NUR 2459 MENTAL AND BEHAVIORAL HEALTH NURSING
EXAM 2 STUDY GUIDE 2026/2027 | Rated A | Latest
Rasmussen College Prep | Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) — 18 Questions
Q1: A 28-year-old female presents to the emergency department with complaints of
persistent sadness for the past 3 weeks, anhedonia, difficulty concentrating at work,
insomnia with early morning awakening, feelings of worthlessness, and a 5-pound
weight loss. She denies suicidal ideation. Her PHQ-9 score is 14. Which nursing
diagnosis takes priority?
A. Risk for suicide related to depressive symptoms as evidenced by feelings of
worthlessness
B. Imbalanced nutrition: less than body requirements related to decreased appetite
C. Ineffective coping related to inability to manage stressors as evidenced by anhedonia
and sadness
D. Risk for self-directed violence related to mood disorder as evidenced by depressive
symptoms and worthlessness
Correct Answer: D
Rationale: While the patient currently denies suicidal ideation, Risk for self-directed
violence is the priority nursing diagnosis for any patient with moderate-to-severe
depression (PHQ-9 score 14 indicates moderately severe depression). The combination
,of worthlessness, anhedonia, and insomnia creates significant risk, even without
expressed suicidal intent. Safety is always the first priority in psychiatric nursing. Option
A is incorrect because the patient denies suicidal ideation, making "Risk for suicide" less
precise than "Risk for self-directed violence," which encompasses the broader safety
concern. Option B addresses a real symptom but is not priority over safety. Option C is
appropriate but secondary to safety concerns.
Q2: A 45-year-old male with bipolar I disorder is admitted to the inpatient unit during a
manic episode. He is currently prescribed lithium carbonate 600mg BID. Which
laboratory value requires immediate nursing intervention?
A. Lithium level: 1.2 mEq/L
B. Serum creatinine: 1.8 mg/dL
C. Thyroid-stimulating hormone (TSH): 4.5 mIU/L
D. White blood cell count: 12,000/mm³
Correct Answer: B
Rationale: A serum creatinine of 1.8 mg/dL indicates impaired renal function and
requires immediate intervention because lithium is excreted renally; reduced clearance
can lead to lithium toxicity even with therapeutic doses. Lithium levels should be
monitored closely with reduced renal function. Option A (1.2 mEq/L) is within the
therapeutic range (0.6-1.2 mEq/L for maintenance, up to 1.5 mEq/L acutely). Option C
(TSH 4.5) is slightly elevated but not emergent—hypothyroidism is a known side effect
requiring monitoring but not immediate action. Option D (WBC 12,000) is mildly
elevated, possibly due to stress or mania, but not critical.
,Q3: A 32-year-old female with major depressive disorder has been taking sertraline
50mg daily for 2 weeks. She calls the clinic stating she feels more energetic but still has
depressed mood and now has increased anxiety and occasional thoughts that "life isn't
worth living." What is the nurse's priority response?
A. Reassure her that these are normal early side effects and will resolve in 2-3 weeks
B. Schedule an urgent appointment today to assess for increased suicide risk and
akathisia
C. Advise her to increase the dose to 100mg to improve therapeutic effect
D. Recommend switching to a different SSRI immediately
Correct Answer: B
Rationale: Increased energy combined with persistent depressed mood and suicidal
ideation during the first weeks of antidepressant therapy represents a high-risk period
for suicide. The patient may have increased energy to act on suicidal thoughts before
mood improves. Additionally, increased anxiety and restlessness may indicate akathisia,
a side effect associated with increased suicide risk. The nurse must prioritize urgent
face-to-face assessment. Option A is dangerous reassurance that could delay critical
intervention. Option C is contraindicated with active suicidal ideation. Option D is
premature without assessment.
Q4: A patient with bipolar II disorder asks the nurse to explain the difference between
their diagnosis and bipolar I disorder. Which response by the nurse is most accurate?
, A. "Bipolar II involves more severe manic episodes than bipolar I, but less severe
depression"
B. "Bipolar I requires at least one major depressive episode, while bipolar II does not"
C. "Bipolar II is characterized by hypomanic episodes and major depressive episodes,
while bipolar I involves full manic episodes"
D. "The main difference is that bipolar II responds better to antidepressant
monotherapy"
Correct Answer: C
Rationale: Per DSM-5 criteria, bipolar II disorder requires at least one hypomanic
episode (not full mania) and at least one major depressive episode, while bipolar I
requires at least one manic episode (major depressive episode not required). Option A
is reversed—bipolar I has more severe mania. Option B is incorrect—bipolar II requires
depressive episodes, while bipolar I does not necessarily. Option D is dangerous;
antidepressant monotherapy can induce mania/hypomania in both disorders and
requires mood stabilizer coverage.
Q5: A 19-year-old college student is brought to the health center by roommates who
report she has been sleeping 2-3 hours nightly for 5 days, spending excessive money on
clothing she cannot afford, talking rapidly about "changing the world," and believing she
has special powers. She is agitated and refuses to consider that she might be unwell.
Which nursing intervention is most appropriate initially?
A. Confront her delusional beliefs directly to establish reality orientation
B. Provide a calm, low-stimulation environment and establish therapeutic rapport
C. Immediately administer PRN antipsychotic medication to reduce agitation
EXAM 2 STUDY GUIDE 2026/2027 | Rated A | Latest
Rasmussen College Prep | Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) — 18 Questions
Q1: A 28-year-old female presents to the emergency department with complaints of
persistent sadness for the past 3 weeks, anhedonia, difficulty concentrating at work,
insomnia with early morning awakening, feelings of worthlessness, and a 5-pound
weight loss. She denies suicidal ideation. Her PHQ-9 score is 14. Which nursing
diagnosis takes priority?
A. Risk for suicide related to depressive symptoms as evidenced by feelings of
worthlessness
B. Imbalanced nutrition: less than body requirements related to decreased appetite
C. Ineffective coping related to inability to manage stressors as evidenced by anhedonia
and sadness
D. Risk for self-directed violence related to mood disorder as evidenced by depressive
symptoms and worthlessness
Correct Answer: D
Rationale: While the patient currently denies suicidal ideation, Risk for self-directed
violence is the priority nursing diagnosis for any patient with moderate-to-severe
depression (PHQ-9 score 14 indicates moderately severe depression). The combination
,of worthlessness, anhedonia, and insomnia creates significant risk, even without
expressed suicidal intent. Safety is always the first priority in psychiatric nursing. Option
A is incorrect because the patient denies suicidal ideation, making "Risk for suicide" less
precise than "Risk for self-directed violence," which encompasses the broader safety
concern. Option B addresses a real symptom but is not priority over safety. Option C is
appropriate but secondary to safety concerns.
Q2: A 45-year-old male with bipolar I disorder is admitted to the inpatient unit during a
manic episode. He is currently prescribed lithium carbonate 600mg BID. Which
laboratory value requires immediate nursing intervention?
A. Lithium level: 1.2 mEq/L
B. Serum creatinine: 1.8 mg/dL
C. Thyroid-stimulating hormone (TSH): 4.5 mIU/L
D. White blood cell count: 12,000/mm³
Correct Answer: B
Rationale: A serum creatinine of 1.8 mg/dL indicates impaired renal function and
requires immediate intervention because lithium is excreted renally; reduced clearance
can lead to lithium toxicity even with therapeutic doses. Lithium levels should be
monitored closely with reduced renal function. Option A (1.2 mEq/L) is within the
therapeutic range (0.6-1.2 mEq/L for maintenance, up to 1.5 mEq/L acutely). Option C
(TSH 4.5) is slightly elevated but not emergent—hypothyroidism is a known side effect
requiring monitoring but not immediate action. Option D (WBC 12,000) is mildly
elevated, possibly due to stress or mania, but not critical.
,Q3: A 32-year-old female with major depressive disorder has been taking sertraline
50mg daily for 2 weeks. She calls the clinic stating she feels more energetic but still has
depressed mood and now has increased anxiety and occasional thoughts that "life isn't
worth living." What is the nurse's priority response?
A. Reassure her that these are normal early side effects and will resolve in 2-3 weeks
B. Schedule an urgent appointment today to assess for increased suicide risk and
akathisia
C. Advise her to increase the dose to 100mg to improve therapeutic effect
D. Recommend switching to a different SSRI immediately
Correct Answer: B
Rationale: Increased energy combined with persistent depressed mood and suicidal
ideation during the first weeks of antidepressant therapy represents a high-risk period
for suicide. The patient may have increased energy to act on suicidal thoughts before
mood improves. Additionally, increased anxiety and restlessness may indicate akathisia,
a side effect associated with increased suicide risk. The nurse must prioritize urgent
face-to-face assessment. Option A is dangerous reassurance that could delay critical
intervention. Option C is contraindicated with active suicidal ideation. Option D is
premature without assessment.
Q4: A patient with bipolar II disorder asks the nurse to explain the difference between
their diagnosis and bipolar I disorder. Which response by the nurse is most accurate?
, A. "Bipolar II involves more severe manic episodes than bipolar I, but less severe
depression"
B. "Bipolar I requires at least one major depressive episode, while bipolar II does not"
C. "Bipolar II is characterized by hypomanic episodes and major depressive episodes,
while bipolar I involves full manic episodes"
D. "The main difference is that bipolar II responds better to antidepressant
monotherapy"
Correct Answer: C
Rationale: Per DSM-5 criteria, bipolar II disorder requires at least one hypomanic
episode (not full mania) and at least one major depressive episode, while bipolar I
requires at least one manic episode (major depressive episode not required). Option A
is reversed—bipolar I has more severe mania. Option B is incorrect—bipolar II requires
depressive episodes, while bipolar I does not necessarily. Option D is dangerous;
antidepressant monotherapy can induce mania/hypomania in both disorders and
requires mood stabilizer coverage.
Q5: A 19-year-old college student is brought to the health center by roommates who
report she has been sleeping 2-3 hours nightly for 5 days, spending excessive money on
clothing she cannot afford, talking rapidly about "changing the world," and believing she
has special powers. She is agitated and refuses to consider that she might be unwell.
Which nursing intervention is most appropriate initially?
A. Confront her delusional beliefs directly to establish reality orientation
B. Provide a calm, low-stimulation environment and establish therapeutic rapport
C. Immediately administer PRN antipsychotic medication to reduce agitation
