, Question 1
A client on clozapine presents with fever, tachycardia, muscle rigidity, and a
creatine kinase of 2,800 U/L. Which pathophysiologic mechanism best
explains this presentation?
A. Dopamine D2 blockade causing acute dystonia with secondary
rhabdomyolysis
B. Idiosyncratic hypersensitivity with cytokine-mediated systemic
inflammatory response and muscle breakdown
C. Serotonergic excess leading to hyperthermia and neuromuscular
excitation
D. Anticholinergic toxidrome with suppressed thermoregulation and
rigidity
Correct Answer: B - Idiosyncratic hypersensitivity with
cytokine-mediated systemic inflammatory response and muscle
breakdown
RATIONALE
Clozapine-induced neuroleptic malignant syndrome is an idiosyncratic
reaction involving cytokine dysregulation, hyperthermia, rigidity, and
elevated CK, not simple D2 blockade. Acute dystonia (A) lacks
fever/CK elevation; serotonin syndrome (C) typically includes
clonus/hyperreflexia; anticholinergic toxidrome (D) presents with dry
skin and delirium, not rigidity.
Question 2
Which statement best reflects the ethical principle of veracity when a client
with terminal illness and decisional capacity asks about prognosis?
A. Withhold distressing information to prevent psychological harm,
invoking therapeutic privilege.
B. Disclose truthfully and compassionately, respecting the client's right to
accurate information.
C. Delegate disclosure to family to preserve cultural harmony and avoid
Page 2
, conflict.
D. Provide only information the treatment team deems beneficial to
maintain hope.
Correct Answer: B - Disclose truthfully and compassionately,
respecting the client's right to accurate information.
RATIONALE
Veracity obligates truthful disclosure to a client with decisional
capacity, balancing compassion. Therapeutic privilege (A) is rarely
justified and risks paternalism; delegating to family (C) violates
autonomy unless the client requests it; selective disclosure (D)
undermines informed consent and trust.
Question 3
A client with borderline personality disorder uses splitting to pit staff against
each other. Which nursing intervention best addresses this dynamic?
A. Allow the client to choose a preferred nurse for all interactions to
reduce anxiety.
B. Confront the client publicly during community meeting to extinguish
manipulation.
C. Implement consistent team communication and limit-setting across all
shifts.
D. Rotate assigned nurses frequently to prevent dependent attachments.
Correct Answer: C - Implement consistent team communication
and limit-setting across all shifts.
RATIONALE
Splitting is managed with consistent, collaborative team boundaries
and communication to prevent staff division. Favoritism (A)
reinforces splitting; public confrontation (B) is shaming and escalates;
frequent rotation (D) increases insecurity and does not address the
underlying dynamic.
Page 3
, Question 4
A client with alcohol use disorder is admitted with tremors, diaphoresis, and a
CIWA-Ar score of 18. Which medication regimen is most appropriate?
A. Naltrexone 50 mg PO daily to reduce cravings and prevent seizures
B. Lorazepam 2 mg IV/PO every 4-6 hours with symptom-triggered
dosing
C. Disulfiram 500 mg PO daily to deter further drinking
D. Acamprosate 666 mg PO TID as first-line for acute withdrawal
Correct Answer: B - Lorazepam 2 mg IV/PO every 4-6 hours with
symptom-triggered dosing
RATIONALE
Benzodiazepines (lorazepam) are first-line for alcohol withdrawal to
prevent seizures and delirium tremens, dosed symptom-triggered per
CIWA. Naltrexone (A) and acamprosate (D) support maintenance, not
acute withdrawal; disulfiram (C) is for motivated abstinence and is
hepatotoxic.
Question 5
A client with schizophrenia on haloperidol develops a sudden sustained
contraction of neck muscles and upward eye deviation. Which intervention
should the nurse anticipate?
A. Administer benztropine or diphenhydramine for acute dystonia
B. Withhold haloperidol and administer dantrolene for NMS
C. Administer propranolol for akathisia management
D. Administer lorazepam for catatonic rigidity
Correct Answer: A - Administer benztropine or
diphenhydramine for acute dystonia
Page 4
A client on clozapine presents with fever, tachycardia, muscle rigidity, and a
creatine kinase of 2,800 U/L. Which pathophysiologic mechanism best
explains this presentation?
A. Dopamine D2 blockade causing acute dystonia with secondary
rhabdomyolysis
B. Idiosyncratic hypersensitivity with cytokine-mediated systemic
inflammatory response and muscle breakdown
C. Serotonergic excess leading to hyperthermia and neuromuscular
excitation
D. Anticholinergic toxidrome with suppressed thermoregulation and
rigidity
Correct Answer: B - Idiosyncratic hypersensitivity with
cytokine-mediated systemic inflammatory response and muscle
breakdown
RATIONALE
Clozapine-induced neuroleptic malignant syndrome is an idiosyncratic
reaction involving cytokine dysregulation, hyperthermia, rigidity, and
elevated CK, not simple D2 blockade. Acute dystonia (A) lacks
fever/CK elevation; serotonin syndrome (C) typically includes
clonus/hyperreflexia; anticholinergic toxidrome (D) presents with dry
skin and delirium, not rigidity.
Question 2
Which statement best reflects the ethical principle of veracity when a client
with terminal illness and decisional capacity asks about prognosis?
A. Withhold distressing information to prevent psychological harm,
invoking therapeutic privilege.
B. Disclose truthfully and compassionately, respecting the client's right to
accurate information.
C. Delegate disclosure to family to preserve cultural harmony and avoid
Page 2
, conflict.
D. Provide only information the treatment team deems beneficial to
maintain hope.
Correct Answer: B - Disclose truthfully and compassionately,
respecting the client's right to accurate information.
RATIONALE
Veracity obligates truthful disclosure to a client with decisional
capacity, balancing compassion. Therapeutic privilege (A) is rarely
justified and risks paternalism; delegating to family (C) violates
autonomy unless the client requests it; selective disclosure (D)
undermines informed consent and trust.
Question 3
A client with borderline personality disorder uses splitting to pit staff against
each other. Which nursing intervention best addresses this dynamic?
A. Allow the client to choose a preferred nurse for all interactions to
reduce anxiety.
B. Confront the client publicly during community meeting to extinguish
manipulation.
C. Implement consistent team communication and limit-setting across all
shifts.
D. Rotate assigned nurses frequently to prevent dependent attachments.
Correct Answer: C - Implement consistent team communication
and limit-setting across all shifts.
RATIONALE
Splitting is managed with consistent, collaborative team boundaries
and communication to prevent staff division. Favoritism (A)
reinforces splitting; public confrontation (B) is shaming and escalates;
frequent rotation (D) increases insecurity and does not address the
underlying dynamic.
Page 3
, Question 4
A client with alcohol use disorder is admitted with tremors, diaphoresis, and a
CIWA-Ar score of 18. Which medication regimen is most appropriate?
A. Naltrexone 50 mg PO daily to reduce cravings and prevent seizures
B. Lorazepam 2 mg IV/PO every 4-6 hours with symptom-triggered
dosing
C. Disulfiram 500 mg PO daily to deter further drinking
D. Acamprosate 666 mg PO TID as first-line for acute withdrawal
Correct Answer: B - Lorazepam 2 mg IV/PO every 4-6 hours with
symptom-triggered dosing
RATIONALE
Benzodiazepines (lorazepam) are first-line for alcohol withdrawal to
prevent seizures and delirium tremens, dosed symptom-triggered per
CIWA. Naltrexone (A) and acamprosate (D) support maintenance, not
acute withdrawal; disulfiram (C) is for motivated abstinence and is
hepatotoxic.
Question 5
A client with schizophrenia on haloperidol develops a sudden sustained
contraction of neck muscles and upward eye deviation. Which intervention
should the nurse anticipate?
A. Administer benztropine or diphenhydramine for acute dystonia
B. Withhold haloperidol and administer dantrolene for NMS
C. Administer propranolol for akathisia management
D. Administer lorazepam for catatonic rigidity
Correct Answer: A - Administer benztropine or
diphenhydramine for acute dystonia
Page 4
