Galen NSG 3450 Final Exam 2 | Mental Health Nursing
Practice (2026) Actual Q&A PDF
1. Which of the following best describes the primary purpose of therapeutic
communication in psychiatric nursing?
A) To gather subjective and objective data for the medical record
B) To establish a trusting relationship and promote patient insight and growth
C) To provide advice and solutions to the patient's problems
D) To maintain professional distance and avoid emotional involvement
Correct Answer: To establish a trusting relationship and promote patient insight and
growth
Rationale: Therapeutic communication is a purposeful, patient-centered interaction
that uses techniques such as active listening, empathy, and open-ended questions to
build trust and facilitate the patient's expression of feelings. It is not primarily for data
collection, advice-giving, or maintaining distance. The goal is to promote healing and
patient growth.
2. A patient with schizophrenia is experiencing auditory hallucinations telling him to
harm himself. Which is the most appropriate initial nursing response?
A) "I don't hear the voices, but I understand they are real to you."
B) "You should try to ignore the voices and focus on something else."
C) "What are the voices telling you to do right now?"
D) "The voices are just a chemical imbalance and are not real."
Correct Answer: "What are the voices telling you to do right now?"
Rationale: Assessing the content of the hallucinations is the priority to ensure patient
safety, especially if the voices are command-oriented. Validating the patient's
experience and presenting reality are important, but safety assessment comes first.
Ignoring the voices is not therapeutic, and dismissing them as unreal is invalidating.
3. According to the DSM-5-TR criteria, which symptom must be present for at least
two weeks to diagnose major depressive disorder?
A) Depressed mood or anhedonia
B) Weight gain and hypersomnia
C) Psychomotor agitation and insomnia
,D) Feelings of worthlessness and guilt
Correct Answer: Depressed mood or anhedonia
Rationale: The DSM-5-TR requires that either depressed mood or loss of interest or
pleasure (anhedonia) be present for at least two weeks for a diagnosis of major
depressive disorder. Weight changes, sleep disturbances, psychomotor changes, and
feelings of worthlessness are additional symptoms but are not the required core criteria.
4. A client is prescribed lithium carbonate for bipolar I disorder. Which serum
lithium level indicates a therapeutic range?
A) 0.4 mEq/L
B) 0.9 mEq/L
C) 1.8 mEq/L
D) 2.2 mEq/L
Correct Answer: 0.9 mEq/L
Rationale: The therapeutic range for lithium maintenance therapy is generally 0.6 to 1.2
mEq/L. Levels below 0.6 mEq/L are usually subtherapeutic, while levels above 1.5
mEq/L indicate toxicity. Regular monitoring is essential to prevent renal and neurological
complications.
5. A nurse is assessing a patient for extrapyramidal symptoms (EPS). Which finding
should the nurse document as akathisia?
A) Involuntary upward deviation of the eyes
B) Continuous restlessness and inability to sit still
C) Muscular weakness and lack of energy
D) Muscle spasms of the neck and back
Correct Answer: Continuous restlessness and inability to sit still
Rationale: Akathisia is characterized by subjective feelings of inner restlessness and an
objective need to move constantly. It is a common side effect of first-generation
antipsychotics. Oculogyric crisis involves eye deviation, dystonia involves muscle
spasms, and weakness is not characteristic of akathisia.
6. A client with major depressive disorder is started on phenelzine. Which food
choice indicates understanding of dietary restrictions?
A) Smoked salmon on a sourdough bagel
B) Pepperoni pizza with extra cheese
,C) A glass of red wine and aged cheddar
D) Grilled chicken with steamed broccoli
Correct Answer: Grilled chicken with steamed broccoli
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI) that requires a low-
tyramine diet to prevent hypertensive crisis. Aged cheeses, cured meats, fermented
products, and red wine are high in tyramine and must be avoided. Grilled chicken and
fresh vegetables are safe choices.
7. A nurse is performing a suicide risk assessment. Which client statement
represents the highest level of lethality?
A) "I have a loaded gun in my nightstand and I'm going to use it tonight."
B) "I have been thinking about ending it all if things don't get better."
C) "I bought some extra pills last week just in case I need them."
D) "Sometimes I wish I could just go to sleep and never wake up."
Correct Answer: "I have a loaded gun in my nightstand and I'm going to use it tonight."
Rationale: This statement indicates a specific plan, available means, and imminent
intent, which represents the highest level of lethality. Vague thoughts, stockpiling pills,
and passive wishes are concerning but less immediately dangerous. Immediate
intervention is required.
8. Which neurotransmitter is primarily associated with mood regulation and is the
target of many antidepressant medications?
A) Dopamine
B) Serotonin
C) Acetylcholine
D) GABA
Correct Answer: Serotonin
Rationale: Serotonin is a key neurotransmitter involved in mood regulation, and
selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for depression.
Dopamine is associated with reward and psychosis, acetylcholine with memory and
muscle function, and GABA with inhibition and anxiety reduction.
9. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement indicates correct understanding of the medication?
A) "I will take this medication only when I feel anxious."
, B) "This medication will take several weeks to become effective."
C) "I should avoid grapefruit juice while taking this medication."
D) "This medication may cause dependency if taken long-term."
Correct Answer: "This medication will take several weeks to become effective."
Rationale: Buspirone requires several weeks of consistent use to achieve therapeutic
effects and is not effective for acute anxiety episodes. It is not a benzodiazepine and
does not cause dependency. Grapefruit juice interactions are more relevant to certain
other psychotropic medications.
10. According to Peplau's theory, which phase of the nurse-patient relationship
involves the nurse and patient working together to solve problems?
A) Preorientation
B) Orientation
C) Working
D) Termination
Correct Answer: Working
Rationale: Peplau's working phase is when the nurse and patient collaboratively identify
and address the patient's problems. The orientation phase establishes trust, the
preorientation phase occurs before the first meeting, and the termination phase
involves ending the relationship and evaluating outcomes.
11. A nurse is caring for a patient with borderline personality disorder who exhibits
splitting behavior. Which intervention is most appropriate?
A) Set consistent limits and maintain a neutral, nonreactive approach
B) Alternate staff assignments to prevent overinvolvement
C) Allow the patient to choose which staff members provide care
D) Confront the patient about manipulative behavior in front of peers
Correct Answer: Set consistent limits and maintain a neutral, nonreactive approach
Rationale: Splitting occurs when patients view staff as either all good or all bad.
Consistent limits and a neutral approach help reduce manipulation and promote a
stable therapeutic environment. Alternating assignments and public confrontation can
worsen splitting and damage trust.
12. Which symptom is a hallmark of schizophrenia and is classified as a positive
symptom?
Practice (2026) Actual Q&A PDF
1. Which of the following best describes the primary purpose of therapeutic
communication in psychiatric nursing?
A) To gather subjective and objective data for the medical record
B) To establish a trusting relationship and promote patient insight and growth
C) To provide advice and solutions to the patient's problems
D) To maintain professional distance and avoid emotional involvement
Correct Answer: To establish a trusting relationship and promote patient insight and
growth
Rationale: Therapeutic communication is a purposeful, patient-centered interaction
that uses techniques such as active listening, empathy, and open-ended questions to
build trust and facilitate the patient's expression of feelings. It is not primarily for data
collection, advice-giving, or maintaining distance. The goal is to promote healing and
patient growth.
2. A patient with schizophrenia is experiencing auditory hallucinations telling him to
harm himself. Which is the most appropriate initial nursing response?
A) "I don't hear the voices, but I understand they are real to you."
B) "You should try to ignore the voices and focus on something else."
C) "What are the voices telling you to do right now?"
D) "The voices are just a chemical imbalance and are not real."
Correct Answer: "What are the voices telling you to do right now?"
Rationale: Assessing the content of the hallucinations is the priority to ensure patient
safety, especially if the voices are command-oriented. Validating the patient's
experience and presenting reality are important, but safety assessment comes first.
Ignoring the voices is not therapeutic, and dismissing them as unreal is invalidating.
3. According to the DSM-5-TR criteria, which symptom must be present for at least
two weeks to diagnose major depressive disorder?
A) Depressed mood or anhedonia
B) Weight gain and hypersomnia
C) Psychomotor agitation and insomnia
,D) Feelings of worthlessness and guilt
Correct Answer: Depressed mood or anhedonia
Rationale: The DSM-5-TR requires that either depressed mood or loss of interest or
pleasure (anhedonia) be present for at least two weeks for a diagnosis of major
depressive disorder. Weight changes, sleep disturbances, psychomotor changes, and
feelings of worthlessness are additional symptoms but are not the required core criteria.
4. A client is prescribed lithium carbonate for bipolar I disorder. Which serum
lithium level indicates a therapeutic range?
A) 0.4 mEq/L
B) 0.9 mEq/L
C) 1.8 mEq/L
D) 2.2 mEq/L
Correct Answer: 0.9 mEq/L
Rationale: The therapeutic range for lithium maintenance therapy is generally 0.6 to 1.2
mEq/L. Levels below 0.6 mEq/L are usually subtherapeutic, while levels above 1.5
mEq/L indicate toxicity. Regular monitoring is essential to prevent renal and neurological
complications.
5. A nurse is assessing a patient for extrapyramidal symptoms (EPS). Which finding
should the nurse document as akathisia?
A) Involuntary upward deviation of the eyes
B) Continuous restlessness and inability to sit still
C) Muscular weakness and lack of energy
D) Muscle spasms of the neck and back
Correct Answer: Continuous restlessness and inability to sit still
Rationale: Akathisia is characterized by subjective feelings of inner restlessness and an
objective need to move constantly. It is a common side effect of first-generation
antipsychotics. Oculogyric crisis involves eye deviation, dystonia involves muscle
spasms, and weakness is not characteristic of akathisia.
6. A client with major depressive disorder is started on phenelzine. Which food
choice indicates understanding of dietary restrictions?
A) Smoked salmon on a sourdough bagel
B) Pepperoni pizza with extra cheese
,C) A glass of red wine and aged cheddar
D) Grilled chicken with steamed broccoli
Correct Answer: Grilled chicken with steamed broccoli
Rationale: Phenelzine is a monoamine oxidase inhibitor (MAOI) that requires a low-
tyramine diet to prevent hypertensive crisis. Aged cheeses, cured meats, fermented
products, and red wine are high in tyramine and must be avoided. Grilled chicken and
fresh vegetables are safe choices.
7. A nurse is performing a suicide risk assessment. Which client statement
represents the highest level of lethality?
A) "I have a loaded gun in my nightstand and I'm going to use it tonight."
B) "I have been thinking about ending it all if things don't get better."
C) "I bought some extra pills last week just in case I need them."
D) "Sometimes I wish I could just go to sleep and never wake up."
Correct Answer: "I have a loaded gun in my nightstand and I'm going to use it tonight."
Rationale: This statement indicates a specific plan, available means, and imminent
intent, which represents the highest level of lethality. Vague thoughts, stockpiling pills,
and passive wishes are concerning but less immediately dangerous. Immediate
intervention is required.
8. Which neurotransmitter is primarily associated with mood regulation and is the
target of many antidepressant medications?
A) Dopamine
B) Serotonin
C) Acetylcholine
D) GABA
Correct Answer: Serotonin
Rationale: Serotonin is a key neurotransmitter involved in mood regulation, and
selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for depression.
Dopamine is associated with reward and psychosis, acetylcholine with memory and
muscle function, and GABA with inhibition and anxiety reduction.
9. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement indicates correct understanding of the medication?
A) "I will take this medication only when I feel anxious."
, B) "This medication will take several weeks to become effective."
C) "I should avoid grapefruit juice while taking this medication."
D) "This medication may cause dependency if taken long-term."
Correct Answer: "This medication will take several weeks to become effective."
Rationale: Buspirone requires several weeks of consistent use to achieve therapeutic
effects and is not effective for acute anxiety episodes. It is not a benzodiazepine and
does not cause dependency. Grapefruit juice interactions are more relevant to certain
other psychotropic medications.
10. According to Peplau's theory, which phase of the nurse-patient relationship
involves the nurse and patient working together to solve problems?
A) Preorientation
B) Orientation
C) Working
D) Termination
Correct Answer: Working
Rationale: Peplau's working phase is when the nurse and patient collaboratively identify
and address the patient's problems. The orientation phase establishes trust, the
preorientation phase occurs before the first meeting, and the termination phase
involves ending the relationship and evaluating outcomes.
11. A nurse is caring for a patient with borderline personality disorder who exhibits
splitting behavior. Which intervention is most appropriate?
A) Set consistent limits and maintain a neutral, nonreactive approach
B) Alternate staff assignments to prevent overinvolvement
C) Allow the patient to choose which staff members provide care
D) Confront the patient about manipulative behavior in front of peers
Correct Answer: Set consistent limits and maintain a neutral, nonreactive approach
Rationale: Splitting occurs when patients view staff as either all good or all bad.
Consistent limits and a neutral approach help reduce manipulation and promote a
stable therapeutic environment. Alternating assignments and public confrontation can
worsen splitting and damage trust.
12. Which symptom is a hallmark of schizophrenia and is classified as a positive
symptom?
