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PSYCHIATRIC-MENTAL HEALTH NURSING – FINAL EXAM FULL
PACKAGE QUESTIONS ANSWERS AND RATIONALES 2026-27
LATEST UPDATED VERSION INSTANT DOWNLOAD PDF..!!z
Q1: A 34-year-old client diagnosed with treatment-resistant
Schizophrenia is brought to the emergency department displaying an
acute exacerbation of auditory hallucinations and paranoid
delusions. The client's medication regimen was changed to Clozapine
six weeks ago. The nurse reviews the client’s routine laboratory
results and notes a White Blood Cell (WBC) count of 2,100/mm³ and
an Absolute Neutrophil Count (ANC) of 950/mm³. Which nursing
action is the absolute priority?
A) Administer the scheduled evening dose of Clozapine and
document the laboratory values in the electronic health record.
B) B) Immediately withhold the Clozapine dose, place the client on
protective reverse isolation precautions, and notify the psychiatric
provider and hematologist.
C) Request a repeat complete blood count with differential to be
drawn within the next 48 hours while monitoring for signs of
infection.
D) Administer an emergency intramuscular injection of Haloperidol
to manage the worsening auditory hallucinations and paranoid
delusions.
Rationale: The correct answer is B because the client’s laboratory
results reveal severe neutropenia (ANC below 1,000/mm³), indicating
a critical and life-threatening risk for agranulocytosis, a known
adverse effect of Clozapine. Immediate treatment requires
discontinuing the medication permanently and implementing
protective isolation to prevent lethal opportunistic infections. Option
,2
A is incorrect because administering further Clozapine would worsen
bone marrow suppression. Option C is incorrect because waiting 48
hours delays vital safety interventions. Option D is incorrect because
it fails to address the underlying haematological emergency, and
switching to a high-potency first-generation antipsychotic could
further complicate the clinical picture.
Q2: A client with an intensive history of Alcohol Use Disorder is
admitted to the medical-psychiatric unit for detox. At 14 hours post-
admission, the nurse observes a marked increase in blood pressure
and heart rate, fine hand tremors, coarse diaphoresis, and transient
visual illusions of insects climbing on the wall. The client is oriented
to person but disoriented to time and place. Which pharmacological
intervention should the nurse anticipate administering immediately?
A) Haloperidol 5 mg intramuscularly to control the escalating visual
illusions and spatial disorientation.
B) B) Lorazepam 2 mg intravenously or orally according to the
validated Clinical Institute Withdrawal Assessment for Alcohol
(CIWA-Ar) protocol thresholds.
C) Disulfiram 250 mg orally to immediately inhibit aldehyde
dehydrogenase and suppress the somatic symptoms of withdrawal.
D) Clonidine 0.1 mg orally to stabilize the blood pressure and
eliminate central nervous system hyperactivity permanently.
Rationale: The correct answer is B because the client is exhibiting
classic signs of acute alcohol withdrawal syndrome, which can rapidly
progress to life-threatening Delirium Tremens (DTs). Benzodiazepines,
such as Lorazepam, are the gold standard treatment to replace the
missing alcohol-mediated GABAergic inhibition, safely reducing
central nervous system hyperexcitability and preventing withdrawal
seizures. Option A is incorrect because antipsychotics like Haloperidol
lower the seizure threshold, increasing withdrawal risks. Option C is
,3
incorrect because Disulfiram is an alcohol deterrent used for long-
term sobriety maintenance; administering it during active withdrawal
or while alcohol remains in the bloodstream can trigger a severe,
dangerous reaction. Option D is incorrect because while Clonidine
mitigates autonomic symptoms, it does not prevent withdrawal
seizures or delirium.
Q3: During a group psychotherapy session on an inpatient unit, a
client diagnosed with Borderline Personality Disorder loudly
interrupts another member, stating, "You always talk about your
pathetic problems, and the staff here loves you, but they hate me!
This nurse is the only good person on this entire unit, and everyone
else is completely incompetent." Which defense mechanism is the
client actively demonstrating, and how should the nurse respond?
A) Projection; the nurse should agree with the client’s assessment of
the staff to solidify a strong therapeutic alignment.
B) B) Splitting; the nurse should remain neutral, address the
interrupting behavior directly, and remind the group of established
communication boundaries while maintaining a cohesive staff
approach.
C) Rationalization; the nurse should explain to the client why the
other staff members are actually highly competent professionals.
D) Intellectualization; the nurse should immediately terminate the
group session and isolate the client to prevent further emotional
contagion.
Rationale: The correct answer is B because "splitting" is a primitive
defense mechanism common in Borderline Personality Disorder,
characterized by an inability to integrate the positive and negative
qualities of oneself or others into a cohesive image. Individuals view
people or situations as either all good or all bad. The nurse must
counter this by avoiding countertransference, maintaining absolute
, 4
staff consistency, and firmly re-establishing interpersonal group
boundaries neutrally. Option A is incorrect because validating the
splitting behavior damages interdisciplinary teamwork and reinforces
maladaptive defense mechanisms. Option C is incorrect because
debating with the client’s split perceptions is ineffective during acute
escalation. Option D is incorrect because canceling the group session
punishes other participants and avoids addressing the behavioral
issue.
Q4: A nurse is caring for an older adult client who was admitted to
the inpatient geriatric psychiatric unit three days ago with severe
Major Depressive Disorder and profound psychomotor retardation.
The client has refused meals, shows negligible verbal communication,
and remains tightly curled in bed. This morning, the client suddenly
appears well-groomed, energetic, conversational, and states,
"Everything is finally fine, and I've found true peace." What is the
nurse's priority assessment tracking requirement?
A) Prepare the client for immediate discharge planning since the
depressive episode has resolved successfully.
B) B) Initiate continuous one-to-one suicide line-of-sight
observation, as the sudden lifting of severe depression often
provides the energy required to execute a suicide plan.
C) Decrease the frequency of room monitoring checks to foster
independent coping strategies and self-care.
D) Document the improvement in mood and request an immediate
reduction in the client's antidepressant medication dosages.
Rationale: The correct answer is B because a sudden, unexpected
improvement in a severely depressed client's mood and energy level
is an ominous warning sign of an imminent suicide attempt. The
resolution of psychomotor retardation gives the client the physical
capability to act on prior suicidal ideations or plans, often
PSYCHIATRIC-MENTAL HEALTH NURSING – FINAL EXAM FULL
PACKAGE QUESTIONS ANSWERS AND RATIONALES 2026-27
LATEST UPDATED VERSION INSTANT DOWNLOAD PDF..!!z
Q1: A 34-year-old client diagnosed with treatment-resistant
Schizophrenia is brought to the emergency department displaying an
acute exacerbation of auditory hallucinations and paranoid
delusions. The client's medication regimen was changed to Clozapine
six weeks ago. The nurse reviews the client’s routine laboratory
results and notes a White Blood Cell (WBC) count of 2,100/mm³ and
an Absolute Neutrophil Count (ANC) of 950/mm³. Which nursing
action is the absolute priority?
A) Administer the scheduled evening dose of Clozapine and
document the laboratory values in the electronic health record.
B) B) Immediately withhold the Clozapine dose, place the client on
protective reverse isolation precautions, and notify the psychiatric
provider and hematologist.
C) Request a repeat complete blood count with differential to be
drawn within the next 48 hours while monitoring for signs of
infection.
D) Administer an emergency intramuscular injection of Haloperidol
to manage the worsening auditory hallucinations and paranoid
delusions.
Rationale: The correct answer is B because the client’s laboratory
results reveal severe neutropenia (ANC below 1,000/mm³), indicating
a critical and life-threatening risk for agranulocytosis, a known
adverse effect of Clozapine. Immediate treatment requires
discontinuing the medication permanently and implementing
protective isolation to prevent lethal opportunistic infections. Option
,2
A is incorrect because administering further Clozapine would worsen
bone marrow suppression. Option C is incorrect because waiting 48
hours delays vital safety interventions. Option D is incorrect because
it fails to address the underlying haematological emergency, and
switching to a high-potency first-generation antipsychotic could
further complicate the clinical picture.
Q2: A client with an intensive history of Alcohol Use Disorder is
admitted to the medical-psychiatric unit for detox. At 14 hours post-
admission, the nurse observes a marked increase in blood pressure
and heart rate, fine hand tremors, coarse diaphoresis, and transient
visual illusions of insects climbing on the wall. The client is oriented
to person but disoriented to time and place. Which pharmacological
intervention should the nurse anticipate administering immediately?
A) Haloperidol 5 mg intramuscularly to control the escalating visual
illusions and spatial disorientation.
B) B) Lorazepam 2 mg intravenously or orally according to the
validated Clinical Institute Withdrawal Assessment for Alcohol
(CIWA-Ar) protocol thresholds.
C) Disulfiram 250 mg orally to immediately inhibit aldehyde
dehydrogenase and suppress the somatic symptoms of withdrawal.
D) Clonidine 0.1 mg orally to stabilize the blood pressure and
eliminate central nervous system hyperactivity permanently.
Rationale: The correct answer is B because the client is exhibiting
classic signs of acute alcohol withdrawal syndrome, which can rapidly
progress to life-threatening Delirium Tremens (DTs). Benzodiazepines,
such as Lorazepam, are the gold standard treatment to replace the
missing alcohol-mediated GABAergic inhibition, safely reducing
central nervous system hyperexcitability and preventing withdrawal
seizures. Option A is incorrect because antipsychotics like Haloperidol
lower the seizure threshold, increasing withdrawal risks. Option C is
,3
incorrect because Disulfiram is an alcohol deterrent used for long-
term sobriety maintenance; administering it during active withdrawal
or while alcohol remains in the bloodstream can trigger a severe,
dangerous reaction. Option D is incorrect because while Clonidine
mitigates autonomic symptoms, it does not prevent withdrawal
seizures or delirium.
Q3: During a group psychotherapy session on an inpatient unit, a
client diagnosed with Borderline Personality Disorder loudly
interrupts another member, stating, "You always talk about your
pathetic problems, and the staff here loves you, but they hate me!
This nurse is the only good person on this entire unit, and everyone
else is completely incompetent." Which defense mechanism is the
client actively demonstrating, and how should the nurse respond?
A) Projection; the nurse should agree with the client’s assessment of
the staff to solidify a strong therapeutic alignment.
B) B) Splitting; the nurse should remain neutral, address the
interrupting behavior directly, and remind the group of established
communication boundaries while maintaining a cohesive staff
approach.
C) Rationalization; the nurse should explain to the client why the
other staff members are actually highly competent professionals.
D) Intellectualization; the nurse should immediately terminate the
group session and isolate the client to prevent further emotional
contagion.
Rationale: The correct answer is B because "splitting" is a primitive
defense mechanism common in Borderline Personality Disorder,
characterized by an inability to integrate the positive and negative
qualities of oneself or others into a cohesive image. Individuals view
people or situations as either all good or all bad. The nurse must
counter this by avoiding countertransference, maintaining absolute
, 4
staff consistency, and firmly re-establishing interpersonal group
boundaries neutrally. Option A is incorrect because validating the
splitting behavior damages interdisciplinary teamwork and reinforces
maladaptive defense mechanisms. Option C is incorrect because
debating with the client’s split perceptions is ineffective during acute
escalation. Option D is incorrect because canceling the group session
punishes other participants and avoids addressing the behavioral
issue.
Q4: A nurse is caring for an older adult client who was admitted to
the inpatient geriatric psychiatric unit three days ago with severe
Major Depressive Disorder and profound psychomotor retardation.
The client has refused meals, shows negligible verbal communication,
and remains tightly curled in bed. This morning, the client suddenly
appears well-groomed, energetic, conversational, and states,
"Everything is finally fine, and I've found true peace." What is the
nurse's priority assessment tracking requirement?
A) Prepare the client for immediate discharge planning since the
depressive episode has resolved successfully.
B) B) Initiate continuous one-to-one suicide line-of-sight
observation, as the sudden lifting of severe depression often
provides the energy required to execute a suicide plan.
C) Decrease the frequency of room monitoring checks to foster
independent coping strategies and self-care.
D) Document the improvement in mood and request an immediate
reduction in the client's antidepressant medication dosages.
Rationale: The correct answer is B because a sudden, unexpected
improvement in a severely depressed client's mood and energy level
is an ominous warning sign of an imminent suicide attempt. The
resolution of psychomotor retardation gives the client the physical
capability to act on prior suicidal ideations or plans, often
