NUR 256 Exam 2 V2 | NUR 256 Concepts
of Mental Health Nursing | Q&A with
Rationale (NUR256 Exam 2) | Galen
College of Nursing
1. A nurse is caring for a client with Major Depressive Disorder who states, ‘I just don’t see
the point in anything anymore.’ Which response by the nurse is the most therapeutic?
A. ‘Why do you feel that way today?’
B. ‘It sounds like you are feeling very hopeless right now.’
C. ‘You have so much to live for, including your family.’
D. ‘Don’t worry, the medication will start working soon.’
Answer: B
Rationale: This response uses the therapeutic technique of reflection and verbalizing the
implied. It validates the client’s feelings without being dismissive or asking ‘why’ questions,
which can be perceived as accusatory. Establishing a therapeutic rapport is essential in the
care of clients with mood disorders.
2. A client diagnosed with Bipolar I Disorder is in the manic phase and is moving quickly
around the unit. Which snack should the nurse provide to this client?
A. A bowl of vegetable soup
B. A cheeseburger and a side of fries
,C. A cup of yogurt with a spoon
D. Apple slices and a turkey wrap
Answer: D
Rationale: Clients in a manic state often have difficulty sitting down to eat due to
hyperactivity and shortened attention spans. Providing ‘finger foods’ that are high in
calories and protein allows the client to maintain nutritional status while on the move. This
intervention prevents exhaustion and weight loss during acute manic episodes.
3. Which laboratory value should the nurse prioritize monitoring for a client newly prescribed
Clozapine?
A. White Blood Cell (WBC) count
B. Serum Lithium levels
C. Blood Urea Nitrogen (BUN)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a significant risk of agranulocytosis, which is a life-
threatening decrease in white blood cells. National protocols require frequent monitoring
of the Absolute Neutrophil Count (ANC) and WBC count to ensure patient safety. If the WBC
count drops too low, the medication must be discontinued immediately to prevent severe
infection.
, 4. A client is being started on Lithium carbonate for Bipolar Disorder. The nurse should
instruct the client to maintain a consistent intake of which substance?
A. Potassium
B. Sodium
C. Vitamin K
D. Magnesium
Answer: B
Rationale: Lithium is a salt, and its excretion by the kidneys is closely tied to sodium levels.
If sodium intake decreases or is lost through excessive sweating, the kidneys retain lithium,
leading to toxicity. Clients must be taught to maintain a consistent intake of both salt and
fluids to keep lithium levels within the therapeutic range.
5. A client is experiencing a panic attack. Which action should the nurse take first?
A. Stay with the client and remain calm.
B. Administer a PRN dose of Lorazepam.
C. Teach the client deep breathing exercises.
D. Ask the client to describe the trigger for the attack.
Answer: A
Rationale: The nurse’s presence provides a sense of security and safety to a client who is
feeling overwhelmed by physical symptoms and terror. During a panic attack, the client’s
of Mental Health Nursing | Q&A with
Rationale (NUR256 Exam 2) | Galen
College of Nursing
1. A nurse is caring for a client with Major Depressive Disorder who states, ‘I just don’t see
the point in anything anymore.’ Which response by the nurse is the most therapeutic?
A. ‘Why do you feel that way today?’
B. ‘It sounds like you are feeling very hopeless right now.’
C. ‘You have so much to live for, including your family.’
D. ‘Don’t worry, the medication will start working soon.’
Answer: B
Rationale: This response uses the therapeutic technique of reflection and verbalizing the
implied. It validates the client’s feelings without being dismissive or asking ‘why’ questions,
which can be perceived as accusatory. Establishing a therapeutic rapport is essential in the
care of clients with mood disorders.
2. A client diagnosed with Bipolar I Disorder is in the manic phase and is moving quickly
around the unit. Which snack should the nurse provide to this client?
A. A bowl of vegetable soup
B. A cheeseburger and a side of fries
,C. A cup of yogurt with a spoon
D. Apple slices and a turkey wrap
Answer: D
Rationale: Clients in a manic state often have difficulty sitting down to eat due to
hyperactivity and shortened attention spans. Providing ‘finger foods’ that are high in
calories and protein allows the client to maintain nutritional status while on the move. This
intervention prevents exhaustion and weight loss during acute manic episodes.
3. Which laboratory value should the nurse prioritize monitoring for a client newly prescribed
Clozapine?
A. White Blood Cell (WBC) count
B. Serum Lithium levels
C. Blood Urea Nitrogen (BUN)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a significant risk of agranulocytosis, which is a life-
threatening decrease in white blood cells. National protocols require frequent monitoring
of the Absolute Neutrophil Count (ANC) and WBC count to ensure patient safety. If the WBC
count drops too low, the medication must be discontinued immediately to prevent severe
infection.
, 4. A client is being started on Lithium carbonate for Bipolar Disorder. The nurse should
instruct the client to maintain a consistent intake of which substance?
A. Potassium
B. Sodium
C. Vitamin K
D. Magnesium
Answer: B
Rationale: Lithium is a salt, and its excretion by the kidneys is closely tied to sodium levels.
If sodium intake decreases or is lost through excessive sweating, the kidneys retain lithium,
leading to toxicity. Clients must be taught to maintain a consistent intake of both salt and
fluids to keep lithium levels within the therapeutic range.
5. A client is experiencing a panic attack. Which action should the nurse take first?
A. Stay with the client and remain calm.
B. Administer a PRN dose of Lorazepam.
C. Teach the client deep breathing exercises.
D. Ask the client to describe the trigger for the attack.
Answer: A
Rationale: The nurse’s presence provides a sense of security and safety to a client who is
feeling overwhelmed by physical symptoms and terror. During a panic attack, the client’s
