Galen NSG 3450 Exam 4 | Nursing Practice – Mental Health
(2026) Actual Q&A PDF
1. Which assessment finding is the strongest predictor of imminent violence in a patient with a
psychiatric disorder?
A) A history of childhood abuse
B) A diagnosis of schizophrenia
C) A past history of violence
D) Verbal threats of harm
Correct Answer: A past history of violence
Rationale: A past history of violence is the most significant predictor of future violent behavior.
While a history of childhood abuse, a schizophrenia diagnosis, and verbal threats are important
risk factors, a documented history of violent acts is the strongest indicator of future risk and
should guide safety planning and interventions.
2. A nurse observes a patient becoming increasingly agitated and verbally aggressive. According
to the principles of de-escalation, what is the nurse's priority action?
A) Place the patient in seclusion immediately
B) Administer a PRN sedative medication
C) Maintain a calm demeanor and use a non-threatening posture
D) Call a code for a security response
Correct Answer: Maintain a calm demeanor and use a non-threatening posture
Rationale: De-escalation techniques are the first line of intervention for a patient demonstrating
escalating agitation. Maintaining a calm demeanor, using a non-threatening posture, and
,speaking in a low, slow tone can help reduce the patient's anxiety and prevent the situation
from escalating to the use of restraints or seclusion.
3. A patient with borderline personality disorder is engaging in splitting behavior. Which
statement by the patient is most consistent with this defense mechanism?
A) "I can't do anything right. I'm a complete failure."
B) "You're the only nurse who understands me. All the other nurses are incompetent."
C) "If you really cared, you would let me leave the unit."
D) "I know I'm manipulative, but I can't help it."
Correct Answer: "You're the only nurse who understands me. All the other nurses are
incompetent."
Rationale: Splitting is a primitive defense mechanism where the patient views people and
situations as either all good or all bad. In this scenario, the patient idealizes one nurse while
devaluing all others, which is a classic manifestation of splitting commonly seen in borderline
personality disorder.
4. A patient with borderline personality disorder is admitted after a self-harm episode. Which
nursing intervention is most important during the initial phase of care?
A) Exploring the underlying trauma that led to the self-harm
B) Establishing a therapeutic relationship and maintaining consistent boundaries
C) Administering a high dose of antipsychotic medication
D) Encouraging the patient to express anger toward their family
Correct Answer: Establishing a therapeutic relationship and maintaining consistent boundaries
Rationale: For a patient with borderline personality disorder, establishing a trusting therapeutic
relationship with consistent, firm boundaries is essential. Exploring trauma is premature before
,trust is established, and medication is not the primary intervention for self-harm. Encouraging
anger expression without therapeutic structure may escalate behaviors.
5. A nurse is assessing a patient for tardive dyskinesia. Which assessment tool should the nurse
use to monitor this condition?
A) The Hamilton Rating Scale for Depression
B) The CAGE questionnaire
C) The Abnormal Involuntary Movement Scale (AIMS)
D) The Mini-Mental State Exam
Correct Answer: The Abnormal Involuntary Movement Scale (AIMS)
Rationale: The Abnormal Involuntary Movement Scale (AIMS) is the standard tool used to
monitor for tardive dyskinesia, a potentially irreversible side effect of antipsychotic medications.
It assesses involuntary movements of the face, mouth, trunk, and extremities. Early detection is
critical to prevent permanent damage.
6. A patient on an antipsychotic medication develops a high fever, muscle rigidity, and altered
mental status. The nurse suspects which life-threatening complication?
A) Serotonin syndrome
B) Tardive dyskinesia
C) Neuroleptic malignant syndrome (NMS)
D) Extrapyramidal symptoms
Correct Answer: Neuroleptic malignant syndrome (NMS)
Rationale: NMS is a life-threatening emergency characterized by hyperthermia, severe muscle
rigidity, autonomic instability, and altered mental status. It is most commonly associated with
, first-generation antipsychotics. Immediate discontinuation of the antipsychotic and supportive
care are required.
7. A patient is diagnosed with antisocial personality disorder. Which behavioral pattern is most
consistent with this diagnosis?
A) Intense fear of abandonment and unstable relationships
B) A pattern of disregard for others' rights and lack of remorse
C) Social inhibition and hypersensitivity to negative evaluation
D) Preoccupation with orderliness and perfectionism
Correct Answer: A pattern of disregard for others' rights and lack of remorse
Rationale: Antisocial personality disorder is characterized by a pervasive pattern of disregard for
and violation of the rights of others, often involving deceitfulness, manipulation, impulsivity,
and a lack of remorse. Fear of abandonment and unstable relationships are characteristic of
borderline personality disorder.
8. A nurse is caring for a patient with schizophrenia who is exhibiting alogia. This is an example
of which type of symptom?
A) Positive symptom
B) Negative symptom
C) Cognitive symptom
D) Affective symptom
Correct Answer: Negative symptom
Rationale: Negative symptoms of schizophrenia involve a decrease or loss of normal functions,
such as alogia (poverty of speech), avolition (lack of motivation), and affective blunting. Positive
symptoms include hallucinations and delusions.
(2026) Actual Q&A PDF
1. Which assessment finding is the strongest predictor of imminent violence in a patient with a
psychiatric disorder?
A) A history of childhood abuse
B) A diagnosis of schizophrenia
C) A past history of violence
D) Verbal threats of harm
Correct Answer: A past history of violence
Rationale: A past history of violence is the most significant predictor of future violent behavior.
While a history of childhood abuse, a schizophrenia diagnosis, and verbal threats are important
risk factors, a documented history of violent acts is the strongest indicator of future risk and
should guide safety planning and interventions.
2. A nurse observes a patient becoming increasingly agitated and verbally aggressive. According
to the principles of de-escalation, what is the nurse's priority action?
A) Place the patient in seclusion immediately
B) Administer a PRN sedative medication
C) Maintain a calm demeanor and use a non-threatening posture
D) Call a code for a security response
Correct Answer: Maintain a calm demeanor and use a non-threatening posture
Rationale: De-escalation techniques are the first line of intervention for a patient demonstrating
escalating agitation. Maintaining a calm demeanor, using a non-threatening posture, and
,speaking in a low, slow tone can help reduce the patient's anxiety and prevent the situation
from escalating to the use of restraints or seclusion.
3. A patient with borderline personality disorder is engaging in splitting behavior. Which
statement by the patient is most consistent with this defense mechanism?
A) "I can't do anything right. I'm a complete failure."
B) "You're the only nurse who understands me. All the other nurses are incompetent."
C) "If you really cared, you would let me leave the unit."
D) "I know I'm manipulative, but I can't help it."
Correct Answer: "You're the only nurse who understands me. All the other nurses are
incompetent."
Rationale: Splitting is a primitive defense mechanism where the patient views people and
situations as either all good or all bad. In this scenario, the patient idealizes one nurse while
devaluing all others, which is a classic manifestation of splitting commonly seen in borderline
personality disorder.
4. A patient with borderline personality disorder is admitted after a self-harm episode. Which
nursing intervention is most important during the initial phase of care?
A) Exploring the underlying trauma that led to the self-harm
B) Establishing a therapeutic relationship and maintaining consistent boundaries
C) Administering a high dose of antipsychotic medication
D) Encouraging the patient to express anger toward their family
Correct Answer: Establishing a therapeutic relationship and maintaining consistent boundaries
Rationale: For a patient with borderline personality disorder, establishing a trusting therapeutic
relationship with consistent, firm boundaries is essential. Exploring trauma is premature before
,trust is established, and medication is not the primary intervention for self-harm. Encouraging
anger expression without therapeutic structure may escalate behaviors.
5. A nurse is assessing a patient for tardive dyskinesia. Which assessment tool should the nurse
use to monitor this condition?
A) The Hamilton Rating Scale for Depression
B) The CAGE questionnaire
C) The Abnormal Involuntary Movement Scale (AIMS)
D) The Mini-Mental State Exam
Correct Answer: The Abnormal Involuntary Movement Scale (AIMS)
Rationale: The Abnormal Involuntary Movement Scale (AIMS) is the standard tool used to
monitor for tardive dyskinesia, a potentially irreversible side effect of antipsychotic medications.
It assesses involuntary movements of the face, mouth, trunk, and extremities. Early detection is
critical to prevent permanent damage.
6. A patient on an antipsychotic medication develops a high fever, muscle rigidity, and altered
mental status. The nurse suspects which life-threatening complication?
A) Serotonin syndrome
B) Tardive dyskinesia
C) Neuroleptic malignant syndrome (NMS)
D) Extrapyramidal symptoms
Correct Answer: Neuroleptic malignant syndrome (NMS)
Rationale: NMS is a life-threatening emergency characterized by hyperthermia, severe muscle
rigidity, autonomic instability, and altered mental status. It is most commonly associated with
, first-generation antipsychotics. Immediate discontinuation of the antipsychotic and supportive
care are required.
7. A patient is diagnosed with antisocial personality disorder. Which behavioral pattern is most
consistent with this diagnosis?
A) Intense fear of abandonment and unstable relationships
B) A pattern of disregard for others' rights and lack of remorse
C) Social inhibition and hypersensitivity to negative evaluation
D) Preoccupation with orderliness and perfectionism
Correct Answer: A pattern of disregard for others' rights and lack of remorse
Rationale: Antisocial personality disorder is characterized by a pervasive pattern of disregard for
and violation of the rights of others, often involving deceitfulness, manipulation, impulsivity,
and a lack of remorse. Fear of abandonment and unstable relationships are characteristic of
borderline personality disorder.
8. A nurse is caring for a patient with schizophrenia who is exhibiting alogia. This is an example
of which type of symptom?
A) Positive symptom
B) Negative symptom
C) Cognitive symptom
D) Affective symptom
Correct Answer: Negative symptom
Rationale: Negative symptoms of schizophrenia involve a decrease or loss of normal functions,
such as alogia (poverty of speech), avolition (lack of motivation), and affective blunting. Positive
symptoms include hallucinations and delusions.
