NUR 253 Exam 1 Actual Exam V3 | NUR 253 Mental Health Nursing
(NUR253 Exam 1) | Galen College of Nursing
1. A patient is admitted voluntarily to the psychiatric unit for treatment of severe depression.
After three days, the patient states, ‘I am tired of being here. I want to leave right now.’ What
is the most appropriate initial nursing action?
A. Inform the patient that they cannot leave because they are a danger to themselves.
B. Notify the family that the patient is choosing to terminate treatment against medical
advice.
C. Immediately call security to prevent the patient from exiting the facility.
D. Explain that the patient must sign a formal request for discharge to allow for evaluation.
Answer: D
Rationale: This exam version is designed to assess the student’s ability to navigate the
legal and ethical complexities of psychiatric nursing. For voluntary patients, the ‘right to
leave’ is subject to a formal review process (usually 72 hours) to ensure the patient is not
an immediate danger to self or others. The nurse must facilitate the legal process of a
written request for release to allow the psychiatrist time to evaluate the need for a status
change to involuntary.
2. During the orientation phase of the nurse-patient relationship, which of the following tasks
is the priority for the nurse to accomplish?
A. Encouraging the patient to describe traumatic experiences in detail.
B. Promoting the patient’s problem-solving skills and self-esteem.
C. Evaluating progress toward the achievement of established goals.
D. Establishing the parameters of the relationship and a contract for meetings.
Answer: D
Rationale: The orientation phase is focused on building trust, defining boundaries, and
establishing a contract. Problem-solving belongs in the working phase, and evaluation
belongs in the termination phase. Discussing trauma too early can overwhelm the patient
before a therapeutic alliance is formed.
3. A patient diagnosed with schizophrenia says, ‘The government is using the television to
monitor my thoughts and control my actions.’ How should the nurse document this finding in
the Mental Status Examination?
A. The patient is experiencing auditory hallucinations.
B. The patient is demonstrating ideas of reference.
,C. The patient is exhibiting delusions of control and persecution.
D. The patient is experiencing a flight of ideas.
Answer: C
Rationale: A delusion is a fixed false belief. The belief that one’s thoughts are being
monitored or controlled by an external force (the government via TV) characterizes
delusions of control and persecution. Hallucinations involve sensory perceptions without
stimuli, which is not described here.
4. A nurse is caring for a patient who was recently prescribed a Selective Serotonin Reuptake
Inhibitor (SSRI). Which patient statement would indicate a need for immediate intervention
regarding Serotonin Syndrome?
A. ‘I am feeling very sleepy and have a dry mouth.’
B. ‘I feel feverish, my heart is racing, and my muscles feel very stiff.’
C. ‘I have developed a fine tremor in my hands when I drink coffee.’
D. ‘I have lost my appetite and feel slightly nauseated in the morning.’
Answer: B
Rationale: Serotonin Syndrome is a medical emergency characterized by mental status
changes, autonomic hyperactivity (tachycardia, hyperthermia), and neuromuscular
abnormalities (rigidity, tremors). Sleepiness and dry mouth are common side effects, not
emergencies.
5. The nurse is practicing within a psychiatric-mental health facility that follows Peplau’s
Theory of Interpersonal Relations. What is the primary goal of the nurse’s role as a ‘resource
person’?
A. To provide the patient with a surrogate parent figure for emotional support.
B. To act as a legal advocate during commitment hearings.
C. To explain the patient’s treatment plan in a way they can understand.
D. To perform all activities of daily living that the patient cannot do.
Answer: C
Rationale: According to Hildegard Peplau, the resource person role involves providing
specific information and helping the patient understand the situation. This empowers the
patient within the therapeutic relationship.
6. A patient is admitted with a diagnosis of Bipolar I Disorder, manic episode. Which
environmental intervention is a priority for the nurse to implement?
A. Placing the patient in a room with a roommate who is calm and quiet.
, B. Providing a high-stimulation environment to distract the patient.
C. Ensuring the patient participates in all group activities to burn off energy.
D. Reducing environmental stimuli by providing a private room and low lighting.
Answer: D
Rationale: Patients in a manic state are easily overstimulated. Reducing noise, light, and
social interaction helps to decrease agitation and promote safety. Group activities are often
too stimulating and may lead to conflict.
7. Which legal principle is being applied when a nurse provides a patient with the least
restrictive environment possible?
A. Justice
B. Veracity
C. Autonomy
D. Beneficence
Answer: D
Rationale: Beneficence is the duty to act to benefit others. In mental health, this includes
providing care in the least restrictive environment, ensuring that the patient’s freedom is
not unnecessarily curtailed while ensuring their safety.
8. A nurse is conducting a suicide risk assessment. Which finding represents the highest
immediate risk for a completed suicide?
A. The patient expresses feelings of hopelessness and worthlessness.
B. The patient has a history of a single suicide attempt five years ago.
C. The patient has a specific plan and access to a lethal weapon (e.g., a gun).
D. The patient lacks a strong social support system at home.
Answer: C
Rationale: While all options are risk factors, the presence of a specific, lethal plan and the
immediate means to carry it out (lethality) represents the highest and most urgent risk for
suicide completion.
9. A patient states, ‘I don’t think my husband likes it when I’m here. He thinks I’m just lazy.’
The nurse responds, ‘You feel that your husband is critical of your need for treatment?’
Which therapeutic technique is the nurse using?
A. Restating
B. Focusing
(NUR253 Exam 1) | Galen College of Nursing
1. A patient is admitted voluntarily to the psychiatric unit for treatment of severe depression.
After three days, the patient states, ‘I am tired of being here. I want to leave right now.’ What
is the most appropriate initial nursing action?
A. Inform the patient that they cannot leave because they are a danger to themselves.
B. Notify the family that the patient is choosing to terminate treatment against medical
advice.
C. Immediately call security to prevent the patient from exiting the facility.
D. Explain that the patient must sign a formal request for discharge to allow for evaluation.
Answer: D
Rationale: This exam version is designed to assess the student’s ability to navigate the
legal and ethical complexities of psychiatric nursing. For voluntary patients, the ‘right to
leave’ is subject to a formal review process (usually 72 hours) to ensure the patient is not
an immediate danger to self or others. The nurse must facilitate the legal process of a
written request for release to allow the psychiatrist time to evaluate the need for a status
change to involuntary.
2. During the orientation phase of the nurse-patient relationship, which of the following tasks
is the priority for the nurse to accomplish?
A. Encouraging the patient to describe traumatic experiences in detail.
B. Promoting the patient’s problem-solving skills and self-esteem.
C. Evaluating progress toward the achievement of established goals.
D. Establishing the parameters of the relationship and a contract for meetings.
Answer: D
Rationale: The orientation phase is focused on building trust, defining boundaries, and
establishing a contract. Problem-solving belongs in the working phase, and evaluation
belongs in the termination phase. Discussing trauma too early can overwhelm the patient
before a therapeutic alliance is formed.
3. A patient diagnosed with schizophrenia says, ‘The government is using the television to
monitor my thoughts and control my actions.’ How should the nurse document this finding in
the Mental Status Examination?
A. The patient is experiencing auditory hallucinations.
B. The patient is demonstrating ideas of reference.
,C. The patient is exhibiting delusions of control and persecution.
D. The patient is experiencing a flight of ideas.
Answer: C
Rationale: A delusion is a fixed false belief. The belief that one’s thoughts are being
monitored or controlled by an external force (the government via TV) characterizes
delusions of control and persecution. Hallucinations involve sensory perceptions without
stimuli, which is not described here.
4. A nurse is caring for a patient who was recently prescribed a Selective Serotonin Reuptake
Inhibitor (SSRI). Which patient statement would indicate a need for immediate intervention
regarding Serotonin Syndrome?
A. ‘I am feeling very sleepy and have a dry mouth.’
B. ‘I feel feverish, my heart is racing, and my muscles feel very stiff.’
C. ‘I have developed a fine tremor in my hands when I drink coffee.’
D. ‘I have lost my appetite and feel slightly nauseated in the morning.’
Answer: B
Rationale: Serotonin Syndrome is a medical emergency characterized by mental status
changes, autonomic hyperactivity (tachycardia, hyperthermia), and neuromuscular
abnormalities (rigidity, tremors). Sleepiness and dry mouth are common side effects, not
emergencies.
5. The nurse is practicing within a psychiatric-mental health facility that follows Peplau’s
Theory of Interpersonal Relations. What is the primary goal of the nurse’s role as a ‘resource
person’?
A. To provide the patient with a surrogate parent figure for emotional support.
B. To act as a legal advocate during commitment hearings.
C. To explain the patient’s treatment plan in a way they can understand.
D. To perform all activities of daily living that the patient cannot do.
Answer: C
Rationale: According to Hildegard Peplau, the resource person role involves providing
specific information and helping the patient understand the situation. This empowers the
patient within the therapeutic relationship.
6. A patient is admitted with a diagnosis of Bipolar I Disorder, manic episode. Which
environmental intervention is a priority for the nurse to implement?
A. Placing the patient in a room with a roommate who is calm and quiet.
, B. Providing a high-stimulation environment to distract the patient.
C. Ensuring the patient participates in all group activities to burn off energy.
D. Reducing environmental stimuli by providing a private room and low lighting.
Answer: D
Rationale: Patients in a manic state are easily overstimulated. Reducing noise, light, and
social interaction helps to decrease agitation and promote safety. Group activities are often
too stimulating and may lead to conflict.
7. Which legal principle is being applied when a nurse provides a patient with the least
restrictive environment possible?
A. Justice
B. Veracity
C. Autonomy
D. Beneficence
Answer: D
Rationale: Beneficence is the duty to act to benefit others. In mental health, this includes
providing care in the least restrictive environment, ensuring that the patient’s freedom is
not unnecessarily curtailed while ensuring their safety.
8. A nurse is conducting a suicide risk assessment. Which finding represents the highest
immediate risk for a completed suicide?
A. The patient expresses feelings of hopelessness and worthlessness.
B. The patient has a history of a single suicide attempt five years ago.
C. The patient has a specific plan and access to a lethal weapon (e.g., a gun).
D. The patient lacks a strong social support system at home.
Answer: C
Rationale: While all options are risk factors, the presence of a specific, lethal plan and the
immediate means to carry it out (lethality) represents the highest and most urgent risk for
suicide completion.
9. A patient states, ‘I don’t think my husband likes it when I’m here. He thinks I’m just lazy.’
The nurse responds, ‘You feel that your husband is critical of your need for treatment?’
Which therapeutic technique is the nurse using?
A. Restating
B. Focusing
