, Question 1
A patient on clozapine presents with fever, tachycardia, and a rigid posture.
Which finding most specifically differentiates neuroleptic malignant syndrome
from serotonin syndrome?
A. Lead-pipe rigidity with hyporeflexia
B. Hyperreflexia with clonus
C. Mydriasis and diaphoresis
D. Tremor and akathisia
Correct Answer: A - Lead-pipe rigidity with hyporeflexia
RATIONALE
NMS is characterized by lead-pipe rigidity and hyporeflexia, while
serotonin syndrome presents with hyperreflexia and clonus. Mydriasis
and diaphoresis occur in both. Tremor and akathisia are nonspecific
and more chronic.
Question 2
Which statement by a patient prescribed lithium indicates a need for immediate
intervention?
A. "I take ibuprofen for my headaches."
B. "I drink 2 liters of water daily."
C. "I maintain a consistent sodium intake."
D. "I have my lithium level checked monthly."
Correct Answer: A - "I take ibuprofen for my headaches."
RATIONALE
NSAIDs like ibuprofen reduce renal lithium clearance, increasing
toxicity risk. Adequate hydration, consistent sodium, and routine level
monitoring are appropriate. The other options reflect safe
management.
Page 2
, Question 3
During a crisis intervention, a patient with borderline personality disorder
engages in splitting. Which nursing approach is most effective?
A. Rotate staff frequently to prevent attachment.
B. Set consistent limits and validate distress without reinforcing
maladaptive behavior.
C. Allow special privileges to reduce anxiety.
D. Confront the behavior publicly to promote insight.
Correct Answer: B - Set consistent limits and validate distress
without reinforcing maladaptive behavior.
RATIONALE
Consistent limits and validation of underlying distress without
reinforcing splitting are core to therapeutic management. Rotating
staff worsens splitting; special privileges reinforce manipulation;
public confrontation is humiliating and countertherapeutic.
Question 4
A patient with schizophrenia reports hearing voices saying, "You are
worthless." Which response by the nurse is most therapeutic?
A. "Those voices aren't real; ignore them."
B. "What are the voices telling you right now?"
C. "I don't hear any voices."
D. "Let's discuss why you feel worthless."
Correct Answer: B - "What are the voices telling you right now?"
RATIONALE
Asking about the content of hallucinations assesses risk and engages
the patient without challenging the experience. Telling the patient to
ignore voices or denying their presence dismisses the experience.
Focusing on worthlessness may reinforce the hallucination.
Page 3
, Question 5
Which finding in a patient taking fluoxetine for major depressive disorder
requires immediate follow-up?
A. Report of increased energy and insomnia
B. Weight gain of 2 kg over 2 months
C. Blood pressure 118/76 mm Hg
D. Complaint of mild nausea
Correct Answer: A - Report of increased energy and insomnia
RATIONALE
Increased energy and insomnia may indicate activation or emerging
hypomania, especially in bipolar spectrum, requiring immediate
evaluation. Weight gain, normal BP, and mild nausea are common,
non-urgent side effects.
Question 6
A patient with alcohol use disorder is admitted with confusion, ataxia, and
ophthalmoplegia. Which intervention is priority?
A. Administer thiamine IV before glucose.
B. Administer glucose IV before thiamine.
C. Initiate lorazepam for withdrawal.
D. Provide oral multivitamins.
Correct Answer: A - Administer thiamine IV before glucose.
RATIONALE
Wernicke encephalopathy requires immediate IV thiamine before
glucose to prevent precipitation or worsening. Glucose first can
deplete thiamine and worsen symptoms. Lorazepam addresses
withdrawal, not this emergency; oral vitamins are inadequate.
Page 4
A patient on clozapine presents with fever, tachycardia, and a rigid posture.
Which finding most specifically differentiates neuroleptic malignant syndrome
from serotonin syndrome?
A. Lead-pipe rigidity with hyporeflexia
B. Hyperreflexia with clonus
C. Mydriasis and diaphoresis
D. Tremor and akathisia
Correct Answer: A - Lead-pipe rigidity with hyporeflexia
RATIONALE
NMS is characterized by lead-pipe rigidity and hyporeflexia, while
serotonin syndrome presents with hyperreflexia and clonus. Mydriasis
and diaphoresis occur in both. Tremor and akathisia are nonspecific
and more chronic.
Question 2
Which statement by a patient prescribed lithium indicates a need for immediate
intervention?
A. "I take ibuprofen for my headaches."
B. "I drink 2 liters of water daily."
C. "I maintain a consistent sodium intake."
D. "I have my lithium level checked monthly."
Correct Answer: A - "I take ibuprofen for my headaches."
RATIONALE
NSAIDs like ibuprofen reduce renal lithium clearance, increasing
toxicity risk. Adequate hydration, consistent sodium, and routine level
monitoring are appropriate. The other options reflect safe
management.
Page 2
, Question 3
During a crisis intervention, a patient with borderline personality disorder
engages in splitting. Which nursing approach is most effective?
A. Rotate staff frequently to prevent attachment.
B. Set consistent limits and validate distress without reinforcing
maladaptive behavior.
C. Allow special privileges to reduce anxiety.
D. Confront the behavior publicly to promote insight.
Correct Answer: B - Set consistent limits and validate distress
without reinforcing maladaptive behavior.
RATIONALE
Consistent limits and validation of underlying distress without
reinforcing splitting are core to therapeutic management. Rotating
staff worsens splitting; special privileges reinforce manipulation;
public confrontation is humiliating and countertherapeutic.
Question 4
A patient with schizophrenia reports hearing voices saying, "You are
worthless." Which response by the nurse is most therapeutic?
A. "Those voices aren't real; ignore them."
B. "What are the voices telling you right now?"
C. "I don't hear any voices."
D. "Let's discuss why you feel worthless."
Correct Answer: B - "What are the voices telling you right now?"
RATIONALE
Asking about the content of hallucinations assesses risk and engages
the patient without challenging the experience. Telling the patient to
ignore voices or denying their presence dismisses the experience.
Focusing on worthlessness may reinforce the hallucination.
Page 3
, Question 5
Which finding in a patient taking fluoxetine for major depressive disorder
requires immediate follow-up?
A. Report of increased energy and insomnia
B. Weight gain of 2 kg over 2 months
C. Blood pressure 118/76 mm Hg
D. Complaint of mild nausea
Correct Answer: A - Report of increased energy and insomnia
RATIONALE
Increased energy and insomnia may indicate activation or emerging
hypomania, especially in bipolar spectrum, requiring immediate
evaluation. Weight gain, normal BP, and mild nausea are common,
non-urgent side effects.
Question 6
A patient with alcohol use disorder is admitted with confusion, ataxia, and
ophthalmoplegia. Which intervention is priority?
A. Administer thiamine IV before glucose.
B. Administer glucose IV before thiamine.
C. Initiate lorazepam for withdrawal.
D. Provide oral multivitamins.
Correct Answer: A - Administer thiamine IV before glucose.
RATIONALE
Wernicke encephalopathy requires immediate IV thiamine before
glucose to prevent precipitation or worsening. Glucose first can
deplete thiamine and worsen symptoms. Lorazepam addresses
withdrawal, not this emergency; oral vitamins are inadequate.
Page 4
