Exam 3: NUR253/ NUR 253 (NEW 2026/
2027 Update) Concepts of Mental Health
Nursing Guide| Q&A| Grade A| 100%
Correct (Accurate Solutions)
SECTION I: DEPRESSIVE DISORDERS (Questions 1–20)
1. A patient with major depressive disorder (MDD) states, "I feel so hopeless. Nothing
matters anymore. My family would be better off without me." What is the nurse's priority
response?
A) "You have so much to live for. Your family loves you."
B) "Are you having thoughts of hurting yourself?"
C) "It sounds like you are feeling very sad right now."
D) "Let's talk about what makes you feel hopeless."
Correct Answer: B
Rationale: The patient's statement contains themes of hopelessness and perceived
burdensomeness, which are significant risk factors for suicide . The priority is to directly assess
for suicidal ideation, plan, and intent. Avoiding the question or offering false reassurance does
not address the immediate safety concern.
2. Which neurotransmitter imbalances are most associated with major depressive disorder?
A) Increased dopamine and decreased GABA
B) Decreased serotonin, norepinephrine, and dopamine
C) Increased acetylcholine and decreased histamine
D) Decreased glutamate and increased substance P
Correct Answer: B
Rationale: The monoamine hypothesis of depression suggests that a deficiency in serotonin,
norepinephrine, and/or dopamine contributes to depressive symptoms . Most antidepressants
work by increasing the availability of these neurotransmitters.
,3. A nurse is caring for a patient with severe depression who has been prescribed a selective
serotonin reuptake inhibitor (SSRI). The patient asks, "How long will it take for this to work?"
What is the nurse's best response?
A) "You should feel better within 24 to 48 hours."
B) "It may take 2 to 4 weeks to notice an improvement in mood."
C) "The full therapeutic effect may take 6 to 8 weeks."
D) "You will notice a difference after the first dose."
Correct Answer: B
Rationale: SSRIs typically require 2 to 4 weeks to begin producing noticeable improvements in
mood, with full therapeutic effects often taking 6 to 8 weeks . Patients should be educated
about this delay to prevent premature discontinuation.
4. A patient with MDD is started on fluoxetine. The nurse should educate the patient about
which common side effect?
A) Weight gain
B) Sexual dysfunction
C) Hypertension
D) Urinary retention
Correct Answer: B
Rationale: Sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia,
is a common side effect of SSRIs . Patients should be informed that this side effect may occur
and encouraged to discuss any concerns with their provider rather than discontinuing the
medication abruptly.
5. A nurse is assessing a patient with depression. Which of the following findings would be
considered a somatic symptom of depression?
A) Auditory hallucinations
B) Flight of ideas
C) Chronic fatigue and unexplained aches
D) Grandiose delusions
Correct Answer: C
Rationale: Somatic symptoms of depression include physical complaints such as fatigue,
headaches, back pain, and gastrointestinal disturbances . These symptoms are often the
primary reason patients with depression seek medical care.
,6. A patient taking phenelzine (Nardil), an MAOI, asks the nurse about dietary restrictions.
Which food should the nurse instruct the patient to avoid?
A) Fresh apples
B) Aged cheese
C) White bread
D) Grilled chicken
Correct Answer: B
Rationale: MAOIs require a tyramine-restricted diet. Tyramine-rich foods include aged cheeses,
smoked/cured meats, fermented foods, and red wine . Combined with MAOIs, tyramine can
cause hypertensive crisis.
7. A patient with MDD has been prescribed bupropion. The nurse should assess for a history
of which condition?
A) Hypertension
B) Seizure disorder
C) Diabetes mellitus
D) Hypothyroidism
Correct Answer: B
Rationale: Bupropion lowers the seizure threshold and is contraindicated in patients with a
seizure disorder or eating disorder . It has a lower risk of sexual side effects compared to SSRIs.
8. Which population has the highest incidence of major depressive disorder?
A) Adolescent males
B) Middle-aged females
C) Older adult males
D) Young children
Correct Answer: B
Rationale: The incidence of depressive disorders is greater in women than in men by a ratio of
almost 2 to 1 . Other risk factors include unmarried status, low socioeconomic status, and family
history of depression.
9. A patient with MDD reports that they have been taking St. John's Wort. The nurse should
educate the patient that:
A) St. John's Wort is safe to take with prescription antidepressants
B) St. John's Wort can increase the risk of serotonin syndrome when combined with SSRIs
, C) St. John's Wort has no effect on depression
D) St. John's Wort should be taken with food to prevent GI upset
Correct Answer: B
Rationale: St. John's Wort has serotonergic effects and can lead to serotonin syndrome when
combined with prescription antidepressants . Patients should consult their provider before
starting any herbal supplements.
10. Which symptom distinguishes major depressive disorder from normal grief?
A) Sadness and crying
B) Difficulty sleeping
C) Persistent anhedonia and feelings of worthlessness
D) Decreased appetite
Correct Answer: C
Rationale: While sadness, sleep disturbances, and appetite changes can occur in both grief and
MDD, persistent anhedonia (loss of pleasure in activities) and pervasive feelings of
worthlessness or guilt are more characteristic of clinical depression .
11. A patient with depression is being treated with electroconvulsive therapy (ECT). The
patient's family asks about the procedure. Which statement indicates an understanding of
ECT?
A) "ECT is a first-line treatment for depression"
B) "ECT requires several treatments to be effective"
C) "ECT causes permanent memory loss"
D) "ECT is only used for schizophrenia"
Correct Answer: B
*Rationale: ECT is typically administered in a series of 6-12 treatments . It is considered for
treatment-resistant depression, severe depression with psychosis, or when rapid response is
needed.*
12. A patient taking an SSRI reports feeling "emotionally numb" and "like a zombie." What is
the nurse's best response?
A) "This means the medication is not working for you."
B) "It sounds like you're feeling emotionally numb. Can you tell me more about that?"
C) "You should stop taking the medication immediately."
D) "That is a sign of an allergic reaction."
2027 Update) Concepts of Mental Health
Nursing Guide| Q&A| Grade A| 100%
Correct (Accurate Solutions)
SECTION I: DEPRESSIVE DISORDERS (Questions 1–20)
1. A patient with major depressive disorder (MDD) states, "I feel so hopeless. Nothing
matters anymore. My family would be better off without me." What is the nurse's priority
response?
A) "You have so much to live for. Your family loves you."
B) "Are you having thoughts of hurting yourself?"
C) "It sounds like you are feeling very sad right now."
D) "Let's talk about what makes you feel hopeless."
Correct Answer: B
Rationale: The patient's statement contains themes of hopelessness and perceived
burdensomeness, which are significant risk factors for suicide . The priority is to directly assess
for suicidal ideation, plan, and intent. Avoiding the question or offering false reassurance does
not address the immediate safety concern.
2. Which neurotransmitter imbalances are most associated with major depressive disorder?
A) Increased dopamine and decreased GABA
B) Decreased serotonin, norepinephrine, and dopamine
C) Increased acetylcholine and decreased histamine
D) Decreased glutamate and increased substance P
Correct Answer: B
Rationale: The monoamine hypothesis of depression suggests that a deficiency in serotonin,
norepinephrine, and/or dopamine contributes to depressive symptoms . Most antidepressants
work by increasing the availability of these neurotransmitters.
,3. A nurse is caring for a patient with severe depression who has been prescribed a selective
serotonin reuptake inhibitor (SSRI). The patient asks, "How long will it take for this to work?"
What is the nurse's best response?
A) "You should feel better within 24 to 48 hours."
B) "It may take 2 to 4 weeks to notice an improvement in mood."
C) "The full therapeutic effect may take 6 to 8 weeks."
D) "You will notice a difference after the first dose."
Correct Answer: B
Rationale: SSRIs typically require 2 to 4 weeks to begin producing noticeable improvements in
mood, with full therapeutic effects often taking 6 to 8 weeks . Patients should be educated
about this delay to prevent premature discontinuation.
4. A patient with MDD is started on fluoxetine. The nurse should educate the patient about
which common side effect?
A) Weight gain
B) Sexual dysfunction
C) Hypertension
D) Urinary retention
Correct Answer: B
Rationale: Sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia,
is a common side effect of SSRIs . Patients should be informed that this side effect may occur
and encouraged to discuss any concerns with their provider rather than discontinuing the
medication abruptly.
5. A nurse is assessing a patient with depression. Which of the following findings would be
considered a somatic symptom of depression?
A) Auditory hallucinations
B) Flight of ideas
C) Chronic fatigue and unexplained aches
D) Grandiose delusions
Correct Answer: C
Rationale: Somatic symptoms of depression include physical complaints such as fatigue,
headaches, back pain, and gastrointestinal disturbances . These symptoms are often the
primary reason patients with depression seek medical care.
,6. A patient taking phenelzine (Nardil), an MAOI, asks the nurse about dietary restrictions.
Which food should the nurse instruct the patient to avoid?
A) Fresh apples
B) Aged cheese
C) White bread
D) Grilled chicken
Correct Answer: B
Rationale: MAOIs require a tyramine-restricted diet. Tyramine-rich foods include aged cheeses,
smoked/cured meats, fermented foods, and red wine . Combined with MAOIs, tyramine can
cause hypertensive crisis.
7. A patient with MDD has been prescribed bupropion. The nurse should assess for a history
of which condition?
A) Hypertension
B) Seizure disorder
C) Diabetes mellitus
D) Hypothyroidism
Correct Answer: B
Rationale: Bupropion lowers the seizure threshold and is contraindicated in patients with a
seizure disorder or eating disorder . It has a lower risk of sexual side effects compared to SSRIs.
8. Which population has the highest incidence of major depressive disorder?
A) Adolescent males
B) Middle-aged females
C) Older adult males
D) Young children
Correct Answer: B
Rationale: The incidence of depressive disorders is greater in women than in men by a ratio of
almost 2 to 1 . Other risk factors include unmarried status, low socioeconomic status, and family
history of depression.
9. A patient with MDD reports that they have been taking St. John's Wort. The nurse should
educate the patient that:
A) St. John's Wort is safe to take with prescription antidepressants
B) St. John's Wort can increase the risk of serotonin syndrome when combined with SSRIs
, C) St. John's Wort has no effect on depression
D) St. John's Wort should be taken with food to prevent GI upset
Correct Answer: B
Rationale: St. John's Wort has serotonergic effects and can lead to serotonin syndrome when
combined with prescription antidepressants . Patients should consult their provider before
starting any herbal supplements.
10. Which symptom distinguishes major depressive disorder from normal grief?
A) Sadness and crying
B) Difficulty sleeping
C) Persistent anhedonia and feelings of worthlessness
D) Decreased appetite
Correct Answer: C
Rationale: While sadness, sleep disturbances, and appetite changes can occur in both grief and
MDD, persistent anhedonia (loss of pleasure in activities) and pervasive feelings of
worthlessness or guilt are more characteristic of clinical depression .
11. A patient with depression is being treated with electroconvulsive therapy (ECT). The
patient's family asks about the procedure. Which statement indicates an understanding of
ECT?
A) "ECT is a first-line treatment for depression"
B) "ECT requires several treatments to be effective"
C) "ECT causes permanent memory loss"
D) "ECT is only used for schizophrenia"
Correct Answer: B
*Rationale: ECT is typically administered in a series of 6-12 treatments . It is considered for
treatment-resistant depression, severe depression with psychosis, or when rapid response is
needed.*
12. A patient taking an SSRI reports feeling "emotionally numb" and "like a zombie." What is
the nurse's best response?
A) "This means the medication is not working for you."
B) "It sounds like you're feeling emotionally numb. Can you tell me more about that?"
C) "You should stop taking the medication immediately."
D) "That is a sign of an allergic reaction."
