MISC.
A widow states, “I miss him so much. I cry every evening, but my sister came over yesterday and for a little while I actually laughed.” Which finding best supports normal grief rather than MDD?
A. Sleep disturbance
B. Ability to experience pleasure intermittently
C. Poor concentration
D. Decreased appetite
Answer: B
Rationale: In normal grief, the person can still have brief moments of pleasure and their self-esteem remains intact. Sleep/appetite/concentration changes can occur in both grief and MDD.
Which findings suggest maladaptive grief? (Select all that apply)
A. Self-esteem remains intact
B. Persistent dysphoria and anhedonia
C. Not responsive to comfort/support
D. Relates depressive feelings clearly to the loss
E. Chronic physical complaints without connecting them to grief
F. Openly expresses anger about the loss
Answer: B, C, E
Rationale: Maladaptive = disturbed self-esteem, persistent dysphoria, anhedonia, not responsive to support, chronic physical complaints, and does NOT relate feelings to the loss.
During ECT prep, the nurse inflates a BP cuff on the lower leg above SBP before the muscle relaxant. What is the purpose?
A. Prevent DVT
B. Reduce post-ECT headache
C. Allow monitoring of seizure activity in an unaffected limb
D. Prevent aspiration
Answer: C
Rationale: Cuff prevents relaxant from reaching that limb, allowing visible seizure monitoring.
A patient with bipolar disorder is prescribed an SSRI without a mood stabilizer. The nurse’s best concern is:
A. It will cause serotonin syndrome in all patients
B. It can trigger mania or rapid cycling
C. It will immediately cure depression
D. It is contraindicated only in older adults
Answer: B
Rationale: Your notes: antidepressant alone in bipolar can bring on mania; typically combined with mood stabilizer.
A client with depression and psychomotor retardation is prescribed an SSRI. The provider wants a medication more likely to be activating rather than sedating.
Which SSRI best matches that?
A. Paroxetine
B. Fluoxetine
C. Sertraline
D. Citalopram
Answer: B — Fluoxetine
Rationale: Your notes: some SSRIs are more activating (fluoxetine) and some more sedating (paroxetine). NCLEX trap is picking based on personal assumptions rather than the specific note.
A client is 8 months after a spouse’s death and reports: “I avoid his clothes and pictures. I drink every night. Nothing matters anymore.” What is the nurse’s best interpretation?
A. Normal grief—time alone will resolve it
B. Maladaptive grief with high-risk features
C. Typical anniversary reaction
D. Denial stage of grief
Answer: B
Rationale: Red flags include avoidance of reminders, substance misuse, meaninglessness, and potential suicidal risk. Anniversary reaction is typically around the date of loss (timing cue) and doesn’t automatically include these dangerous features.
A patient reports depressed mood, insomnia, fatigue, poor concentration, and guilt for 10 days. Which is the best conclusion?
A. Meets criteria for MDD
B. Does not meet MDD duration requirement yet
C. Meets criteria for persistent depressive disorder
D. Meets criteria for cyclothymia
Answer: B
Rationale: MDD requires ≥2 weeks (and 5+ symptoms with either depressed mood or anhedonia).
Which action is highest priority before ECT?
A. Offer the patient breakfast to prevent hypoglycemia
B. Verify informed consent and keep NPO 6–8 hours
C. Encourage the patient to void after the procedure
D. Provide PRN analgesics for expected pain
Answer: B
Rationale: Pre-op safety: consent + NPO reduce aspiration risk; essential before procedure.
A manic client is loud, intrusive, and escalating. Which nursing action is best?
A. Encourage group therapy for social skills immediately
B. Provide low-stimulus structured environment and firm concise limits
C. Offer detailed explanations to improve insight
D. Confront manipulation and argue facts until they agree
Answer: B
Rationale: Mania → low stimuli, structure, frequent observation, calm/firm concise communication, set limits (don’t bargain/argue).
A client abruptly stops taking paroxetine. Two days later they report “flu-like symptoms,” dizziness, irritability, and “brain zaps.”
Best nursing response?
A. “Restart at the full dose and stop again tomorrow.”
B. “These symptoms mean the medication was toxic.”
C. “Do not stop suddenly—SSRIs should be tapered. Notify the provider.”
D. “This indicates serotonin syndrome.”
Answer: C
Rationale: Your notes: SSRIs must be tapered slowly to prevent discontinuation syndrome.
Trap: Confusing discontinuation with serotonin syndrome (toxicity has hyperreflexia, fever, autonomic instability, etc.).
A client says, “My ex died. We were together for 12 years but no one thinks I should be upset.” Which type of grief is this?
A. Anticipatory grief
B. Disenfranchised grief
C. Maladaptive grief
D. Bowlby—reorganization stage
Answer: B
Rationale: Disenfranchised grief = the loss isn’t socially recognized as “valid” (relationship not acknowledged/accepted).
Which scenario best fits persistent depressive disorder?
A. 3 weeks of severe anhedonia and suicidal thoughts
B. 18 months of depressed mood with poor appetite and low energy
C. 2+ years of depressed mood with low self-esteem and hopelessness most days
D. 4 days of euphoric mood with reduced sleep and increased productivity
Answer: C
Rationale: PDD = chronically depressed mood more days than not for ≥2 years (adults) + 2+ associated symptoms (e.g., low self-esteem, hopelessness, sleep/appetite changes, fatigue, poor concentration).
A client on sertraline starts tramadol for pain. Within hours they develop agitation, diaphoresis, diarrhea, fever, hyperreflexia, and tremor. What is the priority nursing action?
A. Reassure this is expected SSRI start-up jitteriness
B. Hold serotonergic agents and notify provider immediately
C. Give a benzodiazepine and discharge home
D. Encourage high-tyramine foods to stabilize BP
Answer: B
Rationale: This is serotonin syndrome: rapid onset + mental status changes + autonomic instability + neuromuscular hyperactivity + GI symptoms. First step: remove offending agent and urgent treatment.
In anorexia nervosa treatment, which statement best reflects appropriate nursing focus?
A. “We will discuss calories and weight at every meal.”
B. “Once the meal plan is set, we’ll focus more on emotions and coping—not food talk.”
C. “If you refuse to eat, we will remove all privileges permanently.”
D. “You should weigh yourself daily to build insight.”
Answer: B
Rationale: Notes: DO NOT focus on food once protocol established; focus on emotional issues and coping. Structure exists, but avoid reinforcing obsession with food/weight.
A client is taking sertraline. After starting tramadol, they develop fever, tachycardia, diaphoresis, diarrhea, and hyperreflexia with tremor.
What is the best interpretation?
A. Expected SSRI startup effects
B. Serotonin syndrome
C. Hypertensive crisis
D. Neuroleptic malignant syndrome
Answer: B — Serotonin syndrome
Rationale: The combo of mental status/autonomic instability + GI + neuromuscular hyperactivity (hyperreflexia, tremor, myoclonus) is classic serotonin syndrome.
Trap: NMS has lead-pipe rigidity and dopamine blockade context (antipsychotics).
A family is “moving through grief” quickly before a loved one dies and is already discussing life “after he’s gone.” Which nurse statement best reflects your notes?
A. “This is healthy and prevents depression later.”
B. “This can sometimes leave the dying person feeling isolated.”
C. “This shows the family is in denial.”
D. “This indicates maladaptive grief.”
Answer: B
Rationale: Your notes: moving too quickly can make the dying person feel lonely/isolated, and anticipatory grief may include detachment from the dying person.
A severely depressed patient suddenly becomes more energetic, starts giving away belongings, and says, “Don’t worry about me anymore.” What is the best nursing interpretation?
A. Treatment is working; risk is decreasing
B. Increased suicide risk due to energy returning
C. Normal grief response
D. Hypomania
Answer: B
Rationale: Your notes: antidepressants may increase energy before mood, making it easier to carry out a plan. Sudden behavior changes + indirect threats = red flag.
A patient taking phenelzine reports severe occipital headache, palpitations, sweating, and markedly elevated BP after eating wine and aged cheese. Best interpretation?
A. Serotonin syndrome
B. Hypertensive crisis from tyramine interaction
C. Discontinuation syndrome
D. Neuroleptic malignant syndrome
Answer: B
Rationale: MAOI + tyramine → hypertensive crisis (severe headache, HTN, palpitations, sweating, possible chest pain/coma).
Which medication is FDA approved for bulimia nervosa in adults per your notes?
A. Bupropion
B. Fluoxetine
C. Lithium
D. Phenelzine
Answer: B
Rationale: Fluoxetine is the approved medication; bupropion is a major safety issue in eating disorders.
A client taking phenelzine asks what to avoid. Which statement shows correct understanding?
A. “I can use OTC cold meds if I check my BP.”
B. “I should avoid aged cheeses and wine.”
C. “Chocolate and beer are always safe in moderation.”
D. “If I feel a severe headache, I’ll wait it out.”
Answer: B
Rationale: Your notes: MAOIs + high tyramine foods (aged cheese, wine, pickles, smoked/processed meats, overripe/fermented foods) can trigger hypertensive crisis. Cold meds/diet pills can worsen HTN too. Severe occipital headache = emergency.
Which statement best aligns with Bowlby?
A. Grief occurs in fixed stages that never overlap
B. Grief is rooted in childhood attachment and is a response to separation
C. Grief is primarily biological and neurotransmitter-driven
D. Grief ends when the person stops crying
Answer: B
Rationale: Bowlby: grief relates to separation and attachment experiences; stages are overlapping/flexible (not rigid).
A patient says, “I just can’t take it anymore.” What is the nurse’s best response?
A. “You shouldn’t feel that way.”
B. “Snap out of it—you have so much going for you.”
C. “When you feel like that, have you thought about ending your life?”
D. “Promise me you won’t do anything.”
Answer: C
Rationale: Directly assess SI. Your notes: do not judge, minimize, provoke guilt, or rely on “secrets/contracts.” Ask about thoughts and plan.
Which patient statement indicates correct understanding of lithium therapy?
A. “I’ll restrict salt to prevent swelling.”
B. “If I get diarrhea and tremors, I’ll hold the dose and call my provider.”
C. “I can take ibuprofen freely for headaches.”
D. “Dehydration won’t affect my lithium level.”
Answer: B
Rationale: Toxicity signs include GI upset, tremor, lethargy. Lithium level rises with dehydration and low sodium; teaching includes steady sodium intake, avoid dehydration, monitor levels.
Which patient should NOT receive bupropion?
A. Major depression with low libido
B. Seasonal affective disorder
C. Bulimia nervosa with binge/purge behaviors
D. Smoking cessation request
Answer: C
Rationale: Your notes: DO NOT GIVE bupropion in eating disorders due to seizure risk.
A patient on lithium asks when blood should be drawn for a lithium level.
Best answer?
A. “Right after you take the dose.”
B. “12 hours after your last dose.”
C. “Any time of day is fine.”
D. “Only when you feel tremors.”
Answer: B
Rationale: Your notes: lithium blood levels should be drawn 12 hours after the last dose.
Trap: timing matters a lot because of the narrow therapeutic window.