Psychiatric-Mental Health Final Exam:
150 Advanced Multiple-Choice Questions
with Rationales for Nursing Students
Table of Contents
1. Therapeutic Communication & the Nurse-Patient Relationship (Questions 1–25)
2. Psychiatric Assessment, Legal & Ethical Issues (Questions 26–50)
3. Psychopharmacology & Neurobiology (Questions 51–75)
4. Anxiety, Mood, & Suicidal Client (Questions 76–100)
5. Schizophrenia Spectrum & Psychotic Disorders (Questions 101–115)
6. Personality, Substance Use, & Eating Disorders (Questions 116–135)
7. Crisis Intervention, Trauma, & Milieu Management (Questions 136–150)
Section 1: Therapeutic Communication & the Nurse-Patient Relationship (Questions 1–25)
🟢 1. A client tells the nurse, "I feel like nobody cares if I live or die." Which response is the best example
of the therapeutic technique of reflection?
A. "You feel that nobody cares about you?"
B. "Why do you think you feel that people don't care?"
C. "Nobody cares?"
D. "Let's focus on your family; they care about you."
🔴🔴 Correct Answer: C. Reflection involves repeating the client's exact words or a key phrase to
encourage elaboration. Option A is paraphrasing, option B uses "why," which can sound accusatory, and
option D changes the subject.
🟢 2. The nurse is establishing a therapeutic alliance with a client. Which action best promotes this
relationship?
A. Giving direct advice to solve the client's problems quickly
B. Establishing mutual trust, respect, and collaboration with the patient
C. Maintaining a casual social friendship with the patient outside of sessions
D. Avoiding all discussions of negative emotions to keep the mood light
🔴🔴 Correct Answer: B. A therapeutic alliance is a professional, collaborative relationship built on trust
and respect. Giving advice promotes dependency, social friendships are boundary violations, and
avoiding negative feelings blocks therapeutic progress.
,🟢 3. A client with schizophrenia refuses to take oral medication. The nurse says, "If you don't take this
pill right now, I am going to put you in four-point restraints for the rest of the day." This is an example
of:
A. Limit setting
B. A threat
C. Bargaining
D. Therapeutic holding
🔴🔴 Correct Answer: B. Threatening punishment is nontherapeutic, unethical, and may constitute
assault. Limit setting explains consequences calmly and clearly without intimidation.
🟢 4. According to Hildegard Peplau's Interpersonal Relations Theory, during which phase does the
patient begin to identify problems to work on and explore feelings?
A. Orientation phase
B. Working phase
C. Termination phase
D. Pre-interaction phase
🔴🔴 Correct Answer: B. In the working phase, the patient actively explores problems, identifies issues,
and works toward change. The orientation phase is for trust-building and setting expectations, while the
termination phase is for ending the relationship.
🟢 5. A patient tells the nurse, "I'm not angry at my boss at all. My co-workers are just too sensitive and
overreact to everything." The nurse recognizes this as which defense mechanism?
A. Projection
B. Rationalization
C. Displacement
D. Reaction formation
🔴🔴 Correct Answer: C. Displacement involves transferring an emotion (anger) from the original source
(the boss) to a safer target (co-workers). Projection would be accusing the boss of being angry, and
reaction formation would be acting overly nice to the boss.
🟢 6. A client states, "I don't want to take my medication anymore. It makes me feel like a zombie." The
nurse's best response is:
A. "You need to take your medication as prescribed."
B. "Tell me more about how the medication makes you feel."
C. "That's a common side effect; it will go away."
D. "You should discuss that with your doctor."
🔴🔴 Correct Answer: B. This response encourages the patient to elaborate on their concerns using an
open-ended question, which is a therapeutic communication technique. Option A is authoritarian,
option C provides false reassurance, and option D defers the concern.
🟢 7. A nurse demonstrates active listening by:
,A. Interrupting the patient to ask clarifying questions
B. Maintaining eye contact, nodding, and using verbal prompts such as "go on" or "tell me more"
C. Giving advice about what the patient should do
D. Changing the subject when the patient becomes emotional
🔴🔴 Correct Answer: B. Active listening involves fully concentrating, understanding, responding, and
remembering what the patient says. It includes non-verbal cues (eye contact, nodding) and minimal
verbal prompts. It does not include interrupting, giving advice, or changing the subject.
🟢 8. Which of the following is an example of an open-ended question?
A. "Are you feeling sad today?"
B. "Did you take your medication this morning?"
C. "Can you tell me more about how you've been feeling lately?"
D. "Is your anxiety better than yesterday?"
🔴🔴 Correct Answer: C. Open-ended questions cannot be answered with "yes" or "no." They encourage
the patient to share more information. "Can you tell me more about how you've been feeling lately?"
invites the patient to elaborate.
🟢 9. The patient says, "I'm so angry that my family never visits." The nurse responds, "You feel angry
because your family hasn't visited." This is an example of:
A. Paraphrasing/reflection
B. False reassurance
C. Giving advice
D. Changing the subject
🔴🔴 Correct Answer: A. Paraphrasing or reflecting restates the patient's message in the nurse's own
words to show understanding. This technique validates the patient's feelings and encourages further
exploration.
🟢 10. A patient is silent for several minutes during a one-on-one session. The nurse should:
A. End the session
B. Ask, "Why aren't you talking?"
C. Sit quietly with the patient, then reflect, "You seem thoughtful today"
D. Start talking about the weather
🔴🔴 Correct Answer: C. Sitting with the patient in silence (therapeutic silence) and then reflecting on
the patient's affect is therapeutic. It respects the patient's need for time to process thoughts. Asking
"why" can be accusatory.
🟢 11. A patient says, "I'm worthless. I can't do anything right." The nurse's best response is:
A. "That's not true. You're a good person."
B. "You've been feeling like you can't do anything right?"
C. "Everyone makes mistakes sometimes."
D. "You should think more positively."
, 🔴🔴 Correct Answer: B. Reflecting the patient's feelings back to them is therapeutic. It validates the
emotion and encourages further exploration. False reassurance (A, C) and giving advice (D) are non-
therapeutic.
🟢 12. A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family
would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's
dying." Which response by the nurse is therapeutic?
A. "Have you shared your feelings with your family?"
B. "I think we should talk more about your anger with your family."
C. "You're feeling angry that your family continues to hope for you to be cured?"
D. "You are probably very depressed, which is understandable with such a diagnosis."
🔴🔴 Correct Answer: C. This response uses restatement and reflection to validate the client's feelings.
Options A and B may be premature; option D labels the client's emotions.
🟢 13. A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by
the nurse to the client's concern?
A. "I don't believe this is true."
B. "The guards are not out to kill you."
C. "Do you feel afraid that people are trying to hurt you?"
D. "What makes you think the guards were sent to hurt you?"
🔴🔴 Correct Answer: C. This response acknowledges the client's feelings without validating the
delusion. Options A and B are confrontational; option D may reinforce the delusional thinking.
🟢 14. A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have
died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse
demonstrates therapeutic communication?
A. "You have everything to live for."
B. "Why do you see yourself as a failure?"
C. "Feeling like this is all part of being depressed."
D. "You've been feeling like a failure for a while?"
🔴🔴 Correct Answer: D. This response uses reflection to acknowledge the client's feelings and
encourages further discussion. Option A offers false reassurance, B uses "why," and C dismisses the
client's feelings.
🟢 15. Which of the following is the most important goal of therapeutic communication in psychiatric-
mental health nursing?
A. To gather information about the patient's medical history
B. To establish a trusting, therapeutic nurse-patient relationship that facilitates patient growth and
healing
C. To provide advice and solutions to the patient's problems
D. To maintain social conversations with the patient
150 Advanced Multiple-Choice Questions
with Rationales for Nursing Students
Table of Contents
1. Therapeutic Communication & the Nurse-Patient Relationship (Questions 1–25)
2. Psychiatric Assessment, Legal & Ethical Issues (Questions 26–50)
3. Psychopharmacology & Neurobiology (Questions 51–75)
4. Anxiety, Mood, & Suicidal Client (Questions 76–100)
5. Schizophrenia Spectrum & Psychotic Disorders (Questions 101–115)
6. Personality, Substance Use, & Eating Disorders (Questions 116–135)
7. Crisis Intervention, Trauma, & Milieu Management (Questions 136–150)
Section 1: Therapeutic Communication & the Nurse-Patient Relationship (Questions 1–25)
🟢 1. A client tells the nurse, "I feel like nobody cares if I live or die." Which response is the best example
of the therapeutic technique of reflection?
A. "You feel that nobody cares about you?"
B. "Why do you think you feel that people don't care?"
C. "Nobody cares?"
D. "Let's focus on your family; they care about you."
🔴🔴 Correct Answer: C. Reflection involves repeating the client's exact words or a key phrase to
encourage elaboration. Option A is paraphrasing, option B uses "why," which can sound accusatory, and
option D changes the subject.
🟢 2. The nurse is establishing a therapeutic alliance with a client. Which action best promotes this
relationship?
A. Giving direct advice to solve the client's problems quickly
B. Establishing mutual trust, respect, and collaboration with the patient
C. Maintaining a casual social friendship with the patient outside of sessions
D. Avoiding all discussions of negative emotions to keep the mood light
🔴🔴 Correct Answer: B. A therapeutic alliance is a professional, collaborative relationship built on trust
and respect. Giving advice promotes dependency, social friendships are boundary violations, and
avoiding negative feelings blocks therapeutic progress.
,🟢 3. A client with schizophrenia refuses to take oral medication. The nurse says, "If you don't take this
pill right now, I am going to put you in four-point restraints for the rest of the day." This is an example
of:
A. Limit setting
B. A threat
C. Bargaining
D. Therapeutic holding
🔴🔴 Correct Answer: B. Threatening punishment is nontherapeutic, unethical, and may constitute
assault. Limit setting explains consequences calmly and clearly without intimidation.
🟢 4. According to Hildegard Peplau's Interpersonal Relations Theory, during which phase does the
patient begin to identify problems to work on and explore feelings?
A. Orientation phase
B. Working phase
C. Termination phase
D. Pre-interaction phase
🔴🔴 Correct Answer: B. In the working phase, the patient actively explores problems, identifies issues,
and works toward change. The orientation phase is for trust-building and setting expectations, while the
termination phase is for ending the relationship.
🟢 5. A patient tells the nurse, "I'm not angry at my boss at all. My co-workers are just too sensitive and
overreact to everything." The nurse recognizes this as which defense mechanism?
A. Projection
B. Rationalization
C. Displacement
D. Reaction formation
🔴🔴 Correct Answer: C. Displacement involves transferring an emotion (anger) from the original source
(the boss) to a safer target (co-workers). Projection would be accusing the boss of being angry, and
reaction formation would be acting overly nice to the boss.
🟢 6. A client states, "I don't want to take my medication anymore. It makes me feel like a zombie." The
nurse's best response is:
A. "You need to take your medication as prescribed."
B. "Tell me more about how the medication makes you feel."
C. "That's a common side effect; it will go away."
D. "You should discuss that with your doctor."
🔴🔴 Correct Answer: B. This response encourages the patient to elaborate on their concerns using an
open-ended question, which is a therapeutic communication technique. Option A is authoritarian,
option C provides false reassurance, and option D defers the concern.
🟢 7. A nurse demonstrates active listening by:
,A. Interrupting the patient to ask clarifying questions
B. Maintaining eye contact, nodding, and using verbal prompts such as "go on" or "tell me more"
C. Giving advice about what the patient should do
D. Changing the subject when the patient becomes emotional
🔴🔴 Correct Answer: B. Active listening involves fully concentrating, understanding, responding, and
remembering what the patient says. It includes non-verbal cues (eye contact, nodding) and minimal
verbal prompts. It does not include interrupting, giving advice, or changing the subject.
🟢 8. Which of the following is an example of an open-ended question?
A. "Are you feeling sad today?"
B. "Did you take your medication this morning?"
C. "Can you tell me more about how you've been feeling lately?"
D. "Is your anxiety better than yesterday?"
🔴🔴 Correct Answer: C. Open-ended questions cannot be answered with "yes" or "no." They encourage
the patient to share more information. "Can you tell me more about how you've been feeling lately?"
invites the patient to elaborate.
🟢 9. The patient says, "I'm so angry that my family never visits." The nurse responds, "You feel angry
because your family hasn't visited." This is an example of:
A. Paraphrasing/reflection
B. False reassurance
C. Giving advice
D. Changing the subject
🔴🔴 Correct Answer: A. Paraphrasing or reflecting restates the patient's message in the nurse's own
words to show understanding. This technique validates the patient's feelings and encourages further
exploration.
🟢 10. A patient is silent for several minutes during a one-on-one session. The nurse should:
A. End the session
B. Ask, "Why aren't you talking?"
C. Sit quietly with the patient, then reflect, "You seem thoughtful today"
D. Start talking about the weather
🔴🔴 Correct Answer: C. Sitting with the patient in silence (therapeutic silence) and then reflecting on
the patient's affect is therapeutic. It respects the patient's need for time to process thoughts. Asking
"why" can be accusatory.
🟢 11. A patient says, "I'm worthless. I can't do anything right." The nurse's best response is:
A. "That's not true. You're a good person."
B. "You've been feeling like you can't do anything right?"
C. "Everyone makes mistakes sometimes."
D. "You should think more positively."
, 🔴🔴 Correct Answer: B. Reflecting the patient's feelings back to them is therapeutic. It validates the
emotion and encourages further exploration. False reassurance (A, C) and giving advice (D) are non-
therapeutic.
🟢 12. A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family
would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's
dying." Which response by the nurse is therapeutic?
A. "Have you shared your feelings with your family?"
B. "I think we should talk more about your anger with your family."
C. "You're feeling angry that your family continues to hope for you to be cured?"
D. "You are probably very depressed, which is understandable with such a diagnosis."
🔴🔴 Correct Answer: C. This response uses restatement and reflection to validate the client's feelings.
Options A and B may be premature; option D labels the client's emotions.
🟢 13. A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by
the nurse to the client's concern?
A. "I don't believe this is true."
B. "The guards are not out to kill you."
C. "Do you feel afraid that people are trying to hurt you?"
D. "What makes you think the guards were sent to hurt you?"
🔴🔴 Correct Answer: C. This response acknowledges the client's feelings without validating the
delusion. Options A and B are confrontational; option D may reinforce the delusional thinking.
🟢 14. A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have
died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse
demonstrates therapeutic communication?
A. "You have everything to live for."
B. "Why do you see yourself as a failure?"
C. "Feeling like this is all part of being depressed."
D. "You've been feeling like a failure for a while?"
🔴🔴 Correct Answer: D. This response uses reflection to acknowledge the client's feelings and
encourages further discussion. Option A offers false reassurance, B uses "why," and C dismisses the
client's feelings.
🟢 15. Which of the following is the most important goal of therapeutic communication in psychiatric-
mental health nursing?
A. To gather information about the patient's medical history
B. To establish a trusting, therapeutic nurse-patient relationship that facilitates patient growth and
healing
C. To provide advice and solutions to the patient's problems
D. To maintain social conversations with the patient
