HESI PN MENTAL HEALTH
A confused and disoriented client is admitted to the psychiatric
unit diagnosed with posttraumatic stress disorder (PTSD). The
nurse initially plans to take which action with this client? –
ANSWER- Accept the client as a person and make the client
feel safe.
A furiously angry and aggressive client was put in restraints and
was told that the restraints would be removed once the client
regained control. The nurse appropriately removes the restraints
when which action occurs? – ANSWER- When no acts of
aggression are observed within 1 hour after release of two
extremity restraints
The nurse is preparing to admit a client diagnosed with
obsessive-compulsive disorder (OCD) to the mental health unit.
The nurse should observe this client for which behavioral
characteristic(s)? – ANSWER- Inflexibility and rigidity
A client in the mental health unit engages in repeated hand
washing throughout the day. The nurse understands that these
repetitive behaviors develop for which reason? – ANSWER- The
client is unconsciously attempting to control unpleasant thoughts
or feelings.
A client who has developed paralysis of the lower extremities is
admitted to the hospital. The client shares information with the
nurse regarding a severe emotional trauma that occurred 6
weeks ago. The nurse develops a plan of care, knowing which
action is the priority? – ANSWER- Look for organic causes of
the paralysis.
A client with obsessive-compulsive disorder (OCD) who
continually cleans the bathroom becomes enraged with the
roommate for using the bar of bathing soap for cleaning the
bathroom. The client begins to yell and slaps the roommate.
Which action should the nurse take first? – ANSWER- Remove
both clients to a separate, safe location.
The nurse is assigned to assist in the care of a client with
obsessive-compulsive disorder (OCD). The nurse should place
first priority on which action when planning care for this client?
- ANSWER- Establish a trusting nurse-client relationship.
The nurse is preparing a care plan for the client with obsessivecompulsive disorder (OCD). The nurse should focus on which as
the primary means to accomplish work with this client? –
ANSWER- Goals and objectives
The nurse is employed in a mental health clinic that specifically
manages somatization disorders. The nurse understands that
which is a characteristic of a somatization disorder – ANSWERThe client has multiple physical complaints.
A client newly admitted to the mental health unit describes a
recent history of emotional turmoil. The client exhibits physical
symptoms and has some loss of physical functioning. The nurse
determines that this client is exhibiting signs compatible with
which? – ANSWER- Somatization disorder
The nurse collecting data from a 35-year-old client determines
that the client has gained more than 100 pounds in an 18-month
period. The client confided in the nurse that she was sexually
molested at the age of 7 and began putting on weight after that
time. The client presently weighs 422 pounds. The nurse
determines that obesity for this client most likely represents
which? – ANSWER- Protection from the risk of intimacy
The nurse is assisting in developing a plan of care for a paranoid
client who experiences religious delusions. Which short-term
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