Focus on Mental Health Exam Questions
& Answers
A nurse overhears a hospitalized client with mania telling another client, "I'm actually a
journalist writing an article for a magazine — I'm just posing as a person with mental illness."
How should the nurse respond? - ANSWERSPresenting the client with the actual situation
Rationale: When dealing with a delusional client, it is important for the nurse to state clearly
that the nurse does not share the client's perceptions. All three of the other options — ignoring
the delusion, taking the client to a quiet room, and supporting the client's denial of illness — do
not focus on reality, and they ignore the issue. Presenting the client with the actual situation
helps orient the client to reality.
A client who is hallucinating fearfully says to the nurse, "Please tell that demon to get out." How
should the nurse respond to the client? - ANSWERS"I know you must be very upset by this, but I
don't see a demon."
Rationale: If the client hallucinates, it is best to provide reality-based perceptions and not
negate the client's experience, because this may lead to a regressive struggle with the client.
Giving advice or false reassurance is incorrect because such techniques indicate that demons
actually are present, which feeds into the client's hallucination and reinforces the client's
behavior.
The mother of a 3-year-old says, "My child hit his teddy bear after being scolded for picking the
neighbors' flowers." Which defense mechanism was the child using? - ANSWERSDisplacement
Rationale: The defense mechanism of displacement involves the discharge of intense feelings
for one person onto a less threatening substitute person or object to satisfy an impulse.
Projection involves attributing an attitude, behavior, or impulse to someone else, such as that
,which occurs in blaming or scapegoating. Sublimation is rechanneling an impulse into a more
socially acceptable object. Identification involves modeling behavior after someone else's.
A client says to the nurse, "Even though my husband and I keep telling them we don't want to
have children, our parents are pressuring us to 'start a family.' What should we say to them?"
Which of the following responses by the nurse is therapeutic? - ANSWERS"This must be very
difficult for both of you."
Rationale: Childless families may elect not to have children or to postpone having them until
they have established themselves occupationally or financially. Telling the client to tell the
parents that the couple can't have children is incorrect because the client is being encouraged
to lie about life decisions rather than helping the parents understand the couple's choices.
Asking how they usually cope with such interference is incorrect because it indicates that the
nurse is judgmental and has decided that the parents are interfering with the client and spouse.
Saying, "Tell them to have more children if they want them so badly," is incorrect because it is
sarcastic and ridicules the situation over which the client has expressed concerns.
A young adult client says, "I just can't seem to stop snapping at my parents. I know they work
hard to support me, but what do I do when they're so overbearing?" Which responses by the
nurse is therapeutic? - ANSWERS"Have you talked to your parents about your frustrations?"
Rationale: The correct response is focused on the client's concerns and encourages the
therapeutic technique of formulating a plan of action. "It's important not to be rude to your
parents" and "You need to be more patient with your parents" are both nontherapeutic,
judgmental responses that do not encourage the client to further explore her feelings and
problem-solve. "Snapping at your parents is childish. How could you?" is incorrect because it is
sarcastic and condescending, which is nontherapeutic.
A client says, "I have so much trouble caring for my husband's child from his first marriage. I
resent the money we have to pay for child support because we have to deprive my own child of
things. How can I stop feeling this way?" Which response by the nurse is therapeutic? -
ANSWERS"Have you shared your feelings with your husband?"
,Rationale: Remarried individuals often encounter problems as a result of the stressors they
bring into a marriage without prior discussion with the new partner. Bonding sometimes does
always occur when a child is not one's biological offspring. The correct answer is focused on the
client's feelings. "Your child benefits from having a sibling" is not facilitative. "I wonder why you
married him, knowing that he wouldn't desert his biological child" is incorrect because it
prejudges the client. "You need to take a second job to give your child what you think she
deserves" is not open ended, does not facilitate feelings, and gives advice.
A client says to the nurse, "My wife retired last year from a lucrative law practice, and I'm really
discouraged. I'll be working until I die, even though I helped pay for her education." Which
response by the nurse is supportive? - ANSWERS"You sound very troubled by this."
Rationale: Saying that the situation is unfair is judgmental and does not encourage the client to
express his feelings; nor does "That's such a tough break for you." Suggesting that the husband
approach the spouse for help is incorrect because it prematurely gives advice, a nontherapeutic
communication technique. The correct option is focused on the client's feelings.
A gay man is brought to the emergency department by the police. The client tells the nurse, "I
was beaten up. I guess I just have to expect this kind of treatment for the rest of my life." Which
statement by the nurse is therapeutic? - ANSWERS"You feel that being beaten up goes along
with being gay?"
Rationale: Many lesbians and gays encounter harassment or violence in the course of their lives.
"I think you should take some self-defense classes" is incorrect because it advises the client, and
giving advice is not therapeutic. "Maybe you should be more discreet when you're in public"
also gives advice and presumes that the client has been indiscreet. "Why not try counseling to
change your sexual orientation?" is incorrect because it assumes that sexual orientation can or
should be changed. The correct option indicates reflection and is focused on the client's
feelings.
A client whose spouse recently died is experiencing dysfunctional grieving. Which intervention
has priority in the plan of care? - ANSWERSAssessing the client's risk for violence toward self
and others
, Rationale: The priority intervention for a client with dysfunctional grieving is assessment of the
client's risk for violence toward self and others. Although the nurse will assist the client in
resolving the grief and monitor the client's sleep pattern, these are not the priority
interventions of the options given. Obtaining a prescription for an antidepressant is not a
priority.
A nurse develops a plan of care for a client in whom AIDS was recently diagnosed. The client is
experiencing difficulty adjusting to the illness. Which interventions are appropriate for this
client? Select all that apply. - ANSWERSAssisting the client in verbalizing fears
Helping the client identify sources of hope
Monitoring the client for signs of self-harm
Assisting the client with problem-solving and decision-making
Rationale: Assisting the client with problem-solving and decision-making, helping the client
verbalize fears, helping the client identify sources of hope, and monitoring the client for signs of
self-harm are all appropriate interventions. In planning care for a client having difficulty
adjusting to an illness, the nurse develops interventions to promote social networking that will
provide needed support and information to the client.
An emergency department nurse is caring for an older client who is a victim of physical abuse.
List in order of priority the following nursing actions, with number 1 representing the first action
and number 4 the last. - ANSWERS1. Checking the client for physical injuries
2. Contacting the appropriate state officials to report the abuse
3. Contacting a social worker to assist in planning care for the client
4. Calling a member of the clergy to address the client's spiritual needs
Rationale: The priority intervention in the event of physical abuse is to check the client for
physical injuries. The nurse should then fulfill the legal obligation of reporting suspected elder
abuse. The next action is to contact the social worker to obtain assistance in planning care for
& Answers
A nurse overhears a hospitalized client with mania telling another client, "I'm actually a
journalist writing an article for a magazine — I'm just posing as a person with mental illness."
How should the nurse respond? - ANSWERSPresenting the client with the actual situation
Rationale: When dealing with a delusional client, it is important for the nurse to state clearly
that the nurse does not share the client's perceptions. All three of the other options — ignoring
the delusion, taking the client to a quiet room, and supporting the client's denial of illness — do
not focus on reality, and they ignore the issue. Presenting the client with the actual situation
helps orient the client to reality.
A client who is hallucinating fearfully says to the nurse, "Please tell that demon to get out." How
should the nurse respond to the client? - ANSWERS"I know you must be very upset by this, but I
don't see a demon."
Rationale: If the client hallucinates, it is best to provide reality-based perceptions and not
negate the client's experience, because this may lead to a regressive struggle with the client.
Giving advice or false reassurance is incorrect because such techniques indicate that demons
actually are present, which feeds into the client's hallucination and reinforces the client's
behavior.
The mother of a 3-year-old says, "My child hit his teddy bear after being scolded for picking the
neighbors' flowers." Which defense mechanism was the child using? - ANSWERSDisplacement
Rationale: The defense mechanism of displacement involves the discharge of intense feelings
for one person onto a less threatening substitute person or object to satisfy an impulse.
Projection involves attributing an attitude, behavior, or impulse to someone else, such as that
,which occurs in blaming or scapegoating. Sublimation is rechanneling an impulse into a more
socially acceptable object. Identification involves modeling behavior after someone else's.
A client says to the nurse, "Even though my husband and I keep telling them we don't want to
have children, our parents are pressuring us to 'start a family.' What should we say to them?"
Which of the following responses by the nurse is therapeutic? - ANSWERS"This must be very
difficult for both of you."
Rationale: Childless families may elect not to have children or to postpone having them until
they have established themselves occupationally or financially. Telling the client to tell the
parents that the couple can't have children is incorrect because the client is being encouraged
to lie about life decisions rather than helping the parents understand the couple's choices.
Asking how they usually cope with such interference is incorrect because it indicates that the
nurse is judgmental and has decided that the parents are interfering with the client and spouse.
Saying, "Tell them to have more children if they want them so badly," is incorrect because it is
sarcastic and ridicules the situation over which the client has expressed concerns.
A young adult client says, "I just can't seem to stop snapping at my parents. I know they work
hard to support me, but what do I do when they're so overbearing?" Which responses by the
nurse is therapeutic? - ANSWERS"Have you talked to your parents about your frustrations?"
Rationale: The correct response is focused on the client's concerns and encourages the
therapeutic technique of formulating a plan of action. "It's important not to be rude to your
parents" and "You need to be more patient with your parents" are both nontherapeutic,
judgmental responses that do not encourage the client to further explore her feelings and
problem-solve. "Snapping at your parents is childish. How could you?" is incorrect because it is
sarcastic and condescending, which is nontherapeutic.
A client says, "I have so much trouble caring for my husband's child from his first marriage. I
resent the money we have to pay for child support because we have to deprive my own child of
things. How can I stop feeling this way?" Which response by the nurse is therapeutic? -
ANSWERS"Have you shared your feelings with your husband?"
,Rationale: Remarried individuals often encounter problems as a result of the stressors they
bring into a marriage without prior discussion with the new partner. Bonding sometimes does
always occur when a child is not one's biological offspring. The correct answer is focused on the
client's feelings. "Your child benefits from having a sibling" is not facilitative. "I wonder why you
married him, knowing that he wouldn't desert his biological child" is incorrect because it
prejudges the client. "You need to take a second job to give your child what you think she
deserves" is not open ended, does not facilitate feelings, and gives advice.
A client says to the nurse, "My wife retired last year from a lucrative law practice, and I'm really
discouraged. I'll be working until I die, even though I helped pay for her education." Which
response by the nurse is supportive? - ANSWERS"You sound very troubled by this."
Rationale: Saying that the situation is unfair is judgmental and does not encourage the client to
express his feelings; nor does "That's such a tough break for you." Suggesting that the husband
approach the spouse for help is incorrect because it prematurely gives advice, a nontherapeutic
communication technique. The correct option is focused on the client's feelings.
A gay man is brought to the emergency department by the police. The client tells the nurse, "I
was beaten up. I guess I just have to expect this kind of treatment for the rest of my life." Which
statement by the nurse is therapeutic? - ANSWERS"You feel that being beaten up goes along
with being gay?"
Rationale: Many lesbians and gays encounter harassment or violence in the course of their lives.
"I think you should take some self-defense classes" is incorrect because it advises the client, and
giving advice is not therapeutic. "Maybe you should be more discreet when you're in public"
also gives advice and presumes that the client has been indiscreet. "Why not try counseling to
change your sexual orientation?" is incorrect because it assumes that sexual orientation can or
should be changed. The correct option indicates reflection and is focused on the client's
feelings.
A client whose spouse recently died is experiencing dysfunctional grieving. Which intervention
has priority in the plan of care? - ANSWERSAssessing the client's risk for violence toward self
and others
, Rationale: The priority intervention for a client with dysfunctional grieving is assessment of the
client's risk for violence toward self and others. Although the nurse will assist the client in
resolving the grief and monitor the client's sleep pattern, these are not the priority
interventions of the options given. Obtaining a prescription for an antidepressant is not a
priority.
A nurse develops a plan of care for a client in whom AIDS was recently diagnosed. The client is
experiencing difficulty adjusting to the illness. Which interventions are appropriate for this
client? Select all that apply. - ANSWERSAssisting the client in verbalizing fears
Helping the client identify sources of hope
Monitoring the client for signs of self-harm
Assisting the client with problem-solving and decision-making
Rationale: Assisting the client with problem-solving and decision-making, helping the client
verbalize fears, helping the client identify sources of hope, and monitoring the client for signs of
self-harm are all appropriate interventions. In planning care for a client having difficulty
adjusting to an illness, the nurse develops interventions to promote social networking that will
provide needed support and information to the client.
An emergency department nurse is caring for an older client who is a victim of physical abuse.
List in order of priority the following nursing actions, with number 1 representing the first action
and number 4 the last. - ANSWERS1. Checking the client for physical injuries
2. Contacting the appropriate state officials to report the abuse
3. Contacting a social worker to assist in planning care for the client
4. Calling a member of the clergy to address the client's spiritual needs
Rationale: The priority intervention in the event of physical abuse is to check the client for
physical injuries. The nurse should then fulfill the legal obligation of reporting suspected elder
abuse. The next action is to contact the social worker to obtain assistance in planning care for
