Galen NUR 253 Exam 3 – Mental Health (2026) Actual
Questions and Answers (PDF), Exams of Nursing
Section 1: Depressive Disorders (Questions 1-75)
1. A patient with major depressive disorder (MDD) states, "I feel so hopeless.
Nothing matters anymore. My family would be better off without me." What
is the nurse's priority response?
a) "You have so much to live for. Your family loves you."
b) "Are you having thoughts of hurting yourself?"
c) "It sounds like you are feeling very sad right now."
d) "Let's talk about what makes you feel hopeless."
Answer: b) "Are you having thoughts of hurting yourself?"
Rationale: The patient's statement contains themes of hopelessness and
perceived burdensomeness ("family would be better off without me"), which
are risk factors for suicide. The priority is to directly assess for suicidal
ideation, plan, and intent.
2. Which neurotransmitter imbalances are most associated with major
depressive disorder?
a) Increased dopamine and decreased GABA
b) Decreased serotonin, norepinephrine, and dopamine
c) Increased acetylcholine and decreased histamine
d) Decreased glutamate and increased substance P
Answer: b) Decreased serotonin, norepinephrine, and dopamine
Rationale: The monoamine hypothesis of depression suggests that a
deficiency in serotonin, norepinephrine, and/or dopamine contributes to
depressive symptoms. Many antidepressants work by increasing the
availability of these neurotransmitters.
3. A nurse is caring for a patient with severe depression who has been
prescribed a selective serotonin reuptake inhibitor (SSRI). The patient asks,
"How long will it take for this to work?" What is the nurse's best response?
,a) "You should feel the effects within 24-48 hours."
b) "It typically takes 4-6 weeks to feel the full therapeutic effect."
c) "Most people feel better after the first week."
d) "It works immediately for anxiety but takes longer for depression."
Answer: b) "It typically takes 4-6 weeks to feel the full therapeutic effect."
Rationale: SSRIs have a delayed onset of action. While some patients may
notice early improvements in sleep or anxiety, the full antidepressant effect
typically takes 4-6 weeks. Managing expectations is crucial for medication
adherence.
4. A patient with MDD has been prescribed phenelzine (Nardil), a
monoamine oxidase inhibitor (MAOI). Which dietary instruction is
essential?
a) "Increase your intake of aged cheeses and red wine."
b) "Avoid foods containing tyramine, such as aged cheese, smoked meats,
and tap beer."
c) "Consume a low-protein diet to prevent toxicity."
d) "Drink grapefruit juice daily to enhance absorption."
Answer: b) "Avoid foods containing tyramine, such as aged cheese, smoked
meats, and tap beer."
Rationale: MAOIs inhibit the breakdown of tyramine. Consumption of
tyramine-rich foods can lead to a hypertensive crisis (severe hypertension,
headache, nausea, potentially stroke). Patients must adhere to strict dietary
restrictions.
5. A patient with depression is started on fluoxetine (Prozac). Which side
effect should the nurse include in patient teaching as most common during
the initial weeks of therapy?
a) Sedation and weight gain
b) Hypertensive crisis
c) Nausea, headache, and insomnia
d) Dry mouth and urinary retention
Answer: c) Nausea, headache, and insomnia
Rationale: Common initial side effects of SSRIs include gastrointestinal upset
,(nausea), headache, insomnia or somnolence, and sexual dysfunction. These
often improve after the first few weeks.
6. (SATA) A nurse is assessing a patient for signs of major depressive
disorder. Which findings are consistent with the diagnosis? (Select all that
apply.)
a) Anhedonia (loss of interest in previously enjoyed activities)
b) Pressured speech and grandiosity
c) Psychomotor retardation or agitation
d) Hypersomnia or insomnia
e) Flight of ideas
Answer: a, c, d
Rationale: Core symptoms of MDD include depressed mood, anhedonia (a),
changes in psychomotor activity (c), and sleep disturbances (d). Pressured
speech (b), grandiosity (b), and flight of ideas (e) are characteristic of mania,
not depression.
7. A patient with depression is noted to be pacing, wringing hands, and
unable to sit still. The nurse documents this behavior as:
a) Psychomotor retardation
b) Akathisia
c) Psychomotor agitation
d) Tardive dyskinesia
Answer: c) Psychomotor agitation
Rationale: Psychomotor agitation is a symptom of depression characterized
by restlessness, pacing, hand-wringing, and an inability to sit still.
Psychomotor retardation is the opposite—slowed movements and speech.
8. A patient who has been taking sertraline (Zoloft) for 2 weeks reports
feeling "more anxious and jittery" than before starting the medication. What
is the nurse's best response?
a) "This is an allergic reaction. Stop taking the medication immediately."
b) "This is a common side effect that often improves within the first few
weeks."
, c) "Your dose is too high. I will contact the provider to reduce it."
d) "You should take the medication with food to prevent this."
Answer: b) "This is a common side effect that often improves within the first
few weeks."
Rationale: Initial activation (anxiety, jitteriness, insomnia) is a common side
effect of SSRIs, especially during the first 1-2 weeks. It typically subsides as
the body adjusts. Reassurance and encouragement to continue the
medication are important.
9. A patient with treatment-resistant depression is scheduled for
electroconvulsive therapy (ECT). The nurse explains to the patient that ECT
is effective because it:
a) Permanently alters personality structure
b) Induces a controlled seizure that modulates neurotransmitter systems
c) Causes localized brain lesions to reduce depressive symptoms
d) Uses magnetic fields to stimulate specific brain regions
Answer: b) Induces a controlled seizure that modulates neurotransmitter
systems
Rationale: ECT involves inducing a brief, controlled seizure under general
anesthesia. The therapeutic effect is thought to result from the seizure's
impact on neurochemistry, including increased release of monoamines and
neuroplasticity changes. It is highly effective for severe, treatment-resistant
depression.
10. A patient with MDD states, "I'm a failure. I can't do anything right."
Which nursing response is most therapeutic?
a) "That's not true. You are a valuable person."
b) "What evidence do you have that you are a failure?"
c) "It sounds like you are feeling very down on yourself. Let's look at what
you accomplished today."
d) "Try to think more positively about yourself."
Answer: c) "It sounds like you are feeling very down on yourself. Let's look at
what you accomplished today."
Rationale: This response validates the patient's feeling (reflective technique)
Questions and Answers (PDF), Exams of Nursing
Section 1: Depressive Disorders (Questions 1-75)
1. A patient with major depressive disorder (MDD) states, "I feel so hopeless.
Nothing matters anymore. My family would be better off without me." What
is the nurse's priority response?
a) "You have so much to live for. Your family loves you."
b) "Are you having thoughts of hurting yourself?"
c) "It sounds like you are feeling very sad right now."
d) "Let's talk about what makes you feel hopeless."
Answer: b) "Are you having thoughts of hurting yourself?"
Rationale: The patient's statement contains themes of hopelessness and
perceived burdensomeness ("family would be better off without me"), which
are risk factors for suicide. The priority is to directly assess for suicidal
ideation, plan, and intent.
2. Which neurotransmitter imbalances are most associated with major
depressive disorder?
a) Increased dopamine and decreased GABA
b) Decreased serotonin, norepinephrine, and dopamine
c) Increased acetylcholine and decreased histamine
d) Decreased glutamate and increased substance P
Answer: b) Decreased serotonin, norepinephrine, and dopamine
Rationale: The monoamine hypothesis of depression suggests that a
deficiency in serotonin, norepinephrine, and/or dopamine contributes to
depressive symptoms. Many antidepressants work by increasing the
availability of these neurotransmitters.
3. A nurse is caring for a patient with severe depression who has been
prescribed a selective serotonin reuptake inhibitor (SSRI). The patient asks,
"How long will it take for this to work?" What is the nurse's best response?
,a) "You should feel the effects within 24-48 hours."
b) "It typically takes 4-6 weeks to feel the full therapeutic effect."
c) "Most people feel better after the first week."
d) "It works immediately for anxiety but takes longer for depression."
Answer: b) "It typically takes 4-6 weeks to feel the full therapeutic effect."
Rationale: SSRIs have a delayed onset of action. While some patients may
notice early improvements in sleep or anxiety, the full antidepressant effect
typically takes 4-6 weeks. Managing expectations is crucial for medication
adherence.
4. A patient with MDD has been prescribed phenelzine (Nardil), a
monoamine oxidase inhibitor (MAOI). Which dietary instruction is
essential?
a) "Increase your intake of aged cheeses and red wine."
b) "Avoid foods containing tyramine, such as aged cheese, smoked meats,
and tap beer."
c) "Consume a low-protein diet to prevent toxicity."
d) "Drink grapefruit juice daily to enhance absorption."
Answer: b) "Avoid foods containing tyramine, such as aged cheese, smoked
meats, and tap beer."
Rationale: MAOIs inhibit the breakdown of tyramine. Consumption of
tyramine-rich foods can lead to a hypertensive crisis (severe hypertension,
headache, nausea, potentially stroke). Patients must adhere to strict dietary
restrictions.
5. A patient with depression is started on fluoxetine (Prozac). Which side
effect should the nurse include in patient teaching as most common during
the initial weeks of therapy?
a) Sedation and weight gain
b) Hypertensive crisis
c) Nausea, headache, and insomnia
d) Dry mouth and urinary retention
Answer: c) Nausea, headache, and insomnia
Rationale: Common initial side effects of SSRIs include gastrointestinal upset
,(nausea), headache, insomnia or somnolence, and sexual dysfunction. These
often improve after the first few weeks.
6. (SATA) A nurse is assessing a patient for signs of major depressive
disorder. Which findings are consistent with the diagnosis? (Select all that
apply.)
a) Anhedonia (loss of interest in previously enjoyed activities)
b) Pressured speech and grandiosity
c) Psychomotor retardation or agitation
d) Hypersomnia or insomnia
e) Flight of ideas
Answer: a, c, d
Rationale: Core symptoms of MDD include depressed mood, anhedonia (a),
changes in psychomotor activity (c), and sleep disturbances (d). Pressured
speech (b), grandiosity (b), and flight of ideas (e) are characteristic of mania,
not depression.
7. A patient with depression is noted to be pacing, wringing hands, and
unable to sit still. The nurse documents this behavior as:
a) Psychomotor retardation
b) Akathisia
c) Psychomotor agitation
d) Tardive dyskinesia
Answer: c) Psychomotor agitation
Rationale: Psychomotor agitation is a symptom of depression characterized
by restlessness, pacing, hand-wringing, and an inability to sit still.
Psychomotor retardation is the opposite—slowed movements and speech.
8. A patient who has been taking sertraline (Zoloft) for 2 weeks reports
feeling "more anxious and jittery" than before starting the medication. What
is the nurse's best response?
a) "This is an allergic reaction. Stop taking the medication immediately."
b) "This is a common side effect that often improves within the first few
weeks."
, c) "Your dose is too high. I will contact the provider to reduce it."
d) "You should take the medication with food to prevent this."
Answer: b) "This is a common side effect that often improves within the first
few weeks."
Rationale: Initial activation (anxiety, jitteriness, insomnia) is a common side
effect of SSRIs, especially during the first 1-2 weeks. It typically subsides as
the body adjusts. Reassurance and encouragement to continue the
medication are important.
9. A patient with treatment-resistant depression is scheduled for
electroconvulsive therapy (ECT). The nurse explains to the patient that ECT
is effective because it:
a) Permanently alters personality structure
b) Induces a controlled seizure that modulates neurotransmitter systems
c) Causes localized brain lesions to reduce depressive symptoms
d) Uses magnetic fields to stimulate specific brain regions
Answer: b) Induces a controlled seizure that modulates neurotransmitter
systems
Rationale: ECT involves inducing a brief, controlled seizure under general
anesthesia. The therapeutic effect is thought to result from the seizure's
impact on neurochemistry, including increased release of monoamines and
neuroplasticity changes. It is highly effective for severe, treatment-resistant
depression.
10. A patient with MDD states, "I'm a failure. I can't do anything right."
Which nursing response is most therapeutic?
a) "That's not true. You are a valuable person."
b) "What evidence do you have that you are a failure?"
c) "It sounds like you are feeling very down on yourself. Let's look at what
you accomplished today."
d) "Try to think more positively about yourself."
Answer: c) "It sounds like you are feeling very down on yourself. Let's look at
what you accomplished today."
Rationale: This response validates the patient's feeling (reflective technique)
