Mental Health NCLEX practice Questions with Correct Answers

Mental Health NCLEX practice Questions with Correct Answers

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• The serum lithium blood level of a client with a mood disorder, manic

episode, is 2.3 mEq/L. What should the nurse expect when assessing this client?

a) Elevation in mood

b) Nausea, thirst, and fine hand tremor

c) Decrease in manic signs and symptoms

d) Vomiting, diarrhea, and decreased coordination: d) Vomiting, diarrhea, and

decreased coordination

Vomiting, diarrhea, and decreased coordination are reflective of lithium toxicity.During the active phase of a manic episode a lithium level of 2.3 mEq/L is more than the therapeutic range of 0.8 to 1.4 mEq/L. An improvement in mood may occur when the therapeutic level is approached early in lithium therapy. Nausea, thirst, and fine hand tremor are common early side effects of lithium treatment. They are not related to lithium toxicity, which is indicated by a 2.3 mEq/L lithium level. During the acute phase of mania the therapeutic serum level of lithium should be between 0.8 and 1.4 mEq/L. The maintenance therapeutic serum level ranges from 0.4 to 1.0 mEq/L. A reduction in symptoms is expected when the therapeutic level of lithium is reached.

• The nurse is caring for a female client who is confused and delirious. What

is the most therapeutic intervention when the nurse is interacting with this client?

a) Reassuring the client that she will get better

b) Directing the client's daily activities on the unit

c) Helping the client clarify her experience and gain insight into her behavior

d) Providing the client with solutions to past and current problems she has

experienced: b) Directing the client's daily activities on the unit

The client needs to have her activities decided and directed until delirium and confusion clear. Reassuring the client that she will get better is false reassurance.Clients who are delirious are unable to develop insight into their behavior. Providing the client with solutions to past and current problems experienced is not therapeutic and does not help the client develop insight.

• A male client with cyclothymic disorder with hypomanic symptoms is

admitted to the psychiatric unit. He has progressively lost weight and does not take the time to eat his food. How can the nurse best respond to this

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situation?

a) By providing a tray for him in his room

b) By assuring him that he is deserving of food

c) By ordering food that he can hold in his hand to eat while moving around

d) By pointing out that he must replace the energy that he is burning up by

eating: c) By ordering food that he can hold in his hand to eat while moving around

The client with hypomanic symptoms cannot tolerate sitting still long enough to eat an adequate meal; handheld foods will help meet the client's nutritional needs and do not require the client to sit down. This client will most likely ignore the tray.Unworthy feelings are related to a depressive, not manic, episode. It is unlikely that this client will understand or care about the need to replace energy with food.

• A client who has a diagnosis of paranoid schizophrenia and has been

violent in the past is admitted to the psychiatric unit. What should the nurse do before conducting an admission interview?

a) Move to the client's side and sit down.

b) Alert the assault response team about the client's history.

c) Have two other staff members present when talking with the client.

d) Enter the room with another staff member while remaining between the

client and the door.: d) Enter the room with another staff member while remaining between the client and the door.

Making sure to stay between the client and the door provides safety for the nurse and the other staff member because it will enable them to make a rapid exit. Moving to the client and sitting down invades the client's territory and may precipitate an aggressive client response. Alerting the assault response team is premature; the team is alerted when a client is out of control, harming self or others, and cannot be managed by the staff on the unit. Having two other staff members present may be viewed by the client as confrontational and may precipitate an aggressive response.

• The nurse is caring for a client with a somatoform disorder, conver-

sion-type paralysis. What is the best nursing approach?

a) Discussing topics other than the paralysis

b) Explaining the reason for the physical problem

c) Asking how the client feels about being paralyzed

d) Encouraging the client to slowly walk around the room: a) Discussing topics

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other than the paralysis Discussion of signs and symptoms should not be initiated by the nurse; the signs and symptoms should be accepted by the nurse. Discussion should be focused on the client's feelings and current situation. Explaining the reason for the physical problem may take away the client's unconscious defense and increase anxiety.Asking how the client feels about being paralyzed focuses on the paralysis rather than feelings. Encouraging the client to slowly walk around the room denies the client's symptoms; in reality this client cannot make the legs move to walk.

• During the intake interview at a mental health clinic, a client in withdrawal

reveals to the nurse long-term, high-dose cocaine use. Which signs and symptoms support the conclusion that the client has been abusing cocaine for a prolonged time? Select all that apply.

a) Sadness

b) Euphoria

c) Loss of appetite

d) Impaired judgment

e) Psychomotor retardation: a) Sadness

e) Psychomotor retardation

Although cocaine is an alkaloid stimulant, depressant effects such as a decreased mood, hypotension, and psychomotor retardation are associated with long-term, high-dose use. Cocaine is a stimulant, and euphoria, loss of appetite, and impaired judgment are all associated with cocaine intoxication, not prolonged high-dose cocaine use.

• An older female client who is hospitalized for depression is receiving

citalopram (Celexa). During discharge teaching, she asks the nurse whether there is anything she should know about taking this medication. The nurse

replies:

• "You're concerned about taking this medication."
• "You should take each dose of medication as prescribed."
• "You must discontinue the medication if side effects occur."
• "You may find it necessary to adjust the dosage if side effects occur.": b)

"You should take each dose of medication as prescribed."

The client should be encouraged to follow the medical regimen to maximize her response to drug therapy. The client asked a direct question; telling her that

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she should take each dose as prescribed does not answer her question. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for discontinuing a medication. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for adjusting a medication dosage.

8. A nurse knows individuals who are alcoholics use alcohol to:

a) Blunt reality

b) Precipitate euphoria

c) Promote social interaction

d) Stimulate the central nervous system: a) Blunt reality

Alcohol, by depressing the central nervous system and distorting or altering reality, reduces anxiety. Alcohol depresses the central nervous system; it may cause lability of mood, impaired judgment, and aggressive actions rather than euphoria. Although alcohol is used as a social lubricant, alcoholics frequently drink in isolation. Also, alcohol can lead to inappropriate and aggressive behavior that may impair social interaction. Alcohol depresses the central nervous system; amphetamines and cocaine are stimulants.

• A nurse concludes that a client has successfully achieved the long-term

goal of mobilizing effective coping responses when the client states that

when he feels himself getting anxious he will:

a) Perform a relaxation exercise.

b) Get involved in some type of quiet activity.

c) Avoid the situation that precipitated the anxiety.

d) Examine carefully what precipitated the anxiety.: a) Perform a relaxation

exercise.

Relaxation techniques refocus energy and eventually ease physical and emotional stress. Getting involved in some type of quiet activity is not always possible; forced quiet activity may increase stress and anger rather than reduce it. Avoiding the situation that precipitated the anxiety is not always possible; stress can develop from a variety of feelings stimulated by many situations. What precipitated feelings of anxiety is not easy to identify; it is better to learn to deal with feelings once they develop.

• A nurse is assigned to care for a group of clients who have been found to

have depression. Which clinical manifestations does the nurse anticipate?