NUR 356 Exam 2: Mental Health Theory & Application V3 -
Arizona College Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with bipolar disorder has a lithium level of 1.8 mEq/L. Which clinical manifestation should the
nurse prioritize?
A. Blurred vision and ataxia
B. Polyuria
C. Fine hand tremors
D. Mild thirst
Ans: A
Explanation: Lithium levels above 1.5 mEq/L indicate toxicity requiring immediate medical
intervention. Blurred vision and ataxia are signs of moderate to severe toxicity that must be addressed to
prevent seizures. Fine hand tremors are considered a common side effect rather than a toxic sign. The
nurse must hold the next dose and notify the provider immediately when toxicity is suspected.
Monitoring therapeutic ranges is a critical safety competency in psychiatric medication management.
2. Which assessment finding is a hallmark of Neuroleptic Malignant Syndrome (NMS) in a patient taking
haloperidol?
A. Respiratory rate of 12
B. Muscle flaccidity
C. Hypotension
D. Severe muscle rigidity and hyperpyrexia
Ans: D
,Explanation: Neuroleptic Malignant Syndrome is a life-threatening idiosyncratic reaction to
antipsychotic drugs. It is characterized by severe ‘lead-pipe’ muscle rigidity and a significantly elevated
temperature. Muscle flaccidity is not associated with this condition as the pathophysiology involves
extreme dopamine blockade. Immediate nursing actions include stopping the offending agent and
initiating cooling measures. Recognition of NMS is essential to prevent cardiovascular collapse and death.
3. A patient is prescribed Clozapine. Which laboratory value requires the nurse to hold the medication and
contact the provider?
A. Platelet count of 150,000/mm3
B. White Blood Cell (WBC) count of 2,500/mm3
C. Hemoglobin of 12 g/dL
D. Blood Urea Nitrogen (BUN) of 15 mg/dL
Ans: B
Explanation: Clozapine carries a high risk for agranulocytosis, which is a dangerous drop in white blood
cell counts. A WBC count below 3,000/mm3 or an Absolute Neutrophil Count (ANC) below 1,500/mm3
requires immediate cessation of the drug. Platelet counts and BUN levels in this range are typically within
normal limits or non-critical. The nurse plays a vital role in monitoring the mandatory Risk Evaluation
and Mitigation Strategy (REMS) program requirements. Ensuring hematologic safety is the highest
priority for patients on second-generation antipsychotics like clozapine.
4. A patient experiencing a panic attack is hyperventilating. Which nursing intervention is most appropriate?
A. Use short, simple sentences and stay with the patient
B. Ask the patient to explain what triggered the attack
C. Leave the patient alone to provide privacy
, D. Teach the patient complex relaxation techniques immediately
Ans: A
Explanation: During a panic attack, the patient’s level of anxiety prevents them from processing complex
information or deep insights. Providing a calm presence and using simple, clear directions helps lower
the patient’s immediate distress. Asking for triggers during the height of panic is counterproductive as
the patient is in a ‘fight or flight’ state. Safety is the priority, so the nurse should never leave a patient
alone during an acute panic episode. Effective communication during a crisis focuses on immediate
stabilization rather than long-term therapy.
5. Which defense mechanism is a patient using when they state, ‘I only drink because my spouse is so
demanding’?
A. Projection
B. Reaction Formation
C. Rationalization
D. Displacement
Ans: C
Explanation: Rationalization involves justifying illogical or unreasonable ideas or feelings by developing
acceptable explanations. In this scenario, the patient is blaming their spouse’s behavior to justify their
own substance use. Projection would involve the patient accusing the spouse of having a drinking
problem instead. The nurse should help the patient recognize these patterns to encourage personal
accountability for their health. Understanding defense mechanisms allows the nurse to identify barriers
to effective coping and treatment.
Arizona College Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with bipolar disorder has a lithium level of 1.8 mEq/L. Which clinical manifestation should the
nurse prioritize?
A. Blurred vision and ataxia
B. Polyuria
C. Fine hand tremors
D. Mild thirst
Ans: A
Explanation: Lithium levels above 1.5 mEq/L indicate toxicity requiring immediate medical
intervention. Blurred vision and ataxia are signs of moderate to severe toxicity that must be addressed to
prevent seizures. Fine hand tremors are considered a common side effect rather than a toxic sign. The
nurse must hold the next dose and notify the provider immediately when toxicity is suspected.
Monitoring therapeutic ranges is a critical safety competency in psychiatric medication management.
2. Which assessment finding is a hallmark of Neuroleptic Malignant Syndrome (NMS) in a patient taking
haloperidol?
A. Respiratory rate of 12
B. Muscle flaccidity
C. Hypotension
D. Severe muscle rigidity and hyperpyrexia
Ans: D
,Explanation: Neuroleptic Malignant Syndrome is a life-threatening idiosyncratic reaction to
antipsychotic drugs. It is characterized by severe ‘lead-pipe’ muscle rigidity and a significantly elevated
temperature. Muscle flaccidity is not associated with this condition as the pathophysiology involves
extreme dopamine blockade. Immediate nursing actions include stopping the offending agent and
initiating cooling measures. Recognition of NMS is essential to prevent cardiovascular collapse and death.
3. A patient is prescribed Clozapine. Which laboratory value requires the nurse to hold the medication and
contact the provider?
A. Platelet count of 150,000/mm3
B. White Blood Cell (WBC) count of 2,500/mm3
C. Hemoglobin of 12 g/dL
D. Blood Urea Nitrogen (BUN) of 15 mg/dL
Ans: B
Explanation: Clozapine carries a high risk for agranulocytosis, which is a dangerous drop in white blood
cell counts. A WBC count below 3,000/mm3 or an Absolute Neutrophil Count (ANC) below 1,500/mm3
requires immediate cessation of the drug. Platelet counts and BUN levels in this range are typically within
normal limits or non-critical. The nurse plays a vital role in monitoring the mandatory Risk Evaluation
and Mitigation Strategy (REMS) program requirements. Ensuring hematologic safety is the highest
priority for patients on second-generation antipsychotics like clozapine.
4. A patient experiencing a panic attack is hyperventilating. Which nursing intervention is most appropriate?
A. Use short, simple sentences and stay with the patient
B. Ask the patient to explain what triggered the attack
C. Leave the patient alone to provide privacy
, D. Teach the patient complex relaxation techniques immediately
Ans: A
Explanation: During a panic attack, the patient’s level of anxiety prevents them from processing complex
information or deep insights. Providing a calm presence and using simple, clear directions helps lower
the patient’s immediate distress. Asking for triggers during the height of panic is counterproductive as
the patient is in a ‘fight or flight’ state. Safety is the priority, so the nurse should never leave a patient
alone during an acute panic episode. Effective communication during a crisis focuses on immediate
stabilization rather than long-term therapy.
5. Which defense mechanism is a patient using when they state, ‘I only drink because my spouse is so
demanding’?
A. Projection
B. Reaction Formation
C. Rationalization
D. Displacement
Ans: C
Explanation: Rationalization involves justifying illogical or unreasonable ideas or feelings by developing
acceptable explanations. In this scenario, the patient is blaming their spouse’s behavior to justify their
own substance use. Projection would involve the patient accusing the spouse of having a drinking
problem instead. The nurse should help the patient recognize these patterns to encourage personal
accountability for their health. Understanding defense mechanisms allows the nurse to identify barriers
to effective coping and treatment.
