HESI RN
Mental Health HESI
1. A healthcare professional is preparing to provide medication education to a client who has just been prescribed an antipsychotic medication. What should the healthcare professional include in the teaching plan?
- A. “You should have regular eye exams.â€
- B. “It is important to avoid caffeine while on this medication.â€
- C. “You may experience dry mouth and blurred vision.â€
- D. “You should increase your intake of vitamin C to prevent side effects.â€
Correct answer: C
Rationale: The correct answer is C. Antipsychotic medications often have anticholinergic side effects like dry mouth and blurred vision. Teaching the client about these potential side effects is essential for their understanding and management. Regular eye exams (Choice A) are not specifically related to antipsychotic medications. While avoiding caffeine (Choice B) might be a general good practice, it is not a specific side effect of antipsychotic medications. Increasing vitamin C intake (Choice D) is not a standard recommendation for preventing antipsychotic medication side effects.
2. The client is preparing to discontinue the use of a sedative-hypnotic medication. Which instruction should the nurse include?
- A. “You may experience withdrawal symptoms; these are usually mild.â€
- B. “The medication will need to be gradually tapered off.â€
- C. “You should increase your caffeine intake to stay alert.â€
- D. “There should be no change in your sleep patterns during discontinuation.â€
Correct answer: B
Rationale: When discontinuing sedative-hypnotic medications, it is crucial to gradually taper them off to prevent withdrawal symptoms. Choice A is incorrect because withdrawal symptoms can be severe, not always mild. Choice C is incorrect as increasing caffeine intake can exacerbate sleep disturbances. Choice D is incorrect because changes in sleep patterns are expected during discontinuation of sedative-hypnotic medications.
3. A client with borderline personality disorder is admitted to the psychiatric unit. Which behavior should the nurse prioritize in the care plan?
- A. Self-harming behavior.
- B. Difficulty with interpersonal relationships.
- C. Impulsive spending and substance abuse.
- D. Inconsistent adherence to the treatment regimen.
Correct answer: A
Rationale: Self-harming behavior is the priority in the care plan for a client with borderline personality disorder. This behavior poses an immediate risk to the client's safety and requires prompt intervention. Difficulty with interpersonal relationships, impulsive spending, and substance abuse are also common in borderline personality disorder; however, self-harming behavior takes precedence due to its potential for severe harm. Inconsistent adherence to the treatment regimen, though important, is not as urgent as addressing the immediate safety concerns related to self-harm.
4. A client is agitated and physically aggressive. What action should the RN take first?
- A. Calmly inform the client that they will be placed in seclusion if they do not calm down.
- B. Discuss with the client the reasons for their agitation and aggression.
- C. Tell the client that physical aggression is not acceptable and must stop.
- D. Seek assistance from other staff members and follow the facility’s protocol.
Correct answer: D
Rationale: In a situation where a client is agitated and physically aggressive, the priority for the RN is to ensure the safety of the client and others. Seeking assistance from other staff members is crucial as it allows for a prompt response to manage the situation effectively and according to the facility’s protocol. Choices A, B, and C do not address the immediate need for safety or involve the collaboration of other staff members, which is essential in handling aggressive behaviors in a healthcare setting.
5. The nurse is assessing a client who has schizophrenia and is exhibiting symptoms of paranoia. Which behavior would the nurse most likely observe?
- A. The client is seen as unmotivated and withdrawn.
- B. The client is preoccupied with a fear of being harmed.
- C. The client displays a blunted affect and lacks emotional response.
- D. The client avoids group activities and shows decreased appetite.
Correct answer: B
Rationale: In clients with paranoia, they typically exhibit an intense fear of being harmed, persecuted, or targeted by others. This fear often dominates their thoughts and can significantly impact their daily functioning and interactions. Choice A, being unmotivated and withdrawn, is more indicative of negative symptoms of schizophrenia, such as avolition and social withdrawal. Choice C, displaying a blunted affect and lacking emotional response, is associated with flat affect, a symptom commonly seen in schizophrenia but not specific to paranoia. Choice D, avoiding group activities and showing decreased appetite, may be related to various symptoms or side effects, but it is not a defining characteristic of paranoia in schizophrenia.
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