NUR 256 Mental Health Nursing – Exam 2 Study Guide | Stress, Anxiety, Mood Disorders, Psychosis, Crisis & Suicide Prevention | Practice Questions with Verified Answers | 2026–2027 Updated Edition

This comprehensive NUR 256 Exam 2 Study Guide contains practice questions with verified correct answers — fully updated for the 2026–2027 academic year. Perfect for nursing students (ADN, BSN, or pre‑licensure programs) preparing for their second mental health nursing examination. Content covers all major exam topics including: Stress & General Adaptation Syndrome (GAS) – alarm, resistance, exhaustion stages; physiological stress response (sympathetic nervous system, HPA axis, cortisol, epinephrine); acute vs. chronic stress effects on immune system (cytokines), cardiovascular health, and metabolism; distress vs. eustress; physical and psychological stressors Stress Management & Coping – coping strategies (health‑sustaining habits, life satisfaction, social support), relaxation techniques (biofeedback, deep breathing, guided imagery, progressive relaxation, meditation, mindfulness, physical exercise), cognitive reframing, journaling Defense Mechanisms – adaptive vs. maladaptive; altruism, compensation, conversion, denial, displacement, dissociation, identification, intellectualization, projection, rationalization, reaction formation, regression, repression, splitting, sublimation, suppression, undoing Anxiety Disorders – levels of anxiety (mild, moderate, severe, panic) with perceptual field changes and physical symptoms; nursing interventions for each level; Generalized Anxiety Disorder (GAD) – unrealistic worry 6 months, physical symptoms; panic disorder (unexpected/expected panic attacks, DSM‑5 criteria ≥4 symptoms); specific phobias (acrophobia, agoraphobia, claustrophobia, hematophobia); social anxiety disorder; separation anxiety disorder (children and adults); selective mutism; substance/medication‑induced anxiety; medical causes of anxiety (respiratory, cardiovascular, endocrine, neurological) Obsessive‑Compulsive Disorder (OCD) – obsessions (recurrent thoughts) and compulsions (ritualistic behaviors) to reduce anxiety; themes; pharmacotherapy (SSRIs – fluoxetine, fluvoxamine, paroxetine, sertraline); psychotherapy (exposure and response prevention, flooding); brain‑based therapies (Gamma Knife, DBS) Crisis Intervention – crisis definition (temporary state, 4–6 weeks duration); types of crisis (maturational, situational, adventitious); phases of crisis; goals of crisis intervention (return to pre‑crisis functioning, safety, anxiety reduction); nursing role (active/directive, assess suicide/homicide risk, identify precipitating event, mobilize support, develop coping skills, regular follow‑up); resources (crisis call lines, warm lines, Crisis Intervention Teams, Crisis Stabilization Facilities); Psychiatric Advance Directive Plan Suicide Prevention & Assessment – suicide definition; suicide ideation (SI) vs. attempt vs. completed suicide; risk factors (psychiatric disorders – MDD, substance use, psychosis, personality disorders, anxiety, eating disorders, trauma; cultural factors; warning signs (giving away possessions, talking about death, mood changes); protective factors; assessment of plan, means, timing; overt/covert statements; highest risk during admission first few days and staff rotations; constant one‑to‑one observation, remove harmful objects, observe medication swallowing; non‑suicidal self‑injury (NSSI) – cutting, burning, skin picking; interventions (wound care, therapeutic alliance, coping skills, CBT, DBT, SSRIs, second‑generation antipsychotics) Schizophrenia Spectrum Disorders – altered cognition/perception, impaired reality testing; phases (prodromal, acute, stabilization, maintenance/residual); positive symptoms (hallucinations – auditory most common, visual, olfactory, gustatory, tactile; delusions – persecutory, referential, grandiose, erotomanic, nihilistic, somatic, control; disorganized speech, bizarre behavior); negative symptoms (blunted affect, social withdrawal, anhedonia, alogia, apathy); cognitive symptoms (inattention, impaired memory, poor problem‑solving); affective symptoms (dysphoria, suicidality); first‑generation antipsychotics (haloperidol, chlorpromazine – dopamine antagonists, risk of extrapyramidal symptoms EPS – acute dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia, neuroleptic malignant syndrome NMS); second‑generation antipsychotics (clozapine, olanzapine, risperidone – serotonin/dopamine antagonists, metabolic syndrome, neutropenia with clozapine); anticholinergic toxicity; nursing interventions for hallucinations (ask content, decrease stimuli, do not negate but offer own perception) and delusions (do not debate, focus on feelings, build trust) Depressive Disorders – Major Depressive Disorder (symptoms for ≥2 weeks, anhedonia, vegetative signs – appetite/sleep changes, constipation, decreased libido; cognitive changes; phases: acute, continuation, maintenance); Persistent Depressive Disorder (PDD/dysthymia – ≥2 years in adults, 1 year in children); Disruptive Mood Dysregulation Disorder (DMDD – ages 6–18, severe irritability, tantrums ≥3 times/week in ≥2 settings); Premenstrual Dysphoric Disorder (PMDD – symptoms in last week before menses, resolve with onset); Substance/Medication‑Induced Depressive Disorder; screening tools (PHQ‑9, Geriatric Depression Scale); pharmacotherapy (SSRIs – fluoxetine, sertraline, paroxetine; SNRIs; TCAs – anticholinergic side effects; MAOIs – dietary tyramine restriction, hypertensive crisis); serotonin syndrome (causes, symptoms, interventions); electroconvulsive therapy (ECT); non‑pharmacological interventions (exercise, complex carbs, sleep, light therapy, acupuncture) Bipolar Disorders – bipolar I (at least one manic episode lasting 1 week, severe mood disturbance, expansiveness, irritability, extreme goal‑directed energy); bipolar II (at least one hypomanic episode + one major depressive episode); cyclothymic disorder (hypomania alternating with mild‑moderate depression for ≥2 years); rapid cycling (≥4 mood episodes in 12 months); hypomania symptoms (low‑level mania, euphoria, increased functioning, excessive energy); risk factors (genetics, neurotransmitters – norepinephrine, dopamine, serotonin, brain structure, hypothyroidism, inflammation); assessment (danger to self/others, need for hospitalization, medical status, understanding of illness); interventions for mania (firm calm communication, low‑stimulation environment, structured activities, monitor nutrition/hydration, encourage rest, hygiene, external control to prevent harm); mood stabilizers (lithium first‑line – narrow therapeutic range 0.5–1.5 mEq/L, monitor blood levels, kidney/thyroid function, toxicity signs – GI distress, tremor, confusion, ataxia; take with meals, maintain fluid/sodium intake; valproate/Depakote, lamotrigine/Lamictal, carbamazepine/Equetro); second‑generation antipsychotics (olanzapine, risperidone); ECT, rTMS, CBT, family‑focused therapy; patient/family teaching (chronic nature, long‑term treatment, signs of relapse, sleep hygiene, avoid alcohol/drugs/caffeine) Mental Status Examination (MSE) – insight, reality testing, judgment, cognition, support systems, coping resources, ADLs (food/fluid, sleep, hygiene, self‑care), medication adherence Neurobiology & Genetics – dopamine (excess in mania/schizophrenia, deficiency in depression/Parkinson’s), norepinephrine (excess in anxiety/schizophrenia/mania, deficiency in depression), serotonin (deficiency in depression), GABA (deficiency in anxiety), glutamate (excess in Alzheimer’s); brain structure abnormalities; prenatal stressors (infection, father 35); environmental factors (toxins, childhood abuse, poverty, foreign culture) All answers are verified and tested — ideal for exam 2 review, clinical rotation preparation, and NCLEX‑RN success.