Depression
A patient with major depressive disorder states, “Nothing matters anymore.” What is the nurse’s priority action?
A. Encourage journaling
B. Assess for suicidal ideation
C. Ask the patient to join a group activity
D. Offer reassurance
Answer: B
Rationale: Feelings of hopelessness may indicate suicide risk—safety assessment is priority.
Which symptom is most characteristic of mania?
A. Hypersomnia
B. Grandiose thinking
C. Social withdrawal
D. Slow speech
Answer: B
Rationale: Grandiosity is a hallmark symptom of mania.
Which assessment finding is priority in anorexia nervosa?
A. Lanugo
B. Constipation
C. Bradycardia
D. Rigid exercise routines
Answer: C
Rationale: Bradycardia indicates cardiovascular instability.
Which laboratory test would the nurse anticipate being prescribed to determine whether a patient has recently used a substance?
A. Urinalysis
B. Hair toxicology
C. Stool Specimen
D. Sputum Sample
Answer: A
Rationale: Urinalysis often provides objective measure of recent drug use. Hari toxicology determines long-term use and costs more than other methods of detection. A stool specimen and sputum specimen sample are not identified as lab tests to determine recent use of substance.
A patient on MAOIs should avoid which food?
A. Fresh apples
B. Aged cheese
C. Lettuce
D. Chicken breast
Answer: B
Rationale: Tyramine-rich foods can cause hypertensive crisis.
Which symptom is considered a cardinal sign of major depressive disorder?
A. Sadness and rapid thought flow
B. Hopelessness and isolation
C. Tactile hallucinations
D. Euphoric mood
Answer: B
Rationale: Persistent hopelessness and withdrawal are classic markers of depression
The priority outcome for a manic patient is:
A. Sleep 4–6 hours per night
B. Attend group therapy
C. Maintain hydration and nutrition
D. Reduce inappropriate behaviors
Answer: C
Rationale: Physiological stability is the immediate priority.
What is the key nursing intervention for a patient with bulimia during meals:
A. Allow privacy while eating
B. Observe for 1–2 hours after meals
C. Encourage restrictive eating
D. Never discuss food
Answer: B
Rationale: Bulimia patients may purge after meals.
Wernicke-Korsakoff syndrome is caused by deficiency in:
A. Vitamin C
B. Vitamin B1 (thiamine)
C. Vitamin D
D. Folate
Answer: B
Rationale: Chronic alcohol use depletes thiamine.
Which Medication can cause mania?
A. Lithium
B. Lamictal
C. Levodapa
D. Depakote
Answer: C
Rationale: Medications that can cause Mania are Steroids, Antidepressants, anticholinergics, stimulants, and Levodapa
A patient taking sertraline reports new restlessness and inability to sit still. The nurse suspects:
A. Akathisia
B. Tardive dyskinesia
C. Serotonin syndrome
D. Lithium toxicity
Answer: A
Rationale: SSRIs may cause akathisia, presenting as motor restlessness.
Which lab must be monitored for a patient on lithium?
A. ALT
B. Platelets
C. Sodium
D. Magnesium
Answer: C
Rationale: Sodium levels affect lithium excretion and toxicity.
Refeeding syndrome is characterized by:
A. Hyperkalemia
B. Fluid overload and electrolyte shifts
C. Tachycardia
D. Metabolic acidosis
Answer: B
What is your priority in a suspected opioid overdose?
A. Give activated charcoal
B. Administer naloxone
C. Force fluids
D. Provide restraints
Answer: B
Rationale: Naloxone reverses respiratory depression.
Patient presents to the office with mild hand tremors after starting Lithium. What would be the nurses best response?
A. "You need to stop the medication"
B. "It is normal to have some mild tremors, it should get better the longer you take it"
C. "We should check your levels"
D. "Lets try an increase in your dose"
Answer: B
Mild tremors are normal and may go away with time. If the tremors persist or worsen it is important to evaluate levels
A depressed patient says, “I’m a burden to everyone.” What is the best therapeutic response?
A. “You shouldn’t think that way.”
B. “Why do you feel like a burden?”
C. “Tell me more about what makes you feel this way.”
D. “Things will get better soon.”
Answer: C
Rationale: Encourages expression without minimizing feelings.
Which patient statement shows insight into bipolar disorder?
A. “I don’t need medication when I feel good.”
B. “My mania helps me get things done.”
C. “Sleep changes are a warning sign for me.”
D. “I only need therapy, not meds.”
Answer: C
Rationale: Recognizing early warning signs is key to relapse prevention.
A patient with binge-eating disorder is likely to present with:
A. Underweight
B. Normal or overweight body weight
C. Lanugo
D. Muscle wasting
Answer: B
Withdrawal from which substance is life-threatening?
A. Cannabis
B. Cocaine
C. Alcohol
D. LSD
Answer: C
Rationale: Alcohol withdrawal can cause seizures and DTs.
The home health nurse visits a client at home and determines that the client is dependent on drugs. During the assessment, which action would the nurse take to plan appropriate nursing care?
A. Ask the client why they started taking illegal drugs
B. Ask the client about the amount of drug use and its effect
C. Ask the client how long they thought that they could take drugs without someone finding out
D. Not ask any questions for fear that the client is in denial and will throw the nurse out of the home.
Answer B
Rationale: Whenever the nurse carries out an assessment for a client who is dependent on drugs, it is best for the nurse to attempt to elicit information by being nonjudgmental and direct. Option 1 is incorrect because it is judgmental and off-focus, and reflects the nurse's bias. Option 3 is incorrect because it is judgmental, insensitive, and aggressive, which is nontherapeutic. Option 4 is incorrect because it indicates passivity on the nurse's part and uses rationalization to avoid the therapeutic nursing intervention.
A patient with major depressive disorder has recently started an SSRI. Today, the patient appears more groomed, is making eye contact, and says, “I finally feel like I know what I need to do.” What is the nurse’s priority action?
A. Ask the patient to describe their plan moving forward
B. Document the improvement as medication effectiveness
C. Encourage the patient to join the afternoon group activity
D. Praise the patient for their positive attitude
Correct Answer: A
Rationale:
Increased energy shortly after starting an SSRI may allow a previously hopeless patient to act on suicidal thoughts. “I know what I need to do” is a veiled warning sign. The nurse must directly assess for plan, intent, and means before assuming improvement.
A patient with Bipolar I Disorder is in the early stages of treatment with lithium. During morning rounds, the patient states,
"I didn’t sleep at all, but I feel amazing. In fact, I doubled my lithium dose last night so it would start working faster."
The patient is pacing rapidly around the unit.
Which action should the nurse take first?
A. Draw a stat lithium level
B. Instruct the patient to drink extra fluids
C. Notify the provider about possible lithium toxicity
D. Assess the patient for signs of neurological or cardiac instability
Correct Answer: D
Rationale: Priority is rapid assessment of immediate physiological danger. Lithium toxicity can rapidly cause Ataxia, Tremors, Confusion, Arrhythmias, seizures
Before labs, calls, or fluids the nurse must assess for current instability to determine urgency and prevent a medical emergency.
A patient with anorexia nervosa has begun nutritional rehabilitation. On day 2, their labs show:
Potassium 3.0 mEq/L (normal 3.6-5.2mEq/L)
Phosphate 1.9 mg/dL (normal 2.5 to 4.5 mg/dL)
Magnesium 1.4 mg/dL (normal 1.7 and 2.2 mg/dL)
The patient says they “feel fine.” What is the nurse’s priority action?
A. Continue feedings and recheck labs in the morning
B. Notify the provider immediately and slow the refeeding rate
C. Encourage the patient to increase oral fluid intake
D. Administer PRN lorazepam for anxiety
Correct Answer: B
Rationale:
Low phosphate, potassium, and magnesium signal refeeding syndrome, a life-threatening shift leading to arrhythmias and respiratory failure. Priority: slow refeeding and correct electrolytes immediately.
A patient with severe alcohol use disorder is on CIWA monitoring. Four hours after admission, the patient becomes diaphoretic, has a BP of 168/98, HR 124, tremors, and reports “seeing bugs on the walls.” What action is the nurse’s priority?
A. Reorient the patient to reality
B. Administer the prescribed benzodiazepine dose
C. Increase environmental lighting
D. Notify security to assist with agitation
Correct Answer: B
Rationale:
Visual hallucinations + autonomic hyperactivity indicate impending delirium tremens, a medical emergency. Benzodiazepines prevent seizures and stabilize withdrawal; this is the priority intervention.
Robert works overnight road construction. He was recently place on lithium carbonate for bipolar disorder. In his job, during the summer, he sweats heavily because of high outside temperatures and the amount of effort it takes to do road construction. What dietary practice should Robert use on a night when he is sweating heavily?
A. Carry glucose tablets for emergencies
B. Drink electrolyte supplement
C. Increase salt intake
D. Restrict salt intake
Answer: C
rationale: Normally, while taking lithium carbonate the patient is to reduce his intake of salt. If the individual is sweating heavily, it is important to increase his intake of salt during that time.