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ATI Mental Health & Psychiatric Nursing NCLEX Practice Exam (Quiz #4: 25 Questions)
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Description: Prepare for success in your mental health and psychiatric nursing exams with our comprehensive ATI NCLEX Challenge Exam (Quiz #1: 50 Questions) package, complete with detailed answers and explanations. This invaluable resource is tailored to help nursing students and professionals ali...

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  • May 10, 2024
  • 33
  • 2023/2024
  • Exam (elaborations)
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  • ATI Mental Health & Psychiatric Nursing NCLEX
  • ATI Mental Health & Psychiatric Nursing NCLEX

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ATI Mental Health & Psychiatric Nursing
NCLEX Practice Exam (Quiz #4: 25
Questions)
1. 1. Question

Which nursing intervention would be most appropriate if a male client
develops orthostatic hypotension while taking amitriptyline (Elavil)?

o A. Consulting with the physician about substituting a different
type of antidepressant.
o B. Advising the client to sit up for 1 minute before getting out
of bed.
o C. Instructing the client to double the dosage until the problem
resolves.
o D. Informing the client that this adverse reaction should disappear
within 1 week.
Answer
Correct Answer: B. Advising the client to sit up for 1 minute before
getting out of bed.
To minimize the effects of amitriptyline-induced orthostatic hypotension,
the nurse should advise the client to sit up for 1 minute before getting out
of bed. Amitriptyline is FDA approved medication to treat depression in
adults. Secondary to its alpha-adrenergic receptor blockade, it can cause
orthostatic hypotension, dizziness, and sedation. It can also cause heart
rate variability, slow intracardiac conduction, induce various arrhythmias,
and cause QTc (corrected QT) prolongation.
• Option A: Orthostatic hypotension commonly occurs with
tricyclic antidepressant therapy. Cardiac symptoms include
tachycardia, hypotension, conduction abnormalities include
QTc prolongation. Amitriptyline is in the tricyclic
antidepressant (TCA) drug classification and acts by blocking
the reuptake of both serotonin and norepinephrine
neurotransmitters. The three-ring central structure, along with
a side chain, is the basic structure of tricyclic antidepressants.

, Amitriptyline is a tertiary amine and has strong binding
affinities for alpha-adrenergic, histamine (H1), and muscarinic
(M1) receptors. It is more sedating and has increased
anticholinergic properties compared to other TCAs.
• Option C: In these cases, the dosage may be reduced or the
physician may prescribe nortriptyline, another tricyclic
antidepressant. Once the patient is stable, amitriptyline should
be continued for three months or longer to prevent relapse of
depression. In cases of therapy cessation, the clinician should
gradually taper to avoid withdrawal. Amitriptyline
administration comes in various forms, the most common
being oral form. The initial dose recommended for depression
is 25 mg/day at bedtime, as it can be sedating.
• Option D: Orthostatic hypotension disappears only when the
drug is discontinued. The most commonly encountered side
effects of amitriptyline include weight gain, gastrointestinal
symptoms like constipation, xerostomia, dizziness, headache,
and somnolence. Patients on amitriptyline can have
anticholinergic, antihistaminic, and alpha-adrenergic blocking
effects. It may not be appropriate for patients with cardiac
problems.
2. 2. Question

Mr. Cruz visits the physician’s office to seek treatment for depression,
feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem,
poor concentration, and difficulty making decisions. The client states that
these symptoms began at least 2 years ago. Based on this report, the nurse
Tiffany suspects:

o A. Cyclothymic disorder.
o B. Atypical affective disorder.
o C. Major depression.
o D. Dysthymic disorder.
Answer
Correct Answer: D. Dysthymic disorder.

, Dysthymic disorder is marked by feelings of depression lasting at least 2
years, accompanied by at least two of the following symptoms: sleep
disturbance, appetite disturbance, low energy or fatigue, low self-esteem,
poor concentration, difficulty making decisions, and hopelessness. These
symptoms may be relatively continuous or separated by intervening
periods of normal mood that last a few days to a few weeks.
• Option A: Cyclothymic disorder is a chronic mood disturbance
of at least 2 years’ duration marked by numerous periods of
depression and hypomania. It is currently classified under the
umbrella of bipolar mood disorders. It is a chronic disease that
must be present for at least two years in order to be
diagnosable in adults and over 1 year in children and
adolescents. As with many other psychiatric disorders, it must
lead to dysfunction and stress in order to be classified as a
disorder and must not be concurrent or caused by another
general medical condition or substance use disorder.
• Option B: Atypical affective disorder is characterized by manic
signs and symptoms. Affective disorders may include manic
(elevated, expansive, or irritable mood with hyperactivity,
pressured speech, and inflated self-esteem) or depressive
(dejected mood with disinterest in life, sleep disturbance,
agitation, and feelings of worthlessness or guilt) episodes, and
often combinations of the two.
• Option C: Major depression is a recurring, persistent sadness
or loss of interest or pleasure in almost all activities, with signs
and symptoms recurring for at least 2 weeks. The investigation
into depressive symptoms begins with inquiries of the
neurovegetative symptoms which include changes in sleeping
patterns, appetite, and energy levels. Positive responses
should elicit further questioning focused on evaluating for the
presence of the symptoms which are diagnostic of major
depression.
3. 3. Question

After taking an overdose of phenobarbital (Barbita), Mario is admitted to
the emergency department. Dr. Trinidad prescribes activated charcoal
(Charcocaps) to be administered by mouth immediately. Before

, administering the dose, the nurse verifies the dosage ordered. What is the
usual minimum dose of activated charcoal?

o A. 5 g mixed in 250 ml of water
o B. 15 g mixed in 500 ml of water
o C. 30 g mixed in 250 ml of water
o D. 60 g mixed in 500 ml of water
Answer
Correct Answer: C. 30 g mixed in 250 ml of water
The usual adult dosage of activated charcoal is 5 to 10 times the estimated
weight of the drug or chemical ingested, or a minimum dose of 30 g,
mixed in 250 ml of water. Doses less than this will be ineffective; doses
greater than this can increase the risk of adverse reactions, although
toxicity doesn’t occur with activated charcoal, even at the maximum dose.
Activated charcoal is widely used in Emergency Departments to treat many
types of toxic ingestions. Its use significantly prevents the absorption of
many toxic drugs and other poisons if given early post-ingestion.
• Option A: An oral suspension of activated charcoal (AC)
should merit consideration in poisonings when there is an
indication for gastrointestinal decontamination of an ingested
toxin, and the clinician can administer activated charcoal
within 1 hour of ingestion. When the dose of the ingested
toxin is known, experts recommend activated charcoal at a 10
to 1 ratio of activated charcoal to the ingested toxin. This ratio
may be impractical to achieve when the patient has ingested
large doses of a toxin.
• Option B: When the amount of toxin ingested is unknown, or
it is impractical to achieve a 10 to 1 ratio in large dose toxic
ingestions, SDAC should be administered at a dose of 1g/kg of
body weight or using a simplified age-based dosing scheme.
Formulations have been attempted to increase the palatability
of activated charcoal, which is black and has a gritty texture.
Ready-to-use aqueous suspensions of activated charcoal are
available in 15 g, 25 g, and 50 g doses as well as formulations
premixed with sorbitol.

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