NUR 2459 MENTAL AND BEHAVIORAL HEALTH NURSING
EXAM 2 2026/2027 | Rated A | Latest Rasmussen College
Guide | Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) (12 Questions)
Q1: A 28-year-old female presents with persistent sadness, loss of interest in activities,
fatigue, difficulty concentrating, and insomnia for the past 3 weeks. She reports a
10-pound weight loss and feelings of worthlessness. She denies suicidal ideation. Her
medical history is unremarkable. What is the most likely diagnosis and priority nursing
intervention?
A. Persistent depressive disorder; focus on long-term psychotherapy
B. Major depressive disorder; assess suicide risk and initiate safety planning [CORRECT]
C. Adjustment disorder; provide supportive counseling
D. Bipolar II disorder; monitor for hypomanic symptoms
Correct Answer: B
Rationale: This patient meets DSM-5 criteria for Major Depressive Disorder (MDD): ≥5
symptoms (depressed mood, anhedonia, weight loss, insomnia, psychomotor changes
implied by fatigue, worthlessness, difficulty concentrating) for ≥2 weeks causing
,significant distress/impairment. Priority nursing intervention is suicide risk
assessment—even without stated ideation, depression severity warrants evaluation.
Safety planning includes means restriction, protective factors identification, and crisis
resources. A is incorrect because persistent depressive disorder (dysthymia) requires
symptoms ≥2 years with less severity; this is acute and severe. C is incorrect because
adjustment disorder requires identifiable stressor within 3 months and doesn't meet full
MDD criteria; this presentation exceeds stress-related criteria. D is incorrect because no
history of hypomania (elevated/expansive mood, increased energy, decreased sleep
need without functional impairment) is present; bipolar diagnosis requires mood
episode history.
Q2: A 34-year-old male with bipolar I disorder is hospitalized during a manic episode. He
is sleeping 2 hours nightly, spending excessively, has grandiose delusions about being a
famous musician, and is sexually inappropriate with staff. He refuses oral medications.
What is the priority nursing intervention?
A. Allow him to continue behaviors to avoid escalating agitation
B. Implement one-to-one observation and prepare for possible IM antipsychotic
administration [CORRECT]
C. Engage in lengthy discussions about his musical abilities to build rapport
D. Restrain him immediately to prevent harm
Correct Answer: B
,Rationale: Manic episodes with severe impairment (psychosis, sexual disinhibition,
sleep deprivation) require immediate safety intervention. One-to-one observation
prevents harm to self/others and elopement. IM antipsychotics (olanzapine,
ziprasidone, aripiprazole) or benzodiazepines may be necessary if oral refusal
continues. Restraint is last resort after de-escalation fails. A is incorrect because
allowing behaviors reinforces illness, increases risk, and prevents stabilization. C is
incorrect because engaging delusions/grandiosity validates psychosis and increases
agitation; brief, reality-oriented communication is preferred. D is incorrect because
immediate restraint violates least-restrictive principle; de-escalation and
voluntary/involuntary medication precede restraint.
Q3: A 45-year-old female on lithium 900 mg daily for bipolar disorder presents with
tremor, ataxia, confusion, and diarrhea. Her lithium level is 2.2 mEq/L (therapeutic
0.6-1.2). She started hydrochlorothiazide 2 weeks ago for hypertension. What explains
this toxicity and immediate nursing action?
A. Thiazide decreased lithium absorption; hold next dose
B. Thiazide reduced lithium renal clearance; hold lithium, hydrate, notify provider
[CORRECT]
C. Lithium induced thiazide metabolism; continue both medications
D. Drug interaction causing hepatic toxicity; check liver enzymes
Correct Answer: B
, Rationale: Thiazide diuretics cause sodium depletion, increasing proximal tubular
lithium reabsorption and reducing clearance by 25-40%. Toxicity symptoms: GI (nausea,
diarrhea), neurologic (tremor, ataxia, confusion), and severe (seizures, coma, death).
Immediate nursing actions: hold lithium, ensure hydration (normal saline), monitor
cardiac/renal function, notify provider for possible dialysis if severe. A is incorrect
because thiazides increase, not decrease, lithium levels. C is incorrect because lithium
doesn't induce thiazide metabolism; interaction is unidirectional. D is incorrect because
lithium is renally eliminated; hepatic toxicity is not the mechanism.
Q4: A 22-year-old college student presents with 2 weeks of elevated mood, decreased
need for sleep (3 hours nightly), racing thoughts, pressured speech, and impulsive
sexual behavior. She has no prior psychiatric history. Her mother has bipolar disorder.
What is the likely diagnosis and key differentiator from schizophrenia?
A. Schizophrenia; age of onset
B. Bipolar I disorder; mood-congruent symptoms and preserved affect [CORRECT]
C. Schizoaffective disorder; hallucinations present
D. Borderline personality disorder; impulsivity
Correct Answer: B
Rationale: This is first manic episode of Bipolar I Disorder (≥1 week abnormally
elevated/expansive/irritable mood with increased energy/activity plus 3+ symptoms:
EXAM 2 2026/2027 | Rated A | Latest Rasmussen College
Guide | Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) (12 Questions)
Q1: A 28-year-old female presents with persistent sadness, loss of interest in activities,
fatigue, difficulty concentrating, and insomnia for the past 3 weeks. She reports a
10-pound weight loss and feelings of worthlessness. She denies suicidal ideation. Her
medical history is unremarkable. What is the most likely diagnosis and priority nursing
intervention?
A. Persistent depressive disorder; focus on long-term psychotherapy
B. Major depressive disorder; assess suicide risk and initiate safety planning [CORRECT]
C. Adjustment disorder; provide supportive counseling
D. Bipolar II disorder; monitor for hypomanic symptoms
Correct Answer: B
Rationale: This patient meets DSM-5 criteria for Major Depressive Disorder (MDD): ≥5
symptoms (depressed mood, anhedonia, weight loss, insomnia, psychomotor changes
implied by fatigue, worthlessness, difficulty concentrating) for ≥2 weeks causing
,significant distress/impairment. Priority nursing intervention is suicide risk
assessment—even without stated ideation, depression severity warrants evaluation.
Safety planning includes means restriction, protective factors identification, and crisis
resources. A is incorrect because persistent depressive disorder (dysthymia) requires
symptoms ≥2 years with less severity; this is acute and severe. C is incorrect because
adjustment disorder requires identifiable stressor within 3 months and doesn't meet full
MDD criteria; this presentation exceeds stress-related criteria. D is incorrect because no
history of hypomania (elevated/expansive mood, increased energy, decreased sleep
need without functional impairment) is present; bipolar diagnosis requires mood
episode history.
Q2: A 34-year-old male with bipolar I disorder is hospitalized during a manic episode. He
is sleeping 2 hours nightly, spending excessively, has grandiose delusions about being a
famous musician, and is sexually inappropriate with staff. He refuses oral medications.
What is the priority nursing intervention?
A. Allow him to continue behaviors to avoid escalating agitation
B. Implement one-to-one observation and prepare for possible IM antipsychotic
administration [CORRECT]
C. Engage in lengthy discussions about his musical abilities to build rapport
D. Restrain him immediately to prevent harm
Correct Answer: B
,Rationale: Manic episodes with severe impairment (psychosis, sexual disinhibition,
sleep deprivation) require immediate safety intervention. One-to-one observation
prevents harm to self/others and elopement. IM antipsychotics (olanzapine,
ziprasidone, aripiprazole) or benzodiazepines may be necessary if oral refusal
continues. Restraint is last resort after de-escalation fails. A is incorrect because
allowing behaviors reinforces illness, increases risk, and prevents stabilization. C is
incorrect because engaging delusions/grandiosity validates psychosis and increases
agitation; brief, reality-oriented communication is preferred. D is incorrect because
immediate restraint violates least-restrictive principle; de-escalation and
voluntary/involuntary medication precede restraint.
Q3: A 45-year-old female on lithium 900 mg daily for bipolar disorder presents with
tremor, ataxia, confusion, and diarrhea. Her lithium level is 2.2 mEq/L (therapeutic
0.6-1.2). She started hydrochlorothiazide 2 weeks ago for hypertension. What explains
this toxicity and immediate nursing action?
A. Thiazide decreased lithium absorption; hold next dose
B. Thiazide reduced lithium renal clearance; hold lithium, hydrate, notify provider
[CORRECT]
C. Lithium induced thiazide metabolism; continue both medications
D. Drug interaction causing hepatic toxicity; check liver enzymes
Correct Answer: B
, Rationale: Thiazide diuretics cause sodium depletion, increasing proximal tubular
lithium reabsorption and reducing clearance by 25-40%. Toxicity symptoms: GI (nausea,
diarrhea), neurologic (tremor, ataxia, confusion), and severe (seizures, coma, death).
Immediate nursing actions: hold lithium, ensure hydration (normal saline), monitor
cardiac/renal function, notify provider for possible dialysis if severe. A is incorrect
because thiazides increase, not decrease, lithium levels. C is incorrect because lithium
doesn't induce thiazide metabolism; interaction is unidirectional. D is incorrect because
lithium is renally eliminated; hepatic toxicity is not the mechanism.
Q4: A 22-year-old college student presents with 2 weeks of elevated mood, decreased
need for sleep (3 hours nightly), racing thoughts, pressured speech, and impulsive
sexual behavior. She has no prior psychiatric history. Her mother has bipolar disorder.
What is the likely diagnosis and key differentiator from schizophrenia?
A. Schizophrenia; age of onset
B. Bipolar I disorder; mood-congruent symptoms and preserved affect [CORRECT]
C. Schizoaffective disorder; hallucinations present
D. Borderline personality disorder; impulsivity
Correct Answer: B
Rationale: This is first manic episode of Bipolar I Disorder (≥1 week abnormally
elevated/expansive/irritable mood with increased energy/activity plus 3+ symptoms:
