N405 Exam 1 Practice Questions
A student nurse has just entered a psychiatric rotation. The student asks a nursing instructor, "How will we know if someone may get violent?" Which is the most appropriate reply by the nursing instructor? A. "Certain behaviors indicate a potential for violence. They are labeled as a 'prodromal syndrome' and include rigid posture, clenched fists, and raised voice." B. "Any client can become violent, so it is best to be aware of your surroundings at all times." C. "You can't really say for sure. There are limited indicators of potential violence." D. "When a client suddenly becomes quiet, is withdrawn, and maintains a flat affect, this is an indicator of potential violence."
A
As an angry client becomes more agitated while talking about problems, the nurse decides to ask for staff assistance in taking control of the situation when the client demonstrates which behavior? A. picking up a pool cue stick and telling the nurse to get out of the way B. making a fist and pounding loudly on the table C. swearing about a spouse's behaviors when discussing marital problems D. coming out of the room instead of staying in time-out
A
Based on a client's history of violence toward others and inability to cope with anger, what should the nurse use as the most important indicator of goal achievement before discharge? A. verbalization of feelings in an appropriate manner B. acknowledgement of the client's angry feelings C. development of a list of how anger has been handled in the past D. ability to describe situations that provoke angry feelings
A
During a therapy group session, after several members relate traumatic incidents that happened during the week, a client with a smile states, "Things haven't gone well in my life this week either. "It is most appropriate for the nurse to: A. Say to the client, "You say things have been bad this week, yet you are smiling." B. Comment, "This seems to have been bad week for several group members." C. Make a note of the incongruity of the client's message but remain silent D. Ask the client to share what has been happening during this week
A
Which probe should the nurse use to encourage client evaluation of his or her own behavior? A. "What did you do differently with your coworker this time?" B. "I can hear that it's still hard for you to talk about this." C. "So what does this all mean to you now?" D. "What will it take to carry out your new plans?"
A.
The client with recurrent depression and suicidal ideation tells the nurse, "I can't afford this medication anymore. I know I'll be ok without it." What should the nurse do next? A. Ask to social worker to find financial assistance for the client. B. Schedule a follow up appointment in 48 hours C. Inform the health provider (HCP) of the clients statement. D. Ask the client whether a family member could help.
A?
When caring for a client with a major depressive disorder, the nurse's priority intervention should be to help the client to: A. Participate in small-group activities B. Feel comfortable with the nurse C. Investigate new leisure activities D. Initiate conversations about feelings
B?
When developing the plan of care for a client with suicidal ideation, the nurse should address which priority issue? A. sleep B. self-esteem C. safety D. stress
C
Which question should the nurse ask to best determine the seriousness of a client's suicidal ideation? A. "Have you made out a will?" B. "How long have you been thinking about harming yourself?" C. "How are you planning on harming yourself?" D. "Does your family know you're here?"
C
The friend of a client with depression and suicidal ideation asks the nurse, "How should I act around her?" Which response by the nurse is best? A. "Be caring and genuine" B. "Control your expressions". C. "Avoid asking directly how she's feeling". D. "Try to cheer her up. This will help if she secretly has feelings of harming herself".
A
When planning the care of a client experiencing aggression, the nurse incorporates the principle of "least restrictive alternative," meaning that less restrictive interventions must be tried before more restrictive measures are employed. What measures should the nurse consider to be the most restrictive? A. haloperidol given intramuscularly B. haloperidol given orally C. voluntary seclusion or time-out D. tension reduction strategies
A
The nurse observes a client's escalating anger. The client begins to pace the hall and shouts, "You all better watch out. I'm going to hurt anyone who gets in my way." Which is the priority nursing intervention? A. Calmly tell the client, "You will need to be medicated and secluded." B. Remove other clients from the area and maintain milieu safety. C. Gather a show of force by contacting security for assistance. D. Calmly tell the client, "Staff will help you to control your impulse to hurt others."
B
The client with major depression and suicidal ideation has been taking bupropion 100 mg PO 3 times daily for 5 days. Assessment reveals the client to be somewhat less withdrawn, able to perform activities of daily living with minimal assistance, and eating 50% of each meal. At this time, the nurse should monitor the client specifically for which behavior ? A. seizure activity B. increased libido C. suicide attempt D. visual disturbances
C
Which of following individual is at highest risk for a suicide attempt? A. A client who has been seeing a doctor for chronic, intractable pain and is taking pain medication. B. An American Indian client who just graduated from high school with honors. C. A client who reports he is in deep emotional pain, feels hopeless, and says "No one is there for me." D. A physician who reports feeling "burn out" and is considering retirement.
C
A client diagnosed with Paranoid Schizophrenia has a history of aggravated assault. The nurse assigns "Risk for other-directed violence" as the client's priority nursing diagnosis. Which is an appropriate, correctly written outcome for the client? A. The client will be restrained if verbal or physical abuse is observed during this shift. B. The client will not verbalize anger or hit anyone. C. The client will verbalize anger rather than hit others. D. The client will not inflict harm on others during this shift.
D
A nurse is taking calls at a local crisis center hotline and receives a telephone call from a suicidal adolescent. The nurse can safely terminate the call when the client: A. Begins repeating the same information that has already been discussed B. Has responded to the nurse's initial assessment of suicidal risk C. Wishes to terminate the conversation D. Can state a preventive plan of action for dealing with self-destructive behaviors
D
The nurse manager in the emergency department (ED) conducts an in-service for the nursing staff about screening clients for suicide. One of the nurses states, "Questioning adolescents about suicide will only increase their thinking about self-harm, and they wouldn't admit it to me anyhow." How should the nurse manager respond? A. "We'll limit the assessment to adolescents with psychiatric diagnoses." B. "It's a myth that talking about suicide leads to suicide attempts. Adolescents will disclose suicidal thoughts when asked directly." C. "If you think the adolescent isn't telling you the truth, you can question the parents." D. "You could be correct. Let's assess only adults because they'll be more honest."
B
A client diagnosed with major depression spends most of the day lying in bed with the sheet pulled over his head. Which approach by the nurse is most therapeutic? A. Question the client until the client responds. B. Initiate contact with the client frequently. C. Sit outside the client's room. D. Wait for the client to begin the conversation.
B?
To further assess a client's suicidal potential, the nurse should be especially alert to the client's expression of: A. Frustration and fear of death B. Loneliness and anxiety C. Helplessness and hopelessness D. Anger and resentment
C
One day the nurse sits by a depressed client's bed and states, "I will be spending some time with you today." The client responds angrily, "Go talk to someone else. They need you more." What is the nurse's most therapeutic response? A. "Why are you angry with me?" B. "I will be spending the next ten minutes with you." C. "I'll go but I will be back tomorrow." D. "Don't you think you are just as important as the others?"
C?
The nurses assesses a client for physiologic responses to stress. Which finding would suggest to the nurse that the client is not experiencing anger? A. increased muscle tension B. decreased peristalsis C. increased respiratory rate D. decreased blood pressure
D
A client lives in a group home and visits the community mental health center regularly. During one visit with the nurse, the client states, "The voices are telling me to hurt myself again." Which question by the nurse is most important to ask? A. "How long have you heard the voices?" B. "Are you going to hurt yourself?" C. "Why are the voices starting again?" D. "When do you hear the voices?"
B
A 17-year-old is diagnosed as having anorexia nervosa. The psychiatrist, in conjunction with the client and the parents, decides to institute a behavior modification program. The nurse identifies that a major component of behavior modification is that it: A. Decreases necessary restrictions B. Deconditions fear of weight gain C. Rewards positive behavior D. Reduces anxiety-producing situations
C
The parents of an autistic child begin family therapy with a nurse therapist. The father states that the family members wish to share their religious beliefs with the therapist. The nurse should: A. Limit the father's discussion of religion B. Include the mutual discussion of religious beliefs C. Keep the sessions focused on the family's concerns D. Invite the family's religious leader to a therapy session
C
What is a crucial goal of therapeutic communication when helping the client deal with personal issues and painful feelings? A. guaranteeing total confidentiality and anonymity for the client B. communicating empathy through gentle touch C. conveying client respect and acceptance even if not all of the client's behaviors are tolerated D. mutual sharing of information, spontaneity, emotions, and intimacy
C
Which activity should the nurse recommend to the client on an inpatient unit when thoughts of suicide occur? A. playing a card game with other patients B. keeping track of feelings in a journal C. talking to the nurse D. engaging in physical activity
C
The nurse is teaching two unlicensed personnel who are new to the inpatient unit about caring for a client who is suicidal. The nurse determines that additional teaching is needed when which statement is made? A. "Documenting suicide checks is absolutely necessary." B. "Clients on one to one precautions can never be left alone." C. "I need to check the client precisely at 15-minute intervals." D. "All clients using razors must be supervised by staff."
C?
A nurse has been caring for a female client with the diagnosis of major depressive disorder. The nurse evaluates that a trusting relationship is beginning to develop when the client: A. Permits the nurse to get her dressed in the morning B. Responds to the nurse when asked questions C. Accompanies the nurse to the dining room D. Establishes eye contact with the nurse
D
In an attempt to remain objective and support a client during a crisis, the nurse uses imagination and determination to project the self into the client's emotions. This is an example of: A. Sympathy B. Acceptance C. Projection D. Empathy
D
The nurse working on the mental health unit finds a depressed client crying. What is the most therapeutic approach to help the client explore feelings? A. "Does crying help?" B. "Do you want to tell me why you are crying?" C. "I know you are upset." D. "Tell me what you are feeling now."
D
Which statement by the nurse reflects the best understanding about suicide in an individual with depression? A. "Every client with depression is potentially suicidal." B. "The more severe the depression, the greater the probability for suicidal behavior." C. "Suicide is less likely when an individual is receiving antidepressant therapy." D. "The person who talks about suicide is less likely to try it."
A
A client loses control and throws two chairs toward another client. What should the nurse do next? A. Process the incident with the client and discuss alternative behaviors. B. Call for assistance to restrain the client and administer a PRN intramuscular tranquillizer. C. Ask the client to go to the quiet area and talk about the behavior. D. Administer an oral PRN tranquilizer and prepare for a show of determination.
B
The nurse identifies establishing trust as a major nursing goal for a depressed client. How can this goal be best accomplished? A. Spending the day with the client B. Asking the client to initiate conversation C. Waiting for the client to initiate conversation D. Spending short periods of time with the client every day
D
The nurse manager overhears two staff members talking in the snack room. One of the staff members states, "Her superficial cuts are just a means of getting our attention. She never should have been admitted. I hope she's out of here soon. Which response by the nurse manager is most appropriate? A. "No matter what the intent, all suicidal behavior is serious and deserves our serious consideration." B. "I know it's hard to understand, but we need to do the best we can even though she'll be back." C. "It's our job to help no matter how we feel about her or what she did. She'll be discharged soon." D. "I won't tolerate that kind of discussion from my staff. Now, it's time for you to go back to work."
A
A client is brought to the psychiatric unit from the emergency department escorted by ED staff and a security officer. The clients shoulder is bandaged, and his arm is in a sling because of a self-inflicted gunshot wound to his shoulder. Later, the clients wife follows with a bag of her husbands belongings. Which nursing action is most appropriate at this time? A. Tell the wife to take her husbands things home because he is suicidal. B. Inspect the bag and its contents in the presence of the client and his wife. C. Ask the wife whether the bag contains anything dangerous. D. Instruct the wife to unpack the bag and put her husbands things in the dresser.
B
A client is hospitalized following a suicide attempt after breaking up with her boyfriend. She says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? A. "I don't understand. You have so much to live for." B. "What exactly do you plan to do?" C. "You are safe here. We will make sure nothing happens to you." D. "You're just lucky your roommate came home when she did."
B
The nurse identifies the primary nursing diagnosis for a client as Risk for suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would be most appropriate for this diagnosis? A. The client expresses some optimism and hope for the future. B. The client has experienced no self-harm. C. The client has reached a stage of acceptance in the loss of the relationship. D. The client sets realistic goals.
B
A client who was recently discharged from the psychiatric unit telephones the unit to speak to the nurse. The client states that she took her children to the neighbors' house and has turned on the gas to kill herself. Which action should the nurse take next? A. Instruct the caller to telephone her family for help. B. Ask the caller whether she telephoned her health care provider (HCP) C. Refer the caller to a 24-hour suicide hotline. D. Tell the caller that another nurse will telephone the police.
D
When assessing a client for suicidal risk, which method of suicide should the nurse identify as most lethal? A. jumping off an 8-foot bridge B. overdosing on aspirin C. slashing both wrists D. use of a gun to the stomach
D
Which risk factor should a nurse recognize as the most reliable indicator of potential client violence? A. Recent eviction from a homeless shelter B. Family history of violence C. A diagnosis of schizotypal personality disorder D. History of assaultive behavior
D
A client is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain the client's suicide attempt in which of the following ways? A. Without her boyfriend, she feels like an outsider with her peers. B. She is feeling intense guilt because her boyfriend broke up with her. C. She feels hopeless about her future without her boyfriend. D. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.
D?
A client was experiencing marital discord with a spouse of 4 years. When the spouse walked out, the client became angry and began to throw things and break dishes. A friend talked the client into seeking help at the local mental health center. Which of these questions should the nurse ask initially to begin to assess this client's immediate problem? A. "Do you feel in control of yourself at this time?" B. "What led you to come in for help today?" C. "What did you do to cause your spouse to leave?" D. "In hindsight, how might you have managed this situation differently?"
B
A nurse is caring for four clients. Which client does the nurse identify is least prone to developing problems with anger and aggression? A. A young adult living in the ghetto of an inner city B. An adolescent raised by Scandinavian immigrant parents C. An adult with a history of epilepsy D. A child raised by a physically abusive parent
B
How can a nurse minimize agitation in a disturbed client? A. Increase environmental sensory stimulation B. Limit unnecessary interactions with the client C. Discuss the reasons for suspicious beliefs D. Ensure constant staff contact
B
The history of a female client who has just been admitted to the unit and is very depressed reveals a weight loss of 10 lb (4.5 kg) in 2 weeks, sleeping 3 hours a night, and poor hygiene. The client states, "I'm no good to anyone. Everyone would be better off without me." Which questions should the nurse ask first? A. "What do you mean?" B. "Does your family not care about you?" C. "Are you thinking about killing yourself?" D. "What happened to make you think that?"
C
As a young male client is receiving a dialysis treatment, the nurse observes he is not talking with the other clients and his eyes are lowered and his jaw is clenched. The nurse states, "You look discouraged." The client replies, "I'm a bother. My wife will at least get some insurance money if I die." Which is the nurse's most therapeutic response? A. "We all have days we feel like that. Let's talk about your diet." B. "I know it's hard. Don't let it get you down because you need time to adjust." C. "I can understand how you feel." D. "You feel so bad you wish you were dead."
D
A client is served divorce papers while on the inpatient psychiatric unit. When the nurse tells the client that the unit telephone cannot be used after hours, the client raises his fists, swears, and spits at the nurse. Which negative coping mechanism is the client exhibiting? A. The defense mechanism of displacement B. The defense mechanism of projection C. The defense mechanism of reaction formation D. The defense mechanism of sublimation
A
A nurse on the psychiatric unit is planning a discharge conference with a client and the client's family. The priority nursing action that should be included in the discharge plan is: A. Exploring what has been learned from this hospitalization B. Discussing new issues that could be worked on at home C. Obtaining a more complete family history D. Teaching the client about the medication to be taken
A
A nursing instructor is teaching about the concept of anger. Which student statement indicates the need for further instruction? A. "Anger and aggression are essentially the same." B. "Anger is not a primary emotion." C. "Anger is physiological arousal." D. "Anger expression is a learned response."
A
A 27-year-old female client was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, tradozone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 hears. I love him so much. I know I'll never get over him." Which is the best response by the nurse? A. "You'll get over him in time." B. "You must be feeling very sad about your loss." C. "Why do you think he broke up with you?" D. "Forget him. There are other fish in the sea."
B
The nurse manager is evaluating a primary nurse's ability to develop a therapeutic relationship. A client with a bipolar mood disorder, manic-phase, has been hyperactive and sarcastic. This behavior has been decreasing and the client states, "My husband and I have problems because we see things differently." What response indicates to the nurse manager that the primary nurse is not being therapeutic? A. "Not getting along with one's spouse is upsetting." B. "Do you know why you are feeling better today?" C. "Can you explain what you mean by seeing things differently?" D. "Tell me about a specific time when you have had problems with your husband."
B
A male client is preparing to leave the hospital and return to college. When saying good-bye, he hugs and kisses the nurse on the cheek. What is the nurse's most appropriate response? A. Hug the client in return. B. Smile at the client but say nothing. C. Encourage him to visit periodically. D. Wish him well with his future studies.
C?
A client whose wife recently died appears extremely depressed. The client states, "What's the use in talking? I'd rather be dead. I can't go on without my wife." What is the nurse's best response? A. "Do you understand why you feel that way?" B. "Would you rather be dead?" C. "What does death mean to you?" D. "Are you thinking about killing yourself?"
D
A client has been rehospitalized with a severe exacerbation of lupus. Her husband approaches the nurse and says, "My wife is scaring me. She says she doesn't want to live with this illness anymore. Our kids are grown, and she feels useless as a mother and a wife." Which statements are the most appropriate responses to the husband? Select all that apply. A. "I'm sure she will feel differently when we get this episode under control." B. "We can talk about what you can say to her that may help." C. "You need to be strong and optimistic when you are with her." D. "I'll have a talk with your wife to see if she is suicidal." E. "I'm glad you shared this with me. I can imagine that this is scary for you."
Only pick one. Maybe D.
The unlicensed assisted personnel (UAP) states to the nurse, "My client talks about how awful and useless she is. Sometimes, she sounds angry for no reason. I'm tired of listening to her." Which response by the nurse is most appropriate? A. "Client's with depression are hard to deal with, but don't take what they say seriously." B. "It's important for you to listen to her because she needs to verbalize how she's feeling." C. "Don't worry about it. I know you haven't done anything to make her angry." D. "I'll switch your assignment to someone who is less depressed and less tiring."
B
A client is admitted to the psychiatric hospital for evaluation after numerous incidents of threatening others, angry outbursts, and two episodes of hitting a coworkers at the client's place of employment. The client is very anxious and tells the nurse, "I didn't mean to hit him. He made me so mad that I just couldn't help it. I hope I don't hit anyone here." To ensure a safe environment, what should the nurse do first? A. Put the client in a private room, and limit the client's time out of the room to when staff can be with the client. B. Let other clients know that the client has a history of hitting others so that they will not provoke the client. C. Tell the client that hitting others is unacceptable behavior, and ask the client to tell a staff member when feeling angry. D. Obtain a prescription for a medication to be administered to decrease the client's anxiety and threatening behavior.
C
A woman who was raped in her home was brought to the emergency department by her husband. After being interviewed by the police, the husband talks to the nurse. "I don't know why she didn't keep the doors locked like I told her. I can't believe she's had sex with another man now." How should the nurse response? A. "It wasn't consensual sex. Let's see if your wife was physically injured." B. "Maybe the doors were locked, but the man broke in anyway." C. "Let's talk about how you feel. Maybe it would help to talk to other men who have been through this." D. "Your wife needs your support right now, not your criticism."
C
In determining the degree of suicidal risk with a client, the nurse assesses the following behavioral manifestations: severely depressed. withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? A. Low risk B. Imminent risk C. High risk D. Unable to be determined
C
A husband is upset that his wife's alcohol withdrawal delirium has persisted for the second day. What is the most appropriate initial response by the nurse? A. "This is expected. I suggest that you go home because there is nothing you can do to help at this time." B. "Are you afraid that your wife may die? I assure you that very few alcoholics die during the detoxification process." C. "Do you think that your wife is uncomfortable while she is undergoing the withdrawal process? I am sure that your wife is not in pain." D. "I see that you are very worried. Medications are being used to lessen your wife's discomfort."
D
A male client with dementia due to Parkinson's disease has been placed in a nursing home. His wife appears tired and angry on her first visit with her husband. As she is leaving she says to the unit nurse in a sarcastic tone, "Let's see what you can do with him." Which is the nurse's most therapeutic response? A. "I don't understand what you mean by that comment." B. "It's too bad you didn't realize you needed help to care for him." C. "I have experience in caring for clients such as your husband." D. "It sounds like it has been difficult for you."
D
