HESI MENTAL HEALTH EXAM TEST BANK
HESI MENTAL HEALTH EXAM 2 TEST BANK
WITH 450 REAL Exam VERIFIED QUESTIONS
AND CORRECT DETAILED ANSWERS GRADED
A+ GUARANTEED PASS (RATIONALES) |
A client on the mental health unit is becoming more agitated, shouting at the
staff, and pacing in the hallway. When a PRN medication is offered, the client
refuses the medication and defiantly sits on the floor in the middle of the unit
hallway. What nursing intervention should the nurse implement first?
A)Transport of the client to the seclusion room
B)Quietly approach the client with additional staff members.
C)Take other client in the area to the client lounge.
A+ TEST BANK 1
, HESI MENTAL HEALTH EXAM TEST BANK
D)Administer medication to chemically restrain the client
ANS: C
Removing other clients from the area will reduce the stimuli in the environment
and create a more calming atmosphere for the agitated client. This will help to
de-escalate the situation and make it easier for the nurse to communicate with
the client.
Protecting other clients from harm is a priority. If the agitated client becomes
aggressive, it is important to remove other clients from the area to prevent
them from being injured.
De-escalation is the next course of action. The nurse should try to talk to the
client in a calm and soothing voice and identify the source of the client's
agitation. If the client is able to calm down, there is no need to resort to more
restrictive interventions.
More restrictive interventions should only be used as a last resort. If the client is
unable to calm down after de-escalation efforts have been made, the nurse may
need to consider offering the client a PRN medication or calling for security
assistance. However, these interventions should only be used as a last resort
and should be used in a way that is least restrictive to the client.
A client who is homeless is diagnosed with schizophrenia and admitted on an
involuntary basis to a mental health hospital 4 days ago. The client stopped
taking prescribed antipsychotic drugs approximately one month ago. Since
hospitalization the client continues to have poor judgment and refuses all
medications. What action should the RN take?
A. Encourage the client to stay in the hospital so the client does not have to be
homeless.
B. Provide the client with medication if the client presents an imminent risk to
self and others.
A+ TEST BANK 2
, HESI MENTAL HEALTH EXAM TEST BANK
C. Administer a long acting antipsychotic medication so that the client can be
discharged to a shelter.
D. Describe to the client treatment options provided at the community mental
health clinics.
ANS: B
This action is rooted in the principles of patient safety and the duty of care to
prevent harm. Schizophrenia is a severe mental disorder that can lead to erratic
behavior, impaired judgment, and a potential for dangerous actions, especially
when the client is not taking prescribed antipsychotic drugs. The client's refusal
of medications, coupled with a history of poor judgment, can put both the client
and others at risk. By administering medication, the RN aims to manage the
client's symptoms and reduce the potential for harm to self and others. It's
essential to balance the client's rights with the need to protect their well-being
and the safety of those around them. This intervention aligns with the ethical
principle of beneficence, which prioritizes the best interests of the client's health
and safety.
A male client comes to the emergency center he has an erection that will no
resolve the client reports that he is taking trazodone (Desyrel) for insomnia
which information is most important for the nurse to ask this client?
A)Have you taken any medication for erectile dysfunction?"
B)Are you having any other sexual dysfunctions or problems?"
C)When was the last time you drank an alcoholic beverage?"
D)Do you have a history of angina or high BP?"
ANS: A
Trazodone, which the client is taking for insomnia, is an antidepressant
medication that can have an uncommon side effect of priapism, a prolonged
A+ TEST BANK 3
, HESI MENTAL HEALTH EXAM TEST BANK
and painful erection that persists for more than four hours. This condition can be
serious and requires immediate medical attention to prevent potential damage
to the penile tissues. By asking about medication for erectile dysfunction, the
nurse can ascertain whether the client might have taken medications that could
potentially interact with trazodone and contribute to the development of
priapism. This information is crucial for the nurse to provide appropriate care
and determine the best course of action to alleviate the client's current
situation.
On admission to the mental health unit, a client diagnosed with schizophrenia
tells the RN that he is the son of God. Based on this statement, which
intervention should the RN include in this client’s plan of care?
A. Lead the client by his arm to the seclusion room.
B. Ensure the client’s environment is safe.
C. Schedule activity therapy twice a week.
D. Confront his delusion as not consistent with reality
ANS: D
The client's statement that he is the son of God is a delusion, which is a fixed
false belief that is not shared by others in the client's culture or subculture. It is
important to confront delusions in a gentle and non-judgmental way, as this can
help the client to start to question their beliefs. The RN should explain to the
client that his belief is not consistent with reality and that there is no evidence to
support it. The RN should also be respectful of the client's religious beliefs and
avoid alienating them.
The other options are not appropriate interventions for this client. Leading the
client to the seclusion room would be a form of restraint and would only serve
to isolate the client and make them feel more paranoid. Ensuring the client's
environment is safe is important, but it is not the most important intervention in
this case. Schedule activity therapy twice a week is not an appropriate
intervention for a client who is experiencing delusions.
A+ TEST BANK 4
HESI MENTAL HEALTH EXAM 2 TEST BANK
WITH 450 REAL Exam VERIFIED QUESTIONS
AND CORRECT DETAILED ANSWERS GRADED
A+ GUARANTEED PASS (RATIONALES) |
A client on the mental health unit is becoming more agitated, shouting at the
staff, and pacing in the hallway. When a PRN medication is offered, the client
refuses the medication and defiantly sits on the floor in the middle of the unit
hallway. What nursing intervention should the nurse implement first?
A)Transport of the client to the seclusion room
B)Quietly approach the client with additional staff members.
C)Take other client in the area to the client lounge.
A+ TEST BANK 1
, HESI MENTAL HEALTH EXAM TEST BANK
D)Administer medication to chemically restrain the client
ANS: C
Removing other clients from the area will reduce the stimuli in the environment
and create a more calming atmosphere for the agitated client. This will help to
de-escalate the situation and make it easier for the nurse to communicate with
the client.
Protecting other clients from harm is a priority. If the agitated client becomes
aggressive, it is important to remove other clients from the area to prevent
them from being injured.
De-escalation is the next course of action. The nurse should try to talk to the
client in a calm and soothing voice and identify the source of the client's
agitation. If the client is able to calm down, there is no need to resort to more
restrictive interventions.
More restrictive interventions should only be used as a last resort. If the client is
unable to calm down after de-escalation efforts have been made, the nurse may
need to consider offering the client a PRN medication or calling for security
assistance. However, these interventions should only be used as a last resort
and should be used in a way that is least restrictive to the client.
A client who is homeless is diagnosed with schizophrenia and admitted on an
involuntary basis to a mental health hospital 4 days ago. The client stopped
taking prescribed antipsychotic drugs approximately one month ago. Since
hospitalization the client continues to have poor judgment and refuses all
medications. What action should the RN take?
A. Encourage the client to stay in the hospital so the client does not have to be
homeless.
B. Provide the client with medication if the client presents an imminent risk to
self and others.
A+ TEST BANK 2
, HESI MENTAL HEALTH EXAM TEST BANK
C. Administer a long acting antipsychotic medication so that the client can be
discharged to a shelter.
D. Describe to the client treatment options provided at the community mental
health clinics.
ANS: B
This action is rooted in the principles of patient safety and the duty of care to
prevent harm. Schizophrenia is a severe mental disorder that can lead to erratic
behavior, impaired judgment, and a potential for dangerous actions, especially
when the client is not taking prescribed antipsychotic drugs. The client's refusal
of medications, coupled with a history of poor judgment, can put both the client
and others at risk. By administering medication, the RN aims to manage the
client's symptoms and reduce the potential for harm to self and others. It's
essential to balance the client's rights with the need to protect their well-being
and the safety of those around them. This intervention aligns with the ethical
principle of beneficence, which prioritizes the best interests of the client's health
and safety.
A male client comes to the emergency center he has an erection that will no
resolve the client reports that he is taking trazodone (Desyrel) for insomnia
which information is most important for the nurse to ask this client?
A)Have you taken any medication for erectile dysfunction?"
B)Are you having any other sexual dysfunctions or problems?"
C)When was the last time you drank an alcoholic beverage?"
D)Do you have a history of angina or high BP?"
ANS: A
Trazodone, which the client is taking for insomnia, is an antidepressant
medication that can have an uncommon side effect of priapism, a prolonged
A+ TEST BANK 3
, HESI MENTAL HEALTH EXAM TEST BANK
and painful erection that persists for more than four hours. This condition can be
serious and requires immediate medical attention to prevent potential damage
to the penile tissues. By asking about medication for erectile dysfunction, the
nurse can ascertain whether the client might have taken medications that could
potentially interact with trazodone and contribute to the development of
priapism. This information is crucial for the nurse to provide appropriate care
and determine the best course of action to alleviate the client's current
situation.
On admission to the mental health unit, a client diagnosed with schizophrenia
tells the RN that he is the son of God. Based on this statement, which
intervention should the RN include in this client’s plan of care?
A. Lead the client by his arm to the seclusion room.
B. Ensure the client’s environment is safe.
C. Schedule activity therapy twice a week.
D. Confront his delusion as not consistent with reality
ANS: D
The client's statement that he is the son of God is a delusion, which is a fixed
false belief that is not shared by others in the client's culture or subculture. It is
important to confront delusions in a gentle and non-judgmental way, as this can
help the client to start to question their beliefs. The RN should explain to the
client that his belief is not consistent with reality and that there is no evidence to
support it. The RN should also be respectful of the client's religious beliefs and
avoid alienating them.
The other options are not appropriate interventions for this client. Leading the
client to the seclusion room would be a form of restraint and would only serve
to isolate the client and make them feel more paranoid. Ensuring the client's
environment is safe is important, but it is not the most important intervention in
this case. Schedule activity therapy twice a week is not an appropriate
intervention for a client who is experiencing delusions.
A+ TEST BANK 4
