Mental Health Nursing Practice Exam – 150
Questions with Rationales
Section 1: Foundations of Psychiatric Nursing
(Questions 1-20)
1. The nurse is caring for a patient with a diagnosis of schizophrenia who is experiencing auditory
hallucinations. Which nursing intervention is most appropriate?
A) Tell the patient that the voices are not real and should be ignored
B) Ask the patient what the voices are saying and acknowledge their distress
C) Encourage the patient to engage in activities to distract from the voices
D) Place the patient in seclusion until the voices stop
Answer: B) Ask the patient what the voices are saying and acknowledge their distress
Rationale: The nurse should acknowledge the patient's experience and assess the content of the
hallucinations to determine if they are command hallucinations (telling the patient to harm self or
others). Distraction techniques may be helpful after assessment.
2. A patient with major depressive disorder is prescribed a selective serotonin reuptake inhibitor
(SSRI). The nurse should educate the patient that therapeutic effects may take:
A) 1-3 days
B) 1-2 weeks
C) 2-4 weeks
D) 4-6 weeks
Answer: C) 2-4 weeks
Rationale: SSRIs typically take 2-4 weeks to achieve therapeutic effects. Patients should continue taking
the medication even if they don't see immediate improvement and should not discontinue abruptly.
3. The nurse is assessing a patient with anxiety disorder. Which symptom is characteristic of a panic
attack?
A) Persistent worry about multiple events
B) Sudden onset of intense fear with palpitations and shortness of breath
, C) Avoidance of social situations due to fear of embarrassment
D) Excessive fear of a specific object or situation
Answer: B) Sudden onset of intense fear with palpitations and shortness of breath
Rationale: Panic attacks are characterized by sudden onset of intense fear or discomfort, with symptoms
such as palpitations, sweating, shortness of breath, and fear of losing control. Generalized anxiety
involves persistent worry, social anxiety involves fear of social situations, and specific phobias involve
fear of specific objects.
4. A patient with bipolar disorder is prescribed lithium. The nurse should monitor which laboratory
value to assess for toxicity?
A) Serum sodium
B) Serum potassium
C) Serum lithium level
D) Serum calcium level
Answer: C) Serum lithium level
Rationale: Lithium has a narrow therapeutic index (0.6-1.2 mEq/L). Monitoring serum lithium levels is
essential to prevent toxicity, which can occur at levels >1.5 mEq/L.
5. The nurse is caring for a patient who is exhibiting signs of serotonin syndrome. Which findings are
characteristic?
A) Bradycardia and hypotension
B) Hyperthermia, agitation, and tremors
C) Hypothermia and lethargy
D) Constipation and dry mouth
Answer: B) Hyperthermia, agitation, and tremors
Rationale: Serotonin syndrome presents with hyperthermia, agitation, tremors, diarrhea, and autonomic
instability. It can be life-threatening and requires immediate medical attention.
6. A patient with borderline personality disorder is admitted to the psychiatric unit. Which nursing
intervention is most important?
A) Maintain consistent boundaries and limits
B) Allow the patient to express emotions freely
C) Provide a highly structured environment
D) Avoid discussing self-harm behaviors
Answer: A) Maintain consistent boundaries and limits
Rationale: Patients with borderline personality disorder benefit from consistent boundaries and limits to
,manage manipulative behaviors and maintain safety. A structured environment and therapeutic
relationship are essential.
7. The nurse is assessing a patient for signs of extrapyramidal symptoms (EPS). Which finding indicates
EPS?
A) Akathisia and parkinsonism
B) Weight gain and sedation
C) Hyperglycemia and hypertension
D) Tachycardia and hypotension
Answer: A) Akathisia and parkinsonism
Rationale: Extrapyramidal symptoms include akathisia (restlessness), parkinsonism (rigidity, tremor,
bradykinesia), dystonia, and tardive dyskinesia. They are common side effects of antipsychotic
medications.
8. The nurse is caring for a patient with obsessive-compulsive disorder (OCD). Which intervention is
appropriate?
A) Allow the patient to perform rituals
B) Set limits on the time spent performing rituals
C) Encourage the patient to stop all compulsive behaviors
D) Avoid discussing the patient's obsessions
Answer: B) Set limits on the time spent performing rituals
Rationale: In OCD, the nurse should set limits on the time spent performing rituals while gradually
reducing them. Complete cessation is not realistic initially, and discussing obsessions is important for
assessment.
9. A patient with post-traumatic stress disorder (PTSD) is experiencing flashbacks. Which nursing
intervention is appropriate?
A) Encourage the patient to talk about the traumatic event
B) Provide a safe, quiet environment and use grounding techniques
C) Tell the patient to "snap out of it"
D) Leave the patient alone to process the flashback
Answer: B) Provide a safe, quiet environment and use grounding techniques
Rationale: During flashbacks, the nurse should provide a calm, safe environment, remain with the
patient, and use grounding techniques (e.g., naming objects in the room) to help the patient reorient to
the present.
10. The nurse is teaching a patient about the signs of impending lithium toxicity. Which symptoms
should the patient report?
, A) Tremor and nausea
B) Sedation and weight gain
C) Hypothyroidism and polyuria
D) Bradycardia and hypotension
Answer: A) Tremor and nausea
Rationale: Early signs of lithium toxicity include fine tremor, nausea, vomiting, diarrhea, and lethargy.
Severe toxicity includes confusion, seizures, and coma. Patients should report these symptoms
immediately.
11. A patient with schizophrenia is prescribed haloperidol. The nurse should monitor for which
adverse effect?
A) Tardive dyskinesia
B) Agranulocytosis
C) Weight gain
D) Sedation
Answer: A) Tardive dyskinesia
Rationale: Haloperidol is a typical antipsychotic associated with a high risk of extrapyramidal symptoms
and tardive dyskinesia (involuntary movements of the face, tongue, and limbs). Clozapine is associated
with agranulocytosis.
12. The nurse is assessing a patient who is experiencing a manic episode. Which finding is
characteristic?
A) Pressured speech and grandiosity
B) Flat affect and social withdrawal
C) Psychomotor retardation and anhedonia
D) Hypersomnia and weight gain
Answer: A) Pressured speech and grandiosity
Rationale: Manic episodes are characterized by elevated mood, grandiosity, decreased need for sleep,
pressured speech, racing thoughts, and risky behavior. Depression is characterized by flat affect,
withdrawal, anhedonia, and hypersomnia.
13. A patient with generalized anxiety disorder is prescribed a benzodiazepine. The nurse should
educate the patient to avoid:
A) Alcohol and caffeine
B) Foods high in tyramine
C) Grapefruit juice
Questions with Rationales
Section 1: Foundations of Psychiatric Nursing
(Questions 1-20)
1. The nurse is caring for a patient with a diagnosis of schizophrenia who is experiencing auditory
hallucinations. Which nursing intervention is most appropriate?
A) Tell the patient that the voices are not real and should be ignored
B) Ask the patient what the voices are saying and acknowledge their distress
C) Encourage the patient to engage in activities to distract from the voices
D) Place the patient in seclusion until the voices stop
Answer: B) Ask the patient what the voices are saying and acknowledge their distress
Rationale: The nurse should acknowledge the patient's experience and assess the content of the
hallucinations to determine if they are command hallucinations (telling the patient to harm self or
others). Distraction techniques may be helpful after assessment.
2. A patient with major depressive disorder is prescribed a selective serotonin reuptake inhibitor
(SSRI). The nurse should educate the patient that therapeutic effects may take:
A) 1-3 days
B) 1-2 weeks
C) 2-4 weeks
D) 4-6 weeks
Answer: C) 2-4 weeks
Rationale: SSRIs typically take 2-4 weeks to achieve therapeutic effects. Patients should continue taking
the medication even if they don't see immediate improvement and should not discontinue abruptly.
3. The nurse is assessing a patient with anxiety disorder. Which symptom is characteristic of a panic
attack?
A) Persistent worry about multiple events
B) Sudden onset of intense fear with palpitations and shortness of breath
, C) Avoidance of social situations due to fear of embarrassment
D) Excessive fear of a specific object or situation
Answer: B) Sudden onset of intense fear with palpitations and shortness of breath
Rationale: Panic attacks are characterized by sudden onset of intense fear or discomfort, with symptoms
such as palpitations, sweating, shortness of breath, and fear of losing control. Generalized anxiety
involves persistent worry, social anxiety involves fear of social situations, and specific phobias involve
fear of specific objects.
4. A patient with bipolar disorder is prescribed lithium. The nurse should monitor which laboratory
value to assess for toxicity?
A) Serum sodium
B) Serum potassium
C) Serum lithium level
D) Serum calcium level
Answer: C) Serum lithium level
Rationale: Lithium has a narrow therapeutic index (0.6-1.2 mEq/L). Monitoring serum lithium levels is
essential to prevent toxicity, which can occur at levels >1.5 mEq/L.
5. The nurse is caring for a patient who is exhibiting signs of serotonin syndrome. Which findings are
characteristic?
A) Bradycardia and hypotension
B) Hyperthermia, agitation, and tremors
C) Hypothermia and lethargy
D) Constipation and dry mouth
Answer: B) Hyperthermia, agitation, and tremors
Rationale: Serotonin syndrome presents with hyperthermia, agitation, tremors, diarrhea, and autonomic
instability. It can be life-threatening and requires immediate medical attention.
6. A patient with borderline personality disorder is admitted to the psychiatric unit. Which nursing
intervention is most important?
A) Maintain consistent boundaries and limits
B) Allow the patient to express emotions freely
C) Provide a highly structured environment
D) Avoid discussing self-harm behaviors
Answer: A) Maintain consistent boundaries and limits
Rationale: Patients with borderline personality disorder benefit from consistent boundaries and limits to
,manage manipulative behaviors and maintain safety. A structured environment and therapeutic
relationship are essential.
7. The nurse is assessing a patient for signs of extrapyramidal symptoms (EPS). Which finding indicates
EPS?
A) Akathisia and parkinsonism
B) Weight gain and sedation
C) Hyperglycemia and hypertension
D) Tachycardia and hypotension
Answer: A) Akathisia and parkinsonism
Rationale: Extrapyramidal symptoms include akathisia (restlessness), parkinsonism (rigidity, tremor,
bradykinesia), dystonia, and tardive dyskinesia. They are common side effects of antipsychotic
medications.
8. The nurse is caring for a patient with obsessive-compulsive disorder (OCD). Which intervention is
appropriate?
A) Allow the patient to perform rituals
B) Set limits on the time spent performing rituals
C) Encourage the patient to stop all compulsive behaviors
D) Avoid discussing the patient's obsessions
Answer: B) Set limits on the time spent performing rituals
Rationale: In OCD, the nurse should set limits on the time spent performing rituals while gradually
reducing them. Complete cessation is not realistic initially, and discussing obsessions is important for
assessment.
9. A patient with post-traumatic stress disorder (PTSD) is experiencing flashbacks. Which nursing
intervention is appropriate?
A) Encourage the patient to talk about the traumatic event
B) Provide a safe, quiet environment and use grounding techniques
C) Tell the patient to "snap out of it"
D) Leave the patient alone to process the flashback
Answer: B) Provide a safe, quiet environment and use grounding techniques
Rationale: During flashbacks, the nurse should provide a calm, safe environment, remain with the
patient, and use grounding techniques (e.g., naming objects in the room) to help the patient reorient to
the present.
10. The nurse is teaching a patient about the signs of impending lithium toxicity. Which symptoms
should the patient report?
, A) Tremor and nausea
B) Sedation and weight gain
C) Hypothyroidism and polyuria
D) Bradycardia and hypotension
Answer: A) Tremor and nausea
Rationale: Early signs of lithium toxicity include fine tremor, nausea, vomiting, diarrhea, and lethargy.
Severe toxicity includes confusion, seizures, and coma. Patients should report these symptoms
immediately.
11. A patient with schizophrenia is prescribed haloperidol. The nurse should monitor for which
adverse effect?
A) Tardive dyskinesia
B) Agranulocytosis
C) Weight gain
D) Sedation
Answer: A) Tardive dyskinesia
Rationale: Haloperidol is a typical antipsychotic associated with a high risk of extrapyramidal symptoms
and tardive dyskinesia (involuntary movements of the face, tongue, and limbs). Clozapine is associated
with agranulocytosis.
12. The nurse is assessing a patient who is experiencing a manic episode. Which finding is
characteristic?
A) Pressured speech and grandiosity
B) Flat affect and social withdrawal
C) Psychomotor retardation and anhedonia
D) Hypersomnia and weight gain
Answer: A) Pressured speech and grandiosity
Rationale: Manic episodes are characterized by elevated mood, grandiosity, decreased need for sleep,
pressured speech, racing thoughts, and risky behavior. Depression is characterized by flat affect,
withdrawal, anhedonia, and hypersomnia.
13. A patient with generalized anxiety disorder is prescribed a benzodiazepine. The nurse should
educate the patient to avoid:
A) Alcohol and caffeine
B) Foods high in tyramine
C) Grapefruit juice
