NUR256 EXAM 3 Actual Exam 2026/2027
Complete Questions and Verified Answers
with Detailed Rationales Concepts of Mental
Health Nursing Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: MOOD DISORDERS (Questions 1-15)
Q1: A client with major depressive disorder tells the nurse, "I'm a failure. Nothing I do ever
works out." Which response by the nurse is most therapeutic?
• A. "You shouldn't feel that way. You have many accomplishments."
• B. "I understand how you feel. I've felt that way before."
• C. "Tell me more about what makes you feel like a failure." [CORRECT]
• D. "Let's focus on the positive things in your life instead."
Correct Answer: C Rationale: Encouraging the client to explore their feelings by asking for
more information is therapeutic (C). It validates the client's experience and opens communication
without being dismissive. Telling the client they shouldn't feel that way (A) dismisses their
feelings and may increase guilt. Sharing personal experiences (B) shifts focus to the nurse and is
not client-centered. Redirecting to positive things (D) may be perceived as minimizing their
distress and invalidating their experience.
Q2: A client with bipolar I disorder is in a manic episode and has been sleeping 2 hours per night
for the past week. The client is agitated, hyperverbal, and has spent $5,000 on unnecessary items.
What is the priority nursing intervention?
• A. Encourage the client to reflect on their spending decisions
• B. Establish a quiet environment and set limits on behavior [CORRECT]
• C. Allow the client to continue activities to expend energy
• D. Discuss medication nonadherence from previous episodes
,Correct Answer: B Rationale: During acute mania, the priority is safety and milieu
management (B). A quiet environment reduces stimulation, and firm, consistent limits protect the
client from poor judgment and potential harm. Reflection (A) is ineffective during acute mania
due to impaired judgment. Allowing continued activity (C) worsens exhaustion and poor
decisions. Discussing nonadherence (D) is inappropriate during acute episodes and may increase
agitation.
Q3: A client taking lithium carbonate reports nausea, vomiting, muscle weakness, and ataxia.
The lithium level is 2.0 mEq/L. What is the nurse's priority action?
• A. Encourage increased fluid intake
• B. Hold the next dose and notify the provider immediately [CORRECT]
• C. Administer an antiemetic and continue lithium
• D. Recheck the level in one week
Correct Answer: B Rationale: The client's symptoms and level of 2.0 mEq/L indicate lithium
toxicity (therapeutic range 0.6-1.2 mEq/L; toxic >1.5 mEq/L). The nurse must hold the dose and
notify the provider immediately (B) to prevent progression to severe toxicity (seizures, coma,
death). Increased fluids (A) are insufficient. Continuing lithium (C) is dangerous. Rechecking in
one week (D) delays critical intervention.
Q4: A client with major depressive disorder is prescribed sertraline (Zoloft). The nurse should
instruct the client to report which symptom immediately?
• A. Dry mouth
• B. Insomnia
• C. Increased suicidal ideation [CORRECT]
• D. Mild nausea
Correct Answer: C Rationale: SSRIs carry a black box warning for increased suicidal thinking
in young adults (18-24), particularly in the first weeks of treatment or dose changes. The nurse
must instruct the client to report increased suicidal ideation immediately (C). Dry mouth (A),
insomnia (B), and mild nausea (D) are common side effects that typically improve and should be
monitored but do not require immediate intervention unless severe.
, Q5: A client with persistent depressive disorder (dysthymia) asks why psychotherapy is
recommended in addition to medication. The nurse's best response is:
• A. "Psychotherapy is only for people who don't respond to medication."
• B. "Combining psychotherapy with medication has better outcomes than either alone."
[CORRECT]
• C. "Medication treats the symptoms, but psychotherapy is unnecessary."
• D. "Psychotherapy works faster than antidepressants."
Correct Answer: B Rationale: Evidence-based practice supports combined treatment (B) for
depression: medications address neurochemical imbalances while psychotherapy (CBT,
interpersonal therapy) addresses cognitive patterns, coping skills, and interpersonal issues,
producing superior outcomes to monotherapy. Psychotherapy is not just for medication non-
responders (A). It is necessary for comprehensive treatment (C). Psychotherapy does not work
faster than medication (D)—benefits typically take weeks.
Q6: A client with bipolar disorder is prescribed lamotrigine (Lamictal). Which education is
essential for the nurse to provide?
• A. "Report any rash immediately, as this can indicate a serious reaction." [CORRECT]
• B. "This medication requires weekly blood level monitoring."
• C. "You may stop this medication if you feel well."
• D. "This medication will treat acute manic episodes."
Correct Answer: A Rationale: Lamotrigine carries a risk of Stevens-Johnson syndrome and
toxic epidermal necrolysis (life-threatening rashes). The nurse must instruct the client to report
any rash immediately (A). Lamotrigine does not require blood monitoring (B—unlike lithium).
Clients should never stop mood stabilizers abruptly (C) due to relapse risk. Lamotrigine is more
effective for depression maintenance than acute mania (D).
Q7: A client with major depressive disorder is undergoing ECT (electroconvulsive therapy).
Which pre-procedure nursing intervention is essential?
• A. Ensure the client has had a full meal 2 hours before
• B. Verify informed consent and maintain NPO status [CORRECT]
• C. Withhold all morning medications
Complete Questions and Verified Answers
with Detailed Rationales Concepts of Mental
Health Nursing Grade A 100% Correct Pass
Guaranteed - A+ Graded
SECTION 1: MOOD DISORDERS (Questions 1-15)
Q1: A client with major depressive disorder tells the nurse, "I'm a failure. Nothing I do ever
works out." Which response by the nurse is most therapeutic?
• A. "You shouldn't feel that way. You have many accomplishments."
• B. "I understand how you feel. I've felt that way before."
• C. "Tell me more about what makes you feel like a failure." [CORRECT]
• D. "Let's focus on the positive things in your life instead."
Correct Answer: C Rationale: Encouraging the client to explore their feelings by asking for
more information is therapeutic (C). It validates the client's experience and opens communication
without being dismissive. Telling the client they shouldn't feel that way (A) dismisses their
feelings and may increase guilt. Sharing personal experiences (B) shifts focus to the nurse and is
not client-centered. Redirecting to positive things (D) may be perceived as minimizing their
distress and invalidating their experience.
Q2: A client with bipolar I disorder is in a manic episode and has been sleeping 2 hours per night
for the past week. The client is agitated, hyperverbal, and has spent $5,000 on unnecessary items.
What is the priority nursing intervention?
• A. Encourage the client to reflect on their spending decisions
• B. Establish a quiet environment and set limits on behavior [CORRECT]
• C. Allow the client to continue activities to expend energy
• D. Discuss medication nonadherence from previous episodes
,Correct Answer: B Rationale: During acute mania, the priority is safety and milieu
management (B). A quiet environment reduces stimulation, and firm, consistent limits protect the
client from poor judgment and potential harm. Reflection (A) is ineffective during acute mania
due to impaired judgment. Allowing continued activity (C) worsens exhaustion and poor
decisions. Discussing nonadherence (D) is inappropriate during acute episodes and may increase
agitation.
Q3: A client taking lithium carbonate reports nausea, vomiting, muscle weakness, and ataxia.
The lithium level is 2.0 mEq/L. What is the nurse's priority action?
• A. Encourage increased fluid intake
• B. Hold the next dose and notify the provider immediately [CORRECT]
• C. Administer an antiemetic and continue lithium
• D. Recheck the level in one week
Correct Answer: B Rationale: The client's symptoms and level of 2.0 mEq/L indicate lithium
toxicity (therapeutic range 0.6-1.2 mEq/L; toxic >1.5 mEq/L). The nurse must hold the dose and
notify the provider immediately (B) to prevent progression to severe toxicity (seizures, coma,
death). Increased fluids (A) are insufficient. Continuing lithium (C) is dangerous. Rechecking in
one week (D) delays critical intervention.
Q4: A client with major depressive disorder is prescribed sertraline (Zoloft). The nurse should
instruct the client to report which symptom immediately?
• A. Dry mouth
• B. Insomnia
• C. Increased suicidal ideation [CORRECT]
• D. Mild nausea
Correct Answer: C Rationale: SSRIs carry a black box warning for increased suicidal thinking
in young adults (18-24), particularly in the first weeks of treatment or dose changes. The nurse
must instruct the client to report increased suicidal ideation immediately (C). Dry mouth (A),
insomnia (B), and mild nausea (D) are common side effects that typically improve and should be
monitored but do not require immediate intervention unless severe.
, Q5: A client with persistent depressive disorder (dysthymia) asks why psychotherapy is
recommended in addition to medication. The nurse's best response is:
• A. "Psychotherapy is only for people who don't respond to medication."
• B. "Combining psychotherapy with medication has better outcomes than either alone."
[CORRECT]
• C. "Medication treats the symptoms, but psychotherapy is unnecessary."
• D. "Psychotherapy works faster than antidepressants."
Correct Answer: B Rationale: Evidence-based practice supports combined treatment (B) for
depression: medications address neurochemical imbalances while psychotherapy (CBT,
interpersonal therapy) addresses cognitive patterns, coping skills, and interpersonal issues,
producing superior outcomes to monotherapy. Psychotherapy is not just for medication non-
responders (A). It is necessary for comprehensive treatment (C). Psychotherapy does not work
faster than medication (D)—benefits typically take weeks.
Q6: A client with bipolar disorder is prescribed lamotrigine (Lamictal). Which education is
essential for the nurse to provide?
• A. "Report any rash immediately, as this can indicate a serious reaction." [CORRECT]
• B. "This medication requires weekly blood level monitoring."
• C. "You may stop this medication if you feel well."
• D. "This medication will treat acute manic episodes."
Correct Answer: A Rationale: Lamotrigine carries a risk of Stevens-Johnson syndrome and
toxic epidermal necrolysis (life-threatening rashes). The nurse must instruct the client to report
any rash immediately (A). Lamotrigine does not require blood monitoring (B—unlike lithium).
Clients should never stop mood stabilizers abruptly (C) due to relapse risk. Lamotrigine is more
effective for depression maintenance than acute mania (D).
Q7: A client with major depressive disorder is undergoing ECT (electroconvulsive therapy).
Which pre-procedure nursing intervention is essential?
• A. Ensure the client has had a full meal 2 hours before
• B. Verify informed consent and maintain NPO status [CORRECT]
• C. Withhold all morning medications
