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1. 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?: Implement measures to prevent intentional self-inflicted injury
2. A nurse is admitting a client who has a generalized anxiety disorder. Which
of the following actions
should the nurse plan to take first?: Provide the client with a quiet environment
3. A nurse is conducting an admission interview with a client who is experi-
encing mania. Which of the
following should the nurse report to the provider?: Reports eating twice in the
past two weeks.
4. A nurse is planning care for a client who has obsessive-compulsive disor-
der. Which of the following
recommendation should the nurse include in the client's plan of care?: -
Thought stopping
5. 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?: Dim the lights in the client's room
6. A nurse is leading a crisis intervention group for adolescents who wit-
nessed the suicide of a
classmate. Which of the following actions should the nurse take first?: Identify
prior coping skills
7. 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?: Clang association
8. An older adult client is brought to the mental health clinic by her daughter.
The daughter reports
that her mother is not eating and seems uninterested in routine activities. The
daughter states "Im so
worried that my mother is depressed" which of the following responses
should the nurse make?: Tell me the reasons you think your mother is depressed.
9. A nurse is planning care for an adolescent who has autism spectrum
disorder. Which of the following
outcomes should the nurse include in the plan care?: Initiates social interactions
with caregivers
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10. A nurse is providing behavior therapy for a client who has obsessive-com-
pulsive disorder. The client
repeatedly checks that the doors are locked at night. Which of the following
instructions should the nurse give the client when using thought stopping
technique?: Snap a rubber band on your wrist when you think about checking the
locks
11. A nurse is caring for a client who is starting treatment for substance use
disorder. Which of the
following actions indicates the nurse is practicing the ethical principle of
nonmaleficence?: Withholding the prescribed medication that is causing adverse
effects for the client
12. A nurse in a group home facility is caring for a client who is developmental-
ly disabled. The client has been stealing belongings from other clients. Which
of the following techniques should the nurse use?: Positive reinforcement to
increase desired behavior
13. A nurse is caring for a client who is experiencing a panic attack. Which
of the following actions should the nurse take?: Have the client breathe into a
paper bag
14. The nurse is caring for a client following a physical assault. The client
states "I don't remember what
happened to me." The nurse should recognize that the client is using which
of the following defense
mechanisms?: Repression
15. A nurse is caring for a client who has anorexia nervosa. Which of the
following findings
requires immediate intervention by the nurse?: Blood pH 7.60
16. A nurse is caring for a client in a mental health facility. The client is agitated
and threatens to harm
herself and others. Which of the following is the priority intervention?: Set
limits on the client's behavior
17. Dosage Calculation: A nurse is preparing to administer Haloperidol 7mg
IM to a client who is
severely agitated. Available is Haloperidol injection 5mg/mL. How many mL
should the nurse
administer?:: 1.4 mL
18. A nurse is caring for a client who was involuntarily committed and is
scheduled to receive
electroconvulsive therapy (ECT). The client refuses the treatment and will not
discuss why with the
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