MENTAL HEALTH 2 Flashcards
A nurse is caring for a client who has major depressive disorder. AFter discussing the treatment with his partner, the client verbally
agrees to electroconvulsive therapy (ECT) but will not sign the consent form. Which of the following actions should the nurse take?
a) Inform the client about the risks of refusing ECT
b) Cancel the scheduled ECT procedure
c) Proceed with preparation for ECT based on implied consent
d) Request that the client’s partner sign the consent form
Answer: B
A nurse is caring for a client ho recently experienced the unexpected death of his child. Which of the following actions should the
nurse take first?
a) Initiate a referral for the client to receive individual counseling
b) Request a prescription for alprazolam
c) Identify the client’s support system
d) Ask the client if he is thinking about self-harm
Answer: D
A nurse is interviewing a client who report is ongoing feelings of depression after the death of his sibling 9 months ago. Which of
the following actions should the nurse take?
a) Encourage the client to avoid discussing the evens surrounding the sibling’s death
b) Cautions the client against feeling angry at the sibling
c) Explain the client that the duration of grief is highly variable and can last for years
d) Recommend that the client participate in more solitary activities
Answer: D (possible C – not sure)
A nurse is providing discharge teaching about manifestations of relapse to the family of a client who has schizophrenia. Which of
the following information should the nurse include in the teaching?
A) The client develops an inability to concentrate
B) The client increases participation in social activities
C) The client exhibits an inflated sense of self
D) The client begins sleeping more than usual
Answer: A
A nurse manager is observing a newly licensed nurse preparing an IM medication to a client who is manic and refuses the
medication. Which of the follow actions should the nurse manger take first?
a) Assess the need for physical restraints
b) Demonstrate how to verbally de-escalate the situation
c) Discuss the purpose of the medication with the client
d) Stop the newly licensed nurse from administering the medication
Answer: D
A nurse is developing a plan of care for a school-age child who has autism spectrum disorder. Which of the following outcomes
should the nurse include in the plan of care?
a) Assign the child to a room with another child of the same age
b) Use a reward system for appropriate behavior
c) Allow flexibility in the child’s daily schedule
d) Discourage the child from making eye contact with caregiver
Answer: C/A (not sure)
A nurse is assigning a client who has bipolar disorder. Which of the following findings should the nurse identify as an indication
that the client is to experiencing acute mania?
a) Refuses to engage in conversation
b) Reports a lack of sleep
c) Isolates self from others
d) Writes a detailed daily activity schedule
Answer: B
A nurse is reviewing the medical record of a client who has anorexia nervosa. Which of the following findings should the nurse
report to the provider? Pt ate 80% of lunch w/ encouragement. Mild Edema to the hands, feet & ankles. Client states, “It feels like my
heart is jumping in my chest.” BP 100/64 mm HG; PR 58/min; RR 16/min; Temp 36.4 (97.5); SaO2 96%; BMI 16
a) Temperature
b) Intake
c) Heart Rhythm
d) Edema
Answer: C
A nurse in an acute care mental health facility is receiving morning report for a group of clients. Which of the following clients
should the nurse see first?
a) A client who is depressed and occasionally expresses suicidal thought but whose mood is report to have improved this morning
b) A client who has generalized anxiety disorder and report being frightened about an upcoming dental appointment
c) A client who has posttraumatic stress disorders and is reported to have experienced a flashback during the night
d) A client who was recently admitted has severe negative manifestation of schizophrenia, and is refusing to get up for breakfast
Answer: A (not sure, even though reported that the client is improving, client still has history of suicidal thoughts); B is not safety
concern; C, flashback is not safety concern; D, even if negative symptoms, patient is just refusing breakfast and it is not safety concern
A nurse is teaching the family of a client who has Alzheimer’s disease about safety interventions for nighttime wandering. Which
of the following interventions should the nurse include?
a) Place rubber backed throw rugs on tiles floors
b) Encourage the client to take naps during the day
c) Place the client’s mattress on the floor
d) Install locks at the bottom of the exit doors
Answer: A (safety concern, at night, patient are at risk of fall);
B, no!; C, weird?; D, at risk for wandering, but not safety concern.
A nurse is assessing a child in the ER. Which of the following findings places the child at greatest risk for physical abuse?
a) The child is homeschooled
b) The child is 10 years old
c) The child has no siblings
d) The child has cystic fibrosis
Answer D
A nurse is caring for a client who is undergoing electroconvulsive therapy. Which of the following tasks should the nurse delegate
to an assistive personnel?
a) Give the client atropine 30 mins before the procedure
b) Check the client’s coordination after the procedure
c) Witness the client’s signature on the consent for the procedure
d) Assist the client to ambulate for the first time following the procedure
Answer: D
A nurse is caring a client who was involuntary committed and is scheduled to receive electroconvulsive therapy (ECT). The client
refuses treatment and will not discuss why with the health care team. Which of the following actions should the nurse take?
a) Inform the client that the ECT does not require client consent
b) Document the client’s refusal of the treatment in the medical record
c) Ask the client’s family to encourage the client to receive ECT
d) Tell the client he cannot refuse the treatment because he was involuntarily committed
Answer: B
A nurse is caring for a client who is experiencing manifestation of alcohol withdrawal, which of the following medications should the nurse plan to administer? a) Methadone b) Clozapine c) Bupropion d) Lorazepam
Answer: D (benzodiazepine)
A nurse is evaluation the medication response of a client who takes naltrexone for the treatment of alcohol use disorder. The nurse
should identify that which of the following is a therapeutic effect of this medication?
a) Decrease the likelihood of seizures
b) Prevents the anxiety of abstinence
c) Blocks aidette dehydrogenase
d) Reduces substance craving
Answer: D
A nurse is caring for a client who has bipolar disorder and is experiencing a manic episode. Which of the following actions should
the nurse take?
a) Administer methylphenidate to the client
b) Dim the lights in the client’s room
c) Encourage the client to join group activities
d) Provide detailed explanations to the client
Answer: B (reduce stimulants causing manic episode)
A, medicine is for ADHD
C, will stimulate the client more
D, during manic episode, patient won’t be able to remember or concentrate
A nurse is caring for a school-age child who has conduct disorder and is being physically aggressive toward other children on the
unit. Which of the following actions should the nurse take first?
a) Use a therapeutic hold technique
b) Administer risperidone
c) Apply wrist restraints
d) Place the child in seclusion
Answer: A or D (I think it’s more A)
A charge nurse is discussing the care of a client who has a substance use disorder with a staff nurse. Which of the following
statements by the staff nurse should the charge nurse identify as countertransference?
a) “The client generally shares his feelings during group therapy session.”
b)“The client asked me to go on a date with him but I refused.”
c)“The client is just like my brother who finally overcame his habit.”
d) “The client needs to accept responsibility for his substance use.”
Answer: C
