NUR2459
Mental Health & Behavioral Health
Nursing
Final Exam Review
(Questions & Solutions)
2025
1
,1. A 52-year-old with treatment-resistant major depressive disorder
reports no improvement after multiple SSRI trials. He endorses severe
suicidal ideation. Which intervention is most evidence-based?
A) Continue current SSRI for another 4 weeks
B) Add bupropion
C) Initiate electroconvulsive therapy (ECT)
D) Switch to buspirone
ANS: C
Rationale: ECT is the most effective rapid-acting treatment for refractory
depression with acute suicidality.
2. A 28-year-old with bipolar I disorder presents in acute mania. Lithium
level is 1.8 mEq/L; he is tremulous and confused. Most appropriate
action?
A) Hold lithium and check renal function
B) Increase fluid intake and continue lithium
C) Add valproate without adjusting lithium
D) Initiate outpatient therapy
ANS: A
Rationale: Toxic lithium level (>1.5) with neurologic symptoms requires
immediate discontinuation and renal evaluation.
3. A 22-year-old with schizophrenia on haloperidol develops sudden
muscle rigidity, fever, and autonomic instability. Lab shows elevated CK.
Diagnosis and management?
A) Neuroleptic malignant syndrome; discontinue antipsychotic and give
dantrolene
B) Serotonin syndrome; stop SSRI
C) Acute dystonia; give benztropine
D) Parkinsonism; give levodopa
ANS: A
Rationale: NMS presents with fever, rigidity, and high CK; treated by
stopping dopamine antagonist and dantrolene.
2
, 4. A patient with opioid use disorder requests treatment. He has failed
detox previously and is highly motivated. Best first‐line option?
A) Methadone maintenance
B) Buprenorphine induction
C) Naltrexone IM
D) Clonidine alone
ANS: B
Rationale: Buprenorphine is preferred outpatient medication for OUD
given its safety and efficacy profile.
5. A borderline personality disorder patient presents with recurrent self-
harm. Which evidence-based therapy reduces self-injury?
A) Dialectical behavior therapy (DBT)
B) Psychoanalysis
C) Supportive counseling only
D) Group therapy alone
ANS: A
Rationale: DBT is the gold standard for reducing suicidal and self-harm
behaviors in BPD.
6. A 45-year-old Vietnam veteran has nightmares, hypervigilance, and
avoidance for 20 years. Best medication to reduce nightmares?
A) Prazosin
B) Sertraline
C) Diazepam
D) Bupropion
ANS: A
Rationale: Prazosin, an alpha-1 blocker, is effective for PTSD-related
nightmares and sleep disturbance.
7. A 34-year-old with generalized anxiety disorder wants rapid relief.
Which is appropriate for acute exacerbations?
A) Short-acting benzodiazepine (e.g., lorazepam)
B) Buspirone
C) SSRIs only
3
Mental Health & Behavioral Health
Nursing
Final Exam Review
(Questions & Solutions)
2025
1
,1. A 52-year-old with treatment-resistant major depressive disorder
reports no improvement after multiple SSRI trials. He endorses severe
suicidal ideation. Which intervention is most evidence-based?
A) Continue current SSRI for another 4 weeks
B) Add bupropion
C) Initiate electroconvulsive therapy (ECT)
D) Switch to buspirone
ANS: C
Rationale: ECT is the most effective rapid-acting treatment for refractory
depression with acute suicidality.
2. A 28-year-old with bipolar I disorder presents in acute mania. Lithium
level is 1.8 mEq/L; he is tremulous and confused. Most appropriate
action?
A) Hold lithium and check renal function
B) Increase fluid intake and continue lithium
C) Add valproate without adjusting lithium
D) Initiate outpatient therapy
ANS: A
Rationale: Toxic lithium level (>1.5) with neurologic symptoms requires
immediate discontinuation and renal evaluation.
3. A 22-year-old with schizophrenia on haloperidol develops sudden
muscle rigidity, fever, and autonomic instability. Lab shows elevated CK.
Diagnosis and management?
A) Neuroleptic malignant syndrome; discontinue antipsychotic and give
dantrolene
B) Serotonin syndrome; stop SSRI
C) Acute dystonia; give benztropine
D) Parkinsonism; give levodopa
ANS: A
Rationale: NMS presents with fever, rigidity, and high CK; treated by
stopping dopamine antagonist and dantrolene.
2
, 4. A patient with opioid use disorder requests treatment. He has failed
detox previously and is highly motivated. Best first‐line option?
A) Methadone maintenance
B) Buprenorphine induction
C) Naltrexone IM
D) Clonidine alone
ANS: B
Rationale: Buprenorphine is preferred outpatient medication for OUD
given its safety and efficacy profile.
5. A borderline personality disorder patient presents with recurrent self-
harm. Which evidence-based therapy reduces self-injury?
A) Dialectical behavior therapy (DBT)
B) Psychoanalysis
C) Supportive counseling only
D) Group therapy alone
ANS: A
Rationale: DBT is the gold standard for reducing suicidal and self-harm
behaviors in BPD.
6. A 45-year-old Vietnam veteran has nightmares, hypervigilance, and
avoidance for 20 years. Best medication to reduce nightmares?
A) Prazosin
B) Sertraline
C) Diazepam
D) Bupropion
ANS: A
Rationale: Prazosin, an alpha-1 blocker, is effective for PTSD-related
nightmares and sleep disturbance.
7. A 34-year-old with generalized anxiety disorder wants rapid relief.
Which is appropriate for acute exacerbations?
A) Short-acting benzodiazepine (e.g., lorazepam)
B) Buspirone
C) SSRIs only
3
