1
2026 NUR 2488 Psychiatric Nursing Comprehensive
Predictor Exam | 200+ Practice Questions and
Rationales
1. A nurse is caring for a patient with major depressive disorder who states, “I am
a burden to everyone. My family would be better off without me.” What is the
nurse’s priority action?
A. Reassure the patient that things will get better.
B. Ask the patient directly, “Are you thinking about killing yourself?”
C. Document the statement and continue the daily assessment.
D. Tell the patient to focus on the positive aspects of life.
Answer: B
Rationale: When a patient makes statements suggesting hopelessness or being a
burden, the nurse must directly assess for suicidal ideation. Asking directly does
not plant the idea and is essential for safety. Reassurance (A) and focusing on
positives (D) dismiss the patient's feelings. Documentation (C) is important but
not the priority before assessment.
2. A patient with schizophrenia has been taking haloperidol for several months
and develops involuntary tongue protrusion, lip smacking, and facial grimacing.
The nurse recognizes these symptoms as:
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Neuroleptic malignant syndrome
Answer: B
Rationale: Tardive dyskinesia (TD) is a late-onset, potentially irreversible
movement disorder characterized by involuntary, repetitive movements of the
face, mouth, and tongue. Acute dystonia (A) involves muscle spasms, often early
pg. 1
,2
in treatment. Akathisia (C) is subjective restlessness. Neuroleptic malignant
syndrome (D) presents with fever, rigidity, and autonomic instability.
3. A patient with bipolar I disorder in the manic phase is shouting, pacing, and
displaying grandiose delusions. Which nursing intervention is most appropriate
initially?
A. Engage the patient in a competitive game to channel energy.
B. Provide a quiet, low-stimulation environment and firm, calm limit-setting.
C. Confront the patient’s delusions directly.
D. Encourage group therapy to improve social skills.
Answer: B
Rationale: During acute mania, reducing environmental stimuli and using calm,
consistent limit-setting helps prevent escalation. Competitive activities (A) can
increase agitation. Confronting delusions (C) is not therapeutic. Group therapy (D)
is overstimulating and inappropriate at this stage.
4. The nurse is educating a patient starting lithium. Which statement by the
patient indicates a need for further teaching?
A. “I will have my blood levels checked regularly.”
B. “I should maintain a consistent salt intake and drink plenty of fluids.”
C. “If I miss a dose, I can double the next dose.”
D. “I should avoid taking ibuprofen for pain.”
Answer: C
Rationale: Patients must never double up on lithium doses; toxicity risk increases
with overdose. Regular lab monitoring (A), consistent sodium and fluid intake (B),
and avoiding NSAIDs (D) which increase lithium levels are correct statements.
5. Which lab value would the nurse report immediately before administering
lithium?
A. Sodium 140 mEq/L
B. Creatinine 1.8 mg/dL
C. Potassium 4.0 mEq/L
pg. 2
,3
D. Lithium level 0.8 mEq/L
Answer: B
Rationale: Elevated creatinine indicates reduced renal function; lithium is renally
excreted and can become toxic in renal impairment. The provider may need to
adjust the dose or discontinue. The other values are within normal limits; lithium
level 0.8 is therapeutic.
6. A patient with depression on sertraline reports no improvement after 2 weeks.
The nurse should respond:
A. “The medication is not working; we need to switch.”
B. “It may take 4–6 weeks to feel the full benefit; continue taking it as
prescribed.”
C. “You should stop taking it if it hasn’t helped by now.”
D. “You must need a higher dose immediately.”
Answer: B
Rationale: Antidepressants typically require 4–6 weeks to achieve full therapeutic
effect. Educating about this timeline encourages adherence. Switching or dose
adjustment (A, D) is premature. Stopping (C) could lead to withdrawal and
relapse.
7. A patient on venlafaxine is scheduled for surgery. The nurse should inform the
surgeon that abruptly discontinuing this medication may cause:
A. Hypertensive crisis
B. Serotonin syndrome
C. Discontinuation syndrome (brain zaps, dizziness, nausea)
D. Tardive dyskinesia
Answer: C
Rationale: Venlafaxine (SNRI) is associated with a discontinuation syndrome
characterized by dizziness, electric shock sensations (“brain zaps”), nausea, and
anxiety. It should be tapered. Hypertensive crisis (A) is more related to MAOIs.
Serotonin syndrome (B) results from excess serotonin. TD (D) is from
antipsychotics.
pg. 3
, 4
8. A patient with generalized anxiety disorder is prescribed buspirone. What is an
important teaching point?
A. It provides immediate relief.
B. It has a high potential for abuse.
C. It may take 2–4 weeks for full effect.
D. It can be used on an as-needed basis.
Answer: C
Rationale: Buspirone is a non-benzodiazepine anxiolytic that requires several
weeks for therapeutic effect; it is not effective for acute anxiety. It has low abuse
potential (B), unlike benzodiazepines. It is not used PRN (D).
9. A patient with PTSD experiences a flashback during a therapy session. The
nurse should:
A. Touch the patient to offer comfort.
B. Encourage the patient to focus on the present environment using grounding
techniques.
C. Explore the details of the traumatic event.
D. Leave the patient alone to regain control.
Answer: B
Rationale: During a flashback, grounding techniques (e.g., “5-4-3-2-1” senses)
help reorient the patient to reality and reduce dissociation. Touching (A) may be
perceived as threatening. Detailed exploration (C) should occur in a controlled
therapeutic setting, not during acute distress. Leaving alone (D) is unsafe.
10. Which medication combination poses the greatest risk for serotonin
syndrome?
A. Lithium and haloperidol
B. Fluoxetine and sumatriptan
C. Bupropion and mirtazapine
D. Lorazepam and sertraline
Answer: B
Rationale: SSRIs (fluoxetine) combined with triptans (sumatriptan) increase
serotonin levels, risking serotonin syndrome (hyperthermia, agitation, clonus).
pg. 4
2026 NUR 2488 Psychiatric Nursing Comprehensive
Predictor Exam | 200+ Practice Questions and
Rationales
1. A nurse is caring for a patient with major depressive disorder who states, “I am
a burden to everyone. My family would be better off without me.” What is the
nurse’s priority action?
A. Reassure the patient that things will get better.
B. Ask the patient directly, “Are you thinking about killing yourself?”
C. Document the statement and continue the daily assessment.
D. Tell the patient to focus on the positive aspects of life.
Answer: B
Rationale: When a patient makes statements suggesting hopelessness or being a
burden, the nurse must directly assess for suicidal ideation. Asking directly does
not plant the idea and is essential for safety. Reassurance (A) and focusing on
positives (D) dismiss the patient's feelings. Documentation (C) is important but
not the priority before assessment.
2. A patient with schizophrenia has been taking haloperidol for several months
and develops involuntary tongue protrusion, lip smacking, and facial grimacing.
The nurse recognizes these symptoms as:
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Neuroleptic malignant syndrome
Answer: B
Rationale: Tardive dyskinesia (TD) is a late-onset, potentially irreversible
movement disorder characterized by involuntary, repetitive movements of the
face, mouth, and tongue. Acute dystonia (A) involves muscle spasms, often early
pg. 1
,2
in treatment. Akathisia (C) is subjective restlessness. Neuroleptic malignant
syndrome (D) presents with fever, rigidity, and autonomic instability.
3. A patient with bipolar I disorder in the manic phase is shouting, pacing, and
displaying grandiose delusions. Which nursing intervention is most appropriate
initially?
A. Engage the patient in a competitive game to channel energy.
B. Provide a quiet, low-stimulation environment and firm, calm limit-setting.
C. Confront the patient’s delusions directly.
D. Encourage group therapy to improve social skills.
Answer: B
Rationale: During acute mania, reducing environmental stimuli and using calm,
consistent limit-setting helps prevent escalation. Competitive activities (A) can
increase agitation. Confronting delusions (C) is not therapeutic. Group therapy (D)
is overstimulating and inappropriate at this stage.
4. The nurse is educating a patient starting lithium. Which statement by the
patient indicates a need for further teaching?
A. “I will have my blood levels checked regularly.”
B. “I should maintain a consistent salt intake and drink plenty of fluids.”
C. “If I miss a dose, I can double the next dose.”
D. “I should avoid taking ibuprofen for pain.”
Answer: C
Rationale: Patients must never double up on lithium doses; toxicity risk increases
with overdose. Regular lab monitoring (A), consistent sodium and fluid intake (B),
and avoiding NSAIDs (D) which increase lithium levels are correct statements.
5. Which lab value would the nurse report immediately before administering
lithium?
A. Sodium 140 mEq/L
B. Creatinine 1.8 mg/dL
C. Potassium 4.0 mEq/L
pg. 2
,3
D. Lithium level 0.8 mEq/L
Answer: B
Rationale: Elevated creatinine indicates reduced renal function; lithium is renally
excreted and can become toxic in renal impairment. The provider may need to
adjust the dose or discontinue. The other values are within normal limits; lithium
level 0.8 is therapeutic.
6. A patient with depression on sertraline reports no improvement after 2 weeks.
The nurse should respond:
A. “The medication is not working; we need to switch.”
B. “It may take 4–6 weeks to feel the full benefit; continue taking it as
prescribed.”
C. “You should stop taking it if it hasn’t helped by now.”
D. “You must need a higher dose immediately.”
Answer: B
Rationale: Antidepressants typically require 4–6 weeks to achieve full therapeutic
effect. Educating about this timeline encourages adherence. Switching or dose
adjustment (A, D) is premature. Stopping (C) could lead to withdrawal and
relapse.
7. A patient on venlafaxine is scheduled for surgery. The nurse should inform the
surgeon that abruptly discontinuing this medication may cause:
A. Hypertensive crisis
B. Serotonin syndrome
C. Discontinuation syndrome (brain zaps, dizziness, nausea)
D. Tardive dyskinesia
Answer: C
Rationale: Venlafaxine (SNRI) is associated with a discontinuation syndrome
characterized by dizziness, electric shock sensations (“brain zaps”), nausea, and
anxiety. It should be tapered. Hypertensive crisis (A) is more related to MAOIs.
Serotonin syndrome (B) results from excess serotonin. TD (D) is from
antipsychotics.
pg. 3
, 4
8. A patient with generalized anxiety disorder is prescribed buspirone. What is an
important teaching point?
A. It provides immediate relief.
B. It has a high potential for abuse.
C. It may take 2–4 weeks for full effect.
D. It can be used on an as-needed basis.
Answer: C
Rationale: Buspirone is a non-benzodiazepine anxiolytic that requires several
weeks for therapeutic effect; it is not effective for acute anxiety. It has low abuse
potential (B), unlike benzodiazepines. It is not used PRN (D).
9. A patient with PTSD experiences a flashback during a therapy session. The
nurse should:
A. Touch the patient to offer comfort.
B. Encourage the patient to focus on the present environment using grounding
techniques.
C. Explore the details of the traumatic event.
D. Leave the patient alone to regain control.
Answer: B
Rationale: During a flashback, grounding techniques (e.g., “5-4-3-2-1” senses)
help reorient the patient to reality and reduce dissociation. Touching (A) may be
perceived as threatening. Detailed exploration (C) should occur in a controlled
therapeutic setting, not during acute distress. Leaving alone (D) is unsafe.
10. Which medication combination poses the greatest risk for serotonin
syndrome?
A. Lithium and haloperidol
B. Fluoxetine and sumatriptan
C. Bupropion and mirtazapine
D. Lorazepam and sertraline
Answer: B
Rationale: SSRIs (fluoxetine) combined with triptans (sumatriptan) increase
serotonin levels, risking serotonin syndrome (hyperthermia, agitation, clonus).
pg. 4
