NUR 253 Mental Health Nursing – Exams 1-4 (2026) Complete
Practice Questions with Correct Answers & Detailed Rationales
Master psychiatric nursing interventions and pass every milestone assessment with this
complete 2026/2027 NUR 253 Mental Health Nursing bundle covering Exams 1 through
4. This comprehensive preparatory test bank features high-yield practice questions
paired with 100% verified answers and rigorous clinical rationales exploring therapeutic
communication, DSM-5-TR mood and psychotic disorders, substance abuse
management, and psychopharmacology safety protocols. It is the ultimate tool for pre-
licensure nursing students looking to optimize study routines, sharpen clinical judgment,
and secure an A+ grade.
1. A client with schizophrenia is prescribed clozapine. The client's white blood cell
count is 2,800/mm³. What is the nurse's priority action?
A. Administer the clozapine as prescribed
B. Hold the clozapine and notify the healthcare provider immediately
C. Increase the clozapine dose to improve efficacy
D. Recheck the WBC in 24 hours
Rationale: Clozapine can cause agranulocytosis, a life-threatening drop in white blood
cells. If WBC falls below 3,000/mm³ or ANC below 1,500/mm³, the medication must be
held and the provider notified immediately. The patient should be monitored for signs of
infection. Dose increases or rechecking without holding is unsafe.
2. A client with borderline personality disorder is engaging in splitting behavior,
praising one staff member and devaluing another. Which nursing intervention is
most appropriate?
A. Agree with the client's assessment of the staff
B. Set consistent limits and maintain a unified approach among staff
C. Allow the client to choose which staff member to work with
D. Avoid confronting the client about the behavior
Rationale: Splitting is a defense mechanism where the client idealizes one person and
devalues another. The most effective intervention is to maintain a consistent, unified
approach among all staff members. This prevents the client from playing staff against
each other and provides a stable therapeutic environment.
,3. A client with narcissistic personality disorder is being assessed. Which statement
by the client is most consistent with this diagnosis?
A. "I'm worthless and everyone hates me."
B. "I am the best at everything I do; others are jealous of me."
C. "I need others to make decisions for me."
D. "I avoid social situations because I fear rejection."
Rationale: Narcissistic personality disorder is characterized by grandiosity, a need for
admiration, and lack of empathy. The statement "I am the best at everything" reflects
grandiose self-importance. Feelings of worthlessness are seen in depression; need for
others to make decisions is seen in dependent personality disorder; fear of rejection is seen
in avoidant personality disorder.
4. The nurse is providing care to a client with major depressive disorder who
reports feeling hopeless and worthless. What is the most important assessment for
the nurse to perform?
A. Assess the client's nutritional status
B. Assess the client for suicidal ideation and intent
C. Assess the client's sleep patterns
D. Assess the client's social support system
Rationale: Hopelessness and worthlessness are significant risk factors for suicide. The nurse
must assess the client for suicidal ideation, plan, and intent. This is the highest priority
because it addresses immediate safety. While nutritional status, sleep patterns, and social
support are important, they are not the priority in the presence of suicidal risk.
5. A client with generalized anxiety disorder is prescribed buspirone. Which
statement by the client indicates understanding of this medication?
A. "This medication will help my anxiety immediately."
B. "I need to take this medication for 2-4 weeks before I see improvement."
C. "I can take this medication as needed when I feel anxious."
D. "This medication is a benzodiazepine and can be addictive."
,Rationale: Buspirone is a non-benzodiazepine anxiolytic that requires 2-4 weeks for full
therapeutic effect. It is not for as-needed use and is not addictive like benzodiazepines.
Patients need education about the delayed onset to prevent premature discontinuation.
6. A client with post-traumatic stress disorder (PTSD) is experiencing a flashback.
Which nursing intervention is most appropriate?
A. Ask the client to describe the traumatic event in detail
B. Use grounding techniques and reassure the client of present safety
C. Tell the client the flashback is not real
D. Administer a sedative to stop the flashback
Rationale: Flashbacks are dissociative re-experiencing of traumatic events. Grounding
techniques (e.g., focusing on present surroundings, deep breathing) help the client return
to the present. Describing the trauma in detail may intensify distress, and telling the client
it's not real may invalidate their experience. Sedation is not first-line.
7. A client with alcohol use disorder is admitted for detoxification. The client is
diaphoretic, tremulous, and reports nausea. Which assessment tool should the
nurse use to guide treatment?
A. CAGE questionnaire
B. CIWA-Ar
C. AUDIT
D. MAST
Rationale: The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol) quantifies
withdrawal severity and guides benzodiazepine dosing. CAGE, AUDIT, and MAST are
screening tools for alcohol use disorder, not withdrawal assessment. The client is showing
signs of alcohol withdrawal, so CIWA-Ar is appropriate.
8. A client with bipolar disorder is prescribed lithium. The client's serum lithium
level is 1.0 mEq/L. Which statement is accurate?
A. The client is experiencing lithium toxicity
, B. The lithium level is within the therapeutic range
C. The client needs a higher dose of lithium
D. The client needs a lower dose of lithium
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. A level of 1.0 mEq/L is
within the therapeutic range. Toxicity occurs at levels >1.5 mEq/L. No dose adjustment is
needed based on this level alone. The provider should be notified if the client experiences
symptoms of toxicity regardless of level.
9. A client with bipolar disorder is prescribed valproic acid. Which laboratory value
should the nurse monitor closely?
A. Serum sodium
B. Liver function tests (AST, ALT)
C. Serum potassium
D. Complete blood count
Rationale: Valproic acid can cause hepatotoxicity, so liver function tests (AST, ALT) should
be monitored before and during therapy. Complete blood count should also be monitored
for thrombocytopenia, but LFTs are the primary concern. Sodium, potassium, and renal
function are not primarily affected by valproic acid.
10. A client with borderline personality disorder is threatening self-harm after a
perceived abandonment. What is the nurse's priority action?
A. Tell the client the threat is manipulative
B. Assess the client's safety and implement a crisis intervention plan
C. Ignore the threat to avoid reinforcing the behavior
D. Place the client in seclusion immediately
Rationale: Any threat of self-harm must be taken seriously, regardless of potential
manipulation. The nurse should assess the client's safety, implement a crisis intervention
plan, and provide a safe environment. Seclusion should only be used when other
interventions fail and safety is at immediate risk.
Practice Questions with Correct Answers & Detailed Rationales
Master psychiatric nursing interventions and pass every milestone assessment with this
complete 2026/2027 NUR 253 Mental Health Nursing bundle covering Exams 1 through
4. This comprehensive preparatory test bank features high-yield practice questions
paired with 100% verified answers and rigorous clinical rationales exploring therapeutic
communication, DSM-5-TR mood and psychotic disorders, substance abuse
management, and psychopharmacology safety protocols. It is the ultimate tool for pre-
licensure nursing students looking to optimize study routines, sharpen clinical judgment,
and secure an A+ grade.
1. A client with schizophrenia is prescribed clozapine. The client's white blood cell
count is 2,800/mm³. What is the nurse's priority action?
A. Administer the clozapine as prescribed
B. Hold the clozapine and notify the healthcare provider immediately
C. Increase the clozapine dose to improve efficacy
D. Recheck the WBC in 24 hours
Rationale: Clozapine can cause agranulocytosis, a life-threatening drop in white blood
cells. If WBC falls below 3,000/mm³ or ANC below 1,500/mm³, the medication must be
held and the provider notified immediately. The patient should be monitored for signs of
infection. Dose increases or rechecking without holding is unsafe.
2. A client with borderline personality disorder is engaging in splitting behavior,
praising one staff member and devaluing another. Which nursing intervention is
most appropriate?
A. Agree with the client's assessment of the staff
B. Set consistent limits and maintain a unified approach among staff
C. Allow the client to choose which staff member to work with
D. Avoid confronting the client about the behavior
Rationale: Splitting is a defense mechanism where the client idealizes one person and
devalues another. The most effective intervention is to maintain a consistent, unified
approach among all staff members. This prevents the client from playing staff against
each other and provides a stable therapeutic environment.
,3. A client with narcissistic personality disorder is being assessed. Which statement
by the client is most consistent with this diagnosis?
A. "I'm worthless and everyone hates me."
B. "I am the best at everything I do; others are jealous of me."
C. "I need others to make decisions for me."
D. "I avoid social situations because I fear rejection."
Rationale: Narcissistic personality disorder is characterized by grandiosity, a need for
admiration, and lack of empathy. The statement "I am the best at everything" reflects
grandiose self-importance. Feelings of worthlessness are seen in depression; need for
others to make decisions is seen in dependent personality disorder; fear of rejection is seen
in avoidant personality disorder.
4. The nurse is providing care to a client with major depressive disorder who
reports feeling hopeless and worthless. What is the most important assessment for
the nurse to perform?
A. Assess the client's nutritional status
B. Assess the client for suicidal ideation and intent
C. Assess the client's sleep patterns
D. Assess the client's social support system
Rationale: Hopelessness and worthlessness are significant risk factors for suicide. The nurse
must assess the client for suicidal ideation, plan, and intent. This is the highest priority
because it addresses immediate safety. While nutritional status, sleep patterns, and social
support are important, they are not the priority in the presence of suicidal risk.
5. A client with generalized anxiety disorder is prescribed buspirone. Which
statement by the client indicates understanding of this medication?
A. "This medication will help my anxiety immediately."
B. "I need to take this medication for 2-4 weeks before I see improvement."
C. "I can take this medication as needed when I feel anxious."
D. "This medication is a benzodiazepine and can be addictive."
,Rationale: Buspirone is a non-benzodiazepine anxiolytic that requires 2-4 weeks for full
therapeutic effect. It is not for as-needed use and is not addictive like benzodiazepines.
Patients need education about the delayed onset to prevent premature discontinuation.
6. A client with post-traumatic stress disorder (PTSD) is experiencing a flashback.
Which nursing intervention is most appropriate?
A. Ask the client to describe the traumatic event in detail
B. Use grounding techniques and reassure the client of present safety
C. Tell the client the flashback is not real
D. Administer a sedative to stop the flashback
Rationale: Flashbacks are dissociative re-experiencing of traumatic events. Grounding
techniques (e.g., focusing on present surroundings, deep breathing) help the client return
to the present. Describing the trauma in detail may intensify distress, and telling the client
it's not real may invalidate their experience. Sedation is not first-line.
7. A client with alcohol use disorder is admitted for detoxification. The client is
diaphoretic, tremulous, and reports nausea. Which assessment tool should the
nurse use to guide treatment?
A. CAGE questionnaire
B. CIWA-Ar
C. AUDIT
D. MAST
Rationale: The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol) quantifies
withdrawal severity and guides benzodiazepine dosing. CAGE, AUDIT, and MAST are
screening tools for alcohol use disorder, not withdrawal assessment. The client is showing
signs of alcohol withdrawal, so CIWA-Ar is appropriate.
8. A client with bipolar disorder is prescribed lithium. The client's serum lithium
level is 1.0 mEq/L. Which statement is accurate?
A. The client is experiencing lithium toxicity
, B. The lithium level is within the therapeutic range
C. The client needs a higher dose of lithium
D. The client needs a lower dose of lithium
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L. A level of 1.0 mEq/L is
within the therapeutic range. Toxicity occurs at levels >1.5 mEq/L. No dose adjustment is
needed based on this level alone. The provider should be notified if the client experiences
symptoms of toxicity regardless of level.
9. A client with bipolar disorder is prescribed valproic acid. Which laboratory value
should the nurse monitor closely?
A. Serum sodium
B. Liver function tests (AST, ALT)
C. Serum potassium
D. Complete blood count
Rationale: Valproic acid can cause hepatotoxicity, so liver function tests (AST, ALT) should
be monitored before and during therapy. Complete blood count should also be monitored
for thrombocytopenia, but LFTs are the primary concern. Sodium, potassium, and renal
function are not primarily affected by valproic acid.
10. A client with borderline personality disorder is threatening self-harm after a
perceived abandonment. What is the nurse's priority action?
A. Tell the client the threat is manipulative
B. Assess the client's safety and implement a crisis intervention plan
C. Ignore the threat to avoid reinforcing the behavior
D. Place the client in seclusion immediately
Rationale: Any threat of self-harm must be taken seriously, regardless of potential
manipulation. The nurse should assess the client's safety, implement a crisis intervention
plan, and provide a safe environment. Seclusion should only be used when other
interventions fail and safety is at immediate risk.
