Question 1

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 of the following responses by the nurse would be appropriate at this time?

Accepted Answer

The nurse should directly address the client's statement by assessing for suicidal ideation. Option A is appropriate as it shows concern and opens up a conversation about the client's safety.

Question 2

The nurse interprets that which of the following comments by the client whose husband uses violence against her is consistent with the presence of low self-esteem commonly found with battered wife syndrome?

Accepted Answer

The statement "Things would be fine at home if I just could do better. He has a lot of pressures on him at work." reflects low self-esteem and self-blame, which are common in individuals experiencing battered wife syndrome. They often believe they are responsible for the abuse.

Question 3

The 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."The nurse would make which response to the client?

Accepted Answer

The correct response, "It sounds as though you are feeling all alone right now," acknowledges the client's feelings and reflects empathy, which is an appropriate therapeutic communication technique.

Question 4

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. Which of the following should the nurse avoid doing when caring for this client?

Accepted Answer

Closing the door to the client's room when giving care to a client who has displayed violent behavior and is at risk for potentially harming others can isolate the nurse and increase the risk of harm. It is safer to keep the door open to ensure that help can be easily called if needed.

Question 5

A client who has attempted suicide by overdosing with a very large number of antidepressant pills has been admitted to the psychiatric unit. Which of the following is the priority nursing action at this time?

Accepted Answer

The priority nursing action for a client who has attempted suicide, especially through overdose, is to ensure their safety. Staying with the client at all times (constant observation) is crucial to prevent another suicide attempt and to provide immediate intervention if necessary. This approach directly addresses the immediate risk to the client's life.

Question 6

The 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. The nurse should take which initial action after noting this client's behavior?

Accepted Answer

A sudden improvement in mood and energy in a client with major depression, especially one who was previously struggling with basic self-care and participation in activities, can be a warning sign of a decision to commit suicide. It's important for the nurse to directly address this possibility by speaking with the client about any thoughts of suicide to assess risk and ensure safety.

Question 7

The 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 of the following statements prior to discharge?

Accepted Answer

The statement "I know that I won't become depressed again after the treatment I received here" indicates a lack of understanding of the chronic nature of depression and the ongoing need for coping strategies, suggesting the client could benefit from further development in this area.

Question 8

A client who attempted suicide by hanging is brought to the emergency department by emergency medical services. The immediate nursing action is which of the following?

Accepted Answer

Assessing the client's respiratory status and for the presence of neck injuries is crucial due to the method of the suicide attempt, which could have compromised the airway and caused cervical spine injuries.

Question 9

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 of the following interventions would the nurse include? Select all that apply.

Accepted Answer

Cognitive-behavioral therapy (CBT) focuses on identifying, challenging, and changing negative thought patterns (A), developing alternative, more positive ways of thinking (B), actively involving the client in their treatment and recovery process (C), and practicing new ways of thinking and behaving in various situations (D). Administering medications (E) and involving the family in group therapy (F) are not specific interventions of CBT, although they might be part of a comprehensive treatment plan.

Question 10

The nurse caring for the hospitalized client diagnosed with bulimia nervosa would closely monitor which of the following? Select all that apply.

Accepted Answer

Bulimia nervosa can lead to electrolyte imbalances due to purging behaviors, so monitoring electrolyte levels is crucial. Intake and output should be monitored to assess fluid balance and potential dehydration. Elimination patterns are important to observe for signs of laxative abuse or other purging methods.

Quiz 5: Mental Health