Mental Health Exam 4

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Sample questions from Mental Health Exam 4

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.During an outpatient intake, a 24-year-old client describes avoiding work meetings and declining invitations because criticism would be unbearable. The client says, "I want friends, but I assume people will reject me once they know me." Which interpretation best guides the nurse's response?

   • A.The client demonstrates schizoid personality features because social interaction is not desired.
   • B.The client demonstrates narcissistic personality features because the client expects others to provide approval.
   • C.The client demonstrates avoidant personality features related to fear of rejection and underlying anxiety.
   • D.The client demonstrates dependent personality features because the client cannot make decisions independently.

   Rationale: Wanting connection while avoiding it because of anticipated rejection and criticism is characteristic of avoidant personality features. Schizoid patterns generally involve limited desire for close relationships, which differs from this client's stated wish for friends. Dependence and entitlement are not supported by the client's account; assess the anxiety and offer gradual, collaborative coping goals rather than labeling the client as uninterested.

2. 2.At change of shift on an inpatient unit, a client with borderline personality features tells the incoming nurse, "The day nurse let me call my partner after quiet hours, so you have to let me do it too." The unit policy prohibits calls after quiet hours. Which response is best?

   • A.Avoid responding to the request so the client does not use staff splitting.
   • B.Tell the client that the day nurse was wrong and that staff will discuss the behavior at the next team meeting.
   • C.Allow the call once to avoid worsening the client's distress.
   • D.State the limit calmly and consistently, explain the policy, and offer an allowed alternative.

   Rationale: A calm, consistent limit with an appropriate alternative reduces confusion and supports a predictable therapeutic environment. Allowing an exception or ignoring the request creates inconsistent responses, while blaming another staff member can intensify splitting and undermine trust. The exam takeaway is to maintain team-consistent boundaries without shaming or arguing with the client.

3. 3.During a community mental health visit, a 31-year-old client with borderline personality features reports, "If my friend does not answer right away, I feel sure they are leaving me." Which nursing approaches are appropriate to support awareness of feelings and therapeutic engagement? Select all that apply.

   • A.Invite the client to journal the situation, feelings, and responses before deciding how to act.
   • B.Reassure the client that the friend will never end the relationship.
   • C.Acknowledge the distress while helping the client identify evidence and alternative interpretations.
   • D.Encourage the client to test the friend's loyalty by repeatedly calling until they answer.
   • E.Use consistent limits and explain them in a calm, nonjudgmental manner.

   Rationale: Journaling can help the client notice emotional triggers and responses, and consistent, nonjudgmental limits support a reliable therapeutic relationship. Acknowledging distress while exploring evidence avoids endorsing an assumption as fact and can build more balanced coping. Promising that another person will never leave is unrealistic, and repeated calls as a loyalty test may reinforce distress-driven behavior rather than coping.

4. 4.Which pattern best describes the broad distinction among personality disorder clusters?

   • A.Cluster A involves emotional instability, Cluster B involves social withdrawal, and Cluster C involves disregard for rules.
   • B.Cluster A involves odd or eccentric behavior, Cluster B involves dramatic or emotional behavior, and Cluster C involves anxious or fearful behavior.
   • C.Cluster A involves anxious behavior, Cluster B involves odd or eccentric behavior, and Cluster C involves dramatic behavior.
   • D.Cluster A involves dramatic behavior, Cluster B involves anxiety, and Cluster C involves odd or eccentric behavior.

   Answer and rationale are in the full material.

5. 5.In a primary care clinic, a 37-year-old client with avoidant personality features declines a group activity and says, "Everyone there will notice how awkward I am." Which response is most therapeutic?

   • A."It sounds as if you want to participate but expect criticism. What small step would feel manageable?"
   • B."If you do not want to meet people, there is no reason to keep discussing this."
   • C."You should go; avoiding the group will only make your problem worse."
   • D."Your concern is not realistic, so try not to think about it."

   Answer and rationale are in the full material.