Comprehensive Mental Health and
Psychiatric Nursing NCLEX Practice
Quiz #3: 75 Questions
1. Question
A psychotic client reports to the evening nurse that the day nurse
put something suspicious in his water with his medication. The
nurse replies, “You’re worried about your medication?” The
nurse’s communication is:
o A. An example of presenting reality
o B. Reinforcing the client’s delusions
o C. Focusing on emotional content
o D. A non-therapeutic technique called mind-reading
Correct Answer: C. Focusing on emotional content
The nurse should help the client focus on the emotional content
rather than delusional material. Sometimes during a
conversation, patients mention something particularly important.
When this happens, nurses can focus on their statement,
prompting patients to discuss it further. Patients don’t always
have an objective perspective on what is relevant to their case;
as impartial observers, nurses can more easily pick out the topics
to focus on.
o Option A: Presenting reality isn’t helpful because it
can lead to confrontation and disengagement. It’s
frequently useful for nurses to summarize what
patients have said after the fact. This demonstrates to
patients that the nurse was listening and allows the
nurse to document conversations. Ending a summary
with a phrase like “Does that sound correct?” gives
patients explicit permission to make corrections if
they’re necessary.
o Option B: Agreeing with the client and supporting his
beliefs are reinforcing delusions. Patients often ask
nurses for advice about what they should do about
, particular problems or in specific situations. Nurses
can ask patients what they think they should do, which
encourages patients to be accountable for their own
actions and helps them come up with solutions
themselves.
o Option D: Mind reading isn’t therapeutic. Similar to
active listening, asking patients for clarification when
they say something confusing or ambiguous is
important. Saying something like “I’m not sure I
understand. Can you explain it to me?” helps nurses
ensure they understand what’s actually being said and
can help patients process their ideas more thoroughly
2. 2. Question
A client is admitted to the inpatient unit of the mental health
center with a diagnosis of paranoid schizophrenia. He’s shouting
that the government of France is trying to assassinate him. Which
of the following responses is most appropriate?
o A. “I think you’re wrong. France is a friendly country and
an ally of the United States. Their government wouldn’t try
to kill you.”
o B. “I find it hard to believe that a foreign
government or anyone else is trying to hurt you. You
must feel frightened by this.”
o C. “You’re wrong. Nobody is trying to kill you.”
o D. “A foreign government is trying to kill you? Please tell
me more about it.”
Correct Answer: B. “I find it hard to believe that a foreign
government or anyone else is trying to hurt you. You must
feel frightened by this.”
Responses should focus on reality while acknowledging the
client’s feelings. Sometimes during a conversation, patients
mention something particularly important. When this happens,
nurses can focus on their statement, prompting patients to
discuss it further. Patients don’t always have an objective
, perspective on what is relevant to their case; as impartial
observers, nurses can more easily pick out the topics to focus on.
o Option A: Arguing with the client or denying his belief
isn’t therapeutic. By using nonverbal and verbal cues
such as nodding and saying “I see,” nurses can
encourage patients to continue talking. Active
listening involves showing interest in what patients
have to say, acknowledging that you’re listening and
understanding, and engaging with them throughout
the conversation. Nurses can offer general leads such
as “What happened next?” to guide the conversation
or propel it forward.
o Option C: Arguing can also inhibit development of a
trusting relationship. Continuing to talk about
delusions may aggravate the psychosis. It’s frequently
useful for nurses to summarize what patients have
said after the fact. This demonstrates to patients that
the nurse was listening and allows the nurse to
document conversations. Ending a summary with a
phrase like “Does that sound correct?” gives patients
explicit permission to make corrections if they’re
necessary.
o Option D: Asking the client if a foreign government is
trying to kill him may increase his anxiety level and
can reinforce his delusions. Voicing doubt can be a
gentler way to call attention to the incorrect or
delusional
3. 3. Question
A client receiving haloperidol (Haldol) complains of a stiff jaw and
difficulty swallowing. The nurse’s first action is to:
o A. Reassure the client and administer as needed
lorazepam (Ativan) I.M.
o B. Administer as needed dose of benztropine
(Cogentin) I.M. as ordered.
o C. Administer as needed dose of benztropine (Cogentin)
by mouth as ordered.
, o D. Administer as needed dose of haloperidol (Haldol) by
mouth.
Correct Answer: B. Administer as needed dose of
benztropine (Cogentin) I.M. as ordered.
The client is most likely suffering from muscle rigidity due to
haloperidol. I.M. benztropine should be administered to prevent
asphyxia or aspiration. The extrapyramidal symptoms are
muscular weakness or rigidity, a generalized or localized tremor
that may be characterized by the akinetic or agitation types of
movements, respectively. Haloperidol overdose is also associated
with ECG changes known as torsade de pointes, which may cause
arrhythmia or cardiac arrest.
o Option A: Lorazepam treats anxiety, not
extrapyramidal effects. Lorazepam is a
benzodiazepine medication developed by DJ Richards.
It went on the market in the United States in 1977.
Lorazepam has common use as the sedative and
anxiolytic of choice in the inpatient setting owing to its
fast (1 to 3 minute) onset of action when administered
intravenously. Lorazepam is also one of the few
sedative-hypnotics with a relatively clean side effect
profile. Lorazepam is FDA approved for short-term (4
months) relief of anxiety symptoms related to anxiety
disorders, anxiety-associated insomnia, anesthesia
premedication in adults to relieve anxiety, or to
produce sedation/amnesia, and treatment of status
epilepticus.
o Option C: Benztropine belongs to the synthetic class
of muscarinic receptor antagonists (anticholinergic
drugs). Thus, it has a structure similar to that of
diphenhydramine and atropine. However, it is long-
acting so that its administration can be with less
frequency than diphenhydramine. It also induces less
CNS stimulation effect compared to that of
trihexyphenidyl, making it a preferable drug of choice
for geriatric patients.
o Option D: Another dose of haloperidol would increase
the severity of the reaction. Since there is no specific
antidote, supportive treatment is the mainstay of
haloperidol toxicity. If a patient develops signs and
symptoms of toxicities, the clinician should consider
Psychiatric Nursing NCLEX Practice
Quiz #3: 75 Questions
1. Question
A psychotic client reports to the evening nurse that the day nurse
put something suspicious in his water with his medication. The
nurse replies, “You’re worried about your medication?” The
nurse’s communication is:
o A. An example of presenting reality
o B. Reinforcing the client’s delusions
o C. Focusing on emotional content
o D. A non-therapeutic technique called mind-reading
Correct Answer: C. Focusing on emotional content
The nurse should help the client focus on the emotional content
rather than delusional material. Sometimes during a
conversation, patients mention something particularly important.
When this happens, nurses can focus on their statement,
prompting patients to discuss it further. Patients don’t always
have an objective perspective on what is relevant to their case;
as impartial observers, nurses can more easily pick out the topics
to focus on.
o Option A: Presenting reality isn’t helpful because it
can lead to confrontation and disengagement. It’s
frequently useful for nurses to summarize what
patients have said after the fact. This demonstrates to
patients that the nurse was listening and allows the
nurse to document conversations. Ending a summary
with a phrase like “Does that sound correct?” gives
patients explicit permission to make corrections if
they’re necessary.
o Option B: Agreeing with the client and supporting his
beliefs are reinforcing delusions. Patients often ask
nurses for advice about what they should do about
, particular problems or in specific situations. Nurses
can ask patients what they think they should do, which
encourages patients to be accountable for their own
actions and helps them come up with solutions
themselves.
o Option D: Mind reading isn’t therapeutic. Similar to
active listening, asking patients for clarification when
they say something confusing or ambiguous is
important. Saying something like “I’m not sure I
understand. Can you explain it to me?” helps nurses
ensure they understand what’s actually being said and
can help patients process their ideas more thoroughly
2. 2. Question
A client is admitted to the inpatient unit of the mental health
center with a diagnosis of paranoid schizophrenia. He’s shouting
that the government of France is trying to assassinate him. Which
of the following responses is most appropriate?
o A. “I think you’re wrong. France is a friendly country and
an ally of the United States. Their government wouldn’t try
to kill you.”
o B. “I find it hard to believe that a foreign
government or anyone else is trying to hurt you. You
must feel frightened by this.”
o C. “You’re wrong. Nobody is trying to kill you.”
o D. “A foreign government is trying to kill you? Please tell
me more about it.”
Correct Answer: B. “I find it hard to believe that a foreign
government or anyone else is trying to hurt you. You must
feel frightened by this.”
Responses should focus on reality while acknowledging the
client’s feelings. Sometimes during a conversation, patients
mention something particularly important. When this happens,
nurses can focus on their statement, prompting patients to
discuss it further. Patients don’t always have an objective
, perspective on what is relevant to their case; as impartial
observers, nurses can more easily pick out the topics to focus on.
o Option A: Arguing with the client or denying his belief
isn’t therapeutic. By using nonverbal and verbal cues
such as nodding and saying “I see,” nurses can
encourage patients to continue talking. Active
listening involves showing interest in what patients
have to say, acknowledging that you’re listening and
understanding, and engaging with them throughout
the conversation. Nurses can offer general leads such
as “What happened next?” to guide the conversation
or propel it forward.
o Option C: Arguing can also inhibit development of a
trusting relationship. Continuing to talk about
delusions may aggravate the psychosis. It’s frequently
useful for nurses to summarize what patients have
said after the fact. This demonstrates to patients that
the nurse was listening and allows the nurse to
document conversations. Ending a summary with a
phrase like “Does that sound correct?” gives patients
explicit permission to make corrections if they’re
necessary.
o Option D: Asking the client if a foreign government is
trying to kill him may increase his anxiety level and
can reinforce his delusions. Voicing doubt can be a
gentler way to call attention to the incorrect or
delusional
3. 3. Question
A client receiving haloperidol (Haldol) complains of a stiff jaw and
difficulty swallowing. The nurse’s first action is to:
o A. Reassure the client and administer as needed
lorazepam (Ativan) I.M.
o B. Administer as needed dose of benztropine
(Cogentin) I.M. as ordered.
o C. Administer as needed dose of benztropine (Cogentin)
by mouth as ordered.
, o D. Administer as needed dose of haloperidol (Haldol) by
mouth.
Correct Answer: B. Administer as needed dose of
benztropine (Cogentin) I.M. as ordered.
The client is most likely suffering from muscle rigidity due to
haloperidol. I.M. benztropine should be administered to prevent
asphyxia or aspiration. The extrapyramidal symptoms are
muscular weakness or rigidity, a generalized or localized tremor
that may be characterized by the akinetic or agitation types of
movements, respectively. Haloperidol overdose is also associated
with ECG changes known as torsade de pointes, which may cause
arrhythmia or cardiac arrest.
o Option A: Lorazepam treats anxiety, not
extrapyramidal effects. Lorazepam is a
benzodiazepine medication developed by DJ Richards.
It went on the market in the United States in 1977.
Lorazepam has common use as the sedative and
anxiolytic of choice in the inpatient setting owing to its
fast (1 to 3 minute) onset of action when administered
intravenously. Lorazepam is also one of the few
sedative-hypnotics with a relatively clean side effect
profile. Lorazepam is FDA approved for short-term (4
months) relief of anxiety symptoms related to anxiety
disorders, anxiety-associated insomnia, anesthesia
premedication in adults to relieve anxiety, or to
produce sedation/amnesia, and treatment of status
epilepticus.
o Option C: Benztropine belongs to the synthetic class
of muscarinic receptor antagonists (anticholinergic
drugs). Thus, it has a structure similar to that of
diphenhydramine and atropine. However, it is long-
acting so that its administration can be with less
frequency than diphenhydramine. It also induces less
CNS stimulation effect compared to that of
trihexyphenidyl, making it a preferable drug of choice
for geriatric patients.
o Option D: Another dose of haloperidol would increase
the severity of the reaction. Since there is no specific
antidote, supportive treatment is the mainstay of
haloperidol toxicity. If a patient develops signs and
symptoms of toxicities, the clinician should consider
