PN NCLEX 6th Edition- Mental Health
The nurse is caring for a client who was recently admitted for anorexia nervosa. Upon entering the
client's room, the nurse finds the client in the middle of a series of sets of rapid sit-ups. Which action
should the nurse take? - ANS Interrupt the client and offer to take her for a walk.
A client with lung cancer says to the nurse, "I'm sick and tired of my family telling me not to worry and
that a cure will be discovered before I know it." Which response by the nurse is therapeutic? - ANS
"You're feeling angry that your family is hoping for a cure?"
A client tells the nurse that he is feeling out of control. The nurse observes that the client is pacing back
and forth. Which approach by the nurse is appropriate to maintain a safe environment? - ANS Move the
client to a quiet room and talk about his feelings.
A client says to the home care nurse, "I can't believe that my wife died yesterday. I keep expecting to
see her everywhere I go in this house, ready to plan our activities for the day." Which is the therapeutic
nursing response? - ANS "It must be hard to accept that she has passed away."
The wife of a client who abuses alcohol tells the nurse she cannot "do it alone" any longer and asks the
nurse about the availability of any free support services for "people like me." The nurse refers the
client's wife to which community group? - ANS Al-Anon
The nurse is caring for a client with depression in the mental health unit who is refusing to take the
prescribed oral antidepressant. Which are the nurse's best actions to this client's medication refusal?
Select all that apply. - ANS -Notify the health care provider.
-Document the refusal of medication.
-Ask the client why he is refusing the medication.
,While the nurse is providing care, a client angrily reports to the nurse that the health care provider
purposefully provided wrong information about her diagnosis and states, "The doctor lied to me." Which
nursing response would likely be a barrier to further communication with the client? - ANS "The health
care provider would never lie to you."
The nurse is caring for an older adult client who has recently lost her husband. The client says, "No one
cares about me anymore. All the people I loved are dead." Which response by the nurse is therapeutic? -
ANS "You must be feeling all alone at this point."
A client with a diagnosis of a recurrent major depression, exhibiting psychotic features, is admitted to
the mental health unit. In an attempt to create a safe environment for the client, the nurse designs a
plan of care that deals specifically with which aspect of the client's disorder? - ANS Altered thought
processes
The nurse is preparing a care plan for the client with obsessive-compulsive disorder (OCD). The nurse
should focus on which as the primary means to accomplish work with this client? - ANS Goals and
objectives
A client is admitted to the psychiatric unit following a serious suicidal attempt by a drug overdose.
Which action should the nurse implement? - ANS Remain with the client at all times.
A client with a phobia will be treated for the condition using a behavior modification technique known
as systematic desensitization. The nurse describes the components of this form of therapy to the client
and reinforces which client instruction? - ANS The client will be introduced to short periods of exposure
to the phobic object while in a relaxed state.
A client with depression reports to the nurse that she has not been sleeping or eating adequately. The
nurse should plan to do which to assist the client in meeting nutritional needs? - ANS Provide small,
frequent meals.
A client with a diagnosis of major depression becomes more anxious, reports sleeping poorly, and seems
to display increased anger. The nurse should make which interpretation about the client's behavior? -
ANS The client is at increased risk for suicide.
, The licensed practical nurse is assisting the registered nurse in admitting a client with an exacerbation of
schizophrenia and knows that which signs/symptoms displayed by the client are considered positive
symptoms? Select all that apply. - ANS Hallucinations
Anhedonia
Delusions
Neologisms
The nurse is collecting data from a client who has recently been violently raped. Which data indicates
that the client is experiencing rape-trauma syndrome? - ANS The client reports nightmares involving
being stalked when alone at night.
The nurse is caring for a client who has been treated with long-term antipsychotic medication. As part of
the nursing care plan, the nurse monitors for tardive dyskinesia. Which should the nurse observe with
tardive dyskinesia? - ANS Abnormal movements and involuntary movements of the mouth, tongue, and
face
The nurse observes that a client with a potential for violence is agitated, pacing up and down in the
hallway, and making aggressive and belligerent gestures at other clients. Which statement is appropriate
to make to this client? - ANS "What is causing you to become agitated?"
The licensed practical nurse is assisting in the admittance of a client who has been involuntarily
committed to the behavioral health unit. Which actions by the client before hospitalization led to the
commitment? Select all that apply. - ANS Client threatened to commit suicide.
Client threatened to kidnap his spouse.
The nurse is caring for a client who was recently admitted for anorexia nervosa. Upon entering the
client's room, the nurse finds the client in the middle of a series of sets of rapid sit-ups. Which action
should the nurse take? - ANS Interrupt the client and offer to take her for a walk.
A client with lung cancer says to the nurse, "I'm sick and tired of my family telling me not to worry and
that a cure will be discovered before I know it." Which response by the nurse is therapeutic? - ANS
"You're feeling angry that your family is hoping for a cure?"
A client tells the nurse that he is feeling out of control. The nurse observes that the client is pacing back
and forth. Which approach by the nurse is appropriate to maintain a safe environment? - ANS Move the
client to a quiet room and talk about his feelings.
A client says to the home care nurse, "I can't believe that my wife died yesterday. I keep expecting to
see her everywhere I go in this house, ready to plan our activities for the day." Which is the therapeutic
nursing response? - ANS "It must be hard to accept that she has passed away."
The wife of a client who abuses alcohol tells the nurse she cannot "do it alone" any longer and asks the
nurse about the availability of any free support services for "people like me." The nurse refers the
client's wife to which community group? - ANS Al-Anon
The nurse is caring for a client with depression in the mental health unit who is refusing to take the
prescribed oral antidepressant. Which are the nurse's best actions to this client's medication refusal?
Select all that apply. - ANS -Notify the health care provider.
-Document the refusal of medication.
-Ask the client why he is refusing the medication.
,While the nurse is providing care, a client angrily reports to the nurse that the health care provider
purposefully provided wrong information about her diagnosis and states, "The doctor lied to me." Which
nursing response would likely be a barrier to further communication with the client? - ANS "The health
care provider would never lie to you."
The nurse is caring for an older adult client who has recently lost her husband. The client says, "No one
cares about me anymore. All the people I loved are dead." Which response by the nurse is therapeutic? -
ANS "You must be feeling all alone at this point."
A client with a diagnosis of a recurrent major depression, exhibiting psychotic features, is admitted to
the mental health unit. In an attempt to create a safe environment for the client, the nurse designs a
plan of care that deals specifically with which aspect of the client's disorder? - ANS Altered thought
processes
The nurse is preparing a care plan for the client with obsessive-compulsive disorder (OCD). The nurse
should focus on which as the primary means to accomplish work with this client? - ANS Goals and
objectives
A client is admitted to the psychiatric unit following a serious suicidal attempt by a drug overdose.
Which action should the nurse implement? - ANS Remain with the client at all times.
A client with a phobia will be treated for the condition using a behavior modification technique known
as systematic desensitization. The nurse describes the components of this form of therapy to the client
and reinforces which client instruction? - ANS The client will be introduced to short periods of exposure
to the phobic object while in a relaxed state.
A client with depression reports to the nurse that she has not been sleeping or eating adequately. The
nurse should plan to do which to assist the client in meeting nutritional needs? - ANS Provide small,
frequent meals.
A client with a diagnosis of major depression becomes more anxious, reports sleeping poorly, and seems
to display increased anger. The nurse should make which interpretation about the client's behavior? -
ANS The client is at increased risk for suicide.
, The licensed practical nurse is assisting the registered nurse in admitting a client with an exacerbation of
schizophrenia and knows that which signs/symptoms displayed by the client are considered positive
symptoms? Select all that apply. - ANS Hallucinations
Anhedonia
Delusions
Neologisms
The nurse is collecting data from a client who has recently been violently raped. Which data indicates
that the client is experiencing rape-trauma syndrome? - ANS The client reports nightmares involving
being stalked when alone at night.
The nurse is caring for a client who has been treated with long-term antipsychotic medication. As part of
the nursing care plan, the nurse monitors for tardive dyskinesia. Which should the nurse observe with
tardive dyskinesia? - ANS Abnormal movements and involuntary movements of the mouth, tongue, and
face
The nurse observes that a client with a potential for violence is agitated, pacing up and down in the
hallway, and making aggressive and belligerent gestures at other clients. Which statement is appropriate
to make to this client? - ANS "What is causing you to become agitated?"
The licensed practical nurse is assisting in the admittance of a client who has been involuntarily
committed to the behavioral health unit. Which actions by the client before hospitalization led to the
commitment? Select all that apply. - ANS Client threatened to commit suicide.
Client threatened to kidnap his spouse.
