NUR 254 Exam 2 Actual Exam 2026/2027: Complete Exam-Style
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Mental Health Assessment and Therapeutic Communication | Q1 – Q10
Section 2 | Mood Disorders and Suicide Risk Management | Q11 – Q20
Section 3 | Anxiety Disorders and Trauma-Related Conditions | Q21 – Q30
Section 4 | Psychopharmacology | Q31 – Q40
Section 5 | Legal, Ethical, and Safety Issues in Psychiatric Nursing | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: MENTAL HEALTH ASSESSMENT AND THERAPEUTIC COMMUNICATION Q1
– Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old man is admitted to the psychiatric unit after his wife found him pacing the
house at 3 a.m. repeating that the FBI has bugged their phones. During the admission
assessment, he avoids eye contact and speaks in a rapid, pressured manner. When the
nurse attempts to gather a history, the patient becomes irritated and says, "You already
know everything—stop pretending." The nurse recognizes this response as most
consistent with which defense mechanism?
A. Denial
B. Projection
C. Projection ✓ CORRECT
D. Sublimation
Correct Answer: C
,Rationale: Projection occurs when a person attributes their own unacceptable thoughts
or feelings to someone else, which fits the patient accusing the nurse of already
knowing everything when the nurse is simply doing her job. Denial would involve
refusing to acknowledge a reality, which is not what is happening here since the patient
is not ignoring a problem but rather redirecting blame. In acute psychotic states,
projection often emerges quickly because the patient cannot tolerate the internal
anxiety of being questioned.
Question 2 of 50
A 67-year-old woman is brought to the emergency department by her daughter, who
reports that her mother has been forgetting to turn off the stove, got lost driving to the
grocery store she has visited for 30 years, and recently accused her neighbor of stealing
a bracelet that was later found in the patient's own purse. The nurse conducts a mental
status examination. Which finding during the assessment would most specifically help
differentiate delirium from dementia?
A. Fluctuating level of consciousness throughout the interview ✓ CORRECT
B. Gradual onset of memory impairment over the past two years
C. Presence of paranoid delusions about the neighbor
D. Impaired ability to recall three objects after five minutes
Correct Answer: A
Rationale: Delirium is characterized by an acute, fluctuating disturbance in attention and
awareness, whereas dementia typically presents with a stable, clear sensorium despite
cognitive decline. Gradual onset of memory impairment is actually more consistent with
dementia than delirium, so this option would point away from the correct diagnosis.
When an older adult presents with acute confusion, the nurse should always consider
infection, medications, or metabolic disturbances as potential reversible causes of
delirium.
,Question 3 of 50
During a group therapy session on an inpatient unit, a 22-year-old patient diagnosed
with borderline personality disorder turns to another patient and says, "You are the only
one who understands me—the staff here are all against me." Later that day, the same
patient screams at the same peer for sitting in her usual chair. The nurse plans care
knowing that this pattern of relating is best described as:
A. Consistent mistrust indicative of paranoid schizophrenia
B. Splitting, where others are viewed as all good or all bad ✓ CORRECT
C. Manipulative behavior intended to gain discharge privileges
D. Normal ambivalence common in young adult development
Correct Answer: B
Rationale: Splitting is a defense mechanism commonly seen in borderline personality
disorder in which individuals perceive others as either entirely good or entirely bad
without integration of both qualities. Paranoid schizophrenia would present with fixed
delusions and hallucinations rather than this rapid, relationship-based fluctuation in
perception. Nurses working with patients who use splitting must maintain consistent
boundaries and avoid being pulled into the all-good or all-bad category by remaining
neutral and predictable.
Question 4 of 50
A psychiatric nurse is conducting an initial assessment of a 41-year-old man who was
referred by his primary care provider for persistent low mood and fatigue. The patient
states he has trouble falling asleep, has lost 12 pounds in six weeks without dieting, and
cannot concentrate enough to read the newspaper. When the nurse asks about suicidal
thoughts, the patient replies, "I wouldn't do that to my kids, but sometimes I wonder if
they'd be better off without me." Based on this statement, the nurse's priority action is
to:
, A. Document the statement and continue with the full mental status exam
B. Reassure the patient that his children would not be better off without him
C. Ask the patient to sign a no-suicide contract before the interview ends
D. Conduct a full suicide risk assessment including plan, means, and intent ✓ CORRECT
Correct Answer: D
Rationale: Any expression of suicidal ideation, even when passive or denied intent,
requires immediate and thorough assessment of plan, means, and protective factors to
determine the level of risk. Reassurance alone minimizes the patient's distress and does
not provide the clinical data needed to keep him safe. In practice, nurses should not rely
on no-suicide contracts as a substitute for thorough risk assessment and environmental
safety measures.
Question 5 of 50
A 19-year-old college student is admitted to the psychiatric unit following her first manic
episode. During the admission interview, she interrupts the nurse repeatedly to
compliment the nurse's scrubs, asks if they can be best friends, and then stands up to
rearrange the furniture because "the energy in here is all wrong." The nurse recognizes
that the most therapeutic response is to:
A. Set clear, simple limits while maintaining a calm, neutral demeanor ✓ CORRECT
B. Engage in the patient's conversation to build therapeutic rapport
C. Ask the patient to sit down immediately and complete the interview
D. Ignore the behavior and continue asking assessment questions
Correct Answer: A
Rationale: During acute mania, patients need firm, consistent, and simple limits
delivered in a calm, nonjudgmental manner to maintain safety and reduce
overstimulation. Engaging in lengthy or tangential conversation reinforces the manic
behavior and can escalate the patient's agitation. Experienced psychiatric nurses know
Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Mental Health Assessment and Therapeutic Communication | Q1 – Q10
Section 2 | Mood Disorders and Suicide Risk Management | Q11 – Q20
Section 3 | Anxiety Disorders and Trauma-Related Conditions | Q21 – Q30
Section 4 | Psychopharmacology | Q31 – Q40
Section 5 | Legal, Ethical, and Safety Issues in Psychiatric Nursing | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: MENTAL HEALTH ASSESSMENT AND THERAPEUTIC COMMUNICATION Q1
– Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old man is admitted to the psychiatric unit after his wife found him pacing the
house at 3 a.m. repeating that the FBI has bugged their phones. During the admission
assessment, he avoids eye contact and speaks in a rapid, pressured manner. When the
nurse attempts to gather a history, the patient becomes irritated and says, "You already
know everything—stop pretending." The nurse recognizes this response as most
consistent with which defense mechanism?
A. Denial
B. Projection
C. Projection ✓ CORRECT
D. Sublimation
Correct Answer: C
,Rationale: Projection occurs when a person attributes their own unacceptable thoughts
or feelings to someone else, which fits the patient accusing the nurse of already
knowing everything when the nurse is simply doing her job. Denial would involve
refusing to acknowledge a reality, which is not what is happening here since the patient
is not ignoring a problem but rather redirecting blame. In acute psychotic states,
projection often emerges quickly because the patient cannot tolerate the internal
anxiety of being questioned.
Question 2 of 50
A 67-year-old woman is brought to the emergency department by her daughter, who
reports that her mother has been forgetting to turn off the stove, got lost driving to the
grocery store she has visited for 30 years, and recently accused her neighbor of stealing
a bracelet that was later found in the patient's own purse. The nurse conducts a mental
status examination. Which finding during the assessment would most specifically help
differentiate delirium from dementia?
A. Fluctuating level of consciousness throughout the interview ✓ CORRECT
B. Gradual onset of memory impairment over the past two years
C. Presence of paranoid delusions about the neighbor
D. Impaired ability to recall three objects after five minutes
Correct Answer: A
Rationale: Delirium is characterized by an acute, fluctuating disturbance in attention and
awareness, whereas dementia typically presents with a stable, clear sensorium despite
cognitive decline. Gradual onset of memory impairment is actually more consistent with
dementia than delirium, so this option would point away from the correct diagnosis.
When an older adult presents with acute confusion, the nurse should always consider
infection, medications, or metabolic disturbances as potential reversible causes of
delirium.
,Question 3 of 50
During a group therapy session on an inpatient unit, a 22-year-old patient diagnosed
with borderline personality disorder turns to another patient and says, "You are the only
one who understands me—the staff here are all against me." Later that day, the same
patient screams at the same peer for sitting in her usual chair. The nurse plans care
knowing that this pattern of relating is best described as:
A. Consistent mistrust indicative of paranoid schizophrenia
B. Splitting, where others are viewed as all good or all bad ✓ CORRECT
C. Manipulative behavior intended to gain discharge privileges
D. Normal ambivalence common in young adult development
Correct Answer: B
Rationale: Splitting is a defense mechanism commonly seen in borderline personality
disorder in which individuals perceive others as either entirely good or entirely bad
without integration of both qualities. Paranoid schizophrenia would present with fixed
delusions and hallucinations rather than this rapid, relationship-based fluctuation in
perception. Nurses working with patients who use splitting must maintain consistent
boundaries and avoid being pulled into the all-good or all-bad category by remaining
neutral and predictable.
Question 4 of 50
A psychiatric nurse is conducting an initial assessment of a 41-year-old man who was
referred by his primary care provider for persistent low mood and fatigue. The patient
states he has trouble falling asleep, has lost 12 pounds in six weeks without dieting, and
cannot concentrate enough to read the newspaper. When the nurse asks about suicidal
thoughts, the patient replies, "I wouldn't do that to my kids, but sometimes I wonder if
they'd be better off without me." Based on this statement, the nurse's priority action is
to:
, A. Document the statement and continue with the full mental status exam
B. Reassure the patient that his children would not be better off without him
C. Ask the patient to sign a no-suicide contract before the interview ends
D. Conduct a full suicide risk assessment including plan, means, and intent ✓ CORRECT
Correct Answer: D
Rationale: Any expression of suicidal ideation, even when passive or denied intent,
requires immediate and thorough assessment of plan, means, and protective factors to
determine the level of risk. Reassurance alone minimizes the patient's distress and does
not provide the clinical data needed to keep him safe. In practice, nurses should not rely
on no-suicide contracts as a substitute for thorough risk assessment and environmental
safety measures.
Question 5 of 50
A 19-year-old college student is admitted to the psychiatric unit following her first manic
episode. During the admission interview, she interrupts the nurse repeatedly to
compliment the nurse's scrubs, asks if they can be best friends, and then stands up to
rearrange the furniture because "the energy in here is all wrong." The nurse recognizes
that the most therapeutic response is to:
A. Set clear, simple limits while maintaining a calm, neutral demeanor ✓ CORRECT
B. Engage in the patient's conversation to build therapeutic rapport
C. Ask the patient to sit down immediately and complete the interview
D. Ignore the behavior and continue asking assessment questions
Correct Answer: A
Rationale: During acute mania, patients need firm, consistent, and simple limits
delivered in a calm, nonjudgmental manner to maintain safety and reduce
overstimulation. Engaging in lengthy or tangential conversation reinforces the manic
behavior and can escalate the patient's agitation. Experienced psychiatric nurses know
