Saunders PN Mental Health Ecpi University
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+| NJXDG
EXAM REVIEW (BRAND NEW!!)
A client experiencing delusions of being poisoned is admitted to the hospital after not eating or
drinking for several days. On data collection, the nurse notes no evidence of dehydration and
malnutrition at this time. The nurse should immediately plan to address which client need? -
answer: Safety and Security
A visitor brings a suicidal client a brightly packaged gift. The nurse accompanies the visitor to
the client's room and takes which action? - answer: Has the client open the gift with the nurse
present
The nurse is collecting data from a newly admitted client recently diagnosed with borderline
personality disorder. Which data provided by the client best supports the nurse's concern that
the client is not using effective coping skills? - answer: Driving under the influence (DUI)
conviction resulted in a 1-year suspended license
The nurse is monitoring a client with anorexia nervosa. Which statement by the client would
indicate to the nurse that treatment has been effective? - answer: "My friends and I went out to
lunch today."
The nurse is working with a victim of rape in a clinic setting and assists in developing a plan of
care for the client. Which is an inappropriate short-term initial goal? - answer: The client will
resolve feelings of fear and anxiety related to the rape trauma.
,A client arrives in the emergency department in a crisis state. The client demonstrates signs of
profound anxiety and is unable to focus on anything but the object of the crisis and the impact
on self. The initial data collection would focus on which information? - answer: The physical
condition of the client
A furiously angry and aggressive client was put in restraints and was told that the restraints
would be removed once the client regained control. The nurse appropriately removes the
restraints when which action occurs? - answer: When no acts of aggression are observed within
1 hour after release of two extremity restraints
After 5 days in the psychiatric unit, a manic client is able to tolerate short periods in the
dayroom. The nurse overhears the client telling another client that he is a journalist posing as a
client in order to write an article for a magazine. Which response is the nurse's best action? -
answer: Privately confront the client with reality.
The nurse is assigned to care for a client being admitted to the nursing unit from the emergency
department who attempted suicide by ingesting several sleeping pills. The nurse implements
which priority action when the client arrives to the unit? - answer: Place the client on one-to-
one suicide precautions.
The nurse is caring for a client with seasonal affective disorder (SAD). Which type of therapy is
considered a first-line treatment for this disorder? - answer: Light therapy
A client who excessively uses alcohol and who is motivated to stop tells the nurse, "I know that
there is a medication that can help people like me quit drinking." Which medication should the
nurse explain is available for this purpose? - answer: Disulfiram
A client in a manic state emerges from her room. The client is dressed in a low-cut blouse and a
miniskirt. She is not wearing underwear and she proceeds to sit on a male client's lap and
begins to make sexual remarks and gestures to the male client. The nurse should take which
action? - answer: Approach the client quietly, take her to her room, and assist her in getting
dressed.
,The nurse is collecting data from a client recently diagnosed with paranoid schizophrenia. Which
information best supports that the client is at risk for harming another individual? - answer:
Sibling stating, "I don't feel safe around my brother."
A hospitalized client who recently experienced the loss of a spouse is grieving. The client
progresses well and is approaching discharge. Which is an appropriate outcome for this client? -
answer: The client verbalizes stages of grief and plans to attend a community grief group.
The nurse has been closely observing a client who has been displaying aggressive behaviors. The
nurse observes that the behavior displayed by the client is escalating. Which nursing
intervention is least likely to be helpful to this client at this time? - answer: Initiate confinement
measures.
The nurse employed in an emergency department is assisting in caring for an adult client who is
a victim of family violence. The nurse reinforces which instruction to the victim in the discharge
plan? - answer: Information regarding the location of shelters
A client is being prepared for electroconvulsive therapy (ECT). The nurse's plan of care for the
night before ECT treatment should include which intervention? - answer: The client shampoos
and dries the hair, freeing it of all hair spray and creams.
The nurse is assisting in conducting a group therapy session. A client who has shared with the
group at a previous session that she isolates herself when she feels depressed, suddenly gets up
to leave. Which nursing action is appropriate? - answer: Encourage the client to stay and ask the
client what she is feeling.
A client with a potential for violence is exhibiting agitated behavior. The client is using
aggressive gestures and making belligerent comments to the other clients and is pacing
continually in the hallway. Which comments by the nurse would be therapeutic at this time? -
answer: "What is causing you to become agitated?"
, A long-term care resident with a history of paranoid schizophrenia refuses to eat and tells the
nurse that she believes that someone is poisoning the food. The nurse should make which
therapeutic response to the client? - answer: "It must be frightening to you. Has something
made you feel that your food is poisoned?"
A client is found to have rape-trauma syndrome. The nurse plans care for the client, knowing
that rape-trauma syndrome is a condition that involves which? - answer: Reexperiencing
recollections of the trauma
A client is scheduled to have electroconvulsive therapy (ECT). Which problem should the nurse
include in the plan as a priority? - answer: Risk for aspiration
The nurse working the evening shift is assisting clients in getting ready to go to sleep. A client
diagnosed with obsessive-compulsive disorder (OCD) becomes upset and agitated and asks the
nurse to sit down and talk. Which response by the nurse would be best at this time? - answer: "I
can see that you're upset. I'm willing to listen."
When caring for a client who has been raped, which intervention should the nurse implement
during the examination? - answer: Explaining procedures to be completed and why the
procedures are necessary
A manic client is placed in a seclusion room after an outburst of violent behavior, including
physical assault on another client. As the client is secluded, which action should the nurse
perform? - answer: Inform the client that she is being secluded to help regain control of herself.
A client has been brought to the emergency department after attempting to commit suicide by
hanging. The nurse should take which nursing action first? - answer: Examine the neck area and
assess the airway.
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+| NJXDG
EXAM REVIEW (BRAND NEW!!)
A client experiencing delusions of being poisoned is admitted to the hospital after not eating or
drinking for several days. On data collection, the nurse notes no evidence of dehydration and
malnutrition at this time. The nurse should immediately plan to address which client need? -
answer: Safety and Security
A visitor brings a suicidal client a brightly packaged gift. The nurse accompanies the visitor to
the client's room and takes which action? - answer: Has the client open the gift with the nurse
present
The nurse is collecting data from a newly admitted client recently diagnosed with borderline
personality disorder. Which data provided by the client best supports the nurse's concern that
the client is not using effective coping skills? - answer: Driving under the influence (DUI)
conviction resulted in a 1-year suspended license
The nurse is monitoring a client with anorexia nervosa. Which statement by the client would
indicate to the nurse that treatment has been effective? - answer: "My friends and I went out to
lunch today."
The nurse is working with a victim of rape in a clinic setting and assists in developing a plan of
care for the client. Which is an inappropriate short-term initial goal? - answer: The client will
resolve feelings of fear and anxiety related to the rape trauma.
,A client arrives in the emergency department in a crisis state. The client demonstrates signs of
profound anxiety and is unable to focus on anything but the object of the crisis and the impact
on self. The initial data collection would focus on which information? - answer: The physical
condition of the client
A furiously angry and aggressive client was put in restraints and was told that the restraints
would be removed once the client regained control. The nurse appropriately removes the
restraints when which action occurs? - answer: When no acts of aggression are observed within
1 hour after release of two extremity restraints
After 5 days in the psychiatric unit, a manic client is able to tolerate short periods in the
dayroom. The nurse overhears the client telling another client that he is a journalist posing as a
client in order to write an article for a magazine. Which response is the nurse's best action? -
answer: Privately confront the client with reality.
The nurse is assigned to care for a client being admitted to the nursing unit from the emergency
department who attempted suicide by ingesting several sleeping pills. The nurse implements
which priority action when the client arrives to the unit? - answer: Place the client on one-to-
one suicide precautions.
The nurse is caring for a client with seasonal affective disorder (SAD). Which type of therapy is
considered a first-line treatment for this disorder? - answer: Light therapy
A client who excessively uses alcohol and who is motivated to stop tells the nurse, "I know that
there is a medication that can help people like me quit drinking." Which medication should the
nurse explain is available for this purpose? - answer: Disulfiram
A client in a manic state emerges from her room. The client is dressed in a low-cut blouse and a
miniskirt. She is not wearing underwear and she proceeds to sit on a male client's lap and
begins to make sexual remarks and gestures to the male client. The nurse should take which
action? - answer: Approach the client quietly, take her to her room, and assist her in getting
dressed.
,The nurse is collecting data from a client recently diagnosed with paranoid schizophrenia. Which
information best supports that the client is at risk for harming another individual? - answer:
Sibling stating, "I don't feel safe around my brother."
A hospitalized client who recently experienced the loss of a spouse is grieving. The client
progresses well and is approaching discharge. Which is an appropriate outcome for this client? -
answer: The client verbalizes stages of grief and plans to attend a community grief group.
The nurse has been closely observing a client who has been displaying aggressive behaviors. The
nurse observes that the behavior displayed by the client is escalating. Which nursing
intervention is least likely to be helpful to this client at this time? - answer: Initiate confinement
measures.
The nurse employed in an emergency department is assisting in caring for an adult client who is
a victim of family violence. The nurse reinforces which instruction to the victim in the discharge
plan? - answer: Information regarding the location of shelters
A client is being prepared for electroconvulsive therapy (ECT). The nurse's plan of care for the
night before ECT treatment should include which intervention? - answer: The client shampoos
and dries the hair, freeing it of all hair spray and creams.
The nurse is assisting in conducting a group therapy session. A client who has shared with the
group at a previous session that she isolates herself when she feels depressed, suddenly gets up
to leave. Which nursing action is appropriate? - answer: Encourage the client to stay and ask the
client what she is feeling.
A client with a potential for violence is exhibiting agitated behavior. The client is using
aggressive gestures and making belligerent comments to the other clients and is pacing
continually in the hallway. Which comments by the nurse would be therapeutic at this time? -
answer: "What is causing you to become agitated?"
, A long-term care resident with a history of paranoid schizophrenia refuses to eat and tells the
nurse that she believes that someone is poisoning the food. The nurse should make which
therapeutic response to the client? - answer: "It must be frightening to you. Has something
made you feel that your food is poisoned?"
A client is found to have rape-trauma syndrome. The nurse plans care for the client, knowing
that rape-trauma syndrome is a condition that involves which? - answer: Reexperiencing
recollections of the trauma
A client is scheduled to have electroconvulsive therapy (ECT). Which problem should the nurse
include in the plan as a priority? - answer: Risk for aspiration
The nurse working the evening shift is assisting clients in getting ready to go to sleep. A client
diagnosed with obsessive-compulsive disorder (OCD) becomes upset and agitated and asks the
nurse to sit down and talk. Which response by the nurse would be best at this time? - answer: "I
can see that you're upset. I'm willing to listen."
When caring for a client who has been raped, which intervention should the nurse implement
during the examination? - answer: Explaining procedures to be completed and why the
procedures are necessary
A manic client is placed in a seclusion room after an outburst of violent behavior, including
physical assault on another client. As the client is secluded, which action should the nurse
perform? - answer: Inform the client that she is being secluded to help regain control of herself.
A client has been brought to the emergency department after attempting to commit suicide by
hanging. The nurse should take which nursing action first? - answer: Examine the neck area and
assess the airway.
