NURS 222 | Mental Health/Psychiatric Nursing: Module 4
Comprehensive Exam 2026 |WCU
1. A nurse is assessing a client with suspected delirium. Which of the following
features most distinguishes delirium from dementia?
A. Progressive, irreversible decline in cognitive function
B. Presence of aphasia and agnosia
C. Sudden onset with fluctuating levels of consciousness
D. Stable symptoms regardless of the time of day
Answer: C
Rationale: Delirium is characterized by a rapid onset and fluctuating level of
consciousness, whereas dementia involves a slow, progressive decline with stable
consciousness.
2. A client is admitted for alcohol detoxification. Which medication should the
nurse expect to administer to prevent seizures and stabilize vital signs during
the acute phase?
A. Disulfiram
B. Chlordiazepoxide
C. Naltrexone
D. Methadone
Answer: B
Rationale: Benzodiazepines like chlordiazepoxide or lorazepam are the gold standard for
managing acute alcohol withdrawal to prevent delirium tremens and seizures.
,3. A nurse is caring for a client with Anorexia Nervosa who has a BMI of 14.
What is the priority nursing intervention?
A. Initiating a high-intensity exercise program
B. Administering high doses of laxatives to prevent constipation
C. Encouraging the client to lead the therapy sessions
D. Monitoring for peripheral edema and crackles during refeeding
Answer: D
Rationale: Refeeding syndrome is a life-threatening complication of nutritional
restoration; the nurse must monitor for fluid overload, cardiac arrhythmias, and electrolyte
shifts.
4. Which physical finding is a hallmark sign of Bulimia Nervosa associated with
self-induced vomiting?
A. Lanugo on the back and arms
B. Amenorrhea for three consecutive months
C. Parotid gland enlargement
D. Yellowish skin discoloration (carotenemia)
Answer: C
Rationale: Repeated vomiting causes hypertrophy of the parotid glands (sialadenosis) and
dental erosion. Lanugo and amenorrhea are more typical of Anorexia Nervosa.
5. A client with Borderline Personality Disorder frequently pits staff members
against each other by praising one and demeaning another. This defense
mechanism is known as:
A. Rationalization
B. Undoing
C. Splitting
D. Reaction Formation
Answer: C
, Rationale: Splitting is the inability to integrate positive and negative qualities of others
into a cohesive image, leading to ‘all-good’ or ‘all-bad’ perceptions.
6. A client presents with pinpoint pupils, respiratory depression, and extreme
somnolence. The nurse should suspect an overdose of which substance?
A. Heroin
B. Amphetamines
C. Cocaine
D. Phencyclidine (PCP)
Answer: A
Rationale: The ‘opioid triad’ includes respiratory depression, pinpoint pupils (miosis), and
coma/unresponsiveness.
7. A client is prescribed Disulfiram for alcohol abstinence. Which education
point is most critical?
A. The medication will reduce cravings for alcohol.
B. Avoid all products containing alcohol, including mouthwash and vanilla extract.
C. The drug must be taken with a glass of red wine to be effective.
D. Wait at least 2 hours after drinking alcohol before taking the first dose.
Answer: B
Rationale: Consuming even small amounts of alcohol while on Disulfiram causes a severe
reaction (vomiting, tachycardia, hypotension). Clients must wait at least 12 hours after
their last drink to start it.
Comprehensive Exam 2026 |WCU
1. A nurse is assessing a client with suspected delirium. Which of the following
features most distinguishes delirium from dementia?
A. Progressive, irreversible decline in cognitive function
B. Presence of aphasia and agnosia
C. Sudden onset with fluctuating levels of consciousness
D. Stable symptoms regardless of the time of day
Answer: C
Rationale: Delirium is characterized by a rapid onset and fluctuating level of
consciousness, whereas dementia involves a slow, progressive decline with stable
consciousness.
2. A client is admitted for alcohol detoxification. Which medication should the
nurse expect to administer to prevent seizures and stabilize vital signs during
the acute phase?
A. Disulfiram
B. Chlordiazepoxide
C. Naltrexone
D. Methadone
Answer: B
Rationale: Benzodiazepines like chlordiazepoxide or lorazepam are the gold standard for
managing acute alcohol withdrawal to prevent delirium tremens and seizures.
,3. A nurse is caring for a client with Anorexia Nervosa who has a BMI of 14.
What is the priority nursing intervention?
A. Initiating a high-intensity exercise program
B. Administering high doses of laxatives to prevent constipation
C. Encouraging the client to lead the therapy sessions
D. Monitoring for peripheral edema and crackles during refeeding
Answer: D
Rationale: Refeeding syndrome is a life-threatening complication of nutritional
restoration; the nurse must monitor for fluid overload, cardiac arrhythmias, and electrolyte
shifts.
4. Which physical finding is a hallmark sign of Bulimia Nervosa associated with
self-induced vomiting?
A. Lanugo on the back and arms
B. Amenorrhea for three consecutive months
C. Parotid gland enlargement
D. Yellowish skin discoloration (carotenemia)
Answer: C
Rationale: Repeated vomiting causes hypertrophy of the parotid glands (sialadenosis) and
dental erosion. Lanugo and amenorrhea are more typical of Anorexia Nervosa.
5. A client with Borderline Personality Disorder frequently pits staff members
against each other by praising one and demeaning another. This defense
mechanism is known as:
A. Rationalization
B. Undoing
C. Splitting
D. Reaction Formation
Answer: C
, Rationale: Splitting is the inability to integrate positive and negative qualities of others
into a cohesive image, leading to ‘all-good’ or ‘all-bad’ perceptions.
6. A client presents with pinpoint pupils, respiratory depression, and extreme
somnolence. The nurse should suspect an overdose of which substance?
A. Heroin
B. Amphetamines
C. Cocaine
D. Phencyclidine (PCP)
Answer: A
Rationale: The ‘opioid triad’ includes respiratory depression, pinpoint pupils (miosis), and
coma/unresponsiveness.
7. A client is prescribed Disulfiram for alcohol abstinence. Which education
point is most critical?
A. The medication will reduce cravings for alcohol.
B. Avoid all products containing alcohol, including mouthwash and vanilla extract.
C. The drug must be taken with a glass of red wine to be effective.
D. Wait at least 2 hours after drinking alcohol before taking the first dose.
Answer: B
Rationale: Consuming even small amounts of alcohol while on Disulfiram causes a severe
reaction (vomiting, tachycardia, hypotension). Clients must wait at least 12 hours after
their last drink to start it.
