NUR 253-256 Mental Health Exam 1 Questions and
100% Correct Answers Latest 2026/2027 Update –
Galen
OVERVIEW:
NUR 253-256 Mental Health Exam 1 covers therapeutic communication
techniques, nurse-client relationship phases and Peplau's theory, QSEN
competencies, client rights, voluntary and involuntary admission, restraints,
malpractice, and documentation. It addresses Maslow's hierarchy, crisis
intervention, cultural competence, Erikson developmental stages,
psychopharmacology including MAOIs, SSRIs, lithium, valproate,
benzodiazepines, buspirone, antipsychotics, EPS, serotonin syndrome, and
safety, ethics, and professional boundaries. Emphasizes holistic mental health
assessment, patient-centered care, advocacy, and safe medication administration
principles.
Correct answer highlighted in bold Green + rationales.
1. The nurse is engaging in the therapeutic communication technique of focusing with a client.
Which of the following statements by the nurse indicates that the nurse is trying to use this
technique?
a. You say you are angry but I notice that you are smiling.
b. Why do you feel so angry about your family?
c. Lets go back and talk about the effect this had on you.
d. I can only imagine how hard this must be for you.
Rationale: Focusing helps the client concentrate on central important details. Option C
redirects to exploring the effect of a specific experience, which is the definition of focusing.
Option A is pointing out discrepancies, B is a 'why' question (non-therapeutic), D is empathy.
2. The nurse is caring for a client who was involuntarily admitted to an inpatient psych unit.
The client appears angry, is verbally abusive to the staff and is repeatedly threatening to sue
,various staff members. Which of the following actions is most appropriate for the nurse to
take?
a. Warn the client that threats of legal action are inappropriate and unwelcome.
b. Continue attempts to establish a good working relationship with the client.
c. Verbally redirect the client and refuse to interact on a one-on-one basis.
d. Consult the hospital's legal advisor as soon as possible.
Rationale: Involuntary admission triggers anger and fear. The nurse should not respond
defensively or retaliate. Therapeutic approach is to maintain professionalism and continue
efforts to establish trust and a working alliance despite the threats. Do not argue about legal
issues.
3. The mental health nurse manager and newly hired nurse are discussing the levels of
psychiatric care for a client. The nurse manager anticipates the client will need care delivered
by an advanced practice registered nurse. Which of the following levels of care should the
newly hired nurse expect to be performed only by the APRN?
a. Milieu therapy
b. Pharmacological educational therapy
c. Health teaching and maintenance
d. Psychotherapy
Rationale: RN can provide milieu therapy, medication education, health teaching.
Psychotherapy (individual, group, family psychotherapy) is within APRN scope of practice
(PMH-APRN), not basic RN.
4. A nurse working on an inpatient psych unit has just received the change of shift report. The
nurse should first plan to assess the client
a. Who has schizophrenia and is having visual hallucinations
b. Whose most recent lithium level was 1.0
c. Who will undergo ECT in 2 hours
d. Who has a WBC of 7.5
, Rationale: Priority is safety and abnormal assessment. Visual hallucinations in schizophrenia
are atypical (auditory is more common) and may indicate organic cause or worsening
psychosis - needs assessment first. Lithium 1.0 is at high end of therapeutic (0.6-1.2) but not
toxic, ECT in 2 hours is expected, WBC 7.5 is normal (4.5-11k).
5. The nurse preceptor in a psych unit is teaching a student nurse how to identify clients
experiencing mental illness. Which of the following assessment findings reported by the
student demonstrates that teaching has been effective?
a. The client reports thoughts about whether to change to a less stressful job
b. The client reports occasional sleeplessness and anxiety
c. The client reports having a few moments of discouragement
d. The client reports recurrent worry about school safety so stays home for long periods
Rationale: Mental illness is indicated when thoughts, feelings, behaviors cause significant
distress and impaired functioning. Options A,B,C are normal human responses. Option D
shows recurrent worry leading to avoidance and inability to attend school = impaired
functioning.
6. The nurse is having a discussion with a client who states, "I just don't think my partner and I
are going to make it." The nurse replies, "That's hard to believe." Which of the following
therapeutic communication techniques is being used by the nurse?
a. Restating a feeling or thought the client has expressed
b. Voicing doubt regarding the client's perception
c. Asking the client to elaborate on a thought discussed
d. Offering of self to show interest in the client
Rationale: 'That's hard to believe' expresses disbelief/doubt about the client's perception,
which is the technique of voicing doubt. This encourages client to re-examine their thought
without direct confrontation.
7. The APRN suspects a newly hired nurse is experiencing countertransference with a client
who is a narcotic addict. Which of the following statements by the newly hired nurse
reinforces the suspicion?
100% Correct Answers Latest 2026/2027 Update –
Galen
OVERVIEW:
NUR 253-256 Mental Health Exam 1 covers therapeutic communication
techniques, nurse-client relationship phases and Peplau's theory, QSEN
competencies, client rights, voluntary and involuntary admission, restraints,
malpractice, and documentation. It addresses Maslow's hierarchy, crisis
intervention, cultural competence, Erikson developmental stages,
psychopharmacology including MAOIs, SSRIs, lithium, valproate,
benzodiazepines, buspirone, antipsychotics, EPS, serotonin syndrome, and
safety, ethics, and professional boundaries. Emphasizes holistic mental health
assessment, patient-centered care, advocacy, and safe medication administration
principles.
Correct answer highlighted in bold Green + rationales.
1. The nurse is engaging in the therapeutic communication technique of focusing with a client.
Which of the following statements by the nurse indicates that the nurse is trying to use this
technique?
a. You say you are angry but I notice that you are smiling.
b. Why do you feel so angry about your family?
c. Lets go back and talk about the effect this had on you.
d. I can only imagine how hard this must be for you.
Rationale: Focusing helps the client concentrate on central important details. Option C
redirects to exploring the effect of a specific experience, which is the definition of focusing.
Option A is pointing out discrepancies, B is a 'why' question (non-therapeutic), D is empathy.
2. The nurse is caring for a client who was involuntarily admitted to an inpatient psych unit.
The client appears angry, is verbally abusive to the staff and is repeatedly threatening to sue
,various staff members. Which of the following actions is most appropriate for the nurse to
take?
a. Warn the client that threats of legal action are inappropriate and unwelcome.
b. Continue attempts to establish a good working relationship with the client.
c. Verbally redirect the client and refuse to interact on a one-on-one basis.
d. Consult the hospital's legal advisor as soon as possible.
Rationale: Involuntary admission triggers anger and fear. The nurse should not respond
defensively or retaliate. Therapeutic approach is to maintain professionalism and continue
efforts to establish trust and a working alliance despite the threats. Do not argue about legal
issues.
3. The mental health nurse manager and newly hired nurse are discussing the levels of
psychiatric care for a client. The nurse manager anticipates the client will need care delivered
by an advanced practice registered nurse. Which of the following levels of care should the
newly hired nurse expect to be performed only by the APRN?
a. Milieu therapy
b. Pharmacological educational therapy
c. Health teaching and maintenance
d. Psychotherapy
Rationale: RN can provide milieu therapy, medication education, health teaching.
Psychotherapy (individual, group, family psychotherapy) is within APRN scope of practice
(PMH-APRN), not basic RN.
4. A nurse working on an inpatient psych unit has just received the change of shift report. The
nurse should first plan to assess the client
a. Who has schizophrenia and is having visual hallucinations
b. Whose most recent lithium level was 1.0
c. Who will undergo ECT in 2 hours
d. Who has a WBC of 7.5
, Rationale: Priority is safety and abnormal assessment. Visual hallucinations in schizophrenia
are atypical (auditory is more common) and may indicate organic cause or worsening
psychosis - needs assessment first. Lithium 1.0 is at high end of therapeutic (0.6-1.2) but not
toxic, ECT in 2 hours is expected, WBC 7.5 is normal (4.5-11k).
5. The nurse preceptor in a psych unit is teaching a student nurse how to identify clients
experiencing mental illness. Which of the following assessment findings reported by the
student demonstrates that teaching has been effective?
a. The client reports thoughts about whether to change to a less stressful job
b. The client reports occasional sleeplessness and anxiety
c. The client reports having a few moments of discouragement
d. The client reports recurrent worry about school safety so stays home for long periods
Rationale: Mental illness is indicated when thoughts, feelings, behaviors cause significant
distress and impaired functioning. Options A,B,C are normal human responses. Option D
shows recurrent worry leading to avoidance and inability to attend school = impaired
functioning.
6. The nurse is having a discussion with a client who states, "I just don't think my partner and I
are going to make it." The nurse replies, "That's hard to believe." Which of the following
therapeutic communication techniques is being used by the nurse?
a. Restating a feeling or thought the client has expressed
b. Voicing doubt regarding the client's perception
c. Asking the client to elaborate on a thought discussed
d. Offering of self to show interest in the client
Rationale: 'That's hard to believe' expresses disbelief/doubt about the client's perception,
which is the technique of voicing doubt. This encourages client to re-examine their thought
without direct confrontation.
7. The APRN suspects a newly hired nurse is experiencing countertransference with a client
who is a narcotic addict. Which of the following statements by the newly hired nurse
reinforces the suspicion?
