PSYCHIATRIC-MENTAL HEALTH NURSING
VIDEBECK, 9TH EDITION | EXAM REVIEW | 2026/2027
Therapeutic Communication, Psychopathology & Psychopharmacology | 70 Questions | 140 Points
Read each question carefully. Select the BEST answer. Each question is worth 2 points. Total: 140 points. Time: 90
minutes. Questions reflect Videbeck's Psychiatric-Mental Health Nursing (9th Ed.) learning objectives, NCSBN
NCLEX-RN Psychosocial Integrity domain, and APNA Standards of Practice.
Domain Questions Points Score
I. Foundations of Psychiatric Nursing & Therapeutic Communication Q1–Q10 20
II. Neurobiological Foundations Q11–Q14 8
III. Psychiatric Assessment & Mental Status Examination Q15–Q19 10
IV. Mood Disorders (Depression & Bipolar) Q20–Q26 14
V. Anxiety, Trauma & Stress-Related Disorders Q27–Q33 14
VI. Psychotic Disorders & Personality Disorders Q34–Q42 18
VII. Psychopharmacology & Nursing Implications Q43–Q52 20
VIII. Crisis Intervention & Suicide Risk Management Q53–Q59 14
IX. Legal/Ethical Standards & Milieu Therapy Q60–Q64 10
X. Substance Use, Special Populations & Nursing Process Q65–Q70 12
TOTAL Q1–Q70 140
I. Foundations of Psychiatric Nursing & Therapeutic Communication (Q1–Q10, 20 pts)
1. Which therapeutic communication technique is demonstrated when the nurse says, "It sounds like you are
feeling very lonely"?
A. Restating B. Reflection of feelings C. Clarification D. Summarization
Answer: B. Reflection of feelings
Rationale: Reflection of feelings involves mirroring the emotional content of the patient's message back to them,
helping the patient feel heard and understood. This validates emotions without judgment. Restating (A) repeats the
factual content in different words. Clarification (C) asks for more detail. Summarization (D) condenses key themes
from a longer conversation.
2. Which nursing response is considered NON-therapeutic?
A. "Tell me more about what you mean by that." B. "I can see this is really difficult for you."
C. "Everything will be fine. Try not to worry about it." D. "It sounds like you're feeling frustrated."
Answer: C. "Everything will be fine. Try not to worry about it."
Rationale: "Everything will be fine" is false reassurance, a non-therapeutic response that minimizes the patient's
feelings and blocks further communication. Open-ended exploration (A), empathic acknowledgment (B), and
reflection (D) are all therapeutic techniques that promote communication.
3. The nurse recognizes countertransference when experiencing which feelings toward a patient?
A. Feeling professionally satisfied after a productive session
B. Feeling overly responsible and anxious due to personal history with similar issues
C. Feeling curious about the patient's cultural background
D. Feeling hopeful about the patient's progress toward recovery
Answer: B. Feeling overly responsible and anxious due to personal history with similar issues
1
, Rationale: Countertransference occurs when the nurse unconsciously projects personal feelings, unresolved issues,
or past experiences onto the patient. Feeling overly responsible and anxious due to personal history indicates the
nurse's own emotional baggage is interfering with care. Professional satisfaction (A), cultural curiosity (C), and
therapeutic hope (D) are appropriate responses.
4. A patient with schizophrenia says, "The voices are telling me not to trust anyone." Which response by the nurse
uses clarification?
A. "I understand how frightening that must be." B. "Can you tell me more about what the voices are
saying?"
C. "You shouldn't listen to those voices." D. "The voices are not real; they are part of your illness."
Answer: B. "Can you tell me more about what the voices are saying?"
Rationale: Clarification asks the patient to elaborate or provide more detail to ensure the nurse fully understands
the content. "Can you tell me more about what the voices are saying?" encourages the patient to describe the
experience further. Empathy (A) is also therapeutic but is not clarification. Telling the patient what to do (C) or
directly challenging delusions (D) during acute psychosis is non-therapeutic.
5. Which principle of the recovery model emphasizes that patients can lead meaningful lives regardless of the
presence or absence of symptoms?
A. Hope B. Self-determination C. Empowerment D. Community inclusion
Answer: B. Self-determination
Rationale: Self-determination in the recovery model means patients have the right to make their own choices,
direct their own care, and lead meaningful lives regardless of symptom status. Recovery is viewed as a journey, not
a cure. Hope (A) is the foundation that recovery is possible. Empowerment (C) involves building skills and
confidence. Community inclusion (D) emphasizes full participation in society.
6. A nursing student refers to a patient as "a schizophrenic" in clinical conference. The instructor corrects the
student by emphasizing which concept?
A. Medical terminology B. Person-first language C. Stigma-free diagnosis D. Clinical documentation
accuracy labeling standards
Answer: B. Person-first language
Rationale: Person-first language ("a person with schizophrenia" rather than "a schizophrenic") separates the person
from the diagnosis, reducing stigma and emphasizing the individual's humanity. This is a core principle of
psychiatric nursing ethics. It is not merely about medical terminology (A), documentation standards (D), or
diagnosis labeling (C).
7. Which nursing action demonstrates trauma-informed care when assessing a new psychiatric patient?
A. Asking "What is wrong with you?" B. Creating a safe, welcoming environment and asking
"What happened to you?"
C. Rapidly probing for details about traumatic events on D. Documenting all trauma history before establishing
admission rapport
Answer: B. Creating a safe, welcoming environment and asking "What happened to you?"
Rationale: Trauma-informed care asks "What happened to you?" rather than "What's wrong with you?" and
emphasizes safety, trustworthiness, and collaboration. Creating a safe environment before exploring trauma history
prevents re-traumatization. Rapid probing (C) and prioritizing documentation over rapport (D) violate trauma-
informed principles.
8. A nurse is caring for a patient who frequently brings gifts and attempts to arrange social meetings outside the
therapeutic setting. Which concept should the nurse apply?
A. Therapeutic use of self B. Professional boundaries C. Cultural competence D. Milieu management
2
, Answer: B. Professional boundaries
Rationale: Professional boundaries define the therapeutic relationship's limits, prohibiting personal relationships,
gift exchanges, or social contact outside the clinical setting. Accepting gifts or meeting socially blurs boundaries
and can harm both patient and nurse. Therapeutic use of self (A) involves appropriate self-disclosure. Cultural
competence (C) and milieu management (D) are unrelated to boundary violations.
9. A patient unconsciously redirects feelings about their abusive parent onto the nurse during therapy. This
phenomenon is best described as:
A. Countertransference B. Resistance C. Transference D. Defense mechanism
Answer: C. Transference
Rationale: Transference occurs when the patient unconsciously redirects feelings, expectations, and attitudes from
a significant past relationship (e.g., an abusive parent) onto the nurse. This is a normal part of psychodynamic
therapy and provides insight into the patient's relational patterns. Countertransference (A) is when the nurse
projects personal feelings onto the patient. Resistance (C) is unconscious opposition to therapy. Defense
mechanisms (D) are broader psychological strategies.
10. During a therapeutic interaction, the nurse remains silent for several moments after the patient shares a painful
memory. The patient then begins to cry and shares deeper feelings. This demonstrates the therapeutic value of:
A. Active listening B. Providing information C. Therapeutic silence D. Summarization
Answer: C. Therapeutic silence
Rationale: Therapeutic silence allows the patient time to process emotions, gather thoughts, and take initiative in
the conversation. It communicates acceptance and patience. Active listening (A) involves attending behaviors.
Providing information (C) is sharing factual knowledge. Summarization (D) condenses key points. Silence is one of
the most powerful yet underutilized therapeutic techniques.
II. Neurobiological Foundations (Q11–Q14, 8 pts)
11. Which neurotransmitter is primarily associated with the positive symptoms of schizophrenia when present in
excess?
A. Serotonin B. Dopamine C. Norepinephrine D. GABA
Answer: B. Dopamine
Rationale: Hyperdopaminergia in the mesolimbic pathway is associated with positive symptoms of schizophrenia
(hallucinations, delusions, disorganized thought). Antipsychotics exert their therapeutic effect primarily by
blocking D2 receptors. Serotonin (A) is more associated with mood disorders. Norepinephrine (C) relates to
anxiety and attention. GABA (D) is the primary inhibitory neurotransmitter and is low in anxiety.
12. A patient is prescribed a benzodiazepine for anxiety. The nurse understands this medication enhances which
neurotransmitter?
A. Serotonin B. Dopamine C. Norepinephrine D. GABA
Answer: D. GABA
Rationale: Benzodiazepines enhance the activity of GABA (gamma-aminobutyric acid), the primary inhibitory
neurotransmitter, by binding to GABA-A receptors and increasing chloride ion influx. This produces sedative,
anxiolytic, and muscle relaxant effects. Low GABA activity is implicated in anxiety disorders. SSRIs affect
serotonin (A), antipsychotics target dopamine (B), and SNRIs affect norepinephrine (C).
13. The hypothalamic-pituitary-adrenal (HPA) axis is responsible for which physiological response?
A. Regulation of circadian rhythm and sleep cycles B. Coordination of the stress response and cortisol release
3
VIDEBECK, 9TH EDITION | EXAM REVIEW | 2026/2027
Therapeutic Communication, Psychopathology & Psychopharmacology | 70 Questions | 140 Points
Read each question carefully. Select the BEST answer. Each question is worth 2 points. Total: 140 points. Time: 90
minutes. Questions reflect Videbeck's Psychiatric-Mental Health Nursing (9th Ed.) learning objectives, NCSBN
NCLEX-RN Psychosocial Integrity domain, and APNA Standards of Practice.
Domain Questions Points Score
I. Foundations of Psychiatric Nursing & Therapeutic Communication Q1–Q10 20
II. Neurobiological Foundations Q11–Q14 8
III. Psychiatric Assessment & Mental Status Examination Q15–Q19 10
IV. Mood Disorders (Depression & Bipolar) Q20–Q26 14
V. Anxiety, Trauma & Stress-Related Disorders Q27–Q33 14
VI. Psychotic Disorders & Personality Disorders Q34–Q42 18
VII. Psychopharmacology & Nursing Implications Q43–Q52 20
VIII. Crisis Intervention & Suicide Risk Management Q53–Q59 14
IX. Legal/Ethical Standards & Milieu Therapy Q60–Q64 10
X. Substance Use, Special Populations & Nursing Process Q65–Q70 12
TOTAL Q1–Q70 140
I. Foundations of Psychiatric Nursing & Therapeutic Communication (Q1–Q10, 20 pts)
1. Which therapeutic communication technique is demonstrated when the nurse says, "It sounds like you are
feeling very lonely"?
A. Restating B. Reflection of feelings C. Clarification D. Summarization
Answer: B. Reflection of feelings
Rationale: Reflection of feelings involves mirroring the emotional content of the patient's message back to them,
helping the patient feel heard and understood. This validates emotions without judgment. Restating (A) repeats the
factual content in different words. Clarification (C) asks for more detail. Summarization (D) condenses key themes
from a longer conversation.
2. Which nursing response is considered NON-therapeutic?
A. "Tell me more about what you mean by that." B. "I can see this is really difficult for you."
C. "Everything will be fine. Try not to worry about it." D. "It sounds like you're feeling frustrated."
Answer: C. "Everything will be fine. Try not to worry about it."
Rationale: "Everything will be fine" is false reassurance, a non-therapeutic response that minimizes the patient's
feelings and blocks further communication. Open-ended exploration (A), empathic acknowledgment (B), and
reflection (D) are all therapeutic techniques that promote communication.
3. The nurse recognizes countertransference when experiencing which feelings toward a patient?
A. Feeling professionally satisfied after a productive session
B. Feeling overly responsible and anxious due to personal history with similar issues
C. Feeling curious about the patient's cultural background
D. Feeling hopeful about the patient's progress toward recovery
Answer: B. Feeling overly responsible and anxious due to personal history with similar issues
1
, Rationale: Countertransference occurs when the nurse unconsciously projects personal feelings, unresolved issues,
or past experiences onto the patient. Feeling overly responsible and anxious due to personal history indicates the
nurse's own emotional baggage is interfering with care. Professional satisfaction (A), cultural curiosity (C), and
therapeutic hope (D) are appropriate responses.
4. A patient with schizophrenia says, "The voices are telling me not to trust anyone." Which response by the nurse
uses clarification?
A. "I understand how frightening that must be." B. "Can you tell me more about what the voices are
saying?"
C. "You shouldn't listen to those voices." D. "The voices are not real; they are part of your illness."
Answer: B. "Can you tell me more about what the voices are saying?"
Rationale: Clarification asks the patient to elaborate or provide more detail to ensure the nurse fully understands
the content. "Can you tell me more about what the voices are saying?" encourages the patient to describe the
experience further. Empathy (A) is also therapeutic but is not clarification. Telling the patient what to do (C) or
directly challenging delusions (D) during acute psychosis is non-therapeutic.
5. Which principle of the recovery model emphasizes that patients can lead meaningful lives regardless of the
presence or absence of symptoms?
A. Hope B. Self-determination C. Empowerment D. Community inclusion
Answer: B. Self-determination
Rationale: Self-determination in the recovery model means patients have the right to make their own choices,
direct their own care, and lead meaningful lives regardless of symptom status. Recovery is viewed as a journey, not
a cure. Hope (A) is the foundation that recovery is possible. Empowerment (C) involves building skills and
confidence. Community inclusion (D) emphasizes full participation in society.
6. A nursing student refers to a patient as "a schizophrenic" in clinical conference. The instructor corrects the
student by emphasizing which concept?
A. Medical terminology B. Person-first language C. Stigma-free diagnosis D. Clinical documentation
accuracy labeling standards
Answer: B. Person-first language
Rationale: Person-first language ("a person with schizophrenia" rather than "a schizophrenic") separates the person
from the diagnosis, reducing stigma and emphasizing the individual's humanity. This is a core principle of
psychiatric nursing ethics. It is not merely about medical terminology (A), documentation standards (D), or
diagnosis labeling (C).
7. Which nursing action demonstrates trauma-informed care when assessing a new psychiatric patient?
A. Asking "What is wrong with you?" B. Creating a safe, welcoming environment and asking
"What happened to you?"
C. Rapidly probing for details about traumatic events on D. Documenting all trauma history before establishing
admission rapport
Answer: B. Creating a safe, welcoming environment and asking "What happened to you?"
Rationale: Trauma-informed care asks "What happened to you?" rather than "What's wrong with you?" and
emphasizes safety, trustworthiness, and collaboration. Creating a safe environment before exploring trauma history
prevents re-traumatization. Rapid probing (C) and prioritizing documentation over rapport (D) violate trauma-
informed principles.
8. A nurse is caring for a patient who frequently brings gifts and attempts to arrange social meetings outside the
therapeutic setting. Which concept should the nurse apply?
A. Therapeutic use of self B. Professional boundaries C. Cultural competence D. Milieu management
2
, Answer: B. Professional boundaries
Rationale: Professional boundaries define the therapeutic relationship's limits, prohibiting personal relationships,
gift exchanges, or social contact outside the clinical setting. Accepting gifts or meeting socially blurs boundaries
and can harm both patient and nurse. Therapeutic use of self (A) involves appropriate self-disclosure. Cultural
competence (C) and milieu management (D) are unrelated to boundary violations.
9. A patient unconsciously redirects feelings about their abusive parent onto the nurse during therapy. This
phenomenon is best described as:
A. Countertransference B. Resistance C. Transference D. Defense mechanism
Answer: C. Transference
Rationale: Transference occurs when the patient unconsciously redirects feelings, expectations, and attitudes from
a significant past relationship (e.g., an abusive parent) onto the nurse. This is a normal part of psychodynamic
therapy and provides insight into the patient's relational patterns. Countertransference (A) is when the nurse
projects personal feelings onto the patient. Resistance (C) is unconscious opposition to therapy. Defense
mechanisms (D) are broader psychological strategies.
10. During a therapeutic interaction, the nurse remains silent for several moments after the patient shares a painful
memory. The patient then begins to cry and shares deeper feelings. This demonstrates the therapeutic value of:
A. Active listening B. Providing information C. Therapeutic silence D. Summarization
Answer: C. Therapeutic silence
Rationale: Therapeutic silence allows the patient time to process emotions, gather thoughts, and take initiative in
the conversation. It communicates acceptance and patience. Active listening (A) involves attending behaviors.
Providing information (C) is sharing factual knowledge. Summarization (D) condenses key points. Silence is one of
the most powerful yet underutilized therapeutic techniques.
II. Neurobiological Foundations (Q11–Q14, 8 pts)
11. Which neurotransmitter is primarily associated with the positive symptoms of schizophrenia when present in
excess?
A. Serotonin B. Dopamine C. Norepinephrine D. GABA
Answer: B. Dopamine
Rationale: Hyperdopaminergia in the mesolimbic pathway is associated with positive symptoms of schizophrenia
(hallucinations, delusions, disorganized thought). Antipsychotics exert their therapeutic effect primarily by
blocking D2 receptors. Serotonin (A) is more associated with mood disorders. Norepinephrine (C) relates to
anxiety and attention. GABA (D) is the primary inhibitory neurotransmitter and is low in anxiety.
12. A patient is prescribed a benzodiazepine for anxiety. The nurse understands this medication enhances which
neurotransmitter?
A. Serotonin B. Dopamine C. Norepinephrine D. GABA
Answer: D. GABA
Rationale: Benzodiazepines enhance the activity of GABA (gamma-aminobutyric acid), the primary inhibitory
neurotransmitter, by binding to GABA-A receptors and increasing chloride ion influx. This produces sedative,
anxiolytic, and muscle relaxant effects. Low GABA activity is implicated in anxiety disorders. SSRIs affect
serotonin (A), antipsychotics target dopamine (B), and SNRIs affect norepinephrine (C).
13. The hypothalamic-pituitary-adrenal (HPA) axis is responsible for which physiological response?
A. Regulation of circadian rhythm and sleep cycles B. Coordination of the stress response and cortisol release
3
