NSG 3450 / NSG3450 Nursing Practice Mental Health
Exam 4 Review Actual 2025/2026 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Mood & Affective Disorders (12 Questions)
Q1: A patient diagnosed with major depressive disorder states, "I don't see any point
in getting out of bed anymore." Which nursing response demonstrates the
therapeutic use of self?
A. "You should try to get up; staying in bed will only make you feel worse."
B. "I know exactly how you feel; I get sad sometimes too."
C. "It sounds like you're feeling hopeless right now. Tell me more about that."
D. "Have you talked to your doctor about increasing your medication?"
Correct Answer: C
Rationale: Correct because reflecting the patient's feelings and using open-ended
communication invites further expression and validates the patient's experience
without minimizing or offering false reassurance.
Q2: A nurse is assessing a patient with bipolar I disorder who is currently in a manic
episode. Which behavior is most consistent with this phase?
A. Sleeping 10 hours per night and refusing meals
B. Speaking rapidly, jumping between topics, and spending excessive money
,C. Sitting alone in the corner and refusing to make eye contact
D. Reporting chronic low mood for the past two years
Correct Answer: B
Rationale: Correct because manic episodes are characterized by elevated or irritable
mood, increased energy, decreased need for sleep, pressured speech, racing
thoughts, and impaired judgment such as excessive spending.
Q3: A patient taking lithium carbonate for bipolar disorder presents with nausea,
vomiting, muscle weakness, and ataxia. The lithium level is 2.0 mEq/L. Which is the
nurse's priority action?
A. Administer the next scheduled dose with food
B. Hold the lithium and notify the provider immediately
C. Encourage increased fluid intake and recheck in one week
D. Administer an antiemetic and continue monitoring
Correct Answer: B
Rationale: Correct because lithium levels above 1.5 mEq/L indicate toxicity; a level of
2.0 mEq/L requires immediate discontinuation of the drug and provider notification
to prevent severe neurological and cardiac complications.
Q4: A patient with persistent depressive disorder (dysthymia) reports feeling "down"
for most of the day, nearly every day, for the past 3 years. Which additional symptom
is required for this diagnosis?
A. Episodes of extreme euphoria and grandiosity
B. Presence of two or more depressive symptoms such as poor appetite or fatigue
,C. Recurrent panic attacks with fear of dying
D. Flashbacks and nightmares related to trauma
Correct Answer: B
Rationale: Correct because persistent depressive disorder requires a depressed
mood lasting at least two years in adults with the presence of two or more additional
depressive symptoms such as poor appetite, sleep disturbance, fatigue, or low
self-esteem.
Q5: A nurse is caring for a patient who recently began taking phenelzine, an MAOI.
Which dietary instruction is most important for the nurse to reinforce?
A. Avoid aged cheeses, fermented foods, and cured meats
B. Increase intake of green leafy vegetables and vitamin K
C. Limit caffeine to no more than two cups of coffee daily
D. Take the medication with grapefruit juice to enhance absorption
Correct Answer: A
Rationale: Correct because MAOIs inhibit the breakdown of tyramine, and consuming
tyramine-rich foods such as aged cheeses, fermented foods, and cured meats can
precipitate a hypertensive crisis.
Q6: During a suicide risk assessment, a patient states, "I have been thinking about
death a lot, but I don't have a plan." Which level of suicide risk does this represent?
A. No risk; the patient denies having a plan
B. Low risk; the patient only has passive ideation
, C. Moderate risk; the patient has active ideation without a plan
D. High risk; any mention of suicide requires immediate intervention
Correct Answer: C
Rationale: Correct because active suicidal ideation without a specific plan or intent is
classified as moderate risk, requiring close monitoring and safety planning, though
not necessarily the highest level of precaution.
Q7: A patient is scheduled to receive electroconvulsive therapy (ECT) for severe,
treatment-resistant depression. Which pre-procedure nursing intervention is most
appropriate?
A. Instruct the patient to eat a full breakfast before the procedure
B. Administer an anticholinergic agent as ordered to reduce secretions
C. Encourage the patient to drink plenty of fluids to prevent dehydration
D. Apply a tourniquet to the extremities to prevent muscle injury
Correct Answer: B
Rationale: Correct because pre-ECT nursing care includes administering an
anticholinergic agent such as glycopyrrolate or atropine to reduce oral and
respiratory secretions and minimize the risk of aspiration during the procedure.
Q8: A patient with major depressive disorder has been taking fluoxetine for 2 weeks
and reports increased anxiety and insomnia. The nurse understands that:
A. These symptoms indicate the patient is experiencing serotonin syndrome
B. The patient is having an allergic reaction and the medication should be stopped
Exam 4 Review Actual 2025/2026 with Detailed
Rationales | 100% Verified | Pass Guaranteed – A+
Graded
SECTION 1: Mood & Affective Disorders (12 Questions)
Q1: A patient diagnosed with major depressive disorder states, "I don't see any point
in getting out of bed anymore." Which nursing response demonstrates the
therapeutic use of self?
A. "You should try to get up; staying in bed will only make you feel worse."
B. "I know exactly how you feel; I get sad sometimes too."
C. "It sounds like you're feeling hopeless right now. Tell me more about that."
D. "Have you talked to your doctor about increasing your medication?"
Correct Answer: C
Rationale: Correct because reflecting the patient's feelings and using open-ended
communication invites further expression and validates the patient's experience
without minimizing or offering false reassurance.
Q2: A nurse is assessing a patient with bipolar I disorder who is currently in a manic
episode. Which behavior is most consistent with this phase?
A. Sleeping 10 hours per night and refusing meals
B. Speaking rapidly, jumping between topics, and spending excessive money
,C. Sitting alone in the corner and refusing to make eye contact
D. Reporting chronic low mood for the past two years
Correct Answer: B
Rationale: Correct because manic episodes are characterized by elevated or irritable
mood, increased energy, decreased need for sleep, pressured speech, racing
thoughts, and impaired judgment such as excessive spending.
Q3: A patient taking lithium carbonate for bipolar disorder presents with nausea,
vomiting, muscle weakness, and ataxia. The lithium level is 2.0 mEq/L. Which is the
nurse's priority action?
A. Administer the next scheduled dose with food
B. Hold the lithium and notify the provider immediately
C. Encourage increased fluid intake and recheck in one week
D. Administer an antiemetic and continue monitoring
Correct Answer: B
Rationale: Correct because lithium levels above 1.5 mEq/L indicate toxicity; a level of
2.0 mEq/L requires immediate discontinuation of the drug and provider notification
to prevent severe neurological and cardiac complications.
Q4: A patient with persistent depressive disorder (dysthymia) reports feeling "down"
for most of the day, nearly every day, for the past 3 years. Which additional symptom
is required for this diagnosis?
A. Episodes of extreme euphoria and grandiosity
B. Presence of two or more depressive symptoms such as poor appetite or fatigue
,C. Recurrent panic attacks with fear of dying
D. Flashbacks and nightmares related to trauma
Correct Answer: B
Rationale: Correct because persistent depressive disorder requires a depressed
mood lasting at least two years in adults with the presence of two or more additional
depressive symptoms such as poor appetite, sleep disturbance, fatigue, or low
self-esteem.
Q5: A nurse is caring for a patient who recently began taking phenelzine, an MAOI.
Which dietary instruction is most important for the nurse to reinforce?
A. Avoid aged cheeses, fermented foods, and cured meats
B. Increase intake of green leafy vegetables and vitamin K
C. Limit caffeine to no more than two cups of coffee daily
D. Take the medication with grapefruit juice to enhance absorption
Correct Answer: A
Rationale: Correct because MAOIs inhibit the breakdown of tyramine, and consuming
tyramine-rich foods such as aged cheeses, fermented foods, and cured meats can
precipitate a hypertensive crisis.
Q6: During a suicide risk assessment, a patient states, "I have been thinking about
death a lot, but I don't have a plan." Which level of suicide risk does this represent?
A. No risk; the patient denies having a plan
B. Low risk; the patient only has passive ideation
, C. Moderate risk; the patient has active ideation without a plan
D. High risk; any mention of suicide requires immediate intervention
Correct Answer: C
Rationale: Correct because active suicidal ideation without a specific plan or intent is
classified as moderate risk, requiring close monitoring and safety planning, though
not necessarily the highest level of precaution.
Q7: A patient is scheduled to receive electroconvulsive therapy (ECT) for severe,
treatment-resistant depression. Which pre-procedure nursing intervention is most
appropriate?
A. Instruct the patient to eat a full breakfast before the procedure
B. Administer an anticholinergic agent as ordered to reduce secretions
C. Encourage the patient to drink plenty of fluids to prevent dehydration
D. Apply a tourniquet to the extremities to prevent muscle injury
Correct Answer: B
Rationale: Correct because pre-ECT nursing care includes administering an
anticholinergic agent such as glycopyrrolate or atropine to reduce oral and
respiratory secretions and minimize the risk of aspiration during the procedure.
Q8: A patient with major depressive disorder has been taking fluoxetine for 2 weeks
and reports increased anxiety and insomnia. The nurse understands that:
A. These symptoms indicate the patient is experiencing serotonin syndrome
B. The patient is having an allergic reaction and the medication should be stopped
