NSG3450 / NSG 3450 Exam 2 2026 Update Nursing Practice: Mental Health | Galen College | Questions & Answers with Detailed Rationales | Grade A 100% Correct | Psychiatric Nursing & NCLEX-RN® Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive Exam 2 preparation guide for NSG3450 / NSG 3450 - Nursing Practice: Mental Health (2026 Update) at Galen College of Nursing, featuring questions and answers with detailed rationales. Designed for psychiatric-mental health nursing students, this resource consolidates the critical mental health concepts required to master the NSG3450 Exam 2 and excel in Nursing Practice: Mental Health. The guide is meticulously aligned with the Galen College curriculum, NCLEX-RN® test plan, DSM-5-TR criteria, and current evidence-based psychiatric nursing practice standards. This verified resource provides comprehensive coverage of key NSG3450 Mental Health Nursing Exam 2 topics, including: Therapeutic Communication (verbal and nonverbal communication techniques; therapeutic vs nontherapeutic responses; active listening; empathy; reflection; clarification; confrontation; open-ended vs closed-ended questions; silence; validation; summarization; nontherapeutic techniques—false reassurance, approval/disapproval, defensive responses, stereotyped responses, changing the subject, asking "why" questions); Therapeutic Relationship (phases of therapeutic relationship—preinteraction, orientation, working, termination; boundaries; transference; countertransference; therapeutic alliance); Mental Health Assessment (mental status examination (MSE)—appearance, behavior, speech, mood, affect, thought process, thought content, perceptual disturbances, cognition, insight, judgment; psychiatric history—chief complaint, history of present illness, past psychiatric history, medical history, substance use history, family history, social history; suicide risk assessment—SAD PERSONS scale, Columbia-Suicide Severity Rating Scale (C-SSRS); self-harm assessment; violence risk assessment); Mood Disorders (major depressive disorder (MDD)—diagnostic criteria (DSM-5-TR): five or more symptoms for 2 weeks including depressed mood or anhedonia; nursing interventions; suicide precautions; antidepressant medications—SSRIs (fluoxetine, sertraline, escitalopram), SNRIs (venlafaxine, duloxetine), TCAs (amitriptyline, nortriptyline), MAOIs (phenelzine, tranylcypromine), atypical antidepressants (bupropion, mirtazapine); side effects; serotonin syndrome; hypertensive crisis (MAOI dietary restrictions); persistent depressive disorder (dysthymia); bipolar disorder—bipolar I, bipolar II, cyclothymic disorder; manic episode diagnostic criteria (DSM-5-TR): elevated/irritable mood, increased activity/energy, grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, goal-directed activity, risky behavior; nursing interventions for mania—safety, low-stimulation environment, high-calorie finger foods, sleep promotion; mood stabilizers—lithium (therapeutic range: 0.8-1.2 mEq/L for acute mania, 0.6-1.2 mEq/L for maintenance; toxicity 1.5 mEq/L; lithium toxicity signs—severe nausea/vomiting, diarrhea, coarse tremor, ataxia, confusion, seizures, coma; nursing implications—monitor serum levels, thyroid function, renal function, encourage adequate hydration and sodium intake); anticonvulsant mood stabilizers—valproate/divalproex (depakote), carbamazepine, lamotrigine; Black Box Warnings; Anxiety Disorders (generalized anxiety disorder (GAD)—diagnostic criteria: excessive anxiety/worry for ≥6 months, three or more symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance); panic disorder—recurrent unexpected panic attacks; panic attack symptoms (DSM-5-TR): palpitations, sweating, trembling, shortness of breath, choking sensation, chest pain, nausea, dizziness, derealization, depersonalization, fear of losing control, fear of dying; agoraphobia; social anxiety disorder (social phobia); specific phobias; nursing interventions for anxiety—anxiety levels (mild, moderate, severe, panic); interventions by level; grounding techniques; breathing exercises; anxiety medications—benzodiazepines (alprazolam, lorazepam, clonazepam, diazepam)—short-term use, dependence risk, withdrawal syndrome; buspirone (non-benzodiazepine, no dependence, delayed onset 2-4 weeks); beta-blockers (propranolol) for performance anxiety); Obsessive-Compulsive and Related Disorders (obsessive-compulsive disorder (OCD)—obsessions (recurrent intrusive thoughts, urges, images) and compulsions (repetitive behaviors or mental acts); common obsessions (contamination, symmetry, forbidden thoughts, harm); common compulsions (washing, checking, counting, ordering, reassurance seeking); nursing interventions—do not reinforce compulsions, provide structured schedule, allow extra time for rituals initially, gradually limit rituals; medications—SSRIs (high-dose fluoxetine, fluvoxamine, sertraline); body dysmorphic disorder; hoarding disorder; trichotillomania (hair-pulling); excoriation (skin-picking)); Trauma and Stressor-Related Disorders (posttraumatic stress disorder (PTSD)—diagnostic criteria (DSM-5-TR): exposure to traumatic event; intrusion symptoms (flashbacks, nightmares, intrusive memories); avoidance; negative alterations in cognition/mood; alterations in arousal/reactivity (hypervigilance, exaggerated startle response, irritability, sleep disturbance); duration 1 month; nursing interventions—safety, grounding techniques, trigger identification, trauma-informed care; medications—SSRIs (sertraline, paroxetine), SNRIs (venlafaxine); acute stress disorder (duration 3 days to 1 month); adjustment disorders; Eating Disorders (anorexia nervosa—diagnostic criteria: restriction of energy intake, intense fear of weight gain, disturbed body image; subtypes—restricting type, binge-eating/purging type; medical complications—bradycardia, hypotension, hypothermia, electrolyte imbalances, amenorrhea, osteoporosis; refeeding syndrome risk; bulimia nervosa—diagnostic criteria: recurrent binge eating, recurrent compensatory behaviors (self-induced vomiting, laxatives, diuretics, fasting, excessive exercise), at least once weekly for 3 months, self-evaluation influenced by weight/shape; medical complications—electrolyte imbalances (hypokalemia, hyponatremia), metabolic alkalosis, dental erosion, parotid gland enlargement, esophageal tears (Mallory-Weiss syndrome), Russell's sign (knuckle calluses); binge-eating disorder—binge eating without compensatory behaviors; nursing interventions for eating disorders—monitor vital signs and electrolytes, supervise meals (1 hour post-meal), structured meal plan, no bathroom access for 1-2 hours post-meal, cognitive behavioral therapy (CBT), family-based treatment (FBT)); Substance Use Disorders (substance use disorder criteria (DSM-5-TR): 2+ of 11 criteria in 12 months (impaired control, social impairment, risky use, pharmacological criteria—tolerance, withdrawal); alcohol use disorder—CAGE questionnaire, CIWA-Ar for withdrawal assessment; alcohol withdrawal—symptoms (tremors, anxiety, nausea, vomiting, insomnia, autonomic hyperactivity); alcohol withdrawal delirium (delirium tremens)—onset 48-72 hours after last drink, symptoms (severe confusion, hallucinations, agitation, seizures, autonomic instability, fever); mortality risk 5-20% if untreated; medications for alcohol withdrawal—benzodiazepines (lorazepam, chlordiazepoxide), thiamine (prevent Wernicke-Korsakoff syndrome), folic acid, multivitamins; medications for alcohol use disorder maintenance—disulfiram (Antabuse)—causes acetaldehyde syndrome (flushing, nausea, vomiting, hypotension, dyspnea) if alcohol consumed; naltrexone (reduces cravings, blocks opioid receptors); acamprosate (reduces protracted withdrawal); opioid use disorder—opioid withdrawal symptoms (yawning, rhinorrhea, mydriasis, piloerection (gooseflesh), muscle aches, nausea, vomiting, diarrhea, abdominal cramps, insomnia); opioid withdrawal is unpleasant but not life-threatening; medications for opioid use disorder—methadone (full agonist, daily dosing at clinic), buprenorphine (partial agonist, prescribed in office), naltrexone (antagonist, blocks effects); naloxone (Narcan)—opioid antagonist, reverses respiratory depression, half-life shorter than most opioids, may require repeat dosing; stimulant use disorder (cocaine, methamphetamine)—no FDA-approved medications, supportive care; cannabis use disorder; sedative-hypnotic use disorder; nicotine use disorder—nicotine replacement therapy (patch, gum, lozenge, inhaler, nasal spray), bupropion (Zyban), varenicline (Chantix)); Schizophrenia Spectrum and Other Psychotic Disorders (schizophrenia—diagnostic criteria (DSM-5-TR): two or more of the following for at least 1 month (at least one must be 1, 2, or 3): 1) delusions (persecutory, referential, grandiose, erotomanic, nihilistic, somatic, bizarre), 2) hallucinations (auditory most common—command hallucinations, running commentary, voices conversing; visual, tactile, olfactory, gustatory), 3) disorganized speech (loose associations, tangentiality, incoherence, neologisms, word salad), 4) grossly disorganized or catatonic behavior, 5) negative symptoms (affective flattening, alogia, avolition, anhedonia, asociality); continuous signs for 6 months; significant functional impairment; schizophrenia subtypes (paranoid, disorganized, catatonic, undifferentiated, residual); phases of schizophrenia (prodromal, active/acute, residual); nursing interventions for psychosis—safety (risk for self-harm, suicide, violence), therapeutic communication (avoid arguing about delusions, acknowledge feelings, focus on underlying emotion, redirect to reality-based topics), hallucination management (do not deny or confirm hallucination, ask what voices are saying, identify triggers, coping strategies—humming, singing, listening to music, exercise), medication adherence, structured environment; antipsychotic medications—first-generation (typical) antipsychotics (FGAs)—dopamine D2 antagonists (haloperidol, fluphenazine, chlorpromazine, perphenazine); side effects—extrapyramidal symptoms (EPS): acute dystonia (muscle spasms, oculogyric crisis), pseudoparkinsonism (rigidity, bradykinesia, tremor, shuffling gait), akathisia (subjective restlessness, pacing, inability to sit still), tardive dyskinesia (involuntary choreoathetoid movements of tongue, face, mouth, jaw, trunk—potentially irreversible); treatment for EPS—anticholinergic medications (benztropine, diphenhydramine); tardive dyskinesia management—discontinue or reduce antipsychotic, switch to atypical, consider valbenazine or deutetrabenazine; neuroleptic malignant syndrome (NMS)—life-threatening emergency: fever, muscle rigidity, autonomic instability, altered mental status, elevated CPK; treatment—stop antipsychotic, supportive care, dantrolene or bromocriptine; second-generation (atypical) antipsychotics (SGAs)—clozapine (requires regular absolute neutrophil count (ANC) monitoring due to agranulocytosis risk—Black Box Warning), risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, paliperidone, lurasidone; metabolic side effects of SGAs—weight gain, hyperglycemia, diabetes, dyslipidemia (most significant with clozapine, olanzapine); Neurocognitive Disorders (delirium—acute onset, fluctuating course, inattention, disorganized thinking, altered level of consciousness; common causes (DELIRIUM mnemonic: Drugs, Electrolyte disturbances, Lack of drugs (withdrawal), Infection, Reduced sensory input, Intracranial, Urinary retention/fecal impaction, Myocardial/pulmonary); nursing interventions for delirium—identify and treat underlying cause, safety (fall precautions), reorientation (clocks, calendars, familiar objects), minimize sensory overload, consistent staff, avoid physical restraints, medications—low-dose haloperidol or atypical antipsychotics only if severe agitation/safety risk; major neurocognitive disorder (dementia)—insidious onset, progressive decline in cognitive function (memory, executive function, visuospatial ability, language, personality changes); common types—Alzheimer's disease (most common, amyloid plaques, neurofibrillary tangles), vascular dementia (stepwise decline, history of stroke/CVA risk factors), Lewy body dementia (fluctuating cognition, visual hallucinations, parkinsonism, REM sleep behavior disorder), frontotemporal dementia (behavioral variant, primary progressive aphasia); nursing interventions for dementia—structured routine, safe environment (wandering prevention, fall prevention), communication strategies (simple sentences, one step at a time, avoid arguments, redirect), validation therapy, reality orientation vs validation therapy considerations, caregiver support; medications for Alzheimer's—cholinesterase inhibitors (donepezil, rivastigmine, galantamine)—modest cognitive benefit, side effects (nausea, diarrhea, bradycardia); memantine (NMDA antagonist) for moderate-severe Alzheimer's); Personality Disorders (definition—enduring, inflexible, pervasive patterns of inner experience and behavior deviating from cultural expectations, onset in adolescence or early adulthood, stable over time, leads to distress or impairment; clusters—Cluster A (odd/eccentric): paranoid, schizoid, schizotypal; Cluster B (dramatic/erratic): antisocial, borderline, histrionic, narcissistic; Cluster C (anxious/fearful): avoidant, dependent, obsessive-compulsive; borderline personality disorder (BPD)—diagnostic criteria: pattern of instability in interpersonal relationships, self-image, affects, marked impulsivity; at least 5 of 9 criteria (frantic efforts to avoid abandonment, unstable intense relationships, identity disturbance, impulsivity (self-damaging), recurrent suicidal behavior/SIB, affective instability, chronic emptiness, intense anger, transient paranoid ideation/dissociation); nursing interventions for BPD—safety (self-harm, suicide), clear consistent boundaries, dialectical behavior therapy (DBT), avoid splitting (staff consistency, written behavioral contracts), emotion regulation skills; antisocial personality disorder (ASPD)—disregard for and violation of rights of others, lack of remorse, conduct disorder before age 15; Somatic Symptom and Related Disorders (somatic symptom disorder—one or more distressing somatic symptoms with excessive thoughts, feelings, behaviors related to symptoms; illness anxiety disorder (hypochondriasis)—preoccupation with having or acquiring serious illness, mild or no somatic symptoms, high health anxiety; conversion disorder (functional neurological symptom disorder)—neurological symptoms (weakness, paralysis, movement disorders, seizures, sensory loss) incompatible with medical conditions; factitious disorder (Munchausen syndrome)—intentional falsification of physical/psychological signs/symptoms without external incentive; factitious disorder imposed on another (Munchausen by proxy); malingering—intentional falsification for external incentive (not a mental disorder); nursing interventions—acknowledge genuine distress, avoid reinforcing illness behavior, shift focus to coping with symptoms rather than curing, consistent approach among staff); Dissociative Disorders (dissociative identity disorder (DID)—two or more distinct personality states with gaps in recall; dissociative amnesia; depersonalization/derealization disorder); Sleep-Wake Disorders (insomnia disorder; hypersomnolence; narcolepsy; breathing-related sleep disorders; parasomnias); Sexual Dysfunction and Paraphilic Disorders (sexual dysfunctions—desire, arousal, orgasm, pain disorders; paraphilic disorders—exhibitionistic, voyeuristic, frotteuristic, sexual sadism, sexual masochism, pedophilic, fetishistic, transvestic disorders; nursing considerations—nonjudgmental care, mandatory reporting for pedophilic disorder involving minors); Crisis and Disaster Nursing (crisis theory—acute time-limited response (4-6 weeks) to overwhelming life event; phases of crisis; crisis intervention—assessment of safety, suicidal/homicidal ideation, identify precipitating event, mobilize resources, develop coping strategies; disaster nursing—types of disasters (natural, accidental, biological, chemical, radiological, terrorist); phases of disaster response (preparedness, response, recovery, mitigation); psychological first aid (PFA); triage in disaster; stress management for disaster responders); Psychopharmacology Review (antidepressants—SSRIs (first-line for depression, anxiety, OCD, PTSD), SNRIs, TCAs (cardiotoxic in overdose), MAOIs (dietary restrictions—avoid tyramine-containing foods: aged cheese, cured meats, fermented products, red wine, draft beer—hypertensive crisis risk), atypical antidepressants; mood stabilizers—lithium (narrow therapeutic index, monitor serum levels, thyroid, renal), anticonvulsants; antipsychotics—first-generation (EPS, NMS, tardive dyskinesia), second-generation (metabolic syndrome); anxiolytics—benzodiazepines (tolerance, dependence, withdrawal, CNS depression risk—do not combine with alcohol/other CNS depressants), buspirone; medications for substance use disorders—naltrexone (alcohol, opioid use disorder), acamprosate (alcohol use disorder), disulfiram (alcohol use disorder), methadone/buprenorphine (opioid use disorder), varenicline/bupropion (nicotine use disorder); medication administration nursing considerations—route, dosage, side effect monitoring, patient education, drug interactions, Black Box Warnings (suicidality in children/young adults with antidepressants; clozapine agranulocytosis; lithium toxicity; benzodiazepine withdrawal); Legal and Ethical Issues in Psychiatric Nursing (ethical principles in mental health—autonomy (informed consent, right to refuse treatment), beneficence, nonmaleficence (do no harm), justice (fair allocation of resources), fidelity (loyalty/commitment); legal issues—voluntary vs involuntary admission; criteria for involuntary commitment (danger to self, danger to others, gravely disabled); patient rights in psychiatric settings (right to treatment, right to refuse treatment, right to least restrictive environment, right to confidentiality (HIPAA), right to communication, right to legal counsel); informed consent in psychiatric nursing—capacity to consent, voluntary consent, disclosure; exceptions to informed consent (emergency, therapeutic privilege, patient waiver); restraint and seclusion—restraint (chemical, physical) and seclusion use only when imminent danger to self or others, physician order within 1 hour, face-to-face evaluation within 1 hour, order time-limited (adults: 4 hours for restraint, 4 hours for seclusion; children/adolescents: shorter durations), continuous monitoring and documentation, debriefing with patient after release; mandated reporting—child abuse/neglect, elder abuse/neglect, dependent adult abuse, Tarasoff duty to protect (duty to warn identifiable victim of serious threat of violence); confidentiality exceptions (Tarasoff, mandated reporting, imminent danger to self/others, court order, insurance billing, quality assurance); advance psychiatric directives; guardianship and conservatorship). It features hundreds of exam-style questions including multiple-choice, select-all-that-apply (SATA), ordered response, fill-in-the-blank, and clinical scenario-based questions. Each question includes verified answers with detailed rationales explaining the correct answer and clarifying common misconceptions, along with cognitive level tags (Bloom's Taxonomy: Remember, Understand, Apply, Analyze) and NCLEX client needs categories (Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, Physiological Integrity—specifically Psychosocial Integrity is heavily emphasized for mental health nursing). Sample Question — "A client with bipolar disorder who is taking lithium carbonate reports nausea, vomiting, blurred vision, and a fine hand tremor. The nurse notes that the client appears confused and is unsteady when walking. Which action should the nurse take first? A) Administer an antiemetic medication as prescribed B) Withhold the next dose of lithium and obtain a STAT serum lithium level C) Reassure the client that these are expected side effects of lithium D) Encourage the client to increase oral fluid intake. Correct Answer: B. Rationale: The client is exhibiting signs of lithium toxicity (nausea, vomiting, blurred vision, confusion, ataxia, coarse tremor—note that fine tremor can be a side effect but coarse tremor with confusion and ataxia suggests toxicity). The priority action is to withhold the next dose and obtain a STAT serum lithium level to confirm toxicity. Antiemetics address symptoms but not the underlying toxicity. These symptoms are NOT normal/expected side effects. Increasing fluids would not reverse established toxicity and could worsen if client has impaired gag/swallow from toxicity." DOCUMENT ACCESS: This study guide is available as an instant digital download (PDF) immediately upon purchase. Fully text-searchable, printable, and accessible anytime through your user account. Trusted by Galen College nursing students for NSG3450 Exam 2 success, Nursing Practice: Mental Health course mastery, and building a strong foundation in psychiatric-mental health nursing, therapeutic communication, psychopharmacology, and NCLEX-RN® preparation.