, Question 1
A patient with schizophrenia is prescribed clozapine. Which laboratory
monitoring parameter is most critical to prevent a life-threatening adverse
effect during the first 18 weeks of therapy?
A. Serum sodium and potassium levels
B. Absolute neutrophil count (ANC)
C. Liver function tests (ALT/AST)
D. Fasting blood glucose and lipid panel
Correct Answer: B - Absolute neutrophil count (ANC)
RATIONALE
Clozapine carries a boxed warning for severe
neutropenia/agranulocytosis, requiring weekly ANC monitoring for
the first 6 months. While metabolic and hepatic effects occur, ANC
monitoring is the most critical early life-saving measure.
Sodium/potassium are not primary concerns.
Question 2
During a group therapy session, a patient discloses intent to harm a specific
neighbor. Which action best reflects the nurse's legal and ethical obligation
under the duty to warn/protect?
A. Maintain confidentiality and document the disclosure without further
action.
B. Encourage the patient to voluntarily report to law enforcement.
C. Notify the intended victim and appropriate authorities while
maintaining minimal necessary disclosure.
D. Transfer the patient to a less restrictive environment to reduce
agitation.
Correct Answer: C - Notify the intended victim and appropriate
authorities while maintaining minimal necessary disclosure.
Page 2
, RATIONALE
The Tarasoff ruling mandates that mental health professionals have a
duty to protect identifiable third parties from credible threats, which
may include warning the victim and notifying authorities.
Confidentiality is breached only to the extent necessary to prevent
harm. Passive encouragement or ignoring the threat is insufficient.
Question 3
A patient with bipolar I disorder in an acute manic episode is pacing, intrusive,
and refusing oral medications. Which nursing intervention should be
prioritized first?
A. Offer a PRN oral antipsychotic mixed in food.
B. Place the patient in seclusion to reduce stimulation.
C. Use a calm, firm approach to set limits and offer a short-term IM
medication if needed.
D. Initiate physical restraints immediately to ensure safety.
Correct Answer: C - Use a calm, firm approach to set limits and
offer a short-term IM medication if needed.
RATIONALE
De-escalation with clear limit-setting and offering a voluntary IM
medication respects patient autonomy and reduces risk of violence.
Seclusion or restraints are last resorts after less restrictive measures
fail. Hiding medication in food violates trust and consent.
Question 4
A patient on an SSRI for major depressive disorder reports new-onset agitation,
diaphoresis, and hyperreflexia after adding tramadol. Which syndrome should
the nurse suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
Page 3
, C. Anticholinergic toxicity
D. Acute dystonia
Correct Answer: B - Serotonin syndrome
RATIONALE
Serotonin syndrome is characterized by mental status changes,
autonomic instability, and neuromuscular abnormalities
(hyperreflexia, clonus) following serotonergic agent combination.
NMS presents with lead-pipe rigidity and bradyreflexia.
Anticholinergic toxicity causes dry skin, flushing, and delirium
without hyperreflexia.
Question 5
Which statement by a patient prescribed lithium indicates a need for further
teaching?
A. I will maintain a consistent sodium intake.
B. I will take the medication with food to reduce stomach upset.
C. I will double my dose if I miss one.
D. I will report excessive urination or thirst.
Correct Answer: C - I will double my dose if I miss one.
RATIONALE
Doubling a missed lithium dose can lead to toxicity due to its narrow
therapeutic index. Consistent sodium intake, taking with food, and
reporting polyuria/polydipsia (signs of toxicity or diabetes insipidus)
are correct. Missed doses should be taken as directed, not doubled.
Question 6
A patient with anorexia nervosa is admitted with a BMI of 15.2 and
hypokalemia. Which nursing intervention is most appropriate during the initial
refeeding phase?
A. Encourage a high-calorie diet to rapidly restore weight.
Page 4
A patient with schizophrenia is prescribed clozapine. Which laboratory
monitoring parameter is most critical to prevent a life-threatening adverse
effect during the first 18 weeks of therapy?
A. Serum sodium and potassium levels
B. Absolute neutrophil count (ANC)
C. Liver function tests (ALT/AST)
D. Fasting blood glucose and lipid panel
Correct Answer: B - Absolute neutrophil count (ANC)
RATIONALE
Clozapine carries a boxed warning for severe
neutropenia/agranulocytosis, requiring weekly ANC monitoring for
the first 6 months. While metabolic and hepatic effects occur, ANC
monitoring is the most critical early life-saving measure.
Sodium/potassium are not primary concerns.
Question 2
During a group therapy session, a patient discloses intent to harm a specific
neighbor. Which action best reflects the nurse's legal and ethical obligation
under the duty to warn/protect?
A. Maintain confidentiality and document the disclosure without further
action.
B. Encourage the patient to voluntarily report to law enforcement.
C. Notify the intended victim and appropriate authorities while
maintaining minimal necessary disclosure.
D. Transfer the patient to a less restrictive environment to reduce
agitation.
Correct Answer: C - Notify the intended victim and appropriate
authorities while maintaining minimal necessary disclosure.
Page 2
, RATIONALE
The Tarasoff ruling mandates that mental health professionals have a
duty to protect identifiable third parties from credible threats, which
may include warning the victim and notifying authorities.
Confidentiality is breached only to the extent necessary to prevent
harm. Passive encouragement or ignoring the threat is insufficient.
Question 3
A patient with bipolar I disorder in an acute manic episode is pacing, intrusive,
and refusing oral medications. Which nursing intervention should be
prioritized first?
A. Offer a PRN oral antipsychotic mixed in food.
B. Place the patient in seclusion to reduce stimulation.
C. Use a calm, firm approach to set limits and offer a short-term IM
medication if needed.
D. Initiate physical restraints immediately to ensure safety.
Correct Answer: C - Use a calm, firm approach to set limits and
offer a short-term IM medication if needed.
RATIONALE
De-escalation with clear limit-setting and offering a voluntary IM
medication respects patient autonomy and reduces risk of violence.
Seclusion or restraints are last resorts after less restrictive measures
fail. Hiding medication in food violates trust and consent.
Question 4
A patient on an SSRI for major depressive disorder reports new-onset agitation,
diaphoresis, and hyperreflexia after adding tramadol. Which syndrome should
the nurse suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
Page 3
, C. Anticholinergic toxicity
D. Acute dystonia
Correct Answer: B - Serotonin syndrome
RATIONALE
Serotonin syndrome is characterized by mental status changes,
autonomic instability, and neuromuscular abnormalities
(hyperreflexia, clonus) following serotonergic agent combination.
NMS presents with lead-pipe rigidity and bradyreflexia.
Anticholinergic toxicity causes dry skin, flushing, and delirium
without hyperreflexia.
Question 5
Which statement by a patient prescribed lithium indicates a need for further
teaching?
A. I will maintain a consistent sodium intake.
B. I will take the medication with food to reduce stomach upset.
C. I will double my dose if I miss one.
D. I will report excessive urination or thirst.
Correct Answer: C - I will double my dose if I miss one.
RATIONALE
Doubling a missed lithium dose can lead to toxicity due to its narrow
therapeutic index. Consistent sodium intake, taking with food, and
reporting polyuria/polydipsia (signs of toxicity or diabetes insipidus)
are correct. Missed doses should be taken as directed, not doubled.
Question 6
A patient with anorexia nervosa is admitted with a BMI of 15.2 and
hypokalemia. Which nursing intervention is most appropriate during the initial
refeeding phase?
A. Encourage a high-calorie diet to rapidly restore weight.
Page 4
