PNG 2254: Mental Health Nursing – Comprehensive
Final Exam Questions and Answers with Rationale
Latest Edition 2026/2027
Question 1
A client diagnosed with major depressive disorder states to the nurse, "I
am a total failure and burden to everyone. Life isn't worth living
anymore." Which of the following is the most appropriate initial nursing
response?
A. "Why do you feel that way? Things will look brighter tomorrow."
B. "You have a lot of people who care about you; you shouldn't talk
like that."
C. "Are you thinking of committing suicide or ending your life?"
D. "Let us focus on something positive instead of dwelling on
negative thoughts."
Correct Answer: C
Rationale: When a client expresses feelings of worthlessness and
hopelessness, the nurse must directly assess for suicidal ideation. Asking
a direct question about suicide does not plant the idea; rather, it provides
safety and opens communication. Options A, B, and D utilize non-
therapeutic communication techniques such as probing, false
reassurance, and changing the subject, which minimize the client's
feelings and jeopardize safety.
Question 2
A nurse is caring for an individual experiencing an acute manic episode
associated with bipolar I disorder. The client is hyperactive, easily
,distracted, and speaks rapidly in loud tones. Which of the following
environmental modifications should the nurse prioritize?
A. Placing the client in a room near the nurses' station with bright
overhead lighting.
B. Providing a quiet, low-stimulation environment away from high-
traffic areas.
C. Encouraging the client to join large group activities to burn off
excess physical energy.
D. Keeping the client's room door open to allow full observation of
ongoing unit activity.
Correct Answer: B
Rationale: Clients experiencing acute mania have a reduced tolerance
for environmental stimuli and easily become overwhelmed, which
escalates agitation and hyperactivity. A quiet, low-stimulation
environment helps promote emotional and physical calm. Large group
activities can overstimulate the client and lead to boundary violations or
exhaustion.
Question 3
A patient prescribed lithium carbonate for bipolar disorder exhibits
coarse hand tremors, ataxia, confusion, and persistent gastrointestinal
upset including severe vomiting and diarrhea. The serum lithium level is
found to be 2.2 mEq/L. How should the nurse interpret these findings?
A. The client is exhibiting expected therapeutic side effects of the
medication.
B. The client is experiencing early signs of mild lithium toxicity.
, C. The client is experiencing severe lithium toxicity requiring
immediate intervention.
D. The client is experiencing subtherapeutic effects requiring a
dosage increase.
Correct Answer: C
Rationale: Therapeutic lithium levels range between 0.6 and 1.2 mEq/L.
Levels above 2.0 mEq/L are considered toxic, manifesting as severe
signs including coarse hand tremors, persistent gastrointestinal distress,
ataxia, confusion, EEG changes, and high risk for seizures or coma. This
constitutes a medical emergency.
Question 4
A nurse is conducting an admission assessment for an adult client
diagnosed with schizophrenia who exhibits blunted affect, social
withdrawal, and poverty of speech. How should the nurse categorize
these specific symptoms?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Affective symptoms
Correct Answer: B
Rationale: Negative symptoms of schizophrenia reflect a loss or
diminution of normal functions and behaviors, including flat or blunted
affect, anhedonia, avolition, alogia (poverty of speech), and asociality.
Positive symptoms include hallucinations, delusions, and disorganized
speech.
Question 5
, A client diagnosed with generalized anxiety disorder (GAD) is
prescribed buspirone. The client asks the nurse how long it will take
before noticing full relief from anxiety symptoms. Which response by
the nurse is accurate?
A. "You will feel complete relief within 15 to 30 minutes of taking
the first dose."
B. "It typically takes 2 to 4 weeks of consistent administration to
achieve full therapeutic effects."
C. "Buspirone works instantly like a benzodiazepine, but without the
risk of physical dependence."
D. "You only need to take this medication when you feel an acute
panic attack coming on."
Correct Answer: B
Rationale: Unlike fast-acting benzodiazepines used for immediate
relief, buspirone is a non-benzodiazepine anxiolytic that requires 2 to 4
weeks of continuous daily use to build up therapeutic efficacy in the
central nervous system. It is not effective for acute, as-needed (PRN)
anxiety management.
Question 6
An adolescent client is admitted to the inpatient psychiatric unit with a
diagnosis of anorexia nervosa. The client's weight is significantly below
normal, and lab values show severe hypokalemia. Which of the
following is the primary nursing goal during initial stabilization?
A. Exploring the psychological root causes of the client's fear of
gaining weight.
B. Restoring nutritional status and correcting life-threatening
electrolyte imbalances.
Final Exam Questions and Answers with Rationale
Latest Edition 2026/2027
Question 1
A client diagnosed with major depressive disorder states to the nurse, "I
am a total failure and burden to everyone. Life isn't worth living
anymore." Which of the following is the most appropriate initial nursing
response?
A. "Why do you feel that way? Things will look brighter tomorrow."
B. "You have a lot of people who care about you; you shouldn't talk
like that."
C. "Are you thinking of committing suicide or ending your life?"
D. "Let us focus on something positive instead of dwelling on
negative thoughts."
Correct Answer: C
Rationale: When a client expresses feelings of worthlessness and
hopelessness, the nurse must directly assess for suicidal ideation. Asking
a direct question about suicide does not plant the idea; rather, it provides
safety and opens communication. Options A, B, and D utilize non-
therapeutic communication techniques such as probing, false
reassurance, and changing the subject, which minimize the client's
feelings and jeopardize safety.
Question 2
A nurse is caring for an individual experiencing an acute manic episode
associated with bipolar I disorder. The client is hyperactive, easily
,distracted, and speaks rapidly in loud tones. Which of the following
environmental modifications should the nurse prioritize?
A. Placing the client in a room near the nurses' station with bright
overhead lighting.
B. Providing a quiet, low-stimulation environment away from high-
traffic areas.
C. Encouraging the client to join large group activities to burn off
excess physical energy.
D. Keeping the client's room door open to allow full observation of
ongoing unit activity.
Correct Answer: B
Rationale: Clients experiencing acute mania have a reduced tolerance
for environmental stimuli and easily become overwhelmed, which
escalates agitation and hyperactivity. A quiet, low-stimulation
environment helps promote emotional and physical calm. Large group
activities can overstimulate the client and lead to boundary violations or
exhaustion.
Question 3
A patient prescribed lithium carbonate for bipolar disorder exhibits
coarse hand tremors, ataxia, confusion, and persistent gastrointestinal
upset including severe vomiting and diarrhea. The serum lithium level is
found to be 2.2 mEq/L. How should the nurse interpret these findings?
A. The client is exhibiting expected therapeutic side effects of the
medication.
B. The client is experiencing early signs of mild lithium toxicity.
, C. The client is experiencing severe lithium toxicity requiring
immediate intervention.
D. The client is experiencing subtherapeutic effects requiring a
dosage increase.
Correct Answer: C
Rationale: Therapeutic lithium levels range between 0.6 and 1.2 mEq/L.
Levels above 2.0 mEq/L are considered toxic, manifesting as severe
signs including coarse hand tremors, persistent gastrointestinal distress,
ataxia, confusion, EEG changes, and high risk for seizures or coma. This
constitutes a medical emergency.
Question 4
A nurse is conducting an admission assessment for an adult client
diagnosed with schizophrenia who exhibits blunted affect, social
withdrawal, and poverty of speech. How should the nurse categorize
these specific symptoms?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Affective symptoms
Correct Answer: B
Rationale: Negative symptoms of schizophrenia reflect a loss or
diminution of normal functions and behaviors, including flat or blunted
affect, anhedonia, avolition, alogia (poverty of speech), and asociality.
Positive symptoms include hallucinations, delusions, and disorganized
speech.
Question 5
, A client diagnosed with generalized anxiety disorder (GAD) is
prescribed buspirone. The client asks the nurse how long it will take
before noticing full relief from anxiety symptoms. Which response by
the nurse is accurate?
A. "You will feel complete relief within 15 to 30 minutes of taking
the first dose."
B. "It typically takes 2 to 4 weeks of consistent administration to
achieve full therapeutic effects."
C. "Buspirone works instantly like a benzodiazepine, but without the
risk of physical dependence."
D. "You only need to take this medication when you feel an acute
panic attack coming on."
Correct Answer: B
Rationale: Unlike fast-acting benzodiazepines used for immediate
relief, buspirone is a non-benzodiazepine anxiolytic that requires 2 to 4
weeks of continuous daily use to build up therapeutic efficacy in the
central nervous system. It is not effective for acute, as-needed (PRN)
anxiety management.
Question 6
An adolescent client is admitted to the inpatient psychiatric unit with a
diagnosis of anorexia nervosa. The client's weight is significantly below
normal, and lab values show severe hypokalemia. Which of the
following is the primary nursing goal during initial stabilization?
A. Exploring the psychological root causes of the client's fear of
gaining weight.
B. Restoring nutritional status and correcting life-threatening
electrolyte imbalances.
