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During admission to the psychiatric unit, a female client is extremely anxious
and states that she is worried about the sun coming up the next day. What
intervention is most important for the RN to implement during the admission
process?
A. Assist the client in developing alternative coping skills.
B. Remain calm and use a matter of fact approach.
C. Ask the client why she is so anxious
D. Administer a PRN sedative to help relieve her anxiety.
A female client is brought to the emergency department after police officers
found her disoriented, disorganized, and confused. The RN also determines that
the client is homeless and is exhibiting suspiciousness. The client’s plan of care
should include what priority problem?
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A. Acute confusion.
B. Ineffective community coping
C. Disturbed sensory perception.
D. Self-care deficit.
The occupational health nurse is working with a female employee who was just
notified that her child was involved in a MVA and taken to the hospital. The
employee states, “I can’t believe this. What should I do?” Which response is best
for the RN to provide in this crisis?
A. Tell me what you think should happen.
B. How serious was the collision?
C. What do you think you should
do? D. Call for transportation to
the hospital.
A client tells the RN that he has an IQ of 400+ and is a genius and an inventor.
He also reports that he is married to a female movie star and thinks that his brother
wants a sexual relationship with her. What is the priority nursing problem for
admission to the psychiatric unit?
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A. Ineffective sexual patterns.
B. Impaired environmental interpretation.
C. Disturbed sensory perception.
D. Compromised family coping.
The RN is providing care for a client diagnosed with borderline personality
disorder who has self-inflicted lacerations on the abdomen. Which approach
should the RN use when changing this client’s dressing?
A. Provide detailed thorough explanations when
cleansing wound. B. Perform the dressing change in a
non-judgmental manner.
C. Ask in a non-threatening manner why the client cut own abdomen.
D. Request another staff member assist with the dressing change.
While sitting in the day room of the mental health unit, a male adolescent
avoids eye contact, looks at the floor, and talks softly when interacting verbally
with the RN. The two trade places, and the RN demonstrates the client’s
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behaviors. What is the main goal of this therapeutic technique?
A. Initiate a non-threatening conversation with the client.
B. Dialog about the ineffectiveness of his
interactions. C. Allow the client to identify the
way he interacts.
D. Discuss the client’s feelings when he responds.
An antidepressant medication is prescribed for a client who reports sleeping
only 4 hours in the past 2 days and weight loss of 9 lbs within the last month.
Which client goal is most important to achieve within the first three days of
treatment?
A. Meet scheduled appointment with
dietitian. B. Sleep at least 6 hours a
night.
C. Understands the purpose of the medication regimen.
D. Describes the reasons for hospitalization.
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