NUR 253 Exam 4 Mental Health EXAM with
Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Mood and Affective Disorders
2. Anxiety and Trauma-Related Disorders
3. Psychotic Disorders and Schizophrenia Spectrum
4. Personality Disorders
5. Substance-Related and Addictive Disorders
6. Cognitive Impairment and Neurocognitive Disorders
7. Crisis Intervention and Suicide Prevention
8. Therapeutic Communication and Milieu Management
1. A patient with major depressive disorder who has been non-responsive to SSRIs is prescribed
phenelzine. Which patient statement indicates an understanding of the necessary safety
precautions associated with this medication?
A. "I will increase my intake of aged cheeses and fermented foods to boost my protein levels."
B. "I will avoid taking over-the-counter cold medications that contain pseudoephedrine or
phenylephrine."
C. "I can continue drinking my evening glass of red wine as long as I limit it to 5 ounces."
D. "If I miss a dose, I will double the next dose to ensure I maintain therapeutic blood levels."
Answer: B
, Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI), which can cause a
hypertensive crisis if taken with sympathomimetic drugs like decongestants. Option A and C are
incorrect because aged cheeses and red wine are high in tyramine, which must be avoided to
prevent hypertensive crisis. Option D is incorrect because doubling doses of MAOIs is
dangerous and could precipitate toxic side effects.
2. A patient with schizophrenia is experiencing auditory hallucinations and insists that the "voices"
are telling him to stop taking his risperidone. Which nursing intervention is the most appropriate
first step in addressing this situation?
A. Confront the patient by explaining that the voices are not real and are a symptom of his
illness.
B. Increase the dosage of the antipsychotic medication to ensure better control of symptoms.
C. Validate the patient's experience while maintaining a focus on reality-based activities.
D. Isolate the patient in a quiet room to reduce sensory input and prevent the voices from
escalating.
Answer: C
Rationale: Validating the patient's distress while grounding them in reality helps build trust and
promotes compliance without reinforcing delusions. Option A is non-therapeutic and may lead to
patient agitation. Option B is outside the nurse's scope of practice without a provider order.
Option D is restrictive and should be a last resort; milieu therapy suggests social engagement is
preferred over isolation.
3. During an assessment, a patient with borderline personality disorder frequently shifts from
idealizing the nurse to extreme hostility when a request is denied. Which defense mechanism is
this patient primarily exhibiting?
A. Projection
B. Splitting
C. Reaction formation
D. Displacement
Answer: B
Rationale: Splitting is the inability to integrate positive and negative qualities of the self or
others into a cohesive image, leading to "all-or-nothing" thinking typical of borderline
personality disorder. Option A involves attributing one's own thoughts to others. Option C
, involves expressing the opposite of one's true feelings. Option D involves shifting emotions to a
safer target.
4. A patient is admitted following a suicide attempt by overdose. The patient states, "I just wanted
the pain to stop, but now I regret that I'm still here." What is the nurse's priority action?
A. Request a psychiatric consultation for a formal suicide risk assessment.
B. Maintain 1:1 observation and ensure the patient is in a safe, ligature-free environment.
C. Facilitate a group therapy session to help the patient connect with others who have similar
struggles.
D. Discuss the patient's feelings about their family to help them identify reasons for living.
Answer: B
Rationale: Patient safety is the absolute priority for someone who has recently attempted suicide.
1:1 observation is the standard of care for high-risk patients. Option A is a task for the
multidisciplinary team, but the nurse must ensure immediate safety first. Option C is
inappropriate for a patient in crisis. Option D is a long-term intervention that can only occur
once immediate safety is established.
5. A patient with post-traumatic stress disorder (PTSD) presents with severe flashbacks when
hearing loud noises. Which nursing intervention is most effective for long-term stabilization?
A. Administering prazosin as ordered to decrease the frequency and intensity of
nightmares and hyperarousal.
B. Encouraging the patient to discuss the traumatic event in detail until the emotion is
extinguished.
C. Implementing sensory deprivation to prevent any potential triggers during the shift.
D. Ensuring the patient receives high doses of benzodiazepines to maintain sedation and reduce
anxiety.
Answer: A
Rationale: Prazosin is an alpha-1 adrenergic antagonist frequently used in PTSD to treat
autonomic hyperarousal and nightmares. Option B can cause re-traumatization if done
prematurely. Option C is not sustainable or therapeutic. Option D is generally avoided for PTSD
due to the risk of dependence and cognitive impairment.
6. A patient with bipolar I disorder is exhibiting rapid speech, flight of ideas, and has not slept in
three days. Which nursing intervention is the highest priority for the current shift?
, A. Encouraging the patient to express feelings about their manic behaviors.
B. Providing a structured, low-stimulation environment to minimize environmental
triggers.
C. Engaging the patient in a group therapy session to facilitate social interaction.
D. Discussing the side effects of lithium to ensure medication adherence.
Answer: B
Rationale: Managing the milieu is critical for a patient in acute mania to prevent escalation and
physical exhaustion. Option A and C may overstimulate the patient. Option D is important but
secondary to immediate physiological stabilization and safety.
CORRECT ANSWER : B
7. A patient with obsessive-compulsive disorder (OCD) performs a hand-washing ritual for 45
minutes every hour. What is the most appropriate initial nursing approach?
A. Physically stop the patient from washing their hands to break the cycle.
B. Allow the ritual but gradually structure time to reduce its frequency over several days.
C. Confront the patient about the irrationality of the behavior to encourage insight.
D. Provide a strict schedule that forbids hand-washing except for bathroom use.
Answer: B
Rationale: Abruptly stopping an OCD ritual causes severe anxiety; the patient needs time to
develop coping mechanisms. Option A is restrictive and contraindicated. Option C is ineffective
as the patient usually knows the behavior is irrational. Option D ignores the patient's underlying
anxiety needs.
CORRECT ANSWER : B
8. Which finding in a patient with anorexia nervosa is the most urgent indicator for inpatient
hospitalization?
A. A BMI of 18.5 and a preoccupation with calorie counting.
B. A serum potassium level of 2.8 mEq/L and EKG changes showing U-waves.
C. Amenorrhea for six months and distorted body image.
Questions and Answers/Plus a Rationale Updated
2026 A+/Instant Download PDF
EXAM COVERAGE
1. Mood and Affective Disorders
2. Anxiety and Trauma-Related Disorders
3. Psychotic Disorders and Schizophrenia Spectrum
4. Personality Disorders
5. Substance-Related and Addictive Disorders
6. Cognitive Impairment and Neurocognitive Disorders
7. Crisis Intervention and Suicide Prevention
8. Therapeutic Communication and Milieu Management
1. A patient with major depressive disorder who has been non-responsive to SSRIs is prescribed
phenelzine. Which patient statement indicates an understanding of the necessary safety
precautions associated with this medication?
A. "I will increase my intake of aged cheeses and fermented foods to boost my protein levels."
B. "I will avoid taking over-the-counter cold medications that contain pseudoephedrine or
phenylephrine."
C. "I can continue drinking my evening glass of red wine as long as I limit it to 5 ounces."
D. "If I miss a dose, I will double the next dose to ensure I maintain therapeutic blood levels."
Answer: B
, Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI), which can cause a
hypertensive crisis if taken with sympathomimetic drugs like decongestants. Option A and C are
incorrect because aged cheeses and red wine are high in tyramine, which must be avoided to
prevent hypertensive crisis. Option D is incorrect because doubling doses of MAOIs is
dangerous and could precipitate toxic side effects.
2. A patient with schizophrenia is experiencing auditory hallucinations and insists that the "voices"
are telling him to stop taking his risperidone. Which nursing intervention is the most appropriate
first step in addressing this situation?
A. Confront the patient by explaining that the voices are not real and are a symptom of his
illness.
B. Increase the dosage of the antipsychotic medication to ensure better control of symptoms.
C. Validate the patient's experience while maintaining a focus on reality-based activities.
D. Isolate the patient in a quiet room to reduce sensory input and prevent the voices from
escalating.
Answer: C
Rationale: Validating the patient's distress while grounding them in reality helps build trust and
promotes compliance without reinforcing delusions. Option A is non-therapeutic and may lead to
patient agitation. Option B is outside the nurse's scope of practice without a provider order.
Option D is restrictive and should be a last resort; milieu therapy suggests social engagement is
preferred over isolation.
3. During an assessment, a patient with borderline personality disorder frequently shifts from
idealizing the nurse to extreme hostility when a request is denied. Which defense mechanism is
this patient primarily exhibiting?
A. Projection
B. Splitting
C. Reaction formation
D. Displacement
Answer: B
Rationale: Splitting is the inability to integrate positive and negative qualities of the self or
others into a cohesive image, leading to "all-or-nothing" thinking typical of borderline
personality disorder. Option A involves attributing one's own thoughts to others. Option C
, involves expressing the opposite of one's true feelings. Option D involves shifting emotions to a
safer target.
4. A patient is admitted following a suicide attempt by overdose. The patient states, "I just wanted
the pain to stop, but now I regret that I'm still here." What is the nurse's priority action?
A. Request a psychiatric consultation for a formal suicide risk assessment.
B. Maintain 1:1 observation and ensure the patient is in a safe, ligature-free environment.
C. Facilitate a group therapy session to help the patient connect with others who have similar
struggles.
D. Discuss the patient's feelings about their family to help them identify reasons for living.
Answer: B
Rationale: Patient safety is the absolute priority for someone who has recently attempted suicide.
1:1 observation is the standard of care for high-risk patients. Option A is a task for the
multidisciplinary team, but the nurse must ensure immediate safety first. Option C is
inappropriate for a patient in crisis. Option D is a long-term intervention that can only occur
once immediate safety is established.
5. A patient with post-traumatic stress disorder (PTSD) presents with severe flashbacks when
hearing loud noises. Which nursing intervention is most effective for long-term stabilization?
A. Administering prazosin as ordered to decrease the frequency and intensity of
nightmares and hyperarousal.
B. Encouraging the patient to discuss the traumatic event in detail until the emotion is
extinguished.
C. Implementing sensory deprivation to prevent any potential triggers during the shift.
D. Ensuring the patient receives high doses of benzodiazepines to maintain sedation and reduce
anxiety.
Answer: A
Rationale: Prazosin is an alpha-1 adrenergic antagonist frequently used in PTSD to treat
autonomic hyperarousal and nightmares. Option B can cause re-traumatization if done
prematurely. Option C is not sustainable or therapeutic. Option D is generally avoided for PTSD
due to the risk of dependence and cognitive impairment.
6. A patient with bipolar I disorder is exhibiting rapid speech, flight of ideas, and has not slept in
three days. Which nursing intervention is the highest priority for the current shift?
, A. Encouraging the patient to express feelings about their manic behaviors.
B. Providing a structured, low-stimulation environment to minimize environmental
triggers.
C. Engaging the patient in a group therapy session to facilitate social interaction.
D. Discussing the side effects of lithium to ensure medication adherence.
Answer: B
Rationale: Managing the milieu is critical for a patient in acute mania to prevent escalation and
physical exhaustion. Option A and C may overstimulate the patient. Option D is important but
secondary to immediate physiological stabilization and safety.
CORRECT ANSWER : B
7. A patient with obsessive-compulsive disorder (OCD) performs a hand-washing ritual for 45
minutes every hour. What is the most appropriate initial nursing approach?
A. Physically stop the patient from washing their hands to break the cycle.
B. Allow the ritual but gradually structure time to reduce its frequency over several days.
C. Confront the patient about the irrationality of the behavior to encourage insight.
D. Provide a strict schedule that forbids hand-washing except for bathroom use.
Answer: B
Rationale: Abruptly stopping an OCD ritual causes severe anxiety; the patient needs time to
develop coping mechanisms. Option A is restrictive and contraindicated. Option C is ineffective
as the patient usually knows the behavior is irrational. Option D ignores the patient's underlying
anxiety needs.
CORRECT ANSWER : B
8. Which finding in a patient with anorexia nervosa is the most urgent indicator for inpatient
hospitalization?
A. A BMI of 18.5 and a preoccupation with calorie counting.
B. A serum potassium level of 2.8 mEq/L and EKG changes showing U-waves.
C. Amenorrhea for six months and distorted body image.
