NFDN 2007 MENTAL HEALTH EXAM
QUESTIONS AND VERIFIED ANSWERS.
JUST RELEASED
1. A client diagnosed with schizophrenia is experiencing auditory hallucinations. Which
nursing intervention is considered the highest priority?
A. Asking the client what the voices are saying to assess for safety.
B. Telling the client that the voices are not real and part of the illness.
C. Turning on the radio or television to provide distracting stimuli.
D. Administering a PRN dose of a benzodiazepine to reduce anxiety.
Answer: A
Conceptual Explanation: Safety is the priority. The nurse must determine if the
hallucinations are ‘command hallucinations’ which could instruct the client to harm
themselves or others.
2. Which electrolyte imbalance should a nurse monitor for most closely in a client taking
Lithium Carbonate?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
,D. Hypermagnesemia
Answer: A
Conceptual Explanation: Lithium is a salt. Low sodium levels (hyponatremia) cause the
kidneys to retain lithium, which can lead to toxicity.
3. A client is admitted with a diagnosis of Neuroleptic Malignant Syndrome (NMS). Which
clinical finding is a hallmark symptom of this condition?
A. Severe muscle rigidity and hyperpyrexia
B. Hypothermia and bradycardia
C. Excessive salivation and diarrhea
D. Grandiosity and pressured speech
Answer: A
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by lead-pipe muscle rigidity, high fever (hyperpyrexia), and autonomic
instability.
4. A nurse is caring for a client with Bipolar I Disorder in the manic phase. Which meal choice
is most appropriate for this client?
A. A cheeseburger, an apple, and a carton of milk.
B. Spaghetti with meatballs and a side salad.
C. A large bowl of hot soup and crackers.
, D. Steak with mashed potatoes and gravy.
Answer: A
Conceptual Explanation: Clients in a manic state are hyperactive and often cannot sit
down to eat. ‘Finger foods’ that are high in protein and calories are best to maintain
nutrition while they move.
5. A client has been prescribed Phenelzine (Nardil). Which food should the nurse instruct the
client to avoid to prevent a hypertensive crisis?
A. Aged cheddar cheese
B. Fresh strawberries
C. Boiled eggs
D. Skim milk
Answer: A
Conceptual Explanation: Phenelzine is an MAOI. Consumption of foods high in tyramine,
such as aged cheese, cured meats, and red wine, can lead to a dangerous increase in blood
pressure.
6. The nurse observes a client with OCD washing their hands for the 10th time in an hour.
What is the most appropriate initial nursing action?
A. Lock the bathroom door to prevent the behavior.
B. Allow the client to complete the ritual to reduce anxiety.
QUESTIONS AND VERIFIED ANSWERS.
JUST RELEASED
1. A client diagnosed with schizophrenia is experiencing auditory hallucinations. Which
nursing intervention is considered the highest priority?
A. Asking the client what the voices are saying to assess for safety.
B. Telling the client that the voices are not real and part of the illness.
C. Turning on the radio or television to provide distracting stimuli.
D. Administering a PRN dose of a benzodiazepine to reduce anxiety.
Answer: A
Conceptual Explanation: Safety is the priority. The nurse must determine if the
hallucinations are ‘command hallucinations’ which could instruct the client to harm
themselves or others.
2. Which electrolyte imbalance should a nurse monitor for most closely in a client taking
Lithium Carbonate?
A. Hyponatremia
B. Hyperkalemia
C. Hypocalcemia
,D. Hypermagnesemia
Answer: A
Conceptual Explanation: Lithium is a salt. Low sodium levels (hyponatremia) cause the
kidneys to retain lithium, which can lead to toxicity.
3. A client is admitted with a diagnosis of Neuroleptic Malignant Syndrome (NMS). Which
clinical finding is a hallmark symptom of this condition?
A. Severe muscle rigidity and hyperpyrexia
B. Hypothermia and bradycardia
C. Excessive salivation and diarrhea
D. Grandiosity and pressured speech
Answer: A
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by lead-pipe muscle rigidity, high fever (hyperpyrexia), and autonomic
instability.
4. A nurse is caring for a client with Bipolar I Disorder in the manic phase. Which meal choice
is most appropriate for this client?
A. A cheeseburger, an apple, and a carton of milk.
B. Spaghetti with meatballs and a side salad.
C. A large bowl of hot soup and crackers.
, D. Steak with mashed potatoes and gravy.
Answer: A
Conceptual Explanation: Clients in a manic state are hyperactive and often cannot sit
down to eat. ‘Finger foods’ that are high in protein and calories are best to maintain
nutrition while they move.
5. A client has been prescribed Phenelzine (Nardil). Which food should the nurse instruct the
client to avoid to prevent a hypertensive crisis?
A. Aged cheddar cheese
B. Fresh strawberries
C. Boiled eggs
D. Skim milk
Answer: A
Conceptual Explanation: Phenelzine is an MAOI. Consumption of foods high in tyramine,
such as aged cheese, cured meats, and red wine, can lead to a dangerous increase in blood
pressure.
6. The nurse observes a client with OCD washing their hands for the 10th time in an hour.
What is the most appropriate initial nursing action?
A. Lock the bathroom door to prevent the behavior.
B. Allow the client to complete the ritual to reduce anxiety.
