MH Exam 2
A nurse employed in the mental health clinic is greeted by a neighbor in a local store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is being seen at your clinic every week." The appropriate nursing response would be which of the following? A. I cannot discuss any client situation with you B. If you want to know about Carol, you will need to ask her yourself C. I'm not supposed to discuss this, but since you are my neighbor I can tell you she is doing great! D. I think I remember her adding you to her list of people to contact in case of an emergency last night, so I can tell that she is doing very well
A
A nurse is planning care for a client being admitted to the unit who attempted suicide. Which of the following priority nursing interventions would the nurse include in the plan of care? A. 1:1 suicide precautions B. Suicide precautions with 30 minute checks C. Checking the whereabouts of the client every 15 minutes D. Asking the client to report suicidal thoughts immediately
A
An SSRI is prescribed for a client. The nurse knows that which drug is an SSRI? A. Paroxetine (Paxil) B. Amitriptyline (Elavil) C. Divalproex Sodium (Depakote) D. Bupropion HCl (Wellbutrin)
A
The client scheduled for ECT tells the nurse, "I'm so afraid. What will happen to me during treatment?" Which of the following statements is most therapeutic for the nurse to make? A. You will be given medicine to relax you during treatment B. The treatment will produce a controlled grand mal seizure C. The treatment might produce nausea and a headache D. You can expect to be sleepy and confused for a time after the treatment
A
The client is having ECT for treatment of severe depression. Prior to the ECT the nurse should: A. Apply a tourniquet to the patient's arm B. Administer an anticonvulsant medication C. Ask the client if he is allergic to shell fish D. Apply a blood pressure cuff to the arm
B
A client comes to the emergency department after an assault and is extremely agitated, trembling, and hyperventilating. The appropriate initial nursing action would be to: A. Encourage the client to discuss the assault B. Place the client in a quiet room alone to decrease stimulation C. Remain with the client until the anxiety decreases D. Begin to teach relaxation techniques
C
A client is admitted to the mental health unit after an attempt of suicide by hanging. A nurse's most important aspect of care is to maintain client safety. This is accomplished best by: A. Requesting that a peer remain with the client at all times B. Removing the client's clothing and placing them in a gown C. Assigning a staff member to the client who will remain with the client at all times D. Admitting the client to a seclusion room where all potentially dangerous articles are removed
C
A nurse is caring for a client who is scheduled for ECT. The nurse notes that an informed consent has not been obtained for the procedure. On review of the record, the nurse notes that the admission was involuntary. Based on this information, the nurse determines: A. That the doctor will provide the informed consent B. That an informed consent does not need to be obtained C. That an informed consent should be obtained from the family D. That an informed consent needs to be obtained from the client
D
A nurse is conducting a group therapy session. During the session, a client with mania consistently talks and dominates the group session, and this behavior is interrupting group interactions. The nurse would initially: A. Ask the client to leave the group session B. Ask another nurse to escort the client out of the group session C. Tell the client that she will not be able to attend any future group sessions D. Tell the client that she needs to allow the other clients in the room time to talk
D
Which of the following is the best predictor of a client's favorable response to the choice of an antidepressant? A. The drug's side effect profile B. The client's age at diagnosis C. The cost of the medication D. A favorable response by a family member
D
You are the triage nurse in the ER. Your initial assessment indicates that depression may be part of the client's problem. Which of the following nursing actions is essential? A. Within 1 week, telephone the client to ensure their mood has improved B. Redirect the client to discuss the stated reason for the visit C. Explore the client's perceptions regarding the severity of the stated reason for the visit D. Ask about depression and suicidal ideation directly
D
Which of the following questions should the nurse ask to best determine the seriousness of a client's suicidal ideation? A. How are you planning on harming yourself? B. Have you made out a will? C. Have you attempted suicide before? D. How long have you been thinking about harming yourself?
A
Select the nursing interventions for a hospitalized client with mania who is exhibiting manipulative behavior. Select all that apply. A. Communicate expected behaviors to the client B. Ensure the client knows that he or she is not in charge of the nursing unit C. Assist the client in identifying ways of setting limits on personal behaviors D. Follow through about the consequences of behavior in a nonpunitive manner E. Enforce rules and inform the client that he or she will not be allowed to attend therapy groups F. Be clear with the client regarding the consequences of exceeding limits that have been set regarding behavior
A, C, D, F
A nurse is caring for a client with anorexia nervosa. The nurse is monitoring the behavior of the client and understands that a client with anorexia nervosa manages anxiety by: A. Engaging in immoral acts B. Always reinforcing self-approval C. Observing rigid rules and regulations D. Having the need to make the right decision
C
A client is taking tranylcypromine sulfate (Parnate) for depression. What advice should the nurse include in the teaching plan for this medication? A. Warn of severe hypotension B. Avoid beer and cheddar cheese C. Encourage ginseng and ephedra D. Encourage fruit such as bananas
B
A nure is providing care for a client admitted to the hospital with a diagnosis of acute anxiety disorder. The client says to the nurse, "I have a secret that I want to tell you. You won't tell anyone about it, will you? The appropriate nursing response would be which of the following? A. No, I won't tell anyone B. I cannot promise to keep a secret C. If you tell me the secret, I will need to tell it to your doctor D. If you tell me the secret, I will need to document it in your record
B
The nurse is reviewing the laboratory report with the client's lithium level taken that morning prior to administering the 5 pm dose of lithium. The lithium level is 1.8 mEq/L. The nurse should: A. Administer the 5 pm dose of lithium B. Hold the 5 pm dose of lithium C. Give the client 8 oz of water with the lithium D. Give the lithium after the client's supper
B
Which behavior observed by the nurse indicates a suspicion that a depressed adolescent client may be suicidal? A. The client runs out of the therapy group, swears at the group leader, and runs to her room B. The client gives away a prized CD and cherished autographed picture of her favorite performer C. The client becomes angry while speaking on the phone and slams down the receiver D. The client gets angry when her roommate borrows her clothes without asking
B
Which of the following comments indicates that a client understands the nurse's teaching about sertraline (Zoloft)? A. Zoloft will probably cause me to gain weight B. This medicine can cause delayed ejaculations C. Dry mouth is a permanent side effect of Zoloft D. I can take my medication with St. John's Wort
B
A client will be discharged on lithium carbonate 600 mg 3 times a day. When teaching the client and his family about lithium therapy, the nurse determines that teaching has been effective if the client and family state that they will notify the prescribing physician immediately if which of the following occur? Select all that apply. A. Nausea B. Muscle Weakness C. Vertigo D. Fine Hand Tremors E. Vomiting F. Anorexia
B, C, E
The client with depression has been consistent with taking 12.5 mg of paroxetine (Paxil) extended release daily. The nurse judges the client to be benefiting from this drug therapy when the client demonstrates which of the following behaviors? Select all that apply. A. Takes 2 hour naps daily B. Completes homework assignment C. Decreases pacing D. Increases somatization E. Verbalizes feelings
B, C, E
A 62 year old female client with severe depression and psychotic symptoms is scheduled for ECT tomorrow morning. The client's daughter asks the nurse, "how painful will the procedure be for mom?" The nurse should respond by stating: A. Your mother will be given pain medication before the treatment B. The physician will make sure your mother doesn't suffer needlessly C. Your mother will be asleep during the procedure and feel no pain D. Your mother will be able to talk and tell us if she's in pain
C
A client is brought to the ED by the police and admitted involuntarily. She is diagnosed with bipolar disorder, manic phase. The physician orders lithium 300 mg PO 3 times a day. The client refuses her morning dose of lithium. The nurse should next: A. Force the client to take the lithium because of the lithium because of the client's involuntary status B. Contact the dr to change the lithium order to be given IM C. Inform the client that she has the right to refuse medication despite her involuntary status D. Tell the client that certain privileges will be revoked if she does not take the medication
C
A client who has had 3 episodes of recurrent endogenous depression within the past 2 years states to the nurse, "I want to know why I'm so depressed." Which of the following statements by the nurse is most helpful? A. I know you'll get better with the right medication B. Let's discuss possible reasons underlying your depression C. Your depression is most likely caused by a brain chemical imbalance D. Members of your family seem very supportive of you
C
A client who overdosed on barbiturates is being transferred to the inpatient psychiatric unit from the ICU. Assessing the client for which of the following needs should be a priority for the nurse receiving the client in the ICU? A. Nutrition B. Sleep C. Safety D. Hygiene
C
A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to a nurse, "I'm finally cured." The nurse interprets this behavior as a cue to modify the treatment plan by: 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 priveleges as needed
C
A client is admitted with bipolar affective disorder. The nurse acknowledges that which medication is used to treat this disorder for some clients in place of lithium? A. Thiopental B. Gingko Biloba C. Fluvoxamine (Luvox) D. Divalproex (Depakote)
D
The client with rapid-cycling bipolar disorder who is about to receive his 5 pm dose of carbamazepine (Tegretol) tells the nurse he has a sore throat and chills. Which of the following should the nurse do next? A. Administer the next dose of carbamazepine B. First, give the client acetaminophen (Tylenol) as ordered PRN C. Report the symptoms to the physician in the morning D. Call the physician to report the symptoms
D
When assessing a client who is receiving tricyclic antidepressant therapy, which of the following should alert the nurse to the possibility that the client is experiencing anticholinergic effects? A. Tremors and cardiac arrhythmias B. Sedation and delirium C. Respiratory depression and convulsions D. Urine retention and blurred vision
D
A client who is depressed states, "I'm an awful person. Everything about me is bad. I can't do anything right." Which of the following responses by the nurse is most therapeutic? A. Everyone here likes you B. I can see many good qualities in you C. Let's discuss what you've done correctly D. You were able to bathe today
D
The nurse is distinguishing between delusions experienced by a client diagnosed with major depression with psychotic features and the delusions of a client diagnosed with schizophrenia. The essential difference is: A. Major depression delusions are more likely to be negative than schizophrenic delusions B. Major depression delusions clear up less quickly than schizophrenic delusions C. Major depression delusions are more likely than schizophrenic delusions to require long acting depot antipsychotic medication given IM D. Major depression delusions are more mood congruent than schizophrenic delusions
D
A client is admitted to the a medical nursing unit with a diagnosis of acute blindness. Many tests are performed, and there seems to be no organic reason why this client can not see. The client became blind after witnessing a hit and run car accident where a family of three was killed. A nurse suspects that the client may be experiencing a: A. Psychosis B. Repression C. Conversion Disorder D. Dissociative Disorder
C
The client has been hospitalized for major depression and suicidal ideation. Which of the following statements indicates to the nurse that the client is improving? A. I couldn't kill myself because I don't want to go to hell B. I don't think about killing myself as much as I used to C. I'm of no use to anyone anymore D. I know my kids don't need me anymore
B
The history of a female client who has just been admitted to the unit and is very depressed reveals a weight loss of 10 lb in 2 weeks, sleeping 3 hours a night, and poor hygiene. The client states, "I'm no good to anyone. Everyone would be better off without me." Which of the following questions should the nurse ask first? A. What do you mean? B. Are you thinking about hurting yourself? C. Doesn't your family care about you? D. What happened to make you think that?
B
When planning the discharge of a client with chronic anxiety, a nurse directs the goals at promoting a safe environment at home. The appropriate maintenance goal should focus on which of the following? A. Ignoring the feelings of anxiety B. Identifying the anxiety-producing situations C. Continued contact with a crisis counselor D. Eliminating all anxiety from daily situations
B
A client taking paroxetine (Paxil) 40 mg PO every morning tells the nurse that her mouth "feels like cotton." Which of the following statements by the client necessitates further assessment by the nurse? A. I'm sucking on ice chips B. I'm using sugarless gum C. I'm sucking on sugarless candy D. I'm drinking 12 glasses of water every day
D
Which of the following amounts of medications is appropriate for a client who is being treated with imipramine (Tofranil) on an outpatient basis for recurring depression and suicidal ideation to have at one time? A. A 22 day supply B. A 14 day supply C. A 10 day supply D. A 3 day suppy
D
A client on the psych unit is in an uncontrollable rage and is threatening other clients and staff. What is the most appropriate action for the nurse to take? A. Call security for assistance and prepare to sedate the client B. Tell the client to calm down and ask him if he would like to play cards C. Tell the client that if he continues his behavior will be punished D. Leave the client alone until he calms down
A
The client with depression is taking imipramine (Tofranil) states to the nurse, "my doctor wants me to have an ECG in weeks, but my heart is fine." Which response by the nurse is most appropriate? A. It is routine to have ECGs periodically because there is a slight chance that the drug may affect the heart B. It is probably a precautionary measure because I'm not aware that you have a cardiac condition C. Try not to worry too much about this. Your doctor is just being very thorough in monitoring your condition D. You had an ECG before you were prescribed imipramine and the procedure will be the same
A
The nurse is teaching 2 nursing assistants who are new to the inpatient unit about caring for a client who is suicidal. The nurse determine that additional teaching is needed when which of the following statements is made? A. I need to check the client precisely at 15 minute intervals B. Documenting suicidal checks is absolutely necessary C. Clients on one-to-one suicide precautions can never be left alone D. All clients using razors must be supervised by staff
A
A nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. The symptom presented by the client that requires the nurse's immediate intervention is the client's: A. Outlandish behaviors and inappropriate dress B. Nonstop physical activity and poor nutritional intake C. Grandiose delusions of being a royal descendent of King Arthur D. Constant incessant talking that includes sexual innuendoes and teasing the staff
B
A nurse is assessing a client with hypomania who wants to stop her mood stabilizing medications because she is "feeling good", has a high energy level, and thinks she is productive at work. Which response by the nurse is most appropriate? A. Maybe you really don't need your medications anymore B. I believe you were hospitalized the last time you stopped your medications C. If you stop your medications, your behavior will quickly spiral out of control D. Why don't you cut your medication dosage in half for a while and see how you respond?
B
A young adult diagnosed with bipolar disorder has been managing the disorder effectively with meds and treatment for several years. The client suddenly becomes manic. The nurse reviews the client's medication record. Which of the following medication may have contributed to the development of his manic state? A. Elevil (amitriptyline) B. Prednisone C. Buspar (buspirone) D. Neurotonin (gabapentin)
B
After the nurse teaches a client with bipolar disorder about lithium therapy, which of the following client statements indicates the need for additional teaching? A. It's important to keep using a regular amount of salt in my diet B. It's okay to double to my next dose of lithium if I forget a dose C. I should drink 8 to 10 glasses of water a day D. I need to take my medication at the same time each day
B
The client with major depression and suicidal ideation has been taking bupropion (Wellbutrin)100 mg PO 4 times a day for 5 days. Assessment reveals the client to be somewhat less withdrawn, able to perform ADL's, and eating 50% of each meal. At this time, the nurse should monitor the client specifically for which of the following behaviors? A. Seizure activity B. Suicide attempt C. Visual disturbances D. Increased libido
B
When assessing a client for suicidal risk, which of the following methods of suicide should the nurse identify as most lethal? A. Aspirin Overdose B. Use of a Gun C. Acetaminophen Overdose D. Wrist-Cutting
B
When teaching the client with atypical depression about food to avoid while taking phenelizine (Nardil), which of the following should the nurse include? A. Roasted chicken B. Salami C. Fresh fish D. Hamburger
B
A nurse is conducting a psychoeducational group for family members of clients hospitalized with depression. Which family member's statement indicates the need for additional teaching? A. My husband will slowly feel better as his medicine takes effect over the next 2 to 4 weeks B. My wife will need to take her antidepressant medicine and go to group to stay well C. My son will only need to attend outpatient appointments when he starts to feel depressed again D. My mother might need help with grocery shopping, cooking, and cleaning for a while
C
A nurse is preparing to care for a dying client, and several family members are at the client's bedside. Select the therapeutic techniques that the nurse would use when communicating with the family. Select all that apply. A. Discourage reminiscing B. Make the decisions for the family C. Encourage expression of feelings,concerns, and fears D. Explain everything that is happening to all family members E. Touch and hold the client's or family members' hands if appropriate F. Be honest and let the client and family know that they will not be abandoned by the nurse
C, E, F
A client is admitted to the mental health unit with a diagnosis of depression. A nurse develops a plan of care for the client and includes which appropriate activity in the plan? A. Reading and writing most of the day B. Several activities from which the client can choose C. Nothing until the client chooses to participate in milieu D. A structured program of activities in which the client can participate
D
A client taking mirtazipine (Remeron) is disheartened about a 20 lb weight gain over the past 3 months. The client tells the nurse, "I stopped taking my Remeron 15 days ago. I don't want to get depressed again, but I feel awful about my weight." Which response by the nurse is most appropriate? A. Focusing on diet and exercise alone should control your weight B. Your depression is much better now, so your medication is helping you C. Look at all the positive things that have happened to you since you started Remeron D. I hear how difficult this is for you and will help you approach the doctor about it
D
A client walks into the clinic and tells the nurse she wants to die because her boyfriend broke up with her. The client states, "I'll show him. He'll be sorry." The nurse notes which of the following as the underlying theme and method to deal with the client? A. Sadness-ask the client to reveal how long she has felt this way B. Escape-ask the client to indicate from what she wants to escape C. Loneliness-ask the client to state who she believes to be her friends D. Retaliation-ask the client about her specific plans to harm herself and/or her boyfriend
D
A client with a diagnosis of major depression who has attempted suicide says to a nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." The therapeutic response to the client is: A. I don't see you as a failure B. You have everything to live for C. Feeling like this is all part of being ill D. You've been feeling like a failure for a while?
D
A client with depression is exhibiting a brighter effect, ability to attend to hygiene and grooming tasks, and beginning to participate in group activities. The nurse asks the client to identify 3 of her strengths. After much hesitation and thinking, the client can state she is usually a nice person, good cook, and a hard worker. Which of the following should the nurse do next? A. Ask the client to identify an additional 3 strengths B. Volunteer the client to lead the cooking group later in the day C. Educate the client about the importance of medication D. Reinforce the client for identifying and sharing her strengths
D
A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which of the following areas is most important for the nurse to review with the client? A. Future plans for going back to work B. A conflict encountered with another client C. Results of psychological testing D. Medication management with outpatient follow-up
D
A male client who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse observes the client to be in need of grooming an hygiene. Which of the following nursing actions is most appropriate? A. Explaining the importance of hygiene to the client B. Asking the client if he is ready to shower C. Waiting until the client's family can participate in the client's care D. Stating to the client that it's time for him to take a shower
D
A nurse is caring for a suicidal client. The appropriate nursing intervention in dealing with this client is to: A. Demonstrate confidence in the client's ability to deal with stressors B. Provide hope and reassurance that the problems will resolve themselves C. Display an attitude of detachment, confrontation, and efficacy D. Provide authority, action, and participation
D
Your client with intense suicidal ideation has been hospitalized for 1 week, during which time he has received a SSRI. He reports "no change" in suicidal ideation, although he demonstrates a wider range of affect and takes more initiative in self-care. The health care is considering his imminent discharge. It is essential to consider which of the following factors? A. For 1 week of pharmacotherapy, the client has been free of untoward side effects B. The health care team has to plan for discharge from the day of admission C. The client will continue to improve because the medication has not yet exerted full therapeutic effect D. The client may have enough energy to plan and complete a suicide attempt
D
The client diagnosed with severe major depression has been taking Lexapro 10 mg daily for the past 2 weeks. Which of the following parameters should the nurse monitor most closely at this time? A. Suicidal ideation B. Sleep C. Appetite D. Energy level
A
The physician orders mirtazapine (Remeron) 30 mg PO at bedtime for a client diagnosed with depression. The nurse should: A. Give the medication as ordered B. Question the physician's order C. Request to give the medication in the morning D. Give the medication in 3 divided doses
A
A client with depression who is taking doxepin (Smequan) 100 mg PO at bedtime has dizziness on arising. Which of the following suggestions is most appropriate? A. Try taking a hot shower B. Get up slowly and dangle your feet before standing C. Stay in bed until you are feeling better D. You need to limit the fluids you drink
B
A depressed client verbalizes feelings of low self esteem and self worth typified by statements such as "I'm such a failure. I can't do anything right." The best nursing response would be to: A. Tell the client that this is not true, we all have a purpose in life B. Identify recent behaviors or accomplishments that demonstrate the client's skills C. Reassure the client that you know how the client is feeling and that things will get better D. Remain with the client and sit in silence. This will encourage the client to verbalize feelings
B
The physician orders fluoxetine (Prozac) orally every morning for a 72 year old client with depression. Which transient adverse effect of this drug requires immediate action by the nurse? A. Nausea B. Dizziness C. Sedation D. Dry Mouth
B
The police arrive at the ED with a client who has seriously lacerated both wrists. The initial nursing action is to: A. Administer an antianxiety agent B. Examine and treat the client's wounds C. Place the client in a room with 1:1 observation D. Explain to the client that once his wounds are repaired he must go with the police to jail
B
A 16 year old client is prescribed 10 mg of paroxetine (Paxil) at bedtime for major depression. The nurse should instruct the client and parents to monitor the client closely for which adverse effect? A. Headache B. Nausea C. Fatigue D. Agitation
D
A nurse is developing a plan of care for a client experiencing anxiety after the loss of a job. The client is verbalizing concerns regarding the ability to meet role expectations and financial obligations. The appropriate nursing diagnosis for this client is: A. Dysfunctional family process B. Disturbed thought processes C. Risk for anxiety D. Ineffective coping
D
The client diagnosed with bipolar disorder, manic phase, states to the nurse, "I'm the Queen of England. Bow before me." The nurse interprets this statement as important to document as which of the following areas: A. Psychomotor behavior B. Mood and affect C. Attitude towards the nurse D. Thought content
D
The client is having ECT for treatment of severe depression. Which of the following indicates that the client's ECT has been effective? A. The client loses consciousness B. The client vomits C. The client's ECG indicates tachycardia D. The client has a grand mal seizure
D
The physician orders valproic acid (Depakene) for a client with bipolar disorder who has achieved limited success with lithium carbonate (Lithane). Which of the following should the nurse include in the client's medication teaching plan? A. Follow-up blood tests are unnecessary B. The tablet can be crushed if necessary C. Drowsiness and upset stomach are common side effects D. Consumption of a moderate amount of alcohol is safe
C
When developing a teaching plan for a client about the medications prescribed for depression, which of the following components is most important for the nurse to include? A. Pharmacokinetics of the medication B. Current research related to the medication C. Management of common adverse effects D. Dosage regulation and adjustment
C
When preparing a teaching plan for a client about imipramine (Tofranil), which of the following substances should the nurse tell the client to avoid while taking the medication? A. Caffeinated coffee B. Sunscreen C. Alcohol D. Artificial tears
C
Which of the following activities should the nurse recommend to the client on an inpatient unit when thoughts of suicide occur? A. Keeping track of feelings in a journal B. Reading a magazine C. Talking with the nurse D. Playing a card game with the other clients
C
The husband of a client to be discharged from the hospital after an episode of major depression and a suicide attempt asks, "What can I do if she tries to kill herself again?" Which of the following responses is most appropriate? A. Don't worry. She'll be okay as long as she takes her medication B. She told me she wants to live so I don't think she'll try again C. Let's talk about some behavioral clues and resources that can help D. Tell her about your concern and just take care of her
C
The nurse realizes that some herbs interact with SSRI's. Which herb interaction may cause serotonin syndrome? A. Feverfew B. Ma-huang C. St. John's Wort D. Gingko Biloba
C
You administer the first dose of an antidepressant to your inpatient client with major depression. The client asks, "Is this medicine going to fix my depression?" Your accurate response includes which of the following? (Select all that apply) A. This medication will decrease the available dopamine, which is associated with psychotic thinking in major depression B. In addition, we are going to assist you in regulating your circadian rhythms, which should improve your depression C. It should help your depression, and you should feel the full therapeutic effect in 2 to 4 weeks D. This medication should increase the availability of neurotransmitters in your brain E. This medication should increase the production of serotonin in your brain
C, D
Which statement is true concerning lithium? A. The maximum dose is 3.4 G/day B. The therapeutic drug range is 2.5 to 3.5 mEq/L C. Lithium increases receptor sensitivity to GABA D. Concurrent NSAIDs may increase lithium levels
D
A client experiencing acute mania has been taking lithium carbonate 600 mg PO 3 times a day for 14 days. The client's serum lithium level is 1.8 mEq/L. The nurse should: A. Call the physician, hold the next dose of lithium, and push fluids B. Call the physician, start an IV, and put the client on bed rest C. Call the physician, then transfer the client to the ICU D. Inform the client that the lithium level is within normal limits
A
A client is unwilling to out of the house for fear of "doing something crazy in public." Because of this fear, the client remains homebound except when accompanied outside by the spouse. Based on these data, a nurse determines that the client is experiencing: A. Agoraphobia B. Social Phobia C. Claustrophobia D. Hypochondriasis
A
A client with a history of alcohol abuse tells a nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with him, the client dresses and begins to walk out of the hospital room. The appropriate nursing action is to: A. Call the nursing supervisor B. Call security to block all exits C. Restrain the client until the physician can be reached D. Tell the client that he cannot return to the hospital again if he leaves now
A
When a client is taking an antidepressant, what should the nurse do? Select all that apply. A. Monitor the client for suicidal tendencies B. Observe the client for orthostatic hypotension C. Teach the client to take the drug with food if GI distress occurs D. Tell the client that the drug may not have full effectiveness for 1 to 2 weeks E. Advise the client to maintain adequate fluid intake of 2 L/day
A, B, C, D
Which milieu activity should the nurse recommend to a client with acute mania? Select all that apply. A. Scheduled rest periods B. Relaxation exercises C. Listening to soft music D. Watching TV E. Aerobic exercises
A, B, C, E
The client states to the nurse, "I take citalopram (Celexa) 40 mg every day like my physician prescribed. I have also been taking St. John's Wort 750 mg daily for the past 2 weeks." Which of the following indicate that the client is developing serotonin syndrome? Select all that apply. A. Confusion B. Restlessness C. Constipation D. Diaphoresis E. Ataxia
A, B, D, E
The client with bipolar disorder, manic phase, has a valproic acid (Depakote) level of 15 ug/mL. Which of the following client behaviors should the nurse judge to be due to his level of valproic acid? Select all that apply. A. Irritability B. Grandiosity C. Anhedonia D. Hypersomnia E. Flight of Ideas
A, B, E
A client is taking lithium. The nurse should be aware of the importance of which nursing intervention(s)? Select all that apply. A. Observe the client for motor tremors B. Monitor the client for orthostatic hypotension C. Draw lithium blood levels immediately after a dose D. Advise the client to drink 750 mL/day of fluid in hot weather E. Advise the client to avoid caffeinated foods and beverages, such as coffee, tea, colas, and chocolate F. Teach the client to take lithium with meals to decrease gastric irritation
A, B, E, F
The client is taking 50 mg of Lamotrigine (Lamictal) daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do? A. Report the rash to the physician B. Explain that the rash is a temporary adverse reaction C. Give the client an ice pack for his arm D. Question the client about recent sun exposure
A.
A client who was recently discharged from the psychiatric unit calls the nurse and states that she took her children to her neighbors' home and has turned on the gas to kill herself. She is home alone and gives the nurse her address. Which of the following actions should the nurse do next? A. Refer the caller to a 24 hour suicide hotline B. Tell the caller that another nurse will call the police C. Ask the caller whether she called her physician D. Instruct the caller to call her family for help
B
A home health nurse visits a client at home and determines that the client is dependent on drugs. Which of the following assessment questions would assist the nurse to provide appropriate nursing care? A. Why did you get started on these drugs? B. How much did you use and what effect does it have on you? C. How long did you think you could take these drugs without someone finding out? D. The nurse should not ask questions for fear that the client may be in denial and will throw the nurse out of the home
B
A client diagnosed with bipolar disorder asks the nurse why it is necessary to have a serum lithium level drawn every 3 to 4 months. The nurse's response should be based on which of the following? A. To monitor compliance with the medication B. To prevent toxicity related to the drug's therapeutic range C. To monitor the client's white blood cell count D. To comply with the drug manufacturer's requirements
B
A client diagnosed with mahor depression spends most of the day lying in bed with the sheet pulled over his head. Which of the following approaches by the nurse is most therapeutic? A. Wait for the client to begin the conversation B. Initiate contact with the client frequently C. Sit outside the client's room D. Question the client until he responds
B
A client is receiving paroxetine (Paxil) 20 mg every morning. After taking the first 3 doses, the client tells the nurse that the medication upsets his stomach. Which of the following instructions should the nurse give to the client? A. Take the medication an hour before breakfast B. Take the medication with some food C. Take the medication at bedtime D. Take the medication with 4 oz of orange juice
B
A client with acute mania is to receive lithium carbonate 600 mg PO 3 times a day and 2 mg of haloperidol (Haldol) PO at bedtime. The nurse should: A. Refuse to give the medications as ordered B. Give the lithium only C. Request a decreased dose of lithium D. Give the medications as ordered
D
A nurse is planning activities for a client who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client? A. Chess B. Writing C. Ping Pong D. Basketball
B
A nurse is educating a client who has been diagnosed with dysthymia about possible treatment for the disorder. Which response by the nurse is most appropriate? A. Antidepressants, particularly the SSRI group, offer the best treatment for your dysthymia B. Doctors recommend that clients experiencing dysthymia receive ECT to treat it C. Because you have a mild, though long lasting dysthymic mood, psychotherapy can usually bring improvement with less likelihood of the need for medication D. Since your dythymia indicates a long lasting mild depression, long term psychoanalysis would be the best treatment for you
C
The client who has been taking vanlafaxine (Effexor) 25 mg PO 3 times a day for the past 2 days states, "This medicine isn't doing me any good. I'm still depressed." Which of the following responses by the nurse is most appropriate? A. Perhaps we'll need to increase your dose B. Let's wait a few days and see how you feel C. It takes about 2 to 4 weeks to receive the full effects D. It's too soon to tell if your medication will help you
C
The client with acute mania has been admitted to the inpatient unit voluntarily. The nurse approaches the client with medication to be taken orally as ordered by the dr. The client states "I don't need that stuff." Which response by the nurse is best? A. You can't refuse to take this medication B. If you don't take it orally, I will give you a shot C. The medication will make you feel calmer D. I'll get some written information about the medication for you
C
The physician orders determination of the serum lithium level tomorrow for a client with bipolar disorder, manic phase, who has been receiving lithium 300 mg PO 3 times a day for the past 5 days. At which of the following times should the nurse plan to have the blood specimen obtained? A. Before bedtime B. After lunch C. Before breakfast D. During the afternoon
C
Which of the following statements by a client taking trazodone (Desyrel) as prescribed by the physician indicates to the nurse that further teaching about the medication is needed? A. I will continue to take my medication after a light snack B. Taking Desyrel at night will help me to sleep C. My depression will be gone in about 5 to 7 days D. I won't drink alcohol while taking Desyrel
C
A client experiencing a great deal of stress and anxiety is being taught to use self-control therapy. Which statement by the client indicates a need for further teaching about the therapy? A. An advantage of this technique is that change is likely to last B. This form of therapy can be applied to new situations C. Talking to onself is a basic component of this form of therapy D. It provides a negative reinforcement when the stimulus is produced
D
A client hospitalized with severe depression and suicidal ideation refuses to talk with the nurse. The nurse recognizes that the suicidal client has difficulty: A. Expressing feelings of low self worth B. Discussing remorse and guilt for actions C. Displaying dependence towards others D. Expressing anger towards others
D
The client states, "Many of the people in my family experience similar symptoms with each depressive episode. Does that mean we have the same genetic defect?" Your best response includes which of the following? A. Related symptoms are probably due to being raised in the same family and learning the same behavioral responses B. Most current theories focus on electrolyte disturbances, particularly the reversal of sodium and potassium in the neruons of depressed individuals C. With the wide variety of mood disorders, a biologic basis is not likely. Therefore, pharmacological treatments for your family members should be individualized D. Heredity does seem to play a role in mood disorders. You and your family members may have the same biologic predisposition E. There are probably several genetic or biologic abnormalities associated with depression
E
