RN Learning System Mental Health Practice Quiz 2

A nurse is providing teaching to a client who has a new prescription for chlorpromazine. Which of the following statements should the nurse make? "This medication is a tricyclic antidepressant and will improve your mood." "This medication is an opioid antagonist that blocks the pleasurable effects of alcohol." "This medication is an antipsychotic that controls manifestations of schizophrenia." "This medication is a cholinesterase inhibitor that slows the progression of dementia."

"This medication is an antipsychotic that controls manifestations of schizophrenia." Antipsychotic medications, such as chlorpromazine, are thought to act directly on the dopamine receptors in the brain to prevent the reuptake of dopamine, thereby controlling psychotic manifestations. (Chapt 24 Schizophrenia and other psychotic disorders) chlorpromazine (Thorazine): central nervous system agent; psychotherapeutic; antipsychotic; phenothiazine; antiemetic

A nurse is reviewing the laboratory report of a client who has been taking lithium carbonate for several months. Which of the following level should the nurse recognizes the therapeutic lithium level? 1.2 mEq/L 1.6 mEq/L 2.0 mEq/L 2.5 mEq/L

1.2 mEq/L A lithium level of 1.2 mEq/L is within the expected reference range. Clients taking lithium should drink six to eight glasses of water a day to maintain a normal state of hydration. Clients should also consume an adequate amount of sodium to prevent lithium toxicity. (Chapt 26 Bipolar and Related Disorders) Normal Lithium Range 0.6 to 1.5 mEq/L

A nurse is assessing a client who has been taking thioridazine for several days. The client reports hand tremors, drooling, and rigid extremities. Which of the following actions should the nurse take? Reassure the client that these effects are expected. Administer diazepam. Encourage deep breathing and relaxation. Administer benztropine.

Administer benztropine. This client is experiencing extrapyramidal effects of thioridazine, which includes pseudoparkinsonism. Benztropine is a medication that counteracts these adverse effects. The nurse should notify the provider if extrapyramidal effects occur and obtain a prescription to alleviate the manifestations.

A nurse is caring for a client with schizophrenia. The client spends a great deal of time repeating rhyming syllables such as, "Me, see, bee, tree." The nurse recognizes that the client is demonstrating which of the following positive manifestations of schizophrenia? Clang association Echolalia Magical thinking Word salad

Clang association The stringing and repeating of words together because of their rhyming sounds is called clang association. Clang association is a positive manifestation of schizophrenia. (Chapt 24 Schizophrenia and other psychotic disorders) A pattern of speech in which the choice of words is governed by sounds. Clang associations often take the form of rhyming.

A nurse is providing teaching to a client who has obsessive-compulsive disorder and performs hand hygiene to decrease anxiety. Which of the following actions by the nurse implement MODELING as a behavioral intervention strategy? Setting a time limit between episodes of hand hygiene Demonstrating performance of hand hygiene at scheduled times Telling the client to shout "stop" each time there is an urge to perform hand hygiene Instructing the client to practice muscle relaxation when experiencing the urge to perform hand hygiene

Demonstrating performance of hand hygiene at scheduled times This action is an example of modeling, which is a behavioral intervention strategy that allows the client to see the expected behaviors performed by the nurse. (Chapt 18 Behavior Therapy) Modeling refers to the learning of new behaviors by imitating the behavior in others

A nurse is providing teaching to a client with schizophrenia and it's taking quetiapine. The nurse should instruct the client that which of the following blood test should be performed periodically? Potassium Uric acid Glucose Calcium

Glucose Clients taking quetiapine are at risk for abnormal glucose metabolism, which can result in diabetes mellitus. Therefore, the client should have glucose testing periodically. (Chapt 24 Schizophrenia and other psychotic disorders) quetiapine (Seroquel): central nervous system (cns) agent; psychotherapeutic agent; antipsychotic, atypical

A nurse in the emergency department is assessing a client who has cocaine intoxication? Which of the following findings should the nurse expect? Pinpoint pupils Drowsiness Nystagmus Hypervigilance

Hypervigilance Paranoid behavior is an expected finding for a client who has cocaine intoxication. (Chapt 23 Substance-related and Addictive Disorders) Amphetamines, nonamphetamine stimulants, and COCAINE produce increased alertness, decrease in fatigue, elation and euphoria, and subjective feelings of greater mental agility and muscular power. Chronic use of these drugs may result in compulsive behavior, paranoia, hallucinations, and aggressive behavior (Street Drugs, 2012).

A nurse is planning to administer a dose of lithium carbonate to a client who has bipolar disorder. The laboratory report indicates that the clients current lithium level is 1.0 mEq/L. Which of the following actions should the nurse take? Contact the provider for a dosage increase. Request a repeat of the lithium level. Administer the medication. Prepare the client for gastric lavage.

Administer the medication. The nurse should administer the medication because the lithium level is within the expected reference range. (Chapt 26 Bipolar and Related Disorders) Normal Lithium Range 0.6 to 1.5 mEq/L

A nurse is caring for a client who has been unable to leave the house for the past 10 years without accompaniment when attempting to go out alone. The client becomes very anxious and must quickly return inside the nurse should identify that the client is exhibiting which of the following disorders? Agoraphobia Posttraumatic stress disorder Panic disorder Obsessive-compulsive disorder

Agoraphobia Agoraphobia is the fear and subsequent avoidance of places or situations from which escape might be difficult. The most common manifestations of this disorder are a fear of leaving one's home and avoiding open public places, such as shopping malls. (Chapt. 27 Anxiety, Obsessive-Compulsive Disorder) The fear of being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of a panic attack.

A nurse is assessing a client who has a psychotic disorder in a new prescription of haloperidol. The client is pacing in the hallway and states I can't seem to set still. Which of the following extrapyramidal side effects is the client likely experiencing? Dystonia Parkinsonism Tardive dyskinesia Akathisia

Akathisia Akathisia is an extrapyramidal adverse effect characterized by the client's report of a sense of inner restlessness and by observable behaviors such as pacing, rocking forward and backward in a chair, and constant foot tapping. (Chapt 24 Schizophrenia and other psychotic disorders) Restlessness; an urgent need for movement. A type of extrapyramidal side effect associated with some antipsychotic medications. haloperidol (Haldol): central nervous system agent; psychotherapeutic; antipsychotic; butyrophenone

A nurse is planning a menu for a client who has bipolar disorder and is experiencing acute manic episode. Which of the following meal should the nurse provide for this client? Spaghetti and meat balls, a salad, and apple pie Beef and vegetable stew, rice, and vanilla pudding Chicken nuggets, crackers with cheese sticks, and a cookie Broiled fish fillets, stewed tomatoes, and ice cream

Chicken nuggets, crackers with cheese sticks, and a cookie A nurse who is caring for a client who is in the manic phase of bipolar disorder should provide him with high-calorie finger foods that can be carried and are relatively easy to manipulate. This meal is a good choice for a client who is hyperactive and has a short attention span who might not sit down to eat.

A school nurse is caring for an adolescent client who has a history of depressive episode 1 year ago. He appears withdrawn from social activities and his school performance is declining. Which of the following actions should the nurse take first? Initiate a structured daily schedule of activities. Conduct a suicide-risk assessment. Encourage the client to express his feelings in a journal. Ask teachers to monitor for other signs of depression.

Conduct a suicide-risk assessment. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the nurse should first conduct a suicide-risk assessment.

A nurse asks an older adult client, "Did you have any visitors yesterday?" The client responds "Yes, several members of my church choir came to see me." The nurse knows that only the clients daughter visited the day before. Which of the following cognitive impairments is the client demonstrating? Perseveration Confabulation Apraxia Agnosia

Confabulation Confabulation is filling in gaps in memory by fabrication. The client unconsciously makes up responses that are inaccurate to avoid the embarrassment of memory loss. (Chap 22 Neurocognitive Disorders) creating imaginary events to fill in memory gaps. Depression and social withdrawal are common.

A nurse is caring for a client who has a obsessive-compulsive disorder. Which of the following actions should the nurse take first? Encourage the client to verbalize her feelings. Teach the client relaxation techniques. Determine the client's anxiety level. Role-play problem solving behaviors with the client.

Determine the client's anxiety level. The nurse should apply the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. Therefore, assessing the client's anxiety level is vital in order to plan appropriate actions, since nursing interventions vary depending on the level of anxiety experienced by the client.

A nurse is assessing a client who has an anxiety disorder and is taking a benzodiazepine. For which of the following adverse affects should the nurse monitor the client? Seizures Dizziness Polyuria Insomnia

Dizziness Dizziness is a common adverse effect the nurse would expect in a client who has a prescription for a benzodiazepine. Other common adverse effects are drowsiness and sedation. (Chapt. 27 Anxiety, Obsessive-Compulsive Disorder) The major risks with BENZODIAZEPINE therapy are physical dependence and tolerance, which may encourage abuse. Because withdrawal symptoms can be life threatening, clients must be warned against abrupt discontinuation of the drug and should be tapered off the medication at the end of therapy.

A nurse is providing discharge teaching for a client who has a new prescription for doxepin. Which of the following adverse affects should the nurse inform the client is associated with this medication? Weight loss Diarrhea Drowsiness Bradycardia

Drowsiness The nurse should inform the client that drowsiness is one of the most common adverse effects of doxepin. doxepin (Adapin): central nervous system agent; psychotherapeutic; tricyclic antidepressant

A nurse in an outpatient mental health clinic is interviewing a client who has schizophrenia and appears to be experiencing auditory hallucinations. Which of the following action should the nurse take first? Teach the client strategies to decrease her hallucinations. Identify if the client is on antipsychotic medications. Distract the client from the hallucination. Explore what the voices are saying to the client.

Explore what the voices are saying to the client. The nurse should apply the safety and risk reduction priority-setting framework when answering this item. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse must assess what the voices are saying to the client to identify suicidal or homicidal ideation, which poses the greatest risk to the client and others.

A nurse is caring for a newly admitted client who is experiencing alcohol withdrawal. Which of the following findings should the nurse expect? Bradycardia Increased somnolence Slurred speech Headache

Headache Headache is an expected finding in a client who is experiencing alcohol withdrawal. This can occur 4 to 12 hr following cessation of alcohol use. Other findings include hand tremors, nausea, vomiting, sweating, depression, or irritability.

A nurse is caring for a client who has dementia. Which of the following findings should the nurse expect? Altered level of consciousness Impaired judgment Rapid change in personality Disturbances in perception

Impaired judgment Impaired judgment occurs in clients who have dementia because they lose their ability to reason, think abstractly, and have rational thoughts.

A nurse is caring for a client who has panic disorder and is experiencing anxiety at the panic level. Which of the following actions should the nurse take first? Identify the cause of the anxiety. Instruct the client to take slow, deep breaths. Teach the client how to use positive self-talk. Explain the physical manifestations of anxiety to the client.

Instruct the client to take slow, deep breaths. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse cannot perform other actions while the client is having a panic attack and experiencing hyperventilation, shortness of breath, dizziness, and other associated manifestations. Therefore, instructing the client to take slow, deep breaths is the priority.

A nurse is assessing a client who has been taking an antipsychotic medication for 6 years and the provider has started tapering off the dosage. The nurse should monitor the client for which of the following manifestations of tardive dyskinesia? Muscular weakness Muscle spasms Involuntary tongue protrusion Uncontrolled rolling of the eyes

Involuntary tongue protrusion Tardive dyskinesia begins with mouth and facial movements and then progresses to involve other muscle groups. All clients receiving antipsychotic therapy for months to years are at risk. This adverse effect is potentially irreversible and discontinuing the drug rarely relieves these manifestations. (Chapt 24 Schizophrenia and other psychotic disorders) Tardive dyskinesia: (bizarre facial and tongue movements, stiff neck, and difficulty swallowing; may occur with all classifications, but more common with typical antipsychotics)

A nurse is assessing a client with schizophrenia. The client states "I need to get my gummamoshu from by my house." The nurse recognizes the statement as an example of which of the following? Flight of ideas Echolalia Perseveration Neologism

Neologism The nurse should recognize the client's response as a neologism, an invented word which has no meaning to those around him. New words that an individual invents that are meaningless to others, but have symbolic meaning to the psychotic person.

An emergency room nurse is assessing a client who has an anxiety disorder. The client has flashed, perspiring profusely, and is experiencing palpitations. The client begins to scream, "I am going to die! This is it! I'm having a heart attack!" The nurse should determine the client's level of anxiety to be which of the following? Moderate Panic Severe Mild

Panic This client's manifestations indicate the panic level of anxiety and indicate manifestations of a panic disorder.

A nurse is performing an admission assessment for a client who has schizophrenia. The nurse notices that the clients appearance is unkempt and he appears to be actively hallucinating. Which of the following should be the nurses priority assessment? Perception of reality Ability to follow directions Physical needs Mental status

Physical needs The nurse should consider Maslow's Hierarchy of Needs, which includes five levels of priority. The first level consists of physiological needs; the second level consists of safety and security needs; the third level consists of love and belonging needs; the fourth level consists of personal achievement and self-esteem needs; and the fifth level consists of achieving full potential and the ability to problem solve and cope with life situations. When applying Maslow's Hierarchy of Needs priority-setting framework, the nurse should review physiological needs first. The nurse should then address the client's needs by following the remaining four hierarchal levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the specific client situation. The fourth level of Maslow's Hierarchy of Needs includes usefulness, self-worth, and self-confidence in fulfilling self-esteem needs.

A nurse is caring for a client who has obsessive-compulsive disorder. Which of the following action should the nurse take when dealing with the clients ritualistic behaviors? Plan the client's schedule to allow time to perform rituals. Verbalize disapproval of ritualistic behavior. Place the client in protective isolation. Increase stimuli in the client's immediate surroundings.

Plan the client's schedule to allow time to perform rituals. The nurse should allot sufficient time for the client to perform rituals early in the treatment. This will help keep anxiety levels manageable and prevent the precipitation of panic anxiety.

A nurse in a mental health clinic is assessing a client who has a history of mania. Which of the following findings indicates that the client is experiencing a relapse? Weight gain Ritualistic behavior Anhedonia Pressured speech

Pressured speech Pressured speech is an indication of a relapse in a client who has mania. (Chapt 22 Neurocognitive Disorders) Pressured speech. Rapid speech that is loud, intrusive, and difficult to interrupt

A nurse is providing teaching to a client who has a new prescription for phenelzine. The nurse should teach the client that which of the following over-the-counter medications can cause hypertensive crisis when taken concurrently with phenelzine? Acetaminophen Ranitidine Naproxen Pseudoephedrine

Pseudoephedrine Pseudoephedrine interacts with MAOI medications and is therefore contraindicated. Ingesting products containing ephedrine along with phenelzine can precipitate a hypertensive crisis. (Chapt 25 Depressive Disorders) phenelzine (Nardil) :central nervous system agent; psychotherapeutic; antidepressant; monoamine oxidase (mao) inhibitor

A nurse is caring for a client who has acute delirium. Which of the following findings should the nurse expect? Progressive deterioration of cognitive function Rapid fluctuation in level of consciousness Loss of language ability Absence of contributing factors to pinpoint cause of delirium

Rapid fluctuation in level of consciousness A rapidly fluctuating level of consciousness is an expected finding for a client who has acute delirium.

A nurse is assessing a newly admitted client who has generalized anxiety disorder and states, "I drink alcohol to forget the pain." The client is exhibiting a maladaptive response to which of the following defense mechanisms? Rationalization Conversion Projection Suppression

Rationalization Rationalization is a defense mechanism by which a person covers up a real or perceived problem or weakness. This client is attempting to justify alcohol use by explaining that it helps to relieve pain. This is done to protect the client's ego and to satisfy the nurse. ???(Chapt 2 Mental Health/Mental Illness) Compensation is the covering up of a real or perceived weakness by emphasizing a trait one considers more desirable.???

I nurse is caring for a client who has a possessive compulsive disorder the client engages in repeated handwashing daily. Which of the following should the nurse recognize as the purpose of the clients behavior? Relieving anxiety Gaining attention Avoiding daily responsibilities Responding to auditory hallucinations

Relieving anxiety Ritualistic and compulsive behaviors, such as repeated handwashing, are associated with obsessive-compulsive disorder. The client has a strong urge to perform these acts in an attempt to reduce anxiety. Performing these acts only temporarily reduces the anxiety; therefore, the compulsive act must be repeatedly performed over and over again.

A nurse is caring for a client who has post-traumatic stress disorder (PTSD). Which of the following actions by the client indicates the current treatment plan is effective? The client reports techniques she uses to promote sleep. The client shows limited emotion when witnessing a traumatic event. The client asks the nurse's opinion about clothes she is wearing. The client avoids situations that might trigger memories of past trauma.

The client reports techniques she uses to promote sleep. Clients who have PTSD often experience disrupted sleep; therefore, reporting techniques she uses to promote sleep indicates the current treatment plan is effective.

A nurse is providing discharge teaching for a female client who has an anxiety disorder and a new prescription for lorazepam. Which of the following instructions should the nurse include in the teaching? "This medication can be safely taken during pregnancy." "This medication must be discontinued by gradual tapering over time." "An extra dose of the medication can be taken at bedtime if you experience insomnia." "You should monitor your blood glucose levels closely while taking the medication."

"This medication must be discontinued by gradual tapering over time." Rapid withdrawal from lorazepam has been associated with manifestations of withdrawal, such as anxiousness, sleeplessness, and irritability. It is discontinued by gradually tapering it off over time to avoid any adverse responses. lorazepam (Ativan): central nervous system agent; anxiolytic; sedative-hypnotic; potent benzodiazepine

A nurse in a mental health facility is caring for a client who has generalized anxiety disorder. Which of the following statement should the nurse make? "We'll assist you with making decisions." "Someone will work with you when you have flashbacks." "You'll be going through aversion therapy to help you cope." "The therapy will help you control your impulses."

"We'll assist you with making decisions." Clients who have generalized anxiety disorder are often indecisive and dread making decisions. Therefore, the nurse should reassure the client that they will receive help with making decisions.

A nurse on an inpatient unit is assessing a client who has claustrophobia. The nurse determines the clients condition has improved when he can perform which of the following task? Ride in an elevator. Attend a class where several service animals are present. Sit in a large room with several people he does not know. Go for a swim in an outdoor pool.

Ride in an elevator. Claustrophobia is an intense anxiety or fear about being in an enclosed space, such as an elevator. Riding in an enclosed elevator is an indication that this client's condition is improving. (Chapt. 27 Anxiety, Obsessive-Compulsive Disorder)

A nurse is caring for a client who has severe anxiety disorder and is in a state of panic in the dayroom. Which of the following action should the nurse take? Speak to the client in a calm voice. Leave the client alone to regain control. Encourage the client to express her feelings. Place the client in restraints.

Speak to the client in a calm voice. The initial goal for a client who is in a state of panic is to obtain relief. The nurse should stay with the client and speak in a calm manner.

A nurse is reviewing the health history of a young adult client who has depressive disorder. Which of the following factors should the nurse identify as increasing the clients risk for depression? The client is an only child. The client lives in an urban setting. The client is married. The client is female.

The client is female. The nurse should identify female gender as a primary risk factor for depression. The incidence of depressive disorders is greater in women than in men by almost 2 to 1.

A nurse is caring for a client who is taking tricyclic antidepressant (TCAs). Which of the following adverse effects should the nurse report to the client provider immediately? Dry mouth Constipation Drowsiness Urinary retention

Urinary retention Urinary retention can lead to bladder infection and, ultimately, loss of bladder tone. The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client.

A nurse is providing teaching to a client who has generalized anxiety disorder and a new prescription for buspirone. Which of the following statements by the client indicates an understanding of the teaching? "This medication can cause dependence." "I should take a dose of my medication when I start to feel anxious." "It's important for me to take my medication 30 minutes before bedtime." "I should expect to feel the full effect of my medication in 2 to 4 weeks."

"I should expect to feel the full effect of my medication in 2 to 4 weeks." The desired response from buspirone can begin within 7 to 10 days; however, it takes 2 to 4 weeks for buspirone to reach its full effect. (Chapt. 27 Anxiety, Obsessive-Compulsive Disorder) buspirone (BuSpar): central nervous system agent; anxiolytic

A nurse is providing teaching to a client who has a new prescription for alprazolam. Which of the following is the priority information the nurse should include in the teaching? "This medication can affect your ability to drive or handle mechanical equipment." "You should avoid drinking beverages that contain caffeine with this medication." "You should avoid taking antacids within 2 hours of taking this medication." "This medication should be taken with or shortly after meals."

"This medication can affect your ability to drive or handle mechanical equipment." The nurse should apply the safety and risk reduction priority-setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client. Handling mechanical equipment or driving creates a safety risk for the client who takes alprazolam. alprazolam (Xanax): central nervous system agent; anxiolytic; sedative-hypnotic; benzodiazepine

A nurse is providing teaching to a client who has a new prescription for diazepam. Which of the following instructions should the nurse include in the teaching? "Expect this medication to make you feel anxious." "This medication can be habit-forming." "Take this medication on an empty stomach." "This medication takes 2 to 3 weeks to reach full therapeutic effect."

"This medication can be habit-forming." Diazepam is a benzodiazepine agent. All drugs in this category can cause physical dependence and are considered controlled substances. (Chapt 23 Substance-related and Addictive Disorders) diazepam (Valium): central nervous system agent; benzodiazepine anticonvulsant; anxiolytic