NU 671
Clinical Decision Making in
Psychiatric Mental Health
Latest Midterm Exam Review
(With Solutions)
2026
1
,A 32-year-old patient with schizophrenia exhibits auditory hallucinations
telling him to harm others. Which immediate nursing intervention best
addresses this symptom?
A) Encourage verbalization of hallucination content
B) Provide a low-stimulation environment and monitor safety
C) Administer PRN anxiolytics without assessment
D) Engage in group therapy immediately
Answer: B
Rationale: Safety is the priority. A low-stimulation environment helps
reduce hallucination intensity and ensures patient and others’ safety.
Verbalization (A) may be addressed later after stabilization.
When deciding to initiate electroconvulsive therapy (ECT) in a patient
with treatment-resistant major depressive disorder, which assessment
finding contraindicates proceeding?
A) Severe suicidal ideation with plan
B) Elevated intracranial pressure
C) History of past effective ECT treatments
D) Insomnia and poor appetite
Answer: B
Rationale: Elevated intracranial pressure is a contraindication due to risk
of cerebral herniation during ECT.
A patient on lithium presents with coarse tremors, confusion, and
vomiting. What should be the first clinical decision?
A) Increase lithium dose
B) Monitor vital signs and hydration status
C) Check serum lithium level and hold medication
D) Administer antiemetics and observe
Answer: C
Rationale: Symptoms suggest lithium toxicity; holding medication and
checking serum levels is essential immediately.
2
, In cases of acute mania, which medication class is most appropriate to
start as a first-line treatment?
A) Selective serotonin reuptake inhibitors (SSRIs)
B) Mood stabilizers such as valproate or lithium
C) Typical antipsychotics only
D) Benzodiazepines only
Answer: B
Rationale: Mood stabilizers are first-line for acute mania to regulate
mood shifts.
A patient with major depressive disorder refuses medications but
consents to psychotherapy. What would be an appropriate clinical
decision?
A) Force medication administration
B) Collaborate with patient to develop a care plan involving
psychotherapy
C) Discharge the patient against medical advice
D) Delay all treatment until medications are accepted
Answer: B
Rationale: Respect for autonomy and collaboration helps improve
adherence and outcomes.
True/False Questions
T/F: Cognitive Behavioral Therapy (CBT) can alter neural pathways
involved in psychosis through neuroplasticity.
Answer: True
Rationale: CBT can facilitate changes in thought patterns and brain
function via neuroplasticity.
T/F: Antipsychotic medications are equally effective in preventing relapse
in all types of schizophrenia.
Answer: False
Rationale: Effectiveness varies; some types may require tailored
3
Clinical Decision Making in
Psychiatric Mental Health
Latest Midterm Exam Review
(With Solutions)
2026
1
,A 32-year-old patient with schizophrenia exhibits auditory hallucinations
telling him to harm others. Which immediate nursing intervention best
addresses this symptom?
A) Encourage verbalization of hallucination content
B) Provide a low-stimulation environment and monitor safety
C) Administer PRN anxiolytics without assessment
D) Engage in group therapy immediately
Answer: B
Rationale: Safety is the priority. A low-stimulation environment helps
reduce hallucination intensity and ensures patient and others’ safety.
Verbalization (A) may be addressed later after stabilization.
When deciding to initiate electroconvulsive therapy (ECT) in a patient
with treatment-resistant major depressive disorder, which assessment
finding contraindicates proceeding?
A) Severe suicidal ideation with plan
B) Elevated intracranial pressure
C) History of past effective ECT treatments
D) Insomnia and poor appetite
Answer: B
Rationale: Elevated intracranial pressure is a contraindication due to risk
of cerebral herniation during ECT.
A patient on lithium presents with coarse tremors, confusion, and
vomiting. What should be the first clinical decision?
A) Increase lithium dose
B) Monitor vital signs and hydration status
C) Check serum lithium level and hold medication
D) Administer antiemetics and observe
Answer: C
Rationale: Symptoms suggest lithium toxicity; holding medication and
checking serum levels is essential immediately.
2
, In cases of acute mania, which medication class is most appropriate to
start as a first-line treatment?
A) Selective serotonin reuptake inhibitors (SSRIs)
B) Mood stabilizers such as valproate or lithium
C) Typical antipsychotics only
D) Benzodiazepines only
Answer: B
Rationale: Mood stabilizers are first-line for acute mania to regulate
mood shifts.
A patient with major depressive disorder refuses medications but
consents to psychotherapy. What would be an appropriate clinical
decision?
A) Force medication administration
B) Collaborate with patient to develop a care plan involving
psychotherapy
C) Discharge the patient against medical advice
D) Delay all treatment until medications are accepted
Answer: B
Rationale: Respect for autonomy and collaboration helps improve
adherence and outcomes.
True/False Questions
T/F: Cognitive Behavioral Therapy (CBT) can alter neural pathways
involved in psychosis through neuroplasticity.
Answer: True
Rationale: CBT can facilitate changes in thought patterns and brain
function via neuroplasticity.
T/F: Antipsychotic medications are equally effective in preventing relapse
in all types of schizophrenia.
Answer: False
Rationale: Effectiveness varies; some types may require tailored
3
