Mental Health Nursing Quiz

1. A client with borderline personality disorder is frequently observed engaging in self-mutilation. The nurse recognizes this behavior is most often an attempt to:

A. Manipulate the staff into granting special privileges B. Express anger toward others in a non-verbal way C. Elicit a rescue response from others D. Practice suicidal gestures in a safe environment

2. During a group therapy session, a client with borderline personality disorder begins to idealize one nurse while devaluing another. This behavior is known as:

A. Projection B. Splitting C. Dissociation D. Rationalization

3. Which nursing intervention is MOST effective when caring for a client with borderline personality disorder who exhibits manipulative behavior?

A. Provide immediate rewards for any positive behavior B. Set clear and consistent boundaries and limits C. Discuss transference issues with the client daily D. Allow the client to verbalize negative feelings without consequences

4. A client with antisocial personality disorder repeatedly blames others for his aggressive outbursts. Which of the following nursing interventions is appropriate?

A. Invite the client to share detailed accounts of how others have caused his anger B. Encourage the client to reflect on behaviors and accept personal responsibility C. Use punitive measures when the client acts out aggressively D. Avoid discussing the client’s behavior to minimize confrontation

5. A client with borderline personality disorder has cuts on both arms after a recent self-harm incident. What is the best nursing action?

A. Ignore the wounds to avoid reinforcing attention-seeking behavior B. Provide immediate emergency care, assess suicidality, and discuss coping strategies C. Restrict the client to a seclusion room for 24 hours as a deterrent D. Reward the client with a privilege for reporting the incident

6. An appropriate long-term goal for a client with borderline personality disorder who engages in self-injurious behaviors would be:

A. Demonstrate decreased anxiety through daily journaling B. Contract with staff to seek help rather than self-harm C. Express feelings of anger by throwing objects instead of cutting D. Accept sedation immediately when feeling anxious

7. The provider has ordered a PRN dose of alprazolam (Xanax) 0.5 mg PO q4h PRN for a newly admitted client with borderline personality disorder who has active suicidal ideation. What is the BEST nursing action regarding this medication?

A. Administer alprazolam every 4 hours around the clock to keep the client calm B. Evaluate the client’s level of anxiety and potential for dependency before administering PRN doses C. Refuse to administer alprazolam to a client with suicidal ideation D. Immediately request a higher dose if the client remains anxious

8. A client with antisocial personality disorder states, “He got what he deserved for making me angry!” Which response by the nurse is MOST therapeutic?

A. “No one deserves to be harmed. You need to learn ways to manage anger.” B. “Yes, other people can be annoying, and you have a right to defend yourself.” C. “I’ll speak with him to see how he contributed to the altercation.” D. “Why would you hurt someone who made you angry?”

9. The nurse is caring for a client with borderline personality disorder who often threatens to leave treatment when upset. Which nursing response is most appropriate?

A. “If you leave, you cannot ever return to this unit.” B. “You can’t leave, so we’ll place you in restraints if necessary.” C. “You have a right to make decisions. Let’s talk about the consequences of leaving.” D. “Why do you always threaten to leave when things get hard?”

10. A client with antisocial personality disorder is verbally abusive to staff members and states, “You’re all incompetent!” The BEST initial response by the nurse would be:

A. “You shouldn’t speak to us like that. We’re trying to help you.” B. “I understand that you’re angry, but disrespectful behavior is not allowed. Let’s focus on why you’re upset.” C. “We are competent nurses; you need to control your behavior.” D. “I’m going to ignore your comments and hope you calm down.”

11. The nurse is teaching a family about caring for an older adult with delirium. Which statement by the family indicates an understanding of this condition?

A. “Delirium is a permanent decline in mental function.” B. “It develops slowly over months and is irreversible.” C. “We should look for acute changes in behavior and thinking.” D. “Once delirium sets in, it’s not safe to reorient the patient.”

12. When a client with dementia fabricates events to fill memory gaps, the nurse recognizes this behavior as:

A. Perseveration B. Confabulation C. Hallucination D. Apraxia

13. A nurse is caring for a client with Alzheimer’s disease who exhibits agraphia. This term refers to the client’s inability to:

A. Write B. Speak C. Understand spoken language D. Recognize objects

14. In a client with late-stage dementia, hyperorality can often be observed. Which behavior is consistent with hyperorality?

A. Excessive, uncontrolled talking without stimulus B. The need to examine and place objects in the mouth C. Urges to yell obscenities D. Difficulty with word-finding and speaking

15. A nurse is teaching about hypermetamorphosis in dementia. Which statement by a caregiver indicates understanding?

A. “It’s when my loved one fixes their gaze on a single object and cannot look away.” B. “It’s characterized by touching or examining every object in their environment.” C. “It refers to constant pacing and inability to stand still.” D. “It’s the inability to remember how to perform certain movements.”

16. A new nurse is caring for a client with moderate-stage Alzheimer’s disease. Which communication strategy would the charge nurse correct?

A. Asking simple, direct questions B. Providing lengthy explanations to orient the client C. Using gestures or pictures along with words D. Speaking clearly and slowly

17. When implementing reminiscence therapy for a client with dementia, the nurse should:

A. Discourage talking about the past to avoid confusion B. Focus on reality orientation rather than past experiences C. Encourage the client to recall pleasant past memories and share them D. Challenge any inaccuracies in the client’s memories to maintain truth

18. A nurse is educating a client and family about delirium. Which of the following factors is most commonly associated with development of acute delirium in hospitalized older adults?

A. Increased social activity B. Sensory deprivation or overload C. Long-term memory impairment D. Strict dietary regulation

19. Which intervention is a priority when caring for an older client with acute delirium?

A. Limiting visitors to 30 minutes per day B. Using bed and chair alarms for safety C. Keeping the client in a dimly lit environment D. Providing no stimulation to reduce confusion

20. A client with Alzheimer’s disease has difficulty with both expressive and receptive language. Which term describes this condition?

A. Aphasia B. Apraxia C. Agnosia D. Amnesia

21. A client with antisocial personality disorder is constantly ignoring unit rules. The nurse’s plan of care should prioritize:

A. Providing special privileges to encourage compliance B. Setting and enforcing clear, consistent limits C. Ignoring minor rule infractions to maintain rapport D. Offering to solve problems for the client to reduce stress

22. A client with borderline personality disorder says, “No one here really cares about me; you’re all just like my abusive parents.” Which response by the nurse is most appropriate?

A. “You’re wrong; we do care about you.” B. “I’m sorry you feel that way; let's discuss what makes you feel uncared for.” C. “Why do you keep comparing us to your parents?” D. “That’s not a fair statement to make.”

23. A nurse assesses a client with borderline personality disorder who expresses suicidal thoughts. After ensuring safety, which intervention is MOST appropriate?

A. Implement physical restraints to prevent self-harm B. Contract for safety with the client and closely monitor C. Encourage the client to keep the suicidal thoughts private D. Discharge the client as they may be seeking attention

24. A client with delirium becomes agitated in the evening and insists “There is someone hiding under my bed!” The nurse should:

A. Provide reassurance and gently reorient the client B. Assert the client is confused and ignore the claim C. Check under the bed in a theatrical way to prove nobody is there D. Immediately place the client in seclusion to reduce stimulation

25. An older adult with suspected dementia is found confabulating when asked about recent events. The nurse knows that confabulation is likely an attempt to:

A. Receive more attention from caregivers B. Deceive staff due to paranoia C. Fill in memory gaps and maintain self-esteem D. Demonstrate grandiose delusions

26. The provider orders haloperidol (Haldol) 2 mg IM q4h PRN for a client experiencing severe agitation. The vial concentration is 5 mg/mL. How many mL should the nurse draw up for a single dose?

A. 0.2 mL B. 0.4 mL C. 0.5 mL D. 0.8 mL

27. The physician orders lorazepam (Ativan) 1 mg IV push for anxiety. The vial reads 2 mg/mL. How many mL will the nurse administer?

A. 0.25 mL B. 0.5 mL C. 1 mL D. 2 mL

28. A client with major depressive disorder has an order for sertraline (Zoloft) 75 mg PO daily. The pharmacy dispenses 25 mg tablets. How many tablets should the nurse administer to achieve the ordered dose?

A. 1 tablet B. 2 tablets C. 3 tablets D. 4 tablets

29. The provider orders risperidone (Risperdal) oral solution 2 mg PO twice daily. The bottle label reads 1 mg/mL. How many mL should the nurse administer per dose?

A. 1 mL B. 2 mL C. 3 mL D. 4 mL

30. A client with schizophrenia has a physician’s order for fluphenazine (Prolixin) 0.5 mg PO TID. Each tablet is 1 mg. How many tablets should the nurse administer at each dose?

A. 0.5 tablet B. 1 tablet C. 1.5 tablets D. 2 tablets

31. A client with delirium has orders for PRN haloperidol for agitation. Under which situation is administration MOST appropriate?

A. The client appears anxious but is cooperative, oriented, and calm B. The client is confused, physically threatening staff, and putting self at risk C. The client states that they do not like the food served D. The client is quietly resting and occasionally asks repetitive questions

32. A client with borderline personality disorder is receiving cognitive-behavioral therapy (CBT). Which outcome is the nurse’s priority to address in therapy?

A. Eliminating all negative thoughts B. Developing more adaptive coping and self-control strategies C. Encouraging immediate confrontation with family about past abuse D. Accepting that the client’s thoughts have minimal impact on emotions

33. A nurse is caring for a client with antisocial personality disorder who frequently violates unit rules. Which approach is BEST?

A. Provide immediate negative consequences for each infraction B. Privately negotiate each rule depending on the situation C. Set up a contract that clearly states the consequences for rule violations D. Offer sympathy when the client complains about the rules

34. A client with borderline personality disorder is being discharged. The discharge plan includes a safety contract. Which statement by the client suggests understanding of the safety contract?

A. “I can harm myself if I’m feeling hopeless, as long as I inform someone first.” B. “If I feel like harming myself, I will contact my therapist or go to the ER.” C. “I only need to keep track of my mood if others say I seem depressed.” D. “I should stay at home and avoid all social interactions.”

35. A nurse is providing education to the family of a client newly diagnosed with Alzheimer’s disease regarding aphasia. The nurse explains aphasia is:

A. Inability to carry out motor activities despite intact motor function B. Difficulty or inability to use or understand language C. Lack of ability to recognize familiar objects D. Total loss of short-term memory

36. A client with antisocial personality disorder is admitted to the psychiatric unit. Which behavior is MOST characteristic of this disorder?

A. Intense fear of abandonment and unstable relationships B. Lack of remorse and violation of others’ rights C. Need for excessive attention and admiration D. Excessive emotionality and dramatic behavior

37. When caring for a client with delirium, the nurse should plan to do which of the following to reduce confusion?

A. Keep a clock and calendar in the room and ensure adequate lighting B. Discourage family visits to allow for total rest C. Provide bright, loud television shows to keep the client awake D. Move the client to a different room daily to avoid sensory overload

38. Which of the following is a key diagnostic criterion for borderline personality disorder?

A. Pervasive disregard for others, repeated unlawful behavior B. Excessive anxiety in social situations, fear of embarrassment C. Unstable relationships, self-image, and marked impulsivity D. Lack of need for interpersonal relationships, extreme independence

39. A client with dementia often becomes agitated at night, believing he must “go home to feed the cows.” Which intervention best addresses this client’s distress?

A. Forcefully reorient the client, informing him he is in a hospital B. Restrain the client until the delusional thinking subsides C. Validate the client’s feelings and gently redirect to a calming activity D. Encourage the client to continue talking about the cows for as long as he wishes

40. The nurse is reviewing orders for a client with borderline personality disorder. Which PRN medication order would be MOST appropriate for acute anxiety or agitation without risking significant respiratory depression or dependency?

A. Alprazolam (Xanax) 1 mg PO PRN B. Buspirone (Buspar) 10 mg PO PRN C. Diazepam (Valium) 10 mg PO PRN D. Hydromorphone (Dilaudid) 2 mg PO PRN

41. A client with antisocial personality disorder says to the nurse, “If you don’t let me use the phone right now, I’ll make sure you’re fired.” What is the best initial response by the nurse?

A. “You’re threatening me, and that is unacceptable. The phone rules will be enforced.” B. “Fine, I’ll let you use it just this once, but don’t threaten me again.” C. “Why do you think threatening staff will help you accomplish your goal?” D. “I’m sure the charge nurse will handle your complaint.”

42. The nurse is caring for a client with delirium who is at high risk for falls. Which nursing intervention is MOST important?

A. Turn off all lights in the room at night to promote sleep B. Keep bed in lowest position with side rails up as needed C. Place the client near a busy nurses’ station for constant stimulation D. Encourage the client to ambulate independently as often as possible

43. A nurse is implementing reminiscence therapy for a client in a long-term care facility. Which action is consistent with this therapy?

A. Spending time reviewing photo albums and asking about past events B. Using large posters to orient the client to the current date and place C. Immediately correcting any misstatement about the past D. Providing complex puzzles and word games to stimulate memory

44. A client with borderline personality disorder frequently refuses to attend group therapy, insisting “I don’t need this stupid group.” How should the nurse respond?

A. “You must attend group or you will be discharged.” B. “Group therapy is part of your treatment plan. Let’s discuss the reasons you don’t want to attend.” C. “Okay, it’s your choice to skip it if you want.” D. “I’ll have the group leader come speak with you about it.”

45. A client with a history of self-harm and borderline personality disorder is threatening to cut herself with a sharp object. The nurse’s first action is to:

A. Tell the client that self-harm is unacceptable and walk away B. Call security to restrain the client immediately C. Remove the sharp object and ensure safety while remaining calm D. Encourage the client to harm an inanimate object instead

46. A client with borderline personality disorder is found cutting her arms. After providing first aid, what is the nurse’s next priority?

A. Assign one-on-one observation to prevent further harm B. Threaten the client with discharge if it happens again C. Leave the client alone to reflect on the consequences D. Give the client privacy until she calms down

47. A client with antisocial personality disorder states, “I hate group therapy—everyone just whines about their problems.” What is the BEST response by the nurse?

A. “You must attend or we’ll take away your privileges.” B. “Let’s talk about how you feel group therapy is not helpful.” C. “Some people do whine, but you can just ignore them.” D. “Perhaps individual therapy would be better; you don’t need the group.”

48. A client in a rehabilitation facility for substance abuse also demonstrates traits of borderline personality disorder. Which intervention is MOST important for maintaining professional boundaries?

A. Encourage the client to spend free time with the nurse to develop trust B. Set time-limited sessions for communication and clarify roles C. Share personal experiences to help the client feel understood D. Avoid discussing the client’s manipulative behaviors

49. A nurse is assessing a client with suspected antisocial personality disorder. Which statement by the client BEST reflects the diagnosis?

A. “I often feel empty and afraid everyone will abandon me.” B. “I hate crowds because I fear I’ll be judged by everyone.” C. “Sometimes I think aliens are controlling my thoughts.” D. “It’s not my fault if people let me take advantage of them.”

50. A nurse observes that a client with borderline personality disorder threatens self-harm after staff members rotate off duty. What is the BEST action to ensure continuity of care?

A. Assign the same nurse every day to avoid conflict B. Establish a consistent treatment plan and discuss it during shift reports C. Minimize the client’s behaviors by ignoring them D. Restrict the client’s interactions to administrative staff only

NCLEX-Style Mental Health Nursing Quiz