NR 547 PSYCHIATRIC–MENTAL HEALTH
NURSING PRACTICE
Exam 100 Original Practice Questions with Answers & Rationales
Section 1: Mood Disorders (Q1-12)
Q1. A client with major depressive disorder states, "Nothing matters anymore, I'm just a
burden." What is the nurse's priority action?
• A. Reassure the client that they are not a burden
• B. Assess for suicidal ideation directly
• C. Document the statement and continue the assessment
• D. Refer the client to social work
Correct Answer: B
Rationale: Statements about being a burden or hopelessness are red flags for suicidal ideation.
The nurse must directly and specifically assess for suicidal thoughts, plan, and intent before
anything else - indirect reassurance or deferring the assessment could miss an acute safety risk.
Q2. Which symptom cluster is most characteristic of a manic episode in bipolar I disorder?
• A. Flat affect, anhedonia, psychomotor retardation
• B. Grandiosity, decreased need for sleep, pressured speech
• C. Excessive worry, muscle tension, restlessness
• D. Disorganized speech, hallucinations, negative symptoms
Correct Answer: B
Rationale: Mania is defined by elevated/irritable mood plus symptoms like grandiosity, decreased
need for sleep, pressured speech, flight of ideas, and increased goal-directed activity. A is
depression, C is generalized anxiety, D is more typical of schizophrenia.
Q3. A client taking lithium reports nausea, vomiting, coarse hand tremors, and ataxia. What
is the nurse's priority?
• A. Administer an antiemetic and reassess in an hour
• B. Hold the next dose and check a lithium level immediately
• C. Encourage increased sodium intake
• D. Document as an expected side effect
Correct Answer: B
NR 547 Practice Exam | Page 1
,Rationale: These are signs of lithium toxicity, which can progress to seizures, coma, and death.
The nurse should hold the dose and obtain a stat lithium level; therapeutic range is roughly 0.6-1.2
mEq/L, and toxicity typically appears above 1.5 mEq/L.
Q4. Which teaching point is essential for a client newly started on lithium?
• A. "Restrict your fluid intake to prevent toxicity."
• B. "Maintain a consistent sodium intake and stay well hydrated."
• C. "Avoid all dairy products while taking this medication."
• D. "You may stop the medication once your mood stabilizes."
Correct Answer: B
Rationale: Sodium and fluid balance directly affect lithium levels - low sodium or dehydration
increases lithium reabsorption and raises the risk of toxicity. Clients should maintain stable,
adequate sodium and fluid intake, not restrict either.
Q5. A client with persistent depressive disorder (dysthymia) differs from major depressive
disorder primarily in which way?
• A. Symptoms are more severe
• B. Symptoms are chronic and lower-grade, lasting 2+ years
• C. Psychotic features are always present
• D. It only occurs in adolescents
Correct Answer: B
Rationale: Persistent depressive disorder involves a chronic, less severe depressed mood lasting
at least 2 years in adults (1 year in children/adolescents), as opposed to the more acute, episodic
presentation of major depressive disorder.
Q6. Which finding would be most concerning in a client recovering from a severe depressive
episode who is beginning to show improved energy?
• A. Improved appetite
• B. Increased engagement in unit activities
• C. Sudden calmness with a clear, organized plan discussed vaguely
• D. Reports of better sleep
Correct Answer: C
Rationale: A sudden lift in mood or calm after severe depression can indicate the client has made
a decision to attempt suicide and now has the energy to act on a plan. This paradoxical
improvement warrants immediate, thorough safety assessment.
Q7. Electroconvulsive therapy (ECT) is most strongly indicated for which client?
• A. A client with mild depression preferring not to take medication
• B. A client with severe, treatment-resistant depression with psychotic or catatonic features
• C. A client with generalized anxiety disorder
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, • D. A client with adjustment disorder
Correct Answer: B
Rationale: ECT is indicated for severe depression unresponsive to medication, depression with
psychotic or catatonic features, and situations requiring rapid response (e.g., acute suicidality,
refusal to eat/drink).
Q8. What is the most common post-ECT nursing concern in the immediate recovery period?
• A. Permanent memory loss
• B. Transient confusion and short-term memory impairment
• C. Seizure recurrence
• D. Hypertension requiring emergency treatment
Correct Answer: B
Rationale: Transient post-ictal confusion and short-term memory disturbance are the most
common effects immediately after ECT and typically resolve within hours to weeks.
Q9. A client with a history of major depression states, "I finally have a plan to end the pain - I
have enough pills saved up." What is this an example of?
• A. Suicidal ideation without a plan
• B. Suicidal ideation with a specific, lethal plan and means
• C. Passive death wish
• D. Non-suicidal self-injury
Correct Answer: B
Rationale: This statement includes both intent and a specific, accessible, lethal method - the
highest-risk combination requiring immediate intervention, likely including hospitalization and
removal of means.
Q10. Which medication class is considered first-line treatment for major depressive
disorder?
• A. Tricyclic antidepressants (TCAs)
• B. Monoamine oxidase inhibitors (MAOIs)
• C. Selective serotonin reuptake inhibitors (SSRIs)
• D. Typical antipsychotics
Correct Answer: C
Rationale: SSRIs are first-line due to a more favorable side effect profile and safety in overdose
compared to TCAs and MAOIs.
Q11. A client on an SSRI develops agitation, high fever, tremor, and diaphoresis after starting
a second serotonergic medication. This suggests:
• A. Neuroleptic malignant syndrome
• B. Serotonin syndrome
NR 547 Practice Exam | Page 3
NURSING PRACTICE
Exam 100 Original Practice Questions with Answers & Rationales
Section 1: Mood Disorders (Q1-12)
Q1. A client with major depressive disorder states, "Nothing matters anymore, I'm just a
burden." What is the nurse's priority action?
• A. Reassure the client that they are not a burden
• B. Assess for suicidal ideation directly
• C. Document the statement and continue the assessment
• D. Refer the client to social work
Correct Answer: B
Rationale: Statements about being a burden or hopelessness are red flags for suicidal ideation.
The nurse must directly and specifically assess for suicidal thoughts, plan, and intent before
anything else - indirect reassurance or deferring the assessment could miss an acute safety risk.
Q2. Which symptom cluster is most characteristic of a manic episode in bipolar I disorder?
• A. Flat affect, anhedonia, psychomotor retardation
• B. Grandiosity, decreased need for sleep, pressured speech
• C. Excessive worry, muscle tension, restlessness
• D. Disorganized speech, hallucinations, negative symptoms
Correct Answer: B
Rationale: Mania is defined by elevated/irritable mood plus symptoms like grandiosity, decreased
need for sleep, pressured speech, flight of ideas, and increased goal-directed activity. A is
depression, C is generalized anxiety, D is more typical of schizophrenia.
Q3. A client taking lithium reports nausea, vomiting, coarse hand tremors, and ataxia. What
is the nurse's priority?
• A. Administer an antiemetic and reassess in an hour
• B. Hold the next dose and check a lithium level immediately
• C. Encourage increased sodium intake
• D. Document as an expected side effect
Correct Answer: B
NR 547 Practice Exam | Page 1
,Rationale: These are signs of lithium toxicity, which can progress to seizures, coma, and death.
The nurse should hold the dose and obtain a stat lithium level; therapeutic range is roughly 0.6-1.2
mEq/L, and toxicity typically appears above 1.5 mEq/L.
Q4. Which teaching point is essential for a client newly started on lithium?
• A. "Restrict your fluid intake to prevent toxicity."
• B. "Maintain a consistent sodium intake and stay well hydrated."
• C. "Avoid all dairy products while taking this medication."
• D. "You may stop the medication once your mood stabilizes."
Correct Answer: B
Rationale: Sodium and fluid balance directly affect lithium levels - low sodium or dehydration
increases lithium reabsorption and raises the risk of toxicity. Clients should maintain stable,
adequate sodium and fluid intake, not restrict either.
Q5. A client with persistent depressive disorder (dysthymia) differs from major depressive
disorder primarily in which way?
• A. Symptoms are more severe
• B. Symptoms are chronic and lower-grade, lasting 2+ years
• C. Psychotic features are always present
• D. It only occurs in adolescents
Correct Answer: B
Rationale: Persistent depressive disorder involves a chronic, less severe depressed mood lasting
at least 2 years in adults (1 year in children/adolescents), as opposed to the more acute, episodic
presentation of major depressive disorder.
Q6. Which finding would be most concerning in a client recovering from a severe depressive
episode who is beginning to show improved energy?
• A. Improved appetite
• B. Increased engagement in unit activities
• C. Sudden calmness with a clear, organized plan discussed vaguely
• D. Reports of better sleep
Correct Answer: C
Rationale: A sudden lift in mood or calm after severe depression can indicate the client has made
a decision to attempt suicide and now has the energy to act on a plan. This paradoxical
improvement warrants immediate, thorough safety assessment.
Q7. Electroconvulsive therapy (ECT) is most strongly indicated for which client?
• A. A client with mild depression preferring not to take medication
• B. A client with severe, treatment-resistant depression with psychotic or catatonic features
• C. A client with generalized anxiety disorder
NR 547 Practice Exam | Page 2
, • D. A client with adjustment disorder
Correct Answer: B
Rationale: ECT is indicated for severe depression unresponsive to medication, depression with
psychotic or catatonic features, and situations requiring rapid response (e.g., acute suicidality,
refusal to eat/drink).
Q8. What is the most common post-ECT nursing concern in the immediate recovery period?
• A. Permanent memory loss
• B. Transient confusion and short-term memory impairment
• C. Seizure recurrence
• D. Hypertension requiring emergency treatment
Correct Answer: B
Rationale: Transient post-ictal confusion and short-term memory disturbance are the most
common effects immediately after ECT and typically resolve within hours to weeks.
Q9. A client with a history of major depression states, "I finally have a plan to end the pain - I
have enough pills saved up." What is this an example of?
• A. Suicidal ideation without a plan
• B. Suicidal ideation with a specific, lethal plan and means
• C. Passive death wish
• D. Non-suicidal self-injury
Correct Answer: B
Rationale: This statement includes both intent and a specific, accessible, lethal method - the
highest-risk combination requiring immediate intervention, likely including hospitalization and
removal of means.
Q10. Which medication class is considered first-line treatment for major depressive
disorder?
• A. Tricyclic antidepressants (TCAs)
• B. Monoamine oxidase inhibitors (MAOIs)
• C. Selective serotonin reuptake inhibitors (SSRIs)
• D. Typical antipsychotics
Correct Answer: C
Rationale: SSRIs are first-line due to a more favorable side effect profile and safety in overdose
compared to TCAs and MAOIs.
Q11. A client on an SSRI develops agitation, high fever, tremor, and diaphoresis after starting
a second serotonergic medication. This suggests:
• A. Neuroleptic malignant syndrome
• B. Serotonin syndrome
NR 547 Practice Exam | Page 3
