NSG221 Exam 4 - Mental Health Nursing Review (2026/2027) Herzing University
NSG 221 Exam 4
Mental Health Nursing Review
Latest Update | Questions and Verified Answers | 100% Correct | Grade A
Herzing University | NSG221 Mental Health Nursing Course
Comprehensive Exam: 85 Questions across 8 Sections
Aligned with DSM-5-TR and Current Mental Health Practice Standards (2026-2027)
Exam Instructions: This examination contains 85 questions divided into 8 sections covering child/adolescent
mental health, geriatric neurocognitive disorders, psychopharmacology across the lifespan, crisis intervention,
legal/ethical issues, therapeutic modalities, community mental health, and NGN clinical judgment. Each question
has one best answer unless marked as NGN multiple-response. Rationales follow each question, citing DSM-5-TR
criteria, lifespan psychopharmacology, therapeutic modalities, legal/ethical principles, and Tanner's Clinical
Judgment Model where applicable. Cognitive distribution: 25% recall, 50% application, 25% analysis.
Section 1: Child and Adolescent Mental Health
ADHD, Autism Spectrum Disorder, Conduct Disorder, & Oppositional Defiant Q1 - Q12
Disorder
Q1: A 7-year-old boy is brought to the clinic by his mother who reports he has difficulty sustaining
attention in classroom tasks, frequently loses school supplies, and avoids tasks requiring sustained
mental effort. The teacher reports he is easily distracted by extraneous stimuli. According to
DSM-5-TR criteria, which additional finding must be present to confirm a diagnosis of ADHD?
A. Symptoms present only at school and not at home
B. Onset of symptoms before age 12 with impairment in two or more settings [CORRECT]
C. Symptoms occurring exclusively during acute illness
D. Hyperactivity present only in structured environments
Correct Answer: B
Rationale:
DSM-5-TR requires ADHD symptoms to be present before age 12 (lowered from age 7 in DSM-IV) and cause
impairment in two or more settings (e.g., home and school). Option A is incorrect because cross-setting impairment is
required. Option C is incorrect because symptoms must not occur exclusively during illness. Option D is incorrect
because hyperactivity typically worsens in unstructured environments, not structured ones.
Q2: A nurse is educating the parents of a 9-year-old child newly prescribed methylphenidate (Ritalin)
for ADHD. Which statement by the parent indicates the need for further teaching?
A. "I will give the medication with breakfast to minimize appetite suppression."
B. "I should expect my child to gain weight rapidly in the first month." [CORRECT]
C. "We will monitor height and weight regularly during treatment."
D. "I will report any new tics or repetitive movements to the provider."
Correct Answer: B
Rationale:
Verified Answers | Grade A | NSG221 Page 1
,NSG221 Exam 4 - Mental Health Nursing Review (2026/2027) Herzing University
Stimulant medications like methylphenidate commonly cause appetite suppression and weight loss, not weight gain.
Growth monitoring is essential because stimulants may slow growth velocity. Giving the medication with breakfast
reduces appetite suppression at lunch. New-onset tics warrant provider notification because stimulants can unmask tic
disorders. The parent's expectation of rapid weight gain signals misunderstanding.
Q3: A 10-year-old child with ADHD has been prescribed a non-stimulant medication after developing
tics on methylphenidate. The provider orders atomoxetine. Which nursing consideration is most
important when initiating this medication?
A. Therapeutic effects are typically seen within 24 to 48 hours
B. Monitor for suicidal ideation, especially during the first weeks of therapy [CORRECT]
C. The medication has high abuse potential and is a Schedule II drug
D. Liver function tests are not required at any point during therapy
Correct Answer: B
Rationale:
Atomoxetine carries an FDA black box warning for suicidal ideation in children and adolescents, particularly during
the first weeks of therapy and after dose changes. Therapeutic effects take 4-6 weeks to manifest, not 24-48 hours.
Unlike stimulants, atomoxetine is not a Schedule II drug and has low abuse potential. Hepatotoxicity is rare but
possible, so liver function should be monitored if jaundice or upper quadrant pain occurs.
Q4: A 4-year-old child with autism spectrum disorder (ASD) is hospitalized for dehydration. The child
covers their ears, rocks back and forth, and avoids eye contact when the nurse enters the room. Which
intervention by the nurse best demonstrates ASD-informed care?
A. Approach the child quickly while speaking in a high-pitched, animated tone
B. Insist on direct eye contact to establish a therapeutic relationship
C. Minimize environmental stimuli, use a quiet voice, and allow extra processing time [CORRECT]
D. Restrict the parents from the room to promote independence
Correct Answer: C
Rationale:
Children with ASD often experience sensory overload; minimizing stimuli, using a quiet voice, and allowing extra
processing time respects their neurologic differences. Forcing eye contact can increase anxiety. Approaching quickly
with animated tone overwhelms sensory systems. Family presence is highly therapeutic and should be encouraged, not
restricted, in pediatric care.
Q5: An 8-year-old with ASD repeatedly lines up toy cars and becomes extremely distressed if the
arrangement is altered. The parents ask the nurse why this behavior occurs. Which explanation is most
accurate according to DSM-5-TR criteria?
A. This behavior is a form of attention-seeking manipulation
B. It reflects restricted, repetitive patterns of behavior and insistence on sameness [CORRECT]
C. The child is exhibiting early signs of obsessive-compulsive disorder
D. This indicates oppositional defiant behavior requiring discipline
Correct Answer: B
Rationale:
DSM-5-TR criteria for ASD include restricted, repetitive patterns of behavior, interests, or activities, including
insistence on sameness and inflexible adherence to routines. This is a core diagnostic feature, not attention-seeking,
OCD, or oppositional behavior. The distress when routines change reflects the child's need for predictability to
manage a confusing sensory and social world.
Verified Answers | Grade A | NSG221 Page 2
, NSG221 Exam 4 - Mental Health Nursing Review (2026/2027) Herzing University
Q6: A nurse is using the Picture Exchange Communication System (PECS) with a nonverbal
5-year-old with ASD. Which statement best describes the primary purpose of this intervention?
A. To cure the child's autism by age 6
B. To teach functional communication by exchanging pictures for desired items [CORRECT]
C. To replace all spoken language permanently
D. To discipline the child for nonverbal behavior
Correct Answer: B
Rationale:
PECS is an evidence-based augmentative and alternative communication (AAC) system that teaches children with
ASD to initiate communication by exchanging pictures for desired objects or activities. It does not cure autism nor
permanently replace speech; many children develop spoken language alongside PECS. It is a therapeutic
communication tool, not a disciplinary measure.
Q7: A 13-year-old adolescent presents with a 3-year history of aggression toward people and animals,
destruction of property, deceitfulness, theft, and serious violation of rules. The nurse suspects conduct
disorder (CD). Which DSM-5-TR specifier is most appropriate if the symptoms began at age 10?
A. Childhood-onset type
B. Adolescent-onset type [CORRECT]
C. Unspecified onset
D. With limited prosocial emotions
Correct Answer: B
Rationale:
DSM-5-TR classifies conduct disorder as childhood-onset (at least one symptom before age 10) or adolescent-onset
(no symptoms before age 10). Since this adolescent's symptoms began at age 10, the specifier is adolescent-onset
type. The 'with limited prosocial emotions' specifier requires two specific characteristics (lack of remorse or
empathy, shallow affect) persisting for 12+ months and is not established by onset alone.
Q8: When differentiating oppositional defiant disorder (ODD) from conduct disorder (CD), which
feature is characteristic of ODD but NOT CD?
A. Destruction of property and physical cruelty to animals
B. Angry/irritable mood, argumentative/defiant behavior, and vindictiveness without serious violations
of others' rights [CORRECT]
C. Theft, burglary, and forced sexual activity
D. Pattern of deliberately setting fires
Correct Answer: B
Rationale:
ODD is characterized by angry/irritable mood, argumentative/defiant behavior, and vindictiveness lasting at least 6
months, WITHOUT serious aggression toward people or animals, destruction of property, theft, or serious rule
violations. Those severe behaviors are diagnostic of CD. The key distinction is whether the youth violates the basic
rights of others or major societal norms.
Q9: A 12-year-old with ODD is participating in family therapy. The therapist uses Parent Management
Training (PMT). Which nursing action best supports this therapeutic modality?
A. Encourage the parents to use physical discipline consistently
B. Coach parents to reinforce positive behaviors with specific praise and use consistent, non-physical
consequences [CORRECT]
C. Recommend the child be removed from the home immediately
D. Advise the parents to argue in front of the child to model conflict resolution
Verified Answers | Grade A | NSG221 Page 3
NSG 221 Exam 4
Mental Health Nursing Review
Latest Update | Questions and Verified Answers | 100% Correct | Grade A
Herzing University | NSG221 Mental Health Nursing Course
Comprehensive Exam: 85 Questions across 8 Sections
Aligned with DSM-5-TR and Current Mental Health Practice Standards (2026-2027)
Exam Instructions: This examination contains 85 questions divided into 8 sections covering child/adolescent
mental health, geriatric neurocognitive disorders, psychopharmacology across the lifespan, crisis intervention,
legal/ethical issues, therapeutic modalities, community mental health, and NGN clinical judgment. Each question
has one best answer unless marked as NGN multiple-response. Rationales follow each question, citing DSM-5-TR
criteria, lifespan psychopharmacology, therapeutic modalities, legal/ethical principles, and Tanner's Clinical
Judgment Model where applicable. Cognitive distribution: 25% recall, 50% application, 25% analysis.
Section 1: Child and Adolescent Mental Health
ADHD, Autism Spectrum Disorder, Conduct Disorder, & Oppositional Defiant Q1 - Q12
Disorder
Q1: A 7-year-old boy is brought to the clinic by his mother who reports he has difficulty sustaining
attention in classroom tasks, frequently loses school supplies, and avoids tasks requiring sustained
mental effort. The teacher reports he is easily distracted by extraneous stimuli. According to
DSM-5-TR criteria, which additional finding must be present to confirm a diagnosis of ADHD?
A. Symptoms present only at school and not at home
B. Onset of symptoms before age 12 with impairment in two or more settings [CORRECT]
C. Symptoms occurring exclusively during acute illness
D. Hyperactivity present only in structured environments
Correct Answer: B
Rationale:
DSM-5-TR requires ADHD symptoms to be present before age 12 (lowered from age 7 in DSM-IV) and cause
impairment in two or more settings (e.g., home and school). Option A is incorrect because cross-setting impairment is
required. Option C is incorrect because symptoms must not occur exclusively during illness. Option D is incorrect
because hyperactivity typically worsens in unstructured environments, not structured ones.
Q2: A nurse is educating the parents of a 9-year-old child newly prescribed methylphenidate (Ritalin)
for ADHD. Which statement by the parent indicates the need for further teaching?
A. "I will give the medication with breakfast to minimize appetite suppression."
B. "I should expect my child to gain weight rapidly in the first month." [CORRECT]
C. "We will monitor height and weight regularly during treatment."
D. "I will report any new tics or repetitive movements to the provider."
Correct Answer: B
Rationale:
Verified Answers | Grade A | NSG221 Page 1
,NSG221 Exam 4 - Mental Health Nursing Review (2026/2027) Herzing University
Stimulant medications like methylphenidate commonly cause appetite suppression and weight loss, not weight gain.
Growth monitoring is essential because stimulants may slow growth velocity. Giving the medication with breakfast
reduces appetite suppression at lunch. New-onset tics warrant provider notification because stimulants can unmask tic
disorders. The parent's expectation of rapid weight gain signals misunderstanding.
Q3: A 10-year-old child with ADHD has been prescribed a non-stimulant medication after developing
tics on methylphenidate. The provider orders atomoxetine. Which nursing consideration is most
important when initiating this medication?
A. Therapeutic effects are typically seen within 24 to 48 hours
B. Monitor for suicidal ideation, especially during the first weeks of therapy [CORRECT]
C. The medication has high abuse potential and is a Schedule II drug
D. Liver function tests are not required at any point during therapy
Correct Answer: B
Rationale:
Atomoxetine carries an FDA black box warning for suicidal ideation in children and adolescents, particularly during
the first weeks of therapy and after dose changes. Therapeutic effects take 4-6 weeks to manifest, not 24-48 hours.
Unlike stimulants, atomoxetine is not a Schedule II drug and has low abuse potential. Hepatotoxicity is rare but
possible, so liver function should be monitored if jaundice or upper quadrant pain occurs.
Q4: A 4-year-old child with autism spectrum disorder (ASD) is hospitalized for dehydration. The child
covers their ears, rocks back and forth, and avoids eye contact when the nurse enters the room. Which
intervention by the nurse best demonstrates ASD-informed care?
A. Approach the child quickly while speaking in a high-pitched, animated tone
B. Insist on direct eye contact to establish a therapeutic relationship
C. Minimize environmental stimuli, use a quiet voice, and allow extra processing time [CORRECT]
D. Restrict the parents from the room to promote independence
Correct Answer: C
Rationale:
Children with ASD often experience sensory overload; minimizing stimuli, using a quiet voice, and allowing extra
processing time respects their neurologic differences. Forcing eye contact can increase anxiety. Approaching quickly
with animated tone overwhelms sensory systems. Family presence is highly therapeutic and should be encouraged, not
restricted, in pediatric care.
Q5: An 8-year-old with ASD repeatedly lines up toy cars and becomes extremely distressed if the
arrangement is altered. The parents ask the nurse why this behavior occurs. Which explanation is most
accurate according to DSM-5-TR criteria?
A. This behavior is a form of attention-seeking manipulation
B. It reflects restricted, repetitive patterns of behavior and insistence on sameness [CORRECT]
C. The child is exhibiting early signs of obsessive-compulsive disorder
D. This indicates oppositional defiant behavior requiring discipline
Correct Answer: B
Rationale:
DSM-5-TR criteria for ASD include restricted, repetitive patterns of behavior, interests, or activities, including
insistence on sameness and inflexible adherence to routines. This is a core diagnostic feature, not attention-seeking,
OCD, or oppositional behavior. The distress when routines change reflects the child's need for predictability to
manage a confusing sensory and social world.
Verified Answers | Grade A | NSG221 Page 2
, NSG221 Exam 4 - Mental Health Nursing Review (2026/2027) Herzing University
Q6: A nurse is using the Picture Exchange Communication System (PECS) with a nonverbal
5-year-old with ASD. Which statement best describes the primary purpose of this intervention?
A. To cure the child's autism by age 6
B. To teach functional communication by exchanging pictures for desired items [CORRECT]
C. To replace all spoken language permanently
D. To discipline the child for nonverbal behavior
Correct Answer: B
Rationale:
PECS is an evidence-based augmentative and alternative communication (AAC) system that teaches children with
ASD to initiate communication by exchanging pictures for desired objects or activities. It does not cure autism nor
permanently replace speech; many children develop spoken language alongside PECS. It is a therapeutic
communication tool, not a disciplinary measure.
Q7: A 13-year-old adolescent presents with a 3-year history of aggression toward people and animals,
destruction of property, deceitfulness, theft, and serious violation of rules. The nurse suspects conduct
disorder (CD). Which DSM-5-TR specifier is most appropriate if the symptoms began at age 10?
A. Childhood-onset type
B. Adolescent-onset type [CORRECT]
C. Unspecified onset
D. With limited prosocial emotions
Correct Answer: B
Rationale:
DSM-5-TR classifies conduct disorder as childhood-onset (at least one symptom before age 10) or adolescent-onset
(no symptoms before age 10). Since this adolescent's symptoms began at age 10, the specifier is adolescent-onset
type. The 'with limited prosocial emotions' specifier requires two specific characteristics (lack of remorse or
empathy, shallow affect) persisting for 12+ months and is not established by onset alone.
Q8: When differentiating oppositional defiant disorder (ODD) from conduct disorder (CD), which
feature is characteristic of ODD but NOT CD?
A. Destruction of property and physical cruelty to animals
B. Angry/irritable mood, argumentative/defiant behavior, and vindictiveness without serious violations
of others' rights [CORRECT]
C. Theft, burglary, and forced sexual activity
D. Pattern of deliberately setting fires
Correct Answer: B
Rationale:
ODD is characterized by angry/irritable mood, argumentative/defiant behavior, and vindictiveness lasting at least 6
months, WITHOUT serious aggression toward people or animals, destruction of property, theft, or serious rule
violations. Those severe behaviors are diagnostic of CD. The key distinction is whether the youth violates the basic
rights of others or major societal norms.
Q9: A 12-year-old with ODD is participating in family therapy. The therapist uses Parent Management
Training (PMT). Which nursing action best supports this therapeutic modality?
A. Encourage the parents to use physical discipline consistently
B. Coach parents to reinforce positive behaviors with specific praise and use consistent, non-physical
consequences [CORRECT]
C. Recommend the child be removed from the home immediately
D. Advise the parents to argue in front of the child to model conflict resolution
Verified Answers | Grade A | NSG221 Page 3
