1. A nurse is admitting a client who has schizophrenia. During the initial interview, the client takes off his belt and screams, "A snake!" Which of the following responses is appropriate?
a. "You know that is you belt and not a snake, don't you?"
b. "Your belt doesn't look like a snake."
c. "Th...
1. A nurse is admitting a client who has schizophrenia. During the initial interview, the client
takes off his belt and screams, "A snake!" Which of the following responses is appropriate?
a. "You know that is you belt and not a snake, don't you?"
b. "Your belt doesn't look like a snake."
c. "This is your belt. I understand how this is scary for you."
d. "Why do you think your belt is a snake?"
C
A nurse working in the emergency department is assessing a client who has generalized
anxiety disorder. Which of the following actions should the nurse take first?
A)Move the client to a quiet area
B)Allow the client time to express his feelings
C)Instruct the client to use guided imagery
D)Assist the client to identify his coping skills
A
DEFINITION
A nurse is caring for a client who has dementia. Which of the following is an appropriate
nursing intervention?
A) Encourage the client to make choices regarding care.
B) Advise family to visit frequently as a group
C) Maintain a low-stimulation environment
D) Assign several tasks at the same time.
C
A nurse is counseling an adult client whose parent just died. The client states, "My son is 4,
and I don't know how h
n he finds out that his grandpa died." The nurse should inform the client that the
preschool-age child commonly has which of the following concepts of death?
a. Death is contagious and can cause other people he loves to die
b. Death creates an interest in the physical aspects of dying
c. Death is not permanent and the loved one may come back to life. d. Death is a part of life
that eventually happens to everyone.
C
A nurse in the emergency department is admitting a client who has a history of alcohol use
disorder. The client has a blood alcohol level of 0.26 g/dL. The nurse should anticipate a
prescription for which of the following medications? (p. 156)
,a. Chlordiazepoxide
b. Disulfram
c. Acamprosate
d. Naltrexone
TERM
IMAGE
A
DEFINITION
6. A nurse is advising an assistive personnel (AP) on the care of a client who has major
depressive disorder. The AP states that he is irritated by the client's depression. Which of the
following statements by the nurse is appropriate?
a. "Please don't take what the client said seriously when she is depressed"
b. "I'll change your assignment to someone who doesn't have depressive disorder."
c. "It's important that the client feel safe verbalizing how she is feeling."
d. "Everybody feels that way about this client, so don't worry about it."
C
DEFINITION
7. A nurse is caring for a client who reports he is angry with his partner because she thinks
he is trying to seek attention. When the nurse questions the client, he becomes angry and
tells her to leave. Which of the following defense mechanisms is the client demonstrating?
(p. 30)
a. Compensation
b. Displacement
c. Denial
B
A nurse working in a mental health facility has just put a client in provider-prescribed
seclusion. Which of the following is the nurse required to document? (Select all that apply)
a. The client's feelings about being secluded
B.The client's behaviors that resulted in the need for seclusion
c. Previous interventions used to prevent the need for seclusion
d. The client's vital signs
e. Thetimethecliententeredseclusion
BCDE
9. A nurse is assessing a client who has major depressive disorder. The client states, "I may
as well be dead. I have always been a failure." Which of the following is an appropriate
response by the nurse?
a. "Let's discuss these feelings further."
, b. "why do you think you feel this way?"
c. "Feeling like a failure is expected with depression."
d. "You have a great deal to offer in life."
A
10. A nurse is planning care for a group of clients in an outpatient facility. For which of the
following clients should the nurse plan to provide assistance with ADLs?
a. A client who has intense manifestations of agoraphobia
b. A client who has negative manifestations of schizophrenia c. A client who is in treatment
for hypomania
d. A client who is in treatment for alcohol use disorder
B
11. A nurse Is planning care for a client who has anorexia nervosa and is admitted to an
inpatient eating disorder unit. Which of the following is an appropriate intervention? (p. 167)
a. Use systematic desensitization to address the client's fears regarding weight gain
b. Allow the client to select meal times
c. Initiate a relationship built on trust with the client.
d. Negotiate with the client the opportunity to reweig
C
nurse is planning an inservice for new nurses about cultural beliefs and their impact on
mental health care. The nurse should identify that which of the following beliefs differs from
the western perspective held by most nurses in the United
States? (Not sure)
a. Mental health is the absence of a mental health disorder.
b. Clients should make independent decisions about their mental health care
c. Mental health care places value on veracity and confidentiality
d. Clients who have a mental health disorder should be passive in their care.
C
nurse is caring for a client who is admitted to a mental health facility after attempting suicide.
Which of the following actions should the nurse take first? (p. 286)
a. Implement continuous one-to-one observation b. Ask the client to sign a no-suicide
contract
c. Encourage client to participate in group therapy d. Establish a rapport to foster trust
A
DEFINITION
14. A nurse is caring for a client in an out-patient mental health facility. The client tells the
nurse that she wants to tell her a secret and asks her to promise not to tell. Which of the
following responses by the nurse is appropriate? (p. 37)
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