NUR 425 EXAM 3 Actual Exam | Official Exam –
Complete Q&A with Rationales – Pass Guaranteed -
A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Psychiatric Mental Health Foundations | Q1 – Q10
Section 2 | Mood Disorders & Suicide Risk | Q11 – Q20
Section 3 | Anxiety, OCD & Trauma-Related Disorders | Q21 – Q30
Section 4 | Psychotic Disorders & Schizophrenia | Q31 – Q40
Section 5 | Crisis Intervention & Legal/Ethical Issues | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: PSYCHIATRIC MENTAL HEALTH FOUNDATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 22-year-old college student is brought to the emergency department by campus
security after peers reported she has been whispering to herself in the library for three
days, has not eaten, and believes her professors are reading her thoughts through the
campus Wi-Fi. Her vital signs are stable, and she is oriented to person and place but not
to date or situation. During the initial nursing assessment, which observation most
strongly indicates the need for immediate psychiatric evaluation over medical
clearance?
A. Her stable vital signs suggest she is medically safe and can be discharged to student
health
B. Her disorientation to date and situation combined with paranoid delusions and
thought broadcasting indicates acute psychosis requiring urgent psychiatric
assessment ✓ CORRECT
,C. Her refusal to eat for three days is typical college stress and does not require
intervention
D. Her whispering to herself is likely a cultural communication style and should be
normalized
Correct Answer: B
Rationale: Disorientation combined with paranoid delusions and thought broadcasting
represents a clear departure from reality that signals acute psychosis and potential
danger to self or others, mandating immediate psychiatric evaluation. Option A is
dangerous because stable vitals do not rule out psychiatric emergency; patients in
acute psychotic states can deteriorate rapidly without intervention. Campus-based
nurses often encounter first-break psychosis in young adults, and early identification
significantly improves long-term outcomes.
Question 2 of 50
A 34-year-old patient admitted for observation after a syncopal episode tells the nurse,
"I don't think I need to be here. My mother had the same thing happen, and she was fine.
I just want to go home and sleep in my own bed." The nurse notes the patient has
signed the admission paperwork and has no active medical concerns. Which response
best demonstrates therapeutic communication while respecting the patient's
autonomy?
A. "You signed the papers, so you have to stay until the doctor discharges you"
B. "It sounds like you're feeling frustrated about being here; let's talk about what
concerns you most and what would help you feel safe" ✓ CORRECT
C. "Your mother was lucky; you could have died, so we need to keep monitoring you"
D. "If you leave against medical advice, your insurance won't cover this visit"
Correct Answer: B
Rationale: Validating the patient's feelings while inviting collaboration addresses the
underlying anxiety without creating a power struggle, which is the foundation of
,therapeutic communication in psychiatric settings. Option A dismisses the patient's
emotional experience and treats admission as a contractual trap rather than a
therapeutic alliance. Nurses who master reflective listening and validation reduce
patient agitation and increase compliance with treatment plans.
Question 3 of 50
A 45-year-old patient with a history of bipolar I disorder is admitted to the psychiatric
unit after discontinuing lithium three months ago. He presents with pressured speech,
decreased need for sleep, and has spent $12,000 on cryptocurrency in the past week.
The nurse is developing the plan of care. Which nursing diagnosis takes priority for this
patient at this stage of illness?
A. Risk for injury related to hyperactivity and impulsive financial decision-making
B. Sleep deprivation related to decreased need for sleep as evidenced by three days
without rest
C. Risk for suicide related to potential for depressive crash following manic episode
D. Imbalanced nutrition: less than body requirements related to hypermetabolic state ✓
CORRECT
Correct Answer: D
Rationale: During acute mania, patients often go days without eating or sleeping,
leading to severe dehydration, electrolyte imbalance, and physical collapse, making
nutrition and fluid balance the immediate physiological priority. Option B addresses
sleep but is less urgent than preventing physical depletion from inadequate intake.
Psychiatric nurses must remember that mania is a medical emergency; patients can die
from exhaustion and dehydration before they ever reach a depressive phase.
Question 4 of 50
A 19-year-old patient in the adolescent psychiatric unit is diagnosed with borderline
personality disorder. During a group therapy session, she accuses another patient of
, stealing her journal, then moments later laughs and hugs the same patient, saying she
was "just kidding." The nurse observes this interaction. Which understanding of this
behavior is most accurate from a nursing perspective?
A. The patient is manipulating the group to gain attention and should be confronted
immediately
B. The patient is demonstrating splitting, a defense mechanism common in borderline
personality disorder, where others are viewed as all-good or all-bad in rapid succession
✓ CORRECT
C. The patient has developed a genuine friendship and is using humor to bond with her
peer
D. The patient is experiencing a medication side effect causing emotional lability
Correct Answer: B
Rationale: Splitting is a hallmark defense mechanism in borderline personality disorder
characterized by rapid oscillation between idealization and devaluation of others, which
explains the sudden shift from accusation to affection. Option A mislabels the behavior
as intentional manipulation rather than a symptom of the disorder, which leads to
punitive responses that worsen outcomes. Nurses working with borderline patients
benefit from understanding that splitting is not personal; it reflects profound fear of
abandonment and unstable self-identity.
Question 5 of 50
A 56-year-old patient with major depressive disorder tells the nurse, "I don't see the point
in taking these pills. I've been on four different antidepressants, and nothing changes.
I'm just broken." The nurse recognizes this statement as indicative of which cognitive
distortion?
A. Magnification, where the patient exaggerates the significance of medication failure
B. All-or-nothing thinking, where past treatment failures are generalized to mean
permanent hopelessness ✓ CORRECT
C. Mind reading, where the patient assumes the nurse agrees that treatment is futile
Complete Q&A with Rationales – Pass Guaranteed -
A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Psychiatric Mental Health Foundations | Q1 – Q10
Section 2 | Mood Disorders & Suicide Risk | Q11 – Q20
Section 3 | Anxiety, OCD & Trauma-Related Disorders | Q21 – Q30
Section 4 | Psychotic Disorders & Schizophrenia | Q31 – Q40
Section 5 | Crisis Intervention & Legal/Ethical Issues | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: PSYCHIATRIC MENTAL HEALTH FOUNDATIONS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 22-year-old college student is brought to the emergency department by campus
security after peers reported she has been whispering to herself in the library for three
days, has not eaten, and believes her professors are reading her thoughts through the
campus Wi-Fi. Her vital signs are stable, and she is oriented to person and place but not
to date or situation. During the initial nursing assessment, which observation most
strongly indicates the need for immediate psychiatric evaluation over medical
clearance?
A. Her stable vital signs suggest she is medically safe and can be discharged to student
health
B. Her disorientation to date and situation combined with paranoid delusions and
thought broadcasting indicates acute psychosis requiring urgent psychiatric
assessment ✓ CORRECT
,C. Her refusal to eat for three days is typical college stress and does not require
intervention
D. Her whispering to herself is likely a cultural communication style and should be
normalized
Correct Answer: B
Rationale: Disorientation combined with paranoid delusions and thought broadcasting
represents a clear departure from reality that signals acute psychosis and potential
danger to self or others, mandating immediate psychiatric evaluation. Option A is
dangerous because stable vitals do not rule out psychiatric emergency; patients in
acute psychotic states can deteriorate rapidly without intervention. Campus-based
nurses often encounter first-break psychosis in young adults, and early identification
significantly improves long-term outcomes.
Question 2 of 50
A 34-year-old patient admitted for observation after a syncopal episode tells the nurse,
"I don't think I need to be here. My mother had the same thing happen, and she was fine.
I just want to go home and sleep in my own bed." The nurse notes the patient has
signed the admission paperwork and has no active medical concerns. Which response
best demonstrates therapeutic communication while respecting the patient's
autonomy?
A. "You signed the papers, so you have to stay until the doctor discharges you"
B. "It sounds like you're feeling frustrated about being here; let's talk about what
concerns you most and what would help you feel safe" ✓ CORRECT
C. "Your mother was lucky; you could have died, so we need to keep monitoring you"
D. "If you leave against medical advice, your insurance won't cover this visit"
Correct Answer: B
Rationale: Validating the patient's feelings while inviting collaboration addresses the
underlying anxiety without creating a power struggle, which is the foundation of
,therapeutic communication in psychiatric settings. Option A dismisses the patient's
emotional experience and treats admission as a contractual trap rather than a
therapeutic alliance. Nurses who master reflective listening and validation reduce
patient agitation and increase compliance with treatment plans.
Question 3 of 50
A 45-year-old patient with a history of bipolar I disorder is admitted to the psychiatric
unit after discontinuing lithium three months ago. He presents with pressured speech,
decreased need for sleep, and has spent $12,000 on cryptocurrency in the past week.
The nurse is developing the plan of care. Which nursing diagnosis takes priority for this
patient at this stage of illness?
A. Risk for injury related to hyperactivity and impulsive financial decision-making
B. Sleep deprivation related to decreased need for sleep as evidenced by three days
without rest
C. Risk for suicide related to potential for depressive crash following manic episode
D. Imbalanced nutrition: less than body requirements related to hypermetabolic state ✓
CORRECT
Correct Answer: D
Rationale: During acute mania, patients often go days without eating or sleeping,
leading to severe dehydration, electrolyte imbalance, and physical collapse, making
nutrition and fluid balance the immediate physiological priority. Option B addresses
sleep but is less urgent than preventing physical depletion from inadequate intake.
Psychiatric nurses must remember that mania is a medical emergency; patients can die
from exhaustion and dehydration before they ever reach a depressive phase.
Question 4 of 50
A 19-year-old patient in the adolescent psychiatric unit is diagnosed with borderline
personality disorder. During a group therapy session, she accuses another patient of
, stealing her journal, then moments later laughs and hugs the same patient, saying she
was "just kidding." The nurse observes this interaction. Which understanding of this
behavior is most accurate from a nursing perspective?
A. The patient is manipulating the group to gain attention and should be confronted
immediately
B. The patient is demonstrating splitting, a defense mechanism common in borderline
personality disorder, where others are viewed as all-good or all-bad in rapid succession
✓ CORRECT
C. The patient has developed a genuine friendship and is using humor to bond with her
peer
D. The patient is experiencing a medication side effect causing emotional lability
Correct Answer: B
Rationale: Splitting is a hallmark defense mechanism in borderline personality disorder
characterized by rapid oscillation between idealization and devaluation of others, which
explains the sudden shift from accusation to affection. Option A mislabels the behavior
as intentional manipulation rather than a symptom of the disorder, which leads to
punitive responses that worsen outcomes. Nurses working with borderline patients
benefit from understanding that splitting is not personal; it reflects profound fear of
abandonment and unstable self-identity.
Question 5 of 50
A 56-year-old patient with major depressive disorder tells the nurse, "I don't see the point
in taking these pills. I've been on four different antidepressants, and nothing changes.
I'm just broken." The nurse recognizes this statement as indicative of which cognitive
distortion?
A. Magnification, where the patient exaggerates the significance of medication failure
B. All-or-nothing thinking, where past treatment failures are generalized to mean
permanent hopelessness ✓ CORRECT
C. Mind reading, where the patient assumes the nurse agrees that treatment is futile
