NUR 256 Exam 1 V3 | NUR 256 Concepts
of Mental Health Nursing | Q&A with
Rationale (NUR256 Exam 1) | Galen
College of Nursing
1. A nurse is performing a mental status examination on a client. The client is able to state
their name, the date, and their current location. How should the nurse document this
finding?
A. Oriented x1
B. Oriented x3
C. Oriented x2
D. Oriented x4
Answer: B
Rationale: Orientation x3 refers to person, place, and time. If the client also knew the
specific situation, they would be documented as oriented x4. This assessment provides a
baseline for the client’s cognitive function and neurological status.
2. A client tells the nurse, ‘I am a failure and I can’t do anything right.’ Which response by the
nurse is an example of the therapeutic technique of reflecting?
A. Why do you feel like a failure?
B. Everyone makes mistakes sometimes.
,C. You feel as though you are not succeeding.
D. Let’s talk about the things you do well.
Answer: C
Rationale: Reflecting directs the client’s feelings or ideas back to the client for better
understanding. It validates the client’s emotions without giving advice or passing judgment.
This technique encourages the client to explore their own thoughts and feelings more
deeply.
3. Which ethical principle is involved when a nurse provides a client with all the information
needed to make an informed decision about their treatment?
A. Beneficence
B. Justice
C. Autonomy
D. Fidelity
Answer: C
Rationale: Autonomy is the right of the individual to make their own decisions regarding
health care. The nurse supports this by ensuring the client is fully informed and respects
their final choice. This principle is fundamental to the concept of self-determination in
mental health nursing.
, 4. A client is scheduled for an involuntary admission to a psychiatric unit. Which of the
following is a legal requirement for this type of admission?
A. The client must have a diagnosed personality disorder.
B. The client must agree to all treatment modalities.
C. The client must be unable to pay for outpatient services.
D. The client must be a danger to themselves or others.
Answer: D
Rationale: Involuntary admission is based on the state’s power to protect the public and
the individual from harm. Criteria usually include being a danger to self, danger to others,
or being unable to care for basic needs. The legal process requires specific documentation
and periodic judicial review to protect the client’s rights.
5. During a therapeutic session, the nurse remains silent after the client shares a painful
memory. What is the primary purpose of this silence?
A. To encourage the client to take the lead and process their thoughts.
B. To show the client that the nurse is tired of listening.
C. To indicate that the nurse disagrees with the client’s actions.
D. To allow the nurse time to chart the interaction.
Answer: A
of Mental Health Nursing | Q&A with
Rationale (NUR256 Exam 1) | Galen
College of Nursing
1. A nurse is performing a mental status examination on a client. The client is able to state
their name, the date, and their current location. How should the nurse document this
finding?
A. Oriented x1
B. Oriented x3
C. Oriented x2
D. Oriented x4
Answer: B
Rationale: Orientation x3 refers to person, place, and time. If the client also knew the
specific situation, they would be documented as oriented x4. This assessment provides a
baseline for the client’s cognitive function and neurological status.
2. A client tells the nurse, ‘I am a failure and I can’t do anything right.’ Which response by the
nurse is an example of the therapeutic technique of reflecting?
A. Why do you feel like a failure?
B. Everyone makes mistakes sometimes.
,C. You feel as though you are not succeeding.
D. Let’s talk about the things you do well.
Answer: C
Rationale: Reflecting directs the client’s feelings or ideas back to the client for better
understanding. It validates the client’s emotions without giving advice or passing judgment.
This technique encourages the client to explore their own thoughts and feelings more
deeply.
3. Which ethical principle is involved when a nurse provides a client with all the information
needed to make an informed decision about their treatment?
A. Beneficence
B. Justice
C. Autonomy
D. Fidelity
Answer: C
Rationale: Autonomy is the right of the individual to make their own decisions regarding
health care. The nurse supports this by ensuring the client is fully informed and respects
their final choice. This principle is fundamental to the concept of self-determination in
mental health nursing.
, 4. A client is scheduled for an involuntary admission to a psychiatric unit. Which of the
following is a legal requirement for this type of admission?
A. The client must have a diagnosed personality disorder.
B. The client must agree to all treatment modalities.
C. The client must be unable to pay for outpatient services.
D. The client must be a danger to themselves or others.
Answer: D
Rationale: Involuntary admission is based on the state’s power to protect the public and
the individual from harm. Criteria usually include being a danger to self, danger to others,
or being unable to care for basic needs. The legal process requires specific documentation
and periodic judicial review to protect the client’s rights.
5. During a therapeutic session, the nurse remains silent after the client shares a painful
memory. What is the primary purpose of this silence?
A. To encourage the client to take the lead and process their thoughts.
B. To show the client that the nurse is tired of listening.
C. To indicate that the nurse disagrees with the client’s actions.
D. To allow the nurse time to chart the interaction.
Answer: A
