HESI: NUR208/ NUR 208 (New 2024/ 2025
Update) Mental Health Nursing| Questions
and Verified Answers| 100% Correct| A
Grade – Fortis
QUESTION
A client is admitted for bipolar disorder and alcohol withdrawal, depressive phase. Based on
which assessment finding will the RN withhold the clonidine (Catapres) prescription?
Answer:
Blood pressure readings of 90/62 mmHg to 92/58 mmHg.
QUESTION
The RN on the evening shift receives report that a client is scheduled for electroconvulsive
treatment (ECT) in the morning. Which intervention should the Rn implement the evening before
the scheduled ECT?
Answer:
Keep the client NPO after mid-night
QUESTION
A client with Bulimia and depression who is taking phenelzine (Nardil) 90 mg daily is admitted
to an acute care hospital for uncontrolled hypertension. What dietary choices should the RN
instruct the client to avoid?
Answer:
Peperoni pizza.
QUESTION
A mental health worker is caring for a client with escalating aggressive behavior. Which action
,by the mental health worker warrants immediate intervention by the RN?
Answer:
Is attempting the physically restrain the patient.
QUESTION
A client who recently experienced the death of a significant other arrives at the mental health
center. The client reports loss of interest in usual activities, expresses a wish to be with the
decreased significant other, has been eating very little, and has not slept in several days. Which
client statement is most important for the RN to explore at this time?
Answer:
Not sleeping for several days.
QUESTION
A middle aged adult with major depressive disorder suffers from psychomotor retardation,
hypersomnia, and motivation. Which intervention is likely to be most effective in returning this
client to a normal level of functioning?
Answer:
Teach the client to develop a plan for daily structured activities.
QUESTION
When developing a plan of care for a client admitted to the psychiatric unit following aspiration
of a caustic material related to a suicide attempt, which nursing problem has the highest priority?
Answer:
Ineffective breathing pattern
QUESTION
A female client on a psychiatric unit is sweating profusely while she vigorously does push-ups
and then runs the length of the corridor several times before crashing into furniture in the sitting
room. Picking herself up, she begins to toss chairs aside, looking for a red one to sit in. When
,another client objects to the disturbance, the client shouts, "I am the boss here. I do what I want."
Which nursing problem best supports these observations?
Answer:
Risk for other related violence related to disruptive behavior.
QUESTION
A RN is preparing the physical environment to interview a new client for admission to the
mental health unit. Which environmental setting facilitates the best outcome of the interview?
Answer:
Reduce the noise level in the room by turning off the television and radio.
QUESTION
An older homeless client visits the psychiatric clinic to obtain a prescription renewal for
alprazolam (Xanax). During the health assessment, the client complains of chest pain. Which
action should the RN take first?
Answer:
Determine if Xanax was taken recently
QUESTION
Several clients with chronic mental illness and multiple substance abuse histories live in a group
residential home and attend daycare mental health facility where group and individual therapies
are provided. The RN finds the common bathroom at the facility with sputum on the walls, urine
in the sink and on the floors, and the toilet stopped up with tissue, paper towels, and feces. What
is the priority issue that the RN should address?
Answer:
Infection control
QUESTION
A client with schizophrenia is admitted to the psychiatric care unit for aggressive behavior,
, auditory hallucinations, and potential for safe harm. The client has not been taking medications
as prescribed and insists that the food has been poisoned and refuses to eat. What intervention
should the RN implement?
Answer:
Provide the client with food in unopened containers
QUESTION
The RN is providing education about strategies for a safety plan for a female client who is a
victim of intimate partner violence. Which strategies should be included in the safety plan?
(SOA)
Answer:
Establish a code with family and friends to signify violence
Have a bag ready that has extra clothes for self and children.
Plan an escape route to use if the abuser blocks the main exit
QUESTION
The RN is admitting a male client who take lithium carbonate (Eskalith) twice a day. Which
information should the RN report to the HCP immediately?
Answer:
Nausea and vomiting
QUESTION
A male client who is admitted with delirium tremens is dehydrated and experiencing auditory
hallucinations. He has a bruised, swollen tongue and is confused. In developing a plan of care,
which action should the RN include to ensure the client is physiologically stable?
Answer:
Monitor vital signs.
QUESTION
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