HESI LPN
HESI Mental Health Questions
Question 1 of 5
A male client with delirium becomes disoriented and confused in his room at night. The best initial nursing intervention is to:
Correct Answer: B
Rationale: The best initial nursing intervention for a male client with delirium who becomes disoriented and confused in his room at night is to use an indirect light source and turn off the television. This approach helps to reduce stimulation and confusion, aiding in the client's orientation and comfort. Moving the client next to the nurse's station (
Choice
A) may not address the root cause of disorientation and could disrupt the client's routine. Keeping the television and a soft light on (
Choice
C) may further contribute to the client's confusion. Playing soft music and maintaining a well-lit room (
Choice
D) may not be as effective in reducing stimulation and promoting orientation as using an indirect light source and turning off the television.
Question 2 of 5
An adult male client who was admitted to the mental health unit yesterday tells the nurse that microchips were planted in his head for military surveillance of his every move. Which response is best for the LPN/LVN to provide?
Correct Answer: A
Rationale: The best response for the LPN/LVN to provide is option A: 'You are in the hospital, and I am the nurse caring for you.' This response is effective as it grounds the client in the present reality while also acknowledging the client's feelings. It shows acceptance of the client's experience without directly challenging the delusional belief, which can help build rapport and trust. Option B focuses on anxiety rather than validating the client's experience or addressing the delusion. Option C suggests an unrelated activity that may not be helpful in this situation. Option D attempts to correct the client's belief, which is not likely to be effective in managing delusional thoughts.
Question 3 of 5
A nurse is caring for a client with major depressive disorder who is withdrawn and refuses to participate in group activities. What is the best nursing intervention?
Correct Answer: A
Rationale: Encouraging the client to attend at least one group session is the best nursing intervention in this scenario. By gently encouraging participation, the nurse can help the client start to engage with others, which may gradually improve their mood and social interaction.
Choice B, respecting the client's wish to remain isolated, may further exacerbate the client's withdrawal and depression by reinforcing avoidance behavior.
Choice C, arranging for individual therapy sessions, can be beneficial but may not address the specific need for social interaction.
Choice D, offering a list of activities to choose from, does not directly address the client's difficulty in participating in group activities and may not provide the necessary support in overcoming social withdrawal.
Question 4 of 5
The occupational health nurse is working with a female employee who was just notified that her child was involved in a MVA and taken to the hospital. The employee states, 'I can't believe this. What should I do?' Which response is best for the nurse to provide in this crisis?
Correct Answer: D
Rationale: Providing immediate practical support, such as arranging transportation to the hospital, is the best response in this crisis situation. It helps the employee to take immediate action and supports her in a highly stressful moment.
Choice A focuses on the employee's thoughts rather than providing immediate aid.
Choice B is not a priority as the severity can be addressed later.
Choice C puts the decision-making burden on the employee at a time of distress, which is not ideal.
Therefore, choice D is the most appropriate response in this situation.
Question 5 of 5
A client with bipolar disorder is prescribed lithium. What is the most important instruction the nurse should provide?
Correct Answer: C
Rationale: Maintaining a consistent sodium intake is crucial for clients taking lithium because changes in sodium levels can impact lithium concentrations, potentially leading to toxicity. It is essential to avoid excessive sodium intake, as both low and high levels can affect lithium levels.
Choices A, B, and D are incorrect. A high potassium diet is not a concern with lithium therapy. While taking lithium with food can help reduce gastrointestinal side effects, it is not the most important instruction. Finally, abruptly stopping lithium can lead to a recurrence of symptoms or a worsening of the condition, so it is vital to follow the prescribed regimen.