CATEGORY 1: PRIORITY & SAFETY
A patient with anxiety begins to hyperventilate and reports dizziness. What is the nurse’s priority action?
A. Administer benzodiazepine
B. Instruct patient to breathe into a paper bag
C. Coach slow, controlled breathing
D. Call the provider
Answer: C
Rationale: Controlled breathing corrects hyperventilation safely. Paper bags are not recommended due to hypoxia risk.
A patient says, “No one understands what I’m going through.” What is the best response?
A. “I understand how you feel.”
B. “Tell me more about that.”
C. “That’s not true.”
D. “You’ll feel better soon.”
Answer: B
Rationale: Encourages expression without making assumptions.
Which finding is most specific to a panic attack?
A. Chronic worry
B. Gradual onset of fear
C. Sudden onset of intense fear
D. Mild restlessness
Answer: C
Rationale: Panic attacks are abrupt and intense.
Which statement indicates improvement in depression?
A. “I feel hopeless.”
B. “I don’t care anymore.”
C. “I want to start walking again.”
D. “I can’t get out of bed.”
Answer: C
Rationale: Increased motivation signals improvement.
Which medication class requires several weeks to see full effect?
A. Benzodiazepines
B. SSRIs
C. Antipsychotics
D. Mood stabilizers
Answer: B
Rationale: SSRIs take weeks for full effect.
A patient with major depression has not eaten for 2 days. What is the priority intervention?
A. Offer large meals
B. Encourage group therapy
C. Provide small frequent meals
D. Educate on nutrition
Answer: C
Rationale: Small, frequent meals are more manageable for depressed patients with low energy.
A patient is silent and withdrawn. What is the best initial approach?
A. Ask direct personal questions
B. Sit quietly with the patient
C. Encourage group participation
D. Leave the patient alone
Answer: B
Rationale: Presence is therapeutic and non-threatening.
A patient avoids public places due to fear of embarrassment. This is most consistent with:
A. GAD
B. Panic disorder
C. Social anxiety disorder
D. OCD
Answer: C
Rationale: Social anxiety involves fear of judgment.
Which patient is at highest suicide risk?
A. No plan
B. Has support system
C. Has a detailed plan
D. Mild sadness
Answer: C
Rationale: A specific plan indicates high risk.
A patient taking SSRIs should be taught to report which symptom?
A. Mild headache
B. Nausea
C. Suicidal thoughts
D. Dry mouth
Answer: C
Rationale: This is the most serious risk.
A patient with panic disorder is scheduled for discharge. Which finding requires intervention?
A. Uses breathing techniques
B. Avoids all triggers
C. Attends therapy
D. Takes medications as prescribed
Answer: B
Rationale: Avoidance worsens anxiety long-term; coping strategies are preferred.
A patient says, “I’m a failure.” What is the best response?
A. “That’s not true.”
B. “Why do you feel that way?”
C. “You shouldn’t think like that.”
D. “Others have it worse.”
Answer: B
Rationale: Encourages exploration of feelings.
Which symptom differentiates panic attack from generalized anxiety?
A. Restlessness
B. Muscle tension
C. Sudden onset
D. Irritability
Answer: C
Rationale: Panic attacks are acute; GAD is chronic.
A patient gives away personal belongings. This may indicate:
A. Recovery
B. Mania
C. Suicide risk
D. Anxiety
Answer: C
Rationale: Giving away belongings is a warning sign.
Which medication requires avoiding alcohol due to CNS depression?
A. SSRIs
B. Benzodiazepines
C. Antidepressants
D. Mood stabilizers
Answer: B
Rationale: Combined effects increase sedation risk.
A patient with anxiety becomes increasingly restless and loud. What is the best nursing action?
A. Apply restraints
B. Encourage discussion of feelings
C. Move patient to a quieter area
D. Administer PRN medication immediately
Answer: C
Rationale: Reducing stimulation is the least restrictive and appropriate first step.
Which response demonstrates therapeutic communication?
A. Giving advice
B. Changing the subject
C. Reflecting feelings
D. Offering reassurance
Answer: C
Rationale: Reflection validates the patient’s emotions.
A patient reports repetitive intrusive thoughts and behaviors. This is characteristic of:
A. Panic disorder
B. OCD
C. PTSD
D. GAD
Answer: B
Rationale: OCD involves obsessions and compulsions.
Which intervention is most important for a suicidal patient?
A. Encourage independence
B. Frequent observation
C. Limit interaction
D. Promote sleep
Answer: B
Rationale: Close monitoring prevents self-harm.
Which side effect is expected with benzodiazepines?
A. Increased energy
B. Sedation
C. Weight loss
D. Insomnia
Answer: B
Rationale: Benzos depress CNS.
Which patient requires immediate intervention?
A. Patient with mild anxiety
B. Patient with insomnia
C. Patient expressing hopelessness
D. Patient requesting discharge
Answer: C
Rationale: Hopelessness is a strong predictor of suicide risk.
A patient with severe anxiety is unable to answer questions. What is the best nursing approach?
A. Continue asking questions
B. Provide detailed explanations
C. Use brief, simple statements
D. Encourage journaling
Answer: C
Rationale: Severe anxiety limits processing ability.
A patient relives a traumatic event with flashbacks. This indicates:
A. Anxiety disorder
B. Panic disorder
C. PTSD
D. Depression
Answer: C
Rationale: PTSD includes re-experiencing trauma.
Which statement requires immediate intervention?
A. “I feel sad.”
B. “I have no energy.”
C. “I wish I were dead.”
D. “I can’t sleep.”
Answer: C
Rationale: Direct expression of death wishes is urgent.
A patient suddenly stops taking benzodiazepines. What is the risk?
A. Hypertension
B. Withdrawal symptoms
C. Weight gain
D. Increased appetite
Answer: B
Rationale: Abrupt stopping can cause withdrawal.