, NUR 2488 Mental Health Nursing Final Exam Study Guide – Volume 2 | 150 Actual Psych Nursing
Questions with Verified Answers & Rationales
SECTION 1: THERAPEUTIC RELATIONSHIP & COMMUNICATION (1–15)
1. A patient with post-traumatic stress disorder (PTSD) tells the nurse, "I don't want to talk about the
assault. Every time I do, I feel like I'm back there." What is the nurse's best response?
A. "You need to talk about it to get better."
B. "Why does talking about it make you feel that way?"
C. "It sounds like discussing the event is very distressing for you. We don't have to talk about it until you
feel ready." (✔)
D. "You're being avoidant, which is a symptom of your disorder."
Rationale: The nurse validates the patient's distress and respects their readiness, which builds trust.
Forcing disclosure can retraumatize. The patient may need grounding and coping skills before
trauma processing.
2. A nurse is caring for a patient who was sexually assaulted 2 days ago. The patient is calm and says,
"I'm fine. It didn't bother me." The nurse recognizes this as:
A. Malingering
B. Insight
C. Healthy coping
D. Possible numbing or denial (✔)
,Rationale: Emotional numbing and denial are common early responses to trauma. The patient may
not be ready to process the event. The nurse should provide support and safety without confronting
the denial.
3. A patient with borderline personality disorder tells the nurse, "You're the only nurse who actually
cares. The night nurse is a cold, heartless witch." The nurse's best response is:
A. "Thank you. I'm glad you trust me."
B. "I hear that you feel cared for by me and angry with the night nurse. Let's talk about what happens when
you feel that way." (✔)
C. "The night nurse is very competent. You're wrong about her."
D. "I'll report the night nurse for you."
Rationale: The patient is demonstrating splitting. The nurse validates both feelings without taking
sides and redirects to explore the pattern. Defending the other nurse or accepting the idealization
reinforces the split.
4. A patient tells the nurse, "I'm worthless. I should just die." Which response by the nurse is most
therapeutic?
A. "Don't say that. You have so much to live for."
B. "You're feeling hopeless right now. Have you had thoughts of hurting yourself?" (✔)
C. "Why would you say something like that?"
D. "Let's focus on the positive things in your life."
Rationale: The nurse validates the feeling (hopelessness) and immediately assesses for suicidal
, ideation. False reassurance ("you have so much to live for") dismisses the patient's pain. Probing
"why" is non-therapeutic.
5. A nurse is working with a patient who has a history of trauma. The patient becomes tearful when
the nurse touches their arm. The nurse should:
A. Stop touching the patient and apologize for causing distress. (✔)
B. Continue touching the patient to desensitize them.
C. Ignore the tears and continue the conversation.
D. Tell the patient, "You're overreacting."
Rationale: The nurse respects the patient's boundary and apologizes for unintended distress. Trauma
survivors may have heightened sensitivity to touch. Desensitization is not a nursing role without a
treatment plan.
6. A patient with schizophrenia is mute and staring at the wall. The nurse sits quietly beside the
patient for 10 minutes, then says, "I'm going to sit here with you for a while. You don't have to talk."
This is an example of:
A. Passive neglect
B. Nontherapeutic silence
C. Therapeutic use of presence (✔)
D. Avoidance
Rationale: Therapeutic presence conveys acceptance and safety without demanding interaction. It is
especially valuable for withdrawn or mute patients. Silence is therapeutic when used intentionally.
Questions with Verified Answers & Rationales
SECTION 1: THERAPEUTIC RELATIONSHIP & COMMUNICATION (1–15)
1. A patient with post-traumatic stress disorder (PTSD) tells the nurse, "I don't want to talk about the
assault. Every time I do, I feel like I'm back there." What is the nurse's best response?
A. "You need to talk about it to get better."
B. "Why does talking about it make you feel that way?"
C. "It sounds like discussing the event is very distressing for you. We don't have to talk about it until you
feel ready." (✔)
D. "You're being avoidant, which is a symptom of your disorder."
Rationale: The nurse validates the patient's distress and respects their readiness, which builds trust.
Forcing disclosure can retraumatize. The patient may need grounding and coping skills before
trauma processing.
2. A nurse is caring for a patient who was sexually assaulted 2 days ago. The patient is calm and says,
"I'm fine. It didn't bother me." The nurse recognizes this as:
A. Malingering
B. Insight
C. Healthy coping
D. Possible numbing or denial (✔)
,Rationale: Emotional numbing and denial are common early responses to trauma. The patient may
not be ready to process the event. The nurse should provide support and safety without confronting
the denial.
3. A patient with borderline personality disorder tells the nurse, "You're the only nurse who actually
cares. The night nurse is a cold, heartless witch." The nurse's best response is:
A. "Thank you. I'm glad you trust me."
B. "I hear that you feel cared for by me and angry with the night nurse. Let's talk about what happens when
you feel that way." (✔)
C. "The night nurse is very competent. You're wrong about her."
D. "I'll report the night nurse for you."
Rationale: The patient is demonstrating splitting. The nurse validates both feelings without taking
sides and redirects to explore the pattern. Defending the other nurse or accepting the idealization
reinforces the split.
4. A patient tells the nurse, "I'm worthless. I should just die." Which response by the nurse is most
therapeutic?
A. "Don't say that. You have so much to live for."
B. "You're feeling hopeless right now. Have you had thoughts of hurting yourself?" (✔)
C. "Why would you say something like that?"
D. "Let's focus on the positive things in your life."
Rationale: The nurse validates the feeling (hopelessness) and immediately assesses for suicidal
, ideation. False reassurance ("you have so much to live for") dismisses the patient's pain. Probing
"why" is non-therapeutic.
5. A nurse is working with a patient who has a history of trauma. The patient becomes tearful when
the nurse touches their arm. The nurse should:
A. Stop touching the patient and apologize for causing distress. (✔)
B. Continue touching the patient to desensitize them.
C. Ignore the tears and continue the conversation.
D. Tell the patient, "You're overreacting."
Rationale: The nurse respects the patient's boundary and apologizes for unintended distress. Trauma
survivors may have heightened sensitivity to touch. Desensitization is not a nursing role without a
treatment plan.
6. A patient with schizophrenia is mute and staring at the wall. The nurse sits quietly beside the
patient for 10 minutes, then says, "I'm going to sit here with you for a while. You don't have to talk."
This is an example of:
A. Passive neglect
B. Nontherapeutic silence
C. Therapeutic use of presence (✔)
D. Avoidance
Rationale: Therapeutic presence conveys acceptance and safety without demanding interaction. It is
especially valuable for withdrawn or mute patients. Silence is therapeutic when used intentionally.
