NursGuru

    Exam Review

    1. A nurse on a medical-surgical unit is caring for a client who tells the nurse about their intentions to harm an ex-partner. Which of the following actions is a legal duty of the nurse?
      A)
      Keep the client hospitalized until there is no longer a threat.
      B)
      Ensure the client's ex-partner is notified of the threat.
      C)
      Ask a friend or family member to monitor the client.
      D)
      Transfer the client to a mental health facility.
    2. A nurse is caring for a client who has bipolar disorder. The client says to the nurse, "Give me your pen to cut the pain out of my chest.” The nurse should identify that the client is at risk for which of the following?
      A)
      Illusion
      B)
      Hallucination
      C)
      Attention-seeking behavior
      D)
      Self-mutilation
    3. A nurse is caring for a client who has dementia and insists that a doll is their infant child. Which of the following behavioral management techniques should the nurse use when interacting with the client?
      A)
      Cognitive reframing
      B)
      Thought stopping
      C)
      Validation therapy
      D)
      Operant conditioning
    4. A nurse on a mental health unit is planning a group therapy session about assertiveness training. For which of the following clients should the nurse recommend the training?
      A)
      A client who has new-onset delirium
      B)
      A client who is experiencing auditory hallucinations
      C)
      A client who is experiencing mania
      D)
      A client who has somatic symptom disorder

    Exam Review

    1. A nurse is preparing to teach a client who has major depressive disorder and is scheduled to undergo electroconvulsive therapy (ECT). Which of the following statements should the nurse include in the teaching?
      A)
      “ECT is contraindicated in clients who have psychotic symptoms.”
      B)
      “ECT is delivered through electrodes attached to the head.”
      C)
      “ECT cannot be administered to clients who have suicidal ideation.”
      D)
      “ECT is conducted under regional anesthesia.”
    2. A nurse is providing teaching to the caretakers of a client who has Alzheimer's disease with mild cognitive decline. The client is beginning to experience sleep disturbances. Which of the following instructions should the nurse include?
      A)
      Give the client a cup of hot black tea before bed.
      B)
      Wake the client at the same time each morning.
      C)
      Take the client for a walk 2 hours before bedtime each night.
      D)
      Allow the client to take a 90-minute nap immediately after lunch.
    3. A nurse in an acute care facility is assessing a client who has schizophrenia. The client states, "Walk tall broom short dog bell." The nurse should document the client's speech as which of the following speech patterns?
      A)
      Flight of ideas
      B)
      Word salad
      C)
      Neologisms
      D)
      Clang associations
    4. A nurse is conducting a child maltreatment screening of a family who has a toddler. Which of the following findings should the nurse identify as an indicator of possible child neglect?
      A)
      The child has a history of jaw fractures.
      B)
      The child seems frightened of their parent.
      C)
      The child has had no immunizations since birth.
      D)
      The child rocks back and forth continually.

    Exam Review

    1. A nurse is discharging a client who was admitted for the treatment of alcohol withdrawal. Which of the following resources should the nurse recommend to the client?
      A)
      Reach to Recovery
      B)
      A 12-step program
      C)
      Al-Anon
      D)
      Light therapy
    2. A nurse is teaching the guardian of a school-age child who has autism spectrum disorder about a new prescription for risperidone. Which of the following statements by the guardian demonstrates an understanding of the teaching?
      A)
      "This medication will help control my child's aggressive behavior."
      B)
      "This medication can cause my child to have low blood sugar."
      C)
      "This medication won't require my child to have routine lab tests."
      D)
      "This medication might need to be increased if my child has muscle spasms."
    3. A nurse is creating a plan of care for a client who has panic disorder. Which of the following interventions should the nurse include?
      A)
      Encourage the client to attend group therapy sessions.
      B)
      Allow the client to choose scheduled daily activities.
      C)
      Use simple words to describe procedures to the client.
      D)
      Avoid discussing topics that can trigger a panic attack.
    4. A nurse is reviewing the medical records of a group of clients. For which of the following clients should the nurse recommend a referral for assertive community treatment (ACT)?
      A)
      A client who has a new diagnosis of major depressive disorder.
      B)
      A client who has repeated acute care admissions due to schizophrenia.
      C)
      A client who has requested family therapy following the death of a family member.
      D)
      A client who has physical injuries following an incident of partner violence.

    Exam Review

    1. A nurse is conducting an assessment for a client who is experiencing an acute manic episode in a crisis shelter. Which of the following behaviors should the nurse expect?
      A)
      Grandiosity
      B)
      Flight of ideas
      C)
      Hyperactivity
      D)
      Withdrawal
    2. A nurse is conducting an assessment for a client who is experiencing an acute manic episode in a crisis shelter. Which of the following behaviors should the nurse expect?
      A)
      Grandiosity
      B)
      Flight of ideas
      C)
      Hyperactivity
      D)
      Withdrawal
    3. A community health nurse is providing preventive care for a group of clients. Which of the following actions represents a secondary prevention strategy?
      A)
      Leading a group discussion with several clients who have schizophrenia and are dealing with tardive dyskinesia.
      B)
      Screening college students who demonstrate manifestations of depressive disorder.
      C)
      Training volunteers in an adult day care facility to communicate effectively with clients who have cognitive impairments.
      D)
      Teaching coping strategies to a group of adults whose parents have Alzheimer’s disease.
    4. A nurse is admitting a client who has posttraumatic stress disorder (PTSD) to a community mental health facility. Which of the following manifestations should the nurse expect during the admission assessment?
      A)
      Decreased startle response to loud noises.
      B)
      Reports uninterrupted sleep of 10 to 12 hours each night.
      C)
      Reluctance to discuss the event that precipitated the distress.
      D)
      Reports feelings of acute distress that began 1 to 2 weeks ago.

    Exam Review

    1. A charge nurse in a community mental health clinic is discussing ethical concepts of client care with a newly licensed nurse. Which of the following situations should the charge nurse use as an example of fidelity?
      A)
      Spending equal time with clients regardless of their insurance status.
      B)
      Explaining possible adverse effects to clients receiving new prescriptions.
      C)
      Respecting the decision of clients to refuse to participate in group therapy.
      D)
      Attending an educational conference on identifying clients at risk for suicide.
    2. A charge nurse is planning an in-service for newly licensed nurses on tort law in mental health care. Which of the following scenarios should the charge nurse provide as an example of an unintentional tort?
      A)
      A nurse did not clarify a client's prescription that was difficult to read, resulting in a medication error.
      B)
      A nurse posted private information on social media about a client who has a substance use disorder.
      C)
      A nurse placed a client in mechanical restraints without obtaining a prescription, resulting in injury.
      D)
      A nurse threatened a client with physical harm after the client became verbally abusive to staff members.
    3. A nurse is caring for a client who has posttraumatic stress disorder (PTSD) after being physically assaulted. The client is unable to recall any details of the event. Which of the following defense mechanisms should the nurse recognize the client is displaying?
      A)
      Dissociation
      B)
      Rationalization
      C)
      Undoing
      D)
      Reaction formation
    4. A nurse is caring for a client who exhibits excessive attention-seeking behaviors, including acting flirtatious and seductive. The nurse should identify these behaviors as manifestations of which of the following personality disorders?
      A)
      Paranoid
      B)
      Histrionic
      C)
      Narcissistic
      D)
      Antisocial

    Exam Review

    1. A nurse is assessing a client who has delirium as a result of sepsis. Which of the following manifestations should the nurse expect? (Select all that apply)
      A)
      Slow speech
      B)
      Rapid mood changes
      C)
      Hallucinations
      D)
      Unaltered level of consciousness
      E)
      Restlessness
    2. A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate into the plan of care?
      A)
      Provide additional attention to the client.
      B)
      Apply mechanical restraints before administering medication.
      C)
      Obtain a verbal contract from the client.
      D)
      Use consistent staff members to work with the client.
    3. A nurse is caring for a client who has a history of suicide attempts. Which of the following findings place the client at risk for another suicide attempt? (Select all that apply.)
      A)
      Hallucinations
      B)
      Depression
      C)
      Delusions
      D)
      Catatonia
      E)
      Tinnitus
    4. A nurse is creating a plan of care for a newly admitted client who has obsessive-compulsive disorder (OCD). Which of the following interventions should the nurse include?
      A)
      Use detailed explanations when providing education to the client
      B)
      Maintain a stimulating environment for the client
      C)
      Provide the client with a structured schedule of daily activities
      D)
      Limit time for rituals to 30 minutes each day