NU473 HESI Psychiatric/Mental Health Practice Exam - 75
Questions
1. The nurse should include which interventions in the plan of care for a
severely depressed client with neurovegetative symptoms? (Select all that
apply.)
o Permit rest periods as needed.
o Speaking slowly and simply.
o Place the client on suicide precautions.
o Observe and encourage food and fluid intake.
o Encourage vigorous exercise and long walks on the unit Ans: o
Permit rest periods as needed.
o Speaking slowly and simply.
o Place the client on suicide precautions.
o Observe and encourage food and fluid intake.
· Neurovegetative symptoms that accompany the mood disorder of depression
include physiological disruptions, such as anorexia, constipation, sleep disturbance,
and psychomotor retardation. The client's plan of care should include measures
that promote the client's comfort and well-being, such as rest, nutrition, suicide
,precautions, and simple communications. Vigorous exercise and long walks are not
indicated for clients in a neurovegetative state.
2. Which diet selection by a client who is depressed and taking the MAO in-
hibitor tranylcypromine sulfate (Parnate) indicates to the nurse that the client
understands the dietary restrictions imposed by this medication regimen?
o Hamburger, French fries, and chocolate milkshake.
o Liver and onions, broccoli, and decaffeinated coffee.
o Pepperoni and cheese pizza, tossed salad, and a soft drink.
o Roast beef, baked potato with butter, and iced tea Ans: o Roast beef, baked
potato with butter, and iced tea.
· Foods with tyramine interact with MAOI antidepressant, such as Parnate, and can
cause a hypertensive crisis that is life-threatening. Roast beef, potatoes, butter, and
tea do not contain tyramine. The other selections contain tyramine and should be
avoided by the client who is taking Parnate.
3. An older male client in the intensive care unit who has been oriented sud-
denly becomes disoriented and fearful. Assessment of vital signs and other
physical parameters reveal no significant change and the nurse formulates the
client's problem as confusion related to ICU psychosis. Which intervention is
most important for the nurse implement?
,o Move all machines away from the client's immediate area.
o Attempt to allay the client's fears by explaining the etiology of confusion.
o Cluster care so brief periods of rest can be scheduled during the day.
o Extend visitation times for family and friends Ans: o Cluster care so brief
periods
, of rest can be scheduled during the day.
· The critical care environment confronts clients with an environment which is
stressful and heightened by treatment modalities that may prove to be lifesaving.
These stressors can result in isolation or sensory overload that leads to confusion.
The best intervention is to cluster care to provide the client with uninterrupted rest
periods. The other actions may not be possible.
4. A male client is admitted to the psychiatric unit with a medical diagnosis of
paranoid schizophrenia. During the admission procedure, the client looks up
and states, "No, it's not MY fault. You can't blame me. I didn't kill him, you did."
What action is best for the nurse to take?
o Reassure the client by telling him that his fear of the admission procedure
is to be expected.
o Tell the client that no one is accusing him of murder and remind him that the
hospital is a safe place.
o Assess the content of the hallucinations by asking the client what he is
hearing.
o Ignore the behavior and make no response at all to his delusional state-
ments Ans: o Assess the content of the hallucinations by asking the client what
he is hearing.
Questions
1. The nurse should include which interventions in the plan of care for a
severely depressed client with neurovegetative symptoms? (Select all that
apply.)
o Permit rest periods as needed.
o Speaking slowly and simply.
o Place the client on suicide precautions.
o Observe and encourage food and fluid intake.
o Encourage vigorous exercise and long walks on the unit Ans: o
Permit rest periods as needed.
o Speaking slowly and simply.
o Place the client on suicide precautions.
o Observe and encourage food and fluid intake.
· Neurovegetative symptoms that accompany the mood disorder of depression
include physiological disruptions, such as anorexia, constipation, sleep disturbance,
and psychomotor retardation. The client's plan of care should include measures
that promote the client's comfort and well-being, such as rest, nutrition, suicide
,precautions, and simple communications. Vigorous exercise and long walks are not
indicated for clients in a neurovegetative state.
2. Which diet selection by a client who is depressed and taking the MAO in-
hibitor tranylcypromine sulfate (Parnate) indicates to the nurse that the client
understands the dietary restrictions imposed by this medication regimen?
o Hamburger, French fries, and chocolate milkshake.
o Liver and onions, broccoli, and decaffeinated coffee.
o Pepperoni and cheese pizza, tossed salad, and a soft drink.
o Roast beef, baked potato with butter, and iced tea Ans: o Roast beef, baked
potato with butter, and iced tea.
· Foods with tyramine interact with MAOI antidepressant, such as Parnate, and can
cause a hypertensive crisis that is life-threatening. Roast beef, potatoes, butter, and
tea do not contain tyramine. The other selections contain tyramine and should be
avoided by the client who is taking Parnate.
3. An older male client in the intensive care unit who has been oriented sud-
denly becomes disoriented and fearful. Assessment of vital signs and other
physical parameters reveal no significant change and the nurse formulates the
client's problem as confusion related to ICU psychosis. Which intervention is
most important for the nurse implement?
,o Move all machines away from the client's immediate area.
o Attempt to allay the client's fears by explaining the etiology of confusion.
o Cluster care so brief periods of rest can be scheduled during the day.
o Extend visitation times for family and friends Ans: o Cluster care so brief
periods
, of rest can be scheduled during the day.
· The critical care environment confronts clients with an environment which is
stressful and heightened by treatment modalities that may prove to be lifesaving.
These stressors can result in isolation or sensory overload that leads to confusion.
The best intervention is to cluster care to provide the client with uninterrupted rest
periods. The other actions may not be possible.
4. A male client is admitted to the psychiatric unit with a medical diagnosis of
paranoid schizophrenia. During the admission procedure, the client looks up
and states, "No, it's not MY fault. You can't blame me. I didn't kill him, you did."
What action is best for the nurse to take?
o Reassure the client by telling him that his fear of the admission procedure
is to be expected.
o Tell the client that no one is accusing him of murder and remind him that the
hospital is a safe place.
o Assess the content of the hallucinations by asking the client what he is
hearing.
o Ignore the behavior and make no response at all to his delusional state-
ments Ans: o Assess the content of the hallucinations by asking the client what
he is hearing.
