MED SURG 201 POST MENTAL HEALTH 2 2026/2027 |
Complete Solutions | Updated Exam Guide | Pass
Guaranteed - A+ Graded
Section 1: Psychosocial Impact of Medical Illness (Q1-12)
1. A 68-year-old patient with end-stage renal disease on hemodialysis scores 12 on the
PHQ-9. Which modification to standard depression screening is most appropriate for
this patient population?
A. Use the PHQ-9 without modification, as somatic items are equally valid in CKD
B. Substitute the PHQ-9 with the GAD-7 exclusively for all CKD patients
C. Interpret somatic items (fatigue, sleep, appetite) cautiously, as they overlap with
uremic symptoms; prioritize cognitive/affective items
D. Discontinue screening, as depression is expected in dialysis patients and requires no
intervention
Correct format: C. Interpret somatic items (fatigue, sleep, appetite) cautiously, as they
overlap with uremic symptoms; prioritize cognitive/affective items [CORRECT]
Rationale: In CKD, uremia causes fatigue, sleep disturbance, and appetite changes that
mimic depression; the 2026/2027 AACN guidelines emphasize weighting
cognitive/affective PHQ-9 items to avoid false positives, while still recognizing that
depression in dialysis patients is underdiagnosed and treatable.
"Correct Answer: C"
2. A 45-year-old woman is admitted for acute appendicectomy. On post-op day 1, she
reports racing thoughts, trembling, and fear of dying. Vital signs are stable. She has no
psychiatric history. What is the nurse's priority action?
A. Administer lorazepam 2 mg IV immediately
B. Reassure the patient and document as normal post-operative anxiety
,C. Assess for hypoxia, pain, and medication side effects before attributing symptoms to
anxiety
D. Initiate a psychiatric consult for panic disorder
Correct format: C. Assess for hypoxia, pain, and medication side effects before
attributing symptoms to anxiety [CORRECT]
Rationale: New-onset anxiety in acute care requires medical rule-out first; hypoxia,
uncontrolled pain, or corticosteroid side effects can mimic anxiety, and premature
psychiatric attribution delays treatment of potentially life-threatening conditions.
"Correct Answer: C"
3. A 52-year-old man recently diagnosed with metastatic lung cancer expresses
hopelessness, difficulty concentrating, and social withdrawal. Symptoms began 3 weeks
after diagnosis. He denies suicidal ideation. Which diagnosis best fits this presentation?
A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Normal grief reaction requiring no intervention
D. Delirium due to malignancy
Correct format: B. Adjustment disorder with depressed mood [CORRECT]
Rationale: Symptoms within 3 months of an identifiable stressor, without meeting full
MDD criteria or suicidal ideation, align with adjustment disorder; while grief is normal,
functional impairment warrants intervention, and the clear temporal relationship to
diagnosis distinguishes this from MDD.
"Correct Answer: B"
4. Which statement accurately reflects the 2026/2027 updated recommendations for
using the GAD-7 in patients hospitalized with COPD exacerbations?
A. The GAD-7 should be avoided in COPD due to respiratory item overlap
B. The GAD-7 is validated for anxiety screening in COPD, but dyspnea-related items
require clinical correlation
C. Only the PHQ-9 should be used for both anxiety and depression in COPD patients
D. The GAD-7 is contraindicated in patients with oxygen saturation below 92%
,Correct format: B. The GAD-7 is validated for anxiety screening in COPD, but
dyspnea-related items require clinical correlation [CORRECT]
Rationale: The 2026/2027 updates confirm GAD-7 validity in COPD while noting that
somatic anxiety symptoms (shortness of breath, palpitations) overlap with respiratory
disease, requiring nurses to differentiate pathological anxiety from physiological
respiratory distress.
"Correct Answer: B"
5. An 82-year-old patient post-hip fracture repair becomes acutely confused, agitated,
and inattentive on post-op day 2. The nurse must differentiate delirium, dementia, and
depression. Which assessment finding most strongly supports delirium?
A. Gradual onset of memory impairment over 2 years
B. Fluctuating consciousness, inattention, and visual hallucinations with acute onset
C. Persistent low mood with intact attention and orientation
D. Stepwise decline in cognition with focal neurological deficits
Correct format: B. Fluctuating consciousness, inattention, and visual hallucinations with
acute onset [CORRECT]
Rationale: Delirium is characterized by acute onset, fluctuating course, inattention, and
altered consciousness; dementia has insidious onset with stable attention until late
stages, while depression features preserved orientation and attention with mood
disturbance.
"Correct Answer: B"
6. A patient with chronic heart failure reports "I feel useless since I can't do anything
anymore" and has lost interest in previously enjoyed activities for 3 weeks. Which
integrated care approach is most appropriate?
A. Focus solely on optimizing cardiac medications, as depression is secondary to heart
failure
B. Initiate collaborative care involving cardiology, nursing, and behavioral health for
simultaneous cardiac and depression management
C. Delay depression treatment until ejection fraction improves above 40%
D. Recommend increased diuretic dosing to improve energy levels
, Correct format: B. Initiate collaborative care involving cardiology, nursing, and behavioral
health for simultaneous cardiac and depression management [CORRECT]
Rationale: The collaborative care model improves outcomes in cardiac patients with
depression; untreated depression worsens heart failure self-management and mortality,
while simultaneous treatment addresses both conditions without waiting for cardiac
stabilization.
"Correct Answer: B"
7. A 35-year-old trauma patient in the ICU becomes withdrawn, refuses physical therapy,
and states "There's no point in getting better." Which psychosocial factor should the
nurse assess first?
A. Pre-injury personality disorder
B. Acute stress reaction and perceived loss of control
C. Malingering to avoid rehabilitation
D. Neuroleptic-induced akathisia
Correct format: B. Acute stress reaction and perceived loss of control [CORRECT]
Rationale: Trauma patients commonly experience acute stress reactions with perceived
loss of control and hopelessness; assessing this first aligns with patient-centered care,
whereas assuming personality disorder or malingering represents harmful attribution
bias.
"Correct Answer: B"
8. When administering the PHQ-9 to a patient with advanced CKD (eGFR <15 mL/min),
which item requires the most careful interpretation?
A. Item 1: Little interest or pleasure in doing things
B. Item 4: Feeling tired or having little energy
C. Item 9: Thoughts of hurting yourself or being better off dead
D. Item 6: Feeling bad about yourself or being a failure
Correct format: B. Item 4: Feeling tired or having little energy [CORRECT]
Rationale: Item 4 (fatigue) has the highest false-positive rate in CKD because uremia,
anemia, and dialysis itself cause profound fatigue; the 2026/2027 AACN standards
recommend evaluating this item in context of dialysis schedule and recent hemoglobin
levels.
Complete Solutions | Updated Exam Guide | Pass
Guaranteed - A+ Graded
Section 1: Psychosocial Impact of Medical Illness (Q1-12)
1. A 68-year-old patient with end-stage renal disease on hemodialysis scores 12 on the
PHQ-9. Which modification to standard depression screening is most appropriate for
this patient population?
A. Use the PHQ-9 without modification, as somatic items are equally valid in CKD
B. Substitute the PHQ-9 with the GAD-7 exclusively for all CKD patients
C. Interpret somatic items (fatigue, sleep, appetite) cautiously, as they overlap with
uremic symptoms; prioritize cognitive/affective items
D. Discontinue screening, as depression is expected in dialysis patients and requires no
intervention
Correct format: C. Interpret somatic items (fatigue, sleep, appetite) cautiously, as they
overlap with uremic symptoms; prioritize cognitive/affective items [CORRECT]
Rationale: In CKD, uremia causes fatigue, sleep disturbance, and appetite changes that
mimic depression; the 2026/2027 AACN guidelines emphasize weighting
cognitive/affective PHQ-9 items to avoid false positives, while still recognizing that
depression in dialysis patients is underdiagnosed and treatable.
"Correct Answer: C"
2. A 45-year-old woman is admitted for acute appendicectomy. On post-op day 1, she
reports racing thoughts, trembling, and fear of dying. Vital signs are stable. She has no
psychiatric history. What is the nurse's priority action?
A. Administer lorazepam 2 mg IV immediately
B. Reassure the patient and document as normal post-operative anxiety
,C. Assess for hypoxia, pain, and medication side effects before attributing symptoms to
anxiety
D. Initiate a psychiatric consult for panic disorder
Correct format: C. Assess for hypoxia, pain, and medication side effects before
attributing symptoms to anxiety [CORRECT]
Rationale: New-onset anxiety in acute care requires medical rule-out first; hypoxia,
uncontrolled pain, or corticosteroid side effects can mimic anxiety, and premature
psychiatric attribution delays treatment of potentially life-threatening conditions.
"Correct Answer: C"
3. A 52-year-old man recently diagnosed with metastatic lung cancer expresses
hopelessness, difficulty concentrating, and social withdrawal. Symptoms began 3 weeks
after diagnosis. He denies suicidal ideation. Which diagnosis best fits this presentation?
A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Normal grief reaction requiring no intervention
D. Delirium due to malignancy
Correct format: B. Adjustment disorder with depressed mood [CORRECT]
Rationale: Symptoms within 3 months of an identifiable stressor, without meeting full
MDD criteria or suicidal ideation, align with adjustment disorder; while grief is normal,
functional impairment warrants intervention, and the clear temporal relationship to
diagnosis distinguishes this from MDD.
"Correct Answer: B"
4. Which statement accurately reflects the 2026/2027 updated recommendations for
using the GAD-7 in patients hospitalized with COPD exacerbations?
A. The GAD-7 should be avoided in COPD due to respiratory item overlap
B. The GAD-7 is validated for anxiety screening in COPD, but dyspnea-related items
require clinical correlation
C. Only the PHQ-9 should be used for both anxiety and depression in COPD patients
D. The GAD-7 is contraindicated in patients with oxygen saturation below 92%
,Correct format: B. The GAD-7 is validated for anxiety screening in COPD, but
dyspnea-related items require clinical correlation [CORRECT]
Rationale: The 2026/2027 updates confirm GAD-7 validity in COPD while noting that
somatic anxiety symptoms (shortness of breath, palpitations) overlap with respiratory
disease, requiring nurses to differentiate pathological anxiety from physiological
respiratory distress.
"Correct Answer: B"
5. An 82-year-old patient post-hip fracture repair becomes acutely confused, agitated,
and inattentive on post-op day 2. The nurse must differentiate delirium, dementia, and
depression. Which assessment finding most strongly supports delirium?
A. Gradual onset of memory impairment over 2 years
B. Fluctuating consciousness, inattention, and visual hallucinations with acute onset
C. Persistent low mood with intact attention and orientation
D. Stepwise decline in cognition with focal neurological deficits
Correct format: B. Fluctuating consciousness, inattention, and visual hallucinations with
acute onset [CORRECT]
Rationale: Delirium is characterized by acute onset, fluctuating course, inattention, and
altered consciousness; dementia has insidious onset with stable attention until late
stages, while depression features preserved orientation and attention with mood
disturbance.
"Correct Answer: B"
6. A patient with chronic heart failure reports "I feel useless since I can't do anything
anymore" and has lost interest in previously enjoyed activities for 3 weeks. Which
integrated care approach is most appropriate?
A. Focus solely on optimizing cardiac medications, as depression is secondary to heart
failure
B. Initiate collaborative care involving cardiology, nursing, and behavioral health for
simultaneous cardiac and depression management
C. Delay depression treatment until ejection fraction improves above 40%
D. Recommend increased diuretic dosing to improve energy levels
, Correct format: B. Initiate collaborative care involving cardiology, nursing, and behavioral
health for simultaneous cardiac and depression management [CORRECT]
Rationale: The collaborative care model improves outcomes in cardiac patients with
depression; untreated depression worsens heart failure self-management and mortality,
while simultaneous treatment addresses both conditions without waiting for cardiac
stabilization.
"Correct Answer: B"
7. A 35-year-old trauma patient in the ICU becomes withdrawn, refuses physical therapy,
and states "There's no point in getting better." Which psychosocial factor should the
nurse assess first?
A. Pre-injury personality disorder
B. Acute stress reaction and perceived loss of control
C. Malingering to avoid rehabilitation
D. Neuroleptic-induced akathisia
Correct format: B. Acute stress reaction and perceived loss of control [CORRECT]
Rationale: Trauma patients commonly experience acute stress reactions with perceived
loss of control and hopelessness; assessing this first aligns with patient-centered care,
whereas assuming personality disorder or malingering represents harmful attribution
bias.
"Correct Answer: B"
8. When administering the PHQ-9 to a patient with advanced CKD (eGFR <15 mL/min),
which item requires the most careful interpretation?
A. Item 1: Little interest or pleasure in doing things
B. Item 4: Feeling tired or having little energy
C. Item 9: Thoughts of hurting yourself or being better off dead
D. Item 6: Feeling bad about yourself or being a failure
Correct format: B. Item 4: Feeling tired or having little energy [CORRECT]
Rationale: Item 4 (fatigue) has the highest false-positive rate in CKD because uremia,
anemia, and dialysis itself cause profound fatigue; the 2026/2027 AACN standards
recommend evaluating this item in context of dialysis schedule and recent hemoglobin
levels.
