NUR 253 Exams 1-4 Mental Health Galen
College of Nursing ACTUAL EXAM
2026/2027 | Galen NUR 253 Mental
Health Bundle | Verified Q&A | Pass
Guaranteed - A+ Graded
EXAM 1 OF 4: THERAPEUTIC COMMUNICATION & LEGAL/ETHICAL FOUNDATIONS
Total Questions: 50 | Time Suggested: 75 min
Q1. A client with major depressive disorder tells the nurse, "There's no point in going on. Everyone
would be better off without me." Which is the most therapeutic response by the nurse?
A. "You have so much to live for. Think about your children."
B. "Why would you say something like that?"
C. "It sounds like you're feeling hopeless. Have you thought about hurting yourself?"
D. "Let's focus on the positive things in your life right now."
Correct Answer: C
Rationale: This response directly acknowledges the client's expressed hopelessness while immediately
assessing for suicidal ideation, which is the priority safety intervention. Direct, non-judgmental
questioning about self-harm is the standard of care when a client makes a statement suggesting possible
suicidal intent. This follows the nursing priority of safety over therapeutic rapport.
Q2. A nurse is conducting an intake interview with a client recently admitted for bipolar mania. The
client states, "I don't need to be here. I'm fine. The police just don't understand my genius." Which
response demonstrates the therapeutic communication technique of clarification?
A. "You believe you don't need hospitalization because you're not ill."
B. "It must be frustrating to feel misunderstood by the police."
,C. "Help me understand what you mean by 'genius.'"
D. "Many people with bipolar disorder feel this way at first."
Correct Answer: C
Rationale: Clarification is a therapeutic technique used to check the understanding of ambiguous or
unclear statements by asking the client to elaborate or explain meaning. Asking the client to explain
"genius" seeks to understand the client's perspective without judgment, interpretation, or premature
closure. This technique prevents miscommunication and demonstrates genuine interest in the client's
subjective experience.
Q3. [SELECT ALL THAT APPLY] A nurse is establishing a therapeutic relationship with a client newly
admitted to an inpatient psychiatric unit. Which actions by the nurse demonstrate the working phase of
the therapeutic relationship? (Select all that apply.)
A. Orienting the client to the unit schedule and expectations
B. Exploring the client's feelings about a recent job loss
C. Setting mutual goals for symptom management
D. Summarizing progress made during hospitalization
E. Identifying maladaptive coping patterns with the client
F. Providing the client with community resource referrals
Correct Answers: B, C, E
Rationale: The working phase of Peplau's therapeutic relationship is characterized by problem
identification, exploration of feelings, and collaborative goal-setting. Exploring feelings about job loss (B)
addresses underlying issues. Setting mutual goals (C) is a core working phase task. Identifying
maladaptive coping (E) facilitates insight and behavior change. Orienting to the unit (A) occurs in the
orientation phase. Summarizing progress (D) and providing referrals (F) occur in the
termination/resolution phase.
Q4. A client with borderline personality disorder tells the nurse, "You're the only one who understands
me. The other nurses are terrible." Which response by the nurse maintains appropriate professional
boundaries?
A. "I appreciate your confidence in me. Let's talk about how you can work with the whole team."
B. "Thank you. I try very hard to be a good nurse."
C. "The other nurses are doing their best. You should give them a chance."
D. "I can see you feel strongly about this. What would help you feel safer with the other staff?"
Correct Answer: D
Rationale: This response validates the client's emotional experience without accepting the splitting
dynamic or reinforcing idealization/devaluation patterns characteristic of borderline personality
,disorder. It redirects the client toward examining their own reactions and building trust with the
treatment team, maintaining the nurse's neutral, consistent stance while addressing the underlying
need for safety. This demonstrates boundary maintenance through non-defensive, exploratory
communication.
Q5. A nurse observes a UAP attempting to apply wrist restraints to an agitated client who is pacing and
yelling but has not threatened anyone. Which action should the nurse take first?
A. Assist the UAP with applying the restraints to prevent escalation
B. Instruct the UAP to stop and assess the client for less restrictive interventions
C. Call the provider to obtain a restraint order
D. Document the UAP's actions in the incident report
Correct Answer: B
Rationale: Restraints are a last-resort intervention requiring imminent danger to self or others. The
nurse must first stop the UAP and conduct an assessment to determine if de-escalation techniques,
environmental modifications, or PRN medications can address the behavior without physical restraint.
This follows the least restrictive intervention principle, CMS CoP requirements, and the nurse's
supervisory responsibility to ensure UAP actions align with patient rights and safety standards.
Q6. [ORDERED RESPONSE – PRIORITY] A client is brought to the emergency department by police under
an emergency detention order for threatening to harm a neighbor. Place the following nursing actions in
order of priority.
1. Assess the client's immediate risk to self and others
2. Notify the mental health provider for evaluation
3. Obtain vital signs and complete a physical assessment
4. Place the client in a quiet, low-stimulation environment
Correct Answer: 1, 4, 3, 2
Rationale: Safety assessment (1) is the absolute first priority when a client is detained for
dangerousness—determining current intent, means, and plan for violence. Placing the client in a low-
stimulation environment (4) reduces agitation and facilitates assessment while maintaining safety. Vital
signs and physical assessment (3) detect medical conditions contributing to behavior (delirium,
intoxication, withdrawal). Notifying the provider (2) follows initial stabilization and assessment, as the
provider needs current clinical data to make informed decisions about commitment and treatment.
, Q7. A client with schizophrenia tells the nurse, "The FBI is monitoring my thoughts through the
television. They planted a chip in my brain during surgery last year." Which is the most therapeutic
response?
A. "That must be frightening for you. Tell me more about what you're experiencing."
B. "The FBI doesn't have the technology to monitor thoughts. That's not possible."
C. "I don't see any evidence of a chip. You're safe here."
D. "Have you considered that this might be a symptom of your illness?"
Correct Answer: A
Rationale: This response validates the client's emotional experience (fear) without confirming or arguing
with the delusional content. Asking the client to elaborate ("tell me more") opens therapeutic dialogue,
gathers assessment data about the delusion's intensity and organization, and builds trust. Arguing with
delusions (B, C) damages rapport and increases agitation. Interpreting the delusion as illness (D) is
premature and may be perceived as dismissive before a therapeutic alliance is established.
Q8. A nurse is documenting a client encounter in the electronic health record. Which documentation
practice best protects client confidentiality?
A. Discussing the client's case with the nursing student assigned to shadow the nurse
B. Leaving the computer screen visible while stepping away to answer a call light
C. Logging out of the EHR before leaving the workstation
D. Emailing the client's discharge plan to their employer at the client's request
Correct Answer: C
Rationale: Logging out of the EHR before leaving the workstation prevents unauthorized access to
protected health information (PHI), which is a fundamental HIPAA requirement. This simple action
protects against casual breaches, "curiosity" viewing by other staff or visitors, and intentional
unauthorized access. It represents the minimum standard for physical safeguards of electronic PHI and
demonstrates the nurse's accountability for information security.
Q9. [SELECT ALL THAT APPLY] A nurse is reviewing the Mental Status Examination (MSE) components
for a client with suspected dementia. Which findings would the nurse document under cognition?
(Select all that apply.)
A. The client correctly recalls three unrelated words after 5 minutes
B. The client can subtract serial 7s from 100
C. The client maintains eye contact throughout the interview
D. The client believes it is 1985 and they are president of the company
E. The client draws a clock showing all numbers in the correct positions
F. The client speaks in a soft, slow monotone
College of Nursing ACTUAL EXAM
2026/2027 | Galen NUR 253 Mental
Health Bundle | Verified Q&A | Pass
Guaranteed - A+ Graded
EXAM 1 OF 4: THERAPEUTIC COMMUNICATION & LEGAL/ETHICAL FOUNDATIONS
Total Questions: 50 | Time Suggested: 75 min
Q1. A client with major depressive disorder tells the nurse, "There's no point in going on. Everyone
would be better off without me." Which is the most therapeutic response by the nurse?
A. "You have so much to live for. Think about your children."
B. "Why would you say something like that?"
C. "It sounds like you're feeling hopeless. Have you thought about hurting yourself?"
D. "Let's focus on the positive things in your life right now."
Correct Answer: C
Rationale: This response directly acknowledges the client's expressed hopelessness while immediately
assessing for suicidal ideation, which is the priority safety intervention. Direct, non-judgmental
questioning about self-harm is the standard of care when a client makes a statement suggesting possible
suicidal intent. This follows the nursing priority of safety over therapeutic rapport.
Q2. A nurse is conducting an intake interview with a client recently admitted for bipolar mania. The
client states, "I don't need to be here. I'm fine. The police just don't understand my genius." Which
response demonstrates the therapeutic communication technique of clarification?
A. "You believe you don't need hospitalization because you're not ill."
B. "It must be frustrating to feel misunderstood by the police."
,C. "Help me understand what you mean by 'genius.'"
D. "Many people with bipolar disorder feel this way at first."
Correct Answer: C
Rationale: Clarification is a therapeutic technique used to check the understanding of ambiguous or
unclear statements by asking the client to elaborate or explain meaning. Asking the client to explain
"genius" seeks to understand the client's perspective without judgment, interpretation, or premature
closure. This technique prevents miscommunication and demonstrates genuine interest in the client's
subjective experience.
Q3. [SELECT ALL THAT APPLY] A nurse is establishing a therapeutic relationship with a client newly
admitted to an inpatient psychiatric unit. Which actions by the nurse demonstrate the working phase of
the therapeutic relationship? (Select all that apply.)
A. Orienting the client to the unit schedule and expectations
B. Exploring the client's feelings about a recent job loss
C. Setting mutual goals for symptom management
D. Summarizing progress made during hospitalization
E. Identifying maladaptive coping patterns with the client
F. Providing the client with community resource referrals
Correct Answers: B, C, E
Rationale: The working phase of Peplau's therapeutic relationship is characterized by problem
identification, exploration of feelings, and collaborative goal-setting. Exploring feelings about job loss (B)
addresses underlying issues. Setting mutual goals (C) is a core working phase task. Identifying
maladaptive coping (E) facilitates insight and behavior change. Orienting to the unit (A) occurs in the
orientation phase. Summarizing progress (D) and providing referrals (F) occur in the
termination/resolution phase.
Q4. A client with borderline personality disorder tells the nurse, "You're the only one who understands
me. The other nurses are terrible." Which response by the nurse maintains appropriate professional
boundaries?
A. "I appreciate your confidence in me. Let's talk about how you can work with the whole team."
B. "Thank you. I try very hard to be a good nurse."
C. "The other nurses are doing their best. You should give them a chance."
D. "I can see you feel strongly about this. What would help you feel safer with the other staff?"
Correct Answer: D
Rationale: This response validates the client's emotional experience without accepting the splitting
dynamic or reinforcing idealization/devaluation patterns characteristic of borderline personality
,disorder. It redirects the client toward examining their own reactions and building trust with the
treatment team, maintaining the nurse's neutral, consistent stance while addressing the underlying
need for safety. This demonstrates boundary maintenance through non-defensive, exploratory
communication.
Q5. A nurse observes a UAP attempting to apply wrist restraints to an agitated client who is pacing and
yelling but has not threatened anyone. Which action should the nurse take first?
A. Assist the UAP with applying the restraints to prevent escalation
B. Instruct the UAP to stop and assess the client for less restrictive interventions
C. Call the provider to obtain a restraint order
D. Document the UAP's actions in the incident report
Correct Answer: B
Rationale: Restraints are a last-resort intervention requiring imminent danger to self or others. The
nurse must first stop the UAP and conduct an assessment to determine if de-escalation techniques,
environmental modifications, or PRN medications can address the behavior without physical restraint.
This follows the least restrictive intervention principle, CMS CoP requirements, and the nurse's
supervisory responsibility to ensure UAP actions align with patient rights and safety standards.
Q6. [ORDERED RESPONSE – PRIORITY] A client is brought to the emergency department by police under
an emergency detention order for threatening to harm a neighbor. Place the following nursing actions in
order of priority.
1. Assess the client's immediate risk to self and others
2. Notify the mental health provider for evaluation
3. Obtain vital signs and complete a physical assessment
4. Place the client in a quiet, low-stimulation environment
Correct Answer: 1, 4, 3, 2
Rationale: Safety assessment (1) is the absolute first priority when a client is detained for
dangerousness—determining current intent, means, and plan for violence. Placing the client in a low-
stimulation environment (4) reduces agitation and facilitates assessment while maintaining safety. Vital
signs and physical assessment (3) detect medical conditions contributing to behavior (delirium,
intoxication, withdrawal). Notifying the provider (2) follows initial stabilization and assessment, as the
provider needs current clinical data to make informed decisions about commitment and treatment.
, Q7. A client with schizophrenia tells the nurse, "The FBI is monitoring my thoughts through the
television. They planted a chip in my brain during surgery last year." Which is the most therapeutic
response?
A. "That must be frightening for you. Tell me more about what you're experiencing."
B. "The FBI doesn't have the technology to monitor thoughts. That's not possible."
C. "I don't see any evidence of a chip. You're safe here."
D. "Have you considered that this might be a symptom of your illness?"
Correct Answer: A
Rationale: This response validates the client's emotional experience (fear) without confirming or arguing
with the delusional content. Asking the client to elaborate ("tell me more") opens therapeutic dialogue,
gathers assessment data about the delusion's intensity and organization, and builds trust. Arguing with
delusions (B, C) damages rapport and increases agitation. Interpreting the delusion as illness (D) is
premature and may be perceived as dismissive before a therapeutic alliance is established.
Q8. A nurse is documenting a client encounter in the electronic health record. Which documentation
practice best protects client confidentiality?
A. Discussing the client's case with the nursing student assigned to shadow the nurse
B. Leaving the computer screen visible while stepping away to answer a call light
C. Logging out of the EHR before leaving the workstation
D. Emailing the client's discharge plan to their employer at the client's request
Correct Answer: C
Rationale: Logging out of the EHR before leaving the workstation prevents unauthorized access to
protected health information (PHI), which is a fundamental HIPAA requirement. This simple action
protects against casual breaches, "curiosity" viewing by other staff or visitors, and intentional
unauthorized access. It represents the minimum standard for physical safeguards of electronic PHI and
demonstrates the nurse's accountability for information security.
Q9. [SELECT ALL THAT APPLY] A nurse is reviewing the Mental Status Examination (MSE) components
for a client with suspected dementia. Which findings would the nurse document under cognition?
(Select all that apply.)
A. The client correctly recalls three unrelated words after 5 minutes
B. The client can subtract serial 7s from 100
C. The client maintains eye contact throughout the interview
D. The client believes it is 1985 and they are president of the company
E. The client draws a clock showing all numbers in the correct positions
F. The client speaks in a soft, slow monotone
