NSG3130 Exam 3: Fundamental Concepts & Skills for Nursing
Practice II
Galen College of Nursing | 2026/2027 Curriculum | 100% Correct Questions & Answers
75 Questions | Aligned with QSEN Competencies & NCLEX-PN Standards
Section 1: Mental Health Nursing and Psychosocial Concepts (Q1-Q12)
Q1: A nurse is caring for a client who states, 'I have been feeling overwhelming sadness for the past 3 weeks. I
have no energy, I can barely get out of bed, and I have lost interest in all activities I used to enjoy.' Which nursing
diagnosis is most appropriate?
A. Ineffective coping related to situational crisis
B. Risk for self-harm related to hopelessness
C. Chronic sorrow related to unresolved loss
D. Social isolation related to withdrawal from activities [CORRECT]
Correct Answer: D
Rationale: The client presents classic symptoms of major depressive disorder (MDD): persistent sadness (greater than 2
weeks), anhedonia (loss of interest in activities), fatigue, and psychomotor retardation. Social isolation is the most
appropriate nursing diagnosis because the client has withdrawn from activities and relationships, which is a defining
characteristic of depression. While risk for self-harm should be assessed, the stem does not indicate suicidal ideation.
Ineffective coping and chronic sorrow do not capture the cluster of symptoms presented. The nurse should validate the
client's feelings and initiate a psychosocial assessment per the Galen NSG3130 standards.
Q2: A nursing student is learning about defense mechanisms. The client says, 'I do not have a drinking problem. I
can stop any time I want.' The client continues to drink a six-pack of beer daily despite missing work and having
strained family relationships. Which defense mechanism is the client demonstrating?
A. Projection
B. Denial [CORRECT]
C. Rationalization
D. Displacement
Correct Answer: B
Rationale: Denial is the defense mechanism where the person refuses to acknowledge an unpleasant reality despite
overwhelming evidence. This client has clear signs of alcohol use disorder (daily heavy drinking, occupational impairment,
family strain) yet insists there is no problem. Projection involves attributing one's own unacceptable feelings to others.
Rationalization involves creating logical excuses to justify unacceptable behavior. Displacement involves transferring
feelings from one target to a safer one. The nurse should gently confront the denial by providing factual feedback and
expressing concern, following therapeutic communication principles taught in NSG3130.
Q3: During a mental status examination (MSE), the nurse observes that the client's speech is rapid, the client is
easily distractible, and the client's mood shifts quickly from euphoria to irritability. The client reports needing
only 3 hours of sleep per night and feels 'on top of the world.' Which condition do these findings most strongly
suggest?
A. Generalized anxiety disorder (GAD)
B. Major depressive disorder (MDD)
C. Bipolar I disorder, manic episode [CORRECT]
D. Schizophrenia
NSG3130 Exam 3 | Fundamental Concepts & Skills for Nursing Practice II | Galen College of Nursing Page 1
, Correct Answer: C
Rationale: The client presents classic signs of a manic episode associated with Bipolar I disorder: pressured speech,
distractibility, mood lability (rapid shifts from euphoria to irritability), decreased need for sleep, and grandiosity (feeling
'on top of the world'). These symptoms meet the DSM-5 criteria for a manic episode, which requires a distinct period of
abnormally elevated mood lasting at least one week. GAD would present with excessive worry and physical tension, not
euphoria. MDD presents with sadness and psychomotor retardation, not increased energy. Schizophrenia presents with
psychosis (hallucinations, delusions), not euphoric mood. Per Galen NSG3130 curriculum, the nurse should prioritize
safety and assess for risk-taking behaviors during a manic episode.
Q4: A nurse is conducting a psychosocial assessment on a newly admitted client. Which component of the mental
status examination (MSE) assesses the client's ability to understand the nature and purpose of the evaluation?
A. Mood
B. Affect
C. Insight [CORRECT]
D. Judgment
Correct Answer: C
Rationale: Insight refers to the client's awareness and understanding of their own mental health condition and the purpose of
the evaluation. A client with good insight recognizes they have a mental health issue and understands why treatment is
needed. Mood is the subjective emotional state reported by the client. Affect is the objective expression of emotion
observed by the nurse. Judgment is the client's ability to make sound decisions regarding safety and care. Per NSG3130
standards, a comprehensive MSE must include all components: appearance, behavior, speech, mood/affect, thought
process/content, cognition, and insight/judgment. Assessing insight helps the nurse determine the client's capacity to
participate in the care plan.
Q5: A nurse is caring for a client diagnosed with schizophrenia who states, 'The voices are telling me that the
nurses are trying to poison my food.' Which nursing intervention is the priority?
A. Explain to the client that the voices are not real
B. Administer a PRN antipsychotic medication immediately
C. Reassure the client that the food is safe to eat
D. Address the client's safety concerns and establish trust [CORRECT]
Correct Answer: D
Rationale: The priority nursing intervention is to address the client's safety concerns and establish trust. The client is
experiencing auditory hallucinations with paranoid content (believing nurses are poisoning food). Arguing or directly
contradicting the client's hallucinations ('the voices are not real') is nontherapeutic and erodes trust. Administering
medication may be appropriate but is not the first priority; establishing rapport and safety comes first. Simply reassuring
the client without acknowledging the fear is dismissive. The therapeutic approach per Galen NSG3130 standards is to
acknowledge the client's feelings without reinforcing the delusion: 'I can see that you are frightened. Let me show you how
your food is prepared to help you feel safer.' This validates the emotion while redirecting toward reality.
Q6: A client with obsessive-compulsive disorder (OCD) spends approximately 3 hours each day washing their
hands, often until the skin is raw and bleeding. The client states, 'I know it does not make sense, but I cannot stop.'
Which defense mechanism is primarily operating in OCD?
A. Undoing [CORRECT]
B. Reaction formation
C. Intellectualization
D. Suppression
Correct Answer: A
NSG3130 Exam 3 | Fundamental Concepts & Skills for Nursing Practice II | Galen College of Nursing Page 2
, Rationale: Undoing is the primary defense mechanism in OCD, where a person performs repetitive behaviors
(compulsions) to neutralize or 'undo' the anxiety caused by obsessive thoughts. The client's hand-washing compulsion is an
attempt to undo the perceived contamination, despite knowing logically that the behavior is excessive. Reaction formation
involves behaving in a way opposite to one's true feelings. Intellectualization involves using excessive reasoning to avoid
emotions. Suppression is a conscious decision to postpone dealing with unpleasant thoughts, which is considered an
adaptive defense mechanism. Per NSG3130 curriculum, OCD is classified under anxiety disorders and involves both
obsessions (intrusive unwanted thoughts) and compulsions (repetitive behaviors performed to reduce anxiety).
Q7: A nursing instructor is teaching students about personality disorders. Which cluster of personality disorders is
characterized by dramatic, emotional, and erratic behavior patterns?
A. Cluster A: Odd or eccentric
B. Cluster B: Dramatic, emotional, or erratic [CORRECT]
C. Cluster C: Anxious or fearful
D. Cluster D: Impulsive or compulsive
Correct Answer: B
Rationale: Personality disorders are organized into three clusters per DSM-5. Cluster B includes antisocial, borderline,
histrionic, and narcissistic personality disorders, all characterized by dramatic, emotional, and erratic behaviors. Cluster A
includes paranoid, schizoid, and schizotypal personality disorders (odd/eccentric). Cluster C includes avoidant, dependent,
and obsessive-compulsive personality disorders (anxious/fearful). There is no Cluster D in the DSM-5 classification. Per
Galen NSG3130 standards, understanding cluster patterns helps nurses anticipate behaviors and plan appropriate
therapeutic interventions, particularly for borderline personality disorder which involves fear of abandonment, unstable
relationships, and impulsivity.
Q8: A nurse is caring for a client with generalized anxiety disorder (GAD). Which of the following is an adaptive
coping strategy the nurse should teach the client?
A. Avoiding situations that trigger anxiety
B. Practicing progressive muscle relaxation [CORRECT]
C. Consuming alcohol to reduce tension before social events
D. Suppressing anxious thoughts by redirecting attention to work
Correct Answer: B
Rationale: Progressive muscle relaxation is an evidence-based adaptive coping strategy for managing anxiety. It involves
systematically tensing and releasing muscle groups to reduce physical tension associated with anxiety. Avoiding
anxiety-provoking situations is maladaptive because it reinforces anxiety and limits functioning. Using alcohol to reduce
tension is substance abuse and is contraindicated, especially in clients with anxiety disorders. Suppressing thoughts without
processing them is maladaptive and can worsen anxiety over time. Per NSG3130 curriculum, adaptive coping strategies
include problem-solving, social support, cognitive restructuring, relaxation techniques (deep breathing, progressive muscle
relaxation, guided imagery), and exercise. The nurse should teach and encourage these strategies as part of the care plan.
Q9: A client diagnosed with post-traumatic stress disorder (PTSD) reports recurring nightmares, hypervigilance,
and flashbacks after a traumatic experience. The nurse understands that PTSD belongs to which category of
psychiatric disorders in the DSM-5?
A. Anxiety disorders
B. Trauma- and stressor-related disorders [CORRECT]
C. Dissociative disorders
D. Somatic symptom disorders
Correct Answer: B
Rationale: In the DSM-5, PTSD was reclassified from anxiety disorders to a new category called 'trauma- and
stressor-related disorders.' This category also includes acute stress disorder, adjustment disorders, and reactive attachment
NSG3130 Exam 3 | Fundamental Concepts & Skills for Nursing Practice II | Galen College of Nursing Page 3
Practice II
Galen College of Nursing | 2026/2027 Curriculum | 100% Correct Questions & Answers
75 Questions | Aligned with QSEN Competencies & NCLEX-PN Standards
Section 1: Mental Health Nursing and Psychosocial Concepts (Q1-Q12)
Q1: A nurse is caring for a client who states, 'I have been feeling overwhelming sadness for the past 3 weeks. I
have no energy, I can barely get out of bed, and I have lost interest in all activities I used to enjoy.' Which nursing
diagnosis is most appropriate?
A. Ineffective coping related to situational crisis
B. Risk for self-harm related to hopelessness
C. Chronic sorrow related to unresolved loss
D. Social isolation related to withdrawal from activities [CORRECT]
Correct Answer: D
Rationale: The client presents classic symptoms of major depressive disorder (MDD): persistent sadness (greater than 2
weeks), anhedonia (loss of interest in activities), fatigue, and psychomotor retardation. Social isolation is the most
appropriate nursing diagnosis because the client has withdrawn from activities and relationships, which is a defining
characteristic of depression. While risk for self-harm should be assessed, the stem does not indicate suicidal ideation.
Ineffective coping and chronic sorrow do not capture the cluster of symptoms presented. The nurse should validate the
client's feelings and initiate a psychosocial assessment per the Galen NSG3130 standards.
Q2: A nursing student is learning about defense mechanisms. The client says, 'I do not have a drinking problem. I
can stop any time I want.' The client continues to drink a six-pack of beer daily despite missing work and having
strained family relationships. Which defense mechanism is the client demonstrating?
A. Projection
B. Denial [CORRECT]
C. Rationalization
D. Displacement
Correct Answer: B
Rationale: Denial is the defense mechanism where the person refuses to acknowledge an unpleasant reality despite
overwhelming evidence. This client has clear signs of alcohol use disorder (daily heavy drinking, occupational impairment,
family strain) yet insists there is no problem. Projection involves attributing one's own unacceptable feelings to others.
Rationalization involves creating logical excuses to justify unacceptable behavior. Displacement involves transferring
feelings from one target to a safer one. The nurse should gently confront the denial by providing factual feedback and
expressing concern, following therapeutic communication principles taught in NSG3130.
Q3: During a mental status examination (MSE), the nurse observes that the client's speech is rapid, the client is
easily distractible, and the client's mood shifts quickly from euphoria to irritability. The client reports needing
only 3 hours of sleep per night and feels 'on top of the world.' Which condition do these findings most strongly
suggest?
A. Generalized anxiety disorder (GAD)
B. Major depressive disorder (MDD)
C. Bipolar I disorder, manic episode [CORRECT]
D. Schizophrenia
NSG3130 Exam 3 | Fundamental Concepts & Skills for Nursing Practice II | Galen College of Nursing Page 1
, Correct Answer: C
Rationale: The client presents classic signs of a manic episode associated with Bipolar I disorder: pressured speech,
distractibility, mood lability (rapid shifts from euphoria to irritability), decreased need for sleep, and grandiosity (feeling
'on top of the world'). These symptoms meet the DSM-5 criteria for a manic episode, which requires a distinct period of
abnormally elevated mood lasting at least one week. GAD would present with excessive worry and physical tension, not
euphoria. MDD presents with sadness and psychomotor retardation, not increased energy. Schizophrenia presents with
psychosis (hallucinations, delusions), not euphoric mood. Per Galen NSG3130 curriculum, the nurse should prioritize
safety and assess for risk-taking behaviors during a manic episode.
Q4: A nurse is conducting a psychosocial assessment on a newly admitted client. Which component of the mental
status examination (MSE) assesses the client's ability to understand the nature and purpose of the evaluation?
A. Mood
B. Affect
C. Insight [CORRECT]
D. Judgment
Correct Answer: C
Rationale: Insight refers to the client's awareness and understanding of their own mental health condition and the purpose of
the evaluation. A client with good insight recognizes they have a mental health issue and understands why treatment is
needed. Mood is the subjective emotional state reported by the client. Affect is the objective expression of emotion
observed by the nurse. Judgment is the client's ability to make sound decisions regarding safety and care. Per NSG3130
standards, a comprehensive MSE must include all components: appearance, behavior, speech, mood/affect, thought
process/content, cognition, and insight/judgment. Assessing insight helps the nurse determine the client's capacity to
participate in the care plan.
Q5: A nurse is caring for a client diagnosed with schizophrenia who states, 'The voices are telling me that the
nurses are trying to poison my food.' Which nursing intervention is the priority?
A. Explain to the client that the voices are not real
B. Administer a PRN antipsychotic medication immediately
C. Reassure the client that the food is safe to eat
D. Address the client's safety concerns and establish trust [CORRECT]
Correct Answer: D
Rationale: The priority nursing intervention is to address the client's safety concerns and establish trust. The client is
experiencing auditory hallucinations with paranoid content (believing nurses are poisoning food). Arguing or directly
contradicting the client's hallucinations ('the voices are not real') is nontherapeutic and erodes trust. Administering
medication may be appropriate but is not the first priority; establishing rapport and safety comes first. Simply reassuring
the client without acknowledging the fear is dismissive. The therapeutic approach per Galen NSG3130 standards is to
acknowledge the client's feelings without reinforcing the delusion: 'I can see that you are frightened. Let me show you how
your food is prepared to help you feel safer.' This validates the emotion while redirecting toward reality.
Q6: A client with obsessive-compulsive disorder (OCD) spends approximately 3 hours each day washing their
hands, often until the skin is raw and bleeding. The client states, 'I know it does not make sense, but I cannot stop.'
Which defense mechanism is primarily operating in OCD?
A. Undoing [CORRECT]
B. Reaction formation
C. Intellectualization
D. Suppression
Correct Answer: A
NSG3130 Exam 3 | Fundamental Concepts & Skills for Nursing Practice II | Galen College of Nursing Page 2
, Rationale: Undoing is the primary defense mechanism in OCD, where a person performs repetitive behaviors
(compulsions) to neutralize or 'undo' the anxiety caused by obsessive thoughts. The client's hand-washing compulsion is an
attempt to undo the perceived contamination, despite knowing logically that the behavior is excessive. Reaction formation
involves behaving in a way opposite to one's true feelings. Intellectualization involves using excessive reasoning to avoid
emotions. Suppression is a conscious decision to postpone dealing with unpleasant thoughts, which is considered an
adaptive defense mechanism. Per NSG3130 curriculum, OCD is classified under anxiety disorders and involves both
obsessions (intrusive unwanted thoughts) and compulsions (repetitive behaviors performed to reduce anxiety).
Q7: A nursing instructor is teaching students about personality disorders. Which cluster of personality disorders is
characterized by dramatic, emotional, and erratic behavior patterns?
A. Cluster A: Odd or eccentric
B. Cluster B: Dramatic, emotional, or erratic [CORRECT]
C. Cluster C: Anxious or fearful
D. Cluster D: Impulsive or compulsive
Correct Answer: B
Rationale: Personality disorders are organized into three clusters per DSM-5. Cluster B includes antisocial, borderline,
histrionic, and narcissistic personality disorders, all characterized by dramatic, emotional, and erratic behaviors. Cluster A
includes paranoid, schizoid, and schizotypal personality disorders (odd/eccentric). Cluster C includes avoidant, dependent,
and obsessive-compulsive personality disorders (anxious/fearful). There is no Cluster D in the DSM-5 classification. Per
Galen NSG3130 standards, understanding cluster patterns helps nurses anticipate behaviors and plan appropriate
therapeutic interventions, particularly for borderline personality disorder which involves fear of abandonment, unstable
relationships, and impulsivity.
Q8: A nurse is caring for a client with generalized anxiety disorder (GAD). Which of the following is an adaptive
coping strategy the nurse should teach the client?
A. Avoiding situations that trigger anxiety
B. Practicing progressive muscle relaxation [CORRECT]
C. Consuming alcohol to reduce tension before social events
D. Suppressing anxious thoughts by redirecting attention to work
Correct Answer: B
Rationale: Progressive muscle relaxation is an evidence-based adaptive coping strategy for managing anxiety. It involves
systematically tensing and releasing muscle groups to reduce physical tension associated with anxiety. Avoiding
anxiety-provoking situations is maladaptive because it reinforces anxiety and limits functioning. Using alcohol to reduce
tension is substance abuse and is contraindicated, especially in clients with anxiety disorders. Suppressing thoughts without
processing them is maladaptive and can worsen anxiety over time. Per NSG3130 curriculum, adaptive coping strategies
include problem-solving, social support, cognitive restructuring, relaxation techniques (deep breathing, progressive muscle
relaxation, guided imagery), and exercise. The nurse should teach and encourage these strategies as part of the care plan.
Q9: A client diagnosed with post-traumatic stress disorder (PTSD) reports recurring nightmares, hypervigilance,
and flashbacks after a traumatic experience. The nurse understands that PTSD belongs to which category of
psychiatric disorders in the DSM-5?
A. Anxiety disorders
B. Trauma- and stressor-related disorders [CORRECT]
C. Dissociative disorders
D. Somatic symptom disorders
Correct Answer: B
Rationale: In the DSM-5, PTSD was reclassified from anxiety disorders to a new category called 'trauma- and
stressor-related disorders.' This category also includes acute stress disorder, adjustment disorders, and reactive attachment
NSG3130 Exam 3 | Fundamental Concepts & Skills for Nursing Practice II | Galen College of Nursing Page 3
