NUR 2459 Exam 3 Actual Exam V3 | NUR 2459 Mental and Behavioral
Health Nursing (NUR2459 Exam 3) | Rasmussen
1. A patient diagnosed with schizophrenia tells the nurse, ‘The silver people are coming out of
the electrical outlets to drain my brain.’ Which response by the nurse is most therapeutic?
A. The outlets are for electricity; there is no way for people to fit inside them.
B. I don’t see any silver people, but I can see that you are feeling very frightened.
C. You are experiencing a hallucination caused by a chemical imbalance in your brain.
D. What do the silver people want from you besides draining your brain?
Answer: B
Rationale: This response acknowledges the patient’s feelings without validating the
delusion or hallucination. The nurse must provide reality orientation while maintaining
empathy for the patient’s distress. Challenging the delusion directly or asking for more
details about it can reinforce the false belief.
2. A nurse is caring for a patient who was recently started on Haloperidol. The patient is now
experiencing high fever, muscle rigidity, and autonomic instability. Which condition should
the nurse suspect?
A. Neuroleptic Malignant Syndrome (NMS)
B. Acute Dystonia
C. Tardive Dyskinesia
D. Pseudoparkinsonism
Answer: A
Rationale: Neuroleptic Malignant Syndrome is a life-threatening emergency characterized
by ‘lead pipe’ rigidity, hyperpyrexia, and tachycardia. It is associated with high-potency
antipsychotics like Haloperidol. Immediate intervention includes stopping the medication
and initiating supportive care to prevent organ failure.
3. A patient with Borderline Personality Disorder is being treated on an inpatient unit. The
patient tells Nurse A, ‘You are the only one who understands me; Nurse B is so mean.’ This
behavior is known as:
A. Splitting
B. Rationalization
C. Projection
D. Intellectualization
,Answer: A
Rationale: Splitting is a common defense mechanism in Borderline Personality Disorder
where individuals view others as either all good or all bad. This behavior often creates
conflict among staff members. Consistent communication and a unified treatment plan
among the nursing team are essential to manage this behavior.
4. A nurse is assessing a patient with Anorexia Nervosa. Which clinical finding would
necessitate immediate hospitalization?
A. Body weight 15% below ideal
B. A history of purging after meals
C. Heart rate of 38 beats per minute
D. Potassium level of 3.6 mEq/L
Answer: C
Rationale: Severe bradycardia (less than 40 bpm) indicates significant physiological
compromise and risk for cardiac arrest. Hospitalization is required for stabilization when
vital signs are unstable or weight loss is extreme. Electrolyte imbalances and hypothermia
are also critical indicators for inpatient care.
5. Which medication is considered the ‘gold standard’ for treatment-resistant schizophrenia
but requires frequent monitoring of White Blood Cell (WBC) counts?
A. Olanzapine
B. Risperidone
C. Clozapine
D. Aripiprazole
Answer: C
Rationale: Clozapine is highly effective for patients who do not respond to other
antipsychotics but carries a risk of agranulocytosis. Agranulocytosis is a severe drop in
WBCs that makes the patient vulnerable to infection. Patients must be registered in a
monitoring program to ensure regular blood draws are performed.
6. A patient with Antisocial Personality Disorder is demanding a special snack that is not on
the menu. How should the nurse respond?
A. The snacks available are listed on the menu; no exceptions can be made.
B. You are being very difficult; please go to your room.
C. I will get it for you this once if you promise to follow the rules later.
D. Why do you feel that you deserve a different snack than the others?
, Answer: A
Rationale: Patients with Antisocial Personality Disorder often test boundaries and attempt
to manipulate staff. Setting firm, consistent limits is the primary nursing intervention.
Providing clear expectations helps maintain the therapeutic milieu and prevents the
patient from exploiting the system.
7. A patient presents with paralysis of the left arm but shows no physiological or neurological
cause. The patient seems strangely unconcerned about the symptom. This is characteristic of:
A. Illness Anxiety Disorder
B. Conversion Disorder
C. Somatic Symptom Disorder
D. Factitious Disorder
Answer: B
Rationale: Conversion Disorder involves the loss of sensory or motor function without a
medical cause, often following a stressful event. ‘La belle indifference’ is the term used to
describe the patient’s lack of concern regarding the severe symptom. The nurse should
focus on the patient’s coping mechanisms rather than the physical symptom itself.
8. A nurse is caring for a patient with Bulimia Nervosa. Which physical assessment finding is
most suggestive of chronic self-induced vomiting?
A. Lanugo on the back and arms
B. Calluses on the knuckles (Russell’s sign)
C. Extreme emaciation
D. Amenorrhea for six months
Answer: B
Rationale: Russell’s sign refers to calluses or scars on the knuckles caused by repeated
contact with the teeth during induced vomiting. While lanugo and emaciation are common
in Anorexia, Bulimic patients are often of normal or near-normal weight. Dental erosion
and parotid gland swelling are also common indicators of bulimia.
9. A patient is experiencing an acute dystonic reaction after receiving a dose of
Prochlorperazine. Which medication should the nurse prepare to administer?
A. Lorazepam
B. Bromocriptine
C. Dantrolene
D. Benztropine
Health Nursing (NUR2459 Exam 3) | Rasmussen
1. A patient diagnosed with schizophrenia tells the nurse, ‘The silver people are coming out of
the electrical outlets to drain my brain.’ Which response by the nurse is most therapeutic?
A. The outlets are for electricity; there is no way for people to fit inside them.
B. I don’t see any silver people, but I can see that you are feeling very frightened.
C. You are experiencing a hallucination caused by a chemical imbalance in your brain.
D. What do the silver people want from you besides draining your brain?
Answer: B
Rationale: This response acknowledges the patient’s feelings without validating the
delusion or hallucination. The nurse must provide reality orientation while maintaining
empathy for the patient’s distress. Challenging the delusion directly or asking for more
details about it can reinforce the false belief.
2. A nurse is caring for a patient who was recently started on Haloperidol. The patient is now
experiencing high fever, muscle rigidity, and autonomic instability. Which condition should
the nurse suspect?
A. Neuroleptic Malignant Syndrome (NMS)
B. Acute Dystonia
C. Tardive Dyskinesia
D. Pseudoparkinsonism
Answer: A
Rationale: Neuroleptic Malignant Syndrome is a life-threatening emergency characterized
by ‘lead pipe’ rigidity, hyperpyrexia, and tachycardia. It is associated with high-potency
antipsychotics like Haloperidol. Immediate intervention includes stopping the medication
and initiating supportive care to prevent organ failure.
3. A patient with Borderline Personality Disorder is being treated on an inpatient unit. The
patient tells Nurse A, ‘You are the only one who understands me; Nurse B is so mean.’ This
behavior is known as:
A. Splitting
B. Rationalization
C. Projection
D. Intellectualization
,Answer: A
Rationale: Splitting is a common defense mechanism in Borderline Personality Disorder
where individuals view others as either all good or all bad. This behavior often creates
conflict among staff members. Consistent communication and a unified treatment plan
among the nursing team are essential to manage this behavior.
4. A nurse is assessing a patient with Anorexia Nervosa. Which clinical finding would
necessitate immediate hospitalization?
A. Body weight 15% below ideal
B. A history of purging after meals
C. Heart rate of 38 beats per minute
D. Potassium level of 3.6 mEq/L
Answer: C
Rationale: Severe bradycardia (less than 40 bpm) indicates significant physiological
compromise and risk for cardiac arrest. Hospitalization is required for stabilization when
vital signs are unstable or weight loss is extreme. Electrolyte imbalances and hypothermia
are also critical indicators for inpatient care.
5. Which medication is considered the ‘gold standard’ for treatment-resistant schizophrenia
but requires frequent monitoring of White Blood Cell (WBC) counts?
A. Olanzapine
B. Risperidone
C. Clozapine
D. Aripiprazole
Answer: C
Rationale: Clozapine is highly effective for patients who do not respond to other
antipsychotics but carries a risk of agranulocytosis. Agranulocytosis is a severe drop in
WBCs that makes the patient vulnerable to infection. Patients must be registered in a
monitoring program to ensure regular blood draws are performed.
6. A patient with Antisocial Personality Disorder is demanding a special snack that is not on
the menu. How should the nurse respond?
A. The snacks available are listed on the menu; no exceptions can be made.
B. You are being very difficult; please go to your room.
C. I will get it for you this once if you promise to follow the rules later.
D. Why do you feel that you deserve a different snack than the others?
, Answer: A
Rationale: Patients with Antisocial Personality Disorder often test boundaries and attempt
to manipulate staff. Setting firm, consistent limits is the primary nursing intervention.
Providing clear expectations helps maintain the therapeutic milieu and prevents the
patient from exploiting the system.
7. A patient presents with paralysis of the left arm but shows no physiological or neurological
cause. The patient seems strangely unconcerned about the symptom. This is characteristic of:
A. Illness Anxiety Disorder
B. Conversion Disorder
C. Somatic Symptom Disorder
D. Factitious Disorder
Answer: B
Rationale: Conversion Disorder involves the loss of sensory or motor function without a
medical cause, often following a stressful event. ‘La belle indifference’ is the term used to
describe the patient’s lack of concern regarding the severe symptom. The nurse should
focus on the patient’s coping mechanisms rather than the physical symptom itself.
8. A nurse is caring for a patient with Bulimia Nervosa. Which physical assessment finding is
most suggestive of chronic self-induced vomiting?
A. Lanugo on the back and arms
B. Calluses on the knuckles (Russell’s sign)
C. Extreme emaciation
D. Amenorrhea for six months
Answer: B
Rationale: Russell’s sign refers to calluses or scars on the knuckles caused by repeated
contact with the teeth during induced vomiting. While lanugo and emaciation are common
in Anorexia, Bulimic patients are often of normal or near-normal weight. Dental erosion
and parotid gland swelling are also common indicators of bulimia.
9. A patient is experiencing an acute dystonic reaction after receiving a dose of
Prochlorperazine. Which medication should the nurse prepare to administer?
A. Lorazepam
B. Bromocriptine
C. Dantrolene
D. Benztropine
