NR 326 Mental Health Nursing:
Comprehensive Exam 2 & Final
Review – A 200-Question Q&A Guide
with Evidence-Based Rationales
1. Three years ago, Anna's dog was killed by a car. Since then, Anna
has lost weight, rarely leaves home, and talks excessively about the
dog. Her behavior would be considered maladaptive for which reason?
Answer: c. Her grief is interfering with her functioning
Rationale: Maladaptive behavior is defined as behavior that interferes
with daily functioning. Anna's weight loss, social isolation, and inability
to resume normal activities indicate functional impairment, making
her grief response maladaptive regardless of the time elapsed since
the loss.
2. According to Maslow's hierarchy of needs, which level is not being
met for Anna, who states no one can replace the relationship she had
with her dog?
Answer: d. Love and belonging needs
Rationale: Maslow's hierarchy places love and belonging needs above
physiological and safety needs. Anna's inability to form new
relationships and her continued focus on her deceased pet indicate
unmet needs in this category.
3. Anna is hearing a voice telling her she was a horrible caretaker and
did not deserve a pet. This best describes which condition?
, Answer: b. Psychosis
Rationale: Auditory hallucinations represent a loss of contact with
reality, which defines psychosis. This is distinct from neurosis (where
reality testing remains intact), depression, or normal bereavement.
4. A 72-year-old who has experienced several losses in a short time is
experiencing what condition?
Answer: a. Bereavement overload
Rationale: Bereavement overload occurs when multiple losses happen
in rapid succession, overwhelming an individual's capacity to grieve
and increasing risk for complicated grief reactions. This is particularly
common in older adults.
5. Anna's daughter has put off seeking help. What is the most likely
reason?
Answer: b. Relatives often try to normalize behavior rather than label
it mental illness
Rationale: Family members frequently attempt to normalize unusual
behaviors to avoid stigma associated with mental illness. This can
delay appropriate treatment and intervention.
6. Anna cannot remember the circumstances of her dog's death. This is
an example of which defense mechanism?
Answer: d. Repression
Rationale: Repression involves unconsciously blocking unacceptable
thoughts or painful memories from conscious awareness. This differs
from suppression (conscious blocking), denial (refusing to accept
reality), or rationalization (creating logical explanations).
,7. A client with schizophrenia is brought to the ED after yelling that
food is poisoned and states "there is nothing wrong with me." What
action demonstrates good clinical judgment?
Answer: b. Document that the client is manifesting suspicious
ideation and anosognosia
Rationale: Anosognosia (lack of insight into one's condition) is
common in schizophrenia. The nurse should accurately document
both the suspicious ideation (paranoid delusion about poisoned food)
and the client's lack of insight.
8. A widow of 7 years reports not wanting to wake up in the morning.
What is the priority action?
Answer: c. Assess the client for symptoms of depression and suicide
risk
Rationale: When a client expresses hopelessness, suicide assessment
is always the priority. This statement requires immediate evaluation
for suicidal ideation, plan, and intent before other interventions.
9. A client with diabetes is anxious about giving self-injections and
states, "I can hardly breathe." What demonstrates good clinical
judgment?
Answer: a. Assist the client in relaxation exercises before commencing
diabetes education
Rationale: A highly anxious client cannot effectively learn new
information. Addressing the acute anxiety first through relaxation
techniques optimizes teaching effectiveness.
10. What is the most important therapeutic tool a nurse should use to
provide quality care to a psychiatric client?
, Answer: b. Self-analysis
Rationale: Self-analysis enables the nurse to examine personal biases,
responses, and emotional triggers. This self-awareness is essential for
providing sensitive, non-judgmental care.
11. Which tasks are associated with the orientation phase of the
therapeutic relationship?
Answer: b. Creating an environment for the establishment of trust
and rapport; e. Formulating nursing diagnoses and setting goals
Rationale: The orientation phase involves building trust, establishing
boundaries, gathering assessment data, and formulating initial goals.
Later phases address implementation and termination.
12. A nurse responds with anger to a client refusing AA meetings,
saying "Don't you even care what happens to your children?" This is an
example of:
Answer: b. Countertransference
Rationale: Countertransference occurs when the nurse projects
personal feelings or unresolved issues onto the client. The nurse's
father died from alcoholism, triggering this angry response.
13. Which actions are associated with the working phase of the
therapeutic relationship?
Answer: d. The nurse assists the client in practicing techniques to
manage anger and provides positive feedback
Comprehensive Exam 2 & Final
Review – A 200-Question Q&A Guide
with Evidence-Based Rationales
1. Three years ago, Anna's dog was killed by a car. Since then, Anna
has lost weight, rarely leaves home, and talks excessively about the
dog. Her behavior would be considered maladaptive for which reason?
Answer: c. Her grief is interfering with her functioning
Rationale: Maladaptive behavior is defined as behavior that interferes
with daily functioning. Anna's weight loss, social isolation, and inability
to resume normal activities indicate functional impairment, making
her grief response maladaptive regardless of the time elapsed since
the loss.
2. According to Maslow's hierarchy of needs, which level is not being
met for Anna, who states no one can replace the relationship she had
with her dog?
Answer: d. Love and belonging needs
Rationale: Maslow's hierarchy places love and belonging needs above
physiological and safety needs. Anna's inability to form new
relationships and her continued focus on her deceased pet indicate
unmet needs in this category.
3. Anna is hearing a voice telling her she was a horrible caretaker and
did not deserve a pet. This best describes which condition?
, Answer: b. Psychosis
Rationale: Auditory hallucinations represent a loss of contact with
reality, which defines psychosis. This is distinct from neurosis (where
reality testing remains intact), depression, or normal bereavement.
4. A 72-year-old who has experienced several losses in a short time is
experiencing what condition?
Answer: a. Bereavement overload
Rationale: Bereavement overload occurs when multiple losses happen
in rapid succession, overwhelming an individual's capacity to grieve
and increasing risk for complicated grief reactions. This is particularly
common in older adults.
5. Anna's daughter has put off seeking help. What is the most likely
reason?
Answer: b. Relatives often try to normalize behavior rather than label
it mental illness
Rationale: Family members frequently attempt to normalize unusual
behaviors to avoid stigma associated with mental illness. This can
delay appropriate treatment and intervention.
6. Anna cannot remember the circumstances of her dog's death. This is
an example of which defense mechanism?
Answer: d. Repression
Rationale: Repression involves unconsciously blocking unacceptable
thoughts or painful memories from conscious awareness. This differs
from suppression (conscious blocking), denial (refusing to accept
reality), or rationalization (creating logical explanations).
,7. A client with schizophrenia is brought to the ED after yelling that
food is poisoned and states "there is nothing wrong with me." What
action demonstrates good clinical judgment?
Answer: b. Document that the client is manifesting suspicious
ideation and anosognosia
Rationale: Anosognosia (lack of insight into one's condition) is
common in schizophrenia. The nurse should accurately document
both the suspicious ideation (paranoid delusion about poisoned food)
and the client's lack of insight.
8. A widow of 7 years reports not wanting to wake up in the morning.
What is the priority action?
Answer: c. Assess the client for symptoms of depression and suicide
risk
Rationale: When a client expresses hopelessness, suicide assessment
is always the priority. This statement requires immediate evaluation
for suicidal ideation, plan, and intent before other interventions.
9. A client with diabetes is anxious about giving self-injections and
states, "I can hardly breathe." What demonstrates good clinical
judgment?
Answer: a. Assist the client in relaxation exercises before commencing
diabetes education
Rationale: A highly anxious client cannot effectively learn new
information. Addressing the acute anxiety first through relaxation
techniques optimizes teaching effectiveness.
10. What is the most important therapeutic tool a nurse should use to
provide quality care to a psychiatric client?
, Answer: b. Self-analysis
Rationale: Self-analysis enables the nurse to examine personal biases,
responses, and emotional triggers. This self-awareness is essential for
providing sensitive, non-judgmental care.
11. Which tasks are associated with the orientation phase of the
therapeutic relationship?
Answer: b. Creating an environment for the establishment of trust
and rapport; e. Formulating nursing diagnoses and setting goals
Rationale: The orientation phase involves building trust, establishing
boundaries, gathering assessment data, and formulating initial goals.
Later phases address implementation and termination.
12. A nurse responds with anger to a client refusing AA meetings,
saying "Don't you even care what happens to your children?" This is an
example of:
Answer: b. Countertransference
Rationale: Countertransference occurs when the nurse projects
personal feelings or unresolved issues onto the client. The nurse's
father died from alcoholism, triggering this angry response.
13. Which actions are associated with the working phase of the
therapeutic relationship?
Answer: d. The nurse assists the client in practicing techniques to
manage anger and provides positive feedback
