Focus on Mental Health Exam 2025
With Questions and Answers 100%
Pass 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? -
ANSWER>>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? -
ANSWER>>"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? - ANSWER>>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? - ANSWER>>"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? -
ANSWER>>"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? -
ANSWER>>"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?
- ANSWER>>"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? - ANSWER>>"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? - ANSWER>>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. -
ANSWER>>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.
With Questions and Answers 100%
Pass 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? -
ANSWER>>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? -
ANSWER>>"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? - ANSWER>>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? - ANSWER>>"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? -
ANSWER>>"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? -
ANSWER>>"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?
- ANSWER>>"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? - ANSWER>>"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? - ANSWER>>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. -
ANSWER>>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.
