NUR 253 Exam 1 Actual Exam V2 | NUR 253 Mental Health Nursing
(NUR253 Exam 1) | Galen College of Nursing
1. A nurse is conducting a mental status examination (MSE) on a newly admitted client. The
nurse notes that the client repeats the last word of every sentence the nurse speaks. Which
term should the nurse use to document this finding?
A. Echolalia
B. Neologism
C. Word salad
D. Clang association
Answer: A
Rationale: Echolalia is the pathological repeating of another’s words and is often seen in
autism or schizophrenia. Neologisms are made-up words that have meaning only to the
client, while word salad is a jumble of words without meaning. Documenting this
accurately is essential for tracking the progression of thought process disturbances.
2. A nurse is caring for a client who is voluntarily admitted to a psychiatric unit. The client
states, ‘I am tired of being here and I want to go home now.’ Which action should the nurse
take first?
A. Review the client’s admission status and the facility’s policy on ‘Request for Release’.
B. Inform the client that they cannot leave until the physician signs a discharge order.
C. Place the client in a seclusion room to prevent them from eloping from the unit.
D. Notify the legal department that the client is seeking immediate discharge.
Answer: A
Rationale: Voluntarily admitted clients have the right to request release, but the facility
usually has a set period to evaluate if involuntary commitment is necessary. The nurse
must first understand the legal status and specific facility policy before responding to the
client’s request. This process ensures patient rights are balanced against safety needs.
3. A client tells the nurse, ‘I don’t think I can handle my problems anymore without drinking.’
Which response by the nurse demonstrates the therapeutic technique of reflection?
A. ‘I think you should try attending an Alcoholics Anonymous meeting today.’
B. ‘Why do you feel that alcohol is the only solution to your problems?’
C. ‘You feel like you need alcohol to cope with your current situation?’
D. ‘Everything will be okay once we start your new therapy sessions.’
,Answer: C
Rationale: Reflection involves directing back the client’s feelings or ideas so they can be
recognized and accepted. Option B is non-therapeutic because it asks ‘why’, and Option C
offers unsolicited advice. Effective reflection encourages the client to explore their own
emotions more deeply.
4. During the orientation phase of the nurse-client relationship, which of the following
activities should be the nurse’s priority?
A. Facilitate behavioral change in the client.
B. Evaluate the client’s progress toward goals.
C. Establish boundaries and a rapport with the client.
D. Discuss the client’s feelings regarding termination.
Answer: C
Rationale: The orientation phase is focused on establishing trust, defining roles, and
setting the contract for the relationship. Behavioral change occurs in the working phase,
while termination issues are addressed in the final phase. Without a strong foundation of
rapport, the subsequent phases of therapy will not be effective.
5. A nurse is assessing a client for the risk of suicide. Which factor should the nurse identify as
the most significant predictor of a future suicide attempt?
A. A family history of depression.
B. A history of previous suicide attempts.
C. Recent loss of a job or financial stability.
D. Statements expressing feelings of hopelessness.
Answer: B
Rationale: A history of prior attempts is statistically the strongest indicator that a client
may attempt suicide again. While hopelessness and situational stressors are significant,
clinical data consistently points to past behavior as a primary risk marker. The nurse must
assess the lethality of past attempts during the intake process.
6. A nurse is caring for a client who is experiencing a crisis. Which of the following is the
primary goal of crisis intervention?
A. To explore the client’s early childhood experiences.
B. To return the client to their pre-crisis level of functioning.
C. To identify long-term personality changes needed.
D. To provide the client with a permanent support system.
, Answer: B
Rationale: Crisis intervention is short-term and focused on immediate stabilization and
returning to the baseline level of functioning. It does not aim for major personality
restructuring or deep psychological exploration. The nurse works with the client’s current
strengths to resolve the immediate threat.
7. Which ethical principle is a nurse demonstrating when they spend extra time with a client
who is anxious, even though it wasn’t scheduled?
A. Autonomy
B. Beneficence
C. Justice
D. Veracity
Answer: B
Rationale: Beneficence refers to the duty to act in ways that benefit or promote the good of
others. Autonomy refers to the client’s right to self-determination, while Justice refers to
fairness. By providing extra support to an anxious client, the nurse is actively working to
improve the client’s wellbeing.
8. A client is admitted to the unit with a diagnosis of Obsessive-Compulsive Disorder (OCD).
The nurse observes the client washing their hands 20 times an hour. What is the most
appropriate initial nursing intervention?
A. Strictly limit the number of times the client can wash their hands.
B. Provide hand lotion to prevent skin breakdown.
C. Explain to the client that their hands are already clean.
D. Allow the client enough time to perform the ritual initially.
Answer: D
Rationale: Initially, preventing a ritual can skyrocket the client’s anxiety and is generally
avoided until a therapeutic alliance is formed and coping strategies are taught. The focus
later shifts to limiting the ritual, but the initial phase requires validation of the client’s
current coping mechanism. Safety (skin integrity) is important, but the psychological
priority is anxiety management.
9. A nurse is documenting a client’s affect. The nurse notices the client’s facial expression
never changes throughout the interview, regardless of the topic. How should this be
documented?
A. Flat affect
B. Blunted affect
(NUR253 Exam 1) | Galen College of Nursing
1. A nurse is conducting a mental status examination (MSE) on a newly admitted client. The
nurse notes that the client repeats the last word of every sentence the nurse speaks. Which
term should the nurse use to document this finding?
A. Echolalia
B. Neologism
C. Word salad
D. Clang association
Answer: A
Rationale: Echolalia is the pathological repeating of another’s words and is often seen in
autism or schizophrenia. Neologisms are made-up words that have meaning only to the
client, while word salad is a jumble of words without meaning. Documenting this
accurately is essential for tracking the progression of thought process disturbances.
2. A nurse is caring for a client who is voluntarily admitted to a psychiatric unit. The client
states, ‘I am tired of being here and I want to go home now.’ Which action should the nurse
take first?
A. Review the client’s admission status and the facility’s policy on ‘Request for Release’.
B. Inform the client that they cannot leave until the physician signs a discharge order.
C. Place the client in a seclusion room to prevent them from eloping from the unit.
D. Notify the legal department that the client is seeking immediate discharge.
Answer: A
Rationale: Voluntarily admitted clients have the right to request release, but the facility
usually has a set period to evaluate if involuntary commitment is necessary. The nurse
must first understand the legal status and specific facility policy before responding to the
client’s request. This process ensures patient rights are balanced against safety needs.
3. A client tells the nurse, ‘I don’t think I can handle my problems anymore without drinking.’
Which response by the nurse demonstrates the therapeutic technique of reflection?
A. ‘I think you should try attending an Alcoholics Anonymous meeting today.’
B. ‘Why do you feel that alcohol is the only solution to your problems?’
C. ‘You feel like you need alcohol to cope with your current situation?’
D. ‘Everything will be okay once we start your new therapy sessions.’
,Answer: C
Rationale: Reflection involves directing back the client’s feelings or ideas so they can be
recognized and accepted. Option B is non-therapeutic because it asks ‘why’, and Option C
offers unsolicited advice. Effective reflection encourages the client to explore their own
emotions more deeply.
4. During the orientation phase of the nurse-client relationship, which of the following
activities should be the nurse’s priority?
A. Facilitate behavioral change in the client.
B. Evaluate the client’s progress toward goals.
C. Establish boundaries and a rapport with the client.
D. Discuss the client’s feelings regarding termination.
Answer: C
Rationale: The orientation phase is focused on establishing trust, defining roles, and
setting the contract for the relationship. Behavioral change occurs in the working phase,
while termination issues are addressed in the final phase. Without a strong foundation of
rapport, the subsequent phases of therapy will not be effective.
5. A nurse is assessing a client for the risk of suicide. Which factor should the nurse identify as
the most significant predictor of a future suicide attempt?
A. A family history of depression.
B. A history of previous suicide attempts.
C. Recent loss of a job or financial stability.
D. Statements expressing feelings of hopelessness.
Answer: B
Rationale: A history of prior attempts is statistically the strongest indicator that a client
may attempt suicide again. While hopelessness and situational stressors are significant,
clinical data consistently points to past behavior as a primary risk marker. The nurse must
assess the lethality of past attempts during the intake process.
6. A nurse is caring for a client who is experiencing a crisis. Which of the following is the
primary goal of crisis intervention?
A. To explore the client’s early childhood experiences.
B. To return the client to their pre-crisis level of functioning.
C. To identify long-term personality changes needed.
D. To provide the client with a permanent support system.
, Answer: B
Rationale: Crisis intervention is short-term and focused on immediate stabilization and
returning to the baseline level of functioning. It does not aim for major personality
restructuring or deep psychological exploration. The nurse works with the client’s current
strengths to resolve the immediate threat.
7. Which ethical principle is a nurse demonstrating when they spend extra time with a client
who is anxious, even though it wasn’t scheduled?
A. Autonomy
B. Beneficence
C. Justice
D. Veracity
Answer: B
Rationale: Beneficence refers to the duty to act in ways that benefit or promote the good of
others. Autonomy refers to the client’s right to self-determination, while Justice refers to
fairness. By providing extra support to an anxious client, the nurse is actively working to
improve the client’s wellbeing.
8. A client is admitted to the unit with a diagnosis of Obsessive-Compulsive Disorder (OCD).
The nurse observes the client washing their hands 20 times an hour. What is the most
appropriate initial nursing intervention?
A. Strictly limit the number of times the client can wash their hands.
B. Provide hand lotion to prevent skin breakdown.
C. Explain to the client that their hands are already clean.
D. Allow the client enough time to perform the ritual initially.
Answer: D
Rationale: Initially, preventing a ritual can skyrocket the client’s anxiety and is generally
avoided until a therapeutic alliance is formed and coping strategies are taught. The focus
later shifts to limiting the ritual, but the initial phase requires validation of the client’s
current coping mechanism. Safety (skin integrity) is important, but the psychological
priority is anxiety management.
9. A nurse is documenting a client’s affect. The nurse notices the client’s facial expression
never changes throughout the interview, regardless of the topic. How should this be
documented?
A. Flat affect
B. Blunted affect
