NURSING FUNDAMENTALS CORE MAIN
EXAMINATION SET QUESTIONS AND ANSWERS
SURE A+
✔✔A nurse is planning a peer group about the DSM-5. Which of the following
information is appropriate to include in the discussion? (Select all that apply).
A) The DSM-5 includes client education handouts for mental health disorders.
B) The DSM-5 establishes diagnostic criteria for individual mental health disorders.
C) The DSM-5 indicates recommended pharmacological treatment for mental health
disorders.
D) The DSM-5 assists nurses in planning care for client's who have mental health
disorders.
E) The DSM-5 indicates expected assessment findings of mental health disorders. -
✔✔B, D, E
✔✔A nurse in an emergency mental health facility is caring for a group of clients. The
nurse should identify that which of the following clients requires a temporary emergency
admission?
A) A client who has schizophrenia with delusions of grandeur
B) A client who has manifestations of depression and attempted suicide a year ago.
C) A client who has borderline personality disorder and assaulted a homeless man with
a metal rod.
,D) A client who has bipolar disorder and paces quickly around the room while talking to
himself. - ✔✔C
✔✔A nurse decides to put a client who has a psychotic disorder in seclusion overnight
because the unit is very short-staffed, and the client frequently fights with other clients.
The nurse's actions are an example of which of the following torts?
A) Invasion of privacy
B) False imprisonment
C) Assault
D) Battery - ✔✔B
✔✔A client tells a nurse, "Don't tell anyone but I hid a sharp knife under my mattress in
order to protect myself from my roommate, who is always yelling at me and threatening
me." Which of the following actions should the nurse take?
A) Keep the client's communication confidential, but talk to the client daily, using
therapeutic communication to convince him to admit to hiding the knife.
B) Keep the client's communication confidential, but watch the client and his roommate
closely.
C) Tell the client that this must be reported to the healthcare team because it concerns
the health and safety of the client and others.
D) Report the incident to the health care team, but do not inform the client of the
intention to do so. - ✔✔D
✔✔A nurse is caring for a client who is in mechanical restraints. Which of the following
statements should the nurse include in the documentation? (Select all that apply)
A) Client ate most of his breakfast
B) Client was offered 8 oz of water every hr
C) Client shouted obscenities at assistive personnel
D) Client received chlorpromazine 15 mg by mouth at 1000
E) Client acted out after lunch - ✔✔B, C, D
✔✔A nurse hears a newly licensed nurse discussing a client's hallucinations in the
hallway with another nurse. Which of the following actions should the nurse take first?
A) Notify the nurse manager
B) Tell the nurse to stop discussing the behavior
C) Provide an in-service program about confidentiality
D) Complete an incident report - ✔✔B
✔✔A nurse is caring for the parents of a child who has demonstrated changes in
behavior and mood. When the mother of the child asks the nurse for reassurance about
her son's condition, which of the following responses should the nurse make?
A) I think your son is getting better. What have you noticed
B) I'm sure everything will be okay. It just takes time to heal
C) I'm not sure what's wrong. Have you asked the doctor about your concerns?
D) I understand you're concerned. Let's discuss what concerns you specifically - ✔✔D
, ✔✔A nurse is caring for a client who smokes and has lung cancer. The client reports,
"I'm coughing because I have that cold that everyone has been getting." The nurse
should identify that the client is using which of the following defense mechanisms?
A) Reaction formation
B) Denial
C) Displacement
D) Sublimation - ✔✔B
✔✔A nurse is providing preoperative teaching for a client who was just informed that
she requires emergency surgery. The client has a respiratory rate 30/min and says,
"This is difficult to comprehend. I feel shaky and nervous." The nurse should identify
that the client is experiencing which of the following levels of anxiety?
A) Mild
B) Moderate
C) Severe
D) Panic - ✔✔B
✔✔A nurse is caring for a client who is experiencing moderate anxiety. Which of the
following actions should the nurse trying to give necessary information to the client?
(Select all that apply)
A) Reassure the client that everything will be okay
B) Discuss prior use of coping mechanisms with the client
C) Ignore the client's anxiety so that she will not be embarrassed
D) Demonstrate a calm manner while using simple and clear directions
E) Gather information from the client using closed-ended questions - ✔✔B, D
✔✔A nurse is talking with a client who is at risk for suicide following the death of his
spouse. Which of the following statements should the nurse make?
A) I feel very feel very sorry for the loneliness you must be experiencing
B) Suicide is not the appropriate way to cope with loss
C) Losing someone close to you must be very upsetting
D) I know how difficult it is to lose a love one - ✔✔C
✔✔A nurse is talking with a client who is at risk for suicide following the death of his
spouse. Which of the following statements should the nurse make?
A) I feel very sorry for the loneliness you must be experiencing
B) Suicide is not the appropriate way to cope with loss
C) Losing someone close to you must be very upsetting
D) I know how difficult it is to lose a love one - ✔✔C
✔✔A nurse is talking with a client who is at risk for suicide following the death of his
spouse. Which of the following statements should the nurse make?
A) I feel very sorry for the loneliness you must be experiencing
B) Suicide is not the appropriate way to cope with loss
EXAMINATION SET QUESTIONS AND ANSWERS
SURE A+
✔✔A nurse is planning a peer group about the DSM-5. Which of the following
information is appropriate to include in the discussion? (Select all that apply).
A) The DSM-5 includes client education handouts for mental health disorders.
B) The DSM-5 establishes diagnostic criteria for individual mental health disorders.
C) The DSM-5 indicates recommended pharmacological treatment for mental health
disorders.
D) The DSM-5 assists nurses in planning care for client's who have mental health
disorders.
E) The DSM-5 indicates expected assessment findings of mental health disorders. -
✔✔B, D, E
✔✔A nurse in an emergency mental health facility is caring for a group of clients. The
nurse should identify that which of the following clients requires a temporary emergency
admission?
A) A client who has schizophrenia with delusions of grandeur
B) A client who has manifestations of depression and attempted suicide a year ago.
C) A client who has borderline personality disorder and assaulted a homeless man with
a metal rod.
,D) A client who has bipolar disorder and paces quickly around the room while talking to
himself. - ✔✔C
✔✔A nurse decides to put a client who has a psychotic disorder in seclusion overnight
because the unit is very short-staffed, and the client frequently fights with other clients.
The nurse's actions are an example of which of the following torts?
A) Invasion of privacy
B) False imprisonment
C) Assault
D) Battery - ✔✔B
✔✔A client tells a nurse, "Don't tell anyone but I hid a sharp knife under my mattress in
order to protect myself from my roommate, who is always yelling at me and threatening
me." Which of the following actions should the nurse take?
A) Keep the client's communication confidential, but talk to the client daily, using
therapeutic communication to convince him to admit to hiding the knife.
B) Keep the client's communication confidential, but watch the client and his roommate
closely.
C) Tell the client that this must be reported to the healthcare team because it concerns
the health and safety of the client and others.
D) Report the incident to the health care team, but do not inform the client of the
intention to do so. - ✔✔D
✔✔A nurse is caring for a client who is in mechanical restraints. Which of the following
statements should the nurse include in the documentation? (Select all that apply)
A) Client ate most of his breakfast
B) Client was offered 8 oz of water every hr
C) Client shouted obscenities at assistive personnel
D) Client received chlorpromazine 15 mg by mouth at 1000
E) Client acted out after lunch - ✔✔B, C, D
✔✔A nurse hears a newly licensed nurse discussing a client's hallucinations in the
hallway with another nurse. Which of the following actions should the nurse take first?
A) Notify the nurse manager
B) Tell the nurse to stop discussing the behavior
C) Provide an in-service program about confidentiality
D) Complete an incident report - ✔✔B
✔✔A nurse is caring for the parents of a child who has demonstrated changes in
behavior and mood. When the mother of the child asks the nurse for reassurance about
her son's condition, which of the following responses should the nurse make?
A) I think your son is getting better. What have you noticed
B) I'm sure everything will be okay. It just takes time to heal
C) I'm not sure what's wrong. Have you asked the doctor about your concerns?
D) I understand you're concerned. Let's discuss what concerns you specifically - ✔✔D
, ✔✔A nurse is caring for a client who smokes and has lung cancer. The client reports,
"I'm coughing because I have that cold that everyone has been getting." The nurse
should identify that the client is using which of the following defense mechanisms?
A) Reaction formation
B) Denial
C) Displacement
D) Sublimation - ✔✔B
✔✔A nurse is providing preoperative teaching for a client who was just informed that
she requires emergency surgery. The client has a respiratory rate 30/min and says,
"This is difficult to comprehend. I feel shaky and nervous." The nurse should identify
that the client is experiencing which of the following levels of anxiety?
A) Mild
B) Moderate
C) Severe
D) Panic - ✔✔B
✔✔A nurse is caring for a client who is experiencing moderate anxiety. Which of the
following actions should the nurse trying to give necessary information to the client?
(Select all that apply)
A) Reassure the client that everything will be okay
B) Discuss prior use of coping mechanisms with the client
C) Ignore the client's anxiety so that she will not be embarrassed
D) Demonstrate a calm manner while using simple and clear directions
E) Gather information from the client using closed-ended questions - ✔✔B, D
✔✔A nurse is talking with a client who is at risk for suicide following the death of his
spouse. Which of the following statements should the nurse make?
A) I feel very feel very sorry for the loneliness you must be experiencing
B) Suicide is not the appropriate way to cope with loss
C) Losing someone close to you must be very upsetting
D) I know how difficult it is to lose a love one - ✔✔C
✔✔A nurse is talking with a client who is at risk for suicide following the death of his
spouse. Which of the following statements should the nurse make?
A) I feel very sorry for the loneliness you must be experiencing
B) Suicide is not the appropriate way to cope with loss
C) Losing someone close to you must be very upsetting
D) I know how difficult it is to lose a love one - ✔✔C
✔✔A nurse is talking with a client who is at risk for suicide following the death of his
spouse. Which of the following statements should the nurse make?
A) I feel very sorry for the loneliness you must be experiencing
B) Suicide is not the appropriate way to cope with loss
