Mental Health

The home care nurse is visiting an older client whose spouse died 6 months ago. Which behavior by the client indicates ineffective coping?
1. Neglecting personal grooming
2. Looking at old snapshots of family
3. Participating in a senior citizens' program
4. Visiting their spouse's grave once a month

A client with a diagnosis of major depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication?
1. "You have everything to live for."
2. "Why do you see yourself as a failure?"
3. "Feeling like this is all part of being depressed."
4. "You've been feeling like a failure for a while?"

When the mental health nurse visits a client at home, the client states, "I haven't slept at all the last couple of nights." Which response by the nurse illustrates a therapeutic communication response to this client?
1. "I see."
2. "Really?"
3. "You're having difficulty sleeping?"
4. "Sometimes, I have trouble sleeping too."

A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat?
1. Using open-ended questions and silence
2. Sharing personal preference regarding food choices
3. Documenting reasons why the client does not want to eat
4. Offering opinions about the necessity of adequate nutrition

A client admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting, "Let me out. There's nothing wrong with me. I don't belong here." What defense mechanism is the client implementing?
1. Denial
2. Projection
3. Regression
4. Rationalization

A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic?
1. "Have you shared your feelings with your family?"
2. "I think we should talk more about your anger with your family."
3. "You're feeling angry that your family continues to hope for you to be cured?"
4. "You are probably very depressed, which is understandable with such a diagnosis."

On review of the client's record, the nurse notes that the mental health admission was voluntary. Based on this information, the nurse anticipates which client behavior?
1. Fearfulness regarding treatment measures.
2. Anger and aggressiveness directed toward others.
3. An understanding of the pathology and symptoms of the diagnosis.
4. A willingness to participate in the planning of the care and treatment plan.

When reviewing the admission assessment, the nurse notes that a client was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this client?
1. Monitor closely for harm to self or others.
2. Assist in completing an application for admission.
3. Supply the client with written information about their mental illness.
4. Provide an opportunity for the family to discuss why they felt the admission was needed.

The nurse is preparing a client for the termination phase of the nurse-client relationship. The nurse prepares to implement which nursing task that is most appropriate for this phase?
1. Planning short-term goals
2. Making appropriate referrals
3. Developing realistic solutions
4. Identifying expected outcomes

The nurse in the mental health unit recognizes which as being therapeutic communication techniques? Select all that apply.
1. Restating
2. Listening
3. Asking the client, "Why?"
4. Maintaining neutral responses
5. Providing acknowledgment and feedback
6. Giving advice and approval or disapproval

A client being seen in the emergency department immediately after being sexually assaulted appears calm and controlled. The nurse analyzes this behavior as indicating which defense mechanism?
1. Denial
2. Projection
3. Rationalization
4. Intellectualization

A client's unresolved feelings related to loss would be most likely observed during which phase of the therapeutic nurse-client relationship?
1. Trusting
2. Working
3. Orientation
4. Termination

The nurse is working with a client who despite making a heroic effort was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse-client relationship?
1. Exploring the client's ability to function
2. Exploring the client's potential for self-harm
3. Inquiring about the client's perception or appraisal of why the rescue was unsuccessful
4. Inquiring about and examining the client's feelings for any that may block adaptive coping

The nurse employed in a mental health unit of a hospital is the leader of a group psychotherapy session. What is the nurse's role during the termination stage of group development?
1. Acknowledging that the group has identified goals
2. Encouraging the accomplishment of the group's work
3. Acknowledging the contributions of each group member
4. Encouraging members to become acquainted with one another

Which are characteristics of the termination stage of group development? Select all that apply.
1. The group evaluates the experience.
2. The real work of the group is accomplished.
3. Group interaction involves superficial conversation.
4. Group members become acquainted with each other.
5. Some structuring of group norms, roles, and responsibilities takes place.
6. The group explores members' feelings about the group and the impending separation.

When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse understands that which is the purpose of this approach?
1. Providing a supportive environment
2. Examining intrapsychic conflicts and past issues
3. Emphasizing social interaction with clients who withdraw
4. Helping the client to examine dysfunctional thoughts and beliefs

The nurse understands that which best describes Gestalt therapy?
1. It emphasizes self-expression, self-exploration, and self-awareness in the present.
2. It promotes the individual's comfort in the group, which then transfers to other relationships.
3. The therapist focuses on how irrational beliefs and thoughts contribute to psychological distress.
4. The therapist's goal is to help others express their feelings toward one another during group sessions.

A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program?
1. Admitting to having a problem
2. Substituting other activities for gambling
3. Stating that the gambling will be stopped
4. Discontinuing relationships with people who gamble

Which describes the primary focus of milieu therapy?
1. A form of behavior modification therapy
2. A cognitive approach to changing behavior
3. A living, learning, or working environment
4. A behavioral approach to changing behavior

While being treated, a client is introduced to short periods of exposure to the phobic object while in a relaxed state. What term is used to describe this form of behavior modification?
1. Milieu therapy
2. Aversion therapy
3. Self-control therapy
4. Systematic desensitization

A client is planning to attend Overeaters Anonymous. Which statement by the client indicates a need for additional information regarding this self-help group?
1. "The leader is a nurse or psychiatrist."
2. "The members provide support to each other."
3. "People who have a similar problem are able to help others."
4. "It is designed to serve people who have a common problem."

What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session?
1. Ask the client to leave the group for this session only.
2. Refer the client to another group that includes other manic clients.
3. Tell the client to stop monopolizing in a firm but compassionate manner.
4. Thank the client for the input, but inform the client that now others need a chance to contribute.

Which type of therapeutic approach has the characteristic that all team members are seen as equally important in helping clients meet their goals?
1. Milieu therapy
2. Interpersonal therapy
3. Behavior modification
4. Rational emotive therapy

A client says to the nurse, "The federal guards were sent to kill me." What is the best nursing response to the client's concern?
1. "I don't believe this is true."
2. "The guards are not out to kill you."
3. "Do you feel afraid that people are trying to hurt you?"
4. "What makes you think the guards were sent to hurt you?"

A client diagnosed with delirium becomes disoriented and confused at night. Which intervention should the nurse implement initially?
1. Move the client next to the nurse's station.
2. Use an indirect light source and turn off the television.
3. Keep the television and a soft light on during the night.
4. Play soft music during the night, and maintain a well-lit room.

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention?
1. Encouraging quiet reading and writing for the first few days
2. Identification of physical activities that will provide exercise
3. No socializing activities, until the client asks to participate in milieu
4. A structured program of activities in which the client can participate

When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal?
1. Suppressing feelings of anxiety
2. Identifying anxiety-producing situations
3. Continued contact with a crisis counselor
4. Eliminating all anxiety from daily situations

A client is unwilling to go out of the house for fear of "making a fool of myself in public." Because of this fear, the client remains homebound. Based on these data, which mental health disorder is the client experiencing?
1. Agoraphobia
2. Social phobia
3. Claustrophobia
4. Hypochondriasis

The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement?
1. Setting limits on the client's behavior
2. Asking the client to leave the group session
3. Asking another nurse to escort the client out of the group session
4. Telling the client that they will not be able to attend any future group sessions

A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. Which condition will be the focus of this consult?
1. Psychosis
2. Repression
3. Conversion disorder
4. Dissociative disorder

A manic client begins to make sexual advance towards visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement?
1. Place the client in seclusion for 30 minutes.
2. Tell the client that the behavior is inappropriate.
3. Escort the client to their room, with the assistance of other staff.
4. Tell the client that their telephone privileges are revoked for 24 hours.

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply.
1. Communicate expected behaviors to the client.
2. Ensure that the client knows that they are not in charge of the nursing unit.
3. Assist the client in identifying ways of setting limits on personal behaviors.
4. Follow through about the consequences of behavior in a nonpunitive manner.
5. Enforce rules by informing the client that they will not be allowed to attend therapy groups.
6. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, what is the nurse's immediate priority of care?
1. Provide safety for the client and other clients on the unit.
2. Provide the clients on the unit with a sense of comfort and safety.
3. Assist the staff in caring for the client in a controlled environment.
4. Offer the client a less stimulating area to calm down in and gain control.

The nurse is preparing a client with a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client understands the instructions?
1. "My medications aren't likely to make me anxious."
2. "I'll go to support group and talk so that I don't hurt anyone."
3. "It's not likely that I'll get anxious or hear things if I get enough sleep and eat well."
4. "When I begin to hallucinate, I'll call my therapist and talk about what I should do."

The nurse is caring for a client diagnosed with catatonic stupor who is lying on the bed in a fetal position. What is the most appropriate nursing intervention?
1. Ask direct questions to encourage talking.
2. Leave the client alone so as to minimize external stimuli.
3. Sit beside the client in silence with occasional open-ended questions.
4. Take the client into the dayroom with other clients so that they can help watch him.

The nurse is caring for a client who is experiencing disturbed thought processes as a result of paranoia. In formulating nursing interventions with the members of the health care team, what best instruction should the nurse provide to the staff?
1. Increase socialization of the client with peers.
2. Avoid laughing or whispering in front of the client.
3. Begin to educate the client about social supports in the community.
4. Have the client sign a release of information to appropriate parties for assessment purposes.

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client?
1. Chess
2. Writing
3. Ping pong
4. Basketball

The home health nurse visits a client at home and determines that the client is dependent on drugs. During the assessment, which action should the nurse take to plan appropriate nursing care?
1. Ask the client why he started taking illegal drugs.
2. Ask the client about the amount of drug use and its effect.
3. Ask the client how long he thought that he could take drugs without someone finding out.
4. Not ask any questions for fear that the client is in denial and will throw the nurse out of the home.

Which interventions are most appropriate for caring for a client in alcohol withdrawal? Select all that apply.
1. Monitor vital signs.
2. Maintain NPO status.
3. Provide a safe environment.
4. Address hallucinations therapeutically.
5. Provide stimulation in the environment.
6. Provide reality orientation as appropriate.

The nurse determines that the wife of an alcoholic client is benefiting from attending an Al-Anon group if the nurse hears the wife make which statement?
1. "I no longer feel that I deserve the beatings my husband inflicts on me."
2. "My attendance at the meetings has helped me to see that I provoke my husband's violence."
3. "I enjoy attending the meetings because they get me out of the house and away from my husband."
4. "I can tolerate my husband's destructive behaviors now that I know they are common with alcoholics."

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take?
1. Call the nursing supervisor.
2. Call security to block all exit areas.
3. Restrain the client until the health care provider (HCP) can be reached.
4. Tell the client that the client cannot return to this hospital again if the client leaves now.

The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment findings does the nurse expect to note? Select all that apply.
1. Dental decay
2. Moist oily skin
3. Loss of tooth enamel
4. Electrolyte imbalances
5. Body weight well below ideal range

The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate?
1. Interrupt the client and weigh her immediately.
2. Interrupt the client and offer to take her for a walk.
3. Allow the client to complete her exercise program.
4. Tell the client that she is not allowed to exercise rigorously.

A client with a diagnosis of anorexia nervosa, who is in a state of starvation, is in a two-bed room. A newly admitted client will be assigned to this client's room. Which client would be the best choice as a roommate for the client with anorexia nervosa?
1. A client with pneumonia
2. A client undergoing diagnostic tests
3. A client who thrives on managing others
4. A client who could benefit from the client's assistance at mealtime

The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential for alcohol withdrawal delirium?
1. Hypotension, ataxia, hunger
2. Stupor, lethargy, muscular rigidity
3. Hypotension, coarse hand tremors, lethargy
4. Hypertension, changes in level of consciousness, hallucinations

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, "I should get out of this bad situation." What is the most helpful response by the nurse?
1. "Why don't you tell your wife about this?"
2. "What do you find difficult about this situation?"
3. "This is not the best time to make that decision."
4. "I agree with you. You should get out of this situation."

A client with anorexia nervosa is a member of a predischarge support group. The client verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes were much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate this behavior?
1. Normal behavior
2. Evidence of the client's disturbed body image
3. Regression as the client is moving toward the community
4. Indicative of the client's ambivalence about hospital discharge

The nurse in the emergency department is caring for a young female victim of sexual assault. The client's physical assessment is complete, and physical evidence has been collected. The nurse notes that the client is withdrawn, confused, and at times physically immobile. How should the nurse interpret these behaviors?
1. Signs of depression
2. Normal reactions to a devastating event
3. Evidence that the client is a high suicide risk
4. Indicative of the need for hospital admission

The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse determines that this type of crisis could be caused by which event?
1. Witnessing a murder
2. The death of a loved one
3. A fire that destroyed the client's home
4. A recent rape episode experienced by the client

The nurse is conducting an initial assessment on a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, what is the most appropriate question?
1. "With whom do you live?"
2. "Who is available to help you?"
3. "What leads you to seek help now?"
4. "What do you usually do to feel better?"

The nurse is developing a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor?
1. A crisis state indicates that the client has a mental illness.
2. A crisis state indicates that the client has an emotional illness.
3. Presenting symptoms in a crisis situation are similar for all clients experiencing a crisis.
4. A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.

The nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway, and is making aggressive and belligerent gestures at other clients. Which statement would be most appropriate to make to this client?
1. "You need to stop that behavior now."
2. "You will need to be placed in seclusion."
3. "You seem restless; tell me what is happening."
4. "You will need to be restrained if you do not change your behavior."

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." What is the nurse's best response?
1. "Have you talked to your family about this?"
2. "Everyone feels this way when they are depressed."
3. "You will feel better once your medication begins to work."
4. "You sound very upset. Are you thinking of hurting yourself?"

The nurse has been observing a client closely who has been displaying aggressive behaviors. The nurse observes that the behavior displayed by the client is escalating. Which nursing intervention is least helpful to this client at this time?
1. Initiate confinement measures.
2. Acknowledge the client's behavior.
3. Assist the client to an area that is quiet.
4. Maintain a safe distance from the client.

Which behavior observed by the nurse indicates a suspicion that a depressed adolescent client may be suicidal?
1. The adolescent gives away a DVD and a cherished autographed picture of a performer.
2. The adolescent runs out of the therapy group, swearing at the group leader, and runs to her room.
3. The adolescent becomes angry while speaking on the telephone and slams down the receiver.
4. The adolescent gets angry with her roommate when the roommate borrows the client's clothes without asking.

The police arrive at the emergency department with a client who has lacerated both wrists. What is the initial nursing action?
1. Administer an antianxiety agent.
2. Examine and treat the wound sites.
3. Secure and record a detailed history.
4. Encourage and assist the client to ventilate feelings.

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." How should the nurse interpret this behavior as a cue to modify the treatment plan?
1. Suggesting a reduction of medication
2. Allowing increased "in-room" activities
3. Increasing the level of suicide precautions
4. Allowing the client off-unit privileges as needed

The nurse is planning care for a client being admitted to the nursing unit who attempted suicide. Which priority nursing intervention should the nurse include in the plan of care?
1. One-to-one suicide precautions
2. Suicide precautions with 30-minute checks
3. Checking the whereabouts of the client every 15 minutes
4. Asking the client to report suicidal thoughts immediately

The emergency department nurse is caring for an adult client who is a victim of family violence. Which priority instruction should be included in the discharge instructions?
1. Information regarding shelters
2. Instructions regarding calling the police
3. Instructions regarding self-defense classes
4. Explaining the importance of leaving the violent situation

A female victim of a sexual assault is being seen in the crisis center. The client states that she still feels "as though the rape just happened yesterday," even though it has been a few months since the incident. What is the most appropriate nursing response?
1. "You need to try to be realistic. The rape did not just occur."
2. "It will take some time to get over these feelings about your rape."
3. "Tell me more about the incident that causes you to feel like the rape just occurred."
4. "What do you think that you can do to alleviate some of your fears about being raped again?"

A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action?
1. Requesting that a peer remain with the client at all times
2. Removing the client's clothing and placing the client in a hospital gown
3. Assigning a staff member to the client who will remain with the client at all times
4. Admitting the client to a seclusion room where all potentially dangerous articles are removed

A client is admitted with a recent history of severe anxiety following a home invasion and robbery. During the initial assessment interview, which statement by the client would indicate to the nurse the possible diagnosis of posttraumatic stress disorder? Select all that apply.
1. "I'm afraid of spiders."
2. "I keep reliving the robbery."
3. "I see his face everywhere I go."
4. "I don't want anything to eat now."
5. "I might have died over a few dollars in my pocket."
6. "I have to wash my hands over and over again many times."

The emergency department nurse is caring for a client who has been identified as a victim of physical abuse. In planning care for the client, which is the priority nursing action?
1. Adhering to the mandatory abuse-reporting laws
2. Notifying the case worker of the family situation
3. Removing the client from any immediate danger
4. Obtaining treatment for the abusing family member

The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action?
1. Incessant talking and sexual innuendoes
2. Grandiose delusions and poor concentration
3. Outlandish behaviors and inappropriate dress
4. Nonstop physical activity and poor nutritional intake

The nurse is performing an assessment on a client with dementia. Which data gathered during the assessment indicates a manifestation associated with dementia?
1. Uses confabulation
2. Improvement in sleeping
3. Absence of sundown syndrome
4. Presence of personal hygienic care

The nurse is caring for a client with anorexia nervosa. Which behavior is characteristic of this disorder and reflects anxiety management?
1. Engaging in immoral acts
2. Always reinforcing self-approval
3. Observing rigid rules and regulations
4. Having the need always to make the right decision

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right." How should the nurse plan on responding to the client's statement?
1. Reassure the client that things will get better.
2. Tell the client that this is not true and that we all have a purpose in life.
3. Identify recent behaviors or accomplishments that demonstrate the client's skills.
4. Remain with the client and sit in silence; this will encourage the client to verbalize feelings.

A client with diabetes mellitus is told that amputation of the leg is necessary to sustain life. The client is very upset and tells the nurse, "This is all my health care provider's fault. I have done everything I've been asked to do!" Which nursing interpretation is best for this situation?
1. An expected coping mechanism
2. An ineffective coping mechanism
3. A need to notify the hospital lawyer
4. An expression of guilt on the part of the client

A client experiencing a great deal of stress and anxiety is being taught to use self-control therapy. Which statement by the client indicates a need for further teaching about the therapy?
1. "This form of therapy can be applied to new situations."
2. "An advantage of this technique is that change is likely to last."
3. "Talking to oneself is a basic component of this form of therapy."
4. "This form of therapy provides a negative reinforcement when the stimulus is produced."

The nurse is caring for a client who is at risk for suicide. What is the priority nursing action for this client?
1. Provide authority, action, and participation.
2. Display an attitude of detachment, confrontation, and efficiency.
3. Demonstrate confidence in the client's ability to deal with stressors.
4. Provide hope and reassurance that the problems will resolve themselves.

A client comes to the emergency department after an assault and is extremely agitated, trembling, and hyperventilating. What is the priority nursing action for this client?
1. Begin to teach relaxation techniques.
2. Encourage the client to discuss the assault.
3. Remain with the client until the anxiety decreases.
4. Place the client in a quiet room alone to decrease stimulation.

The nurse is developing a plan of care for a client who was experiencing anxiety after the loss of a job. The client is now verbalizing concerns regarding the ability to meet role expectations and financial obligations. What is the priority problem for this client?
1. Anxiety
2. Unrealistic outlook
3. Lack of ability to cope effectively
4. Disturbances in thoughts and ideas

The nurse has developed a plan of care for a client diagnosed with anorexia nervosa. Which client problem would the nurse select as the priority in the plan of care?
1. Disrupted appearance because of weight
2. Inability to feed self because of weakness
3. Pain because of an inflamed gastric mucosa
4. Nutritional imbalance because of lack of intake

Which statement made by an unlicensed assistive personnel (UAP) indicates to the registered nurse that the UAP understands the concepts related to suicide?
1. "Discussing suicide with a client is not harmful."
2. "Those clients who talk about suicide never do it."
3. "Depressed clients are the only persons who commit suicide."
4. "When a person talks about making suicide threats, the only thing the person wants is attention from family and friends."

Which client is most at risk for committing suicide?
1. A 75-year-old client with metastatic cancer
2. A 71-year-old client with a cardiac disorder
3. A 24-year-old client who just had an argument with her roommate
4. A 30-year-old newly divorced client who states she has custody of the children

A nursing instructor teaches a group of nursing students about violence in the family. Which statement by a student indicates a need for further teaching?
1. "Abusers use fear and intimidation."
2. "Abusers usually have poor self-esteem."
3. "Abusers often are jealous or self-centered."
4. "Abuse occurs more often in low-income families."

A client is being prepared for electroconvulsive therapy (ECT). The nurse's plan of care for the day before ECT includes ensuring that the client follows which guideline?
1. Does not smoke at all
2. Receives no visitors and participates in limited unit activities
3. Reports to the clinic for blood draws and an electrocardiogram (ECG)
4. Is placed on nothing by mouth (NPO) status for 16 to 24 hours before the ECT

A nursing student is assisting with the care of a client with a chronic mental illness. The nurse informs the student that a behavior modification approach (operant conditioning) will be used in treatment for the client. Which statement by the student indicates a need for further information about the therapy?
1. "It uses positive reinforcement."
2. "It uses negative reinforcement."
3. "It increases social behaviors in the client."
4. "It increases the level of self-care in the client."

The nurse is performing an admission assessment on a client at high risk for suicide. The nurse should prepare to ask the client which assessment question to elicit data related to this risk?
1. "What are you feeling right now?"
2. "Do you have a plan to commit suicide?"
3. "How many times have you attempted suicide in the past?"
4. "Why were your attempts at suicide unsuccessful in the past?"

The nurse in the mental health unit is performing an assessment in a client who has a history of multiple somatic complaints involving several organ systems. Diagnostic studies revealed no organic pathology. The care plan developed for this client will reflect that the client is experiencing which disorder?
1. Depression
2. Schizophrenia
3. Somatization disorder
4. Obsessive-compulsive disorder

A mental health nurse in a psychiatric unit is meeting with a client who has a long history of acting out and violent behavior. The client also is known to have abused drugs on numerous occasions. During the session the client says to the nurse, "I'm feeling much better now, and I'm ready to go straight." Which response by the nurse would be therapeutic?
1. "You have said this many times before!"
2. "Tell me what makes you feel that you are ready."
3. "I have not seen any changes in you to believe that you are ready to go straight."
4. "I'm so glad to hear you talking this way. I will let your health care provider know."

A client with a diagnosis of depression has been meeting with the mental health nurse for therapy sessions for the past 6 weeks. During the session the client says to the nurse, "I lost my job this week, and I'm going to be evicted from my apartment if I can't pay my bill. The only person that I have is my daughter, but I don't want to burden her with my problems." Which response by the nurse would be therapeutic?
1. "Why did you lose your job?"
2. "There are homeless shelters available, and we will get you into one if you are evicted from your apartment."
3. "If you get evicted from your apartment, we will commit you to the hospital, so you will have a place to eat and sleep."
4. "Let's talk about contacting your daughter. Wouldn't you want to know if your daughter was having difficulty and try to help her if you could?"

During a therapy session with a client with paranoid disorder, the client says to the nurse, "You look so nice today. I love how you do your hair, and I love that perfume you're wearing." Which response by the nurse would be therapeutic?
1. "Your comment is inappropriate."
2. "Thank you for noticing. I just bought this new perfume."
3. "My hair has been a mess. I really needed to have it done."
4. "We are not here to discuss how I look or smell. We are here to talk about you."

The nurse in the mental health unit is assigned to care for a female client with a diagnosis of acute depression. In communicating with the client, which statement would be appropriate for the nurse to make?
1. "You look lovely today."
2. "You're wearing a new blouse."
3. "Don't worry–everyone gets depressed once in a while."
4. "You will feel better when your medication starts to work."

The nurse is planning care for a client with bipolar disorder who is experiencing psychomotor agitation. Which activity should the nurse plan for this client?
1. Reading letters and books in a quiet environment
2. Providing an activity such as checkers for the client
3. Involving the client in a card game with other clients on the unit
4. Including the client in a clay-molding class that is scheduled for today

The nurse is developing a plan of care for a client with depression whose food intake is poor. The nurse should include which interventions in the plan of care? Select all that apply.
1. Assist the client in selecting foods from the food menu.
2. Offer high-calorie fluids throughout the day and evening.
3. Allow the client to eat alone in the room if the client requests to do so.
4. Offer small high-calorie, high-protein snacks during the day and evening.
5. Select the foods for the client to be sure that the client eats a balanced diet.

The nurse is monitoring a client with a diagnosis of schizophrenia. The nurse notes that the client's emotional responses to situations occurring throughout the day are incongruent with the tone of the situation. The nurse should document the findings using which description of the client's behavioral response?
1. Flat affect
2. Bizarre affect
3. Blunted affect
4. Inappropriate affect

A mental health nurse notes that a client with schizophrenia is exhibiting an immobile facial expression and a blank look. Which should the nurse document in the client's record?
1. The client has a flat affect.
2. The client has an inappropriate affect.
3. The client is exhibiting bizarre behavior.
4. The client's emotional responses exhibit a blunted affect.

The nurse is developing a plan of care for the client with a diagnosis of paranoia and should include which interventions in the plan of care? Select all that apply.
1. Provide a warm approach to the client.
2. Ask permission before touching the client.
3. Eliminate physical contact with the client.
4. Defuse any anger or verbal attacks with a nondefensive stance.
5. Use simple and clear language when communicating with the client.

The nurse is preparing a client for electroconvulsive therapy (ECT), which is scheduled for the next morning. Which interventions would be included in the preprocedural plan? Select all that apply.
1. Obtain an informed consent.
2. Have the client void before the procedure.
3. Remove dentures and contact lenses before the procedure.
4. Withhold food and fluids for 6 hours before the treatment.
5. Administer tap water enemas on the evening before the procedure.

A hospitalized client is receiving clozapine (Clozaril) for the treatment of a schizophrenic disorder. The nurse determines that the client may be having an adverse reaction to the medication if abnormalities are noted on which laboratory study?
1. Platelet count
2. Cholesterol level
3. Blood urea nitrogen
4. White blood cell (WBC) count

A client has been prescribed disulfiram (Antabuse). Before giving the client the first dose of this medication, what should the psychiatric home health nurse determine?
1. If there is a history of hyperthyroidism
2. When the last full meal was consumed
3. If there is a history of diabetes insipidus
4. When the last alcoholic drink was consumed

A home care nurse making an initial home visit notes that a client is taking donepezil hydrochloride (Aricept). The nurse questions the client's spouse about a history of which disorder that is treated with this medication?
1. Dementia
2. Schizophrenia
3. Seizure disorder
4. Obsessive-compulsive disorder

The nurse is caring for a client with a diagnosis of agoraphobia. When communicating with the client about the disorder, the nurse should expect the client to describe which behavior?
1. A fear of dirt and germs
2. A fear of leaving the house
3. A fear of speaking in public
4. A fear of riding in elevators

A client recently admitted to the hospital in the manic phase of bipolar disorder is dehydrated, unkempt, taking antipsychotic medications, and complaining of abdominal fullness and discomfort. The nurse determines that which intervention is most appropriate for these complaints?
1. Teach self-grooming skills.
2. Reward cleanliness with unit privileges.
3. Monitor the adequacy of the antipsychotic dosage.
4. Encourage frequent fluid intake and a high-fiber diet.

A homebound client confidentially discusses suicidal plans with the visiting nurse. Based on professional duty to observe confidentiality, which statement bestdescribes the nurse's obligation to the client?
1. The nurse must have the client go to the local mental health center daily for counseling.
2. The nurse must ask the client not to reveal suicidal plans if the information needs to be kept confidential.
3. The nurse cannot tell anyone what the client said and must strictly adhere to the professional duty for confidentiality.
4. The nurse must override the duty to observe confidentiality and notify the client's health care provider (HCP) about the suicidal ideation.

The mental health nurse is reviewing the discharge plan for a hospitalized client. In reviewing the plan, the nurse recognizes that which is the most prominent problem in the management of a client with a mental health problem in the community?
1. The community's opposition
2. The client's noncompliance with medication therapy
3. The associated increased incidence of social problems
4. The family's reaction to keeping the client in the community

During a home visit, the nurse suspects that a young daughter of the client is bulimic. The nurse bases this suspicion on which primary characteristic of bulimia?
1. Refusing to eat and excessive exercising
2. Eating only vegetables and fruits and fasting
3. Hoarding of food and difficulty controlling food intake
4. Eating a lot of food in a short period of time and misuse of laxatives

The mental health nurse is talking to a client who has been diagnosed with posttraumatic stress disorder. During the conversation, the nurse notes that the client is exhibiting a paranoid stare and that he begins to pace and fidget. What is the appropriate nursing intervention?
1. Allow the client to pace.
2. Escort the client to a quiet room.
3. Change the conversation to a less threatening subject.
4. Share the observation with the client and help the client to recognize his feelings.

The nurse is reviewing the record of a client admitted to the mental health unit. The nurse notes documentation that the client experiences flashbacks. What diagnosis should the nurse expect to be documented for this client?
1. Anxiety
2. Agoraphobia
3. Schizophrenia
4. Posttraumatic stress disorder (PTSD)

The nurse is admitting a client with a diagnosis of posttraumatic stress disorder to the mental health unit. The client is confused and disoriented. During the assessment, what is the nurse's primary goal for this client?
1. Explain the unit rules.
2. Orient the client to the unit.
3. Stabilize the client's psychiatric needs.
4. Accept the client and make the client feel safe.

The nurse in the mental health unit is having a conversation with a client diagnosed with posttraumatic stress disorder. The client seems upset and looks anxious. What is the appropriate nursing statement the nurse should make to the client?
1. "Don't worry so much."
2. "I can see that you are upset."
3. "Everything is going to be all right."
4. "Why are you having so much trouble controlling your anxiety?"

A client with depression is scheduled to receive three sessions of electroconvulsive therapy (ECT). The client asks the nurse about the length of time it will take for improvement in the condition. The nurse should tell the client he or she will see improvement approximately how long after the three treatments?
1. 1 week
2. 3 weeks
3. 4 weeks
4. 8 weeks

A client has been diagnosed with major depression. The nurse notes that the client is not eating adequately and at times refuses to eat. What should the nurse plan to do to meet the client's nutritional needs?
1. Force foods and fluids.
2. Provide small, frequent meals.
3. Provide snacks and meals as requested.
4. Tell the client that social activities will be restricted unless food intake is increased.

The health care provider has prescribed medication therapy for a client with an alcohol abuse problem to assist in the maintenance of sobriety. The nurse reviews the client's record and expects to note that which medication has been prescribed?
1. Clonidine (Catapres)
2. Disulfiram (Antabuse)
3. Pyridoxine hydrochloride (vitamin B₆)
4. Chlordiazepoxide hydrochloride (Librium)

The mental health nurse is caring for a client with a social phobia. The nurse tells the client that a music therapy session has been scheduled as part of the treatment plan. The client tells the nurse that she cannot sing and refuses to attend. What is the appropriate nursing response?
1. "You must go. You have no choice."
2. "Why don't you want to attend? What is the real reason?"
3. "The health care provider has prescribed this therapy for you."
4. "You don't have to sing at the session. You can listen and enjoy the music."

The nurse is monitoring a client who has been placed in restraints because of violent behavior. When should the nurse determine that it will be safe to remove the restraints?
1. Administered medication has taken effect.
2. The client verbalizes the reasons for the violent behavior.
3. The client apologizes and tells the nurse that it will never happen again.
4. No acts of aggression have been observed within 1 hour after the release of two of the extremity restraints.

The mental health nurse is conducting a group therapy session and is monitoring a client with a diagnosis of agoraphobia who has been attending the sessions for several months. The nurse notes that the client is cooperative, sharing with peers, and making appropriate suggestions during group discussions. How should the nurse interpret this behavior?
1. Manipulation
2. Improvement
3. Attention seeking
4. Desire to be accepted

The nurse is preparing a client for electroconvulsive therapy (ECT). The family of the client asks the nurse about this treatment. The nurse responds, knowing that which statements are accurate regarding this treatment? Select all that apply.
1. The average series involves 6 to 12 treatments.
2. Some confusion may be noted after the procedure.
3. Memory loss will occur but will resolve with time.
4. This treatment is a permanent cure to the condition.
5. This treatment is tried before the use of medications.

The nurse is planning a stress management seminar for clients in an ambulatory care setting. Which concept should the nurse plan to include in the content of the seminar?
1. Biofeedback has the advantage of using no equipment at all.
2. Guided imagery is a helpful technique but requires video equipment for its use.
3. Confrontation is a useful method for solving potentially stressful conflicts with others.
4. Progressive muscle relaxation techniques are useful for easing tension from many causes.

A 15-year-old client who is pregnant and unwed tells the nurse, "My life was unbearable before I met Johnny. My mother beats me up every day, and my dad has been sleeping with me since I was 10 years old!" Which response is appropriate for the nurse to make?
1. "Why didn't you just report your parents for abuse?"
2. "What are you saying? Your parents abused you so you got pregnant?"
3. "Sounds like you decided to have a baby so you'd have someone for yourself."
4. "It seems that you needed help to separate from your family. Do you feel you are ready to have a baby with Johnny?"

A 10-year-old girl who has been referred for evaluation for drawing sexually explicit scenes in her textbooks says to the psychiatric nurse, "I just felt like it." Which response is therapeutic for the nurse to make in order to assess abuse-related symptoms?
1. "Well, a picture paints a thousand words."
2. "You just felt like destroying your textbooks?"
3. "Your parents and teachers are very concerned about your drawings."
4. "I am concerned about you. Are you now or have you ever been abused?"

During a nursing interview, a client says, "My daughter was murdered in her New York apartment, and her estranged husband called to tell me. I can't help wondering if he killed her, but the police have eliminated him as a suspect." Which statement is a therapeutic nursing response?
1. "I agree. What do you want to bet he did it?"
2. "Have you shared your concerns with the police?"
3. "I don't think that you should blame yourself one little bit."
4. "It feels terrible to lose a daughter. I'd have suspicions about him, too."

The nurse is assessing a client in the coronary care unit (CCU) who seems to fluctuate in his ability to focus during the day. On the basis of this assessment, which client problem should the nurse suspect?
1. Dementia as a result of isolation
2. Acute confusion as a result of CCU psychosis
3. Dementia as a result of substance intoxication
4. Interruption in the family as a result of alcohol withdrawal

A client with diabetes mellitus is told that amputation of the leg is necessary to sustain life. The client is very upset and tells the nurse, "This is all the health care provider's fault. I have done everything that he has asked me to do!" How should the nurse interpret the client's statement?
1. An expected coping mechanism
2. An ineffective coping mechanism
3. A need to notify the hospital lawyer
4. An expression of guilt on the part of the client

The nurse is planning to formulate a psychotherapy group. Several clients are interested in attending the session. The nurse plans the group, knowing that which is the maximum number of group members that can be included?
1. 3
2. 8
3. 14
4. 16

A nurse assists a client with a diagnosis of obsessive-compulsive disorder (OCD) in his preparations for bedtime. One hour later the client calls the nurse and says that he is feeling anxious; he asks the nurse to sit and talk for a while. Which is the appropriate initial nursing action?
1. Sit and talk with the client.
2. Ask the unlicensed assistive personnel to sit with the client.
3. Administer the prescribed as-needed antianxiety medication.
4. Tell the client that it is time for sleep and that you will talk with him tomorrow.

A nurse is planning care for a group of clients on a mental health unit. The nurse notes that most of the assigned clients require interventions commonly used to treat anxiety disorders. Such antianxiety interventions would be appropriate for which clients? Select all that apply.
1. A client with panic disorder
2. Generalized anxiety disorder
3. A client with multiple personality disorder
4. A client with posttraumatic stress disorder (PTSD)
5. A client with obsessive-compulsive disorder (OCD)

A nurse is preparing to admit a client with a diagnosis of obsessive-compulsive disorder (OCD) to the mental health unit. The nurse would expect to note which behaviors in the client?
1. Suspicious and hostile
2. Flexible and adaptable
3. Frightened and delusional
4. Rigidness in thought and inflexibility

A nurse is performing an assessment on a client admitted to the mental health unit. The client tells the nurse that she cannot leave home without checking numerous times that the iron and coffee pot have been shut off. The client states that this activity makes her late for many functions and that she misses engagements on occasion because of it. The nurse would expect to note which anxiety disorder documented in the client's record?
1. A phobia
2. Generalized anxiety disorder
3. Posttraumatic stress disorder (PTSD)
4. Obsessive-compulsive disorder (OCD)

A nurse is performing an assessment on a client admitted to the mental health unit. The nurse notes that the client's diagnosis is documented as obsessive-compulsive disorder. The nurse plans care knowing that the client is most likely to experience which type of compulsive behavior?
1. Fears
2. Actions
3. Illusions
4. Thoughts

A mental health nurse asks a nurse orientee to describe the underlying pathophysiology associated with acts of compulsion, such as repeated hand washing, performed by clients with obsessive-compulsive disorder (OCD). The nurse determines that the orientee understands this disorder if the orientee identifies which characteristic of the client?
1. Unaware that the client is performing the ritual
2. Consciously attempting to punish the self or others
3. Unconsciously controlling unpleasant thoughts or feelings
4. Responding to "the voices" telling the client to perform rituals

A nurse is performing an assessment on a client being admitted to the mental health unit. During the interview, the nurse discovers that the client suffered a severe emotional trauma 1 month earlier and is now experiencing paralysis of the right arm. Which is the initial nursing action?
1. Refer the client to a psychiatrist.
2. Encourage the client to move and use the arm.
3. Assess the client for organic causes of the paralysis.
4. Encourage the client to talk about his or her feelings.

A nurse is developing a plan of care for a client admitted to the mental health unit with a diagnosis of obsessive-compulsive disorder (OCD). What is the nurse's first priority in the plan of care?
1. Monitor for repetitive behavior.
2. Demand active participation in care.
3. Educate the client about self-care needs.
4. Establish a trusting nurse-client relationship.

A nurse is preparing to develop a care plan for a client admitted to the mental health unit with a diagnosis of obsessive-compulsive disorder (OCD). The nurse should plan to include which component as a priority in the nursing plan of care?
1. The medical diagnosis of the client
2. Individualized goals and objectives
3. Attendance at group therapy sessions
4. Self-care measures to improve hygiene

A nurse is reviewing the assessment findings documented in the chart of a client who is newly admitted to the mental health unit. The nurse notes that the client has experienced emotional turmoil and is exhibiting signs and symptoms that usually result from a loss of physical functioning, although no such loss can be confirmed medically. The nurse interprets these findings as indicating which condition?
1. Depression
2. Somatization disorder
3. Posttraumatic stress disorder
4. Obsessive-compulsive disorder

The home health nurse visits an older adult client who has recently lost her husband. The client says, "No one cares about me anymore. All the people I loved are dead." Which is the appropriate response?
1. "Right! Why not just ‘pack it in'?"
2. "That seems rather unlikely to me."
3. "I don't believe that, and neither do you."
4. "You must be feeling all alone at this point."

A depressed client who appeared sullen, distraught, and hopeless a few days ago now suddenly appears calm, relaxed, and more energetic. Which is the nurse's best initialaction with regard to the client's altered demeanor?
1. Continue to assess the client's behaviors and document clearly in the chart.
2. Report to the health care provider that the client is adapting to the unit and is feeling safe.
3. Notify the health team of these observations and alert them to the suspicion that the client is contemplating suicide.
4. Engage the client in one-to-one supervision, share with the client the observations that have been assessed, and ask whether the client is thinking about suicide.

The nurse is performing an assessment on a 16-year-old female client who has been diagnosed with anorexia nervosa. Which statement, if made by the client, would the nurse identify as necessitating further assessment on a priority basis?
1. "I check my weight every day without fail."
2. "I've been told that I am 10% below ideal body weight."
3. "I exercise 3 to 4 hours every day to keep my slim figure."
4. "My best friend was in the hospital with this disease a year ago."

A nurse is assessing a client in crisis and is determining the potential for self-harm. Which assessment data would indicate that the client is at very high risk for suicide?
1. The client is impulsive.
2. The client is disorganized.
3. The client has a history of suicide attempts.
4. The client has an immediate plan for a suicide attempt.

The nurse is planning to instruct a mental health client and his or her family about the importance of medication compliance. The nurse should plan for which interventions that are associated with increased compliance? Select all that apply.
1. Giving all medications just once per day
2. Including the family in the medication planning process
3. Working with the psychiatrist to find the right medication at the right dose
4. Providing the client with the injectable, long-acting form of the medication if available
5. Working with the psychiatrist to find the medication that provides the least side effects for the client

The nurse is planning care for a client who has been hospitalized for violent behavior and is at risk for harming others. Which intervention could potentially present a danger to the client, health care providers, and others on the nursing unit?
1. Facing the client when providing care
2. Assigning the client to a room at the end of the hall
3. Ensuring that a security officer is within the immediate area
4. Keeping the door to the client's room open when providing care to the client

A nurse who is caring for a client with severe depression is planning activities for the client. The nurse goes to the activity room and finds a puzzle; a checkerboard game; a paint-by-number picture; and crayons, colored pencils, and paper for drawing. Which activity would be most appropriate for this client?
1. Drawing
2. Playing checkers
3. Painting by numbers
4. Putting a puzzle together

The nurse is developing a plan of care for a client who is scheduled to have electroconvulsive therapy (ECT). Which problem is a priority for this client?
1. Fear
2. Anxiety
3. Risk for aspiration
4. Worry about body image

A female client in a manic state emerges from her hospital room. She is topless and is making sexual remarks and gestures toward the staff and other clients. Which is the best initial nursing action?
1. Ignore the client.
2. Tell the client to go back to her room.
3. Escort the client to her room and assist her in getting dressed.
4. Tell the other clients to go into the nursing unit day room immediately.

A nurse is monitoring a group therapy session. During this session the members are identifying tasks and boundaries. The nurse determines that these activities are characteristic of which stage of group development?
1. Forming
2. Storming
3. Norming
4. Performing

When planning discharge care for a client with bipolar disorder, the nurse determines theneed for further teaching when the client makes which statement?
1. "I hope I am going to like my new counselor."
2. "I sure hope I will still be productive at work."
3. "I am going to keep a close check on any stress in my life."
4. "I will take the medicine until I am sure I am feeling well enough to handle my problems again."

A client has consented to participate in Alcoholics Anonymous (AA) community groups after discharge from the hospital. The nurse is monitoring the client's response to the substance abuse sessions. Which statement by the client best reflects the development of an effective coping response style and effective processing of information for self-use?
1. "I know I'm ready to be discharged. I feel like I can say ‘no' and leave a group of friends if they are drinking. No problem."
2. "I'll keep all my appointments and go to all my AA groups; I'll do everything I'm supposed to. Nothing will go wrong that way."
3. "I'm looking forward to leaving here. I will miss all of you. So, I'm happy and I'm sad, I'm excited, and I'm scared. I know that I have to work hard to be strong and that everyone isn't going to be as helpful as you people."
4. "This group has really helped a lot. I know it will be different when I go home. But I'm sure that my family and friends will all help me like the people in this group have.... They'll all help me.... I know they will.... They won't let me go back to old ways."

A client who is on lithium carbonate will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse should include which precaution?
1. Avoid soy sauce, wine, and aged cheese.
2. Have the blood lithium level checked every 2 weeks.
3. Take the medication only as prescribed because it can become addicting.
4. Check with the psychiatrist before using any over-the-counter medications.

The home health nurse visits an agoraphobic client who experiences panic attacks. Which statement by the client would indicate a therapeutic response to behavioral and pharmacological treatment?
1. "I took an extra pill for anxiety and got through the funeral fairly well."
2. "Taking my anxiety pills before I leave has helped me to cross the bridge and go to work every morning."
3. "I went to the movies with my family and stayed through the whole film by sitting in a seat along the aisle."
4. "I have noticed that I'm becoming anxious, and I worry that if I don't take my anxiety pill just before it's due, I'll go crazy, so I get it ready to take to calm down."

The psychiatric home care nurse visits a client with a phobia who experiences panic attacks. The nurse teaches the client to use paradoxical intention and employs which method to teach the client this form of therapy?
1. Having the client confront the anxiety-provoking stimulus and providing support during the episode
2. Instructing the client to do what the client fears and, if possible, to exaggerate the outcome of this exposure to the point of humor
3. Presenting the anxiety-provoking stimulus without any preparation of the client and having him or her remain exposed until the anxiety subsides
4. Using progressive relaxation toward the client's individual anxiety hierarchy, increasing the level of difficulty, and pairing relaxation with the gradual exposure to reduce his or her anxiety

A client tentatively diagnosed with a borderline personality disorder says to the nurse, "I don't know why I got my tattoo; it was for me. OK? Sometimes I do these things to get my parents mad, and sometimes I do them because I'm bored. That's what happened the night I crashed the family car. I wasn't drunk or suicidal or anything like the police thought. It was just for kicks!" Which is the appropriate nursing response?
1. "Next time, pick less dangerous and expensive ways to explode."
2. "What can you do to stop your behavior when it gets to that point the next time?"
3. "It's a good thing that you don't abuse substances or you might be dead because of your reckless disregard."
4. "It is scary when you feel out of control with such feelings of emptiness and anger that you can't stop yourself."

The nurse is reviewing the medical record of a client who received electroconvulsive therapy (ECT) in the past. Which assessment data would indicate to the nurse the presence of long-term retrograde amnesia in the client?
1. The client has memory loss for 2 days after the procedure.
2. After the procedure, the client has difficulty recalling newly learned information.
3. The client had difficulty remembering information learned for 4 months before ECT.
4. The client has difficulty recalling newly learned information for 2 weeks following the procedure.

The mother of a teenage client with an anxiety disorder is concerned about her daughter's progress on discharge. She states that her daughter stashes food, eats all the foods that make her hyperactive, and hangs out with the "wrong crowd." In helping the mother prepare for her daughter's discharge, what instruction should the nurse provide?
1. Restrict the daughter's socializing time with her friends.
2. Restrict the amount of chocolate and caffeine products in the home.
3. Keep her daughter out of school until she can adjust to the school environment.
4. Consider taking time off from work to help her daughter readjust to the home environment.

The nurse is reviewing the record of a client scheduled for electroconvulsive therapy (ECT). Which medical diagnosis, if noted on the client's record, would indicate a need to contact the health care provider scheduled to perform the ECT?
1. Diabetes mellitus
2. Hyperthyroidism
3. Peripheral vascular disease
4. Recent myocardial infarction

A woman who is a victim of family violence is now engaged in group therapy sessions. She begins yelling at another client during the therapy session and screams, "I can't listen to this. You people are no different from the ones at home." The client stands up and tips the chair over backward. What is the nurse's immediate action?
1. Inform the yelling client that she must leave the group.
2. Call security personnel to come to the group therapy session.
3. Explore the other client's responses to the woman's yelling behavior.
4. Firmly reinforce group rules to the woman, stating that aggressive yelling is not acceptable in the group.

A client hospitalized in the mental health unit with depression is preparing to be discharged to outpatient status. The nurse is discussing termination and follow-up plans with the client. Which client statement would most concern the nurse about the client's discharge and indicate the need for follow-up treatment?
1. "I want to say thank you. I think I've worked hard and you, too. I know I'm not finished yet. I need to come back for appointments. I'm glad. I don't think I could leave totally on my own."
2. "This has been the hardest trip here for me, but I have made progress in learning how to communicate, especially with my family. I'm ready to go. I feel I'm ready this time...more than the last!"
3. "I really tried to listen to what people said in the group this time. Sometimes it was hard, but I tried to listen. I think we really helped each other. I think I've learned to listen better rather than my jumping too quickly into something."
4. "I think I really couldn't have worked that job even if the man had given me the time he should have during the interview. It's just as well. I really didn't want a job where I had to work such long hours. But I had good reason to get depressed and end up here. But it all worked out. I really didn't want that job anyway."

During a support group session for battered women, a client says, "I was abused by my father and then my husband, so I finally stabbed my husband when he came after me, but no one on the jury believed me "cause my husband, the ‘big shot,' can lie to anyone and be believed." If no one in the group responds, which statement is the therapeutic response by the nurse?
1. "A pretty horrible experience for you to undergo. Does anyone in the group want to respond?"
2. "Yes. Everyone here was ill-used and abused, but what makes you think that this is a reason to stab someone?"
3. "Your story is very much like every woman's here. I think you had other options besides violence, don't you?"
4. "Seems as if you went from one abusing man to another. Do you really think you're here because your husband is a good liar and a ‘big shot'?"

The nurse is caring for a client with Alzheimer's disease who is having difficulty recognizing objects that are well known, including people. The nurse determines that the client is experiencing which problem?
1. Ataxia
2. Agnosia
3. Apraxia
4. Aphasia

A client with schizophrenia says to the nurse, "Will you protect me from the Grand Duchess?" and points to an older client who is sitting reading a book. Which statement is the therapeutic response by the nurse?
1. "Where is she? I'll talk to her."
2. "I can see no Grand Duchess. You will need to trust me on that."
3. "You will be safe here. Your thinking will be clearer after your medication starts to work."
4. "The Grand Duchess, huh? Well, I'm the Queen, and I will order her to stay away from you."

The night nurse reported to the nurse manager that a client was admitted to the mental health unit after attacking his father with an iron for interrupting him at his computer. During nursing rounds, this client interrupts the nurse manager and says, "I need to get out of here, so I can work on my computer project to save the world!" Which statement is a therapeutic response by the nurse manager?
1. "I will be able to talk with you in 15 minutes after I complete nursing rounds."
2. "You have a project to save the world? I'd really like to hear about that after I finish rounds."
3. "Well, sit right down and eat your breakfast. You're not going to save the world on an empty stomach."
4. "You hurt your father because of these thoughts, and you won't leave here until you can control yourself better."

The nurse is performing a mental status examination on a client, and the client states, "Glass breaks if you throw stones or shoot at it with a gun. My cousin shoots guns at the police all the time at target practice. People who live in glass houses shouldn't throw stones." Which interpretation by the nurse is appropriate?
1. Speech is incoherent and tangential.
2. Speech is illogical and loosely associated.
3. Speech is distractible and contains flight of ideas.
4. Speech is pressured and contains clang associations.

The nurse is caring for a client with schizophrenia who states, "I decided not to take my medication because I realize that it really can't help me. Only I can help me." Which nursing response would be therapeutic?
1. "Only you can help?"
2. "You decided not to take your medication?"
3. "If you can make this wise observation, you probably don't need your medication any longer."
4. "Your health care provider wants you to continue with this medication because it is helping you. Do you recall needing to be hospitalized because you stopped your medication?"

A nursing student is asked to identify suicide methods that are referred to as soft methods. The nursing instructor determines that the student understands the subject if he or she states that which is a soft method?
1. Hanging
2. Using a gun
3. Inhaling natural gas
4. Jumping off a bridge

The nurse in a mental health clinic is reviewing the records of the clients to be seen that day. The nurse determines that which client is at highest risk for suicide?
1. An African-American male lawyer who is 47 years old and recently divorced
2. A 25-year-old housewife who is married to a widower and has one 2-year-old son and a 3-year-old stepdaughter
3. A single parent who failed the general equivalency diploma examination and whose six children are on scholarship in graduate and medical schools
4. An 18-year-old alcohol- and drug-abusing youth who must tell his parents that he failed to pass an examination required for graduation from high school

The spouse of an alcoholic client is attending a support group and says to the group members, "It's all very well for everyone to label me an enabler, but if I didn't call him in sick at work, he'd lose his job. Where would we be then?" Which statement by the nurse co-leader would be therapeutic?
1. "Does anyone in the group want to respond to that?"
2. "So you only call him in sick because you are worried about money?"
3. "Do you know that enabling creates codependency? Isn't viewing his failure as yours significant?"
4. "Do you need a house to fall on you to understand this disease? Can someone else deal with this client's statements?"

A heroin-addicted client who is taking methadone hydrochloride (Dolophine) discontinues the methadone without consulting the health care provider. The client says to the nurse, "I thought I didn't need the methadone after 1 year. I had a job and was even saving money. I can't believe I ruined everything." Which statement by the nurse is therapeutic?
1. "It sounds as if everything you do is either all-or-none."
2. "Your counselor called and asked for you, so it would seem that everything isn't ruined yet."
3. "The methadone program is now refusing you, and your boss fired you, so you're at square one, so to speak."
4. "It does sound as if you need to work on repair, but now you will need to be more alert to your signs of being vulnerable to slipping off your treatment program."

An alcohol-troubled client says, "The 12 Steps of Alcoholics Anonymous (AA) freak me out. I had to go for a drink after 1 hour with those people; they're fanatics!" Which statement by the nurse would be therapeutic?
1. "It sounds as if you look for any reason to drink!"
2. "I agree. AA is definitely not for you if you find it is a trigger to restart drinking."
3. "You think AA is for fanatics? You know, I just don't understand how you can judge individuals who are sober."
4. "Not all strategies for remaining sober are the best for everyone. It seems that you don't view yourself as having the same problem as others in the group."

A 37-year-old client who is recovering from benzodiazepine dependence says, "I think I've walked under a black cloud. I've lost so many people. First, my brother dies of the big C; then my husband leaves me for a 20-year-old bimbo. I wish I had a Xanax right now." Which statement by the nurse would be therapeutic?
1. "The big C—it must have been a terrible loss for you when your brother died."
2. "Did you ever stop to think that your spouse might have gotten fed up with your using Xanax so much?"
3. "It sounds as if you feel that all of this has just happened to you. I wonder what part you played in events?"
4. "Can you tell me what you think the Xanax can do for you? Are there other things you used to do that might help you just as well?"

The husband of an alcohol-troubled wife says, "If anyone had said I'd be henpecked, I'd have called them a liar, but now I realize that I'm codependent." Which statement by the nurse would be therapeutic?
1. "Did you know that more people identify with just what you are saying?"
2. "Which of the features that describe codependence caused you to sit up and take notice?"
3. "Can you tell me more about that? You see yourself as being codependent with your wife?"
4. "Have you discussed your feelings with your wife? What does your wife think about what you've said?"

A 45-year-old client states that he used to drink a cocktail nightly after work and also had a drink with his meal. Now he has two drinks before dinner and two or three more drinks during his meal. As the client continues to describe his alcohol intake, the nurse discovers that he also has added a couple of drinks at night to help him sleep. Which is the most accurate assessment of his alcohol consumption?
1. Tolerance
2. Addiction
3. Adjustment
4. Heavy social drinking

A battered wife says, "My husband never beat me up, so I didn't think he was abusive even after he lost all our money through bad deals, bullying me into his schemes, gambling, womanizing, and now not holding a real job with benefits. I still let him refinance our mortgage, take money out of the bank, and put the house in his name." Which statement by the nurse is therapeutic?
1. "When did you do that? How could you be so gullible?"
2. "Most emotionally battered spouses begin to heal once they start to identify their husbands' behaviors."
3. "How is it that a man who doesn't earn the chief supporting income can maneuver someone like he has?"
4. "So you realize that there are many ways to erode someone's self-confidence and independence? Can you share with me some ways that you feel you can cope with this abuse?"

An 80-year-old resident in a long-term care facility prepares to walk out into a rainstorm after saying, "My father is waiting to take me for a ride." Which is the appropriate response by the nurse?
1. "I need to place you in restraints."
2. "I need you to sign a form before leaving."
3. "How old are you? Your father must no longer be living."
4. "I'm glad you told me that. Let's have a cup of coffee, and you can tell me about your father."

A client who is exhibiting psychotic behaviors is admitted to the psychiatric unit. In developing a plan of care, the nurse should identify which as the priority client problem?
1. Disturbed thought processes
2. Lack of knowledge about the behavior
3. Inability to care for self with bathing procedures
4. Altered nutrition: inadequate consumption of food

The nurse is developing a daily care program for a depressed client who was just admitted to the mental health unit. Which is the best approach when planning activities for this client?
1. Plan nothing until the client asks to participate in milieu.
2. Encourage the client to play solitaire while providing a deck of cards.
3. Provide a structured daily program of activities and encourage the client to participate.
4. Offer the client a menu of daily activities and insist that the client participate in all of them.

A client with a history of panic disorder comes to the emergency department and states to the nurse: "Please help me—I think I'm having a heart attack." What is the priority nursing action?
1. Assess the client's vital signs.
2. Identify the client's activity during the pain.
3. Assess for signs related to a panic disorder.
4. Determine the client's use of relaxation techniques.

The nurse reviews the assessment data of a client admitted to the hospital with a diagnosis of anxiety. The nurse should assign priority to which assessment finding?
1. Tearful, self-isolated
2. Affect bland, withdrawn
3. Fist clenched, pounding table, fearful
4. Temperature 98.4° F; respirations 18 breaths/min

A home care nurse suspects that a client's spouse is experiencing caregiver strain. Which nursing action will assist in supporting the nurse's suspicion?
1. Obtaining feedback from the client about the coping abilities of the caregiver
2. Gathering subjective and objective assessment from the caregiver and the client
3. Making a referral to the home care agency social worker to complete the assessment
4. Waiting until the caregiver expresses concern about the significant responsibility in caring for the client

A client who has a history of being sexually assaulted is admitted to a psychiatric unit for self-mutilation. She is found sucking her thumb while rocking in her bed and does not respond to verbal communication. The nurse should recognize that this behavior demonstrates which coping mechanism?
1. Fantasy
2. Regression
3. Displacement
4. Compensation

A client is being evaluated for possible antisocial personality disorder. Which behavior is expected of a client with this disorder?
1. Asking for reassurance
2. Hypervigilance around others
3. Disregard for the rights of others
4. Always wanting to spend time with others

The client with a diagnosis of dependent personality disorder is most likely to have problems coping with which issue?
1. Trust
2. Socialization
3. Making decisions
4. Self-centeredness

Which piece of subjective data obtained during assessment of a severely anxious client would indicate the possibility of posttraumatic stress disorder?
1. "I'm afraid to go outside."
2. "I keep reliving the abuse."
3. "I am afraid to drive on the freeway."
4. "I keep washing my hands over and over."

A client admitted to the hospital at the beginning of the nursing shift with a diagnosis of alcohol dependence tells the nurse that she had her last drink 6 hours ago. The nurse expects which finding based on knowledge of time for appearance of withdrawal symptoms?
1. The danger time has passed.
2. The next hour could be critical.
3. Signs may appear during the present shift.
4. Withdrawal will occur after the shift is over.

Thiamine supplementation and other nutritional vitamin support measures are prescribed for clients who have been using alcohol to prevent or decrease the risk of which complication?
1. Cirrhosis
2. Delirium tremens
3. Esophageal varices
4. Wernicke-Korsakoff syndrome

Which mental health professional is responsible for the milieu in an inpatient psychiatric setting?
1. Nurse
2. Psychiatrist
3. Psychologist
4. Social worker

Which best describes the purpose of behavioral therapy?
1. Fosters positive behavioral change
2. Develops structure and organizes time
3. Creates insight into maladaptive behavior
4. Decreases stress through relaxation training

The client experiencing a great deal of stress and anxiety is being taught to use self-control therapy. Which statement by the client indicates a need for further teaching about the therapy?
1. "This form of therapy can be applied to new situations."
2. "An advantage of this technique is that change is likely to last."
3. "Talking to oneself is a basic component of this form of therapy."
4. "It provides a negative reinforcement when the stimulus is produced."

Laboratory work is prescribed for a client who has been experiencing delusions. When the nurse approaches the client to obtain a specimen of blood, the client begins to shout, "You're all vampires. Let me out of here!" Which is the appropriate nursing response?
1. "What makes you think that I am a vampire?"
2. "I'll leave and come back later for your blood."
3. "I am not going to hurt you; I am going to help you."
4. "It must be frightening to think that others want to hurt you."

A supervisor reprimands the nurse in charge of the nursing unit because the charge nurse has not adhered to the unit budget. Later that afternoon the charge nurse accuses the nursing staff of wasting supplies. What type of behavior is this an example of?
1. Denial
2. Repression
3. Suppression
4. Displacement

A client comes to the emergency department following an assault and is extremely agitated, trembling, and hyperventilating. What is the appropriate initial nursing action?
1. Begin to teach relaxation techniques.
2. Encourage the client to discuss the assault.
3. Remain with the client until the anxiety decreases.
4. Place the client in a quiet room alone to decrease stimulation.

A client comes to the emergency department following an assault and is extremely agitated, trembling, and hyperventilating. What is the appropriate initial nursing action?
1. Begin to teach relaxation techniques.
2. Encourage the client to discuss the assault.
3. Remain with the client until the anxiety decreases.
4. Place the client in a quiet room alone to decrease stimulation.

A woman comes into the emergency department following an assault. She presents with hyperventilation, pacing, rapid speech, and headache. Which level of anxiety should the nurse assess that the client is experiencing?
1. Panic
2. Severe
3. Moderate
4. Psychotic

A nurse is developing a plan of care for the client who is upset following the loss of a job. The client is verbalizing concerns regarding the ability to meet financial obligations. Which is the appropriate client problem?
1. Anxiety
2. Confusion about social roles
3. Inability to meet role expectations
4. Impairment of interactions among family members

A client arrives in the emergency department in a crisis state. The client demonstrates signs of profound anxiety and is unable to focus on anything but the object of the crisis and the effect on self. Which item should the initial nursing assessment focus on?
1. The object of the crisis
2. The client's coping mechanisms
3. The presence of support systems
4. The physical condition of the client

A clinic nurse is monitoring a client with anorexia nervosa. Which statement, if made by a client, should indicate to the nurse that treatment has been effective?
1. "I'll eat until I don't feel hungry."
2. "I no longer have a weight problem."
3. "I don't want to starve myself anymore."
4. "My friends and I went out to lunch today."

A client with a history of anxiety appears to be in the second phase of crisis response. The nurse prepares for the possibility that which will occur?
1. The client will show the initial signs that coping methods are failing.
2. The client will employ new coping methods that will resolve the problem.
3. The client will experience severe anxiety as a result of failed coping methods.
4. The client will begin to implement coping methods that have been successful in the past.

Which is the primary goal of crisis intervention therapy?
1. Introduce new, effective coping methods to the client.
2 .Assess the client in order to identify the causative stressors.
3. Establish a sustainable therapeutic nurse-client relationship.
4. Assist the client in returning to the level of pre-crisis functioning.

Which statement, if made by a client who has recently experienced an emotional crisis, ismost likely to assure the nurse that she has returned to her pre-crisis level of functioning?
1. "My husband tells me that I'm back to my old cheerful self."
2. "When I find myself getting stressed, I immediately use the relaxation techniques I've learned."
3. "My boss tells me that I'm being considered for a promotion and a raise."
4. "I have a different perspective on life now. I'm more confident of my ability to handle any problem."

A homeless shelter has sustained severe damage as a result of a fire, and most of the structure and people's belongings were destroyed. Ten of the individuals who are being displaced have a history of chronic mental illness. The mental health team coordinating support initially should focus their efforts on which action?
1. Assessing the clients' need for supportive therapy
2. Evaluating the clients for signs of stress overload
3. Providing the clients with shelter, clothing, and food
4. Planning means for the clients to receive their medications

A small rural community has experienced a hurricane that has destroyed 65% of the homes and businesses in the area. Community mental health teams recognize that in the immediate post-disaster period, the most effective means of identifying individuals experiencing difficulty coping psychologically with the disaster is to take which action?
1. Establish a centrally located mental health disaster center.
2. Ask for referrals from local health care providers and clergy.
3. Station mental health professionals at established assistance centers.
4. Distribute fliers identifying the availability of psychological counseling.

The nurse is preparing a care plan for a client exhibiting negative symptoms of schizophrenia. Which are indicative of negative symptoms? Select all that apply.
1. Short attention span
2. Delusional thoughts
3. Inappropriate body movements
4. Loose associations of thought
5. Limited ability to communicate verbally

The nurse caring for a client diagnosed with schizophrenia should include which interventions into the plan of care to assist in managing the client's concrete thinking?
1. Provide the client with written instructions regarding the routine of the unit.
2. Present verbal instructions regarding expectations in single, simple commands.
3. Assess the client's understanding of instructions by requiring restatement of expectations.
4. Incorporate family members in determining the emotional and physical needs of the client.

The nurse understands that schizophrenia hinders a client's cognitive ability to appropriately process data from external stimuli. This dysfunctional processing can result in which problem?
1. Catatonia
2. Hallucinations
3. Magical thinking
4. Delusional beliefs

During the admission assessment process, the nurse observes that a client with paranoid schizophrenia has multiple dental caries and mouth ulcers. The client denies oral pain or difficulty eating and does not present any concern over the nurse's finding. The nurse recognizes the client's response as most likely the result of which client factor?
1. Apathy
2. Impaired pain perception
3. Distrust of authority figures
4. Poor verbal communication skills

A client who is watching television in the dayroom shares with the nurse that he has begun seeing his mother being assaulted on the television screen. Which is the nurse's initial intervention?
1. Turn off the television.
2. Walk with the client around the unit.
3. Discuss the possible hallucinatory triggers.
4. Help him call his mother so he can speak with her.

The nurse is planning relapse prevention information for a client with schizophrenia who is being discharged. The nurse understands that it is important to ensure which primaryintervention in the plan whenever possible?
1. Including the client's support system in the teaching
2. Facilitating weekly maintenance therapy for the client
3. Having the client restate discharge goals and strategies
4. Stressing the importance of client compliance with the medication plan

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as, "I'm such a failure. I can't do anything right." Which is the best nursing response?
1. Tell the client that this is not true, that we all have a purpose in life.
2. Identify recent behaviors or accomplishments that demonstrate the client's skills.
3. Reassure the client that you know how the client is feeling and that things will get better.
4. Remain with the client and sit in silence. This will encourage the client to verbalize feelings.

The history assessment of a client diagnosed with schizophrenia confirms a routine that includes smoking two packs of cigarettes and drinking 10 cups of coffee daily. The nurse recognizes that which is the greatest risk for injury these behaviors present for this client?
1. Developing lung cancer and/or other respiratory disorders
2. Withdrawal symptoms triggering a stress-induced relapse
3. Diminishing the effectiveness of psychotropic medication
4. Developing gastrointestinal disorders, including bleeding ulcers

The nurse should identify which best goal for a client experiencing hallucinations?
1. Support the client through the hallucination in a caring, therapeutic manner.
2. Provide the client with insight as to why he is experiencing the hallucination.
3. Facilitate the client's awareness that the hallucination is not the reality of the world.
4. Help the client understand that he can learn to ignore the hallucination through appropriate coping mechanisms.

The parents of a young adult have expressed concerns about the cognitive and emotional changes they have noted in their child. The nurse recognizes which assessment and diagnostic data as associated with the diagnosis of schizophrenia? Select all that apply.
1 .A birthday of March 30
2. A loss of interest in hobbies
3. A suicide attempt 6 months ago
4. Adopted by family at age 14 months
5. Brain scan shows increased blood flow to the frontal lobes
6. Magnetic resonance imaging shows temporal lobe atrophy

The nurse reviewing a client's diagnostic results recognizes that which is a possible positive indication for a diagnosis of schizophrenia?
1. Abnormally high blood flow to the frontal lobes
2. Atrophy of both the limbic structures and cerebellum
3. Abnormally small fissures on the surface of the brain
4. Atrophy of the lateral and/or third ventricles of the brain

The nurse should provide which information to the parents of a teenager about their child's new diagnosis of schizophrenia?
1. Their child will very likely experience difficulty in school.
2. The prognosis for their child is good because he is so young.
3. Their child likely has an imbalance of the chemical dopamine.
4. With medication, their child is not likely to experience relapses.

The nurse should include which information in the medication teaching plan for a client diagnosed with schizophrenia?
1. Coffee, tea, and soda consumption should be limited.
2. If the client is compliant, the relapse of symptoms will never occur.
3. Psychotropic medications may cause mild cardiovascular symptoms.
4. Most schizophrenic clients are able to taper off their medications eventually.

Which statement made by a severely depressed client requires the nurse's immediate attention?
1. "Feeling better really isn't important to me anymore."
2. "No one can really understand what I've had to deal with."
3. "I really don't like the way that new depression pill makes me feel."
4. "I've not been the least bit interested in socializing since my divorce."

The nurse is developing a discharge plan for the family of a client diagnosed with a mood disorder. The nurse should plan to include which priority information to the family?
1. Signs that the client may be considering suicide
2. Brain anomalies that are responsible for this disorder
3. The importance benzodiazepines play in the management of this disorder
4. The possibility that the client will experience medication-induced tinnitus

Which are characteristics of seasonal affective disorder (SAD)? Select all that apply.
1. Affects males more often than females
2. Stimulates a craving for carbohydrates
3. Is related to abnormal melatonin metabolism
4. Usually results in debilitating symptomatology
5. Improves during the spring and summer months
6. Is a result of alterations in the available amounts of sunlight

When assessing a client's possible physical dependency on alcohol, the nurse should ask which priority question?
1. "Are you drinking more than you did 5 years ago?"
2. "How do you feel when you haven't had a drink all day?"
3. "Does your drinking ever cause you problems with your family?"
4. "Do you ever feel that you really need a drink to calm your nerves?"

Which are the most likely characteristics of an alcohol abuser? Select all that apply.
1. Male
2. Single
3. Suicidal at least once
4. Abusing drugs as well as alcohol
5. Employed in a minimal wage job
6. Been through detoxification at least twice

The nurse is providing a health promotion session to a group of teenagers and is discussing the abuse of barbiturates. The nurse should provide which information to the teenagers?
1. Commonly results in a rush of energy
2. Is the cause of many drug overdose deaths
3. Results in only psychological dependency
4. Brings about an increase in blood pressure (BP)

Which is a common outcome that results from the effect of methamphetamine abuse on the vascular system?
1. Poor wound healing
2. Thrombophlebitis
3. Hypotension
4. Emboli

An adolescent has been prescribed an amphetamine to help manage a diagnosis of attention deficient hyperactivity disorder. To best minimize the risk of abuse and/or overdose, the nurse expects that the medication will be administered via which method?
1. Sublingual tablets
2. Rectal suppository
3. Intradermal patch
4. Weekly intramuscular injections

A client who has a history of opiate abuse asks the nurse, "Why do I crave this stuff so much?" The nurse responds, knowing that the client's craving is a result of which factor?
1. Lack of naturally occurring endorphins
2. Development of tolerance for the drug
3. Client's psychological dependency on opiates
4. Typical abuse pattern for central nervous system (CNS) depressants

When admitting a client to the mental health unit who has a history of hallucinogenic drug use, the nurse should be prepared to manage which occurrences unique to abuse of this classification of drugs?
1. Flashbacks
2. Amotivational syndrome
3. Enhanced physical strength
4. Absence of pain perception

When discussing an individual's tendency to substance abuse, the nurse should identify which as a primary biological factor?
1. Male gender
2. Family history
3. Ethnic background
4. Risk-taking personality

During the termination phase of the nurse-client relationship, the clinic nurse observes that the client has made several sarcastic remarks and has an angry affect. Which is the most appropriate interpretation of the client's behavior?
1. The client needs to be admitted to the hospital.
2. The client needs to be referred to the psychiatrist as soon as possible.
3. The client requires further treatment and is not ready to be discharged.
4. The client is displaying typical behaviors that can occur during termination.

A home health nurse is talking to the spouse of a client who is taking an antidepressant. The spouse says, "Now that my husband is responding to the antidepressant, the suicidal risk is over and you can stop making these home visits." After analyzing this statement, which is the appropriate nursing response?
1. "I need to continue with my visits. Your comment reflects a lack of knowledge that this disease runs in families."
2. "I agree with you. Clients who want to kill themselves are suicidal for only a limited time. No one can feel self-destructive forever."
3. "I agree with you. The suicidal threats were really attention seeking. Continuing to visit would reinforce your husband's use of manipulation."
4. "I need to continue with my visits. Most suicides occur within 3 months after improvement begins, because the client now has the energy to carry out the suicidal intentions."

A client comes into the emergency department in a severe state of anxiety after a car crash. Which is the appropriate nursing intervention?
1. Remain with the client.
2. Put the client in a quiet room.
3. Teach the client deep breathing.
4. Encourage the client to talk about her feelings and concerns.

The nurse assesses a client with an admitting diagnosis of bipolar affective disorder, mania. Which symptom presented by the client would require the nurse's immediate intervention?
1. Outlandish behaviors and inappropriate dress
2. Nonstop physical activity and poor nutritional intake
3. Grandiose delusions of being a royal descendent of King Arthur
4. Constant, incessant talking that includes sexual innuendoes and teasing the staff

The nurse is performing an assessment on a client with dementia. Which would be a manifestation associated with dementia?
1. Confabulation
2. Improvement in sleeping
3. Absence of sundown syndrome
4. Presence of personal hygienic care

A client is admitted to the hospital with a diagnosis of major depression, severe, single episode. The nurse assesses the client and notes that the client has poor nutritional intake. Which is the appropriate nursing intervention?
1. Weigh the client three times per week before breakfast.
2. Explain to the client the importance of a good nutritional intake.
3. Report the nutritional concern to the psychiatrist and obtain a nutritional consultation as soon as possible.
4. Schedule brief nursing interactions with the client during several meals in which small portions are offered.

A client with a diagnosis of major depression, recurrent, with psychotic features, is admitted to the mental health unit. To create a safe environment for the client, the nurse most importantly devises a plan of care that deals specifically with which problem?
1. Nutrition
2. Self-care needs
3. Disturbed thinking
4. Knowledge about the disorder

The nurse is caring for a client with anorexia nervosa. The nurse is monitoring the behavior of the client and understands that the client with anorexia nervosa manages anxiety by which action?
1. Engaging in immoral acts
2. Always reinforcing self-approval
3. Observing rigid rules and regulations
4. Having the need always to make the right decision

The nurse has been working with a victim of rape in a clinic setting for the past 4 weeks. Which would be unrealistic as a short-term initial goal for this client?
1. Physical wounds will heal.
2. The client will participate in the treatment plan.
3. The client will verbalize feelings about the event.
4.The client will resolve feelings of fear and anxiety related to the rape trauma.

Which is the best approach for the nurse to use in crisis counseling?
1. Reassuring
2. Passive listening
3. Explore early life experiences
4. Active, with focus on the current situation

A client comes to the clinic after losing all of his personal belongings in a hurricane. The nurse notes that the client is coping ineffectively with the situation. Which is the least realistic goal for this client?
1. The client will develop adaptive coping patterns.
2. The client will identify a realistic perception of stressors.
3. The client will stop blaming himself for the lack of insurance.
4. The client will express and share feelings regarding the present crisis.

The nursing care plan indicates a problem of self-directed violence and the risk for suicide,related to suicidal ideations with a plan. An expected outcome of this plan of care would be that the client does which?
1. Displays less anxiety and agitation
2. Establishes a relationship with staff and peers
3. Develops adequate coping and problem-solving skills
4. Denies suicidal ideation and identifies options to deal with stressors

A client is admitted to the mental health unit with a problem related to grieving, because of the loss of a spouse. The client progresses well and is approaching discharge. Which is an appropriate outcome for the client?
1. The client reports three additional coping strategies.
2. The client verbalizes stages of grief and plans to attend a community grief group.
3. The client verbalizes connections between significant losses and low self-esteem.
4. The client verbalizes decreased desire for self-harm and discusses two alternatives to suicide.

A client who has been hospitalized with a paranoid disorder refuses to turn off the lights in the room at night and states, "My roommate will steal me blind." Which is the appropriate response by the nurse?
1. "Why do you believe this?"
2. "Tell me more about the details of your belief."
3. "I hear what you are saying, but I don't share your belief."
4. "If you want a pass for tomorrow evening's movie, you'd better turn that light off this minute."

A client who has just received a diagnosis of asthma says to the nurse, "This condition is just another nail in my coffin." Which response by the nurse is therapeutic?
1. "Do you think that having asthma will kill you?"
2. "You seem very distressed over learning you have asthma."
3. "I'm not going to work with you if you can't view this as a challenge rather than a ‘nail in your coffin.'"
4. "Asthma is a very treatable condition. It is important to properly administer your medications. Let's practice with your inhalant."

A 63-year-old woman whose husband died 2 months ago says to the visiting nurse, "My daughter came over yesterday to help me move my husband's things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn't know how much I'm hurting." Which statement by the nurse would be therapeutic?
1. "I know just how you feel because I lost my husband last summer."
2. "It's OK to grieve and be angry with your daughter and anyone else for a time."
3. "You need to focus on the many good years you both enjoyed together and move on."
4. "Although it's a troubling time for you, try to focus on your children and grandchildren."

An older client says to the home care nurse, "I can't believe that my wife died yesterday. I keep expecting to see her everywhere I go in this house, ready to plan our activities for the day." Which is the therapeutic nursing response?
1. "It must be hard to accept that she has passed away."
2. "Are you saying that she made all the social plans for you?"
3. "Focus on the fact that her suffering is over and that she had a good life with you."
4. "Try to focus on the fact that you have three wonderful children and that you and your wife loved one another for years."

A hospitalized client with a diagnosis of schizophrenia who is experiencing delusions says to the nurse, "I know that the doctor is talking to the top man in the mob to get rid of me." Which response should the nurse make to the client?
1. "I don't believe this is true."
2. "The doctor is not talking to the mob."
3. "What makes you think the doctor wants to get rid of you?"
4. "I don't know anything about the top man in the mob. Do you feel afraid that people are trying to hurt you?"

A nurse is gathering data from a client with a phobia. The client tells the nurse that he consistently avoids attending community functions because he fears that he will be asked to speak publicly to the members. On the basis of this information, the nurse determines that the client is experiencing which condition?
1. Nyctophobia
2. Social phobia
3. Agoraphobia
4. Claustrophobia

The nurse is monitoring a woman with a diagnosis of depression. Which behavior, if observed by the nurse, indicates that suicide precautions should be implemented for this client?
1. The woman refuses to attend group therapy.
2. The woman asks to meet with a lawyer to take care of unfinished business.
3. The woman has an argument with her significant other during visiting hours.
4. The woman swears at her roommate because she takes too much time in the bathroom.

A client is found to have rape trauma syndrome. The nurse plans care for the client knowing that which occurs in this condition?
1. More than one assault
2. Re-experiencing recollections of the trauma
3. Actively initiating situations in which sex is forced
4. Imagining the use of foreign objects in a sexual situation

A nurse working in the day care center is told that a child with autism will be attending the center. The nurse collaborates with the staff of the day care center to plan activities that will meet the child's needs. Which should have the priority consideration in planning activities for the child?
1. Safety with activities
2. Familiarity with all activities
3. Activities providing verbal stimulation
4. Social interactions with other children

A nurse is assigned to care for a chemically dependent client who has the potential for violent episodes. In planning to care for the client, which action by the nurse should receive priority?
1. Speaks slowly to the client
2. Projects an attitude of calmness
3. Bargains to prevent the violent episodes
4. Moves quietly when approaching the client

A nurse has been caring for a client with a diagnosis of depression. The client says to the nurse, "I wish you would just be my friend." Which is the appropriate response by the nurse?
1. "I am your friend."
2. "Our relationship is a therapeutic and helping one."
3. "I can't be your friend. I'm the nurse, and you're the client."
4. "You have plenty of friends. You don't need me to be your friend, too."

A nurse is developing a care plan that will include goals that will help the client achieve an optimal level of functioning and appropriate resource utilization. When the nurse enters the client's room, the client asks the nurse, "Could you ask the health care provider (HCP) to let me have a pass for the weekend?" Which response is appropriate that assists the client in achieving these goals?
1. "When your HCP comes in, I will ask for a pass for the weekend."
2. "When the HCP arrives on the unit, I will let them know that you have a question."
3. "You can't have a pass for the weekend. You are not ready, and I'm sure that your HCP will say no."
4." I will call the HCP and find out if you can have a pass so that you can make your arrangements."

Which subject should the nurse address in preparing for the orientation phase of the therapeutic relationship?
1. Facilitating behavioral change
2. Promoting self-esteem in the client
3. Promoting problem solving skills in the client
4. Establishing the parameters of the relationship

A nurse who is reviewing the record of a client admitted to the mental health unit notes that the client was admitted by voluntary status. Which statement describes voluntary status?
1. The admission was mandated by court order.
2. The admission was made without the client's consent.
3. The client has the right to demand and obtain release from the hospital.
4. The client was committed by a group of designated mental health professionals.

A nurse is collecting data on a client diagnosed with mild depression. The client says to the nurse, "I haven't had an appetite at all for the last few weeks." Which best response should the nurse make?
1. "The last few weeks?"
2. "You haven't had an appetite at all?"
3. "When the medication begins to work, you will begin to feel better."
4. "Think about everything that you have been through. It will take time for your appetite to improve."

A nurse in the emergency department is preparing to care for a client who has just been sexually assaulted. Which client behavior demonstrates denial?
1. The client is calm and quiet.
2. The client is blaming her sister for the incident.
3. The client is justifying unacceptable self-behaviors.
4. The client is verbalizing generalizations about the incident.

The day nurses in a psychiatric unit are receiving report from the night shift. While this is occurring, a client approaches the nurses' station, becomes very loud and offensive, and demands to be seen by the health care provider (HCP) immediately. Which is the appropriate nursing intervention?
1. Inform the client that the behavior is unacceptable.
2. Tell the client to wait in his or her room until report is over.
3. Tell the client that the HCP will be called as soon as report is completed.
4. Offer to assist the client to an examination room until the HCP is notified.

A nurse is developing a plan of care for a client with a psychotic disorder who is experiencing altered thoughts that include the belief food is being poisoned. Which strategy should the nurse plan to implement that will encourage the client to discuss feelings?
1. Use open-ended questions and silence.
2. Focus on the components of adequate nutrition.
3. Focus on the fact that the client's beliefs are untrue.
4. Instruct the client about the need for adequate nutrition.

A mental health nurse has been meeting with a client on a weekly basis and over the past several weeks, the client has been consistently 15 minutes late. Which nursing action is appropriate regarding the client's lateness for the scheduled meetings?
1. Ignore the behavior.
2. Tell the client that the meetings will be terminated.
3. Ask the client if something is going on that the client may have difficulty handling.
4. Because the client is consistently late, begin to arrive 15 minutes later than the scheduled time also.

A mental health nurse who has been meeting with a client with a diagnosis of post-traumatic stress disorder is in the termination phase of the nurse-client relationship. The nurse notes that the client has been quiet and withdrawn. Which interpretation should the nurse make about the client's behavior?
1. An indication of the need for antidepressants
2. An inability of the client to terminate from the nurse
3. A normal behavior that can occur during termination
4. An indication of the need for additional therapy sessions

A nurse is preparing for the arrival of a new client at a drug abusers' residential treatment center and prepares to explain to the client that the emphasis of the center is on group and social interaction, and that rules and expectations are mediated by peer pressure. Which is the most likely focus of therapy of this residential center?
1. Milieu therapy
2. Aversion conditioning
3. Systematic desensitization
4. Cognitive-behavioral therapy

A client with a phobia will be treated for the condition using a behavior modification technique known as systematic desensitization. Which describes the components of this form of therapy?
1. The client will take medication daily to control the condition.
2. The client will talk to himself or herself to control actions more effectively.
3. The client will be introduced to short periods of exposure to the phobic object while in a relaxed state.
4. The client will meet with others with the same problem in a support group that focuses on the client's phobia.

A nurse is conducting a group therapy session when a client who has shared with the group at a previous session that she isolates herself when she feels depressed, suddenly gets up to leave. Which is the appropriate nursing action?
1. Tell the client that it is not safe to leave.
2. Encourage the client to stay, and ask the client what she is feeling.
3. Tell the client that if she leaves she cannot return to this therapy group.
4. Lock the door so that the client cannot leave at this potentially vulnerable time.

A nurse is helping to conduct a group therapy session. During the session, a client threatens to act out physically and states that he will punch another member of the group. Which is the appropriate initial nursing action?
1. Tell the client that he must leave immediately.
2. Call security to come to the session immediately.
3. Tell the client that if he hits another client, he will be restrained and placed in seclusion.
4. Tell the client that he can talk about his anger but cannot act on it in during the group session.

A nurse is preparing a plan of care for a client with an autistic disorder. A behavior modification approach (operant conditioning) is being used to improve communication. Which should the nurse include in the plan of care?
1. Avoid providing rewards to the client.
2. Promote complete independence in the client.
3. Reward the client when a desired behavior is performed.
4. Provide consistent negative reinforcement to promote appropriate behaviors.

A nursing student is conducting a clinical conference and is describing the characteristics associated with milieu therapy. Which statement indicates an understanding of the focus of this form of therapy?
1. "Milieu therapy provides a cognitive approach to changing behavior."
2. "A living, learning, or working environment is the focus of milieu therapy."
3. "Milieu therapy provides a behavior modification approach type of therapy."
4. "A behavioral approach to changing behavior is the focus of milieu therapy."

A nurse working in an urgent care center is interviewing a woman with vague somatic complaints. The client states that she was raped a few weeks ago but still feels "as if it just happened to me." Which therapeutic response should the nurse make to the client?
1. "It is very, very hard to get over these types of feelings after being raped."
2. "What do you think you should do to reduce the likelihood that you will be raped again?"
3. "Tell me more about what happened, and what causes you to feel like the rape just occurred."
4. "It's hard, but try to keep a sense of perspective. After all, it's been a while since the rape occurred."

A nurse is developing a plan of care for a client at high risk for suicide who was just admitted to the psychiatric unit. The focus of the plan is to promote a safe and therapeutic environment. Which intervention should the nurse include in the plan of care?
1. Place the client in a private room.
2. Establish a therapeutic relationship.
3. Assign a leadership task to the client.
4. Maintain a distance of 10 inches at all times.

A client admitted to the mental health unit with depression states to the nurse, "My life has been such a failure. Nothing I do turns out right." Which therapeutic response should the nurse make?
1. "You are certainly entitled to your own opinion."
2. "I know just how you feel. I have those days myself once in a while."
3. "I disagree with you; we all have some value and accomplishments in life."
4. "You seem very discouraged. Can you think of anything recently that went as you planned?"

A client is admitted to the psychiatric unit with a diagnosis of bipolar affective disorder and mania. The nurse should prioritize that which symptoms or behaviors require immediate intervention?
1. Grandiose delusions of being a czar of Russia
2. Constant physical activity and poor oral intake
3. Constant, incessant talking, with sexual innuendoes
4. Outlandish behaviors and wearing odd and eccentric clothing

A nurse is working with a client who is delusional. The client says to the nurse, "The leaders of a religious cult are being sent to assassinate me." Which is the best response by the nurse?
1. "I don't believe that what you are telling me is true."
2. "There are no religious cults in this area that are going to kill you."
3. "What makes you think that cult members are being sent to hurt you?"
4. "I don't know about a religious cult. Are you afraid that people are trying to hurt you?"

A woman is seen in the emergency department in a severe state of anxiety following assault and battery. Which nursing action should the nurse place highest priority on taking at this time?
1. Remaining with the client
2. Teaching the client deep-breathing techniques
3. Encouraging the client to talk about her feelings
4. Putting the client in a quiet room, away from other clients

A mental health nurse is assigned to care for a client with a diagnosis of acute schizophrenia. The nurse should use which approach when planning care for this client?
1. Allow the client to set the goals for the plan of care.
2. Let the client act out initially, and use the quiet room and restraints as needed.
3. Provide assistance with grooming and nutrition until the client's thinking has cleared.
4. Repeatedly point out inconsistencies in the client's communication during initial treatment.

A mental health nurse is assigned to care for a client with a diagnosis of acute schizophrenia. The nurse should use which approach when planning care for this client?
1. Allow the client to set the goals for the plan of care.
2. Let the client act out initially, and use the quiet room and restraints as needed.
3. Provide assistance with grooming and nutrition until the client's thinking has cleared.
4. Repeatedly point out inconsistencies in the client's communication during initial treatment.

A nurse is talking with a client who is actively hallucinating. The client is fearful that the voices will direct him to kill himself or will hurt him directly. Which therapeutic statement should the nurse make at this time?
1. "I can hear the voices too, but they are telling you to go to bed now."
2. "I know whose voices you are hearing and told them not to hurt you."
3. "I know you believe they are going to cause you harm, but it's not true."
4. "I don't hear them, but it must be frightening to hear voices that others can't hear."

A client tentatively diagnosed with a borderline personality is admitted to the psychiatric unit for control of symptoms. Based on an understanding of personality disorders, the nurse should determine that which problem is the priority?
1. Isolating self
2. Inability to cope
3. Low self-esteem
4. Risk for self-harm

A client admitted to the inpatient unit is being considered for electroconvulsive therapy (ECT). The client is calm, but the client's daughter is hypervigilant and anxious. The daughter says to the nurse, "My mother's brain will be shocked with electricity. How can the doctor even think about doing this to her?" Which response by the nurse is therapeutic?
1. "I think you need to speak directly to the psychiatrist."
2. "Maybe you'll feel better if you see the ECT room and speak to the staff."
3. "Your mother has decided to have this treatment. You should support her."
4. "It sounds as though you are very concerned about the procedure. Let's discuss the procedure."

A nurse is assigned to a client who is psychotic, pacing, agitated, and using aggressive gestures and rapid speech. The nurse should determine that which action is the priority of care at this time?
1. Providing safety for the client and other clients on the unit
2. Offering the client a less stimulated area in which to calm down and gain control
3. Assisting in caring for the client in a controlled environment, such as a quiet room
4. Providing the other clients on the unit with a sense of comfort and safety by isolating the client

A client diagnosed with catatonic stupor is lying on the bed, hidden under the sheets, in a fetal position. Which appropriate action should the nurse should take?
1. Ask direct questions to encourage talking.
2. Leave the client alone but check on her every 30 minutes.
3. Sit beside the client in silence, with occasional open-ended questions.
4. Take the client into the dayroom with other clients for added supervision.

A client who has sustained severe injuries in a motorcycle crash was diagnosed with intensive care unit (ICU) psychosis. Which indicates to the nurse that the client's status is improving?
1. Increases the number of hours slept at one time and is increasingly alert
2. Appears to be delirious but has stopped trying to pull out the nasogastric tube
3. Tells his wife, "I feel better, but the doctors want to give me a lethal injection."
4. Keeps his eyes fixed on the nurses while they are working in the room but has stable vital signs

A nurse caring for a client recently admitted to the hospital for anorexia nervosa enters the client's room and finds her in the middle of performing rapid exercises. Which action should be the priority?
1. Interrupt the client, and offer to take her for a walk.
2. Allow the client to complete her exercise program.
3. Ignore the behavior, and return when the client is finished.
4. Tell the client that she is not allowed to exercise rigorously.

A postsurgical client with a history of heavy alcohol intake has returned to the nursing unit. Which signs/symptoms of delirium tremens (DTs) should the nurse plan to continuously assess for?
1. Coarse hand tremor, agitation, hallucinations, and hypotension
2. Hypotension, ataxia, muscular rigidity, and tactile hallucinations
3. Hypotension, stupor, agitation, headache, and auditory hallucinations
4. Fever, hypertension, changes in level of consciousness, and hallucinations

A nurse working in a detoxification unit is admitting a client for alcohol withdrawal. The client's spouse states, "I don't know why I don't get out of this rotten situation." Which is the therapeutic response by the nurse?
1. "This is not a good time to make that decision."
2. "What would your spouse think about your decision?"
3. "What aspects of this situation are the most difficult for you?"
4. "You seem to have a good grip on this situation. You probably should get out."

A nurse should monitor a client with a history of opioid abuse for which signs and symptoms associated with opioid withdrawal?
1. Tachycardia, mild hypertension and fever, sweating, nausea, vomiting, and marked tremor
2. Increased appetite, irritability, anxiety, restlessness, anxiety, and altered concentration
3. Increased pulse and blood pressure, low-grade fever, yawning, restlessness, anxiety, craving, diarrhea, and mydriasis
4. Depression, high drug craving, fatigue with altered sleep (insomnia or hypersomnia), hypertension, agitation, and paranoia

A nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse should suspect that the client has suddenly discontinued taking which prescribed medication?
1. Sertraline (Zoloft)
2. Fluoxetine (Prozac)
3. Diazepam (Valium)
4. Haloperidol (Haldol)

A nurse is admitting a client who is in a state of starvation because of anorexia nervosa. Which roommate choice is least appropriate for this client?
1. A client with pneumonia
2. A client who had back surgery
3. A client with a fractured pelvis
4. A client who has had a myocardial infarction

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I don't want help. I have other things to attend to that are more important." The nurse attempts to discuss the client's concerns, but the client dresses and begins to walk out of the hospital room. Which action should the nurse take at this time?
1. Call the nursing supervisor.
2. Call security to block the exits to the nursing unit.
3. Restrain the client, and call the health care provider (HCP).
4. Tell the client that readmission is not possible after leaving against medical advice (AMA).

A nurse should monitor the client with a history of heroin addiction for which signs/symptoms of heroin withdrawal?
1. Constipation, insomnia, and hallucinations
2. Staggering gait, slurred speech, and violent outbursts
3. Nausea, vomiting, diarrhea, muscle aches, and diaphoresis
4. Decreased heart rate and blood pressure and dry nose, mouth, and skin

A nurse is interviewing a client in crisis to assess the risk for self-harm. The nurse interprets that the client is most at risk for suicide if which is assessed?
1. Client exhibits impulsive behavior.
2. Client exhibits disorganized behavior.
3. Client has a history of suicide attempts.
4. Client has an immediate plan for a suicide attempt.

A client with a potential for violence is exhibiting aggressive gestures, making belligerent comments to the other clients, and is continuously pacing in the hallway. Which comment by the nurse would be therapeutic at this time?
1. "What is causing you to become agitated?"
2. "Why are you intent on upsetting the other clients?"
3. "Please stop so I don't have to put you in seclusion."
4. "You are going to be restrained if you do not change your behavior."

A nurse is having a conversation with a depressed client on an inpatient psychiatric unit. The client says to the nurse, "Things would be so much better for everyone if I just weren't around." Which appropriate response should the nurse make at this time?
1. "You sound very unhappy. Are you thinking of harming yourself?"
2. "Have you talked to anyone specifically about what is bothering you?"
3. "Those feelings will go away when your medication really takes effect."
4. "I know what you mean; everyone gets that way when they are depressed."

A nurse should interpret that which comment by a client whose husband uses violence against her is consistent with the presence of low self-esteem commonly found with battered wife syndrome?
1. "I'm lucky to be married to a man who really loves me the way that he does."
2. "I told him that this is his last chance. If it happens again, I'm leaving for good."
3. "I stay because there's enough in it for me. I don't have to work full time this way."
4. "Things would be fine at home if I just could do better. He has a lot of pressures on him at work."

A nurse is caring for an older client whose husband died approximately 6 weeks ago. The client says, "There's no one left to care about me. Everyone that I have loved is now gone." Which response should the nurse make to the client?
1. "That doesn't sound like the real you talking!"
2. "I'm sure you have someone if you think hard enough."
3. "It sounds as though you are feeling all alone right now."
4. "I don't believe that, and I really don't think you do either."

A client has been admitted to the inpatient psychiatric unit because the client has displayed violent behavior and is at risk for potentially harming others. What should the nurse avoid doing when caring for this client?
1. Admitting the client to a room near the nurses' station
2. Facing the client while speaking and providing nursing care
3. Arranging for a security officer to be available in the general area
4. Closing the door to the client's room when giving care to the client

A client who has attempted suicide by overdosing with a very large number of antidepressant pills has been admitted to the psychiatric unit. Which is the priority nursing action at this time?
1. Stay with the client at all times.
2. Request that a friend of the client remain with the client at all times.
3. Have the client put on a hospital gown, and remove the client's clothing from the room.
4. Suggest placing the client in a seclusion room where all potentially dangerous articles have been removed.

A client admitted to the mental health unit with major depression 3 days ago could hardly get out of bed without coaxing and needed constant encouragement to get dressed and participate in unit activities. Today the client appears in the dayroom dressed and well groomed, without any guidance from the staff. The client appears to be calm and relaxed, yet more energetic than before. Which initial action should the nurse take after noting this client's behavior?
1. Continue to monitor the client's behavior from a distance.
2. Document that the client is adapting to the unit and is feeling safe.
3. Notify the staff of these observations at the team meeting, which will begin in 3 hours.
4. Speak to the client personally about the nurse's observations, and ask if the client is thinking about suicide.

A nurse is preparing a client for discharge who was hospitalized following a suicide attempt. The nurse evaluates that the client could benefit from further development of coping strategies if the client was overheard making which statement before discharge?
1. "I know now that I can't be all things to all people all the time."
2. "It is important for me to take my medications just as prescribed."
3. "It's been good to learn better ways to deal with the stresses in my life."
4. "I know that I won't become depressed again after the treatment I received here."

A client who attempted suicide by hanging is brought to the emergency department by emergency medical services. Which is the immediate nursing action?
1. Take the client's vital signs.
2. Assess the client's respiratory status and for the presence of neck injuries.
3. Perform a focused assessment, paying particular attention to the client's neurological status.
4. Call the mental health crisis team and notify them that a client who attempted suicide is being admitted to the hospital.

An acutely depressed client is receiving cognitive-behavioral therapy. The nurse is developing a plan of care for the client and includes interventions that focus on this type of therapy. Which interventions should the nurse include? Select all that apply.
1. Assisting the client to identify and test negative cognition
2. Assisting the client to participate in the treatment process
3. Assisting the client to develop alternative thinking patterns
4. Assisting the client to rehearse new cognitive and behavioral responses
5. Assisting the client with the administration of antidepressant medications
6. Assisting the client's family to participate in group therapy on a regular basis

Which should a nurse closely monitor when caring for a hospitalized client diagnosed with bulimia nervosa? Select all that apply.
1. Electrolyte levels
2. Exercise patterns
3. Intake and output
4. Pupillary response
5. Deep tendon reflexes
6. Elimination patterns