NUR 2459 MENTAL AND BEHAVIORAL HEALTH NURSING
EXAM 2 2026/2027 | Rated A Quiz Bank | Rasmussen College
| Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) (20 Questions)
Q1: A 28-year-old patient presents with depressed mood, anhedonia, insomnia, fatigue,
poor concentration, and feelings of worthlessness for the past 3 weeks. The patient
denies manic or hypomanic episodes. What is the priority nursing diagnosis?
A. Risk for self-directed violence
B. Ineffective coping
C. Hopelessness [CORRECT]
D. Social isolation
Correct Answer: C
Rationale: This patient meets DSM-5 criteria for Major Depressive Disorder (≥5
symptoms including depressed mood or anhedonia for >2 weeks). While all options are
relevant, "Hopelessness" is the priority nursing diagnosis because it is the strongest
predictor of suicide risk and drives the other symptoms. According to the Interpersonal
Theory of Suicide, perceived burdensomeness and thwarted belongingness stem from
hopelessness . Option A is important but secondary—hopelessness must be addressed
first to reduce suicide risk. Option B is a contributing factor. Option D is a consequence
rather than the core issue.
,Q2: A patient with Bipolar I Disorder is prescribed lithium carbonate 300mg TID. Which
laboratory monitoring is essential before initiating therapy?
A. Complete blood count only
B. Thyroid function tests and renal function studies [CORRECT]
C. Liver function tests only
D. Cardiac enzymes only
Correct Answer: B
Rationale: Lithium requires baseline and ongoing monitoring of thyroid function (TSH,
T3, T4) and renal function (BUN, creatinine, electrolytes) because lithium is filtered by
the kidneys and can cause hypothyroidism and nephrotoxicity. The therapeutic index is
narrow (0.6-1.2 mEq/L), making monitoring critical. Option A is incomplete. Option C
(liver) is more relevant for valproate or carbamazepine. Option D is not standard for
lithium initiation .
Q3: A patient with Major Depressive Disorder is started on sertraline 50mg daily. After 3
days, the patient reports increased anxiety and restlessness. What is the nurse's best
response?
A. "Stop the medication immediately; you're having an allergic reaction"
B. "This is a normal early side effect that usually resolves within 1-2 weeks. Let's
monitor your symptoms closely" [CORRECT]
C. "The dose needs to be increased to 100mg"
D. "You need to switch to a different class of antidepressant"
Correct Answer: B
,Rationale: SSRIs like sertraline commonly cause activation syndrome (increased
anxiety, restlessness, insomnia) during the first 1-2 weeks of treatment before
therapeutic effects emerge. This is not an allergic reaction (Option A). Increasing the
dose (Option C) would worsen activation. Switching classes (Option D) is
premature—SSRIs remain first-line, and early side effects typically resolve. The nurse
should provide reassurance, monitor for suicidality, and consider temporary anxiolytic
support if needed.
Q4: A patient with Bipolar II Disorder is experiencing a hypomanic episode. Which
symptom differentiates hypomania from mania?
A. Decreased need for sleep
B. Grandiosity
C. No marked impairment in social or occupational functioning [CORRECT]
D. Racing thoughts
Correct Answer: C
Rationale: The critical differentiator between hypomania and mania per DSM-5 is
severity: hypomania causes no marked impairment in social or occupational functioning
and does not require hospitalization or include psychotic features. If psychosis or
marked impairment occurs, it is mania (Bipolar I). Options A, B, and D occur in both
hypomania and mania. The patient maintains functionality during hypomania, though
others notice the change .
Q5: A patient prescribed phenelzine (Nardil) asks about dietary restrictions. Which
instruction is most accurate?
, A. "Avoid only alcoholic beverages"
B. "Avoid tyramine-rich foods such as aged cheeses, cured meats, and fermented
products to prevent hypertensive crisis" [CORRECT]
C. "Take with grapefruit juice to enhance absorption"
D. "Increase sodium intake to prevent orthostatic hypotension"
Correct Answer: B
Rationale: Phenelzine is an MAOI that irreversibly inhibits MAO-A and MAO-B, preventing
tyramine metabolism. Tyramine-rich foods (aged cheeses, cured meats, fermented
products, fava beans, tap beer) can cause tyramine to enter systemic circulation
unmetabolized, triggering norepinephrine release and potentially fatal hypertensive
crisis. Option A is incomplete. Option C is dangerous (grapefruit affects metabolism of
other drugs, not MAOIs specifically). Option D is incorrect—MAOIs can cause
orthostatic hypotension, but sodium increase is not the management strategy.
Q6: A patient with severe depression is receiving electroconvulsive therapy (ECT). Which
nursing intervention is priority post-treatment?
A. Encourage immediate ambulation to prevent venous stasis
B. Monitor for confusion and memory loss, provide orientation, ensure safety
[CORRECT]
C. Restrict fluids to prevent cerebral edema
D. Administer prophylactic antipsychotics
Correct Answer: B
EXAM 2 2026/2027 | Rated A Quiz Bank | Rasmussen College
| Pass Guaranteed
Domain 1: Mood Disorders (Depression, Bipolar) (20 Questions)
Q1: A 28-year-old patient presents with depressed mood, anhedonia, insomnia, fatigue,
poor concentration, and feelings of worthlessness for the past 3 weeks. The patient
denies manic or hypomanic episodes. What is the priority nursing diagnosis?
A. Risk for self-directed violence
B. Ineffective coping
C. Hopelessness [CORRECT]
D. Social isolation
Correct Answer: C
Rationale: This patient meets DSM-5 criteria for Major Depressive Disorder (≥5
symptoms including depressed mood or anhedonia for >2 weeks). While all options are
relevant, "Hopelessness" is the priority nursing diagnosis because it is the strongest
predictor of suicide risk and drives the other symptoms. According to the Interpersonal
Theory of Suicide, perceived burdensomeness and thwarted belongingness stem from
hopelessness . Option A is important but secondary—hopelessness must be addressed
first to reduce suicide risk. Option B is a contributing factor. Option D is a consequence
rather than the core issue.
,Q2: A patient with Bipolar I Disorder is prescribed lithium carbonate 300mg TID. Which
laboratory monitoring is essential before initiating therapy?
A. Complete blood count only
B. Thyroid function tests and renal function studies [CORRECT]
C. Liver function tests only
D. Cardiac enzymes only
Correct Answer: B
Rationale: Lithium requires baseline and ongoing monitoring of thyroid function (TSH,
T3, T4) and renal function (BUN, creatinine, electrolytes) because lithium is filtered by
the kidneys and can cause hypothyroidism and nephrotoxicity. The therapeutic index is
narrow (0.6-1.2 mEq/L), making monitoring critical. Option A is incomplete. Option C
(liver) is more relevant for valproate or carbamazepine. Option D is not standard for
lithium initiation .
Q3: A patient with Major Depressive Disorder is started on sertraline 50mg daily. After 3
days, the patient reports increased anxiety and restlessness. What is the nurse's best
response?
A. "Stop the medication immediately; you're having an allergic reaction"
B. "This is a normal early side effect that usually resolves within 1-2 weeks. Let's
monitor your symptoms closely" [CORRECT]
C. "The dose needs to be increased to 100mg"
D. "You need to switch to a different class of antidepressant"
Correct Answer: B
,Rationale: SSRIs like sertraline commonly cause activation syndrome (increased
anxiety, restlessness, insomnia) during the first 1-2 weeks of treatment before
therapeutic effects emerge. This is not an allergic reaction (Option A). Increasing the
dose (Option C) would worsen activation. Switching classes (Option D) is
premature—SSRIs remain first-line, and early side effects typically resolve. The nurse
should provide reassurance, monitor for suicidality, and consider temporary anxiolytic
support if needed.
Q4: A patient with Bipolar II Disorder is experiencing a hypomanic episode. Which
symptom differentiates hypomania from mania?
A. Decreased need for sleep
B. Grandiosity
C. No marked impairment in social or occupational functioning [CORRECT]
D. Racing thoughts
Correct Answer: C
Rationale: The critical differentiator between hypomania and mania per DSM-5 is
severity: hypomania causes no marked impairment in social or occupational functioning
and does not require hospitalization or include psychotic features. If psychosis or
marked impairment occurs, it is mania (Bipolar I). Options A, B, and D occur in both
hypomania and mania. The patient maintains functionality during hypomania, though
others notice the change .
Q5: A patient prescribed phenelzine (Nardil) asks about dietary restrictions. Which
instruction is most accurate?
, A. "Avoid only alcoholic beverages"
B. "Avoid tyramine-rich foods such as aged cheeses, cured meats, and fermented
products to prevent hypertensive crisis" [CORRECT]
C. "Take with grapefruit juice to enhance absorption"
D. "Increase sodium intake to prevent orthostatic hypotension"
Correct Answer: B
Rationale: Phenelzine is an MAOI that irreversibly inhibits MAO-A and MAO-B, preventing
tyramine metabolism. Tyramine-rich foods (aged cheeses, cured meats, fermented
products, fava beans, tap beer) can cause tyramine to enter systemic circulation
unmetabolized, triggering norepinephrine release and potentially fatal hypertensive
crisis. Option A is incomplete. Option C is dangerous (grapefruit affects metabolism of
other drugs, not MAOIs specifically). Option D is incorrect—MAOIs can cause
orthostatic hypotension, but sodium increase is not the management strategy.
Q6: A patient with severe depression is receiving electroconvulsive therapy (ECT). Which
nursing intervention is priority post-treatment?
A. Encourage immediate ambulation to prevent venous stasis
B. Monitor for confusion and memory loss, provide orientation, ensure safety
[CORRECT]
C. Restrict fluids to prevent cerebral edema
D. Administer prophylactic antipsychotics
Correct Answer: B
