Page 1 of 133
NUR 253 EXAM 4 – MENTAL HEALTH NURSING (GALEN COLLEGE OF
NURSING) EXAM QUESTIONS LATEST VERSION 2026 - 2027
NUR 253 Exam 4 – Mental Health Nursing (Galen College of Nursing) — Questions
10-Point Summarized Exam Coverage
1. Therapeutic Communication & the Nurse-Client Relationship (Q1–30):
Therapeutic techniques (reflecting, restating, clarifying), non-therapeutic
responses, boundaries, and Peplau's phases.
2. Mental Status Examination & Assessment (Q31–60): Cognitive assessment,
affect, abstract thinking, memory, and documentation of mental status findings.
3. Psychotic Disorders & Schizophrenia (Q61–100): Positive and negative
symptoms, delusions, hallucinations, antipsychotic medications, and nursing
interventions.
4. Personality Disorders (Q101–140): Borderline, antisocial, narcissistic, and
histrionic personality disorders; splitting; and limit-setting.
5. Eating Disorders (Q141–175): Anorexia nervosa, bulimia nervosa, binge-eating
disorder, refeeding syndrome, and nutritional stabilization.
6. Substance Use Disorders (Q176–210): Alcohol withdrawal, delirium tremens,
opioid overdose, CIWA-Ar, detoxification, and recovery.
7. Grief, Loss & End-of-Life Care (Q211–240): Types of grief, anticipatory grief,
disenfranchised grief, hospice care, and stages of dying.
8. Crisis, Anger & Aggression (Q241–265): De-escalation, seclusion and restraint,
cycle of violence, and crisis intervention.
9. Psychopharmacology & Medication Safety (Q266–290): Antipsychotics,
antidepressants, mood stabilizers, and adverse effects (NMS, serotonin
syndrome, tardive dyskinesia).
10. Legal, Ethical & Safety Issues (Q291–300): Informed consent, confidentiality,
mandatory reporting, and patient rights.
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SECTION 1: THERAPEUTIC COMMUNICATION & THE NURSE-CLIENT RELATIONSHIP
(Questions 1–30)
Question 1
A nurse is caring for a client who is pacing and clenching fists. Which action should the
nurse take first?
A) Use de-escalation techniques such as calm speech and providing personal space.
B) Administer a PRN antipsychotic immediately.
C) Place the client in seclusion.
D) Call security before speaking to the client.
Answer: A
Rationale: De-escalation is the first-line intervention for escalating anger to prevent
progression to violence. Seclusion and restraints are used only when less restrictive
measures fail and the client is a danger to self or others. Medication may be used later if
de-escalation is ineffective.
Question 2
A client is placed in seclusion after becoming violent. Which documentation is
essential?
A) The client was placed in seclusion for 2 hours.
B) All other interventions were attempted first, and seclusion was the only option to
ensure safety.
C) The client was calm and cooperative in seclusion.
D) The client's room number and diagnosis.
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Answer: B
Rationale: Documentation for seclusion and restraint must demonstrate that less
restrictive measures were tried first and the intervention was necessary for safety.
Merely stating the duration or client's calmness is insufficient.
Question 3
During therapeutic communication, a client says, "I feel like nobody cares about me."
The nurse responds, "It sounds like you are feeling very alone right now." This response
is an example of which communication technique?
A) Clarifying
B) Restating
C) Reflecting
D) Offering self
Answer: C
Rationale: Reflecting involves paraphrasing or mirroring the emotional content of what
the client has said, directing feelings and ideas back to the client. Restating involves
repeating the client's own words. Clarifying seeks to better understand ambiguous
statements.
Question 4
A nurse is caring for a client who has been admitted following a suicide attempt. Which
statement by the nurse is an example of a NON-therapeutic communication technique?
A) "Can you tell me what led up to this event?"
B) "Why did you do this to yourself? Don't you know how much your family would
suffer?"
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C) "I want to understand what you are going through."
D) "You seem very distressed. Would you like to talk about it?"
Answer: B
Rationale: Asking "why" questions and making statements that express judgment or
guilt are non-therapeutic. They can make the client feel defensive and hinder open
communication.
Question 5
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
Answer: B
Rationale: The working phase is when the patient identifies problems and explores
feelings. The orientation phase establishes trust, and the termination phase focuses on
reviewing progress and ending the relationship.
Question 6
A charge nurse is discussing the characteristics of a nurse-client relationship with a
newly licensed nurse. Which characteristic should the nurse include? (Select all that
apply)
A) The needs of both participants are met
B) An emotional commitment exists between the participants
NUR 253 EXAM 4 – MENTAL HEALTH NURSING (GALEN COLLEGE OF
NURSING) EXAM QUESTIONS LATEST VERSION 2026 - 2027
NUR 253 Exam 4 – Mental Health Nursing (Galen College of Nursing) — Questions
10-Point Summarized Exam Coverage
1. Therapeutic Communication & the Nurse-Client Relationship (Q1–30):
Therapeutic techniques (reflecting, restating, clarifying), non-therapeutic
responses, boundaries, and Peplau's phases.
2. Mental Status Examination & Assessment (Q31–60): Cognitive assessment,
affect, abstract thinking, memory, and documentation of mental status findings.
3. Psychotic Disorders & Schizophrenia (Q61–100): Positive and negative
symptoms, delusions, hallucinations, antipsychotic medications, and nursing
interventions.
4. Personality Disorders (Q101–140): Borderline, antisocial, narcissistic, and
histrionic personality disorders; splitting; and limit-setting.
5. Eating Disorders (Q141–175): Anorexia nervosa, bulimia nervosa, binge-eating
disorder, refeeding syndrome, and nutritional stabilization.
6. Substance Use Disorders (Q176–210): Alcohol withdrawal, delirium tremens,
opioid overdose, CIWA-Ar, detoxification, and recovery.
7. Grief, Loss & End-of-Life Care (Q211–240): Types of grief, anticipatory grief,
disenfranchised grief, hospice care, and stages of dying.
8. Crisis, Anger & Aggression (Q241–265): De-escalation, seclusion and restraint,
cycle of violence, and crisis intervention.
9. Psychopharmacology & Medication Safety (Q266–290): Antipsychotics,
antidepressants, mood stabilizers, and adverse effects (NMS, serotonin
syndrome, tardive dyskinesia).
10. Legal, Ethical & Safety Issues (Q291–300): Informed consent, confidentiality,
mandatory reporting, and patient rights.
, Page 2 of 133
SECTION 1: THERAPEUTIC COMMUNICATION & THE NURSE-CLIENT RELATIONSHIP
(Questions 1–30)
Question 1
A nurse is caring for a client who is pacing and clenching fists. Which action should the
nurse take first?
A) Use de-escalation techniques such as calm speech and providing personal space.
B) Administer a PRN antipsychotic immediately.
C) Place the client in seclusion.
D) Call security before speaking to the client.
Answer: A
Rationale: De-escalation is the first-line intervention for escalating anger to prevent
progression to violence. Seclusion and restraints are used only when less restrictive
measures fail and the client is a danger to self or others. Medication may be used later if
de-escalation is ineffective.
Question 2
A client is placed in seclusion after becoming violent. Which documentation is
essential?
A) The client was placed in seclusion for 2 hours.
B) All other interventions were attempted first, and seclusion was the only option to
ensure safety.
C) The client was calm and cooperative in seclusion.
D) The client's room number and diagnosis.
, Page 3 of 133
Answer: B
Rationale: Documentation for seclusion and restraint must demonstrate that less
restrictive measures were tried first and the intervention was necessary for safety.
Merely stating the duration or client's calmness is insufficient.
Question 3
During therapeutic communication, a client says, "I feel like nobody cares about me."
The nurse responds, "It sounds like you are feeling very alone right now." This response
is an example of which communication technique?
A) Clarifying
B) Restating
C) Reflecting
D) Offering self
Answer: C
Rationale: Reflecting involves paraphrasing or mirroring the emotional content of what
the client has said, directing feelings and ideas back to the client. Restating involves
repeating the client's own words. Clarifying seeks to better understand ambiguous
statements.
Question 4
A nurse is caring for a client who has been admitted following a suicide attempt. Which
statement by the nurse is an example of a NON-therapeutic communication technique?
A) "Can you tell me what led up to this event?"
B) "Why did you do this to yourself? Don't you know how much your family would
suffer?"
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C) "I want to understand what you are going through."
D) "You seem very distressed. Would you like to talk about it?"
Answer: B
Rationale: Asking "why" questions and making statements that express judgment or
guilt are non-therapeutic. They can make the client feel defensive and hinder open
communication.
Question 5
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
Answer: B
Rationale: The working phase is when the patient identifies problems and explores
feelings. The orientation phase establishes trust, and the termination phase focuses on
reviewing progress and ending the relationship.
Question 6
A charge nurse is discussing the characteristics of a nurse-client relationship with a
newly licensed nurse. Which characteristic should the nurse include? (Select all that
apply)
A) The needs of both participants are met
B) An emotional commitment exists between the participants
