Clinical Judgment Practice Exam: Mental Health
Case 1: Lithium Toxicity
• Patient Profile: 45-year-old male with Bipolar I Disorder, taking lithium carbonate for 2 years.
• Assessment Data: Complains of blurred vision and excessive urination. Hand tremors are coarse.
Reports "feeling thirsty" (Distractor).
• Question: The nurse notes the client is confused and stumbling. What is the priority nursing
action?
• Options:
A. Administer the scheduled dose of lithium.
B. Encourage fluid intake to prevent dehydration.
C. Hold the medication and notify the provider.
D. Check the client's blood sugar.
• Correct Answer: C
• Nurse Head Explanation: This is classic lithium toxicity. Coarse tremors, confusion, and ataxia
indicate levels likely $> 1.5\text{ mEq/L}$. C is the priority because giving more drug kills the
patient. B is helpful later, but stopping the toxin is step one. D is a valid assessment for confusion
but less likely given the history. A is negligence.
Case 2: Neuroleptic Malignant Syndrome (NMS)
• Patient Profile: 30-year-old female started on haloperidol 3 days ago.
• Assessment Data: Temperature $103.5^\circ\text{F}$, BP 170/110, lead-pipe muscle rigidity.
Complains of anxiety (Distractor).
• Question: Which order should the nurse implement first?
• Options:
A. Administer acetaminophen for fever.
B. Administer bromocriptine (Parlodel).
C. Draw blood for creatinine kinase (CK).
D. Discontinue haloperidol immediately.
• Correct Answer: D
, • Nurse Head Explanation: NMS is a drug-induced emergency. You must remove the offending
agent before treating the symptoms. D stops the cause. B (muscle relaxant) and A (antipyretic)
are treatments, but they are futile if the drug is still being given. C confirms muscle breakdown
but doesn't save the life.
Case 3: Suicide Risk Assessment
• Patient Profile: 22-year-old male admitted for major depression.
• Assessment Data: Client gives his favorite guitar to another patient. Mood appears suddenly
elevated and calm. States "Everything will be fine soon."
• Question: What is the nurse's priority action?
• Options:
A. Document the change in mood.
B. Ask the client, "Do you have a plan to harm yourself today?"
C. Retrieve the guitar and return it to the client.
D. Discuss discharge planning since the client is feeling better.
• Correct Answer: B
• Nurse Head Explanation: Sudden calmness and giving away possessions are red flags for
imminent suicide (the client has made peace with the decision). B is the only direct safety
intervention. A is passive. C is secondary. D is dangerous; the client is not better, they are
resolved.
Case 4: Alcohol Withdrawal (Delirium Tremens)
• Patient Profile: 55-year-old female admitted for a fracture, history of heavy alcohol use.
• Assessment Data: HR 126, BP 160/95, tremors. Claims to see spiders on the bedsheets.
• Question: The client attempts to climb out of bed. What is the priority intervention?
• Options:
A. Reorient the client to reality.
B. Administer lorazepam (Ativan) IV push.
C. Apply soft wrist restraints.
D. Call security for assistance.
• Correct Answer: B
Case 1: Lithium Toxicity
• Patient Profile: 45-year-old male with Bipolar I Disorder, taking lithium carbonate for 2 years.
• Assessment Data: Complains of blurred vision and excessive urination. Hand tremors are coarse.
Reports "feeling thirsty" (Distractor).
• Question: The nurse notes the client is confused and stumbling. What is the priority nursing
action?
• Options:
A. Administer the scheduled dose of lithium.
B. Encourage fluid intake to prevent dehydration.
C. Hold the medication and notify the provider.
D. Check the client's blood sugar.
• Correct Answer: C
• Nurse Head Explanation: This is classic lithium toxicity. Coarse tremors, confusion, and ataxia
indicate levels likely $> 1.5\text{ mEq/L}$. C is the priority because giving more drug kills the
patient. B is helpful later, but stopping the toxin is step one. D is a valid assessment for confusion
but less likely given the history. A is negligence.
Case 2: Neuroleptic Malignant Syndrome (NMS)
• Patient Profile: 30-year-old female started on haloperidol 3 days ago.
• Assessment Data: Temperature $103.5^\circ\text{F}$, BP 170/110, lead-pipe muscle rigidity.
Complains of anxiety (Distractor).
• Question: Which order should the nurse implement first?
• Options:
A. Administer acetaminophen for fever.
B. Administer bromocriptine (Parlodel).
C. Draw blood for creatinine kinase (CK).
D. Discontinue haloperidol immediately.
• Correct Answer: D
, • Nurse Head Explanation: NMS is a drug-induced emergency. You must remove the offending
agent before treating the symptoms. D stops the cause. B (muscle relaxant) and A (antipyretic)
are treatments, but they are futile if the drug is still being given. C confirms muscle breakdown
but doesn't save the life.
Case 3: Suicide Risk Assessment
• Patient Profile: 22-year-old male admitted for major depression.
• Assessment Data: Client gives his favorite guitar to another patient. Mood appears suddenly
elevated and calm. States "Everything will be fine soon."
• Question: What is the nurse's priority action?
• Options:
A. Document the change in mood.
B. Ask the client, "Do you have a plan to harm yourself today?"
C. Retrieve the guitar and return it to the client.
D. Discuss discharge planning since the client is feeling better.
• Correct Answer: B
• Nurse Head Explanation: Sudden calmness and giving away possessions are red flags for
imminent suicide (the client has made peace with the decision). B is the only direct safety
intervention. A is passive. C is secondary. D is dangerous; the client is not better, they are
resolved.
Case 4: Alcohol Withdrawal (Delirium Tremens)
• Patient Profile: 55-year-old female admitted for a fracture, history of heavy alcohol use.
• Assessment Data: HR 126, BP 160/95, tremors. Claims to see spiders on the bedsheets.
• Question: The client attempts to climb out of bed. What is the priority intervention?
• Options:
A. Reorient the client to reality.
B. Administer lorazepam (Ativan) IV push.
C. Apply soft wrist restraints.
D. Call security for assistance.
• Correct Answer: B
