NSG 3450 / NSG3450 Exam 3 – Mental Health
Review
Galen College of Nursing
2026/2027 Update
40 Questions | 100 Points
Table of Contents
• Section 1: Psychopharmacology & Neurobiology (Q1–Q10)
• Section 2: Mood, Anxiety, & Trauma-Related Disorders (Q11–Q20)
• Section 3: Psychotic, Personality, & Neurocognitive Disorders (Q21–Q30)
• Section 4: Crisis Intervention, Therapeutic Communication, & Ethical/Legal Issues (Q31–Q40)
• Grading Rubric & Scoring Guide
Section 1: Psychopharmacology & Neurobiology (Q1-Q10)
Question 1
A client with major depressive disorder starts sertraline (Zoloft). Which statement by the client indicates
the medication education was effective?
A. I should expect immediate improvement in my mood within the first few days
B. I may experience headaches and nausea, but these usually improve over time [CORRECT]
C. I need to avoid foods high in tyramine while taking this medication
D. I should take this medication only on days when I feel very sad
Correct Answer: B
Rationale:
SSRIs require 2–4 weeks for therapeutic effect; initial side effects (headache, nausea, insomnia) are common and
typically resolve. Tyramine restriction applies to MAOIs. Antidepressants must be taken daily.
Question 2
A nurse is assessing a client taking lithium carbonate (Lithobid) for bipolar disorder. Which finding
requires IMMEDIATE intervention?
A. Lithium level of 0.8 mEq/L
B. Fine hand tremor
C. Vomiting, diarrhea, and coarse hand tremor [CORRECT]
D. Mild polyuria and increased thirst
Correct Answer: C
Rationale:
Vomiting, diarrhea, coarse tremor, ataxia, and confusion indicate lithium toxicity requiring immediate intervention.
Therapeutic level is 0.6–1.2 mEq/L. Fine tremor and polyuria are expected side effects.
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, NSG 3450 Exam 3 | Mental Health Review | Galen College of Nursing | 2026/2027
Question 3
A client is admitted with suspected serotonin syndrome. Which triad of symptoms should the nurse
expect?
A. Hypothermia, bradycardia, and somnolence
B. Hypertension, bradykinesia, and euphoria
C. Hyperthermia, autonomic instability, and altered mental status [CORRECT]
D. Hypotension, muscle flaccidity, and agitation
Correct Answer: C
Rationale:
The serotonin syndrome triad is hyperthermia, autonomic instability (tachycardia, labile BP, diaphoresis), and
altered mental status (agitation, confusion). It occurs when serotonergic agents are combined or doses are
increased.
Question 4
A nurse is caring for a client who just received their first dose of haloperidol (Haldol). The client
develops torticollis and oculogyric crisis. The nurse should FIRST:
A. Hold the medication and notify the provider
B. Administer diphenhydramine (Benadryl) or benztropine (Cogentin) as ordered [CORRECT]
C. Restrain the client to prevent injury
D. Document the reaction and continue the medication at a lower dose
Correct Answer: B
Rationale:
Acute dystonia is treated immediately with anticholinergic medications (diphenhydramine or benztropine). This is
an extrapyramidal side effect that requires prompt intervention. Holding the antipsychotic is also necessary but
pharmacological treatment is the priority.
Question 5
Which medication is classified as an atypical antipsychotic and carries the highest risk for metabolic
syndrome?
A. Haloperidol
B. Clozapine (Clozaril) [CORRECT]
C. Chlorpromazine (Thorazine)
D. Lithium carbonate
Correct Answer: B
Rationale:
Clozapine has the highest metabolic risk among atypical antipsychotics (weight gain, diabetes, dyslipidemia) and
requires CBC monitoring for agranulocytosis. Olanzapine and quetiapine also carry significant metabolic risk.
Question 6
A client with schizophrenia is prescribed risperidone (Risperdal). The nurse should monitor for which
potential side effect that is unique to this medication at higher doses?
A. Agranulocytosis
B. Prolactin elevation [CORRECT]
Page 2
Review
Galen College of Nursing
2026/2027 Update
40 Questions | 100 Points
Table of Contents
• Section 1: Psychopharmacology & Neurobiology (Q1–Q10)
• Section 2: Mood, Anxiety, & Trauma-Related Disorders (Q11–Q20)
• Section 3: Psychotic, Personality, & Neurocognitive Disorders (Q21–Q30)
• Section 4: Crisis Intervention, Therapeutic Communication, & Ethical/Legal Issues (Q31–Q40)
• Grading Rubric & Scoring Guide
Section 1: Psychopharmacology & Neurobiology (Q1-Q10)
Question 1
A client with major depressive disorder starts sertraline (Zoloft). Which statement by the client indicates
the medication education was effective?
A. I should expect immediate improvement in my mood within the first few days
B. I may experience headaches and nausea, but these usually improve over time [CORRECT]
C. I need to avoid foods high in tyramine while taking this medication
D. I should take this medication only on days when I feel very sad
Correct Answer: B
Rationale:
SSRIs require 2–4 weeks for therapeutic effect; initial side effects (headache, nausea, insomnia) are common and
typically resolve. Tyramine restriction applies to MAOIs. Antidepressants must be taken daily.
Question 2
A nurse is assessing a client taking lithium carbonate (Lithobid) for bipolar disorder. Which finding
requires IMMEDIATE intervention?
A. Lithium level of 0.8 mEq/L
B. Fine hand tremor
C. Vomiting, diarrhea, and coarse hand tremor [CORRECT]
D. Mild polyuria and increased thirst
Correct Answer: C
Rationale:
Vomiting, diarrhea, coarse tremor, ataxia, and confusion indicate lithium toxicity requiring immediate intervention.
Therapeutic level is 0.6–1.2 mEq/L. Fine tremor and polyuria are expected side effects.
Page 1
, NSG 3450 Exam 3 | Mental Health Review | Galen College of Nursing | 2026/2027
Question 3
A client is admitted with suspected serotonin syndrome. Which triad of symptoms should the nurse
expect?
A. Hypothermia, bradycardia, and somnolence
B. Hypertension, bradykinesia, and euphoria
C. Hyperthermia, autonomic instability, and altered mental status [CORRECT]
D. Hypotension, muscle flaccidity, and agitation
Correct Answer: C
Rationale:
The serotonin syndrome triad is hyperthermia, autonomic instability (tachycardia, labile BP, diaphoresis), and
altered mental status (agitation, confusion). It occurs when serotonergic agents are combined or doses are
increased.
Question 4
A nurse is caring for a client who just received their first dose of haloperidol (Haldol). The client
develops torticollis and oculogyric crisis. The nurse should FIRST:
A. Hold the medication and notify the provider
B. Administer diphenhydramine (Benadryl) or benztropine (Cogentin) as ordered [CORRECT]
C. Restrain the client to prevent injury
D. Document the reaction and continue the medication at a lower dose
Correct Answer: B
Rationale:
Acute dystonia is treated immediately with anticholinergic medications (diphenhydramine or benztropine). This is
an extrapyramidal side effect that requires prompt intervention. Holding the antipsychotic is also necessary but
pharmacological treatment is the priority.
Question 5
Which medication is classified as an atypical antipsychotic and carries the highest risk for metabolic
syndrome?
A. Haloperidol
B. Clozapine (Clozaril) [CORRECT]
C. Chlorpromazine (Thorazine)
D. Lithium carbonate
Correct Answer: B
Rationale:
Clozapine has the highest metabolic risk among atypical antipsychotics (weight gain, diabetes, dyslipidemia) and
requires CBC monitoring for agranulocytosis. Olanzapine and quetiapine also carry significant metabolic risk.
Question 6
A client with schizophrenia is prescribed risperidone (Risperdal). The nurse should monitor for which
potential side effect that is unique to this medication at higher doses?
A. Agranulocytosis
B. Prolactin elevation [CORRECT]
Page 2
