RN MENTAL HEALTH ONLINE PRACTIC
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E 2023 A EXAM QUESTIONS AND COR
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RECT ANSWERS 33
A6nurse6is6establishing6a6therapeutic6relationship6with6a6client6who6has6antisocial6person
ality6disorder.6Which6of6the6following6strategies6should6the6nurse6use6when6communicati
ng6with6this6client?
Behave6in6a6friendly6manner6toward6the6client
Set6realistic6limits6on6the6client's6behavior
Show6respect6for6the6client's6need6for6isolation
Act6as6a6role6model6for6assertiveness6-6ans--Set6realistic6limits6on6the6clients6behavior
Clients6who6have6antisocial6personality6disorder6can6seem6to6be6in6control6of6their6behav
ior,6but6are6manipulative6and6impulsive6and6can6suddenly6become6aggressive6and6assa
ultive.6The6nurse6should6establish6clear6limits6on6specific6aggressive6and6demanding6be
haviors.
A6nurse6is6caring6for6a6child6who6has6conducted6disorder6and6is6behaving6in6a6destructiv
e6manner,6throwing6objects,6and6kicking6others.6Which6of6the6following6therapeutic6nursi
ng6interventions6is6the6priority?
Encourage6expression6of6feelings
Support6the6child's6attendance6at6an6assertiveness6training6group
Assist6the6child6to6perform6relaxation6breathing6
Reduce6environmental6stimuli6-6ans--Reduce6environmental6stimuli
The6greatest6risk6to6the6child6and6others6is6harm.6Therefore,6the6nurse's6priority6intervent
ion6is6to6reduce6environmental6stimuli6in6an6attempt6to6de-
escalate6the6behavior6and6prevent6injury.
,A6nurse6in6a6community6health6center6is6working6with6a6group6of6clients6who6have6post-
traumatic6stress6disorder.6Which6of6the6following6interventions6should6the6nurse6include6t
o6reduce6anxiety6among6the6group6members?
Response6prevention
Guided6imagery
Aversion6therapy
Light6therapy6-6ans--Guided6imagery
Guided6imagery6involves6assisting6the6client6to6imagine6a6restful6and6safe6place.6This6m
ethod6is6effective6in6reducing6anxiety6in6clients6who6have6post-traumatic6stress6disorder.
A6nurse6is6performing6a6cognitive6assessment6to6distinguish6delirium6from6dementia6in6a6
client6whose6family6reports6episodes6of6confusion.6Which6of6the6following6assessment6fin
dings6supports6the6nurse's6suspicion6of6delirium?
Slow6onset
Aphasia
Confabulation
Easily6distracted6-6ans--Easily6distracted
Extreme6distractibility6is6a6hallmark6manifestation6of6delirium.
A6nurse6is6caring6for6an6older6adult6client6who6begins6to6cry6and6states,6"I6knew6God6wou
ld6punish6me6and6I6deserve6this6horrible6sickness!"6Which6of6the6following6responses6sh
ould6the6nurse6make?
"Why6do6you6think6you6deserve6this6punishment?"
"Don't6worry6about6being6punished6by6God."
"Let's6talk6about6what6is6upsetting6you."
"You6shouldn't6say6things6that6will6upset6you6so6much."6-
6ans--"Let's6talk6about6what6is6upsetting6you."
The6nurse6is6acknowledging6the6client's6concerns6and6is6showing6a6desire6to6understand
6what6the6client6is6thinking6and6feeling.
, A6client6who6has6a6recent6diagnosis6of6bipolar6disorder6is6placed6in6a6room6with6a6client6
who6has6severe6depression.6The6client6who6has6depression6reports6to6the6nurse,6"My6ro
ommate6never6sleeps6and6keeps6me6up,6too."6Which6of6the6following6actions6should6the6
nurse6take?
Move6the6client6who6has6bipolar6disorder6to6a6private6room
Administer6sleep6medication6to6the6client6who6has6bipolar6disorder.
Move6the6client6who6has6severe6depression6to6a6private6room.
Administer6sleep6medication6to6the6c6-6ans--
Move6the6client6who6has6bipolar6disorder6to6a6private6room.
Clients6who6have6bipolar6disorder6can6disrupt6the6therapeutic6milieu6for6other6clients.6Th
erefore,6the6nurse6should6move6this6client6to6a6private6room.
A6nurse6is6caring6for6a6group6of6clients.6Which6of6the6following6findings6is6he6nurse6requir
ed6to6report?
A6client6who6has6bipolar6disorder6and6tested6positive6for6genital6herpes6simplex6virus6rep
orts6having6multiple6sexual6partners.
A6client6who6has6depression6reports6having6a6lack6of6interest6in6assisting6their6partner6in6
the6care6of6their6children.
A6client6who6has6borderline6personality6disorder6threatened6to6harm6their6roommate.
An6adolescent6client6who6has6anorexia6nervosa6has6a6BMI6of6-6ans--
A6client6who6has6borderline6personality6disorder6threatened6to6harm6their6roommate.
Manifestations6of6borderline6personality6disorder6include6disturbed6interpersonal6relation
ships6accompanied6by6threats6and6other-
directed6violence.6While6it6is6important6for6the6nurse6to6maintain6the6client's6confidentialit
y,6on6occasions6when6another6individual's6life6might6be6in6danger,6the6nurse6is6required6
by6law6to6report6it6to6authorities.
A6nurse6is6planning6discharge6teaching6with6a6new6family6member6of6a6client6who6has6a6
new6diagnosis6of6depression.6Which6of6the6following6information6about6relapse6should6th
e6nurse6include?
Additional6acute6episodes6of6depression6are6unlikely6following6inpatient6care.
Early6identification6of6changes,6such6as6decreased6social6involvement,6is6important.
Medication6compliance6will6prevent6further6need6for6inpatient6hospitalization.
33 33 33 33
E 2023 A EXAM QUESTIONS AND COR
33 33 33 33 33 33
RECT ANSWERS 33
A6nurse6is6establishing6a6therapeutic6relationship6with6a6client6who6has6antisocial6person
ality6disorder.6Which6of6the6following6strategies6should6the6nurse6use6when6communicati
ng6with6this6client?
Behave6in6a6friendly6manner6toward6the6client
Set6realistic6limits6on6the6client's6behavior
Show6respect6for6the6client's6need6for6isolation
Act6as6a6role6model6for6assertiveness6-6ans--Set6realistic6limits6on6the6clients6behavior
Clients6who6have6antisocial6personality6disorder6can6seem6to6be6in6control6of6their6behav
ior,6but6are6manipulative6and6impulsive6and6can6suddenly6become6aggressive6and6assa
ultive.6The6nurse6should6establish6clear6limits6on6specific6aggressive6and6demanding6be
haviors.
A6nurse6is6caring6for6a6child6who6has6conducted6disorder6and6is6behaving6in6a6destructiv
e6manner,6throwing6objects,6and6kicking6others.6Which6of6the6following6therapeutic6nursi
ng6interventions6is6the6priority?
Encourage6expression6of6feelings
Support6the6child's6attendance6at6an6assertiveness6training6group
Assist6the6child6to6perform6relaxation6breathing6
Reduce6environmental6stimuli6-6ans--Reduce6environmental6stimuli
The6greatest6risk6to6the6child6and6others6is6harm.6Therefore,6the6nurse's6priority6intervent
ion6is6to6reduce6environmental6stimuli6in6an6attempt6to6de-
escalate6the6behavior6and6prevent6injury.
,A6nurse6in6a6community6health6center6is6working6with6a6group6of6clients6who6have6post-
traumatic6stress6disorder.6Which6of6the6following6interventions6should6the6nurse6include6t
o6reduce6anxiety6among6the6group6members?
Response6prevention
Guided6imagery
Aversion6therapy
Light6therapy6-6ans--Guided6imagery
Guided6imagery6involves6assisting6the6client6to6imagine6a6restful6and6safe6place.6This6m
ethod6is6effective6in6reducing6anxiety6in6clients6who6have6post-traumatic6stress6disorder.
A6nurse6is6performing6a6cognitive6assessment6to6distinguish6delirium6from6dementia6in6a6
client6whose6family6reports6episodes6of6confusion.6Which6of6the6following6assessment6fin
dings6supports6the6nurse's6suspicion6of6delirium?
Slow6onset
Aphasia
Confabulation
Easily6distracted6-6ans--Easily6distracted
Extreme6distractibility6is6a6hallmark6manifestation6of6delirium.
A6nurse6is6caring6for6an6older6adult6client6who6begins6to6cry6and6states,6"I6knew6God6wou
ld6punish6me6and6I6deserve6this6horrible6sickness!"6Which6of6the6following6responses6sh
ould6the6nurse6make?
"Why6do6you6think6you6deserve6this6punishment?"
"Don't6worry6about6being6punished6by6God."
"Let's6talk6about6what6is6upsetting6you."
"You6shouldn't6say6things6that6will6upset6you6so6much."6-
6ans--"Let's6talk6about6what6is6upsetting6you."
The6nurse6is6acknowledging6the6client's6concerns6and6is6showing6a6desire6to6understand
6what6the6client6is6thinking6and6feeling.
, A6client6who6has6a6recent6diagnosis6of6bipolar6disorder6is6placed6in6a6room6with6a6client6
who6has6severe6depression.6The6client6who6has6depression6reports6to6the6nurse,6"My6ro
ommate6never6sleeps6and6keeps6me6up,6too."6Which6of6the6following6actions6should6the6
nurse6take?
Move6the6client6who6has6bipolar6disorder6to6a6private6room
Administer6sleep6medication6to6the6client6who6has6bipolar6disorder.
Move6the6client6who6has6severe6depression6to6a6private6room.
Administer6sleep6medication6to6the6c6-6ans--
Move6the6client6who6has6bipolar6disorder6to6a6private6room.
Clients6who6have6bipolar6disorder6can6disrupt6the6therapeutic6milieu6for6other6clients.6Th
erefore,6the6nurse6should6move6this6client6to6a6private6room.
A6nurse6is6caring6for6a6group6of6clients.6Which6of6the6following6findings6is6he6nurse6requir
ed6to6report?
A6client6who6has6bipolar6disorder6and6tested6positive6for6genital6herpes6simplex6virus6rep
orts6having6multiple6sexual6partners.
A6client6who6has6depression6reports6having6a6lack6of6interest6in6assisting6their6partner6in6
the6care6of6their6children.
A6client6who6has6borderline6personality6disorder6threatened6to6harm6their6roommate.
An6adolescent6client6who6has6anorexia6nervosa6has6a6BMI6of6-6ans--
A6client6who6has6borderline6personality6disorder6threatened6to6harm6their6roommate.
Manifestations6of6borderline6personality6disorder6include6disturbed6interpersonal6relation
ships6accompanied6by6threats6and6other-
directed6violence.6While6it6is6important6for6the6nurse6to6maintain6the6client's6confidentialit
y,6on6occasions6when6another6individual's6life6might6be6in6danger,6the6nurse6is6required6
by6law6to6report6it6to6authorities.
A6nurse6is6planning6discharge6teaching6with6a6new6family6member6of6a6client6who6has6a6
new6diagnosis6of6depression.6Which6of6the6following6information6about6relapse6should6th
e6nurse6include?
Additional6acute6episodes6of6depression6are6unlikely6following6inpatient6care.
Early6identification6of6changes,6such6as6decreased6social6involvement,6is6important.
Medication6compliance6will6prevent6further6need6for6inpatient6hospitalization.
