MENTAL HEALTH HESI 7
A male client with schizophrenia is admitted to the mental health unit after abruptly stopping his prescription for ziprasidone
... [Show More] (Geodon) one month ago. Which question is most important for the nurse to ask the client? - Do you hear voices
A female client with a history of drinking who was admitted 8 hours ago after receiving treatmetn for minor abrasions occurred from a fall at home. The nurse determines the client's blood alcohol level (BAL) was not analyzed on administration action should the nurse take - Ask client about alcohol quantity, frequency, and time of last drink
*Which client statement suggests to the nurse that the client is using the defense mechanism of projection to deal with anxiety related to admission to a psychiatric unit - "I am here because the police thought I was doing something wrong"
Projection- transferring one's internal feelings, thoughts, and unacceptable ideas and
traits to someone else (Saunders 991.)
A female client on a psychiatric unit is sweating profusely while she vigorously does push ups and then runs the length of the corrider several times before crashing inot the furniture in the sitting room. Picking herself up, she begins to toss chairs aside, looking for a red one to sit in. When another client objects to the disturbances, the client shouts," I am the boss here. I do what I want." Which nursing problem best supports these observations - Risk for other related violence related to disruptive behavior
A male client is admitted to the psychiatric inpatient unit with a bandaged flesh wound after attempting to shoot himself. he is recently divorced one year ago, lost his job four months ago, and suffered a break up of his current relationship last week. What is the most likely source of this client's current feelings of depression - a sense of loss
What is the most important goal for a client diagnosed with major depression who has been receiving an antidepressant medication for two weeks - [...]
Rational: The nurse also looks for indications that the patient is communicating thoughts and feelings more readily and that the patient's social network is widening. If the person is able to talk about feelings and engage in problem solving with you, this is a positive sign (Varcarolis 485.)
What nursing assessment is the priority focus for a client with major depression? -
suicidal ideation: suicidal ideation is a major risk factor in a client with major depression
A male adult comes to the mental health clinic and walks back and fourth in front of the
offic door, but does not enter the office. He then walks arond a chair that is in the
hallway several times before sitting down in the chair. What action should the nurse
take first - observe the client in the chair
A female client engages in repeated checks of door and window locks. Behavior that prevents her form arriving on time and interferes with her ability to function effectively.
What action should the nures take - plan a list of activities to be carried out daily... Bipolar patients who manifest behavior that interferes with ability to function do better when given a schedule to adhere to with a list of planned daily activities
*A male client in the mental health unit is guarded and vaguely answers the nurse's questions. He isolates to his room and sometimes opens the door to peek into the hall. Which problem can the nurse anticipate - delusions of persecution
A male client who is seen in the mental health clinic monthly reports feeling very stressed and nervous and further describes becom [Show Less]