NUR 256 MENTAL HEALTH EXAM 4 2026/2027
STUDY GUIDE | VERIFIED QUESTIONS AND
ANSWERS WITH DETAILED RATIONALES | GALEN
COLLEGE OF NURSING | LATEST UPDATED
VERSION
• This verified study guide contains 200 MCQs with detailed EXPERT RATIONALE
designed to prepare you for NUR 256 Mental Health Nursing Exam 4 at Galen
College of Nursing — latest 2026/2027 version.
• Use this material by reading each question carefully, selecting your answer before
checking the highlighted correct option and EXPERT RATIONALE below it for deep
conceptual understanding.
1. A nurse is caring for a client diagnosed with schizophrenia who is
experiencing auditory hallucinations. Which nursing intervention is most
appropriate?
A. Tell the client that the voices are not real and to ignore them
B. Isolate the client to reduce stimulation
C. Encourage the client to watch television to distract from the voices
D. Ask the client to describe the content of the hallucinations to assess for safety
E. Administer a PRN sedative immediately without assessment
D. Ask the client to describe the content of the hallucinations to assess for
safety
EXPERT RATIONALE: Assessing the content of hallucinations is a priority
because command hallucinations may instruct the client to harm themselves or
others. The nurse must determine safety risk before implementing other
interventions.
2. A client with bipolar disorder is in the manic phase. Which behavior would
the nurse most likely observe?
,A. Hypersomnia and social withdrawal
B. Flat affect and psychomotor retardation
C. Grandiosity, decreased need for sleep, and pressured speech
D. Persistent sadness and anhedonia
E. Weight gain and loss of interest in activities
C. Grandiosity, decreased need for sleep, and pressured speech
EXPERT RATIONALE: Classic manifestations of the manic phase include
grandiosity, decreased need for sleep, pressured speech, flight of ideas, and
increased goal-directed activity. These reflect the heightened CNS arousal
characteristic of mania.
3. Which medication is considered the gold standard for maintenance
treatment of bipolar disorder?
A. Haloperidol
B. Diazepam
C. Fluoxetine
D. Lithium carbonate
E. Risperidone
D. Lithium carbonate
EXPERT RATIONALE: Lithium is the first-line mood stabilizer for bipolar disorder
and helps prevent both manic and depressive episodes. Monitoring serum levels
(therapeutic range 0.6–1.2 mEq/L) is essential due to its narrow therapeutic index.
4. A nurse is monitoring a client on lithium therapy. Which finding requires
immediate intervention?
A. Mild thirst and increased urination
,B. Serum lithium level of 0.9 mEq/L
C. Fine hand tremor
D. Coarse tremor, confusion, and ataxia
E. Mild nausea after taking the medication
D. Coarse tremor, confusion, and ataxia
EXPERT RATIONALE: Coarse tremor, confusion, and ataxia are signs of lithium
toxicity, which occurs when serum levels exceed 1.5 mEq/L. This is a medical
emergency requiring immediate withholding of lithium and physician notification.
5. A client with major depressive disorder tells the nurse, "I just feel empty
and nothing matters anymore." Which is the priority nursing intervention?
A. Encourage the client to join group therapy immediately
B. Assess the client for suicidal ideation
C. Provide the client with a list of activities to improve mood
D. Tell the client that things will get better with time
E. Administer an antidepressant and reassess in two weeks
B. Assess the client for suicidal ideation
EXPERT RATIONALE: When a client expresses hopelessness and emptiness, the
priority is always safety. The nurse must assess for suicidal ideation, plan, and
means before any other intervention to determine the level of risk.
6. A client is prescribed fluoxetine (Prozac) for depression. The nurse should
teach the client that therapeutic effects typically occur within:
A. 24 to 48 hours
B. 3 to 5 days
C. 2 to 4 weeks
, D. 6 to 8 weeks
E. Several months
C. 2 to 4 weeks
EXPERT RATIONALE: SSRIs like fluoxetine typically take 2–4 weeks to produce
noticeable therapeutic effects, though full effects may take up to 6–8 weeks.
Teaching this timeline improves medication adherence.
7. Which statement by a client taking an MAOI (monoamine oxidase inhibitor)
indicates understanding of dietary restrictions?
A. "I can eat aged cheese as long as I limit it to small amounts."
B. "I will avoid tyramine-rich foods such as aged cheese and cured meats."
C. "I should eat high-protein foods to enhance the medication's effect."
D. "I can drink red wine occasionally without any problems."
E. "Dietary restrictions only apply during the first month of treatment."
B. "I will avoid tyramine-rich foods such as aged cheese and cured meats."
EXPERT RATIONALE: MAOIs inhibit the breakdown of tyramine, and consuming
tyramine-rich foods can cause a hypertensive crisis, which is life-threatening.
Clients must strictly avoid aged cheese, cured meats, fermented products, and
alcohol.
8. A nurse is assessing a client for serotonin syndrome. Which cluster of
symptoms would the nurse expect?
A. Bradycardia, hypothermia, and dry skin
B. Agitation, hyperthermia, diaphoresis, and muscle rigidity
C. Sedation, weight gain, and flat affect
D. Polyuria, polydipsia, and weight gain
STUDY GUIDE | VERIFIED QUESTIONS AND
ANSWERS WITH DETAILED RATIONALES | GALEN
COLLEGE OF NURSING | LATEST UPDATED
VERSION
• This verified study guide contains 200 MCQs with detailed EXPERT RATIONALE
designed to prepare you for NUR 256 Mental Health Nursing Exam 4 at Galen
College of Nursing — latest 2026/2027 version.
• Use this material by reading each question carefully, selecting your answer before
checking the highlighted correct option and EXPERT RATIONALE below it for deep
conceptual understanding.
1. A nurse is caring for a client diagnosed with schizophrenia who is
experiencing auditory hallucinations. Which nursing intervention is most
appropriate?
A. Tell the client that the voices are not real and to ignore them
B. Isolate the client to reduce stimulation
C. Encourage the client to watch television to distract from the voices
D. Ask the client to describe the content of the hallucinations to assess for safety
E. Administer a PRN sedative immediately without assessment
D. Ask the client to describe the content of the hallucinations to assess for
safety
EXPERT RATIONALE: Assessing the content of hallucinations is a priority
because command hallucinations may instruct the client to harm themselves or
others. The nurse must determine safety risk before implementing other
interventions.
2. A client with bipolar disorder is in the manic phase. Which behavior would
the nurse most likely observe?
,A. Hypersomnia and social withdrawal
B. Flat affect and psychomotor retardation
C. Grandiosity, decreased need for sleep, and pressured speech
D. Persistent sadness and anhedonia
E. Weight gain and loss of interest in activities
C. Grandiosity, decreased need for sleep, and pressured speech
EXPERT RATIONALE: Classic manifestations of the manic phase include
grandiosity, decreased need for sleep, pressured speech, flight of ideas, and
increased goal-directed activity. These reflect the heightened CNS arousal
characteristic of mania.
3. Which medication is considered the gold standard for maintenance
treatment of bipolar disorder?
A. Haloperidol
B. Diazepam
C. Fluoxetine
D. Lithium carbonate
E. Risperidone
D. Lithium carbonate
EXPERT RATIONALE: Lithium is the first-line mood stabilizer for bipolar disorder
and helps prevent both manic and depressive episodes. Monitoring serum levels
(therapeutic range 0.6–1.2 mEq/L) is essential due to its narrow therapeutic index.
4. A nurse is monitoring a client on lithium therapy. Which finding requires
immediate intervention?
A. Mild thirst and increased urination
,B. Serum lithium level of 0.9 mEq/L
C. Fine hand tremor
D. Coarse tremor, confusion, and ataxia
E. Mild nausea after taking the medication
D. Coarse tremor, confusion, and ataxia
EXPERT RATIONALE: Coarse tremor, confusion, and ataxia are signs of lithium
toxicity, which occurs when serum levels exceed 1.5 mEq/L. This is a medical
emergency requiring immediate withholding of lithium and physician notification.
5. A client with major depressive disorder tells the nurse, "I just feel empty
and nothing matters anymore." Which is the priority nursing intervention?
A. Encourage the client to join group therapy immediately
B. Assess the client for suicidal ideation
C. Provide the client with a list of activities to improve mood
D. Tell the client that things will get better with time
E. Administer an antidepressant and reassess in two weeks
B. Assess the client for suicidal ideation
EXPERT RATIONALE: When a client expresses hopelessness and emptiness, the
priority is always safety. The nurse must assess for suicidal ideation, plan, and
means before any other intervention to determine the level of risk.
6. A client is prescribed fluoxetine (Prozac) for depression. The nurse should
teach the client that therapeutic effects typically occur within:
A. 24 to 48 hours
B. 3 to 5 days
C. 2 to 4 weeks
, D. 6 to 8 weeks
E. Several months
C. 2 to 4 weeks
EXPERT RATIONALE: SSRIs like fluoxetine typically take 2–4 weeks to produce
noticeable therapeutic effects, though full effects may take up to 6–8 weeks.
Teaching this timeline improves medication adherence.
7. Which statement by a client taking an MAOI (monoamine oxidase inhibitor)
indicates understanding of dietary restrictions?
A. "I can eat aged cheese as long as I limit it to small amounts."
B. "I will avoid tyramine-rich foods such as aged cheese and cured meats."
C. "I should eat high-protein foods to enhance the medication's effect."
D. "I can drink red wine occasionally without any problems."
E. "Dietary restrictions only apply during the first month of treatment."
B. "I will avoid tyramine-rich foods such as aged cheese and cured meats."
EXPERT RATIONALE: MAOIs inhibit the breakdown of tyramine, and consuming
tyramine-rich foods can cause a hypertensive crisis, which is life-threatening.
Clients must strictly avoid aged cheese, cured meats, fermented products, and
alcohol.
8. A nurse is assessing a client for serotonin syndrome. Which cluster of
symptoms would the nurse expect?
A. Bradycardia, hypothermia, and dry skin
B. Agitation, hyperthermia, diaphoresis, and muscle rigidity
C. Sedation, weight gain, and flat affect
D. Polyuria, polydipsia, and weight gain
