A client in the emergency department tells the nurse he plans to take the pills he has saved up, tonight, 'so it will finally be over.' After admission to the psychiatric unit he says, 'I'll be fine now, just leave me alone.' Which level of observation is most appropriate on admission?
Routine rounds with a check on the client once every hour and at night
Observation every 15 minutes with the client's location and behavior documented each time
Constant one-to-one observation by a staff member who stays within sight or arm's length, per policy
Increased observation during meals, medication times and group sessions, when staff are already with the client throughout the day
Show the answer and explanation
Answer: C. Constant one-to-one observation by a staff member who stays within sight or arm's length, per policy
Topic: observation level for plan and intent
A client with a specific plan, the means at hand, intent and a near time frame is at high and immediate risk. Constant one-to-one observation keeps a staff member with the client at all times, including bathroom use and sleep, until the treatment team lowers the level. A statement such as 'I'll be fine' does not lower the risk.
Why the others are wrong
A – Hourly rounds leave long gaps and suit clients at low risk; this client has a plan and intent.
B – Fifteen-minute checks are used for lower or moderate risk; a client with a plan and intent needs continuous observation.
D – Watching only when staff are already present leaves most of the day unmonitored.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A client who has been hospitalized for 10 days with severe depression has been withdrawn and silent. Today she is cheerful, gives her books to another client and thanks the nurse 'for everything.' Which action by the nurse is best?
Ask her directly about suicidal thoughts and plans, and report the sudden change to the provider
Document the improvement in mood and encourage her to attend the afternoon group therapy session
Tell her how pleased the team is with her progress and begin planning for an early discharge
Reassess her mood at the start of the next shift, since the antidepressant is probably working
Show the answer and explanation
Answer: A. Ask her directly about suicidal thoughts and plans, and report the sudden change to the provider
Topic: sudden improvement as a warning sign
An abrupt shift from withdrawn to cheerful, together with giving away belongings and thanking staff, can mean the client has decided to die and feels relief. Energy often returns before mood improves, which is itself a high-risk period. The nurse asks directly about suicide and shares the change with the team so that observation can be increased.
Why the others are wrong
B – This treats the change as recovery and does not check for risk; the warning signs are missed.
C – Planning an early discharge on the basis of an unexplained mood lift could send a client with a decided plan home.
D – Waiting for the next shift delays a risk assessment that is needed now; improvement this fast is not explained by a new medication.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A nurse is teaching the family of a client who has major depression and recent suicidal thoughts and who will go home tomorrow. Which instructions should the nurse include?
Select all that apply.
Remove firearms from the home, or lock them away with the ammunition stored separately
Keep medications locked up and keep only small supplies in the house
Agree to keep the client's suicide plans secret to protect his trust
Relax the watch once the client says he feels much better
Learn the warning signs and keep the 988 Suicide and Crisis Lifeline number handy
Avoid mentioning suicide so that the idea is not planted
Show the answers and explanation
Answers: A, B and E.
A – Remove firearms from the home, or lock them away with the ammunition stored separately
B – Keep medications locked up and keep only small supplies in the house
E – Learn the warning signs and keep the 988 Suicide and Crisis Lifeline number handy
Topic: lethal means restriction and discharge safety
Limiting access to lethal means such as firearms and large medication supplies lowers the chance that a crisis becomes an attempt. Families should know the warning signs and how to reach crisis help, including calling or texting 988. Talking openly about suicide does not plant the idea, and plans must never be kept secret.
Why the others are wrong
C – Suicide plans cannot be kept secret; the family must be able to act on them and tell the care team.
D – Feeling better, especially early in recovery, can come with new energy to act; vigilance continues.
F – Asking directly about suicide does not cause it and often brings relief; avoiding the topic leaves the family blind to risk.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A client whose home was destroyed in a tornado is overwhelmed and unable to cope with daily tasks. The nurse recognizes this as which type of crisis?
Maturational crisis
Adventitious crisis
Situational crisis
Psychiatric crisis
Show the answer and explanation
Answer: B. Adventitious crisis
Topic: types of crisis
An adventitious crisis results from an unplanned event outside everyday life, such as a natural disaster, a crime of violence or a mass casualty event. A maturational crisis comes from predictable developmental transitions, and a situational crisis from a specific life event such as job loss, divorce or illness.
Why the others are wrong
A – Maturational crises arise from expected life transitions such as adolescence, marriage or retirement.
C – Situational crises stem from a personal life event such as job loss or a death; a disaster is classed separately.
D – Psychiatric crisis is not one of the crisis categories; the client's distress is a response to an event, not a mental disorder.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
On an inpatient psychiatric unit a client is pacing the dayroom with clenched fists, speaking loudly and saying, 'Everybody stay away from me.' Which actions by the nurse are appropriate to de-escalate the situation?
Select all that apply.
Stay more than an arm's length away and keep a clear path to the door.
Speak in a calm, low voice and acknowledge that the client is upset.
Place a hand on the client's shoulder to show concern.
Offer choices, such as going to a quiet room or taking a prescribed oral medication.
Tell the client that privileges will be removed unless the behaviour stops.
Show the answers and explanation
Answers: A, B and D.
A – Stay more than an arm's length away and keep a clear path to the door.
B – Speak in a calm, low voice and acknowledge that the client is upset.
D – Offer choices, such as going to a quiet room or taking a prescribed oral medication.
Topic: de-escalation of an agitated client
The least restrictive measures come first: keep a safe distance and an exit, use a calm voice and short statements, acknowledge the feeling and offer choices that return some control to the client. Restraint or seclusion is a last resort for imminent danger.
Why the others are wrong
C – Touch can be felt as a threat by an agitated person and may trigger an assault.
E – Threats and ultimatums raise anger and start a power struggle.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
In the dayroom a client begins pacing rapidly, clenching both fists and muttering loudly after a telephone call. No one has been threatened. Which action should the nurse take first?
Approach calmly at a safe distance and say in a low voice, 'You seem upset. Tell me what is happening.'
Call for staff to escort the client to the seclusion room.
Tell the client firmly that this behavior is unacceptable and that privileges will be lost if it continues.
Place a hand on the client's shoulder and guide the client to the bedroom.
Show the answer and explanation
Answer: A. Approach calmly at a safe distance and say in a low voice, 'You seem upset. Tell me what is happening.'
Topic: de-escalation steps
Pacing, clenched fists and a raised voice are early signs of escalating anger. The first step is verbal de-escalation: a calm, non-threatening approach that respects personal space, acknowledges the feeling and invites the client to talk. More restrictive measures are used only if the less restrictive ones fail and safety is at risk.
Why the others are wrong
B – Seclusion is a last resort for imminent danger; using it before verbal measures is overly restrictive.
C – Threatening consequences is a power struggle that tends to escalate an already angry client.
D – Touching an agitated client may be perceived as an attack and invades personal space.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
The parents of a 7-year-old who witnessed a house fire three weeks ago tell the nurse they are worried about changes in the child's behavior. Which behavior is the nurse most likely to hear described?
Calm, detailed conversation about how frightening the fire was
Playing the same fire-rescue scene again and again with toys
Eagerness to try new activities with unfamiliar children
Sleeping more soundly than before the fire
Show the answer and explanation
Answer: B. Playing the same fire-rescue scene again and again with toys
Topic: children's response to trauma
Young children often cannot put a traumatic experience into words, and they act it out through repetitive play that reenacts parts of the event. Calm discussion, new-activity seeking and better sleep are not typical after a frightening event.
Why the others are wrong
A – A calm, detailed verbal account is less typical for a child who is distressed and lacks words for the event.
C – Trauma more often causes avoidance and clinging than eagerness for new social situations.
D – Sleep problems and nightmares are common after trauma; better sleep is not expected.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
Ten days after a house fire, a client has recurring intrusive memories, nightmares, jumpiness and avoidance of the old neighborhood, all causing distress at work. The client asks the nurse whether this means a lifelong disorder. Which response by the nurse is most accurate?
"Symptoms in the first month after trauma fit acute stress disorder, and many people recover; follow-up will show whether they persist."
"These symptoms already confirm posttraumatic stress disorder, which is a lifelong condition that needs treatment from now on."
"Intrusive memories without a physical injury are unrelated to the fire and likely reflect a separate anxiety disorder."
"Most people who live through a trauma like this go on to develop a chronic disorder, so long-term treatment is expected."
Show the answer and explanation
Answer: A. "Symptoms in the first month after trauma fit acute stress disorder, and many people recover; follow-up will show whether they persist."
Topic: acute stress disorder versus PTSD
Acute stress disorder is diagnosed when trauma-related symptoms last from 3 days up to 1 month; posttraumatic stress disorder requires symptoms lasting more than 1 month. Most people exposed to trauma do not develop PTSD, and many with early symptoms recover, though persistent symptoms need further evaluation.
Why the others are wrong
B – PTSD cannot be diagnosed until symptoms last longer than one month, and it is not always lifelong.
C – Trauma-related symptoms can occur without physical injury, so the link to the fire is not ruled out.
D – Most people exposed to trauma do not develop a chronic disorder.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
After a fatal highway crash, a hospital plans to give every survivor a single-session psychological debriefing the same day to prevent PTSD. What should the nurse recognize?
Routine single-session debriefing is not recommended for preventing PTSD; offer practical support and screen for continuing symptoms instead
It is the most effective method for preventing PTSD and should be mandatory
It is only harmful if it lasts longer than five minutes
It replaces the need for any later follow-up
Show the answer and explanation
Answer: A. Routine single-session debriefing is not recommended for preventing PTSD; offer practical support and screen for continuing symptoms instead
Topic: psychological debriefing after trauma
Guidelines advise against routine single-session psychological debriefing for trauma survivors because it has not been shown to prevent PTSD and may not help or may even worsen outcomes. Recommended care is practical and emotional support, monitoring, and evidence-based treatment for those who develop symptoms.
Why the others are wrong
B – Evidence does not show debriefing prevents PTSD, so mandating it is unsupported.
C – There is no five-minute threshold; the concern is the routine, single-session model itself.
D – No single session replaces follow-up; those with ongoing symptoms need assessment and treatment.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A man tells the emergency department nurse that he hears voices commanding him to hurt others and asks for admission. Staff saw him chatting calmly and laughing with another client, and he mentions having nowhere to sleep tonight. Which nursing action is most appropriate?
Tell him he is pretending and prepare him for discharge
Document that he is malingering to obtain shelter
Assess his risk, notify the provider, and document his statements and observed behavior without labeling intent
Reassure him and wait for the day team to evaluate him
Show the answer and explanation
Answer: C. Assess his risk, notify the provider, and document his statements and observed behavior without labeling intent
Topic: suspected malingering and risk
Malingering is intentional exaggeration or fabrication of symptoms for an external incentive, but that conclusion is the clinician's to reach after assessment and not the nurse's to assume. A stated threat to others requires risk assessment and provider notification, with objective documentation.
Why the others are wrong
A – Dismissing a possible threat risks serious harm; intent cannot be assumed.
B – Charting an intent-based label like malingering is a judgment the nurse should not make; chart facts.
D – Waiting delays assessment of a stated risk to others.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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