RN VATI Comprehensive Predictor 2019 | Mental Health Assessment

1. A nurse is caring for a client who is taking alprazolam. Which of the following prescriptions should the nurse clarify with the provider? A. Digoxin B. Lorazepam C. Atomoxetine D. Ceftriaxone 2. A nurse is assessing a client who is postoperative following abdominal surgery. The client states "I feel like my incision ripped open" the nurse notes dehiscence of the incision. which of the following actions should the nurse take? A. Extend the client’s legs above heart level B. Place the client in low fowlers position. C. Instruct the client to perform the Valsalva maneuver D. Apply a dry gauze dressing to the incision. 3. A nurse is caring for a client who is receiving radiation therapy through a sealed implant. Which of the following actions should the nurse take? Wear a lead apron when providing care for the client. 4. A nurse is inserting an IV catheter for a client who requires fluid replacement. Which of the following actions should the nurse take? A. Apply the tourniquet 15cm (6 in) above the insertion site B. Check for pulsation at sited proximal to the tourniquet C. Anchor the vein by stretching the skin 2.5 cm (1 in) proximal to the insertion site D. Wipe the skin dry before inserting the catheter 5. A nurse is administering medications to a client who has dysphagia and a new prescription for divalproex sodium extended-release tablets. Which of the following actions should the nurse take? Administer the medication with applesauce 6. A nurse is completing a dietary assessment for a client who is Jewish and observes kosher dietary practices. Which of the following behaviors would the nurse expect to fine? A. Leavened bread maybe eaten during Passover. B. Shellfish is commonly consumed in the diet. C. Meat and dairy products are eaten separately. D. Fasting from meat occurs during Hanukkah. 7. A nurse is assessing a client who has minor injuries following a motor-vehicle crash and appears agitated and apprehensive. The nurse identifies that the client is in the arm stage of general adaptation syndrome and should expect which of the following findings. Tachycardia 8. A nurse is caring for a client who has a femur fracture and is on bedrest with Buck’s extension traction. which of the following actions should the nurse take? A. Inspect the client’s skin under the device every 8 hours 9. A charge nurse is creating assignments for the next shift for several nurses and one of them is pregnant. Which of the following clients should the charge nurse assign to a nurse who is not pregnant? A. A 60-year-old client who is recovering from shingles B. A 20-year-old client who is HIV positive C. A 40-year-old client who is suspected of having tuberculosis D. An 80-year-old client who has alcoholic pancreatitis and is being treated for impetigo 10. A nurse is caring for a client who has a partial laryngectomy and is receiving continuous internal feeding at 65 ml/hr through a gastrostomy tube. which of the following findings requires immediate intervention by the nurse? A. The gastric residual volume is 250 mL following two hours of infusion. B. The client is lying in a supine position. C. The infusion pump for administering continuous feeding is turned off. D. Interior feeding bag and tubing are not dated. 11. A nurse is teaching a client about smoking cessation. Which of the following client statements should the nurse identify as an understanding of the teaching? A. If I stop abruptly I cannot use a nicotine replacement. B. After 6 months, my risk of heart disease is the same as that of a nonsmoker C. I will set a specific date to stop smoking D. I will use high carbohydrate snacks as a substitute for cigarette. 12. A nurse has been caring for a female client who has bruises on her arms that are a result of physical abuse by her partner. The client states, "I don't know how much longer I can take this, but I'm afraid he'll really hurt me if I leave" Which of the following is an appropriate nursing intervention? A. Assist the client to identity personal behaviors that trigger abusive behavior B. Insist that the client report the abusive behavior to the proper authority C. Offer to speak to the client’s partner regarding his abusive behavior D. Help the client to recognize the signs of escalation of abusive behavior 13. A client who is 8 hr postpartum asks the nurse if she will need to receive Rh immune globulin. The client is gravid 2, para 2, and her blood type is AB negative. The newborn's blood type is B Positive. Which of the following statements is appropriate? A. "You only need to receive Rh immune globulin if you have a positive blood type. " B. "You should receive Rh immune globulin within 72 hours of delivery." C. "Both you and your baby should receive Rh immune globulin at your week appointment." D. "immune globulin is not necessary since this is your second pregnancy." 14. A client hospitalized for a bone marrow transplant is in protective isolation while undergoing total body radiation and intense chemotherapy. The client’s sibling comes to visit but has obvious manifestations of an upper respiratory infection. which of the following nursing actions is appropriate at this time? A. Allow the sibling to wave at the client through the window or door. B. Allow the sibling to visit after donning a sterile gown, mask and gloves, but prohibit physical contact. C. D. 15. A nurse is planning care for a client who takes haloperidol for the treatment of schizophrenia. which of the following should the nurse include in the plan of care? A. Monitor the client for hypothermia B. Screen the client for tardive dyskinesia C. Check the client’s weekly potassium level D. Schedule the client for a 24hr urine collection 16. A nurse is performing a vision screening for a client. which of the following findings should the nurse identify as an indication that the client has cataracts? A. Report of a chronic dull ache in the eyes B. Bilateral redness of the sclerae C. Increased opacity of the lens of the eye D. Report of seeing halos around lights 17. A nurse is caring for a client who reports difficulty falling asleep at night. Which of the following actions should the nurse take? A. Encourage the client to ambulate in the hallway 1 hr before bedtime B. Tell the client to avoid drinking fluids 1 hr before bedtime C. Schedule routine care tasks during hours when the client is awake D. Advise the client to leave the television in the room on when trying to fall asleep 18. A nurse is providing discharge teaching to a client who is postpartum and plans to breastfeed. which of the following should the nurse recommend the client increases in their diet during lactation? A. Vitamin D B. Iron C. Vitamin A D. Calcium 19. A nurse is providing nutritional counseling to the parents of a toddler. Which of the following instructions should the nurse include in the teaching? A. Offer snacks throughout the day