NUR 253 Mental Health Exam 1–4 Bundle 2026/2027 – Most Tested
Questions with Verified Answers & In-Depth Rationales | Galen College of
Nursing PDF Study Guide for A+ Success
📘 Exam 1: Foundations of Psychiatric Nursing
Covers the basics: theories, communication, legal/ethical, treatment settings.
Number of Questions: ~60
Key Topics:
o Therapeutic nurse-patient relationship (phases, boundaries)
o Therapeutic vs. non-therapeutic communication techniques
o Defense mechanisms (identification of examples)
o Legal and ethical issues (involuntary admission, duty to protect, restraints)
o Mental status exam and assessment
o Introduction to psychopharmacology
o Milieu therapy and roles of the interdisciplinary team
o Stress, coping, and crisis intervention
📗 Exam 2: Mood Disorders & Suicide
Focuses on depressive and bipolar disorders, suicide risk, and related treatments.
Number of Questions: ~60
Key Topics:
o Major depressive disorder (assessment, interventions)
o Bipolar I & II: manic, hypomanic, and depressive episodes
o Cyclothymic disorder
o Suicide risk assessment, safety planning, no-suicide contract
o Electroconvulsive therapy (ECT): nursing role, preparation, post-care
o Antidepressants: SSRIs, SNRIs, TCAs, MAOIs (teaching, side effects, tyramine diet)
o Mood stabilizers: lithium, valproic acid, carbamazepine, lamotrigine (therapeutic levels,
toxicity)
,o Postpartum depression and grief
📙 Exam 3: Psychotic & Thought Disorders
Covers schizophrenia spectrum and antipsychotic medications in depth.
Number of Questions: ~60
Key Topics:
o Schizophrenia: positive, negative, cognitive, and catatonic symptoms
o Delusional disorders, brief psychotic disorder, schizoaffective disorder
o Antipsychotics: first-generation (haloperidol) and second-generation (olanzapine,
risperidone, clozapine, aripiprazole)
o Extrapyramidal symptoms (EPS): acute dystonia, akathisia, pseudoparkinsonism, tardive
dyskinesia (AIMS scale)
o Neuroleptic malignant syndrome (NMS) recognition and intervention
o Clozapine REMS monitoring (agranulocytosis, ANC)
o Metabolic syndrome and long-term monitoring
o Therapeutic communication with psychotic patients (delusions, hallucinations)
o Schizoid, schizotypal, and paranoid personality disorders
📕 Exam 4: Anxiety, Trauma, Personality, Eating & Substance Disorders
Broad exam covering a range of high-frequency disorders and crisis management.
Number of Questions: ~60
Key Topics:
o Anxiety disorders: GAD, panic disorder, phobias, social anxiety
o Obsessive-compulsive disorder and related disorders (body dysmorphic, hoarding)
o PTSD and acute stress disorder (trauma-informed care, grounding)
o Dissociative disorders: dissociative identity disorder, amnesia
o Somatic symptom and related disorders (illness anxiety, conversion)
o Eating disorders: anorexia nervosa, bulimia nervosa (refeeding syndrome, electrolyte
monitoring)
,o Personality disorders: borderline, antisocial, histrionic, dependent, avoidant, OCPD
o Substance use disorders: alcohol, opioids, stimulants (CIWA, COWS, withdrawal
management)
o Medications for substance use: naltrexone, buprenorphine, disulfiram, acamprosate
o Crisis and aggression management (de-escalation, least restrictive interventions)
o
Exam 1
Q1. A patient with schizophrenia says, “The voices are telling me to hurt myself.”
What is the nurse’s best initial response?
A) “Ignore the voices, they are not real.”
B) ✓ “I do not hear the voices, but I understand that you are frightened.”
C) “Why would you want to hurt yourself?”
D) “The voices will stop if you take your medication.”
The nurse should acknowledge the patient’s feelings without validating the hallucination.
Saying “I do not hear the voices” presents reality while expressing empathy.
Q2. Which defense mechanism is being used when a patient who was sexually
abused as a child cannot remember the abuse?
A) Projection
B) Sublimation
C) ✓ Repression
D) Rationalization
Repression is the unconscious exclusion of painful or traumatic memories from awareness.
Q3. A patient with bipolar disorder, manic phase, is pacing and shouting. Which
nursing intervention has the highest priority?
A) Encourage group therapy.
B) ✓ Provide a quiet environment and decrease stimulation.
C) Ask the patient to write in a journal.
, D) Confront the behavior directly.
Overstimulation can escalate mania. Reducing environmental stimuli helps prevent
escalation and promotes safety.
Q4. A patient on lithium has a lithium level of 1.8 mEq/L. The nurse should first:
A) Administer the next dose as scheduled.
B) ✓ Hold the lithium and notify the provider.
C) Encourage increased salt intake.
D) Reassure the patient that this is normal.
The therapeutic range is 0.6–1.2 mEq/L. A level of 1.8 mEq/L is approaching toxic range
and requires immediate intervention.
Q5. Which therapeutic communication technique is the nurse using when saying,
“You seem upset about your family visit today”?
A) Clarification
B) Restating
C) ✓ Reflection
D) Summarizing
Reflection directs the patient’s feelings or thoughts back to them, encouraging further
expression.
Q6. A patient with major depressive disorder is prescribed sertraline. The nurse
should instruct the patient that the full therapeutic effect may take:
A) 1–2 days
B) ✓ 4–6 weeks
C) 1 week
D) 12 hours
Questions with Verified Answers & In-Depth Rationales | Galen College of
Nursing PDF Study Guide for A+ Success
📘 Exam 1: Foundations of Psychiatric Nursing
Covers the basics: theories, communication, legal/ethical, treatment settings.
Number of Questions: ~60
Key Topics:
o Therapeutic nurse-patient relationship (phases, boundaries)
o Therapeutic vs. non-therapeutic communication techniques
o Defense mechanisms (identification of examples)
o Legal and ethical issues (involuntary admission, duty to protect, restraints)
o Mental status exam and assessment
o Introduction to psychopharmacology
o Milieu therapy and roles of the interdisciplinary team
o Stress, coping, and crisis intervention
📗 Exam 2: Mood Disorders & Suicide
Focuses on depressive and bipolar disorders, suicide risk, and related treatments.
Number of Questions: ~60
Key Topics:
o Major depressive disorder (assessment, interventions)
o Bipolar I & II: manic, hypomanic, and depressive episodes
o Cyclothymic disorder
o Suicide risk assessment, safety planning, no-suicide contract
o Electroconvulsive therapy (ECT): nursing role, preparation, post-care
o Antidepressants: SSRIs, SNRIs, TCAs, MAOIs (teaching, side effects, tyramine diet)
o Mood stabilizers: lithium, valproic acid, carbamazepine, lamotrigine (therapeutic levels,
toxicity)
,o Postpartum depression and grief
📙 Exam 3: Psychotic & Thought Disorders
Covers schizophrenia spectrum and antipsychotic medications in depth.
Number of Questions: ~60
Key Topics:
o Schizophrenia: positive, negative, cognitive, and catatonic symptoms
o Delusional disorders, brief psychotic disorder, schizoaffective disorder
o Antipsychotics: first-generation (haloperidol) and second-generation (olanzapine,
risperidone, clozapine, aripiprazole)
o Extrapyramidal symptoms (EPS): acute dystonia, akathisia, pseudoparkinsonism, tardive
dyskinesia (AIMS scale)
o Neuroleptic malignant syndrome (NMS) recognition and intervention
o Clozapine REMS monitoring (agranulocytosis, ANC)
o Metabolic syndrome and long-term monitoring
o Therapeutic communication with psychotic patients (delusions, hallucinations)
o Schizoid, schizotypal, and paranoid personality disorders
📕 Exam 4: Anxiety, Trauma, Personality, Eating & Substance Disorders
Broad exam covering a range of high-frequency disorders and crisis management.
Number of Questions: ~60
Key Topics:
o Anxiety disorders: GAD, panic disorder, phobias, social anxiety
o Obsessive-compulsive disorder and related disorders (body dysmorphic, hoarding)
o PTSD and acute stress disorder (trauma-informed care, grounding)
o Dissociative disorders: dissociative identity disorder, amnesia
o Somatic symptom and related disorders (illness anxiety, conversion)
o Eating disorders: anorexia nervosa, bulimia nervosa (refeeding syndrome, electrolyte
monitoring)
,o Personality disorders: borderline, antisocial, histrionic, dependent, avoidant, OCPD
o Substance use disorders: alcohol, opioids, stimulants (CIWA, COWS, withdrawal
management)
o Medications for substance use: naltrexone, buprenorphine, disulfiram, acamprosate
o Crisis and aggression management (de-escalation, least restrictive interventions)
o
Exam 1
Q1. A patient with schizophrenia says, “The voices are telling me to hurt myself.”
What is the nurse’s best initial response?
A) “Ignore the voices, they are not real.”
B) ✓ “I do not hear the voices, but I understand that you are frightened.”
C) “Why would you want to hurt yourself?”
D) “The voices will stop if you take your medication.”
The nurse should acknowledge the patient’s feelings without validating the hallucination.
Saying “I do not hear the voices” presents reality while expressing empathy.
Q2. Which defense mechanism is being used when a patient who was sexually
abused as a child cannot remember the abuse?
A) Projection
B) Sublimation
C) ✓ Repression
D) Rationalization
Repression is the unconscious exclusion of painful or traumatic memories from awareness.
Q3. A patient with bipolar disorder, manic phase, is pacing and shouting. Which
nursing intervention has the highest priority?
A) Encourage group therapy.
B) ✓ Provide a quiet environment and decrease stimulation.
C) Ask the patient to write in a journal.
, D) Confront the behavior directly.
Overstimulation can escalate mania. Reducing environmental stimuli helps prevent
escalation and promotes safety.
Q4. A patient on lithium has a lithium level of 1.8 mEq/L. The nurse should first:
A) Administer the next dose as scheduled.
B) ✓ Hold the lithium and notify the provider.
C) Encourage increased salt intake.
D) Reassure the patient that this is normal.
The therapeutic range is 0.6–1.2 mEq/L. A level of 1.8 mEq/L is approaching toxic range
and requires immediate intervention.
Q5. Which therapeutic communication technique is the nurse using when saying,
“You seem upset about your family visit today”?
A) Clarification
B) Restating
C) ✓ Reflection
D) Summarizing
Reflection directs the patient’s feelings or thoughts back to them, encouraging further
expression.
Q6. A patient with major depressive disorder is prescribed sertraline. The nurse
should instruct the patient that the full therapeutic effect may take:
A) 1–2 days
B) ✓ 4–6 weeks
C) 1 week
D) 12 hours
