, Question 1
A patient with treatment-resistant schizophrenia is initiated on clozapine.
Which laboratory monitoring parameter is most critical to obtain at baseline
and weekly for the first six months?
A. Serum creatinine and BUN
B. Absolute neutrophil count
C. Liver function tests
D. Fasting lipid panel
Correct Answer: B - Absolute neutrophil count
RATIONALE
Clozapine carries a black box warning for severe
neutropenia/agranulocytosis, requiring baseline and weekly ANC
monitoring for six months, then biweekly. Renal, hepatic, and lipid
parameters are monitored but are not the highest-priority weekly
safety lab.
Question 2
Which nursing action best reflects the ethical principle of veracity when a
patient asks whether a newly prescribed antipsychotic will cause weight gain?
A. Deflect the question to reduce anxiety and discuss it at discharge.
B. State that weight gain is rare to encourage adherence.
C. Provide factual information about the risk and discuss management
strategies.
D. Tell the patient to ask the prescriber instead.
Correct Answer: C - Provide factual information about the risk
and discuss management strategies.
Page 2
, RATIONALE
Veracity requires truthful disclosure; providing accurate risk
information and collaborative management respects autonomy and
informed consent. Deflection, minimization, and avoidance all violate
veracity and therapeutic trust.
Question 3
Which statement by a nurse best demonstrates the use of the therapeutic
communication technique of 'making observations'?
A. You seem tense today; tell me what you are feeling.
B. Why do you always look away when we talk?
C. I noticed you are pacing and wringing your hands.
D. Everything will be fine; just relax.
Correct Answer: C - I noticed you are pacing and wringing your
hands.
RATIONALE
Making observations involves stating what the nurse perceives,
inviting the patient to explore feelings without pressure. 'Why'
questions, false reassurance, and directing feelings are nontherapeutic.
Question 4
A patient with bipolar I disorder in a manic episode is prescribed lithium.
Which serum lithium level indicates a therapeutic range but also requires
immediate nursing intervention due to early toxicity?
A. 0.4 mEq/L
B. 0.8 mEq/L
C. 1.2 mEq/L
D. 1.6 mEq/L
Correct Answer: D - 1.6 mEq/L
Page 3
, RATIONALE
Therapeutic lithium range is typically 0.6-1.2 mEq/L. A level of 1.6
mEq/L is above therapeutic and indicates early toxicity, requiring
immediate intervention. 0.4 is subtherapeutic; 0.8 and 1.2 are
therapeutic.
Question 5
Which factor is most predictive of a complicated grief reaction in a patient who
recently lost a spouse?
A. Attending a support group
B. History of major depressive disorder
C. Having a strong social network
D. Ritualistic mourning practices
Correct Answer: B - History of major depressive disorder
RATIONALE
Preexisting psychiatric history, especially depression, is a strong
predictor of complicated grief. Social support and ritualistic practices
are protective; support group attendance is generally beneficial.
Question 6
A patient experiencing alcohol withdrawal is assessed with a CIWA-Ar score
of 18. Which nursing action is the priority?
A. Administer a PRN benzodiazepine as prescribed.
B. Encourage oral fluids and reorient.
C. Place the patient in a quiet, dimly lit room.
D. Document the score and reassess in 4 hours.
Correct Answer: A - Administer a PRN benzodiazepine as
prescribed.
Page 4
A patient with treatment-resistant schizophrenia is initiated on clozapine.
Which laboratory monitoring parameter is most critical to obtain at baseline
and weekly for the first six months?
A. Serum creatinine and BUN
B. Absolute neutrophil count
C. Liver function tests
D. Fasting lipid panel
Correct Answer: B - Absolute neutrophil count
RATIONALE
Clozapine carries a black box warning for severe
neutropenia/agranulocytosis, requiring baseline and weekly ANC
monitoring for six months, then biweekly. Renal, hepatic, and lipid
parameters are monitored but are not the highest-priority weekly
safety lab.
Question 2
Which nursing action best reflects the ethical principle of veracity when a
patient asks whether a newly prescribed antipsychotic will cause weight gain?
A. Deflect the question to reduce anxiety and discuss it at discharge.
B. State that weight gain is rare to encourage adherence.
C. Provide factual information about the risk and discuss management
strategies.
D. Tell the patient to ask the prescriber instead.
Correct Answer: C - Provide factual information about the risk
and discuss management strategies.
Page 2
, RATIONALE
Veracity requires truthful disclosure; providing accurate risk
information and collaborative management respects autonomy and
informed consent. Deflection, minimization, and avoidance all violate
veracity and therapeutic trust.
Question 3
Which statement by a nurse best demonstrates the use of the therapeutic
communication technique of 'making observations'?
A. You seem tense today; tell me what you are feeling.
B. Why do you always look away when we talk?
C. I noticed you are pacing and wringing your hands.
D. Everything will be fine; just relax.
Correct Answer: C - I noticed you are pacing and wringing your
hands.
RATIONALE
Making observations involves stating what the nurse perceives,
inviting the patient to explore feelings without pressure. 'Why'
questions, false reassurance, and directing feelings are nontherapeutic.
Question 4
A patient with bipolar I disorder in a manic episode is prescribed lithium.
Which serum lithium level indicates a therapeutic range but also requires
immediate nursing intervention due to early toxicity?
A. 0.4 mEq/L
B. 0.8 mEq/L
C. 1.2 mEq/L
D. 1.6 mEq/L
Correct Answer: D - 1.6 mEq/L
Page 3
, RATIONALE
Therapeutic lithium range is typically 0.6-1.2 mEq/L. A level of 1.6
mEq/L is above therapeutic and indicates early toxicity, requiring
immediate intervention. 0.4 is subtherapeutic; 0.8 and 1.2 are
therapeutic.
Question 5
Which factor is most predictive of a complicated grief reaction in a patient who
recently lost a spouse?
A. Attending a support group
B. History of major depressive disorder
C. Having a strong social network
D. Ritualistic mourning practices
Correct Answer: B - History of major depressive disorder
RATIONALE
Preexisting psychiatric history, especially depression, is a strong
predictor of complicated grief. Social support and ritualistic practices
are protective; support group attendance is generally beneficial.
Question 6
A patient experiencing alcohol withdrawal is assessed with a CIWA-Ar score
of 18. Which nursing action is the priority?
A. Administer a PRN benzodiazepine as prescribed.
B. Encourage oral fluids and reorient.
C. Place the patient in a quiet, dimly lit room.
D. Document the score and reassess in 4 hours.
Correct Answer: A - Administer a PRN benzodiazepine as
prescribed.
Page 4
