WGU D449 |1
WGU D449 — PSYCHIATRIC AND MENTAL HEALTH
NURSING | STUDY GUIDE | LATEST UPDATE
2026/2027 | PRACTICE QUESTIONS AND ANSWERS |
EXAM PREP
Table of Contents
1. Therapeutic Communication and the Nurse-Client Relationship
2. Psychiatric Assessment and Clinical Judgment
3. Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders
4. Depressive and Bipolar Disorders
5. Schizophrenia and Other Psychotic Disorders
6. Personality Disorders
7. Substance Use and Addictive Disorders
8. Eating Disorders and Self-Harm
9. Psychopharmacology
10. Crisis Intervention, Safety, and Legal-Ethical Practice
, WGU D449 |2
Question 1: A client with agoraphobia tells the nurse, "I can't go to the grocery store because I
might get trapped and not be able to escape." Which nursing diagnosis should the nurse
prioritize?
A) Ineffective coping
B) Fear
C) Social isolation
D) Risk for injury
Correct Answer: B) Fear
The client's specific statement about being "trapped" and unable to "escape" directly reflects
the defining characteristic of fear related to agoraphobia. While social isolation is a
consequence, fear is the priority problem driving the client's behavior and distress.
Question 2: A patient with schizophrenia tells the nurse, "The voices are telling me to hurt
myself." What is the priority nursing action?
A) Ask what the voices are saying and ensure a safe environment
B) Tell the patient the voices are not real
C) Administer antipsychotic medication without further assessment
D) Change the subject to distract the patient
Correct Answer: A) Ask what the voices are saying and ensure a safe environment
Command hallucinations instructing self-harm require immediate assessment of content to
determine the risk of harm. Safety is the priority. Arguing about the reality of voices or
changing the subject does not address the potential danger.
Question 3: A nurse is caring for a patient with major depressive disorder who has not gotten
out of bed for two days. What is the most appropriate initial nursing action?
A) Assist the patient to sit up and engage in a simple activity
B) Allow the patient to rest until they feel ready
C) Tell the patient they must get out of bed immediately
D) Administer a PRN antidepressant
Correct Answer: A) Assist the patient to sit up and engage in a simple activity
, WGU D449 |3
For a patient with severe depression, the nurse should begin with small, achievable tasks to
prevent overwhelming the patient. Assisting the patient to sit up and engage in a simple
activity promotes gradual activation and reduces the risk of complications from immobility.
Question 4: When administering lorazepam (Ativan) to a patient withdrawing from alcohol,
which interventions should the nurse prioritize? (Select all that apply.)
A) Monitor for signs of respiratory depression
B) Assess vital signs frequently
C) Monitor for signs of delirium tremens
D) Administer the medication intramuscularly only
E) Restrict fluid intake
Correct Answer: A, B, C
Benzodiazepines like lorazepam are used in alcohol withdrawal to prevent seizures and
delirium tremens. Priority monitoring includes respiratory status due to risk of respiratory
depression, frequent vital signs to monitor autonomic instability, and assessment for delirium
tremens.
Question 5: A patient on lithium carbonate (Lithium) presents with nausea, vomiting, and
tremors. What are the priority actions the nurse should take? (Select all that apply.)
A) Assess lithium levels to check for toxicity
B) Notify the healthcare provider immediately if levels exceed therapeutic range
C) Monitor hydration status and encourage fluid intake
D) Administer a PRN antipsychotic
E) Restrict sodium intake
Correct Answer: A, B, C
Nausea, vomiting, and tremors are signs of lithium toxicity. The nurse should assess lithium
levels, notify the provider if levels exceed the therapeutic range (0.6–1.2 mEq/L), and monitor
hydration because dehydration can increase lithium levels.
Question 6: A patient with schizophrenia is prescribed haloperidol (Haldol). What is the
nurse's priority assessment when starting this medication?
A) Extrapyramidal symptoms (EPS)
B) Blood glucose levels
, WGU D449 |4
C) Liver function tests
D) Serum sodium
Correct Answer: A) Extrapyramidal symptoms (EPS)
Haloperidol is a first-generation antipsychotic known to cause extrapyramidal symptoms
such as tremors, rigidity, and akathisia. Priority assessment includes monitoring for these
adverse effects.
Question 7: Which of the following are priority nursing interventions when administering a
monoamine oxidase inhibitor (MAOI) like phenelzine (Nardil)? (Select all that apply.)
A) Monitor for signs of hypertensive crisis
B) Instruct the patient to avoid foods containing tyramine
C) Monitor liver function tests regularly
D) Encourage a high-tyramine diet
E) Administer with grapefruit juice
Correct Answer: A, B, C
MAOIs carry a risk of hypertensive crisis when combined with tyramine-rich foods (aged
cheese, cured meats). The nurse must monitor for signs of hypertensive crisis, instruct the
patient to avoid tyramine, and monitor liver function tests.
Question 8: A patient with bipolar disorder is experiencing a manic episode. Which nursing
intervention is the priority?
A) Ensuring adequate nutrition and rest
B) Providing a stimulating environment
C) Encouraging the patient to make major life decisions
D) Allowing unlimited physical activity
Correct Answer: A) Ensuring adequate nutrition and rest
During a manic episode, patients often neglect basic needs such as eating and sleeping. The
priority is to ensure physical safety and meet physiologic needs, including adequate nutrition
and rest.
Question 9: A nurse is assessing a patient with borderline personality disorder who is
demanding and splitting staff. Which nursing action is most appropriate?
WGU D449 — PSYCHIATRIC AND MENTAL HEALTH
NURSING | STUDY GUIDE | LATEST UPDATE
2026/2027 | PRACTICE QUESTIONS AND ANSWERS |
EXAM PREP
Table of Contents
1. Therapeutic Communication and the Nurse-Client Relationship
2. Psychiatric Assessment and Clinical Judgment
3. Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders
4. Depressive and Bipolar Disorders
5. Schizophrenia and Other Psychotic Disorders
6. Personality Disorders
7. Substance Use and Addictive Disorders
8. Eating Disorders and Self-Harm
9. Psychopharmacology
10. Crisis Intervention, Safety, and Legal-Ethical Practice
, WGU D449 |2
Question 1: A client with agoraphobia tells the nurse, "I can't go to the grocery store because I
might get trapped and not be able to escape." Which nursing diagnosis should the nurse
prioritize?
A) Ineffective coping
B) Fear
C) Social isolation
D) Risk for injury
Correct Answer: B) Fear
The client's specific statement about being "trapped" and unable to "escape" directly reflects
the defining characteristic of fear related to agoraphobia. While social isolation is a
consequence, fear is the priority problem driving the client's behavior and distress.
Question 2: A patient with schizophrenia tells the nurse, "The voices are telling me to hurt
myself." What is the priority nursing action?
A) Ask what the voices are saying and ensure a safe environment
B) Tell the patient the voices are not real
C) Administer antipsychotic medication without further assessment
D) Change the subject to distract the patient
Correct Answer: A) Ask what the voices are saying and ensure a safe environment
Command hallucinations instructing self-harm require immediate assessment of content to
determine the risk of harm. Safety is the priority. Arguing about the reality of voices or
changing the subject does not address the potential danger.
Question 3: A nurse is caring for a patient with major depressive disorder who has not gotten
out of bed for two days. What is the most appropriate initial nursing action?
A) Assist the patient to sit up and engage in a simple activity
B) Allow the patient to rest until they feel ready
C) Tell the patient they must get out of bed immediately
D) Administer a PRN antidepressant
Correct Answer: A) Assist the patient to sit up and engage in a simple activity
, WGU D449 |3
For a patient with severe depression, the nurse should begin with small, achievable tasks to
prevent overwhelming the patient. Assisting the patient to sit up and engage in a simple
activity promotes gradual activation and reduces the risk of complications from immobility.
Question 4: When administering lorazepam (Ativan) to a patient withdrawing from alcohol,
which interventions should the nurse prioritize? (Select all that apply.)
A) Monitor for signs of respiratory depression
B) Assess vital signs frequently
C) Monitor for signs of delirium tremens
D) Administer the medication intramuscularly only
E) Restrict fluid intake
Correct Answer: A, B, C
Benzodiazepines like lorazepam are used in alcohol withdrawal to prevent seizures and
delirium tremens. Priority monitoring includes respiratory status due to risk of respiratory
depression, frequent vital signs to monitor autonomic instability, and assessment for delirium
tremens.
Question 5: A patient on lithium carbonate (Lithium) presents with nausea, vomiting, and
tremors. What are the priority actions the nurse should take? (Select all that apply.)
A) Assess lithium levels to check for toxicity
B) Notify the healthcare provider immediately if levels exceed therapeutic range
C) Monitor hydration status and encourage fluid intake
D) Administer a PRN antipsychotic
E) Restrict sodium intake
Correct Answer: A, B, C
Nausea, vomiting, and tremors are signs of lithium toxicity. The nurse should assess lithium
levels, notify the provider if levels exceed the therapeutic range (0.6–1.2 mEq/L), and monitor
hydration because dehydration can increase lithium levels.
Question 6: A patient with schizophrenia is prescribed haloperidol (Haldol). What is the
nurse's priority assessment when starting this medication?
A) Extrapyramidal symptoms (EPS)
B) Blood glucose levels
, WGU D449 |4
C) Liver function tests
D) Serum sodium
Correct Answer: A) Extrapyramidal symptoms (EPS)
Haloperidol is a first-generation antipsychotic known to cause extrapyramidal symptoms
such as tremors, rigidity, and akathisia. Priority assessment includes monitoring for these
adverse effects.
Question 7: Which of the following are priority nursing interventions when administering a
monoamine oxidase inhibitor (MAOI) like phenelzine (Nardil)? (Select all that apply.)
A) Monitor for signs of hypertensive crisis
B) Instruct the patient to avoid foods containing tyramine
C) Monitor liver function tests regularly
D) Encourage a high-tyramine diet
E) Administer with grapefruit juice
Correct Answer: A, B, C
MAOIs carry a risk of hypertensive crisis when combined with tyramine-rich foods (aged
cheese, cured meats). The nurse must monitor for signs of hypertensive crisis, instruct the
patient to avoid tyramine, and monitor liver function tests.
Question 8: A patient with bipolar disorder is experiencing a manic episode. Which nursing
intervention is the priority?
A) Ensuring adequate nutrition and rest
B) Providing a stimulating environment
C) Encouraging the patient to make major life decisions
D) Allowing unlimited physical activity
Correct Answer: A) Ensuring adequate nutrition and rest
During a manic episode, patients often neglect basic needs such as eating and sleeping. The
priority is to ensure physical safety and meet physiologic needs, including adequate nutrition
and rest.
Question 9: A nurse is assessing a patient with borderline personality disorder who is
demanding and splitting staff. Which nursing action is most appropriate?
