Focus on Mental Health Exam
Questions and Answers (complete
solution).
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? |- |ANS |-Presenting |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? |- |ANS |-"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? |- |ANS |-Displacement
,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? |- |ANS |-"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? |- |ANS |-"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? |- |
ANS |-"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? |- |ANS |-"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? |- |ANS |-"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? |- |ANS |-Assessing |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. |- |ANS |-Assisting |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. |- |ANS |-1. |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
Questions and Answers (complete
solution).
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? |- |ANS |-Presenting |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? |- |ANS |-"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? |- |ANS |-Displacement
,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? |- |ANS |-"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? |- |ANS |-"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? |- |
ANS |-"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? |- |ANS |-"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? |- |ANS |-"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? |- |ANS |-Assessing |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. |- |ANS |-Assisting |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. |- |ANS |-1. |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
