HESI Case Studies–Psychiatric/Mental Health-Major Depressive Disorder (Joan Miller)

1. During the initial assessment, the nurse should focus on which areas? (Select all)
-Symptoms of anxiety
-Increasing symptoms of depression
-Suicidal ideation
2. What should the nurse say to elicit the most subjective information from the client?
“Tell me more about your anxiety.”
3. The nurse recognizes that Joan is experiencing what level of anxiety?
Severe
4. Which question is most important for the nurse to ask Joan?
Do you have a plan for harming yourself?
5. How should the nurse respond to Joan’s comments?
“Tell me more about your chest pain.”

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6. Which nursing diagnosis for the client’s anxiety should the nurse record?
Ineffective coping related to interpersonal conflicts
7. Which behavior should the nurse illicit from the client?
Stating the sources for present anxiety
8. Which nursing diagnosis should the nurse add to Joan’s plan of care? (Select all)
-Anxiety related to maturational crisis
-Powerlessness related to work conflict
-Situational low self-esteem related to work
9. Which question or statement by the nurse is most likely to encourage Joan to talk about the issues that are contributing to her anxiety?
“What does being 52 years old mean to you?”
10. How should the nurse answer Joan’s question about when to take the lorazepam (Ativan)?
“Measure your anxiety on a scale, then decide when to use lorazepam (Ativan), but do not exceed twice a day.”
11. What information should the nurse discuss with Joan about bupropion (Wellbutrin XL)?
Anxiety level may increase
12. Before Joan has the prescription for bupropion (Wellbutrin XL) filled, the nurse should ensure that the client has not experienced whihc problem(s)? (Select all)
-Anorexia or bulimia
-Seizures
13. How should the nurse respond to Joan’s question?
Do not consume alcohol while taking the medication
14. lorazepam (Ativan) is ordered as 0.5mg. The pharmacy only has 1mg tabs available. How many tabs should the nurse instruct Joan to take with each dose?
0.5
15. How should the nurse respond to Joan’s complain of headaches?
“The headaches usually go away within a few days.”
16. What is the most important question the nurse should ask the client once the client is taking the medication bupropion (Wellbutrin XL)?
“Have you had any suicide thoughts since starting bupropioon (Wellbutrin XL)?”
17. Which question should the nurse ask Joan first?
How do you plan to hurt yourself?
18. How should the nurse respond to Joan?
“Go to the hospital now because this is a serious situation.”
19. Which statement by the client best suggests that the medication combination and therapy are working?
“The things that happen at work don’t bother me so much.”
20. How should the nurse respond to the client’s statement?
“Most clients do better by taking the medicine for a year.”
21. On which statement by the client is the nurse basing this assessment?
“I just tell the boss that nothing she does will upset me.”
22. The nurse knows that Joan is still easily upset by her boss’ behavior. How should the nurse respond to Joan?
“How do you feel when your boss says something that upsets you?”
23. In considering Joan’s statements about her interactions with her boss, which standard of the ANA Psychiatric-Mental Health Nursing care should the nurse apply to the current situation?
Assessment
24. What makes termination important to the nurse-client relationship?
Termination summarizes the goals and objectives attained
25. How should the nurse respond to Joan’s request?
Instruct the client to make an appointment for follow-up
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