Galen College of Nursing NUR 253 Final Exam (pdf) | 2026/2027 |
Mental Health Q&A | Mental Health Nursing
1. A client tells the nurse, "I feel like nobody cares if I live or die." Which
response is the best example of the therapeutic technique of "reflection"?
A) "You feel that nobody cares about you?"
B) "Why do you think you feel that people don't care?"
C) "Nobody cares?"
D) "Let's focus on your family; they care about you."
Correct Answer: "Nobody cares?"
Rationale: Reflection involves repeating the client's exact words or a key
phrase to encourage elaboration. Option A is paraphrasing, option B uses
"why," which can sound accusatory, and option D changes the subject.
2. The nurse is establishing a therapeutic alliance with a client. Which action
best promotes this relationship?
A) Giving direct advice to solve the client's problems quickly
B) Establishing mutual trust, respect, and collaboration with the patient
C) Maintaining a casual social friendship with the patient outside of sessions
D) Avoiding all discussions of negative emotions to keep the mood light
Correct Answer: Establishing mutual trust, respect, and collaboration with the
patient
Rationale: A therapeutic alliance is a professional, collaborative relationship
built on trust and respect. Giving advice promotes dependency, social
friendships are boundary violations, and avoiding negative feelings blocks
therapeutic progress.
,3. A client with schizophrenia refuses to take oral medication. The nurse
says, "If you don't take this pill right now, I am going to put you in four-point
restraints for the rest of the day." This is an example of:
A) Limit setting
B) A threat
C) Bargaining
D) Therapeutic holding
Correct Answer: A threat
Rationale: Threatening punishment is nontherapeutic, unethical, and may
constitute assault. Limit setting explains consequences calmly and clearly
without intimidation.
4. According to Hildegard Peplau's Interpersonal Relations Theory, during
which phase does the patient begin to identify problems to work on and
explore feelings?
A) Orientation phase
B) Working phase
C) Termination phase
D) Pre-interaction phase
Correct Answer: Working phase
Rationale: In the working phase, the patient actively explores problems,
identifies issues, and works toward change. The orientation phase is for
trust-building and setting expectations, while the termination phase is for
ending the relationship.
,5. A patient tells the nurse, "I'm not angry at my boss at all. My co-workers
are just too sensitive and overreact to everything." The nurse recognizes this
as which defense mechanism?
A) Projection
B) Rationalization
C) Displacement
D) Reaction formation
Correct Answer: Displacement
Rationale: Displacement involves transferring an emotion (anger) from the
original source (the boss) to a safer target (co-workers). Projection would be
accusing the boss of being angry, and reaction formation would be acting
overly nice to the boss.
6. A nursing student is studying the concept of a "therapeutic alliance."
Which action by the nurse best promotes this alliance?
A) Giving direct advice to solve the patient's problems quickly
B) Establishing mutual trust, respect, and collaboration with the patient
C) Maintaining a casual social friendship with the patient outside of sessions
D) Avoiding all discussions of negative emotions to keep the mood light
Correct Answer: Establishing mutual trust, respect, and collaboration with the
patient
Rationale: A therapeutic alliance is a professional, collaborative relationship
built on trust and respect. Giving advice promotes dependency, social
friendships are boundary violations, and avoiding negative feelings blocks
therapeutic progress.
, 7. A client states, "I don't want to take my antipsychotic medication because
it makes me feel like a zombie." Which is the most therapeutic response by
the nurse?
A) "You must take it or you will relapse and go back to the hospital."
B) "I understand. Let's talk to your provider about these side effects."
C) "That is a common side effect; you will get used to it."
D) "Would you like to try a different medication?"
Correct Answer: "I understand. Let's talk to your provider about these side
effects."
Rationale: This response validates the client's feelings and offers a
collaborative solution. It respects the client's autonomy while promoting
adherence by addressing the side effects with the provider.
8. The nurse is caring for a client who is using the defense mechanism of
denial. Which statement by the client is most consistent with this
mechanism?
A) "I only drink a little bit on the weekends. It's not a problem."
B) "I didn't get the job because the interviewer was biased against me."
C) "I'm not angry; I'm just disappointed."
D) "I can't remember anything about that day."
Correct Answer: "I only drink a little bit on the weekends. It's not a problem."
Rationale: Denial is the refusal to acknowledge the reality of a situation or
the existence of a problem. By stating their drinking is not a problem, the
patient is actively denying the reality of their alcohol use disorder.
Mental Health Q&A | Mental Health Nursing
1. A client tells the nurse, "I feel like nobody cares if I live or die." Which
response is the best example of the therapeutic technique of "reflection"?
A) "You feel that nobody cares about you?"
B) "Why do you think you feel that people don't care?"
C) "Nobody cares?"
D) "Let's focus on your family; they care about you."
Correct Answer: "Nobody cares?"
Rationale: Reflection involves repeating the client's exact words or a key
phrase to encourage elaboration. Option A is paraphrasing, option B uses
"why," which can sound accusatory, and option D changes the subject.
2. The nurse is establishing a therapeutic alliance with a client. Which action
best promotes this relationship?
A) Giving direct advice to solve the client's problems quickly
B) Establishing mutual trust, respect, and collaboration with the patient
C) Maintaining a casual social friendship with the patient outside of sessions
D) Avoiding all discussions of negative emotions to keep the mood light
Correct Answer: Establishing mutual trust, respect, and collaboration with the
patient
Rationale: A therapeutic alliance is a professional, collaborative relationship
built on trust and respect. Giving advice promotes dependency, social
friendships are boundary violations, and avoiding negative feelings blocks
therapeutic progress.
,3. A client with schizophrenia refuses to take oral medication. The nurse
says, "If you don't take this pill right now, I am going to put you in four-point
restraints for the rest of the day." This is an example of:
A) Limit setting
B) A threat
C) Bargaining
D) Therapeutic holding
Correct Answer: A threat
Rationale: Threatening punishment is nontherapeutic, unethical, and may
constitute assault. Limit setting explains consequences calmly and clearly
without intimidation.
4. According to Hildegard Peplau's Interpersonal Relations Theory, during
which phase does the patient begin to identify problems to work on and
explore feelings?
A) Orientation phase
B) Working phase
C) Termination phase
D) Pre-interaction phase
Correct Answer: Working phase
Rationale: In the working phase, the patient actively explores problems,
identifies issues, and works toward change. The orientation phase is for
trust-building and setting expectations, while the termination phase is for
ending the relationship.
,5. A patient tells the nurse, "I'm not angry at my boss at all. My co-workers
are just too sensitive and overreact to everything." The nurse recognizes this
as which defense mechanism?
A) Projection
B) Rationalization
C) Displacement
D) Reaction formation
Correct Answer: Displacement
Rationale: Displacement involves transferring an emotion (anger) from the
original source (the boss) to a safer target (co-workers). Projection would be
accusing the boss of being angry, and reaction formation would be acting
overly nice to the boss.
6. A nursing student is studying the concept of a "therapeutic alliance."
Which action by the nurse best promotes this alliance?
A) Giving direct advice to solve the patient's problems quickly
B) Establishing mutual trust, respect, and collaboration with the patient
C) Maintaining a casual social friendship with the patient outside of sessions
D) Avoiding all discussions of negative emotions to keep the mood light
Correct Answer: Establishing mutual trust, respect, and collaboration with the
patient
Rationale: A therapeutic alliance is a professional, collaborative relationship
built on trust and respect. Giving advice promotes dependency, social
friendships are boundary violations, and avoiding negative feelings blocks
therapeutic progress.
, 7. A client states, "I don't want to take my antipsychotic medication because
it makes me feel like a zombie." Which is the most therapeutic response by
the nurse?
A) "You must take it or you will relapse and go back to the hospital."
B) "I understand. Let's talk to your provider about these side effects."
C) "That is a common side effect; you will get used to it."
D) "Would you like to try a different medication?"
Correct Answer: "I understand. Let's talk to your provider about these side
effects."
Rationale: This response validates the client's feelings and offers a
collaborative solution. It respects the client's autonomy while promoting
adherence by addressing the side effects with the provider.
8. The nurse is caring for a client who is using the defense mechanism of
denial. Which statement by the client is most consistent with this
mechanism?
A) "I only drink a little bit on the weekends. It's not a problem."
B) "I didn't get the job because the interviewer was biased against me."
C) "I'm not angry; I'm just disappointed."
D) "I can't remember anything about that day."
Correct Answer: "I only drink a little bit on the weekends. It's not a problem."
Rationale: Denial is the refusal to acknowledge the reality of a situation or
the existence of a problem. By stating their drinking is not a problem, the
patient is actively denying the reality of their alcohol use disorder.
