# Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital after 3 weeks of poor sleep and staying in his room. His family says he has no known medical illness and does not use alcohol or drugs. The nurse performs a mental status examination (MSE) on admission. When asked how he feels, the client says, "Heavy. Like a stone is sitting on my chest all day." His vital signs and physical examination are normal. Under which component of the mental status examination should the nurse record this statement?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629986  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 29-year-old man is admitted to the psychiatric unit of a general hospital after 3 weeks of poor sleep and staying in his room. His family says he has no known medical illness and does not use alcohol or drugs. The nurse performs a mental status examination (MSE) on admission.

When asked how he feels, the client says, "Heavy. Like a stone is sitting on my chest all day." His vital signs and physical examination are normal. Under which component of the mental status examination should the nurse record this statement?

## 보기

1. Perception
2. Affect
3. Mood **✔ 정답**
4. Thought content

**정답: 3**

## 해설

Mood is the client's own description of how he feels, recorded in his own words; affect is the emotional expression the nurse observes. The client uses a comparison ("like a stone") to describe a feeling, not a fixed false belief or a false sensory experience.

## 심화 해설

Mood is the client's own report
In the mental status examination (MSE), mood is the client's subjective description of his sustained emotional state, recorded in his own words. When asked how he feels, he answers, "Heavy. Like a stone is sitting on my chest all day." This is his self-report of how he feels, so it is recorded under mood, ideally quoted exactly. The comparison to a stone is a figure of speech describing a feeling, not a belief that there is a real stone or a sensory experience without a stimulus.

Mood versus affect
Affect is the emotional expression the nurse observes: facial expression, tone of voice, range, intensity, and whether it fits the content of speech. A client might report a sad mood while showing a flat or restricted affect, or might report feeling fine while appearing tearful. Recording the two separately allows the nurse to compare what the client says with what the nurse sees, and a mismatch is itself an important finding.

| MSE component | What it records | Would this statement fit? |
| --- | --- | --- |
| Mood | Client's own description of feeling | Yes |
| Affect | Nurse's observation of emotional expression | No: this is a report, not an observation |
| Perception | Hallucinations and illusions | No: no sensation without a stimulus |
| Thought content | Delusions, obsessions, suicidal ideas | No: he does not believe a real stone is there |

Why the other components do not fit
Perception covers hallucinations, which are sensations without a stimulus, and illusions, which are misinterpretations of real stimuli; he describes neither. Thought content would apply if he held a fixed false belief, for example that a real stone is inside his chest. His vital signs and physical examination are normal, which supports reading the statement as a description of emotional heaviness common in depression rather than a physical complaint.

Watch out! Clients often describe emotions in physical terms or with metaphors, and some cultures express distress mainly through body language. Ask clarifying questions to distinguish a figure of speech from a somatic delusion before recording thought content.

Exam takeaway
Key point! Mood is what the client says he feels; affect is what the nurse sees. Record mood in the client's own words, and use perception and thought content only when there are hallucinations, illusions, or fixed false beliefs.

## 임상 시나리오

Recording Mood in the MSESubjective report versus observation
Mood is the client's own description of how he feels and is recorded in his words, such as "Heavy, like a stone is sitting on my chest."

Affect is what the nurse observes: facial expression, tone, range, and fit with content. Compare the two and note any mismatch.

A metaphor describing a feeling is not a hallucination or delusion. Normal physical findings support recording it as mood.

CautionClarify whether a physical-sounding statement is a figure of speech before recording it as a somatic delusion.

## 핵심 개념

- **Mental status examination** — A structured assessment of appearance, behavior, mood, affect, thought, perception, cognition, and insight.
- **Mood** — The client's subjective, sustained emotional state as described in his own words.
- **Affect** — The observable expression of emotion, judged by the nurse from face, voice, and behavior.
- **Thought content** — What a client thinks about, including delusions, obsessions, and suicidal ideas.

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