RN Mental Health Online Practice 2019 A
A nurse is caring for a group of clients. For which of the following situations should the nurse complete
an incident report? - ANS A client was administered one-half of the prescribed dose of medication
an incident report is a recording of any occurrence that does not meet the standard of care. the nurse
should report medication errors using the facility's incident or occurrence form
a nurse is caring for a group of clients. Which of the following findings is the nurse required to report? -
ANS A client who has borderline personality disorder threatened to harm their roommate
s/s of BPD include interpersonal relationships accompanied by threats and other-directed violence.
while it is important for the nurse to maintain the pts confidentiality on occasions when another
individuals like might be in danger, the nurse is required by law to report it to authorities
A nurse is caring for a client who has borderline personality disorder. Which of the following goals is the
priority when planning care for this client? - ANS The client will refrain from self-mutilation
the greatest risk to the pt is injury to self and others. therefore, the priority goal is for the pt to refrain
from self-mutilation
a nurse is discussing the home care of a client who has advanced Alzheimer's disease with he client's
partner, who is planning to go out of town for several days. Which of the following resources should the
nurse recommended to the caregiver? - ANS Respite care
respirte care programs allow the pt to stay ina nursing facility for a set number of days, allowing the
caregivers to go on vacation or have some time to themselves
, A nurse is caring for an older adult client who has dementia and has wandered into the day room
looking for their deceased partner. Which of the following actions should the nurse take? - ANS Talk with
the client about activities they enjoyed with their partner
talking about positive experiences can help distract the pt from their disorientation
A nurse is admitting a client who has schizophrenia to an acute care setting. When the nurse questions
the client regarding their admission, the client states, "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? - ANS Clang association
the nurse should document that the pts speech uses clang associations which often rhyme or contain a
string of words that can have a similar sound
A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse
document as a negative symptom of this disorder? - ANS Anhedonia
neg symptoms of schizophrenia affect a person's ability to interact with others and are less dominant
than pos symptoms. these symptoms develop over time. examples of neg symptoms include flat affect,
anergia (lack of energy), anhedonia (inability to enjoy otherwise pleasurable activities and thought
blocking
A nurse is delegating client care tasks to a licensed practical nurse (LPN) and an assistive personnel.
Which of the following tasks should the nurse assign to the LPN? - ANS Change the dressing of a client
who has borderline personality disorder and superficial self-inflicted wounds
a pt who has borderline personality disorder is at risk for self-mutilation such as cutting, self-inflicted
wounds, scratching or picking at wounds. it is within the LPNs scope of practice to change the dressing
cleanse the wound, and collect data regarding the healing of the wound
A nurse is assessing a school-age child who has conduct disorder. Which of the following characteristics
should the nurse expect the child to demonstrate? - ANS Aggression toward animals
A nurse is caring for a group of clients. For which of the following situations should the nurse complete
an incident report? - ANS A client was administered one-half of the prescribed dose of medication
an incident report is a recording of any occurrence that does not meet the standard of care. the nurse
should report medication errors using the facility's incident or occurrence form
a nurse is caring for a group of clients. Which of the following findings is the nurse required to report? -
ANS A client who has borderline personality disorder threatened to harm their roommate
s/s of BPD include interpersonal relationships accompanied by threats and other-directed violence.
while it is important for the nurse to maintain the pts confidentiality on occasions when another
individuals like might be in danger, the nurse is required by law to report it to authorities
A nurse is caring for a client who has borderline personality disorder. Which of the following goals is the
priority when planning care for this client? - ANS The client will refrain from self-mutilation
the greatest risk to the pt is injury to self and others. therefore, the priority goal is for the pt to refrain
from self-mutilation
a nurse is discussing the home care of a client who has advanced Alzheimer's disease with he client's
partner, who is planning to go out of town for several days. Which of the following resources should the
nurse recommended to the caregiver? - ANS Respite care
respirte care programs allow the pt to stay ina nursing facility for a set number of days, allowing the
caregivers to go on vacation or have some time to themselves
, A nurse is caring for an older adult client who has dementia and has wandered into the day room
looking for their deceased partner. Which of the following actions should the nurse take? - ANS Talk with
the client about activities they enjoyed with their partner
talking about positive experiences can help distract the pt from their disorientation
A nurse is admitting a client who has schizophrenia to an acute care setting. When the nurse questions
the client regarding their admission, the client states, "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? - ANS Clang association
the nurse should document that the pts speech uses clang associations which often rhyme or contain a
string of words that can have a similar sound
A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse
document as a negative symptom of this disorder? - ANS Anhedonia
neg symptoms of schizophrenia affect a person's ability to interact with others and are less dominant
than pos symptoms. these symptoms develop over time. examples of neg symptoms include flat affect,
anergia (lack of energy), anhedonia (inability to enjoy otherwise pleasurable activities and thought
blocking
A nurse is delegating client care tasks to a licensed practical nurse (LPN) and an assistive personnel.
Which of the following tasks should the nurse assign to the LPN? - ANS Change the dressing of a client
who has borderline personality disorder and superficial self-inflicted wounds
a pt who has borderline personality disorder is at risk for self-mutilation such as cutting, self-inflicted
wounds, scratching or picking at wounds. it is within the LPNs scope of practice to change the dressing
cleanse the wound, and collect data regarding the healing of the wound
A nurse is assessing a school-age child who has conduct disorder. Which of the following characteristics
should the nurse expect the child to demonstrate? - ANS Aggression toward animals
