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Questions & Answers 100) Complete
Solution.
A nurse in the emergency department is caring for a client who reports
feeling sad, worthless, and hopeless 9 months after the death of her
son. Which of the following actions should the nurse take first?
a. Request a mental health consult for the client.
b. Ask the client if she has thought about harming herself.
c. Encourage the client to attend a grief support group.
d. Discuss the clients coping skills. - correctANSWERSc. Encourage
the client to attend a grief support group.
A nurse is caring for a client who has borderline personality disorder
and has been engaging in self- mutilation. The nurse should encourage
the client to participate in which of the following groups.
a. Dual diagnosis treatment group
b. Dialectical Behavior treatment group
c. Desensitization therapy - correctANSWERSb. Dialectical Behavior
treatment group
The nurse is reviewing the medication administration record of a client
who has schizophrenia. The nurse should plan to initiate the Abnormal
Involuntary Movement Scale to monitor for adverse effects of which of
the following medications.?
a. Amantadine
b. Diphenhydramine
c. Benztropine
d. Haloperidol - correctANSWERSd. Haloperidol
,A nurse is counseling a client following the death of a client's partner
8 months ago. Which of the following client statements indicates
maladaptive grieving?
a. I am so sorry for the times I was angry with my partner.
b. I find myself thinking about my partner often.
c. I still don't feel up to returning to work.
d. I like looking at his personal items in the closet. -
correctANSWERSc. I still don't feel up to returning to work.
A nurse is planning overall strategies to address problems for a client
who
has a borderline personality disorder. Which of the following strategies
is the
priority for the nurse to incorporate into the plan of care?
a. discuss the appropriate use of assertive behavior with the client
b. encourage the client to attend weekly support group meetings
c. assist the client to maintain awareness of her thoughts and feelings
d. implement measures to prevent intentional self-inflicted injury -
correctANSWERSd. implement measures to prevent intentional self-
inflicted injury
A nurse is admitting a client who has a generalized anxiety disorder.
Which of the following actions should the nurse plan to take first?
a. Provide the client with a quiet environment
b. Determine how the client handles stress.
c. Teach the client to use guided imagery.
d. Ask the client to identify her strengths - correctANSWERSa. Provide
the client with a quiet environment
A nurse is conducting an admission interview with a client who is
experiencing mania. Which of the following should the nurse report to
the provider?
a. States that he hasn't bathed in 2 days
b. Reports eating twice in the past two weeks.
, c. Makes inappropriate sexual comments.
d. Speaks in rhyming sentences. - correctANSWERSb. Reports eating
twice in the past two weeks.
A nurse is planning care for a client who has obsessive-compulsive
disorder. Which of the following recommendation should the nurse
include in the client's plan of care?
a. Validation therapy
b. Thought stopping
c. Operant conditioning
d. Reality orientation therapy - correctANSWERSb. Thought stopping
A nurse is caring for a client who has bipolar disorder and is
experiencing a manic episode. Which of the following actions should
the nurse take?
a. Encourage the client to join group activities
b. Dim the lights in the client's room
c. Provide detailed explanations to the client
d. Administer methylphenidate - correctANSWERSb. Dim the lights in
the client's room
A nurse is leading a crisis intervention group for adolescents who
witnessed the suicide of a classmate. Which of the following actions
should the nurse take first?
a. Initiate referrals
b. Review community resources
c. Identify prior coping skills
d. Discuss the importance of confidentiality - correctANSWERSc.
Identify prior coping skills
A nurse overhears a client saying"I am a spy, a spy for the FBI .I am an
I,an eye for an eye in the sky. Sky is up high." The nurse should
document the client's statement as which of the following speech
alterations?