1
NUR 2488 Mental Health Nursing Midterm Exam
Complete Review \ 75 Psychiatric Nursing Questions
with Detailed Rationales
Section 1: Therapeutic Communication and the Nurse-Patient Relationship
(Questions 1-12)
1. A patient with major depressive disorder tells the nurse, "I'm a failure. I can't
do anything right. My family would be better off without me." Which nursing
response is MOST therapeutic?
A. "That's not true. You have many good qualities and your family loves you."
B. "Why do you feel like a failure? You've accomplished so much in your life."
C. "It sounds like you're feeling hopeless and worthless right now. Can you tell me
more about what you're experiencing?"
D. "You shouldn't talk like that. Think positive thoughts."
Answer: C. "It sounds like you're feeling hopeless and worthless right now.
Can you tell me more about what you're experiencing?"
RATIONALE: This response uses the therapeutic communication techniques of
REFLECTING and EXPLORING. The nurse acknowledges the patient's expressed
feelings ("It sounds like you're feeling hopeless and worthless") without
judgment, validates their emotional experience, and uses an open-ended
question to encourage further expression. This approach conveys empathy, builds
trust, and facilitates deeper exploration of the patient's suicidal ideation, which is
critical for safety assessment.
• A: False reassurance - Incorrect. "That's not true" dismisses the patient's
feelings and cuts off communication. False reassurance is non-therapeutic
because it invalidates the patient's lived experience.
• B: "Why" questioning - Incorrect. Asking "why" is judgmental and puts the
patient on the defensive. It implies the patient should justify their feelings.
pg. 1
,2
• D: Giving advice/minimizing - Incorrect. "You shouldn't talk like that" is
dismissive and implies the patient's feelings are wrong or unacceptable.
This shuts down therapeutic communication.
2. During a therapeutic interaction, a patient who recently lost their spouse in a
car accident begins to cry. What is the nurse's BEST response?
A. "Don't cry. Your spouse wouldn't want you to be sad."
B. "It's okay to cry. I'll sit here with you for a while."
C. "Let me get you some tissues and we can talk about something happier."
D. "You need to be strong for your children."
Answer: B. "It's okay to cry. I'll sit here with you for a while."
RATIONALE: This response uses the therapeutic technique of OFFERING SELF and
conveys ACCEPTANCE. The nurse validates the patient's grief, gives permission to
express emotion, and offers presence without pressure to talk. Sitting silently
with a patient communicates caring, acceptance, and willingness to be with them
in their pain. This is the essence of therapeutic presence.
• A: "Don't cry" - Incorrect. This is non-therapeutic because it invalidates the
patient's feelings and implies that crying is unacceptable. It also imposes
the nurse's assumption about what the deceased spouse would want.
• C: Changing the subject - Incorrect. Offering to change the subject to
"something happier" avoids the patient's pain and communicates that the
nurse is uncomfortable with strong emotions.
• D: "Be strong" - Incorrect. This is cliché advice that dismisses the patient's
grief and imposes an expectation that may be unrealistic or harmful.
3. A nurse is working with a patient who has been withdrawn and silent for
several days. Which nursing intervention is MOST appropriate to establish a
therapeutic relationship?
A. Insist that the patient join the unit's group activities to encourage socialization
B. Sit quietly with the patient for short, frequent periods without demanding
conversation
C. Tell the patient that their silence is a sign of resistance to treatment
D. Avoid interacting with the patient until they are ready to talk
pg. 2
,3
Answer: B. Sit quietly with the patient for short, frequent periods without
demanding conversation
RATIONALE: For a withdrawn patient, the therapeutic approach is to establish
trust through consistent, non-demanding PRESENCE. Sitting quietly nearby for
brief periods (5-10 minutes) several times a day communicates acceptance,
respect, and availability without being threatening or overwhelming. This
approach allows the patient to feel safe and gradually become more comfortable
with the nurse's presence. The nurse can make brief, neutral observations ("I'll be
here if you need anything") and gradually increase interaction as the patient
becomes more receptive.
• A: Insist on group activities - Incorrect. Forcing socialization increases
anxiety, threatens the therapeutic relationship, and does not respect the
patient's current capacity. The patient may not be ready for group
interaction.
• C: Label as resistance - Incorrect. Labeling the patient's silence as
"resistance" is judgmental and may reflect the patient's symptoms
(depression, paranoia, catatonia) rather than willful opposition.
• D: Avoid interacting - Incorrect. While the patient's need for personal
space must be respected, the nurse has a responsibility to engage
therapeutically and offer opportunities for interaction. Complete avoidance
is neglectful.
4. The nurse asks a patient, "How are you feeling today?" The patient responds,
"I'm fine," but is sitting slumped in a chair, avoiding eye contact, and has tears
in their eyes. Which communication technique should the nurse use?
A. Accept the patient's verbal response and move on
B. Confront the patient about lying
C. Point out the discrepancy between the patient's verbal and nonverbal
communication
D. Ignore the nonverbal cues to respect the patient's privacy
Answer: C. Point out the discrepancy between the patient's verbal and
nonverbal communication
pg. 3
, 4
RATIONALE: The nurse has observed an INCONGRUENCE between the patient's
verbal message ("I'm fine") and nonverbal behavior (slumped posture, avoiding
eye contact, tears). The therapeutic technique of POINTING OUT DISCREPANCIES
(sometimes called "confrontation" in therapeutic communication, which differs
from aggressive confrontation) involves gently, respectfully describing the
observed inconsistency. For example: "You say you're fine, but I notice you're
sitting slumped over and it looks like you've been crying. Can you help me
understand what's going on?" This technique helps the patient become aware of
their own feelings and encourages honest expression.
• A: Accept verbal response - Incorrect. Ignoring clear nonverbal cues of
distress misses an opportunity to engage the patient and address
underlying issues.
• B: Confront about lying - Incorrect. Accusing the patient of lying is
aggressive, judgmental, and damages the therapeutic relationship.
• D: Ignore nonverbal cues - Incorrect. Nonverbal communication is often
more revealing than verbal. The nurse should assess and respond to the
whole patient presentation.
5. A patient states, "My doctor told me I have bipolar disorder. I don't
understand what that means." Which response by the nurse demonstrates the
therapeutic technique of GIVING INFORMATION?
A. "Don't worry about the diagnosis. Just take your medications and you'll be
fine."
B. "Bipolar disorder is a mood disorder characterized by episodes of mania and
depression. Would you like me to explain more about what that means for you?"
C. "Why are you worried about the diagnosis? You should focus on getting
better."
D. "I'll have the doctor come explain it to you again since you didn't understand
the first time."
Answer: B. "Bipolar disorder is a mood disorder characterized by episodes
of mania and depression. Would you like me to explain more about what that
means for you?"
pg. 4
NUR 2488 Mental Health Nursing Midterm Exam
Complete Review \ 75 Psychiatric Nursing Questions
with Detailed Rationales
Section 1: Therapeutic Communication and the Nurse-Patient Relationship
(Questions 1-12)
1. A patient with major depressive disorder tells the nurse, "I'm a failure. I can't
do anything right. My family would be better off without me." Which nursing
response is MOST therapeutic?
A. "That's not true. You have many good qualities and your family loves you."
B. "Why do you feel like a failure? You've accomplished so much in your life."
C. "It sounds like you're feeling hopeless and worthless right now. Can you tell me
more about what you're experiencing?"
D. "You shouldn't talk like that. Think positive thoughts."
Answer: C. "It sounds like you're feeling hopeless and worthless right now.
Can you tell me more about what you're experiencing?"
RATIONALE: This response uses the therapeutic communication techniques of
REFLECTING and EXPLORING. The nurse acknowledges the patient's expressed
feelings ("It sounds like you're feeling hopeless and worthless") without
judgment, validates their emotional experience, and uses an open-ended
question to encourage further expression. This approach conveys empathy, builds
trust, and facilitates deeper exploration of the patient's suicidal ideation, which is
critical for safety assessment.
• A: False reassurance - Incorrect. "That's not true" dismisses the patient's
feelings and cuts off communication. False reassurance is non-therapeutic
because it invalidates the patient's lived experience.
• B: "Why" questioning - Incorrect. Asking "why" is judgmental and puts the
patient on the defensive. It implies the patient should justify their feelings.
pg. 1
,2
• D: Giving advice/minimizing - Incorrect. "You shouldn't talk like that" is
dismissive and implies the patient's feelings are wrong or unacceptable.
This shuts down therapeutic communication.
2. During a therapeutic interaction, a patient who recently lost their spouse in a
car accident begins to cry. What is the nurse's BEST response?
A. "Don't cry. Your spouse wouldn't want you to be sad."
B. "It's okay to cry. I'll sit here with you for a while."
C. "Let me get you some tissues and we can talk about something happier."
D. "You need to be strong for your children."
Answer: B. "It's okay to cry. I'll sit here with you for a while."
RATIONALE: This response uses the therapeutic technique of OFFERING SELF and
conveys ACCEPTANCE. The nurse validates the patient's grief, gives permission to
express emotion, and offers presence without pressure to talk. Sitting silently
with a patient communicates caring, acceptance, and willingness to be with them
in their pain. This is the essence of therapeutic presence.
• A: "Don't cry" - Incorrect. This is non-therapeutic because it invalidates the
patient's feelings and implies that crying is unacceptable. It also imposes
the nurse's assumption about what the deceased spouse would want.
• C: Changing the subject - Incorrect. Offering to change the subject to
"something happier" avoids the patient's pain and communicates that the
nurse is uncomfortable with strong emotions.
• D: "Be strong" - Incorrect. This is cliché advice that dismisses the patient's
grief and imposes an expectation that may be unrealistic or harmful.
3. A nurse is working with a patient who has been withdrawn and silent for
several days. Which nursing intervention is MOST appropriate to establish a
therapeutic relationship?
A. Insist that the patient join the unit's group activities to encourage socialization
B. Sit quietly with the patient for short, frequent periods without demanding
conversation
C. Tell the patient that their silence is a sign of resistance to treatment
D. Avoid interacting with the patient until they are ready to talk
pg. 2
,3
Answer: B. Sit quietly with the patient for short, frequent periods without
demanding conversation
RATIONALE: For a withdrawn patient, the therapeutic approach is to establish
trust through consistent, non-demanding PRESENCE. Sitting quietly nearby for
brief periods (5-10 minutes) several times a day communicates acceptance,
respect, and availability without being threatening or overwhelming. This
approach allows the patient to feel safe and gradually become more comfortable
with the nurse's presence. The nurse can make brief, neutral observations ("I'll be
here if you need anything") and gradually increase interaction as the patient
becomes more receptive.
• A: Insist on group activities - Incorrect. Forcing socialization increases
anxiety, threatens the therapeutic relationship, and does not respect the
patient's current capacity. The patient may not be ready for group
interaction.
• C: Label as resistance - Incorrect. Labeling the patient's silence as
"resistance" is judgmental and may reflect the patient's symptoms
(depression, paranoia, catatonia) rather than willful opposition.
• D: Avoid interacting - Incorrect. While the patient's need for personal
space must be respected, the nurse has a responsibility to engage
therapeutically and offer opportunities for interaction. Complete avoidance
is neglectful.
4. The nurse asks a patient, "How are you feeling today?" The patient responds,
"I'm fine," but is sitting slumped in a chair, avoiding eye contact, and has tears
in their eyes. Which communication technique should the nurse use?
A. Accept the patient's verbal response and move on
B. Confront the patient about lying
C. Point out the discrepancy between the patient's verbal and nonverbal
communication
D. Ignore the nonverbal cues to respect the patient's privacy
Answer: C. Point out the discrepancy between the patient's verbal and
nonverbal communication
pg. 3
, 4
RATIONALE: The nurse has observed an INCONGRUENCE between the patient's
verbal message ("I'm fine") and nonverbal behavior (slumped posture, avoiding
eye contact, tears). The therapeutic technique of POINTING OUT DISCREPANCIES
(sometimes called "confrontation" in therapeutic communication, which differs
from aggressive confrontation) involves gently, respectfully describing the
observed inconsistency. For example: "You say you're fine, but I notice you're
sitting slumped over and it looks like you've been crying. Can you help me
understand what's going on?" This technique helps the patient become aware of
their own feelings and encourages honest expression.
• A: Accept verbal response - Incorrect. Ignoring clear nonverbal cues of
distress misses an opportunity to engage the patient and address
underlying issues.
• B: Confront about lying - Incorrect. Accusing the patient of lying is
aggressive, judgmental, and damages the therapeutic relationship.
• D: Ignore nonverbal cues - Incorrect. Nonverbal communication is often
more revealing than verbal. The nurse should assess and respond to the
whole patient presentation.
5. A patient states, "My doctor told me I have bipolar disorder. I don't
understand what that means." Which response by the nurse demonstrates the
therapeutic technique of GIVING INFORMATION?
A. "Don't worry about the diagnosis. Just take your medications and you'll be
fine."
B. "Bipolar disorder is a mood disorder characterized by episodes of mania and
depression. Would you like me to explain more about what that means for you?"
C. "Why are you worried about the diagnosis? You should focus on getting
better."
D. "I'll have the doctor come explain it to you again since you didn't understand
the first time."
Answer: B. "Bipolar disorder is a mood disorder characterized by episodes
of mania and depression. Would you like me to explain more about what that
means for you?"
pg. 4
