NUR 253 Exam 4 Mental Health 2026–2027 | Galen College of Nursing
Concepts of Mental Health Nursing Exam 4 Study Guide & Complete Test
Prep | NUR 253 Mental Health Exam Review, Psychiatric Nursing,
Therapeutic Communication, Mental Health Assessment, Grief & Loss,
Crisis Intervention, Suicide Risk & Prevention, Anxiety Disorders, Mood
Disorders, Trauma & Stressor-Related Disorders, Psychotic Disorders,
Personality Disorders, Substance Use Disorders, Eating Disorders,
Psychiatric Emergencies, Patient Safety, Psychopharmacology, Ethical &
Legal Issues, Nursing Interventions, Clinical Judgment, Practice
Questions, Answers & Detailed Rationales
Question 1: A nurse is assessing a client who has been prescribed lithium for
bipolar disorder. Which of the following client statements indicates a need for
immediate intervention?
A. "I will take the medication with food to avoid stomach upset."
B. "I have been sweating a lot and have had a fever for two days."
C. "I will avoid driving until I know how the medication affects me."
D. "I plan to have my blood levels checked regularly."
CORRECT ANSWER: B. "I have been sweating a lot and have had a fever for two
days."
Rationale: Lithium is a mood stabilizer with a narrow therapeutic index.
Dehydration from sweating and fever can increase serum lithium levels, leading to
toxicity. This requires immediate intervention. Taking the medication with food,
avoiding driving until effects are known, and monitoring blood levels are
appropriate self-care measures.
Question 2: A client with schizophrenia is experiencing auditory hallucinations.
Which nursing intervention is most appropriate initially?
A. Tell the client that the voices are not real.
B. Ask the client what the voices are saying.
C. Ignore the client's comments about the voices.
D. Restrict the client's access to other clients.
CORRECT ANSWER: B. Ask the client what the voices are saying.
Rationale: Initially, the nurse should assess the content of the hallucinations to
determine if they are command hallucinations that might pose a risk to the client
,or others. Telling the client the voices are not real is dismissive, ignoring them is
not therapeutic, and restricting access is not the first priority.
Question 3: A nurse is caring for a client who is experiencing acute alcohol
withdrawal. Which of the following medications should the nurse anticipate
administering?
A. Naltrexone
B. Lorazepam
C. Disulfiram
D. Acamprosate
CORRECT ANSWER: B. Lorazepam
Rationale: Benzodiazepines such as lorazepam are the first-line treatment for
acute alcohol withdrawal to prevent seizures and delirium tremens. Naltrexone,
disulfiram, and acamprosate are used for maintenance of abstinence, not acute
withdrawal.
Question 4: A client with major depressive disorder is started on sertraline.
Which of the following instructions should the nurse include?
A. "You should feel better within 2 to 3 days."
B. "Stop the medication if you feel nauseated."
C. "It may take 4 to 6 weeks for full therapeutic effect."
D. "You can drink alcohol in moderation."
CORRECT ANSWER: C. "It may take 4 to 6 weeks for full therapeutic effect."
Rationale: SSRIs such as sertraline typically take 4 to 6 weeks to reach full
therapeutic effect. Clients should be informed of this to prevent premature
discontinuation. Nausea is a common side effect that often subsides; alcohol
should be avoided; and improvement is not immediate.
Question 5: A nurse is assessing a client who has anorexia nervosa. Which of the
following findings should the nurse expect?
A. Bradycardia
B. Hyperkalemia
,C. Increased body temperature
D. Elevated blood pressure
CORRECT ANSWER: A. Bradycardia
Rationale: Anorexia nervosa often leads to bradycardia due to malnutrition and
decreased metabolic rate. Clients typically have hypokalemia, hypothermia, and
hypotension rather than hyperkalemia, fever, or hypertension.
Question 6: A client with borderline personality disorder is engaging in self-
mutilation. Which of the following is the priority nursing diagnosis?
A. Impaired social interaction
B. Risk for self-directed violence
C. Chronic low self-esteem
D. Disturbed personal identity
CORRECT ANSWER: B. Risk for self-directed violence
Rationale: Safety is always the priority in nursing care. Risk for self-directed
violence takes precedence over psychosocial diagnoses such as impaired social
interaction, low self-esteem, or disturbed identity.
Question 7: A nurse is teaching a client about clozapine. Which of the following
adverse effects should the nurse emphasize as requiring immediate medical
attention?
A. Weight gain
B. Sedation
C. Sore throat and fever
D. Constipation
CORRECT ANSWER: C. Sore throat and fever
Rationale: Clozapine can cause agranulocytosis, which presents with signs of
infection such as sore throat and fever. This is a medical emergency requiring
immediate attention. Weight gain, sedation, and constipation are common but
less urgent side effects.
Question 8: A client is admitted with suspected serotonin syndrome. Which of
the following findings should the nurse expect?
, A. Hyperreflexia and clonus
B. Bradycardia and hypotension
C. Hypothermia and lethargy
D. Constricted pupils and dry mouth
CORRECT ANSWER: A. Hyperreflexia and clonus
Rationale: Serotonin syndrome is characterized by neuromuscular excitability,
including hyperreflexia, clonus, agitation, hyperthermia, and tachycardia.
Bradycardia, hypotension, hypothermia, and lethargy are not typical.
Question 9: A nurse is caring for a client who is prescribed haloperidol. The
client develops a stiff neck and difficulty swallowing. Which of the following
medications should the nurse anticipate administering?
A. Benztropine
B. Lorazepam
C. Propranolol
D. Valproic acid
CORRECT ANSWER: A. Benztropine
Rationale: The client is experiencing acute dystonia, an extrapyramidal side effect
of typical antipsychotics like haloperidol. Benztropine, an anticholinergic, is the
treatment of choice. Lorazepam, propranolol, and valproic acid are not first-line
for acute dystonia.
Question 10: A client with post-traumatic stress disorder (PTSD) is experiencing
flashbacks. Which nursing action is most therapeutic?
A. Tell the client to think about something else.
B. Encourage the client to describe the trauma in detail.
C. Remain with the client and provide a calm, safe environment.
D. Administer a PRN antipsychotic medication immediately.
CORRECT ANSWER: C. Remain with the client and provide a calm, safe
environment.
Rationale: During a flashback, the priority is to ground the client and provide a
sense of safety. Telling the client to think about something else is dismissive.
Concepts of Mental Health Nursing Exam 4 Study Guide & Complete Test
Prep | NUR 253 Mental Health Exam Review, Psychiatric Nursing,
Therapeutic Communication, Mental Health Assessment, Grief & Loss,
Crisis Intervention, Suicide Risk & Prevention, Anxiety Disorders, Mood
Disorders, Trauma & Stressor-Related Disorders, Psychotic Disorders,
Personality Disorders, Substance Use Disorders, Eating Disorders,
Psychiatric Emergencies, Patient Safety, Psychopharmacology, Ethical &
Legal Issues, Nursing Interventions, Clinical Judgment, Practice
Questions, Answers & Detailed Rationales
Question 1: A nurse is assessing a client who has been prescribed lithium for
bipolar disorder. Which of the following client statements indicates a need for
immediate intervention?
A. "I will take the medication with food to avoid stomach upset."
B. "I have been sweating a lot and have had a fever for two days."
C. "I will avoid driving until I know how the medication affects me."
D. "I plan to have my blood levels checked regularly."
CORRECT ANSWER: B. "I have been sweating a lot and have had a fever for two
days."
Rationale: Lithium is a mood stabilizer with a narrow therapeutic index.
Dehydration from sweating and fever can increase serum lithium levels, leading to
toxicity. This requires immediate intervention. Taking the medication with food,
avoiding driving until effects are known, and monitoring blood levels are
appropriate self-care measures.
Question 2: A client with schizophrenia is experiencing auditory hallucinations.
Which nursing intervention is most appropriate initially?
A. Tell the client that the voices are not real.
B. Ask the client what the voices are saying.
C. Ignore the client's comments about the voices.
D. Restrict the client's access to other clients.
CORRECT ANSWER: B. Ask the client what the voices are saying.
Rationale: Initially, the nurse should assess the content of the hallucinations to
determine if they are command hallucinations that might pose a risk to the client
,or others. Telling the client the voices are not real is dismissive, ignoring them is
not therapeutic, and restricting access is not the first priority.
Question 3: A nurse is caring for a client who is experiencing acute alcohol
withdrawal. Which of the following medications should the nurse anticipate
administering?
A. Naltrexone
B. Lorazepam
C. Disulfiram
D. Acamprosate
CORRECT ANSWER: B. Lorazepam
Rationale: Benzodiazepines such as lorazepam are the first-line treatment for
acute alcohol withdrawal to prevent seizures and delirium tremens. Naltrexone,
disulfiram, and acamprosate are used for maintenance of abstinence, not acute
withdrawal.
Question 4: A client with major depressive disorder is started on sertraline.
Which of the following instructions should the nurse include?
A. "You should feel better within 2 to 3 days."
B. "Stop the medication if you feel nauseated."
C. "It may take 4 to 6 weeks for full therapeutic effect."
D. "You can drink alcohol in moderation."
CORRECT ANSWER: C. "It may take 4 to 6 weeks for full therapeutic effect."
Rationale: SSRIs such as sertraline typically take 4 to 6 weeks to reach full
therapeutic effect. Clients should be informed of this to prevent premature
discontinuation. Nausea is a common side effect that often subsides; alcohol
should be avoided; and improvement is not immediate.
Question 5: A nurse is assessing a client who has anorexia nervosa. Which of the
following findings should the nurse expect?
A. Bradycardia
B. Hyperkalemia
,C. Increased body temperature
D. Elevated blood pressure
CORRECT ANSWER: A. Bradycardia
Rationale: Anorexia nervosa often leads to bradycardia due to malnutrition and
decreased metabolic rate. Clients typically have hypokalemia, hypothermia, and
hypotension rather than hyperkalemia, fever, or hypertension.
Question 6: A client with borderline personality disorder is engaging in self-
mutilation. Which of the following is the priority nursing diagnosis?
A. Impaired social interaction
B. Risk for self-directed violence
C. Chronic low self-esteem
D. Disturbed personal identity
CORRECT ANSWER: B. Risk for self-directed violence
Rationale: Safety is always the priority in nursing care. Risk for self-directed
violence takes precedence over psychosocial diagnoses such as impaired social
interaction, low self-esteem, or disturbed identity.
Question 7: A nurse is teaching a client about clozapine. Which of the following
adverse effects should the nurse emphasize as requiring immediate medical
attention?
A. Weight gain
B. Sedation
C. Sore throat and fever
D. Constipation
CORRECT ANSWER: C. Sore throat and fever
Rationale: Clozapine can cause agranulocytosis, which presents with signs of
infection such as sore throat and fever. This is a medical emergency requiring
immediate attention. Weight gain, sedation, and constipation are common but
less urgent side effects.
Question 8: A client is admitted with suspected serotonin syndrome. Which of
the following findings should the nurse expect?
, A. Hyperreflexia and clonus
B. Bradycardia and hypotension
C. Hypothermia and lethargy
D. Constricted pupils and dry mouth
CORRECT ANSWER: A. Hyperreflexia and clonus
Rationale: Serotonin syndrome is characterized by neuromuscular excitability,
including hyperreflexia, clonus, agitation, hyperthermia, and tachycardia.
Bradycardia, hypotension, hypothermia, and lethargy are not typical.
Question 9: A nurse is caring for a client who is prescribed haloperidol. The
client develops a stiff neck and difficulty swallowing. Which of the following
medications should the nurse anticipate administering?
A. Benztropine
B. Lorazepam
C. Propranolol
D. Valproic acid
CORRECT ANSWER: A. Benztropine
Rationale: The client is experiencing acute dystonia, an extrapyramidal side effect
of typical antipsychotics like haloperidol. Benztropine, an anticholinergic, is the
treatment of choice. Lorazepam, propranolol, and valproic acid are not first-line
for acute dystonia.
Question 10: A client with post-traumatic stress disorder (PTSD) is experiencing
flashbacks. Which nursing action is most therapeutic?
A. Tell the client to think about something else.
B. Encourage the client to describe the trauma in detail.
C. Remain with the client and provide a calm, safe environment.
D. Administer a PRN antipsychotic medication immediately.
CORRECT ANSWER: C. Remain with the client and provide a calm, safe
environment.
Rationale: During a flashback, the priority is to ground the client and provide a
sense of safety. Telling the client to think about something else is dismissive.
