NSG221 Exam 3 – Mental Health Nursing (2026/2027) Herzing University – Grade A
NSG221 / NSG 221 Exam 3: Mental Health Review
Latest Update — Questions and Verified Answers
100% Correct • Grade A • Herzing University
Cognitive Distribution: 25% Recall • 50% Application • 25% Analysis • 80% Scenario-Based NGN Integration • 20% Direct
Recall
SECTION 1: Mood Disorders (Depression, Bipolar Disorder, Suicidality, &
Pharmacological Management)
Question Range: Q1 – Q15
Q1: A 42-year-old female presents with depressed mood, anhedonia, 5% unintentional weight loss over four
weeks, early-morning awakening, fatigue, feelings of worthlessness, and recurrent thoughts of death lasting
for the past 18 days. Perfusion, electrolytes, and TSH are within normal limits. Which DSM-5-TR finding is
essential to confirm the diagnosis of Major Depressive Disorder (MDD)?
A. Presence of at least five symptoms (including depressed mood or anhedonia) for a minimum of two
weeks [CORRECT]
B. A Hamilton Depression Rating Scale score of 20 or higher within the past week
C. Documented family history of major depression in a first-degree relative
D. A positive clinical response to a two-week trial of an SSRI
Correct Answer: A
Rationale: DSM-5-TR criteria for MDD require at least five depressive symptoms during the same two-week period,
with at least one being depressed mood or anhedonia, causing functional impairment and not attributable to a substance
or medical condition. The patient meets this threshold (symptoms present for 18 days, with depressed mood, anhedonia,
weight loss, insomnia, fatigue, worthlessness, and suicidal ideation). Option B describes a rating scale that supports but
does not establish the diagnosis, while family history (C) and SSRI response (D) are neither diagnostic nor required by
DSM-5-TR.
Q2: A patient is initiating fluoxetine (Prozac) 20 mg daily for major depressive disorder. Which teaching point
is most important for the nurse to include?
A. Therapeutic effects typically occur within 24 to 48 hours after the first dose
B. The medication should be discontinued as soon as mood improves to prevent dependence
C. Therapeutic effects may take four to six weeks to manifest; continue taking it as prescribed even if
symptomatic improvement is not yet apparent [CORRECT]
D. The primary side effect to expect is significant weight gain of 10 to 15 pounds within the first month
Correct Answer: C
Rationale: SSRIs such as fluoxetine require four to six weeks to achieve full therapeutic effect because they slowly
downregulate presynaptic serotonin autoreceptors and adapt postsynaptic receptor density. Premature discontinuation
(B) risks relapse and SSRI discontinuation syndrome, while (A) is pharmacologically inaccurate. Although fluoxetine is
more activating and less sedating than paroxetine, weight changes (D) are variable and typically mild; GI upset,
headache, and sexual dysfunction are far more common early adverse effects.
Page 1 • 80-Question Comprehensive Exam
,NSG221 Exam 3 – Mental Health Nursing (2026/2027) Herzing University – Grade A
Q3: A patient with bipolar I disorder is started on lithium carbonate 600 mg twice daily. The nurse should
monitor serum lithium levels to maintain which therapeutic range for maintenance therapy?
A. 0.3 to 0.8 mEq/L
B. 0.6 to 1.2 mEq/L [CORRECT]
C. 1.5 to 2.0 mEq/L
D. 2.0 to 2.5 mEq/L
Correct Answer: B
Rationale: The therapeutic maintenance range for lithium in adults with bipolar disorder is 0.6 to 1.2 mEq/L, with acute
mania sometimes requiring up to 1.5 mEq/L. Levels below 0.6 mEq/L (A) are subtherapeutic, while levels above 1.5
mEq/L (C) approach toxicity (coarse tremor, confusion, ataxia, GI upset), and levels at or above 2.0 mEq/L (D) reflect
severe toxicity that can progress to seizures, arrhythmias, and renal failure. Blood should be drawn 12 hours after the
last dose (trough) for accurate monitoring.
Q4: A 35-year-old patient with bipolar I disorder is experiencing an acute manic episode, exhibiting pressured
speech, hyperactivity, decreased need for sleep, and grandiose delusions. Which nursing intervention is the
highest priority?
A. Encourage active participation in competitive group therapy sessions to channel excess energy
B. Provide a low-stimulation environment with reduced lighting and limited environmental stimuli to
decrease agitation and prevent exhaustion [CORRECT]
C. Engage the patient in lengthy decision-making discussions about long-term medication adherence
D. Insist the patient adhere to the unit's full daily schedule of structured activities
Correct Answer: B
Rationale: During acute mania, patients are highly distractible and overstimulated, and environmental stimuli escalate
agitation, sleep disruption, and exhaustion. A low-stimulation environment with consistent routines, reduced lighting,
soft voices, and short interactions is the priority. Group activities (A) and lengthy psychoeducation (C) overtax
cognitive capacity during mania and should be deferred to the recovery phase. Forcing adherence to a full schedule (D)
is unrealistic and may provoke aggression.
Q5: A 28-year-old patient with depression is admitted after expressing suicidal ideation with a plan to
overdose on medications. Which assessment finding indicates the highest imminent suicide risk?
A. The patient has a history of one previous non-lethal attempt five years ago
B. The patient expresses pervasive hopelessness and has access to firearms in the home [CORRECT]
C. The patient reports occasional passive thoughts of death without a plan
D. The patient has a strong, supportive family and a steady job
Correct Answer: B
Rationale: Hopelessness is the strongest psychological predictor of completed suicide, and access to firearms is the
most lethal means. The combination of pervasive hopelessness plus immediate access to a lethal method (B) represents
the highest imminent risk. A prior attempt (A) increases baseline risk but is less acute than current intent plus lethal
means. Passive ideation without a plan (C) carries lower imminent risk, and protective factors such as social support and
employment (D) reduce overall risk.
Page 2 • 80-Question Comprehensive Exam
,NSG221 Exam 3 – Mental Health Nursing (2026/2027) Herzing University – Grade A
Q6: A patient taking phenelzine (Nardil), an MAOI, for atypical depression asks the nurse about dietary
restrictions. Which food choice indicates the patient needs further teaching?
A. Aged cheddar cheese and pepperoni pizza [CORRECT]
B. Fresh cottage cheese with sliced fruit
C. Grilled chicken breast with steamed rice
D. Mixed green salad with vinaigrette dressing
Correct Answer: A
Rationale: MAOIs irreversibly inhibit monoamine oxidase, the enzyme that metabolizes tyramine in the gut. Ingestion
of tyramine-rich foods (aged cheeses, cured meats, fermented soy products, smoked fish, certain beers, and red wine)
can precipitate a hypertensive crisis characterized by severe headache, hypertension, chest pain, and possible stroke.
Cottage cheese, fresh fruits, poultry, and salads (B, C, D) are low in tyramine and safe. The patient selecting aged
cheddar and pepperoni pizza (A) requires reinforced teaching.
Q7: A nurse is assessing a 68-year-old patient with new-onset depressive symptoms. Which manifestation is
most consistent with how depression often presents in older adults?
A. Increased energy, agitation, and euphoric mood
B. Somatic complaints such as pain, fatigue, and cognitive changes; rarely a verbalized complaint of
sadness [CORRECT]
C. A classic complaint of 'feeling sad' identical to younger adult presentations
D. Increased appetite and significant weight gain
Correct Answer: B
Rationale: Depression in older adults frequently presents atypically with somatic complaints (unexplained pain,
fatigue, gastrointestinal symptoms), cognitive changes that mimic dementia (sometimes called 'pseudodementia'), and
reduced engagement, rather than the classic sad mood reported by younger adults. This is why depression is
underdiagnosed in the elderly. Options A and D describe manic or atypical features inconsistent with this presentation.
The nurse should screen all older adults with new somatic or cognitive complaints for depression.
Q8: A patient on lithium therapy presents with coarse tremor, confusion, ataxia, muscle fasciculations,
vomiting, and diarrhea. The serum lithium level is 2.2 mEq/L (drawn 12 hours post-dose). The priority
nursing action is to:
A. Administer the next scheduled dose and recheck the level in 12 hours
B. Hold the lithium, stop any diuretics, initiate IV hydration, and notify the provider immediately
[CORRECT]
C. Encourage increased oral fluid intake with caffeinated beverages and continue therapy
D. Document the findings as expected side effects and reassess in the morning
Correct Answer: B
Rationale: A lithium level of 2.2 mEq/L with neurologic and GI symptoms reflects moderate to severe toxicity. The
priority is to hold the drug, ensure IV hydration with normal saline to enhance renal lithium excretion, and notify the
provider immediately; hemodialysis may be required for levels above 2.5 mEq/L with severe symptoms or renal
impairment. Administering further doses (A) and caffeine (C, which lowers lithium clearance) would worsen toxicity,
and (D) delays critical intervention. Loop diuretics, NSAIDs, ACE inhibitors, and dehydration commonly precipitate
toxicity.
Page 3 • 80-Question Comprehensive Exam
, NSG221 Exam 3 – Mental Health Nursing (2026/2027) Herzing University – Grade A
Q9: A patient is scheduled for the sixth electroconvulsive therapy (ECT) treatment for severe
treatment-resistant depression with psychotic features. Which nursing intervention is most important in the
immediate post-procedure period?
A. Encourage early ambulation to prevent deep vein thrombosis
B. Monitor airway patency, vital signs, level of consciousness, and reorientation [CORRECT]
C. Provide a full meal to restore energy depleted by seizure activity
D. Engage the patient immediately in cognitive remediation tasks
Correct Answer: B
Rationale: ECT uses general anesthesia and a brief induced seizure. The immediate postictal period carries airway,
respiratory, cardiovascular, and cognitive risks. The nurse must prioritize airway patency, vital signs, continuous pulse
oximetry, and reorientation because patients are disoriented for 10 to 30 minutes post-treatment. Aspiration risk
precludes a full meal (C) until full alertness and gag reflex return. Ambulation (A) and cognitive tasks (D) are deferred
until the patient is fully oriented.
Q10: A patient in acute mania approaches the nurse and says, 'I just bought three new cars and I'm flying to
Vegas tonight to marry a billionaire I just met!' Which response demonstrates the most therapeutic
communication?
A. 'That sounds unrealistic and grandiose. You need to slow down and think this through.'
B. 'I can see you have lots of energy and big plans right now. Let's go to a quieter room and talk about
how you're feeling.' [CORRECT]
C. 'You shouldn't make such big decisions while you're in the hospital. We need to stop you.'
D. 'Why would you want to marry someone you just met? That doesn't make any sense.'
Correct Answer: B
Rationale: Therapeutic communication during mania uses a calm, nonjudgmental, redirecting approach that
acknowledges the patient's experience without validating the delusional content or arguing. Option B acknowledges
energy and redirects to a low-stimulus setting. Option A argues with the delusion and is confrontational, option C is
directive and controlling without offering an alternative, and option D asks a 'why' question that the patient cannot
meaningfully process while manic and may provoke agitation.
Q11: A patient is prescribed venlafaxine (Effexor XR) for major depressive disorder. Which adverse effect
requires close monitoring, particularly in patients with pre-existing hypertension?
A. Sedation and weight gain of 5 to 10 pounds
B. Dose-dependent increase in blood pressure due to norepinephrine reuptake inhibition [CORRECT]
C. QT prolongation on electrocardiogram requiring annual ECG
D. Increased risk of hepatotoxicity requiring monthly LFTs
Correct Answer: B
Rationale: Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). At doses above 150 to 225 mg/day,
norepinephrine reuptake inhibition becomes clinically significant and can produce sustained diastolic hypertension,
particularly in patients with pre-existing hypertension. Baseline and periodic BP monitoring is mandatory. Sedation and
weight gain (A) are more typical of mirtazapine; QT prolongation (C) is associated with certain TCAs and ziprasidone;
hepatotoxicity (D) is more characteristic of nefazodone, not venlafaxine.
Page 4 • 80-Question Comprehensive Exam
NSG221 / NSG 221 Exam 3: Mental Health Review
Latest Update — Questions and Verified Answers
100% Correct • Grade A • Herzing University
Cognitive Distribution: 25% Recall • 50% Application • 25% Analysis • 80% Scenario-Based NGN Integration • 20% Direct
Recall
SECTION 1: Mood Disorders (Depression, Bipolar Disorder, Suicidality, &
Pharmacological Management)
Question Range: Q1 – Q15
Q1: A 42-year-old female presents with depressed mood, anhedonia, 5% unintentional weight loss over four
weeks, early-morning awakening, fatigue, feelings of worthlessness, and recurrent thoughts of death lasting
for the past 18 days. Perfusion, electrolytes, and TSH are within normal limits. Which DSM-5-TR finding is
essential to confirm the diagnosis of Major Depressive Disorder (MDD)?
A. Presence of at least five symptoms (including depressed mood or anhedonia) for a minimum of two
weeks [CORRECT]
B. A Hamilton Depression Rating Scale score of 20 or higher within the past week
C. Documented family history of major depression in a first-degree relative
D. A positive clinical response to a two-week trial of an SSRI
Correct Answer: A
Rationale: DSM-5-TR criteria for MDD require at least five depressive symptoms during the same two-week period,
with at least one being depressed mood or anhedonia, causing functional impairment and not attributable to a substance
or medical condition. The patient meets this threshold (symptoms present for 18 days, with depressed mood, anhedonia,
weight loss, insomnia, fatigue, worthlessness, and suicidal ideation). Option B describes a rating scale that supports but
does not establish the diagnosis, while family history (C) and SSRI response (D) are neither diagnostic nor required by
DSM-5-TR.
Q2: A patient is initiating fluoxetine (Prozac) 20 mg daily for major depressive disorder. Which teaching point
is most important for the nurse to include?
A. Therapeutic effects typically occur within 24 to 48 hours after the first dose
B. The medication should be discontinued as soon as mood improves to prevent dependence
C. Therapeutic effects may take four to six weeks to manifest; continue taking it as prescribed even if
symptomatic improvement is not yet apparent [CORRECT]
D. The primary side effect to expect is significant weight gain of 10 to 15 pounds within the first month
Correct Answer: C
Rationale: SSRIs such as fluoxetine require four to six weeks to achieve full therapeutic effect because they slowly
downregulate presynaptic serotonin autoreceptors and adapt postsynaptic receptor density. Premature discontinuation
(B) risks relapse and SSRI discontinuation syndrome, while (A) is pharmacologically inaccurate. Although fluoxetine is
more activating and less sedating than paroxetine, weight changes (D) are variable and typically mild; GI upset,
headache, and sexual dysfunction are far more common early adverse effects.
Page 1 • 80-Question Comprehensive Exam
,NSG221 Exam 3 – Mental Health Nursing (2026/2027) Herzing University – Grade A
Q3: A patient with bipolar I disorder is started on lithium carbonate 600 mg twice daily. The nurse should
monitor serum lithium levels to maintain which therapeutic range for maintenance therapy?
A. 0.3 to 0.8 mEq/L
B. 0.6 to 1.2 mEq/L [CORRECT]
C. 1.5 to 2.0 mEq/L
D. 2.0 to 2.5 mEq/L
Correct Answer: B
Rationale: The therapeutic maintenance range for lithium in adults with bipolar disorder is 0.6 to 1.2 mEq/L, with acute
mania sometimes requiring up to 1.5 mEq/L. Levels below 0.6 mEq/L (A) are subtherapeutic, while levels above 1.5
mEq/L (C) approach toxicity (coarse tremor, confusion, ataxia, GI upset), and levels at or above 2.0 mEq/L (D) reflect
severe toxicity that can progress to seizures, arrhythmias, and renal failure. Blood should be drawn 12 hours after the
last dose (trough) for accurate monitoring.
Q4: A 35-year-old patient with bipolar I disorder is experiencing an acute manic episode, exhibiting pressured
speech, hyperactivity, decreased need for sleep, and grandiose delusions. Which nursing intervention is the
highest priority?
A. Encourage active participation in competitive group therapy sessions to channel excess energy
B. Provide a low-stimulation environment with reduced lighting and limited environmental stimuli to
decrease agitation and prevent exhaustion [CORRECT]
C. Engage the patient in lengthy decision-making discussions about long-term medication adherence
D. Insist the patient adhere to the unit's full daily schedule of structured activities
Correct Answer: B
Rationale: During acute mania, patients are highly distractible and overstimulated, and environmental stimuli escalate
agitation, sleep disruption, and exhaustion. A low-stimulation environment with consistent routines, reduced lighting,
soft voices, and short interactions is the priority. Group activities (A) and lengthy psychoeducation (C) overtax
cognitive capacity during mania and should be deferred to the recovery phase. Forcing adherence to a full schedule (D)
is unrealistic and may provoke aggression.
Q5: A 28-year-old patient with depression is admitted after expressing suicidal ideation with a plan to
overdose on medications. Which assessment finding indicates the highest imminent suicide risk?
A. The patient has a history of one previous non-lethal attempt five years ago
B. The patient expresses pervasive hopelessness and has access to firearms in the home [CORRECT]
C. The patient reports occasional passive thoughts of death without a plan
D. The patient has a strong, supportive family and a steady job
Correct Answer: B
Rationale: Hopelessness is the strongest psychological predictor of completed suicide, and access to firearms is the
most lethal means. The combination of pervasive hopelessness plus immediate access to a lethal method (B) represents
the highest imminent risk. A prior attempt (A) increases baseline risk but is less acute than current intent plus lethal
means. Passive ideation without a plan (C) carries lower imminent risk, and protective factors such as social support and
employment (D) reduce overall risk.
Page 2 • 80-Question Comprehensive Exam
,NSG221 Exam 3 – Mental Health Nursing (2026/2027) Herzing University – Grade A
Q6: A patient taking phenelzine (Nardil), an MAOI, for atypical depression asks the nurse about dietary
restrictions. Which food choice indicates the patient needs further teaching?
A. Aged cheddar cheese and pepperoni pizza [CORRECT]
B. Fresh cottage cheese with sliced fruit
C. Grilled chicken breast with steamed rice
D. Mixed green salad with vinaigrette dressing
Correct Answer: A
Rationale: MAOIs irreversibly inhibit monoamine oxidase, the enzyme that metabolizes tyramine in the gut. Ingestion
of tyramine-rich foods (aged cheeses, cured meats, fermented soy products, smoked fish, certain beers, and red wine)
can precipitate a hypertensive crisis characterized by severe headache, hypertension, chest pain, and possible stroke.
Cottage cheese, fresh fruits, poultry, and salads (B, C, D) are low in tyramine and safe. The patient selecting aged
cheddar and pepperoni pizza (A) requires reinforced teaching.
Q7: A nurse is assessing a 68-year-old patient with new-onset depressive symptoms. Which manifestation is
most consistent with how depression often presents in older adults?
A. Increased energy, agitation, and euphoric mood
B. Somatic complaints such as pain, fatigue, and cognitive changes; rarely a verbalized complaint of
sadness [CORRECT]
C. A classic complaint of 'feeling sad' identical to younger adult presentations
D. Increased appetite and significant weight gain
Correct Answer: B
Rationale: Depression in older adults frequently presents atypically with somatic complaints (unexplained pain,
fatigue, gastrointestinal symptoms), cognitive changes that mimic dementia (sometimes called 'pseudodementia'), and
reduced engagement, rather than the classic sad mood reported by younger adults. This is why depression is
underdiagnosed in the elderly. Options A and D describe manic or atypical features inconsistent with this presentation.
The nurse should screen all older adults with new somatic or cognitive complaints for depression.
Q8: A patient on lithium therapy presents with coarse tremor, confusion, ataxia, muscle fasciculations,
vomiting, and diarrhea. The serum lithium level is 2.2 mEq/L (drawn 12 hours post-dose). The priority
nursing action is to:
A. Administer the next scheduled dose and recheck the level in 12 hours
B. Hold the lithium, stop any diuretics, initiate IV hydration, and notify the provider immediately
[CORRECT]
C. Encourage increased oral fluid intake with caffeinated beverages and continue therapy
D. Document the findings as expected side effects and reassess in the morning
Correct Answer: B
Rationale: A lithium level of 2.2 mEq/L with neurologic and GI symptoms reflects moderate to severe toxicity. The
priority is to hold the drug, ensure IV hydration with normal saline to enhance renal lithium excretion, and notify the
provider immediately; hemodialysis may be required for levels above 2.5 mEq/L with severe symptoms or renal
impairment. Administering further doses (A) and caffeine (C, which lowers lithium clearance) would worsen toxicity,
and (D) delays critical intervention. Loop diuretics, NSAIDs, ACE inhibitors, and dehydration commonly precipitate
toxicity.
Page 3 • 80-Question Comprehensive Exam
, NSG221 Exam 3 – Mental Health Nursing (2026/2027) Herzing University – Grade A
Q9: A patient is scheduled for the sixth electroconvulsive therapy (ECT) treatment for severe
treatment-resistant depression with psychotic features. Which nursing intervention is most important in the
immediate post-procedure period?
A. Encourage early ambulation to prevent deep vein thrombosis
B. Monitor airway patency, vital signs, level of consciousness, and reorientation [CORRECT]
C. Provide a full meal to restore energy depleted by seizure activity
D. Engage the patient immediately in cognitive remediation tasks
Correct Answer: B
Rationale: ECT uses general anesthesia and a brief induced seizure. The immediate postictal period carries airway,
respiratory, cardiovascular, and cognitive risks. The nurse must prioritize airway patency, vital signs, continuous pulse
oximetry, and reorientation because patients are disoriented for 10 to 30 minutes post-treatment. Aspiration risk
precludes a full meal (C) until full alertness and gag reflex return. Ambulation (A) and cognitive tasks (D) are deferred
until the patient is fully oriented.
Q10: A patient in acute mania approaches the nurse and says, 'I just bought three new cars and I'm flying to
Vegas tonight to marry a billionaire I just met!' Which response demonstrates the most therapeutic
communication?
A. 'That sounds unrealistic and grandiose. You need to slow down and think this through.'
B. 'I can see you have lots of energy and big plans right now. Let's go to a quieter room and talk about
how you're feeling.' [CORRECT]
C. 'You shouldn't make such big decisions while you're in the hospital. We need to stop you.'
D. 'Why would you want to marry someone you just met? That doesn't make any sense.'
Correct Answer: B
Rationale: Therapeutic communication during mania uses a calm, nonjudgmental, redirecting approach that
acknowledges the patient's experience without validating the delusional content or arguing. Option B acknowledges
energy and redirects to a low-stimulus setting. Option A argues with the delusion and is confrontational, option C is
directive and controlling without offering an alternative, and option D asks a 'why' question that the patient cannot
meaningfully process while manic and may provoke agitation.
Q11: A patient is prescribed venlafaxine (Effexor XR) for major depressive disorder. Which adverse effect
requires close monitoring, particularly in patients with pre-existing hypertension?
A. Sedation and weight gain of 5 to 10 pounds
B. Dose-dependent increase in blood pressure due to norepinephrine reuptake inhibition [CORRECT]
C. QT prolongation on electrocardiogram requiring annual ECG
D. Increased risk of hepatotoxicity requiring monthly LFTs
Correct Answer: B
Rationale: Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). At doses above 150 to 225 mg/day,
norepinephrine reuptake inhibition becomes clinically significant and can produce sustained diastolic hypertension,
particularly in patients with pre-existing hypertension. Baseline and periodic BP monitoring is mandatory. Sedation and
weight gain (A) are more typical of mirtazapine; QT prolongation (C) is associated with certain TCAs and ziprasidone;
hepatotoxicity (D) is more characteristic of nefazodone, not venlafaxine.
Page 4 • 80-Question Comprehensive Exam
