Psychiatric-Mental Health Practice Exam HESI
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1. 1. Photosensitivity is a side effect of Prolixin and a
A male client with schizophrenia who vacation in the Bahamas (with its tropical island cli-
is taking fluphenazine decanoate (Pro- mate) increases the client's chance of experiencing
lixin decanoate) is being discharged in this side effect. He should be instructed to avoid
the morning. A repeat dose of med- direct sun (A) and wear sunscreen. (B, C, and D)
ication is scheduled for 20 days after indicate accurate knowledge. Alcohol acts syner-
discharge. The client tells the nurse gistically with Prolixin (B). (C) lists signs of agran-
that he is going on vacation in the ulocytosis, which is also a side effect of Prolixin.
Bahamas and will return in 18 days. In order to avoid extrapyramidal symptoms (EPS),
Which statement by the client indi- anticholinergic drugs, such as Cogentin, are often
cates a need for health teaching? prescribed prophylactically with Prolixin.
A) When I return from my tropical is-
land vacation, I will go to the clinic to Correct Answer(s): A
get my Prolixin injection.
B) While I am on vacation and when I
return, I will not eat or drink anything
that contains alcohol.
C) I will notify the healthcare provider
if I have a sore throat or flu-like symp-
toms.
D) I will continue to take my ben-
ztropine mesylate (Cogentin) every
day.
2. 2. The most important nursing diagnosis is related
A male client is admitted to the mental to alcohol detoxification (B) because the client has
health unit because he was feeling de- elevated vital signs, a sign of alcohol detoxification.
pressed about the loss of his wife and Maintaining client safety related to (A) should be
job. The client has a history of alcohol addressed after giving the client Ativan for elevated
dependency and admits that he was vital signs secondary to alcohol withdrawal. (C and
drinking alcohol 12 hours ago. Vital D) can be addressed when immediate needs for
signs are: temperature, 100° F, pulse safety are met.
, Psychiatric-Mental Health Practice Exam HESI
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100, and BP 142/100. The nurse plans
to give the client lorazepam (Ativan) Correct Answer(s): B
based on which priority nursing diag-
nosis?
A) Risk for injury related to suicidal
ideation.
B) Risk for injury related to alcohol
detoxification.
C) Knowledge deficit related to ineffec-
tive coping.
D) Health seeking behaviors related to
personal crisis.
3. 3. The most important reason for closely observing
The charge nurse is collaborating with a depressed client immediately after admission is
the nursing staff about the plan of to maintain safety (B), since suicide is a risk with
care for a client who is very depressed. depression. (A, C, and D) are all important inter-
What is the most important interven- ventions, but safety is the priority.
tion to implement during the first 48
hours after the client's admission to Correct Answer(s): B
the unit?
A) Monitor appetite and observe in-
take at meals.
B) Maintain safety in the client's mi-
lieu.
C) Provide ongoing, supportive con-
tact.
D) Encourage participation in activi-
ties.
4. 4. (A) is the best choice cited. The nurse does not
A 38-year-old female client is admitted argue with the client nor demand that she eat, but
, Psychiatric-Mental Health Practice Exam HESI
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with a diagnosis of paranoid schizo- offers support by agreeing to "be there if needed",
phrenia. When her tray is brought to e.g., to warm the food. (B and C) are arguing with
her, she refuses to eat and tells the the client's delusions, and (B) asks "why" which is
nurse, "I know you are trying to poison usually not a good question for a psychotic client.
me with that food." Which response (D) has nothing to do with the actual problem; i.e.,
is most appropriate for the nurse to the problem is not the diet (she thinks any food
make? given to her is poisoned.)
A) I'll leave your tray here. I am avail-
able if you need anything else. Correct Answer(s): A
B) You're not being poisoned. Why do
you think someone is trying to poison
you?
C) No one on this unit has ever died
from poisoning. You're safe here.
D) I will talk to your healthcare
provider about the possibility of
changing your diet.
5. 5. Early side effects of lithium carbonate (occurring
A client who is being treated with lithi- with serum lithium levels below 2.0 mEq per liter)
um carbonate for bipolar disorder de- generally follow a progressive pattern beginning
velops diarrhea, vomiting, and drowsi- with diarrhea, vomiting, drowsiness, and muscular
ness. What action should the nurse weakness. At higher levels, ataxia, tinnitus, blurred
take? vision, and large dilute urine output may occur. (B)
A) Notify the healthcare provider im- is the best choice. Although these are expected
mediately and prepare for administra- symptoms, the healthcare provider should be no-
tion of an antidote. tified prior to the next administration of the drug.
B) Notify the healthcare provider of (A, C, and D) would not reflect good nursing judg-
the symptoms prior to the next admin- ment.
istration of the drug.
C) Record the symptoms as normal Correct Answer(s): B
side effects and continue administra-
, Psychiatric-Mental Health Practice Exam HESI
Study online at https://quizlet.com/_8bceqm
tion of the prescribed dosage.
D) Hold the medication and refuse to
administer additional amounts of the
drug.
6. 6. Knowledge of all substances taken (C) will guide
The parents of a 14-year-old boy further treatment, such as administration of antag-
bring their son to the hospital. He is onists, so obtaining this information has the high-
lethargic, but responsive. The mother est priority. (A and B) are also valuable in planning
states, "I think he took some of my treatment. (D) is not appropriate during the acute
pain pills." During initial assessment management of a drug overdose.
of the teenager, what information is
most important for the nurse to ob- Correct Answer(s): C
tain from the parents?
A) If he has seemed depressed recent-
ly.
B) If a drug overdose has ever oc-
curred before.
C) If he might have taken any other
drugs.
D) If he has a desire to quit taking
drugs.
7. 7. The nurse should answer the client's question with
The wife of a male client recently di- factual information and explain that schizophrenia
agnosed with schizophrenia asks the is a chemical imbalance in the brain (B). (A) is
nurse, "What exactly is schizophrenia? a therapeutic response but does not answer the
Is my husband all right?" Which re- question, and may be an appropriate response af-
sponse is best for the nurse to provide ter the nurse answers the question asked. Although
to this family member? (C) is likely true to some degree, it is also true that
A) It sounds like you're worried about some clients continue to have disorganized think-
your husband. Let's sit down and talk. ing even with antipsychotic medications. Referring
Study online at https://quizlet.com/_8bceqm
1. 1. Photosensitivity is a side effect of Prolixin and a
A male client with schizophrenia who vacation in the Bahamas (with its tropical island cli-
is taking fluphenazine decanoate (Pro- mate) increases the client's chance of experiencing
lixin decanoate) is being discharged in this side effect. He should be instructed to avoid
the morning. A repeat dose of med- direct sun (A) and wear sunscreen. (B, C, and D)
ication is scheduled for 20 days after indicate accurate knowledge. Alcohol acts syner-
discharge. The client tells the nurse gistically with Prolixin (B). (C) lists signs of agran-
that he is going on vacation in the ulocytosis, which is also a side effect of Prolixin.
Bahamas and will return in 18 days. In order to avoid extrapyramidal symptoms (EPS),
Which statement by the client indi- anticholinergic drugs, such as Cogentin, are often
cates a need for health teaching? prescribed prophylactically with Prolixin.
A) When I return from my tropical is-
land vacation, I will go to the clinic to Correct Answer(s): A
get my Prolixin injection.
B) While I am on vacation and when I
return, I will not eat or drink anything
that contains alcohol.
C) I will notify the healthcare provider
if I have a sore throat or flu-like symp-
toms.
D) I will continue to take my ben-
ztropine mesylate (Cogentin) every
day.
2. 2. The most important nursing diagnosis is related
A male client is admitted to the mental to alcohol detoxification (B) because the client has
health unit because he was feeling de- elevated vital signs, a sign of alcohol detoxification.
pressed about the loss of his wife and Maintaining client safety related to (A) should be
job. The client has a history of alcohol addressed after giving the client Ativan for elevated
dependency and admits that he was vital signs secondary to alcohol withdrawal. (C and
drinking alcohol 12 hours ago. Vital D) can be addressed when immediate needs for
signs are: temperature, 100° F, pulse safety are met.
, Psychiatric-Mental Health Practice Exam HESI
Study online at https://quizlet.com/_8bceqm
100, and BP 142/100. The nurse plans
to give the client lorazepam (Ativan) Correct Answer(s): B
based on which priority nursing diag-
nosis?
A) Risk for injury related to suicidal
ideation.
B) Risk for injury related to alcohol
detoxification.
C) Knowledge deficit related to ineffec-
tive coping.
D) Health seeking behaviors related to
personal crisis.
3. 3. The most important reason for closely observing
The charge nurse is collaborating with a depressed client immediately after admission is
the nursing staff about the plan of to maintain safety (B), since suicide is a risk with
care for a client who is very depressed. depression. (A, C, and D) are all important inter-
What is the most important interven- ventions, but safety is the priority.
tion to implement during the first 48
hours after the client's admission to Correct Answer(s): B
the unit?
A) Monitor appetite and observe in-
take at meals.
B) Maintain safety in the client's mi-
lieu.
C) Provide ongoing, supportive con-
tact.
D) Encourage participation in activi-
ties.
4. 4. (A) is the best choice cited. The nurse does not
A 38-year-old female client is admitted argue with the client nor demand that she eat, but
, Psychiatric-Mental Health Practice Exam HESI
Study online at https://quizlet.com/_8bceqm
with a diagnosis of paranoid schizo- offers support by agreeing to "be there if needed",
phrenia. When her tray is brought to e.g., to warm the food. (B and C) are arguing with
her, she refuses to eat and tells the the client's delusions, and (B) asks "why" which is
nurse, "I know you are trying to poison usually not a good question for a psychotic client.
me with that food." Which response (D) has nothing to do with the actual problem; i.e.,
is most appropriate for the nurse to the problem is not the diet (she thinks any food
make? given to her is poisoned.)
A) I'll leave your tray here. I am avail-
able if you need anything else. Correct Answer(s): A
B) You're not being poisoned. Why do
you think someone is trying to poison
you?
C) No one on this unit has ever died
from poisoning. You're safe here.
D) I will talk to your healthcare
provider about the possibility of
changing your diet.
5. 5. Early side effects of lithium carbonate (occurring
A client who is being treated with lithi- with serum lithium levels below 2.0 mEq per liter)
um carbonate for bipolar disorder de- generally follow a progressive pattern beginning
velops diarrhea, vomiting, and drowsi- with diarrhea, vomiting, drowsiness, and muscular
ness. What action should the nurse weakness. At higher levels, ataxia, tinnitus, blurred
take? vision, and large dilute urine output may occur. (B)
A) Notify the healthcare provider im- is the best choice. Although these are expected
mediately and prepare for administra- symptoms, the healthcare provider should be no-
tion of an antidote. tified prior to the next administration of the drug.
B) Notify the healthcare provider of (A, C, and D) would not reflect good nursing judg-
the symptoms prior to the next admin- ment.
istration of the drug.
C) Record the symptoms as normal Correct Answer(s): B
side effects and continue administra-
, Psychiatric-Mental Health Practice Exam HESI
Study online at https://quizlet.com/_8bceqm
tion of the prescribed dosage.
D) Hold the medication and refuse to
administer additional amounts of the
drug.
6. 6. Knowledge of all substances taken (C) will guide
The parents of a 14-year-old boy further treatment, such as administration of antag-
bring their son to the hospital. He is onists, so obtaining this information has the high-
lethargic, but responsive. The mother est priority. (A and B) are also valuable in planning
states, "I think he took some of my treatment. (D) is not appropriate during the acute
pain pills." During initial assessment management of a drug overdose.
of the teenager, what information is
most important for the nurse to ob- Correct Answer(s): C
tain from the parents?
A) If he has seemed depressed recent-
ly.
B) If a drug overdose has ever oc-
curred before.
C) If he might have taken any other
drugs.
D) If he has a desire to quit taking
drugs.
7. 7. The nurse should answer the client's question with
The wife of a male client recently di- factual information and explain that schizophrenia
agnosed with schizophrenia asks the is a chemical imbalance in the brain (B). (A) is
nurse, "What exactly is schizophrenia? a therapeutic response but does not answer the
Is my husband all right?" Which re- question, and may be an appropriate response af-
sponse is best for the nurse to provide ter the nurse answers the question asked. Although
to this family member? (C) is likely true to some degree, it is also true that
A) It sounds like you're worried about some clients continue to have disorganized think-
your husband. Let's sit down and talk. ing even with antipsychotic medications. Referring
