Psychology Capstone - Mental Health Exam Question

1. An 18-year-old referred to the mental health center often cooks gourmet meals but eats only tiny portions. The patient wears layers of loose clothing saying, “I like the style.” The patient’s weight dropped from 130 to 95 pounds. She has amenorrhea. Which diagnosis is most likely? • A. Eating disorder not otherwise specified • B. Anorexia nervosa • C. Bulimia nervosa • D. Binge eating 2. Disturbed body image is the nursing diagnosis for a patient with an eating disorder. Which outcome indicator is most applicable to this diagnosis? • A. Weight, muscle, and fat congruence with height, frame, age, and sex • B. Calorie intake within required parameters of treatment plan • C. Weight at established normal range for the patient • D. Patient satisfaction with body appearance 3. A patient referred to the eating disorders clinic lost 35 pounds over 3 months. To assess eating patterns, the nurse should ask: • A. “Do you often feel fat?” • B. “Who plans the family meals?” • C. “What do you eat in a typical day?” • D. “What do you think about your present weight? 4. A history reveals that a patient virtually stopped eating 5 months ago and lost 25% of body weight. The nurse says, “Describe what you think about your present weight and how you look.” Which response would be most consistent with anorexia nervosa? • A. I’m fat and ugly.” • B. “What I think about myself is my business.” • C. “I’m grossly underweight, but I cover it well.” • D. “I’m a few pounds overweight, but I can live with it.” 5. A patient has anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is 2.7 mg/dL. Which nursing diagnosis applies? • A. Adult failure to thrive related to abuse of laxatives, as evidenced by electrolyte imbalances and • B. Ineffective health maintenance related to self-induced vomiting, as evidenced by swollen parotid glands and hyperkalemia • C. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake, as evidenced by weight loss and hyperkalemia • D. Imbalanced nutrition: less than body requirements related to refusal to eat, as evidenced by loss of 25% of body weight and hypokalemia 6. 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: • A. Gain 1 to 2 pounds. • B. Exercise 1 hour daily. • C. Take a laxative every 3 days. • D. Weigh self accurately using balanced scales. 7. Therapeutic nutrition begins for a patient with anorexia nervosa who is 70% of ideal body weight. Which nursing intervention is most important to add to the plan of care? • A. Communicate empathy for the patient’s feelings. • B. Observe for adverse effects associated with refeeding. • C. Teach patient about psychological origins of the disorder. • D. Direct the patient to balance energy expenditure and caloric intake. 8. A patient with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures to produce a specified weekly weight gain • A. Severe anxiety concerning eating is expected, so objective and subjective data must be routinely collected. • B. Patient involvement in decision making increases sense of control and promotes adherence. • C. Because of risks of physical problems from refeeding, the patient’s consent is essential. • D. A team approach to treatment planning ensures that physical and emotional needs are met. 9. A nurse monitors a patient with anorexia nervosa for complications of refeeding. Which assessment is most important? • A. Pupillary reaction to light • B. Temperature measurements • C. Reports of serum electrolytes • D. Complaints of sleep disturbances 10. A psychiatric clinical nurse specialist uses cognitive therapy with a patient with anorexia nervosa. Which statement by the nurse supports this type of therapy? • A. “What are your feelings about not eating foods you prepare?” • B. “You seem to feel much better about yourself when you eat something.” • C. “It must be difficult to talk about private matters to someone you just met.” • D. “Being thin doesn’t seem to solve problems. You’re thin now but still unhappy 11. A student transfers from a hometown college to a university 200 miles away after breaking up with her boyfriend of 2 years. She was slow to make friends at the university. The history shows a close relationship with her mother and sister. She began eating large quantities when she felt sad, and then she induced vomiting. When the student’s schoolwork declined, she sought help from the university health clinic. During the initial interview, what priority issue should the nurse address? • A. Losses • B. Sleep patterns • C. School activities • D. Menstrual flow 12. What behavior signals that a nurse caring for a patient with bulimia nervosa is experiencing rescue feelings? The nurse: • A. Makes nonjudgmental comments. • B. Refers the patient to a self-help group for persons with eating disorders. • C. Teaches the patient about signs of increased anxiety and ways to intervene. • D. Determines the patient has poor eating habits and provides a diet to follow. 13. A nursing diagnosis for a patient with bulimia nervosa is Ineffective coping related to feelings of loneliness and isolation, as evidenced by use of overeating and self-induced vomiting to comfort self. Select the best outcome related to this diagnosis. Within 2 weeks, the patient will: • A. Appropriately express angry feelings. • B. Verbalize two positive things about self. • C. Verbalize the importance of eating a balanced diet. • D. Identify two alternative methods of coping with loneliness and isolation. 14. Which nursing intervention has highest priority for a patient with bulimia nervosa? • A. Assist the patient to identify triggers to binge eating. • B. Provide remedial consequences for weight loss. • C. Assess for signs of impulsive eating. • D. Explore needs for health teaching. 15. One bed is available on the eating disorders unit. Which patient should be admitted? The patient whose assessment findings show the weight dropped from: • A. 150 to 102 pounds over a 4-month period. Vital signs: temperature, 96.1° F; pulse, 38 beats/min; blood pressure 64/42 mm Hg. • B. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 97.2° F; pulse, 50 beats/min; blood pressure 70/50 mm Hg. • C. 110 to 70 pounds over a 4-month period. Vital signs: temperature 97.6° F; pulse, 60 beats/min; blood pressure 80/66 mm Hg. • D. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 98.6° F; pulse, 62 beats/min; blood pressure 74/48 mm Hg. 16. A patient has recently been under significant stress and worked long hours. At home, the patient watches television and eats until going to bed. The patient is too tired to exercise and has gained 25 pounds in 1 month. A desired outcome for the patient is to recognize anxiety that precedes binge eating and reduce it. Which intervention addresses the outcome • A. Teach stress-reduction techniques such as relaxation and imagery. • B. Encourage the patient to design and implement an exercise program. • C. Explore ways in which the patient may feel more in control of the environment. • D. Encourage the patient to attend a support group such as Overeaters Anonymous. 17. A patient’s body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet 4 inches tall. Which term should be documented? • A. Amenorrhea • B. Alopecia • C. Lanugo • D. Stupor 18. A patient admitted to the eating disorders unit has yellow skin, the extremities are cold, and the heart rate is 42 bpm. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet during the assessment saying only, “I will not eat until I lose enough weight to look thin.” Select the best initial nursing diagnosis. • A. Anxiety related to fear of weight gain • B. Disturbed body image related to weight loss • C. Ineffective coping related to lack of conflict resolution skills • D. Imbalanced nutrition: less than body requirements related to self-starvation 19. A nurse conducts group therapy on the eating disorders unit. Sessions are scheduled immediately after meals. What is the rationale? • A. Provide a forum for journaling about foods eaten. • B. Shift the patients’ focus from food to psychotherapy. • C. Promote processing of anxiety associated with eating. • D. Focus on weight control mechanisms and food preparation. 20. Which assessment finding is most associated with bulimia nervosa? • A. Prominent parotid glands • B. Peripheral edema • C. Thin, brittle hair • D. Amenorrhea 21. Which personality characteristic is most likely in a patient with anorexia nervosa? • A. Open displays of emotion • B. Perfectionism • C. Optimism • D. Flexibility 22. Which finding for a patient with an eating disorder most clearly indicates the need for hospitalization? • A. Weight 15% below ideal weight • B. Urine output less than 30 mL/hr • C. Serum potassium 3.4 mEq/L • D. Pulse rate 54 beats/min 23. Which statement is most likely from a patient with anorexia nervosa? • A. Im fat and ugly • B. I have nice eyes • C. Im thin for my height • D. My mom hates me 24. Which nursing diagnosis is more relevant for a patient with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient with bulimia nervosa who purges? • A. Powerlessness • B. Ineffective coping • C. Disturbed body image • D. Imbalanced nutrition: less than body requirements 25. Which theme is most likely during family therapy with parents, siblings, and a teen patient with anorexia nervosa who engages in provocative behavior? • A. Stable coalitions between family members • B. Interpreting negative messages as positive • C. Competition between the patient and father • D. Lack of trust in the patient by family members 26. A nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Select the nurse’s best comment. • A. It bothers me to see you exercising.” • B. “You and I will have to sit down and discuss this problem.” • C. “Let’s discuss the relationship between exercise and weight loss and how that affects your body.” • D. “According to our agreement, exercising is not permitted until you have gained a specific amount of weight.” 27. Which statement by a patient with an eating disorder reflects a correct understanding of the condition? • A. “Gaining 1 pound is as much of a disaster as gaining 100 pounds.” • B. “I was happy when I was a size 4, so I must diet to that size.” • C. “I’ve been coping with my feelings by overeating.” • D. “Binging is the only way I can soothe myself.” 28. A patient with anorexia nervosa in outpatient treatment has begun refeeding. Between the first and second appointment, the patient gained 8 pounds. The nurse should: • A. Praise the weight gain. • B. Assess lung sounds and extremities. • C. Suggest implementation of an exercise program. • D. Establish a higher target for weight gain for the next week. 29. When teaching a patient with binge-purge bulimia, the nurse should give priority to information about: • A. Self-monitoring of daily food and fluid intake. • B. Establishing the desired daily weight gain. • C. Symptoms of hypokalemia. • D. Self-esteem maintenance • A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain? • A. Hippocampus • B. Frontal lobe • C. Cerebellum • D. Brainstem A patient has acute anxiety related to an automobile accident 2 hours ago. The patient needs teaching about drugs from which group? • A. Tricyclic antidepressants • B. Antipsychotic drugs • C. Antimanic drugs • D. Benzodiazepines • A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about: • A. Chlordiazepoxide (Librium). • B. Clozapine (Clozaril). • C. Sertraline (Zoloft). • D. Tacrine (Cognex). • A drug causes muscarinic receptor blockade. The nurse will assess the patient for • A. Dry mouth. • B. Gynecomastia. • C. Pseudoparkinsonism. • D. Orthostatic hypotension. • A patient tells the nurse, “My doctor prescribed Paxil (paroxetine) for my depression. I assume I’ll have side effects like I had when I was taking Tofranil (imipramine).” The nurse’s reply should be based on the knowledge that paroxetine is a: • A. Selective norepinephrine reuptake inhibitor. • B. Tricyclic antidepressant. • C. MAO inhibitor. • D. SSRI • A nurse can anticipate anticholinergic side effects are likely when a patient takes: • A. Lithium (Lithobid). • B. Buspirone (BuSpar). • C. Risperidone (Risperdal). • D. Fluphenazine (Prolixin) • Which instruction has priority when teaching a patient taking clozapine (Clozaril)? • A. “Avoid unprotected sex.” • B. “Report sore throat and fever immediately.” • C. “Reduce foods high in polyunsaturated fats.” • D. “Use over-the-counter preparations for rashes.” • A Hispanic woman comes to the mental health center at the urging of her adult children. The patient has lost 5 pounds since her husband’s death 6 months ago and says, “My husband comes to visit me in the night but I cannot understand what he says.” How should the nurse analyze this situation? The patient is: • A. Experiencing auditory and visual hallucinations. • B. At high risk for imbalanced nutrition. • C. Grieving the husband’s death. • D. Denying the husband’s death. • A woman became severely depressed when the last of her six children moved out of the home 4 months ago. Since then she has neglected to care for herself, sleeps poorly, lost weight, and repeatedly states, “No one cares about me anymore. I’m worthless.” After hospitalization, the nursing diagnosis of situational low self-esteem related to feelings of abandonment was identified. The nurse wishes to reinforce the patient's self-esteem by acknowledging the improvement in her personal appearance. She’s wearing a new dress and has combed her hair. The most appropriate remark would be: • A. “You look very nice this morning, Mrs. J.” • B. “I like the dress you’re wearing, it’s very pretty.” • C. “What brought about this glamorous transformation?” • D. “You’ve combed your hair and are wearing a new dress.” • 62. 9. A depressed patient who is taking a tricyclic antidepressant tells the nurse, “I don’t think I can keep taking these pills. They make me very dizzy, especially when I stand up.” The best nursing response is: • A. “That is annoying, but it is something most patients are able to learn to live with as time goes on. You’ll get used to the medicine’s side effects.” • B. “The medicine can slow the body’s adjustment of blood pressure when changing position; drinking more fluids and changing position slowly can help.” • C. “Compared to the problems caused by the depression, it seems like a relatively small annoyance to have to put up with.” • D. “All medicines have side effects, and this one is relatively mild. It could be that your depression is causing you to think negatively about the medicine.” • 63. 10. A depressed patient is receiving imipramine (Tofranil) 300 mg daily. Which side effect requires seeking medical attention? • A. Dry mouth • B. Blurred vision • C. Nasal congestion • D. Urinary retention • 64. 13. The priority nursing focus for the period immediately after electroconvulsive therapy treatment should be on: • A. Monitoring for the return of the capacity for full range of motion. monitoring for the return of the capacity for full range of motion. • B. Assessing the degree of accumulating memory impairment. • C. Making positive comments while the patient is more receptive. • D. Assessing the level of consciousness and normal body functions. • 65. 16. Which nursing progress note would most suggest that the treatment plan of a severely depressed and withdrawn patient has been effective? • A. “Slept 6 hours straight, sang with activity group, eager to see grandchild.” • B. “Slept 8 hours, attended craft group, ate half of lunch, denies suicidal ideation.” • C. “Slept 10 hours, personal hygiene adequate with assistance, lost one pound.” • D. “Slept 7 hours on and off, reports “food has no taste”, no self-harm noted.” • A patient being treated for major depression is the CEO of her own business. She has shown significant improvement and is about to be discharged after completing a course of 15 electroconvulsive therapy sessions. She will continue on SSRI medications. The patient has been counseled not to make a major business decision for a month. The rationale for this is that: • A. SSRIs may cause confusion in susceptible persons. • B. ECT often causes temporary memory impairment. • C. Lingering depression makes the patient incompetent. • D. The patient needs months to readjust to work pressures. 24. A nurse teaching a patient about a tyramine-restricted diet would approve a meal consisting of: • A. Mashed potatoes, ground beef patty, corn, green beans, and apple pie • B. Avocado salad, ham, creamed potatoes, asparagus, and chocolate cake • C. Noodles with cheddar cheese sauce, sausage, lettuce salad, and yeast rolls • D. Macaroni and cheese, hot dogs, banana bread, and caffeinated coffee 25. A patient who has been taking fluoxetine (Prozac) 60 mg daily for the past 6 months tells the nurse at the medication follow-up clinic that he is considering stopping the Prozac. He states his mood is fine, and now that he is living normally, his wife is concerned that he has no sex drive. Which response would be best? • A. “Without the medicine the depression will likely return; you and your wife will need to adjust to the sexual side effects.” • B. “If we switch your medication time to the morning, the sexual side effects will be worn off in time for evening sexual activity.” • C. “The problem is not likely due to the medicine. Often the depression itself, even after it improves, continues to dampen sex drive.” • D. “Without an antidepressant, the depression is more likely to reoccur, but there are other medications that do not interfere so much with sex.” 26. A patient being treated for depression has been taking 300 mg amitriptyline (Elavil) daily for nearly a year. She calls her case manager at the mental health clinic, stating she stopped taking her antidepressant 2 days ago and has developed something like the “flu,” with cold sweats, nausea, a rapid heartbeat, terrible nightmares when she sleeps, but no other symptoms. How should the nurse respond? • A. Advise her to go to the nearest emergency department for an evaluation. • B. Tell her to take two aspirin, drink plenty of fluids, and call her family doctor. • C. Explain it may be withdrawal; tell her to take one Elavil and contact her doctor. • D. Direct her to take the medicine every other day for 2 weeks, then stop. 28. A depressed patient tells the nurse, “The bad things that happen are always my fault.” How should the nurse respond to assist the patient to reframe this overgeneralization? • A. “I really doubt that one person can be blamed for all the bad things that happen.” • B. “You are being exceptionally hard on yourself when you imply you are a jinx.” • C. “What about the good things that happen; are any of those ever your fault?” • D. “Let’s look at one bad thing that happened to see if another explanation exists.” 29. A severely depressed patient with psychomotor retardation has begun activities therapy. His schedule is: 9 AM, ceramics; 10 AM, exercise group; 11 AM to noon, open; noon, lunch. The nurse creating the patient’s schedule should opt to fill the hour block from 11 AM to noon with: • A. Group therapy. • B. A rest period. • C. Reminiscence group. • D. Individual counseling. 31. A depressed patient is to have his first electroconvulsive therapy (ECT) session tomorrow morning. Which intervention would routinely be implemented in preparing the patient for treatment? • A. Explaining that 20 or more treatments will be needed • B. Advising the patient that memory loss is usually transient • C. Preparing the patient to be restrained during the procedure • D. Educating the patient about how ECT will end his depression 32. The spouse of a man being treated with sertraline (Zoloft) calls to report that he had a grand mal seizure. Prior to the seizure, he had seemed confused and his forehead felt hot. The man does not have a seizure-disorder history. Which action should the nurse direct the spouse to take? • A. Monitor the patient and notify the clinic if there are more seizures. • B. Hold all medications and call 911 for transportation to the hospital. • C. Hold tonight’s sertraline and encourage him to drink more fluids. • D. Administer an antipyretic drug to lower his fever and prevent seizures. 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? • A. Pressured speech and grandiosity • B. Hyperactivity; not eating and sleeping • C. Poor concentration and decision making • D. Insulting, provocative behavior directed at staff • 76. 4. A patient with mania has not eaten or slept for 3 days. Which nursing diagnosis has priority? • A. Risk for injury • B. Ineffective coping • C. Ineffective management of therapeutic regime • D. Imbalanced nutrition, less than body requirements A patient with bipolar disorder is hyperactive and has not slept for 3 days. Mood and behavior are labile. The patient threatens to hit another patient. Which response by the nurse is appropriate? • A. “Stop that now. No one did anything to provoke an attack by you.” • B. “If you try that again, you will be placed in seclusion immediately.” • C. “Do not hit anyone. If you are unable to control yourself, we will help you.” • D. “You know we will not let you hit anyone. Why do you continue this behavior?” A patient with bipolar disorder, mania, relapsed after discontinuing lithium. The health care provider prescribes lithium 600 mg BID and olanzapine (Zyprexa) 10 mg BID. What is the rationale for addition of olanzapine to the lithium regime? It will: • A. Minimize the side effects of lithium. • B. Bring hyperactivity under rapid control. • C. Potentiate the antimanic action of lithium. • D. Be used for long-term control of hyperactivity. 8. A patient with bipolar disorder has rapid cycles. To prepare teaching materials, the nurse anticipates which medication will be prescribed? • A. Clonidine (Catapres) • B. Phenytoin (Dilantin) • C. Carbamazepine (Tegretol) • D. Chlorpromazine (Thorazine) • 80. 9. Consider these three drugs: divalproex (Depakote), carbamazepine (Tegretol), gabapentin (Neurontin). Which drug also belongs with this group? • A. Clonazepam (Klonopin) • B. Lamotrigine (Lamictal) • C. Risperidone (Risperdal) • D. Aripiprazole (Abilify) 13. During a manic episode, a patient is hyperactive, restless, and disorganized. The patient goes to the dining room and begins to throw food and dishes. Verbal intervention is ineffective. The patient’s behavior poses a substantial risk of harm to others. Staff escorts the patient to the patient’s room to dine alone. What is the rationale for this action? • A. Prevent other patients from observing the behavior. • B. Reduce environmental stimuli that negatively affect the patient. • C. Protect the patient’s biological integrity until medication takes effect. • D. Reinforce limit setting, enabling the patient to learn to follow unit rules. 18. A patient with acute mania approaches the nurse, waves a newspaper, and says, “I want the phone right now. I need to call this store while their sale is going on. I need ten dresses and four pairs of shoes.” Select the nurse’s best intervention. • A. Suggest the patient ask a friend do the shopping and bring purchases to the unit. • B. Invite the patient to sit with the nurse and look at new fashion magazines. • C. Tell the patient phone use is not allowed until self-control is improved. • D. Ask whether the patient has enough money to pay for the purchases. A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior? • A. Idea of reference • B. Delusion of infidelity • C. Auditory hallucination • D. Echolalia 3. A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation? • A. The patient is unable to face having an illness and is in denial. • B. Stigma causes the patient to refuse to admit his mental illness. • C. The illness itself is preventing the patient from realizing he is ill. • D. Command hallucinations are instructing him to deny the illness. • 105. 4. Family members of a patient newly diagnosed with paranoid schizophrenia state that they do not understand what caused the patient’s illness. The nurse’s response should be predicated on the: • A. Neurobiological-genetic model. • B. Stress model. • C. Family theory model. • D. Developmental model. • 106. 6. When a patient diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine), a conventional (first generation) antipsychotic medication, 300 mg po daily. He tells the nurse he stopped taking his pills after a few months because they made him feel like a “zombie.” What other common side effects should the nurse determine if the patient experienced? • A. Sweating, nausea, and weight gain • B. Sedation, tremor, and muscle stiffness • C. Headache, watery eyes, and runny nose • D. Mild fever, sore throat, and skin rash 8. A patient’s nursing care plan includes assessment for auditory hallucinations. Indicators that suggest the patient may be hallucinating include: • A. Aloofness, increased distractibility, and suspicion. • B. Elevated mood, hypertalkativeness, and distractibility. • C. Performing rituals and avoiding open places. • D. Darting eyes, distracted, and mumbling to self. • 9. A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which nursing intervention should receive the highest priority? • A. Conducting passive range-of-motion exercises • B. Exposing the patient to auditory and visual stimuli Exposing the patient to auditory and visual stimuli • C. Interacting with the patient as if he is responding • D. Including the patient in a variety of milieu activities 12. Police bring a 63-year-old woman to the emergency room, reporting that her behavior is disorganized and disruptive, that her speech makes little sense, and that she does not seem able to take care of herself. The woman has had elective surgeries at the hospital previously and was seen in the ER last week after a fall; records show no history of similar symptoms or mental illness. The ER physician speaks with the patient but does not examine her medically, diagnoses her with schizophrenia, and orders admission to the inpatient psychiatric unit. Which response by the nurse would be most appropriate? • A. Ask another physician with more of an interest in psychiatry to also take a look at this patient, explaining that you just want to be as thorough as possible. • B. Suggest that a psychiatric consult be requested before admitting the patient to a psychiatric unit, to validate the diagnosis and speed the initiation of medication. • C. Remind the physician that schizophrenia usually develops earlier in life, that such presentations may be caused by medical problems, and suggest a medical work-up. • D. Note that the patient’s blood pressure and respirations were elevated when she arrived, and suggest that they be evaluated before admitting the patient to the psychiatric unit. 14. A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has _________ , and the nurse should _________. • A. A dystonic reaction…administer PRN IM benztropine (Cogentin) • B. Tardive dyskinesia…seek a change in the drug or its dosage • C. Waxy flexibility…continue treatment with antipsychotic drugs • D. Akathisia…administer PRN diphenhydramine (Benadryl) PO 20. A patient has not come out of her room for breakfast. The nurse finds the patient moving restlessly about her room in a disorganized manner. The patient is talking to herself, and her verbal responses to the nurse are nonsensical and suggest disorientation. The nurse notices that the patient’s skin is hot and dry, and her pupils are somewhat dilated. All these symptoms are significant departures from the patient’s recent presentation. The patient is likely experiencing ________ , and the nurse should ___________. • A. Anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat • B. Relapse of her psychosis…administer PRN antipsychotic drugs and notify her physician • C. Neuroleptic malignant syndrome…contact her physician for a transfer to intensive care • D. Agranulocytosis…hold her antipsychotic and draw blood for a complete blood count 22. A patient with the diagnosis of schizophrenia, disorganized type, approaches the nurse and says, “It’s beat, it’s eat. No room for doom.” The nurse can correctly assess this verbalization as: • A. Neologisms • B. Clanging • C. Ideas of reference. • D. Associative looseness. 23. A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to: • A. Haloperidol (Haldol). • B. Olanzapine (Zyprexa). • C. Diphenhydramine (Benadryl). • D. Chlorpromazine (Thorazine). 31. A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _________ and should ______________. • A. Neuroleptic malignant syndrome…place him in a cooling blanket and transfer to ICU • B. Anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat • C. Relapse of his psychosis…administer PRN antipsychotic drugs and notify his physician • D. Agranulocytosis…hold his antipsychotic and draw blood for a complete blood count 20. A teaching plan for a patient taking lithium should include instructions to: • A. Maintain normal salt and fluids in the diet. • B. Drink twice the usual daily amount of fluid. • C. Have regular laboratory studies of liver function. • D. Avoid eating aged cheese, processed meats, and red wine. 21. Which nursing diagnosis is a priority for both a patient with depression and one with acute mania? • A. Deficient diversional activity • B. Disturbed sleep pattern • C. Fluid volume excess • D. Defensive coping 22. Which menu is best suited for a patient with acute mania? • A. Roast beef, green beans, pudding with whipped cream • B. Broiled chicken breast on a roll, ear of corn, apple • C. Beef and vegetable stew, roll, strawberry gelatin • D. Spaghetti and meatballs, salad, banana • 86. 24. Which documentation indicates that the treatment plan for a patient with acute mania was effective? • A. “Converses without interrupting; clothing matched; participates in activities.” • B. “Irritable; suggestible; distractible; napped for 10 minutes in afternoon.” • C. “Attention span 1 to 3 minutes; journals frequently about unit activities.” • D. “Heavy makeup; seductive toward staff; pressured speech.” 26. A patient with bipolar disorder was hospitalized 5 days ago and has received lithium 600 mg TID. The staff now observes agitation, pressured speech, poor personal hygiene, hyperactivity, and bizarre clothing. Select the nurse’s best action. • A. Consider the need to measure the serum lithium level. The patient may not be swallowing the medication. • B. Include the patient in psychoeducational groups about personal hygiene, dressing, and grooming. • C. Ask the health care provider to prescribe an increased dose and frequency of lithium. • D. Continue to monitor and document the patient’s speech patterns and motor activity. 28. A patient with acute mania dances atop a pool table, waves a cue in one hand, and says, “I’ll throw the pool balls if anyone comes near me.” The nurse’s first intervention is to: • A. Tell the patient, “We are taking you to seclusion.” • B. Remove the patient from the pool table. • C. Clear the room of all other patients. • D. Assemble a show of force. A patient takes lithium daily. The nurse should monitor the patient for: • A. Pharyngitis, mydriasis, and dystonia. • B. Alopecia, purpura, and drowsiness. • C. Diaphoresis, weakness, and nausea. • D. Ascites, dyspnea, and edema. A patient who takes lithium phones the nurse at the clinic to say, “I’ve had diarrhea for 4 days. I feel weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?” Which instruction by the nurse is appropriate? • A. “Have someone bring you to the clinic immediately.” • B. “Restrict food and fluids for 24 hours and stay in bed.” • C. “Drink a large glass of water with 1 teaspoon of salt added.” • D. “Take antidiarrheal medication hourly until the diarrhea subsides.” 35. Which assessment findings would be expected for a patient diagnosed with bipolar I disorder? • A. Rapid cycling • B. Major depression and acute mania • C. Major depression and/or hypomania • D. Hypomania and/or minor depression 2. The patient on the mental health unit who should be assessed as being at highest risk for directing violent behavior toward others is the patient who has: • A. Obsessive-compulsive disorder and performs many rituals. • B. Paranoid delusions of being followed by the Mafia. • C. Severe depression with feelings of worthlessness and self-loathing. • D. Completed alcohol withdrawal and is now in a rehabilitation program.