NUR 253 Final Exam 4 | Concepts of Mental Health
Nursing (2026) Q&A | Galen College
1. According to Kübler-Ross, which stage of grief is characterized by trying to
negotiate for more time or a different outcome?
A) Denial
B) Anger
C) Bargaining
D) Depression
Correct Answer: Bargaining
Rationale: Bargaining involves attempting to negotiate with a higher power or medical
professionals for more time or a better prognosis. This stage often includes promises of
good behavior in exchange for a different outcome. It follows anger and precedes
depression in the Kübler-Ross model. Recognizing this stage helps the nurse provide
empathetic support without reinforcing false hope.
2. What is the primary function of the DSM-5-TR in psychiatric nursing?
A) To provide standardized criteria for diagnosing mental disorders
B) To list all available psychiatric medications
C) To outline nursing care plans for every disorder
D) To determine the legal status of involuntary admissions
Correct Answer: To provide standardized criteria for diagnosing mental disorders
Rationale: The DSM-5-TR offers a common language and standardized diagnostic
criteria for mental health disorders. This allows for consistent communication among
healthcare professionals and facilitates accurate treatment planning. It does not
prescribe nursing care plans or list medications, though it informs those decisions. Its
primary role is diagnostic classification.
3. A nurse is assessing a patient for suicidal ideation. Which question is most
appropriate?
A) "You aren't thinking of hurting yourself, are you?"
B) "Are you having thoughts of killing yourself?"
C) "Do you ever feel sad or hopeless?"
D) "Have you ever thought about death?"
Correct Answer: "Are you having thoughts of killing yourself?"
Rationale: Direct, clear questioning about suicidal thoughts is essential for accurate
assessment. Asking "Are you having thoughts of killing yourself?" is direct and leaves no
ambiguity. Indirect questions can miss critical information. This approach demonstrates
the nurse's willingness to discuss difficult topics openly.
, 4. Which term refers to the outward expression of grief through cultural or religious
rituals?
A) Bereavement
B) Mourning
C) Anticipatory grief
D) Complicated grief
Correct Answer: Mourning
Rationale: Mourning is the outward, social expression of grief, often influenced by
cultural, religious, and personal practices. Bereavement refers to the state of having
experienced a loss. Anticipatory grief occurs before an expected death, and
complicated grief is prolonged and impairing. Understanding these distinctions guides
appropriate nursing support.
5. A hospice nurse is caring for a terminally ill client who states, "I can't believe this
is happening to me. There must be some mistake." According to Kübler-Ross,
which stage of grief is the client exhibiting?
A) Anger
B) Bargaining
C) Denial
D) Depression
Correct Answer: Denial
Rationale: Denial is the first stage of the Kübler-Ross grief model, characterized by
shock and disbelief. The client's statement reflects an inability to accept the reality of
the situation. Denial serves as a temporary defense mechanism that allows the client to
process overwhelming news at their own pace. The nurse should allow the client to
express feelings without pushing them to move to another stage.
6. What is the most likely outcome if a nurse fails to validate a patient's feelings
during a therapeutic interaction?
A) The patient will feel understood and supported
B) The patient may feel dismissed and distrustful
C) The patient will immediately disclose all concerns
D) The patient will experience improved coping
Correct Answer: The patient may feel dismissed and distrustful
Rationale: Validation communicates acceptance and understanding of a patient's
emotional experience. Without it, the patient may perceive the nurse as dismissive or
judgmental, which can erode trust and hinder the therapeutic relationship. Trust is
foundational to effective psychiatric nursing care. Validation does not require agreement
with the patient's perspective.
, 7. A nurse is providing education to a client who is in the bargaining stage of grief.
Which statement by the client is most consistent with this stage?
A) "I can't believe this is happening to me."
B) "If I just do everything right, maybe I'll be okay."
C) "Why me? This isn't fair."
D) "I'm ready to let go."
Correct Answer: "If I just do everything right, maybe I'll be okay."
Rationale: Bargaining is characterized by attempts to negotiate for more time or a better
outcome, often with a higher power. The statement reflects a desire to control the
situation through good behavior. This is a common coping mechanism in the dying
process, and the nurse should listen empathetically without reinforcing false hope.
8. Which principle explains why a nurse should avoid asking "why" questions during
a mental health assessment?
A) They encourage elaboration and deeper exploration
B) They can be perceived as accusatory or judgmental
C) They are too open-ended for effective assessment
D) They require the patient to recall specific events
Correct Answer: They can be perceived as accusatory or judgmental
Rationale: "Why" questions often imply blame or criticism, which can make patients
defensive or reluctant to share information. Therapeutic communication emphasizes
open-ended questions that invite exploration without judgment. Using "what" or "how"
questions is generally more effective. This principle is central to establishing trust in
psychiatric nursing.
9. In the context of Peplau's theory, what is the primary focus during the orientation
phase of the nurse-patient relationship?
A) Exploring termination issues
B) Establishing trust and setting mutually agreed-upon goals
C) Working through transference reactions
D) Summarizing progress made
Correct Answer: Establishing trust and setting mutually agreed-upon goals
Rationale: The orientation phase focuses on building trust, establishing boundaries, and
identifying patient goals. This phase sets the foundation for the working phase.
Termination and transference are addressed in later phases. Effective orientation is
critical for a therapeutic alliance.
10. A client whose spouse died 8 months ago tells the nurse, "I still feel so empty
inside. I don't know how to go on without them." Which response by the nurse is
most therapeutic?
Nursing (2026) Q&A | Galen College
1. According to Kübler-Ross, which stage of grief is characterized by trying to
negotiate for more time or a different outcome?
A) Denial
B) Anger
C) Bargaining
D) Depression
Correct Answer: Bargaining
Rationale: Bargaining involves attempting to negotiate with a higher power or medical
professionals for more time or a better prognosis. This stage often includes promises of
good behavior in exchange for a different outcome. It follows anger and precedes
depression in the Kübler-Ross model. Recognizing this stage helps the nurse provide
empathetic support without reinforcing false hope.
2. What is the primary function of the DSM-5-TR in psychiatric nursing?
A) To provide standardized criteria for diagnosing mental disorders
B) To list all available psychiatric medications
C) To outline nursing care plans for every disorder
D) To determine the legal status of involuntary admissions
Correct Answer: To provide standardized criteria for diagnosing mental disorders
Rationale: The DSM-5-TR offers a common language and standardized diagnostic
criteria for mental health disorders. This allows for consistent communication among
healthcare professionals and facilitates accurate treatment planning. It does not
prescribe nursing care plans or list medications, though it informs those decisions. Its
primary role is diagnostic classification.
3. A nurse is assessing a patient for suicidal ideation. Which question is most
appropriate?
A) "You aren't thinking of hurting yourself, are you?"
B) "Are you having thoughts of killing yourself?"
C) "Do you ever feel sad or hopeless?"
D) "Have you ever thought about death?"
Correct Answer: "Are you having thoughts of killing yourself?"
Rationale: Direct, clear questioning about suicidal thoughts is essential for accurate
assessment. Asking "Are you having thoughts of killing yourself?" is direct and leaves no
ambiguity. Indirect questions can miss critical information. This approach demonstrates
the nurse's willingness to discuss difficult topics openly.
, 4. Which term refers to the outward expression of grief through cultural or religious
rituals?
A) Bereavement
B) Mourning
C) Anticipatory grief
D) Complicated grief
Correct Answer: Mourning
Rationale: Mourning is the outward, social expression of grief, often influenced by
cultural, religious, and personal practices. Bereavement refers to the state of having
experienced a loss. Anticipatory grief occurs before an expected death, and
complicated grief is prolonged and impairing. Understanding these distinctions guides
appropriate nursing support.
5. A hospice nurse is caring for a terminally ill client who states, "I can't believe this
is happening to me. There must be some mistake." According to Kübler-Ross,
which stage of grief is the client exhibiting?
A) Anger
B) Bargaining
C) Denial
D) Depression
Correct Answer: Denial
Rationale: Denial is the first stage of the Kübler-Ross grief model, characterized by
shock and disbelief. The client's statement reflects an inability to accept the reality of
the situation. Denial serves as a temporary defense mechanism that allows the client to
process overwhelming news at their own pace. The nurse should allow the client to
express feelings without pushing them to move to another stage.
6. What is the most likely outcome if a nurse fails to validate a patient's feelings
during a therapeutic interaction?
A) The patient will feel understood and supported
B) The patient may feel dismissed and distrustful
C) The patient will immediately disclose all concerns
D) The patient will experience improved coping
Correct Answer: The patient may feel dismissed and distrustful
Rationale: Validation communicates acceptance and understanding of a patient's
emotional experience. Without it, the patient may perceive the nurse as dismissive or
judgmental, which can erode trust and hinder the therapeutic relationship. Trust is
foundational to effective psychiatric nursing care. Validation does not require agreement
with the patient's perspective.
, 7. A nurse is providing education to a client who is in the bargaining stage of grief.
Which statement by the client is most consistent with this stage?
A) "I can't believe this is happening to me."
B) "If I just do everything right, maybe I'll be okay."
C) "Why me? This isn't fair."
D) "I'm ready to let go."
Correct Answer: "If I just do everything right, maybe I'll be okay."
Rationale: Bargaining is characterized by attempts to negotiate for more time or a better
outcome, often with a higher power. The statement reflects a desire to control the
situation through good behavior. This is a common coping mechanism in the dying
process, and the nurse should listen empathetically without reinforcing false hope.
8. Which principle explains why a nurse should avoid asking "why" questions during
a mental health assessment?
A) They encourage elaboration and deeper exploration
B) They can be perceived as accusatory or judgmental
C) They are too open-ended for effective assessment
D) They require the patient to recall specific events
Correct Answer: They can be perceived as accusatory or judgmental
Rationale: "Why" questions often imply blame or criticism, which can make patients
defensive or reluctant to share information. Therapeutic communication emphasizes
open-ended questions that invite exploration without judgment. Using "what" or "how"
questions is generally more effective. This principle is central to establishing trust in
psychiatric nursing.
9. In the context of Peplau's theory, what is the primary focus during the orientation
phase of the nurse-patient relationship?
A) Exploring termination issues
B) Establishing trust and setting mutually agreed-upon goals
C) Working through transference reactions
D) Summarizing progress made
Correct Answer: Establishing trust and setting mutually agreed-upon goals
Rationale: The orientation phase focuses on building trust, establishing boundaries, and
identifying patient goals. This phase sets the foundation for the working phase.
Termination and transference are addressed in later phases. Effective orientation is
critical for a therapeutic alliance.
10. A client whose spouse died 8 months ago tells the nurse, "I still feel so empty
inside. I don't know how to go on without them." Which response by the nurse is
most therapeutic?
