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    Exam Review

    1. A nurse is caring for a client. The nurse is collecting data from the client 12 hr later. How should the nurse interpret the following findings? For each potential finding, click to specify whether the finding is an indication of potential improvement or an indication of potential worsening condition.
      Indication of Potential ImprovementIndication of Potential Worsening Condition
      Lithium level✓
      Urine output✓
      Vision✓
      Vital signs✓
      Mucus membranes✓
    2. A nurse in a substance use disorder clinic is explaining the alcohol recovery process to a client's family. Which of the following should the nurse identify as the first step toward successful recovery from alcohol use disorder?
      A)
      Acknowledge an inability to control drinking.
      B)
      Incorporate a form of spirituality into daily life.
      C)
      Agree to a prescription for an alcohol use deterrent.
      D)
      Form a close support network.
    3. A nurse is caring for a client who experienced a fall. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to collect data about the client's progress.
      ✓Monitor for an underlying infection.
      ✓Use symbols rather than written signs for directions.
      ✓Delirium
      ✓Ability to complete familiar tasks
      ✓Presence of agnosia
      Actions to Take
      ✓Monitor for an underlying infection.
      ✓Use symbols rather than written signs for directions.
      ✕Anticipate a prescription for duloxetine.
      ✕Determine the date of the client's last eye examination.
      ✕Anticipate a prescription for donepezil
      Potential Condition
      ✕Alzheimer's disease
      ✓Delirium
      ✕Expected aging process
      ✕Major depressive disorder
      Parameters to Monitor
      ✕Oxygen saturation
      ✕Night vision
      ✓Ability to complete familiar tasks
      ✕Attendance at group therapy
      ✓Presence of agnosia
    4. A nurse is reviewing the vital signs of a client who has a prescription for imipramine. Which of the following findings requires follow-up by the nurse?
      A)
      Blood pressure 88/64 mm Hg
      B)
      Pulse rate 66/min
      C)
      Respiratory rate 16/min
      D)
      Temperature 36.7° C (98° F)
    Page 1 of 15

    Exam Review

    1. A nurse is interviewing a client who was recently admitted. The client tells the nurse, "I have something to tell you, but you can't tell anyone else." Which of the following responses should the nurse make?
      A)
      "I can't promise you that. I may need to share information."
      B)
      "You can tell me what information you want me to share with your provider."
      C)
      "I will tell you what I feel I should share with the treatment team."
      D)
      "Try not to worry. Your secret is safe with me."
    2. A nurse is caring for a client who has a terminal illness. Which of the following statements should the nurse make to reinforce teaching about anticipatory grief reactions with the client's partner?
      A)
      "The anticipatory grief process won't begin until after your partner dies."
      B)
      "You might find yourself feeling detached from your partner during this time."
      C)
      "Your partner might experience a spurt of energy during this time."
      D)
      "Anticipatory grief delays the normal grief response."
    3. A charge nurse overhears a staff nurse talking to a nurse from another unit in the hallway. The staff nurse says, "I heard that Mr. Smith was admitted for a suicide attempt." Which of the following responses should the charge nurse make?
      A)
      "It is an invasion of privacy to discuss that information."
      B)
      "If you are going to talk about a client in public, do not use their name."
      C)
      "You should continue this conversation in a private place."
      D)
      "I will be informing the provider about this conversation."
    4. A nurse is assisting with a community health education and support service for individuals who have lost loved ones to suicide. Which of the following actions should the nurse take when caring for these individuals?
      A)
      Refer to the deceased person as the client, not the individual.
      B)
      Wait until the individual talks about their deceased loved one before mentioning their name.
      C)
      Ask open-ended questions when talking to the individual about their grief.
      D)
      Recommend that the individual wait at least 3 months before joining a support group.
    Page 2 of 15

    Exam Review

    1. A nurse is caring for a client who has agreed to a verbal safety contract following a self-mutilation attempt. Which of the following behaviors indicates that the contract has been effective?
      A)
      The client suppresses their feelings when they are angry.
      B)
      The client notifies the nurse when they want to harm themselves.
      C)
      The client displaces their feelings of self-harm until they talk to the provider.
      D)
      The client goes to their room alone when they feel overwhelmed.
    2. A nurse is collecting data from a client who has anorexia nervosa. Which of the following findings should the nurse identify as an indication that the client has an impaired nutritional status?
      A)
      Polyuria
      B)
      Constipation
      C)
      Increased bowel sounds
      D)
      Hyperkalemia
    3. A nurse is preparing to discharge a client who has depression. Which of the following information should the nurse plan to reinforce with the client regarding relapse?
      A)
      Use systematic desensitization to help prevent relapse.
      B)
      Your antidepressant medication will make you feel better in a few days.
      C)
      You should identify how you react to stressful events.
      D)
      Try snapping a rubber band on your wrist when depressive thoughts occur.
    4. A nurse is caring for a client who states, "I'm overwhelmed, and no one understands. I can't take it anymore." Which of the following responses should the nurse make first?
      A)
      "Are you thinking of harming yourself?"
      B)
      "Do you have anyone you can talk to about your feelings?"
      C)
      "Are you saying that no one understands your concerns?"
      D)
      "Tell me more about how you are feeling."
    Page 3 of 15

    Exam Review

    1. A nurse is collecting data from a new client. Which of the following questions should the nurse include when determining the client's psychosocial status?
      A)
      "Who do you talk to when you are upset?"
      B)
      "Do you have medical insurance?"
      C)
      "When did you last have a mammogram?"
      D)
      "How old were you when you started your menses?"
    2. A nurse in a mental health facility is discussing client rights with an adult client who was involuntarily committed. Which of the following statements should the nurse make?
      A)
      "If you want to leave the hospital, you need to sign a release form."
      B)
      "Your provider will need to notify your employer of your admission."
      C)
      "You have the option to refuse your medication while in the facility."
      D)
      "Once 90 days have passed, you can request a review of your admission."
    3. A nurse is reinforcing teaching with a client who has a new prescription for amitriptyline. The client reports taking herbal supplements. The nurse should instruct the client that they should avoid taking which of the following supplements?
      A)
      Echinacea
      B)
      St. John's wort
      C)
      Saw palmetto
      D)
      Glucosamine
    4. A nurse is contributing to the plan of care for a client who has schizophrenia. The client often directs brief, hostile verbal outbursts toward the staff. Which of the following interventions should the nurse recommend?
      A)
      Bring a security guard whenever approaching the client.
      B)
      Use a calm, clear tone when speaking to the client.
      C)
      Encourage the client to participate in a board game.
      D)
      Touch the client on the shoulder to console them.
    Page 4 of 15

    Exam Review

    1. A nurse is caring for a client who is experiencing moderate anxiety and appears distracted and unable to focus. Which of the following actions should the nurse take?
      A)
      Encourage the client to walk around the courtyard.
      B)
      Escort the client to the dayroom to interact with others.
      C)
      Administer a dose of escitalopram to the client.
      D)
      Request an antipsychotic medication from the provider.
    2. A nurse is caring for a client who has depressive disorder following the recent death of their partner. Which of the following responses should the nurse make?
      A)
      "Tell me more about your relationship with your partner.”.
      B)
      "Grief affects everyone differently; your feelings are valid.”.
      C)
      "It's important to stay busy to take your mind off things.”.
      D)
      "Have you considered joining a support group for bereavement?"
    3. A nurse is collecting data from a client who has a major depressive disorder and a new prescription for bupropion. Which of the following findings should the nurse identify as a contraindication for this medication?
      A)
      The client has asthma.
      B)
      The client smokes two packs of cigarettes per day.
      C)
      The client has a seizure disorder.
      D)
      The client has an allergy to peanuts.
    4. A nurse is helping lead a support group for clients in a long-term care facility. Which of the following is the leader's task during the termination phase of group development?
      A)
      Discuss ground rules.
      B)
      Encourage problem solving.
      C)
      Reflect on progress.
      D)
      Guide conflict resolution.
    Page 5 of 15

    Exam Review

    1. A nurse at a mental health clinic is caring for an adolescent client who has posttraumatic stress disorder following a violent episode with a stranger. Which of the following actions should the nurse take?
      A)
      Direct the client to use regression to cope with the stress caused by flashbacks.
      B)
      Instruct the client to avoid expressions of anger and fear related to the episode.
      C)
      Ask the client's guardians to go to another room during counseling sessions.
      D)
      Encourage the client to use guided imagery to decrease anxiety.
    2. The nurse is assisting in the care of a client in an inpatient mental health facility. The nurse is assisting in the care of the client. Which of the following findings should the nurse report to the charge nurse immediately? Select all that apply.
      A)
      Oxygen saturation
      B)
      Heart rate
      C)
      Orientation
      D)
      Medical history
      E)
      Respiratory rate
      F)
      Pupils
    3. The nurse is assisting in the care of a client in an inpatient mental health facility. For each finding, click to specify if the finding is consistent with opioid, stimulant, or hallucinogen intoxication. Each finding may be consistent with more than 1 substance or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.
      A)
      Pinpoint pupils
      B)
      Paranoia
      C)
      Sedation
      D)
      Tachycardia
      E)
      Dilated pupils
      F)
      Seizures
      G)
      Hypertension
    4. The nurse is assisting in the care of a client in an inpatient mental health facility. Select the 4 manifestations of withdrawal for which the client is at risk.
      A)
      Diaphoresis
      B)
      Hypothermia
      C)
      Hyperreflexia
      D)
      Anxiety
      E)
      Slurred speech
      F)
      Insomnia
    Page 6 of 15