354 Mental Health Exam 3 NCLEX Questions

The activity of gamma-aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitates the action of GABA? a. Benzodiazepines b. Antihistamines c. Anticonvulsants d. Noradrenergic

a. Benzodiazepines

Which chronic medical condition is a common trigger for major depressive disorder? a. Pain b. Hypertension c. Hypothyroidism d. Crohn's disease

a. Pain

A nurse is completing a suicide assessment on all patients on an inpatient unit. The nurse identifies the patient of which demographic to have the lowest risk of suicide? a. 82 y/o White male b. 17 y/o White female c. 22 y/o Hispanic male d. 19 y/o Native American male

c. 22 y/o Hispanic male

When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior? a. Dyssynchronous b. Incongruent c. Cyclothymic d. Rapid cycling

d. Rapid cycling Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology. None of the other options are associated with this characteristic behavior.

The psychiatric nurse enters a patient's room and finds that the patient is current exhibiting signs of a panic attack. Which of the following symptoms can the nurse expect the patient to be experiencing? a. obsessions b. apathy c. fever d. fear of impending doom

d. fear of impending doom The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur. None of the other symptoms are associated with a panic attack.

A client diagnosed with bipolar disorder has a nursing care plan that includes several nursing diagnoses listed. Order the nursing diagnoses to the level of priority (1 to 4). 1. risk for injury 2. nonadherence 3. self-care deficit, bathing, and hygiene 4. knowledge deficit

1. Risk for injury 3. self-care deficit, bathing, and hygiene 4. knowledge deficit 2. nonadherence

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 Disorder? A. Divalproex sodium (Depakote) B. Clonazepam (Klonopin) C. Olanzapine (Zyprexa) D. Lithium (Lithobid)

A. Divalproex sodium (Depakote)

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

Which question would be a priority when assessing for symptoms of major depression? A. "Tell me about any special powers you believe you have." B. "You look really sad. Have you ever thought of harming yourself?" C. "Your family says you never stop. How much sleep do you get?" D. "Do you ever find that you don't remember where you've been or what you've done?"

B. "You look really sad. Have you ever thought of harming yourself?"

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

B. Hypersomnia

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 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.

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

Two months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement? a. "Depression often begins after a major loss. Losing dad was a major loss." b. "Bereavement and depression are the same problem." c. "Mourning is pathological and not normal behavior." d. "Antidepressant medications will not help this type of depression."

a. "Depression often begins after a major loss. Losing dad was a major loss."

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply. a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." c. "Lithium may help me lose the few extra pounds I tend to carry around." d. "I take my lithium on an empty stomach to help with absorption." e. "I've already made arrangements for my monthly lab work."

a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." e. "I've already made arrangements for my monthly lab work."

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? a. "Let's look at what you just said, that you can 'never do anything right.'" b. "Tell me what things you think you are not able to do correctly." c. "Is this part of the reason you think no one likes you?" d. "That is the most unrealistic thing I have ever heard."

a. "Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling.

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply. a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." b. "Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder. c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? a. "What things have you done in the past that helped you feel more comfortable?" b. "Let's try to focus on that adorable little granddaughter of yours." c. "Why don't you sit down over there and work on that jigsaw puzzle?" d. "Try not to think about the feelings and sensations you're experiencing."

a. "What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. While distraction may be helpful in some situations, it is not the initial intervention.

When considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings? Select all that apply. a. 10- to 34-year-olds b. Males c. College-educated adults d. Rural population e. Native American

a. 10- to 34-year-olds b. Males e. Native American

The nurse anticipates that the history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal what common assessment data? Select all that apply. a. A history of childhood trauma b. A sibling with the disorder c. A history of sexual abuse d. A previous suicide attempt e. An eating disorder

a. A history of childhood trauma b. A sibling with the disorder c. A history of sexual abuse e. An eating disorder Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD.

A travel nurse is working on a psychiatric unit and reviewing the orders of her patients. The nurse recognizes which of the following as having the greatest potential for injury? Select all that apply. a. A patient is prescribed Amitriptyline (Elavil) to treat fibromyalgia pain b. A patient taking Phenelzine (Nardil) reports a headache c. A patient prescribed Sertraline (Zoloft) asks the nurse if a family member can bring in St. John's Wort for them d. A patient is ordered to take the first dose of Isocarboxazid (Marplan) one day after discontinuing Escitalopram (Lexapro) e. A patient prescribed Selegilline (EMSAM) asks the nurse if they can have a peanut butter and jelly sandwich for lunch f. A patient prescribed Clozapine (Clozaril) reports a sore throat and morning vitals show a low grade fever

a. A patient is prescribed Amitriptyline (Elavil) to treat fibromyalgia pain b. A patient taking Phenelzine (Nardil) reports a headache c. A patient prescribed Sertraline (Zoloft) asks the nurse if a family member can bring in St. John's Wort for them d. A patient is ordered to take the first dose of Isocarboxazid (Marplan) one day after discontinuing Escitalopram (Lexapro) f. A patient prescribed Clozapine (Clozaril) reports a sore throat and morning vitals show a low grade fever Amitriptyline (Elavil) is a tricyclic antidepressant and very sedating. A headache while on phenelzine is an early sign of hypertensive crisis and increases the risk for CVA. Sertraline and Escitalopram are SSRIs and should never be combined with St. John's Wort or MAOIs. MAOIs need a 2 week washout period prior to beginning any new antidepressants. This sandwich does not contain tyramine like alcohol, cheese, and meats do, therefore it is acceptable for a patient taking an MAOI selegiline to eat it. Clozapine is an 2nd generation antipsychotic and has a risk of agranulocytosis, fever and sore throat are early indicators.

Which interventions will help make the environment on the unit safer for suicidal patients? Select all that apply. a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open. e. Staying within listening distance of the patient.

a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open.

Which medications have the most potential risk for injury? Select all that apply. a. Amitriptyline (Elavil) b. Diphenhydramine (Benadryl) c. Docusate Sodium (Colace) d. Alprazolam (Xanax) e. Buspirone (BuSpar)

a. Amitriptyline (Elavil) b. Diphenhydramine (Benadryl) d. Alprazolam (Xanax) The medications that have the greatest potential for injury are those that cause sedation.

What is a possible outcome criterion for a client diagnosed with anxiety disorder? a. Client demonstrates effective coping strategies. b. Client reports reduced hallucinations. c. Client reports feelings of tension and fatigue. d. Client demonstrates persistent avoidance behaviors.

a. Client demonstrates effective coping strategies.

Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population? a. Conducting routine suicide screenings at a senior center. b. Identifying depression as a natural, but treatable result of aging. c. Identifying males as being at a greater risk for developing depression. d. Stressing that most individuals experience just a single episode of major depression in a lifetime.

a. Conducting routine suicide screenings at a senior center.

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? a. Constant 24-hour, one-to-one observation at arm's length b. One-to-one observation while client is awake c. Every 15-minute observation around the clock d. Seclusion with 15-minute observation

a. Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch since the client is unable to commit to seeking help to resist suicidal ideations.

A client experiencing a panic attack keeps repeating, "I'm dying, I can't breathe.". What action by the nurse should be most therapeutic initially? a. Encouraging the client to take slow, deep breaths b. Verbalizing mild disapproval of the anxious behavior c. Asking the client what he means when he says "I am dying." d. Offering an explanation about why the symptoms are occurring

a. Encouraging the client to take slow, deep breaths Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. The client needs help to regain composure and stabilize vital signs; the only option that addresses these issues is the correct option.

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 to 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 Eye contact reflects a willingness to be open and connect with another person, this usually occurs when trust exists.

Which patient has an increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply. a. Exacerbation of asthma signs and symptoms b. History of peanut and strawberry allergies c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injury

a. Exacerbation of asthma signs and symptoms c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injury

Which of the following describe the symptoms of the manic phase of bipolar disorder? Select all that apply. a. Excessive energy b. Fatigue and increased sleep c. Low self-esteem d. Pressured speech e. Purposeless movement f. Racing thoughts g. Withdrawal from environment h. Distractibility

a. Excessive energy d. Pressured speech e. Purposeless movement f. Racing thoughts h. Distractibility

Which side effects of lithium can be expected at therapeutic levels? a. Fine hand tremor and polyuria b. Nausea and thirst c. Coarse hand tremor and gastrointestinal upset d. Ataxia and hypotension

a. Fine hand tremor and polyuria These are expected side effects of lithium at therapeutic levels. The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance. Symptoms of lithium toxicity include severe nausea and vomiting, severe hand tremors, and excessive thirst.

Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? a. Fluoxetine (Prozac) b. Isocarboxazid (Marplan) c. Amitriptyline d. Duloxetine (Cymbalta)

a. Fluoxetine (Prozac)

Which behavior would be characteristic of a client during a manic episode? a. Going rapidly from one activity to another b. Taking frequent rest periods and naps during the day c Being unwilling to leave home to see other people d. Watching others intently and talking little

a. Going rapidly from one activity to another Hyperactivity and distractibility are basic to manic episodes. None of the other options demonstrate such characteristics.

What is a desired outcome for the maintenance phase of treatment for a manic client? a. Exhibit optimistic, energetic, playful behavior. b. Adhere to follow-up medical appointments. c. Take medication more than 50% of the time. d. Use alcohol to moderate occasional mood "highs."

b. Adhere to follow-up medical appointments. The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable. None of the other options are accurate.

Unit practice requires inspection of all items being brought onto the unit by visitors. How can this be most effectively done? a. Having a staff member sit at the door and check packages as visitors enter. b. Having a staff member make frequent rounds during visiting hours to inspect gifts. c. Asking all visitors to report to the nurse's station before visiting a client. d. Asking clients to give staff any unsafe item that might have been left by a visitor.

a. Having a staff member sit at the door and check packages A number of ways to inspect items are possible.Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client's belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client's room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety. None of the other options provide a measure of control before clients and visitors meet. Self-reporting by the visitors is not reliable.

A client tells the nurse that he believes his situation is intolerable and is observed isolating socially. Which nursing diagnosis should be considered? a. Hopelessness b. Deficient knowledge c. Chronic low self-esteem d. Compromised family coping

a. Hopelessness The defining characteristics are present for the nursing diagnosis of hopelessness.

What are the nursing responsibilities to a patient expressing suicidal thoughts? Select all that apply. a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication. e. Discussing triggers of depression.

a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication.

While intoxicated a client unsuccessfully attempted suicide by using a gun. This method of using a gun to attempt suicide should be described in what terms? a. It is high risk, or a hard method. b. It is low risk, or a soft method. c. It was not an actual suicide attempt because the client was intoxicated. d. Considering the results, it is a nonlethal means.

a. It is high risk, or a hard method. Higher risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

What is the first-line drug used to treat mania? a. Lithium carbonate (Ekalith) b. Carbamazepine (Tegretol) c. Lamotrigine (Lamictal) d. Clonazepam (Klonopin)

a. Lithium carbonate (Ekalith) Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. The other options are prescribed to manage other related symptoms of bipolar disorder.

Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply. a. Monitor the patient's vital signs frequently. b. Keep the patient distracted with group-oriented activities. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.

a. Monitor the patient's vital signs frequently. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? a. Onset of action is from 1 to 3 weeks or longer. b. They tend to be more effective for men. c. Recent memory impairment is commonly observed. d. They often cause the client to have diurnal variation.

a. Onset of action is from 1 to 3 weeks or longer. A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. None of the other options provide correct information regarding antidepressant medications.

Inability to leave one's home because of avoidance of severe anxiety suggests the existence of which anxiety disorder? a. Panic attacks with agoraphobia b. Obsessive-compulsive disorder c. Posttraumatic stress response d. Generalized anxiety disorder

a. Panic attacks with agoraphobia Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred.

What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? a. Risk for injury b. Ineffective role performance c. Risk for other-directed violence d. Impaired verbal communication

a. Risk for injury Risk for injury is high, related to the client's hyperactivity and poor judgment. Safety is always the priority when considering client care.

A parent is shopping with a 5 year old child in a large, busy urban mall. The parent suddenly realizes that the child is missing. What behaviors might this parent exhibit that would indicate panic-level anxiety? Select all that apply. a. Running b. Shouting c. Erratic physical movements d. Impulsivity e. Loss of physical coordination

a. Running b. Shouting c. Erratic physical movements d. Impulsivity e. Loss of physical coordination These are all behaviors that would indicate panic level anxiety. Other behaviors that would be indicative of this include pacing and screaming.

Which combination of drugs should the nurse question? Select all that apply. a. Sertraline (Zoloft) with Selegiline (EMSAM) b. Alprazolam (Xanax) with Citalopram (Celexa) c. Buspirone (BuSpar) with Phenelzine (Nardil) d. Lithium (Eskalith) with Ketorolac (Toradol) e. St. John's Wort with Buspirone (BuSpar)

a. Sertraline (Zoloft) with Selegiline (EMSAM) d. Lithium (Eskalith) with Ketorolac (Toradol) SSRIs like sertraline, escitalopram, and citalopram should never be used in combination with MAOIs like selegiline, phenelzine, isocarboxazid, and tranylcypromine due to potential for deadly serotonin syndrome. Lithium should not be used in combination with ketorolac or any other NSAIDs because it can increase serum lithium levels significantly and lead to lithium toxicity. Patients taking lithium should only take acetaminophen.

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? a. Suddenly trembling severely b. Exhibit stoic behavior c. Report both nausea and vomiting d. Laugh inappropriately

a. Suddenly trembling severely Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity. None of the other options are associated with this cultural response to stress.

In a parent teacher conference, the school nurse meets with the parents of a profoundly shy 8-year-old girl. The parents hold hands, speak softly, respond briefly, and have poor eye contact. The nurse recognizes that the child is most likely exposed to parental modeling and: a. The inherited shyness trait b. A lack of affection in the home c. Severe punishment by the parents d. Is afraid to say something foolish

a. The inherited shyness trait

Generally, which statement regarding ego defense mechanisms is true? a. They often involve some degree of self-deception. b. They are rarely used by mentally healthy people. c. They seldom make the person more comfortable. d. They are usually effective in resolving conflicts.

a. They often involve some degree of self-deception. Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception. This information helps eliminate the other options as the correct statement.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? a. Waiting quietly for the client to reply b. Prompting the client if the reply is slow c. Repeating the question if the client does not answer promptly d. Reviewing the client's medical record to support the client's response

a. Waiting quietly for the client to reply Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.

When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication? a. With meals b. With an antacid c. 30 minutes before meals d. 2 hours after meals

a. With meals Many clients find that taking lithium with or shortly after meals minimizes gastric distress. None of the other options present accurate information.

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a. Withhold medication and notify the physician. b. Continue to administer medication as ordered. c. Advise the client to limit fluids for 12 hours. d. Advise the client to curtail salt intake for 24 hours.

a. Withhold medication and notify the physician. The therapeutic range of lithium in acute mania 0.8-1.2 mEq/L, lithium toxicity is a concern at levels greater than or equal to 1.5 mEq/L. The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld and the physician notified.

An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? a. Writing in a diary b. Exercising in the gym c. Directing unit activities d. Orienting a new client to the unit

a. Writing in a diary Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active. None of the remaining options presents this opportunity to reduce physical activity.

The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is: a. Transcranial magnetic stimulation b. Deep brain stimulation c. Vagus nerve stimulation d. Electroconvulsive therapy

b. Deep brain stimulation

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement? a. "That is a good observation. Depression does mostly strike people older than 50 years." b. "Depression is seen in people of all ages, from childhood to old age." c. "Depression is most often seen among the middle adult age group." d. "The age of onset for most depressive episodes is given as 18 years."

b. "Depression is seen in people of all ages, from childhood to old age." Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

Which patient statement does not demonstrate an understanding of a suicide safety plan? a. "I know that when I start thinking about my dad, I'm going to start thinking about killing myself." b. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts." c. "My sister is always there for me when I start getting suicidal." d. "I keep the suicide prevention phone number in my wallet."

b. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts."

Which statement by the nurse would best demonstrate acceptance to a depressed, mute client? a. "I will be spending time with you each day to try to improve your mood." b. "I would like to sit with you for 15 minutes now and again this afternoon." c. "Each day we will spend time together to talk about things that are bothering you." c. "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

b. "I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the client without making demands is a good way to show acceptance. While not inappropriate, the other options are less accepting.

Which statement(s) made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply. a. "Relaxation therapy's main goal is to prevent exhaustion by removing muscle tension." b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

Martin is a 23-year-old male with a new diagnosis of schizophrenia, and his family is receiving information from a home health nurse. The topic of education is suicide prevention, and the nurse recognizes effective teaching when the mother says: a. "Persons with schizophrenia rarely commit suicide." b. "Suicide risk is greatest in the first few years after diagnosis." c. "Suicide is not common in schizophrenia due to confusion." d. "Most persons diagnosed with schizophrenia die of suicide."

b. "Suicide risk is greatest in the first few years after diagnosis."

Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply. a. "Do rules apply to you?" b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?" e. "Have you ever been arrested for committing a crime?"

b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?"

Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply. a. Female b. 7 years old c. Comorbid autism diagnosis d. Outbursts occur at least once a week e. Temper tantrums occur at home and in school

b. 7 years old c. Comorbid autism diagnosis e. Temper tantrums occur at home and in school

Which person is at the highest risk for suicide? a. A 50-year-old married white male with depression who has a plan to overdose if circumstances at work do not improve. b. A 45-year-old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teenager. c. A young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden. d. An older Hispanic male who is Catholic, is living with a debilitating chronic illness, is recently widowed, and who states, "I wish that God would take me too."

b. A 45-year-old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teenager.

An obsession is defined as what? a. Thinking of an action and immediately taking the action b. A recurrent, persistent thought or impulse c. An intense irrational fear of an object or situation d. A recurrent behavior performed in the same manner

b. A recurrent, persistent thought or impulse Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.

Which is the greatest protective factor against the risk of suicide? a. One or more previous suicide attempts b. A sense of responsibility to family c. Fear of dying d. A cultural belief that suicide is a shameful resolution for a dilemma

b. A sense of responsibility to family Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor. Previous attempts are a high risk factor. None of the remaining options have the impact that support has on preventing suicide

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 provider b. Administer the medication c. Observe for adverse effects d. Withhold the next dose of medication

b. Administer the medication The therapeutic range of lithium is 0.6-1.2 mEq/L, therefore, the medication should be administered as prescribed to increase the serum drug level.

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? a. Panic disorder b. Adult separation anxiety disorder c. Agoraphobia d. Social anxiety disorder

b. Adult separation anxiety disorder People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.

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 Sertraline is an SSRI that inhibits reuptake of serotonin. CNS side effects include agitation, anxiety, confusion, dizziness, drowsiness, and headache. Seizures and agranulocytosis are side effects of clozapine, an antipsychotic, not sertraline which is an antidepressant. Tachycardia is a side effect of tricyclic antidepressants.

Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that: a. Anxiety may be present. b. Alcohol ingestion is a form of self-medication. c. The patient is lacking a sufficient number of neurotransmitters. d. The patient is using alcohol because she is depressed.

b. Alcohol ingestion is a form of self-medication.

What defense mechanisms can only be used in healthy ways? a. Suppression and humor b. Altruism and sublimation c. Idealization and splitting d. Reaction formation and denial

b. Altruism and sublimation Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.

Kara is a 23-year-old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply. a. Focus primarily on developing solutions to the problems leading the patient to feel suicidal. b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. c. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct? a. Shortness of breath, gastrointestinal distress, chronic cough b. Ataxia, severe hypotension, large volume of dilute urine c. Gastrointestinal distress, thirst, nystagmus d. Electroencephalographic changes, chest pain, dizziness

b. Ataxia, severe hypotension, large volume of dilute urine

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? a. Symptoms started right after being robbed at gunpoint. b. Being unable to work for the last 12 months. c. Eating in public makes the client extremely uncomfortable. d. Repeated verbalizing prayers results in a relaxed feeling.

b. Being unable to work for the last 12 months. GAD is characterized by symptomatology that lasts 6 months or longer. None of the other descriptions would support the diagnosis.

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? a. Dark colored and modest b. Colorful and outlandish c. Compulsively neat and clean d. Ill-fitted and ragged

b. Colorful and outlandish Manic clients often manage to dress and apply makeup in ways that create a colorful, even bizarre, appearance. None of the remaining options meet that criteria.

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of which ego defense mechanism? a. Altruism b. Denial c. Undoing d. Suppression

b. Denial Denial involves escaping unpleasant reality by ignoring its existence.

What statement about the comorbidity of depression is accurate? a. Depression most often exists in an individual as a single entity. b. Depression is commonly seen in individuals with medical disorders. c. Substance abuse and depression are seldom seen as comorbid disorders. d. Depression may coexist with other disorders but is rarely seen with schizophrenia.

b. Depression is commonly seen in individuals with medical disorders. Depression commonly accompanies medical disorders. The other options are false statements.

What can be said about the comorbidity of anxiety disorders? a. Anxiety disorders generally exist alone. b. Depression may occur prior to onset of anxiety. c. Anxiety disorders virtually never coexist with mood disorders. d. Substance abuse disorders rarely coexist with anxiety disorders.

b. Depression may occur prior to onset of anxiety. In many instances, major depression may occur prior to the onset of panic disorder or may occur at the same time. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of which feeling? a. Anger b. Disbelief c. Confusion d. Sympathy

b. Disbelief Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life."

Which medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks? a. Alprazolam (Xanax) b. Fluoxetine (Prozac) c. Clonazepam (Klonopin) d. Venlafaxine (Effexor)

b. Fluoxetine (Prozac)

What is the focus of the SAFE-T assessment tool? Select all that apply. a. Facilitate hospitalization. b. Identify level of suicidal risk. c. Development of client focused treatment. d. Introduce antidepressant medication therapy e. Stress collaboration with the client

b. Identify level of suicidal risk. c. Development of client focused treatment. e. Stress collaboration with the client The Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is an assessment tool that allows the clinician to benchmark relative risk (high, moderate, low) and to develop a treatment plan, in consultation with the patient, to reduce current risk. The tool does not provide for specific interventions.

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 Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid a specific stimulus. Counselors will not be available for all anxiety-producing situations, and this option does not encourage the development of internal strengths. Suppressing feelings will not resolve anxiety. Elimination of all anxiety from life is impossible.

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? a. Reinforce that the level is considered therapeutic. b. Instruct the patient to hold the next dose of medication and contact the prescriber. c. Have the patient go to the hospital emergency room immediately. d. Alert the patient to the possibility of seizures and appropriate precautions.

b. Instruct the patient to hold the next dose of medication and contact the prescriber.

Samantha is a new patient to the mental health clinic and is seeking assistance for what she describes as "severe anxiety." In addition to daily self-medicating with alcohol, Samantha describes long-term use of herbal kava. The nurse knows that kava is associated with inhibiting P450 and orders which of the following tests? a. Electrocardiogram b. Liver enzymes c. Glomerular filtration rate d. Complete blood count

b. Liver enzymes

Selective inattention is first noted when experiencing which level of anxiety? a. Mild b. Moderate c. Severe d. Panic

b. Moderate When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events.

Which of the following statements is true regarding culture and protective factors against suicide? a. Asian Americans have the highest rates of suicide. b. Religion and the importance of family are protective factors for Hispanic Americans. c. Older women have the highest risk for suicide among African Americans. d. American Indians and Pacific Islanders have the lowest rates of suicide.

b. Religion and the importance of family are protective factors for Hispanic Americans. Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true.

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? a. Projection b. Repression c. Displacement d. Reaction formation

b. Repression Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness.

When assessing a client's risk for suicide in the emergency department, the nurse is most likely to use which of the following assessment tools? a. AIMS scale. b. SAFE-T. c. CAGE questionnaire. d. Mini-Mental Status Examination.

b. SAFE-T. Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. The SAFE-T is short and easy to use and is focused on the risk for self-injury.

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 this data, which mental health disorder is the client experiencing? a. Agoraphobia b. Social phobia c. Claustrophobia d. Generalized Anxiety disorder

b. Social phobia Social phobia is a fear of situations in which one might be embarrassed or criticized, such as the fear of speaking, performing, or eating in public. The person fears making a fool of oneself. Agoraphobia is a fear of open spaces and the fear of being trapped in a situation from which there may not be an escape or help. Claustrophobia is a fear of closed places. Clients with hypochondrial symptoms focus their anxiety on physical complaints and are preoccupied with their health.

What is the major reason for the hospitalization of a depressed patient? a. Inability to go to work b. Suicidal ideation c. Loss of appetite d. Psychomotor agitation

b. Suicidal ideation Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.

Which of the following is true of the relationship between bipolar disorder and suicide? a. Patients need to be monitored only in the depressed phase because this is when suicides occur. b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. c. Patients with bipolar disorder are not considered high risk for suicide. d. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar patients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide.

The nurse is speaking to a client diagnosed with major depressive disorder. Throughout the course of the conversation the nurse picks up on which nonverbal cue that the patient may be suicidal and a risk assessment should be completed immediately? a. The client is careful not to mention the idea of suicide b. The client appears brighter than usual with more energy after starting an SSRI a week ago c. The client appears more than lethargic than usual and interrupts the conversation with nurse to take a phone call from her son's teacher d. The client asks the nurse to continue their conversation later after her afternoon prayers

b. The client appears brighter than usual with more energy after starting an SSRI a week ago

A 72-year-old patient diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When his provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? a. The client may become addicted faster than younger patients. b. The client is at risk for falls. c. The client has a history of nonadherence with medications. d. The client should be treated with cognitive therapies because of his advanced age.

b. The client is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" The nurse's response is based on what fact concerning hostility? a. The client is getting better and is able to be assertive. b. The client may be at high risk for self-harm. c. The client is probably experiencing transference. d. The client may be angry at someone else and projecting that anger to staff.

b. The client may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken.

Sigmund Freud, Karl Menninger, and Aaron Beck theorized that hopelessness was an integral part of why a person commits suicide. A more recent theory suggest suicide results from: a. Elevated serotonin levels b. The diathesis-stress model c. Outward aggression turned inward d. A lack of perfectionism

b. The diathesis-stress model

The practitioner prescribes a tricyclic antidepressant to decrease a suicidal client's depression. What factor should the nurse consider when initiating treatment with this type of medication? a. Eating ages 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 GI irritation d. Blood specimens are required weekly for 3 months to check for therapeutic drug levels

b. There may not be a noticeable improvement for 2 to 3 weeks Tricyclic antidepressants don't produce immediate effects, nursing measures must include a continued monitoring of risk of suicide. Aged cheese, smoked meats, and wine are food precautions taken with MAOIs, toxicity is not as prevalent of a problem with tricyclics as with medications such as lithium. Precautions of taking tricyclics with milk are not necessary.

A parent is shopping with a 5 year old child in a large, busy urban mall. The parent suddenly realizes that the child is missing. What would be some appropriate interventions for this parent who is experiencing panic level anxiety? Select all that apply. a. Start shouting the child's name and running with them to help find the child b. Use a low-pitched voice and speak slowly c. Ask for a full explanation of every detail the parent can possibly remember d. Move to a quieter setting and remain with the parent e. Use clear, simple statements and repetition

b. Use a low-pitched voice and speak slowly d. Move to a quieter setting and remain with the parent e. Use clear, simple statements and repetition Interventions for panic-level anxiety include maintaining a calm manner, remaining with the individual, minimizing environmental stimuli if possible, using clear, simple statements, repetition, speaking slowly in a low-pitched voice. Other appropriate interventions include recognizing that the person is in distress and being willing to listen.

A nurse is assessing the lethality of the client's plan for suicide after the client disclosed that they are experiencing suicidal ideation. What factors would be relevant to that assessment? Select all that apply. a. How long the client has been suicidal b. Whether the plan has specific details c. Whether the method is one that could cause death d. Whether the client has the means to implement the plan e. Has the client been suicidal in the past

b. Whether the plan has specific details c. Whether the method is one that could cause death d. Whether the client has the means to implement the plan Lethality refers to how deadly a plan is. The length of time a client has been suicidal or a history suicidal thoughts have nothing to do with the lethality of the plan. While the remaining options present important about the seriousness of the plan.

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat which menu choice? a. avocado salad plate. b. fruit and cottage cheese plate. c. kielbasa and sauerkraut. d. liver and onion sandwich.

b. fruit and cottage cheese plate. Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat, contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident.

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to: a. question the client's motive. b. set verbal limits. c. initiate physical confrontation. d. prepare the client for seclusion.

b. set verbal limits. Verbal limit setting should always precede more restrictive measures. Questioning motives does not address the safety issue that exists.

A student nurse on the psychiatric unit expresses being uncomfortable about discussing possible suicidal ideations with clients because "It might put ideas in their head about suicide." What is the nurse's best response to this student's concern? a. "I'm glad you are thinking that way. They may not have thought of suicide before, and we don't want to introduce that." b. "You are right; however, because of professional liability, we have to ask that question." c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." d. "If I were you, I'd ask the health provider to talk to the patient about that subject."

c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially when attempting to help the patient deescalate their anxiety? a. "Do you know what will help you manage your anxiety?" b. "Do you need help to manage your anxiety?" c. "Can you identify what was happening when your anxiety began to increase?" d. "Are you feeling anxious right now?"

c. "Can you identify what was happening when your anxiety began to increase?"

Gladys is seeing a therapist because her husband committed suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?" The therapist's best response would be: a. "He probably acted quickly on his impulse to kill himself." b. "He did not want to think about the pain he would cause you." c. "He was not able to think clearly due to his emotional pain." d. "He thought you may think it was an accident if there was no note."

c. "He was not able to think clearly due to his emotional pain."

A 38-year-old patient is admitted with major depression. Which statement made by the patient alerts the nurse to a common accompaniment to depression? a. "I still pray and read my Bible every day." b. "My mother wants to move in with me, but I want to independent." c. "I still feel bad about my sister dying of cancer. I should have done more for her!" d. "I've heard others say that depression is a sign of weakness."

c. "I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? a. "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." b. "I will not take any over-the-counter medication while on the fluoxetine." c. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." d. "I will report increased thirst and urination to my provider."

c. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

Isabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states: a. "I would like to try a benzodiazepine for my anxiety." b. "If I study harder, my anxiety level will go down." c. "Mild anxiety is okay because it helps me to focus." d. "I have fear that I will fail at college."

c. "Mild anxiety is okay because it helps me to focus."

A homebound patient diagnosed with agoraphobia has been receiving therapy in the home. The nurse evaluates patient teaching is effective when the patient states: a. "I may never leave the house again." b. "Having groceries delivered is very convenient." c. "My risk for agoraphobia is increased by my family history." d. "I will go out again, someday, just not today."

c. "My risk for agoraphobia is increased by my family history."

A patient being treated for depression has taken 300mg of amitriptyline (Elavil) daily for 1 year. The patient calls the case manager at the clinic and says, "I've stopped taking my antidepressant 2 days ago and 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 be alarmed. Take 2 aspirin and drink plenty of fluids." c. "Take a dose of your antidepressant now and come to the clinic to see the healthcare provider." d. "Resume taking your antidepressant for 2 more weeks and then you can discontinue them again."

c. "Take a dose of your antidepressant now and come to the clinic to see the healthcare provider." The patient is experiencing discontinuation syndrome and needs a dose of the medication to quell symptoms in addition to coming in for an evaluation.

A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, "You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing": a. A higher dosage b. Once a week dosing c. A lower dosage d. A different drug

c. A lower dosage

Which room placement would be best for a client experiencing a manic episode? a. A shared room with a client with dementia b. A single room near the unit activities area c. A single room near the nurses' station d. A shared room away from the unit entrance

c. A single room near the nurses' station The room placement that provides a nonstimulating environment is best. Nearness to the nurses' station means close supervision can be provided. None of the other options provide low stimulation.

The nurse is caring for a patient on day 1 post surgical procedure. The patient becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the patient's actions? a. Reassure the patient that what they are feeling is normal anxiety and do deep breathing exercises with her. b. Use the call light to inquire whether the patient has been prescribed prn anxiety medication. c. Call for staff help and assess the client's vital signs. d. Reassure the patient that you will stay until the anxiety subsides.

c. Call for staff help and assess the client's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case, Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period? a. Bipolar II disorder. b. Bipolar I disorder. c. Cyclothymia. d. Seasonal affective disorder.

c. Cyclothymia. Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years duration. The mood swings are not severe enough to prompt hospitalization. None of the other options meet that criteria.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of importance to this particular client? a. Ascertain how long ago the trauma occurred. b. Find out if the client uses acting-out behavior. c. Determine the use of chemical substances for anxiety relief. d. Establish whether the client has chronic hypertension related to high anxiety.

c. Determine the use of chemical substances for anxiety relief. Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior? a. Reprimand the client by stating, "What an offensive thing to suggest!" b. Clarifying the nurse-client relationship by stating, "I don't have sex with clients." c. Distracting the client by suggesting, "It's time to work on your art project." d. Enforcing consequences by responding, "Let's walk down to the seclusion room."

c. Distracting the client by suggesting, "It's time to work on your art project." Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client. This intervention is both therapeutic and less restrictive.

Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania the psychiatric nurse practitioner recommends: a. Clonazepam (Klonopin) b. Fluoxetine (Prozac) c. Electroconvulsive therapy (ECT) d. Lurasidone (Latuda)

c. Electroconvulsive therapy (ECT)

Panic attacks in Latin American individuals often involve demonstration of which behavior? a. Repetitive involuntary actions b. Blushing c. Fear of dying d. Offensive verbalizations

c. Fear of dying Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying.

A 31-year-old patient admitted with acute mania tells the staff and the other patients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? a. Unpredictability b. Rapid cycling c. Grandiosity d. Flight of ideas

c. Grandiosity Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes.

The medical record states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? a. Makes jokes to relieve tension. b. Misses appointments. c. Justifies illogical ideas and feelings. d. Behaves in ways that are the opposite of his or her feelings.

c. Justifies illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener.

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? a. Self-blame b. Catatonia c. Learned helplessness d. Discounting positive attributes

c. Learned helplessness Learned helplessness results in depression when the client feels no control over the outcome of a situation.

Beck's cognitive theory suggests that the etiology of depression is related to what factor? a. Sleep abnormalities b. Serotonin circuit dysfunction c. Negative processing of information d. A belief that one has no control over outcomes

c. Negative processing of information Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. None of the other options are related to this theory.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? a. Poor retention of recent events b. A weight loss from anorexia c. No pleasure from previously enjoyed activities d. Difficulty with tasks requiring fine motor skills

c. No pleasure from previously enjoyed activities

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? a. Having the client repeatedly touch "dirty" objects b. Not allowing the client to seek reassurance from staff c. Not allowing the client to wash hands after touching a "dirty" object d. Telling the client that he or she must relax whenever tension mounts

c. Not allowing the client to wash hands after touching a "dirty" object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval.

Which suicide prevention intervention that has the greatest impact on a client's safety? a. Educating visitors about potentially dangerous gifts. b. Restricting the client from potentially dangerous areas of the unit. c. One-on-one observation by the staff. d. Removal of personal items that might prove harmful.

c. One-on-one observation by the staff. One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm. While the remaining options provide some protection, none have the impact of constant supervision.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? a. Senile dementia b. Hypertensive crisis c. Psychomotor agitation d. Central serotonin syndrome

c. Psychomotor agitation These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. None of the other options are associated so directly with these behaviors.

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? a. Projection b. Rationalization c. Reaction formation d. Undoing

c. Reaction formation Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. Which is the most appropriate short-term goal for this diagnosis? a. Will reclaim any prized possessions that were given away. b. Be able to name three personal strengths. c. Seek help when feeling self-destructive. d. Consistently participate in a self-help group.

c. Seek help when feeling self-destructive. Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal presented for Risk for self-directed violence since it focuses on client safety.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? a. Good memory and concentration b. Delusions of persecution c. Self-deprecatory ideation d. Sexual preoccupation

c. Self-deprecatory ideation Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world.

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? a. γ-Amino-butyric acid b. Dopamine c. Serotonin d. Acetylcholine

c. Serotonin Low serotonin levels have been noted among individuals who have committed suicide. None of the other options are as directly related in the physiology of depression.

When a nurse uses therapeutic communication with a withdrawn patient who has major depression, an effective method of managing the silence is to: a. Meditate in the quiet environment b. Ask simple questions even if the patient will not answer c. Use the technique of making observations d. Simply sit quietly and leave when the patient falls asleep

c. Use the technique of making observations

What are the most important characteristics for staff members who work with suicidal clients? a. Organization b. Problem-solving skills c. Warm, consistent interaction d. Effective interview and counseling skills

c. Warm, consistent interaction Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency since they support the nurse-client relationship. While helpful, none of the other options have the impact of a effective nurse-client relationship.

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as: a. mild. b. moderate. c. severe. d. panic.

c. severe. Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild and moderate levels of anxiety do not demonstrate these feels while panic is even more intense than the scenario implies.

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should: a. question the physician's order because the dose is excessive. b. explain the long-term nature of benzodiazepine therapy. c. teach the client to limit caffeine intake. d. tell the client to expect mild insomnia.

c. teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication. None of the other options present accurate information regarding lorazepam.

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." How should the nurse respond to the client's concern? a. "I understand" and allow the client to close the door. b. Keep the door open, but step to the side out of the client's view. c. Leave the client's room and wait outside in the hall. d. "For your safety I can be no more than an arm's length away."

d. "For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate. The correct statement reinforces the basic need for client safety. The other options fail to provide for the degree of client safety required.

Working to help the client view an occurrence in a more positive light is referred to by which term? a. Flooding b. Desensitization c. Response prevention d. Cognitive restructuring

d. Cognitive restructuring The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive.

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? a. "I'm so restless. I can't seem to sit still." b. "I spend most of my time studying. I have to get into a good college." c. "I'm not trying to diet, but I've lost about 5 pounds in the past 5 months." d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

Which statement, made by a patient admitted with a diagnosis of depression, indicates the need for further assessment? a. "I know a lot of people care about me and want me to get better." b. "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." c. "I don't have a good support system, but I am planning on joining a recovery group." d. "I think things will be better soon."

d. "I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

The nurse educator is presenting on the topic of suicide to a group of new graduate nurses, which of the following statements by a new nurse indicates that the teaching has been effective? a. More women than men commit suicide. b. The Jewish culture has the lowest suicide rate. c. Suicide is the leading cause of death in the United States. d. A client diagnosed with schizophrenia is at great risk for attempting suicide.

d. A client diagnosed with schizophrenia is at great risk for attempting suicide. Individuals with schizophrenia are 8 times more likely to attempt suicide than is the general public. Suicide is the tenth leading cause of death in the United States. Protestants and the Jewish culture have a higher rate of suicide than do Catholics. More women attempt suicide, but more men are successful.

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medications? a. Standard antipsychotic medication. b. Tricyclic antidepressant medication. c. Anticholinergic medication. d. A short-acting benzodiazepine medication.

d. A short-acting benzodiazepine medication. A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? a. Amitriptyline is very expensive, so the patient may have to buy fewer at a time. b. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness. c. The health care provider wants to see whether any side effects occur within the first week of administration. d. Amitriptyline is lethal in overdose.

d. Amitriptyline is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply. a. Increased attentiveness b. Getting up at night to urinate c. Improved vision d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult

d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult

When a client diagnosed with major depressive disorder says to the nurse, "It'll all be okay soon, no one will have to worry about me anymore.", the nurse should respond with which of the following strategies? a. Being careful not to mention the idea of suicide. b. Listening carefully to see whether the client mentions suicide more overtly. c. Asking about the possibility of suicidal thoughts in a covert way. d. Asking the client directly if they are thinking of attempting suicide.

d. Asking the client directly if they are thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the client. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis.

Dysthymia cannot be diagnosed unless it has existed for what period of time? a. At least 3 months b. At least 6 months c. At least 1 year d. At least 2 years

d. At least 2 years Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years. None of the other options present a sufficient time period.

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has been recently prescribed an antianxiety medication? a. Eating high protein foods. b. Using acetaminophen without first discussing it with a healthcare provider c. Taking medications after eating dinner or while having a bedtime snack d. Buying a large coffee with sugar and extra cream each morning on the way to work

d. Buying a large coffee with sugar and extra cream each morning on the way to work

A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the patient and the family to recognize possible signs of impending mania? a. Increased appetite b. Decreased social interaction c. Increased attention to bodily functions d. Decreased sleep

d. Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania.

The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious and begins to report dizziness and heart pounding. The patient also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? a. To reinforce the preoperative teaching by restating it slowly. b. Have the patient read the teaching materials instead of providing verbal instruction. c. Have a family member read the preoperative materials to the patient. d. Do not attempt any further teaching at this time.

d. Do not attempt any further teaching at this time. Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

Which medication is FDA approved for treatment of anxiety in children? a. Sertraline b. Fluoxetine c. Clomipramine d. Duloxetine

d. Duloxetine A few drugs are approved specifically for anxiety and obsessive-compulsive disorders in children and adolescents. The FDA approved the selective SNRI duloxetine (Cymbalta) in 2014 for children aged 7 to 17 years for generalized anxiety disorder. The FDA has approved four medications for use in children with obsessive-compulsive disorder. They are clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft).

Luc's family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting? a. Hypodermic needles b. Fast food wrappers c. Empty soda cans d. Energy drink containers

d. Energy drink containers

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. The nurse should provide the client with what information regarding this practice? a. Agreeing that this will help the client to remember the medications. b. Caution the client to drink several glasses of water daily. c. Suggest that the client also use a sun lamp daily. d. Explain the high possibility of an adverse reaction.

d. Explain the high possibility of an adverse reaction. Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. None of the other options are relevant to the situation.

The nurse understands that the major distinction between fear and anxiety is which of the following? a. Fear is a universal experience; anxiety is neurotic. b. Fear enables constructive action; anxiety is dysfunctional. c. Fear is a psychological experience; anxiety is a physiological experience. d. Fear is a response to a specific danger; anxiety is a response to an unknown danger.

d. Fear is a response to a specific danger; anxiety is a response to an unknown danger.

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior? a. Flight of ideas b. Distractibility c. Limit testing d. Grandiosity

d. Grandiosity Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. None of the other options are associated with this behavior.

A female client 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 70-80 times a day. The client's hands are red and raw with some bleeding. An immediate nursing intervention for this client is to get her 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 This action still permits the client to cope with feelings of anxiety while aiming to reduce skin damage.

Research supports which intervention implemented on a long-term basis significantly reduces the incidence of suicide and suicide attempts in a patient diagnosed with bipolar disorder? a. A selective serotonin reuptake inhibitor (SSRI) b. Electroconvulsive therapy (ECT) c. One-on-one observation d. Lithium

d. Lithium

A nurse on a psychiatric unit is checking the lunch trays prior to being distributed to clients. Which of the following items does the nurse remove from the meal tray prior to delivering it to a client who is suicidal? a. Plastic plate b. Cloth napkin c. Styrofoam cup d. Metal utensils

d. Metal utensils In most health care agencies, suicidal clients receive plastic dinnerware on their meal trays since metal utensils can be used to cause physical harm. None of the other options carry that same degree of risk.

Cabot has multiple symptoms of depression including mood reactivity, social phobia, anxiety, and overeating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? a. Tricyclic antidepressants b. Selective serotonin reuptake inhibitors c. Serotonin and norepinephrine reuptake inhibitors d. Monoamine oxidase inhibitor

d. Monoamine oxidase inhibitor

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

d. Panic

Delusionary thinking is a characteristic of which form of anxiety? a. Chronic anxiety b. Acute anxiety c. Severe anxiety d. Panic level anxiety

d. Panic level anxiety Panic level anxiety is the most extreme level and results in markedly disturbed thinking greater than in any of the other options.

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. Withhold the drug, push PO fluids and notify the healthcare provider immediately b. Limit the patient's activities to ones that can be performed from a sitting position c. Update this aspect of the patient's mental status exam d. Teach the patient strategies to manage postural hypotension

d. Teach the patient strategies to manage postural hypotension

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? a. No research exists to suggest genetic transmission. b. Much depends on the socioeconomic class of the individuals. c. Highly creative people tend toward development of the disorder. d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder.

d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder. This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.