NU 671 Mental Health Nursing Exam #1 Latest Update 2024-2025 Actual Exam 125 Questions and 100% Verified Correct Answers Guaranteed A+
A basic-level psychiatric-mental health nurse is helping with intake screening in the emergency department. What other function could the nurse perform?
- Prescribing psychopharmacological agents
- Completing a comprehensive psychiatric and mental health evaluation
- Providing integrative therapy interventions
D) Assisting with crisis intervention and stabilization - CORRECT ANSWER: D)
Assisting with crisis intervention and stabilization
A client approaches a nurse and blurts "You have got to help me! Something terrible is happening. I am falling apart. I can't think. My heart is pounding and my head is throbbing." The nurse should assess the client's level of anxiety as
- Mild
- Moderate
- Severe
D. Panic - CORRECT ANSWER: C. Severe
Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart
A client comes to the crisis intervention clinic because her boyfriend of 6 years has announced he is marrying another woman. She tearfully tells the nurse "It is so painful! I have thought about it and I cannot see how I can go on." The nurse states "You have resilience and will look back on this in a year as only a minor problem." Analysis of this interaction reveals that the nurse.
- Has a good understanding of the effect of time on perception of a crisis 1 / 4
- Is offering a statement of positive outcome based on client coping ability.
- Has not followed up on the client's verbal clues to suicidal thoughts.
- Has stepped into the territory of traditional psychotherapy. - CORRECT ANSWER: C.
Has not followed up on the client's verbal clues to suicidal thoughts.
Nurses who are uncomfortable with the idea of suicide may fail to pick up on a client's clues. This client clearly was open to discussing her suicidal thoughts or she would not have said "I cannot see how I can go on."
A client diagnosed with dependent personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate?
- It would be best to do that in order to increase independence.
- Why would you want to leave a secure home?
- Let's discuss and explore all of your options.
- I'm afraid you would feel very guilty leaving your parents - CORRECT ANSWER: C.
Let's discuss and explore all of your options.
A client has been placed in seclusion to control aggressive behavior. Care while the client is secluded should include
- Observation every 30 minutes.
- Releasing the client every 8 hours.
- Increasing sensory stimulation.
D. Providing for nutrition and hydration. - CORRECT ANSWER: D. Providing for
nutrition and hydration.
A client is demonstrating a moderate level of anxiety. She tells the nurse "I am so anxious that I could fly! I do not know what to do." A helpful response for the nurse to make would be
- "What things have you done in the past that helped you feel more comfortable?"
- "Let's try to focus on that adorable little granddaughter of yours."
- "Why don't you sit down over there and work on that jigsaw puzzle?" 2 / 4
- "Try not to think about the feelings and sensations you're experiencing." - CORRECT
ANSWER: A. "What things have you done in the past that helped you feel more comfortable?"
Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again
A client is experiencing a panic attack. The nurse can be most therapeutic by
- Telling the client to take slow, deep breaths.
- Verbalizing mild disapproval of the anxious behavior.
- Asking the client what he means when he says "I am dying."
- Offering an explanation about the role of the sympathetic nervous system in
symptom formation. - CORRECT ANSWER: A. Telling the client to take slow, deep
breaths.
Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety.Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms
A client is noted to have a high level of non-goal-directed motor activity, running from chair to chair in the solarium. He is wide eyed and seems terror stricken. He repeats "They are coming! They are coming!" He neither follows staff direction nor responds to
verbal efforts to calm him. The level of anxiety can be assessed as:
- Mild
- Moderate
- Severe
D. Panic - CORRECT ANSWER: D. Panic
Panic level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety 3 / 4
A client on one-to-one supervision at arm's length indicates a need to go to the bathroom. She tells the nurse "I cannot 'go' with you standing there." The nurse should;
- Say "I understand" and allow the client to close the door.
- Keep the door open, but step to the side out of the client's view.
- Leave the client's room and wait outside in the hall.
- Say "For your safety I can be no more than an arm's length away." - CORRECT
ANSWER: D. Say "For your safety I can be no more than an arm's length away."
A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic?
- It is quite common for clients to feel that way after a lengthy hospitalization
- Why don't you talk to your mother? You may find out she doesn't feel that way.
- Your mother seems like an understanding person. I'll help you approach her
- You feel that your mother does not want you to come back home? - CORRECT
ANSWER: D. You feel that your mother does not want you to come back home?
A client threatens to kill himself, his wife, and their children if the wife follows through with the divorce proceedings. During the pre-interaction phase of the nurse patient relationship, which interaction should the nurse employ?
- Acknowledging the client's actions and encouraging alternative behaviors.
- Establishing rapport and developing treatment goals
- Providing community resources on aggression management
- Exploring personal thoughts and feelings that may adversely impact the provision of
care - CORRECT ANSWER: D. Exploring personal thoughts and feelings that may
adversely impact the provision of care
A client who is experiencing great stress associated with a disturbing new diagnosis asks the nurse "Do you think saying a prayer would help?" The answer the nurse should give is
- "Of course you may pray if you wish. I'll leave you alone."
- "At the moment we should continue the stress assessment."
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