NUR 190 Psychiatric-Mental Health Nursing
Final Exam (2025/2026) — Real 130
Questions & Answers with Rationales
(Comprehensive Assessment, DSM-5-TR
Aligned)
1. A client with major depressive disorder reports early morning awakening, anhedonia,
and significant weight loss. Which feature best describes this presentation?
A. Atypical features
B. Melancholic features
C. Seasonal pattern
D. Catatonia
Answer: B. Melancholic features.
Rationale: Early morning awakening, profound anhedonia, and weight loss are classic
melancholic features per DSM-5-TR.
2. A 25-year-old with generalized anxiety disorder (GAD) complains of excessive worry for
8 months and muscle tension. First-line nursing intervention?
A. Start benzodiazepine immediately
B. Teach diaphragmatic breathing and relaxation techniques
C. Recommend alcohol to relax
D. Encourage isolation to avoid stressors
Answer: B. Teach diaphragmatic breathing and relaxation techniques.
Rationale: Nonpharmacologic coping skills (relaxation, breathing) are essential first-line
nursing interventions; benzodiazepines are not first teaching step.
3. A client with schizophrenia exhibits flat affect and poverty of speech. These are
examples of:
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Mood symptoms
Answer: B. Negative symptoms.
Rationale: Flat affect and alogia (poverty of speech) are negative symptoms indicating
diminished function.
4. A patient on haloperidol develops acute muscle rigidity and fever. What is the priority
action?
, A. Continue medication and observe
B. Give benztropine IM and reassess in 24 hours
C. Immediately hold antipsychotic and notify provider — possible neuroleptic malignant
syndrome (NMS)
D. Administer lorazepam and discharge
Answer: C. Immediately hold antipsychotic and notify provider — possible NMS.
Rationale: Rigidity and fever suggest NMS, a life-threatening emergency requiring
stopping antipsychotic and urgent treatment.
5. A client with anorexia nervosa has BMI 16 and bradycardia. Nursing priority?
A. Provide group therapy only
B. Weight restoration and medical stabilization (monitor vitals, electrolytes)
C. Encourage aerobic exercise
D. Focus only on cognitive restructuring
Answer: B. Weight restoration and medical stabilization (monitor vitals,
electrolytes).
Rationale: Severe malnutrition requires medical stabilization before intensive
psychotherapy.
6. A patient refuses all food but has capacity. Nurse should:
A. Force-feed to prevent malnutrition
B. Respect refusal and document, while assessing capacity and offering alternatives
C. Restrain and administer NG feeding without order
D. Discharge immediately
Answer: B. Respect refusal and document, while assessing capacity and offering
alternatives.
Rationale: Adults with capacity have the right to refuse; nurses must assess
decision-making capacity and document; seek provider orders if medically necessary.
7. Which medication is first-line for PTSD in adults?
A. Sertraline (SSRI)
B. Haloperidol
C. Benzodiazepines long-term
D. Lithium
Answer: A. Sertraline (SSRI).
Rationale: SSRIs (sertraline, paroxetine) are evidence-based first-line
pharmacotherapy for PTSD.
8. A patient hears voices telling them to harm others. Best immediate nursing action?
A. Ignore — auditory hallucinations are harmless
B. Ensure safety of patient and others; conduct risk assessment and remove means
C. Tell patient voices are imaginary and punish them
D. Leave the patient alone to avoid escalation
Answer: B. Ensure safety of patient and others; conduct risk assessment and
, remove means.
Rationale: Command hallucinations require safety assessment and immediate
interventions to prevent harm.
9. Lithium monitoring requires regular measurement of:
A. Liver enzymes weekly
B. Serum lithium level and kidney function (BUN/Cr, TSH)
C. Plasma glucose only
D. CBC only
Answer: B. Serum lithium level and kidney function (BUN/Cr, TSH).
Rationale: Lithium has a narrow therapeutic index; monitor levels and renal/thyroid
function.
10.A client with borderline personality disorder threatens self-harm during an argument.
Nursing response:
A. Ignore to avoid reinforcement
B. Provide calm, empathetic limit setting and safety planning (contracting, observe)
C. Agree with manipulation to end conflict
D. Immediately discharge the client
Answer: B. Provide calm, empathetic limit setting and safety planning
(contracting, observe).
Rationale: Use validation, boundary setting, and safety measures; de-escalation is key.
11.An adolescent presents with binge eating episodes and distress but no compensatory
behaviors — likely diagnosis:
A. Bulimia nervosa
B. Anorexia nervosa binge-purge type
C. Binge-eating disorder
D. Avoidant/restrictive food intake disorder
Answer: C. Binge-eating disorder.
Rationale: Binge episodes with distress and no compensatory behaviors fit
binge-eating disorder criteria.
12.A patient with dementia becomes agitated at night (sundowning). Nursing interventions
include:
A. Increase nighttime stimuli and lights only
B. Reorientation, consistent routine, low stimulation environment, daytime activity
C. Physical restraints at night
D. High-dose antipsychotic as first step
Answer: B. Reorientation, consistent routine, low stimulation environment,
daytime activity.
Rationale: Nonpharmacologic measures (routines, orientation) are first-line for
sundowning.
, 13.A first-line medication class for OCD is:
A. SSRIs at higher doses
B. Low-dose antipsychotics only
C. Tricyclics exclusively
D. Benzodiazepines exclusively
Answer: A. SSRIs at higher doses.
Rationale: SSRIs (and clomipramine, a TCA) are evidence-based; SSRIs often
required at higher doses.
14.Which statement indicates insight loss in psychosis?
A. “The doctor is helping me.”
B. “I don’t need medication — the TV controls my brain.”
C. “I feel sad sometimes.”
D. “I worry about finances.”
Answer: B. “I don’t need medication — the TV controls my brain.”
Rationale: Delusional belief and refusal of treatment reflect impaired insight.
15.A priority nursing action for a client with imminent suicide risk is:
A. Provide brochures on coping
B. Implement one-to-one observation, remove dangerous items, ensure constant
supervision
C. Allow the patient privacy overnight
D. Ask family to leave
Answer: B. Implement one-to-one observation, remove dangerous items, ensure
constant supervision.
Rationale: Immediate safety measures are essential for high suicide risk.
16.Electroconvulsive therapy (ECT) is most indicated for:
A. Mild anxiety disorder only
B. Treatment-resistant severe depression with psychotic features or suicidality
C. Simple phobias
D. Antisocial personality disorder
Answer: B. Treatment-resistant severe depression with psychotic features or
suicidality.
Rationale: ECT is effective for severe, refractory depression and life-threatening cases.
17.What is the nurse’s best response when a patient says, “I feel hopeless”?
A. “Everyone feels that way sometimes.”
B. “Tell me more about those feelings; are you having thoughts of harming yourself?”
C. “You shouldn’t feel hopeless.”
D. “Stop complaining.”
Answer: B. “Tell me more about those feelings; are you having thoughts of
harming yourself?”
Final Exam (2025/2026) — Real 130
Questions & Answers with Rationales
(Comprehensive Assessment, DSM-5-TR
Aligned)
1. A client with major depressive disorder reports early morning awakening, anhedonia,
and significant weight loss. Which feature best describes this presentation?
A. Atypical features
B. Melancholic features
C. Seasonal pattern
D. Catatonia
Answer: B. Melancholic features.
Rationale: Early morning awakening, profound anhedonia, and weight loss are classic
melancholic features per DSM-5-TR.
2. A 25-year-old with generalized anxiety disorder (GAD) complains of excessive worry for
8 months and muscle tension. First-line nursing intervention?
A. Start benzodiazepine immediately
B. Teach diaphragmatic breathing and relaxation techniques
C. Recommend alcohol to relax
D. Encourage isolation to avoid stressors
Answer: B. Teach diaphragmatic breathing and relaxation techniques.
Rationale: Nonpharmacologic coping skills (relaxation, breathing) are essential first-line
nursing interventions; benzodiazepines are not first teaching step.
3. A client with schizophrenia exhibits flat affect and poverty of speech. These are
examples of:
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Mood symptoms
Answer: B. Negative symptoms.
Rationale: Flat affect and alogia (poverty of speech) are negative symptoms indicating
diminished function.
4. A patient on haloperidol develops acute muscle rigidity and fever. What is the priority
action?
, A. Continue medication and observe
B. Give benztropine IM and reassess in 24 hours
C. Immediately hold antipsychotic and notify provider — possible neuroleptic malignant
syndrome (NMS)
D. Administer lorazepam and discharge
Answer: C. Immediately hold antipsychotic and notify provider — possible NMS.
Rationale: Rigidity and fever suggest NMS, a life-threatening emergency requiring
stopping antipsychotic and urgent treatment.
5. A client with anorexia nervosa has BMI 16 and bradycardia. Nursing priority?
A. Provide group therapy only
B. Weight restoration and medical stabilization (monitor vitals, electrolytes)
C. Encourage aerobic exercise
D. Focus only on cognitive restructuring
Answer: B. Weight restoration and medical stabilization (monitor vitals,
electrolytes).
Rationale: Severe malnutrition requires medical stabilization before intensive
psychotherapy.
6. A patient refuses all food but has capacity. Nurse should:
A. Force-feed to prevent malnutrition
B. Respect refusal and document, while assessing capacity and offering alternatives
C. Restrain and administer NG feeding without order
D. Discharge immediately
Answer: B. Respect refusal and document, while assessing capacity and offering
alternatives.
Rationale: Adults with capacity have the right to refuse; nurses must assess
decision-making capacity and document; seek provider orders if medically necessary.
7. Which medication is first-line for PTSD in adults?
A. Sertraline (SSRI)
B. Haloperidol
C. Benzodiazepines long-term
D. Lithium
Answer: A. Sertraline (SSRI).
Rationale: SSRIs (sertraline, paroxetine) are evidence-based first-line
pharmacotherapy for PTSD.
8. A patient hears voices telling them to harm others. Best immediate nursing action?
A. Ignore — auditory hallucinations are harmless
B. Ensure safety of patient and others; conduct risk assessment and remove means
C. Tell patient voices are imaginary and punish them
D. Leave the patient alone to avoid escalation
Answer: B. Ensure safety of patient and others; conduct risk assessment and
, remove means.
Rationale: Command hallucinations require safety assessment and immediate
interventions to prevent harm.
9. Lithium monitoring requires regular measurement of:
A. Liver enzymes weekly
B. Serum lithium level and kidney function (BUN/Cr, TSH)
C. Plasma glucose only
D. CBC only
Answer: B. Serum lithium level and kidney function (BUN/Cr, TSH).
Rationale: Lithium has a narrow therapeutic index; monitor levels and renal/thyroid
function.
10.A client with borderline personality disorder threatens self-harm during an argument.
Nursing response:
A. Ignore to avoid reinforcement
B. Provide calm, empathetic limit setting and safety planning (contracting, observe)
C. Agree with manipulation to end conflict
D. Immediately discharge the client
Answer: B. Provide calm, empathetic limit setting and safety planning
(contracting, observe).
Rationale: Use validation, boundary setting, and safety measures; de-escalation is key.
11.An adolescent presents with binge eating episodes and distress but no compensatory
behaviors — likely diagnosis:
A. Bulimia nervosa
B. Anorexia nervosa binge-purge type
C. Binge-eating disorder
D. Avoidant/restrictive food intake disorder
Answer: C. Binge-eating disorder.
Rationale: Binge episodes with distress and no compensatory behaviors fit
binge-eating disorder criteria.
12.A patient with dementia becomes agitated at night (sundowning). Nursing interventions
include:
A. Increase nighttime stimuli and lights only
B. Reorientation, consistent routine, low stimulation environment, daytime activity
C. Physical restraints at night
D. High-dose antipsychotic as first step
Answer: B. Reorientation, consistent routine, low stimulation environment,
daytime activity.
Rationale: Nonpharmacologic measures (routines, orientation) are first-line for
sundowning.
, 13.A first-line medication class for OCD is:
A. SSRIs at higher doses
B. Low-dose antipsychotics only
C. Tricyclics exclusively
D. Benzodiazepines exclusively
Answer: A. SSRIs at higher doses.
Rationale: SSRIs (and clomipramine, a TCA) are evidence-based; SSRIs often
required at higher doses.
14.Which statement indicates insight loss in psychosis?
A. “The doctor is helping me.”
B. “I don’t need medication — the TV controls my brain.”
C. “I feel sad sometimes.”
D. “I worry about finances.”
Answer: B. “I don’t need medication — the TV controls my brain.”
Rationale: Delusional belief and refusal of treatment reflect impaired insight.
15.A priority nursing action for a client with imminent suicide risk is:
A. Provide brochures on coping
B. Implement one-to-one observation, remove dangerous items, ensure constant
supervision
C. Allow the patient privacy overnight
D. Ask family to leave
Answer: B. Implement one-to-one observation, remove dangerous items, ensure
constant supervision.
Rationale: Immediate safety measures are essential for high suicide risk.
16.Electroconvulsive therapy (ECT) is most indicated for:
A. Mild anxiety disorder only
B. Treatment-resistant severe depression with psychotic features or suicidality
C. Simple phobias
D. Antisocial personality disorder
Answer: B. Treatment-resistant severe depression with psychotic features or
suicidality.
Rationale: ECT is effective for severe, refractory depression and life-threatening cases.
17.What is the nurse’s best response when a patient says, “I feel hopeless”?
A. “Everyone feels that way sometimes.”
B. “Tell me more about those feelings; are you having thoughts of harming yourself?”
C. “You shouldn’t feel hopeless.”
D. “Stop complaining.”
Answer: B. “Tell me more about those feelings; are you having thoughts of
harming yourself?”
