NUR 4241 – Mental Health Nursing Final
Exam | 2025/2026 Updated Verified
Questions
Question 1: Psychiatric Disorders - Schizophrenia
A client with schizophrenia reports hearing voices telling them to harm others. This is an example
of:
A. Delusions of grandeur.
B. Command auditory hallucinations.
C. Loose associations.
D. Flight of ideas.
Rationale: Per APA DSM-6 (2025), command hallucinations in schizophrenia pose immediate safety
risks, requiring 1:1 observation and antipsychotic adjustment to reduce symptom acuity by
40-60%.
Question 2: Restraints
The least restrictive restraint for a client attempting to remove IV lines is:
A. Four-point leather restraints.
B. Soft wrist mittens.
C. Seclusion room.
D. Chemical sedation.
Rationale: ANA 2026 standards prioritize least restrictive interventions; mittens allow movement
while protecting access, with q2h assessment to promote dignity and reduce trauma.
Question 3: Suicide Precautions
A client with passive suicidal ideation is placed on suicide precautions including:
A. No-sharps environment only.
,B. 15-minute checks, safety contract, and removal of hazards.
C. Full seclusion.
D. Visitor ban.
Rationale: NIMH 2025 suicide prevention guidelines emphasize environmental safety and contracts
to build alliance; reassess q shift using C-SSRS for escalation.
Question 4: Psych Meds - Lithium
A client on lithium 900 mg/day has a level of 1.4 mEq/L. The nurse's action is:
A. Increase dose.
B. Continue and monitor for fine tremor.
C. Hold and notify provider.
D. Switch to valproate.
Rationale: Therapeutic range 0.6-1.2 mEq/L (APA 2026); 1.4 is mildly elevated but stable—monitor
hydration/thyroid to prevent toxicity.
Question 5: Therapeutic Communication
A client says, "I hate my life." The therapeutic response is:
A. "Everyone feels that way sometimes."
B. "Tell me more about what makes you feel that way."
C. "You have so much to live for."
D. "Let's talk about something else."
Rationale: Open-ended questions per Peplau's theory (2025) encourage exploration, fostering trust
and reducing isolation in depressive clients.
Question 6: Psychiatric Disorders - Bipolar Disorder
During a manic episode, a client spends excessively and sleeps 3 hours/night. This meets criteria
for:
A. Hypomania.
B. Bipolar I disorder.
, C. Cyclothymia.
D. MDD with agitation.
Rationale: DSM-6 (2025) requires ≥1 week of mania with impairment for Bipolar I; prioritize safety
and mood stabilizer initiation.
Question 7: Restraints
Before applying restraints, the nurse must obtain:
A. Client consent only.
B. Provider order within 1 hour per Joint Commission.
C. Family approval.
D. No documentation.
Rationale: 2026 Joint Commission: emergency use allowed but order required; q4h RN/ q2h
provider assessment to evaluate need.
Question 8: Suicide Precautions
The highest suicide risk factor in adolescents is:
A. Male gender.
B. Previous attempt.
C. Urban residence.
D. Single parent home.
Rationale: CDC 2025 youth risk data: prior attempt increases risk 30x; screen with ASQ and
involve multidisciplinary team.
Question 9: Psych Meds - SSRIs
A client starting sertraline 50 mg reports nausea. The nurse advises:
A. Discontinue immediately.
B. Take with food and continue, as it resolves in 1-2 weeks.
C. Double dose.
Exam | 2025/2026 Updated Verified
Questions
Question 1: Psychiatric Disorders - Schizophrenia
A client with schizophrenia reports hearing voices telling them to harm others. This is an example
of:
A. Delusions of grandeur.
B. Command auditory hallucinations.
C. Loose associations.
D. Flight of ideas.
Rationale: Per APA DSM-6 (2025), command hallucinations in schizophrenia pose immediate safety
risks, requiring 1:1 observation and antipsychotic adjustment to reduce symptom acuity by
40-60%.
Question 2: Restraints
The least restrictive restraint for a client attempting to remove IV lines is:
A. Four-point leather restraints.
B. Soft wrist mittens.
C. Seclusion room.
D. Chemical sedation.
Rationale: ANA 2026 standards prioritize least restrictive interventions; mittens allow movement
while protecting access, with q2h assessment to promote dignity and reduce trauma.
Question 3: Suicide Precautions
A client with passive suicidal ideation is placed on suicide precautions including:
A. No-sharps environment only.
,B. 15-minute checks, safety contract, and removal of hazards.
C. Full seclusion.
D. Visitor ban.
Rationale: NIMH 2025 suicide prevention guidelines emphasize environmental safety and contracts
to build alliance; reassess q shift using C-SSRS for escalation.
Question 4: Psych Meds - Lithium
A client on lithium 900 mg/day has a level of 1.4 mEq/L. The nurse's action is:
A. Increase dose.
B. Continue and monitor for fine tremor.
C. Hold and notify provider.
D. Switch to valproate.
Rationale: Therapeutic range 0.6-1.2 mEq/L (APA 2026); 1.4 is mildly elevated but stable—monitor
hydration/thyroid to prevent toxicity.
Question 5: Therapeutic Communication
A client says, "I hate my life." The therapeutic response is:
A. "Everyone feels that way sometimes."
B. "Tell me more about what makes you feel that way."
C. "You have so much to live for."
D. "Let's talk about something else."
Rationale: Open-ended questions per Peplau's theory (2025) encourage exploration, fostering trust
and reducing isolation in depressive clients.
Question 6: Psychiatric Disorders - Bipolar Disorder
During a manic episode, a client spends excessively and sleeps 3 hours/night. This meets criteria
for:
A. Hypomania.
B. Bipolar I disorder.
, C. Cyclothymia.
D. MDD with agitation.
Rationale: DSM-6 (2025) requires ≥1 week of mania with impairment for Bipolar I; prioritize safety
and mood stabilizer initiation.
Question 7: Restraints
Before applying restraints, the nurse must obtain:
A. Client consent only.
B. Provider order within 1 hour per Joint Commission.
C. Family approval.
D. No documentation.
Rationale: 2026 Joint Commission: emergency use allowed but order required; q4h RN/ q2h
provider assessment to evaluate need.
Question 8: Suicide Precautions
The highest suicide risk factor in adolescents is:
A. Male gender.
B. Previous attempt.
C. Urban residence.
D. Single parent home.
Rationale: CDC 2025 youth risk data: prior attempt increases risk 30x; screen with ASQ and
involve multidisciplinary team.
Question 9: Psych Meds - SSRIs
A client starting sertraline 50 mg reports nausea. The nurse advises:
A. Discontinue immediately.
B. Take with food and continue, as it resolves in 1-2 weeks.
C. Double dose.
