NUR 211 PSYCHIATRIC NURSING VERIFIED EXAM GUIDE 2026
1. A client with major depressive disorder is prescribed fluoxetine 20
mg daily. Two weeks later, the client reports increased anxiety and
restlessness. What is the most appropriate nursing action?
A. Stop the medication immediately and notify the provider
B. Reassure the client that these are common side effects that will
subside
C. Assess for suicidal ideation and notify the provider promptly
D. Increase the dose to 40 mg to accelerate therapeutic effects
Correct Answer: C
Explanation: SSRIs like fluoxetine can initially increase anxiety and
restlessness, and there is a black box warning for increased
suicidal ideation in young adults during the first few weeks of
treatment. The nurse must assess for suicide risk and notify the
provider. Stopping abruptly (A) can cause withdrawal, reassurance
alone (B) misses critical safety assessment, and increasing the
dose (D) could worsen symptoms.
2. A client with schizophrenia is experiencing auditory hallucinations
telling them to harm themselves. Which intervention is the
nurse's priority?
A. Provide reality orientation by stating the voices are not real
B. Implement suicide precautions and ensure one-to-one
observation
C. Administer PRN antianxiety medication as prescribed
D. Encourage the client to join a group therapy session
Correct Answer: B
, Explanation: When hallucinations command self-harm, the priority
is client safety through suicide precautions and continuous
observation. Reality orientation (A) may increase agitation,
antianxiety meds (C) don't address the immediate command
hallucination risk, and group therapy (D) is inappropriate during
acute psychosis.
3. A client taking lithium carbonate for bipolar disorder has a serum
lithium level of 1.8 mEq/L. What nursing intervention is most
appropriate?
A. Administer the next scheduled dose as ordered
B. Hold the medication and notify the provider immediately
C. Encourage increased fluid intake and recheck in 24 hours
D. Administer IV fluids and prepare for hemodialysis
Correct Answer: B
Explanation: Therapeutic lithium levels are 0.6-1.2 mEq/L. A level
of 1.8 mEq/L indicates toxicity (1.5-2.0 mEq/L is moderate toxicity).
The nurse should hold the medication and notify the provider.
Administering more (A) worsens toxicity, increased fluids alone (C)
is insufficient for toxic levels, and hemodialysis (D) is reserved for
severe toxicity (>2.5 mEq/L).
4. Which assessment finding in a client taking clozapine requires
immediate nursing intervention?
A. White blood cell count of 3,200/mm³
B. Heart rate of 92 bpm
C. Blood glucose of 145 mg/dL
, D. Weight gain of 4 pounds in 2 weeks
Correct Answer: A
Explanation: Clozapine carries a black box warning for
agranulocytosis. WBC <3,500/mm³ or ANC <2,000/mm³ requires
immediate discontinuation and provider notification. Tachycardia
(B), elevated glucose (C), and weight gain (D) are known side
effects but not immediately life-threatening.
5. A client with PTSD is experiencing flashbacks after a traumatic
event. Which intervention is most therapeutic?
A. Tell the client to "snap out of it" and focus on the present
B. Guide the client through grounding techniques focusing on
sensory awareness
C. Administer a benzodiazepine to reduce anxiety immediately
D. Encourage the client to discuss detailed memories of the
trauma
Correct Answer: B
Explanation: Grounding techniques help clients reconnect with the
present during flashbacks. Dismissing the experience (A) is
nontherapeutic, benzodiazepines (C) are generally avoided in PTSD
due to dependency risk, and detailed trauma discussion (D) should
only occur in controlled therapy settings, not during acute
flashbacks.
6. A client with generalized anxiety disorder is prescribed buspirone.
Which statement by the client indicates understanding of the
medication?
, A. "I'll take this medication only when I feel anxious"
B. "I may need to take this for 2-4 weeks before feeling full effects"
C. "I can drink alcohol moderately while taking this medication"
D. "This medication will cure my anxiety permanently"
Correct Answer: B
Explanation: Buspirone requires 2-4 weeks for full therapeutic
effect and must be taken consistently, not PRN. It's not taken PRN
(A), alcohol should be avoided (C), and it manages symptoms but
doesn't cure anxiety (D).
7. Which assessment finding suggests a client with anorexia nervosa
is at highest risk for cardiac complications?
A. Body mass index of 17.5
B. Potassium level of 2.9 mEq/L
C. Heart rate of 58 bpm
D. Amenorrhea for 3 months
Correct Answer: B
Explanation: Hypokalemia (K+ <3.5 mEq/L) significantly increases
risk for fatal cardiac arrhythmias in anorexia nervosa, especially
with purging behaviors. Low BMI (A), bradycardia (C), and
amenorrhea (D) are concerning but less immediately life-
threatening than severe hypokalemia.
8. A client with bipolar disorder is in a manic episode. Which nursing
intervention is most appropriate for mealtime?
A. Provide a low-carbohydrate diet to reduce weight gain
B. Offer finger foods and high-calorie snacks that can be eaten
1. A client with major depressive disorder is prescribed fluoxetine 20
mg daily. Two weeks later, the client reports increased anxiety and
restlessness. What is the most appropriate nursing action?
A. Stop the medication immediately and notify the provider
B. Reassure the client that these are common side effects that will
subside
C. Assess for suicidal ideation and notify the provider promptly
D. Increase the dose to 40 mg to accelerate therapeutic effects
Correct Answer: C
Explanation: SSRIs like fluoxetine can initially increase anxiety and
restlessness, and there is a black box warning for increased
suicidal ideation in young adults during the first few weeks of
treatment. The nurse must assess for suicide risk and notify the
provider. Stopping abruptly (A) can cause withdrawal, reassurance
alone (B) misses critical safety assessment, and increasing the
dose (D) could worsen symptoms.
2. A client with schizophrenia is experiencing auditory hallucinations
telling them to harm themselves. Which intervention is the
nurse's priority?
A. Provide reality orientation by stating the voices are not real
B. Implement suicide precautions and ensure one-to-one
observation
C. Administer PRN antianxiety medication as prescribed
D. Encourage the client to join a group therapy session
Correct Answer: B
, Explanation: When hallucinations command self-harm, the priority
is client safety through suicide precautions and continuous
observation. Reality orientation (A) may increase agitation,
antianxiety meds (C) don't address the immediate command
hallucination risk, and group therapy (D) is inappropriate during
acute psychosis.
3. A client taking lithium carbonate for bipolar disorder has a serum
lithium level of 1.8 mEq/L. What nursing intervention is most
appropriate?
A. Administer the next scheduled dose as ordered
B. Hold the medication and notify the provider immediately
C. Encourage increased fluid intake and recheck in 24 hours
D. Administer IV fluids and prepare for hemodialysis
Correct Answer: B
Explanation: Therapeutic lithium levels are 0.6-1.2 mEq/L. A level
of 1.8 mEq/L indicates toxicity (1.5-2.0 mEq/L is moderate toxicity).
The nurse should hold the medication and notify the provider.
Administering more (A) worsens toxicity, increased fluids alone (C)
is insufficient for toxic levels, and hemodialysis (D) is reserved for
severe toxicity (>2.5 mEq/L).
4. Which assessment finding in a client taking clozapine requires
immediate nursing intervention?
A. White blood cell count of 3,200/mm³
B. Heart rate of 92 bpm
C. Blood glucose of 145 mg/dL
, D. Weight gain of 4 pounds in 2 weeks
Correct Answer: A
Explanation: Clozapine carries a black box warning for
agranulocytosis. WBC <3,500/mm³ or ANC <2,000/mm³ requires
immediate discontinuation and provider notification. Tachycardia
(B), elevated glucose (C), and weight gain (D) are known side
effects but not immediately life-threatening.
5. A client with PTSD is experiencing flashbacks after a traumatic
event. Which intervention is most therapeutic?
A. Tell the client to "snap out of it" and focus on the present
B. Guide the client through grounding techniques focusing on
sensory awareness
C. Administer a benzodiazepine to reduce anxiety immediately
D. Encourage the client to discuss detailed memories of the
trauma
Correct Answer: B
Explanation: Grounding techniques help clients reconnect with the
present during flashbacks. Dismissing the experience (A) is
nontherapeutic, benzodiazepines (C) are generally avoided in PTSD
due to dependency risk, and detailed trauma discussion (D) should
only occur in controlled therapy settings, not during acute
flashbacks.
6. A client with generalized anxiety disorder is prescribed buspirone.
Which statement by the client indicates understanding of the
medication?
, A. "I'll take this medication only when I feel anxious"
B. "I may need to take this for 2-4 weeks before feeling full effects"
C. "I can drink alcohol moderately while taking this medication"
D. "This medication will cure my anxiety permanently"
Correct Answer: B
Explanation: Buspirone requires 2-4 weeks for full therapeutic
effect and must be taken consistently, not PRN. It's not taken PRN
(A), alcohol should be avoided (C), and it manages symptoms but
doesn't cure anxiety (D).
7. Which assessment finding suggests a client with anorexia nervosa
is at highest risk for cardiac complications?
A. Body mass index of 17.5
B. Potassium level of 2.9 mEq/L
C. Heart rate of 58 bpm
D. Amenorrhea for 3 months
Correct Answer: B
Explanation: Hypokalemia (K+ <3.5 mEq/L) significantly increases
risk for fatal cardiac arrhythmias in anorexia nervosa, especially
with purging behaviors. Low BMI (A), bradycardia (C), and
amenorrhea (D) are concerning but less immediately life-
threatening than severe hypokalemia.
8. A client with bipolar disorder is in a manic episode. Which nursing
intervention is most appropriate for mealtime?
A. Provide a low-carbohydrate diet to reduce weight gain
B. Offer finger foods and high-calorie snacks that can be eaten
