NCLEX RN Psychiatric Questions
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Question 1 of 5.
Extract:The following scenario applies to the next 1 items The emergency department (ED) nurse is caring for a 54-year-old female Item 1 of 1 History and Physical 1655 - 54-year-old female presents with her husband with reports of her 'not acting right.' The husband reports that three days ago, he noticed his wife 'acting odd' and reported her experiencing intermittent abdominal cramping, sweating heavily, and irritability. Today, the client woke up completely disoriented, feeling hot, and reporting that her heart was beating out of her chest. The client's husband reports that one week ago, she had such low motivation to get out of bed that he believes she has been taking more paroxetine than prescribed. The husband called their doctor and was instructed to report to the ED. The client has a medical history of chronic back pain, hypothyroidism, vitamin D deficiency, and peptic ulcer disease. She has recently been prescribed tramadol for back pain, which the husband says is contributing to her depressed mood. The client has a complicated and complex psychiatric history and is currently being treated for major depressive disorder - severe, generalized anxiety disorder, and dependent personality disorder. The client's current medications include levothyroxine, paroxetine, vitamin D, tramadol, and esomeprazole. The client was recently involuntarily hospitalized for four days because she was observed attempting to kill herself with a large kitchen knife. Prior to this, the client was being treated with outpatient electroconvulsive therapy (ECT), which she later became non-adherent with, and thus, the treatment was abandoned. Since the discontinuation of the ECT, the client was prescribed paroxetine. On exam, the client is hyper-alert, disoriented to place and situation, appears somewhat agitated, and has myoclonus of the legs and feet. She has generalized diaphoresis. Her gait is disturbed, and she requires maximum assistance to the bathroom, where she has been having bouts of diarrhea. The speech was somewhat pressured and nonsensical at times. She denied hallucinations and suicidal ideations. Vital signs: T 104° F (40° C), P 134, RR 21, BP 168/99, pulse oximetry reading 95% on room air.
The nurse is reviewing the client's history & physical and inserted a peripheral venous access device (VAD). Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
Action To take
- A.request a prescription for diazepam
- B. request a prescription for dantrolene
- C. implement seizure precautions
- D. establish limits in a nonjudgmental manner
- E. request a prescription for propylthiouracil.
Potential Condition
- A.manic episode
- B. neuroleptic malignant syndrome
- C. serotonin syndrome
- D. malignant hyperthermia.
Parameter to Monitor
- A.electrocardiogram (ECG) rhythm and rate
- B. urine output
- C. temperature
- D. thyroid panel
- E. mood and affect.
Explanation: The client's symptoms (hyperthermia, myoclonus, diaphoresis, disorientation) suggest serotonin syndrome, likely due to paroxetine overdose. Diazepam can manage agitation and seizures, and seizure precautions are necessary. Monitoring ECG and temperature assesses cardiac stability and hyperthermia resolution.
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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