NUR 356 Final Exam: Mental Health Theory & Application
V2 - Arizona College Updated and Latest Questions and
Correct Answers with Rationale
1. A patient diagnosed with bipolar disorder is prescribed Lithium Carbonate. Which laboratory value should
the nurse monitor most closely to prevent toxicity?
A. Serum potassium level
B. Serum sodium level
C. Blood glucose level
D. Serum calcium level
Ans: B
Explanation: Lithium is a salt that is handled by the kidneys in a manner similar to sodium. If sodium
levels are depleted, the kidneys will retain lithium to maintain electrolyte balance. This retention can
quickly lead to toxic levels of lithium in the bloodstream. Patients must be educated to maintain a
consistent intake of salt and water. Monitoring the serum sodium level is therefore critical for patient
safety during lithium therapy.
2. A nurse is caring for a client who is experiencing a manic episode. Which of the following activities is most
appropriate for this client?
A. Playing a competitive game of basketball
B. Watching a high-action movie in the dayroom
C. Walking with the nurse around the unit
D. Participating in a detailed group debate
Ans: C
,Explanation: Clients in a manic state require low-stimulation environments to help de-escalate their
behavior. Walking with a nurse provides an outlet for physical energy without overstimulating the client.
Competitive or highly social activities can increase agitation or lead to conflicts with others. Detailed
tasks are often impossible due to the client’s shortened attention span and distractibility. This
intervention allows for one-on-one supervision and movement in a controlled manner.
3. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which side effect requires
immediate notification of the provider?
A. Dry mouth and constipation
B. Weight gain of 2 pounds in a week
C. Sore throat and fever
D. Drowsiness in the morning
Ans: C
Explanation: Clozapine carries a significant risk of agranulocytosis, which is a dangerous drop in white
blood cell count. Sore throat and fever are early clinical indicators of a potential infection due to low
immunity. The nurse must assess the client’s absolute neutrophil count regularly as mandated by safety
protocols. Immediate medical intervention is necessary to prevent life-threatening sepsis or systemic
infection. While weight gain and sedation are common, they are not immediately life-threatening
compared to agranulocytosis.
4. A nurse uses the technique of ‘reflecting’ during a conversation with a depressed client. Which statement
by the nurse best illustrates this technique?
A. What do you think you should do about this?
B. I noticed that you seem very angry today.
, C. You feel that no one understands your pain?
D. Tell me more about your relationship with your mother.
Ans: C
Explanation: Reflecting involves directing back the client’s feelings or ideas so they can recognize them.
This technique encourages the client to accept their own feelings and continue exploring their thoughts.
It validates the client’s experience without the nurse offering a personal opinion or judgment. By
paraphrasing the emotional content, the nurse shows active listening and empathy. In this case, ‘You feel
that no one understands’ mirrors the client’s underlying emotional state.
5. A client with Borderline Personality Disorder is praising one nurse while demeaning another nurse on the
same shift. What is this defense mechanism called?
A. Projection
B. Splitting
C. Reaction Formation
D. Sublimation
Ans: B
Explanation: Splitting is a hallmark defense mechanism where individuals see others as either ‘all good’
or ‘all bad.’ This occurs because the client cannot integrate the positive and negative qualities of a person
into a cohesive whole. It often creates conflict among staff members and disrupts the therapeutic
environment on the unit. Staff must use consistent communication and a unified approach to manage this
behavior effectively. Identifying splitting early helps the treatment team maintain professional
boundaries and limit-setting.
V2 - Arizona College Updated and Latest Questions and
Correct Answers with Rationale
1. A patient diagnosed with bipolar disorder is prescribed Lithium Carbonate. Which laboratory value should
the nurse monitor most closely to prevent toxicity?
A. Serum potassium level
B. Serum sodium level
C. Blood glucose level
D. Serum calcium level
Ans: B
Explanation: Lithium is a salt that is handled by the kidneys in a manner similar to sodium. If sodium
levels are depleted, the kidneys will retain lithium to maintain electrolyte balance. This retention can
quickly lead to toxic levels of lithium in the bloodstream. Patients must be educated to maintain a
consistent intake of salt and water. Monitoring the serum sodium level is therefore critical for patient
safety during lithium therapy.
2. A nurse is caring for a client who is experiencing a manic episode. Which of the following activities is most
appropriate for this client?
A. Playing a competitive game of basketball
B. Watching a high-action movie in the dayroom
C. Walking with the nurse around the unit
D. Participating in a detailed group debate
Ans: C
,Explanation: Clients in a manic state require low-stimulation environments to help de-escalate their
behavior. Walking with a nurse provides an outlet for physical energy without overstimulating the client.
Competitive or highly social activities can increase agitation or lead to conflicts with others. Detailed
tasks are often impossible due to the client’s shortened attention span and distractibility. This
intervention allows for one-on-one supervision and movement in a controlled manner.
3. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which side effect requires
immediate notification of the provider?
A. Dry mouth and constipation
B. Weight gain of 2 pounds in a week
C. Sore throat and fever
D. Drowsiness in the morning
Ans: C
Explanation: Clozapine carries a significant risk of agranulocytosis, which is a dangerous drop in white
blood cell count. Sore throat and fever are early clinical indicators of a potential infection due to low
immunity. The nurse must assess the client’s absolute neutrophil count regularly as mandated by safety
protocols. Immediate medical intervention is necessary to prevent life-threatening sepsis or systemic
infection. While weight gain and sedation are common, they are not immediately life-threatening
compared to agranulocytosis.
4. A nurse uses the technique of ‘reflecting’ during a conversation with a depressed client. Which statement
by the nurse best illustrates this technique?
A. What do you think you should do about this?
B. I noticed that you seem very angry today.
, C. You feel that no one understands your pain?
D. Tell me more about your relationship with your mother.
Ans: C
Explanation: Reflecting involves directing back the client’s feelings or ideas so they can recognize them.
This technique encourages the client to accept their own feelings and continue exploring their thoughts.
It validates the client’s experience without the nurse offering a personal opinion or judgment. By
paraphrasing the emotional content, the nurse shows active listening and empathy. In this case, ‘You feel
that no one understands’ mirrors the client’s underlying emotional state.
5. A client with Borderline Personality Disorder is praising one nurse while demeaning another nurse on the
same shift. What is this defense mechanism called?
A. Projection
B. Splitting
C. Reaction Formation
D. Sublimation
Ans: B
Explanation: Splitting is a hallmark defense mechanism where individuals see others as either ‘all good’
or ‘all bad.’ This occurs because the client cannot integrate the positive and negative qualities of a person
into a cohesive whole. It often creates conflict among staff members and disrupts the therapeutic
environment on the unit. Staff must use consistent communication and a unified approach to manage this
behavior effectively. Identifying splitting early helps the treatment team maintain professional
boundaries and limit-setting.
