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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 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 and
, Extra 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 this
, Extra 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 the
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