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 28-year-old 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) invalidates their feelings. Sharing
personal experiences (B) shifts focus to the nurse and is inappropriate. Redirecting to positive
things (D) may be perceived as minimizing their distress and is nontherapeutic.
Q2: A nurse is assessing a client with bipolar I disorder who is currently in a manic episode.
Which behavior documented in the chart requires immediate intervention?
A. The client is sleeping 4 hours per night instead of usual 8 hours
B. The client is spending $5,000 on online shopping in one day despite having only $200 in
savings
C. The client is speaking rapidly and interrupting others during group therapy
D. The client has written 15 pages of a novel in the past 2 hours
,Correct Answer: B
Rationale: Excessive spending with potential for financial ruin and serious consequences
requires immediate intervention (B). While decreased need for sleep (A), pressured speech (C),
and increased goal-directed activity (D) are symptoms of mania, they do not pose the immediate
serious consequences that impulsive high-risk spending does. The nurse must intervene to
prevent financial catastrophe.
Q3: A client prescribed sertraline for major depressive disorder asks the nurse when they will
start feeling better. What is the nurse's best response?
A. "You should feel dramatically better within 3-4 days."
B. "It usually takes 2-6 weeks to notice the full therapeutic effects." [CORRECT]
C. "If you don't feel better in one week, we'll need to change medications."
D. "Most people feel better immediately once they start taking the medication."
Correct Answer: B
Rationale: SSRIs such as sertraline typically require 2-6 weeks to achieve full therapeutic
effects (B). Setting realistic expectations prevents premature discontinuation and
discouragement. Stating 3-4 days (A) or immediate effects (D) is incorrect and misleading.
Suggesting a change after one week (C) is premature and inaccurate, as therapeutic trials of
antidepressants require adequate time.
Q4: A nurse is caring for a client with persistent depressive disorder (dysthymia). Which
statement by the client best supports this diagnosis?
A. "I've had periods of intense sadness followed by weeks of feeling great and spending lots of
money."
B. "For the past 3 years, I've felt down most days but can still go to work and function."
C. "I had a terrible month after my divorce where I couldn't get out of bed."
D. "I suddenly started feeling hopeless and suicidal 3 weeks ago with no reason."
Correct Answer: B
Rationale: Persistent depressive disorder (dysthymia) is characterized by depressed mood for at
least 2 years (1 year in children/adolescents) on most days, with intact functioning but chronic
low-grade symptoms (B). Option A describes bipolar disorder, C describes an adjustment
disorder or major depression, and D describes acute onset major depressive disorder.
,Q5: A client with bipolar disorder is prescribed lithium carbonate. Which laboratory value
requires immediate notification to the healthcare provider?
A. Lithium level 1.0 mEq/L
B. Serum sodium 128 mEq/L
C. Thyroid-stimulating hormone (TSH) 4.5 mIU/L
D. Creatinine 1.1 mg/dL
Correct Answer: B
Rationale: Hyponatremia (serum sodium <135 mEq/L) increases lithium retention and toxicity
risk, requiring immediate provider notification (B). A lithium level of 1.0 mEq/L (A) is within
therapeutic range (0.6-1.2 mEq/L). TSH 4.5 mIU/L (C) is borderline but not immediately
dangerous. Creatinine 1.1 mg/dL (D) is within normal limits but should be monitored as lithium
affects renal function.
Q6: A nurse is teaching a client about potential side effects of bupropion. Which information is
essential to include?
A. "You may experience significant weight gain while taking this medication."
B. "This medication commonly causes sexual dysfunction in most patients."
C. "You should take this medication at bedtime because it causes drowsiness."
D. "This medication can lower the seizure threshold, especially at higher doses." [CORRECT]
Correct Answer: D
Rationale: Bupropion lowers the seizure threshold, with risk increasing at doses >450 mg/day
(D). This is a critical safety teaching point. Unlike many antidepressants, bupropion is weight-
neutral or may cause weight loss (A is incorrect). It has lower rates of sexual dysfunction than
SSRIs (B is incorrect). It is activating and should be taken in the morning to avoid insomnia (C is
incorrect).
Q7: A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT).
Which pre-procedure nursing intervention is most appropriate?
A. Ensure the client has been NPO for at least 6-8 hours prior to treatment [CORRECT]
B. Administer a stimulant medication to counteract anesthesia effects
, C. Encourage the client to eat a light breakfast 2 hours before the procedure
D. Withhold all psychiatric medications for 48 hours prior to ECT
Correct Answer: A
Rationale: NPO status for 6-8 hours is required before ECT due to general anesthesia
administration and aspiration risk (A). Stimulants (B) are contraindicated. Eating before the
procedure (C) is dangerous. Psychiatric medications are typically continued (D), though some
may be held per provider orders.
Q8: A nurse is assessing a client using the SIGECAPS mnemonic for depression. Which finding
indicates a positive symptom?
A. The client reports sleeping 8 hours per night without difficulty
B. The client has maintained interest in hobbies and social activities
C. The client describes feeling guilty about past mistakes daily [CORRECT]
D. The client has maintained normal appetite and weight
Correct Answer: C
Rationale: SIGECAPS stands for Sleep changes, Interest loss, Guilt, Energy loss, Concentration
problems, Appetite changes, Psychomotor changes, and Suicidal ideation. Excessive or
inappropriate guilt (C) is a positive symptom of depression. Options A, B, and D indicate
absence of depressive symptoms.
Q9: A client with cyclothymic disorder asks the nurse to explain how this differs from bipolar
disorder. What is the nurse's best response?
A. "Cyclothymic disorder involves more severe mood swings than bipolar disorder."
B. "You experience numerous periods of hypomanic and depressive symptoms for at least 2
years without meeting full criteria for manic or major depressive episodes." [CORRECT]
C. "Cyclothymic disorder only affects your energy levels, not your mood."
D. "This diagnosis means you have rapid cycling between mania and depression every few
days."
Correct Answer: B
Rationale: Cyclothymic disorder involves chronic fluctuating mood disturbance with hypomanic
and depressive symptoms that do not meet full criteria for manic or major depressive episodes,
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 28-year-old 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) invalidates their feelings. Sharing
personal experiences (B) shifts focus to the nurse and is inappropriate. Redirecting to positive
things (D) may be perceived as minimizing their distress and is nontherapeutic.
Q2: A nurse is assessing a client with bipolar I disorder who is currently in a manic episode.
Which behavior documented in the chart requires immediate intervention?
A. The client is sleeping 4 hours per night instead of usual 8 hours
B. The client is spending $5,000 on online shopping in one day despite having only $200 in
savings
C. The client is speaking rapidly and interrupting others during group therapy
D. The client has written 15 pages of a novel in the past 2 hours
,Correct Answer: B
Rationale: Excessive spending with potential for financial ruin and serious consequences
requires immediate intervention (B). While decreased need for sleep (A), pressured speech (C),
and increased goal-directed activity (D) are symptoms of mania, they do not pose the immediate
serious consequences that impulsive high-risk spending does. The nurse must intervene to
prevent financial catastrophe.
Q3: A client prescribed sertraline for major depressive disorder asks the nurse when they will
start feeling better. What is the nurse's best response?
A. "You should feel dramatically better within 3-4 days."
B. "It usually takes 2-6 weeks to notice the full therapeutic effects." [CORRECT]
C. "If you don't feel better in one week, we'll need to change medications."
D. "Most people feel better immediately once they start taking the medication."
Correct Answer: B
Rationale: SSRIs such as sertraline typically require 2-6 weeks to achieve full therapeutic
effects (B). Setting realistic expectations prevents premature discontinuation and
discouragement. Stating 3-4 days (A) or immediate effects (D) is incorrect and misleading.
Suggesting a change after one week (C) is premature and inaccurate, as therapeutic trials of
antidepressants require adequate time.
Q4: A nurse is caring for a client with persistent depressive disorder (dysthymia). Which
statement by the client best supports this diagnosis?
A. "I've had periods of intense sadness followed by weeks of feeling great and spending lots of
money."
B. "For the past 3 years, I've felt down most days but can still go to work and function."
C. "I had a terrible month after my divorce where I couldn't get out of bed."
D. "I suddenly started feeling hopeless and suicidal 3 weeks ago with no reason."
Correct Answer: B
Rationale: Persistent depressive disorder (dysthymia) is characterized by depressed mood for at
least 2 years (1 year in children/adolescents) on most days, with intact functioning but chronic
low-grade symptoms (B). Option A describes bipolar disorder, C describes an adjustment
disorder or major depression, and D describes acute onset major depressive disorder.
,Q5: A client with bipolar disorder is prescribed lithium carbonate. Which laboratory value
requires immediate notification to the healthcare provider?
A. Lithium level 1.0 mEq/L
B. Serum sodium 128 mEq/L
C. Thyroid-stimulating hormone (TSH) 4.5 mIU/L
D. Creatinine 1.1 mg/dL
Correct Answer: B
Rationale: Hyponatremia (serum sodium <135 mEq/L) increases lithium retention and toxicity
risk, requiring immediate provider notification (B). A lithium level of 1.0 mEq/L (A) is within
therapeutic range (0.6-1.2 mEq/L). TSH 4.5 mIU/L (C) is borderline but not immediately
dangerous. Creatinine 1.1 mg/dL (D) is within normal limits but should be monitored as lithium
affects renal function.
Q6: A nurse is teaching a client about potential side effects of bupropion. Which information is
essential to include?
A. "You may experience significant weight gain while taking this medication."
B. "This medication commonly causes sexual dysfunction in most patients."
C. "You should take this medication at bedtime because it causes drowsiness."
D. "This medication can lower the seizure threshold, especially at higher doses." [CORRECT]
Correct Answer: D
Rationale: Bupropion lowers the seizure threshold, with risk increasing at doses >450 mg/day
(D). This is a critical safety teaching point. Unlike many antidepressants, bupropion is weight-
neutral or may cause weight loss (A is incorrect). It has lower rates of sexual dysfunction than
SSRIs (B is incorrect). It is activating and should be taken in the morning to avoid insomnia (C is
incorrect).
Q7: A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT).
Which pre-procedure nursing intervention is most appropriate?
A. Ensure the client has been NPO for at least 6-8 hours prior to treatment [CORRECT]
B. Administer a stimulant medication to counteract anesthesia effects
, C. Encourage the client to eat a light breakfast 2 hours before the procedure
D. Withhold all psychiatric medications for 48 hours prior to ECT
Correct Answer: A
Rationale: NPO status for 6-8 hours is required before ECT due to general anesthesia
administration and aspiration risk (A). Stimulants (B) are contraindicated. Eating before the
procedure (C) is dangerous. Psychiatric medications are typically continued (D), though some
may be held per provider orders.
Q8: A nurse is assessing a client using the SIGECAPS mnemonic for depression. Which finding
indicates a positive symptom?
A. The client reports sleeping 8 hours per night without difficulty
B. The client has maintained interest in hobbies and social activities
C. The client describes feeling guilty about past mistakes daily [CORRECT]
D. The client has maintained normal appetite and weight
Correct Answer: C
Rationale: SIGECAPS stands for Sleep changes, Interest loss, Guilt, Energy loss, Concentration
problems, Appetite changes, Psychomotor changes, and Suicidal ideation. Excessive or
inappropriate guilt (C) is a positive symptom of depression. Options A, B, and D indicate
absence of depressive symptoms.
Q9: A client with cyclothymic disorder asks the nurse to explain how this differs from bipolar
disorder. What is the nurse's best response?
A. "Cyclothymic disorder involves more severe mood swings than bipolar disorder."
B. "You experience numerous periods of hypomanic and depressive symptoms for at least 2
years without meeting full criteria for manic or major depressive episodes." [CORRECT]
C. "Cyclothymic disorder only affects your energy levels, not your mood."
D. "This diagnosis means you have rapid cycling between mania and depression every few
days."
Correct Answer: B
Rationale: Cyclothymic disorder involves chronic fluctuating mood disturbance with hypomanic
and depressive symptoms that do not meet full criteria for manic or major depressive episodes,
