night.
B. Assure the client that the nurse will hold in
confidence anything the client says.
C. Repeatedly discuss previous suicide attempts with
the client.
, D. Disregard decreased communication by the client
because this is common with suicidal clients.
Correct Answer: A. Check the client frequently at irregular
intervals throughout the night
Checking the client frequently but at irregular intervals prevents
the client from predicting when observation will take place and
altering behavior in a misleading way at these times. Once the
patient is deemed to be at risk for suicide, then intervention
steps must be initiated right away. The individual must not be left
alone. Enlist the help of a support person while at home. The
suicidal individual must be treated in a safe and secure place. In
addition, the place has to be monitored.
Option B: This may encourage the client to try to
manipulate the nurse or seek attention for having a
secret suicide plan. Assessing the individual’s
judgment is critical. One should try and determine how
the individual can handle stress. Does he or she have
an impairment in decision making? Does the individual
know that jumping in front of a train is dangerous?
Reflect empathy and concern. Offer a hand to help.
Provide the patient with confidence that he or she can
overcome the issues.
Option C: This may reinforce suicidal ideas. Help
develop internal coping strategies (e.g., exercise,
journaling, reading, developing a hobby). Utilize the
help of healthcare professionals to follow up on
therapy. Once the individual is safe as an inpatient or
outpatient, a formal treatment plan should be
established. The next step is to refer all patients
deemed to be at higher risk for suicide to a mental
health counselor as soon as possible. Every state has
laws and procedures regarding this process which
must be incorporated into the clinical practice when
addressing individuals at high suicide risk.
Option D: Decreased communication is a sign of
withdrawal that may indicate the client has decided to
commit suicide; the nurse shouldn’t disregard it. In
some cases, assessment of the mental status may
provide a clue to the individual’s potential for self-
harm. Depressed patients will often tend to appear
unclean and unkempt. The clothing may not be ironed
Psychiatric Nursing NCLEX Practice
Quiz #1: 75 Questions
1. Question
Flumazenil (Romazicon) has been ordered for a male client who
has overdosed on oxazepam (Serax). Before administering the
medication, nurse Gina should be prepared for which common
adverse effect?
o A. Seizures
o B. Shivering
o C. Anxiety
o D. Chest pain
Correct Answer: A. Seizures
Seizures are the most common serious adverse effect of using
flumazenil to reverse benzodiazepine overdose. The effect is
magnified if the client has a combined tricyclic antidepressant
and benzodiazepine overdose. Benzodiazepine reversal has
correlations with seizures. Seizures may happen more frequently
in patients who have been on benzodiazepines for long-term
sedation or in patients who are showing signs of severe tricyclic
antidepressant overdose. The required dosage of Flumazenil
should be measured and prepared by the practitioners to manage
seizures. Flumazenil use requires caution in patients relying on a
benzodiazepine for seizure control.
Option B: Shivering is not an adverse effect of
flumazenil. Monitor the patient for the possible return
of sedation, mostly in those who are tolerant of
benzodiazepines. Patients should have monitoring for
respiratory depression, benzodiazepine withdrawal,
and other residual effects of benzodiazepines for at
least 2 hours.
Option C: Anxiety is a rare adverse effect for people
using flumazenil. Flumazenil has some associations
, with precipitation of seizures in patients with
benzodiazepine dependence with a history of seizures.
Flumazenil overdose is extremely rare. There is no
precise antidote for flumazenil toxicity. In mild to
severe toxicity, symptomatic and supportive
treatment should be a consideration.
Option D: An overdose of flumazenil in a patient who
is not a chronic benzodiazepine user would not be
expected. Chronic benzodiazepines users may
experience withdrawal with abrupt discontinuation of
the drug. Administration of benzodiazepines or
barbiturates may be necessary for seizure control.
2. 2. Question
Nurse Tamara is caring for a client diagnosed with bulimia. The
most appropriate initial goal for a client diagnosed with bulimia
is to:
A. Avoid shopping for large amounts of food.
B. Control eating impulses.
C. Identify anxiety-causing situations.
D. Eat only three meals per day.
Correct Answer: C. Identify anxiety-causing situations
Bulimic behavior is generally a maladaptive coping response to
stress and underlying issues. The client must identify anxiety-
causing situations that stimulate the bulimic behavior and then
learn new ways of coping with the anxiety. Bulimia nervosa is a
condition that occurs most commonly in adolescent females,
characterized by indulgence in binge-eating, and inappropriate
compensatory behaviors to prevent weight gain.
Option A: Controlling shopping for large amounts of
food isn’t a goal early in treatment. It is important to
educate patients who abuse laxatives that these
medications work in the gastrointestinal tract after the
areas where caloric absorption has occurred primarily.
It is crucial to inform patients that a period of edema
, and weight gain may follow up to several weeks after
discontinuation of purging behavior.
Option B: Managing eating impulses and replacing
them with adaptive coping mechanisms can be
integrated into the plan of care after initially
addressing stress and underlying issues. The primary
objective of treatment is a cessation of the binging
and purging behavior. Selective serotonin reuptake
inhibitors such as fluoxetine, citalopram, and
sertraline have shown to reduce symptoms of bulimia
nervosa. Fluoxetine is the only FDA approved
medication for bulimia nervosa. It appears that a
higher dose (60 mg) is significantly better than a
placebo in decreasing the frequency of binge and
vomiting episodes.
Option D: Eating three meals per day isn’t a realistic
goal early in treatment. Patients with bulimia nervosa
who purge by vomiting often brush their teeth
immediately after purging, which can accelerate
dental erosion. The clinician should instruct the
patients who persist in vomiting to rinse their mouths
with water or fluoride rather than brushing their teeth
within 30 minutes of each episode. Consider
consulting a dentist to address dental issues
associated with vomiting.
3. 3. Question
A female client who’s at high risk for suicide needs close
supervision. To best ensure the client’s safety, Nurse Mary
should:
A. Check the client frequently at irregular
intervals throughout the night.
B. Assure the client that the nurse will hold in
confidence anything the client says.
C. Repeatedly discuss previous suicide attempts with
the client.
, D. Disregard decreased communication by the client
because this is common with suicidal clients.
Correct Answer: A. Check the client frequently at irregular
intervals throughout the night
Checking the client frequently but at irregular intervals prevents
the client from predicting when observation will take place and
altering behavior in a misleading way at these times. Once the
patient is deemed to be at risk for suicide, then intervention
steps must be initiated right away. The individual must not be left
alone. Enlist the help of a support person while at home. The
suicidal individual must be treated in a safe and secure place. In
addition, the place has to be monitored.
Option B: This may encourage the client to try to
manipulate the nurse or seek attention for having a
secret suicide plan. Assessing the individual’s
judgment is critical. One should try and determine how
the individual can handle stress. Does he or she have
an impairment in decision making? Does the individual
know that jumping in front of a train is dangerous?
Reflect empathy and concern. Offer a hand to help.
Provide the patient with confidence that he or she can
overcome the issues.
Option C: This may reinforce suicidal ideas. Help
develop internal coping strategies (e.g., exercise,
journaling, reading, developing a hobby). Utilize the
help of healthcare professionals to follow up on
therapy. Once the individual is safe as an inpatient or
outpatient, a formal treatment plan should be
established. The next step is to refer all patients
deemed to be at higher risk for suicide to a mental
health counselor as soon as possible. Every state has
laws and procedures regarding this process which
must be incorporated into the clinical practice when
addressing individuals at high suicide risk.
Option D: Decreased communication is a sign of
withdrawal that may indicate the client has decided to
commit suicide; the nurse shouldn’t disregard it. In
some cases, assessment of the mental status may
provide a clue to the individual’s potential for self-
harm. Depressed patients will often tend to appear
unclean and unkempt. The clothing may not be ironed
