MENTAL HEALTH EXAM #2 -
RASMUSSEN WITH CORRECT
ANSWERS 2025
Immature correct
defenses answers
Beck's Cognitive Triad correct answers o Beck proposed that people
acquire a psychological predisposition to depression through early life
experiences
o Three autonomic (uncontrollable and repetitive) negative thoughts
(triad) are
responsible for development of depression
Three autonomic (uncontrollable and repetitive) negative thoughts
(triad) are responsible for development of depression correct
answers ▪ Negative, self- deprecating
view of self
• "I really never do anything well; everyone else seems smarter."
▪ Pessimistic view of the world
• "Once you're down, you can't get up." • "Bad things everywhere you
look."
Belief
Risk
▪ for that negative reinforcement
suicide; (no validation
correct answers for the self) will
▪ SADPERSONS
continue
Questions scale
••S-
"Itsex-
doesn't
1 malematter what you do, nothing will get better."
••D-
"I'll
A- be at
age- 1 ifthis
<19stupid
or job for the
depression/hopelessness- 2 rest of my life."
• P-
>45 previous attempts/psychiatric care- 1
• E- excessive alcohol or drug use- 1
• R- rational thinking loss (psychotic or organic illness- 1
• S- separated/widowed/divorced- 1
• O- organized plan or serious attempt- 2
• N- no social support- 1
• S- stated future intent- 1
• Guidelines
o 0-5: may be safe to discharge- discharge with family or
friend
o 6-8: probably requires psych consult
o >8: probably requires hospital admission, voluntary or
Overt statements- RISK FOR
involuntary correct answers • I can't take it
SUICIDE anymore
• Life isn't worth living anymore
• I wish I were dead
,• Everyone would be better off if I were
dead
Covert statements- RISK FOR correct answers • It's okay now.
SUICIDE will be fine Everything
• Things will never work out
• I won't be a problem much longer
• Nothing feels good to me anymore and probably
never will
• How can I give my body to medical science?
Behaviors: RISK FOR SUICIDE correct ▪ Giving away
answers possessions
▪ Writing farewell notes
▪ Making out a will
▪ Putting personal affairs in order
▪ Sudden improvements
Having global insomniain mood after being depressed or
withdrawn
▪ Neglecting personal hygiene
Protective factors from suicide: correct answers • Ability to cope with
Internal stress
• Religious beliefs
• Frustration tolerance
Protective factors from suicide: correct • Responsibility to
External or beloved pets answers children
• Positive therapeutic relationships
• Social supports
What do you inquire about Suicide correct answers ▪ Ideation:
frequency, intensity, duration
▪ Plan: timing, location, lethality, availability, prep acts
▪ Behavior: past attempts, aborted attempts, rehearsals, non-suicidal self-
injury
▪ Intent: extent to which patient expects to carry out plan and believes
that plan to be lethal
▪ Explore ambivalence: reasons to die vs. reasons to live
NURSING DIAGNOSIS: Risk for suicide; risk for self-mutilation
correct answers ▪ Previous
suicide attempts, putting affairs in order, giving away prized possessions,
suicidal ideation, overt or covert statements regarding killing self, feelings
of worthlessness, hopelessness, helplessness
NURSING DIAGNOSIS: Decisional conflict, impaired memory, acute
confusion
correct answers Lack of judgement, memory difficulty, poor concentration,
inaccurate interpretation of environment, negative ruminations, cognitive
distortions
NURSING DIAGNOSIS:Ineffective coping, interrupted family process, risk for
impaired parent/infant/child attachment, ineffective role performance
correct answers ▪
, Difficulty with simple tasks, inability to function at previous level, poor
problem solving, poor cognitive functioning, verbalizations of inability to
cope
NURSING DIAGNOSIS:Decisional conflict, ineffective role performance
correct answers ▪
Difficulty making decisions, poor concentration, inability to take action
NURSING DIAGNOSIS: hopelessness correct answers ▪ Feelings of
helplessness, hopelessness, powerlessness
Nutritional INTERVENTIONS correct answers ▪ Offer small, high calorie,
and high protein snack frequently throughout the day and evening
• More easily tolerated
▪ Offer high protein and high calorie fluids frequently throughout the day
and evening
• Prevent dehydration and minimize constipation
▪ When possible, encourage family and friends to remain with patient
during meals
•Reinforces idea that someone cares, can raise patient's self-
esteem, serve as incentive to eat
▪ Ask patients which foods or drinks he/she likes. Offer choices,
involve dietician
• Patient is more likely to eat foods provided
▪ Weigh patient weekly and observe eating patterns
• Monitoring gives information needed for revision of the intervention
Sleep-insomnia INTERVENTIONS correct answers ▪ Provide periods of rest
after activities
• Fatigue can intensify feelings of depression
▪ Encourage patient to get up and dress and to stay out of bed during the
day
• Minimizing sleep during the day increases the likelihood of sleep at night
▪ Encourage use of relaxation measures in evening
• Induce relaxation and sleep
▪ Reduce environmental and physical stimulants- decaf coffee, soft /music
• Increases possibility of sleep
SSRI (MOST
Self-care POPULAR)
deficits correct answers
INTERVENTIONS correct Citalopram
answers ▪ Encourage use
escitalopram
of toothbrush, washcloth,(Celexa)
soap, makeup, shaving equipment, and
(Lexapro)
so forth fluoxetine
(Prozac)
• Being clean and well-groomed can temporarily increase self-
fluvoxamine
esteem (Luvox)
paroxetine
▪ (Paxil)
Give step by step reminders where appropriate
sertraline (Zoloft) and difficulty concentrating make organizing
• Slowed thinking
simple tasks difficult
RASMUSSEN WITH CORRECT
ANSWERS 2025
Immature correct
defenses answers
Beck's Cognitive Triad correct answers o Beck proposed that people
acquire a psychological predisposition to depression through early life
experiences
o Three autonomic (uncontrollable and repetitive) negative thoughts
(triad) are
responsible for development of depression
Three autonomic (uncontrollable and repetitive) negative thoughts
(triad) are responsible for development of depression correct
answers ▪ Negative, self- deprecating
view of self
• "I really never do anything well; everyone else seems smarter."
▪ Pessimistic view of the world
• "Once you're down, you can't get up." • "Bad things everywhere you
look."
Belief
Risk
▪ for that negative reinforcement
suicide; (no validation
correct answers for the self) will
▪ SADPERSONS
continue
Questions scale
••S-
"Itsex-
doesn't
1 malematter what you do, nothing will get better."
••D-
"I'll
A- be at
age- 1 ifthis
<19stupid
or job for the
depression/hopelessness- 2 rest of my life."
• P-
>45 previous attempts/psychiatric care- 1
• E- excessive alcohol or drug use- 1
• R- rational thinking loss (psychotic or organic illness- 1
• S- separated/widowed/divorced- 1
• O- organized plan or serious attempt- 2
• N- no social support- 1
• S- stated future intent- 1
• Guidelines
o 0-5: may be safe to discharge- discharge with family or
friend
o 6-8: probably requires psych consult
o >8: probably requires hospital admission, voluntary or
Overt statements- RISK FOR
involuntary correct answers • I can't take it
SUICIDE anymore
• Life isn't worth living anymore
• I wish I were dead
,• Everyone would be better off if I were
dead
Covert statements- RISK FOR correct answers • It's okay now.
SUICIDE will be fine Everything
• Things will never work out
• I won't be a problem much longer
• Nothing feels good to me anymore and probably
never will
• How can I give my body to medical science?
Behaviors: RISK FOR SUICIDE correct ▪ Giving away
answers possessions
▪ Writing farewell notes
▪ Making out a will
▪ Putting personal affairs in order
▪ Sudden improvements
Having global insomniain mood after being depressed or
withdrawn
▪ Neglecting personal hygiene
Protective factors from suicide: correct answers • Ability to cope with
Internal stress
• Religious beliefs
• Frustration tolerance
Protective factors from suicide: correct • Responsibility to
External or beloved pets answers children
• Positive therapeutic relationships
• Social supports
What do you inquire about Suicide correct answers ▪ Ideation:
frequency, intensity, duration
▪ Plan: timing, location, lethality, availability, prep acts
▪ Behavior: past attempts, aborted attempts, rehearsals, non-suicidal self-
injury
▪ Intent: extent to which patient expects to carry out plan and believes
that plan to be lethal
▪ Explore ambivalence: reasons to die vs. reasons to live
NURSING DIAGNOSIS: Risk for suicide; risk for self-mutilation
correct answers ▪ Previous
suicide attempts, putting affairs in order, giving away prized possessions,
suicidal ideation, overt or covert statements regarding killing self, feelings
of worthlessness, hopelessness, helplessness
NURSING DIAGNOSIS: Decisional conflict, impaired memory, acute
confusion
correct answers Lack of judgement, memory difficulty, poor concentration,
inaccurate interpretation of environment, negative ruminations, cognitive
distortions
NURSING DIAGNOSIS:Ineffective coping, interrupted family process, risk for
impaired parent/infant/child attachment, ineffective role performance
correct answers ▪
, Difficulty with simple tasks, inability to function at previous level, poor
problem solving, poor cognitive functioning, verbalizations of inability to
cope
NURSING DIAGNOSIS:Decisional conflict, ineffective role performance
correct answers ▪
Difficulty making decisions, poor concentration, inability to take action
NURSING DIAGNOSIS: hopelessness correct answers ▪ Feelings of
helplessness, hopelessness, powerlessness
Nutritional INTERVENTIONS correct answers ▪ Offer small, high calorie,
and high protein snack frequently throughout the day and evening
• More easily tolerated
▪ Offer high protein and high calorie fluids frequently throughout the day
and evening
• Prevent dehydration and minimize constipation
▪ When possible, encourage family and friends to remain with patient
during meals
•Reinforces idea that someone cares, can raise patient's self-
esteem, serve as incentive to eat
▪ Ask patients which foods or drinks he/she likes. Offer choices,
involve dietician
• Patient is more likely to eat foods provided
▪ Weigh patient weekly and observe eating patterns
• Monitoring gives information needed for revision of the intervention
Sleep-insomnia INTERVENTIONS correct answers ▪ Provide periods of rest
after activities
• Fatigue can intensify feelings of depression
▪ Encourage patient to get up and dress and to stay out of bed during the
day
• Minimizing sleep during the day increases the likelihood of sleep at night
▪ Encourage use of relaxation measures in evening
• Induce relaxation and sleep
▪ Reduce environmental and physical stimulants- decaf coffee, soft /music
• Increases possibility of sleep
SSRI (MOST
Self-care POPULAR)
deficits correct answers
INTERVENTIONS correct Citalopram
answers ▪ Encourage use
escitalopram
of toothbrush, washcloth,(Celexa)
soap, makeup, shaving equipment, and
(Lexapro)
so forth fluoxetine
(Prozac)
• Being clean and well-groomed can temporarily increase self-
fluvoxamine
esteem (Luvox)
paroxetine
▪ (Paxil)
Give step by step reminders where appropriate
sertraline (Zoloft) and difficulty concentrating make organizing
• Slowed thinking
simple tasks difficult
