NUR 253 EXAM 2 MENTAL HEALTH
GALEN COLLEGE OF NURSING
2026/2027| NEWLY RELEASED
50 Questions with Detailed Rationales | A+ Graded
Exam Information:
• Time Allowed: 75 minutes
• Number of Items: 50
• Points per Item: 2
• Total Possible Points: 100
•
Academic Integrity Statement: Academic dishonesty includes copying from or
collaborating with another student, selling or illegally obtaining exam materials, discussing
the test with students who have not yet taken it, and using unauthorized materials. By signing
above, I affirm that I will complete this examination independently and in accordance with
the Galen College of Nursing academic integrity policy.
SECTION 1: MOOD DISORDERS (Questions 1-10)
1. A 22-year-old college student is admitted to the psychiatric unit with major
depressive disorder. During the admission assessment, the nurse asks, "Have you been
thinking about hurting yourself?" The patient responds, "Sometimes I think it would be
easier if I just didn't wake up tomorrow." What is the priority nursing action?
A. Tell the patient that suicide is a permanent solution to temporary problems
B. Ask the patient if they have a specific plan for ending their life
C. Immediately place the patient on one-to-one observation
D. Administer a PRN sedative to help the patient sleep
Correct Answer: B. [CORRECT]
Verified Explanation: This response indicates passive suicidal ideation (wish to not
wake up), but the nurse must determine if there is active suicidal intent with a specific
plan. Assessing for a plan (means, method, opportunity) is essential to determine
,immediate risk level and appropriate interventions. Without a specific plan, one-to-one
observation may not be immediately necessary, but further assessment is critical.
Distractor Analysis:
• A: Minimizes patient's feelings; non-therapeutic and doesn't assess risk
• C: Premature without assessing if patient has active plan/intent; resource -intensive
if not needed
• D: Sedation doesn't address suicide risk; inappropriate priority
Galen Tip: "Suicide assessment = Ideation → Plan → Intent → Means. Always assess
the plan."
2. A patient with bipolar I disorder is admitted during an acute manic episode. The
patient is pacing, speaking rapidly, and attempting to organize a "business meeting"
with other patients at 2:00 AM. Which nursing intervention is most appropriate?
A. Participate in the patient's business meeting to build therapeutic rapport
B. Firmly tell the patient to return to bed immediately
C. Redirect the patient to a quiet activity while maintaining consistent limits
D. Administer lithium carbonate STAT to rapidly sedate the patient
Correct Answer: C. [CORRECT]
Verified Explanation: During acute mania, nursing interventions focus on reducing
environmental stimulation, maintaining safety, and setting consistent limits without
power struggles. Redirection to a quiet, low-stimulus activity (walking with nurse,
listening to calming music) respects the patient's need for movement while establishing
boundaries. Lithium takes days to weeks for therapeutic effect, not immediate sedation.
Distractor Analysis:
• A: Reinforces delusional/grandiose thinking; inappropriate
• B: Authoritarian approach likely to escalate agitation in manic patient
• D: Lithium has delayed onset (5-7 days); not for immediate sedation; serum levels
must be therapeutic not toxic
Galen Tip: "Mania = Low stimulation, Clear limits, Redirection not Confrontation"
,3. A patient prescribed sertraline (Zoloft) for major depressive disorder asks the nurse,
"How long before I start feeling better?" Which response by the nurse is most accurate?
A. "You should feel dramatically better within 3-4 days."
B. "Most patients notice some improvement in 2-4 weeks, with full effect in 6-8
weeks."
C. "If you don't feel better in 2 weeks, we'll need to change medications."
D. "Antidepressants work immediately, so you should feel better right away."
Correct Answer: B. [CORRECT]
Verified Explanation: SSRIs (selective serotonin reuptake inhibitors) like sertraline
require 2-4 weeks for initial therapeutic response and 6-8 weeks for full
antidepressant effect. This delayed onset is due to downstream neuroadaptive changes
(receptor sensitization), not immediate serotonin increase. Setting realistic expectations
improves medication adherence.
Distractor Analysis:
• A: 3-4 days is too soon; may notice side effects but not therapeutic effect
• C: 2 weeks is insufficient trial; premature medication change
• D: Misinformation; antidepressants do not work immediately
Galen Tip: "SSRIs = 2 weeks to start working, 6-8 weeks for full effect, Patience
required"
4. A patient taking lithium carbonate for bipolar disorder has a serum lithium level of 2.2
mEq/L (therapeutic range 0.6-1.2 mEq/L). Which finding requires immediate
intervention?
A. Mild hand tremor
B. Severe diarrhea and vomiting with ataxia
C. Increased thirst and urination
D. Fine hand tremor with mild nausea
Correct Answer: B. [CORRECT]
Verified Explanation: Lithium toxicity levels:
• Mild (1.5-2.0 mEq/L): Tremor, nausea, diarrhea, thirst, polyuria
, • Moderate-Severe (>2.0 mEq/L): Severe GI symptoms, ataxia, confusion,
seizures, coma, death
Level 2.2 mEq/L indicates severe toxicity. Severe diarrhea/vomiting causes dehydration,
which further impairs lithium excretion (kidney compensates by reabsorbing lithium).
Ataxia indicates CNS involvement. Immediate: Hold lithium, aggressive hydration,
possible hemodialysis if severe.
Distractor Analysis:
• A, C, D: Expected side effects at therapeutic levels or mild toxicity; not emergent
Galen Tip: "Lithium >2.0 = Toxic territory, Ataxia means trouble, Stop the drug,
Hydrate fast"
5. A patient with major depressive disorder tells the nurse, "I'm worthless. Nothing I do
matters. I can't even get out of bed." Which therapeutic response by the nurse
demonstrates validation?
A. "You should try harder to be positive. Other people have it worse."
B. "It sounds like you're feeling overwhelmed and hopeless right now."
C. "Why can't you get out of bed? You need to try to exercise."
D. "I know exactly how you feel. I was depressed once too."
Correct Answer: B. [CORRECT]
Verified Explanation: Validation acknowledges the patient's emotional experience
without judgment, minimization, or advice-giving. This response uses reflection to
identify the underlying emotions (overwhelmed, hopeless) while communicating
understanding. It builds therapeutic alliance and encourages further expression.
Distractor Analysis:
• A: Minimization and invalidation; toxic positivity
• C: Confrontational "why" question; premature advice without understanding
• D: Inappropriate self-disclosure; shifts focus from patient to nurse; "exactly" is
presumptuous
Galen Tip: "Validation = Name the feeling, No fixing, No comparing, Just
understanding"
GALEN COLLEGE OF NURSING
2026/2027| NEWLY RELEASED
50 Questions with Detailed Rationales | A+ Graded
Exam Information:
• Time Allowed: 75 minutes
• Number of Items: 50
• Points per Item: 2
• Total Possible Points: 100
•
Academic Integrity Statement: Academic dishonesty includes copying from or
collaborating with another student, selling or illegally obtaining exam materials, discussing
the test with students who have not yet taken it, and using unauthorized materials. By signing
above, I affirm that I will complete this examination independently and in accordance with
the Galen College of Nursing academic integrity policy.
SECTION 1: MOOD DISORDERS (Questions 1-10)
1. A 22-year-old college student is admitted to the psychiatric unit with major
depressive disorder. During the admission assessment, the nurse asks, "Have you been
thinking about hurting yourself?" The patient responds, "Sometimes I think it would be
easier if I just didn't wake up tomorrow." What is the priority nursing action?
A. Tell the patient that suicide is a permanent solution to temporary problems
B. Ask the patient if they have a specific plan for ending their life
C. Immediately place the patient on one-to-one observation
D. Administer a PRN sedative to help the patient sleep
Correct Answer: B. [CORRECT]
Verified Explanation: This response indicates passive suicidal ideation (wish to not
wake up), but the nurse must determine if there is active suicidal intent with a specific
plan. Assessing for a plan (means, method, opportunity) is essential to determine
,immediate risk level and appropriate interventions. Without a specific plan, one-to-one
observation may not be immediately necessary, but further assessment is critical.
Distractor Analysis:
• A: Minimizes patient's feelings; non-therapeutic and doesn't assess risk
• C: Premature without assessing if patient has active plan/intent; resource -intensive
if not needed
• D: Sedation doesn't address suicide risk; inappropriate priority
Galen Tip: "Suicide assessment = Ideation → Plan → Intent → Means. Always assess
the plan."
2. A patient with bipolar I disorder is admitted during an acute manic episode. The
patient is pacing, speaking rapidly, and attempting to organize a "business meeting"
with other patients at 2:00 AM. Which nursing intervention is most appropriate?
A. Participate in the patient's business meeting to build therapeutic rapport
B. Firmly tell the patient to return to bed immediately
C. Redirect the patient to a quiet activity while maintaining consistent limits
D. Administer lithium carbonate STAT to rapidly sedate the patient
Correct Answer: C. [CORRECT]
Verified Explanation: During acute mania, nursing interventions focus on reducing
environmental stimulation, maintaining safety, and setting consistent limits without
power struggles. Redirection to a quiet, low-stimulus activity (walking with nurse,
listening to calming music) respects the patient's need for movement while establishing
boundaries. Lithium takes days to weeks for therapeutic effect, not immediate sedation.
Distractor Analysis:
• A: Reinforces delusional/grandiose thinking; inappropriate
• B: Authoritarian approach likely to escalate agitation in manic patient
• D: Lithium has delayed onset (5-7 days); not for immediate sedation; serum levels
must be therapeutic not toxic
Galen Tip: "Mania = Low stimulation, Clear limits, Redirection not Confrontation"
,3. A patient prescribed sertraline (Zoloft) for major depressive disorder asks the nurse,
"How long before I start feeling better?" Which response by the nurse is most accurate?
A. "You should feel dramatically better within 3-4 days."
B. "Most patients notice some improvement in 2-4 weeks, with full effect in 6-8
weeks."
C. "If you don't feel better in 2 weeks, we'll need to change medications."
D. "Antidepressants work immediately, so you should feel better right away."
Correct Answer: B. [CORRECT]
Verified Explanation: SSRIs (selective serotonin reuptake inhibitors) like sertraline
require 2-4 weeks for initial therapeutic response and 6-8 weeks for full
antidepressant effect. This delayed onset is due to downstream neuroadaptive changes
(receptor sensitization), not immediate serotonin increase. Setting realistic expectations
improves medication adherence.
Distractor Analysis:
• A: 3-4 days is too soon; may notice side effects but not therapeutic effect
• C: 2 weeks is insufficient trial; premature medication change
• D: Misinformation; antidepressants do not work immediately
Galen Tip: "SSRIs = 2 weeks to start working, 6-8 weeks for full effect, Patience
required"
4. A patient taking lithium carbonate for bipolar disorder has a serum lithium level of 2.2
mEq/L (therapeutic range 0.6-1.2 mEq/L). Which finding requires immediate
intervention?
A. Mild hand tremor
B. Severe diarrhea and vomiting with ataxia
C. Increased thirst and urination
D. Fine hand tremor with mild nausea
Correct Answer: B. [CORRECT]
Verified Explanation: Lithium toxicity levels:
• Mild (1.5-2.0 mEq/L): Tremor, nausea, diarrhea, thirst, polyuria
, • Moderate-Severe (>2.0 mEq/L): Severe GI symptoms, ataxia, confusion,
seizures, coma, death
Level 2.2 mEq/L indicates severe toxicity. Severe diarrhea/vomiting causes dehydration,
which further impairs lithium excretion (kidney compensates by reabsorbing lithium).
Ataxia indicates CNS involvement. Immediate: Hold lithium, aggressive hydration,
possible hemodialysis if severe.
Distractor Analysis:
• A, C, D: Expected side effects at therapeutic levels or mild toxicity; not emergent
Galen Tip: "Lithium >2.0 = Toxic territory, Ataxia means trouble, Stop the drug,
Hydrate fast"
5. A patient with major depressive disorder tells the nurse, "I'm worthless. Nothing I do
matters. I can't even get out of bed." Which therapeutic response by the nurse
demonstrates validation?
A. "You should try harder to be positive. Other people have it worse."
B. "It sounds like you're feeling overwhelmed and hopeless right now."
C. "Why can't you get out of bed? You need to try to exercise."
D. "I know exactly how you feel. I was depressed once too."
Correct Answer: B. [CORRECT]
Verified Explanation: Validation acknowledges the patient's emotional experience
without judgment, minimization, or advice-giving. This response uses reflection to
identify the underlying emotions (overwhelmed, hopeless) while communicating
understanding. It builds therapeutic alliance and encourages further expression.
Distractor Analysis:
• A: Minimization and invalidation; toxic positivity
• C: Confrontational "why" question; premature advice without understanding
• D: Inappropriate self-disclosure; shifts focus from patient to nurse; "exactly" is
presumptuous
Galen Tip: "Validation = Name the feeling, No fixing, No comparing, Just
understanding"
