A man taking trazodone at night for depression and insomnia calls the ward to say he has had a painful erection for three hours. The nurse should advise him to:

Go to the emergency department at once

Take his next dose and wait until morning

Stop the drug and see the clinic next week

A psychiatrist proposes psychosurgery for a man with severe, long-standing obsessive-compulsive disorder. Under the Mental Healthcare Act 2017, the operation needs:

The person's informed consent and the Board's approval

The written opinion of two psychiatrists

The consent of the nominated representative alone

Approval of the hospital's medical superintendent

A patient started on fluoxetine a week ago says the drug is not working and he wants to stop. The nurse's best response is:

Explain that mood usually lifts only after a few weeks

Agree that he can stop it because a week is long enough

Tell him to take it only on days he feels low

Advise him to double the dose to make it work faster

Therapeutic communication, psychopharmacology and mental health law

30 Staff nurse recruitment practice questions on Therapeutic communication, psychopharmacology and mental health law, part of Mental Health Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A man taking trazodone at night for depression and insomnia calls the ward to say he has had a painful erection for three hours. The nurse should advise him to:
1. AApply heat and rest at home
2. BTake his next dose and wait until morning
3. CGo to the emergency department at once
4. DStop the drug and see the clinic next week
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Answer: C · Go to the emergency department at once
Priapism is a rare but recognised adverse effect of trazodone, caused by its alpha-1 adrenergic blockade. An erection lasting more than four hours can permanently damage the erectile tissue, so it is a urological emergency. The patient needs urgent assessment and aspiration or drug treatment. Men starting trazodone are warned to report this effect at once.
- A: Home measures delay treatment of an emergency.
- B: Another dose may worsen the priapism and waiting risks permanent damage.
- D: A week's delay is far too long; treatment is needed within hours.
Question 2 · Medium
A psychiatrist proposes psychosurgery for a man with severe, long-standing obsessive-compulsive disorder. Under the Mental Healthcare Act 2017, the operation needs:
1. AThe written opinion of two psychiatrists
2. BThe consent of the nominated representative alone
3. CThe person's informed consent and the Board's approval
4. DApproval of the hospital's medical superintendent
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Answer: C · The person's informed consent and the Board's approval
MHCA 2017 restricts psychosurgery very tightly. It needs both the informed consent of the person himself and approval from the concerned Mental Health Review Board. A nominated representative cannot consent on his behalf. This protects people from an irreversible procedure they have not chosen.
- A: Two psychiatrists' opinions are not enough without the person's consent and the Board's approval.
- B: A nominated representative cannot give consent for psychosurgery.
- D: A hospital official has no power to approve psychosurgery under the Act.
Question 3 · Easy
Reviewing progress towards goals and helping the patient handle feelings about separation are main tasks of which phase of the nurse-patient relationship?
1. AWorking phase
2. BOrientation phase
3. CTermination phase
4. DPre-interaction phase
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Answer: C · Termination phase
In the termination phase the nurse and patient review what has been achieved, summarise progress and plan for life after discharge. Endings may stir up sadness, anger or a return of old symptoms, so these feelings are discussed openly. The date of termination is mentioned from the start so the ending is not a shock. A planned ending is itself a learning experience for the patient.
- A: The working phase explores problems and practises new coping behaviour.
- B: The orientation phase builds trust and agrees the contract and goals.
- D: The pre-interaction phase happens before the nurse meets the patient.
Question 4 · Medium
A patient started on fluoxetine a week ago says the drug is not working and he wants to stop. The nurse's best response is:
1. AAgree that he can stop it because a week is long enough
2. BTell him to take it only on days he feels low
3. CExplain that mood usually lifts only after a few weeks
4. DAdvise him to double the dose to make it work faster
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Answer: C · Explain that mood usually lifts only after a few weeks
Antidepressants need some weeks to improve mood, although sleep and appetite may improve earlier. Stopping after one week means the drug never gets a fair trial. The nurse encourages him to continue, to report side effects, and to tell staff about any worsening low mood or suicidal thoughts. Dose changes are decided only by the prescriber.
- A: One week is too short to judge an antidepressant.
- B: Antidepressants work only with regular daily use, not as needed.
- D: Changing the dose is the prescriber's decision and may raise side effects.
Question 5 · Easy
A nursing student starts to speak, dress and handle patients exactly like a clinical instructor she admires. This defence mechanism is:
1. AProjection
2. BDisplacement
3. CIntrojection
4. DIdentification
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Answer: D · Identification
Identification is taking on the qualities, attitudes or behaviour of an admired person to raise one's own self-worth. It is common in childhood and adolescence and is a normal part of forming a professional identity. Unlike introjection, the person copies outward traits rather than absorbing another's values whole. It is usually adaptive.
- A: Projection attributes one's own unacceptable feelings to someone else.
- B: Displacement moves a feeling from its real target to a safer one.
- C: Introjection is absorbing another person's values or attitudes into one's own conscience.
Question 6 · Easy
Haloperidol belongs to which chemical group of antipsychotic drugs?
1. APhenothiazines
2. BBenzamides
3. CButyrophenones
4. DThioxanthenes
Answer and explanation in LearnFree account
Question 7 · Hard
Olanzapine 2.5 mg IM is ordered for an agitated older patient. A 10 mg vial is reconstituted with 2.1 mL of sterile water to give 5 mg/mL. What volume should be drawn up?
1. A0.25 mL
2. B0.5 mL
3. C1 mL
4. D0.53 mL
Answer and explanation in LearnFree account
Question 8 · Hard
A woman made a valid advance directive refusing ECT. She is now admitted with severe depression, refusing food and lacking capacity. The psychiatrist believes ECT is needed. Under the Mental Healthcare Act 2017, what is the correct step?
1. AGive ECT with her husband's written consent
2. BGive ECT because she now lacks capacity
3. CAsk the medical superintendent to cancel the directive
4. DApply to the Mental Health Review Board to review the directive
Answer and explanation in LearnFree account
Question 9 · Medium
A patient on clozapine for two months says he has not opened his bowels for four days and has cramping abdominal pain. What should the nurse do?
1. AAdvise him to cut down on drinking water
2. BGive his clozapine dose and order a high-fibre meal
3. CReport it promptly as possible bowel obstruction
4. DReassure him that it is a minor side effect
Answer and explanation in LearnFree account
Question 10 · Medium
A patient with depression says she feels useless. The nurse answers, 'Everybody feels low now and then, it will pass.' This response is non-therapeutic because it:
1. ABelittles the feelings the patient expressed
2. BGives the nurse's personal advice
3. CChanges the subject to a safer topic
4. DAsks the patient to explain her behaviour
Answer and explanation in LearnFree account
Question 11 · Easy
Which drug in the premedication for modified ECT dries secretions and protects against bradycardia from the stimulus?
1. AGlycopyrrolate
2. BPropofol
3. CSuccinylcholine
4. DOndansetron
Answer and explanation in LearnFree account
Question 12 · Medium
A patient on lithium has a serum level of 0.8 mEq/L and a fine tremor of both hands, with no other complaints. This tremor is best regarded as:
1. AA reason to stop the lithium treatment at once
2. BAn early sign of lithium toxicity
3. CA common side effect at a therapeutic level
4. DA sign of tardive dyskinesia
Answer and explanation in LearnFree account
Question 13 · Easy
Second-generation (atypical) antipsychotics such as risperidone and olanzapine differ from older drugs mainly because they block:
1. ADopamine D2 receptors only, but more strongly
2. BReuptake of serotonin and noradrenaline
3. CSerotonin 5-HT2A as well as dopamine D2 receptors
4. DMuscarinic receptors in the basal ganglia
Answer and explanation in LearnFree account
Question 14 · Hard
A woman on lithium for four years drinks water all day and passes about 4.5 litres of urine daily. Lithium 0.8 mEq/L (0.6-1.2), sodium 146 mmol/L (135-145), fasting glucose 92 mg/dL, urine specific gravity 1.002. The most likely cause is:
1. APsychogenic (primary) polydipsia
2. BLithium-induced nephrogenic diabetes insipidus
3. CUncontrolled diabetes mellitus
4. DAcute lithium toxicity
Answer and explanation in LearnFree account
Question 15 · Easy
The nurse's ability to understand a patient's feelings from the patient's point of view, while staying objective, is called:
1. ATransference
2. BSympathy
3. CCountertransference
4. DEmpathy
Answer and explanation in LearnFree account
Question 16 · Easy
Which group of antidepressants is preferred when a depressed patient is at high risk of taking an overdose?
1. ASelective serotonin reuptake inhibitors
2. BMonoamine oxidase inhibitors
3. CLithium salts
4. DTricyclic antidepressants
Answer and explanation in LearnFree account
Question 17 · Medium
Near the end of a session, the nurse says, 'Today we talked about your fear of going back to work and two ways you could cope.' This technique is called:
1. ASummarising
2. BFocusing
3. CEncouraging comparison
4. DPlacing the event in sequence
Answer and explanation in LearnFree account
Question 18 · Easy
A short boy who is teased about his height works hard and becomes the top student in his class. The defence mechanism shown is:
1. ASublimation
2. BCompensation
3. CRationalisation
4. DReaction formation
Answer and explanation in LearnFree account
Question 19 · Medium
A patient with paranoid ideas watches the staff closely and believes they are plotting against him. Which approach by the nurse best builds trust?
1. AJoke with him to lighten his mood
2. BTouch his arm often to show warmth
3. CTalk with staff quietly near him
4. DBe honest, consistent and keep every promise
Answer and explanation in LearnFree account
Question 20 · Easy
Under the Mental Healthcare Act 2017, a new private mental health establishment in a state must be registered with the:
1. AState Mental Health Authority
2. BDirectorate of Health Services
3. CMental Health Review Board
4. DState Nursing Council
Answer and explanation in LearnFree account
Question 21 · Medium
A patient says, 'Everything is going wrong because of them.' The nurse replies, 'I'm not sure who you mean by them. Could you tell me more?' This technique is:
1. ASeeking clarification
2. BReflecting feelings
3. CRestating
4. DGiving broad openings
Answer and explanation in LearnFree account
Question 22 · Medium
The best way to give a long-acting depot antipsychotic such as fluphenazine decanoate is:
1. ASlow IV injection over five minutes
2. BIM into the deltoid, then massage the site well
3. CDeep IM by Z-track, without massaging the site
4. DSubcutaneous injection into the abdomen
Answer and explanation in LearnFree account
Question 23 · Medium
A farm worker is started on chlorpromazine. Which advice does the nurse stress for his daily work in the fields?
1. ATake the tablets only after sunset
2. BCover the skin and use sunscreen outdoors
3. CStop the drug on very hot days
4. DDrink less water during the hot afternoons
Answer and explanation in LearnFree account
Question 24 · Hard
A man stable on lithium has a routine level of 1.5 mEq/L (target 0.6-1.2). He feels well, has no tremor and normal bowels. The chart shows the sample was drawn two hours after his morning dose. What should the nurse do?
1. AStop lithium for two days because the level is toxic
2. BGive the next dose early to keep the level steady
3. CDouble his fluids and continue the same dose without comment
4. DReport the timing and arrange a proper 12-hour trough level
Answer and explanation in LearnFree account
Question 25 · Hard
A 72-year-old woman started sertraline two weeks ago. She is now confused and drowsy, with no fever or focal weakness. Sodium 122 mmol/L (135-145). What is the nurse's best action?
1. AContinue the sertraline and recheck the sodium next week
2. BGive extra oral fluids to clear the confusion
3. CGive haloperidol to settle the confusion
4. DHold the sertraline and report the low sodium urgently
Answer and explanation in LearnFree account

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Therapeutic communication, psychopharmacology and mental health law

A man taking trazodone at night for depression and insomnia calls the ward to say he has had a painful erection for three hours. The nurse should advise him to:

A psychiatrist proposes psychosurgery for a man with severe, long-standing obsessive-compulsive disorder. Under the Mental Healthcare Act 2017, the operation needs:

Reviewing progress towards goals and helping the patient handle feelings about separation are main tasks of which phase of the nurse-patient relationship?

A patient started on fluoxetine a week ago says the drug is not working and he wants to stop. The nurse's best response is:

A nursing student starts to speak, dress and handle patients exactly like a clinical instructor she admires. This defence mechanism is:

Haloperidol belongs to which chemical group of antipsychotic drugs?

Olanzapine 2.5 mg IM is ordered for an agitated older patient. A 10 mg vial is reconstituted with 2.1 mL of sterile water to give 5 mg/mL. What volume should be drawn up?

A woman made a valid advance directive refusing ECT. She is now admitted with severe depression, refusing food and lacking capacity. The psychiatrist believes ECT is needed. Under the Mental Healthcare Act 2017, what is the correct step?

A patient on clozapine for two months says he has not opened his bowels for four days and has cramping abdominal pain. What should the nurse do?

A patient with depression says she feels useless. The nurse answers, 'Everybody feels low now and then, it will pass.' This response is non-therapeutic because it:

Which drug in the premedication for modified ECT dries secretions and protects against bradycardia from the stimulus?

A patient on lithium has a serum level of 0.8 mEq/L and a fine tremor of both hands, with no other complaints. This tremor is best regarded as:

Second-generation (atypical) antipsychotics such as risperidone and olanzapine differ from older drugs mainly because they block:

A woman on lithium for four years drinks water all day and passes about 4.5 litres of urine daily. Lithium 0.8 mEq/L (0.6-1.2), sodium 146 mmol/L (135-145), fasting glucose 92 mg/dL, urine specific gravity 1.002. The most likely cause is:

The nurse's ability to understand a patient's feelings from the patient's point of view, while staying objective, is called:

Which group of antidepressants is preferred when a depressed patient is at high risk of taking an overdose?

Near the end of a session, the nurse says, 'Today we talked about your fear of going back to work and two ways you could cope.' This technique is called:

A short boy who is teased about his height works hard and becomes the top student in his class. The defence mechanism shown is:

A patient with paranoid ideas watches the staff closely and believes they are plotting against him. Which approach by the nurse best builds trust?

Under the Mental Healthcare Act 2017, a new private mental health establishment in a state must be registered with the:

A patient says, 'Everything is going wrong because of them.' The nurse replies, 'I'm not sure who you mean by them. Could you tell me more?' This technique is:

The best way to give a long-acting depot antipsychotic such as fluphenazine decanoate is:

A farm worker is started on chlorpromazine. Which advice does the nurse stress for his daily work in the fields?

A man stable on lithium has a routine level of 1.5 mEq/L (target 0.6-1.2). He feels well, has no tremor and normal bowels. The chart shows the sample was drawn two hours after his morning dose. What should the nurse do?

A 72-year-old woman started sertraline two weeks ago. She is now confused and drowsy, with no fever or focal weakness. Sodium 122 mmol/L (135-145). What is the nurse's best action?