NR 547 MENTAL HEALTH NURSING
COMPREHENSIVE FINAL EXAM 2026
STUDY GUIDE & PRACTICE TEST —
QUESTIONS 1–200
1. A nurse is assessing a client who reports hearing voices telling them to harm
another person. Which action should the nurse take first?
A. Ask the client to explain why the voices are occurring.
B. Determine whether the client has a specific plan or intent to harm someone.
C. Tell the client that the voices are not real.
D. Encourage the client to ignore the voices.
Answer: B
Rationale: Command hallucinations involving harm require immediate
assessment of the client's intent, plan, means, and ability to act. Safety takes
priority. Arguing about whether the hallucinations are real is not therapeutic.
2. A client experiencing mania is pacing continuously, speaking rapidly, and
refusing meals. Which nursing intervention is most appropriate?
A. Provide lengthy explanations about the importance of nutrition.
B. Encourage participation in group therapy.
C. Offer frequent high-calorie finger foods and fluids.
D. Ask the client to remain in bed until mealtime.
Answer: C
Rationale: Clients experiencing mania often have increased activity and
decreased attention span. Nutrient-dense finger foods and fluids allow the client
,to maintain nutritional intake without requiring prolonged sitting or
concentration.
3. Which finding is most concerning in a client taking lithium?
A. Mild thirst
B. Fine hand tremor
C. Severe diarrhea and vomiting
D. Increased urination
Answer: C
Rationale: Severe gastrointestinal symptoms can indicate lithium toxicity,
particularly when dehydration increases lithium concentration. Toxicity requires
prompt evaluation. Mild thirst and increased urination can occur with lithium
therapy.
4. A client taking an SSRI reports agitation, sweating, diarrhea, and muscle rigidity.
Which complication should the nurse suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium toxicity
Answer: B
Rationale: Serotonin syndrome can occur with excessive serotonergic activity and
may present with agitation, diaphoresis, diarrhea, hyperreflexia, tremor, and
muscle rigidity. It can become life-threatening.
5. Which statement by a client demonstrates understanding of cognitive
behavioral therapy?
,A. “My therapist will tell me exactly what decisions to make.”
B. “I will learn to recognize and challenge unhealthy thought patterns.”
C. “The goal is to uncover all of my unconscious memories.”
D. “I should avoid discussing negative thoughts.”
Answer: B
Rationale: Cognitive behavioral therapy focuses on identifying maladaptive
thoughts and behaviors and developing healthier patterns. The client actively
participates in changing distorted thinking.
6. A client with major depressive disorder says, “My family would be better off
without me.” What is the nurse's priority response?
A. “You shouldn't think that way.”
B. “Your family needs you.”
C. “Are you thinking about killing yourself?”
D. “Let's focus on something positive.”
Answer: C
Rationale: Directly asking about suicide does not cause suicidal behavior and is
essential when warning signs are present. The nurse should assess suicidal
thoughts, plan, intent, means, and protective factors.
7. Which assessment finding is characteristic of generalized anxiety disorder?
A. Persistent excessive worry about multiple areas of life
B. Recurrent episodes of elevated mood
C. Fixed false beliefs
D. Alternating periods of amnesia and identity disruption
Answer: A
Rationale: Generalized anxiety disorder involves excessive, difficult-to-control
worry occurring across multiple areas and is commonly accompanied by
, restlessness, fatigue, poor concentration, irritability, muscle tension, or sleep
disturbance.
8. A client is experiencing a panic attack. Which nursing intervention is most
appropriate?
A. Ask the client to describe the cause of the anxiety in detail.
B. Leave the client alone to decrease stimulation.
C. Remain with the client and use short, calm statements.
D. Encourage the client to make important decisions.
Answer: C
Rationale: During severe anxiety or panic, the client's ability to process
information is impaired. Remaining with the client, reducing stimulation, and
communicating calmly promote safety and decrease anxiety.
9. Which behavior is most consistent with obsessive-compulsive disorder?
A. Hearing voices commenting on behavior
B. Repeatedly checking whether a door is locked
C. Experiencing alternating manic and depressive episodes
D. Avoiding social situations because of fear of embarrassment
Answer: B
Rationale: Compulsions are repetitive behaviors performed to reduce anxiety
associated with obsessive thoughts. Repeated checking is a common compulsion.
10. A client with schizophrenia says, “The FBI implanted a tracking device in my
brain.” Which response is therapeutic?
A. “That is impossible.”
B. “Why would the FBI want to track you?”
COMPREHENSIVE FINAL EXAM 2026
STUDY GUIDE & PRACTICE TEST —
QUESTIONS 1–200
1. A nurse is assessing a client who reports hearing voices telling them to harm
another person. Which action should the nurse take first?
A. Ask the client to explain why the voices are occurring.
B. Determine whether the client has a specific plan or intent to harm someone.
C. Tell the client that the voices are not real.
D. Encourage the client to ignore the voices.
Answer: B
Rationale: Command hallucinations involving harm require immediate
assessment of the client's intent, plan, means, and ability to act. Safety takes
priority. Arguing about whether the hallucinations are real is not therapeutic.
2. A client experiencing mania is pacing continuously, speaking rapidly, and
refusing meals. Which nursing intervention is most appropriate?
A. Provide lengthy explanations about the importance of nutrition.
B. Encourage participation in group therapy.
C. Offer frequent high-calorie finger foods and fluids.
D. Ask the client to remain in bed until mealtime.
Answer: C
Rationale: Clients experiencing mania often have increased activity and
decreased attention span. Nutrient-dense finger foods and fluids allow the client
,to maintain nutritional intake without requiring prolonged sitting or
concentration.
3. Which finding is most concerning in a client taking lithium?
A. Mild thirst
B. Fine hand tremor
C. Severe diarrhea and vomiting
D. Increased urination
Answer: C
Rationale: Severe gastrointestinal symptoms can indicate lithium toxicity,
particularly when dehydration increases lithium concentration. Toxicity requires
prompt evaluation. Mild thirst and increased urination can occur with lithium
therapy.
4. A client taking an SSRI reports agitation, sweating, diarrhea, and muscle rigidity.
Which complication should the nurse suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium toxicity
Answer: B
Rationale: Serotonin syndrome can occur with excessive serotonergic activity and
may present with agitation, diaphoresis, diarrhea, hyperreflexia, tremor, and
muscle rigidity. It can become life-threatening.
5. Which statement by a client demonstrates understanding of cognitive
behavioral therapy?
,A. “My therapist will tell me exactly what decisions to make.”
B. “I will learn to recognize and challenge unhealthy thought patterns.”
C. “The goal is to uncover all of my unconscious memories.”
D. “I should avoid discussing negative thoughts.”
Answer: B
Rationale: Cognitive behavioral therapy focuses on identifying maladaptive
thoughts and behaviors and developing healthier patterns. The client actively
participates in changing distorted thinking.
6. A client with major depressive disorder says, “My family would be better off
without me.” What is the nurse's priority response?
A. “You shouldn't think that way.”
B. “Your family needs you.”
C. “Are you thinking about killing yourself?”
D. “Let's focus on something positive.”
Answer: C
Rationale: Directly asking about suicide does not cause suicidal behavior and is
essential when warning signs are present. The nurse should assess suicidal
thoughts, plan, intent, means, and protective factors.
7. Which assessment finding is characteristic of generalized anxiety disorder?
A. Persistent excessive worry about multiple areas of life
B. Recurrent episodes of elevated mood
C. Fixed false beliefs
D. Alternating periods of amnesia and identity disruption
Answer: A
Rationale: Generalized anxiety disorder involves excessive, difficult-to-control
worry occurring across multiple areas and is commonly accompanied by
, restlessness, fatigue, poor concentration, irritability, muscle tension, or sleep
disturbance.
8. A client is experiencing a panic attack. Which nursing intervention is most
appropriate?
A. Ask the client to describe the cause of the anxiety in detail.
B. Leave the client alone to decrease stimulation.
C. Remain with the client and use short, calm statements.
D. Encourage the client to make important decisions.
Answer: C
Rationale: During severe anxiety or panic, the client's ability to process
information is impaired. Remaining with the client, reducing stimulation, and
communicating calmly promote safety and decrease anxiety.
9. Which behavior is most consistent with obsessive-compulsive disorder?
A. Hearing voices commenting on behavior
B. Repeatedly checking whether a door is locked
C. Experiencing alternating manic and depressive episodes
D. Avoiding social situations because of fear of embarrassment
Answer: B
Rationale: Compulsions are repetitive behaviors performed to reduce anxiety
associated with obsessive thoughts. Repeated checking is a common compulsion.
10. A client with schizophrenia says, “The FBI implanted a tracking device in my
brain.” Which response is therapeutic?
A. “That is impossible.”
B. “Why would the FBI want to track you?”
