PNR 200/PNR200 Exam 3 V1 | Mental Health
Nursing Q&A with Rationale | Fortis College
1. A client diagnosed with Bipolar I Disorder is experiencing a manic episode. Which snack
should the nurse offer to provide the best nutritional support for this client?
A. A bowl of vegetable soup and crackers
B. A cup of yogurt with a spoon
C. Spaghetti and meatballs with a side salad
D. A turkey sandwich and an apple
Correct Answer: D
Explanation: Clients in a manic state are hyperactive and often unable to sit down to eat.
The nurse should provide ‘finger foods’ that are high in protein and calories to ensure the
client maintains adequate nutrition while on the move. A sandwich and an apple allow the
client to eat while walking, whereas the other options require sitting and the use of
utensils.
2. The nurse is monitoring a client who started taking Lithium Carbonate one week ago.
Which finding should the nurse report to the provider as a potential sign of toxicity?
A. Mild thirst
B. Fine hand tremors
C. Coarse hand tremors and diarrhea
,D. Polyuria
Correct Answer: C
Explanation: Coarse tremors, diarrhea, and vomiting are early signs of lithium toxicity and
require immediate intervention. Mild thirst, fine tremors, and polyuria are common side
effects that often diminish over time. The nurse must monitor serum lithium levels closely
to ensure they remain within the therapeutic range of 0.6 to 1.2 mEq/L.
3. A client with Borderline Personality Disorder is observed being extremely friendly to one
nurse while telling another nurse that they are ‘unprofessional and incompetent.’ This
behavior is known as:
A. Projection
B. Sublimation
C. Regression
D. Splitting
Correct Answer: D
Explanation: Splitting is a common defense mechanism used by individuals with
Borderline Personality Disorder to manage anxiety by labeling people as all good or all bad.
This behavior often creates conflict among the nursing staff and disrupts the therapeutic
milieu. The nursing team must communicate effectively and maintain consistent
boundaries to counter this behavior.
, 4. Which of the following dietary choices should be avoided by a client prescribed Phenelzine
(Nardil)?
A. Fresh chicken and corn
B. Aged cheddar cheese and pepperoni
C. Apples and grapes
D. Scrambled eggs and toast
Correct Answer: B
Explanation: Phenelzine is an Monoamine Oxidase Inhibitor (MAOI) that requires a low-
tyramine diet to prevent a hypertensive crisis. Aged cheeses, cured meats like pepperoni,
and fermented foods are high in tyramine and must be avoided. The nurse should educate
the client that a hypertensive crisis is a medical emergency characterized by a severe
headache and elevated blood pressure.
5. A client is admitted to the inpatient unit with Anorexia Nervosa. What is the priority
nursing intervention during the first 24 hours of admission?
A. Monitoring electrolyte levels and cardiac rhythm
B. Encouraging the client to express feelings about body image
C. Setting up a high-calorie meal plan
D. Supervising the client during aerobic exercise
Correct Answer: A
Nursing Q&A with Rationale | Fortis College
1. A client diagnosed with Bipolar I Disorder is experiencing a manic episode. Which snack
should the nurse offer to provide the best nutritional support for this client?
A. A bowl of vegetable soup and crackers
B. A cup of yogurt with a spoon
C. Spaghetti and meatballs with a side salad
D. A turkey sandwich and an apple
Correct Answer: D
Explanation: Clients in a manic state are hyperactive and often unable to sit down to eat.
The nurse should provide ‘finger foods’ that are high in protein and calories to ensure the
client maintains adequate nutrition while on the move. A sandwich and an apple allow the
client to eat while walking, whereas the other options require sitting and the use of
utensils.
2. The nurse is monitoring a client who started taking Lithium Carbonate one week ago.
Which finding should the nurse report to the provider as a potential sign of toxicity?
A. Mild thirst
B. Fine hand tremors
C. Coarse hand tremors and diarrhea
,D. Polyuria
Correct Answer: C
Explanation: Coarse tremors, diarrhea, and vomiting are early signs of lithium toxicity and
require immediate intervention. Mild thirst, fine tremors, and polyuria are common side
effects that often diminish over time. The nurse must monitor serum lithium levels closely
to ensure they remain within the therapeutic range of 0.6 to 1.2 mEq/L.
3. A client with Borderline Personality Disorder is observed being extremely friendly to one
nurse while telling another nurse that they are ‘unprofessional and incompetent.’ This
behavior is known as:
A. Projection
B. Sublimation
C. Regression
D. Splitting
Correct Answer: D
Explanation: Splitting is a common defense mechanism used by individuals with
Borderline Personality Disorder to manage anxiety by labeling people as all good or all bad.
This behavior often creates conflict among the nursing staff and disrupts the therapeutic
milieu. The nursing team must communicate effectively and maintain consistent
boundaries to counter this behavior.
, 4. Which of the following dietary choices should be avoided by a client prescribed Phenelzine
(Nardil)?
A. Fresh chicken and corn
B. Aged cheddar cheese and pepperoni
C. Apples and grapes
D. Scrambled eggs and toast
Correct Answer: B
Explanation: Phenelzine is an Monoamine Oxidase Inhibitor (MAOI) that requires a low-
tyramine diet to prevent a hypertensive crisis. Aged cheeses, cured meats like pepperoni,
and fermented foods are high in tyramine and must be avoided. The nurse should educate
the client that a hypertensive crisis is a medical emergency characterized by a severe
headache and elevated blood pressure.
5. A client is admitted to the inpatient unit with Anorexia Nervosa. What is the priority
nursing intervention during the first 24 hours of admission?
A. Monitoring electrolyte levels and cardiac rhythm
B. Encouraging the client to express feelings about body image
C. Setting up a high-calorie meal plan
D. Supervising the client during aerobic exercise
Correct Answer: A
