NUR 2459 MENTAL AND BEHAVIOUR
HEALTH NURSING FINAL EXAM
QUESTIONS CORRECTLY ANSWERED
| RASMUSSEN COLLEGE
A patient admitted yesterday for injuries sustained in a fall while
intoxicated believes the window blinds are snakes trying to get in the
room. The patient is anxious, agitated, and diaphoretic. Which
medicationcan the nurse anticipate the health care provider will
prescribe?
Selected A phenothiazine, such as chlorpromazine or
Answer:
thioridazine
Answers: A benzodiazepine, such as lorazepam or
chlordiazepoxide
A phenothiazine, such as chlorpromazine or
thioridazine
A monoamine oxidase inhibitor, such as
phenelzine
A narcotic analgesic, such as codeine
Response Sedation allows for safe withdrawal from alcohol.
Feedback:
Benzodiazepines are the drugs of choice in most regions
because of their high therapeutic safety index and
anticonvulsant properties.
• Question 2
A patient is pacing the hall near the nurses’ station, swearing loudly.
Which of the following best describes how the nurse should address this
situation in a therapeutic manner?
Selected “You seem upset. Will you tell me more about
Answer:
it?”
Answers: “Please quiet down.”
“Hey, you’re too loud. It’s bothering people”
“You seem upset. Will you tell me more about
it?”
“You need to go to your room to get control
of yourself.”
Response Intervention should begin with analysis of the patient and the
Feedback:
situation. With this response the nurse is attempting to hear
the patient’s feelings and concerns. This leads to the next step
,of planning an intervention.
• Question 3
Which of the following nursing interventions are necessary after
administration of naloxone (Narcan)?
Selected Monitor airway. Vital signs every 15
Answer:
minutes.
Answers: Monitor airway. Vital signs every 15
minutes.
, Insert an indwelling urinary
catheter.
Insert a nasogastric tube and test
gastric pH.
Treat hyperpyrexia with cooling
measures
Response Narcotic antagonists such as naloxone quickly reverse CNS
Feedback
:
depression, but because the narcotics have a longer span of
action than antagonists, the patient may lapse into
unconsciousness or require respiratory support again. The
remaining options are measures unrelated to naloxone use.
• Question 32
What is a nurse’s legal responsibility if child abuse or neglect is
suspected?
Selected Report the suspected abuse or neglect according to state
Answer:
regulations
Answers: Discuss the findings with the child’s teacher, principal, and
school psychologist
Report the suspected abuse or neglect according to state
regulations
Document the observations and speculations in the medical
record
Continue the assessment.
Response Each state has specific regulations for reporting child abuse
Feedback:
that must be observed. The nurse is usually a mandated
reporter. The reporter does not need to be absolutely sure that
abuse or neglect occurred, only that it is suspected. Speculation
should not be documented, only the facts.
• Question 33
What is the priority nursing diagnosis for a patient who is experiencing
fluctuating levels of consciousness, disturbed orientation, and visual and
tactile hallucinations?
Selected Risk for injury related to altered cerebral function,
Answer:
misperception of the environment, and unsteady gait
Answers: Bathing/hygiene self-care deficit related to altered cerebral
function, as evidenced by confusion and inability to perform
personal hygiene tasks
Risk for injury related to altered cerebral function,
HEALTH NURSING FINAL EXAM
QUESTIONS CORRECTLY ANSWERED
| RASMUSSEN COLLEGE
A patient admitted yesterday for injuries sustained in a fall while
intoxicated believes the window blinds are snakes trying to get in the
room. The patient is anxious, agitated, and diaphoretic. Which
medicationcan the nurse anticipate the health care provider will
prescribe?
Selected A phenothiazine, such as chlorpromazine or
Answer:
thioridazine
Answers: A benzodiazepine, such as lorazepam or
chlordiazepoxide
A phenothiazine, such as chlorpromazine or
thioridazine
A monoamine oxidase inhibitor, such as
phenelzine
A narcotic analgesic, such as codeine
Response Sedation allows for safe withdrawal from alcohol.
Feedback:
Benzodiazepines are the drugs of choice in most regions
because of their high therapeutic safety index and
anticonvulsant properties.
• Question 2
A patient is pacing the hall near the nurses’ station, swearing loudly.
Which of the following best describes how the nurse should address this
situation in a therapeutic manner?
Selected “You seem upset. Will you tell me more about
Answer:
it?”
Answers: “Please quiet down.”
“Hey, you’re too loud. It’s bothering people”
“You seem upset. Will you tell me more about
it?”
“You need to go to your room to get control
of yourself.”
Response Intervention should begin with analysis of the patient and the
Feedback:
situation. With this response the nurse is attempting to hear
the patient’s feelings and concerns. This leads to the next step
,of planning an intervention.
• Question 3
Which of the following nursing interventions are necessary after
administration of naloxone (Narcan)?
Selected Monitor airway. Vital signs every 15
Answer:
minutes.
Answers: Monitor airway. Vital signs every 15
minutes.
, Insert an indwelling urinary
catheter.
Insert a nasogastric tube and test
gastric pH.
Treat hyperpyrexia with cooling
measures
Response Narcotic antagonists such as naloxone quickly reverse CNS
Feedback
:
depression, but because the narcotics have a longer span of
action than antagonists, the patient may lapse into
unconsciousness or require respiratory support again. The
remaining options are measures unrelated to naloxone use.
• Question 32
What is a nurse’s legal responsibility if child abuse or neglect is
suspected?
Selected Report the suspected abuse or neglect according to state
Answer:
regulations
Answers: Discuss the findings with the child’s teacher, principal, and
school psychologist
Report the suspected abuse or neglect according to state
regulations
Document the observations and speculations in the medical
record
Continue the assessment.
Response Each state has specific regulations for reporting child abuse
Feedback:
that must be observed. The nurse is usually a mandated
reporter. The reporter does not need to be absolutely sure that
abuse or neglect occurred, only that it is suspected. Speculation
should not be documented, only the facts.
• Question 33
What is the priority nursing diagnosis for a patient who is experiencing
fluctuating levels of consciousness, disturbed orientation, and visual and
tactile hallucinations?
Selected Risk for injury related to altered cerebral function,
Answer:
misperception of the environment, and unsteady gait
Answers: Bathing/hygiene self-care deficit related to altered cerebral
function, as evidenced by confusion and inability to perform
personal hygiene tasks
Risk for injury related to altered cerebral function,
