RASMUSSEN MENTAL HEALTH FINAL
EXAM THERAPEUTIC COMMUNICATION,
PSYCHIATRIC DISORDERS,
PSYCHOPHARMACOLOGY, LEGAL/ETHICAL ISSUES,
CRISIS INTERVENTION, AND NURSING PROCESS.
Section 1: Therapeutic Communication & The Nurse-Patient Relationship
1. A patient tells the nurse, “I don’t think I’ll ever get out of here. What’s the point?” Which is the
most therapeutic response?
a) “Don’t worry, you’ll be out soon.”
b) “Why do you feel that way?”
c) “You feel hopeless about your situation right now.”
d) “Everyone feels that way at first.”
Correct Answer: c) “You feel hopeless about your situation right now.”
Rationale: This is an example of reflection and validation. It focuses on the patient’s feelings
(hopelessness) without judgment, encouraging further expression. Option b is a “why” question, which
can make patients defensive.
2. A nurse sits with a silent, withdrawn patient. After 20 minutes, the patient asks, “Are you going to
leave now?” The nurse responds, “Would you like me to stay?” This is an example of which
therapeutic technique?
a) Focusing
b) Clarifying
c) Placing the event in time
d) Offering self
Correct Answer: d) Offering self
Rationale: Offering self means making oneself available to the patient. The nurse’s presence
communicates worth and availability without demanding the patient interact.
,3. Which of the following is a non-therapeutic communication technique? (Select all that apply)
a) Asking “Why” questions
b) Offering reassurance
c) Giving advice
d) Active listening
Correct Answers: a, b, c
Rationale: Asking “why” implies judgment and often leads to rationalization. Reassurance (“Everything
will be fine”) dismisses the patient’s feelings. Giving advice promotes dependence. Active listening (d) is
therapeutic.
4. A nurse is working with a patient who has a history of manipulating staff. Which boundary
management strategy is most appropriate?
a) Allowing extra time for sessions to build trust
b) Maintaining consistent limit-setting among the team
c) Agreeing to keep a secret to strengthen rapport
d) Giving the patient a small gift to show caring
Correct Answer: b) Maintaining consistent limit-setting among the team
Rationale: Manipulative behavior thrives on inconsistency. All staff must adhere to the same limits (e.g.,
unit rules, privileges) to prevent splitting (playing staff against each other).
Section 2: Mood Disorders (Depression & Bipolar)
5. A patient with major depressive disorder (MDD) has been started on fluoxetine (Prozac). What is
the most important teaching point regarding medication onset?
a) “You will feel better immediately after the first dose.”
b) “Report any worsening of suicidal thoughts to your provider immediately.”
c) “Avoid all foods containing tyramine.”
d) “You may experience severe weight gain.”
Correct Answer: b) “Report any worsening of suicidal thoughts to your provider immediately.”
Rationale: SSRIs carry a black box warning for increased risk of suicidal ideation, especially in children,
adolescents, and young adults during the first few weeks of treatment, as energy increases before mood
improves.
6. A patient experiencing a manic episode says, “I’m the president of the universe. I can fly to the
moon.” The nurse’s best response is:
a) “You are not the president; you are in the hospital.”
b) “I know you believe that, but it must be scary to feel that powerful.”
, c) “Let’s go to the day room to play cards.”
d) “Tell me more about the moon.”
Correct Answer: c) “Let’s go to the day room to play cards.”
Rationale: During mania, the priority is to redirect the patient’s grandiose, high-energy behavior to non-
stimulating, structured activities. Arguing with delusions (a) is futile and increases agitation. Exploring
delusions (d) reinforces them.
7. Which lab value is critical to monitor for a patient taking lithium carbonate (Lithobid)?
a) Serum potassium
b) Serum sodium
c) Blood urea nitrogen (BUN) and serum creatinine
d) Thyroid stimulating hormone (TSH)
Correct Answers: c and d
Rationale: Lithium is excreted by the kidneys; therefore, renal function (BUN/Cr) must be monitored.
Lithium also commonly causes hypothyroidism; TSH should be monitored every 6-12 months. Low
sodium can increase lithium levels, leading to toxicity.
8. A patient with bipolar disorder presents with a lithium level of 2.0 mEq/L. What symptoms would
the nurse expect to see?
a) Fine hand tremor, nausea, thirst
b) Ataxia, coarse tremor, confusion, vomiting
c) Hypertensive crisis, diaphoresis
d) Agranulocytosis, fever, sore throat
Correct Answer: b) Ataxia, coarse tremor, confusion, vomiting
Rationale: Therapeutic lithium level is 0.6–1.2 mEq/L. A level of 2.0 mEq/L indicates moderate to severe
toxicity, characterized by neurological symptoms (ataxia, confusion, coarse tremor) and gastrointestinal
distress (nausea, vomiting). Fine tremor and thirst (a) are common side effects within therapeutic range.
Section 3: Anxiety, OCD, and Trauma-Related Disorders
9. A patient with generalized anxiety disorder (GAD) is pacing, wringing hands, and hyperventilating.
What is the priority nursing intervention?
a) Administer a PRN dose of lorazepam (Ativan)
b) Walk with the patient to a quiet area
c) Instruct the patient to breathe into a paper bag
d) Ask the patient to identify the source of anxiety
EXAM THERAPEUTIC COMMUNICATION,
PSYCHIATRIC DISORDERS,
PSYCHOPHARMACOLOGY, LEGAL/ETHICAL ISSUES,
CRISIS INTERVENTION, AND NURSING PROCESS.
Section 1: Therapeutic Communication & The Nurse-Patient Relationship
1. A patient tells the nurse, “I don’t think I’ll ever get out of here. What’s the point?” Which is the
most therapeutic response?
a) “Don’t worry, you’ll be out soon.”
b) “Why do you feel that way?”
c) “You feel hopeless about your situation right now.”
d) “Everyone feels that way at first.”
Correct Answer: c) “You feel hopeless about your situation right now.”
Rationale: This is an example of reflection and validation. It focuses on the patient’s feelings
(hopelessness) without judgment, encouraging further expression. Option b is a “why” question, which
can make patients defensive.
2. A nurse sits with a silent, withdrawn patient. After 20 minutes, the patient asks, “Are you going to
leave now?” The nurse responds, “Would you like me to stay?” This is an example of which
therapeutic technique?
a) Focusing
b) Clarifying
c) Placing the event in time
d) Offering self
Correct Answer: d) Offering self
Rationale: Offering self means making oneself available to the patient. The nurse’s presence
communicates worth and availability without demanding the patient interact.
,3. Which of the following is a non-therapeutic communication technique? (Select all that apply)
a) Asking “Why” questions
b) Offering reassurance
c) Giving advice
d) Active listening
Correct Answers: a, b, c
Rationale: Asking “why” implies judgment and often leads to rationalization. Reassurance (“Everything
will be fine”) dismisses the patient’s feelings. Giving advice promotes dependence. Active listening (d) is
therapeutic.
4. A nurse is working with a patient who has a history of manipulating staff. Which boundary
management strategy is most appropriate?
a) Allowing extra time for sessions to build trust
b) Maintaining consistent limit-setting among the team
c) Agreeing to keep a secret to strengthen rapport
d) Giving the patient a small gift to show caring
Correct Answer: b) Maintaining consistent limit-setting among the team
Rationale: Manipulative behavior thrives on inconsistency. All staff must adhere to the same limits (e.g.,
unit rules, privileges) to prevent splitting (playing staff against each other).
Section 2: Mood Disorders (Depression & Bipolar)
5. A patient with major depressive disorder (MDD) has been started on fluoxetine (Prozac). What is
the most important teaching point regarding medication onset?
a) “You will feel better immediately after the first dose.”
b) “Report any worsening of suicidal thoughts to your provider immediately.”
c) “Avoid all foods containing tyramine.”
d) “You may experience severe weight gain.”
Correct Answer: b) “Report any worsening of suicidal thoughts to your provider immediately.”
Rationale: SSRIs carry a black box warning for increased risk of suicidal ideation, especially in children,
adolescents, and young adults during the first few weeks of treatment, as energy increases before mood
improves.
6. A patient experiencing a manic episode says, “I’m the president of the universe. I can fly to the
moon.” The nurse’s best response is:
a) “You are not the president; you are in the hospital.”
b) “I know you believe that, but it must be scary to feel that powerful.”
, c) “Let’s go to the day room to play cards.”
d) “Tell me more about the moon.”
Correct Answer: c) “Let’s go to the day room to play cards.”
Rationale: During mania, the priority is to redirect the patient’s grandiose, high-energy behavior to non-
stimulating, structured activities. Arguing with delusions (a) is futile and increases agitation. Exploring
delusions (d) reinforces them.
7. Which lab value is critical to monitor for a patient taking lithium carbonate (Lithobid)?
a) Serum potassium
b) Serum sodium
c) Blood urea nitrogen (BUN) and serum creatinine
d) Thyroid stimulating hormone (TSH)
Correct Answers: c and d
Rationale: Lithium is excreted by the kidneys; therefore, renal function (BUN/Cr) must be monitored.
Lithium also commonly causes hypothyroidism; TSH should be monitored every 6-12 months. Low
sodium can increase lithium levels, leading to toxicity.
8. A patient with bipolar disorder presents with a lithium level of 2.0 mEq/L. What symptoms would
the nurse expect to see?
a) Fine hand tremor, nausea, thirst
b) Ataxia, coarse tremor, confusion, vomiting
c) Hypertensive crisis, diaphoresis
d) Agranulocytosis, fever, sore throat
Correct Answer: b) Ataxia, coarse tremor, confusion, vomiting
Rationale: Therapeutic lithium level is 0.6–1.2 mEq/L. A level of 2.0 mEq/L indicates moderate to severe
toxicity, characterized by neurological symptoms (ataxia, confusion, coarse tremor) and gastrointestinal
distress (nausea, vomiting). Fine tremor and thirst (a) are common side effects within therapeutic range.
Section 3: Anxiety, OCD, and Trauma-Related Disorders
9. A patient with generalized anxiety disorder (GAD) is pacing, wringing hands, and hyperventilating.
What is the priority nursing intervention?
a) Administer a PRN dose of lorazepam (Ativan)
b) Walk with the patient to a quiet area
c) Instruct the patient to breathe into a paper bag
d) Ask the patient to identify the source of anxiety
