At what point should the nurse determine that a client is at risk for developing mental illness? When:

a client communicates significant distress.

maladaptive responses to stress are coupled with interference in daily functioning.

thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria.

a client uses defense mechanisms as ego protection.

Answer and Explanation

The Correct Answer is B

a. a client communicates significant distress. While significant distress is important to consider, it alone does not necessarily indicate a risk for developing mental illness unless it also impacts daily functioning and coping mechanisms.
b. maladaptive responses to stress are coupled with interference in daily functioning. This choice is correct because it reflects a combination of maladaptive coping (which can exacerbate mental health issues) and interference with daily functioning (a key indicator of mental illness according to DSM-5 criteria).
c. thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. While alignment with DSM-5 criteria is crucial for diagnosis, this choice alone does not address the risk aspect. The focus should be on behaviors that lead to impairment in daily functioning and coping.
d. a client uses defense mechanisms as ego protection. Using defense mechanisms is a normal part of human behavior and not necessarily indicative of mental illness risk unless these mechanisms are maladaptive and interfere with functioning.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is B

Explanation

a. "I may consider dating you once you have fully recovered." This response, while seemingly kind, is unprofessional. It creates a false sense of hope for the client and blurs the professional line.
b. "This is a professional relationship, and we need to be clear on that." This is a direct and professional way to set boundaries. It reminds the client of the nature of the relationship and avoids any misunderstanding.
c. "It's against hospital policy for me to date clients." While some hospitals might have such policies, this isn't always the case. A broader and more direct response like option b is preferable.
d. "I'm sorry, but I'm married and not interested in dating." This response might be true, but it focuses on the nurse's personal life and deflects from the professional aspect. Option b is more appropriate.

A. The unit can be managed with fewer staff B. Clients are encouraged to communicate with others C. The reduced sensory input allows the client to regain control D. Clients are forced to be responsible for themselves

Correct Answer is C

Explanation

a. The unit can be managed with fewer staff. Seclusion requires close monitoring by staff.
b. Clients are encouraged to communicate with others. Seclusion is meant to be a temporary measure to prevent further harm, not necessarily to promote communication.
c. The reduced sensory input allows the client to regain control. Seclusion is a time-limited safety intervention used when a client poses a danger to themselves or others. It provides a safe space with reduced stimulation to allow the client to calm down and regain control.
d. Clients are forced to be responsible for themselves. Seclusion is not a punitive measure. The goal is to ensure safety and facilitate regaining control.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

At what point should the nurse determine that a client is at risk for developing mental illness? When:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After having one conversation with a female nurse, a young male client asks the nurse for her phone number. He says that he would like to date her. Which of the following responses would be most appropriate?

Correct Answer is B

Explanation

A new nurse orientee asks why a client admitted to the psychiatric unit is placed in seclusion. The nurse precepting the new nurse explains that which of the following is a benefit of seclusion?

Correct Answer is C

Explanation

The nurse is caring for a client who lost the ability to use their arm. All tests have ruled out any medical diagnosis. The nurse understands that the loss of use of the arm is a symptom of:

During a client intake assessment, the nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." What is the nurse's best response?

The nurse is interviewing a newly admitted client. Which of the following nursing statements is an example of offering a "general lead"?

A client diagnosed with major neurocognitive disorder is exhibiting behavioral problems daily. At change of shift, the client's behavior escalates from pacing to screaming and waving their arms while on the ground. Which action should be a nursing priority?

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? The client:

The nurse is assessing an alert and independent older client for the risk of malnutrition. What item is most appropriate to assess?

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia disorder?

While planning care for a client with anorexia nervosa, the nurse determines that a realistic outcome would be that the client will: