ATI Mental Health — Mood Disorders & Suicide Risk
2026/2027 | ATI RN Mental Health Nursing Study Guide &
Practice Questions | ATI Mental Health Proctored Exam &
Content Mastery Review, Mood Disorders, Major Depressive
Disorder, Bipolar Disorder, Suicide Risk Assessment, Suicidal
Ideation, Suicide Precautions, Safety Planning, Crisis
Intervention, Therapeutic Communication, Antidepressants,
Mood Stabilizers, Lithium, Psychopharmacology, Priority
Nursing Interventions, Clinical Judgment, Patient Safety,
NCLEX-Style Questions, Case Studies & Detailed Rationales
Question 1: Which neurotransmitter dysfunction is most strongly
implicated in the pathophysiology of major depressive disorder
according to the monoamine hypothesis?
A. Excess dopamine activity in the mesolimbic pathway
B. Deficiency of serotonin, norepinephrine, and dopamine
C. Excess GABA activity in the cerebral cortex
D. Deficiency of acetylcholine in the basal ganglia
CORRECT ANSWER: B. Deficiency of serotonin, norepinephrine,
and dopamine
Rationale: The monoamine hypothesis proposes that depression results
from a functional deficiency of monoamine neurotransmitters—serotonin,
norepinephrine, and dopamine—in the synaptic cleft. This underpins the
mechanism of action of SSRIs, SNRIs, and MAOIs. Excess dopamine is
linked to mania and psychosis, excess GABA to sedation, and acetylcholine
deficiency is associated with Alzheimer disease, not depression.
Question 2: A patient presents with a 2-week history of depressed
mood, anhedonia, insomnia, fatigue, and recurrent thoughts of
death. Which diagnosis is most consistent with these findings?
A. Generalized anxiety disorder
B. Persistent depressive disorder
C. Major depressive disorder
D. Bipolar I disorder, current episode manic
CORRECT ANSWER: C. Major depressive disorder
Rationale: Major depressive disorder requires at least five depressive
symptoms, including depressed mood or anhedonia, for a minimum of 2
weeks, causing clinically significant distress. Recurrent thoughts of death is
,a hallmark criterion. Persistent depressive disorder requires a 2-year
duration, generalized anxiety disorder lacks the mood criteria, and mania
presents with elevated mood, not depressed mood.
Question 3: A nurse is assessing a client with major depressive
disorder. Which symptom would the nurse expect to find as a
criterion for the diagnosis?
A. Grandiosity
B. Anhedonia
C. Flight of ideas
D. Hallucinations**
CORRECT ANSWER: B. Anhedonia
Rationale: Anhedonia, the loss of interest or pleasure in previously
enjoyable activities, is one of the two core criteria for major depressive
disorder. Grandiosity and flight of ideas are manic symptoms, and
hallucinations are psychotic features more characteristic of schizophrenia or
psychotic depression rather than a core mood criterion.
Question 4: Which class of antidepressant medications carries a
black box warning for increased risk of suicidal ideation in children
and young adults?
A. Benzodiazepines
B. Atypical antipsychotics
C. SSRIs and other antidepressants
D. Mood stabilizers
CORRECT ANSWER: C. SSRIs and other antidepressants
Rationale: The FDA requires a black box warning on all antidepressants
indicating an increased risk of suicidal thoughts and behaviors in patients
under age 25, particularly during the first weeks of therapy.
Benzodiazepines carry dependence warnings, atypical antipsychotics carry
metabolic and cerebrovascular warnings in elderly patients, and mood
stabilizers carry hematologic and teratogenic warnings.
Question 5: A client on sertraline reports feeling restless, agitated,
and having increased suicidal thoughts during the second week of
treatment. What is the nurse's priority action?
,A. Reassure the client that these are expected side effects
B. Instruct the client to double the dose to achieve therapeutic effect faster
C. Notify the provider immediately and implement suicide precautions
D. Tell the client to stop the medication abruptly**
CORRECT ANSWER: C. Notify the provider immediately and
implement suicide precautions
Rationale: Worsening suicidal ideation during antidepressant initiation
indicates increased suicide risk, especially in the first few weeks. The nurse
must immediately notify the provider and initiate safety precautions such as
one-to-one observation and environmental safety checks. Doubling the
dose is dangerous, abrupt discontinuation causes discontinuation
syndrome, and reassurance alone neglects the safety risk.
Question 6: Which laboratory test should be obtained before
initiating lithium therapy?
A. Serum amylase
B. Renal function tests and thyroid function tests
C. Liver function tests only
D. Serum calcium and phosphate
CORRECT ANSWER: B. Renal function tests and thyroid function
tests
Rationale: Lithium is excreted renally and affects thyroid function, so
baseline creatinine, BUN, and TSH/T3/T4 must be obtained. Lithium can
cause nephrogenic diabetes insipidus and hypothyroidism. Amylase is used
for pancreatitis, liver function tests are more relevant for valproate, and
calcium/phosphate are not the primary baseline for lithium.
Question 7: A client taking lithium reports a coarse hand tremor,
vomiting, and ataxia. Which lithium level is most consistent with
these findings?
A. 0.6 mEq/L
B. 1.0 mEq/L
C. 1.4 mEq/L
D. 2.2 mEq/L**
CORRECT ANSWER: D. 2.2 mEq/L
, Rationale: Lithium toxicity signs—coarse tremor, vomiting, ataxia,
confusion, and seizures—occur at levels above 2.0 mEq/L. Therapeutic
range is 0.6–1.2 mEq/L. A level of 1.4 mEq/L is borderline and may
produce fine tremor, but 2.2 mEq/L represents moderate to severe toxicity
requiring urgent intervention.
Question 8: A nurse is teaching a client about lithium therapy.
Which statement indicates correct understanding?
A. "I should maintain a consistent sodium intake and drink 2–3 liters of fluid
daily."
B. "I should follow a low-sodium diet to prevent toxicity."
C. "I can stop taking lithium once my mood stabilizes."
D. "I should take lithium only when I feel manic."**
CORRECT ANSWER: A. "I should maintain a consistent sodium
intake and drink 2–3 liters of fluid daily."
Rationale: Sodium and lithium compete for renal reabsorption; low sodium
increases lithium retention and toxicity risk, so consistent sodium intake
and adequate hydration are essential. Lithium is taken daily as maintenance
therapy, not PRN, and must not be stopped abruptly because of relapse and
withdrawal risk.
Question 9: Which medication is FDA-approved for the acute
treatment of mania and for maintenance therapy in bipolar I
disorder, and requires monitoring of serum levels?
A. Fluoxetine
B. Lithium carbonate
C. Lorazepam
D. Buspirone
CORRECT ANSWER: B. Lithium carbonate
Rationale: Lithium carbonate is the gold-standard mood stabilizer approved
for acute mania and maintenance in bipolar I disorder, with a narrow
therapeutic index requiring regular serum level monitoring. Fluoxetine is an
SSRI for depression, lorazepam is a benzodiazepine for acute agitation, and
buspirone is an anxiolytic without mood-stabilizing properties.
Question 10: A client in the manic phase of bipolar disorder is
admitted to the unit. Which nursing intervention is the priority?
2026/2027 | ATI RN Mental Health Nursing Study Guide &
Practice Questions | ATI Mental Health Proctored Exam &
Content Mastery Review, Mood Disorders, Major Depressive
Disorder, Bipolar Disorder, Suicide Risk Assessment, Suicidal
Ideation, Suicide Precautions, Safety Planning, Crisis
Intervention, Therapeutic Communication, Antidepressants,
Mood Stabilizers, Lithium, Psychopharmacology, Priority
Nursing Interventions, Clinical Judgment, Patient Safety,
NCLEX-Style Questions, Case Studies & Detailed Rationales
Question 1: Which neurotransmitter dysfunction is most strongly
implicated in the pathophysiology of major depressive disorder
according to the monoamine hypothesis?
A. Excess dopamine activity in the mesolimbic pathway
B. Deficiency of serotonin, norepinephrine, and dopamine
C. Excess GABA activity in the cerebral cortex
D. Deficiency of acetylcholine in the basal ganglia
CORRECT ANSWER: B. Deficiency of serotonin, norepinephrine,
and dopamine
Rationale: The monoamine hypothesis proposes that depression results
from a functional deficiency of monoamine neurotransmitters—serotonin,
norepinephrine, and dopamine—in the synaptic cleft. This underpins the
mechanism of action of SSRIs, SNRIs, and MAOIs. Excess dopamine is
linked to mania and psychosis, excess GABA to sedation, and acetylcholine
deficiency is associated with Alzheimer disease, not depression.
Question 2: A patient presents with a 2-week history of depressed
mood, anhedonia, insomnia, fatigue, and recurrent thoughts of
death. Which diagnosis is most consistent with these findings?
A. Generalized anxiety disorder
B. Persistent depressive disorder
C. Major depressive disorder
D. Bipolar I disorder, current episode manic
CORRECT ANSWER: C. Major depressive disorder
Rationale: Major depressive disorder requires at least five depressive
symptoms, including depressed mood or anhedonia, for a minimum of 2
weeks, causing clinically significant distress. Recurrent thoughts of death is
,a hallmark criterion. Persistent depressive disorder requires a 2-year
duration, generalized anxiety disorder lacks the mood criteria, and mania
presents with elevated mood, not depressed mood.
Question 3: A nurse is assessing a client with major depressive
disorder. Which symptom would the nurse expect to find as a
criterion for the diagnosis?
A. Grandiosity
B. Anhedonia
C. Flight of ideas
D. Hallucinations**
CORRECT ANSWER: B. Anhedonia
Rationale: Anhedonia, the loss of interest or pleasure in previously
enjoyable activities, is one of the two core criteria for major depressive
disorder. Grandiosity and flight of ideas are manic symptoms, and
hallucinations are psychotic features more characteristic of schizophrenia or
psychotic depression rather than a core mood criterion.
Question 4: Which class of antidepressant medications carries a
black box warning for increased risk of suicidal ideation in children
and young adults?
A. Benzodiazepines
B. Atypical antipsychotics
C. SSRIs and other antidepressants
D. Mood stabilizers
CORRECT ANSWER: C. SSRIs and other antidepressants
Rationale: The FDA requires a black box warning on all antidepressants
indicating an increased risk of suicidal thoughts and behaviors in patients
under age 25, particularly during the first weeks of therapy.
Benzodiazepines carry dependence warnings, atypical antipsychotics carry
metabolic and cerebrovascular warnings in elderly patients, and mood
stabilizers carry hematologic and teratogenic warnings.
Question 5: A client on sertraline reports feeling restless, agitated,
and having increased suicidal thoughts during the second week of
treatment. What is the nurse's priority action?
,A. Reassure the client that these are expected side effects
B. Instruct the client to double the dose to achieve therapeutic effect faster
C. Notify the provider immediately and implement suicide precautions
D. Tell the client to stop the medication abruptly**
CORRECT ANSWER: C. Notify the provider immediately and
implement suicide precautions
Rationale: Worsening suicidal ideation during antidepressant initiation
indicates increased suicide risk, especially in the first few weeks. The nurse
must immediately notify the provider and initiate safety precautions such as
one-to-one observation and environmental safety checks. Doubling the
dose is dangerous, abrupt discontinuation causes discontinuation
syndrome, and reassurance alone neglects the safety risk.
Question 6: Which laboratory test should be obtained before
initiating lithium therapy?
A. Serum amylase
B. Renal function tests and thyroid function tests
C. Liver function tests only
D. Serum calcium and phosphate
CORRECT ANSWER: B. Renal function tests and thyroid function
tests
Rationale: Lithium is excreted renally and affects thyroid function, so
baseline creatinine, BUN, and TSH/T3/T4 must be obtained. Lithium can
cause nephrogenic diabetes insipidus and hypothyroidism. Amylase is used
for pancreatitis, liver function tests are more relevant for valproate, and
calcium/phosphate are not the primary baseline for lithium.
Question 7: A client taking lithium reports a coarse hand tremor,
vomiting, and ataxia. Which lithium level is most consistent with
these findings?
A. 0.6 mEq/L
B. 1.0 mEq/L
C. 1.4 mEq/L
D. 2.2 mEq/L**
CORRECT ANSWER: D. 2.2 mEq/L
, Rationale: Lithium toxicity signs—coarse tremor, vomiting, ataxia,
confusion, and seizures—occur at levels above 2.0 mEq/L. Therapeutic
range is 0.6–1.2 mEq/L. A level of 1.4 mEq/L is borderline and may
produce fine tremor, but 2.2 mEq/L represents moderate to severe toxicity
requiring urgent intervention.
Question 8: A nurse is teaching a client about lithium therapy.
Which statement indicates correct understanding?
A. "I should maintain a consistent sodium intake and drink 2–3 liters of fluid
daily."
B. "I should follow a low-sodium diet to prevent toxicity."
C. "I can stop taking lithium once my mood stabilizes."
D. "I should take lithium only when I feel manic."**
CORRECT ANSWER: A. "I should maintain a consistent sodium
intake and drink 2–3 liters of fluid daily."
Rationale: Sodium and lithium compete for renal reabsorption; low sodium
increases lithium retention and toxicity risk, so consistent sodium intake
and adequate hydration are essential. Lithium is taken daily as maintenance
therapy, not PRN, and must not be stopped abruptly because of relapse and
withdrawal risk.
Question 9: Which medication is FDA-approved for the acute
treatment of mania and for maintenance therapy in bipolar I
disorder, and requires monitoring of serum levels?
A. Fluoxetine
B. Lithium carbonate
C. Lorazepam
D. Buspirone
CORRECT ANSWER: B. Lithium carbonate
Rationale: Lithium carbonate is the gold-standard mood stabilizer approved
for acute mania and maintenance in bipolar I disorder, with a narrow
therapeutic index requiring regular serum level monitoring. Fluoxetine is an
SSRI for depression, lorazepam is a benzodiazepine for acute agitation, and
buspirone is an anxiolytic without mood-stabilizing properties.
Question 10: A client in the manic phase of bipolar disorder is
admitted to the unit. Which nursing intervention is the priority?
