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NUR 253 - Mental Health Exam 3 Test
Papers 2025/2026 Questions And
Answers Fully Solved
QUARANTEED A
A child diagnosed with autism will demonstrate impaired development in which area?
Socail interactions and communication skills
When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment.
What is Temperament
What is nursing education provided to parents on Tic disorders?
Tics are sudden, nonrhythmic and rapid motor movements or vocalizations. Tics usually involve the head, torso or limbs and change in location, frequency and severity over time.
Characteristics of a resilient child
- Adaptive temperament
- Ability to form nurturing relationships
with surrogate parental figures
- Ability to distance self from emotional
chaos in parents and family
- Good social intelligence and problem-solving
skills
- Ability to perceive a future
attention-deficit/hyperactivity disorders are evidenced by
- Inattentiveness
- Hyperactivity
- Impulsivity that are developmentally inappropriate
Dyscalculia
Difficulty understanding math
Side effects of medication (Stimulant) for ADD
Insomnia, appetite suppression, headache, abdominal pain and lethargy
What symptom can the nurse expect a client diagnosed with depersonalization disorder to manifest?
A feeling of detachments from one's body or mental processes.
Depersonalization is characterized by a sense of unreality or self-estrangement
- Assist the parents in resolving their emotional distress about the trauma.
Attachment theory describes
The importance and dynamics of the infant/caregiver relationship and how this early relationship can affect the individual throughout their life. (Positive and negative)
Presence of 2 or more distinct personality states that recurrently take control of behavior
Dissociative Identity Disorder
A women suddenly finds she cannot see but seems unconcerned about her symptoms and tells her husband "Don't worry dear, things will all work out." Her attitude is an example of what process?
La belle indifference
La belle indifference
An attitude of unconcern about symptoms that is unconsciously used to lower anxiety.
The primary difference between unconscious and conscious somatic disorders are?
Unconscious not under the patients voluntary control (Headache, N/V, sweating, GI)
Conscious has symptomatology that is controlled by the client.
Factitious disorders and malingering in contrast to other somatic disorders and under conscious control.
Nursing assessment for pts with somatic symptom disorders
- Assess for nature, location, onset, characteristics and duration of sx.
- Explore past hx of adverse childhood events
- Identify sx of anxiety, depression and past trauma
- Determine current quality of life, social support and coping skills
- identify any secondary gains
- explore the pts cognitive style and ability to communicate feelings/needs
- assess current psychosocial and biological needs
- screen for misuse of prescribed mediations and or substance abuse
Which disorder is characterized by the pts misinterpretations of physical sensations or feelings?
Illness anxiety disorder (hypochondriasis.)
Can be obsessive, thoughts about illness may be intrusive and difficult to dismiss, even when the pt recognizes that his or her fears are unrealistic.
Pt presents with neurological symptoms in the absence of a neurological diagnosis. Deficits in voluntary motor or sensory function, paralysis, blindness, movement disorder, numbness, paresthesia, loss of vision or hearing.
Conversion Disorder
What is secondary gain?
Benefits from the sx (Sick role for attention)
- Promote a climate of safety for the pt and others
- Establish rapport
- Set limits and exceptions
What are techniques for managing disruptive behaviors?
Counseling, modeling, role-playing, planned to ignore, physical distance and touch control, redirection of positive feedback, clarification, restructuring, limit setting, simple restitution, physical restraint
This disorder conflicts with authority and adults, emotion dysregulation, chronic negative mood, temper, outbursts, and if left untreated - the child may grow out of it.
Oppositional Defiant Disorder
This disorder has the inability to control aggressive impulses, leads to problems with interpersonal relationships, occupation and criminal difficulties. Anything can trigger
Intermittent Explosive Disorder
This disorder conflict with authority/adults is more severe than oppositional defiant, with aggressions towards people/animals, theft, deceit, distraction of property (abnormally aggressive), callousness, untreated can develop into antisocial personality disorder as an adult.
Conduct Disorder
A family member report that the pt has been oriented and bale to carry on a logical conservation last evening, but this morning is confused and disoriented. The nurse can suspect that the pt is displaying sx associated with which cognitive disorder?
Delirium
Characterized by a disturbance of consciousness, a change in cognition, and fluctuating LOC that develop over a short time.
The nurse caring for a pt diagnosed with Alzheimer's disease can anticipate that the family will need information about which of medication therapy?
Acetylcholinesterase Inhibitors
Prevents chemical that destroys acetylcholine from acting, thus leaving more available.
An older pt diagnosed with early-stage Alzheimer's disease will have the greatest difficulty with?
Memory lapses, initially recent member is impaired, and remote memory remains intact.
EX - Difficulty retrieving correct gourds of names previously known
Broad term used to describe progressive deterioration of cognitive function and global impairment of intellect.
Dementia
What are the two cognitive and perceptual disturbances?
Illusions - error in perception of sensory stimuli
The stimulus is a real object in the environment but the individual misinterprets it and often become the object of pts projected fear
Constant 24-hour, one-to-one observation at arm's length
A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch since the client is unable to commit to seeking help to resist suicidal ideations.
When a colleague committed suicide, the nurse stated, "I do not understand why she would take her own life." This is an expression of which feeling?
Disbelief
Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life."
What suicide protective factors have the greatest impact on a client's safety (making it less likely to consider, attempt or die by suicide)?
- Effective mental healthcare
- Strong connections to individuals family, community and social institutions
- Problem-solving and conflict resolution skills
- Contact with providers
- Attending church
A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." How should the nurse respond to the client's concern?
"For your safety I can be no more than an arm's length away."
This level of suicide watch does not make adjustments based on client preference. The explanation and the reason (your safety) reinforces the basic need for client safety.
These injuries are deliberate and direct attempt to inflict shallow but painful injuries. There is NOT an intent to end one's life. Cutting, burning, scratching, and scraping self.
Self-Harm
What is the Intent of self-harm.. why do they do it.
- Alleviate psychic pain
- Pierce psychic numbness
- Get attention
- Escape a responsibility
- Avoid a situation
Obsessive-Compulsive personality disorder is characterized by limited emotional expression, stubbornness, perseverance and indecisiveness. What are the 3 hallmarks of this disorder?
1.Preoccupation with orderliness
- Preoccupation with perfectionism
- Preoccupation with control
This PD has symptoms of severe impairments in functioning, emotional lability, impulsivity, self- destructive behaviors, and antagonism.
Borderline PD
- Assist the patient to clarify feelings because they often have difficulty identifying them
- Teach and role model assertiveness
Characteristics/symptoms of Anti-social PD
- Deceitful and manipulative for personal gain. Exploit others
- Hostile if needs are blocked
- Antagonistic behaviors
- Disinhibited - high risk taking, disregard for responsibility and impulsivity
- Criminal misconduct and substance misuse are common
- Main concern - gaining personal power or pleasure
- Callousness - lack of empathy, lack of concern about other's feelings and the absence of remorse or guild except when facing punishment
What are the protective factors in the elderly to help mitigate suicide risk?
- Spiritual beliefs
- Married or have a partner
- Personal resilience
- Perception of social/family support
- Children/other family members (in contact)
An elderly patient who is newly confused, falling, disrobing and fighting with staff. What is the nursing priority?
Assess for Delirium
What are some key concepts to teach the patient & family about polypharmacy or drug safety?
- Learn about your medicines
- Keep track of side effects or possible drug interactions and notify your provider immediately
- Have a "medicine check-up" as least once a year
What is the Patient Self-Determination Act say about Mental Health patients?
Guidelines and philosophy of care that call for patients to be free from unnecessary use of drugs and physical restraints.
The most common anxiety disorder in older adults
Generalized Anxiety Disorder.
This disorder is often associated with pain, with both problems increasing the other. That is, increased pain increases anxiety and increased anxiety results in increased perception of pain.
Priority Intervention for an elderly client admitted for depression after suicide assessment is completed
Nutrition
Older adult hospitalized is agitated and screaming in a foreign language... what is your next step.
Interpretor
Pervasive pattern of preoccupation with orderliness, perfectionism, and mental control
Obsessive Compulsive
Pervasive pattern of distrust and suspiciousness
Paranoid
Pervasive pattern of detachment fromsocial relationships and restricted affect
Schizoid
Pervasive pattern of social deficits and eccentricities
Schizotypal
Trauma Informed Care
- Realizes the widespread impact of trauma and understands potential paths for recovery;
- Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
- Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
- Resist re-traumatizing the patient, family and all involved.
PTSD Sx in Children
Intrusion SX - Repetitive play w/ aspects of trauma, trauma reenactment in play, nightmares, self-blame, detachment, estrangements, loss of interest in significant activities, hyper-vigilance, loss of concentration.
Avoidance
Alterations in cognition and mood (somatic sx)
Alterations in reactivity and arousal.
Clinical Picture of PTSD in Children
PTSD in preschool children may manifest as reduction in play.
Play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame or confusion.
Children may blame themselves for the traumatic event
PTSD in adults
persistent re-experiencing of a highly traumatic event, involves actual or threatened death or serious injury to self or others, responses of fear, helplessness, or horror are felt
PTSD Sx in Adults
Flashbacks, re-experiencing the trauma (involuntary memories), hypervigilance, alterations in mood, and avoidance of stimuli associated with trauma. Sensation of terror in the stomach, heart palpitations, muscle tensing occur.
What are secondary gains? What are they getting out of the sick role?
Consciously pretend to be ill to get emotional needs met and attain the status of the patient.
Attention and excitement perpetuate the relationship with healthcare providers.
What are symptoms of malingering? What is their secondary gain?
Reported pains are vague and hard for clinical to prove or disprove, such as back pain, stomach ailments, headache, or toothache.
To become eligible for disability compensation, communicate fraud against insurance companies, prescription meds, evade military service, or receive a reduced prison sentence.
Ex: Mr.Harris injures his foot to avoid military service.
What is somatic symptom disorder?
One or more distressing sx
Excessive thoughts, anxiety and behaviors around symptoms or health concerns
Without significant physical findings and medical diagnosis
Suffering is authentic
High-level function impairment
Symptoms are involuntary
Sense of dread, choking, shaky, rapid HR, feeling faint, wobbly legs. (Must rule out medical first- VS, Labs, Assessment)
Somatic Symtom Disorder
Factitious disorder imposed on another
caregiver deliberately falsifies illness in a vulnerable dependent
Secondary gain of attention and excitement to perpetuate the relationship with healthcare providers
factitious disorder imposed on self
symptoms of illness are deliberately induced, simulated, or exaggerated.
The secondary gain of being ill is to get their emotional needs met and attain the status of the patient.
Deficits in voluntary motor or sensory function - paralysis, blindness, movement disorder, gait disorder, numbness, paresthesias, loss of vision or hearing
Conversion disorder
Many pts show lack of emotional concern (La belle indifference)
Dementia - Interventions
Focus on forming meaningful relationship with pt and caregivers
