HESI RN
Quizlet Mental Health HESI Questions
Question 1 of 5
A client with borderline personality disorder is admitted to the psychiatric unit. Which behavior should the nurse prioritize in the care plan?
Correct Answer: A
Rationale: Self-harming behavior is the priority in the care plan for a client with borderline personality disorder. This behavior poses an immediate risk to the client's safety and requires prompt intervention. Difficulty with interpersonal relationships, impulsive spending, and substance abuse are also common in borderline personality disorder; however, self-harming behavior takes precedence due to its potential for severe harm. Inconsistent adherence to the treatment regimen, though important, is not as urgent as addressing the immediate safety concerns related to self-harm.
Question 2 of 5
A client with major depressive disorder is beginning a new antidepressant medication. Which instruction should the nurse include in the discharge teaching?
Correct Answer: A
Rationale: The correct instruction the nurse should include in the discharge teaching for a client starting a new antidepressant medication is that "It may take several weeks to notice improvement." This is because antidepressants often require several weeks before the individual starts to feel the full therapeutic effects. Choice B is incorrect because immediate effects are not typically seen with antidepressants. Choice C is incorrect as stopping the medication abruptly can lead to worsening symptoms or withdrawal effects. Choice D is incorrect as open communication with the therapist is crucial for effective management of major depressive disorder.
Question 3 of 5
A female client requests that her husband be allowed to stay in the room during the admission assessment. While interviewing the client, the nurse notes a discrepancy between the client's verbal and nonverbal communication. What action should the nurse take?
Correct Answer: A
Rationale: When a nurse observes a discrepancy between a client's verbal and nonverbal communication, it is essential to pay close attention and document the nonverbal messages. Nonverbal cues, such as body language and facial expressions, can provide valuable insights into the client's emotional state, feelings, and concerns that may not be expressed verbally. By documenting these nonverbal messages, the nurse can gain a more comprehensive understanding of the client's communication and address any potential underlying issues. Asking the client's husband to interpret the discrepancy (Choice B) may not always provide an accurate understanding of the client's nonverbal cues. Ignoring the nonverbal behavior (Choice C) could lead to missing important cues affecting the client's care. Integrating verbal and nonverbal messages (Choice D) is important, but initially focusing on documenting and understanding the nonverbal cues can enhance the nurse's assessment and communication with the client.
Question 4 of 5
A male client with schizophrenia is admitted to the mental health unit after abruptly stopping his prescription for ziprasidone (Geodon) one month ago. Which question is most important for the nurse to ask the client?
Correct Answer: D
Rationale: Inquiring about hallucinations is crucial for assessing the return of psychotic symptoms due to discontinuation of antipsychotic medication. Hearing sounds or voices that others do not hear can indicate the presence of auditory hallucinations, a common symptom in schizophrenia. Choices A, B, and C are important aspects to assess in clients with schizophrenia, but in this scenario, the priority is to determine if the client is experiencing hallucinations, which can be a sign of worsening psychotic symptoms.
Question 5 of 5
A mental health worker (MHW) is caring for a client with escalating aggressive behavior. Which action by the MHW warrants immediate intervention by the nurse?
Correct Answer: A
Rationale: The correct answer is A: Attempting to physically restrain the client. Physical restraint should only be performed by trained professionals in a safe manner to prevent harm to the client and staff. In this scenario, the mental health worker should not attempt physical restraint, as it can escalate the situation and potentially lead to harm. Choices B, C, and D do not pose an immediate risk and can be part of de-escalation strategies. Choice B suggests guiding the client to a quiet area, choice C involves using a loud voice for better communication, and choice D indicates maintaining a safe distance, which are appropriate interventions to manage escalating aggressive behavior.