NUR 384 Exam 2 – Mental Health Nursing (2026)
Concordia University | Practice Questions & Rationales
1. A client with schizophrenia exhibits a flat affect, apathy, and
lacks the energy to participate in unit activities. The nurse
recognizes these as which type of symptoms?
A) Positive symptoms
B) Negative symptoms
C) Cognitive symptoms
D) Affective symptoms
Answer: B) Negative symptoms
Rationale: Negative symptoms reflect an absence or deficit of
normal functioning. Examples include flat affect, avolition (lack
of drive), anhedonia (lack of pleasure), and alogia (poverty of
speech).
2. A client prescribed clozapine for treatment-resistant
schizophrenia has a baseline WBC of 7,000/mm³. After 6 weeks,
the WBC drops to 2,800/mm³. What is the nurse's priority
action?
A) Administer the next dose and monitor for signs of infection.
,B) Hold the medication and notify the provider immediately.
C) Isolate the client in a negative-pressure room.
D) Administer an injection of epoetin alfa.
Answer: B) Hold the medication and notify the provider
immediately.
Rationale: Clozapine carries a black box warning for
agranulocytosis. A WBC count below 3,000/mm³ (or ANC below
1,500/mm³) requires immediate discontinuation of the drug to
prevent fatal sepsis.
3. A client with schizophrenia states, "The doctor wants to
poison me with these pills." Which response by the nurse
demonstrates the therapeutic technique of "presenting
reality"?
A) "You know the doctor is here to help you, not poison you."
B) "I will make sure none of the staff poisons your food."
C) "These pills are risperidone, which will help calm your
thoughts. I take my job seriously and would never give you
poison."
D) "Why do you think the doctor wants to poison you?"
,Answer: C) "These pills are risperidone, which will help calm
your thoughts. I take my job seriously and would never give you
poison."
Rationale: Presenting reality involves disagreeing with the
delusion or hallucination while offering a factual statement. The
nurse does not argue but clearly states the purpose of the
medication and offers reassurance of safety.
4. A client taking haloperidol develops muscle rigidity, a fever of
104°F (40°C), and altered mental status. The nurse recognizes
these as signs of:
A) Tardive dyskinesia
B) Acute dystonia
C) Neuroleptic malignant syndrome (NMS)
D) Serotonin syndrome
Answer: C) Neuroleptic malignant syndrome (NMS)
Rationale: NMS is a life-threatening complication of
antipsychotic (neuroleptic) medications. The classic triad is
hyperthermia, severe muscle rigidity ("lead pipe"), and altered
mental status.
, 5. A client with bipolar disorder is in the acute manic phase.
They are pacing, talking rapidly, and refusing to sit down to eat.
Which intervention is most appropriate to meet the client's
nutritional needs?
A) Insist the client sits at the table for 60 minutes per meal.
B) Provide high-calorie, high-protein finger foods and snacks.
C) Insert a nasogastric tube for supplemental feeding.
D) Administer an appetite stimulant medication.
Answer: B) Provide high-calorie, high-protein finger foods and
snacks.
Rationale: Clients in mania cannot sit still for long periods.
Providing nutritious finger foods and snacks that can be eaten
"on the go" ensures they receive adequate caloric intake
without creating a power struggle.
6. A client with bipolar disorder has a serum lithium level of 2.2
mEq/L. The nurse observes coarse hand tremors, vomiting, and
confusion. What is the priority nursing action?
A) Administer an antiemetic for the vomiting.
B) Encourage the client to drink more water.
C) Stop the medication and prepare for hemodialysis.
Concordia University | Practice Questions & Rationales
1. A client with schizophrenia exhibits a flat affect, apathy, and
lacks the energy to participate in unit activities. The nurse
recognizes these as which type of symptoms?
A) Positive symptoms
B) Negative symptoms
C) Cognitive symptoms
D) Affective symptoms
Answer: B) Negative symptoms
Rationale: Negative symptoms reflect an absence or deficit of
normal functioning. Examples include flat affect, avolition (lack
of drive), anhedonia (lack of pleasure), and alogia (poverty of
speech).
2. A client prescribed clozapine for treatment-resistant
schizophrenia has a baseline WBC of 7,000/mm³. After 6 weeks,
the WBC drops to 2,800/mm³. What is the nurse's priority
action?
A) Administer the next dose and monitor for signs of infection.
,B) Hold the medication and notify the provider immediately.
C) Isolate the client in a negative-pressure room.
D) Administer an injection of epoetin alfa.
Answer: B) Hold the medication and notify the provider
immediately.
Rationale: Clozapine carries a black box warning for
agranulocytosis. A WBC count below 3,000/mm³ (or ANC below
1,500/mm³) requires immediate discontinuation of the drug to
prevent fatal sepsis.
3. A client with schizophrenia states, "The doctor wants to
poison me with these pills." Which response by the nurse
demonstrates the therapeutic technique of "presenting
reality"?
A) "You know the doctor is here to help you, not poison you."
B) "I will make sure none of the staff poisons your food."
C) "These pills are risperidone, which will help calm your
thoughts. I take my job seriously and would never give you
poison."
D) "Why do you think the doctor wants to poison you?"
,Answer: C) "These pills are risperidone, which will help calm
your thoughts. I take my job seriously and would never give you
poison."
Rationale: Presenting reality involves disagreeing with the
delusion or hallucination while offering a factual statement. The
nurse does not argue but clearly states the purpose of the
medication and offers reassurance of safety.
4. A client taking haloperidol develops muscle rigidity, a fever of
104°F (40°C), and altered mental status. The nurse recognizes
these as signs of:
A) Tardive dyskinesia
B) Acute dystonia
C) Neuroleptic malignant syndrome (NMS)
D) Serotonin syndrome
Answer: C) Neuroleptic malignant syndrome (NMS)
Rationale: NMS is a life-threatening complication of
antipsychotic (neuroleptic) medications. The classic triad is
hyperthermia, severe muscle rigidity ("lead pipe"), and altered
mental status.
, 5. A client with bipolar disorder is in the acute manic phase.
They are pacing, talking rapidly, and refusing to sit down to eat.
Which intervention is most appropriate to meet the client's
nutritional needs?
A) Insist the client sits at the table for 60 minutes per meal.
B) Provide high-calorie, high-protein finger foods and snacks.
C) Insert a nasogastric tube for supplemental feeding.
D) Administer an appetite stimulant medication.
Answer: B) Provide high-calorie, high-protein finger foods and
snacks.
Rationale: Clients in mania cannot sit still for long periods.
Providing nutritious finger foods and snacks that can be eaten
"on the go" ensures they receive adequate caloric intake
without creating a power struggle.
6. A client with bipolar disorder has a serum lithium level of 2.2
mEq/L. The nurse observes coarse hand tremors, vomiting, and
confusion. What is the priority nursing action?
A) Administer an antiemetic for the vomiting.
B) Encourage the client to drink more water.
C) Stop the medication and prepare for hemodialysis.
