NURS 222: Mental Health/Psychiatric Nursing Exam 2 -
Comprehensive Study Guide 2026 |WCU
1. A client diagnosed with schizophrenia is prescribed clozapine. Which
laboratory result would require the nurse to immediately withhold the
medication and notify the provider?
A. Blood glucose of 110 mg/dL
B. Absolute Neutrophil Count (ANC) of 900/mm³
C. Potassium level of 3.8 mEq/L
D. White blood cell count of 5,500/mm³
Answer: B
Rationale: Clozapine carries a risk for agranulocytosis. An ANC below 1,000/mm³ or a
WBC below 3,000/mm³ typically requires treatment interruption per safety protocols.
2. A patient in a manic phase of bipolar disorder is pacing the hallways and has
not slept in 48 hours. Which nursing intervention is the priority?
A. Encourage the patient to attend a group therapy session
B. Administer a PRN dose of a stimulant medication
C. Engage the patient in a competitive game of basketball
D. Provide a high-calorie finger food and fluids to consume while pacing
Answer: D
Rationale: Physical safety and nutrition are priorities during mania. Finger foods allow the
patient to maintain caloric intake without having to sit still, which they are currently
unable to do.
,3. A nurse is caring for a client with major depressive disorder who was started
on phenelzine (an MAOI) one week ago. The client complains of a sudden,
severe ‘pounding’ headache and stiff neck. What is the nurse’s priority action?
A. Suggest the client avoid tyramine-rich foods in the next meal
B. Administer an over-the-counter analgesic for the headache
C. Encourage the client to lie down in a dark room
D. Assess the client’s blood pressure
Answer: D
Rationale: A severe headache while taking an MAOI is a hallmark sign of a hypertensive
crisis, often triggered by tyramine. Immediate BP assessment is required.
4. A client is experiencing an acute panic attack. Which approach by the nurse is
most therapeutic?
A. Asking the client to explain what triggered the panic
B. Staying with the client and using short, simple sentences
C. Giving the client detailed information about panic disorder
D. Leaving the client alone to reduce environmental stimuli
Answer: B
Rationale: During severe anxiety or panic, a person’s cognitive processing is impaired.
Staying with the client provides safety, and simple communication is more effective than
complex explanations.
5. The nurse is assessing a client for potential lithium toxicity. Which of the
following findings would indicate an early sign of toxicity?
A. Seizures and cardiovascular collapse
B. Coarse hand tremors, ataxia, and persistent GI upset
C. Mild thirst and polyuria
D. Weight gain and acne
Answer: B
, Rationale: While mild thirst is a common side effect, coarse hand tremors and persistent
GI distress are early indicators of lithium levels exceeding the therapeutic range (usually
>1.5 mEq/L).
6. A client with Borderline Personality Disorder (BPD) tells the day-shift nurse,
‘You are so much better than the night nurse; she is incompetent.’ The nurse
recognizes this behavior as:
A. Splitting
B. Manipulation
C. Altruism
D. Reaction formation
Answer: A
Rationale: Splitting is a defense mechanism common in BPD where individuals view
people or situations as either all good or all bad, unable to integrate positive and negative
qualities.
7. Which assessment finding is most characteristic of a client experiencing
Neuroleptic Malignant Syndrome (NMS)?
A. Diarrhea and hyperreflexia
B. Hypotension and bradycardia
C. Hyperpyrexia and ‘lead pipe’ muscle rigidity
D. Butterfly rash and joint pain
Answer: C
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by high fever
(hyperpyrexia), muscle rigidity, autonomic instability, and altered mental status.
Comprehensive Study Guide 2026 |WCU
1. A client diagnosed with schizophrenia is prescribed clozapine. Which
laboratory result would require the nurse to immediately withhold the
medication and notify the provider?
A. Blood glucose of 110 mg/dL
B. Absolute Neutrophil Count (ANC) of 900/mm³
C. Potassium level of 3.8 mEq/L
D. White blood cell count of 5,500/mm³
Answer: B
Rationale: Clozapine carries a risk for agranulocytosis. An ANC below 1,000/mm³ or a
WBC below 3,000/mm³ typically requires treatment interruption per safety protocols.
2. A patient in a manic phase of bipolar disorder is pacing the hallways and has
not slept in 48 hours. Which nursing intervention is the priority?
A. Encourage the patient to attend a group therapy session
B. Administer a PRN dose of a stimulant medication
C. Engage the patient in a competitive game of basketball
D. Provide a high-calorie finger food and fluids to consume while pacing
Answer: D
Rationale: Physical safety and nutrition are priorities during mania. Finger foods allow the
patient to maintain caloric intake without having to sit still, which they are currently
unable to do.
,3. A nurse is caring for a client with major depressive disorder who was started
on phenelzine (an MAOI) one week ago. The client complains of a sudden,
severe ‘pounding’ headache and stiff neck. What is the nurse’s priority action?
A. Suggest the client avoid tyramine-rich foods in the next meal
B. Administer an over-the-counter analgesic for the headache
C. Encourage the client to lie down in a dark room
D. Assess the client’s blood pressure
Answer: D
Rationale: A severe headache while taking an MAOI is a hallmark sign of a hypertensive
crisis, often triggered by tyramine. Immediate BP assessment is required.
4. A client is experiencing an acute panic attack. Which approach by the nurse is
most therapeutic?
A. Asking the client to explain what triggered the panic
B. Staying with the client and using short, simple sentences
C. Giving the client detailed information about panic disorder
D. Leaving the client alone to reduce environmental stimuli
Answer: B
Rationale: During severe anxiety or panic, a person’s cognitive processing is impaired.
Staying with the client provides safety, and simple communication is more effective than
complex explanations.
5. The nurse is assessing a client for potential lithium toxicity. Which of the
following findings would indicate an early sign of toxicity?
A. Seizures and cardiovascular collapse
B. Coarse hand tremors, ataxia, and persistent GI upset
C. Mild thirst and polyuria
D. Weight gain and acne
Answer: B
, Rationale: While mild thirst is a common side effect, coarse hand tremors and persistent
GI distress are early indicators of lithium levels exceeding the therapeutic range (usually
>1.5 mEq/L).
6. A client with Borderline Personality Disorder (BPD) tells the day-shift nurse,
‘You are so much better than the night nurse; she is incompetent.’ The nurse
recognizes this behavior as:
A. Splitting
B. Manipulation
C. Altruism
D. Reaction formation
Answer: A
Rationale: Splitting is a defense mechanism common in BPD where individuals view
people or situations as either all good or all bad, unable to integrate positive and negative
qualities.
7. Which assessment finding is most characteristic of a client experiencing
Neuroleptic Malignant Syndrome (NMS)?
A. Diarrhea and hyperreflexia
B. Hypotension and bradycardia
C. Hyperpyrexia and ‘lead pipe’ muscle rigidity
D. Butterfly rash and joint pain
Answer: C
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by high fever
(hyperpyrexia), muscle rigidity, autonomic instability, and altered mental status.
