2026 NUR 253 Mental Health Nursing – Exams 1-4 Complete
Practice Questions with Correct Answers & Detailed Rationales
Master psychiatric nursing interventions and pass every milestone assessment with this
complete 2026/2027 NUR 253 Mental Health Nursing bundle covering Exams 1 through
4. This comprehensive preparatory test bank features high-yield practice questions
paired with 100% verified answers and rigorous clinical rationales exploring therapeutic
communication, DSM-5-TR mood and psychotic disorders, substance abuse
management, and psychopharmacology safety protocols. It is the ultimate tool for pre-
licensure nursing students looking to optimize study routines, sharpen clinical judgment,
and secure an A+ grade.
1. A client with major depressive disorder is started on phenelzine. The nurse
provides dietary education. Which statement by the client indicates a need for
further teaching?
A. "I will avoid aged cheeses while taking this medication."
B. "I can continue to drink red wine with my dinner."
C. "I should avoid cured meats like salami and pepperoni."
D. "I will not eat fermented foods like sauerkraut."
Rationale: Phenelzine is an MAOI (monoamine oxidase inhibitor). Red wine contains
tyramine and should be avoided. Aged cheeses, cured meats, and fermented foods are also
high in tyramine and must be avoided to prevent hypertensive crisis. The client's statement
about red wine indicates a need for further education.
2. A client with schizophrenia is prescribed haloperidol and develops acute
dystonia. Which medication should the nurse anticipate administering?
A. Propranolol
B. Diphenhydramine (Benadryl)
C. Clonazepam
D. Olanzapine
Rationale: Acute dystonia is an extrapyramidal side effect characterized by muscle spasms,
torticollis, and oculogyric crisis. It is treated with anticholinergics such as diphenhydramine
or benztropine. Propranolol is used for akathisia; clonazepam is used for anxiety or
seizures; olanzapine is an antipsychotic and would not treat dystonia.
,3. A client with borderline personality disorder is admitted to the unit after a
suicide attempt. The client is manipulative and demanding. Which nursing
intervention is most appropriate?
A. Grant all requests to avoid conflict
B. Set consistent limits and maintain a structured environment
C. Ignore the client's demands
D. Transfer the client to another unit
Rationale: Clients with borderline personality disorder benefit from consistent, firm limits
and structure. This provides a sense of safety and reduces manipulative behaviors.
Granting all requests reinforces the behavior; ignoring demands may escalate the
situation; transferring the client is not therapeutic.
4. A client with Alzheimer's disease is becoming increasingly agitated in the
evening. The nurse identifies this as:
A. Delirium
B. Sundowning
C. Confabulation
D. Agnosia
Rationale: Sundowning is a common behavior in Alzheimer's disease characterized by
increased confusion, agitation, and restlessness in the late afternoon and evening.
Delirium is acute and fluctuating; confabulation is the fabrication of stories to fill memory
gaps; agnosia is the inability to recognize objects or people.
5. A client with generalized anxiety disorder is prescribed buspirone. The client
asks, "How long will it take for this medication to work?" The nurse's best
response is:
A. "It will work immediately."
B. "It may take 2-4 weeks to reach its full effect."
C. "It will work within 24 hours."
D. "It is not effective for generalized anxiety."
Rationale: Buspirone is a non-benzodiazepine anxiolytic that requires 2-4 weeks for full
therapeutic effect. It is not for as-needed use and does not cause dependence like
,benzodiazepines. Patients should be educated about this delay to prevent premature
discontinuation.
6. A client with bipolar disorder is prescribed lithium and reports excessive thirst
and frequent urination. The nurse should assess for:
A. Diabetes mellitus
B. Nephrogenic diabetes insipidus
C. Hyperglycemia
D. Hypothyroidism
Rationale: Lithium can cause nephrogenic diabetes insipidus, characterized by polyuria
and polydipsia. This occurs because lithium interferes with the action of antidiuretic
hormone (ADH) on the kidneys. Diabetes mellitus, hyperglycemia, and hypothyroidism are
not directly caused by lithium, though hypothyroidism is also a possible side effect.
7. A client with schizophrenia is experiencing auditory hallucinations. The client
states, "The voices are telling me to hurt myself." What is the nurse's priority
action?
A. Tell the client to ignore the voices
B. Assess the client for suicidal ideation and intent, and implement a safety plan
C. Ask the client to describe the voices in detail
D. Administer a PRN antipsychotic
Rationale: Command hallucinations to harm oneself are a safety risk. The nurse must
assess for suicidal ideation, plan, and intent and implement a safety plan. Describing the
voices may reinforce them, and medication should not be the first response without
assessment.
8. A client with major depressive disorder is prescribed sertraline. Which statement
by the client indicates understanding of the medication?
A. "I will feel better in 24 hours."
B. "It may take 4-6 weeks to see improvement."
, C. "I can stop taking the medication once I feel better."
D. "This medication is not addictive."
Rationale: SSRIs require 4-6 weeks for full therapeutic effect. Patients should be educated
about this delay to prevent premature discontinuation. The medication should not be
stopped abruptly; though SSRIs are not considered addictive, they can cause withdrawal
symptoms if stopped suddenly.
9. A client with PTSD is experiencing flashbacks. Which nursing intervention is
most appropriate?
A. Ask the client to describe the traumatic event
B. Use grounding techniques and reassure the client of present safety
C. Tell the client the flashback is not real
D. Administer a sedative to stop the flashback
Rationale: Flashbacks are dissociative re-experiencing of traumatic events. Grounding
techniques (e.g., focusing on present surroundings, deep breathing) help the client return
to the present. Describing the trauma may intensify distress, and telling the client it's not
real may invalidate their experience. Sedation is not first-line.
10. A client with schizophrenia is experiencing extrapyramidal symptoms (EPS)
after taking haloperidol. Which symptom is most consistent with EPS?
A. Weight gain
B. Tremors and bradykinesia
C. Hyperglycemia
D. Sedation
Rationale: EPS is a common side effect of first-generation antipsychotics like haloperidol.
Symptoms include muscle rigidity, tremors, bradykinesia, and akathisia. Tardive dyskinesia
(involuntary movements) can occur with long-term use. Weight gain, sedation, and
hyperglycemia are more common with second-generation antipsychotics.
Practice Questions with Correct Answers & Detailed Rationales
Master psychiatric nursing interventions and pass every milestone assessment with this
complete 2026/2027 NUR 253 Mental Health Nursing bundle covering Exams 1 through
4. This comprehensive preparatory test bank features high-yield practice questions
paired with 100% verified answers and rigorous clinical rationales exploring therapeutic
communication, DSM-5-TR mood and psychotic disorders, substance abuse
management, and psychopharmacology safety protocols. It is the ultimate tool for pre-
licensure nursing students looking to optimize study routines, sharpen clinical judgment,
and secure an A+ grade.
1. A client with major depressive disorder is started on phenelzine. The nurse
provides dietary education. Which statement by the client indicates a need for
further teaching?
A. "I will avoid aged cheeses while taking this medication."
B. "I can continue to drink red wine with my dinner."
C. "I should avoid cured meats like salami and pepperoni."
D. "I will not eat fermented foods like sauerkraut."
Rationale: Phenelzine is an MAOI (monoamine oxidase inhibitor). Red wine contains
tyramine and should be avoided. Aged cheeses, cured meats, and fermented foods are also
high in tyramine and must be avoided to prevent hypertensive crisis. The client's statement
about red wine indicates a need for further education.
2. A client with schizophrenia is prescribed haloperidol and develops acute
dystonia. Which medication should the nurse anticipate administering?
A. Propranolol
B. Diphenhydramine (Benadryl)
C. Clonazepam
D. Olanzapine
Rationale: Acute dystonia is an extrapyramidal side effect characterized by muscle spasms,
torticollis, and oculogyric crisis. It is treated with anticholinergics such as diphenhydramine
or benztropine. Propranolol is used for akathisia; clonazepam is used for anxiety or
seizures; olanzapine is an antipsychotic and would not treat dystonia.
,3. A client with borderline personality disorder is admitted to the unit after a
suicide attempt. The client is manipulative and demanding. Which nursing
intervention is most appropriate?
A. Grant all requests to avoid conflict
B. Set consistent limits and maintain a structured environment
C. Ignore the client's demands
D. Transfer the client to another unit
Rationale: Clients with borderline personality disorder benefit from consistent, firm limits
and structure. This provides a sense of safety and reduces manipulative behaviors.
Granting all requests reinforces the behavior; ignoring demands may escalate the
situation; transferring the client is not therapeutic.
4. A client with Alzheimer's disease is becoming increasingly agitated in the
evening. The nurse identifies this as:
A. Delirium
B. Sundowning
C. Confabulation
D. Agnosia
Rationale: Sundowning is a common behavior in Alzheimer's disease characterized by
increased confusion, agitation, and restlessness in the late afternoon and evening.
Delirium is acute and fluctuating; confabulation is the fabrication of stories to fill memory
gaps; agnosia is the inability to recognize objects or people.
5. A client with generalized anxiety disorder is prescribed buspirone. The client
asks, "How long will it take for this medication to work?" The nurse's best
response is:
A. "It will work immediately."
B. "It may take 2-4 weeks to reach its full effect."
C. "It will work within 24 hours."
D. "It is not effective for generalized anxiety."
Rationale: Buspirone is a non-benzodiazepine anxiolytic that requires 2-4 weeks for full
therapeutic effect. It is not for as-needed use and does not cause dependence like
,benzodiazepines. Patients should be educated about this delay to prevent premature
discontinuation.
6. A client with bipolar disorder is prescribed lithium and reports excessive thirst
and frequent urination. The nurse should assess for:
A. Diabetes mellitus
B. Nephrogenic diabetes insipidus
C. Hyperglycemia
D. Hypothyroidism
Rationale: Lithium can cause nephrogenic diabetes insipidus, characterized by polyuria
and polydipsia. This occurs because lithium interferes with the action of antidiuretic
hormone (ADH) on the kidneys. Diabetes mellitus, hyperglycemia, and hypothyroidism are
not directly caused by lithium, though hypothyroidism is also a possible side effect.
7. A client with schizophrenia is experiencing auditory hallucinations. The client
states, "The voices are telling me to hurt myself." What is the nurse's priority
action?
A. Tell the client to ignore the voices
B. Assess the client for suicidal ideation and intent, and implement a safety plan
C. Ask the client to describe the voices in detail
D. Administer a PRN antipsychotic
Rationale: Command hallucinations to harm oneself are a safety risk. The nurse must
assess for suicidal ideation, plan, and intent and implement a safety plan. Describing the
voices may reinforce them, and medication should not be the first response without
assessment.
8. A client with major depressive disorder is prescribed sertraline. Which statement
by the client indicates understanding of the medication?
A. "I will feel better in 24 hours."
B. "It may take 4-6 weeks to see improvement."
, C. "I can stop taking the medication once I feel better."
D. "This medication is not addictive."
Rationale: SSRIs require 4-6 weeks for full therapeutic effect. Patients should be educated
about this delay to prevent premature discontinuation. The medication should not be
stopped abruptly; though SSRIs are not considered addictive, they can cause withdrawal
symptoms if stopped suddenly.
9. A client with PTSD is experiencing flashbacks. Which nursing intervention is
most appropriate?
A. Ask the client to describe the traumatic event
B. Use grounding techniques and reassure the client of present safety
C. Tell the client the flashback is not real
D. Administer a sedative to stop the flashback
Rationale: Flashbacks are dissociative re-experiencing of traumatic events. Grounding
techniques (e.g., focusing on present surroundings, deep breathing) help the client return
to the present. Describing the trauma may intensify distress, and telling the client it's not
real may invalidate their experience. Sedation is not first-line.
10. A client with schizophrenia is experiencing extrapyramidal symptoms (EPS)
after taking haloperidol. Which symptom is most consistent with EPS?
A. Weight gain
B. Tremors and bradykinesia
C. Hyperglycemia
D. Sedation
Rationale: EPS is a common side effect of first-generation antipsychotics like haloperidol.
Symptoms include muscle rigidity, tremors, bradykinesia, and akathisia. Tardive dyskinesia
(involuntary movements) can occur with long-term use. Weight gain, sedation, and
hyperglycemia are more common with second-generation antipsychotics.
