NUR 253 EXAM 4 CONCEPTS MENTAL HEALTH NURSING 2026/2027 –
QUESTIONS AND ANSWERS | 100% VERIFIED | DETAILED
RATIONALES – PASS GUARANTEED – A+ GRADED
Core Domains
• Therapeutic Communication & Nurse-Patient Relationship
• Mood Disorders & Suicide Risk
• Anxiety, Trauma & Stressor-Related Disorders
• Schizophrenia, Psychosis & Psychopharmacology
• Substance Use, Personality Disorders, Crisis & End-of-Life Care
Introduction
This comprehensive practice examination assesses the knowledge required for
NUR 253 Exam 4 at Galen College of Nursing. It evaluates therapeutic
communication, psychiatric disorders, psychopharmacology, and crisis
intervention. Questions emphasize clinical judgment, safety, and evidence-based
mental health nursing practice.
1. A client with major depression says, "I'm a burden to everyone. Nothing I
do matters." The nurse's most therapeutic response is:
A. "It sounds as if you're feeling worthless right now. Tell me more about that."
B. "You're not a burden; many people care about you."
C. "You should focus on the positive things in your life."
D. "Let's talk about something more cheerful instead."
Correct answer: A. "It sounds as if you're feeling worthless right now. Tell me
more about that."
RATIONALE: Reflecting the client's feeling of worthlessness and inviting
further expression is therapeutic. Reassurance without exploration, advice-giving,
and topic changes block communication.
,2. During an initial assessment a client becomes silent for nearly a minute
after the nurse asks about recent stressors. The most appropriate nursing
action is to:
A. Repeat the question more loudly to prompt an answer.
B. Change the subject to a less sensitive topic immediately.
C. Remain silent and allow the client time to gather thoughts.
D. Document that the client is uncooperative and end the interview.
Correct answer: C. Remain silent and allow the client time to gather thoughts.
RATIONALE: Therapeutic silence gives the client space to process and
respond. Pressuring, abruptly changing topics, or labeling the client as
uncooperative are non-therapeutic.
3. A client states, "I know the staff is talking about me behind my back." The
nurse recognizes this as a possible delusion and responds most therapeutically
by:
A. "It must feel frightening to think others are talking about you. Can we talk about
what you've noticed?"
B. "That's not true; no one is talking about you."
C. "I find that hard to believe. You're being paranoid."
D. "You need to stop thinking that way or you'll get worse."
Correct answer: A. "It must feel frightening to think others are talking about
you. Can we talk about what you've noticed?"
RATIONALE: Acknowledging the client's feeling while gently exploring the
experience maintains trust without reinforcing or ridiculing the delusion.
4. A nurse is establishing a therapeutic relationship with a newly admitted
client. In the orientation phase the priority nursing action is to:
A. Explore the client's deep childhood traumas.
B. Confront maladaptive behaviors immediately.
C. Establish trust, clarify roles, and set mutual goals and boundaries.
D. Plan for termination of the relationship.
, Correct answer: C. Establish trust, clarify roles, and set mutual goals and
boundaries.
RATIONALE: The orientation phase focuses on trust-building, role
clarification, and collaborative goal-setting. Deep exploration and confrontation
occur later; termination planning begins early but is not the immediate priority.
5. A client who has major depressive disorder states, "I've been giving away
my belongings and saying goodbye to people." The nurse's priority action is
to:
A. Document the statement and continue the assessment.
B. Recognize this as a behavioral warning sign of suicide and initiate immediate
safety interventions.
C. Reassure the client that things will get better.
D. Ask the client if they are feeling sad.
Correct answer: B. Recognize this as a behavioral warning sign of suicide and
initiate immediate safety interventions.
RATIONALE: Giving away belongings and saying goodbye are behavioral
warning signs of suicide planning and imminent risk. This is a psychiatric
emergency requiring immediate intervention.
6. Which finding indicates the highest suicide risk?
A. Client says, "I'm fine now."
B. Client gives away prized possessions.
C. Client sleeps 10 hours.
D. Client refuses dessert.
Correct answer: B. Client gives away prized possessions.
RATIONALE: Giving away possessions may indicate the client has decided to
complete suicide and is putting affairs in order.
, 7. A client is at high risk for suicide. What is the appropriate level of
observation?
A. Every 30 minutes
B. Every 15 minutes
C. 1:1 continuous observation
D. Check at shift change
Correct answer: C. 1:1 continuous observation
RATIONALE: Clients at imminent risk for suicide require continuous 1:1
observation to ensure safety.
8. A nurse is caring for a client who has schizoaffective disorder. Which of the
following statements indicates the client is experiencing depersonalization?
A. "I am a superhero and am immortal."
B. "I am no one, and everyone is me."
C. "I feel monsters pinching me all over."
D. "I know that you are stealing my thoughts."
Correct answer: B. "I am no one, and everyone is me."
RATIONALE: Depersonalization is characterized by a sense of unreality or
self-estrangement. The client's statement reflects a disturbed sense of self.
9. A nurse is completing an admission assessment for a client who has
schizophrenia. Which of the following findings should the nurse document as
positive symptoms? (Select all that apply.)
A. Auditory hallucinations
B. Lack of motivation
C. Use of clang association
D. Delusion of persecution
E. Constantly waving arms
F. Flat affect
Correct answer: A, C, D
QUESTIONS AND ANSWERS | 100% VERIFIED | DETAILED
RATIONALES – PASS GUARANTEED – A+ GRADED
Core Domains
• Therapeutic Communication & Nurse-Patient Relationship
• Mood Disorders & Suicide Risk
• Anxiety, Trauma & Stressor-Related Disorders
• Schizophrenia, Psychosis & Psychopharmacology
• Substance Use, Personality Disorders, Crisis & End-of-Life Care
Introduction
This comprehensive practice examination assesses the knowledge required for
NUR 253 Exam 4 at Galen College of Nursing. It evaluates therapeutic
communication, psychiatric disorders, psychopharmacology, and crisis
intervention. Questions emphasize clinical judgment, safety, and evidence-based
mental health nursing practice.
1. A client with major depression says, "I'm a burden to everyone. Nothing I
do matters." The nurse's most therapeutic response is:
A. "It sounds as if you're feeling worthless right now. Tell me more about that."
B. "You're not a burden; many people care about you."
C. "You should focus on the positive things in your life."
D. "Let's talk about something more cheerful instead."
Correct answer: A. "It sounds as if you're feeling worthless right now. Tell me
more about that."
RATIONALE: Reflecting the client's feeling of worthlessness and inviting
further expression is therapeutic. Reassurance without exploration, advice-giving,
and topic changes block communication.
,2. During an initial assessment a client becomes silent for nearly a minute
after the nurse asks about recent stressors. The most appropriate nursing
action is to:
A. Repeat the question more loudly to prompt an answer.
B. Change the subject to a less sensitive topic immediately.
C. Remain silent and allow the client time to gather thoughts.
D. Document that the client is uncooperative and end the interview.
Correct answer: C. Remain silent and allow the client time to gather thoughts.
RATIONALE: Therapeutic silence gives the client space to process and
respond. Pressuring, abruptly changing topics, or labeling the client as
uncooperative are non-therapeutic.
3. A client states, "I know the staff is talking about me behind my back." The
nurse recognizes this as a possible delusion and responds most therapeutically
by:
A. "It must feel frightening to think others are talking about you. Can we talk about
what you've noticed?"
B. "That's not true; no one is talking about you."
C. "I find that hard to believe. You're being paranoid."
D. "You need to stop thinking that way or you'll get worse."
Correct answer: A. "It must feel frightening to think others are talking about
you. Can we talk about what you've noticed?"
RATIONALE: Acknowledging the client's feeling while gently exploring the
experience maintains trust without reinforcing or ridiculing the delusion.
4. A nurse is establishing a therapeutic relationship with a newly admitted
client. In the orientation phase the priority nursing action is to:
A. Explore the client's deep childhood traumas.
B. Confront maladaptive behaviors immediately.
C. Establish trust, clarify roles, and set mutual goals and boundaries.
D. Plan for termination of the relationship.
, Correct answer: C. Establish trust, clarify roles, and set mutual goals and
boundaries.
RATIONALE: The orientation phase focuses on trust-building, role
clarification, and collaborative goal-setting. Deep exploration and confrontation
occur later; termination planning begins early but is not the immediate priority.
5. A client who has major depressive disorder states, "I've been giving away
my belongings and saying goodbye to people." The nurse's priority action is
to:
A. Document the statement and continue the assessment.
B. Recognize this as a behavioral warning sign of suicide and initiate immediate
safety interventions.
C. Reassure the client that things will get better.
D. Ask the client if they are feeling sad.
Correct answer: B. Recognize this as a behavioral warning sign of suicide and
initiate immediate safety interventions.
RATIONALE: Giving away belongings and saying goodbye are behavioral
warning signs of suicide planning and imminent risk. This is a psychiatric
emergency requiring immediate intervention.
6. Which finding indicates the highest suicide risk?
A. Client says, "I'm fine now."
B. Client gives away prized possessions.
C. Client sleeps 10 hours.
D. Client refuses dessert.
Correct answer: B. Client gives away prized possessions.
RATIONALE: Giving away possessions may indicate the client has decided to
complete suicide and is putting affairs in order.
, 7. A client is at high risk for suicide. What is the appropriate level of
observation?
A. Every 30 minutes
B. Every 15 minutes
C. 1:1 continuous observation
D. Check at shift change
Correct answer: C. 1:1 continuous observation
RATIONALE: Clients at imminent risk for suicide require continuous 1:1
observation to ensure safety.
8. A nurse is caring for a client who has schizoaffective disorder. Which of the
following statements indicates the client is experiencing depersonalization?
A. "I am a superhero and am immortal."
B. "I am no one, and everyone is me."
C. "I feel monsters pinching me all over."
D. "I know that you are stealing my thoughts."
Correct answer: B. "I am no one, and everyone is me."
RATIONALE: Depersonalization is characterized by a sense of unreality or
self-estrangement. The client's statement reflects a disturbed sense of self.
9. A nurse is completing an admission assessment for a client who has
schizophrenia. Which of the following findings should the nurse document as
positive symptoms? (Select all that apply.)
A. Auditory hallucinations
B. Lack of motivation
C. Use of clang association
D. Delusion of persecution
E. Constantly waving arms
F. Flat affect
Correct answer: A, C, D
