Mental Health Concepts
Question 1
pts
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?
Projection
Sublimation
Correct!
Displacement
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
Question 2
, pts
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?
“I don’t believe that you have been following your diet, because you haven’t lost any
weight.”
Correct!
“Some people have added exercise to diet and medication therapy and gotten positive
results. Do you think that this would work for you?”
“Sounds fine to me. Let’s meet again in 6 months.”
“Well, you’ve talked about diet in your terms, but perhaps I should test you on specific
things.”
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
Question 3
pts
,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?
“Don’t worry. Everyone who comes in here for the first time feels reluctant to talk.”
“Why not just start talking and see where it takes you?”
“If I were you, I’d begin with what you were doing this morning.”
Correct!
“Perhaps you can start by sharing some of your most recent concerns.”
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 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
Question 4
pts
, 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?
Correct!
“It seems that your parents expect you to follow their rules when you live under their
roof.”
“Well, if you directly discussed your concerns with them, I guess it’s a case of ‘When in
Rome, do as the Romans do.’”
“Well, I guess you could move out and live on your own if you wanted to.”
“You tell me you live rent free, yet you expect the same privileges as an adult who
supports the household?”
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 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
Question 1
pts
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?
Projection
Sublimation
Correct!
Displacement
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
Question 2
, pts
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?
“I don’t believe that you have been following your diet, because you haven’t lost any
weight.”
Correct!
“Some people have added exercise to diet and medication therapy and gotten positive
results. Do you think that this would work for you?”
“Sounds fine to me. Let’s meet again in 6 months.”
“Well, you’ve talked about diet in your terms, but perhaps I should test you on specific
things.”
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
Question 3
pts
,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?
“Don’t worry. Everyone who comes in here for the first time feels reluctant to talk.”
“Why not just start talking and see where it takes you?”
“If I were you, I’d begin with what you were doing this morning.”
Correct!
“Perhaps you can start by sharing some of your most recent concerns.”
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 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
Question 4
pts
, 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?
Correct!
“It seems that your parents expect you to follow their rules when you live under their
roof.”
“Well, if you directly discussed your concerns with them, I guess it’s a case of ‘When in
Rome, do as the Romans do.’”
“Well, I guess you could move out and live on your own if you wanted to.”
“You tell me you live rent free, yet you expect the same privileges as an adult who
supports the household?”
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 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
