HESI RN
RN Hesi Mental Health Exam 1 Questions
Extract:
Question 1 of 5
During admission to the psychiatric unit, a client is extremely anxious and reports being worried about the sun coming up the next day. Which intervention is most important for the nurse to implement during the admission process?
Correct Answer: A
Rationale: A calm, matter-of-fact approach reduces anxiety by providing reassurance and stability, building trust during admission. Developing coping skills, administering sedatives, or asking 'why' are less immediate priorities.
Question 2 of 5
The nurse is providing care for a client diagnosed with a borderline personality disorder who has self-inflicted lacerations on the abdomen. Which approach should the nurse use when changing this client's dressings?
Correct Answer: D
Rationale: A non-judgmental approach prioritizes the client's comfort and builds trust, essential for those with borderline personality disorder. Other actions may distress or are less relevant during dressing changes.
Question 3 of 5
A client with schizoaffective disorder and type 2 diabetes mellitus who receives a prescription for a second generation antipsychotic. The client expresses concern to the nurse about the effect of this antipsychotic on blood glucose levels. Which response should the nurse make?
Correct Answer: D
Rationale: Acknowledging the client's concern and inviting further discussion addresses the specific worry about blood glucose levels while maintaining a supportive dialogue. Other responses dismiss or sidestep the concern.
Question 4 of 5
When assessing a female client who has been taking an antipsychotic medication for the past year, the nurse observes that the client demonstrates involuntary foot tapping while both feet are flat on the floor. The nurse plans to report the observation to the healthcare provider. Which additional action should the nurse take?
Correct Answer: A
Rationale: Involuntary foot tapping may indicate tardive dyskinesia, a side effect of antipsychotics. Documenting on the AIMS allows systematic monitoring. Other actions misattribute the symptom or are irrelevant.
Question 5 of 5
A homeless male who was found sitting in the middle of a busy street is brought to the emergency department (ED). On admission, the client is confused and has difficulty answering questions. After ruling out a physiological etiology for the client's behavior, he is transferred to the mental health unit. When admitting the client to the unit, which action is most important for the nurse to take?
Correct Answer: B
Rationale: A mental status exam assesses cognitive and psychological state, essential for planning care in a confused client. Other actions are secondary to this initial assessment.