NUR2459 Final Exam V2 | NUR 2459
Mental and Behavioral Health Nursing
Exam Q&A | Rasmussen University
1. A patient is admitted with severe depression and expresses feelings of hopelessness. What
is the priority nursing action?
A. Assess the patient for suicidal ideation and intent.
B. Administer the prescribed antidepressant medication.
C. Encourage the patient to join a group therapy session immediately.
D. Assist the patient in identifying personal strengths.
Answer: A
Rationale: Safety is always the primary priority in psychiatric nursing. Hopelessness is a
significant risk factor for suicide. The nurse must immediately determine if the patient has
a plan or intent to self-harm to ensure their physical safety before proceeding with other
interventions.
2. A nurse is caring for a client who has schizophrenia and is experiencing auditory
hallucinations. Which response by the nurse is appropriate?
A. Why do you think the voices are talking to you right now?
B. I don’t hear the voices, but I understand they are real to you.
C. The voices are not real; you are just having a bad day.
,D. I will leave you alone until the voices stop talking.
Answer: B
Rationale: This response acknowledges the patient’s experience without validating the
hallucination as reality. It provides support while maintaining a basis in reality. The nurse
avoids challenging the patient’s perception directly, which could increase anxiety or
defensiveness.
3. Which medication requires the nurse to monitor for signs of agranulocytosis?
A. Haloperidol
B. Clozapine
C. Risperidone
D. Olanzapine
Answer: B
Rationale: Clozapine is an atypical antipsychotic that carries a significant risk of
agranulocytosis, a severe reduction in white blood cell count. Patients must undergo
regular blood testing (CBC with differential) to ensure safety. This monitoring is mandated
by the FDA due to the potential for life-threatening infections.
4. A patient with Bipolar I Disorder is in the manic phase. Which meal choice is most
appropriate for this patient?
A. Spaghetti and meatballs with a side salad.
, B. A chicken wrap and an apple.
C. Steak and a baked potato.
D. Soup and crackers.
Answer: B
Rationale: During a manic episode, patients are often too hyperactive to sit down for a full
meal. ‘Finger foods’ that are high in protein and calories allow the patient to eat while on
the move. A chicken wrap and an apple are portable and provide necessary nutrition
without requiring the patient to remain still.
5. A nurse is teaching a client about a new prescription for Phenelzine (an MAOI). Which food
should the nurse instruct the client to avoid?
A. Fresh strawberries
B. Aged cheddar cheese
C. Whole grain bread
D. Grilled chicken breast
Answer: B
Rationale: MAOIs interact with tyramine-rich foods, which can lead to a hypertensive
crisis. Aged cheeses, cured meats, and fermented products are high in tyramine and must
be avoided. Education on dietary restrictions is a critical safety component when
prescribing MAOIs.
Mental and Behavioral Health Nursing
Exam Q&A | Rasmussen University
1. A patient is admitted with severe depression and expresses feelings of hopelessness. What
is the priority nursing action?
A. Assess the patient for suicidal ideation and intent.
B. Administer the prescribed antidepressant medication.
C. Encourage the patient to join a group therapy session immediately.
D. Assist the patient in identifying personal strengths.
Answer: A
Rationale: Safety is always the primary priority in psychiatric nursing. Hopelessness is a
significant risk factor for suicide. The nurse must immediately determine if the patient has
a plan or intent to self-harm to ensure their physical safety before proceeding with other
interventions.
2. A nurse is caring for a client who has schizophrenia and is experiencing auditory
hallucinations. Which response by the nurse is appropriate?
A. Why do you think the voices are talking to you right now?
B. I don’t hear the voices, but I understand they are real to you.
C. The voices are not real; you are just having a bad day.
,D. I will leave you alone until the voices stop talking.
Answer: B
Rationale: This response acknowledges the patient’s experience without validating the
hallucination as reality. It provides support while maintaining a basis in reality. The nurse
avoids challenging the patient’s perception directly, which could increase anxiety or
defensiveness.
3. Which medication requires the nurse to monitor for signs of agranulocytosis?
A. Haloperidol
B. Clozapine
C. Risperidone
D. Olanzapine
Answer: B
Rationale: Clozapine is an atypical antipsychotic that carries a significant risk of
agranulocytosis, a severe reduction in white blood cell count. Patients must undergo
regular blood testing (CBC with differential) to ensure safety. This monitoring is mandated
by the FDA due to the potential for life-threatening infections.
4. A patient with Bipolar I Disorder is in the manic phase. Which meal choice is most
appropriate for this patient?
A. Spaghetti and meatballs with a side salad.
, B. A chicken wrap and an apple.
C. Steak and a baked potato.
D. Soup and crackers.
Answer: B
Rationale: During a manic episode, patients are often too hyperactive to sit down for a full
meal. ‘Finger foods’ that are high in protein and calories allow the patient to eat while on
the move. A chicken wrap and an apple are portable and provide necessary nutrition
without requiring the patient to remain still.
5. A nurse is teaching a client about a new prescription for Phenelzine (an MAOI). Which food
should the nurse instruct the client to avoid?
A. Fresh strawberries
B. Aged cheddar cheese
C. Whole grain bread
D. Grilled chicken breast
Answer: B
Rationale: MAOIs interact with tyramine-rich foods, which can lead to a hypertensive
crisis. Aged cheeses, cured meats, and fermented products are high in tyramine and must
be avoided. Education on dietary restrictions is a critical safety component when
prescribing MAOIs.
