Ethiopian Psychiatric Nursing University Exit Exam Practice Questions (50 Items)

Thematic Area 1: Foundations of Psychiatric Nursing & Communication

Q1. A psychiatric nurse is conducting an admission interview with a client. The client states, “Everyone here is out to get me, and you’re part of them too!” Which response by the nurse best demonstrates therapeutic communication? A) “Why do you think we want to hurt you? We are here to help.” B) “It must be very frightening to feel that way. I am here to ensure your safety.” C) “That is not true. No one here has any intention of harming you.” D) “Let’s talk about something else since you are feeling upset.”

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• Correct Answer: B
• Rationale: Acknowledging the client’s feelings (“It must be frightening”) validates their emotional experience without validating or reinforcing the delusional premise, while simultaneously offering reality-based reassurance of safety.

Q2. During a one-on-one session, a client stops talking mid-sentence and looks at the floor for a prolonged period. Which action should the psychiatric nurse prioritize? A) Ask a direct question to redirect the conversation immediately B) Terminate the session and schedule it for another time C) Remain seated quietly alongside the client, maintaining an attentive posture D) Document that the client is uncooperative and mute

• Correct Answer: C
• Rationale: Therapeutic silence allows the client time to organize thoughts, process emotions, and realize that the nurse accepts their pace of communication, serving as an effective nonverbal therapeutic intervention.

Q3. According to Peplau’s Theory of Interpersonal Relations, during which phase of the nurse-client relationship do the nurse and client work together to solve problems, foster independence, and practice new coping skills? A) Orientation phase B) Identification phase C) Exploitation (Working) phase D) Resolution (Termination) phase

• Correct Answer: C
• Rationale: The working (exploitation) phase focuses on implementing the care plan, exploring stressors, problem-solving, and utilizing available services to achieve goals.

Q4. A client with a history of severe depression tells the nurse, “I’ve finally found a solution to all my problems. Everything will be sorted out by tomorrow morning.” What is the most critical assessment for the nurse to make? A) Ask the client about their specific plans for tomorrow B) Screen the client immediately for active suicidal ideation and intent C) Congratulate the client on finding a positive solution D) Document that the client’s mood has spontaneously improved

• Correct Answer: B
• Rationale: A sudden change in a depressed client’s mood from despair to apparent calm or resolution often indicates they have made a definitive decision to commit suicide, necessitating an immediate risk assessment.

Q5. Which ethical principle is a psychiatric nurse practicing when they protect a client’s right to refuse psychotropic medications, provided the client has the legal capacity to make that decision? A) Beneficence B) Autonomy C) Non-maleficence D) Justice

• Correct Answer: B
• Rationale: Autonomy refers to the right of individuals to make self-determining choices about their own medical and psychiatric care, including treatment refusal.

Q6. A client admitted to the psychiatric ward becomes increasingly agitated, pacing the hallway and shouting obscenities. What is the nurse’s first-line intervention? A) Call the security team to place the client in mechanical restraints B) Administer an emergency intramuscular injection of Haloperidol C) Verbal de-escalation using a calm, non-threatening tone in a quiet area D) Lock the client inside their bedroom until they calm down

• Correct Answer: C
• Rationale: Standard practice dictates using the least restrictive environment. Verbal de-escalation must always be attempted to manage agitation before moving to chemical or physical restraints.

Q7. When assessing a client’s mental status, the nurse asks, “What does the proverb ‘People who live in glass houses shouldn’t throw stones’ mean?” What specific cognitive function is the nurse testing? A) Orientation to reality B) Immediate memory recall C) Abstract thinking capacity D) Insight into illness

• Correct Answer: C
• Rationale: Asking a client to interpret common proverbs or identify similarities between objects tests their ability to think abstractly versus concretely.

Q8. A nurse experiences a strong feeling of anger and frustration toward a client who reminds them of an abusive relative from their past. This psychological phenomenon is known as: A) Transference B) Countertransference C) Displacement D) Projection

• Correct Answer: B
• Rationale: Countertransference occurs when a healthcare professional unconsciously displaces emotional reactions or attitudes from their own past onto the client.

Q9. Which component of the Mental Status Examination (MSE) is being evaluated when the nurse notes that the client is unkempt, wearing mismatched clothing inside out, and has poor body hygiene? A) Affect and mood B) Thought content C) Appearance and general behavior D) Sensorium and cognition

• Correct Answer: C
• Rationale: Grooming, hygiene, clothing choice, and posture are standard parameters evaluated under the appearance and general behavior section of the MSE.

Q10. A client with a diagnosis of schizophrenia tells the nurse, “The microchip implanted in my left shoulder by the government is tracking my thoughts.” This statement is an example of what type of thought content abnormality? A) An obsession B) A phobia C) A delusion D) An illusion

• Correct Answer: C
• Rationale: A delusion is a fixed, false belief that is firmly held despite clear, contradictory evidence to the contrary and is inconsistent with the client’s cultural background.

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Thematic Area 2: Psychopharmacology

Q11. A client taking Chlorpromazine (a typical antipsychotic) develops severe muscle rigidity, a high fever of 39.5∘C, altered consciousness, and autonomic instability. What life-threatening complication should the nurse suspect? A) Serotonin syndrome B) Neuroleptic Malignant Syndrome (NMS) C) Acute dystonic reaction D) Tardive dyskinesia

• Correct Answer: B
• Rationale: NMS is a medical emergency associated with antipsychotic drugs, characterized by severe rigidity (“lead-pipe”), hyperthermia, altered mental status, and autonomic dysfunction.

Q12. A client diagnosed with Bipolar I disorder is prescribed Lithium Carbonate. Which of the following lab values represents a safe therapeutic serum lithium range for the maintenance phase of treatment? A) 0.6 to 1.2 mEq/L B) 1.5 to 2.0 mEq/L C) 2.5 to 3.0 mEq/L D) 0.1 to 0.4 mEq/L

• Correct Answer: A
• Rationale: The therapeutic index for lithium is narrow. The standard maintenance range is 0.6–1.2 mEq/L; levels exceeding 1.5 mEq/L can cause toxicity.

Q13. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which baseline and ongoing laboratory evaluation is mandatory due to the risk of agranulocytosis? A) Serum electrolyte panel B) Liver Function Tests (LFTs) C) Complete Blood Count (CBC) with Absolute Neutrophil Count (ANC) D) Fasting blood glucose level

• Correct Answer: C
• Rationale: Clozapine carries a black box warning for agranulocytosis. Regular ANC monitoring is mandatory to detect severe bone marrow suppression early.

Q14. A client taking Fluoxetine (an SSRI) for depression presents with agitation, confusion, hyperreflexia, tremors, and diaphoresis after taking an over-the-counter cough medicine containing dextromethorphan. What is the likely cause? A) Anticholinergic toxicity B) Serotonin Syndrome C) Extrapyramidal symptoms D) Lithium toxicity

• Correct Answer: B
• Rationale: Serotonin Syndrome results from overstimulation of central and peripheral serotonin receptors, often triggered by combining multiple serotonergic agents.

Q15. Which of the following adverse effects is considered an Extrapyramidal Symptom (EPS) characterized by an intense, subjective feeling of internal restlessness and the need to pace continuously? A) Akathisia B) Pseudoparkinsonism C) Acute dystonia D) Tardive dyskinesia

• Correct Answer: A
• Rationale: Akathisia is a common EPS characterized by motor restlessness and an internal urge to move, which can be mistaken for worsening psychotic agitation.

Q16. A client receiving a Monoamine Oxidase Inhibitor (MAOI) for treatment-resistant depression must be educated to completely avoid foods rich in which substance to prevent a hypertensive crisis? A) Tryptophan B) Tyramine C) Phenylalanine D) Purine

• Correct Answer: B
• Rationale: MAOIs prevent the breakdown of tyramine. Consuming tyramine-rich foods (e.g., aged cheeses, fermented meats, red wine) can cause a massive release of norepinephrine, leading to a hypertensive crisis.

Q17. What is the primary mechanism of action of first-generation (typical) antipsychotic medications like Haloperidol in reducing positive psychotic symptoms? A) Selective blockade of serotonin 5-HT2​ receptors B) Enhancement of GABA transmission C) Competitive antagonism of central Dopamine D2​ receptors D) Inhibition of norepinephrine reuptake

• Correct Answer: C
• Rationale: First-generation antipsychotics primarily exert their therapeutic effect by blocking dopamine D2​ receptors in the mesolimbic pathway of the brain.

Q18. A client is prescribed Amitriptyline (a Tricyclic Antidepressant). Because of the drug’s strong anticholinergic side-effect profile, which medical condition is a contraindication to its use? A) Chronic diarrhea B) Narrow-angle glaucoma C) Hypothyroidism D) Rheumatoid arthritis

• Correct Answer: B
• Rationale: Anticholinergic effects include pupillary dilation (mydriasis), which can obstruct the outflow of aqueous humor and cause dangerous intraocular pressure spikes in narrow-angle glaucoma.

Q19. A nurse is planning discharge teaching for a client prescribed a Benzodiazepine (e.g., Diazepam) for severe anxiety. What is the most critical instruction to include regarding treatment cessation? A) Stop taking the medication immediately once the anxiety resolves B) Taper the dose down gradually under medical supervision to avoid withdrawal seizures C) Double the dose if a stressful event is anticipated the next day D) Avoid drinking water within one hour of taking the tablet

• Correct Answer: B
• Rationale: Abrupt discontinuation of long-term benzodiazepines can trigger withdrawal syndrome, marked by rebound anxiety, tremors, and life-threatening seizures.

Q20. Which medication is commonly co-administered with Haloperidol intramuscularly to treat or prevent acute dystonic reactions, such as torticollis or oculogyric crisis? A) Benztropine (or Diphenhydramine) B) Propanolol C) Flumazenil D) Naloxone

• Correct Answer: A
• Rationale: Acute dystonia results from a drug-induced dopamine-acetylcholine imbalance. Anticholinergic drugs like benztropine help restore balance and relieve muscle spasms.

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Thematic Area 3: Schizophrenia & Psychotic Disorders

Q21. A client with schizophrenia stands in the corner of the dayroom with their arm raised awkwardly in the air for 4 hours. When the nurse lowers the client’s arm, it remains in the new position. This sign is known as: A) Neologism B) Waxy flexibility C) Echopraxia D) Anhedonia

• Correct Answer: B
• Rationale: Waxy flexibility is a feature of catatonic schizophrenia where a client maintains an immobilized body posture or position imposed upon them by another person.

Q22. During an assessment, a client with schizophrenia states, “The bashful flim-flam went to the splish-splash to cry.” The client is combining invented words that have no real meaning. This is documented as: A) Word salad B) Clang association C) Neologisms D) Echolalia

• Correct Answer: C
• Rationale: Neologisms are newly coined or invented words created by a client that have a symbolic meaning known only to them.

Q23. Which of the following clinical features represents a “negative symptom” of schizophrenia that significantly impairs the client’s ability to engage in goal-directed activities? A) Auditory hallucinations B) Delusions of grandeur C) Avolition D) Looseness of association

• Correct Answer: C
• Rationale: Negative symptoms represent a deficit or loss of normal functioning. Avolition is a lack of motivation to initiate and sustain purposeful, goal-directed activities.

Q24. A client with schizophrenia tells the nurse, “I hear the voice of the devil telling me to set fire to the nursing station right now.” What type of hallucination is the client experiencing? A) Olfactory hallucination B) Command hallucination C) Visual hallucination D) Somatic hallucination

• Correct Answer: B
• Rationale: Command hallucinations are a form of auditory hallucination where voices direct the client to perform specific actions, often posing a safety risk.

Q25. A client states, “The news anchor on the television was looking directly at me tonight and sending a secret coded message for me to save the world.” What type of delusion is this? A) Delusion of persecution B) Delusion of reference C) Somatic delusion D) Nihilistic delusion

• Correct Answer: B
• Rationale: In delusions of reference, clients interpret neutral, external events or remarks (like TV broadcasts or newspaper articles) as having direct, personal significance to them.

Q26. A client has experienced symptoms of delusions, hallucinations, disorganized speech, and negative symptoms for a duration of 3 months. According to DSM-5 criteria, what is the most appropriate provisional diagnosis before reaching a 6-month threshold? A) Schizophreniform disorder B) Brief psychotic disorder C) Schizoaffective disorder D) Delusional disorder

• Correct Answer: A
• Rationale: Schizophreniform disorder has clinical features identical to schizophrenia, but the duration of symptoms is at least 1 month and less than 6 months.

Q27. When working with a client experiencing active delusions, which nursing action is most effective for building trust? A) Challenge the delusion with logic and evidence B) Play along with the delusion to avoid upsetting the client C) Validate the client’s feelings while refocusing communication on reality-based topics D) Separate the client from all peer interactions immediately

• Correct Answer: C
• Rationale: Validating the underlying emotion helps build rapport without reinforcing the false belief, and redirecting to reality helps anchor the client’s focus.

Q28. A client demonstrates a thought process where they move from one unrelated topic to another during a conversation, with no logical connection between ideas. This is termed: A) Flight of ideas B) Circumstantiality C) Loose associations (derailment) D) Tangentiality

• Correct Answer: C
• Rationale: Loose associations refer to a pattern of speech where ideas shift from one subject to another in an unrelated or loosely connected manner.

Q29. A client with schizoaffective disorder differs from a client with schizophrenia because the schizoaffective client experiences: A) Continuous hallucinations without any cognitive impairments B) An uninterrupted period of illness during which there is a major mood episode concurrent with symptoms of schizophrenia C) Symptoms that last for less than one week only D) No positive symptoms of psychosis

• Correct Answer: B
• Rationale: Schizoaffective disorder requires a major mood episode (depressive or manic) concurrent with criteria for schizophrenia, along with delusions or hallucinations for at least 2 weeks in the absence of a major mood episode.

Q30. A nurse observes a client with schizophrenia repeating every word the nurse says, mimicking their phrasing exactly. This speech pattern is documented as: A) Echopraxia B) Echolalia C) Verbigeration D) Perseveration

• Correct Answer: B
• Rationale: Echolalia is the involuntary, parrot-like repetition of words or phrases spoken by another person, often seen in schizophrenia and catatonic states.

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Thematic Area 4: Mood Disorders (Depression & Bipolar)

Q31. A client is admitted to the psychiatric unit with severe Major Depressive Disorder (MDD). The nurse notes that the client has a complete loss of interest or pleasure in all previously enjoyed activities. What clinical term describes this symptom? A) Dysphoria ) Alogia C) Anhedonia D) Psychomotor retardation

• Correct Answer: C
• Rationale: Anhedonia is a core diagnostic criterion for major depressive disorder, defined as the inability to experience pleasure from activities that were previously found enjoyable.

Q32. A client on the inpatient unit is in an acute manic phase of Bipolar I Disorder. They are pacing rapidly, singing loudly, and disrupting others. Which meal choice is most appropriate for this client? A) A hot bowl of traditional vegetable soup with bread B) A beef burger, french fries, and a banana (finger foods) C) A full traditional meat kitfo dish requiring utensils D) A large green salad with dressing on the side

• Correct Answer: B
• Rationale: Manic clients often cannot sit down to eat due to hyperactivity. High-calorie, nutrient-dense “finger foods” allow them to consume nutrition while on the move.

Q33. A 42-year-old female client reports a chronically depressed mood for most of the day, more days than not, for at least the past 2 years, accompanied by low energy and poor self-esteem. She notes she has never been without these symptoms for more than 2 months at a time. What is the likely diagnosis? A) Major Depressive Disorder B) Cyclothymic disorder C) Persistent Depressive Disorder (Dysthymia) D) Disruptive Mood Dysregulation Disorder

• Correct Answer: C
• Rationale: Persistent Depressive Disorder is characterized by a continuous, low-grade chronically depressed mood that persists for at least 2 years in adults.

Q34. A nurse is caring for a client with severe depression who has stopped eating, refuses to speak, and states, “My internal organs have completely rotted away and I am already dead.” What type of delusion is this client displaying? A) Persecutory delusion B) Somatic / Nihilistic delusion C) Delusion of reference D) Erotomanic delusion

• Correct Answer: B
• Rationale: Nihilistic delusions center on themes of nonexistence, catastrophically believing that oneself, a body part, or the world has ceased to exist or is dead.

Q35. A client diagnosed with severe treatment-resistant depression is scheduled for Electroconvulsive Therapy (ECT). What is the primary role of the nurse during the immediate post-ECT recovery phase? A) Maintain the client in a prone position to prevent back injuries B) Monitor airway patency, vital signs, and reorient the client due to transient confusion and memory loss C) Administer a dose of an oral antidepressant immediately D) Restrict all fluid intake for at least 12 hours post-procedure

• Correct Answer: B
• Rationale: Post-ECT nursing priorities include monitoring ABCs as the client emerges from anesthesia and managing temporary confusion or short-term memory deficits through frequent reorientation.

Q36. A nurse is assigning a room for a newly admitted client experiencing acute mania. Which room placement is most therapeutic? A) A double room next to the highly active dayroom lounge B) A private room located in a quiet corridor away from high-traffic areas C) A room next to the main nursing station with the door kept open at all times D) A shared room with a client experiencing severe paranoid delusions

• Correct Answer: B
• Rationale: Manic clients are highly sensitive to environmental stimuli. Placing them in a quiet, low-stimulus room helps minimize agitation and hyperactivity.

Q37. A client with Bipolar Disorder exhibits rapid cycling. By clinical definition, how many distinct mood episodes must the client experience within a 12-month period to meet criteria for rapid cycling? A) At least 2 episodes B) At least 4 episodes C) At least 6 episodes D) At least 12 episodes

• Correct Answer: B
• Rationale: Rapid cycling is a specifier for Bipolar I or II disorder, defined by the occurrence of 4 or more distinct mood episodes (mania, hypomania, or depression) within a single year.

Q38. When assessing a manic client’s thought processes, the nurse notes that the client speaks rapidly and continuously, shifting topics based on sound associations or rhyming words (e.g., “The sky is high, tie a tie, don’t cry, say goodbye”). This is documented as: A) Word salad B) Clang association C) Neologism D) Circumstantial speech

• Correct Answer: B
• Rationale: Clang associations refer to a speech pattern where choice of words is governed by rhyming or sound patterns rather than logical meaning.

Q39. What type of cognitive distortions are common in depressed clients, according to Aaron Beck’s cognitive triad of depression? A) Negative views about the self, the world, and the future B) Grandiose views about power, wealth, and identity C) Obsessive focus on handwashing, ordering, and symmetry D) Paranoia regarding food safety, medicine, and tracking devices

• Correct Answer: A
• Rationale: Beck’s cognitive triad asserts that depression is sustained by automated negative schemas regarding oneself, the surrounding environment/world, and the future.

Q40. A client with major depression tells the nurse, “I am a complete failure and my family would be much better off if I were dead.” Which response by the nurse is most appropriate? A) “Don’t say that, you have a beautiful family that loves you.” B) “Are you having thoughts of killing yourself?” C) “Why do you feel like a failure? You have a good job.” D) “Let’s change the subject and look at the bright side of things.”

• Correct Answer: B
• Rationale: Direct, unambiguous communication is critical when assessing suicide risk. Asking directly about suicidal thoughts helps clarify intent without introducing the idea to the client.

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Thematic Area 5: Anxiety, Stressor & Obsessive-Compulsive Disorders

Q41. A client is admitted to the emergency department experiencing sudden, intense fear, palpitations, sweating, shortness of breath, hyperventilation, and a fear of losing control or dying. The symptoms peak within 10 minutes. What is the likely cause? A) Generalized Anxiety Disorder (GAD) B) A panic attack C) Post-Traumatic Stress Disorder (PTSD) D) Social Anxiety Disorder

• Correct Answer: B
• Rationale: A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes and includes characteristic somatic symptoms like palpitations and dyspnea.

Q42. During a panic attack, what is the priority nursing intervention to assist the client? A) Teach the client new long-term problem-solving strategies B) Leave the client alone in a dark room to reduce stimulus exposure C) Stay with the client, use short, simple sentences, and encourage slow, deep breathing D) Administer high-dose continuous oxygen via a non-rebreather mask

• Correct Answer: C
• Rationale: During a panic attack, severe anxiety impairs information processing. Staying with the client provides reassurance, and simple instructions help manage hyperventilation.

Q43. A client with Obsessive-Compulsive Disorder (OCD) spends 2 hours every morning checking and re-checking door locks before leaving for the dayroom. Initially, how should the nurse manage this compulsive behavior? A) Lock the client’s door and forbid them from checking it ) Allow the client sufficient time to perform the ritual to prevent severe anxiety, while gradually working to reduce it C) Tell the client that their behavior is irrational and disrupting the ward schedule D) Administer an emergency sedative whenever the client approaches the door

• Correct Answer: B
• Rationale: Forcing a client to stop a compulsive ritual early in treatment can cause severe, unmanageable anxiety. Treatment focuses on slowly reducing the time spent on rituals through behavioral therapy.

Q44. Six months after surviving a severe motor vehicle accident, a client reports vivid flashbacks, nightmares, hypervigilance, and avoids driving or passing near the accident site. What diagnosis do these symptoms suggest? A) Acute Stress Disorder B) Adjustment Disorder C) Post-Traumatic Stress Disorder (PTSD) D) Agoraphobia

• Correct Answer: C
• Rationale: PTSD requires symptoms from clusters including intrusion (flashbacks), avoidance, alterations in cognition/mood, and hyperarousal, persisting for more than 1 month following exposure to a traumatic event.

Q45. A client experiences excessive, uncontrollable worry about various everyday events (finances, health, family) for more days than not for at least 6 months, accompanied by muscle tension and restlessness. What is the diagnosis? A) Panic Disorder B) Generalized Anxiety Disorder (GAD) C) Obsessive-Compulsive Disorder D) Specific Phobia

• Correct Answer: B
• Rationale: GAD is defined by chronic, pervasive, and excessive anxiety and worry about multiple daily domains lasting for at least 6 months.

Q46. A nurse is utilizing systemic desensitization therapy for a client with a severe phobia of spiders. What does this behavioral therapy technique involve? A) Exposing the client to a cage full of spiders all at once until their fear resolves B) Teaching relaxation techniques and gradually exposing the client to a hierarchy of fear-producing stimuli from least to most scary C) Administering a mild electric shock whenever the client looks at a picture of a spider D) Hypnotizing the client to forget that spiders exist

• Correct Answer: B
• Rationale: Systemic desensitization pairs relaxation techniques with progressive exposure to a hierarchy of feared stimuli, helping extinguish the anxiety response over time.

Q47. What is the fundamental psychological difference between the obsessions and the compulsions observed in clients diagnosed with OCD? A) Obsessions are physical actions, while compulsions are abstract ideas B) Obsessions are recurrent, intrusive thoughts that cause anxiety, while compulsions are repetitive behaviors performed to reduce that anxiety C) Obsessions are pleasant fantasies, while compulsions are painful memories D) Obsessions indicate psychosis, while compulsions indicate neurosis

• Correct Answer: B
• Rationale: Obsessions are persistent thoughts, urges, or images that cause distress, whereas compulsions are repetitive behavioral or mental acts driven by the obsession to neutralize anxiety.

Q48. A client experiences a fear of being in public places or open situations where escape might be difficult or help unavailable in the event of panic-like symptoms. This condition is known as: A) Social Anxiety Disorder ) Xenophobia C) Agoraphobia D) Claustrophobia

• Correct Answer: C
• Rationale: Agoraphobia involves intense fear or anxiety triggered by real or anticipated exposure to public transport, open spaces, enclosed places, lines, or crowds due to fears of being trapped.

Q49. A client develops severe emotional and behavioral symptoms within 2 months of a stressful life event (a sudden divorce). The symptoms resolve within 6 months of the stressor’s termination. What is the appropriate diagnosis? A) Major Depressive Disorder B) Acute Stress Disorder C) Adjustment Disorder D) Post-Traumatic Stress Disorder

• Correct Answer: C
• Rationale: Adjustment Disorder involves emotional or behavioral reactions to an identifiable stressor occurring within 3 months of its onset, and typically resolving within 6 months once the stressor ends.

Q50. Which cognitive behavioral technique involves exposing a client with OCD to an anxiety-producing stimulus (e.g., touching a dirty surface) and preventing them from performing the associated compulsion (e.g., handwashing)? A) Flooding therapy B) Thought stopping technique C) Exposure and Response Prevention (ERP) D) Modeling therapy

• Correct Answer: C
• Rationale: ERP is a first-line behavioral therapy for OCD where the client is exposed to the obsessional trigger but refrains from the compulsive ritual, helping reduce the behavior over time.