Psych test #1
What teaching should the nurse provide to a client taking an SSRI? (Select all) A. To avoid processed meat B. To avoid fermented fish C. To avoid grapefruit juice D. To avoid discontinuation of medication E. Notify your healthcare provider if you experience suicidal thinking
C,D+E
Buspirone is used to treat which of the following? a. Alcohol withdrawal b. Anxiety c.Seizure d. Agitation
B
When reviewing the discharge medications, Mr. Chen asks the nurse whether there are any specific instructions for administration of venlafaxine. What is the best response? a. "Take the medicine with food to decrease gastrointestinal upset." b."Take venlafaxine at bedtime on an empty stomach." c. "You may skip the dose if you do not feel it is needed." d. "There are no special considerations with this medication."
A
.When patients are admitted to a locked psychiatric unit, which action should be the nurse's priority intervention? a.Ensure that patients and their belongings have been searched. c. Complete the admission data tool. d. Educate the patient on the rules of the unit. e. Give the patients a tour so that they will be more comfortable.
A
After Mrs. Chen has been discharged for 3 days, she tells her husband, "I do not know what is wrong with me. I keep thinking about overdosing and feel so helpless." What is the priority for Mr. Chen? a. Call 911 as instructed by the discharge nurse, because Mrs. Chen may be suicidal. b. Give Mrs. Chen the as-needed antianxiety medicine per the discharge paperwork. c.Give Mrs. Chen some warm tea and suggest she lie down. d.Call the nurse on the floor to ask whether Mrs. Chen can attend a day program.
A
Jamie admits that she has not told her parents she is taking antipsychotic medication because she is afraid her parents will think she is crazy. The nurse responds by asking if Jamie is sure about her parents' views. Which of the following could be the purpose of the nurse's inquiry? A. Encourage reconsideration B. Mirror the emotion in Jamie's message C. Convey empathy D. Provide clues to recurring patterns
A
Mr. Chen asks for a rationale as to why his wife is depressed. Which statement from the nurse is the best rationale? a. "Depression is an illness that has many causes, including chemical imbalances in the brain." b. "Depression happens at midlife, but the exact cause is unknown." c. "Depression is very common in the Asian culture; many patients seek treatment." d."Depression is due to lack of motivation to perform better each day."
A
Mr. Chen is anxious about his wife being home alone when he travels. He asks whether a visiting nurse would be helpful. Which of the following should the nurse mention regarding community-based supports? A. They aid patients by providing structure and assessment. B. They are only available when patients do not have a family. C. They will discourage patients from caring for themselves.' D. They can be intrusive and unwelcomed by many patients and make symptoms worse.
A
Mr. Chen is worried that his children will be depressed and he will not recognize the signs. What is the best response from the nurse? a. "Children may become more irritable and display a school phobia." b. "Children with depression become more social and engaged in activities." c. "Often children do not show signs of depression until they are at least 16." d."Children will tell you when they feel sad."
A
The nurse tries to put into words or behaviors the ideas or feelings that she is trying to convey to jamie. This is an example of which therapeutic communication technique? A. Encoding B. Decoding C. Positive reframing D. Perception check
A
What is a characteristic of moderate anxiety? a. Concentrating independently is difficult b. Adrenaline surge greatly increases vital signs d. Pupils enlarge to let in more light e. Reasoning is disrupted
A
What is the basic foundation for the nurse's response to the high degree of importance Ms. Waterfall places on her missing medicine bundle? a. Her feelings and beliefs should be accepted without judgement. b. Spiritual beliefs can influence one's health. c. She is entitled to her own unique spiritual beliefs. d.Her beliefs are very different from those of most Americans.
A
What is the priority nursing intervention before Mrs. Chen leaves to go home? a. Ensuring she is safe by asking if she feels suicidal b.Ensuring she has eaten a meal in case her family is not home c. Ensuring that her insurance information is up to date d. Ensuring she has a ride, because she cannot drive while on medication
A
Which of the following points should the nurse adhere to while using self-disclosure for Jamie's therapeutic benefit? A. Monitor the client's nonverbal behavior to determine whether he or she is receptive to the nurse's self-disclosure B. Discuss painful situation from which a nurse has not recovered so that the client feels less pain about the situation C. Narrate the disclosure in detail to make sure the client has understood the nurse's point of view D. Imply that his or her experience is exactly the same as the clients so that the client can relate better
A
The patient has been prescribed sertraline and venlafaxine. The nurse recognizes that these medications given together can cause which condition? a. Confusion b. Hypervigilance c. Dry mouth d. Bradycardia
A rationale: Serotonin syndrome should be considered when more than one SSRI (or an SSRI and any other type of serotonin-increasing medication) are given together. Symptom onset is rapid and typically occurs a short time after elevated serotonin levels. Symptoms of serotonin syndrome include the following: confusion and agitation (not hypervigilance), muscle rigidity, weakness, sluggish pupils, shivering, tremors, myoclonic jerks, collapse, muscle paralysis, hyperthermia, tachycardia (not bradycardia), tachypnea, hypersalivation (not dry mouth), and diaphoresis.
Why is it important to generate a baseline for Harry following a thorough physical examination before initiating antidepressant medication? (Select all that apply) A. To determine any cardiovascular irregularity B. To clearly understand what factors led to Dan finding Harry unconscious on the floOr C. To effectively monitor the medication's side effects D. To determine if Harry's health insurance will pay for antidepressants
A + C
The nurse must assess Harry for increased risk for suicide before and after the start of antidepresant therapy. What factors increase Harr's risk for suicide? (Select all) A. Change in life circumstance B. Depression C. Cognitive impairment D. Death of a spouse E. Living alone
A, B, D and E
Dan is convinced that his father should continue the medication for at least 2 more weeks for noticeable improvement. He can't take any more leave from work but wants to ensure that his father receives good care. What options can the nurse suggest to Dan so that his father can be cared for while Dan attends to his work? (select all) A. Contracting a home care nurse to take responsibility for care giving B. Nominating a family member or friends to check in on Harry every day C.Joining an outpatient support group D. Procure a therapy dog E. Have Harry take a cruise
A,B,C
During another follow-up appointment, Harry says he does not want to continue with the antidepressant because of its side-effects. Dan discusses his father's treatment and other options with the nurse. What should the nurse do to assess the side effects that Harry is experiencing? (select all) A. Perform medication reconciliation B. Ask about Harry's therapeutic response to the medication C. Ask about the side effects that Harry is experiencing D. Obtain Harry's oxygen saturation level E.Inquire if Harry is experiencing vertigo
A,B,C
What are some assessment questions the nurse needs to address to determine the family's current and future needs for services? (Select All) A. Does the client have any other medical problems? B. Do any other family members live with the client? C. Has the client been previously admitted to the hospital with similar symptoms? D. Does Harry enjoy swimming? E. Are Harry's parents still living?
A,B,C
Which characteristics are associated with anxiety? (Select all that apply.) a. A feeling that is unavoidable in life b. A reaction to internal or external stimuli c. A vague feeling of apprehension d. A sensation of being afraid e. A response to a stimulus that is clearly identifiable
A,B,C
What other information should the nurse ask to further assess Harry's risk for suicide? (Select All) A. When you think about the future, what will you be doing three months from now? B. Some of my patients with similar problems have told me they have thought about ending their life. I wonder if you have had similar thoughts? C. Do you take illicit drugs? D. Are you feeling hopeless about the present or future? E. Do you enjoy being outdoors?
A,B,D
Which of the following factors would require exercise of caution for the use of benzodiazepines? (select all that apply) a. Depression b. Old age c. Agitation d. History of substance abuse e. Seizure threshold
A,B,D
What are the positive functions associated with "normal anxiety"? (Select all that apply.) a. It serves to motivate the individual to take action. b. It is usually easily managed. c.It triggers action to resolve an existing crisis. d. It is a learned response to stress. e. It serves to bring about a solution to a problem.
A,C,E
During discharge teaching for a patient with major depression, which interventions should the nurse include? (Select all that apply.) a. Encourage support groups for the patient as well as the family. b. Explain that this will not happen again if the patient continues to take the medications. c.Teach the patient and family to call for an appointment if the patient is feeling suicidal. d. Teach the patient and family to identify signs of early relapse. e.Review the importance of therapy and attending follow up appointments.
A,D,E
The nurse should warn Mrs. Cole and her husband that lorazepam therapy should not be stopped abruptly because doing so will likely result in which consequence? a.Triggering of withdrawal symptoms b.A depressive episode c. A decrease in the effects of lithium d. A manic episode
Answer: A Rationale: Lorazepam is a benzodiazepine that can cause addiction when used long-term or when abused. Don't stop taking lorazepam abruptly after long-term use because withdrawal symptoms may occur. None of the remaining options are accurate statements about the effect of a sudden cessation in lorazepam therapy.
Which intervention should be considered to help prevent Mrs. Cole from becoming more agitated? a. Turn off the television in her room. b. Encourage her friends to visit often. c. Medicate her with the prescribed as-needed lorazepam. d. Take her out to the dayroom in a wheelchair.
Answer: A Rationale: Provide a safe environment for the patient. Note that a patient in a manic phase requires a calm and highly structured environment to decrease stimuli that may agitate or excite her. Keeping the lights in her room dim and the television off are appropriate interventions. Spending time in the dayroom and interacting with friends will likely subject her to increased stimulation, which will adversely affect her manic behaviors. Medication with lorazepam is an option to help manage agitation that can arise if external stimulation isn't effectively managed.
The nurse is providing medication education to Mrs. Cole and her husband regarding the appropriate administration and use of oral lorazepam. What information should be provided when her husband asks how long it will take for the medication to start to affect her symptoms? a. 1 hour b.2 hours c.30 minutes d.90 minutes
Answer: A Rationale: The onset of lorazepam is 1 hour, its peak is 2 hours, and its duration is 12 to 24 hours.
Which symptoms are consistent with a diagnosis of bipolar disorder? (Select all that apply.) Compulsiveness Depression Delusion Anxiety Mania
Answer: A and D (depression and mania) Rationale: Bipolar disorder involves extreme mood swings from episodes of mania to episodes of depression. Although the individual may demonstrate other emotional characteristics, such as the ones suggested, they are not considered when diagnosing bipolar disorder.
Which of the following symptoms indicate that Harry may benefit from antidepressants? (Select all) A. Dysphoria B. Anhedonia C. Vertigo D. Hopelessness E. Loss of appetite F. Difficulty concentrating
Answer: A, B, D, E, and F
The nurse needs to build a trusting relationship with jamie so that she is free to express her thoughts, feelings and opinions. What behaviors should the nurse demonstrate to stimulate therapeutic communication? (select all) A. Empathy B. Aloofness C. Listening D. Responsiveness E. Avoiding eye contact
Answer: A, C, and D
What are the most important aspects of care of an elderly man taking antidepressants that traditional medical models ignore? (select all) A. Advocacy B. Adherence to medication C. Family issues D. Environmental factors E. Case management
Answer: A, C, and E
Which symptom of mania places a patient with bipolar disorder at greatest risk for injury? A. Agitation B. Hyperactivity C. Insomnia D. Impulsivity
Answer: D (impulsivity) Rationale: Patients in the manic phase demonstrate poor judgment and impulsivity, making them vulnerable for a variety of risk-taking activities. Although the other characteristics may contribute to the risk for injury, poor judgment and impulsivity are the primary risk factors.
When the nurse meets with Jamie after her most recent couple's session, Jamie asks the nurse if she has ever been through similar difficulties. How should the nurse respond to the personal question posed by Jamie? (select all) A. The nurse should reflect aloud on Jamie's situation to try and maintain a patient-centered focus B. The nurse should tell Jamie about a friend who had a similar problem C. Affirm she hasn't similar difficulties and then ask Jamie an open ended question about her citation D.Ignore the question completely E. The nurse could tough Jamie and acknowledge that while she is going through a difficult time, that she is not alone, the healthcare team is here to support her.
Answer: A, C, and E
Which instruction should the nurse include in medication teaching to Mrs. Cole and her husband regarding lithium therapy? (Select all that apply.) a. Regular blood tests are vital to assure serum lithium levels remain below 1.5 mEq/L. b. Fluid intake should be 2 ½ to 3 L daily. c . Thyroid function should be monitored every 6 to 12 months. d.If experiencing an abnormal heart beat, medication should be stopped immediately. e.Recognize that occasional light-headedness is an acceptable side effect.
Answer: A,B,C Rationale: Instructions concerning fluid intake and diagnostic monitoring are correct. Light-headedness and an abnormal heart beat require immediate medical attention, but lithium therapy should never be abruptly stopped.
The nurse practitioner prescribes the benzodiazepine diazepam (valim) 5 mg BID for Bill to help control his anxiety. The registered nurse is scheduling a follow-up appointment for Bill in 1 week to monitor his response to the medication. Bill says "I really don't see how a few pills can change me. However, i'll give it a try because nothing else seems to work." The RN sees a need to educate Bill and his wife about the purpose, risks, and benefits of diazepam. (select all that apply) A. The purpose of diazepam is to help with symptoms of anxiety and muscle spasms B. Diazepam is generally considered safe and effective C. Benzodiazepines can be excessively sedating D. There's a risk of developing drug dependence E. Intramuscular administration is more reliable than oral absorption F. Benzodiazepines may cause timidity
Answer: A,B,C,D
What are the classic behaviors associated with the manic phase of bipolar disorder? (Select all that apply.) A. Flight of Ideas B. Agitation C. Paranoid thinking D. Extreme distractibility E. Introvert tendencies
Answer: A,B,C,D (Flight of Ideas, Agitation, Paranoid thinking, Extreme distractibility) Rationale: Mania is characterized by agitation, flight of ideas, paranoia, distractibility, and excessive social extroversion.
What should the nurse assess prior to administration of any medication? (select all that apply) a. Health history b. Experience with psychotropic medications c. Use of alcohol,nicotine, caffeine, or narcotics d. The need for adjunct care, such as group, individual, or family treatment e. The type and quality of community and family support he has
Answer: A,B,C,D,E
Which characteristics are associated with the manic phase of bipolar disorder? (Select all that apply.) A. Distractibility B. Flight of ideas C. Grandiosity D. Anti-social behaviors E. High-risk behaviors
Answer: A,B,C,E (distractibility, flight of ideas, grandiosity, high-risk behaviors) Rationale: The diagnosis of a manic episode or mania requires unusual and incessantly heightened, grandiose, or agitated mood, in addition to three or more of the following symptoms: exaggerated self-esteem; sleeplessness; pressured speech; flight of ideas; reduced ability to filter extraneous stimuli; distractibility; increased activities with increased energy; and multiple, grandiose, high-risk activities involving poor judgment and severe consequences. The behaviors associated with anti-social activity are not associated with mania.
Which factors should the nurse consider when determining what influenced the state of Ms. Waterfall's perceived crisis? (Select all that apply.) a. Circumstances surrounding her mother's death b. Her pre-existing cancer diagnosis c. Her age and gender d. Physical distance from her family e. Her cultural belief in the power of a medicine bundle
Answer: A,B,D,E
Which of the following factors will be part of the nurse's assessment of Bill with regards to his symptoms of anxiety? (select all that apply) a. Specific event (if any) that triggered the crisis b. What his A1C level is c. Bill's perception of the problem d.Whether he's been hospitalized for psychiatric issues before e. Inquire as to whether bill practices earthing
Answer: A,C,D
Which factors increase the index of risk for self-harm for a patient experiencing the manic phase of bipolar I disorder? (Select all that apply.) a. Potential for delusional thinking b. Distractibility c. Increased energy d. Lack of sleep e. Distorted thinking
Answer: A,C,E Rationale: A patient experiencing a manic episode is at high risk for suicide because of his or her increased energy, distorted thinking, and the potential for hallucinations and delusions. Distractibility and lack of sleep are risk factors for unintended injury.
What are some other possible side effects of diazepam that Bill might experience? (select all that apply) a. Urinary retention b. White sores on the tongue c. Apathy d. Rashes e. Diarrhea f. Changes in libido
Answer: A,C,E,F
Which interventions demonstrate advocacy for Ms. Waterfall's decision to delay surgery? (Select all that apply.) a. Defer the conversation regarding the surgery to her surgeon. b. Present the information to her in a clear, concise manner. c. Provide all appropriate information she requests. d. Make all interventions focus on Ms. Waterfall. e. Suggest that her family be involved in her decision to delay surgery.
Answer: B,C,D
Which nursing interventions are appropriate for inclusion into the care plan of a patient demonstrating agitation resulting from a manic episode? (Select all that apply.) a. Manage initial signs of agitation with prescribed medication. b. Provide the patient with a consistent routine. c. Approach the patient in a nonjudgmental manner. d. Maintain a calm, quiet environment for the patient. e. Restrict the patient's sugar and carbohydrates intake.
Answer: B,C,D Rationale: Agitation refers to a state of hyperarousal, increased tension, and irritability that can arise gradually or suddenly and last for minutes or months. Appropriate interventions include providing an environment that is as free of external stimuli as possible, maintaining a predictable routine, and staff relationships that are nonjudgmental. The patient should be provided a well-balanced diet that meets his or her dietary and caloric needs. Agitation should be met initially with de-escalation techniques, with medications being used as a last resort.
Which of Ms. Waterfall's behaviors or characteristics does the Hamilton Rating Scale for Anxiety consider? (Select all that apply.) a.Her deep spirituality b.Her statement, "I can't breathe" c.Her statement, "I feel like I'm going to die" d. That she is pacing about the room e. Her current cancer diagnosis
Answer: B,C,D,E
To best encourage medication adherence to her newly prescribed lithium therapy, which instructions should the nurse provide Mrs. Cole and her family? (Select all that apply.) a. Cease drinking any beverage containing caffeine b. Expect intermittent bouts of nausea for several days after lithium therapy begins c. Initially expect a sensation of thirst d. Restrict salt intake to minimize polyuria e.Drink plenty of water when taking the medication to minimize gastrointestinal upset
Answer: B,C,E
Considering bipolar I disorder, which statement made by a patient should be considered an indicator of high risk for self-harm? a. "I haven't had a good night's sleep in weeks; that can't be healthy." b. "I really don't want to hurt my family, but I can't seem to stop." c."I hope my husband will remember how much I loved him after I'm gone." d."I really enjoy all the freedom I have when I've got all this energy."
Answer: C
Which statement about light therapy is true? a.It can be effective for major depression with manic episodes. b. Light therapy is not effective for any depressive diagnosis. c. It can be effective for mild-to-moderate seasonal depressive episodes. d.It can be effective for severe major depression.
Answer: C Rationale: Light therapy (phototherapy) is used for mild-to-moderate seasonal depressive episodes. Evidence correlates light to enhanced moods; oftentimes in patients with a diagnosed bipolar disorder, the light enhances manic symptoms.
The nurse discourages Harry from abruptly stopping the medication. What are the possible side effects of abrupt discontinuation of an SSRI? (select all) A. Sudden weight gain B. Tachycardia and hypertension C. Feelings of being on the verge of losing consciousness D. Short-term memory loss E. Electrical surges in the head or body
Answer: C, D, and E
The patient has overdosed on 50 tablets of nortriptyline. Which intervention is the priority action? a. Complete a mini-mental exam. b. Take vital signs c. Complete the admission paperwork for transfer to an inpatient facility. d. Obtain an order for an electrocardiogram.
Answer: D Rationale : Tricyclic antidepressants, such as nortriptyline, can cause cardiac dysrhythmias and death in an overdose. Obtaining an electrocardiogram aids in the assessment of cardiac function. Although taking vital signs is important, assessment of cardiac rhythm with the possibility of cardiac arrest is the priority. The mini-mental exam is for evaluating cognitive function in patients with dementia, and thus would not be appropriate to perform in this case. Transfer to an inpatient facility, if needed, would be a lower priority than conducting an electrocardiogram.
What is the priority safety-related outcome for a patient currently experiencing mania associated with bipolar disorder? A. Demonstrates the ability to control impulsive behavior B. Demonstrates the ability to follow safe health behaviors C. Demonstrates compliance with the treatment program D. Remains free from injury or trauma
Answer: D Rationale: Because of the safety risks taken by patients in the manic phase, safety plays a primary role in care and is the priority nursing responsibility. Remaining free of injury or trauma is the associated outcome. The remaining options are outcomes that can be achieved once the patient's mania is being managed effectively.
Which serum level indicates that the patient is receiving an appropriate maintenance dose of lithium? 2 mEq/L 0.3 mEq/L 1.5 mEq/L 0.7 mEq/L
Answer: D (0.7) Rationale: There is a narrow range of safety among maintenance levels (0.5 to 1 mEq/L), treatment levels (0.8 to 1.5 mEq/L), and toxic levels (1.5 mEq/L and above).
Which as-needed medication should the nurse administer to a patient demonstrating agitation related to mania? A. Risperidone B. Vancomycin C. Lithium D. Lorazepam
Answer: D (lorazepam) Rationale: Lorazepam is a benzodiazepine prescribed for agitation. Lithium is a mood stabilizer, risperidone is an antipsychotic, and vancomycin is an antibiotic.
The term lability is used to define what type of mood-associated behavior? A. Behaviors that result from one's current mood B. Demonstrations of low self-esteem C. A sense of guilt demonstrated by depression D. Rapid shifts between emotional extremes
Answer: D (rapid shifts between emotional extremes) Rationale: Mood lability is associated with alternating periods of mania and depression (e.g., loud laughter and episodes of tears). None of the other options accurately describe the characteristics of mood lability.
A patient with multiple suicide attempts is at a higher risk of a repeat attempt. At discharge, the nurse should ask the family to carry out which priority intervention for a patient with a recent overdose? a. Designate who will be administering all medications to the patient. b. Discard previous medications. c.Provide a one-on-one sitter for the patient at home. d.Identify the medications that the patient may have left over.
B
Mr. Chen asks whether his wife will be able to resume her daily activities at home, such as laundry and cooking. What is the nurse's best answer? a. "Why would you ask that? Can't you take time off to be with your wife?" b. "Many people with recurrent depression have difficulty with responsibilities." c. "No, she will need to rest for a few weeks." d. "A housekeeper would be a good idea."
B
The patient is being admitted to an inpatient psychiatric unit after an overdose in a suicide attempt. The patient is now medically stable. Which intervention should the registered nurse recognize as the priority action? a. Complete the full admission history. b. Place the patient on safety precautions. c. Take the patient's vital signs and ensure he or she eats a meal. d. Record the patient's current medications.
B
Which anxiety-related assessment tool is administered by a healthcare professional? a. Anxiety Sensitivity Index b. Hamilton Rating Scale for Anxiety c. Fear Questionnaire d. Beck Anxiety Inventory
B
Which individual characteristic has the greatest influence on one's personal health beliefs and practices? a. Gender b. Culture c. Education d. Age
B
Which intervention best demonstrates the nurse acting as an advocate for Ms. Waterfall as she experiences an emotional crisis regarding her impending surgery? a. Being familiar with Ms. Waterfall's cultural beliefs in the importance of a medicine bundle b. Effectively communicating to Ms. Waterfall's surgeon her wish to delay surgery c. Assuring the surgeon that Ms. Waterfall's family agrees with her decision to delay surgery d. Documenting the details of the conversation with Ms. Waterfall regarding her wish to delay surgery
B
Which of the following best defines "normal anxiety"? a. Fright that is associated with a physical danger b. Dread that is appropriate to the situation in intensity and duration c. Terror triggered by the threat of known danger d. Apprehension that is ongoing and not associated with any specific stimulus
B
Which of the following is an example of overgeneralization? a. "Are my children going to be ok?" b. "The therapy will not work; it didn't last time." c. "I should not have taken those pills." d. "I should tell my husband if I feel suicidal."
B
Which of the following should the nurse encourage Mr. and Mrs. Chen to do when she is discharged? a. Urge Mr. Chen to take on more household chores. b. Participate in individual or group therapy. c. Suggest a variety of jobs for Mrs. Chen outside the home. d. Encourage Mrs. Chen to rest as much as possible during the first weeks after discharge.
B
Which response by the nurse would best address Ms. Waterfall's doubts about the effectiveness of relaxation techniques to help manage her anxiety? a. "Deep breathing is a fundamental relaxation technique that is easy to learn and do effectively." b. "The exercises will help you regain your sense of calmness so you can better address your health concerns." c."You have to get relaxed if you are ever going to make the right decisions about your health." d."Anxiety is based on stress levels that are greater than we can cope with."
B
Which scale is used to screen for the presence of depressive symptoms? a. CIWA b. HAM-D c. CAGE d. Y-BOCS
B
What is the highest priority when educating the patient who is taking monoamine oxidase inhibitors? a. The need for fluid and sodium replacement b. Avoidance of foods containing tyramine c. The purpose of frequent blood level draws d. Careful recognition of signs and symptoms of toxicity
B Rationale: Tyramine is an amino acid naturally found in small amounts in protein-containing foods such as strong or aged cheeses; cured, smoked, or processed meats; pickled or fermented foods; soybeans and soy products; and dried or overripe fruits. Monoamine oxidase inhibitors block the breakdown of tyramine and may can cause a hypertensive crisis, which can be life-threatening. Therefore, patients should be taught to avoid consuming foods that contain tyramine. The other answers are of lower priority because they are less likely to be life-threatening.
The nurse talks to HArry and Dan about the risk of serotonin syndrome. The combined use of an SSRI with which of the following is a risk factor for serotonin syndrome? (select all) A. Propranolol B. St. John's wort C. TCA D. Diazepam E. Serotonergic agonists
B, C, and E
Which behavior suggests that Mrs. Cole would benefit from a prescribed as-needed dose of lorazepam? a. Reporting pain at her surgical site b .Expressing auditory hallucinations c. Becoming noticeably agitated d. Pacing for extended periods of time
C
Which statement made by a nurse best demonstrates an understanding of cultural competence relating to mental health issues? a. "Unfortunately, among some Native American tribes, mental illness is stigmatized." b. "Native Americans tend to rely on their shamans for both physical and emotional healing." c. "It's easy to forget, but not all members of a cultural group always think alike." d. "I always conduct a thorough cultural assessment on all my clients."
C
As their meeting continues, Jamie continues to express anger with the nurse. At one point, she refers to the nurse by using a swear word. The nurse tells Jamie, "I don't want you saying that about me. You can call me by my name." Which of the following techniques did the nurse apply? A. Empathy B. Decoding C. Confrontation D. Assertiveness
C
Bill consumes approximately 250 mg of caffeine daily. How may this intake affect the efficacy of this medication? a. It sedates excitatory neurotransmitters b. It stimulates adenosine receptors c. It changes the pH of gastric acid d. It sedates the frontal lobes of the brain
C
During their initial meeting the nurse suspects that Jamie as suicidal tendencies. Which of the following statements by the nurse indicates an effective attempt to promote active listening? A. "This reminds me of an incident I'd like to tell you about." B. I'm going to keep the door open because I may have to attend phone calls" C. You may use a pillow or lie down if you are uncomfortable" D.I think even the thought of suicide is unfair to your family"
C
Mr. Chen asks the provider about additional treatments to consider if his wife relapses. The provider tells Mr. Chen that electroconvulsive therapy (ECT) may be an option if the new medication does not help Mrs. Chen manage her depression. Which of the following is part of teaching for a patient considering ECT? a. ECT is no longer being used as a treatment for major depression. b. ECT does not affect short-term memory the afternoon after ECT. c. ECT is a treatment that requires conscious sedation. d. ECT is only performed if the patient is not suicidal.
C
Mrs. Chen articulates that she has learned new coping strategies while at the hospital. The nurse recognizes that Mrs. Chen's statement indicates which outcome? a. Mrs. Chen is still intelligent. b. Mrs. Chen is safe for discharge and will not relapse. c. Mrs. Chen realizes that coping strategies can prevent a relapse. d. Mrs. Chen has gained social skills.
C
The nurse must take Bill's ethnic background into consideration before prescribing medication. Which of the following terms suggest that people respond differently to psychotropic medication based on ethnic background? a. Half-life b. Polypharmacy c.Pharmacogenetics d. Psychopharmacology
C
The nurse practitioner at the clinic considers prescibing buspirone until she sees that Bill has a history of liver impairment. Which of the following are contraindications of the use of buspirone? (select all that apply) a. Gastrointestinal distress b. Lightheadedness c. Liver impairment d. Renal impairment e. Lactation
C,D,E
Mrs. Chen states "None of the medications have made me feel better at all, and I've been on them for several months. Is there another treatment that may be helpful?" What is the best response from the nurse? A. "Why not try another medication to augment what you are currently taking?" B. "These medications do not work unless there is a sleeping medication used, too." C. "You should give it more time; your body will get used to the medication." D."Have you discussed electroconvulsive therapy with your provider?"
D
13. Mr. Chen asks the nurse at discharge if his two children are at risk for developing major depression like their mother. Which is the best response by the nurse? a. "Unfortunately, there is no research to show the genetic link." b. "No, major depression is more associated with socioeconomic factors than genetic factors." c. "Yes, the children are both highly likely to develop major depression." d. "Possibly. Evidence shows a strong genetic link to depression, with children being at a higher risk if one parent is diagnosed."
D
During a report from the emergency department, the registered nurse is told the patient is of Asian descent. What will the registered nurse recognize when caring for this patient? a. Patients of Asian descent hold firm eye contact. b Patients of Asian descent come alone to appointments. c. Patients of Asian descent are cooperative and welcome psychotropic medications. d. Patients of Asian descent may not need as high a dose of medications as others.
D
In a patient with recurrent depression and multiple suicide attempts, which of the following is most likely to help preclude another depressive episode? a. Lithium carbonate b. Light therapy c. Maintaining a healthy lifestyle d.Early recognition of symptoms
D
Jamie tells the nurse that Steven encourages her to go out with friends or family, but instead she spends the entire time angry. When the nurse asks Jamie if she has ever tried Steven's suggestion, Jamie becomes angry and accuses the nurse of taking Steven's side. She then says that the nurse is conspiring with Steven to cover up his affairs. Jamie then becomes silent and will not talk to the nurse. How should the nurse react to Jamie's anger and accusations? (select all) A. "If that's how you feel about it, then we have nothing more to discuss" B. "We'll talk about this next time" C. "Steven is right, you should spend time with your friends and family" D. "I'm not taking sides, I am trying to get an accurate account of your response to the situation"
D
Mrs. Chen asks when she will be discharged home. What is the best response from the multidisciplinary team? a. "Patients admitted with a suicide attempt are released after 10 days." b. "When the 12 days of your section 12 have expired." c. "It's up to you. What do you think?" d. "You'll be discharged once you've met the goals we've developed with you."
D
Mrs. Chen has been taking sertraline and venlafaxine for several days. This morning she is smiling and engaging in conversation. During the conversation, she tells the nurse, "I am feeling relieved." What is the nurse's priority assessment? a. Assess the patient's vital signs. b. Monitor the patient's intake and output. c.Ensure the patient continues to attend groups. d.Assess the patient for suicidality and place her on closer observation
D
Mrs. Chen is being discharged with orders for sertraline and venlafaxine. During discharge teaching, the nurse should make it a priority to ensure that the patient recognizes which symptoms that indicate a problem with the medication? A. Hypertensive crisis B. ETOH withdrawal C. Serotonin withdrawal D. Serotonin syndrome
D
The nurse learns that Bill occasionally smokes cigarettes in social situations, but is not a regular smoker. Which of the following is an effect of nicotine that may be of special interest to a nurse practitioner prescribing anxiolytics? a. Blocks stimulating neurotransmitters b.Blocks the release of stored glycogen in the liver c. Decreases the release of dopamine d.Reduces drowsiness
D
The patient is prescribed paroxetine 25 mg by mouth daily and asks, "Why is my mouth so dry? Water does not help." What is the nurse's best response? a. "I am sorry you are having discomfort. That must be from your depression." b. "Have you had your throat examined for an infection?" c."The air in the hospital is very dry. Keep drinking lots of water." d. "A side effect of paroxetine is dry mouth and throat. Have you tried sugar-free candies?"
D
The provider suggests changing Mrs. Chen's medication to phenelzine. Mrs. Chen says to the nurse, "The provider says I will need to watch my diet if I take a new medication; I am not sure I want to do this. Which foods would I have to avoid?" Which foods should the nurse mention? a. Milk, kale, tomatoes b. Black beans, garlic, pears c. Pork, shellfish, egg yolks d. Blue cheese, beer, pepperoni
D
Which assessment question should the nurse ask Mrs. Cole to best help determine the cause of her manic behavior? a. "When were you diagnosed with bipolar disorder?" b. "What were you doing when you fractured your ankle?" c. "What sort of stress have you been experiencing lately?" d."When did you take your last dose of lithium?"
D
Which intervention is most likely to aid in the development of a positive and therapeutic relationship with the nurse? a. Expecting the patient to sit and converse for at least 20 minutes b. Patient participation in multiple groups c.Asking the patient to eat in the dining room d.Frequent and short conversations throughout the day
D
Which nursing intervention would be most effective for assessing Ms. Waterfall's anxiety level? a. Reassuring her that her medicine bundle will be brought to the hospital b. Discussing the importance of stress reduction c. Identifying which family members she needs to contact d. Encouraging her to express her feelings and concerns
D
Which physiological response describes an individual preparing to defend himself or herself against a perceived stressor? a. Hypothalamus stimulation b. Denial c. Panic d. Fight-or-flight
D
Which statement below is true only of the panic stage of anxiety? a. Redirection is needed to maintain focus. b. Restless pacing is common. c. Vital signs begin to increase. d. Learning is impossible.
D
The nurse tells Bill that he shouldn't drink alcohol while taking benzodiazepines. True False
true
The nurse is debating whether or not to use self-disclosure with Jamie. The nurse should not use self-disclosure to discuss painful situations from which Jamie has not recovered. True False
FALSE
The nurse suggests that Harry immediately stop consuming the medication? True False
FALSE
Harry has been prescribed an initial dose of Fluoxetine (prozac) 20 mg/ day PO in the morning. Fluoxetine is an oral SSRI. The physician has given Harry one week's worth of medication, with an appointment made for follow-up at the end of that week. The nurse is responsible for teaching the client about the medication. The nurse should encourage Harry to consume fluoxetine with grapefruit juice. True False
FASLE
This agitation and restlessness experienced by Harry are likely side effects of the medication? True False
TRUE
During their meeting, Jamie says something that may mean something different to her than to the nurse, given their different cultural backgrounds. Should the nurse take Jamie's messages at face value, regardless of the cultural background or environment in which Jamie lives? Yes No
NO
SSRIs block neuronal transport of serotonin, which stimulates many postsynaptic receptor sites and contributes to associated side effects. True False
TRUE
Which signs and symptoms would indicate that Ms. Waterfall is experiencing a myocardial infarction (MI)? (Select all that apply.) a. Diaphoresis b. Nausea c. Substernal pain d. Vomiting e. Impaired concentration
a, b,c,d
Which symptoms are consistent with a diagnosis of major depressive disorder? (Select all that apply.) a. Disruption in appetite b. Disruption in sleep c. Depressed mood d. Feelings of worthlessness e. Delusions
a,b,c,d
A care plan states that a patient should attend groups on the unit, but the patient states, "I do not want to go; just let me sleep." What is the best response by the nurse? a. "You don't want to go?" b. "Oh, it will be fine. It is a glorious day." c. "Ok, I will check back with you after a few hours." d. "I know you feel like staying in bed, but it is time for group. I will walk with you."
d
The nurse discusses using caffeine while on benzodiazepines with Bill. True False
false
At the follow-up session 1 week later, Bill reports taking the prescribes diazepam regularly. He says that after the first 3 days of use, he experienced fatigue, lightheadedness, confusion, and constipation. Are bills symptoms likely side effects of diazepam? Yes No
yes
