HESI Module 3 Mental Health Concepts
A nurse is caring for a patient whose spouse has died. How does the nurse determine that a
client who has lost a spouse has successfully completed the tasks of mourning? Select all that
apply.
A. Heard explaining to family that illness “took” her husband
B. Purchasing a smaller car she is comfortable driving
C. Placing a picture of her husband on the bedside stand
D. Reporting that sleeping alone is so hard now
E. Relating that “its better he went first”
A. Heard explaining to family that illness “took” her husband
B. Purchasing a smaller car she is comfortable driving
C. Placing a picture of her husband on the bedside stand
D. Reporting that sleeping alone is so hard now
Rationale: The tasks of mourning have been identified as accepting the reality of the loss;
experiencing the pain of grief; adjusting to life without the lost one; and relocating and
memorializing the loved one. It is not necessary to find a positive aspect to the loss in order to
deal with the loss in a psychologically healthy manner. Therefore relating that “its better he went
first” is incorrect.
A client who is an alcoholic, and has been sober for 8 months asks the nurse, "Do you think I
should add individual therapy to my treatment plan?" Which response by the nurse would be
therapeutic?
A. "Okay, what's going on with you? You had to be coerced into treatment, but now you seem to
want the full monty."
,B. "The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals
vary, though, and it may be that you are asking because you feel ready to work on your issues."
C. "Are you feeling that you're vulnerable to a slip? If not, why complicate treatment further?"
D. "What do you think? What is the individual therapy all about?"
B. “The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals
vary, though, and it may be that you are asking because you feel ready to work on your issues.”
Rationale: The appropriate response is the one that provides information to the client about
individual therapy. In asking, “What do you think? What is the individual therapy all about?” the
nurse makes a sincere query without doubting and probing but does not provide any information
to the client, which is not helpful. In asking, “Are you feeling like you are still very vulnerable to a
slip? If not, why complicate treatment further?” the nurse is challenging the client. In asking,
“Okay, what’s going on with you? You had to be coerced into treatment, but now you seem to
want the full monty,” the nurse questions and is aggressive to the client, using an accusatory
style of expressing doubt.
A client says to the nurse, "My doctor says he thinks I'm ready to taper off my pain medication,
but the new painkiller he prescribed doesn't relieve my pain the way the other pill did. I get pain
when I try to do things." Which nursing response would be most supportive to the client?
A. "Your health care provider feels that your body is physically ready to make the change in
medication."
B. "Well, your health care provider is concerned that you will become physically dependent on
the first painkiller."
C. "Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the
medicine will be more effective."
D. "I think you need to listen to your health care provider when it comes to taking such strong
medication."
C. “Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the
medicine will be more effective.”
Rationale: The most supportive response is the one that addresses the client’s concern and
provides a plan that will help minimize the client’s pain. If this nursing measure does not afford
pain relief, then the nurse can report the client’s continued pain to the health care provider. In
stating, “Your health care provider feels that your body is physically ready to make the change in
medication,” the nurse is shifting attention from the client’s feelings to the health care provider’s
,view. In telling the client that he or she needs to listen to the health care provider, the nurse is
nontherapeutically giving advice and patronizing the client. Stating, “Well, your doctor is
concerned that you will become physically dependent on the first painkiller” is a defensive
response, and the nurse’s assertion about dependence may not be based on fact.
The client is the wife of a former workaholic who now has not worked in years, refusing to get a
job or help with chores around the house. The man watches television and snacks all day. The
client tells the nurse that her husband now weighs more than 300 lb (136 kg) and expects her to
support him. The client states, "I keep saying everything will be fine. It will be if he keeps up
these bad health habits, because they'll kill him, and then I would be free and wouldn't have to
deal with his obnoxious behavior." Which negative stress response does the nurse recognize in
the client's behavior?
A. Wishful thinking
B. Daydreaming
C. Problem- solving
D. Blaming
A. Wishful thinking
Rationale: Wishful thinking, a negative stress response, involves the belief that everything will
work out and resolve itself. Blaming involves placing the reason for a particular occurrence on
another person or object. Daydreaming is thinking but not necessarily verbalizing.
Problem-solving involves the use of a systematic plan to work through problems.
The mother of a 3-year-old child tells the nurse that her child hit her doll after the mother
scolded her for picking the neighbors' flowers. Which defense mechanism used by the child
does the nurse identify in the mother's report?
A. Sublimation
B. Identification
C. Projection
D. Displacement
D. Displacement
Rationale: The defense mechanism of displacement involves the discharge of intense feelings
for one person onto a substitute person or object that is less threatening to satisfy an impulse.
Projection involves attributing an attitude, behavior, or impulse, such as that which occurs in
blaming or scapegoating, to someone else. Sublimation is the act of rechanneling an impulse
into a more socially acceptable object. Identification involves modeling behavior after someone
else's.
, We have an expert-written solution to this problem!
A client's son and daughter were killed during a fellow student's murderous rampage at their
high school 9 months ago. The client says to the nurse, "My wife and I just feel empty and
exhausted. I can't believe that I had a vasectomy after our son and daughter were born because
we wanted to give them both whatever they needed. We have college funds for both of them
that they'll never use now." The nurse should make which appropriate statement to the client?
A. "My parents would be devastated if they lost me and my sister, too. How can I be of service
to you?"
B. "Your loss touches me so. How truly devastated you both must be. Can you share what
things you have been doing to grieve?"
C. "Your feelings are appropriate for the extent of your loss and how your children's deaths
happened."
D. "Your loss is incalculable. Perhaps you could consider some ways in which to commemorate
their lives for you and in your community."
B. “Your loss touches me so. How truly devastated you both must be. Can you share what
things you have been doing to grieve?”
Rationale: The parents in this question have experienced a truly devastating loss. Although
there are no set strategies for this situation, certain actions are important. First, the nurse
communicates to the parents that the terrible loss is sad for others and offer empathy. Second,
the nurse gathers data about what has happened to the parents over the 9 months since the
loss. In stating, “My parents would be devastated if they lost me and my sister, too. How can I
be of service to you?” the nurse nontherapeutically uses a social response that personalizes
and shifts the focus from their feelings. In stating, “Your feelings are appropriate for the extent of
your loss and how their deaths happened,” the nurse lectures and moves away from the
parents’ expressed feelings to intellectualize. By stating, “Your loss is incalculable. Perhaps you
could consider some ways in which to commemorate their lives for you and in your community,”
the nurse is empathetic and then begins to try to guide them toward creating a memorial. There
may be a time when the nurse can help the parents reframe what has happened and think of
ways to commemorate their children’s lives, but they have not moved to that level of mourning
yet, probably because of the nature of their children’s deaths.
A 32-year-old married woman who recently gave birth to her first child by cesarean section says,
"My husband and I worry about our baby all the time. We did everything right, yet he had so
many problems at birth." Which statement by the nurse would be therapeutic?
A nurse is caring for a patient whose spouse has died. How does the nurse determine that a
client who has lost a spouse has successfully completed the tasks of mourning? Select all that
apply.
A. Heard explaining to family that illness “took” her husband
B. Purchasing a smaller car she is comfortable driving
C. Placing a picture of her husband on the bedside stand
D. Reporting that sleeping alone is so hard now
E. Relating that “its better he went first”
A. Heard explaining to family that illness “took” her husband
B. Purchasing a smaller car she is comfortable driving
C. Placing a picture of her husband on the bedside stand
D. Reporting that sleeping alone is so hard now
Rationale: The tasks of mourning have been identified as accepting the reality of the loss;
experiencing the pain of grief; adjusting to life without the lost one; and relocating and
memorializing the loved one. It is not necessary to find a positive aspect to the loss in order to
deal with the loss in a psychologically healthy manner. Therefore relating that “its better he went
first” is incorrect.
A client who is an alcoholic, and has been sober for 8 months asks the nurse, "Do you think I
should add individual therapy to my treatment plan?" Which response by the nurse would be
therapeutic?
A. "Okay, what's going on with you? You had to be coerced into treatment, but now you seem to
want the full monty."
,B. "The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals
vary, though, and it may be that you are asking because you feel ready to work on your issues."
C. "Are you feeling that you're vulnerable to a slip? If not, why complicate treatment further?"
D. "What do you think? What is the individual therapy all about?"
B. “The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals
vary, though, and it may be that you are asking because you feel ready to work on your issues.”
Rationale: The appropriate response is the one that provides information to the client about
individual therapy. In asking, “What do you think? What is the individual therapy all about?” the
nurse makes a sincere query without doubting and probing but does not provide any information
to the client, which is not helpful. In asking, “Are you feeling like you are still very vulnerable to a
slip? If not, why complicate treatment further?” the nurse is challenging the client. In asking,
“Okay, what’s going on with you? You had to be coerced into treatment, but now you seem to
want the full monty,” the nurse questions and is aggressive to the client, using an accusatory
style of expressing doubt.
A client says to the nurse, "My doctor says he thinks I'm ready to taper off my pain medication,
but the new painkiller he prescribed doesn't relieve my pain the way the other pill did. I get pain
when I try to do things." Which nursing response would be most supportive to the client?
A. "Your health care provider feels that your body is physically ready to make the change in
medication."
B. "Well, your health care provider is concerned that you will become physically dependent on
the first painkiller."
C. "Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the
medicine will be more effective."
D. "I think you need to listen to your health care provider when it comes to taking such strong
medication."
C. “Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the
medicine will be more effective.”
Rationale: The most supportive response is the one that addresses the client’s concern and
provides a plan that will help minimize the client’s pain. If this nursing measure does not afford
pain relief, then the nurse can report the client’s continued pain to the health care provider. In
stating, “Your health care provider feels that your body is physically ready to make the change in
medication,” the nurse is shifting attention from the client’s feelings to the health care provider’s
,view. In telling the client that he or she needs to listen to the health care provider, the nurse is
nontherapeutically giving advice and patronizing the client. Stating, “Well, your doctor is
concerned that you will become physically dependent on the first painkiller” is a defensive
response, and the nurse’s assertion about dependence may not be based on fact.
The client is the wife of a former workaholic who now has not worked in years, refusing to get a
job or help with chores around the house. The man watches television and snacks all day. The
client tells the nurse that her husband now weighs more than 300 lb (136 kg) and expects her to
support him. The client states, "I keep saying everything will be fine. It will be if he keeps up
these bad health habits, because they'll kill him, and then I would be free and wouldn't have to
deal with his obnoxious behavior." Which negative stress response does the nurse recognize in
the client's behavior?
A. Wishful thinking
B. Daydreaming
C. Problem- solving
D. Blaming
A. Wishful thinking
Rationale: Wishful thinking, a negative stress response, involves the belief that everything will
work out and resolve itself. Blaming involves placing the reason for a particular occurrence on
another person or object. Daydreaming is thinking but not necessarily verbalizing.
Problem-solving involves the use of a systematic plan to work through problems.
The mother of a 3-year-old child tells the nurse that her child hit her doll after the mother
scolded her for picking the neighbors' flowers. Which defense mechanism used by the child
does the nurse identify in the mother's report?
A. Sublimation
B. Identification
C. Projection
D. Displacement
D. Displacement
Rationale: The defense mechanism of displacement involves the discharge of intense feelings
for one person onto a substitute person or object that is less threatening to satisfy an impulse.
Projection involves attributing an attitude, behavior, or impulse, such as that which occurs in
blaming or scapegoating, to someone else. Sublimation is the act of rechanneling an impulse
into a more socially acceptable object. Identification involves modeling behavior after someone
else's.
, We have an expert-written solution to this problem!
A client's son and daughter were killed during a fellow student's murderous rampage at their
high school 9 months ago. The client says to the nurse, "My wife and I just feel empty and
exhausted. I can't believe that I had a vasectomy after our son and daughter were born because
we wanted to give them both whatever they needed. We have college funds for both of them
that they'll never use now." The nurse should make which appropriate statement to the client?
A. "My parents would be devastated if they lost me and my sister, too. How can I be of service
to you?"
B. "Your loss touches me so. How truly devastated you both must be. Can you share what
things you have been doing to grieve?"
C. "Your feelings are appropriate for the extent of your loss and how your children's deaths
happened."
D. "Your loss is incalculable. Perhaps you could consider some ways in which to commemorate
their lives for you and in your community."
B. “Your loss touches me so. How truly devastated you both must be. Can you share what
things you have been doing to grieve?”
Rationale: The parents in this question have experienced a truly devastating loss. Although
there are no set strategies for this situation, certain actions are important. First, the nurse
communicates to the parents that the terrible loss is sad for others and offer empathy. Second,
the nurse gathers data about what has happened to the parents over the 9 months since the
loss. In stating, “My parents would be devastated if they lost me and my sister, too. How can I
be of service to you?” the nurse nontherapeutically uses a social response that personalizes
and shifts the focus from their feelings. In stating, “Your feelings are appropriate for the extent of
your loss and how their deaths happened,” the nurse lectures and moves away from the
parents’ expressed feelings to intellectualize. By stating, “Your loss is incalculable. Perhaps you
could consider some ways in which to commemorate their lives for you and in your community,”
the nurse is empathetic and then begins to try to guide them toward creating a memorial. There
may be a time when the nurse can help the parents reframe what has happened and think of
ways to commemorate their children’s lives, but they have not moved to that level of mourning
yet, probably because of the nature of their children’s deaths.
A 32-year-old married woman who recently gave birth to her first child by cesarean section says,
"My husband and I worry about our baby all the time. We did everything right, yet he had so
many problems at birth." Which statement by the nurse would be therapeutic?
