NURS 222 Mental Health Exam 3: Personality, Eating, Substance Use,
and Cognitive Disorders 2026 |WCU
1. A nurse is caring for a client with Borderline Personality Disorder who
alternates between praising and devaluing staff members. Which defense
mechanism should the nurse document?
A. Splitting
B. Reaction Formation
C. Projection
D. Rationalization
Answer: A
Rationale: Splitting is a primary defense mechanism in Borderline Personality Disorder
where the individual is unable to integrate positive and negative qualities of self or others,
seeing them as all good or all bad.
2. When planning care for a client with Antisocial Personality Disorder, which
nursing intervention is the highest priority?
A. Setting clear and consistent limits on behavior
B. Encouraging the client to join group therapy
C. Teaching the client relaxation techniques
D. Exploring the client’s childhood trauma
Answer: A
Rationale: Clients with Antisocial Personality Disorder are often manipulative and lack
regard for rules; therefore, setting firm, consistent limits is essential for safety and
therapeutic structure.
,3. A client is admitted with Anorexia Nervosa. Which physical assessment
finding requires immediate nursing intervention?
A. Presence of lanugo on the back
B. Amenorrhea for six months
C. Dry, flaky skin
D. Pulse rate of 38 beats per minute
Answer: D
Rationale: A heart rate below 40 bpm indicates severe cardiovascular instability and is a
criterion for emergency hospitalization in eating disorders.
4. A client with Anorexia Nervosa is starting a refeeding protocol. The nurse
should monitor which laboratory value most closely to detect refeeding
syndrome?
A. Serum Sodium
B. Blood Urea Nitrogen
C. Serum Phosphate
D. Serum Creatinine
Answer: C
Rationale: Hypophosphatemia is the hallmark of refeeding syndrome, caused by a shift of
phosphate from the blood into cells during rapid nutritional replenishment.
5. The nurse observes calluses on the knuckles of a client suspected of having
Bulimia Nervosa. How should the nurse document this finding?
A. Russell’s sign
B. Trousseau’s sign
C. Chvostek’s sign
D. Cullen’s sign
Answer: A
, Rationale: Russell’s sign refers to calluses on the knuckles or back of the hand from self-
induced vomiting.
6. A client is experiencing alcohol withdrawal. Which symptom indicates that
the client may be progressing to Delirium Tremens (DTs)?
A. Mild tremors and anxiety
B. Hallucinations and fluctuating level of consciousness
C. Hypotension and bradycardia
D. Increased appetite and lethargy
Answer: B
Rationale: Delirium Tremens is characterized by severe autonomic hyperactivity,
confusion, and hallucinations, usually occurring 48 to 72 hours after the last drink.
7. A client with chronic alcohol use disorder presents with ataxia, nystagmus,
and confusion. The nurse anticipates administering which medication?
A. Haloperidol
B. Disulfiram
C. Lorazepam
D. Thiamine (Vitamin B1)
Answer: D
Rationale: These symptoms are classic for Wernicke’s encephalopathy, a medical
emergency caused by thiamine deficiency common in alcohol abuse.
8. A client is prescribed Disulfiram (Antabuse) for alcohol abstinence. Which
statement by the client indicates a need for further teaching?
A. ‘If I drink alcohol while taking this, I will just get a mild headache.’
B. ‘I will wait at least 12 hours after my last drink before starting this.’
C. ‘I should avoid using mouthwash that contains alcohol.’
D. ‘I need to read labels on cough syrups and vanilla extracts.’
Answer: A
and Cognitive Disorders 2026 |WCU
1. A nurse is caring for a client with Borderline Personality Disorder who
alternates between praising and devaluing staff members. Which defense
mechanism should the nurse document?
A. Splitting
B. Reaction Formation
C. Projection
D. Rationalization
Answer: A
Rationale: Splitting is a primary defense mechanism in Borderline Personality Disorder
where the individual is unable to integrate positive and negative qualities of self or others,
seeing them as all good or all bad.
2. When planning care for a client with Antisocial Personality Disorder, which
nursing intervention is the highest priority?
A. Setting clear and consistent limits on behavior
B. Encouraging the client to join group therapy
C. Teaching the client relaxation techniques
D. Exploring the client’s childhood trauma
Answer: A
Rationale: Clients with Antisocial Personality Disorder are often manipulative and lack
regard for rules; therefore, setting firm, consistent limits is essential for safety and
therapeutic structure.
,3. A client is admitted with Anorexia Nervosa. Which physical assessment
finding requires immediate nursing intervention?
A. Presence of lanugo on the back
B. Amenorrhea for six months
C. Dry, flaky skin
D. Pulse rate of 38 beats per minute
Answer: D
Rationale: A heart rate below 40 bpm indicates severe cardiovascular instability and is a
criterion for emergency hospitalization in eating disorders.
4. A client with Anorexia Nervosa is starting a refeeding protocol. The nurse
should monitor which laboratory value most closely to detect refeeding
syndrome?
A. Serum Sodium
B. Blood Urea Nitrogen
C. Serum Phosphate
D. Serum Creatinine
Answer: C
Rationale: Hypophosphatemia is the hallmark of refeeding syndrome, caused by a shift of
phosphate from the blood into cells during rapid nutritional replenishment.
5. The nurse observes calluses on the knuckles of a client suspected of having
Bulimia Nervosa. How should the nurse document this finding?
A. Russell’s sign
B. Trousseau’s sign
C. Chvostek’s sign
D. Cullen’s sign
Answer: A
, Rationale: Russell’s sign refers to calluses on the knuckles or back of the hand from self-
induced vomiting.
6. A client is experiencing alcohol withdrawal. Which symptom indicates that
the client may be progressing to Delirium Tremens (DTs)?
A. Mild tremors and anxiety
B. Hallucinations and fluctuating level of consciousness
C. Hypotension and bradycardia
D. Increased appetite and lethargy
Answer: B
Rationale: Delirium Tremens is characterized by severe autonomic hyperactivity,
confusion, and hallucinations, usually occurring 48 to 72 hours after the last drink.
7. A client with chronic alcohol use disorder presents with ataxia, nystagmus,
and confusion. The nurse anticipates administering which medication?
A. Haloperidol
B. Disulfiram
C. Lorazepam
D. Thiamine (Vitamin B1)
Answer: D
Rationale: These symptoms are classic for Wernicke’s encephalopathy, a medical
emergency caused by thiamine deficiency common in alcohol abuse.
8. A client is prescribed Disulfiram (Antabuse) for alcohol abstinence. Which
statement by the client indicates a need for further teaching?
A. ‘If I drink alcohol while taking this, I will just get a mild headache.’
B. ‘I will wait at least 12 hours after my last drink before starting this.’
C. ‘I should avoid using mouthwash that contains alcohol.’
D. ‘I need to read labels on cough syrups and vanilla extracts.’
Answer: A
