Exam (elaborations)
HESI Green Book Psych Practice Test
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HESI Green Book Psych Practice TestA client on the psychiatric unit, diagnosed with bipolar disorder, becomes loud and shouts at one of the
nurses, "You fat tub of lard, get something done around here!" What is the best initial action for the
nurse to take?
A. Have the staff escort the client to his room.
B. Tell the client that his behavior will be documented in his record.
C. Redirect the client by offering an activity such as playing card games.
D. Review the medication record for an antipsychotic drug. - ANS C
Distracting the client, or redirecting him toward a constructive activity, prevents further escalation of
the inappropriate behavior. Option A could result in escalating the abuse and might unnecessarily
involve another staff member in the abusive situation. Option B may be more threatening to the client.
Option D may be indicated if the behavior escalates, but at this time the best initial action is option C.
The nurse is assigned to a client admitted with paranoia. Which actions will the nurse include in the
client's plan of care? (Select all that apply.)
A. Assess for suicide risk.
B. Offer lots of hugs to reassure the client.
C. Plan to care for the client when on duty.
D. Whisper in the presence of the client.
E. Provide a nonthreatening environment. - ANS A, C, E
Limit physical contact and do not whisper around the client. This client is at risk for self-harm. Continuity
of care is important for the paranoid client. A nonthreatening environment helps establish trust.
,A woman brings her 48-year-old husband to the outpatient psychiatric unit and tells the nurse that he is
being treated for dissociative disorder. Which data are consistent with this diagnosis? (Select all that
apply.)
A. Sleepwalking
B. Unable to remember who he is
C. Has recurrent intrusive obsessions
D. Acute attack of anxiety
E. Exhibits multiple personalities - ANS A, B, E
Sleepwalking, amnesia, and multiple personalities are examples of detaching emotional conflict from
one's consciousness and are consistent with a diagnosis of dissociative disorder (A, B, E). (C) is consistent
with obsessive-compulsive disorder. (D) is associated with neuro-cognitive disorders.
The nurse notes multiple burns on the arms and chest of a 2-year-old Vietnamese child who is being
treated for dehydration. When questioned, the child's father states that he treated the child's vomiting
with the cultural practice termed coining, which resulted in burned areas. Which expected outcome
statement has the highest priority?
A. The child will be protected from further harm.
B. The family's cultural values will be respected.
C. The parents will express regret at harming their child.
D. The parents will demonstrate an ability to care for burn wounds. - ANS A
The nurse's highest priority is to ensure that no further harm befalls the child. Options B, C, and D are
also important objectives but are secondary to option A.
A 45-year-old male client tells the nurse that he used to believe that he was Jesus Christ, but now he
knows that he is not. What is the nurse's best response?
,A. "Did you really believe you were Jesus Christ?"
B. "I think you're getting well."
C. "Others have had similar thoughts when under stress."
D. "Why did you think you were Jesus Christ?" - ANS C
Option C offers support by assuring the client that others have experienced similar situations. Option A
is belittling. Option B is making an inappropriate judgment. You may have narrowed your choices to
options C and D. However, you should eliminate option D because it is a "why" question, and the client
does not know why.
A newly admitted client to the behavioral health unit states, "I think my own mother is out to kill me. I
saw her yesterday in the kitchen cutting up vegetables. I know that knife was meant for me." The nurse
will initiate a plan of care based on which most likely medical diagnosis?
A. Depression
B. Paranoid disorder
C. Tactile hallucinations
D. Delusions - ANS B
Those who are paranoid demonstrate suspiciousness and mistrust. Depressive behavior is characterized
by profound feelings of sadness. Tactile hallucinations touch sensations in the absence of any stimuli.
Delusional thinking involves a belief thought to be true, even when presented with evidence that the
thought is not true.
For the client with an altered thought process, what will the nurse include in the client's plan of care?
(Select all that apply.)
A. Place items from home in the client's room.
, B. Place a calendar on the wall across from the client's bed.
C. Place a clock on the client's bedside table.
D. Establish a different waking pattern every day.
E. Call the client by a new name, "Sweetie Pie." - ANS A, B, C
For those with an altered thought process, routine and patterns are familiar and need to be encouraged.
Call the client by name, not an unfamiliar nickname, as the client may not realize who the nurse is
talking to. The remaining actions help with orientation.
A client who has been hospitalized for 2 weeks for paranoia reports continuously to the staff that some
clothing is missing from the closet. What is the correct action for the nurse to take based on the client's
complaints?
A. Enroll the client in an exercise class to promote positive activities.
B. Place a lock on the client's closet to allay the client's concerns.
C. Promote extinction of the ideation by ignoring the client.
D. Explain to the client that these suspicions are certainly false. - ANS A
Diverting the client's attention from paranoid ideation and encouraging the client to engage in positive
activities can be helpful in assisting to develop a positive self-image. Option B actually supports paranoid
ideation. Option C may lower self-esteem. The nurse should not argue with the client about the
delusions (option D).
The nurse cares for an adolescent with a history of violence who now exhibits signs of sublimation.
Which behavior by the adolescent best represents sublimation?
A. Recently started wetting the bed
B. Joined a competitive boxing team
C. Kicks the dog after being scolded by his dad
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