Exam 3 Practice Questions

A patient was just admitted to your unit with bipolar disorder I and is in the manic state. What symptoms might you expect to see?

-Extreme drive and energy Inflated sense of self-importance -Drastically reduced sleep requirements -Excessive talking combined with pressured speech -Personal feeling of racing thoughts -Distraction by environmental events -Unusually obsessed with and overfocused on goals -Purposeless arousal and movement -Dangerous activities, such as indiscriminate spending, reckless sexual encounters, or risky investments

You are worried about a close friend who recently broke up with a boyfriend. She is taking the breakup very hard and seems depressed. What are some questions you could ask to assess for suicide ideation?

-Have you ever felt that life was not worth living? -Have you been thinking about death recently? -Did you ever think about suicide? -Have you ever attempted suicide? -Do you have a plan for completing suicide? -If so, what is your plan for suicide?

What would be some appropriate interventions for the parent whose child is missing at the mall and is experiencing panic level anxiety?

-Maintain a calm manner -Remain with the parent -Minimize environmental stimuli if possible -Move to a quieter setting if possible and stay with the parent -Use clear, simple statements and repetition -Use a low-pitched voice; speak slowly -Recognize the anxious person's distress -Being willing to listen

What behaviors might this parent be exhibiting that would indicate panic-level anxiety?

-Pacing -Running -Shouting -Screaming -Erratic -Uncoordinated -Impulsive

What are some problems that can be avoided if your bipolar I manic patient gets proper treatment?

-Suicide attempts -Alcohol or substance abuse -Marital or work problems -Development of medical comorbidity

For assessment purposes, the nurse should identify the body system most at risk for decompensation during a severe manic episode as: A. Cardiac B. Renal C. Endocrine D. Pulmonary

A. Cardiac

Which anticonvulsant might be prescribed for bipolar d/o? A. Divalproex sodium (Depakote) B. Clonazepam (Klonopin) C. Olanzapine (Zyprexa) D. Lithium (Lithobid)

A. Divalproex sodium (Depakote)

A nurse has been caring for a female client with the diagnosis of major depressive disorder. The nurse evaluates that a trusting relationship is beginning to develop when the client: A. Establishes eye contact with the nurse B. Accompanies the nurse to the dining room C.Responds to the nurse when asked a question D.Permits the nurse to get her dressed in the morning

A. Establishes eye contact with the nurse Rationale: Eye contact reflects a willingness to be open and connect with another person; usually this occurs when trust exists. The others are wrong because: accompanying the nurse to the dining room may or may not indicate the presence of trust and this behavior may merely indicate the acceptance of an authority figure. Responding to a question may or may not indicate the presence of trust; this behavior may merely indicate the acceptance of an authority figure. Allowing others to provide for ADLs may or may not indicate the presence of trust; this behavior may merely indicate the acceptance of an authority figure.

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding? A. Psychomotor retardation B. Psychomotor agitation C. Vegetative sign D. Anhedonia

A. Psychomotor retardation

A client has been receiving lithium carbonate (Eskalith) for 3 days. The nurse checks the client's lithium level before administering the medication and finds it to be 0.3 mEq/L. The nurse should: A. Notify the practitioner B. Administer the medication C. Observe for adverse side effects D. Withhold the next dose of medication

B. Administer the medication Rationale: The level 0.3 mEq/L is below the therapeutic range of 0.5 to 1.5 mEq/L; therefore, the medication should be administered as prescribed to increase the serum drug level

A client is prescribed sertraline (Zoloft) for depression. What should the nurse include when preparing a teaching plan about the side effects of this drug? A. Seizures B. Agitation C. Tachycardia D. Agranulocytosis

B. Agitation Rationale: Sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI), inhibits neuronal uptake of serotonin in the central nervous system, thus potentiating the activity of serotonin. Central nervous system side effects of this drug include agitation, anxiety, confusion, dizziness, drowsiness, and headache. The others are incorrect because: Seizures are a side effect of clozapine (Clozaril), an antipsychotic, not sertraline, which is an antidepressant. Tachycardia is a side effect of tricyclic antidepressants, not sertraline, which is an SSRI antidepressant. A decrease in the production of granulocytes (agranulocytosis) causing a pronounced neutropenia is a side effect of clozapine, not sertraline, which is an antidepressant.

Which assessment in MDD represents a vegetative sign? A. Restlessness B. Hypersomnia C. Feelings of guilt D. Frequent crying

B. Hypersomnia

When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal? A. Suppressing feelings of anxiety B. Identifying anxiety-producing situations C. Continued contact with a crisis counselor D. Eliminating all anxiety from daily situations

B. Identifying anxiety-producing situations

A person with which psychiatric problem is most likely to complete suicide? A. Personality disorder B. Major depression C. Substance abuse D. Schizophrenia

B. Major depression

A client is unwilling to go out of the house for fear of "making a fool of myself in public." Because of this fear, the client remains homebound. Based on these data, which mental health disorder is the client experiencing? A. Agoraphobia B. Social phobia C. Claustrophobia D. Generalized Anxiety Disorder

B. Social phobia

A patient is hospitalized with major depression and suicidal ideation. He has a history of several suicide attempts. For the first 2 days of hospitalization, the patient eats 20% of meals and stays in his room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider? A. The patient is showing improvement and may be ready for discharge. B. The patient may have decided to commit suicide; the nurse should reassess suicidality. C. The patient is feeling rested, supported by the therapeutic milieu, and less depressed. D. The patient is benefiting from the antidepressant he has been taking for 4 days.

B. The patient may have decided to commit suicide; the nurse should reassess suicidality.

The practitioner prescribes a tricyclic antidepressant medication to decrease a suicidal client's depression. What factor should the nurse consider when initiating treatment with this type of medication? A. Eating aged cheese may cause a hypertensive crisis B. There may not be a noticeable improvement for 2 to 3 weeks C. They must be given with milk to avoid gastrointestinal irritation D. Blood specimens are required weekly for 3 months to check for

B. There may not be a noticeable improvement for 2 to 3 weeks

A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, "I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares." The nurse will advise the patient to: A. "Go to the nearest emergency department immediately." B. "Do not to be alarmed. Take two aspirin and drink plenty of fluids." C. "Take a dose of your antidepressant now and come to the clinic to see the health care provider." D. "Resume taking your antidepressants for 2 more weeks and then discontinue them again."

C. "Take a dose of your antidepressant now and come to the clinic to see the health care provider."

A nurse is completing a suicide assessment on all patients on an inpatient unit. Which of these has the lowest risk for suicide? A. 82yo White male B. 17yo white female C. 22yo hispanic male D. 19yo native american male

C. 22yo hispanic male

A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse will: A. Update this aspect of the patient's mental status exam B. Limit the patients activities to ones that can be performed from a sitting position C. Teach the patient strategies to manage postural hypotension D. Withhold the drug, push PO fluids, and notify healthcare provider immediately

C. Teach the patient strategies to manage postural hypotension

A major principle the nurse should use when communicating with a patient experiencing elated mood is to: A. Avoid teaching patient when in this state B. Give thorough, expanded explanations as these patients are high functioning C. Use a calm, firm approach D. Wait until patient mood is no longer elated to communicate with them

C. Use a calm, firm approach

A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of: A. Dysthymia B. Euphoria C. Anergia D. Anhedonia

D. Anhedonia

A female client with the diagnosis of obsessive-compulsive disorder attends a day treatment program. The client feels her hands are dirty and has a need to wash them 70 to 80 times a day. The client's hands are red and raw with some bleeding. An immediate nursing intervention for this client is to get the client to: A. Understand that her hands are not dirty B. Gain insight into her emotional problems C. Stop washing her hands so the skin will heal D. Limit the number of times she washes her hands

D. Limit the number of times she washes her hands Rationale: This action still permits the client to cope with feelings of anxiety while aiming to reduce skin damage

A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result? A. Mild B. Moderate C. Severe D. Panic

D. Panic

Your patient with bipolar I mania has been started on lithium. What patient teaching about this medication should the nurse provide before the patient is discharged?

The patient and family should be given careful instructions about... -The purpose and requirements of lithium therapy -Its adverse effects -Its toxic effects and complications -Situations in which the physician should be contacted -The need for periodic blood tests to monitor lithium levels -Patients also need to know that two major long-term risks of lithium therapy are hypothyroidism and impairment of the kidneys' ability to concentrate urine.