NUR 253: Concepts of Mental Health Nursing
Exams 1 – 4 | 2026/2027 Edition | Galen College
of Nursing 300 Questions | A+ Graded Answers
with Expert Rationales
EXAM 1: Foundations, Therapeutic Communication, Legal &
Ethical Issues (Questions 1-75)
1. A nurse uses silence after a client shares a traumatic experience. What is the
therapeutic purpose of this technique?
A. To change the subject to something less distressing
B. To encourage further expression and allow the client to process thoughts
C. To show disapproval for the client's emotional reaction
D. To signal the end of the conversation
Rationale: : Silence gives the client time to reflect, organize thoughts, and continue at
their own pace. It is a powerful therapeutic tool that conveys acceptance and respect,
not discomfort or disapproval.
2. Which statement by the nurse is the best example of therapeutic communication?
A. "You shouldn't feel that way about your family."
B. "Everything will be okay; don't worry so much."
C. "Tell me more about how you feel."
D. "I know exactly what you mean; the same thing happened to me."
Rationale: : "Tell me more" is an open-ended invitation that encourages the client to
express feelings without judgment. The other options either invalidate feelings, offer
false reassurance, or shift focus to the nurse.
3. A client is admitted to the psychiatric unit involuntarily after expressing suicidal
ideation with a plan. What is the priority nursing action upon admission?
A. Administer prescribed PRN sedative medication
B. Ensure the client's legal rights are protected and explained
C. Obtain a complete family psychiatric history
D. Begin individual therapy immediately
Rationale: : Even involuntarily committed clients retain legal rights (e.g., right to refuse
treatment, right to confidentiality). Explaining these rights is an ethical and legal priority
before any other interventions.
,4. Which defense mechanism involves refusing to accept reality or acknowledge an
obvious truth?
A. Projection
B. Denial
C. Displacement
D. Regression
Rationale: : Denial is the unconscious refusal to acknowledge an unbearable reality.
Projection attributes one's own feelings to others, displacement redirects emotions to a
safer target, and regression returns to an earlier developmental stage.
5. A client diagnosed with cancer says, "There must be a mistake. The lab mixed up my
results with someone else's." This statement demonstrates which defense mechanism?
A. Repression
B. Suppression
C. Denial
D. Rationalization
Rationale: : Denial blocks external events from awareness. The client rejects the
diagnosis despite evidence. Repression involves unconsciously forgetting, suppression is
conscious forgetting, and rationalization uses logical excuses.
6. A nursing student is learning about biological risk factors for mental illness. Which
factor is classified as a biological and genetic risk factor?
A. Family conflict during childhood
B. Prenatal exposure to alcohol
C. Lack of access to healthy food
D. Low socioeconomic status
Rationale: : Prenatal alcohol exposure is a biological insult to the developing brain,
directly increasing risk for neurodevelopmental disorders. The other options are
environmental or social risk factors.
7. The nurse recognizes that stigma surrounding mental illness is characterized by:
A. A temporary change in behavior due to stress
B. The belief that the overall person is flawed, leading to social shunning and
shame
C. A normal response to life challenges
D. An expected part of aging
Rationale: : Stigma involves labeling, stereotyping, and discrimination. It goes beyond
temporary stress responses and can prevent individuals from seeking help.
8. Which neurotransmitter is primarily involved in the regulation of mood, appetite, and
sleep?
,A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Rationale: : Serotonin regulates mood, appetite, sleep, and aggression. Dopamine is
involved in reward and movement; norepinephrine in arousal; GABA in inhibition.
9. A patient with schizophrenia experiences hallucinations, delusions, and disorganized
thinking. These symptoms are most likely related to excess activity of which
neurotransmitter?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. Glutamate
Rationale: : The dopamine hypothesis of schizophrenia suggests that excess dopamine
(especially in mesolimbic pathways) causes positive symptoms. Antipsychotics block D2
receptors to reduce these symptoms.
10. The nurse is teaching a patient about SSRIs. Which statement correctly explains how
SSRIs work?
A. Blocking the reuptake of serotonin, increasing serotonin availability in the
synapse
B. Blocking the reuptake of both serotonin and norepinephrine
C. Blocking dopamine receptors in the mesolimbic pathway
D. Increasing GABA activity throughout the central nervous system
Rationale: : SSRIs selectively block the serotonin transporter, prolonging serotonin's
action. Option B describes SNRIs, C describes antipsychotics, D describes
benzodiazepines.
11. A patient on a psychiatric unit tells the nurse, "You remind me exactly of my sister.
You have the same caring way about you." The nurse recognizes this statement as an
example of:
A. Countertransference
B. Transference
C. Empathy
D. Sympathy
Rationale: : Transference occurs when a patient unconsciously redirects feelings about a
significant person onto the nurse. Countertransference is the nurse's emotional reaction
to the patient.
, 12. A nurse notices that she feels unusually irritated with a new patient who reminds her
of an ex-spouse. This phenomenon is known as:
A. Countertransference
B. Transference
C. Resistance
D. Splitting
Rationale: : Countertransference is the nurse's emotional response based on personal
unresolved conflicts. It must be recognized and managed to avoid negatively affecting
care.
13. The nurse is preparing to interview a client. Which seating arrangement is most
appropriate to promote therapeutic communication?
A. Nurse and client on opposite sides of a large desk
B. Nurse and client facing each other directly, 2 feet apart
C. Nurse and client in chairs at a 90- to 120-degree angle, same height
D. Nurse standing and client sitting to establish authority
Rationale: : A 90-120 degree angle with chairs at equal height reduces confrontation
(direct facing) and barriers (desk), promoting open, non-threatening conversation.
14. The nurse begins an interview by stating, "What would you like to discuss today?"
This is an example of which therapeutic communication technique?
A. Focusing
B. Broad openings
C. Paraphrasing
D. Clarifying
Rationale: : Broad openings allow the client to choose the topic, conveying respect and
client-centered care. Focusing narrows the topic, paraphrasing restates, clarifying asks
for more detail.
15. A patient says, "I'm so angry that my family never visits me." The nurse responds,
"You feel angry because your family hasn't visited." This is an example of:
A. Paraphrasing/restating
B. Interpreting
C. Challenging
D. Reassuring
Rationale: : Paraphrasing repeats the client's message in the nurse's own words to
confirm understanding and show active listening. It does not add meaning (interpreting)
or argue.
16. Which of the following is an example of an open-ended question?
A. "Are you feeling sad today?"
Exams 1 – 4 | 2026/2027 Edition | Galen College
of Nursing 300 Questions | A+ Graded Answers
with Expert Rationales
EXAM 1: Foundations, Therapeutic Communication, Legal &
Ethical Issues (Questions 1-75)
1. A nurse uses silence after a client shares a traumatic experience. What is the
therapeutic purpose of this technique?
A. To change the subject to something less distressing
B. To encourage further expression and allow the client to process thoughts
C. To show disapproval for the client's emotional reaction
D. To signal the end of the conversation
Rationale: : Silence gives the client time to reflect, organize thoughts, and continue at
their own pace. It is a powerful therapeutic tool that conveys acceptance and respect,
not discomfort or disapproval.
2. Which statement by the nurse is the best example of therapeutic communication?
A. "You shouldn't feel that way about your family."
B. "Everything will be okay; don't worry so much."
C. "Tell me more about how you feel."
D. "I know exactly what you mean; the same thing happened to me."
Rationale: : "Tell me more" is an open-ended invitation that encourages the client to
express feelings without judgment. The other options either invalidate feelings, offer
false reassurance, or shift focus to the nurse.
3. A client is admitted to the psychiatric unit involuntarily after expressing suicidal
ideation with a plan. What is the priority nursing action upon admission?
A. Administer prescribed PRN sedative medication
B. Ensure the client's legal rights are protected and explained
C. Obtain a complete family psychiatric history
D. Begin individual therapy immediately
Rationale: : Even involuntarily committed clients retain legal rights (e.g., right to refuse
treatment, right to confidentiality). Explaining these rights is an ethical and legal priority
before any other interventions.
,4. Which defense mechanism involves refusing to accept reality or acknowledge an
obvious truth?
A. Projection
B. Denial
C. Displacement
D. Regression
Rationale: : Denial is the unconscious refusal to acknowledge an unbearable reality.
Projection attributes one's own feelings to others, displacement redirects emotions to a
safer target, and regression returns to an earlier developmental stage.
5. A client diagnosed with cancer says, "There must be a mistake. The lab mixed up my
results with someone else's." This statement demonstrates which defense mechanism?
A. Repression
B. Suppression
C. Denial
D. Rationalization
Rationale: : Denial blocks external events from awareness. The client rejects the
diagnosis despite evidence. Repression involves unconsciously forgetting, suppression is
conscious forgetting, and rationalization uses logical excuses.
6. A nursing student is learning about biological risk factors for mental illness. Which
factor is classified as a biological and genetic risk factor?
A. Family conflict during childhood
B. Prenatal exposure to alcohol
C. Lack of access to healthy food
D. Low socioeconomic status
Rationale: : Prenatal alcohol exposure is a biological insult to the developing brain,
directly increasing risk for neurodevelopmental disorders. The other options are
environmental or social risk factors.
7. The nurse recognizes that stigma surrounding mental illness is characterized by:
A. A temporary change in behavior due to stress
B. The belief that the overall person is flawed, leading to social shunning and
shame
C. A normal response to life challenges
D. An expected part of aging
Rationale: : Stigma involves labeling, stereotyping, and discrimination. It goes beyond
temporary stress responses and can prevent individuals from seeking help.
8. Which neurotransmitter is primarily involved in the regulation of mood, appetite, and
sleep?
,A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Rationale: : Serotonin regulates mood, appetite, sleep, and aggression. Dopamine is
involved in reward and movement; norepinephrine in arousal; GABA in inhibition.
9. A patient with schizophrenia experiences hallucinations, delusions, and disorganized
thinking. These symptoms are most likely related to excess activity of which
neurotransmitter?
A. Dopamine
B. Serotonin
C. Acetylcholine
D. Glutamate
Rationale: : The dopamine hypothesis of schizophrenia suggests that excess dopamine
(especially in mesolimbic pathways) causes positive symptoms. Antipsychotics block D2
receptors to reduce these symptoms.
10. The nurse is teaching a patient about SSRIs. Which statement correctly explains how
SSRIs work?
A. Blocking the reuptake of serotonin, increasing serotonin availability in the
synapse
B. Blocking the reuptake of both serotonin and norepinephrine
C. Blocking dopamine receptors in the mesolimbic pathway
D. Increasing GABA activity throughout the central nervous system
Rationale: : SSRIs selectively block the serotonin transporter, prolonging serotonin's
action. Option B describes SNRIs, C describes antipsychotics, D describes
benzodiazepines.
11. A patient on a psychiatric unit tells the nurse, "You remind me exactly of my sister.
You have the same caring way about you." The nurse recognizes this statement as an
example of:
A. Countertransference
B. Transference
C. Empathy
D. Sympathy
Rationale: : Transference occurs when a patient unconsciously redirects feelings about a
significant person onto the nurse. Countertransference is the nurse's emotional reaction
to the patient.
, 12. A nurse notices that she feels unusually irritated with a new patient who reminds her
of an ex-spouse. This phenomenon is known as:
A. Countertransference
B. Transference
C. Resistance
D. Splitting
Rationale: : Countertransference is the nurse's emotional response based on personal
unresolved conflicts. It must be recognized and managed to avoid negatively affecting
care.
13. The nurse is preparing to interview a client. Which seating arrangement is most
appropriate to promote therapeutic communication?
A. Nurse and client on opposite sides of a large desk
B. Nurse and client facing each other directly, 2 feet apart
C. Nurse and client in chairs at a 90- to 120-degree angle, same height
D. Nurse standing and client sitting to establish authority
Rationale: : A 90-120 degree angle with chairs at equal height reduces confrontation
(direct facing) and barriers (desk), promoting open, non-threatening conversation.
14. The nurse begins an interview by stating, "What would you like to discuss today?"
This is an example of which therapeutic communication technique?
A. Focusing
B. Broad openings
C. Paraphrasing
D. Clarifying
Rationale: : Broad openings allow the client to choose the topic, conveying respect and
client-centered care. Focusing narrows the topic, paraphrasing restates, clarifying asks
for more detail.
15. A patient says, "I'm so angry that my family never visits me." The nurse responds,
"You feel angry because your family hasn't visited." This is an example of:
A. Paraphrasing/restating
B. Interpreting
C. Challenging
D. Reassuring
Rationale: : Paraphrasing repeats the client's message in the nurse's own words to
confirm understanding and show active listening. It does not add meaning (interpreting)
or argue.
16. Which of the following is an example of an open-ended question?
A. "Are you feeling sad today?"
