40. A female client reports feeling hopeless

40. A female client reports feeling hopeless and is unable to stop crying. She explains that she is worried about losing her job. Since the client’s husband recently lost his job, she feels her employment is essential to the family’s survival. To evaluate the effectiveness of cognitive- behavioral techniques, which client outcome should the nurse include in the plan of care? A. Relates insight into problematic relationships. B. Demonstrates a healthy relationship with husband. C. Describes how the family can resolve problems. D. Changes thought patterns related to problem solving. 41. The nurse determines that a client has been taking antidepressants for the past six months. Which symptoms are common side effects of this classification of drugs? A. Insomnia, hypertension, and vomiting. B. Dry mouth, blurred vision, and constipation. C. Bradycardia, delirium, and sedation. D. Headache, jaundice, and diarrhea. 42. Which is the best approach for the nurse to use when interviewing a client about suicidal ideations? A. Begin with questions that are less sensitive in nature. B. Get the most difficult questions over with first. C. Ask questions in a vague, non-specific format. D. Share personal values to put the client at ease. 43. A client with post-traumatic stress disorder (PTSD) is experiencing a dissociative disorder episode. The situation quickly escalates, and the client becomes physically aggressive. Which intervention should the nurse implement first? A. Confirm the client’s identity and orientation to time and place. B. Request a team member to assist with seclusion and restraint. C. Inspect the area for objects that can be used in a dangerous manner. D. Administer lorazepam 1.5 mg instramuscularly twice daily as needed. 44. After several days of being despondent and nonverbal, a female client with depression begins to talk and exhibit energy Which action should the nurse implement? A. Observe her actions continuously. B. Praise her for the new behavior. C. Involve her in group therapy. D. Offer her a choice of activities. 45. The nurse is teaching a group of adolescents about assertive communication. Two of the adolescents are seated at a round table and another is sitting on a small sofa nearby. To facilitate group interaction, which intervention is best for the nurse to implement? A. Ask the adolescent sitting on the couch to join the group at the table. B. Allow the adolescents to sit wherever they wish as long as they participate. C. Determine which adolescents would like to participate in the discussion. D. Suggest that they all sit together to increase the interaction. 46. 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? A. Ineffective breathing pattern. B. Risk for injury. C. Ineffective coping. D. Impaired comfort. 47. Which reasons should the nurse expect a female client to use when she is having difficulty leaving a relationship where she is a victim of intimate partner violence? (Select all that apply.) A. Religious beliefs about marriage. B. The perpetrator will not change. C. Shame and guilt. D. Children. E. Financial dependency. 48. A client is admitted to an inpatient psychiatric unit, and the antipsychotic medication clozapine is prescribed. Which intervention should the nurse include in this client’s plan of care? A. Place the client in protective isolation for the first two weeks of treatment with this medication. B. Offer this medication to the client with food to decrease the possibility of gastric upset. C. Inform unlicensed assistive personnel (UAP) that the client will likely complain of a sore throat and fever D Report findings from the client’s weekly white blood cell (WBC) counts to the healthcare provider. 49. A client with paranoia is admitted to the mental health unit and immediately goes to the corner of the room and sits quietly without communicating. In approaching the client, what intervention should the nurse implement first? A. Read the client his/her rights. B. Show the client the unit. C. Explain the nurse’s role to the client. D. Offer medication to the client. 50. Two weeks after a tornado hit a small town, a young woman whose home was destroyed comes to the crisis center for assistance. The client tells the nurse, that though her home was destroyed, none of her family was hurt. She further states, “You don’t know what it was like, and now I am having to live with relatives.” Which response is best for the nurse to provide? A. Tell me about your experience with this disaster. B. What are you doing to cope with these changes? C. How did you and your family survive the tornado? D. Disaster relief funds can assist you with housing. 51. Prior to initiating a treatment regimen with the antidepressant sertraline, it is most important for the nurse to obtain which information? A. Familial history of mental illness. B. Current weight. C. Any history of heart disease. D. Medication history. 52. A client who is experiencing a severe level of anxiety and reports a racing heartbeat, dizziness, and expresses a sense that something dreadful will happen. The nurse observes the client pacing and waving hands rapidly Which action should the nurse take? A. Help the client to identify thoughts that may be triggers. B. Explore past behaviors that have provided relief. C. Attempt to distract to another focus or activity. D. Speak calmly to the client stating assurance of safety. 53. After receiving large doses of chlorpromazine for two weeks, a client begins to develop spasms of the neck and back. Which action should the nurse take? A. Determine if the client is taking an anticholinergic drug such as benztropine mesylate. B. Call the healthcare provider and refuse to administer any more chlorpromazine. C. Decrease the dose of chlorpromazine and notify the healthcare provider. D. This is an expected side effect of chlorpromazine which requires no further action. 54. A young adult female client is admitted to the Emergency Department after being raped in a shopping center parking lot. The client expresses no suicidal ideation, but expresses feelings of self-blame for not taking precautions when going to her car. According to theorists, such as Maslow and Erikson, this client is struggling with which issue? A. Self-control. B. Self-actualization C. Self-esteem. D. Self-absorption. 55. A male client tells the nurse that he has an IQ of 400+ and is a genius and an inventor. He also reports that he is married to a female movie star and thinks that his brother wants a sexual relationship with her. Which is the priority nursing problem for admission to the psychiatric unit? A. Ineffective sexual patterns. B. Disturbed sensory perception. C. Impaired environmental interpretation. D. Compromised family coping. SCIENCE HEALTH SCIENCE NURSING NURS NURS-3410

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