NSG 3450 Exam 3 Mental Health Nursing Test Bank
(2026/2027) | 300 Q&As with Rationales | Verbatim Review
Ace your NSG 3450 Exam 3 with absolute confidence! This premium, high-yield
study resource contains 300 comprehensive multiple-choice practice questions
specifically engineered for the Mental Health Nursing Exam 3 curriculum.
Every single question features a highlighted correct answer and an in-depth, evidence-
based clinical rationale to ensure you master the core concepts, diagnostic criteria, and
nursing priorities.
Question 1
A nurse is caring for a client admitted with a diagnosis of bulimia nervosa. Which clinical
finding should the nurse anticipate during the physical assessment?
A) Body mass index (BMI) of 14.5
B) Presence of fine, downy lanugo hair on the back
C) Enlarged parotid glands and dental enamel erosion
D) Severe hypotension and hypothermia
Answer: C) Enlarged parotid glands and dental enamel erosion
Rationale: Clients with bulimia nervosa typically maintain a normal or near-normal body
weight, unlike clients with anorexia nervosa who exhibit severe emaciation (low BMI)
and lanugo. Repeated, self-induced vomiting causes compensatory hypertrophy of the
parotid salivary glands and exposes dental structures to acidic gastric contents, leading
to the erosion of dental enamel.
Question 2
A client diagnosed with bipolar I disorder is pacing the unit, interrupting groups, and
demanding to use the staff telephone immediately. Which nursing intervention is the
priority?
A) Administer a PRN dose of a chemical restraint.
B) Set firm limits and inform the client they will lose privileges.
C) Redirect the client to a quiet area and offer a high-calorie finger food.
D) Instruct the client to sit quietly in their room for one hour.
Answer: C) Redirect the client to a quiet area and offer a high-calorie finger food.
Rationale: During an acute manic phase, clients are highly distractible and respond
well to calm, non-confrontational redirection. Moving the client to a quiet area reduces
environmental stimuli that exacerbate mania. Providing high-calorie finger foods
addresses the critical physiological risk of nutritional deficit and exhaustion caused by
constant hyperactivity.
Question 3
A nurse is reviewing the laboratory results for a client who has been taking lithium
,carbonate for six months. The total serum lithium level is reported as 1.9 mEq/L. Which
action must the nurse take first?
A) Administer the next scheduled dose as prescribed.
B) Hold the next dose of lithium and notify the healthcare provider.
C) Instruct the client to immediately increase their physical exercise.
D) Order a repeat lithium draw for the following morning.
Answer: B) Hold the next dose of lithium and notify the healthcare provider.
Rationale: The therapeutic reference range for serum lithium is 0.6 to 1.2 mEq/L. A
serum level of 1.9 mEq/L indicates lithium toxicity, which poses severe neurological and
systemic health risks. The immediate safety action is to hold the medication to stop
further drug accumulation and notify the healthcare provider for emergency
management instructions.
Question 4
A client is admitted to the emergency department in an acute state of crisis following the
sudden death of their spouse. Which assessment question should the nurse prioritize
during the initial intake?
A) "What coping mechanisms did you learn during your childhood?"
B) "What does this loss mean to you and how does it affect your life right now?"
C) "Do you have a history of major depressive disorder in your family?"
D) "Can you list your current monthly financial responsibilities?"
Answer: B) "What does this loss mean to you and how does it affect your life
right now?"
Rationale: The first step in crisis intervention is to assess the client's internal perception
of the precipitating event. A event constitutes a crisis based entirely on the individual's
unique appraisal and definition of the situation. Family history and childhood coping
styles are secondary to understanding the immediate psychological impact of the
current event.
Question 5
A client with bulimia nervosa is admitted to an inpatient psychiatric unit. Which nursing
intervention is most critical to include in the client's daily plan of care?
A) Restricting the client from drinking water before meals.
B) Accompanying the client to the bathroom for at least one hour after meals.
C) Weighing the client secretly without their knowledge twice per day.
D) Permitting the client to plan their own low-calorie meal menus.
Answer: B) Accompanying the client to the bathroom for at least one hour after
meals.
Rationale: Clients with bulimia nervosa often experience a strong urge to purge (via
self-induced vomiting) immediately following food consumption. Monitoring the client
during and for at least 60 minutes after meals prevents purging behaviors and breaks
the binge-purge cycle. Secret weighing or low-calorie menu planning exacerbates
anxiety and eating disorder pathologies.
,Question 6
A client taking lithium carbonate complains of severe diarrhea, blurred vision, coarse
hand tremors, and muscular incoordination. How should the nurse interpret these
findings?
A) These are expected, transient side effects of early lithium therapy.
B) These are classic signs of advanced lithium toxicity.
C) The client is experiencing an acute allergic reaction to the drug.
D) The client's lithium levels have dropped below the therapeutic threshold.
Answer: B) These are classic signs of advanced lithium toxicity.
Rationale: Coarse hand tremors, severe gastrointestinal upset (diarrhea, vomiting),
blurred vision, ataxia, and muscle weakness are hallmarks of moderate-to-severe
lithium toxicity (typically levels >1.5–2.0 mEq/L). Fine hand tremors are an expected
side effect, but coarse tremors and ataxia signal worsening neurotoxicity that requires
immediate medical intervention.
Question 7
A nurse is developing a teaching plan for a client who is newly prescribed lithium
carbonate for bipolar disorder. Which dietary instruction is vital to include?
A) Maintain a strict low-sodium diet to prevent fluid retention.
B) Eliminate caffeine and chocolate entirely from the daily diet.
C) Maintain a consistent, normal intake of dietary sodium and fluids.
D) Restrict fluid intake to less than 1,000 mL per day.
Answer: C) Maintain a consistent, normal intake of dietary sodium and fluids.
Rationale: Lithium is a salt that is handled by the kidneys in a manner identical to
sodium. If dietary sodium drops or fluid intake decreases (causing dehydration), the
kidneys conserve lithium, leading to toxic accumulations. Conversely, a massive
increase in sodium will cause lithium drop-offs. Consistency in sodium and fluid intake
(2,000–3,000 mL/day) is critical.
Question 8
A nurse assessments a client with anorexia nervosa. Which cardiac manifestation
should the nurse recognize as a direct physiological adaptation to prolonged starvation?
A) Sinus bradycardia and orthostatic hypotension
B) Ventricular tachycardia and hypertension
C) Elevated cardiac output and bounding pulses
D) Left ventricular hypertrophy and tall T waves
Answer: A) Sinus bradycardia and orthostatic hypotension
Rationale: Prolonged starvation in anorexia nervosa leads to a state of
hypometabolism, resulting in bradycardia, orthostatic hypotension, and hypothermia as
the body attempts to conserve energy. Severe electrolyte imbalances can lead to
dysrhythmias, but baseline starvation causes bradycardia and structural wasting of the
myocardium.
, Question 9
During an intake assessment, a client reveals that they have been experiencing a
depressed mood for most of the day, more days than not, for the past two and a half
years. The nurse notes that the client remains functional but describes life as a
"constant drag." The nurse recognizes these symptoms are indicative of:
A) Major Depressive Disorder (MDD)
B) Bipolar II Disorder
C) Persistent Depressive Disorder (Dysthymia)
D) Cyclothymic Disorder
Answer: C) Persistent Depressive Disorder (Dysthymia)
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by a chronically
depressed mood that occurs for most of the day, more days than not, for at least 2
years in adults. The symptoms are often less severe than those of Major Depressive
Disorder but are long-lasting and pervasive, allowing for basic functioning while clouding
overall quality of life.
Question 10
A manic client in an inpatient setting is noticed wearing mismatching, bright clothing,
heavy makeup, and is singing loudly while banging on the dayroom piano. Which
environment is most appropriate for this client?
A) The main dayroom during a scheduled community group meeting.
B) A quiet private room with low lighting and minimal wall decorations.
C) The unit gym during an active volleyball game.
D) The central nursing station so staff can constantly converse with them.
Answer: B) A quiet private room with low lighting and minimal wall decorations.
Rationale: An environment with low sensory stimulation is essential for a client in an
acute manic episode. Hyperactive clients are unable to filter out environmental stimuli,
which increases their agitation, racing thoughts, and behavioral disorganization. A
private room with muted lighting and low stimuli helps calm the hyperactive nervous
system.
Question 11
A nurse is preparing a discharge plan for a client with a history of bulimia nervosa.
Which psychological mechanism should the nurse recognize as the primary internal
function of the binge-purge cycle?
A) A desire to assert dominance and control over family figures.
B) An attempt to regulate overwhelming negative emotions and anxiety.
C) A conscious effort to reduce physical energy expenditures.
D) A secondary gain strategy to obtain medical attention.
Answer: B) An attempt to regulate overwhelming negative emotions and anxiety.
Rationale: Binge eating and subsequent purging behaviors serve as maladaptive
emotional regulation strategies. The binge is typically triggered by anxiety, low self-
esteem, or interpersonal stressors, providing temporary numbness, while the purge acts
to alleviate the intense guilt, shame, and fear of weight gain that follows the binge.
(2026/2027) | 300 Q&As with Rationales | Verbatim Review
Ace your NSG 3450 Exam 3 with absolute confidence! This premium, high-yield
study resource contains 300 comprehensive multiple-choice practice questions
specifically engineered for the Mental Health Nursing Exam 3 curriculum.
Every single question features a highlighted correct answer and an in-depth, evidence-
based clinical rationale to ensure you master the core concepts, diagnostic criteria, and
nursing priorities.
Question 1
A nurse is caring for a client admitted with a diagnosis of bulimia nervosa. Which clinical
finding should the nurse anticipate during the physical assessment?
A) Body mass index (BMI) of 14.5
B) Presence of fine, downy lanugo hair on the back
C) Enlarged parotid glands and dental enamel erosion
D) Severe hypotension and hypothermia
Answer: C) Enlarged parotid glands and dental enamel erosion
Rationale: Clients with bulimia nervosa typically maintain a normal or near-normal body
weight, unlike clients with anorexia nervosa who exhibit severe emaciation (low BMI)
and lanugo. Repeated, self-induced vomiting causes compensatory hypertrophy of the
parotid salivary glands and exposes dental structures to acidic gastric contents, leading
to the erosion of dental enamel.
Question 2
A client diagnosed with bipolar I disorder is pacing the unit, interrupting groups, and
demanding to use the staff telephone immediately. Which nursing intervention is the
priority?
A) Administer a PRN dose of a chemical restraint.
B) Set firm limits and inform the client they will lose privileges.
C) Redirect the client to a quiet area and offer a high-calorie finger food.
D) Instruct the client to sit quietly in their room for one hour.
Answer: C) Redirect the client to a quiet area and offer a high-calorie finger food.
Rationale: During an acute manic phase, clients are highly distractible and respond
well to calm, non-confrontational redirection. Moving the client to a quiet area reduces
environmental stimuli that exacerbate mania. Providing high-calorie finger foods
addresses the critical physiological risk of nutritional deficit and exhaustion caused by
constant hyperactivity.
Question 3
A nurse is reviewing the laboratory results for a client who has been taking lithium
,carbonate for six months. The total serum lithium level is reported as 1.9 mEq/L. Which
action must the nurse take first?
A) Administer the next scheduled dose as prescribed.
B) Hold the next dose of lithium and notify the healthcare provider.
C) Instruct the client to immediately increase their physical exercise.
D) Order a repeat lithium draw for the following morning.
Answer: B) Hold the next dose of lithium and notify the healthcare provider.
Rationale: The therapeutic reference range for serum lithium is 0.6 to 1.2 mEq/L. A
serum level of 1.9 mEq/L indicates lithium toxicity, which poses severe neurological and
systemic health risks. The immediate safety action is to hold the medication to stop
further drug accumulation and notify the healthcare provider for emergency
management instructions.
Question 4
A client is admitted to the emergency department in an acute state of crisis following the
sudden death of their spouse. Which assessment question should the nurse prioritize
during the initial intake?
A) "What coping mechanisms did you learn during your childhood?"
B) "What does this loss mean to you and how does it affect your life right now?"
C) "Do you have a history of major depressive disorder in your family?"
D) "Can you list your current monthly financial responsibilities?"
Answer: B) "What does this loss mean to you and how does it affect your life
right now?"
Rationale: The first step in crisis intervention is to assess the client's internal perception
of the precipitating event. A event constitutes a crisis based entirely on the individual's
unique appraisal and definition of the situation. Family history and childhood coping
styles are secondary to understanding the immediate psychological impact of the
current event.
Question 5
A client with bulimia nervosa is admitted to an inpatient psychiatric unit. Which nursing
intervention is most critical to include in the client's daily plan of care?
A) Restricting the client from drinking water before meals.
B) Accompanying the client to the bathroom for at least one hour after meals.
C) Weighing the client secretly without their knowledge twice per day.
D) Permitting the client to plan their own low-calorie meal menus.
Answer: B) Accompanying the client to the bathroom for at least one hour after
meals.
Rationale: Clients with bulimia nervosa often experience a strong urge to purge (via
self-induced vomiting) immediately following food consumption. Monitoring the client
during and for at least 60 minutes after meals prevents purging behaviors and breaks
the binge-purge cycle. Secret weighing or low-calorie menu planning exacerbates
anxiety and eating disorder pathologies.
,Question 6
A client taking lithium carbonate complains of severe diarrhea, blurred vision, coarse
hand tremors, and muscular incoordination. How should the nurse interpret these
findings?
A) These are expected, transient side effects of early lithium therapy.
B) These are classic signs of advanced lithium toxicity.
C) The client is experiencing an acute allergic reaction to the drug.
D) The client's lithium levels have dropped below the therapeutic threshold.
Answer: B) These are classic signs of advanced lithium toxicity.
Rationale: Coarse hand tremors, severe gastrointestinal upset (diarrhea, vomiting),
blurred vision, ataxia, and muscle weakness are hallmarks of moderate-to-severe
lithium toxicity (typically levels >1.5–2.0 mEq/L). Fine hand tremors are an expected
side effect, but coarse tremors and ataxia signal worsening neurotoxicity that requires
immediate medical intervention.
Question 7
A nurse is developing a teaching plan for a client who is newly prescribed lithium
carbonate for bipolar disorder. Which dietary instruction is vital to include?
A) Maintain a strict low-sodium diet to prevent fluid retention.
B) Eliminate caffeine and chocolate entirely from the daily diet.
C) Maintain a consistent, normal intake of dietary sodium and fluids.
D) Restrict fluid intake to less than 1,000 mL per day.
Answer: C) Maintain a consistent, normal intake of dietary sodium and fluids.
Rationale: Lithium is a salt that is handled by the kidneys in a manner identical to
sodium. If dietary sodium drops or fluid intake decreases (causing dehydration), the
kidneys conserve lithium, leading to toxic accumulations. Conversely, a massive
increase in sodium will cause lithium drop-offs. Consistency in sodium and fluid intake
(2,000–3,000 mL/day) is critical.
Question 8
A nurse assessments a client with anorexia nervosa. Which cardiac manifestation
should the nurse recognize as a direct physiological adaptation to prolonged starvation?
A) Sinus bradycardia and orthostatic hypotension
B) Ventricular tachycardia and hypertension
C) Elevated cardiac output and bounding pulses
D) Left ventricular hypertrophy and tall T waves
Answer: A) Sinus bradycardia and orthostatic hypotension
Rationale: Prolonged starvation in anorexia nervosa leads to a state of
hypometabolism, resulting in bradycardia, orthostatic hypotension, and hypothermia as
the body attempts to conserve energy. Severe electrolyte imbalances can lead to
dysrhythmias, but baseline starvation causes bradycardia and structural wasting of the
myocardium.
, Question 9
During an intake assessment, a client reveals that they have been experiencing a
depressed mood for most of the day, more days than not, for the past two and a half
years. The nurse notes that the client remains functional but describes life as a
"constant drag." The nurse recognizes these symptoms are indicative of:
A) Major Depressive Disorder (MDD)
B) Bipolar II Disorder
C) Persistent Depressive Disorder (Dysthymia)
D) Cyclothymic Disorder
Answer: C) Persistent Depressive Disorder (Dysthymia)
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by a chronically
depressed mood that occurs for most of the day, more days than not, for at least 2
years in adults. The symptoms are often less severe than those of Major Depressive
Disorder but are long-lasting and pervasive, allowing for basic functioning while clouding
overall quality of life.
Question 10
A manic client in an inpatient setting is noticed wearing mismatching, bright clothing,
heavy makeup, and is singing loudly while banging on the dayroom piano. Which
environment is most appropriate for this client?
A) The main dayroom during a scheduled community group meeting.
B) A quiet private room with low lighting and minimal wall decorations.
C) The unit gym during an active volleyball game.
D) The central nursing station so staff can constantly converse with them.
Answer: B) A quiet private room with low lighting and minimal wall decorations.
Rationale: An environment with low sensory stimulation is essential for a client in an
acute manic episode. Hyperactive clients are unable to filter out environmental stimuli,
which increases their agitation, racing thoughts, and behavioral disorganization. A
private room with muted lighting and low stimuli helps calm the hyperactive nervous
system.
Question 11
A nurse is preparing a discharge plan for a client with a history of bulimia nervosa.
Which psychological mechanism should the nurse recognize as the primary internal
function of the binge-purge cycle?
A) A desire to assert dominance and control over family figures.
B) An attempt to regulate overwhelming negative emotions and anxiety.
C) A conscious effort to reduce physical energy expenditures.
D) A secondary gain strategy to obtain medical attention.
Answer: B) An attempt to regulate overwhelming negative emotions and anxiety.
Rationale: Binge eating and subsequent purging behaviors serve as maladaptive
emotional regulation strategies. The binge is typically triggered by anxiety, low self-
esteem, or interpersonal stressors, providing temporary numbness, while the purge acts
to alleviate the intense guilt, shame, and fear of weight gain that follows the binge.
