NUR 2459 / NUR2459 Mental and Behavioral Health
Nursing Exam 2 Practice Test Actual 2025/2026 with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
SECTION 1: Mood Disorders — Depression & Bipolar (Questions
1–12)
Q1: A patient with major depressive disorder has been taking sertraline for 4 weeks
and reports improved sleep and appetite but no change in mood. The nurse should
recognize that:
A. The medication is ineffective and should be discontinued
B. Full antidepressant effects typically require 4–6 weeks
C. The dose should be immediately doubled
D. The patient has treatment-resistant depression
Correct Answer: B
Rationale: Antidepressants such as sertraline often produce early improvements in
vegetative symptoms (sleep, appetite) within 2–4 weeks, while mood elevation
typically requires 4–6 weeks of continuous therapy. The nurse should reassure the
patient and encourage continued adherence to the prescribed regimen.
Q2: A patient with bipolar I disorder is in a manic episode and has been prescribed
lithium carbonate. Which laboratory value is most critical to monitor during the first
week of therapy?
A. White blood cell count
,B. Serum lithium level
C. Thyroid-stimulating hormone
D. Liver function tests
Correct Answer: B
Rationale: Serum lithium levels must be monitored frequently during initiation and
dose titration because lithium has a narrow therapeutic index (0.6–1.2 mEq/L for
maintenance). Levels above 1.5 mEq/L indicate toxicity, and early monitoring
prevents serious adverse effects including seizures, coma, and renal damage.
Q3: A patient with persistent depressive disorder (dysthymia) asks why
psychotherapy is recommended in addition to medication. The nurse's best response
is:
A. "Psychotherapy alone is more effective than medication for your condition."
B. "Combined treatment addresses both cognitive patterns and neurochemical
imbalances."
C. "Medication is only a temporary solution until psychotherapy takes effect."
D. "Psychotherapy is required by insurance for all mood disorder diagnoses."
Correct Answer: B
Rationale: Persistent depressive disorder responds best to a combination of
antidepressant medication and evidence-based psychotherapy such as cognitive
behavioral therapy. This dual approach addresses neurochemical dysregulation
through medication while simultaneously targeting maladaptive thought patterns,
interpersonal difficulties, and behavioral activation through therapy.
Q4: A patient with bipolar disorder has been stable on lithium for 2 years but recently
started a low-sodium diet for hypertension. The nurse should be concerned about
which potential outcome?
A. Decreased lithium absorption
,B. Increased lithium toxicity risk
C. Development of lithium-induced diabetes
D. Reduced therapeutic effect of lithium
Correct Answer: B
Rationale: Lithium is filtered by the kidneys in proportion to sodium; reduced sodium
intake causes compensatory sodium retention and decreased lithium excretion,
leading to elevated serum lithium levels and increased toxicity risk. Patients must
maintain consistent sodium intake and report signs of toxicity including tremor,
ataxia, and confusion.
Q5: A patient hospitalized for severe depression expresses hopelessness and states,
"Nothing will ever get better." Which nursing response demonstrates therapeutic
communication?
A. "You have so much to live for—think about your family."
B. "Things will improve once the medication starts working."
C. "You feel like nothing will ever get better. Tell me more about that."
D. "Many people feel this way when they're depressed, but it passes."
Correct Answer: C
Rationale: Therapeutic communication requires validating the patient's feelings
without minimizing, offering false reassurance, or imposing the nurse's perspective.
Reflecting the patient's statement and inviting further exploration demonstrates
empathy, encourages emotional expression, and builds trust essential for the
nurse-patient relationship.
Q6: A patient with bipolar disorder is prescribed lamotrigine as maintenance therapy.
The nurse should instruct the patient to report which serious adverse effect
immediately?
A. Mild headache
, B. Rash or skin changes
C. Mild nausea
D. Drowsiness
Correct Answer: B
Rationale: Lamotrigine carries a black box warning for life-threatening rashes
including Stevens-Johnson syndrome and toxic epidermal necrolysis. The risk is
minimized by slow dose titration, but any new rash, mucosal lesions, or skin changes
require immediate discontinuation and emergency medical evaluation to prevent
potentially fatal outcomes.
Q7: A patient with seasonal affective disorder is prescribed light therapy. The nurse
should instruct the patient to use the light box:
A. For 30 minutes before bedtime to improve sleep
B. For 20–30 minutes within the first hour of waking
C. Throughout the day whenever mood is low
D. Only on cloudy days when natural light is insufficient
Correct Answer: B
Rationale: Light therapy for seasonal affective disorder is most effective when
administered for 20–30 minutes within the first hour after waking, using a 10,000-lux
light box at arm's length. Morning exposure helps regulate circadian rhythms and
melatonin secretion, while evening use can cause insomnia and circadian disruption.
Q8: A patient with major depressive disorder is started on bupropion. Which patient
history would contraindicate this medication?
A. History of hypertension
B. History of seizure disorder
C. History of asthma
D. History of osteoarthritis
Nursing Exam 2 Practice Test Actual 2025/2026 with
Detailed Rationales | 100% Verified | Pass Guaranteed –
A+ Graded
SECTION 1: Mood Disorders — Depression & Bipolar (Questions
1–12)
Q1: A patient with major depressive disorder has been taking sertraline for 4 weeks
and reports improved sleep and appetite but no change in mood. The nurse should
recognize that:
A. The medication is ineffective and should be discontinued
B. Full antidepressant effects typically require 4–6 weeks
C. The dose should be immediately doubled
D. The patient has treatment-resistant depression
Correct Answer: B
Rationale: Antidepressants such as sertraline often produce early improvements in
vegetative symptoms (sleep, appetite) within 2–4 weeks, while mood elevation
typically requires 4–6 weeks of continuous therapy. The nurse should reassure the
patient and encourage continued adherence to the prescribed regimen.
Q2: A patient with bipolar I disorder is in a manic episode and has been prescribed
lithium carbonate. Which laboratory value is most critical to monitor during the first
week of therapy?
A. White blood cell count
,B. Serum lithium level
C. Thyroid-stimulating hormone
D. Liver function tests
Correct Answer: B
Rationale: Serum lithium levels must be monitored frequently during initiation and
dose titration because lithium has a narrow therapeutic index (0.6–1.2 mEq/L for
maintenance). Levels above 1.5 mEq/L indicate toxicity, and early monitoring
prevents serious adverse effects including seizures, coma, and renal damage.
Q3: A patient with persistent depressive disorder (dysthymia) asks why
psychotherapy is recommended in addition to medication. The nurse's best response
is:
A. "Psychotherapy alone is more effective than medication for your condition."
B. "Combined treatment addresses both cognitive patterns and neurochemical
imbalances."
C. "Medication is only a temporary solution until psychotherapy takes effect."
D. "Psychotherapy is required by insurance for all mood disorder diagnoses."
Correct Answer: B
Rationale: Persistent depressive disorder responds best to a combination of
antidepressant medication and evidence-based psychotherapy such as cognitive
behavioral therapy. This dual approach addresses neurochemical dysregulation
through medication while simultaneously targeting maladaptive thought patterns,
interpersonal difficulties, and behavioral activation through therapy.
Q4: A patient with bipolar disorder has been stable on lithium for 2 years but recently
started a low-sodium diet for hypertension. The nurse should be concerned about
which potential outcome?
A. Decreased lithium absorption
,B. Increased lithium toxicity risk
C. Development of lithium-induced diabetes
D. Reduced therapeutic effect of lithium
Correct Answer: B
Rationale: Lithium is filtered by the kidneys in proportion to sodium; reduced sodium
intake causes compensatory sodium retention and decreased lithium excretion,
leading to elevated serum lithium levels and increased toxicity risk. Patients must
maintain consistent sodium intake and report signs of toxicity including tremor,
ataxia, and confusion.
Q5: A patient hospitalized for severe depression expresses hopelessness and states,
"Nothing will ever get better." Which nursing response demonstrates therapeutic
communication?
A. "You have so much to live for—think about your family."
B. "Things will improve once the medication starts working."
C. "You feel like nothing will ever get better. Tell me more about that."
D. "Many people feel this way when they're depressed, but it passes."
Correct Answer: C
Rationale: Therapeutic communication requires validating the patient's feelings
without minimizing, offering false reassurance, or imposing the nurse's perspective.
Reflecting the patient's statement and inviting further exploration demonstrates
empathy, encourages emotional expression, and builds trust essential for the
nurse-patient relationship.
Q6: A patient with bipolar disorder is prescribed lamotrigine as maintenance therapy.
The nurse should instruct the patient to report which serious adverse effect
immediately?
A. Mild headache
, B. Rash or skin changes
C. Mild nausea
D. Drowsiness
Correct Answer: B
Rationale: Lamotrigine carries a black box warning for life-threatening rashes
including Stevens-Johnson syndrome and toxic epidermal necrolysis. The risk is
minimized by slow dose titration, but any new rash, mucosal lesions, or skin changes
require immediate discontinuation and emergency medical evaluation to prevent
potentially fatal outcomes.
Q7: A patient with seasonal affective disorder is prescribed light therapy. The nurse
should instruct the patient to use the light box:
A. For 30 minutes before bedtime to improve sleep
B. For 20–30 minutes within the first hour of waking
C. Throughout the day whenever mood is low
D. Only on cloudy days when natural light is insufficient
Correct Answer: B
Rationale: Light therapy for seasonal affective disorder is most effective when
administered for 20–30 minutes within the first hour after waking, using a 10,000-lux
light box at arm's length. Morning exposure helps regulate circadian rhythms and
melatonin secretion, while evening use can cause insomnia and circadian disruption.
Q8: A patient with major depressive disorder is started on bupropion. Which patient
history would contraindicate this medication?
A. History of hypertension
B. History of seizure disorder
C. History of asthma
D. History of osteoarthritis
