MENTAL HEALTH NURSING WITH
ALL 100% CORRECT ANSWERS
A nurse enters a client's room, and observes that the client is agitated and
pacing rapidly. The patient looks at the nurse and says, "back off. Leave me
alone" What statement should the nurse make?
"I will give you some space if you calm down. Tell me what is making
you feel so tense."
*Stay at safe distance and remain calm
A nurse is caring for a client who has dementia. The client states to the
nurse, "Everyone wants to kill me." Which of the following responses should
the nurse make?
"You must feel very frightened, if you think someone wants to hurt
you"
A community mental health nurse is planning strategies to address
substance use by adolescents. Which of the following interventions should
the nurse plan as a method of primary prevention?
Provide a presentation at area high schools on resisting peer
pressure for substance abuse
A nurse is preparing to apply wrist restraints on a client who is threatening to
harm others and has not responded to less invasive interventions. Which of
the following actions should the nurse plan to take?
Document the clients behaviors every 15 minutes while in restraints
, *There should be TWO fingers that can fit between wrist and clients
restraint
*There should be someone one-on-one with the client at all times
while in restraints
A nurse is caring for a client who has schizophrenia. The client states, "My
internal organs have turned to stone." The nurse should document this
finding as which of the following types of delusions?
Somatic
*Believe that their body part in no longer functioning in a realistic or
expected manner
A nurse is completing an admission assessment for an adolescent client who
has depression. The nurse should identify which of the following findings as
the priority?
The client gives his favorite possessions to his friends
A nurse is caring for a client who has borderline personality disorder. The
nurse enters the client's room and finds the client cutting into his flesh with a
paper clip. After providing first aid, which of the following actions should the
nurse take first?
Identify the clients feelings that lead to the self injury
ALL 100% CORRECT ANSWERS
A nurse enters a client's room, and observes that the client is agitated and
pacing rapidly. The patient looks at the nurse and says, "back off. Leave me
alone" What statement should the nurse make?
"I will give you some space if you calm down. Tell me what is making
you feel so tense."
*Stay at safe distance and remain calm
A nurse is caring for a client who has dementia. The client states to the
nurse, "Everyone wants to kill me." Which of the following responses should
the nurse make?
"You must feel very frightened, if you think someone wants to hurt
you"
A community mental health nurse is planning strategies to address
substance use by adolescents. Which of the following interventions should
the nurse plan as a method of primary prevention?
Provide a presentation at area high schools on resisting peer
pressure for substance abuse
A nurse is preparing to apply wrist restraints on a client who is threatening to
harm others and has not responded to less invasive interventions. Which of
the following actions should the nurse plan to take?
Document the clients behaviors every 15 minutes while in restraints
, *There should be TWO fingers that can fit between wrist and clients
restraint
*There should be someone one-on-one with the client at all times
while in restraints
A nurse is caring for a client who has schizophrenia. The client states, "My
internal organs have turned to stone." The nurse should document this
finding as which of the following types of delusions?
Somatic
*Believe that their body part in no longer functioning in a realistic or
expected manner
A nurse is completing an admission assessment for an adolescent client who
has depression. The nurse should identify which of the following findings as
the priority?
The client gives his favorite possessions to his friends
A nurse is caring for a client who has borderline personality disorder. The
nurse enters the client's room and finds the client cutting into his flesh with a
paper clip. After providing first aid, which of the following actions should the
nurse take first?
Identify the clients feelings that lead to the self injury
