NCLEX mental health questions for exam 2

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. 1. Confusion. 2. Restlessness. 3. Constipation. 4. Diaphoresis. 5. Ataxia.

1, 2, 4, 5

a client exhibits a flat affect, psychomotor retardation, and depressed mood. the nurse attempts to engage the client in an interaction, but the client does not respond to the nurse. which response by the nurse is the most appropriate? 1. "I'll sit here with you for 15 minutes" 2. "I'll come back in a little bit to talk with you" 3. "I'll find someone else for you to talk with" 4. "I'll get you something to read"

1.

a client is scheduled for the first electroconvulsive therapy (ECT) treatment in the morning. The client has been unable to sleep but at 10 pm refused to take Restoril as the nurse suggested. The client is still unable to sleep at 11:15 pm. in what order should the nurse do the following? a. sit quietly with the client b. encourage the use of restoril c. offer use of MP3 player with relaxing music d. discuss specific concerns

a, d, c, b

a client newly dx w DM is instructed by the HCP to obtain glucagon for emergency home use. The client asks a home care nurse about the purpose of the medication. what is the nurses' best response to the clients question? a. "It will boost the cells in your pancreas if you have insufficient insulin" b. "it will help promote insulin absorption when your glucose levels are high" c. "It is for the times when your blood glucose is too low from too much insulin" d. "It will help prevent lipoatrophy from the multiple insulin injections over the years"

c

the nurse assesses a client with the admitting dx of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action? a. incessant talking and sexual intercourse b. grandiose delusions and poor concentration c. outlandish behaviors and inappropriate dress d. nonstop physical activity and poor nutritional intake

d

a client with major depression and psychotic features is admitted involuntarily to the hospital. He will not eat because his "bowels have turned to jelly," which the client states is punishment for his wickedness. the client requests to leave the hospital. the nurse denies this request because commitment papers have been initiated by the HCP. which of the following should the nurse identify as criterion for the client to be legally committed? 1. evidence of psychosis 2. being gravely disabled 3. risk of harm to self or others 4. diagnosis of mental illness

2

the client with recurring depression will be discharged from the psychiatric unit. which suggestion to the family is best to help them prepare for the client's return home? 1. discourage visitors while the client is at home 2. provide for a schedule of activities outside the home 3. involve the client in usual-at home activities 4. encourage the client to sleep as much as possible

3

which of the following behaviors exhibited by the client with depresssion should lead the nurse to determine that the client is ready for discharge? 1. interactions with staff and peers 2. sleeping for 4 hours in the afternoon and 4 hours at night 3. verbalization of feeling in control of self and situations 4. statements of dissatisfaction over not being able to perform at work

3

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." How should the nurse plan on responding to the client's statements? a. reassure the client things will get better b. tell the client that this is not true and that we all have a purpose in life. c. identify recent behaviors or accomplishments that demonstrate the client's skills d. remain with the client and sit in silence; this will encourage the client to verbalize feelings

c

the nurse is caring for a client who was involuntarily hospitalized and is scheduled for electroconvulsive therapy. the nurse notes that an informed consent has not been obtained for the procedure. Based on this information, what is the nurse's best determination? a. the informed consent does not need to be obtained b. the informed consent should be obtained from the family c. the informed consent needs to be obtained from the client d. the HCP will provide the informed consent

c