NR 326 Mental Health Exam 1 Study Set Questions With
Complete Solutions
4 Phases of the Nurse-Client Relationship: Correct Answer 1.
Pre-interaction
2. Orientation
3. Working
4. Termination
A 31-year-old patient admitted with acute mania tells the staff
and the other patients that he is on a secret mission for the
President of the United States. He states, "I am the only one he
trusts, because I am the best!" What term will the nurse use
when documenting this behavior?
a. Unpredictability
b. Rapid cycling
c. Grandiosity
d. Flight of ideas Correct Answer c
A client admitted with major depression and suicidal ideation
with a plan to overdose is preparing for discharge and asks you,
"Why did I get a prescription for only 7 days of amitriptyline?"
The nurse's response is based on what fact?
a. Amitriptyline is very expensive, so the patient may have to
buy fewer at a time.
b. The goal is to see how the client responds to the first week of
medication to evaluate its effectiveness.
c. The health care provider wants to see whether any side effects
occur within the first week of administration.
,d. Amitriptyline is lethal in overdose. Correct Answer d, since
the patient had a plan to overdose and TCA is lethal in excessive
amounts
A client diagnosed with bipolar disorder has a nursing care plan
that includes several nursing diagnoses listed. Match the nursing
diagnosis to the level of priority (1 to 4):
self -care deficit, bathing, and hygiene, risk for injury,
nonadherence, knowledge, deficient Correct Answer 1. Risk
for Injury
2. Self-care deficit, bathing, and hygiene
3. knowledge, deficient
4. nonadherence
A client prescribed a monamine oxidase inhibitor (MOA) has a
pass to go out to lunch. Given a choice of the following entrees,
the client can safely eat:
a. avocado salad plate.
b. fruit and cottage cheese plate.
c. kielbasa and sauerkraut.
d. liver and onion sandwich. Correct Answer b, Fruit and
cottage cheese do not contain tyramine
A client prescribed a selective serotonin reuptake inhibitor
mentions taking the medication along with the St. John's wort
daily. The nurse should provide the client with what information
regarding this practice?
, a. Agreeing that this will help the client to remember the
medications.
b. Caution the client to drink several glasses of water daily.
c. Suggest that the client also use a sun lamp daily.
d. Explain the high possibility of an adverse reaction. Correct
Answer d, due to St. John's wort interaction
A client prescribed fluoxetine demonstrates an understanding of
the medication teaching when making which statement?
a. "I will make sure to get plenty of sunshine and not use
sunscreen to avoid a skin reaction."
b. "I will not take any over-the-counter medication while on the
fluoxetine."
c. "I will report any symptoms of high fever, fast heartbeat, or
abdominal pain to my provider right away."
d. "I will report increased thirst and urination to my provider."
Correct Answer c, because of serotonin syndrome which is a
life-threatening complication of SSRIs
A client tells the nurse that he believes his situation is
intolerable and is observed isolating socially. Which nursing
diagnosis should be considered?
a. Hopelessness
b. Deficient knowledge
c. Chronic low self-esteem
d. Compromised family coping Correct Answer a
A client who presents no danger to himself or to others is forced
to take medication against his will. This situation represents:
Complete Solutions
4 Phases of the Nurse-Client Relationship: Correct Answer 1.
Pre-interaction
2. Orientation
3. Working
4. Termination
A 31-year-old patient admitted with acute mania tells the staff
and the other patients that he is on a secret mission for the
President of the United States. He states, "I am the only one he
trusts, because I am the best!" What term will the nurse use
when documenting this behavior?
a. Unpredictability
b. Rapid cycling
c. Grandiosity
d. Flight of ideas Correct Answer c
A client admitted with major depression and suicidal ideation
with a plan to overdose is preparing for discharge and asks you,
"Why did I get a prescription for only 7 days of amitriptyline?"
The nurse's response is based on what fact?
a. Amitriptyline is very expensive, so the patient may have to
buy fewer at a time.
b. The goal is to see how the client responds to the first week of
medication to evaluate its effectiveness.
c. The health care provider wants to see whether any side effects
occur within the first week of administration.
,d. Amitriptyline is lethal in overdose. Correct Answer d, since
the patient had a plan to overdose and TCA is lethal in excessive
amounts
A client diagnosed with bipolar disorder has a nursing care plan
that includes several nursing diagnoses listed. Match the nursing
diagnosis to the level of priority (1 to 4):
self -care deficit, bathing, and hygiene, risk for injury,
nonadherence, knowledge, deficient Correct Answer 1. Risk
for Injury
2. Self-care deficit, bathing, and hygiene
3. knowledge, deficient
4. nonadherence
A client prescribed a monamine oxidase inhibitor (MOA) has a
pass to go out to lunch. Given a choice of the following entrees,
the client can safely eat:
a. avocado salad plate.
b. fruit and cottage cheese plate.
c. kielbasa and sauerkraut.
d. liver and onion sandwich. Correct Answer b, Fruit and
cottage cheese do not contain tyramine
A client prescribed a selective serotonin reuptake inhibitor
mentions taking the medication along with the St. John's wort
daily. The nurse should provide the client with what information
regarding this practice?
, a. Agreeing that this will help the client to remember the
medications.
b. Caution the client to drink several glasses of water daily.
c. Suggest that the client also use a sun lamp daily.
d. Explain the high possibility of an adverse reaction. Correct
Answer d, due to St. John's wort interaction
A client prescribed fluoxetine demonstrates an understanding of
the medication teaching when making which statement?
a. "I will make sure to get plenty of sunshine and not use
sunscreen to avoid a skin reaction."
b. "I will not take any over-the-counter medication while on the
fluoxetine."
c. "I will report any symptoms of high fever, fast heartbeat, or
abdominal pain to my provider right away."
d. "I will report increased thirst and urination to my provider."
Correct Answer c, because of serotonin syndrome which is a
life-threatening complication of SSRIs
A client tells the nurse that he believes his situation is
intolerable and is observed isolating socially. Which nursing
diagnosis should be considered?
a. Hopelessness
b. Deficient knowledge
c. Chronic low self-esteem
d. Compromised family coping Correct Answer a
A client who presents no danger to himself or to others is forced
to take medication against his will. This situation represents:
