NURS 222 Mental Health Psychiatric Nursing Exam 3 2026 |WCU
1. A client with bipolar disorder is prescribed Lithium carbonate. The nurse
notes a serum lithium level of 1.8 mEq/L. Which action should the nurse take
first?
A. Hold the medication and notify the provider
B. Increase fluid intake to 3 liters per day
C. Administer the next dose as scheduled
D. Document the finding as a therapeutic level
Answer: A
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L
indicates toxicity, necessitating holding the dose and immediate notification of the
healthcare provider.
2. A patient diagnosed with schizophrenia is experiencing muscle rigidity, a
temperature of 103 F, and tachycardia. Which condition should the nurse
suspect?
A. Neuroleptic malignant syndrome (NMS)
B. Tardive dyskinesia
C. Agranulocytosis
D. Dystonic reaction
Answer: A
Rationale: NMS is a life-threatening complication of antipsychotic therapy characterized
by high fever, muscle rigidity, altered mental status, and autonomic instability.
,3. Which assessment finding in a patient taking Clozapine requires immediate
nursing intervention?
A. Weight gain of 2 pounds in a week
B. Report of excessive salivation
C. White blood cell (WBC) count of 2,500/mm3
D. Drowsiness in the morning
Answer: C
Rationale: Clozapine carries a risk for agranulocytosis. A WBC count below 3,000/mm3
requires immediate cessation of the drug and infection precautions.
4. A client with Borderline Personality Disorder frequently pits staff members
against each other by claiming one nurse is ‘better’ than another. What is this
defense mechanism called?
A. Projection
B. Splitting
C. Reaction formation
D. Sublimation
Answer: B
Rationale: Splitting is the inability to integrate positive and negative qualities of others,
resulting in seeing people as either all good or all bad.
5. A patient is admitted for severe depression and expresses feelings of
worthlessness. What is the priority nursing diagnosis?
A. Social isolation
B. Imbalanced nutrition: less than body requirements
C. Risk for self-directed violence
D. Disturbed sleep pattern
Answer: C
, Rationale: Safety is the highest priority for a patient with severe depression, making risk
for self-harm the primary diagnosis.
6. A nurse is teaching a patient about Phenelzine (an MAOI). Which food choice
by the patient indicates a need for further instruction?
A. Fresh grilled chicken breast
B. Aged cheddar cheese and pepperoni pizza
C. Steamed broccoli and carrots
D. Mashed potatoes with butter
Answer: B
Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, cured meats) to cause a
hypertensive crisis.
7. A patient with mania is pacing the hallway and unable to sit for meals. Which
intervention is most appropriate?
A. Restrict the patient to their room for safety
B. Provide high-calorie finger foods
C. Offer a quiet activity like a jigsaw puzzle
D. Wait until the patient is calm to offer food
Answer: B
Rationale: Patients in a manic phase have high energy expenditure and poor focus; finger
foods allow them to maintain caloric intake while moving.
8. During an intake assessment, a client with Antisocial Personality Disorder is
manipulative and charming. What is the most important nursing goal?
A. Set clear and firm limits on behavior
B. Help the client recall childhood trauma
C. Provide a warm and overly nurturing environment
D. Encourage the client to lead group therapy
Answer: A
1. A client with bipolar disorder is prescribed Lithium carbonate. The nurse
notes a serum lithium level of 1.8 mEq/L. Which action should the nurse take
first?
A. Hold the medication and notify the provider
B. Increase fluid intake to 3 liters per day
C. Administer the next dose as scheduled
D. Document the finding as a therapeutic level
Answer: A
Rationale: The therapeutic range for lithium is 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L
indicates toxicity, necessitating holding the dose and immediate notification of the
healthcare provider.
2. A patient diagnosed with schizophrenia is experiencing muscle rigidity, a
temperature of 103 F, and tachycardia. Which condition should the nurse
suspect?
A. Neuroleptic malignant syndrome (NMS)
B. Tardive dyskinesia
C. Agranulocytosis
D. Dystonic reaction
Answer: A
Rationale: NMS is a life-threatening complication of antipsychotic therapy characterized
by high fever, muscle rigidity, altered mental status, and autonomic instability.
,3. Which assessment finding in a patient taking Clozapine requires immediate
nursing intervention?
A. Weight gain of 2 pounds in a week
B. Report of excessive salivation
C. White blood cell (WBC) count of 2,500/mm3
D. Drowsiness in the morning
Answer: C
Rationale: Clozapine carries a risk for agranulocytosis. A WBC count below 3,000/mm3
requires immediate cessation of the drug and infection precautions.
4. A client with Borderline Personality Disorder frequently pits staff members
against each other by claiming one nurse is ‘better’ than another. What is this
defense mechanism called?
A. Projection
B. Splitting
C. Reaction formation
D. Sublimation
Answer: B
Rationale: Splitting is the inability to integrate positive and negative qualities of others,
resulting in seeing people as either all good or all bad.
5. A patient is admitted for severe depression and expresses feelings of
worthlessness. What is the priority nursing diagnosis?
A. Social isolation
B. Imbalanced nutrition: less than body requirements
C. Risk for self-directed violence
D. Disturbed sleep pattern
Answer: C
, Rationale: Safety is the highest priority for a patient with severe depression, making risk
for self-harm the primary diagnosis.
6. A nurse is teaching a patient about Phenelzine (an MAOI). Which food choice
by the patient indicates a need for further instruction?
A. Fresh grilled chicken breast
B. Aged cheddar cheese and pepperoni pizza
C. Steamed broccoli and carrots
D. Mashed potatoes with butter
Answer: B
Rationale: MAOIs interact with tyramine-rich foods (aged cheeses, cured meats) to cause a
hypertensive crisis.
7. A patient with mania is pacing the hallway and unable to sit for meals. Which
intervention is most appropriate?
A. Restrict the patient to their room for safety
B. Provide high-calorie finger foods
C. Offer a quiet activity like a jigsaw puzzle
D. Wait until the patient is calm to offer food
Answer: B
Rationale: Patients in a manic phase have high energy expenditure and poor focus; finger
foods allow them to maintain caloric intake while moving.
8. During an intake assessment, a client with Antisocial Personality Disorder is
manipulative and charming. What is the most important nursing goal?
A. Set clear and firm limits on behavior
B. Help the client recall childhood trauma
C. Provide a warm and overly nurturing environment
D. Encourage the client to lead group therapy
Answer: A
