PN VATI MENTAL HEALTH 2025 ACTUAL EXAM TEST BANK QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
A nurse is assisting with the care of a client immediately following electroconvulsive therapy (ECT).
Which of the following findings should the nurse document as an unexpected response to the
procedure? -(answer)Irregular heart rhythm
An irregular heart rhythm is an unexpected response to ECT. During the procedure, the client's heart can
be stressed, which can cause cardiac abnormalities. especially if the client already has impaired cardiac
function. The nurse should document this finding and notify the charge nurse or the client's provider.
A nurse is caring for a client who is admitted for alcohol use disorder. The client states, "I have not had
anything to drink for 24 hours." Which the following is the priority nursing intervention? -(answer)Check
the client's vital signs.
Clients who have alcohol use disorder are at risk for the development of abstinence syndrome.
Manifestations of abstinence syndrome occur 12 to 72 hr after the client has last consumed alcohol and
can include tachycardia, hypertension, and an elevated temperature. Therefore, the first action the
nurse should take when using the airway, breathing, circulation (ABC) approach to client care is to check
the client's vital signs to monitor for signs of abstinence syndrome.
A nurse is reinforcing teaching with the adult child of a client who is scheduled to have electroconvulsive
therapy (ECT). Which of the following statements should the nurse make? -(answer)"Your father might
experience short-term memory loss after the procedure."
The nurse should reinforce to the client's child that short-term memory loss is a common adverse effect
of ECT.
A nurse is assisting with planning care for a client who is in the manic phase of bipolar disorder. Which
of the following actions is the priority for the nurse to include in the plan? -(answer)Offer frequent high-
calorie fluids throughout the day.
,PN VATI MENTAL HEALTH 2025 ACTUAL EXAM TEST BANK QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
The priority action the nurse should take when using Maslow's hierarchy of needs is to meet the client's
physiological need for food and fluids. The priority nursing action is to frequently.offer the client high-
calorie fluids to prevent dehydration and ensure the client's caloric is adequate to meet intake physical
needs.
A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for valproic
acid. Which of the following manifestations should the nurse instruct the client to report to the provider
as an adverse effect of this medication? -(answer)Abdominal pain
The nurse should instruct the client that abdominal pain can indicate hepatoxicity or pancreatitis, both
adverse effects of valproic acid; therefore, the client should report this to the provider.
A nurse is establishing a therapeutic relationship with a client who has generalized anxiety disorder.
Which of the following actions should the nurse take first? -(answer)Explain confidentiality guidelines to
the client.
Evidence-based practice indicates that the nurse should first begin a therapeutic relationship with the
orientation phase. During this phase, the nurse should explain the guidelines for confidentiality. This
initial step in developing a therapeutic relationship builds trust between the client and the nurse.
A nurse is interviewing an adolescent client who reports that they were sexually assaulted. Which of the
following actions should the nurse take? -(answer)Move the client to a private examination room to
perform the interview.
The nurse should interview the client in a private room without others present. Providing privacy in a
safe environment will foster trust and promote open communication between the client and the nurse.
, PN VATI MENTAL HEALTH 2025 ACTUAL EXAM TEST BANK QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
A nurse is caring for a client who is experiencing a severe panic attack. Which of the following actions
should the nurse take during the panic attack? (Select all that apply.) -(answer)Stay with the client is
correct. The nurse should stay with the client during the panic attack to ensure that the client remains
safe and reduce feelings of abandonment.
Instruct the client to take slow, deep breaths is correct. The nurse should instruct the client to breathe
slowly and deeply to distract from the distressing manifestations of the attack and reduce the risk for
hyperventilation.
Set physical limits is correct. The nurse should set physical limits to maintain the safety of the client and
others because the client might have difficulty controlling their actions during the attack.
A nurse is collecting data from a 5-year-old child who is brought to the emergency department by a
parent who states that the child fell out of a tree. The child is guarding their right arm. For which of the
following findings should the nurse suspect physical maltreatment? -(answer)An x-ray of the right arm
indicates a spiral fracture.
The nurse should identify that an x-ray indicating a fracture can be an expected finding for a child who
fell out of a tree. However, a spiral fracture is caused by twisting of the extremity and can be an
indication of physical maltreatment. The nurse should report the findings to the registered nurse.
A nurse is reinforcing discharge teaching with the family of a client who has mild dementia. The family
plans to care for the client in their home. Which of the following instructions should the nurse include? -
(answer)Use signs to identify different rooms in the home.
DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
A nurse is assisting with the care of a client immediately following electroconvulsive therapy (ECT).
Which of the following findings should the nurse document as an unexpected response to the
procedure? -(answer)Irregular heart rhythm
An irregular heart rhythm is an unexpected response to ECT. During the procedure, the client's heart can
be stressed, which can cause cardiac abnormalities. especially if the client already has impaired cardiac
function. The nurse should document this finding and notify the charge nurse or the client's provider.
A nurse is caring for a client who is admitted for alcohol use disorder. The client states, "I have not had
anything to drink for 24 hours." Which the following is the priority nursing intervention? -(answer)Check
the client's vital signs.
Clients who have alcohol use disorder are at risk for the development of abstinence syndrome.
Manifestations of abstinence syndrome occur 12 to 72 hr after the client has last consumed alcohol and
can include tachycardia, hypertension, and an elevated temperature. Therefore, the first action the
nurse should take when using the airway, breathing, circulation (ABC) approach to client care is to check
the client's vital signs to monitor for signs of abstinence syndrome.
A nurse is reinforcing teaching with the adult child of a client who is scheduled to have electroconvulsive
therapy (ECT). Which of the following statements should the nurse make? -(answer)"Your father might
experience short-term memory loss after the procedure."
The nurse should reinforce to the client's child that short-term memory loss is a common adverse effect
of ECT.
A nurse is assisting with planning care for a client who is in the manic phase of bipolar disorder. Which
of the following actions is the priority for the nurse to include in the plan? -(answer)Offer frequent high-
calorie fluids throughout the day.
,PN VATI MENTAL HEALTH 2025 ACTUAL EXAM TEST BANK QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
The priority action the nurse should take when using Maslow's hierarchy of needs is to meet the client's
physiological need for food and fluids. The priority nursing action is to frequently.offer the client high-
calorie fluids to prevent dehydration and ensure the client's caloric is adequate to meet intake physical
needs.
A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for valproic
acid. Which of the following manifestations should the nurse instruct the client to report to the provider
as an adverse effect of this medication? -(answer)Abdominal pain
The nurse should instruct the client that abdominal pain can indicate hepatoxicity or pancreatitis, both
adverse effects of valproic acid; therefore, the client should report this to the provider.
A nurse is establishing a therapeutic relationship with a client who has generalized anxiety disorder.
Which of the following actions should the nurse take first? -(answer)Explain confidentiality guidelines to
the client.
Evidence-based practice indicates that the nurse should first begin a therapeutic relationship with the
orientation phase. During this phase, the nurse should explain the guidelines for confidentiality. This
initial step in developing a therapeutic relationship builds trust between the client and the nurse.
A nurse is interviewing an adolescent client who reports that they were sexually assaulted. Which of the
following actions should the nurse take? -(answer)Move the client to a private examination room to
perform the interview.
The nurse should interview the client in a private room without others present. Providing privacy in a
safe environment will foster trust and promote open communication between the client and the nurse.
, PN VATI MENTAL HEALTH 2025 ACTUAL EXAM TEST BANK QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY GRADED A+
A nurse is caring for a client who is experiencing a severe panic attack. Which of the following actions
should the nurse take during the panic attack? (Select all that apply.) -(answer)Stay with the client is
correct. The nurse should stay with the client during the panic attack to ensure that the client remains
safe and reduce feelings of abandonment.
Instruct the client to take slow, deep breaths is correct. The nurse should instruct the client to breathe
slowly and deeply to distract from the distressing manifestations of the attack and reduce the risk for
hyperventilation.
Set physical limits is correct. The nurse should set physical limits to maintain the safety of the client and
others because the client might have difficulty controlling their actions during the attack.
A nurse is collecting data from a 5-year-old child who is brought to the emergency department by a
parent who states that the child fell out of a tree. The child is guarding their right arm. For which of the
following findings should the nurse suspect physical maltreatment? -(answer)An x-ray of the right arm
indicates a spiral fracture.
The nurse should identify that an x-ray indicating a fracture can be an expected finding for a child who
fell out of a tree. However, a spiral fracture is caused by twisting of the extremity and can be an
indication of physical maltreatment. The nurse should report the findings to the registered nurse.
A nurse is reinforcing discharge teaching with the family of a client who has mild dementia. The family
plans to care for the client in their home. Which of the following instructions should the nurse include? -
(answer)Use signs to identify different rooms in the home.
