NR 547 PSYCHIATRIC MENTAL HEALTH
NURSING FINAL EXAM 2026 COMPLETE
STUDY GUIDE — PRACTICE QUESTIONS,
ANSWERS & RATIONALES
1. A client with major depressive disorder states, “Everyone would be better off
without me.” What is the nurse’s priority response?
A. “You have many people who care about you.”
B. “Why do you think everyone would be better off without you?”
C. “Are you thinking about killing yourself?”
D. “Try to focus on some positive things in your life.”
Answer: C
Rationale: Directly assessing suicidal ideation is the priority. Asking about suicide
does not increase the risk of suicide and allows the nurse to determine the
immediacy of the danger and implement appropriate safety measures.
2. Which finding is most characteristic of a manic episode?
A. Social withdrawal
B. Decreased need for sleep
C. Psychomotor retardation
D. Increased appetite with weight gain
Answer: B
Rationale: Mania commonly involves elevated or irritable mood, increased
energy, pressured speech, racing thoughts, impulsivity, grandiosity, and a
decreased need for sleep.
3. A client taking lithium reports diarrhea, vomiting, coarse hand tremors, and
difficulty walking. What should the nurse do first?
,A. Administer the next lithium dose
B. Encourage increased caffeine intake
C. Hold lithium and notify the provider
D. Encourage the client to exercise
Answer: C
Rationale: These findings can indicate lithium toxicity. Lithium has a narrow
therapeutic index, and significant gastrointestinal symptoms, coarse tremors,
ataxia, and neurologic changes require prompt evaluation.
4. A client taking an SSRI develops agitation, confusion, diaphoresis, fever,
hyperreflexia, and muscle rigidity. Which condition 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.
Typical manifestations include agitation, confusion, diaphoresis, hyperthermia,
hyperreflexia, tremor, and neuromuscular abnormalities.
5. Which intervention is most appropriate for a client experiencing acute panic?
A. Ask the client to describe childhood stressors
B. Leave the client alone to decrease stimulation
C. Use short, simple statements and remain with the client
D. Encourage the client to analyze the cause of the panic
Answer: C
Rationale: During severe anxiety or panic, the client's ability to process
information is impaired. The nurse should remain with the client, reduce
environmental stimuli, and use brief, clear communication.
,6. A client with schizophrenia says, “The voices are telling me that I am
worthless.” Which response is therapeutic?
A. “The voices aren't real, so ignore them.”
B. “I don't hear the voices, but I understand that you hear them.”
C. “What did you do to make the voices angry?”
D. “You should argue with the voices.”
Answer: B
Rationale: The nurse should acknowledge the client's experience without
validating the hallucination as reality. Presenting reality calmly is therapeutic.
7. Which assessment finding represents a negative symptom of schizophrenia?
A. Auditory hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Answer: C
Rationale: Negative symptoms include diminished emotional expression,
avolition, anhedonia, alogia, and social withdrawal. Hallucinations and delusions
are positive symptoms.
8. A client taking clozapine reports a sore throat and fever. Which laboratory
test is particularly important?
A. Serum sodium
B. Absolute neutrophil count
C. Serum lithium level
D. Troponin level
Answer: B
, Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and
sore throat may indicate infection and require prompt evaluation of the absolute
neutrophil count.
9. Which statement by a client demonstrates understanding of benzodiazepine
safety?
A. “I can drink alcohol while taking this medication.”
B. “I should stop the medication abruptly when I feel better.”
C. “This medication may cause sedation, so I should use caution with driving.”
D. “This medication has no potential for dependence.”
Answer: C
Rationale: Benzodiazepines can cause sedation, impaired coordination, and
dependence. Alcohol and other CNS depressants can increase their effects.
10. A client with obsessive-compulsive disorder repeatedly washes their hands.
Which nursing intervention is appropriate initially?
A. Immediately prevent all handwashing
B. Shame the client for the behavior
C. Establish limits while supporting anxiety-management strategies
D. Encourage the client to increase the ritual
Answer: C
Rationale: Abruptly stopping compulsive rituals can dramatically increase anxiety.
Nursing care should promote coping strategies while gradually addressing
maladaptive behaviors.
11. Which finding is most consistent with post-traumatic stress disorder (PTSD)?
A. Persistent elevated mood
B. Re-experiencing the traumatic event
NURSING FINAL EXAM 2026 COMPLETE
STUDY GUIDE — PRACTICE QUESTIONS,
ANSWERS & RATIONALES
1. A client with major depressive disorder states, “Everyone would be better off
without me.” What is the nurse’s priority response?
A. “You have many people who care about you.”
B. “Why do you think everyone would be better off without you?”
C. “Are you thinking about killing yourself?”
D. “Try to focus on some positive things in your life.”
Answer: C
Rationale: Directly assessing suicidal ideation is the priority. Asking about suicide
does not increase the risk of suicide and allows the nurse to determine the
immediacy of the danger and implement appropriate safety measures.
2. Which finding is most characteristic of a manic episode?
A. Social withdrawal
B. Decreased need for sleep
C. Psychomotor retardation
D. Increased appetite with weight gain
Answer: B
Rationale: Mania commonly involves elevated or irritable mood, increased
energy, pressured speech, racing thoughts, impulsivity, grandiosity, and a
decreased need for sleep.
3. A client taking lithium reports diarrhea, vomiting, coarse hand tremors, and
difficulty walking. What should the nurse do first?
,A. Administer the next lithium dose
B. Encourage increased caffeine intake
C. Hold lithium and notify the provider
D. Encourage the client to exercise
Answer: C
Rationale: These findings can indicate lithium toxicity. Lithium has a narrow
therapeutic index, and significant gastrointestinal symptoms, coarse tremors,
ataxia, and neurologic changes require prompt evaluation.
4. A client taking an SSRI develops agitation, confusion, diaphoresis, fever,
hyperreflexia, and muscle rigidity. Which condition 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.
Typical manifestations include agitation, confusion, diaphoresis, hyperthermia,
hyperreflexia, tremor, and neuromuscular abnormalities.
5. Which intervention is most appropriate for a client experiencing acute panic?
A. Ask the client to describe childhood stressors
B. Leave the client alone to decrease stimulation
C. Use short, simple statements and remain with the client
D. Encourage the client to analyze the cause of the panic
Answer: C
Rationale: During severe anxiety or panic, the client's ability to process
information is impaired. The nurse should remain with the client, reduce
environmental stimuli, and use brief, clear communication.
,6. A client with schizophrenia says, “The voices are telling me that I am
worthless.” Which response is therapeutic?
A. “The voices aren't real, so ignore them.”
B. “I don't hear the voices, but I understand that you hear them.”
C. “What did you do to make the voices angry?”
D. “You should argue with the voices.”
Answer: B
Rationale: The nurse should acknowledge the client's experience without
validating the hallucination as reality. Presenting reality calmly is therapeutic.
7. Which assessment finding represents a negative symptom of schizophrenia?
A. Auditory hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Answer: C
Rationale: Negative symptoms include diminished emotional expression,
avolition, anhedonia, alogia, and social withdrawal. Hallucinations and delusions
are positive symptoms.
8. A client taking clozapine reports a sore throat and fever. Which laboratory
test is particularly important?
A. Serum sodium
B. Absolute neutrophil count
C. Serum lithium level
D. Troponin level
Answer: B
, Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Fever and
sore throat may indicate infection and require prompt evaluation of the absolute
neutrophil count.
9. Which statement by a client demonstrates understanding of benzodiazepine
safety?
A. “I can drink alcohol while taking this medication.”
B. “I should stop the medication abruptly when I feel better.”
C. “This medication may cause sedation, so I should use caution with driving.”
D. “This medication has no potential for dependence.”
Answer: C
Rationale: Benzodiazepines can cause sedation, impaired coordination, and
dependence. Alcohol and other CNS depressants can increase their effects.
10. A client with obsessive-compulsive disorder repeatedly washes their hands.
Which nursing intervention is appropriate initially?
A. Immediately prevent all handwashing
B. Shame the client for the behavior
C. Establish limits while supporting anxiety-management strategies
D. Encourage the client to increase the ritual
Answer: C
Rationale: Abruptly stopping compulsive rituals can dramatically increase anxiety.
Nursing care should promote coping strategies while gradually addressing
maladaptive behaviors.
11. Which finding is most consistent with post-traumatic stress disorder (PTSD)?
A. Persistent elevated mood
B. Re-experiencing the traumatic event
