NSG 3450 / NSG3450 (Latest ) LATEST
EDITION WITH CORRECT
ANSWERS/VERIFIED/GRADED A+/
Domain: Therapeutic Communication and Nursing Process
1. A patient with major depressive disorder states, "I’m just a burden to my family. They would be better
off without me." Which of the following is the most therapeutic response by the nurse?
A) "Don't say that. Your family loves you very much and needs you."
B) "You have a lot to live for, and things will get better soon."
C) "It sounds like you are feeling very hopeless and that your family would be better off without you."
D) "Why do you feel like a burden to your family?"
Answer: C
Rationale: This response uses the therapeutic technique of restating and reflecting the patient's feelings,
which validates their experience and encourages further exploration. Option A and B offer false
reassurance and minimize the patient's feelings. Option D asks a "why" question, which can make the
patient feel defensive or judged.
2. A patient experiencing a panic attack is hyperventilating and states, "I can't breathe, I'm going to die!"
What is the nurse's priority intervention?
A) Administer a PRN dose of lorazepam immediately.
B) Stay with the patient, speak in a calm, short, and simple manner, and guide them through slow, deep
breathing.
C) Ask the patient to identify the underlying psychological cause of the panic attack.
D) Leave the room to get the patient a cup of water to help them swallow.
Answer: B
Rationale: During a panic attack, the patient's cognitive ability to process complex information is
severely impaired. The priority is to ensure safety and provide grounding. Staying with the patient and
using a calm, simple voice to guide breathing helps reduce hyperventilation and provides a sense of
,security. Asking "why" (Option C) is non-therapeutic during acute anxiety, and leaving the patient alone
(Option D) increases fear and abandonment.
3. The nurse is assessing a patient's thought processes. The patient rapidly shifts from one topic to
another, and the topics are loosely connected but still somewhat understandable. The nurse should
document this as:
A) Flight of ideas
B) Word salad
C) Tangentiality
D) Circumstantiality
Answer: A
Rationale: Flight of ideas is characterized by rapid, continuous speech with abrupt shifts from one topic
to another, though the topics are usually connected by discernible links (e.g., rhyming or puns). Word
salad is a jumble of incomprehensible words. Tangentiality is wandering off the topic and never
returning to the original point. Circumstantiality includes excessive, unnecessary details but eventually
returns to the original point.
4. A patient newly prescribed an SSRI (e.g., sertraline) asks, "When will I start feeling better?" What is
the most accurate response by the nurse?
A) "You should notice a significant improvement in your mood within 24 to 48 hours."
B) "It typically takes 2 to 4 weeks to begin noticing an improvement in mood, and up to 6 to 8 weeks for
the full therapeutic effect."
C) "The medication works immediately, but the side effects will last for a few weeks."
D) "If you don't feel better in one week, we will double the dose."
Answer: B
Rationale: SSRIs take time to alter neurotransmitter levels and receptor sensitivity in the brain. Patients
must be educated that it typically takes 2 to 4 weeks to notice initial improvements and up to 6 to 8
weeks for the full therapeutic effect. Educating the patient on this timeline is crucial to prevent
premature discontinuation of the medication.
5. A patient with severe depression is admitted to the psychiatric unit. Which of the following nursing
interventions is the highest priority?
,A) Encouraging the patient to participate in group therapy.
B) Placing the patient on 15-minute suicide observation checks.
C) Assisting the patient with activities of daily living (ADLs).
D) Educating the patient about the side effects of antidepressants.
Answer: B
Rationale: Safety is always the highest priority in psychiatric nursing. A patient with severe depression is
at a high risk for suicide. Implementing close observation (e.g., 15-minute checks or 1:1 observation,
depending on the assessed risk) is the priority intervention to ensure the patient's physical safety before
addressing ADLs, therapy, or education.
Domain: Legal and Ethical Issues in Mental Health
6. A patient is brought to the emergency department by police after threatening to harm their neighbor.
The patient is voluntarily agreeing to be admitted to the psychiatric unit. What is the most appropriate
action by the nurse?
A) Initiate involuntary commitment paperwork immediately.
B) Accept the voluntary admission, as the patient is willing to sign in and is not currently an imminent
danger to self or others while in the hospital.
C) Restrain the patient to prevent them from leaving.
D) Refuse admission because the patient made a threat.
Answer: B
Rationale: Voluntary admission is the least restrictive alternative and is preferred when the patient is
willing to seek treatment and does not meet the strict criteria for involuntary commitment (which
requires being an imminent danger to self or others, or gravely disabled). Since the patient is agreeing to
admission, voluntary status is appropriate.
7. A patient tells the nurse, "I'm going to kill my boss when I get out of here, and I know exactly how I'm
going to do it." What is the nurse's legal and ethical obligation?
A) Maintain confidentiality, as the nurse-patient relationship is privileged.
B) Document the statement in the chart but take no further action to preserve trust.
C) Notify the healthcare provider and the intended victim (or law enforcement), fulfilling the "duty to
warn/protect."
, D) Administer a PRN antipsychotic medication to calm the patient down.
Answer: C
Rationale: Under the Tarasoff ruling and subsequent laws, mental health professionals have a "duty to
warn" or "duty to protect" an identifiable third party when a patient makes a specific, credible threat of
violence against them. This is a legal exception to patient confidentiality.
8. Which of the following scenarios best illustrates the ethical principle of "beneficence" in psychiatric
nursing?
A) Respecting a patient's right to refuse a medication after being fully informed of the risks.
B) Ensuring that the distribution of nursing care is fair and equitable among all patients on the unit.
C) Taking action to prevent a patient from harming themselves by removing dangerous objects from
their room.
D) Telling the truth to a patient about their diagnosis, even if it is distressing.
Answer: C
Rationale: Beneficence is the ethical duty to do good and take positive actions to help others, including
preventing harm. Removing dangerous objects to prevent self-harm is a direct action to promote the
patient's well-being. Option A is autonomy, Option B is justice, and Option D is veracity.
9. A patient is placed in seclusion due to aggressive, violent behavior toward staff. What is the required
nursing intervention while the patient is in seclusion?
A) Check on the patient every 2 hours and provide meals at the door.
B) Continuously monitor the patient via video or direct line-of-sight, and assess vital signs and physical
needs every 15 minutes (or per facility policy).
C) Leave the patient alone until they verbally apologize to the staff.
D) Administer IM medication only if the patient requests it.
Answer: B
Rationale: Seclusion is a highly restrictive intervention. Regulatory bodies (like The Joint Commission and
CMS) mandate continuous monitoring (direct line-of-sight or video) and frequent assessments (at least
every 15 minutes) of the patient's physical and psychological status, including vital signs, hydration, and
toileting needs, to ensure their safety and dignity.
10. A patient with schizophrenia has a valid, legally executed psychiatric advance directive stating they
EDITION WITH CORRECT
ANSWERS/VERIFIED/GRADED A+/
Domain: Therapeutic Communication and Nursing Process
1. A patient with major depressive disorder states, "I’m just a burden to my family. They would be better
off without me." Which of the following is the most therapeutic response by the nurse?
A) "Don't say that. Your family loves you very much and needs you."
B) "You have a lot to live for, and things will get better soon."
C) "It sounds like you are feeling very hopeless and that your family would be better off without you."
D) "Why do you feel like a burden to your family?"
Answer: C
Rationale: This response uses the therapeutic technique of restating and reflecting the patient's feelings,
which validates their experience and encourages further exploration. Option A and B offer false
reassurance and minimize the patient's feelings. Option D asks a "why" question, which can make the
patient feel defensive or judged.
2. A patient experiencing a panic attack is hyperventilating and states, "I can't breathe, I'm going to die!"
What is the nurse's priority intervention?
A) Administer a PRN dose of lorazepam immediately.
B) Stay with the patient, speak in a calm, short, and simple manner, and guide them through slow, deep
breathing.
C) Ask the patient to identify the underlying psychological cause of the panic attack.
D) Leave the room to get the patient a cup of water to help them swallow.
Answer: B
Rationale: During a panic attack, the patient's cognitive ability to process complex information is
severely impaired. The priority is to ensure safety and provide grounding. Staying with the patient and
using a calm, simple voice to guide breathing helps reduce hyperventilation and provides a sense of
,security. Asking "why" (Option C) is non-therapeutic during acute anxiety, and leaving the patient alone
(Option D) increases fear and abandonment.
3. The nurse is assessing a patient's thought processes. The patient rapidly shifts from one topic to
another, and the topics are loosely connected but still somewhat understandable. The nurse should
document this as:
A) Flight of ideas
B) Word salad
C) Tangentiality
D) Circumstantiality
Answer: A
Rationale: Flight of ideas is characterized by rapid, continuous speech with abrupt shifts from one topic
to another, though the topics are usually connected by discernible links (e.g., rhyming or puns). Word
salad is a jumble of incomprehensible words. Tangentiality is wandering off the topic and never
returning to the original point. Circumstantiality includes excessive, unnecessary details but eventually
returns to the original point.
4. A patient newly prescribed an SSRI (e.g., sertraline) asks, "When will I start feeling better?" What is
the most accurate response by the nurse?
A) "You should notice a significant improvement in your mood within 24 to 48 hours."
B) "It typically takes 2 to 4 weeks to begin noticing an improvement in mood, and up to 6 to 8 weeks for
the full therapeutic effect."
C) "The medication works immediately, but the side effects will last for a few weeks."
D) "If you don't feel better in one week, we will double the dose."
Answer: B
Rationale: SSRIs take time to alter neurotransmitter levels and receptor sensitivity in the brain. Patients
must be educated that it typically takes 2 to 4 weeks to notice initial improvements and up to 6 to 8
weeks for the full therapeutic effect. Educating the patient on this timeline is crucial to prevent
premature discontinuation of the medication.
5. A patient with severe depression is admitted to the psychiatric unit. Which of the following nursing
interventions is the highest priority?
,A) Encouraging the patient to participate in group therapy.
B) Placing the patient on 15-minute suicide observation checks.
C) Assisting the patient with activities of daily living (ADLs).
D) Educating the patient about the side effects of antidepressants.
Answer: B
Rationale: Safety is always the highest priority in psychiatric nursing. A patient with severe depression is
at a high risk for suicide. Implementing close observation (e.g., 15-minute checks or 1:1 observation,
depending on the assessed risk) is the priority intervention to ensure the patient's physical safety before
addressing ADLs, therapy, or education.
Domain: Legal and Ethical Issues in Mental Health
6. A patient is brought to the emergency department by police after threatening to harm their neighbor.
The patient is voluntarily agreeing to be admitted to the psychiatric unit. What is the most appropriate
action by the nurse?
A) Initiate involuntary commitment paperwork immediately.
B) Accept the voluntary admission, as the patient is willing to sign in and is not currently an imminent
danger to self or others while in the hospital.
C) Restrain the patient to prevent them from leaving.
D) Refuse admission because the patient made a threat.
Answer: B
Rationale: Voluntary admission is the least restrictive alternative and is preferred when the patient is
willing to seek treatment and does not meet the strict criteria for involuntary commitment (which
requires being an imminent danger to self or others, or gravely disabled). Since the patient is agreeing to
admission, voluntary status is appropriate.
7. A patient tells the nurse, "I'm going to kill my boss when I get out of here, and I know exactly how I'm
going to do it." What is the nurse's legal and ethical obligation?
A) Maintain confidentiality, as the nurse-patient relationship is privileged.
B) Document the statement in the chart but take no further action to preserve trust.
C) Notify the healthcare provider and the intended victim (or law enforcement), fulfilling the "duty to
warn/protect."
, D) Administer a PRN antipsychotic medication to calm the patient down.
Answer: C
Rationale: Under the Tarasoff ruling and subsequent laws, mental health professionals have a "duty to
warn" or "duty to protect" an identifiable third party when a patient makes a specific, credible threat of
violence against them. This is a legal exception to patient confidentiality.
8. Which of the following scenarios best illustrates the ethical principle of "beneficence" in psychiatric
nursing?
A) Respecting a patient's right to refuse a medication after being fully informed of the risks.
B) Ensuring that the distribution of nursing care is fair and equitable among all patients on the unit.
C) Taking action to prevent a patient from harming themselves by removing dangerous objects from
their room.
D) Telling the truth to a patient about their diagnosis, even if it is distressing.
Answer: C
Rationale: Beneficence is the ethical duty to do good and take positive actions to help others, including
preventing harm. Removing dangerous objects to prevent self-harm is a direct action to promote the
patient's well-being. Option A is autonomy, Option B is justice, and Option D is veracity.
9. A patient is placed in seclusion due to aggressive, violent behavior toward staff. What is the required
nursing intervention while the patient is in seclusion?
A) Check on the patient every 2 hours and provide meals at the door.
B) Continuously monitor the patient via video or direct line-of-sight, and assess vital signs and physical
needs every 15 minutes (or per facility policy).
C) Leave the patient alone until they verbally apologize to the staff.
D) Administer IM medication only if the patient requests it.
Answer: B
Rationale: Seclusion is a highly restrictive intervention. Regulatory bodies (like The Joint Commission and
CMS) mandate continuous monitoring (direct line-of-sight or video) and frequent assessments (at least
every 15 minutes) of the patient's physical and psychological status, including vital signs, hydration, and
toileting needs, to ensure their safety and dignity.
10. A patient with schizophrenia has a valid, legally executed psychiatric advance directive stating they
