NSG 3450 Final Exam V3 | NSG 3450 Mental Health
Guide | Actual Q&A with Rationale (NSG3450 Final
Exam) | Galen College of Nursing
1. A nurse is caring for a client who has a prescription for lithium carbonate to treat bipolar
disorder. Which of the following findings should the nurse identify as an early indication of
lithium toxicity?
A. Severe hypertension
B. Fine hand tremors and nausea
C. Urinary retention
D. Coarse tremors and confusion
Correct Answer: B
Explanation: Early signs of lithium toxicity often manifest as gastrointestinal distress and
mild neurological changes. Fine hand tremors, nausea, vomiting, and diarrhea are common
indicators that the serum lithium level is approaching or slightly exceeding the therapeutic
range. The nurse must monitor these symptoms closely to prevent progression to more
severe neurotoxicity.
2. A nurse is conducting a mental status examination on a client who is experiencing a manic
episode. The client is speaking rapidly and shifting from one topic to another. The nurse
should document this as which of the following?
A. Flight of ideas
,B. Concrete thinking
C. Neologisms
D. Clang associations
Correct Answer: A
Explanation: Flight of ideas is characterized by a nearly continuous flow of accelerated
speech with abrupt changes from topic to topic. This is a hallmark symptom of mania in
bipolar disorder where the thoughts are loosely connected but follow a logical progression,
albeit very fast. This differs from clang associations, which rely on rhyming, or neologisms,
which are made-up words.
3. Which of the following interventions is a priority for a nurse when caring for a client
experiencing a panic attack?
A. Stay with the client and remain calm.
B. Instruct the client to use progressive muscle relaxation.
C. Ask the client to identify the trigger of the attack.
D. Encourage the client to describe their feelings in detail.
Correct Answer: A
Explanation: During a panic attack, the client’s ability to process information is severely
limited due to extreme anxiety. The primary nursing goal is to provide safety and reduce
,external stimuli by staying with the client in a quiet environment. Using a calm, low-pitched
voice helps reassure the client and promotes a sense of security until the attack subsides.
4. A client is admitted to the psychiatric unit with a diagnosis of schizophrenia and is
experiencing auditory hallucinations. What is the most appropriate initial response by the
nurse?
A. I don’t hear the voices, but I can see that you are upset.
B. Tell the voices to go away so we can talk.
C. What are the voices telling you to do?
D. Why do you think you are hearing those voices?
Correct Answer: C
Explanation: Safety is the priority when a client is experiencing hallucinations, particularly
auditory ones. The nurse must determine if the voices are ‘command hallucinations’ that
might instruct the client to harm themselves or others. Once safety is assessed, the nurse
can then validate that they do not hear the voices while acknowledging the client’s
experience.
5. A client taking clozapine for treatment-resistant schizophrenia must have which laboratory
test performed weekly for the first six months?
A. Liver function tests (LFTs)
B. Complete blood count (CBC) with differential
C. Blood urea nitrogen (BUN) and creatinine
, D. Serum glucose levels
Correct Answer: B
Explanation: Clozapine carries a significant risk of agranulocytosis, which is a life-
threatening drop in white blood cell counts. Regular monitoring of the absolute neutrophil
count (ANC) via a CBC with differential is mandatory to ensure the safety of the patient. If
the count falls below a specific threshold, the medication must be discontinued
immediately to prevent severe infection.
6. A nurse is assessing a client for Neuroleptic Malignant Syndrome (NMS) after starting a
first-generation antipsychotic. Which symptom is a hallmark sign of this condition?
A. Extreme muscle rigidity and high fever
B. Hypotension and bradycardia
C. Excessive salivation and drooling
D. Pinpoint pupils and respiratory depression
Correct Answer: A
Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening reaction to
antipsychotic drugs characterized by ‘lead pipe’ muscle rigidity, high fever (hyperpyrexia),
and autonomic instability. It requires immediate medical intervention, including stopping
the causative agent and supportive care. Vital signs typically show tachycardia and
fluctuating blood pressure alongside the elevated temperature.
Guide | Actual Q&A with Rationale (NSG3450 Final
Exam) | Galen College of Nursing
1. A nurse is caring for a client who has a prescription for lithium carbonate to treat bipolar
disorder. Which of the following findings should the nurse identify as an early indication of
lithium toxicity?
A. Severe hypertension
B. Fine hand tremors and nausea
C. Urinary retention
D. Coarse tremors and confusion
Correct Answer: B
Explanation: Early signs of lithium toxicity often manifest as gastrointestinal distress and
mild neurological changes. Fine hand tremors, nausea, vomiting, and diarrhea are common
indicators that the serum lithium level is approaching or slightly exceeding the therapeutic
range. The nurse must monitor these symptoms closely to prevent progression to more
severe neurotoxicity.
2. A nurse is conducting a mental status examination on a client who is experiencing a manic
episode. The client is speaking rapidly and shifting from one topic to another. The nurse
should document this as which of the following?
A. Flight of ideas
,B. Concrete thinking
C. Neologisms
D. Clang associations
Correct Answer: A
Explanation: Flight of ideas is characterized by a nearly continuous flow of accelerated
speech with abrupt changes from topic to topic. This is a hallmark symptom of mania in
bipolar disorder where the thoughts are loosely connected but follow a logical progression,
albeit very fast. This differs from clang associations, which rely on rhyming, or neologisms,
which are made-up words.
3. Which of the following interventions is a priority for a nurse when caring for a client
experiencing a panic attack?
A. Stay with the client and remain calm.
B. Instruct the client to use progressive muscle relaxation.
C. Ask the client to identify the trigger of the attack.
D. Encourage the client to describe their feelings in detail.
Correct Answer: A
Explanation: During a panic attack, the client’s ability to process information is severely
limited due to extreme anxiety. The primary nursing goal is to provide safety and reduce
,external stimuli by staying with the client in a quiet environment. Using a calm, low-pitched
voice helps reassure the client and promotes a sense of security until the attack subsides.
4. A client is admitted to the psychiatric unit with a diagnosis of schizophrenia and is
experiencing auditory hallucinations. What is the most appropriate initial response by the
nurse?
A. I don’t hear the voices, but I can see that you are upset.
B. Tell the voices to go away so we can talk.
C. What are the voices telling you to do?
D. Why do you think you are hearing those voices?
Correct Answer: C
Explanation: Safety is the priority when a client is experiencing hallucinations, particularly
auditory ones. The nurse must determine if the voices are ‘command hallucinations’ that
might instruct the client to harm themselves or others. Once safety is assessed, the nurse
can then validate that they do not hear the voices while acknowledging the client’s
experience.
5. A client taking clozapine for treatment-resistant schizophrenia must have which laboratory
test performed weekly for the first six months?
A. Liver function tests (LFTs)
B. Complete blood count (CBC) with differential
C. Blood urea nitrogen (BUN) and creatinine
, D. Serum glucose levels
Correct Answer: B
Explanation: Clozapine carries a significant risk of agranulocytosis, which is a life-
threatening drop in white blood cell counts. Regular monitoring of the absolute neutrophil
count (ANC) via a CBC with differential is mandatory to ensure the safety of the patient. If
the count falls below a specific threshold, the medication must be discontinued
immediately to prevent severe infection.
6. A nurse is assessing a client for Neuroleptic Malignant Syndrome (NMS) after starting a
first-generation antipsychotic. Which symptom is a hallmark sign of this condition?
A. Extreme muscle rigidity and high fever
B. Hypotension and bradycardia
C. Excessive salivation and drooling
D. Pinpoint pupils and respiratory depression
Correct Answer: A
Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening reaction to
antipsychotic drugs characterized by ‘lead pipe’ muscle rigidity, high fever (hyperpyrexia),
and autonomic instability. It requires immediate medical intervention, including stopping
the causative agent and supportive care. Vital signs typically show tachycardia and
fluctuating blood pressure alongside the elevated temperature.
