1) If client is taking Antabuse, what should we tell him?
Client must stop drinking to make Antabuse effective.
2) Patient is on Haldol, Cogentin,
... [Show More] Depakote, and Tylenol.
Discontinue Tylenol.
3) Why is creatinine ordered as lab?
To check lithium levels and creatinine in kidney.
4) Which patient is at highest risk for suicide?
Client with divorced parents.
5) Client states only had 4 hrs of sleep. Which immediate intervention after
24 hours?
Promote Sleep.
6) Alcohol withdrawal client.
need to insert IV.
7) Client depression. Nurse asks questions, but client looks down. What to
do?
–Wait for response.
8) Client is co-dependent. Which makes them co-dependent?
-Blaming husband.
9) Client had a divorce, lost job, and recent breakup of relationship. What is
he at risk for?
10) Client had biopsy and positive for cancer. Ask family to assist her ADL.
What is her outcome?
–Expected, as client quiet area.
11) Working phase?
–Explore issues and new problem areas.
12) Client on Zyprexa. What to assess
–Weight
13) Nurse immediately reports to therapist and staff. Therapist
immediately calls client’s supervisor. What were their actions?
–Both Nurse and therapist did the right thing…appropriate.
14) What nursing assessment is the priority focus for a client with
major depression?
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Hesi Version 1_March 2019
Mood and affect.
Suicidal ideation. Correct
Nutritional status.
Fluid and electrolyte balance.
15) Which action is most important for the nurse to implement
during the initial interview for a client who is admitted to the
mental health unit?
Establish rapport in each phase of the nurse-client relationship.
Correct
Determine the client's ability to communicate effectively.
Reflect on previous psychiatric interviews the nurse has performed.
Ensure data is collected and recorded in a systematic sequence.
16) GAD taking Xanax. The client will?
–Decrease anxiety using 10-point scale.
17) Female heart attack 4 years ago. Use of which medication high risk for
MI?
–Methamphetamine
18) One-to-one session. Admitted for chronic depression. Recognize which
defense mechanism? –Repression.
19) Woman fear of open places and crows. Nursing diagnosis?
–Ineffective Individual Coping.
20) A female client with OCD admitted for cardiac catheterization. What
action should the nurse implement? –Express feelings regarding
procedure.
21) Client with bulimia nervosa. Highest priority
–Electrolyte status [Show Less]