mental health exam 1 EAQs

Which activities would the nurse perform to meet the client's safety and security needs based on Maslow's hierarchy of needs? (select all that apply) - Providing a cold bath to reduce the client's body temperature - Positioning the bed in a low position and keeping the side rails up - Monitoring vital signs, such as blood pressure to decrease the risk of falls - Observing a client who has suicidal tendencies to prevent adverse incidents - Collaborating with family members to provide emotional support for the client post-surgery

- Positioning the bed in a low position and keeping the side rails up - Monitoring vital signs, such as blood pressure to decrease the risk of falls - Observing a client who has suicidal tendencies to prevent adverse incidents

Read the details about the four clients from the nurse's logbook. Which client has the highest chance of receiving inadequate health access leading to health disparity? CLIENT A: Visually disabled American, 30 years in US, Medicaid, no Medicare, Supplemental security income CLIENT B: Hispanic immigrant, 6 years in US, no Medicaid or Medicare, Supplemental security income CLIENT C: Chinese immigrant, 4 years in US, no Medicaid or Medicare, no Supplemental security income CLIENT D: Older adult American, in US since birth, no Medicaid, Medicare, no Supplemental security income - Client A - Client B - Client C - Client D

Client C

The nurse asks an unlicensed assistive personnel (UAP) to provide an ice pack to a client. Which nursing function does this represent? - Delegation - Implementation - Case management - Interprofessional teamwork

Delegation

A family member of a client who is prescribed a blood transfusion mentions that blood transfusion are not permitted in their faith. Which action would the nurse take to handle the situation? - Wait for the court's order to give blood to the client - Proceed with the transfusion to save the client's life - Inform the primary health care provider and not give blood to the client - Explain to the family member that the client needs this transfusion

Inform the primary health care provider and not give blood to the client

To meet the criteria of ethical practice, which action would the nurse who witnessed the spouse of a client fall take? - Initiate an agency incident report - Report the fall to the state (provincial) health department - Write a brief description of the incident to be kept by the nurse manager - Determine that no documentation is needed because the visitor is not a client in the hospital

Initiate an agency incident report

An older client is treated in the emergency department for soft tissue injuries that the medical team suspects might be caused by physical abuse. An adult child states that the client is confused and often falls down. A mini-mental examination indicates that the client is oriented to person, place, and time. Which action would the nurse take next? - Interview the client without the presence of family members - Suggest that the client call law enforcement officers if threatened by family members - Accept the adult child's explanation until more data can be collected - Refer the client's clinical record to the hospital ethics committee for review

Interview the client without the presence of family members

A client develops phlebitis after the nurse forgets to monitor the client after administering medication via the central venous access device (CVAD). Which charges may the nurse face for this action? - Battery - Malpractice - False imprisonment - Defamation of character

Malpractice

Which action would the nurse take first when caring for a postoperative client who reports pain? - Provide an ice bag - Administer pain medication as prescribed - Perform a focused assessment of the client - Document the client's complaint in the chart

Perform a focused assessment of the client

Which description does beneficence in health ethics refer to? - The agreement to keep promises - Taking positive actions to help others - The ability to answer for one's actions - Avoiding harming or hurting an individual

Taking positive actions to help others

Which information is appropriate to include in education about sentinel events? - Causes moderate harm to the client - Undesirable and largely avoidable - Effect is mitigated by interventions - Very common in hospital settings

Undesirable and largely avoidable

Which action would the nurse take to minimize ambiguity and confusion when entering a client's data in the electronic health record? - Use consistent, codified terminology - Record the data in the client's presence - Enter the data in the client's native language - Upload scanned copies of the client's records

Use consistent, codified terminology

Which basic health care ethic does the nurse follow when signing the client's consent form as a witness? - Justice - Autonomy - Beneficence - Nonmaleficence

Autonomy

How would the nurse respond to an alcohol recovery program sponsor requesting to read the client's progress record? - By allowing the visitor to review the record; sponsors have access to privileged information - By asking the primary health care provider about granting permission to the sponsor - By not allowing the sponsor to review the record - By allowing the visitor to review the record; clients with alcoholism need reassurance from sponsors

By not allowing the sponsor to review the record