NUR 168 Exam 1 | Galen College of Nursing | Independent Study Resource
NUR 168
Exam 1 Study Guide + Practice
Questions
Integrated Concepts of Registered Nursing Practice
Standards of Care • Mental-Health Nursing • Therapeutic Communication
Mental-Health Concepts & Conditions • Clinical Judgment
2026/2027 Updated Study Resource
Aligned to the current 2026 Galen catalog course description and the publicly available NUR 168
Exam 1 blueprint framework.
Original educational content. Not an official Galen exam, answer key, or guarantee of a passing score.
Page 1
, NUR 168 Exam 1 | Galen College of Nursing | Independent Study Resource
How This Guide Is Aligned
The 2026 Galen College of Nursing catalog describes NUR 168 as an 8-quarter-credit LPN-to-RN transition course
guided by professional standards, guidelines, and competencies, with content that includes patients
experiencing mental-health problems. A publicly available NUR 168 syllabus blueprint identifies Exam 1 as a 50-
question assessment distributed across three areas: Unit 1 standards of care/introduction to mental-health
nursing, Unit 2 mental-health concepts and conditions, and Unit 3 mental-health conditions. This guide
organizes review around those domains without reproducing proprietary test questions.
Exam 1 Domain Blueprint Weight Guide Emphasis
Unit 1: Standards of care + 16-18 of 50 Safety, nursing process,
introduction to mental-health documentation, communication,
nursing legal/ethical foundations,
psychotropic medication principles
Unit 2: Mental-health concepts and 16-18 of 50 Defense mechanisms, anxiety,
conditions trauma/PTSD, OCD, crisis, mood
disorders, suicide risk
Unit 3: Mental-health conditions 16-18 of 50 Recognition, nursing priorities,
safety, communication, medication
monitoring, clinical judgment
Study strategy: spend roughly one-third of review time on each domain, then complete the 75-question original practice set under
timed conditions.
Learning Outcomes for Exam 1 Review
Apply the nursing process and standards of care to psychiatric-mental-health scenarios.
Differentiate therapeutic from nontherapeutic communication and select the safest nurse response.
Recognize legal and ethical responsibilities involving privacy, consent, least-restrictive care, and patient
rights.
Identify common anxiety, trauma, obsessive-compulsive, mood, psychotic, substance-related, and
personality-pattern presentations.
Prioritize suicide precautions, de-escalation, medication monitoring, and interprofessional escalation.
Use clinical judgment to distinguish expected findings from urgent safety threats.
Page 2
, NUR 168 Exam 1 | Galen College of Nursing | Independent Study Resource
UNIT 1 - Standards of Care & Foundations of Mental-Health Nursing
1. Nursing Process in Mental-Health Care
Assessment: Begin with safety: suicidal or homicidal thoughts, command hallucinations, escalating agitation,
intoxication/withdrawal, medical instability. Assess appearance, behavior, speech, mood/affect, thought
process/content, perception, cognition, insight, judgment, sleep, nutrition, medications, substance use, supports,
and functional status.
Diagnosis: Use nursing diagnoses that describe human responses rather than medical labels. Examples include
Risk for Suicide, Anxiety, Disturbed Thought Processes, Ineffective Coping, Social Isolation, and Sleep Pattern
Disturbance.
Planning: Write measurable, patient-centered goals. Safety goals come first. Example: “Patient will remain free
from self-harm during the shift and will identify two staff members to contact if suicidal urges increase.”
Implementation: Use therapeutic communication, environmental modification, medication
administration/monitoring, structured activities, patient education, coping-skills coaching, and collaboration.
Evaluation: Compare outcomes with goals. If risk increases or goals are not met, reassess and revise the plan
immediately.
2. Care Plans & Clinical Judgment
Prioritize: Airway/breathing/circulation and acute medical instability remain priorities even in psychiatric
settings. Next address immediate violence/suicide risk, severe withdrawal, inability to meet basic physiologic
needs, then psychosocial concerns.
Cue clustering: Do not react to a single cue in isolation. Combine behavior, statements, vital signs, medication
changes, history, and environment.
Least restrictive principle: Use the least restrictive intervention that can safely meet the patient’s needs.
Verbal de-escalation and environmental changes precede seclusion/restraint when clinically appropriate.
Reassessment: After any intervention—especially PRN medication, suicide precautions, seclusion/restraint, or a
change in observation level—document and reassess response.
3. HIPAA, Privacy & Confidentiality
Minimum necessary: Access and disclose only information needed to perform the care role. Avoid discussing
patients in public spaces or with uninvolved persons.
Exceptions: Confidentiality may be limited by legal requirements involving imminent safety threats, suspected
abuse/neglect, court orders, or mandatory reporting. Follow policy and jurisdictional law.
Family communication: Family members do not automatically receive clinical information. Verify
authorization and capacity, while still listening to information the family offers.
Digital safety: Never photograph records/screens or post patient information on social media. De-identification
must be genuine; unusual details can still reveal identity.
4. Evidence-Based Practice & Quality
Evidence hierarchy: Use current high-quality evidence, clinical expertise, and patient values/preferences
together. Policies should reflect authoritative standards and local regulation.
Page 3
, NUR 168 Exam 1 | Galen College of Nursing | Independent Study Resource
Safety culture: Report medication errors, near misses, falls, elopement risks, assaults, and hazards according to
policy. Incident reports support quality improvement and are not substitutes for chart documentation.
Patient-centered care: Respect culture, identity, literacy, preferences, trauma history, and recovery goals.
Avoid coercive or stigmatizing language.
5. Documentation & ISBAR
Objective charting: Describe observable behavior rather than labels. Write “paced hallway for 20 minutes and
shouted ‘leave me alone’” rather than “patient was crazy/aggressive.”
Quotes: Use direct quotes for clinically important patient statements, especially threats, suicidal content,
hallucination descriptions, or refusal reasons.
Timeliness: Chart promptly, accurately, and chronologically. Never alter a record deceptively. Correct errors
according to policy.
ISBAR: Identify, Situation, Background, Assessment, Recommendation. Use concise data and a clear request
when escalating concerns.
6. Infection Prevention in Behavioral Health
Standard precautions: Apply hand hygiene, PPE based on anticipated exposure, injection safety, respiratory
hygiene, and safe sharps practices.
Transmission-based precautions: Use contact, droplet, or airborne precautions when indicated by the
condition—not by psychiatric diagnosis.
Environment: Behavioral units must balance infection prevention with ligature, sharps, and self-harm safety.
Follow unit-specific equipment rules.
7. Mental Status Examination (MSE) - High-Yield Framework
Domain What to Assess Example Documentation
Appearance/behavior Grooming, eye contact, motor Disheveled; limited eye contact;
activity, cooperation restless but cooperative.
Speech Rate, volume, latency, fluency Rapid, loud, difficult to interrupt.
Mood/affect Patient-reported mood vs observed Mood “sad”; affect constricted and
emotional expression congruent.
Thought process Organization: linear, tangential, Thought process tangential with
circumstantial, flight of ideas frequent redirection needed.
Thought content Delusions, obsessions, Persecutory delusion; denies SI/HI.
suicidal/homicidal ideas
Perception Hallucinations/illusions Reports auditory hallucinations
commanding self-harm.
Cognition Orientation, attention, memory Alert; oriented x4; attention
impaired.
Page 4
NUR 168
Exam 1 Study Guide + Practice
Questions
Integrated Concepts of Registered Nursing Practice
Standards of Care • Mental-Health Nursing • Therapeutic Communication
Mental-Health Concepts & Conditions • Clinical Judgment
2026/2027 Updated Study Resource
Aligned to the current 2026 Galen catalog course description and the publicly available NUR 168
Exam 1 blueprint framework.
Original educational content. Not an official Galen exam, answer key, or guarantee of a passing score.
Page 1
, NUR 168 Exam 1 | Galen College of Nursing | Independent Study Resource
How This Guide Is Aligned
The 2026 Galen College of Nursing catalog describes NUR 168 as an 8-quarter-credit LPN-to-RN transition course
guided by professional standards, guidelines, and competencies, with content that includes patients
experiencing mental-health problems. A publicly available NUR 168 syllabus blueprint identifies Exam 1 as a 50-
question assessment distributed across three areas: Unit 1 standards of care/introduction to mental-health
nursing, Unit 2 mental-health concepts and conditions, and Unit 3 mental-health conditions. This guide
organizes review around those domains without reproducing proprietary test questions.
Exam 1 Domain Blueprint Weight Guide Emphasis
Unit 1: Standards of care + 16-18 of 50 Safety, nursing process,
introduction to mental-health documentation, communication,
nursing legal/ethical foundations,
psychotropic medication principles
Unit 2: Mental-health concepts and 16-18 of 50 Defense mechanisms, anxiety,
conditions trauma/PTSD, OCD, crisis, mood
disorders, suicide risk
Unit 3: Mental-health conditions 16-18 of 50 Recognition, nursing priorities,
safety, communication, medication
monitoring, clinical judgment
Study strategy: spend roughly one-third of review time on each domain, then complete the 75-question original practice set under
timed conditions.
Learning Outcomes for Exam 1 Review
Apply the nursing process and standards of care to psychiatric-mental-health scenarios.
Differentiate therapeutic from nontherapeutic communication and select the safest nurse response.
Recognize legal and ethical responsibilities involving privacy, consent, least-restrictive care, and patient
rights.
Identify common anxiety, trauma, obsessive-compulsive, mood, psychotic, substance-related, and
personality-pattern presentations.
Prioritize suicide precautions, de-escalation, medication monitoring, and interprofessional escalation.
Use clinical judgment to distinguish expected findings from urgent safety threats.
Page 2
, NUR 168 Exam 1 | Galen College of Nursing | Independent Study Resource
UNIT 1 - Standards of Care & Foundations of Mental-Health Nursing
1. Nursing Process in Mental-Health Care
Assessment: Begin with safety: suicidal or homicidal thoughts, command hallucinations, escalating agitation,
intoxication/withdrawal, medical instability. Assess appearance, behavior, speech, mood/affect, thought
process/content, perception, cognition, insight, judgment, sleep, nutrition, medications, substance use, supports,
and functional status.
Diagnosis: Use nursing diagnoses that describe human responses rather than medical labels. Examples include
Risk for Suicide, Anxiety, Disturbed Thought Processes, Ineffective Coping, Social Isolation, and Sleep Pattern
Disturbance.
Planning: Write measurable, patient-centered goals. Safety goals come first. Example: “Patient will remain free
from self-harm during the shift and will identify two staff members to contact if suicidal urges increase.”
Implementation: Use therapeutic communication, environmental modification, medication
administration/monitoring, structured activities, patient education, coping-skills coaching, and collaboration.
Evaluation: Compare outcomes with goals. If risk increases or goals are not met, reassess and revise the plan
immediately.
2. Care Plans & Clinical Judgment
Prioritize: Airway/breathing/circulation and acute medical instability remain priorities even in psychiatric
settings. Next address immediate violence/suicide risk, severe withdrawal, inability to meet basic physiologic
needs, then psychosocial concerns.
Cue clustering: Do not react to a single cue in isolation. Combine behavior, statements, vital signs, medication
changes, history, and environment.
Least restrictive principle: Use the least restrictive intervention that can safely meet the patient’s needs.
Verbal de-escalation and environmental changes precede seclusion/restraint when clinically appropriate.
Reassessment: After any intervention—especially PRN medication, suicide precautions, seclusion/restraint, or a
change in observation level—document and reassess response.
3. HIPAA, Privacy & Confidentiality
Minimum necessary: Access and disclose only information needed to perform the care role. Avoid discussing
patients in public spaces or with uninvolved persons.
Exceptions: Confidentiality may be limited by legal requirements involving imminent safety threats, suspected
abuse/neglect, court orders, or mandatory reporting. Follow policy and jurisdictional law.
Family communication: Family members do not automatically receive clinical information. Verify
authorization and capacity, while still listening to information the family offers.
Digital safety: Never photograph records/screens or post patient information on social media. De-identification
must be genuine; unusual details can still reveal identity.
4. Evidence-Based Practice & Quality
Evidence hierarchy: Use current high-quality evidence, clinical expertise, and patient values/preferences
together. Policies should reflect authoritative standards and local regulation.
Page 3
, NUR 168 Exam 1 | Galen College of Nursing | Independent Study Resource
Safety culture: Report medication errors, near misses, falls, elopement risks, assaults, and hazards according to
policy. Incident reports support quality improvement and are not substitutes for chart documentation.
Patient-centered care: Respect culture, identity, literacy, preferences, trauma history, and recovery goals.
Avoid coercive or stigmatizing language.
5. Documentation & ISBAR
Objective charting: Describe observable behavior rather than labels. Write “paced hallway for 20 minutes and
shouted ‘leave me alone’” rather than “patient was crazy/aggressive.”
Quotes: Use direct quotes for clinically important patient statements, especially threats, suicidal content,
hallucination descriptions, or refusal reasons.
Timeliness: Chart promptly, accurately, and chronologically. Never alter a record deceptively. Correct errors
according to policy.
ISBAR: Identify, Situation, Background, Assessment, Recommendation. Use concise data and a clear request
when escalating concerns.
6. Infection Prevention in Behavioral Health
Standard precautions: Apply hand hygiene, PPE based on anticipated exposure, injection safety, respiratory
hygiene, and safe sharps practices.
Transmission-based precautions: Use contact, droplet, or airborne precautions when indicated by the
condition—not by psychiatric diagnosis.
Environment: Behavioral units must balance infection prevention with ligature, sharps, and self-harm safety.
Follow unit-specific equipment rules.
7. Mental Status Examination (MSE) - High-Yield Framework
Domain What to Assess Example Documentation
Appearance/behavior Grooming, eye contact, motor Disheveled; limited eye contact;
activity, cooperation restless but cooperative.
Speech Rate, volume, latency, fluency Rapid, loud, difficult to interrupt.
Mood/affect Patient-reported mood vs observed Mood “sad”; affect constricted and
emotional expression congruent.
Thought process Organization: linear, tangential, Thought process tangential with
circumstantial, flight of ideas frequent redirection needed.
Thought content Delusions, obsessions, Persecutory delusion; denies SI/HI.
suicidal/homicidal ideas
Perception Hallucinations/illusions Reports auditory hallucinations
commanding self-harm.
Cognition Orientation, attention, memory Alert; oriented x4; attention
impaired.
Page 4
