NUR 190 Mental Health Nursing
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Free NUR 190 Mental Health Nursing Questions
A nurse is assessing a client with schizophrenia who reports hearing voices that are not present, saying negative things about him. The nurse recognizes this symptom as which type of hallucination?
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Visual hallucinations
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Tactile hallucinations
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Auditory hallucinations
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Olfactory hallucinations
Explanation
The Correct Answer is:
C. Auditory hallucinations
Detailed Explanation:
Auditory hallucinations are the most common type of hallucination in schizophrenia and involve hearing sounds or voices that are not real. Clients often perceive voices commenting on their behavior, issuing commands, or insulting them. This symptom reflects a disturbance in sensory perception linked to altered brain function. Visual hallucinations involve seeing things, tactile involve sensations on the skin, and olfactory involve smelling odors that are not present.
Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder?
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Client fears criticism from others, including staff.
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Client cries loudly whenever requests are denied.
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Client shows no remorse when accidentally breaking another client’s bracelet.
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Client talks about three failed marriages.
Explanation
The Correct Answer is:
A. Client fears criticism from others, including staff.
Detailed Explanation:
A client who fears criticism and rejection, even from authority figures or supportive individuals like staff, demonstrates the core features of avoidant personality disorder. These individuals often experience deep feelings of inadequacy and are hypersensitive to negative evaluation. As a result, they may avoid social or occupational situations that involve close contact with others, despite desiring acceptance. Their self-esteem is fragile, and even mild criticism can lead to withdrawal or emotional distress.
A client with histrionic personality disorder frequently seeks attention by exaggerating emotional responses and displaying dramatic behavior. Which nursing intervention is most appropriate for this client?
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Assist the client to eliminate passive behavior
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Set limits on attention-seeking behavior
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Accept the client’s behavior
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Try to meet the client’s needs for attention
Explanation
The Correct Answer is:
B. Set limits on attention-seeking behavior
Detailed Explanation:
Clients with histrionic personality disorder often display excessive emotionality and attention-seeking behaviors. The nurse’s role is to set clear, consistent limits while maintaining a supportive but professional relationship. This approach prevents reinforcement of manipulative or dramatic behavior and encourages more appropriate ways of gaining attention. Accepting or catering to such behaviors reinforces dependency, while focusing on eliminating “passive behavior” misses the core issue—managing attention-seeking patterns.
A young woman has stopped attending classes and withdrawn from friends and family, spending most of her time in her room without speaking to anyone. Which of the following is the highest priority for this client?
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Obtaining more data about her college experiences
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Assessing fluid intake and outpu
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Completing an assessment of mental status
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Providing for adequate rest
Explanation
The Correct Answer is:
C. Completing an assessment of mental status
Detailed Explanation:
The highest priority for a client showing signs of social withdrawal, isolation, and possible depression is to complete a thorough mental status assessment. This helps determine the client’s level of functioning, mood, thought processes, and risk for self-harm or suicidal ideation. Understanding the client’s mental state ensures appropriate interventions and safety measures are implemented. While rest, nutrition, and history are important, mental status evaluation directly addresses potential psychiatric risk.
The doctor's order states your patient is to receive 2 mL/kg/hr of IV fluid containing 20 mEq KCl. The patient's weight is 220 lbs. How many mL of IV fluid will your patient receive in 8 hours?
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1.6 L
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1 L
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1.5 L
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2 L
Explanation
The Correct Answer is:
A. 1.6 L
Detailed Explanation:
Step 1: Convert pounds to kilograms
220 lbs ÷ 2.2 = 100 kg
Step 2: Multiply by the ordered rate
2 mL × 100 kg = 200 mL/hr
Step 3: Multiply by the duration (8 hours)
200 mL/hr × 8 hr = 1600 mL
Step 4: Convert to liters
1600 mL ÷ 1000 = 1.6 L
Therefore, the patient will receive 1.6 liters of IV fluid in 8 hours.
A client displays suspiciousness, mistrust of others, and reluctance to confide in anyone, often interpreting others’ actions as deliberately threatening or demeaning. The nurse recognizes these traits as characteristic of which personality disorder?
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Schizotypal
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Paranoid
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Histrionic
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Narcissistic
Explanation
The Correct Answer is:
B. Paranoid
Detailed Explanation:
Paranoid personality disorder is characterized by a pervasive distrust and suspicion of others, leading individuals to interpret benign remarks or actions as hostile or malicious. These clients are often guarded, hypersensitive, and unwilling to share personal information due to fear of betrayal. In contrast, schizotypal personality disorder involves eccentric behavior and odd beliefs, histrionic focuses on attention-seeking and dramatic emotions, and narcissistic features grandiosity and a lack of empathy for others.
A client who was in a severe car accident is unable to recall any details of the event. The nurse recognizes this as an example of which defense mechanism?
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Devaluation
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Reaction formation
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Dissociation
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Repression
Explanation
The Correct Answer is:
D. Repression
Detailed Explanation:
Repression is an unconscious defense mechanism in which painful or anxiety-producing memories, thoughts, or feelings are blocked from conscious awareness. In this case, the client’s inability to remember the traumatic accident protects them from emotional distress. Unlike suppression, which is intentional, repression occurs involuntarily and often manifests after trauma or conflict.
A young client, diagnosed with oppositional defiant disorder, becomes angry and defiant over the rules of the day treatment program. The client is shouting at the nurse. Which action by the nurse can help defuse the situation?
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Placing the client in a time-out
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Suggesting that the client go to the gym and shoot baskets
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Providing an as-needed anxiolytic medication
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Calling staff to seclude the client
Explanation
The Correct Answer is:
B. Suggesting that the client go to the gym and shoot baskets
Detailed Explanation:
Children and adolescents with oppositional defiant disorder (ODD) often respond best to interventions that allow them to release frustration in a safe and constructive manner. Suggesting a physical activity, such as shooting basketballs, helps the client channel anger and energy appropriately while regaining self-control. This approach prevents escalation and preserves the therapeutic relationship.
A time-out may be useful later if the behavior persists, but in this situation, a calming physical outlet is the most effective first response. Medications or seclusion are unnecessary unless safety is threatened.
A nurse is monitoring a child who has recently started taking stimulant medication for Attention-Deficit/Hyperactivity Disorder (ADHD). Which potential side effect should the nurse closely assess for during follow-up visits?
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Cognitive impairment
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Weight gain
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Growth suppression
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Drowsiness
Explanation
The Correct Answer is:
C. Growth suppression
Detailed Explanation:
Stimulant medications, such as methylphenidate or amphetamine-based drugs, may cause appetite suppression, leading to decreased calorie intake and, over time, growth suppression in children. The nurse should regularly monitor height, weight, and nutritional intake to detect early signs of slowed growth. Encouraging high-calorie meals and snacks outside medication peak times can help minimize this effect. The other options are not common adverse effects of stimulant therapy.
Which of the following statements about stress and anxiety is most accurate?
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Anxiety occurs when a person has trouble dealing with life situations, problems, and goals
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Stress is a person’s reaction to anxiety
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Stress is the wear and tear that life causes on the body
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All people handle stress in the same way
Explanation
The Correct Answer is:
C. Stress is the wear and tear that life causes on the body
Detailed Explanation:
Stress is the body’s physiological and psychological response to external pressures or challenges—often described as the “wear and tear” of life. It can be triggered by positive or negative experiences and affects the body through the release of stress hormones like cortisol. While anxiety can result from stress, people respond to stress in different ways, depending on personality, coping skills, and support systems.
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