NR 547 MENTAL HEALTH NURSING MIDTERM
2026 | COMPREHENSIVE EXAM REVIEW
QUESTIONS AND ANSWER WITH RATIONALES
NR 547 Mental Health Nursing: Comprehensive Midterm Practice Review
1. Therapeutic Communication
Question: A patient with major depressive disorder states, "I'm a burden to my family and they
would be better off without me." Which of the following responses by the nurse is the most
therapeutic?
A. "You shouldn't feel that way; your family loves you very much."
B. "Tell me more about what makes you feel like a burden."
C. "We all feel overwhelmed sometimes, but things will get better."
D. "You have a lot to live for, let's focus on the positive aspects of your life."
Answer: B
Rationale: Option B uses the therapeutic technique of exploring, which encourages the patient
to elaborate on their feelings and provides the nurse with critical assessment data regarding
suicide risk. Options A, C, and D are non-therapeutic because they minimize the patient's
feelings, offer false reassurance, or inappropriately change the subject.
2. Psychopharmacology (Mood Stabilizers)
Question: A patient with bipolar disorder is prescribed lithium carbonate. Which of the
following laboratory findings should the nurse report to the healthcare provider immediately?
A. Serum lithium level of 1.1 mEq/L
B. Serum sodium level of 128 mEq/L
C. Blood urea nitrogen (BUN) of 18 mg/dL
,D. White blood cell count of 7,500/mm³
Answer: B
Rationale: A serum sodium level of 128 mEq/L indicates hyponatremia. Low sodium levels can
lead to lithium retention and toxicity, as lithium and sodium compete for reabsorption in the
kidneys. A lithium level of 1.1 mEq/L is within the standard therapeutic range (0.6–1.2 mEq/L).
BUN and WBC are within normal limits.
3. Psychotic Disorders & Extrapyramidal Symptoms (EPS)
Question: A patient diagnosed with schizophrenia has been taking haloperidol for two weeks.
The nurse observes the patient experiencing muscle stiffness, tremors, and a shuffling gait.
Which of the following actions should the nurse anticipate?
A. Administering benztropine (Cogentin) as prescribed.
B. Discontinuing the haloperidol immediately without a replacement.
C. Administering dantrolene sodium for neuroleptic malignant syndrome.
D. Increasing the dose of haloperidol to overcome the side effects.
Answer: A
Rationale: The patient is exhibiting extrapyramidal symptoms (EPS), specifically
pseudoparkinsonism, a common side effect of typical (first-generation) antipsychotics like
haloperidol. Benztropine, an anticholinergic medication, is commonly prescribed to treat EPS.
Neuroleptic malignant syndrome (NMS) would present with high fever, severe "lead-pipe"
muscle rigidity, and autonomic instability.
4. Anxiety Disorders
Question: A patient arrives at the emergency department experiencing a panic attack, with a
heart rate of 120 bpm, shortness of breath, and a sense of impending doom. What is the
nurse's priority intervention?
A. Teach the patient deep breathing exercises.
B. Stay with the patient and provide a calm, reassuring presence.
C. Ask the patient to identify the trigger for the panic attack.
D. Administer a prescribed PRN dose of buspirone.
,Answer: B
Rationale: During a panic attack, the patient's cognitive ability to process information or learn
new skills (like deep breathing) is severely diminished. The priority is to ensure safety and
provide a calm, non-stimulating environment with a reassuring presence. Buspirone is used for
generalized anxiety disorder, not acute panic attacks (benzodiazepines are typically used PRN
for acute panic).
5. Legal and Ethical Considerations
Question: A patient with a history of severe depression tells the nurse, "I am going to kill my
neighbor when I get home because he has been spying on me." What is the nurse's most
appropriate action?
A. Document the statement in the patient's chart and continue monitoring.
B. Assure the patient that the information will remain strictly confidential.
C. Notify the healthcare provider and the intended victim immediately.
D. Ask the patient to sign a no-harm contract before discharge.
Answer: C
Rationale: This scenario invokes the "duty to warn" (Tarasoff rule). When a patient makes a
specific, credible threat of harm to an identifiable third party, the healthcare provider has a
legal and ethical obligation to breach confidentiality to protect the intended victim.
6. Neurocognitive Disorders
Question: The nurse is assessing an older adult patient. Which of the following findings best
differentiates delirium from dementia?
A. Gradual onset of memory loss over several years.
B. Fluctuating level of consciousness and acute onset of confusion.
C. Inability to perform activities of daily living (ADLs) independently.
D. Presence of aphasia and apraxia.
Answer: B
Rationale: Delirium is characterized by an acute onset, fluctuating level of consciousness, and
inattention, often due to an underlying, reversible medical condition (e.g., UTI, electrolyte
, imbalance). Dementia has an insidious, gradual onset with progressive, irreversible cognitive
decline. Aphasia, apraxia, and gradual ADL decline are more characteristic of dementia.
7. Substance Use Disorders
Question: A patient is admitted for alcohol detoxification. The patient's last drink was 12 hours
ago. Which of the following assessment findings should the nurse monitor for as an early sign of
alcohol withdrawal?
A. Bradycardia and hypotension
B. Diaphoresis, tremors, and agitation
C. Decreased deep tendon reflexes
D. Pinpoint pupils and respiratory depression
Answer: B
Rationale: Early signs of alcohol withdrawal (within 6–24 hours) include autonomic
hyperactivity such as diaphoresis, tachycardia, hypertension, tremors, and agitation.
Bradycardia and hypotension are not typical. Pinpoint pupils and respiratory depression are
signs of opioid toxicity, not alcohol withdrawal.
8. Mood Disorders (Bipolar Mania)
Question: A patient in a manic episode of bipolar disorder is pacing the hallway, speaking
rapidly, and unable to sit still during meals. Which of the following nursing interventions is the
most appropriate?
A. Encourage the patient to participate in group therapy to socialize.
B. Provide high-calorie, high-protein finger foods that can be eaten on the go.
C. Restrict the patient to their room to decrease environmental stimulation.
D. Confront the patient about their disruptive behavior.
Answer: B
Rationale: Patients in a manic state often have excessive psychomotor activity and a shortened
attention span, making it difficult to sit for traditional meals. Providing high-calorie, high-
protein finger foods allows them to eat while moving, preventing severe weight loss and
2026 | COMPREHENSIVE EXAM REVIEW
QUESTIONS AND ANSWER WITH RATIONALES
NR 547 Mental Health Nursing: Comprehensive Midterm Practice Review
1. Therapeutic Communication
Question: A patient with major depressive disorder states, "I'm a burden to my family and they
would be better off without me." Which of the following responses by the nurse is the most
therapeutic?
A. "You shouldn't feel that way; your family loves you very much."
B. "Tell me more about what makes you feel like a burden."
C. "We all feel overwhelmed sometimes, but things will get better."
D. "You have a lot to live for, let's focus on the positive aspects of your life."
Answer: B
Rationale: Option B uses the therapeutic technique of exploring, which encourages the patient
to elaborate on their feelings and provides the nurse with critical assessment data regarding
suicide risk. Options A, C, and D are non-therapeutic because they minimize the patient's
feelings, offer false reassurance, or inappropriately change the subject.
2. Psychopharmacology (Mood Stabilizers)
Question: A patient with bipolar disorder is prescribed lithium carbonate. Which of the
following laboratory findings should the nurse report to the healthcare provider immediately?
A. Serum lithium level of 1.1 mEq/L
B. Serum sodium level of 128 mEq/L
C. Blood urea nitrogen (BUN) of 18 mg/dL
,D. White blood cell count of 7,500/mm³
Answer: B
Rationale: A serum sodium level of 128 mEq/L indicates hyponatremia. Low sodium levels can
lead to lithium retention and toxicity, as lithium and sodium compete for reabsorption in the
kidneys. A lithium level of 1.1 mEq/L is within the standard therapeutic range (0.6–1.2 mEq/L).
BUN and WBC are within normal limits.
3. Psychotic Disorders & Extrapyramidal Symptoms (EPS)
Question: A patient diagnosed with schizophrenia has been taking haloperidol for two weeks.
The nurse observes the patient experiencing muscle stiffness, tremors, and a shuffling gait.
Which of the following actions should the nurse anticipate?
A. Administering benztropine (Cogentin) as prescribed.
B. Discontinuing the haloperidol immediately without a replacement.
C. Administering dantrolene sodium for neuroleptic malignant syndrome.
D. Increasing the dose of haloperidol to overcome the side effects.
Answer: A
Rationale: The patient is exhibiting extrapyramidal symptoms (EPS), specifically
pseudoparkinsonism, a common side effect of typical (first-generation) antipsychotics like
haloperidol. Benztropine, an anticholinergic medication, is commonly prescribed to treat EPS.
Neuroleptic malignant syndrome (NMS) would present with high fever, severe "lead-pipe"
muscle rigidity, and autonomic instability.
4. Anxiety Disorders
Question: A patient arrives at the emergency department experiencing a panic attack, with a
heart rate of 120 bpm, shortness of breath, and a sense of impending doom. What is the
nurse's priority intervention?
A. Teach the patient deep breathing exercises.
B. Stay with the patient and provide a calm, reassuring presence.
C. Ask the patient to identify the trigger for the panic attack.
D. Administer a prescribed PRN dose of buspirone.
,Answer: B
Rationale: During a panic attack, the patient's cognitive ability to process information or learn
new skills (like deep breathing) is severely diminished. The priority is to ensure safety and
provide a calm, non-stimulating environment with a reassuring presence. Buspirone is used for
generalized anxiety disorder, not acute panic attacks (benzodiazepines are typically used PRN
for acute panic).
5. Legal and Ethical Considerations
Question: A patient with a history of severe depression tells the nurse, "I am going to kill my
neighbor when I get home because he has been spying on me." What is the nurse's most
appropriate action?
A. Document the statement in the patient's chart and continue monitoring.
B. Assure the patient that the information will remain strictly confidential.
C. Notify the healthcare provider and the intended victim immediately.
D. Ask the patient to sign a no-harm contract before discharge.
Answer: C
Rationale: This scenario invokes the "duty to warn" (Tarasoff rule). When a patient makes a
specific, credible threat of harm to an identifiable third party, the healthcare provider has a
legal and ethical obligation to breach confidentiality to protect the intended victim.
6. Neurocognitive Disorders
Question: The nurse is assessing an older adult patient. Which of the following findings best
differentiates delirium from dementia?
A. Gradual onset of memory loss over several years.
B. Fluctuating level of consciousness and acute onset of confusion.
C. Inability to perform activities of daily living (ADLs) independently.
D. Presence of aphasia and apraxia.
Answer: B
Rationale: Delirium is characterized by an acute onset, fluctuating level of consciousness, and
inattention, often due to an underlying, reversible medical condition (e.g., UTI, electrolyte
, imbalance). Dementia has an insidious, gradual onset with progressive, irreversible cognitive
decline. Aphasia, apraxia, and gradual ADL decline are more characteristic of dementia.
7. Substance Use Disorders
Question: A patient is admitted for alcohol detoxification. The patient's last drink was 12 hours
ago. Which of the following assessment findings should the nurse monitor for as an early sign of
alcohol withdrawal?
A. Bradycardia and hypotension
B. Diaphoresis, tremors, and agitation
C. Decreased deep tendon reflexes
D. Pinpoint pupils and respiratory depression
Answer: B
Rationale: Early signs of alcohol withdrawal (within 6–24 hours) include autonomic
hyperactivity such as diaphoresis, tachycardia, hypertension, tremors, and agitation.
Bradycardia and hypotension are not typical. Pinpoint pupils and respiratory depression are
signs of opioid toxicity, not alcohol withdrawal.
8. Mood Disorders (Bipolar Mania)
Question: A patient in a manic episode of bipolar disorder is pacing the hallway, speaking
rapidly, and unable to sit still during meals. Which of the following nursing interventions is the
most appropriate?
A. Encourage the patient to participate in group therapy to socialize.
B. Provide high-calorie, high-protein finger foods that can be eaten on the go.
C. Restrict the patient to their room to decrease environmental stimulation.
D. Confront the patient about their disruptive behavior.
Answer: B
Rationale: Patients in a manic state often have excessive psychomotor activity and a shortened
attention span, making it difficult to sit for traditional meals. Providing high-calorie, high-
protein finger foods allows them to eat while moving, preventing severe weight loss and
