NSG 3450 Mental Health Nursing – Exam 1 Practice Questions (1–40) Questions
with Correct DETAILED ANSWERs and Explanations
Domain 1: Foundations of Psychiatric-Mental Health Nursing
1. A nursing student asks the instructor, "What is the primary difference between
the DSM-5 and the nursing diagnosis?" Which response by the instructor is MOST
accurate?
A) "There is no real difference; both classify mental disorders."
B) "The DSM-5 provides diagnostic criteria for mental disorders used by all healthcare
professionals, while the nursing diagnosis describes the patient's response to the mental
disorder, which is what nurses treat."
C) "The DSM-5 is only used by psychiatrists, and nursing diagnosis is only used by
nurses."
D) "The nursing diagnosis replaces the DSM-5 in psychiatric settings."
Correct Answer: B) "The DSM-5 provides diagnostic criteria for mental disorders
used by all healthcare professionals, while the nursing diagnosis describes the
patient's response to the mental disorder, which is what nurses treat."
Explanation: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5) is the standard classification system used by mental health professionals in the
United States to diagnose psychiatric disorders based on specific criteria sets. It
describes what the patient has. The nursing diagnosis, according to NANDA-I, describes
human responses to health conditions and life processes that nurses are licensed and
competent to treat. It focuses on what the patient experiences as a result of the illness.
,For example, a DSM-5 diagnosis of "Major Depressive Disorder, Single Episode,
Moderate" might correspond to nursing diagnoses like "Hopelessness," "Social
Isolation," or "Imbalanced Nutrition: Less Than Body Requirements."
2. A patient tells the nurse, "I'm not going to talk to you. You're a student nurse,
and I only want to talk to the real doctor." According to Peplau's theory, what
phase of the nurse-patient relationship is MOST challenged by this statement?
A) Termination phase
B) Working phase
C) Orientation phase
D) Pre-interaction phase
Correct Answer: C) Orientation phase
Explanation: Hildegard Peplau's Interpersonal Relations Theory identifies four phases:
(1) Pre-interaction – nurse prepares before meeting the patient; (2) Orientation – nurse
and patient meet, establish rapport, set boundaries, and clarify roles; (3) Working –
therapeutic work occurs through sub-roles (teacher, counselor, surrogate); (4)
Termination – relationship ends and goals are evaluated. The patient's statement
challenges the orientation phase because they are questioning the nurse's role and
credibility. The nurse's task during this phase is to establish trust and define the
professional role, which may require acknowledging the patient's feelings and clarifying
the nursing role.
,3. A psychiatric-mental health nurse is practicing at the advanced practice level.
Which function is EXCLUSIVE to the advanced practice registered nurse (APRN-
PMH) and NOT within the scope of the registered nurse (RN-PMH)?
A) Establishing a therapeutic relationship.
B) Administering and monitoring psychotropic medications.
C) Diagnosing a mental disorder and prescribing treatment, including pharmacotherapy.
D) Leading a psychoeducational group on stress management.
Correct Answer: C) Diagnosing a mental disorder and prescribing treatment,
including pharmacotherapy.
Explanation: The psychiatric-mental health clinical nurse specialist (PMH-CNS) or
psychiatric-mental health nurse practitioner (PMH-NP) holds a master's or doctoral
degree with specialized training. The advanced practice role includes the authority to
diagnose mental disorders using the DSM-5, provide individual and group
psychotherapy, and prescribe pharmacological treatments (with prescriptive authority,
dependent on state law). The RN-PMH can establish therapeutic relationships,
administer medications (with an order), lead psychoeducational groups, and implement
the nursing plan of care, but cannot independently diagnose or prescribe.
4. According to Maslow's Hierarchy of Needs, a patient with active suicidal
ideation and a specific plan should be prioritized at which level of need?
A) Self-actualization
B) Esteem
C) Love and belonging
D) Safety and security
Correct Answer: D) Safety and security
, Explanation: Maslow's hierarchy (from base to apex) is: Physiological needs → Safety
and Security → Love and Belonging → Esteem → Self-actualization. Lower-level needs
must be addressed before higher-level needs can be met. A patient with active suicidal
ideation has a deficit in the safety and security level. The immediate priority is to ensure
the patient is physically safe (suicide precautions, continuous observation, removing
potentially harmful objects). Addressing love and belonging or self-esteem issues is
inappropriate until safety is established.
5. The nurse is admitting a patient who identifies as a member of the Native
American culture. The patient is accompanied by a tribal elder who wishes to
perform a healing ceremony in the patient's room. What is the nurse's BEST
response?
A) "I'm sorry, but hospital policy prohibits any ceremonies that involve burning
materials."
B) "I will need to check with the healthcare provider to see if this is medically approved."
C) "Tell me more about the ceremony and what it involves so we can work together to
accommodate your cultural and spiritual needs safely."
D) "This is not evidence-based practice, so I would discourage it."
Correct Answer: C) "Tell me more about the ceremony and what it involves so we
can work together to accommodate your cultural and spiritual needs safely."
Explanation: Culturally competent care requires the nurse to avoid ethnocentrism and
demonstrate cultural humility. The nurse should explore the request openly and
respectfully. If the ceremony involves elements that pose a fire or safety risk (e.g.,
smudging with sage), the nurse can negotiate a safe alternative (e.g., using an electric
candle, performing the ceremony in a designated area). The goal is to integrate the
with Correct DETAILED ANSWERs and Explanations
Domain 1: Foundations of Psychiatric-Mental Health Nursing
1. A nursing student asks the instructor, "What is the primary difference between
the DSM-5 and the nursing diagnosis?" Which response by the instructor is MOST
accurate?
A) "There is no real difference; both classify mental disorders."
B) "The DSM-5 provides diagnostic criteria for mental disorders used by all healthcare
professionals, while the nursing diagnosis describes the patient's response to the mental
disorder, which is what nurses treat."
C) "The DSM-5 is only used by psychiatrists, and nursing diagnosis is only used by
nurses."
D) "The nursing diagnosis replaces the DSM-5 in psychiatric settings."
Correct Answer: B) "The DSM-5 provides diagnostic criteria for mental disorders
used by all healthcare professionals, while the nursing diagnosis describes the
patient's response to the mental disorder, which is what nurses treat."
Explanation: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
(DSM-5) is the standard classification system used by mental health professionals in the
United States to diagnose psychiatric disorders based on specific criteria sets. It
describes what the patient has. The nursing diagnosis, according to NANDA-I, describes
human responses to health conditions and life processes that nurses are licensed and
competent to treat. It focuses on what the patient experiences as a result of the illness.
,For example, a DSM-5 diagnosis of "Major Depressive Disorder, Single Episode,
Moderate" might correspond to nursing diagnoses like "Hopelessness," "Social
Isolation," or "Imbalanced Nutrition: Less Than Body Requirements."
2. A patient tells the nurse, "I'm not going to talk to you. You're a student nurse,
and I only want to talk to the real doctor." According to Peplau's theory, what
phase of the nurse-patient relationship is MOST challenged by this statement?
A) Termination phase
B) Working phase
C) Orientation phase
D) Pre-interaction phase
Correct Answer: C) Orientation phase
Explanation: Hildegard Peplau's Interpersonal Relations Theory identifies four phases:
(1) Pre-interaction – nurse prepares before meeting the patient; (2) Orientation – nurse
and patient meet, establish rapport, set boundaries, and clarify roles; (3) Working –
therapeutic work occurs through sub-roles (teacher, counselor, surrogate); (4)
Termination – relationship ends and goals are evaluated. The patient's statement
challenges the orientation phase because they are questioning the nurse's role and
credibility. The nurse's task during this phase is to establish trust and define the
professional role, which may require acknowledging the patient's feelings and clarifying
the nursing role.
,3. A psychiatric-mental health nurse is practicing at the advanced practice level.
Which function is EXCLUSIVE to the advanced practice registered nurse (APRN-
PMH) and NOT within the scope of the registered nurse (RN-PMH)?
A) Establishing a therapeutic relationship.
B) Administering and monitoring psychotropic medications.
C) Diagnosing a mental disorder and prescribing treatment, including pharmacotherapy.
D) Leading a psychoeducational group on stress management.
Correct Answer: C) Diagnosing a mental disorder and prescribing treatment,
including pharmacotherapy.
Explanation: The psychiatric-mental health clinical nurse specialist (PMH-CNS) or
psychiatric-mental health nurse practitioner (PMH-NP) holds a master's or doctoral
degree with specialized training. The advanced practice role includes the authority to
diagnose mental disorders using the DSM-5, provide individual and group
psychotherapy, and prescribe pharmacological treatments (with prescriptive authority,
dependent on state law). The RN-PMH can establish therapeutic relationships,
administer medications (with an order), lead psychoeducational groups, and implement
the nursing plan of care, but cannot independently diagnose or prescribe.
4. According to Maslow's Hierarchy of Needs, a patient with active suicidal
ideation and a specific plan should be prioritized at which level of need?
A) Self-actualization
B) Esteem
C) Love and belonging
D) Safety and security
Correct Answer: D) Safety and security
, Explanation: Maslow's hierarchy (from base to apex) is: Physiological needs → Safety
and Security → Love and Belonging → Esteem → Self-actualization. Lower-level needs
must be addressed before higher-level needs can be met. A patient with active suicidal
ideation has a deficit in the safety and security level. The immediate priority is to ensure
the patient is physically safe (suicide precautions, continuous observation, removing
potentially harmful objects). Addressing love and belonging or self-esteem issues is
inappropriate until safety is established.
5. The nurse is admitting a patient who identifies as a member of the Native
American culture. The patient is accompanied by a tribal elder who wishes to
perform a healing ceremony in the patient's room. What is the nurse's BEST
response?
A) "I'm sorry, but hospital policy prohibits any ceremonies that involve burning
materials."
B) "I will need to check with the healthcare provider to see if this is medically approved."
C) "Tell me more about the ceremony and what it involves so we can work together to
accommodate your cultural and spiritual needs safely."
D) "This is not evidence-based practice, so I would discourage it."
Correct Answer: C) "Tell me more about the ceremony and what it involves so we
can work together to accommodate your cultural and spiritual needs safely."
Explanation: Culturally competent care requires the nurse to avoid ethnocentrism and
demonstrate cultural humility. The nurse should explore the request openly and
respectfully. If the ceremony involves elements that pose a fire or safety risk (e.g.,
smudging with sage), the nurse can negotiate a safe alternative (e.g., using an electric
candle, performing the ceremony in a designated area). The goal is to integrate the
