Mental Health Final Exam 2026/2027 | Mental Health Nursing
Final Exam Study Guide, Psychiatric Nursing Exam Prep,
Mental Health Assessment, Therapeutic Communication,
Psychiatric Disorders, Psychopharmacology, Crisis
Intervention, Patient Safety, Practice Questions, Answers &
Rationales
Question 1: A nurse is assessing a client who has been experiencing persistent
sadness, anhedonia, and insomnia for the past three months. Which diagnosis is
most consistent with these findings?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
CORRECT ANSWER: B. Major depressive disorder
Rationale: Major depressive disorder is characterized by a constellation of
symptoms including depressed mood, anhedonia, sleep disturbances, and fatigue
lasting at least two weeks. The three-month duration and the presence of
anhedonia (loss of pleasure) meet the criteria for major depressive disorder
rather than adjustment disorder, which follows an identifiable stressor. Persistent
depressive disorder requires a two-year duration in adults.
Question 2: Which neurotransmitter deficiency is most commonly associated
with the pathophysiology of major depressive disorder?
A. Dopamine
B. Acetylcholine
C. Serotonin
D. Glutamate
CORRECT ANSWER: C. Serotonin
Rationale: The monoamine hypothesis of depression posits that deficiencies in
serotonin, norepinephrine, and/or dopamine contribute to depressive symptoms.
Serotonin deficiency is most strongly linked to the core symptoms of depression,
including depressed mood, anhedonia, and sleep disturbances. Dopamine is more
,associated with psychosis and motivation, while acetylcholine and glutamate have
other primary roles.
Question 3: A client with schizophrenia consistently demonstrates a lack of
motivation, social withdrawal, and diminished emotional expression. These
findings represent which category of symptoms?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Affective symptoms
CORRECT ANSWER: B. Negative symptoms
Rationale: Negative symptoms of schizophrenia involve deficits in normal
functioning, including avolition (lack of motivation), social withdrawal, anhedonia,
and affective flattening. Positive symptoms involve added experiences such as
hallucinations and delusions. Cognitive symptoms involve impaired attention and
memory, while affective symptoms relate to mood disturbances.
Question 4: A nurse is caring for a client with borderline personality disorder
who exhibits frequent manipulation and splitting behaviors. Which nursing
intervention is most appropriate?
A. Allow the client to negotiate unit rules on a case-by-case basis
B. Enforce unit rules and consequences consistently for all clients
C. Ignore manipulative behaviors to avoid reinforcing them
D. Restrict the client's privileges whenever manipulation occurs
CORRECT ANSWER: B. Enforce unit rules and consequences consistently for all
clients
Rationale: Clients with borderline personality disorder often test limits and use
splitting to divide staff. Consistent enforcement of unit rules provides a
structured, predictable environment that reduces anxiety and is therapeutic.
Allowing negotiation reinforces manipulation, ignoring behaviors may escalate
them, and punitive restriction is not therapeutic.
,Question 5: A client taking haloperidol for several years develops involuntary
tongue protrusion and lip smacking. The nurse should recognize these findings
as which condition?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Parkinsonism
CORRECT ANSWER: C. Tardive dyskinesia
Rationale: Tardive dyskinesia is a late-onset extrapyramidal symptom associated
with long-term use of typical antipsychotics such as haloperidol. It is characterized
by involuntary repetitive movements of the tongue, lips, and face. Acute dystonia
involves muscle spasms, akathisia is motor restlessness, and parkinsonism
includes tremor and rigidity.
Question 6: A client prescribed phenelzine asks the nurse about dietary
restrictions. Which instruction is most critical?
A. Increase intake of foods high in tyramine
B. Avoid foods containing tyramine such as aged cheese and cured meats
C. Restrict fluid intake to prevent fluid overload
D. Consume a high-fiber diet to prevent constipation
CORRECT ANSWER: B. Avoid foods containing tyramine such as aged cheese and
cured meats
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Concurrent
ingestion of tyramine-rich foods can precipitate a hypertensive crisis, a life-
threatening emergency. Clients must strictly avoid aged cheeses, cured meats,
fermented products, and other tyramine-containing foods. Increasing tyramine is
dangerous, and fluid and fiber instructions are not specific to MAOI safety.
Question 7: A nurse is preparing to administer a benzodiazepine to a client with
generalized anxiety disorder. Which mechanism of action describes this
medication class?
A. Blocking dopamine receptors in the mesolimbic pathway
B. Potentiating the effects of gamma-aminobutyric acid (GABA)
, C. Inhibiting the reuptake of norepinephrine
D. Increasing serotonin availability in the synaptic cleft
CORRECT ANSWER: B. Potentiating the effects of gamma-aminobutyric acid
(GABA)
Rationale: Benzodiazepines enhance the inhibitory neurotransmitter GABA by
binding to the GABA-A receptor complex, increasing the frequency of chloride
channel opening and producing a calming effect. Blocking dopamine receptors is
characteristic of antipsychotics, while serotonin and norepinephrine effects
describe antidepressants.
Question 8: A client with post-traumatic stress disorder reports recurrent
nightmares and intrusive thoughts. Which finding is a common physiological
manifestation of this disorder?
A. Bradycardia and hypotension
B. Hypervigilance and exaggerated startle response
C. Decreased muscle tension and relaxation
D. Increased need for sleep and rest
CORRECT ANSWER: B. Hypervigilance and exaggerated startle response
Rationale: PTSD is characterized by a dysregulated stress response with
hyperarousal symptoms including hypervigilance, exaggerated startle response,
sleep disturbances, and irritability. These reflect sustained sympathetic nervous
system activation, not bradycardia, hypotension, or increased rest needs.
Question 9: A client with alcohol use disorder is admitted with severe tremors,
diaphoresis, and hallucinations. Which medication should the nurse anticipate
administering first?
A. Naltrexone
B. Disulfiram
C. Chlordiazepoxide
D. Acamprosate
CORRECT ANSWER: C. Chlordiazepoxide
Final Exam Study Guide, Psychiatric Nursing Exam Prep,
Mental Health Assessment, Therapeutic Communication,
Psychiatric Disorders, Psychopharmacology, Crisis
Intervention, Patient Safety, Practice Questions, Answers &
Rationales
Question 1: A nurse is assessing a client who has been experiencing persistent
sadness, anhedonia, and insomnia for the past three months. Which diagnosis is
most consistent with these findings?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
CORRECT ANSWER: B. Major depressive disorder
Rationale: Major depressive disorder is characterized by a constellation of
symptoms including depressed mood, anhedonia, sleep disturbances, and fatigue
lasting at least two weeks. The three-month duration and the presence of
anhedonia (loss of pleasure) meet the criteria for major depressive disorder
rather than adjustment disorder, which follows an identifiable stressor. Persistent
depressive disorder requires a two-year duration in adults.
Question 2: Which neurotransmitter deficiency is most commonly associated
with the pathophysiology of major depressive disorder?
A. Dopamine
B. Acetylcholine
C. Serotonin
D. Glutamate
CORRECT ANSWER: C. Serotonin
Rationale: The monoamine hypothesis of depression posits that deficiencies in
serotonin, norepinephrine, and/or dopamine contribute to depressive symptoms.
Serotonin deficiency is most strongly linked to the core symptoms of depression,
including depressed mood, anhedonia, and sleep disturbances. Dopamine is more
,associated with psychosis and motivation, while acetylcholine and glutamate have
other primary roles.
Question 3: A client with schizophrenia consistently demonstrates a lack of
motivation, social withdrawal, and diminished emotional expression. These
findings represent which category of symptoms?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Affective symptoms
CORRECT ANSWER: B. Negative symptoms
Rationale: Negative symptoms of schizophrenia involve deficits in normal
functioning, including avolition (lack of motivation), social withdrawal, anhedonia,
and affective flattening. Positive symptoms involve added experiences such as
hallucinations and delusions. Cognitive symptoms involve impaired attention and
memory, while affective symptoms relate to mood disturbances.
Question 4: A nurse is caring for a client with borderline personality disorder
who exhibits frequent manipulation and splitting behaviors. Which nursing
intervention is most appropriate?
A. Allow the client to negotiate unit rules on a case-by-case basis
B. Enforce unit rules and consequences consistently for all clients
C. Ignore manipulative behaviors to avoid reinforcing them
D. Restrict the client's privileges whenever manipulation occurs
CORRECT ANSWER: B. Enforce unit rules and consequences consistently for all
clients
Rationale: Clients with borderline personality disorder often test limits and use
splitting to divide staff. Consistent enforcement of unit rules provides a
structured, predictable environment that reduces anxiety and is therapeutic.
Allowing negotiation reinforces manipulation, ignoring behaviors may escalate
them, and punitive restriction is not therapeutic.
,Question 5: A client taking haloperidol for several years develops involuntary
tongue protrusion and lip smacking. The nurse should recognize these findings
as which condition?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Parkinsonism
CORRECT ANSWER: C. Tardive dyskinesia
Rationale: Tardive dyskinesia is a late-onset extrapyramidal symptom associated
with long-term use of typical antipsychotics such as haloperidol. It is characterized
by involuntary repetitive movements of the tongue, lips, and face. Acute dystonia
involves muscle spasms, akathisia is motor restlessness, and parkinsonism
includes tremor and rigidity.
Question 6: A client prescribed phenelzine asks the nurse about dietary
restrictions. Which instruction is most critical?
A. Increase intake of foods high in tyramine
B. Avoid foods containing tyramine such as aged cheese and cured meats
C. Restrict fluid intake to prevent fluid overload
D. Consume a high-fiber diet to prevent constipation
CORRECT ANSWER: B. Avoid foods containing tyramine such as aged cheese and
cured meats
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI). Concurrent
ingestion of tyramine-rich foods can precipitate a hypertensive crisis, a life-
threatening emergency. Clients must strictly avoid aged cheeses, cured meats,
fermented products, and other tyramine-containing foods. Increasing tyramine is
dangerous, and fluid and fiber instructions are not specific to MAOI safety.
Question 7: A nurse is preparing to administer a benzodiazepine to a client with
generalized anxiety disorder. Which mechanism of action describes this
medication class?
A. Blocking dopamine receptors in the mesolimbic pathway
B. Potentiating the effects of gamma-aminobutyric acid (GABA)
, C. Inhibiting the reuptake of norepinephrine
D. Increasing serotonin availability in the synaptic cleft
CORRECT ANSWER: B. Potentiating the effects of gamma-aminobutyric acid
(GABA)
Rationale: Benzodiazepines enhance the inhibitory neurotransmitter GABA by
binding to the GABA-A receptor complex, increasing the frequency of chloride
channel opening and producing a calming effect. Blocking dopamine receptors is
characteristic of antipsychotics, while serotonin and norepinephrine effects
describe antidepressants.
Question 8: A client with post-traumatic stress disorder reports recurrent
nightmares and intrusive thoughts. Which finding is a common physiological
manifestation of this disorder?
A. Bradycardia and hypotension
B. Hypervigilance and exaggerated startle response
C. Decreased muscle tension and relaxation
D. Increased need for sleep and rest
CORRECT ANSWER: B. Hypervigilance and exaggerated startle response
Rationale: PTSD is characterized by a dysregulated stress response with
hyperarousal symptoms including hypervigilance, exaggerated startle response,
sleep disturbances, and irritability. These reflect sustained sympathetic nervous
system activation, not bradycardia, hypotension, or increased rest needs.
Question 9: A client with alcohol use disorder is admitted with severe tremors,
diaphoresis, and hallucinations. Which medication should the nurse anticipate
administering first?
A. Naltrexone
B. Disulfiram
C. Chlordiazepoxide
D. Acamprosate
CORRECT ANSWER: C. Chlordiazepoxide
