MENTAL HEALTH NURSING PRACTICE
EXAM
ALL CHAPTERS COVERED
A+ GUARANTEED
The clinic nurse reviews telephone messages left by 4 clients. Which
client is the priority to call back first?
Client recovering from opioid addiction having cravings after losing
job [0%]
1.
Client with schizophrenia hearing voices advising to harm a
neighbor [55%]
2.
Parent of a client with conduct disorder who refuses to leave a locked
room [0%]
3.
Spouse of a client with depression reporting the client is threatening
suicide [43%]
4.
Auditory hallucinations are the most common form of hallucination,
noted by falsely perceived sounds, most often in the form of voices.
Command hallucinations are a specific type of auditory hallucination,
during which voices instruct the client to perform specific actions,
often demanding harm to the client or others.
Clients who are alone and experiencing command hallucinations that are
homicidal or suicidal in nature require immediate intervention to ensure
the safety of themselves and others (Option 2).
(Option 1) A client experiencing addiction cravings needs assistance but
is not a priority over a client with command hallucinations demanding
harm to others.
,(Option 3) Parents of clients with conduct disorder need guidance and
training to appropriately respond to problem behavior; however, this is
not an immediate safety risk.
(Option 4) A spouse calling about a suicidal client is not the first
priority; the client is not alone, and the spouse can call others for help (eg,
police, suicide hotline) if necessary while awaiting the nurse's return call.
This should be the second returned call.
Educational objective:
A client who is alone with command hallucinations that are homicidal or
suicidal in nature requires immediate intervention to prevent harm.
Clients who are homicidal or suicidal but are with another person should
be addressed after those who are alone.
A client is receiving nasogastric tube feedings as nutritional rehabilitation
for anorexia nervosa. After a weigh-in, the client learns of gaining 2 lb
(0.9 kg) and says to the nurse, "See what your force feeding has done to
me? I'm fatter and uglier than ever." What is the best action by the
nurse?
Have the client keep a journal and write about feelings [28%]
1.
Initiate one-on-one supervision of the client during feedings [38%]
2.
Remind the client that gaining weight means being able to go
home [16%]
3.
Say that the client is not fat and ugly [15%]
Nutrition support (enteral tube feedings and total parenteral nutrition) is
usually reserved for clients with anorexia nervosa who are severely ill
and/or have not responded to oral nutritional therapy.
Such clients are at high risk for medical complications from anorexia
nervosa, including death. Criteria for nutrition support include:
• Severe weight loss that is life threatening
• Client's unwillingness to adhere to a treatment plan of oral feedings
,The priority nursing actions for this high-risk client include interventions
to meet physiological and safety needs.
Providing one-on-one supervision during the tube feeding will ensure that
the client is actually receiving the feeding and prevent the client from
stopping the feeding and/or pulling out the nasogastric tube.
During the one-on-one contact with the client, the nurse can promote a
therapeutic and trusting relationship with the client by:
• Being honest and accepting of the client
• Presenting the reality of the condition
• Acknowledging the client's feelings of loss of control and anger
• Encouraging the client to express feelings and fears
(Option 1) This is an appropriate intervention for a client with anorexia
nervosa.
Feelings related to lack of control are an underlying problem for these
clients, who use food as a way to deal with them.
Keeping a diary or journal of feelings will help the client recognize and
express them more clearly. However, this is not the priority nursing
action.
(Option 3) This may be a true statement; clients with anorexia nervosa
are usually discharged to out-patient follow-up and treatment or to a
residential treatment facility once an acceptable weight gain has been
achieved and maintained. However, this is not the priority nursing action.
(Option 4) Clients with anorexia nervosa have a distorted body image
and a morbid fear of being overweight; they perceive themselves as "fat
and ugly" even when they are emaciated. Saying that the client is not "fat
and ugly" will not change this perception.
Educational objective:
The priority nursing care for a client with anorexia nervosa is nutritional
rehabilitation and prevention of medical complications, including death.
Clients who are severely ill and/or resistant to oral refeeding may require
nutrition support with intense monitoring to achieve adequate caloric
intake and weight gain.
The client with narcissistic personality disorder often behaves in
grandiose and entitled ways, believes that he/she is perfect, and relies on
constant reinforcement and admiration from people perceived as ideal.
What is the best explanation for these clinical characteristics?
, The client is attempting to maintain self-esteem [46%]
1.
The client is experiencing delusions of grandeur [47%]
2.
The client is feeling threatened [4%]
3.
The client is trying to prevent a panic attack [1%]
4.
A client with narcissistic personality disorder (NPD) exhibits a recurrent
pattern of grandiosity, need for admiration, and lack of empathy.
Clients with NPD may project a picture of superiority, uniqueness, and
independence that hides their true sense of emptiness.
From a psychodynamic perspective, individuals with NPD have a fragile
and damaged ego resulting from a childhood environment that fostered a
sense of inferiority, poor self-esteem, and severe self-criticism.
Narcissistic characteristics develop as a way to regulate self-esteem and
protect the ego from further psychic injury.
(Option 2) Delusions of grandeur are experienced by clients with a
psychotic disorder; NPD is a personality disorder.
(Option 3) Clients with NPD may feel threatened if criticized or if others
do not meet their emotional demands. However, this is not the best
explanation of the clinical characteristics associated with NPD.
(Option 4) Panic attacks are characteristic of clients with an anxiety
disorder, not NPD.
Educational objective:
The clinical characteristics of narcissistic personality disorder can best be
explained as an attempt to maintain a fragile self-esteem that was
damaged during childhood due to an environment that was highly critical,
demanding, and fostered a sense of inferiority.
A client with moderate Alzheimer disease is started on memantine. In
evaluating the effectiveness of this medication, the registered nurse
should assess the client for which of the following?
EXAM
ALL CHAPTERS COVERED
A+ GUARANTEED
The clinic nurse reviews telephone messages left by 4 clients. Which
client is the priority to call back first?
Client recovering from opioid addiction having cravings after losing
job [0%]
1.
Client with schizophrenia hearing voices advising to harm a
neighbor [55%]
2.
Parent of a client with conduct disorder who refuses to leave a locked
room [0%]
3.
Spouse of a client with depression reporting the client is threatening
suicide [43%]
4.
Auditory hallucinations are the most common form of hallucination,
noted by falsely perceived sounds, most often in the form of voices.
Command hallucinations are a specific type of auditory hallucination,
during which voices instruct the client to perform specific actions,
often demanding harm to the client or others.
Clients who are alone and experiencing command hallucinations that are
homicidal or suicidal in nature require immediate intervention to ensure
the safety of themselves and others (Option 2).
(Option 1) A client experiencing addiction cravings needs assistance but
is not a priority over a client with command hallucinations demanding
harm to others.
,(Option 3) Parents of clients with conduct disorder need guidance and
training to appropriately respond to problem behavior; however, this is
not an immediate safety risk.
(Option 4) A spouse calling about a suicidal client is not the first
priority; the client is not alone, and the spouse can call others for help (eg,
police, suicide hotline) if necessary while awaiting the nurse's return call.
This should be the second returned call.
Educational objective:
A client who is alone with command hallucinations that are homicidal or
suicidal in nature requires immediate intervention to prevent harm.
Clients who are homicidal or suicidal but are with another person should
be addressed after those who are alone.
A client is receiving nasogastric tube feedings as nutritional rehabilitation
for anorexia nervosa. After a weigh-in, the client learns of gaining 2 lb
(0.9 kg) and says to the nurse, "See what your force feeding has done to
me? I'm fatter and uglier than ever." What is the best action by the
nurse?
Have the client keep a journal and write about feelings [28%]
1.
Initiate one-on-one supervision of the client during feedings [38%]
2.
Remind the client that gaining weight means being able to go
home [16%]
3.
Say that the client is not fat and ugly [15%]
Nutrition support (enteral tube feedings and total parenteral nutrition) is
usually reserved for clients with anorexia nervosa who are severely ill
and/or have not responded to oral nutritional therapy.
Such clients are at high risk for medical complications from anorexia
nervosa, including death. Criteria for nutrition support include:
• Severe weight loss that is life threatening
• Client's unwillingness to adhere to a treatment plan of oral feedings
,The priority nursing actions for this high-risk client include interventions
to meet physiological and safety needs.
Providing one-on-one supervision during the tube feeding will ensure that
the client is actually receiving the feeding and prevent the client from
stopping the feeding and/or pulling out the nasogastric tube.
During the one-on-one contact with the client, the nurse can promote a
therapeutic and trusting relationship with the client by:
• Being honest and accepting of the client
• Presenting the reality of the condition
• Acknowledging the client's feelings of loss of control and anger
• Encouraging the client to express feelings and fears
(Option 1) This is an appropriate intervention for a client with anorexia
nervosa.
Feelings related to lack of control are an underlying problem for these
clients, who use food as a way to deal with them.
Keeping a diary or journal of feelings will help the client recognize and
express them more clearly. However, this is not the priority nursing
action.
(Option 3) This may be a true statement; clients with anorexia nervosa
are usually discharged to out-patient follow-up and treatment or to a
residential treatment facility once an acceptable weight gain has been
achieved and maintained. However, this is not the priority nursing action.
(Option 4) Clients with anorexia nervosa have a distorted body image
and a morbid fear of being overweight; they perceive themselves as "fat
and ugly" even when they are emaciated. Saying that the client is not "fat
and ugly" will not change this perception.
Educational objective:
The priority nursing care for a client with anorexia nervosa is nutritional
rehabilitation and prevention of medical complications, including death.
Clients who are severely ill and/or resistant to oral refeeding may require
nutrition support with intense monitoring to achieve adequate caloric
intake and weight gain.
The client with narcissistic personality disorder often behaves in
grandiose and entitled ways, believes that he/she is perfect, and relies on
constant reinforcement and admiration from people perceived as ideal.
What is the best explanation for these clinical characteristics?
, The client is attempting to maintain self-esteem [46%]
1.
The client is experiencing delusions of grandeur [47%]
2.
The client is feeling threatened [4%]
3.
The client is trying to prevent a panic attack [1%]
4.
A client with narcissistic personality disorder (NPD) exhibits a recurrent
pattern of grandiosity, need for admiration, and lack of empathy.
Clients with NPD may project a picture of superiority, uniqueness, and
independence that hides their true sense of emptiness.
From a psychodynamic perspective, individuals with NPD have a fragile
and damaged ego resulting from a childhood environment that fostered a
sense of inferiority, poor self-esteem, and severe self-criticism.
Narcissistic characteristics develop as a way to regulate self-esteem and
protect the ego from further psychic injury.
(Option 2) Delusions of grandeur are experienced by clients with a
psychotic disorder; NPD is a personality disorder.
(Option 3) Clients with NPD may feel threatened if criticized or if others
do not meet their emotional demands. However, this is not the best
explanation of the clinical characteristics associated with NPD.
(Option 4) Panic attacks are characteristic of clients with an anxiety
disorder, not NPD.
Educational objective:
The clinical characteristics of narcissistic personality disorder can best be
explained as an attempt to maintain a fragile self-esteem that was
damaged during childhood due to an environment that was highly critical,
demanding, and fostered a sense of inferiority.
A client with moderate Alzheimer disease is started on memantine. In
evaluating the effectiveness of this medication, the registered nurse
should assess the client for which of the following?
