NR-326 – Mental Health Nursing Focuses on
psychiatric disorders, therapeutic communication,
mental health assessments, treatment strategies, and
compassionate nursing interventions.
1. A nurse is caring for a client with major depressive disorder. Which
statement by the nurse reflects the therapeutic communication technique of
“reflecting”?
A. “Tell me more about your feelings of hopelessness.”
B. “You seem to be feeling sad today.”
C. “Why do you think you feel this way?”
D. “I understand how you feel; I’ve been depressed too.”
Correct Answer: B
Rationale: Reflecting involves identifying and feeding back the client’s emotions
(“you seem sad”). Option A is exploring; C is asking “why” (often non-
therapeutic); D is offering self inappropriately and assuming similarity.
2. A client tells the nurse, “I don’t think I can go on anymore.” Which
response by the nurse is most appropriate to assess for suicide risk?
A. “Don’t worry, things will get better.”
B. “Are you thinking about harming yourself?”
C. “Let’s talk about something positive.”
D. “I’ll call your family to come stay with you.”
Correct Answer: B
Rationale: Direct, non-judgmental questioning about suicidal ideation is essential.
Asking “Are you thinking about harming yourself?” does not plant the idea; it
allows assessment of risk. False reassurance and changing the subject are unsafe.
3. A nurse is establishing a therapeutic relationship with a client. Which phase
involves identification and resolution of the client’s problems and resistance?
A. Preorientation phase
B. Orientation phase
C. Working phase
D. Termination phase
Correct Answer: C
,Rationale: The working phase is when the client actively addresses problems,
explores ambivalence, and works through resistance. Orientation sets goals;
termination ends relationship.
4. A client with borderline personality disorder says, “You’re the only nurse
who understands me. The others are all incompetent.” The nurse’s best
response is:
A. “Thank you, but you shouldn’t talk about other nurses that way.”
B. “I am here to help you, but it sounds like you have strong feelings about the
other staff. Let’s talk about that.”
C. “You’re right; I am the best nurse on this unit.”
D. “I will report that comment to the charge nurse.”
Correct Answer: B
Rationale: Splitting (idealizing one staff, devaluing others) is common in
borderline PD. The nurse should neither accept idealization nor reject the client,
but instead explore the feelings and set consistent boundaries.
5. A client with anxiety disorder is pacing and hyperventilating. Which
nursing intervention should be implemented first?
A. Administer PRN lorazepam
B. Stay with the client and encourage slow, deep breathing
C. Place the client in seclusion
D. Ask the client to talk about the trigger
Correct Answer: B
Rationale: First, provide a calm presence and use non-pharmacologic techniques
(slow breathing) to reduce anxiety. Medication may be used if non-pharmacologic
fails. Seclusion is for safety only if imminent danger.
6. The nurse is using the mnemonic “SOLER” to improve active listening.
What does the “E” stand for?
A. Evaluate the client’s statements
B. Eye contact
C. Ethical behavior
D. Empathy
Correct Answer: B (in SOLER: Sit squarely, Open posture, Lean forward,
Eye contact, Relax)
Rationale: SOLER is a nonverbal listening technique. E = Eye contact. It conveys
interest and respect. Empathy is a separate concept.
,7. A client with schizophrenia tells the nurse, “The CIA is putting microchips
in my cereal.” The nurse’s most therapeutic response is:
A. “That’s not true. The CIA doesn’t do that.”
B. “I don’t know about that, but I know you believe it. It must feel frightening.”
C. “Let’s stop talking about that.”
D. “Have you told your doctor about that?”
Correct Answer: B
Rationale: This response acknowledges the client’s feelings without endorsing the
delusion. Validating the emotional experience (frightening) is therapeutic. Arguing
or dismissing increases anxiety.
8. A nurse is assessing a client’s capacity to give informed consent for
psychiatric treatment. Which element is essential?
A. The client agrees with the treatment plan
B. The client can communicate a choice, understand relevant information,
appreciate the situation, and reason about options
C. The client’s family gives permission
D. The client is free of all psychiatric symptoms
Correct Answer: B
Rationale: Capacity requires: ability to communicate a choice, understand
information, appreciate consequences, and reason rationally. It is decision-specific
and does not require absence of all symptoms.
9. A client states, “I’m so worthless. I can’t do anything right.” Which
response by the nurse is most therapeutic?
A. “You shouldn’t say that about yourself.”
B. “Tell me about a time when you felt successful.”
C. “I agree that you have made mistakes.”
D. “Cheer up; things will improve.”
Correct Answer: B
Rationale: Challenging automatic negative thoughts by asking for
counterexamples is cognitive restructuring. False reassurance and agreeing
reinforce low self-esteem.
10. A nurse is caring for a client with post-traumatic stress disorder (PTSD)
who reports nightmares. Which intervention is evidence-based for reducing
nightmare frequency?
A. Prazosin (an alpha-1 antagonist)
, B. Diphenhydramine
C. Lorazepam
D. Haloperidol
Correct Answer: A
Rationale: Prazosin has shown efficacy in reducing trauma-related nightmares in
PTSD. Benzos (lorazepam) are not first-line; diphenhydramine is not evidence-
based for PTSD nightmares.
11. A client in an inpatient psychiatric unit becomes verbally aggressive,
shouting profanities. The nurse should first:
A. Call the security team for immediate restraint
B. Use a calm, low voice and set limits (“Shouting is not allowed. Please lower
your voice.”)
C. Walk away and ignore the behavior
D. Give the client an injection of haloperidol
Correct Answer: B
Rationale: De-escalation starts with calm limit-setting. Restraint/seclusion is for
imminent danger to self/others, not for verbal aggression alone. Walking away may
escalate.
12. A client with bipolar disorder in the manic phase says, “I have millions of
dollars and I’m going to buy the hospital.” The nurse’s best response is:
A. “No, you don’t have millions; you’re in a hospital.”
B. “It sounds exciting, but let’s focus on something you can do right now.”
C. “That’s a delusion; you need medication.”
D. “I’m calling your family to check your finances.”
Correct Answer: B
Rationale: Redirecting without directly confronting grandiosity. Do not argue with
delusions; redirect to concrete, reality-based activities. Option A argues; C labels;
D invades privacy.
13. A nurse is preparing a client for electroconvulsive therapy (ECT). Which
statement about ECT is accurate for the nurse to include in teaching?
A. “ECT is painful and you will remember everything.”
B. “You will receive general anesthesia and a muscle relaxant; you will not feel the
procedure.”
C. “ECT causes permanent brain damage.”
D. “You will not need any other medications after ECT.”
psychiatric disorders, therapeutic communication,
mental health assessments, treatment strategies, and
compassionate nursing interventions.
1. A nurse is caring for a client with major depressive disorder. Which
statement by the nurse reflects the therapeutic communication technique of
“reflecting”?
A. “Tell me more about your feelings of hopelessness.”
B. “You seem to be feeling sad today.”
C. “Why do you think you feel this way?”
D. “I understand how you feel; I’ve been depressed too.”
Correct Answer: B
Rationale: Reflecting involves identifying and feeding back the client’s emotions
(“you seem sad”). Option A is exploring; C is asking “why” (often non-
therapeutic); D is offering self inappropriately and assuming similarity.
2. A client tells the nurse, “I don’t think I can go on anymore.” Which
response by the nurse is most appropriate to assess for suicide risk?
A. “Don’t worry, things will get better.”
B. “Are you thinking about harming yourself?”
C. “Let’s talk about something positive.”
D. “I’ll call your family to come stay with you.”
Correct Answer: B
Rationale: Direct, non-judgmental questioning about suicidal ideation is essential.
Asking “Are you thinking about harming yourself?” does not plant the idea; it
allows assessment of risk. False reassurance and changing the subject are unsafe.
3. A nurse is establishing a therapeutic relationship with a client. Which phase
involves identification and resolution of the client’s problems and resistance?
A. Preorientation phase
B. Orientation phase
C. Working phase
D. Termination phase
Correct Answer: C
,Rationale: The working phase is when the client actively addresses problems,
explores ambivalence, and works through resistance. Orientation sets goals;
termination ends relationship.
4. A client with borderline personality disorder says, “You’re the only nurse
who understands me. The others are all incompetent.” The nurse’s best
response is:
A. “Thank you, but you shouldn’t talk about other nurses that way.”
B. “I am here to help you, but it sounds like you have strong feelings about the
other staff. Let’s talk about that.”
C. “You’re right; I am the best nurse on this unit.”
D. “I will report that comment to the charge nurse.”
Correct Answer: B
Rationale: Splitting (idealizing one staff, devaluing others) is common in
borderline PD. The nurse should neither accept idealization nor reject the client,
but instead explore the feelings and set consistent boundaries.
5. A client with anxiety disorder is pacing and hyperventilating. Which
nursing intervention should be implemented first?
A. Administer PRN lorazepam
B. Stay with the client and encourage slow, deep breathing
C. Place the client in seclusion
D. Ask the client to talk about the trigger
Correct Answer: B
Rationale: First, provide a calm presence and use non-pharmacologic techniques
(slow breathing) to reduce anxiety. Medication may be used if non-pharmacologic
fails. Seclusion is for safety only if imminent danger.
6. The nurse is using the mnemonic “SOLER” to improve active listening.
What does the “E” stand for?
A. Evaluate the client’s statements
B. Eye contact
C. Ethical behavior
D. Empathy
Correct Answer: B (in SOLER: Sit squarely, Open posture, Lean forward,
Eye contact, Relax)
Rationale: SOLER is a nonverbal listening technique. E = Eye contact. It conveys
interest and respect. Empathy is a separate concept.
,7. A client with schizophrenia tells the nurse, “The CIA is putting microchips
in my cereal.” The nurse’s most therapeutic response is:
A. “That’s not true. The CIA doesn’t do that.”
B. “I don’t know about that, but I know you believe it. It must feel frightening.”
C. “Let’s stop talking about that.”
D. “Have you told your doctor about that?”
Correct Answer: B
Rationale: This response acknowledges the client’s feelings without endorsing the
delusion. Validating the emotional experience (frightening) is therapeutic. Arguing
or dismissing increases anxiety.
8. A nurse is assessing a client’s capacity to give informed consent for
psychiatric treatment. Which element is essential?
A. The client agrees with the treatment plan
B. The client can communicate a choice, understand relevant information,
appreciate the situation, and reason about options
C. The client’s family gives permission
D. The client is free of all psychiatric symptoms
Correct Answer: B
Rationale: Capacity requires: ability to communicate a choice, understand
information, appreciate consequences, and reason rationally. It is decision-specific
and does not require absence of all symptoms.
9. A client states, “I’m so worthless. I can’t do anything right.” Which
response by the nurse is most therapeutic?
A. “You shouldn’t say that about yourself.”
B. “Tell me about a time when you felt successful.”
C. “I agree that you have made mistakes.”
D. “Cheer up; things will improve.”
Correct Answer: B
Rationale: Challenging automatic negative thoughts by asking for
counterexamples is cognitive restructuring. False reassurance and agreeing
reinforce low self-esteem.
10. A nurse is caring for a client with post-traumatic stress disorder (PTSD)
who reports nightmares. Which intervention is evidence-based for reducing
nightmare frequency?
A. Prazosin (an alpha-1 antagonist)
, B. Diphenhydramine
C. Lorazepam
D. Haloperidol
Correct Answer: A
Rationale: Prazosin has shown efficacy in reducing trauma-related nightmares in
PTSD. Benzos (lorazepam) are not first-line; diphenhydramine is not evidence-
based for PTSD nightmares.
11. A client in an inpatient psychiatric unit becomes verbally aggressive,
shouting profanities. The nurse should first:
A. Call the security team for immediate restraint
B. Use a calm, low voice and set limits (“Shouting is not allowed. Please lower
your voice.”)
C. Walk away and ignore the behavior
D. Give the client an injection of haloperidol
Correct Answer: B
Rationale: De-escalation starts with calm limit-setting. Restraint/seclusion is for
imminent danger to self/others, not for verbal aggression alone. Walking away may
escalate.
12. A client with bipolar disorder in the manic phase says, “I have millions of
dollars and I’m going to buy the hospital.” The nurse’s best response is:
A. “No, you don’t have millions; you’re in a hospital.”
B. “It sounds exciting, but let’s focus on something you can do right now.”
C. “That’s a delusion; you need medication.”
D. “I’m calling your family to check your finances.”
Correct Answer: B
Rationale: Redirecting without directly confronting grandiosity. Do not argue with
delusions; redirect to concrete, reality-based activities. Option A argues; C labels;
D invades privacy.
13. A nurse is preparing a client for electroconvulsive therapy (ECT). Which
statement about ECT is accurate for the nurse to include in teaching?
A. “ECT is painful and you will remember everything.”
B. “You will receive general anesthesia and a muscle relaxant; you will not feel the
procedure.”
C. “ECT causes permanent brain damage.”
D. “You will not need any other medications after ECT.”
