51. A patient says, “I hear voices telling me to hurt myself.” What is the nurse’s priority action?
A. Ask the patient to describe the voices
B. Provide a quiet environment
C. Place the patient under one-to-one observation
D. Administer PRN medication
Answer: C. Place the patient under one-to-one observation
👉 Explanation: Safety is the priority when a patient has command hallucinations directing self-harm.
52. Which drug is considered the first-line treatment for depression?
A. Tricyclic antidepressants
B. SSRIs
C. MAO inhibitors
D. Benzodiazepines
Answer: B. SSRIs
👉 Explanation: SSRIs are commonly prescribed due to fewer side effects and safety in overdose compared to other antidepressants.
53. The nurse observes a patient with schizophrenia holding a rigid posture and not responding to external stimuli. This is:
A. Catatonic stupor
B. Derealization
C. Neologism
D. Flight of ideas
Answer: A. Catatonic stupor
👉 Explanation: Catatonic stupor involves motor immobility and unresponsiveness.
54. Which medication is commonly prescribed for panic disorder?
A. Haloperidol
B. Alprazolam
C. Lithium
D. Risperidone
Answer: B. Alprazolam
👉 Explanation: Benzodiazepines like alprazolam are used short-term for panic attacks.
55. A patient repeatedly checks the door lock 20 times before leaving home. This behavior is:
A. Obsession
B. Compulsion
C. Delusion
D. Hallucination
Answer: B. Compulsion
👉 Explanation: Compulsions are repetitive behaviors performed to reduce anxiety caused by obsessions.
56. Which symptom is considered positive in schizophrenia?
A. Flat affect
B. Social withdrawal
C. Hallucinations
D. Poor hygiene
Answer: C. Hallucinations
👉 Explanation: Positive symptoms add abnormal experiences (hallucinations, delusions), while negative symptoms involve loss of function.
57. Which nursing action is most therapeutic for a manic patient?
A. Encourage group activities
B. Provide finger foods and fluids
C. Allow patient to stay awake all night
D. Engage in detailed conversations
Answer: B. Provide finger foods and fluids
👉 Explanation: Manic patients are hyperactive and may not sit for meals, so finger foods maintain nutrition.
58. A patient on haloperidol develops muscle rigidity, fever, and altered mental status. The nurse suspects:
A. Tardive dyskinesia
B. Neuroleptic malignant syndrome (NMS)
C. Akathisia
D. Serotonin syndrome
Answer: B. Neuroleptic malignant syndrome (NMS)
👉 Explanation: NMS is a life-threatening reaction to antipsychotics requiring immediate medical attention.
59. Which therapy is most effective for patients with phobias?
A. Electroconvulsive therapy
B. Systematic desensitization
C. Free association
D. Aversion therapy
Answer: B. Systematic desensitization
👉 Explanation: Gradual exposure with relaxation helps reduce phobic anxiety.
60. A nurse caring for a patient with dementia should:
A. Provide multiple choices to promote independence
B. Give short, simple instructions
C. Repeatedly quiz the patient about the past
D. Ignore memory problems
Answer: B. Give short, simple instructions
👉 Explanation: Simple instructions prevent frustration and improve compliance.
61. Which neurotransmitter imbalance is linked to Parkinson’s disease and schizophrenia?
A. Dopamine
B. Serotonin
C. GABA
D. Acetylcholine
Answer: A. Dopamine
👉 Explanation: Dopamine excess is linked to schizophrenia, while deficiency causes Parkinson’s.
62. A patient on lithium has diarrhea, tremors, and confusion. The nurse suspects:
A. Mild side effects
B. Lithium toxicity
C. Withdrawal
D. Depression relapse
Answer: B. Lithium toxicity
👉 Explanation: Toxicity causes GI upset, tremors, confusion, and requires urgent treatment.
63. Which drug class is most effective for obsessive-compulsive disorder (OCD)?
A. Antipsychotics
B. SSRIs
C. Benzodiazepines
D. MAO inhibitors
Answer: B. SSRIs
👉 Explanation: SSRIs are the first-line pharmacological treatment for OCD.
64. A patient with schizophrenia says, “The sun talks to me.” This is an example of:
A. Delusion of grandeur
B. Delusion of reference
C. Hallucination
D. Compulsion
Answer: B. Delusion of reference
👉 Explanation: Belief that external events (sun) are related personally to them is delusion of reference.
65. Which personality disorder is associated with dramatic, attention-seeking behavior?
A. Antisocial
B. Borderline
C. Histrionic
D. Schizoid
Answer: C. Histrionic
👉 Explanation: Histrionic personality disorder involves excessive emotionality and attention-seeking.
66. Which nursing action is best for a patient with acute mania?
A. Place the patient in group therapy
B. Provide a low-stimulation environment
C. Encourage detailed conversations
D. Promote long discussions with staff
Answer: B. Provide a low-stimulation environment
👉 Explanation: Low stimulation reduces agitation and helps control hyperactivity.
67. A patient on SSRIs develops agitation, confusion, sweating, and tremors. The nurse suspects:
A. Withdrawal syndrome
B. Neuroleptic malignant syndrome
C. Serotonin syndrome
D. Lithium toxicity
Answer: C. Serotonin syndrome
👉 Explanation: Excess serotonin causes this life-threatening condition.
68. Which antipsychotic has the lowest risk of extrapyramidal side effects (EPS)?
A. Haloperidol
B. Chlorpromazine
C. Clozapine
D. Fluphenazine
Answer: C. Clozapine
👉 Explanation: Clozapine is effective with low EPS risk but requires blood monitoring for agranulocytosis.
69. Which technique is most therapeutic when a patient expresses suicidal thoughts?
A. Change the subject
B. Explore their feelings and intent
C. Reassure that everything will be fine
D. Avoid discussing suicide
Answer: B. Explore their feelings and intent
👉 Explanation: Direct, empathetic exploration of suicidal thoughts promotes safety.
70. Which defense mechanism is used when a patient says, “I don’t drink” despite obvious alcohol abuse?
A. Rationalization
B. Denial
C. Projection
D. Displacement
Answer: B. Denial
👉 Explanation: Denial is refusal to acknowledge reality.
71. A nurse finds a depressed patient isolating in their room. The best action is:
A. Ignore them to promote independence
B. Encourage them to attend a group activity
C. Leave them until they come out
D. Confront them about their behavior
Answer: B. Encourage them to attend a group activity
👉 Explanation: Group participation helps reduce isolation and promotes recovery.
72. Which drug is used for acute alcohol withdrawal?
A. Disulfiram
B. Acamprosate
C. Diazepam
D. Lithium
Answer: C. Diazepam
👉 Explanation: Benzodiazepines reduce withdrawal symptoms and prevent seizures.
73. A patient says, “I am Jesus Christ.” This is an example of:
A. Nihilistic delusion
B. Grandiose delusion
C. Delusion of reference
D. Hallucination
Answer: B. Grandiose delusion
👉 Explanation: Belief of having extraordinary identity is grandiose delusion.
74. Which intervention is most appropriate for a patient experiencing a panic attack?
A. Ask detailed questions
B. Provide a calm, quiet environment
C. Encourage group activity
D. Force the patient to talk about fears
Answer: B. Provide a calm, quiet environment
👉 Explanation: Reducing stimulation helps panic subside.
75. Which lab test is required regularly for patients on clozapine?
A. Liver function test
B. Complete blood count (CBC)
C. Renal function test
D. Thyroid function test
Answer: B. Complete blood count (CBC)
👉 Explanation: Clozapine can cause agranulocytosis, requiring frequent CBC monitoring.
76. Which communication is therapeutic for a patient with schizophrenia experiencing delusions?
A. “That’s not real, stop talking about it.”
B. “I understand you believe this, but I don’t see it that way.”
C. “You’re imagining things.”
D. “Yes, you are right.”
Answer: B. “I understand you believe this, but I don’t see it that way.”
👉 Explanation: Acknowledges patient’s feelings without reinforcing delusions.
77. Which drug is used for long-term management of generalized anxiety disorder (GAD)?
A. Lorazepam
B. Buspirone
C. Diazepam
D. Alprazolam
Answer: B. Buspirone
👉 Explanation: Buspirone is non-addictive and used long-term for GAD.
78. Which patient behavior indicates paranoia?
A. Believing food is poisoned
B. Repeating words
C. Staring blankly
D. Making up new words
Answer: A. Believing food is poisoned
👉 Explanation: False belief of being harmed is a sign of paranoia.
79. Which drug is the gold standard for bipolar disorder maintenance therapy?
A. Lithium
B. Valproic acid
C. Haloperidol
D. Sertraline
Answer: A. Lithium
👉 Explanation: Lithium remains the gold standard for long-term management of bipolar disorder.
80. Which antipsychotic has the highest risk of tardive dyskinesia?
A. Risperidone
B. Haloperidol
C. Olanzapine
D. Clozapine
Answer: B. Haloperidol
👉 Explanation: First-generation antipsychotics, especially haloperidol, increase tardive dyskinesia risk.
81. Which neurotransmitter is primarily decreased in depression?
A. Dopamine
B. Norepinephrine
C. Acetylcholine
D. GABA
Answer: B. Norepinephrine
👉 Explanation: Both norepinephrine and serotonin deficiencies are strongly linked to depression.
82. A patient says, “I feel hopeless and worthless.” Which is the nurse’s best response?
A. “Don’t worry, things will get better.”
B. “Tell me more about how you are feeling.”
C. “You shouldn’t think like that.”
D. “Ignore those thoughts.”
Answer: B. “Tell me more about how you are feeling.”
👉 Explanation: Therapeutic communication encourages expression of feelings rather than giving false reassurance.
83. Which medication is used to prevent relapse in alcohol dependence?
A. Methadone
B. Disulfiram
C. Clozapine
D. Diazepam
Answer: B. Disulfiram
👉 Explanation: Disulfiram causes unpleasant reactions when alcohol is consumed, helping in relapse prevention.
84. Which is the priority nursing diagnosis for a patient with anorexia nervosa?
A. Disturbed body image
B. Imbalanced nutrition: less than body requirements
C. Anxiety
D. Ineffective coping
Answer: B. Imbalanced nutrition: less than body requirements
👉 Explanation: Malnutrition and weight loss pose the most immediate life-threatening risk.
85. A nurse caring for a patient with dementia should avoid:
A. Using simple communication
B. Providing frequent orientation cues
C. Offering familiar routines
D. Giving multiple complex choices
Answer: D. Giving multiple complex choices
👉 Explanation: Too many options increase confusion and frustration in dementia patients.
86. Which finding is most concerning in a patient on MAO inhibitors?
A. Drowsiness
B. Headache
C. Orthostatic hypotension
D. Hypertensive crisis after eating cheese
Answer: D. Hypertensive crisis after eating cheese
👉 Explanation: MAOIs interact with tyramine-rich foods, leading to life-threatening hypertension.
87. A patient with schizophrenia says, “The sky is red because I’m powerful.” This is:
A. Neologism
B. Delusion of grandeur
C. Hallucination
D. Tangentiality
Answer: B. Delusion of grandeur
👉 Explanation: Belief of having great power or influence is grandiose delusion.
88. Which statement indicates a patient understands lithium therapy?
A. “I can reduce my salt intake to stay healthy.”
B. “I will avoid dehydration and drink adequate fluids.”
C. “I can stop the drug once I feel better.”
D. “I don’t need blood tests regularly.”
Answer: B. “I will avoid dehydration and drink adequate fluids.”
👉 Explanation: Dehydration and low sodium can increase lithium toxicity risk.
89. Which drug is most effective in treating acute agitation in schizophrenia?
A. Clozapine
B. Haloperidol
C. Fluoxetine
D. Lithium
Answer: B. Haloperidol
👉 Explanation: Haloperidol is a first-generation antipsychotic effective in controlling acute agitation.
90. Which therapy is most effective for post-traumatic stress disorder (PTSD)?
A. Electroconvulsive therapy
B. Cognitive-behavioral therapy (CBT)
C. Psychoanalysis
D. Aversion therapy
Answer: B. Cognitive-behavioral therapy (CBT)
👉 Explanation: CBT helps patients reframe traumatic thoughts and reduce anxiety.
91. Which medication is contraindicated with benzodiazepines due to risk of respiratory depression?
A. SSRIs
B. Alcohol
C. Antacids
D. Vitamins
Answer: B. Alcohol
👉 Explanation: Alcohol and benzodiazepines both depress the CNS, increasing risk of fatal overdose.
92. A patient is pacing, restless, and cannot sit still after starting haloperidol. This is:
A. Akathisia
B. Dystonia
C. Tardive dyskinesia
D. Parkinsonism
Answer: A. Akathisia
👉 Explanation: Akathisia is restlessness and inability to stay still, a common EPS.
93. Which of the following is a negative symptom of schizophrenia?
A. Delusions
B. Hallucinations
C. Flat affect
D. Disorganized speech
Answer: C. Flat affect
👉 Explanation: Negative symptoms include flat affect, alogia, and social withdrawal.
94. Which drug is considered the gold standard mood stabilizer in bipolar disorder?
A. Lithium
B. Carbamazepine
C. Valproic acid
D. Lamotrigine
Answer: A. Lithium
👉 Explanation: Lithium remains the primary long-term treatment for bipolar disorder.
95. A patient on SSRIs reports sexual dysfunction. Which alternative drug may be prescribed?
A. Haloperidol
B. Bupropion
C. Diazepam
D. Clozapine
Answer: B. Bupropion
👉 Explanation: Bupropion is an antidepressant with minimal sexual side effects.
96. A nurse suspects a patient is malingering. This means the patient:
A. Has unconscious physical symptoms due to stress
B. Intentionally fakes illness for secondary gain
C. Believes false things about reality
D. Has a split personality
Answer: B. Intentionally fakes illness for secondary gain
👉 Explanation: Malingering is deliberate falsification of symptoms for benefits.
97. A patient with borderline personality disorder is at high risk for:
A. Obsessive rituals
B. Violent behavior toward others
C. Self-harm and suicide
D. Delusions of reference
Answer: C. Self-harm and suicide
👉 Explanation: Borderline personality disorder is strongly associated with impulsivity and self-harming behaviors.
98. Which drug is an atypical antipsychotic?
A. Chlorpromazine
B. Haloperidol
C. Olanzapine
D. Fluphenazine
Answer: C. Olanzapine
👉 Explanation: Olanzapine is a second-generation antipsychotic with fewer EPS risks.
99. The nurse knows ECT (electroconvulsive therapy) is primarily used in:
A. Schizophrenia
B. Severe depression unresponsive to medications
C. Dementia
D. Anxiety
Answer: B. Severe depression unresponsive to medications
👉 Explanation: ECT is reserved for treatment-resistant depression and sometimes acute mania.
100. Which symptom suggests serotonin syndrome?
A. Slow reflexes, constipation, dry mouth
B. Muscle rigidity, high fever, confusion
C. Sweating, tremors, hyperreflexia
D. Weight gain, increased appetite, sedation
Answer: C. Sweating, tremors, hyperreflexia
👉 Explanation: Serotonin syndrome is marked by neuromuscular hyperactivity, autonomic instability, and altered mental status.