NUR 253 EXAM 3 MENTAL HEALTH
GALEN COLLEGE OF NURSING
2026/2027 | NEWLY RELEASED
50 Questions with Detailed Rationales | A+ Graded
50 | Time Allowed: 75 minutes | Points per Question: 2 | Total Points: 100
Instructions: Select the best answer for each question. This comprehensive practice
exam reflects the actual NUR 253 Exam 3 blueprint for the 2026/2027 academic year at
Galen College of Nursing. Questions are organized by unit with progressive difficulty
(Questions 1-20 foundational, 21-35 application, 36-50 critical thinking/prioritization).
Detailed rationales are provided for every question to enhance learning and retention.
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==============================
UNIT 1: MOOD DISORDERS (Questions 1-12)
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==============================
Q1. A patient diagnosed with major depressive disorder tells the nurse, "I don't see any
point in going on. My family would be better off without me." Which is the nurse's most
therapeutic response?
A. "Your family loves you and would be devastated if anything happened to you."
B. "You have so much to live for. Let's think about your positive qualities."
C. "Are you thinking about hurting yourself right now?"
D. "Everyone feels this way sometimes. Things will get better soon."
,Correct Answer: C. [CORRECT]
Rationale: When a patient makes statements suggesting hopelessness or potential self-
harm, the nurse's priority is direct suicide risk assessment. Asking directly about
suicidal ideation does not plant the idea but rather validates the patient's pain and
opens essential dialogue for safety planning. This follows Peplau's therapeutic
relationship principles of authenticity and focusing on the patient's immediate needs.
Option A offers false reassurance and minimizes the patient's feelings. Option B
attempts to problem-solve before assessing safety, violating the priority of care
hierarchy. Option D minimizes the patient's experience and provides false reassurance,
which is non-therapeutic and potentially dangerous.
Galen Tip: When in doubt, assess for suicide. Direct questioning is always appropriate
and may be life-saving.
Q2. A patient with bipolar disorder is in the manic phase and has been sleeping 2 hours
per night for the past week. Which nursing intervention is the priority?
A. Encourage the patient to attend all group therapy sessions
B. Administer prescribed mood stabilizer and monitor for sedation
C. Provide high-protein, high-calorie finger foods frequently
D. Set firm limits on inappropriate behavior toward other patients
Correct Answer: B. [CORRECT]
Rationale: Physiologic needs take priority per Maslow's hierarchy. Severe sleep
deprivation in mania can lead to exhaustion, cardiovascular collapse, and psychotic
decompensation. Administering mood stabilizers (lithium, valproate, or atypical
antipsychotics) addresses the underlying neurochemical dysregulation causing the
mania. While Option C addresses nutrition (also important in mania where patients
forget to eat), sleep restoration is more immediately critical. Option A is inappropriate as
the patient cannot process group therapy in this state. Option D addresses behavioral
issues but is secondary to physiologic stabilization.
Galen Tip: In acute mania: Sleep > Nutrition > Safety > Psychotherapy. Always prioritize
physiologic needs first.
,Q3. A patient taking phenelzine (Nardil) for depression asks if they can have pizza for
dinner. Which is the nurse's best response?
A. "Yes, but only one slice."
B. "No, aged cheeses and processed meats can cause a dangerous reaction with your
medication."
C. "Only if you take your medication right after eating."
D. "Yes, but avoid drinking soda with your meal."
Correct Answer: B. [CORRECT]
Rationale: Phenelzine is an MAOI (monoamine oxidase inhibitor) that prevents
breakdown of tyramine, a substance found in aged cheeses, processed meats,
fermented foods, and some beverages. Tyramine accumulation can precipitate
hypertensive crisis (severe headache, stiff neck, sweating, elevated BP, potential
stroke). The nurse must provide clear dietary education and restrictions. Options A, C,
and D all allow consumption of dangerous food combinations and demonstrate
inadequate knowledge of MAOI dietary restrictions, potentially placing the patient at
risk for medical emergency.
Galen Tip: MAOI diet = No Aged, Fermented, or Pickled foods. Remember "MAOI =
NO": No aged cheese, No wine, No processed meats.
Q4. A patient with postpartum depression tells the nurse, "I feel like such a failure. I can't
even bond with my own baby." Which response demonstrates therapeutic
communication?
A. "You're not a failure. Many new mothers feel this way."
B. "Have you tried singing to the baby? That might help you bond."
C. "Tell me more about what you're feeling when you look at your baby."
D. "You should be grateful you have a healthy baby. Some women can't have children."
Correct Answer: C. [CORRECT]
Rationale: Exploring and clarifying the patient's specific feelings demonstrates
empathy and encourages deeper expression without judgment, consistent with Peplau's
therapeutic communication principles. This response validates the patient's experience
while gathering assessment data. Option A, while attempting to be supportive,
, minimizes the patient's feelings by generalizing. Option B offers premature advice
before fully understanding the problem. Option D is judgmental and guilt-inducing,
creating a barrier to the therapeutic relationship and potentially worsening depressive
symptoms.
Galen Tip: Therapeutic communication techniques: Exploring, Restating, Reflecting,
Clarifying. Avoid: Advising, Minimizing, Judging, False reassurance.
Q5. A patient with seasonal affective disorder asks the nurse how light therapy works.
Which explanation is most accurate?
A. "It increases melatonin production to help you sleep better."
B. "It suppresses melatonin and increases serotonin to improve your mood."
C. "It works like a tanning bed to increase vitamin D absorption."
D. "It stimulates your pituitary gland to produce more hormones."
Correct Answer: B. [CORRECT]
Rationale: Seasonal affective disorder (SAD) is linked to reduced sunlight exposure in
winter months, leading to increased melatonin (causing lethargy) and decreased
serotonin (causing depression). Light therapy (10,000 lux for 30 minutes daily)
suppresses melatonin secretion and is thought to increase serotonin transmission,
similar to antidepressant mechanisms. Option A is incorrect because increasing
melatonin would worsen symptoms. Option C confuses light therapy with UV exposure;
therapeutic light filters out UV radiation. Option D describes an inaccurate mechanism;
the hypothalamus and pineal gland are primarily affected, not the pituitary.
Galen Tip: SAD pathophysiology: Less light = More melatonin (sleepy) + Less serotonin
(sad). Light therapy reverses both effects.
Q6. [SATA] A patient is starting lithium carbonate for bipolar disorder. Which
instructions should the nurse include? (Select all that apply.)
A. "Maintain adequate fluid intake of 2-3 liters daily."
B. "Avoid excessive caffeine and alcohol consumption."
C. "Take your medication on an empty stomach for better absorption."
D. "Report muscle weakness, severe tremor, or confusion immediately."
E. "You will need regular blood tests to check lithium levels."
GALEN COLLEGE OF NURSING
2026/2027 | NEWLY RELEASED
50 Questions with Detailed Rationales | A+ Graded
50 | Time Allowed: 75 minutes | Points per Question: 2 | Total Points: 100
Instructions: Select the best answer for each question. This comprehensive practice
exam reflects the actual NUR 253 Exam 3 blueprint for the 2026/2027 academic year at
Galen College of Nursing. Questions are organized by unit with progressive difficulty
(Questions 1-20 foundational, 21-35 application, 36-50 critical thinking/prioritization).
Detailed rationales are provided for every question to enhance learning and retention.
=================================================
==============================
UNIT 1: MOOD DISORDERS (Questions 1-12)
=================================================
==============================
Q1. A patient diagnosed with major depressive disorder tells the nurse, "I don't see any
point in going on. My family would be better off without me." Which is the nurse's most
therapeutic response?
A. "Your family loves you and would be devastated if anything happened to you."
B. "You have so much to live for. Let's think about your positive qualities."
C. "Are you thinking about hurting yourself right now?"
D. "Everyone feels this way sometimes. Things will get better soon."
,Correct Answer: C. [CORRECT]
Rationale: When a patient makes statements suggesting hopelessness or potential self-
harm, the nurse's priority is direct suicide risk assessment. Asking directly about
suicidal ideation does not plant the idea but rather validates the patient's pain and
opens essential dialogue for safety planning. This follows Peplau's therapeutic
relationship principles of authenticity and focusing on the patient's immediate needs.
Option A offers false reassurance and minimizes the patient's feelings. Option B
attempts to problem-solve before assessing safety, violating the priority of care
hierarchy. Option D minimizes the patient's experience and provides false reassurance,
which is non-therapeutic and potentially dangerous.
Galen Tip: When in doubt, assess for suicide. Direct questioning is always appropriate
and may be life-saving.
Q2. A patient with bipolar disorder is in the manic phase and has been sleeping 2 hours
per night for the past week. Which nursing intervention is the priority?
A. Encourage the patient to attend all group therapy sessions
B. Administer prescribed mood stabilizer and monitor for sedation
C. Provide high-protein, high-calorie finger foods frequently
D. Set firm limits on inappropriate behavior toward other patients
Correct Answer: B. [CORRECT]
Rationale: Physiologic needs take priority per Maslow's hierarchy. Severe sleep
deprivation in mania can lead to exhaustion, cardiovascular collapse, and psychotic
decompensation. Administering mood stabilizers (lithium, valproate, or atypical
antipsychotics) addresses the underlying neurochemical dysregulation causing the
mania. While Option C addresses nutrition (also important in mania where patients
forget to eat), sleep restoration is more immediately critical. Option A is inappropriate as
the patient cannot process group therapy in this state. Option D addresses behavioral
issues but is secondary to physiologic stabilization.
Galen Tip: In acute mania: Sleep > Nutrition > Safety > Psychotherapy. Always prioritize
physiologic needs first.
,Q3. A patient taking phenelzine (Nardil) for depression asks if they can have pizza for
dinner. Which is the nurse's best response?
A. "Yes, but only one slice."
B. "No, aged cheeses and processed meats can cause a dangerous reaction with your
medication."
C. "Only if you take your medication right after eating."
D. "Yes, but avoid drinking soda with your meal."
Correct Answer: B. [CORRECT]
Rationale: Phenelzine is an MAOI (monoamine oxidase inhibitor) that prevents
breakdown of tyramine, a substance found in aged cheeses, processed meats,
fermented foods, and some beverages. Tyramine accumulation can precipitate
hypertensive crisis (severe headache, stiff neck, sweating, elevated BP, potential
stroke). The nurse must provide clear dietary education and restrictions. Options A, C,
and D all allow consumption of dangerous food combinations and demonstrate
inadequate knowledge of MAOI dietary restrictions, potentially placing the patient at
risk for medical emergency.
Galen Tip: MAOI diet = No Aged, Fermented, or Pickled foods. Remember "MAOI =
NO": No aged cheese, No wine, No processed meats.
Q4. A patient with postpartum depression tells the nurse, "I feel like such a failure. I can't
even bond with my own baby." Which response demonstrates therapeutic
communication?
A. "You're not a failure. Many new mothers feel this way."
B. "Have you tried singing to the baby? That might help you bond."
C. "Tell me more about what you're feeling when you look at your baby."
D. "You should be grateful you have a healthy baby. Some women can't have children."
Correct Answer: C. [CORRECT]
Rationale: Exploring and clarifying the patient's specific feelings demonstrates
empathy and encourages deeper expression without judgment, consistent with Peplau's
therapeutic communication principles. This response validates the patient's experience
while gathering assessment data. Option A, while attempting to be supportive,
, minimizes the patient's feelings by generalizing. Option B offers premature advice
before fully understanding the problem. Option D is judgmental and guilt-inducing,
creating a barrier to the therapeutic relationship and potentially worsening depressive
symptoms.
Galen Tip: Therapeutic communication techniques: Exploring, Restating, Reflecting,
Clarifying. Avoid: Advising, Minimizing, Judging, False reassurance.
Q5. A patient with seasonal affective disorder asks the nurse how light therapy works.
Which explanation is most accurate?
A. "It increases melatonin production to help you sleep better."
B. "It suppresses melatonin and increases serotonin to improve your mood."
C. "It works like a tanning bed to increase vitamin D absorption."
D. "It stimulates your pituitary gland to produce more hormones."
Correct Answer: B. [CORRECT]
Rationale: Seasonal affective disorder (SAD) is linked to reduced sunlight exposure in
winter months, leading to increased melatonin (causing lethargy) and decreased
serotonin (causing depression). Light therapy (10,000 lux for 30 minutes daily)
suppresses melatonin secretion and is thought to increase serotonin transmission,
similar to antidepressant mechanisms. Option A is incorrect because increasing
melatonin would worsen symptoms. Option C confuses light therapy with UV exposure;
therapeutic light filters out UV radiation. Option D describes an inaccurate mechanism;
the hypothalamus and pineal gland are primarily affected, not the pituitary.
Galen Tip: SAD pathophysiology: Less light = More melatonin (sleepy) + Less serotonin
(sad). Light therapy reverses both effects.
Q6. [SATA] A patient is starting lithium carbonate for bipolar disorder. Which
instructions should the nurse include? (Select all that apply.)
A. "Maintain adequate fluid intake of 2-3 liters daily."
B. "Avoid excessive caffeine and alcohol consumption."
C. "Take your medication on an empty stomach for better absorption."
D. "Report muscle weakness, severe tremor, or confusion immediately."
E. "You will need regular blood tests to check lithium levels."
