NR 547 MENTAL HEALTH NURSING — EXAM 1
STUDY GUIDE FOUNDATIONS, THERAPEUTIC
COMMUNICATION & ANXIETY-RELATED
DISORDER
Part 2: Practice Questions with Rationales
Foundations, Therapeutic Communication & Anxiety-Related Disorders
Q1. A nurse is caring for a client who states, "You remind me so much of my older sister—you always
know just what to say." This is an example of:
A. Countertransference
B. Transference
C. Sympathy
D. Empathy
Answer: B. Transference
Rationale: The client is displacing feelings and perceptions about a significant person from their past,
their sister, onto the nurse. Countertransference would be the nurse's reaction based on their own past
experiences. Sympathy and empathy are unrelated to this specific concept.
Q2. Which nursing response demonstrates a therapeutic communication technique?
A. "Why do you feel that way?"
B. "Don't worry, everything will work out fine."
C. "You seem upset. Tell me more about what's on your mind."
D. "I think you should call your daughter and apologize."
Answer: C. "You seem upset. Tell me more about what's on your mind."
Rationale: This response makes an observation and uses a broad opening/exploring technique,
encouraging the client to elaborate. "Why" questions can sound accusatory, false reassurance can
dismiss feelings, and giving advice can foster dependence.
Q3. A client with severe anxiety is pacing, has a heart rate of 128, and states, "I can't think straight."
What is the nurse's priority intervention?
,A. Ask the client to explain what is causing the anxiety.
B. Reduce environmental stimuli and stay with the client.
C. Encourage the client to journal about their feelings.
D. Leave the client alone to allow self-calming.
Answer: B. Reduce environmental stimuli and stay with the client.
Rationale: At the severe level of anxiety, the perceptual field is greatly reduced, and the client cannot
process complex information or engage in insight-oriented tasks. The priority is safety and stimulus
reduction. Staying with the client provides reassurance, while leaving the client alone could allow the
anxiety to escalate toward panic.
Q4. A nurse assesses a client's affect as "flat" while the client reports feeling "pretty good today." This
is an example of:
A. Mood-congruent affect
B. Mood-incongruent affect
C. Labile affect
D. Blunted mood
Answer: B. Mood-incongruent affect
Rationale: Affect is the objective, observable expression of emotion, while mood is the client's
subjective report. When the observed affect does not match the stated mood, the affect is mood-
incongruent. Blunted describes affect rather than mood.
Q5. Which client statement reflects use of the defense mechanism of rationalization?
A. "I didn't get the promotion because my boss doesn't like men."
B. "I failed the test because the professor writes terrible questions."
C. "I'm going to hit the gym instead of yelling at my brother."
D. "I don't even remember what happened that night."
Answer: B. "I failed the test because the professor writes terrible questions."
Rationale: Rationalization involves offering a logical-sounding but self-protective excuse to avoid the
actual reason for a shortcoming. Projection involves attributing one's own unacceptable feelings or
motives to another person. Sublimation channels an impulse into a socially acceptable activity, while
repression involves unconsciously excluding distressing information from awareness.
,Q6. A client is brought to the ED by police after threatening a neighbor with a weapon and is
exhibiting command hallucinations. The client refuses admission. What is the appropriate legal
action?
A. Discharge the client since they have the right to refuse treatment.
B. Initiate involuntary admission based on danger to others.
C. Ask the family to sign consent on the client's behalf.
D. Wait 24 hours to reassess before taking action.
Answer: B. Initiate involuntary admission based on danger to others.
Rationale: The right to refuse treatment is not absolute. When a client poses an imminent danger to self
or others, involuntary admission procedures may be legally justified, subject to applicable jurisdictional
requirements. Delaying action could place others at risk.
Q7. During the orientation phase of the nurse-client relationship, which action is most appropriate?
A. Confronting the client about maladaptive coping patterns
B. Establishing the therapeutic contract, including confidentiality limits
C. Reviewing progress and preparing the client for discharge
D. Reviewing the client's chart prior to the first meeting
Answer: B. Establishing the therapeutic contract, including confidentiality limits
Rationale: The orientation phase focuses on establishing trust and the working agreement, including
relevant confidentiality limits. Confrontation generally belongs to the working phase, discharge
preparation is associated with termination, and chart review occurs during the preinteraction phase.
Q8. A client with generalized anxiety disorder (GAD) asks the nurse how long they must have
symptoms to meet the diagnostic criteria. The nurse's best response is:
A. "Symptoms must be present most days for at least 6 months."
B. "A single panic attack is enough for diagnosis."
C. "Symptoms must last at least 2 weeks."
D. "There is no minimum time requirement."
Answer: A. "Symptoms must be present most days for at least 6 months."
Rationale: GAD involves excessive anxiety and worry occurring more days than not for at least 6
months, along with associated symptoms such as restlessness, fatigue, muscle tension, and sleep
disturbance that cause functional impairment.
, Q9. Which statement by a new nursing student indicates a need for further teaching about
countertransference?
A. "If I notice I'm becoming overly protective of a client who reminds me of my brother, I should discuss
it in supervision."
B. "Countertransference is the client's emotional reaction to me based on a past relationship."
C. "I should reflect on my own emotional responses to clients regularly."
D. "Self-awareness helps me recognize when countertransference is occurring."
Answer: B. "Countertransference is the client's emotional reaction to me based on a past
relationship."
Rationale: This statement describes transference, which involves the client's feelings toward the nurse
based on past relationships. Countertransference refers to the nurse's emotional responses toward the
client that may be influenced by the nurse's own experiences.
Q10. A client says, "The government has planted a chip in my brain to monitor my thoughts." The
nurse recognizes this as:
A. An illusion
B. A delusion
C. A hallucination
D. Depersonalization
Answer: B. A delusion
Rationale: A delusion is a fixed, false belief that is not amenable to reason and is inconsistent with the
person's cultural context. An illusion is a misperception of a real external stimulus, while a hallucination
is a sensory perception without an external stimulus. Depersonalization involves feeling detached from
oneself.
Mood Disorders — Questions 11–25
Q11. A client with major depressive disorder states, "Nothing matters anymore, I'm worthless." What
is the priority nursing action?
A. Encourage a structured daily schedule
B. Assess for suicidal ideation and a plan
C. Refer to occupational therapy
STUDY GUIDE FOUNDATIONS, THERAPEUTIC
COMMUNICATION & ANXIETY-RELATED
DISORDER
Part 2: Practice Questions with Rationales
Foundations, Therapeutic Communication & Anxiety-Related Disorders
Q1. A nurse is caring for a client who states, "You remind me so much of my older sister—you always
know just what to say." This is an example of:
A. Countertransference
B. Transference
C. Sympathy
D. Empathy
Answer: B. Transference
Rationale: The client is displacing feelings and perceptions about a significant person from their past,
their sister, onto the nurse. Countertransference would be the nurse's reaction based on their own past
experiences. Sympathy and empathy are unrelated to this specific concept.
Q2. Which nursing response demonstrates a therapeutic communication technique?
A. "Why do you feel that way?"
B. "Don't worry, everything will work out fine."
C. "You seem upset. Tell me more about what's on your mind."
D. "I think you should call your daughter and apologize."
Answer: C. "You seem upset. Tell me more about what's on your mind."
Rationale: This response makes an observation and uses a broad opening/exploring technique,
encouraging the client to elaborate. "Why" questions can sound accusatory, false reassurance can
dismiss feelings, and giving advice can foster dependence.
Q3. A client with severe anxiety is pacing, has a heart rate of 128, and states, "I can't think straight."
What is the nurse's priority intervention?
,A. Ask the client to explain what is causing the anxiety.
B. Reduce environmental stimuli and stay with the client.
C. Encourage the client to journal about their feelings.
D. Leave the client alone to allow self-calming.
Answer: B. Reduce environmental stimuli and stay with the client.
Rationale: At the severe level of anxiety, the perceptual field is greatly reduced, and the client cannot
process complex information or engage in insight-oriented tasks. The priority is safety and stimulus
reduction. Staying with the client provides reassurance, while leaving the client alone could allow the
anxiety to escalate toward panic.
Q4. A nurse assesses a client's affect as "flat" while the client reports feeling "pretty good today." This
is an example of:
A. Mood-congruent affect
B. Mood-incongruent affect
C. Labile affect
D. Blunted mood
Answer: B. Mood-incongruent affect
Rationale: Affect is the objective, observable expression of emotion, while mood is the client's
subjective report. When the observed affect does not match the stated mood, the affect is mood-
incongruent. Blunted describes affect rather than mood.
Q5. Which client statement reflects use of the defense mechanism of rationalization?
A. "I didn't get the promotion because my boss doesn't like men."
B. "I failed the test because the professor writes terrible questions."
C. "I'm going to hit the gym instead of yelling at my brother."
D. "I don't even remember what happened that night."
Answer: B. "I failed the test because the professor writes terrible questions."
Rationale: Rationalization involves offering a logical-sounding but self-protective excuse to avoid the
actual reason for a shortcoming. Projection involves attributing one's own unacceptable feelings or
motives to another person. Sublimation channels an impulse into a socially acceptable activity, while
repression involves unconsciously excluding distressing information from awareness.
,Q6. A client is brought to the ED by police after threatening a neighbor with a weapon and is
exhibiting command hallucinations. The client refuses admission. What is the appropriate legal
action?
A. Discharge the client since they have the right to refuse treatment.
B. Initiate involuntary admission based on danger to others.
C. Ask the family to sign consent on the client's behalf.
D. Wait 24 hours to reassess before taking action.
Answer: B. Initiate involuntary admission based on danger to others.
Rationale: The right to refuse treatment is not absolute. When a client poses an imminent danger to self
or others, involuntary admission procedures may be legally justified, subject to applicable jurisdictional
requirements. Delaying action could place others at risk.
Q7. During the orientation phase of the nurse-client relationship, which action is most appropriate?
A. Confronting the client about maladaptive coping patterns
B. Establishing the therapeutic contract, including confidentiality limits
C. Reviewing progress and preparing the client for discharge
D. Reviewing the client's chart prior to the first meeting
Answer: B. Establishing the therapeutic contract, including confidentiality limits
Rationale: The orientation phase focuses on establishing trust and the working agreement, including
relevant confidentiality limits. Confrontation generally belongs to the working phase, discharge
preparation is associated with termination, and chart review occurs during the preinteraction phase.
Q8. A client with generalized anxiety disorder (GAD) asks the nurse how long they must have
symptoms to meet the diagnostic criteria. The nurse's best response is:
A. "Symptoms must be present most days for at least 6 months."
B. "A single panic attack is enough for diagnosis."
C. "Symptoms must last at least 2 weeks."
D. "There is no minimum time requirement."
Answer: A. "Symptoms must be present most days for at least 6 months."
Rationale: GAD involves excessive anxiety and worry occurring more days than not for at least 6
months, along with associated symptoms such as restlessness, fatigue, muscle tension, and sleep
disturbance that cause functional impairment.
, Q9. Which statement by a new nursing student indicates a need for further teaching about
countertransference?
A. "If I notice I'm becoming overly protective of a client who reminds me of my brother, I should discuss
it in supervision."
B. "Countertransference is the client's emotional reaction to me based on a past relationship."
C. "I should reflect on my own emotional responses to clients regularly."
D. "Self-awareness helps me recognize when countertransference is occurring."
Answer: B. "Countertransference is the client's emotional reaction to me based on a past
relationship."
Rationale: This statement describes transference, which involves the client's feelings toward the nurse
based on past relationships. Countertransference refers to the nurse's emotional responses toward the
client that may be influenced by the nurse's own experiences.
Q10. A client says, "The government has planted a chip in my brain to monitor my thoughts." The
nurse recognizes this as:
A. An illusion
B. A delusion
C. A hallucination
D. Depersonalization
Answer: B. A delusion
Rationale: A delusion is a fixed, false belief that is not amenable to reason and is inconsistent with the
person's cultural context. An illusion is a misperception of a real external stimulus, while a hallucination
is a sensory perception without an external stimulus. Depersonalization involves feeling detached from
oneself.
Mood Disorders — Questions 11–25
Q11. A client with major depressive disorder states, "Nothing matters anymore, I'm worthless." What
is the priority nursing action?
A. Encourage a structured daily schedule
B. Assess for suicidal ideation and a plan
C. Refer to occupational therapy
