NUR 253 EXAM 3 | ACTUAL TEST QUESTIONS AND
ANSWERS | 2026 UPDATE | 100% CORRECT - GALEN
COLLEGE OF NURSING
Core Domains:
1. Therapeutic Communication and Nurse-Patient Relationship
2. Anxiety Disorders and Stress-Related Disorders
3. Mood Disorders: Depression and Bipolar Disorder
4. Psychotic Disorders: Schizophrenia and Related Conditions
5. Personality Disorders and Impulse Control
6. Substance Use Disorders and Dual Diagnosis
7. Psychopharmacology: Antidepressants, Mood Stabilizers, Antipsychotics,
Anxiolytics
8. Crisis Intervention and Suicide Prevention
9. Legal and Ethical Issues in Mental Health Nursing
10. Neurocognitive Disorders and Geriatric Psychiatry
This examination is designed to assess the essential mental health nursing
competencies required for NUR 253 at Galen College of Nursing. It focuses on the
application of the nursing process in the care of clients experiencing psychiatric
and mental health disorders across the lifespan. The exam consists of 150
multiple-choice questions that integrate theoretical knowledge with clinical
scenarios, challenging you to prioritize care, apply therapeutic communication
techniques, and manage complex psychopharmacological regimens. You will be
tested on your ability to recognize signs and symptoms of major psychiatric
disorders, implement appropriate nursing interventions, evaluate patient
responses to treatment, and navigate legal and ethical dilemmas. Each question is
accompanied by a detailed RATIONALE to reinforce critical thinking and
evidence-based RATIONALE . Mastering this material will prepare you not only for
Exam 3 but also for safe, compassionate, and effective mental health nursing
practice.
,SECTION ONE: QUESTIONS 1–150
1. A nurse is caring for a client with major depressive disorder who states,
"I'm a burden to everyone. They'd be better off without me." What is the
nurse's priority response?
A. "That's not true; you have so much to live for."
B. "Why do you feel that way?"
C. "Are you thinking about harming yourself?"
D. "Let's focus on the positive things in your life."
RATIONALE : The client's statement indicates potential suicidal
ideation. The priority is to directly assess for suicide risk by asking a clear,
direct question about thoughts of self-harm. Reassurance or focusing on
positives may dismiss the client's feelings, and asking "why" can be
perceived as judgmental.
2. A client with schizophrenia is experiencing auditory hallucinations telling
them to harm staff. Which nursing intervention is most appropriate?
A. Tell the client the voices are not real and to ignore them.
B. Leave the client alone to prevent escalation.
C. Provide a safe environment, acknowledge the client's distress, and
redirect to reality-based activities.
D. Argue with the client about the content of the hallucinations.
RATIONALE : Safety is the priority. The nurse should acknowledge the
client's distress without reinforcing the hallucination ("I understand you're
hearing voices that are frightening") and then redirect to a calming, reality-
based activity. Arguing or dismissing increases anxiety. The client should
not be left alone if they are at risk.
3. A client taking lithium for bipolar disorder has a serum lithium level of 1.8
mEq/L. The nurse should assess for which signs of toxicity?
A. Sedation and constipation
B. Coarse tremor, confusion, and severe diarrhea
C. Hypersalivation and bradycardia
D. Weight loss and hypertension
, RATIONALE : Lithium levels above 1.5 mEq/L indicate toxicity.
Symptoms include coarse tremor, persistent gastrointestinal upset (severe
diarrhea, vomiting), confusion, ataxia, and muscle weakness. Sedation and
constipation are not typical; fine tremor is common at therapeutic levels.
4. A nurse is using therapeutic communication with a client who has
borderline personality disorder. The client frequently makes demands and
then becomes angry when they are not immediately met. Which approach
is most effective?
A. Confront the client about their manipulative behavior.
B. Allow the client to have whatever they request to avoid conflict.
C. Set clear, consistent limits using a calm, matter-of-fact approach.
D. Ignore the demands until the client calms down.
RATIONALE : Limit-setting is essential with clients who have borderline
personality disorder to maintain boundaries and reduce manipulation. The
approach should be firm, consistent, and non-punitive. Ignoring or granting
demands reinforces maladaptive behaviors; confrontation may escalate the
situation.
5. Which of the following is a positive symptom of schizophrenia?
A. Alogia
B. Avolition
C. Delusions
D. Affective flattening
RATIONALE : Positive symptoms reflect an excess or distortion of
normal functions and include hallucinations, delusions, disorganized
speech, and bizarre behavior. Alogia, avolition, and affective flattening are
negative symptoms (diminution or loss of normal functions).
6. A client with generalized anxiety disorder (GAD) is started on buspirone.
What is an important teaching point for the nurse to include?
A. "This medication will provide immediate relief of anxiety."
B. "You should take this medication on an as-needed basis."
C. "It may take 2 to 4 weeks to achieve the full therapeutic effect."
D. "This medication carries a high risk of dependence."
RATIONALE : Buspirone is a non-benzodiazepine anxiolytic that
, requires 2-4 weeks for full therapeutic effect. It is not for as-needed use,
does not cause dependence like benzodiazepines, and does not provide
immediate relief.
7. A nurse is assessing a client admitted with anorexia nervosa. Which finding
is most concerning and requires immediate intervention?
A. BMI of 17.0 kg/m²
B. Amenorrhea for 3 months
C. Serum potassium of 2.9 mEq/L
D. Fine lanugo hair on the body
RATIONALE : Hypokalemia (potassium <3.5 mEq/L) can cause life-
threatening cardiac arrhythmias and requires immediate medical
intervention. While low BMI, amenorrhea, and lanugo are signs of anorexia,
severe electrolyte imbalance is the priority.
8. A client with bipolar I disorder is in a manic episode. They are hyperverbal,
grandiose, and have not slept for 3 days. Which nursing intervention is the
priority?
A. Engage the client in a competitive group activity to expend energy.
B. Provide a stimulating environment with bright lights.
C. Offer high-calorie finger foods and fluids, and provide a quiet, low-
stimulation environment.
D. Encourage the client to process their feelings about their behavior.
RATIONALE : During acute mania, the priority is maintaining physical
safety and nutrition. The client is at risk for exhaustion and dehydration.
High-calorie foods that can be eaten on the go, a quiet environment, and
limiting stimulation are essential. Insight and group activities are unrealistic
during acute mania.
9. A client with depression is started on fluoxetine. Two weeks later, the client
reports feeling more energetic but still depressed. What is the nurse's
priority concern?
A. The client is not responding to the medication.
B. The client may be at increased risk for suicide.
C. The medication dose needs to be doubled.
D. The client should switch to a different SSRI immediately.
ANSWERS | 2026 UPDATE | 100% CORRECT - GALEN
COLLEGE OF NURSING
Core Domains:
1. Therapeutic Communication and Nurse-Patient Relationship
2. Anxiety Disorders and Stress-Related Disorders
3. Mood Disorders: Depression and Bipolar Disorder
4. Psychotic Disorders: Schizophrenia and Related Conditions
5. Personality Disorders and Impulse Control
6. Substance Use Disorders and Dual Diagnosis
7. Psychopharmacology: Antidepressants, Mood Stabilizers, Antipsychotics,
Anxiolytics
8. Crisis Intervention and Suicide Prevention
9. Legal and Ethical Issues in Mental Health Nursing
10. Neurocognitive Disorders and Geriatric Psychiatry
This examination is designed to assess the essential mental health nursing
competencies required for NUR 253 at Galen College of Nursing. It focuses on the
application of the nursing process in the care of clients experiencing psychiatric
and mental health disorders across the lifespan. The exam consists of 150
multiple-choice questions that integrate theoretical knowledge with clinical
scenarios, challenging you to prioritize care, apply therapeutic communication
techniques, and manage complex psychopharmacological regimens. You will be
tested on your ability to recognize signs and symptoms of major psychiatric
disorders, implement appropriate nursing interventions, evaluate patient
responses to treatment, and navigate legal and ethical dilemmas. Each question is
accompanied by a detailed RATIONALE to reinforce critical thinking and
evidence-based RATIONALE . Mastering this material will prepare you not only for
Exam 3 but also for safe, compassionate, and effective mental health nursing
practice.
,SECTION ONE: QUESTIONS 1–150
1. A nurse is caring for a client with major depressive disorder who states,
"I'm a burden to everyone. They'd be better off without me." What is the
nurse's priority response?
A. "That's not true; you have so much to live for."
B. "Why do you feel that way?"
C. "Are you thinking about harming yourself?"
D. "Let's focus on the positive things in your life."
RATIONALE : The client's statement indicates potential suicidal
ideation. The priority is to directly assess for suicide risk by asking a clear,
direct question about thoughts of self-harm. Reassurance or focusing on
positives may dismiss the client's feelings, and asking "why" can be
perceived as judgmental.
2. A client with schizophrenia is experiencing auditory hallucinations telling
them to harm staff. Which nursing intervention is most appropriate?
A. Tell the client the voices are not real and to ignore them.
B. Leave the client alone to prevent escalation.
C. Provide a safe environment, acknowledge the client's distress, and
redirect to reality-based activities.
D. Argue with the client about the content of the hallucinations.
RATIONALE : Safety is the priority. The nurse should acknowledge the
client's distress without reinforcing the hallucination ("I understand you're
hearing voices that are frightening") and then redirect to a calming, reality-
based activity. Arguing or dismissing increases anxiety. The client should
not be left alone if they are at risk.
3. A client taking lithium for bipolar disorder has a serum lithium level of 1.8
mEq/L. The nurse should assess for which signs of toxicity?
A. Sedation and constipation
B. Coarse tremor, confusion, and severe diarrhea
C. Hypersalivation and bradycardia
D. Weight loss and hypertension
, RATIONALE : Lithium levels above 1.5 mEq/L indicate toxicity.
Symptoms include coarse tremor, persistent gastrointestinal upset (severe
diarrhea, vomiting), confusion, ataxia, and muscle weakness. Sedation and
constipation are not typical; fine tremor is common at therapeutic levels.
4. A nurse is using therapeutic communication with a client who has
borderline personality disorder. The client frequently makes demands and
then becomes angry when they are not immediately met. Which approach
is most effective?
A. Confront the client about their manipulative behavior.
B. Allow the client to have whatever they request to avoid conflict.
C. Set clear, consistent limits using a calm, matter-of-fact approach.
D. Ignore the demands until the client calms down.
RATIONALE : Limit-setting is essential with clients who have borderline
personality disorder to maintain boundaries and reduce manipulation. The
approach should be firm, consistent, and non-punitive. Ignoring or granting
demands reinforces maladaptive behaviors; confrontation may escalate the
situation.
5. Which of the following is a positive symptom of schizophrenia?
A. Alogia
B. Avolition
C. Delusions
D. Affective flattening
RATIONALE : Positive symptoms reflect an excess or distortion of
normal functions and include hallucinations, delusions, disorganized
speech, and bizarre behavior. Alogia, avolition, and affective flattening are
negative symptoms (diminution or loss of normal functions).
6. A client with generalized anxiety disorder (GAD) is started on buspirone.
What is an important teaching point for the nurse to include?
A. "This medication will provide immediate relief of anxiety."
B. "You should take this medication on an as-needed basis."
C. "It may take 2 to 4 weeks to achieve the full therapeutic effect."
D. "This medication carries a high risk of dependence."
RATIONALE : Buspirone is a non-benzodiazepine anxiolytic that
, requires 2-4 weeks for full therapeutic effect. It is not for as-needed use,
does not cause dependence like benzodiazepines, and does not provide
immediate relief.
7. A nurse is assessing a client admitted with anorexia nervosa. Which finding
is most concerning and requires immediate intervention?
A. BMI of 17.0 kg/m²
B. Amenorrhea for 3 months
C. Serum potassium of 2.9 mEq/L
D. Fine lanugo hair on the body
RATIONALE : Hypokalemia (potassium <3.5 mEq/L) can cause life-
threatening cardiac arrhythmias and requires immediate medical
intervention. While low BMI, amenorrhea, and lanugo are signs of anorexia,
severe electrolyte imbalance is the priority.
8. A client with bipolar I disorder is in a manic episode. They are hyperverbal,
grandiose, and have not slept for 3 days. Which nursing intervention is the
priority?
A. Engage the client in a competitive group activity to expend energy.
B. Provide a stimulating environment with bright lights.
C. Offer high-calorie finger foods and fluids, and provide a quiet, low-
stimulation environment.
D. Encourage the client to process their feelings about their behavior.
RATIONALE : During acute mania, the priority is maintaining physical
safety and nutrition. The client is at risk for exhaustion and dehydration.
High-calorie foods that can be eaten on the go, a quiet environment, and
limiting stimulation are essential. Insight and group activities are unrealistic
during acute mania.
9. A client with depression is started on fluoxetine. Two weeks later, the client
reports feeling more energetic but still depressed. What is the nurse's
priority concern?
A. The client is not responding to the medication.
B. The client may be at increased risk for suicide.
C. The medication dose needs to be doubled.
D. The client should switch to a different SSRI immediately.
