NUR 253 Final Exam: Concepts of Mental Health Nursing -
Galen College of Nursing Updated and Latest Questions
and Correct Answers with Rationale
1. A nurse is caring for a client with schizophrenia who is experiencing auditory hallucinations. Which is the
most appropriate initial nursing intervention?
A. Tell the client that the voices are not real and they should ignore them.
B. Leave the client alone in a quiet room to decrease external stimuli.
C. Ask the client directly what the voices are saying to assess for safety.
D. Agree with the client so they feel supported and understood.
Correct Answer: C
Rationale: Safety is always the primary concern when a patient experiences hallucinations in a
psychiatric setting. The nurse must determine if the voices are command hallucinations that might
instruct the patient to hurt themselves or others. Validating the patient’s experience without agreeing
that the voices are real helps maintain a therapeutic relationship. Providing a safe environment begins
with a thorough assessment of the internal stimuli the patient is experiencing. This approach allows the
nurse to implement appropriate precautions based on the content of the hallucination.
2. A patient is prescribed Lithium Carbonate for Bipolar Disorder. Which laboratory value should the nurse
prioritize for monitoring to prevent toxicity?
A. Serum Sodium levels
B. Blood Urea Nitrogen (BUN)
C. Aspartate Aminotransferase (AST)
D. Platelet Count
,Correct Answer: A
Rationale: Lithium is a salt that is closely related to sodium levels within the human body. When sodium
levels decrease, the kidneys retain lithium, which significantly increases the risk of lithium toxicity. The
therapeutic window for lithium is very narrow, making constant monitoring of electrolytes essential for
patient safety. Patients should be educated to maintain a consistent intake of salt and fluids to keep levels
stable. Recognizing that hyponatremia can lead to dangerous lithium buildup is a critical component of
psychopharmacological nursing care.
3. Which defense mechanism is a patient using when they kick a chair after being told they cannot have an
extra snack?
A. Projection
B. Displacement
C. Rationalization
D. Reaction Formation
Correct Answer: B
Rationale: Displacement involves transferring emotional feelings from their original source to a
substitute target that is less threatening. In this scenario, the patient is angry with the staff member but
redirects that anger toward an inanimate object. This mechanism allows the individual to discharge pent-
up feelings without confronting the actual source of frustration. Understanding defense mechanisms
helps nurses interpret patient behaviors and identify underlying stressors. Addressing the root cause of
the anger is more effective than simply focusing on the physical act of kicking the chair.
4. A nurse is assessing a client for Neuroleptic Malignant Syndrome (NMS). Which clinical finding is a
hallmark sign of this condition?
A. Hypothermia and bradycardia
,B. Muscle rigidity and high fever
C. Increased appetite and weight gain
D. Hypotension and sedation
Correct Answer: B
Rationale: Neuroleptic Malignant Syndrome is a rare but life-threatening reaction to antipsychotic
medications. The condition is characterized by severe muscle rigidity, often described as lead-pipe
rigidity, and a high fever. Other signs include autonomic instability, such as tachycardia and fluctuating
blood pressure, as well as altered mental status. Immediate nursing action includes stopping the
offending medication and notifying the provider immediately. Treatment usually involves supportive
care and medications like dantrolene or bromocriptine to manage the symptoms.
5. During a panic attack, which nursing intervention is most effective for a patient experiencing severe
anxiety?
A. Stay with the patient and use short, simple instructions.
B. Explain the physiological reasons for the panic attack in detail.
C. Teach the patient new coping skills to use in the future.
D. Encourage the patient to walk around the unit to burn off energy.
Correct Answer: A
Rationale: During a panic-level of anxiety, a person’s ability to process information is severely
diminished. Staying with the patient provides a sense of security and prevents injury during the height of
the attack. Short, simple instructions are necessary because the patient cannot focus on complex thoughts
or teaching. The nurse’s calm presence helps to eventually lower the patient’s anxiety level through co-
, regulation. Once the panic subsides, the nurse can then focus on teaching and exploring triggers with the
patient.
6. A client with Borderline Personality Disorder (BPD) tells a morning nurse that the night nurse was ‘mean
and incompetent.’ This behavior is known as:
A. Sublimation
B. Splitting
C. Altruism
D. Idealization
Correct Answer: B
Rationale: Splitting is a common defense mechanism where individuals view people or situations as
either all good or all bad. This inability to integrate positive and negative qualities of others leads to
volatile relationships and staff conflict. In a clinical setting, splitting often results in ‘pitting’ staff
members against one another to gain control or validation. Consistent communication among the
treatment team is vital to maintain boundaries and prevent manipulation. Nurses must remain neutral
and refer the patient back to the original source of conflict when splitting occurs.
7. A nurse is teaching a client about a new prescription for Phenelzine (an MAOI). Which food choice
indicates the client understands the dietary restrictions?
A. Pepperoni pizza and a beer
B. Smoked salmon and cream cheese bagels
C. Aged cheddar cheese and crackers
D. Grilled chicken breast and steamed broccoli
Correct Answer: D
Galen College of Nursing Updated and Latest Questions
and Correct Answers with Rationale
1. A nurse is caring for a client with schizophrenia who is experiencing auditory hallucinations. Which is the
most appropriate initial nursing intervention?
A. Tell the client that the voices are not real and they should ignore them.
B. Leave the client alone in a quiet room to decrease external stimuli.
C. Ask the client directly what the voices are saying to assess for safety.
D. Agree with the client so they feel supported and understood.
Correct Answer: C
Rationale: Safety is always the primary concern when a patient experiences hallucinations in a
psychiatric setting. The nurse must determine if the voices are command hallucinations that might
instruct the patient to hurt themselves or others. Validating the patient’s experience without agreeing
that the voices are real helps maintain a therapeutic relationship. Providing a safe environment begins
with a thorough assessment of the internal stimuli the patient is experiencing. This approach allows the
nurse to implement appropriate precautions based on the content of the hallucination.
2. A patient is prescribed Lithium Carbonate for Bipolar Disorder. Which laboratory value should the nurse
prioritize for monitoring to prevent toxicity?
A. Serum Sodium levels
B. Blood Urea Nitrogen (BUN)
C. Aspartate Aminotransferase (AST)
D. Platelet Count
,Correct Answer: A
Rationale: Lithium is a salt that is closely related to sodium levels within the human body. When sodium
levels decrease, the kidneys retain lithium, which significantly increases the risk of lithium toxicity. The
therapeutic window for lithium is very narrow, making constant monitoring of electrolytes essential for
patient safety. Patients should be educated to maintain a consistent intake of salt and fluids to keep levels
stable. Recognizing that hyponatremia can lead to dangerous lithium buildup is a critical component of
psychopharmacological nursing care.
3. Which defense mechanism is a patient using when they kick a chair after being told they cannot have an
extra snack?
A. Projection
B. Displacement
C. Rationalization
D. Reaction Formation
Correct Answer: B
Rationale: Displacement involves transferring emotional feelings from their original source to a
substitute target that is less threatening. In this scenario, the patient is angry with the staff member but
redirects that anger toward an inanimate object. This mechanism allows the individual to discharge pent-
up feelings without confronting the actual source of frustration. Understanding defense mechanisms
helps nurses interpret patient behaviors and identify underlying stressors. Addressing the root cause of
the anger is more effective than simply focusing on the physical act of kicking the chair.
4. A nurse is assessing a client for Neuroleptic Malignant Syndrome (NMS). Which clinical finding is a
hallmark sign of this condition?
A. Hypothermia and bradycardia
,B. Muscle rigidity and high fever
C. Increased appetite and weight gain
D. Hypotension and sedation
Correct Answer: B
Rationale: Neuroleptic Malignant Syndrome is a rare but life-threatening reaction to antipsychotic
medications. The condition is characterized by severe muscle rigidity, often described as lead-pipe
rigidity, and a high fever. Other signs include autonomic instability, such as tachycardia and fluctuating
blood pressure, as well as altered mental status. Immediate nursing action includes stopping the
offending medication and notifying the provider immediately. Treatment usually involves supportive
care and medications like dantrolene or bromocriptine to manage the symptoms.
5. During a panic attack, which nursing intervention is most effective for a patient experiencing severe
anxiety?
A. Stay with the patient and use short, simple instructions.
B. Explain the physiological reasons for the panic attack in detail.
C. Teach the patient new coping skills to use in the future.
D. Encourage the patient to walk around the unit to burn off energy.
Correct Answer: A
Rationale: During a panic-level of anxiety, a person’s ability to process information is severely
diminished. Staying with the patient provides a sense of security and prevents injury during the height of
the attack. Short, simple instructions are necessary because the patient cannot focus on complex thoughts
or teaching. The nurse’s calm presence helps to eventually lower the patient’s anxiety level through co-
, regulation. Once the panic subsides, the nurse can then focus on teaching and exploring triggers with the
patient.
6. A client with Borderline Personality Disorder (BPD) tells a morning nurse that the night nurse was ‘mean
and incompetent.’ This behavior is known as:
A. Sublimation
B. Splitting
C. Altruism
D. Idealization
Correct Answer: B
Rationale: Splitting is a common defense mechanism where individuals view people or situations as
either all good or all bad. This inability to integrate positive and negative qualities of others leads to
volatile relationships and staff conflict. In a clinical setting, splitting often results in ‘pitting’ staff
members against one another to gain control or validation. Consistent communication among the
treatment team is vital to maintain boundaries and prevent manipulation. Nurses must remain neutral
and refer the patient back to the original source of conflict when splitting occurs.
7. A nurse is teaching a client about a new prescription for Phenelzine (an MAOI). Which food choice
indicates the client understands the dietary restrictions?
A. Pepperoni pizza and a beer
B. Smoked salmon and cream cheese bagels
C. Aged cheddar cheese and crackers
D. Grilled chicken breast and steamed broccoli
Correct Answer: D
