NUR 253 Exam 4 Mental Health (2026/2027) |
Galen College of Nursing | Comprehensive
Practice Questions & Verified Answers
Study Guide | NCLEX-Style Mental Health
Nursing Review PDF
•NCLEX-style multiple-choice questions designed for comprehensive mental
health nursing review and exam preparation
• Detailed evidence-based EXPERT RATIONALE with clinical context to strengthen
understanding and retention for practice and certification exams
QUESTION 1
A patient with major depressive disorder reports feeling hopeless and states,
"Nothing will ever get better." The nurse recognizes this statement as
indicative of which cognitive distortion?
A) Personalization
B) Catastrophizing
C) All-or-nothing thinking
D) Overgeneralization
E) Mind reading
CORRECT ANSWER: C) All-or-nothing thinking
EXPERT RATIONALE: All-or-nothing thinking involves viewing situations in absolute,
black-and-white terms without considering middle ground. The patient's statement
"Nothing will ever get better" demonstrates this distortion by seeing only the worst
outcome with no possibility of improvement. Personalization involves taking
responsibility for events outside one's control. Catastrophizing involves expecting
the worst outcome. Overgeneralization applies isolated incidents to all situations.
Mind reading assumes knowing what others are thinking without evidence.
QUESTION 2
,A 34-year-old client is admitted to the psychiatric unit with a diagnosis of
bipolar disorder, currently in a manic episode. Which behavioral
manifestation would the nurse expect to observe?
A) Increased need for sleep and psychomotor retardation
B) Flight of ideas, grandiosity, and excessive goal-directed activity
C) Social withdrawal and anhedonia
D) Persecutory delusions and command hallucinations
E) Flat affect and avolition
CORRECT ANSWER: B) Flight of ideas, grandiosity, and excessive goal-directed
activity
EXPERT RATIONALE: During a manic episode, clients exhibit characteristic
behaviors including flight of ideas (racing thoughts), grandiosity (inflated self-
esteem), and excessive goal-directed activity (high energy). They typically have a
decreased need for sleep and psychomotor agitation. Psychomotor retardation and
increased sleep are depressive features. Social withdrawal and anhedonia are
associated with depression. Persecutory delusions are more common in
schizophrenia. Flat affect and avolition are negative symptoms of schizophrenia.
QUESTION 3
The nurse is caring for a client with generalized anxiety disorder. Which
physiological response is NOT typically associated with anxiety?
A) Tachycardia
B) Pupil dilation
C) Decreased respiratory rate
D) Increased sweating
E) Muscle tension
CORRECT ANSWER: C) Decreased respiratory rate
,EXPERT RATIONALE: During anxiety, the sympathetic nervous system activates,
increasing respiratory rate (tachypnea), not decreasing it. Tachycardia, pupil
dilation, increased sweating, and muscle tension are all typical physiological
responses to anxiety mediated by sympathetic activation. Understanding these
normal anxiety responses helps nurses assess severity and guide appropriate
interventions.
QUESTION 4
A client with schizophrenia is experiencing command hallucinations telling
him to harm himself. Which nursing intervention is the priority?
A) Ask the client to describe the voices in detail
B) Ensure the client's safety and remove potential harmful objects
C) Tell the client the voices aren't real and to ignore them
D) Encourage the client to engage in recreational activities
E) Administer anti-anxiety medication as prescribed
CORRECT ANSWER: B) Ensure the client's safety and remove potential harmful
objects
EXPERT RATIONALE: When a client is experiencing command hallucinations that
pose a safety risk, the priority intervention is ensuring physical safety by removing
potential weapons or harmful objects and providing close observation. While asking
about voices can be therapeutic, it is not the priority when safety is at risk. Telling
the client voices aren't real may be dismissive of their experience. Recreational
activities and medication are supportive but secondary to safety. The nurse must
assess risk and implement safety precautions first.
QUESTION 5
, A 28-year-old client admitted with severe depression has been prescribed
sertraline (Zoloft). The nurse provides education about this medication.
Which statement by the client indicates understanding?
A) "I should see improvement in my mood within 24 hours of starting this
medication"
B) "This medication may increase my suicidal thoughts initially, and I should report
this immediately"
C) "I can stop taking this medication once I feel better"
D) "I should avoid foods containing tyramine while taking this medication"
E) "This medication will cure my depression completely"
CORRECT ANSWER: B) "This medication may increase my suicidal thoughts
initially, and I should report this immediately"
EXPERT RATIONALE: SSRIs carry a black box warning for increased suicidal
ideation, especially in younger clients during initial treatment phases. This is critical
safety information clients must understand. SSRIs typically take 2-4 weeks for
therapeutic effects. Abrupt discontinuation can cause withdrawal syndrome and
relapse. Tyramine restrictions apply to MAOIs, not SSRIs. While medication is
beneficial, it helps manage symptoms rather than "cure" depression. The client's
understanding of this warning indicates appropriate safety awareness.
QUESTION 6
During an assessment, a client demonstrates signs of being in crisis. The
nurse recognizes that a crisis state is characterized by which of the following?
A) A state of chronic stress lasting more than 3 months
B) An acute state of disequilibrium triggered by a precipitating event with
inadequate coping mechanisms
C) A temporary feeling of sadness that resolves with support
D) Manifestation of a personality disorder
Galen College of Nursing | Comprehensive
Practice Questions & Verified Answers
Study Guide | NCLEX-Style Mental Health
Nursing Review PDF
•NCLEX-style multiple-choice questions designed for comprehensive mental
health nursing review and exam preparation
• Detailed evidence-based EXPERT RATIONALE with clinical context to strengthen
understanding and retention for practice and certification exams
QUESTION 1
A patient with major depressive disorder reports feeling hopeless and states,
"Nothing will ever get better." The nurse recognizes this statement as
indicative of which cognitive distortion?
A) Personalization
B) Catastrophizing
C) All-or-nothing thinking
D) Overgeneralization
E) Mind reading
CORRECT ANSWER: C) All-or-nothing thinking
EXPERT RATIONALE: All-or-nothing thinking involves viewing situations in absolute,
black-and-white terms without considering middle ground. The patient's statement
"Nothing will ever get better" demonstrates this distortion by seeing only the worst
outcome with no possibility of improvement. Personalization involves taking
responsibility for events outside one's control. Catastrophizing involves expecting
the worst outcome. Overgeneralization applies isolated incidents to all situations.
Mind reading assumes knowing what others are thinking without evidence.
QUESTION 2
,A 34-year-old client is admitted to the psychiatric unit with a diagnosis of
bipolar disorder, currently in a manic episode. Which behavioral
manifestation would the nurse expect to observe?
A) Increased need for sleep and psychomotor retardation
B) Flight of ideas, grandiosity, and excessive goal-directed activity
C) Social withdrawal and anhedonia
D) Persecutory delusions and command hallucinations
E) Flat affect and avolition
CORRECT ANSWER: B) Flight of ideas, grandiosity, and excessive goal-directed
activity
EXPERT RATIONALE: During a manic episode, clients exhibit characteristic
behaviors including flight of ideas (racing thoughts), grandiosity (inflated self-
esteem), and excessive goal-directed activity (high energy). They typically have a
decreased need for sleep and psychomotor agitation. Psychomotor retardation and
increased sleep are depressive features. Social withdrawal and anhedonia are
associated with depression. Persecutory delusions are more common in
schizophrenia. Flat affect and avolition are negative symptoms of schizophrenia.
QUESTION 3
The nurse is caring for a client with generalized anxiety disorder. Which
physiological response is NOT typically associated with anxiety?
A) Tachycardia
B) Pupil dilation
C) Decreased respiratory rate
D) Increased sweating
E) Muscle tension
CORRECT ANSWER: C) Decreased respiratory rate
,EXPERT RATIONALE: During anxiety, the sympathetic nervous system activates,
increasing respiratory rate (tachypnea), not decreasing it. Tachycardia, pupil
dilation, increased sweating, and muscle tension are all typical physiological
responses to anxiety mediated by sympathetic activation. Understanding these
normal anxiety responses helps nurses assess severity and guide appropriate
interventions.
QUESTION 4
A client with schizophrenia is experiencing command hallucinations telling
him to harm himself. Which nursing intervention is the priority?
A) Ask the client to describe the voices in detail
B) Ensure the client's safety and remove potential harmful objects
C) Tell the client the voices aren't real and to ignore them
D) Encourage the client to engage in recreational activities
E) Administer anti-anxiety medication as prescribed
CORRECT ANSWER: B) Ensure the client's safety and remove potential harmful
objects
EXPERT RATIONALE: When a client is experiencing command hallucinations that
pose a safety risk, the priority intervention is ensuring physical safety by removing
potential weapons or harmful objects and providing close observation. While asking
about voices can be therapeutic, it is not the priority when safety is at risk. Telling
the client voices aren't real may be dismissive of their experience. Recreational
activities and medication are supportive but secondary to safety. The nurse must
assess risk and implement safety precautions first.
QUESTION 5
, A 28-year-old client admitted with severe depression has been prescribed
sertraline (Zoloft). The nurse provides education about this medication.
Which statement by the client indicates understanding?
A) "I should see improvement in my mood within 24 hours of starting this
medication"
B) "This medication may increase my suicidal thoughts initially, and I should report
this immediately"
C) "I can stop taking this medication once I feel better"
D) "I should avoid foods containing tyramine while taking this medication"
E) "This medication will cure my depression completely"
CORRECT ANSWER: B) "This medication may increase my suicidal thoughts
initially, and I should report this immediately"
EXPERT RATIONALE: SSRIs carry a black box warning for increased suicidal
ideation, especially in younger clients during initial treatment phases. This is critical
safety information clients must understand. SSRIs typically take 2-4 weeks for
therapeutic effects. Abrupt discontinuation can cause withdrawal syndrome and
relapse. Tyramine restrictions apply to MAOIs, not SSRIs. While medication is
beneficial, it helps manage symptoms rather than "cure" depression. The client's
understanding of this warning indicates appropriate safety awareness.
QUESTION 6
During an assessment, a client demonstrates signs of being in crisis. The
nurse recognizes that a crisis state is characterized by which of the following?
A) A state of chronic stress lasting more than 3 months
B) An acute state of disequilibrium triggered by a precipitating event with
inadequate coping mechanisms
C) A temporary feeling of sadness that resolves with support
D) Manifestation of a personality disorder
