HESI mental health/HESI Mental Health Exam, Mental Health HESI
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A man who has been admitted numerous times for alcohol detoxification is found
wandering in the street and is unable to identify himself or his home address. He is
manifesting ataxia, nystagmus, and confusion and has a blood alcohol level (BAL) of
0.29%. Which prescribed medication should the practical nurse (PN) administer to
prevent Korsakoff's psychosis?
A. Thiamine
B. Benzodiazepines
C. Glucose solution
D. Haloperidol (Haldol)
A. Thiamine
Rationale:
A BAL greater than 0.20% depresses the entire motor area of brain causing the client to
stagger, lose conscious control of reason, and react in an unpredictable manner. The
client's confusion and alcohol tolerance causing Wernicke's encephalopathy places the
client at risk for Korsakoff's psychosis, a form of amnesia characterized by loss of short-
term memory and precipitated by acute abstinence. Thiamine deficiency causes Wernicke-
Korsakoff's syndromes, so thiamine (B) should be administered. (B,C,D) may be indicated
during withdrawal but do not prevent alcoholic encephalopathies.
An older client who is hospitalized with pneumonia becomes disoriented and
confused 2 days after admission. Which factor should the practical nurse (PN)
identify to differentiate that the client is experiencing delirium, not dementia?
A. impaired memory
B. clear awareness of surrounding
C. unrelated to specific cause
D. acute onset of symptoms
D. acute onset of symptoms
rationale:
Delirium has an acute onset (D) characterized by a reduced level of consciousness, not (B),
,disturbed sleep-wake patterns, disorientation and perceptual problems, and is often
associated with drug cumulative effects, a medical condition, or hospitalization, not (C).
Dementia has a slow, insidious onset of symptoms, which include impaired memory (A) with
loss of abstract thinking, judgment, language and motor skills and is often not reversible.
Which finding should the practical nurse (PN) report immediately when talking with a
new mother who is diagnosed with postpartum depression with psychotic features?
A. thoughts of harming her infant
B. personal hygiene
C. outbursts of anger
D. disinterest in her husband
A. thoughts of harming her infant
rationale:
thoughts of harming her infant (A) is consistent with postpartum depression and should be
reported immediately. Although (B,C,D) may occur in postpartum depression, the major
concern is the potential of harm to herself or to her infant.
During a prenatal visit, a client who is in the second trimester of pregnancy tells the
practical nurse (PN) that she is using cocaine. What information about cocaine is
most important for the PN to provide the client?
A. CNS stimulants increase fetal heart rate and intrauterine movement
B. Eat foods high in iron and protein if a decrease in appetite occurs
C. Counseling should be sought to learn alternative coping behaviors
D. Cocaine can cause miscarriage or premature onset of labor
D. Cocaine can cause miscarriage or premature onset of labor
rationale:
Cocaine, a central nervous system (CNS) stimulant, use during pregnancy (D) increases the
risk of uterine tonicity and preterm labor, which can result in miscarriage (D), abruptio
placentae, and stillbirth. Although the client should understand other factors about cocaine
use in pregnancy (A,B,C), the most important information is the risk of premature birth.
Which part of the client's plan of care is the practical nurse (PN) implementing when
plans are used to increase a male client's participation in his own care and social
environment?
A. client autonomy
B. the therapeutic community
,C. the nurse-client relationship
D. the multidisciplinary mental health team
B. the therapeutic community
rationale:
a therapeutic community (B) provides ways to increase a client's utilization of the social
environment by providing therapeutic milieu but do not best describe the client's
engagement in therapeutic experiences.
A practical nurse (PN) is interacting with a female client who is discussing her
divorce as a stressor. What areas should be explored with the client to gather the
most relevant information?
A. affective responses
B. social responses
C. physiological responses
D. biopsychosocial responses
D. biopsychosocial responses
rationale:
Appraisal of a stressor is the processing and comprehension of stressful situations that
takes place on many levels, specifically cognitive, affective, physiological, behavioral, and
social (D). Limiting the client's self analysis (A,B,C) may omit an important variable that
needs further intervention.
The practical nurse (PN) is inquiring about coping strategies with a male client who is
admitted for alcohol abuse. The client tells the PN that his job skills and
communication skills are his best assets and support. Which additional information
should the PN obtain about maladaptive mechanisms?
A. family support
B. self indulgence
C. financial security
D. daily stressors
B. self indulgence
rationale:
Coping resources include economic assets, abilities, skills, defensive techniques, social
supports, and motivation. Coping mechanisms can be defines as efforts directed at stress
, management and can be constructive (assets) or destructive (liabilities), such as alcohol
abuse, which should be determined by the client's self assessment of amount and duration
of alcohol abuse (B). (A,C,D) are incorrect.
The practical nurse (PN) is caring for a male client who is admitted for schizophrenia
and observes that his thoughts do not flow logically and he uses invented words.
How should the PN document this behavior?
A. interacts with others using child like expressions
B. uses neologisms and tangential expressions
C. demonstrates rapid speech while anxious
D. responds with defensive language to cope with others
B. uses neologisms and tangential expressions
rationale:
Documentation of the client's altered thought processes reflected in speech should be
described as tangential ideas, circumstantially, loose associations, and neologisms, or
"word salad" (B). (A,C, and D) are not accurate descriptors for this client.
A male client arrives at the mental health clinic complaining of insomnia, irritability,
increased tension, and headaches. He tells the practical nurse that the symptoms
began a week ago after he lost his job, and he is concerned that he may have to
relocate his family. Which stressor is this client experiencing?
A. an anxiety reaction
B. a situational crisis
C. a maturational crisis
D. an adjustment disorder
B. a situational crisis
rationale:
A situational crisis occurs when a life event upsets an individual's psychosocial equilibrium.
Loss of a job can give rise to a situational crisis (B). (A,C, and D) do not depict this client's
situation.
A 19 year old calls the clinic and tells the practical nurse (PN) that since bringing her
newborn infant home, she has felt apathetic, fatigued, and helpless. She states, " I
don't know what's expected of me." What action is most important for the PN to take?
A. tell the charge nurse to come to the phone and talk with the client
B. direct the client to come to the clinic for mother baby care instructions
Exam latest version with answers update | UPDATE /GET IT 100%
ACCURATE
A man who has been admitted numerous times for alcohol detoxification is found
wandering in the street and is unable to identify himself or his home address. He is
manifesting ataxia, nystagmus, and confusion and has a blood alcohol level (BAL) of
0.29%. Which prescribed medication should the practical nurse (PN) administer to
prevent Korsakoff's psychosis?
A. Thiamine
B. Benzodiazepines
C. Glucose solution
D. Haloperidol (Haldol)
A. Thiamine
Rationale:
A BAL greater than 0.20% depresses the entire motor area of brain causing the client to
stagger, lose conscious control of reason, and react in an unpredictable manner. The
client's confusion and alcohol tolerance causing Wernicke's encephalopathy places the
client at risk for Korsakoff's psychosis, a form of amnesia characterized by loss of short-
term memory and precipitated by acute abstinence. Thiamine deficiency causes Wernicke-
Korsakoff's syndromes, so thiamine (B) should be administered. (B,C,D) may be indicated
during withdrawal but do not prevent alcoholic encephalopathies.
An older client who is hospitalized with pneumonia becomes disoriented and
confused 2 days after admission. Which factor should the practical nurse (PN)
identify to differentiate that the client is experiencing delirium, not dementia?
A. impaired memory
B. clear awareness of surrounding
C. unrelated to specific cause
D. acute onset of symptoms
D. acute onset of symptoms
rationale:
Delirium has an acute onset (D) characterized by a reduced level of consciousness, not (B),
,disturbed sleep-wake patterns, disorientation and perceptual problems, and is often
associated with drug cumulative effects, a medical condition, or hospitalization, not (C).
Dementia has a slow, insidious onset of symptoms, which include impaired memory (A) with
loss of abstract thinking, judgment, language and motor skills and is often not reversible.
Which finding should the practical nurse (PN) report immediately when talking with a
new mother who is diagnosed with postpartum depression with psychotic features?
A. thoughts of harming her infant
B. personal hygiene
C. outbursts of anger
D. disinterest in her husband
A. thoughts of harming her infant
rationale:
thoughts of harming her infant (A) is consistent with postpartum depression and should be
reported immediately. Although (B,C,D) may occur in postpartum depression, the major
concern is the potential of harm to herself or to her infant.
During a prenatal visit, a client who is in the second trimester of pregnancy tells the
practical nurse (PN) that she is using cocaine. What information about cocaine is
most important for the PN to provide the client?
A. CNS stimulants increase fetal heart rate and intrauterine movement
B. Eat foods high in iron and protein if a decrease in appetite occurs
C. Counseling should be sought to learn alternative coping behaviors
D. Cocaine can cause miscarriage or premature onset of labor
D. Cocaine can cause miscarriage or premature onset of labor
rationale:
Cocaine, a central nervous system (CNS) stimulant, use during pregnancy (D) increases the
risk of uterine tonicity and preterm labor, which can result in miscarriage (D), abruptio
placentae, and stillbirth. Although the client should understand other factors about cocaine
use in pregnancy (A,B,C), the most important information is the risk of premature birth.
Which part of the client's plan of care is the practical nurse (PN) implementing when
plans are used to increase a male client's participation in his own care and social
environment?
A. client autonomy
B. the therapeutic community
,C. the nurse-client relationship
D. the multidisciplinary mental health team
B. the therapeutic community
rationale:
a therapeutic community (B) provides ways to increase a client's utilization of the social
environment by providing therapeutic milieu but do not best describe the client's
engagement in therapeutic experiences.
A practical nurse (PN) is interacting with a female client who is discussing her
divorce as a stressor. What areas should be explored with the client to gather the
most relevant information?
A. affective responses
B. social responses
C. physiological responses
D. biopsychosocial responses
D. biopsychosocial responses
rationale:
Appraisal of a stressor is the processing and comprehension of stressful situations that
takes place on many levels, specifically cognitive, affective, physiological, behavioral, and
social (D). Limiting the client's self analysis (A,B,C) may omit an important variable that
needs further intervention.
The practical nurse (PN) is inquiring about coping strategies with a male client who is
admitted for alcohol abuse. The client tells the PN that his job skills and
communication skills are his best assets and support. Which additional information
should the PN obtain about maladaptive mechanisms?
A. family support
B. self indulgence
C. financial security
D. daily stressors
B. self indulgence
rationale:
Coping resources include economic assets, abilities, skills, defensive techniques, social
supports, and motivation. Coping mechanisms can be defines as efforts directed at stress
, management and can be constructive (assets) or destructive (liabilities), such as alcohol
abuse, which should be determined by the client's self assessment of amount and duration
of alcohol abuse (B). (A,C,D) are incorrect.
The practical nurse (PN) is caring for a male client who is admitted for schizophrenia
and observes that his thoughts do not flow logically and he uses invented words.
How should the PN document this behavior?
A. interacts with others using child like expressions
B. uses neologisms and tangential expressions
C. demonstrates rapid speech while anxious
D. responds with defensive language to cope with others
B. uses neologisms and tangential expressions
rationale:
Documentation of the client's altered thought processes reflected in speech should be
described as tangential ideas, circumstantially, loose associations, and neologisms, or
"word salad" (B). (A,C, and D) are not accurate descriptors for this client.
A male client arrives at the mental health clinic complaining of insomnia, irritability,
increased tension, and headaches. He tells the practical nurse that the symptoms
began a week ago after he lost his job, and he is concerned that he may have to
relocate his family. Which stressor is this client experiencing?
A. an anxiety reaction
B. a situational crisis
C. a maturational crisis
D. an adjustment disorder
B. a situational crisis
rationale:
A situational crisis occurs when a life event upsets an individual's psychosocial equilibrium.
Loss of a job can give rise to a situational crisis (B). (A,C, and D) do not depict this client's
situation.
A 19 year old calls the clinic and tells the practical nurse (PN) that since bringing her
newborn infant home, she has felt apathetic, fatigued, and helpless. She states, " I
don't know what's expected of me." What action is most important for the PN to take?
A. tell the charge nurse to come to the phone and talk with the client
B. direct the client to come to the clinic for mother baby care instructions
