CORRECT QUESTIONS AND VERIFIED
DETAILED RATIONALES ANSWERS 2024
(NEWEST) ALREADY GRADED A+
Assessment of a newly admitted client with schizophrenia finds that the client is demonstrating inability
to trust others, verbalizing hearing voices and refusing to interact with staff and peers. Nursing staff
knows that this assessment likely means this client is suffering from paranoid delusions, auditory
hallucinations, and withdrawn behavior. Which of the following nursing diagnoses would be appropriate
for this client?
A. Social isolation
B. Disturbed sensory perception
C. Disturbed thought processes
D. All of the above nursing diagnoses would be appropriate for this client
D
Assessment of a newly admitted client with major depression finds that the client has severe body odor.
His daughter brings groceries and fills his medication box on a weekly basis. She reports that it seems
that he has eaten very little in the past 2 weeks, and she reports that he hasn't been taking his
medications for about the last 3-4 weeks. Which of the following are appropriate nursing diagnoses for
this client?
A. Imbalanced nutrition: less than body requirements
B. Ineffective health management
C. Self-care deficit
D. All of the above nursing diagnoses would be appropriate for this client
D
Which of the following is not true about the DSM-5?
A. The DSM-5 is a diagnostic tool to identify mental health diagnoses, which is used by nurses, as well as
providers, in the mental health setting.
B. The DSM-5 is a diagnostic tool to identify mental health diagnoses, which is only used by professionals
with prescribing privileges.
C. The DSM-5 is a shortened name for the Diagnostic and Statistical Manual of Mental Disorders, 5th
edition
D. The DSM-5 is used to identify diagnoses and diagnostic critieria to guide assessment.
B
,A client you are working with tells another patient, "The 'Shopatouliens' took my shoes out of my room
last night." Which is an appropriate charting entry to describe this client's statement?
A. "The client is verbalizing a word salad."
B. "The client is expressing a neologism."
C. "The client is experiencing command hallucinations."
D. "The client is experiencing a paranoia."
B
A client you are working with tells another patient, "The shoe is dog table going television too." Which is
an appropriate charting entry to describe the client's statement?
A. "The client is verbalizing a word salad."
B. "The client is experiencing a paranoia."
C. "The client is experiencing command hallucinations."
D. "The client is expressing a neologism."
A
Which of the following is a type of disordered thought content?
A. Paranoia
B. Command hallucinations
C. Word salad
D. Neologism
A
Which statement would indicate to a nurse that an individual is experiencing a delusion?
A. "I see my dead husband everywhere I go."
B. "I'm not going to eat my food. It smells like brimstone."
C. "The IRS may audit my taxes."
D. "There's an alien growing in my liver."
D
Which statement should indicate to a nurse that an individual is experiencing a visual hallucination?
A. "I'm not going to eat my food. It smells like brimstone."
B. "I see my dead husband everywhere I go."
C. "There's an alien growing in my liver."
D. "The IRS may audit my taxes."
B
What is the difference between circumstantiality and tangentiality?
,A. Circumstantiality is disordered thought formation; whereas, tangentiality is disordered thought
content.
B. With circumstantiality, the person eventually gets to the point of the story. With tangentiality, the
person never gets to the point of the story.
C. There is not a difference. Circumstantiality and tangentiality are two terms for the same type of
disordered thought formation.
D. With tangentiality, the person eventually gets to the point of the story. With circumstantiality, the
person never gets to the point of the story.
B
All of the following are true about aphasia, except:
A. It may involve difficulty thinking of specific words
B. It may involve not being able to recognize people who are significant in their life
C. It may involve difficulty forming words, as well as using incorrect words
D. It may involve making up words (neologisms)
B
Which of the following is true about poverty of speech?
A. Poverty of speech is thought to be reflective of lack of thoughts to express
B. Someone with poverty of speech may speak very little
C. Someone with poverty of speech may speak in monosyllables
D. All of the above are true about poverty of speech
D
Which neurotransmitters are most closely associated with depressive disorders?
A. Serotonin, norepinephrine, and dopamine
B. Serotonin, GABA, and dopamine
C. Serotonin, norepinephrine, and acetylcholine
D. GABA, norepinephrine, and dopamine
A
DSM-5 criteria for diagnosis of Major Depressive Disorder (MDD) includes specific clinical findings, which
must occur almost every day for a minimum of ______________, and last most of the day.
A. 2 days
B. 2 weeks
C. 2 months
D. 2 years
B
, For antidepressants in general, it is important to teach patients to:
A. Take the antidepressant as prescribed each and every day, and discontinue it when you begin to feel
better
B. Take the antidepressant only on the days you are feeling down or depressed (EX: as needed)
C. Take the antidepressant as prescribed each and every day, and continue to take it even when you
begin to feel better.
C
inflated self-esteem
grandiosity
talking as if they cannot get the words out fast enough
pressured speech
subjective sensory experiences that are not actually caused by external sensory stimuli
hallucinations
mistaken or false beliefs about the self or the environment that are firmly held even in the face of
disconfirming evidence
delusions
True/False: A client tells that nurse that he is planning to commit suicide, but asks the nurse to keep it a
secret. If the nurse tells the client's treatment team, this is a breach of confidentiality.
False
True/False: An adult client discloses that he's been financially exploiting his 80yo mother. If the nurse
reports this to the local law enforcement agency, it is a breach of confidentiality.
False
True/False: A client under the age of 18 confides in the nurse that his alcoholic father regularly punches
and slaps him. If the nurse reports this to the local law enforcement agency, it is a breach of
confidentiality.
False
Which of the following is not true about involuntary (civil) commitment to a mental health facility?
A. Clients admitted under involuntary commitment are not considered competent and do not have the
right to refuse treatment.
B. The client enters the mental health facility against her will for an indefinite period of time
C. Clients admitted under involuntary commitment are still considered competent and have the right to
refuse treatment, unless they have gone through a legal competency hearing and have been judged
incompetent