RASMUSSEN: MENTAL HEALTH EXAM 2
WITH CORRECT ANSWERS 2025
-A neologism is a newly coined word having special meaning to the patient.
"Volmer" is not a known common noun.
- Concrete thinking refers to the inability to think abstractly.
- Thought insertion refers to thoughts of others that are implanted in one's
mind.
-An idea of reference is a type of delusion in which trivial events are given
personal significance. correct answers 1) A patient with
schizophrenia begins to talks about "volmers" hiding in the warehouse at
work. The term "volmers" should be documented as:
a. neologism
b. concrete thinking
c. thought insertion
d. idea of reference
ANS: A, B, F
One-on-one observation is necessary for anyone who has limited control
over suicidal impulses.
- Plastic dishes on trays and the removal of potentially harmful objects from
the patient's possession are measures included in any-level suicide
precautions.
The remaining options are used in less stringent levels of suicide
precautions.
correct answers 2) A
patient with suicidal impulses is placed on the highest level of suicide
precautions. Which measures should be incorporated into the plan of care by
the nurse caring for the patient? (More than one answer is correct.)
e. Maintain arm's-length, one-on-one nursing observation around the clock.
f. Allow no glass or metal on meal trays.
g.Keep patient within visual range while awake. Check every 15 to 30
minutes while the patient is sleeping.
h. Check the patient's whereabouts every 15 minutes and make frequent
verbal
contacts.
e. Check whereabouts every hour. Make verbal contact at least three times
each shift.
f. Remove all potentially harmful objects from the patient's possession.
ANS: D
,The patient is describing phenomena that indicate personal boundary
difficulties. The nurse should maintain an appropriate social distance and not
touch the patient, because the patient is anxious about the inability to
maintain ego boundaries and merging with or being swallowed by the
environment. Physical closeness or touch could precipitate panic.
correct answers 3) A patient diagnosed with schizophrenia anxiously
says, "I can see the left side of my body merging with the wall, then my face
appears and disappears in the mirror." While listening, the nurse should:
a. sit close to the patient.
b. place an arm protectively around the patient's shoulders.
c. place a hand on the patient's arm and exert light pressure.
d. maintain a normal social interaction distance from the patient.
During an acute phase of major depression, the client may feel worthless
and deserve bad things to happen personally. correct answers 4) Which
statement indicates a patient with major depression is most likely outlook on
life during the acute phase of the illness?
ANS: B
Patients diagnosed with bipolar disorder may be maintained on lithium
indefinitely to prevent recurrences. Helping the patient understand this need
will promote medication compliance. correct answers 5) A patient
diagnosed with bipolar disorder is in the maintenance phase of treatment.
The patient asks, "Do I have to keep taking this lithium even though my
mood is stable now?" Select the nurse's appropriate response.
e. "You will be able to stop the medication in about 1 month."
f. "Taking the medication every day helps reduce the risk of a relapse."
g. "Usually patients take medication for approximately 6 months after
discharge."
h. "It's unusual that the health care provider hasn't already stopped your
medication."
ANS: B
Resist focusing on content; instead, focus on the feelings the patient is
expressing. This strategy prevents arguing about the reality of delusional
beliefs. Such arguments increase patient anxiety and the tenacity with which
the patient holds to the delusion.
The other options focus on content and provide opportunity for argument.
correct answers 6) A
person has had difficulty keeping a job because of arguing with co- workers
and accusing them of conspiracy. Today the person shouts, "They're all
plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic
response.
i. "Everyone here is trying to help you. No one wants to harm you."
j. "Feeling that people want to destroy you must be very frightening."
k. "That is not true. People here are trying to help you if you will let them."
l. "Staff members are health care professionals who are qualified to help
you."
, ANS: C
Denial is an unconscious blocking of threatening or painful information or
feelings. Regression involves using behaviors appropriate at an earlier stage
of psychosexual development. Displacement shifts feelings to a more neutral
person or object. Projection attributes one's own unacceptable thoughts or
feelings to another correct answers
7) A patient is undergoing a series of diagnostic tests. The patient says,
"Nothing is wrong with me except a stubborn chest cold." The spouse reports
the patient smokes and coughs a lot, has lost 15 pounds, and is easily
fatigued. Which defense mechanism is the patient using?
a. Regression
b. Displacement
c. Denial
d. Projection
ANS: D
The nurse should suspect that the client has exhibited signs/symptoms of a
panic disorder. The priority nursing diagnosis should be anxiety. Panic
disorder is characterized by recurrent, sudden onset panic attacks in which
the person feels intense fear, apprehension, or terror. correct answers 8) A
cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic,
tachycardia and dyspneic. A workup in an emergency department reveals
no pathology. Which medical diagnosis should a nurse suspect, and what
nursing diagnosis should be the nurse's first priority?
1. Generalized anxiety disorder and a nursing diagnosis of fear
2. Altered sensory perception and a nursing diagnosis of panic disorder
3. Pain disorder and a nursing diagnosis of altered role performance
4. Panic disorder and a nursing diagnosis of anxiety
hypertensive crisis correct answers 9) The nurse is providing health
teaching for a patient who has been prescribed Phenelzine (Nardil) for
depression and provides a written list of foods that should not be eaten
while taking this medication. What is the potential problem if the patient is
not compliant with these dietary restrictions?
Aged meats or aged cheeses, protein extracts, sour cream, alcohol,
anchovies, liver, sausages, overripe figs, bananas, avocados, chocolate,
soy sauce, bean curd, natural yogurt, fava beans—tyramine-containing
foods—may precipitate hypertensive crisis. Avoid chocolate or caffeine.
Herbal: Ginseng, ephedra, ma huang, St. John's wort may cause
hypertensive crisis. correct answers foods with tyramine in it
cheese, sour cream, wine, beer, figs, anchovies, shrimp, bananas, and
chocolate, and avoid drugs (e.g., TCAs). correct answers For depression
that is refractory to TCAs. Avoid certain foods such as
WITH CORRECT ANSWERS 2025
-A neologism is a newly coined word having special meaning to the patient.
"Volmer" is not a known common noun.
- Concrete thinking refers to the inability to think abstractly.
- Thought insertion refers to thoughts of others that are implanted in one's
mind.
-An idea of reference is a type of delusion in which trivial events are given
personal significance. correct answers 1) A patient with
schizophrenia begins to talks about "volmers" hiding in the warehouse at
work. The term "volmers" should be documented as:
a. neologism
b. concrete thinking
c. thought insertion
d. idea of reference
ANS: A, B, F
One-on-one observation is necessary for anyone who has limited control
over suicidal impulses.
- Plastic dishes on trays and the removal of potentially harmful objects from
the patient's possession are measures included in any-level suicide
precautions.
The remaining options are used in less stringent levels of suicide
precautions.
correct answers 2) A
patient with suicidal impulses is placed on the highest level of suicide
precautions. Which measures should be incorporated into the plan of care by
the nurse caring for the patient? (More than one answer is correct.)
e. Maintain arm's-length, one-on-one nursing observation around the clock.
f. Allow no glass or metal on meal trays.
g.Keep patient within visual range while awake. Check every 15 to 30
minutes while the patient is sleeping.
h. Check the patient's whereabouts every 15 minutes and make frequent
verbal
contacts.
e. Check whereabouts every hour. Make verbal contact at least three times
each shift.
f. Remove all potentially harmful objects from the patient's possession.
ANS: D
,The patient is describing phenomena that indicate personal boundary
difficulties. The nurse should maintain an appropriate social distance and not
touch the patient, because the patient is anxious about the inability to
maintain ego boundaries and merging with or being swallowed by the
environment. Physical closeness or touch could precipitate panic.
correct answers 3) A patient diagnosed with schizophrenia anxiously
says, "I can see the left side of my body merging with the wall, then my face
appears and disappears in the mirror." While listening, the nurse should:
a. sit close to the patient.
b. place an arm protectively around the patient's shoulders.
c. place a hand on the patient's arm and exert light pressure.
d. maintain a normal social interaction distance from the patient.
During an acute phase of major depression, the client may feel worthless
and deserve bad things to happen personally. correct answers 4) Which
statement indicates a patient with major depression is most likely outlook on
life during the acute phase of the illness?
ANS: B
Patients diagnosed with bipolar disorder may be maintained on lithium
indefinitely to prevent recurrences. Helping the patient understand this need
will promote medication compliance. correct answers 5) A patient
diagnosed with bipolar disorder is in the maintenance phase of treatment.
The patient asks, "Do I have to keep taking this lithium even though my
mood is stable now?" Select the nurse's appropriate response.
e. "You will be able to stop the medication in about 1 month."
f. "Taking the medication every day helps reduce the risk of a relapse."
g. "Usually patients take medication for approximately 6 months after
discharge."
h. "It's unusual that the health care provider hasn't already stopped your
medication."
ANS: B
Resist focusing on content; instead, focus on the feelings the patient is
expressing. This strategy prevents arguing about the reality of delusional
beliefs. Such arguments increase patient anxiety and the tenacity with which
the patient holds to the delusion.
The other options focus on content and provide opportunity for argument.
correct answers 6) A
person has had difficulty keeping a job because of arguing with co- workers
and accusing them of conspiracy. Today the person shouts, "They're all
plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic
response.
i. "Everyone here is trying to help you. No one wants to harm you."
j. "Feeling that people want to destroy you must be very frightening."
k. "That is not true. People here are trying to help you if you will let them."
l. "Staff members are health care professionals who are qualified to help
you."
, ANS: C
Denial is an unconscious blocking of threatening or painful information or
feelings. Regression involves using behaviors appropriate at an earlier stage
of psychosexual development. Displacement shifts feelings to a more neutral
person or object. Projection attributes one's own unacceptable thoughts or
feelings to another correct answers
7) A patient is undergoing a series of diagnostic tests. The patient says,
"Nothing is wrong with me except a stubborn chest cold." The spouse reports
the patient smokes and coughs a lot, has lost 15 pounds, and is easily
fatigued. Which defense mechanism is the patient using?
a. Regression
b. Displacement
c. Denial
d. Projection
ANS: D
The nurse should suspect that the client has exhibited signs/symptoms of a
panic disorder. The priority nursing diagnosis should be anxiety. Panic
disorder is characterized by recurrent, sudden onset panic attacks in which
the person feels intense fear, apprehension, or terror. correct answers 8) A
cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic,
tachycardia and dyspneic. A workup in an emergency department reveals
no pathology. Which medical diagnosis should a nurse suspect, and what
nursing diagnosis should be the nurse's first priority?
1. Generalized anxiety disorder and a nursing diagnosis of fear
2. Altered sensory perception and a nursing diagnosis of panic disorder
3. Pain disorder and a nursing diagnosis of altered role performance
4. Panic disorder and a nursing diagnosis of anxiety
hypertensive crisis correct answers 9) The nurse is providing health
teaching for a patient who has been prescribed Phenelzine (Nardil) for
depression and provides a written list of foods that should not be eaten
while taking this medication. What is the potential problem if the patient is
not compliant with these dietary restrictions?
Aged meats or aged cheeses, protein extracts, sour cream, alcohol,
anchovies, liver, sausages, overripe figs, bananas, avocados, chocolate,
soy sauce, bean curd, natural yogurt, fava beans—tyramine-containing
foods—may precipitate hypertensive crisis. Avoid chocolate or caffeine.
Herbal: Ginseng, ephedra, ma huang, St. John's wort may cause
hypertensive crisis. correct answers foods with tyramine in it
cheese, sour cream, wine, beer, figs, anchovies, shrimp, bananas, and
chocolate, and avoid drugs (e.g., TCAs). correct answers For depression
that is refractory to TCAs. Avoid certain foods such as
