NR 326 COMPREHENSIVE FINAL EXAM:
MENTAL HEALTH NURSING ACTUAL
QUESTIONS & ANSWERS (GUARANTEE
PASS) CHAMBERLAIN
1. A nurse is caring for a client with schizophrenia who is experiencing auditory
hallucinations. Which response by the nurse is the most therapeutic?
A. I don’t hear the voices, but I can see that you are frightened.
B. The voices are not real; they are just part of your illness.
C. Why do you think the voices are talking to you right now?
D. I will turn up the radio to help drown out what the voices are saying.
Answer: A
Conceptual Explanation: Validating the client’s feelings while presenting reality without
arguing is the standard therapeutic approach for hallucinations.
2. A client is prescribed Lithium Carbonate for Bipolar I Disorder. The nurse should instruct
the client to maintain a consistent intake of which substance to avoid toxicity?
A. Potassium
B. Calcium
C. Sodium
,D. Magnesium
Answer: C
Conceptual Explanation: Lithium is a salt; low sodium levels cause the kidneys to retain
lithium, leading to toxicity. High sodium levels can cause lithium levels to drop.
3. A client tells the nurse, ‘I’m going to kill my wife when I get out of here.’ Which legal
principle requires the nurse to take action?
A. Beneficence
B. Duty to warn (Tarasoff ruling)
C. Fidelity
D. Right to refuse treatment
Answer: B
Conceptual Explanation: The Tarasoff ruling establishes that mental health professionals
have a duty to warn identifiable third parties of a serious threat of harm.
4. A client taking an SSRI for depression reports high fever, muscle rigidity, and rapid heart
rate. The nurse suspects Serotonin Syndrome. Which medication should the nurse expect to
be discontinued immediately?
A. Fluoxetine
B. Haloperidol
C. Benztropine
, D. Lorazepam
Answer: A
Conceptual Explanation: Fluoxetine is an SSRI. Serotonin Syndrome is a life-threatening
condition caused by excess serotonin, requiring immediate cessation of the offending
agent.
5. A client with Borderline Personality Disorder (BPD) tells Nurse A that she is the only one
who understands her, while telling Nurse B that he is incompetent. This behavior is known as:
A. Projection
B. Reaction Formation
C. Rationalization
D. Splitting
Answer: D
Conceptual Explanation: Splitting is a common defense mechanism in BPD where
individuals view others as all good or all bad, failing to integrate positive and negative
qualities.
6. A client is experiencing acute mania and is pacing the unit rapidly. Which meal is most
appropriate for this client?
A. Spaghetti and meatballs
B. Soup and crackers
MENTAL HEALTH NURSING ACTUAL
QUESTIONS & ANSWERS (GUARANTEE
PASS) CHAMBERLAIN
1. A nurse is caring for a client with schizophrenia who is experiencing auditory
hallucinations. Which response by the nurse is the most therapeutic?
A. I don’t hear the voices, but I can see that you are frightened.
B. The voices are not real; they are just part of your illness.
C. Why do you think the voices are talking to you right now?
D. I will turn up the radio to help drown out what the voices are saying.
Answer: A
Conceptual Explanation: Validating the client’s feelings while presenting reality without
arguing is the standard therapeutic approach for hallucinations.
2. A client is prescribed Lithium Carbonate for Bipolar I Disorder. The nurse should instruct
the client to maintain a consistent intake of which substance to avoid toxicity?
A. Potassium
B. Calcium
C. Sodium
,D. Magnesium
Answer: C
Conceptual Explanation: Lithium is a salt; low sodium levels cause the kidneys to retain
lithium, leading to toxicity. High sodium levels can cause lithium levels to drop.
3. A client tells the nurse, ‘I’m going to kill my wife when I get out of here.’ Which legal
principle requires the nurse to take action?
A. Beneficence
B. Duty to warn (Tarasoff ruling)
C. Fidelity
D. Right to refuse treatment
Answer: B
Conceptual Explanation: The Tarasoff ruling establishes that mental health professionals
have a duty to warn identifiable third parties of a serious threat of harm.
4. A client taking an SSRI for depression reports high fever, muscle rigidity, and rapid heart
rate. The nurse suspects Serotonin Syndrome. Which medication should the nurse expect to
be discontinued immediately?
A. Fluoxetine
B. Haloperidol
C. Benztropine
, D. Lorazepam
Answer: A
Conceptual Explanation: Fluoxetine is an SSRI. Serotonin Syndrome is a life-threatening
condition caused by excess serotonin, requiring immediate cessation of the offending
agent.
5. A client with Borderline Personality Disorder (BPD) tells Nurse A that she is the only one
who understands her, while telling Nurse B that he is incompetent. This behavior is known as:
A. Projection
B. Reaction Formation
C. Rationalization
D. Splitting
Answer: D
Conceptual Explanation: Splitting is a common defense mechanism in BPD where
individuals view others as all good or all bad, failing to integrate positive and negative
qualities.
6. A client is experiencing acute mania and is pacing the unit rapidly. Which meal is most
appropriate for this client?
A. Spaghetti and meatballs
B. Soup and crackers
