, Question 1
A patient with schizophrenia has been stabilized on clozapine for 6 months but
now presents with fever, tachycardia, and a new-onset seizure. Which
laboratory finding is most critical to obtain immediately to guide management?
A. Serum clozapine level
B. Complete blood count with absolute neutrophil count
C. Liver function tests
D. Serum creatinine and electrolytes
Correct Answer: B - Complete blood count with absolute
neutrophil count
RATIONALE
Clozapine can cause severe neutropenia, which may present with fever
and infection; a CBC with ANC is essential to rule out
agranulocytosis. While clozapine levels and LFTs are relevant, the
acute symptoms suggest infection or immunosuppression, making
ANC the priority. Seizures can occur with clozapine toxicity, but fever
and tachycardia strongly indicate infection risk from neutropenia.
Question 2
During a therapeutic communication session, a patient with borderline
personality disorder says, 'You're the only one who understands me; the other
nurses don't care.' Which response best reflects the nurse's understanding of
splitting?
A. 'I'm glad you feel understood, but let's talk about why you feel others
don't care.'
B. 'It sounds like you feel more connected to me than to others; let's
explore those feelings.'
C. 'I appreciate that, but all staff here are committed to your care.'
D. 'You shouldn't say that about your other nurses; they work hard.'
Correct Answer: C - 'I appreciate that, but all staff here are
Page 2
,committed to your care.'
RATIONALE
Splitting involves idealizing one staff member while devaluing others;
the nurse should avoid reinforcing the split by acknowledging the
patient's feelings but affirming that all staff are caring. Option A
invites exploration but may inadvertently validate the idealization.
Option B focuses on feelings but doesn't address the split. Option D is
judgmental and dismissive.
Question 3
Which factor most significantly increases the risk of suicide in a patient with
major depressive disorder who has recently started an SSRI?
A. Improved energy and motivation before mood fully lifts
B. Serotonin syndrome from drug interaction
C. Increased anxiety due to medication side effects
D. Development of akathisia
Correct Answer: A - Improved energy and motivation before
mood fully lifts
RATIONALE
As SSRIs begin to work, energy and motivation may return before
mood improves, increasing suicide risk because the patient now has
the capacity to act on suicidal thoughts. Serotonin syndrome and
akathisia are serious but not the primary reason for increased suicide
risk in early treatment. Increased anxiety can occur but is less directly
linked to suicide than the energy-mood mismatch.
Question 4
A patient with bipolar I disorder in a manic episode is admitted. Which nursing
intervention should be the priority?
A. Provide a stimulating environment to channel energy.
B. Offer frequent high-calorie finger foods and fluids.
Page 3
, C. Encourage group therapy to improve socialization.
D. Set strict limits on manipulative behavior.
Correct Answer: B - Offer frequent high-calorie finger foods and
fluids.
RATIONALE
During mania, patients are at risk for exhaustion and dehydration due
to hyperactivity; providing high-calorie finger foods and fluids
addresses physiological needs. A stimulating environment would
worsen mania. Group therapy may be overstimulating. Limit-setting is
important but not the immediate priority over safety and physiological
stabilization.
Question 5
A patient with PTSD reports frequent flashbacks and hyperarousal. Which
medication class is considered first-line for core PTSD symptoms according to
current guidelines?
A. Benzodiazepines
B. SSRIs
C. Atypical antipsychotics
D. Mood stabilizers
Correct Answer: B - SSRIs
RATIONALE
SSRIs (e.g., sertraline, paroxetine) are first-line for PTSD, reducing
hyperarousal and re-experiencing symptoms. Benzodiazepines are
generally avoided due to risk of dependence and may worsen PTSD.
Atypical antipsychotics and mood stabilizers are adjunctive or for
comorbid symptoms, not first-line.
Page 4
A patient with schizophrenia has been stabilized on clozapine for 6 months but
now presents with fever, tachycardia, and a new-onset seizure. Which
laboratory finding is most critical to obtain immediately to guide management?
A. Serum clozapine level
B. Complete blood count with absolute neutrophil count
C. Liver function tests
D. Serum creatinine and electrolytes
Correct Answer: B - Complete blood count with absolute
neutrophil count
RATIONALE
Clozapine can cause severe neutropenia, which may present with fever
and infection; a CBC with ANC is essential to rule out
agranulocytosis. While clozapine levels and LFTs are relevant, the
acute symptoms suggest infection or immunosuppression, making
ANC the priority. Seizures can occur with clozapine toxicity, but fever
and tachycardia strongly indicate infection risk from neutropenia.
Question 2
During a therapeutic communication session, a patient with borderline
personality disorder says, 'You're the only one who understands me; the other
nurses don't care.' Which response best reflects the nurse's understanding of
splitting?
A. 'I'm glad you feel understood, but let's talk about why you feel others
don't care.'
B. 'It sounds like you feel more connected to me than to others; let's
explore those feelings.'
C. 'I appreciate that, but all staff here are committed to your care.'
D. 'You shouldn't say that about your other nurses; they work hard.'
Correct Answer: C - 'I appreciate that, but all staff here are
Page 2
,committed to your care.'
RATIONALE
Splitting involves idealizing one staff member while devaluing others;
the nurse should avoid reinforcing the split by acknowledging the
patient's feelings but affirming that all staff are caring. Option A
invites exploration but may inadvertently validate the idealization.
Option B focuses on feelings but doesn't address the split. Option D is
judgmental and dismissive.
Question 3
Which factor most significantly increases the risk of suicide in a patient with
major depressive disorder who has recently started an SSRI?
A. Improved energy and motivation before mood fully lifts
B. Serotonin syndrome from drug interaction
C. Increased anxiety due to medication side effects
D. Development of akathisia
Correct Answer: A - Improved energy and motivation before
mood fully lifts
RATIONALE
As SSRIs begin to work, energy and motivation may return before
mood improves, increasing suicide risk because the patient now has
the capacity to act on suicidal thoughts. Serotonin syndrome and
akathisia are serious but not the primary reason for increased suicide
risk in early treatment. Increased anxiety can occur but is less directly
linked to suicide than the energy-mood mismatch.
Question 4
A patient with bipolar I disorder in a manic episode is admitted. Which nursing
intervention should be the priority?
A. Provide a stimulating environment to channel energy.
B. Offer frequent high-calorie finger foods and fluids.
Page 3
, C. Encourage group therapy to improve socialization.
D. Set strict limits on manipulative behavior.
Correct Answer: B - Offer frequent high-calorie finger foods and
fluids.
RATIONALE
During mania, patients are at risk for exhaustion and dehydration due
to hyperactivity; providing high-calorie finger foods and fluids
addresses physiological needs. A stimulating environment would
worsen mania. Group therapy may be overstimulating. Limit-setting is
important but not the immediate priority over safety and physiological
stabilization.
Question 5
A patient with PTSD reports frequent flashbacks and hyperarousal. Which
medication class is considered first-line for core PTSD symptoms according to
current guidelines?
A. Benzodiazepines
B. SSRIs
C. Atypical antipsychotics
D. Mood stabilizers
Correct Answer: B - SSRIs
RATIONALE
SSRIs (e.g., sertraline, paroxetine) are first-line for PTSD, reducing
hyperarousal and re-experiencing symptoms. Benzodiazepines are
generally avoided due to risk of dependence and may worsen PTSD.
Atypical antipsychotics and mood stabilizers are adjunctive or for
comorbid symptoms, not first-line.
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