Galen College NSG 3450 Exam 4 (pdf) | 2026/2027 | Mental Health
Q&A | Mental Health Nursing
1. Which Cluster B personality disorder is characterized by a pattern of
marked instability, impulsivity, identity distortions, unstable mood, and
unstable interpersonal relationships?
A) Antisocial personality disorder
B) Narcissistic personality disorder
C) Histrionic personality disorder
D) Borderline personality disorder
Correct Answer: Borderline personality disorder
Rationale: Borderline personality disorder (Cluster B) features patterns of
marked instability, impulsivity, identity or self-image distortions, unstable
mood, and unstable interpersonal relationships. Self-destructing behaviors
such as cutting are prominent. Antisocial personality disorder involves
disregard for others' rights, while narcissistic and histrionic disorders have
different core features.
2. A patient is prescribed a first-generation antipsychotic and develops acute
dystonia. Which medications should the nurse anticipate administering?
A) Haloperidol and chlorpromazine
B) Benadryl and cogentin
C) Clozapine and olanzapine
D) Lithium and valproate
Correct Answer: Benadryl and cogentin
Rationale: Acute dystonia is a reversible extrapyramidal side effect of first-
generation antipsychotics characterized by sudden contraction of head or
,neck muscles. The antidote for these reactions is Benadryl
(diphenhydramine) and cogentin (benztropine). Haloperidol and
chlorpromazine are first-generation antipsychotics that can cause EPS, not
treat it.
3. A patient with schizophrenia has been on an antipsychotic for several
years and now exhibits involuntary rhythmic movements of the tongue and
face. The nurse recognizes this as:
A) Acute dystonia
B) Akathisia
C) Pseudoparkinsonism
D) Tardive dyskinesia
Correct Answer: Tardive dyskinesia
Rationale: Tardive dyskinesia is a persistent EPS side effect involving
involuntary rhythmic movements that develops in 10% or more of patients
after prolonged antipsychotic treatment. It may be irreversible even after
discontinuation. The Abnormal Involuntary Movement Scale (AIMS) is used
for monitoring and early detection.
4. Which assessment tool should the nurse use to monitor for tardive
dyskinesia in a patient taking long-term antipsychotic medication?
A) Braden Scale
B) Morse Fall Scale
C) Abnormal Involuntary Movement Scale (AIMS)
D) Mini-Mental State Examination (MMSE)
Correct Answer: Abnormal Involuntary Movement Scale (AIMS)
,Rationale: The AIMS is specifically designed to monitor and detect tardive
dyskinesia, a potentially irreversible EPS side effect of antipsychotic
medications. The Braden Scale assesses pressure ulcer risk, the Morse Fall
Scale assesses fall risk, and the MMSE assesses cognitive function.
5. A patient is experiencing neuroleptic malignant syndrome (NMS) after
starting an antipsychotic. Which findings would the nurse expect?
A) Hypotension and bradycardia
B) Hyperthermia, generalized muscle rigidity, and autonomic dysfunction
C) Sedation and weight gain
D) Dry mouth and constipation
Correct Answer: Hyperthermia, generalized muscle rigidity, and autonomic
dysfunction
Rationale: NMS is characterized by reduced consciousness, increased muscle
tone (generalized muscle rigidity), autonomic dysfunction, hyperthermia
(fever), and incontinence. It is caused by excessive dopamine receptor
blockade, usually occurring early in therapy. Prompt detection and
discontinuation of the antipsychotic agent are essential.
6. A patient with schizophrenia is prescribed clozapine. The nurse should
monitor which laboratory value closely due to risk of a life-threatening side
effect?
A) Serum glucose
B) Complete blood count (CBC) for agranulocytosis
C) Liver function tests
D) Serum creatinine
Correct Answer: Complete blood count (CBC) for agranulocytosis
, Rationale: Clozapine carries a risk of agranulocytosis, requiring regular CBC
monitoring. Serum glucose, liver function, and creatinine are monitored for
other medications but are not the primary concern with clozapine. Clozapine
has a REMS program for monitoring.
7. A patient is prescribed paliperidone palmitate (Invega Trinza), a long-
acting injectable antipsychotic. How often does this medication need to be
administered?
A) Every 2-4 weeks
B) Every 3 months
C) Every 6 months
D) Weekly
Correct Answer: Every 3 months
Rationale: Paliperidone palmitate (Invega Trinza) is the only long-acting
injectable that can last 3 months; other long-acting injectables are
administered every 2-4 weeks. Long-acting injectables are particularly useful
for patients who are "cheeking or palming" medications or resistant to
treatment.
8. Which statement accurately describes the difference between first-
generation (FGA) and second-generation (SGA) antipsychotics?
A) FGAs primarily affect negative symptoms; SGAs primarily affect positive
symptoms
B) FGAs primarily affect positive symptoms with little effect on negative
symptoms; SGAs affect both
C) FGAs have no side effects; SGAs have severe side effects
D) FGAs are serotonin antagonists; SGAs are dopamine antagonists
Q&A | Mental Health Nursing
1. Which Cluster B personality disorder is characterized by a pattern of
marked instability, impulsivity, identity distortions, unstable mood, and
unstable interpersonal relationships?
A) Antisocial personality disorder
B) Narcissistic personality disorder
C) Histrionic personality disorder
D) Borderline personality disorder
Correct Answer: Borderline personality disorder
Rationale: Borderline personality disorder (Cluster B) features patterns of
marked instability, impulsivity, identity or self-image distortions, unstable
mood, and unstable interpersonal relationships. Self-destructing behaviors
such as cutting are prominent. Antisocial personality disorder involves
disregard for others' rights, while narcissistic and histrionic disorders have
different core features.
2. A patient is prescribed a first-generation antipsychotic and develops acute
dystonia. Which medications should the nurse anticipate administering?
A) Haloperidol and chlorpromazine
B) Benadryl and cogentin
C) Clozapine and olanzapine
D) Lithium and valproate
Correct Answer: Benadryl and cogentin
Rationale: Acute dystonia is a reversible extrapyramidal side effect of first-
generation antipsychotics characterized by sudden contraction of head or
,neck muscles. The antidote for these reactions is Benadryl
(diphenhydramine) and cogentin (benztropine). Haloperidol and
chlorpromazine are first-generation antipsychotics that can cause EPS, not
treat it.
3. A patient with schizophrenia has been on an antipsychotic for several
years and now exhibits involuntary rhythmic movements of the tongue and
face. The nurse recognizes this as:
A) Acute dystonia
B) Akathisia
C) Pseudoparkinsonism
D) Tardive dyskinesia
Correct Answer: Tardive dyskinesia
Rationale: Tardive dyskinesia is a persistent EPS side effect involving
involuntary rhythmic movements that develops in 10% or more of patients
after prolonged antipsychotic treatment. It may be irreversible even after
discontinuation. The Abnormal Involuntary Movement Scale (AIMS) is used
for monitoring and early detection.
4. Which assessment tool should the nurse use to monitor for tardive
dyskinesia in a patient taking long-term antipsychotic medication?
A) Braden Scale
B) Morse Fall Scale
C) Abnormal Involuntary Movement Scale (AIMS)
D) Mini-Mental State Examination (MMSE)
Correct Answer: Abnormal Involuntary Movement Scale (AIMS)
,Rationale: The AIMS is specifically designed to monitor and detect tardive
dyskinesia, a potentially irreversible EPS side effect of antipsychotic
medications. The Braden Scale assesses pressure ulcer risk, the Morse Fall
Scale assesses fall risk, and the MMSE assesses cognitive function.
5. A patient is experiencing neuroleptic malignant syndrome (NMS) after
starting an antipsychotic. Which findings would the nurse expect?
A) Hypotension and bradycardia
B) Hyperthermia, generalized muscle rigidity, and autonomic dysfunction
C) Sedation and weight gain
D) Dry mouth and constipation
Correct Answer: Hyperthermia, generalized muscle rigidity, and autonomic
dysfunction
Rationale: NMS is characterized by reduced consciousness, increased muscle
tone (generalized muscle rigidity), autonomic dysfunction, hyperthermia
(fever), and incontinence. It is caused by excessive dopamine receptor
blockade, usually occurring early in therapy. Prompt detection and
discontinuation of the antipsychotic agent are essential.
6. A patient with schizophrenia is prescribed clozapine. The nurse should
monitor which laboratory value closely due to risk of a life-threatening side
effect?
A) Serum glucose
B) Complete blood count (CBC) for agranulocytosis
C) Liver function tests
D) Serum creatinine
Correct Answer: Complete blood count (CBC) for agranulocytosis
, Rationale: Clozapine carries a risk of agranulocytosis, requiring regular CBC
monitoring. Serum glucose, liver function, and creatinine are monitored for
other medications but are not the primary concern with clozapine. Clozapine
has a REMS program for monitoring.
7. A patient is prescribed paliperidone palmitate (Invega Trinza), a long-
acting injectable antipsychotic. How often does this medication need to be
administered?
A) Every 2-4 weeks
B) Every 3 months
C) Every 6 months
D) Weekly
Correct Answer: Every 3 months
Rationale: Paliperidone palmitate (Invega Trinza) is the only long-acting
injectable that can last 3 months; other long-acting injectables are
administered every 2-4 weeks. Long-acting injectables are particularly useful
for patients who are "cheeking or palming" medications or resistant to
treatment.
8. Which statement accurately describes the difference between first-
generation (FGA) and second-generation (SGA) antipsychotics?
A) FGAs primarily affect negative symptoms; SGAs primarily affect positive
symptoms
B) FGAs primarily affect positive symptoms with little effect on negative
symptoms; SGAs affect both
C) FGAs have no side effects; SGAs have severe side effects
D) FGAs are serotonin antagonists; SGAs are dopamine antagonists
