NCLEX RN Psychiatric Questions
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Question 1 of 5.
Extract:The emergency department (ED) nurse is caring for a 56-year-old male client • Nurses' Notes 1056: 56-year-old male presents to the ED with his wife after she found him tremulous, talking incoherently to various pieces of furniture, and disoriented. She stated that two nights ago, he was in a rage and got rid of a medication bottle because he was tired of feeling 'numb.' The wife is unsure what medications he discarded, but he has been acting irritable and confused since, with bouts of anxiety and panic. On assessment, the client's breathing is unlabored, and he has clear lung sounds. Skin is warm and pink in tone; pulses 2+ and regular. Capillary refill is 3 seconds. The client is alert, irritable, and confused. Pupils are equal, round, and reactive to light. Vital signs: T 98° F (36.7° C), P 92, RR 19, BP 142/76. The client has a medical history of generalized anxiety disorder, polysubstance use, major depressive disorder, chronic back pain, hypertension, duodenal ulcer, and low testosterone. • Current Medications • omeprazole 20 mg by mouth daily • fluvoxamine 100 mg by mouth daily • oxycodone extended-release (ER) 10 mg by mouth daily • multivitamin 1 tablet by mouth daily • clonidine 0.1 mg by mouth daily • propranolol 10 mg by mouth daily • alprazolam 1 mg by mouth twice daily • testosterone cypionate 200 mg intramuscular (IM) every two weeks
Complete the sentence below by choosing from the list of options.The client is demonstrating signs and symptoms consistent with-----------------
A. Opioid intoxitaion
B. benzodiazepine intoxication.
C. serotonin syndrome.
D. benzodiazepine withdrawal.
Explanation: The client's current medications indicate he is taking alprazolam, and his irritability, disorientation, high blood pressure, and anxiety suggest benzodiazepine withdrawal. Benzodiazepine intoxication leads to a client developing confusion, bradycardia, sedation, and ataxia. Serotonin syndrome is unlikely because the case study suggested that the client got rid of pills that would put the client in a withdrawal. Serotonin syndrome would be if the client took too much of a serotonergic, such as their prescribed fluvoxamine. While the manifestations overlap with serotonin syndrome, it is not plausible, considering this condition is caused by too much - not too little. Opioid intoxication is unlikely. While the client does take extended-release oxycodone, opioid intoxication would cause more psychomotor retardation, decreased respirations, and pinpoint pupils. None of the client's manifestations support this finding. The client self-discontinuing his medication without taper is the cause of the withdrawal symptoms. When benzodiazepines are discontinued, they should be tapered.
Question 2 of 5.
A client was admitted to the inpatient unit 3 days ago with a flat affect, psychomotor retardation, anorexia, hopelessness, and suicidal ideation. The physician prescribed 75 mg of venlafaxine extended release (Effexor XR) to be given every morning. The client interacted minimally with the staff and spent most of the day in his room. As the nurse enters the unit at the beginning of the evening shift, the client is smiling and cheerfully greets the nurse. He appears to be relaxed and joins the group for community meeting before supper. What should the nurse interpret as the most likely cause of the client's behavior?
A. The author is helping the client's symptoms of depression significantly.
B. The client's sudden improvement calls for close observation by the staff.
C. The staff can decrease their observation of the client.
D. The client is nearing discharge due to the improvement of his symptoms.
Explanation: Sudden improvement in a suicidal client may indicate a resolved decision to act on suicidal thoughts, requiring close observation.
Question 3 of 5.
A client who has had three episodes of recurrent endogenous depression within the past 2 years states to the nurse, 'I want to know why I'm so depressed.' Which of the following statements by the nurse is most helpful?
A. I know you'll get better with the right medication.'
B. Let's discuss possible reasons underlying your depression.'
C. Your depression is most likely caused by a brain chemical imbalance.'
D. Members of your family seem very supportive of you.'
Explanation: Discussing possible reasons encourages exploration of triggers and fosters therapeutic engagement.
Question 4 of 5.
A client who experienced sleep disturbances, feelings of worthlessness, and an inability to concentrate for the past 3 months was fired from her job a month ago. The client tells the nurse, 'My boss was wonderful! He was understanding and a really nice man.' The nurse interprets the client's statement as representing the defense mechanism of reaction formation. Which of the following would be the best response by the nurse?
A. But, I don't understand, wasn't he the one who fired you?'
B. Tell me more about having to work while not being able to sleep or concentrate.'
C. It must have been hard to leave a boss like that.'
D. It sounds like he would hire you back if you asked.'
Explanation: Encouraging the client to discuss difficulties at work may uncover underlying feelings masked by reaction formation.
Question 5 of 5.
A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which of the following areas is most important for the nurse to review with the client?
A. Future plans for going back to work.
B. A conflict encountered with another client.
C. Results of psychological testing.
D. Medication management with outpatient follow-up.
Explanation: Medication adherence and outpatient follow-up are critical to prevent relapse in major depression.
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