Mental Health Midterm Questions

Which class of medication has an increased risk of tardive dyskinesia?

1st generation (TYPICAL) antipsychotics

What statement should the nurse make to a client diagnosed with post traumatic stress disorder who appears to be experiencing anxiety? A. "Try not to worry so much." B. "I can see that you are becoming upset." C. "Everything is going to be all right; just relax." D. "Why are you having trouble controlling your anxiety?"

B

The nurse is providing discharge teaching for a client who has a new prescription for Doxepin (Silenor). Which of the following side effects should the nurse inform the client is associated with this medication? A. Weight loss B. Diarrhea C. Drowsiness D. Bradycardia

C Sleep aid Treats insomnia if pt has issues staying asleep

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? A. Lithium Toxicity B. EPS C. Tardive Dyskinesia D. Serotonin Syndrome

Tardive dyskinesia

The nurse is creating a plan of care for a client diagnosed with depression whose food intake is poor. The nurse should include which interventions in the plan of care? Select all that apply. A. Assist the client in selecting foods from the food menu. B. Offer high-calorie fluids throughout the day and evening. C. Allow the client to eat alone in the room if the client requests to do so. D. Offer small high-calorie, high-protein snacks during the day and evening. E. Select the foods for the client to be sure that the client eats a balanced diet.

A B D

A nurse is providing teaching to a client who has a new prescription for alprazolam (Xanax). Which of the following is the PRIORITY teaching information to provide the patient? A. This medication can affect your ability to drive or handle mechanical equipment B. You should avoid drinking beverages that contain caffeine with this medication C. You should avoid taking antacids with two hours of taking this medication D. This medication should be taken with or shortly after meals

A Benzodiazepine = Anxiolytic Treatment for anxiety SE: Sedation, Ataxia, Enteral grade amnesia

While caring for a client with schizophrenia the nurse notices the client spends a great deal of time repeating rhyming syllable such as "Me see bee tree". The nurse recognizes that the client is demonstrating which of the following positive signs of schizophrenia? A. Clang association B. Echolalia C. Magical thinking D. Word salad

A Clang associations are groups of words chosen because of the catchy way they sound not because of what they mean.

A moderately depressed client who was hospitalized two days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." How should the nurse interpret this behavior as a cue to modify the treatment plan? A. Suggesting a reduction of medication B. Allowing increased "in-room" activities C. Increasing the level of suicide precautions D. Allowing the client off-unit privileges as needed

A Pt who is moderately depressed and has only been in the hospital two days is unlikely to have a sudden cure. When a depressive episode is suddenly lifted it is likely that the client may have made the decision to harm themself

Which of the following clients is at greatest risk for committing suicide? A. A client with metastatic cancer B. A client with a newly diagnosed cardiac disorder C. A client who just had an argument with her fiancé D. A newly divorced client who states she has custody of the children

A Pt with terminal illness. Other high-risk groups include adolescents, drug abusers, persons who have experienced recent losses, those who have few or no social supports, and those with a history of suicide attempts and a suicide plan.

The nurse reviews the assessment data of a client admitted to the hospital with a diagnosis of anxiety. The nurse should assign priority to which assessment finding? A. Tearful, self-isolated B. Affect bland, withdrawn C. Fist clenched, pounding table, fearful D. Temperature 98.4°F (36.8°C); respirations 18 breaths/min

C

A client calls the nurse and reports feeling anxious. What is the appropriate initial nursing action? A. Sit and talk with the client about the feelings. B. Ask the unlicensed assistive personnel to check on the client. C. Administer the prescribed as-needed antianxiety medication. D. Call the client's health care provider to report the client's anxiety.

A

A client who is recovering from benzodiazepine dependence says, "I've lost so many people. First, my brother dies of cancer; then my husband leaves me for a 20-year-old. I wish I had one of those pills right now." Which statement by the nurse would be therapeutic? A. "Can you tell me what you think the pills can do for you?" B. "It sounds as if you feel that all of this has just happened to you." C. "It must have been a terrible loss for you when your brother died." D. "How did your husband's interest in a younger woman make you feel?"

A

A nurse is reviewing the laboratory report of a client who has been taking lithium carbonate for several months which of the following level should the nurse recognize is the therapeutic lithium level? A. 1.2 B. 1.6 C. 2.0 D. 0.4

A

A nurse is providing discharge teaching for a female client who has an anxiety disorder and a new prescription for lorazepam which of the following instructions should the nurse include in the teaching? A. This medication can be safely taken during pregnancy B. This medication must be discontinued by gradual tapering overtime C. An extra dose of the medication can be taken at bedtime if you experience insomnia D. You should monitor your blood glucose levels while taking this medication

B

A school nurse is caring for an adolescent client who has a history of depressive episode one year ago he appears to be drawn from social activities in a school performance is declining which of the following actions should the nurse take first? A. Initiating structure daily schedule of activities B. Conduct a suicide risk assessment C. Encourage the client to express his feelings in a journal D. Ask teachers to monitor for other signs of depression

B

During a mental status examination, the client states, "Glass breaks if you throw stones or shoot at it with a gun. My cousin shoots guns at the police all the time at target practice. People who live in glass houses shouldn't throw stones." How will the nurse appropriately document the client's speech? A. Speech is incoherent and tangential. B. Speech is illogical and loosely associated. C. Speech is distractible and contains flight of ideas. D. Speech is pressured and contains clang associations.

B

During a nursing interview, a client says, "My daughter was murdered. I can't help wondering if her husband killed her, but he's been eliminated as a suspect." Which statement is a therapeutic nursing response? A. "I agree. What do you want to bet he did it?" B. "Have you shared your concerns with the police?" C. "I don't think that you should blame yourself one little bit." D. "It feels terrible to lose a daughter. Your suspicions are only natural."

B

The nurse is assessing a client who has been taking an antipsychotic medication for the past six years. The provider has recently started tapering off the dosage. Which of the following symptoms should the nurse monitor for that would suggest signs of Tardive dyskinesia? A. Muscular weakness B. Involuntary tongue protrusion C. Muscle spasms D. Uncontrolled rolling of the eyes

B

The nurse is monitoring a client diagnosed with schizophrenia who demonstrates a dysfunctional affect. Which situation is congruent with inappropriate affect? A. When told that a beloved pet has died, the client responds, "OK." B. The client giggled while describing being physically abused as a child. C. The client's facial expressions are unchanged during the entire admission process. D. When staff members attempt to engage the client in conversation, the client only mumbles.

B

The nurse is performing an admission assessment on a client at high risk for suicide. Which assessment question will best elicit data related to this risk? A. "What are you feeling right now?" B. "Do you have a plan to commit suicide?" C. "How many times have you attempted suicide in the past?" D. "Why were your attempts at suicide unsuccessful in the past?"

B

The nurse assigned to care for a female client diagnosed with acute depression would be appropriate in making which statement to the client? A. "You look lovely today." B. "You're wearing a new blouse." C. "Don't worry; everyone gets depressed once in a while." D. "You will feel better when your medication starts to work."

B A Pt who is depressed sees the negative side of everything. Telling the client that she looks lovely today can be interpreted as "I didn't look lovely last time we met." Neutral comments such as that identified in the correct option will avoid negative interpretations. The client should not be told not to worry, that everyone gets depressed once in a while, or that he or she will feel better because such statements are inappropriate and minimize the client's feelings

The nurse is providing teaching to a client who has a new prescription for Diazepam. Which of the following instruction should the nurse include in the teaching? A. Expect this medication to make you feel anxious B. This medication can be habit-forming C. Take this medication on an empty stomach D. This medication takes 2 to 3 weeks to reach it's therapeutic effect

B Benzodiazepines Treatment of anxiety

A nurse is caring for a client who has acute delirium. Which of the following findings should the nurse expect on assessment? A. Progressive deterioration of cognitive function B. Rapid fluctuation in level of consciousness C. Loss of language ability D. Absence of contributing factors to pinpoint cause of delirium

B Onset is sudden

During the assessment, what is the nurse's primary goal for a confused and disoriented client diagnosed with post traumatic stress disorder? A. Explaining the unit rules B. Making the client feel safe C. Orienting the client to the unit D. Stabilizing the client's psychiatric needs

B SAFETY is always PRIORITY

Clients with which diagnoses are commonly prescribed interventions to manage anxiety? Select all that apply. A. Dementia B. Panic disorder C. Multiple personality disorder D. PTSD E. OCD

B D E

The nurse is providing teaching to a client who has a new prescription for Risperidone (Risperdal) which of the following statements should the nurse make? A. This medication is a tricyclic antidepressant and will improve your mood B. This medication is an opioid antagonist that blocks the pleasurable effects of alcohol C. This medication as an antipsychotic that controls manifestations of schizophrenia D. This medication is a cholinesterase inhibitor that slows the progression of dementia

C Antipsychotic Higest risk of EPS Increases prolactin

A nurse is planning to administer a dose of lithium carbonate to a client who has bipolar disorder. The laboratory report indicates that the clients current lithium level is 1.2. Which of the following actions should the nurse take? A. Contact the provider for a dosage increase B. Request a repeat of the lithium level C. Administer the medication D. Prepare the client for gastric lavage

C

A nurse is providing teaching to a client with schizophrenia who is taking Quetiapine (Seroquel). The nurse should instruct the client that which of the following blood test should be performed periodically? A. Potassium B. Uric acid C. Glucose D. Calcium

C

The nurse in the mental health unit is performing an assessment in a client who has a history of multiple physical complaints involving several organ systems. Diagnostic studies revealed no organic pathology. The care plan developed for this client will reflect that the client is experiencing which disorder? A. Depression B. Schizophrenia C. Somatization disorder D. Obsessive-compulsive disorder

C

A 10-year-old referred for evaluation after drawing sexually explicit scenes says to the psychiatric nurse, "I just felt like it." Which response by the nurse is focused on assessing for abuse-related symptoms? A. "Well, a picture paints a thousand words." B. "You just felt like destroying your textbooks?" C. "Your parents and teachers are very concerned about your drawings." D. "I am concerned about you. Are you now or have you ever been abused?"

D

A client diagnosed with depression is not eating adequately and at times even refuses to eat at all. What should the nurse plan to do to meet the client's nutritional needs? A. Force foods and fluids. B. Restrict social activities until food intake is increased. C. Promptly provide snacks and meals when the client requests them. D. Provide small, frequent meals that include the client's food preferences.

D

A client recently admitted to the hospital in the manic phase of bipolar disorder is unkempt, taking antipsychotic medications, and complaining of abdominal fullness and discomfort. Which intervention addresses the priority sign/symptom? A. Teach self-grooming skills. B. Reward cleanliness with unit privileges. C. Monitor the adequacy of the antipsychotic dosage. D. Encourage frequent fluid intake and a high-fiber diet.

D

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." Which is the nurse's best response? A."Have you talked to your family about this?" B."Everyone feels this way when they are depressed." C."You will feel better once your medication begins to work." D."You sound very upset. Are you thinking of hurting yourself?"

D

A homebound client confidentially discusses suicidal plans with the visiting nurse. Based on professional duty to observe confidentiality, which statement describes the nurse's obligation to the client? A. Arrange for the client go to the local mental health center daily for counseling. B. Ask the client's permission to reveal the suicidal plans to the health care provider (HCP). C. Assure the client that the confidence between nurse and client will be strictly adhered to. D. Share that the risk to their safety requires that the client's HCP be notified.

D

A nurse in a mental health clinic is assessing a client who has a history of mania which of the following findings indicates that the client is experiencing a relapse? A. Weight gain B. Ritualistic behavior C. Anhedonia D. Pressured speech

D

During a therapy session a client with a personality disorder says to the nurse, "You look so nice today. I love how you do your hair, and I love that perfume you're wearing." Which response by the nurse would best address this breech of boundaries? A. "Your comment is really inappropriate." B. "Thank you, the perfume was a gift." C. "Neither my hair nor my perfume is the focus of today's session." D. "The focus of today's session is on your issues, so let's get started."

D

The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action? A. Incessant talking and sexual innuendoes B. Grandiose delusions and poor concentration C. Outlandish behaviors and inappropriate dress D. Nonstop physical activity and poor nutritional intake

D

The nurse in an outpatient mental health clinic is interviewing a client who has schizophrenia and appears to be experiencing auditory hallucinations. Which of the following actions should the nurse take FIRST? A. Teach the client strategies to decrease her hallucinations B. Identify if the client is on antipsychotic medications C. Distract the client from the hallucination D. Explore what the voices are saying to the client

D

The nurse is caring for a client who is taking a tricyclic antidepressant. Which of the following adverse effects should the nurse report to the client provider immediately? A. Drive mouth B. Constipation C. Drowsiness D. Urinary retention

D

What is the appropriate nursing intervention for a client diagnosed with post traumatic stress disorder and paranoid tendencies who begins to pace and fidget? A. Escort the client to a private, low-stimulus room. B. Engage the client in a nonthreatening conversation. C. Allow the client to pace unless the behavior becomes aggressive. D. Share the observation with the client so the behavior can be recognized.

D

A nurse is assessing a client who has a psychotic disorder in a new prescription of haloperidol the client is pacing in the hallway and states I can't seem to set still which of the following extrapyramidal side effects is the client likely experiencing? A. Dystonia B. Parkinsonism C. Tardive dyskinesia D. Akathisia

D A feeling of muscle quivering, restlessness and inability to sit still. Side effect of antipsychotic or antidepressant meds

A nurse is providing teaching to a client who has generalized anxiety disorder about their new prescription for Buspirone (Buspar). Which of the following statements by the client indicates an understanding of the teaching? A. This medication can cause dependence B. I should take a dose of my medication when I start to feel anxious C. It's important for me to take my medication 30 minutes before bedtime D. I should expect to feel the full effect of my medication in two to four weeks

D Anxiolytic Reduces anxiety without sedative effects Taken every day - effects takes several weeks for anti anxiety onset SE: DIZZINESS and INSOMNIA

The nurse is providing education to a patient with a new prescription for Phenelzine (Nardil) which is an MAOI. Which of the following stated by the patient would require the need for more education from the nurse? A. I can not take this medication within 2 weeks of another antidepressant B. My doctor prescribes this medicine to treat my social phobia C. I should avoid taking NSAID's while on this medication D. I have to limit myself to 1-2 four oz glasses of red wine a week

D Pt's taking MAOI's can not have foods or beverages with tyramine No: Wine/cheese Beer Chocolate Sausage, salami

Why are patients advised not to take St. Johns Wort with SSRI's?

Increase in serotonin levels can lead to Serotonin syndrome