MENTAL HEALTH CONCEPTS; GERONTICS; DEATH AND DYING WITH SPIRITUAL WELLNESS

1. The CNS is composed of the brain, the spinal cord, and associated nerves that control voluntary acts.
Structurally the brain is divided into the cerebrum, cerebellum, brain stem, and limbic system. An
emergency psychiatric client presents with amnesia, hyperthermia and unexplained loss of appetite.
Accompanying family members state that the client suffered a head injury while falling from a ladder
several days previously. The nurse concludes that the client’s symptoms are consistent with trauma to
which area of the brain?
A. Thalamus
B. Hypothalamus
C. Cerebrum
D. Cerebellum

2. Psychoanalytic theory supports the notion that all human behavior is caused and can be explained
(deterministic theory). Freud believed that repressed (driven from conscious awareness) sexual
impulses and desires motivated much human behavior. Under the psychoanalytic model of Freud, the
ego functions include all of the following except:
A. Store up experiences in memory
B. Operate on the pleasure principle to reduce tension or discomfort
C. Control and regulate instinctual drives
D. Use defense mechanism to protect self

3. Psychosocial growth occurs in sequential phases and each stage is dependent on completion of the
previous stage and life task. The nurse is aware that according to Erikson, a young child’s increased
vulnerability to anxiety in response to separations or pending separations from significant others
results from failure to complete the developmental task called:
A. Trust
B. Identity
C. Initiative
D. Autonomy
4. The clients in psychiatric nursing includes individuals, families, groups and communities. The scope of
psychiatric nursing encompasses primary to tertiary level of prevention. Secondary level of prevention
in mental health and psychiatric nursing encompasses all of the following except:
A. Assisting the community to better understand basic emotional needs
B. Electroconvulsive therapy for manic patients
C. Mini mental exam in the admission room
D. Haldol for Mang Boyet, a schizophrenic patient

5. Mental health problems have 4 facets as a public health burden. Mang Lerkey has been diagnosed to
have Bipolar Disorder. He is now being discriminatedby the community and is labeled as “Baliw”
because of his illness. This is an example of ?
A. Defined burden
B. Undefined burden
C. Hidden burden
D. Future burden
 6. A 16-year old client with a diagnosis of undifferentiated schizophrenia has become very clingy and
begins sucking her thumb while interacting with the nurse. The nurse interprets this behavior as which
of the following?
A. Repression
B. Regression
C. Rationalization
D. Projection

Rationale:
Regression, a return to earlier behavior in order to reduce anxiety, is the basic defense mechanism in
schizophrenia. Repression is the blocking of unacceptable thoughts or impulses from the consciousness.
Rationalization is a defense mechanism used to justify one’s behavior. Projection is a defense mechanism in
which one blames others and attempts to justify actions.

7. The nurse is developing short-term goals for a client who repeatedly makes statements about not
deserving things. The nurse determines that which of the following is an appropriate short-term goal?
A. Identify distorted thoughts
B. Describe self-care patterns
C. Discuss family relationships
D. Explore communication skills

Rationale:
It’s important to identify distorted thinking because self-deprecating thoughts lead to depression. Self-care
patterns don’t necessarily reflect distorted thinking. Family relationships might not influence distorted
thinking patterns. A form of communication called negative self-talk would be explored only after distorted
thinking patterns were identified.

8. During conversation with a client, the nurse observes that he shifts from one topic to the next on a
regular basis. Which disorder is the client most likely to have?
A. Flight of ideas
B. Concrete thinking
C. Ideas of reference
D. Loose associations

Rationale:
Loose associations are conversations that constantly shift in topic. Loose associations don’t necessarily start
in a disorganized way; the conversations can begin cogently and then become loose. Flight of ideas is
characterized by conversation that’s disorganized from the onset. Concrete thinking implies highly definitive
thought processes. Ideas of reference are characterized by a delusional belief that things irrelevant to the
client, such as newspaper, headlines, are referring the client directly.

9. Nurse Lara is giving a report to the nurse on the next shift. Which description of a client’s experience
and behavior can be shared as an example of the client experiencing an illusion?
A. “The client tried to push me away, hit me, and cursed at me every time I went into the room to
take vital signs.”
B. “Repeatedly the client yelled, ‘I keep hearing my mother’s voice telling me to get dressed and run
away.’”
C. “Whenever I went to leave the room, the client became anxious and grabbed my hand and begged
me to stay.”
 D. “Every time the client looked at the shadows on a wall she said, ‘There are frightening faces on that
wall.’”

Rationale:
An illusion is an inaccurate perception or false response to a sensory stimulus. Auditory hallucinations are
associated with sound and are more common in schizophrenia. Anxiety and agitation can be secondary to
illusions.

10. Sandra is demonstrating hostility toward the nursing staff he just met. The nurse interprets the
behavior as:
A. Intellectualization
B. Transference
C. Triangulation
D. Splitting

Rationale:
Transference is the unconscious assignment of negative or positive feelings evoked by a significant person in
the client’s past to another person. Intellectualization is a defense mechanism in which the client avoids
dealing with emotions by focusing on facts. Triangulation refers to conflicts involving three family members.
Splitting is a defense mechanism commonly seen in clients with personality disorders in which the world is
perceived as all good or all bad.

11. Jose was hospitalized after his son filed a petition for involuntary hospitalization for safety reasons.
Jose’s son seeks out the nurse because his father is angry and refuses to talk with him. He’s frustrated
and feeling very guilty about his decision. What is the most appropriate response by the nurse?
A. “Your father is here because he needs help.”
B. “He’ll feel differently about you as he gets better.”
C. “It sounds like you’re feeling guilty about leaving your father here.”
D. “This is a stressful time for you, but you’ll feel better as he gets well.”

Rationale:
This response focuses on the son and helps him discuss and deal with his feelings. Unresolved feelings of
guilt, shame, isolation, and loss of hope impact on the family’s ability to manage the crisis and be
supportive to the client. The other options offer premature reassurance and cut off the opportunity for the
son to discuss his feelings.

12. An acutely manic client kisses a nurse on the lips and asks her to marry him. The nurse is taken by
surprise. What is the most appropriate response by the nurse?
A. Seclude the client for his inappropriate behavior
B. Ask the client what he’s trying to prove by his behavior
C. Ask the client to fold some laundry
D. Tell the client his behavior is offensive

Rationale:
Having the client help with laundry rechannels his energy in a positive activity. The client needs direction
and structure, not seclusion. Asking the client what he’s trying to prove ignores his impaired judgement and
poor impulse control. Telling the client his behavior is offensive doesn’t assist him in controlling his
behavior.
 13. A delusional client approaches a nurse, states, “I am the Easter Bunny,” and insists that the nurse refer
to him as such. Which nursing interventions should the nurse implement when working with this
client?
1. Consistently use the client’s name in interaction
2. Smile at the humor of the situation
3. Agree that the client is the Easter Bunny
4. Logically point out why the client could not be the Easter Bunny
5. Provide as needed medication
6. Provide the client with structured activities

A. 1 and 6
B. 1, 2, 4, 6
C. 1, 3, 5
D. All of the above

Rationale:
Continued reality-based orientation is necessary, so it is appropriate to use the client’s name in any
interaction. Structured activities can help the client refocus and resolve his delusion. The nurse shouldn’t
contribute to the delusion by going along with the situation. Logical arguments and as needed medication
aren’t likely to change the client’s beliefs.

14. The nurse needs to communicate with a client experiencing mania. It is most important for the nurse
to do which of the following?
A. Address the client in a light and joking manner.
B. Focus and redirect the conversation as necessary.
C. Allow the client to talk about several different topics.
D. Ask only open-ended questions to facilitate conversation.

Rationale:
To decrease stimulation, the nurse should attempt to redirect and focus the client’s communication, not
allow the client to talk about different topics. By addressing the client in a light and joking manner the
conversation may contribute to the client’s feelings out of control. For a manic client, it’s best to ask closed
questions because open-ended questions may enable the client to talk endlessly, again possibly
contributing to the client’s feeling out of control.

15. Gender identity disorder in adult involves the discomfort with one’s gender or the role of that gender.
In adult, this disorder can include the desire to live as the other gender or can involve feelings and
reactions of the other gender. What is the gender identity disorder that results in the person believing
he or she is the opposite sex?
A. Exhibitionism
B. Homosexuality
C. Transsexualism
D. Transvestitism
16. A 17-year-old client has a record of being absent in the class without permission, and “borrowing” other people’s things without asking permission. The
client denies stealing; rationalizing instead that as long as no one was using the items, there is no problem to use it by other people. It is important for the
nurse to understand that psychodynamically, the behavior of the client may be largely attributed to a development defect related to the:

A. Oedipal complex C. Id
B. Superego D. Ego
Rationale B. This shows a weak sense of moral consciousness. According to Freudian theory, personality disorders stem from a weak superego.

17. A client tells the nurse, “Yesterday, I was planning to kill myself.” What is the best nursing response to this client?

A. “What are you going to do this time?”

B. Say nothing. Wait for the client’s next comment
C. “You seem upset. I am going to be here with you; perhaps you will want to talk about it”
D. “Have you felt this way before?”

Rationale: C. The client needs to have his or her feelings acknowledged, with encouragement to discuss feelings, and be reassured about the nurse’s
presence

18. A client in the psychiatric unit is shouting out loud and tells the nurse, “Please, help me. They are coming to get me.” What would be the appropriate
nursing response?

A. “ I won’t let anyone get you.”

B. “Who are they?”
C. “I don’t see anyone coming.”
D. “You look frightened.”

Rationale: C. This option is an example of pointing out reality- the nurse’s perception.

19. A nurse is going to give a rectal suppository as a preoperative medication to a 4-year-old boy. The boy is very anxious and frightened. Which of the
following statement by the nurse would be most appropriate to gain the child’s cooperation?

A. “Be a big kid! Everyone’s waiting for you.”

B. “Lie still now and I’ll let you have one of your presents before you even have your operation.”
C. “Take a nice, big, deep breath and then let me hear you count to five.”
D. “You look so scared. Want to know a secret? This won’t hurt a bit!”

Rationale : C. Preschool children commonly experience fears and fantasies regarding invasive procedures. The nurse should attempts to momentarily
distract the child with a simple task that can be easily accomplished while the child remains in the side-lying position. The suppository can be slipped into
place while the child is counting, and then the nurse can praise the child for cooperating, while holding the buttocks together to prevent expulsion of the
suppository.

20. A client is withdrawn and does not want to interact to anybody even to the nurse. What is the best initial nursing approach to encourage communication
with this client?

A. Use simple questions that call for a response.

B. Encourage discussion of feelings.
C. Look through a photo album together.
D. Bring up neutral topic

Rationale: D. Neutral, nonthreatening topics are best in attempting to encourage a response.