NSG 3450 Mental Health Nursing –
Exam 2 Practice Questions (1–40)
Questions with Correct ANSWERs and
Explanations
Domain 1: Therapeutic Communication & Nurse-Patient Relationship
1. A patient admitted for major depressive disorder is sitting alone in their room,
head down, refusing breakfast. Which statement by the nurse demonstrates the
therapeutic communication technique of "making observations"?
A) "Why aren't you eating your breakfast? You need to keep your strength up."
B) "I notice you haven't touched your breakfast tray and you're looking down. Can you
tell me what you're experiencing right now?"
C) "Everyone else on the unit is eating in the dining room. You should join them."
D) "I know exactly how you feel. I was depressed once too."
Correct Answer: B) "I notice you haven't touched your breakfast tray and you're
looking down. Can you tell me what you're experiencing right now?"
Explanation: Making observations is a therapeutic communication technique where the
nurse verbalizes what is perceived about the patient's behavior or appearance. This
opens the door for the patient to share their feelings without feeling interrogated.
Option B neutrally states the observation ("you haven't touched your breakfast, you're
,looking down") and invites the patient to elaborate. This demonstrates active
engagement without judgment.
• A is non-therapeutic; asking "why" can feel accusatory, and "you need to" is
giving unsolicited advice.
• C is non-therapeutic; comparing the patient to others ("everyone else") can
induce guilt and shame.
• D is non-therapeutic; shifting the focus to the nurse's experience minimizes
the patient's unique feelings.
2. A patient with paranoid schizophrenia tells the nurse, "The FBI has planted
listening devices in the television to monitor my thoughts. I can't talk in here."
What is the nurse's MOST therapeutic response?
A) "That's not true. There are no listening devices in your television. This is a hospital,
and you are safe."
B) "Why would the FBI be interested in monitoring your thoughts?"
C) "I understand that you feel very frightened and unsafe right now. Let's go to the
dayroom where it might feel more comfortable for you to talk."
D) "Let's focus on reality. Tell me three things you can see in this room that are real."
Correct Answer: C) "I understand that you feel very frightened and unsafe right
now. Let's go to the dayroom where it might feel more comfortable for you to
talk."
Explanation: This response uses the therapeutic techniques of validation and offering
an alternative. The nurse acknowledges the feeling (fear, lack of safety) without
validating the delusion. Saying "I understand that you feel..." is not the same as agreeing
with the delusional content. Offering to relocate to the dayroom pragmatically
addresses the patient's stated barrier to communication ("I can't talk in here").
, • A is challenging/challenging the delusion directly, which can escalate
anxiety and damage rapport. Arguing about delusions is ineffective.
• B asks "why," which is a non-therapeutic probing question. Patients rarely
know "why" they have delusions, and asking can increase defensiveness.
• D is reorientation/reality testing, which can be useful but is too abrupt
here. Acknowledging the distress first is essential before any gentle reality
orientation.
3. During a group therapy session, a patient begins to cry and states, "I don't want
to talk about my childhood. It's too painful." The nurse leading the group
responds by remaining silent and allowing other group members to offer support.
This silence is considered:
A) Non-therapeutic; the leader should have immediately redirected the conversation to
a neutral topic.
B) Therapeutic; silence gives the patient space to process emotions and allows the
group to function therapeutically.
C) Non-therapeutic; the leader should have terminated the session to protect the
patient from further distress.
D) A boundary violation; the leader should not allow other patients to intervene.
Correct Answer: B) Therapeutic; silence gives the patient space to process
emotions and allows the group to function therapeutically.
Explanation: Therapeutic silence is a deliberate, purposeful communication technique.
In group therapy, the leader's silence can serve multiple functions: it communicates
acceptance of the patient's emotional state, it gives the patient time to collect
themselves without pressure, and it allows group members to step in with peer support,
which is a powerful therapeutic factor (Yalom's universality, altruism, and cohesiveness).
Exam 2 Practice Questions (1–40)
Questions with Correct ANSWERs and
Explanations
Domain 1: Therapeutic Communication & Nurse-Patient Relationship
1. A patient admitted for major depressive disorder is sitting alone in their room,
head down, refusing breakfast. Which statement by the nurse demonstrates the
therapeutic communication technique of "making observations"?
A) "Why aren't you eating your breakfast? You need to keep your strength up."
B) "I notice you haven't touched your breakfast tray and you're looking down. Can you
tell me what you're experiencing right now?"
C) "Everyone else on the unit is eating in the dining room. You should join them."
D) "I know exactly how you feel. I was depressed once too."
Correct Answer: B) "I notice you haven't touched your breakfast tray and you're
looking down. Can you tell me what you're experiencing right now?"
Explanation: Making observations is a therapeutic communication technique where the
nurse verbalizes what is perceived about the patient's behavior or appearance. This
opens the door for the patient to share their feelings without feeling interrogated.
Option B neutrally states the observation ("you haven't touched your breakfast, you're
,looking down") and invites the patient to elaborate. This demonstrates active
engagement without judgment.
• A is non-therapeutic; asking "why" can feel accusatory, and "you need to" is
giving unsolicited advice.
• C is non-therapeutic; comparing the patient to others ("everyone else") can
induce guilt and shame.
• D is non-therapeutic; shifting the focus to the nurse's experience minimizes
the patient's unique feelings.
2. A patient with paranoid schizophrenia tells the nurse, "The FBI has planted
listening devices in the television to monitor my thoughts. I can't talk in here."
What is the nurse's MOST therapeutic response?
A) "That's not true. There are no listening devices in your television. This is a hospital,
and you are safe."
B) "Why would the FBI be interested in monitoring your thoughts?"
C) "I understand that you feel very frightened and unsafe right now. Let's go to the
dayroom where it might feel more comfortable for you to talk."
D) "Let's focus on reality. Tell me three things you can see in this room that are real."
Correct Answer: C) "I understand that you feel very frightened and unsafe right
now. Let's go to the dayroom where it might feel more comfortable for you to
talk."
Explanation: This response uses the therapeutic techniques of validation and offering
an alternative. The nurse acknowledges the feeling (fear, lack of safety) without
validating the delusion. Saying "I understand that you feel..." is not the same as agreeing
with the delusional content. Offering to relocate to the dayroom pragmatically
addresses the patient's stated barrier to communication ("I can't talk in here").
, • A is challenging/challenging the delusion directly, which can escalate
anxiety and damage rapport. Arguing about delusions is ineffective.
• B asks "why," which is a non-therapeutic probing question. Patients rarely
know "why" they have delusions, and asking can increase defensiveness.
• D is reorientation/reality testing, which can be useful but is too abrupt
here. Acknowledging the distress first is essential before any gentle reality
orientation.
3. During a group therapy session, a patient begins to cry and states, "I don't want
to talk about my childhood. It's too painful." The nurse leading the group
responds by remaining silent and allowing other group members to offer support.
This silence is considered:
A) Non-therapeutic; the leader should have immediately redirected the conversation to
a neutral topic.
B) Therapeutic; silence gives the patient space to process emotions and allows the
group to function therapeutically.
C) Non-therapeutic; the leader should have terminated the session to protect the
patient from further distress.
D) A boundary violation; the leader should not allow other patients to intervene.
Correct Answer: B) Therapeutic; silence gives the patient space to process
emotions and allows the group to function therapeutically.
Explanation: Therapeutic silence is a deliberate, purposeful communication technique.
In group therapy, the leader's silence can serve multiple functions: it communicates
acceptance of the patient's emotional state, it gives the patient time to collect
themselves without pressure, and it allows group members to step in with peer support,
which is a powerful therapeutic factor (Yalom's universality, altruism, and cohesiveness).
