RN Mental Health online practice B

RN Mental Health online practice B 1. A nurse is planning care for an older adult client who is experiencing delirium. Which of the following interventions will meet the needs of this client? a. Offer the client various choices for meal selection b. Assign different nursing personnel for each shift c. Permit the client daily rituals to decrease anxiety d. Maintain an environment that has low lighting 2. A nurse in a 24-hr mental health facility is planning discharge for a client who has a long history of alcohol use disorder. Which of the following postdischarge activities should the nurse plan to include? a. Taking the oral medication buprenorphine to prevent alcohol use b. Attending a relapse prevention group several times each week c. Beginning a methadone treatment program at a local center d. Living with her mother, who has promised to keep her away from alcohol 3. A nurse is caring for a client who is schedules to undergo electroconvulsive therapy (ECT). Which of the following client statements indicates that further teaching is needed? a. “I will be able to stop taking my antidepressant after the treatment.” b. “I can expect to experience some memory loss after the procedure.” c. “My blood pressure will be checked frequently after the procedure.” d. “I will receive a muscle-relaxant before the doctor begins the treatment.” 4. A nurse is planning strategies to address suicide in the community. Which of the following should the nurse plan as a tertiary intervention? a. Refer families to a grief counselor following a suicide b. Work with the school nurse to identify students at risk for suicide c. Establish a telephone hotline for individuals experiencing a suicidal crisis d. Review suicide precautions with acute care nursing staff 5. A nurse is teaching a client who is to start therapy with paroxetine. The nurse should instruct the client to report which of the following findings immediately to the provider? a. Insomnia b. Sexual dysfunction c. Dry mouth d. fever 6. A nurse is receiving shift report for four clients in an acute care mental health facility. Which of the following clients should the nurse assess first? a. A client who does not recognize familiar people b. A client who cannot verbalize his needs c. A client who is awake and disoriented at night d. A client who is experiencing command hallucinations 7. A nurse is caring for a client who has an anxiety disorder and displays obsessive-compulsive behavior. Which of the following actions should the nurse take to assist the client to decrease the unwanted behaviors? a. Have the client monitor the number of times the client has compulsive thoughts b. Discourage the client’s verbalization of thoughts that provoke anxiety c. Help the client to set time limits for compulsive behaviors d. Assist the client to minimize anxiety by taking extra care with grooming activities 8. A nurse is planning teaching about relapse prevention to a client who just began an outpatient substance use disorder treatment program. Which of the following strategies should the nurse use at the beginning of the program? a. Simplify program rules and objectives for the client b. Provide opportunities in the program for the client to rehearse new coping skills c. Determine with the client what secondary gain the addiction provides d. Assist the client to identify healthy supportive relationships 9. A nurse is caring for a client who has bipolar disorder and is taking valproic acid. Which of the following is the priority assessment finding? a. The client has not slept in 24 hr b. The client states missing a dose of valproic acid yesterday c. The client has been evicted from his apartment d. The client reports fine hand tremors 10. A nurse is teaching a client to use cognitive refraining to manage the stress of public speaking. Which of the following statements by the client indicates an understanding of the teaching? a. “I have stayed up all night giving this speech in the mirror.” (increasing the amount of time the client practices the speech by staying up all night will increase the client’s stress and does not change the perception of the activity) b. “I know about the topic I’ve been asked to speak about.”(a technique that replaces negative thoughts with positive self-statements is the correct use of cognitive reframing and will reduce the client’s anxiety) c. “I was asked to speak because I’m expected to know about the topic.”( the client is verbalizing a statement that is based on other people’s perceptions This does not change the client’s perception of the activity and will not reduce the client’s anxiety) d. “I will be done speaking in about an hour, and then I can relax.” (The client is verbalizing that his anxiety will be reduced when the activity is completed. This does not change the client’s perception of the activity and thus will not reduce his anxiety) 11. A nurse is discussing simple restitution with the parents of a school-age child who has conduct disorder. Which of the following should the nurse recommend when discussing this behavioral management technique? a. Advising the parents to ignore the child’s attention-seeking behavior if it is not dangerous (planned ignoring behavioral management technique) b. Recommending a change in activity if the child begins to demonstrate frustration (restructuring as a behavioral management technique) c. Establishing clear expectations for the child’s behavior during meals(using limit setting as a behavior management technique) d. Instructing the child to put away the books he threw during a period of aggression (simple restitution as a behavioral management technique) 12. A nurse on a medical-surgical unit is assessing a client who has acute pancreatitis related to chronic alcohol use disorder. Which of the following is an expected finding? a. Hypoglycemia (acute pancreatitis to have hyperglycemia due to impaired insulin release from the pancreas) b. Decreased serum amylase(acute pancreatitis to have an elevated serum amylase due to injury to the cells of the pancreas) c. Epigastric pain (expect to client who has acute pancreatitis to have severe and constant epigastric pain) d. Hyperactive bowel sounds (decreased, and possibly absent ,bowel sounds due to the risk for paralytic ileus) 13. A nurse is assessing a family’s dynamics during a counseling session. The nurse should recognize which of the following as an indication of a boundary issue? a. An adolescent family member who questions parental authority (demonstrating appropriate behavior for developmental age) b. A family with three generations in the same household (scenario occurs in many households) c. Older children who are responsible for their younger siblings (enmeshed boundaries in which there are no distinctions between the roles of family members) d. Two adults and their children from prior relationships in the same household (blended family) 14. A nurse is providing teaching to a client who is to begin undergoing light therapy at home to treat seasonal affective disorder. Which of the following should the nurse include in the teaching? a. Have a family member present during treatment ( precaution is not necessary with light therapy) b. Increase fluid intake (does not increase the risk of dehydration) c. Change position slowly (hypotension or dizziness) d. Wear sunglasses when outdoors (eye strain and sensitivity to light) 15. A nurse is documenting admission assessment finding s for a client who has major depressive disorder. The nurse should identify which of the following finding as clinical manifestations? (select all that apply.) a. Feeling of hopelessness (the nurse should document feeling of hopelessness as a clinical manifestation of major depressive disorder) b. Pressured speech (this clinical manifestation is associated with clients who are experiencing mania, rather than major depressive disorder) c. Grandiosity (this clinical manifestation is associated with clients who are experiencing mania, rather than major depressive disorder) d. Anhedonia(the nurse should document the inability to experience pleasure as a clinical manifestation of major depressive disorder) e. Flat facial expression (the nurse should document a flat facial expression as a clinical manifestation of major depressive disorder) 16. A nurse is having a conversation with a client who frequently becomes angry and aggressive toward others. When the client becomes verbally abusive toward the nurse, which of the following statements by the nurse is appropriate? a. “I will take away privileges if you continue to be abusive.”(Threatening the client verbally is not appropriate response to the client’s verbal abuse) b. “I am leaving now but will return in few minutes to see if you are calmer.”(an effective technique for handling verbal abuse is to leave the room immediately and return later to check on the client. The nurse should keep communication neutral and refrain from arguing with the client) c. “You have no right to talk like this and must stop yelling.”(simply telling the client to stop may reinforce the client’s inappropriate behavior) d. “I don’t talk angrily to you and you shouldn’t talk that way to me.”(Arguing with the client about the verbal abuse may simply reinforce the client’s inappropriate behavior) 17. A nurse is caring for a client who is receiving hospice care and refusing nourishment. The client tells the nurse “There is no point in eating because I am dying anyway.” Which of the following is a therapeutic response? a. “We need to discuss this with your family first.” (the nurse’s response is dismissive of the client’s concerns and the client does not need his family’s permission to refuse treatment) b. “Tell me more about your concerns.”(the nurse is offering a general lead to give the client a chance to elaborate his feelings, which enables the nurse to gain insight on his right to refuse treatment) c. “Would you rather not receive any care or treatment?”(the nurse’s response is a close-ended question and does not allow the client to express his feelings regarding his right to refuse treatment) d. “Do you have an advance directive on file?”(the nurse’s response is a close-ended question and may make the client defensive) 18. A nurse is caring for a client who is experience alcohol withdrawal. Which of the following medications should the nurse administer first? VS: HR 110/min, BP 170/96 mm hg, Temp 38.9˚C (102˚F); History and physical: client states he consumed alcohol 12 hr prior to admission. Client has 12 packs per year smoking history; Progress report (Nurse’s Notes): Tremors of hands and fingers bilaterally. Client restless and unable to sit still. Client is diaphorestic and has flushed skin. Emesis of 30 mL bile-colored fluid. a. Diazepam 5 mg IV bolus (The greatest risk to the client experiencing alcohol withdrawal is seizures and an elevated heart rate and blood pressure. IV diazepam acts rapidly to prevent seizures, stabilize vital signs, and decrease the intensity of withdrawal symptoms) b. Clonidine 0.1 mg transdermal patch (stabilize vital signs and is used as an adjunct to a benzodiazepine. It is administered only PO or transdermally and does not act rapidly) c. Naltrexone 380 mg IM (long-term abstinence maintenance, but it is not the first medication the nurse should administer) d. Bupropion 150 mg PO (smoking cessation, but it is not the first medication the nurse should administer) 19. A nurse is caring for a client who has a new prescription for lithium carbonate. Prior to administering this medication, the nurse reviews the client’s laboratory reports. The nurse should withhold the medication and call the provider based on which of the following laboratory values? a. Bun 45 mg/dL (BUN 10-30 mg/dl) b. Serum sodium 138 mg/dL (134-145) c. T₃ 175 ng/mL(110-230) d. Total cholesterol 190 mg/dL (<200) 20. A nurse is admitting a client who has schizophrenia to an acute care setting. When the nurse questions the client regarding his admission, the client stats, “I’m red, in the head, and I’m going to bed!” The nurse should document the client’s speech pattern as which of the following? a. Clang association (rhyme or contain a string of words that may have the same beginning sound) b. Word salad (words are completely meaningless and disorganized) c. Neologism (words that are made up by the client) d. Echolalia (client repeats the words of another person) 21. A nurse is caring for a client who developed neuroleptic malignant syndrome (NMS) as a result of taking haloperidol. After administering dantrolene IV, the nurse should monitor the client for which of the following findings indicating that the treatment is effective? a. Increased level of consciousness (Dantrolene can cause drowsiness and confusion) b. Decreased rigidity (Dantrolene is a muscle relaxant. For client who have NMS, it can reduce muscle rigidity and spasms) c. Increased heart rate (cause tachycardia, but this is not indicate that treatment is effective) d. Decreased blood pressure(blood pressure fluctuation) 22. A nurse is caring for a client who has recently been admitted with anorexia nervosa and needs to increase oral intake. Which of the following interventions should the nurse implement? a. Offer rewards for gaining weight (the nurse should offer rewards for the amount of calories consumed, not the amount of weight gained) b. Initially increase daily intake to 2,500 calories (initial intake should not go below 1,200 calories per day, but 2,500 calories may be too overwhelming. The client should begin with small frequent meals until food tolerance increases) c. Temporarily decrease fiber intake (a high-fiber diet may be helpful in controlling constipation, a problem that commonly occurs in clients who have anorexia nervosa) d. Restrict caffeine in the diet (should avoided due to its stimulative and diuretic effects) 23. A nurse is caring for a client who has paranoid schizophrenia, has been physically violent toward others and received several as needed doses of haloperidol IM. The nurse is preparing to administer benstropine to treat which of the following adverse effects of haloperidol? a. Increased blood pressure and pulse rate ( Haloperidol can cause an increase in blood pressure and pulse rate; however, this not the reason for prescribing benstropine) b. Stiff and stooped posture (manifestation of Pseudoparkinsonism, which is an extrapyramidal side effect of haloperidol that can be treated with benstropine) c. Sore throat and mouth sores (no common adverse effects of haloperidol) d. Abdominal pain and diarrhea (administration of haloperidol can cause diarrhea and resulting abdominal pain; however, this is not a reason to prescribe benstropine) 24. A nurse is planning care for a client who has depression and has made frequent suicide attempt. Which of the following statements indicates the client has a decreased risk for suicide? a. “I’m relieved now that my financial affairs are in order.” (depression verbalize getting their affair in order, they are at an increased risk for suicide) b. “It is easier to talk about my feelings now.”(client express their feelings, positive treatment outcome) c. “Suddenly I have enough energy to do anything I want.”(depression suddenly have more energy, they are at an increased risk for suicide) d. “Thank you for always taking such good care of me.”(depression often show an appreciation for loved ones when they are comtemplating suicide) 25. A nurse is caring for a client who has a history of aggressive behavior. The client is playing cards and throws the cards at other clients. Which of the following interventions is appropriate in this situation? a. Ask the client to express how he is feeling (to prevent further escalation of the client’s anger, the nurse should use therapeutic communication to determine what the client feeling) b. Admonish the client for inappropriate behavior(scolding the client is likely to escalate the aggressive behavior) c. Explain the rules of the unit to the client (reiterating the rules of the unit is unlikely to reduce the client’s aggression and can escalate the situation d. Take the cards away from the client (removing the cards at this time might increase the client’s aggression and escalate the situation) 26. A nurse is preparing to administer chlorpromazine 0.55 mg/kg to an adolescent client who weighs 110 lbs. Available is chlorpromazine syrup 10 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest whole number.) 2.2 lb/1kg =110 lb/x kg X=50 0.55mgx 50kg =27.5 mg 10 mg/5 mL= 27.5 mg/X mL X = 13.75 = 14 mL 27. A nurse is conducting a private counseling session with a client who is a recent victim of intimate partner abuse. Which of the following statements by the client indicates that counseling has been effective? a. “I have no reason to prepare a getaway kit, because my husband has changed.” b. “I feel more independent when I talk to you about what happened with my husband.” c. “I’m going to try to keep the house clean like my husband wants it.” d. “I still wonder what I did to make my husband act that ways?” 28. A nurse is facilitating a community meeting for inpatient clients. One client is constantly talking and using up the majority of the group’s time. Which of the following interventions should the nurse implement? a. Tell the client that the he must talk less or he will be removed from the meeting b. Focus on other group members and ignore the client who is doing all the talking c. End the group meeting and take the client aside to discuss his behavior d. Ask group members to discuss their feelings about this client’s monpolizing behavior 29. A nurse is teaching a female client who has schizophrenia about a new prescription for risperidone. Which of the following should the nurse include in the teaching (select all that apply.) a. “This medication may nausea an excessive growth of body hair.” b. “This medication may cause an elevated blood sugar.” c. "menstrual irregularities may cause an elevate blood sugar.” d. “You may experience dizziness while taking this medication.” e. “You may notice a increase in sexual desire while taking this medication.” 30. A nurse is caring for a client in a mental health facility. The nurse overhears another staff member make derogatory comments to the client. Which of following actions should the nurse take? a. Confront the staff member b. Encourage the client to report the incident. c. Document has enough the client‘s health record. d. Report the occurrences to the charge nurse. 31. A nurse is caring for a client who has just been told he is dying. The nurse determines that the client is going through a typical early stage of grief when he says, a. “I’m trying to feel at peace with my diagnosis.” b. “I’m so angry that I’d like to hurt someone.” c. “I think my lab results got mixed up with someone else’s.” d. “I just want to live to see my daughter get married.” 32. A nurse is admitting a client who is experiencing alcohol withdrawal and appears shaky, irritable, and reports nausea. Which of the following is the priority information for the nurse to obtain? a. The number of years the client has been drinking b. The events that triggered the client’s alcohol use c. The date and time of the client’s last drink d. The client’s family history of substance use 33. A nurse takes a phone call from a man who states that he is a client’s pastor and then asks about the client’s condition. Which of the following is an appropriate response by the nurse? a. Refer the caller to the hospital’s public relations department and notify the client b. Tell the caller that he must come to the hospital to get that information c. Put the caller on hold and forward the call to the charge nurse d. Suggest that the caller contact the family regarding the client’s condition 34. A nurse in a mental health clinic is caring for a client who has bipolar disorder and reports that she stopped taking her lithium 2 weeks ago. The nurse recognizes which of the following as an expected adverse effect that may have caused the client to stop taking a. Hand tremors b. Photophobia c. Sore throat d. constipation 35. A nurse in a mental health unit observes a client who has acute mania hit another client. Which of the following actions should the nurse take first? a. Call the provider to obtain an immediate order for restraint b. Prepare to administer benzodiazepine IM c. Call for a team of staff members to help with the situation 36. A nurse is performing an admission assessment for a client who voluntary entered an outpatient mental health crisis facility. The client states, “I’ve lost control of everything in my life!” which of the following questions should the nurse ask first? a. “What has helped you to cope with a crisis in the past?” b. “Who can we call to support you during this crisis?” c. “Are you having thoughts about harming yourself today?” d. “What event brought on this crisis?” 37. A nurse in a mental health facility is assessing the use of defense mechanisms in a client show has bulimia nervosa. Which of the following client behaviors should the nurse identify as displacement? a. The client reports a headache each day when group therapy is scheduled b. The client criticizes the nurse at each medication administration time c. The client continually talks about the benefits of healthy eating habits d. The client complains about the taste of the food 38. A nurse in a community mental health clinic is planning staff education about the levels of prevention of intimate partner abuse. Which of the following should the nurse identify as a strategy for primary prevention? a. Referring a client who left a violent relationship to a legal advocacy program b. Administering pharmacotherapy to minimize long-term effects of violence c. Promoting self-esteem by having a client identify personal strengths d. Establishing a support group for survivors to foster emotional healing 39. A nurse is admitting a client who has schizophrenia and has recently attempted to commit suicide. The client is angry over this admission and wants to go home. Which of the following interventions should the nurse anticipate implementing? (Select all that apply.) a. Place the client in seclusion b. Obtain a no-suicide contract c. Institute one-to-one observation d. Administer an antidepressant medication e. Restrain the client during change of shift 40. A nurse in a community health center is obtaining a health history of an older adult client who reports being abused by a caregiver. Which of the following actions is appropriate for the nurse to take? a. Arrange for admission to a long-term care facility b. Notify a protective agency c. Inform the client’s family d. Discuss the concerns with the caregiver 41. A nurse is providing discharge teaching for a client who has a prescription for buspirone. Which of the following should the nurse include in the teaching? a. Taking the medication with grapefruit juice can intensify the effects of the medication b. It may take up to a week for the medication to reach its full therapeutic effect c. Avoid sudden discontinuation of this medication to prevent withdrawal symptoms d. When filling the prescription for this medication it is limited to a 90-day supply 42. A nurse in a mental health facility is admitting a client who is at risk for suicide. Which of the following nursing intervention should be included in the plan of care? a. Search the client’s personal belongings daily for potentially harmful objects b. Minimize talking about the client’s future plans c. Assess the client for manifestations of psychosis on a regular basis d. Initiate discussion regarding the client’s thoughts about suicide 43. A nurse is caring for a client who is in hospice for an inoperable brain tumor. When completing a spiritual assessment as part of end-of-life care, which of the following interventions should the nurse implement? a. Discuss spiritual issues in a conversational manner b. Engage in a formal discussion of the client’s religious beliefs c. Prompt the client to the specific when asking question related to his own spirituality d. Offer suggestions based on personal spiritual values 44. A nurse is planning care for a newly admitted client who has bipolar disorder. Which of the following is the priority action by the nurse? a. Schedule the client for group therapy sessions b. Maintain consistent rules c. Provide frequent high-carlorie snacks d. Avoid the use of value judgments 45. A nurse is caring for a client who was sexually assaulted in her home. The nurse should recognize that the client is recovering when she a. Moves to a different residence b. Seeks out different groups of friends c. States a plan to revise her daily schedule d. Expresses interest intimate relationships 46. A nurse is planning to interview an older adult client to obtain a mental health history. Which of the following techniques is appropriate? a. Interview the client in private setting b. Begin the interview by explaining the plan of care c. Use open-ended questions throughout the interview d. Ask the client to complete a detailed questionnaire 47. A nurse is planning care for a client who has obsessive compulsive disorder. Which of the following is the highest priority intervention by the nurse? a. Develop a structured activity schedule for the client b. Help the client to identify sources of anxiety c. Teach the client focused relaxation techniques d. Encourage nonritualistic behavior with positive reinforcement 48. A nurse is planning to develop a relationship with a new client. Order the phases of the nurse-client relationship by placing all of the letters in the letters in the correct sequence. a. Recognize safety risks b. Set the parameters of the relationship c. Promote problem-solving skills d. Summarize relationship goals 49. A nurse is planning care for four clients in a mental health facility. Which of the following clients is at greatest risk for injury when performing ADLs? a. The client who has stage 6 Alzheimer’s disease b. The client who is in the maintenance phase of schizophrenia c. The client who has obsessive-compulsive disorder d. The client who has dysthymic disorder 50. A nurse is planning care for a preschool-age child who has ADHD. Which of the following interventions is the highest priority? a. Decrease distractions during meal times b. Provide positive feedback when the child completes a task c. Clearly identify consequences for unacceptable behavior d. Remove unnecessary equipment from the child’s surroundings. 51. A nurse working in a community mental health facility is teaching a client who has alcohol use disorder and is considering attending Alcoholics Anonymous (AA). Which of the following statements by the client demonstrates an understanding of the teaching? a. “I can have an occasional drink with dinner after completing AA.” b. “AA can also help me with my addiction to pain medication.” c. “AA will allow me to confront family members who also have alcohol use disorder.” d. “In AA, I will play a role in the recovery of others who are addicted to alcohol.” 52. A nurse is reviewing the laboratory values for a client who has been taking clozapine for schizophrenia for the last 3 months. Which of the following laboratory finding should the nurse report to the provider? a. Serum chloride 3.8 mEq/L b. WBC count 2500/mm³ c. Total serum bilirubin 0.8 mg/dL d. Alanine aminotransferase 16 units/L 53. A nurse is caring for a client who has end stage pancreatic cancer. The nurse overhears the client say to her sister, “I love our time together. I am going to miss you.” Which of the following grief reactions is the client experiencing? a. Anticipatory b. Inhibited c. Disenfranchised d. distorted 54. A nurse is admitting a client who is experiencing alcohol withdrawal delirium. The nurse plans a room assignment. Which of the following clients is the most appropriate roommate for this client? a. A client who has insomnia b. A client who receives frequent visitors c. A client who is hypervigilant d. A client who has depressive disorder 55. A case manager is implementing a program to help client increase adherence to their treatment regime. Which of the following actions should the nurse take? a. Provide care for a client’s physical health needs b. Track the outcomes of client care c. Develop community based program goals d. Promote client use of a crisis hotline 56. A nurse is admitting a client who has of alcohol use and a new diagnosis of Korsakoff’s syndrome. Which of the following should the nurse include in the client’s plan of care? a. Initiate contact precautions b. Provide assistance with ambulation c. Teach stress-management techniques d. Administer lithium therapy d. Approach the client while speaking in a low, calm voice 57. A nurse in a mental health clinic is planning care for a client who has a new prescription for olanzapine. Which of the following interventions is the highest priority? a. Advise the client to take frequent sips of water b. Instruct the client to avoid driving during initial therapy c. Consult a dietitian for a calorie-controlled diet plan d. Recommend that the client exercise regularly 58. A nurse is working with a group of older adult client at an independent living facility who are discussing their plans for family reunions. Which of the following statements by a group member warrants further assessment by the nurse? a. “I should have taken the time to enjoy the reunions with my wife when she was alive.” b. “I wish that we would have had family reunions when I was younger, so I could have enjoyed them more.” c. “I’d like to go back to the days when my children were small and enjoyed spending time playing with their cousins.” d. “I’m not going to the reunion because no one asked me to help plan it.” 59. A nurse is caring for a client in a mental health facility who is place in physical restraints for aggressive behavior. Which of the following behaviors indicates the client should have the restraints removed? a. Follows the nurse’s directions b. Makes eye contact with the nurse c. Asks for a drink of water d. Stays awake throughout the day 60. A nurse is reviewing the medical record of a client who has masochism. Which of the following information should the nurse expect in the client’s history? a. Exposing his genitalia to unsuspecting strangers b. Sexual fantasies involving non-living objects c. Urges to touch and rub against non-consenting individuals d. Fantasies involving the act of being humiliated and bound