NR 326 MENTAL HEALTH NURSING EXAM 3 — CHAMBERLAIN
UNIVERSITY Actual Exam Complete Questions and Answers
Detailed Rationales Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Schizophrenia Spectrum & Psychotic Disorders | Q1 – Q12
Section 2 | Bipolar & Related Disorders | Q13 – Q22
Section 3 | Personality Disorders | Q23 – Q32
Section 4 | Substance Use Disorders | Q33 – Q42
Section 5 | Crisis Intervention & Psychiatric Emergencies | Q43 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: SCHIZOPHRENIA SPECTRUM & PSYCHOTIC DISORDERS Q1 – Q12
══════════════════════════════════════
Question 1 of 50
A 24-year-old male college student is brought to the emergency department by campus
police after his roommate found him pacing the dorm hallway at 3 a.m., speaking loudly
to himself about "government agents planting thoughts." His roommate reports the
patient has been isolating for three weeks, stopped attending classes, and was recently
seen collecting empty soda cans "to build a signal blocker." The patient appears
agitated, makes poor eye contact, and states, "You can't help me—they're already inside
my head." His vital signs are stable. He has no known psychiatric history and takes no
medications.
A. Administer haloperidol 5 mg IM and place the patient in seclusion
B. Offer a low-stimulus environment and establish a calm, nonconfrontational presence
✓ CORRECT
C. Immediately challenge the patient's delusional beliefs to orient him to reality
,D. Request a 72-hour involuntary hold without further assessment
Correct Answer: B
Rationale: A calm, nonconfrontational approach in a low-stimulus environment is the
first-line nursing intervention for a patient experiencing acute psychosis, as it reduces
agitation and builds trust without escalating paranoia. Challenging delusions or using
seclusion prematurely increases distress and may provoke aggression. Establishing
safety through presence and environmental control allows for a thorough assessment
before pharmacologic or legal interventions are considered.
Question 2 of 50
A 38-year-old woman with a 10-year history of paranoid schizophrenia is admitted to the
inpatient unit after a relapse. She has been nonadherent with her oral risperidone for six
months. During the admission assessment, she tells the nurse, "The voices are telling
me not to take my medicine because it is poison." She is cooperative with vitals but
repeatedly scans the room corners and flinches at unseen stimuli. Her psychiatrist
orders risperidone consta 25 mg IM every two weeks.
A. Explain that the voices are not real and encourage her to ignore them
B. Teach the patient that the long-acting injection will stop the voices immediately
C. Acknowledge her distress about the voices and explain how the medication can
reduce their intensity ✓ CORRECT
D. Tell her she must take the injection because it is a court order
Correct Answer: C
Rationale: Validating the patient's distress while providing accurate education about
medication benefits respects her experience without reinforcing delusions, which is the
therapeutic communication standard in schizophrenia care. Telling a patient to ignore
voices or promising immediate relief is dismissive and sets unrealistic expectations
that undermine trust. Court-order language is coercive and damages the therapeutic
alliance, especially when no such order exists.
,Question 3 of 50
A 29-year-old man with schizophrenia is on the psychiatric unit and has been receiving
clozapine 400 mg daily for eight weeks. During morning vital signs, the nurse notes his
temperature is 38.9°C (102°F), heart rate 112, and he reports feeling "achy all over." His
WBC count from yesterday was 8,200/mm³. The patient appears flushed and mildly
confused.
A. Hold the next dose of clozapine and notify the provider immediately ✓ CORRECT
B. Administer acetaminophen and continue the clozapine as scheduled
C. Recheck vital signs in two hours and document the findings
D. Obtain a repeat WBC and wait for results before acting
Correct Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, and any fever in a
patient on this medication requires immediate discontinuation and provider notification
to rule out life-threatening neutropenia. Waiting for WBC results or simply treating the
fever delays critical intervention in a condition where every hour matters. The nurse
must act on clinical suspicion rather than waiting for confirmatory lab values in this
high-risk scenario.
Question 4 of 50
A 45-year-old man with chronic schizophrenia has been stable on olanzapine 15 mg
daily for three years. He arrives at the outpatient clinic for a follow-up and reports a
15-pound weight gain over the past six months, increased thirst, and urination. His
fasting blood glucose is 186 mg/dL, and his BMI has increased from 28 to 32. He
denies any changes in diet or activity level.
A. Switch the patient to haloperidol immediately to reverse metabolic effects
B. Recommend a structured diet and exercise plan and schedule glucose monitoring ✓
CORRECT
C. Discontinue olanzapine abruptly and start a mood stabilizer instead
, D. Reassure the patient that weight gain is normal and not clinically significant
Correct Answer: B
Rationale: Olanzapine is associated with significant metabolic adverse effects, and the
appropriate nursing response is to implement lifestyle interventions and enhanced
monitoring while collaborating with the prescriber on medication review. Abrupt
discontinuation of any antipsychotic risks relapse, and switching to haloperidol without
prescriber involvement is outside nursing scope. Dismissing metabolic changes as
normal ignores the well-established cardiovascular and diabetes risks in this
population.
Question 5 of 50
A 19-year-old woman is brought to the emergency department by her parents after she
began screaming that "demons are crawling out of the walls" and attempted to jump
from a second-story window. In the ED, she is disheveled, hypervigilant, and repeatedly
looks over her shoulder. She tells the nurse, "They can hear everything you say—don't
talk about the plan." Her urine drug screen is negative, and she has no prior psychiatric
history. Her parents report she had a mild upper respiratory infection two weeks ago.
A. Suspect substance-induced psychosis and observe for 24 hours before intervening
B. Consider acute psychotic disorder and implement safety precautions with one-to-one
observation ✓ CORRECT
C. Diagnose schizophrenia and begin long-term antipsychotic therapy immediately
D. Attribute the symptoms to the recent viral illness and discharge with follow-up
Correct Answer: B
Rationale: A first psychotic episode with acute onset, negative drug screen, and no prior
history warrants safety-focused nursing care including one-to-one observation, as the
patient has already demonstrated dangerous behavior by attempting to jump from a
window. Assuming substance use without evidence or making a definitive
schizophrenia diagnosis during an acute crisis exceeds nursing scope and delays
UNIVERSITY Actual Exam Complete Questions and Answers
Detailed Rationales Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Schizophrenia Spectrum & Psychotic Disorders | Q1 – Q12
Section 2 | Bipolar & Related Disorders | Q13 – Q22
Section 3 | Personality Disorders | Q23 – Q32
Section 4 | Substance Use Disorders | Q33 – Q42
Section 5 | Crisis Intervention & Psychiatric Emergencies | Q43 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: SCHIZOPHRENIA SPECTRUM & PSYCHOTIC DISORDERS Q1 – Q12
══════════════════════════════════════
Question 1 of 50
A 24-year-old male college student is brought to the emergency department by campus
police after his roommate found him pacing the dorm hallway at 3 a.m., speaking loudly
to himself about "government agents planting thoughts." His roommate reports the
patient has been isolating for three weeks, stopped attending classes, and was recently
seen collecting empty soda cans "to build a signal blocker." The patient appears
agitated, makes poor eye contact, and states, "You can't help me—they're already inside
my head." His vital signs are stable. He has no known psychiatric history and takes no
medications.
A. Administer haloperidol 5 mg IM and place the patient in seclusion
B. Offer a low-stimulus environment and establish a calm, nonconfrontational presence
✓ CORRECT
C. Immediately challenge the patient's delusional beliefs to orient him to reality
,D. Request a 72-hour involuntary hold without further assessment
Correct Answer: B
Rationale: A calm, nonconfrontational approach in a low-stimulus environment is the
first-line nursing intervention for a patient experiencing acute psychosis, as it reduces
agitation and builds trust without escalating paranoia. Challenging delusions or using
seclusion prematurely increases distress and may provoke aggression. Establishing
safety through presence and environmental control allows for a thorough assessment
before pharmacologic or legal interventions are considered.
Question 2 of 50
A 38-year-old woman with a 10-year history of paranoid schizophrenia is admitted to the
inpatient unit after a relapse. She has been nonadherent with her oral risperidone for six
months. During the admission assessment, she tells the nurse, "The voices are telling
me not to take my medicine because it is poison." She is cooperative with vitals but
repeatedly scans the room corners and flinches at unseen stimuli. Her psychiatrist
orders risperidone consta 25 mg IM every two weeks.
A. Explain that the voices are not real and encourage her to ignore them
B. Teach the patient that the long-acting injection will stop the voices immediately
C. Acknowledge her distress about the voices and explain how the medication can
reduce their intensity ✓ CORRECT
D. Tell her she must take the injection because it is a court order
Correct Answer: C
Rationale: Validating the patient's distress while providing accurate education about
medication benefits respects her experience without reinforcing delusions, which is the
therapeutic communication standard in schizophrenia care. Telling a patient to ignore
voices or promising immediate relief is dismissive and sets unrealistic expectations
that undermine trust. Court-order language is coercive and damages the therapeutic
alliance, especially when no such order exists.
,Question 3 of 50
A 29-year-old man with schizophrenia is on the psychiatric unit and has been receiving
clozapine 400 mg daily for eight weeks. During morning vital signs, the nurse notes his
temperature is 38.9°C (102°F), heart rate 112, and he reports feeling "achy all over." His
WBC count from yesterday was 8,200/mm³. The patient appears flushed and mildly
confused.
A. Hold the next dose of clozapine and notify the provider immediately ✓ CORRECT
B. Administer acetaminophen and continue the clozapine as scheduled
C. Recheck vital signs in two hours and document the findings
D. Obtain a repeat WBC and wait for results before acting
Correct Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, and any fever in a
patient on this medication requires immediate discontinuation and provider notification
to rule out life-threatening neutropenia. Waiting for WBC results or simply treating the
fever delays critical intervention in a condition where every hour matters. The nurse
must act on clinical suspicion rather than waiting for confirmatory lab values in this
high-risk scenario.
Question 4 of 50
A 45-year-old man with chronic schizophrenia has been stable on olanzapine 15 mg
daily for three years. He arrives at the outpatient clinic for a follow-up and reports a
15-pound weight gain over the past six months, increased thirst, and urination. His
fasting blood glucose is 186 mg/dL, and his BMI has increased from 28 to 32. He
denies any changes in diet or activity level.
A. Switch the patient to haloperidol immediately to reverse metabolic effects
B. Recommend a structured diet and exercise plan and schedule glucose monitoring ✓
CORRECT
C. Discontinue olanzapine abruptly and start a mood stabilizer instead
, D. Reassure the patient that weight gain is normal and not clinically significant
Correct Answer: B
Rationale: Olanzapine is associated with significant metabolic adverse effects, and the
appropriate nursing response is to implement lifestyle interventions and enhanced
monitoring while collaborating with the prescriber on medication review. Abrupt
discontinuation of any antipsychotic risks relapse, and switching to haloperidol without
prescriber involvement is outside nursing scope. Dismissing metabolic changes as
normal ignores the well-established cardiovascular and diabetes risks in this
population.
Question 5 of 50
A 19-year-old woman is brought to the emergency department by her parents after she
began screaming that "demons are crawling out of the walls" and attempted to jump
from a second-story window. In the ED, she is disheveled, hypervigilant, and repeatedly
looks over her shoulder. She tells the nurse, "They can hear everything you say—don't
talk about the plan." Her urine drug screen is negative, and she has no prior psychiatric
history. Her parents report she had a mild upper respiratory infection two weeks ago.
A. Suspect substance-induced psychosis and observe for 24 hours before intervening
B. Consider acute psychotic disorder and implement safety precautions with one-to-one
observation ✓ CORRECT
C. Diagnose schizophrenia and begin long-term antipsychotic therapy immediately
D. Attribute the symptoms to the recent viral illness and discharge with follow-up
Correct Answer: B
Rationale: A first psychotic episode with acute onset, negative drug screen, and no prior
history warrants safety-focused nursing care including one-to-one observation, as the
patient has already demonstrated dangerous behavior by attempting to jump from a
window. Assuming substance use without evidence or making a definitive
schizophrenia diagnosis during an acute crisis exceeds nursing scope and delays
