NUR 101 MODULE 3 EXAM QUESTIONS WITH CORRECT ANSWERS
1. 1.ID: 9477081360
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. Projection Incorrect
B. Sublimation
C. Displacement Correct
D. Identification
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.
Test-Taking Strategy: Note the subject of the question, defense mechanisms. Focusing on the data
in the question and the child’s behavior will direct you to the correct option. Review: these defense
mechanisms
2. 2.ID: 9477084316
A client says to the nurse, “I’ve been following my diet and taking my medication. What else do you
want to talk about today?” Which response would be most helpful during the working phase of the
therapeutic alliance?
A. “Sounds fine to me. Let’s meet again in 6 months.”
B. “I don’t believe that you have been following your diet, because you haven’t lost
any weight.”
C. “Well, you’ve talked about diet in your terms, but perhaps I should test you on
specific things.”
D. “Some people have added exercise to diet and medication therapy and gotten
positive results. Do you think that this would work for you?” Correct
Rationale: Although suggestion or overt giving of advice is sometimes nontherapeutic, these
strategies are therapeutic when used in the working phase, because in this situation they will
increase the client’s perception of all available options in the treatment plan. Answering, “Sounds
fine to me. Let’s meet again in 6 months” stops the communication process. Stating to the client that
he or she has not lost any weight implies disbelief and does not explore the reasons for the client’s
failure to lose weight. “Testing” challenges the client and is nontherapeutic.
Test-Taking Strategy: Note the strategic word “most” and remember therapeutic communication
techniques. Noting the words “working phase” in the question will direct you to the correct option.
3. 3.ID: 9477084348
, As the nurse prepares to interview a client being admitted to the mental health unit, the client says, “I
asked my family to bring me in here to talk to someone, but now I don’t know where to begin.” Which
response by the nurse would be most helpful?
A. “Why not just start talking and see where it takes you?”
B. “If I were you, I’d begin with what you were doing this morning.”
C. “Perhaps you can start by sharing some of your most recent concerns.” Correct
D. “Don’t worry. Everyone who comes in here for the first time feels reluctant to
talk.”
Rationale: The intake interview is usually the first contact with the client. It is intended to establish
rapport, to help the nurse understand the client’s current problem and level of functioning, and to
help the nurse formulate a nursing care plan. The clinician usually allows the client to set the pace of
the interview and uses open-ended questions to elicit a comprehensive diagnostic picture of the
client’s problems and level of coping. Sharing concerns is a good place to start the conversation,
because it will allow the client to express feelings. The response “Why not just start talking and see
where it takes you?” is too general and does not provide the client with a focus on self. Telling the
client not to worry is nontherapeutic and avoids addressing the client’s concerns.
Test-Taking Strategy: Note the strategic word “most.” Use your knowledge of therapeutic
communication techniques. Focusing on the client’s feelings will direct you to the correct option.
Review: therapeutic communication techniques .
4. 4.ID: 9477092800
During a mental health intake interview, a young adult client who lives with his family rent free says,
“I’m tired of not being able to offer my friends a beer just because my folks don’t believe in taking a
drink socially.” Which nursing response would be therapeutic?
A. “Well, I guess you could move out and live on your own if you wanted to.”
B. “It seems that your parents expect you to follow their rules when you live under
their roof.” Correct
C. “You tell me you live rent free, yet you expect the same privileges as an adult
who supports the household?”
D. “Well, if you directly discussed your concerns with them, I guess it’s a case of
‘When in Rome, do as the Romans do.’”
Rationale: The therapeutic nursing response uses reflection, in which the nurse directs the content
of the client’s message back for the client to review from a new perspective. This technique also
includes an element of focusing on the crux of the issue — in this case, that it is his parents’ home
and they set the rules for living in their home, just as he someday will in his. Telling the client to move
out is giving advice or suggestions to the client prematurely. Although this technique can be useful in
the working phase, it is usually nontherapeutic when the nurse needs to promote client
understanding and self-exploration. Stating, “You tell me you live rent free, yet you expect the same
privileges as an adult who supports the household?” is judgmental and poorly timed in that it
humiliates the client unnecessarily. The client has acknowledged that he pays no rent, so there is no
helpful purpose in reemphasizing this fact. Stating, “Well, if you directly discussed your concerns
with them, I guess it’s a case of ‘When in Rome, do as the Romans do.’” is nontherapeutic in that it
, offers a cliché and expresses hopelessness and powerlessness, two emotions that the client is no
doubt already experiencing.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. This will direct
you to the correct option, the nursing response that focuses on the client’s concerns and feelings.
Review: therapeutic communication techniques .
.
5. 5.ID: 9477089705
The nurse developing a plan of care for a client whose spouse recently died determines the client
has a problem with dysfunctional grieving. Which priority intervention does the nurse incorporate into
the plan?
A. Monitoring the client’s sleep pattern
B. Assessing the client’s risk for violence toward self and others health care
provider Correct
C. Obtaining a health care provider’s prescription for an antidepressant
D. Assisting the client in resolving the grief through emotional, cognitive, and
behavioral means Incorrect
Rationale: The priority intervention for a client with dysfunctional grieving is assessing the client’s
risk for violence toward self and others. Although the nurse will assist the client in resolving the grief
and will monitor the client’s sleep pattern, these are not priorities in the list of options given.
Obtaining a health care provider’s prescription for an antidepressant is not a priority. In fact,
chemical dependency can present a barrier to the client’s goal attainment.
Test-Taking Strategy: Use the steps of the nursing process. Both monitoring the client’s sleep pattern
and assessing the client’s risk for violence toward self and others involve assessment. From these
options, select the one that addresses the safety of the client. Review: interventions for a client with
dysfunctional grieving .
.
6. 6.ID: 9477084360
A client in the mental health unit tells the nurse, “My husband makes all the decisions about money,
but I’m the one who’s making the money now, not him. He needs to back off, but he’s always
directing every decision we make.” Which nursing response would be the most therapeutic?
A. “Have you told your husband to back off”?
B. “You’re making the most money, so the decisions should be left to you.”
C. “How do you feel the money decisions could best be handled in your
household?” Correct
D. “You seem frustrated with your husband’s habit of controlling financial decisions.”
Rationale: The therapeutic nursing response is the one that provides a broad opening or statement
and is focused on the client’s feelings. In this response, the nurse will be able to assess what the
client believes concerning family financial decision-making. Asking, “Have you told your husband to
‘back off’?” is improperly paraphrasing the client and assumes that the client’s stance is correct.
Stating, “You’re making the most money, so decisions should be left to you,” is inappropriate
restating and provides an opinion; this response may be seen by the client as reassurance that her
, interpretation is being judged correct. When stating, “You seem to feel frustrated….,” the nurse is
sharing perceptions, which may appear to be challenging to the client when used in this context.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Remember to
focus on the client’s feelings and to provide the client the opportunity to communicate. This will direct
you to the correct option. Review: therapeutic communication techniques .
References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31). St.
Louis: Mosby.
.
7. 7.ID: 9477084328
The nurse is developing a plan of care for a client who recently received a diagnosis of acquired
immunodeficiency syndrome and is experiencing difficulty adjusting to the illness. Which action is
an inappropriate intervention for this client?
A. Monitoring the client for signs of self-harm
B. Helping the client verbalize concerns related to fear
C. Assisting the client with problem-solving and decision-making
D. Discouraging social networking to prevent the spread of infection Correct
Rationale: In planning care for a client experiencing difficulty in adjusting to an illness, the nurse
develops interventions to promote (not discourage) social networking that will provide needed
information to the client. The other options are appropriate interventions.
Test-Taking Strategy: Note the strategic word “inappropriate.” Recalling that social support is
important will direct you to the correct option. Also, note the relationship between the word
“inappropriate” in the question and “discouraging” in the correct option. Review: interventions for a
client experiencing difficulty in adjusting to an illness.
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 483, 484). St.
Louis: Mosby.
.
8. 8.ID: 9477084366
How does a client who has lost a spouse show that she is successfully completing the tasks of
mourning? Select all that apply.
A. Relating that its better “he went first”
B. Reporting that sleeping alone is so hard now Correct
C. Purchasing a smaller car she is comfortable driving Correct
D. Placing a picture of her husband on the bedside stand Correct
E. Heard explaining to family that illness “took” her husband
Correct
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.
Test-Taking Strategy: Use the process of elimination and focus on the subject, completing the tasks
1. 1.ID: 9477081360
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. Projection Incorrect
B. Sublimation
C. Displacement Correct
D. Identification
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.
Test-Taking Strategy: Note the subject of the question, defense mechanisms. Focusing on the data
in the question and the child’s behavior will direct you to the correct option. Review: these defense
mechanisms
2. 2.ID: 9477084316
A client says to the nurse, “I’ve been following my diet and taking my medication. What else do you
want to talk about today?” Which response would be most helpful during the working phase of the
therapeutic alliance?
A. “Sounds fine to me. Let’s meet again in 6 months.”
B. “I don’t believe that you have been following your diet, because you haven’t lost
any weight.”
C. “Well, you’ve talked about diet in your terms, but perhaps I should test you on
specific things.”
D. “Some people have added exercise to diet and medication therapy and gotten
positive results. Do you think that this would work for you?” Correct
Rationale: Although suggestion or overt giving of advice is sometimes nontherapeutic, these
strategies are therapeutic when used in the working phase, because in this situation they will
increase the client’s perception of all available options in the treatment plan. Answering, “Sounds
fine to me. Let’s meet again in 6 months” stops the communication process. Stating to the client that
he or she has not lost any weight implies disbelief and does not explore the reasons for the client’s
failure to lose weight. “Testing” challenges the client and is nontherapeutic.
Test-Taking Strategy: Note the strategic word “most” and remember therapeutic communication
techniques. Noting the words “working phase” in the question will direct you to the correct option.
3. 3.ID: 9477084348
, As the nurse prepares to interview a client being admitted to the mental health unit, the client says, “I
asked my family to bring me in here to talk to someone, but now I don’t know where to begin.” Which
response by the nurse would be most helpful?
A. “Why not just start talking and see where it takes you?”
B. “If I were you, I’d begin with what you were doing this morning.”
C. “Perhaps you can start by sharing some of your most recent concerns.” Correct
D. “Don’t worry. Everyone who comes in here for the first time feels reluctant to
talk.”
Rationale: The intake interview is usually the first contact with the client. It is intended to establish
rapport, to help the nurse understand the client’s current problem and level of functioning, and to
help the nurse formulate a nursing care plan. The clinician usually allows the client to set the pace of
the interview and uses open-ended questions to elicit a comprehensive diagnostic picture of the
client’s problems and level of coping. Sharing concerns is a good place to start the conversation,
because it will allow the client to express feelings. The response “Why not just start talking and see
where it takes you?” is too general and does not provide the client with a focus on self. Telling the
client not to worry is nontherapeutic and avoids addressing the client’s concerns.
Test-Taking Strategy: Note the strategic word “most.” Use your knowledge of therapeutic
communication techniques. Focusing on the client’s feelings will direct you to the correct option.
Review: therapeutic communication techniques .
4. 4.ID: 9477092800
During a mental health intake interview, a young adult client who lives with his family rent free says,
“I’m tired of not being able to offer my friends a beer just because my folks don’t believe in taking a
drink socially.” Which nursing response would be therapeutic?
A. “Well, I guess you could move out and live on your own if you wanted to.”
B. “It seems that your parents expect you to follow their rules when you live under
their roof.” Correct
C. “You tell me you live rent free, yet you expect the same privileges as an adult
who supports the household?”
D. “Well, if you directly discussed your concerns with them, I guess it’s a case of
‘When in Rome, do as the Romans do.’”
Rationale: The therapeutic nursing response uses reflection, in which the nurse directs the content
of the client’s message back for the client to review from a new perspective. This technique also
includes an element of focusing on the crux of the issue — in this case, that it is his parents’ home
and they set the rules for living in their home, just as he someday will in his. Telling the client to move
out is giving advice or suggestions to the client prematurely. Although this technique can be useful in
the working phase, it is usually nontherapeutic when the nurse needs to promote client
understanding and self-exploration. Stating, “You tell me you live rent free, yet you expect the same
privileges as an adult who supports the household?” is judgmental and poorly timed in that it
humiliates the client unnecessarily. The client has acknowledged that he pays no rent, so there is no
helpful purpose in reemphasizing this fact. Stating, “Well, if you directly discussed your concerns
with them, I guess it’s a case of ‘When in Rome, do as the Romans do.’” is nontherapeutic in that it
, offers a cliché and expresses hopelessness and powerlessness, two emotions that the client is no
doubt already experiencing.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. This will direct
you to the correct option, the nursing response that focuses on the client’s concerns and feelings.
Review: therapeutic communication techniques .
.
5. 5.ID: 9477089705
The nurse developing a plan of care for a client whose spouse recently died determines the client
has a problem with dysfunctional grieving. Which priority intervention does the nurse incorporate into
the plan?
A. Monitoring the client’s sleep pattern
B. Assessing the client’s risk for violence toward self and others health care
provider Correct
C. Obtaining a health care provider’s prescription for an antidepressant
D. Assisting the client in resolving the grief through emotional, cognitive, and
behavioral means Incorrect
Rationale: The priority intervention for a client with dysfunctional grieving is assessing the client’s
risk for violence toward self and others. Although the nurse will assist the client in resolving the grief
and will monitor the client’s sleep pattern, these are not priorities in the list of options given.
Obtaining a health care provider’s prescription for an antidepressant is not a priority. In fact,
chemical dependency can present a barrier to the client’s goal attainment.
Test-Taking Strategy: Use the steps of the nursing process. Both monitoring the client’s sleep pattern
and assessing the client’s risk for violence toward self and others involve assessment. From these
options, select the one that addresses the safety of the client. Review: interventions for a client with
dysfunctional grieving .
.
6. 6.ID: 9477084360
A client in the mental health unit tells the nurse, “My husband makes all the decisions about money,
but I’m the one who’s making the money now, not him. He needs to back off, but he’s always
directing every decision we make.” Which nursing response would be the most therapeutic?
A. “Have you told your husband to back off”?
B. “You’re making the most money, so the decisions should be left to you.”
C. “How do you feel the money decisions could best be handled in your
household?” Correct
D. “You seem frustrated with your husband’s habit of controlling financial decisions.”
Rationale: The therapeutic nursing response is the one that provides a broad opening or statement
and is focused on the client’s feelings. In this response, the nurse will be able to assess what the
client believes concerning family financial decision-making. Asking, “Have you told your husband to
‘back off’?” is improperly paraphrasing the client and assumes that the client’s stance is correct.
Stating, “You’re making the most money, so decisions should be left to you,” is inappropriate
restating and provides an opinion; this response may be seen by the client as reassurance that her
, interpretation is being judged correct. When stating, “You seem to feel frustrated….,” the nurse is
sharing perceptions, which may appear to be challenging to the client when used in this context.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Remember to
focus on the client’s feelings and to provide the client the opportunity to communicate. This will direct
you to the correct option. Review: therapeutic communication techniques .
References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31). St.
Louis: Mosby.
.
7. 7.ID: 9477084328
The nurse is developing a plan of care for a client who recently received a diagnosis of acquired
immunodeficiency syndrome and is experiencing difficulty adjusting to the illness. Which action is
an inappropriate intervention for this client?
A. Monitoring the client for signs of self-harm
B. Helping the client verbalize concerns related to fear
C. Assisting the client with problem-solving and decision-making
D. Discouraging social networking to prevent the spread of infection Correct
Rationale: In planning care for a client experiencing difficulty in adjusting to an illness, the nurse
develops interventions to promote (not discourage) social networking that will provide needed
information to the client. The other options are appropriate interventions.
Test-Taking Strategy: Note the strategic word “inappropriate.” Recalling that social support is
important will direct you to the correct option. Also, note the relationship between the word
“inappropriate” in the question and “discouraging” in the correct option. Review: interventions for a
client experiencing difficulty in adjusting to an illness.
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 483, 484). St.
Louis: Mosby.
.
8. 8.ID: 9477084366
How does a client who has lost a spouse show that she is successfully completing the tasks of
mourning? Select all that apply.
A. Relating that its better “he went first”
B. Reporting that sleeping alone is so hard now Correct
C. Purchasing a smaller car she is comfortable driving Correct
D. Placing a picture of her husband on the bedside stand Correct
E. Heard explaining to family that illness “took” her husband
Correct
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.
Test-Taking Strategy: Use the process of elimination and focus on the subject, completing the tasks
