NUR 253 Exam 4 Mental Health - 190 Questions and Answers
Already Graded A+ Premium Exam Tested And Verified
Subject Area NUR 253 Exam 4 Mental Health
Description Comprehensive examination on NUR 253 Exam 4 Mental Health.
Expected Grade A+
Total Questions 190
Duration 3 hours
Learning Outcomes 1. Demonstrate mastery of core concepts
Accreditation Aligned with US university standards.
Page 1
,1. A patient with major depressive disorder has been treated with sertraline for 6
weeks without significant improvement. The provider considers augmentation with a
second-generation antipsychotic. Which of the following best explains the
neurobiological rationale for this strategy?
Answer: Aripiprazole acts as a partial agonist at D2 and 5-HT1A receptors,
providing a modulatory effect that can augment SSRI efficacy in
treatment-resistant depression.
Aripiprazole is FDA-approved for adjunctive treatment of major depressive disorder.
Its partial agonism at D2 and 5-HT1A receptors modulates dopamine and serotonin
systems, which can enhance response when added to an SSRI. Option A overemphasizes
noradrenergic effects; option B misstates quetiapine's mechanism (quetiapine has low
5-HT2A affinity); option C inaccurately describes olanzapine's mechanism (olanzapine
is not a 5-HT1A agonist).
2. A patient with a history of bipolar I disorder is admitted for acute mania. The
patient is severely agitated, with psychotic features. Which combination of
pharmacologic interventions is most appropriate for rapid symptom control while
minimizing risk of adverse effects?
Answer: Initiate valproate loading (20 mg/kg/day) plus oral olanzapine 10 mg
twice daily; use intramuscular lorazepam 2 mg for acute agitation.
For acute mania with severe agitation and psychosis, guidelines recommend a mood
stabilizer (valproate loading achieves rapid therapeutic levels) plus an atypical
antipsychotic (olanzapine has robust antimanic efficacy). Lorazepam is preferred for
acute agitation due to rapid onset and safety. Option A is suboptimal because lithium
has a slow onset and haloperidol carries higher risk of extrapyramidal symptoms.
Option C: carbamazepine requires slow titration and ziprasidone has limited evidence
for acute mania. Option D: lamotrigine is ineffective for acute mania and quetiapine at
low doses is not antimanic.
Page 2
,3. A patient with schizophrenia has been stable on clozapine for 6 months with no
psychotic symptoms. The patient develops new-onset tachycardia (heart rate 110
bpm) and complains of dizziness upon standing. Vital signs show orthostatic
hypotension (BP 130/80 supine, 100/60 standing). Which of the following is the most
appropriate next step?
Answer: Obtain a serum clozapine level and electrocardiogram; consider dose
reduction if level is supratherapeutic.
Clozapine can cause dose-related cardiovascular effects including tachycardia and
orthostatic hypotension. Checking a serum level and ECG helps rule out toxicity or
arrhythmia. Dose reduction is appropriate if levels are high. Option A is too drastic;
clozapine is the gold standard for refractory schizophrenia, and switching may lead to
relapse. Option C: beta-blockers can worsen orthostatic hypotension. Option D: these
symptoms are not benign and may indicate serious side effects.
4. A patient with generalized anxiety disorder (GAD) has been treated with
sertraline 100 mg daily for 8 weeks with minimal improvement. The patient reports
insomnia and jitteriness. Which of the following medication adjustments is most
consistent with evidence-based guidelines?
Answer: Switch to venlafaxine extended-release 75 mg daily and titrate upward.
For SSRI non-response in GAD, guidelines recommend switching to another first-line
agent such as venlafaxine XR (SNRI), which has strong evidence for GAD. Option A
may worsen side effects without benefit. Option B: buspirone is less effective for GAD
than SSRIs and SNRIs. Option C: gabapentin lacks robust evidence for GAD and has
abuse potential.
5. A patient with borderline personality disorder (BPD) is admitted following a
suicide attempt by overdose. The patient has a history of multiple hospitalizations
and self-harm. Which of the following therapeutic approaches is most consistent
with evidence-based treatment for BPD?
Answer: Initiate dialectical behavior therapy (DBT) with a focus on mindfulness
and distress tolerance skills, combined with pharmacotherapy for comorbid
conditions.
DBT is the gold-standard psychotherapy for BPD, specifically targeting emotion
dysregulation and self-harm. Pharmacotherapy may address comorbid depression or
anxiety but is not primary. Option B: antidepressants have limited efficacy for core
BPD symptoms. Option C: psychodynamic therapy lacks strong evidence for BPD.
Option D: behavioral contracts are contraindicated as they may increase self-harm and
are not therapeutic.
Page 3
, 6. A patient with alcohol use disorder (AUD) is admitted for detoxification. The
patient has a history of seizure disorder controlled on phenytoin. Which of the
following pharmacologic regimens is most appropriate for alcohol withdrawal
prophylaxis, considering the patient's seizure history?
Answer: Use a fixed-dose regimen of diazepam 10 mg every 6 hours for 4 days,
with as-needed doses for breakthrough symptoms.
For patients with seizure disorder, a fixed-dose benzodiazepine regimen (e.g., diazepam)
provides consistent anticonvulsant coverage and reduces withdrawal seizure risk.
Option A: symptom-triggered therapy may miss early seizures. Option C:
carbamazepine is a second-line agent and can lower phenytoin levels. Option D: IV
lorazepam as needed is less predictable and requires intensive monitoring.
7. A patient with posttraumatic stress disorder (PTSD) has been treated with
prolonged exposure therapy for 12 sessions. The patient continues to have significant
hyperarousal symptoms and nightmares. Which of the following medication
additions is supported by the strongest evidence?
Answer: Prazosin 1 mg at bedtime, titrated to effect, to reduce nightmares and
improve sleep quality.
Prazosin, an alpha-1 antagonist, has strong evidence for reducing PTSD-related
nightmares and hyperarousal. Option B: quetiapine has limited evidence for PTSD and
significant metabolic side effects. Option C: buspirone is not effective for PTSD. Option
D: lamotrigine has mixed evidence and is not first-line.
8. A patient with obsessive-compulsive disorder (OCD) has been on fluoxetine 80 mg
daily for 12 weeks with partial response. The patient continues to have significant
rituals that interfere with daily functioning. Which of the following augmentation
strategies is most appropriate?
Answer: Add cognitive-behavioral therapy (CBT) with exposure and response
prevention (ERP).
For OCD with partial response to SSRI, adding CBT with ERP is the most
evidence-based approach, as it targets the behavioral component. Option A:
antipsychotic augmentation is second-line and has modest evidence. Option B:
clomipramine is effective but has a less favorable side effect profile; switching may be
considered if CBT fails. Option D: doses above 80 mg are not recommended due to
increased side effects without clear benefit.
Page 4
Already Graded A+ Premium Exam Tested And Verified
Subject Area NUR 253 Exam 4 Mental Health
Description Comprehensive examination on NUR 253 Exam 4 Mental Health.
Expected Grade A+
Total Questions 190
Duration 3 hours
Learning Outcomes 1. Demonstrate mastery of core concepts
Accreditation Aligned with US university standards.
Page 1
,1. A patient with major depressive disorder has been treated with sertraline for 6
weeks without significant improvement. The provider considers augmentation with a
second-generation antipsychotic. Which of the following best explains the
neurobiological rationale for this strategy?
Answer: Aripiprazole acts as a partial agonist at D2 and 5-HT1A receptors,
providing a modulatory effect that can augment SSRI efficacy in
treatment-resistant depression.
Aripiprazole is FDA-approved for adjunctive treatment of major depressive disorder.
Its partial agonism at D2 and 5-HT1A receptors modulates dopamine and serotonin
systems, which can enhance response when added to an SSRI. Option A overemphasizes
noradrenergic effects; option B misstates quetiapine's mechanism (quetiapine has low
5-HT2A affinity); option C inaccurately describes olanzapine's mechanism (olanzapine
is not a 5-HT1A agonist).
2. A patient with a history of bipolar I disorder is admitted for acute mania. The
patient is severely agitated, with psychotic features. Which combination of
pharmacologic interventions is most appropriate for rapid symptom control while
minimizing risk of adverse effects?
Answer: Initiate valproate loading (20 mg/kg/day) plus oral olanzapine 10 mg
twice daily; use intramuscular lorazepam 2 mg for acute agitation.
For acute mania with severe agitation and psychosis, guidelines recommend a mood
stabilizer (valproate loading achieves rapid therapeutic levels) plus an atypical
antipsychotic (olanzapine has robust antimanic efficacy). Lorazepam is preferred for
acute agitation due to rapid onset and safety. Option A is suboptimal because lithium
has a slow onset and haloperidol carries higher risk of extrapyramidal symptoms.
Option C: carbamazepine requires slow titration and ziprasidone has limited evidence
for acute mania. Option D: lamotrigine is ineffective for acute mania and quetiapine at
low doses is not antimanic.
Page 2
,3. A patient with schizophrenia has been stable on clozapine for 6 months with no
psychotic symptoms. The patient develops new-onset tachycardia (heart rate 110
bpm) and complains of dizziness upon standing. Vital signs show orthostatic
hypotension (BP 130/80 supine, 100/60 standing). Which of the following is the most
appropriate next step?
Answer: Obtain a serum clozapine level and electrocardiogram; consider dose
reduction if level is supratherapeutic.
Clozapine can cause dose-related cardiovascular effects including tachycardia and
orthostatic hypotension. Checking a serum level and ECG helps rule out toxicity or
arrhythmia. Dose reduction is appropriate if levels are high. Option A is too drastic;
clozapine is the gold standard for refractory schizophrenia, and switching may lead to
relapse. Option C: beta-blockers can worsen orthostatic hypotension. Option D: these
symptoms are not benign and may indicate serious side effects.
4. A patient with generalized anxiety disorder (GAD) has been treated with
sertraline 100 mg daily for 8 weeks with minimal improvement. The patient reports
insomnia and jitteriness. Which of the following medication adjustments is most
consistent with evidence-based guidelines?
Answer: Switch to venlafaxine extended-release 75 mg daily and titrate upward.
For SSRI non-response in GAD, guidelines recommend switching to another first-line
agent such as venlafaxine XR (SNRI), which has strong evidence for GAD. Option A
may worsen side effects without benefit. Option B: buspirone is less effective for GAD
than SSRIs and SNRIs. Option C: gabapentin lacks robust evidence for GAD and has
abuse potential.
5. A patient with borderline personality disorder (BPD) is admitted following a
suicide attempt by overdose. The patient has a history of multiple hospitalizations
and self-harm. Which of the following therapeutic approaches is most consistent
with evidence-based treatment for BPD?
Answer: Initiate dialectical behavior therapy (DBT) with a focus on mindfulness
and distress tolerance skills, combined with pharmacotherapy for comorbid
conditions.
DBT is the gold-standard psychotherapy for BPD, specifically targeting emotion
dysregulation and self-harm. Pharmacotherapy may address comorbid depression or
anxiety but is not primary. Option B: antidepressants have limited efficacy for core
BPD symptoms. Option C: psychodynamic therapy lacks strong evidence for BPD.
Option D: behavioral contracts are contraindicated as they may increase self-harm and
are not therapeutic.
Page 3
, 6. A patient with alcohol use disorder (AUD) is admitted for detoxification. The
patient has a history of seizure disorder controlled on phenytoin. Which of the
following pharmacologic regimens is most appropriate for alcohol withdrawal
prophylaxis, considering the patient's seizure history?
Answer: Use a fixed-dose regimen of diazepam 10 mg every 6 hours for 4 days,
with as-needed doses for breakthrough symptoms.
For patients with seizure disorder, a fixed-dose benzodiazepine regimen (e.g., diazepam)
provides consistent anticonvulsant coverage and reduces withdrawal seizure risk.
Option A: symptom-triggered therapy may miss early seizures. Option C:
carbamazepine is a second-line agent and can lower phenytoin levels. Option D: IV
lorazepam as needed is less predictable and requires intensive monitoring.
7. A patient with posttraumatic stress disorder (PTSD) has been treated with
prolonged exposure therapy for 12 sessions. The patient continues to have significant
hyperarousal symptoms and nightmares. Which of the following medication
additions is supported by the strongest evidence?
Answer: Prazosin 1 mg at bedtime, titrated to effect, to reduce nightmares and
improve sleep quality.
Prazosin, an alpha-1 antagonist, has strong evidence for reducing PTSD-related
nightmares and hyperarousal. Option B: quetiapine has limited evidence for PTSD and
significant metabolic side effects. Option C: buspirone is not effective for PTSD. Option
D: lamotrigine has mixed evidence and is not first-line.
8. A patient with obsessive-compulsive disorder (OCD) has been on fluoxetine 80 mg
daily for 12 weeks with partial response. The patient continues to have significant
rituals that interfere with daily functioning. Which of the following augmentation
strategies is most appropriate?
Answer: Add cognitive-behavioral therapy (CBT) with exposure and response
prevention (ERP).
For OCD with partial response to SSRI, adding CBT with ERP is the most
evidence-based approach, as it targets the behavioral component. Option A:
antipsychotic augmentation is second-line and has modest evidence. Option B:
clomipramine is effective but has a less favorable side effect profile; switching may be
considered if CBT fails. Option D: doses above 80 mg are not recommended due to
increased side effects without clear benefit.
Page 4
