NSRG 126 Final Exam V3 | NSRG 126
Mental Health Nursing | Actual Q&A with
Rationale (NSRG126 Final Exam) | Ivy
Tech
1. A nurse is caring for a client who is voluntarily admitted to a mental health facility. Which
of the following statements by the client indicates an understanding of their rights?
A. I can leave the facility whenever I want even if the doctor disagrees.
B. I can be forced to participate in group therapy sessions.
C. I am not allowed to make phone calls to my family until I am discharged.
D. I have the right to refuse my morning dose of antidepressant medication.
Correct Answer: D
Clients admitted voluntarily retain the right to refuse treatment, including medications,
unless they pose an immediate danger to themselves or others. This right is grounded in
the ethical principle of autonomy and is a legal standard in mental health care. The nurse
must document the refusal and notify the provider while exploring the client’s reasons for
refusal.
2. A nurse is performing a mental status examination on a client. Which of the following
findings should the nurse document as an observation of the client’s affect?
A. The client states that they feel hopeless and lonely.
,B. The client reports having visions of religious figures.
C. The client is unable to recall what they ate for breakfast.
D. The client’s facial expression remains flat while discussing a tragedy.
Correct Answer: D
Affect refers to the external, observable emotional expression of a client, such as a flat or
blunted expression. Mood, conversely, is the subjective emotional state that the client
reports. Identifying the congruence between mood and affect is a critical component of a
comprehensive psychiatric assessment.
3. A nurse is interacting with a client who says, ‘The government is tracking me through my
television.’ Which of the following responses by the nurse is therapeutic?
A. It must be very frightening to feel like you are being watched.
B. That is impossible because televisions only receive signals.
C. Why would the government want to track a person like you?
D. I don’t see any cameras in the television in your room.
Correct Answer: A
This response uses the therapeutic technique of focusing on the client’s feelings rather
than the content of the delusion. Acknowledging the client’s underlying fear helps build
trust without validating the false belief. Arguing with a delusional client is non-therapeutic
and can cause the client to become defensive or more entrenched in the delusion.
, 4. A nurse is caring for a client diagnosed with Major Depressive Disorder. Which of the
following assessment findings is the highest priority for the nurse to report?
A. The client reports sleeping 12 hours per day.
B. The client states they have a plan to end their life tonight.
C. The client has lost 5 pounds in the past two weeks.
D. The client refuses to attend the morning hygiene session.
Correct Answer: B
Suicide ideation with a specific plan represents an immediate threat to the client’s safety
and is the highest priority for nursing intervention. Safety is always the primary concern in
mental health nursing according to Maslow’s hierarchy of needs. The nurse must
implement suicide precautions and provide continuous observation immediately.
5. A nurse is assessing a client in the manic phase of Bipolar Disorder. Which of the following
symptoms should the nurse expect to observe?
A. Extreme fatigue and excessive sleeping.
B. Poverty of thought and content.
C. Significant weight gain from overeating.
D. Slow, deliberate speech patterns.
E. Social isolation and lack of interest in surroundings.
F. Flight of ideas and grandiosity.
Mental Health Nursing | Actual Q&A with
Rationale (NSRG126 Final Exam) | Ivy
Tech
1. A nurse is caring for a client who is voluntarily admitted to a mental health facility. Which
of the following statements by the client indicates an understanding of their rights?
A. I can leave the facility whenever I want even if the doctor disagrees.
B. I can be forced to participate in group therapy sessions.
C. I am not allowed to make phone calls to my family until I am discharged.
D. I have the right to refuse my morning dose of antidepressant medication.
Correct Answer: D
Clients admitted voluntarily retain the right to refuse treatment, including medications,
unless they pose an immediate danger to themselves or others. This right is grounded in
the ethical principle of autonomy and is a legal standard in mental health care. The nurse
must document the refusal and notify the provider while exploring the client’s reasons for
refusal.
2. A nurse is performing a mental status examination on a client. Which of the following
findings should the nurse document as an observation of the client’s affect?
A. The client states that they feel hopeless and lonely.
,B. The client reports having visions of religious figures.
C. The client is unable to recall what they ate for breakfast.
D. The client’s facial expression remains flat while discussing a tragedy.
Correct Answer: D
Affect refers to the external, observable emotional expression of a client, such as a flat or
blunted expression. Mood, conversely, is the subjective emotional state that the client
reports. Identifying the congruence between mood and affect is a critical component of a
comprehensive psychiatric assessment.
3. A nurse is interacting with a client who says, ‘The government is tracking me through my
television.’ Which of the following responses by the nurse is therapeutic?
A. It must be very frightening to feel like you are being watched.
B. That is impossible because televisions only receive signals.
C. Why would the government want to track a person like you?
D. I don’t see any cameras in the television in your room.
Correct Answer: A
This response uses the therapeutic technique of focusing on the client’s feelings rather
than the content of the delusion. Acknowledging the client’s underlying fear helps build
trust without validating the false belief. Arguing with a delusional client is non-therapeutic
and can cause the client to become defensive or more entrenched in the delusion.
, 4. A nurse is caring for a client diagnosed with Major Depressive Disorder. Which of the
following assessment findings is the highest priority for the nurse to report?
A. The client reports sleeping 12 hours per day.
B. The client states they have a plan to end their life tonight.
C. The client has lost 5 pounds in the past two weeks.
D. The client refuses to attend the morning hygiene session.
Correct Answer: B
Suicide ideation with a specific plan represents an immediate threat to the client’s safety
and is the highest priority for nursing intervention. Safety is always the primary concern in
mental health nursing according to Maslow’s hierarchy of needs. The nurse must
implement suicide precautions and provide continuous observation immediately.
5. A nurse is assessing a client in the manic phase of Bipolar Disorder. Which of the following
symptoms should the nurse expect to observe?
A. Extreme fatigue and excessive sleeping.
B. Poverty of thought and content.
C. Significant weight gain from overeating.
D. Slow, deliberate speech patterns.
E. Social isolation and lack of interest in surroundings.
F. Flight of ideas and grandiosity.
