NUR 2459 Exam 3 Questions With Answers and Explanations
Question 1. A nurse is managing a situation involving suicidal plan and access to means. What is the nurse's
priority after learning of this plan and access to the firearm?
A. End the interview to avoid reinforcing suicidal thinking.
B. Ask the patient to call back next week if the thoughts persist.
C. Rely on a verbal promise that the firearm will not be used.
D. Maintain immediate safety and activate emergency suicide precautions and evaluation according to policy.
Correct Answer: D. Maintain immediate safety and activate emergency suicide precautions and evaluation according
to policy.
Explanation: The combination of intent, plan, timing, and access to lethal means warrants urgent intervention. Safety measures
should include continuous clinical response and reduction of access to lethal means when feasible and lawful. The other choices
are less appropriate because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in
this situation. After the intervention, the nurse should reassess suicide risk, mood, function, and treatment response and escalate
care if risk increases.
Question 2. A patient arrives shortly after a sexual assault and is visibly shaking, repeatedly apologizing, and
unsure whether to have a forensic exam. Which care principle is most important?
A. Elder abuse
B. Crisis intervention
C. Sexual assault trauma-informed care
D. Nonfatal strangulation
Correct Answer: C. Sexual assault trauma-informed care
Explanation: Sexual-assault care should maximize safety, autonomy, informed consent, and control over each step of examination
and evidence collection. The patient should not be pressured into procedures or law-enforcement decisions except where specific
reporting laws apply. The other options describe different conditions, findings, techniques, or medication effects and do not best
match the defining feature in the stem. The nurse should integrate immediate safety with medical assessment, autonomy,
trauma-informed communication, social context, and the least restrictive effective response.
Question 3. During patient care related to lithium, which routine monitoring is relevant during long-term lithium
therapy?
A. Only liver enzymes because lithium is cleared primarily by the liver.
B. Daily chest radiographs.
C. No laboratory testing after the first month.
D. Serum lithium levels plus renal, thyroid, electrolyte, and other patient-specific monitoring.
Correct Answer: D. Serum lithium levels plus renal, thyroid, electrolyte, and other patient-specific monitoring.
Explanation: Lithium is renally cleared and can affect both kidney concentrating ability and thyroid function. Structured monitoring
helps detect toxicity and long-term complications while maintaining therapeutic benefit. The other choices are less appropriate
because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this situation. After
the intervention, the nurse should reassess adverse effects, vital signs or laboratories when indicated, adherence, and clinical
response.
NUR 2459 Exam 3 Page 1
, Question 4. A patient with bipolar disorder repeatedly loses medication because belongings are stolen while
sleeping outdoors and has no reliable food storage or transportation. Which nursing principle is most
important?
A. Recovery-oriented psychiatric care
B. Nightmare disorder
C. Social determinants and homelessness
D. Case management
Correct Answer: C. Social determinants and homelessness
Explanation: Social conditions such as housing instability, food insecurity, transportation, safety, and access to communication
directly affect the feasibility of treatment plans. Labeling these barriers as simple nonadherence misses modifiable causes. The
other options describe different conditions, findings, techniques, or medication effects and do not best match the defining feature in
the stem. The nurse should integrate immediate safety with medical assessment, autonomy, trauma-informed communication,
social context, and the least restrictive effective response.
Question 5. A patient presents with repeated injuries, a controlling partner answers every question, and the
patient appears fearful when the partner speaks. Which nursing approach is best?
A. Nonfatal strangulation
B. Intimate partner violence screening
C. Emergency restraint for imminent harm
D. Sexual assault trauma-informed care
Correct Answer: B. Intimate partner violence screening
Explanation: Intimate partner violence screening is safest and most reliable when performed privately, without the partner present,
using direct nonjudgmental questions. The nurse should assess immediate danger and respect the patient's autonomy while
following reporting laws. The other options describe different conditions, findings, techniques, or medication effects and do not best
match the defining feature in the stem. The nurse should integrate immediate safety with medical assessment, autonomy,
trauma-informed communication, social context, and the least restrictive effective response.
Question 6. A patient reports hearing a running commentary spoken by voices when no one else is present.
Which perceptual disturbance is most likely?
A. Disorganized speech
B. Somatic delusion
C. Auditory hallucination
D. Command hallucination
Correct Answer: C. Auditory hallucination
Explanation: An auditory hallucination is a perception of sound without an external stimulus and is common in psychotic disorders.
Hallucinations differ from delusions, which are false beliefs rather than sensory perceptions. The other options describe different
conditions, findings, techniques, or medication effects and do not best match the defining feature in the stem. The nurse should
evaluate how psychosis affects safety, function, distress, insight, medication adherence, and the possibility of medical or
substance-related causes.
NUR 2459 Exam 3 Page 2
, Question 7. A patient with bipolar disorder has experienced five distinct mood episodes during the past 12
months, separated by remissions or switches to the opposite pole. Which course specifier is most applicable?
A. Suicide risk in bipolar disorder
B. Pregnancy planning with bipolar disorder
C. Rapid cycling
D. Circadian rhythm regularity
Correct Answer: C. Rapid cycling
Explanation: Rapid cycling describes four or more mood episodes within a 12-month period in bipolar disorder. It is a course
specifier rather than a separate bipolar diagnosis. The other options describe different conditions, findings, techniques, or
medication effects and do not best match the defining feature in the stem. Longitudinal assessment of sleep, energy, judgment,
psychosis, substances, medications, and suicide risk is essential when bipolar symptoms change.
Question 8. During patient care related to cannabis withdrawal, which nursing intervention is most appropriate?
A. Use restraints for routine irritability without de-escalation.
B. Offer supportive symptom management, sleep and coping strategies, and treatment for the underlying cannabis use disorder.
C. Recommend resuming heavy use as the only treatment.
D. Tell the patient withdrawal is impossible with cannabis.
Correct Answer: B. Offer supportive symptom management, sleep and coping strategies, and treatment for the
underlying cannabis use disorder.
Explanation: Recognition of withdrawal validates the patient's experience and supports relapse-prevention planning. Behavioral
treatment and management of comorbid anxiety or sleep problems may improve recovery. The other choices are less appropriate
because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this situation. After
the intervention, the nurse should reassess airway or physiologic stability, withdrawal or intoxication severity, safety, and linkage to
ongoing treatment.
Question 9. A clinical scenario involves hoarding disorder. What is a priority nursing assessment for a patient
with severe hoarding in the home?
A. Tell the patient that attachment to objects is meaningless.
B. Focus only on the monetary value of the possessions.
C. Secretly remove all possessions while the patient is away.
D. Assess fire hazards, blocked exits, falls risk, sanitation, and the patient's readiness for collaborative change.
Correct Answer: D. Assess fire hazards, blocked exits, falls risk, sanitation, and the patient's readiness for
collaborative change.
Explanation: Severe clutter can create immediate environmental dangers, so safety assessment is essential. Forced clean-outs
without engagement can increase distress, damage trust, and fail to address the underlying behavior. The other choices are less
appropriate because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this
situation. After the intervention, the nurse should reassess arousal, orientation, safety, and the patient's ability to engage in coping
or treatment.
NUR 2459 Exam 3 Page 3
, Question 10. A patient with active suicidal thoughts says, "I love my children and usually they are the reason I
keep going." Which interpretation is most accurate?
A. Trazodone
B. Protective factors do not erase suicide risk
C. Bupropion and seizure risk
D. Sudden energy improvement during severe depression
Correct Answer: B. Protective factors do not erase suicide risk
Explanation: Connection to children can be a meaningful protective factor, but protective factors do not negate active suicidal
ideation or other acute risk indicators. Risk formulation must integrate both risk and protective factors rather than treating either as
decisive alone. The other options describe different conditions, findings, techniques, or medication effects and do not best match
the defining feature in the stem. Because depressive and grief presentations can change quickly, assessment should include
function, safety, medical contributors, supports, and the longitudinal course.
Question 11. A nurse is managing a situation involving command hallucination. What is the nurse's priority
response?
A. Leave the patient alone with access to sharp objects.
B. Encourage the patient to confront the roommate to prove the voice is wrong.
C. Separate the patient from potential victims or weapons, assess intent and ability to resist, and obtain urgent team support.
D. Tell the patient to follow the command once so it will stop.
Correct Answer: C. Separate the patient from potential victims or weapons, assess intent and ability to resist, and
obtain urgent team support.
Explanation: Immediate environmental safety and risk assessment are necessary when hallucinations command violence.
Treatment should also address escalating psychosis and agitation while preserving calm communication. The other choices are
less appropriate because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this
situation. After the intervention, the nurse should reassess agitation, psychotic content, ability to follow directions, and medication
or environmental effects.
Question 12. A suicidal patient and clinician identify warning signs, internal coping strategies, supportive
people, professional contacts, and ways to reduce access to lethal means. Which intervention is being used?
A. No-suicide contract is not a safety plan
B. Suicidal plan and access to means
C. Collaborative safety planning
D. Suicide precautions and observation
Correct Answer: C. Collaborative safety planning
Explanation: A collaborative safety plan is a prioritized set of practical steps a person can use when suicidal thoughts intensify. It
includes warning signs, coping strategies, social and professional supports, and lethal-means safety. The other options describe
different conditions, findings, techniques, or medication effects and do not best match the defining feature in the stem. Because
depressive and grief presentations can change quickly, assessment should include function, safety, medical contributors, supports,
and the longitudinal course.
NUR 2459 Exam 3 Page 4
Question 1. A nurse is managing a situation involving suicidal plan and access to means. What is the nurse's
priority after learning of this plan and access to the firearm?
A. End the interview to avoid reinforcing suicidal thinking.
B. Ask the patient to call back next week if the thoughts persist.
C. Rely on a verbal promise that the firearm will not be used.
D. Maintain immediate safety and activate emergency suicide precautions and evaluation according to policy.
Correct Answer: D. Maintain immediate safety and activate emergency suicide precautions and evaluation according
to policy.
Explanation: The combination of intent, plan, timing, and access to lethal means warrants urgent intervention. Safety measures
should include continuous clinical response and reduction of access to lethal means when feasible and lawful. The other choices
are less appropriate because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in
this situation. After the intervention, the nurse should reassess suicide risk, mood, function, and treatment response and escalate
care if risk increases.
Question 2. A patient arrives shortly after a sexual assault and is visibly shaking, repeatedly apologizing, and
unsure whether to have a forensic exam. Which care principle is most important?
A. Elder abuse
B. Crisis intervention
C. Sexual assault trauma-informed care
D. Nonfatal strangulation
Correct Answer: C. Sexual assault trauma-informed care
Explanation: Sexual-assault care should maximize safety, autonomy, informed consent, and control over each step of examination
and evidence collection. The patient should not be pressured into procedures or law-enforcement decisions except where specific
reporting laws apply. The other options describe different conditions, findings, techniques, or medication effects and do not best
match the defining feature in the stem. The nurse should integrate immediate safety with medical assessment, autonomy,
trauma-informed communication, social context, and the least restrictive effective response.
Question 3. During patient care related to lithium, which routine monitoring is relevant during long-term lithium
therapy?
A. Only liver enzymes because lithium is cleared primarily by the liver.
B. Daily chest radiographs.
C. No laboratory testing after the first month.
D. Serum lithium levels plus renal, thyroid, electrolyte, and other patient-specific monitoring.
Correct Answer: D. Serum lithium levels plus renal, thyroid, electrolyte, and other patient-specific monitoring.
Explanation: Lithium is renally cleared and can affect both kidney concentrating ability and thyroid function. Structured monitoring
helps detect toxicity and long-term complications while maintaining therapeutic benefit. The other choices are less appropriate
because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this situation. After
the intervention, the nurse should reassess adverse effects, vital signs or laboratories when indicated, adherence, and clinical
response.
NUR 2459 Exam 3 Page 1
, Question 4. A patient with bipolar disorder repeatedly loses medication because belongings are stolen while
sleeping outdoors and has no reliable food storage or transportation. Which nursing principle is most
important?
A. Recovery-oriented psychiatric care
B. Nightmare disorder
C. Social determinants and homelessness
D. Case management
Correct Answer: C. Social determinants and homelessness
Explanation: Social conditions such as housing instability, food insecurity, transportation, safety, and access to communication
directly affect the feasibility of treatment plans. Labeling these barriers as simple nonadherence misses modifiable causes. The
other options describe different conditions, findings, techniques, or medication effects and do not best match the defining feature in
the stem. The nurse should integrate immediate safety with medical assessment, autonomy, trauma-informed communication,
social context, and the least restrictive effective response.
Question 5. A patient presents with repeated injuries, a controlling partner answers every question, and the
patient appears fearful when the partner speaks. Which nursing approach is best?
A. Nonfatal strangulation
B. Intimate partner violence screening
C. Emergency restraint for imminent harm
D. Sexual assault trauma-informed care
Correct Answer: B. Intimate partner violence screening
Explanation: Intimate partner violence screening is safest and most reliable when performed privately, without the partner present,
using direct nonjudgmental questions. The nurse should assess immediate danger and respect the patient's autonomy while
following reporting laws. The other options describe different conditions, findings, techniques, or medication effects and do not best
match the defining feature in the stem. The nurse should integrate immediate safety with medical assessment, autonomy,
trauma-informed communication, social context, and the least restrictive effective response.
Question 6. A patient reports hearing a running commentary spoken by voices when no one else is present.
Which perceptual disturbance is most likely?
A. Disorganized speech
B. Somatic delusion
C. Auditory hallucination
D. Command hallucination
Correct Answer: C. Auditory hallucination
Explanation: An auditory hallucination is a perception of sound without an external stimulus and is common in psychotic disorders.
Hallucinations differ from delusions, which are false beliefs rather than sensory perceptions. The other options describe different
conditions, findings, techniques, or medication effects and do not best match the defining feature in the stem. The nurse should
evaluate how psychosis affects safety, function, distress, insight, medication adherence, and the possibility of medical or
substance-related causes.
NUR 2459 Exam 3 Page 2
, Question 7. A patient with bipolar disorder has experienced five distinct mood episodes during the past 12
months, separated by remissions or switches to the opposite pole. Which course specifier is most applicable?
A. Suicide risk in bipolar disorder
B. Pregnancy planning with bipolar disorder
C. Rapid cycling
D. Circadian rhythm regularity
Correct Answer: C. Rapid cycling
Explanation: Rapid cycling describes four or more mood episodes within a 12-month period in bipolar disorder. It is a course
specifier rather than a separate bipolar diagnosis. The other options describe different conditions, findings, techniques, or
medication effects and do not best match the defining feature in the stem. Longitudinal assessment of sleep, energy, judgment,
psychosis, substances, medications, and suicide risk is essential when bipolar symptoms change.
Question 8. During patient care related to cannabis withdrawal, which nursing intervention is most appropriate?
A. Use restraints for routine irritability without de-escalation.
B. Offer supportive symptom management, sleep and coping strategies, and treatment for the underlying cannabis use disorder.
C. Recommend resuming heavy use as the only treatment.
D. Tell the patient withdrawal is impossible with cannabis.
Correct Answer: B. Offer supportive symptom management, sleep and coping strategies, and treatment for the
underlying cannabis use disorder.
Explanation: Recognition of withdrawal validates the patient's experience and supports relapse-prevention planning. Behavioral
treatment and management of comorbid anxiety or sleep problems may improve recovery. The other choices are less appropriate
because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this situation. After
the intervention, the nurse should reassess airway or physiologic stability, withdrawal or intoxication severity, safety, and linkage to
ongoing treatment.
Question 9. A clinical scenario involves hoarding disorder. What is a priority nursing assessment for a patient
with severe hoarding in the home?
A. Tell the patient that attachment to objects is meaningless.
B. Focus only on the monetary value of the possessions.
C. Secretly remove all possessions while the patient is away.
D. Assess fire hazards, blocked exits, falls risk, sanitation, and the patient's readiness for collaborative change.
Correct Answer: D. Assess fire hazards, blocked exits, falls risk, sanitation, and the patient's readiness for
collaborative change.
Explanation: Severe clutter can create immediate environmental dangers, so safety assessment is essential. Forced clean-outs
without engagement can increase distress, damage trust, and fail to address the underlying behavior. The other choices are less
appropriate because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this
situation. After the intervention, the nurse should reassess arousal, orientation, safety, and the patient's ability to engage in coping
or treatment.
NUR 2459 Exam 3 Page 3
, Question 10. A patient with active suicidal thoughts says, "I love my children and usually they are the reason I
keep going." Which interpretation is most accurate?
A. Trazodone
B. Protective factors do not erase suicide risk
C. Bupropion and seizure risk
D. Sudden energy improvement during severe depression
Correct Answer: B. Protective factors do not erase suicide risk
Explanation: Connection to children can be a meaningful protective factor, but protective factors do not negate active suicidal
ideation or other acute risk indicators. Risk formulation must integrate both risk and protective factors rather than treating either as
decisive alone. The other options describe different conditions, findings, techniques, or medication effects and do not best match
the defining feature in the stem. Because depressive and grief presentations can change quickly, assessment should include
function, safety, medical contributors, supports, and the longitudinal course.
Question 11. A nurse is managing a situation involving command hallucination. What is the nurse's priority
response?
A. Leave the patient alone with access to sharp objects.
B. Encourage the patient to confront the roommate to prove the voice is wrong.
C. Separate the patient from potential victims or weapons, assess intent and ability to resist, and obtain urgent team support.
D. Tell the patient to follow the command once so it will stop.
Correct Answer: C. Separate the patient from potential victims or weapons, assess intent and ability to resist, and
obtain urgent team support.
Explanation: Immediate environmental safety and risk assessment are necessary when hallucinations command violence.
Treatment should also address escalating psychosis and agitation while preserving calm communication. The other choices are
less appropriate because they either miss the immediate priority, reinforce maladaptive behavior, or introduce avoidable risk in this
situation. After the intervention, the nurse should reassess agitation, psychotic content, ability to follow directions, and medication
or environmental effects.
Question 12. A suicidal patient and clinician identify warning signs, internal coping strategies, supportive
people, professional contacts, and ways to reduce access to lethal means. Which intervention is being used?
A. No-suicide contract is not a safety plan
B. Suicidal plan and access to means
C. Collaborative safety planning
D. Suicide precautions and observation
Correct Answer: C. Collaborative safety planning
Explanation: A collaborative safety plan is a prioritized set of practical steps a person can use when suicidal thoughts intensify. It
includes warning signs, coping strategies, social and professional supports, and lethal-means safety. The other options describe
different conditions, findings, techniques, or medication effects and do not best match the defining feature in the stem. Because
depressive and grief presentations can change quickly, assessment should include function, safety, medical contributors, supports,
and the longitudinal course.
NUR 2459 Exam 3 Page 4
