NURS 222 Mental Health/Psychiatric Nursing Exam 3 Study Guide
2026 |WCU
1. A patient with a history of Bipolar Disorder is admitted with a serum lithium
level of 1.9 mEq/L. Which clinical finding should the nurse prioritize?
A. Mental confusion, incoordination, and coarse tremors
B. Polyuria and weight gain
C. Persistent gastrointestinal upset and blurred vision
D. Fine hand tremors and mild thirst
Answer: A
Rationale: Lithium levels between 1.5 and 2.0 mEq/L indicate advanced toxicity. Clinical
manifestations include coarse hand tremors, persistent GI upset, mental confusion, and
lack of coordination. Fine tremors are common at therapeutic levels (0.6-1.2 mEq/L).
2. A patient with Borderline Personality Disorder (BPD) tells a nurse, ‘You are
the only one who cares about me. That other nurse is cruel and incompetent.’
What is this defensive mechanism called?
A. Reaction formation
B. Intellectualization
C. Projective identification
D. Splitting
Answer: D
Rationale: Splitting is a primitive defense mechanism common in BPD where the
individual is unable to integrate positive and negative qualities of others into a cohesive
image, viewing people as all good or all bad.
,3. When assessing a patient for Neuroleptic Malignant Syndrome (NMS) after
starting a high-potency antipsychotic, which constellation of symptoms is
definitive?
A. Bradycardia, hypothermia, and muscle flaccidity
B. Tachycardia, hypertension, and fine tremors
C. Severe muscle rigidity, hyperpyrexia, and autonomic instability
D. Akathisia, dystonia, and oculogyric crisis
Answer: C
Rationale: NMS is a life-threatening medical emergency characterized by lead-pipe muscle
rigidity, very high fever (hyperpyrexia), and autonomic instability (tachycardia,
diaphoresis, labile blood pressure).
4. A nurse is caring for a patient experiencing alcohol withdrawal. At 48 hours
after the last drink, the patient becomes agitated and reports ‘bugs crawling on
the walls.’ Which condition is likely?
A. Wernicke’s encephalopathy
B. Delirium Tremens (DTs)
C. Alcoholic hallucinosis
D. Korsakoff’s psychosis
Answer: B
Rationale: Delirium Tremens typically occurs 48-72 hours after the last drink and involves
autonomic hyperactivity, sensory hallucinations, and severe agitation. It is a medical
emergency.
, 5. Which laboratory value is the most critical for a nurse to monitor in a patient
newly prescribed Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Liver function tests (LFTs)
C. Serum sodium levels
D. Creatinine clearance
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis. Weekly or bi-weekly monitoring of
the Absolute Neutrophil Count (ANC) is mandatory to ensure the patient does not develop
life-threatening neutropenia.
6. An adolescent patient is admitted with Anorexia Nervosa. Which physical
finding most likely indicates the severity of the malnutrition?
A. Parotid gland swelling
B. Presence of lanugo and bradycardia
C. Tachycardia and hypertension
D. Russell’s sign on the knuckles
Answer: B
Rationale: Lanugo (fine, downy hair) and bradycardia are physiological adaptations to
starvation and low body temperature in Anorexia. Parotid swelling and Russell’s sign are
more common in Bulimia Nervosa.
7. A patient with Antisocial Personality Disorder is being treated in a locked
unit. Which nursing intervention is the priority?
A. Setting clear, consistent limits on behavior
B. Encouraging the patient to express feelings of guilt
C. Providing a warm, nurturing environment
D. Allowing the patient to lead the group therapy session
Answer: A
2026 |WCU
1. A patient with a history of Bipolar Disorder is admitted with a serum lithium
level of 1.9 mEq/L. Which clinical finding should the nurse prioritize?
A. Mental confusion, incoordination, and coarse tremors
B. Polyuria and weight gain
C. Persistent gastrointestinal upset and blurred vision
D. Fine hand tremors and mild thirst
Answer: A
Rationale: Lithium levels between 1.5 and 2.0 mEq/L indicate advanced toxicity. Clinical
manifestations include coarse hand tremors, persistent GI upset, mental confusion, and
lack of coordination. Fine tremors are common at therapeutic levels (0.6-1.2 mEq/L).
2. A patient with Borderline Personality Disorder (BPD) tells a nurse, ‘You are
the only one who cares about me. That other nurse is cruel and incompetent.’
What is this defensive mechanism called?
A. Reaction formation
B. Intellectualization
C. Projective identification
D. Splitting
Answer: D
Rationale: Splitting is a primitive defense mechanism common in BPD where the
individual is unable to integrate positive and negative qualities of others into a cohesive
image, viewing people as all good or all bad.
,3. When assessing a patient for Neuroleptic Malignant Syndrome (NMS) after
starting a high-potency antipsychotic, which constellation of symptoms is
definitive?
A. Bradycardia, hypothermia, and muscle flaccidity
B. Tachycardia, hypertension, and fine tremors
C. Severe muscle rigidity, hyperpyrexia, and autonomic instability
D. Akathisia, dystonia, and oculogyric crisis
Answer: C
Rationale: NMS is a life-threatening medical emergency characterized by lead-pipe muscle
rigidity, very high fever (hyperpyrexia), and autonomic instability (tachycardia,
diaphoresis, labile blood pressure).
4. A nurse is caring for a patient experiencing alcohol withdrawal. At 48 hours
after the last drink, the patient becomes agitated and reports ‘bugs crawling on
the walls.’ Which condition is likely?
A. Wernicke’s encephalopathy
B. Delirium Tremens (DTs)
C. Alcoholic hallucinosis
D. Korsakoff’s psychosis
Answer: B
Rationale: Delirium Tremens typically occurs 48-72 hours after the last drink and involves
autonomic hyperactivity, sensory hallucinations, and severe agitation. It is a medical
emergency.
, 5. Which laboratory value is the most critical for a nurse to monitor in a patient
newly prescribed Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Liver function tests (LFTs)
C. Serum sodium levels
D. Creatinine clearance
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis. Weekly or bi-weekly monitoring of
the Absolute Neutrophil Count (ANC) is mandatory to ensure the patient does not develop
life-threatening neutropenia.
6. An adolescent patient is admitted with Anorexia Nervosa. Which physical
finding most likely indicates the severity of the malnutrition?
A. Parotid gland swelling
B. Presence of lanugo and bradycardia
C. Tachycardia and hypertension
D. Russell’s sign on the knuckles
Answer: B
Rationale: Lanugo (fine, downy hair) and bradycardia are physiological adaptations to
starvation and low body temperature in Anorexia. Parotid swelling and Russell’s sign are
more common in Bulimia Nervosa.
7. A patient with Antisocial Personality Disorder is being treated in a locked
unit. Which nursing intervention is the priority?
A. Setting clear, consistent limits on behavior
B. Encouraging the patient to express feelings of guilt
C. Providing a warm, nurturing environment
D. Allowing the patient to lead the group therapy session
Answer: A
