NSRG 126 Exam 4 V3 | NSRG 126 Mental Health
Nursing | Actual Q&A with Rationale (NSRG126
Exam 4) | Ivy Tech
1. A nurse is caring for a client with Borderline Personality Disorder. Which of the following
behaviors is the nurse most likely to observe?
A. Perfectionism and preoccupation with orderliness
B. Consistent lack of remorse for violating the rights of others
C. Extreme emotional lability and splitting
D. Social withdrawal and lack of interest in relationships
Correct Answer: C
Explanation: Borderline Personality Disorder is characterized by instability in affect,
identity, and relationships. Splitting is a common defense mechanism where individuals see
others as either all good or all bad. This behavior often leads to frequent crises and intense,
unstable interpersonal relationships.
2. A client is admitted to the emergency department displaying tremors, diaphoresis, and a
heart rate of 110 bpm. The client’s last alcoholic drink was 24 hours ago. Which stage of
alcohol withdrawal is the client experiencing?
A. Delirium tremens
B. Wernicke-Korsakoff syndrome
,C. Mild to moderate withdrawal symptoms
D. Alcoholic hallucinosis
Correct Answer: C
Explanation: The client is exhibiting early signs of alcohol withdrawal, which typically
occur within 6 to 24 hours after the last drink. Symptoms include tachycardia,
hypertension, tremors, and anxiety. It is critical to monitor the client closely as these
symptoms can progress to more severe stages like seizures or delirium.
3. A nurse is assessing a client for potential Anorexia Nervosa. Which physical finding should
the nurse recognize as a common manifestation of this disorder?
A. Lanugo on the back and face
B. Hyperkalemia
C. Hypertension
D. Increased core body temperature
Correct Answer: A
Explanation: Lanugo, or fine downy hair, grows as a physiological response to extreme
weight loss and the body’s attempt to provide insulation. Clients with Anorexia Nervosa
also frequently exhibit bradycardia, hypotension, and hypothermia. These symptoms are
indicative of a severe state of starvation and metabolic slowdown.
, 4. Which of the following interventions is a priority for a nurse when working with a client
who has Antisocial Personality Disorder?
A. Setting clear, consistent limits on manipulative behavior
B. Encouraging the client to lead group therapy sessions
C. Providing a warm, unstructured environment
D. Allowing the client to negotiate the unit rules
Correct Answer: A
Explanation: Clients with Antisocial Personality Disorder often exhibit manipulative and
impulsive behaviors while disregarding the rights of others. Establishing firm and
consistent boundaries is essential to maintain safety and prevent the client from exploiting
others. All staff members must be consistent in enforcing these limits to be effective.
5. A client who recently lost their job and their home in a fire is experiencing which type of
crisis?
A. Situational and adventitious crisis
B. Maturational crisis
C. Developmental crisis
D. Internal crisis
Correct Answer: A
Nursing | Actual Q&A with Rationale (NSRG126
Exam 4) | Ivy Tech
1. A nurse is caring for a client with Borderline Personality Disorder. Which of the following
behaviors is the nurse most likely to observe?
A. Perfectionism and preoccupation with orderliness
B. Consistent lack of remorse for violating the rights of others
C. Extreme emotional lability and splitting
D. Social withdrawal and lack of interest in relationships
Correct Answer: C
Explanation: Borderline Personality Disorder is characterized by instability in affect,
identity, and relationships. Splitting is a common defense mechanism where individuals see
others as either all good or all bad. This behavior often leads to frequent crises and intense,
unstable interpersonal relationships.
2. A client is admitted to the emergency department displaying tremors, diaphoresis, and a
heart rate of 110 bpm. The client’s last alcoholic drink was 24 hours ago. Which stage of
alcohol withdrawal is the client experiencing?
A. Delirium tremens
B. Wernicke-Korsakoff syndrome
,C. Mild to moderate withdrawal symptoms
D. Alcoholic hallucinosis
Correct Answer: C
Explanation: The client is exhibiting early signs of alcohol withdrawal, which typically
occur within 6 to 24 hours after the last drink. Symptoms include tachycardia,
hypertension, tremors, and anxiety. It is critical to monitor the client closely as these
symptoms can progress to more severe stages like seizures or delirium.
3. A nurse is assessing a client for potential Anorexia Nervosa. Which physical finding should
the nurse recognize as a common manifestation of this disorder?
A. Lanugo on the back and face
B. Hyperkalemia
C. Hypertension
D. Increased core body temperature
Correct Answer: A
Explanation: Lanugo, or fine downy hair, grows as a physiological response to extreme
weight loss and the body’s attempt to provide insulation. Clients with Anorexia Nervosa
also frequently exhibit bradycardia, hypotension, and hypothermia. These symptoms are
indicative of a severe state of starvation and metabolic slowdown.
, 4. Which of the following interventions is a priority for a nurse when working with a client
who has Antisocial Personality Disorder?
A. Setting clear, consistent limits on manipulative behavior
B. Encouraging the client to lead group therapy sessions
C. Providing a warm, unstructured environment
D. Allowing the client to negotiate the unit rules
Correct Answer: A
Explanation: Clients with Antisocial Personality Disorder often exhibit manipulative and
impulsive behaviors while disregarding the rights of others. Establishing firm and
consistent boundaries is essential to maintain safety and prevent the client from exploiting
others. All staff members must be consistent in enforcing these limits to be effective.
5. A client who recently lost their job and their home in a fire is experiencing which type of
crisis?
A. Situational and adventitious crisis
B. Maturational crisis
C. Developmental crisis
D. Internal crisis
Correct Answer: A
