NSG 3450 Exam 3 Mental Health Nursing Test Bank
(2026/2027) | 250 Q&As with Rationales | Verbatim Review
Ace your NSG 3450 Exam 3 with absolute confidence! This premium, high-yield
study resource contains 250 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 assessing an adolescent client suspected of having bulimia nervosa. Which
clinical manifestation should the nurse expect to find?
A) Severe emaciation and a body mass index (BMI) below 17
B) Fine, downy hair (lanugo) covering the face and back
C) Enlarged parotid glands and severe dental erosion
D) Bradycardia and severe orthostatic hypotension
Answer: C) Enlarged parotid glands and severe dental erosion
Rationale: Clients with bulimia nervosa often maintain a body weight at or slightly
above normal, unlike those with anorexia nervosa who present with emaciation and
lanugo. Repeated vomiting causes hypertrophy of the parotid salivary glands
(parotidomegaly) due to overstimulation. The chronic exposure to acidic gastric contents
during purging leads to severe erosion of dental enamel and dental caries.
Question 2
A client in the manic phase of bipolar disorder is pacing the unit hallways, loudly
demanding attention, and ordering other clients around. Which intervention should the
nurse implement first?
A) Tell the client calmly that their behavior is inappropriate and must stop.
B) Distract the client by inviting them to a quiet room for a high-calorie snack.
C) Administer a PRN dose of a sedative medication immediately.
D) Place the client in mechanical restraints to ensure unit safety.
Answer: B) Distract the client by inviting them to a quiet room for a high-calorie
snack.
Rationale: For a manic client who is highly active and disruptive, the priority nursing
action is redirection and distraction. Inviting the client away from the main area to a
quieter environment reduces external stimuli, while offering a high-calorie snack
addresses the physiological risk of exhaustion and nutritional deficit common in manic
phases. Direct confrontation or limit setting can escalate aggression.
,Question 3
A nurse is reviewing laboratory results for a client who has been taking lithium
carbonate for the treatment of bipolar disorder. The client's blood sample was drawn 12
hours after the last dose, and the lithium level is 1.8 mEq/L. Which action should the
nurse take immediately?
A) Document the finding as a therapeutic level and continue regular monitoring.
B) Request an increase in the lithium dosage due to subtherapeutic levels.
C) Hold the next dose of lithium and notify the healthcare provider immediately.
D) Instruct the client to restrict their fluid intake for the next 24 hours.
Answer: C) Hold the next dose of lithium and notify the healthcare provider
immediately.
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L
indicates lithium toxicity, which can cause severe neurological and cardiovascular
complications if left unmanaged. The nurse must hold the medication to prevent further
toxicity and notify the provider. Restricting fluids is contraindicated; adequate fluid and
sodium intake are required to facilitate lithium excretion.
Question 4
A client is admitted to the psychiatric unit following a sudden, unexpected job loss and
the end of a long-term relationship. What is the priority nursing action during the initial
crisis assessment?
A) Teach the client new long-term coping mechanisms and relaxation techniques.
B) Determine the client's own perception of the precipitating problem.
C) Explore childhood traumatic events that may contribute to the current distress.
D) Refer the client to a local career counselor and community housing resources.
Answer: B) Determine the client's own perception of the precipitating problem.
Rationale: The initial step in crisis intervention is to evaluate the psychological impact
of the event by assessing the client's realistic perception of the problem. A crisis is
defined by the individual's appraisal of the situation. Teaching long-term skills or
exploring past childhood trauma are inappropriate during the acute phase of a crisis,
which focuses on immediate stabilization.
Question 5
A nurse is caring for a client with bulimia nervosa who purges via self-induced vomiting.
Which laboratory value represents the most critical immediate safety concern for this
client?
A) A potassium level of 2.8 mEq/L
B) A blood urea nitrogen (BUN) level of 22 mg/dL
C) A hemoglobin level of 11.5 g/dL
D) A fasting blood glucose level of 105 mg/dL
Answer: A) A potassium level of 2.8 mEq/L
Rationale: Frequent self-induced vomiting results in the loss of hydrochloric acid and
potassium from the stomach, leading to hypokalemia (normal range: 3.5 to 5.0 mEq/L).
A potassium level of 2.8 mEq/L is critically low and poses an immediate threat of life-
,threatening cardiac arrhythmias. While the BUN may be mildly elevated due to
dehydration from purging, correcting the electrolyte imbalance is the highest clinical
priority.
Question 6
A nurse is planning care for a client admitted with anorexia nervosa who is 30% below
ideal body weight. Which intervention is most appropriate to include in the plan of care?
A) Allow the client to choose when meals will be served to promote autonomy.
B) Observe the client during meals and for at least 1 hour after eating.
C) Encourage the client to engage in rigorous exercise to reduce anxiety.
D) Avoid discussing food, weight, or eating habits at any time during admission.
Answer: B) Observe the client during meals and for at least 1 hour after eating.
Rationale: Clients with eating disorders must be closely monitored during and after
meals to prevent the discarding or hiding of food, as well as to prevent purging
behaviors like self-induced vomiting. Autonomy regarding meal times is limited initially
to establish structured nutritional rehabilitation. Rigorous exercise is restricted due to
cardiovascular vulnerability and severe caloric depletion.
Question 7
A nurse is conducting a medication teaching session for a client newly prescribed
lithium carbonate. Which statement by the client indicates a correct understanding of
the teaching?
A) "I need to cut back on salt and salty foods while taking this medicine."
B) "I should drink 2 to 3 liters of fluid every day and keep my salt intake steady."
C) "If I develop a fever or a bad cough, I should double my lithium dose."
D) "I will stop taking this medication as soon as my mood feels stable again."
Answer: B) "I should drink 2 to 3 liters of fluid every day and keep my salt intake
steady."
Rationale: Lithium is a salt, and its excretion is directly linked to sodium levels. A drop
in sodium intake or dehydration causes the kidneys to retain lithium, leading to toxicity.
Clients must maintain a stable sodium intake and drink 2,000 to 3,000 mL of fluid daily.
Changing doses during illness without direct orders or stopping the medication abruptly
is dangerous.
Question 8
A client is admitted to the emergency department displaying rapid, pressured speech,
grandiosity, and flight of ideas. The spouse reports the client has not slept in four days.
Which bipolar disorder phase is the client experiencing?
A) Major Depressive Episode
B) Acute Manic Episode
C) Cyclothymic Disturbance
D) Euthymic Phase
Answer: B) Acute Manic Episode
, Rationale: Pressured speech, grandiosity (inflated self-esteem), flight of ideas (rapid
skipping from topic to topic), and a drastically decreased need for sleep are classic
hallmarks of an acute manic episode in Bipolar I disorder. Cyclothymia involves milder
mood swings over a longer period, and euthymia represents a normal, stable mood
state.
Question 9
A nurse is assessing a client who is taking an antipsychotic medication and notes a high
fever, severe muscle rigidity, altered consciousness, and autonomic instability. What
condition should the nurse suspect?
A) Serotonin Syndrome
B) Tardive Dyskinesia
C) Neuroleptic Malignant Syndrome (NMS)
D) Acute Dystonic Reaction
Answer: C) Neuroleptic Malignant Syndrome (NMS)
Rationale: Neuroleptic Malignant Syndrome (NMS) is a life-threatening, idiosyncratic
reaction to antipsychotic drugs. It is characterized by high fever (hyperpyrexia), severe
"lead-pipe" muscle rigidity, altered mental status, and autonomic instability (tachycardia,
labile blood pressure). Serotonin syndrome features hyperreflexia and clonus rather
than severe rigidity, and is caused by serotonergic agents.
Question 10
A psychiatric nurse is responding to a community disaster where survivors are
displaying acute stress reactions. Which concept should guide the nurse’s immediate
crisis intervention strategy?
A) Assisting the client to achieve deep personality restructuring.
B) Focusing on current, immediate problems to restore pre-crisis functioning.
C) Uncovering unresolved childhood conflicts that amplify stress.
D) Prescribing long-term lifestyle modifications and career changes.
Answer: B) Focusing on current, immediate problems to restore pre-crisis
functioning.
Rationale: The primary goal of crisis intervention is to assist the individual in returning
to their adaptive, pre-crisis level of functioning. The focus must remain exclusively on
the "here and now" problem that triggered the crisis. Long-term therapy, personality
reconstruction, and probing past childhood traumas are inappropriate and
counterproductive during an acute crisis phase.
Question 11
A client diagnosed with anorexia nervosa is started on a nutritional replenishment
program. The nurse monitors the client closely for refeeding syndrome. Which
laboratory finding indicates this complication is occurring?
A) Hyperkalemia
B) Hypophosphatemia
C) Hypermagnesemia
D) Hypocalcemia
(2026/2027) | 250 Q&As with Rationales | Verbatim Review
Ace your NSG 3450 Exam 3 with absolute confidence! This premium, high-yield
study resource contains 250 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 assessing an adolescent client suspected of having bulimia nervosa. Which
clinical manifestation should the nurse expect to find?
A) Severe emaciation and a body mass index (BMI) below 17
B) Fine, downy hair (lanugo) covering the face and back
C) Enlarged parotid glands and severe dental erosion
D) Bradycardia and severe orthostatic hypotension
Answer: C) Enlarged parotid glands and severe dental erosion
Rationale: Clients with bulimia nervosa often maintain a body weight at or slightly
above normal, unlike those with anorexia nervosa who present with emaciation and
lanugo. Repeated vomiting causes hypertrophy of the parotid salivary glands
(parotidomegaly) due to overstimulation. The chronic exposure to acidic gastric contents
during purging leads to severe erosion of dental enamel and dental caries.
Question 2
A client in the manic phase of bipolar disorder is pacing the unit hallways, loudly
demanding attention, and ordering other clients around. Which intervention should the
nurse implement first?
A) Tell the client calmly that their behavior is inappropriate and must stop.
B) Distract the client by inviting them to a quiet room for a high-calorie snack.
C) Administer a PRN dose of a sedative medication immediately.
D) Place the client in mechanical restraints to ensure unit safety.
Answer: B) Distract the client by inviting them to a quiet room for a high-calorie
snack.
Rationale: For a manic client who is highly active and disruptive, the priority nursing
action is redirection and distraction. Inviting the client away from the main area to a
quieter environment reduces external stimuli, while offering a high-calorie snack
addresses the physiological risk of exhaustion and nutritional deficit common in manic
phases. Direct confrontation or limit setting can escalate aggression.
,Question 3
A nurse is reviewing laboratory results for a client who has been taking lithium
carbonate for the treatment of bipolar disorder. The client's blood sample was drawn 12
hours after the last dose, and the lithium level is 1.8 mEq/L. Which action should the
nurse take immediately?
A) Document the finding as a therapeutic level and continue regular monitoring.
B) Request an increase in the lithium dosage due to subtherapeutic levels.
C) Hold the next dose of lithium and notify the healthcare provider immediately.
D) Instruct the client to restrict their fluid intake for the next 24 hours.
Answer: C) Hold the next dose of lithium and notify the healthcare provider
immediately.
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L
indicates lithium toxicity, which can cause severe neurological and cardiovascular
complications if left unmanaged. The nurse must hold the medication to prevent further
toxicity and notify the provider. Restricting fluids is contraindicated; adequate fluid and
sodium intake are required to facilitate lithium excretion.
Question 4
A client is admitted to the psychiatric unit following a sudden, unexpected job loss and
the end of a long-term relationship. What is the priority nursing action during the initial
crisis assessment?
A) Teach the client new long-term coping mechanisms and relaxation techniques.
B) Determine the client's own perception of the precipitating problem.
C) Explore childhood traumatic events that may contribute to the current distress.
D) Refer the client to a local career counselor and community housing resources.
Answer: B) Determine the client's own perception of the precipitating problem.
Rationale: The initial step in crisis intervention is to evaluate the psychological impact
of the event by assessing the client's realistic perception of the problem. A crisis is
defined by the individual's appraisal of the situation. Teaching long-term skills or
exploring past childhood trauma are inappropriate during the acute phase of a crisis,
which focuses on immediate stabilization.
Question 5
A nurse is caring for a client with bulimia nervosa who purges via self-induced vomiting.
Which laboratory value represents the most critical immediate safety concern for this
client?
A) A potassium level of 2.8 mEq/L
B) A blood urea nitrogen (BUN) level of 22 mg/dL
C) A hemoglobin level of 11.5 g/dL
D) A fasting blood glucose level of 105 mg/dL
Answer: A) A potassium level of 2.8 mEq/L
Rationale: Frequent self-induced vomiting results in the loss of hydrochloric acid and
potassium from the stomach, leading to hypokalemia (normal range: 3.5 to 5.0 mEq/L).
A potassium level of 2.8 mEq/L is critically low and poses an immediate threat of life-
,threatening cardiac arrhythmias. While the BUN may be mildly elevated due to
dehydration from purging, correcting the electrolyte imbalance is the highest clinical
priority.
Question 6
A nurse is planning care for a client admitted with anorexia nervosa who is 30% below
ideal body weight. Which intervention is most appropriate to include in the plan of care?
A) Allow the client to choose when meals will be served to promote autonomy.
B) Observe the client during meals and for at least 1 hour after eating.
C) Encourage the client to engage in rigorous exercise to reduce anxiety.
D) Avoid discussing food, weight, or eating habits at any time during admission.
Answer: B) Observe the client during meals and for at least 1 hour after eating.
Rationale: Clients with eating disorders must be closely monitored during and after
meals to prevent the discarding or hiding of food, as well as to prevent purging
behaviors like self-induced vomiting. Autonomy regarding meal times is limited initially
to establish structured nutritional rehabilitation. Rigorous exercise is restricted due to
cardiovascular vulnerability and severe caloric depletion.
Question 7
A nurse is conducting a medication teaching session for a client newly prescribed
lithium carbonate. Which statement by the client indicates a correct understanding of
the teaching?
A) "I need to cut back on salt and salty foods while taking this medicine."
B) "I should drink 2 to 3 liters of fluid every day and keep my salt intake steady."
C) "If I develop a fever or a bad cough, I should double my lithium dose."
D) "I will stop taking this medication as soon as my mood feels stable again."
Answer: B) "I should drink 2 to 3 liters of fluid every day and keep my salt intake
steady."
Rationale: Lithium is a salt, and its excretion is directly linked to sodium levels. A drop
in sodium intake or dehydration causes the kidneys to retain lithium, leading to toxicity.
Clients must maintain a stable sodium intake and drink 2,000 to 3,000 mL of fluid daily.
Changing doses during illness without direct orders or stopping the medication abruptly
is dangerous.
Question 8
A client is admitted to the emergency department displaying rapid, pressured speech,
grandiosity, and flight of ideas. The spouse reports the client has not slept in four days.
Which bipolar disorder phase is the client experiencing?
A) Major Depressive Episode
B) Acute Manic Episode
C) Cyclothymic Disturbance
D) Euthymic Phase
Answer: B) Acute Manic Episode
, Rationale: Pressured speech, grandiosity (inflated self-esteem), flight of ideas (rapid
skipping from topic to topic), and a drastically decreased need for sleep are classic
hallmarks of an acute manic episode in Bipolar I disorder. Cyclothymia involves milder
mood swings over a longer period, and euthymia represents a normal, stable mood
state.
Question 9
A nurse is assessing a client who is taking an antipsychotic medication and notes a high
fever, severe muscle rigidity, altered consciousness, and autonomic instability. What
condition should the nurse suspect?
A) Serotonin Syndrome
B) Tardive Dyskinesia
C) Neuroleptic Malignant Syndrome (NMS)
D) Acute Dystonic Reaction
Answer: C) Neuroleptic Malignant Syndrome (NMS)
Rationale: Neuroleptic Malignant Syndrome (NMS) is a life-threatening, idiosyncratic
reaction to antipsychotic drugs. It is characterized by high fever (hyperpyrexia), severe
"lead-pipe" muscle rigidity, altered mental status, and autonomic instability (tachycardia,
labile blood pressure). Serotonin syndrome features hyperreflexia and clonus rather
than severe rigidity, and is caused by serotonergic agents.
Question 10
A psychiatric nurse is responding to a community disaster where survivors are
displaying acute stress reactions. Which concept should guide the nurse’s immediate
crisis intervention strategy?
A) Assisting the client to achieve deep personality restructuring.
B) Focusing on current, immediate problems to restore pre-crisis functioning.
C) Uncovering unresolved childhood conflicts that amplify stress.
D) Prescribing long-term lifestyle modifications and career changes.
Answer: B) Focusing on current, immediate problems to restore pre-crisis
functioning.
Rationale: The primary goal of crisis intervention is to assist the individual in returning
to their adaptive, pre-crisis level of functioning. The focus must remain exclusively on
the "here and now" problem that triggered the crisis. Long-term therapy, personality
reconstruction, and probing past childhood traumas are inappropriate and
counterproductive during an acute crisis phase.
Question 11
A client diagnosed with anorexia nervosa is started on a nutritional replenishment
program. The nurse monitors the client closely for refeeding syndrome. Which
laboratory finding indicates this complication is occurring?
A) Hyperkalemia
B) Hypophosphatemia
C) Hypermagnesemia
D) Hypocalcemia
