Mental Health Practice Test

a nurse observes that a client is sitting alone in her room crying. as the nurse approaches, she states, "I'm feeling really down and dont want to talk to anyone right now." which of the following responses is appropriate for the nurse

I'll just sit here with you for a few minutes then

a nurse is caring for a client who is 1 day postpartum. the client tells the nurse, " the baby has been breathing funny, fast and slow, off and on." which of the following responses should the nurse make

I'll sit here while you feed him and we'll check out his breathing

a nurse is caring for a client who has paranoid schizophrenia and is taking quetiapine. the nurse should observe the client for which of the following

drowsiness

a nurse is preparing to change the dressing on the lower leg of the older adult client who is in a wheel chair, and has a history of maladaptive coping skills. the client begins swearing at and verbally abusing the nurse. which of the following actions should the nurse take

tell the client when he will return and leave the room

a nurse is caring for a client who has schizophrenia. the client states, "they lie about me all the time and are trying to poison my food." whish of the following Reponses should the nurse make

you seem to be having some very frightening thoughts

a nurse on the mental health unit is caring for a client who has bipolar disorder and comes to the nurse's station at 0300 demanding to see the provider. which of the following responses should the nurse make

you seem to be very upset about something. tell me about it

a nurse is caring for an older adult client who is scheduled for surgery. the client becomes upset when the nurse asks her to remove her dentures prior to the surgery. which of the following is a therapeutic response by the nurse

you seem worried. are you concerned someone may see you without your teeth

a nurse is discussing group therapy with a client who has a depressive disorder. which of the following benefits of group therapy should the nurse include

- decreasing feelings of isolation - gaining support and encouragement from other group members

A nurse is caring for a client who has received electroconvulsive therapy (ECT) treatments and reports short-term memory loss. Which of the following responses should the nurse make

Memory loss is common and usually improves after a few weeks

A nurse is contributing to the plan for a newly-admitted client who has severe depressive disorder. Which of the following interventions should the nurse include in the plan

Spend time with the client

a nurse is preparing an education program about herbal supplements. which of the following information should the nurse include in discussing st. johns wort

St. johns wort may improve symptoms of depression

a nurse is caring for an older adult client who has fractured hip. the client says, " i guess I've lived long enough and my time is up." which of the following responses should the nurse make

you feel as though your life is ending

A nurse is caring for a client who has paranoid schizophrenia and a new prescription for risperidone. The client asks the nurse what the medicine is supposed to do. Which of the following responses should the nurse make

This medication will clear your thinking

a nurse in an acute care mental health facility is caring for a hospitalized client who has agoraphobia. the nurse observes that the client is making progress when he is able to participate in which of the following activities

a picnic in a local park

a nurse is in a mental health facility is sitting with a client who has schizophrenia. the client whispers to the nurse, "I'm being kept in this prison against my will. Please try to get me out." which of the following responses should the nurse make

you feel that you dont belong here

A nurse is caring for an older adult client admitted to the hospital following a cerebrovascular accident. The clients daughter tells the nurse, "I wish i could stay with my father, but i need to go home to my family." Which of the following responses should the nurse make?

You are feeling drawn in two different directions

a nurse is caring for four clients at an urgent center. which of the following clients should the nurse suspect has been physically abused

a 9-month-old infant who sustained near drowning when he reportedly climbed into the tub and turned on the water

the nurse is caring for a group of clients in a mental health facility. which of the following clients must recommend the provider first

a client taking clozapine who has a sore throat and mild fever

a nurse on an inpatient unit is caring for a client who has major depressive disorder. the nurse observes an improvement in the clients grooming when the client comes to breakfast. which of the following statements should the nurse make

you look very nice after you bathe

a nurse is caring for a client who is experiencing delusions. which of the following actions should the nurse take

acknowledge the feelings the client is experiencing regarding the delusion

a nurse is caring for a client who just delivered a stillborn infant at 36 weeks gestation. which of the following responses should the nurse make

you may hold your baby as long as you want

a nurse is reinforcing teaching with a client who is scheduled to receive electroconvulsive therapy (ECT). which of the following statements should the nurse include in the teaching

you might feel a bit confused and disoriented when you first wake up

a nurse in an acute care mental facility is caring for a client who has a major depression and states "everyone will be much better off when i'm gone." which of the following actions should the nurse first take?

question the client about a suicide plan and method

a nurse is conducting a home health visit for an older adult client who lives with family members. the nurse notices that the client has multiple unusual bruises, and, based on several other factors, the nurse suspects that the client has been physically abused. which of the following actions should the nurse take first

follow the agency's guidelines for reporting suspected abuse

A nurse is sitting in the day room at an acute care mental health facility with a group of clients who are watching television. Suddenly one of the clients jumps up screaming and runs out of the room. Which of the following actions should the nurse take

follow the client to determine the cause of this behavior

A nurse in a long-term care facility is caring for an older adult client who is anxious and has trouble sleeping at night. Which of the following nursing measures should the nurse implement

get the client ready for sleep at the same time each day

a nurse is assisting with the admission of an older adult who is confused. which of the following statements by the clients partner indicates that the client may be experiencing delirium

her behavior changed so quickly, I wasn't sure what was happening

a nursterm-1e is planning an interview for a newly admitted client and plans to include the clients family members. which of the following methods should the nurse use to determine who to include in the interview?

include people whom the client views as family

a nurse is caring foe an older adult client who has a prescription for lorazepam 0.5 mg. which of the following findings should the nurse report to the provider immediately

increased anxiety

a nurse is collecting data from a client who has conversation disorder. which of the following findings should the nurse expect

involuntary loss of a sensory function

a nurse on a mental unit is assisting with several group therapy sessions. the nurse should include which of the following information about using group therapy as a treatment method

it establishes a situation where the client can relate to others and share perceptions

a nurse is caring for a couple who experienced a fetal death at 37 weeks of gestation. which of the following responses by the nurse is therapeutic?

it must be very difficult for you both. i will be available if you need anything

a nurse is contributing to the plan of care for a client who is newly admitted with severe depression. which of the following actions should be added to the plan of care

offer the client frequent small snacks during waking hours

a nurse is caring for a client who is experiencing acute mania. which the following actions should the nurse take

offer the client high-calorie foods and food frequently

a nurse is caring for a client who is bipolar disorder and is experiencing acute mania. which of the following is an appropriate food choice for the client

peanut butter sandwich

a nurse is caring for a client who witnessed her brothers homicide and has posttraumatic stress disorder (PTSD). which of the following findings should the nurse expect

the client is easily startled by loud voices

a nurse is helping a client relieve stress through reframing. which of the following actions by the client demonstrates effective use of cognitive reframing

the client learns the source of his stress by writing down daily events

a nurse is caring for a postpartum and her newborn. the client asks the nurse to feed the newborn. which of the following responses should the nurse make

feeding an infant can feel a little intimidating at first, but I'll stay with you to help

a nurse is collecting data from an adolescent client who has anorexia nervosa. which of the following findings should the nurse expect

- amenorrhea - altered body image - hypokalemia

A nurse is an acute care mental health facility is caring for a client who is experiencing an acute manic episode. which of the following is the nurse's priority intervention

protect the client and others from impulsive behavior

a nurse is assisting with the plan of care for a client who is newly diagnosed with borderline personality disorder. which of the following interventions is the nurse's priority

protecting the client from self harm behavior

a nurse in a community clinic is caring for a 20 month old toddler who has spiral fractures of the right ulna and radius. which of the following findings should the nurse recognize as a potential indication of abuse

the parents report that the child injured herself by falling off the couch

A nurse is caring for a client who is 2 weeks postpartum. The client tells the nurse, "I feel really down and sad lately. I have no energy and I feel like I'm going to cry." Which of the following actions should the nurse take first

use postpartum depression-screening tool with the client

a nurse is reinforcing discharge teaching with a client who has bipolar disorder and is to begin taking lithium. which of the following instructions should the nurse include about the teaching

avoid dieting

A nurse is caring for a client who has schizophrenia and begins to talk about fantasy subjects. Which of the following is an appropriate intervention by the nurse?

Encourage the client to focus on reality-based issues

A nurse is caring for a client who has bipolar disorder and states that his latest computer project is "revolutionizing the industry." Which of the following behaviors is the client exhibiting

Grandiosity

A nurse is caring for a newly admitted female client who has depression and refuses to get out of bed, dress, or participate in group therapy. which of the following is an appropriate nursing response

I will assist you in getting out of bed and getting dressed

a nurse in an acute care facility is caring for a preschool-age child who is terminally ill and receiving palliative care. the parents tell the nurse that they have decided to take their child home. which of the following responses should the nurse make

I will help you get ready to leave

a nurse is caring for a client who is scheduled to undergo abdominal surgury and tells the nurse that he is very anxious about the operation. which of the following actions should the nurse take first

ask him to describe his concerns

a client who has had a significant myocardial infarction receives a referral to the cardiac rehabilitation unit. during his first visit to the unit, he tells the nurse that he doesn't understand why he needs to be there because there is nothing more to do as the damage is done. which of the following responses should the nurse make

cardiac rehabilitation cant undo the damage to your heart, but it can help you get back to your previous level of activity safely

a nurse is caring for a client who is taking disulfiram and is experiencing severe nausea and vomiting. the nurse should identify that which of the following is a cause for the clients nausea and vomiting

consumption of alcohol

a nurse is caring for a client who has depression and is taking a monoamine oxidase inhibitor (MAOI). the nurse should inform the client that his diet may include which of the following foods

cottage cheese and bananas

a nurse is reviewing the admission laboratory values for a client who has a history of bulimia nervosa. which of the following findings is the nurse's priority

potassium 2.8 mEq/L

a nurse is caring for a client who has obsessive compulsive disorder (OCD) and is constantly picking up after others and cleaning in the day room. The nurse should recognize the client's actions as which of the following?

decreasing anxiety to a tolerable level

A nurse in an urgent care facility is caring for a client who has traumatic injuries following an assault. The client sits quietly and calmly tells the nurse, "I'm fine." The nurse should recognize the client's behavior as which of the following reactions

denial

a nurse is an acute care mental health unit is speaking with a client who reports that other clients leave trash in the lounge. which of the following actions should the nurse take

encourage the client to discuss the problem with other clients

a nurse in a mental health clinic is attempting to develop a therapeutic relationship with a client. which of the following actions should the nurse take

engage in friendly interactions with the client

a nurse is reinforcing teaching with a client who has a new prescription for fluoxetine. which of the following instructions should the nurse include

expect that your mood might take one to three weeks to begin improving

a nurse in a community clinic is speaking to a parent who expresses concern for her adolescent son. which of the following statements by the mother should indicate to the nurse that the adolescent is at risk for suicide

his basketball coach committed suicide last month

a nurse is reinforcing teaching with a client about manifestations of lithium toxicity. which of the following manifestations should the nurse include in the teaching

vomiting and diarrhea

a nurse is caring for a client who is in the acute manic phase of bipolar disorder. Which of the following activities is appropriate for the nurse to suggest to the clients

walking with the nurse on the grounds of the facility

A nurse is caring for a client who has anorexia nervosa and insists on exercising three times each day. Which of the following actions should the nurse take

Allow the client to exercise once per day for a set amount of time

a nurse is an assisted-living facility for a client who is in early stages of dementia. the client has been oriented to name and place and is usually cooperative. which of the following nursing actions is appropriate if the client refuses to take morning medications

ask the client to express her reasons for refusing the morning medications and document the event

a nurse in an acute care facility is assisting with the admission of an older adult client who has late stage Alzheimer's disease. the nurse notes that the clients partner appears to be exhausted. he states that he is finding ie more and more difficulty to care for his partner. which of the following actions should the nurse take first

ask the partner to talk about his difficulties in caring for the client

a nurse is caring for a client following major spinal surgery who is reporting pain. the clients partner tells the nurse, " I wish I could do something to make my wife feel better." which of the following responses should the nurse make

it must be very difficult for you to see your wife in pain

A nurse is contributing to the plan of care for a client who has obsessive-compulsive disorder regarding brushing his teeth. The client brushes his tongue several times a day and has developed several ulcerations. Which of the following interventions should the nurse identify as a priority

assist the client in identifying his anxiety level

a nurse is caring for a hospitalized client who has bipolar disorder and is distributing other clients who incessant talking. which of the following actions should the nurse do first

assist the client to practice social interaction with peers during a community meeting

a nurse reinforcing teaching with a client who has alcohol use disorder and is taking disulfiram. which of the following statements should the nurse include in the teaching

avoid alcohol for 2 weeks after discontinuing the medication

a nurse is caring for a client with whom he has developed a therapeutic relationship and who will be discharged later in the day. the client thanks the nurse for his help during hospitalization. which of the following responses should the nurse make

how do you feel about being discharged

A nurse is caring for a client who is threatening to commit suicide. Which of the following questions should the nurse ask

how will you carry out your plan

a nurse is caring for a client who has a history of alcohol use disorder and has been hospitalized for alcohol intoxication. the nurse enters the room and fid clients shouting, "Get those bugs off of me!" which of the following responses should the nurse make

i don't see any bugs, but you seem very frightened

As part of the plan of care for a client with borderline personality disorder, the nurse reviews the day's schedule with him each morning. While doing so, the client states, "Why dont you shut up already! I can read it myself, you know!" Which of the following is an appropriate nursing response

i expect you to speak to me in a civil tone of voice

a nurse in a community clinic is speaking to other nurses about risk factors for domestic violence. which of the following statements by one of the other nurses indicates the need for further teaching

i have heard that abusers think of themselves as important and have high self-esteem

a nurse is caring for a 20 year old college student who has a 2-year history of bulimia nervosa. she tells the nurse, "i know my eating binges and vomiting are not normal, but cannot do anything about them." which of the following is a therapeutic response by the nurse

it seems like you are feeling helpless about this behavior

a nurse is talking to a client following a cesarean delivery due to failure to progress in labor. the client expresses her disappointment that she was unable to have natural childbirth. which of the following responses should the nurse make

it sounds like you are feeling sad that things didnt go as planned

a nurse is collecting data from a client who is admitted to undergo a left lobectomy to treat lung cancer. the client tells the nurse that she is scared and wishes she had never smoked. which of the following responses should the nurse make

its okay to feel afraid. lets talk about what you are afraid of

a nurse is collecting data from a client whose child was killed 2 years ago. which of the following actions indicates that the client is experiencing maladaptive grieving

leaving the child's room exactly as it was before

a home care nurse is visiting an older adult client who tells the nurse that she is feeling tired, is unable to shop for groceries, and would like the nurse to shop for her. shopping and preforming personal errands for the clients is prohibited in the nurse's job description. which of the following is an appropriate reponse

lets look at some other resources to solve this problem

a nurse is reinforcing teaching about valproate with a client who has bipolar disorder. which of the following information should the nurse include in the teaching

liver function test must be monitored regularly

a nurse in a mental health facility is caring for a client who is readmitted for schizophrenia after 2 weeks following the previous discharge. the nurse notices that the clients appearance is unkempt, and the client is mumbling to himself constantly. which of the following assessments is the nurse's priority

physical health needs

a nurse is caring for a newly-admitted client who has obsessive disorder. which of the following actions should the nurse take

plan the clients schedule to allow time for rituals

a nurse is making a home visit for a 16-year-old adolescent who attempted suicide. which of the following behaviors should alert the nurse that the adolescent still has suicidal intent

planning to give CD collection to girlfriend

a nurse is caring for a client who has alcohol use disorder and is experiencing withdrawal. which of the following interventions is the nurses priority

prevent the client from harming herself or others

a nurse is caring for a client who washes her hands repeatly and almost constantly. the nurse should recognize the clients actions as which of the following

relieving the clients anxiety

a nurse is caring for a client who has paranoid delusions and believes the hospital food is being poisoned by the staff. which meal presentation should the nurse consider to be an effective method of encouraging nutritional intake

serve individual items that have sealed packages

A nurse is contributing to the plan of care for an adolescent who is admitted for anorexia nervosa and is at 50% of her ideal body weight. Which of the following interventions should the nurse include in the plan

set a specific duration for mealtimes

a nurse is caring for a newly admitted client who is suspicious of the nursing staff and other clients. which of the following actions should the nurse take to establish a relationship with this client

set aside short, frequent times each day to spend with the client

a nurse is caring for a client who has major depressive disorder. which of the following actions should the nurse take when developing a relationship with the client

set boundaries with the client regarding personal space

Nurse in acute mental health unit is contributing to the plan of care for a client who is newly diagnosed with schizophrenia and is verbalizing paranoid delusions, which of the following intervention should the client include in the plan of care?

set limits on the amount of time the client can talk about his illusions

a nurse in a mental health facility is preparing to interview a client who is schizophrenia. which of the following actions should the nurse take

sit beside the client rather than facing him

a nurse on an inpatient mental health unit is assisting with the admission of a client who reports feeling depressed, sad, moody, and overly anxious. which of the following assessments should the nurse make first

suicide risk

a nurse is caring for a client with schizophrenia and is taking haloperidol. the nurse should monitor the client for which of the following adverse effects

tardive dyskinesia

a nurse is caring for a young adult client who has ulcerative colitis and is scheduled for surgery to create an ileostomy. After speaking provider, the client says, "How will i ever be able to have normal life after this?" Which of the following responses should the nurse take

tell me how you think having the ileostomy will affect you

a nurse is caring for a client who has just been diagnosed with angina pectoris. the client tells the nurse that he is afraid of dying from a heart attack. which of the following is an appropriate nursing response

tell me more about these fears

An assistive personnel (AP) says to the nurse, " the client is incontinent of stool three or four times a day. i get angry because i think that the client might be doing it just to get attention." which of the following responses by the nurse is therapeutic

tell me what makes you feel the client is doing this on purpose

The nurse is caring for a client who has been admitted involuntarily for psychiatric treatment. Which of the following information about involuntary commitment should the nurse provide the clients family

the clients behavior is a threat to self or others

a nurse on an acute care mental health unit is caring for a caring for a client who has generalized anxiety disorder. the client received an upsetting telephone call and is now rapidly pacing the corridors of the unit. which of the following actions should the nurse take

walk with the client at a gradually slowly pace

a nurse is an acute care facility is caring for an older adult client who is being discharged to an extended-care nursing facility the next day. the client asks," why do i have to go to that place?" which response should the nurse make

what have you been told about going to this new facility

a nurse is caring for a client on an acute care mental health unit who was involuntary admitted for 72 hr after attacking a neighbor. to keep the client in the hospital when the initial time to hold the client expires, which of the following must be determined

whether the client is a danger to herself or others

a client who is depressed and has attempted suicide tells the nurse, " i should of died because i am totally worthless." which of the following responses should the nurse make

you've been feeling that your life has no meaning