NR-326 Mental Health Nursing - Set 2 - Part 2

Correct Answer: "You feel like a burden. Tell me more about that."

Reflecting the feeling and inviting elaboration keeps the client talking and shows the nurse can tolerate her despair. Acknowledging what she said beats correcting it, and hopelessness needs exploring rather than argument. Option a is incorrect because listing reasons to live minimises what the client just disclosed. She hears that her feelings are wrong, and most clients respond by closing the subject down. Option b is incorrect because forced cheerfulness asks a depressed woman to perform an optimism she cannot feel. Brightness from staff widens the distance between her inner state and the person sitting with her. Option c is incorrect because asking why demands an explanation the client has no capacity to construct. The question also shifts attention onto the family when the feeling in the room belongs to her.

Correct Answer: A previous suicide attempt earlier in life

A prior attempt is the single strongest predictor of eventual death by suicide, and risk stays elevated for years afterward. Recency of that attempt sharpens the concern and drives the level of observation chosen. Option a is incorrect because family history of psychiatric illness raises risk but sits well below a personal attempt in predictive weight. It is one contributing factor among many rather than the dominant one. Option b is incorrect because job or housing change counts as a situational stressor. Stressors can trigger a crisis, yet they predict far less reliably than behavior the client has already carried out. Option d is incorrect because disturbed sleep belongs on the risk list without carrying predictive power of that magnitude. Severe insomnia warrants attention, though it never outranks a documented history of prior attempts.

Correct Answer: Identification with an admired other

Identification takes on the qualities of an admired person as a way of easing anxiety and building a sense of competence. Like every defense it works outside awareness and is adaptive in moderation. Option a is incorrect because sublimation redirects an unacceptable drive into an acceptable outlet, such as channeling rage into hard exercise. Adopting another person's manner is imitation of a model, not the rerouting of an impulse. Option b is incorrect because compensation offsets a felt weakness by excelling somewhere else entirely. The client is not making up for a deficit; she is borrowing a manner that helps her feel steadier. Option c is incorrect because projection assigns one's own disowned feeling to somebody else, as when a frightened client insists the staff are the anxious ones. Nothing here is being pushed onto the nurse.

Correct Answer: The client attends and answers questions clearly

New skills are learned only when the perceptual field is open, which happens at mild to moderate anxiety. A client who attends and responds clearly can take the instruction in and rehearse it. Option a is incorrect because purposeless motor activity such as pacing marks severe anxiety. Learning capacity is gone at that point, so the nurse stays, lowers stimulation, and postpones the relaxation lesson. Option b is incorrect because speech that cannot be understood signals panic or severe anxiety. Words are not being processed in either direction, and instruction given now would be lost before the client could use it. Option d is incorrect because a sense of impending death is a panic level finding. Presence and safety are what the client needs, and any attempt at structured teaching would fail completely.

Correct Answer: Psychomotor retardation with prolonged response latency

Psychomotor retardation slows movement, speech, and thinking, so the client needs far longer to process a question and answer it. The change is observable by others, which the diagnostic criteria require. Option b is incorrect because stupor involves near total unresponsiveness with mutism, posturing, and limbs that hold whatever position they are placed in. This client is answering, only slowly. Option c is incorrect because affect refers to observed emotional expression, not to the speed of movement or speech. A flattened face would be documented separately from the delay described here. Option d is incorrect because blocking is a sudden stop in the middle of a sentence, with the client losing the thread entirely. Here speech is uniformly slow but stays on track.

Correct Answer: "You are safe. Breathe with me, slow and steady."

Short, simple, repeated statements in a calm voice are what reach a client in panic. Naming safety and modeling slow breathing gives her something concrete to follow while the surge subsides. Option a is incorrect because asking for the precipitant requires analysis the client cannot perform mid attack. Triggers are explored later, once anxiety has dropped to a level where she can think back over events. Option c is incorrect because false reassurance dismisses terror that feels entirely real to her. Telling a frightened client there is nothing to fear closes the conversation and signals that the nurse does not understand. Option d is incorrect because redirecting to pleasant thoughts asks for mental effort that panic has taken away. Guided imagery belongs to calmer moments, and offering it now changes the subject instead of steadying her.

Correct Answer: Provide a written daily schedule and escort him

Unstructured time paralyses a depressed client, so the nurse supplies the structure: a written schedule, getting him up and dressed, and walking with him to meals and groups rather than inviting him. Option b is incorrect because choosing among many options is the exact task he has just said he cannot perform. Indecisiveness is a symptom of the illness, so open menus produce paralysis, not participation. Option c is incorrect because motivation follows action in depression rather than preceding it. Bed rest through the morning worsens rumination, disrupts night time sleep, and removes every chance for a small success. Option d is incorrect because a client with impaired concentration absorbs little from an explanation and still faces the same decision afterward. Persuasion is weaker than a specific directive delivered simply.

Correct Answer: Irritability can replace sadness in adolescent depression

In children and adolescents the diagnostic criteria allow irritable mood to stand in for depressed mood. Falling grades, lost interest in a valued sport, and short temper fit a depressive episode. Option a is incorrect because dismissing the picture as ordinary teenage behaviour is exactly how adolescent depression gets missed. A cluster lasting weeks with academic decline crosses well past normal developmental turbulence. Option c is incorrect because conduct disorder requires a repetitive pattern of violating rules and the rights of others, such as aggression, theft, or destruction. Snapping at parents does not meet that description. Option d is incorrect because substance use is common in depressed teenagers but nothing here points to it. Quitting a sport reflects lost interest, and confirming a drug problem would need actual assessment data.

Correct Answer: Appetite loss, early waking, constipation, and fatigue

Vegetative signs are the bodily disturbances of depression: appetite and weight change, disrupted sleep, constipation, reduced libido, and the profound fatigue called anergia. They are tracked because they respond earliest to treatment. Option a is incorrect because guilt and self reproach are affective and cognitive features rather than physical ones. They matter for diagnosis and for planning care, but no bodily function is described. Option b is incorrect because those observations belong to the mental status examination, describing appearance and speech. Useful as they are, they record how the client presents rather than how the body is functioning. Option c is incorrect because impaired concentration, circular thinking, and difficulty deciding are the cognitive symptoms of depression. Nurses assess them separately from intake, output, sleep hours, and weight.

Correct Answer: Social anxiety disorder centered on scrutiny

Social anxiety disorder is marked fear of situations where others may scrutinize the person. Blushing, trembling, avoided eye contact, refusing roles that involve performing, and eating alone are the classic findings. Option a is incorrect because obsessive compulsive disorder pairs intrusive unwanted thoughts with repetitive acts performed to lower the anxiety they create. No obsession or ritual appears anywhere in this description. Option b is incorrect because panic disorder turns on abrupt attacks that come out of the blue. This worker's distress is predictable, arising only when other people are watching or evaluating him. Option d is incorrect because generalized worry spreads over work, health, money, and family rather than settling on one theme. Here every symptom clusters tightly around being observed by other people.

Correct Answer: Intrusion, shown by a dissociative flashback

A flashback is dissociative reliving in which the client acts as though the event is happening again. It sits in the intrusion cluster along with nightmares, unwanted memories, and strong reactions to trauma cues. Option b is incorrect because avoidance describes deliberate steering away from thoughts, feelings, people, and places tied to the event. The veteran is not evading anything here; the memory has broken through on its own. Option c is incorrect because that cluster covers distorted beliefs, blame, shame, detachment, and inability to recall part of the event. It captures how the client thinks and feels between episodes, not a reliving experience. Option d is incorrect because arousal symptoms are hypervigilance, exaggerated startle, irritability, reckless behavior, and disturbed sleep. Startling at a loud noise would fit, but believing he is back in combat goes further than that.

Correct Answer: State the expectation calmly and follow through consistently

Limits work when the nurse names the behavior, states a simple expectation in a calm low voice, and enforces it the same way every shift. Consistency supplies the control the client cannot generate. Option a is incorrect because lengthy reasoning gives a distractible client material for a debate. Manic thinking is fast and impervious to logic, so long explanations lengthen the encounter without changing the behavior. Option b is incorrect because a threat delivered in an authoritarian tone reads as punishment. Limits are set with consequences the staff can actually enforce, offered without hostility, not with warnings meant to intimidate. Option d is incorrect because bargaining creates a private exception that other staff will not honor. Splitting follows, the client tests every shift for a better deal, and the milieu grows steadily less safe.

Correct Answer: "You sound frustrated. I have crackers and juice here."

The nurse names the feeling in a calm low voice and offers something concrete, which meets the real need without conceding the limit. Labile mood flips fast in mania, so brief and matter of fact works best. Option a is incorrect because a corrective statement delivered during rising anger reads as a challenge. The client hears an opponent, the volume climbs, and the nurse has traded de-escalation for a contest. Option b is incorrect because praising past behavior while criticizing the present shames a client whose control is impaired by illness. Rage on frustration is a symptom, not a choice he made this morning. Option c is incorrect because a why question asks for an explanation the client cannot produce while flooded. Analysis takes time and attention, and neither is available in the middle of an escalating outburst.

Correct Answer: "Would you rather wear the blue shirt or the green one?"

A choice between two named items respects autonomy while matching impaired decision making. Depression slows and paralyses thinking, so a limited concrete option lets the client act instead of standing frozen. Option a is incorrect because a wide open question is precisely what this client cannot answer. Facing an entire closet with no structure, she is likely to remain at the door undressed. Option c is incorrect because unlimited time does not solve indecisiveness; it prolongs it. The nurse offers patience but no framework, and the client is left with the same impossible task. Option d is incorrect because invoking a unit rule pressures the client without reducing the demand. Adding urgency to a task she already cannot start tends to produce shame and further withdrawal.

Correct Answer: Generalized anxiety disorder with muscle tension

Generalized anxiety disorder is uncontrollable worry across several domains for at least six months, with symptoms such as restlessness, fatigue, poor concentration, irritability, sleep trouble, and the muscle tension this client describes. Option a is incorrect because agoraphobia is fear of situations where escape or help might be unavailable, such as crowds or public transport. This client describes worry about topics, not avoidance of places. Option b is incorrect because panic disorder requires recurrent attacks that surge abruptly and peak within minutes. Continuous low grade worry running for a year has a different shape from those discrete episodes. Option c is incorrect because an adjustment disorder follows an identifiable stressor within three months and clears within six months after it ends. No triggering event appears here, and the worry has run far longer.

Correct Answer: "You miss that energy. What did last spring end up costing?"

Naming the loss without judgment keeps the client talking, and asking about the cost brings the debt, arrests, and damaged relationships into the same conversation. That contrast supports adherence better than any warning. Option b is incorrect because a generic reassurance dismisses a feeling that drives most medication stops. The client hears that the complaint does not matter and simply stops raising it with the treatment team. Option c is incorrect because arguing the merits of treatment turns a disclosure into a lecture. Insight grows from the client weighing personal losses, not from the nurse ranking safety above how life currently feels. Option d is incorrect because jumping to a drug change skips the exploration that identifies what is actually wrong. Flatness may reflect grief for the lost high rather than a side effect needing a new prescription.

Correct Answer: Get up and dress at the same time daily

A consistent rise time anchors the sleep wake cycle, and getting dressed signals the start of a structured day. Daytime napping is limited so that sleep pressure builds for the night. Option a is incorrect because lying awake teaches the body that bed is a place for frustration rather than sleep. Depressed clients also need to be out of bed and moving during the day. Option b is incorrect because afternoon caffeine lingers for hours and fragments the very sleep the client is trying to recover. Alertness bought that way is paid for after midnight. Option d is incorrect because hard exercise close to bedtime raises body temperature and arousal, delaying sleep onset. Physical activity helps depression, but it belongs earlier in the day for this client.

Correct Answer: A quiet room away from the nurses station

A low stimulation room away from the unit hub cuts the noise and traffic that fuel mania. Dim lighting, minimal clutter, and few short visits give the impaired filter less to process. Option a is incorrect because day room traffic and a roommate supply constant novelty. Sharing space also exposes the other client to intrusive and disinhibited behavior that nobody on the unit agreed to tolerate. Option c is incorrect because a corridor view keeps carts, staff, and voices moving past the door all shift. Every passing stimulus captures a distractible client and pulls attention away from rest. Option d is incorrect because bright light and lounge activity work against the sleep that mania has already destroyed. Nursing care here lowers lighting rather than placing the client beside a social space.

Correct Answer: Panic disorder with anticipatory avoidance behavior

Attacks that arrive without warning are the unexpected attacks that define panic disorder, and the lasting worry plus a change in driving habits completes the picture. Anticipatory fear drives that avoidance. Option a is incorrect because a phobia produces symptoms only on exposure to the feared object or setting. These episodes began at home with no trigger present, which rules out a conditioned situational fear. Option b is incorrect because social anxiety centers on scrutiny by other people during conversation, eating, or performing. Nothing in the history involves an audience, and the episodes happened while the client was alone. Option d is incorrect because generalized anxiety is steady, spread across many life domains, and marked by muscle tension and fatigue. Discrete surges peaking within minutes are not how that chronic worry pattern presents.

Correct Answer: "He is sleeping now, so I can stop watching."

Improved sleep and energy arrive before mood lifts, so the weeks after starting an antidepressant call for closer watching, not less. The spouse needs to understand that early physical gains are not recovery. Option a is incorrect because keeping the scheduled visit shows exactly the understanding the nurse wants. Early follow up after discharge is a core part of the plan and needs no correction. Option b is incorrect because that remark repeats the timeline accurately: sleep, appetite, and energy respond first, and mood commonly takes four to six weeks. Accurate statements do not signal a teaching gap. Option c is incorrect because contacting the clinic at any sign of deterioration is precisely what families are asked to do. Willingness to call early protects the client during a vulnerable stretch.