NUR 253 MENTAL HEALTH NURSING EXAM 2 REVIEW: 200 COMPREHENSIVE PRACTICE QUESTIONS WITH CORRECT ANSWERS AND IN-DEPTH RATIONALES COVERING GROUP THERAPY, PSYCHOPHARMACOLOGY, THERAPEUTIC COMMUNICATION, GRIEF, CRISIS INTERVENTION, AND MAJOR PSYCHIATRIC DISORDE

NUR 253 MENTAL HEALTH NURSING EXAM 2 REVIEW: 200 COMPREHENSIVE PRACTICE QUESTIONS WITH CORRECT ANSWERS AND IN-DEPTH RATIONALES COVERING GROUP THERAPY, PSYCHOPHARMACOLOGY, THERAPEUTIC COMMUNICATION, GRIEF, CRISIS INTERVENTION, AND MAJOR PSYCHIATRIC DISORDERS 1. A client in a grief support group states, "I just can't accept that my husband is gone. I keep setting his place at the dinner table." The nurse recognizes this behavior is most consistent with which stage of Kübler-Ross's grief model? A. Anger B. Bargaining C. Denial D. Depression Correct Answer: C Rationale: The client's behavior of setting a place at the table for the deceased husband reflects an inability to acknowledge the reality of the loss, which is the hallmark of the denial stage. Denial serves as a temporary buffer against the shock of the loss. Anger involves resentment or rage, bargaining involves attempts to negotiate for more time or a different outcome, and depression involves overwhelming sadness and hopelessness. 2. A nurse is leading a group session and notices a client consistently interrupts others. The nurse states, "I notice you have spoken several times, and I want to make sure everyone has a chance to share." This intervention is an example of which therapeutic technique? A. Giving advice B. Setting limits C. Clarification D. Confrontation Correct Answer: B Rationale: Setting limits involves establishing boundaries and expectations for behavior within the group. The nurse's statement clearly communicates the expectation that all members should have an opportunity to participate, without being punitive or judgmental. Giving advice would be telling the client what to do, clarification seeks to understand the client's message, and confrontation points out discrepancies in the client's behavior or communication. 3. A client experiencing acute mania is pacing rapidly, talking loudly, and making grandiose plans. Which nursing intervention is the priority? A. Encourage the client to participate in a competitive game. B. Provide a structured environment with minimal stimulation. C. Allow the client to make all decisions regarding daily activities. D. Assign the client to a private room with windows facing a busy courtyard. Correct Answer: B Rationale: During acute mania, the client is highly stimulated and distractible. A structured environment with minimal stimulation helps reduce sensory overload and provides a sense of safety and predictability. Competitive games may increase agitation, allowing the client to make all decisions is not appropriate due to impaired judgment, and a room facing a busy courtyard would provide excessive stimulation. 4. A nurse is providing care to a client who is terminally ill. The client states, "I know I haven't been a perfect person, but I've tried to do good. I'm just not ready to go yet." Which response by the nurse is most therapeutic? A. "You have lived a long and full life." B. "I understand you are not ready, but we all have to go sometime." C. "Tell me more about what makes you feel you are not ready." D. "Maybe you should make peace with your family." Correct Answer: C Rationale: This open-ended response encourages the client to explore their feelings and concerns about dying. It validates the client's statement and invites further discussion, which is therapeutic. False reassurance, dismissing the client's feelings, and giving advice are nontherapeutic approaches. 5. A client with major depressive disorder says, "Nothing I do matters anymore. I'm completely worthless." Which response by the nurse is most therapeutic? A. "You have so much to live for. Think about your children." B. "Why do you feel that way about yourself?" C. "It sounds like you are feeling hopeless and worthless." D. "Everyone feels that way sometimes. You'll get through it." Correct Answer: C Rationale: This response uses the therapeutic technique of reflecting feelings. It validates the client's expressed emotions of hopelessness and worthlessness without judgment. Avoiding "why" questions prevents putting the client on the defensive, and false reassurance is avoided. 6. A nurse is caring for a client who has just been informed of a terminal diagnosis. The client responds, "No, that can't be right. The tests must be wrong. I feel fine." The nurse recognizes this response as an example of which defense mechanism? A. Projection B. Rationalization C. Denial D. Regression Correct Answer: C Rationale: Denial is the refusal to accept reality or facts, acting as if a painful event, thought, or feeling does not exist. The client's statement that the diagnosis cannot be right and the tests must be wrong is a classic example of denial. Projection involves attributing one's own unacceptable feelings to others, rationalization involves creating logical explanations for behaviors, and regression involves reverting to an earlier developmental stage. 7. A client with bipolar disorder is being discharged on lithium. Which teaching point is most important for the nurse to include? A. "Increase your fluid intake if you feel thirsty." B. "Take your lithium with a full glass of milk." C. "Report any persistent nausea, vomiting, or diarrhea to your provider." D. "You can stop taking lithium once you feel better." Correct Answer: C Rationale: Persistent nausea, vomiting, or diarrhea can lead to dehydration and lithium toxicity, a medical emergency. Clients must be taught to report these symptoms immediately. Lithium is taken with food or water to reduce GI upset, not specifically milk. Fluid intake should be consistent (1.5-2 L/day), not just increased when thirsty. Lithium must be taken continuously to maintain therapeutic levels and prevent relapse. 8. A nurse is leading a new self-esteem group. Which intervention is best for assuring mutual respect within the group? A. Announce that any members who are disrespectful will be asked to leave. B. Describe the importance of treating each other with consideration at the beginning of each session. C. Give members a brochure describing the purpose, norms, and expectations of group. D. Reinforce to members that the group leader will always begin and end discussions. Correct Answer: C