1
NUR 256 Concepts of Mental Health Nursing
ACTUAL EXAM QUESTIONS AND ANSWERS
2026/2027 | Exam 3 | Aligned with NCLEX-RN 2026 &
DSM-5-TR | Pass Guaranteed - A+ Graded
Section 1: Mood Disorders & Suicide (Questions 1-20)
Q1: The nurse is assessing a patient admitted with major depressive disorder. Which statement
by the patient indicates the highest immediate risk for a suicide attempt?
A. "I've been feeling really tired and hopeless for months."
B. "I gave my favorite books to my roommate because I won't need them anymore."
[CORRECT]
C. "My family would be better off if I just disappeared."
D. "I think about dying sometimes, but I'd never actually do it."
Correct Answer: B Rationale: Giving away prized possessions is a behavioral warning sign
that indicates the patient has moved from ideation to planning and preparation. This action
suggests imminent risk and requires immediate safety intervention. Distractor A indicates
hopelessness (a risk factor) but not imminent planning. Distractor C is passive suicidal ideation
without a plan. Distractor D indicates ideation without intent, which is lower risk than active
planning behaviors. The nurse must implement 1:1 observation and remove means of self-harm
immediately.
Q2: The nurse is caring for a patient experiencing acute mania. Which intervention should the
nurse prioritize to maintain patient safety?
A. Encourage the patient to join group therapy to socialize.
B. Provide high-calorie finger foods the patient can eat while pacing. [CORRECT]
C. Limit fluid intake to prevent bathroom accidents.
D. Keep the lights bright to help the patient stay oriented.
Correct Answer: B Rationale: Patients in acute mania experience high psychomotor activity
and may not sit still to eat, putting them at risk for dehydration and malnutrition. Providing
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high-calorie finger foods addresses this physiological need (Maslow's hierarchy) while
accommodating their activity level. Distractor A is incorrect because the patient is too agitated
for group therapy; individual, low-stimulus care is needed. Distractor C is dangerous—
hydration is critical given increased metabolic demands. Distractor D is incorrect because bright
lights can overstimulate; a calm, low-stimulus environment with reduced lighting is preferred.
Q3: A patient with bipolar I disorder has been prescribed lithium carbonate. Which laboratory
value requires immediate notification to the provider?
A. Sodium level of 138 mEq/L
B. Lithium level of 1.8 mEq/L [CORRECT]
C. White blood cell count of 8,500/mm³
D. Thyroid stimulating hormone (TSH) of 3.5 mIU/L
Correct Answer: B Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L (some
sources extend to 1.5 mEq/L for acute mania). A level of 1.8 mEq/L indicates toxicity and
requires immediate intervention—hold the next dose, increase hydration, and notify the provider.
Early signs of toxicity include coarse tremor, ataxia, and confusion; severe toxicity can cause
seizures and coma. Distractor A is within normal range (135-145). Distractor C is normal WBC.
Distractor D is within normal TSH range (0.4-4.0), though lithium can cause hypothyroidism
over time—this value does not require immediate action.
Q4: [Select ALL that apply] The nurse is teaching a patient beginning phenelzine (Nardil), an
MAOI. Which foods should the patient avoid? (Select all that apply)
A. Aged cheddar cheese [CORRECT]
B. Smoked salmon [CORRECT]
C. Soy sauce [CORRECT]
D. Fresh mozzarella cheese
E. Red wine [CORRECT]
Correct Answers: A, B, C, E Rationale: MAOIs inhibit the breakdown of tyramine, which can
cause hypertensive crisis (sudden severe hypertension, headache, potential stroke). High-
tyramine foods to avoid include: aged/fermented cheeses (A), processed/smoked meats (B),
fermented soy products (C), red wine (E), draft beer, and yeast extracts. Fresh mozzarella (D)
is safe because it is not aged. The patient should carry a list of prohibited foods and a medical
alert card. Symptoms of hypertensive crisis require immediate emergency care.
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Q5: A patient with major depressive disorder is started on sertraline (Zoloft). The patient asks
when they will start feeling better. What is the nurse's best response?
A. "You should notice significant improvement within 2-3 days."
B. "Most patients begin to notice some improvement in 2-4 weeks, with full effect in 6-8 weeks."
[CORRECT]
C. "This medication works immediately, but you need to believe it will help."
D. "Depression medications usually take 3-6 months to start working."
Correct Answer: B Rationale: SSRIs like sertraline require 2-4 weeks for initial therapeutic
effects (improved sleep, appetite, energy) and 4-6 weeks (up to 8 weeks) for full
antidepressant effect (improved mood, interest). This delayed onset is due to adaptive
neurochemical changes (downregulation of 5-HT1A autoreceptors), not immediate reuptake
inhibition. Distractor A is incorrect—2-3 days is too soon (though some anxiety reduction may
occur earlier). Distractor C suggests a placebo effect, which undermines the therapeutic
relationship. Distractor D overestimates the delay, potentially causing the patient to discontinue
prematurely.
Q6: The nurse is assessing suicide risk using the SAFE-T protocol. Which finding indicates the
patient is at highest risk and requires immediate intervention?
A. The patient has a plan but no access to means.
B. The patient has intent but no specific plan.
C. The patient has a specific plan, access to means, and states they will act tonight.
[CORRECT]
D. The patient has ideation with no plan or intent.
Correct Answer: C Rationale: The SAFE-T (Suicide Assessment Five-Step Evaluation and
Triage) protocol assesses: Ideation, Substance use, Purpose, Anxiety, Agitation, Sleep,
Hopelessness, Previous attempts, and Treatment/Stressors. Highest risk combines: specific
plan + access to means + intent + timeframe (imminence). Option C represents this lethal
combination requiring immediate psychiatric emergency intervention, 1:1 observation, and
means restriction. Distractor A lacks intent. Distractor B lacks plan specificity and means.
Distractor D represents ideation without imminent risk.
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Q7: A patient with persistent depressive disorder (dysthymia) states, "I've felt this way for so
long, I don't even remember what normal feels like." Which therapeutic response by the nurse
demonstrates empathy and validation?
A. "At least you don't have the severe ups and downs like bipolar patients."
B. "You should focus on the positive things in your life."
C. "It sounds like this chronic low mood has become your baseline, and that must be
exhausting." [CORRECT]
D. "Have you tried exercising more? That always helps with depression."
Correct Answer: C Rationale: This response uses therapeutic communication—specifically
empathy, validation, and reflection. It acknowledges the patient's subjective experience
without minimizing, comparing, or offering false reassurance. Dysthymia lasts ≥2 years (1 year
in children/adolescents) with symptoms present most days, making it truly feel like a "new
normal." Distractor A minimizes by comparison. Distractor B uses nontherapeutic
communication (false reassurance, "should" statements). Distractor D offers unwanted advice
and oversimplifies treatment.
Q8: The nurse is caring for a patient in the depressive phase of bipolar disorder. The patient
refuses to get out of bed, stating, "What's the point?" Which nursing intervention is most
appropriate?
A. Leave the patient alone until they feel ready to engage.
B. Insist the patient get up and participate in activities for their own good.
C. Sit with the patient and offer choices for small, achievable activities. [CORRECT]
D. Tell the patient that staying in bed will only make depression worse.
Correct Answer: C Rationale: Behavioral activation is evidence-based for depression, but
must be introduced gradually without overwhelming the patient. Offering choices promotes
autonomy and self-efficacy ("Would you like to sit by the window or take a 5-minute walk?").
This approach is patient-centered and respects the patient's energy level while encouraging
movement. Distractor A reinforces isolation and inactivity. Distractor B is authoritarian and
may increase resistance. Distractor D uses therapeutic nihilism (blaming the patient) and is
nontherapeutic.
Q9: A patient taking valproic acid (Depakote) for bipolar disorder reports nausea and "unusual
bruising." Which laboratory test is the nurse's priority?
NUR 256 Concepts of Mental Health Nursing
ACTUAL EXAM QUESTIONS AND ANSWERS
2026/2027 | Exam 3 | Aligned with NCLEX-RN 2026 &
DSM-5-TR | Pass Guaranteed - A+ Graded
Section 1: Mood Disorders & Suicide (Questions 1-20)
Q1: The nurse is assessing a patient admitted with major depressive disorder. Which statement
by the patient indicates the highest immediate risk for a suicide attempt?
A. "I've been feeling really tired and hopeless for months."
B. "I gave my favorite books to my roommate because I won't need them anymore."
[CORRECT]
C. "My family would be better off if I just disappeared."
D. "I think about dying sometimes, but I'd never actually do it."
Correct Answer: B Rationale: Giving away prized possessions is a behavioral warning sign
that indicates the patient has moved from ideation to planning and preparation. This action
suggests imminent risk and requires immediate safety intervention. Distractor A indicates
hopelessness (a risk factor) but not imminent planning. Distractor C is passive suicidal ideation
without a plan. Distractor D indicates ideation without intent, which is lower risk than active
planning behaviors. The nurse must implement 1:1 observation and remove means of self-harm
immediately.
Q2: The nurse is caring for a patient experiencing acute mania. Which intervention should the
nurse prioritize to maintain patient safety?
A. Encourage the patient to join group therapy to socialize.
B. Provide high-calorie finger foods the patient can eat while pacing. [CORRECT]
C. Limit fluid intake to prevent bathroom accidents.
D. Keep the lights bright to help the patient stay oriented.
Correct Answer: B Rationale: Patients in acute mania experience high psychomotor activity
and may not sit still to eat, putting them at risk for dehydration and malnutrition. Providing
,2
high-calorie finger foods addresses this physiological need (Maslow's hierarchy) while
accommodating their activity level. Distractor A is incorrect because the patient is too agitated
for group therapy; individual, low-stimulus care is needed. Distractor C is dangerous—
hydration is critical given increased metabolic demands. Distractor D is incorrect because bright
lights can overstimulate; a calm, low-stimulus environment with reduced lighting is preferred.
Q3: A patient with bipolar I disorder has been prescribed lithium carbonate. Which laboratory
value requires immediate notification to the provider?
A. Sodium level of 138 mEq/L
B. Lithium level of 1.8 mEq/L [CORRECT]
C. White blood cell count of 8,500/mm³
D. Thyroid stimulating hormone (TSH) of 3.5 mIU/L
Correct Answer: B Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L (some
sources extend to 1.5 mEq/L for acute mania). A level of 1.8 mEq/L indicates toxicity and
requires immediate intervention—hold the next dose, increase hydration, and notify the provider.
Early signs of toxicity include coarse tremor, ataxia, and confusion; severe toxicity can cause
seizures and coma. Distractor A is within normal range (135-145). Distractor C is normal WBC.
Distractor D is within normal TSH range (0.4-4.0), though lithium can cause hypothyroidism
over time—this value does not require immediate action.
Q4: [Select ALL that apply] The nurse is teaching a patient beginning phenelzine (Nardil), an
MAOI. Which foods should the patient avoid? (Select all that apply)
A. Aged cheddar cheese [CORRECT]
B. Smoked salmon [CORRECT]
C. Soy sauce [CORRECT]
D. Fresh mozzarella cheese
E. Red wine [CORRECT]
Correct Answers: A, B, C, E Rationale: MAOIs inhibit the breakdown of tyramine, which can
cause hypertensive crisis (sudden severe hypertension, headache, potential stroke). High-
tyramine foods to avoid include: aged/fermented cheeses (A), processed/smoked meats (B),
fermented soy products (C), red wine (E), draft beer, and yeast extracts. Fresh mozzarella (D)
is safe because it is not aged. The patient should carry a list of prohibited foods and a medical
alert card. Symptoms of hypertensive crisis require immediate emergency care.
,3
Q5: A patient with major depressive disorder is started on sertraline (Zoloft). The patient asks
when they will start feeling better. What is the nurse's best response?
A. "You should notice significant improvement within 2-3 days."
B. "Most patients begin to notice some improvement in 2-4 weeks, with full effect in 6-8 weeks."
[CORRECT]
C. "This medication works immediately, but you need to believe it will help."
D. "Depression medications usually take 3-6 months to start working."
Correct Answer: B Rationale: SSRIs like sertraline require 2-4 weeks for initial therapeutic
effects (improved sleep, appetite, energy) and 4-6 weeks (up to 8 weeks) for full
antidepressant effect (improved mood, interest). This delayed onset is due to adaptive
neurochemical changes (downregulation of 5-HT1A autoreceptors), not immediate reuptake
inhibition. Distractor A is incorrect—2-3 days is too soon (though some anxiety reduction may
occur earlier). Distractor C suggests a placebo effect, which undermines the therapeutic
relationship. Distractor D overestimates the delay, potentially causing the patient to discontinue
prematurely.
Q6: The nurse is assessing suicide risk using the SAFE-T protocol. Which finding indicates the
patient is at highest risk and requires immediate intervention?
A. The patient has a plan but no access to means.
B. The patient has intent but no specific plan.
C. The patient has a specific plan, access to means, and states they will act tonight.
[CORRECT]
D. The patient has ideation with no plan or intent.
Correct Answer: C Rationale: The SAFE-T (Suicide Assessment Five-Step Evaluation and
Triage) protocol assesses: Ideation, Substance use, Purpose, Anxiety, Agitation, Sleep,
Hopelessness, Previous attempts, and Treatment/Stressors. Highest risk combines: specific
plan + access to means + intent + timeframe (imminence). Option C represents this lethal
combination requiring immediate psychiatric emergency intervention, 1:1 observation, and
means restriction. Distractor A lacks intent. Distractor B lacks plan specificity and means.
Distractor D represents ideation without imminent risk.
, 4
Q7: A patient with persistent depressive disorder (dysthymia) states, "I've felt this way for so
long, I don't even remember what normal feels like." Which therapeutic response by the nurse
demonstrates empathy and validation?
A. "At least you don't have the severe ups and downs like bipolar patients."
B. "You should focus on the positive things in your life."
C. "It sounds like this chronic low mood has become your baseline, and that must be
exhausting." [CORRECT]
D. "Have you tried exercising more? That always helps with depression."
Correct Answer: C Rationale: This response uses therapeutic communication—specifically
empathy, validation, and reflection. It acknowledges the patient's subjective experience
without minimizing, comparing, or offering false reassurance. Dysthymia lasts ≥2 years (1 year
in children/adolescents) with symptoms present most days, making it truly feel like a "new
normal." Distractor A minimizes by comparison. Distractor B uses nontherapeutic
communication (false reassurance, "should" statements). Distractor D offers unwanted advice
and oversimplifies treatment.
Q8: The nurse is caring for a patient in the depressive phase of bipolar disorder. The patient
refuses to get out of bed, stating, "What's the point?" Which nursing intervention is most
appropriate?
A. Leave the patient alone until they feel ready to engage.
B. Insist the patient get up and participate in activities for their own good.
C. Sit with the patient and offer choices for small, achievable activities. [CORRECT]
D. Tell the patient that staying in bed will only make depression worse.
Correct Answer: C Rationale: Behavioral activation is evidence-based for depression, but
must be introduced gradually without overwhelming the patient. Offering choices promotes
autonomy and self-efficacy ("Would you like to sit by the window or take a 5-minute walk?").
This approach is patient-centered and respects the patient's energy level while encouraging
movement. Distractor A reinforces isolation and inactivity. Distractor B is authoritarian and
may increase resistance. Distractor D uses therapeutic nihilism (blaming the patient) and is
nontherapeutic.
Q9: A patient taking valproic acid (Depakote) for bipolar disorder reports nausea and "unusual
bruising." Which laboratory test is the nurse's priority?
