1. A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of
the following statements indicates an understanding of
... [Show More] the teaching? (Select all that apply.)
A. "To assess cognitive ability, I should ask the client to count backward by sevens."
B. "To assess affect, I should observe the client's facial expression."
C. "To assess language ability, I should instruct the client to write a sentence."
D. "To assess remote memory, I should have the client repeat a list of objects."
E. "To assess the client's abstract thinking, I should ask the client to identify our most
recent presidents." - Ans-A, B, C
2. A nurse is planning care for a client who has a mental health disorder. Which of the following
actions should the nurse include as a psychobiological intervention?
A. assist the client with systematic desensitization therapy
B. teach the client appropriate coping mechanisms
C. assess the client for comorbid health conditions
D. monitor the client for adverse effects of medications - Ans-D
3. A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview.
When conducting the interview, which of the following actions should the nurse identify as the
priority?
A. coordinate holistic care with social services
B. identify the client's perception of her mental health status
C. include the client's family in the interview
D. teach the client about her current mental health disorder - Ans-B
4. A nurse is told during change-of-shift report that a client is stuporous. When assessing the client,
which of the following findings should the nurse expect?
A. the client arouses briefly in response to a sternal rub
B. the client has a Glasgow Coma Scale score of less than 7
C. the client exhibits decorticate rigidity
D. the client is alert but disoriented to time and place - Ans-A
5. A nurse is planning a peer group discussions about the Diagnostic and Statistical Manual of
Mental Disorders, 5th Edition (DSM-5). Which of the following information is appropriate to
include in the discussion? (Select all that apply.)
A. the DSM-5 includes client education handouts for mental health disorders
B. the DSM-5 establishes diagnostic criteria for individual mental health disorders
C. The DSM-5 indicates recommended pharmacological treatment for mental health
disorders
D. the DSM-5 assists nurses in planning care for clients who have mental health
disorders
E. the DSM-5 indicates expected assessment findings of mental health disorders - AnsB, D, E
6. A nurse in an emergency mental health facility is caring for a group of clients. The nurse should
identify that which of the following clients requires a temporary emergency admission?
A. a client who has schizophrenia with delusions of grandeur
B. a client who has manifestations of depression and attempted suicide a year ago
C. a client who has borderline personality disorder and assaulted a homeless man with
a metal rod
D. a client who has bipolar disorder and paces quickly around the room while talking to
himself - Ans-C
7. A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the
unit is very short-staffed, and the client frequently fights with other clients. The nurse's actions
are an example of which of the following torts?
A. invasion of privacy
B. false imprisonment
C. assault
D. battery - Ans-B
8. A client tells a nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to
protect myself from my roommate, who is always yelling at me an threatening me." Which of
the following actions should the nurse take?
A. keep the client's communication confidential, but talk to the client daily, using
therapeutic communication to convince him to admit to hiding the knife
B. keep the client's communication confidential, but watch the client and his
roommate closely
C. tell the client that this must be reported to the health care team because it concerns
the health and safety of the client and others
D. report the incident to the health care team, but do not inform the client of the
intention to do so - Ans-C
9. A nurse is caring for a client who is in mechanical restraints. Which of the following statements
should the nurse include in the documentation?
A. "Client ate most of his breakfast."
B. "Client was offered 8 oz of water every hr."
C. "Client shouted obscenities at assistive personnel."
D. "Client received chlorpromazine 15 mg by mouth at 1000."
E. "Client acted out after lunch." - Ans-B, C, D
10. A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with
another nurse. Which of the following actions should the nurse take first?
A. notify the nurse manager
B. tell the nurse to stop discussing the behavior
C. provide an in-service program about confidentiality
D. complete an incident report - Ans-B
11. A charge nurse is conducting a class on therapeutic communication to a group of newly licensed
nurses. Which of the following aspects of communication should the nurse identify as a
component of verbal communication?
A. personal space
B. posture
C. eye contact
D. innotation - Ans-D
12. A nurse in an acute mental health facility is communicating with a client. The client states, "I
can't sleep. I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which
of the following therapeutic communication techniques is the nurse demonstrating?
A. offering general leads
B. summarizing
C. focusing
D. restating - Ans-D
13. A nurse is communicating with a client who was just admitted for treatment of a substance use
disorder. Which of the following communication techniques should the nurse identify as a
barrier to therapeutic communication?
A. offering advice
B. reflecting
C. listening attentively
D. giving information - Ans-A
14. A nurse is caring for a client who has anorexia nervosa. Which of the following examples
demonstrates the nurse's use of interpersonal communication?
A. the nurse discusses the client's weight loss during a health care team meeting
B. the nurse examines her own personal feelings about clients who have anorexia
nervosa
C. the nurse asks the client about her body image perception
D. the nurse presents an educational session about anorexia nervosa to a large group
of adolescents - Ans-C [Show Less]