NUR 208 Mental Health Exam 3 Practice
Test Bank – 450 Questions |Verified Answers with
Detailed Rationales Latest 2026/2027 Update |
Fortis College
SECTION 1: MOOD DISORDERS (Questions 1-85)
1. A patient with major depressive disorder (MDD) reports hopelessness,
anhedonia, and early morning awakening. Which is the most appropriate first-line
antidepressant?
A) Fluoxetine (SSRI)
B) Amitriptyline (TCA)
C) Phenelzine (MAOI)
D) Bupropion (NDRI)
Answer: A
Rationale: SSRIs are first-line for MDD due to safety and tolerability. TCAs have
cardiotoxicity; MAOIs require dietary restrictions; bupropion may worsen anxiety.
2. A patient with bipolar I disorder in acute mania has grandiosity, pressured
speech, and aggression. Which medication is most appropriate?
A) Lithium
B) Fluoxetine
C) Clozapine
D) Buspirone
Answer: A
Rationale: Lithium is first-line for acute mania and maintenance. Antidepressants
can worsen mania. Clozapine is for refractory schizophrenia.
1
,3. A patient on sertraline for 6 weeks reports no improvement. What is the next
step?
A) Increase dose
B) Switch to another SSRI
C) Add lithium
D) Start ECT
Answer: A
Rationale: Full effect may take 8 weeks. Dose increase is appropriate before
switching. Lithium augmentation is for treatment-resistant cases.
4. A patient on lithium requires regular monitoring of which labs?
A) Lithium level, BUN, creatinine, TSH
B) LFTs only
C) CBC only
D) Cardiac enzymes
Answer: A
Rationale: Lithium toxicity risk requires level monitoring; it can cause nephrogenic
DI and hypothyroidism.
5. A suicidal patient with a plan to overdose needs what initial nursing action?
A) 1:1 constant observation, remove means
B) No-suicide contract
C) PRN lorazepam
D) Discharge to family
2
,Answer: A
Rationale: Safety priority: constant observation and environmental safety.
Contracts are unreliable.
6. A patient with MDD and psychotic features is prescribed which medication
combination?
A) Antidepressant + antipsychotic
B) Antidepressant alone
C) Antipsychotic alone
D) Mood stabilizer alone
Answer: A
Rationale: Psychotic depression requires both an antidepressant and an
antipsychotic (e.g., olanzapine-fluoxetine combination).
7. A patient with bipolar disorder on lithium has a level of 1.8 mEq/L and reports
nausea, ataxia, and coarse tremor. What is the priority?
A) Hold lithium, assess renal function, consider dialysis
B) Increase lithium dose
C) Add haloperidol
D) Discharge home
Answer: A
Rationale: Lithium toxicity (level >1.5) with neurologic symptoms requires
immediate holding of lithium and medical evaluation.
8. A patient with MDD is started on phenelzine (MAOI). Which dietary instruction
is most important?
3
, A) Avoid aged cheese, red wine, cured meats
B) Increase tyramine-rich foods
C) Avoid grapefruit juice
D) Limit caffeine
Answer: A
Rationale: Tyramine-rich foods can cause hypertensive crisis with MAOIs.
Grapefruit affects other meds.
9. A patient with seasonal affective disorder (SAD) is best treated with which first-
line intervention?
A) Fluoxetine
B) Bupropion XL
C) Light therapy (10,000 lux daily)
D) Electroconvulsive therapy
Answer: C
Rationale: Light therapy is first-line for SAD, often combined with bupropion or
SSRIs if severe.
10. A postpartum patient presents with depressed mood, excessive guilt, and
thoughts of harming her baby. What is the most likely diagnosis?
A) Adjustment disorder
B) Postpartum blues
C) Postpartum depression
D) Postpartum psychosis
Answer: D
4
Test Bank – 450 Questions |Verified Answers with
Detailed Rationales Latest 2026/2027 Update |
Fortis College
SECTION 1: MOOD DISORDERS (Questions 1-85)
1. A patient with major depressive disorder (MDD) reports hopelessness,
anhedonia, and early morning awakening. Which is the most appropriate first-line
antidepressant?
A) Fluoxetine (SSRI)
B) Amitriptyline (TCA)
C) Phenelzine (MAOI)
D) Bupropion (NDRI)
Answer: A
Rationale: SSRIs are first-line for MDD due to safety and tolerability. TCAs have
cardiotoxicity; MAOIs require dietary restrictions; bupropion may worsen anxiety.
2. A patient with bipolar I disorder in acute mania has grandiosity, pressured
speech, and aggression. Which medication is most appropriate?
A) Lithium
B) Fluoxetine
C) Clozapine
D) Buspirone
Answer: A
Rationale: Lithium is first-line for acute mania and maintenance. Antidepressants
can worsen mania. Clozapine is for refractory schizophrenia.
1
,3. A patient on sertraline for 6 weeks reports no improvement. What is the next
step?
A) Increase dose
B) Switch to another SSRI
C) Add lithium
D) Start ECT
Answer: A
Rationale: Full effect may take 8 weeks. Dose increase is appropriate before
switching. Lithium augmentation is for treatment-resistant cases.
4. A patient on lithium requires regular monitoring of which labs?
A) Lithium level, BUN, creatinine, TSH
B) LFTs only
C) CBC only
D) Cardiac enzymes
Answer: A
Rationale: Lithium toxicity risk requires level monitoring; it can cause nephrogenic
DI and hypothyroidism.
5. A suicidal patient with a plan to overdose needs what initial nursing action?
A) 1:1 constant observation, remove means
B) No-suicide contract
C) PRN lorazepam
D) Discharge to family
2
,Answer: A
Rationale: Safety priority: constant observation and environmental safety.
Contracts are unreliable.
6. A patient with MDD and psychotic features is prescribed which medication
combination?
A) Antidepressant + antipsychotic
B) Antidepressant alone
C) Antipsychotic alone
D) Mood stabilizer alone
Answer: A
Rationale: Psychotic depression requires both an antidepressant and an
antipsychotic (e.g., olanzapine-fluoxetine combination).
7. A patient with bipolar disorder on lithium has a level of 1.8 mEq/L and reports
nausea, ataxia, and coarse tremor. What is the priority?
A) Hold lithium, assess renal function, consider dialysis
B) Increase lithium dose
C) Add haloperidol
D) Discharge home
Answer: A
Rationale: Lithium toxicity (level >1.5) with neurologic symptoms requires
immediate holding of lithium and medical evaluation.
8. A patient with MDD is started on phenelzine (MAOI). Which dietary instruction
is most important?
3
, A) Avoid aged cheese, red wine, cured meats
B) Increase tyramine-rich foods
C) Avoid grapefruit juice
D) Limit caffeine
Answer: A
Rationale: Tyramine-rich foods can cause hypertensive crisis with MAOIs.
Grapefruit affects other meds.
9. A patient with seasonal affective disorder (SAD) is best treated with which first-
line intervention?
A) Fluoxetine
B) Bupropion XL
C) Light therapy (10,000 lux daily)
D) Electroconvulsive therapy
Answer: C
Rationale: Light therapy is first-line for SAD, often combined with bupropion or
SSRIs if severe.
10. A postpartum patient presents with depressed mood, excessive guilt, and
thoughts of harming her baby. What is the most likely diagnosis?
A) Adjustment disorder
B) Postpartum blues
C) Postpartum depression
D) Postpartum psychosis
Answer: D
4
