, Question 1
A client receiving clozapine for treatment-resistant schizophrenia presents with
fever, tachycardia, and a diffuse erythematous rash. Which laboratory finding
would most specifically confirm the priority life-threatening adverse effect?
A. Absolute neutrophil count of 450/mm³
B. Serum clozapine level of 600 ng/mL
C. Creatine kinase of 1,200 U/L
D. Eosinophil count of 8%
Correct Answer: A - Absolute neutrophil count of 450/mm³
RATIONALE
Fever, tachycardia, and rash suggest neutropenic sepsis from
clozapine-induced agranulocytosis; an ANC <500/mm³ confirms
severe neutropenia. Elevated CK indicates neuroleptic malignant
syndrome, not agranulocytosis. Clozapine levels and eosinophilia are
nonspecific and do not confirm the priority risk.
Question 2
Which nursing action best reflects the ethical principle of veracity when a
client with terminal illness and depression asks whether their antidepressant
'will make everything better'?
A. Reassure the client that medications always improve mood within
days.
B. Provide honest information about expected benefits, timeline, and
limitations of pharmacotherapy.
C. Defer the question to the provider to avoid causing distress.
D. Offer a comforting statement that everything will work out.
Correct Answer: B - Provide honest information about expected
benefits, timeline, and limitations of pharmacotherapy.
Page 2
, RATIONALE
Veracity obligates truthful communication; the nurse must accurately
explain realistic expectations, onset, and limits of antidepressants.
Reassurance with false certainty violates veracity, and deferral or
platitudes avoid the ethical duty rather than fulfill it.
Question 3
During a therapeutic communication session, a client with borderline
personality disorder says, 'You're the only nurse who understands me; the
others are incompetent.' Which response best demonstrates maintaining
professional boundaries?
A. 'I appreciate that, and I feel the same about you.'
B. 'That's a strong feeling; let's explore what makes it hard to trust the
team.'
C. 'You shouldn't say that about your other nurses.'
D. 'I'll request to be your only assigned nurse.'
Correct Answer: B - 'That's a strong feeling; let's explore what
makes it hard to trust the team.'
RATIONALE
Reflecting the client's feeling and exploring trust dynamics maintains
boundaries while addressing splitting. Agreeing, scolding, or
arranging exclusive assignment reinforces splitting or boundary
violation and undermines the therapeutic alliance.
Question 4
A client with alcohol use disorder is admitted with tremors, diaphoresis, and
HR 122. Which prescription should the nurse question as contraindicated
during acute withdrawal management?
A. Thiamine 100 mg IV
B. Lorazepam 2 mg IV PRN CIWA >15
Page 3
, C. Chlordiazepoxide 25 mg PO QID
D. Disulfiram 500 mg PO daily
Correct Answer: D - Disulfiram 500 mg PO daily
RATIONALE
Disulfiram is contraindicated during acute withdrawal and while any
alcohol may remain in the body due to risk of severe acetaldehyde
reaction; it is initiated only after detoxification and abstinence are
established. Thiamine, lorazepam, and chlordiazepoxide are
appropriate for withdrawal management.
Question 5
A client with major depressive disorder reports no improvement after 3 weeks
of sertraline 50 mg daily. Which action best reflects current evidence-based
practice?
A. Immediately discontinue sertraline and start a monoamine oxidase
inhibitor.
B. Continue the current dose and reassess at 6-8 weeks before any
change.
C. Collaborate with the provider to consider dose optimization or
augmentation.
D. Add St. John's wort to enhance antidepressant effect.
Correct Answer: C - Collaborate with the provider to consider
dose optimization or augmentation.
RATIONALE
Partial or no response at 3 weeks warrants reassessment and possible
dose increase or augmentation, not premature discontinuation. Waiting
until 6-8 weeks without adjustment may delay effective treatment, and
adding St. John's wort risks serotonin syndrome.
Page 4
A client receiving clozapine for treatment-resistant schizophrenia presents with
fever, tachycardia, and a diffuse erythematous rash. Which laboratory finding
would most specifically confirm the priority life-threatening adverse effect?
A. Absolute neutrophil count of 450/mm³
B. Serum clozapine level of 600 ng/mL
C. Creatine kinase of 1,200 U/L
D. Eosinophil count of 8%
Correct Answer: A - Absolute neutrophil count of 450/mm³
RATIONALE
Fever, tachycardia, and rash suggest neutropenic sepsis from
clozapine-induced agranulocytosis; an ANC <500/mm³ confirms
severe neutropenia. Elevated CK indicates neuroleptic malignant
syndrome, not agranulocytosis. Clozapine levels and eosinophilia are
nonspecific and do not confirm the priority risk.
Question 2
Which nursing action best reflects the ethical principle of veracity when a
client with terminal illness and depression asks whether their antidepressant
'will make everything better'?
A. Reassure the client that medications always improve mood within
days.
B. Provide honest information about expected benefits, timeline, and
limitations of pharmacotherapy.
C. Defer the question to the provider to avoid causing distress.
D. Offer a comforting statement that everything will work out.
Correct Answer: B - Provide honest information about expected
benefits, timeline, and limitations of pharmacotherapy.
Page 2
, RATIONALE
Veracity obligates truthful communication; the nurse must accurately
explain realistic expectations, onset, and limits of antidepressants.
Reassurance with false certainty violates veracity, and deferral or
platitudes avoid the ethical duty rather than fulfill it.
Question 3
During a therapeutic communication session, a client with borderline
personality disorder says, 'You're the only nurse who understands me; the
others are incompetent.' Which response best demonstrates maintaining
professional boundaries?
A. 'I appreciate that, and I feel the same about you.'
B. 'That's a strong feeling; let's explore what makes it hard to trust the
team.'
C. 'You shouldn't say that about your other nurses.'
D. 'I'll request to be your only assigned nurse.'
Correct Answer: B - 'That's a strong feeling; let's explore what
makes it hard to trust the team.'
RATIONALE
Reflecting the client's feeling and exploring trust dynamics maintains
boundaries while addressing splitting. Agreeing, scolding, or
arranging exclusive assignment reinforces splitting or boundary
violation and undermines the therapeutic alliance.
Question 4
A client with alcohol use disorder is admitted with tremors, diaphoresis, and
HR 122. Which prescription should the nurse question as contraindicated
during acute withdrawal management?
A. Thiamine 100 mg IV
B. Lorazepam 2 mg IV PRN CIWA >15
Page 3
, C. Chlordiazepoxide 25 mg PO QID
D. Disulfiram 500 mg PO daily
Correct Answer: D - Disulfiram 500 mg PO daily
RATIONALE
Disulfiram is contraindicated during acute withdrawal and while any
alcohol may remain in the body due to risk of severe acetaldehyde
reaction; it is initiated only after detoxification and abstinence are
established. Thiamine, lorazepam, and chlordiazepoxide are
appropriate for withdrawal management.
Question 5
A client with major depressive disorder reports no improvement after 3 weeks
of sertraline 50 mg daily. Which action best reflects current evidence-based
practice?
A. Immediately discontinue sertraline and start a monoamine oxidase
inhibitor.
B. Continue the current dose and reassess at 6-8 weeks before any
change.
C. Collaborate with the provider to consider dose optimization or
augmentation.
D. Add St. John's wort to enhance antidepressant effect.
Correct Answer: C - Collaborate with the provider to consider
dose optimization or augmentation.
RATIONALE
Partial or no response at 3 weeks warrants reassessment and possible
dose increase or augmentation, not premature discontinuation. Waiting
until 6-8 weeks without adjustment may delay effective treatment, and
adding St. John's wort risks serotonin syndrome.
Page 4
