NUR 208/NUR208 Exam 3 V2 | Mental
Health Nursing Q&A with Rationale | Fortis
College
1. A patient with Borderline Personality Disorder is observed trying to convince a night shift
nurse that the day shift nurse is incompetent. What is the most appropriate nursing
intervention for this behavior?
A. Agree with the patient to build rapport.
B. Ignore the comment and continue with medication administration.
C. Hold a staff meeting to ensure all team members provide consistent limits.
D. Confront the patient about their manipulative behavior immediately.
Correct Answer: C
Expert Explanation: Splitting is a common defense mechanism in Borderline Personality
Disorder where the patient views individuals as either all good or all bad. Consistency
among staff members is vital to prevent the patient from playing staff against each other.
This collective approach maintains professional boundaries and provides the structure
necessary for therapeutic progress.
2. Which physical assessment finding is most characteristic of a patient diagnosed with
Bulimia Nervosa?
A. Lanugo on the back and arms
,B. Extreme bradycardia
C. Parotid gland swelling
D. Amenorrhea
Correct Answer: C
Expert Explanation: Parotid gland swelling, also known as ‘chipmunk cheeks,’ occurs due
to the repeated stimulation of salivary glands during self-induced vomiting. This physical
sign is a common indicator of Bulimia Nervosa rather than Anorexia. Other signs include
dental erosion and Russell’s sign on the knuckles from inducing the gag reflex.
3. A patient is admitted for alcohol detoxification. Which medication should the nurse expect
to administer to manage acute withdrawal symptoms and prevent seizures?
A. Disulfiram
B. Chlordiazepoxide
C. Methadone
D. Naloxone
Correct Answer: B
Expert Explanation: Benzodiazepines like chlordiazepoxide or lorazepam are the first-line
treatment for acute alcohol withdrawal. These medications provide cross-tolerance to
alcohol and help stabilize vital signs while preventing progression to seizures or delirium
tremens. The dosage is typically titrated based on the patient’s CIWA-Ar scale score.
, 4. An elderly patient is admitted with a sudden onset of confusion, agitation, and visual
hallucinations. Which condition is most likely based on these acute symptoms?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Depression
Correct Answer: A
Expert Explanation: Delirium is characterized by an acute, rapid onset of cognitive
impairment and fluctuating levels of consciousness. Unlike dementia, which is progressive
and irreversible, delirium is often caused by an underlying medical issue like infection or
dehydration. Identifying and treating the root cause usually reverses the symptoms of
delirium.
5. A nurse is caring for a patient with Antisocial Personality Disorder. Which behavior is the
nurse most likely to observe?
A. Extreme social anxiety and fear of rejection
B. Preoccupation with orderliness and perfectionism
C. Excessive emotionality and attention-seeking
D. A pervasive pattern of disregard for the rights of others
Correct Answer: D
Health Nursing Q&A with Rationale | Fortis
College
1. A patient with Borderline Personality Disorder is observed trying to convince a night shift
nurse that the day shift nurse is incompetent. What is the most appropriate nursing
intervention for this behavior?
A. Agree with the patient to build rapport.
B. Ignore the comment and continue with medication administration.
C. Hold a staff meeting to ensure all team members provide consistent limits.
D. Confront the patient about their manipulative behavior immediately.
Correct Answer: C
Expert Explanation: Splitting is a common defense mechanism in Borderline Personality
Disorder where the patient views individuals as either all good or all bad. Consistency
among staff members is vital to prevent the patient from playing staff against each other.
This collective approach maintains professional boundaries and provides the structure
necessary for therapeutic progress.
2. Which physical assessment finding is most characteristic of a patient diagnosed with
Bulimia Nervosa?
A. Lanugo on the back and arms
,B. Extreme bradycardia
C. Parotid gland swelling
D. Amenorrhea
Correct Answer: C
Expert Explanation: Parotid gland swelling, also known as ‘chipmunk cheeks,’ occurs due
to the repeated stimulation of salivary glands during self-induced vomiting. This physical
sign is a common indicator of Bulimia Nervosa rather than Anorexia. Other signs include
dental erosion and Russell’s sign on the knuckles from inducing the gag reflex.
3. A patient is admitted for alcohol detoxification. Which medication should the nurse expect
to administer to manage acute withdrawal symptoms and prevent seizures?
A. Disulfiram
B. Chlordiazepoxide
C. Methadone
D. Naloxone
Correct Answer: B
Expert Explanation: Benzodiazepines like chlordiazepoxide or lorazepam are the first-line
treatment for acute alcohol withdrawal. These medications provide cross-tolerance to
alcohol and help stabilize vital signs while preventing progression to seizures or delirium
tremens. The dosage is typically titrated based on the patient’s CIWA-Ar scale score.
, 4. An elderly patient is admitted with a sudden onset of confusion, agitation, and visual
hallucinations. Which condition is most likely based on these acute symptoms?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Depression
Correct Answer: A
Expert Explanation: Delirium is characterized by an acute, rapid onset of cognitive
impairment and fluctuating levels of consciousness. Unlike dementia, which is progressive
and irreversible, delirium is often caused by an underlying medical issue like infection or
dehydration. Identifying and treating the root cause usually reverses the symptoms of
delirium.
5. A nurse is caring for a patient with Antisocial Personality Disorder. Which behavior is the
nurse most likely to observe?
A. Extreme social anxiety and fear of rejection
B. Preoccupation with orderliness and perfectionism
C. Excessive emotionality and attention-seeking
D. A pervasive pattern of disregard for the rights of others
Correct Answer: D
