PSYCHIATRIC/MENTAL HEALTH PRACTICE EXAM
EVOLVE HESI QUESTIONS
A 38-year-old female client is admitted with a diagnosis of paranoid schizophrenia.
When her tray is brought to her, she refuses to eat and tells the nurse, "I know you are
trying to poison me with that food." Which response would be most appropriate for the
nurse to make?
A. "I'll leave your tray here. I am available if you need anything else."
B. "You're not being poisoned. Why do you think someone is trying to poison you?"
C. "No one on this unit has ever died from poisoning. You're safe here."
D. "I will talk to your healthcare provider about the possibility of changing your diet." -
Answers :A. "I'll leave your tray here. I am available if you need anything else."
(A) is the best choice cited. The nurse does not argue with the client nor demand that
she eat, but offers support by agreeing to "be there if needed", e. g., to warm the food.
(B and C) are arguing with the client's delusions, and (B) asks "why" which is usually not
a good question for a psychotic client. (D) has nothing to do with the actual problem; i.
e., the problem is not the diet (she thinks any food given to her is poisoned).
A 25-year-old female client has been particularly restless and the nurse finds her trying
to leave the psychiatric unit. She tells the nurse, "Please let me go! I must leave
because the secret police are after me." Which response is best for the nurse to make?
A. "No one is after you, you're safe here."
B. "You'll feel better after you have rested."
C. "I know you must feel lonely and frightened."
D. "Come with me to your room and I will sit with you." - Answers :D. "Come with me to
your room and I will sit with you."
(D) is the best response because it offers support without judgment or demands. (A) is
arguing with the client's delusion. (B) is offering false reassurance. (C) is a violation of
therapeutic communication in that the nurse is telling the client how she feels
(frightened and lonely), rather than allowing the client to describe her own feelings.
Hallucinating and/or delusional clients are not capable of discussing their feelings,
particularly when they perceive a crisis.
A 45-year-old male client tells the nurse that he used to believe that he was Jesus
Christ, but now he knows he is not. Which response is best for the nurse to make?
A. "Did you really believe you were Jesus Christ?"
B. "I think you're getting well."
C. "Others have had similar thoughts when under stress."
D. "Why did you think you were Jesus Christ?" - Answers :C. "Others have had similar
thoughts when under stress."
(C) offers support by assuring the client that others have suffered as he has (also the
principle on which Alcoholics Anonymous acts). (A) is belittling. (B) is making an
,inappropriate judgment. You may have narrowed your choices to (C and D). However,
you should eliminate (D) because it is a "why" question, and the client does not know
why!
A nurse working in the emergency room of a children's hospital admits a child whose
injuries could have resulted from abuse. Which statement most accurately describes the
nurse's responsibility in cases of suspected child abuse?
A. The nurse should obtain objective data such as x-rays before reporting suspicions to
the authorities.
B. The nurse should confirm any suspicions of child abuse with the healthcare provider
before reporting to the authorities.
C. The nurse should report any case of suspected child abuse to the nurse in charge.
D. The nurse should note in the client's record any suspicions of child abuse so that a
history of such suspicions can be tracked. - Answers :C. The nurse should report any
case of suspected child abuse to the nurse in charge.
It is the nurse's legal responsibility to report all suspected cases of child abuse.
Notifying the charge nurse starts the legal reporting process (C).
A client who is being treated with lithium carbonate for bipolar disorder develops
diarrhea, vomiting, and drowsiness. What action should the nurse take?
A. Notify the healthcare provider immediately and prepare for administration of an
antidote.
B. Notify the healthcare provider of the symptoms prior to the next administration of the
drug.
C. Record the symptoms as normal side effects and continue administration of the
prescribed dosage.
D. Hold the medication and refuse to administer additional amounts of the drug. -
Answers :B. Notify the healthcare provider of the symptoms prior to the next
administration of the drug.
Early side effects of lithium carbonate (occurring with serum lithium levels below 2.0
mEq per liter) generally follow a progressive pattern beginning with diarrhea, vomiting,
drowsiness, and muscular weakness. At higher levels, ataxia, tinnitus, blurred vision,
and large dilute urine output may occur. (B) is the best choice. Although these are
expected symptoms, the healthcare provider should be notified prior to the next
administration of the drug. (A, C, and D) would not reflect good nursing judgment.
A client on the psychiatric unit appears to imitate a certain nurse on the unit. The client
seeks out this particular nurse and imitates the nurse's mannerisms. The nurse knows
that the client is using which defense mechanism?
A. Sublimation.
B. Identification.
C. Introjection.
D. Repression. - Answers :B. Identification.
, Identification (B) is an attempt to be like someone or emulate the personality traits of
another. (A) is substituting an unacceptable feeling for one that is more socially
acceptable. (C) is incorporating the values or qualities of an admired person or group
into one's own ego structure. (D) is the involuntary exclusion of painful thoughts or
memories from one's awareness.
The nurse is planning the care for a 32-year-old male client with acute depression.
Which nursing intervention would be best in helping this client deal with his depression?
A. Ensure that the client's day is filled with group activities.
B. Assist the client in exploring feelings of shame, anger, and guilt.
C. Allow the client to initiate and determine activities of daily living.
D. Encourage the client to explore the rationale for his depression. - Answers :B. Assist
the client in exploring feelings of shame, anger, and guilt.
Depression is associated with feelings of shame, anger, and guilt. Exploring such
feelings is an important nursing intervention for the depressed client (B). If the client's
day is filled with group activities (A) he might not have the opportunity to explore these
feelings. (C) is a good intervention for the chronically depressed client who exhibits
vegetative signs of depression. (D) is essentially asking the client "why" he is
depressed--avoid "whys" disguised as "rationale."
At the first meeting of a group of older adults at a daycare center for the elderly, the
nurse asks one of the members what kinds of things she would like to do with the group.
The older woman shrugs her shoulders and says, "You tell me, you're the leader." What
is the best response for the nurse to make?
A. "Yes, I am the leader today. Would you like to be the leader tomorrow?"
B. "Yes, I will be leading this group. What would you like to accomplish during this
time?"
C. "Yes, I have been assigned to be the leader of this group. I will be here for the next
six weeks."
D. "Yes, I am the leader. You seem angry about not being the leader yourself." -
Answers :B. "Yes, I will be leading this group. What would you like to accomplish during
this time?"
Anxiety over participation in a group and testing of the leader characteristically occur in
the initial phase of group dynamics.
(B) provides information and focuses the group back to defining its function.
(A) is manipulative bargaining.
Although (C) provides information, it does not focus the group on its purpose or task.
(D) is interpreting the client's feelings and is almost challenging.
Over a period of several weeks, one male participant of a socialization group at a
community day care center for the elderly monopolizes most of the group's time and
interrupts others when they are talking. What is the best action for the nurse to take in
this situation?
EVOLVE HESI QUESTIONS
A 38-year-old female client is admitted with a diagnosis of paranoid schizophrenia.
When her tray is brought to her, she refuses to eat and tells the nurse, "I know you are
trying to poison me with that food." Which response would be most appropriate for the
nurse to make?
A. "I'll leave your tray here. I am available if you need anything else."
B. "You're not being poisoned. Why do you think someone is trying to poison you?"
C. "No one on this unit has ever died from poisoning. You're safe here."
D. "I will talk to your healthcare provider about the possibility of changing your diet." -
Answers :A. "I'll leave your tray here. I am available if you need anything else."
(A) is the best choice cited. The nurse does not argue with the client nor demand that
she eat, but offers support by agreeing to "be there if needed", e. g., to warm the food.
(B and C) are arguing with the client's delusions, and (B) asks "why" which is usually not
a good question for a psychotic client. (D) has nothing to do with the actual problem; i.
e., the problem is not the diet (she thinks any food given to her is poisoned).
A 25-year-old female client has been particularly restless and the nurse finds her trying
to leave the psychiatric unit. She tells the nurse, "Please let me go! I must leave
because the secret police are after me." Which response is best for the nurse to make?
A. "No one is after you, you're safe here."
B. "You'll feel better after you have rested."
C. "I know you must feel lonely and frightened."
D. "Come with me to your room and I will sit with you." - Answers :D. "Come with me to
your room and I will sit with you."
(D) is the best response because it offers support without judgment or demands. (A) is
arguing with the client's delusion. (B) is offering false reassurance. (C) is a violation of
therapeutic communication in that the nurse is telling the client how she feels
(frightened and lonely), rather than allowing the client to describe her own feelings.
Hallucinating and/or delusional clients are not capable of discussing their feelings,
particularly when they perceive a crisis.
A 45-year-old male client tells the nurse that he used to believe that he was Jesus
Christ, but now he knows he is not. Which response is best for the nurse to make?
A. "Did you really believe you were Jesus Christ?"
B. "I think you're getting well."
C. "Others have had similar thoughts when under stress."
D. "Why did you think you were Jesus Christ?" - Answers :C. "Others have had similar
thoughts when under stress."
(C) offers support by assuring the client that others have suffered as he has (also the
principle on which Alcoholics Anonymous acts). (A) is belittling. (B) is making an
,inappropriate judgment. You may have narrowed your choices to (C and D). However,
you should eliminate (D) because it is a "why" question, and the client does not know
why!
A nurse working in the emergency room of a children's hospital admits a child whose
injuries could have resulted from abuse. Which statement most accurately describes the
nurse's responsibility in cases of suspected child abuse?
A. The nurse should obtain objective data such as x-rays before reporting suspicions to
the authorities.
B. The nurse should confirm any suspicions of child abuse with the healthcare provider
before reporting to the authorities.
C. The nurse should report any case of suspected child abuse to the nurse in charge.
D. The nurse should note in the client's record any suspicions of child abuse so that a
history of such suspicions can be tracked. - Answers :C. The nurse should report any
case of suspected child abuse to the nurse in charge.
It is the nurse's legal responsibility to report all suspected cases of child abuse.
Notifying the charge nurse starts the legal reporting process (C).
A client who is being treated with lithium carbonate for bipolar disorder develops
diarrhea, vomiting, and drowsiness. What action should the nurse take?
A. Notify the healthcare provider immediately and prepare for administration of an
antidote.
B. Notify the healthcare provider of the symptoms prior to the next administration of the
drug.
C. Record the symptoms as normal side effects and continue administration of the
prescribed dosage.
D. Hold the medication and refuse to administer additional amounts of the drug. -
Answers :B. Notify the healthcare provider of the symptoms prior to the next
administration of the drug.
Early side effects of lithium carbonate (occurring with serum lithium levels below 2.0
mEq per liter) generally follow a progressive pattern beginning with diarrhea, vomiting,
drowsiness, and muscular weakness. At higher levels, ataxia, tinnitus, blurred vision,
and large dilute urine output may occur. (B) is the best choice. Although these are
expected symptoms, the healthcare provider should be notified prior to the next
administration of the drug. (A, C, and D) would not reflect good nursing judgment.
A client on the psychiatric unit appears to imitate a certain nurse on the unit. The client
seeks out this particular nurse and imitates the nurse's mannerisms. The nurse knows
that the client is using which defense mechanism?
A. Sublimation.
B. Identification.
C. Introjection.
D. Repression. - Answers :B. Identification.
, Identification (B) is an attempt to be like someone or emulate the personality traits of
another. (A) is substituting an unacceptable feeling for one that is more socially
acceptable. (C) is incorporating the values or qualities of an admired person or group
into one's own ego structure. (D) is the involuntary exclusion of painful thoughts or
memories from one's awareness.
The nurse is planning the care for a 32-year-old male client with acute depression.
Which nursing intervention would be best in helping this client deal with his depression?
A. Ensure that the client's day is filled with group activities.
B. Assist the client in exploring feelings of shame, anger, and guilt.
C. Allow the client to initiate and determine activities of daily living.
D. Encourage the client to explore the rationale for his depression. - Answers :B. Assist
the client in exploring feelings of shame, anger, and guilt.
Depression is associated with feelings of shame, anger, and guilt. Exploring such
feelings is an important nursing intervention for the depressed client (B). If the client's
day is filled with group activities (A) he might not have the opportunity to explore these
feelings. (C) is a good intervention for the chronically depressed client who exhibits
vegetative signs of depression. (D) is essentially asking the client "why" he is
depressed--avoid "whys" disguised as "rationale."
At the first meeting of a group of older adults at a daycare center for the elderly, the
nurse asks one of the members what kinds of things she would like to do with the group.
The older woman shrugs her shoulders and says, "You tell me, you're the leader." What
is the best response for the nurse to make?
A. "Yes, I am the leader today. Would you like to be the leader tomorrow?"
B. "Yes, I will be leading this group. What would you like to accomplish during this
time?"
C. "Yes, I have been assigned to be the leader of this group. I will be here for the next
six weeks."
D. "Yes, I am the leader. You seem angry about not being the leader yourself." -
Answers :B. "Yes, I will be leading this group. What would you like to accomplish during
this time?"
Anxiety over participation in a group and testing of the leader characteristically occur in
the initial phase of group dynamics.
(B) provides information and focuses the group back to defining its function.
(A) is manipulative bargaining.
Although (C) provides information, it does not focus the group on its purpose or task.
(D) is interpreting the client's feelings and is almost challenging.
Over a period of several weeks, one male participant of a socialization group at a
community day care center for the elderly monopolizes most of the group's time and
interrupts others when they are talking. What is the best action for the nurse to take in
this situation?
