Mental Health Final Exam
an 80-year-old female client arrives at the emergency room with her son
and daughter in- law, with whom she lives. she is found to have a broken
arm. her son and daughter- in law seem very agitated with the client. when
questioned about how it happened, she drops her head and mumbles that
she doesn't really know. after a thorough assessment, the nurse suspect
that the client is a victim of elder correct answersDomestic Abuse
according to maslows hierarchy of needs, which of the following needs
should the nurse address first correct answersEither SAFETY or BASIC NEEDS.
after her husband died of heart failure, a wife approaches the nurse who
cared for her husband. in the hospital hallway the wife shouts angrily, "he'd
still be alive if you'd given him your undivided attention!" which response
should the nurse implement correct answersI understand you're feeling
upset. Let's go to our
conference room, and I'll stay with you until your family comes."
after suffering a myocardial infarction, a 37- year-old executive demands to
be discharged from the hospital. he tells the nurse, "just give me my
prescriptions and let me get back to work". which is the most appropriate
reply correct answers"To ensure improved health, we need to discuss diet,
medication, exercise, and lifestyle changes before you are discharged."
After the death of a spouse, an adult repeatedly says, "I should have
made him go to the doctor when he said he didn't feel well." This
individual is experiencing: correct answersguilt
After threatening to jump off a bridge, a client is brought to an emergency
department by police. To assess for suicide potential, which question
should a nurse ask first? correct answers"Are you currently thinking about
harming yourself?"
Ann is a psychiatric home health nurse. She has just received an order to
begin regular visits to a 79-year-old widow with mild dementia who lives
alone and has a new diagnosis of depression. based on a needs assessment,
which of the following problems would the nurse address during her first
visit correct answersthis must be very difficult for you
A child drowned while swimming in a local lake 2 years ago. Which behavior
indicates the child's parents are mourning in an effective way correct
answersthrow flowers on the lake at each anniversary date of the accident
, a child was abducted and raped. in the emergency department, the child is
crying uncontrollably. which personal reaction by the nurse could interfere
with childs care correct answersFeelings of empathy, concern, and
compassion are helpful. Anger, on the other hand, may make objectivity
impossible.
the client admitted to the psychiatric unit diagnosed with schizo is
prescribed clozapine (clozaril), an atypical antipsychotic. which laboratory
data should the nurse evaluate correct answersClient's white blood cell
count.
a client diagnosed with bipolar disorder in the manic phase is yelling at
another peer in the common area. which nursing intervention takes priority
correct answersCalmly redirect and remove the client from the milieu.
a client diagnosed with dementia wanders the halls of the locked nursing
unit during the day. which would the nurse do first to ensure safe care is
implemented correct answersassess the clients gait for steadiness
a client has been receiving oxycodone for moderate pain. the client has
returned to the clinic three times for refills of their
prescription. what assessment by the nurse, in addition to slurred
speech, leads the nurse to suspect opioid intoxication correct
answersconstricted pupils
a client is diagnosed with late-stage Alzheimers dementia. to address the
client symptoms, which nursing intervention should take priority correct
answerspatient safety
the client is in a crisis state following an environmental disaster. at the
beginning of the initial assessment interview, what should the nurse assist
the client to identify correct answersphysical safety
A client on an in-patient psychiatric unit is experiencing a flashback. Which
intervention takes priority? correct answersmaintain and reassure the client
of his or her safety and security
a client on a psychiatric unit says " it's a waste of time to be here. i can't
talk to you or anyone". which would be an appropriate therapeutic nursing
response correct answers"Are you feeling that no one understands?"
a client says to the nurse. "i have nobody anymore. i wish i could just die"
which response from the nurse would be considered non-therapeutic correct
answers"You feel like alone; would you like to talk more about the way you
feel?"
a client who has major depressive disorder states to the nurse that he
and his family would be better off if he were gone. which is the nurse
priority response correct answersare you having thoughts about harming
yourself?
an 80-year-old female client arrives at the emergency room with her son
and daughter in- law, with whom she lives. she is found to have a broken
arm. her son and daughter- in law seem very agitated with the client. when
questioned about how it happened, she drops her head and mumbles that
she doesn't really know. after a thorough assessment, the nurse suspect
that the client is a victim of elder correct answersDomestic Abuse
according to maslows hierarchy of needs, which of the following needs
should the nurse address first correct answersEither SAFETY or BASIC NEEDS.
after her husband died of heart failure, a wife approaches the nurse who
cared for her husband. in the hospital hallway the wife shouts angrily, "he'd
still be alive if you'd given him your undivided attention!" which response
should the nurse implement correct answersI understand you're feeling
upset. Let's go to our
conference room, and I'll stay with you until your family comes."
after suffering a myocardial infarction, a 37- year-old executive demands to
be discharged from the hospital. he tells the nurse, "just give me my
prescriptions and let me get back to work". which is the most appropriate
reply correct answers"To ensure improved health, we need to discuss diet,
medication, exercise, and lifestyle changes before you are discharged."
After the death of a spouse, an adult repeatedly says, "I should have
made him go to the doctor when he said he didn't feel well." This
individual is experiencing: correct answersguilt
After threatening to jump off a bridge, a client is brought to an emergency
department by police. To assess for suicide potential, which question
should a nurse ask first? correct answers"Are you currently thinking about
harming yourself?"
Ann is a psychiatric home health nurse. She has just received an order to
begin regular visits to a 79-year-old widow with mild dementia who lives
alone and has a new diagnosis of depression. based on a needs assessment,
which of the following problems would the nurse address during her first
visit correct answersthis must be very difficult for you
A child drowned while swimming in a local lake 2 years ago. Which behavior
indicates the child's parents are mourning in an effective way correct
answersthrow flowers on the lake at each anniversary date of the accident
, a child was abducted and raped. in the emergency department, the child is
crying uncontrollably. which personal reaction by the nurse could interfere
with childs care correct answersFeelings of empathy, concern, and
compassion are helpful. Anger, on the other hand, may make objectivity
impossible.
the client admitted to the psychiatric unit diagnosed with schizo is
prescribed clozapine (clozaril), an atypical antipsychotic. which laboratory
data should the nurse evaluate correct answersClient's white blood cell
count.
a client diagnosed with bipolar disorder in the manic phase is yelling at
another peer in the common area. which nursing intervention takes priority
correct answersCalmly redirect and remove the client from the milieu.
a client diagnosed with dementia wanders the halls of the locked nursing
unit during the day. which would the nurse do first to ensure safe care is
implemented correct answersassess the clients gait for steadiness
a client has been receiving oxycodone for moderate pain. the client has
returned to the clinic three times for refills of their
prescription. what assessment by the nurse, in addition to slurred
speech, leads the nurse to suspect opioid intoxication correct
answersconstricted pupils
a client is diagnosed with late-stage Alzheimers dementia. to address the
client symptoms, which nursing intervention should take priority correct
answerspatient safety
the client is in a crisis state following an environmental disaster. at the
beginning of the initial assessment interview, what should the nurse assist
the client to identify correct answersphysical safety
A client on an in-patient psychiatric unit is experiencing a flashback. Which
intervention takes priority? correct answersmaintain and reassure the client
of his or her safety and security
a client on a psychiatric unit says " it's a waste of time to be here. i can't
talk to you or anyone". which would be an appropriate therapeutic nursing
response correct answers"Are you feeling that no one understands?"
a client says to the nurse. "i have nobody anymore. i wish i could just die"
which response from the nurse would be considered non-therapeutic correct
answers"You feel like alone; would you like to talk more about the way you
feel?"
a client who has major depressive disorder states to the nurse that he
and his family would be better off if he were gone. which is the nurse
priority response correct answersare you having thoughts about harming
yourself?
