Mental Health Exam 2 NCLEX questions
a client experiencing a severe major depressive episode is unable to address activities of daily living. the appropriate nursing intervention is to: A.feed, bathe, and dress the client as needed until the client can perform these activities independently. B.offer the client choices and consequences to the failure to comply with the expectation of maintaining activities of daily living. C.structure the client's day so that adequate time can be devoted to the client's assuming responsibility for the activities of daily living D.have the client's peers confront the client about how the noncompliance in addressing activities of daily living affects the milieu.
A
a client taking buspirone (buspar) for 1 month returns to the clinic for a follow-up visit. which of the following would indicate medication effectiveness? A. no rapid heartbeats or anxiety B. no paranoid thought process C. no thought broadcasting or delusions D. no reports of alcohol withdrawal symptoms
A
a nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine (prozac) what information would be important for the nurse to gather regarding the adverse effects related to the medication? A. cardiovascular symptoms B. gastrointestinal dysfunctions C. problem with mouth dryness D. problems with excessive sweating
B
the police arrive at the emergency room with a client who has seriously lacerated both wrists. the initial nursing action is to: A. administer an anti anxiety agent B. examine and treat the wound sites C. secure and record a detailed history D. encourage and assist the client to vent feelings
B
Fluoxetine (Prozac) is prescribed for the client. the nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about administration of the medication? A."I should take the medication with my evening meal" B."i should take the medication at noon with an antacid" C."I should take the medication in the morning when i first arise" D.I should take the medication right before bed time with a snack"
C
Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health care clinic. the nurse is collecting data on the client and is providing instructions regarding the use of this medication. Which is most important for the nurse to determine before administration of this medication? A.a history of hyperthyroidism B.a history of diabetes insipid us C.when the last full meal was consumed D.when the last alcoholic drink was consumed
D
a client has reported that crying spells have been a major problem over the past several weeks, and that the doctor said that depression is probably the reason. The nurse observes that the client is sitting slumped in the chair and the clothes that the client is wearing do not fit well. The nurse interprets that further data collection should focus on: A. weight loss B. sleep patterns C. medication compliance D. onset of the crying spells
A
a client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. the lithium level is checked as part of the routine follow-up and the level is 3.0 mEq/L. the nurse knows that this level is: A. Toxic B. Normal C. Slightly above normal D. Excessively below normal
A
a nurse is assisting in planning care for a client being admitted to the nursing unit who has attempted suicide. which priority nursing intervention will the nurse include in the plan of care? A. one to one suicide precautions B. suicide precautions, with 30 minute checks C .checking the whereabouts of the client every 15 minutes D. asking that the client report suicidal thoughts immediately
A
a nurse is collecting data from a client and the client's spouse reports that the client is taking donepezil hydrochloride (Aricept). which disorder would the nurse suspect that this client may have based on the use of this medication? A.dementia B.schizophrenia C.seizure disorder D.obsessive-compulsive disorder
A
a nurse observes that a client is psychotic, pacing, and agitated and is making aggressive gestures. The client's speech pattern is rapid and the client's affect is belligerent. Based on these observations, the nurse's immediate priority of care is to: A. Provide safety for the client and other clients on the unit B. Provide the clients on the unit with a sense of comfort and safety C. Assist the staff in caring for the client in a controlled environment D. offer the client a less-stimulating area to calm down and gain control
A
which behaviors observed by the nurse might lead to the suspicion that a depressed adolescent client could be suicidal? A. the client gives away a prized CD and a cherished autographed picture of the performer B. the client runs out of the therapy group swearing at the group leader and then runs to her room C. the client gets angry with her roommate when the roommate borrows her clothes without asking D. the client becomes angry while speaking on the telephone and slams the receiver down on the hook.
A
a nurse is caring for a client with severe depression. Which of the following activities would be appropriate for this client? A. a puzzle B. drawing C. checkers D. paint by number
B
an older client is a victim of elder abuse, and the client's family has been attending weekly counseling sessions. Which statement by the abusive family member would indicate the client has learned positive coping skills? A."i will be more careful to make sure that my father's needs are met" B."now that my father is moving into my home, I will need to change my ways" C."i feel better able to care for my father now that I know where to obtain assistance" D."I am so sorry and embarrassed that the abusive event occurred. It won't happen again."
C
a client arrives at the health care clinic and tells the nurse that he has been doubling his daily dosage of buprotion hydrochloride (Wellbutrin) to help him get better faster. The nurse understands that the client is now at risk for which of the following? A. insomnia B. weight gain C. seizure activity D. orthostatic hypotension
C
a client is admitted to the psychiatric unit after a serious suicidal attempt by hanging. the nurse's most important aspect of care is to maintain client safety and plans to: A. request that a peer remain with the client at all times B. remove the client's clothing and place the client in a hospital gown. C. assign a staff member to the client who will remain with him or her at all times D. admit the client to a seclusion room where all potentially dangerous articles are removed
C
a client receiving a tricyclic antidepressent arrives at the mental health clinic. Which observation indicates that the client is correctly following the medication plan? A. reports not going to work for this past week B. complains of not being able to "do anything" anymore C. arrives at the clinic neat and appropriate in appearance D. reports sleeping 12 hours per night and 3 to 4 hours during the day
C
a hospitalized client is started on phenelzine sulfate (Nardil) for the treatment of depression. the nurse instructs the client to avoid consuming which foods while taking this medication? Select all that apply. A. figs B. yogurt C. crackers D. aged cheese E. tossed salad F. Wine
A, B, D, F
a client who is diagnosed with pedophilia and has been recently paroled as a sex offender says "Im in treatment and I have served my time. Now this group has posters of me all over the neighborhood telling about me with my picture on it" which of the following is an appropriate response by the nurse? A. "when children are hurt as you hurt them, people want you isolated" B. "you're lucky it doesn't escalate into something pretty scary after your crime" C. "you understand that people fear for their children, but you're feeling unfairly treated?" D. "you seem angry, but you have committed serious crimes against several children, so your neighbors are frightened?"
C
a nurse is caring for a hospitalized client who has been taking clozapine (clozaril) for the treatment of schizophrenic disorder. which laboratory study prescribed for the client will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? A. platelet count B. cholesterol level C. WBC D. Blood urea nitrogen level
C
a nurse observes that a client with a potential for violence is agitated, pacing up and down in the hallway, and making aggressive and belligerent gestures at other clients. which statement would be appropriate to make to this client? A."you need to stop that behavior now" B."you will need to be placed in seclusion" C.what is causing you to become agitated" D."you will need to be restrained if you do not change your behavior"
C
a nurse is caring for an older adult client who has recently lost her husband. The client says, "no one cares about me anymore. All the people I loved are dead." Which response by the nurse is therapeutic? A. "right! why not just pack it in?" B. "that seems rather unlikely to me" C. "i don't believe that, and neither do you" D. "you must be feeling all alone at this point"
D
a nurse is planning care for a client who is being hospitalized because the client has been displaying violent behavior and is at risk for potential harm to others. The nurse avoids which intervention in the plan of care? A. facing the client when providing care B. ensuring that a security officer is within the immediate area C. keeping the door to the client's room open when with the client D. assigning the client to a room at the end of the hall to prevent disturbing the other clients.
D
a nurse is preparing for the hospital discharge of a client with a history of command hallucinations to harm self or others. The nurse instructs the client about about interventions for hallucinations and anxiety and determines that the client understands the interventions when the client states: A. "my medications won't make me anxious" B. "I'll go to a support group and talk so that I won't hurt anyone." C. "I won't get anxious or hear things if I get enough sleep and eat well" D. "I can call my therapist when I'm hallucinating so that I can talk about my feelings and plans and not hurt anyone"
D
during a conversation with a depressed client on psychiatric unit, the client says to the nurse, "My family would be better off without me" the nurse should make which therapeutic response to the client? A."have you talked to your family about this?" B."everyone feels this way when they are depressed" C."you will feel better once your medication begins to work" D."you sound very upset. are you thinking of hurting yourself?"
D
