Psychiatric Mental Health Nursing NCLEX RN Questions Part 2
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Question 1 of 5.
Extract:The nurse in the behavioral health clinic is caring for a 48-year-old male client. • Diagnostic Results Diagnostic, Result ,Reference Range Calcium, 10.5 mg/di (2.75mmol/I), 9.0-10.5 mg/dL (2.25-2.75 mmol/L) Chloride, 99 mEq/1 (99 mmol/l), 98 to 106 mEq/L (98 to 106 mmol/l) Creatinine, 0.9 mg/dI (79.6mcmol/L), 0.6 to 1.2 mg/di (53-106 mcmol/L) Potassium, 3.8 mEq/1 (3.8, mmol/D), 3.5-5.0 mEq/L (3.5-5.0 mmol/L) Sodium,137 mEq/1 (137mmol/l), 135 to 145 mEq/1 (135 to 145 mmol/I) Blood urea nitrogen,12 mg/di (4.2mmol/I), 10-20 mg/dL (3.6-7.1 mmol/L) Fasting glucose ,202 mg/dL (11.2mmol/L), 70-110 mg/dL (4-6 mmol/L) White blood cell, 11,000/mm3 (11 × 109 /L), 5,000-10,000/mm 3 (5-10 × 109 /L) Hemoglobin (Hgb), 15 g/dL (150 g/L), Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L) Hematocrit (Hct), 45% (0.47), Male: 42%-52% (0.42-0.52) Female: 37%-47% (0.37-0.47) Lithium level, 0.4 mEg/L , 0.6-1.2 mEg/L • Nurses' Notes 1230: Client presents for a follow-up appointment. He reports 100% adherence with prescribed ziprasidone. Two weeks ago, he was prescribed lithium, for which he reports a mild thirst. This thirst is causing him to go to the bathroom more frequently overnight. He reports that he recently got a second job to save for a vacation. On assessment, the client is alert and completely oriented. He had a logical thought process. Lung sounds clear bilaterally, and peripheral pulses were 2+. Skin is warm, dry, and normal for ethnicity. Rapid eye blinking and persistent chewing motions in his mouth despite not eating any food or gum. He reports that this started two weeks ago. Current weight is 128 kg (282 pounds). Current BMI is 26kg/m2. Previous weight one month ago was 126 kg (277 pounds). The most recent hospitalization was one month ago for a manic episode. Laboratory data reviewed.
The nurse is reviewing the initial intake information. Which of the following assessment findings requires immediate follow-up? Select all that apply.
A. White blood cell count
B. Eye blinking
C. Chewing motion
D. Fasting plasma glucose
E. Body mass index
F. Lithium level
G. Hemoglobin and hematocrit
Explanation: The client's eye blinking and chewing motion indicates extrapyramidal symptoms (EPS), specifically tardive dyskinesia, a potential adverse effect of ziprasidone (an atypical antipsychotic). These movements are involuntary, persistent, and can become irreversible. Prompt evaluation is needed to consider a change in medication or dosage. The client's plasma glucose level is significantly elevated and in the diabetic range (≥126 mg/dL fasting). Atypical antipsychotics like ziprasidone can contribute to glucose dysregulation. This finding requires immediate follow-up to assess for diabetes or worsening glucose control. The client's lithium level is subtherapeutic; the therapeutic range is 0.6–1.2 mEq/L. While not immediately dangerous, it indicates that lithium is not yet at an effective dose, putting the client at risk for recurrence of mania, especially with the recent hospitalization for a manic episode. The client's body mass index (BMI) requires follow-up. While this normally not require immediate follow-up, this combined with the client's significantly elevated plasma glucose level suggests metabolic syndrome. The other findings, including the slightly elevated white blood cell count, normal hemoglobin and hematocrit, and reports of mild thirst, do not require urgent follow-up at this time. Lithium is known to cause a client to experience a mild thirst. Additionally, leukocytosis is common with lithium. These findings can be monitored over time unless they worsen or are accompanied by other concerning symptoms.
Question 2 of 5.
A client has been taking 30 mg of duloxetine hydrochloride (Cymbalta) twice daily for 2 months because of depression and vague aches and pains. While interacting with the nurse, the client discloses a pattern of drinking a 6-pack of beer daily for the past 10 years to help with sleep. What should the nurse do first?
A. Refer the client to the dual diagnosis program at the clinic.
B. Share the information at the next interdisciplinary treatment conference.
C. Report the client's beer consumption to the physician.
D. Teach the client relaxation exercises to perform before bedtime.
Explanation: Reporting alcohol use to the physician is critical due to potential interactions with Cymbalta, which can increase liver risks or exacerbate depression.
Question 3 of 5.
The nurse is assessing the outcomes of care for a client who has an Axis I diagnosis of major depression. Following the initiation of treatment, arrange the symptoms in chronological order from the one that improves first to the one that improves last.
- A. Self-esteem.
- B. Sleep.
- C. Energy level.
- D. Appetite.
- B. Sleep.
- D. Appetite.
- C. Energy level.
- A. Self-esteem.
Correct arrangement
Explanation: Depression treatment typically improves sleep first, followed by appetite, energy level, and finally self-esteem, which takes longer to recover.
Question 4 of 5.
A 62-year-old female client with severe depression and psychotic symptoms is scheduled for electroconvulsive therapy (ECT) tomorrow morning. The client's daughter asks the nurse, 'How painful will the treatment be for Mom?' The nurse should respond by saying which of the following?
A. Your mother will be given something for pain before the treatment.'
B. The physician will make sure your mother doesn't suffer needlessly.'
C. Your mother will be asleep during the treatment and will not be in pain.'
D. Your mother will be able to talk to us and tell us if she's in pain.'
Explanation: ECT is performed under anesthesia, ensuring the client is unconscious and feels no pain during the procedure.
Question 5 of 5.
The client with recurring depression will be discharged to the community in a few days. Which of the following is the best approach for the nurse to help the family prepare for the client's return home?
A. Discourage visitors while the client is at home.
B. Provide for a schedule of activities outside the home.
C. Involve the client in usual at-home activities.
D. Encourage the client to sleep as much as possible.
Explanation: Involving the client in usual activities promotes normalcy and recovery, balancing rest and engagement.
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