NUR 2459 Exam 3 | Mental & Behavioral Health Nursing Questions
With Answers and Explanations
600-Question Comprehensive Mock Exam
Question 1. A client with borderline personality disorder tells one nurse that all other staff are terrible. What is the best
response?
A. Invite the client to rank staff members.
B. Explain that staff use a consistent plan and limits.
C. Agree that the other staff are difficult.
D. Assign only the preferred nurse.
Correct Answer: B. Explain that staff use a consistent plan and limits.
Explanation: Clients with borderline personality disorder may use splitting, viewing people as all good or all bad. A unified staff
approach with consistent limits reduces reinforcement of splitting. Taking sides can intensify unstable relationships and staff
conflict. The nurse should remain neutral and focus on treatment goals.
Question 2. A client with antisocial personality disorder repeatedly violates unit rules. Which intervention is best?
A. Set clear expectations and consistently enforce realistic consequences.
B. Make exceptions whenever the client becomes angry.
C. Threaten consequences staff cannot enforce.
D. Use guilt to produce remorse.
Correct Answer: A. Set clear expectations and consistently enforce realistic consequences.
Explanation: Clear expectations and consistent consequences promote accountability and protect the milieu. Inconsistent
responses can reinforce maladaptive behavior and boundary testing. Moralizing is generally ineffective and nontherapeutic.
Consequences should be realistic, related to behavior, and never punitive.
Question 3. A client with avoidant personality disorder wants friends but fears criticism. Which approach is best?
A. Force immediate large-group participation.
B. Tell the client criticism cannot hurt.
C. Discourage relationships until anxiety disappears.
D. Encourage gradual supportive social interaction.
Correct Answer: D. Encourage gradual supportive social interaction.
Explanation: Avoidant personality disorder involves social inhibition and hypersensitivity to negative evaluation despite a desire for
connection. Gradual, manageable interaction can build confidence. Forced participation may increase anxiety and withdrawal.
Nursing care should support social skill development while respecting the client's pace.
Question 4. Which behavior is most characteristic of narcissistic personality disorder?
A. Progressive memory loss
B. Acute fluctuating inattention
C. A pervasive need for admiration and grandiosity
D. Recurrent contamination rituals
Correct Answer: C. A pervasive need for admiration and grandiosity
Explanation: Narcissistic personality disorder is associated with grandiosity, a need for admiration, and impaired empathy. The
pattern is pervasive and affects interpersonal functioning. Contamination rituals suggest OCD. Fluctuating attention and progressive
memory problems point toward neurocognitive conditions.
Question 5. A client with dependent personality disorder asks the nurse to make every daily decision. What should the
nurse do?
Page 1
,A. Ask another client to decide.
B. Make all decisions to reduce anxiety.
C. Encourage one manageable independent choice at a time.
D. Tell the client dependence is unacceptable.
Correct Answer: C. Encourage one manageable independent choice at a time.
Explanation: Dependent traits include difficulty making everyday decisions without reassurance. Encouraging small independent
choices strengthens autonomy and confidence. Making all decisions reinforces dependency. Support should be offered without
shaming the client.
Question 6. A client with anorexia nervosa has a heart rate of 38/min and dizziness. What is the priority?
A. Group therapy
B. Immediate medical assessment
C. Meal-preference discussion
D. Body-image journaling
Correct Answer: B. Immediate medical assessment
Explanation: Severe bradycardia with dizziness indicates potentially dangerous physiologic compromise from malnutrition. Cardiac
instability takes priority because it can become life-threatening. Psychological and nutritional interventions remain important after
stabilization. Psychiatric nursing priorities still follow airway, breathing, circulation, and physiologic safety.
Question 7. Which complication should be monitored during nutritional rehabilitation after severe prolonged
restriction?
A. Refeeding syndrome
B. Serotonin syndrome
C. Tardive dyskinesia
D. Acute dystonia
Correct Answer: A. Refeeding syndrome
Explanation: Refeeding syndrome can occur when nutrition is reintroduced after significant malnutrition. Insulin-driven electrolyte
shifts, especially hypophosphatemia, may cause cardiac, respiratory, and neurologic complications. Nutritional advancement
therefore requires careful planning and monitoring. The other syndromes are primarily medication-related.
Question 8. A client with bulimia nervosa who vomits frequently has potassium 2.8 mEq/L. Why is this concerning?
A. It is an expected harmless finding.
B. It indicates normal hydration.
C. It confirms opioid intoxication.
D. It increases risk for cardiac dysrhythmias.
Correct Answer: D. It increases risk for cardiac dysrhythmias.
Explanation: Recurrent vomiting can cause significant potassium loss. Hypokalemia can produce weakness and dangerous
cardiac dysrhythmias. Electrolytes and cardiac status are therefore important assessment priorities in purging disorders. A
potassium of 2.8 mEq/L warrants prompt clinical attention.
Question 9. Which finding is commonly associated with recurrent self-induced vomiting?
A. Profound bradykinesia
B. Lead-pipe rigidity
C. Pinpoint pupils
D. Dental enamel erosion
Correct Answer: D. Dental enamel erosion
Page 2
,Explanation: Gastric acid repeatedly contacting the teeth can erode dental enamel. Clients may also develop parotid enlargement,
electrolyte disturbances, and hand calluses. Pinpoint pupils suggest opioid effects, and lead-pipe rigidity may occur in neuroleptic
malignant syndrome. Medical assessment is essential in eating disorders.
Question 10. How does binge-eating disorder generally differ from bulimia nervosa?
A. It never involves loss of control.
B. The disorders are identical.
C. Binges occur without regular compensatory behaviors such as purging.
D. It always produces dangerously low weight.
Correct Answer: C. Binges occur without regular compensatory behaviors such as purging.
Explanation: Binge-eating disorder involves recurrent binge episodes with distress but without the regular inappropriate
compensatory behaviors characteristic of bulimia. Body weight can vary considerably. Both disorders may involve a sense of loss of
control while eating. Accurate differentiation helps guide treatment.
Question 11. A client stopped heavy daily alcohol use 10 hours ago and has tremor, diaphoresis, anxiety, and
tachycardia. What should the nurse suspect?
A. Stable remission
B. Alcohol withdrawal
C. Cannabis intoxication
D. Opioid overdose
Correct Answer: B. Alcohol withdrawal
Explanation: Autonomic hyperactivity, tremor, and anxiety after cessation of heavy alcohol use are typical withdrawal findings.
Alcohol withdrawal can progress to seizures or delirium and requires monitoring and treatment. Opioid overdose more often causes
respiratory depression and decreased consciousness. Withdrawal severity should be assessed systematically.
Question 12. Which alcohol-withdrawal finding requires the most urgent intervention?
A. Generalized seizure
B. Mild insomnia
C. Request for fluids
D. Mild anxiety
Correct Answer: A. Generalized seizure
Explanation: Alcohol-withdrawal seizures represent severe withdrawal and create immediate risks of injury and further
deterioration. Severe withdrawal can progress to delirium and marked autonomic instability. Mild anxiety and insomnia are common
but less urgent. Airway, safety, seizure management, and prescribed treatment are priorities.
Question 13. Why is thiamine commonly administered to clients at risk from chronic heavy alcohol use?
A. To prevent or treat neurologic complications of thiamine deficiency
B. To reverse opioid overdose
C. To eliminate alcohol instantly
D. To prevent every future craving
Correct Answer: A. To prevent or treat neurologic complications of thiamine deficiency
Explanation: Chronic heavy alcohol use can be associated with poor nutrition and thiamine deficiency. Deficiency can contribute to
serious neurologic syndromes, so replacement is an important component of care in at-risk clients. Thiamine is not an opioid
antagonist. Recovery also requires broader medical and psychosocial treatment.
Question 14. A client is unresponsive with respirations of 6/min and pinpoint pupils after suspected opioid use. What
is the priority?
A. Give an oral sedative.
B. Encourage walking.
Page 3
, C. Wait for spontaneous awakening.
D. Support airway and breathing and give naloxone as indicated.
Correct Answer: D. Support airway and breathing and give naloxone as indicated.
Explanation: Severe respiratory depression is the immediate life threat in opioid overdose. Airway and ventilation are priorities, and
naloxone can reverse opioid effects. Continued observation is necessary because naloxone may wear off before the opioid. Waiting
or adding a CNS depressant can be dangerous.
Question 15. Why must a client be monitored after naloxone reverses an opioid overdose?
A. Naloxone always causes prolonged coma.
B. The opioid stays inactive for days.
C. Naloxone may wear off before the opioid does.
D. Naloxone prevents all future overdoses.
Correct Answer: C. Naloxone may wear off before the opioid does.
Explanation: Naloxone's duration can be shorter than that of the opioid, allowing respiratory depression to recur. Repeated doses
may be necessary depending on the exposure. Respiratory and neurologic monitoring should continue after initial improvement.
Reversal does not eliminate the need for emergency evaluation.
Question 16. Which finding is most consistent with stimulant intoxication?
A. Rhinorrhea and yawning only
B. Tachycardia, hypertension, agitation, and dilated pupils
C. Profound sedation with bradycardia
D. Respirations of 5/min and pinpoint pupils
Correct Answer: B. Tachycardia, hypertension, agitation, and dilated pupils
Explanation: Stimulants such as cocaine and amphetamines increase sympathetic activity. Intoxication can cause tachycardia,
hypertension, agitation, hyperthermia, and mydriasis. Severe cases may produce seizures, dysrhythmias, or psychosis. Respiratory
depression with miosis is more characteristic of opioid toxicity.
Question 17. Which findings are typical of opioid withdrawal?
A. Profound sedation and apnea
B. Diarrhea, rhinorrhea, yawning, myalgias, and dilated pupils
C. High fever with lead-pipe rigidity
D. Respiratory depression and pinpoint pupils
Correct Answer: B. Diarrhea, rhinorrhea, yawning, myalgias, and dilated pupils
Explanation: Opioid withdrawal commonly produces autonomic and gastrointestinal symptoms including rhinorrhea, yawning,
diarrhea, piloerection, myalgias, and mydriasis. It is extremely uncomfortable but usually less medically dangerous than severe
alcohol or sedative withdrawal. Opioid intoxication produces CNS and respiratory depression. Treatment can include
evidence-based medications for opioid use disorder.
Question 18. Which teaching is essential for a client taking disulfiram?
A. Avoid alcohol-containing products because alcohol can cause a severe reaction.
B. Drink alcohol only with meals.
C. Use it to reverse opioid overdose.
D. Skip one dose before drinking.
Correct Answer: A. Avoid alcohol-containing products because alcohol can cause a severe reaction.
Explanation: Disulfiram interferes with alcohol metabolism and can cause a significant adverse reaction if alcohol is consumed.
Clients should be taught about hidden alcohol in some products and follow prescriber instructions. It is not an opioid antagonist.
Medication should be integrated with a broader recovery plan.
Question 19. Which medication is commonly used to treat opioid use disorder?
Page 4
With Answers and Explanations
600-Question Comprehensive Mock Exam
Question 1. A client with borderline personality disorder tells one nurse that all other staff are terrible. What is the best
response?
A. Invite the client to rank staff members.
B. Explain that staff use a consistent plan and limits.
C. Agree that the other staff are difficult.
D. Assign only the preferred nurse.
Correct Answer: B. Explain that staff use a consistent plan and limits.
Explanation: Clients with borderline personality disorder may use splitting, viewing people as all good or all bad. A unified staff
approach with consistent limits reduces reinforcement of splitting. Taking sides can intensify unstable relationships and staff
conflict. The nurse should remain neutral and focus on treatment goals.
Question 2. A client with antisocial personality disorder repeatedly violates unit rules. Which intervention is best?
A. Set clear expectations and consistently enforce realistic consequences.
B. Make exceptions whenever the client becomes angry.
C. Threaten consequences staff cannot enforce.
D. Use guilt to produce remorse.
Correct Answer: A. Set clear expectations and consistently enforce realistic consequences.
Explanation: Clear expectations and consistent consequences promote accountability and protect the milieu. Inconsistent
responses can reinforce maladaptive behavior and boundary testing. Moralizing is generally ineffective and nontherapeutic.
Consequences should be realistic, related to behavior, and never punitive.
Question 3. A client with avoidant personality disorder wants friends but fears criticism. Which approach is best?
A. Force immediate large-group participation.
B. Tell the client criticism cannot hurt.
C. Discourage relationships until anxiety disappears.
D. Encourage gradual supportive social interaction.
Correct Answer: D. Encourage gradual supportive social interaction.
Explanation: Avoidant personality disorder involves social inhibition and hypersensitivity to negative evaluation despite a desire for
connection. Gradual, manageable interaction can build confidence. Forced participation may increase anxiety and withdrawal.
Nursing care should support social skill development while respecting the client's pace.
Question 4. Which behavior is most characteristic of narcissistic personality disorder?
A. Progressive memory loss
B. Acute fluctuating inattention
C. A pervasive need for admiration and grandiosity
D. Recurrent contamination rituals
Correct Answer: C. A pervasive need for admiration and grandiosity
Explanation: Narcissistic personality disorder is associated with grandiosity, a need for admiration, and impaired empathy. The
pattern is pervasive and affects interpersonal functioning. Contamination rituals suggest OCD. Fluctuating attention and progressive
memory problems point toward neurocognitive conditions.
Question 5. A client with dependent personality disorder asks the nurse to make every daily decision. What should the
nurse do?
Page 1
,A. Ask another client to decide.
B. Make all decisions to reduce anxiety.
C. Encourage one manageable independent choice at a time.
D. Tell the client dependence is unacceptable.
Correct Answer: C. Encourage one manageable independent choice at a time.
Explanation: Dependent traits include difficulty making everyday decisions without reassurance. Encouraging small independent
choices strengthens autonomy and confidence. Making all decisions reinforces dependency. Support should be offered without
shaming the client.
Question 6. A client with anorexia nervosa has a heart rate of 38/min and dizziness. What is the priority?
A. Group therapy
B. Immediate medical assessment
C. Meal-preference discussion
D. Body-image journaling
Correct Answer: B. Immediate medical assessment
Explanation: Severe bradycardia with dizziness indicates potentially dangerous physiologic compromise from malnutrition. Cardiac
instability takes priority because it can become life-threatening. Psychological and nutritional interventions remain important after
stabilization. Psychiatric nursing priorities still follow airway, breathing, circulation, and physiologic safety.
Question 7. Which complication should be monitored during nutritional rehabilitation after severe prolonged
restriction?
A. Refeeding syndrome
B. Serotonin syndrome
C. Tardive dyskinesia
D. Acute dystonia
Correct Answer: A. Refeeding syndrome
Explanation: Refeeding syndrome can occur when nutrition is reintroduced after significant malnutrition. Insulin-driven electrolyte
shifts, especially hypophosphatemia, may cause cardiac, respiratory, and neurologic complications. Nutritional advancement
therefore requires careful planning and monitoring. The other syndromes are primarily medication-related.
Question 8. A client with bulimia nervosa who vomits frequently has potassium 2.8 mEq/L. Why is this concerning?
A. It is an expected harmless finding.
B. It indicates normal hydration.
C. It confirms opioid intoxication.
D. It increases risk for cardiac dysrhythmias.
Correct Answer: D. It increases risk for cardiac dysrhythmias.
Explanation: Recurrent vomiting can cause significant potassium loss. Hypokalemia can produce weakness and dangerous
cardiac dysrhythmias. Electrolytes and cardiac status are therefore important assessment priorities in purging disorders. A
potassium of 2.8 mEq/L warrants prompt clinical attention.
Question 9. Which finding is commonly associated with recurrent self-induced vomiting?
A. Profound bradykinesia
B. Lead-pipe rigidity
C. Pinpoint pupils
D. Dental enamel erosion
Correct Answer: D. Dental enamel erosion
Page 2
,Explanation: Gastric acid repeatedly contacting the teeth can erode dental enamel. Clients may also develop parotid enlargement,
electrolyte disturbances, and hand calluses. Pinpoint pupils suggest opioid effects, and lead-pipe rigidity may occur in neuroleptic
malignant syndrome. Medical assessment is essential in eating disorders.
Question 10. How does binge-eating disorder generally differ from bulimia nervosa?
A. It never involves loss of control.
B. The disorders are identical.
C. Binges occur without regular compensatory behaviors such as purging.
D. It always produces dangerously low weight.
Correct Answer: C. Binges occur without regular compensatory behaviors such as purging.
Explanation: Binge-eating disorder involves recurrent binge episodes with distress but without the regular inappropriate
compensatory behaviors characteristic of bulimia. Body weight can vary considerably. Both disorders may involve a sense of loss of
control while eating. Accurate differentiation helps guide treatment.
Question 11. A client stopped heavy daily alcohol use 10 hours ago and has tremor, diaphoresis, anxiety, and
tachycardia. What should the nurse suspect?
A. Stable remission
B. Alcohol withdrawal
C. Cannabis intoxication
D. Opioid overdose
Correct Answer: B. Alcohol withdrawal
Explanation: Autonomic hyperactivity, tremor, and anxiety after cessation of heavy alcohol use are typical withdrawal findings.
Alcohol withdrawal can progress to seizures or delirium and requires monitoring and treatment. Opioid overdose more often causes
respiratory depression and decreased consciousness. Withdrawal severity should be assessed systematically.
Question 12. Which alcohol-withdrawal finding requires the most urgent intervention?
A. Generalized seizure
B. Mild insomnia
C. Request for fluids
D. Mild anxiety
Correct Answer: A. Generalized seizure
Explanation: Alcohol-withdrawal seizures represent severe withdrawal and create immediate risks of injury and further
deterioration. Severe withdrawal can progress to delirium and marked autonomic instability. Mild anxiety and insomnia are common
but less urgent. Airway, safety, seizure management, and prescribed treatment are priorities.
Question 13. Why is thiamine commonly administered to clients at risk from chronic heavy alcohol use?
A. To prevent or treat neurologic complications of thiamine deficiency
B. To reverse opioid overdose
C. To eliminate alcohol instantly
D. To prevent every future craving
Correct Answer: A. To prevent or treat neurologic complications of thiamine deficiency
Explanation: Chronic heavy alcohol use can be associated with poor nutrition and thiamine deficiency. Deficiency can contribute to
serious neurologic syndromes, so replacement is an important component of care in at-risk clients. Thiamine is not an opioid
antagonist. Recovery also requires broader medical and psychosocial treatment.
Question 14. A client is unresponsive with respirations of 6/min and pinpoint pupils after suspected opioid use. What
is the priority?
A. Give an oral sedative.
B. Encourage walking.
Page 3
, C. Wait for spontaneous awakening.
D. Support airway and breathing and give naloxone as indicated.
Correct Answer: D. Support airway and breathing and give naloxone as indicated.
Explanation: Severe respiratory depression is the immediate life threat in opioid overdose. Airway and ventilation are priorities, and
naloxone can reverse opioid effects. Continued observation is necessary because naloxone may wear off before the opioid. Waiting
or adding a CNS depressant can be dangerous.
Question 15. Why must a client be monitored after naloxone reverses an opioid overdose?
A. Naloxone always causes prolonged coma.
B. The opioid stays inactive for days.
C. Naloxone may wear off before the opioid does.
D. Naloxone prevents all future overdoses.
Correct Answer: C. Naloxone may wear off before the opioid does.
Explanation: Naloxone's duration can be shorter than that of the opioid, allowing respiratory depression to recur. Repeated doses
may be necessary depending on the exposure. Respiratory and neurologic monitoring should continue after initial improvement.
Reversal does not eliminate the need for emergency evaluation.
Question 16. Which finding is most consistent with stimulant intoxication?
A. Rhinorrhea and yawning only
B. Tachycardia, hypertension, agitation, and dilated pupils
C. Profound sedation with bradycardia
D. Respirations of 5/min and pinpoint pupils
Correct Answer: B. Tachycardia, hypertension, agitation, and dilated pupils
Explanation: Stimulants such as cocaine and amphetamines increase sympathetic activity. Intoxication can cause tachycardia,
hypertension, agitation, hyperthermia, and mydriasis. Severe cases may produce seizures, dysrhythmias, or psychosis. Respiratory
depression with miosis is more characteristic of opioid toxicity.
Question 17. Which findings are typical of opioid withdrawal?
A. Profound sedation and apnea
B. Diarrhea, rhinorrhea, yawning, myalgias, and dilated pupils
C. High fever with lead-pipe rigidity
D. Respiratory depression and pinpoint pupils
Correct Answer: B. Diarrhea, rhinorrhea, yawning, myalgias, and dilated pupils
Explanation: Opioid withdrawal commonly produces autonomic and gastrointestinal symptoms including rhinorrhea, yawning,
diarrhea, piloerection, myalgias, and mydriasis. It is extremely uncomfortable but usually less medically dangerous than severe
alcohol or sedative withdrawal. Opioid intoxication produces CNS and respiratory depression. Treatment can include
evidence-based medications for opioid use disorder.
Question 18. Which teaching is essential for a client taking disulfiram?
A. Avoid alcohol-containing products because alcohol can cause a severe reaction.
B. Drink alcohol only with meals.
C. Use it to reverse opioid overdose.
D. Skip one dose before drinking.
Correct Answer: A. Avoid alcohol-containing products because alcohol can cause a severe reaction.
Explanation: Disulfiram interferes with alcohol metabolism and can cause a significant adverse reaction if alcohol is consumed.
Clients should be taught about hidden alcohol in some products and follow prescriber instructions. It is not an opioid antagonist.
Medication should be integrated with a broader recovery plan.
Question 19. Which medication is commonly used to treat opioid use disorder?
Page 4
