NSG 3450 Final Exam V3 | NSG 3450
Mental Health Guide | Actual Q&A with
Rationale (NSG3450 Final Exam) | Galen
College of Nursing
1. A nurse is caring for a client who is experiencing command hallucinations. Which of the
following is the priority nursing action?
A. Monitor the client for signs of anxiety
B. Ask the client what the voices are saying
C. Encourage the client to use headphones to listen to music
D. Administer a PRN dose of an antipsychotic medication
Answer: B
Rationale: The nurse’s priority when a client reports hallucinations is to assess the content
to ensure the safety of the client and others. If the voices are commanding the client to
harm someone, immediate safety precautions must be implemented. This assessment
allows the nurse to determine the lethality and urgency of the client’s internal experience.
2. A client is prescribed lithium carbonate for the treatment of bipolar disorder. Which of the
following instructions should the nurse include in the teaching?
A. Limit your daily fluid intake to 1 liter
B. Maintain a consistent intake of dietary sodium
,C. Take the medication on an empty stomach
D. Stop the medication if you experience fine hand tremors
Answer: B
Rationale: Lithium is a salt, and its excretion is directly related to serum sodium levels;
low sodium levels can lead to lithium toxicity. Clients should maintain a consistent salt and
fluid intake to keep blood levels within the therapeutic range of 0.6 to 1.2 mEq/L.
Dehydration or excessive sweating can also lead to increased lithium levels and potential
toxicity symptoms.
3. A client with schizophrenia is started on clozapine. Which laboratory result must the nurse
monitor most closely throughout treatment?
A. Platelet count
B. Liver function tests
C. Serum creatinine
D. White blood cell (WBC) count
Answer: D
Rationale: Clozapine carries a high risk of agranulocytosis, which is a life-threatening
decrease in white blood cells. National registries require weekly or biweekly WBC
monitoring to continue the prescription for safety. The nurse must educate the client to
report any signs of infection, such as fever or sore throat, immediately to the provider.
,4. A nurse is providing teaching to a client starting a Monoamine Oxidase Inhibitor (MAOI).
Which food choice should the client be told to avoid?
A. Fresh grilled chicken breast
B. Aged cheddar cheese
C. Whole grain bread
D. Cooked green beans
Answer: B
Rationale: Clients taking MAOIs must avoid foods high in tyramine to prevent a
hypertensive crisis. Aged cheeses, fermented meats, and certain wines are high in tyramine
and can trigger a dangerous spike in blood pressure. The nurse should provide a
comprehensive list of restricted foods and emphasize that this restriction continues for two
weeks after stopping the medication.
5. Which of the following legal principles applies when a client tells a nurse they plan to harm
their ex-spouse upon discharge?
A. Beneficence
B. Fidelity
C. Duty to warn
D. Autonomy
Answer: C
, Rationale: The duty to warn is a legal obligation that supersedes client confidentiality
when a specific threat is made against a third party. The nurse must report this threat to
the treatment team, and the provider or hospital must ensure the intended victim is
notified. This principle protects public safety in instances where a client presents a clear
and present danger to others.
6. A client with Borderline Personality Disorder uses ‘splitting’ as a defense mechanism.
Which behavior should the nurse expect?
A. Projecting their feelings onto the nurse
B. Labeling one nurse as ‘the best’ and another as ‘the worst’
C. Developing physical symptoms without an organic cause
D. Returning to an earlier developmental stage of behavior
Answer: B
Rationale: Splitting is a primitive defense mechanism common in borderline personality
disorder where individuals see things as all good or all bad. This often results in the client
attempting to pit staff members against one another by praising some and demeaning
others. Consistent communication among the nursing staff is essential to prevent this
behavior from disrupting the therapeutic milieu.
7. A client is admitted for alcohol withdrawal. Which of the following medications is
commonly used to prevent seizures and manage agitation?
A. Disulfiram
Mental Health Guide | Actual Q&A with
Rationale (NSG3450 Final Exam) | Galen
College of Nursing
1. A nurse is caring for a client who is experiencing command hallucinations. Which of the
following is the priority nursing action?
A. Monitor the client for signs of anxiety
B. Ask the client what the voices are saying
C. Encourage the client to use headphones to listen to music
D. Administer a PRN dose of an antipsychotic medication
Answer: B
Rationale: The nurse’s priority when a client reports hallucinations is to assess the content
to ensure the safety of the client and others. If the voices are commanding the client to
harm someone, immediate safety precautions must be implemented. This assessment
allows the nurse to determine the lethality and urgency of the client’s internal experience.
2. A client is prescribed lithium carbonate for the treatment of bipolar disorder. Which of the
following instructions should the nurse include in the teaching?
A. Limit your daily fluid intake to 1 liter
B. Maintain a consistent intake of dietary sodium
,C. Take the medication on an empty stomach
D. Stop the medication if you experience fine hand tremors
Answer: B
Rationale: Lithium is a salt, and its excretion is directly related to serum sodium levels;
low sodium levels can lead to lithium toxicity. Clients should maintain a consistent salt and
fluid intake to keep blood levels within the therapeutic range of 0.6 to 1.2 mEq/L.
Dehydration or excessive sweating can also lead to increased lithium levels and potential
toxicity symptoms.
3. A client with schizophrenia is started on clozapine. Which laboratory result must the nurse
monitor most closely throughout treatment?
A. Platelet count
B. Liver function tests
C. Serum creatinine
D. White blood cell (WBC) count
Answer: D
Rationale: Clozapine carries a high risk of agranulocytosis, which is a life-threatening
decrease in white blood cells. National registries require weekly or biweekly WBC
monitoring to continue the prescription for safety. The nurse must educate the client to
report any signs of infection, such as fever or sore throat, immediately to the provider.
,4. A nurse is providing teaching to a client starting a Monoamine Oxidase Inhibitor (MAOI).
Which food choice should the client be told to avoid?
A. Fresh grilled chicken breast
B. Aged cheddar cheese
C. Whole grain bread
D. Cooked green beans
Answer: B
Rationale: Clients taking MAOIs must avoid foods high in tyramine to prevent a
hypertensive crisis. Aged cheeses, fermented meats, and certain wines are high in tyramine
and can trigger a dangerous spike in blood pressure. The nurse should provide a
comprehensive list of restricted foods and emphasize that this restriction continues for two
weeks after stopping the medication.
5. Which of the following legal principles applies when a client tells a nurse they plan to harm
their ex-spouse upon discharge?
A. Beneficence
B. Fidelity
C. Duty to warn
D. Autonomy
Answer: C
, Rationale: The duty to warn is a legal obligation that supersedes client confidentiality
when a specific threat is made against a third party. The nurse must report this threat to
the treatment team, and the provider or hospital must ensure the intended victim is
notified. This principle protects public safety in instances where a client presents a clear
and present danger to others.
6. A client with Borderline Personality Disorder uses ‘splitting’ as a defense mechanism.
Which behavior should the nurse expect?
A. Projecting their feelings onto the nurse
B. Labeling one nurse as ‘the best’ and another as ‘the worst’
C. Developing physical symptoms without an organic cause
D. Returning to an earlier developmental stage of behavior
Answer: B
Rationale: Splitting is a primitive defense mechanism common in borderline personality
disorder where individuals see things as all good or all bad. This often results in the client
attempting to pit staff members against one another by praising some and demeaning
others. Consistent communication among the nursing staff is essential to prevent this
behavior from disrupting the therapeutic milieu.
7. A client is admitted for alcohol withdrawal. Which of the following medications is
commonly used to prevent seizures and manage agitation?
A. Disulfiram
