NUR253 Exam 4 V2 | NUR 253 Mental Health
Nursing Exam Q&A | Galen College of Nursing
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This study guide is intended to help students strengthen their understanding of lifespan
psychiatric nursing, special populations in mental healthcare, and community mental
health interventions. The content reflects practical psychiatric nursing concepts frequently
tested in nursing examinations.
The questions are designed to simulate actual exam conditions while reinforcing psychiatric
prioritization, therapeutic communication, and interdisciplinary mental health collaboration
skills. Detailed expert explanations are included to support concept mastery and exam
preparedness.
════════════════════════════════════
The Exam Covers:
• Pediatric behavioral disorders
• Geriatric depression and dementia
• Family dynamics in mental healthcare
• Community crisis resources
• Psychiatric advocacy and patient rights
• Mental health nursing ethics
• Therapeutic family interventions
• Long-term psychiatric management
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1. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS). The
patient is on a ventilator and PEEP has been increased to 15 cm H2O. Which assessment
finding is the priority to report to the provider?
A. Heart rate of 102 beats per minute
B. Oxygen saturation of 92%
,C. Decreased breath sounds on the right side
D. Scattered crackles throughout both lung fields
Correct Answer: C
Expert Explanation: High PEEP increases the risk of barotrauma, which can lead to a
tension pneumothorax. Decreased breath sounds on one side is a hallmark sign of a
pneumothorax and requires immediate intervention. The nurse must recognize that while
crackles are expected in ARDS, asymmetrical breath sounds are a critical complication.
2. The nurse is assessing a patient in the early stages of septic shock. Which of the following
clinical manifestations should the nurse expect to find?
A. Warm, flushed skin and tachycardia
B. Hypotension and bradycardia
C. Cool, clammy skin and decreased urine output
D. Bradypnea and increased cardiac output
Correct Answer: A
Expert Explanation: In the early (hyperdynamic) stage of septic shock, the patient often
exhibits warm, flushed skin due to vasodilation and tachycardia as a compensatory
mechanism. This is distinct from other types of shock where the skin is usually cool and
clammy. This stage is often called ‘warm shock’ and precedes the drop in cardiac output.
,3. A patient is admitted to the ICU with a diagnosis of Acute Respiratory Failure. The nurse
notes the pH is 7.28, PaCO2 is 55 mmHg, and HCO3 is 26 mEq/L. How should the nurse
interpret these ABG results?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Expert Explanation: A pH of 7.28 indicates acidosis, and a PaCO2 of 55 indicates that the
cause is respiratory in nature as the CO2 is elevated. The bicarbonate level is within normal
limits, suggesting no compensation has occurred yet. This pattern is common in patients
with hypoventilation or obstructive lung diseases.
4. During the primary survey of a trauma patient, the nurse notes a sucking chest wound.
What is the immediate nursing action?
A. Apply a four-sided occlusive dressing
B. Apply a three-sided occlusive dressing
C. Insert a large-bore IV line
D. Prepare for immediate endotracheal intubation
Correct Answer: B
, Expert Explanation: An open pneumothorax or sucking chest wound requires a dressing
taped on three sides. This creates a one-way valve that allows air to escape during
expiration but prevents air from entering during inspiration. Taping on four sides could
lead to a tension pneumothorax by trapping air in the pleural space.
5. A hospice nurse is managing a patient’s pain at the end of life. The patient’s family is
concerned that the dose of morphine is ‘too high’ and might ‘kill him.’ What is the nurse’s
best response?
A. ‘The law requires me to give the dose as prescribed by the doctor.’
B. ‘Morphine actually helps the patient breathe better at the end of life.’
C. ‘I will lower the dose to ease your concerns for now.’
D. ‘We are only using enough to keep him comfortable, which is our priority.’
Correct Answer: D
Expert Explanation: The nurse should use therapeutic communication to address the
family’s fears while emphasizing the goal of comfort care. In hospice, the principle of
double effect is often applied, where the intent is to relieve suffering even if the medication
might hasten death. Educating the family on the priority of palliative goals is essential for
holistic care.
6. A nurse is monitoring a patient with an arterial line. The monitor shows a flat line, but the
patient is awake, alert, and talking. What should the nurse do first?
A. Check the connection of the pressure tubing
Nursing Exam Q&A | Galen College of Nursing
────────────────────────────────────
This study guide is intended to help students strengthen their understanding of lifespan
psychiatric nursing, special populations in mental healthcare, and community mental
health interventions. The content reflects practical psychiatric nursing concepts frequently
tested in nursing examinations.
The questions are designed to simulate actual exam conditions while reinforcing psychiatric
prioritization, therapeutic communication, and interdisciplinary mental health collaboration
skills. Detailed expert explanations are included to support concept mastery and exam
preparedness.
════════════════════════════════════
The Exam Covers:
• Pediatric behavioral disorders
• Geriatric depression and dementia
• Family dynamics in mental healthcare
• Community crisis resources
• Psychiatric advocacy and patient rights
• Mental health nursing ethics
• Therapeutic family interventions
• Long-term psychiatric management
════════════════════════════════════
1. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS). The
patient is on a ventilator and PEEP has been increased to 15 cm H2O. Which assessment
finding is the priority to report to the provider?
A. Heart rate of 102 beats per minute
B. Oxygen saturation of 92%
,C. Decreased breath sounds on the right side
D. Scattered crackles throughout both lung fields
Correct Answer: C
Expert Explanation: High PEEP increases the risk of barotrauma, which can lead to a
tension pneumothorax. Decreased breath sounds on one side is a hallmark sign of a
pneumothorax and requires immediate intervention. The nurse must recognize that while
crackles are expected in ARDS, asymmetrical breath sounds are a critical complication.
2. The nurse is assessing a patient in the early stages of septic shock. Which of the following
clinical manifestations should the nurse expect to find?
A. Warm, flushed skin and tachycardia
B. Hypotension and bradycardia
C. Cool, clammy skin and decreased urine output
D. Bradypnea and increased cardiac output
Correct Answer: A
Expert Explanation: In the early (hyperdynamic) stage of septic shock, the patient often
exhibits warm, flushed skin due to vasodilation and tachycardia as a compensatory
mechanism. This is distinct from other types of shock where the skin is usually cool and
clammy. This stage is often called ‘warm shock’ and precedes the drop in cardiac output.
,3. A patient is admitted to the ICU with a diagnosis of Acute Respiratory Failure. The nurse
notes the pH is 7.28, PaCO2 is 55 mmHg, and HCO3 is 26 mEq/L. How should the nurse
interpret these ABG results?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Expert Explanation: A pH of 7.28 indicates acidosis, and a PaCO2 of 55 indicates that the
cause is respiratory in nature as the CO2 is elevated. The bicarbonate level is within normal
limits, suggesting no compensation has occurred yet. This pattern is common in patients
with hypoventilation or obstructive lung diseases.
4. During the primary survey of a trauma patient, the nurse notes a sucking chest wound.
What is the immediate nursing action?
A. Apply a four-sided occlusive dressing
B. Apply a three-sided occlusive dressing
C. Insert a large-bore IV line
D. Prepare for immediate endotracheal intubation
Correct Answer: B
, Expert Explanation: An open pneumothorax or sucking chest wound requires a dressing
taped on three sides. This creates a one-way valve that allows air to escape during
expiration but prevents air from entering during inspiration. Taping on four sides could
lead to a tension pneumothorax by trapping air in the pleural space.
5. A hospice nurse is managing a patient’s pain at the end of life. The patient’s family is
concerned that the dose of morphine is ‘too high’ and might ‘kill him.’ What is the nurse’s
best response?
A. ‘The law requires me to give the dose as prescribed by the doctor.’
B. ‘Morphine actually helps the patient breathe better at the end of life.’
C. ‘I will lower the dose to ease your concerns for now.’
D. ‘We are only using enough to keep him comfortable, which is our priority.’
Correct Answer: D
Expert Explanation: The nurse should use therapeutic communication to address the
family’s fears while emphasizing the goal of comfort care. In hospice, the principle of
double effect is often applied, where the intent is to relieve suffering even if the medication
might hasten death. Educating the family on the priority of palliative goals is essential for
holistic care.
6. A nurse is monitoring a patient with an arterial line. The monitor shows a flat line, but the
patient is awake, alert, and talking. What should the nurse do first?
A. Check the connection of the pressure tubing
