NSG 3450 Exam 4 V1 | NSG 3450 Mental Health
Guide | Actual Q&A with Rationale (NSG3450 Exam
4) | Galen College of Nursing
1. A nurse is assessing a client with anorexia nervosa who has a BMI of 16. Which
physiological finding should the nurse prioritize?
A. Presence of lanugo on the back and arms
B. Complaints of feeling cold all the time
C. Bradycardia and orthostatic hypotension
D. Dry, yellowish skin texture
Correct Answer: C
Explanation: The nurse must prioritize physiological stability, specifically cardiac function.
Bradycardia and orthostatic hypotension indicate severe cardiovascular compromise and
potential for collapse. Monitoring vital signs is the first priority in an acute care setting for
eating disorders.
2. A client with bulimia nervosa is admitted to the psychiatric unit. Which assessment finding
is most characteristic of this disorder?
A. Severe weight loss of 25% or more
B. Calluses on the knuckles (Russell’s sign)
C. Amenorrhea for at least three cycles
,D. Preference for eating alone in public
Correct Answer: B
Explanation: Russell’s sign is a common physical indicator of repeated self-induced
vomiting. Unlike anorexia, clients with bulimia usually maintain a weight within or slightly
above the normal range. Identifying these physical marks helps the nurse assess the
severity of purging behaviors.
3. An elderly client is experiencing sudden confusion, fluctuating levels of consciousness, and
visual hallucinations. The nurse suspects:
A. Delirium
B. Alzheimer’s disease
C. Schizophrenia
D. Major Depressive Disorder
Correct Answer: A
Explanation: Delirium is characterized by an acute onset, fluctuating course, and
disturbances in consciousness. It is often caused by an underlying medical condition, such
as a urinary tract infection or electrolyte imbalance. In contrast, dementia follows a slow,
progressive decline without initial changes in consciousness.
4. Which nursing intervention is most appropriate for a client with Alzheimer’s disease who is
experiencing agnosia?
A. Provide a detailed map of the facility
, B. Cover mirrors to prevent agitation
C. Place signs on doors to identify rooms
D. Use simple, one-step instructions
Correct Answer: C
Explanation: Agnosia is the inability to recognize familiar objects or people. Labeling
rooms and objects with simple signs or pictures helps the client navigate the environment
safely. This intervention supports independence while minimizing confusion associated
with sensory processing deficits.
5. A nurse is caring for a client with Borderline Personality Disorder who is ‘splitting’ staff
members. What is the best nursing approach?
A. Allow the client to choose their favorite nurse
B. Assign the client to a different nurse each shift
C. Confront the client about their manipulative behavior
D. Hold a staff meeting to ensure a consistent approach
Correct Answer: D
Explanation: Splitting is a defense mechanism where the client views individuals as all
good or all bad. Consistency among the treatment team is vital to prevent the client from
playing staff against each other. Regular staff meetings help maintain boundaries and
ensure a unified care plan.
Guide | Actual Q&A with Rationale (NSG3450 Exam
4) | Galen College of Nursing
1. A nurse is assessing a client with anorexia nervosa who has a BMI of 16. Which
physiological finding should the nurse prioritize?
A. Presence of lanugo on the back and arms
B. Complaints of feeling cold all the time
C. Bradycardia and orthostatic hypotension
D. Dry, yellowish skin texture
Correct Answer: C
Explanation: The nurse must prioritize physiological stability, specifically cardiac function.
Bradycardia and orthostatic hypotension indicate severe cardiovascular compromise and
potential for collapse. Monitoring vital signs is the first priority in an acute care setting for
eating disorders.
2. A client with bulimia nervosa is admitted to the psychiatric unit. Which assessment finding
is most characteristic of this disorder?
A. Severe weight loss of 25% or more
B. Calluses on the knuckles (Russell’s sign)
C. Amenorrhea for at least three cycles
,D. Preference for eating alone in public
Correct Answer: B
Explanation: Russell’s sign is a common physical indicator of repeated self-induced
vomiting. Unlike anorexia, clients with bulimia usually maintain a weight within or slightly
above the normal range. Identifying these physical marks helps the nurse assess the
severity of purging behaviors.
3. An elderly client is experiencing sudden confusion, fluctuating levels of consciousness, and
visual hallucinations. The nurse suspects:
A. Delirium
B. Alzheimer’s disease
C. Schizophrenia
D. Major Depressive Disorder
Correct Answer: A
Explanation: Delirium is characterized by an acute onset, fluctuating course, and
disturbances in consciousness. It is often caused by an underlying medical condition, such
as a urinary tract infection or electrolyte imbalance. In contrast, dementia follows a slow,
progressive decline without initial changes in consciousness.
4. Which nursing intervention is most appropriate for a client with Alzheimer’s disease who is
experiencing agnosia?
A. Provide a detailed map of the facility
, B. Cover mirrors to prevent agitation
C. Place signs on doors to identify rooms
D. Use simple, one-step instructions
Correct Answer: C
Explanation: Agnosia is the inability to recognize familiar objects or people. Labeling
rooms and objects with simple signs or pictures helps the client navigate the environment
safely. This intervention supports independence while minimizing confusion associated
with sensory processing deficits.
5. A nurse is caring for a client with Borderline Personality Disorder who is ‘splitting’ staff
members. What is the best nursing approach?
A. Allow the client to choose their favorite nurse
B. Assign the client to a different nurse each shift
C. Confront the client about their manipulative behavior
D. Hold a staff meeting to ensure a consistent approach
Correct Answer: D
Explanation: Splitting is a defense mechanism where the client views individuals as all
good or all bad. Consistency among the treatment team is vital to prevent the client from
playing staff against each other. Regular staff meetings help maintain boundaries and
ensure a unified care plan.
