Extra Credit HESI Module 3 – Mental Health Concepts
1. Questions
1. 1.ID: 9477081360
The mother of a 3-year-old child tells the nurse that her child
... [Show More] 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
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 .
Reference: Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental
health nursing: A communication approach to evidence-based care (p. 133). St.
Louis: Saunders.
Cognitive Ability: Understanding
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process/Assessment
Content Area: Mental Health
Giddens Concepts: Development, Mood and Affect
HESI Concepts: Developmental, Mood and Affect
Awarded 1.0 points out of 1.0 possible points.
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.”Extra Credit HESI Module 3 – Mental Health Concepts
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. Review: therapeutic communication
techniques .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 27-31, 553). St. Louis: Mosby.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Health Promotion
HESI Concepts: Communication, Health, Wellness, and Illness—Health
Promotion
Awarded 1.0 points out of 1.0 possible points.
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 andExtra Credit HESI Module 3 – Mental Health Concepts
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
.
References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 27-31). St. Louis: Mosby.
Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health
nursing: A communication approach to evidence-based care (pp. 117-118). St.
Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Mood and Affect
HESI Concepts: Communication, Mood and Affect
Awarded 1.0 points out of 1.0 possible points.
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 thisExtra Credit HESI Module 3 – Mental Health Concepts
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 .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 27-31). St. Louis: Mosby.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Family Dynamics
HESI Concepts: Communication, Developmental—Family Dynamics
Awarded 1.0 points out of 1.0 possible points.
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
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 theExtra Credit HESI Module 3 – Mental Health Concepts
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 .
Reference: Fortinash, K., & Holoday-Worret, P. (2008). Psychiatric mental
health nursing (4th ed., pp. 596, 599-600). St. Louis: Mosby.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Clinical Judgment, Mood and Affect
HESI Concepts: Clinical Decision-Making, Mood and Affect
Awarded 1.0 points out of 1.0 possible points.
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 (9thExtra Credit HESI Module 3 – Mental Health Concepts
ed., pp. 27-31). St. Louis: Mosby.
Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health
nursing: A communication approach to evidence-based care (pp. 380, 381). St.
Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Family Dynamics
HESI Concepts: Communication, Developmental—Family Dynamics
Awarded 1.0 points out of 1.0 possible points.
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.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process/Planning
Content Area: Mental Health
Giddens Concepts: Clinical Judgment, Immunity
HESI Concepts: Clinical Decision-Making/Clinical Judgment, Immunity
Awarded 1.0 points out of 1.0 possible points.
8. 8.ID: 9477084366Extra Credit HESI Module 3 – Mental Health Concepts
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 of mourning. Recalling the tasks of mourning will direct
you to the correct options. Review the tasks related to mourning and grief and
loss if you had difficulty with this question.
Reference:Varcarolis, E., & Halter, M. (2010).
Foundations of Psychiatric Mental Health Nursing: A Clinical Approach. (6th
ed., p. 453). Philadelphia: W.B. Saunders.
Cognitive Ability:Analyzing
Client Needs: Psychosocial IntegrityIntegrated Process: Nursing
Process/Assessment
Content Area: Mental Health Giddens Concepts: Family Dynamics, Stress
HESI Concepts: Grief and Loss, Stress and Coping
Awarded 4.0 points out of 4.0 possible points.
9. 9.ID: 9477089778
The psychiatric nurse is caring for a 15-year-old girl who has been hospitalized
for bipolar disorder. The client tells the nurse that she had her hair styled just
like her young math teacher, whom she admires. Which defense mechanism
should the nurse recognize that the client is using?
A. Projection
B. Regression
C. Identification Correct
D. Intellectualization
Rationale: Identification is the process by which a person tries to become like
someone he or she admires by taking on the beliefs, mannerisms, or tastes of
that person. Projection is attributing one's thoughts or impulses to another
person. Regression is retreating to a behavior characteristic of an earlier level
of development. Intellectualization is excessive reasoning or logic used to avoidExtra Credit HESI Module 3 – Mental Health Concepts
experiencing disturbed feelings.
Test-Taking Strategy: Focus on the subject, the client adjusting her appearance
based on a person she admires. Noting that the client is mimicking a
characteristic of another person will direct you to the correct option. Review:
these defense mechanisms .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 377, 378). St. Louis: Mosby.
Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health
nursing: A communication approach to evidence-based care (p. 136). St. Louis:
Saunders.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Clinical Judgment, Mood and Affect
HESI Concepts: Clinical Decision-Making/Clinical Judgment, Mood and Affect
Awarded 1.0 points out of 1.0 possible points.
10. 10.ID: 9477089792
The mental health home care nurse says to the client, “Do you feel ready to try
attending a group session at the clinic?” The client shakes his head. Which
nursing statement would be therapeutic?
A. “No? Why not?”
B. “You seem to be saying no. Would you tell me more about your
reluctance?” Correct
C. “OK, but I hope you will let me know when you feel ready to
attend a group session at the clinic.”
D. “Perhaps a group session would be too overwhelming for you
right now. How about just seeing me?” [Show Less]