VATI PN MENTAL HEALTH
ASSESSMENT EXAM WITH CORRECT
ANSWERS 2025
A nurse is assisting with the care of a client immediately following
electroconvulsive
therapy (ECT). Which of the following findings should the nurse
document as an
unexpected response
An irregular heart to the
rhythm procedure?
is an - Correct
unexpected answers
response - Irregular
to ECT. During the
heart rhythm
procedure, thecan be stressed, which can cause cardiac abnormalities.
client's heart
especially
client already
if thehas impaired cardiac function. The nurse should document
this finding
and notify the charge nurse or the client's
provider.
A nurse is caring for a client who is admitted for alcohol use disorder. The
client
"I havestates,
not had anything to drink for 24 hours." Which the following is the
priority nursing
intervention? - Correct answers - Check the client's
vital signs.
Clients who have alcohol use disorder are at risk for the development of
syndrome. Manifestations of abstinence syndrome occur 12 to 72 hr after
abstinence
the client
last consumedhas alcohol and can include tachycardia, hypertension, and
an elevated Therefore, the first action the nurse should take when using
temperature.
the airway,circulation (ABC) approach to client care is to check the client's
breathing,
vital signs
monitor fortosigns of abstinence
syndrome.
A nurse is reinforcing teaching with the adult child of a client who is
scheduled to havetherapy (ECT). Which of the following statements should
electroconvulsive
the nurse
make? - Correct answers - "Your father might experience short-term
memory loss after
the
procedure."
The nurse should reinforce to the client's child that short-term memory loss is
a common
adverse effect of
ECT.
A nurse is assisting with planning care for a client who is in the manic
phase of bipolar
disorder. Which of the following actions is the priority for the nurse to
include
plan? in the answers - Offer frequent high-calorie fluids
- Correct
throughout the day.
The priority action the nurse should take when using Maslow's hierarchy of
needsthe
meet is toclient's physiological need for food and fluids. The priority nursing
action is to
frequently.offer the client high-calorie fluids to prevent dehydration and
ensure the
client's caloric is adequate to meet intake physical
needs.
, A nurse is reinforcing teaching with a client who has bipolar disorder
and a new for valproic acid. Which of the following manifestations
prescription
should the
instruct thenurse
client to report to the provider as an adverse effect of this
medication?
Correct answers - - Abdominal
pain
The nurse should instruct the client that abdominal pain can indicate
hepatoxicity or
pancreatitis, both adverse effects of valproic acid; therefore, the client
should
to the report this
provider.
A nurse is establishing a therapeutic relationship with a client who has
generalized
anxiety disorder. Which of the following actions should the nurse take
first? - Correct
answers - Explain confidentiality guidelines to
the client.
Evidence-based practice indicates that the nurse should first begin a
therapeutic
relationship with the orientation phase. During this phase, the nurse should
explain thefor confidentiality. This initial step in developing a therapeutic
guidelines
relationship
builds trust between the client and the
nurse.
A nurse is interviewing an adolescent client who reports that they
were sexually
assaulted. Which of the following actions should the nurse take? - Correct
answers
Move the- client to a private examination room to perform the
interview.
The nurse should interview the client in a private room without others
present.inProviding
privacy a safe environment will foster trust and promote open
communication
between the client and the
nurse.
A nurse is caring for a client who is experiencing a severe panic attack.
Which of the
following actions should the nurse take during the panic attack? (Select all
that apply.)
Correct -
answers - Stay with the client is correct. The nurse should stay
with the
during theclient
panic attack to ensure that the client remains safe and reduce
feelings of
abandonme
nt.
Instruct the client to take slow, deep breaths is correct. The nurse should
instruct
client to the
breathe slowly and deeply to distract from the distressing
manifestations
attack and reduce of the
the risk for
hyperventilation.
Set physical limits is correct. The nurse should set physical limits to
maintain
of the clienttheandsafety
others because the client might have difficulty controlling
their actions
during the
attack.
A nurse is collecting data from a 5-year-old child who is brought to the
department by a parent who states that the child fell out of a tree. The child
emergency
is guarding
their right arm. For which of the following findings should the nurse
suspect physical- Correct answers - An x-ray of the right arm indicates a
maltreatment?
spiral fracture.
ASSESSMENT EXAM WITH CORRECT
ANSWERS 2025
A nurse is assisting with the care of a client immediately following
electroconvulsive
therapy (ECT). Which of the following findings should the nurse
document as an
unexpected response
An irregular heart to the
rhythm procedure?
is an - Correct
unexpected answers
response - Irregular
to ECT. During the
heart rhythm
procedure, thecan be stressed, which can cause cardiac abnormalities.
client's heart
especially
client already
if thehas impaired cardiac function. The nurse should document
this finding
and notify the charge nurse or the client's
provider.
A nurse is caring for a client who is admitted for alcohol use disorder. The
client
"I havestates,
not had anything to drink for 24 hours." Which the following is the
priority nursing
intervention? - Correct answers - Check the client's
vital signs.
Clients who have alcohol use disorder are at risk for the development of
syndrome. Manifestations of abstinence syndrome occur 12 to 72 hr after
abstinence
the client
last consumedhas alcohol and can include tachycardia, hypertension, and
an elevated Therefore, the first action the nurse should take when using
temperature.
the airway,circulation (ABC) approach to client care is to check the client's
breathing,
vital signs
monitor fortosigns of abstinence
syndrome.
A nurse is reinforcing teaching with the adult child of a client who is
scheduled to havetherapy (ECT). Which of the following statements should
electroconvulsive
the nurse
make? - Correct answers - "Your father might experience short-term
memory loss after
the
procedure."
The nurse should reinforce to the client's child that short-term memory loss is
a common
adverse effect of
ECT.
A nurse is assisting with planning care for a client who is in the manic
phase of bipolar
disorder. Which of the following actions is the priority for the nurse to
include
plan? in the answers - Offer frequent high-calorie fluids
- Correct
throughout the day.
The priority action the nurse should take when using Maslow's hierarchy of
needsthe
meet is toclient's physiological need for food and fluids. The priority nursing
action is to
frequently.offer the client high-calorie fluids to prevent dehydration and
ensure the
client's caloric is adequate to meet intake physical
needs.
, A nurse is reinforcing teaching with a client who has bipolar disorder
and a new for valproic acid. Which of the following manifestations
prescription
should the
instruct thenurse
client to report to the provider as an adverse effect of this
medication?
Correct answers - - Abdominal
pain
The nurse should instruct the client that abdominal pain can indicate
hepatoxicity or
pancreatitis, both adverse effects of valproic acid; therefore, the client
should
to the report this
provider.
A nurse is establishing a therapeutic relationship with a client who has
generalized
anxiety disorder. Which of the following actions should the nurse take
first? - Correct
answers - Explain confidentiality guidelines to
the client.
Evidence-based practice indicates that the nurse should first begin a
therapeutic
relationship with the orientation phase. During this phase, the nurse should
explain thefor confidentiality. This initial step in developing a therapeutic
guidelines
relationship
builds trust between the client and the
nurse.
A nurse is interviewing an adolescent client who reports that they
were sexually
assaulted. Which of the following actions should the nurse take? - Correct
answers
Move the- client to a private examination room to perform the
interview.
The nurse should interview the client in a private room without others
present.inProviding
privacy a safe environment will foster trust and promote open
communication
between the client and the
nurse.
A nurse is caring for a client who is experiencing a severe panic attack.
Which of the
following actions should the nurse take during the panic attack? (Select all
that apply.)
Correct -
answers - Stay with the client is correct. The nurse should stay
with the
during theclient
panic attack to ensure that the client remains safe and reduce
feelings of
abandonme
nt.
Instruct the client to take slow, deep breaths is correct. The nurse should
instruct
client to the
breathe slowly and deeply to distract from the distressing
manifestations
attack and reduce of the
the risk for
hyperventilation.
Set physical limits is correct. The nurse should set physical limits to
maintain
of the clienttheandsafety
others because the client might have difficulty controlling
their actions
during the
attack.
A nurse is collecting data from a 5-year-old child who is brought to the
department by a parent who states that the child fell out of a tree. The child
emergency
is guarding
their right arm. For which of the following findings should the nurse
suspect physical- Correct answers - An x-ray of the right arm indicates a
maltreatment?
spiral fracture.
