NR 547 PSYCHIATRIC–MENTAL HEALTH
NURSING 100 ORIGINAL PRACTICE QUESTIONS
WITH ANSWERS & RATIONALES
Section 1: Mood Disorders
Q1. A client with major depressive disorder states, "Nothing matters anymore, I'm
just a burden." What is the nurse's priority action?
A. Reassure the client that they are not a burden.
B. Assess for suicidal ideation directly.
C. Document the statement and continue the assessment.
D. Refer the client to social work.
Answer: B. Assess for suicidal ideation directly
Rationale: Statements about being a burden or hopelessness are red flags for
suicidal ideation. The nurse must directly and specifically assess for suicidal
thoughts, plan, and intent before anything else. Indirect reassurance or deferring
the assessment could miss an acute safety risk.
Q2. Which symptom cluster is most characteristic of a manic episode in bipolar I
disorder?
A. Flat affect, anhedonia, psychomotor retardation.
B. Grandiosity, decreased need for sleep, pressured speech.
C. Excessive worry, muscle tension, restlessness.
D. Disorganized speech, hallucinations, negative symptoms.
Answer: B. Grandiosity, decreased need for sleep, pressured speech
,Rationale: Mania is defined by elevated or irritable mood plus symptoms such as
grandiosity, decreased need for sleep, pressured speech, flight of ideas, and
increased goal-directed activity. Option A describes depression, C is more
consistent with generalized anxiety, and D is more typical of schizophrenia.
Q3. A client taking lithium reports nausea, vomiting, coarse hand tremors, and
ataxia. What is the nurse's priority?
A. Administer an antiemetic and reassess in an hour.
B. Hold the next dose and check a lithium level immediately.
C. Encourage increased sodium intake.
D. Document as an expected side effect.
Answer: B. Hold the next dose and check a lithium level immediately
Rationale: These are signs of lithium toxicity, which can progress to seizures,
coma, and death. The nurse should hold the dose and obtain a stat lithium level.
The therapeutic range is roughly 0.6–1.2 mEq/L, and toxicity typically appears
above 1.5 mEq/L.
Q4. Which teaching point is essential for a client newly started on lithium?
A. "Restrict your fluid intake to prevent toxicity."
B. "Maintain a consistent sodium intake and stay well hydrated."
C. "Avoid all dairy products while taking this medication."
D. "You may stop the medication once your mood stabilizes."
Answer: B. Maintain a consistent sodium intake and stay well hydrated
Rationale: Sodium and fluid balance directly affect lithium levels. Low sodium or
dehydration increases lithium reabsorption and raises the risk of toxicity. Clients
should maintain stable, adequate sodium and fluid intake rather than restricting
either.
,Q5. A client with persistent depressive disorder (dysthymia) differs from major
depressive disorder primarily in which way?
A. Symptoms are more severe.
B. Symptoms are chronic and lower-grade, lasting 2+ years.
C. Psychotic features are always present.
D. It only occurs in adolescents.
Answer: B. Symptoms are chronic and lower-grade, lasting 2+ years
Rationale: Persistent depressive disorder involves a chronic, less severe
depressed mood lasting at least 2 years in adults and 1 year in children or
adolescents, unlike the more acute, episodic presentation of major depressive
disorder.
Q6. Which finding would be most concerning in a client recovering from a severe
depressive episode who is beginning to show improved energy?
A. Improved appetite.
B. Increased engagement in unit activities.
C. Sudden calmness with a clear, organized plan discussed vaguely.
D. Reports of better sleep.
Answer: C. Sudden calmness with a clear, organized plan discussed vaguely
Rationale: A sudden lift in mood or calm after severe depression can indicate that
the client has made a decision to attempt suicide and now has the energy to act
on a plan. This paradoxical improvement warrants immediate, thorough safety
assessment.
Q7. Electroconvulsive therapy (ECT) is most strongly indicated for which client?
A. A client with mild depression preferring not to take medication.
, B. A client with severe, treatment-resistant depression with psychotic or catatonic
features.
C. A client with generalized anxiety disorder.
D. A client with adjustment disorder.
Answer: B. A client with severe, treatment-resistant depression with psychotic
or catatonic features
Rationale: ECT is indicated for severe depression unresponsive to medication,
depression with psychotic or catatonic features, and situations requiring a rapid
response, such as acute suicidality or refusal to eat or drink.
Q8. What is the most common post-ECT nursing concern in the immediate
recovery period?
A. Permanent memory loss.
B. Transient confusion and short-term memory impairment.
C. Seizure recurrence.
D. Hypertension requiring emergency treatment.
Answer: B. Transient confusion and short-term memory impairment
Rationale: Transient post-ictal confusion and short-term memory disturbance are
common effects immediately after ECT and typically resolve over time.
Q9. A client with a history of major depression states, "I finally have a plan to end
the pain — I have enough pills saved up." What is this an example of?
A. Suicidal ideation without a plan.
B. Suicidal ideation with a specific, lethal plan and means.
C. Passive death wish.
D. Non-suicidal self-injury.
NURSING 100 ORIGINAL PRACTICE QUESTIONS
WITH ANSWERS & RATIONALES
Section 1: Mood Disorders
Q1. A client with major depressive disorder states, "Nothing matters anymore, I'm
just a burden." What is the nurse's priority action?
A. Reassure the client that they are not a burden.
B. Assess for suicidal ideation directly.
C. Document the statement and continue the assessment.
D. Refer the client to social work.
Answer: B. Assess for suicidal ideation directly
Rationale: Statements about being a burden or hopelessness are red flags for
suicidal ideation. The nurse must directly and specifically assess for suicidal
thoughts, plan, and intent before anything else. Indirect reassurance or deferring
the assessment could miss an acute safety risk.
Q2. Which symptom cluster is most characteristic of a manic episode in bipolar I
disorder?
A. Flat affect, anhedonia, psychomotor retardation.
B. Grandiosity, decreased need for sleep, pressured speech.
C. Excessive worry, muscle tension, restlessness.
D. Disorganized speech, hallucinations, negative symptoms.
Answer: B. Grandiosity, decreased need for sleep, pressured speech
,Rationale: Mania is defined by elevated or irritable mood plus symptoms such as
grandiosity, decreased need for sleep, pressured speech, flight of ideas, and
increased goal-directed activity. Option A describes depression, C is more
consistent with generalized anxiety, and D is more typical of schizophrenia.
Q3. A client taking lithium reports nausea, vomiting, coarse hand tremors, and
ataxia. What is the nurse's priority?
A. Administer an antiemetic and reassess in an hour.
B. Hold the next dose and check a lithium level immediately.
C. Encourage increased sodium intake.
D. Document as an expected side effect.
Answer: B. Hold the next dose and check a lithium level immediately
Rationale: These are signs of lithium toxicity, which can progress to seizures,
coma, and death. The nurse should hold the dose and obtain a stat lithium level.
The therapeutic range is roughly 0.6–1.2 mEq/L, and toxicity typically appears
above 1.5 mEq/L.
Q4. Which teaching point is essential for a client newly started on lithium?
A. "Restrict your fluid intake to prevent toxicity."
B. "Maintain a consistent sodium intake and stay well hydrated."
C. "Avoid all dairy products while taking this medication."
D. "You may stop the medication once your mood stabilizes."
Answer: B. Maintain a consistent sodium intake and stay well hydrated
Rationale: Sodium and fluid balance directly affect lithium levels. Low sodium or
dehydration increases lithium reabsorption and raises the risk of toxicity. Clients
should maintain stable, adequate sodium and fluid intake rather than restricting
either.
,Q5. A client with persistent depressive disorder (dysthymia) differs from major
depressive disorder primarily in which way?
A. Symptoms are more severe.
B. Symptoms are chronic and lower-grade, lasting 2+ years.
C. Psychotic features are always present.
D. It only occurs in adolescents.
Answer: B. Symptoms are chronic and lower-grade, lasting 2+ years
Rationale: Persistent depressive disorder involves a chronic, less severe
depressed mood lasting at least 2 years in adults and 1 year in children or
adolescents, unlike the more acute, episodic presentation of major depressive
disorder.
Q6. Which finding would be most concerning in a client recovering from a severe
depressive episode who is beginning to show improved energy?
A. Improved appetite.
B. Increased engagement in unit activities.
C. Sudden calmness with a clear, organized plan discussed vaguely.
D. Reports of better sleep.
Answer: C. Sudden calmness with a clear, organized plan discussed vaguely
Rationale: A sudden lift in mood or calm after severe depression can indicate that
the client has made a decision to attempt suicide and now has the energy to act
on a plan. This paradoxical improvement warrants immediate, thorough safety
assessment.
Q7. Electroconvulsive therapy (ECT) is most strongly indicated for which client?
A. A client with mild depression preferring not to take medication.
, B. A client with severe, treatment-resistant depression with psychotic or catatonic
features.
C. A client with generalized anxiety disorder.
D. A client with adjustment disorder.
Answer: B. A client with severe, treatment-resistant depression with psychotic
or catatonic features
Rationale: ECT is indicated for severe depression unresponsive to medication,
depression with psychotic or catatonic features, and situations requiring a rapid
response, such as acute suicidality or refusal to eat or drink.
Q8. What is the most common post-ECT nursing concern in the immediate
recovery period?
A. Permanent memory loss.
B. Transient confusion and short-term memory impairment.
C. Seizure recurrence.
D. Hypertension requiring emergency treatment.
Answer: B. Transient confusion and short-term memory impairment
Rationale: Transient post-ictal confusion and short-term memory disturbance are
common effects immediately after ECT and typically resolve over time.
Q9. A client with a history of major depression states, "I finally have a plan to end
the pain — I have enough pills saved up." What is this an example of?
A. Suicidal ideation without a plan.
B. Suicidal ideation with a specific, lethal plan and means.
C. Passive death wish.
D. Non-suicidal self-injury.
