NUR 253 Exam 4 Mental Health (2026 /
2027) Practice Questions with Rationales
1. A client with schizophrenia is prescribed clozapine. Which
laboratory value requires the nurse to hold the medication and
notify the provider immediately?
A) WBC 2,900/mm³ and ANC 1,200/mm³
B) WBC 8,000/mm³ and ANC 4,500/mm³
C) RBC 4.2 million/mm³
D) Platelets 150,000/mm³
Answer: A) WBC 2,900/mm³ and ANC 1,200/mm³
Rationale: Clozapine causes agranulocytosis. If the WBC is <
3,000/mm³ or the ANC is < 1,500/mm³, the medication must be
held immediately to prevent fatal infections.
2. A nurse is caring for a client experiencing acute alcohol
withdrawal. Which of the following medications is the priority
to administer to prevent life-threatening seizures?
A) Naloxone
B) Flumazenil
,C) Lorazepam
D) Disulfiram
Answer: C) Lorazepam
Rationale: Benzodiazepines (like lorazepam) are the drug of
choice for alcohol withdrawal to prevent seizures and manage
symptoms of delirium tremens.
3. A client on a psychiatric unit states, "The government is
monitoring my thoughts through the television." Which nursing
response is most appropriate?
A) "You know that isn't true. The TV is just a TV."
B) "I don't see the government monitoring you, but I know you
believe that. It must be scary."
C) "Let's turn off the TV so they can't monitor you."
D) "Why do you think the government is interested in you?"
Answer: B) "I don't see the government monitoring you, but I
know you believe that. It must be scary."
Rationale: This response demonstrates the therapeutic
technique of "validating the feeling but not the delusion"
(presenting reality). It builds trust without reinforcing the
paranoid delusion.
,4. A client with bipolar disorder is pacing the halls, speaking
rapidly, and making inappropriate sexual comments to staff.
What is the nurse's priority intervention?
A) Administer a PRN dose of haloperidol.
B) Place the client in seclusion.
C) Move the client to a quiet, low-stimulation environment.
D) Ignore the behavior; it is part of the disease process.
Answer: C) Move the client to a quiet, low-stimulation
environment.
Rationale: The client is exhibiting manic behavior exacerbated
by environmental stimuli. The priority is to decrease
stimulation. Medication or seclusion may be needed later, but
reducing stimuli is the least restrictive first step.
5. A client is admitted after a suicide attempt. The nurse
searches the client's belongings. Which item found in the
luggage must be removed immediately?
A) A bottle of hand lotion
B) A pair of shoelaces
C) A paperback book
, D) A plastic hairbrush
Answer: B) A pair of shoelaces
Rationale: Shoelaces can be used as a ligature for hanging. All
ligatures (shoelaces, belts, cords, ties) must be removed from
clients on suicide precautions.
6. A client taking lithium carbonate reports severe vomiting,
diarrhea, and a coarse hand tremor. The serum lithium level is
2.4 mEq/L. Which action should the nurse take first?
A) Administer an antiemetic.
B) Hold the next dose and prepare for hemodialysis.
C) Encourage the client to drink more water.
D) Administer the next dose with food.
Answer: B) Hold the next dose and prepare for hemodialysis.
Rationale: A lithium level of 2.4 mEq/L with severe GI and
neurological symptoms indicates severe toxicity. The nurse must
hold the drug and prepare for hemodialysis, which rapidly
removes lithium.
7. A client with anorexia nervosa is prescribed to begin a
refeeding protocol. The nurse knows to monitor closely for
2027) Practice Questions with Rationales
1. A client with schizophrenia is prescribed clozapine. Which
laboratory value requires the nurse to hold the medication and
notify the provider immediately?
A) WBC 2,900/mm³ and ANC 1,200/mm³
B) WBC 8,000/mm³ and ANC 4,500/mm³
C) RBC 4.2 million/mm³
D) Platelets 150,000/mm³
Answer: A) WBC 2,900/mm³ and ANC 1,200/mm³
Rationale: Clozapine causes agranulocytosis. If the WBC is <
3,000/mm³ or the ANC is < 1,500/mm³, the medication must be
held immediately to prevent fatal infections.
2. A nurse is caring for a client experiencing acute alcohol
withdrawal. Which of the following medications is the priority
to administer to prevent life-threatening seizures?
A) Naloxone
B) Flumazenil
,C) Lorazepam
D) Disulfiram
Answer: C) Lorazepam
Rationale: Benzodiazepines (like lorazepam) are the drug of
choice for alcohol withdrawal to prevent seizures and manage
symptoms of delirium tremens.
3. A client on a psychiatric unit states, "The government is
monitoring my thoughts through the television." Which nursing
response is most appropriate?
A) "You know that isn't true. The TV is just a TV."
B) "I don't see the government monitoring you, but I know you
believe that. It must be scary."
C) "Let's turn off the TV so they can't monitor you."
D) "Why do you think the government is interested in you?"
Answer: B) "I don't see the government monitoring you, but I
know you believe that. It must be scary."
Rationale: This response demonstrates the therapeutic
technique of "validating the feeling but not the delusion"
(presenting reality). It builds trust without reinforcing the
paranoid delusion.
,4. A client with bipolar disorder is pacing the halls, speaking
rapidly, and making inappropriate sexual comments to staff.
What is the nurse's priority intervention?
A) Administer a PRN dose of haloperidol.
B) Place the client in seclusion.
C) Move the client to a quiet, low-stimulation environment.
D) Ignore the behavior; it is part of the disease process.
Answer: C) Move the client to a quiet, low-stimulation
environment.
Rationale: The client is exhibiting manic behavior exacerbated
by environmental stimuli. The priority is to decrease
stimulation. Medication or seclusion may be needed later, but
reducing stimuli is the least restrictive first step.
5. A client is admitted after a suicide attempt. The nurse
searches the client's belongings. Which item found in the
luggage must be removed immediately?
A) A bottle of hand lotion
B) A pair of shoelaces
C) A paperback book
, D) A plastic hairbrush
Answer: B) A pair of shoelaces
Rationale: Shoelaces can be used as a ligature for hanging. All
ligatures (shoelaces, belts, cords, ties) must be removed from
clients on suicide precautions.
6. A client taking lithium carbonate reports severe vomiting,
diarrhea, and a coarse hand tremor. The serum lithium level is
2.4 mEq/L. Which action should the nurse take first?
A) Administer an antiemetic.
B) Hold the next dose and prepare for hemodialysis.
C) Encourage the client to drink more water.
D) Administer the next dose with food.
Answer: B) Hold the next dose and prepare for hemodialysis.
Rationale: A lithium level of 2.4 mEq/L with severe GI and
neurological symptoms indicates severe toxicity. The nurse must
hold the drug and prepare for hemodialysis, which rapidly
removes lithium.
7. A client with anorexia nervosa is prescribed to begin a
refeeding protocol. The nurse knows to monitor closely for
