HESI RN
Quizlet HESI Mental Health
1. An elderly client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which assessment finding is most concerning for the nurse?
- A. Weight loss of 5 pounds in one week.
- B. Lack of interest in previously enjoyed activities.
- C. Disorganized speech and thought processes.
- D. Severe fatigue and low energy levels.
Correct answer: C
Rationale: In an elderly client with major depressive disorder, disorganized speech and thought processes are the most concerning assessment findings for the nurse. These symptoms can suggest a more severe condition such as psychosis or cognitive impairment, which require immediate attention and intervention. While weight loss, lack of interest in activities, severe fatigue, and low energy levels are common symptoms of major depressive disorder, they do not pose an immediate risk as disorganized speech and thought processes do. Therefore, the nurse should prioritize addressing the disorganized speech and thought processes to ensure the safety and well-being of the client.
2. An adult male is admitted to the psychiatric unit from the emergency department because he is in the manic disorder. He has lost 10 pounds in the last two weeks and has not bathed in a week because he has been 'trying to start a new business' and is 'too busy to eat.' He is alert and oriented to time, place and person, but not situation. Which nursing diagnosis has the greatest priority?
- A. Self-care deficit
- B. Disturbed sleep pattern
- C. Disturbed thought processes
- D. Imbalanced nutrition
Correct answer: D
Rationale: Imbalanced nutrition is the most critical nursing diagnosis to address in this scenario. The patient's significant weight loss and neglect of basic needs, such as eating and personal hygiene, indicate a severe imbalance in nutrition. Addressing this issue is crucial to prevent further health deterioration. Self-care deficit, disturbed sleep pattern, and disturbed thought processes are important but secondary concerns compared to the immediate risk posed by imbalanced nutrition. While self-care deficit and disturbed sleep pattern are valid concerns, the patient's weight loss and neglect of basic needs take precedence. Disturbed thought processes are also significant but addressing the imbalanced nutrition is more urgent in this context.
3. A client with a history of pancreatitis should avoid which of the following food choices?
- A. Noodles
- B. Vegetable soup
- C. Baked fish
- D. Cheddar cheese
Correct answer: D
Rationale: Clients with pancreatitis should avoid high-fat foods like cheddar cheese as they can exacerbate symptoms. Noodles, vegetable soup, and baked fish are generally lower in fat and may be better tolerated by clients with pancreatitis.
4. The healthcare provider is assessing a client who has just returned from hemodialysis. Which finding requires immediate intervention?
- A. Weight gain of 2 pounds.
- B. Dizziness.
- C. Blood pressure of 150/90 mm Hg.
- D. Heart rate of 88 beats per minute.
Correct answer: B
Rationale: Dizziness after hemodialysis can indicate hypovolemia, hypotension, or other complications that require immediate intervention to prevent further deterioration or adverse events. Weight gain of 2 pounds may not be immediately concerning post-hemodialysis. A blood pressure of 150/90 mm Hg is slightly elevated but may not require immediate intervention unless accompanied by symptoms. A heart rate of 88 beats per minute falls within the normal range and may not be an immediate cause for concern after hemodialysis.
5. The healthcare professional is preparing a presentation on the impact of substance abuse on families. Which approach is most effective for engaging the audience?
- A. showing statistical data on substance abuse rates
- B. sharing personal stories from individuals affected by substance abuse
- C. distributing informational brochures on substance abuse
- D. providing a list of local substance abuse treatment centers
Correct answer: B
Rationale: Sharing personal stories from individuals affected by substance abuse is the most effective approach for engaging the audience. Personal stories evoke emotions, create empathy, and make the impact of substance abuse more relatable and tangible for the audience. This approach helps in fostering a deeper understanding of the real-life consequences of substance abuse on families. The other options, such as showing statistical data (choice A), distributing informational brochures (choice C), and providing a list of treatment centers (choice D), may be informative but may not engage the audience on an emotional level as effectively as personal stories.