HESI NSG Mental Health Nursing (Exam 1)

Correct Answer: "Suicide rates for males are highest among those aged 75 and older."

Explanation:

Among males, older adults (75 and older) have the highest suicide rates compared to other age groups. Risk factors for older men include:

Social isolation

Chronic illness or pain

Loss of a spouse

Depression that often goes undiagnosed and untreated

Why the Other Options Are Incorrect:

"Women take their own lives more often than men." 

Men die by suicide at a higher rate than women, despite women attempting suicide more often. This is because men tend to use more lethal methods (e.g., firearms), whereas women more commonly use less lethal means (e.g., poisoning).

"Men attempt suicide more often than women." 

Women attempt suicide more often than men, but men have higher completion rates due to using more lethal methods. Women are also more likely to seek help for mental health concerns before attempting suicide.

"Poisoning is the most common method of suicide for both sexes." 

Firearms are the most common method for men, while poisoning is more common among women. Men tend to choose high-lethality methods, contributing to their higher suicide completion rate.

Summary:

Men die by suicide at a higher rate than women, with the highest risk in men aged 75 and older. Women attempt suicide more often, but men use more lethal methods. Firearms are the most common method for men, while poisoning is more common for women.

Correct Answer: A. “I will stay with you to make sure you remain safe.”

Explanation:

When a patient is experiencing severe to panic-level anxiety, they may feel overwhelmed, disoriented, and even lose touch with reality. At this stage, providing safety and reassurance is the nurse’s priority. Stating “I will stay with you to make sure you remain safe” helps establish a sense of security, support, and stability in a highly distressing moment.

Why the Other Options Are Incorrect:

b. “First, you must stop pacing and wringing your hands.” – This statement is too directive and demanding, which may increase distress rather than provide reassurance. Patients in panic-level anxiety often cannot follow complex instructions until their anxiety subsides.

c. “How can I help you get control of yourself and this anxiety?” – While offering help is beneficial, this question may be too abstract for someone in a state of panic. When anxiety is severe, the patient may not be able to think clearly to answer such a question.

d. “Can you tell me what was happening just before you got upset?” – Exploring triggers is a useful intervention for mild to moderate anxiety, but at severe or panic levels, the focus should be on immediate safety and calming measures, rather than analysis.

Summary:

During severe to panic-level anxiety, providing safety, presence, and reassurance is the top priority. The correct answer (A) ensures the patient feels supported and not alone, which helps reduce anxiety and prevent escalation.

Correct Answers: 

Use clinical vignettes for training.

Provide opportunities for staff members to discuss their dilemmas and effective ways of dealing with them.

Hold regular meetings to discuss inappropriate relationships and feelings toward clients.

Explanation of Correct Answers:

Use clinical vignettes for training.

Clinical vignettes (case studies) provide realistic scenarios to help nurses recognize boundary violations and ethical dilemmas. Training using vignettes allows nurses to reflect on appropriate professional behavior and how to handle challenging situations.

Provide opportunities for staff members to discuss their dilemmas and effective ways of dealing with them.

Open discussions create a safe environment for nurses to seek guidance on professional boundaries. Peer discussions can help prevent inappropriate relationships by reinforcing ethical nursing practices and encouraging support.

Hold regular meetings to discuss inappropriate relationships and feelings toward clients.

Regular meetings provide ongoing education and allow nurses to voice concerns about professional boundaries. This helps prevent ethical violations and ensures staff members are aware of their responsibilities in maintaining therapeutic relationships.

Explanation of Incorrect Answer:

Provide new nurses to model effective therapeutic interventions with difficult clients.

While mentorship and modeling appropriate behavior are valuable, simply providing new nurses to manage difficult clients does not directly prevent inappropriate relationships. The focus should be on guidance, training, and discussions rather than assigning new nurses to difficult cases.

Summary:

To avoid inappropriate relationships between nurses and clients, healthcare facilities should emphasize training with clinical vignettes, open discussions about ethical dilemmas, and regular meetings to address boundaries. While mentorship is important, it is not a direct method to prevent inappropriate relationships.

Correct Answer: A. Endorphins.

Rationale:

Endorphins are naturally occurring neurotransmitters that act as the body's natural painkillers and stress relievers. They are released by the brain, particularly in response to:

Physical pain (e.g., injury, exercise).

Emotional stress (e.g., trauma, anxiety).

Pleasurable activities (e.g., laughter, eating, sex).

Endorphins work by binding to opioid receptors in the brain, reducing pain perception and promoting a sense of well-being and relaxation.

Why the Other Options Are Incorrect:

B. Dopamine

Dopamine is the "feel-good" neurotransmitter associated with pleasure, motivation, and reward. It plays a role in addiction, mood regulation, and movement, but it is not the primary substance for pain relief.

C. Norepinephrine

Norepinephrine is a stress hormone that triggers the fight-or-flight response. It increases heart rate, blood pressure, and alertness but does not primarily relieve pain.

D. Acetylcholine

Acetylcholine is essential for muscle movement, memory, and learning. It is not involved in stress or pain relief.

Summary:

Endorphins (A) are the body’s natural pain relievers, reducing discomfort and enhancing well-being during stress and physical exertion.

Correct Answer:

d. Setting limits on the behavior

Explanation:

Setting clear and consistent limits is the most appropriate intervention for managing manipulative or non-compliant behavior in a therapeutic setting. In this case, Mario is complaining to other clients about a rule (no food in rooms), which can create conflict, encourage rule-breaking, or disrupt the environment. The nurse should:

• Firmly and respectfully remind Mario of the facility's rules.


• Explain the rationale for the rule (e.g., hygiene, fairness, and maintaining a therapeutic environment).


• Encourage appropriate ways to express concerns, such as speaking with staff instead of complaining to peers.


• This approach maintains structure, promotes accountability, and prevents escalation of negative behaviors.

Why the Other Options Are Incorrect:

• a. Allowing a snack to be kept in his room
  
  
  
  
  • Incorrect because making exceptions for one client can undermine rules and lead to favoritism or further rule-breaking. If there is a legitimate concern (e.g., medical need for snacks), it should be addressed through proper channels, not by bending the rules.
  
  
  
  


• b. Reprimanding the client
  
  
  
  • Incorrect because harsh discipline or confrontation may escalate defensiveness, resentment, or defiance. A firm but respectful approach is more effective than reprimanding.
  
  
  
  


• c. Ignoring the client's behavior
  
  
  
  • Incorrect because ignoring could allow manipulative behavior to continue or worsen. It may also encourage other clients to break rules or feel staff is inconsistent in enforcing policies.
  
  
  
  

Summary:

The best intervention is setting limits on the behavior (option d) by reinforcing rules in a firm but respectful manner. Allowing food (option a) undermines policies, reprimanding (option b) may increase resistance, and ignoring (option c) can reinforce negative behavior.

Correct Answer:  c. Community

Explanation:

The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines four major dimensions that support recovery:

Health – Managing disease symptoms, making healthy choices.

Home – Having a stable and safe living environment.

Purpose – Engaging in meaningful activities, like work or volunteering.

Community – Building relationships and social networks that provide support, love, and friendship.

Since loneliness and supportive friends are directly related to social connections and belonging, they fall under the Community dimension.

Why the Other Options Are Incorrect:

a. Health 

Focuses on physical and mental well-being, not social support.

b. Home 

Refers to a stable and safe place to live, not interpersonal relationships.

d. Spirituality 

While spirituality can offer support, it's not one of SAMHSA’s four major dimensions of recovery.

e. Purpose 

Involves meaningful daily activities (work, education, volunteering) but not directly about social relationships.

Summary:

SAMHSA’s Community dimension focuses on social support, friendships, and overcoming loneliness, making option (c) the correct answer.

Correct Answer: a. Antisocial Personality Disorder

Explanation:

Kevin’s history of delinquency, running away, theft, vandalism, and disregard for societal rules strongly suggests antisocial personality disorder (ASPD). This disorder is characterized by persistent patterns of disregard for the rights of others, deceitfulness, impulsivity, irresponsibility, and a lack of remorse.

Early Conduct Disorder: Many individuals with ASPD show signs of conduct disorder in childhood or adolescence, including truancy, aggression, destruction of property, and serious rule violations.

Criminal Behavior: Repeated legal trouble, like auto theft and vandalism, is a hallmark of ASPD.

Lack of Stability: Dropping out of school and living independently at a young age suggests a pattern of instability and disregard for conventional expectations.

Why the Other Choices Are Incorrect:

b. Borderline Personality Disorder (BPD)

BPD is characterized by emotional instability, fear of abandonment, impulsivity, and self-destructive behaviors (e.g., self-harm, unstable relationships). Kevin’s history points more toward antisocial behaviors rather than intense emotional instability seen in BPD.

c. Obsessive-Compulsive Personality Disorder (OCPD)

OCPD involves extreme perfectionism, rigidity, and a preoccupation with order and control. Kevin’s reckless and delinquent behaviors are the opposite of OCPD traits, which emphasize strict adherence to rules and morality.

d. Narcissistic Personality Disorder (NPD)

NPD is defined by grandiosity, entitlement, need for admiration, and a lack of empathy. While a lack of empathy is common in both NPD and ASPD, Kevin’s criminal behaviors and disregard for societal norms suggest ASPD rather than excessive self-importance.

Summary:

Kevin’s history of delinquent acts, disregard for rules, and impulsive, irresponsible behavior aligns most closely with antisocial personality disorder (ASPD) (Option A).

Correct Answer: d. “I’ve learned to react to my daily stress by having anxious thoughts and panic attacks.”

Explanation:

Cognitive Behavioral Therapy (CBT) is based on the concept that thoughts, feelings, and behaviors are interconnected. It teaches individuals to recognize and change maladaptive thought patterns that contribute to anxiety. The statement “I’ve learned to react to my daily stress by having anxious thoughts and panic attacks” reflects an understanding of CBT, as it acknowledges that anxiety is linked to learned thought patterns and reactions, which can be modified through therapy.

Why the Other Options Are Incorrect:

a. “My abusive childhood has resulted in my overreaction to stress.” – While past trauma can contribute to anxiety, CBT focuses on modifying present thought patterns and behaviors, rather than primarily exploring past experiences.

b. “My delusional thoughts of extreme anxiety are what cause my panic attacks.” – Delusions are typically associated with psychotic disorders, not anxiety disorders. CBT does not focus on delusions but rather on distorted thinking and maladaptive behaviors.

c. “My brain chemistry causes me to overreact to common stress by getting so anxious.” – While biological factors can contribute to anxiety, CBT emphasizes that thoughts and learned behaviors play a significant role in managing stress rather than focusing solely on brain chemistry.

Summary:

CBT emphasizes changing thought patterns and behaviors to reduce anxiety. The correct answer (D) reflects this understanding by acknowledging that the way the patient has learned to think contributes to anxiety, which aligns with the core principles of CBT.

Correct Answer: Terminate the session before the feelings escalate.

Rationale:

A nurse should always maintain professionalism and ensure a therapeutic environment during one-on-one sessions. If a nurse begins to feel angry with a client, it is essential to recognize these emotions early and take steps to prevent them from interfering with the therapeutic relationship. Terminating the session before emotions escalate helps prevent unprofessional behavior, maintains ethical boundaries, and allows the nurse to regain composure before resuming care. This approach aligns with maintaining patient safety and providing unbiased, patient-centered care.

Why the Other Options Are Incorrect:

Resolve the feelings with the client after discharge:

This is inappropriate because the nurse’s emotions should not be processed with the client. Addressing personal emotions about a professional relationship after the client has been discharged does not resolve the issue in a timely or therapeutic manner. Emotional concerns should be processed with a supervisor or through professional reflection, not with the client.

Share similar experiences the nurse has had in the past:

While therapeutic self-disclosure can sometimes be beneficial, this is not an appropriate time for it. The focus should remain on the client, and sharing personal experiences may shift the conversation away from the client’s needs. Furthermore, if the nurse is feeling angry, sharing personal stories might escalate emotions rather than de-escalate the situation.

Identify the client's transference of feelings of annoyance:

While transference (when a client projects emotions onto the nurse) is an important concept in therapy, the question focuses on the nurse's emotions. The nurse experiencing anger is more likely dealing with countertransference (the nurse projecting their emotions onto the client). Identifying transference does not resolve the immediate issue, which is the nurse's emotional reaction and the need to maintain professionalism.

Summary:

When a nurse begins to feel angry during a one-on-one session, the best course of action is to terminate the session before emotions escalate. This prevents unprofessional behavior and maintains therapeutic boundaries. The other options are inappropriate because they either shift the focus away from professionalism, do not immediately address the issue, or involve improper emotional processing with the client.