UR 256/ NUR256 Exam 2 –
N
Concepts of Mental Health Nursing
Guide ACTUAL EXAM 2026/2027 |
Mental Health Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
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PART A – MULTIPLE CHOICE (Q1‑60)
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* *Q1 (Eating disorders – anorexia nervosa medical complication):** A 17-year-old female with
anorexia nervosa (BMI 15.2) is admitted for medical stabilization. On day 3 of refeeding, she
develops confusion, peripheral edema, and a serum phosphate of 1.8 mg/dL. What is the
nurse's priority action?
A. Increase caloric intake to 2,000 kcal/day to promote weight gain
B. Administer IV thiamine 100 mg before starting dextrose-containing fluids
C. Slow the rate of refeeding and supplement with IV phosphate
D. Obtain a 12-lead ECG and place the patient on telemetry monitoring
**[CORRECT]** C
*Rationale: Per DSM-5-TR and ASPEN guidelines, refeeding syndrome is characterized by
hypophosphatemia, hypokalemia, and hypomagnesemia due to rapid shifts in metabolism
during refeeding; slowing refeeding and phosphate supplementation is the priority intervention.
Option A is incorrect because increasing calories accelerates the syndrome—caloric
advancement should start at 1,000–1,200 kcal/day and increase gradually. Clinical pearl for
Galen students: Always check phosphate, potassium, and magnesium levels before and during
the first week of refeeding in anorexia nervosa.*
* *Q2 (Anxiety disorders – panic disorder):** A 28-year-old patient reports recurrent, unexpected
panic attacks with palpitations, chest pain, and fear of dying. For the past 3 months, she has
, voided grocery stores, malls, and public transportation. Which DSM-5-TR diagnosis is most
a
appropriate?
A. Panic disorder without agoraphobia
B. Panic disorder with agoraphobia
C. Generalized anxiety disorder
D. Social anxiety disorder
**[CORRECT]** B
*Rationale: DSM-5-TR Criterion B for panic disorder requires persistent concern about
additional attacks or maladaptive behavior changes for ≥1 month; this patient meets criteria for
panic disorder with agoraphobia due to fear/avoidance of situations where escape might be
difficult. Option A is incorrect because the patient clearly exhibits agoraphobic avoidance.
Clinical pearl: Agoraphobia often develops secondary to panic disorder as patients begin
avoiding places where panic attacks occurred.*
* *Q3 (OCD – first-line treatment):** A 22-year-old nursing student is diagnosed with OCD after
spending 4 hours daily performing hand-washing rituals due to contamination fears. What is the
first-line evidence-based treatment?
A. Benzodiazepines (e.g., clonazepam) for rapid symptom relief
B. Exposure and response prevention (ERP) plus SSRI (e.g., sertraline)
C. Antipsychotic monotherapy (e.g., risperidone)
D. Supportive psychotherapy alone
**[CORRECT]** B
*Rationale: APA practice guidelines (2026 update) and NICE guidelines recommend ERP as the
first-line psychotherapy for OCD, with SSRIs (sertraline, fluoxetine, or fluvoxamine) as first-line
pharmacotherapy; combined treatment yields the best outcomes. Option A is incorrect because
benzodiazepines are not indicated for OCD and carry dependence risk. Clinical pearl: ERP
involves exposing the patient to feared stimuli while preventing the compulsive response—this
is the gold standard behavioral intervention.*
* *Q4 (PTSD – diagnostic criteria):** A 35-year-old veteran presents 8 months after deployment.
He reports intrusive memories, nightmares, hypervigilance, exaggerated startle response, and
persistent negative beliefs about himself and the world. He avoids reminders of combat and
reports feeling emotionally numb. How many DSM-5-TR symptom clusters does he meet?
A. 2 clusters
B. 3 clusters
C. 4 clusters
D. 5 clusters
**[CORRECT]** C
*Rationale: DSM-5-TR PTSD requires exposure to Criterion A trauma plus symptoms from 4
clusters: intrusion (memories, nightmares), avoidance (avoiding reminders), negative alterations
in cognition/mood (negative beliefs, emotional numbness), and marked alterations in
arousal/reactivity (hypervigilance, startle). Option B is incorrect because the patient meets all 4
required clusters, not 3. Clinical pearl: PTSD requires symptoms persisting >1 month; if <1
month, consider acute stress disorder.*
,* *Q5 (PTSD – first-line pharmacotherapy):** Which medication is considered first-line
pharmacotherapy for PTSD per the 2026 APA guidelines?
A. Prazosin for nightmare reduction
B. Sertraline (SSRI)
C. Risperidone (second-generation antipsychotic)
D. Propranolol (beta-blocker)
**[CORRECT]** B
*Rationale: APA PTSD guidelines (2026 update) and VA/DoD clinical practice guidelines list
SSRIs (sertraline, paroxetine) and SNRIs (venlafaxine) as first-line pharmacotherapy for PTSD;
these are the only FDA-approved medications for PTSD. Option A is incorrect because prazosin
may help nightmares but is not first-line monotherapy. Clinical pearl: SSRIs/SNRIs target the
broad symptom clusters of PTSD, not just one symptom.*
* *Q6 (Dissociative disorders – DID):** A 29-year-old patient with dissociative identity disorder
(DID) is admitted to the inpatient unit. During shift change, the nurse notes the patient is
speaking with a childlike voice, using a different name, and appears confused about the date
and location. What is the priority nursing intervention?
A. Confront the patient about 'faking' the behavior
B. Orient the patient to person, place, and time using a calm, nonjudgmental approach
C. Administer PRN lorazepam to suppress the dissociative episode
D. Place the patient in seclusion for safety
**[CORRECT]** B
*Rationale: Per ISSTD (International Society for the Study of Trauma and Dissociation)
guidelines, grounding and orientation techniques are the primary nursing interventions for
dissociative episodes in DID; confrontation increases distress and shame. Option A is incorrect
because DID is a validated DSM-5-TR diagnosis, and confrontation damages therapeutic
alliance. Clinical pearl: Grounding techniques (5-4-3-2-1 senses technique, holding ice, tactile
objects) help patients return to the present.*
* *Q7 (Somatic symptom disorder):** A 42-year-old patient has been seen by 8 specialists over 2
years for persistent gastrointestinal symptoms. Extensive workup is negative. The patient is
preoccupied with the symptoms, spends hours researching illnesses online, and reports that the
symptoms are 'ruining my life.' Which diagnosis best fits?
A. Illness anxiety disorder
B. Somatic symptom disorder
C. Conversion disorder
D. Factitious disorder
**[CORRECT]** B
*Rationale: DSM-5-TR criteria for somatic symptom disorder require one or more distressing
somatic symptoms plus excessive thoughts, feelings, or behaviors related to the symptoms
(e.g., high anxiety, disproportionate time/energy devoted); this patient meets criteria. Option A is
incorrect because illness anxiety disorder focuses on fear of having a serious illness with
, inimal somatic symptoms. Clinical pearl: The key differentiator is that somatic symptom
m
disorder involves actual, distressing physical symptoms with excessive psychological reaction.*
* *Q8 (Bulimia nervosa – electrolyte imbalance):** A 19-year-old college student with bulimia
nervosa (purging type) presents to the ER with weakness, fatigue, and muscle cramps.
Laboratory studies reveal potassium 2.8 mEq/L, chloride 88 mEq/L, and bicarbonate 32 mEq/L.
What acid-base disturbance is most likely present?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
**[CORRECT]** B
*Rationale: Self-induced vomiting leads to loss of gastric acid (HCl), resulting in hypochloremic
metabolic alkalosis; hypokalemia occurs due to renal potassium wasting and intracellular shifts.
Option A is incorrect because laxative abuse causes metabolic acidosis, not vomiting. Clinical
pearl: The 'classic triad' in bulimia nervosa from vomiting is hypokalemia, hypochloremia, and
metabolic alkalosis—always monitor these electrolytes.*
* *Q9 (Binge-eating disorder – treatment):** A 34-year-old patient with binge-eating disorder
(BED) has failed behavioral weight-loss programs. What is the first-line pharmacological
treatment for BED?
A. Methylphenidate (stimulant)
B. Lisdexamfetamine (Vyvanse)
C. Fluoxetine (SSRI)
D. Topiramate (anticonvulsant)
**[CORRECT]** B
*Rationale: Lisdexamfetamine is FDA-approved specifically for moderate-to-severe BED in
adults and is considered first-line pharmacotherapy per APA guidelines; it reduces binge days
and binge episodes. Option C is incorrect because while SSRIs may help, lisdexamfetamine
has stronger evidence and FDA approval for BED. Clinical pearl: Lisdexamfetamine is also used
for ADHD; screen for substance use disorder and cardiovascular risk before prescribing.*
* *Q10 (Borderline personality disorder – nursing intervention):** A 24-year-old patient with
borderline personality disorder (BPD) becomes angry when the nurse is 5 minutes late for a
scheduled meeting, stating, 'You don't care about me at all.' What is the best nursing response?
A. 'I'm sorry I'm late. Let's discuss your feelings about this situation.'
B. 'Your reaction is disproportionate to the situation. You need to calm down.'
C. 'I had an emergency with another patient. You need to be more understanding.'
D. Ignore the outburst and proceed with the scheduled activity
**[CORRECT]** A
*Rationale: Per Linehan's DBT principles and APA guidelines, validation combined with setting
limits is the core nursing intervention for BPD; acknowledging the patient's feelings while
maintaining boundaries models healthy interpersonal skills. Option B is incorrect because
invalidating the patient's emotional response (a core feature of BPD etiology) escalates distress
N
Concepts of Mental Health Nursing
Guide ACTUAL EXAM 2026/2027 |
Mental Health Nursing Guide |
Verified Q&A | Pass Guaranteed - A+
Graded
=======================================================================
=
========
PART A – MULTIPLE CHOICE (Q1‑60)
========================================================================
========
* *Q1 (Eating disorders – anorexia nervosa medical complication):** A 17-year-old female with
anorexia nervosa (BMI 15.2) is admitted for medical stabilization. On day 3 of refeeding, she
develops confusion, peripheral edema, and a serum phosphate of 1.8 mg/dL. What is the
nurse's priority action?
A. Increase caloric intake to 2,000 kcal/day to promote weight gain
B. Administer IV thiamine 100 mg before starting dextrose-containing fluids
C. Slow the rate of refeeding and supplement with IV phosphate
D. Obtain a 12-lead ECG and place the patient on telemetry monitoring
**[CORRECT]** C
*Rationale: Per DSM-5-TR and ASPEN guidelines, refeeding syndrome is characterized by
hypophosphatemia, hypokalemia, and hypomagnesemia due to rapid shifts in metabolism
during refeeding; slowing refeeding and phosphate supplementation is the priority intervention.
Option A is incorrect because increasing calories accelerates the syndrome—caloric
advancement should start at 1,000–1,200 kcal/day and increase gradually. Clinical pearl for
Galen students: Always check phosphate, potassium, and magnesium levels before and during
the first week of refeeding in anorexia nervosa.*
* *Q2 (Anxiety disorders – panic disorder):** A 28-year-old patient reports recurrent, unexpected
panic attacks with palpitations, chest pain, and fear of dying. For the past 3 months, she has
, voided grocery stores, malls, and public transportation. Which DSM-5-TR diagnosis is most
a
appropriate?
A. Panic disorder without agoraphobia
B. Panic disorder with agoraphobia
C. Generalized anxiety disorder
D. Social anxiety disorder
**[CORRECT]** B
*Rationale: DSM-5-TR Criterion B for panic disorder requires persistent concern about
additional attacks or maladaptive behavior changes for ≥1 month; this patient meets criteria for
panic disorder with agoraphobia due to fear/avoidance of situations where escape might be
difficult. Option A is incorrect because the patient clearly exhibits agoraphobic avoidance.
Clinical pearl: Agoraphobia often develops secondary to panic disorder as patients begin
avoiding places where panic attacks occurred.*
* *Q3 (OCD – first-line treatment):** A 22-year-old nursing student is diagnosed with OCD after
spending 4 hours daily performing hand-washing rituals due to contamination fears. What is the
first-line evidence-based treatment?
A. Benzodiazepines (e.g., clonazepam) for rapid symptom relief
B. Exposure and response prevention (ERP) plus SSRI (e.g., sertraline)
C. Antipsychotic monotherapy (e.g., risperidone)
D. Supportive psychotherapy alone
**[CORRECT]** B
*Rationale: APA practice guidelines (2026 update) and NICE guidelines recommend ERP as the
first-line psychotherapy for OCD, with SSRIs (sertraline, fluoxetine, or fluvoxamine) as first-line
pharmacotherapy; combined treatment yields the best outcomes. Option A is incorrect because
benzodiazepines are not indicated for OCD and carry dependence risk. Clinical pearl: ERP
involves exposing the patient to feared stimuli while preventing the compulsive response—this
is the gold standard behavioral intervention.*
* *Q4 (PTSD – diagnostic criteria):** A 35-year-old veteran presents 8 months after deployment.
He reports intrusive memories, nightmares, hypervigilance, exaggerated startle response, and
persistent negative beliefs about himself and the world. He avoids reminders of combat and
reports feeling emotionally numb. How many DSM-5-TR symptom clusters does he meet?
A. 2 clusters
B. 3 clusters
C. 4 clusters
D. 5 clusters
**[CORRECT]** C
*Rationale: DSM-5-TR PTSD requires exposure to Criterion A trauma plus symptoms from 4
clusters: intrusion (memories, nightmares), avoidance (avoiding reminders), negative alterations
in cognition/mood (negative beliefs, emotional numbness), and marked alterations in
arousal/reactivity (hypervigilance, startle). Option B is incorrect because the patient meets all 4
required clusters, not 3. Clinical pearl: PTSD requires symptoms persisting >1 month; if <1
month, consider acute stress disorder.*
,* *Q5 (PTSD – first-line pharmacotherapy):** Which medication is considered first-line
pharmacotherapy for PTSD per the 2026 APA guidelines?
A. Prazosin for nightmare reduction
B. Sertraline (SSRI)
C. Risperidone (second-generation antipsychotic)
D. Propranolol (beta-blocker)
**[CORRECT]** B
*Rationale: APA PTSD guidelines (2026 update) and VA/DoD clinical practice guidelines list
SSRIs (sertraline, paroxetine) and SNRIs (venlafaxine) as first-line pharmacotherapy for PTSD;
these are the only FDA-approved medications for PTSD. Option A is incorrect because prazosin
may help nightmares but is not first-line monotherapy. Clinical pearl: SSRIs/SNRIs target the
broad symptom clusters of PTSD, not just one symptom.*
* *Q6 (Dissociative disorders – DID):** A 29-year-old patient with dissociative identity disorder
(DID) is admitted to the inpatient unit. During shift change, the nurse notes the patient is
speaking with a childlike voice, using a different name, and appears confused about the date
and location. What is the priority nursing intervention?
A. Confront the patient about 'faking' the behavior
B. Orient the patient to person, place, and time using a calm, nonjudgmental approach
C. Administer PRN lorazepam to suppress the dissociative episode
D. Place the patient in seclusion for safety
**[CORRECT]** B
*Rationale: Per ISSTD (International Society for the Study of Trauma and Dissociation)
guidelines, grounding and orientation techniques are the primary nursing interventions for
dissociative episodes in DID; confrontation increases distress and shame. Option A is incorrect
because DID is a validated DSM-5-TR diagnosis, and confrontation damages therapeutic
alliance. Clinical pearl: Grounding techniques (5-4-3-2-1 senses technique, holding ice, tactile
objects) help patients return to the present.*
* *Q7 (Somatic symptom disorder):** A 42-year-old patient has been seen by 8 specialists over 2
years for persistent gastrointestinal symptoms. Extensive workup is negative. The patient is
preoccupied with the symptoms, spends hours researching illnesses online, and reports that the
symptoms are 'ruining my life.' Which diagnosis best fits?
A. Illness anxiety disorder
B. Somatic symptom disorder
C. Conversion disorder
D. Factitious disorder
**[CORRECT]** B
*Rationale: DSM-5-TR criteria for somatic symptom disorder require one or more distressing
somatic symptoms plus excessive thoughts, feelings, or behaviors related to the symptoms
(e.g., high anxiety, disproportionate time/energy devoted); this patient meets criteria. Option A is
incorrect because illness anxiety disorder focuses on fear of having a serious illness with
, inimal somatic symptoms. Clinical pearl: The key differentiator is that somatic symptom
m
disorder involves actual, distressing physical symptoms with excessive psychological reaction.*
* *Q8 (Bulimia nervosa – electrolyte imbalance):** A 19-year-old college student with bulimia
nervosa (purging type) presents to the ER with weakness, fatigue, and muscle cramps.
Laboratory studies reveal potassium 2.8 mEq/L, chloride 88 mEq/L, and bicarbonate 32 mEq/L.
What acid-base disturbance is most likely present?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
**[CORRECT]** B
*Rationale: Self-induced vomiting leads to loss of gastric acid (HCl), resulting in hypochloremic
metabolic alkalosis; hypokalemia occurs due to renal potassium wasting and intracellular shifts.
Option A is incorrect because laxative abuse causes metabolic acidosis, not vomiting. Clinical
pearl: The 'classic triad' in bulimia nervosa from vomiting is hypokalemia, hypochloremia, and
metabolic alkalosis—always monitor these electrolytes.*
* *Q9 (Binge-eating disorder – treatment):** A 34-year-old patient with binge-eating disorder
(BED) has failed behavioral weight-loss programs. What is the first-line pharmacological
treatment for BED?
A. Methylphenidate (stimulant)
B. Lisdexamfetamine (Vyvanse)
C. Fluoxetine (SSRI)
D. Topiramate (anticonvulsant)
**[CORRECT]** B
*Rationale: Lisdexamfetamine is FDA-approved specifically for moderate-to-severe BED in
adults and is considered first-line pharmacotherapy per APA guidelines; it reduces binge days
and binge episodes. Option C is incorrect because while SSRIs may help, lisdexamfetamine
has stronger evidence and FDA approval for BED. Clinical pearl: Lisdexamfetamine is also used
for ADHD; screen for substance use disorder and cardiovascular risk before prescribing.*
* *Q10 (Borderline personality disorder – nursing intervention):** A 24-year-old patient with
borderline personality disorder (BPD) becomes angry when the nurse is 5 minutes late for a
scheduled meeting, stating, 'You don't care about me at all.' What is the best nursing response?
A. 'I'm sorry I'm late. Let's discuss your feelings about this situation.'
B. 'Your reaction is disproportionate to the situation. You need to calm down.'
C. 'I had an emergency with another patient. You need to be more understanding.'
D. Ignore the outburst and proceed with the scheduled activity
**[CORRECT]** A
*Rationale: Per Linehan's DBT principles and APA guidelines, validation combined with setting
limits is the core nursing intervention for BPD; acknowledging the patient's feelings while
maintaining boundaries models healthy interpersonal skills. Option B is incorrect because
invalidating the patient's emotional response (a core feature of BPD etiology) escalates distress
