,NUR 256 Final Exam | Concepts of Mental Health Nursing
(2026) Q&A | Galen College
1. A client is admitted to the psychiatric unit with a diagnosis of paranoid
schizophrenia. The client states, "You are trying to poison me." The family asks if the
nurse can force the client to take medications. Which response is most appropriate?
A) "We cannot force medications unless specific legal criteria are met."
B) "Yes, since he is court - committed, we can administer medications against his
will."
C) "We will wait until he calms down and then ask him again."
D) "The family can make this decision since he is unable to."
Correct Answer: "We cannot force medications unless specific legal criteria are
met."
Rationale: For involuntary medication administration, specific legal criteria must be
met: serious mental illness, deteriorating ability to function, benefits of treatment
outweigh harm, and all less restrictive services have been found unhelpful. Court
commitment a lone does not automatically authorize forced medications. This
upholds the client's right to autonomy while ensuring safety.
2. Which historical figure is considered the founder of modern psychiatric nursing in
the United States?
A) Dorothea Dix
B) Hildegard Peplau
C) Florence Nightingale
D) Mildred Loomis
Correct Answer: Hildegard Peplau
Rationale: Hildegard Peplau developed the Theory of Interpersonal Relations in 1952,
which became the foundation for psychiatric nursing practice. Dorothea Dix
advocated for humane treatment but was not a nurse. Nightingale established
,modern nursing but not specifically psychiatric nursing. Peplau's work transformed
the nurse - client relationship.
3. A nurse is assessing a client for delirium. Which clinical characteristic most
clearly distinguishes delirium from dementia?
A) The client experiences a progressive decline in cognitive function.
B) The symptoms develop rapidly over a short period of time.
C) The client exhibits frequent periods of confabulation.
D) The client has difficulty recognizing familiar objects (agnosia).
Correct Answer: The symptoms develop rapidly over a short period of time.
Rationale: Delirium is characterized by a rapid onset of symptoms (hours to days),
whereas dementia involves a slow, progressive decline in cognitive function over
months or years. Confabulation and agnosia can occur in both conditions. Early
identification of delir ium is critical because it is often reversible with treatment of
the underlying cause.
4. A client with a long history of chronic alcohol use disorder is admitted. The nurse
notes ataxia, confusion, and nystagmus. Which deficiency does the nurse suspect?
A) Vitamin B12 (Cobalamin)
B) Vitamin B1 (Thiamine)
C) Vitamin B6 (Pyridoxine)
D) Vitamin C (Ascorbic Acid)
Correct Answer: Vitamin B1 (Thiamine)
Rationale: Wernicke - Korsakoff syndrome is caused by a deficiency in thiamine
(Vitamin B1), common in chronic alcoholism, and presents with the triad of
confusion, ataxia, and ocular abnormalities (nystagmus). Prompt administration of
IV thiamine is essential to prev ent permanent neurological damage. Other vitamin
deficiencies do not produce this classic triad.
, 5. A client diagnosed with anorexia nervosa has a BMI of 15 and is being admitted
for stabilization. What is the priority nursing intervention during the first week of
refeeding?
A) Assessing for lanugo and cold intolerance.
B) Encouraging the client to engage in aerobic exercise.
C) Monitoring serum phosphorus, potassium, and magnesium levels.
D) Implementing a strict 2,500 calorie per day diet immediately.
Correct Answer: Monitoring serum phosphorus, potassium, and magnesium levels.
Rationale: Refeeding syndrome is a potentially fatal shift in fluids and electrolytes
(especially phosphorus) that occurs in malnourished patients. Monitoring these
levels is the priority safety intervention during the first week of refeeding.
Immediate high - calorie diets and exercise are contraindicated in the initial
stabilization phase.
6. A nurse is caring for a client with borderline personality disorder. The client tells
the nurse, "You are the only one who cares, the night nurse is incompetent and
cruel." This is an example of:
A) Projection
B) Splitting
C) Rationalization
D) Reaction Formation
Correct Answer: Splitting
Rationale: Splitting is a common defense mechanism in borderline personality
disorder where individuals view people or situations as either "all good" or "all bad,"
unable to integrate positive and negative qualities. The client idealizes one nurse
while devaluing a nother. Consistent limit - setting and avoiding participation in the
split are essential nursing interventions.
7. A patient refuses a recommended treatment despite the nurse's concerns about
potential consequences. Which ethical principle supports honoring the patient's
choice?
(2026) Q&A | Galen College
1. A client is admitted to the psychiatric unit with a diagnosis of paranoid
schizophrenia. The client states, "You are trying to poison me." The family asks if the
nurse can force the client to take medications. Which response is most appropriate?
A) "We cannot force medications unless specific legal criteria are met."
B) "Yes, since he is court - committed, we can administer medications against his
will."
C) "We will wait until he calms down and then ask him again."
D) "The family can make this decision since he is unable to."
Correct Answer: "We cannot force medications unless specific legal criteria are
met."
Rationale: For involuntary medication administration, specific legal criteria must be
met: serious mental illness, deteriorating ability to function, benefits of treatment
outweigh harm, and all less restrictive services have been found unhelpful. Court
commitment a lone does not automatically authorize forced medications. This
upholds the client's right to autonomy while ensuring safety.
2. Which historical figure is considered the founder of modern psychiatric nursing in
the United States?
A) Dorothea Dix
B) Hildegard Peplau
C) Florence Nightingale
D) Mildred Loomis
Correct Answer: Hildegard Peplau
Rationale: Hildegard Peplau developed the Theory of Interpersonal Relations in 1952,
which became the foundation for psychiatric nursing practice. Dorothea Dix
advocated for humane treatment but was not a nurse. Nightingale established
,modern nursing but not specifically psychiatric nursing. Peplau's work transformed
the nurse - client relationship.
3. A nurse is assessing a client for delirium. Which clinical characteristic most
clearly distinguishes delirium from dementia?
A) The client experiences a progressive decline in cognitive function.
B) The symptoms develop rapidly over a short period of time.
C) The client exhibits frequent periods of confabulation.
D) The client has difficulty recognizing familiar objects (agnosia).
Correct Answer: The symptoms develop rapidly over a short period of time.
Rationale: Delirium is characterized by a rapid onset of symptoms (hours to days),
whereas dementia involves a slow, progressive decline in cognitive function over
months or years. Confabulation and agnosia can occur in both conditions. Early
identification of delir ium is critical because it is often reversible with treatment of
the underlying cause.
4. A client with a long history of chronic alcohol use disorder is admitted. The nurse
notes ataxia, confusion, and nystagmus. Which deficiency does the nurse suspect?
A) Vitamin B12 (Cobalamin)
B) Vitamin B1 (Thiamine)
C) Vitamin B6 (Pyridoxine)
D) Vitamin C (Ascorbic Acid)
Correct Answer: Vitamin B1 (Thiamine)
Rationale: Wernicke - Korsakoff syndrome is caused by a deficiency in thiamine
(Vitamin B1), common in chronic alcoholism, and presents with the triad of
confusion, ataxia, and ocular abnormalities (nystagmus). Prompt administration of
IV thiamine is essential to prev ent permanent neurological damage. Other vitamin
deficiencies do not produce this classic triad.
, 5. A client diagnosed with anorexia nervosa has a BMI of 15 and is being admitted
for stabilization. What is the priority nursing intervention during the first week of
refeeding?
A) Assessing for lanugo and cold intolerance.
B) Encouraging the client to engage in aerobic exercise.
C) Monitoring serum phosphorus, potassium, and magnesium levels.
D) Implementing a strict 2,500 calorie per day diet immediately.
Correct Answer: Monitoring serum phosphorus, potassium, and magnesium levels.
Rationale: Refeeding syndrome is a potentially fatal shift in fluids and electrolytes
(especially phosphorus) that occurs in malnourished patients. Monitoring these
levels is the priority safety intervention during the first week of refeeding.
Immediate high - calorie diets and exercise are contraindicated in the initial
stabilization phase.
6. A nurse is caring for a client with borderline personality disorder. The client tells
the nurse, "You are the only one who cares, the night nurse is incompetent and
cruel." This is an example of:
A) Projection
B) Splitting
C) Rationalization
D) Reaction Formation
Correct Answer: Splitting
Rationale: Splitting is a common defense mechanism in borderline personality
disorder where individuals view people or situations as either "all good" or "all bad,"
unable to integrate positive and negative qualities. The client idealizes one nurse
while devaluing a nother. Consistent limit - setting and avoiding participation in the
split are essential nursing interventions.
7. A patient refuses a recommended treatment despite the nurse's concerns about
potential consequences. Which ethical principle supports honoring the patient's
choice?
