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NUR 253 Mental Health Exam 3 Actual Exam 2026/2027
– Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed – A+
Graded
Section 1: Depressive Disorders (Questions 1-30)
1. A patient with major depressive disorder (MDD) states, "I feel so hopeless. Nothing matters
anymore. My family would be better off without me." What is the nurse's priority response?
A. "You have so much to live for. Your family loves you."
B. "Are you having thoughts of hurting yourself?"
C. "It sounds like you are feeling very sad right now."
D. "Let's talk about what makes you feel hopeless."
Answer: B. "Are you having thoughts of hurting yourself?"
Rationale: The patient's statement contains themes of hopelessness and perceived burdensomeness,
which are significant risk factors for suicide. The priority is to directly assess for suicidal ideation, plan,
and intent. Avoiding the question or offering false reassurance does not address the immediate safety
concern.
2. Which neurotransmitter imbalances are most associated with major depressive disorder?
A. Increased dopamine and decreased GABA
B. Decreased serotonin, norepinephrine, and dopamine
C. Increased acetylcholine and decreased histamine
D. Decreased glutamate and increased substance P
Answer: B. Decreased serotonin, norepinephrine, and dopamine
Rationale: The monoamine hypothesis of depression suggests that a deficiency in serotonin,
norepinephrine, and/or dopamine contributes to depressive symptoms. Most antidepressants work by
increasing the availability of these neurotransmitters.
3. A nurse is caring for a patient with severe depression who has been prescribed a selective serotonin
reuptake inhibitor (SSRI). The patient asks, "How long will it take for this to work?" What is the nurse's
best response?
A. "You should feel better within 24 to 48 hours."
B. "It may take 2 to 4 weeks to notice an improvement in mood."
,2
C. "The full therapeutic effect may take 6 to 8 weeks."
D. "You will notice a difference after the first dose."
Answer: B. "It may take 2 to 4 weeks to notice an improvement in mood."
Rationale: SSRIs typically require 2 to 4 weeks to begin producing noticeable improvements in mood,
with full therapeutic effects often taking 6 to 8 weeks. Patients should be educated about this delay to
prevent premature discontinuation.
4. A patient with MDD is started on fluoxetine. The nurse should educate the patient about which
common side effect?
A. Weight gain
B. Sexual dysfunction
C. Hypertension
D. Urinary retention
Answer: B. Sexual dysfunction
Rationale: Sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia, is a
common side effect of SSRIs. Patients should be informed that this side effect may occur and encouraged
to discuss any concerns with their provider rather than discontinuing the medication abruptly.
5. A nurse is assessing a patient with depression. Which of the following findings would be considered
a somatic symptom of depression?
A. Auditory hallucinations
B. Flight of ideas
C. Chronic fatigue and unexplained aches
D. Grandiose delusions
Answer: C. Chronic fatigue and unexplained aches
Rationale: Somatic symptoms of depression include physical complaints such as fatigue, headaches, back
pain, and gastrointestinal disturbances. These symptoms are often the primary reason patients with
depression seek medical care.
6. A patient taking phenelzine (Nardil), an MAOI, asks the nurse about dietary restrictions. Which food
should the nurse instruct the patient to avoid?
A. Fresh apples
B. Aged cheese
C. White bread
D. Grilled chicken
,3
Answer: B. Aged cheese
Rationale: MAOIs interact with tyramine-rich foods, potentially causing a hypertensive crisis. Aged
cheese, cured meats, fermented foods, and red wine are high in tyramine and must be avoided.
7. A nurse is caring for a patient who has been taking sertraline for 6 months and reports feeling
"much better." The patient asks if they can stop taking the medication. What is the nurse's best
response?
A. "You can stop taking it immediately since you're feeling better."
B. "You should continue the medication for at least 6 more months to prevent relapse."
C. "You can taper off the medication by taking it every other day."
D. "You should double your dose for a few weeks before stopping."
Answer: B. "You should continue the medication for at least 6 more months to prevent relapse."
Rationale: After achieving remission, antidepressant therapy should continue for at least 6 to 12 months
to prevent relapse. Discontinuation should be gradual and under medical supervision to avoid
withdrawal symptoms.
8. A patient with MDD is being evaluated for suicidal ideation. Which question is most appropriate for
the nurse to ask?
A. "You're not thinking about suicide, are you?"
B. "Do you have a plan to harm yourself?"
C. "Why would you want to hurt yourself?"
D. "You have so much to live for, don't you?"
Answer: B. "Do you have a plan to harm yourself?"
Rationale: Direct, non-judgmental questions about suicidal ideation, plan, and intent are essential for
safety assessment. Asking about a specific plan helps determine the level of risk and guides immediate
interventions.
9. Which of the following is a risk factor for major depressive disorder?
A. Male gender
B. Married status
C. Female gender
D. High socioeconomic status
Answer: C. Female gender
, 4
Rationale: The incidence of depressive disorders is greater in women than in men by a ratio of almost 2
to 1. Other risk factors include unmarried status, low socioeconomic status, and family history of
depression.
10. A nurse is providing education to a patient prescribed a tricyclic antidepressant (TCA). Which side
effect should the nurse prioritize in teaching?
A. Diarrhea
B. Orthostatic hypotension
C. Weight loss
D. Insomnia
Answer: B. Orthostatic hypotension
Rationale: TCAs cause significant anticholinergic effects and alpha-adrenergic blockade, leading to
orthostatic hypotension. Patients should be instructed to change positions slowly to prevent falls and
injuries.
11. A patient with depression is started on venlafaxine. The nurse should monitor for which adverse
effect?
A. Hypotension
B. Hypertension
C. Bradycardia
D. Hypoglycemia
Answer: B. Hypertension
Rationale: Venlafaxine, an SNRI, can increase blood pressure, especially at higher doses. Blood pressure
should be monitored regularly throughout treatment.
12. A patient with MDD reports that they have been taking St. John's Wort. The nurse should educate
the patient that:
A. St. John's Wort is safe to take with prescription antidepressants.
B. St. John's Wort can increase the risk of serotonin syndrome when combined with SSRIs.
C. St. John's Wort has no effect on depression.
D. St. John's Wort should be taken with food to prevent GI upset.
Answer: B. St. John's Wort can increase the risk of serotonin syndrome when combined with SSRIs.
Rationale: St. John's Wort has serotonergic effects and can lead to serotonin syndrome when combined
with prescription antidepressants. Patients should be advised to discontinue St. John's Wort and consult
their provider before starting any herbal supplements.
NUR 253 Mental Health Exam 3 Actual Exam 2026/2027
– Complete Exam-Style Questions with Detailed
Rationales | 100% Verified – Pass Guaranteed – A+
Graded
Section 1: Depressive Disorders (Questions 1-30)
1. A patient with major depressive disorder (MDD) states, "I feel so hopeless. Nothing matters
anymore. My family would be better off without me." What is the nurse's priority response?
A. "You have so much to live for. Your family loves you."
B. "Are you having thoughts of hurting yourself?"
C. "It sounds like you are feeling very sad right now."
D. "Let's talk about what makes you feel hopeless."
Answer: B. "Are you having thoughts of hurting yourself?"
Rationale: The patient's statement contains themes of hopelessness and perceived burdensomeness,
which are significant risk factors for suicide. The priority is to directly assess for suicidal ideation, plan,
and intent. Avoiding the question or offering false reassurance does not address the immediate safety
concern.
2. Which neurotransmitter imbalances are most associated with major depressive disorder?
A. Increased dopamine and decreased GABA
B. Decreased serotonin, norepinephrine, and dopamine
C. Increased acetylcholine and decreased histamine
D. Decreased glutamate and increased substance P
Answer: B. Decreased serotonin, norepinephrine, and dopamine
Rationale: The monoamine hypothesis of depression suggests that a deficiency in serotonin,
norepinephrine, and/or dopamine contributes to depressive symptoms. Most antidepressants work by
increasing the availability of these neurotransmitters.
3. A nurse is caring for a patient with severe depression who has been prescribed a selective serotonin
reuptake inhibitor (SSRI). The patient asks, "How long will it take for this to work?" What is the nurse's
best response?
A. "You should feel better within 24 to 48 hours."
B. "It may take 2 to 4 weeks to notice an improvement in mood."
,2
C. "The full therapeutic effect may take 6 to 8 weeks."
D. "You will notice a difference after the first dose."
Answer: B. "It may take 2 to 4 weeks to notice an improvement in mood."
Rationale: SSRIs typically require 2 to 4 weeks to begin producing noticeable improvements in mood,
with full therapeutic effects often taking 6 to 8 weeks. Patients should be educated about this delay to
prevent premature discontinuation.
4. A patient with MDD is started on fluoxetine. The nurse should educate the patient about which
common side effect?
A. Weight gain
B. Sexual dysfunction
C. Hypertension
D. Urinary retention
Answer: B. Sexual dysfunction
Rationale: Sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia, is a
common side effect of SSRIs. Patients should be informed that this side effect may occur and encouraged
to discuss any concerns with their provider rather than discontinuing the medication abruptly.
5. A nurse is assessing a patient with depression. Which of the following findings would be considered
a somatic symptom of depression?
A. Auditory hallucinations
B. Flight of ideas
C. Chronic fatigue and unexplained aches
D. Grandiose delusions
Answer: C. Chronic fatigue and unexplained aches
Rationale: Somatic symptoms of depression include physical complaints such as fatigue, headaches, back
pain, and gastrointestinal disturbances. These symptoms are often the primary reason patients with
depression seek medical care.
6. A patient taking phenelzine (Nardil), an MAOI, asks the nurse about dietary restrictions. Which food
should the nurse instruct the patient to avoid?
A. Fresh apples
B. Aged cheese
C. White bread
D. Grilled chicken
,3
Answer: B. Aged cheese
Rationale: MAOIs interact with tyramine-rich foods, potentially causing a hypertensive crisis. Aged
cheese, cured meats, fermented foods, and red wine are high in tyramine and must be avoided.
7. A nurse is caring for a patient who has been taking sertraline for 6 months and reports feeling
"much better." The patient asks if they can stop taking the medication. What is the nurse's best
response?
A. "You can stop taking it immediately since you're feeling better."
B. "You should continue the medication for at least 6 more months to prevent relapse."
C. "You can taper off the medication by taking it every other day."
D. "You should double your dose for a few weeks before stopping."
Answer: B. "You should continue the medication for at least 6 more months to prevent relapse."
Rationale: After achieving remission, antidepressant therapy should continue for at least 6 to 12 months
to prevent relapse. Discontinuation should be gradual and under medical supervision to avoid
withdrawal symptoms.
8. A patient with MDD is being evaluated for suicidal ideation. Which question is most appropriate for
the nurse to ask?
A. "You're not thinking about suicide, are you?"
B. "Do you have a plan to harm yourself?"
C. "Why would you want to hurt yourself?"
D. "You have so much to live for, don't you?"
Answer: B. "Do you have a plan to harm yourself?"
Rationale: Direct, non-judgmental questions about suicidal ideation, plan, and intent are essential for
safety assessment. Asking about a specific plan helps determine the level of risk and guides immediate
interventions.
9. Which of the following is a risk factor for major depressive disorder?
A. Male gender
B. Married status
C. Female gender
D. High socioeconomic status
Answer: C. Female gender
, 4
Rationale: The incidence of depressive disorders is greater in women than in men by a ratio of almost 2
to 1. Other risk factors include unmarried status, low socioeconomic status, and family history of
depression.
10. A nurse is providing education to a patient prescribed a tricyclic antidepressant (TCA). Which side
effect should the nurse prioritize in teaching?
A. Diarrhea
B. Orthostatic hypotension
C. Weight loss
D. Insomnia
Answer: B. Orthostatic hypotension
Rationale: TCAs cause significant anticholinergic effects and alpha-adrenergic blockade, leading to
orthostatic hypotension. Patients should be instructed to change positions slowly to prevent falls and
injuries.
11. A patient with depression is started on venlafaxine. The nurse should monitor for which adverse
effect?
A. Hypotension
B. Hypertension
C. Bradycardia
D. Hypoglycemia
Answer: B. Hypertension
Rationale: Venlafaxine, an SNRI, can increase blood pressure, especially at higher doses. Blood pressure
should be monitored regularly throughout treatment.
12. A patient with MDD reports that they have been taking St. John's Wort. The nurse should educate
the patient that:
A. St. John's Wort is safe to take with prescription antidepressants.
B. St. John's Wort can increase the risk of serotonin syndrome when combined with SSRIs.
C. St. John's Wort has no effect on depression.
D. St. John's Wort should be taken with food to prevent GI upset.
Answer: B. St. John's Wort can increase the risk of serotonin syndrome when combined with SSRIs.
Rationale: St. John's Wort has serotonergic effects and can lead to serotonin syndrome when combined
with prescription antidepressants. Patients should be advised to discontinue St. John's Wort and consult
their provider before starting any herbal supplements.
