Mental Health Disorders
A 19-year-old college student reports anxiety, sadness, and difficulty concentrating after failing an exam. What is the most likely diagnosis?
A. Major depressive disorder
B. PTSD
C. Adjustment disorder
D. Generalized anxiety disorder
Answer: C. Adjustment disorder
Rationale: This disorder occurs in response to a life stressor like academic failure, and symptoms typically resolve within 6 months once the stressor is removed.
A patient says, “I get anxious being around people.” What is the most therapeutic response?
A. “You shouldn’t feel that way.”
B. “It sounds like being around your classmates is uncomfortable. Tell me more.”
C. “Do you still attend class when that happens?”
D. “I also felt that way when I was younger.”
Answer: B
Rationale: This is an open-ended, therapeutic response that validates feelings and encourages expression without judgment.
Which medication is used to rapidly reverse the effects of an opioid overdose?
A. Methadone
B. Buprenorphine
C. Naloxone
D. Suboxone
Answer: C. Naloxone
Rationale: Naloxone is an opioid antagonist that blocks opioid receptors and restores normal breathing during overdose.
A patient in the ED has torn clothing, bruising, and states she was sexually assaulted. The nurse reports it to the charge nurse, who says, “Just keep an eye on her.” What ethical principle is being violated?
A. Veracity
B. Autonomy
C. Beneficence
D. Justice
Answer: C. Beneficence
Rationale: Beneficence means acting in the best interest of the patient. Ignoring a reported assault without initiating proper care (e.g., a SANE exam or safety plan) is neglectful and violates the duty to protect and help the patient.
A patient with terminal illness says they want to stop all treatment. The family insists the nurse persuade them to continue. Respecting the patient’s choice demonstrates which ethical principle?
A. Justice
B. Autonomy
C. Fidelity
D. Beneficence
Answer: B. Autonomy
Rationale: Autonomy means respecting a patient's right to make their own healthcare decisions, even if others disagree.
A patient with schizophrenia is hearing voices and appears agitated. What is the most appropriate initial nursing intervention?
A. Encourage group therapy
B. Provide a quiet, low-stim environment
C. Allow the patient to make all their care decisions
D. Redirect the patient to watch TV
Answer: B
Rationale: A quiet, structured environment reduces sensory overload, which helps manage symptoms of psychosis.
A child with ADHD often disrupts class and struggles with focus. Which intervention is most appropriate?
A. Allow unlimited play breaks
B. Ignore misbehavior
C. Use a behavioral contract with clear expectations
D. Give lengthy verbal instructions
Answer: C
Rationale: Structured behavior contracts help manage disruptive behavior in ADHD by setting clear expectations and accountability.
A 17-year-old with anorexia nervosa is admitted. What is the nurse’s priority assessment?
A. Daily food log
B. Heart rate and electrolytes
C. Nutritional education
D. Family history of anxiety
Answer: B
Rationale: Electrolyte imbalances (especially hypokalemia) and bradycardia can be life-threatening in anorexia nervosa and must be monitored closely.
Sara, an ICU nurse during the COVID-19 pandemic, frequently recalls young patients who died under her care. What mental health disorder is she at risk for?
A. Panic disorder
B. Obsessive-compulsive disorder
C. Social anxiety disorder
D. Post-traumatic stress disorder
Answer: D. PTSD
Rationale: Exposure to traumatic events, especially in healthcare settings during crises like the pandemic, places nurses at high risk for PTSD.
A depressed client says, “No one would care if I wasn’t here.” What is the nurse’s most appropriate response?
A. “Have you thought about hurting yourself?”
B. “It sounds like you're overwhelmed.”
C. “Don’t talk like that.”
D. “Try to think more positively.”
Answer: A
Rationale: Directly assessing suicidal ideation is crucial. It shows concern, doesn’t increase risk, and helps with safety planning.
Which finding in a patient taking lithium requires immediate intervention?
A. Fine hand tremor
B. Increased thirst and urination
C. Slurred speech and confusion
D. Mild nausea
Answer: C. Slurred speech and confusion
Rationale: These are signs of lithium toxicity, which is life-threatening. Immediate intervention is necessary.
Kate, a 37-year-old woman diagnosed with breast cancer, feels depressed and anxious. This is an example of what type of crisis?
A. Maturational
B. Situational
C. Adventitious
D. Existential
Answer: B. Situational
Rationale: Situational crises are caused by unexpected external events, such as illness, job loss, or divorce.
A student nurse accesses charts of patients not assigned to her and shares information in a group chat. What law was violated?
A. Social Media Law
B. Affordable Care Act
C. HIPAA
D. Mental Health Parity Act
Answer: C. HIPAA
Rationale: HIPAA protects patients’ private health information. Accessing and sharing patient records without consent is a violation.
A nurse uses cognitive interventions to reduce a client’s anxiety. Which statement by the client indicates success?
A. “I paced the hallway until I felt better.”
B. “I reminded myself the panic attack would end soon.”
C. “I took an Ativan right away.”
D. “I stopped eating to avoid getting anxious.”
Answer: B
Rationale: This reflects successful use of cognitive-behavioral therapy (CBT), which teaches patients to reframe irrational thoughts.
What term describes a child’s habitual mood, behavior, and coping style in response to their environment?
A. Intelligence
B. Resilience
C. Temperament
D. Mood regulation
Answer: C
Rationale: Temperament refers to the child’s natural disposition, which influences how they respond to challenges and stimuli.
Which physical finding is commonly associated with anorexia nervosa?
A. Acne
B. Jaundice
C. Lanugo
D. Alopecia
Answer: C
Rationale: Lanugo (fine body hair) develops as a physiological response to extreme weight loss and poor thermoregulation.
A client has 5+ symptoms like loss of appetite, insomnia, guilt, and anhedonia for 2 weeks. What is the likely diagnosis?
A. Bipolar Disorder
B. Major Depressive Disorder
C. Persistent Depressive Disorder
D. Seasonal Affective Disorder
Answer: B. Major Depressive Disorder
Rationale: Per DSM-5, MDD is diagnosed when a person has ≥5 specific symptoms for at least 2 weeks, impacting daily functioning.
A patient says, “The voices are telling me I’m worthless.” What is the nurse’s best response?
A. “Ignore the voices.”
B. “I don’t hear them, but I understand they’re real to you. What are they saying?”
C. “You're not worthless.”
D. “Let’s turn on the TV so you don’t hear them.”
Answer: B
Rationale: This response validates the patient’s experience without reinforcing the hallucination, and encourages safe discussion.
A client starts fluoxetine (an SSRI). Which side effect should the nurse teach them to watch for?
A. Muscle rigidity
B. Liver failure
C. Mood changes, suicidal ideation
D. Constipation
Answer: C. Mood changes, suicidal ideation
Rationale: SSRIs carry a black box warning for increased suicidal ideation, especially in adolescents and young adults.
A woman comes to her OB appointment with bruises on her thighs and says her partner “loves her deeply and just gets upset.” What stage of the abuse cycle is this?
A. Acute battering
B. Recovery
C. Honeymoon
D. Tension-building
Answer: C. Honeymoon
Rationale: The client is justifying the abuser’s behavior and highlighting kindness — classic signs of the honeymoon phase.
A nurse places a patient in seclusion without a provider order and without evidence of harm. What tort is being committed?
A. Assault
B. Negligence
C. Battery
D. False imprisonment
Answer: D. False imprisonment
Rationale: Confining someone without legal justification (like an order or imminent risk) is false imprisonment.
According to Maslow’s hierarchy, what is the nurse’s priority intervention for a newly admitted schizophrenic patient?
A. Provide support group materials
B. Explore the patient’s self-worth
C. Ensure nutrition and hydration
D. Discuss coping skills
Answer: C
Rationale: Physiological needs (food, water, shelter) must be met before addressing emotional or psychological concerns.
A 3-year-old has not spoken their first word, but intellectual disability has been ruled out. What disorder should be assessed next?
A. ADHD
B. Autism Spectrum Disorder (ASD)
C. Childhood-Onset Fluency Disorder
D. Social Communication Disorder
Answer: B
Rationale: Once intellectual disability is ruled out, delayed speech is a hallmark early sign of Autism Spectrum Disorder.
A newly admitted anorexia patient has a phosphate level of 1.5 mg/dL. What is the nurse’s concern?
A. Electrolyte rebound
B. Refeeding syndrome
C. Vomiting
D. Anemia
Answer: B
Rationale: Low phosphate is a critical indicator of refeeding syndrome, a potentially fatal complication during nutritional rehab in severely malnourished patients.
A patient with schizophrenia exhibits anhedonia and flat affect. These are examples of:
A. Positive symptoms
B. Cognitive symptoms
C. Negative symptoms
D. Mood symptoms
Answer: C. Negative symptoms
Rationale: Negative symptoms refer to the absence of typical behaviors (e.g., lack of pleasure, affect, motivation).
A patient says, “The government is spying on me through the light.” What is the best response?
A. “That’s not true.”
B. “Let’s turn off the light then.”
C. “You seem scared. Tell me more about what you’re experiencing.”
D. “You're just imagining that.”
Answer: C
Rationale: This therapeutic response acknowledges emotions and builds trust without challenging or reinforcing the delusion.
Which of the following should be avoided when taking an MAOI?
A. Grapefruit juice
B. Aged cheese and cured meats
C. Coffee
D. Leafy greens
Answer: B. Aged cheese and cured meats
Rationale: Foods high in tyramine can cause a hypertensive crisis in patients taking MAOIs.
A 3-year-old is brought to the ER with bruises and states they haven’t eaten or attended school in over a week. What type of abuse is this?
A. Emotional abuse
B. Acts of commission
C. Acts of omission
D. Physical abuse
Answer: C. Acts of omission
Rationale: Neglect is a form of abuse where caregivers fail to meet a child’s basic needs, classified as an act of omission.
A nurse is overheard saying to a patient, “If you don’t take your meds, I won’t take you to the bathroom.” The patient tells their family they're scared. What is this an example of?
A. Negligence
B. Battery
C. Assault
D. Defamation
Answer: C. Assault
Rationale: Verbal threats that cause fear are considered assault — no physical contact is needed.
A client with generalized anxiety disorder says, “I always feel like something bad will happen.” What technique should the nurse reinforce?
A. Thought-stopping
B. Encouraging avoidance
C. Group confrontation
D. Medication dependency
Answer: A. Thought-stopping
Rationale: CBT helps clients recognize and reframe irrational thinking, like catastrophizing, to regain control over anxiety.
Parents of a 7-year-old girl with terminal cancer are attending counseling and planning a fundraiser after her death. What stage of grief are they in?
A. Denial
B. Bargaining
C. Anticipatory
D. Acceptance
Answer: D
Rationale: They’ve accepted the prognosis and are channeling their emotions into advocacy and preparation for loss.
A client says, “I eat a huge amount of food and then make myself vomit.” What disorder does this describe?
A. Binge eating disorder
B. Anorexia nervosa, restricting type
C. Anorexia nervosa, binge/purge type
D. Avoidant food intake disorder
Answer: C
Rationale: Anorexia nervosa binge/purge type includes both restriction and purging behaviors, driven by intense fear of gaining weight.
A patient with GAD says, “I always feel like something terrible is going to happen.” What cognitive distortion is this?
A. Mind reading
B. All-or-nothing thinking
C. Personalization
D. Catastrophizing
Answer: D. Catastrophizing
Rationale: This is an exaggerated and irrational thought that the worst will always occur, common in GAD.
A client with borderline personality disorder says, “No one cares about me. I might as well disappear.” What should the nurse say?
A. “You know that’s not true.”
B. “Try thinking about something positive.”
C. “I can see you're feeling upset. Let’s talk about what’s bothering you.”
D. “Why do you always say that?”
Answer: C
Rationale: This response acknowledges emotion and invites open discussion while avoiding judgment or minimizing the patient’s experience.
What is a common side effect of the second-generation antipsychotic risperidone?
A. Bradycardia
B. Weight gain
C. Alopecia
D. Constipation
Answer: B. Weight gain
Rationale: Risperidone is associated with metabolic syndrome including weight gain, increased blood glucose, and lipid changes.
A nurse is caring for a client who confides that they were sexually assaulted. What is the nurse’s first legal obligation?
A. Contact their emergency contact
B. Notify law enforcement
C. Ensure privacy and obtain consent for a SANE exam
D. Call social services
Answer: C
Rationale: The nurse’s priority is the patient's safety, privacy, and trauma-informed care. Consent is required before exams or evidence collection.
A nurse explains the possible unpleasant side effects of a medication honestly. This demonstrates which ethical principle?
A. Justice
B. Fidelity
C. Beneficence
D. Veracity
Answer: D. Veracity
Rationale: Veracity means being truthful with patients. It helps maintain trust, even when the truth is difficult.
A patient says, “Voices are telling me to harm myself.” What is the nurse’s first action?
A. Ask what the voices are saying
B. Give a PRN antipsychotic
C. Assess for suicidal ideation and plan
D. Provide quiet time alone
Answer: C
Rationale: When hallucinations involve harm, the nurse must immediately assess safety and intent before proceeding with interventions.
A child struggles with forming sentences and finding the right words but understands directions well. Which disorder is likely?
A. Receptive Language Disorder
B. Expressive Language Disorder
C. Fluency Disorder
D. Social Communication Disorder
Answer: B
Rationale: Expressive Language Disorder is characterized by difficulty producing language, despite normal comprehension.
A patient who is significantly underweight insists they are “still fat.” This is an example of:
A. Delusion
B. Hallucination
C. Body image distortion
D. Projection
Answer: C
Rationale: Body image distortion is a hallmark symptom of eating disorders, especially anorexia, where perception of body weight is unrealistic.
Which statement correctly differentiates Conduct Disorder (CD) from Oppositional Defiant Disorder (ODD)?
A. ODD is more severe than CD
B. CD may lead to antisocial personality disorder in adulthood
C. CD does not involve aggression
D. ODD is only diagnosed in adults
Answer: B. CD may lead to antisocial personality disorder
Rationale: CD involves serious violations of rules/rights and is a known precursor to antisocial personality disorder.
A patient expresses suicidal thoughts. What is the nurse’s priority action?
A. Encourage them to write their thoughts in a journal
B. Leave the patient alone for privacy
C. Initiate a safety plan and assess for means/intent
D. Call their family immediately
Answer: C
Rationale: Suicide safety requires immediate assessment for plan and means. A written or verbal plan with supervision is essential.
A client starting venlafaxine (Effexor) should have which parameter closely monitored?
A. Liver enzymes
B. Blood pressure
C. Potassium
D. Creatinine
Answer: B. Blood pressure
Rationale: Effexor can increase blood pressure, especially at higher doses. Monitoring is essential.
A pediatric patient is malnourished and says they’ve been left alone for days. What form of abuse is this?
A. Physical
B. Emotional
C. Sexual
D. Neglect (Omission)
Answer: D. Neglect (Omission)
Rationale: When caregivers fail to provide adequate care, it’s an act of omission — a common form of child abuse.
A nurse initiates physical restraints during a violent outburst. What is the correct legal follow-up?
A. Wait up to 24 hours for a provider order
B. Use PRN orders for restraints
C. Obtain a provider’s verbal or written order ASAP
D. Apply restraints without documentation
Answer: C
Rationale: Restraints can be initiated in emergencies, but a verbal or written provider order must be obtained as soon as possible.
A patient is pacing, yelling, and throwing items in the room. What should the nurse do first?
A. Call security
B. Apply restraints
C. Attempt de-escalation and reduce stimuli
D. Tell the patient to stop
Answer: C
Rationale: The priority is to attempt nonviolent de-escalation techniques and reduce environmental stimuli. Restraints are last resort.
A child arrives at the ER with bruises on wrists and abdomen. The parent says they “fell off the swing.” What should the nurse suspect?
A. Behavioral outburst
B. Child neglect
C. Developmental delay
D. Physical abuse
Answer: D
Rationale: Bruising around non-bony areas like the abdomen and wrists is not typical of accidental injuries and should raise concern for abuse.
What distinguishes the binge/purge type of anorexia nervosa from the restricting type?
A. Caloric intake
B. Fear of weight gain
C. Use of compensatory behaviors (e.g., vomiting, laxatives)
D. BMI level
Answer: C
Rationale: The key difference is whether the patient uses purging methods to compensate for food intake; restricting type avoids these behaviors.
A client says, “I feel blue, I want to go to the zoo, and I’m stuck on giraffes like glue.” This is an example of:
A. Clang association
B. Pressured speech
C. Circumstantiality
D. Flight of ideas
Answer: A. Clang association
Rationale: Clang associations are linked by rhyming sounds rather than meaning, often seen in mania.
A client says, “I feel blue, I want to go to the zoo, I’m stuck on giraffes like glue.” What is the nurse’s best response?
A. “You’re not making sense.”
B. “You seem excited. What are you trying to tell me?”
C. “Let’s stay focused on what we’re discussing.”
D. “Why are you saying that?”
Answer: B
Rationale: This maintains therapeutic engagement while acknowledging the patient’s communication style without ridicule or dismissal.
A patient in alcohol withdrawal is experiencing tremors and hypertension. What is the nurse’s priority intervention?
A. Dim the lights and turn on music
B. Administer lorazepam as prescribed
C. Offer food and fluids
D. Start IV fluids
Answer: B. Administer lorazepam
Rationale: Benzodiazepines like lorazepam are first-line for preventing seizures and delirium in alcohol withdrawal.
You’re caring for a patient in the ED who reports sexual assault and has visible injuries. What is your first action?
A. Call the police
B. Begin the SANE exam
C. Ensure privacy and patient safety
D. Take photographs of injuries
Answer: C
Rationale: Patient safety, privacy, and consent come before evidence collection or law enforcement notification. Trauma-informed care is essential.
A nurse suspects an elderly woman is being abused by her son. What is the appropriate action?
A. Ask the patient if she wants to report it
B. Document and monitor over time
C. Report it immediately per mandatory reporting laws
D. Call the family to intervene
Answer: C
Rationale: Nurses are legally mandated reporters and must report suspected abuse of vulnerable populations immediately.
An elderly patient becomes confused and agitated in the hospital. What intervention best reduces the patient’s disorientation?
A. Play TV at a low volume
B. Provide frequent reorientation and a calm setting
C. Turn off all lights
D. Encourage long naps during the day
Answer: B
Rationale: Reorientation and a calm, familiar environment reduce delirium and agitation, especially in geriatric patients.
Which term describes a child’s habitual way of responding to the world, including mood and adaptability?
A. Cognition
B. Temperament
C. Impulsivity
D. Emotional regulation
Answer: B
Rationale: Temperament is an inborn trait influencing how children interact with their surroundings and handle challenges.
Which statement by a recovering anorexia patient indicates a need for further teaching?
A. “I need to eat even if I’m not hungry.”
B. “Eating regularly can help me feel more in control.”
C. “I should weigh myself daily to stay on track.”
D. “I should follow my meal plan even when anxious.”
Answer: C
Rationale: Daily weighing reinforces obsession with body image and should be avoided during recovery; weights should be monitored by staff.
What must be present for a schizophrenia diagnosis according to DSM-5?
A. One symptom for 6 months
B. Functional impairment + 1 positive symptom for 1 month
C. Two or more symptoms (e.g., delusions, hallucinations) for ≥1 month, with 6-month disturbance
D. No substance use history
Answer: C
Rationale: DSM-5 requires two or more core symptoms lasting ≥1 month, with 6 months of overall disturbance.
A patient with schizophrenia suddenly stops speaking mid-sentence and stares blankly. What is the nurse’s best response?
A. “You were talking about your mother. What were you going to say?”
B. “That’s okay, you’ll remember later.”
C. “Why did you stop talking?”
D. “Maybe you should go rest.”
Answer: A
Rationale: Gently helping the patient return to the topic supports communication and addresses possible thought blocking in a non-pressuring way.
What is the first-line treatment for bulimia nervosa? (Select all that apply)
A. SSRI (e.g., fluoxetine)
B. Tricyclic antidepressants
C. Cognitive Behavioral Therapy (CBT)
D. Bupropion
Answer: A & C
Rationale: Fluoxetine and CBT are first-line for bulimia. Bupropion is contraindicated due to seizure risk in patients with eating disorders.
A nurse is assessing a patient after a traumatic event. The patient is confused, disoriented, and reports feeling helpless. According to the phases of crisis, which phase is the patient likely in?
A. Phase 1
B. Phase 2
C. Phase 3
D. Phase 4
Answer: D. Phase 4
Rationale: In Phase 4, the person experiences severe anxiety and is unable to cope, resulting in disorganized behavior and potential breakdown. This is the most critical stage and requires immediate intervention.
Which of the following is an exception to confidentiality under HIPAA?
A. A patient refuses medication
B. A patient threatens to steal
C. A patient discloses self-harm intent
D. A patient discusses a past assault
Answer: C. Self-harm intent
Rationale: If a patient expresses current intent to harm themselves, it must be reported for safety. This overrides standard confidentiality.
During a group session, a patient is interrupting and tapping others on the shoulder. What is the nurse’s best intervention?
A. Give them a fidget toy
B. Ignore the behavior
C. Privately remove them and explore their feelings
D. Call security
Answer: C
Rationale: The nurse should calmly remove the patient from the group and explore underlying emotions in a private, therapeutic setting.
A 10-year-old becomes extremely distressed when away from their parent, even during school. What condition is this?
A. Reactive Attachment Disorder
B. Separation Anxiety Disorder
C. Generalized Anxiety Disorder
D. Social Phobia
Answer: B
Rationale: SAD is excessive fear or anxiety concerning separation from attachment figures, often beyond the developmental norm.
Which of the following are first-line treatments for bulimia nervosa? (Select all that apply)
A. Fluoxetine (SSRI)
B. Cognitive Behavioral Therapy (CBT)
C. Bupropion
D. Antipsychotics
E. Family-based therapy
Answer: A & B
Rationale: Fluoxetine and CBT are evidence-based first-line treatments. Bupropion is contraindicated due to seizure risk in eating disorders.