NUR 253 Mental Health Nursing
Exam 3 (2026/2027) - Galen College of Nursing
Mood Disorders & Suicide Risk | Anxiety, OCD & Trauma | Schizophrenia Spectrum | Personality Disorders | Substance Use
Disorders | Eating & Somatic Disorders | Psychiatric Emergencies, Ethics & Therapeutic Communication
Total Questions 110
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-Based | 25% Direct Recall
Sections 7 (Mood through Psychiatric Emergencies)
Scoring Standard Verified Answers against DSM-5-TR and Current Mental Health Standards
Audience NUR 253 Mental Health Nursing Students (Galen College)
Edition 2026/2027 Curriculum-Aligned
This comprehensive Exam 3 assesses mastery of mental health nursing competencies across the NUR 253 curriculum at
Galen College of Nursing. Each question is presented with the verified correct answer and a complete rationale grounded
in DSM-5-TR diagnostic criteria, psychopharmacology principles, safety considerations, and therapeutic communication
rationale. Distractors are designed around common mental health nursing student errors: misapplying DSM-5-TR criteria,
confusing similar diagnoses (Bipolar I vs. II, OCD vs. OCPD, Anorexia vs. Bulimia, serotonin syndrome vs. NMS),
overlooking suicide risk factors, misidentifying medication side effects, failing to prioritize safety, misapplying therapeutic
communication techniques, confusing withdrawal protocols (CIWA, COWS, benzodiazepine tapers), and
misunderstanding legal obligations (Tarasoff, involuntary commitment). Verification notes embedded in each rationale
confirm accuracy against current mental health nursing standards to support A+ preparation.
Section 1: Mood Disorders and Suicide Risk
,Q1: A 34-year-old patient presents with depressed mood, anhedonia, weight loss of 8 lb in 4
weeks, insomnia, fatigue, feelings of worthlessness, and recurrent thoughts of death lasting 6
weeks. Which DSM-5-TR criterion is met for Major Depressive Disorder (MDD)?
A. At least 4 symptoms including depressed mood or anhedonia for at least 2 weeks.
B. At least 5 symptoms including depressed mood or anhedonia for at least 2 weeks. [CORRECT]
C. At least 5 symptoms without anhedonia for at least 4 weeks.
D. At least 3 symptoms including insomnia for at least 6 weeks.
Correct Answer: B. At least 5 symptoms including depressed mood or anhedonia for at least 2
weeks.
Rationale: DSM-5-TR requires 5+ symptoms during the same 2-week period, with at least one being either depressed
mood or anhedonia, causing significant impairment. The patient meets criteria (depressed mood, anhedonia, weight
loss, insomnia, fatigue, worthlessness, suicidal ideation = 7 symptoms). A+ verification: SIG: E(CAPS) mnemonic =
Sleep change, Interest loss (anhedonia), Guilt, Energy loss, Concentration, Appetite, Psychomotor changes, Suicidal
ideation. Study tip: count symptoms systematically.
Q2: Which assessment tool is most appropriate for screening the severity of depressive
symptoms in primary care?
A. YMRS.
B. PHQ-9. [CORRECT]
C. GAD-7.
D. CIWA-Ar.
Correct Answer: B. PHQ-9.
Rationale: The Patient Health Questionnaire-9 (PHQ-9) screens for depression severity in primary care; items align
with DSM-5-TR criteria and include a suicide risk question. YMRS (A) measures mania severity. GAD-7 (C) screens
for anxiety. CIWA-Ar (D) assesses alcohol withdrawal. A+ verification: PHQ-9 score interpretation: 5-9 mild, 10-14
moderate, 15-19 moderately severe, 20-27 severe.
Q3: A patient with MDD is started on sertraline. The patient asks when symptom improvement will
begin. The nurse's best response is:
A. Within 24 hours.
B. Within 1 to 4 weeks, with full effects in 6-8 weeks. [CORRECT]
C. Immediately after the first dose.
D. After 3 months of therapy.
Correct Answer: B. Within 1 to 4 weeks, with full effects in 6-8 weeks.
Rationale: SSRIs take 1-4 weeks to begin showing improvement and 6-8 weeks for full therapeutic effect. Educating
the patient supports adherence. Options A and C are incorrect. Option D is too long. A+ verification: educating about
delayed onset prevents premature discontinuation.
,Q4: A patient taking fluoxetine reports restlessness, agitation, confusion, fever, diaphoresis,
tremor, and muscle rigidity after a dose increase. Which adverse effect is most concerning?
A. Extrapyramidal symptoms.
B. Serotonin syndrome. [CORRECT]
C. Tardive dyskinesia.
D. Neuroleptic malignant syndrome.
Correct Answer: B. Serotonin syndrome.
Rationale: Serotonin syndrome presents with agitation, autonomic instability (fever, diaphoresis), neuromuscular
excitation (tremor, rigidity, hyperreflexia), and altered mental status; it occurs with serotonergic agents like SSRIs.
EPS (A) and TD (C) are antipsychotic adverse effects. NMS (D) is also antipsychotic-related. A+ verification: this
commonly confused pair (serotonin syndrome vs NMS) requires distinguishing neuromuscular findings: serotonin
syndrome = hyperreflexia/clonus; NMS = lead-pipe rigidity.
Q5: A patient with MDD is started on antidepressant therapy. Which adverse effect requires
vigilant monitoring, especially in patients 24 years and younger?
A. Weight gain.
B. Increased suicidal ideation. [CORRECT]
C. Hypertension.
D. Hair loss.
Correct Answer: B. Increased suicidal ideation.
Rationale: SSRIs carry an FDA black box warning for increased suicidality in patients 24 years and younger. Monitor
closely for worsened depression, agitation, and suicidal thinking during the first 4 weeks. A+ verification: increased
energy may precede suicidal action; this is why monitoring in early treatment is critical.
Q6: Which statement best differentiates Bipolar I Disorder from Bipolar II Disorder?
A. Bipolar I requires a manic episode; Bipolar II requires a hypomanic episode plus a major depressive episode.
[CORRECT]
B. Bipolar I requires only hypomania; Bipolar II requires mania.
C. They are identical.
D. Bipolar I requires depressive episodes only.
Correct Answer: A. Bipolar I requires a manic episode; Bipolar II requires a hypomanic episode
plus a majo...
Rationale: Bipolar I requires at least one manic episode; Bipolar II requires at least one hypomanic plus one major
depressive episode, with NO manic episodes. This commonly confused pair is heavily tested. A+ verification: mania
causes marked impairment, often with psychotic features; hypomania does not cause marked impairment and lacks
psychosis.
, Q7: A patient in acute mania paces the unit, speaks rapidly, talks over others, makes grandiose
claims, and has not slept in 3 days. Which nursing intervention is priority?
A. Encourage group activities to promote socialization.
B. Provide a low-stimulation environment and ensure adequate nutrition and hydration. [CORRECT]
C. Engage in long therapeutic conversations.
D. Schedule multiple recreational activities.
Correct Answer: B. Provide a low-stimulation environment and ensure adequate nutrition and
hydration.
Rationale: Acute mania requires a low-stimulation environment with brief interactions to reduce agitation; ensure
adequate nutrition, hydration, and sleep. Options A, C, D overstimulate. A+ verification: manic patients easily become
overstimulated; provide finger foods, simple communication, and rest periods.
Q8: A patient with bipolar disorder is prescribed lithium. The therapeutic serum level range is:
A. 0.2 to 0.6 mEq/L.
B. 0.6 to 1.2 mEq/L (acute: 0.8-1.2; maintenance: 0.6-1.0). [CORRECT]
C. 1.5 to 2.5 mEq/L.
D. 2.0 to 3.0 mEq/L.
Correct Answer: B. 0.6 to 1.2 mEq/L (acute: 0.8-1.2; maintenance: 0.6-1.0).
Rationale: Lithium therapeutic range is 0.6-1.2 mEq/L for acute treatment; 0.6-1.0 for maintenance. Levels >1.5 =
toxicity. A+ verification: lithium has a narrow therapeutic window; levels are drawn 12 hours after the last dose
(trough). Study tip: 'lithium = tight window, trough level.'
Q9: A patient on lithium presents with coarse tremor, vomiting, diarrhea, ataxia, and confusion.
Lithium level is 2.0 mEq/L. Which intervention is priority?
A. Administer an additional dose of lithium.
B. Stop lithium, initiate IV fluids, and notify the provider; prepare for hemodialysis if severe. [CORRECT]
C. Continue lithium and reassess in 4 hours.
D. Administer a benzodiazepine to control tremor.
Correct Answer: B. Stop lithium, initiate IV fluids, and notify the provider; prepare for hemodialysis
if ...
Rationale: These signs indicate lithium toxicity (level 2.0 mEq/L); stop lithium, hydrate, notify provider, and consider
hemodialysis for severe toxicity. Option A is unsafe. Option C delays treatment. Option D does not address toxicity.
A+ verification: lithium toxicity risk increases with dehydration, NSAIDs, ACE inhibitors, diuretics, and
sodium-restricted diets.
Exam 3 (2026/2027) - Galen College of Nursing
Mood Disorders & Suicide Risk | Anxiety, OCD & Trauma | Schizophrenia Spectrum | Personality Disorders | Substance Use
Disorders | Eating & Somatic Disorders | Psychiatric Emergencies, Ethics & Therapeutic Communication
Total Questions 110
Cognitive Mix 30% Recall | 50% Application | 20% Analysis
Question Style 75% Scenario-Based | 25% Direct Recall
Sections 7 (Mood through Psychiatric Emergencies)
Scoring Standard Verified Answers against DSM-5-TR and Current Mental Health Standards
Audience NUR 253 Mental Health Nursing Students (Galen College)
Edition 2026/2027 Curriculum-Aligned
This comprehensive Exam 3 assesses mastery of mental health nursing competencies across the NUR 253 curriculum at
Galen College of Nursing. Each question is presented with the verified correct answer and a complete rationale grounded
in DSM-5-TR diagnostic criteria, psychopharmacology principles, safety considerations, and therapeutic communication
rationale. Distractors are designed around common mental health nursing student errors: misapplying DSM-5-TR criteria,
confusing similar diagnoses (Bipolar I vs. II, OCD vs. OCPD, Anorexia vs. Bulimia, serotonin syndrome vs. NMS),
overlooking suicide risk factors, misidentifying medication side effects, failing to prioritize safety, misapplying therapeutic
communication techniques, confusing withdrawal protocols (CIWA, COWS, benzodiazepine tapers), and
misunderstanding legal obligations (Tarasoff, involuntary commitment). Verification notes embedded in each rationale
confirm accuracy against current mental health nursing standards to support A+ preparation.
Section 1: Mood Disorders and Suicide Risk
,Q1: A 34-year-old patient presents with depressed mood, anhedonia, weight loss of 8 lb in 4
weeks, insomnia, fatigue, feelings of worthlessness, and recurrent thoughts of death lasting 6
weeks. Which DSM-5-TR criterion is met for Major Depressive Disorder (MDD)?
A. At least 4 symptoms including depressed mood or anhedonia for at least 2 weeks.
B. At least 5 symptoms including depressed mood or anhedonia for at least 2 weeks. [CORRECT]
C. At least 5 symptoms without anhedonia for at least 4 weeks.
D. At least 3 symptoms including insomnia for at least 6 weeks.
Correct Answer: B. At least 5 symptoms including depressed mood or anhedonia for at least 2
weeks.
Rationale: DSM-5-TR requires 5+ symptoms during the same 2-week period, with at least one being either depressed
mood or anhedonia, causing significant impairment. The patient meets criteria (depressed mood, anhedonia, weight
loss, insomnia, fatigue, worthlessness, suicidal ideation = 7 symptoms). A+ verification: SIG: E(CAPS) mnemonic =
Sleep change, Interest loss (anhedonia), Guilt, Energy loss, Concentration, Appetite, Psychomotor changes, Suicidal
ideation. Study tip: count symptoms systematically.
Q2: Which assessment tool is most appropriate for screening the severity of depressive
symptoms in primary care?
A. YMRS.
B. PHQ-9. [CORRECT]
C. GAD-7.
D. CIWA-Ar.
Correct Answer: B. PHQ-9.
Rationale: The Patient Health Questionnaire-9 (PHQ-9) screens for depression severity in primary care; items align
with DSM-5-TR criteria and include a suicide risk question. YMRS (A) measures mania severity. GAD-7 (C) screens
for anxiety. CIWA-Ar (D) assesses alcohol withdrawal. A+ verification: PHQ-9 score interpretation: 5-9 mild, 10-14
moderate, 15-19 moderately severe, 20-27 severe.
Q3: A patient with MDD is started on sertraline. The patient asks when symptom improvement will
begin. The nurse's best response is:
A. Within 24 hours.
B. Within 1 to 4 weeks, with full effects in 6-8 weeks. [CORRECT]
C. Immediately after the first dose.
D. After 3 months of therapy.
Correct Answer: B. Within 1 to 4 weeks, with full effects in 6-8 weeks.
Rationale: SSRIs take 1-4 weeks to begin showing improvement and 6-8 weeks for full therapeutic effect. Educating
the patient supports adherence. Options A and C are incorrect. Option D is too long. A+ verification: educating about
delayed onset prevents premature discontinuation.
,Q4: A patient taking fluoxetine reports restlessness, agitation, confusion, fever, diaphoresis,
tremor, and muscle rigidity after a dose increase. Which adverse effect is most concerning?
A. Extrapyramidal symptoms.
B. Serotonin syndrome. [CORRECT]
C. Tardive dyskinesia.
D. Neuroleptic malignant syndrome.
Correct Answer: B. Serotonin syndrome.
Rationale: Serotonin syndrome presents with agitation, autonomic instability (fever, diaphoresis), neuromuscular
excitation (tremor, rigidity, hyperreflexia), and altered mental status; it occurs with serotonergic agents like SSRIs.
EPS (A) and TD (C) are antipsychotic adverse effects. NMS (D) is also antipsychotic-related. A+ verification: this
commonly confused pair (serotonin syndrome vs NMS) requires distinguishing neuromuscular findings: serotonin
syndrome = hyperreflexia/clonus; NMS = lead-pipe rigidity.
Q5: A patient with MDD is started on antidepressant therapy. Which adverse effect requires
vigilant monitoring, especially in patients 24 years and younger?
A. Weight gain.
B. Increased suicidal ideation. [CORRECT]
C. Hypertension.
D. Hair loss.
Correct Answer: B. Increased suicidal ideation.
Rationale: SSRIs carry an FDA black box warning for increased suicidality in patients 24 years and younger. Monitor
closely for worsened depression, agitation, and suicidal thinking during the first 4 weeks. A+ verification: increased
energy may precede suicidal action; this is why monitoring in early treatment is critical.
Q6: Which statement best differentiates Bipolar I Disorder from Bipolar II Disorder?
A. Bipolar I requires a manic episode; Bipolar II requires a hypomanic episode plus a major depressive episode.
[CORRECT]
B. Bipolar I requires only hypomania; Bipolar II requires mania.
C. They are identical.
D. Bipolar I requires depressive episodes only.
Correct Answer: A. Bipolar I requires a manic episode; Bipolar II requires a hypomanic episode
plus a majo...
Rationale: Bipolar I requires at least one manic episode; Bipolar II requires at least one hypomanic plus one major
depressive episode, with NO manic episodes. This commonly confused pair is heavily tested. A+ verification: mania
causes marked impairment, often with psychotic features; hypomania does not cause marked impairment and lacks
psychosis.
, Q7: A patient in acute mania paces the unit, speaks rapidly, talks over others, makes grandiose
claims, and has not slept in 3 days. Which nursing intervention is priority?
A. Encourage group activities to promote socialization.
B. Provide a low-stimulation environment and ensure adequate nutrition and hydration. [CORRECT]
C. Engage in long therapeutic conversations.
D. Schedule multiple recreational activities.
Correct Answer: B. Provide a low-stimulation environment and ensure adequate nutrition and
hydration.
Rationale: Acute mania requires a low-stimulation environment with brief interactions to reduce agitation; ensure
adequate nutrition, hydration, and sleep. Options A, C, D overstimulate. A+ verification: manic patients easily become
overstimulated; provide finger foods, simple communication, and rest periods.
Q8: A patient with bipolar disorder is prescribed lithium. The therapeutic serum level range is:
A. 0.2 to 0.6 mEq/L.
B. 0.6 to 1.2 mEq/L (acute: 0.8-1.2; maintenance: 0.6-1.0). [CORRECT]
C. 1.5 to 2.5 mEq/L.
D. 2.0 to 3.0 mEq/L.
Correct Answer: B. 0.6 to 1.2 mEq/L (acute: 0.8-1.2; maintenance: 0.6-1.0).
Rationale: Lithium therapeutic range is 0.6-1.2 mEq/L for acute treatment; 0.6-1.0 for maintenance. Levels >1.5 =
toxicity. A+ verification: lithium has a narrow therapeutic window; levels are drawn 12 hours after the last dose
(trough). Study tip: 'lithium = tight window, trough level.'
Q9: A patient on lithium presents with coarse tremor, vomiting, diarrhea, ataxia, and confusion.
Lithium level is 2.0 mEq/L. Which intervention is priority?
A. Administer an additional dose of lithium.
B. Stop lithium, initiate IV fluids, and notify the provider; prepare for hemodialysis if severe. [CORRECT]
C. Continue lithium and reassess in 4 hours.
D. Administer a benzodiazepine to control tremor.
Correct Answer: B. Stop lithium, initiate IV fluids, and notify the provider; prepare for hemodialysis
if ...
Rationale: These signs indicate lithium toxicity (level 2.0 mEq/L); stop lithium, hydrate, notify provider, and consider
hemodialysis for severe toxicity. Option A is unsafe. Option C delays treatment. Option D does not address toxicity.
A+ verification: lithium toxicity risk increases with dehydration, NSAIDs, ACE inhibitors, diuretics, and
sodium-restricted diets.
