Question 1

A 28-year-old mother named Almaz is in the first postpartum week; she feels persistently guilty and negative about herself, cries easily, and feels tired and agitated. What might she be suffering from?

Accepted Answer

Answer reason: Persistent guilt and negative self-appraisal indicate depressive cognitions beyond the transient mood lability of the postpartum blues; no psychotic features are described.

Question 2

A client with a reactive depression has the greatest chance of success in activities that require psychic and physical energy if the nurse schedules activities in the?

Accepted Answer

Answer reason: Depressed clients often have the lowest energy and motivation in the morning with gradual improvement later in the day; demanding activities are best scheduled in the afternoon.

Question 3

In a geriatric unit, one patient’s behavior changes. Which symptom does NOT indicate depression?

Accepted Answer

Answer reason: Depression commonly presents with insomnia, fatigue, and appetite changes. Being talkative is not typical of depression and may suggest mania or normal variability.

Question 4

What is the most common disorder among people who commit suicide?

Accepted Answer

Answer reason: Major depressive disorder is the most frequently associated psychiatric diagnosis among individuals who die by suicide, far more common than schizophrenia or social phobia.

Question 5

A dexamethasone-suppression test has been ordered for a client with severe depression. The purpose of the dexamethasone suppression test is to?

Accepted Answer

Answer reason: The dexamethasone suppression test evaluates HPA-axis cortisol suppression; nonsuppression is associated with severe endogenous depression, making it a diagnostic indicator of severity rather than a treatment or guide for social or ECT interventions.

Question 6

The nurse is reviewing a depressed client's history from an earlier admission. Documentation of anhedonia is noted. The nurse understands that this symptom refers to?

Accepted Answer

Answer reason: Anhedonia is the loss of interest or pleasure in activities; thus lack of enjoyment in usual pleasures is correct. The other options describe insomnia, suicidal ideation, and sensory loss.

Question 7

A 25-year-old man is in an acute manic episode. The nurse knows that which client behavior would be MOST characteristic of mania?

Accepted Answer

Answer reason: Classic manic features include elevated or euphoric mood, increased activity/agitation, grandiosity, and poor concentration/distractibility. These are best captured by option 1.

Question 8

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to feeling sad and hopeless, the nurse would assess for?

Accepted Answer

Answer reason: Major depressive disorder commonly presents with psychomotor changes—either retardation or agitation—along with somatic symptoms. This is a characteristic assessment finding beyond sadness and hopelessness.

Question 9

A client was admitted to the psychiatric unit with a diagnosis of bipolar disorder. He constantly bothers other clients, tries to help the housekeeping staff, demonstrates pressured speech and demands constant attention from the staff. Which of the following activities would be BEST for the client?

Accepted Answer

Answer reason: In acute mania, choose simple, gross-motor activities that provide an outlet for excess energy and require minimal concentration or sustained interaction. Ping-pong fits best; reading, cards, and checkers require more focus and prolonged sitting/social stimulation.

Question 10

The nurse is talking with a client. The client abruptly says to the nurse, "The moon is full. Astronauts walk on the moon. Walking is a good health habit." The client's behavior MOST likely indicates?

Accepted Answer

Answer reason: Speech rapidly shifts from one topic to another with superficial connections, characteristic of flight of ideas. There are no made-up words (neologisms), the speech is not incoherent word salad, and this is not dissociation.

Question 11

Which of the following times is a depressed client at highest risk for attempting suicide?

Accepted Answer

Answer reason: Suicide risk peaks as antidepressant therapy begins to restore energy before mood and hope improve, enabling the client to act on suicidal plans.

Question 12

Which of the following is a mood disorder?

Accepted Answer

Answer reason: Bipolar disorder is classified as a mood disorder because it involves pathological disturbances in mood, including episodes of mania/hypomania and often depression. Migraine is a neurologic headache syndrome, tuberculosis is an infectious disease caused by Mycobacterium tuberculosis, and hypertension is a cardiovascular condition. Therefore, only bipolar disorder fits the definition of a mood disorder among the options.

Question 13

A client with bipolar disorder experiencing mania is pacing the unit, talking loudly & interrupting others. What is the best nursing intervention?

Accepted Answer

Answer reason: In acute mania, the priority is to decrease environmental stimuli and support behavioral control to reduce escalating agitation and protect the client and others. A quiet, low-stimulation setting helps limit triggers (noise, social interaction) that can worsen pressured speech, intrusiveness, and hyperactivity. Group activities can increase stimulation and disrupt others further, and confrontation can provoke anger or escalation. While pacing may be allowed briefly for safety, it does not address the overall need for structured reduction of stimulation and limit-setting.

Question 14

A patient is prescribed Aripiprazole. The nurse evaluates the history and physical for which disorder?

Accepted Answer

Answer reason: Aripiprazole is an atypical antipsychotic indicated for schizophrenia and for bipolar I disorder (including manic/mixed episodes), and it is also used as an adjunct in major depressive disorder and for acute agitation. Because the stem is select-all-that-apply, multiple listed disorders could be appropriate indications. Under the single-best-answer constraint, bipolar disorder is a clearly established primary indication, but this item requires multiple selections.

Question 15

Which disorder is characterized by extreme mood swings, including periods of depression and mania?

Accepted Answer

Answer reason: Bipolar disorder is defined by episodic mood disturbances that include manic (or hypomanic) episodes and typically depressive episodes, producing the classic pattern of extreme mood swings. Schizophrenia is primarily characterized by psychosis and functional decline rather than distinct manic and depressive cycles. OCD involves obsessions and compulsions, and GAD involves persistent, excessive worry—neither includes mania. Therefore, bipolar disorder best matches the description.

Question 16

The nurse assesses a patient with a history of mental illness. The nurse documents which behaviors as evidence of mania?

Accepted Answer

Answer reason:  Flight of ideas Mania is characterized by accelerated, disorganized thought processes that commonly present as flight of ideas (rapid shifting from topic to topic). Other classic manic behaviors include pressured speech, decreased need for sleep (not increased sleep), and impulsivity. Avoidance of social interaction is more consistent with depression, anxiety, or negative symptoms rather than mania.

Question 17

Which of the following mental health disorders may place a patient at risk for detrimental behaviors such as unsafe sexual practices or impulsive spending?

Accepted Answer

Answer reason: Bipolar disorder, particularly during manic or hypomanic episodes, is characterized by impulsivity, poor judgment, increased risk-taking, hypersexuality, and excessive involvement in pleasurable but harmful activities (e.g., spending sprees). Major depressive disorder more typically involves low energy, anhedonia, and reduced libido rather than impulsive risky behaviors. Conduct disorder involves rule-breaking and aggression but the classic association with unsafe sex and impulsive spending as a mood-driven symptom cluster aligns best with mania in bipolar disorder; schizophrenia is more associated with psychosis and functional decline than targeted impulsive spending behaviors.

Question 18

Patients with bipolar disorder should avoid caffeine?

Accepted Answer

Answer reason: True Caffeine is a CNS stimulant that can worsen insomnia, anxiety, agitation, and potentially exacerbate manic symptoms in bipolar disorder. Avoiding or minimizing caffeine is a common teaching to support sleep hygiene and mood stability, especially for patients prone to mania or who are sensitive to stimulants. Additionally, caffeine can contribute to restlessness and interfere with treatment goals that emphasize regular sleep and reduced stimulation. Therefore, advising avoidance is an appropriate general recommendation.

Question 19

The nurse is caring for a female client who was recently admitted to the hospital for anorexia nervosa. The nurse enters the client's room and notes that the client is doing vigorous push-ups. Which nursing action is appropriate?

Accepted Answer

Answer reason: Tell the client that she is not allowed to exercise vigorously. Vigorous exercise is a common compensatory behavior in anorexia nervosa and can worsen malnutrition, bradycardia, hypotension, and risk of dysrhythmias. Early inpatient care prioritizes medical safety and behavioral limits with clear, firm, nonjudgmental boundary setting to prevent further physiologic compromise. Offering an alternative activity like a walk still reinforces exercise behavior, and allowing completion permits ongoing self-harm through caloric expenditure. Immediate weighing is not the priority in the moment compared with stopping unsafe behavior.

Question 20

Hopelessness, worthlessness and hopelessness are the features of-?

Accepted Answer

Answer reason: These symptoms are classic cognitive and affective features of major depressive episodes, reflecting negative self-appraisal and pessimism about the future. In mania, the typical pattern is elevated or irritable mood with grandiosity and increased energy rather than feelings of worthlessness. Delirium is characterized by acute fluctuating attention and awareness changes, not persistent depressive cognitions. Schizophrenia primarily involves psychosis (delusions, hallucinations, disorganized thought) rather than these core depressive themes.

Question 21

Anorexia nervosa is disorder of...?

Accepted Answer

Answer reason: Anorexia nervosa involves restrictive intake, possible binge/purge behaviors, and compulsive weight-control practices, making the core disturbance behavioral. While distorted beliefs about weight and shape are central, the disorder’s defining clinical pattern is the sustained abnormal eating/compensatory behaviors. Mood and memory disturbances may co-occur but are not the defining domain of the diagnosis.

Question 22

Major depression most prominently affects?

Accepted Answer

Answer reason: Epidemiologically, major depressive disorder has a higher lifetime prevalence in women than in men (commonly taught as about 2:1). This difference is consistent across many populations and is thought to relate to a mix of biological, hormonal, and psychosocial risk factors. Employment and education status are not defining demographic groups with the most prominent overall burden compared with sex-based prevalence patterns. “Affluent women” is too narrow and not supported as the primary broad demographic most affected.

Question 23

In a client with anorexia nervosa, the nurse expects to see?

Accepted Answer

Answer reason: Severe caloric restriction and low body fat suppress the hypothalamic–pituitary–gonadal axis, leading to decreased gonadotropin release and loss of menses. This is a common physiologic finding in anorexia nervosa due to malnutrition and endocrine adaptation to starvation. The other options do not match the defining features: patients typically have an intense fear of weight gain (not weight loss) and a persistent drive for thinness (not to maintain weight). Recurrent binge eating is more characteristic of bulimia nervosa or the binge-eating/purging subtype rather than the expected general presentation tested here.

Question 24

The nurse is caring for the client with a major depressive disorder. Which nursing problem should be priority?

Accepted Answer

Answer reason: A recent or current suicide attempt indicates imminent danger and mandates precautions such as close observation, environmental safety measures, and rapid psychiatric evaluation. Other problems like sleep disturbance, powerlessness, and grief are important but are addressed after ensuring the client’s immediate physical safety. Prioritization follows ABCs and safety-first principles, making self-harm risk the most critical nursing problem to manage first.

Question 25

The mother of a middle school boy tells the school nurse she is concerned that her 13-year-old son may be depressed. Which behavior would the nurse expect the boy to exhibit?

Accepted Answer

Answer reason: Interpersonal conflict and increased reactivity to peers can be a behavioral sign of a depressive mood disorder at this age. By contrast, actively seeking peer support suggests adaptive coping and connection rather than the social withdrawal/irritability commonly seen in depression. The other choices do not reflect typical depressive features such as low self-esteem, hopelessness, sleep/appetite disturbance, or loss of interest.

Question 26

The nurse is reviewing diet restrictions with the client taking an MAOI. The nurse should inform the client of which symptom that can occur when the client is non adherent to diet restrictions?

Accepted Answer

Answer reason: A sudden, severe “explosive” headache (often described as occipital) is a classic warning symptom of this emergency and may be accompanied by hypertension, diaphoresis, and palpitations. This finding is the key diet-related adverse effect nurses emphasize to support safe self-management. Akathisia is associated with antipsychotics, and agranulocytosis is most associated with clozapine; severe hypotension is not the hallmark complication of tyramine nonadherence.

Question 27

The psychiatric home health nurse arrives to visit a client with bipolar disorder. The client is swinging rapidly on the porch swing. She is wearing a red polka dot dress, large yellow hat, and heavy makeup with large gold jewelry. The nurse interprets the client's behavior as evidence of which of the following?

Accepted Answer

Answer reason: Rapid, restless movement (swinging rapidly) and flamboyant, brightly colored, attention-seeking dress with heavy makeup and jewelry reflect heightened energy, grandiosity, and disinhibition. Depression would more typically present with low energy, slowed behavior, and diminished self-care rather than conspicuous styling. Delusions and paranoia require fixed false beliefs or suspiciousness, which are not demonstrated by the described appearance and activity alone.

Question 28

The nurse assesses the client who reports feeling full of energy in spite of having been awake for the past 48 hours. Which diagnosis is the nurse likely to find documented in the client’s medical record?

Accepted Answer

Answer reason: Being awake for 48 hours while still feeling energetic strongly suggests mania rather than insomnia from anxiety or compulsions. A mixed episode would typically include prominent depressive symptoms occurring alongside manic features, which are not described here. Korsakoff’s psychosis is associated with thiamine deficiency and severe memory impairment/confabulation, not increased energy with little sleep.

Question 29

The nurse is planning care for the recently admitted client who is exhibiting agitation associated with acute mania. Which intervention should the nurse plan to implement?

Accepted Answer

Answer reason: Agitation in acute mania is worsened by environmental stimulation, so the priority is to reduce triggers that escalate arousal and impulsivity. A quiet, low-stimulation setting supports de-escalation, improves ability to follow directions, and helps prevent progression to aggression or exhaustion. Group activities commonly increase noise, competition, and social demands, which can intensify manic behavior rather than structure it. Leaving the client alone increases risk for unsafe behavior and reduces observation, and restraints are a last resort only when the client presents an imminent danger after less restrictive measures fail.

Question 30

During the client education class, the nurse is asked, “What is an effective treatment for seasonal affective disorder?” Which intervention should the nurse recommend as an evidenced-based practice for the first-line treatment of seasonal affective disorder?

Accepted Answer

Answer reason: Bright light therapy has strong evidence as a first-line, nonpharmacologic intervention that can reduce depressive symptoms and improve energy and sleep-wake timing. Quetiapine and lithium are not standard first-line treatments for SAD and carry unnecessary adverse-effect and monitoring burdens when used for this indication. Psychotherapy can be helpful as an adjunct, but it is not as directly targeted or as strongly established as first-line compared with light therapy for typical SAD presentations.

Question 31

The nurse is assessing the client diagnosed with pseudocyesis. Which statement from the client is consistent with pseudocyesis?

Accepted Answer

Answer reason: Pseudocyesis is a false belief of being pregnant that is accompanied by perceived or even physical signs of pregnancy despite absence of an actual pregnancy. The statement reflects a conviction of pregnancy and interpretation of bodily/appearance changes as pregnancy-related. The other options align more with syncope/blackouts, anosmia, or nonepileptic/absence-like staring episodes rather than a pregnancy delusion with somatic focus. In pseudocyesis, assessment focuses on validating feelings while gently reality-orienting and ensuring appropriate medical evaluation to rule out pregnancy and endocrine causes.

Question 32

The HCP writes in the client’s progress notes, “Will switch medications from the older medications to a newer GABA-ergic anticonulsant to treat client’s instability of mood, transient mood crashes, and inappropriate and intense outbursts of anger.” Which medication should the nurse consider when reviewing the HCP’s new prescriptions?

Accepted Answer

Answer reason: This choice best matches the prescriber’s wording emphasizing a newer anticonvulsant with GABA-ergic activity to address impulsive anger and mood instability. Lithium is a classic mood stabilizer but is not an anticonvulsant and is not described as GABA-ergic. Valproic acid and carbamazepine are anticonvulsant mood stabilizers, but they are generally considered older antiepileptics rather than “newer” in typical exam framing.

Question 33

The client recently admitted to a psychiatric unit is experiencing acute mania. Which intervention should the nurse include when developing the client’s plan of care?

Accepted Answer

Answer reason: Acute mania commonly causes hyperactivity, distractibility, and poor ability to sit for meals, creating high risk for inadequate nutrition and dehydration. Offering portable, high-calorie finger foods matches the client’s increased motor activity and limited attention span, improving intake without escalating stimulation. Prolonged conversations are typically ineffective and can increase agitation, so interactions should be brief and focused. Family teaching and community resources are more appropriate once acute symptoms are stabilized rather than during the immediate manic phase. Confrontation tends to intensify irritability and can worsen behavioral dyscontrol; calm limit-setting is safer.

Question 34

The nurse is evaluating the attainment of outcomes for the adolescent client diagnosed with bulimia nervosa. Which behavior indicates that the client is meeting an expected outcome for the disorder?

Accepted Answer

Answer reason: A clear, measurable reduction in purging frequency reflects progress toward symptom remission and decreased medical risk (e.g., electrolyte disturbance, esophageal injury). Weight gain is not a reliable short-term indicator in bulimia because many clients maintain near-normal weight despite ongoing pathology. Increased focus on food-related conversation can reflect preoccupation rather than recovery, whereas symptom frequency reduction is a more direct treatment outcome measure.

Question 35

The nurse is assessing the client with dysthymia who reports symptoms of depressed mood. Which assessment finding should the nurse most associate with the essential feature of dysthymia?

Accepted Answer

Answer reason: The essential distinguishing feature is duration: depressed mood for most of the day, more days than not, for at least 2 years in adults. The 2-week time frame in other options aligns more with a major depressive episode criteria timeframe rather than persistent depressive disorder. A recent suicide attempt reflects severity and safety risk that requires immediate intervention, but it is not the defining diagnostic hallmark of dysthymia.

Question 36

The father of the teenager diagnosed with an eating disorder states to the nurse, “My wife was always too protective; that’s the reason our child has this problem now.” The nurse should realize that the father’s statement is indicative of what?

Accepted Answer

Answer reason: The father’s statement frames the disorder as directly produced by the mother’s protectiveness, which is not an evidence-based causal explanation. This kind of blaming can increase family conflict and stigma and may interfere with engagement in treatment approaches that emphasize support and collaborative coping. While family dynamics may influence course and recovery, they are not a singular cause, making this primarily a misconception rather than an accurate interpretation.

Question 37

The nurse is assessing the client’s alcohol intake as part of a routine screening examination. The client reports drinking three to four beers five times per week. The client is being treated for depression with sertraline 100 mg daily. Which conclusion by the nurse is accurate?

Accepted Answer

Answer reason: Alcohol is a central nervous system depressant that can worsen depressive symptoms, impair sleep, and increase suicide risk, undermining recovery. Regular drinking at the level described can interfere with antidepressant response and adherence, and may increase adverse effects such as sedation and impaired judgment. Combining alcohol with SSRIs can also exacerbate cognitive/motor impairment and reduce treatment effectiveness through behavioral and physiologic mechanisms. The distractors are inaccurate because alcohol is not a stimulant, “normal” use is defined by weekly limits and binge thresholds (not just a 24-hour cap), and using alcohol to cope tends to worsen mood over time.

Question 38

The NA comments to the nurse about the recently admitted client with bipolar disorder. “I think the new admit is faking being ill. Yesterday the client didn’t say a word, and today it’s nonstop talking.” Which response by the nurse is most helpful?

Accepted Answer

Answer reason:  The key principle is that abrupt shifts in energy, speech, and behavior can be manifestations of bipolar illness rather than willful “faking.” This response educates the NA with a clinical explanation that normalizes the observation and reduces stigma, supporting more therapeutic, objective care. It redirects the focus from judgmental labeling to understanding symptoms and expected patterns in mood disorders. In contrast, attributing behavior to “attention” reinforces bias, and the other options either address wording only or dismiss the symptom change rather than explaining it.

Question 39

The client on the mental health unit is diagnosed with major depressive disorder and was started on an antidepressant two days ago. The nurse observes that two days ago the client appeared sad and remained in bed. Now the client is awake at 4 am. and planning a unit party. Which conclusion should the nurse make regarding the client's change in behavior?

Accepted Answer

Answer reason: A sudden shift from severe depression to markedly increased energy, decreased need for sleep (awake at 4 a.m.), and goal-directed/social activity can indicate hypomania/mania. Antidepressants typically take weeks for full therapeutic effect, so a dramatic “improvement” after only two days is less consistent with true response. In bipolar disorder, antidepressants can precipitate or unmask manic symptoms, especially when not paired with a mood stabilizer. This pattern should prompt reassessment of diagnosis and monitoring for escalating mania and safety risks rather than assuming recovery or discharge readiness.

Question 40

The nurse is caring for a client experiencing a mental health concern. Which of the following findings would most support a diagnosis of bipolar I disorder?

Accepted Answer

Answer reason: " Bipolar I disorder is defined by the presence of at least one manic episode, which typically includes an abnormally elevated or expansive mood with increased energy and impaired judgment. This statement best reflects an overly elevated, expansive mood consistent with mania rather than a normal range of happiness. In contrast, hearing “voices” more strongly suggests a primary psychotic process (or psychotic features, which are not required to diagnose bipolar I), and feeling “on edge” with poor concentration aligns more with anxiety. The statement about having no point in living indicates suicidal ideation, which can occur in depression but does not specifically support bipolar I over other depressive disorders.

Question 41

A client with bipolar disorder presents to the Emergency Department for help, stating “I’m just not myself. I’m having weird thoughts.” Which assessment findings would reflect a state of depression?

Accepted Answer

Answer reason: Poor concentration and a flat (blunted) affect align with depressive symptom patterns and commonly appear in bipolar depression. In contrast, distractibility, irritability, and decreased need for sleep are more consistent with mania/hypomania. Grandiosity is a hallmark manic feature, so any option including it is unlikely to represent a depressive state. Assessing these differentiators helps guide immediate safety screening for suicidality and appropriate stabilization.

Question 42

The nurse works on a psychiatric unit. Which client does the nurse anticipate as most likely to experience delusions of grandeur?

Accepted Answer

Answer reason: Bipolar I disorder includes full manic episodes, which are more likely than hypomania to progress to psychosis (e.g., believing one has special powers, wealth, or status). Bipolar II involves hypomania, which by definition is less severe and typically does not include psychotic features. PTSD more commonly involves hypervigilance, intrusive memories, and avoidance, while dissociative disorders involve disruptions in identity/memory rather than fixed grandiose false beliefs.

Question 43

A patient presents to a mental health facility with parotid gland swelling, dental erosion, and Russell’s sign. The nurse knows these findings are consistent with which mental health disorder?

Accepted Answer

Answer reason: Parotid gland enlargement occurs from recurrent salivary gland stimulation/irritation, while dental enamel erosion results from chronic exposure to gastric acid. Russell’s sign (calluses/abrasions on the knuckles) is caused by using the fingers to induce emesis. In contrast, anorexia nervosa is more classically associated with severe weight loss, lanugo, and bradycardia rather than prominent purging stigmata.

Question 44

The most important risk factor for postpartum psychosis is?

Accepted Answer

Answer reason: A prior bipolar diagnosis is the most predictive clinical history factor for developing severe postpartum mood destabilization with psychotic features. Obstetric factors like cesarean delivery may contribute to stress or recovery burden but are not primary drivers of psychosis risk. Endocrine/metabolic family history (e.g., diabetes) and infertility are not established major predictors compared with bipolar history and prior postpartum psychosis.

Question 45

A 14-year old client is to be admitted to a psychiatric in-patient unit for treatment of bipolar disorder. When assisting staff to understand behaviors that are likely to be seen in this client what should the nurse emphasize?

Accepted Answer

Answer reason: The most broadly reliable expectation for staff is that the client will have sustained, distinct periods of markedly different mood states, which drive many downstream behaviors. Other listed behaviors can occur during mania (e.g., grandiosity, distractibility, poor financial judgment), but they are not as universally descriptive as the core pattern of episodic extreme mood changes. Emphasizing the episodic nature helps staff anticipate fluctuations in risk, sleep, impulse control, and need for structure across the admission.

Question 46

Depression is a ...... disorder?

Accepted Answer

Answer reason: Somatoform disorders involve physical symptoms that are not fully explained by medical conditions and are not defined by persistent depressed mood. Dissociative disorders primarily involve disruptions in consciousness, memory, identity, or perception rather than affective symptoms. Schizophrenic disorders are psychotic disorders characterized by delusions, hallucinations, and disorganized thinking, which is distinct from primary depressive syndromes.

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