NR 326: MENTAL HEALTH NURSING ATI / HESI PROCTORED COMPLETE
EXAM QUESTIONS AND EXPLAINED ANSWERS LATEST VERSION 2026/2027
PASS GUARANTEE
Q: A client with schizophrenia says, 'The TV is sending me special
1
messages.' This is an example of which symptom?
ANSWER Ideas of reference — a positive symptom of schizophrenia
A where the client believes that external events or objects have special
personal significance directed at them.
Q: Which antipsychotic medication requires weekly WBC monitoring for
2
the first 6 months?
ANSWER Clozapine (Clozaril) — due to the risk of agranulocytosis.
A WBC is monitored weekly for 6 months, then biweekly for 6 months,
then monthly if stable. ANC must be >1500/mm³ to continue therapy.
Q: A nurse observes a client sitting motionless for hours, unresponsive to
3
stimuli. Which subtype of schizophrenia does this suggest?
ANSWER Catatonic schizophrenia — characterized by marked
A psychomotor disturbance, including stupor, negativism, mutism, and
waxy flexibility (posturing).
Q: Which finding in a client taking haloperidol (Haldol) requires
4
IMMEDIATE intervention?
ANSWER Neuroleptic Malignant Syndrome (NMS) — manifested by
hyperthermia, severe muscle rigidity, altered consciousness, and
A
autonomic instability. It is a life-threatening emergency requiring
immediate discontinuation of the drug.
Page 1 of 53 | For Educational Use Only
, Q: A client with schizophrenia shows blunted affect, poverty of speech,
5
and social withdrawal. These are classified as:
ANSWER Negative symptoms of schizophrenia — they represent a
A diminution of normal function. Includes flat/blunted affect, alogia
(poverty of speech), avolition, anhedonia, and social withdrawal.
Q: Which nursing intervention is PRIORITY when a client experiencing
6
command hallucinations says a voice is telling them to hurt themselves?
ANSWER Ensure client and staff safety — assess lethality, remove
A dangerous objects, implement one-to-one observation, notify the
provider, and document. Safety is always the priority.
Q: Tardive dyskinesia is a long-term side effect of antipsychotics. How is
7
it characterized?
ANSWER Involuntary, repetitive movements — especially of the face,
lips, tongue (lip smacking, tongue protrusion), and extremities. It is often
A
irreversible. The AIMS (Abnormal Involuntary Movement Scale) is used
to screen for it.
Q: A client taking risperidone develops muscle stiffness, restlessness, and
8
an inability to sit still. What is this called and how is it treated?
ANSWER Akathisia (subjective restlessness) and extrapyramidal
A symptoms (EPS) — treated with benztropine (Cogentin),
diphenhydramine (Benadryl), or propranolol for akathisia.
9 Q: What is the difference between a hallucination and a delusion?
ANSWER A hallucination is a false sensory perception with no external
A stimulus (e.g., hearing voices). A delusion is a fixed, false belief not
based in reality (e.g., believing one is being poisoned).
Q: A nurse is caring for a client who is actively hallucinating. Which
10
therapeutic response is best?
Page 2 of 53 | For Educational Use Only
, ANSWER 'I don't hear the voice, but I can see you are frightened.' —
A The nurse acknowledges the client's experience without reinforcing the
hallucination or being confrontational.
11 Q: What is the primary mechanism of clozapine?
ANSWER Clozapine is an atypical antipsychotic that blocks dopamine
D4 receptors and serotonin 5-HT2 receptors. It has high efficacy for both
A
positive and negative symptoms and reduces suicidal ideation in
schizophrenia.
Q: Which laboratory value is MOST important to monitor in a client
12
taking lithium?
ANSWER Serum lithium level — therapeutic range is 0.6-1.2 mEq/L
A (maintenance); 0.8-1.4 mEq/L (acute mania). Also monitor renal function
(BUN, creatinine) and thyroid function. Toxic level: >1.5 mEq/L.
Q: A client with schizophrenia refuses antipsychotic medication. What is
13
the nurse's first action?
ANSWER Explore the reason for refusal — side effects, cultural
A beliefs, lack of insight. Provide education, involve the treatment team.
Forced medication requires a court order unless there is imminent danger.
Q: Dystonia is an acute EPS reaction. What is the PRIORITY nursing
14
intervention?
ANSWER Administer benztropine (Cogentin) IM or IV as ordered —
A acute dystonia (torticollis, oculogyric crisis, opisthotonos) is painful and
frightening. Diphenhydramine (Benadryl) IM is also effective.
Q: Which generation of antipsychotics causes more extrapyramidal side
15
effects?
ANSWER First-generation (typical) antipsychotics (e.g., haloperidol,
A
chlorpromazine, fluphenazine) — they strongly block D2 receptors in the
Page 3 of 53 | For Educational Use Only
, nigrostriatal pathway, causing EPS. Atypical antipsychotics have lower
EPS risk.
Q: A client with schizophrenia says, 'My thoughts are being broadcast on
16
the radio.' This is an example of:
ANSWER Thought broadcasting — a positive symptom/Schneiderian
A first-rank symptom where the client believes others can hear their
thoughts being transmitted externally.
17 Q: What is 'loose associations' in mental health nursing?
ANSWER Loose associations (derailment) — a thought disorder where
A ideas shift from one topic to another with no logical connection. It is a
positive symptom of schizophrenia and reflects disorganized thinking.
Q: A client taking quetiapine (Seroquel) should be monitored for which
18
metabolic side effect?
ANSWER Weight gain, hyperglycemia, and dyslipidemia (metabolic
A syndrome) — atypical antipsychotics, particularly clozapine, olanzapine,
and quetiapine, carry the highest metabolic risk.
Q: What is pseudoparkinsonism (drug-induced) and which medication
19
treats it?
ANSWER Pseudoparkinsonism — pill-rolling tremor, shuffling gait,
A masklike facies, rigidity — caused by dopamine blockade. Treated with
benztropine (Cogentin) or amantadine.
20 Q: What is the prodromal phase of schizophrenia?
ANSWER The prodromal phase is the period before psychosis fully
A develops, characterized by social withdrawal, odd behavior, declining
functioning, sleep disturbances, and attenuated psychotic symptoms.
Page 4 of 53 | For Educational Use Only
EXAM QUESTIONS AND EXPLAINED ANSWERS LATEST VERSION 2026/2027
PASS GUARANTEE
Q: A client with schizophrenia says, 'The TV is sending me special
1
messages.' This is an example of which symptom?
ANSWER Ideas of reference — a positive symptom of schizophrenia
A where the client believes that external events or objects have special
personal significance directed at them.
Q: Which antipsychotic medication requires weekly WBC monitoring for
2
the first 6 months?
ANSWER Clozapine (Clozaril) — due to the risk of agranulocytosis.
A WBC is monitored weekly for 6 months, then biweekly for 6 months,
then monthly if stable. ANC must be >1500/mm³ to continue therapy.
Q: A nurse observes a client sitting motionless for hours, unresponsive to
3
stimuli. Which subtype of schizophrenia does this suggest?
ANSWER Catatonic schizophrenia — characterized by marked
A psychomotor disturbance, including stupor, negativism, mutism, and
waxy flexibility (posturing).
Q: Which finding in a client taking haloperidol (Haldol) requires
4
IMMEDIATE intervention?
ANSWER Neuroleptic Malignant Syndrome (NMS) — manifested by
hyperthermia, severe muscle rigidity, altered consciousness, and
A
autonomic instability. It is a life-threatening emergency requiring
immediate discontinuation of the drug.
Page 1 of 53 | For Educational Use Only
, Q: A client with schizophrenia shows blunted affect, poverty of speech,
5
and social withdrawal. These are classified as:
ANSWER Negative symptoms of schizophrenia — they represent a
A diminution of normal function. Includes flat/blunted affect, alogia
(poverty of speech), avolition, anhedonia, and social withdrawal.
Q: Which nursing intervention is PRIORITY when a client experiencing
6
command hallucinations says a voice is telling them to hurt themselves?
ANSWER Ensure client and staff safety — assess lethality, remove
A dangerous objects, implement one-to-one observation, notify the
provider, and document. Safety is always the priority.
Q: Tardive dyskinesia is a long-term side effect of antipsychotics. How is
7
it characterized?
ANSWER Involuntary, repetitive movements — especially of the face,
lips, tongue (lip smacking, tongue protrusion), and extremities. It is often
A
irreversible. The AIMS (Abnormal Involuntary Movement Scale) is used
to screen for it.
Q: A client taking risperidone develops muscle stiffness, restlessness, and
8
an inability to sit still. What is this called and how is it treated?
ANSWER Akathisia (subjective restlessness) and extrapyramidal
A symptoms (EPS) — treated with benztropine (Cogentin),
diphenhydramine (Benadryl), or propranolol for akathisia.
9 Q: What is the difference between a hallucination and a delusion?
ANSWER A hallucination is a false sensory perception with no external
A stimulus (e.g., hearing voices). A delusion is a fixed, false belief not
based in reality (e.g., believing one is being poisoned).
Q: A nurse is caring for a client who is actively hallucinating. Which
10
therapeutic response is best?
Page 2 of 53 | For Educational Use Only
, ANSWER 'I don't hear the voice, but I can see you are frightened.' —
A The nurse acknowledges the client's experience without reinforcing the
hallucination or being confrontational.
11 Q: What is the primary mechanism of clozapine?
ANSWER Clozapine is an atypical antipsychotic that blocks dopamine
D4 receptors and serotonin 5-HT2 receptors. It has high efficacy for both
A
positive and negative symptoms and reduces suicidal ideation in
schizophrenia.
Q: Which laboratory value is MOST important to monitor in a client
12
taking lithium?
ANSWER Serum lithium level — therapeutic range is 0.6-1.2 mEq/L
A (maintenance); 0.8-1.4 mEq/L (acute mania). Also monitor renal function
(BUN, creatinine) and thyroid function. Toxic level: >1.5 mEq/L.
Q: A client with schizophrenia refuses antipsychotic medication. What is
13
the nurse's first action?
ANSWER Explore the reason for refusal — side effects, cultural
A beliefs, lack of insight. Provide education, involve the treatment team.
Forced medication requires a court order unless there is imminent danger.
Q: Dystonia is an acute EPS reaction. What is the PRIORITY nursing
14
intervention?
ANSWER Administer benztropine (Cogentin) IM or IV as ordered —
A acute dystonia (torticollis, oculogyric crisis, opisthotonos) is painful and
frightening. Diphenhydramine (Benadryl) IM is also effective.
Q: Which generation of antipsychotics causes more extrapyramidal side
15
effects?
ANSWER First-generation (typical) antipsychotics (e.g., haloperidol,
A
chlorpromazine, fluphenazine) — they strongly block D2 receptors in the
Page 3 of 53 | For Educational Use Only
, nigrostriatal pathway, causing EPS. Atypical antipsychotics have lower
EPS risk.
Q: A client with schizophrenia says, 'My thoughts are being broadcast on
16
the radio.' This is an example of:
ANSWER Thought broadcasting — a positive symptom/Schneiderian
A first-rank symptom where the client believes others can hear their
thoughts being transmitted externally.
17 Q: What is 'loose associations' in mental health nursing?
ANSWER Loose associations (derailment) — a thought disorder where
A ideas shift from one topic to another with no logical connection. It is a
positive symptom of schizophrenia and reflects disorganized thinking.
Q: A client taking quetiapine (Seroquel) should be monitored for which
18
metabolic side effect?
ANSWER Weight gain, hyperglycemia, and dyslipidemia (metabolic
A syndrome) — atypical antipsychotics, particularly clozapine, olanzapine,
and quetiapine, carry the highest metabolic risk.
Q: What is pseudoparkinsonism (drug-induced) and which medication
19
treats it?
ANSWER Pseudoparkinsonism — pill-rolling tremor, shuffling gait,
A masklike facies, rigidity — caused by dopamine blockade. Treated with
benztropine (Cogentin) or amantadine.
20 Q: What is the prodromal phase of schizophrenia?
ANSWER The prodromal phase is the period before psychosis fully
A develops, characterized by social withdrawal, odd behavior, declining
functioning, sleep disturbances, and attenuated psychotic symptoms.
Page 4 of 53 | For Educational Use Only
