N3381 MENTAL HEALTH UPDATED
COMPREHENSIVE EXAM QUESTIONS AND ANSWERS
SURE A+
✔✔The nurse preparing to admit a client with a diagnosis of obsessive-compulsive
disorder to the mental health unit should expect to note which behaviors in the client?
1.Sad and tearful
2.Suspicious and hostile
3.Frightened and delusional
4.Rigidness in thought and inflexibility - ✔✔Rigidness in thought and inflexibility
Rationale:Rigid and inflexible behaviors are characteristic of the client with obsessive-
compulsive disorder (OCD). Clients with this disorder usually are not hostile unless they
are prevented from engaging in the obsession or compulsion because this behavior is
what decreases the anxiety. None of the other options are associated with OCD.
✔✔The nurse determines that the client understands the basis of the diagnosis of
obsessive-compulsive disorder after making which statement?
1."Inner voices tell me to perform my rituals."
2."My behavior is a conscious attempt to punish myself."
3."I'm demonstrating control when I engage in my rituals."
,4."My rituals are ways for me to control unpleasant thoughts or feelings." - ✔✔"My
rituals are ways for me to control unpleasant thoughts or feelings."
Rationale:In obsessive-compulsive disorder (OCD), the rituals performed by the client
are an unconscious response that helps to divert and control the unpleasant thought or
feeling and prevent acting on it. This decreases the client's anxiety. OCD is not
associated with a need for control or punishment, or with hallucinations.
✔✔The nurse is performing an assessment on a client being admitted to the mental
health unit. During the interview, the nurse discovers that the client suffered a severe
emotional trauma 1 month earlier and is now experiencing paralysis of the right arm.
Which is the initial nursing action?
1.Refer the client to a psychiatrist.
2.Encourage the client to move and use the arm.
3.Assess the client for organic causes of the paralysis.
4.Encourage the client to talk about his or her feelings. - ✔✔Assess the client for
organic causes of the paralysis.
Rationale:The initial nursing action would be to assess for any physiological causes of
the paralysis. Although the client may be referred to a psychiatrist, this is not the initial
action. It is not appropriate to encourage the client to use the arm without ruling out a
physiological cause of the paralysis. Although a component of the plan of care would be
to encourage the client to discuss feelings, this would not be the initial nursing action.
✔✔The nurse is developing a plan of care for a client admitted to the mental health unit
with a diagnosis of obsessive-compulsive disorder. What is the nurse's priority in the
plan of care?
1.Monitor for repetitive behavior.
2.Demand active participation in care.
3.Educate the client about self-care needs.
4.Establish a trusting nurse-client relationship. - ✔✔Establish a trusting nurse-client
relationship.
Rationale:The priority is to establish a trusting relationship with the client. Demanding
anything from the client should never occur. The remaining options are appropriate
components of the plan of care but are not the priority. A trusting nurse-client
relationship needs to be established first.
✔✔A newly admitted client is exhibiting signs and symptoms associated with a loss of
physical functioning, although no such loss can be confirmed medically. This situation
supports which mental health diagnosis?
1.Depression
2.Somatization disorder
,3.Post-traumatic stress disorder
4.Obsessive-compulsive disorder - ✔✔Somatization disorder
Rationale:Emotional turmoil expressed in physical signs is the hallmark of somatization
disorder. None of the other options are associated with loss of physical function.
✔✔A heroin-addicted client who is taking methadone hydrochloride discontinues the
methadone without consulting the primary health care provider. The client says to the
nurse, "I thought I didn't need the methadone after 1 year. I had a job and was even
saving money. I can't believe I ruined everything." Which statement by the nurse is
therapeutic?
1."It sounds as if everything you do is either all or nothing."
2."Talk to your counselor; maybe everything isn't ruined yet."
3."You will need to restart your recovery starting from the beginning." 4."We need to
prepare you to recognize those things that trigger you to relapse." - ✔✔"We need to
prepare you to recognize those things that trigger you to relapse."
Rationale:The therapeutic statement is the one that helps the client to reframe with
more moderation. In reframing, the nurse focuses on the positive aspects of learning to
overcome failure. The nurse must avoid being condescending or overly negative. The
nurse uses an example of 1 support system that still exists to detour the faulty thinking.
However, the nurse does not have the ability to know whether the counselor is
supportive, so this is not the therapeutic statement.
✔✔Which piece of subjective data obtained during assessment of a severely anxious
client would indicate the possibility of post-traumatic stress disorder?
1."I'm always crying."
2."I'm afraid to go outside."
3."I keep reliving the abuse."
4."I keep washing my hands over and over." - ✔✔"I keep reliving the abuse."
Rationale:In post-traumatic stress disorder, the client relives the traumatic experience.
Only the correct option includes the defining characteristic symptom of post-traumatic
stress disorder. Fear of going outside is characteristic of a phobia, while always crying
may indicate depression. Excessive hand washing is a characteristic of obsessive-
compulsive disorder.
✔✔Which statement, made by a client who has recently experienced an emotional
crisis, is most likely to assure the nurse that the client has returned to her precrisis level
of functioning?
1."My husband tells me that I'm back to my old cheerful self."
2."My boss tells me that I'm being considered for a promotion and a raise."
, 3."When I find myself getting stressed, I immediately use the relaxation techniques I've
learned."
4."I have a different perspective on life now. I'm more confident of my ability to handle
any problem." - ✔✔"My boss tells me that I'm being considered for a promotion and a
raise."
Rationale:The report that the client is doing well at work indicates a level of functioning
amid stress that is at least equal to that of the precrisis period. Being told by her spouse
that she is again cheerful is a positive improvement but is not indicative of general
functioning. Being self-aware and recognizing the need to implement coping methods
appropriately when stress triggers are present is a positive indicator of improvement, as
is an improved sense of empowerment and confidence in handling problems, but
neither indicates the true ability to successfully handle stress efficiently or the client's
return to her precrisis level of functioning.
✔✔The history assessment of a client diagnosed with schizophrenia confirms a routine
that includes smoking 2 packs of cigarettes and drinking 10 cups of coffee daily.
Considering the assessment data, the nurse recognizes which as placing the client at
most risk for injury?
1.Developing lung cancer and/or other respiratory disorders 2.Withdrawal symptoms
triggering a stress-induced relapse 3.Diminishing the effectiveness of psychotropic
medication 4.Developing gastrointestinal disorders, including bleeding ulcers -
✔✔Diminishing the effectiveness of psychotropic medication
Rationale:Both caffeine and nicotine can inhibit the action of psychotropic medications,
which are commonly prescribed for schizophrenia. Although each of the remaining
options presents a risk for injury, ineffective medication therapy presents the greatest
risk for injury that currently affects this client.
✔✔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
- ✔✔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.
COMPREHENSIVE EXAM QUESTIONS AND ANSWERS
SURE A+
✔✔The nurse preparing to admit a client with a diagnosis of obsessive-compulsive
disorder to the mental health unit should expect to note which behaviors in the client?
1.Sad and tearful
2.Suspicious and hostile
3.Frightened and delusional
4.Rigidness in thought and inflexibility - ✔✔Rigidness in thought and inflexibility
Rationale:Rigid and inflexible behaviors are characteristic of the client with obsessive-
compulsive disorder (OCD). Clients with this disorder usually are not hostile unless they
are prevented from engaging in the obsession or compulsion because this behavior is
what decreases the anxiety. None of the other options are associated with OCD.
✔✔The nurse determines that the client understands the basis of the diagnosis of
obsessive-compulsive disorder after making which statement?
1."Inner voices tell me to perform my rituals."
2."My behavior is a conscious attempt to punish myself."
3."I'm demonstrating control when I engage in my rituals."
,4."My rituals are ways for me to control unpleasant thoughts or feelings." - ✔✔"My
rituals are ways for me to control unpleasant thoughts or feelings."
Rationale:In obsessive-compulsive disorder (OCD), the rituals performed by the client
are an unconscious response that helps to divert and control the unpleasant thought or
feeling and prevent acting on it. This decreases the client's anxiety. OCD is not
associated with a need for control or punishment, or with hallucinations.
✔✔The nurse is performing an assessment on a client being admitted to the mental
health unit. During the interview, the nurse discovers that the client suffered a severe
emotional trauma 1 month earlier and is now experiencing paralysis of the right arm.
Which is the initial nursing action?
1.Refer the client to a psychiatrist.
2.Encourage the client to move and use the arm.
3.Assess the client for organic causes of the paralysis.
4.Encourage the client to talk about his or her feelings. - ✔✔Assess the client for
organic causes of the paralysis.
Rationale:The initial nursing action would be to assess for any physiological causes of
the paralysis. Although the client may be referred to a psychiatrist, this is not the initial
action. It is not appropriate to encourage the client to use the arm without ruling out a
physiological cause of the paralysis. Although a component of the plan of care would be
to encourage the client to discuss feelings, this would not be the initial nursing action.
✔✔The nurse is developing a plan of care for a client admitted to the mental health unit
with a diagnosis of obsessive-compulsive disorder. What is the nurse's priority in the
plan of care?
1.Monitor for repetitive behavior.
2.Demand active participation in care.
3.Educate the client about self-care needs.
4.Establish a trusting nurse-client relationship. - ✔✔Establish a trusting nurse-client
relationship.
Rationale:The priority is to establish a trusting relationship with the client. Demanding
anything from the client should never occur. The remaining options are appropriate
components of the plan of care but are not the priority. A trusting nurse-client
relationship needs to be established first.
✔✔A newly admitted client is exhibiting signs and symptoms associated with a loss of
physical functioning, although no such loss can be confirmed medically. This situation
supports which mental health diagnosis?
1.Depression
2.Somatization disorder
,3.Post-traumatic stress disorder
4.Obsessive-compulsive disorder - ✔✔Somatization disorder
Rationale:Emotional turmoil expressed in physical signs is the hallmark of somatization
disorder. None of the other options are associated with loss of physical function.
✔✔A heroin-addicted client who is taking methadone hydrochloride discontinues the
methadone without consulting the primary health care provider. The client says to the
nurse, "I thought I didn't need the methadone after 1 year. I had a job and was even
saving money. I can't believe I ruined everything." Which statement by the nurse is
therapeutic?
1."It sounds as if everything you do is either all or nothing."
2."Talk to your counselor; maybe everything isn't ruined yet."
3."You will need to restart your recovery starting from the beginning." 4."We need to
prepare you to recognize those things that trigger you to relapse." - ✔✔"We need to
prepare you to recognize those things that trigger you to relapse."
Rationale:The therapeutic statement is the one that helps the client to reframe with
more moderation. In reframing, the nurse focuses on the positive aspects of learning to
overcome failure. The nurse must avoid being condescending or overly negative. The
nurse uses an example of 1 support system that still exists to detour the faulty thinking.
However, the nurse does not have the ability to know whether the counselor is
supportive, so this is not the therapeutic statement.
✔✔Which piece of subjective data obtained during assessment of a severely anxious
client would indicate the possibility of post-traumatic stress disorder?
1."I'm always crying."
2."I'm afraid to go outside."
3."I keep reliving the abuse."
4."I keep washing my hands over and over." - ✔✔"I keep reliving the abuse."
Rationale:In post-traumatic stress disorder, the client relives the traumatic experience.
Only the correct option includes the defining characteristic symptom of post-traumatic
stress disorder. Fear of going outside is characteristic of a phobia, while always crying
may indicate depression. Excessive hand washing is a characteristic of obsessive-
compulsive disorder.
✔✔Which statement, made by a client who has recently experienced an emotional
crisis, is most likely to assure the nurse that the client has returned to her precrisis level
of functioning?
1."My husband tells me that I'm back to my old cheerful self."
2."My boss tells me that I'm being considered for a promotion and a raise."
, 3."When I find myself getting stressed, I immediately use the relaxation techniques I've
learned."
4."I have a different perspective on life now. I'm more confident of my ability to handle
any problem." - ✔✔"My boss tells me that I'm being considered for a promotion and a
raise."
Rationale:The report that the client is doing well at work indicates a level of functioning
amid stress that is at least equal to that of the precrisis period. Being told by her spouse
that she is again cheerful is a positive improvement but is not indicative of general
functioning. Being self-aware and recognizing the need to implement coping methods
appropriately when stress triggers are present is a positive indicator of improvement, as
is an improved sense of empowerment and confidence in handling problems, but
neither indicates the true ability to successfully handle stress efficiently or the client's
return to her precrisis level of functioning.
✔✔The history assessment of a client diagnosed with schizophrenia confirms a routine
that includes smoking 2 packs of cigarettes and drinking 10 cups of coffee daily.
Considering the assessment data, the nurse recognizes which as placing the client at
most risk for injury?
1.Developing lung cancer and/or other respiratory disorders 2.Withdrawal symptoms
triggering a stress-induced relapse 3.Diminishing the effectiveness of psychotropic
medication 4.Developing gastrointestinal disorders, including bleeding ulcers -
✔✔Diminishing the effectiveness of psychotropic medication
Rationale:Both caffeine and nicotine can inhibit the action of psychotropic medications,
which are commonly prescribed for schizophrenia. Although each of the remaining
options presents a risk for injury, ineffective medication therapy presents the greatest
risk for injury that currently affects this client.
✔✔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
- ✔✔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.
