,NR-326 Verified Final Exam — Mental Health
Nursing | Chamberlain College of Nursing | Q
& A | 2026/2027
1. A client with major depressive disorder has been taking fluoxetine 40 mg daily for 6 weeks
with minimal improvement. The client reports continued sadness, insomnia, and loss of interest
in activities. Which action should the nurse take first?
A) Increase the fluoxetine dose to 60 mg daily
B) Assess the client for suicidal ideation
C) Discontinue fluoxetine and start a different antidepressant
D) Reassure the client that full therapeutic effect may take 4-6 weeks
Correct Answer: Assess the client for suicidal ideation
Rationale: Suicide risk assessment is the priority when a client with depression shows minimal
improvement, as the risk of suicide may increase during the early weeks of antidepressant
treatment when energy improves but mood has not yet lifted. While full therapeutic effect may
take 4-6 weeks, safety assessment must come first. Dose adjustments and medication changes
require provider orders.
2. Which nursing response best demonstrates therapeutic communication when a client states,
"I feel like nobody cares about me"?
A) "I'm sure that's not true, your family loves you."
B) "Why do you feel that way?"
,C) "You feel like nobody cares about you."
D) "Have you tried reaching out to your family?"
Correct Answer: "You feel like nobody cares about you."
Rationale: Reflecting the client's feelings back validates the client's emotions and demonstrates
understanding, which is a therapeutic communication technique. "Why" questions can feel
accusatory and are generally nontherapeutic. Giving reassurance without exploring feelings
minimizes the client's experience, and giving advice blocks further communication.
3. A client with schizophrenia is experiencing auditory hallucinations and appears to be
responding to internal stimuli. Which nursing intervention is most appropriate?
A) Tell the client, "The voices are not real."
B) Ask the client, "What are the voices saying to you?"
C) Ignore the behavior and redirect to another activity
D) Tell the client, "I hear the voices too."
Correct Answer: Ask the client, "What are the voices saying to you?"
Rationale: The nurse should assess the content of hallucinations, particularly for command
hallucinations that may indicate risk of harm to self or others. Telling the client the voices are
not real can increase distress; ignoring them fails to assess safety; and agreeing with the client
reinforces psychotic thinking.
4. A client with bipolar disorder is prescribed lithium carbonate. Which serum lithium level
indicates a therapeutic range for maintenance therapy?
A) 0.4-0.8 mEq/L
, B) 0.6-1.2 mEq/L
C) 1.5-2.0 mEq/L
D) 2.5-3.0 mEq/L
Correct Answer: 0.6-1.2 mEq/L
Rationale: The therapeutic range for lithium maintenance therapy is 0.6-1.2 mEq/L. Levels
below 0.6 are generally subtherapeutic, while levels above 1.5 mEq/L indicate toxicity. Signs of
lithium toxicity include nausea, vomiting, diarrhea, coarse tremor, ataxia, and confusion.
5. A client with alcohol use disorder is admitted for detoxification. The nurse administers the
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) and obtains a score of 18. Which
action should the nurse take?
A) Continue monitoring without medication
B) Administer chlordiazepoxide as per symptom-triggered protocol
C) Place the client in seclusion
D) Administer naloxone immediately
Correct Answer: Administer chlordiazepoxide as per symptom-triggered protocol
Rationale: A CIWA-Ar score of 10-19 indicates moderate withdrawal requiring symptom-
triggered medication administration. Chlordiazepoxide is a benzodiazepine commonly used in
alcohol withdrawal to prevent seizures and delirium tremens. Scores below 8 indicate mild
withdrawal; scores above 20 indicate severe withdrawal.
6. A client with borderline personality disorder is using splitting behavior, frequently praising
one staff member while criticizing another. Which nursing intervention is the priority?
Nursing | Chamberlain College of Nursing | Q
& A | 2026/2027
1. A client with major depressive disorder has been taking fluoxetine 40 mg daily for 6 weeks
with minimal improvement. The client reports continued sadness, insomnia, and loss of interest
in activities. Which action should the nurse take first?
A) Increase the fluoxetine dose to 60 mg daily
B) Assess the client for suicidal ideation
C) Discontinue fluoxetine and start a different antidepressant
D) Reassure the client that full therapeutic effect may take 4-6 weeks
Correct Answer: Assess the client for suicidal ideation
Rationale: Suicide risk assessment is the priority when a client with depression shows minimal
improvement, as the risk of suicide may increase during the early weeks of antidepressant
treatment when energy improves but mood has not yet lifted. While full therapeutic effect may
take 4-6 weeks, safety assessment must come first. Dose adjustments and medication changes
require provider orders.
2. Which nursing response best demonstrates therapeutic communication when a client states,
"I feel like nobody cares about me"?
A) "I'm sure that's not true, your family loves you."
B) "Why do you feel that way?"
,C) "You feel like nobody cares about you."
D) "Have you tried reaching out to your family?"
Correct Answer: "You feel like nobody cares about you."
Rationale: Reflecting the client's feelings back validates the client's emotions and demonstrates
understanding, which is a therapeutic communication technique. "Why" questions can feel
accusatory and are generally nontherapeutic. Giving reassurance without exploring feelings
minimizes the client's experience, and giving advice blocks further communication.
3. A client with schizophrenia is experiencing auditory hallucinations and appears to be
responding to internal stimuli. Which nursing intervention is most appropriate?
A) Tell the client, "The voices are not real."
B) Ask the client, "What are the voices saying to you?"
C) Ignore the behavior and redirect to another activity
D) Tell the client, "I hear the voices too."
Correct Answer: Ask the client, "What are the voices saying to you?"
Rationale: The nurse should assess the content of hallucinations, particularly for command
hallucinations that may indicate risk of harm to self or others. Telling the client the voices are
not real can increase distress; ignoring them fails to assess safety; and agreeing with the client
reinforces psychotic thinking.
4. A client with bipolar disorder is prescribed lithium carbonate. Which serum lithium level
indicates a therapeutic range for maintenance therapy?
A) 0.4-0.8 mEq/L
, B) 0.6-1.2 mEq/L
C) 1.5-2.0 mEq/L
D) 2.5-3.0 mEq/L
Correct Answer: 0.6-1.2 mEq/L
Rationale: The therapeutic range for lithium maintenance therapy is 0.6-1.2 mEq/L. Levels
below 0.6 are generally subtherapeutic, while levels above 1.5 mEq/L indicate toxicity. Signs of
lithium toxicity include nausea, vomiting, diarrhea, coarse tremor, ataxia, and confusion.
5. A client with alcohol use disorder is admitted for detoxification. The nurse administers the
Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) and obtains a score of 18. Which
action should the nurse take?
A) Continue monitoring without medication
B) Administer chlordiazepoxide as per symptom-triggered protocol
C) Place the client in seclusion
D) Administer naloxone immediately
Correct Answer: Administer chlordiazepoxide as per symptom-triggered protocol
Rationale: A CIWA-Ar score of 10-19 indicates moderate withdrawal requiring symptom-
triggered medication administration. Chlordiazepoxide is a benzodiazepine commonly used in
alcohol withdrawal to prevent seizures and delirium tremens. Scores below 8 indicate mild
withdrawal; scores above 20 indicate severe withdrawal.
6. A client with borderline personality disorder is using splitting behavior, frequently praising
one staff member while criticizing another. Which nursing intervention is the priority?
