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HESI Extra Credit Module 3 Exam.
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
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.”
,HESI Extra Credit Module 3 Exam.
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
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
,HESI Extra Credit Module 3 Exam.
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
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
Rationale: The therapeutic
Romans do.’” 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
, HESI Extra Credit Module 3 Exam.
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
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.
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