Exam (elaborations)
Psych/Mental Health Exit HESI – Saunders Exam/110 Q’s and A’s
Psych/Mental Health Exit HESI – Saunders Exam/110 Q’s and A’s
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Psych/Mental Health Exit HESI –Saunders Exam/110 Q’s and A’s
The home care nurse is visiting an older client whose spouse died 6 months
ago. Which behavior by the client indicates ineffective coping?
1. Neglecting personal grooming
2. Looking at old snapshots of family
3. Participating in a senior citizens' program
4. Visiting their spouse's grave once a month - -1. Neglecting personal
grooming
Rational:
Coping mechanisms are behaviors used to decrease stress and anxiety. In
response to a death, ineffective coping is manifested by an extreme behavior
that in some cases may be harmful to the individual physically or
psychologically. The correct option is indicative of a behavior that identifies
an ineffective coping behavior in the grieving process.
-A client with a diagnosis of major depression who has attempted suicide
says to the nurse, "I should have died. I've always been a failure. Nothing
ever goes right for me." Which response demonstrates therapeutic
communication?
1. "You have everything to live for."
2. "Why do you see yourself as a failure?"
3. "Feeling like this is all part of being depressed."
4. "You've been feeling like a failure for a while?" - -4. "You've been feeling
like a failure for a while?"
Rationale:
Responding to the feelings expressed by a client is an effective therapeutic
communication technique. The correct option is an example of the use of
restating. The remaining options block communication because they
minimize the client's experience and do not facilitate exploration of the
client's expressed feelings. In addition, use of the word "why" is
nontherapeutic.
-When the mental health nurse visits a client at home, the client states, "I
haven't slept at all the last couple of nights." Which response by the nurse
illustrates a therapeutic communication response to this client?
1. "I see."
2. "Really?"
,3. "You're having difficulty sleeping?"
4. "Sometimes, I have trouble sleeping too." - -3. "You're having difficulty
sleeping?"
Rationale:
The correct option uses the therapeutic communication technique of
restatement. Although restatement is a technique that has a prompting
component to it, it repeats the client's major theme, which assists the nurse
to obtain a more specific perception of the problem from the client. The
remaining options are not therapeutic responses since none encourage the
client to expand on the problem. Offering personal experiences moves the
focus away from the client and onto the nurse.
-A client experiencing disturbed thought processes believes that his food is
being poisoned. Which communication technique should the nurse use to
encourage the client to eat?
1. Using open-ended questions and silence
2. Sharing personal preference regarding food choices
3. Documenting reasons why the client does not want to eat
4. Offering opinions about the necessity of adequate nutrition - -1. Using
open-ended questions and silence
Rationale:
Open-ended questions and silence are strategies used to encourage clients
to discuss their problems. Sharing personal food preferences is not a client-
centered intervention. The remaining options are not helpful to the client
because they do not encourage the client to express feelings. The nurse
should not offer opinions and should encourage the client to identify the
reasons for the behavior.
-A client admitted to a mental health unit for treatment of psychotic
behavior spends hours at the locked exit door shouting, "Let me out. There's
nothing wrong with me. I don't belong here." What defense mechanism is the
client implementing?
1. Denial
2. Projection
3. Regression
4. Rationalization - -1. Denial
Rationale:
Denial is refusal to admit to a painful reality, which is treated as if it does not
exist. In projection, a person unconsciously rejects emotionally unacceptable
features and attributes them to other persons, objects, or situations.
Regression allows the client to return to an earlier, more comforting,
,although less mature, way of behaving. Rationalization is justifying illogical
or unreasonable ideas, actions, or feelings by developing acceptable
explanations that satisfy the teller and the listener.
-A client diagnosed with terminal cancer says to the nurse, "I'm going to die,
and I wish my family would stop hoping for a cure! I get so angry when they
carry on like this. After all, I'm the one who's dying." Which response by the
nurse is therapeutic?
1. "Have you shared your feelings with your family?"
2. "I think we should talk more about your anger with your family."
3. "You're feeling angry that your family continues to hope for you to be
cured?"
4. "You are probably very depressed, which is understandable with such a
diagnosis." - -3. "You're feeling angry that your family continues to hope for
you to be cured?"
Rationale:
Restating is a therapeutic communication technique in which the nurse
repeats what the client says to show understanding and to review what was
said. While it is appropriate for the nurse to attempt to assess the client's
ability to discuss feelings openly with family members, it does not help the
client discuss the feelings causing the anger. The nurse's attempt to focus on
the central issue of anger is premature. The nurse would never make a
judgment regarding the reason for the client's feeling; this is nontherapeutic
in the one-to-one relationship.
-On review of the client's record, the nurse notes that the mental health
admission was voluntary. Based on this information, the nurse anticipates
which client behavior?
1. Fearfulness regarding treatment measures.
2. Anger and aggressiveness directed toward others.
3. An understanding of the pathology and symptoms of the diagnosis.
4. A willingness to participate in the planning of the care and treatment plan.
- -4. A willingness to participate in the planning of the care and treatment
plan.
Rationale:
In general, clients seek voluntary admission. If a client seeks voluntary
admission, the most likely expectation is that the client will participate in the
treatment program since they are actively seeking help. The remaining
options are not characteristics of this type of admission. Fearfulness, anger,
and aggressiveness are more characteristic of an involuntary admission.
Voluntary admission does not guarantee a client's understanding of their
illness, only of their desire for help.
, -When reviewing the admission assessment, the nurse notes that a client
was admitted to the mental health unit involuntarily. Based on this type of
admission, the nurse should provide which intervention for this client?
1. Monitor closely for harm to self or others.
2. Assist in completing an application for admission.
3. Supply the client with written information about their mental illness.
4. Provide an opportunity for the family to discuss why they felt the
admission was needed. - -1. Monitor closely for harm to self or others.
Rationale:
Involuntary admission is necessary when a person is a danger to self or
others or is in need of psychiatric treatment regardless of the client's
willingness to consent to the hospitalization. A written request is a
component of a voluntary admission. Providing written information regarding
the illness is likely premature initially. The family may have had no role to
play in the client's admission.
-The nurse is preparing a client for the termination phase of the nurse-client
relationship. The nurse prepares to implement which nursing task that is
most appropriate for this phase?
1. Planning short-term goals
2. Making appointment referrals
3. Developing realistic solutions
4. Identifying expected outcomes - -2. Making appointment referrals
Rationale:
Tasks of the termination phase include evaluating client performance,
evaluating achievement of expected outcomes, evaluating future needs,
making appropriate referrals, and dealing with the common behaviors
associated with termination. The remaining options identify tasks
appropriate for the working phase of the relationship.
-The nurse in the mental health unit recognizes which as being therapeutic
communication techniques? Select all that apply.
1. Restating
2. Listening
3. Asking the client, "Why?"
4. Maintaining neutral responses
5. Providing acknowledgment and feedback
6. Giving advice and approval or disapproval - -1, 2, 4, 5
Rationale:
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