MENTAL HEALTH

1. The nurse employs play therapy with a small group of 6-year-old clients. The
primary expected outcome is for the clients to do which of the following?
A. Act out feelings in a constructive manner.
RATIONALE: Play therapy is especially useful for children under 12 because
their developmental level makes them less able to verbalize thoughts and
feelings. Learning to talk openly about themselves (option B), learning how to
give and receive feedback (option C), and learning problem-solving skills
(option D) are not the intended goals of play therapy. Options B, C, and D
require more structured group and individual activities that 6-year-olds are
able to master. Play therapy provides an opportunity for children to express
their feelings through play, without the need for advanced verbal or social
skill sets.
STRATEGY: Recall developmentally appropriate behaviors of 6-year-old
children. Think perhaps about 6-year-old children you have known or worked
with in clinical settings.
B. Learn to talk openly about themselves.
C. Learn how to give and receive feedback.
D. Learn problem-solving skills.
2. While conducting a mental status examination with an 8-year-old girl, the nurse
asks the client to explain the meaning of the expression Dont cry over spilled
milk. The child looks puzzled and shrugs her shoulders. The nurse using Piagets
theory will view the childs response as suggestive of which of the following?
A. Impaired cognition
B. Concrete operational thinking
RATIONALE: Option B is correct. This child is demonstrating inability to think
abstractly. Rather than being alarmed by this, the nurse should recognize it
as normal growth and development. Eight-year-olds cannot be expected to
think abstractly. In Piagets theory, abstract thinking develops during the
formal operational phase (12 years to adult). Children between 7-12 are in
Piagets concrete operational phase and cannot think abstractly, although
they can pretend. Option A is incorrect because while Piagets theory does
focus on cognitive styles, and this option contains the term cognition,
Piagets theory does not address impaired cognition. Impaired condition is
abnormal. Piagets theory deals with normal growth and development. Option
C is incorrect as this client is not able to think abstractly. In Piagets theory,
ability to reason abstractly is a function of formal operational thinking that
begins at approximately 12 years of age and extends into adulthood. Option
D is incorrect because Piagets theory does not use the term illogical thought
processes. To describe any period of normal growth and development.
STRATEGY: Notice the age of the child. Apply that to the basic concepts of
Piagets theory.
C. Formal operational thinking
D. Immature thought processes
3. The nurse is conducting discharge teaching for a client taking tranylcypromine
(Parnate). The nurse determines that the client understands the instructions
given if the client says, While I take this medicine, I should not eat:

A. Potatoes.
B. Salami.
RATIONALE: Salami is a cured meat and must be avoided by clients taking
tranylcypromine, a monoamine oxidase inhibitor (MAOI). Foods rich in
tyramine or tryptophan, such as cured foods, may induce a hypertensive
episode in clients taking MAOI medication. Other foods to be avoided include
those that have been aged, pickled, fermented, or smoked. Clients taking
monoamine oxidase inhibitors (MAOIs) can eat potatoes (option A), baked
chicken (option C), and cottage cheese in reasonable amounts (option D).
STRATEGY: Notice that salami is the only food listed that is prepared for a
long-term shelf-life.
C. Baked chicken.
D. Cottage cheese.
4. An organ transplant nurse is meeting with various cultural and religious groups
to discuss organ donation. The nurse is aware that members of which group are
restricted from donating their organs?
A. Hindu
B. Islam
C. Native American
RATIONALE: Only option C includes a religion or culture that is restricted in
the donation of an individuals organs. Individuals with the religious
backgrounds in options A, B, and D are able to donate if they desire. Nurses
need to be aware of the diverse culture religious practices and beliefs.
STRATEGY: To answer this question correctly, it is necessary to know specific
cultural information as it relates to organ donation. Use this knowledge and
the process of elimination to make a selection.
D. Christianity
5. A client taking antipsychotic medications for treatment of schizophrenia reports
feeling nervous. The nurse notices that the client is pacing the long hallway and
is unable to remain still, even when in conversation with other clients. What term
should the nurse use to document this occurrence?
A. Akathisia
RATIONALE: Akathisia is an extrapyramidal side effect of antipsychotic
medications that may manifest as subjective and objective restlessness and
increased motor movement. Akinesia (option B) is also an extrapyramidal
side effect, but it is not shown in this clients behavior. Akinesia is decreased
activity or motor movement. Dystonia (option C) is also an extrapyramidal
side effect, but is not shown in this clients behavior. Dystonia presents as
sudden and often painful contractions of muscles, especially of the head and
neck. Tardive dyskinesia (option D) is also an extrapyramidal side effect, but
it is not shown in this clients behavior. Tardive dyskinesia presents as
involuntary muscle movements, strange tics, and repetitive motor
movements in persons who have taken antipsychotics for a long period of
time. The situation gives no past history of the client.
STRATEGY: Define each term for yourself and then look back at the client
behaviors described in the stem of the question.
B. Akinesia
C. Dystonia

D. Tardive dyskinesia
6. A hospitalized client states, I just want to sleep all of the time. The nurse
recognizes that this sleep pattern is most clearly indicative of which of the
following?
A. Emotional problems
B. Physical illnesses
C. Nothing in particular
D. Sleep disruptions
RATIONALE: Option D is correct. Sleep disruptions can take a number of
forms, including hypersomnolence and impaired sleep efficiency. Options A
and B are incorrect because in order to reach the conclusion that the client
has physical or emotional problems, the nurse would require more data.
Option C is incorrect as this is a nonsensical answer. Dont give it a second
glance.
STRATEGY: Use the question to help you focus on what is obvious in a
situation, but expect to see much more challenging questions in the
examination.
7. The nurse working in the maternal care are is reinforcing physician health
teaching about the risks of substance use during pregnancy. When questioned
by the client, the nurse should reply, The drugs that are most likely to lead to
significant physical, cognitive, and developmental problems for any infant would
be:
A. Benzodiazepines.
B. Hallucinogens.
C. Alcohol.
RATIONALE: Alcohol use during pregnancy causes dysmorphic prenatal and
postnatal difficulties and central nervous system dysfunction. These problems
range from subtle cognitive-behavioral impairments to fetal alcohol
syndrome, both of which predispose the infant to later academic and
behavioral problems, as well as mental illness. Since alcohol is so widely
used, many people do not recognize its dangers, as they either do not
consider it a drug or think that it is a safe drug. Options A, B, and D indicate
substances that can cause significant health problems for the infant, but
these problems are not as pervasive as those associated with the mothers
using alcohol during pregnancy.
STRATEGY: Think about the nature of the drugs listed and their potential
effects to make a selection. Do not be misled by the fact that alcohol is a
drug that can be obtained legally without a prescription.
D. Cocaine.
8. Before a newly admitted anxious client begins treatment with benzodiazepines,
it is most important for the nurse to assess the clients:
A. Level of motivation for treatment.
B. Situational and social support.
C. Stressors and use of coping mechanisms.
D. Recent use of alcohol or other depressants.
RATIONALE: Combined use of benzodiazepines and other central nervous
system depressants can lead to death from respiratory failure. If the alcohol

has been ingested shortly before admission (which is not at all uncommon for
a client experiencing anxiety), giving a benzodiazepine could put the client at
risk. Social support, coping mechanisms, and motivation for treatment
(options A, B, and C) are all important factors to document during the
assessment. However, the clients immediate risk for safety is the priority at
this point and must be assessed first. The other data can be compiled when
the normal assessment is completed at a later time.
STRATEGY:
9.