Question 1

The parents of a 9-year-old child diagnosed with oppositional defiant disorder (ODD) are discussing treatment options with the nurse. Which action would the nurse expect to have the most positive impact on managing the child's behavior?

Accepted Answer

Answer reason: Specific, immediate positive reinforcement increases the frequency of compliant and prosocial actions and supports a more cooperative parent-child interaction pattern. Stimulant medication is not a primary treatment for ODD unless comorbid ADHD is present and targeted, so it is less directly impactful on oppositional behavior. Group therapy can be helpful but is not as reliably effective as parent-focused behavioral reinforcement and may risk negative peer influence. Assigning multiple chores without a clear, immediate reinforcement plan can increase power struggles and noncompliance rather than improving behavior.

Question 2

The 10-year-old with precocious puberty is being teased by classmates. Which approach should the school nurse use to assist the child in communicating with peers?

Accepted Answer

Answer reason: Children benefit most from concrete skill-building that practices assertive, age-appropriate responses in a safe setting. Role-playing allows the nurse to model language, rehearse tone/body posture, and give immediate feedback, which directly improves peer-communication and coping. Simply ignoring teasing is unreliable and can reinforce peer targeting, leaving the child without tools to respond. Referring the child to tell an adult may be necessary for escalation or bullying, but it does not primarily develop the child’s own communication skills with peers.

Question 3

The 12-year-old being treated for GH deficiency is angry and refusing to go to school because everyone the same age is taller. The child is belligerent toward the mother, who gives the daily GH injection. Which initial intervention should be attempted by the nurse?

Accepted Answer

Answer reason: Supporting adolescent autonomy and sense of control is a first-line behavioral strategy to improve adherence and reduce conflict with caregivers. Allowing the child to learn and gradually take responsibility for injections directly targets the trigger for belligerence toward the mother and can enhance self-efficacy and coping with stature-related distress. Counseling can be helpful if problems persist, but it is not the most immediate, least restrictive initial nursing intervention for this situation. Home schooling or an IEP does not address the core psychosocial issue and could reinforce avoidance rather than building adaptive coping.

Question 4

When providing information to the parents of a child who’s receiving growth hormone replacement therapy for hypopituitarism, the nurse should include which intervention?

Accepted Answer

Answer reason: Family teaching should emphasize age-appropriate expectations and activities to support normal psychosocial development while physical growth lags. It is incorrect to suggest delaying normal life milestones (such as school progression) based on size, because cognitive and social readiness track age more than height. Administration teaching should also reflect that growth hormone is typically given by subcutaneous injection rather than requiring venipuncture, making that option unsafe and impractical.

Question 5

The nurse is developing the plan of care for the 4-year-old who is to have eye surgery. Which intervention should the nurse most definitely include in the plan to prepare the child for surgery?

Accepted Answer

Answer reason: Preschool-aged children learn and cope best through therapeutic play and concrete, hands-on rehearsal of what will happen. Allowing the child to play with a doll wearing an eye patch helps the child express fears, gain a sense of control, and become familiar with a likely postoperative change in appearance. Relying on parents alone to explain can lead to inaccurate or developmentally inappropriate information and misses the nurse’s role in structured preop preparation. Long videos and meeting postoperative patients are less targeted, may overwhelm attention span, and could increase anxiety by exposing the child to distressing appearances or stories.

Question 6

Staff members have expressed fear of the client who has a history of violent behavior. Which response made by the lead nurse would be most beneficial in addressing the staff's expressed concerns?

Accepted Answer

Answer reason:  Effective violence prevention relies on staff maintaining a calm, nonthreatening stance while staying vigilant for early escalation cues. This response gives the team a concrete, immediately actionable behavioral approach that improves safety and reduces the chance of provoking the client. It also acknowledges staff discomfort while reinforcing a therapeutic, controlled milieu. By contrast, attributing safety to medication or claiming staff can handle any crisis may minimize risk and discourage appropriate precautionary planning.

Question 7

The nurse manager on a psychiatric unit is planning an in-service that focuses on staff management of potential suicidal ideation among clients. Which activity has the greatest likelihood for improving staff effectiveness?

Accepted Answer

Answer reason: Skill acquisition in suicide risk assessment depends on practicing therapeutic communication and structured questioning in realistic scenarios with feedback. Role-play builds staff competence and confidence to ask direct questions about suicidal thoughts, intent, plan, and means while maintaining a calm, nonjudgmental stance. It also allows correction of unsafe habits (e.g., avoiding the topic, minimizing cues) and reinforces consistent escalation actions when risk is identified. In contrast, policies or expert discussions are more passive learning methods and are less likely to translate into reliable bedside performance during high-stakes encounters.

Question 8

The child who was physically abused has begun pulling out hair. The behavior appears to be a result of the child’s repressed anger. In order to facilitate the child’s recovery, the nurse encourages the parent to initially implement which response?

Accepted Answer

Answer reason: Behavioral management of self-injurious or maladaptive coping in children starts with immediate harm reduction and replacement with an adaptive, competing response. Providing distraction and an alternative pleasurable activity can interrupt the behavior chain, reduce reinforcement, and protect the child’s scalp/hair while underlying trauma and anger are addressed in therapy. Simply accepting or ignoring the behavior does not reduce injury risk and may allow it to become more entrenched. Confrontational limit-setting framed as “must stop” can increase shame/anxiety and worsen coping, especially in an abused child who needs safety and supportive redirection.

Question 9

The 10-year-old who was sexually abused by a family member experiences flashbacks of a disagreement with that adult and the resulting sexual assault. Which suggestion should the nurse make to the parents in order to help minimize this reaction?

Accepted Answer

Answer reason: Trauma-related flashbacks are often triggered by cues that resemble the original event, so reducing predictable triggers in the environment is a key behavioral strategy. Teaching caregivers to identify escalating conflict and de-escalate early helps prevent arguments that can serve as reminders and activate re-experiencing symptoms. This is a practical, family-level intervention that increases emotional safety without placing responsibility on the child to manage adult conflict. Medication is not a first-line response to situational triggers, and repeatedly focusing on “bad memories” without structured trauma-focused therapy can worsen distress or dysregulation.

Question 10

A nurse working at an eating disorder treatment center is caring for a client with anorexia nervosa who has recently arrived at the facility. Which intervention should the nurse apply following the client's meals?

Accepted Answer

Answer reason:  Following meals, early treatment of anorexia nervosa commonly uses structured behavioral limits to reduce compensatory behaviors and promote weight restoration. Limiting bathroom access shortly after eating helps prevent self-induced vomiting and other purging behaviors during the highest-risk window. Post-meal exercise (including walking) increases calorie expenditure and can reinforce compulsive activity, which undermines nutritional rehabilitation. Having the client lie down for prolonged periods is not a standard safety-focused post-meal intervention and does not directly address the key risk of immediate purging.

Question 11

A nurse is caring for a client with bipolar I disorder who is exhibiting pressured speech, flight of ideas, and minimal sleep for 4 consecutive nights. Which of the following interventions should the nurse prioritize?

Accepted Answer

Answer reason: Acute mania is marked by heightened arousal and distractibility, so immediate nursing priority is to decrease stimulation to reduce escalation and support sleep/rest. Limiting noise, crowds, and intense interactions helps lower anxiety and agitation and can reduce risk of impulsive or aggressive behavior. Goal-setting and group discussion require sustained attention and can increase stimulation or frustration, worsening pressured speech and flight of ideas. High-calorie finger foods are appropriate for preventing weight loss in mania, but safety and stabilization of arousal take precedence when the client is severely activated and sleep-deprived.

Question 12

A female patient on the unit has a diagnosis of bipolar disorder and has exhibited odd behaviors the last two days. She is very active pacing the hallways, has drawn over 50 detailed images on paper, and asks multiple times a day for more craft supplies. She is very talkative but appears happy and excited. How can the nurse best support the patient at this time?

Accepted Answer

Answer reason: Portable, calorie-dense foods that can be eaten “on the go” help meet nutritional needs despite nonstop pacing and talkativeness. Protein-rich snacks also support sustained energy and reduce catabolism when the patient is too stimulated to sit for meals. Sedating solely to force sleep is not the first-line nursing support absent severe agitation or danger, and punitive limit-setting (denying supplies) or unnecessary security escalation can worsen agitation and damage the therapeutic relationship.

Question 13

A patient with obsessive compulsive disorder is admitted to the psychiatric unit. She washes her hands between every bite of food during mealtimes and at least every hour when she is awake. On the fourth hospital day, the patient states she is feeling better during group therapy. The therapist relays this information to the nurse, who knows the most appropriate intervention is?

Accepted Answer

Answer reason: Collaborating to limit the time spent in rituals is a practical behavioral strategy that preserves rapport and builds the patient’s sense of control and mastery. Praising the compulsion reinforces the maladaptive behavior, while ignoring it is nontherapeutic and can increase distress and worsen compulsive urges. Discharge readiness is not determined by the mere presence of symptoms but by safety, functioning, and a realistic plan for ongoing treatment and symptom management.

Question 14

A nurse is caring for a client with Alzheimer’s disease who refuses to take their medication. Which action should the nurse take first?

Accepted Answer

Answer reason:  Clients with Alzheimer’s disease may refuse medications due to confusion, fear, or reduced ability to process explanations, so the first approach should be nonconfrontational and supportive while preserving safety and dignity. Backing off briefly and re-approaching later can reduce agitation and increase cooperation without escalating distress. Forcing medication is unsafe and violates client rights, and detailed explanations often overwhelm or do not improve adherence in moderate-to-severe cognitive impairment. Notifying the provider is appropriate only after reasonable nursing strategies to improve acceptance have been attempted and refusal persists or poses immediate risk.

Question 15

A nurse on a psychiatric unit observes a client in the corner of the room moving his lips as if he were talking to himself. What is the most appropriate intervention?

Accepted Answer

Answer reason: The behavior suggests the client may be responding to internal stimuli (e.g., hallucinations). The most appropriate intervention is to gently redirect the client to reality-based activities, which can reduce focus on internal stimuli. Questioning, ignoring, or criticizing the behavior does not provide therapeutic support and may increase distress.

Question 16

A client who has been discharged is waiting in the dayroom for transportation and suddenly begins throwing papers and stomping. What is the nurse’s initial action?

Accepted Answer

Answer reason: The client’s behavior suggests acute frustration likely related to waiting for transportation. The priority is to identify and address the immediate trigger of the behavior. Resolving the underlying issue can quickly de-escalate agitation more effectively than distraction or theoretical assessment.

Question 17

The nurse employs play therapy with a small group of 6-year old clients. The primary expected outcome is for the clients to do which of the following?

Accepted Answer

Answer reason: A key therapeutic goal is helping the child externalize and work through feelings safely, reducing anxiety and maladaptive behaviors. This option directly reflects the primary outcome of play therapy: expression and processing of emotions in a healthier way. Options focused on verbal self-disclosure or giving/receiving feedback are more typical goals for older children/adolescents in talk/group therapies. Problem-solving can improve over time, but it is secondary to emotional expression and mastery in early school-age play therapy.

Question 18

When planning the care of a 6-year-child with oppositional defiant disorder, the psychiatric nurse should include which of the following?

Accepted Answer

Answer reason: A structured plan using rewards for desired behaviors and predictable consequences for rule-breaking directly targets defiance, arguing, and noncompliance. This approach is evidence-based and practical for a 6-year-old whose insight and abstract cognitive skills are still developing. In contrast, reminiscence is geared toward older adults, and cognitive reframing is typically more effective when a client can reliably identify and challenge automatic thoughts at a more advanced developmental level.

Question 19

The nurse is evaluating the progress of an adolescent bulimic client who is being treated as an outpatient. Which behavior would indicate that the client is making positive progress? The client?

Accepted Answer

Answer reason: Bringing a completed food-and-emotion diary demonstrates engagement with therapy, honesty in reporting, and use of adaptive coping skills. In contrast, preferring to be alone after meals can signal ongoing purging risk and avoidance of post-meal supervision. Focusing heavily on nutritional details may reflect continued preoccupation/rigidity rather than recovery, and eating separately from family often maintains secrecy and disordered routines.

Question 20

The client diagnosed with bipolar I disorder is in an inpatient locked unit. The client begins to yell loudly at another client who is also sitting in the dayroom. In order to provide a safe environment for both clients, the nurse should take which action?

Accepted Answer

Answer reason: This action directly addresses rising agitation, helps reduce stimulus and threat perception, and protects the other client by interrupting the confrontation before it becomes physical. Distracting with TV is unreliable and can increase stimulation, while PRN medication is considered if nonpharmacologic measures fail or the patient becomes an imminent danger. Seclusion is a last-resort restrictive measure reserved for immediate risk to safety when less restrictive interventions are ineffective.

Question 21

The parent of a child with attention-deficit hyperactivity disorder (ADHD) tells the nurse that the child does not follow instructions well. Which strategy should the nurse recommend to the parent?

Accepted Answer

Answer reason: Having the child repeat directions provides immediate feedback that the instruction was heard and understood, and it reinforces encoding before the task begins. This approach is a practical, nonpunitive behavioral technique that improves task initiation and follow-through in the moment. By contrast, punishment-based strategies like time-out are better reserved for clearly defined rule-breaking behaviors, not primarily for inconsistent instruction-following tied to distractibility.

Question 22

The nurse is formulating a plan of care for a client with a cognitive disorder. Which activity is most appropriate for the client with confusion and a short attention span?

Accepted Answer

Answer reason: Reality-orientation uses frequent cues (person, place, time, situation) and brief, concrete interactions that match a short attention span while supporting cognitive function. In contrast, assertiveness training and community goal setting require sustained concentration, abstract thinking, and complex social processing, which are often impaired in cognitive disorders. A field trip adds environmental change and stimulation that can worsen disorientation and increase safety risks.

Question 23

The family of the client with an acute myocardial infarction (MI) continues to bring in chewing tobacco for the client, despite knowing that chewing tobacco is prohibited. What action does the nurse take?

Accepted Answer

Answer reason: Nicotine is a potent sympathomimetic that increases heart rate, blood pressure, and myocardial oxygen demand, which is unsafe after an acute MI and contradicts the facility’s prohibition. The nurse’s priority is a therapeutic, patient-centered intervention that addresses the underlying dependence and promotes behavior change while maintaining rapport. Providing cessation support (education, coping strategies, and referral for cessation resources/therapy per orders) directly reduces ongoing cardiovascular risk and supports recovery. In contrast, surveillance or searching visitors’ belongings is punitive, can violate client/family rights and facility policy, and does not address the root cause of continued tobacco use.

Question 24

The health care provider prescribes risperidone(Risperdal) for a client with Alzheimer’s disease. The nurse anticipates administering this medication to help decrease which of the following behaviors?

Accepted Answer

Answer reason: Risperidone can decrease aggression, agitation, and hostility by modulating dopamine and serotonin pathways. Sleep disturbance and depression are not primary target symptoms for risperidone and are better addressed with nonpharmacologic strategies or antidepressants when indicated. Confusion and withdrawal are core dementia features and can worsen with sedating or adverse CNS effects, so they are not the intended behaviors to treat with this medication.

Question 25

The psychiatric nurse is providing care for a patient who has just calmed down after exhibiting inappropriate behaviors related to Bipolar disorder. The nurse knows that which of the following is the best way to help prevent another unseemly episode?

Accepted Answer

Answer reason: After a patient regains control, the priority for preventing recurrence is to build insight and teach strategies to recognize early warning signs and triggers. Exploring precipitating events, feelings, and situational cues supports relapse prevention planning and helps the patient practice alternative coping responses before escalation. Focusing on consequences can feel punitive and may increase defensiveness without strengthening self-regulation skills. Safety is essential during agitation, but once the patient is calm it is not the most direct prevention strategy compared with identifying and managing triggers.

Question 26

A 6-year-old who received chemotherapy and had anorexia is now cheerfully eating peanut butter, yogurt, and applesauce. When the mother arrives, the child refuses to eat and throws the dish on the floor. What is your best response to this behavior?

Accepted Answer

Answer reason: Young children often express fear, anger, or loss of control through regressive or acting-out behaviors, especially during stressful illness and treatment. The abrupt change when the parent arrives suggests the child is displacing emotions or seeking control/attention rather than suddenly losing appetite. Normalizing the reaction for the parent supports coping and reduces blame, which helps preserve the therapeutic relationship and facilitates calmer limit-setting afterward. Options that pressure eating or remove the parent can escalate distress, reinforce avoidance, and miss the underlying emotional need driving the behavior.

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Behavioral Interventions Practice Test 3

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