Title: Exam 2
Course: NUR 1521C Psychiatric/Mental Health Nursing > Section: Module 5

Q: A woman with a history of several suicide attempts by overdose is found to have recurrent major depression. Given this patient's history and diagnosis, which of the following antidepressant medications would the nurse expect to be ordered?
- Amitriptyline (Elavil), a sedating tricyclic medication
- Desipramine (Norpramin), a stimulating tricyclic medication
- Fluoxetine (Prozac), a selective serotonin reuptake inhibitor
- Tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor
A: Fluoxetine (Prozac), a selective serotonin reuptake inhibitor

Q: Which behavior observed by a nurse indicates a suspicion that a depressed adolescent patient may be suicidal?
- The patient runs out of the therapy group swearing at the group leader, and runs to her room.
- The patient gives away a prized CD and a cherished picture of the performer.
- The patient becomes angry while speaking on the telephone and slams down the receiver.
- The patient gets angry with her roommate when the roommate borrows the patient's clothes without asking.
A: The patient gives away a prized CD and a cherished picture of the performer.

Q: A patient with acute mania has exhausted staff by noon after joking, manipulating, and insulting all morning. Staff members feel defensive and fatigued. Select the best action.
- Call the health care provider to evaluate the patient.
- Hold a staff meeting to discuss consistency and limit-setting approaches.
- Seclude the patient, and then call the health care provider to write an order.
- Explain to the patient that the behavior is unacceptable. Ask the patient to be more cooperative.
A: Hold a staff meeting to discuss consistency and limit-setting approaches.

Q: A patient is admitted to the mental health unit with a diagnosis of depression. A nurse develops a plan of care for the patient and includes which appropriate activity in the plan?
- Reading and writing most of the day.
- Several activities from which the client can choose.
- Nothing, until the client asks to participate in the milieu.
- A structured program of activities in which the client can participate.
A: A structured program of activities in which the client can participate.

Q: A nurse talks with a woman who recently learned that her husband died while jogging. Select the appropriate statement for the nurse.
- "At least your husband did not suffer."
- "It's better to go quickly as your husband did."
- "Your husband's loss must be very painful for you."
- "You will begin to feel better after you get over the shock."
A: "Your husband's loss must be very painful for you."

Q: Police bring a patient to the mental health unit. The patient was directing traffic and shouting rhymes on a busy city street. The patient's spouse reports that the patient has not slept or eaten for 3 days. Which assessment findings have priority concern for this patient's plan of care?
- Pressured speech and grandiosity
- Hyperactivity; not eating and sleeping
- Poor concentration and decision making
- Insulting, provocative behavior directed at staff
A: Hyperactivity; not eating and sleeping

Q: Select the priority nursing intervention when caring for a patient after an overdose of amphetamines.
- Monitor vital signs.
- Observe for depression.
- Use warmers to maintain body temperature.
- Offer intellectual activities to stimulate concentration.
A: Monitor vital signs.

Q: During periods of laughter, talkativeness, and joking, a patient with manic behavior is noted to abruptly become irritable. How should such changes in mood be assessed?
- dissociation.
- labile mood.
- loose associations.
- flight of ideas.
A: labile mood.

Q: A nurse with a history of narcotic abuse became unconscious in the locker room after overdosing. After stabilization, the nurse was transferred to the inpatient psychiatric unit. Which action by nursing staff may be enabling?
- Empathizing when the nurse discusses fears of disciplinary action by the state board of nursing.
- Pointing out that work problems are the result, not the cause, of substance abuse.
- Conveying understanding that pressures associated with nursing practice cause substance abuse.
- Providing health teaching about stress management.
A: Conveying understanding that pressures associated with nursing practice cause substance abuse.

Q: Which observations, if documented in the medical record, would indicate that the treatment plan for a patient with acute mania has been effective?
- "Converses appropriately, clothing is matched, participates in activities."
- "Irritable, suggestible, distractible, napped for 10 minutes in afternoon."
- "Attention span short, writing copious notes, intrudes in conversations."
- "Heavily made up, seductive toward male staff, pressured speech."
A: "Converses appropriately, clothing is matched, participates in activities."

Q: A patient admitted for treatment of trauma sustained in a fall while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. Which nursing diagnosis has the highest priority?
- ineffective health maintenance.
- ineffective coping.
- ineffective denial.
- risk for injury.
A: risk for injury.

Q: The nurse uses the SAD PERSONS scale as he interviews a patient who has expressed suicidal ideation. This tool provides data relevant to:
- mood disturbance.
- suicide potential.
- current stress level.
- level of anxiety.
A: suicide potential.

Q: A patient is being treated with phenelzine (Nardil) for depression. Which indicator (s) would be useful to monitor the outcome "Client will understand the potential side effects of monoamine oxidase inhibitor (MAOI) antidepressants? (Choose all that apply)
- avoids sausage and chocolate
- avoids over-the-counter medications
- avoids eating at Chinese restaurants
- maintains a stable intake of sodium
A: avoids sausage and chocolate; avoids over-the-counter medications; avoids eating at Chinese restaurants

Q: The nurse reports to the interdisciplinary team that an antisocial patient lies to other patients, verbally abuses a patient with Alzheimer's disease, flatters his primary nurse, and is detached and superficial during counseling sessions. Which behavior should be the priority focus of limit setting?
- lying to other patients
- flattering the nursing staff
- verbally abusing other patients
- superficiality during counseling
A: verbally abusing other patients

Q: The husband of a bipolar client asks the nurse what causes manic disorder. What information given by the nurse is most helpful?
- several factors, including heredity, may have roles.
- excess norepinephrine is the most important factor.
- brain structures have been altered by stress early in life.
- bipolar clients always have excess dopamine receptors.
A: several factors, including heredity, may have roles.

Q: A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, "If you had given him your undivided attention, he would still be alive." Which analysis applies?
- The comment warns of a malpractice suit.
- Anger is a phenomenon experienced during grieving.
- The patient had ambivalent feelings about her husband.
- In some cultures, grief is expressed solely through anger.
A: Anger is a phenomenon experienced during grieving.

Q: What is the most appropriate response by the nurse when a despondent patient says "nothing matters anymore"?
- "Are you having thoughts of suicide?"
- "I am not sure I understand what you are trying to say."
- "Try to stay hopeful. Things have a way of working out."
- "Tell me more about the things that interested you before you began to feel depressed."
A: "Are you having thoughts of suicide?"

Q: A patient, who has been diagnosed with prostate cancer and received chemotherapy and radiation treatments, is admitted to a hospital for palliative care. A nurse understands that the patient:
- will require minimal nursing care since a cure is no longer a treatment option.
- is expected to expire within 5-7 days.
- is unable to make decisions independently regarding medical treatment.
- will receive care that relieves symptoms without hastening or postponing the patient's death.
A: will receive care that relieves symptoms without hastening or postponing the patient's death.

Q: Information given to a depressed patient and family when the patient begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy should include the directive to:
- avoid exposure to bright sunlight.
- report increased suicidal thoughts.
- restrict sodium intake to 1 gm daily.
- maintain a tyramine-free diet.
A: report increased suicidal thoughts.

Q: What is the most important nursing intervention for the period immediately after awakening from electroconvulsive therapy treatment?
- monitoring the return to capacity for full range of motion
- assessing the degree of accumulating memory impairments
- making positive comments while the client is more receptive.
- assessing the level of consciousness and normal body functions.
A: assessing the level of consciousness and normal body functions.

Q: A teaching plan for a patient taking a Selective Serotonin Reuptake Inhibitor (SSRI) should include instructions:
- Increase the normal salt and fluids in the diet
- Avoid foods that contain tyramine
- May cause drowsiness, hypotension, and dizziness
- May cause insomnia, anxiety, and nervousness
A: May cause insomnia, anxiety, and nervousness

Q: A teaching plan for a patient taking lithium should include instructions to:
- maintain normal salt and fluids in the diet.
- drink twice the usual daily amount of fluid.
- have regular laboratory studies of liver function.
- avoid eating aged cheese, processed meats, and red wine.
A: maintain normal salt and fluids in the diet.

Q: When assessing a patient's plan for suicide, the priority areas to consider include
- client financial and educational status.
- client insight into his or her suicidal motivation.
- availability of means and lethality of method.
- quality and availability of client social support.
A: availability of means and lethality of method.

Q: The nurse is performing the morning assessment of a patient who is taking Lithium. What symptoms are most consistent with Lithium toxicity?
- nausea, fine hand tremor, mild thirst
- agranulocysosis, aplastic anemia, abnormal liver function tests
- ataxia, vomiting, polyuria, mental confusion
- constipation, visual disturbances, hypertensive crisis.
A: ataxia, vomiting, polyuria, mental confusion

Q: A nurse prepares the plan of care for a patient having a manic episode. Which nursing diagnosis is most likely to relate this patient's care?
- Social isolation
- Chronic confusion
- Disturbed sleep pattern
- Disturbed body image
A: Disturbed sleep pattern

Q: The nurse in the medication clinic receives the following lithium level for a client: 1.0 mEq/L. How should the lithium level be assessed?
- within therapeutic limits.
- below therapeutic limits.
- above therapeutic limits.
- completely incorrect because of inaccurate testing.
A: within therapeutic limits.

Q: A nurse is monitoring a patient who abuses alcohol for signs of alcohol withdrawal. Which of the following would alert the nurse to the potential for withdrawal delirium?
- Hypotension, ataxia, hunger
- Stupor, agitation, muscular rigidity
- Hypotension, coarse hand tremors, agitation
- Hypertension, changes in level of consciousness, hallucinations
A: Hypertension, changes in level of consciousness, hallucinations

Q: An individual uses alcohol to relieve tension. When he first began self-medicating with alcohol, two drinks made him relaxed and drowsy. Now, after 1 year, he needs four drinks to bring himself to the same relaxed, drowsy state. How is this best explained?
- the alcohol is less potent.
- he is developing tolerance.
- he is developing abuse
- the alcohol has an antagonistic effect
A: he is developing tolerance.

Q: A nurse teaching a patient about a tyramine-restricted diet would approve a meal consisting of:
- mashed potatoes, ground beef patty, corn, green beans, and apple pie
- avocado salad, ham, creamed potatoes, asparagus, and chocolate cake
- noodles with cheddar cheese sauce, sausage, lettuce salad, and yeast rolls
- macaroni and cheese, hot dogs, banana bread, and caffeinated coffee
A: mashed potatoes, ground beef patty, corn, green beans, and apple pie

Q: What is a priority intervention for a severely depressed patient?
- allowing the client to remain alone if he or she prefers.
- careful observation around the clock.
- encouraging the client to spend a major portion of each day in bed.
- opportunities to assume a leadership role in the therapeutic milieu.
A: careful observation around the clock.

Q: The admitting note describes a patient with depression as having anergia and anhedoni
- Channel excessive energy.
- Reduce guilty ruminations.
- Promote physical activity.
- Reduce stimulation
A: Promote physical activity.

Q: A patient who became severely depressed after losing her job tells the nurse that she is not worth the time the nurse spends with her. The patient often mentions that she is "the worst person in the world." On the basis of these data, what is the best nursing diagnosis ?
- Powerlessness.
- Defensive coping.
- Situational low self-esteem.
- Disturbed personal identity.
A: Situational low self-esteem.

Q: What statement provides the best rationale for the nursing intervention of monitoring the severely depressed client closely during antidepressant therapy?
- as depression lifts, physical energy becomes available to carry out a plan for suicide.
- suicide may be precipitated by a variety of internal and external events.
- suicidal clients have difficulty using social supports.
- suicide is an impulsive act.
A: as depression lifts, physical energy becomes available to carry out a plan for suicide.

Q: When assessing a patient for depression what are the key findings that indicate major depression?
- Paranoid delusions and lack of energy.
- Evidence of an earlier hypomanic episode.
- Depressed mood, anhedonia, and anergi
- Disorganized thoughts and poor concentration.
A: Depressed mood, anhedonia, and anergi

Q: Which statement by a patient with borderline personality disorder best indicates the treatment plan is helping?
- "I think you are the best nurse on the unit."
- "I hate my doctor. He never gives me what I ask for."
- "I feel empty and want to cut myself, so I called to talk to you."
- "I'm never going to get high on drugs again."
A: "I feel empty and want to cut myself, so I called to talk to you."

Q: Physical assessment of a bulimic client often reveals which of the following?
- prominent paratid glands
- low weight
- thin, brittle hair
- amenorrhe
A: prominent paratid glands

Q: Which intervention is most appropriate for an antisocial patient with a nursing diagnosis of ineffective coping related to manipulation of others?
- set clear and realistic limits on manipulative behavior
- provide negative reinforcement for manipulative behavior.
- ignore, rather than confront, his inappropriate behavior.
- encourage the client to discuss feelings of fear and inferiority.
A: set clear and realistic limits on manipulative behavior

Q: What question is of highest priority to ask a newly admitted patient with a history of alcohol abuse?
- "Has drinking caused you any problems?"
- "Have you ever had blackouts?"
- "When did you take your last drink?"
- "When did you decide to seek treatment?"
A: "When did you take your last drink?"

Q: Which of the following is an important nursing intervention when caring for a patient withdrawing from a Central Nervous System (CNS) stimulant?
- make physical contact by frequently touching the client.
- offer intellectual activities requiring concentration.
- assess for depression and suicidal ideation.
- avoid manipulation by denying all client requests
A: assess for depression and suicidal ideation.

Q: I have thoroughly read the course description, requirements, assignments/due dates, and calendar information on this site. Further, I have reviewed the procedures for using the discussion, assignments dropbox, and e-mail features of the site. I understand what is required to complete this course successfully and how to use the online tools to do so.
- Yes, I do
- No, I don't
A: Yes, I do
If right: Great, then begin work on Module 1.
If wrong: Uh oh! Then go back and re-read the syllabus materials completely. If you still cannot answer, Yes, I do, contact the instructor immediately.

Q: Which of the following nursing interventions is most appropriate on the first day of alcohol detoxification?
- strongly encourage the patient to attend two AA meetings.
- educate the patient about the biopsychosocial consequences of alcohol abuse.
- monitor the patient's vital signs every four hours, or sooner, if necessary.
- ensure that the patient consumes 95% of his meals.
A: monitor the patient's vital signs every four hours, or sooner, if necessary.

Q: Police bring a patient to the emergency department after an automobile accident. The patient is ataxic and has slurred speech and mild confusion. The blood alcohol level is 0.4 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable? The patient:
- rarely drinks alcohol.
- has a high tolerance to alcohol.
- has been treated with disulfiram (Antabuse).
- has ingested both alcohol and sedative drugs recently.
A: has a high tolerance to alcohol.

Q: Which assessment findings are likely for a patient who recently injected heroin?
- anxiety, restlessness, paranoid delusions
- muscle aching, dilated pupils, tachycardia
- insomnia, dilated pupils, ataxia
- drowsiness, constricted pupils, slurred speech
A: drowsiness, constricted pupils, slurred speech

Q: Disturbed body image is the nursing diagnosis for a patient with an eating disorder. Which outcome indicator is most applicable to this diagnosis?
- Weight, muscle, and fat congruence with height, frame, age, and sex
- Calorie intake within required parameters of treatment plan
- Weight at established normal range for the patient
- Patient satisfaction with body appearance
A: Patient satisfaction with body appearance

Q: A patient is taking a drug that acts by inhibiting MAO. If the patient does not follow a special diet what complication may occur?
- Hypotensive shock
- Hypertensive crisis.
- Cardiac dysrhythmi
- Cardiogenic shock.
A: Hypertensive crisis.

Q: An adolescent who attempted suicide and was admitted to an inpatient mental health unit had been assessed as being at high risk of self-harm, but he has shown improvement. His doctor is now considering discharge and asks the nurse's opinion. Which of the following observations most reliably indicates that he may be ready for discharge to outpatient care?
- He denies that suicide ideation and intent are present.
- His family agrees to observe him closely at home.
- He continues to isolate himself during unit activities .
- He focuses on problem solving and hope for the future.
A: He focuses on problem solving and hope for the future.

Q: A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy. Patient teaching should include the need to: (Select all that apply.)
- avoid aged cheeses
- avoid alcohol based skin products
- read labels of all liquid medications
- maintain an adequate dietary intake of sodium
A: avoid aged cheeses; avoid alcohol based skin products; read labels of all liquid medications

Q: A patient with anorexia nervosa is treated as an outpatient. Select the desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the patient will:
- gain 1 to 2 pounds.
- exercise 1 hour daily.
- take a laxative every 3 days.
- weigh self accurately using balanced scales.
A: gain 1 to 2 pounds.

Q: The nurse manager tells a new staff nurse "We anticipate this patient will have symptoms of withdrawal from sedative-hypnotics or Central Nervous System (CNS) depressants. For which symptoms should the staff nurse assess for CNS depressant withdrawal?
- dilated pupils, tachycardia, elevated blood pressure, elation
- labile mood, poor coordination, fever, drowsiness
- nausea, vomiting, diaphoresis, anxiety, tremors
- excessive eating, constipation, headache
A: nausea, vomiting, diaphoresis, anxiety, tremors

Q: Select the most accurate description of substance dependence.
- Syptoms occur whe two or more drugs affecting the central nervous system are used for their additive effects.
- Lack of control over use. Tolerence exists. Withdrawl symptoms occur when intake is reduced or stopped.
- Psychoactive drug use interferes with the action of competing neurotransmitters.
- Take a combination of drugs to weaken or inhibit the effect of another drug.
A: Lack of control over use. Tolerence exists. Withdrawl symptoms occur when intake is reduced or stopped.