NSG 322/NSG322 Exam 2 V3 | Behavioral
Health Nursing Q&A with Rationale |
Grand Canyon University
1. A client is diagnosed with Generalized Anxiety Disorder (GAD). Which symptom is most
characteristic of this condition?
A. Flashbacks and nightmares regarding a past event
B. Recurrent rituals that interfere with daily functioning
C. Sudden onset of intense fear with physical symptoms like chest pain
D. Persistent, excessive worry about various life circumstances
Answer: D
Rationale: Generalized Anxiety Disorder is characterized by chronic, unrealistic, and
excessive anxiety and worry for at least six months. This worry is often difficult to control
and is not focused on one specific event. Other options like flashbacks relate to PTSD, while
rituals are associated with OCD.
2. A nurse is caring for a client with OCD. The client spends hours washing their hands. What
is the initial nursing intervention?
A. Allow the client to perform the ritual initially to reduce anxiety
B. Lock the bathroom door to prevent handwashing
C. Immediately confront the client about the irrational behavior
,D. Administer an antipsychotic medication to stop the ritual
Answer: A
Rationale: In the initial phase of treatment for OCD, the nurse should allow the client to
perform the rituals to prevent a panic-level increase in anxiety. Forcing the client to stop
before they have alternative coping mechanisms can be counterproductive. As treatment
progresses, the nurse and client will work together to set limits on the behavior and
develop cognitive strategies.
3. Which assessment finding should the nurse prioritize in a client with Major Depressive
Disorder (MDD)?
A. Statements indicating feelings of hopelessness or worthlessness
B. Poor grooming and hygiene
C. Inability to concentrate on simple tasks
D. Sleep disturbances including insomnia or hypersomnia
Answer: A
Rationale: Hopelessness and worthlessness are significant indicators of suicide risk in
clients with Major Depressive Disorder. While hygiene and sleep are important, the safety
of the client is always the highest priority in behavioral health nursing. The nurse must
assess for suicidal ideation immediately when these feelings are expressed.
, 4. A client is prescribed Lithium Carbonate for Bipolar I disorder. Which serum level indicates
a therapeutic range?
A. 0.2 - 0.5 mEq/L
B. 1.5 - 2.0 mEq/L
C. 0.6 - 1.2 mEq/L
D. 2.5 - 3.0 mEq/L
Answer: C
Rationale: The therapeutic range for Lithium during maintenance therapy is generally
accepted as 0.6 to 1.2 mEq/L. Levels below 0.6 are often sub-therapeutic, and levels above
1.5 are considered toxic. Monitoring blood levels is essential to prevent severe
complications like renal failure or seizures.
5. A client taking an MAOI (Phenelzine) should avoid which of the following foods to prevent
a hypertensive crisis?
A. Aged cheddar cheese and red wine
B. Fresh green leafy vegetables and milk
C. Lean chicken and white rice
D. Apples, bananas, and oranges
Answer: A
Health Nursing Q&A with Rationale |
Grand Canyon University
1. A client is diagnosed with Generalized Anxiety Disorder (GAD). Which symptom is most
characteristic of this condition?
A. Flashbacks and nightmares regarding a past event
B. Recurrent rituals that interfere with daily functioning
C. Sudden onset of intense fear with physical symptoms like chest pain
D. Persistent, excessive worry about various life circumstances
Answer: D
Rationale: Generalized Anxiety Disorder is characterized by chronic, unrealistic, and
excessive anxiety and worry for at least six months. This worry is often difficult to control
and is not focused on one specific event. Other options like flashbacks relate to PTSD, while
rituals are associated with OCD.
2. A nurse is caring for a client with OCD. The client spends hours washing their hands. What
is the initial nursing intervention?
A. Allow the client to perform the ritual initially to reduce anxiety
B. Lock the bathroom door to prevent handwashing
C. Immediately confront the client about the irrational behavior
,D. Administer an antipsychotic medication to stop the ritual
Answer: A
Rationale: In the initial phase of treatment for OCD, the nurse should allow the client to
perform the rituals to prevent a panic-level increase in anxiety. Forcing the client to stop
before they have alternative coping mechanisms can be counterproductive. As treatment
progresses, the nurse and client will work together to set limits on the behavior and
develop cognitive strategies.
3. Which assessment finding should the nurse prioritize in a client with Major Depressive
Disorder (MDD)?
A. Statements indicating feelings of hopelessness or worthlessness
B. Poor grooming and hygiene
C. Inability to concentrate on simple tasks
D. Sleep disturbances including insomnia or hypersomnia
Answer: A
Rationale: Hopelessness and worthlessness are significant indicators of suicide risk in
clients with Major Depressive Disorder. While hygiene and sleep are important, the safety
of the client is always the highest priority in behavioral health nursing. The nurse must
assess for suicidal ideation immediately when these feelings are expressed.
, 4. A client is prescribed Lithium Carbonate for Bipolar I disorder. Which serum level indicates
a therapeutic range?
A. 0.2 - 0.5 mEq/L
B. 1.5 - 2.0 mEq/L
C. 0.6 - 1.2 mEq/L
D. 2.5 - 3.0 mEq/L
Answer: C
Rationale: The therapeutic range for Lithium during maintenance therapy is generally
accepted as 0.6 to 1.2 mEq/L. Levels below 0.6 are often sub-therapeutic, and levels above
1.5 are considered toxic. Monitoring blood levels is essential to prevent severe
complications like renal failure or seizures.
5. A client taking an MAOI (Phenelzine) should avoid which of the following foods to prevent
a hypertensive crisis?
A. Aged cheddar cheese and red wine
B. Fresh green leafy vegetables and milk
C. Lean chicken and white rice
D. Apples, bananas, and oranges
Answer: A
