BEHAVIORAL HEALTH NURSING
EXAM 3 REVIEW | 2026/2027
Psychiatric-Mental Health Nursing Competency | 60 Questions | 120 Points Total
Read each question carefully. Select the BEST answer. Each question is worth 2 points. Total: 120 points. Time: 90
minutes. Questions reflect NCSBN NCLEX-RN Psychosocial Integrity domain competencies and APNA Standards of
Practice.
Scoring Summary
Domain Questions Points Score
I. Therapeutic Communication & 1–7 14 ____
Nurse-Patient Relationship
II. Psychiatric Disorders & Clinical 8–17 20 ____
Recognition
III. Psychopharmacology & Nursing 18–28 22 ____
Implications
IV. Crisis Intervention & Suicide Risk 29–38 20 ____
Assessment
V. Legal & Ethical Standards in 39–44 12 ____
Psychiatric Nursing
VI. Milieu Therapy & Therapeutic 45–49 10 ____
Environment
VII. Substance Use Disorders & Dual 50–54 10 ____
Diagnosis
VIII. Special Populations & Nursing 55–60 12 ____
Process Application
Total 60 120 ____
1
,Domain I: Therapeutic Communication & Nurse-Patient Relationship (1–7, 14 pts)
1. A patient diagnosed with major depressive disorder states, "Nobody cares about me. I'm completely alone."
Which response by the nurse demonstrates therapeutic communication?
A. Everyone cares about you. You have so many friends.
B. You sound like you're feeling very lonely right now.
C. You shouldn't feel that way. You have a wonderful family.
D. I understand exactly how you feel. I get lonely too.
Answer: B. You sound like you're feeling very lonely right now.
Rationale: Reflecting the patient's feelings ("You sound like you're feeling very lonely right now") is a therapeutic
technique that validates emotions without judgment. False reassurance (A), giving advice or dismissing feelings
(C), and over-identifying (D) are non-therapeutic responses that block communication.
2. Which nursing statement best demonstrates the use of an open-ended question to encourage a patient to explore
thoughts and feelings?
A. Are you feeling sad today? B. Do you want to take your medication?
C. Tell me about what has been on your mind lately. D. Have you been sleeping well this week?
Answer: C. Tell me about what has been on your mind lately.
Rationale: Open-ended questions ("Tell me about what has been on your mind lately") invite the patient to share
freely and elaborate on concerns. Options A, B, and D are closed-ended questions that elicit yes/no or limited
responses and do not promote therapeutic exploration.
3. A nurse is caring for a patient with borderline personality disorder who frequently texts the nurse's personal
phone after shift. Which action best demonstrates maintaining professional boundaries?
A. Respond to texts to maintain the therapeutic relationship.
B. Give the patient the nurse's work phone number instead.
C. Politely redirect the patient to call the unit and discuss boundary expectations during the next session.
D. Block the patient's number without explanation.
Answer: C. Politely redirect the patient to call the unit and discuss boundary expectations during the next
session.
Rationale: Professional boundaries are maintained by addressing boundary violations directly, explaining the
rationale, and redirecting to appropriate channels. Responding personally (A) reinforces the violation. Simply
changing the number (B) does not address the underlying issue. Blocking without explanation (D) damages the
therapeutic alliance without teaching appropriate communication.
4. A nurse who was raised by an alcoholic parent feels overly responsible and anxious when caring for a patient
with alcohol use disorder. This phenomenon is best described as:
A. Transference B. Countertransference C. Resistance D. Therapeutic rapport
Answer: B. Countertransference
Rationale: Countertransference occurs when the nurse projects personal feelings, experiences, or unresolved issues
onto the patient. The nurse's personal history with an alcoholic parent creates an emotional reaction that interferes
2
, with objective care. Transference (A) is when the patient projects feelings onto the nurse. Recognizing
countertransference is essential for seeking supervision and maintaining therapeutic effectiveness.
5. During a therapeutic interaction, a patient suddenly becomes silent after discussing a traumatic event. Which
nursing action is MOST appropriate?
A. Immediately ask another question to redirect the conversation.
B. Say "It seems like this topic is difficult for you. I'll sit here with you while you process your thoughts."
C. Leave the room to give the patient privacy.
D. Document the silence as noncompliance with therapy.
Answer: B. Say "It seems like this topic is difficult for you. I'll sit here with you while you process your
thoughts."
Rationale: Therapeutic silence is a powerful communication technique that allows the patient time to process
emotions, gather thoughts, and decide what to share next. Acknowledging the difficulty and offering presence
validates the patient's experience. Interrupting silence (A), leaving (C), or interpreting silence negatively (D) are
non-therapeutic responses.
6. Which technique is used when the nurse restates what the patient said in different words to confirm
understanding?
A. Interpretation B. Clarification C. Reflection D. Summarization
Answer: B. Clarification
Rationale: Clarification involves restating or rephrasing what the patient said to verify accuracy and ensure mutual
understanding. It differs from reflection (C), which mirrors feelings, interpretation (A), which provides insight, and
summarization (D), which reviews key themes over time. Clarification is essential for avoiding miscommunication
in psychiatric nursing.
7. A nurse is establishing a therapeutic relationship with a newly admitted patient. Which approach best promotes
trust and rapport during the orientation phase?
A. Sharing personal experiences to build connection quickly.
B. Maintaining consistent, reliable, and honest communication while setting clear expectations.
C. Avoiding difficult topics until the patient is fully comfortable.
D. Agreeing with everything the patient says to avoid conflict.
Answer: B. Maintaining consistent, reliable, and honest communication while setting clear expectations.
Rationale: The orientation phase of the therapeutic relationship requires consistency, reliability, honesty, and clear
expectations to establish trust. Self-disclosure (A) is generally reserved for the working phase and used sparingly.
Avoiding topics (C) delays therapeutic progress. Excessive agreement (D) is non-therapeutic and undermines
authenticity.
Domain II: Psychiatric Disorders & Clinical Recognition (8–17, 20 pts)
8. A patient with bipolar disorder is admitted during a manic episode. Which finding is MOST consistent with this
phase?
A. Hypersomnia, psychomotor retardation, and feelings of worthlessness
3
EXAM 3 REVIEW | 2026/2027
Psychiatric-Mental Health Nursing Competency | 60 Questions | 120 Points Total
Read each question carefully. Select the BEST answer. Each question is worth 2 points. Total: 120 points. Time: 90
minutes. Questions reflect NCSBN NCLEX-RN Psychosocial Integrity domain competencies and APNA Standards of
Practice.
Scoring Summary
Domain Questions Points Score
I. Therapeutic Communication & 1–7 14 ____
Nurse-Patient Relationship
II. Psychiatric Disorders & Clinical 8–17 20 ____
Recognition
III. Psychopharmacology & Nursing 18–28 22 ____
Implications
IV. Crisis Intervention & Suicide Risk 29–38 20 ____
Assessment
V. Legal & Ethical Standards in 39–44 12 ____
Psychiatric Nursing
VI. Milieu Therapy & Therapeutic 45–49 10 ____
Environment
VII. Substance Use Disorders & Dual 50–54 10 ____
Diagnosis
VIII. Special Populations & Nursing 55–60 12 ____
Process Application
Total 60 120 ____
1
,Domain I: Therapeutic Communication & Nurse-Patient Relationship (1–7, 14 pts)
1. A patient diagnosed with major depressive disorder states, "Nobody cares about me. I'm completely alone."
Which response by the nurse demonstrates therapeutic communication?
A. Everyone cares about you. You have so many friends.
B. You sound like you're feeling very lonely right now.
C. You shouldn't feel that way. You have a wonderful family.
D. I understand exactly how you feel. I get lonely too.
Answer: B. You sound like you're feeling very lonely right now.
Rationale: Reflecting the patient's feelings ("You sound like you're feeling very lonely right now") is a therapeutic
technique that validates emotions without judgment. False reassurance (A), giving advice or dismissing feelings
(C), and over-identifying (D) are non-therapeutic responses that block communication.
2. Which nursing statement best demonstrates the use of an open-ended question to encourage a patient to explore
thoughts and feelings?
A. Are you feeling sad today? B. Do you want to take your medication?
C. Tell me about what has been on your mind lately. D. Have you been sleeping well this week?
Answer: C. Tell me about what has been on your mind lately.
Rationale: Open-ended questions ("Tell me about what has been on your mind lately") invite the patient to share
freely and elaborate on concerns. Options A, B, and D are closed-ended questions that elicit yes/no or limited
responses and do not promote therapeutic exploration.
3. A nurse is caring for a patient with borderline personality disorder who frequently texts the nurse's personal
phone after shift. Which action best demonstrates maintaining professional boundaries?
A. Respond to texts to maintain the therapeutic relationship.
B. Give the patient the nurse's work phone number instead.
C. Politely redirect the patient to call the unit and discuss boundary expectations during the next session.
D. Block the patient's number without explanation.
Answer: C. Politely redirect the patient to call the unit and discuss boundary expectations during the next
session.
Rationale: Professional boundaries are maintained by addressing boundary violations directly, explaining the
rationale, and redirecting to appropriate channels. Responding personally (A) reinforces the violation. Simply
changing the number (B) does not address the underlying issue. Blocking without explanation (D) damages the
therapeutic alliance without teaching appropriate communication.
4. A nurse who was raised by an alcoholic parent feels overly responsible and anxious when caring for a patient
with alcohol use disorder. This phenomenon is best described as:
A. Transference B. Countertransference C. Resistance D. Therapeutic rapport
Answer: B. Countertransference
Rationale: Countertransference occurs when the nurse projects personal feelings, experiences, or unresolved issues
onto the patient. The nurse's personal history with an alcoholic parent creates an emotional reaction that interferes
2
, with objective care. Transference (A) is when the patient projects feelings onto the nurse. Recognizing
countertransference is essential for seeking supervision and maintaining therapeutic effectiveness.
5. During a therapeutic interaction, a patient suddenly becomes silent after discussing a traumatic event. Which
nursing action is MOST appropriate?
A. Immediately ask another question to redirect the conversation.
B. Say "It seems like this topic is difficult for you. I'll sit here with you while you process your thoughts."
C. Leave the room to give the patient privacy.
D. Document the silence as noncompliance with therapy.
Answer: B. Say "It seems like this topic is difficult for you. I'll sit here with you while you process your
thoughts."
Rationale: Therapeutic silence is a powerful communication technique that allows the patient time to process
emotions, gather thoughts, and decide what to share next. Acknowledging the difficulty and offering presence
validates the patient's experience. Interrupting silence (A), leaving (C), or interpreting silence negatively (D) are
non-therapeutic responses.
6. Which technique is used when the nurse restates what the patient said in different words to confirm
understanding?
A. Interpretation B. Clarification C. Reflection D. Summarization
Answer: B. Clarification
Rationale: Clarification involves restating or rephrasing what the patient said to verify accuracy and ensure mutual
understanding. It differs from reflection (C), which mirrors feelings, interpretation (A), which provides insight, and
summarization (D), which reviews key themes over time. Clarification is essential for avoiding miscommunication
in psychiatric nursing.
7. A nurse is establishing a therapeutic relationship with a newly admitted patient. Which approach best promotes
trust and rapport during the orientation phase?
A. Sharing personal experiences to build connection quickly.
B. Maintaining consistent, reliable, and honest communication while setting clear expectations.
C. Avoiding difficult topics until the patient is fully comfortable.
D. Agreeing with everything the patient says to avoid conflict.
Answer: B. Maintaining consistent, reliable, and honest communication while setting clear expectations.
Rationale: The orientation phase of the therapeutic relationship requires consistency, reliability, honesty, and clear
expectations to establish trust. Self-disclosure (A) is generally reserved for the working phase and used sparingly.
Avoiding topics (C) delays therapeutic progress. Excessive agreement (D) is non-therapeutic and undermines
authenticity.
Domain II: Psychiatric Disorders & Clinical Recognition (8–17, 20 pts)
8. A patient with bipolar disorder is admitted during a manic episode. Which finding is MOST consistent with this
phase?
A. Hypersomnia, psychomotor retardation, and feelings of worthlessness
3
