NUR 253 Comprehensive Final Examination (Exams
1–4)| WITH MUST KNOW QUESTIONS AND ANSWERS
2026 | 2025 LATEST UPDATED TEST
1. A nursing student asks, “What is the primary purpose of the DSM-5-TR in psychiatric nursing?”
A. To provide treatment guidelines for all mental disorders
B. To classify and diagnose mental disorders using common criteria
C. To list all psychiatric medications with side effects
D. To determine nursing care plans for psychiatric patients
Answer: B
Rationale: The DSM-5-TR provides standardized diagnostic criteria for mental disorders, enabling
consistent communication and treatment planning among professionals.
2. Which statement by a patient reflects mental health rather than mental illness?
A. “I can’t get out of bed for days because I feel so sad.”
B. “I hear voices telling me to hurt myself.”
C. “I feel anxious about my exam, but I am studying and managing.”
D. “I believe the FBI is following me everywhere.”
Answer: C
Rationale: Mental health involves effective coping, realistic thinking, and functioning despite transient
stress. Option C shows adaptive anxiety management.
3. A nurse is using a therapeutic communication technique. Which response is an example of
reflecting?
A. “Tell me more about your feelings when that happened.”
B. “You seem sad today.”
C. “What do you think you should do about your problem?”
,D. “Why did you stop taking your medication?”
Answer: B
Rationale: Reflecting acknowledges the patient’s emotional state, helping them recognize and explore
feelings. “Why” questions (D) are non-therapeutic.
4. A patient says, “Nobody cares about me.” The nurse responds, “You feel alone and uncared for?”
This is an example of:
A. Restating
B. Clarifying
C. Paraphrasing
D. Validating
Answer: D
Rationale: Validating shows acceptance of the patient’s emotional experience without judgment,
helping them feel understood.
5. Which defense mechanism is a patient using who says, “I’m not angry, you’re the one who is
angry”?
A. Projection
B. Denial
C. Rationalization
D. Displacement
Answer: A
Rationale: Projection involves attributing one’s own unacceptable feelings to another person.
6. During the orientation phase of the nurse-patient relationship, the nurse should:
A. Explore termination issues
B. Establish trust and set mutually agreed-upon goals
,C. Work through transference reactions
D. Summarize progress made
Answer: B
Rationale: Orientation phase focuses on trust, confidentiality, boundaries, and goal-setting.
7. A patient with schizophrenia refuses medications because “they poison me.” The nurse says, “You
believe the medications are harmful. Let’s talk about your concerns.” This is an example of:
A. False reassurance
B. Validating the patient’s feeling without agreeing with delusion
C. Challenging the delusion
D. Changing the subject
Answer: B
Rationale: Validating feelings while not reinforcing delusional content maintains therapeutic rapport.
8. A nurse notices a colleague is signing out PRN lorazepam for a patient but not documenting
administration. What is the nurse’s best action?
A. Ignore it to avoid conflict
B. Report to the nurse manager immediately
C. Confront the colleague in the med room
D. Document for the colleague to “help out”
Answer: B
Rationale: Diversion of controlled substances is a legal and ethical violation; reporting to management
is mandatory.
9. Which patient statement indicates understanding of informed consent for ECT?
A. “I can change my mind and stop treatment anytime.”
B. “Once I sign, I cannot withdraw consent.”
, C. “My family will decide for me.”
D. “ECT will cure all my symptoms permanently.”
Answer: A
Rationale: Informed consent requires voluntary participation with right to withdraw at any time
without penalty.
10. A patient is placed in seclusion due to imminent danger to others. How often must a face-to-face
assessment be conducted?
A. Every 15 minutes
B. Every 30 minutes
C. Every hour
D. Every 4 hours
Answer: C
Rationale: CMS guidelines require face-to-face evaluation by a physician or RN within 1 hour of
seclusion initiation, then ongoing regular monitoring.
11. A nurse says to a patient, “You say you want to get better, but you keep missing group therapy.”
This is an example of:
A. Confrontation
B. Interpretation
C. Offering self
D. Restating
Answer: A
Rationale: Confrontation gently points out discrepancies between words and actions to promote
insight.
12. Which ethical principle is violated when a nurse shares a patient’s diagnosis with a neighbor?
1–4)| WITH MUST KNOW QUESTIONS AND ANSWERS
2026 | 2025 LATEST UPDATED TEST
1. A nursing student asks, “What is the primary purpose of the DSM-5-TR in psychiatric nursing?”
A. To provide treatment guidelines for all mental disorders
B. To classify and diagnose mental disorders using common criteria
C. To list all psychiatric medications with side effects
D. To determine nursing care plans for psychiatric patients
Answer: B
Rationale: The DSM-5-TR provides standardized diagnostic criteria for mental disorders, enabling
consistent communication and treatment planning among professionals.
2. Which statement by a patient reflects mental health rather than mental illness?
A. “I can’t get out of bed for days because I feel so sad.”
B. “I hear voices telling me to hurt myself.”
C. “I feel anxious about my exam, but I am studying and managing.”
D. “I believe the FBI is following me everywhere.”
Answer: C
Rationale: Mental health involves effective coping, realistic thinking, and functioning despite transient
stress. Option C shows adaptive anxiety management.
3. A nurse is using a therapeutic communication technique. Which response is an example of
reflecting?
A. “Tell me more about your feelings when that happened.”
B. “You seem sad today.”
C. “What do you think you should do about your problem?”
,D. “Why did you stop taking your medication?”
Answer: B
Rationale: Reflecting acknowledges the patient’s emotional state, helping them recognize and explore
feelings. “Why” questions (D) are non-therapeutic.
4. A patient says, “Nobody cares about me.” The nurse responds, “You feel alone and uncared for?”
This is an example of:
A. Restating
B. Clarifying
C. Paraphrasing
D. Validating
Answer: D
Rationale: Validating shows acceptance of the patient’s emotional experience without judgment,
helping them feel understood.
5. Which defense mechanism is a patient using who says, “I’m not angry, you’re the one who is
angry”?
A. Projection
B. Denial
C. Rationalization
D. Displacement
Answer: A
Rationale: Projection involves attributing one’s own unacceptable feelings to another person.
6. During the orientation phase of the nurse-patient relationship, the nurse should:
A. Explore termination issues
B. Establish trust and set mutually agreed-upon goals
,C. Work through transference reactions
D. Summarize progress made
Answer: B
Rationale: Orientation phase focuses on trust, confidentiality, boundaries, and goal-setting.
7. A patient with schizophrenia refuses medications because “they poison me.” The nurse says, “You
believe the medications are harmful. Let’s talk about your concerns.” This is an example of:
A. False reassurance
B. Validating the patient’s feeling without agreeing with delusion
C. Challenging the delusion
D. Changing the subject
Answer: B
Rationale: Validating feelings while not reinforcing delusional content maintains therapeutic rapport.
8. A nurse notices a colleague is signing out PRN lorazepam for a patient but not documenting
administration. What is the nurse’s best action?
A. Ignore it to avoid conflict
B. Report to the nurse manager immediately
C. Confront the colleague in the med room
D. Document for the colleague to “help out”
Answer: B
Rationale: Diversion of controlled substances is a legal and ethical violation; reporting to management
is mandatory.
9. Which patient statement indicates understanding of informed consent for ECT?
A. “I can change my mind and stop treatment anytime.”
B. “Once I sign, I cannot withdraw consent.”
, C. “My family will decide for me.”
D. “ECT will cure all my symptoms permanently.”
Answer: A
Rationale: Informed consent requires voluntary participation with right to withdraw at any time
without penalty.
10. A patient is placed in seclusion due to imminent danger to others. How often must a face-to-face
assessment be conducted?
A. Every 15 minutes
B. Every 30 minutes
C. Every hour
D. Every 4 hours
Answer: C
Rationale: CMS guidelines require face-to-face evaluation by a physician or RN within 1 hour of
seclusion initiation, then ongoing regular monitoring.
11. A nurse says to a patient, “You say you want to get better, but you keep missing group therapy.”
This is an example of:
A. Confrontation
B. Interpretation
C. Offering self
D. Restating
Answer: A
Rationale: Confrontation gently points out discrepancies between words and actions to promote
insight.
12. Which ethical principle is violated when a nurse shares a patient’s diagnosis with a neighbor?
