NURS 222: Mental Health/Psychiatric Nursing Exam 4 Practice 2026
|WCU
1. A patient with Bipolar I Disorder is experiencing acute mania and has a
Lithium level of 1.4 mEq/L. Which clinical manifestation should the nurse
prioritize?
A. Fine hand tremors and mild thirst
B. Polyuria and occasional nausea
C. Coarse hand tremors, persistent GI upset, and mental confusion
D. Weight gain and mild acne
Answer: C
Rationale: A lithium level of 1.4 mEq/L is near the toxic threshold (1.5 mEq/L). Coarse
tremors, GI distress, and confusion are early signs of toxicity, whereas fine tremors are
common side effects.
2. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which
laboratory value requires the nurse to withhold the medication and contact the
provider immediately?
A. White Blood Cell (WBC) count of 2,500/mm³
B. Fast blood glucose of 110 mg/dL
C. Total cholesterol of 210 mg/dL
D. Platelet count of 150,000/mm³
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis. A WBC count below 3,000/mm³ or
an Absolute Neutrophil Count (ANC) below 1,500/mm³ requires immediate
discontinuation of the drug.
,3. Which assessment finding is most characteristic of Neuroleptic Malignant
Syndrome (NMS) in a patient taking Haloperidol?
A. Hypotension and bradycardia
B. Hyperpyrexia and severe muscle rigidity
C. Diarrhea and hyperreflexia
D. Mydriasis and urinary retention
Answer: B
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by high fever
(hyperpyrexia), ‘lead pipe’ muscle rigidity, and autonomic instability.
4. A patient with Borderline Personality Disorder is observed ‘splitting’ staff
members—praising one nurse while devaluing another. What is the most
appropriate nursing intervention?
A. Ignore the behavior to avoid reinforcing it
B. Explain to the patient how their behavior affects the staff
C. Allow the patient to only work with the nurse they prefer
D. Hold a staff meeting to ensure a consistent, unified approach to the patient’s care
Answer: D
Rationale: Consistency and limit-setting are vital for patients with Borderline Personality
Disorder. A unified staff approach prevents the patient from playing staff against each
other.
5. A client experiencing alcohol withdrawal is prescribed Lorazepam. What is the
primary rationale for this medication?
A. To prevent seizures and delirium tremens
B. To induce sleep during the detox process
C. To decrease the patient’s craving for alcohol
D. To treat underlying anxiety disorders
Answer: A
, Rationale: Benzodiazepines like Lorazepam provide substituted therapy to prevent the
over-excitation of the CNS during alcohol withdrawal, reducing the risk of seizures and
DTs.
6. A nurse is caring for a client with Major Depressive Disorder who has started
taking Phenelzine (an MAOI). Which food choice on the client’s tray indicates a
need for further teaching?
A. Grilled chicken breast and steamed broccoli
B. Scrambled eggs and toast
C. Fresh apple slices and peanut butter
D. Pepperoni pizza with extra cheese and a glass of red wine
Answer: D
Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, cured meats like
pepperoni, and red wine), which can lead to a hypertensive crisis.
7. A client diagnosed with Anorexia Nervosa is admitted to the inpatient unit.
Which assessment finding is the highest priority for the nurse?
A. Body mass index (BMI) of 17
B. Lanugo on the back and arms
C. Pulse rate of 38 beats per minute
D. Amenorrhea for the past six months
Answer: C
Rationale: Severe bradycardia (pulse < 40 bpm) or electrolyte imbalances are medical
emergencies in eating disorders and take priority over psychological or chronic symptoms.
|WCU
1. A patient with Bipolar I Disorder is experiencing acute mania and has a
Lithium level of 1.4 mEq/L. Which clinical manifestation should the nurse
prioritize?
A. Fine hand tremors and mild thirst
B. Polyuria and occasional nausea
C. Coarse hand tremors, persistent GI upset, and mental confusion
D. Weight gain and mild acne
Answer: C
Rationale: A lithium level of 1.4 mEq/L is near the toxic threshold (1.5 mEq/L). Coarse
tremors, GI distress, and confusion are early signs of toxicity, whereas fine tremors are
common side effects.
2. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which
laboratory value requires the nurse to withhold the medication and contact the
provider immediately?
A. White Blood Cell (WBC) count of 2,500/mm³
B. Fast blood glucose of 110 mg/dL
C. Total cholesterol of 210 mg/dL
D. Platelet count of 150,000/mm³
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis. A WBC count below 3,000/mm³ or
an Absolute Neutrophil Count (ANC) below 1,500/mm³ requires immediate
discontinuation of the drug.
,3. Which assessment finding is most characteristic of Neuroleptic Malignant
Syndrome (NMS) in a patient taking Haloperidol?
A. Hypotension and bradycardia
B. Hyperpyrexia and severe muscle rigidity
C. Diarrhea and hyperreflexia
D. Mydriasis and urinary retention
Answer: B
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by high fever
(hyperpyrexia), ‘lead pipe’ muscle rigidity, and autonomic instability.
4. A patient with Borderline Personality Disorder is observed ‘splitting’ staff
members—praising one nurse while devaluing another. What is the most
appropriate nursing intervention?
A. Ignore the behavior to avoid reinforcing it
B. Explain to the patient how their behavior affects the staff
C. Allow the patient to only work with the nurse they prefer
D. Hold a staff meeting to ensure a consistent, unified approach to the patient’s care
Answer: D
Rationale: Consistency and limit-setting are vital for patients with Borderline Personality
Disorder. A unified staff approach prevents the patient from playing staff against each
other.
5. A client experiencing alcohol withdrawal is prescribed Lorazepam. What is the
primary rationale for this medication?
A. To prevent seizures and delirium tremens
B. To induce sleep during the detox process
C. To decrease the patient’s craving for alcohol
D. To treat underlying anxiety disorders
Answer: A
, Rationale: Benzodiazepines like Lorazepam provide substituted therapy to prevent the
over-excitation of the CNS during alcohol withdrawal, reducing the risk of seizures and
DTs.
6. A nurse is caring for a client with Major Depressive Disorder who has started
taking Phenelzine (an MAOI). Which food choice on the client’s tray indicates a
need for further teaching?
A. Grilled chicken breast and steamed broccoli
B. Scrambled eggs and toast
C. Fresh apple slices and peanut butter
D. Pepperoni pizza with extra cheese and a glass of red wine
Answer: D
Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, cured meats like
pepperoni, and red wine), which can lead to a hypertensive crisis.
7. A client diagnosed with Anorexia Nervosa is admitted to the inpatient unit.
Which assessment finding is the highest priority for the nurse?
A. Body mass index (BMI) of 17
B. Lanugo on the back and arms
C. Pulse rate of 38 beats per minute
D. Amenorrhea for the past six months
Answer: C
Rationale: Severe bradycardia (pulse < 40 bpm) or electrolyte imbalances are medical
emergencies in eating disorders and take priority over psychological or chronic symptoms.
