ISPN & CGFNS Qualifying Exam — Questions and Answers

Question 1: Which of the following correctly describes how the NCLEX-RN uses computerized adaptive testing (CAT)?

Every candidate receives the same 265 questions in the same order
Questions are randomly selected with no adaptation
The exam adapts question difficulty based on the candidate's previous answers to determine competency (Correct answer)
Candidates choose their own question difficulty level

Correct answer: The exam adapts question difficulty based on the candidate's previous answers to determine competency

CAT adjusts the difficulty of each subsequent question based on whether the candidate answered the previous question correctly, efficiently determining competency level.

Question 2: Which study resource is most aligned with CGFNS-QE preparation because it covers the same client needs framework?

Hospital-specific policy manuals
Medical school entrance exam guides
Pharmacology textbooks from the applicant's home country only
NCLEX-RN review books and practice questions (Correct answer)

Correct answer: NCLEX-RN review books and practice questions

NCLEX-RN review books are the most relevant resources because the CGFNS-QE mirrors the NCLEX-RN client needs framework and content areas.

Question 3: A patient on an SSRI develops agitation, hyperthermia, diaphoresis, and muscle rigidity. Which condition should the nurse suspect?

Serotonin syndrome (Correct answer)
Alcohol withdrawal delirium
Lithium toxicity
Neuroleptic malignant syndrome

Correct answer: Serotonin syndrome

The combination of agitation, hyperthermia, diaphoresis, and rigidity is the classic triad of serotonin syndrome, a dangerous reaction to serotonergic drugs.

Question 4: Dextroamphetamine (Dexedrine) has been prescribed for an 10-year-old child who has been acting out in class. The nurse will tell the parents to do the:

Give the last dose at least 6 hours before going to bed. (Correct answer)
Ensure that the child consumes 6-8 glasses of water per day.
Unless otherwise directed, ensure that dosages are given consistently.
Make sure to take the prescription after a full meal.

Correct answer: Give the last dose at least 6 hours before going to bed.

Dextroamphetamine (Dexedrine) is a central nervous system stimulant used to treat ADHD. A common side effect of stimulants is insomnia or difficulty sleeping. To minimize sleep disturbances, parents are typically instructed to administer the last dose of the medication at least 6 hours before the child's bedtime, allowing the stimulating effects to wear off.

Question 5: For the CGFNS VisaScreen, which minimum English language score on TOEFL iBT is generally required?

A total score of 83 with specific minimum scores in each section (Correct answer)
A perfect score of 120
Scores are not used; only oral interviews count
Any passing score above 60

Correct answer: A total score of 83 with specific minimum scores in each section

CGFNS generally requires a TOEFL iBT total score of at least 83 with specified minimums in speaking, listening, reading, and writing sections.

Question 6: Which of the following is a NON-THERAPEUTIC communication technique?

Seeking clarification
Giving false reassurance (Correct answer)
Reflecting the patient's feelings
Using therapeutic silence

Correct answer: Giving false reassurance

Giving false reassurance dismisses the patient's real concerns and closes off genuine communication by minimizing problems with empty comfort.

Question 7: A psychiatric nurse notes a patient has 'poor insight' into their illness. What does this mean clinically?

The patient does not recognize that they have a mental illness or need treatment (Correct answer)
The patient has an accurate understanding of their diagnosis
The patient agrees with all treatment recommendations
The patient is highly educated about their condition

Correct answer: The patient does not recognize that they have a mental illness or need treatment

Poor insight means the patient lacks awareness that they have a mental illness or that their symptoms require treatment, which is common in schizophrenia and mania.

Question 8: A client suffering from ulcerative colitis is receiving instruction from the nurse. What kind of diet is the nurse going to recommend?

High-calcium diet
High-calorie, high-protein diet
Low-residue, low-fiber diet (Correct answer)
Carbohydrate-consistent diet

Correct answer: Low-residue, low-fiber diet

Ulcerative colitis is an inflammatory bowel disease characterized by inflammation and ulcers in the colon. A low-residue, low-fiber diet is often recommended during acute flares or to manage symptoms. This type of diet reduces the amount of undigested material passing through the colon, minimizing irritation to the inflamed bowel and potentially reducing abdominal pain, cramping, and diarrhea.

Question 9: Maslow's hierarchy suggests a nurse should address which need before psychosocial concerns?

Self-esteem
Career goals
Physiological needs such as oxygen and nutrition (Correct answer)
Spiritual fulfillment

Correct answer: Physiological needs such as oxygen and nutrition

Physiological needs are the foundation of Maslow's hierarchy and must be met before higher-level needs.

Question 10: An indwelling abdominal catheter is used by a client who is having peritoneal dialysis for chronic renal failure. If the client spills water over the catheter dressing, what should the nurse do?

Reinforce the dressing
Change the dressing (Correct answer)
Sterilize the catheter with povidone-iodine
Replace the catheter

Correct answer: Change the dressing

An indwelling abdominal catheter for peritoneal dialysis creates a direct pathway into the peritoneal cavity, making sterility paramount. Spilling water on the dressing compromises its sterile barrier and creates a moist environment conducive to bacterial growth. Changing the dressing immediately is crucial to prevent infection, which is a serious and potentially life-threatening complication of peritoneal dialysis.

Question 11: Which infection-control practice is the single most effective at preventing transmission?

Wearing gloves at all times
Using antibiotics broadly
Isolating every patient
Hand hygiene (Correct answer)

Correct answer: Hand hygiene

Hand hygiene is the most effective and fundamental measure to prevent the spread of infection.

Question 12: A nurse whose home country uses a nursing licensure system different from the US should expect CGFNS to do what?

Evaluate equivalency of the foreign license to US RN licensure standards (Correct answer)
Require the nurse to repeat nursing school in the US
Automatically reject the application
Issue a temporary permit without evaluation

Correct answer: Evaluate equivalency of the foreign license to US RN licensure standards

CGFNS evaluates whether the foreign licensure is equivalent to US RN standards rather than requiring the nurse to repeat education.

Question 13: A psychiatric nurse administers haloperidol (Haldol) and the patient develops acute muscle spasms of the neck and jaw. Which condition has occurred?

Neuroleptic malignant syndrome
Akathisia
Tardive dyskinesia
Acute dystonia (Correct answer)

Correct answer: Acute dystonia

Acute dystonia — sudden, sustained involuntary muscle contractions, commonly affecting the neck (torticollis) and jaw — is an acute extrapyramidal side effect of antipsychotics.

Question 14: Which of the following BEST describes 'suggesting collaboration' in therapeutic communication?

Let's think together about strategies that might help you manage stress. (Correct answer)
I will coordinate your care plan with the full treatment team.
The team has already determined the best approach for your recovery.
I'll refer you to occupational therapy for coping skills training.

Correct answer: Let's think together about strategies that might help you manage stress.

Suggesting collaboration invites the patient to participate as an active partner in their own care, promoting autonomy, engagement, and therapeutic rapport.

Question 15: Which assessment tool is specifically used to identify symptoms of post-traumatic stress disorder (PTSD) in a psychiatric nursing evaluation?

Mini-Mental State Examination (MMSE)
Geriatric Depression Scale (GDS)
PTSD Checklist for DSM-5 (PCL-5) (Correct answer)
Confusion Assessment Method (CAM)

Correct answer: PTSD Checklist for DSM-5 (PCL-5)

The PCL-5 is a validated 20-item self-report measure that assesses the presence and severity of DSM-5 PTSD symptoms.

Question 16: What might a nurse anticipate to see after transfusing platelets into a trauma patient who has several cuts?

Decreased blood flow from cuts (Correct answer)
Increase in energy level
Less clammy skin
Relief of fever and headache

Correct answer: Decreased blood flow from cuts

Platelets are crucial for hemostasis, the process of stopping bleeding by forming clots. In a trauma patient with cuts, a platelet transfusion directly addresses any deficiency in the body's ability to clot blood. Therefore, the anticipated therapeutic effect is improved clot formation and a reduction in active bleeding from the cuts.

Question 17: Which statement by the nurse is an example of 'offering self'?

I'll have the doctor come to see you right away.
I have some time available if you would like to talk. (Correct answer)
Let me review your treatment plan for you.
The social worker can help you work through that.

Correct answer: I have some time available if you would like to talk.

Offering self means making one's personal presence available as a therapeutic resource, communicating genuine willingness to be with the patient.

Question 18: Which best describes the overall goal of standardized credentialing like CGFNS and related programs?

To eliminate the NCLEX requirement
To protect the public by ensuring foreign-educated nurses meet U.S. competency standards (Correct answer)
To replace national licensing boards
To restrict all nurse migration

Correct answer: To protect the public by ensuring foreign-educated nurses meet U.S. competency standards

These programs protect the public by verifying that foreign-educated nurses meet U.S. education, licensure, and language standards.

Question 19: Which ISPN-endorsed competency involves psychiatric nurses advocating for systemic changes to improve mental health care access?

Policy and advocacy (Correct answer)
Diagnostic imaging review
Direct care and treatment
Documentation and coding

Correct answer: Policy and advocacy

Policy and advocacy is a competency in ISPN's standards where psychiatric nurses work to improve mental health systems and access at organizational and policy levels.

Question 20: Which principle guides the NCLEX-RN in determining the minimum passing standard?

The 'passing standard' represents the minimum level of competency needed for safe and effective entry-level nursing practice (Correct answer)
The passing standard requires answering 75% of questions correctly
The passing standard is set at the 50th percentile of all test-takers
The passing standard is based on academic GPA from nursing school

Correct answer: The 'passing standard' represents the minimum level of competency needed for safe and effective entry-level nursing practice

The NCLEX-RN passing standard represents the minimum competency threshold for safe, effective entry-level nursing practice, as determined by NCSBN practice analysis surveys.

Question 21: What is one reason a CGFNS CES application might be returned as incomplete?

The nurse graduated from a BSN program rather than a diploma program
The nurse has more than 10 years of experience
Missing official transcripts sent directly from the nursing school (Correct answer)
The applicant requested expedited processing

Correct answer: Missing official transcripts sent directly from the nursing school

Applications are returned as incomplete when required documents such as official transcripts sent directly from the institution are missing.

Question 22: What is the minimum number of questions an NCLEX-RN candidate can answer before the exam ends under the current NGN format?

265 questions
25 questions
85 questions (Correct answer)
50 questions

Correct answer: 85 questions

Under the current NGN format, the NCLEX-RN has a minimum of 85 questions, which includes both scoreable and pretest items before CAT can determine competency.

Question 23: The nurse asks 'What would you like to focus on today?' at the start of a session. This technique is called:

Confrontation
Exploring
Giving broad openings (Correct answer)
Giving information

Correct answer: Giving broad openings

Giving broad openings invites the patient to set the agenda for the conversation, empowering them to direct discussion toward their most pressing concerns.

Question 24: Cultural competence in therapeutic communication requires the psychiatric nurse to recognize that:

Direct eye contact always signals respect in every cultural context
Direct questioning is universally acceptable in mental health care
Nonverbal communication norms vary significantly across cultures (Correct answer)
Therapeutic techniques should be applied uniformly to all patients

Correct answer: Nonverbal communication norms vary significantly across cultures

Nonverbal communication norms — such as appropriate eye contact, personal space, and physical touch — vary across cultures and must be adapted for culturally competent care.

Question 25: Which framework guides the ANCC PMHN-BC exam content outline?

DSM-5 diagnostic criteria exclusively
The NIH mental health research agenda
The Joint Commission behavioral health standards
ISPN's Psychiatric-Mental Health Nursing: Scope and Standards of Practice (Correct answer)

Correct answer: ISPN's Psychiatric-Mental Health Nursing: Scope and Standards of Practice

The ANCC PMHN-BC exam content outline is derived from ISPN's Scope and Standards of Practice, which defines the competencies of psychiatric-mental health nurses.

Question 26: The nurse will utilize an administration kit specifically intended for flood when preparing for a blood transfusion. The blood administration set with straight tubing will help with the following:

It has a filter that collects fibrin clots. (Correct answer)
It's made to fit an 18- or 19-gauge IV needle.
It makes acetaminophen premedication simple.
It maintains blood temperature to guarantee patient compatibility.

Correct answer: It has a filter that collects fibrin clots.

Blood administration sets are specifically designed with an in-line filter as a critical safety feature. This filter's purpose is to trap any small clots, cellular debris, or fibrin strands that may have formed in the blood product during collection or storage. This prevents these particles from entering the client's circulation and potentially causing adverse reactions or complications like pulmonary emboli.

Question 27: Which type of nurse is the CGFNS VisaScreen certificate primarily designed for?

Nurses seeking ISPN board certification
Internationally educated nurses seeking US occupational visas (Correct answer)
Nurses applying for state-level endorsements
US-born nurses applying for travel nursing

Correct answer: Internationally educated nurses seeking US occupational visas

The CGFNS VisaScreen certificate is required for internationally educated healthcare workers applying for US occupational visas under certain visa categories.

Question 28: A psychiatric patient becomes agitated and says 'You never listen to me!' The MOST therapeutic response is:

I can see you're feeling frustrated — I want to hear what you're experiencing. (Correct answer)
You shouldn't speak to me that way; I'm here to help you.
I'm sorry you feel that way, but that isn't fair to me.
I have been listening carefully to everything you've said.

Correct answer: I can see you're feeling frustrated — I want to hear what you're experiencing.

Acknowledging the patient's frustration and expressing genuine interest in their experience de-escalates tension and maintains the therapeutic relationship without defensiveness.

Question 29: How does passing the CGFNS-QE benefit an internationally educated nurse applying for US licensure?

It replaces the CGFNS CES credentials evaluation
It automatically grants the nurse a US RN license without taking NCLEX
It demonstrates readiness for NCLEX-RN and may satisfy some state board pre-licensure requirements (Correct answer)
It qualifies the nurse for prescriptive authority in all states

Correct answer: It demonstrates readiness for NCLEX-RN and may satisfy some state board pre-licensure requirements

A passing CGFNS-QE score demonstrates readiness for NCLEX-RN and may satisfy certain state board requirements as part of the endorsement process for international nurses.

Question 30: When a nurse seeks clarification during a therapeutic interaction, the primary purpose is to:

Redirect the patient's focus to more productive topics
Guide the patient toward healthier thought patterns
Challenge the patient's interpretation of events
Ensure the nurse accurately understands the patient's experience (Correct answer)

Correct answer: Ensure the nurse accurately understands the patient's experience

Seeking clarification ensures the nurse accurately understands what the patient is communicating, preventing misinterpretation and strengthening therapeutic rapport.

Question 31: An internationally educated nurse who has passed NCLEX-RN wishes to practice in a different US state. Which is true?

They must retake NCLEX-RN for each new state
They can apply for licensure by endorsement in the new state without retaking NCLEX (Correct answer)
They must obtain a new CGFNS-QE score for the new state
They must complete a new nursing degree program in the US

Correct answer: They can apply for licensure by endorsement in the new state without retaking NCLEX

Licensure by endorsement allows nurses who have already passed NCLEX-RN to obtain a license in additional states without repeating the examination.

Question 32: Under the Next Generation NCLEX (NGN), which cognitive skill is most emphasized through the new item types?

Advanced research methodology
Surgical technique
Clinical judgment (Correct answer)
Memorization of drug names

Correct answer: Clinical judgment

NGN's new item types are specifically designed to measure clinical judgment — the nurse's ability to recognize cues, analyze findings, and take appropriate action.

Question 33: A patient with bipolar disorder is admitted in a manic state. Which MSE finding is most expected?

Mutism and poverty of speech
Disorientation to time and place
Flat affect and social withdrawal
Pressured speech and grandiosity (Correct answer)

Correct answer: Pressured speech and grandiosity

Pressured speech (fast, difficult to interrupt) and grandiosity (inflated self-esteem) are hallmark MSE findings during a manic episode of bipolar disorder.

Question 34: Which infection control concept is commonly tested on the CGFNS-QE under the Safe Care Environment category?

Radiation oncology protocols
Advanced pharmacogenomics
Surgical suture techniques
Standard and transmission-based precautions (Correct answer)

Correct answer: Standard and transmission-based precautions

Standard and transmission-based precautions are fundamental infection control measures heavily tested under the Safe and Effective Care Environment category.

Question 35: When a nurse says 'You mentioned feeling overwhelmed — tell me more about that,' which technique is being used?

Restating
Summarizing
Giving information
Exploring (Correct answer)

Correct answer: Exploring

Exploring encourages the patient to elaborate on a topic by inviting them to delve deeper into their thoughts, feelings, or experiences.

Question 36: Which of the following conditions is metoclopramide prescribed for?

Ulcer disease
Vomiting after chemotherapy (Correct answer)
Chronic bronchitis
Tuberculosis

Correct answer: Vomiting after chemotherapy

Metoclopramide (Reglan) is a prokinetic agent and an antiemetic that blocks dopamine receptors in the chemoreceptor trigger zone (CTZ) in the brain, thereby reducing nausea and vomiting. It also increases gastrointestinal motility, which helps empty the stomach. These actions make it particularly effective in managing severe nausea and vomiting, such as that experienced after chemotherapy.

Question 37: A nurse's professional license submitted to CGFNS must generally be:

Current, valid, and unencumbered (Correct answer)
Issued only by the United States
From any healthcare field
Expired but recently held

Correct answer: Current, valid, and unencumbered

CGFNS requires a current, valid, and unencumbered license for its evaluation and VisaScreen services.

Question 38: During a softball game, the client was hit by a wild pitch and incurred an eye injury. What is the nurse's initial response?

Immediately apply ice to the affected area.
Notify the doctor
Perform visual acuity tests
Put on an eye patch. (Correct answer)

Correct answer: Put on an eye patch.

The immediate priority for an eye injury is to protect the eye from further damage and prevent the client from inadvertently touching or rubbing it. Applying an eye patch immobilizes the eye, shields it from external irritants, and helps reduce pain. While other actions like visual acuity tests and notifying the doctor are important, immediate protection is the initial critical step.

Question 39: Under which visa category do most internationally educated nurses immigrate to the US for permanent employment?

H-1B specialty occupation visa
F-1 student visa
B-2 tourist visa
EB-3 (Employment-Based Third Preference) visa (Correct answer)

Correct answer: EB-3 (Employment-Based Third Preference) visa

Most internationally educated nurses immigrate to the US for permanent employment under the EB-3 employment-based immigration visa, which requires CGFNS VisaScreen certification.

Question 40: A foreign-educated nurse completes CGFNS Certification; what must they still typically obtain to practice as an RN in a U.S. state?

Nothing further
A second bachelor's degree
A state nursing license, usually by passing the NCLEX-RN (Correct answer)
A medical degree

Correct answer: A state nursing license, usually by passing the NCLEX-RN

CGFNS Certification does not grant a license; the nurse must still obtain state licensure, typically by passing the NCLEX-RN.

Question 41: Which benzodiazepine property is most important for psychiatric nurses to teach patients regarding long-term use?

Physical dependence and the risk of withdrawal seizures if stopped abruptly (Correct answer)
No risk of interaction with other CNS depressants
Permanent cure of anxiety disorders after 6 months of use
Improved cognitive function over time

Correct answer: Physical dependence and the risk of withdrawal seizures if stopped abruptly

Benzodiazepines cause physical dependence, and abrupt discontinuation after prolonged use can trigger life-threatening withdrawal seizures, requiring gradual tapering.

Question 42: Which document type does CGFNS require to be sent directly from the issuing institution?

A notarized self-statement
A personal photocopy of the diploma
An employer reference letter
Official transcripts and verification of licensure from the source (Correct answer)

Correct answer: Official transcripts and verification of licensure from the source

CGFNS requires official transcripts and license verification sent directly from the educational institution and licensing authority to ensure authenticity.

Question 43: Which one of the following is not a source of acquired immunity?

Antibodies received in response to disease
Antibodies received from the mother
Prescribed multivitamins (Correct answer)
Animal serum

Correct answer: Prescribed multivitamins

Acquired immunity refers to the immunity developed during an individual's lifetime, either actively (e.g., through exposure to disease or vaccination) or passively (e.g., through antibodies received from the mother or animal serum). Prescribed multivitamins provide essential nutrients that support overall health, but they do not directly confer or contribute to acquired immunity itself.

Question 44: Which mood stabilizer requires monitoring of serum levels and is associated with teratogenic risk including neural tube defects?

Valproate (Depakote) (Correct answer)
Lithium
Lamotrigine
Carbamazepine

Correct answer: Valproate (Depakote)

Valproate is associated with neural tube defects and requires serum level monitoring; it is contraindicated in pregnancy due to high teratogenic risk.

Question 45: Before administering a medication, the nurse should verify the rights of medication administration, which include:

Right patient, drug, dose, route, and time (Correct answer)
Right insurance and billing code
Right room temperature
Right visiting hours

Correct answer: Right patient, drug, dose, route, and time

The classic rights of medication administration include the right patient, drug, dose, route, and time.

Question 46: Which of the following best describes the 'advanced practice' tier of psychiatric nursing recognized by ISPN?

Staff nurses who work on inpatient psychiatric units
Psychiatric-Mental Health Nurse Practitioners who diagnose and prescribe (Correct answer)
Nurses with 2 years of psychiatric experience only
Nurses who have completed a CE course in mental health

Correct answer: Psychiatric-Mental Health Nurse Practitioners who diagnose and prescribe

Advanced practice psychiatric nursing is represented by PMHNPs who have graduate education and are authorized to diagnose mental health conditions and prescribe medications.

Question 47: The CGFNS Qualifying Exam (CGFNS-QE) is modeled after which US nursing licensure examination?

MCAT
NAPLEX
NCLEX-RN (Correct answer)
USMLE Step 1

Correct answer: NCLEX-RN

The CGFNS-QE is modeled after the NCLEX-RN and is used to predict whether an internationally educated nurse will pass the US nursing licensure exam.

Question 48: Under ISPN standards, which assessment tool aligns with psychiatric nursing's emphasis on biopsychosocial evaluation?

Glasgow Coma Scale
Braden Scale
Mental Status Examination (MSE) (Correct answer)
APGAR score

Correct answer: Mental Status Examination (MSE)

The Mental Status Examination (MSE) is a structured psychiatric assessment tool that evaluates cognition, affect, and behavior, consistent with biopsychosocial psychiatric nursing practice.

Question 49: Which phase of the therapeutic nurse-patient relationship involves establishing goals, defining roles, and setting expectations for the relationship?

Orientation phase (Correct answer)
Working phase
Pre-orientation phase
Termination phase

Correct answer: Orientation phase

The orientation (introductory) phase is when the nurse and patient establish the parameters of their relationship, including mutual goals, roles, and confidentiality boundaries.

Question 50: Which medication is used as a 'prn' (as-needed) oral intervention for acute agitation in psychiatric inpatient settings?

Lorazepam (Ativan) (Correct answer)
Fluoxetine (Prozac)
Sertraline (Zoloft)
Lithium carbonate

Correct answer: Lorazepam (Ativan)

Lorazepam, a benzodiazepine, is commonly administered on a PRN basis for acute agitation in inpatient psychiatric settings due to its rapid onset.

Question 51: Cultural competence in nursing practice primarily means:

Providing care that respects patients' cultural beliefs, values, and language needs (Correct answer)
Treating all patients identically regardless of background
Avoiding patients from other countries
Requiring patients to adopt the nurse's customs

Correct answer: Providing care that respects patients' cultural beliefs, values, and language needs

Cultural competence means delivering care that respects and responds to patients' cultural beliefs, values, and language needs.

Question 52: Which NCLEX-RN content area covers the nurse's responsibility for safe medication administration?

Psychosocial Integrity
Management of Care
Pharmacological and Parenteral Therapies (Correct answer)
Basic Care and Comfort

Correct answer: Pharmacological and Parenteral Therapies

Pharmacological and Parenteral Therapies covers medication administration, IV therapy, and related nursing responsibilities within the NCLEX-RN test plan.

Question 53: What format of clinical scenario is most commonly used in CGFNS-QE questions?

A fill-in-the-blank drug dosage problem
A brief patient situation followed by a question about the nurse's best action (Correct answer)
A series of calculations with no patient context
A lengthy case study requiring a written essay response

Correct answer: A brief patient situation followed by a question about the nurse's best action

CGFNS-QE questions typically present a brief clinical scenario and ask which nursing action is most appropriate, mirroring the NCLEX-RN question format.

Question 54: How does CGFNS obtain official transcripts from a foreign nursing school?

The applicant uploads scanned copies online
The school sends transcripts directly to CGFNS in a sealed official envelope (Correct answer)
The applicant hand-delivers them to a US embassy
The school emails them to the applicant to forward

Correct answer: The school sends transcripts directly to CGFNS in a sealed official envelope

Official transcripts must be sent directly from the educational institution to CGFNS in a sealed, official envelope to maintain authenticity.

Question 55: The PMHN-BC credential stands for what?

Primary Mental Health Nurse-Basic Certified
Psychiatric-Mental Health Nurse-Board Certified (Correct answer)
Professional Mental Health Nurse-Behavior Certified
Psychiatric-Medical Health Nurse-Broadly Certified

Correct answer: Psychiatric-Mental Health Nurse-Board Certified

PMHN-BC stands for Psychiatric-Mental Health Nurse-Board Certified, the credential awarded to RNs who pass the ANCC psychiatric nursing exam.

Question 56: What is the primary eligibility requirement related to licensure for the PMHN-BC certification?

A foreign nursing credential verified by CGFNS
A DNP degree from an accredited program
An LPN license with 10 years of psychiatric experience
A current, active RN license in the US or its territories (Correct answer)

Correct answer: A current, active RN license in the US or its territories

Applicants must hold a current, active RN license in the US or its territories to be eligible for the PMHN-BC certification.

Question 57: Which step of the nursing process involves collecting subjective and objective data?

Planning
Implementation
Evaluation
Assessment (Correct answer)

Correct answer: Assessment

Assessment is the first step of the nursing process, focused on gathering subjective and objective data.

Question 58: What is the purpose of the CGFNS credentials evaluation (CES) report?

To compare foreign education and licensure to U.S. standards for boards of nursing (Correct answer)
To schedule the NCLEX exam
To grant a U.S. nursing license directly
To issue a U.S. visa

Correct answer: To compare foreign education and licensure to U.S. standards for boards of nursing

The Credentials Evaluation Service report compares a nurse's foreign education and licensure against U.S. standards for state boards of nursing.

Question 59: Which US nursing endorsement process allows an RN licensed in one state to obtain licensure in another state?

Retaking NCLEX-RN in every new state
Endorsement by reciprocity through the new state's board of nursing (Correct answer)
Obtaining a new CGFNS CES report for each state
Passing a state-specific practical examination

Correct answer: Endorsement by reciprocity through the new state's board of nursing

Endorsement allows a nurse licensed in one US state to apply for licensure in another state without retaking NCLEX-RN, provided they meet the new state's requirements.

Question 60: On the CGFNS-QE, which client needs category addresses physiological integrity?

Safe and Effective Care Environment
Psychosocial Integrity
Health Promotion and Maintenance
Physiological Adaptation and Reduction of Risk Potential (Correct answer)

Correct answer: Physiological Adaptation and Reduction of Risk Potential

Physiological Adaptation and Reduction of Risk Potential are subcategories of Physiological Integrity, a major client needs category on both the CGFNS-QE and NCLEX-RN.

Question 61: Which medication is used to treat extrapyramidal side effects (EPS) caused by antipsychotics?

Naloxone (Narcan)
Benztropine (Cogentin) (Correct answer)
Flumazenil (Romazicon)
Lithium carbonate

Correct answer: Benztropine (Cogentin)

Benztropine is an anticholinergic medication used to treat EPS including acute dystonia, pseudoparkinsonism, and akathisia caused by antipsychotic drugs.

Question 62: Which nursing assessment finding would most concern a psychiatric nurse evaluating a patient for command hallucinations?

The patient sleeps more than 10 hours per night
The patient refuses to eat breakfast
The patient reports mild anxiety about hospitalization
The patient reports hearing a voice telling them to hurt themselves or others (Correct answer)

Correct answer: The patient reports hearing a voice telling them to hurt themselves or others

Command hallucinations — voices instructing the patient to harm themselves or others — represent an acute safety risk requiring immediate intervention.

Question 63: In a psychiatric assessment, 'flight of ideas' is best described as which of the following?

Rapid, loosely connected thoughts that jump from topic to topic (Correct answer)
Slow, deliberate thought processing
A fixed false belief held despite evidence to the contrary
Hearing voices that others cannot hear

Correct answer: Rapid, loosely connected thoughts that jump from topic to topic

Flight of ideas refers to a rapid succession of thoughts that are loosely connected, shifting quickly from one idea to another, commonly seen in manic episodes.

Question 64: The VisaScreen certificate issued by CGFNS is required for what purpose?

Hospital employment in the home country
U.S. state licensure
Enrolling in a nursing program
Obtaining an occupational visa to work as a healthcare professional in the U.S. (Correct answer)

Correct answer: Obtaining an occupational visa to work as a healthcare professional in the U.S.

The VisaScreen certificate is required by U.S. immigration law for foreign healthcare workers seeking an occupational visa.

Question 65: What does the CGFNS-QE result report indicate to a state board of nursing?

The nurse's final US licensure status
A guarantee of employment in the state
The nurse's immigration visa approval
The likelihood that the nurse will pass the NCLEX-RN (Correct answer)

Correct answer: The likelihood that the nurse will pass the NCLEX-RN

The CGFNS-QE result indicates the probability of the nurse passing the NCLEX-RN; a passing score signals readiness, but licensure itself is granted by the state board.

Question 66: A patient taking lithium for bipolar disorder reports nausea, tremor, and polyuria. Which nursing action is the priority?

Withhold the next dose without notifying the provider
Check the serum lithium level immediately (Correct answer)
Increase fluid restriction to reduce polyuria
Administer an antiemetic and reassure the patient

Correct answer: Check the serum lithium level immediately

These symptoms suggest possible lithium toxicity; checking the serum lithium level immediately is the priority to determine if toxicity is occurring.

Question 67: What does 'flat affect' indicate in a psychiatric mental status examination?

Inappropriately happy mood in a sad situation
A marked reduction or absence of emotional expressiveness (Correct answer)
Rapid and dramatic mood shifts
An elevated and expansive emotional state

Correct answer: A marked reduction or absence of emotional expressiveness

Flat affect refers to a significant reduction in the range and intensity of emotional expression, commonly seen in schizophrenia and severe depression.

Question 68: A client with hypokalemia is receiving instruction from the nurse. What kind of diet will the nurse be introducing?

Cardiac diet
Sodium-restricted diet
High-potassium diet (Correct answer)
Fat-restricted diet

Correct answer: High-potassium diet

Hypokalemia is a condition characterized by lower-than-normal potassium levels in the blood, which can impair nerve and muscle function, including cardiac activity. To correct this electrolyte imbalance, the nurse would recommend a high-potassium diet. This involves incorporating foods rich in potassium, such as bananas, oranges, leafy green vegetables, and potatoes, to help restore normal potassium levels.

Question 69: Which of the following is an example of a basic-level intervention within psychiatric-mental health nursing according to ISPN standards?

Prescribing psychotropic medications
Performing electroconvulsive therapy
Milieu therapy (Correct answer)
Interpreting neuroimaging studies

Correct answer: Milieu therapy

Milieu therapy, which involves managing the therapeutic environment, is a basic-level psychiatric nursing intervention available to all registered nurses in the specialty.

Question 70: Which NCLEX-RN format change adopted in 2023 affects test-taking strategy for international nurses?

Next Generation NCLEX (NGN) with new item types including case studies and extended multiple response (Correct answer)
Reduction of the exam to 50 questions maximum
Replacement of multiple-choice with all essay questions
Addition of a hands-on clinical simulation component

Correct answer: Next Generation NCLEX (NGN) with new item types including case studies and extended multiple response

The NGN introduced new item types such as extended multiple response, matrix questions, and case studies to better measure clinical judgment, which internationally educated nurses must prepare for.

Question 71: When a patient states 'I feel like two different people living in the same body,' which assessment domain should the psychiatric nurse explore further?

Suicidal ideation
Auditory hallucinations
Dissociation and identity disturbance (Correct answer)
Cognitive impairment

Correct answer: Dissociation and identity disturbance

Feeling like two different people describes a possible dissociative experience or identity disturbance, which requires further assessment for dissociative disorders or trauma history.

Question 72: A patient says 'I've been feeling really anxious about everything lately.' The nurse responds, 'You've been feeling a lot of anxiety lately.' This is an example of:

Clarification
Restating (Correct answer)
Summarizing
Reflection of feeling

Correct answer: Restating

Restating involves repeating back the patient's key words to acknowledge what was said and invite the patient to continue elaborating.

Question 73: A CGFNS-QE candidate who fails the exam may do which of the following?

Reapply and retake the exam after satisfying waiting period requirements (Correct answer)
Automatically receive their nursing license anyway
Appeal to have the score waived by a state board
Transfer their score to a different country's nursing board

Correct answer: Reapply and retake the exam after satisfying waiting period requirements

Candidates who fail the CGFNS-QE may reapply and retake the exam, but they must satisfy applicable waiting period and reapplication requirements.

Question 74: An internationally educated nurse taking NCLEX-RN encounters a question about 'standard precautions.' Which practice does this refer to?

Isolating only patients with confirmed infections
Using full PPE only when a patient has HIV
Treating all patient blood and body fluids as potentially infectious regardless of diagnosis (Correct answer)
Handwashing only when visible soil is present

Correct answer: Treating all patient blood and body fluids as potentially infectious regardless of diagnosis

Standard precautions require treating all blood and body fluids as potentially infectious for every patient, regardless of their known diagnosis or infection status.

Question 75: Which organization provides the Authorization to Test (ATT) letter that internationally educated nurses need to schedule the NCLEX-RN?

CGFNS International
The National Nurses Association
The candidate's employer
Pearson VUE, after the state board approves the candidate's eligibility (Correct answer)

Correct answer: Pearson VUE, after the state board approves the candidate's eligibility

Once a state board approves an international nurse's eligibility, Pearson VUE (NCLEX's test delivery vendor) issues the Authorization to Test (ATT) letter required to schedule the exam.

Question 76: What does the acronym CGFNS stand for?

Commission on Graduates of Foreign Nursing Schools (Correct answer)
Center for Global Foreign Nurse Services
Certification Group for Foreign Nursing Specialists
Council for General Foreign Nursing Standards

Correct answer: Commission on Graduates of Foreign Nursing Schools

CGFNS International stands for the Commission on Graduates of Foreign Nursing Schools.

Question 77: Which resource does CGFNS recommend candidates review to understand what topics appear on the CGFNS-QE?

The official CGFNS-QE Candidate Handbook and content outline (Correct answer)
The Joint Commission hospital accreditation manual
Any foreign nursing textbook published before 1990
US state-specific nursing practice acts only

Correct answer: The official CGFNS-QE Candidate Handbook and content outline

The official CGFNS-QE Candidate Handbook contains the content outline describing exactly what topics and client needs categories are tested on the exam.

Question 78: Which psychiatric nursing assessment strategy is most effective when a patient is acutely psychotic and paranoid?

Restraining the patient immediately as a precaution
Using a calm, non-threatening tone and avoiding sudden movements (Correct answer)
Leaving the patient alone in the room to self-calm
Confronting the patient's delusions directly with factual evidence

Correct answer: Using a calm, non-threatening tone and avoiding sudden movements

A calm, non-threatening approach de-escalates paranoid patients by reducing perceived threat, which is safer and more therapeutic than confrontation or physical intervention.

Question 79: How long is a VisaScreen certificate typically valid?

5 years (Correct answer)
10 years
It never expires
6 months

Correct answer: 5 years

A VisaScreen certificate is generally valid for five years from its issuance date.

Question 80: Which step must an internationally educated nurse complete BEFORE taking the NCLEX-RN in most US states?

Obtain a Social Security number
Complete 500 US clinical hours
Submit a CGFNS CES report to the state board of nursing (Correct answer)
Pass the CGFNS-QE

Correct answer: Submit a CGFNS CES report to the state board of nursing

Most state boards of nursing require a CGFNS CES report verifying that an internationally educated nurse's credentials meet US standards before NCLEX eligibility is granted.

Question 81: Which of the following is the most important assessment for a client receiving bumetanide (Bumex) intravenously for acute congestive heart failure?

Monitoring weight loss
Monitoring potassium level
Monitoring blood pressure (Correct answer)
Monitoring urine output

Correct answer: Monitoring blood pressure

Bumetanide (Bumex) is a potent loop diuretic used to treat fluid overload in conditions like acute congestive heart failure. Diuretics promote significant fluid excretion, which can lead to volume depletion and a dangerous drop in blood pressure (hypotension). Therefore, closely monitoring blood pressure is the most important assessment to ensure patient safety and prevent adverse cardiovascular events.

Question 82: A patient reports a pain level of 8 out of 10 after surgery; the nurse's priority action is to:

Discharge the patient
Document and reassess in 4 hours
Tell the patient pain is expected
Assess the pain and administer prescribed analgesia (Correct answer)

Correct answer: Assess the pain and administer prescribed analgesia

Severe reported pain warrants assessment and prompt administration of prescribed pain relief.

Question 83: A CGFNS-QE question asks about the correct action when a patient's oxygen saturation drops to 88%. What category does this fall under?

Health Promotion
Physiological Adaptation (Correct answer)
Psychosocial Integrity
Safe Environment — Safety and Infection Control

Correct answer: Physiological Adaptation

Responding to a declining oxygen saturation is a physiological adaptation scenario involving recognition and management of acute physiological changes.

Question 84: Which area of the CGFNS-QE covers nursing interventions related to pain management?

Physiological Integrity — Basic Care and Comfort (Correct answer)
Safe and Effective Care Environment — Management of Care
Psychosocial Integrity
Health Promotion and Maintenance

Correct answer: Physiological Integrity — Basic Care and Comfort

Pain management falls under Physiological Integrity, specifically the Basic Care and Comfort subcategory, which addresses comfort and rest interventions.

Question 85: How many hours of psychiatric-mental health nursing practice are required to sit for the PMHN-BC exam?

No practice hours are required
500 hours total in any setting
2,000 hours within the past 3 years (Correct answer)
10,000 hours over a 10-year career

Correct answer: 2,000 hours within the past 3 years

Applicants must have a minimum of 2,000 hours of clinical practice in psychiatric-mental health nursing within the past 3 years to qualify for PMHN-BC.

Question 86: Which organization is responsible for developing and administering the NCLEX-RN examination?

CGFNS International
National Council of State Boards of Nursing (NCSBN) (Correct answer)
American Nurses Association (ANA)
National Institutes of Health (NIH)

Correct answer: National Council of State Boards of Nursing (NCSBN)

The NCSBN develops and owns the NCLEX-RN, which is used by US state boards of nursing to determine minimum competency for RN licensure.

Question 87: Which rating scale is commonly used by psychiatric nurses to assess depression severity?

Glasgow Coma Scale
Morse Fall Scale
Braden Scale for Pressure Sores
Patient Health Questionnaire-9 (PHQ-9) (Correct answer)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a validated 9-item self-report tool used to screen for and assess the severity of depression in clinical settings.

Question 88: A temperature of 101 degrees has been recorded in a patient with acquired immunodeficiency syndrome and pneumocystis jiroveci infection. Pentamidine is administered to the patient (pentam 300). Which of the following symptoms does a fever indicate?

The patient's thermoregulation has become insufficient.
The medication's dose is too low.
Another infection developed as a result of the medication's leukopenic side effects. (Correct answer)
The drug is causing side effects in the patient.

Correct answer: Another infection developed as a result of the medication's leukopenic side effects.

Pentamidine, used to treat Pneumocystis jiroveci infection in AIDS patients, can cause bone marrow suppression, leading to leukopenia (low white blood cell count). In an immunocompromised patient with leukopenia, a fever is a critical indicator of a new or worsening infection. Their compromised immune system makes them highly susceptible to opportunistic infections, and fever signals the body's struggle against pathogens.

Question 89: A nurse notes that a patient looks away and becomes quiet whenever family is mentioned. The nurse says 'I notice you seem uncomfortable when we talk about your family.' This is an example of:

Interpreting behavior
Voicing doubt
Making observations (Correct answer)
Confrontation

Correct answer: Making observations

Making observations involves describing what the nurse has noticed about the patient's behavior or affect without interpreting it, inviting the patient to explore its meaning.

Question 90: Which professional behavior best demonstrates ethical nursing practice valued across these standards?

Skipping documentation to save time
Making decisions for competent patients without input
Maintaining patient confidentiality and obtaining informed consent (Correct answer)
Sharing patient information freely with visitors

Correct answer: Maintaining patient confidentiality and obtaining informed consent

Protecting confidentiality and ensuring informed consent are core ethical obligations in professional nursing.

Question 91: ISPN's standards of practice for psychiatric-mental health nurses are published in collaboration with which organization?

National Alliance on Mental Illness (NAMI)
American Psychiatric Nurses Association (APNA) (Correct answer)
American Medical Association (AMA)
Centers for Medicare & Medicaid Services (CMS)

Correct answer: American Psychiatric Nurses Association (APNA)

ISPN collaborates with the American Psychiatric Nurses Association (APNA) to develop and publish the scope and standards of psychiatric-mental health nursing practice.

Question 92: When conducting a psychiatric nursing assessment, asking 'What would you do if you found a stamped, addressed envelope on the sidewalk?' tests which cognitive function?

Language fluency
Abstract thinking and judgment (Correct answer)
Spatial orientation
Long-term memory

Correct answer: Abstract thinking and judgment

This classic question assesses abstract thinking and judgment by evaluating whether the patient can reason beyond a literal level and make a socially appropriate decision.

Question 93: Which scale is used in psychiatric nursing to monitor alcohol withdrawal severity?

Young Mania Rating Scale (YMRS)
Columbia Suicide Severity Rating Scale (C-SSRS)
GAD-7
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) (Correct answer)

Correct answer: Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar)

The CIWA-Ar is the standard clinical tool for monitoring alcohol withdrawal symptoms and guiding pharmacological management in detoxification settings.

Question 94: During a psychiatric nursing assessment, which question best screens for suicidal ideation?

'How long have you been in the hospital?'
'Are you feeling happy today?'
'Do you take any prescription medications?'
'Have you had any thoughts of harming yourself or ending your life?' (Correct answer)

Correct answer: 'Have you had any thoughts of harming yourself or ending your life?'

Directly asking about thoughts of self-harm or suicide is the most effective and evidence-based screen for suicidal ideation in psychiatric nursing assessment.

Question 95: Under the NGN NCLEX-RN, which new item type presents a patient scenario in 6 sequential 'tabs' of information for the candidate to analyze?

Matrix/grid question
Extended drag-and-drop
Bow-tie item
Unfolding case study (Correct answer)

Correct answer: Unfolding case study

The unfolding case study presents evolving patient information across 6 connected tabs, testing how nurses analyze and respond to changing clinical situations.

Question 96: When prescribing Allopurinol (Zyloprim) to a patient, the nurse should include the following instructions:

That swelling of the lips is a normal and expected reaction.
The medicine should be taken on an empty stomach.
a daily fluid intake of 3000 mL (Correct answer)
The medication's effect will be felt right away.

Correct answer: a daily fluid intake of 3000 mL

Allopurinol (Zyloprim) is prescribed to reduce uric acid levels, which helps prevent gout attacks and kidney stones. Maintaining a high fluid intake, typically around 3000 mL daily, is crucial when taking allopurinol. This increased hydration helps to promote the excretion of uric acid and its metabolites through the kidneys, thereby preventing the formation of uric acid kidney stones.

Question 97: Which scenario would most likely delay a CGFNS credentials evaluation?

Documents sent directly by the school
Transcripts that arrive incomplete or not from the source institution (Correct answer)
An unencumbered current license
An accepted English test score

Correct answer: Transcripts that arrive incomplete or not from the source institution

Incomplete documents or those not sent directly from the source institution commonly delay the evaluation.

Question 98: What happens if CGFNS cannot verify a foreign nursing school's accreditation status?

The credentials evaluation cannot be completed and the report may be withheld (Correct answer)
The applicant automatically fails the NCLEX
The application is escalated to ANCC
CGFNS issues a conditional approval

Correct answer: The credentials evaluation cannot be completed and the report may be withheld

If CGFNS cannot verify a school's accreditation, the credentials evaluation cannot be completed and the report will not be issued.

Question 99: The treatment of which symptom is the expected effect of omeprazole (Prilosec).

Flatulence
Heartburn (Correct answer)
Constipation
Diarrhea

Correct answer: Heartburn

Omeprazole (Prilosec) is a proton pump inhibitor (PPI) that works by irreversibly blocking the enzyme responsible for producing stomach acid. Heartburn is a primary symptom caused by stomach acid refluxing into the esophagus. By significantly reducing acid production, omeprazole effectively alleviates and prevents heartburn associated with gastroesophageal reflux disease (GERD).

Question 100: Which U.S. agency requires the VisaScreen certificate under immigration law?

The Department of Education
The CDC
The FDA
U.S. Citizenship and Immigration Services (USCIS) (Correct answer)

Correct answer: U.S. Citizenship and Immigration Services (USCIS)

U.S. Citizenship and Immigration Services requires the VisaScreen certificate for foreign healthcare worker visas.

Question 101: What is the typical processing time applicants should expect for a standard CGFNS CES report?

Several months depending on response times from foreign institutions (Correct answer)
24–48 hours after submission
One business week
Exactly 30 days by law

Correct answer: Several months depending on response times from foreign institutions

CES processing can take several months because CGFNS must contact foreign institutions and verify documents, which varies by country.

Question 102: Which of the following best describes the CGFNS Qualifying Exam (CGFNS-QE)?

The final licensing exam required to practice in the US
An exam exclusively for psychiatric nurses
A continuing education assessment for experienced RNs
A predictor exam that assesses readiness for the NCLEX-RN for internationally educated nurses (Correct answer)

Correct answer: A predictor exam that assesses readiness for the NCLEX-RN for internationally educated nurses

The CGFNS-QE is a predictor examination designed to assess whether internationally educated nurses are likely to pass the NCLEX-RN.

Question 103: What does CGFNS verify when reviewing a foreign nursing license for CES?

That the nurse holds a BSN degree
That the nurse passed the NCLEX-RN
That the nurse has at least five years of experience
That the license was valid and in good standing at the time of graduation (Correct answer)

Correct answer: That the license was valid and in good standing at the time of graduation

CGFNS confirms the foreign nursing license was valid and in good standing when the nurse graduated and practiced.

Question 104: When a client has been sexually abused, the nurse is in the preinteraction phase of the nurse-client relationship. During this time, the nurse should do:

Determine how people react to termination and separation.
Examine the personal beliefs, preconceptions, and biases as they relate to the nurse-client interaction. (Correct answer)
Actively listen to the client as he expresses his feelings and thoughts.
Identify themes in patient behavior patterns and potential coping methods.

Correct answer: Examine the personal beliefs, preconceptions, and biases as they relate to the nurse-client interaction.

The preinteraction phase of the nurse-client relationship occurs before the nurse physically meets the client. During this crucial phase, the nurse's primary task is self-reflection and self-assessment. This involves examining personal beliefs, preconceptions, and potential biases related to the client's situation to ensure the provision of non-judgmental, empathetic, and professional care.

Question 105: On Coumadin, the client had a prothrombin time of 20 seconds and a control time of 11 seconds. According to the nurse, this means:

Test needs to be repeated
Within the therapeutic range (Correct answer)
The results are above the therapeutic range.
Results are lower than the needed therapeutic level

Correct answer: Within the therapeutic range

Coumadin (warfarin) is an anticoagulant, and its therapeutic effect is monitored by the prothrombin time (PT) and International Normalized Ratio (INR). A common therapeutic range for PT when a client is on warfarin is 1.5 to 2.5 times the control value. With a client's PT of 20 seconds and a control of 11 seconds, the ratio is approximately 1.82 (20/11), which falls within this established therapeutic range.

Question 106: Summarizing in therapeutic communication is MOST useful for:

Gathering new information from the patient
Providing closure and reviewing key themes at the end of a session (Correct answer)
Redirecting the patient away from distressing content
Encouraging the patient to explore a specific topic in depth

Correct answer: Providing closure and reviewing key themes at the end of a session

Summarizing reviews the main themes of a conversation to provide closure, confirm mutual understanding, and help the patient reflect on what was discussed.

Question 107: Which medication is FDA-approved for the treatment of opioid use disorder by blocking opioid receptors?

Quetiapine (Seroquel)
Clonazepam (Klonopin)
Naltrexone (Vivitrol) (Correct answer)
Valproate (Depakote)

Correct answer: Naltrexone (Vivitrol)

Naltrexone is an opioid antagonist FDA-approved for treating opioid use disorder and alcohol use disorder by blocking the euphoric effects of opioids.

Question 108: What is the purpose of the Columbia Suicide Severity Rating Scale (C-SSRS) in psychiatric nursing?

To diagnose borderline personality disorder
To systematically assess and document the severity of suicidal ideation and behavior (Correct answer)
To assess cognitive impairment in elderly patients
To measure depression medication adherence

Correct answer: To systematically assess and document the severity of suicidal ideation and behavior

The C-SSRS provides a structured, validated framework to assess the intensity and nature of suicidal ideation and behavior, supporting clinical decision-making and safety planning.

Question 109: An internationally educated nurse's CGFNS CES report is typically submitted to whom?

Directly to NCLEX testing centers
State boards of nursing or employers requesting the report (Correct answer)
The US Bureau of Labor Statistics
The nurse's home country government

Correct answer: State boards of nursing or employers requesting the report

CES reports are delivered to state boards of nursing or employers who require credential verification as part of the licensure or hiring process.

Question 110: What is the primary purpose of the CGFNS Credentials Evaluation Service (CES)?

To issue work visas for nurses
To administer the NCLEX-RN examination
To verify and evaluate the educational and licensure credentials of internationally educated nurses (Correct answer)
To provide continuing education credits

Correct answer: To verify and evaluate the educational and licensure credentials of internationally educated nurses

CGFNS CES verifies and evaluates educational and licensure credentials of internationally educated health professionals seeking to work in the US.

Question 111: Which component of the Mental Status Examination (MSE) evaluates whether a patient knows the current date, location, and their own identity?

Orientation (Correct answer)
Thought content
Affect
Insight

Correct answer: Orientation

Orientation assesses whether the patient is oriented to person, place, and time — a foundational component of the Mental Status Examination.

Question 112: Which tool is used in psychiatric nursing to assess the risk of violence toward others?

Hamilton Anxiety Rating Scale
Brøset Violence Checklist (BVC) (Correct answer)
CAGE questionnaire
CIWA-Ar

Correct answer: Brøset Violence Checklist (BVC)

The Brøset Violence Checklist (BVC) is a validated tool used in inpatient psychiatric settings to assess short-term risk of patient violence.

Question 113: A nurse who identifies a medication error they made should first:

Report it promptly and assess the patient for harm (Correct answer)
Conceal it to avoid blame
Wait until the end of the shift
Blame the pharmacy

Correct answer: Report it promptly and assess the patient for harm

Ethical and safe practice requires promptly reporting the error and assessing the patient for any harm.

Question 114: Which antipsychotic side effect requires the psychiatric nurse to regularly monitor for abnormal involuntary movements?

Serotonin syndrome
Tardive dyskinesia (Correct answer)
Agranulocytosis
Hypertensive crisis

Correct answer: Tardive dyskinesia

Tardive dyskinesia — repetitive, involuntary movements — is a serious long-term side effect of antipsychotic medications requiring regular monitoring with tools like the AIMS.

Question 115: When a nurse sits quietly with a grieving patient without attempting to fill the silence, this illustrates:

Passive disengagement from the patient
Avoidant communication style
Therapeutic use of silence (Correct answer)
Social withdrawal by the nurse

Correct answer: Therapeutic use of silence

Therapeutic use of silence allows the patient time to process emotions and communicate at their own pace while the nurse's presence conveys support.

Question 116: Which of the following reports would be useful to a nurse caring for a pyrazinamide-addicted client?

Sputum culture (Correct answer)
Lead test
Complete blood count
Blood culture

Correct answer: Sputum culture

Pyrazinamide is an antitubercular drug used in the treatment of tuberculosis (TB). A sputum culture is a diagnostic test that identifies the presence of Mycobacterium tuberculosis in respiratory secretions. Monitoring sputum cultures during treatment is essential to assess the effectiveness of the medication in eradicating the bacteria and to determine when the client is no longer infectious.

Question 117: The nurse expects the following laboratory tests to evaluate the therapeutic impact of heparin intravenously given to the client:

Hemoglobin
Prothrombin time
Activated partial thromboplastin time (Correct answer)
Hematocrit

Correct answer: Activated partial thromboplastin time

Heparin is an anticoagulant medication that works by enhancing the activity of antithrombin, which inhibits various clotting factors. The therapeutic effect of unfractionated heparin is primarily monitored by measuring the activated partial thromboplastin time (aPTT). The aPTT assesses the intrinsic and common pathways of coagulation, which are directly affected by heparin's action.

Question 118: Methamphetamine (Desoxyn) was prescribed to a 8-year-old girl who was overly energetic at home. The nurse instructs the parents to do:

Make sure to take the prescription after a full meal.
Ensure that the child sleeps for at least 8 hours.
Give the last dose at least 6 hours before going to bed. (Correct answer)
Establish that the child eats a low-sodium diet

Correct answer: Give the last dose at least 6 hours before going to bed.

Methamphetamine (Desoxyn) is a central nervous system stimulant used for ADHD, similar to other amphetamines. Like other stimulants, it can cause insomnia and interfere with sleep. To prevent sleep disturbances, the last dose of the medication should be given at least 6 hours before bedtime, allowing its stimulating effects to diminish before the child attempts to sleep.

Question 119: Which organization officially authorizes CGFNS to issue VisaScreen certificates?

The World Health Organization
The US Department of Health and Human Services (Correct answer)
The National Council of State Boards of Nursing
The American Nurses Association

Correct answer: The US Department of Health and Human Services

The US Department of Health and Human Services designated CGFNS as an approved credentialing organization authorized to issue VisaScreen certificates.

Question 120: When preparing for the CGFNS-QE, why is understanding US nursing scope of practice important?

Because CGFNS only accepts candidates from countries that mirror US nursing laws
Because passing requires knowledge of US immigration law
Because exam questions are based on US standards of nursing practice, which may differ from the nurse's home country (Correct answer)
Because US scope of practice is tested as trivia about American history

Correct answer: Because exam questions are based on US standards of nursing practice, which may differ from the nurse's home country

Questions are written according to US nursing scope of practice standards, so candidates from other countries must understand how US nursing roles and responsibilities are defined.

Question 121: What dietary restriction must a patient taking a monoamine oxidase inhibitor (MAOI) follow?

Limit water intake to 1 liter per day
Avoid vitamin C-containing foods
Avoid all dairy products
Avoid tyramine-rich foods such as aged cheeses, cured meats, and red wine (Correct answer)

Correct answer: Avoid tyramine-rich foods such as aged cheeses, cured meats, and red wine

MAOIs inhibit the breakdown of tyramine; consuming tyramine-rich foods can trigger a hypertensive crisis, making dietary restriction essential for patient safety.

Question 122: Which compact agreement allows nurses to practice in multiple US states with one license?

NAFTA Healthcare Agreement
Interstate Medical Compact
Nurse Licensure Compact (NLC) (Correct answer)
Federal Nurse Practice Act

Correct answer: Nurse Licensure Compact (NLC)

The Nurse Licensure Compact (NLC) allows nurses holding a multistate license in their primary state of residence to practice in other NLC member states without obtaining additional licenses.

Question 123: Which nursing intervention is most important when a patient taking clozapine develops a sore throat and fever?

Document the finding and reassess in 24 hours
Obtain a CBC with differential and notify the provider immediately (Correct answer)
Encourage increased oral fluid intake only
Administer acetaminophen and reassure the patient

Correct answer: Obtain a CBC with differential and notify the provider immediately

Sore throat and fever in a patient on clozapine may indicate agranulocytosis; an immediate CBC with differential is required to assess the white blood cell count.

Question 124: Which laboratory value must be monitored regularly in patients taking clozapine (Clozaril)?

Serum potassium
Absolute neutrophil count (ANC) (Correct answer)
Blood glucose
Thyroid-stimulating hormone (TSH)

Correct answer: Absolute neutrophil count (ANC)

Clozapine can cause agranulocytosis; regular ANC monitoring is mandatory and patients must be enrolled in a Risk Evaluation and Mitigation Strategy (REMS) program.

Question 125: When prioritizing care for multiple patients, which principle should a nurse apply first?

Room number sequence
Order of admission
Airway, breathing, and circulation (ABCs) (Correct answer)
Alphabetical order of patient names

Correct answer: Airway, breathing, and circulation (ABCs)

Life-threatening airway, breathing, and circulation problems take priority in patient care decisions.

Question 126: Passing the CGFNS Qualifying Exam predicts likelihood of success on which U.S. exam?

The TOEFL
The NCLEX-RN (Correct answer)
The USMLE
The MCAT

Correct answer: The NCLEX-RN

The CGFNS Qualifying Exam is designed to predict a candidate's likelihood of passing the NCLEX-RN.

Question 127: A nurse maintains appropriate eye contact, leans slightly toward the patient, and nods during the conversation. These behaviors are examples of:

Non-therapeutic social mannerisms
Boundary violations in psychiatric nursing
Therapeutic nonverbal communication (Correct answer)
Verbal therapeutic techniques

Correct answer: Therapeutic nonverbal communication

Therapeutic nonverbal communication — including appropriate eye contact, open body posture, and nodding — conveys attentiveness, respect, and genuine interest.

Question 128: On the CGFNS-QE, a question about teaching a newly diagnosed diabetic patient about insulin self-injection falls under which category?

Health Promotion and Maintenance (Correct answer)
Management of Care
Physiological Adaptation
Psychosocial Integrity

Correct answer: Health Promotion and Maintenance

Patient teaching about self-management of a chronic condition such as diabetes falls under Health Promotion and Maintenance on both the CGFNS-QE and NCLEX-RN.

Question 129: A patient has voluntarily checked herself into the hospital's mental health unit. The nurse anticipates the following from the client:

The patient will be participating in the treatment and care planning. (Correct answer)
The client will be angry and confrontational
The client refuses to be treated.
The client's family is not going to cooperate.

Correct answer: The patient will be participating in the treatment and care planning.

A client who has voluntarily checked into a mental health unit has chosen to seek treatment and engage in their care. This implies a willingness to participate actively in their treatment and care planning. Voluntary admission grants the client more autonomy and rights regarding their treatment decisions compared to involuntary commitment.

Question 130: What document does a state board of nursing issue to an internationally educated nurse who has passed NCLEX-RN and met all licensure requirements?

ANCC board certification
Registered Nurse (RN) license for that state (Correct answer)
VisaScreen certificate
CGFNS CES report

Correct answer: Registered Nurse (RN) license for that state

Upon passing NCLEX-RN and meeting all requirements, the state board issues the nurse an RN license for that state, authorizing legal practice as a registered nurse.

Question 131: Which English proficiency exam is accepted by CGFNS for VisaScreen purposes?

TOEFL iBT (Correct answer)
USMLE
MCAT
GRE

Correct answer: TOEFL iBT

CGFNS accepts the TOEFL iBT (among other approved tests) as evidence of English language proficiency for VisaScreen certification.

Question 132: How long is the PMHN-BC certification valid before renewal is required?

5 years (Correct answer)
10 years
1 year
2 years

Correct answer: 5 years

ANCC certifications including PMHN-BC are valid for 5 years, after which recertification through CE or re-examination is required.

Question 133: Which three components make up the CGFNS Certification Program?

Background check, fingerprinting, and oath
Clinical rotation, thesis, and viva
Credentials review, the qualifying exam, and an English language test (Correct answer)
Interview, essay, and practicum

Correct answer: Credentials review, the qualifying exam, and an English language test

The CGFNS Certification Program consists of a credentials review, the CGFNS Qualifying Exam, and an English language proficiency test.

Question 134: A assistance group has been talking with a depressed hospital patient. Which behaviors suggest that the patient is on the verge of committing suicide?

The patient begins to give away his or her stuff. (Correct answer)
The patient expresses his dissatisfaction with the other members of the group to the nurse.
The patient has outbursts of anger
Because he dislikes the group leader, the patient requests to be placed in another group.

Correct answer: The patient begins to give away his or her stuff.

A critical warning sign of impending suicide, especially in a depressed individual, is the act of giving away cherished possessions or making final arrangements. This behavior often indicates that the person has made a decision to end their life and is 'tying up loose ends.' It suggests a shift from suicidal ideation to concrete planning and intent, requiring immediate and urgent intervention.

Question 135: A patient states 'I don't know if I can go on.' The MOST therapeutic nurse response is:

I'm sure you'll feel better soon.
Are you thinking about harming yourself? (Correct answer)
Let's focus on the positive things in your life.
Everyone feels that way sometimes.

Correct answer: Are you thinking about harming yourself?

When a patient's statement may indicate suicidal ideation, the nurse must directly assess safety by asking about thoughts of self-harm.

Question 136: According to ISPN, the psychiatric-mental health nurse's role in health promotion includes which activity?

Conducting brain MRI interpretations
Performing psychiatric diagnostic interviews only
Prescribing antipsychotic medications
Providing psychoeducation to patients and families about mental illness and treatment (Correct answer)

Correct answer: Providing psychoeducation to patients and families about mental illness and treatment

Psychoeducation — teaching patients and families about mental illness, symptoms, and treatment — is a key health promotion activity for psychiatric-mental health nurses.

Question 137: For the PMHN-BC exam, which content area addresses the nurse's role in managing psychiatric emergencies?

Pharmacology and prescribing protocols
Health informatics
Crisis intervention and de-escalation (Correct answer)
Research methodology

Correct answer: Crisis intervention and de-escalation

Crisis intervention and de-escalation is a core content area for the PMHN-BC, covering the RN's role in managing acute psychiatric emergencies safely.

Question 138: What language must all documents submitted to CGFNS be translated into if originally in a foreign language?

English (Correct answer)
Spanish
French
The official language of the applicant's home country

Correct answer: English

All documents submitted to CGFNS must be accompanied by certified English translations if they are originally written in another language.

Question 139: An order for Bupropion (Wellbutrin) has been placed with a client. When is it appropriate for the nurse to give the order?

Immediately before bed
When the patient requests it
Early in the day (Correct answer)
On an empty stomach

Correct answer: Early in the day

Bupropion (Wellbutrin) is an antidepressant that can have stimulating effects on the central nervous system. To minimize the risk of insomnia and other sleep disturbances, it is typically advised to administer bupropion early in the day, often in the morning. Taking it later in the day could interfere with the patient's ability to fall asleep.

Question 140: The therapy in which a client's feelings, attitudes, and behaviors are modified by focusing on the therapist-client relationship is called:

Interpersonal psychotherapy (Correct answer)
Behavior therapy
Cognitive therapy
Family therapy

Correct answer: Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is a focused, time-limited form of therapy that emphasizes the role of interpersonal relationships and social functioning in mental health. It aims to help clients improve their communication patterns and the way they relate to others, thereby modifying maladaptive feelings, attitudes, and behaviors that contribute to their psychological distress.

Question 141: A patient with paranoid delusions states 'The government is monitoring all my phone calls.' The MOST therapeutic nurse response is:

That must feel frightening. What has been happening for you recently? (Correct answer)
Let me call the doctor to reassess your medications right away.
I find that hard to believe. What makes you think that?
That's impossible — the government doesn't do that to private citizens.

Correct answer: That must feel frightening. What has been happening for you recently?

Acknowledging the patient's emotional experience without reinforcing or arguing against the delusion preserves the therapeutic relationship and gathers useful clinical information.

Question 142: Which second-generation (atypical) antipsychotic is FDA-approved for treatment-resistant schizophrenia?

Clozapine (Clozaril) (Correct answer)
Perphenazine (Trilafon)
Chlorpromazine (Thorazine)
Haloperidol (Haldol)

Correct answer: Clozapine (Clozaril)

Clozapine is the only FDA-approved antipsychotic for treatment-resistant schizophrenia, though its use requires strict monitoring due to agranulocytosis risk.

Question 143: What does the acronym ISPN refer to in the context of nurse credentialing programs?

Institute for Surgical and Pediatric Nursing
International Standards for Professional Nurses (Correct answer)
International Society of Public Nursing
Internal Service for Patient Notification

Correct answer: International Standards for Professional Nurses

In this credentialing context ISPN refers to International Standards for Professional Nurses.

Question 144: In a psychiatric nursing assessment, which finding suggests a patient may have a thought insertion delusion?

The patient feels detached from their own body
The patient cannot recall recent events
The patient hears music that others cannot hear
The patient believes external forces are placing thoughts into their mind (Correct answer)

Correct answer: The patient believes external forces are placing thoughts into their mind

Thought insertion is a delusion in which the patient believes that external entities or forces are implanting thoughts into their mind, a symptom of psychosis.

Question 145: Which credential is most directly comparable in purpose to CGFNS for foreign-educated nurses entering the U.S.?

A CPR card
A pharmacy technician license
A teaching certificate
A state board credentials evaluation service (Correct answer)

Correct answer: A state board credentials evaluation service

A state board's credentials evaluation serves a comparable purpose, assessing foreign education against U.S. licensure standards.

Question 146: Which organization administers the ISPN psychiatric-mental health nursing certification examinations?

Commission on Graduates of Foreign Nursing Schools (CGFNS)
American Nurses Credentialing Center (ANCC) (Correct answer)
American Psychiatric Nurses Association
National Board of Nursing Specialists

Correct answer: American Nurses Credentialing Center (ANCC)

The American Nurses Credentialing Center (ANCC) administers psychiatric-mental health nursing certification examinations endorsed by ISPN.

Question 147: The technique of 'focusing' in therapeutic communication is BEST described as:

Directing the conversation to a specific theme or concern (Correct answer)
Repeating the main points the patient has made
Asking multiple questions to explore all aspects of a problem simultaneously
Pausing to allow the patient to think in silence

Correct answer: Directing the conversation to a specific theme or concern

Focusing helps the patient concentrate on a specific topic that is particularly relevant to their care, preventing the conversation from becoming too diffuse.

Question 148: Which English language test is commonly accepted within the CGFNS Certification Program?

GMAT
GRE
SAT
TOEFL iBT or IELTS Academic (Correct answer)

Correct answer: TOEFL iBT or IELTS Academic

CGFNS accepts approved English proficiency tests such as the TOEFL iBT and IELTS Academic.

Question 149: Which advanced practice certification in psychiatric nursing requires a graduate-level nursing degree?

PMHNP-BC (Psychiatric-Mental Health Nurse Practitioner-Board Certified) (Correct answer)
CMSRN (Certified Medical-Surgical Registered Nurse)
CEN (Certified Emergency Nurse)
PMHN-BC (Psychiatric-Mental Health Nurse-Board Certified)

Correct answer: PMHNP-BC (Psychiatric-Mental Health Nurse Practitioner-Board Certified)

The PMHNP-BC requires a graduate degree (MSN or DNP) with a psychiatric-mental health nurse practitioner focus, unlike the RN-level PMHN-BC.

Question 150: When the nurse uses the technique of 'restating,' the nurse:

Repeats the patient's exact words to prompt further elaboration (Correct answer)
Summarizes the main themes of the entire conversation
Reflects the emotional content of what the patient expressed
Paraphrases the patient's message in different words

Correct answer: Repeats the patient's exact words to prompt further elaboration

Restating involves repeating the patient's own key words back to them to acknowledge what was said and encourage the patient to continue elaborating.

Question 151: A patient taking an atypical antipsychotic gains 15 pounds and develops hyperglycemia. These findings are characteristic of which side effect syndrome?

Serotonin syndrome
Tardive dyskinesia
Stevens-Johnson syndrome
Metabolic syndrome (Correct answer)

Correct answer: Metabolic syndrome

Atypical antipsychotics are associated with metabolic syndrome, which includes weight gain, hyperglycemia, dyslipidemia, and increased cardiovascular risk.

Question 152: Which client needs category on the CGFNS-QE addresses mental health and coping mechanisms?

Psychosocial Integrity (Correct answer)
Reduction of Risk Potential
Health Promotion and Maintenance
Physiological Integrity

Correct answer: Psychosocial Integrity

Psychosocial Integrity covers mental health, coping, crisis intervention, and psychosocial support — all key content areas within the CGFNS-QE.

Question 153: 'Voicing doubt' as a therapeutic technique involves:

Asking the patient for evidence to support their stated beliefs
Directly telling the patient their beliefs are irrational
Expressing uncertainty about the patient's interpretation without direct confrontation (Correct answer)
Remaining silent to avoid reinforcing false beliefs

Correct answer: Expressing uncertainty about the patient's interpretation without direct confrontation

Voicing doubt gently expresses the nurse's uncertainty about the patient's perception of reality without direct argument, preserving rapport while introducing gentle reality testing.

Question 154: Which nursing concept is central to questions on the CGFNS-QE related to patient safety?

Prioritization and delegation (Correct answer)
Research grant writing
Hospital administration finance
Advanced surgical techniques

Correct answer: Prioritization and delegation

Prioritization and delegation are central patient safety concepts heavily tested on the CGFNS-QE, reflecting NCLEX-RN's focus on safe nursing practice.

Question 155: A psychiatric nurse who documents a patient's delusions, hallucinations, and flat affect is performing which part of the nursing process?

Planning
Implementation
Evaluation
Assessment (Correct answer)

Correct answer: Assessment

Documenting symptoms such as delusions, hallucinations, and affect is part of the assessment phase of the nursing process in psychiatric care.

Question 156: What is the significance of 'therapeutic communication' questions on the CGFNS-QE?

They evaluate advanced diagnostic reasoning
They test the nurse's ability to select appropriate verbal and nonverbal responses to patients in various clinical scenarios (Correct answer)
They test foreign language translation skills
They assess nursing research methodology

Correct answer: They test the nurse's ability to select appropriate verbal and nonverbal responses to patients in various clinical scenarios

Therapeutic communication questions assess whether nurses can identify the most helpful responses to patients, a core skill across medical, surgical, and psychiatric settings.

Question 157: The CGFNS Certification Program is primarily designed for which group?

Physicians trained abroad
U.S.-educated registered nurses only
Nursing assistants in the United States
Foreign-educated first-level general nurses seeking U.S. licensure (Correct answer)

Correct answer: Foreign-educated first-level general nurses seeking U.S. licensure

The CGFNS Certification Program evaluates foreign-educated first-level general nurses planning to practice in the United States.

Question 158: In a psychiatric assessment, 'loosening of associations' refers to which thought process abnormality?

Disorganized thinking where connections between ideas are unclear or absent (Correct answer)
Repeating the same word or phrase involuntarily
Inability to start new topics of conversation
Abrupt stopping of speech mid-sentence

Correct answer: Disorganized thinking where connections between ideas are unclear or absent

Loosening of associations describes disorganized thinking where the logical connection between sequential ideas is unclear, a common feature of psychotic disorders.

Question 159: The CGFNS Qualifying Exam content is most closely organized around which framework?

The nursing process and client need categories (Correct answer)
Pharmaceutical chemistry only
Medical billing codes
Hospital administration policy

Correct answer: The nursing process and client need categories

The Qualifying Exam is built around the nursing process and client-need categories similar to the NCLEX-RN test plan.

Question 160: Which component of the CGFNS VisaScreen involves a review of the applicant's professional healthcare education?

Academic credentials evaluation (Correct answer)
Occupational health screening
State board endorsement
English language proficiency test

Correct answer: Academic credentials evaluation

Academic credentials evaluation is one component of VisaScreen that reviews whether the applicant's healthcare education meets US equivalency standards.

Question 161: What is the first step an internationally educated nurse must complete to begin the NCLEX-RN licensure process in the US?

Apply to a state board of nursing for eligibility determination (Correct answer)
Obtain a Social Security number before anything else
Submit NCLEX scores from their home country
Register directly with Pearson VUE test centers

Correct answer: Apply to a state board of nursing for eligibility determination

The first step is applying to a specific state board of nursing, which determines whether the international nurse's credentials meet eligibility requirements for NCLEX-RN testing.

Question 162: Which of the following is a closed-ended question that limits therapeutic communication?

Did you sleep last night? (Correct answer)
What brings you to the hospital today?
How has your week been?
What does your depression feel like for you?

Correct answer: Did you sleep last night?

'Did you sleep last night?' is a closed-ended question answerable with yes or no, limiting the patient's opportunity to express their full experience.

Question 163: The primary goal of therapeutic communication in psychiatric nursing is to:

Minimize patient anxiety during procedures
Establish a trusting relationship that promotes patient healing (Correct answer)
Advise patients on how to solve their problems
Gather data for the medical record

Correct answer: Establish a trusting relationship that promotes patient healing

Therapeutic communication focuses on building a trusting nurse-patient relationship that supports mental health recovery and patient wellbeing.

Question 164: Which content area is the largest percentage of the NCLEX-RN test plan for the Safe and Effective Care Environment category?

Management of Care (Correct answer)
Safety and Infection Control
Pharmacological Therapies
Basic Care and Comfort

Correct answer: Management of Care

Management of Care is the largest subcategory in Safe and Effective Care Environment, reflecting the priority placed on care coordination, delegation, and legal/ethical practice.

Question 165: Which acronym is used to systematically assess the features of a patient's hallucinations in psychiatric nursing?

CIWA: Clinical Institute Withdrawal Assessment
NEWS: National Early Warning Score
SOAP: Subjective, Objective, Assessment, Plan
STAMP: Severity, Triggers, Affect, Meaning, Pattern (Correct answer)

Correct answer: STAMP: Severity, Triggers, Affect, Meaning, Pattern

Structured acronyms like STAMP help psychiatric nurses assess the features of hallucinations systematically, including triggers, meaning, and frequency.

ISPN & CGFNS Qualifying Exam

The CGFNS Qualifying Exam evaluates foreign-educated nurses for U.S. licensure eligibility across NCLEX-style client needs domains, while the ISPN PMH-BC certification validates psychiatric-mental health nursing competencies for registered nurses.

165

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180 min

Time Limit

70%

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