NR 326 EXAM 4: ADVANCED
PSYCHIATRIC-MENTAL HEALTH
NURSING ACTUAL QUESTIONS &
ANSWERS (GUARANTEE PASS)
CHAMBERLAIN
1. A patient with Borderline Personality Disorder (BPD) is admitted to the unit. The patient
alternates between praising a nurse as the ‘only one who understands’ and screaming that
the same nurse is ‘incompetent’ the next day. Which defense mechanism is this?
A. Projection
B. Intellectualization
C. Splitting
D. Reaction Formation
Answer: C
Conceptual Explanation: Splitting is a primary defense mechanism in BPD where
individuals view people or situations as either all good or all bad, unable to integrate
positive and negative qualities.
2. A nurse is assessing a client for alcohol withdrawal. The client’s last drink was 8 hours ago.
Which clinical manifestation should the nurse expect first?
A. Grand mal seizures
,B. Delirium Tremens (DTs)
C. Fine tremors and tachycardia
D. Visual hallucinations
Answer: C
Conceptual Explanation: Early signs of alcohol withdrawal (6-12 hours after last drink)
include fine tremors, anxiety, tachycardia, and hypertension. Seizures and DTs occur later.
3. Which physiological finding is a hallmark sign of Refeeding Syndrome in a client being
treated for Anorexia Nervosa?
A. Hyperkalemia
B. Hypophosphatemia
C. Hypermagnesemia
D. Hyponatremia
Answer: B
Conceptual Explanation: Refeeding syndrome occurs when a starved patient begins to
eat; the shift from catabolism to anabolism triggers insulin release, driving phosphate into
cells, causing severe hypophosphatemia.
4. A client with Antisocial Personality Disorder is being manipulative with the staff. Which
nursing intervention is most appropriate?
A. Allowing the client to negotiate the rules for one day.
, B. Confronting the client angrily regarding the behavior.
C. Encouraging the client to explain why they feel the need to manipulate.
D. Consistently enforcing unit rules and limits.
Answer: D
Conceptual Explanation: For clients with Antisocial PD, clear, consistent limit-setting by
all staff members is essential to prevent manipulation and maintain a therapeutic
environment.
5. A client is admitted with suspected opioid overdose. Which assessment finding most
strongly supports this diagnosis?
A. Mydriasis and agitation
B. Increased bowel sounds and diarrhea
C. Tachycardia and diaphoresis
D. Pinpoint pupils and respiratory depression
Answer: D
Conceptual Explanation: Opioid overdose is characterized by the ‘opioid triad’:
respiratory depression, pinpoint pupils (miosis), and coma/decreased consciousness.
6. A child with ADHD is prescribed Methylphenidate. Which side effect should the nurse
instruct the parents to monitor most closely?
A. Weight loss and insomnia
PSYCHIATRIC-MENTAL HEALTH
NURSING ACTUAL QUESTIONS &
ANSWERS (GUARANTEE PASS)
CHAMBERLAIN
1. A patient with Borderline Personality Disorder (BPD) is admitted to the unit. The patient
alternates between praising a nurse as the ‘only one who understands’ and screaming that
the same nurse is ‘incompetent’ the next day. Which defense mechanism is this?
A. Projection
B. Intellectualization
C. Splitting
D. Reaction Formation
Answer: C
Conceptual Explanation: Splitting is a primary defense mechanism in BPD where
individuals view people or situations as either all good or all bad, unable to integrate
positive and negative qualities.
2. A nurse is assessing a client for alcohol withdrawal. The client’s last drink was 8 hours ago.
Which clinical manifestation should the nurse expect first?
A. Grand mal seizures
,B. Delirium Tremens (DTs)
C. Fine tremors and tachycardia
D. Visual hallucinations
Answer: C
Conceptual Explanation: Early signs of alcohol withdrawal (6-12 hours after last drink)
include fine tremors, anxiety, tachycardia, and hypertension. Seizures and DTs occur later.
3. Which physiological finding is a hallmark sign of Refeeding Syndrome in a client being
treated for Anorexia Nervosa?
A. Hyperkalemia
B. Hypophosphatemia
C. Hypermagnesemia
D. Hyponatremia
Answer: B
Conceptual Explanation: Refeeding syndrome occurs when a starved patient begins to
eat; the shift from catabolism to anabolism triggers insulin release, driving phosphate into
cells, causing severe hypophosphatemia.
4. A client with Antisocial Personality Disorder is being manipulative with the staff. Which
nursing intervention is most appropriate?
A. Allowing the client to negotiate the rules for one day.
, B. Confronting the client angrily regarding the behavior.
C. Encouraging the client to explain why they feel the need to manipulate.
D. Consistently enforcing unit rules and limits.
Answer: D
Conceptual Explanation: For clients with Antisocial PD, clear, consistent limit-setting by
all staff members is essential to prevent manipulation and maintain a therapeutic
environment.
5. A client is admitted with suspected opioid overdose. Which assessment finding most
strongly supports this diagnosis?
A. Mydriasis and agitation
B. Increased bowel sounds and diarrhea
C. Tachycardia and diaphoresis
D. Pinpoint pupils and respiratory depression
Answer: D
Conceptual Explanation: Opioid overdose is characterized by the ‘opioid triad’:
respiratory depression, pinpoint pupils (miosis), and coma/decreased consciousness.
6. A child with ADHD is prescribed Methylphenidate. Which side effect should the nurse
instruct the parents to monitor most closely?
A. Weight loss and insomnia
