NUR 2459 MENTAL AND BEHAVIORAL HEALTH NURSING
EXAM 2 2026/2027 | Graded A Questions and Answers with
Rationales | Rasmussen College | Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) (12 Questions)
Q1: A 28-year-old female presents to the outpatient clinic with complaints of persistent
sadness, loss of interest in previously enjoyed activities for the past 6 weeks, difficulty
sleeping with early morning awakening, fatigue, poor concentration, feelings of
worthlessness, and a 5-pound weight loss. She denies suicidal ideation. Based on
DSM-5 criteria, which diagnosis is most appropriate?
A. Persistent depressive disorder (dysthymia)
B. Major depressive disorder, single episode, moderate severity [CORRECT]
C. Adjustment disorder with depressed mood
D. Bipolar II disorder
Correct Answer: B
Rationale: The patient meets DSM-5 criteria for Major Depressive Disorder (MDD): ≥5
symptoms present during the same 2-week period, including either depressed mood or
loss of interest/pleasure (anhedonia). She has both core symptoms plus sleep
disturbance, fatigue, poor concentration, worthlessness, and weight loss—totaling 6
symptoms. The 6-week duration exceeds the 2-week minimum. Moderate severity is
indicated by symptoms exceeding mild but without psychotic features or severe
,functional impairment. Option A (Persistent Depressive Disorder) requires symptoms
for ≥2 years. Option C (Adjustment Disorder) occurs within 3 months of an identifiable
stressor and doesn't meet full MDD criteria. Option D (Bipolar II) requires history of
hypomanic episode, which is absent. The absence of manic/hypomanic symptoms
rules out bipolar spectrum disorders.
Q2: A patient diagnosed with bipolar I disorder is prescribed lithium carbonate. Which
laboratory monitoring is essential before initiating and during maintenance therapy?
A. Complete blood count and liver function tests only
B. Thyroid function tests, renal function tests, and serum lithium levels [CORRECT]
C. Cardiac enzymes and lipid panel only
D. Serum magnesium and calcium levels only
Correct Answer: B
Rationale: Lithium requires comprehensive monitoring due to its narrow therapeutic
index (0.6-1.2 mEq/L for maintenance, 1.0-1.5 mEq/L for acute mania). Baseline and
periodic monitoring includes: (1) Thyroid function (TSH, free T4)—lithium can cause
hypothyroidism in 10-20% of patients; (2) Renal function (BUN, creatinine,
urinalysis)—lithium is renally excreted and can cause nephrogenic diabetes insipidus
and chronic kidney disease; (3) Serum lithium levels—therapeutic drug monitoring is
essential. Option A misses critical renal and thyroid monitoring. Option C (cardiac
enzymes) is not routine unless cardiac symptoms present. Option D is incorrect; while
electrolytes affect lithium excretion, magnesium and calcium are not primary
monitoring parameters.
,Q3: A nurse is assessing a 35-year-old male with depression who states, "I don't see the
point in taking my sertraline anymore. I've been on it for 3 days and I still feel terrible."
Which nursing response demonstrates therapeutic communication?
A. "You need to give it more time. These medications take 4-6 weeks to reach full
therapeutic effect." [CORRECT]
B. "If you don't take your medication, you'll end up back in the hospital."
C. "Just keep taking it. Your doctor knows what's best for you."
D. "Maybe you should stop since it's not working anyway."
Correct Answer: A
Rationale: SSRIs like sertraline require 2-4 weeks for initial improvement and 4-6 weeks
for full therapeutic effect. This response provides accurate psychoeducation about
realistic medication timelines, validates the patient's frustration while correcting the
misconception that immediate results are expected, and encourages adherence. Option
B uses threatening language, creating power struggle and fear. Option C is paternalistic,
dismisses patient concerns, and undermines autonomy. Option D supports
non-adherence without clinical justification and could harm the patient. Therapeutic
communication involves empathy, education, and collaborative partnership.
Q4: A patient with bipolar I disorder is experiencing a manic episode characterized by
decreased sleep, pressured speech, flight of ideas, grandiosity, and excessive spending.
Which nursing intervention is the priority?
, A. Encourage the patient to complete all activities of daily living independently
B. Implement environmental modifications to reduce stimulation and prevent injury
[CORRECT]
C. Facilitate group therapy sessions to process feelings
D. Allow unrestricted access to personal finances
Correct Answer: B
Rationale: During acute mania, safety is the priority. Manic patients have impaired
judgment, increased impulsivity, and heightened psychomotor activity. Environmental
modifications include: reducing stimuli (quiet, low-light environment), removing
dangerous objects, limiting access to money/credit cards (prevent financial harm), and
providing structured, simple activities. Option A is inappropriate as manic patients
cannot independently manage complex tasks. Option C is contraindicated—group
therapy is overwhelming and patients cannot process effectively during mania. Option D
enables dangerous impulsive behavior (excessive spending, risky investments). The
nurse must protect the patient from consequences of poor judgment.
Q5: A 42-year-old patient presents with symptoms of depression but reports a history of
a "really productive period" 3 months ago when they slept only 3 hours nightly,
completed extensive home renovation projects, and spent $15,000 on new business
equipment they never used. Currently, they feel "crashed" and suicidal. Which diagnosis
should the nurse anticipate?
A. Major depressive disorder, recurrent
B. Bipolar I disorder [CORRECT]
EXAM 2 2026/2027 | Graded A Questions and Answers with
Rationales | Rasmussen College | Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) (12 Questions)
Q1: A 28-year-old female presents to the outpatient clinic with complaints of persistent
sadness, loss of interest in previously enjoyed activities for the past 6 weeks, difficulty
sleeping with early morning awakening, fatigue, poor concentration, feelings of
worthlessness, and a 5-pound weight loss. She denies suicidal ideation. Based on
DSM-5 criteria, which diagnosis is most appropriate?
A. Persistent depressive disorder (dysthymia)
B. Major depressive disorder, single episode, moderate severity [CORRECT]
C. Adjustment disorder with depressed mood
D. Bipolar II disorder
Correct Answer: B
Rationale: The patient meets DSM-5 criteria for Major Depressive Disorder (MDD): ≥5
symptoms present during the same 2-week period, including either depressed mood or
loss of interest/pleasure (anhedonia). She has both core symptoms plus sleep
disturbance, fatigue, poor concentration, worthlessness, and weight loss—totaling 6
symptoms. The 6-week duration exceeds the 2-week minimum. Moderate severity is
indicated by symptoms exceeding mild but without psychotic features or severe
,functional impairment. Option A (Persistent Depressive Disorder) requires symptoms
for ≥2 years. Option C (Adjustment Disorder) occurs within 3 months of an identifiable
stressor and doesn't meet full MDD criteria. Option D (Bipolar II) requires history of
hypomanic episode, which is absent. The absence of manic/hypomanic symptoms
rules out bipolar spectrum disorders.
Q2: A patient diagnosed with bipolar I disorder is prescribed lithium carbonate. Which
laboratory monitoring is essential before initiating and during maintenance therapy?
A. Complete blood count and liver function tests only
B. Thyroid function tests, renal function tests, and serum lithium levels [CORRECT]
C. Cardiac enzymes and lipid panel only
D. Serum magnesium and calcium levels only
Correct Answer: B
Rationale: Lithium requires comprehensive monitoring due to its narrow therapeutic
index (0.6-1.2 mEq/L for maintenance, 1.0-1.5 mEq/L for acute mania). Baseline and
periodic monitoring includes: (1) Thyroid function (TSH, free T4)—lithium can cause
hypothyroidism in 10-20% of patients; (2) Renal function (BUN, creatinine,
urinalysis)—lithium is renally excreted and can cause nephrogenic diabetes insipidus
and chronic kidney disease; (3) Serum lithium levels—therapeutic drug monitoring is
essential. Option A misses critical renal and thyroid monitoring. Option C (cardiac
enzymes) is not routine unless cardiac symptoms present. Option D is incorrect; while
electrolytes affect lithium excretion, magnesium and calcium are not primary
monitoring parameters.
,Q3: A nurse is assessing a 35-year-old male with depression who states, "I don't see the
point in taking my sertraline anymore. I've been on it for 3 days and I still feel terrible."
Which nursing response demonstrates therapeutic communication?
A. "You need to give it more time. These medications take 4-6 weeks to reach full
therapeutic effect." [CORRECT]
B. "If you don't take your medication, you'll end up back in the hospital."
C. "Just keep taking it. Your doctor knows what's best for you."
D. "Maybe you should stop since it's not working anyway."
Correct Answer: A
Rationale: SSRIs like sertraline require 2-4 weeks for initial improvement and 4-6 weeks
for full therapeutic effect. This response provides accurate psychoeducation about
realistic medication timelines, validates the patient's frustration while correcting the
misconception that immediate results are expected, and encourages adherence. Option
B uses threatening language, creating power struggle and fear. Option C is paternalistic,
dismisses patient concerns, and undermines autonomy. Option D supports
non-adherence without clinical justification and could harm the patient. Therapeutic
communication involves empathy, education, and collaborative partnership.
Q4: A patient with bipolar I disorder is experiencing a manic episode characterized by
decreased sleep, pressured speech, flight of ideas, grandiosity, and excessive spending.
Which nursing intervention is the priority?
, A. Encourage the patient to complete all activities of daily living independently
B. Implement environmental modifications to reduce stimulation and prevent injury
[CORRECT]
C. Facilitate group therapy sessions to process feelings
D. Allow unrestricted access to personal finances
Correct Answer: B
Rationale: During acute mania, safety is the priority. Manic patients have impaired
judgment, increased impulsivity, and heightened psychomotor activity. Environmental
modifications include: reducing stimuli (quiet, low-light environment), removing
dangerous objects, limiting access to money/credit cards (prevent financial harm), and
providing structured, simple activities. Option A is inappropriate as manic patients
cannot independently manage complex tasks. Option C is contraindicated—group
therapy is overwhelming and patients cannot process effectively during mania. Option D
enables dangerous impulsive behavior (excessive spending, risky investments). The
nurse must protect the patient from consequences of poor judgment.
Q5: A 42-year-old patient presents with symptoms of depression but reports a history of
a "really productive period" 3 months ago when they slept only 3 hours nightly,
completed extensive home renovation projects, and spent $15,000 on new business
equipment they never used. Currently, they feel "crashed" and suicidal. Which diagnosis
should the nurse anticipate?
A. Major depressive disorder, recurrent
B. Bipolar I disorder [CORRECT]
