NURS 354: ADVANCED PSYCHIATRIC-
MENTAL HEALTH NURSING
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with a history of Major Depressive Disorder is prescribed Phenelzine. Which of
the following dinner choices indicates the patient requires further teaching?
A. Grilled chicken with a side of steamed broccoli
B. Baked cod with a lemon butter sauce and asparagus
C. Fresh garden salad with oil and vinegar dressing
D. Pepperoni pizza with aged cheddar and a glass of red wine
Answer: D
Conceptual Explanation: Phenelzine is an MAOI. Consuming tyramine-rich foods like
pepperoni, aged cheese, and red wine can trigger a hypertensive crisis.
2. Which neurotransmitter imbalance is primarily associated with the pathophysiology of
Schizophrenia according to the dopamine hypothesis?
A. Deficiency of dopamine in the mesocortical pathway
B. Excess of serotonin in the prefrontal cortex
,C. Deficiency of GABA in the basal ganglia
D. Excess of dopamine in the mesolimbic pathway
Answer: D
Conceptual Explanation: The dopamine hypothesis suggests that positive symptoms of
schizophrenia result from excessive dopamine activity in the mesolimbic pathway.
3. A nurse is assessing a patient for Neuroleptic Malignant Syndrome (NMS). Which clinical
finding is most characteristic of this life-threatening condition?
A. Fine hand tremors and polyuria
B. Hyperreflexia and myoclonus
C. Lead-pipe muscle rigidity and hyperpyrexia
D. Orthostatic hypotension and dry mouth
Answer: C
Conceptual Explanation: NMS is characterized by severe muscle rigidity (lead-pipe), high
fever (hyperpyrexia), autonomic instability, and altered mental status.
4. In the orientation phase of the nurse-client relationship, which of the following is the
primary goal?
A. Promoting the patient’s insight into problematic behaviors
B. Overcoming resistance to change and identifying stressors
C. Evaluating the progress toward goals and preparing for discharge
, D. Establishing trust and defining the boundaries of the relationship
Answer: D
Conceptual Explanation: The orientation phase focuses on establishing rapport, trust, and
setting the contract/boundaries for the therapeutic relationship.
5. A patient taking Lithium Carbonate for Bipolar Disorder reports blurred vision and a coarse
hand tremor. The serum lithium level is 2.1 mEq/L. Which action is the priority?
A. Administer the next scheduled dose and recheck the level in 24 hours
B. Withhold the medication and prepare for possible hemodialysis
C. Increase fluid intake to flush the medication out of the system
D. Administer Benztropine to treat the extrapyramidal symptoms
Answer: B
Conceptual Explanation: A lithium level of 2.1 mEq/L is toxic (normal range 0.6-1.2
mEq/L). Symptoms like coarse tremors and blurred vision indicate severe toxicity
requiring immediate intervention.
6. Which defense mechanism is being used when a patient who is angry with their physician
yells at the nurse instead?
A. Sublimation
B. Projection
C. Displacement
MENTAL HEALTH NURSING
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient with a history of Major Depressive Disorder is prescribed Phenelzine. Which of
the following dinner choices indicates the patient requires further teaching?
A. Grilled chicken with a side of steamed broccoli
B. Baked cod with a lemon butter sauce and asparagus
C. Fresh garden salad with oil and vinegar dressing
D. Pepperoni pizza with aged cheddar and a glass of red wine
Answer: D
Conceptual Explanation: Phenelzine is an MAOI. Consuming tyramine-rich foods like
pepperoni, aged cheese, and red wine can trigger a hypertensive crisis.
2. Which neurotransmitter imbalance is primarily associated with the pathophysiology of
Schizophrenia according to the dopamine hypothesis?
A. Deficiency of dopamine in the mesocortical pathway
B. Excess of serotonin in the prefrontal cortex
,C. Deficiency of GABA in the basal ganglia
D. Excess of dopamine in the mesolimbic pathway
Answer: D
Conceptual Explanation: The dopamine hypothesis suggests that positive symptoms of
schizophrenia result from excessive dopamine activity in the mesolimbic pathway.
3. A nurse is assessing a patient for Neuroleptic Malignant Syndrome (NMS). Which clinical
finding is most characteristic of this life-threatening condition?
A. Fine hand tremors and polyuria
B. Hyperreflexia and myoclonus
C. Lead-pipe muscle rigidity and hyperpyrexia
D. Orthostatic hypotension and dry mouth
Answer: C
Conceptual Explanation: NMS is characterized by severe muscle rigidity (lead-pipe), high
fever (hyperpyrexia), autonomic instability, and altered mental status.
4. In the orientation phase of the nurse-client relationship, which of the following is the
primary goal?
A. Promoting the patient’s insight into problematic behaviors
B. Overcoming resistance to change and identifying stressors
C. Evaluating the progress toward goals and preparing for discharge
, D. Establishing trust and defining the boundaries of the relationship
Answer: D
Conceptual Explanation: The orientation phase focuses on establishing rapport, trust, and
setting the contract/boundaries for the therapeutic relationship.
5. A patient taking Lithium Carbonate for Bipolar Disorder reports blurred vision and a coarse
hand tremor. The serum lithium level is 2.1 mEq/L. Which action is the priority?
A. Administer the next scheduled dose and recheck the level in 24 hours
B. Withhold the medication and prepare for possible hemodialysis
C. Increase fluid intake to flush the medication out of the system
D. Administer Benztropine to treat the extrapyramidal symptoms
Answer: B
Conceptual Explanation: A lithium level of 2.1 mEq/L is toxic (normal range 0.6-1.2
mEq/L). Symptoms like coarse tremors and blurred vision indicate severe toxicity
requiring immediate intervention.
6. Which defense mechanism is being used when a patient who is angry with their physician
yells at the nurse instead?
A. Sublimation
B. Projection
C. Displacement
