HESI MENTAL HEALTH

1. A 30-year-old sales manager tells the nurse, "I am thinking about a job change. I don't feel

like I am living up to my potential." Which of Maslow's developmental stages is the sales

manager attempting to achieve?

A. Self-Actualization. Correct

B. Loving and Belonging.

C. Basic Needs.

D. Safety and Security.

Self-actualization is the highest level of Maslow's development stages, which is an attempt to

fulfill one's full potential (C). (B) is identifying support systems. (C) is the first level of Maslow's

developmental stages and is the foundation upon which higher needs rest. Individuals who feel

safe and secure (D) in their environment perceive themselves as having physical safety and lack

fear of harm.

2. The nurse observes a client who is admitted to the mental health unit and identifies that

the client is talking continuously, using words that rhyme but that have no context or

relationship with one topic to the next in the conversation. This client's behavior and thought

processes are consistent with which syndrome?

A. Dementia.

B. Depression.

C. Schizophrenia. Correct

D. Chronic brain syndrome.

The client is demonstrating symptoms of schizophrenia (C), such as disorganized speech that

may include word salad (communication that includes both real and imaginary words in no

logical order), incoherent speech, and clanging (rhyming). Dementia (A) is a global impairment

of intellectual (cognitive) functions that may be progressive, such as Alzheimer's or organic

brain syndrome (D). Depression (C) is typified by psychomotor retardation, and the client

appearsto be slowed down in movement, in speech, and would appear listless and disheveled.

3. A homeless person who is in the manic phase of bipolar disorder is admitted to the mental

health unit. Which laboratory finding obtained on admission is most important for the nurse

to report to the healthcare provider?

A. Decreased thyroid stimulating hormone level. Correct

B. Elevated liver function profile.

C. Increased white blood cell count.

D. Decreased hematocrit and hemoglobin levels.

Hyperthyroidism causes an increased level of serum thyroid hormones (T3 and T4), which

inhibit the release of TSH (A), so the client's manic behavior may be related to an endocrine

disorder. (B, C, and D) are abnormal findings that are commonly found in the homeless

population because of poor sanitation, poor nutrition, and the prevalence of substance abuse.

4. An adult male client who was admitted to the mental health unit yesterday tells the nurse

that microchips were planted in his head for military surveillance of his every move. Which

response is best for the nurse to provide?

A. You are in the hospital, and I am the nurse caring for you.

B. It must be difficult for you to control your anxiousfeelings.

C. Go to occupational therapy and start a project. Correct

D. You are not in a war area now; this is the United States.

Delusions often generate fear and isolation, so the nurse should help the client participate in

activitiesthat avoid focusing on the false belief and encourage interaction with others (C).

Delusions are often well-fixed, and though (A) reinforces reality, it is argumentative and

dismisses the client's fears. It is often difficult for the client to recognize the relationship

between delusions and anxiety (B), and the nurse should reassure the client that he is in a safe

place. Dismissing delusional thinking (D) is unrealistic because neurochemical imbalances that

cause positive symptoms of schizophrenia require antipsychotic drug therapy.

5. The nurse is assessing a client's intelligence. Which factor should the nurse remember

during this part of the mental status exam?

A. Acute psychiatric illnesses impair intelligence.

B. Intelligence isinfluenced by social and cultural beliefs. Correct

C. Poor concentration skills suggests limited intelligence.

D. The inability to think abstractly indicates limited intelligence.

Social and cultural beliefs (B) have significant impact on intelligence. Chronic psychiatric illness

may impair intelligence (A), especially if it remains untreated. Limited concentration does not

suggest limited intelligence (C). Difficulties with abstractions are suggestive of psychotic

thinking (D), not limited intelligence.

6. At a support meeting of parents of a teenager with polysubstance dependency, a parent

states, "Each time my son tries to quit taking drugs, he gets so depressed that I'm afraid he

will commit suicide." The nurse's response should be based on which information?

A. Addiction is a chronic, incurable disease.

B. Tolerance to the effects of drugs causesfeelings of depression.

C. Feelings of depression frequently lead to drug abuse and addiction.

D. Careful monitoring should be provided during withdrawal from the drugs. Correct

The priority is to teach the parents that their son will need monitoring and support during

withdrawal (D) to ensure that he does not attempt suicide. Although (A and C) are true, they

are not asrelevant to the parent's expressed concern. There is no information to support (B).

7. The wife of a male client recently diagnosed with schizophrenia asks the nurse, "What

exactly is schizophrenia? Is my husband all right?" Which response is best for the nurse to

provide to this family member?

A. It sounds like you're worried about your husband. Let's sit down and talk.

B. It is a chemical imbalance in the brain that causes disorganized thinking. Correct

C. Your husband will be just fine if he takes his medications regularly.

D. I think you should talk to your husband's psychologist about this question.

The nurse should answer the client's question with factual information and explain that

schizophrenia is a chemical imbalance in the brain (B). (A) is a therapeutic response but does

not answer the question, and may be an appropriate response after the nurse answers the

question asked. Although (C) is likely true to some degree, it is also true that some clients

continue to have disorganized thinking even with antipsychotic medications. Referring the

spouse to the psychologist (D) is avoiding the issue; the nurse can and should answer the

question.

8. A young adult male client, diagnosed with paranoid schizophrenia, believes that world is

trying poison him. What intervention should the nurse include in this client's plan of care?

A. Remind the client that his suspicions are not true.

B. Ask one nurse to spend time with the client daily. Correct

C. Encourage the client to participate in group activities.

D. Assign the client to a room closest to the activity room.

A client with paranoid schizophrenia has difficulty with trust and developing a trusting

relationship with one nurse (B) is likely to be therapeutic for this client. (A) is argumentative.

Stress increases anxiety, and anxiety increases paranoid ideation; (C) would be too stressful and

anxiety-promoting for a client who is experiencing pathological suspicions. (D) also might

increase anxiety and stress.

9. The community health nurse talks to a male client who has bipolar disorder. The client

explains that he sleeps 4 to 5 hours a night and is working with his partner to start two new

businesses and build an empire. The client stopped taking his medications several days ago.

What nursing problem has the highest priority?

A. Excessive work activity.

B. Decreased need for sleep.

C. Medication management. Correct

D. Inflated self-esteem.

The most important nursing problem is medication management (C) because compliance with

the medication regimen will help prevent hospitalization. The client is also exhibiting signs of

(A, B, and C); however, these problems do not have the priority of medication management.

10. A female client with obsessive-compulsive disorder (OCD) is describing her obsessions and

compulsions and asks the nurse why these make her feel safer. What information should the

nurse include in this client's teaching plan? (Select all that apply.)

A. Compulsionsrelieve anxiety. Correct

B. Anxiety is the key reason for OCD. Correct

C. Obsessions cause compulsions.

D. Obsessive thoughts are linked to levels of neurochemicals. Correct

E. Antidepressant medications increase serotonin levels. Correct

Correct choices are (A, B, D, and E). To promote client understanding and compliance, the

teaching plan should include explanations about the origin and treatment options of OCD

symptomology. Compulsions are behaviors that help relieve anxiety (A), which is a vague

feeling related to unknown fears, that motivate behavior (B) to help the client cope and feel

secure. All obsessions (C) do not result in compulsive behavior. OCD is supported by the

neurophysiology theory, which attributes a diminished level of neurochemicals (D), particularly

serotonin, and responds to selective serotonin reuptake inhibitors (SSRI).

11. The nurse observes a female client with schizophrenia watching the news on TV. She

begins to laugh softly and says, "Yes, my love, I'll do it." When the nurse questions the client

about her comment she states, "The news commentator is my lover and he speaks to me

each evening. Only I can understand what he says." What is the best response for the nurse

to make?

A. What do you believe the news commentator said to you? Correct

B. Let's watch news on a different television channel.

C. Does the news commentator have plans to harm you or others?

D. The news commentator is not talking to you.

It is imperative that the nurse determine what the client believes she heard (A). The idea of

reference may be to hurt herself or someone else, and the main function of a psychiatric nurse

is to maintain safety. (B) is acceptable, but it is best to determine the client's beliefs. (C) is

validating the idea of reference, while (D) is challenging the client.

12. A 40-year-old male client diagnosed with schizophrenia and alcohol dependence has not

had any visitors or phone calls since admission. He reports he has no family that cares about

him and was living on the streets prior to this admission. According to Erikson's theory of

psychosocial development, which stage is the client in at this time?

A. Isolation.

B. Stagnation. Correct

C. Despair.

D. Role confusion.

The client is in Erikson's "Generativity vs. Stagnation" stage (age 24 to 45), and meeting the task

includes maintaining intimate relationships and moving toward developing a family (B). (A)

occurs in young adulthood (age 18 to 25), (C) occurs in maturity (age 45 to death), and (D)

occurs in adolescence (age 12 to 20). These are all stages that occur if individuals are not

successfully coping with their psychosocial developmental stage.

13. The parents of a 14-year-old boy bring their son to the hospital. He is lethargic, but

responsive. The mother states, "I think he took some of my pain pills." During initial

assessment of the teenager, what information is most important for the nurse to obtain from

the parents?

A. If he has seemed depressed recently.

B. If a drug overdose has ever occurred before.

C. If he might have taken any other drugs. Correct

D. If he has a desire to quit taking drugs.

Knowledge of all substances taken (C) will guide further treatment, such as administration of

antagonists, so obtaining this information has the highest priority. (A and B) are also valuable in

planning treatment. (D) is not appropriate during the acute management of a drug overdose.

14. A male client with mental illness and substance dependency tells the mental health nurse

that he has started using illegal drugs again and wants to seek treatment. Since he has a dual

diagnosis, which person is best for the nurse to refer this client to first?

A. The emergency room nurse.

B. His case manager. Correct

C. The clinic healthcare provider.

D. Hissupport group sponsor.

The case manager (B) is responsible for coordinating community services, and since this client

has a dual diagnosis, this is the best person to describe available treatment options. (A) is

unnecessary, unless the client experiences behaviors that threaten his safety or the safety of

others. (C and D) might also be useful, but it is most important at this time that a treatment

program be coordinated to meet this client's needs.

15. A male client is admitted to a mental health unit on Friday afternoon and is very upset on

Sunday because he has not had the opportunity to talk with the healthcare provider. Which

response is best for the nurse to provide this client?

A. Let me call and leave a message for your healthcare provider. Correct

B. The healthcare providershould be here on Monday morning.

C. How can I help answer your questions?

D. What concerns do you have at this time?

It is best for the nurse to call the healthcare provider (A) because clients have the right to

information about their treatment. Suggesting that the healthcare provider will be available the

following day (B) does not provide immediate reassurance to the client. The nurse can also

implement offer to assist the client (C and D), but the highest priority intervention is contacting

the healthcare provider.

16. A female client refuses to take an oral hypoglycemic agent because she believes that the

drug is being administered as part of an elaborate plan by the Mafia to harm her. Which

nursing intervention is most important to include in this client's plan of care?

A. Reassure the client that no one will harm her while she is in the hospital.

B. Ask the healthcare provider to give the client the medication.

C. Explain that the diabetic medication is important to take.

D. Reassess client's mentalstatus for thought processes and content. Correct

The most important intervention is to reassess the client's mental status (D) and to take further

action based on the findings of this assessment. Attempting to reassure the client (A) is in effect

arguing with the client's delusions and could escalate an already anxious situation.

Collaborating about diabetic care (B and C) is not likely to help change the client's false beliefs.

17. A male client is admitted to the psychiatric unit with a medical diagnosis of paranoid

schizophrenia. During the admission procedure, the client looks up and states, "No, it's not

MY fault. You can't blame me. I didn't kill him, you did." What action is best for the nurse to

take?

A. Reassure the client by telling him that his fear of the admission procedure is to be

expected.

B. Tell the client that no one is accusing him of murder and remind him that the hospital

is a safe place.

C. Assess the content of the hallucinations by asking the client what he is hearing.

Correct

D. Ignore the behavior and make no response at all to his delusional statements.

Further assessment is indicated (C). The nurse should obtain information about what the client

believes the voices are telling him--they may be telling him to kill the nurse! (A) is telling the

client how he feels (fearful). The nurse should leave communications open and seek more

information. (B) is arguing with the client's delusion, and the nurse should never argue with a

client's hallucinations or delusions, also (B) is possibly offering false reassurance. (D) is avoiding

the situation and the client's needs.

18. An 86-year-old female client with Alzheimer's disease is wandering the busy halls of the

extended care facility and asks the nurse, "Where should I stand for the parade?" Which

response is best for the nurse to provide?

A. Anywhere you want to stand as long as you do not get hurt by those in the parade.

B. You are confused because of all the activity in the hall. There is no parade.

C. Let us go back to the activity room and see what is going on in there. Correct

D. Remember I told you that this is a nursing home and I am your nurse.

It is common for those with Alzheimer's disease to use the wrong words. Redirecting the client

(using an accepting non-judgmental dialogue) to a safer place and familiar activities (C) is most

helpful because clients experience short-term memory loss. (A) dismisses the client's attempt

to find order and does not help her relate to hersurroundings. (B) dismisses the client and may

increase her anxiety level because it merely labels the client's behavior and offers no solution. It

is very frustrating for those with Alzheimer's disease to "remember," and scolding them (D)

may hurt their feelings