The Ultimate and Complete Varcarolis’ Foundations of
Psychiatric-Mental Health Nursing Study Guide 2025,
Covering Mental Health Nursing Fundamentals,
Therapeutic Communication Techniques, Psychiatric
Assessment and Diagnosis, Neurobiology and
Psychopharmacology Principles, Anxiety Disorders and
Mood Disorders, Schizophrenia and Psychotic Disorders,
Personality Disorders and Behavioral Health, Crisis
Intervention and Suicide Prevention, Substance Use and
Addiction Nursing Care, Trauma-Informed Care and
Recovery Models, Legal and Ethical Issues in Psychiatric
Nursing, Detailed Chapter-by-Chapter Review, Practice
Questions with Verified Answers and Explanations, Real
Clinical Mental Health Case Studies, Step-by-Step
Nursing Care Plans, and Proven Strategies to
Successfully Master Psychiatric-Mental Health Nursing,
ATI, HESI, and NCLEX-RN Examinations
Question 1: A psychiatric-mental health nurse is assessing a client diagnosed with major
depressive disorder who states, "I am a burden to my family and they would be better off
without me." What is the priority nursing action?
A. Reassure the client that their family loves them very much.
B. Ask the client directly if they are having thoughts of self-harm.
C. Distract the client by engaging them in a structured group activity.
D. Document the statement and continue the routine morning assessment.
CORRECT ANSWER: B. Ask the client directly if they are having thoughts of self-harm.
Rationale: Any statement indicating worthlessness or being a burden requires immediate,
direct assessment for suicidal ideation to ensure client safety. Reassurance or distraction
minimizes the client's feelings and delays critical safety interventions.
Question 2: A nurse is leading a therapeutic group for clients with schizophrenia. A client
becomes agitated and begins shouting at another group member. Which nursing intervention
is most appropriate?
A. Immediately eject the client from the group to maintain order.
B. Ignore the behavior to avoid reinforcing the client's agitation.
,C. Set firm, calm limits on the behavior while acknowledging the client's feelings.
D. Physically restrain the client to prevent any potential harm to others.
CORRECT ANSWER: C. Set firm, calm limits on the behavior while acknowledging the client's
feelings.
Rationale: Setting firm, calm limits provides a safe environment and helps the client regain
control. Acknowledging feelings validates the client without condoning the inappropriate
behavior, promoting therapeutic de-escalation.
Question 3: A client diagnosed with bipolar disorder is prescribed lithium carbonate. Which of
the following client statements indicates a need for further teaching regarding this
medication?
A. "I will drink at least 2 to 3 liters of water every day."
B. "I will maintain a consistent intake of dietary sodium."
C. "I can take ibuprofen for my occasional headaches."
D. "I will have my blood drawn regularly to check my lithium levels."
CORRECT ANSWER: C. "I can take ibuprofen for my occasional headaches."
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can decrease lithium
excretion, leading to increased lithium levels and potential toxicity. Clients should be taught to
use acetaminophen instead and to avoid NSAIDs unless specifically approved by their provider.
Question 4: A psychiatric nurse is caring for a client who is experiencing a panic attack. The
client is hyperventilating, trembling, and states, "I think I am having a heart attack." What is
the nurse's best initial response?
A. "You are not having a heart attack; it is just a panic attack."
B. "Stay with me. I am here with you, and you are safe."
C. "Let's explore what triggered this feeling of panic."
D. "I will go get the healthcare provider to evaluate your heart."
CORRECT ANSWER: B. "Stay with me. I am here with you, and you are safe."
Rationale: During a panic attack, the client's cognitive ability to process information is severely
impaired. The priority is to provide a calm, reassuring presence and ensure the client feels safe,
which helps reduce anxiety and hyperventilation.
Question 5: A client is admitted to the psychiatric unit under an involuntary hold. The client
demands to leave the hospital immediately. What is the nurse's most appropriate response?
A. "You signed the admission papers, so you cannot leave yet."
B. "I understand you want to leave, but you are currently on a legal hold for your safety."
,C. "If you try to leave, the security guards will physically restrain you."
D. "You can leave as soon as you agree to take your prescribed medications."
CORRECT ANSWER: B. "I understand you want to leave, but you are currently on a legal hold
for your safety."
Rationale: The nurse must provide factual, clear, and non-threatening information regarding
the client's legal status. Acknowledging the client's desire to leave while explaining the legal
hold maintains transparency and therapeutic rapport.
Question 6: A nurse is administering clozapine to a client with treatment-resistant
schizophrenia. Which laboratory value is the highest priority for the nurse to monitor?
A. Fasting blood glucose
B. Absolute neutrophil count (ANC)
C. Liver function tests (LFTs)
D. Thyroid-stimulating hormone (TSH)
CORRECT ANSWER: B. Absolute neutrophil count (ANC)
Rationale: Clozapine carries a black box warning for severe neutropenia and agranulocytosis.
Regular monitoring of the ANC is mandatory to detect early signs of bone marrow suppression
and prevent life-threatening infections.
Question 7: A client with anorexia nervosa is admitted to the medical-psychiatric unit. The
client's vital signs show a heart rate of 48 bpm and blood pressure of 85/50 mmHg. What is
the nurse's priority action?
A. Encourage the client to eat a high-calorie meal immediately.
B. Place the client on continuous cardiac monitoring.
C. Weigh the client in a hospital gown without shoes.
D. Assess the client's body image perception.
CORRECT ANSWER: B. Place the client on continuous cardiac monitoring.
Rationale: Bradycardia and hypotension are common, life-threatening complications of severe
malnutrition in anorexia nervosa. Continuous cardiac monitoring is the priority to detect and
manage potential arrhythmias or cardiac arrest.
Question 8: A psychiatric-mental health nurse is evaluating a client for neuroleptic malignant
syndrome (NMS). Which cluster of symptoms should the nurse recognize as indicative of
NMS?
A. Tremors, shuffling gait, and masked facies
B. High fever, severe muscle rigidity, and altered mental status
, C. Involuntary facial movements and lip smacking
D. Restlessness, pacing, and an inability to sit still
CORRECT ANSWER: B. High fever, severe muscle rigidity, and altered mental status
Rationale: NMS is a rare but life-threatening reaction to antipsychotic medications
characterized by hyperthermia, severe "lead-pipe" muscle rigidity, autonomic instability, and
altered mental status. Immediate medical intervention is required.
Question 9: A client diagnosed with borderline personality disorder (BPD) states, "You are the
only nurse who cares about me. The other nurses are all cruel and useless." What is the
nurse's best response?
A. "Thank you, I think you are a wonderful person too."
B. "It is inappropriate for you to speak about the other nurses that way."
C. "I am part of the treatment team, and we all work together to help you."
D. "Why do you feel that the other nurses are cruel to you?"
CORRECT ANSWER: C. "I am part of the treatment team, and we all work together to help
you."
Rationale: Clients with BPD often exhibit splitting, viewing staff as all good or all bad. The nurse
must maintain professional boundaries and reinforce the unity of the treatment team to
prevent manipulation and promote consistent care.
Question 10: A client is prescribed a monoamine oxidase inhibitor (MAOI) for depression.
Which food choice by the client indicates a need for further dietary teaching?
A. Grilled chicken breast with steamed broccoli
B. Aged cheddar cheese and a glass of red wine
C. Fresh apples and whole-grain crackers
D. Baked cod with a side of white rice
CORRECT ANSWER: B. Aged cheddar cheese and a glass of red wine
Rationale: MAOIs inhibit the breakdown of tyramine. Consuming tyramine-rich foods like aged
cheeses, cured meats, and certain alcoholic beverages can precipitate a hypertensive crisis,
which is a medical emergency.
Question 11: A nurse is caring for a client experiencing alcohol withdrawal. The client is
diaphoretic, tremulous, and reports seeing spiders on the wall. Which medication should the
nurse anticipate administering?
A. Haloperidol
B. Lorazepam
Psychiatric-Mental Health Nursing Study Guide 2025,
Covering Mental Health Nursing Fundamentals,
Therapeutic Communication Techniques, Psychiatric
Assessment and Diagnosis, Neurobiology and
Psychopharmacology Principles, Anxiety Disorders and
Mood Disorders, Schizophrenia and Psychotic Disorders,
Personality Disorders and Behavioral Health, Crisis
Intervention and Suicide Prevention, Substance Use and
Addiction Nursing Care, Trauma-Informed Care and
Recovery Models, Legal and Ethical Issues in Psychiatric
Nursing, Detailed Chapter-by-Chapter Review, Practice
Questions with Verified Answers and Explanations, Real
Clinical Mental Health Case Studies, Step-by-Step
Nursing Care Plans, and Proven Strategies to
Successfully Master Psychiatric-Mental Health Nursing,
ATI, HESI, and NCLEX-RN Examinations
Question 1: A psychiatric-mental health nurse is assessing a client diagnosed with major
depressive disorder who states, "I am a burden to my family and they would be better off
without me." What is the priority nursing action?
A. Reassure the client that their family loves them very much.
B. Ask the client directly if they are having thoughts of self-harm.
C. Distract the client by engaging them in a structured group activity.
D. Document the statement and continue the routine morning assessment.
CORRECT ANSWER: B. Ask the client directly if they are having thoughts of self-harm.
Rationale: Any statement indicating worthlessness or being a burden requires immediate,
direct assessment for suicidal ideation to ensure client safety. Reassurance or distraction
minimizes the client's feelings and delays critical safety interventions.
Question 2: A nurse is leading a therapeutic group for clients with schizophrenia. A client
becomes agitated and begins shouting at another group member. Which nursing intervention
is most appropriate?
A. Immediately eject the client from the group to maintain order.
B. Ignore the behavior to avoid reinforcing the client's agitation.
,C. Set firm, calm limits on the behavior while acknowledging the client's feelings.
D. Physically restrain the client to prevent any potential harm to others.
CORRECT ANSWER: C. Set firm, calm limits on the behavior while acknowledging the client's
feelings.
Rationale: Setting firm, calm limits provides a safe environment and helps the client regain
control. Acknowledging feelings validates the client without condoning the inappropriate
behavior, promoting therapeutic de-escalation.
Question 3: A client diagnosed with bipolar disorder is prescribed lithium carbonate. Which of
the following client statements indicates a need for further teaching regarding this
medication?
A. "I will drink at least 2 to 3 liters of water every day."
B. "I will maintain a consistent intake of dietary sodium."
C. "I can take ibuprofen for my occasional headaches."
D. "I will have my blood drawn regularly to check my lithium levels."
CORRECT ANSWER: C. "I can take ibuprofen for my occasional headaches."
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can decrease lithium
excretion, leading to increased lithium levels and potential toxicity. Clients should be taught to
use acetaminophen instead and to avoid NSAIDs unless specifically approved by their provider.
Question 4: A psychiatric nurse is caring for a client who is experiencing a panic attack. The
client is hyperventilating, trembling, and states, "I think I am having a heart attack." What is
the nurse's best initial response?
A. "You are not having a heart attack; it is just a panic attack."
B. "Stay with me. I am here with you, and you are safe."
C. "Let's explore what triggered this feeling of panic."
D. "I will go get the healthcare provider to evaluate your heart."
CORRECT ANSWER: B. "Stay with me. I am here with you, and you are safe."
Rationale: During a panic attack, the client's cognitive ability to process information is severely
impaired. The priority is to provide a calm, reassuring presence and ensure the client feels safe,
which helps reduce anxiety and hyperventilation.
Question 5: A client is admitted to the psychiatric unit under an involuntary hold. The client
demands to leave the hospital immediately. What is the nurse's most appropriate response?
A. "You signed the admission papers, so you cannot leave yet."
B. "I understand you want to leave, but you are currently on a legal hold for your safety."
,C. "If you try to leave, the security guards will physically restrain you."
D. "You can leave as soon as you agree to take your prescribed medications."
CORRECT ANSWER: B. "I understand you want to leave, but you are currently on a legal hold
for your safety."
Rationale: The nurse must provide factual, clear, and non-threatening information regarding
the client's legal status. Acknowledging the client's desire to leave while explaining the legal
hold maintains transparency and therapeutic rapport.
Question 6: A nurse is administering clozapine to a client with treatment-resistant
schizophrenia. Which laboratory value is the highest priority for the nurse to monitor?
A. Fasting blood glucose
B. Absolute neutrophil count (ANC)
C. Liver function tests (LFTs)
D. Thyroid-stimulating hormone (TSH)
CORRECT ANSWER: B. Absolute neutrophil count (ANC)
Rationale: Clozapine carries a black box warning for severe neutropenia and agranulocytosis.
Regular monitoring of the ANC is mandatory to detect early signs of bone marrow suppression
and prevent life-threatening infections.
Question 7: A client with anorexia nervosa is admitted to the medical-psychiatric unit. The
client's vital signs show a heart rate of 48 bpm and blood pressure of 85/50 mmHg. What is
the nurse's priority action?
A. Encourage the client to eat a high-calorie meal immediately.
B. Place the client on continuous cardiac monitoring.
C. Weigh the client in a hospital gown without shoes.
D. Assess the client's body image perception.
CORRECT ANSWER: B. Place the client on continuous cardiac monitoring.
Rationale: Bradycardia and hypotension are common, life-threatening complications of severe
malnutrition in anorexia nervosa. Continuous cardiac monitoring is the priority to detect and
manage potential arrhythmias or cardiac arrest.
Question 8: A psychiatric-mental health nurse is evaluating a client for neuroleptic malignant
syndrome (NMS). Which cluster of symptoms should the nurse recognize as indicative of
NMS?
A. Tremors, shuffling gait, and masked facies
B. High fever, severe muscle rigidity, and altered mental status
, C. Involuntary facial movements and lip smacking
D. Restlessness, pacing, and an inability to sit still
CORRECT ANSWER: B. High fever, severe muscle rigidity, and altered mental status
Rationale: NMS is a rare but life-threatening reaction to antipsychotic medications
characterized by hyperthermia, severe "lead-pipe" muscle rigidity, autonomic instability, and
altered mental status. Immediate medical intervention is required.
Question 9: A client diagnosed with borderline personality disorder (BPD) states, "You are the
only nurse who cares about me. The other nurses are all cruel and useless." What is the
nurse's best response?
A. "Thank you, I think you are a wonderful person too."
B. "It is inappropriate for you to speak about the other nurses that way."
C. "I am part of the treatment team, and we all work together to help you."
D. "Why do you feel that the other nurses are cruel to you?"
CORRECT ANSWER: C. "I am part of the treatment team, and we all work together to help
you."
Rationale: Clients with BPD often exhibit splitting, viewing staff as all good or all bad. The nurse
must maintain professional boundaries and reinforce the unity of the treatment team to
prevent manipulation and promote consistent care.
Question 10: A client is prescribed a monoamine oxidase inhibitor (MAOI) for depression.
Which food choice by the client indicates a need for further dietary teaching?
A. Grilled chicken breast with steamed broccoli
B. Aged cheddar cheese and a glass of red wine
C. Fresh apples and whole-grain crackers
D. Baked cod with a side of white rice
CORRECT ANSWER: B. Aged cheddar cheese and a glass of red wine
Rationale: MAOIs inhibit the breakdown of tyramine. Consuming tyramine-rich foods like aged
cheeses, cured meats, and certain alcoholic beverages can precipitate a hypertensive crisis,
which is a medical emergency.
Question 11: A nurse is caring for a client experiencing alcohol withdrawal. The client is
diaphoretic, tremulous, and reports seeing spiders on the wall. Which medication should the
nurse anticipate administering?
A. Haloperidol
B. Lorazepam
