ATI RN Mental Health and Psychiatric Nursing Test bank with answers & Rationale
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Course
ATI RN
Institution
ATI RN
Nursing)
(Set 10)
1. Tristan is on Lithium and has suffered from diarrhea and vomiting. What should the nurse in- charge do first:
A. Recognize this as a drug interaction.
B. Give the client Cogentin.
C. Reassure the client that these are common side effects of lithium therapy.
D. Hold the ...
ati rn mental health and psychiatric nursing test bank with answers amp rationale
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ATI RN Mental Health and Psychiatric
Nursing Test bank with answers &
Rationale
(Comprehensive Mental Health and Psychiatric
Nursing)
(Set 10)
1. Tristan is on Lithium and has suffered from diarrhea and vomiting. What should the nurse in-
charge do first:
A. Recognize this as a drug interaction.
B. Give the client Cogentin.
C. Reassure the client that these are common side effects of lithium therapy.
D. Hold the next dose and obtain an order for a stat serum lithium level.
Correct Answer: D. Hold the next dose and obtain an order for a stat serum lithium level
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be
withheld and a test is done to validate the observation. Monitoring of therapeutic levels includes
trough plasma levels drawn 8 to 12 hours after the last dose. The therapeutic range is 1.0 to 1.5 mEq/L
for acute treatment and 0.6 to 1.2 mEq/L for chronic therapy. Monitoring should be done every 1 to 2
weeks until reaching the desired therapeutic levels. Then, check lithium levels every 2 to 3 months for
six months. It is also important to monitor patients for dehydration and lower the dose when there are
signs of infection, excessive sweating, or diarrhea. Toxic levels are when the drug level is more than 2
mEq/L.
Option A: The manifestations are not due to drug interaction. Lithium has a very narrow therapeutic
index, and toxic levels are when the drug is above 2 mEq/L, which is very close to its therapeutic
range. Lithium toxicity can cause interstitial nephritis, arrhythmia, sick sinus syndrome, hypotension,
T wave abnormalities, and bradycardia. Rarely, toxicity can cause pseudotumor cerebri and seizures.
Lithium toxicity has no antidote.
Option B: Cogentin is used to manage the extrapyramidal symptom side effects of antipsychotics.
Benztropine is used to treat symptoms of Parkinson’s disease or involuntary movements due to the
side effects of certain psychiatric drugs (antipsychotics such as chlorpromazine/haloperidol).
Benztropine belongs to a class of medication called anticholinergics that work by blocking a certain
natural substance (acetylcholine). This helps decrease muscle stiffness, sweating, and the
production of saliva, and helps improve walking ability in people with Parkinson’s disease.
Option C: The common side effects of Lithium are fine hand tremors, nausea, polyuria, and
polydipsia. Lithium can cause several adverse effects. Typically the side effects are dose-related.
Treatment for lithium toxicity is primarily hydration and to stop the drug. Give hydration with
normal saline, which will also enhance lithium excretion. Avoid all diuretics. If the patient has severe
renal dysfunction or failure, or severely altered mental status, then start with hemodialysis. 20 to 30
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,mg of propranolol given 2 to 3 times per day may help reduce tremors.
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, 2. What herbal medication for depression, widely used in Europe, is now being prescribed in the
United States?
A. Ginkgo biloba
B. Echinacea
C. St. John's wort
D. Ephedra
Correct Answer: C. St. John’s wort
St. John’s wort has been found to have serotonin-elevating properties, similar to prescription
antidepressants. St. John’s Wort (Hypericum perforatum) is commonly used to treat mild-to-moderate
depression. Several bioactive compounds have been identified in St. John’s Wort that work
synergistically to provide its antidepressant and anti-inflammatory attributes. St. John’s Wort was more
efficacious than standard antidepressant therapy in patients with mild-to-moderate depression.
Option A: Ginkgo biloba is prescribed to enhance mental acuity. Ginkgo biloba is commonly used to
improve memory and cognition in the elderly suffering from impaired cerebral circulation.
Mitochondrial dysfunction is one theory proposed as the leading cause of cognitive decline. The two
main components in Gingko biloba leaves are flavonoids and terpenes tri lactones. Together, these
compounds enhance and protect mitochondrial function and scavenge reactive molecules like
hydroxyl and peroxyl radicals, nitric oxide, and superoxide ions.
Option B: Echinacea has immune-stimulating properties. Echinacea is known as an
immunostimulant, boosting both innate and specific immunity. It has also demonstrated anti-viral,
anti-inflammatory, and antimicrobial effects. Intracellular bactericidal activity and enhanced
phagocytosis were also observed. A randomized, double-blind study of 473 patients virologically
confirmed with influenza infection, showed Echinacea was as effective as oseltamivir with fewer
adverse events and reduced risk.
Option D: Ephedra is a naturally occurring stimulant that is similar to ephedrine. Ephedra is a
medicinal preparation from the plant Ephedra sinica. Several additional species belonging to the
genus Ephedra have traditionally been used for a variety of medicinal purposes, and are a possible
candidate for the Soma plant of Indo-Iranian religion.
3. A male client recently admitted to the hospital with sharp, substernal chest pain suddenly
complains of palpitations. Nurse Ryan notes a rise in the client’s arterial blood pressure and a
heart rate of 144 beats/minute. On further questioning, the client admits to having used cocaine
recently after previously denying use of the drug. The nurse concludes that the client is at high
risk for which complication of cocaine use?
A. Coronary artery spasm
B. Bradyarrhythmias
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, C. Neurobehavioral deficits
D. Panic disorder
Correct Answer: A. Coronary artery spasm
Cocaine use may cause such cardiac complications as coronary artery spasm, myocardial infarction,
dilated cardiomyopathy, acute heart failure, endocarditis, and sudden death. Cocaine blocks reuptake of
norepinephrine, epinephrine, and dopamine, causing an excess of these neurotransmitters at
postsynaptic receptor sites. Cocaine and its metabolites may cause arterial vasoconstriction hours after
use. Epicardial coronary arteries are especially vulnerable to these effects, leading to a decreased
myocardial oxygen supply.
Option B: Consequently, the drug is more likely to cause tachyarrhythmias than bradyarrhythmias.
Cocaine-induced central sympathetic stimulation and direct cardiac effects may lead to tachycardia,
hypertension, and coronary or cerebral artery vasoconstriction leading to myocardial infarction and
stroke.
Option C: Although neurobehavioral deficits are common in neonates born to cocaine users, they
are rare in adults. CNS reactions may be more excitatory than depressant. In its mild form, the
patient may display anxiety, restlessness, and excitement. Full-body tonic-clonic seizures may result
from moderate to severe CNS stimulation. These seizures are often followed by CNS depression,
with death resulting from respiratory failure and/or asphyxiation if concomitant emesis is present.
Option D: As craving for the drug increases, a person who’s addicted to cocaine typically
experiences euphoria followed by depression, not panic disorder. Cardiovascular toxicity and
agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
However, there is a risk of over-sedation and respiratory depression with escalating and numerous
doses of benzodiazepines, which is often necessary. Non-dihydropyridine calcium channel blockers
such as diltiazem and verapamil have shown the ability to reduce hypertension reliably, but not
tachycardia.
4. A male client is hospitalized with fractures of the right femur and right humerus sustained in a
motorcycle accident. Police suspect the client was intoxicated at the time of the accident.
Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to
drinking heavily for years. During hospitalization, the client periodically complains of tingling and
numbness in the hands and feet. Nurse Gian realizes that these symptoms probably result from:
A. Acetate accumulation
B. Thiamine deficiency
C. Triglyceride buildup.
D. A below-normal serum potassium level
Correct Answer: B. Thiamine deficiency
Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results
from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake.
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