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NSG 3450 Exam 4 – Comprehensive Exam
Questions, Answers & Verified Rationales
| Exam Preparation Guide
SUMMARIZED EXAM COVERAGE
This comprehensive examination covers psychiatric-mental health nursing concepts including
schizophrenia (positive and negative symptoms), personality disorders (Clusters A, B, C), bipolar
disorder management, medication adherence, neuroleptic malignant syndrome, substance use
disorders, child and adolescent mental health, geriatric considerations (Alzheimer's disease and
delirium), crisis intervention, forensic nursing roles, abuse and violence prevention, suicide risk
assessment, medication side effects (atomoxetine, methylphenidate, clozapine, fluphenazine),
therapeutic communication techniques, safety protocols including restraint use, legal and ethical
issues including durable power of attorney, and management of acute psychiatric emergencies.
1. A 32-year-old male with schizophrenia is brought to the emergency department by police after
screaming in a language that no one understands. What is the nurse's priority action?
A) Administer haloperidol immediately
B) Place the patient in seclusion
C) Obtain a translator or interpreter
D) Assess for command hallucinations
Correct Answer: C)
Rationale: Before assuming the patient is having a psychotic episode, the nurse must first
determine if the patient is speaking a different language. Obtaining an interpreter ensures
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accurate assessment and prevents misdiagnosis or inappropriate treatment based on language
barriers.
2. A patient with Alzheimer's disease is exhibiting confusion and agitation. Which intervention
should the nurse prioritize to maintain safety?
A) Encourage family members to visit frequently
B) Provide a structured daily routine
C) Ensure eating and drinking at regular intervals
D) Administer sedative medications as needed
Correct Answer: C)
Rationale: Patients with Alzheimer's often forget to eat and drink, leading to dehydration and
malnutrition that can worsen confusion. Regular intervals for food and fluid intake help maintain
physiological stability and reduce agitation from hunger or thirst.
3. A patient with bipolar disorder has been off lithium for two weeks due to financial difficulties.
What is the most appropriate nursing intervention?
A) Notify the healthcare provider immediately
B) Instruct the patient to restart lithium at the previous dose
C) Refer the patient for prescription assistance programs
D) Discharge the patient with samples of lithium
Correct Answer: C)
Rationale: Medication adherence is critical in bipolar disorder. When patients stop lithium due
to financial constraints, addressing the underlying barrier through prescription assistance
programs is essential for preventing relapse and maintaining therapeutic levels.
4. A patient diagnosed with borderline personality disorder is in the day room and becomes
increasingly agitated. The nurse notices the patient holding a pen. What is the priority nursing
action?
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A) Allow the patient to keep the pen for writing
B) Remove the pen from the room
C) Ask the patient to put the pen down
D) Call security for assistance
Correct Answer: B)
Rationale: Patients with borderline personality disorder may engage in self-harm behaviors
when emotionally dysregulated. Removing potentially dangerous objects like pens is a safety
intervention that prevents the patient from using items to harm themselves or others.
5. A patient is diagnosed with schizoid personality disorder. Which behavior would the nurse
most likely observe?
A) Dramatic and attention-seeking behaviors
B) Odd beliefs and magical thinking
C) Submissive and clinging behavior
D) Emotional detachment and social withdrawal
Correct Answer: D)
Rationale: Schizoid personality disorder is characterized by a pattern of detachment from social
relationships and restricted emotional expression. Patients typically prefer solitary activities and
show little interest in forming close relationships.
6. A patient who was sexually assaulted states, "I cannot face my friends now." What is the
nurse's most therapeutic response?
A) "Your friends will understand what happened to you."
B) "Why do you feel that you cannot face your friends?"
C) "Would you like to talk about what you are feeling right now?"
D) "You need to give yourself time to process this trauma."
Correct Answer: C)
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Rationale: This open-ended question gives the patient control over whether to discuss their
feelings and validates their emotional state. It uses therapeutic communication by offering
support while respecting the patient's autonomy and readiness to share.
7. An 81-year-old patient with delirium keeps insisting they are in a hotel rather than the hospital.
What is the nurse's priority assessment?
A) Determine if the patient has a history of travel
B) Ask the patient to describe the hotel
C) Monitor vital signs and oxygen saturation
D) Reorient the patient to their actual location
Correct Answer: C)
Rationale: Delirium is an acute confusional state often caused by physiological disturbances.
Monitoring vital signs and oxygen saturation helps identify underlying causes such as infection,
hypoxia, or metabolic imbalances that require immediate intervention.
8. A patient with schizophrenia exhibits anhedonia, social withdrawal, and lack of goal-directed
behavior. These symptoms are classified as:
A) Positive symptoms
B) Negative symptoms
C) Cognitive symptoms
D) Affective symptoms
Correct Answer: B)
Rationale: Negative symptoms represent the absence or reduction of normal functions in
schizophrenia. Anhedonia, social withdrawal, and lack of goal-directed behavior are deficits that
significantly impact daily functioning and quality of life.
9. The nurse is caring for a patient with a history of alcohol abuse whose spouse died one year
ago. Which finding would indicate the patient is at high risk for relapse?
NSG 3450 Exam 4 – Comprehensive Exam
Questions, Answers & Verified Rationales
| Exam Preparation Guide
SUMMARIZED EXAM COVERAGE
This comprehensive examination covers psychiatric-mental health nursing concepts including
schizophrenia (positive and negative symptoms), personality disorders (Clusters A, B, C), bipolar
disorder management, medication adherence, neuroleptic malignant syndrome, substance use
disorders, child and adolescent mental health, geriatric considerations (Alzheimer's disease and
delirium), crisis intervention, forensic nursing roles, abuse and violence prevention, suicide risk
assessment, medication side effects (atomoxetine, methylphenidate, clozapine, fluphenazine),
therapeutic communication techniques, safety protocols including restraint use, legal and ethical
issues including durable power of attorney, and management of acute psychiatric emergencies.
1. A 32-year-old male with schizophrenia is brought to the emergency department by police after
screaming in a language that no one understands. What is the nurse's priority action?
A) Administer haloperidol immediately
B) Place the patient in seclusion
C) Obtain a translator or interpreter
D) Assess for command hallucinations
Correct Answer: C)
Rationale: Before assuming the patient is having a psychotic episode, the nurse must first
determine if the patient is speaking a different language. Obtaining an interpreter ensures
,2|Page
accurate assessment and prevents misdiagnosis or inappropriate treatment based on language
barriers.
2. A patient with Alzheimer's disease is exhibiting confusion and agitation. Which intervention
should the nurse prioritize to maintain safety?
A) Encourage family members to visit frequently
B) Provide a structured daily routine
C) Ensure eating and drinking at regular intervals
D) Administer sedative medications as needed
Correct Answer: C)
Rationale: Patients with Alzheimer's often forget to eat and drink, leading to dehydration and
malnutrition that can worsen confusion. Regular intervals for food and fluid intake help maintain
physiological stability and reduce agitation from hunger or thirst.
3. A patient with bipolar disorder has been off lithium for two weeks due to financial difficulties.
What is the most appropriate nursing intervention?
A) Notify the healthcare provider immediately
B) Instruct the patient to restart lithium at the previous dose
C) Refer the patient for prescription assistance programs
D) Discharge the patient with samples of lithium
Correct Answer: C)
Rationale: Medication adherence is critical in bipolar disorder. When patients stop lithium due
to financial constraints, addressing the underlying barrier through prescription assistance
programs is essential for preventing relapse and maintaining therapeutic levels.
4. A patient diagnosed with borderline personality disorder is in the day room and becomes
increasingly agitated. The nurse notices the patient holding a pen. What is the priority nursing
action?
,3|Page
A) Allow the patient to keep the pen for writing
B) Remove the pen from the room
C) Ask the patient to put the pen down
D) Call security for assistance
Correct Answer: B)
Rationale: Patients with borderline personality disorder may engage in self-harm behaviors
when emotionally dysregulated. Removing potentially dangerous objects like pens is a safety
intervention that prevents the patient from using items to harm themselves or others.
5. A patient is diagnosed with schizoid personality disorder. Which behavior would the nurse
most likely observe?
A) Dramatic and attention-seeking behaviors
B) Odd beliefs and magical thinking
C) Submissive and clinging behavior
D) Emotional detachment and social withdrawal
Correct Answer: D)
Rationale: Schizoid personality disorder is characterized by a pattern of detachment from social
relationships and restricted emotional expression. Patients typically prefer solitary activities and
show little interest in forming close relationships.
6. A patient who was sexually assaulted states, "I cannot face my friends now." What is the
nurse's most therapeutic response?
A) "Your friends will understand what happened to you."
B) "Why do you feel that you cannot face your friends?"
C) "Would you like to talk about what you are feeling right now?"
D) "You need to give yourself time to process this trauma."
Correct Answer: C)
, 4|Page
Rationale: This open-ended question gives the patient control over whether to discuss their
feelings and validates their emotional state. It uses therapeutic communication by offering
support while respecting the patient's autonomy and readiness to share.
7. An 81-year-old patient with delirium keeps insisting they are in a hotel rather than the hospital.
What is the nurse's priority assessment?
A) Determine if the patient has a history of travel
B) Ask the patient to describe the hotel
C) Monitor vital signs and oxygen saturation
D) Reorient the patient to their actual location
Correct Answer: C)
Rationale: Delirium is an acute confusional state often caused by physiological disturbances.
Monitoring vital signs and oxygen saturation helps identify underlying causes such as infection,
hypoxia, or metabolic imbalances that require immediate intervention.
8. A patient with schizophrenia exhibits anhedonia, social withdrawal, and lack of goal-directed
behavior. These symptoms are classified as:
A) Positive symptoms
B) Negative symptoms
C) Cognitive symptoms
D) Affective symptoms
Correct Answer: B)
Rationale: Negative symptoms represent the absence or reduction of normal functions in
schizophrenia. Anhedonia, social withdrawal, and lack of goal-directed behavior are deficits that
significantly impact daily functioning and quality of life.
9. The nurse is caring for a patient with a history of alcohol abuse whose spouse died one year
ago. Which finding would indicate the patient is at high risk for relapse?
