Exam Review

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
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
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.
A nurse is caring for a client in the outpatient mental health facility. Exhibits Drag words from the choices below to fill in each blank in the following sentence. The nurse should include in the teaching to the client that behavioral therapy will▾ encourage the client to face their fears in a safe environment and ▾ involve incremental exposure while using relaxation techniques
Dropdown 1:
Option 1: Involves increasing their interpersonal effectiveness
Option 2: encourage the client to face their fears in a safe environment
Option 3: help the client to practice the new skill in a role playing situation
Option 4: target behaviour with a negative stimulus to extinguish undesirable
Option 5: involve incremental exposure while using relaxation techniques
Dropdown 2:
Option 1: Involves increasing their interpersonal effectiveness
Option 2: encourage the client to face their fears in a safe environment
Option 3: help the client to practice the new skill in a role playing situation
Option 4: target behaviour with a negative stimulus to extinguish undesirable
Option 5: involve incremental exposure while using relaxation techniques

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Exam Review

A nurse is providing counseling to a client who has substance use disorder. Exhibits The nurse is discussing the client's concerns regarding relapse. Which of the following client statements indicates the client is adhering to the relapse prevention plan? (Select all that apply)
A)
"I've quit drinking plenty of times before; I don't want to give it up for good."
B)
"I was angry at my friends for putting me in that situation, but I called my sponsor."
C)
"I just don't feel like myself and I don't know who this new person is."
D)
"I'm not sure I can manage staying sober."
E)
"I can manage it all if I just cut down on the drinking."
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."
A nurse is conducting an admission assessment for a client who is experiencing a manic episode of bipolar disorder. Which of the following behaviors should the nurse expect? (Select all that apply.)
(SATA)
A)
Grandiosity
B)
Flight of ideas
C)
Splitting
D)
Hyperactivity
E)
Withdrawal
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

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Exam Review

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 factures.
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.
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
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 hr before bedtime each night.
D)
Allow the client to take a 90 min nap immediately after lunch.
A nurse in an urgent-care clinic is caring for a school-age child who has several visible bruises. The child's parent states, "My partner got fired today and came home angry. I don't think this will happen again." Which of the following responses should the nurse make?
A)
"I agree with you. I'm sure this will never happen again."
B)
"This is awful. You should file charges against your partner."
C)
"This is clearly child endangerment. I will have to call the police."
D)
"I'd like to know more about what happened. Let's sit and talk."

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Exam Review

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.
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
A nurse is caring for a client in the outpatient mental health facility. Exhibits Drag words from the choices below to fill in each blank in the following sentence. The nurse should include in the teaching to the client that behavioral therapy will dropdown and dropdown
The nurse is caring for a client admitted to an inpatient eating-disorder unit. Exhibits For each potential provider's assessment finding, click to specify if the finding is consistent with anorexia nervosa or bulimia nervosa. Each finding may support more than 1 disease process.
A)
Lanugo
B)
Skin color
C)
Body Mass Index
D)
Potassium level
E)
Extremity assessment
F)
Past medical history

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Exam Review

The nurse is caring for a client admitted to an inpatient eating-disorder unit. Exhibits Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The nurse should first address the client'sdropdown followed by dropdown
The nurse continues to care for the client. Exhibits The nurse is planning care for the client. Which of the following parameters should the nurse plan to monitor throughout the client's stay? Select all that apply
A)
Anxiety level
B)
Blood Pressure
C)
Body weight
D)
Participation in group therapy
E)
White blood cell count
F)
Oral intake
G)
Self-esteem
The nurse continues to care for the client. Exhibits The nurse is discussing the plan of care with the client. Select the 3 statements the nurse should make.
A)
"We will explore your thoughts that trigger you to participate in a rigorous exercise regimen."
B)
"We will create an exercise plan once you reach your target weight
C)
"We would like you to eat independently to limit distractions during mealtime.
D)
"We will monitor your blood pressure every other day until it is stable."
E)
"We will set a goal for you to gain 2 to 3 pounds per week."
F)
"We will weigh you every evening to monitor your progress."
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."

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Exam Review

A nurse is assessing a client who takes diazepam for anxiety and hydromorphone for severe pain. Which of the following is the priority finding that the nurse should report to the provider?
A)
Urinary retention
B)
Blurred vision
C)
Headache
D)
Bradypnea
A nurse is caring for a client who has undergone electroconvulsive therapy (ECT). The nurse should monitor the client for which of the following adverse effects of ECT?
A)
Voice alteration
B)
Neck pain
C)
Memory deficit
D)
Headache
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
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 in 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)
Limit staff members who work with the client.

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