NCLEX-RN
Psychiatric Mental Health Nursing NCLEX RN Questions Questions
Extract:
Question 1 of 5
A 33-year-old client named Becky, who is diagnosed with Dissociative Identity Disorder, is admitted to the unit after a suicide attempt. During a group therapy session the next morning, the topic of anger toward parents came up. Becky suddenly throws herself on the floor and starts screaming, 'Mommy, Mommy, help Annie girl, help Annie girl.' The nurse should take the following actions in which order of priority from first to last?
Correct Answer: C, A, D, B
Rationale: The order is: 1) Protect Annie from injury (
C). 2) Ask other clients to leave (
A). 3) Ask Annie about the event (
D). 4) Ask Becky about the session (
B). Safety is first, followed by managing the environment and exploring the trigger.
Question 2 of 5
Which of the following liquids should the nurse administer to a client who is intoxicated on phencyclidine (PCP) to hasten excretion of the chemical?
Correct Answer: C
Rationale: Cranberry juice is administered, as its acidity may enhance PCP excretion by acidifying urine, aiding in elimination of the drug.
Question 3 of 5
While meeting with the nurse, a client's wife states, 'I don't know what else to do to make him stop drinking.' The nurse should refer the wife to which of the following organizations?
Correct Answer: B
Rationale: Referring the wife to Al-Anon is appropriate, as it provides support for family members of individuals with alcohol dependency, helping her cope and set boundaries.
Question 4 of 5
A client with schizophrenia completes a self-care task independently. Which response by the nurse is most appropriate?
Correct Answer: B
Rationale: Praising the achievement and encouraging further tasks reinforces independence and builds confidence.
Question 5 of 5
When conducting a mental status examination with a newly admitted client who has an Axis I diagnosis of paranoid schizophrenia, the client states, 'I'm being followed; it's not safe. They're monitoring my every move.' In which of the following areas of the mental status examination should be the mental status examined.
Correct Answer: A
Rationale: The client's statement reflects paranoid delusions, which are assessed under thought content in a mental status examination, as this area evaluates the presence of delusions or hallucinations.