NUR 253 Exam 3: Concepts of Mental Health Nursing -
Galen College of Nursing Updated and Latest Questions
and Correct Answers with Rationale
1. A nurse is caring for a client with schizophrenia who is experiencing auditory hallucinations. Which of the
following responses by the nurse is the most therapeutic?
A. I don’t hear the voices, but I can see that you are frightened.
B. Tell the voices to go away and leave you alone immediately.
C. Why do you think you are hearing those voices right now?
D. The voices are just a part of your imagination and are not real.
Correct Answer: A
Rationale: Therapeutic communication in schizophrenia involves acknowledging the client’s feelings
without reinforcing the hallucination itself. The nurse should state the reality that they do not hear the
voices while showing empathy for the client’s distress. Challenging the hallucination or calling it
‘imagination’ can cause the client to become defensive or withdrawn. Asking ‘why’ questions is often non-
therapeutic and may confuse a client who is already disorganized. This approach helps build trust and
maintain a safe environment for the client’s recovery.
2. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory value must the
nurse monitor most closely for this patient?
A. White blood cell (WBC) count
B. Serum potassium levels
C. Blood urea nitrogen (BUN)
D. Prothrombin time (PT)
,Correct Answer: A
Rationale: Clozapine carries a significant risk of agranulocytosis, which is a life-threatening decrease in
the white blood cell count. Regular monitoring of the WBC count and Absolute Neutrophil Count (ANC) is
mandatory for patients taking this medication. If the count drops below a certain threshold, the
medication must be discontinued to prevent severe infection. Nurses must educate patients to report any
signs of infection, such as fever or sore throat, immediately. This protocol is strictly regulated through a
risk evaluation and mitigation strategy (REMS) program.
3. A nurse is assessing a client for alcohol withdrawal. Which assessment tool should the nurse use to
determine the severity of the withdrawal symptoms?
A. PHQ-9
B. CAGE Questionnaire
C. CIWA-Ar scale
D. AIMS scale
Correct Answer: C
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the gold standard for
assessing alcohol withdrawal severity. It measures ten different categories including nausea, tremors,
sweats, and anxiety to guide pharmacological treatment. The PHQ-9 is used for depression screening,
while CAGE is used to screen for alcohol use disorder, not withdrawal. The AIMS scale is used specifically
to detect abnormal involuntary movements related to antipsychotic medications. Using the CIWA-Ar
ensures that medication like benzodiazepines are administered safely based on objective symptom
scores.
, 4. A client with schizophrenia is exhibiting ‘waxy flexibility.’ Which nursing intervention is the highest
priority for this client?
A. Encouraging the client to participate in group therapy
B. Performing passive range-of-motion exercises
C. Assessing for physiological needs like nutrition and hydration
D. Explaining the importance of medication adherence
Correct Answer: C
Rationale: Waxy flexibility is a catatonic symptom where a client remains in a fixed position for long
periods. Because the client may not move to eat, drink, or use the bathroom, physiological stability is the
primary concern. Nurses must ensure the client receives adequate fluids and nutrition to prevent skin
breakdown or dehydration. While range-of-motion is helpful, it does not take priority over basic survival
needs in a catatonic state. Safety and physical maintenance are the foundations of care during this acute
phase of the illness.
5. Which of the following symptoms is considered a ‘negative symptom’ of schizophrenia?
A. Anhedonia
B. Auditory hallucinations
C. Delusions of grandeur
D. Disorganized speech
Correct Answer: A
Rationale: Negative symptoms of schizophrenia involve a loss or deficit in normal functioning, such as
anhedonia, which is the inability to feel pleasure. Positive symptoms, such as hallucinations and
delusions, reflect an excess or distortion of normal functions. Anhedonia significantly impacts a client’s
Galen College of Nursing Updated and Latest Questions
and Correct Answers with Rationale
1. A nurse is caring for a client with schizophrenia who is experiencing auditory hallucinations. Which of the
following responses by the nurse is the most therapeutic?
A. I don’t hear the voices, but I can see that you are frightened.
B. Tell the voices to go away and leave you alone immediately.
C. Why do you think you are hearing those voices right now?
D. The voices are just a part of your imagination and are not real.
Correct Answer: A
Rationale: Therapeutic communication in schizophrenia involves acknowledging the client’s feelings
without reinforcing the hallucination itself. The nurse should state the reality that they do not hear the
voices while showing empathy for the client’s distress. Challenging the hallucination or calling it
‘imagination’ can cause the client to become defensive or withdrawn. Asking ‘why’ questions is often non-
therapeutic and may confuse a client who is already disorganized. This approach helps build trust and
maintain a safe environment for the client’s recovery.
2. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory value must the
nurse monitor most closely for this patient?
A. White blood cell (WBC) count
B. Serum potassium levels
C. Blood urea nitrogen (BUN)
D. Prothrombin time (PT)
,Correct Answer: A
Rationale: Clozapine carries a significant risk of agranulocytosis, which is a life-threatening decrease in
the white blood cell count. Regular monitoring of the WBC count and Absolute Neutrophil Count (ANC) is
mandatory for patients taking this medication. If the count drops below a certain threshold, the
medication must be discontinued to prevent severe infection. Nurses must educate patients to report any
signs of infection, such as fever or sore throat, immediately. This protocol is strictly regulated through a
risk evaluation and mitigation strategy (REMS) program.
3. A nurse is assessing a client for alcohol withdrawal. Which assessment tool should the nurse use to
determine the severity of the withdrawal symptoms?
A. PHQ-9
B. CAGE Questionnaire
C. CIWA-Ar scale
D. AIMS scale
Correct Answer: C
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the gold standard for
assessing alcohol withdrawal severity. It measures ten different categories including nausea, tremors,
sweats, and anxiety to guide pharmacological treatment. The PHQ-9 is used for depression screening,
while CAGE is used to screen for alcohol use disorder, not withdrawal. The AIMS scale is used specifically
to detect abnormal involuntary movements related to antipsychotic medications. Using the CIWA-Ar
ensures that medication like benzodiazepines are administered safely based on objective symptom
scores.
, 4. A client with schizophrenia is exhibiting ‘waxy flexibility.’ Which nursing intervention is the highest
priority for this client?
A. Encouraging the client to participate in group therapy
B. Performing passive range-of-motion exercises
C. Assessing for physiological needs like nutrition and hydration
D. Explaining the importance of medication adherence
Correct Answer: C
Rationale: Waxy flexibility is a catatonic symptom where a client remains in a fixed position for long
periods. Because the client may not move to eat, drink, or use the bathroom, physiological stability is the
primary concern. Nurses must ensure the client receives adequate fluids and nutrition to prevent skin
breakdown or dehydration. While range-of-motion is helpful, it does not take priority over basic survival
needs in a catatonic state. Safety and physical maintenance are the foundations of care during this acute
phase of the illness.
5. Which of the following symptoms is considered a ‘negative symptom’ of schizophrenia?
A. Anhedonia
B. Auditory hallucinations
C. Delusions of grandeur
D. Disorganized speech
Correct Answer: A
Rationale: Negative symptoms of schizophrenia involve a loss or deficit in normal functioning, such as
anhedonia, which is the inability to feel pleasure. Positive symptoms, such as hallucinations and
delusions, reflect an excess or distortion of normal functions. Anhedonia significantly impacts a client’s
