NUR256 EXAM 3 Actual Exam 2026/2027
Complete Questions and Verified Answers
with Detailed Rationales Concepts of Mental
Health Nursing Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: MOOD DISORDERS (Questions 1-15)
Q1: A client with major depressive disorder tells the nurse, "I'm a failure. Nothing I do ever
works out." Which response by the nurse is most therapeutic?
• A. "You shouldn't feel that way. You have many accomplishments."
• B. "I understand how you feel. I've felt that way before."
• C. "Tell me more about what makes you feel like a failure." [CORRECT]
• D. "Let's focus on the positive things in your life instead."
Correct Answer: C
Rationale: Encouraging the client to explore their feelings by asking for more information is
therapeutic (C). It validates the client's experience and opens communication without being
dismissive. Telling the client they shouldn't feel that way (A) dismisses their feelings. Sharing
personal experiences (B) shifts focus to the nurse. Redirecting to positive things (D) may be
perceived as minimizing their distress.
Q2: A client with bipolar I disorder is in an acute manic episode. Which nursing intervention is
the priority?
• A. Encourage the client to attend all group therapy sessions
• B. Provide a stimulating environment to burn off energy
• C. Maintain a low-stimulation environment and set clear limits [CORRECT]
• D. Allow the client to make all decisions about daily routine
Correct Answer: C
,Rationale: During acute mania, the priority is to reduce environmental stimulation and provide
structure (C) to decrease agitation, prevent escalation, and maintain safety. Manic clients have
poor impulse control and judgment; excessive stimulation worsens symptoms. Setting clear
limits is essential for safety and milieu management.
Q3: A client with major depressive disorder is prescribed fluoxetine (Prozac). Which teaching
point is essential for the nurse to include?
• A. "You will notice immediate improvement within 2-3 days."
• B. "Take the medication at bedtime to avoid daytime drowsiness."
• C. "Avoid foods containing tyramine such as aged cheese and wine."
• D. "It may take 2-4 weeks to notice significant improvement." [CORRECT]
Correct Answer: D
Rationale: SSRIs like fluoxetine require 2-4 weeks (sometimes longer) to achieve therapeutic
antidepressant effects (D). Clients need education about delayed onset to prevent discouragement
and nonadherence. Tyramine restriction (C) applies to MAOIs, not SSRIs. Fluoxetine is typically
taken in the morning due to activating effects.
Q4: A client with bipolar disorder is prescribed lithium carbonate. Which laboratory value
requires ongoing monitoring?
• A. Hemoglobin and hematocrit
• B. Lithium level, thyroid function, and renal function [CORRECT]
• C. Liver function tests only
• D. Cardiac enzymes
Correct Answer: B
Rationale: Lithium requires monitoring of serum lithium levels (therapeutic 0.6-1.2 mEq/L;
toxic >1.5 mEq/L), thyroid function (hypothyroidism risk), and renal function (nephrotoxicity
risk) (B). Regular monitoring is essential for safe long-term maintenance therapy. Lithium has a
narrow therapeutic index.
Q5: A client with depression reports taking St. John's wort in addition to prescribed sertraline.
What is the nurse's primary concern?
, • A. The combination will cause excessive drowsiness
• B. Risk of serotonin syndrome [CORRECT]
• C. St. John's wort will cancel out the sertraline
• D. The client will develop tardive dyskinesia
Correct Answer: B
Rationale: Combining sertraline (SSRI) with St. John's wort increases serotonin levels and risk
of serotonin syndrome (B): agitation, confusion, tachycardia, hypertension, hyperthermia, muscle
rigidity. This potentially life-threatening condition requires immediate intervention. Clients must
disclose all herbal supplements.
Q6: Which symptom is considered a "negative symptom" of schizophrenia rather than a mood
disorder symptom?
• A. Auditory hallucinations
• B. Flat affect [CORRECT]
• C. Delusions of grandeur
• D. Flight of ideas
Correct Answer: B
Rationale: Flat affect (diminished emotional expression) is a negative symptom of schizophrenia
(B). Negative symptoms represent loss or reduction of normal functions. Auditory hallucinations
(A) and delusions (C) are positive symptoms. Flight of ideas (D) is a symptom of mania, not
schizophrenia.
Q7: A client with major depressive disorder is being assessed for suicide risk. Which question is
most appropriate for the nurse to ask?
• A. "You're not thinking about hurting yourself, are you?"
• B. "Have you had thoughts about killing yourself?" [CORRECT]
• C. "You wouldn't do anything stupid, would you?"
• D. "I know you wouldn't commit suicide, right?"
Correct Answer: B
, Rationale: Direct, non-judgmental questioning about suicidal thoughts (B) is the appropriate
assessment technique. Asking directly does not plant the idea; it opens communication. Leading
questions that assume the answer (A, C, D) minimize risk and may elicit dishonest responses.
Use the Columbia Suicide Severity Rating Scale.
Q8: A client with dysthymia (persistent depressive disorder) asks how this differs from major
depressive disorder. Which explanation by the nurse is most accurate?
• A. "Dysthymia causes more severe symptoms but for a shorter time."
• B. "Dysthymia has milder symptoms lasting at least 2 years." [CORRECT]
• C. "Dysthymia only affects your physical health, not your mood."
• D. "Dysthymia requires hospitalization while MDD does not."
Correct Answer: B
Rationale: Persistent depressive disorder (dysthymia) is characterized by milder depressive
symptoms that persist for at least 2 years (1 year in children/adolescents) (B). MDD has more
severe symptoms but typically distinct episodes. Dysthymia causes significant functional
impairment despite "milder" symptoms.
Q9: A client with bipolar disorder is prescribed lamotrigine. Which serious adverse effect must
the nurse monitor for?
• A. Agranulocytosis
• B. Stevens-Johnson syndrome/toxic epidermal necrolysis [CORRECT]
• C. Nephrotoxicity
• D. Ototoxicity
Correct Answer: B
Rationale: Lamotrigine carries a black box warning for serious rashes including Stevens-
Johnson syndrome and toxic epidermal necrolysis (B), which can be life-threatening. The dose
must be titrated slowly. Any rash requires immediate medical evaluation. Agranulocytosis (A) is
associated with clozapine and carbamazepine.
Q10: Which behavioral activation technique would be most appropriate for a client with major
depressive disorder?
Complete Questions and Verified Answers
with Detailed Rationales Concepts of Mental
Health Nursing Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: MOOD DISORDERS (Questions 1-15)
Q1: A client with major depressive disorder tells the nurse, "I'm a failure. Nothing I do ever
works out." Which response by the nurse is most therapeutic?
• A. "You shouldn't feel that way. You have many accomplishments."
• B. "I understand how you feel. I've felt that way before."
• C. "Tell me more about what makes you feel like a failure." [CORRECT]
• D. "Let's focus on the positive things in your life instead."
Correct Answer: C
Rationale: Encouraging the client to explore their feelings by asking for more information is
therapeutic (C). It validates the client's experience and opens communication without being
dismissive. Telling the client they shouldn't feel that way (A) dismisses their feelings. Sharing
personal experiences (B) shifts focus to the nurse. Redirecting to positive things (D) may be
perceived as minimizing their distress.
Q2: A client with bipolar I disorder is in an acute manic episode. Which nursing intervention is
the priority?
• A. Encourage the client to attend all group therapy sessions
• B. Provide a stimulating environment to burn off energy
• C. Maintain a low-stimulation environment and set clear limits [CORRECT]
• D. Allow the client to make all decisions about daily routine
Correct Answer: C
,Rationale: During acute mania, the priority is to reduce environmental stimulation and provide
structure (C) to decrease agitation, prevent escalation, and maintain safety. Manic clients have
poor impulse control and judgment; excessive stimulation worsens symptoms. Setting clear
limits is essential for safety and milieu management.
Q3: A client with major depressive disorder is prescribed fluoxetine (Prozac). Which teaching
point is essential for the nurse to include?
• A. "You will notice immediate improvement within 2-3 days."
• B. "Take the medication at bedtime to avoid daytime drowsiness."
• C. "Avoid foods containing tyramine such as aged cheese and wine."
• D. "It may take 2-4 weeks to notice significant improvement." [CORRECT]
Correct Answer: D
Rationale: SSRIs like fluoxetine require 2-4 weeks (sometimes longer) to achieve therapeutic
antidepressant effects (D). Clients need education about delayed onset to prevent discouragement
and nonadherence. Tyramine restriction (C) applies to MAOIs, not SSRIs. Fluoxetine is typically
taken in the morning due to activating effects.
Q4: A client with bipolar disorder is prescribed lithium carbonate. Which laboratory value
requires ongoing monitoring?
• A. Hemoglobin and hematocrit
• B. Lithium level, thyroid function, and renal function [CORRECT]
• C. Liver function tests only
• D. Cardiac enzymes
Correct Answer: B
Rationale: Lithium requires monitoring of serum lithium levels (therapeutic 0.6-1.2 mEq/L;
toxic >1.5 mEq/L), thyroid function (hypothyroidism risk), and renal function (nephrotoxicity
risk) (B). Regular monitoring is essential for safe long-term maintenance therapy. Lithium has a
narrow therapeutic index.
Q5: A client with depression reports taking St. John's wort in addition to prescribed sertraline.
What is the nurse's primary concern?
, • A. The combination will cause excessive drowsiness
• B. Risk of serotonin syndrome [CORRECT]
• C. St. John's wort will cancel out the sertraline
• D. The client will develop tardive dyskinesia
Correct Answer: B
Rationale: Combining sertraline (SSRI) with St. John's wort increases serotonin levels and risk
of serotonin syndrome (B): agitation, confusion, tachycardia, hypertension, hyperthermia, muscle
rigidity. This potentially life-threatening condition requires immediate intervention. Clients must
disclose all herbal supplements.
Q6: Which symptom is considered a "negative symptom" of schizophrenia rather than a mood
disorder symptom?
• A. Auditory hallucinations
• B. Flat affect [CORRECT]
• C. Delusions of grandeur
• D. Flight of ideas
Correct Answer: B
Rationale: Flat affect (diminished emotional expression) is a negative symptom of schizophrenia
(B). Negative symptoms represent loss or reduction of normal functions. Auditory hallucinations
(A) and delusions (C) are positive symptoms. Flight of ideas (D) is a symptom of mania, not
schizophrenia.
Q7: A client with major depressive disorder is being assessed for suicide risk. Which question is
most appropriate for the nurse to ask?
• A. "You're not thinking about hurting yourself, are you?"
• B. "Have you had thoughts about killing yourself?" [CORRECT]
• C. "You wouldn't do anything stupid, would you?"
• D. "I know you wouldn't commit suicide, right?"
Correct Answer: B
, Rationale: Direct, non-judgmental questioning about suicidal thoughts (B) is the appropriate
assessment technique. Asking directly does not plant the idea; it opens communication. Leading
questions that assume the answer (A, C, D) minimize risk and may elicit dishonest responses.
Use the Columbia Suicide Severity Rating Scale.
Q8: A client with dysthymia (persistent depressive disorder) asks how this differs from major
depressive disorder. Which explanation by the nurse is most accurate?
• A. "Dysthymia causes more severe symptoms but for a shorter time."
• B. "Dysthymia has milder symptoms lasting at least 2 years." [CORRECT]
• C. "Dysthymia only affects your physical health, not your mood."
• D. "Dysthymia requires hospitalization while MDD does not."
Correct Answer: B
Rationale: Persistent depressive disorder (dysthymia) is characterized by milder depressive
symptoms that persist for at least 2 years (1 year in children/adolescents) (B). MDD has more
severe symptoms but typically distinct episodes. Dysthymia causes significant functional
impairment despite "milder" symptoms.
Q9: A client with bipolar disorder is prescribed lamotrigine. Which serious adverse effect must
the nurse monitor for?
• A. Agranulocytosis
• B. Stevens-Johnson syndrome/toxic epidermal necrolysis [CORRECT]
• C. Nephrotoxicity
• D. Ototoxicity
Correct Answer: B
Rationale: Lamotrigine carries a black box warning for serious rashes including Stevens-
Johnson syndrome and toxic epidermal necrolysis (B), which can be life-threatening. The dose
must be titrated slowly. Any rash requires immediate medical evaluation. Agranulocytosis (A) is
associated with clozapine and carbamazepine.
Q10: Which behavioral activation technique would be most appropriate for a client with major
depressive disorder?
