NUR 253 Final Exam 2 | Concepts of Mental Health
Nursing (2026) Q&A | Galen College
1. Which of the following best describes the diathesis-stress model of mental
illness?
A) Mental illness results solely from genetic predisposition
B) Mental illness develops when a biological predisposition combines with
environmental stress
C) Mental illness is caused exclusively by childhood trauma
D) Mental illness occurs only when defense mechanisms fail
Correct Answer: Mental illness develops when a biological predisposition combines
with environmental stress
Rationale: The diathesis-stress model proposes that mental disorders result from the
interaction between a biological or genetic vulnerability (diathesis) and environmental
stressors. Neither factor alone is sufficient to cause mental illness. This model is widely
accepted as the most comprehensive explanation for the etiology of psychiatric
disorders.
2. A nursing student preparing for a high-stakes exam has elevated heart rate,
sharply focused attention, and efficient problem-solving. Which level of anxiety
does this represent?
A) Mild anxiety
B) Moderate anxiety
C) Severe anxiety
D) Panic-level anxiety
Correct Answer: Mild anxiety
Rationale: Mild anxiety heightens awareness and sharpens focus, making it optimal for
learning and performance. Moderate anxiety begins to narrow the perceptual field,
severe anxiety impairs cognition significantly, and panic-level anxiety involves loss of
reality testing. Mild anxiety is the only level that enhances functioning.
3. According to Kübler-Ross, which stage of grief is characterized by shock and
disbelief?
A) Anger
B) Denial
C) Bargaining
D) Depression
Correct Answer: Denial
,Rationale: Denial is the first stage of Kübler-Ross's grief model, characterized by shock
and disbelief. The individual struggles to accept the reality of the loss, often expecting
the deceased to return. This defense mechanism serves as a buffer against the initial
overwhelming pain.
4. A client whose spouse died two years ago continues to experience intense grief
and is unable to function at work. Which type of grief does this represent?
A) Anticipatory grief
B) Disenfranchised grief
C) Complicated grief
D) Normal grief
Correct Answer: Complicated grief
Rationale: Complicated grief is characterized by prolonged, intense grief that impairs
daily functioning. When grief extends beyond 6 to 12 months and prevents the individual
from resuming normal activities, it is considered complicated and may require
professional intervention. Anticipatory grief occurs before a loss, disenfranchised grief is
not socially acknowledged, and normal grief resolves over time.
5. A client states, "I failed the test because the instructor hates me and the
questions were unfair," after minimal study. Which defense mechanism is being
used?
A) Introjection
B) Compensation
C) Denial
D) Rationalization
Correct Answer: Rationalization
Rationale: Rationalization creates plausible but inaccurate reasons for behavior or
outcomes, protecting self-esteem by shifting responsibility away from personal effort.
The client attributes failure to external factors rather than acknowledging insufficient
preparation. Introjection involves incorporating others' values, compensation involves
offsetting weaknesses, and denial involves refusing to accept reality.
6. During a stressful family meeting, a client develops numbness in the right arm
with no organic cause. Which defense mechanism does this represent?
A) Conversion
B) Dissociation
C) Rationalization
D) Suppression
Correct Answer: Conversion
,Rationale: Conversion transfers emotional conflict into a physical symptom that has no
medical explanation. The symptom often symbolically relates to the conflict and
reduces conscious anxiety. Dissociation involves temporary loss of memory or identity,
rationalization invents logical reasons, and suppression is a conscious decision to
ignore conflict.
7. A client who was recently diagnosed with a serious illness begins laughing loudly
whenever staff discuss the prognosis. Which defense mechanism is this?
A) Sublimation
B) Intellectualization
C) Reaction formation
D) Projection
Correct Answer: Reaction formation
Rationale: Reaction formation involves expressing the opposite of the true feeling.
Laughing when the underlying emotion is fear or grief protects the client from
overwhelming affect in the short term. Sublimation channels impulses into productive
activity, intellectualization focuses on abstract facts, and projection attributes one's
own feelings to others.
8. Which of the following best describes the primary purpose of defense
mechanisms?
A) Eliminating all anxiety from conscious awareness
B) Protecting the individual from overwhelming anxiety and maintaining self-
image
C) Permanently resolving unconscious conflicts
D) Increasing awareness of repressed memories
Correct Answer: Protecting the individual from overwhelming anxiety and maintaining
self-image
Rationale: Defense mechanisms are automatic coping styles that protect people from
anxiety and maintain self-image by blocking feelings, conflicts, and memories. Adaptive
use helps decrease anxiety, while maladaptive use can interfere with functioning. They
do not eliminate anxiety entirely, permanently resolve conflicts, or increase awareness
of repressed material.
9. A patient receiving clozapine develops sudden fever, diaphoresis, and delirium
with vital signs showing BP 90/50 and HR 120. Which life-threatening condition
should the nurse suspect?
A) Agranulocytosis
B) Neuroleptic malignant syndrome
C) Serotonin syndrome
D) Tardive dyskinesia
, Correct Answer: Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening adverse effect of
antipsychotics characterized by hyperthermia, severe muscle rigidity, autonomic
instability, and altered mental status. The combination of fever, diaphoresis, delirium,
hypotension, and tachycardia in a client taking clozapine strongly suggests NMS.
Agranulocytosis presents with infection signs, serotonin syndrome involves serotonergic
drugs, and tardive dyskinesia causes involuntary movements.
10. A client taking haloperidol develops high fever, muscle rigidity, and tachycardia.
Which condition is most likely?
A) Acute dystonia
B) Akathisia
C) Neuroleptic malignant syndrome
D) Tardive dyskinesia
Correct Answer: Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to
antipsychotics characterized by lead-pipe rigidity, high fever, autonomic instability, and
altered mental status. Acute dystonia involves muscle spasms, akathisia is
restlessness, and tardive dyskinesia involves involuntary facial movements. NMS
requires immediate discontinuation of the antipsychotic and supportive care.
11. A client with schizophrenia is prescribed clozapine. Which laboratory value
requires the most careful monitoring?
A) Serum potassium
B) White blood cell count
C) Serum creatinine
D) Liver function tests
Correct Answer: White blood cell count
Rationale: Clozapine carries a significant risk for agranulocytosis, a potentially fatal drop
in white blood cell counts. Clients require regular monitoring of white blood cell counts
and absolute neutrophil counts. Potassium, creatinine, and liver function tests are
important but not the primary monitoring parameter for clozapine.
12. A client with schizophrenia who has been stable on risperidone presents with
acute dystonia after missing three doses. Which medication should the nurse
anticipate administering?
A) Benztropine
B) Lorazepam
C) Haloperidol
D) Fluoxetine
Nursing (2026) Q&A | Galen College
1. Which of the following best describes the diathesis-stress model of mental
illness?
A) Mental illness results solely from genetic predisposition
B) Mental illness develops when a biological predisposition combines with
environmental stress
C) Mental illness is caused exclusively by childhood trauma
D) Mental illness occurs only when defense mechanisms fail
Correct Answer: Mental illness develops when a biological predisposition combines
with environmental stress
Rationale: The diathesis-stress model proposes that mental disorders result from the
interaction between a biological or genetic vulnerability (diathesis) and environmental
stressors. Neither factor alone is sufficient to cause mental illness. This model is widely
accepted as the most comprehensive explanation for the etiology of psychiatric
disorders.
2. A nursing student preparing for a high-stakes exam has elevated heart rate,
sharply focused attention, and efficient problem-solving. Which level of anxiety
does this represent?
A) Mild anxiety
B) Moderate anxiety
C) Severe anxiety
D) Panic-level anxiety
Correct Answer: Mild anxiety
Rationale: Mild anxiety heightens awareness and sharpens focus, making it optimal for
learning and performance. Moderate anxiety begins to narrow the perceptual field,
severe anxiety impairs cognition significantly, and panic-level anxiety involves loss of
reality testing. Mild anxiety is the only level that enhances functioning.
3. According to Kübler-Ross, which stage of grief is characterized by shock and
disbelief?
A) Anger
B) Denial
C) Bargaining
D) Depression
Correct Answer: Denial
,Rationale: Denial is the first stage of Kübler-Ross's grief model, characterized by shock
and disbelief. The individual struggles to accept the reality of the loss, often expecting
the deceased to return. This defense mechanism serves as a buffer against the initial
overwhelming pain.
4. A client whose spouse died two years ago continues to experience intense grief
and is unable to function at work. Which type of grief does this represent?
A) Anticipatory grief
B) Disenfranchised grief
C) Complicated grief
D) Normal grief
Correct Answer: Complicated grief
Rationale: Complicated grief is characterized by prolonged, intense grief that impairs
daily functioning. When grief extends beyond 6 to 12 months and prevents the individual
from resuming normal activities, it is considered complicated and may require
professional intervention. Anticipatory grief occurs before a loss, disenfranchised grief is
not socially acknowledged, and normal grief resolves over time.
5. A client states, "I failed the test because the instructor hates me and the
questions were unfair," after minimal study. Which defense mechanism is being
used?
A) Introjection
B) Compensation
C) Denial
D) Rationalization
Correct Answer: Rationalization
Rationale: Rationalization creates plausible but inaccurate reasons for behavior or
outcomes, protecting self-esteem by shifting responsibility away from personal effort.
The client attributes failure to external factors rather than acknowledging insufficient
preparation. Introjection involves incorporating others' values, compensation involves
offsetting weaknesses, and denial involves refusing to accept reality.
6. During a stressful family meeting, a client develops numbness in the right arm
with no organic cause. Which defense mechanism does this represent?
A) Conversion
B) Dissociation
C) Rationalization
D) Suppression
Correct Answer: Conversion
,Rationale: Conversion transfers emotional conflict into a physical symptom that has no
medical explanation. The symptom often symbolically relates to the conflict and
reduces conscious anxiety. Dissociation involves temporary loss of memory or identity,
rationalization invents logical reasons, and suppression is a conscious decision to
ignore conflict.
7. A client who was recently diagnosed with a serious illness begins laughing loudly
whenever staff discuss the prognosis. Which defense mechanism is this?
A) Sublimation
B) Intellectualization
C) Reaction formation
D) Projection
Correct Answer: Reaction formation
Rationale: Reaction formation involves expressing the opposite of the true feeling.
Laughing when the underlying emotion is fear or grief protects the client from
overwhelming affect in the short term. Sublimation channels impulses into productive
activity, intellectualization focuses on abstract facts, and projection attributes one's
own feelings to others.
8. Which of the following best describes the primary purpose of defense
mechanisms?
A) Eliminating all anxiety from conscious awareness
B) Protecting the individual from overwhelming anxiety and maintaining self-
image
C) Permanently resolving unconscious conflicts
D) Increasing awareness of repressed memories
Correct Answer: Protecting the individual from overwhelming anxiety and maintaining
self-image
Rationale: Defense mechanisms are automatic coping styles that protect people from
anxiety and maintain self-image by blocking feelings, conflicts, and memories. Adaptive
use helps decrease anxiety, while maladaptive use can interfere with functioning. They
do not eliminate anxiety entirely, permanently resolve conflicts, or increase awareness
of repressed material.
9. A patient receiving clozapine develops sudden fever, diaphoresis, and delirium
with vital signs showing BP 90/50 and HR 120. Which life-threatening condition
should the nurse suspect?
A) Agranulocytosis
B) Neuroleptic malignant syndrome
C) Serotonin syndrome
D) Tardive dyskinesia
, Correct Answer: Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening adverse effect of
antipsychotics characterized by hyperthermia, severe muscle rigidity, autonomic
instability, and altered mental status. The combination of fever, diaphoresis, delirium,
hypotension, and tachycardia in a client taking clozapine strongly suggests NMS.
Agranulocytosis presents with infection signs, serotonin syndrome involves serotonergic
drugs, and tardive dyskinesia causes involuntary movements.
10. A client taking haloperidol develops high fever, muscle rigidity, and tachycardia.
Which condition is most likely?
A) Acute dystonia
B) Akathisia
C) Neuroleptic malignant syndrome
D) Tardive dyskinesia
Correct Answer: Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to
antipsychotics characterized by lead-pipe rigidity, high fever, autonomic instability, and
altered mental status. Acute dystonia involves muscle spasms, akathisia is
restlessness, and tardive dyskinesia involves involuntary facial movements. NMS
requires immediate discontinuation of the antipsychotic and supportive care.
11. A client with schizophrenia is prescribed clozapine. Which laboratory value
requires the most careful monitoring?
A) Serum potassium
B) White blood cell count
C) Serum creatinine
D) Liver function tests
Correct Answer: White blood cell count
Rationale: Clozapine carries a significant risk for agranulocytosis, a potentially fatal drop
in white blood cell counts. Clients require regular monitoring of white blood cell counts
and absolute neutrophil counts. Potassium, creatinine, and liver function tests are
important but not the primary monitoring parameter for clozapine.
12. A client with schizophrenia who has been stable on risperidone presents with
acute dystonia after missing three doses. Which medication should the nurse
anticipate administering?
A) Benztropine
B) Lorazepam
C) Haloperidol
D) Fluoxetine
