NUR 208 Mental Health Nursing Exam 3 Study Set | 2026/2027
NUR 208 MENTAL HEALTH NURSING EXAM 3 STUDY SET
2026/2027 | 75 Questions | Latest 2025-2026 Exam Update
Questions and Answers | Verified Solutions | 100% Correct | Graded A+
NGN-Aligned Format | NCSBN Clinical Judgment Measurement Model (CJMM)
Exam Structure: 75 multiple-choice and Next Generation NCLEX-style questions (standard MC, SATA,
Ordered Response, Matrix/Matching, Scenario-Based). Total testing time: approximately 90-120 minutes.
Passing score: typically 75-80% required (56-60/75 correct).
Domains Covered: Psychopharmacology Mastery, Mood Disorders Management, Psychotic Disorders
Care, Anxiety and Trauma-Related Disorders, Therapeutic Communication, Crisis Intervention and Suicide
Prevention, Legal and Ethical Responsibilities, Vulnerable Populations in Mental Health, Therapeutic
Milieu and Group Therapy, and NGN Clinical Decision-Making.
Note: "NUR 208" is an institution-specific course code representing Mental Health Nursing at various
colleges. Content is high-probability practice material based on standard psychiatric-mental health
nursing textbooks (Varcarolis, Keltner, Boyd), DSM-5-TR criteria, APA Practice Guidelines, NCSBN
CJMM standards, and commonly tested concepts.
Psychopharmacology Mastery
1. A client diagnosed with schizophrenia begins taking haloperidol (Haldol), a typical
antipsychotic. The nurse should monitor the client for which extrapyramidal side effect
(EPS) that presents with involuntary, rhythmic movements of the face, tongue, and jaw?
A. Akathisia
B. Tardive dyskinesia
C. Dystonia
D. Pseudoparkinsonism
Correct Answer: B. Tardive dyskinesia
Rationale: Tardive dyskinesia is a potentially irreversible EPS associated with long-term use of typical
antipsychotics such as haloperidol. It is characterized by involuntary, rhythmic, fly-catching movements
of the mouth, tongue, jaw, and facial muscles. Akathisia presents as motor restlessness and an inability to
sit still. Dystonia involves acute, painful muscle spasms, often of the neck and back. Pseudoparkinsonism
mimics Parkinson's disease with bradykinesia, rigidity, and a shuffling gait. The risk of tardive
dyskinesia increases with prolonged use of typical antipsychotics, and nurses should assess for early
signs during each client encounter.
2. A client taking clozapine (Clozaril) reports a sore throat, fever, and fatigue. Which action
should the nurse take FIRST?
A. Administer acetaminophen as ordered
B. Obtain a stat complete blood count (CBC) with differential
C. Encourage increased fluid intake and rest
D. Document the findings and continue monitoring
Correct Answer: B. Obtain a stat complete blood count (CBC) with differential
Rationale: Clozapine carries a black-box warning for agranulocytosis, a life-threatening drop in white
blood cells. Flu-like symptoms such as sore throat, fever, and malaise may signal the onset of
1
, NUR 208 Mental Health Nursing Exam 3 Study Set | 2026/2027
agranulocytosis. The nurse must obtain a stat CBC with differential and notify the prescribing provider
immediately. Clozapine requires enrollment in a REMS (Risk Evaluation and Mitigation Strategy)
program with mandatory blood monitoring. Treatment must be interrupted if the absolute neutrophil
count (ANC) drops below specified thresholds. Administering acetaminophen or encouraging fluids
without investigating the underlying cause could delay identification of this potentially fatal adverse
effect.
3. **[SATA]** A client with major depressive disorder is prescribed fluoxetine (Prozac), a
selective serotonin reuptake inhibitor (SSRI). Which findings should the nurse identify as
manifestations of serotonin syndrome? (Select all that apply)
A. Hyperthermia
B. Hypotension
C. Myoclonus
D. Bradycardia
E. Agitation
F. Diaphoresis
Correct Answers: A, C, E, F - Hyperthermia, Myoclonus, Agitation, Diaphoresis
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excessive
serotonergic activity, which can occur when SSRIs are combined with other serotonergic agents or taken
in overdose. Key manifestations include the triad of cognitive changes (agitation, confusion, delirium),
autonomic instability (hyperthermia, diaphoresis, tachycardia, hypertension), and neuromuscular
excitability (myoclonus, hyperreflexia, tremor, rigidity). Hypotension and bradycardia are not associated
with serotonin syndrome; in fact, tachycardia and hypertension are more commonly observed. Serotonin
syndrome requires immediate recognition, discontinuation of the serotonergic agent, and supportive
care. Severe cases may require cyproheptadine or benzodiazepines.
4. A client prescribed a monoamine oxidase inhibitor (MAOI) asks the nurse which foods
should be avoided. Which response by the nurse is most appropriate?
A. Avoid all dairy products and leafy green vegetables
B. Avoid aged cheeses, cured meats, fermented foods, and tap beer
C. Avoid high-sugar foods and caffeinated beverages
D. Avoid citrus fruits and carbonated beverages
Correct Answer: B. Avoid aged cheeses, cured meats, fermented foods, and tap beer
Rationale: MAOIs such as phenelzine (Nardil) and tranylcypromine (Parnate) inhibit the enzyme
monoamine oxidase, which is responsible for breaking down tyramine in the gastrointestinal tract.
Ingesting tyramine-rich foods can lead to a hypertensive crisis characterized by severe headache,
hypertension, neck stiffness, palpitations, and risk of hemorrhagic stroke. Foods to avoid include aged
cheeses (cheddar, Swiss, brie), cured or smoked meats (salami, pepperoni), fermented foods (sauerkraut,
soy sauce, tofu), tap beer, and red wine. Clients should be educated on these dietary restrictions before
initiating therapy and whenever a new MAOI prescription is written.
5. A client with bipolar disorder has a serum lithium level of 1.5 mEq/L. Which finding
should the nurse anticipate?
A. Therapeutic effect with no adverse effects
B. Mild tremor and polyuria
C. Coarse tremor, nausea, ataxia, and confusion
D. Seizures, cardiac arrhythmias, and coma
Correct Answer: C. Coarse tremor, nausea, ataxia, and confusion
2
, NUR 208 Mental Health Nursing Exam 3 Study Set | 2026/2027
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.5 mEq/L indicates
moderate lithium toxicity. Manifestations of moderate toxicity include coarse hand tremor, persistent
nausea and vomiting, ataxia (unsteady gait), slurred speech, drowsiness, and confusion. Mild toxicity
(1.2-1.5 mEq/L) may present with fine tremor, polyuria, polydipsia, and mild GI upset. Severe toxicity
(above 2.0 mEq/L) can progress to seizures, cardiac arrhythmias, circulatory collapse, coma, and death.
The nurse should immediately withhold lithium, notify the provider, and prepare for potential
interventions such as IV normal saline, monitoring of serum levels, and in severe cases hemodialysis.
6. Which atypical antipsychotic is most likely to cause significant metabolic side effects,
including weight gain, hyperglycemia, and dyslipidemia?
A. Aripiprazole (Abilify)
B. Ziprasidone (Geodon)
C. Olanzapine (Zyprexa)
D. Haloperidol (Haldol)
Correct Answer: C. Olanzapine (Zyprexa)
Rationale: Among atypical antipsychotics, clozapine and olanzapine carry the highest risk for
metabolic side effects, including significant weight gain, hyperglycemia, new-onset type 2 diabetes
mellitus, and dyslipidemia. These metabolic effects increase the client's long-term cardiovascular risk.
Aripiprazole and ziprasidone have more favorable metabolic profiles and are often preferred when
weight management is a concern. Haloperidol is a typical antipsychotic with lower metabolic risk but
higher EPS risk. Nurses should monitor baseline and ongoing metabolic parameters (weight, BMI, fasting
glucose, lipid panel) and collaborate with the provider to implement lifestyle modifications and consider
medication adjustments when necessary.
7. A client has been taking benzodiazepines for anxiety for 6 months and wants to
discontinue the medication. Which instruction by the nurse is most important?
A. Stop taking the medication immediately to avoid dependence
B. Taper the dose gradually under medical supervision
C. Switch to an SSRI and then stop the benzodiazepine abruptly
D. Reduce the dose by half each week until discontinued
Correct Answer: B. Taper the dose gradually under medical supervision
Rationale: Abrupt discontinuation of benzodiazepines after prolonged use can lead to withdrawal
symptoms including anxiety, insomnia, tremors, diaphoresis, perceptual disturbances, and potentially
life-threatening seizures. The safest approach is a slow, gradual taper under medical supervision,
typically reducing the dose by 10-25% every 1-2 weeks depending on the specific benzodiazepine and
duration of use. Stopping abruptly is dangerous. Switching to an SSRI and then abruptly discontinuing
does not address benzodiazepine withdrawal. Reducing by half each week is too rapid and increases
seizure risk. The nurse should educate the client about the importance of adherence to the tapering
schedule and the dangers of abrupt discontinuation.
8. A client taking lithium for bipolar disorder reports increased urination and excessive
thirst. Which lab value should the nurse monitor to assess for a common renal
complication?
A. Blood urea nitrogen (BUN)
B. Serum creatinine
C. Serum sodium
D. Urine specific gravity
Correct Answer: C. Serum sodium
3
NUR 208 MENTAL HEALTH NURSING EXAM 3 STUDY SET
2026/2027 | 75 Questions | Latest 2025-2026 Exam Update
Questions and Answers | Verified Solutions | 100% Correct | Graded A+
NGN-Aligned Format | NCSBN Clinical Judgment Measurement Model (CJMM)
Exam Structure: 75 multiple-choice and Next Generation NCLEX-style questions (standard MC, SATA,
Ordered Response, Matrix/Matching, Scenario-Based). Total testing time: approximately 90-120 minutes.
Passing score: typically 75-80% required (56-60/75 correct).
Domains Covered: Psychopharmacology Mastery, Mood Disorders Management, Psychotic Disorders
Care, Anxiety and Trauma-Related Disorders, Therapeutic Communication, Crisis Intervention and Suicide
Prevention, Legal and Ethical Responsibilities, Vulnerable Populations in Mental Health, Therapeutic
Milieu and Group Therapy, and NGN Clinical Decision-Making.
Note: "NUR 208" is an institution-specific course code representing Mental Health Nursing at various
colleges. Content is high-probability practice material based on standard psychiatric-mental health
nursing textbooks (Varcarolis, Keltner, Boyd), DSM-5-TR criteria, APA Practice Guidelines, NCSBN
CJMM standards, and commonly tested concepts.
Psychopharmacology Mastery
1. A client diagnosed with schizophrenia begins taking haloperidol (Haldol), a typical
antipsychotic. The nurse should monitor the client for which extrapyramidal side effect
(EPS) that presents with involuntary, rhythmic movements of the face, tongue, and jaw?
A. Akathisia
B. Tardive dyskinesia
C. Dystonia
D. Pseudoparkinsonism
Correct Answer: B. Tardive dyskinesia
Rationale: Tardive dyskinesia is a potentially irreversible EPS associated with long-term use of typical
antipsychotics such as haloperidol. It is characterized by involuntary, rhythmic, fly-catching movements
of the mouth, tongue, jaw, and facial muscles. Akathisia presents as motor restlessness and an inability to
sit still. Dystonia involves acute, painful muscle spasms, often of the neck and back. Pseudoparkinsonism
mimics Parkinson's disease with bradykinesia, rigidity, and a shuffling gait. The risk of tardive
dyskinesia increases with prolonged use of typical antipsychotics, and nurses should assess for early
signs during each client encounter.
2. A client taking clozapine (Clozaril) reports a sore throat, fever, and fatigue. Which action
should the nurse take FIRST?
A. Administer acetaminophen as ordered
B. Obtain a stat complete blood count (CBC) with differential
C. Encourage increased fluid intake and rest
D. Document the findings and continue monitoring
Correct Answer: B. Obtain a stat complete blood count (CBC) with differential
Rationale: Clozapine carries a black-box warning for agranulocytosis, a life-threatening drop in white
blood cells. Flu-like symptoms such as sore throat, fever, and malaise may signal the onset of
1
, NUR 208 Mental Health Nursing Exam 3 Study Set | 2026/2027
agranulocytosis. The nurse must obtain a stat CBC with differential and notify the prescribing provider
immediately. Clozapine requires enrollment in a REMS (Risk Evaluation and Mitigation Strategy)
program with mandatory blood monitoring. Treatment must be interrupted if the absolute neutrophil
count (ANC) drops below specified thresholds. Administering acetaminophen or encouraging fluids
without investigating the underlying cause could delay identification of this potentially fatal adverse
effect.
3. **[SATA]** A client with major depressive disorder is prescribed fluoxetine (Prozac), a
selective serotonin reuptake inhibitor (SSRI). Which findings should the nurse identify as
manifestations of serotonin syndrome? (Select all that apply)
A. Hyperthermia
B. Hypotension
C. Myoclonus
D. Bradycardia
E. Agitation
F. Diaphoresis
Correct Answers: A, C, E, F - Hyperthermia, Myoclonus, Agitation, Diaphoresis
Rationale: Serotonin syndrome is a potentially life-threatening condition caused by excessive
serotonergic activity, which can occur when SSRIs are combined with other serotonergic agents or taken
in overdose. Key manifestations include the triad of cognitive changes (agitation, confusion, delirium),
autonomic instability (hyperthermia, diaphoresis, tachycardia, hypertension), and neuromuscular
excitability (myoclonus, hyperreflexia, tremor, rigidity). Hypotension and bradycardia are not associated
with serotonin syndrome; in fact, tachycardia and hypertension are more commonly observed. Serotonin
syndrome requires immediate recognition, discontinuation of the serotonergic agent, and supportive
care. Severe cases may require cyproheptadine or benzodiazepines.
4. A client prescribed a monoamine oxidase inhibitor (MAOI) asks the nurse which foods
should be avoided. Which response by the nurse is most appropriate?
A. Avoid all dairy products and leafy green vegetables
B. Avoid aged cheeses, cured meats, fermented foods, and tap beer
C. Avoid high-sugar foods and caffeinated beverages
D. Avoid citrus fruits and carbonated beverages
Correct Answer: B. Avoid aged cheeses, cured meats, fermented foods, and tap beer
Rationale: MAOIs such as phenelzine (Nardil) and tranylcypromine (Parnate) inhibit the enzyme
monoamine oxidase, which is responsible for breaking down tyramine in the gastrointestinal tract.
Ingesting tyramine-rich foods can lead to a hypertensive crisis characterized by severe headache,
hypertension, neck stiffness, palpitations, and risk of hemorrhagic stroke. Foods to avoid include aged
cheeses (cheddar, Swiss, brie), cured or smoked meats (salami, pepperoni), fermented foods (sauerkraut,
soy sauce, tofu), tap beer, and red wine. Clients should be educated on these dietary restrictions before
initiating therapy and whenever a new MAOI prescription is written.
5. A client with bipolar disorder has a serum lithium level of 1.5 mEq/L. Which finding
should the nurse anticipate?
A. Therapeutic effect with no adverse effects
B. Mild tremor and polyuria
C. Coarse tremor, nausea, ataxia, and confusion
D. Seizures, cardiac arrhythmias, and coma
Correct Answer: C. Coarse tremor, nausea, ataxia, and confusion
2
, NUR 208 Mental Health Nursing Exam 3 Study Set | 2026/2027
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.5 mEq/L indicates
moderate lithium toxicity. Manifestations of moderate toxicity include coarse hand tremor, persistent
nausea and vomiting, ataxia (unsteady gait), slurred speech, drowsiness, and confusion. Mild toxicity
(1.2-1.5 mEq/L) may present with fine tremor, polyuria, polydipsia, and mild GI upset. Severe toxicity
(above 2.0 mEq/L) can progress to seizures, cardiac arrhythmias, circulatory collapse, coma, and death.
The nurse should immediately withhold lithium, notify the provider, and prepare for potential
interventions such as IV normal saline, monitoring of serum levels, and in severe cases hemodialysis.
6. Which atypical antipsychotic is most likely to cause significant metabolic side effects,
including weight gain, hyperglycemia, and dyslipidemia?
A. Aripiprazole (Abilify)
B. Ziprasidone (Geodon)
C. Olanzapine (Zyprexa)
D. Haloperidol (Haldol)
Correct Answer: C. Olanzapine (Zyprexa)
Rationale: Among atypical antipsychotics, clozapine and olanzapine carry the highest risk for
metabolic side effects, including significant weight gain, hyperglycemia, new-onset type 2 diabetes
mellitus, and dyslipidemia. These metabolic effects increase the client's long-term cardiovascular risk.
Aripiprazole and ziprasidone have more favorable metabolic profiles and are often preferred when
weight management is a concern. Haloperidol is a typical antipsychotic with lower metabolic risk but
higher EPS risk. Nurses should monitor baseline and ongoing metabolic parameters (weight, BMI, fasting
glucose, lipid panel) and collaborate with the provider to implement lifestyle modifications and consider
medication adjustments when necessary.
7. A client has been taking benzodiazepines for anxiety for 6 months and wants to
discontinue the medication. Which instruction by the nurse is most important?
A. Stop taking the medication immediately to avoid dependence
B. Taper the dose gradually under medical supervision
C. Switch to an SSRI and then stop the benzodiazepine abruptly
D. Reduce the dose by half each week until discontinued
Correct Answer: B. Taper the dose gradually under medical supervision
Rationale: Abrupt discontinuation of benzodiazepines after prolonged use can lead to withdrawal
symptoms including anxiety, insomnia, tremors, diaphoresis, perceptual disturbances, and potentially
life-threatening seizures. The safest approach is a slow, gradual taper under medical supervision,
typically reducing the dose by 10-25% every 1-2 weeks depending on the specific benzodiazepine and
duration of use. Stopping abruptly is dangerous. Switching to an SSRI and then abruptly discontinuing
does not address benzodiazepine withdrawal. Reducing by half each week is too rapid and increases
seizure risk. The nurse should educate the client about the importance of adherence to the tapering
schedule and the dangers of abrupt discontinuation.
8. A client taking lithium for bipolar disorder reports increased urination and excessive
thirst. Which lab value should the nurse monitor to assess for a common renal
complication?
A. Blood urea nitrogen (BUN)
B. Serum creatinine
C. Serum sodium
D. Urine specific gravity
Correct Answer: C. Serum sodium
3
