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Mental Health NCLEX-Style Practice Exam Review Formatted: Centered
Formatted: Top: (Single solid line, Auto, 2.25 pt Line
Comprehensive Mental Health Nursing Practice width), Bottom: (Single solid line, Auto, 2.25 pt Line
width), Left: (Single solid line, Auto, 2.25 pt Line width),
Examination Right: (Single solid line, Auto, 2.25 pt Line width)
1. A client with major depressive disorder is prescribed fluoxetine. The nurse should include which
instruction in the teaching plan?
A) "Take the medication at bedtime to prevent daytime sedation"
B) "Monitor for signs of serotonin syndrome including fever and agitation"
C) "Discontinue the medication if you feel better after 2 weeks"
D) "Avoid all foods containing tyramine while taking this medication"
Answer: B) "Monitor for signs of serotonin syndrome including fever and agitation"
Rationale: Fluoxetine is an SSRI that can cause serotonin syndrome, especially when combined with other
serotonergic medications. Signs include fever, agitation, tachycardia, and confusion. SSRIs are typically
taken in the morning to prevent insomnia, should not be abruptly discontinued, and tyramine restriction
is for MAOIs, not SSRIs.
2. A client with bipolar disorder is prescribed lithium. Which laboratory value should the nurse
monitor to assess for toxicity?
A) Serum lithium level
B) Complete blood count
C) Serum potassium level
D) Thyroid stimulating hormone
Answer: A) Serum lithium level
Rationale: Lithium has a narrow therapeutic range (0.8-1.2 mEq/L for acute mania, 0.6-1.0 mEq/L for
maintenance). Serum lithium levels must be monitored closely to prevent toxicity. Signs of toxicity include
nausea, vomiting, diarrhea, tremor, and ataxia.
3. A client diagnosed with schizophrenia is experiencing auditory hallucinations. Which nursing
intervention is most therapeutic?
A) Tell the client that the voices are not real
B) Encourage the client to ignore the voices
C) Acknowledge the client's experience and focus on reality-based activities
D) Ask the client to describe what the voices are saying in detail
,Answer: C) Acknowledge the client's experience and focus on reality-based activities
Rationale: Acknowledging the client's experience without reinforcing the hallucinations is therapeutic.
The nurse should not argue with the client about the reality of the voices but should redirect to reality-
based activities. Asking for detailed descriptions can reinforce hallucinations, and telling the client to
ignore them is not helpful.
4. A client with generalized anxiety disorder is experiencing panic attacks. Which intervention should
the nurse implement first?
A) Administer prescribed PRN lorazepam
B) Encourage the client to talk about the feelings
C) Stay with the client and provide a calm environment
D) Teach the client deep breathing exercises
Answer: C) Stay with the client and provide a calm environment
Rationale: During a panic attack, the priority is to remain with the client to provide safety and
reassurance. A calm, quiet environment helps reduce stimuli. While medication and teaching are
important, they are not the immediate priority during an acute panic attack.
5. A client with post-traumatic stress disorder (PTSD) reports recurrent nightmares and flashbacks.
Which medication is most commonly prescribed for this condition?
A) Lorazepam
B) Paroxetine
C) Haloperidol
D) Lithium
Answer: B) Paroxetine
Rationale: SSRIs such as paroxetine and sertraline are first-line medications for PTSD. They help reduce
symptoms including nightmares, flashbacks, and hyperarousal. Benzodiazepines like lorazepam are not
first-line and can be habit-forming. Antipsychotics and mood stabilizers are not primary treatments for
PTSD.
6. A client with anorexia nervosa has a BMI of 16. Which nursing intervention is a priority?
A) Monitor vital signs and electrolyte levels
B) Encourage the client to eat a balanced meal
C) Allow the client to eat in private to reduce anxiety
D) Weigh the client weekly to monitor progress
Answer: A) Monitor vital signs and electrolyte levels
,Rationale: Medical stabilization is the priority in severe anorexia nervosa. Bradycardia, hypotension, and
electrolyte imbalances can be life-threatening. Vital signs and electrolytes must be monitored closely.
Nutritional rehabilitation is important but secondary to medical stabilization.
7. A client with borderline personality disorder is admitted after self-harming behavior. The nurse
overhears the client saying to another patient, "I'm going to hurt myself again tonight." What is the
nurse's priority action?
A) Document the statement and continue monitoring
B) Ask the client to clarify the statement
C) Place the client on one-to-one observation
D) Notify the healthcare provider
Answer: C) Place the client on one-to-one observation
Rationale: The client has expressed a plan for self-harm, which requires immediate intervention. One-to-
one observation is the priority to ensure client safety. The healthcare provider should be notified, but the
first action is to implement safety measures.
8. A client with major depressive disorder has been taking venlafaxine for 4 weeks. Which statement
by the client indicates the medication is having the desired effect?
A) "I'm sleeping much better at night now"
B) "I feel more energetic and motivated to do things"
C) "I've stopped crying and feel numb instead"
D) "I take the medication with food to prevent nausea"
Answer: B) "I feel more energetic and motivated to do things"
Rationale: Improvement in energy and motivation indicates the antidepressant is working. SSRIs and
SNRIs take 2-6 weeks to reach full effect. While sleeping better is a positive sign, increased energy and
motivation are key indicators of improvement. Feeling numb is not a therapeutic response.
9. A client with obsessive-compulsive disorder (OCD) spends 2 hours each day washing hands. The
nurse should recognize this behavior as:
A) A coping mechanism that should not be interrupted
B) An obsessive behavior that needs to be stopped immediately
C) A compulsive behavior that serves to reduce anxiety
D) A manipulative behavior to gain attention
Answer: C) A compulsive behavior that serves to reduce anxiety
, Rationale: Compulsions are repetitive behaviors performed to reduce anxiety caused by obsessions. The
hand washing temporarily reduces the client's anxiety. The nurse should not interrupt the behavior
abruptly but should work with the client on gradual reduction strategies.
10. A client with bipolar disorder is in the manic phase. Which nursing intervention is most
appropriate?
A) Place the client in seclusion when agitated
B) Provide a structured environment with limited stimuli
C) Encourage the client to engage in competitive games
D) Allow the client to make all decisions about care
Answer: B) Provide a structured environment with limited stimuli
Rationale: During the manic phase, clients need a structured, low-stimulation environment to reduce
agitation and help maintain boundaries. Seclusion is used only as a last resort for safety. Competitive
activities can increase agitation, and the client's judgment is impaired, so they should not make all care
decisions.
11. A client with alcohol use disorder is experiencing withdrawal symptoms. Which finding requires
immediate intervention?
A) Tremors and diaphoresis
B) Nausea and vomiting
C) Seizure activity
D) Insomnia and anxiety
Answer: C) Seizure activity
Rationale: Seizure activity during alcohol withdrawal is a medical emergency requiring immediate
intervention. While tremors, diaphoresis, nausea, and insomnia are expected withdrawal symptoms,
seizures indicate severe withdrawal (delirium tremens) and require emergency treatment.
12. A client with depression is prescribed phenelzine. Which food should the client avoid?
A) Fresh fruits and vegetables
B) Aged cheese and cured meats
C) Pasta and bread
D) Low-fat dairy products
Answer: B) Aged cheese and cured meats
Rationale: Phenelzine is an MAOI. Tyramine-rich foods (aged cheese, cured meats, fermented products)
can cause a hypertensive crisis. Clients on MAOIs must strictly avoid these foods. This is a critical
teaching point for client safety.
Mental Health NCLEX-Style Practice Exam Review Formatted: Centered
Formatted: Top: (Single solid line, Auto, 2.25 pt Line
Comprehensive Mental Health Nursing Practice width), Bottom: (Single solid line, Auto, 2.25 pt Line
width), Left: (Single solid line, Auto, 2.25 pt Line width),
Examination Right: (Single solid line, Auto, 2.25 pt Line width)
1. A client with major depressive disorder is prescribed fluoxetine. The nurse should include which
instruction in the teaching plan?
A) "Take the medication at bedtime to prevent daytime sedation"
B) "Monitor for signs of serotonin syndrome including fever and agitation"
C) "Discontinue the medication if you feel better after 2 weeks"
D) "Avoid all foods containing tyramine while taking this medication"
Answer: B) "Monitor for signs of serotonin syndrome including fever and agitation"
Rationale: Fluoxetine is an SSRI that can cause serotonin syndrome, especially when combined with other
serotonergic medications. Signs include fever, agitation, tachycardia, and confusion. SSRIs are typically
taken in the morning to prevent insomnia, should not be abruptly discontinued, and tyramine restriction
is for MAOIs, not SSRIs.
2. A client with bipolar disorder is prescribed lithium. Which laboratory value should the nurse
monitor to assess for toxicity?
A) Serum lithium level
B) Complete blood count
C) Serum potassium level
D) Thyroid stimulating hormone
Answer: A) Serum lithium level
Rationale: Lithium has a narrow therapeutic range (0.8-1.2 mEq/L for acute mania, 0.6-1.0 mEq/L for
maintenance). Serum lithium levels must be monitored closely to prevent toxicity. Signs of toxicity include
nausea, vomiting, diarrhea, tremor, and ataxia.
3. A client diagnosed with schizophrenia is experiencing auditory hallucinations. Which nursing
intervention is most therapeutic?
A) Tell the client that the voices are not real
B) Encourage the client to ignore the voices
C) Acknowledge the client's experience and focus on reality-based activities
D) Ask the client to describe what the voices are saying in detail
,Answer: C) Acknowledge the client's experience and focus on reality-based activities
Rationale: Acknowledging the client's experience without reinforcing the hallucinations is therapeutic.
The nurse should not argue with the client about the reality of the voices but should redirect to reality-
based activities. Asking for detailed descriptions can reinforce hallucinations, and telling the client to
ignore them is not helpful.
4. A client with generalized anxiety disorder is experiencing panic attacks. Which intervention should
the nurse implement first?
A) Administer prescribed PRN lorazepam
B) Encourage the client to talk about the feelings
C) Stay with the client and provide a calm environment
D) Teach the client deep breathing exercises
Answer: C) Stay with the client and provide a calm environment
Rationale: During a panic attack, the priority is to remain with the client to provide safety and
reassurance. A calm, quiet environment helps reduce stimuli. While medication and teaching are
important, they are not the immediate priority during an acute panic attack.
5. A client with post-traumatic stress disorder (PTSD) reports recurrent nightmares and flashbacks.
Which medication is most commonly prescribed for this condition?
A) Lorazepam
B) Paroxetine
C) Haloperidol
D) Lithium
Answer: B) Paroxetine
Rationale: SSRIs such as paroxetine and sertraline are first-line medications for PTSD. They help reduce
symptoms including nightmares, flashbacks, and hyperarousal. Benzodiazepines like lorazepam are not
first-line and can be habit-forming. Antipsychotics and mood stabilizers are not primary treatments for
PTSD.
6. A client with anorexia nervosa has a BMI of 16. Which nursing intervention is a priority?
A) Monitor vital signs and electrolyte levels
B) Encourage the client to eat a balanced meal
C) Allow the client to eat in private to reduce anxiety
D) Weigh the client weekly to monitor progress
Answer: A) Monitor vital signs and electrolyte levels
,Rationale: Medical stabilization is the priority in severe anorexia nervosa. Bradycardia, hypotension, and
electrolyte imbalances can be life-threatening. Vital signs and electrolytes must be monitored closely.
Nutritional rehabilitation is important but secondary to medical stabilization.
7. A client with borderline personality disorder is admitted after self-harming behavior. The nurse
overhears the client saying to another patient, "I'm going to hurt myself again tonight." What is the
nurse's priority action?
A) Document the statement and continue monitoring
B) Ask the client to clarify the statement
C) Place the client on one-to-one observation
D) Notify the healthcare provider
Answer: C) Place the client on one-to-one observation
Rationale: The client has expressed a plan for self-harm, which requires immediate intervention. One-to-
one observation is the priority to ensure client safety. The healthcare provider should be notified, but the
first action is to implement safety measures.
8. A client with major depressive disorder has been taking venlafaxine for 4 weeks. Which statement
by the client indicates the medication is having the desired effect?
A) "I'm sleeping much better at night now"
B) "I feel more energetic and motivated to do things"
C) "I've stopped crying and feel numb instead"
D) "I take the medication with food to prevent nausea"
Answer: B) "I feel more energetic and motivated to do things"
Rationale: Improvement in energy and motivation indicates the antidepressant is working. SSRIs and
SNRIs take 2-6 weeks to reach full effect. While sleeping better is a positive sign, increased energy and
motivation are key indicators of improvement. Feeling numb is not a therapeutic response.
9. A client with obsessive-compulsive disorder (OCD) spends 2 hours each day washing hands. The
nurse should recognize this behavior as:
A) A coping mechanism that should not be interrupted
B) An obsessive behavior that needs to be stopped immediately
C) A compulsive behavior that serves to reduce anxiety
D) A manipulative behavior to gain attention
Answer: C) A compulsive behavior that serves to reduce anxiety
, Rationale: Compulsions are repetitive behaviors performed to reduce anxiety caused by obsessions. The
hand washing temporarily reduces the client's anxiety. The nurse should not interrupt the behavior
abruptly but should work with the client on gradual reduction strategies.
10. A client with bipolar disorder is in the manic phase. Which nursing intervention is most
appropriate?
A) Place the client in seclusion when agitated
B) Provide a structured environment with limited stimuli
C) Encourage the client to engage in competitive games
D) Allow the client to make all decisions about care
Answer: B) Provide a structured environment with limited stimuli
Rationale: During the manic phase, clients need a structured, low-stimulation environment to reduce
agitation and help maintain boundaries. Seclusion is used only as a last resort for safety. Competitive
activities can increase agitation, and the client's judgment is impaired, so they should not make all care
decisions.
11. A client with alcohol use disorder is experiencing withdrawal symptoms. Which finding requires
immediate intervention?
A) Tremors and diaphoresis
B) Nausea and vomiting
C) Seizure activity
D) Insomnia and anxiety
Answer: C) Seizure activity
Rationale: Seizure activity during alcohol withdrawal is a medical emergency requiring immediate
intervention. While tremors, diaphoresis, nausea, and insomnia are expected withdrawal symptoms,
seizures indicate severe withdrawal (delirium tremens) and require emergency treatment.
12. A client with depression is prescribed phenelzine. Which food should the client avoid?
A) Fresh fruits and vegetables
B) Aged cheese and cured meats
C) Pasta and bread
D) Low-fat dairy products
Answer: B) Aged cheese and cured meats
Rationale: Phenelzine is an MAOI. Tyramine-rich foods (aged cheese, cured meats, fermented products)
can cause a hypertensive crisis. Clients on MAOIs must strictly avoid these foods. This is a critical
teaching point for client safety.
