2023-2024 NR326 HESI Mental Health Real Exam With Answers (75 Solved Questions)

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NR 326 MENTAL HESI 7real exam 2023-2024 latestupdate graded APractice exam1.A 30-year-old sales manager tells the nurse, "I am thinking about a jobchange. I don't feel like I am living up to my potential." Which of Maslow'sdevelopmental stages is the sales manager attempting to achieve?A.Self-Actualization.CorrectB.Loving and Belonging.C.Basic Needs.D.Safety and Security.Self-actualization is the highest level of Maslow's development stages, which is anattempt to fulfill one's full potential (C). (B) is identifying support systems. (C) is thefirst level of Maslow's developmental stages and is the foundation upon which higherneeds rest. Individuals who feel safe and secure (D) in their environment perceivethemselves as having physical safety and lack fear of harm.2.The nurse observes a client who is admitted to the mental health unit andidentifies that the client is talking continuously, using words that rhyme butthat have no context or relationship with one topic to the next in theconversation. This client's behavior and thought processes are consistentwith which syndrome?A.Dementia.B.Depression.C.Schizophrenia.CorrectD.Chronic brain syndrome.The client is demonstrating symptoms of schizophrenia (C), such as disorganized speechthat may include word salad (communication that includes both real and imaginarywords in no logical order), incoherent speech, and clanging (rhyming). Dementia (A) is a

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global impairment of intellectual (cognitive) functions that may be progressive, such asAlzheimer's or organic brain syndrome (D). Depression (C) is typified by psychomotorretardation, and the client appears to be slowed down in movement, in speech, andwould appear listless and disheveled.3.A homeless person who is in the manic phase of bipolar disorder isadmitted to the mental health unit. Which laboratory finding obtained onadmission is most important for the nurse to report to the healthcareprovider?A.Decreasedthyroidstimulatinghormonelevel.CorrectB.Elevated liver function profile.C.Increased white blood cell count.D.Decreased hematocrit and hemoglobin levels.Hyperthyroidism causes an increased level of serum thyroid hormones (T3 and T4),which inhibit the release of TSH (A), so the client's manic behavior may be related to anendocrine disorder. (B, C, and D) are abnormal findings that are commonly found in thehomeless population because of poor sanitation, poor nutrition, and the prevalence ofsubstance abuse.4.An adult male client who was admitted to the mental health unityesterday tells the nurse that microchips were planted in his head formilitary surveillance of his every move. Which response is best for thenurse to provide?A.You are in the hospital, and I am the nurse caring for you.B.It must be difficult for you to control your anxious feelings.C.Gotooccupationaltherapyandstartaproject.CorrectD.You are not in a war area now; this is the United States.Delusions often generate fear and isolation, so the nurse should help the clientparticipate in activities that avoid focusing on the false belief and encourage interactionwith others (C). Delusions are often well-fixed, and though (A) reinforces reality, it is

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argumentative and dismisses the client's fears. It is often difficult for the client torecognize the relationship between delusions and anxiety (B), and the nurse shouldreassure the client that he is in a safe place. Dismissing delusional thinking (D) isunrealistic because neurochemical imbalances that cause positive symptoms ofschizophrenia require antipsychotic drug therapy.5.The nurse is assessing a client's intelligence. Which factor should thenurse remember during this part of the mental status exam?A.Acute psychiatric illnesses impair intelligence.B.Intelligenceisinfluencedbysocialandculturalbeliefs.CorrectC.Poor concentration skills suggests limited intelligence.D.The inability to think abstractly indicates limited intelligence.Social and cultural beliefs (B) have significant impact on intelligence. Chronicpsychiatric illness may impair intelligence (A), especially if it remains untreated.Limited concentration does not suggest limited intelligence (C). Difficulties withabstractions are suggestive of psychotic thinking (D), not limited intelligence.6.At a support meeting of parents of a teenager with polysubstancedependency, a parent states, "Each time my son tries to quit taking drugs,he gets so depressed that I'm afraid he will commit suicide." The nurse'sresponse should be based on which information?A.Addiction is a chronic, incurable disease.B.Tolerance to the effects of drugs causes feelings of depression.C.Feelings of depression frequently lead to drug abuse and addiction.D.Carefulmonitoringshouldbeprovidedduringwithdrawalfromthedrugs. CorrectThe priority is to teach the parents that their son will need monitoring and supportduring withdrawal (D) to ensure that he does not attempt suicide. Although (A and C)are true, they are not as relevant to the parent's expressed concern. There is noinformation to support (B).

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7.The wife of a male client recently diagnosed with schizophrenia asks thenurse, "What exactly is schizophrenia? Is my husband all right?" Whichresponse is best for the nurse to provide to this family member?A.It sounds like you're worried about your husband. Let's sit down and talk.B.Itisachemicalimbalanceinthebrainthatcausesdisorganizedthinking. CorrectC.Your husband will be just fine if he takes his medications regularly.D.I think you should talk to your husband's psychologist about this question.The nurse should answer the client's question with factual information and explain thatschizophrenia is a chemical imbalance in the brain (B). (A) is a therapeutic response butdoes not answer the question, and may be an appropriate response after the nurseanswers the question asked. Although (C) is likely true to some degree, it is also truethat some clients continue to have disorganized thinking even with antipsychoticmedications. Referring the spouse to the psychologist (D) is avoiding the issue; thenurse can and should answer the question.8.A young adult male client, diagnosed with paranoid schizophrenia,believes that world is trying poison him. What intervention should thenurse include in this client's plan of care?A.Remind the client that his suspicions are not true.B.Askonenurseto spend timewith theclientdaily.CorrectC.Encourage the client to participate in group activities.D.Assign the client to a room closest to the activity room.A client with paranoid schizophrenia has difficulty with trust and developing a trustingrelationship with one nurse (B) is likely to be therapeutic for this client. (A) isargumentative. Stress increases anxiety, and anxiety increases paranoid ideation; (C)would be too stressful and anxiety-promoting for a client who is experiencingpathological suspicions. (D) also might increase anxiety and stress.

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9.The community health nurse talks to a male client who has bipolardisorder. The client explains that he sleeps 4 to 5 hours a night and isworking with his partner to start two new businesses and build an empire.The client stopped taking his medications several days ago. What nursingproblem has the highest priority?A.Excessive work activity.B.Decreased need for sleep.C.Medicationmanagement.CorrectD.Inflated self-esteem.The most important nursing problem is medication management (C) becausecompliance with the medication regimen will help prevent hospitalization. The client isalso exhibiting signs of (A, B, and C); however, these problems do not have the priorityof medication management.10.A female client with obsessive-compulsive disorder (OCD) is describingher obsessions and compulsions and asks the nurse why these make herfeel safer. What information should the nurse include in this client'steaching plan? (Select all that apply.)A.Compulsionsrelieveanxiety.CorrectB.AnxietyisthekeyreasonforOCD.CorrectC.Obsessions cause compulsions.D.Obsessivethoughtsarelinkedtolevelsofneurochemicals.CorrectE.Antidepressantmedicationsincreaseserotoninlevels.CorrectCorrect choices are (A, B, D, and E). To promote client understanding and compliance,the teaching plan should include explanations about the origin and treatment options ofOCD symptomology. Compulsions are behaviors that help relieve anxiety (A), which is avague feeling related to unknown fears, that motivate behavior (B) to help the clientcope and feel secure. All obsessions (C) do not result in compulsive behavior. OCD issupported by the neurophysiology theory, which attributes a diminished level of

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neurochemicals (D), particularly serotonin, and responds to selective serotoninreuptake inhibitors (SSRI).11.The nurse observes a female client with schizophrenia watching thenews on TV. She begins to laugh softly and says, "Yes, my love, I'll do it."When the nurse questions the client about her comment she states, "Thenews commentator is my lover and he speaks to me each evening. Only I canunderstand what he says." What is the best response for the nurse tomake?A.Whatdo you believethenewscommentatorsaidtoyou?CorrectB.Let's watch news on a different television channel.C.Does the news commentator have plans to harm you or others?D.The news commentator is not talking to you.It is imperative that the nurse determine what the client believes she heard (A). The ideaof reference may be to hurt herself or someone else, and the main function of apsychiatric nurse is to maintain safety. (B) is acceptable, but it is best to determine theclient's beliefs. (C) is validating the idea of reference, while (D) is challenging the client.12.A 40-year-old male client diagnosed with schizophrenia and alcoholdependence has not had any visitors or phone calls since admission. Hereports he has no family that cares about him and was living on the streetsprior to this admission. According to Erikson's theory of psychosocialdevelopment, which stage is the client in at this time?A.Isolation.B.Stagnation.CorrectC.Despair.D.Role confusion.The client is in Erikson's "Generativity vs. Stagnation" stage (age 24 to 45), and meetingthe task includes maintaining intimate relationships and moving toward developing afamily (B). (A) occurs in young adulthood (age 18 to 25), (C) occurs in maturity (age 45

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to death), and (D) occurs in adolescence (age 12 to 20). These are all stages that occur ifindividuals are not successfully coping with their psychosocial developmental stage.13.The parents of a 14-year-old boy bring their son to the hospital. He islethargic, but responsive. The mother states, "I think he took some of mypain pills." During initial assessment of the teenager, what information ismost important for the nurse to obtain from the parents?A.If he has seemed depressed recently.B.If a drug overdose has ever occurred before.C.Ifhemighthavetakenanyotherdrugs.CorrectD.If he has a desire to quit taking drugs.Knowledge of all substances taken (C) will guide further treatment, such asadministration of antagonists, so obtaining this information has the highest priority. (Aand B) are also valuable in planning treatment. (D) is not appropriate during the acutemanagement of a drug overdose.14.A male client with mental illness and substance dependency tells themental health nurse that he has started using illegal drugs again and wantsto seek treatment. Since he has a dual diagnosis, which person is best forthe nurse to refer this client to first?A.The emergency room nurse.B.Hiscasemanager.C.The clinic healthcare provider.D.His support group sponsor.The case manager (B) is responsible for coordinating community services, and since thisclient has a dual diagnosis, this is the best person to describe available treatmentoptions. (A) is unnecessary, unless the client experiences behaviors that threaten hissafety or the safety of others. (C and D) might also be useful, but it is most important atthis time that a treatment program be coordinated to meet this client's needs.

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15.A male client is admitted to a mental health unit on Friday afternoonand is very upset on Sunday because he has not had the opportunity to talkwith the healthcare provider. Which response is best for the nurse toprovide this client?A.Letmecalland leavea messageforyourhealthcareprovider.B.The healthcare provider should be here on Monday morning.C.How can I help answer your questions?D.What concerns do you have at this time?It is best for the nurse to call the healthcare provider (A) because clients have the rightto information about their treatment. Suggesting that the healthcare provider will beavailable the following day (B) does not provide immediate reassurance to the client.The nurse can also implement offer to assist the client (C and D), but the highest priorityintervention is contacting the healthcare provider.16.A female client refuses to take an oral hypoglycemic agent because shebelieves that the drug is being administered as part of an elaborate plan bythe Mafia to harm her. Which nursing intervention is most important toinclude in this client's plan of care?A.Reassure the client that no one will harm her while she is in the hospital.B.Ask the healthcare provider to give the client the medication.C.Explain that the diabetic medication is important to take.D.Reassessclient'smentalstatusforthoughtprocessesandcontent.The most important intervention is to reassess the client's mental status (D) and to takefurther action based on the findings of this assessment. Attempting to reassure theclient (A) is in effect arguing with the client's delusions and could escalate an alreadyanxious situation. Collaborating about diabetic care (B and C) is not likely to helpchange the client's false beliefs.17.A male client is admitted to the psychiatric unit with a medical diagnosisof paranoid schizophrenia. During the admission procedure, the client

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looks up and states, "No, it's not MY fault. You can't blame me. I didn't killhim, you did." What action is best for the nurse to take?A.Reassure the client by telling him that his fear of the admission procedure is tobe expected.B.Tell the client that no one is accusing him of murder and remind him that thehospital is a safe place.C.Assessthecontentofthehallucinationsbyaskingtheclientwhatheis hearing.D.Ignore the behavior and make no response at all to his delusional statements.Further assessment is indicated (C). The nurse should obtain information about whatthe client believes the voices are telling him--they may be telling him to kill the nurse!(A) is telling the client how he feels (fearful). The nurse should leave communicationsopen and seek more information. (B) is arguing with the client's delusion, and the nurseshould never argue with a client's hallucinations or delusions, also (B) is possiblyoffering false reassurance. (D) is avoiding the situation and the client's needs.18.An 86-year-old female client with Alzheimer's disease is wandering thebusy halls of the extended care facility and asks the nurse, "Where should Istand for the parade?" Which response is best for the nurse to provide?A.Anywhere you want to stand as long as you do not get hurt by those in theparade.B.You are confused because of all the activity in the hall. There is no parade.C.Letus gobackto theactivityroomand seewhatis goingoninthere.D.Remember I told you that this is a nursing home and I am your nurse.It is common for those with Alzheimer's disease to use the wrong words. Redirecting theclient (using an accepting non-judgmental dialogue) to a safer place and familiaractivities (C) is most helpful because clients experience short-term memory loss. (A)dismisses the client's attempt to find order and does not help her relate to hersurroundings. (B) dismisses the client and may increase her anxiety level because it

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merely labels the client's behavior and offers no solution. It is very frustrating for thosewith Alzheimer's disease to "remember," and scolding them (D) may hurt their feelings.19.Physical examination of a 6-year-old reveals several bite marks invarious locations on his body. X-ray examination reveals healed fracturesof the ribs. The mother tells the nurse that her child is always havingaccidents. Which initial response by the nurse would be most appropriate?A.I need to inform the healthcare provider about your child's tendency to beaccident prone.B.Tellmemorespecificallyaboutyourchild'saccidents.C.I must report these injuries to the authorities because they do not seemaccidental.D.Boys this age always seem to require more supervision and can be quite accidentprone.(B) seeks more information using an open ended, non-threatening statement. (A) couldbe appropriate, but it is not the best answer because the nurse is being somewhatsarcastic and is also avoiding the situation by referring it to the healthcare provider forresolution. Although it is true that suspected cases of child abuse must be reported, (C)is virtually an attack and is jumping to conclusions before conclusive data has beenobtained. (D) is a cliché and dismisses the seriousness of the situation.20.A child is brought to the emergency room with a broken arm. Because ofother injuries, the nurse suspects the child may be a victim of abuse. Whenthe nurse tries to give the child an injection, the child's mother becomesvery loud and shouts, "I won't leave my son! Don't you touch him! You'llhurt my child!" What is the best interpretation of the mother's statements?The mother isA.regressing to an earlier behavior pattern.B.sublimating her anger.C.projectingherfeelingsontothenurse.D.suppressing her fear.

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Projection is attributing one's own thoughts, impulses, or behaviors onto another--it isthe mother who is probably harming the child and she is attributing her actions to thenurse (C). The mother may be immature, but (A) is not the best description of herbehavior. (B) is substituting a socially acceptable feeling for an unacceptable one. Theseare not socially acceptable feelings. The mother may be suppressing her fear (D) bydisplaying anger, but such an interpretation cannot be concluded from the datapresented.21.A 38-year-old female client is admitted with a diagnosis of paranoidschizophrenia. When her tray is brought to her, she refuses to eat and tellsthe nurse, "I know you are trying to poison me with that food." Whichresponse is most appropriate for the nurse to make?A.I'll leaveyourtrayhere.Iam availableifyouneedanythingelse.B.You're not being poisoned. Why do you think someone is trying to poison you?C.No one on this unit has ever died from poisoning. You're safe here.D.I will talk to your healthcare provider about the possibility of changing your diet.A) is the best choice cited. The nurse does not argue with the client nor demand that sheeat, but offers support by agreeing to "be there if needed", e.g., to warm the food. (B andC) are arguing with the client's delusions, and (B) asks "why" which is usually not a goodquestion for a psychotic client. (D) has nothing to do with the actual problem; i.e., theproblem is not the diet (she thinks any food given to her is poisoned.)22.A 25-year-old female client has been particularly restless and the nursefinds her trying to leave the psychiatric unit. She tells the nurse, "Please letme go! I must leave because the secret police are after me." Which responseis best for the nurse to make?A.No one is after you, you're safe here.B.You'll feel better after you have rested.C.I know you must feel lonely and frightened.D.Comewith meto yourroom and Iwillsitwithyou.

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