NURS RN MENTAL HEALTH EXAM QUESTIONS WITH ANSWERS
AND RATIONALE
1. What herbal medication for depression, widely used in Europe, is now being prescribed in the
United States?
A. Ginkgo biloba
B. Echinacea
C. St. John's wort
D. Ephedra
Correct Answer: C. St. John’s wort
St. John’s wort has been found to have serotonin-elevating properties, similar to prescription
antidepressants. St. John’s Wort (Hypericum perforatum) is commonly used to treat mild-to-moderate
depression. Several bioactive compounds have been identified in St. John’s Wort that work
synergistically to provide its antidepressant and anti-inflammatory attributes. St. John’s Wort was more
efficacious than standard antidepressant therapy in patients with mild-to-moderate depression.
Option A: Ginkgo biloba is prescribed to enhance mental acuity. Ginkgo biloba is commonly used to
improve memory and cognition in the elderly suffering from impaired cerebral circulation.
Mitochondrial dysfunction is one theory proposed as the leading cause of cognitive decline. The two
main components in Gingko biloba leaves are flavonoids and terpenes tri lactones. Together, these
compounds enhance and protect mitochondrial function and scavenge reactive molecules like
hydroxyl and peroxyl radicals, nitric oxide, and superoxide ions.
Option B: Echinacea has immune-stimulating properties. Echinacea is known as an
immunostimulant, boosting both innate and specific immunity. It has also demonstrated anti-viral,
anti-inflammatory, and antimicrobial effects. Intracellular bactericidal activity and enhanced
phagocytosis were also observed. A randomized, double-blind study of 473 patients virologically
confirmed with influenza infection, showed Echinacea was as effective as oseltamivir with fewer
adverse events and reduced risk.
Option D: Ephedra is a naturally occurring stimulant that is similar to ephedrine. Ephedra is a
medicinal preparation from the plant Ephedra sinica. Several additional species belonging to the
genus Ephedra have traditionally been used for a variety of medicinal purposes, and are a possible
candidate for the Soma plant of Indo-Iranian religion.
2. A male client recently admitted to the hospital with sharp, substernal chest pain suddenly
complains of palpitations. Nurse Ryan notes a rise in the client’s arterial blood pressure and a
heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine
recently after previously denying use of the drug. The nurse concludes that the client is at high
risk for which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
,NURS RN MENTAL HEALTH EXAM QUESTIONS WITH ANSWERS
AND RATIONALE
C. Neurobehavioral deficits
D. Panic disorder
Correct Answer: A. Coronary artery spasm
Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial infarction,
dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death. Cocaine blocks reuptake of
norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at
postsynaptic receptor sites. Cocaine and its metabolites may cause arterial vasoconstriction hours after
use. Epicardial coronary arteries are especially vulnerable to these effects, leading to a decreased
myocardial oxygen supply.
Option B: Consequently, the drug is more likely to cause tachyarrhythmias than bradyarrhythmias.
Cocaine-induced central sympathetic stimulation and direct cardiac effects may lead to tachycardia,
hypertension, and coronary or cerebral artery vasoconstriction leading to myocardial infarction and
stroke.
Option C: Although neurobehavioral deficits are common in neonates born to cocaine users, they
are rare in adults. CNS reactions may be more excitatory than depressant. In its mild form, the
patient may display anxiety, restlessness, and excitement. Full-body tonic-clonic seizures may result
from moderate to severe CNS stimulation. These seizures are often followed by CNS depression,
with death resulting from respiratory failure and/or asphyxiation if concomitant emesis is present.
Option D: As craving for the drug increases, a person who’s addicted to cocaine typically
experiences euphoria followed by depression, not panic disorder. Cardiovascular toxicity and
agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
However, there is a risk of over-sedation and respiratory depression with escalating and numerous
doses of benzodiazepines, which is often necessary. Non-dihydropyridine calcium channel blockers
such as diltiazem and verapamil have shown the ability to reduce hypertension reliably, but not
tachycardia.
3. A male client is hospitalized with fractures of the right femur and right humerus sustained in a
motorcycle accident. Police suspect the client was intoxicated at the time of the accident.
Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to
drinking heavily for years. During hospitalization, the client periodically complains of tingling and
numbness in the hands and feet. Nurse Gian realizes that these symptoms probably result from:
A. Acetate accumulation
B Thiamine deficiency
B. Triglyceride buildup.
C. A below-normal serum potassium level
Correct Answer: B. Thiamine deficiency
Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results
from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake.
,NURS RN MENTAL HEALTH EXAM QUESTIONS WITH ANSWERS
AND RATIONALE
Treatment includes reducing alcohol intake, correcting nutritional deficiencies through diet and vitamin
supplements, and preventing such residual disabilities as foot and wrist drop.
Option A: When thiamine stores are depleted (which takes about 4 weeks after stopping intake),
symptoms start to appear. When evaluating for thiamine deficiency, the typical history may include
poor nutritional intake, excessive alcohol intake, or the patient belonging to the special populations
of individuals previously mentioned (pregnant women, recipients of bariatric surgery, patients with
prolonged diuretic use, anyone with poor overall nutritional status, etc.).
Option C: Initial symptoms of B1 deficiency include anorexia, irritability, and difficulties with short-
term memory. With prolonged thiamine deficiency, patients may endorse loss of sensation in the
extremities, symptoms of heart failure including swelling of the hands or feet and chest pain related
to demand ischemia, or feelings of vertigo, double vision, and memory loss. Additionally, close
friends and family of the patient may describe confusion or symptoms of confabulation.
Option D: Detection of thiamine deficiency relies on relevant history and physical exam findings and
follow up with laboratory testing for confirmation. Functional enzymatic assay of transketolase
activity is the activity of transketolase measured before and after the addition of thiamine
pyrophosphate; >25% stimulation response is abnormal. Measurement of thiamine or the
phosphorylated esters of thiamine in serum or blood using high-performance liquid chromatography
is used. Urine studies exist but are not a reliable test for the evaluation of total body thiamine.
4. Nurse Myrna develops a counter-transference reaction. This is evidenced by:
A. Revealing personal information to the client.
B. Focusing on the feelings of the client.
C. Confronting the client about discrepancies in verbal or nonverbal behavior.
D. The client feels angry towards the nurse who resembles his mother.
Correct Answer: A. Revealing personal information to the client
Counter-transference is an emotional reaction of the nurse on the client based on her unconscious
needs and conflicts. Countertransference is defined as redirection of a psychotherapist’s feelings toward
a client – or, more generally, as a therapist’s emotional entanglement with a client. Just as transference
is the concept of a client redirecting feelings meant for others onto the therapist, countertransference is
the reaction to a client’s transference, in which the counselor projects his or her feelings unconsciously
onto the client. How countertransference is used in therapy can make it either helpful or problematic.
Option B: It is important for the therapist to understand the role that of transference and
countertransference, and deal with those emotions in such a way that the core of the counseling
relationship is not shattered by these feelings. Once countertransference is recognized, it is
important that the therapist acknowledge and work through those feelings.
Option C: This is a therapeutic approach. The idea of countertransference — the counselor’s
unconscious feelings that emerge as a result of working with the client — is most often attributed to
Sigmund Freud, who was the first to name the phenomenon and caution other analysts to manage it
within themselves. Some suggest that categorizing countertransference as part of the
, NURS RN MENTAL HEALTH EXAM QUESTIONS WITH ANSWERS
AND RATIONALE
“psychodynamic approach” has made its understanding more difficult, particularly with the rise of
other counseling styles that may not emphasize self-awareness and exploration.
Option D: This is a transference reaction where a client has an emotional reaction towards the nurse
based on her past. Signs of countertransference in therapy can include a variety of behaviors,
including excessive self-disclosure on the part of the therapist or an inappropriate interest in
irrelevant details from the life of the person in treatment. A therapist who acts on their feelings
toward the person being treated or that person’s situation or engages in behavior not appropriate
to the treatment process may not be effectively managing countertransference.
5. After taking an overdose of phenobarbital (Barbita), Mario is admitted to the emergency
department. Dr. Trinidad prescribes activated charcoal (Charcocaps) to be administered by
mouth immediately. Before administering the dose, the nurse verifies the dosage ordered. What
is the usual minimum dose of activated charcoal?
A. 5 g mixed in 250 ml of water
B. 15 g mixed in 500 ml of water
C. 30 g mixed in 250 ml of water
D. 60 g mixed in 500 ml of water
Correct Answer: C. 30 g mixed in 250 ml of water
The usual adult dosage of activated charcoal is 5 to 10 times the estimated weight of the drug or
chemical ingested, or a minimum dose of 30 g, mixed in 250 ml of water. Doses less than this will be
ineffective; doses greater than this can increase the risk of adverse reactions, although toxicity doesn’t
occur with activated charcoal, even at the maximum dose. Activated charcoal is widely used in
Emergency Departments to treat many types of toxic ingestions. Its use significantly prevents the
absorption of many toxic drugs and other poisons if given early post-ingestion.
Option A: An oral suspension of activated charcoal (AC) should merit consideration in poisonings
when there is an indication for gastrointestinal decontamination of an ingested toxin, and the
clinician can administer activated charcoal within 1 hour of ingestion. When the dose of the ingested
toxin is known, experts recommend activated charcoal at a 10 to 1 ratio of activated charcoal to the
ingested toxin. This ratio may be impractical to achieve when the patient has ingested large doses of
a toxin.
Option B: When the amount of toxin ingested is unknown, or it is impractical to achieve a 10 to 1
ratio in large dose toxic ingestions, SDAC should be administered at a dose of 1g/kg of body weight
or using a simplified age-based dosing scheme. Formulations have been attempted to increase the
palatability of activated charcoal, which is black and has a gritty texture. Ready-to-use aqueous
suspensions of activated charcoal are available in 15 g, 25 g, and 50 g doses as well as formulations
premixed with sorbitol.
Option D: Pulmonary aspiration and a resulting aspiration pneumonitis are the most concerning
risks of administration of activated charcoal. Aspiration from emesis and misplaced nasogastric
tubes for activated charcoal administration can lead to severe respiratory compromise and even
AND RATIONALE
1. What herbal medication for depression, widely used in Europe, is now being prescribed in the
United States?
A. Ginkgo biloba
B. Echinacea
C. St. John's wort
D. Ephedra
Correct Answer: C. St. John’s wort
St. John’s wort has been found to have serotonin-elevating properties, similar to prescription
antidepressants. St. John’s Wort (Hypericum perforatum) is commonly used to treat mild-to-moderate
depression. Several bioactive compounds have been identified in St. John’s Wort that work
synergistically to provide its antidepressant and anti-inflammatory attributes. St. John’s Wort was more
efficacious than standard antidepressant therapy in patients with mild-to-moderate depression.
Option A: Ginkgo biloba is prescribed to enhance mental acuity. Ginkgo biloba is commonly used to
improve memory and cognition in the elderly suffering from impaired cerebral circulation.
Mitochondrial dysfunction is one theory proposed as the leading cause of cognitive decline. The two
main components in Gingko biloba leaves are flavonoids and terpenes tri lactones. Together, these
compounds enhance and protect mitochondrial function and scavenge reactive molecules like
hydroxyl and peroxyl radicals, nitric oxide, and superoxide ions.
Option B: Echinacea has immune-stimulating properties. Echinacea is known as an
immunostimulant, boosting both innate and specific immunity. It has also demonstrated anti-viral,
anti-inflammatory, and antimicrobial effects. Intracellular bactericidal activity and enhanced
phagocytosis were also observed. A randomized, double-blind study of 473 patients virologically
confirmed with influenza infection, showed Echinacea was as effective as oseltamivir with fewer
adverse events and reduced risk.
Option D: Ephedra is a naturally occurring stimulant that is similar to ephedrine. Ephedra is a
medicinal preparation from the plant Ephedra sinica. Several additional species belonging to the
genus Ephedra have traditionally been used for a variety of medicinal purposes, and are a possible
candidate for the Soma plant of Indo-Iranian religion.
2. A male client recently admitted to the hospital with sharp, substernal chest pain suddenly
complains of palpitations. Nurse Ryan notes a rise in the client’s arterial blood pressure and a
heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine
recently after previously denying use of the drug. The nurse concludes that the client is at high
risk for which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
,NURS RN MENTAL HEALTH EXAM QUESTIONS WITH ANSWERS
AND RATIONALE
C. Neurobehavioral deficits
D. Panic disorder
Correct Answer: A. Coronary artery spasm
Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial infarction,
dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death. Cocaine blocks reuptake of
norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at
postsynaptic receptor sites. Cocaine and its metabolites may cause arterial vasoconstriction hours after
use. Epicardial coronary arteries are especially vulnerable to these effects, leading to a decreased
myocardial oxygen supply.
Option B: Consequently, the drug is more likely to cause tachyarrhythmias than bradyarrhythmias.
Cocaine-induced central sympathetic stimulation and direct cardiac effects may lead to tachycardia,
hypertension, and coronary or cerebral artery vasoconstriction leading to myocardial infarction and
stroke.
Option C: Although neurobehavioral deficits are common in neonates born to cocaine users, they
are rare in adults. CNS reactions may be more excitatory than depressant. In its mild form, the
patient may display anxiety, restlessness, and excitement. Full-body tonic-clonic seizures may result
from moderate to severe CNS stimulation. These seizures are often followed by CNS depression,
with death resulting from respiratory failure and/or asphyxiation if concomitant emesis is present.
Option D: As craving for the drug increases, a person who’s addicted to cocaine typically
experiences euphoria followed by depression, not panic disorder. Cardiovascular toxicity and
agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
However, there is a risk of over-sedation and respiratory depression with escalating and numerous
doses of benzodiazepines, which is often necessary. Non-dihydropyridine calcium channel blockers
such as diltiazem and verapamil have shown the ability to reduce hypertension reliably, but not
tachycardia.
3. A male client is hospitalized with fractures of the right femur and right humerus sustained in a
motorcycle accident. Police suspect the client was intoxicated at the time of the accident.
Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to
drinking heavily for years. During hospitalization, the client periodically complains of tingling and
numbness in the hands and feet. Nurse Gian realizes that these symptoms probably result from:
A. Acetate accumulation
B Thiamine deficiency
B. Triglyceride buildup.
C. A below-normal serum potassium level
Correct Answer: B. Thiamine deficiency
Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results
from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake.
,NURS RN MENTAL HEALTH EXAM QUESTIONS WITH ANSWERS
AND RATIONALE
Treatment includes reducing alcohol intake, correcting nutritional deficiencies through diet and vitamin
supplements, and preventing such residual disabilities as foot and wrist drop.
Option A: When thiamine stores are depleted (which takes about 4 weeks after stopping intake),
symptoms start to appear. When evaluating for thiamine deficiency, the typical history may include
poor nutritional intake, excessive alcohol intake, or the patient belonging to the special populations
of individuals previously mentioned (pregnant women, recipients of bariatric surgery, patients with
prolonged diuretic use, anyone with poor overall nutritional status, etc.).
Option C: Initial symptoms of B1 deficiency include anorexia, irritability, and difficulties with short-
term memory. With prolonged thiamine deficiency, patients may endorse loss of sensation in the
extremities, symptoms of heart failure including swelling of the hands or feet and chest pain related
to demand ischemia, or feelings of vertigo, double vision, and memory loss. Additionally, close
friends and family of the patient may describe confusion or symptoms of confabulation.
Option D: Detection of thiamine deficiency relies on relevant history and physical exam findings and
follow up with laboratory testing for confirmation. Functional enzymatic assay of transketolase
activity is the activity of transketolase measured before and after the addition of thiamine
pyrophosphate; >25% stimulation response is abnormal. Measurement of thiamine or the
phosphorylated esters of thiamine in serum or blood using high-performance liquid chromatography
is used. Urine studies exist but are not a reliable test for the evaluation of total body thiamine.
4. Nurse Myrna develops a counter-transference reaction. This is evidenced by:
A. Revealing personal information to the client.
B. Focusing on the feelings of the client.
C. Confronting the client about discrepancies in verbal or nonverbal behavior.
D. The client feels angry towards the nurse who resembles his mother.
Correct Answer: A. Revealing personal information to the client
Counter-transference is an emotional reaction of the nurse on the client based on her unconscious
needs and conflicts. Countertransference is defined as redirection of a psychotherapist’s feelings toward
a client – or, more generally, as a therapist’s emotional entanglement with a client. Just as transference
is the concept of a client redirecting feelings meant for others onto the therapist, countertransference is
the reaction to a client’s transference, in which the counselor projects his or her feelings unconsciously
onto the client. How countertransference is used in therapy can make it either helpful or problematic.
Option B: It is important for the therapist to understand the role that of transference and
countertransference, and deal with those emotions in such a way that the core of the counseling
relationship is not shattered by these feelings. Once countertransference is recognized, it is
important that the therapist acknowledge and work through those feelings.
Option C: This is a therapeutic approach. The idea of countertransference — the counselor’s
unconscious feelings that emerge as a result of working with the client — is most often attributed to
Sigmund Freud, who was the first to name the phenomenon and caution other analysts to manage it
within themselves. Some suggest that categorizing countertransference as part of the
, NURS RN MENTAL HEALTH EXAM QUESTIONS WITH ANSWERS
AND RATIONALE
“psychodynamic approach” has made its understanding more difficult, particularly with the rise of
other counseling styles that may not emphasize self-awareness and exploration.
Option D: This is a transference reaction where a client has an emotional reaction towards the nurse
based on her past. Signs of countertransference in therapy can include a variety of behaviors,
including excessive self-disclosure on the part of the therapist or an inappropriate interest in
irrelevant details from the life of the person in treatment. A therapist who acts on their feelings
toward the person being treated or that person’s situation or engages in behavior not appropriate
to the treatment process may not be effectively managing countertransference.
5. After taking an overdose of phenobarbital (Barbita), Mario is admitted to the emergency
department. Dr. Trinidad prescribes activated charcoal (Charcocaps) to be administered by
mouth immediately. Before administering the dose, the nurse verifies the dosage ordered. What
is the usual minimum dose of activated charcoal?
A. 5 g mixed in 250 ml of water
B. 15 g mixed in 500 ml of water
C. 30 g mixed in 250 ml of water
D. 60 g mixed in 500 ml of water
Correct Answer: C. 30 g mixed in 250 ml of water
The usual adult dosage of activated charcoal is 5 to 10 times the estimated weight of the drug or
chemical ingested, or a minimum dose of 30 g, mixed in 250 ml of water. Doses less than this will be
ineffective; doses greater than this can increase the risk of adverse reactions, although toxicity doesn’t
occur with activated charcoal, even at the maximum dose. Activated charcoal is widely used in
Emergency Departments to treat many types of toxic ingestions. Its use significantly prevents the
absorption of many toxic drugs and other poisons if given early post-ingestion.
Option A: An oral suspension of activated charcoal (AC) should merit consideration in poisonings
when there is an indication for gastrointestinal decontamination of an ingested toxin, and the
clinician can administer activated charcoal within 1 hour of ingestion. When the dose of the ingested
toxin is known, experts recommend activated charcoal at a 10 to 1 ratio of activated charcoal to the
ingested toxin. This ratio may be impractical to achieve when the patient has ingested large doses of
a toxin.
Option B: When the amount of toxin ingested is unknown, or it is impractical to achieve a 10 to 1
ratio in large dose toxic ingestions, SDAC should be administered at a dose of 1g/kg of body weight
or using a simplified age-based dosing scheme. Formulations have been attempted to increase the
palatability of activated charcoal, which is black and has a gritty texture. Ready-to-use aqueous
suspensions of activated charcoal are available in 15 g, 25 g, and 50 g doses as well as formulations
premixed with sorbitol.
Option D: Pulmonary aspiration and a resulting aspiration pneumonitis are the most concerning
risks of administration of activated charcoal. Aspiration from emesis and misplaced nasogastric
tubes for activated charcoal administration can lead to severe respiratory compromise and even
