Galen NUR 253 Exam 4 – Mental Health (2026)
Actual Questions and Answers (PDF), Exams of
Nursing
Section 1: Crisis Intervention & Suicide (Questions 1-75)
1. A patient in the emergency department states, "I can't do this anymore. I
have a gun at home, and I'm going to use it tonight." What is the nurse's
priority action?
a) Ask the patient, "Do you have a plan to kill yourself?"
b) Notify the provider and prepare for involuntary admission.
c) Search the patient’s belongings for the weapon.
d) Call the patient’s family to remove the gun from the home.
Answer: b) Notify the provider and prepare for involuntary admission.
Rationale: The patient has expressed a plan (gun), intent ("going to
use it"), and means (gun at home), indicating imminent risk. The
priority is to ensure safety through immediate psychiatric evaluation
and involuntary hospitalization (duty to protect). Option A is not the
priority as the plan is already stated; options C and D are safety
actions but do not supersede the need for immediate containment
and evaluation.
2. A nurse is assessing a patient for suicidal ideation. Which question
demonstrates the most therapeutic and direct approach?
a) "You’re not thinking of hurting yourself, are you?"
b) "Life can be stressful. Do you ever feel sad?"
c) "Are you having thoughts of killing yourself?"
d) "Tell me about your support system."
Answer: c) "Are you having thoughts of killing yourself?"
Rationale: Assessment of suicidal ideation requires a direct, non-
judgmental, and unambiguous question. Using the word "killing"
leaves no room for misinterpretation. Options A and B are leading or
,vague; option D assesses support but not the immediate presence of
ideation.
3. Which patient has the highest risk for completed suicide?
a) A 35-year-old female with a new diagnosis of generalized anxiety disorder.
b) A 22-year-old male who just broke up with his girlfriend.
c) A 70-year-old White male with major depression and chronic pain.
d) A 45-year-old female with a history of a single suicide attempt 10 years
ago.
Answer: c) A 70-year-old White male with major depression and
chronic pain.
Rationale: High-risk factors for suicide include: older adult (especially
White males), presence of a mood disorder (depression), and physical
illness/chronic pain. Older adults often use more lethal means and
have fewer protective factors.
4. A nurse is caring for a patient on suicide precautions. Which
environmental intervention is most important?
a) Placing the patient in a private room at the end of the hall.
b) Removing all glass, metal utensils, and potential ligature points.
c) Allowing the patient to keep their belt for ambulation.
d) Checking on the patient every 30 minutes.
Answer: b) Removing all glass, metal utensils, and potential ligature
points.
Rationale: Environmental safety is paramount. This involves removing
any potential means of self-harm (ligature points, sharps, glass).
Constant observation (not every 30 minutes) is typically required for
imminent risk. A private room can increase isolation and risk.
5. A patient with a history of suicide attempts is being discharged. Which
statement by the patient indicates effective safety planning?
a) "I promised my wife I wouldn't do it again."
b) "If I feel urges again, I'll call my therapist or go to the ER."
c) "I just need to stay busy and not think about it."
,d) "They took my guns, so I should be fine."
Answer: b) "If I feel urges again, I'll call my therapist or go to the ER."
Rationale: A safety plan involves identifying triggers, internal coping
strategies, social contacts for distraction, and professional resources.
Stating a specific plan to use professional resources is the most
protective factor. Promises (A) are unreliable; avoidance (C) is not a
plan; removal of one means (D) does not eliminate risk.
6. (SATA) A nurse is assessing a patient for protective factors against suicide.
Which factors should the nurse identify? (Select all that apply.)
a) Strong connections to family and friends.
b) Current substance abuse disorder.
c) Sense of responsibility to children.
d) Access to firearms.
e) Active involvement in a faith community.
Answer: a, c, e
Rationale: Protective factors are those that reduce the likelihood of
suicide. These include social support (a, c), religious or spiritual
beliefs (e), and effective coping skills. Substance abuse (b) and access
to lethal means (d) are risk factors.
7. A nurse is using the SAD PERSONS scale to assess suicide risk. Which
factor is represented by the "P" (Previous attempt)?
a) Age
b) Sex
c) Psychiatric diagnosis
d) History of prior self-harm
Answer: d) History of prior self-harm
Rationale: The SAD PERSONS mnemonic stands for: Sex (male), Age
(<19 or >45), Depression, Previous attempt, Ethanol abuse, Rational
thinking loss, Social supports lacking, Organized plan, No spouse,
Sickness.
, 8. Which medication is most commonly associated with an increased risk of
suicidal ideation as a side effect, particularly in children and young adults?
a) Haloperidol (Haldol)
b) Fluoxetine (Prozac)
c) Lorazepam (Ativan)
d) Valproic acid (Depakote)
Answer: b) Fluoxetine (Prozac)
Rationale: SSRIs like fluoxetine carry a black box warning for an
increased risk of suicidal thinking and behavior in children,
adolescents, and young adults (under 24), especially during the initial
weeks of treatment or dosage changes.
9. A patient states, "I have a plan to overdose on my sleeping pills tonight."
The nurse asks, "When did you last have alcohol or take any pills?" What is
the rationale for this question?
a) To determine if the patient is under the influence and cannot be held
responsible.
b) To assess the lethality of the plan and urgency of intervention.
c) To change the subject away from the plan.
d) To determine if the patient is hallucinating.
Answer: b) To assess the lethality of the plan and urgency of
intervention.
Rationale: Assessing the lethality of a suicide plan involves
determining how soon, how lethal, and if there are any contributing
factors (like alcohol or other drugs) that would impair judgment or
increase the likelihood of carrying out the plan.
10. After a patient has been started on an antidepressant, the nurse should be
most concerned about the risk of suicide during which time frame?
a) Immediately after the first dose.
b) The first 1-2 weeks of therapy.
c) 4-6 weeks into therapy.
d) Only during the discontinuation phase.
Answer: b) The first 1-2 weeks of therapy.
Actual Questions and Answers (PDF), Exams of
Nursing
Section 1: Crisis Intervention & Suicide (Questions 1-75)
1. A patient in the emergency department states, "I can't do this anymore. I
have a gun at home, and I'm going to use it tonight." What is the nurse's
priority action?
a) Ask the patient, "Do you have a plan to kill yourself?"
b) Notify the provider and prepare for involuntary admission.
c) Search the patient’s belongings for the weapon.
d) Call the patient’s family to remove the gun from the home.
Answer: b) Notify the provider and prepare for involuntary admission.
Rationale: The patient has expressed a plan (gun), intent ("going to
use it"), and means (gun at home), indicating imminent risk. The
priority is to ensure safety through immediate psychiatric evaluation
and involuntary hospitalization (duty to protect). Option A is not the
priority as the plan is already stated; options C and D are safety
actions but do not supersede the need for immediate containment
and evaluation.
2. A nurse is assessing a patient for suicidal ideation. Which question
demonstrates the most therapeutic and direct approach?
a) "You’re not thinking of hurting yourself, are you?"
b) "Life can be stressful. Do you ever feel sad?"
c) "Are you having thoughts of killing yourself?"
d) "Tell me about your support system."
Answer: c) "Are you having thoughts of killing yourself?"
Rationale: Assessment of suicidal ideation requires a direct, non-
judgmental, and unambiguous question. Using the word "killing"
leaves no room for misinterpretation. Options A and B are leading or
,vague; option D assesses support but not the immediate presence of
ideation.
3. Which patient has the highest risk for completed suicide?
a) A 35-year-old female with a new diagnosis of generalized anxiety disorder.
b) A 22-year-old male who just broke up with his girlfriend.
c) A 70-year-old White male with major depression and chronic pain.
d) A 45-year-old female with a history of a single suicide attempt 10 years
ago.
Answer: c) A 70-year-old White male with major depression and
chronic pain.
Rationale: High-risk factors for suicide include: older adult (especially
White males), presence of a mood disorder (depression), and physical
illness/chronic pain. Older adults often use more lethal means and
have fewer protective factors.
4. A nurse is caring for a patient on suicide precautions. Which
environmental intervention is most important?
a) Placing the patient in a private room at the end of the hall.
b) Removing all glass, metal utensils, and potential ligature points.
c) Allowing the patient to keep their belt for ambulation.
d) Checking on the patient every 30 minutes.
Answer: b) Removing all glass, metal utensils, and potential ligature
points.
Rationale: Environmental safety is paramount. This involves removing
any potential means of self-harm (ligature points, sharps, glass).
Constant observation (not every 30 minutes) is typically required for
imminent risk. A private room can increase isolation and risk.
5. A patient with a history of suicide attempts is being discharged. Which
statement by the patient indicates effective safety planning?
a) "I promised my wife I wouldn't do it again."
b) "If I feel urges again, I'll call my therapist or go to the ER."
c) "I just need to stay busy and not think about it."
,d) "They took my guns, so I should be fine."
Answer: b) "If I feel urges again, I'll call my therapist or go to the ER."
Rationale: A safety plan involves identifying triggers, internal coping
strategies, social contacts for distraction, and professional resources.
Stating a specific plan to use professional resources is the most
protective factor. Promises (A) are unreliable; avoidance (C) is not a
plan; removal of one means (D) does not eliminate risk.
6. (SATA) A nurse is assessing a patient for protective factors against suicide.
Which factors should the nurse identify? (Select all that apply.)
a) Strong connections to family and friends.
b) Current substance abuse disorder.
c) Sense of responsibility to children.
d) Access to firearms.
e) Active involvement in a faith community.
Answer: a, c, e
Rationale: Protective factors are those that reduce the likelihood of
suicide. These include social support (a, c), religious or spiritual
beliefs (e), and effective coping skills. Substance abuse (b) and access
to lethal means (d) are risk factors.
7. A nurse is using the SAD PERSONS scale to assess suicide risk. Which
factor is represented by the "P" (Previous attempt)?
a) Age
b) Sex
c) Psychiatric diagnosis
d) History of prior self-harm
Answer: d) History of prior self-harm
Rationale: The SAD PERSONS mnemonic stands for: Sex (male), Age
(<19 or >45), Depression, Previous attempt, Ethanol abuse, Rational
thinking loss, Social supports lacking, Organized plan, No spouse,
Sickness.
, 8. Which medication is most commonly associated with an increased risk of
suicidal ideation as a side effect, particularly in children and young adults?
a) Haloperidol (Haldol)
b) Fluoxetine (Prozac)
c) Lorazepam (Ativan)
d) Valproic acid (Depakote)
Answer: b) Fluoxetine (Prozac)
Rationale: SSRIs like fluoxetine carry a black box warning for an
increased risk of suicidal thinking and behavior in children,
adolescents, and young adults (under 24), especially during the initial
weeks of treatment or dosage changes.
9. A patient states, "I have a plan to overdose on my sleeping pills tonight."
The nurse asks, "When did you last have alcohol or take any pills?" What is
the rationale for this question?
a) To determine if the patient is under the influence and cannot be held
responsible.
b) To assess the lethality of the plan and urgency of intervention.
c) To change the subject away from the plan.
d) To determine if the patient is hallucinating.
Answer: b) To assess the lethality of the plan and urgency of
intervention.
Rationale: Assessing the lethality of a suicide plan involves
determining how soon, how lethal, and if there are any contributing
factors (like alcohol or other drugs) that would impair judgment or
increase the likelihood of carrying out the plan.
10. After a patient has been started on an antidepressant, the nurse should be
most concerned about the risk of suicide during which time frame?
a) Immediately after the first dose.
b) The first 1-2 weeks of therapy.
c) 4-6 weeks into therapy.
d) Only during the discontinuation phase.
Answer: b) The first 1-2 weeks of therapy.
