NRSG 530 EAQ #1 Questions and Verified Detailed Answers; for Guaranteed Success -Wilkes University

Which factor would the nurse assess to best determine the client's present mental status who has generalized in anxiety disorder?

Behavior

Place the emergency admission psychiatric assessments and interventions in the order of priority.

1. Collect brief demographic information

2. Assess for intent to harm self or others

3. Obtain the client's perspective of the situation

4. Identify presenting clinical findings

5. Explore the previous psychosocial history

6. Document

Which term would be used to document the client's affect, which was observed during the mental status assessment?

Flat

Which interventions would the nurse implement when a client who attempted suicide by slashing the wrists is transferred from the emergency department to a mental health unit?

What behaviors describe a mentally healthy person? (select all that apply)

Accepts Aging

Engages available strengths

Sustains positive relationships

Which statement best describes the goal of psychiatric nursing?

To help people with existing or potential mental health problems

Which factor is related to safety when discussing standards for involuntary admission to a mental health facility?

Currently Cutting

Which information can be found in the Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.?

Signs and symptoms associated with mental disorders

Which assessments are priority for disturbed client who is brought to the emergency department by the police?

Current behavior, appearance, cognitive function, affect, and orientation

Which consideration is the most accurate when applying the principles of mental health?

Emotional health is promoted when there is a sense of mastery of self and the environment

During orientation the newly hired nurse it told, "People with mental health emergencies shall be triaged within 5 minutes of entering the emergency department." Which entity is the source of this information?

Hospital policy statement

Which rights to clients have when they are admitted to an inpatient psychiatric facility?

Receiving personal mail

Refusing treatment

Viewing written treatment plans

Being in the least restrictive environment

Having freedom from excessive or unnecessary medication

The team includes and RN, LPN, and UAP; 1 client is 1:1 for suicidal ideation. Which combination of assignments and duties utilized the team members according to scope of practice?

RN: Performs client care and admin duties

LPN: administers meds

UAP: observes 1:1 client

Which behavior would alert the nurse to closely monitor a client for a suicide attempt?

If the client describes a plan for suicide

Which initial action would the nurse take for a depressed, suicidal client whose energy is returning and has been taking a mood-elevating medication for several weeks?

Keep the client under close observation.

Which factors apply when interviewing an older adult?

Adequate lighting is necessary

Assessment of chronic illness is necessary

Risk for depression should be assessed

Additional time is needed to answer questions

During the admission interview the client whose spouse died 6 months ago avoids eye contact, responds in a low voice, and is tearful. Which response would the nurse use?

I know that this is difficult, but as soon as we're finished I'll take you to your room.

Which assessment would be priority for a paranoid client diagnosed with schizophrenia?

Suspicious feelings

The nurse is caring for a client who is displaying increased agitation and anger that is not responding to de-escalatory techniques. Which interventions would the nurse perform next to maintain client and staff safety?

Apply restraints

Place in seclusion

Administer medication

Which intervention would provide the greatest safety for a client admitted to a mental health unit because off suicidal ideation?

Continual 1:1 supervision

At 4am a client calls the crisis hotline. Which assessment is the priority?

Current issues affecting safety.

Which intervention is most important for maintaining the safety of a restrained client?

Assess every 15 minutes

Which strategies would the nurse use to deal with burnout?

Identify personal responses to daily work stresses

Change to a nurse position on a low-stress unit

Attend educational programs as often as possible

Seek out professional and personal support systems

Leave the work at work at the end of the shift

Which safety features would the nurse have set in the room to prevent a client, who's been admitted for attempted suicide, from inflicting self-harm?

Doors that open outward

Furniture that is anchored

Shower rods that are not weight bearing

The nurse is caring for a client who was brought to the ER after binge drinking at a party. Which interventions would the nurse include in the plan of care to prevent a suicide attempt?

Require sitter in the room at all times

Verify medications are swallowed

Use plastic utensils and paper cups