N322 Mental Health Nursing EXAM 2026-2027 LATEST
UPDATED VERSION QUESTIONS AND ANSWERS
A client commits suicide in an acute mental health facility. Which of the following is the priority
intervention for staff following this incident?
A. Provide professional counseling for staff members.
B. Change policies for staff observation of clients who are suicidal.
C. Identify cues in the client's behavior that might have warned them that he was contemplating
suicide.
D. Give the family an opportunity to talk about their feelings. - answer>>C. Identify cues in the client's
behavior that might have warned them that he was contemplating suicide.
Rationale: Identifying cues in the client's behavior is the priority intervention when taking the nursing
process approach to client care. Assessment is the first step in dealing with a situation.
A charge nurse is discussing suicide interventions with nursing staff. Which of the following should the
nurse identify as an example of secondary intervention?
A. Providing support for family and friends following a suicide
B. Identifying individuals who are at higher risk for attempting suicide
C. Recognizing the warning signs of suicide
D. Performing life-saving measures following a suicide attempt - answer>>D. Performing life-saving
measures following a suicide attempt
Rationale: The first statement is an example of tertiary intervention. The second and third statements
are both examples of primary intervention.
A nurse is teaching a group of clients about St. John's wort. Which of the following information should
the nurse include in the teaching?
,A. "St. John's wort can be used to treat mild depression."
B. "St. John's wort increases estrogen levels in the body."
C. "St. John's wort can reduce the effectiveness of oral contraceptives."
D. "St. John's wort can lower prostate-specific antigen levels." - answer>>A. "St. John's wort can be used
to treat mild depression."
Rationale: The nurse should teach that St. John's wort increases the serotonin level of serotonin-
enhancing antidepressants, which may place the client at risk for serotonin syndrome.
A nurse is caring for a client following a recent suicide attempt. Which of the following actions should
the nurse take?
A. Place metal utensils on the client's meal tray.
B. Assign the client to a private room.
C. Inspect the client's personal belongings.
D. Tuck bedcovers over client's hands and arms. - answer>>C. Inspect the client's personal belongings.
Rationale: Inspecting the client and his personal belongings is an appropriate intervention to ensure
that the client does not have access to potentially harmful objects.
A nurse caring for a client who has depression observes the client comes to breakfast freshly bathed,
wearing clean clothes and with combed and styled hair. Which of the following responses by the nurse
is therapeutic?
A. "Everyone feels better after showering."
B. "You must be getting better. You look great!"
C. "I see you have done some grooming today."
D. "Why are you all dressed up today? Is it a special occasion?" - answer>>C. "I see you have done some
grooming today."
,Rationale: This response is open-ended, and this response is therapeutic because it offers the client
recognition of positive behavior and encourages further discussion.
A nurse in an acute care mental health facility is preparing to administer morning medication for a client
who has been taking lithium for 2 weeks and has a current lithium level of 1.0 mEq/L. Which of the
following actions should the nurse take?
A. Prepare for gastric lavage due to an extremely elevated lithium level.
B. Administer the morning dose of lithium.
C. Check the client's medication record to assess whether the client has been refusing her lithium.
D. Hold the medication and assess for early manifestations of toxicity. - answer>>B. Administer the
morning dose of lithium.
Rationale: The nurse should administer the lithium dose since a lithium level of 1.0 mEq/L is within the
expected initial therapeutic range of 0.8 to 1.3 mEq/L. At a therapeutic level the client might
demonstrate adverse effects of lithium, such as a fine hand tremor, thirst, and mild nausea, and the
nurse should note if any of these manifestations are present. The nurse should continue to monitor for
adverse effects and signs of toxicity, which usually occur at levels of 1.5 mEq/L or higher.
A nurse is caring for an adolescent who has a history of violent behavior and has asked the nurse to
keep confidential information about the desire to kill several classmates and a school teacher. Which of
the following responses by the nurse is appropriate to give?
A. "Because you are a minor, I have to share any information that I feel is important with your parents."
B. "I cannot promise that. I must share this information with other members of the team who are
responsible for planning your care."
C. "I will not violate our nurse-client relationship. The information we discuss will remain confidential
between us."
D. "I can see that you trust me, but you should share those feelings with your psychiatrist, not me." -
answer>>B. "I cannot promise that. I must share this information with other members of the team who
are responsible for planning your care."
, Rationale: The nurse should report issues that are potentially life-threatening to the treatment team.
Although trust is the hallmark of the nurse-client relationship, confidentiality does not extend to these
situations.
A nurse in an acute care mental health facility is assessing a client who has bipolar disorder. Which of
the following findings indicates the client is at risk for suicide?
A. The client has begun playing basketball with several other clients during the past month.
B. The client identifies with problems expressed by other clients.
C. The client's behavior has become impulsive in the past few weeks.
D. The client states she wants to go home to be with her children and partner. - answer>>C. The client's
behavior has become impulsive in the past few weeks.
Rationale: The presence of impulsive behavior is a primary risk factor for suicide and clients who have
mania can act in a manner which is hostile, aggressive, and impulsive.
A nurse is admitting a client who is in the manic phase of bipolar disorder. The nurse should plan to
make which of the following room assignments for the client?
A. A private room in a quiet location on the unit
B. A semi-private room with a roommate who has a similar diagnosis
C. A private room close to the nursing station
D. A seclusion room until the client's activity level becomes more subdued. - answer>>A. A private room
in a quiet location on the unit
Rationale: A private room in a quiet location is ideal for a client with mania. The client may easily
become overstimulated by the number of people and activities in a nursing care unit. A private room
can be used for time-out during the day and to settle down to sleep at night.
A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with
a prescription for lithium. The nurse should teach the client that which of the following factors puts her
at risk for lithium toxicity?
UPDATED VERSION QUESTIONS AND ANSWERS
A client commits suicide in an acute mental health facility. Which of the following is the priority
intervention for staff following this incident?
A. Provide professional counseling for staff members.
B. Change policies for staff observation of clients who are suicidal.
C. Identify cues in the client's behavior that might have warned them that he was contemplating
suicide.
D. Give the family an opportunity to talk about their feelings. - answer>>C. Identify cues in the client's
behavior that might have warned them that he was contemplating suicide.
Rationale: Identifying cues in the client's behavior is the priority intervention when taking the nursing
process approach to client care. Assessment is the first step in dealing with a situation.
A charge nurse is discussing suicide interventions with nursing staff. Which of the following should the
nurse identify as an example of secondary intervention?
A. Providing support for family and friends following a suicide
B. Identifying individuals who are at higher risk for attempting suicide
C. Recognizing the warning signs of suicide
D. Performing life-saving measures following a suicide attempt - answer>>D. Performing life-saving
measures following a suicide attempt
Rationale: The first statement is an example of tertiary intervention. The second and third statements
are both examples of primary intervention.
A nurse is teaching a group of clients about St. John's wort. Which of the following information should
the nurse include in the teaching?
,A. "St. John's wort can be used to treat mild depression."
B. "St. John's wort increases estrogen levels in the body."
C. "St. John's wort can reduce the effectiveness of oral contraceptives."
D. "St. John's wort can lower prostate-specific antigen levels." - answer>>A. "St. John's wort can be used
to treat mild depression."
Rationale: The nurse should teach that St. John's wort increases the serotonin level of serotonin-
enhancing antidepressants, which may place the client at risk for serotonin syndrome.
A nurse is caring for a client following a recent suicide attempt. Which of the following actions should
the nurse take?
A. Place metal utensils on the client's meal tray.
B. Assign the client to a private room.
C. Inspect the client's personal belongings.
D. Tuck bedcovers over client's hands and arms. - answer>>C. Inspect the client's personal belongings.
Rationale: Inspecting the client and his personal belongings is an appropriate intervention to ensure
that the client does not have access to potentially harmful objects.
A nurse caring for a client who has depression observes the client comes to breakfast freshly bathed,
wearing clean clothes and with combed and styled hair. Which of the following responses by the nurse
is therapeutic?
A. "Everyone feels better after showering."
B. "You must be getting better. You look great!"
C. "I see you have done some grooming today."
D. "Why are you all dressed up today? Is it a special occasion?" - answer>>C. "I see you have done some
grooming today."
,Rationale: This response is open-ended, and this response is therapeutic because it offers the client
recognition of positive behavior and encourages further discussion.
A nurse in an acute care mental health facility is preparing to administer morning medication for a client
who has been taking lithium for 2 weeks and has a current lithium level of 1.0 mEq/L. Which of the
following actions should the nurse take?
A. Prepare for gastric lavage due to an extremely elevated lithium level.
B. Administer the morning dose of lithium.
C. Check the client's medication record to assess whether the client has been refusing her lithium.
D. Hold the medication and assess for early manifestations of toxicity. - answer>>B. Administer the
morning dose of lithium.
Rationale: The nurse should administer the lithium dose since a lithium level of 1.0 mEq/L is within the
expected initial therapeutic range of 0.8 to 1.3 mEq/L. At a therapeutic level the client might
demonstrate adverse effects of lithium, such as a fine hand tremor, thirst, and mild nausea, and the
nurse should note if any of these manifestations are present. The nurse should continue to monitor for
adverse effects and signs of toxicity, which usually occur at levels of 1.5 mEq/L or higher.
A nurse is caring for an adolescent who has a history of violent behavior and has asked the nurse to
keep confidential information about the desire to kill several classmates and a school teacher. Which of
the following responses by the nurse is appropriate to give?
A. "Because you are a minor, I have to share any information that I feel is important with your parents."
B. "I cannot promise that. I must share this information with other members of the team who are
responsible for planning your care."
C. "I will not violate our nurse-client relationship. The information we discuss will remain confidential
between us."
D. "I can see that you trust me, but you should share those feelings with your psychiatrist, not me." -
answer>>B. "I cannot promise that. I must share this information with other members of the team who
are responsible for planning your care."
, Rationale: The nurse should report issues that are potentially life-threatening to the treatment team.
Although trust is the hallmark of the nurse-client relationship, confidentiality does not extend to these
situations.
A nurse in an acute care mental health facility is assessing a client who has bipolar disorder. Which of
the following findings indicates the client is at risk for suicide?
A. The client has begun playing basketball with several other clients during the past month.
B. The client identifies with problems expressed by other clients.
C. The client's behavior has become impulsive in the past few weeks.
D. The client states she wants to go home to be with her children and partner. - answer>>C. The client's
behavior has become impulsive in the past few weeks.
Rationale: The presence of impulsive behavior is a primary risk factor for suicide and clients who have
mania can act in a manner which is hostile, aggressive, and impulsive.
A nurse is admitting a client who is in the manic phase of bipolar disorder. The nurse should plan to
make which of the following room assignments for the client?
A. A private room in a quiet location on the unit
B. A semi-private room with a roommate who has a similar diagnosis
C. A private room close to the nursing station
D. A seclusion room until the client's activity level becomes more subdued. - answer>>A. A private room
in a quiet location on the unit
Rationale: A private room in a quiet location is ideal for a client with mania. The client may easily
become overstimulated by the number of people and activities in a nursing care unit. A private room
can be used for time-out during the day and to settle down to sleep at night.
A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with
a prescription for lithium. The nurse should teach the client that which of the following factors puts her
at risk for lithium toxicity?
