NUR 213 Exam 3
- 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
Answer 3
(pt who is moderately depressed and has only been in the hospital 2 days is unlikely to have such a dramatic cure. When a depression suddenly lifts, it is likely that the client may have made the decision to harm himself or herself. Suicide precautions are necessary to keep the client safe)
- 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 1 / 4
3.Instructions regarding self-defense classes
4.Explaining the importance of leaving the violent situation
Answer 1
- 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. Which 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?"
Answer 3
(trash response irl though)
- 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 / 4
2.Removing the client's clothing and placing the client in a hospital gown
3.Assigning to the client a staff member who will remain with the client at all times
4.Admitting the client to a seclusion room where all potentially dangerous articles are removed
Answer 3
- Which behavior observed by the nurse indicates a suspicion that a de- pressed 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 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.
Answer 1
- A depressed client on an inpatient unit says to the nurse, "My family would be better off
without me." Which is the nurse's best response?
1."Have you talked to your family about this?"
2. 3 / 4
"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?"
Answer 4
- 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 should 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."
Answer
- 3 5
- / 4