NUR 208/NUR208 Exam 4 V1 | Mental Health
Nursing Q&A with Rationale | Fortis College
1. A nurse is assessing a client who has a fast onset of confusion and fluctuating levels of
consciousness. Which condition should the nurse suspect?
A. Alzheimer’s Disease
B. Major Depressive Disorder
C. Vascular Dementia
D. Delirium
Correct Answer: D
Explanation: Delirium is characterized by an acute onset and a fluctuating course of
consciousness and cognition. It is often reversible once the underlying medical cause is
treated. In contrast, dementia has a slow, progressive onset that is usually irreversible.
2. Which of the following findings is most characteristic of a client with Anorexia Nervosa?
A. Normal body weight with binge-purge cycles
B. Frequent episodes of binge eating without purging
C. Body weight less than 85% of expected range
D. High self-esteem related to food intake
Correct Answer: C
,Explanation: Anorexia Nervosa involves an intense fear of gaining weight and a body
weight significantly below the expected range. Clients often have a distorted body image
and perceive themselves as overweight despite being emaciated. This physical criterion is a
primary differentiator from Bulimia Nervosa.
3. A client with Borderline Personality Disorder is praising one nurse while complaining about
another. This behavior is known as:
A. Splitting
B. Projection
C. Rationalization
D. Reaction Formation
Correct Answer: A
Explanation: Splitting is a common defense mechanism in Borderline Personality Disorder
where the client views people as all good or all bad. This behavior often creates conflict
among staff members on the treatment team. It is essential for the nursing staff to
communicate frequently to maintain consistency.
4. A nurse is monitoring a client undergoing alcohol withdrawal. Which medication is the gold
standard for preventing seizures and DTs?
A. Lorazepam
B. Methadone
C. Disulfiram
, D. Fluoxetine
Correct Answer: A
Explanation: Benzodiazepines like Lorazepam are the primary treatment for alcohol
withdrawal symptoms. They help stabilize vital signs and reduce the risk of seizures and
delirium tremens. Proper titration based on clinical scales like the CIWA is necessary for
safety.
5. A child is diagnosed with Conduct Disorder. Which behavior should the nurse expect to
see?
A. Excessive shyness and withdrawal
B. Difficulty focusing on schoolwork
C. Repetitive hand-flapping and social isolation
D. Physical aggression toward others and animals
Correct Answer: D
Explanation: Conduct Disorder is characterized by a persistent pattern of violating the
rights of others and societal norms. Symptoms often include aggression, destruction of
property, and deceitfulness. Early intervention is critical to prevent the progression to
antisocial personality disorder in adulthood.
6. What is the primary nursing priority for a client diagnosed with Bulimia Nervosa who has
frequent vomiting?
A. Assessing family dynamics
Nursing Q&A with Rationale | Fortis College
1. A nurse is assessing a client who has a fast onset of confusion and fluctuating levels of
consciousness. Which condition should the nurse suspect?
A. Alzheimer’s Disease
B. Major Depressive Disorder
C. Vascular Dementia
D. Delirium
Correct Answer: D
Explanation: Delirium is characterized by an acute onset and a fluctuating course of
consciousness and cognition. It is often reversible once the underlying medical cause is
treated. In contrast, dementia has a slow, progressive onset that is usually irreversible.
2. Which of the following findings is most characteristic of a client with Anorexia Nervosa?
A. Normal body weight with binge-purge cycles
B. Frequent episodes of binge eating without purging
C. Body weight less than 85% of expected range
D. High self-esteem related to food intake
Correct Answer: C
,Explanation: Anorexia Nervosa involves an intense fear of gaining weight and a body
weight significantly below the expected range. Clients often have a distorted body image
and perceive themselves as overweight despite being emaciated. This physical criterion is a
primary differentiator from Bulimia Nervosa.
3. A client with Borderline Personality Disorder is praising one nurse while complaining about
another. This behavior is known as:
A. Splitting
B. Projection
C. Rationalization
D. Reaction Formation
Correct Answer: A
Explanation: Splitting is a common defense mechanism in Borderline Personality Disorder
where the client views people as all good or all bad. This behavior often creates conflict
among staff members on the treatment team. It is essential for the nursing staff to
communicate frequently to maintain consistency.
4. A nurse is monitoring a client undergoing alcohol withdrawal. Which medication is the gold
standard for preventing seizures and DTs?
A. Lorazepam
B. Methadone
C. Disulfiram
, D. Fluoxetine
Correct Answer: A
Explanation: Benzodiazepines like Lorazepam are the primary treatment for alcohol
withdrawal symptoms. They help stabilize vital signs and reduce the risk of seizures and
delirium tremens. Proper titration based on clinical scales like the CIWA is necessary for
safety.
5. A child is diagnosed with Conduct Disorder. Which behavior should the nurse expect to
see?
A. Excessive shyness and withdrawal
B. Difficulty focusing on schoolwork
C. Repetitive hand-flapping and social isolation
D. Physical aggression toward others and animals
Correct Answer: D
Explanation: Conduct Disorder is characterized by a persistent pattern of violating the
rights of others and societal norms. Symptoms often include aggression, destruction of
property, and deceitfulness. Early intervention is critical to prevent the progression to
antisocial personality disorder in adulthood.
6. What is the primary nursing priority for a client diagnosed with Bulimia Nervosa who has
frequent vomiting?
A. Assessing family dynamics
