NUR 2488 – Mental Health Nursing Final Exam |
2025/2026 Verified 100% Correct Q&A
Questions 1-10: Psychiatric Disorders & Therapeutic Communication Basics
Question 1: Psychiatric Disorders
A 28-year-old female client with a history of major depressive disorder presents to the emergency
department reporting feelings of hopelessness, fatigue, and passive suicidal ideation for the past two
weeks. She states, "I just want to sleep all the time and nothing matters anymore." Vital signs are stable,
but she has lost 8 pounds unintentionally. The nurse's priority assessment is:
A. Evaluating for manic symptoms indicative of bipolar disorder
B. Assessing the client's suicide risk and protective factors
C. Administering a routine mood screening tool like the PHQ-9
D. Encouraging immediate family involvement for support
B. Assessing the client's suicide risk and protective factors
Rationale: In major depressive disorder, passive suicidal ideation signals an elevated risk for self-harm,
prioritizing immediate safety through a thorough suicide risk assessment (e.g., using the
Columbia-Suicide Severity Rating Scale). This ensures patient safety by identifying lethality and
protective factors, while psychosocially addressing the client's hopelessness through empathetic
exploration of coping mechanisms, preventing escalation without prematurely shifting focus to other
disorders or interventions.
Question 2: Therapeutic Communication
During a group therapy session for clients with generalized anxiety disorder, a 35-year-old male client
interrupts others repeatedly, saying, "This is all pointless; no one understands my worries." The nurse
facilitator notices increasing tension among group members. The most therapeutic communication
response is:
A. "Let's move on; everyone gets a turn to speak equally."
B. "It sounds like your anxiety is really overwhelming you right now—can you tell us more about what
that feels like?"
C. "Interrupting isn't helpful; please wait for your turn."
D. "Why do you think the group doesn't understand? That's not fair to them."
,B. "It sounds like your anxiety is really overwhelming you right now—can you tell us more about
what that feels like?"
Rationale: Therapeutic communication in anxiety disorders uses reflective and empathetic statements to
validate emotions, fostering trust and reducing defensiveness. This approach promotes psychosocial
safety by de-escalating group dynamics, encouraging emotional expression, and modeling active
listening, which enhances group cohesion without confrontation or judgment that could exacerbate the
client's anxiety and lead to disengagement.
Question 3: Pharmacologic Interventions
A 42-year-old client diagnosed with schizophrenia is prescribed risperidone 2 mg PO BID. On day 3 of
treatment, the client reports muscle stiffness, restlessness, and a shuffling gait. The nurse recognizes these
as early signs of:
A. Neuroleptic malignant syndrome (NMS)
B. Extrapyramidal symptoms (EPS)
C. Tardive dyskinesia
D. Anticholinergic toxicity
B. Extrapyramidal symptoms (EPS)
Rationale: Risperidone, a second-generation antipsychotic, commonly causes EPS (e.g., akathisia,
dystonia) due to dopamine D2 receptor blockade, requiring prompt intervention with anticholinergics like
benztropine for patient safety. Psychosocially, addressing EPS prevents non-adherence, as movement
disorders can heighten paranoia or withdrawal in schizophrenia, undermining therapeutic alliance and
long-term symptom management.
Question 4: Psychiatric Disorders
A 19-year-old college student is admitted after an acute panic attack during finals week, where she
experienced chest pain, shortness of breath, and a sense of impending doom. She endorses chronic worry
about academic failure and social isolation. The nurse's initial nursing diagnosis is most likely:
A. Ineffective coping related to unresolved trauma
B. Acute anxiety related to situational stressors
C. Disturbed body image related to weight changes
D. Impaired social interaction related to auditory hallucinations
B. Acute anxiety related to situational stressors
Rationale: Panic disorder manifests with sudden, intense episodes triggered by stressors like exams,
warranting a diagnosis focused on acute anxiety for targeted interventions (e.g., grounding techniques).
This prioritizes safety by mitigating physiological symptoms that mimic cardiac events, while
,psychosocially supporting the client's fear of loss of control, promoting resilience through stress
management education to prevent chronicity.
Question 5: Therapeutic Communication
A client with borderline personality disorder storms out of a one-on-one session after the nurse sets a
boundary about discussing self-harm superficially. Upon returning, the client yells, "You don't care about
me at all!" The nurse's best response to rebuild rapport is:
A. "I do care, but we need to follow session guidelines for your safety."
B. "Your anger seems really strong right now—what's making you feel uncared for?"
C. "Calm down; yelling won't help us progress."
D. "Let's focus on positive things instead of this conflict."
B. "Your anger seems really strong right now—what's making you feel uncared for?"
Rationale: Clients with borderline personality disorder often experience intense abandonment fears, and
reflective questioning validates emotions while exploring underlying triggers, enhancing psychosocial
safety. This therapeutic technique de-escalates emotional dysregulation, reduces splitting
(idealizing/devaluing), and fosters secure attachment, preventing self-harm escalation compared to
directive or dismissive responses that could reinforce perceived rejection.
Question 6: Pharmacologic Interventions
An elderly client with bipolar disorder in the manic phase is started on lithium carbonate 300 mg TID.
After one week, lab results show a serum lithium level of 1.4 mEq/L. The nurse's priority action is:
A. Continue the dose and monitor for therapeutic effects
B. Hold the next dose and notify the provider for dose adjustment
C. Administer an additional 300 mg to achieve euthymia
D. Switch to valproic acid due to age-related risks
B. Hold the next dose and notify the provider for dose adjustment
Rationale: Lithium's therapeutic range is 0.6-1.2 mEq/L; levels above 1.2 mEq/L risk toxicity (e.g.,
tremor, confusion), especially in the elderly with reduced renal clearance, necessitating immediate safety
measures like dose holding. Psychosocially, this prevents manic exacerbation or cognitive impairment
that could impair decision-making and family dynamics, ensuring adherence through education on
hydration and monitoring.
Question 7: Psychiatric Disorders
A 50-year-old male veteran with PTSD is triggered by fireworks on Independence Day, leading to
hypervigilance, nightmares, and avoidance of crowds. He refuses to leave his home. The most appropriate
community-based intervention is:
, A. Inpatient admission for stabilization
B. Referral to eye movement desensitization and reprocessing (EMDR) therapy
C. Prescribing a benzodiazepine for immediate symptom relief
D. Encouraging isolation to avoid further triggers
B. Referral to eye movement desensitization and reprocessing (EMDR) therapy
Rationale: PTSD involves re-experiencing trauma, and EMDR is evidence-based for processing
memories, promoting long-term psychosocial recovery. This prioritizes safety by reducing avoidance
behaviors that isolate the client, while addressing hyperarousal through trauma-focused care, enhancing
quality of life and social reintegration without over-reliance on sedatives that risk dependency.
Question 8: Therapeutic Communication
In a milieu setting, a client with schizophrenia whispers to the nurse, "The voices are telling me the other
patients are poisoning my food." The nurse observes no acute distress but notes the client is refusing
meals. The most therapeutic initial response is:
A. "Those voices aren't real; let's talk about something else."
B. "That must be very frightening—tell me more about what the voices are saying."
C. "I'll check your food myself to make sure it's safe."
D. "We can increase your antipsychotic dose right away."
B. "That must be very frightening—tell me more about what the voices are saying."
Rationale: Therapeutic communication with delusions uses empathy to build alliance without challenging
reality prematurely, which could provoke defensiveness. This ensures safety by assessing command
hallucinations' intensity, allowing psychosocial exploration of fears, and facilitating trust for collaborative
interventions like reality orientation, reducing paranoia-driven refusal of care.
Question 9: Pharmacologic Interventions
A client with obsessive-compulsive disorder (OCD) is prescribed sertraline 50 mg daily, titrated to 200
mg over four weeks. At week 2 (100 mg dose), the client reports worsening anxiety and intrusive
thoughts. The nurse advises:
A. Discontinue sertraline due to paradoxical effects
B. Continue the current dose and monitor for two more weeks
C. Add a benzodiazepine like lorazepam PRN for breakthrough anxiety
D. Switch to a tricyclic antidepressant like clomipramine
B. Continue the current dose and monitor for two more weeks
2025/2026 Verified 100% Correct Q&A
Questions 1-10: Psychiatric Disorders & Therapeutic Communication Basics
Question 1: Psychiatric Disorders
A 28-year-old female client with a history of major depressive disorder presents to the emergency
department reporting feelings of hopelessness, fatigue, and passive suicidal ideation for the past two
weeks. She states, "I just want to sleep all the time and nothing matters anymore." Vital signs are stable,
but she has lost 8 pounds unintentionally. The nurse's priority assessment is:
A. Evaluating for manic symptoms indicative of bipolar disorder
B. Assessing the client's suicide risk and protective factors
C. Administering a routine mood screening tool like the PHQ-9
D. Encouraging immediate family involvement for support
B. Assessing the client's suicide risk and protective factors
Rationale: In major depressive disorder, passive suicidal ideation signals an elevated risk for self-harm,
prioritizing immediate safety through a thorough suicide risk assessment (e.g., using the
Columbia-Suicide Severity Rating Scale). This ensures patient safety by identifying lethality and
protective factors, while psychosocially addressing the client's hopelessness through empathetic
exploration of coping mechanisms, preventing escalation without prematurely shifting focus to other
disorders or interventions.
Question 2: Therapeutic Communication
During a group therapy session for clients with generalized anxiety disorder, a 35-year-old male client
interrupts others repeatedly, saying, "This is all pointless; no one understands my worries." The nurse
facilitator notices increasing tension among group members. The most therapeutic communication
response is:
A. "Let's move on; everyone gets a turn to speak equally."
B. "It sounds like your anxiety is really overwhelming you right now—can you tell us more about what
that feels like?"
C. "Interrupting isn't helpful; please wait for your turn."
D. "Why do you think the group doesn't understand? That's not fair to them."
,B. "It sounds like your anxiety is really overwhelming you right now—can you tell us more about
what that feels like?"
Rationale: Therapeutic communication in anxiety disorders uses reflective and empathetic statements to
validate emotions, fostering trust and reducing defensiveness. This approach promotes psychosocial
safety by de-escalating group dynamics, encouraging emotional expression, and modeling active
listening, which enhances group cohesion without confrontation or judgment that could exacerbate the
client's anxiety and lead to disengagement.
Question 3: Pharmacologic Interventions
A 42-year-old client diagnosed with schizophrenia is prescribed risperidone 2 mg PO BID. On day 3 of
treatment, the client reports muscle stiffness, restlessness, and a shuffling gait. The nurse recognizes these
as early signs of:
A. Neuroleptic malignant syndrome (NMS)
B. Extrapyramidal symptoms (EPS)
C. Tardive dyskinesia
D. Anticholinergic toxicity
B. Extrapyramidal symptoms (EPS)
Rationale: Risperidone, a second-generation antipsychotic, commonly causes EPS (e.g., akathisia,
dystonia) due to dopamine D2 receptor blockade, requiring prompt intervention with anticholinergics like
benztropine for patient safety. Psychosocially, addressing EPS prevents non-adherence, as movement
disorders can heighten paranoia or withdrawal in schizophrenia, undermining therapeutic alliance and
long-term symptom management.
Question 4: Psychiatric Disorders
A 19-year-old college student is admitted after an acute panic attack during finals week, where she
experienced chest pain, shortness of breath, and a sense of impending doom. She endorses chronic worry
about academic failure and social isolation. The nurse's initial nursing diagnosis is most likely:
A. Ineffective coping related to unresolved trauma
B. Acute anxiety related to situational stressors
C. Disturbed body image related to weight changes
D. Impaired social interaction related to auditory hallucinations
B. Acute anxiety related to situational stressors
Rationale: Panic disorder manifests with sudden, intense episodes triggered by stressors like exams,
warranting a diagnosis focused on acute anxiety for targeted interventions (e.g., grounding techniques).
This prioritizes safety by mitigating physiological symptoms that mimic cardiac events, while
,psychosocially supporting the client's fear of loss of control, promoting resilience through stress
management education to prevent chronicity.
Question 5: Therapeutic Communication
A client with borderline personality disorder storms out of a one-on-one session after the nurse sets a
boundary about discussing self-harm superficially. Upon returning, the client yells, "You don't care about
me at all!" The nurse's best response to rebuild rapport is:
A. "I do care, but we need to follow session guidelines for your safety."
B. "Your anger seems really strong right now—what's making you feel uncared for?"
C. "Calm down; yelling won't help us progress."
D. "Let's focus on positive things instead of this conflict."
B. "Your anger seems really strong right now—what's making you feel uncared for?"
Rationale: Clients with borderline personality disorder often experience intense abandonment fears, and
reflective questioning validates emotions while exploring underlying triggers, enhancing psychosocial
safety. This therapeutic technique de-escalates emotional dysregulation, reduces splitting
(idealizing/devaluing), and fosters secure attachment, preventing self-harm escalation compared to
directive or dismissive responses that could reinforce perceived rejection.
Question 6: Pharmacologic Interventions
An elderly client with bipolar disorder in the manic phase is started on lithium carbonate 300 mg TID.
After one week, lab results show a serum lithium level of 1.4 mEq/L. The nurse's priority action is:
A. Continue the dose and monitor for therapeutic effects
B. Hold the next dose and notify the provider for dose adjustment
C. Administer an additional 300 mg to achieve euthymia
D. Switch to valproic acid due to age-related risks
B. Hold the next dose and notify the provider for dose adjustment
Rationale: Lithium's therapeutic range is 0.6-1.2 mEq/L; levels above 1.2 mEq/L risk toxicity (e.g.,
tremor, confusion), especially in the elderly with reduced renal clearance, necessitating immediate safety
measures like dose holding. Psychosocially, this prevents manic exacerbation or cognitive impairment
that could impair decision-making and family dynamics, ensuring adherence through education on
hydration and monitoring.
Question 7: Psychiatric Disorders
A 50-year-old male veteran with PTSD is triggered by fireworks on Independence Day, leading to
hypervigilance, nightmares, and avoidance of crowds. He refuses to leave his home. The most appropriate
community-based intervention is:
, A. Inpatient admission for stabilization
B. Referral to eye movement desensitization and reprocessing (EMDR) therapy
C. Prescribing a benzodiazepine for immediate symptom relief
D. Encouraging isolation to avoid further triggers
B. Referral to eye movement desensitization and reprocessing (EMDR) therapy
Rationale: PTSD involves re-experiencing trauma, and EMDR is evidence-based for processing
memories, promoting long-term psychosocial recovery. This prioritizes safety by reducing avoidance
behaviors that isolate the client, while addressing hyperarousal through trauma-focused care, enhancing
quality of life and social reintegration without over-reliance on sedatives that risk dependency.
Question 8: Therapeutic Communication
In a milieu setting, a client with schizophrenia whispers to the nurse, "The voices are telling me the other
patients are poisoning my food." The nurse observes no acute distress but notes the client is refusing
meals. The most therapeutic initial response is:
A. "Those voices aren't real; let's talk about something else."
B. "That must be very frightening—tell me more about what the voices are saying."
C. "I'll check your food myself to make sure it's safe."
D. "We can increase your antipsychotic dose right away."
B. "That must be very frightening—tell me more about what the voices are saying."
Rationale: Therapeutic communication with delusions uses empathy to build alliance without challenging
reality prematurely, which could provoke defensiveness. This ensures safety by assessing command
hallucinations' intensity, allowing psychosocial exploration of fears, and facilitating trust for collaborative
interventions like reality orientation, reducing paranoia-driven refusal of care.
Question 9: Pharmacologic Interventions
A client with obsessive-compulsive disorder (OCD) is prescribed sertraline 50 mg daily, titrated to 200
mg over four weeks. At week 2 (100 mg dose), the client reports worsening anxiety and intrusive
thoughts. The nurse advises:
A. Discontinue sertraline due to paradoxical effects
B. Continue the current dose and monitor for two more weeks
C. Add a benzodiazepine like lorazepam PRN for breakthrough anxiety
D. Switch to a tricyclic antidepressant like clomipramine
B. Continue the current dose and monitor for two more weeks
