PSYCHIATRIC MED
A client is taking an antidepressant and the nurse is concerned about lethality in an overdose. Which medication has the LOWEST lethality risk according to the study guide?
A. Imipramine
B. Phenelzine
C. Tranylcypromine
D. Sertraline
Answer: D. Sertraline
Rationale: Sertraline is an SSRI. The study guide identifies SSRIs as having a low lethality risk compared with TCAs and MAOIs
A psychiatric client is disruptive but is not threatening anyone and refuses medication. What should the nurse do?
A. Force the medication
B. Apply restraints
C. Allow the client to refuse the medication
D. Place the client in seclusion
Answer: C. Allow the client to refuse the medication
Rationale: Psychiatric clients retain the right to refuse treatment. A disruptive but non-threatening client does not automatically require restraint, seclusion, or involuntary commitment
Which finding is associated with mild anxiety?
A. Hallucinations
B. Extremely limited attention span
C. Increased awareness and learning
D. Inability to communicate effectively
Answer: C. Increased awareness and learning
Rationale: Mild anxiety can sharpen the senses, increase motivation and awareness, and enhance learning.
What primarily drives the obsessions and compulsions associated with OCD?
A. Euphoria
B. Anxiety and fear
C. Hallucinations
D. Mania
Answer: B. Anxiety and fear
Rationale: Obsessions are intrusive thoughts or images that create anxiety. Compulsions are performed to reduce that anxiety or prevent a feared consequence.
Which finding is most characteristic of mania?
A. Increased need for sleep
B. Slow speech
C. Decreased need for sleep
D. Social withdrawal
Answer: C. Decreased need for sleep
Rationale: Mania can include decreased need for sleep, pressured speech, flight of ideas, distractibility, increased activity, poor judgment, impulsivity, and grandiosity.
A client prescribed an MAOI asks which food should be avoided. Which choice requires further teaching?
A. Cottage cheese
B. Fresh chicken
C. Pepperoni
D. Processed cheese slices
Answer: C. Pepperoni
Rationale: Pepperoni is an aged meat and is listed as a food to avoid with MAOIs because tyramine-containing foods can contribute to a hypertensive crisis.
Which situation is an example of false imprisonment?
A. Allowing a client to refuse medication
B. Inappropriately restraining a psychiatric client
C. Providing a quiet room
D. Encouraging a client to participate in therapy
Answer: B. Inappropriately restraining a psychiatric client
Rationale: False imprisonment is the unjustifiable detention of a client. Inappropriate restraint or seclusion can constitute false imprisonment.
A client experiencing panic-level anxiety is unable to focus and is misperceiving the environment. What is the nurse's priority intervention?
A. Leave the client alone
B. Provide detailed instructions
C. Remain with the client and ensure safety
D. Ask the client to complete paperwork
Answer: C. Remain with the client and ensure safety
Rationale: Panic-level anxiety can involve extreme dread, inability to focus, misperceptions, ineffective communication, and potentially life-threatening effects if prolonged. The nurse should remain with the client, ensure safety, decrease stimuli, and use simple statements.
Which nursing intervention is appropriate for a client who performs OCD rituals?
A. Tell the client to stop immediately
B. Shame the client for the behavior
C. Gradually decrease the amount of time spent performing rituals
D. Prevent all rituals immediately
Answer: C. Gradually decrease the amount of time spent performing rituals
Rationale: The nurse should provide support and gradually help decrease ritual time. Exposure and response prevention may also be used when the client is willing.
Which patient meets the study-guide description of Bipolar I disorder?
A. A client with hypomania and major depressive episodes
B. A client with mild depression and mild hypomania for 2 years
C. A client with at least one manic episode lasting at least 1 week
D. A client with anxiety lasting 6 months
Answer: C. A client with at least one manic episode lasting at least 1 week
Rationale: Bipolar I is characterized by at least one manic episode lasting at least 1 week or requiring hospitalization.
A client taking an SSRI asks when they should expect symptom improvement. What is the best response?
A. Within several hours
B. Within 1–2 days
C. Within 2–3 weeks
D. After 3–6 months
Answer: C. Within 2–3 weeks
Rationale: The study guide states that SSRIs typically take 2–3 weeks to become effective and reduce symptoms.
A client is escalating and becoming verbally aggressive. Which nursing action is most appropriate?
A. Argue with the client
B. Speak loudly to gain control
C. Use short, clear statements in a calm voice
D. Stand very close to the client
Answer: C. Use short, clear statements in a calm voice
Rationale: During de-escalation, the nurse should use a calm, nonthreatening approach, maintain personal space, and use short, simple statements.
Which statement by a client taking lorazepam indicates a need for further teaching?
A. “I should avoid alcohol.”
B. “I should not stop the medication abruptly.”
C. “I can drive immediately after taking it.”
D. “I should take it only as prescribed.”
Answer: C. “I can drive immediately after taking it.”
Rationale: Lorazepam can cause dizziness, clumsiness, and sedation. Clients should take precautions and should not plan to drive after taking the medication.
A client says, “The television announcer is sending me secret messages.” Which alteration does this demonstrate?
A. Echolalia
B. Word salad
C. Ideas of reference
D. Associative looseness
Answer: C. Ideas of reference
Rationale: Ideas of reference occur when a person believes outside events or circumstances have special meaning specifically related to them.
A manic client is hypersexual and attempting to approach other patients inappropriately. What should the nurse do?
A. Ignore the behavior
B. Laugh with the client
C. Set clear limits and redirect the client
D. Punish the client
Answer: C. Set clear limits and redirect the client
Rationale: The nurse should use a calm, firm, nonjudgmental approach, set clear limits, state expected behavior, and redirect the client to an appropriate activity.
Which finding in a client taking lithium is most concerning for toxicity?
A. Mild thirst
B. Severe diarrhea and vomiting
C. Increased appetite
D. Mild headache
Answer: B. Severe diarrhea and vomiting
Rationale: A lithium level above 1.5 mEq/L is usually considered toxic. Severe diarrhea and vomiting are signs of lithium toxicity, and lithium should be discontinued when toxic signs occur.
A client becomes physically aggressive and presents an immediate danger to others. Less restrictive interventions have failed. What is the priority?
A. Allow the client to continue expressing anger
B. Ensure safety using appropriate emergency interventions
C. Leave the client alone
D. Lecture the client about their behavior
Answer: B. Ensure safety using appropriate emergency interventions
Rationale: During the crisis phase, the client is physically aggressive and safety becomes the priority. Restraint or seclusion may be used when the client is imminently dangerous and less restrictive measures have failed.
A client develops symptoms 2 weeks after experiencing a traumatic event. Which disorder is most consistent with this timing?
A. PTSD
B. Acute stress disorder
C. Generalized anxiety disorder
D. Adjustment disorder
Answer: B. Acute stress disorder
Rationale: According to the study guide, ASD occurs 3 days to 1 month after trauma. PTSD symptoms occur 3 months or more after trauma.
A client reports hearing voices telling them to harm another person. What should the nurse do FIRST?
A. Tell the client the voices are not real
B. Ignore the hallucination
C. Assess what the voices are commanding the client to do and maintain safety
D. Tell the client to stop listening to the voices
Answer: C. Assess what the voices are commanding the client to do and maintain safety
Rationale: Command hallucinations require assessment of what the voices are telling the client to do, followed by appropriate safety measures. The nurse should not argue with or reinforce the hallucination.
Which statement by a client newly prescribed lithium indicates correct understanding?
A. “I should drastically reduce my salt intake.”
B. “I should keep my salt intake consistent every day.”
C. “I should stop drinking fluids.”
D. “I can stop lithium once I feel better.”
Answer: B. “I should keep my salt intake consistent every day.”
Rationale: Clients taking lithium should maintain adequate fluid intake and keep salt intake consistent. Sudden changes in salt or caffeine intake can affect lithium therapy.
A client taking an antipsychotic develops repetitive tongue thrusting, lip smacking, and grimacing. Which condition does the nurse suspect?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Pseudoparkinsonism
Answer: C. Tardive dyskinesia
Rationale: Tardive dyskinesia causes involuntary repetitive movements such as tongue thrusting, lip smacking, blinking, and grimacing. It can become irreversible.
After a restrained client regains behavioral control, which action should the nurse take?
A. Lecture the client about the behavior
B. Keep the client restrained for the remainder of the shift
C. Remove the restraint when behavioral criteria are met
D. Avoid discussing the event
Answer: C. Remove the restraint when behavioral criteria are met
Rationale: During the postcrisis phase, restraint or seclusion should be discontinued as soon as behavioral criteria are met. The nurse should discuss the event calmly and help the client identify alternatives to aggression.
A client with PTSD is experiencing a dissociative response. Which intervention is appropriate?
A. Encourage isolation
B. Use grounding techniques
C. Tell the client to forget the trauma
D. Avoid discussing emotions
Answer: B. Use grounding techniques
Rationale: Grounding techniques can help the client cope with stress and emotions and reduce dissociative responses. A safe and supportive environment is also important.
A client receiving an antipsychotic suddenly develops upward rolling of the eyes. Which medication should the nurse anticipate administering?
A. Lithium
B. Diphenhydramine
C. Sertraline
D. Buspirone
Answer: B. Diphenhydramine
Rationale: An oculogyric crisis is an acute dystonic reaction and an EPS caused by antipsychotic medication. Acute treatment includes IM/IV diphenhydramine or IM benztropine.
A client's lithium level is 1.8 mEq/L. Which action should the nurse anticipate?
A. Administer the next dose as scheduled
B. Increase the lithium dose
C. Recognize the level as toxic and discontinue lithium
D. Tell the client the level is therapeutic
Answer: C. Recognize the level as toxic and discontinue lithium
Rationale: The study guide identifies lithium levels above 1.5 mEq/L as usually toxic. When toxic signs occur, lithium should be discontinued and the client monitored for worsening toxicity.