NUR 253 Exam 1 V1 | Mental
Health Nursing Q&A with Rationale
| Galen College of Nursing
1. A nurse is caring for a client who is voluntarily admitted to an inpatient mental health
facility. The client states, ‘I am tired of being here and I want to go home now.’ Which of the
following responses should the nurse make?
A. You cannot leave until the doctor signs your discharge papers.
B. I will get the form for you to sign for a request for release.
C. If you leave now, your insurance will not cover your stay.
D. You signed yourself in, so you must stay for at least 72 hours.
Correct Answer: B
Expert Explanation: Voluntary clients have the right to request release at any time during
their stay. The nurse should facilitate this process by providing the necessary legal forms
for the request. This document allows the facility to review the case to ensure the client is
not a danger to self or others before official discharge.
2. Which ethical principle is a nurse following when they keep a promise to a client to return
at a specific time to talk?
A. Fidelity
B. Justice
,C. Beneficence
D. Autonomy
Correct Answer: A
Expert Explanation: Fidelity refers to the obligation of the nurse to remain faithful to their
commitments and promises. It is a critical component in building trust within the
therapeutic relationship. By returning as promised, the nurse demonstrates reliability and
respect for the client.
3. A nurse observes a client pacing the hallway and breathing rapidly. The client states, ‘I feel
like something terrible is going to happen.’ The nurse should identify this as which level of
anxiety?
A. Mild
B. Moderate
C. Panic
D. Severe
Correct Answer: D
Expert Explanation: Severe anxiety is characterized by a greatly reduced perceptual field
and difficulty focusing on the environment. The client may experience physical symptoms
like rapid breathing and a sense of impending doom. Intervention is required to prevent
the client from escalating to a panic state.
, 4. A client is scheduled for an invasive procedure but refuses to sign the consent form. Which
ethical principle is the nurse upholding by respecting this decision?
A. Autonomy
B. Veracity
C. Nonmaleficence
D. Justice
Correct Answer: A
Expert Explanation: Autonomy is the right of the individual to make their own healthcare
decisions. This includes the right to refuse treatment even if the medical team believes it is
necessary. The nurse’s role is to ensure the client is informed and that their choice is
honored without coercion.
5. During a mental status examination, the nurse asks the client to explain the meaning of the
phrase, ‘Don’t cry over spilled milk.’ What is the nurse assessing?
A. Orientation
B. Memory
C. Attention span
D. Abstract thinking
Correct Answer: D
Health Nursing Q&A with Rationale
| Galen College of Nursing
1. A nurse is caring for a client who is voluntarily admitted to an inpatient mental health
facility. The client states, ‘I am tired of being here and I want to go home now.’ Which of the
following responses should the nurse make?
A. You cannot leave until the doctor signs your discharge papers.
B. I will get the form for you to sign for a request for release.
C. If you leave now, your insurance will not cover your stay.
D. You signed yourself in, so you must stay for at least 72 hours.
Correct Answer: B
Expert Explanation: Voluntary clients have the right to request release at any time during
their stay. The nurse should facilitate this process by providing the necessary legal forms
for the request. This document allows the facility to review the case to ensure the client is
not a danger to self or others before official discharge.
2. Which ethical principle is a nurse following when they keep a promise to a client to return
at a specific time to talk?
A. Fidelity
B. Justice
,C. Beneficence
D. Autonomy
Correct Answer: A
Expert Explanation: Fidelity refers to the obligation of the nurse to remain faithful to their
commitments and promises. It is a critical component in building trust within the
therapeutic relationship. By returning as promised, the nurse demonstrates reliability and
respect for the client.
3. A nurse observes a client pacing the hallway and breathing rapidly. The client states, ‘I feel
like something terrible is going to happen.’ The nurse should identify this as which level of
anxiety?
A. Mild
B. Moderate
C. Panic
D. Severe
Correct Answer: D
Expert Explanation: Severe anxiety is characterized by a greatly reduced perceptual field
and difficulty focusing on the environment. The client may experience physical symptoms
like rapid breathing and a sense of impending doom. Intervention is required to prevent
the client from escalating to a panic state.
, 4. A client is scheduled for an invasive procedure but refuses to sign the consent form. Which
ethical principle is the nurse upholding by respecting this decision?
A. Autonomy
B. Veracity
C. Nonmaleficence
D. Justice
Correct Answer: A
Expert Explanation: Autonomy is the right of the individual to make their own healthcare
decisions. This includes the right to refuse treatment even if the medical team believes it is
necessary. The nurse’s role is to ensure the client is informed and that their choice is
honored without coercion.
5. During a mental status examination, the nurse asks the client to explain the meaning of the
phrase, ‘Don’t cry over spilled milk.’ What is the nurse assessing?
A. Orientation
B. Memory
C. Attention span
D. Abstract thinking
Correct Answer: D
