NUR 326 Complex Medical-Surgical Nursing – Final
Examination (2026/2027)
SECTION 1: MENTAL HEALTH NURSING (Qs 1-30)
1. A nurse is assessing a male client being admitted for alcohol withdrawal. Which
finding is the nurse most likely to note?
A) Perceptual disorders
B) Impending coma
C) Recent alcohol intake
D) Depression with mutism
Answer: A
Rationale: Frightening visual hallucinations are especially common in clients
experiencing alcohol withdrawal. Perceptual disorders are a key feature of alcohol
withdrawal syndrome .
2. A client has agreed to take amitriptyline (Elavil) for 3 days but now complains
that it "doesn't help" and refuses to take it. What should the nurse say?
A) Withhold the drug
B) Record the client's response
C) Encourage the client to tell the physician
D) Suggest that it takes a while before seeing the results
Answer: D
Rationale: Amitriptyline typically takes 2 to 3 weeks to reach therapeutic blood levels
and produce noticeable effects. The nurse should educate the client about this delayed
onset of action .
, 3. In preparing a female client for electroconvulsive therapy (ECT), the nurse
knows that succinylcholine (Anectine) will be administered for which therapeutic
effect?
A) Short-acting anesthesia
B) Decreased oral and respiratory secretions
C) Skeletal muscle paralysis
D) Analgesia
Answer: C
Rationale: Succinylcholine is a depolarizing muscle relaxant that causes paralysis. It is
used to reduce the intensity of muscle contractions during the convulsive stage, thereby
reducing the risk of bone fractures or dislocation .
4. A nurse notices that a client with obsessive-compulsive disorder washes her
hands for long periods each day. How should the nurse respond to this compulsive
behavior?
A) By designating times during which the client can focus on the behavior
B) By urging the client to reduce the frequency of the behavior as rapidly as possible
C) By calling attention to, or attempting to prevent the behavior
D) By discouraging the client from verbalizing anxieties
Answer: A
Rationale: The nurse should designate times during which the client can focus on the
compulsive behavior or obsessive thoughts. The nurse should encourage, not
discourage, verbalization of anxieties, and should not call attention to or try to prevent
the behavior, as this may cause distress .
5. A client who was raped while walking her dog is diagnosed with posttraumatic
stress disorder (PTSD). Three months later, the client returns complaining of fear,
loss of control, and helpless feelings. Which nursing intervention is most
appropriate?
, A) Recommending a high-protein, low-fat diet
B) Giving sleep medication to restore a normal sleep-wake cycle
C) Allowing the client time to heal
D) Exploring the meaning of the traumatic event with the client
Answer: D
Rationale: The client with PTSD needs encouragement to examine and understand the
meaning of the traumatic event and consequent losses. Otherwise, symptoms may
persist .
6. A client rarely goes out with friends, cancels at the last minute, and says they
are sick. Which anxiety disorder is most consistent with this behavior?
A) Generalized anxiety disorder
B) Panic disorder
C) Agoraphobia
D) Social anxiety disorder
Answer: C
Rationale: Agoraphobia is characterized by fear of situations where escape might be
difficult, often leading to avoidance of social events and public places. The client's
pattern of canceling plans and avoiding social situations is consistent with this
diagnosis .
7. A nurse enters a client's room and finds them on the floor with their knees to
their chest, rocking back and forth, and staring aimlessly. When asked a question,
the client does not respond. These findings are consistent with which level of
anxiety?
A) Mild anxiety
B) Moderate anxiety
C) Severe anxiety
D) Panic
, Answer: D
Rationale: Panic-level anxiety is characterized by an inability to respond to the
environment, disorganized behavior, and a sense of terror. The client's rocking, staring,
and failure to respond are characteristic of panic-level anxiety .
8. A patient newly diagnosed with depression asks, "I have had other people in my
family say that they have depression. Is this an inherited problem?" What is the
nurse's best response?
A) "Depression is not inherited."
B) "Members of the same family may have the same biological predisposition to
experiencing mood disorders."
C) "You should not worry about genetics."
D) "Your family history does not affect your diagnosis."
Answer: B
Rationale: Genetics play a role in depression. Research indicates that first-degree
relatives of individuals with depression have a higher risk of developing the disorder,
suggesting a biological predisposition .
9. Risk factors for depression include which of the following? (Select all that
apply.)
A) Co-occurring disorders such as substance use disorder, anxiety, or personality
disorders
B) Living with chronic or disabling medical conditions
C) Being female
D) Having adverse childhood experiences
Answer: A, B, C, D
Rationale: Risk factors for depression include co-occurring disorders, chronic or
disabling medical conditions, being female, and adverse childhood experiences .
Examination (2026/2027)
SECTION 1: MENTAL HEALTH NURSING (Qs 1-30)
1. A nurse is assessing a male client being admitted for alcohol withdrawal. Which
finding is the nurse most likely to note?
A) Perceptual disorders
B) Impending coma
C) Recent alcohol intake
D) Depression with mutism
Answer: A
Rationale: Frightening visual hallucinations are especially common in clients
experiencing alcohol withdrawal. Perceptual disorders are a key feature of alcohol
withdrawal syndrome .
2. A client has agreed to take amitriptyline (Elavil) for 3 days but now complains
that it "doesn't help" and refuses to take it. What should the nurse say?
A) Withhold the drug
B) Record the client's response
C) Encourage the client to tell the physician
D) Suggest that it takes a while before seeing the results
Answer: D
Rationale: Amitriptyline typically takes 2 to 3 weeks to reach therapeutic blood levels
and produce noticeable effects. The nurse should educate the client about this delayed
onset of action .
, 3. In preparing a female client for electroconvulsive therapy (ECT), the nurse
knows that succinylcholine (Anectine) will be administered for which therapeutic
effect?
A) Short-acting anesthesia
B) Decreased oral and respiratory secretions
C) Skeletal muscle paralysis
D) Analgesia
Answer: C
Rationale: Succinylcholine is a depolarizing muscle relaxant that causes paralysis. It is
used to reduce the intensity of muscle contractions during the convulsive stage, thereby
reducing the risk of bone fractures or dislocation .
4. A nurse notices that a client with obsessive-compulsive disorder washes her
hands for long periods each day. How should the nurse respond to this compulsive
behavior?
A) By designating times during which the client can focus on the behavior
B) By urging the client to reduce the frequency of the behavior as rapidly as possible
C) By calling attention to, or attempting to prevent the behavior
D) By discouraging the client from verbalizing anxieties
Answer: A
Rationale: The nurse should designate times during which the client can focus on the
compulsive behavior or obsessive thoughts. The nurse should encourage, not
discourage, verbalization of anxieties, and should not call attention to or try to prevent
the behavior, as this may cause distress .
5. A client who was raped while walking her dog is diagnosed with posttraumatic
stress disorder (PTSD). Three months later, the client returns complaining of fear,
loss of control, and helpless feelings. Which nursing intervention is most
appropriate?
, A) Recommending a high-protein, low-fat diet
B) Giving sleep medication to restore a normal sleep-wake cycle
C) Allowing the client time to heal
D) Exploring the meaning of the traumatic event with the client
Answer: D
Rationale: The client with PTSD needs encouragement to examine and understand the
meaning of the traumatic event and consequent losses. Otherwise, symptoms may
persist .
6. A client rarely goes out with friends, cancels at the last minute, and says they
are sick. Which anxiety disorder is most consistent with this behavior?
A) Generalized anxiety disorder
B) Panic disorder
C) Agoraphobia
D) Social anxiety disorder
Answer: C
Rationale: Agoraphobia is characterized by fear of situations where escape might be
difficult, often leading to avoidance of social events and public places. The client's
pattern of canceling plans and avoiding social situations is consistent with this
diagnosis .
7. A nurse enters a client's room and finds them on the floor with their knees to
their chest, rocking back and forth, and staring aimlessly. When asked a question,
the client does not respond. These findings are consistent with which level of
anxiety?
A) Mild anxiety
B) Moderate anxiety
C) Severe anxiety
D) Panic
, Answer: D
Rationale: Panic-level anxiety is characterized by an inability to respond to the
environment, disorganized behavior, and a sense of terror. The client's rocking, staring,
and failure to respond are characteristic of panic-level anxiety .
8. A patient newly diagnosed with depression asks, "I have had other people in my
family say that they have depression. Is this an inherited problem?" What is the
nurse's best response?
A) "Depression is not inherited."
B) "Members of the same family may have the same biological predisposition to
experiencing mood disorders."
C) "You should not worry about genetics."
D) "Your family history does not affect your diagnosis."
Answer: B
Rationale: Genetics play a role in depression. Research indicates that first-degree
relatives of individuals with depression have a higher risk of developing the disorder,
suggesting a biological predisposition .
9. Risk factors for depression include which of the following? (Select all that
apply.)
A) Co-occurring disorders such as substance use disorder, anxiety, or personality
disorders
B) Living with chronic or disabling medical conditions
C) Being female
D) Having adverse childhood experiences
Answer: A, B, C, D
Rationale: Risk factors for depression include co-occurring disorders, chronic or
disabling medical conditions, being female, and adverse childhood experiences .
