WGU D449 Psychiatric and Mental Health Nursing
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Free WGU D449 Psychiatric and Mental Health Nursing Questions
Following involvement in a motor vehicle collision, a middle-aged adult client is admitted to the hospital with multiple facial fractures. The client's blood alcohol level is high on admission. Which PRN prescription should be administered if the client begins to exhibit signs and symptoms of delirium tremens (DTs)?
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Chlorpromazine 50 mg IM.
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Lorazepam 2 mg IM.
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Hydromorphone 2 mg IM.
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Prochlorperazine 5 mg IM.
Explanation
Explanation
Delirium tremens is a severe form of alcohol withdrawal characterized by agitation, confusion, tremors, and autonomic instability. Benzodiazepines such as lorazepam are the first-line treatment because they reduce central nervous system hyperactivity, control agitation, and help prevent seizures associated with alcohol withdrawal.Correct Answer Is:
B. Lorazepam 2 mg IM.Which short-term outcome should the nurse include in the initial treatment plan for a client with dementia?
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Verbalizes no hallucinations and delusions for 48 hours.
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Performs activities of daily living for 3 sequential days.
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Remembers family member’s names at their next visit.
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Expresses no paranoid ideation for at least 1 week.
Explanation
Explanation
Treatment goals for clients with dementia focus on maintaining functional abilities and independence for as long as possible. A realistic short-term outcome is the ability to perform activities of daily living such as eating, dressing, or hygiene with minimal assistance. Expectations such as eliminating hallucinations or remembering names are often unrealistic because dementia primarily affects memory and cognition.Correct Answer Is:
B. Performs activities of daily living for 3 sequential days.Patient Data
History and Physical
The client is in the hospital after her house collapsed during a hurricane. She has been in the intensive care unit for 2 weeks and moved today to the surgical floor to continue monitoring her respiratory function and to complete IV antibiotic administration.
Nurses' Notes
0900
Pain assessment completed. The client's pain is 2 on a 0 to 10 pain scale. The client requests sleeping medication for the night.
She explains that she keeps having horrible thoughts and memories about the house collapsing and that it is keeping her from falling asleep. She states, “I used to be so happy before all of this happened. Now I can't seem to get out of this funk I am in.”
The client would also prefer to be in a quieter area of the unit as she is currently by the nurses' station and hears talking and alarms constantly.
Which other treatment(s) might be helpful for this client? Select all that apply.
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Cognitive behavioral therapy
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Consciousness raising
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Phototherapy
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Electroconvulsive therapy
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Administration of lithium
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Animal therapy
Explanation
Explanation
The client is experiencing symptoms consistent with acute stress reaction or trauma-related anxiety following the traumatic event of her home collapsing. Cognitive behavioral therapy (CBT) is an evidence-based psychological treatment that helps individuals process traumatic experiences, identify negative thought patterns, and develop coping strategies to manage anxiety, intrusive memories, and sleep disturbances. CBT is commonly used in treating trauma-related stress and early symptoms of post-traumatic stress disorder. Animal therapy can also be beneficial because interaction with therapy animals has been shown to reduce stress, anxiety, and emotional distress in hospitalized patients. It can promote relaxation, improve mood, and provide emotional comfort during recovery from traumatic events. The other options are not appropriate in this context: consciousness raising is a concept used in behavior change models rather than clinical trauma treatment, phototherapy is used for conditions such as seasonal affective disorder or neonatal jaundice, electroconvulsive therapy is reserved for severe depression or refractory psychiatric conditions, and lithium is primarily used for bipolar disorder rather than trauma-related anxiety.Correct Answer Is:
A. Cognitive behavioral therapyF. Animal therapy
An adult female client with bipolar disorder is seen in the outpatient psychiatric clinic and tells the nurse that she is thinking of harming her sister. Which action is most important for the nurse to take?
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Notify the healthcare provider of the threat.
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Inform the sister of the client’s threat.
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Report the threat to the healthcare team.
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Document the threat in the medical record.
Explanation
Explanation
When a client expresses a threat of harm toward another person, the nurse has a duty to protect potential victims and ensure immediate intervention. The priority action is to notify the healthcare provider so that appropriate safety measures and further evaluation can occur. Documentation and team communication are important but notifying the provider is the most urgent step.Correct Answer Is:
A. Notify the healthcare provider of the threat.Patient Data
History and Physical
The client is in the hospital after her house collapsed during a hurricane. She has been in the intensive care unit for 2 weeks and moved today to the surgical floor to continue monitoring her respiratory function and to complete IV antibiotic administration.
Nurses' Notes
0900
Pain assessment completed. The client's pain is 2 on a 0 to 10 pain scale. The client requests sleeping medication for the night.
She explains that she keeps having horrible thoughts and memories about the house collapsing and that it is keeping her from falling asleep. She states, “I used to be so happy before all of this happened. Now I can't seem to get out of this funk I am in.”
The client would also prefer to be in a quieter area of the unit as she is currently by the nurses' station and hears talking and alarms constantly.
1100
Noted that the client is using fantasy, isolation, and suppression as defense mechanisms. Notified the client's healthcare provider (HCP) about the client's issues and concerns.
1200
Provided the client with education about acute stress disorder.
Orders
1115
Start clonazepam 0.25 mg PO every 12 hours.
Which client statement(s) require(s) follow-up teaching by the nurse? Select all that apply.
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“This diagnosis means that I am crazy.”
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“I am at high risk for post traumatic stress disorder because I have acute stress disorder.”
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“Many people have the same response to a stressful situation as I am having right now.”
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“I can learn to manage my thoughts better through therapy.”
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“I can use holistic approaches like meditation to help my symptoms.”
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“I will probably need to be on medication for the rest of my life.”
Explanation
Explanation
Acute stress disorder is a temporary reaction to trauma and does not mean a person is “crazy,” so statement A shows misunderstanding. Statement F is also incorrect because medications like clonazepam are usually used short term to manage symptoms. Many clients improve with therapy and coping strategies rather than lifelong medication.Correct Answer Is:
A. “This diagnosis means that I am crazy.”F. “I will probably need to be on medication for the rest of my life.”
The nurse is planning the care for a client who is hospitalized with bipolar disorder. The client wanders the hallways, talks excessively, and makes sexual comments about the staff. Which intervention(s) should the nurse include in the plan of care? Select all that apply.
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Provide television programs with suspense to keep attention engaged.
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Give concise and firm directions for hygiene and dressing.
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Engage the client in competitive activities.
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Invite for a walk when the client's energy is high.
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Assign the client to a single room.
Explanation
Explanation
Clients experiencing mania often demonstrate hyperactivity, poor boundaries, excessive talking, and impulsive behavior. Nursing care focuses on providing structure, reducing stimulation, and safely channeling excess energy. Clear and concise directions help the client maintain basic self-care activities. Physical activities such as walking help release excess energy in a safe way. Assigning a single room reduces environmental stimulation and helps prevent disruption of other clients. Suspenseful television and competitive activities can increase stimulation and worsen manic behaviors.Correct Answer Is:
B. Give concise and firm directions for hygiene and dressing.D. Invite for a walk when the client's energy is high.
E. Assign the client to a single room.
The nurse plans to use role playing as a therapeutic measure. Which individual is most likely to benefit from this type of therapeutic intervention?
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An adolescent who is depressed over not being accepted by peers.
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A hyperactive 4-year-old who has recently been tested for autism.
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An adult with schizophrenia who often refuses to take prescribed antipsychotic medications.
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An older adult resident of a long-term care facility who sometimes takes other residents' belongings.
Explanation
Explanation
Role playing is a therapeutic communication technique commonly used to help clients practice social interactions, improve communication skills, and develop confidence in challenging situations. Adolescents experiencing peer rejection may benefit from practicing social scenarios in a safe environment, allowing them to explore appropriate responses and build coping strategies. This intervention helps strengthen interpersonal skills and self-esteem, making it particularly effective for adolescents struggling with peer relationships and social acceptance.Correct Answer Is:
A. An adolescent who is depressed over not being accepted by peers.A client who has been abused by a spouse multiple times is admitted to the emergency department (ED). When taking the history, which information is most important for the nurse to obtain?
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Determine if the client has a plan to leave if their life is in danger.
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Discuss the injuries that occurred from the previous abuse.
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Find out the circumstances that prompted this abusive episode.
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Ask if the spouse drinks alcohol or does drugs before abuse occurs.
Explanation
Explanation
The priority when caring for a client experiencing intimate partner violence is immediate safety. Determining whether the client has a safety plan if the situation becomes life threatening helps assess the client’s risk and guides interventions to protect the client. Information about previous injuries, triggers for abuse, or substance use may be helpful later but are not the most urgent priority during the initial assessment.Correct Answer Is:
A. Determine if the client has a plan to leave if their life is in danger.A client is admitted to the psychiatric inpatient unit with a bandaged flesh wound after attempting self injury by shooting. The client reports going through a divorce one year ago, job loss four months ago, and suffering from a breakup of a current relationship last week. Which is the most likely source of this client’s current feelings of depression?
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Poor self esteem.
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A lack of intimate relationships.
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Feelings of frustration.
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A sense of loss.
Explanation
Explanation
The client has experienced several significant life losses, including divorce, job loss, and a recent breakup. Multiple losses within a short period commonly contribute to feelings of grief, hopelessness, and depression. These events suggest that the client’s depressive feelings are most likely related to a strong sense of loss.Correct Answer Is:
D. A sense of loss.The mental health unit nurse completes the admission assessment for a depressed adolescent client with suicidal ideation. The client reports becoming angry with a sibling, so the client took a handful of pills. Which goal is most important for the nurse to establish with this client?
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Identify three effective ways to cope with feelings.
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Attend at least 2 group sessions daily on the unit.
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Verbally express anger towards family.
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Interact positively with the staff on the unit.
Explanation
Explanation
The client attempted self-harm after becoming angry, indicating difficulty managing emotions. The priority goal is to help the client develop healthy coping strategies for dealing with intense feelings. Learning effective coping methods can reduce impulsive behaviors and decrease the risk of future self-harm.Correct Answer Is:
A. Identify three effective ways to cope with feelings.How to Order
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