NUR 253 Exam 3 Actual Exam V2 | NUR 253 Mental Health Nursing
(NUR253 Exam 3) | Galen College of Nursing
1. A patient with generalized anxiety disorder (GAD) reports a constant sense of dread and
difficulty concentrating. Which physiological manifestation should the nurse prioritize during
the assessment?
A. Occasional muscle tension in the neck and shoulders
B. Occasional cold hands and feet during stress
C. Complaints of mild indigestion after meals
D. Increased heart rate and blood pressure readings
Answer: D
Rationale: Generalized anxiety disorder is characterized by persistent and excessive worry
that manifests physically through autonomic hyperactivity. Prioritizing vital signs like
heart rate and blood pressure is essential to assess the immediate physiological impact of
the anxiety state. This allows the nurse to determine if medical intervention is needed
before addressing psychological symptoms.
2. A client is admitted to the psychiatric unit with severe obsessive-compulsive disorder
(OCD). The nurse observes the client spending two hours washing their hands before meals.
What is the most appropriate initial nursing intervention?
A. Lock the bathroom door to prevent the client from washing their hands.
B. Inform the client that hand washing is unnecessary and illogical.
C. Limit the hand-washing time to 15 minutes immediately.
D. Allow the client to complete the ritual to decrease anxiety.
Answer: D
Rationale: In the initial phase of treatment for OCD, the nurse should allow the client to
perform rituals to prevent overwhelming anxiety. Forcing a sudden cessation of rituals can
lead to panic-level anxiety and a breakdown in the therapeutic relationship. The nurse
should eventually work with the client to gradually limit the time spent on rituals once
coping mechanisms are established.
3. A nurse is caring for a veteran diagnosed with Post-Traumatic Stress Disorder (PTSD) who
experiences frequent flashbacks. Which nursing action is most effective during an active
flashback?
A. Shaking the client to bring them back to reality.
B. Using a loud voice to command the client to stop.
,C. Reorienting the client to the present environment using a calm voice.
D. Leaving the client alone to let the flashback subside naturally.
Answer: C
Rationale: Reorienting the client to the ‘here and now’ is the primary intervention for a
client experiencing a flashback. The nurse should use a calm, non-threatening voice and
state where the client is and that they are safe. This grounding technique helps the client
distinguish the past trauma from the current reality and ensures safety.
4. A client diagnosed with Somatic Symptom Disorder continues to focus on physical
symptoms despite negative diagnostic tests. Which therapeutic approach should the nurse
utilize?
A. Acknowledge the physical complaint but shift the focus to feelings.
B. Explain the medical results in detail to prove nothing is wrong.
C. Ignore the client’s physical complaints entirely.
D. Refer the client to a different specialist for further testing.
Answer: A
Rationale: Somatic symptom disorder involves physical symptoms that are real to the
client but lack a clear medical cause. The nurse should acknowledge that the client is
experiencing discomfort while gently redirecting the conversation toward psychological
stressors or emotions. This shift helps the client develop a connection between their
emotional state and their physical sensations.
5. A nurse is assessing a client for illness anxiety disorder. Which behavior is most
characteristic of this condition?
A. Constant preoccupation with having a serious, undiagnosed disease.
B. Loss of sensory or motor function following a stressful event.
C. Purposely inducing symptoms to gain attention.
D. Multiple surgical procedures for vague abdominal pain.
Answer: A
Rationale: Illness anxiety disorder, formerly known as hypochondriasis, is characterized
by a persistent fear or belief that one has a serious illness despite medical reassurance.
These individuals often misinterpret normal bodily functions as signs of severe disease.
Unlike conversion disorder, there is no actual loss of physical function.
, 6. A client is brought to the emergency department with sudden, bilateral blindness after
witnessing a violent crime. Diagnostic tests show no neurological deficit. Which condition
does the nurse suspect?
A. Factitious Disorder
B. Conversion Disorder
C. Malingering
D. Dissociative Fugue
Answer: B
Rationale: Conversion disorder involves the sudden onset of neurological symptoms, such
as blindness or paralysis, without a biological cause, often following a stressful event. The
symptoms are involuntary and are a psychological defense mechanism. The classic sign ‘la
belle indifference’ (a lack of concern about the symptom) may also be present.
7. A client with Dissociative Identity Disorder (DID) switches to a child-like personality during
a therapy session. What is the nurse’s priority when interacting with the new personality?
A. Address the personality by its name and maintain safety.
B. Challenge the personality to prove it is not real.
C. Ask to speak with the primary host personality immediately.
D. Administer an anti-anxiety medication to stop the switch.
Answer: A
Rationale: When a client with DID switches personalities (alters), the nurse should accept
the alter and interact with it in a non-judgmental way. The primary goal is to maintain a
safe environment and build trust with all parts of the client’s system. Forcing a switch back
to the host can be traumatic and counterproductive to the long-term goal of integration.
8. A nurse is caring for a client with Borderline Personality Disorder who is ‘splitting’ staff
members. How should the nurse manager respond?
A. Assign only one nurse to care for the client for the entire week.
B. Allow the client to choose their favorite nurse for all shifts.
C. Hold a staff meeting to ensure consistent communication and boundaries.
D. Ignore the behavior as it is a normal part of the illness.
Answer: C
Rationale: Splitting is a defense mechanism where the client views people as all good or all
bad, which can cause conflict among staff. Consistent communication and a unified
approach are essential to prevent staff splitting and to provide the client with clear
(NUR253 Exam 3) | Galen College of Nursing
1. A patient with generalized anxiety disorder (GAD) reports a constant sense of dread and
difficulty concentrating. Which physiological manifestation should the nurse prioritize during
the assessment?
A. Occasional muscle tension in the neck and shoulders
B. Occasional cold hands and feet during stress
C. Complaints of mild indigestion after meals
D. Increased heart rate and blood pressure readings
Answer: D
Rationale: Generalized anxiety disorder is characterized by persistent and excessive worry
that manifests physically through autonomic hyperactivity. Prioritizing vital signs like
heart rate and blood pressure is essential to assess the immediate physiological impact of
the anxiety state. This allows the nurse to determine if medical intervention is needed
before addressing psychological symptoms.
2. A client is admitted to the psychiatric unit with severe obsessive-compulsive disorder
(OCD). The nurse observes the client spending two hours washing their hands before meals.
What is the most appropriate initial nursing intervention?
A. Lock the bathroom door to prevent the client from washing their hands.
B. Inform the client that hand washing is unnecessary and illogical.
C. Limit the hand-washing time to 15 minutes immediately.
D. Allow the client to complete the ritual to decrease anxiety.
Answer: D
Rationale: In the initial phase of treatment for OCD, the nurse should allow the client to
perform rituals to prevent overwhelming anxiety. Forcing a sudden cessation of rituals can
lead to panic-level anxiety and a breakdown in the therapeutic relationship. The nurse
should eventually work with the client to gradually limit the time spent on rituals once
coping mechanisms are established.
3. A nurse is caring for a veteran diagnosed with Post-Traumatic Stress Disorder (PTSD) who
experiences frequent flashbacks. Which nursing action is most effective during an active
flashback?
A. Shaking the client to bring them back to reality.
B. Using a loud voice to command the client to stop.
,C. Reorienting the client to the present environment using a calm voice.
D. Leaving the client alone to let the flashback subside naturally.
Answer: C
Rationale: Reorienting the client to the ‘here and now’ is the primary intervention for a
client experiencing a flashback. The nurse should use a calm, non-threatening voice and
state where the client is and that they are safe. This grounding technique helps the client
distinguish the past trauma from the current reality and ensures safety.
4. A client diagnosed with Somatic Symptom Disorder continues to focus on physical
symptoms despite negative diagnostic tests. Which therapeutic approach should the nurse
utilize?
A. Acknowledge the physical complaint but shift the focus to feelings.
B. Explain the medical results in detail to prove nothing is wrong.
C. Ignore the client’s physical complaints entirely.
D. Refer the client to a different specialist for further testing.
Answer: A
Rationale: Somatic symptom disorder involves physical symptoms that are real to the
client but lack a clear medical cause. The nurse should acknowledge that the client is
experiencing discomfort while gently redirecting the conversation toward psychological
stressors or emotions. This shift helps the client develop a connection between their
emotional state and their physical sensations.
5. A nurse is assessing a client for illness anxiety disorder. Which behavior is most
characteristic of this condition?
A. Constant preoccupation with having a serious, undiagnosed disease.
B. Loss of sensory or motor function following a stressful event.
C. Purposely inducing symptoms to gain attention.
D. Multiple surgical procedures for vague abdominal pain.
Answer: A
Rationale: Illness anxiety disorder, formerly known as hypochondriasis, is characterized
by a persistent fear or belief that one has a serious illness despite medical reassurance.
These individuals often misinterpret normal bodily functions as signs of severe disease.
Unlike conversion disorder, there is no actual loss of physical function.
, 6. A client is brought to the emergency department with sudden, bilateral blindness after
witnessing a violent crime. Diagnostic tests show no neurological deficit. Which condition
does the nurse suspect?
A. Factitious Disorder
B. Conversion Disorder
C. Malingering
D. Dissociative Fugue
Answer: B
Rationale: Conversion disorder involves the sudden onset of neurological symptoms, such
as blindness or paralysis, without a biological cause, often following a stressful event. The
symptoms are involuntary and are a psychological defense mechanism. The classic sign ‘la
belle indifference’ (a lack of concern about the symptom) may also be present.
7. A client with Dissociative Identity Disorder (DID) switches to a child-like personality during
a therapy session. What is the nurse’s priority when interacting with the new personality?
A. Address the personality by its name and maintain safety.
B. Challenge the personality to prove it is not real.
C. Ask to speak with the primary host personality immediately.
D. Administer an anti-anxiety medication to stop the switch.
Answer: A
Rationale: When a client with DID switches personalities (alters), the nurse should accept
the alter and interact with it in a non-judgmental way. The primary goal is to maintain a
safe environment and build trust with all parts of the client’s system. Forcing a switch back
to the host can be traumatic and counterproductive to the long-term goal of integration.
8. A nurse is caring for a client with Borderline Personality Disorder who is ‘splitting’ staff
members. How should the nurse manager respond?
A. Assign only one nurse to care for the client for the entire week.
B. Allow the client to choose their favorite nurse for all shifts.
C. Hold a staff meeting to ensure consistent communication and boundaries.
D. Ignore the behavior as it is a normal part of the illness.
Answer: C
Rationale: Splitting is a defense mechanism where the client views people as all good or all
bad, which can cause conflict among staff. Consistent communication and a unified
approach are essential to prevent staff splitting and to provide the client with clear
