A charge nurse on a mental health unit is describing assessments for suicide risks to a group of newly licensed nurses. Which of the following tests should the nurse include?(Select All that Apply.)

Harvard Implicit Association Test (IAT)

PHQ-9

Altman Self-Rating Mania Scale

SAD PERSONS

SAFE-T

Answer and Explanation

Correct Answer : B,D,E

Rationale:

A. The Harvard Implicit Association Test (IAT) measures implicit biases and is not used specifically for assessing suicide risk.

B. The PHQ-9 (Patient Health Questionnaire-9) is a validated tool for screening, diagnosing, monitoring, and measuring the severity of depression, which is closely related to suicide risk.

C. The Altman Self-Rating Mania Scale is used to assess the severity of manic symptoms in clients with bipolar disorder, not for suicide risk assessment.

D. The SAD PERSONS scale is a tool specifically designed to assess suicide risk based on key risk factors.

E. The SAFE-T (Suicide Assessment Five-Step Evaluation and Triage) is a comprehensive framework for assessing suicide risk, making it an appropriate tool to include in suicide risk assessments.

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Correct Answer is C

Explanation

Rationale:

A. HIV infection can cause cognitive impairment, but it typically does not present with fluctuating cognition and visual hallucinations as primary symptoms.

B. Traumatic brain injury can lead to cognitive changes, but it is not typically associated with fluctuating cognition and visual hallucinations.

C. Lewy body disease is characterized by fluctuating cognition, visual hallucinations, and motor symptoms, making it the most likely diagnosis for these symptoms.

D. Prion disease is associated with rapidly progressive dementia but not specifically with fluctuating cognition and visual hallucinations.

A. The final 2 min B. The final 15 min C. The first 15 min D. The first 2 min

Correct Answer is C

Explanation

Rationale:

A. Observing the final 2 minutes is not sufficient for detecting acute transfusion reactions, which can occur at any time during the transfusion.

B. Observing the final 15 minutes is also not adequate; reactions can occur earlier.

C. The first 15 minutes is the most critical time for observing for transfusion reactions, as most reactions occur during this period.

D. The first 2 minutes are too brief to detect potential transfusion reactions, which typically manifest within the first 15 minutes.

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A charge nurse on a mental health unit is describing assessments for suicide risks to a group of newly licensed nurses. Which of the following tests should the nurse include?(Select All that Apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is experiencing fluctuating cognition and visual hallucinations. Which of the following types of dementia should the nurse expect this client to have?

Correct Answer is C

Explanation

A nurse is caring for a client who has a prescription for one unit of packed RBCs. The nurse should plan to remain in the room with the client at which of the following times during the infusion to observe for a transfusion reaction?

Correct Answer is C

Explanation

A nurse working in a community health center is speaking with a client who has a serious mental illness. The client states that they are unable to find employment and they do not understand why. Which of the following questions should the nurse ask? (Select all that apply.)

A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority?

A nurse is discussing borderline personality disorder and the risk for self-harm with a newly licensed nurse. Which of the following situations should the nurse identify as the highest risk for self-harm?

A nurse is caring for a client who has posttraumatic stress disorder (PTSD). The nurse anticipates the provider might prescribe which of the following medications?

A nurse is caring for a client who is experiencing manifestations of anxiety. The nurse should recognize which of the following statements about the neurophysiologic manifestations of anxiety as correct?

A nurse is discussing bias issues in mental health with a newly licensed nurse. Which of the following statements should the nurse include in the discussion?

A nurse is discussing strategies to develop nurse-client therapeutic relationships with a newly licensed nurse. Which statement by the nurse accurately describes strategies for building a therapeutic relationship?

A nurse is caring for a client who is experiencing lack of sleep, lack of appetite, and difficulties with concentration. Which of the following types of dementia should the nurse expect this client to have?