NUR 253 Exam 3 Mental Health (2026) PDF | Galen
College of Nursing
NUR 253 – EXAM 3 (MENTAL HEALTH)
50 TOUGHEST & MOST-TESTED LONG, CASE-BASED QUESTIONS
1. Schizophrenia – Command Hallucinations (PRIORITY)
A patient with schizophrenia tells the nurse, “The voices are telling me to kill myself.” The patient
appears anxious and is pacing.
What is the nurse’s priority action?
,A. Encourage the patient to ignore the voices
B. Ask what the voices are saying in detail
C. Stay with the patient and notify the provider immediately
D. Explain that hallucinations are part of schizophrenia
✅ Correct Answer: C
Rationale:
Command hallucinations involving self-harm = emergency. Safety and continuous supervision come
first.
2. Antipsychotics – Neuroleptic Malignant Syndrome
A patient on haloperidol develops muscle rigidity, fever (103°F), altered mental status, and autonomic
instability.
What is the nurse’s priority action?
A. Administer PRN anticholinergic
B. Hold medication and notify provider immediately
C. Encourage oral fluids
D. Reassure the patient
✅ Correct Answer: B
Rationale:
This is neuroleptic malignant syndrome (NMS) — a life-threatening emergency.
3. Lithium Toxicity – Recognition
A patient taking lithium presents with coarse tremors, vomiting, diarrhea, confusion, and slurred speech.
What should the nurse do first?
A. Give the next lithium dose
B. Restrict sodium
C. Hold lithium and notify the provider
D. Encourage exercise
✅ Correct Answer: C
Rationale:
These are classic signs of lithium toxicity. Lithium must be held immediately.
4. Borderline Personality Disorder – Limit Setting
, A patient with borderline personality disorder says,
"If you don’t stay with me tonight, I’ll hurt myself."
What is the best nursing response?
A. Stay with the patient to prevent harm
B. Call security
C. “I care about your safety, but threats won’t change the rules. Let’s talk about how you’re feeling.”
D. Ignore the statement
✅ Correct Answer: C
Rationale:
BPD requires clear, consistent limits without reinforcing manipulation, while still addressing safety.
5. Antisocial Personality Disorder
Which behavior is most characteristic of antisocial personality disorder?
A. Fear of abandonment
B. Excessive emotional expression
C. Lack of remorse and repeated violation of others’ rights
D. Social withdrawal
✅ Correct Answer: C
Rationale:
Antisocial PD = deceit, manipulation, lack of empathy or remorse.
6. PTSD – Flashbacks
A veteran suddenly dives under a table during a loud noise and yells, “We’re under attack!”
What is the nurse’s best response?
A. “You’re safe now. You’re in the hospital.”
B. “Why did you react that way?”
C. Restrain the patient
D. Leave the patient alone
✅ Correct Answer: A
Rationale:
During flashbacks, reorientation to reality and safety is essential.
7. Acute Stress Disorder vs PTSD
College of Nursing
NUR 253 – EXAM 3 (MENTAL HEALTH)
50 TOUGHEST & MOST-TESTED LONG, CASE-BASED QUESTIONS
1. Schizophrenia – Command Hallucinations (PRIORITY)
A patient with schizophrenia tells the nurse, “The voices are telling me to kill myself.” The patient
appears anxious and is pacing.
What is the nurse’s priority action?
,A. Encourage the patient to ignore the voices
B. Ask what the voices are saying in detail
C. Stay with the patient and notify the provider immediately
D. Explain that hallucinations are part of schizophrenia
✅ Correct Answer: C
Rationale:
Command hallucinations involving self-harm = emergency. Safety and continuous supervision come
first.
2. Antipsychotics – Neuroleptic Malignant Syndrome
A patient on haloperidol develops muscle rigidity, fever (103°F), altered mental status, and autonomic
instability.
What is the nurse’s priority action?
A. Administer PRN anticholinergic
B. Hold medication and notify provider immediately
C. Encourage oral fluids
D. Reassure the patient
✅ Correct Answer: B
Rationale:
This is neuroleptic malignant syndrome (NMS) — a life-threatening emergency.
3. Lithium Toxicity – Recognition
A patient taking lithium presents with coarse tremors, vomiting, diarrhea, confusion, and slurred speech.
What should the nurse do first?
A. Give the next lithium dose
B. Restrict sodium
C. Hold lithium and notify the provider
D. Encourage exercise
✅ Correct Answer: C
Rationale:
These are classic signs of lithium toxicity. Lithium must be held immediately.
4. Borderline Personality Disorder – Limit Setting
, A patient with borderline personality disorder says,
"If you don’t stay with me tonight, I’ll hurt myself."
What is the best nursing response?
A. Stay with the patient to prevent harm
B. Call security
C. “I care about your safety, but threats won’t change the rules. Let’s talk about how you’re feeling.”
D. Ignore the statement
✅ Correct Answer: C
Rationale:
BPD requires clear, consistent limits without reinforcing manipulation, while still addressing safety.
5. Antisocial Personality Disorder
Which behavior is most characteristic of antisocial personality disorder?
A. Fear of abandonment
B. Excessive emotional expression
C. Lack of remorse and repeated violation of others’ rights
D. Social withdrawal
✅ Correct Answer: C
Rationale:
Antisocial PD = deceit, manipulation, lack of empathy or remorse.
6. PTSD – Flashbacks
A veteran suddenly dives under a table during a loud noise and yells, “We’re under attack!”
What is the nurse’s best response?
A. “You’re safe now. You’re in the hospital.”
B. “Why did you react that way?”
C. Restrain the patient
D. Leave the patient alone
✅ Correct Answer: A
Rationale:
During flashbacks, reorientation to reality and safety is essential.
7. Acute Stress Disorder vs PTSD
