,NUR253/NUR 253 Exam 3 | Mental Health Nursing
1. The nurse is caring for a client who was involved in a motor vehicle accident 10 days ago. The client
reports intrusive thoughts, hypervigilance, and difficulty sleeping. Which diagnosis should the nurse
suspect?
A) Post-traumatic stress disorder
B) Acute stress disorder
C) Adjustment disorder
D) Generalized anxiety disorder
Correct Answer: Acute stress disorder
Rationale: Acute stress disorder is diagnosed when symptoms of intrusion, avoidance, negative mood,
dissociation, and arousal last for at least 3 days but less than 1 month after a traumatic event. Post-
traumatic stress disorder requires symptoms to persist beyond 1 month. Adjustment disorder involves
a stressor that is less severe than a life-threatening event.
2. A client with post-traumatic stress disorder tells the nurse, "I don't go to the grocery store anymore
because it's too crowded. I never know who might be behind me." The nurse should document this as
which type of symptom?
A) Intrusive symptom
B) Negative cognition symptom
C) Avoidance symptom
D) Dissociative symptom
Correct Answer: Avoidance symptom
Rationale: Avoidance symptoms in PTSD involve efforts to avoid distressing memories, thoughts,
feelings, or external reminders of the traumatic event. Avoiding crowded places to prevent trauma-
related distress is a classic example. Intrusive symptoms include flashbacks and nightmares. Negative
cognitions involve persistent negative beliefs about oneself.
,3. The nurse is assessing a client with somatic symptom disorder. Which statement by the client is
most consistent with this diagnosis?
A) "I am terrified that I have cancer, even though all my tests are normal."
B) "I have severe pain in my back that has not been explained by any test."
C) "My leg is paralyzed, but the doctors cannot find a physical cause."
D) "I have intentionally made myself ill so I can be cared for."
Correct Answer: I have severe pain in my back that has not been explained by any test.
Rationale: Somatic symptom disorder is characterized by one or more distressing physical symptoms,
accompanied by excessive thoughts, feelings, or behaviors related to the symptoms. Illness anxiety
disorder involves worry about illness with minimal somatic symptoms. Conversion disorder involves
neurological symptoms incompatible with medical conditions.
4. A client diagnosed with illness anxiety disorder tells the nurse, "I know the doctors say I'm fine, but
I just know something is wrong with my heart." Which response by the nurse is most therapeutic?
A) "You need to trust your doctors; they are experts."
B) "I understand you are worried. Let's talk about what you are afraid might happen."
C) "Your tests are all normal, so there is nothing to worry about."
D) "Why do you keep going to the doctor if you don't believe them?"
Correct Answer: I understand you are worried. Let's talk about what you are afraid might happen.
Rationale: This response validates the client's anxiety while exploring the underlying fear, which is
therapeutic for illness anxiety disorder. Reassurance alone is often ineffective because it does not
address the anxiety. "Why" questions can feel accusatory and damage the therapeutic relationship.
5. The nurse is caring for a client with conversion disorder who presents with sudden-onset paralysis
of the right arm. Which nursing intervention is most appropriate?
A) Encourage the client to use the arm despite the paralysis
B) Explore the client's emotional stressors and provide supportive care
C) Apply a splint to the arm to prevent contractures
, D) Refer the client for physical therapy to strengthen the arm
Correct Answer: Explore the client's emotional stressors and provide supportive care
Rationale: Conversion disorder involves neurological symptoms that are incompatible with medical
conditions, often related to psychological stressors. The priority is to address the underlying
emotional conflict while providing supportive care. Encouraging use of the arm may increase anxiety.
6. The nurse is assessing a client with dissociative amnesia. Which statement by the client is most
consistent with this diagnosis?
A) "I cannot remember anything about the car accident that happened last week."
B) "I feel like I am watching myself from outside my body."
C) "I have two distinct personalities that take control of my behavior."
D) "I have episodes where I wander away from home and cannot remember who I am."
Correct Answer: I cannot remember anything about the car accident that happened last week.
Rationale: Dissociative amnesia is characterized by an inability to recall important autobiographical
information, typically following a traumatic or stressful event. Depersonalization (B) involves feeling
detached from oneself. Dissociative identity disorder (C) involves distinct personality states.
Dissociative fugue (D) involves sudden, unexpected travel and amnesia for identity.
7. A client diagnosed with dissociative fugue is found wandering in a different city and cannot recall
their name or address. The nurse anticipates that the client's treatment will focus on:
A) Reintegrating the client's distinct personality states
B) Helping the client recover memories of their identity and past
C) Teaching the client to recognize and interrupt dissociative episodes
D) Managing the client's auditory hallucinations and delusions
Correct Answer: Helping the client recover memories of their identity and past
1. The nurse is caring for a client who was involved in a motor vehicle accident 10 days ago. The client
reports intrusive thoughts, hypervigilance, and difficulty sleeping. Which diagnosis should the nurse
suspect?
A) Post-traumatic stress disorder
B) Acute stress disorder
C) Adjustment disorder
D) Generalized anxiety disorder
Correct Answer: Acute stress disorder
Rationale: Acute stress disorder is diagnosed when symptoms of intrusion, avoidance, negative mood,
dissociation, and arousal last for at least 3 days but less than 1 month after a traumatic event. Post-
traumatic stress disorder requires symptoms to persist beyond 1 month. Adjustment disorder involves
a stressor that is less severe than a life-threatening event.
2. A client with post-traumatic stress disorder tells the nurse, "I don't go to the grocery store anymore
because it's too crowded. I never know who might be behind me." The nurse should document this as
which type of symptom?
A) Intrusive symptom
B) Negative cognition symptom
C) Avoidance symptom
D) Dissociative symptom
Correct Answer: Avoidance symptom
Rationale: Avoidance symptoms in PTSD involve efforts to avoid distressing memories, thoughts,
feelings, or external reminders of the traumatic event. Avoiding crowded places to prevent trauma-
related distress is a classic example. Intrusive symptoms include flashbacks and nightmares. Negative
cognitions involve persistent negative beliefs about oneself.
,3. The nurse is assessing a client with somatic symptom disorder. Which statement by the client is
most consistent with this diagnosis?
A) "I am terrified that I have cancer, even though all my tests are normal."
B) "I have severe pain in my back that has not been explained by any test."
C) "My leg is paralyzed, but the doctors cannot find a physical cause."
D) "I have intentionally made myself ill so I can be cared for."
Correct Answer: I have severe pain in my back that has not been explained by any test.
Rationale: Somatic symptom disorder is characterized by one or more distressing physical symptoms,
accompanied by excessive thoughts, feelings, or behaviors related to the symptoms. Illness anxiety
disorder involves worry about illness with minimal somatic symptoms. Conversion disorder involves
neurological symptoms incompatible with medical conditions.
4. A client diagnosed with illness anxiety disorder tells the nurse, "I know the doctors say I'm fine, but
I just know something is wrong with my heart." Which response by the nurse is most therapeutic?
A) "You need to trust your doctors; they are experts."
B) "I understand you are worried. Let's talk about what you are afraid might happen."
C) "Your tests are all normal, so there is nothing to worry about."
D) "Why do you keep going to the doctor if you don't believe them?"
Correct Answer: I understand you are worried. Let's talk about what you are afraid might happen.
Rationale: This response validates the client's anxiety while exploring the underlying fear, which is
therapeutic for illness anxiety disorder. Reassurance alone is often ineffective because it does not
address the anxiety. "Why" questions can feel accusatory and damage the therapeutic relationship.
5. The nurse is caring for a client with conversion disorder who presents with sudden-onset paralysis
of the right arm. Which nursing intervention is most appropriate?
A) Encourage the client to use the arm despite the paralysis
B) Explore the client's emotional stressors and provide supportive care
C) Apply a splint to the arm to prevent contractures
, D) Refer the client for physical therapy to strengthen the arm
Correct Answer: Explore the client's emotional stressors and provide supportive care
Rationale: Conversion disorder involves neurological symptoms that are incompatible with medical
conditions, often related to psychological stressors. The priority is to address the underlying
emotional conflict while providing supportive care. Encouraging use of the arm may increase anxiety.
6. The nurse is assessing a client with dissociative amnesia. Which statement by the client is most
consistent with this diagnosis?
A) "I cannot remember anything about the car accident that happened last week."
B) "I feel like I am watching myself from outside my body."
C) "I have two distinct personalities that take control of my behavior."
D) "I have episodes where I wander away from home and cannot remember who I am."
Correct Answer: I cannot remember anything about the car accident that happened last week.
Rationale: Dissociative amnesia is characterized by an inability to recall important autobiographical
information, typically following a traumatic or stressful event. Depersonalization (B) involves feeling
detached from oneself. Dissociative identity disorder (C) involves distinct personality states.
Dissociative fugue (D) involves sudden, unexpected travel and amnesia for identity.
7. A client diagnosed with dissociative fugue is found wandering in a different city and cannot recall
their name or address. The nurse anticipates that the client's treatment will focus on:
A) Reintegrating the client's distinct personality states
B) Helping the client recover memories of their identity and past
C) Teaching the client to recognize and interrupt dissociative episodes
D) Managing the client's auditory hallucinations and delusions
Correct Answer: Helping the client recover memories of their identity and past
