1
NUR 2488 Mental Health Nursing Final Exam Study
Guide \ 150 Actual Psych Nursing Questions with
Verified Answers & Rationales
SECTION 1: THERAPEUTIC COMMUNICATION & NURSE-PATIENT RELATIONSHIP
(1–15)
1. A patient with major depressive disorder tells the nurse, "I'm a failure and
everyone would be better off without me." What is the nurse's most
therapeutic response?
A. "You have so much to live for."
B. "Why do you feel that way?"
C. "It sounds like you're feeling hopeless right now."
D. "You shouldn't talk like that."
Answer: C
Rationale: This response uses reflection and validation of the patient's feelings,
which is a therapeutic communication technique. Option A gives false
reassurance, B asks "why" which can be probing, and D is dismissive.
2. A nurse is sitting with a patient who is crying after receiving bad news. What
is the best initial action?
A. Leave the room to provide privacy.
B. Offer a tissue and sit quietly with the patient.
C. Tell the patient that everything will be okay.
D. Ask the patient to explain what is wrong.
Answer: B
Rationale: Offering a tissue and therapeutic silence conveys acceptance and
allows the patient to process emotions. Leaving abruptly or offering false
reassurance is non-therapeutic. Asking "why" can be intrusive at this moment.
pg. 1
,2
3. During a group therapy session, a patient becomes angry and starts yelling at
other members. What is the nurse's priority intervention?
A. Ask the patient to leave the group immediately.
B. Acknowledge the patient's anger and set limits on behavior.
C. Ignore the outburst and continue the session.
D. Call security to remove the patient.
Answer: B
Rationale: Acknowledging the emotion validates the patient, while setting limits
on unacceptable behavior maintains a safe environment. Removing the patient
should be a last resort if de-escalation fails.
4. A patient states, "I don't want to talk to you because you remind me of my
mother." This is an example of:
A. Transference
B. Countertransference
C. Projection
D. Dissociation
Answer: A
Rationale: Transference occurs when a patient unconsciously displaces feelings
about a significant person onto the nurse. Countertransference is the nurse's
emotional reaction to the patient. Projection is attributing one's own
unacceptable feelings to others.
5. The nurse is caring for a patient who repeatedly asks for pain medication
despite no physiological need. The nurse feels frustrated. What should the
nurse do first?
A. Tell the patient to stop asking.
B. Explore the meaning of the behavior with the patient.
C. Ignore the requests.
D. Administer a placebo.
Answer: B
Rationale: Exploring the meaning of the behavior helps identify underlying
pg. 2
,3
emotional needs (e.g., anxiety, loneliness). The nurse should also process feelings
in clinical supervision to avoid countertransference.
6. A patient says, "I'm so anxious. I can't sit still." What is the nurse's best
response?
A. "Let's sit down and talk about what's making you anxious."
B. "Would you like to take a walk with me?"
C. "You need to calm down."
D. "Why are you anxious?"
Answer: B
Rationale: Offering to walk with the patient provides an outlet for physical energy
while maintaining a therapeutic presence. Once anxiety decreases, verbal
exploration can occur. "Why" questions and telling a patient to calm down are
non-therapeutic.
7. The termination phase of the nurse-patient relationship is characterized by:
A. Establishing trust and rapport
B. Reviewing progress and discussing feelings about ending the relationship
C. Identifying problems and setting goals
D. Implementing interventions
Answer: B
Rationale: During termination, the nurse helps the patient review progress,
process feelings about separation, and plan for the future. Trust is established in
the orientation phase; goal-setting in the working phase.
8. A patient with borderline personality disorder frequently calls the nurse a
"hero" then later says the nurse is "useless." The nurse recognizes this as:
A. Projection
B. Splitting
C. Denial
D. Regression
pg. 3
, 4
Answer: B
Rationale: Splitting is a primitive defense mechanism where people are viewed as
all good or all bad. It is common in borderline personality disorder. The nurse
must maintain consistent, non-reactive boundaries.
9. The nurse is caring for a patient who has just learned of a terminal diagnosis.
The patient says, "There must be a mistake. I feel fine." The nurse recognizes
this as which stage of grief?
A. Acceptance
B. Bargaining
C. Denial
D. Anger
Answer: C
Rationale: Denial is the first stage in Kübler-Ross's grief model. It serves as a
protective buffer. The nurse should allow the patient to process at their own pace
without forcing acceptance.
10. A patient is admitted for suicidal ideation. What is the priority nursing
intervention?
A. Administer antidepressants
B. Conduct a thorough suicide risk assessment and remove harmful objects
C. Place the patient in seclusion
D. Call the family for collateral information
Answer: B
Rationale: Safety is the highest priority. A suicide risk assessment (plan, means,
intent, lethality) must be completed, and the environment made safe. Medication
and family involvement follow.
11. A patient says, "The FBI is watching me through the TV." What is the nurse's
most therapeutic response?
A. "That's not true. The FBI isn't watching you."
pg. 4
NUR 2488 Mental Health Nursing Final Exam Study
Guide \ 150 Actual Psych Nursing Questions with
Verified Answers & Rationales
SECTION 1: THERAPEUTIC COMMUNICATION & NURSE-PATIENT RELATIONSHIP
(1–15)
1. A patient with major depressive disorder tells the nurse, "I'm a failure and
everyone would be better off without me." What is the nurse's most
therapeutic response?
A. "You have so much to live for."
B. "Why do you feel that way?"
C. "It sounds like you're feeling hopeless right now."
D. "You shouldn't talk like that."
Answer: C
Rationale: This response uses reflection and validation of the patient's feelings,
which is a therapeutic communication technique. Option A gives false
reassurance, B asks "why" which can be probing, and D is dismissive.
2. A nurse is sitting with a patient who is crying after receiving bad news. What
is the best initial action?
A. Leave the room to provide privacy.
B. Offer a tissue and sit quietly with the patient.
C. Tell the patient that everything will be okay.
D. Ask the patient to explain what is wrong.
Answer: B
Rationale: Offering a tissue and therapeutic silence conveys acceptance and
allows the patient to process emotions. Leaving abruptly or offering false
reassurance is non-therapeutic. Asking "why" can be intrusive at this moment.
pg. 1
,2
3. During a group therapy session, a patient becomes angry and starts yelling at
other members. What is the nurse's priority intervention?
A. Ask the patient to leave the group immediately.
B. Acknowledge the patient's anger and set limits on behavior.
C. Ignore the outburst and continue the session.
D. Call security to remove the patient.
Answer: B
Rationale: Acknowledging the emotion validates the patient, while setting limits
on unacceptable behavior maintains a safe environment. Removing the patient
should be a last resort if de-escalation fails.
4. A patient states, "I don't want to talk to you because you remind me of my
mother." This is an example of:
A. Transference
B. Countertransference
C. Projection
D. Dissociation
Answer: A
Rationale: Transference occurs when a patient unconsciously displaces feelings
about a significant person onto the nurse. Countertransference is the nurse's
emotional reaction to the patient. Projection is attributing one's own
unacceptable feelings to others.
5. The nurse is caring for a patient who repeatedly asks for pain medication
despite no physiological need. The nurse feels frustrated. What should the
nurse do first?
A. Tell the patient to stop asking.
B. Explore the meaning of the behavior with the patient.
C. Ignore the requests.
D. Administer a placebo.
Answer: B
Rationale: Exploring the meaning of the behavior helps identify underlying
pg. 2
,3
emotional needs (e.g., anxiety, loneliness). The nurse should also process feelings
in clinical supervision to avoid countertransference.
6. A patient says, "I'm so anxious. I can't sit still." What is the nurse's best
response?
A. "Let's sit down and talk about what's making you anxious."
B. "Would you like to take a walk with me?"
C. "You need to calm down."
D. "Why are you anxious?"
Answer: B
Rationale: Offering to walk with the patient provides an outlet for physical energy
while maintaining a therapeutic presence. Once anxiety decreases, verbal
exploration can occur. "Why" questions and telling a patient to calm down are
non-therapeutic.
7. The termination phase of the nurse-patient relationship is characterized by:
A. Establishing trust and rapport
B. Reviewing progress and discussing feelings about ending the relationship
C. Identifying problems and setting goals
D. Implementing interventions
Answer: B
Rationale: During termination, the nurse helps the patient review progress,
process feelings about separation, and plan for the future. Trust is established in
the orientation phase; goal-setting in the working phase.
8. A patient with borderline personality disorder frequently calls the nurse a
"hero" then later says the nurse is "useless." The nurse recognizes this as:
A. Projection
B. Splitting
C. Denial
D. Regression
pg. 3
, 4
Answer: B
Rationale: Splitting is a primitive defense mechanism where people are viewed as
all good or all bad. It is common in borderline personality disorder. The nurse
must maintain consistent, non-reactive boundaries.
9. The nurse is caring for a patient who has just learned of a terminal diagnosis.
The patient says, "There must be a mistake. I feel fine." The nurse recognizes
this as which stage of grief?
A. Acceptance
B. Bargaining
C. Denial
D. Anger
Answer: C
Rationale: Denial is the first stage in Kübler-Ross's grief model. It serves as a
protective buffer. The nurse should allow the patient to process at their own pace
without forcing acceptance.
10. A patient is admitted for suicidal ideation. What is the priority nursing
intervention?
A. Administer antidepressants
B. Conduct a thorough suicide risk assessment and remove harmful objects
C. Place the patient in seclusion
D. Call the family for collateral information
Answer: B
Rationale: Safety is the highest priority. A suicide risk assessment (plan, means,
intent, lethality) must be completed, and the environment made safe. Medication
and family involvement follow.
11. A patient says, "The FBI is watching me through the TV." What is the nurse's
most therapeutic response?
A. "That's not true. The FBI isn't watching you."
pg. 4
