Mental Health Nursing for the NCLEX ®

A client who is being prepared for surgery is experiencing severe anxiety about the procedure. Which of the following interventions could the nurse employ to decrease this client’s anxiety levels? Select all that apply.

A nurse is working with a client to use biofeedback as a method of controlling anxiety. Which of the following outcomes would most likely result from correct use of this mechanism?

A 51-year-old client is getting ready to undergo a cardiac catheterization and is very anxious about the procedure. Which intervention can the nurse provide that will most likely help this client to remain calm?

A nurse has given her client a nursing diagnosis of Anxiety because of her behavior when she found out that she was pregnant. Which of the following interventions would be most appropriate for this type of nursing diagnosis? Select all that apply.

An emergency department nurse is working with a client who sought care for a sudden panic attack. The client tells the nurse that she feels like she is dying and is sweating and shaking. Which statement by the nurse is best?

A client who has been diagnosed with anxiety tells the nurse that his thoughts contribute to his problems. Which information can the nurse give the client that is true about automatic negative thoughts?

The nurse is preparing a presentation on stress and anxiety. Which of the following is included as part of this presentation? Select all that apply.

A client is scheduled for surgery and admits that he has never been so anxious in his life. Which of the following symptoms are common for a client in this situation? Select all that apply.

A nurse is caring for a 20-year-old client with testicular cancer. The client has expressed feelings of anxiety related to his diagnosis and appears restless and agitated every time the nurse tries to talk with him. Which intervention would be the most appropriate for the nurse to help this client with anxiety?

A client is suffering from stress and anxiety and is being seen at a healthcare clinic for help and management. Which best describes the initial physical effects of stress and anxiety in the body? Select all that apply.

A case management nurse is reviewing the chart for a client in a psychiatric hospital who has been diagnosed with panic disorder. The client is anxious and irritable. The nurse has done teaching on relaxation techniques, but the client requires close monitoring due to lack of adherence to the regimen. Which action of the case manager will most likely support this client best?

A client is experiencing an anxiety attack. The nurse reviews the client’s home medications and notes that they take an anti-anxiety medication. Which of the following medications is likely prescribed to this client?

A nurse is caring for a client who is hospitalized in a very busy unit. The client complains to the nurse that it is too noisy to sleep and that he is not getting rest. Which of the following nursing interventions is most appropriate to better help this client sleep?

A nurse is working with a client who is having sleep difficulties at night. The nurse recommends that the client keep a sleep diary and write down the times he goes to bed, the times he gets up and how many times he awakens each night. The nurse can best describe the purpose of keeping a sleep diary as which of the following?

A client with anxiety disorder is in a state of panic after becoming injured while outside. The nurse caring for this client would most likely observe which behaviors? Select all that apply.

The nurse is caring for a client with generalized anxiety disorder requiring treatment. Which of the following treatments does the nurse anticipate the client will need? Select all that apply.

A client presents to the emergency department with an anxiety attack, stating that he has had multiple attacks over the last six months. The client is hyperventilating, so the nurse administers a benzodiazepine to help with the acute attack. The nurse anticipates that the client will begin to take which of the following medications on a regular basis to help with the anxiety?

A client was recently treated for sepsis and may have developed post-sepsis PTSD. Which information is accurate for the nurse to give the client about how this condition is treated?

A client is experiencing stress response syndrome after losing his job where he had worked for 21 years. What describes the difference between stress response syndrome and clinical depression?

A 29-year-old client suffered a subarachnoid hemorrhage 4 months ago and has now been diagnosed with post-traumatic stress disorder (PTSD). Based on this diagnosis, the nurse knows that the client would most likely demonstrate which of the following symptoms?

A nurse is caring for a 40-year-old client with post-traumatic stress disorder following a severe injury last year. The client requires a morning dose of an antidepressant medication and is scheduled for EMDR therapy in 2 hours. The provider has been in to see the client for the day and has also left new orders. Which task can the nurse delegate to the nursing assistant who is helping her?

A client is being seen for care at her primary care clinic. The client tells the nurse that she has difficulty sleeping because of nightmares. Identify which description best explains the difference between night terrors and nightmares.

A 46-year-old client is experiencing symptoms of post-traumatic stress disorder after being involved in a traumatic accident. The client has symptoms of nightmares and flashbacks about the event. The nurse knows that these symptoms most likely develop because of which of the following?

A nurse is providing care to a client who has just witnessed a shooting at a shopping mall. Which of the following interventions would the nurse employ to help the client cope with this traumatic event? Select all that apply.

A client on the mental health unit has been diagnosed with cancer and is displaying a lack of healthy coping mechanisms to deal with this diagnosis. The client is unable to make any decisions for herself and has developed headaches and fatigue. Which of the following nursing interventions is most appropriate for this client?

A nurse is caring for a client who is displaying symptoms of dissociative identity disorder (DID). Which of the following is an appropriate intervention for DID? Select all that apply.

A client is undergoing behavioral therapy through counseling for manic behaviors exhibited during episodes of bipolar disorder. Which best describes how cognitive-behavioral therapy is used as treatment for a client with bipolar disorder?

A nurse is caring for a client who has been diagnosed with bipolar disorder, type I. Which best describes the difference between bipolar type I and type II?

A public health nurse is caring for a client in a psychiatric facility who has a diagnosis of bipolar disorder. Which best demonstrates that the nurse is acting as a liaison to coordinate this client’s plan of care?

A client with a history of bipolar disorder has been brought in to the hospital because the client was running through a neighborhood without any clothes on. Which of the following is evidence that the client is voluntarily willing to be admitted to the hospital? Select all that apply.

A nurse is caring for a client with bipolar disorder who is frequently manic. What describes the most appropriate psychotherapy for a client with this condition? Select all that apply.

A client is undergoing a clinical interview as part of diagnostic testing for bipolar disorder. Which best describes why a clinical interview would be conducted?

A client has been newly diagnosed with acute bipolar depression. What medications does the nurse plan to administer? Select all that apply.

A 44-year-old client is being seen for symptoms of bipolar disorder. After talking with the client, the provider has determined that the client should start taking medication. The client says to the nurse, “How do you know for sure? Isn’t there a lab test that will tell you if I have this condition?” Which response from the nurse is accurate?

A client who has been diagnosed with bipolar disorder is seeking treatment during the manic phase of illness. Based on the nurse’s knowledge of this mental state, the nurse understands that which of the following is likely during this phase?

A nurse is caring for a client with bipolar disorder. The client has been taking antidepressants for depression but is most recently in a manic state and for the past three days has not been sleeping or eating. Which of the following questions from the nurse is correct in this assessment?

A nurse is caring for a client has undergone ECT for the treatment of severe depression and has developed some complications afterward. Which of the following is a physical side effect that has been associated with ECT?

A 30-year-old client has been diagnosed with major depressive disorder. Which nutrition guideline should the nurse give to this client that could help with some symptoms of depression?

A nurse is counseling a client who has been diagnosed with depression to attend a support group as part of treatment. Which best describes how the nurse would explain what to expect for the client?

A nurse is working with a client who suffers from depression. The client has started taking medications and is engaged in group therapy, but still tells the nurse, “I do not like myself. I am annoying, even to me.” Which activities can the nurse suggest that would most likely increase this client’s self-concept? Select all that apply.

A client in the psychiatric unit has been diagnosed with severe, intractable depression and is preparing to undergo electroconvulsive therapy (ECT). Which best describes the role of the nurse during ECT? Select all that apply.

A nurse is performing depression screenings in the community. Which question would most likely be included in this screening?

An 11-year-old boy has been diagnosed with depression after his parents’ divorce. The nurse understands that depression in children of this age most commonly manifests as:

A nurse is assisting a client who has undergone electroconvulsive therapy for treatment of severe depression. Following the procedure, the client develops postictal agitation. Based on the nurse’s knowledge of this condition, the nurse would expect to see which of the following?

A client who has developed depression after experiencing chronic back pain is being seen at the acute care clinic. Which best describes how the nurse would demonstrate psychoeducation when working with this client?

A nurse is working with a client who has schizoaffective disorder and believes that the hospital has poisoned the food. Which response from the nurse is most appropriate?

A 25-year-old client with mental illness is having delusions of grandeur. Which tasks would the nurse utilize when orienting this client to reality? Select all that apply.

A client with schizophrenia has been non-compliant with taking his medications. The nurse understands that the most likely reason for non-compliance with the treatment regimen for the client is which of the following?

A nurse is working with a client who is experiencing hallucinations of water running down the walls. Which of the following intervention would be most helpful for the client?

A nurse is providing reality orientation to a client who has been experiencing auditory hallucinations. Which of the following elements should the nurse consider when orienting this client to reality? Select all that apply.

A client is demonstrating catatonic schizophrenia. Which of the following characteristics would the nurse most likely see with this condition?

Which of the following are common findings in a client with schizophrenia? Select all that apply.

The nurse is caring for a schizophrenic client who is talking to someone who is not there. The client states, “I am talking to Cheryl. She’s right here.” No one is there. What is the most appropriate response for the nurse?

A client informs the nurse that he is hearing voices. What is the first action the nurse should take?

A client with catatonic schizophrenia is in the hospital on the mental health unit. The client has not moved for three days. Which of the following nursing interventions best demonstrates that the nurse is upholding the client’s safety in this situation?

A client has been brought into the emergency department under the influence of illicit drugs. The client is experiencing paranoia and yells at the nurse, “You can’t hurt me! I am more powerful than you!” Which tactics would the nurse use that would help to orient this client to reality? Select all that apply.

A nurse is working with a client who has paranoid thinking. The client believes that a secret chip has been implanted under the client’s skin by the government. Which is the most appropriate first approach from the nurse?

A 23-year-old client is being seen for treatment after purposely cutting the skin on her arm. The client has impulsive behavior, is angry, and has been losing friends because of intense and needy behavior. Which type of personality disorder does this best describe?

A client with obsessive-compulsive disorder (OCD) is in the hospital after having been diagnosed with a chronic illness. Which best describes what the nurse would see in this client while trying to provide care?

A 65-year-old woman has been diagnosed with Alzheimer’s disease and is suffering from repeated bouts of memory loss. The client asks the nurse, “How am I supposed to handle this? I do not think I can cope with having this many memory problems.” Which response from the nurse is most appropriate?

Which medical condition has been shown to cause dementia in some adults?

A nurse is caring for a client with dementia as a result of progressive Alzheimer’s disease. The client’s family requests that the client eat fewer carbohydrates because of recent research the daughter has been studying. Which response from the nurse best indicates respect for this family’s choices?

A nurse is helping a family in which the mother has Alzheimer’s disease and is being cared for in the home by her son. Which of the following safety principles should the nurse teach the son to best keep his mother safe?

A client is cognitively impaired. What techniques can the nurse use to facilitate communication? Select all that apply.

A client with Alzheimer’s disease has been transferred to the medical unit accompanied by the spouse. The client is cognitively impaired and confused. The nurse assigns the client a room with low lighting near the nurse’s station. Which of the following best explains the reason for this room assignment?

A nurse is preparing to move a 150-pound client with Alzheimer’s disease from a chair to a stretcher in the emergency room. The client can help with the move but is uncooperative with the nurses. Which best describes how the nurse should move this client?

A 9-year-old child has been diagnosed with ADHD and is acting impulsively with hyperactivity. Which developmental activity would most likely be difficult for this child to achieve?

A nurse is caring for a client who has dementia and is in the hospital. Which of the following situations would most likely result in a client suffering bed entrapment? Select all that apply.

A nurse is working with the adult daughter of a client who has Alzheimer’s disease. The daughter cares for her parent in her home but is becoming exhausted with meeting the demands of caregiving. Which of the following actions could the nurse take that would help this caregiver to provide for her own needs? Select all that apply.

A nurse is assigned to care for a client with bulimia nervosa and assists the client to order a meal. Which of the following actions is important for the nurse to take regarding mealtime?

The nurse is caring for a client with a poor appetite. The nurse notes that the client is consuming less than 10% of meals and does not snack in between meals. Which of the following is NOT an appropriate intervention? Select all that apply.

A nurse is discussing inpatient treatment options for a client who has an eating disorder. The client wants to try to manage the condition independently instead. Which response from the nurse is most appropriate?

Which nursing intervention would be most appropriate for the following care plan? Altered Nutrition: Less than body requirements, related to an unwillingness to eat, as evidenced by severe weight loss greater than 10%.

A nurse is assessing a client who is being seen for malnutrition associated with a history of anorexia. Which of the following characteristics of the nervous system would the nurse expect to see in this client?

The nurse is caring for a client who presents to the ER with complaints of a fall with a laceration to the right arm. The client is slurring their speech. All vital signs are within normal limits. Which substance should be suspected in this client?

After being admitted as an inpatient for treatment of substance abuse, a client becomes confused and disoriented and is demonstrating tachycardia, sweating, and tremor. Which nursing intervention is most appropriate for management of this client?

The nurse is working in the emergency department caring for a client with delirium tremens and severe alcohol withdrawal. Which question is the priority?

A client is admitted to the floor from the ER for Ulcerative Colitis complicated with infection. The client is slurring their words and stumbling. The nurse notes empty mini vodka bottles in the client belonging bag. The client reports that they drink every day and asks the nurse to get them more vodka. What is the nurse’s priority at this time?

While working with a client who is experiencing acute alcohol withdrawal, a nurse performs an assessment by asking the client to drink a glass of water. Which best explains the significance of this test?

The nurse is caring for a client who is an alcoholic with a history of seizures while going through withdrawals. The nurse is setting up the room and implementing seizure precautions. Which of the following does the nurse ensure is included in the client’s plan of care?

A nurse arrives at work in the psychiatric unit and is given the assignments for the day. The nurse has a client who is experiencing delirium tremens after alcohol withdrawal and needs medication, a client who will be undergoing ECT later that day, a client with obsessive-compulsive disorder who has not had breakfast yet, and a client who needs to go to eating disorder group therapy. Which client should the nurse see first?

A client is undergoing acute alcohol withdrawal and is experiencing delirium tremens. Which nursing diagnosis would most likely be associated with this condition?

The nurse is caring for a client admitted for alcohol addiction. Which of the following questions is the priority at this time?

A client has orders for lorazepam administration, seizure precautions, and a banana bag. The nurse recognizes that this client is at risk for which of the following conditions?

A client is suffering from feelings of loss after experiencing a miscarriage. Which action of the nurse would best support this client in working through her grief?

A 35-year-old client is undergoing a lower limb amputation after a crushing injury. Which best describes how the nurse can support the client’s anticipated grief during this time?

A nurse is helping a family whose loved one died thirty minutes ago. The family exhibits sadness and crying. What kind of grief is the family experiencing?

The parents of a 2-year-old child who died of leukemia are experiencing intense grief in the months following the death. Which of the following is a factor that would affect how these parents experience grief?

A 58-year-old client is feeling sadness and loss after his mother died. Which best describes the difference between grief and depression?

Which best describes disenfranchised grief?

A nurse is caring for a woman whose mother died six months ago and who is grieving over the loss. The nurse assesses the woman for any signs of complicated grief patterns. Based on the nurse’s understanding of this condition, the nurse knows to look for what signs that indicate complicated grief? Select all that apply.

The parents of a 1-year-old child who has been adopted from Ethiopia ask the nurse about the child’s feelings of grief. The mother tells the nurse, “I do not think the understands the loss at one year old.” Which response from the nurse is correct?

Which of the following situations best describes acute grief?

A nurse is caring for a client who lost her father to cancer last year. The client is demonstrating dysfunctional grief in that she has intense feelings of guilt over the situation. Which of the following factors would increase a person’s risk of developing dysfunctional grief?

A psych nurse is floated to the emergency room to help with the number of psych clients that are being triaged. The psych nurse knows to see the client with which of the following first?

Which of the following are risk factors for suicide? Select all that apply.

The nurse is caring for a 14-year-old client. The client’s mother informs the nurse that the client told her that he wants to kill himself. What is the priority?

Signs of suicidal intent or planning include which of the following? Select all that apply.

A client with depression has been taken to the emergency department by a friend after making statements that he was contemplating suicide. The provider has ordered that the client be admitted for inpatient treatment but the client refuses. Which of the following best explains the client’s rights in this situation?

A client with suicidal ideation is undergoing dialectical behavior therapy. The nurse should educate the client to expect which type of treatment?

The nurse is leading group therapy in a behavioral health unit. Which client concerns the nurse the most?

A client with a history of severe depression and anxiety is in the hospital after attempting suicide. Which evidence would most likely be seen that indicates a crisis in a person with a mental illness? Select all that apply.

The provider has finished seeing four clients in the emergency room. The nurse should first assess the client with which condition?